Probiotics (probiotik) are live microorganisms, usually bacteria such as Lactobacillus and Bifidobacterium, that give a health benefit when taken in adequate amounts. They are found in some fermented foods and in supplements. The strongest evidence is for reducing diarrhoea caused by antibiotics, and some strains may help constipation. For many other popular claims the evidence is weak, and an effect seen with one strain does not mean another strain will work the same way. Prebiotics are different: they are fibres that feed the good bacteria already in your gut. This guide explains what probiotics can and cannot do, the difference between probiotics and prebiotics, which foods contain live cultures, how to choose and take a probiotic, and who should be careful.
What are probiotics?
The internationally accepted definition, first set by the FAO and WHO and reaffirmed by the International Scientific Association for Probiotics and Prebiotics (ISAPP) in 2014, describes probiotics as "live microorganisms which when administered in adequate amounts confer a health benefit on the host". Three parts of that definition matter when you shop:
- Live: the microbes need to be alive when you take them.
- Adequate amounts: the dose, measured in colony-forming units (CFU), needs to match what was tested in studies.
- Health benefit: the benefit should be shown in research, ideally for the specific strain in the product.
Probiotics are named by genus, species and strain, for example Lactobacillus rhamnosus GG. The strain matters because, as the American Gastroenterological Association (AGA) notes in its 2020 guideline, different strains of the same species can have very different effects.
Probiotics vs prebiotics
ISAPP's 2017 consensus defines a prebiotic as "a substrate that is selectively utilized by host microorganisms conferring a health benefit". Products that combine probiotics and prebiotics are called synbiotics. Eating plenty of fibre from vegetables, fruit, beans and wholegrains is the simplest way to feed your gut bacteria.
What can probiotics actually do?
The table below summarises what major reviews and guidelines say. Results depend on the specific strain and dose.
For constipation, fibre, fluids and activity are still the first steps; see our guide to sembelit (constipation). If you take probiotics for general wellbeing, keep in mind that the NHS notes there is little evidence for many health claims made about them. For indigestion, bloating and heartburn, see our gastrik guide.
Makanan probiotik: which foods contain probiotics?
Fermented foods are made with the help of microbes, but not all of them still contain live microbes when you eat them. ISAPP's 2021 consensus on fermented foods groups them like this:
- Usually contain live microbes: yoghurt, kefir, sour cream, most cheeses, miso, natto, tempeh, non-heated fermented vegetables, most kombuchas.
- No live microbes: bread, soy sauce, vinegar, wine and heat-treated or pasteurised fermented foods. Cooking, baking or pasteurising after fermentation kills the microbes, so fried tempeh will not provide live cultures.
A fermented food is not automatically a probiotic, because the microbes in it are usually not identified or tested for a health benefit. Even so, fermented foods may be good for your gut: in a 17-week randomised Stanford study published in 2021, healthy adults assigned to a diet high in fermented foods had steadily increased gut microbiome diversity and lower markers of inflammation. The study was small (18 people per group), so more research is needed. Traditional Malaysian fermented foods such as tapai, tempoyak, budu and cincalok have been studied far less, and their live microbe content varies.
How to choose a probiotic
- Start with your goal. Choose a product whose specific strains have been studied for what you want, such as use with antibiotics, rather than a general "good bacteria" claim.
- Look for named strains. A good label lists the genus, species and strain code, not just "Lactobacillus".
- Check the CFU count and date. Look for the number of live microbes guaranteed until the expiry date, not only at manufacture.
- Follow storage instructions. Some probiotics need refrigeration; others are shelf-stable.
- Check registration and halal status. The NHS points out that because probiotics are usually regulated as food, products are not tested as rigorously as medicines and may not contain what the label says. Choosing a product registered in Malaysia with a recognised halal certificate helps; our guide to checking KKM registration and halal status shows how.
- Check allergens. Many probiotics contain milk or soy.
How to take probiotics
Common questions about cara makan probiotik and pantang larang (what to avoid):
- Timing: there is no single best time for all products. Follow the label, and take it at a time you will remember every day, because consistency matters more than the exact hour.
- Avoid very hot drinks: do not mix powders or sachets into very hot water, coffee or tea, because heat can kill live bacteria.
- With antibiotics: many studies gave probiotics during the antibiotic course. Ask your pharmacist how to time your product with your antibiotic.
- Expect mild changes at first: in the Cochrane review of children, the most common side effects were rash, nausea, wind, bloating and constipation, and side effects were not more common than in the control groups.
- Keep eating fibre: prebiotic fibre from food feeds the good bacteria. Drann's Chocolate Meal Replacement Shake, for example, contains 2 g of prebiotic fibre per sachet, but most of your fibre should come from whole foods.
