Probiotics have been recommended for many conditions during the past century, ranging from long-term immunomodulatory effects to proven benefits in the management of chronic diseases. There is an increased availability of commercial products containing probiotic strains. Do all of them indeed provide health benefits for their consumers? I am convinced they don’t.
When I see that the growth of probiotic sales appears to slow down significantly, I feel compelled to ask the companies which sell low-quality probiotics: “Do you not feel that this is a very short-sighted method of doing business?”
Quality in probiotics means that the consumer feels the effect of a product within one month. This is what we aim for at the Institut Allergosan. In this article, I will outline how it is possible to achieve this.
1. Screening of bacterial strains
The study of the interactions between microbiota, probiotics, health and disease is needed to achieve effective probiotic formulations. This research helps to select the most effective bacteria for each indication and to develop indication-specific formulations. Selection should be evidence-based and consider in vivo as well as in vitro data. It is important to note that all bacterial strains should have QPS (Qualified Presumption of Safety) status or an extensive safety file and all strains of bacteria used must neither be resistant to antibiotics nor be able to acquire resistance.
2. Using metabolic activity as a marker of viability
Metabolic or biological activity is one of the most significant parameters for the quality of a probiotic product: even more important than the amount of colony-forming units in the final product. Passage through the GI tract or the addition of another ingredient might damage the bacterial cells, so they no longer reach their full potential. These cells will be counted in a viable cell count, but do not have much health value for the user. The production of lactic acid is a health-promoting factor of probiotics which can be used as an indicator for the metabolic activity of probiotic bacteria and is considered a beneficial method for measuring this activity.
3. Ensuring survival in the GI tract
To survive the passage through the stomach and the small intestine, probiotic strains must tolerate the acidic and protease-rich conditions of the stomach and survive and grow in the presence of bile acids. Therefore, acid tolerance is one of the first properties screened for when selecting probiotic strains. Bacteria from human sources normally have the genetic capacity to survive the acid which surrounds the gut.
4. Using multispecies formulation
High-quality probiotics contain more than one strain to promote synergistic effects. Therefore, selected strains must be carefully selected for compatibility. After selection of different single strains, in vitro experiments are repeated with the complete formulation. There are tests for potential collaboration between the used strains to minimize antagonistic effects and promote synergistic ones. Recently published studies have shown that more than 90 per cent of metabolic activity in the gut is carried out by teams of bacteria. Only very few will be done by single strains. It is more straightforward to investigate single strains for research reasons. However, to achieve real health benefits, one has to use more than one bacterial strain. Keep in mind – bacteria are team-workers!
Evidence-based use of high-quality multispecies probiotics
Patient-centred treatment and improvement of health conditions via probiotics will only be accepted when data from indication-specific studies are available. It is particularly important to investigate the final product, not just one single strain of a formulation. Several studies we have published at the Institut AllergoSan demonstrate the positive effects of our high-quality multispecies OMNi-BiOTiC®.
For increasing numbers of patients, it will be of utmost importance to receive probiotic treatment due to its effectiveness and lack of side effects. Most significantly, high-quality probiotics can treat the cause of a disease, not merely the symptoms.
Anita Frauwallner is CEO at Institut Allergosan.
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