Metformin is a commonly prescribed medication for managing type 2 diabetes. While it is designed to contribute to lowering blood sugar levels by improving the way your body handles insulin, it may sometimes lead to gastrointestinal issues, such as diarrhea or bloating in some people.
This is where probiotics may potentially help. Certain probiotic strains are associated with gut health support and may contribute to managing bloating and other potential gastrointestinal side effects, making them a viable option to support digestive health.
In this article, we will review the top probiotic supplements that may help you support gut health and potentially contribute to the management of gastrointestinal side effects of medication use.
Best probiotics to take with metformin: a shortlist
- Best for overall gut health: Ritual
- Best for reducing bloating: Unbloat
- Best for postbiotics inclusion: Bioma Health
- Best probiotic with advanced formulation: Seed
- Best for high CFU count: Physician's Choice
- Best budget-friendly probiotic option: Culturelle
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Comparing the best probiotics to take alongside metformin
| Brand | CFU*/AFU** count | Number of strains | Additional key ingredients | Daily dose (per capsules) | Servings | Price per serving | Third-party tested |
| Ritual | 11 billion CFUs | 2 | PreforPro® prebiotic, tributyrin | 1 | 30 | $1.80 | Yes |
| Unbloat | 25 billion CFUs | 7 | 21 digestive enzymes, 1 prebiotic fiber, 6 herbal remedies, and 4 additional ingredients | 2 | 30 | $2.19 | No information |
| Bioma Health | 9 billion CFUs | 3 | Xylooligosaccharides (XOS), tributyrin | 2 | 30 | $2.66 | No information |
| Seed | 56.3 billion AFUs | 24 | Polyphenol-based prebiotic from Indian pomegranate | 2 | 30 | $1.66 | Yes |
| Physician’s Choice | 60 billion CFUs | 10 | 3 prebiotic fibers | 1 | 30 | $0.97 | Yes |
| Culturelle | 10 billion CFUs | 1 | Inulin (chicory root extract) | 1 | 30 | $0.58 | No information |
*CFU — Colony Forming Unit; **AFU — Active Fluorescent Unit. Probiotic supplements often list CFU or AFU counts. CFU measures live bacteria using a traditional method of culturing on agar plates to count visible colonies. In contrast, AFU uses flow cytometry and lasers to count viable microbes more precisely. Research shows that AFU may be a more accurate and precise measurement method than CFU as it measures all the viable cells some of which might be missed in a culture.
Why we think Ritual Synbiotic+ is the best probiotic to take with metformin
Ritual Synbiotic+ is a top option for metformin users. It offers a well-rounded blend of prebiotics, probiotics, and postbiotics in a delayed-release capsule designed to deliver probiotics directly to the gut.
This formula features scientifically backed strains, including Bifidobacterium animalis (BB-12) and Lacticaseibacillus rhamnosus (LGG), which may help alleviate metformin-related digestive discomforts, such as bloating and bowel irregularity, by promoting microbiota balance and overall gut health.
The delayed-release technology ensures probiotics survive stomach acid to reach the colon.
Ritual’s commitment to ingredient transparency and sustainability, reflected in its Certified B Corporation status, bolsters consumer confidence in the product’s quality. While Ritual Synbiotic+ is priced higher than some alternatives, it offers a premium choice for individuals seeking digestive and immune support alongside metformin use.
Best probiotics to take with metformin: an overview
When paired with metformin, certain probiotics may offer additional digestive support and help manage common side effects.
Below, we’ve highlighted some top choices based on specific benefits for gut health and digestion.
1. Ritual — best for overall gut health
Amazon rating — 4.0 ⭐⭐⭐⭐
Trustpilot rating — 1.4 ⭐⭐
Ritual website rating — 4.8 ⭐⭐⭐⭐⭐
Ritual Synbiotic+ combines prebiotics, probiotics, and postbiotics in a delayed-release capsule designed to help probiotics reach the colon and support gut health. This could potentially help manage metformin-related bloating and gas.
Its key strains, Bifidobacterium animalis (BB-12) and Lacticaseibacillus rhamnosus (LGG), have shown potential in supporting digestive microbiota balance.
