Additional Criteria We Considered in Our Investigation
In addition to the considerations above, we also looked into the following factors in our search for the best probiotic brands.
Quality Assurance Testing
As you know, independent testing is really important to the Gimme team. Like other supplements, one of the biggest quality assurance issues the probiotic industry faces is the lack of FDA regulation. The best probiotic brands conduct testing to ensure the potency and the purity of their product. We gave extra points to those brands that provided us with a Certificate of Analysis (COA) to prove their label’s claims.
No Added Junk
When evaluating probiotics, we screened for all the usual suspects, from “natural flavors” to preservatives. Sometimes titanium dioxide is included in probiotic capsults to ensure a uniform white color. Magnesium stearate is oftens used as an anticaking agent. The best probiotic brands will contain none of these additives.
Several probiotic brands are delivered slow-release capsule (known as an “enteric coating”) in order to allow the probiotics to make it safely through the harsh acidic stomach environment and into the small intestine. Because of the magic of postbiotics (see above), we don’t view this protective layer as necessary. That said, we don’t penalize companies for the minor “extras” that this adds to the ingredient list as long as the enteric coating is derived from plant cellulose, rather than petroleum or some other synthetic. Most commonly this coating will appear on the label as either hydroxypropyl methylcellulose AKA hypromellose AKA HPMC, gelatin/ gellan gum, pectin, and/or silica.
Ranking Probiotic Brands
So now you know what we factors we considered when evaluating probiotic brands. What follows is our ranking of the probiotic supplements you asked about most.
Best Probiotic Brands for Kids
While children’s probiotics are beyond the scope of this post, we will cover them in a future investigation! Here is what we do know:
- There is good evidence that probiotic supplementation is an effective treatment for kids with diarrhea (both from infection and related to antibiotics), IBS, and atopic dermatitis.
- The doses used in clinical studies has been sbetween 5 to 10 billion CFUs. We recommend going to the high end of this range for the reasons we explain elsewhere in this post.
- There do not appear to be any adverse affects associated with probiotic supplementation in children.
We like two chewable brands of probiotics for kids:
- My kids take the Llama Naturals pre/probiotic because they prefer the taste of this one. It has only 1 billion CFUs, so I let them take more than two gummies, but you should check with your pediatrician before doing so.
- Hiya is another brand we like. This one contains 10 billion CFUs made up of three strains, as well as a larch tree fiber prebiotic.
Probiotic Strains for Specific Conditions
What follows is not a comprehensive list, but a good starting point if you’re looking for specific probriotic strains to treat specific health conditions. For more details, this website provides a searchable list of commercial probiotics and links clinical studies on various health conditions.
Dr. Hopkins points out that “even strong scientific evidence does not translate to every person experiencing the same positive outcomes. Each of us has our own unique microbiome and in practice, just like any dietary intervention, different probiotic blends will “work” differently for different people.”
And while there’s no harm in choosing a probiotic with the exact strains that have been shown to produce a good outcome for a particular health metric, we think that many brands tend to overemphasize the importance of this strain specificity. After all, they want to convince you that their formula is the only one that will work!
Lactic Acid Bacterial Strains (Cultured)
Featuring some of the most widely-studied strains, these are the probiotics you commonly get from fermented foods. All of the strains listed below are shown to help with general digestive health, so only specific health conditions beyond “gut health” are noted in the descriptions.
Lactobacillus acidophilus. One of the most highly researched strains and probably the most commonly found in commercially available supplements. Can help treat diarrhea, vaginal yeast infections, lung infections in children, eczema, and irritable bowel syndrome.
Lactobacillus rhamnosus. Effective in treating diarrhea, particularly in children, as well as reducing the risk of upper respiratory tract infections and preventing allergic symptoms.
Limosilactobacillus reuteri. Can help treat diarrhea, IBD/IBS, and colorectal cancer. Helps boost the immune system.
Lactobacillus plantarum. Can reduce the symptoms of irritable bowel syndrome, rheumatoid arthritis, diabetes, obesity, hypertension, and liver disorders. Shown effective as an add-on treatment for Parkinson’s.
Lactobacillus gasseri. Has been shown to aid in weight loss and improve metabolism, as well as in reducing stress-associated anxiety and sleep disturbance.
Bifidobacterium bifidum. Can help treat diarrhea, IBS, and eczema. Boosts the immune system.
Bifidobacterium lactis. Can reduce the risk of upper respiratory tract infections, depression, anxiety, and Type 2 diabetes. Boosts the immune system.
Bifidobacterium infantis. Can relieve symptoms of irritable bowel syndrome, reduce inflammatory markers, treat leaky gut, and lower the risk of atopic dermatitis in infants.
