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Head-to-head evidence comparison — which supplement is right for you?
Lactase vs VSL#3 / Visbiome: VSL#3 / Visbiome has the stronger overall evidence (6.5 vs 5.5/10); they're alternatives for improve digestion — the best pick depends on your goals. Take the 60-second quiz for a pick tailored to your goals.
VSL#3 / Visbiome wins 2 of 3 categories. Both are solid choices — the best pick depends on your specific goals.
Verdict
Too few graded studies
Top outcomes
Verdict
Too few graded studies
Top outcomes
Taken per lactose-containing meal, not as a daily dose. Trials gave 3,000 to 11,250 units of lactase (mostly FCC units) immediately before or with a single dairy or lactose challenge. One 2022 trial used 4,662 FCC units and describes 4,500 FCC units as the amount in the EU-approved health claim. More lactose needs more enzyme: 50 g of lactose given in water overwhelmed about 6,000 units in one trial. Products differ, so dose by the enzyme units on the label rather than by tablet count.
With meals
Lactase tablets, capsules or chewables labelled in FCC units, taken with dairy
Prevention and maintenance are DIFFERENT doses and are often conflated. Preventing the first onset of acute pouchitis used 900 billion CFU/day (1 sachet). Maintaining remission in established chronic or refractory pouchitis — where the effect size is largest — used 6 g/day, which at 5 x 10^11 viable bacteria per gram is about 3 trillion CFU/day, in both maintenance trials. As a ulcerative colitis add-on, 3.6 trillion CFU daily; the active-UC induction trial went highest at 3.6 trillion CFU TWICE daily (7.2 trillion/day), and the paediatric trial lowest at 450 billion/day weight-based
Any time of day
Refrigerated sachet of the De Simone Formulation
Hours (same meal)
Hours (same meal)
Hours (same meal)
Hours (same meal)
9-12 months
12 months
8-12 weeks
n/a
Systematic review: effective management strategies for lactose intolerance.
Annals of Internal Medicine (2010) · Systematic review
36 randomised trials met the inclusion criteria, 26 of them on lactase- or lactose-hydrolysed milk supplements, lactose-reduced milk, or tolerable doses of lactose.
Effect of lactase supplementation on infant colic: Systematic review of randomized controlled trials.
Journal of Pediatric Gastroenterology and Nutrition (2024) · Meta analysis · n=391
Five randomised trials with 391 infants under 6 months old with colic were included.
The effect of oral supplementation with Lactobacillus reuteri or tilactase in lactose intolerant patients: randomized trial.
European Review for Medical and Pharmacological Sciences (2010) · Rct · n=60
60 lactose-intolerant patients were randomised to tilactase taken 15 minutes before a lactose breath test, placebo, or Lactobacillus reuteri twice daily for 10 days beforehand (20 per group).
Treatment and prevention of pouchitis after ileal pouch-anal anastomosis for chronic ulcerative colitis.
Cochrane Database Syst Rev (2019) · Meta analysis
Chronic pouchitis maintenance: 85% (34/40) maintained remission at 9-12 months vs 3% (1/36) placebo — RR 20.24 (95% CI 4.28-95.81), low certainty
Oral bacteriotherapy as maintenance treatment in patients with chronic pouchitis: a double-blind, placebo-controlled trial.
Gastroenterology (2000) · Rct · n=40
Relapse in 3/20 (15%) on the probiotic vs 20/20 (100%) on placebo, P<0.001
Once daily high dose probiotic therapy (VSL#3) for maintaining remission in recurrent or refractory pouchitis.
Gut (2004) · Rct · n=36
Remission maintained at 1 year in 17/20 (85%) vs 1/16 (6%) placebo, p<0.0001
VSL#3 / Visbiome has a higher evidence score (6.5/10 vs 5.5/10) and wins in 2 of 3 categories.
For improve digestion, VSL#3 / Visbiome has a higher relevance score (52 vs 45).
No known interactions between Lactase and VSL#3 / Visbiome have been documented in our database. However, always consult a healthcare provider before combining supplements.
The right pick depends on your goals. Answer a few quick questions for a personalised recommendation — or dig into the full evidence on each.