What to tell your patients about postbiotics

Canadian consumers are starting to hear about postbiotics and healthcare professionals should play a key role in educating the public about the latest “biotic” to become popular, experts say. “I believe pharmacists and healthcare professionals should lead the way, instead of Instagram influencers talking about it,” said Dragana Skokovic-Sunjic, author of the Clinical Guide to Probiotics Products Available in Canada and a clinical pharmacist at the Hamilton Family Health Team in Hamilton, Ont. What are postbiotics? The International Scientific Association for Probiotics and Prebiotics (ISAPP) defines postbiotics as: “a preparation of inanimate microorganisms and/or their components that confers a health benefit on the host.” Postbiotics can be non-viable microorganisms such as heat-killed bacteria. They can also be waste products of microorganisms, their components or metabolites of microorganisms. Yet in order to be classified as a postbiotic according to the ISAPP definition, there has to be evidence of a health benefit. “What I’m seeing now in marketing, and maybe taking advantage of this “anything biotic” popularity, is that even in a plain heat-inactivated bacteria are labelled as postbiotic. It does not satisfy the definition unless they have proof that when inactive they actually provide benefit,” Skokovic-Sunjic explained. Not all postbiotics come from probiotics. The microorganism from which postbiotics are derived doesn’t have to show a benefit to human health when it is alive. The part of the cell or metabolites after it is killed must show benefit. Read: Do probiotics play a role in pharmacy? Are they safe? The interest in postbiotics is fueled by the hypothesis that they present less risk of infection than probiotics, which are beneficial microorganisms that are consumed live. The non-viable nature of postbiotics may make them safer than probiotics for children, pregnant women or others at higher risk of infection. “For most of the postbiotic components, they should be safe. They are not likely to cause infection,” Skokovic-Sunjic said. “It would be something that our body is already used to processing.” Postbiotics may also have a better shelf life because they aren’t live microorganisms. There is also the potential to put a higher concentration of postbiotic in a supplement than live microorganisms could supply. Despite the safety of postbiotics, there’s huge potential that people might use products labeled as postbiotics that don’t provide benefit. This could then cause a delay in appropriate treatment, or simply waste a patient’s money and time, Skokovic-Sunjic said. To date there’s little evidence supporting the specific health benefits of postbiotics and how to tailor their use to help patients. There are some clinical trial results that suggest benefit, including one conducted by Korean researchers, who found heat-treated bacteria supplements improved atopic dermatitis symptoms in children. The results were published in Pediatric Allergy and Immunology in 2020. Read: Gut microbe mix may indicate risk for long-COVID What if a patient asks about postbiotics? If a patient asks about postbiotics, it means that they are interested in taking control of their health, Skokovic-Sunjic said. Pharmacists can use this opening to engage with the patient and ask about their symptoms. They may recommend other approaches supported by evidence, including probiotics since the patient is interested in biotics. Pharmacists can access existing resources, such as Skokovic-Sunjic’s Clinical Guide to Probiotics, to determine what probiotic may work best. Clinical trials investigating postbiotics are ongoing, and there may be more clinically relavant information available soon. Skokovic-Sunjic suggested to tell patients to ask about postbiotics again in a year. Where can patients find postbiotics? Postbiotics in supplements are regulated by Health Canada as a natural health product and have a Natural Products Number, or NPN. Foods with high concentrations of postbiotics include kimchi, kefir, yoghurt with active bacteria or fermented food such as kombucha, sauerkraut or pickles, according to Jennifer Stearns, a microbiologist and assistant professor in McMaster University’s department of medicine. She spoke about postbiotics on an episode of CBC’s The Dose. Stearns foresees a rise in functional foods with postbiotics. In Europe, functional foods must have clinical evidence to support their claims. Canadian regulations do not require this unless the food is considered a drug. Product labels boasting the inclusion of postbiotics may also begin to pop-up in other parts of the pharmacy. The cosmetic industry is exploring the influence of the skin microbiome and is experimenting with putting postbiotics in products where regulations allow. Read: Gut microbes identified to be associated with incidence of diabetes

What to tell your patients about postbiotics

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