Probiotics are beneficial microorganisms that can positively impact your health. After choosing the right probiotic supplement with the strains that address your specific health needs, one question often arises: Should Probiotics Be Taken With Food? This article explores the optimal timing for probiotic consumption, backed by scientific evidence, to maximize their effectiveness.
The information available online can be conflicting, leading to confusion about whether to take probiotics on an empty stomach or with food. Let’s delve into the research and separate fact from fiction.
Navigating the Stomach Acid Challenge
Probiotics, being live microorganisms, must survive the harsh acidic environment of the stomach to reach the small and large intestines, where they exert their beneficial effects.
Stomach acid is essential for digesting food and eliminating harmful pathogens. However, this acidity can also kill probiotic bacteria. The pH level, which measures acidity, varies throughout the digestive system. The stomach has a highly acidic pH of 1-3, while the intestines have a more neutral pH of 6-7.
The goal is for probiotics to pass through the stomach as quickly as possible to minimize exposure to stomach acid. Some argue that taking probiotics with food might slow down this passage, leading to a higher death rate of the beneficial bacteria. Conversely, food can buffer the stomach acid, raising the pH and creating a more favorable environment for probiotic survival. Furthermore, a meal may stimulate digestive enzyme and bile salt production, which could negatively affect probiotic viability.
This debate about whether probiotics should be taken with food and what the best time of day is has been ongoing. It’s important to note that recent studies use simulated models of the gastrointestinal (GI) tract, which provide more accurate results than traditional test tube experiments by demonstrating improved survival rates for probiotic bacteria.
One notable study published in Beneficial Microbes investigated the impact of meals on probiotic survival. It found that the highest survival rates were observed when probiotics were consumed with a meal or 30 minutes before a meal (specifically, cooked oatmeal with milk). Taking probiotics 30 minutes after a meal resulted in significantly lower survival rates. Furthermore, survival was better when the supplement was taken 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.”
The Role of Protective Technology
Modern probiotic manufacturers prioritize gastric acid resistance and survivability.
Encapsulation is a common technique used to protect probiotics and maintain their stability without altering their natural properties. Various encapsulation methods exist to shield these live microorganisms, enhance their stability, and facilitate targeted delivery to the intestines. In vitro studies, such as simulated static or dynamic in vitro digestion systems, can confirm the successful delivery of probiotics. However, further in vivo studies are necessary to confirm their efficacy in the body.
Enteric-coated and delayed-release capsules are also employed to protect probiotics from the acidic environment of the stomach.
Strain-Specific Survival Rates
The ability to withstand stomach acid varies among different bacterial strains. Some strains are naturally more resilient and exhibit higher survival rates as they pass through the stomach. The delivery method of the probiotic supplement can also influence survival rates.
Gastric resistance varies from species to species and within strains.
Lactobacillus spp. (recently reclassified based on whole-genome sequencing) tend to be more viable in gastric conditions than other probiotic species. This means that gastro-resistance may be less of a concern when choosing a dosage form for these 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 tested without protective capsules and were added to a food matrix. Lactobacillus plantarum demonstrated the highest resistance to the culture medium conditions. It exhibited significant growth under both in vitro gastric conditions at pH 4.0 and 5.0, as well as in vitro intestinal conditions at all tested bile salt concentrations.
Studies have also reported that the presence of glucose can enhance the survival of probiotic lactic acid bacteria in acidic conditions.
Interestingly, when used in a multi-strain product, probiotics do not negatively impact each other’s survival compared to a single-strain product, at least within a simulated colonic environment.
Other bacteria also show variation in acid survival within the same species:
Bifidobacteria generally exhibit weak acid tolerance, with the exception of Bifidobacterium lactis and Bifidobacterium animalis.
In contrast, Saccharomyces boulardii has shown equal survival rates with or without a meal, indicating intrinsic protection against stomach acid.
Key Considerations
While limited evidence suggests that probiotics may survive better when taken before a meal, advancements in manufacturing techniques have significantly improved their ability to withstand the harsh stomach environment. Regardless, always consult the product label for specific instructions regarding when and how to take the probiotic, as formulations can vary considerably.
Ultimately, it’s crucial to choose a probiotic strain with an evidence-based effective dose that targets your specific health needs and remains potent throughout the product’s shelf life.
Beyond the science, a practical tip is to take your probiotic supplement at the same time each day. Establishing a routine will make it easier to remember, ensuring consistent consumption and maximizing the potential benefits.
NOTE: Alternative Delivery Methods
Gastric conditions and bile exposure become irrelevant when probiotic supplements are delivered directly to specific sites outside the GI tract.
- For instance, 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 preventing conditions like gingivitis and periodontitis.
- Rectally administered probiotic formulations show promise in treating inflammatory disorders like ulcerative colitis.
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
