Natren Trenev Trio is an excellent brand of probiotic...i get mine from my chiropractor it is expensive but it lasts a long time and it's worth it...yes it comes refrigerated so all the happy bacteria are alive..also wanted to point out to any ladies reading... taking this will get rid of yeast infections or if you take an Antibiotic this is an absolute must to use in conjuction if you absolutely feel you have to do an antibiotic(yuck)..also a heads up if it gets occasionally itchy down there pay attention to your Sugar intake...lots of sodas and junk food let yeast thrive in your body as well as produce great amounts of mucous(sugar also responsible for many sinus infections which people run to doctors for Antibiotics which kills good bacteria which lets the yeast party...blah blah it's a vicious circle is what i'm getting at) hopefully this can help someone it's just what i've come to discover about how my own body works.. it might not be true for everyone!! kenzi LMT