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Mary Ellen Sanders PhD Comment ID #61

Submitted 09/03/2013

We scientists of the International Scientific Association for Probiotics and Prebiotics propose that the 2015 US Dietary Guidelines Advisory Committee consider live microbes and probiotics as part of the healthy, American diet. The 2010 DGAC noted that gut microbiota play a role in health, but fell short of making a recommendation for intake of probiotics or fermented foods. We believe that research over the past 5 years in this area has developed substantially and suggest that the committee evaluate the following question: What is the impact of foods containing live and active cultures and probiotics on long term health maintenance and reduction in disease risk?

ISAPP is a non-profit scientific organization established in 2002 whose mission is to promote the science of probiotics and prebiotics. The credentials of the governing Board of Directors are unparalleled for probiotic organizations (

We have concluded that evidence for consuming live microbes and probiotics should be addressed by the committee based on three observations:
1. The role of the microbiome in human health is undisputed. Recent research has indicated the importance of the microbiota in digestive, cardiac and endocrine health and healthy aging in the general population.
2. Probiotics are a means of impacting the composition and functions of the microbiota. Mounting evidence from randomized, controlled human studies on diverse strains of probiotics have provided convincing evidence that incorporation of probiotics as such or in the form of fermented foods into diets can improve a variety of health outcomes.
3. Fermented foods, such as yogurt, deliver live microbes including probiotics, and have also been associated with reduced risk for some diseases.

It is clear that discussions of human health must include reference to the vast array of commensal microbes that inhabit human bodies. The body is now viewed as a super-organism, comprising a dynamic interaction between human cells and colonizing microbes (Wu & Lewis 2013). The human microbiome influences a broad range of physiological systems including food digestion, immune system development, energy homeostasis, reproduction, fat storage, blood lipids, brain signaling and gut integrity and function. Furthermore, the microbiota form configurations in health that are distinct from those associated with many diseases (Yatsunenko et al. 2012). Importantly, diet influences the microbiome. Wu et al. (2011) demonstrated that diet-dependent differences in diversity exists in the microbiome of individuals in industrialized countries such as the US compared to people in less developed regions of the world. Such differences in microbiota are thought to be a factor in the onset of human diseases and conditions such as diabetes, cardiovascular disease, obesity and immune-senescence. These observations point to the importance of taking the microbiome into account for dietary recommendations.

A wealth of information exists on probiotics, much of it in the following areas:
• Healthy gut function
o Improved tolerance to lactose in lactose maldigesters, facilitating consumption of nutrient-rich dairy products (de Vrese et al. 2001; Labayen et al. 2001; Pelletier et al. 2001)
o Improved symptoms of IBS (Hoveyda et al. 2009)
o Improved gut homeostasis (van Baarlen et al. 2013)
• Healthy metabolic function
o Reduced plasma LDL levels (Jones et al. 2012; Amar et al. 2013)
• Healthy immune function
o Reduced incidence and duration of upper respiratory tract infections (Hao et al. 2012)
o Improved function of the immune system to improve pathogen resistance and reduce chronic inflammation (Brestoff & Artis 2013; Chu & Mazmanian 2013)

Evidence supports the beneficial relationship between foods containing live microbes, especially fermented dairy products, and reduced risk for certain chronic disease. For example, fermented dairy products have been associated with:
• Reduced risk for type 2 diabetes or improved markers for glucose homeostasis (Tong et al. 2011; Struijk et al. 2012; Sluijs et al. 2012)
• Less weight gain over time in a study of >120,000 adults (Mozaffarian et al. 2011)
• Reduced risk of overall mortality (Soedamah-Muthu et al. 2012)

Therefore, we support the idea that dietary recommendations should include foods rich in live microbes as a part of a healthy, American diet. Such foods comprise fermented dairy products (yogurt, kefir, cheese, fermented milk) and fermented vegetables (kim chi, sauerkraut) among others. Consumers would further benefit if these foods were described as a source of potentially useful bacteria, and not only as a valuable source of calcium and other nutrients.

Because of this prevalence of persuasive science, we believe that the committee should study the following question: What is the relationship between foods with live and active cultures and probiotics on long term health maintenance and reduced disease risk?

Affiliation: Professional Association Organization: International Scientific Association for Probiotics and Prebiotics
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