Top 6 Probiotic Supplements: Choosing the best for You and Your Gut Health
Choosing a supplemental probiotic is as confusing as choosing any kind of supplement — the limitless brands all seem the same, but all claim to be different. Many brands claim their probiotic is the “best” because it has a certain amount of a certain bacterial strain proven to improve gut health. But where is the proof? And even if they provide some kind of proof, how do we know how much and what type of bacteria is best for our situation?
The only foolproof way to know if a probiotic supplement is right for you is to try it and see if it helps. Still, a common problem with this approach is that it’ll only produce more questions. Is it working? How do I know if it is working? How long is this thing supposed to take until I start feeling better?Many brands seem to only offer a placebo effect, and because of the high price of probiotics, we often stop trying. I know this all too well; along my journey in battling IBD I tried countless probiotic supplements and was left with all of these questions and more.
It wasn’t until a coworker suggested Visbiome as a probiotic to improve my IBD when I noticed marginal differences in my gut health.
I came to the conclusion that we often choose our probiotic supplements based on marketing versus how well they actually work in improving our personal gut health. This article is my best attempt to answer the questions above and provide the top six, Whealthy-approved best probiotic supplements, where you’re likely to notice a measurable difference in the improvement of gut health.
What are Probiotics ?
First, let’s get some definitions down.
Probiotics = Live microorganisms that confer a health benefit on the host when administered in adequate amounts.
Prebiotic = Dietary substances that nurture specific changes in the composition and/or activity of the gastrointestinal microbiota (favoring beneficial bacteria), thus conferring benefit(s) upon host health.
Synbiotics = Products that contain both probiotics and prebiotics.
For a more in-depth read, I recommend A gastroenterologist Guide to Probiotics.
What to look for in probiotics?
Colony Forming Units (CFUs)
CFU are the number of live bacteria per serving. While the “best” probiotic supplement varies from person to person, the standard minimum for probiotics supplements should include at least 1 billion CFUss. While the bottom threshold is 1 billion,you’re likely to see 5 billion+ CFUs come in quality probiotics.
Strain types
High quality probiotics contain at least one of the three most researched probiotic bacterial strains: Lactobacillus, Bifidobacterium, and Saccharomyces boulardii. The most common probiotics that manufacturers add to commercial products are species of Bifidobacterium and Lactobacillus bacteria.
Refrigerated vs. non-refrigerated
Go for refrigerated over non-refrigerated. Always. The need to refrigerate speaks to the quality of the company and bacteria included in a probiotic.
When should I take my probiotics?
Is it okay to take a probiotic supplement every day?
Yes, it is recommended to take your probiotic supplement daily, even after you begin seeing improvements in gut health. This will help create a stable ecosystem in your microbiome.
Even when you decide to stop taking probiotics as a supplement you still want to feed and repopulate your gut daily with probiotic and prebiotic containing foods.
What time of day should I take my probiotics?
Most probiotic supplements come with instructions for consumption to produce the best results. In general the best results are produced when taking your probiotic at the same time you are eating. If applicable, it’s also best to take your probiotics at the same time as you take antibiotics you’re on.
Who needs probiotics as a supplement?
Signs you may need a probiotic supplement
IBD/IBS*
Lack of mental clarity (gut-brain connection i.e. foggy mind, depression, anxiety, mental struggles)
Unhealthy stool habits (irregularity and poor quality, gas and bloating)
Skin problems (eczema, psoriasis, rashes)
Recent use of antibiotics*
Sugar and carbohydrate cravings (indicates poor microbiome balance)
Pre-term, low-birthweight infants born at less than 37 weeks weighing less than 2,500 grams.*
*Supported research published by the American Gastroenterological Association.
Signs your probiotic supplements are working include
Improved stool health
Decreased sugar and carbohydrate cravings
Clearer skin
Increased energy
Clearness of mind
What are the side effects of taking probiotics?
The introduction of probiotics into your routine can include side effects such as gas, bloating, and diarrhea. Changes in our microbiome come with gas as the good bacteria are creating a healthy ecosystem in our gut. These changes and side effects should go away in a few days to a few weeks.
Who should avoid probiotics?
As always, consult your doctor before taking any new supplements. Individuals with a compromised immune system, like cancer patients receiving chemotherapy, or patients who have semi-permanent intravenous lines in their bodies, should avoid probiotics.
Practical considerations to probiotics before getting started
Common side effects of probiotics are typically transient but include gas and bloating
Different probiotic strains possess unique properties for benefiting host physiology
One probiotic does not fit all GI illnesses; probiotic selection should be based on the clinical indication and take into consideration the strain and dosage used in clinical trials
Symptomatic benefits offered by probiotics are likely to be modest; thus, probiotic therapies may best be used to supplement rather than replace conventional therapies
Continuous consumption throughout the period of desired effect appears required for probiotics.
Without further ado, here’s the rankings of the top six Whealthy-approved probiotics.
