The Science, Microbes & Health Podcast 

This podcast covers emerging topics and challenges in the science of probiotics, prebiotics, synbiotics, postbiotics and fermented foods. This is the podcast of The International Scientific Association for Probiotics and Prebiotic (ISAPP), a nonprofit scientific organization dedicated to advancing the science of these fields.

Episode 7: Evidence for probiotic use in pediatric populations

/in Podcast, Season One /by KC

Podcast: Play in new window | Download

Subscribe: Apple Podcasts | Spotify | RSS

The Science, Microbes & Health Podcast 

This podcast covers emerging topics and challenges in the science of probiotics, prebiotics, synbiotics, postbiotics and fermented foods. This is the podcast of The International Scientific Association for Probiotics and Prebiotic (ISAPP), a nonprofit scientific organization dedicated to advancing the science of these fields.

Evidence for probiotic use in pediatric populations, with Prof. Michael Cabana

Episode summary:

In this episode, the ISAPP hosts discuss probiotics for pediatric populations with Prof. Michael Cabana, MD, MPH, from Albert Einstein College of Medicine and The Children’s Hospital at Montefiore. Prof. Cabana starts by acknowledging the gap between the demand for probiotic interventions and the evidence that currently exists for their efficacy. He gives an overview of the challenges in designing trials on probiotic interventions for children, and summarizes what the evidence shows to date.

Key topics from this episode:

  • A concerning gap exists between the strength of evidence for probiotic interventions in children and the high demand by parents for these interventions.
  • A clinician supports clinical recommendations if they are based on multiple high-quality randomized, controlled trials in different settings. Unfortunately, this level of evidence is often missing for pediatric interventions, including for probiotics.
  • A clinician is less concerned about what regulatory category (drug, supplement) a recommendation falls into, and more about the level of evidence supporting its use.
  • At a minimum, a clinician looks first for evidence of no harm.
  • Conducting clinical trials in children presents many challenges. What are the “5 Ds”, which make clinical studies in children different from those in adults, as described by Forrest in 1997?
  • A lot of adult diseases have roots in childhood, so understanding pediatric health is important not just for kids, but also for adults. Preventing adult disease starts at an early age. This is the ‘delayed payoff’ that Forrest refers to.
  • Compelling evidence exists for probiotic efficacy in children for a few endpoints: colic, antibiotic-associated diarrhea, and necrotizing enterocolitis.
  • When it comes to necrotizing enterocolitis, strong evidence, reproducibility, dose-response, and biological mechanisms are what give clinicians the confidence to use probiotics.
  • An individual patient data meta-analysis (a project that emerged from an ISAPP meeting), enabled combining data from numerous studies that looked at the probiotic L. reuteri DSM17938 given to babies with colic. An overall positive effect was seen. Factors that predicted success in infants were being formula-fed, being younger, and not being on proton pump inhibitors.

 

Episode links:

  • One of many reports on the growing market for probiotic products for infants and children 
  • Information about the 2003 Pediatric Research Equity Act (PREA) and the Best Pharmaceuticals for Children Act (BPCA) mentioned in the podcast 
  • The 5 “Ds” in Pediatrics mentioned in the podcast
  • The TIPS study mentioned in the podcast is described here and here
  • The meta-analysis on colic mentioned in the podcast

 

Additional resources:

ISAPP Digs Deeper into Evidence on Probiotics for Colic with New Meta-Analysis. ISAPP blog
Probiotics to Prevent Necrotizing Enterocolitis: Moving to Evidence-Based Use. ISAPP blog

 

About Prof. Michael Cabana, MD:

Prof. Michael Cabana, MD, MPH, is a Professor of Pediatrics & the Michael I. Cohen University Chair of Pediatrics at Albert Einstein College of Medicine, as well as Physician-in-Chief, The Children’s Hospital at Montefiore (CHAM). He is also a member of the United States Preventive Services Task Force USPSTF (here), a prestigious appointment for medical personnel to weigh evidence (risk vs. harms) on prevention interventions recommended in the United States. He is a clinical trialist (see the trials listed here), with a focus on allergy in children. He has also conducted trials using probiotic interventions. Prof. Cabana served on the ISAPP board of directors from 2008 to 2018. He has an MD from University of Pennsylvania, an MPH from Johns Hopkins, and an MA in business from Wharton Business School.

