Podcasts about international probiotics association

George Parakevakos, executive director of the International Probiotics Association says it's not easy being one of the most popular consumed dietary supplements, and here's why: Probiotics have taken center stage, rising to popularity quickly in the past decade largely due to how probiotics make people feel - but do they work?

George Parakevakos, executive director of the International Probiotics Association says it's not easy being one of the most popular consumed dietary supplements, and here's why: Probiotics have taken center stage, rising to popularity quickly in the past decade largely due to how probiotics make people feel - but do they work?George Parakevakos, executive director of the International Probiotics Association says it's not easy being one of the most popular consumed dietary supplements, and here's why: Probiotics have taken center stage, rising to popularity quickly in the past decade largely due to how probiotics make people feel - but do they work?

Probiotics have taken center stage, rising to popularity quickly in the past decade largely due to how probiotics make people feel.George Parakevakos, executive director of the International Probiotics Association says it's not easy being one of the most popular consumed dietary supplements, and here's why: Probiotics have taken center stage, rising to popularity quickly in the past decade largely due to how probiotics make people feel - but do they work?This is a question that has been raised more recently as skeptics of probiotics appeal to the probiotics industry for in-depth answers. Parakevakos' nonprofit organization has been leading the charge on the science and safety of probiotics for the past two decades.He joins Dr. Friedman in this encore episode from February 2021 to share what science says when it comes to probiotic efficacy and safety, and address misconceptions on how and when to use them.

Probiotics have taken center stage, rising to popularity quickly in the past decade largely due to how probiotics make people feel.George Parakevakos, executive director of the International Probiotics Association says it's not easy being one of the most popular consumed dietary supplements, and here's why: Probiotics have taken center stage, rising to popularity quickly in the past decade largely due to how probiotics make people feel - but do they work?This is a question that has been raised more recently as skeptics of probiotics appeal to the probiotics industry for in-depth answers. Parakevakos' nonprofit organization has been leading the charge on the science and safety of probiotics for the past two decades.He joins Dr. Friedman in this encore episode from February 2021 to share what science says when it comes to probiotic efficacy and safety, and address misconceptions on how and when to use them.

Join Duffy MacKay, Senior Vice President of Dietary Supplements at CHPA, and George Paraskevakos, Executive Director of the International Probiotics Association to explore the science behind probiotics, why gut health is so important, and what's next for this growing category. With special guest: George Paraskevakos, Executive Director, International Probiotics Association (IPA) Hosted by: Anita Brikman, Senior Vice President, Communications & Public Affairs, and Executive Director, CHPA Educational Foundation and Duffy MacKay, Senior Vice President, Dietary Supplements, CHPA

In this episode, HBW Insight talks probiotics with David Pineda Ereño, founder of DPE International Consulting and consultant to the International Probiotics Association. Since 2006, no health claims for probiotics have been allowed by harmonised European Union regulations. Even the term probiotics is considered an unauthorised health claim by the European Commission. However, as David explains, many EU member states, including Italy and Spain, are starting to go their own way, adopting a more liberal approach to this booming wellness market. We discuss what the future of EU probiotics regulation may hold, as well as some of the exciting science that is coming out all the time, pointing to the health benefits of this extremely popular ingredient.

No matter your age, stage of life, or health status, there are a multitude of benefits to taking probiotics! Today I am joined by Jessica Terhaar, Director of the International Probiotics Association, who is here to share how probiotics impact our health and why we should all pay more attention to them. You'll learn about the difference between a microbe and a probiotic, both of which are very beneficial to us, and what you should look out for when deciding which probiotics to take. Jessica explains how probiotics help us to balance our hormones, digest our food, and produce vitamins, and why exposure to all different types of microbes is so important. Microbes exist in and around us in the trillions, but restrictions relating to the COVID-19 pandemic could have negative implications on how our bodies respond to them, and we need to learn to balance the risks and benefits of exposure. Your microbes work for you, and there are many ways that you can help them thrive!Key Points From This Episode:An introduction to today's probiotic expert, Jessica. Jessica explains what colony forming units are.The importance of diversity when it comes to what probiotics are made of.How to differentiate between microbes and probiotics. Examples of foods which optimize the potential of microbes. Popular probiotic and microbe strains.Information you should be able to find on the label of a probiotic bottle.What opportunistic pathogens are, and when they can be detrimental to our health.How the COVID-19 pandemic has changed our relationship with microbes, and why this is problematic.The multitude of benefits of taking probiotics.A rapid-fire round with Jessica. Why it is so important to take probiotics before, during, and after you take antibiotics. Links Mentioned in Today's Episode:Jessica Terhaar Email AddressJessica Terhaar on LinkedInInternational Probiotic AssociationProbiotic Rescue by Allison TannisDeliciously GeekyAllison Tannis on LinkedInAllison Tannis on InstagramNatural Health Influencer on InstagramPure-Lē Natural

