Facts: Probiotics & LBPs

Probiotics 101

Probiotics are live microorganisms, such as bacteria and yeast, that can provide health benefits to the host, if consumed in adequate amounts. They are commonly found in fermented foods (e.g., kimchi, sauerkraut), dietary supplements and functional foods (e.g., yogurt, kefir). Common probiotic strains include Lactobacillus rhamnosus, Lactobacillus reuteri, Escherichia coli Nissle 1917, and Bifidobacterium bifidum.

It is important to note that the efficacy of probiotics is not consistent in different individuals. Our personal gut microbiomes vary, which means that we may require different species to benefit our gut health. Furthermore, recent evidence reveals that our lifestyle, geography and culture can greatly influence our microbiome. For example, the westernized lifestyle dramatically alters the gut microbiome compared to non-westernized individuals.¹

Downsides to Probiotics & LBPs

While probiotics & LBPs have the potential to support gut health, digestion and immune function, several fundamental issues have limited their success and therapeutic potential.

At the core of the downsides to probiotics are the biological barriers that prevent them from delivering their natural benefits:

Weak Engraftment & Poor Colonization

Probiotics & LBPs often fail to establish long-term residence in the intestines. Gut inflammation and the overgrowth of harmful microbes disrupt their ability to engraft and persist, leading to transient or negligible benefits.

Lacking Strong Clinical Efficacy

There are conflicting evidence regarding the clinical efficacy of probiotics.²'³ Some individuals are naturally more resistant to probiotics, based on their existing microbiome.⁴ In those with chronic diseases such as IBD, probiotics have shown little to no benefit in reducing remission in patients.⁵ Additionally, many clinical studies vary in design and rely on subjective reports, making it difficult to draw conclusions regarding on their efficacy.²'⁶

These challenges underscore the need for more advanced, scientifically validated approaches for microbiome-based therapeutics.

Many issues with probiotics and LBPs stem from poor product design, inadequate manufacturing and weak regulatory oversight:

Poor Viability

Loss of potency before reaching consumers because manufacturing processes fail to maintain long-term shelf life, resulting in a significant loss of Colony Forming Units (CFUs)

Inability to Survive Transit to Gut

Many products cannot survive the harsh environments during gastrointestinal transit (e.g., stomach acid, bile, digestive enzymes), preventing them from delivering their intended benefits

Inaccurate Label Claims

Over 48% of probiotics marketed as drugs or dietary supplements contain fewer viable cells than claimed, and over 40% do not even contain the microbial strain listed on their products.⁷

These issues highlight the flaws in how probiotics are produced, regulated and delivered to consumers.

Globally >48% of human commercialized products have fewer viable cells than claimed, and >40% are not even the microbial strains claimed. ⁷

Key Terms to Know

Prebiotics: non-digestible fibers that are a food source for beneficial bacteria - what does the good bacteria need to grow?

Probiotics: live microorganisms that provide health benefits when consumed - the actual microbial strains

Postbiotics: specific compounds produced by the probiotics (e.g. short-chain fatty acids, enzymes, popyphenols) - what beneficial products are produced by the microbes?

Live Biotherapeutic Products (LBPs): microbial-based drugs designed to target specific diseases, regulated as a pharmaceutical

How Do LBPs Differ From Probiotics?

Live Biotherapeutic Products (LBPs) are therapeutic microorganisms that are developed for the purpose of treating specific diseases. Unlike probiotics, LBPs are considered drugs, therefore they must go through rigorous clinical testing and regulatory approval.

Feature	Probiotics	Live Biotherapeutic Products (LBPs)
Regulation	Dietary supplement, not well regulated	Regulated as a drug (FDA, Health Canada, etc.)
Examples	Yogurt, kombucha, supplements	Rebyota®, VOWST™
Purpose	Generally improve gut health	Targets specific diseases
Scientific Evidence	Inconsistent – efficacy is variable	Clinical trials show varying efficacy

Feature	Probiotics	Live Biotherapeutic Products (LBPs)
Regulation	Dietary supplement, not well regulated	Regulated as a drug (FDA, Health Canada, etc.)
Examples	Yogurt, kombucha, supplements	Rebyota®, VOWST™
Purpose	Generally improve gut health	Targets specific diseases
Scientific Evidence	Inconsistent – efficacy is variable	Clinical trials show varying efficacy

Feature	Probiotics	Live Biotherapeutic Products (LBPs)
Regulation	Dietary supplement, not well regulated	Regulated as a drug (FDA, Health Canada, etc.)
Examples	Yogurt, kombucha, supplements	Rebyota®, VOWST™
Purpose	Generally improve gut health	Targets specific diseases
Scientific Evidence	Inconsistent – efficacy is variable	Clinical trials show varying efficacy