Probiotics as a Tx resource in primary care

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Applied Evidence

Probiotics as a Tx resource in primary care

J Fam Pract. 2020 April;69(3):E1-E10

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References

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What to look for in the future

Basic research, human trials, and market development in the field of probiotics are progressing rapidly. Probiotics at this time are primarily from the genera Lactobacillus, Bifidobacterium, and Saccharomyces. But the potential of probiotics has spurred research into previously untapped microbial members of the healthy human microbiota. Microbes such as Akkermansia, Faecalibacterium, and Rosburia may comprise “next-generation probiotics” that will likely be developed as drugs.⁷²

Since the risks of using traditional probiotics are low, trial and error may be warranted at times.

Active areas of research holding some promise involve microbiome-driven components of intractable problems such as metabolic syndrome (obesity,⁷³ diabetes, and lipid dysregulation) and brain dysfunction⁷⁴ (depression, anxiety, cognition, autism). A guide to the clinical use of probiotic products available in the United States, updated yearly, may be a useful reference (but the reader may want to examine the referenced studies as their level of evidence is different than the SORT method).⁷⁵ Science-based videos, infographics, and other resources are available from the International Scientific Association for Probiotics and Prebiotics, (mentioned earlier; www.isappscience.org/).

It appears that probiotics will continue to be widely used and hopefully in a more evidence-based manner. As we learn more about individual microbiome variations, recommendations will likely be more patient specific. Probiotics that have robust evidence represent the strongest recommendations. Even so, since the risks of using traditional probiotics (such as Lactobacillus, Bifidobacterium and Saccharomyces strains) are low, trial and error may be warranted at times.

CORRESPONDENCE
Daniel J. Merenstein, MD, 4000 Reservoir Road NW, Building D 240, Washington, DC 20007; djm23@georgetown.edu.

ACKNOWLEDGMENT
We thank Alexandra Mannerings, PhD, for preparing the FIGURE.