While some doctors are less familiar with probiotics, others are confident in recommending them to their patients. Probiotics are not meant to treat any disease, but they can support overall health and be a useful addition to conventional treatment. However, not all probiotics are the same. Which probiotics are recommended by doctors, and how can expert advice help you choose the right strain and dosage?
Disclaimer: This article provides an overview of the research on probiotics. It is for informational purposes only and is not meant to provide any medical advice. Please talk to your doctor about your health concerns and consult them before taking any supplements or making changes to your supplement regime.
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The Dark Side of the Probiotic Supplements Industry
We are going through an epidemic of digestive disorders. According to the GI Alliance, about 62 million Americans are diagnosed with a digestive disorder yearly. Skyrocketing numbers of gastrointestinal disorders among both adults and children are fueling the probiotics supplements industry.
On the bright side, the increasing need for probiotics means that new research is coming out daily.
Yet, the dark side to this trend is the rise in commercial probiotic products that have not been through clinical trials or any sort of research studies.
Some products are so poorly formulated that none of the probiotic strains listed on the label make it to the gut (Wang et al., 2020).
Consumers are left confused as to which products actually work and how to choose the right one. This isn’t surprising, since even doctors have a hard time keeping up with new evidence and formulations while making well-grounded recommendations for their patients.
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How Doctors Recommend Probiotics
According to the National Institutes of Health (NIH), there aren’t any expert recommendations for or against probiotic use by healthy people.
However, NIH advises doctors to seek guidance in published studies and reviews when making probiotic recommendations for people with various health conditions. It’s important to choose the right probiotic species, strain, and dose that might help alleviate a person’s symptoms (NIH - Probiotics Fact Sheet).
Aside from the published research, doctors may also rely on their clinical judgment and experience. It’s key to know that probiotics often aren’t used alone. Doctors practicing within an integrative medical framework recommend probiotics alongside conventional treatment, diet, lifestyle changes, and other supplements if needed.
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Summary
With probiotics gaining popularity, many products reaching the market have not been through adequate research. Doctors need to review the evidence and recommend only safe and tested probiotics.
Gastroenterologists (gut health)
According to one US-based study of gastroenterologists and other doctors interested in gut health, all surveyed physicians responded that they believed probiotics to be safe for most patients.
In this study, 98% considered probiotics in gastrointestinal illnesses and 93% recommended probiotics for irritable bowel syndrome (IBS). Physicians also recommended probiotics for Crohn’s disease and diarrhea from antibiotics and bacterial infection (Clostridium difficile) (Williams et al., 2010).
Commonly used probiotics included (Williams et al., 2010; Krammer et al., 2021):
- Yogurt-based products
- Bifidobacterium infantis 35624 (Align)
- VSL#3
- Lactobacillus rhamnosus GG (Culturelle), and
- Saccharomyces Boulardii (Florastor)
- Lactobacillus plantarum 299V
This study had another interesting finding: physicians seemed to be recommending probiotic strains they were familiar with. The probiotics that were marketed to physicians and had an affordable price were the most recommended ones despite often not being the most evidence-based choice.
For example, most physicians were familiar with the commercially marketed probiotic B. infantis (Align). Some evidence supports its use for IBS. Yet, physicians are also recommending it for other conditions that it hasn’t been tested for.
To bridge this knowledge gap, leading experts are publishing guidelines with the most up-to-date research on probiotics for specific conditions (Ciorba, 2012; Sniffen et al., 2018).
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Cardiologists (heart health and cholesterol)
Cardiologists are becoming increasingly aware of the link between gut health and heart health.
Integrative cardiologist, Dr. Joel Kahn, recommends probiotics and says on his blog:
“A number of studies indicate that one of the benefits of a healthier GI tract is a lower blood cholesterol level. A recent analysis of the published data found important support for this observation, and I’ve seen similar improvements in patients I have treated.”
He also notes that the increase in vitamin D from supplementation is essential to heart function.