Bifidobacterium breve. Can reduce the risk of upper respiratory tract infections, boost the immune system, and reduce insulin resistance and body fat in people with obesity.
Bifidobacterium longum. Can help reduce colitis and chronic inflammation, lower the risk of upper respiratory tract infections, and boost the immune system. This strain is also able to ferment several carbohydrates including lactose and the sugars found in cruciferous vegetables that humans can’t digest. Notable for its ability to colonize the gut following supplementation.
Streptococcus thermophilus. While there is some promising evidence from animal models, we really don’t have solid clinical data yet to support its use as a supplement beyond playing a supporting role in general digestive health.
Enterococcus faecium. May help reduce the risk of upper respiratory tract infections, boost the immune system, and lower cholesterol. Unfortunately, due to the potential for antibiotic resistance, E. faecium is less commonly used as a probiotic supplement and currently has neither Generally Recognized as Safe (GRAS) status by the FDA, nor has it been included in the Qualified Presumption of Safety (QPS) list in Europe.
Yeast Strains
There’s really only one probiotic in this category, but it’s a good one! Being a fungus rather than bacteria, this strain has some properties that may be helpful for your particular microbiome.
Saccharomyces-boulardii. Known to be an effective treatment for diarrhea, particularly in people taking antibiotics. Can be used to treat Crohn’s disease, ulcerative colitis, and IBS.
Soil-Based or Spore-Forming Bacteria
Like the name suggests, these are typically found in soil rather than food. This type of bacteria forms spores, which tend to be very hardy and resilient.
Bacillus clausii. Can aid in the treatment of diarrhea from various causes, particularly in children. Has been shown effective in treating bacterial overgrowth (SIBO).
Bacillus coagulans. The most studied and well-established spore-forming probiotic. Can help treat abdominal pain, IBS, IBD, diarrhea, as well as pouchitis, gingivitis, Clostrum difficile-induced colitis, and Helicobacter pylori infection.
Bacillus subtilis. Can aid in treating diarrhea and has been shown to have antiviral and antimicrobial properties. Commonly used in livestock feed to promote animal growth and promising studies from animal models suggest that it may treat upper respiratory tract infections, but we did not find human clinical data to support this yet. It is being explored for use as an antibiotic treatment.
Bacillus lichenformis. Appears to help to improve gut health and reduce the risk of certain infections. There are few clinical studies examining its efficacy and up until now these studies have included itin conjunction with other probiotic strains and treatments, so more data is needed.
The Best Probiotic Strains for Specific Conditions
All of the best probiotic brands help with general gut health as well as diarrhea. People looking for relief from the following specific health problems should consider supplements with the strains outlined in this table. (The brands listed in the third column are just a small sampling–the probiotic supplements we have identified above in our Best Stuff and Good Stuff sections will all contain a combination of these well-researched strains.)
Stay sane,
Probiotics FAQ
Who needs to take probiotic supplements and who should avoid them?
Our recommendation is determined by which of the following three profiles you identify with:
Type #1: You are generally healthy and looking for a day-to-day product to support your overall health, or you suffer from occassional mild health issues like bloating, fatigue, idiopathic diarrhea, insomnia, etc.
Type #2: You have a chronic, diagnosed condition such as IBD/IBS, SIBO, Crohn’s, asthma, psoriasis, atopic dermatitis, eczema, etc,. or you are looking to treat a specific acute issue, such as antibiotic-associated diarrhea.
Type #3: You are experiencing a serious acute health issue and/or are severely immunocompromised. This does not include people with chronic manageable health complications that may contribute to compromised immune function, but rather patients who are already receiving acute care in a hospital setting and/or are dealing with a life-threatening condition.
For the vast majority of adults who fall into profiles 1 and 2, there are many great reasons to consider probiotics as a part of your wellness routine. You can comfortably experiment with a variety of trusted probiotic formulas without worrying about potential risks. Any negative side effects will likely take the form of mild gas, bloating, and/or abdominal pain. These effects are thought to reflect the shifting balance of microbes as the newly introduced probiotics compete with the existing microbiota and they should subside on their own within a few days or a week.
For those who identify with Type #2, we recommend reading the above section on specific strains for specific conditions in order to help you find a supplement that includes strains that have solid clinical evidence for your condition. For everyone in group 1 or 2, evidence suggests that you’re more likely to experience the desired outcome if you lean toward a greater variety of strains and higher CFU count.
People in the 3rd category who are dealing with very serious health issues face risks associated with probiotic supplements and in rare cases, these risks can be significant. Anyone in this category is advised to be cautious about consuming probiotic supplements and should consult with their primary care provider before trialing any of the probiotics recommended in this guide.
Can you get enough probiotics from food?