George Parakevakos, executive director of the International Probiotics Association says it’s not easy being one of the most popular consumed dietary supplements, and here’s why: Probiotics have taken center stage, rising to popularity quickly in the past decade largely due to how probiotics make people feel - but do they work?George Parakevakos, executive director of the International Probiotics Association says it’s not easy being one of the most popular consumed dietary supplements, and here’s why: Probiotics have taken center stage, rising to popularity quickly in the past decade largely due to how probiotics make people feel - but do they work? This is a question that has been raised more recently as skeptics of probiotics appeal to the probiotics industry for in-depth answers. Parakevakos’ nonprofit organization has been leading the charge on the science and safety of probiotics for the past two decades. He joins Dr. Friedman to share what science says when it comes to probiotic efficacy and safety, address misconceptions on how and when to use them, and explain why probiotics are positioned to be a pandemic hero.

George Parakevakos, executive director of the International Probiotics Association says it’s not easy being one of the most popular consumed dietary supplements, and here’s why: Probiotics have taken center stage, rising to popularity quickly in the past decade largely due to how probiotics make people feel - but do they work?George Parakevakos, executive director of the International Probiotics Association says it’s not easy being one of the most popular consumed dietary supplements, and here’s why: Probiotics have taken center stage, rising to popularity quickly in the past decade largely due to how probiotics make people feel - but do they work? This is a question that has been raised more recently as skeptics of probiotics appeal to the probiotics industry for in-depth answers. Parakevakos’ nonprofit organization has been leading the charge on the science and safety of probiotics for the past two decades. He joins Dr. Friedman to share what science says when it comes to probiotic efficacy and safety, address misconceptions on how and when to use them, and explain why probiotics are positioned to be a pandemic hero.

Scientific director of the International Probiotics Association, Jessica ter Haar, Ph.D., says many of us are living in that proverbial protected bubble that we previously condemned, and with good reason (due to COVID-19), but will all this clean living and social distancing cause future problems for our health?Scientific director of the International Probiotics Association, Jessica ter Haar, Ph.D., says many of us are living in that proverbial protected bubble that we previously condemned, and with good reason (due to COVID-19), but will all this clean living and social distancing cause future problems for our health? Microbes and nutrition expert, ter Haar says while we sterilize everything to protect ourselves from the virus, at the same time by not exposing ourselves to germs we are weakening our body’s own natural defenses to everyday threats. She says many microbes are indeed good for your health, while others can make us sick. Knowing the difference between the most popular microbes, bacteria, fungi, and viruses can help us get back to living life without fear and she is here with us today to help us navigate our new germophobic world.Dr. ter Haar & Dr. Friedman talk good germs vs. bad germs, the cons of quarantine, and probiotics.

Scientific director of the International Probiotics Association, Jessica ter Haar, Ph.D., says many of us are living in that proverbial protected bubble that we previously condemned, and with good reason (due to COVID-19), but will all this clean living and social distancing cause future problems for our health?Scientific director of the International Probiotics Association, Jessica ter Haar, Ph.D., says many of us are living in that proverbial protected bubble that we previously condemned, and with good reason (due to COVID-19), but will all this clean living and social distancing cause future problems for our health? Microbes and nutrition expert, ter Haar says while we sterilize everything to protect ourselves from the virus, at the same time by not exposing ourselves to germs we are weakening our body’s own natural defenses to everyday threats. She says many microbes are indeed good for your health, while others can make us sick. Knowing the difference between the most popular microbes, bacteria, fungi, and viruses can help us get back to living life without fear and she is here with us today to help us navigate our new germophobic world.Dr. ter Haar & Dr. Friedman talk good germs vs. bad germs, the cons of quarantine, and probiotics.

LIVING TOO CLEAN DURING COVID-19?Summary: Jessica ter Haar, Ph.D., scientific director of the International Probiotics Association says many of us are living in that proverbial protected bubble that we previously condemned, and with good reason (due to COVID-19), but will all this clean living and social distancing cause future problems for our health? Microbes and nutrition expert, ter Haar says sterilizing everything to protect ourselves from the virus, can also weaken our body's own natural defenses to everyday threats, because we need certain beneficial microbes for good health. In this 2-part interview, she helps us navigate our new germophobic world, and discusses how we can get back to living life without fear.

LIVING TOO CLEAN DURING COVID-19?Summary: Jessica ter Haar, Ph.D., scientific director of the International Probiotics Association says many of us are living in that proverbial protected bubble that we previously condemned, and with good reason (due to COVID-19), but will all this clean living and social distancing cause future problems for our health? Microbes and nutrition expert, ter Haar says sterilizing everything to protect ourselves from the virus, can also weaken our body's own natural defenses to everyday threats, because we need certain beneficial microbes for good health. In this 2-part interview, she helps us navigate our new germophobic world, and discusses how we can get back to living life without fear.

