Of all the probiotic products on the market, how do I choose which one is the best for me or my patient?

Jason C Sniffen, Lynne V McFarland, Charlesnika T Evans, Ellie J C Goldstein

Overview

A review of the literature found 249 clinical trials investigating 22 different types of probiotics for various types of diseases. What we found was that not all probiotics were effective for all types of diseases. Only specific types of probiotics were effective (called 'strain specificity') and the same strain/mix was not equally effective for all types of diseases (called 'disease specificity'). Some diseases (prevention of antibiotic-associated diarrhea and treatment of acute pediatric diarrhea) have several types of probiotics that are effective and safe.

Summary

It is difficult for the general public and for healthcare providers o find information on which probiotic is the most appropriate for their patients and many reviews simply lump all different types of probiotics together and conclude that probiotics are or are not effective. This practical guide gives the information the public and physicians need to choose the best one for their patient.

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Author Comments

Lynne V McFarland, PHD
Lynne V McFarland, PHD
University of Washington
Affiliate Associate Professor
Probiotics, C. diffiicle infections, meta-analysis
Seattle, Washington | United States
When healthcare providers suggest their patient take a probiotic, or the patient searches online for probiotic products, the choice is dizzying in its diversity. Because of varying regulations, the health claims on the label often add to the confusion. This guideline provides the tools everyone needs to choose the best probiotic for them.Lynne V McFarland, PHD

Resources

Sniffen J et al.
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0209205

Choosing an appropriate probiotic product for your patient: An evidence-based practical guide.

Authors:
Lynne V McFarland, PHD
Lynne V McFarland, PHD
University of Washington
Affiliate Associate Professor
Probiotics, C. diffiicle infections, meta-analysis
Seattle, Washington | United States

PLoS One 2018 26;13(12):e0209205. Epub 2018 Dec 26.

RM Alden Research Laboratory and David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America.

Introduction: Clinicians and patients face a daunting task when choosing the most appropriate probiotic for their specific needs. Available preparations encompass a diverse and continuously expanding product base, with most available products lacking evidence-based trials that support their use. Even when evidence exists, not all probiotic products are equally effective for all disease prevention or treatment indications. At this point in time, drug regulatory agencies offer limited assistance with regard to guidance and oversight in most countries, including the U.S.

Methods: We reviewed the current medical literature and sources on the internet to survey the types of available probiotic products and to determine which probiotics had evidence-based efficacy data. Standard medical databases from inception to June 2018 were searched and discussions with experts in the field were conducted. We graded the strength of the evidence for probiotics having multiple, randomized controlled trials and developed a guide for the practical selection of current probiotic products for specific uses.

Results: We found the efficacy of probiotic products is both strain-specific and disease-specific. Important factors involved in choosing the appropriate probiotic include matching the strain(s) with the targeted disease or condition, type of formulation, dose used and the source (manufacturing quality control and shelf-life). While we found many probiotic products lacked confirmatory trials, we found sufficient evidence for 22 different types of probiotics from 249 trials to be included. For example, several types of probiotics had strong evidence for the prevention of antibiotic-associated diarrhea [Saccharomyces boulardii I-745, a three-strain mixture (Lactobacillus acidophilus CL1285, L. casei Lbc80r, L. rhamnosus CLR2) and L. casei DN114001]. Strong evidence was also found for four types of probiotics for the prevention of a variety of other diseases/conditions (enteral-feed associated diarrhea, travellers' diarrhea, necrotizing enterocolits and side-effects associated with H. pylori treatments. The evidence was most robust for the treatment of pediatric acute diarrhea based on 59 trials (7 types of probiotics have strong efficacy), while an eight-strain multi-strain mixture showed strong efficacy for inflammatory bowel disease and two types of probiotics had strong efficacy for irritable bowel disease. Of the 22 types of probiotics reviewed, 15 (68%) had strong-moderate evidence for efficacy for at least one type of disease.

Conclusion: The choice of an appropriate probiotic is multi-factored, based on the mode and type of disease indication and the specific efficacy of probiotic strain(s), as well as product quality and formulation.

Trial Registration: This review was registered with PROSPERO: CRD42018103979.

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Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0209205PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6306248PMC
May 2019
51 Reads
3.234 Impact Factor

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