10/11/2018 10:32 EDT | Updated 10/11/2018 10:33 EDT

How To Navigate Through The Probiotic Paradox

If you are thinking of going the probiotic route to wellness in Canada, there are three things you need to look for in a product.

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At one time, the basis for medicinal health treatments came down to two simple words, "It works." If something seemed to be effective, then there was a good likelihood everyone would benefit. But that view has changed over the centuries and we've come to learn this simple approach is for the most part unacceptable.

Today, new medical treatments must pass several hurdles both in the lab and through clinical trials. These controlled and highly structured human experiments assess the safety and effectiveness of a particular drug or treatment. The result is compared to that of a negative control – a placebo – or another product or method already in use. In the latter case, if the outcome is better than the traditional option, known as noninferiority, there's a solid chance for acceptance by governments and the general public.

In most cases, clinical trial success usually means smooth sailing. However, in some cases, this achievement isn't the end of the struggle. This problem usually arises when the product isn't a single entity like a drug or a surgical procedure but rather a compilation of many different types of health options coined into one type of intervention, such as diet, exercise, vitamin supplementation, and beauty.

We've seen this problem arise quite a bit over the last few years. We've heard of contradictions in trials dealing with coffee consumption, vitamin D supplementation, certain traditional techniques such as acupuncture, and various diet fads. When this happens, the public is left wondering which one if any can be believed.

One of the more contentious dilemmas is the use of probiotics. According to the definition, these are live microscopic organisms that are ingested to provide a health benefit. From a marketing perspective, this is a great description as it is both vague and enticing. As a result, an entire sector of health options have arrived all in the name of health improvement. You can buy probiotics as supplements, purchase food items that contain probiotic species and even acquire cosmetics made with byproducts from bacteria considered to be probiotic.

Probiotic yogurt, drink and pills.

But do they work? That's been a highly debated issue. There is a split between two groups. One believes in the value of probiotics while the other feel they are a waste of money. The arguments have been going on for years and don't seem to be slowing.

To set themselves apart, some probiotic companies have gone the extra mile and tried clinical trials much like medicines to show their products work in large populations. In this case, they choose one species of bacteria at one concentration, and compare the results to a placebo. One might expect this to help the cause but even this approach has its problems.

A recent examples is the claimed ability of probiotics to help fight the common cold. Last year, a study from a group of researchers and company scientists suggested that probiotics may be able to reduce the extent of symptoms during infection. However, earlier this year, many of the same researchers revealed the exact opposite result revealing the same probiotic bacteria had no effect. Instead, as they pointed out, the nature of the individual's own nasal microbial population determined how bad a person suffers.

While this is outcome is becoming more common, it does little for the public who must try to navigate through the studies and determine which side is right. Unfortunately, the lack of certainty in the science tends to lead people to take one of two different paths. The first is to forego the option and learn to live without the implied benefit. The other is to ignore the science and just go with whatever feels right. Both of these are not particularly good choices but some may feel it's all they have.

There is, however, a third path. One can first identify the mechanism of action. It's what sets drugs and other pharmaceuticals apart from wellness options. Before these molecules can even see the light of a clinical trial, researchers must first determine how they work inside the body. When this information is known with certainty, then it can move to clinical trials and eventual acceptance.

Last week, a group of researchers decided this mechanistic approach is needed for probiotics. In order to gain the confidence necessary for community trust in a product, scientists need to figure out what is happening at the molecular level and then develop an understanding of the mechanism behind the benefits both at the cellular as well as the human level. Only then can successful products be seen in a positive light and unsuccessful ones kept off the shelves.

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Thankfully, some probiotic companies have already taken this approach and shown both the mechanism of action and successes in clinical trials. Admittedly, they are rare in the overcrowded market but they do exist. Finding them is a matter of heading to their websites and learning not just what the products do but how. The few who have followed this two pronged approach are happy to share both the mechanism of action and how that benefits health and wellness.

If you are thinking of going the probiotic route to wellness in Canada, there are three things you need to look for in a product. The first is that mechanism of action. The second is the reporting of clinical trial success. The third is to look for a Natural Product Number. It's the official licence for the product in this country and shows it has gone through proper government testing. More importantly, it allows you the chance to see exactly what benefits you can get. All you need to do is head to Health Canada's Licensed Natural Health Product Database and look up the product number. You'll learn of what the product can - and cannot - do for you.

Figuring out how to stay healthy in today's world is not easy as the onslaught of companies trying to sell you on their vision of wellness is difficult to ignore. However, knowing the mechanism of action may be the best way forward for probiotics and other products as well. This approach can give us a chance to go beyond the traditional and uncertain, "It works," mentality to a more sure position based on the equally simple but so much more important phrase, "How it works."

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