GI Health
|
September 10, 2024

Do Probiotics Survive Stomach Acid?

Medically Reviewed by
Updated On
September 27, 2024

If you're looking to support your health, you've likely come across the topic of probiotics – and you're not alone: With the growing recognition of the role probiotics play in supporting systemic health, supplemental probiotics have quickly become one of the top-selling dietary supplements on the market. But how do you know if probiotics are working? This article will discuss how to supplement probiotics effectively to maximize their health benefits and survival through the digestive tract.

[signup]

What Are Probiotics?

Probiotics are live microorganisms, including bacteria and yeasts, that confer a health benefit to the host when consumed in adequate amounts. They are classified by their genus, species, and strain. For example: Lactobacillus (genus) rhamnosus (species) GG (strain).Β 

The primary sources of probiotics are diet and supplements. Dietary supplements contain seven main genera of microbes:Β 

  • Lactobacillus
  • Bifidobacterium
  • Saccharomyces
  • Streptococcus
  • Enterococcus
  • Escherichia
  • Bacillus

Probiotics alter the composition of the microbiome, the community of microorganisms residing in or on the human body. The gut microbiome is the collection of microorganisms that colonize the gastrointestinal (GI) tract and has been found to influence human health by their roles in:Β 

  • Regulating digestion and metabolism
  • Producing nutrients, neurotransmitters, enzymes, and short-chain fatty acids
  • Inhibiting the growth of pathogenic organisms
  • Modulating immune function
  • Communicating with the nervous system

Probiotics combat dysbiosis (an imbalance in the microbiome) and are beneficial in treating and preventing a range of human diseases, including:Β 

The Challenge of Stomach Acid

Stomach acid, also called gastric acid, is a highly acidic digestive secretion produced by the stomach's lining. Hydrochloric acid, produced by parietal cells, is the main constituent responsible for gastric acid's acidic quality. (17)

Acidity is measured on a pH scale ranging from 0 to 14. The lower the pH level, the more acidic a substance is. Stomach acid has a pH of 1.5-2.5. Acid aids digestion because it helps break down food so important nutrients can be absorbed into circulation. It also acts as a natural antimicrobial substance and one of the body's first-line defenses against infectious pathogens entering the body through the mouth. (17)

Mechanisms of Probiotic Survival

Stomach acid's broad antimicrobial nature poses a barrier to probiotic efficacy. It does not differentiate between "good" and "bad" bugs. Probiotics' survivability is a critical factor in their efficacy. Therefore, one of the main concerns of oral probiotics is whether they are effective if they must travel through the stomach.Β 

The stomach harbors its own distinct microbiota composed of acid-resistant bacterial strains. Studies using culturing methods have identified Lactobacillus and Bifidobacterium as two of the most predominant bacterial genera in the stomach. These bacteria demonstrate remarkable resilience to the harsh conditions of the upper digestive tract, including exposure to stomach acid and bile acids, which are significant threats to probiotic viability. Their ability to thrive in such an acidic environment underscores their potential as effective probiotics capable of surviving the journey through the stomach to confer their health benefits in the intestines. (12)Β 

Spore-forming probiotics, particularly those of the Bacillus genus, have been used for medical purposes in humans since the 1960s. Spores are dormant, or inactive, bacterial lifeforms. Bacterial spores are highly resistant to environmental stressors, such as heat and acid, increasing their likelihood to survive the acid environment of the stomach. Once they travel into the more hospitable environment of the lower digestive tract, bacterial spores can germinate into vegetative cells and become metabolically active. (20)Β 

Strategies have been developed to enhance the survival rate of non-spore-forming probiotics as they pass through the stomach. These include microencapsulation techniques, which involve coating the probiotic cells with a protective layer of polysaccharides, proteins, or fats. Probiotic encapsulation improves the supplement's shelf life and shields it from stomach acid during GI transit.Β 

