Choosing the right probiotic supplement with beneficial strains is only half the battle. Many people also wonder about the best time to take probiotics: Do You Take A Probiotic With Food, or is an empty stomach better? The answer isn’t always straightforward, and conflicting advice can lead to confusion. Let’s examine the available research to help you decide.
The Stomach Acid Challenge for Probiotics
Probiotics are live microorganisms that need to survive the harsh acidity of the stomach to reach the small and large intestines, where they exert their beneficial effects.
Stomach acid, crucial for digesting carbohydrates and proteins and eliminating harmful pathogens, can also kill probiotic bacteria. The acidity is measured by pH levels. The human digestive system exhibits variable pH levels: the stomach ranges from 1–3, while the small and large intestines range from 6-7.
One theory suggests that probiotics should pass through the stomach as quickly as possible. Taking a probiotic with food might slow down the passage, leading to a higher mortality rate of the probiotic bacteria. However, food can also raise the stomach’s pH, creating a safer environment for the probiotics. Conversely, a meal can stimulate the production of digestive enzymes and bile salts, which may negatively impact the viability of probiotics.
The question of whether to take a probiotic with food or on an empty stomach, and therefore the optimal time of day, has been debated extensively. It’s important to consider that newer research employs simulated models of the gastrointestinal tract, which demonstrate improved survival rates of probiotic bacteria compared to test tubes.
One study revealed that the survival of bacteria in a probiotic product was maximized when taken with a meal or 30 minutes before a meal (specifically, cooked oatmeal with milk). Probiotics taken 30 minutes after a meal showed reduced survival rates. Moreover, survival was enhanced when the supplement was ingested with oatmeal or low-fat milk, compared to water or apple juice. The study concluded that “ideally, non-enteric coated bacterial probiotic products should be taken with or just prior to a meal containing some fats.”
Probiotic Protection: Advanced Delivery Methods
Fortunately, many high-quality probiotic manufacturers prioritize gastric acid resistance and survivability.
Encapsulation is a method to protect probiotics, maintaining their stability without altering their natural properties. Various encapsulation techniques have been developed to protect these live microorganisms, improve stability, and offer targeted delivery. The delivery of probiotics can be confirmed through in vitro studies using simulated digestion systems. Further research is necessary to confirm in vivo efficacy. Enteric-coated or delayed-release capsules are also employed by manufacturers to shield probiotics from the acidic gastric environment.
Strain-Specific Survival Rates
The survival rate of probiotics varies significantly depending on the bacterial strain and how the probiotic supplement is delivered.
Gastric resistance differs among species and even within strains.
Lactobacillus spp. (recently reclassified based on whole-genome sequencing) tend to exhibit greater viability in gastric conditions compared to other probiotic species, reducing the need for specialized dosage forms for gastro-resistance.
A 2021 study assessed the survival of five lactic acid bacteria strains from commercial probiotics under simulated gastrointestinal conditions, without protective capsules and added within a food matrix. Lactobacillus plantarum exhibited the highest resistance, showing noticeable growth under both in vitro gastric conditions at pH 4.0 and 5.0, and in vitro intestinal conditions across all tested concentrations of bile salts.
The increased survival of probiotic lactic acid bacteria in acidic conditions in the presence of glucose has also been observed.
Interestingly, multi-strain probiotic products do not appear to have an antagonistic effect on the survival of individual strains compared to single-strain products, at least within a simulated colonic environment.
Acid survival also varies within the same species for other bacteria:
Bifidobacteria generally exhibit weak acid tolerance, with the exceptions of Bifidobacterium lactis and Bifidobacterium animalis.
One study showed that Saccharomyces boulardii survived equally well with or without a meal, suggesting inherent protection.
Key Takeaways: Probiotics and Food
Limited evidence suggests that certain probiotics might exhibit improved survival if taken shortly before a meal. However, the importance of timing may be diminishing due to advancements in probiotic protection techniques. Always consult the product label for specific instructions regarding how and when to take the probiotic supplement, as formulations differ significantly.
Ultimately, the chosen strain must provide an evidence-based effective dose throughout the product’s shelf life to address your specific health needs.
Finally, timing can be important for practical reasons: establishing a routine time of day for your probiotic supplement can improve adherence, ensuring consistent consumption and maximizing potential benefits.
Alternative Delivery Methods
The challenges posed by gastric conditions and bile exposure in the GI tract become less relevant when probiotic supplements are delivered directly to specific sites.
- For example, lactobacilli strains, prevalent in the female urogenital tract, have shown positive results when delivered directly to the vagina.
- The oral cavity has also been targeted for the prevention of conditions like gingivitis and periodontitis.
- Furthermore, rectally administered probiotic formulations show promise in treating inflammatory disorders such as ulcerative colitis.
Key References
Charalampopoulos, D et al. “Evaluation of the effect of malt, wheat and barley extracts on the viability of potentially probiotic lactic acid bacteria under acidic conditions.” International journal of food microbiology vol. 82,2 (2003): 133-41. doi:10.1016/s0168-1605(02)00248-9
Forssten, S D, and A C Ouwehand. “Simulating colonic survival of probiotics in single-strain products compared to multi-strain products.” Microbial ecology in health and disease vol. 28,1 1378061. 17 Oct. 2017, doi:10.1080/16512235.2017.1378061
Matsumoto, Mitsuharu et al. “H+-ATPase activity in Bifidobacterium with special reference to acid tolerance.” International journal of food microbiology vol. 93,1 (2004): 109-13. doi:10.1016/j.ijfoodmicro.2003.10.009
Stasiak-Różańska, Lidia et al. “Effect of Simulated Gastrointestinal Tract Conditions on Survivability of Probiotic Bacteria Present in Commercial Preparations.” International journal of environmental research and public health vol. 18,3 1108. 27 Jan. 2021, doi:10.3390/ijerph18031108
Tannock, Gerald W. “A special fondness for lactobacilli.” Applied and environmental microbiology vol. 70,6 (2004): 3189-94. doi:10.1128/AEM.70.6.3189-3194.2004
Tompkins, T A et al. “The impact of meals on a probiotic during transit through a model of the human upper gastrointestinal tract.” Beneficial microbes vol. 2,4 (2011): 295-303. doi:10.3920/BM2011.0022
Toribio-Mateas, Miguel. “Harnessing the Power of Microbiome Assessment Tools as Part of Neuroprotective Nutrition and Lifestyle Medicine Interventions.” Microorganisms vol. 6,2 35. 25 Apr. 2018, doi:10.3390/microorganisms6020035
Yoha, K S et al. “Targeted Delivery of Probiotics: Perspectives on Research and Commercialization.” Probiotics and antimicrobial proteins, 1–34. 27 Apr. 2021, doi:10.1007/s12602-021-09791-7
