The updated guidance praised potential within conditions related to the digestive tract, but questioning effects outside of this.
The state health system said: “Probiotics are thought to help restore the natural balance of your gut bacteria when it has been disrupted. However, there is little evidence to support most health claims made for them.”
The NHS Choices online advice also noted: “There's likely to be a huge difference between the pharmaceutical-grade probiotics that show promise in clinical trials and the ‘probiotic’ yoghurts and supplements sold in shops, which may not live up to the advertised claims”.
Dr Mary Ellen Sanders, executive science officer for the International Scientific Association for Probiotics and Prebiotics (ISAPP), told NutraIngredients that the guidance “ignores some important advances and evidence in support of probiotic benefits”.
Dr Luca Bucchini, managing director of Hylobates Consulting, said that while the NHS had made negative assertions about probiotics in foods, it showed the NHS backed probiotics for combating antibiotic-associated diarrhoea (AAD), a health benefit not yet supported by The European Food Safety Authority (EFSA).
Pulling no punches
The advice outlined some of the health benefits and conditions probiotics had been associated with such as antibiotic-associated diarrhoea (AAD), persistent diarrhoea, protecting premature babies from gut disease, irritable bowel syndrome (IBS), lactose intolerance, pouchitis, colic, immune system vaginal conditions, inflammatory bowel disease (IBD) and eczema.
However it said:“Generally, it's hard to see how swallowable bacteria could have an effect on conditions outside of the digestive tract.”
Sanders said this ignored a “wealth of information” on how gut microbes can impact a range of body systems including the immune system, brain function and metabolic disorders such as obesity and diabetes.
Elsewhere, she said the advice that probiotics could reduce the likelihood of premature babies contracting necrotising enterocolitis (NEC) – when tissues in the baby's gut become inflamed and start to die - was a “flagrant understatement”. She said there was strong evidence for this benefit.
Bucchini said he could not agree with the statement that the food industry – particularly with regards to claimed health benefits - faced a less rigorous testing and approval process compared to the medical sector.
Responding to the assertions about levels of live bacteria in supplements and yoghurts, he said this was more a case of law enforcement and potential law-breaking food firms than regulation on paper.
“It is also very disappointing that NHS Choices says that yogurt does not help people with lactose intolerance, whereas there is an approved health claim ("Live cultures in yoghurt or fermented milk improve lactose digestion of the product in individuals who have difficulty digesting lactose") with very specific conditions - at least 108 Colony Forming Units live starter microorganisms (Lactobacillus delbrueckii subsp. bulgaricus and Streptococcus thermophilus) consumers can trust,” he said.
NHS getting ahead of EFSA
On AAD, the NHS said: “There's fairly good evidence that giving high doses of Lactobacillus rhamnosus and Saccharomyces boulardii when also taking antibiotics can help prevent children getting AAD. Without probiotics, the antibiotics tend to wipe out the protective gut bacteria, which results in diarrhoea.”
Responding to this point, Bucchini told us: “EFSA has not validated these benefits yet, and it is interesting that a sceptical eye as NHS Choices would see the evidence in a more favourable light than EFSA itself - though it's fair to say that EFSA is obliged to look at individual applications, and the evidence therein, not at the entire literature.”
He said that helping consumers navigate “promising, but not definitive”, evidence on persistent diarrhea and gastroenteritis in children as well as pointing out the different characteristics of each probiotic strain was a “step in the right direction”. He said this reflected the more nuanced nature of science, in contrast with the ‘yes/no’ system of health claims approval.
Sanders said she appreciated that “the article cautions consumers that not all probiotic products are equivalent and that some may not contain effective types or levels of strains. I also appreciate that the article advises people to try probiotic products and judge for themselves if they are effective”.