We recommend a diet high in probiotics (found in miso, sourkraut, kombucha, yogurt, and more). Still, probiotic supplementation can be helpful because you can get a much larger dose from a supplement than from a food. In addition, taking a probiotic supplement allows you to select a particular strain of probiotics. This may not matter very much for general health, but may be important for those looking to treat a specific illness.
Should probiotics be refrigerated?
When lacto-based probiotics are exposed to heat, light, oxygen (and more), they can become active again. It makes sense in theory that you don’t want the strains to “wake up” until they’ve entered the body, and therefore keeping them refrigerated seems smart.
There are now widely available stabilization methods such as freeze-drying, spray-drying, vacuum-drying, and encapsulation that results in all three classes of probiotic in a shelf-stable form. Our take is that you’re better off with a probiotic that does not require refrigeration, now that these are widely available.
How many CFUs should probiotics have?
ISAPP suggests that there should be at least one billion CFUs (colony forming units) in a serving of probiotics. We feel the evidence favors of a much higher dosage, especially for those using probiotics to treat an illness. We think the best probiotic brands will have CFUs above 20 billion.
What is the best probiotic for kids?
We will post a seperate guide covering probiotic supplementation in children in the future. For now, we can say that Maia’s kids take Llama Naturals or Hiya.
Should you take a probiotic while you are taking antibioticsor after you finish your course?
This is actually one of the most well-established applications of probiotic supplementation. It is indeed counterintuitive to consume bacteria at the very same time you are taking medicine to wipe out bacteria. But it turns out the right time to add a probiotic supplement to prevent antibiotic-associated diarrhea is in fact during the antibiotic treatment course and for at least a week or so afterward. Saccharomyces boulardii in particular is very effective in this regard, presumably in part because it is a species of yeast and therefore not an antibiotic target.
Why do some supplements have probiotic strains with numbers or extra letters at the end?
If you find a supplement with specific proprietary substrains denoted by several numbers and/or letters at the end of their names, it’s a good sign of a quality manufacturer.
During a clinical study, it’s essential to control the precise strain(s) and quantity of the probiotics being administered. When the probiotic organisms are genetically identical for all the participants in a clinical setting, conclusions can be appropriately attributed to that exact organism. This leads to proprietary cloned strains that are named beyond the genus, species, and strain, such as: “Lactobacillus acidophilus Rosell-52” or “Lactobacillus rhamnosus GG.”
This doesn’t mean that these particular clones are the only strains that “work.” In fact, there is a great deal of overlap across entirely different strains and even species of probiotics when it comes to health benefits. There is also a great deal of individual variability when it comes to which species an individual will respond to.
Some brands use one or more of these proprietary strains in their formula and leverage that to make claims implying this is the only probiotic to have undergone clinical testing. This is misleading. Dr. Hopkins says, “I wouldn’t use this as essential criteria for choosing your probiotic, nor should you read too much into the link between that particular substrain and health outcome. ”
What probiotic brand does Maia and Dr. Hopkins take?
Maia takes the Llama Naturals chewable, despite its low CFU count, because she loves the taste of these gummies. When she remembers, she also takes the Needed probiotic capsules. Dr. Hopkins thinks Innovix is the best probiotic brand at the most reasonable price point, so that’s the one you’d find in his cabinet. We both are pretty convinced that more is more when it comes to probiotic supplementation!
Selected Sources
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Hempel S, Newberry SJ, Maher AR, et al. Probiotics for the prevention and treatment of antibiotic-associated diarrhea: a systematic review and meta-analysis. JAMA. 2012;307(18):1959-1969. doi:10.1001/jama.2012.3507
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4 comments
kai
What do you think about activated you, morning complete? I’ve heard good things but don’t see it anywhere on your list, thank you!
Auroragaze
Hi, Maia.
I was wondering what your thoughts were about Garden of Life Dr. Formulated Probiotics Organic Kids chewables? These are the ones I give to my son. Also, how much weight was placed on supplements being organic (i.e., was there less priority for something to be organic than potent/effective)? Thank you for the phenomenal review, by the way! Dawnblueberly31
In the linked probiotic chart, there is a product, RepHreshâ„¢ Pro-Bâ„¢ Probiotic, that shows level 1 evidence for help with BV and yeast. This same product, however, is on your list, “Probiotic Brands That Contain Fillers: Note that all of these have under one billion CFUs and none has more than one class of probiotic.” I am a little confused because the product’s website says that it contains 2 probiotics. Did LabDoor do testing and found these to be false claims? Please clarify if possible. Thanks
remalu14
FYI – Renew Life has a version of its Ultimate Flora Ultimate Car Probiotic that has (only) 150 billion live cultures but has 40 different strains. This is the highest number of strains I’ve been able to find in a single probiotic.