I bought some "pearls" type probiotics at the health food store in a blue package NOT refridgerated. The sales clerk said they do not need to be kept cool?? Anyway, my Naturopath told me her brand she sells were superior so I bought hers...but I am not going back to her. Anyone who charges me over 250.00 USD for a visit and 3 items is in it not to sure but to make money off of selling supplements.