Dr. Cabana’s comments do not necessarily reflect the views of the USPSTF.

Episode 6: Mechanisms of action for probiotics

/in Podcast, Season One /by KC

Podcast: Play in new window | Download

Subscribe: Apple Podcasts | Spotify | RSS

The Science, Microbes & Health Podcast 

This podcast covers emerging topics and challenges in the science of probiotics, prebiotics, synbiotics, postbiotics and fermented foods. This is the podcast of The International Scientific Association for Probiotics and Prebiotic (ISAPP), a nonprofit scientific organization dedicated to advancing the science of these fields.

Mechanisms of action for probiotics, with Prof. Sarah Lebeer

Episode summary:

In this episode, the ISAPP hosts speak with Prof. Sarah Lebeer of University of Antwerp, Belgium, to bring clarity to a commonly misunderstood topic: probiotic mechanisms of action. They discuss how probiotic mechanisms are often multi-factorial and difficult to unravel scientifically. Nevertheless, Prof. Lebeer describes five distinct mechanisms of action by which a probiotic may benefit a host.

See ISAPP’s other podcast episode on mechanisms of action, with Prof. Maria Marco: Why mechanistic research on probiotics is captivating and important.

Key topics from this episode:

  • Probiotics are live microorganisms with documented health benefits; their mode of action is multifactorial.
  • Mechanism of action is crucial in the probiotic field. This knowledge helps scientists understand how probiotics interact with the human host and the microbiota. However, even if mode of action for a strain is known it can be difficult to translate it into measurable outcomes for the host.
  • Probiotics can benefit health by five main mechanisms of action applicable at different body sites (gut, vagina, skin, nose, etc.):
    1. Modulation of microbe-microbe interactions by inhibiting pathogens and promoting beneficial microbes. This is based on the production of metabolically active molecules, such as lactic acid. 
    2. Enhancement of mucosal barrier function through interaction with epithelial cells, promoting the integrity of the barrier. 
    3. Modulation of immune responses by interacting with various immune cells. Interaction with the immune cells is also the clearest strain-specific capacity of probiotics.
    4. Modulation of metabolic responses by modulating insulin resistance or cholesterol metabolism. This mode of action is novel, and research is emerging.
    5. Modulation of neurological signaling pathways. This is also a novel mode of action with new evidence building up.
  • Postbiotics can have similar modes of action, provided the active molecules are not inactivated.

 

Episode links:

The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic

 

Graphical summary of 5 main mechanisms of action for probiotics

(Image by Sarah Lebeer. Image copyright.)

 

Additional resources:

Current status of research on probiotic and prebiotic mechanisms of action. ISAPP blog
Importance of understanding probiotic mechanisms of action. ISAPP blog

 

About Prof. Sarah Lebeer:

Sarah Lebeer is a research professor at the Department of Bioscience Engineering of the University of Antwerp, Belgium. She has studied bioscience engineering, with a specialisation in cell and gene technology/food & health and obtained her Master at KU Leuven (Belgium). In 2008, she obtained a PhD degree with a topic on the mode of action of gastro-intestinal probiotics in inflammatory bowel diseases and a scholarship in the team of Prof. Jos Vanderleyden (KU Leuven). After a postdoc on the interaction between lactobacilli, viruses and mucosal immunology, in November 2011, she was offered a tenure track position at the University of Antwerp. Since then, she is leading the Laboratory for Applied Microbiology and Biotechnology of the ENdEMIC research group.

In 2020, she was awarded with an ERC Starting Grant that enables her to gain more in-depth knowledge of the evolutionary history and ecology of lactobacilli (https://www.lebeerlab.com). This rationale was also an important driving force to revise the Lactobacillus genus taxonomy with  a large international consortium. Within the ERC project, Sarah has also launched the Isala citizen-science project to gain new insights in the role of vaginal lactobacilli for women’s health (https://isala.be). Since 2018, Sarah is an academic board member of the International Scientific Association on Probiotics and Prebiotics (www.isappscience.org). Communicating about beneficial microbes and probiotics for experts and laymen is an important inspiration for her daily work. 

