Probiotics and prebiotics: a new guide indicates why and in what cases to include them

For some time now, knowledge of the gut-brain axis is in full expansion and includes growing evidence of both the role played by the microbiota in health and immunity, as well as the beneficial impact of prebiotics and probiotics.

So much so that his study appears as one of the most promising fields when it comes to talking about wellness and disease prevention. And although much progress has been made in understanding the role they play, there is still a long way to go.

In short, much is heard about them, but when it comes to knowing how and when to incorporate them, many doubts arise. It is in this context that a new resource for gastroenterologists on the use of probiotics and prebiotics in clinical practice becomes relevant.

What is the new guide?

It is a guide that summarizes the evidence regarding what its true impact on health is and how it can help in certain digestive diseases.

It was conducted by experts from the World Gastroenterology Organization (WGO), with contributions from the International Scientific Association for Probiotics and Prebiotics (ISAPP).

Within the justification for why they carried out an update of the guidance, they argue: "Scientific evidence, not popular ideas, should drive recommendations for probiotics and prebiotics in clinical settings. Globally, evidence continually emerges on how they can be used effectively in patient care, but healthcare professionals often struggle to figure out where the evidence lies for a particular condition."

The guideline aims to guide health professionals based on evidence. Photo Shutterstock.

In this regard, Clarín consulted Gabriel Vinderola, CONICET researcher, professor at the National University of the Litoral in Santa Fe and member of the Scientific Association for Probiotics and Prebiotics (ISAPP).

"Not all probiotics are the same, so it is necessary that they are correctly identified at the level of genus, species and strain. If that happens, I can go look for scientific evidence," said the Argentine researcher.

Although for most people it may sound too technical, the specialist points out that each probiotic must be correctly identified with the genus, species and strain to which it corresponds. And give an example: Genus Lactobacillus, species reuteri, strain DSM17938.

Prebiotics and probiotics: what they are

A probiotic is a live microorganism that, when administered in adequate amounts, exerts a beneficial effect. In order for us to ensure that it is a probiotic, Vinderola explained in an article published in Clarín, the microbiological identity of the microorganism must be known, and some clinical study that demonstrates the beneficial effect.

Meanwhile, a prebiotic is the food for some beneficial bacteria resident in the gut. Not all beneficial bacteria require prebiotics to function, but many probiotics enter directly into the gut, interact with the immune system, and can inhibit a pathogen.

Health professionals often look for evidence regarding the link between priobiotic and a particular condition. Photo Shutterstock.

Evidence-based recommendations

Before carrying out such an update, experts comprehensively assessed the evidence from randomised controlled trials on gastrointestinal conditions, including which specific strain or prebiotic substance showed a positive effect.

Accordingly, the guideline presents a list of conditions in which prebiotics and/or probiotics have been shown by evidence to be effective.

"Our goal for this project was to provide guidance to global gastroenterologists and other health professionals to enable them to integrate evidence-based probiotics and prebiotics into their daily work," said Francisco Guarner, WGO project leader.

How they impact known and new conditions

Conditions for which probiotics and/or prebiotics show benefits include some well-known ones: diarrhea, irritable bowel syndrome, inflammatory bowel disease, and lactose maldigestion. In the case of infants, infantile colic and necrotizing enterocolitis are included in the list.

"Infantile colic and prevention of necrotizing colitis are perhaps two of the most and best studied cases, for infantile colic there is evidence for the strain L. reuteri DSM17938 and for a partially fermented infant formula with Bifidobacterium breve C50 and Streptococcus thermophilus O65", specifies Vinderola.

However, there is also positive evidence for some conditions that are not usually associated with the benefits of probiotics or prebiotics, such as insulin resistance, non-alcoholic fatty liver disease, Helicobacter pylori infection. Even links were found with an improvement in overall quality of life.

"The mechanisms are not always known, that is, why they work, but they work, for example for insulin resistance because they manage to control chronic low-grade inflammation, which is the origin of insulin resistance. In the case of Helicobacter pylori, because they increase the immune response against that pathogen," Guarner added.

The evidence summarized in the guideline reinforces the idea that not all probiotics are created equal and that positive results in trials depend on which probiotics or prebiotic substances are being tested and in what dosage.

According to Mary Ellen Sanders, ISAPP's executive scientific director and co-chair of the project, "This guideline recognizes that there is actionable evidence for the use of probiotics and prebiotics in clinical practice. It's an excellent tool for healthcare providers to help them tailor the probiotic or prebiotic to the patient's needs."

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See also

Is there a cure for irritable bowel syndrome?

SIBO: what it is, symptoms and how this disease of the small intestine is treated