Probiotics Most Likely to Survive Stomach Acid

Lactobacilli are lactic acid bacteria; they produce lactic acid as a main byproduct of their metabolic activity. This explains their natural resiliency to high-acidity environments, including the stomach and vagina. Lactobacillus rhamnosus GG has been demonstrated to survive passage through the GI tract and acidic environments (pH 2.5) for up to four hours. Lactobacillus casei Shirota is another probiotic proven to survive transit through the GI tract.Β 

As mentioned above, Bifidobacterium are also commonly used in supplemental probiotic blends due to their natural acid-resistant properties. Research demonstrates that, in particular, Bifidobacterium longum and Bifidobacterium animalis subsp. lactis BB-12 exhibit high acid tolerance. (29, 34)Β 

Bacillus coagulans is the most studied spore-forming probiotic. Other spore-formers commonly incorporated into oral probiotic supplements include Bacillus subtilis and Bacillus clausii. The fact that these probiotics colonize the GI tract and are effective in treating a range of GI-related symptoms and conditions supports the notion that they can survive stomach acid.

Best Ways to Take Probiotics

Many questions inevitably come up when deciding what probiotics to buy and how to take them.Β 

Timing and Dosage

Some manufacturers suggest taking probiotics on an empty stomach, while others recommend consuming them with food. When in doubt, follow the label instructions or the advice of your doctor.Β 

Recommendations for the timing of probiotic supplements may vary based on the type of probiotic supplement you're taking. For example, research indicates that Saccharomyces boulardii shows consistent viability whether taken with or without food. On the other hand, Lactobacillus and Bifidobacterium tend to survive better when taken with food or up to 30 minutes before a meal. (32)

Pairing probiotics with certain foods may enhance bacterial survival rates. Fats, for example, can buffer the stomach's acidic environment to a pH closer to 3 or 4, which appears optimal for the survival of Lactobacilli and Bifidobacteria.Β 

Sugars and carbohydrates also appear to enhance the survival of Lactobacilli in acidic environments.

Dosage will also affect probiotic efficacy. Probiotics are dosed per colony forming units (CFUs), which measure the number of viable cells per dose. Most probiotic supplements contain anywhere from 1 to 50 billion CFUs per dose. (27)Β 

The amount of probiotics you should take will depend on why you are taking them: some conditions respond to lower doses and others higher. Dosing should be guided based on what the clinical research says about your specific health concern. This website is a helpful resource that consolidates scientific evidence into clinically relevant probiotic dosing information. In general, common doses range from 5-10 billion CFUs daily for children and 10-20 billion CFUs daily for adults.

Formulation and Delivery Methods

Probiotic supplements are most commonly sold in capsule, powder, tablet, or liquid form. Patients who dislike or cannot swallow pills may benefit from mixing a powder in their food or beverage. (18)Β 

To ensure the safety of probiotic supplements, it is important to select high-quality, clinically tested products. Quality control measures, such as third-party testing, ensure that the product contains the stated amount of live bacteria and is free from contaminants.

Probiotics can also be obtained through food, just like our ancestors did before the development of dietary supplements. Fermented foods like yogurt, kefir, sauerkraut, and kimchi naturally contain probiotics.Β 

Enhancing Probiotic Survival and Efficacy

In addition to the considerations discussed above, the following tips will help enhance probiotic survival and efficacy:

  • Select probiotic strains tailored to specific health conditions. Probiotics are strain- and disease-specific, meaning the choice of probiotic strain plays an important role in determining its effectiveness for targeted health treatments.
  • Use synbiotics, which are probiotics combined with prebiotics. Synbiotics enhance the usefulness of probiotics by stimulating their growth and activity and improving their survival in the gut.Β 
  • Support gut health with a healthy diet, regular exercise, managing stress, avoiding excessive alcohol consumption, and sleeping well.Β 

[signup]

Key Takeaways

  • The survival of probiotics through stomach acid is a critical factor influencing their efficacy. Research highlights that specific probiotics, such as certain Lactobacillus, Bifidobacterium, and spore-forming Bacillus species, demonstrate superior acid resistance and higher survival rates. Optimal timing, dosage, and probiotic delivery methods will further enhance probiotic viability.Β 
  • In addition to dietary and supplemental probiotics, gut health can be supported by eating a balanced diet, a healthy lifestyle, and prebiotic supplements.
  • It is highly recommended that people make informed choices about probiotic supplementation, guided by evidence-based research and the advice of a healthcare professional, to ensure probiotic safety and maximize health benefits tailored to individual needs.
The information in this article is designed for educational purposes only and is not intended to be a substitute for informed medical advice or care. This information should not be used to diagnose or treat any health problems or illnesses without consulting a doctor. Consult with a health care practitioner before relying on any information in this article or on this website.

