Recommendations for when to take probiotics vary from empty stomach to full stomach and from morning to bed time. In this post, I will show how you can get the most benefits out of your probiotics and when they should be taken.

Probiotics on an empty stomach?

A Canadian study from 2011 found that probiotic bacteria survive the stomach and its acids best if taken with food or in the 30 minute period before eating. The scientists noted that the food eaten should have fat in it for maximum preservation of the bacterial organisms. (1)

In the same study probiotic yeast saccharomyces boulardii survived stomach acid environment equally as effective with or without food.

It is often said that living organisms in probiotics would survive best if taken on an empty stomach because stomach acid levels are lower at that time. But this is not true as was indicated in the study. Probiotics should be taken with food or just before eating as they seem to survive best when carried through the stomach with food mass.

It makes sense in the point of view of evolutionary history as well that probiotics work best if taken with food. The human animal that has evolved in the past million years is used to eating foodstuffs straight from the ground with all of the bacteria included and none of today’s sanitation. The human digestive tract and immune systems are optimized to work when constant bacterial exposure is present with foods.

Enteric coating

Some probiotics are packed in capsules, which have an enteric coating. This polymer surface, at least in theory, stays intact in the acidic environment of the stomach (pH ~3), but will start to dissolve in the more neutral acidity of the small intestine.

These coated probiotics will likely work when taken on an empty stomach, but I still like to them also with food.

Should probiotics be taken with antibiotics?

Yes. Not at the same time as antibiotics. But – yes, probiotics should always be taken with antibiotics. In the past, it was a common advice to start taking probiotics after the antibiotic regimen. But numerous studies have shown that probiotics should be eaten for the whole duration of an antibiotic regimen and a good time past it’s ending.

A meta-analysis of 33 different placebo-controlled studies showed that probiotics reduced the risk of diarrhea caused by the antibiotics by 52 %. Both the conventional probiotics and the probiotic yeasts such as saccharomyces boulardii have been found effective (2)

Similar results were found in an English study in which hospital patients were given probiotics twice a day during a course of antibiotics. In the probiotic group 7 patients suffered a stomach illness caused by the antibiotics. In a same sized placebo control group 19 patients got stomach illnesses. The probiotic used in the study was a normal multi-strain probiotic. (3)

Probiotics should be taken at least two hours after taking the antibiotics, to prevent the antibiotics from killing the probiotic bacteria.

The reduction of beneficial bacteria in the intestines is not the only problem with antibiotics. A big drawback is also the diminishing diversity of different bacteria species. It is good to eat a probiotic that has multiple strains of beneficial bacteria in it. Also, probiotic foods such as sauerkraut and yogurt are beneficial for the preservation of healthy gut flora during antibiotic regimens.

die-off reactions

Die-off reaction – also known as the Herxheimer reaction – is caused when some substance or therapy is resulting in a shift in microbial ratios or death of certain microbes in the intestinal tract.

Part of the cell wall remnants of the ousted bacteria will be absorbed into the bloodstream through the intestinal walls. This toxic substance will burden the liver and the body as a whole causing inflammation. (4)

This kind of damage originating from the intestines is called endotoxemia. Typical symptoms of endotoxemia are headaches, insomnia, depression, anxiety, and nausea.

Probiotics can displace and even kill unwanted microbes in the intestines. For some people, this causes die-off reactions. It takes 6-10 hours for the probiotics to reach the colon, where they do their work. This is usually the time when the die-off reactions begin.

If die-off-reactions occur, it’s beneficial to try to take the probiotics at different times of day and observe the responses to the varied timings. The afternoon may often be a good time to take the probiotics so that you will be resting or sleeping at night when the probiotics hit the colon and face off with the unwanted microbes.

Summing it up

• Probiotics can be taken at any time during the day
• …As long as you take them with food
• Just one portion (capsule) a day has been enough to provide health benefits in probiotic studies
• Almost always the health benefits have been achieved with traditional probiotics, that have 2 – 8 billion bacteria per capsule
• If you have to do an antibiotic regimen, eat probiotics through the course and at least a month after it
• If probiotics cause die-off reactions, reduce the dosage and try to take them in the evening

I recommend this effective multi-strain probiotic. Jarrow also has a high-quality Saccharomyces boulardii probiotic. When talking about healthy gut bacteria levels, prebiotics, the fibers which feed probiotics, are also important. If you are interested, check out my post about GOS prebiotics.

• Jarro-Dophilus – Amazon, iHerb
• Saccharomyces Boulardii – Amazon, iHerb

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