Over 50% of dietary supplement users trust a medical doctor/physician for advice and support regarding supplements, but it is well established that many physicians and other healthcare practitioners do not have a good understanding of the role of nutrition, let alone the emerging science around ingredients like probiotics, prebiotics and postbiotics.
The IPA World Congress + Probiota Americas, which took place June 10 to 12 in Salt Lake City, featured a discussion on how best to engage with healthcare practitioner to further understanding and acceptance of probiotics, prebiotics and postbiotics.
Dr. Chris Oswald, DC, CNS, head of medical affairs at Atrium Professional Brands, Nestlé Health Science, noted that he has been trying to understand how to better communicate around supplements and microbiome modulation for a long time.
“The ideas, whether you're a medical doctor, or naturopathic doesn't really matter,” he said. “It matters where you are in your general understanding of these spaces. In every single health profession, there are people that have drunk the Kool Aid, and they are as far down the rabbit hole as you can imagine. And you can just sit there and say one thing, and you get to learn from them. So, the idea is more identifying where they are in that level of understanding.”
Dr. Dan Merenstein, professor of family medicine at Georgetown University, said that the level of understanding around the microbiome is not really the question. "You don't need to know what causes Alzheimer's to treat Alzheimer's," he said. "The doctor just wants to know the clinical outcome, and I think we're already there. I mean, I think for antibiotic-associated diarrhea, or IBD, maybe IBS, it is the standard of care to use a probiotic."
Panel discussion
The hour-long panel discussion, which also featured Dr. Emanuele Chisari, MD, PhD, chief medical officer at Parvizi Surgical Innovation, and Sandra Saville, RD, director of education and communication at the International Probiotics Association (IPA), led to three main conclusions on how to better engage the healthcare practitioners:
- Be honest about the evidence and label the products accurately.
- Engage with primary care physicians.
- Publish the findings in peer-review medical journals.
Be honest about the evidence and label the products accurately
Dr. Chisari said that the quality of probiotic studies has improved over time but that the reality is that a lot of the research out there is very poor.
"This is something that confounds the few clinicians who maybe spend the time to research the literature: They're going to see from papers in Nature, for example, saying that GG [Lacticaseibacillus rhamnosus GG]—or whatever other probiotic—doesn't work for [a specific] application. And then I'm going to see the same strain in maybe a lower tier journal saying it works. So now the question starts to arise, how we can do better?"
"I think we have to be honest with where the evidence is," said Dr. Merenstein. "And if we’re not, then I think that that looks bad on everyone, and that puts us back years."
Dr. Merenstein co-authored a 2019 paper that reported that over 60% of probiotic supplements in the U.S. may lack sufficient information on their labels to allow consumers to make informed decisions.
"I think that when that when the consumer or my patient goes to Whole Foods or CVS, they should be able to tell what the evidence is, but I still see lots of people bringing their probiotic that has no published evidence," he said.
When asked if he has plans to repeat the 2019 analysis, Dr. Merenstein said he cannot imagine the situation has changed much, but it may be worthwhile to re-do the study to check.
Engage with primary care physicians
Another major take home was on engaging with primary care physicians. Dr. Merenstein said that it feels like industry is obsessed with gastrointestinal doctors. "And I really don't understand why, because primary care doctors are the ones that talk to patients about nutrition," he said. "I love GI doctors, but they're not really trained to do nutritional tasks.
"I’m the president of ISAPP and we’re having the same issues. We, for some reason, key in on GI doctors, and maybe it's because they did more research than primary care doctors, but I would put a shout out for primary care doctors: I think they're the ones who intuitively believe in alternative medicine and supplemental medicine, so I think they need to be reached out to."
IPA’s Saville added: “I'd say educational empowerment for all health professionals is important. In terms of doctors, yes, everything in terms of your health, medications, people should be conversing with their doctor. However, if you think about the stages of life, you've got everything from the pregnant woman to the OBGYN right through to geroscience.
"In terms of every specialty for physicians, let's get everyone involved."
Publish the findings in peer-review medical journals
The last big lesson from the panel was the need to publish microbiome modulation science in the big medical journals. Dr. Merenstein pointed to findings from a multicenter randomized placebo-controlled trial presented earlier in the conference by Dr. Richard Day from ADM on pro- and postbiotic use in adults with IBS D, commenting, "when you have articles, articles like that should be in JAMA."
Dr. Merenstein also noted research from Dr. Greg Leyer from Novonesis, who was in attendance in Salt Lake City. “I've talked to [Greg], and he has the most amazing article about colds. We just have nothing in clinical medicine for colds," he said. "Of course, those articles should be in the New England Journal, if they're legit.
"It's worth the time, but we have to be honest when we have some of the things we present here are not really clinical evidence yet."