Probiotics, friend or foe?

Or, let's just take a step back and think about this. There can be no denying that the news is shocking: Twenty-four deaths in a clinical trial procedure to treat acute pancreatitis with probiotics. But we need a measured and sensible response in order to avoid a consumer backlash based on these results, and to protect a valuable nutritional commodity. The collective probiotic industry has been quick and right in its response, and displays a perfect example as to how to react to such situations. Industry groups, most notably the International Probiotics Association (IPA) and the European Food and Feed Cultures Association (EFFCA), have been quick to put the results into context, without sounding defensive or patronising. Both groups note that pancreatitis is a disease associated with high mortality rates, and the participants in the study were classified as critically ill. They also stress that the probiotics were fed via​ a tube straight into the intestine and employed as a 'drug' and not a nutritional supplement. The benefits of probiotics are numerous, and the safety record is impeccable for the consumption of probiotics in foods, supplements and beverages when used according to manufacturers' recommendations in healthy and mildly ill people. But the study, conducted in Holland between 2004 and 2007 with 296 participants, raises questions about the 'friendly bacteria'. If you read only the headlines, as some people do, then you come away with quite a scary image: The Daily Telegraph ran with "'Friendly bacteria' products linked to 24 deaths"​, while United Press International had a similar feel, "Healthy bacteria may have caused 24 deaths"​. The news does look bad. But the AFP was a bit more accurate and measured, running with "Dutch researchers warn against probiotics for pancreatitis."​ Let's ignore for the moment that most people wouldn't have a clue what pancreatitis is, but note that it sounds serious. Based on previous smaller tests that showed that probiotics may reduce the rate of infection in the pancreas, researchers at the University Medical Centre Utrecht tested a probiotic blend in patients with pancreatitis. Because it was a double blind study - which means neither patients or researchers knew whether they were in the control or experimental group - the findings that 24 people had died in the probiotic group, compared to nine in the control group, did not emerge until the end of the trial. Unanswered questions ​ So what went wrong? The details are too sketchy at present to allow us to draw any firm conclusions, and too many questions remain unanswered. Could you say it was irresponsible of the researchers to test probiotics in such a way in critically ill patients? Maybe, but that would be unfair - it is the responsibility of science to continue to explore other avenues of research. Could we say it was an 'oversight' to take probiotics 'out of context', and employ the probiotic mixed strain as a drug and feeding them through a tube? Perhaps, but again that would be unfair. The fact remains that probiotics have displayed significant benefits for a range of health conditions, and the safety record is exemplary when used by the average health consumer at recommended intakes. A bigger issue? ​ As undesirable as the situation is, it may serve as an interesting example of expecting too much from nutritional supplements. Whether it's a probiotic, a pomegranate extract, an omega-3, or whatever, the bigger issue from these data may be that the benefit of nutrients is in the prevention, not cure of disease. Probiotics are big business, particularly in Europe where the market is expected to more than double by 2013, according to Frost & Sullivan. Its Strategic Analysis of the European Food and Beverage Probiotics Market predicts a rise from its 2006 position of $61.7m (€45.4m) to $163.5m (€120.3m) by 2013. Because industry and regulators have put the research in context and avoided the knee-jerk reaction of criticising the research and sounding overly defensive, potential damage to the burgeoning probiotic market, and the health benefits such products confer, should hopefully be negligible. Stephen Daniells is the Science Editor for NutraIngredients.com and FoodNavigator.com. He has a PhD in Chemistry from Queen's University Belfast and has worked in research in the Netherlands and France. ​ ​If you would like to comment on this article please contact stephen.daniells'at'decisionnews.com​