About Probiotics for Professionals
The information below provides a general overview of the potential health benefits/uses, mechanisms of action, and safety of probiotics.
According to a definition developed by the Food and Agriculture Organization of the United Nations (FAO) and World Health Organization (WHO), probiotics are "live microorganisms, which, when administered in adequate amounts, confer a health benefit on the host."1
The use of live microorganisms in the diet has a long history. The original scientific observation of the potential health benefits of some selected bacteria was made by Eli Metchnikoff (a Russian scientist, Nobel laureate, and professor at the Pasteur Institute in Paris) more than a century ago.1,2 The International Scientific Association for Probiotics and Prebiotics (ISAPP) states that "the concept of probiotics has been around for over 100 years, but scientists are just starting to understand their role in maintaining health, regulating the immune system, and managing disease."3
Today, probiotics are available to consumers mainly in the form of dietary supplements and foods.4
- Potential Health Benefits and Uses
- Proposed Mechanisms of Action
- Safety of Probiotics
- Common Misunderstandings About Probiotics
Potential Health Benefits and Uses of Probiotics in General
A number of potential health effects are associated with the usage of probiotics.1 However, there are differing degrees of evidence supporting each potential benefit.1 In addition, although research suggests a broad range of potential health benefits, the current evidence suggests that probiotic effects are strain.2-6 Other strains of even the same species cannot be presumed to demonstrate the same effect.6 According to the World Gastroenterology Organisation (WGO) Practice Guidelines on Probiotics and Prebiotics, the potential probiotic health benefits "can only be attributed to the strain or strains tested, and not to the species or the whole group of lactic acid bacterias or other probiotics."2
According to the WGO Practice Guidelines on Probiotics and Prebiotics, "Probiotics are intended to assist the body's naturally occurring gut microbiota. Some probiotic preparations have been used to prevent diarrhea caused by antibiotics, or as part of the treatment for antibiotic-related dysbiosis. Studies have documented probiotic effects on a variety of gastrointestinal and extraintestinal disorders, including inflammatory bowel disease (IBD), vaginal infections, and immune enhancement. Some probiotics have also been investigated in relation to atopic eczema, rheumatoid arthritis, and liver cirrhosis. Although there is some clinical evidence for the role of probiotics in lowering cholesterol, the results are conflicting. In general, the strongest clinical evidence for probiotics is related to their use in improving gut health and stimulating immune function."2
Most of the identified benefits of probiotics relate to gastrointestinal conditions.7 The American Gastroenterological Association's (AGA) patient's guide on probiotics states that "probiotics are most often used to promote digestive health." Probiotics also may help treat digestive diseases. Some of the most common gastrointestinal uses for probiotics include: IBD, infectious diarrhea, antibiotic-related diarrhea, and traveler's diarrhea.8
The science behind these benefits is still emerging and appears to be strain. Though Bifantis is a probiotic, it has not been studied in many of these areas, and as such there is no data to show that it can provide all these benefits. For information particular to Bifantis, see About Bifantis. For additional information on potential health benefits of certain probiotics, see professional resources and Probiotic Scientific Data.
Proposed Mechanisms of Action of Probiotics in General
The mechanism of action of probiotics is uncertain. According to a joint FAO/WHO Expert Consultation, "Although it is known that certain probiotics can elicit beneficial effects, little is known about the molecular mechanisms of the benefits reported. The mechanisms may vary from one probiotic to another (for the same benefit via different means) and the mechanism may be a combination of events, thus making this a very difficult and complex area."1 The WGO Practice Guidelines on Probiotics and Prebiotics state that "probiotics affect the intestinal ecosystem by stimulating mucosal immune mechanisms and by stimulating nonimmune mechanisms through antagonism/competition with potential pathogens."2 Possible probiotic mechanisms of action cited by the WGO include:2
- Activate local macrophages.
- Modulate cytokine profiles.
- Induce hyporesponsiveness to food antigens.
- Digest food and compete for nutrients.
- Alter local pH.
- Produce bacteriocins.
- Scavenge superoxide radicals.
- Stimulate epithelial mucin production.
- Enhance intestinal barrier function.
- Compete for adhesion.
- Modify pathogen-derived toxins.
