On October 23, 2013 a panel of scientific experts* – including Profs. Reid and Morelli, who were part of the original committee that developed the widely used 2001 FAO/WHO definition of ‘probiotic’ – assembled in London to discuss the scope and appropriate use of the term ‘probiotic.’ The International Scientific Association for Probiotics and Prebiotics (ISAPP) organized the meeting to review the relevance of the FAO/WHO definition of probiotic, 12 years after it was initially published (2001). The aim was to develop a consensus opinion, which considers mechanistic and efficacy evidence that has emerged since 2001. The hope is that the panel findings will provide all stakeholders (consumers, researchers, health-care professionals, industry and regulatory bodies) a better understanding of appropriate use of the term ‘probiotic’ within the context of the body of current science regarding probiotics. The findings of the panel were published this week in Nature Reviews in Gastroenterology and Hepatology. The paper is open access.
- The panel agreed that the FAO/WHO definition for probiotics was still relevant, but advised a minor grammatical correction: “live microorganisms that, when administered in adequate amounts, confer a health benefit on the host”.
- The panel considered the general benefit of supporting a healthy digestive tract was supported by evidence gathered on a large number of different probiotic strains representing commonly studied species, such as a variety of Lactobacillus and Bifidobacterium species. Thus, use of the term ‘probiotic’ to describe a product that contains a minimum number of one of these well-studied species is appropriate. Such a benefit does not require demonstration at the strain level. However, any specific claim beyond “contains probiotics” must be further substantiated. This runs counter to a current position within some countries in the European Union that have banned use of the term ‘probiotic’ on foods due to the lack of approved probiotic health claims for foods.
- The panel discussed whether certain microbial products fit under the framework of ‘probiotic.’
- ‘Live cultures’, traditionally associated with fermented foods, would be outside the framework of probiotic if they were undefined and if there were no proven health benefits associated with them. Traditional fermented foods are great components of a healthy diet, and the microbes associated with them may impart health benefits. But there must be a convincing level of evidence to support their health effects to be considered ‘probiotics’. Note that the yogurt starter bacteria, Lactobacillus bulgaricus and Streptococcus thermophilus are considered to be probiotics due to the evidence that they help alleviate symptoms of lactose maldigestion.
- Undefined, fecal microbiota transplants are not considered to be probiotics.
- New commensals and consortia comprising defined strains from human samples, with adequate evidence of safety and efficacy, are probiotics.
- Some inconsistences between the Expert Consultation (EC)(ref) and the subsequent FAO/WHO Guidelines (2002) and were clarified, including that although the overall scope of the EC was intended to focus only on foods, many therapeutic applications for probiotics were discussed. Furthermore, the EC made statements that were no longer considered accurate. For example, the panel disagreed with the need for adherence of probiotics; furthermore, the panel accepted that yogurt bacteria are probiotics due to their ability to improve symptoms of lactose intolerance.
This Consensus Statement provides updates to the probiotic concept that reflect important developments in human microbiota research, such as fecal microbial transplants, as well as the evidence on probiotic efficacy that has amassed since 2001.
*Panel of scientific experts:
Glenn Gibson, Chair, University of Reading, UK; Colin Hill, Alimentary Pharmabiotic Centre, Ireland; Roberto Berni Canani, University of Naples Federico II, Italy; Harry Flint, University of Aberdeen, Scotland; Francisco Guarner, University Hospital vall d’Hebron, CEBERehd, Spain; Dan Merenstein , Georgetown University, USA; Lorenzo Morelli, Università Cattolica del Sacro Cuore, Italy; Bruno Pot, Institut Pasteur – Lille, France; Gregor Reid, University of Western Ontario, Canada; Seppo Salminen, University of Turku, Finland; and Mary Ellen Sanders, ISAPP Executive Science Officer, USA. Philip Calder, was unable to be present at the meeting in person, but participated fully in developing the conclusions from the discussion and in preparation of the manuscript.
1. Hill C, Guarner F, Reid G, Gibson GR, Merenstein DJ, Pot B, Morelli L, Canani RB, Flint, HJ, Salminen S, Calder PC, Sanders ME. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nature Rev Gastro Hepatol. advance online publication 10 June 2014; doi: 10.1038/nrgastro.2014.66
2. Food and Agricultural Organization of the United Nations and World Health Organization. Health and nutritional properties of probiotics in food including powder milk with live lactic acid bacteria. (2001).
3. Food and Agricultural Organization of the United Nations and World Health Organization. Joint FAO/WHO working group report on drafting guidelines for the evaluation of probiotics in food. (2002).