Learn more

No items found.

Lab Tests in This Article

No lab tests!
  1. Acosta-RodrΓ­guez-Bueno, C. P., Abreu y Abreu, A. T., Guarner, F., et al. (2022). Bacillus clausii for Gastrointestinal Disorders: A Narrative Literature Review. Advances in Therapy, 39(11), 4854–4874. https://doi.org/10.1007/s12325-022-02285-0
  2. Bertagna, B. (2024, March 7). Fermented Foods For Gut Health: What The Science Says. Rupa Health. https://www.rupahealth.com/post/fermented-foods-for-gut-health-what-the-science-says
  3. Blaabjerg, S., Artzi, D., & Aabenhus, R. (2017). Probiotics for the Prevention of Antibiotic-Associated Diarrhea in Outpatientsβ€”A Systematic Review and Meta-Analysis. Antibiotics, 6(4), 21. https://doi.org/10.3390/antibiotics6040021
  4. Brody, T. (2018). Stomach pH. ScienceDirect. https://www.sciencedirect.com/topics/biochemistry-genetics-and-molecular-biology/stomach-ph
  5. Chieng, W. K., Abdul Jalal, M. I., Bedi, J. S., et al. (2022). Probiotics, a promising therapy to reduce the recurrence of bacterial vaginosis in women? a systematic review and meta-analysis of randomized controlled trials. Frontiers in Nutrition, 9, 938838. https://doi.org/10.3389/fnut.2022.938838
  6. Clinical Guide to Probiotic Products Available in USA. (2024). AEProbio. https://usprobioticguide.com/PBCIntroduction.html?utm_source=intro_pg&utm_medium=civ&utm_campaign=USA_CHART
  7. Cloyd, J. (2023, April 28). What is the difference between medical-grade supplements and over-the-counter supplements? Rupa Health. https://www.rupahealth.com/post/what-is-the-difference-between-medical-grade-supplements-and-over-the-counter-supplements
  8. Cloyd, J. (2024, January 25). What is the Gut Microbiome? Rupa Health. https://www.rupahealth.com/post/what-is-the-gut-microbiome
  9. Corcoran, B. M., Stanton, C., Fitzgerald, G. F., et al. (2005). Survival of Probiotic Lactobacilli in Acidic Environments Is Enhanced in the Presence of Metabolizable Sugars. Applied and Environmental Microbiology, 71(6), 3060–3067. https://doi.org/10.1128/aem.71.6.3060-3067.2005
  10. DeCesaris, L. (2022, June 6). What Is Gut Dysbiosis? 7 Signs To Watch For. Rupa Health. https://www.rupahealth.com/post/how-your-gut-bacteria-affects-your-overall-health
  11. Derrien, M., & van Hylckama Vlieg, J. E. T. (2015). Fate, activity, and impact of ingested bacteria within the human gut microbiota. Trends in Microbiology, 23(6), 354–366. https://doi.org/10.1016/j.tim.2015.03.002
  12. Fijan, S. (2014). Microorganisms with Claimed Probiotic Properties: An Overview of Recent Literature. International Journal of Environmental Research and Public Health, 11(5), 4745–4767. https://doi.org/10.3390/ijerph110504745
  13. Garvey, S. M., Mah, E., Blonquist, T. M., et al. (2022). The probiotic Bacillus subtilis BS50 decreases gastrointestinal symptoms in healthy adults: a randomized, double-blind, placebo-controlled trial. Gut Microbes, 14(1). https://doi.org/10.1080/19490976.2022.2122668
