When Considering Probiotics, Consider This

Image: MRSA, by Dr. Carr, CDC


Randomized clinical trials – the gold standard of medical evidence – have demonstrated significant benefits of Probiotics in a variety of patient populations.

I just reviewed some of these here on this blog: http://wp.me/pR4iB-Gj


Unfortunately, most Probiotics are delicate, and are sensitive to various conditions.

These things can KILL your expensive Probiotics:

  • Heat: the best probiotics are prepared using a low heat process to avoid damaging the organisms
  • Moisture: probiotics must be kept dry until they enter your system; a rainy or humid day can be all that is needed to kill a probiotic preparation
  • Oxygen: all probiotics naturally live in an anaerobic environment – without oxygen; oxygen will kill probiotics
  • Stomach acid: our stomach acid is designed specifically to kill bacteria that we ingest; stomach acid will rapidly kill most probiotic strains


There is a huge variation in the quality of Probiotic preparations, in the number and type of bacteria in the preparations, and in the “survivability” of the preparations.

Due to these factors, most probiotic preparations are not guaranteed beyond a certain shelf life or expiration date. Furthermore, there is no way to guarantee how much of the probiotic preparation will make it into your lower GI tract alive.

Most manufacturers simply tell you how much of the preparation is alive at the end of the manufacturing process. This is usually declared on the package as a number of colony-forming-units (CFU’s), named for the number of “colonies” the preparation formed when cultured in the laboratory.


For any Probiotic organism to be effective it must do these things:

  • Survive stomach acid
  • Make it through the stomach to the lower GI tract
  • “Stick” or adhere to the cells of the intestinal wall – the enterocytes
  • Incite the proper immune response – cytokines, bacteriocidins, etc.

That’s a lot of variables.

Maybe that’s why some Randomized Clinical Trials find a strong effect of Probiotics, and some don’t find any effect.

How to Use This Information?

  • If you simply swallow some bacteria, the majority of them will be killed by exposure to the air, and by your stomach acid.
    Result? You just wasted a bunch of money on Probiotic bacteria that weren’t alive when they got where you need them. How to avoid that?
  • In general, look for a Probiotic preparation with a higher CFU number. That is, the higher the CFU number, the more useful bugs there are in the preparation.
  • In general, look for a Probiotic preparation with 3 or 4 different species of bacteria in them. Most of the Randomized Clinical Trials that have found a benefit from Probiotics were based on multi-bacteria preparations.
  • Enteric-coated is better than not enteri-coated; powders probably survive least-well – they are exposed to the air (oxygen) and stomach acid. If powder is the best that you can get into your infant, it is probably better than nothing. Look below for comments under Looks Promising for the best of the best for getting active Probiotics to your lower GI tract.

We Don’t Know

Things that we don’t know include how well the probiotic preparations attach to the lining of the GI tract. The biological benefits of probiotic bacteria are due in part to their ability to attach to those lining cells – the enterocytes.

Binding of probiotic bacteria to the GI lining enterocytes results in:

  • That binding of beneficial bacteria inhibits the binding of the bad bacteria – the pathogens.
  • That binding of probiotic species to the enterocyte also results in the production of “cytokines” – biochemical signals that can enhance the immune system.
  • Probiotic bacteria affect the balance of bacteria in the GI tract by their production of lactic acid, and bacteriocidins. These substances inhibit the growth of pathogens, and also change the balance of species in the local environment – the gut ecological balance – the “microbiome”.
  • Some probiotic species help neutralize the effects of carcinogenic metabolites such as nitrosamines.

As always, the challenge with Probiotics is to get a preparation that can deliver the proper combination of bacteria past the stomach, to the lower GI tract, alive.

Looks Promising

For Probiotic preparations that look promising, see website for Integrative Therapeutics – an outstanding resource for information on Probiotics. The Probiotic Pearls from Integrative Therapeutics – with the triple enteric coating – allows their Probiotics to make it to the lower GI tract alive!

This is worth repeating:

Probiotic Pearls from Integrative Therapeutics has the FDA regulated guarantee that their Probiotic preparation will make it to the lower GI tract alive!!   I am looking forward to reviewing the randomized clinical trials data for their Probiotic preparations as data become available.

Their data looks good to me. Check out their Probiotic Pearls for yourself.

This is the Probiotic preparation that I am using personally, for our children, and recommend to my patients.

Transparency:  I have NO financial or other arrangements with Integrative Therapeutics.

To summarize, at this time, there are not many evidence-based recommendations in the medical literature. However, we can expect more to come in the near future, as clinical trials demonstrate significant benefits in a variety of patient populations, including newborns, infants, toddlers, and children.


Click here to download my free guide to Probiotics: http://bit.ly/dFi1q7


One caution:  A few studies have shown that patients with extremely compromised immune systems have actually been made sick when given probiotics. If a person has an immune system problem, he or she should consult a doctor before taking probiotics.

Let me put in a plug here for Dr. Greene’s site. He is a pediatrician at Stanford / Packard Children’s Hospital, and his site is a GREAT resource.

Dr. Greene reviews some studies of probiotics, and recommends which ones to get for your little boogorheads:



Please leave a message and tell us:

Have you used probiotics for your child(ren)?

If so, what was your goal – what were you treating, if anything?

How did it go?

Which probiotics did you use?

We will all benefit by everyone sharing their experiences.


Image Credit: MRSA, Just another extraordinary electron-microscopy image by Janice Haney Carr, CDC, Published in the Public Health Image Library.

I want to acknowledge and thank Cathy Leet, BSN, Medical Development Consultant at Integrative Therapeutics, Inc., for kindly pointing out the factors that we should take into account when selecting our probiotic preparations, and for kindly providing data on their probiotic preparations.