Who might benefit the most from Ritual?
These probiotics may be suitable for individuals experiencing mild to moderate occasional gastrointestinal issues such as bloating or excessive gas.
Key ingredients
A probiotic blend of 11 billion CFUs, PreforPro® prebiotic, and tributyrin.
What users like about the product
Customers appreciate the potential support for gut health, noting that it makes their supplement use routine more enjoyable and supports their overall well-being.
What users don’t like about the product
Some customers feel the product is overpriced and have concerns about the seal quality. Opinions vary on its effectiveness, with mixed feedback on bloating relief, taste, smell, and probiotic content.
Company review
Founded in 2016, Ritual offers a range of
supplements, including prenatal vitamins, multivitamins, and protein powders.
As a Certified B Corporation, Ritual is committed to social and environmental
responsibility and prioritizes transparency by detailing ingredient sourcing,
supply chains, and certifying partners on its website.
Ritual’s products are available in the U.S., UK, and Canada through its online store, Whole Foods, and Amazon.
At $54 for a 30-day supply, Ritual Synbiotic+ may contribute to the relief of potential metformin side effects causing digestive discomfort like excessive bloating and gas, while also supporting gut and immune health through scientifically studied probiotic strains.
With a delayed-release capsule design, which should ensure the probiotics survive stomach acid to reach the gut, and high standards in transparency and sourcing, Ritual Synbiotic+ is a reliable choice for those seeking digestive support alongside metformin medication use.
2. Unbloat — best for reducing bloating
Amazon rating — 3.7 ⭐⭐⭐⭐
Unbloat website rating — 4.7 ⭐⭐⭐⭐⭐
Unbloat features a blend of 40 ingredients, including digestive enzymes, seven beneficial bacterial strains of Lactobacillus and Bifidobacterium genus, prebiotic fibers, herbal extracts, and essential micronutrients.
The probiotics introduce beneficial bacteria, while prebiotics act as their food, though they may sometimes cause excessive bloating. Unbloat’s prebiotic dose (275 mg) is below the commonly studied 3–5 g, leaving its full impact unclear.
Who might benefit the most from Unbloat?
Unbloat may be an option for individuals dealing with occasional bloating or digestive discomfort, including those on metformin who may experience gastrointestinal adverse effects. Designed to target common issues like excessive bloating, gas, and irregular bowel movements, Unbloat may contribute to supporting digestive health.
Key ingredients
25 billion CFU probiotic blend, 21 digestive enzymes, prebiotic fiber, six herbal remedies, folate, and magnesium.
What users like about the product
Customers appreciate the supplement supporting digestion. Many report that it helps reduce excessive gas and bloating without causing additional discomfort.
What users don’t like about the product
Some customers have mixed opinions regarding Unbloat's potential digestive benefits and feel it may not always provide the value for money expected.
Company review
Unbloat is a relatively new direct-to-consumer
brand that has quickly gained popularity for its targeted approach to digestive
health, specifically aimed at reducing excessive bloating in women.
Overall, taking the supplement ($65.95 for a 30-day supply of 60 capsules) may help support gut bacterial balance, potentially contributing to the reduction of excessive gas and bloating associated with metformin use. With 25 billion CFUs per serving, this probiotic may support a balanced gut microbiome.
3. Bioma Health — best for postbiotic inclusion
Trustpilot rating — 3.5 ⭐⭐⭐⭐
Bioma Health website rating — 4.0 ⭐⭐⭐⭐
Bioma Health combines Bifidobacterium strains, which may contribute to easing common digestive issues like bloating, gas, and irregular bowel movements by supporting gut balance.
According to the brand, with additional support from tributyrin, a postbiotic that is associated with intestinal lining support in animal studies, and prebiotics to nourish gut bacteria, Bioma aims to balance the gut microbiome and contribute to the reduction of gastrointestinal discomfort.
However, while individual ingredients are well-researched, the effectiveness of Bioma’s formula may vary, and further data is needed to confirm its specific potential benefits.
Who might benefit the most from Bioma Health?
