When Is The Best Time To Take A Probiotic? (Based On Studies)
Believe it or not, but the question of when is the best time to take a probiotic supplement, specifically whether you should take it with or without food, is very controversial! Everyone seems to have a different opinion. In fact, if you look at the labels of different probiotic supplements out there, you’ll find a variety of conflicting recommendations. And as one key study noted "this has led to serious confusion for the industry and the consumer”. So to put this debate to bed once and for all, I got together with our research team at Essential Stacks. We dug through every study that’s ever been done on probiotic timing. And gee, are there a lot of studies! But the good news for you - finally, you’ll have a very straightforward recommendation based on actual research, as opposed to someone’s gut feeling. Let’s go!
Table of Contents
You versus probiotics
So let’s quickly look at how your body and probiotics work together.
The first thing we need to realize is that probiotics, which are good bacteria, are most helpful when they reach our intestines. And that makes sense, after all this is where most of our existing good bacteria lives. We call this our Microbiome.
Now to get there alive and well, probiotics need to navigate some dangerous territory.
- First, they have to make it through your highly acidic stomach, which is filled with acid that helps digest your food - but which can also harm bacteria, both the good and bad kinds.
- Then they have to go up against enzymes, bile acids and even the physical churning of your stomach - all of which can hurt them as well.
So as you can see, your probiotics are kind of like Frodo and Sam in Lord Of The Rings - bravely marching through Mordor and being attacked by everyone from orcs to witch kings and even Sauron!
Protecting probiotics with or without food
So the question becomes how can we protect our little hobbits...I mean... probiotics? And specifically, will taking them WITH or WITHOUT food help them survive best?
Now, initially, you might think taking them without food will help most. After all, if you’re not eating, there won’t be as much acid in your stomach.
But here’s the thing: while the volume of stomach acid will be at its lowest when you’re not eating, the acid that remains will be at its strongest. Based on studies, we can see that when we are fasting our stomach acidity drops to a pH less than 3. And given this pH level can Range from 0.3 to 3, it is very acidic.
And just a side note here: low pH means high acidity, and high pH means low acidity.
By contrast, when we eat food, while the volume of stomach acid is much higher, the pH is also higher with a range from 4.5 to 5.8. Meaning although there is more stomach acid, it is less acidic.
So with all of this in mind, one might reasonably change their mind. And now start to think taking probiotics WITH food will offer more protection.
But what do the actual studies say?
When is the best time to take probiotics (based on studies)
Well in a 2011 study done in beautiful Quebec, Canada - which we believe is the most helpful of ALL the studies we’ve seen on probiotic timing - researchers actually went and built a model of the human digestive system.
- They called it the IVIDIS model - I think they’ve watched a lot of Star Wars in their time!
- Anyways, so they filled it with acid, bile fluids and all the components needed to mimic our actual GI tract.
- Then they fed it probiotics.
- And of course, they did this with and without food.
Here’s what they found…
“Survival of all the bacteria in the product was best when given with a meal or 30 minutes before a meal”
And by contrast, they found...
“Probiotics given 30 minutes after the meal did not survive in high numbers.”
Interesting, right! So based on these results, we can start to see that taking your probiotics just BEFORE you sit down to eat your meal or just as you START eating your meal, is probably best.
Which type of meal is best for probiotics?
Now the story doesn’t finish there. It turns out the researchers also experimented with feeding the Model GI Tract different types of foods. They wanted to see whether the protein, carb or fat content of different foods added any extra protection for the probiotics.
And here’s what they found…
“Survival in milk with 1% milk fat and oatmeal-milk gruel were significantly better...”.
Which led them to conclude…
“bacterial probiotic products should be taken with or just prior to a meal containing some FATS.”
So with all of this in mind, you’re probably thinking that you need to be vigilant and really make sure that you take your probiotic supplement at the right time and with a meal or beverage that contains some fat.
But is all of this really necessary?
And isn’t there a smarter way to make probiotic supplements?
Well, here’s the thing, if you really dig closely into the study, you’ll find this important point:
“The bacteria in this product are NOT microencapsulated…NOR is the capsule enteric-coated, which would render the capsules impermeable to the gastric acid.”
And when the researchers say “impermeable” they basically mean the acid would NOT be able to break through the capsule and impact the probiotics. And so this brings up a huge point:
If you are taking a probiotic supplement that does use microencapsulation AND enteric coating (which is a type of protective barrier that goes over the capsule), then timing doesn’t matter so much.
Instead, since your probiotic superheroes are protected, like mini astronauts in a space shuttle, you can take them any time. Not only do you NOT need to worry about whether there is fat in your meal; you don’t even need to worry if you take them with a meal at all!
