Bacteria that fuel the growing probiotic industry

Probiotic products in a pharmacy in Madrid Santi Burgos

Confidence that eating certain live microorganisms improves health is not new.

Already in the Japan of the thirties the biologist Minoru Shirota isolated and cultivated a lactic bacteria to use it in a drink against intestinal infections.

It was the starting point of an industry, that of probiotics, that the consulting firm Grand View Research values ​​at 44,500 million euros and that over the decades has added a second arm to its food division, that of nutritional preparations from free sale in pharmacy.

A segment that moves 3,700 million and that in Spain has grown strongly in recent years, going from billing 73 million in 2016 to 121 in 2019, 65% more, according to data from the IQVIA consultancy.

The increasing importance that medicine attaches to prevention, together with powerful marketing campaigns and an expanded offering, explain that both these microbes and the prebiotics, the fibers on which they feed, are experiencing an upward trend.

Solutions for the digestive system lead the market, but, as Guillermo Álvarez, president of the Spanish Society of Probiotics and Prebiotics, points out, “that is something that is changing”.

"There are more and more gynecological products or products for the respiratory system," he points out, adding that formulas will appear, currently under development, to combat obesity, Alzheimer's or autism.

Supplements that regenerate the intestinal flora gained popularity as doctors began to prescribe them to offset the damaging effect of certain antibiotics.

Despite this, two formulas for the protection of the vaginal mucosa and another that slows colic in babies are among the 10 best-selling preparations.

The pandemic, however, has affected these products.

After the collection of medicines that took place in March, and which was extended to these supplements, the interannual sales in April and May fell by 20%, and from January to September the fall was 8%.

Some setbacks suffered especially by manufacturers - there are about 270 laboratories and only eight reach a market share of 61% - and extend to distributors.

Cofares, one of the largest, claims to have delivered 45% fewer probiotic preparations at points of sale between March and July compared to the same months in 2019.

Among the causes, the lower influx to the medical consultation due to the fear of contagion and, to a lesser extent, the impossibility for laboratories and distributors to visit doctors to promote their products.

“And still a third”, explains Alex Coloma, Salvat's marketing manager, “the drop in self-consumption”.

“There was a fear that colds or flu were cases of covid-19 and, instead of going to the pharmacy, they chose to follow the diagnostic protocol dictated by the authorities.

Something correct, but that has taken away income ”, he says.

The sources consulted agree that the situation is exceptional and affirm that the worst that can happen is that growth slows down.

The real workhorse, they say, remains the same: the demonstration of the benefits they attribute to their products.

They believe that any progress in this direction would exponentially increase their profits, since today, as explained by food technologist Beatriz Robles, "laboratories play with two meanings of the term probiotic."

"They designate with it the preparations that meet the requirement of reaching the intestine with a minimum amount of microorganisms, but that does not guarantee any benefit, which is what they actually appeal to with the use of the term," he argues.

Effective strains?

Experts question whether many marketed strains are effective.

To do this, the healthy bacteria ingested should prove that they have the ability to reproduce, cause the same effect in different individuals and are responsible for improving certain parameters.

Current legislation - very restrictive in the attribution of health benefits - takes care of this lack of scientific evidence, states Robles: “The vast majority of requests to associate benefits with a product, be it a food or a supplement of sale in pharmacy, are rejected by the European Food Safety Authority ".

In fact, of the 129 applications related to probiotics that this body has received since 2007, it has only approved one related to some strains used in the production of yogurt.

However, the preparations end up being equally healthy for the intestinal flora based on other components, such as vitamins.

The situation led the Consumer Ministry to warn in October that, although they "meet the safety requirement", probiotics "have not been able to demonstrate any beneficial effect."

To bridge this gap, the industry is investing more and more in research.

Kai Möller, CEO of Casen Recordati, a leading sales laboratory, says that the company, which had a turnover of more than 16 million euros in 2019, used 977,000 in clinical studies, 22% more than the previous year.

"It seems to us something inescapable because we only endorse before health professionals products that have previously proven their benefit against certain pathologies," he points out.

The reasoning is repeated by several heads of other laboratories, but the increase in budgets destined to test the benefits of microorganisms has not prevented the opening of a debate that laboratories do not even want to talk about: equating these food supplements with medicines.

For now, only a small minority are listed as drugs, including Ultralevura, the best-selling and registered when the requirements to do so were less strict.

"There are reasons to believe that, in the face of more restrictive registration regulations, professionals would prescribe them more and with greater certainty," says Álvarez.

In return, far fewer references would be sold and those of low efficiency would disappear.

"The fundamental thing is that the strains used have passed clinical studies with patients, a process with which our products already comply", opposes Carlos Badiola, medical director of Casen Recordati.