Episode 5: Prebiotics for animal health

/in Podcast, Season One /by KC

Podcast: Play in new window | Download

Subscribe: Apple Podcasts | Spotify | RSS

The Science, Microbes & Health Podcast 

This podcast covers emerging topics and challenges in the science of probiotics, prebiotics, synbiotics, postbiotics and fermented foods. This is the podcast of The International Scientific Association for Probiotics and Prebiotic (ISAPP), a nonprofit scientific organization dedicated to advancing the science of these fields.

Prebiotics for animal health, with Prof. George Fahey

Episode summary:

The hosts discuss prebiotics for animals with Prof. George Fahey, a prominent animal nutrition scientist who is currently Professor Emeritus at University of Illinois. Fahey explains how animal nutrition research relates to human nutrition research, and the changes in the field he has seen over the course of his long career. He describes the research on prebiotics for animal nutrition, covering both livestock and companion animals.

Key topics from this episode:

  • A short history of animal prebiotics research as well as future opportunities in animal nutrition.
  • Pro- and prebiotics are being explored as an alternative to antibiotic treatment in production animals. Antibiotics are overused, leading to an increase in antibiotic resistance; the “biotics” therefore have great potential in animal nutrition.
  • Probiotics can potentially be used instead of antibiotics to inhibit pathogens and support the gut microbiota in animals.
  • Prebiotics possibly have high nutritional value and beneficial effects in animals, especially in poultry and pigs.
  • There are limitations to using prebiotics in the animal industry, especially for some animals such as horses and ruminants.
  • There has been increased use of prebiotics for companion animals (pets) in the past few years. Now many pet foods contain prebiotics.
  • Benefits of using prebiotics in companion animals:
    •  Support digestive health
    •  Improve stool quality
    • Support the gut microbiota, which also translates to good stool quality
  • A short overview of how companion animals’ food is produced, and the timing of adding prebiotics.
  • Wild animals’ diet has low nutrition with limited to no prebiotic intake, resulting in a shorter lifespan in comparison with companion animals
  • Some take-home points from animal models and animal nutrition research.

 

Episode links:

Expert consensus document: The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of prebiotics
The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic

 

Additional resources:

Are prebiotics good for dogs and cats? An animal gut health expert explains. ISAPP blog post
Using probiotics to support digestive health for dogs. ISAPP blog post
Prebiotics. ISAPP infographic

 

About Prof. George Fahey:

George C. Fahey, Jr. is Professor Emeritus of Animal Sciences and Nutritional Sciences at the University of Illinois at Urbana-Champaign. He served on the faculty since 1976 and held research, teaching, and administrative appointments. His research was in the area of carbohydrate nutrition of animals and humans. He published numerous books, book chapters, journal articles, and research abstracts.

He currently serves on two editorial boards, numerous GRAS expert panels, and is scientific advisor to both industry and governmental organizations. He retired from the University in 2010 but continues to serve on graduate student committees and departmental search committees. He owns Fahey Nutrition Consulting, Inc. that provides services to the human and pet food industries.

Episode 4: Weighing evidence for probiotic interventions: Perspectives of a primary care physician

/in Podcast, Season One /by KC

Podcast: Play in new window | Download

Subscribe: Apple Podcasts | Spotify | RSS

The Science, Microbes & Health Podcast 

This podcast covers emerging topics and challenges in the science of probiotics, prebiotics, synbiotics, postbiotics and fermented foods. This is the podcast of The International Scientific Association for Probiotics and Prebiotic (ISAPP), a nonprofit scientific organization dedicated to advancing the science of these fields.

Weighing evidence for probiotic interventions: Perspectives of a primary care physician, with Prof. Dan Merenstein, MD

Episode summary:

In this episode, the ISAPP host Prof. Dan Tancredi discusses evidence for probiotic interventions with Prof. Dan Merenstein, MD, a family medicine researcher based at Georgetown University. They discuss what it means to practice evidence-based medicine, and what kind of evidence clinicians should look for when deciding whether an intervention is appropriate. Prof. Merenstein shares how probiotic evidence has strengthened in the past few decades, and gives tips on what to look for in a probiotic intervention study.

