Probiotics are live microorganisms that can provide health benefits when consumed. Choosing the right probiotic supplement with the right strains for your specific needs is the first step, but figuring out the best time to take it can be confusing. You might wonder: Should I Take A Probiotic With Food, or is an empty stomach better? Conflicting advice abounds, so let’s examine the evidence-based science to find out.
How Stomach Acid Affects Probiotics
Probiotics, to be effective in the small and large intestines, must navigate the harsh acidic environment of the stomach. Stomach acid, crucial for digesting carbohydrates and proteins, also acts as a barrier against harmful pathogens and viruses ingested with food and drinks. However, this acid can also harm beneficial microorganisms, including probiotics.
The acidity level is measured by pH. The stomach typically has a pH of 1-3, a highly acidic environment, while the small and large intestines have a pH range of 6-7, which is much more neutral.
The idea is that probiotics need to pass through the stomach quickly to minimize exposure to the acid. Taking probiotics with food could slow down this passage, potentially leading to a higher death rate of the microorganisms. However, food can also raise the stomach’s pH, creating a more protective environment for the probiotics. Conversely, eating may also stimulate the production of digestive enzymes and bile salts, which could negatively affect probiotic viability.
Therefore, the optimal timing of probiotic intake – with food or on an empty stomach – has been a point of discussion. Newer research, using simulated models of the gastrointestinal (GI) tract, indicates better survival rates for probiotic bacteria than earlier test tube studies suggested.
One study published in Beneficial Microbes found that the survival rate of bacteria in a probiotic product was highest when taken with a meal or 30 minutes before a meal (specifically, cooked oatmeal with milk). Probiotics taken 30 minutes after a meal did not show the same high survival rates. Furthermore, survival was improved when the supplement was taken with oatmeal or low-fat milk compared to water or apple juice. The authors concluded that non-enteric coated bacterial probiotic products are best taken with or just before a meal containing some fats.
Advanced Probiotic Protection Methods
Fortunately, reputable probiotic manufacturers recognize the importance of gastric acid resistance and survivability.
Encapsulation is a well-established method to protect probiotics and ensure stability without affecting their natural properties. Researchers have explored various encapsulation techniques to shield these live microorganisms, improve their stability, and provide targeted delivery. In vitro studies, using simulated digestion systems, can initially confirm the successful delivery of probiotics. However, in vivo efficacy requires further confirmation.
Enteric-coated or delayed-release capsules are also used to protect probiotics from the harsh gastric environment.
Strain-Specific Survival Rates
The resilience of probiotics to stomach acid varies among different bacterial strains. Some strains have naturally higher survival rates than others during their passage through the stomach. Moreover, the delivery method of the probiotic supplement can also affect the survival rates of different strains.
Gastric resistance varies from species to species and within strains.
Lactobacillus species (recently reclassified based on whole-genome sequencing) tend to be more resistant to gastric conditions compared to other probiotic species. Therefore, gastric resistance may be less of a concern when selecting a dosage form for Lactobacillus probiotics.
A 2021 study published in the International Journal of Environmental Research and Public Health assessed the survivability of five lactic acid bacteria strains from commercial probiotics under simulated gastrointestinal conditions. The strains were without protective capsules and were added to a food matrix. Lactobacillus plantarum exhibited the highest resistance to the tested conditions in the culture medium. It showed significant growth under in vitro gastric conditions at pH 4.0 and 5.0, as well as under in vitro intestinal conditions at all tested concentrations of bile salts.
Increased survival of probiotic lactic acid bacteria in acidic conditions in the presence of glucose has also been documented.
Interestingly, when used in a multi-strain product, probiotics do not appear to negatively affect each other’s survival compared to single-strain products, at least in a simulated colonic environment.
Other bacteria also show variation in acid survival within the same species:
Bifidobacteria generally exhibit weak acid tolerance, with the exceptions of Bifidobacterium lactis and Bifidobacterium animalis.
According to one study published in Beneficial Microbes, Saccharomyces boulardii survived equally well with or without a meal, suggesting it may possess some inherent protective mechanisms.
Key Takeaways on Probiotic Timing
Limited evidence suggests that probiotics might survive better if taken before a meal. However, advancements in probiotic manufacturing, such as encapsulation and enteric coatings, have mitigated the importance of timing. Always follow the label instructions on your specific product, as formulations can vary significantly.
The most important factor is to choose a strain and dose that has been proven effective throughout the product’s shelf life for your particular health concern.
Finally, while timing may not be crucial for survival, it can be important for adherence. Taking your probiotic at the same time each day can help you remember to take it consistently, ensuring you receive the full benefits.
Probiotics Delivered Outside the GI Tract
The challenges of gastric conditions and bile exposure are irrelevant when probiotics are delivered directly to specific sites in the body.
For example, direct vaginal delivery of lactobacilli strains, which are dominant in the female urogenital tract, has shown positive results.
The oral cavity has also been targeted for the prevention of conditions like gingivitis and periodontitis. Additionally, 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
