There exists some apparent ambiguity among health professionals on whether to take probiotic supplements with or without food. The product labels of various probiotic manufacturors may contradict each other by advising to take their probiotic product before meals, during meals or after meals or even without meals. These contradictions lead to confusion within the health industry and for the consumer.
Advocates in favor of taking probiotic supplements on an empty stomach state that there are no digestive enzymes and bile acids that can damage the probiotics. The water taken with the probiotics supposedly dilute the acid in the stomach and quickly transport the probiotic into the small intestine.
Opposing advocates argue that the stomach acid in a fasting state (empty stomach) has a lower stomach acid pH than when the stomach is filled with food, and that a lower stomach acid pH rapidly kills probiotics. The lower the stomach acid pH, the more detrimental to the probiotic, as stomach acid kills the live microorganisms.
When the stomach is empty (in a fasted state), the gastric (stomach acid) pH is in the range of 0.8 to 3.0. The lower number of this range can be as high as 1.3.
After eating food, gastric pH can raise to as high as 4.0-5.8, and can be as high as 7.0. 1 Within 1 hour after eating, the pH of the stomach decreases to less than 3.1. The quantity, food pH value and composition of the food eaten plays a major role in the time required to re-store the fasting pH levels.
Researchers in 1990 set out to measure the pH in the upper gastrointestinal tracts of young, healthy men and women in the fasting state and after administration of a standard solid and liquid meal.
In the fasted state, the median gastric pH was 1.7. When the meal was administered the gastric pH climbed briefly to a median peak value of 6.7, then declined gradually back to the fasted state value over a period of less than 2 hours. 2
When probiotic supplements are taken with a meal, the food buffers stomach acid thereby providing increased protection for the probiotics. Some foods, like high fiber foods, (vegetable and certain fruits) can also nourish the probiotics in the gastrointestinal tract by supplying fermentable substrates.
The advocates of taking probiotic supplements with food also would remind you that before the invention and production of probiotic supplements, individuals obtained their probiotics in foods, usually fermented foods, like yogurt, kefir and sauerkraut. The probiotics in these foods were consumed with and as part of the food.
The question may have been answered in 2011, when a team of researchers examined the impact of the time of administration with respect to mealtime and the impact of the buffering capacity of the food on the survival of probiotic microbes during gastrointestinal transit.
In their experiment they used a probiotic that contained four strains:
- Lactobacillus helveticus R0052
- Lactobacillus rhamnosus R0011
- Bifidobacterium longum R0175
- Saccharomyces cerevisiae boulardii (non-pathogenic yeast)
Enumeration during and after transit of the stomach and duodenal models showed that survival of all the bacteria in the product was best when given with a meal or 30 minutes before a meal (cooked oatmeal with milk). Probiotics given 30 minutes after the meal did not survive in high numbers.
What they found important for the survival of the probiotics was the fat content of the meal and not so much the protein content. They used milk with 1% milk fat and oatmeal-milk gruel. This fat content meal had a better result than water or apple juice.
They concluded that ideally, non-enteric coated bacterial probiotic supplements should be taken with or just prior to a meal containing some fats. 3
It is also important to note that probiotic supplements should not be taken with hot foods or beverages since the excessive heat can kill the probiotics.