So if you want to find a probiotic supplement that comes in a protective capsule like this, all you need to do is check the label for terms like:
- Enteric coated capsules
- Delayed release capsules or DR capsules for short
- Or even time delayed capsules
For example, here at Essential Stacks we make a 50 billion CFUs probiotic called Smart Probiotic. And since we love the 11 strains of good bacteria in it - and want to make sure they can make it down into your intestines alive and well - you’ll see right here on the front of the label “Delayed Release Capsules”.
Exception to the rule - special probiotics
Now, just before we go on - if you’ve tried our probiotics before, you might notice we also make another probiotic using Saccharomyces Boulardii .
And if you look on the label, you won’t find any mention of delayed release capsules. So why is that?
Well, unlike most probiotic strains, Saccharomyces Boulardii can survive and pass through your GI tract fine without any extra protection. Which is pretty amazing - it’s kinda like Frodo surviving Mordor without Sam!
In fact, if we look at the 2011 study from Quebec again, here’s what they said about S Boulardii…
“S. boulardii was much less affected by pH and survived in any situation”
And if we look at the table from the study, we can see the survival rate of S boulardii staying pretty much constant - no matter what is thrown at it.
So to wrap everything up: although most probiotics should come in delayed release capsules to help them survive and make it to your intestine alive and well, some probiotic strains, like S boulardii, can get there by themselves and don’t need special encapsulation.
Technical explanation of probiotic timing
If you find yourself asking questions about whether it’s best to take probiotics with or without a meal, you’re not alone. Variations of this question have been the subject of several research studies, all carried out in the hopes of identifying optimal probiotic delivery strategies.
While there is a growing body of evidence surrounding the impact of foods (or lack thereof) on probiotic delivery, a number of variables are part of the equation.
For this reason, a definitive answer on how meals might impact probiotics is not possible under all circumstances.
In order to best answer this question, the following will be addressed:
- What is the goal behind taking probiotics with or without a meal?
- Why your gastrointestinal tract is a probiotic death trap -- the challenges surrounding probiotic delivery.
- With or without food? How different food components or an empty stomach could theoretically impact probiotic viability.
- Is it even worth the hassle? How probiotic formulation can side-step the need for targeted dietary strategies.
- Key takeaways
What is our true Goal?
- If you’re looking into the pros and cons of taking probiotics with or without meals, what you’re truly looking for is a way to optimize probiotic delivery.
- In order to understand what optimized probiotic delivery is, we first have to understand the definition of probiotics:
- Probiotics are defined as live microorganisms, which when administered in adequate amounts, confer a health benefit to the host.1
- Important components of the probiotic definition can form the basis behind the goals of optimized probiotic delivery:
- By definition, probiotics must be live microorganisms, meaning a primary goal when optimizing probiotic delivery with diet strategies is to retain viability, and subsequently, greater health benefits.2
- Notably, there is evidence that under some circumstances, dead and non-viable strains might also provide some therapeutic benefits due to the retention of important bacterial structures which are capable of biological activity.3
- Even so, in most cases, viable probiotics have proven to be more effective than non-viable microorganisms.2
- Optimal probiotic delivery also means supplying an adequate probiotic dose to produce a benefit.
- Ideally, probiotic supplements should provide a dose of a given probiotic strain that has demonstrated health benefits in clinical trials.4
- Likewise, retaining a viable probiotic dose is critical through to the best by date for optimal delivery.4 However, the importance of viability also extends into the gastrointestinal tract.
- The most targeted and optimized probiotic delivery strategies take into account where probiotics must (viably) arrive in the intestines to promote the most benefits.
- It has been stated that the so called “minimum therapeutic” level of viable probiotic microorganisms should be at least 106 CFU/g of viable cells throughout the product shelf-life. Based on the amount of ingested food along with the effect of storage on probiotic viability, it was suggested that a daily intake of 108–109 cfu/g probiotic bacteria could survive the upper ingestion to exert their positive physiological functions in the human body.2
Why Your GI Tract is a Probiotic Death Trap
- Even though, by definition, probiotics must be alive, and provided in adequate amounts to produce a health benefit, living up to this definition is not a simple task.
