Timing of probiotic consumption 'unimportant’ for colonization: Study

By Stephen Daniells

- Last updated on GMT

 © iStock/frentusha
© iStock/frentusha

Related tags Gut microbiota Gut flora Bacteria

Should probiotics be consumed on an empty stomach or with a meal? A new study from the University of Milan suggests it doesn’t matter.

The importance of the timing of consumption of probiotics is a common question – consuming the beneficial microorganisms on an empty stomach would theoretically mean a shorter stay in the stomach but the pH is very low. Consuming with a meal would mean it stays in the stomach for longer, albeit under gradually increasing (neutralizing) pH.

A new study, published in the World Journal of Gastroenterology​, indicated  that timing did not appear to affect the ability of a combination of Bifidobacterium longum​ BB536 and Lactobacillus rhamnosus​ HN001 to beneficially change the composition of the gut microbiota in healthy participants.

The study’s findings were welcomed by the Scientific Committee of the International Probiotics Association, which told NutraIngredients-USA: “The study by Toscano and co-workers is interesting as it, for the first time, addresses the question; does it matter when probiotics are consumed: ie. 30 minutes before breakfast or 30 minutes after breakfast. Volunteers followed on or the other dietary regime for one month. Although substantial variation was observed between subjects, the timing of the probiotic consumption did not appear to influence the number of volunteers with detectable ​L. rhamnosus HN0001 or ​B. longum BB536.

“Interestingly, many subjects who had detectable levels of the probiotic strains were still excreting detectable levels one month after they stopped consuming them, indicating transient colonization,” ​added the IPA’s scientific experts.

“Furthermore, the study investigated the influence of the two strains on the composition of the fecal microbiota. Although some changes in the composition were observed, the volunteers were healthy and these changes should thus not be over-interpreted.”

Study details

The Milan-based scientists recruited 20 healthy volunteers (12 women and 8 men, to participate in their study. The participants were randomly assigned to consumer either 4 billion colony forming units (CFUs) of B. longum​ BB536 plus one billion CFUs of L. rhamnosus​ HN001 30 minutes before or after breakfast for one month.

Results showed that, for the 16 people who successfully completed the study, that both groups displayed an increase in B. longum​ BB536 and L. rhamnosus​ HN001 load after one month, and again one month after the end of the intervention period.

The probiotic supplement was found to significantly impact the composition of the gut microbiota, with a 50% reduction in the abundance of Firmicutes​ bacteria after one month, with these levels 20% reduced one month later, compared to baseline values.

“This result may be of importance since a high abundance of Firmicutes has previously been related to obesity, and with a reduction of Bacteroidetes, as obese individuals often show an unbalanced ratio of Firmicutes and Bacteroidetes in their intestinal microbiota,” ​explained the researchers.  “[It has been] hypothesized that the Firmicutes phylum contains numerous bacterial species with an increased ability to harvest energy from diet, leading to a large increase in total body fat.”

In addition, the probiotic was associated with a 58% reduction in Proteobacteria after one month. This is also considered beneficial because microorganisms belonging to this phylum include Campylobacter​, enterohepatic Helicobacter​ and Escherichia coli, ​and these are often linked to the development of inflammatory bowel disease (IBD), said the researchers.

“Consequently, these changes can be considered positive marks due to B. longum BB536 and L. rhamnosus HN001, which seem to be acting as beneficial biomodulators of gut microbiota,” ​they added.

Species level effects

When the scientists narrowed their analysis to the species level, they found that probiotic bacteria consumption was associated with a higher abundance of Blautia producta, Blautia wexlerae​ and Haemophilus ducrey ​(which are considered beneficial), while the abundance of Holdemania filiformis​, Escherichia vulneris, Gemmiger formicilis​ and Streptococcus sinensis​ decreased (these organisms are considered detrimental as they may exert pro-inflammatory actions in the gut).

The abundance of a species of bacteria called Akkermansia muciniphila​ was also increased when compared baseline line values.

“A. muciniphila is closely related with human health and it is inversely associated with body fat mass and glucose intolerance,” ​explained Toscano et al. “Moreover, this bacterium seems to be involved in the maintenance of intestinal barrier functions and above all in prevention of intestinal inflammation, playing a pivotal role in the host’s overall health status.”

The researchers added: “We did not observe a negative impact of probiotic on the general health status of the hosts.Contrariwise, the two bacterial strains seemed able to exert a beneficial effect on the bacterial ecology of the gastrointestinal tract, as many significant positive changes in gut microbiota composition have been highlighted.”


The IPA’s scientific committee pointed out that the number of volunteers was limited, with two groups of eight volunteers complicating interpretation of the results.

“The researchers also used qPCR primers, which do not seem to be strain but rather species specific,”​ added the experts.

“We need further clinical and pre-clinical studies to demonstrate a clear application of this probiotics combination in the clinical field,” ​wrote Toscano et al.

Source: World Journal of Gastroenterology
2017, Volume 23, Number 15, Pages 2696–2704, doi:  10.3748/wjg.v23.i15.2696
“Effect of ​Lactobacillus rhamnosus HN001 and ​Bifidobacterium longum BB536 on the healthy gut microbiota composition at phyla and species level: A preliminary study”
Authors: M. Toscano et al. 

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