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  1. Kim Finkler says:

    Dr. Faust,
    I have enjoyed your posts on probiotics and have learned a lot. I have a daughter who has recurrent (?chronic) sinusitis and asthma and has been on multiple courses of antibiotics recently. I have started using probiotics for her during her recent courses and plan to continue as a daily supplement. I had a few follow up questions after reading your posts…
    -can you share any guidelines when taking probiotics and antibiotics together?
    – do you recommend increasing the dose of probiotic when taking an antibiotic course?
    -i noticed the pearls you mentioned (and which we are currently trying) have only 500 million CFU’s – is that because they are enteric coated? I thought the higher the CFU’s the better?

    Thanks so much for being such a wonderful resource for information.


    • Russell A. Faust, PhD, MD says:

      Hi Kim,

      First, thank you for visiting, and for contributing to our little (but growing) community of “boogor heads”. I really appreciate that you took the time to leave your comment.

      Let me start with the facts – there are really no “guidelines” yet established for taking probiotics. One of the points that I tried to make in those articles is that there is such great variability in Probiotic preparations – things like the number and types of bacteria included, the amounts of each, and whether they are enteric-coated – all of these contribute to the confusion about how well probiotics “work” as a remedy for any particular disorder. That variability has certainly contributed to the variability in results from randomized clinical trials.

      That was a long way to say – I don’t know. These variability issues have resulted in a lack of guidelines. I have yet to find a good guide regarding taking antibiotics and probiotics at the same time. I do not recommend increasing the probiotic dosing during a course of antibiotics. Many of the probiotic species are not affected by antibiotics.

      Regarding the “low” (500 Million) CFU’s of the Probiotic Pearls for Children (from Integrative Therapeutics, I can only speculate that they have reduced the CFU’s because that preparation is specifically formulated for children. I take one of their adult probiotic preparations, and the one I take has 5 Billion CFU’s. Both of them have their special enteric coating.

      Finally, thank you for your kind comments. Tell your friends to visit too!
      RF (boogs)

  2. Childrens Probiotic Pearls are triple coated to assure 100% delivery of all the bacteria to the intestines. Other probiotics will only deliver a portion of what the label states if they are killed off by moisture, heat, oxygen, or in the stomach. So lesser amount is needed as you will be getting 100% of the probiotic.
    The general rule is to take probiotics a few hours or more away from antibiotic. And the belief is if you start giving the porbiotic at same time as antibiotic you may avoid the antibiotic side effects due to it killing off too much good bacteria in the intestines.
    There is the heavy duty 5 billion probiotic pearl (Probiotic Pearls Advantage), and a 1 billion pearl (Probiotic Pearls), and the Childrens 500 million pearl (Childrens Probiotic Pearls). Doctors have used all on all ages, but the Childrens pearl is the best for easy swallowing as it is as tiny as a tip of a ink pin.
    Studies show 90% of the probiotic can be killed off before arriving to the intestines, so 500 million guaranteed delivery could be equal to 5 billion, 1 billion to 10 billion, and so on. I think you will be pleased.

    • Russell A. Faust, PhD, MD says:

      Hi Cathy,
      Thanks for visiting, and for providing the details on the Probiotic Pearls products!

      As you know, the Probiotic Pearls preparation from Integrative Therapeutics is the probiotic that I personally take, use for my own children, and recommend for my patients in clinic.

      The benefits of Probiotics for treating antibiotic-related diarrhea, and for reducing the frequency, severity, and duration of URI’s is a huge benefit in children. Because the majority of children that I see in clinic are troubled with respiratory disorders – allergies, rhinitis, sinusitis, otitis, asthma – most benefit from probitoics.

      Due to my background in science and long history of medical research, I only support remedies (whether “conventional” or “alternative”) that are based on good solid evidence. The benefits of Probiotics in children (and adults for that matter) are clearly supported by multiple randomized clinical trials, the gold standard in medical evidence.
      Thanks again for contributing!
      RF (boogs)

  3. Hello dr Kim
    I have a son who is a 6 years old very healthy boy.
    My son have a gas problem. This problem startes last year it is been over year. I m trying to feed him very healthy.We always ate organic food ,and very natural water.But every time when he ate something ,like anything he makes a lot of gas, and he is mouth is smells disgusting. When i gave him a pineapple all the sympthons are gone by next day. I asked a doctors but they told me as he can poop regularly he is just fine. But i don’t think so, it is not a normal situation,he is making a gas a lot every single time. what i trying to do is just gave him a pineapple every day to keep him getting better but i need to find out about what is going on his stomach. After reading your proboitic post , my though are changed i thnk he needs a probiotic, if he needs that which one you recommended us.

    • Russell A. Faust, PhD, MD says:

      Hi Didi,
      No worries about that Dr. Kim thing :))
      Thanks for visiting.
      I cannot give medical advice, but I can suggest that you take these questions to your pediatrician.
      I can also say that the probiotics that I take are from Integrative Therapeutics; I also use their “Probiotic Pearls for Children” for my own children, and recommend their products for my patients. They are the only preparation of probiotics that are FDA-approved to make the claim that 90% of the probiotic makes it through the stomach acid alive – after all, that is what you want – to have live probiotics make it to the GI tract and not simply be killed by your stomach acid.
      Note that Integrative Therapeutics does not sell direct retail. I purchase mine through http://www.covenanthealthproducts.com, but if you find their probiotics at a great price online, PLEASE come back here and let us all know! For transparency: I have no financial arrangements with either Integrative Therapeutics or Covenant Health Products.
      Thanks again for visiting, and please keep us posted on your progress!
      RF (boogs)

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