shelf of colourful probiotic bottles

Wondering which probiotic is right for you? Here’s what you should look for when you pick out a probiotic in 2022. This post is not sponsored and provides science-backed recommendations for two top-rated probiotics that I use in my clinical practice as a registered dietitian.

As an anti-inflammatory, gut health-focused dietitian (who wrote Good For Your Gut, a gut health cookbook!), I talk about probiotics all the time. But amazingly, when I looked through my posts, I noticed that while I’ve covered the benefits of fermented foods, I hadn’t really covered how to choose a probiotic supplement!

The reason is that I often share my two top probiotics picks (more on that later). But I do feel it’s important to walk through how to make this decision for yourself. Both so you can see how seriously I take my recommendations AND so you can assess new products that come to market—as well as how to make a choice if my recommended products aren’t available.

In this post, you’ll discover:

So let’s get into some common FAQ about probiotics:

What are probiotics good for?

According to the official definition from the World Health Organization, probiotics are “live microorganisms which, when administered in adequate amounts, confer a health benefit on the host.” So simply put, probiotics are microbes (usually bacteria but sometimes yeasts) that can improve your health.

So what are the benefits of a probiotic? It’s important to match the right probiotic to your individual needs, but the main potential benefits of a good quality probiotic include:

Improved digestion: gas, bloating, diarrhea and constipation can all be connected to the gut microbiota. What’s more, imbalances in gut bacteria are common in digestive issues such as IBS and Ulcerative Colitis. Research suggests that some probiotics may help you improve these symptoms.

Support of immune function: the gut microbiota interacts with the immune system located in your gut and some probiotic bacteria have been shown to positively influence different facets of immunity.

Managing chronic inflammation: inflammation can be associated with dysbiosis and gut barrier dysfunction. Probiotics may help support these issues, along with an anti-inflammatory diet.

How do I choose a probiotic that actually works?

There are four main things to consider: refrigeration, CFU count, coating, and clinical trials. Probiotics are different from other supplements because they’re actual living organisms, either bacteria or yeasts. They aren’t like vitamin D, which can sit on the shelf forever, so you want to ensure a few standard criteria are met:

1) The product is refrigerated, unless it specifically states that no refrigeration is necessary.
Bacteria are alive. At room temperature, they’ll die faster than if refrigerated because the cold slows their life cycle. Some products are truly shelf stable, which means they are manufactured in a way that keeps the bacteria alive at room temperatures.

2) The CFU (colony forming unit) count is guaranteed until the expiry date.
You wouldn’t believe how many ways there are to dog this system. Most commonly, by guaranteeing the CFU count (the number of bacteria) at manufacture—then providing an expiry date but not telling you how many of those bacteria are still alive at expiry.

For example, say a product has been shown to be effective at 100 million or 1 billion CFU, and they guarantee 1 billion at manufacture. But by the time that product expires in two years, there are only 10 million left. Well, that product isn’t going to work for you. Think this doesn’t happen? One of the most popular probiotics on the market does just that.

3) The product is enteric coated so your gut doesn’t destroy it.
You want the bacteria to get to your colon, which is where most of the bacterial party happens. However, your acidic stomach acid, followed by the alkaline digestive juices in the small intestine, do a really good job of killing off bacteria. So, an enteric coated probiotic ensures that the bacteria are delivered to where they need to go. The coating resists the acidic pH and dissolves at a pH that is safe for the bacteria inside.

There are a couple of exceptions to this rule: a fresh, live product where the bacteria have not been freeze dried, or a few freeze dried products where the research confirms that the non-enteric coated product works, often because it comes in very high dosages that help account for that die off effect.

4) The product has been used in at least one human clinical trial to verify its effectiveness.
A probiotic can have the slickest marketing on the planet, but if they haven’t invested in human clinical trials, whether or not it works is theoretical. Which is not the same as saying it definitely doesn’t work; It’s just that when I’m making recommendations to you here, or in my practice, I won’t take a chance on a probiotic if I’m not sure it works (i.e. I can see the trial).

So, if you want (and can afford) to roll the dice, and the probiotic seems to hold up on all other criteria, go for it.

How long does it take for probiotics to work?

Give it four weeks. If it is working for you, you will feel a difference after four weeks (usually sooner). If you feel it, continue for at least eight more weeks to see if it improves your condition. If not, try another one.

That’s the cool thing about probiotics: if they are working, you will feel it. You’ll get less constipated, or your irritable bowel syndrome or arthritis symptoms will lessen. A probiotic usually can’t do 100% of the job on its own—you’ll need good nutrition and lifestyle too—but you’ll feel a real shift in your symptoms.

