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It seems like gut issues are a pandemic.

What’s more disturbing is the improper diagnosis of gut dysfunction, which leads to improper treatment. Sadly, many practitioners who specialize in gastrointestinal dysfunctions don’t have a clue as to what to do for those conditions.

Reflux, constipation, diarrhea, small intestinal bacterial overgrowth (SIBO), irritable bowel syndrome (IBS), autoimmune diseases of the gut, infections such as H. Pylori, Hafnia, C. Diff, candida, klebsiella pneumonia, and a slew of other problems can create symptoms and suffering for those afflicted.

While there are multiple reasons behind these gut problems, probiotics are necessary to help rebuild from them.

When is the best time to take a probiotic? 

With countless different nutraceuticals (supplements) available—probiotics being one type—there is a world of confusion on what to take, why to take it, and when to take it.

I’m often asked about the best time to take a probiotic—morning or evening, with or without food.

There is no science to support taking probiotics either at night or in the morning. Taking them with or without food is the more important decision.

The only reason for taking bugs at night is possibly to avoid some of the side effects that can happen when changing your gut flora—symptoms like gas and bloating, which are more easily tolerated when you are asleep.

The digestive tract can be hostile to probiotics due to the acidity of the gut rather than the time of day you take them.

Rather than sunrise or sunset, it’s more important to take probiotics with food, not on an empty stomach.

The reason is the pH balance. Stomach acidity is described in terms of pH—the lower the pH, the higher the acidity, whereas higher pH is more neutral.

On an empty stomach, the low pH (more acidic) is too harsh for bacterial survival.

During a fasting state, the stomach is more acidic with a pH around 2. After a meal, the pH of the stomach contents rises to a more basic value of around 7, which is less acidic. That means there is less chance of the probiotics dying.

In a study found in Beneficial Microbes, researchers found that probiotics taken within 30 minutes of a meal, or with the meal, survived in much higher numbers than if taken 30 minutes after a meal. In fact, they found probiotics taken with food containing healthful fats had the greatest survival.

To make more sense of this, here is an explanation.

After working their way out of the stomach, the bacteria also have to survive the fluctuating pH of the small intestine. After leaving the stomach, bacteria with food are subjected to a lower pH, similar to the contents of the stomach.

Slightly lower down in the upper small intestine, the contents (food and probiotics) are subjected to bile and pancreatic juices that increase the pH making the environment more alkaline and more favorable for survival.

The small intestine is the crucial site of nutrient digestion and absorption.

After leaving the stomach, food and bacteria move through this area fairly quickly, and so there are no huge colonies of flora (bacteria) in the small intestine. However, it is in the small intestine where we want a healthy recolonizing of healthful bacteria, including lactobacillus and bifidobacterium species.

The large intestine is where we see the greatest number of bacterial colonies. Where the small intestine meets the large intestine is the location where we absorb fat-soluble vitamins, and recycle digestive enzymes. The goal of probiotic therapy is not only to properly populate the small intestine, but to repopulate the junction of the small and large intestine with healthful bacteria.

Taking a probiotic with an evening meal can also make the side effects (gas, bloating) more tolerable because you are asleep. As the bacteria make their way through the digestive tract assisting in the digestion of your food, often times hydrogen and methane gases are produced, creating bloating and stomach pain. When you are asleep, you hopefully won’t feel those symptoms.

When making a decision to take probiotics, I suggest evaluating and understanding your gut health to determine what type of probiotic to take.

Comprehensive stool testing is the diagnostic test of choice. Based on what is found in the gut, specific probiotics are recommended to restore normal function and combat disease.

For example, Saccharomyces Boulardii is the bug of choice to help eliminate candida, parasites, and other unwanted pathogenic micro-organisms found in the gastrointestinal tract (GI) tract.

Lactobacillus acidophilus NCFM® and Bifidobacterium lactis Bi-07 are powerful anti-inflammatories. General strains of Lactobacillus and Bifidobacterium are good to repopulate the GI tract if there is small intestinal bacterial overgrowth (SIBO).

While gut health is more complicated than just the population of bacteria that reside there, understanding when to take probiotics will help you quickly rebuild from your chronic gut problems.

References

Tompkins TA, Mainville I, Arcand Y. The impact of meals on a probiotic during transit through a model of the human upper gastrointestinal tract. Beneficial Microbes. 2011 Dec 1;2(4):295-303.