Most doctors generally agree that taking a probiotic is good for your health. But physicians rarely give specific advice about what kind of probiotic is best to take, especially in conjunction with a specific medical diagnosis. But in the last 20 years, science has discovered so much more about these beneficial bacteria than we ever knew before.
We now know that certain strains of bacteria seem to be particularly helpful when treating specific medical conditions. So while the general rule of “just take a high-potency multi-strain probiotic” is often still good medical advice, patients may be able to get a lot more benefit from their probiotic if they take a specific set of strains. Today I’m going to break down for you some of the best probiotic strains based on your medical condition. This is the second article in our series as the research in this area is plentiful. See part one here.
Acute Diarrhea:
While many patients suffer from chronic diarrhea, acute diarrhea is also a common reason why patients visit their doctor, especially children. Acute diarrhea is usually a result of food poisoning or infections like Rotavirus, Escherichia coli, Shigella, and Salmonella. The probiotic that shows the greatest effectiveness against acute diarrhea appears to be Lactobacillus rhamnosus GG. Lactobacillus reuteri and Lactobacillus casei have also shown good effectiveness (1).
Antibiotic-associated diarrhea can also be counteracted by the right strains of probiotics. One of the biggest risks of antibiotics is a secondary Clostridium difficile infection, so I always advise my patients to take a high-quality probiotic after taking any kind of antibiotic treatment. But the research indicates that certain combinations of strains are better at preventing C diff than others. Saccharomyces boulardii, Lactobacillus acidophilus, and Lactobacillus casei used together or a combination of Lactobacillus acidophilus, Lactobacillus delbrueckii subsp bulgaricus, and Bifidobacterium bifidum have the strongest research support in this condition (2).
We have already covered the best probiotics for chronic diarrhea in the IBS section of part one in this series.
Menopause:
While it may seem surprising that menopausal symptoms could be improved by probiotics, there is actually a significant amount of research showing their benefit. Studies show that certain strains of probiotics can modulate estrogen levels. We also know that drops in estrogen levels can shift the microflora drastically (3).
Estrogen regulates the microbial environment of the female reproductive tract by maintaining the thickness of the epithelial tissues, aiding in mucus secretion, and acidifying the vaginal pH through the promotion of lactic acid production (4). Urinary tract infections and bacterial vaginosis are very common in post-menopausal women, and the most likely cause of this is the vaginal environment becoming less acidic. Bacteria can reproduce much more readily in a low-acid environment.
Newer research suggests that the vaginal changes that take place during menopause might not be a direct result of lowered estrogen levels, but instead may be caused by a reduction of probiotic bacteria in the vagina. This change in bacterial content may in fact then be the cause of vaginal dryness, atrophy, and the increased potential for vaginal infections (5).
So what probiotics a should we be taking in menopause to counteract all these symptoms? The first answer is a blend of Lactobacillus species as we know that Lactobacillus levels drop during this time (6). Lactobacillus rhamnosus GG is a specific strain of interest during this time. This strain appears to help with reducing the frequency and severity of hot flashes, improving bone density, reducing vaginal dryness, and improving mood during the menopausal period. Lactobacillus rhamosus HN001 has many similar effects (7). The Bifidobacterium lactis species also appears to be helpful with improving hot flashes, reducing vaginal dryness, and modulating mood.
As a naturopathic physician who specializes in treating digestive disorders, it is unlikely that I would use probiotics as a monotherapy for either acute diarrhea or menopausal symptoms. But I do see them as an important part of a comprehensive treatment protocol for most conditions. Our new ability to give specific strains for conditions like IBS, constipation, acute diarrhea, anxiety/depression, and menopausal symptoms gives our treatment protocols an extra level of effectiveness that we didn’t have in prior years.
Dr. Katie Nuckolls is a naturopathic physician and owner of Thrive GI: Natural Digestive Medicine in Vancouver, Washington. For more information, visit our contact page or schedule a free 15-minute consultation online.
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3424311/
- https://www.health.com/condition/digestive-health/the-right-probiotics-for-your-stomach-problems-and-more
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5592136/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3552825/
- https://pubmed.ncbi.nlm.nih.gov/27451320/
- https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2017.01884/full
- https://link.springer.com/article/10.1007/s13668-023-00462-3
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5806794/
- Bifidobacterium lactis GG improves hot flashes and night sweats in menopausal women: a randomised, double-blind, placebo-controlled trial. Menopause. (2012).