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Dermatologists (skin health)
The way to the skin is through the gut! Skin specialists are acknowledging the role of probiotics in soothing eczema, psoriasis, acne, and other skin conditions (Navarro-Lopez et al., 2021).
Probiotics backed by evidence for eczema include various Lactobacillus and Bifidobacterium strains (including brands like Latopic) (Sodre et al., 2022, Drago et al., 2011, Drago et al. 2012):
Dermatologists also recommend probiotics to children atopic dermatitis, the most common type of eczema (Fuchs-Tarlovsky et al., 2016)
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Women’s and men’s health
Some OB/GYNs are embracing new research and recommending specific probiotic strains to women. Strains most commonly recommended and backed up by studies for vaginal and urogenital health include L rhamnosus GR-1 and L reuteri RC-14 (ProFem) (Griffin, 2015; Reid et al., 2004).
Many probiotics are marketed to men as well, but these are not as popular among physicians. Most probiotics targeting men support exercise performance and overall gut health. Experimental research is testing specific strains for conditions like prostate inflammation and low sperm count, but clinical trials are lacking (Chiancone et al., 2019).
Mental health practitioners
There’s been a lot of hype about using probiotics for mood and mental health. Even researchers have coined the term “psychobiotics” to refer to the effects of gut bacteria on our brain and psyche (Dinan et al., 2013).
Are psychiatrists and mental health specialists on board? Or is this trend limited to biohackers?
Most doctors agree that while new research sounds promising, there are still a lot of unknowns. Several clinical trials point to the benefits of probiotics for improving mood and reducing depression and stress. The data on anxiety are mixed. Read more about the research in this post.
All in all, more trials are needed before probiotics can be widely recommended by mental health specialists.
However, probiotics seem to be a good option for healthy people who want to support their mood and stress resilience.
Naturopaths
Most naturopathic doctors are immersed in gut microbiome research. Many recommend specialized probiotic supplements to their patients and have clinical experience with different brands (Steel et al., 2020).
Naturopaths are also ready to tackle complex and chronic health conditions—often dismissed by conventional practitioners—that are tied to gut microbiome disruption.
Summary
Specific probiotic strains may be helpful for eczema, vaginal health, heart health, and mental health. Doctors may recommend them to some patients alongside other treatments.
How to Choose a Probiotic
1) Probiotic strain and formulation
This is the most important factor in choosing the right probiotic: look for a strain or combination of strains that have been clinically tested. Make sure that the participants this probiotic has been tested on applies to you (e.g. adults, women, babies) (McFarland et al., 2018).
Different probiotics have different health effects. Saying all probiotics are the same is like saying all vitamins are the same. While all probiotics tend to be good for gut health and overall wellness, many probiotic benefits are highly strain-specific (Bubnov et al., 2018; McFarland et al., 2018).
For example, Microbiome Plus+ L. Reuteri NCIMB 30242 is considered a heart-healthy probiotic because it has been clinically proven to support already normal levels of LDL and total cholesterol. This health benefit does not extend to other Lactobacillus Reuteri strains (Jones et al., 2012; Jones et al., 2012).
Read more about probiotic strains and their effect on different areas of health, such as immune health, heart health, mental health, and bloating and gas.
Remember, more does not equal better when it comes to probiotic strains. Some brands will list dozens and dozens of probiotic strains. To a layperson, this may seem like a good idea: why not just up those probiotics to the max?
Let’s look at the vitamins analogy again: this would be something like a no-name supplement with untested doses of various synthetic versions of vitamins that your body can’t use or absorb. Similarly, more probiotic strains do not equal more health benefits. Untested probiotic mixtures are likely to be ineffective and may even worsen gut issues in people who are sensitive.
Summary
Not all probiotics are the same. Look for products that contain only clinically tested probiotic strains.
2) With or without prebiotics
One extra ingredient in probiotic supplements is worth the hype: prebiotic fiber. Prebiotics act as fuel for probiotic bacteria and can boost the overall benefits.
