Best Probiotic for Nausea
For nausea specifically, the combination of Lactobacillus acidophilus and Bifidobacterium longum (3 × 10⁹ CFU twice daily) is the best choice based on the highest quality evidence demonstrating significant reduction in stress-induced nausea and vomiting. 1
Primary Recommendation
The most direct evidence for nausea reduction comes from a double-blind, placebo-controlled trial showing that Lactobacillus acidophilus Rosell-52 combined with Bifidobacterium longum Rosell-175 significantly reduced nausea and vomiting in stressed individuals when taken at 3 × 10⁹ CFU per dose, twice daily for 3 weeks. 1 This specific formulation targets the gastrointestinal symptoms most relevant to your question.
Alternative Evidence-Based Options
For Chemotherapy-Induced Nausea
- Lactobacillus rhamnosus at 5 × 10⁹ CFU twice daily significantly reduced nausea (RR 0.5,95% CI 0.4-0.8) in children with acute leukemia receiving chemotherapy. 2 This represents strong evidence for chemotherapy-related nausea specifically.
For Metformin-Induced Nausea
- The combination of Lactobacillus acidophilus and Bifidobacterium animalis shows efficacy for reducing multiple GI adverse effects including nausea in the context of medication-induced symptoms. 3
For GERD-Related Nausea
- Multiple probiotic formulations improved nausea in patients with gastroesophageal reflux disease, with 81% of studies showing improvements in upper GI symptoms including nausea. 4 However, specific strain recommendations are less clear in this context.
Dosing Specifications
- Standard effective dose: 3-5 × 10⁹ CFU per dose, administered twice daily 2, 1
- Duration: Minimum 3 weeks for symptom improvement 1
- Timing: Take with or without food, though consistency in administration is important
Important Safety Considerations
Do not use probiotics in immunocompromised patients due to risk of bacteremia or fungemia. 3 This includes patients with:
- Active chemotherapy (unless specifically indicated and monitored)
- HIV/AIDS with low CD4 counts
- Organ transplant recipients
- Severe debilitation
Context-Specific Guidance
The choice of probiotic should be refined based on the underlying cause of nausea:
- Stress-related nausea: L. acidophilus + B. longum combination 1
- Medication-induced nausea: L. acidophilus + B. animalis 3
- Chemotherapy nausea: L. rhamnosus alone 2
- H. pylori treatment-related nausea: Multi-strain probiotics containing Lactobacillus species reduce nausea as an adverse effect of eradication therapy 5
Evidence Quality Note
The evidence for nausea specifically is more limited than for other GI symptoms like diarrhea. 5 Most probiotic studies report nausea as a secondary outcome or adverse event rather than a primary endpoint. The strongest direct evidence comes from the stress-induced symptom study 1 and the chemotherapy study 2, both showing statistically significant reductions in nausea with specific probiotic formulations.