The Probiotic I Use When Traveling and Taking Antibiotics

I don’t know about you, but I worry about my ass a lot.    

That’s why I love the supplement I’m going to talk about today: it protects my sensitive butthole from the ravages of both modern medicine and third world water supplies.  

Wait, you know what– let’s back this story up a bit.  

You see, I’ve been sick for the past three weeks.  

Yep, you heard that right.  Three weeks

First it was bronchitis.  I thought that was just a cold at first, but after it kept getting worse I had to take a course of antibiotics.

Right before I was prescribed the antibiotics, I also developed conjunctivitis, aka pink eye.  The doctor said that would go away on it’s own.  It didn’t, so a week later my bronchitis was better, the pink eye was worse, and it was more antibiotics.  Then a few days later, even more antibiotics because the pink eye wasn’t improving fast enough.  

Now, taking oral antibiotics for two weeks straight normally causes severe diarrhea.  In my case, that was only an issue for about the first two days, then it stopped being a problem.  

Why?  Because I was taking a probiotics– but not just any probiotic.  Not the ones you usually find in stores.

This probiotic is called Saccharomyces boulardii, or S. Boulardi for short.  I also use it to prevent traveller’s diarrhea on some trips, most notably in 2016 when I was living as a digital nomad.  

Now, probiotics have been the subject of a lot of unsubstantiated and really inflated claims over the years, so let’s make this clear: S. Boulardi works, and there’s ample research evidence to support that.  We’re talking dozens of studies here.

Here’s a quote from a 2010 meta-analysis of 31 studies on S. Boulardi: Of 31 randomized, placebo-controlled treatment arms in 27 trials (encompassing 5029 study patients), S. boulardii was found to be significantly efficacious and safe in 84% of those treatment arms. 

A meta-analysis found a significant therapeutic efficacy for S. boulardii in the prevention of antibiotic-associated diarrhea (AAD) (RR = 0.47, 95% CI: 0.35-0.63, P < 0.001). In adults, S. boulardii can be strongly recommended for the prevention of AAD and the traveler’s diarrhea. Randomized trials also support the use of this yeast probiotic for prevention of enteral nutrition-related diarrhea and reduction of Heliobacter pylori treatment-related symptoms. 

S. boulardii shows promise for the prevention of C. difficile disease recurrences; treatment of irritable bowel syndrome, acute adult diarrhea, Crohn’s disease, giardiasis, human immunodeficiency virus-related diarrhea; but more supporting evidence is recommended for these indications. The use of S. boulardii as a therapeutic probiotic is evidence-based for both efficacy and safety for several types of diarrhea.

In other words, it works, and perhaps even better than the more commonly-sold lactobacillus probiotics.  In the next few paragraphs I’ll explain why it’s so awesome and where to buy it.  

Why S. Boulardi is The Best Probiotic to Take When You’re Taking Antibiotics

Simple: it’s a yeast, not a bacteria.  Probiotics, for those who don’t know, are living bacteria (usually) that replace or augment the ones already in your intestines.  Not to be confused with prebiotics, which are fibers that feed the bacteria in your gut. 

Taking probiotics when you’re on oral antibiotics is usually tantamount to lighting your money on fire, since the probiotics will get killed off just as surely as the bacteria already in your gut.  

As one of the few gut flora that’s a yeast instead of a bacteria, S. Boulardi is immune to this, and in fact can replace (at least temporarily) the lost bacterial gut flora, doing the work they’re unable to do, since they’re mostly dead.  

Why S. Boulardi Can Prevent Traveler’s Diarrhea, and Is The Only Worthwhile Probiotic for Travelers

This part’s also simple: it’s heat-stable, i.e. it doesn’t need to be refrigerated.  Most probiotics won’t live very long at room temperature when they’re stuck in a capsule without food.

To be clear: obviously, it’s not cold inside your gut.  It’s not that gut flora need to be cold to live; it’s more that they need be cold to go into a sort of hibernation when they’re nothing for them to eat.  

S. Boulardi can hibernate– or at least survive somehow, I don’t actually know the specifics– without food, and at room temperature, for months.  That makes it the only probiotic I know of that’s actually any good if you take it with you when you travel.

For that matter, it also means it’s the only probiotic you can order off the internet, or buy off a non-refrigerated store shelf, and have any confidence that it’s still effective.

How To Use S. Boulardi and Where to Buy It

It’s sometimes sold in stores, though not as commonly as other probiotics.  I’ve seen it at Whole Foods a few times.  

As a side note, Whole Foods also refrigerates its probiotics, which is why it’s the only store I’ve bought any other probiotic from in the last decade.  

However, I usually buy it off Amazon these days, since that’s cheaper, shipping is free and only takes a day, and there’s no Whole Foods near where I live now.  

I like this supplement by Jarrow Formulas, since it’s very clear about what’s in it, including how many viable cells per capsule it contains (5 billion), and Jarrow has great quality control.  I’ll usually take two capsules with each meal, so about six a day, and ideally I’d start a few days before I begin traveling if possible.  Obviously that’s usually not possible with antibiotics, even though it would be ideal.

If I’m traveling longer-term, I’ll get this 180-cap bottle, which is otherwise identical to the first.  For a really long trip I’ll cut back to 2-3 pills a day after the first few days, and if it’s over three months I’ll drop to one pill a day after a month or two to stretch the bottle out for longer.  

Regardless of how you’re using it, it’s important to remember that this is just one probiotic, and your gut actually needs a variety of them.  I prefer to get the others from food rather than more supplements, so while I’m traveling I’ll eat fermented foods like Greek yogurt, kombucha, sauerkraut, kimchi, and miso whenever I can.  

If I’m on antibiotics, I’ll instead consume massive amounts of a variety of fermented foods, along with a lot of fiber-rich vegetables, for about a week after I’m done with the antibiotics, to replenish my gut flora.  Not much point doing that while I’m still on the meds, though of course it doesn’t hurt.

I think you can see why I love S. Boulardi so much.  It’s my favorite probiotic, and quite possibly the only one I’ll ever take in supplement form from here on out.