Meta Information
ID:probiotics
Name:
Schema Version:AIM-2.0
Interactions
Target id:
/class/antibiotics-long-term
Target name:
Antibiotics
Severity:
major
Interaction type:
diminishing
Nature:
temporal
Temporal spacing:
Hours before target:
2
Hours after target:
2
Description:
Antibiotics are designed to kill bacteria and will destroy the live organisms in bacterial probiotic supplements, rendering them ineffective.
Actionable advice:
Take probiotics at least 2 hours apart from any antibiotic dose.
Target id:
/condition/immunocompromised
Target name:
Immunocompromised State
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
In individuals with severely weakened immune systems (e.g., from chemotherapy, immunosuppressant drugs, or certain diseases), live probiotic organisms could potentially cause a serious systemic infection (bacteremia or fungemia).
Actionable advice:
Avoid taking live probiotics if you are severely immunocompromised, unless specifically directed by your physician.
Target id:
/dietary/hot-foods-beverages
Target name:
Hot Foods or Beverages
Severity:
major
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
null
Description:
High temperatures (typically above 110°F or 43°C) will kill the live bacteria and yeasts in probiotic supplements, making them useless.
Actionable advice:
Never mix probiotics with hot foods or drinks like coffee, tea, or soup; take with cool or room-temperature liquids or food.
Target id:
/class/antibiotics-long-term
Target name:
Antifungal Medications
Severity:
major
Interaction type:
diminishing
Nature:
temporal
Temporal spacing:
Hours before target:
2
Hours after target:
2
Description:
Antifungal medications (e.g., fluconazole, nystatin) will kill yeast-based probiotics like Saccharomyces boulardii, making them ineffective. This interaction does not apply to bacterial probiotics.
Actionable advice:
If taking a yeast-based probiotic (S. boulardii), separate it from antifungal medication by at least 2 hours.
Target id:
/dietary/meal
Target name:
Any Caloric Meal
Severity:
moderate
Interaction type:
synergistic
Nature:
temporal
Temporal spacing:
Hours before target:
0.5
Hours after target:
0
Description:
Food, particularly sources of fat and protein, helps buffer stomach acid, which significantly increases the survival rate of probiotic organisms as they pass through the harsh gastric environment to the intestines.
Actionable advice:
Take probiotics with a meal or a small snack for best results, or choose an enteric-coated or delayed-release capsule if taking on an empty stomach.
Target id:
/class/antibiotics-long-term
Target name:
Herbal Antimicrobials (e.g., Oregano Oil, Berberine)
Severity:
moderate
Interaction type:
diminishing
Nature:
temporal
Temporal spacing:
Hours before target:
2
Hours after target:
2
Description:
Certain herbal supplements have potent antimicrobial properties that can kill the live organisms in probiotic supplements, reducing their efficacy in a similar way to pharmaceutical antibiotics.
Actionable advice:
Separate doses of antimicrobial herbs and probiotics by at least 2 hours.
Target id:
/class/viscous-fibers
Target name:
Prebiotic Fibers (e.g., Inulin, FOS, GOS)
Severity:
moderate
Interaction type:
synergistic
Nature:
temporal
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Prebiotic fibers are non-digestible carbohydrates that serve as a food source for beneficial gut bacteria, enhancing the growth, colonization, and activity of probiotics.
Actionable advice:
Consider taking probiotics with a source of prebiotic fiber to enhance their effectiveness.
Target id:
/condition/critical-illness
Target name:
Critical Illness
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
In critically ill patients, especially those in an ICU with central venous catheters or compromised gut integrity (e.g., acute pancreatitis), probiotics have been associated with an increased risk of sepsis.
Actionable advice:
Probiotics are generally contraindicated in critically ill patients in an ICU setting.
Target id:
/condition/short-bowel-syndrome
Target name:
Short Bowel Syndrome
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Patients with short bowel syndrome may be at risk for D-lactic acidosis from bacterial overproduction of D-lactate, a condition that can be exacerbated by certain probiotic strains, particularly Lactobacillus.
Actionable advice:
Use probiotics with extreme caution and only under strict medical supervision if you have short bowel syndrome.
Target id:
/dietary/fermented-foods
Target name:
Fermented Foods (Kefir, Yogurt, Kimchi)
Severity:
minor
Interaction type:
synergistic
Nature:
absolute
Temporal spacing:
null
Description:
Consuming fermented foods provides a diverse range of beneficial microbes and beneficial metabolic byproducts that can complement and support the specific strains found in probiotic supplements.
Actionable advice:
Incorporate a variety of fermented foods into your diet for broader microbiome support.
Target id:
/class/acid-suppressors
Target name:
Gastric Acid Suppressors (PPIs, H2 Blockers)
Severity:
minor
Interaction type:
synergistic
Nature:
absolute
Temporal spacing:
null
Description:
By reducing stomach acid, these medications may create a more hospitable environment for probiotics to survive transit to the intestines. However, long-term use can also negatively alter the native microbiome.
Actionable advice:
If you take acid-suppressing medication, it may slightly enhance probiotic survival, but this is not a reason to start taking them.
Target id:
/condition/valvular-heart-disease
Target name:
Valvular Heart Disease
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
There are rare case reports of endocarditis (heart valve infection) linked to probiotic bacteremia, particularly in individuals with pre-existing structural heart valve problems.
Actionable advice:
Discuss the very low but potential risks with your cardiologist before starting probiotics if you have a history of heart valve disease.
Target id:
/intervention/digestive-enzymes
Target name:
Digestive Enzymes (Proteases)
Severity:
minor
Interaction type:
diminishing
Nature:
temporal
Temporal spacing:
Hours before target:
0.5
Hours after target:
0.5
Description:
Proteolytic enzymes, if taken at the same time as a non-enteric coated probiotic, could theoretically degrade the bacterial organisms. This effect is likely minimal and not clinically significant for most.
Actionable advice:
If concerned, separate doses of protease-containing enzymes and non-enteric coated probiotics by about 30 minutes.