Bioma Health may be an option for individuals looking to support gut health and overall well-being. It may benefit those dealing with occasional digestive issues like bloating, gas, and irregular bowel movements.
Key ingredients
Probiotic blend, XOS prebiotic, and tributyrin.
What users like about the product
Customers appreciate the quality of the probiotics, noting positive effects on personal digestive health.
What users don’t like about the product
Some customers report limited effectiveness for gut health support and feel it lacks value for money. A few have experienced increased bloating, fewer bowel movements, and mild nausea after initial use. Opinions also vary regarding the ease of swallowing the capsules.
Company review
Bioma Health focuses only on probiotic formulations, utilizing research-backed bacterial strains for optimal gut health support.
Bioma Health Probiotics typically cost around $79.99 for a one-month supply, though occasional discounts may lower the price to $44.99, aligning it with other premium probiotic brands.
This supplement may be a choice for individuals experiencing digestive discomfort associated with metformin use, thanks to its formula aimed at supporting overall gut health. However, greater transparency regarding manufacturing practices and third-party testing for label accuracy would increase trust and enhance its appeal for consumers seeking reliable support for their gut health.
4. Seed — best probiotic with advanced formulation
Amazon rating — 4.0 ⭐⭐⭐⭐
Trustpilot rating — 2.1 ⭐⭐
Seed website rating — 4.6 ⭐⭐⭐⭐⭐
Seed DS-01® Daily Synbiotic may be a choice for those on metformin due to its potential support in easing common digestive issues such as excessive bloating, gas, and irregular bowel movements. With 24 bacterial strains, including Bifidobacterium and Lactobacillus genus, it aims to support balanced gut bacteria, potentially offsetting metformin's impact on the gut microbiome.
The product’s prebiotics, derived from Indian pomegranate may further support gut health, while Seed’s ViaCap® technology ensures that the probiotics survive stomach acid to reach the colon more effectively.
This tailored approach may offer metformin users digestive and broader health support.
Who might benefit the most from Seed?
The supplement is intended for adults who are looking to support overall gut health and contribute to reducing certain digestive symptoms, including occasional diarrhea or constipation instances.
It may also be an option for those on metformin, as it may contribute to addressing common gastrointestinal side effects associated with the medication.
Key ingredients
Probiotic blend of 56.3 billion AFUs, polyphenol-based prebiotic from Indian pomegranate.
What users like about the product
Customers appreciate it for its quality and noticeable gut health support. Many find it contributes to digestion and value the high-quality probiotics, along with the capsule's easy-to-swallow design.
What users don’t like about the product
Some customers feel the product doesn’t justify the price and have experienced digestive discomfort after use. Opinions vary regarding its potential effectiveness in easing digestion issues.
Company review
Founded in 2018 by Ara Katz and Raja Dhir, Seed
is a subscription-based company specializing in probiotics. Seed offers two
products for gut health: the
DS-01® Daily Synbiotic for adults and the PDS-08®
Pediatric Daily
Synbiotic for kids and teens aged 3–17. The DS-01 includes four targeted
probiotic blends, each formulated to support specific areas of health.
Seed's DS-01® Daily Synbiotic, priced at $49.99 per month (with discounts for longer subscriptions), combines a unique blend of prebiotics and probiotics that may potentially contribute to easing metformin-related digestive discomforts, such as excessive bloating and irregular bowel movements.
Although the DS-01 is pricier than some probiotic alternatives, the formulation and delivery system may make it a valuable option for those looking to support the management of digestive issues while on metformin.
5. Physician's Choice — best probiotic with high CFU count
Amazon rating — 4.5 ⭐⭐⭐⭐⭐
Trustpilot rating — 2.7 ⭐⭐⭐
Physician‘s Choice website rating — 4.8 ⭐⭐⭐⭐⭐
Physician's Choice 60 Billion Probiotic combines 10 strains, including Lactobacillus acidophilus and Bifidobacterium longum, with 60 billion CFUs and an organic prebiotic blend.
This formula aims to support gut health and immune function, potentially contributing to easing metformin-related digestive issues like excessive bloating and gas by supporting a balanced gut microbiome.
