Probiotics: 2020 and Beyond

This time of year, it’s fun to look back and ahead. I started consulting in the probiotics field in 1990. In 1990, awareness – by consumers, researchers, and healthcare providers – of probiotics in the United States was minimal. There were few controlled, human trials published on probiotics, so most benefits were hypothetical. Today, a search of the PubMed database lists over 2000 citations for ‘probiotic’ AND ‘clinical trial’. A Codex proposal on probiotics indicates that in 2017, the global retail value of the probiotic market was $45 billion, with probiotic yogurt or fermented milks making up the majority at $39.8 billion. Probiotics, it seems, have arrived.

What will 2020 and beyond bring? Here are a few issues I think are worth noting.

The marketplace. An important development for probiotics in the United States would be improved communication about product quality to end-users. Third-party verification that probiotic products are manufactured according to established quality standards and are labeled accurately would go a long way to improve consumer and healthcare provider confidence in commercial products (End-User Trust in Probiotic Products). Further, the labels of retail products are often insufficient (Label information lacking on probiotic supplements). A published survey indicated that evidence supporting claims for 65% of retail dietary supplements could not be determined (although probiotic dairy products performed better, unpublished data). Overall, with regard to commercial probiotic products in the United States, we can and should do better.

The media. Reading, listening to or watching media coverage of probiotics can be frustrating. I wish a probiotic primer were required reading for anyone aiming to communicate about probiotics. At a minimum, communicators should realize: 1. Fermented foods are not the same as probiotics. 2. Not all probiotics are the same; different strains of even the same species may have different effects. 3. Probiotics don’t need to colonize or restructure the human microbiota to elicit a health benefit. 4. A study that shows no benefit for a specific probiotic strain(s), at a specific dose, for a specific indication, in a specific setting does not negate all other evidence. Clear and scientifically accurate basic information on probiotics is available (videos, infographics, blogs).

The science. Reading a well-controlled efficacy trial for a probiotic can be pure joy. Even if no benefit is found, a good study will tell us what does not work, and that’s an important contribution. Further, the ambition, ingenuity and optimism of researchers are contagious. I have no doubt that tremendous strides will be made in this decade on newly defined (aka “next-gen”) probiotics and related substances (Rebuilding the gut microbiota ecosystem). We will begin to incorporate actions of dead microbes (postbiotics) into our thinking about probiotics. And I trust we can do a better job of putting aside biases and ulterior motives and strive for truth in the conduct, communication and translation of scientific findings.

Fermented foods. Fermented foods are hot. But why? I think this is a “perfect storm” convergence of the widespread coverage of microbiome research indicating the importance of our resident microbes (including the ability to get your own fecal microbiota tested); the modern re-discovery of traditional fermented foods (yogurt, kombucha, kefir, and others) and  the fun of making them at home (Maintaining a family tradition: Bulgarian whole fermented cabbage); and interest in gut health. Although convincing science often lags behind consumer enthusiasm, I expect by the end of this decade we will better understand the role of consuming live microbes as part of our diet and our health. Thought leader scientists today are promoting the concept that consuming live dietary microbes might be worthy of official recommendation (RDA for microbes – are you getting your daily dose?).

Discoveries surrounding probiotics and related substances, including prebiotics, synbiotics, postbiotics, and fermented foods, will continue. In 2020 and beyond, we will understand better how they can be useful tools to improve the activities of our body’s microbial partners, in health and disease.