Gut bacteria
Probiotics in India: a doctor’s guide to choosing one
There is no single probiotic that suits everyone. The right one is the strain that has been studied for your particular problem, at the dose used in those studies. Check the label for the full strain name, the number of live organisms present up to the expiry date, and storage instructions. For general health, you do not need a probiotic at all. This guide names no brands.
In short
- Choose by strain and purpose, not by brand, price or the number of strains.
- In India most probiotics are sold as food supplements. They do not have to prove that they work before being sold.
- A good label states the genus, species and strain, the live count at expiry, and how to store the product.
- Try one product for four weeks. If it has not helped, stop.
Do I need a probiotic?
Reasonable to use
- While taking antibiotics, to lower the chance of diarrhoea
- During treatment for H. pylori, to reduce side effects
- For specific conditions, on a doctor’s advice
Reasonable to try
- Irritable bowel syndrome, for four weeks, accepting that the evidence is mixed
Not needed
- General health in someone eating a varied diet
- “Boosting immunity”
- Weight loss
See what probiotics are for the evidence in more detail.
How do I read a probiotic label?
| Look for | Why it matters |
|---|---|
| Genus, species and strain, in full | Benefits are specific to the strain. “Lactobacillus blend” is not enough. |
| Live count at the end of shelf life | Counts “at the time of manufacture” fall before you take the product. |
| A dose that matches published studies | Most studied doses are in the billions of organisms a day. |
| Storage instructions and an expiry date | Heat and moisture kill live organisms. |
| The manufacturer’s name and licence number | Basic accountability. |
Which strains have been studied for which problem?
| Situation | Organisms with supporting evidence |
|---|---|
| Diarrhoea linked to antibiotics | Saccharomyces boulardii; Lactobacillus rhamnosus GG; certain defined combinations |
| Side effects of H. pylori treatment | Saccharomyces boulardii and some Lactobacillus strains |
| Pouchitis after surgery for colitis | A specific eight-strain combination |
| Irritable bowel syndrome | Individual strains have shown benefit in single trials; no strain is firmly established |
Ask your doctor or pharmacist to help match the strain on the label to the purpose.
Which claims should make me cautious?
- Words such as “cures” or “detoxifies”
- A “proprietary blend” with no strain names or individual counts
- Very long lists of benefits, from skin to mood to weight
- Counts stated only at manufacture
- Products that need refrigeration but are sold from an open shelf
A higher price and a higher count do not mean a better product.
How do I take it?
Timing
With or just after food, unless the label says otherwise.
With antibiotics
Separate the probiotic from each antibiotic dose by at least two hours. Continue for one to two weeks after the course.
Duration
Four weeks for a trial. Benefits last only while the product is taken.
Storage
As directed. In Indian summers, do not leave products in a car or near the stove.
Who should not take probiotics?
People who are critically ill, have severely weakened immunity, have a central venous line or have a damaged heart valve should not take probiotics without specialist advice, because of a rare risk of bloodstream infection.
What can I do in place of a probiotic?
- A bowl of curd or a glass of buttermilk daily
- A variety of vegetables, fruit, pulses and whole grains, which feed your own gut bacteria
- Fewer unnecessary antibiotics
See fermented foods and prebiotics.
When should I see a doctor?
See a doctor if bloating, diarrhoea or pain has lasted more than a few weeks. A probiotic is not a substitute for a diagnosis.
Questions patients ask me
Which probiotic is right for IBS?
None is firmly established. Some single strains have helped in trials. Try one product for four weeks; if it does not help, a different approach is more useful than another probiotic.
Is home-made curd as good as a probiotic capsule?
For everyday gut health, curd is a good choice. For a specific medical purpose, such as during antibiotics, a studied strain at a known dose is more reliable.
Can I take a probiotic with my regular medicines?
Generally yes. Keep it two hours apart from antibiotics and antifungal medicines.
Are refrigerated probiotics better?
Not necessarily. Some strains are stable at room temperature. What matters is that the product is stored as its label directs.
Sources
This page is written for patients and is based on the guidelines and studies below. It is for education and does not replace a consultation.
- American Gastroenterological Association guideline on probiotics in digestive disorders. Su GL et al. Gastroenterology. 2020. PubMed 32531291
- International consensus statement on the term probiotic. Hill C et al. Nat Rev Gastroenterol Hepatol. 2014. PubMed 24912386
- Maastricht VI/Florence consensus on Helicobacter pylori infection. Malfertheiner P et al. Gut. 2022. PubMed 35944925
- American College of Gastroenterology guideline on irritable bowel syndrome. Lacy BE et al. Am J Gastroenterol. 2021. doi:10.14309/ajg.0000000000001036