While the probiotic is designed to survive stomach acid for efficacy, individual responses may vary, and some may experience mild digestive adjustments as the body adapts.
Who might benefit the most from Physician's Choice 60 Billion Probiotic?
Physician's Choice 60 Billion Probiotic may be an option for individuals experiencing mild to moderate occasional digestive discomforts, as well as those taking metformin who may suffer from excessive bloating, gas, or irregular bowel movements.
Key ingredients
A probiotic blend of 60 billion CFUs, three prebiotic fibers.
What users like about the product
Customers appreciate the supplement's support for digestion and gut health, often reporting reduced excessive bloating. The inclusion of prebiotics is also seen as a positive feature, and users find the capsules easy to swallow.
What users don’t like about the product
Some customers have mixed opinions about probiotics' potential effectiveness, with varying experiences regarding how they feel after taking the product.
Company review
Physician's Choice was established to address the need for high-quality, reliable supplements. According to the brand, ingredients are sourced from trusted suppliers, with manufacturing in the U.S. in NSF- and GMP-certified facilities. All products are third-party tested for purity and potency.
Overall, Physician's Choice 60 Billion Probiotic may be an option for daily gut support, priced at $29.38. While it aims to support digestive discomfort reduction and contribute to the immune system's health, individual responses may vary.
6. Culturelle — the best budget-friendly probiotic option
Amazon rating — 4.6 ⭐⭐⭐⭐⭐
Culturelle website rating — 4.5 ⭐⭐⭐⭐⭐
Culturelle Digestive Daily Probiotic may be a choice for individuals taking metformin, as Lactobacillus rhamnosus GG (the primary strain in Culturelle) is associated with gut health support, potentially easing common gastrointestinal issues such as excessive bloating, gas, and irregular bowel movements.
This bacterial strain may survive stomach acidity, reaching the intestines intact, helping strengthen the gut barrier, and further contributing to gut health.
Additionally, Culturelle includes inulin, a prebiotic fiber that may help support overall digestion, though it may cause mild bloating in some individuals.
Who might benefit the most from Culturelle?
This probiotic may be an option for individuals on metformin who are seeking gentle, ongoing support for digestive balance.
Key ingredients
A probiotic blend of 10 billion CFUs, and inulin.
What users like about the product
Customers like the digestion support, and value of the supplement. They mention that the supplement helps them keep the gut in check.
Some also appreciate the quality, saying it's a reliable product and comes in proper condition every month. Customers also appreciate the ease of use.
What users don’t like about the product
Initial digestive adjustments, such as increased bloating, may appear for some users after starting the supplement.
Company review
Culturelle specializes in probiotics and supplements for digestive health, offering diverse formats like capsules, chewables, gummies, and powders. Their range provides convenient options to support gut health and overall wellness.
Overall, Culturelle's Digestive Daily Probiotic is an affordable option for daily gut health, priced at $17.47. While this probiotic is designed to support digestive wellness, its effects may vary for each individual.
How we chose the best probiotics to take with metformin
| CFU (colony-forming unit) type and strain diversity | Additional ingredients | User reviews | Price range |
| Variety of bacteria strains | Extra components like vitamins and minerals | Feedback from real-life experiences | Price per serving ($0.58–2.66) |
- CFU type. We checked the number and variety of beneficial bacteria strains that target digestive health.
- Additional ingredients. Selecting product with extra components, like vitamins and minerals may potentially provide additional support to overall well-being.
- User reviews. We outline feedback from consumers to assess satisfaction and effectiveness. Reviews help gauge user satisfaction of the product.
- Price. Knowing details of the relative cost of the probiotics price per serving, from lowest to highest, reflects the value provided by the probiotic.
What is metformin?
Metformin is a widely prescribed medication primarily used to manage type 2 diabetes.
It works by decreasing the amount of glucose produced by the liver, increasing the body's sensitivity to insulin, and improving glucose uptake in muscle cells.
Common doses range from 500 mg to 2,000 mg daily, depending on the individual prescription, typically taken in divided doses.