Ellen Kamhi talks with George Paraskevakos, the Executive Director of the International Probiotics Association, about its mission, which is to promote the safe and efficacious use of probiotics throughout the world while being “The Global Voice of Probiotics.”

Jessica ter Haar, Ph.D., scientific director of the International Probiotics Association says many of us are living in that proverbial protected bubble that we previously condemned, and with good reason (due to COVID-19), but will all this clean living and social distancing cause future problems for our health? Microbes and nutrition expert, ter Haar says while we sterilize everything to protect ourselves from the virus, at the same time by not exposing ourselves to germs we are weakening our body’s own natural defenses to everyday threats. She says many microbes are indeed good for your health, while others can make us sick. Knowing the difference between the most popular microbes, bacteria, fungi and viruses can help us get back to living life without fear and she is here with us today to help us navigate our new germophobic world. Jessica spends time with Mark Alyn talking about the health benifits of probiotics.

Jessica ter Haar, Ph.D., scientific director of the International Probiotics Association says many of us are living in that proverbial protected bubble that we previously condemned, and with good reason (due to COVID-19), but will all this clean living and social distancing cause future problems for our health? Microbes and nutrition expert, ter Haar says while we sterilize everything to protect ourselves from the virus, at the same time by not exposing ourselves to germs we are weakening our body’s own natural defenses to everyday threats. She says many microbes are indeed good for your health, while others can make us sick. Knowing the difference between the most popular microbes, bacteria, fungi and viruses can help us get back to living life without fear and she is here with us today to help us navigate our new germophobic world. Jessica spends time with Mark Alyn talking about the health benifits of probiotics.

Jessica ter Haar, Ph.D. Microbes Expert Jessica ter Haar, Ph.D., is scientific director of the International Probiotics Association and says many of us are living in that proverbial protected bubble that we previously condemned, and with good reason (due to COVID-19), but will all this clean living and social distancing cause future problems for our health? Microbes expert, ter Haar says while we sterilize everything to protect ourselves from the virus, at the same time by not exposing ourselves to germs we are weakening our body’s own natural defenses to everyday threats. She says many microbes are indeed good for your health, while others can make us sick. Knowing the difference between the most popular micbrobes, bacteria, fungi and viruses can help us get back to living life without fear. Science shows clearly that the more microbes babies and little ones come in contact with, the healthier they are long term Social distancing and sheltering in place is making people more susceptible to bacteria, fungus and viral infections. We are exchanging microbes with everyone, everything all the time and this is how the immune system is strenghted. The literature shows that babies and little ones who live with pets are healthier overall because of the introduction of more varied microbes from the dogs and cats. There are beneficial probiotics and their are probiotics that don’t work that well. The Science overwhelming shows that good, viable probiotics are quite beneficial to the entire gut microbiome. Kissing is a nice way to share microbes.

Probiotics have been one of the consistent growth categories across the natural products space, with product introductions in the supplement, food, beverage and even personal care categories. However, even as researchers are exploring the health benefits of specific strains, inconsistencies in regulatory approaches could hamper product introductions or line extensions—particularly into new geographies. In the lead-in to SupplySide West, Heather Granato, vice president of content, spoke with George Paraskevakos, executive director, International Probiotics Association (internationalprobiotics.org), about the market opportunities and challenges, as well as what SupplySide West attendees can learn at this year’s Probiotics Workshop and in the IPA Probiotics Resource Center. Key points of this podcast include: What types of health benefits are being substantiated by clinical research, and the ways those studies can be used to in effective consumer communication. The regulatory conundrum that marketers face when trying to extend product lines into new geos, and the work being done by IPA and other firms to even the playing field. Steps being taken by IPA to educate the market, both through its own educational efforts and outreach at SupplySide West.

