Miraculous probiotics? Take claims with a pinch of salt, says study

A new study published in the magazine. Frontiers in medicine warns the public against believing and acting on probiotic information online because most of the websites that offer such information are unreliable and their sources are doubtful.

The researchers say Google does a good job selecting and promoting the best quality websites when a consumer uses its search function. However, this does not change the fact that most sites that offer information on probiotics are commercial, backed by commercial or news media for the sake of profit. Researcher Pietro Ghezzi says that, as a result, “these provide the least complete information, in terms of not discussing possible side effects or regulatory problems.”

In addition, they claim many benefits for probiotics in diseases for which the evidence is not of high quality or has been collected from studies in mice instead of clinical trials in humans.

3d illustration of intestinal bacteria Credit: nobeastsofierce / Shutterstock

What are probiotics?

Probiotics are beneficial living organisms that can improve health status when taken internally in adequate amounts, both in general and in specific diseases. They are now available without a prescription in hundreds of different formulations.

Many millions of Americans use probiotics for a variety of health and illness indications, with a market value of $ 40 billion in 2017. However, because advertising regulations for products that claim to have health benefits are stricter in the US UU., The European market is smaller. However, the consumer base of these products is constantly increasing, due to the global increase in the sale of products online.

This prompted the study based on the large volume of health claims often exaggerated for probiotics presented by online sites and the media. The indication was to evaluate the accuracy of the news and the information that the average member of the public could hear, see or read through an online search.

The study

The purpose of the study was to examine what would happen if the word probiotics were written in a Google search box. The first 150 pages were examined with reference to their online location, such as commercial, news, government, health portal and professionals, making 8 categories in total.

The researchers then analyzed the quality of health information on the site, based on two criteria: the JAMA score and the HONcode certification. The JAMA score is based on four elements:

  • The authors are named
  • Publication date
  • The website owner is indicated
  • Reference is made to the sources.

The Health-On-the-Net (HON) code is assigned by an independent Swiss organization that evaluates the reliability and credibility of health information presented online using 8 criteria, ranging from the author’s credentials and the type of information, Up to relevant quotes, justifiability, transparency (indicating editor and webmaster with contact information), financial disclosure and separation of real content ads clearly.

The diseases and pathological or physiological processes mentioned in the mentioned web pages were listed below.

The organisms mentioned as probiotics were listed.

Then, they evaluated whether the site gave complete information, using four criteria:

  • if scientific references were given
  • warns that the evidence was not always solid for all the probiotic benefits proposed
  • safety problems with probiotics
  • regulatory status of the probiotic in question

Finally, they observed the scientific evidence available for the efficacy of probiotics against these diseases for this purpose, they used the Cochrane library, which contains a large amount of information based on evidence from clinical trials and meta-analysis.

The study also included a more practical aspect: Google’s ranking of websites and if the information appeared in 3 clicks or less, which is the average range of the lego reader. Co-researcher Michael Goldman explains: “Often, the public will not exceed the first ten results; therefore, these will have greater visibility and impact.”

The results

The scientists found that only 1 in 10 web pages were of high quality, in terms of meeting all four criteria. About 40% contained a warning about the possible limitation of benefits. Approximately the same number referred to scientific work to support the claims they made. Only a quarter even talked about possible adverse effects.

The researchers conclude that the majority of the first 150 results were linked to commercial media (43%) or news providers (31%). However, the top 10 websites were health or commercial portals, with 44% and 22%. The 10 had an average JAMA score of 3 of a possible 4. Among the 10, 44% had a HONcode seal but only 6% of the remaining websites.

Based on the analysis of the diseases mentioned on the web pages and the evidence that probiotics could help significantly in the management of these conditions, the results showed that most of these high-ranking pages provided misleading information. The average commercial website that promotes probiotics was unlikely to provide reliable health information. The average completeness score was 2 and 1 for the 10 main websites and the rest of the websites, respectively.

Many of them did not even mention the risks of using probiotics in individuals with weakened immunity, nor did the issue of regulatory restrictions arise. And many of the inflated claims that probiotics had been found to be useful for treating specific conditions in humans were, in fact, based on findings in experiments with mice. Only less than a quarter had supporting evidence, and one in five had no evidence!

Surprisingly, probiotics were strongly recommended for gastrointestinal disorders, strengthening the immune system, mental disorders and cardiovascular disorders; however, only the first area has corresponding experimental references, while the others do not have Cochrane reviews at all. Even with intestinal disorders, the evidence is partial and uncertain, which is not reflected in the web pages.

On the other hand, Google Analytics uses very strict standards to ensure that websites that offer health information meet high quality standards. According to the information of the researchers, the greater the information and the greater scientific support, the higher the ranking of the page linked to probiotics. This is particularly true if the website is part of a health portal. This will raise the web pages of science-based probiotics to a higher rank than a commercial web page.

However, the large volume of commercially oriented information is a big problem for people who really want to know if taking probiotics could help them. In realistic terms, it is now up to the consumer to evaluate the source of information on any site. It is necessary to establish a new framework, as well as policies to regulate how probiotic information is presented to the public to avoid false claims and misuse of this freedom.

Journal reference:

Online information on probiotics: does it match the scientific evidence? Marie Neunez, Michel Goldman and Pietro Ghezzi. Frontiers in Medicine, January 2020. https://doi.org/10.3389/fmed.2019.00296. https://www.frontiersin.org/articles/10.3389/fmed.2019.00296/full

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