Is a higher CFU count always better?

The short answer: no. More bacteria isn’t always better, or more effective. Which is important to know, because we are starting to see companies play a numbers game. But 100 billion of a bad probiotic won’t help you.

In the research, it appears that 10 billion CFU is a kind of average/minimum for effectiveness. However, there are exceptions to this, where evidence-based probiotics have been found to work at lower doses.

Each product will have its own specific CFU count that is its effective dose, and that dosage should be based on actual research…not just what sounds good on the front of the package. The way to know? Check the brand’s website to see if they link to studies that show if the product works at the dosage they sell.

So, if you have a probiotic you like, and then another one comes out with double the CFU, don’t assume it’s going to be better.

Are more probiotic strains better?

This is another numbers game. A strain is the individual bacterium within a species. For example, most people think that acidophilus is one bacterium, or strain…but it’s a species, like human beings are.

So, there are many different strains of acidophilus – some great, some less so. The strains should be listed with their full name on the label, such as Lactobacillus acidophilus CL1285.

You’ll often see the very lazy argument that since your own gut flora is super diverse, a single strain couldn’t possibly work…and that more strains means a more diverse product that will work better. But nope. There are single strain products that are excellent, and multi-strain products that are garbage. Just give the good bacteria in a high enough dosage, and they’ll do their job.

Another potential issue with multi-strain probiotics is that since bacteria compete with each other, if the probiotic hasn’t been properly tested, you could be buying a ten strain product that in reality, has one or two strains that outcompete all the rest…and you’re really not getting what you paid for.
Instead, focus on ensuring that the probiotic actually works, which you can verify by using the criteria I just talked about above.

How do I choose the right probiotic for constipation, irritable bowel syndrome, or….?

This is a way less clear cut question than you might expect. The reason for this, is that not all probiotics have been tested for all conditions. Why? Research is damn expensive. Which is also why many brands that make probiotics don’t bother to do it at all (really!).

So, in an ideal situation, there is an evidence-based probiotic that has been tested for your unique concern. In the absence of that, choose an evidence-based probiotic that has been tested for other concerns. For example, if you have celiac disease, there is no celiac disease specific probiotic. But there are probiotics for IBS and Ulcerative Colitis, so try one of those.

Eventually, I expect that we will see a future where there are individualized probiotics for your unique concerns…but we aren’t there yet. Not even close.

Whew! So, you can see how much thought goes into selecting a probiotic – and this is just the high level overview. I don’t know about you, but doing the research on which probiotic is best is not often realistic for a lot of people. So how do you make this decision easier?

When is the best time to take a probiotic?

This is probably one of the most common questions I receive. Some probiotics are specific about when you should take them, while others give no advice. My take? Probiotics that aren’t manufactured as well will often ask you to take them on an empty stomach so they bypass the stomach faster to ensure survival. When you eat, the stomach holds onto its contents and it gets way more acidic, which can kill off the probiotics.

However, if you are taking a good quality, enteric-coated probiotic then you don’t have to worry about it. Treat probiotics the same way you do exercise: the best time to take them is whenever it will be easiest to fit it in.

The Easiest Way to Find the Top Rated Probiotics

As a probiotics dietitian, my favourite tool for selecting a good probiotic supplement, if you live in Canada or the US, is called Probiotic Chart. Each year, they independently review all of the probiotics on the market to assess the level of evidence and serve it up in a fairly easy to read chart. I recommend you take a peek at what is available and if you can, stick to the products with level I or II evidence.

Probiotic Chart Canada

Probiotic Chart US

Desiree’s Top Rated Probiotics

And finally, if you just want to know what probiotic supplement I use, you can give one of my favourites a try: Bio-K+ or Visbiome. Both are excellent, well-researched probiotics made by companies that focus only on probiotics.

Bio-K+ is Canadian made, gluten free and comes in both a fresh drinkable product (dairy and vegan) and an enteric coated vegan capsule.

Visbiome is USA made, gluten free and comes in vegetarian (non-vegan, contains dairy) sachet and capsules. If you’ve been following me for a while, you know that I used to recommend VSL#3. I now recommend Visbiome, which is the true VSL#3 formula, which you can read more about here.

Disclosure: This is not a sponsored post, however, I am a paid spokesperson for Bio-K+ Probiotics. I strongly recommend both these brands, based on research and results in my clinical practice, and stand behind my recommendations.