  14. Greenan, S. (2021, December 8). 5 Probiotic-Rich Foods To Eat Instead Of Taking Supplements. Rupa Health. https://www.rupahealth.com/post/the-different-types-of-probiotics-health-benefits
  15. He, Y., Zhu, L., Chen, J., et al. (2022). Efficacy of Probiotic Compounds in Relieving Constipation and Their Colonization in Gut Microbiota. Molecules, 27(3), 666. https://doi.org/10.3390/molecules27030666
  16. Holzapfel, W. H., Haberer, P., Geisen, R., et al. (2001). Taxonomy and important features of probiotic microorganisms in food and nutrition. The American Journal of Clinical Nutrition, 73(2), 365s373s. https://doi.org/10.1093/ajcn/73.2.365s
  17. Hsu, M., Safadi, A. O., & Lui, F. (2018). Physiology, Stomach. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK535425/
  18. Kligler, B., & Cohrssen, A. (2008). Probiotics. American Family Physician, 78(9), 1073–1078. https://www.aafp.org/pubs/afp/issues/2008/1101/p1073.html
  19. Koga, Y. (2022). Microbiota in the stomach and application of probiotics to gastroduodenal diseases. World Journal of Gastroenterology, 28(47), 6702–6715. https://doi.org/10.3748/wjg.v28.i47.6702
  20. Koopman, N., Remijas, L., Seppen, J., et al. (2022). Mechanisms and Applications of Bacterial Sporulation and Germination in the Intestine. International Journal of Molecular Sciences, 23(6), 3405. https://doi.org/10.3390/ijms23063405
  21. Maholy, N. (2023, June 29). The Role of Probiotics and Prebiotics in Gut Health: An Integrative Perspective. Rupa Health. https://www.rupahealth.com/post/the-role-of-probiotics-and-prebiotics-in-gut-health-an-integrative-perspective
  22. McFarland, L. V., Evans, C. T., & Goldstein, E. J. C. (2018). Strain-Specificity and Disease-Specificity of Probiotic Efficacy: A Systematic Review and Meta-Analysis. Frontiers in Medicine, 5(124). https://doi.org/10.3389/fmed.2018.00124
  23. Merkouris, E., Mavroudi, T., Miliotas, D., et al. (2024). Probiotics’ Effects in the Treatment of Anxiety and Depression: A Comprehensive Review of 2014–2023 Clinical Trials. Microorganisms, 12(2), 411–411. https://doi.org/10.3390/microorganisms12020411
  24. Mu, Y., & Cong, Y. (2019). Bacillus coagulans and its applications in medicine. Beneficial Microbes, 10(6), 679–688. https://doi.org/10.3920/bm2019.0016
  25. Nardone, G., & Compare, D. (2015). The human gastric microbiota: Is it time to rethink the pathogenesis of stomach diseases? United European Gastroenterology Journal, 3(3), 255–260. https://doi.org/10.1177/2050640614566846
  26. Neibling, K. (2023, March 24). Why Functional Medicine Practitioners Focus on Gut Health. Rupa Health. https://www.rupahealth.com/post/why-functional-medicine-practitioners-focus-on-gut-health
  27. Probiotics Fact Sheet for Health Professionals. (2017). Office of Dietary Supplements; National Institutes of Health. https://ods.od.nih.gov/factsheets/Probiotics-HealthProfessional/
