When will you get a microbiome therapy tailored exactly to you?

Probiotics are not just one thing. This is clear to anyone who has dug a little deeper than just reading headlines in a newspaper. Probiotics, and other microbiome directed therapies, represent a diverse array of products and approaches. With that comes the possibility of tailoring a therapy to the specific needs that an individual has (I would like one therapy that makes me run faster, an other one that lifts my mood, and a bag of potato chips on the side, please!). But just how far have we come in terms of this kind of personalization? >>> A new paper written by 16 industry and academic scientists gives us some pointers.    

The paper is titled “Shaping the Future of Probiotics and Prebiotics” and covers a broad range of topics. One message stands out, however: The ability to tell what kind of probiotic or prebiotic a particular person will benefit from is one of the aspects that has the greatest potential to bring the effectiveness of microbiome-targeted therapies a great step forward. Let us delve further into that aspect of the paper.

We already know that one type of probiotic may have a good effect in one type of disease, while a different probiotic is better for an other disease. But within a group of people with the same disease we are at loss of knowing if a particular patient will benefit or not. Today it is not routine to run a stool test, get the result back and say: This is the right probiotic for you! Even with extensive measurements of the microbes in the body, different blood tests and other information on an individual, we are still a far cry from predicting how the response will differ between individuals. But this has started to change, as the authors write:  

“Broad technological advances in data collection and analytical tools are enabling the exploration of new candidate probiotics and prebiotics as well as providing deeper insights into their interactions with the microbiome and host. Interest continues to grow into new applications of probiotics and prebiotics across health conditions, body sites, population subgroups, and delivery formats.”

The authors thus here speak to the fact that we are already at a stage where population subgroups can be given advice that is somewhat specific in terms of what pre- or probiotic that are to be used. Further personalization advances are likely to be accelerated by recent and future technological improvements.

Not just “Who is there?” in your gut, but also ”What are they doing there?”

What are the different ways that personalization can be done? If we include information about both an individual and a group of individuals that can be used to choose one microbiome therapy over an other, these are some of the current and future ways that exist (based on what the authors write):

• Target unique health states of a person (e.g., one probiotic for eczema and an other for obesity)
• Target individual characteristics of a person (e.g., choose a specific probiotic for someone who eats a low fiber diet)
• Target individual microbiome composition of a person (e.g., reintroduce “missing” bacteria in the microbiome based on an analysis of the person’s microbiome composition)
• Target individual microbiome function of a person (e.g., finding low levels of a bacterial substance known to be associated with good health, and supplement with a diet component that can increase the amount of the substance by feeding the bacteria with that component, or by giving a probiotic that is known to produce high levels of the substance)

A future dream scenario could thus for example be that a person with both obesity, IBS and food sensitivities could do a stool test (or other microbiome specimen test), blood tests and other tests to find out if there for instance are low levels of metabolites produced by the microbiome that suppress appetite,  if increased amounts of histamine (an “allergy substance”) is produced in the gut, if the number of microbes generally associated with leanness are low and if the microbes present produce increased amounts of virulence factors (“disease inducing factors”). This could then be used as a basis both for a tailored diet, probiotic, prebiotic, postbiotic and exercise advice. This can to some extent already be achieved, but most of the information mentioned here cannot be obtained through tests that currently are available to the average consumer or clinician.  

But, how can I possibly be able to choose the right product?

When more of the personalization tools are available this must be accompanied by many more developments in both the range of products and treatments on the one hand and how products are labelled on the other hand. Consider the situation today: The authorities within the EU (EFSA) do not allow health claims to be made for probiotics as nutritional supplements and there is no way of quickly finding out if a particular product is supported by evidence of effect, or even that the product contains what it says it contains.

While the authors of “Shaping the Future of Probiotics and Prebiotics” make a strong case for what further research into different probiotics and prebiotics can mean for personalized microbiome therapies, they leave one question hanging: How can the actual selection of a product for a consumer or clinician be done? The solution the authors provide appear to be to wait for the science to show the benefits more clearly and use that science to work with the authorities that are in charge of regulatory aspects. But we at MyMicrobiome believe that this could result in a very lengthy process. And, this is not using all the possibilities at hand.

What can be done already today is to label products based on their quality, and by making the connection to the different health effects easier for the clinician to find about. In fact, and perhaps surprisingly, the larger part of probiotics on the dietary supplement market lacks one or more of these quality aspects:

• Listing of the particular strain or strains that the product contains on the label of the product
• Scientific studies to back up the effect
• Information about what ailments the probiotic should be used for

 While it is not allowed to claim on a product label that a certain product will impact a certain disease, discarding those products that do not list the particular strains or do not have any clinical trials that have been done on the product, will make it easier to find the good products, just because of the sheer number of products that do not fulfill these criteria.

Thus, a stamp could solve the major first step of finding the right product. Once the consumer or clinician know that there are clinical studies done on the product, going through the scientific literature will provide more details about what ailments the product can be used for. This is of course not so easy for the average consumer to do, but a listing of the studies that the seal was based on, on a website, can make the search much easier. Then it is up to the reader to find out if the studies are convincing enough for the ailment that one is interested in.