This paper is part of NMJ's 2018 Microbiome Special Issue. Download the full issue here. In this interview, naturopathic physician and probiotic expert Donald Brown, ND, discusses the role of probiotics in supporting the gut microbiome. Brown also describes the mechanisms of action and clinical applications of probiotics, as well as strains, dosages and potential contraindications. About the Expert Donald J. Brown, ND, is one of the leading authorities in the USA on the safety and efficacy of dietary supplements, evidence-based herbal medicine, and probiotics. Brown currently serves as the director of Natural Product Research Consultants (NPRC) in Seattle. He is a member of the Advisory Board of the American Botanical Council (ABC) and the Editorial Board of The Integrative Medicine Alert. He was a member of the Board of Directors for the International Probiotics Association (2008-2010) and its Scientific Advisory Board (2006-2008). He has also previously served as an advisor to the Office of Dietary Supplements at the National Institutes of Health. Brown is the author of Herbal Prescriptions for Health and Healing (Lotus Press, 2002) and was a contributor to The Natural Pharmacy (Prima Publishing, 2006), the A-Z Guide to Drug-Herb-Vitamin Interactions (Prima Publishing, 2006), and The Textbook of Natural Medicine (Churchill Livingstone, 2006). About the Sponsor Founded in 1979 by molecular geneticist Stephen Levine, PhD, Allergy Research Group® is one of the very first truly hypoallergenic nutritional supplement companies. For nearly 40 years Allergy Research Group® has been a leading innovator and educator in the natural products industry. Our dedication to the latest research about cutting-edge nutritional supplements continues to this day. Our purpose is to provide customers with products they can use to improve their patients’ quality of life, through scientific based innovation, purity of ingredients, education and outstanding service. ARG is proud to be a sponsor of the Clinical Education LinkedIn Forum, a closed peer-to-peer group on LinkedIn where healthcare professionals can ask clinical questions and receive evidence-based and clinical-based responses by experts in their field. Visit www.clinicaleducation.org/linkedin for more information & to sign up for free! Visit www.allergyresearchgroup.com for more information on ARG and our products. Transcript Karolyn Gazella: Hello. I'm Karolyn Gazella, the publisher of the Natural Medicine Journal. Today we are exploring the impact that probiotics can have on the gut microbiome. Before we begin, I'd like to thank the sponsor of this topic who is Allergy Research Group. My guest is naturopathic physician and a leading probiotic expert, Dr. Donald Brown. Dr. Brown, thank you so much for joining me. Donald J. Brown, ND: Hi Karolyn. It's a pleasure to talk to you. It's been a long time. Gazella: I know. Brown: How are you? Gazella: I'm doing great. I know. This is like old times. And you know, before we dig into this topic, I have to tell you that I am just fascinated by the human microbiome, and it seems like the research in this area has really exploded. Why is that? Brown: Well, I think, again, it's ironic as a naturopath talking about it because we've always talked about the impact that the intestinal tract has on health in general. Immune health, skin health, so forth and so on, and I think that what's happened is that particularly probiotic research has led us to realize that there's these microbes on our body. And we have a tendency in probiotics to focus on bacteria, but what's exploding in this area is that we have resident microbes that are viral microbes. We have fungal microbes that are natural inhabitants of our body. So looking at this, we're really talking about 40 trillion microbes, predominantly bacteria, and sort of the balance that we have with these microbes which are part of our body. And it's funny because the research [inaudible 00:01:54] dramatic, and we have 10 times more microbes on us and in us, mainly in us, than we have cells. And the new data is really indicating that that's not the case; it's about 1.3 to 1. So people who get itchy when they think that they have more bacteria on them than cells, it's not quite as dramatic as we thought. Again, I think it gets back to the fact that we're recognizing the fact that these things play such an interesting part in our health and our wellness, and when it tips in the wrong direction, our illness too. So expanding it out so we're not just looking at the microbes in the GI tract, but the microbes in other parts of our body as well. Gazella: Yeah, I think that's really some of the most interesting parts of this research is that it does expand beyond the intestinal tract. So as it relates to the human microbiome, remind us of the mechanisms of actions that probiotics have. How and why do probiotics even work? Brown: Well, probiotics ... When you think about the GI tract, the analogy I like to use, especially when I'm talking to the public ... talking to healthcare professionals here ... is it's sort of like a busy parking lot. And you have organisms that are health promoting, and then you have organisms that are potential pathogens, and they're looking for parking spots. Remember that bacteria ... viruses are the same way ... have to adhere to cells to be able to be either health promoting or disease promoting. So that's one of the first things that probiotics are doing is they're competing for spots. And once they actually set up house, they then start creating a micro-environment that is inhospitable to potential pathogens, producing things that are anti ... compounds that are antimicrobial. They alter the pH slightly to make it inhospitable for these microbes and really create a situation where, "Hey, this is our home. This is our neighborhood, and you're not welcome here" kind of a thing. The other thing that should resonate with most of the doctors on the phone is the whole idea of leaky gut and intestinal barrier function, too. It's one of the things that probiotics do once they set up house is they're also helping to produce mucin and to sort of keep those tight junctions in the intestinal tract, the cells healthy and intact. And that's very, very important. The other thing that they do is they also, in the colon, are producing short-chain fatty acids which are associated with reducing risk of cancer as we age. Production of short-chain fatty acids act to help with digestive health as well. And then one of the really interesting things that's really been