  28. Probiotics: What You Need To Know. (2019, August). National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/probiotics-what-you-need-to-know
  29. Sanchez, B., Champomier-Verges, M. C., Collado, M. d. C., et al. (2007). Low-pH Adaptation and the Acid Tolerance Response of Bifidobacterium longum Biotype longum. Applied and Environmental Microbiology, 73(20), 6450–6459. https://doi.org/10.1128/aem.00886-07
  30. Tannock, G. W. (2004). A Special Fondness for Lactobacilli. Applied and Environmental Microbiology, 70(6), 3189–3194. https://doi.org/10.1128/aem.70.6.3189-3194.2004
  31. Terpou, A., Papadaki, A., Lappa, I. K., et al. (2019). Probiotics in Food Systems: Significance and Emerging Strategies Towards Improved Viability and Delivery of Enhanced Beneficial Value. Nutrients, 11(7), 1591. https://doi.org/10.3390/nu11071591
  32. Tompkins, T., Mainville, I., & Arcand, Y. (2011). The impact of meals on a probiotic during transit through a model of the human upper gastrointestinal tract. Beneficial Microbes, 2(4), 295–303. https://doi.org/10.3920/bm2011.0022
  33. United States Environmental Protection Agency. (2015, August 11). What is pH? US EPA. https://www.epa.gov/goldkingmine/what-ph
  34. Vernazza, C. L., Gibson, G. R., & Rastall, R. A. (2006). Carbohydrate preference, acid tolerance and bile tolerance in five strains of Bifidobacterium. Journal of Applied Microbiology, 100(4), 846–853. https://doi.org/10.1111/j.1365-2672.2006.02832.x
  35. Virk, M. S., Virk, M. A., He, Y., et al. (2024). The Anti-Inflammatory and Curative Exponent of Probiotics: A Comprehensive and Authentic Ingredient for the Sustained Functioning of Major Human Organs. Nutrients, 16(4), 546–546. https://doi.org/10.3390/nu16040546
  36. Wahab, S., Almaghaslah, D., Mahmood, S. E., et al. (2022). Pharmacological Efficacy of Probiotics in Respiratory Viral Infections: A Comprehensive Review. Journal of Personalized Medicine, 12(8), 1292. https://doi.org/10.3390/jpm12081292
  37. WiciΕ„ski, M., GΔ™balski, J., GoΕ‚Δ™biewski, J., et al. (2020). Probiotics for the Treatment of Overweight and Obesity in Humansβ€”A Review of Clinical Trials. Microorganisms, 8(8). https://doi.org/10.3390/microorganisms8081148
  38. Yang, R., Jiang, J., Ouyang, J., et al. (2024). Efficacy and safety of probiotics in irritable bowel syndrome: A systematic review and meta-analysis. Clinical Nutrition ESPEN, 60, 362–372. https://doi.org/10.1016/j.clnesp.2024.02.025
  39. Yuki, N., Watanabe, K., Mike, A., et al. (1999). Survival of a probiotic, Lactobacillus casei strain Shirota, in the gastrointestinal tract: Selective isolation from faeces and identification using monoclonal antibodies. International Journal of Food Microbiology, 48(1), 51–57. https://doi.org/10.1016/s0168-1605(99)00029-x
Order from 30+ labs in 20 seconds (DUTCH, Mosaic, Genova & More!)
We make ordering quick and painless β€” and best of all, it's free for practitioners.