The combination of probiotics and prebiotics that has a synergistic effect on the microbiome is called a synbiotic. It’s crucial to choose a well-researched synbiotic if you’re looking for added prebiotic benefits (Sergeev et al., 2020).
Microbiome Plus+ offers a synergistic combination of scFOS fiber that acts as a prebiotic and L. Reuteri NCIMB 30242, our clinically tested probiotic. The prebiotic in our supplements, scFOS, has also been tested in patients with IBS with good results (Azpiroz et al., 2016).
Summary
For added benefits, search for a synbiotic: a tested combination of probiotics and prebiotics.
3) Dosage and CFUs
The optimal dose of probiotics depends on the strain and product. Doctors who recommend probiotics need to understand the probiotic strains, doses, and duration of use that studies in humans have shown to be beneficial.
Probiotics are measured in colony-forming units (CFU)—the number of viable cells. Many probiotic supplements contain 1 to 10 billion CFU per dose; some contain up to 50 billion CFU (NIH - Probiotics Factsheet).
More CFUs do not equal more benefits. The safest and most effective doses are those that have been clinically tested. Different dosages of specific strains are used for various conditions.
Although manufacturers are not required to list CFUs based on the current guidelines, high-quality brands will make sure to list the CFUs for each strain (NIH - Probiotics Factsheet).
As a consumer, you should also check the labels of probiotic supplements for recommended storage conditions. Some probiotics need to be kept in the fridge, others can be stored at room temperature.
4) Safety
If you are in good health, you can safely take probiotics at the studied CFU level daily (WGO - Global Guide on Probiotics).
Be sure to consult your healthcare provider if you have a weakened immune system, short bowel syndrome, or any other health problems. Also, check with your provider first if you are considering probiotic supplementation during pregnancy and breastfeeding or if plan on giving it to your baby.
For a probiotic to be safe, it should be approved for human consumption by a recognized regulatory or food safety authority. In the US, probiotics labeled as GRAS (Generally Recognized As Safe) by the FDA are considered safe.
Our probiotic, L. reuteri NCIMB 30242, is one of the few probiotics with GRAS status.
Summary
For best results, go for a probiotic dosage and strain that has been through human trials and is labeled Generally Recognized As Safe (GRAS) by the FDA.
List of Top Probiotics Recommended by Doctors
- Lactobacillus reuteri NCIMB 30242 (Microbiome Plus+)
- Bifidobacterium infantis 35624 (Align)
- VSL#3
- Lactobacillus rhamnosus GG (Culturelle)
- L rhamnosus GR-1 and L reuteri RC-14 (ProFem)
- Lactobacillus paracasei LOCK 0919, Lactobacillus casei LOCK 0908, and Lactobacillus casei LOCK 0900 (Latopic)
- Lactobacillus helveticus R0052 and Bifidobacterium longum R0175 (Innovix Labs Mood Probiotic)
How Can You Know Which Probiotic Is Right for You?
There are hundreds of probiotic products to choose from on the market, so finding the right one for you may seem overwhelming. Yet, only a fragment of these products has been through clinical trials.
More and more doctors are recommending probiotic supplements and keeping up with the latest research. If you’re unsure where to start, consult a doctor knowledgeable about probiotics to get expert advice.
To support your health goals, you should be taking the right strain and dosage for the required amount of time.
If you are looking to boost your heart and immune health, our clinically tested L. reuteri NCIMB 30242 may be a good choice.
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Ana Aleksic, MSc (Pharmacy)
Ana is an integrative pharmacist and scientist with many years of medical writing, clinical research, and health advising experience. She loves communicating science and empowering people to achieve their optimal health. Ana has edited 800+ and written 200+ posts, some of which reached over 1 million people. Her specialties are natural remedies, drug-supplement interactions, women’s health, and mental health. She is also a birth doula and a strong advocate of bridging scientific knowledge with holistic medicine.