Key topics from this episode:

  • What is evidence-based medicine, and why is it important to practice it? Evidence-based medicine provides proper care for patients at the appropriate time by focusing on the existing evidence provided by clinical studies.
  • What is evidence, and how do we obtain a high level of evidence for probiotics? Evidence should come from well-designed clinical studies. Animal and in vitro studies provide supportive preclinical information and mechanistic insights.
  • The quality of probiotic research has improved in recent years. Compared with decades ago, studies are more likely to be high quality and more likely to be properly-powered. Such studies have provided a clearer sense of the circumstances under which probiotics may – or may not – provide health benefits.
  • What is the proper way to report clinical trials in the probiotic field? Focus on the rules for conducting a clinical trial: for example, CONSORT (see below). Compliance is also important for good outcomes.
  • How can a clinician evaluate if a patient should use an intervention? The focus should be on the evidence for each intervention, the potential harm of the intervention, and the positive and negative outcomes.
  • Evidence-based medicine also needs to account for regional differences and where the clinical studies have been performed. Evidence about probiotic effects needs to account for microbiome differences and lifestyle differences between countries.
  • For which indications do we now have actionable evidence for probiotic use?
    • Use of certain probiotics together with antibiotic treatment to prevent antibiotic-associated diarrhea
    • Use of an L. reuteri strain to reduce crying time for infants suffering from colic
    • Certain probiotics can help prevent traveler’s diarrhea or treat acute pediatric infectious diarrhea.
    • Probiotics to help with endpoints such as weight loss and metabolic syndrome, for autism and gut-brain indications, for skin conditions such as eczema and acne, and inflammatory bowel disease are active areas of research and soon scientists will have more answers.
  • Probiotic research is improving. Patients are using probiotics, and they are aware of the benefits of probiotics – Prof. Merenstein estimates that 80% of his patients are taking a probiotic. The job of the doctor is to get them to use probiotics in an evidence-based manner.

 

Episode links:

CONSORT (Consolidated Standards of Reporting Trials) establishes a well-accepted, evidence-based, minimum set of recommendations for reporting randomized trials.
IPDMA (individual patient data meta-analysis) – see this Sung et al. paper on infantile colic and L. reuteri
BB12: Bifidobacterium animalis subsp. lactis BB-12, a well-studied probiotic. See this paper.
A priori: without prior knowledge

 

Additional resources:

The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic

 

About Prof. Dan Merenstein:

Dr. Daniel Merenstein is a Professor with tenure of Family Medicine at Georgetown University, where he also directs Family Medicine research. Dr. Merenstein has a secondary appointment in the undergraduate Department of Human Science, in the School of Nursing and Health Studies. Dr. Merenstein teaches two undergraduate classes, a research capstone and a seminar class on evaluating evidence based medical decisions. He has been funded by the NIH, USDA, Foundations and Industry, for grants over $100 million. Dr. Merenstein is the President of the board of directors of the International Scientific Association of Probiotics and Prebiotics.

The primary goal of Dr. Merenstein’s research is to provide answers to common clinical questions that lack evidence and improve patient care. Dr. Merenstein is a clinical trialist who has recruited over 2,100 participants for 10 probiotic trials since 2006. He is an expert on probiotics, antibiotic stewardship in outpatient settings and also conducts HIV research in a large women’s cohort. He sees patients in clinic one day a week.

Episode 3: The science of fermented foods, part 2

/in Podcast, Season One /by KC

Podcast: Play in new window | Download

Subscribe: Apple Podcasts | Spotify | RSS

The Science, Microbes & Health Podcast 

This podcast covers emerging topics and challenges in the science of probiotics, prebiotics, synbiotics, postbiotics and fermented foods. This is the podcast of The International Scientific Association for Probiotics and Prebiotic (ISAPP), a nonprofit scientific organization dedicated to advancing the science of these fields.

