Concept of healthy microbiome gaining acceptance among MDs
The event, hosted by NutraIngredients-USA's parent company William Reed, brought together more than 200 scientists, regulators, formulators, marketers and brand holders in Chicago. It featured a first for the probiotics space, a presentation by regulators from five national and international bodies: FDA, Health Canada, EFSA, Food Standards Australia New Zealand (a joint standards-development body) and ANVISA, Brazil’s supplement and foods regulatory body. It is the second iteration of the event in North America. Next’s year’s event is scheduled to be held in San Francisco, June 7-9, 2017.
Dr Robert Martindale, MD, PhD, brought a unique perspective to the program. Dr Martindale in his various stops in his medical career has advocated for the clinical use of probiotics. Much of that advocacy involved educating his fellow physicians who have been trained that microorganisms are bad and must be killed at every opportunity. Dr Martindale is currently professor of surgery and chief of the division of general and gastrointestinal surgery at Oregon Health & Science University in Portland.
Clinical uses rises but data still deficient
Dr Martindale said the clinical use of probiotics in the USA has risen exponentially in the past five years but widespread support is hampered by the lack of randomized prospective studies. A lack of strain-specific data sets or dose response, poor understanding of the clear links to mechanism and general misinformation about probiotic products and their therapeutic uses have limited their routine adoption by clinicians. But things are changing for the better, Dr Martindale said. The very fact that he was at the event was a sign of progress.
“You don’t expect a trauma surgeon to up here talking about the microbiome,” he said.
Dr Martindale said much of physician’s hesitancy about probiotics is an outgrowth of their general lack of nutritional knowledge. Even today physicians get very little in the way of nutrition education in their medical school curriculums, he said. His mission is to bridge that gap, and to help hospital staffs see that nutrition, and a healthy microbiome, is a critical part of getting better outcomes in recovery from surgery.
“In the 70s and 80s we were giving intravenous feeding because we thought we knew better than Mother Nature,” Dr Martindale said. The fluid consisted of food broken down into its consistent nutrients, and was meant to nourish the body’s cells and bypass digestion altogether. But the practice proved to suppress the immune system.
“What we found is that those people who got intravenous feeding got many more infections,” he said.
Safety more accepted
Dr Martindale said the notion that probiotics are safe is becoming more accepted among physicians and that fewer of them believe that administering them is akin to spraying a superbug around the operating room. More is now know about how quickly the gut reacts to injury to the host organism, and dealing with those changes, or perhaps even heading them off at the pass, will lead to better outcomes, he said.
“We think now that literally within minutes of an injury the microbiome starts to change. The bacteria will change their phenotypes,” he said. These changes can even lead helpful bacteria to change to become harmful, in effect drilling into the intestinal wall in an attempt to survive the stormy season of trauma to the host organism.
While there is still much ignorance and resistance on the part of physicians, Dr Martindale said change will continue to be driven by patients.
“The future will be driven by the public because it is difficult for physicians to change. I’ve even had a patient come up to my asking me what I intend to do about his microbiome when I operated on his pancreatic cancer.”
