No-one is spared in Scottish-born, Canada-based professor Gregor Reid’s paper ‘Probiotics: definition, scope and mechanisms of action’, in which the medical profession, the food industry, EFSA and the US Food and Drug Administration (FDA) come under fire for compounding misunderstandings around probiotics.
He described EFSA (European Food Safety Authority) as a “committee of people with no expertise in probiotics”, who made decisions “arbitrarily and without adequate guidelines or feedback”.
Speaking exclusively with NutraIngredients he said: “I have long been a critic of a panel [EFSA's Panel on Dietetic Products, Nutrition and Allergies (NDA) that deals with health claims] that should never have been assigned to this task, is ill-equipped to do so, and has made many people ashamed of the European bureaucrats who hide behind it.”
He said one of the fundamental problems is that Europe’s regulatory system and the nutrition and health claims regulation (NHCR) only acknowledges that drugs - not food - can cure, treat, mitigate and prevent disease. This, he argued, rendered it inadequate for providing consumers with clarity on the health merits of probiotics and created a prohibitive research culture to build the science behind the benefits.
The Canadian example - 'miles ahead'
The paper praised Canada's food agency Health Canada for being “at the forefront of regulating probiotics, having already permitted informative claims on some products” and for creating the Canadian Clinical Guide for consumers. This contains a table of probiotic products sold in Canada, and, based on peer-reviewed publications which it lists, the guide classifies each product in terms of the data that exists for each, with gut and immune health claims permitted
“This helps consumers and practitioners determine for themselves if a product has been tested in humans and found to have merit,” wrote professor Reid.
He advocated the implementation of similar guideline charts in Europe, saying: “Firstly, EFSA should be disbanded. Then, a committee of appropriately qualified expertise in probiotics should be given a mandate to provide levels of evidence for given products.
“They certainly exist, and Canada has been miles ahead of Europe in recognising it and coming up with lists that guide consumers and healthcare professionals.”
Profit ahead of science
Industry was not innocent either. The way in which food and supplement manufacturers have handled probiotic research hasn’t helped to allay consumer confusion either, in professor Reid’s view. Many food and supplement companies were guilty of putting profit ahead of science and failing to perform appropriate human clinical studies to support formulations and claims.
He said this had undermined the efforts of companies with scientific and clinical documentation as they were obstructed from differentiating themselves from the mass market.
To right this situation, he suggested that “first companies need to do studies, then, if the regulators like EFSA won’t let them make claims, at least the scientists who did the studies can publicise the results to consumers.”
The microbiome gap
There is also a knowledge gap that needs to be closed among physicians. This stems from the failure of medical schools to teach future practitioners about the human microbiome and applications of probiotics and prebiotics, wrote professor Reid.
He emphasised that as rapid diagnostic tools become available to inform about the contents of the microbiome, it will be even more important for specialists to consider the role of probiotics in health and disease.
“While guidance will accompany results, it will make life much easier for interpreters of the findings if they have some knowledge of this field,” he wrote.
Ultimately, in order for probiotics to be applied as a therapy or for health maintenance, professor Reid said “thorough documentation of the strain(s) and product formulation and mechanisms of action” were needed - a task that would inevitably fall to the food industry and scientific community.
Source: Best Practice & Research Clinical Gastroenterology
“Probiotics: definition, scope and mechanisms of action”
Author: Gregor Reid