Probiotics for women's health
Lactobacillus bacteria are a normal part of a healthy vaginal environment, which is why many women's probiotics use Lactobacillus strains. The research on probiotics for vaginal and urinary health is still developing, and results vary by strain. Probiotics do not treat an active infection. If you have unusual discharge, itching or burning, see a doctor; our guides to keputihan (vaginal discharge) and UTI symptoms explain when to get checked.
Some products combine probiotics with cranberry for urinary health. Drann's Cran-Max Probiotics contains 5 Lactobacillus strains (6 billion CFU) with cranberry extract and D-mannose to support urinary and feminine health. Our guide to cranberry probiotics explains what the evidence shows.
Who should be careful?
For most healthy people, the NHS says probiotics appear to be safe. Talk to a doctor before taking them if you:
- have a weakened immune system, for example from chemotherapy or medicines that suppress immunity;
- are seriously ill or in hospital, or have a central venous line. The Cochrane review notes that serious infections linked to probiotics have been reported in severely ill or immunocompromised patients;
- have an existing health condition;
- are pregnant or breastfeeding, or want to give probiotics to a baby or young child.
Frequently asked questions (FAQ)
What are probiotics for (probiotik untuk apa)?
Probiotics are live microorganisms that, when taken in adequate amounts, give a health benefit. The best evidence is for reducing diarrhoea caused by antibiotics. Some strains may help constipation, but for many other claims the evidence is limited, and the benefit depends on the specific strain and dose.
What is the difference between probiotics and prebiotics?
Probiotics are live beneficial microbes. Prebiotics are substances, usually types of fibre, that are selectively used by the microbes already in your gut and give a health benefit. In simple terms, probiotics are the bacteria and prebiotics are their food. Products that combine both are called synbiotics.
Do probiotics help with antibiotics?
Yes, this is their best-supported use. A 2021 meta-analysis of 42 trials found that taking probiotics with antibiotics reduced the risk of antibiotic-associated diarrhoea in adults by 37%, and a Cochrane review found that it fell from 19% to 8% in children. Ask your doctor or pharmacist which product and timing suit you.
Do probiotics help constipation?
Some may. A 2022 meta-analysis found that 57% of adults with chronic constipation responded to probiotics compared with 44% on control treatments, and probiotics increased stool frequency, with Bifidobacterium lactis showing a clear effect. Fibre, fluids and exercise remain the first steps.
Which foods contain probiotics (makanan probiotik)?
Fermented foods that still contain live microbes include yoghurt, kefir, most cheeses, miso, natto, tempeh and non-heated fermented vegetables. Cooking, baking or pasteurising kills the microbes, so fried tempeh, bread, soy sauce and vinegar do not provide live cultures. Fermented foods are not automatically probiotics, because the specific microbes have usually not been tested for a health benefit.
What should I avoid when taking probiotics (pantang larang makan probiotik)?
Follow the product label. Do not mix probiotics into very hot drinks, because heat can kill live bacteria, and store them as directed. If you are on antibiotics, ask a pharmacist about timing. People with a weakened immune system, serious illness or a central line should talk to a doctor before taking probiotics.
Are probiotics safe?
For most healthy people, probiotics appear to be safe. Mild wind, bloating or a change in bowel habits can happen at first. Serious infections have been reported rarely in very ill or immunocompromised people, so they should check with a doctor first.
Disclaimer
This article is for general information only and is not a substitute for advice, diagnosis or treatment from a doctor or pharmacist. Health supplements are not intended to diagnose, treat, cure or prevent any disease.
References
- Probiotics — NHS
- Hill C, et al. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat Rev Gastroenterol Hepatol. 2014;11(8):506-514.
- Gibson GR, et al. The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of prebiotics. Nat Rev Gastroenterol Hepatol. 2017;14(8):491-502.
- Marco ML, et al. The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on fermented foods. Nat Rev Gastroenterol Hepatol. 2021;18(3):196-208.
- Su GL, et al. AGA clinical practice guidelines on the role of probiotics in the management of gastrointestinal disorders. Gastroenterology. 2020;159(2):697-705.
- Goodman C, et al. Probiotics for the prevention of antibiotic-associated diarrhoea: a systematic review and meta-analysis. BMJ Open. 2021;11(8):e043054.
- Guo Q, et al. Probiotics for the prevention of pediatric antibiotic-associated diarrhea. Cochrane Database Syst Rev. 2019;4(4):CD004827.
- van der Schoot A, et al. Probiotics and synbiotics in chronic constipation in adults: a systematic review and meta-analysis of randomized controlled trials. Clin Nutr. 2022;41(12):2759-2777.
- Wastyk HC, et al. Gut-microbiota-targeted diets modulate human immune status. Cell. 2021;184(16):4137-4153.
