Probiotics, Public Health and Nutritional Recommendations

In June 2013, an international group of experts met in New York to discuss a key facet of probiotic and prebiotic science: the use of the growing substantiation of the benefits of probiotics and prebiotics to inform effective public policy. The paper (Sanders, et al. 2014), which was published in February this year in Annals of the New York Academy of Sciences, outlined the challenges and ways forward to creating health policy that accurately reflects the benefits of probiotics.

The paper cites numerous systematic reviews combined with meta-analyses that have been published on a diversity of health endpoints for probiotics. The systematic review and meta-analysis process is the key means to weigh the strength of evidence for an effect in an unbiased manner. These studies set parameters for what will be reviewed, and then seek to find all evidence for the specific topic that fit the parameters. Many of these paper show that probiotics can be effective in some important health interventions, including preventing common upper respiratory infections (reduce incidence by 42%, reduced duration by almost 1 day, and reduced antibiotic prescriptions by 33%), reducing side effects of antibiotics (reduced risk of getting antibiotic-associated diarrhea by 42%), and preventing morbidity and mortality of a debilitating condition that befalls premature infants, necrotizing enterocolitis (reduced risk of severe NEC by 65%; reduced infant mortality from NEC by 60%). Using probiotics appropriately could even enhance the quality of hospital care—a very hot topic at the moment—by reducing dangerous secondary infections from C. difficile (reduced risk of getting C. difficile by 64%). As importantly, especially from a health policy perspective, probiotics and prebiotics are very safe to use.

However, there is a large disconnect between the scientific community’s understanding of probiotic benefits and its uptake by policy makers. To date, public health policy has failed to incorporate recommendations for probiotic use, not only across the United States but much of Europe as well. The final 2010 US Dietary Guidelines failed to even mention probiotics; Great Britain gave a decidedly lukewarm nod to them by suggesting that they were “worth a try.”

The New York group, representing eight countries and 28 organizations, attempted to tackle these obstacles by constructing a framework for promoting recommendations based on sound, scientific evidence. The six steps are:

  1. Refine the definition of “probiotic,” to incorporate the mounting evidence of benefits associated a core group of well-studied genera and species.
  2. Promote quality research on probiotics and prebiotics, to provide the foundation for evidence-based recommendations.
  3. Support standards for quality research.
  4. Accept information gleaned from well-conducted observational studies, which can help illuminate complicated, real-life situations.
  5. Evaluate the potential positive social and economic impacts of probiotic use, such as reduced health care costs from improving chronic conditions like irritable bowel syndrome, hypercholesterolemia or even diabetes.
  6. Expand policy guidelines to include foods that contain helpful or potentially helpful live microorganisms, even if they are not probiotics.
  7. Improve regulatory attitudes toward probiotics, to encourage dialogue and the incorporation of relevant research.     

There is certainly much research still needed to address questions and gaps in our knowledge, but the current science already justifies policy and dietary recommendations that promote the use of probiotics in both clinical settings and the general population. The support for probiotics is at least comparable to that of many other foods, like whole grains or mono-saturated fats, which have already received policy and dietary guideline recommendations. Consumers are increasingly attending to their own health and seeking information regarding food and supplement choices; clear, evidence-based statements—such as dietary recommendations — could greatly help consumers make both healthy and informed decisions. Given the mounting evidence for disease-reducing and health-maintaining properties of probiotics, along with the virtual absence of severe side effects among the general population, public health policy makers should evaluate the strength of existing evidence to determine if the time has come to add recommendations on probiotics to public health and dietary recommendations.


Sanders ME, Lenoir-Wijnkoop I, Salminen S, Merenstein DJ, Gibson GR, Petschow BW, Nieuwdorp M, Tancredi DJ, Cifelli CJ, Jacques P, Pot B. Probiotics and prebiotics: prospects for public health and nutritional recommendations. Ann N Y Acad Sci. 2014 Feb;1309(1):19-29. doi: 10.1111/nyas.12377.