- For instance, the gastrointestinal tract is designed not only for digestion, but also to destroy bacteria and pathogens, with the acidic pH of the stomach being the primary restrictive component of digestion which severely limits bacterial colonization and survival.5
- Obviously, this is great when it comes to fending off harmful infections, but this can also present a massive viability challenge for many types of probiotics that aren’t well suited to the normal stomach pH range of 1.0-3.0.6
- Likewise, several functions and byproducts of digestion alone, including digestive enzymes, the physical churning of our stomach, or bile acids which help with fat digestion, have known antimicrobial effects, meaning that probiotics have to make it through a number of obstacles to be able to viably get to where they need to be to produce benefits.6
- With all of this in mind, it only makes sense to want to support our microbial friends by maintaining their viability, whether that be through selecting probiotics with good shelf stability, probiotic suppliers selecting strains that show a high level of resilience to the challenges of the gastrointestinal environment, or by paying close attention to how probiotics are formulated and packaged to deliver desired health benefits.
- Similarly, it’s understandable why we might look for ways that we can take probiotics to best preserve their benefits, such as by taking them with or without a meal, or with certain meal components.
With or Without Food?
How Food Components or an Empty Stomach Could Theoretically Impact Probiotic Viability
- A small number of studies have investigated ways in which meal intake (or lack thereof) might impact the viability of probiotics.7,8
- Related studies by food scientists have also looked at the interactions of several food components to see how dietary factors and ingredients might protect or threaten the viability of probiotics when producing probiotic-containing foods.2,9
- The more we learn about and study this topic, the more it becomes obvious that a clear-cut, definitive answer may not exist, and can’t be applied to all meal scenarios or probiotic strains.
- For instance, taking probiotics on an empty stomach might sound like the obvious choice when it comes to reducing interactions with dietary components that could possibly hinder probiotic viability.
- But, a look into normal stomach physiology reveals that, while stomach acid volume is lowest while we’re fasting, the pH of the stomach is most acidic during fasting too, ranging anywhere from a pH of 0.3-2.5; with anything less than 3.0 falling within the normal range.10,11,12
- After meals, the stomach pH is immediately buffered by foods, which brings the pH of the stomach up to a less acidic 4.5 to 5.8 range, falling back below a pH of 3.1 within one hour after the meal.11
- It’s possible that this acid-buffering effect of food could help to protect the viability of otherwise uncoated and unprotected probiotics.
- Using dietary components to form a protective barrier for non-encapsulated probiotics is a tactic commonly described in studies. For instance, components such as milk, milk proteins, fats, a fiber called acacia gum, inulin, glucose, and cereal extracts, amongst other components have been studied and used to protect the viability and benefits of probiotics.9,13
- One 2011 study using a model of the human intestinal tract lends support to the idea that certain food components might be helpful in preserving probiotic viability under certain circumstances. The study used a constructed model of the human gastrointestinal tract to look at the impact of taking probiotics 30 minutes before or after a meal using various meal components in different combinations such as spring water, apple juice, milk, and oatmeal.8
- The consensus of this study was that probiotics that aren’t delivered with a special protective coating (non enteric-coated) should be taken with a meal containing some fats to best preserve viability.8
- However, the study conclusion also noted that probiotic survival was poorest when taken after a meal or when taken with spring water or apple juice. Moreover, the probiotic yeast, S. boulardii, appeared less influenced by most of the study interventions compared against other strains.8
- These findings point to an interesting conclusion, which is that meal timing, while important in this study, may not account for enough variables. Additional variables include individual food components which can result in either a positive or negative impact on probiotic viability. Additionally, these differential effects were not true for all probiotic strains under all circumstances.
- It’s imperative to note that this study was not done in humans, but in an intestinal model, with a small number of defined probiotic strains, and a limited mixture of foods. While the results are intriguing, the findings regarding dietary components which protect probiotics may not extend to all real-world dietary circumstances and probiotics, and therefore we can only say with confidence the following:
- Probiotics administered with a low-variable, fat containing meal, in an intestinal model, using a specific set of strains, was found to be protective.
- This is where the question becomes challenging to answer with any absolutes. Just as researchers have studied factors which can protect probiotic viability, so too have they identified food components that may be damaging to probiotics.
- For instance, even natural fruit juices have been found to contain antimicrobial compounds that might work to the detriment of certain probiotic strains.14
- Moreover, antimicrobial compounds can be found in some of the healthiest foods. One example of this would be berries, which are rich in the beneficial, yet antimicrobial compound called anthocyanin.15
- Nitrates are found naturally in several fruits and vegetables, and can be formed in our mouth by bacteria. Nitrates are also commonly used as a preservative for cured meats.16
- Nitrates entering the stomach through saliva have been found to have bactericidal effects.9
- So what happens if the suggested “fat containing meal” comes from eating nitrate preserved ham or bacon? If food preservatives such as nitrates have antimicrobial effects which prevent food spoilage from microorganism growth, how might small amounts of this dietary exposure interact with a co-administered probiotic?
