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Head-to-head evidence comparison — which supplement is right for you?
L. acidophilus vs VSL#3 / Visbiome: VSL#3 / Visbiome has the stronger overall evidence (6.5 vs 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
1-100 billion CFU (10^9 to 10^11) per serving — the range FDA reviewed without objection for L. acidophilus DDS-1 in foods generally (GRAS Notice GRN 871); La-14 was noticed at 1 billion CFU per 250 g serving (GRN 502) (the one cited trial that states a dose used 10 billion CFU a day)
Any time of day
A product naming its strain (e.g. NCFM, DDS-1, La-14, La-5)
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
Weeks
Weeks
Course of antibiotics
9-12 months
12 months
8-12 weeks
n/a
Lactobacillus acidophilus DDS-1 and Bifidobacterium lactis UABla-12 Improve Abdominal Pain Severity and Symptomology in Irritable Bowel Syndrome: Randomized Controlled Trial.
Nutrients (2020) · Rct · n=330
Randomised, double-blind, placebo-controlled multicentre trial in 330 adults with IBS (Rome IV), allocated 1:1:1 to placebo, L. acidophilus DDS-1 alone or B. lactis UABla-12 alone, each at 1 × 10^10 CFU/day for six weeks
The effects of the DDS-1 strain of lactobacillus on symptomatic relief for lactose intolerance - a randomized, double-blind, placebo-controlled, crossover clinical trial.
Nutr J (2016) · Crossover
Randomised, double-blind, placebo-controlled crossover trial in adults with self-reported lactose intolerance confirmed by a lactose challenge: 4 weeks of DDS-1 or maltodextrin placebo once daily, with a 2-week washout
Lactobacilli and bifidobacteria in the prevention of antibiotic-associated diarrhoea and Clostridium difficile diarrhoea in older inpatients (PLACIDE): a randomised, double-blind, placebo-controlled, multicentre trial.
Lancet (2013) · Rct · n=2981
Randomised, double-blind, placebo-controlled multicentre trial in 2,981 inpatients aged 65 and over taking antibiotics, given a multistrain preparation of lactobacilli and bifidobacteria (6 × 10^10 organisms per day for 21 days) or placebo
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 5/10) and wins in 2 of 3 categories.
For improve digestion, L. acidophilus has a higher relevance score (55 vs 52).
No documented interaction was found in the data searched. This does not establish that this exact combination is safe.
The right pick depends on your goals. Answer a few quick questions for a personalised recommendation — or dig into the full evidence on each.