- Probiotics might help prevent C. diff after antibiotics or if you develop pouchitis after surgery .
- A high-fiber diet that includes fermented foods creates a strong foundation for gut health.
- Talk with a healthcare provider if you have concerns like bloating, weight loss or pain.
There’s no shortage of claims that probiotic supplements are the cure to your digestive troubles—but do these pricey pills actually deliver? And are they even necessary? To help separate fact from fiction, we spoke with leading gastroenterologist Trisha Pasricha, MD. What she told us might challenge some of your existing assumptions about probiotics. What we learned is that while probiotic supplements can be helpful in a few scenarios, they’re not a magic bullet and most people probably don’t even need them.
“Probiotics are a multibillion-dollar industry, but for many people, they’re not the magic fix they’re marketed to be,” Pasricha says. While there’s little evidence for using probiotics in most scenarios, there is strong evidence that a fiber-rich diet supports the microbiome and improves overall gut functioning. “If you want to invest in your gut, that’s where I’d start,” Pasricha says.
Learn more about the situations when probiotics may be helpful and why a gut-friendly diet is often more effective.
When a Probiotic Supplement Might Be Helpful
Most people do not need to take a probiotic supplement, Pasricha tells us. In fact, the American Gastroenterological Association (AGA) doesn’t recommend taking probiotics for most digestive issues because there’s simply not enough clinical evidence.
There is a lot of existing research on probiotics, but the research methods, probiotic strains, doses, patient populations and research findings vary so widely from one study to another that it’s hard to draw any broad conclusions about who might benefit, Pasricha says.
Among adults, there are two scenarios in which probiotics may be helpful, and clinical guidance supports their use, Pasricha says.
To Prevent C. difficile Infection While Taking Antibiotics
Certain probiotics may help lower the risk of a bacterial infection called Clostridioides difficile (C. diff) that can develop while taking antibiotics, research shows. A healthy microbiome can help protect against infections like C. diff, but taking antibiotics can disrupt your microbiome over the next few months, making you more susceptible to infections like C. diff.
But don’t assume any probiotics will be effective here. Researchers recommend specific probiotic strains and combinations of strains for preventing C. diff, including S boulardii, the 2-strain combination of L acidophilus CL1285 and L casei LBC80R; and a few other strain combinations.
If You Have Pouchitis
For people with inflammatory bowel disease who have had bowel surgery and develop a complication called pouchitis, probiotics may be effective. In this scenario, research shows that a specific combination of 8 different probiotic strains (L paracasei subsp paracasei, L plantarum, L acidophilus, L delbrueckii subsp bulgaricus, B longum subsp longum, B breve, B longum subsp infantis, and S salivarius subsp thermophilus) may be helpful.
For Other Scenarios, Probiotics Probably Aren’t Necessary
“Some individuals report feeling better on a probiotic, and personal experience matters,” Pasricha says. “But more often, I see patients who have spent hundreds of dollars trying supplements without addressing the underlying drivers of their symptoms, such as stool form, fiber intake, motility or stress.”
The AGA says probiotics should be recommended only if there is a clear, documented benefit. They point out that there isn’t enough evidence to support taking probiotics to treat C. difficile infection, ulcerative colitis, Crohn’s disease or IBS.
All the hype around probiotics—especially when it comes to detoxing claims—can create unnecessary fear and may even distract people from concerns that need medical attention, Pasricha tells us.
“If someone has persistent symptoms like bloating, pain, weight loss or bleeding, a probiotic shouldn’t replace proper medical evaluation,” Pasricha says. “Supplements can create a false sense of action while the real issue goes unaddressed.”
Why Eating a Nutritious Diet Is Usually A Better Option
Whole foods provide gut health benefits that probiotics can’t replicate, Pasricha says. Some of the best foods for gut health are fermented foods like kimchi, sauerkraut, plain kefir, miso and yogurt with live and active cultures. Fiber-rich foods like fruits, vegetables, whole grains, legumes, nuts and seeds are also important because they help feed important gut microbes and support a diverse microbiome.
“The more diverse your plant intake in your diet—fruits, vegetables, legumes, nuts, whole grains—the more resilient your microbiome becomes,” Pasricha says. “Supplements don’t substitute for that foundation.”
What to Look for in a Probiotic Supplement (and What to Avoid)
If you’ve tried shopping for a probiotic supplement, you’re probably aware of the seemingly endless options. But not all probiotics are the same. These supplements vary widely depending on factors such as the probiotic strains they include, the dose and their efficacy.
“Quality varies between brands, so choosing a product vetted by a reputable third-party can provide some reassurance, but it does not change the limitations of the evidence,” Pasricha says.
Probiotics aren’t regulated by the FDA like drugs, so they don’t go through the same testing as medications. “That makes it difficult to draw strong, universal recommendations,” Pasricha says. Additionally, quality and potency can vary widely from one probiotic to the next.
If you see marketing claims about detoxing or cleansing, that may be a sign to use caution. Pasricha agrees, “Any product marketed around fear of toxins should raise red flags.” Probiotics are generally safe for healthy people, but those who are immunocompromised or critically ill should be cautious, says Pasricha.
Meal Plan to Try
7-Day High-Protein, High-Fiber Meal Plan for Gut Health, Created by a Dietitian
Our Expert Take
Probiotic supplements can be helpful in some select health situations, such as to prevent C. diff while taking antibiotics or if you’ve developed a condition called pouchitis after bowel surgery. But for the most part, there currently isn’t sufficient evidence to support their use. If you’re experiencing digestive concerns like bloating, weight loss or pain, it’s a good idea to speak with a licensed healthcare professional rather than spending money on a supplement that may not work.