discovered over the last, I would say, eight to 10 years, is that when these little bacteria actually bind, they're communicating through the intestinal wall with what are called dendritic cells which are funny-looking, little, sort of odd-looking starfish type things that send little feelers up through the ... into the epithelial cells. And the probiotics are actually communicating with them to sort of modulate the immune system. So they produce a little bit more of this, produce a little less of this. Inflammatory responses are also modulated through it. And then the last thing and one of the really, really interesting things right now is we're beginning to realize that the intestinal tract is communicating with the brain. So the gut-brain axis is what that's called, and we know that stress, for instance, can actually negatively impact the probiotics in the GI tract, the healthy bacteria in the GI tract, and in turn, through the vagal nerve going up to the hypothalamic-pituitary axis, actually modulates that response. So we're now finding out that probiotics may actually be involved in ... I'm sure you've done interviews where you talk about the HPA axis and stress response. We're now finding out that the GI tract is very, very directly involved in that. So it could be negatively impacted by stress but can also positively impact the HPA axis, which is a whole new mechanism of action which is wild. So we've got gut health, digestive health. We have immune health based on responses with the GI tract. Now we're finding out that there's actually effects on mood, stress response, that sort of thing. And that's not even covering the female genitourinary tract which has its whole population of probiotics that are positively affecting genitourinary tract health as well, so it's big. It's a vast influence on the body. Gazella: Yeah. There is a lot going on here with probiotics. I think that's why I like the topic so much because there's just so much to talk about. So when we're looking at the scientific literature and the research, what conditions have the most compelling research in terms of improved outcomes? I realize that this may be a pretty long list, given the mechanisms that you've just described, but take us through that list from a research perspective. Well, I think what I like to do is I like to start with the things that are accepted by the larger medical community. And one of those is the fact that we've known for a long time that probiotics have a positive effect on prevention of antibiotic-associated diarrhea. So I would put that probably at the top of the list of, hey, if I'm in a room and I've got people who are skeptical of alternative medicine, integrative medicine, that's always a good starting point because we have really solid data that antibiotics definitely are good at preventing that. My background is in pediatrics, and I think another area that has sort of reached a critical mass is actually ... it's fascinating ... is the prevention of atopic dermatitis in children who are potentially at risk. The studies started ... First one was in the Lancet in early 2000s, and basically the studies are looking at mom particularly but also whoever the partner is, and risk of ... that have a background of atopic diseases, allergic diseases, and actually starting to give mom probiotics during the second half of her last trimester. And then once the baby is born, if mom's nursing, continuing to give the probiotics to the mom until she stops. And then, anyway, it varies on the study, but usually then the infant starts to take the probiotics. What they're finding is that it's reducing the incidence of atopic dermatitis by about 50%. That's amazing to me because if you look at sort of tracking the use of the antibiotics in children on a graph and you look at the increase in atopic diseases, so you're looking at eczema, atopic dermatitis. You look at asthma. They track almost exactly if you look at from 25 years ago to now, they track almost exactly. And also cesarean births contributing to that as well where the microbiome, so that's really fascinating to me. I would say the other area, sort of shifting gears, that I think has reached a critical mass is also adjunctive use of probiotics in female genitourinary tract health. So treatment using standard treatments for things like bacterial vaginosis would probably be the top area, but also prevention of recurrence of urinary tract infections. We're, particularly in the bacterial vaginosis area, I think really reaching a point where we have enough data to sort of suggest that, hey, using these things really can help with prevention. And then I would probably put the last one, as we move into the immune system and we really have reached a critical amount of data. Not a lot of pediatric data but adult data now that suggests that routine use of probiotics seems to reduce the incidence of upper respiratory tract infections. So, again, I could go on and on and on. Gazella: Right. Yeah. Brown: There's a lot of stuff. There's a lot of stuff that's emerging and that we're sort of on the edge. But one of the things I think the listeners need to know about is the fact that I think we like to think about alternatives too, but one of the great things about probiotics is that adjunctive use. Obviously it's antibiotics, but Helicobacter pylori, for instance. The standard treatment of that is very rough on people. Recurrence rates are really high, so one of the themes that I always like to talk about when I talk in my lectures to healthcare professionals is that remember that a lot of the treatments that we use for ... Let's take urinary tract infections. E coli are really good at setting up what are called biofilms that are these little bits like taking a Visqueen sheet and putting it over themselves so that you can get to use the antibiotics. You can get to the ones that are not underneath the protective shield, but the ones that are under there don't get affected. So one of the things that probiotics are great about is going in and helping to break up that biofilm and actually make standard treatment perform better, and then continuing to use the probiotics actually reduce recurrence rates. So, and there's reduced recurrence rates, and there's a whole litany of examples of areas where if we use probiotics. I mentioned helicobacter pylori but also UTI's, bacterial vaginosis, where probiotics actually help the treatment go better, outcomes are better, and then really reduces recurrence rates. Gazella: Yeah. That's such a good point and you know, you mentioned