Safety of Probiotics
Probiotics are well tolerated. There are typically few or no adverse effects.7 Side effects, if they occur, tend to be mild and self-limiting. In general, the most common side effects appear to be gas, bloating, and abdominal discomfort.4,7,8 In placebo-controlled clinical studies, there was no difference in side effects between Bifantis and placebo. Although Bifantis has not been studied in people who are severely ill or immunocompromised, a review of available probiotic data with the use of supplements containing Bifidobacterium does not suggest cause for concern. As with other dietary changes, patients who are severely ill or immunocompromised should be evaluated by their healthcare professional to determine if a probiotic is right for them.
Common Misunderstandings About Probiotics
There are hundreds of probiotic products in the marketplace and an overwhelming amount of information for healthcare professionals to understand and sort through. Thus, it is not surprising that there are a number of common misconceptions and misunderstandings about these products. Some important facts about probiotics that are often misunderstood are:
Not all probiotics are alike. Different probiotic strains can have different effects: A key concept essential to understanding probiotics is that the benefits of probiotics are strain . Probiotics within the same genus or even species do not necessarily provide the same benefits. The probiotic strain is key to connecting the probiotic strain to the strain's published scientific evidence.2,3,6,9
The concept of a strain of bacteria is similar to the breed of a dog – all dogs are the same genus and species, but different breeds of dogs have different attributes, and different breeds are better at performing different tasks.3
More is not necessarily better: The amount of probiotics is usually expressed as the number of colony forming units (CFUs), or the number of viable microbes, per serving. The required amount of probiotics varies greatly for different strains and the health effect under investigation – it depends on evaluation in clinical studies and the amount that has been shown to be effective. The fact is that more is not necessarily better; different strains have been shown to be effective at different amounts. There is no minimum or maximum number of bacteria that must be ingested to obtain a beneficial effect. The benefits of probiotics are strain, and the required amount varies for different strains and the health effect.2,3,6,9 Similarly a probiotic product with multiple strains is not necessarily better than a probiotic product with a single strain. Again it depends on the desired benefit and if the single strain and/or multiple strain probiotic has been shown to be effective for that health benefit.
Important considerations when recommending a probiotic supplement
- The benefits of probiotics are strain2,3,6,9
- A probiotic is identified by the genus, species, and alphanumeric strain designation2,3,9
- The required amount of colony-forming units (CFUs) varies greatly depending on the strain of bacterium. Higher CFU counts do not necessarily correlate with greater efficacy2,3,6,9
- Amount on label should be based on studies that have shown a health benefit in humans3,9
- Strains used in multiple-strain probiotics should be compatible or synergistic10
Reference to institutions and agencies is provided for informational purposes only and does not suggest an endorsement or approval of Bifantis®.
1 Joint FAO/WHO Expert Consultation on Evaluation of Health and Nutritional Properties of Probiotics in Food Including Powder Milk with Live Lactic Acid Bacteria. Cordoba, Argentina, 2001 Oct 1-4. Available at: https://www.who.int/foodsafety/publications/fs_management/en/probiotics.pdf.
2 World Gastroenterology Organisation Global Guidelines. Probiotics and prebiotics. 2011 October. Available at: www.worldgastroenterology.org/probiotics-prebiotics.html.
3 The International Scientific Association for Probiotics and Prebiotics. Probiotics: A Consumer Guide for Making Smart Choices Available at: https://www.isapp.net/docs/Consumer_Guidelines-probiotic.pdf.
4 National Center for Complementary and Alternative Medicine. National Institutes of Health. Get the facts. Oral probiotics: An introduction. Updated November 2011. Available at: nccam.nih.gov/health/probiotics.
5 Joint FAO/WHO Working Group on Drafting Guidelines for the Evaluation of Probiotics in Food. London, Ontario, Canada. 2002 Apr 30—May 1. Available at: https://www.who.int/foodsafety/publications/fs_management/en/probiotics.pdf.
6 Douglas LC, Sanders ME. Probiotics and prebiotics in dietetics practice. J Am Diet Assoc 2008 Mar;108(3):510-21.
7 Kligler B, Cohrssen A. Probiotics. Am Fam Phys 2008 Nov;78(9):1073-8.
8 The American Gastroenterological Association. AGA Institute. Probiotics. What they are and what they can do for you. Available at: https://www.gastro.org/patient-center/diet-medications/probiotics.
9 Sanders ME. How do we know when something called "probiotic" is really a probiotic? A guideline for consumers and health care professionals. Funct Food Rev. 2009;1:3-12.
10 Timmerman HM, Koning CJM, Mulder L, et al. Monostrain, multistrain and multispecies probiotics—a comparison of functionality and efficacy. Int J Food Microbiol. 2004;96:219-233