Probiotics are live microorganisms promoted with claims that they provide health benefits when

consumed, generally by improving or restoring the gut microbiota.[1][2] Probiotics are

considered generally safe to consume, but may cause bacteria-host interactions and
unwanted side effects in rare cases.[3][4][5] There is some evidence that probiotics are beneficial for
some conditions, but there is little evidence for many of the health benefits claimed for them.[1]
The first discovered probiotic was a certain strain of bacillus in Bulgarian yoghurt,
called Lactobacillus bulgaricus. The discovery was made in 1905 by Bulgarian physician and
microbiologist Stamen Grigorov. The modern-day theory is generally attributed to Russian Nobel
laureate Élie Metchnikoff, who postulated around 1907 that yoghurt-consuming Bulgarian
peasants lived longer.[6]
A growing probiotics market has led to the need for stricter requirements for scientific
substantiation of putative benefits conferred by microorganisms claimed to be probiotic.
[7]
Although numerous claimed benefits are marketed towards using consumer probiotic products,
such as reducing gastrointestinal discomfort, improving immune health,[8] relieving constipation, or
avoiding the common cold, such claims are not supported by scientific evidence,[7][9][10] and are
prohibited as deceptive advertising in the United States by the Federal Trade Commission.[11] As
of 2019, numerous applications for approval of health claims by European manufacturers of
probiotic dietary supplements have been rejected by the European Food Safety Authority for
insufficient evidence of beneficial mechanism or efficacy.[8][12]

Definition[edit]
An October 2001 report by the World Health Organization (WHO) defines probiotics as "live
microorganisms which when administered in adequate amounts confer a health benefit on the
host."[13][14] Following this definition, a working group convened by the Food and Agriculture
Organization (FAO)/WHO in May 2002 issued the Guidelines for the Evaluation of Probiotics in
Food.[15] A consensus definition of the term probiotics, based on available information and
scientific evidence, was adopted after the aforementioned joint expert consultation between
the FAO of the United Nations and the WHO. This effort was accompanied by local governmental
and supra-governmental regulatory bodies' requirements to better characterize health claims
substantiations.[citation needed]
That first global effort was further developed in 2010; two expert groups of academic scientists
and industry representatives made recommendations for the evaluation and validation of probiotic
health claims.[16][17] The same principles emerged from those two groups as were expressed in the
"Guidelines" of FAO/WHO in 2002. This definition, though widely adopted, is not acceptable to
the European Food Safety Authority because it embeds a health claim that is not measurable.[7]
A group of scientific experts assembled in Canada in October 2013 to discuss the scope and
appropriate use of the term "probiotic", adjusting the definition to be "live microorganisms that,
when administered in adequate amounts, confer a health benefit on the host."[18]

In food[edit]
Live probiotic cultures are part of fermented dairy products, other fermented foods, and probiotic-
fortified foods.[19]
Additionally, lactic acid bacteria (LABs), which are food fermenting bacteria, have the ability to
prevent food spoilage and can improve the nutritive value of the foods they inhabit. Also due to its
low cost and low energy requirements when processing and preparing foods, acid fermentation,
combined with salting, remains one of the most practical methods of preservation of fresh
vegetables, cereal gruels, and milk-cereal mixtures.[20]
Fermented products that contain lactic acid bacteria include vegetables such as pickled
vegetables,[21] kimchi,[21][22] pao cai,[23] and sauerkraut;[24] sourdough bread or bread-like products
made without wheat or rye flour, amino acid/peptide meat-flavored sauces and pastes produced
by fermentation of cereals and legumes; fermented cereal-fish-shrimp mixtures and fermented
meats;[20] soy products such as tempeh,[25] miso,[26] and soy sauce;[27] dairy products such
as yogurt, kefir,[28] buttermilk;[29] and non-dairy products such as bee pollen.[30]
More precisely, sauerkraut contains the bacteria Leuconostoc mesenteroides, Lactobacillus
plantarum, Pediococcus pentosaceus, Lactobacillus brevis, Leuconostoc citreum, Leuconostoc
argentinum, Lactobacillus paraplantarum, Lactobacillus coryniformis, and Weissella spp.
[31]
Kimchi contains the bacteria Leuconostoc spp., Weissella spp., and Lactobacillus spp. Pao cai
contains L. pentosus, L. plantarum , Leuconostoc mesenteroides , L. brevis, L. lactis, and L.
fermentum. A list of many other bacteria found in several Asian fermented fruits and vegetables
also is available.[32][33] Kefir contains Lactobacillus acidophilus, Bifidobacterium
bifidum, Streptococcus thermophilus, Lactobacillus delbrueckii subsp. bulgaricus, Lactobacillus
helveticus, Lactobacillus kefiranofaciens, Lactococcus lactis, and Leuconostoc species.[34]
[35]
Buttermilk contains either Lactococcus lactis or L. bulgaricus.
Other acidic bacteria, said to be probiotic,[36][37] also can be found in kombucha. This drink
contains Gluconacetobacter xylinus.[38][39] It also contains Zygosaccharomyces sp., Acetobacter
pasteurianus, Acetobacter aceti, and Gluconobacter oxydans.[40]