While metformin is effective in helping to control blood sugar levels, it may cause side effects such as gastrointestinal discomfort, including diarrhea and nausea.
How to decide on the right probiotic to take with metformin
When selecting a probiotic to take with metformin, consider the following factors:
- Formulation. Probiotics come in capsules, powders, and even gummies. Choose a form that fits your preferences and needs.
- Price. Compare product pricing and check for any subscriptions or bundle offers for better value.
- Quality and transparency. Consider brands that provide third-party testing for label accuracy and transparency about their sourcing and manufacturing processes.
- User reviews. Reading user reviews can provide insight into the effectiveness and tolerability of the product.
- Consulting a healthcare provider. While no direct interactions between metformin and probiotics are known, always consult your healthcare provider before starting any new supplement to ensure it is appropriate for your health condition.
Remember, dietary supplements are not intended to prevent, treat, manage, or cure any health conditions and should complement, not replace, prescribed medication.
The potential benefits of probiotics for metformin users
For individuals taking metformin, adding probiotics may provide several potential health benefits, especially in managing common digestive side effects and supporting gut health:
Contribution to gastrointestinal issues reduction
Metformin may potentially lead to side effects such as bloating and diarrhea. Probiotics, especially strains like Lactobacillus acidophilus, may help ease some of the symptoms by supporting a balanced gut microbiome.
Preliminary animal research suggests that metformin and probiotics may work together to reduce gut inflammation, as shown in a study with 96 male Balb/c mice. The study indicated that the combined use of metformin and probiotics appeared to reduce inflammatory markers (IL-6 and TNF-α) and oxidative stress.
However, since these findings are from animal models, further research is needed to confirm whether the same benefits would apply to humans, and to explore their potential therapeutic uses.
Supporting nutrient absorption
Probiotics support a healthy gut microbiome, which may contribute to proper micronutrient absorption — especially important for individuals on metformin, as the drug may interfere with the absorption of B vitamins.
A clinical study with 40 adolescents evaluated the impact of probiotics on nutrient absorption over a 10-week period. Divided into probiotic and placebo groups, participants were assessed at baseline, 5 weeks, and 10 weeks, measuring levels of vitamins, calcium, and other minerals. Results showed that probiotic supplementation may potentially increase these micronutrient levels in the blood in the intervention group compared to the placebo group, suggesting that probiotics may help support nutrient absorption.
While promising, further research is needed to confirm these effects and establish the best probiotic protocols for supporting nutrient absorption in metformin users.
Supporting overall gut health
Regular use of probiotics may support gut health by fostering beneficial bacteria.
In a study of 156 people with newly diagnosed type 2 diabetes or prediabetes, participants were given either metformin alone or metformin with Bifidobacterium animalis subsp. lactis (BB-12) probiotic for three months. Those taking the probiotic alongside metformin (MET-PRO group) showed better metformin adherence (91.7% vs. 71.4%), greater reductions in HbA1c (0.9% vs. 0.4%), and fewer gastrointestinal symptoms such as abdominal pain, diarrhea, and bloating compared to those on metformin alone.
Additionally, gastrointestinal symptoms and non-compliance were delayed in the MET-PRO group, suggesting probiotics may support both metformin tolerance and its long-term effects.
Safety and side effects of probiotics with metformin
Probiotics are generally safe to take with metformin. However, some individuals may experience mild side effects, such as gas or bloating, when first starting probiotics. It’s always best to consult a healthcare provider before adding any new supplement to your regimen.
Understanding doses for probiotics when taking metformin
Further research, particularly randomized controlled trials, is essential to establish conclusive evidence regarding the effects of specific probiotic strains and doses for those taking metformin.
Preliminary studies suggest that probiotics may benefit people by supporting the management of blood glucose levels and insulin resistance alongside medication use, but findings remain inconsistent.
For optimal results, it’s crucial to follow the dose instructions on the product label or as advised by the manufacturer. If you’re uncertain about the appropriate probiotic dose, consult a healthcare provider for guidance.
Best probiotic to take with metformin: final thoughts
Selecting the right probiotic to use alongside metformin may contribute to easing common digestive side effects and supporting overall gut health.