antibiotics and how they disrupt gut flora and how probiotics can help reverse that dysbiosis. Are there other medications that kind of do the same thing as antibiotics where they disrupt that gut microbiota diversity and that probiotics may be able to help reverse that? Brown: We're thinking that some of the more aggressive inflammatories that people take may have an affect. That's still sort of in the early phases. One of the early ones, interesting ones that there's still a limited amount of data, but I actually reviewed it, was a study with a proton pump inhibitor, so things that we're using for reflex and that sort of thing, having a very negative effect on the microbiome. So, we're sort of still in the early stages of learning what specific drugs and the effects are. Obviously antibiotics would the be the easiest case study, because we can actually look at the what affects. They've done studies with people who are getting the triple therapy for helicobacter pylori and realizing that during that therapy, the healthy bacteria in the G.I. tract can be reduced by as much as 80%. If we use probiotics, during that treatment, it reduces that to 40 to 50% and then if we continue to use it after, people tend to bounce back quicker. There are other drugs that we know are beginning to emerge that have negative effects, but stay tuned on that one. Gazella: Right. Right. Now, let's switch gears and talk little bit about strains, because I know that that's a hot topic. So, specifically for the conditions that you mentioned in helping to restore gut microbiota that's been disrupted by medications like you were just talking about, what are the more common strains used for these types of clinical applications? If you don't mind my backing that up, I am very, very disturbed when I hear people lecturing who say that strains don't matter. I go to a lot of international conferences. I sit on committees that set standards, international standards for probiotics and it is something that experts who know a lot more about this area than I do are upset about, because there are people out there who are saying that it's species specific and strains don't matter. I beg to differ. I think that it's very, very important that health care professionals realize that, particularly health care professionals realize that ... and Karolyn, you've known me for a long time. We've done interviews about [bontanical 00:16:20] medicine that I'm an evidenced based person. I like to see the ... particularly if we're talking about treating a condition. And so when we go from species level where there's very little research to strain level, we emerge into an area where we know what the dosage was, that was used in the study. Particularly when we talk about pediatrics, we talked about people who might be immune compromised. We talked about older folks like myself. It's important also to ... safety is pertinent too and that's one of the areas that is a little bit of a red flag for me with the whole probiotic area. Particularly on the commercial side where we have this race to do all these different things and some of the species level stuff that's being sold has not been clinically studied. And so, very, very important that people realize that some of the standards that go around a strain or viability is the lack of bacillus or the bifidobacterium strain that you're using shown to be viable. Does it actually adhere in the intestine is one of the things that we now have the ... within the persons body, but we now have technology that can actually show that these things sort of do adhere, and how long they adhere, and how long they stick around. Another thing that's really important that I've given many lectures to health care professionals is they don't think about is that we also don't want these strains, what's called trans located, we don't want them to go from the intestine to the blood stream. And they're having case studies. There was a paper published a number of years ago on people who were really severely immune compromised where the probiotic that was being ... it was a specific strain actually trans located into the blood stream and caused sepsis. People then had to be treated with very aggressive antibiotics. So, we don't want them to go from the intestinal tract into the blood stream. Another one that's [inaudible 00:18:39] ... we're talking about antibiotics, I always chuckle when I remiss on this one is also we realized that hey, probiotics are good for people who are taking antibiotics, but we also want to be sure that the probiotics strain has been tested for not blocking the ability of the antibiotic to do it's job. So, it's called antibiotic resistance. And it can be transferable. They have run into organisms that we think are probiotics that actually have a negative effect on an antibiotic doing it's job, so that's important. I already talked about safety and efficacy. I'm all about that. A silly one that I just want to toss in that's talked about internationally, that I still bump into in the U.S. more so than in other areas is the fact when we talk about being a probiotic supplement, we want to look at the label, and we want to be sure that these stability, or the shelf life of the product is actually been proven to the time expiration. There are still a lot of probiotic products that are sold in the United States that actually declare their potency at the time of manufacture, which is like, well okay, but I have a vitamin C product. They told me the potency when it was manufactured, but it says it has a two year shelf life. Have they actually tested that? Has that actually been proven? And so, remember, these are living organisms. Very, very important that stability or shelf life be proven for these as part of the choice of picking a supplement.  