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Dr. Hibberd>> So then the question is,
well, if there's always interest in probiotics,
what is the evidence for those benefits that we've been
promised by the definition?
Now you would think
if there were something like 120 trials a year,
and in more recent times, that's true,
we must have great evidence about probiotics.
But also look at this.
All these meta-analyses.
Goodness gracious, it's almost an industry of
generating meta-analyses relating to probiotics.
And I think what this suggests is there are a lot of trials,
but maybe some of the questions are not been answered.
So what do we think about when
we think about the efficacy of probiotics?
The predominantly studied conditions are gastrointestinal.
Clearly antibiotic associated diarrhea,
C. diff diarrhea, inflammatory bowel disease,
and necrotizing enterocolitis
are a huge number of the trials published today,
but other major areas of research are how
probiotics may modulate the immune system allergy and atopy
and also—something that's near and dear to my heart—
getting rid of the antimicrobial resistant organisms.
But despite that, there are issues with understanding
the efficacy of probiotics.
There are unfortunately poor quality trials,
and lousy clinical trial reports.
There are concerns about safety.
Safety is often not even reported.
Did anybody even think about it?
Did anybody ask if there were any questions with safety?
And the recent 2011 AHRQ/Rand report complained that really
there was very inadequate information in the literature
to substantiate that probiotics were safe.
Yet, millions of people take them every day.
So this is of concern.
There have been a lot of concerns about the product.
What about the quality of the product?
We know there are products out there that don't even contain
the organism they say they're supposed to contain.
We also know that there are some products out there that contain
other organisms which are not even listed on the label.
So that's a concern about safety.
Does it matter if the probiotic is in a food or a yogurt or in a
bread or in a straw or in a chocolate?
Quite likely, but there's very little information on that.
Also there's a lot of questions about strain specificity.
It's not like you can just have any old probiotic.
Probably some probiotics work in certain circumstances
but not all.
And honestly, one of the most annoying things is it's hard
sometimes to understand the biological plausibility and the
mechanism of action of probiotics.
So guess what?
It's time out.
And from a Brit— that's really time out.
We've got to stop and try and understand
what we're doing with probiotics.