Overall, we chose Ritual Synbiotic+ as our number one choice because it offers a well-rounded, scientifically-backed formula specifically designed to support digestive health for metformin users. Its delayed-release technology ensures effective delivery of probiotics, while the inclusion of trusted strains like BB-12 and LGG addresses common metformin-related digestive issues.
Additionally, Ritual's commitment to ingredient transparency and sustainability provides confidence in its quality. Despite its higher price, its premium formulation and added benefits make it a top choice for those seeking comprehensive digestive and immune support.
Check out other probiotic options
Check out the best prebiotics to nourish healthy gut bacteria and support digestion.
Explore how these probiotics for weight loss can help maintain healthy body weight.
Find out which probiotics to take with antibiotics for a good balance of good and bad bacteria.
FAQ
Can probiotics reduce metformin side effects?
Probiotics may contribute to the reduction of the gastrointestinal (GI) side effects associated with taking metformin, such as diarrhea and bloating. Research indicates that people taking metformin alongside probiotics may experience fewer GI adverse events compared to those on metformin alone. This suggests that probiotics may support gut health and potentially support the reduction of digestive issues often linked to metformin use.
Which probiotic strains are best to take with metformin?
For those taking metformin, a multi-strain probiotic formula may support gut health. Key strains like Lactobacillus acidophilus, Bifidobacterium longum, and Lactobacillus rhamnosus can help balance gut bacteria, support gut function, and reduce bloating. Since research on probiotics and metformin is limited, it’s important to consult a healthcare provider before starting any new supplement, especially for individuals managing type 2 diabetes.
Are probiotics safe to take with metformin?
Probiotics are generally considered safe to take with metformin. However, it is always advisable to consult a healthcare provider before starting any new supplement to ensure it’s suitable for your specific health condition.
How should I time my probiotic intake with metformin?
There is no strict rule for timing probiotics with metformin, but it is generally recommended to take probiotics between meals. Taking them at different times than metformin may also reduce any potential interaction.
15 resources
- Frontiers in Nutrition. Bifidobacterium animalis subsp. lactis HN019 effects on gut health: a review.
- Foods. Prebiotics: definition, types, sources, mechanisms, and clinical applications.
- Journal of Diabetes Investigation. Effects of probiotic Bifidobacterium bifidum G9‐1 on the gastrointestinal symptoms of patients with type 2 diabetes mellitus treated with metformin: An open‐label, single‐arm, exploratory research trial.
- Gastroenterology Research and Practice. Prebiotic effects of xylooligosaccharides on the improvement of microbiota balance in human subjects.
- PLoS One. Tributyrin alleviates gut microbiota dysbiosis to repair intestinal damage in antibiotic-treated mice.
- International Journal of Molecular Sciences. Delivery of metabolically neuroactive probiotics to the human gut.
- Microorganisms. The science behind the probiotic strain Bifidobacterium animalis subsp. lactis BB-12®.
- Food Frontiers. Possible actions of inulin as prebiotic polysaccharide: a review.
- Cancers. Metformin and probiotics in the crosstalk between colitis-associated colorectal cancer and diabetes in mice.
- The Turkish Journal of Gastroenterology. Metformin with versus without concomitant probiotic therapy in newly diagnosed patients with type 2 diabetes or prediabetes: a comparative analysis in relation to glycemic control, gastrointestinal side effects, and treatment compliance.
- Journal of AOAC International. An alternative microbiological validation for an online water bioburden analyzer.
- Diabetes Research and Clinical Practice. Effects of combined treatment of probiotics and metformin in management of type 2 diabetes: a systematic review and meta-analysis.
- World Journal of Diabetes. Association between metformin and vitamin B12 deficiency in patients with type 2 diabetes.
- European Review for Medical and Pharmacological Sciences. Effect of probiotics on the occurrence of nutrition absorption capacities in healthy children: a randomized double-blinded placebo-controlled pilot study.
- Cureus. Probiotics and their role in the management of type 2 diabetes mellitus (short-term versus long-term effect): a systematic review and meta-analysis.
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