Gazella: Well, I was just going to say, do you have some go to strains that you like to focus on when it comes to recommending probiotics? Brown: I think there's a lot of them right now, actually. That's another area where we could probably go on and on about. There are what I like to call legacy strains that have been around for a while that have a lot of research on them that have ... and we also understand their mechanism of action really well. The one that people probably know the most is lactobacillus GG, which is a rhamnosus strain that was discovered by a couple of guys in Boston. I always like it when they give their own name to the strains. It was Gorbach and Goldin I think were their names, so they named it lactobacillus GG. But anyway, that one has been around for a long time. A lot of really, really excellent research. Some of the bifidobacterium strains from Japan from [Morinaga 00:21:24] is the name of the company, have a lot of research, particularly in the pediatric area. Been around really since the ... lactobacillus GG, since the early '60's, the Morinaga [inaudible 00:21:38] really since the '50's. The Japanese were doing isolation in human studies long before we were doing them here in the U.S. Brown: Another one that I really like is lactobacillus acidophilus DDS-1. It's an interesting strain that was discovered by a guy named Dr. [Shahani 00:21:56]. By the way, all of these strains that we're talking about are derived from humans. These are human derived strains and this one was actually discovered and isolated first in 1959. And like the lactobacillus GG and some of the Morinaga strains has a lot of clinical research. It also ... in vitro research that shows that it adheres, that it survives. And then human trials, actually looking at it's ability to treat things like travelers diarrhea, prevent antibiotic associated diarrhea, those sorts of things. When I look at products, I always look at what's the indication? What's been studied? There's commercial strains the lactobacillus, I'm sorry rhamnosus HN001, for instance, in the atopic dermatitis prevention area that has phenomenal studies. And so there are a number of strains out there that have reached that critical point of whether its specific to one condition or have been looked at in other areas that have really excellent data. And again, being somebody whose background was in pediatrics, I'm always also looking at what's your safety data as well. That would be an example of a few strains that I think have really excellent data. Gazella: Yeah. That's good. And you know, not that long ago, we were seeing maybe just one or two species, one or two strains. Now we're seeing multi species, multi strains in these formulations, sometimes six, nine, twelve different species or strains in one formulation. Is that a good thing? Brown: Sometimes it's a commercial thing. Here's my theory and I could easily be misproven [inaudible 00:23:58], but or unproven. Are you misproven or unproven? Which- Gazella: I'm not sure. Brown: Called out for my lack of proof. My answer to that, when I get asked that, and it's more common when I'm lecturing to the public or to managers of supplement sections is that probably for wellness purposes. So if I'm taking a probiotic or if I'm a doctor and I'm recommending a probiotic supplement to be taken daily, I probably would use something that's a little bit more of a multi strain. Sort of a balance between the lactobacilli family and the bifidobacterium family. That's a sort of my go to. And as you get into the senior population, seniors have a tendency to have a drop in the bifido. That's probably dietary related, because fiber and that sorts of things, they like to feed on ... They're probably eating less fiber in their diet. But anyway. Having a balance of a number of strains, is there a magical number of strains? I don't think so at this point. I don't think anybody's proven that. I think the difficulty ... what I say to people is, is that when you shift, it's much easier to talk about a single strain or a combination of a couple strains. You know, in irritable bowel syndrome, inflammatory bowel disease, BSL-3 has eight different strains in it. I mean, that's a lot of strains. It's been around for a long time. They use very high doses, but its easier to look at disease endpoints when we do a clinical trials, because we have very clear outcomes that we're looking for compared to what's a placebo, for instance, Wellness studies are really hard to do, so I don't know that there's an easy answer to your question because I don't know if the company after I ... know a lot of them, and some of them have a lot of ... have deep pockets. I don't know who's gonna do a wellness study that shows that, "Hey, if you do this many strains at this potency, that it works better than if you only do one strain at this potency, or if you do nothing." 'Cause those are expensive studies to do. Gazella: Yeah. Totally. And I'm gonna ask you another unfair question, and it's regarding dosage. You know that can be somewhat controversial, still debatable. How do you dose probiotics or recommend ... What's your philosophy on the dosage? Brown: Well, I always start with what is the clinical. If I'm treating a specific condition and I'm using an evidence-based strain I dose it at the dose. And it's interesting, 'cause there's extremes and that's one of the issues when we look at meta-analyses that have been done, so stuff like say, not only was there this cacophony of strains that were used, going from one strain to five strains. That sort of thing. But the dose, the potency and we measure the potency of probiotics, what are called colony forming units so we talk about milligrams or gram amounts of these things. So I always try to look up with what the research showed. Again, leading back to wellness and sort of, regular use. I have a patient who's take a multi-vitamin, who's taking fish oil every day and I say, "Hey, one of the things you should think about is keeping your intestinal tract healthy and probiotics are gonna contribute to that, keeping your immune system healthy." I don't have an easy answer for that. I typically use multi-strains and I'll probably usually go in the 10 to 50 billion CFU per day. Is that correct? Is there clinical data to back that up? The answer is no, I don't know for sure. But that's sort of how I think. The one thing that I can tell you is that I remember a client who decided to go high potency and high potency is definitely [inaudible 00:28:23] was like 25 billion CFUs per instance, it was like a shot across the balance. It was 12 years ago. And I'm freaking out because [inaudible 00:28:33]. You can't go run 5 billion CFUs per day or people gonna be having a [inaudible 00:28:41] reaction or getting thrown out of dinner parties 'cause they're farting and having to go to the bathroom all the time. So what I can tell you is that we have enough data now in healthy people that if we go to, even, 100 billion CFUs per day that we're not seeing any adverse effects. We're usually with this ... How much of that is actually ... adhering how much of it is actually having an impact versus 40 billion, 50 billion or even 10 billion for that instance. So that's another one that's gonna be interesting to see how that evolves. There's obviously, particularly