- Likewise, sulfite compounds are commonly used as food preservatives in beer, wine, juices, dried fruits, processed fish, and meats, amongst other sources.
- One study evaluated the impact of two sulfite compounds on 4 probiotic strains. Even with the sulfites being supplied in a concentration within the safe limits established by the FDA, with a short exposure time, and with optimal growth conditions for the probiotics, a significant bactericidal effect from these common dietary preservatives was still observed.9
- The recommendation to take probiotics with fats might also be dependent on circumstances. Fat intake results in the release of bile acids in the small intestine to aid digestion. Bile acids are known to have antimicrobial effects, with some suggesting that the increased release of bile acids after a fatty meal could possibly be detrimental to probiotics with less bile acid tolerance.6
- Adding to the complexity was a small 2017 study on 20 human participants. The study evaluated the effectiveness of probiotics given either 30 minutes pre or post breakfast for the duration of a month.
- A 2-strain probiotic was provided with strains selected for specific health benefits and high gastrointestinal resilience and tolerance.
- The probiotic was provided in a sachet, with study details suggesting the probiotic was in a powdered form rather than encapsulated, though this was not explicitly stated.
- The results? Both the pre and post breakfast groups were found to have strains of the probiotic in their fecal samples at the end of one month of administration, and both groups showed changes in the gut microbiota associated with benefits, such as a lowering of potentially pathogenic microbes.
In this case, the carefully chosen strains and probiotic delivery system was robust and capable enough of withstanding the harsh intestinal environment, even though they appear to not have been provided in an encapsulated form. Similarly, taking probiotics 30 minutes before or after breakfast did not appear to impact the beneficial study outcome for each group.7
Does it even matter given probiotic capsule technology?
How Probiotic Formulation can Side-Step the Need for Targeted Dietary Strategies
- Trying to perfectly match meal components to support optimal probiotic benefits is likely an exercise in futility. There are so many environmental variables with or without diet coming into play, that it's truly an impossibility to account for each and every circumstance.
- Probiotic formulators can use a number of methods to bypass many environmental challenges.
- Several systems have been developed for the delivery of probiotics such as pharmaceutical formulations and food-based products. Pharmaceutical preparations in particular are considered more effective compared to commercial food-based carrier systems. Examples of pharmaceuticals for the delivery of probiotics currently include, capsules, liquids, powder beads, and tablets. Strain selection is considered a crucial step in both pharmaceutical and food systems as strain selection plays a key role in selecting the appropriate delivery matrix, which may vary from strain to strain.2
- Probiotic encapsulation is known to enhance stability, facilitate handling and storage of probiotic cultures, and protect sensitive probiotic lactic acid bacteria from oxygen, freezing, and acidic conditions during production, storage, and gastrointestinal transit. So far, several parameters have been identified to affect the efficacy of encapsulation in probiotic protection.5
- For instance food-grade polymers, such as alginate, chitosan, xanthan gum, gum acacia, starch, gelatin, and pectin, amongst others, are commonly applied through targeted probiotic delivery systems to protect probiotic viability to optimal intestinal sights.17,18
- One study which evaluated eight probiotic strains to assess for tolerance of acid, bile, and heat found that a form of highly targeted encapsulation called microencapsulation improved the survival of probiotic bacteria when exposed to acidic conditions, bile acids, and mild heat treatment.19
- Another study which tested probiotic viability in test tubes by exposing unprotected microorganisms to stomach acid, found that only 1 out of 15 probiotic strains studied appeared to be naturally resistant to stomach acid, while the rest were killed after exposure.20
- The results of these studies suggest that, while appropriate probiotic strain selection is imperative for achieving a desired health effect and gastrointestinal tolerance, more often than not, viability comes down to how the product has been formulated and protected against environmental insults.
- If you’re taking a well-formulated probiotic, the pre or post meal timing of administration, along with nuanced dietary factors may become irrelevant. Targeted strain selection practices and/or appropriate methods of delivery should both protect the viability of the probiotic, and ideally should ensure delivery to the target region of the intestines for optimal benefit.21
- Given these circumstances, rather than asking the question of how or when to take a probiotic, the question may be better posed as: “Who?” and “What?”
- Who have I chosen as my probiotic supplier?
- What specific strains and delivery methods are they using to ensure maximal probiotic benefits?
An evidence hierarchy is followed to ensure conclusions are formed off of the most up-to-date and well-designed studies available. We aim to reference studies conducted within the past five years when possible.