The science of fermented foods, part 2, with Prof. Bob Hutkins

Episode summary:

Before listening to this episode, it’s recommended that you check out episode #1, The science of fermented foods, Part 1. In this episode, the hosts continue their discussion of fermented foods with Prof. Bob Hutkins, University of Nebraska – Lincoln. Prof. Hutkins elaborates on how the microbes associated with fermented foods may confer health benefits, as well as how food scientists choose strains for fermentation. He emphasizes how the live microbes in fermented foods differ from probiotics.

Key topics from this episode:

  • Why working in the field of fermented foods is exciting and rewarding
  • The challenges for scientists, especially when it comes to designing clinical studies with various fermented foods
  • The benefits of fermented foods – from being safe as well as nutritious, to the health benefits that live microbes present in the foods can provide
  • How microbes are selected for fermentation; companies focus on strain performance – i.e., good growth and survival to preserve the food and provide a desired flavor and texture
  • The activities of live microbes present in fermented foods, from initiating the fermentation process to benefiting human health
  • The differences between probiotics and live microbes in fermented foods
  • How live microbes in fermented foods might affect your gut microbiota and why some scientists believe that fermented foods are important for getting regular doses of live microbes

 

Episode links:

Microbiology and Technology of Fermented Foods, 2nd Ed., by Robert W. Hutkins
The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on fermented foods
The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic
Gut-microbiota-targeted diets modulate human immune status, study by Stanford researchers

 

Additional resources:

Expert consensus document: The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of postbiotics.
Postbiotics. ISAPP infographic
Fermented foods. ISAPP infographic
What are fermented foods? ISAPP video
Do fermented foods contain probiotics? ISAPP blog post
How are probiotic foods and fermented foods different? ISAPP infographic
Are fermented foods probiotics? Webinar by Mary Ellen Sanders, PhD

 

About Prof. Bob Hutkins:

Bob Hutkins is the Khem Shahani Professor of Food Microbiology at the University of Nebraska. He received his Ph.D. from the University of Minnesota and was a postdoctoral fellow at Boston University School of Medicine. Prior to joining the University of Nebraska, he was a research scientist at Sanofi Bio Ingredients.

The Hutkins Lab studies bacteria important in human health and in fermented foods. His group is particularly interested in understanding factors affecting persistence and colonization of probiotic bacteria in the gastrointestinal tract and how prebiotics shift the intestinal microbiota and metabolic activities. The lab also conducts clinical studies using combinations of pro- and prebiotics (synbiotics) to enhance health outcomes. More recently we have developed metagenome-based models that can be used in personalized nutrition.

Professor Hutkins has published widely on probiotics, prebiotics, and fermented foods and is the author of the recently published 2nd edition of Microbiology and Technology of Fermented Foods.

Episode 2: Why mechanistic research on probiotics is captivating and important

/in Podcast, Season One /by KC

Podcast: Play in new window | Download

Subscribe: Apple Podcasts | Spotify | RSS

The Science, Microbes & Health Podcast 

This podcast covers emerging topics and challenges in the science of probiotics, prebiotics, synbiotics, postbiotics and fermented foods. This is the podcast of The International Scientific Association for Probiotics and Prebiotic (ISAPP), a nonprofit scientific organization dedicated to advancing the science of these fields.

Why mechanistic research on probiotics is captivating and important, with Prof. Maria Marco

Episode summary:

In this episode, the ISAPP hosts discuss probiotic mechanisms of action with Prof. Maria Marco, University of California, Davis. Prof. Marco is a well-known probiotic researcher with special expertise in food-associated lactobacilli. Here she explains how studying probiotics in food science can lead to fundamental insights in biology. She shares why it’s important to understand probiotic mechanisms of action, and describes how scientists go about identifying which compounds or pathways are important for probiotic health effects.

Key topics from this episode:

  • The search for probiotic mechanisms of action: why this research is essential and the added value of this type of research for the end consumer.
  • What we now understand about probiotic mode of action: probiotic mode of action for different strains is mediated by multiple working mechanisms, from cell-wall-associated molecules to bacteriocin production and metabolite synthesis.
  • How researchers set the stage for studying probiotics’ mode of action, from large scale screening, to molecular techniques focusing on single molecules and genome comparisons between strains.
  • Whether we need to apply something similar to Koch’s postulates when talking about the effects of probiotics.
  • The potential effects of food or delivery matrix on a probiotic mechanism of action.  
  • What we can learn from the postbiotic research, which can help inform probiotic mechanisms of action.
  • The most exciting developments in probiotic mode of action research in the past 10 years and the future of this area of research.