on the retail side in this race to see who can come out with the highest potency with most strains and we'll see how that goes. Gazella: Right, yeah. Well, I think that was a difficult question and you answered it brilliantly. So now it seems like many probiotics on the market are actually synbiotics because they combine pro and prebiotics. Now, what's your view about this combination and why are more companies going in that direction? And am I right, are companies going in this direction? Brown: Well, here's my criticism of that and I like synbiotics. I think the whole concept is an interesting one. On the retail commercial sense, it's been difficult for consumers to wrap their head around a probiotic and then also there's this concept called prebiotics and then again for people who are listening, a prebiotic is basically something that acts as a food for probiotics to feed on and grow and encourage growth even on their own. The issue that I have with a lot of products that combine probiotics and prebiotics, whether it's FOS, GOS, XOS now is another one that's used. Now these are basically complex sugars. Really, for all intents and purposes, kind of fibers. All of the FDAs now said that they are probably not gonna qualify to make the cut. The problem is that if you look at the studies on the prebiotics, the dosages are way higher than what you're gonna put into a capsule. There are some probiotic products that I've seen that have ... that are powders or that are in the sachets where you can actually get the prebiotic up to a dose that actually has any meaningful effect clinically. So remember with prebiotics, we're rack out a low of a gram and many of the studies were as high as 10 to 15 grams. So again, really important to sort of ... And I know this is a challenge for people who are in clinical practice because they're trying to treat some patients with what they think is the best, but it's really an issue of, again, getting back to sort of ... Does the company make an attempt to sort of match up the dosage of the prebiotic that actually showed an effect, a positive effect on probiotics? And that's a challenge. That your delivery yet [inaudible 00:31:50] in capsules, it's under dose. You don't get enough of the prebiotic. Gazella: Yeah, that's really interesting because I was not aware of that. So, that's a good heads up there. Now you talked about safety, but are there any contraindications that clinicians should be aware of? Direct contraindications that says, "This patient should not be on probiotics"? Brown: The area that I'm most cautious about ... I used to think it was premature infants, very low growth weight infants, but there's been enough research. When you ask, probably why the other thing too, that would be our [inaudible 00:32:24] list of things that have really reached critical masses, prevention of what's called Necrotizing Enterocolitis and in very low growth rate entrance ... fascinating and it worked. It's basically saving lives is what we are talking about. The death rate from that is quite high. So used to saying, "Hey, these kids are born ... GI tracts not really developed." That's a potentially dangerous use in that population. The answer to that is "No, actually. It's actually good." I would still continue to encourage on healthcare professionals to be very selective in strains that they use in people ... HIV positive, AIDS, people with really severe immune deficiencies. Cancer patients who ... technically more advanced cancer. Be very selective and try to get to the best of their possibility, look at the data and say, "Okay, this is strain that actually was used in that population and works." That would not ... Those two populations are ... that collection of population severely immunocompromised people is not one that I could, probably just use any probiotic supplement. Particularly multi-strain, high potency without doing any sort of research. I'm very selective and usually do one strain or two strains in that population that I feel have enough safety data. Gazella: Yeah, that's good advice. Anything else that you'd like to add on the topic of probiotics for listeners that you'd like to leave them with? Brown: Again, I just think that it very, very important to first and foremost, and I'm repeating myself. First and foremost look at if you're using it for specific use. We didn't even get into female genital urinary tract health nursing. Really amazing stuff going on in that area. Your oral use of probiotics to actually, finding that they're populating in the vagina and that you're getting significant effects, which is amazing. We used to think you'd have to use everything with ... through a vaginal, pessary type of an effect. So that's it. I think again, trying as much as possible to deal with companies that are trying to ... that are working with strain suppliers or strain suppliers that are manufacturing products for them that are looking at the essentials that we talked about at the beginning. It's really, really important to me. And also again, trying to insist that companies refer back to the data on specific strains as opposed to just saying "It doesn't matter, you can use anything you want." I'm horrified when I go to professional lectures and I hear ... For instance, medical doctor getting up and saying that it's [inaudible 00:35:14]. So it goes against every thing that is accepted in the probiotic world. So, again, a lot of white noise in this area. Healthcare professionals are going to be as susceptible to it as consumers are but that's a couple of areas where I think you can sort of cut through that and try to get to what really has been shown to be effective and safe. Gazella: Yeah. I mean, it's a big topic for sure. We're going to have you back to dig in a little bit more deeply on some of these topics, but I want to thank you for definitely shedding some light on this important topic, and helping us get through it. And I'd also like to once again thank the sponsor of this topic, who is Allergy Research Group. So Dr. Brown, thank you again for giving us all this wonderful information and I hope you have an awesome day. Brown: Thank you Karolyn.

The Asia-Pacific probiotics market is the largest globally, accounting for an estimated share of 38 percent in 2016. Part of this can be attributed to increasing awareness of the benefits of probiotics, and George Paraskevakos, executive director of the International Probiotics Association, joins us to discuss the consumer trends, popular products and innovation shaping the probiotics market in Asia.