Side effects[edit]
The manipulation of the gut microbiota is complex and may cause bacteria-host interactions.
[5]
Though probiotics are considered safe, some have concerns about their safety in certain cases.
[5][41]
Some people, such as those with immunodeficiency, short bowel syndrome, central venous
catheters, and cardiac valve disease, and premature infants, may be at higher risk for adverse
events.[3] In severely ill people with inflammatory bowel disease, a risk exists for the passage of
viable bacteria from the gastrointestinal tract to the internal organs (bacterial translocation) as a
consequence of bacteremia, which can cause adverse health consequences.[5] Rarely,
consumption of probiotics by children with lowered immune system function or who are already
critically ill may result in bacteremia or fungemia (i.e., bacteria or fungi in the blood), which can
lead to sepsis, a potentially fatal disease.[4]
Lactobacillus species have been suggested to contribute to obesity in humans, but no evidence
of this relationship has been found.[42]

Consumption[edit]
In 2015, the global retail market value for probiotics was US$41 billion, including sales of
probiotic supplements, fermented milk products, and yogurt, which alone accounted for 75% of
total consumption.[43] Innovation in probiotic products in 2015 was mainly from supplements, which
produced US$4 billion and was projected to grow 37% globally by 2020.[43] Consumption of yogurt
products in China has increased by 20% per year since 2014.[44]

Regulation[edit]
As of 2019, the European Food Safety Authority has rejected all petitions by commercial
manufacturers for health claims on probiotic products in Europe due to insufficient evidence for
a cause-and-effect mechanism for benefit, thus inconclusive proof of effectiveness.[7][8]
[12]
The European Commission placed a ban on putting the word "probiotic" on the packaging of
products because such labeling misleads consumers to believe a health benefit is provided by
the product when no scientific proof exists to demonstrate that health effect.[7][45][46][47]
In the United States, the Food and Drug Administration (FDA) and Federal Trade
Commission (FTC) have issued warning letters and imposed punishment on various
manufacturers of probiotic products whose labels claim to treat a disease or condition.[10][11][48] Food
product labeling requires language approved by the FDA, so probiotic manufacturers have
received warning letters for making disease or treatment claims.[10][48] The FTC has taken punitive
actions, including a US$21 million fine coordinated by 39 different state governments against a
major probiotic manufacturer for deceptive advertising and exaggerated claims of health benefits
for yogurt and probiotic dairy drink.[11]
Yogurt labeling[edit]
The National Yogurt Association (NYA) of the United States gives a "Live & Active Cultures Seal"
to refrigerated yogurt products that contain 100 million cells per gram, or frozen yogurt products
that contain 10 million cells per gram at the time of manufacture.[49] In 2002, the FDA and WHO
recommended that "the minimum viable numbers of each probiotic strain at the end of the shelf-
life" be reported on labeling,[50] but most companies that give a number report the viable cell count
at the date of manufacture, a number that could be much higher than that which exists at
consumption.[51] Because of the variability in storage conditions and time before eating, exactly
how many active culture cells remain at the time of consumption is difficult to determine. The
survival of probiotics was strongly dependent on the storage temperature and remarkable viability
loss occurred in room temperature compared to refrigerated storage.[52]