 

Episode links:

The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic
Prof. Marco refers to two of her mentors, Willem De Vos and Michiel Kleerebezem
See this overview of Koch’s postulates

 

Additional resources:

Bacterial genes lead researchers to discover a new way that lactic acid bacteria can make energy and thrive in their environments, ISAPP blog post featuring recent work from Prof. Marco’s lab

 

About Prof. Maria Marco:

Maria Marco is a Professor in the Department of Food Science and Technology and Chair of the Food Science Graduate Group at the University of California, Davis. She received her PhD in microbiology from the University of California, Berkeley and then was a postdoc and project leader at NIZO Food Research, The Netherlands. Dr. Marco has 20 years’ experience investigating fermented foods, probiotics, and diet-dependent, host-microbe interactions in digestive tract. Her laboratory at UC Davis is broadly engaged in the study of food and intestinal microbiomes and the ecology and genetics of lactic acid bacteria. 

Episode 1: The science of fermented foods, part 1

/in Podcast, Season One /by KC

Podcast: Play in new window | Download

Subscribe: Apple Podcasts | Spotify | RSS

The Science, Microbes & Health Podcast 

This podcast covers emerging topics and challenges in the science of probiotics, prebiotics, synbiotics, postbiotics and fermented foods. This is the podcast of The International Scientific Association for Probiotics and Prebiotic (ISAPP), a nonprofit scientific organization dedicated to advancing the science of these fields.

The science of fermented foods, part 1, with Prof. Bob Hutkins

Episode summary:

The hosts discuss fermented foods with Prof. Bob Hutkins, University of Nebraska – Lincoln. Prof. Hutkins wrote a popular textbook on fermented foods and has had a 40-year career in fermentation science. He shares why he ended up in fermentation science, as well as how fermented foods are made and how important live microbes are for their health benefits.

Key topics from this episode:

  • What fermented foods are
  • The scientific consensus definition published by ISAPP
  • Fermentation processes and practices used in early times and still used today
  • The benefits and safety of fermented foods, as well as the difference between fermentation and food spoilage
  • The live microbes present in fermented foods, how many are present, and their potential health benefits
  • Why some fermented foods have live microbes and others do not; and how even when live microbes are absent due to heat treatment, for example, these products may still be classified as fermented 
  • The differences between fermented foods, probiotics, and probiotic fermented foods

 

Episode links:

Microbiology and Technology of Fermented Foods, 2nd Ed., by Robert W. Hutkins
The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on fermented foods
The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic
Synbiotics: Definitions, Characterization, and Assessment – ISAPP webinar featuring Prof. Bob Hutkins and Prof. Kelly Swanson

 

Additional resources:

Fermented foods. ISAPP infographic
What are fermented foods? ISAPP video
Do fermented foods contain probiotics? ISAPP blog post
How are probiotic foods and fermented foods different? ISAPP infographic
Are fermented foods probiotics? Webinar by Mary Ellen Sanders, PhD

 

About Prof. Bob Hutkins:

Bob Hutkins is the Khem Shahani Professor of Food Microbiology at the University of Nebraska. He received his Ph.D. from the University of Minnesota and was a postdoctoral fellow at Boston University School of Medicine. Prior to joining the University of Nebraska, he was a research scientist at Sanofi Bio Ingredients.

The Hutkins Lab studies bacteria important in human health and in fermented foods. His group is particularly interested in understanding factors affecting persistence and colonization of probiotic bacteria in the gastrointestinal tract and how prebiotics shift the intestinal microbiota and metabolic activities. The lab also conducts clinical studies using combinations of pro- and prebiotics (synbiotics) to enhance health outcomes. More recently we have developed metagenome-based models that can be used in personalized nutrition.

Professor Hutkins has published widely on probiotics, prebiotics, and fermented foods and is the author of the recently published 2nd edition of Microbiology and Technology of Fermented Foods.