Latest Articles

View more on GI Health
Subscribe to the magazine for expert-written articles straight to your inbox
Join the thousands of savvy readers who get root cause medicine articles written by doctors in their inbox every week!
Thanks for subscribing!
Oops! Something went wrong while submitting the form.
Are you a healthcare practitioner?
Thanks for subscribing!
Oops! Something went wrong while submitting the form.
Subscribe to the Magazine for free to keep reading!
Subscribe for free to keep reading, If you are already subscribed, enter your email address to log back in.
Thanks for subscribing!
Oops! Something went wrong while submitting the form.
Are you a healthcare practitioner?
Thanks for subscribing!
Oops! Something went wrong while submitting the form.
Trusted Source
Rupa Health
Medical Education Platform
Visit Source
Visit Source
American Cancer Society
Foundation for Cancer Research
Visit Source
Visit Source
National Library of Medicine
Government Authority
Visit Source
Visit Source
Journal of The American College of Radiology
Peer Reviewed Journal
Visit Source
Visit Source
National Cancer Institute
Government Authority
Visit Source
Visit Source
World Health Organization (WHO)
Government Authority
Visit Source
Visit Source
The Journal of Pediatrics
Peer Reviewed Journal
Visit Source
Visit Source
CDC
Government Authority
Visit Source
Visit Source
Office of Dietary Supplements
Government Authority
Visit Source
Visit Source
National Heart Lung and Blood Institute
Government Authority
Visit Source
Visit Source
National Institutes of Health
Government Authority
Visit Source
Visit Source
Clinical Infectious Diseases
Peer Reviewed Journal
Visit Source
Visit Source
Brain
Peer Reviewed Journal
Visit Source
Visit Source
The Journal of Rheumatology
Peer Reviewed Journal
Visit Source
Visit Source
Journal of the National Cancer Institute (JNCI)
Peer Reviewed Journal
Visit Source
Visit Source
Journal of Cardiovascular Magnetic Resonance
Peer Reviewed Journal
Visit Source
Visit Source
Hepatology
Peer Reviewed Journal
Visit Source
Visit Source
The American Journal of Clinical Nutrition
Peer Reviewed Journal
Visit Source
Visit Source
The Journal of Bone and Joint Surgery
Peer Reviewed Journal
Visit Source
Visit Source
Kidney International
Peer Reviewed Journal
Visit Source
Visit Source
The Journal of Allergy and Clinical Immunology
Peer Reviewed Journal
Visit Source
Visit Source
Annals of Surgery
Peer Reviewed Journal
Visit Source
Visit Source
Chest
Peer Reviewed Journal
Visit Source
Visit Source
The Journal of Neurology, Neurosurgery & Psychiatry
Peer Reviewed Journal
Visit Source
Visit Source
Blood
Peer Reviewed Journal
Visit Source
Visit Source
Gastroenterology
Peer Reviewed Journal
Visit Source
Visit Source
The American Journal of Respiratory and Critical Care Medicine
Peer Reviewed Journal
Visit Source
Visit Source
The American Journal of Psychiatry
Peer Reviewed Journal
Visit Source
Visit Source
Diabetes Care
Peer Reviewed Journal
Visit Source
Visit Source
The Journal of the American College of Cardiology (JACC)
Peer Reviewed Journal
Visit Source
Visit Source
The Journal of Clinical Oncology (JCO)
Peer Reviewed Journal
Visit Source
Visit Source
Journal of Clinical Investigation (JCI)
Peer Reviewed Journal
Visit Source
Visit Source
Circulation
Peer Reviewed Journal
Visit Source
Visit Source
JAMA Internal Medicine
Peer Reviewed Journal
Visit Source
Visit Source
PLOS Medicine
Peer Reviewed Journal
Visit Source
Visit Source
Annals of Internal Medicine
Peer Reviewed Journal
Visit Source
Visit Source
Nature Medicine
Peer Reviewed Journal
Visit Source
Visit Source
The BMJ (British Medical Journal)
Peer Reviewed Journal
Visit Source
Visit Source
The Lancet
Peer Reviewed Journal
Visit Source
Visit Source
Journal of the American Medical Association (JAMA)
Peer Reviewed Journal
Visit Source
Visit Source
Pubmed
Comprehensive biomedical database
Visit Source
Visit Source
Harvard
Educational/Medical Institution
Visit Source
Visit Source
Cleveland Clinic
Educational/Medical Institution
Visit Source
Visit Source
Mayo Clinic
Educational/Medical Institution
Visit Source
Visit Source
The New England Journal of Medicine (NEJM)
Peer Reviewed Journal
Visit Source
Visit Source
Johns Hopkins
Educational/Medical Institution
Visit Source
Visit Source

Hey practitioners! πŸ‘‹ Join Dr. Chris Magryta and Dr. Erik Lundquist for a comprehensive 6-week course on evaluating functional medicine labs from two perspectives: adult and pediatric. In this course, you’ll explore the convergence of lab results across different diseases and age groups, understanding how human lab values vary on a continuum influenced by age, genetics, and time. Register Here! Register Here.

Hey practitioners! πŸ‘‹ Join Dr. Terry Wahls for a 3-week bootcamp on integrating functional medicine into conventional practice, focusing on complex cases like Multiple Sclerosis. Learn to analyze labs through a functional lens, perform nutrition-focused physical exams, and develop personalized care strategies. Register Here.