I attended my very first nutritional conference for pharmacists almost twenty-five years ago. One of the first things we were exposed to was the use of probiotics which was foreign to me at the time. What I learned then and what we know now hasn’t changed in theory. We know how important a healthy microbiome is for our overall health. The microbiome is the collective population of trillions of bacteria and other microorganisms that live inside us. The use of probiotics has escalated dramatically over the last decade. However, I have seen a lot of different thoughts on what to take, when to take, how long to take, etc.

Refrigerated or non-refrigerated? For a long time, we taught our patients to only take probiotics that were kept in the refrigerator as they were live cultures. That was certainly true in my opinion at the time but more recently experts have figured out how to deliver a population of good bacteria in non-refrigerated capsules and powders.

Should we take probiotics with or without food? Initially I felt always on an empty stomach but now it varies based on what product you are taking.

To rotate or not to rotate? The idea that we should rotate our probiotic formulas every three to four months so that we introduce different strains of bacteria always made sense. Then a few years back I learned that maybe it doesn’t really matter if we rotate products or take the same probiotic formulation day after day. Part of this alternate theory highlighted the importance of feeding the bacteria with diverse, whole foods in our diet or by taking a prebiotic (which is food for probiotic organisms). My opinion has shifted back to making sure to change your probiotic formulas periodically. This comes from a lecture by a popular gastroenterologist with a vast knowledge of the microbiome. He used the potato famine in Ireland in the 1800s as an example. At that time everyone planted one type of potato and when a blight struck it completed wiped out the potato crop creating a devastating famine. The problem was a lack of diversity. The same holds true for our microbiome. It should be diverse so if we experience an issue that attacks or disrupts our system our diversely populated microbiome may continue to protect our digestive and immune systems.

Finally, what about spore-forming probiotics? The theory is that because we don’t eat dirt anymore, we have little to no ingestion of the spore-forming organisms that should be a part of our microbiome. These cleverly named “sporebiotics” support the growth of other important gut bacteria, can survive the low pH of the gastric system, resist breakdown from enzymes, are heat stable and often antibiotic-resistant. Spore-forming probiotics are virtually indestructible and survive to make it to the GI where they offer profound health benefits.