„AGA Clinical Practice Guidelines on the Role of Probiotics in the Management of Gastrointestinal Disorders” was developed by the American Gastroenterological Association (AGA). This document presents the official recommendations of AGA on the role of probiotics in the management of gastrointestinal disorders. The report was led by many to the wrong conclusion: “Probiotics don’t work!” However, no point in the report generalized the effects of all available probiotics. The report does not state that probiotic bacteria are not working at all. The authors of the report highlight and publicize a completely different, very important problem – the diverse, unfortunately sometimes outrageous quality of probiotics and the research carried out in this area.
It was strongly emphasized in the report that a probiotic probiotic is not equal to: “…we were not able to assess the viability of each formulation reported in the studies, as this information was not routinely available. We recognize that different manufacturers use different processes, which may affect the actual content of the probiotic utilized”– we read in the report.
Furthermore, the report only reviews the following conditions: Clostridioides difficile-related diseases, inflammatory bowel disease, irritable bowel syndrome, infectious gastroenteritis, and necrotizing enteritis. As the authors of the report emphasize: „Given likely differences in host genetics, diet, sanitation, and endemic enteropathogens between North America and the other global regions, as well as different causes of acute infectious gastroenteritis in children, we do not feel that the studies conducted in other regions can be generalized to the population served by the AGA”. The report also found that for premature babies (born less than 37 weeks old), low birth weight infants (<2,500 g), certain probiotics can prevent mortality and necrotizing enteritis, reduce the number of days required to reach full feeding, and hospitalization time.
Probiotics have undoubtedly beneficial effects on the human body. There is definitely a need for further research on the mechanisms of action of probiotic bacteria, conducting reliable and statistically significant clinical trials and verification of the quality of specific probiotic preparations, which is also emphasized in the report: „The gut microbiome plays an important role in gastrointestinal health and disease and probiotics represent a promising modality for therapeutic intervention. (…) We identified that significant knowledge gaps exist in this very promising and important area of research due to the significant heterogeneity between studies and variability in the probiotic strains studied”.
As a company dealing in the production of probiotics for years, we emphasize that you should choose probiotics produced by experienced, caring for the quality of their products, regularly testing the activity of probiotic bacteria and cooperating with scientific units, and pay attention to the form of the preparations (the liquid form contains vital and active probiotic bacteria ready for immediate action, and the long-term, cascade cultivation of probiotic bacteria does not require further processes of their preservation). It should also be noted that the studies included in the analyzed report concern the vast majority of probiotics in the freeze-dried form, because they are flooding the market, which was also emphasized by the authors of the report: „Within the last 20 years, there has been increasing recognition and interest in the role of the gut microbiome in gastrointestinal health. (…) . Enthusiasm and popularity within the community for probiotics has led to a multibillion-dollar industry worldwide. (…) The industry is largely unregulated and marketing of product is often geared directly at consumers without providing direct and consistent proof of effectiveness”.
We also asked to refer to the report by prof. UPP dr hab. Daria Szymanowska, who gave her opinion on this subject:
„I am very happy with the reports mobilizing producers to increase or maintain the quality of their probiotics, and consumers to carefully select the product. This is also the case here. The authors of the report “AGA Clinical Practice Guidelines on the Role of Probiotics in the Management of Gastrointestinal Disorders” noted that both research on probiotics and the probiotic market itself require verification.
I have tested (and still do) a lot of different probiotic preparations, from various companies – both Polish and foreign. The results obtained by me do not fill me with optimism …
However, I wholeheartedly support Polish producers who often reliably (although there are also exceptions here, unfortunately) provide knowledge about the probiotic preparations. Reliable producers analyze the quality of their products not only after their production, but also during the production process, as well as during the storage of finished products. Another advantage is the impeccable description on the label, consistent with the actual state of the product and meeting the requirements of legal regulations. There are not many Polish companies that have published research results in their portfolio – both research related to the basic indicators related to the quality of its products, as well as those related to their functionality, such as the impact of in vitro digestion (simulated conditions in the digestive tract) on the number and viability of microorganisms probiotics, the effect of probiotic microorganisms on the components of the intestinal microbiome (both desirable and undesirable), or the adhesion ability of probiotic microorganisms to colon epithelial cells, demonstrated with the use of cell lines”.
Therefore, remember: First of all, pay attention to the quality and biofunctionality of probiotics. We are glad that the quality of probiotics is starting to matter and does not paint probiotics with the same brush.