Visbiome (4.8/5)
Name: Visbiome
Price: $58+
Background: Visbiome is by far the most expensive, but worth the price. If you need that extra help as many of those with IBS/IBD, UC, Crohns, pouchitis, and hepatic encephalopathy do, then visbiome is for you.
Main Benefits: Visbiome is clinical tested in over 250 patients for the dietary management of dysbiosis, including
IBS: patients who received visbiome saw improvements in stool quality and bloating and a reduction in gas (1, 2, 3, 4)
UC: visbiome improved time of remission rates (vs placebo) in UC patients when taken in combination with current therapies (5, 6, 7, 8, 9)
Pouchitis: in three double-blind, placebo-controlled trials and one open trial, the De Simone Formulation has been shown to aid in the dietary management of pouchitis.(10, 11, 12) Visbiome has since been recognized as an effective tool for the dietary management of pouchitis by the American College of Gastroenterology, the German Association of Gastroenterology, the British Society of Gastroenterology, the European Crohn’s and Colitis Organization (ECCO), and The Cochrane Collaboration.(13, 14, 15, 16)
Hepatic encephalopathy (HE): those consuming Visbiome for dysbiosis experienced a reduced incidence of HE, reduced ammonia levels, and improvements in psychometric test compared to controls
Strains & amount: Visbiome contain an eight-strain cocktail known as the De Simone Formulation, which includes: Lactobacillus paracasei, Lactobacillus plantarum, Lactobacillus acidophilus, Lactobacillus delbrueckii subspecies bulgaricus*, Bifidobacterium longum, Bifidobacterium infantis±, Bifidobacterium breve, and Streptococcus thermophilus.
Amount varies from 112.5 Billion to 900 Billion CPUs, depending on which package you purchase.
Pros: extensively researched in humans, eight high-quality strains, high CFU count, research-proven to work for a number of ailments.
Cons: costly.
Whealthy Rating: 4.8/5. Truly the only true con for me is the price, but if you can afford it, Visbiome is worth every penny.
2. Florajen (4.5/5)
Name: Florajen
Price: $24+
Background: Florajen is attractive because of the 3 strain probiotic blend, and the fact that it needs to be refrigerated. Not to mention they have a special formula for women (to support vaginal pH) and children (to support food allergy and immune health). Their 3 strain blend of Lactobacillus acidophilus, Lactobacillus rhamnosus, and Bifidobacterium has the ability to improve intestinal health regulate the digestive and vaginal environments, ease gastrointestinal infections and diarrhea, stimulate immune responses, and prevent certain allergic symptoms by keeping the intestinal lining healthy (17, 18, 19).
Main Benefits:
GI support (strengthens intestinal lining)
Combats allergies
Supports women’s health
Strains & amount:Lactobacillus acidophilus, Lactobacillus rhamnosus, and Bifidobacterium.
15 billion live cultures per capsule, 6 billion live cultures for kids
Pros:contains 3 highly researched strains, high CFUs, and unique formulas for women and kids.
Cons: needs to be refrigerated to be effective
Whealthy Rating:4.5/5; I have no personal experience with this probiotic given I’m a visibiome guy, but given the 3 strain formula and the price this deserves a 4.5/5. While it doesn't have 8 strains like Visbiome, it does require refrigeration — indicating the 15 billion live cultures per capsule are actually live cultures.
3. Florastor (4.0/5)
Name: Florastor
Price: $28+
Background: Florastor boasts the unique strain, Saccharomyces boulardii, which is larger and stronger than many other probiotics, and provides increased intestinal coverage and protection. One of the main benefits of this strain is the prevention of diarrhea, including travelers’ diarrhea and pediatric diarrhea. There is evidence that it provides minimal support in helping manage IBD/IBS. One other thing Florastor does seem to help with is lactose intolerance, as it creates lactose (an enzyme which processes lactose) as a by-product from the bacteria.
Main Benefits:
Preventing diarrhea
Helping ease lactose intolerance
Strains & amount:Saccharomyces boulardii lyo CNCM I-745 with 1-5 Billion (250mg) CFU per capsule
Pros: contains a proprietary bacterial strain which is larger and stronger, prevents diarrhea, provides minor support for IBD/IBS; additional supplements for kids and infants as well as a prebiotic formula.
Cons: only one strain, minimum CFU.
Whealthy Rating - 4.0/5; while Florastor only has one bacterial strain with limited CFU count, it seems to be powerful enough to provide some relief to IBD/IBS — especially if you experience loose stool.