- Systematic review or meta-analysis of randomized controlled trials
- Randomized controlled trials
- Controlled trials without randomization
- Case-control (retrospective) and cohort (prospective) studies
- A systematic review of descriptive, qualitative, or mixed-method studies
- A single descriptive, qualitative, or mixed-method study
- Studies without controls, case reports, and case series
- Animal research
- In vitro research
- Bubnov RV, Babenko LP, Lazarenko LM, Mokrozub VV, Spivak MY. Specific properties of probiotic strains: relevance and benefits for the host. EPMA J. 2018;9(2):205-223
- Terpou A, Papadaki A, Lappa IK, Kachrimanidou V, Bosnea LA, Kopsahelis N. Probiotics in food systems: significance and emerging strategies towards improved viability and delivery of enhanced beneficial value. Nutrients. 2019;11(7):1591
- Rout GK, Jayanta KP, Sushanto G, Yooheon P, Han-Seung S, Gitishree D. Benefaction of probiotics for human health: A review. Journal of Food and Drug Analysis. 2018;26(3):927-939
- Sanders ME, Merenstein D, Merrifield CA, Hutkins R. Probiotics for human use. Nutrition Bulletin. 2018;43: 212–225
- Alexander S, James GF. The role of the gastrointestinal microbiome in Helicobacter Pylori pathogenesis. Gut Microbes. 2013;4(6): 505-531
- Mingfei Yao, Jiaojiao Xie, Hengjun Du, McClements DJ, Hang Xiao, Lanjuan Li. Progress in microencapsulation of probiotics: A review. Comprehensive Review in Food Science and Food Safety. 2020;19(2):857-874
- Toscano M, De Grandi R, Stronati L, De Vecchi E, Drago L. Effect of Lactobacillus rhamnosus HN001 and Bifidobacterium longum BB536 on the healthy gut microbiota composition at phyla and species level: A preliminary study. World J Gastroenterol. 2017;23(15):2696-2704
- Tompkins TA, Mainville I, Arcand Y. The impact of meals on a probiotic during transit through a model of the human upper gastrointestinal tract. Beneficial Microbes. 2011;2(4): 295-303
- Corcoran BM, Stanton C, Fitzgerald GF, Ross RP. Survival of probiotic lactobacilli in acidic environments is enhanced in the presence of metabolizable sugars. Appl Environ Microbiol. 2005;71(6):3060-306
- Clark GWB, Jamieson IR, Hinder RA, Polishuk PV, Demeester TR, Gupta N, Cheng SC. The relationship between gastric pH and the emptying of solid, semisolid and liquid meals. Neurogastroenterology and Motility. 1993;5(4):273-279
- Masaki Sanaka, Takatsugu Yamamoto, Yasushi Kuyama. Effects of proton pump inhibitors on gastric emptying: a systematic review. Dig Dis Sci. 2010;55:2431–2440
- Guilliams, Thomas G, Drake, Lindsey E. Meal-time supplementation with betaine HCl for functional hypochlorhydria: what is the evidence. Integrative Medicine; Mendota Heights. 2020;19(1):32-36
- Govender M, Choonara YE, Kumar P, du Toit LC, van Vuuren S, Pillay V. A review of the advancements in probiotic delivery: Conventional vs. non-conventional formulations for intestinal flora supplementation. AAPS PharmSciTech. 2014;15(1):29-43
- Vinderola CG, Costa GA, Regenhardt S, Reinheimer JA. Influence of compounds associated with fermented dairy products on the growth of lactic acid starter and probiotic. International Dairy Journal. 2002;12(7):579-589
- Cisowska A, Wojnicz D, Hendrich AB. Anthocyanins as antimicrobial agents of natural plant origin. Natural Product Communications. 2011
- Norman GH, Yaoping T, Nathan SB. Food sources of nitrates and nitrites: the physiologic context for potential health benefits. The American Journal of Clinical Nutrition. 2009;90(1):1-10
- Amal BS. Microencapsulation improved probiotics survival during gastric transit. HAYATI Journal of Biosciences. 2017;24(1):1-5
- Desmond C et al. Improved survival of Lactobacillus paracasei NFBC 338 in spray-dried powders containing gum acacia. Journal of Applied Microbiology. 2002;93:1003–1011
- Ding WK, Shah NP. Acid, bile, and heat tolerance of free and microencapsulated probiotic bacteria. Journal of Food Science. 2007;72(9):M446-M450
- Dodoo CC,Wang J, Basit AW, Stapleton P, Gaisford S. Targeted delivery of probiotics to enhance gastrointestinal stability and intestinal colonisation. International Journal of Pharmaceutics. 2017;530(1-2):224-229
- Kim J, Muhammad N, Hak Jhun B, Yoo J. Probiotic delivery systems: a brief overview. Journal of Pharmaceutical Investigation. 2016