Probiotics
Not all probiotics are equal. Lactobacillus, Bifidobacterium, and spore-based strains have different mechanisms and evidence. India guide to strain selection, dosing, and what conditions each addresses.
What Probiotics Do
Probiotics are live microorganisms that, when administered in adequate amounts, confer a health benefit. They work through multiple mechanisms:
- Competitive exclusion: Colonise the gut and physically crowd out pathogenic bacteria
- Short-chain fatty acid production: Ferment dietary fibre into butyrate, propionate, and acetate — which feed colonocytes, reduce inflammation, and regulate gut barrier integrity
- Immune modulation: Interact with Peyer's patches and gut-associated lymphoid tissue (GALT), training immune response
- Gut barrier function: Certain strains upregulate tight junction proteins, reducing intestinal permeability ("leaky gut")
- Gut-brain axis: The gut produces ~90% of serotonin and has direct neural (vagal) and hormonal communication with the brain. Specific probiotic strains modulate neurotransmitter production.
- GLP-1 secretion: Some strains increase GLP-1 release from L-cells in the gut, contributing to satiety and glucose regulation
Key Genera — Lactobacillus vs Bifidobacterium
Lactobacillus species primarily inhabit the small intestine and upper gut. They produce lactic acid (creating an acidic environment that inhibits pathogens), are the dominant organisms in yogurt and fermented milk, and are generally more relevant for:
- Lactose digestion assistance
- Vaginal microbiome health (L. crispatus, L. rhamnosus)
- Traveller's diarrhoea prevention
- Immune support
Bifidobacterium species primarily colonise the large intestine (colon). They are the dominant genus in the infant gut and decline significantly with age. Bifidobacterium is particularly important for:
- Post-antibiotic recovery
- Older adult gut health (Bifidobacterium declines 1000× from infancy to old age)
- Colon fermentation and butyrate production
- Allergy and immune regulation
Saccharomyces Boulardii — The Yeast Probiotic
Saccharomyces boulardii is a non-pathogenic tropical yeast, not a bacterium. Its key advantage: it is completely resistant to antibiotics (being a yeast, not bacteria) and specifically prevents and treats antibiotic-associated diarrhoea (AAD) — the most robust application in the probiotic evidence base. It also shows evidence for C. difficile infection prevention and traveller's diarrhoea.
Spore-Based Probiotics — India Advantage
Standard Lactobacillus and Bifidobacterium strains are sensitive to heat, humidity, and stomach acid. In India's climate, products not kept refrigerated can lose the majority of live organisms before consumption. Even refrigerated products lose potency through distribution chains.
Spore-based probiotics (Bacillus coagulans, Bacillus subtilis, Bacillus clausii) form dormant endospores that survive:
- Temperatures up to 80°C
- Stomach acid (pH 1–3)
- No refrigeration required
- 2-year+ shelf stability
For general gut health supplementation in India's warm climate, spore-based probiotics offer a practical advantage. Bacillus clausii (sold as Enterogermina in India) is one of the most prescribed probiotics by Indian physicians, particularly for antibiotic recovery.
India's high antibiotic prescription rate, spicy diet, seasonal gut infections, and hot climate all make robust probiotic strains particularly relevant. For general India use: choose spore-based (shelf-stable) strains for convenience or refrigerated multi-strain products from reputable brands. Confirm CFU count at expiry — not just at manufacture.
Condition-to-Strain Guide
| Condition | Recommended Strain(s) | Evidence Level |
|---|---|---|
| Antibiotic-associated diarrhoea | Saccharomyces boulardii; L. rhamnosus GG | Strong |
| IBS (general) | L. acidophilus NCFM; B. infantis 35624 | Moderate-Strong |
| IBS-D (diarrhoea) | B. infantis 35624; S. boulardii | Moderate |
| IBD (Crohn's/Colitis) | VSL#3 (multi-strain high dose) | Moderate |
| H. pylori (adjunct) | L. reuteri; multi-strain | Moderate |
| Allergies / eczema | B. longum BB536; L. rhamnosus GG | Moderate |
| Post-antibiotic recovery | Multi-strain 50B+ CFU; B. clausii | Strong |
| LDL / cholesterol | L. reuteri NCIMB 30242 | Moderate |
| General gut / longevity | Spore-based (B. coagulans, B. subtilis) | Moderate |
Prebiotics vs Probiotics — The Distinction
Probiotics are live organisms. Prebiotics are non-digestible food components (primarily fibres) that selectively feed beneficial gut bacteria — particularly inulin, FOS (fructooligosaccharides), and GOS (galactooligosaccharides).
For optimal gut health, both are important. Prebiotics feed the probiotic bacteria and help them establish. Synbiotics (combined probiotic + prebiotic products) are increasingly available and offer theoretical advantages. Foods rich in prebiotics: onions, garlic, leeks, raw banana, asparagus, and oats — all accessible in India.
Dosing, Storage & Quality
General health maintenance: 10–20 billion CFU/day
Post-antibiotic, therapeutic use: 50 billion CFU/day for 30 days
Storage: Most Lactobacillus/Bifidobacterium products require refrigeration. Spore-based (Bacillus) products are shelf-stable. Always check the label — "store in a cool, dry place" vs "refrigerate."
CFU labelling: Ensure the CFU count is guaranteed "at expiry" not just at manufacture — some products lose 90% of organisms by expiry if stored at room temperature.
Frequently Asked Questions
Which probiotic strain is best for IBS in India?
L. acidophilus NCFM has strong evidence for IBS bloating and pain. B. infantis 35624 is particularly good for diarrhoea-predominant IBS. Multi-strain products covering both Lactobacillus and Bifidobacterium are often most effective in practice. Trial for 4–8 weeks and assess — probiotic response is individual.
Should I take probiotics after antibiotics?
Yes, strongly. Take high-dose probiotics (50B+ CFU), starting during the antibiotic course (space 2 hours from antibiotic dose). Include Saccharomyces boulardii specifically — as a yeast, it is resistant to antibiotics and directly reduces antibiotic-associated diarrhoea. Continue for 30 days after finishing antibiotics to restore microbiome diversity.
What is the difference between Lactobacillus and Bifidobacterium?
Lactobacillus colonises the small intestine, produces lactic acid, and is most common in yogurt. Important for lactose digestion, vaginal health, and immune support. Bifidobacterium inhabits the large intestine, is critical in infancy and older age, and produces short-chain fatty acids for colon health. Both are important — multi-strain products covering both genera are most comprehensive.
Are spore-based probiotics better in India?
For practical use in India's climate, yes — spore-based probiotics (Bacillus coagulans, Bacillus subtilis) survive heat, humidity, and stomach acid without refrigeration. Standard Lactobacillus strains can lose most viability in Indian distribution chains without cold storage. For general gut health in India, spore-based products are highly practical and reliable.