4. Garden of Life: Raw Probiotics (3.8/5)
Name: Garden of Life: Raw probiotics Ultimate Care
Price: $40+
Background: 34 bacterial strains and 100 billion live cultures per capsule helps Garden of Life: Raw Probiotics pack a strong punch for your gut. Garden of Life: Raw Probiotics Ultimate Care Includes the clinically studied “Replenish Blend” to restore good bacteria that’s been lost. With the main bacterial strain being Bifidobacterium lactis this probiotic seems to be particularly helpful in relieving constipation (21). In addition, it also includes a protein enzyme blend to aid in digestion, and a raw fruits and veggies blend to help create a healthy microbiome ecosystem. This probiotic, however, does not require refrigeration. Like many other probiotics that do not require them to remain cold past two weeks, it makes me question how many of these 34 strains and 100 billion CFUs remain alive and actually make it to the gut. Although this probiotic contains high strain count and high CFUs, I’m skeptical that the majority of the good stuff might not even be active by the time you digest it.
Main benefits:
Relieving constipation
Supporting digestion
Acting as a multivitamin
Strains & amount: Bifidobacterium lactis + 33 other bacterial strains; 100 billion live cultures per capsule
Pros: strain count, number of cultures per capsule, and proven bacterial strain to relieve constipation
Cons: somewhat pricey, unsure about stability through the GI tract, and contains milk.
Whealthy Rating: 3.8/5. This probiotic is able to provide relief to many and serves multi-purposes with an enzyme blend plus fruits and veggies blend. However, if you are looking strictly for a quality probiotic, you may want to choose one of the previous options on this list.
5. Culturelle (3.5/5)
Name: Culturelle
Price:$16+
Background - Culturelle contains L. rhamnosus GG (LGG) the number one most clinically studied probiotic strain proven to survive stomach acid and support a strong barrier of the intestinal wall. L. rhamnosus GG (LGG) is also proven to help prevent diarrhea and provide minor support in IBD/IBS. Fun fact: this is the strain available in Danimals yogurt. Culturelle guarantees 10 billion CFUs and their digestive daily probiotic comes with prebiotics to help feed the bacteria.
Main Benefits:
Preventing diarrhea
GI support (intestinal wall)
Strains & amount: L. rhamnosus GG (LGG), 10 Billion CFUs
Pros: comes with prebiotics and probiotics to form a symbiotic relationship, offers gummies for kids, kids and baby formulas, dairy free, gluten free, and soy free.
Cons: minimal strains, minimal strain count.
Whealthy Rating- 3.5/5; While we always recommend getting nutrition from whole food sources, if you are going to spend extra on a probiotic supplement you probably don’t want to pay extra for something available in Danimals yogurt. With that being said, Culturelle as a probiotic supplement offers much more in terms of CFUs than Danimals… and a lot less sugar.
6. Align (3.0/5)
Name:Align
Price: $25+
Background: Align’s main strain is A Bifidobacterium infantis strain (B.infantis 35624, Align, Proctor and Gamble, Cincinnati, OH) which was evaluated in two clinical trials. One study found significant reductions in pain, bloating, bowel movement difficulty and composite symptom score versus placebo and a lactobacillus species (21). In a larger follow-up study, reduction in pain and global relief of IBS symptoms were significantly greater in the B.infantis treated group compared to placebo (22). Single strain lactobacillus and bifidobacterium (infantis 35624, Align) probiotics did not show efficacy for maintaining UC remission in clinical trials (23, 24).
Main Benefits:
IBD (reducing pain, bloating, unhealthy bowel movements)
Strains & amount: Bifidobacterium infantis , 1 Billion CFUs
Pros: well-researched strain, widely available.
Cons: limited strains and bare minimum CFUs
Whealthy Rating 3.0/5; Align was the very first probiotic I tried, and while it did provide relief to pain and bloating it ultimately did nothing for my IBD. If you have the funds and the choice, choose any of the other brands listed above, but if Align is all you have access to it seems to be better than nothing.
*Disclaimer: As a general rule, more research is needed to prove that probiotics are effective in humans. The reason for this lack of evidence in the field is because not only is every person (and every microbiome) different, but there are an uncounted number of beneficial bacteria that come in all strain sizes, types, CFU counts, and combinations; making probiotics a tricky topic for scientific research. Always consult your doctor before trying new supplements or medications. This article is based on personal research and years worth of experience with IBD treatment.*
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(minimum cfu count) https://health.clevelandclinic.org/how-to-pick-the-best-probiotic-for-you/
(high quality probiotics contain) https://health.clevelandclinic.org/how-to-pick-the-best-probiotic-for-you/
(most common probiotic strains) https://www.medicalnewstoday.com/articles/323821#overview
(probiotic side effects) https://www.medicalnewstoday.com/articles/323821
https://www.florahealth.com/us/blog/probiotics-5-signs/
(Florastor - minimal support in helping manage IBD/IBS, Culturelle - prevention of diarrhea) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3424311/
https://badgut.org/information-centre/product-reviews/florastor/
https://whealthyperformance.com/articles/probiotics-vs-prebiotic-naturally-change-your-microbiome
(practical considerations) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3424311/
https://www.gastrojournal.org/action/showPdf?pii=S0016-5085%2820%2934729-6