Data published in the Mexican Journal of Gastroenterology indicated that both groups of healthcare professionals were aware of and familiar with the probiotic concept, personally recommended them often to patients, and also believed they are safe.
The vast majority of nutritionists (98%) and gastroenterologists (97%) stated that probiotics are effective for managing digestive symptoms, and are considered a safe therapeutic tool without major adverse health risks.
Of those nutritionists and gastroenterologists asked, 211 of gastroenterologists (64.92%) and 245 of the nutritionists (76.08%) knew the definition of probiotics by the Food and Agriculture Organization (FAO) of the United Nations. In total, 64.9% always recommend probiotics, 31.7% rarely did and 3.6% never did.
Probiotics product features
Scientists from the National Institute of Medical Sciences and Nutrition Salvador Zubirán and the Mexican Social Security Institute also identified and relayed the most important features in products to influence a probiotic prescription. Firstly the specific strain analyzed in a clinical study for the specific symptom or disease is key, followed by the wide availability and accessible price of the product.
Whether it contains a greater variety of strains and the number of live microorganisms is next, before the quality control and ethics of the industry or company that produces the probiotic product is considered. Next, product cost and presentation will be evaluated.
Treatment versus prevention
Disparities between the reasons for recommending probiotics differ between nutritionists and gastroenterologists, however. While the majority of gastroenterologists (56.5%) believe probiotics are effective in the treatment of diseases, only 35.5% of nutritionists affirm this view. On the other hand, the larger percentage (39%) of nutritionists and only 21.5% of gastroenterologists agree that probiotics are required to maintain a good state of health.
Over 80% of respondents in both areas of clinical practice relayed the belief that probiotics are useful for a number of treatments, including irritable bowel syndrome, acute diarrhea and antibiotic-associated diarrhea.
However, both groups did not consider them useful in the treatment of other healthcare conditions, including idiopathic chronic ulcerative colitis, Crohn's disease, pouchitis, radiation enteritis, necrotizing enterocolitis or in infant colic.
Using probiotics for the treatment of chronic constipation was agreed as a recommend prescription practice by 83.49% of nutritionists and 65.01% of gastroenterologists. Yet, while the majority of gastroenterologists recommend probiotics for treating pseudomembranous colitis due to Clostridium difficile, 52.04% of nutritionists agree that probiotics are useful in treating this infection.
The cost of probiotics was cited as the leading reason for nutritionists (27.6%) and gastroenterologists (19.7%) not to recommend products.
In addition, 18.8% of gastroenterologists do not recommend probiotics as they state that the evidence is insufficient to support its use, while 7% do not because they do not know the scientific evidence on the use of probiotics. Of those asked, 213 nutritionists (66.14%) and 147 gastroenterologists (50.34%) reported the personal consumption of probiotics.
Results from the study show that the “concept that probiotics are beneficial in health and disease states has permeated in health professionals”. An increase in the market and sales of probiotics around the globe and the media awareness of probiotics are considered key influences impacting the support and uptake of probiotics.
However, in over 80% of products recommended, nutritionists and gastroenterologists are unaware of the probiotic strain within the commercial product. The study warns that in the future, this may create an undesirable prescription pattern that may lead to therapeutic probiotic failures.
Emphasizing education and information
Moving forward within the probiotics sphere, the study emphasizes that probiotics understanding and the benefits they provide in health and disease conditions, through information and guidance, needs to be the priority.
At present, there is “partial ignorance of the scientific evidence and clinical guidelines about the efficacy of probiotics in digestive disorders”, and as such, recommendations are made without knowing probiotic strains contained within the product.
Medical educational programs continue to be powerful resources that need to be promoted, along with the need for clear clinical guidance on appropriate use practices of probiotics in Mexico.
The survey, which is described as the first-of-its-kind, aimed to explore and assess both the use and prescription of probiotics made by nutritionists and gastroenterologists in Mexico. Additionally, the study strived to investigate the most commonly used probiotics in Mexico, along with the recommendations for their use by nutritionists and gastroenterologists working in the country.
To gauge levels of industry knowledge and understanding of the use of probiotics and experience in prescribing the live microorganisms for gastrointestinal diseases, the study’s researchers sent an online questionnaire survey to members of professional industry bodies, including the Mexican Association of Gastroenterology, the Mexican Association of Nutritionology, and healthcare professionals registered at the Fourth International Symposium: Intestinal Microbiota.
The electronic survey measured the demographic characteristics of respondents, including their gender, age, specialist field, level of education, type of practice they work in and the patients they treat.
Using cloud-based software, Survey Monkey, the researchers delved into the pattern of probiotic prescription recommendations in relation to the “frequency of recommendation, justification for prescription, indications, recommended strains, commercial products of greater prescription, more important characteristic of the probiotic for its recommendation, perception of safety of probiotics and personal use of these Agents”.
A total of 997 surveys were answered, which amounted to a 34% response rate. Of these, 570 were women (64%) and the average age of the respondents asked who were between 18-83 that answered was 36.2 years.
Of all the healthcare practitioners asked, nutritionists provided the highest number of answers at 453, providing 46% of the survey results. This was followed by gastroenterologists at 382 (36%), and then chemical, microbiologist and other practitioners at 162 (18%).
Market outlook in Mexico
Speaking to NutraIngredients-LATAM, Lumina Intelligence’s Market Analyst, Emer Mackle, revealed that “in Mexico, 69 out of 86 captured probiotic supplements by Lumina Intelligence claim to benefit digestion”. In July 2019, “digestion was the most engaged health benefit in Mexico receiving the most online reviews (393 reviews)”, Mackle added.
“Immunity is also an engaged health benefit as the nine supplements Lumina Intelligence captured in Mexico claiming to help immunity achieved a total of 165 online reviews in July 2019,” Mackle shared.
Throughout Mexico, there is a lack of knowledge of the microbial composition of probiotic products. The awareness and promotion of probiotic products are present among most gastroenterologists and nutritionists in Mexico. Yet, there is a viable and large opportunity to invest in and promote education around the probiotic products themselves in terms of their uses, benefits and lack of side effects.
Source: Mexican Journal of Gastroenterology
Volume 84, Issue 3, July – September 2019, Pages 303-309, doi: 10.1016/j.rgmx.2018.05.004
“Probiotic use in clinical practice: Results of a national survey of gastroenterologists and nutritionists”
Authors: L.R. Valdovinos-García, et al.