Probiotics and Prebiotics:
Frequently Asked Questions
PATIENT HANDOUT 3
University of Wisconsin Integrative Medicine
www.fammed.wisc.edu/integrative
recently been argued that it is okay to take
probiotics and antibiotics at the same time,
though some sources say it is best to take them
2 hours apart from each other. Start the probiotic
as soon as possible and continue it until at least
a few days after the antibiotic course is
complete. (Some say until 2 weeks after the
antibiotic is finished.)
6. Are there any people who should not
take probiotics?
Probiotics tend to be quite safe, with few
adverse effects. Some prescribers recommend
that they should be avoided in people whose
immune systems are severely compromised
because of reports of bacteria entering the
bloodstream. Occasionally, people will feel more
gassy when they first start taking probiotics.
Twenty billion doses of probiotics are taken each
year, but only a handful of people develop
complications from taking them.
A recent study of patients with severe acute
pancreatitis found that giving probiotics might
increase risk of death, though a later analysis of
multiple studies did not show a change in death
rates. For now, it is probably best for people with
acute pancreatitis to avoid probiotics.
7. Can’t I just eat probiotic foods?
Fermented dairy products must contain live-
cultures to have probiotic effects. Yogurts, kefir,
and other fermented foods, such as sauerkraut,
miso, and tempeh may contain helpful bacteria.
How many bacteria each food contains varies a
lot. Look for foods labeled “contains live active
cultures.” Frozen yogurt has
no
live bacteria.
Many yogurts contain organisms that are not
native to humans and don’t survive in their
intestines.
8. Will the bacteria even make it to my
intestines if I take them?
It is important to be sure that the probiotic can
survive moving through stomach acid. It should
be able to handle a pH of less than 3.5 in the
stomach. It must also be able to survive in the
duodenum (the first part of the small intestine),
with all the bile salts and digestive enzymes
there. Most probiotics have added compounds to
help protect the bacteria from digestion. People
on a Candida reduction diet should keep in mind
that dextrin, contained in many probiotics, is
often listed as a yeast-stimulating compound. In
general,
Lactobacillus, Bifidobacterium,
and
Streptococcus
species do not need to be in a
special preparation to survive moving through
the stomach.
L. bulgaricus
and
S. thermophilus,
as well as
Leuconostoc
and
Lactococcus
species
canno
t survive passage through the
stomach and must be in enteric-coated
capsules. These have a special coating that
protects the bacteria until the capsule reaches
the intestine.
9. What are some reliable brands?
Remember that different studies test different
bacterial species, which makes it difficult to know
if a particular product will work for a particular
problem.
ConsumerLab.com, a site that evaluates
supplements to see if they contain what their
packaging claims, tested over 25 different
products. Of these, several contained fewer
bacteria than they claimed. Products that passed
ConsumerLab testing (contained the amount of
organisms claimed on the packaging) are listed
below. Note, however, that there are many other
products that were not included in the testing.