What can we learn from end consumers about probiotic usage?
Probiotics have gained the attention of both end consumers and health care practitioners in recent decades. Many randomized clinical trials, meta-analyses, systematic reviews, and qualitative approaches have verified probiotics' beneficial role in advancing human health and well-being. Besides the wide range of health benefits attributable to probiotics in gut-related diseases and complaints, more and more attention is being paid to the effects of probiotic use in multiple indications beyond the gut. In addition, despite the countless scientific studies assessing the beneficial effects of probiotics on these various indications, information not only on users’ experiences and views on the daily use but also on the societal impact of probiotics is still rather limited. This type of actual first-hand information is, however, essential.
The increased interest among end consumers in microbiota and probiotics is also noticed in clinical practice. More and more, as patients want to do more on ‘self-management’ of their disease and complaints, they are asking health care professionals for their opinion on probiotics in a particular situation. Also, in the doctor's consulting room, it has become clear that what counts the most for the patients is their quality of life. Together, we should engage the end-users to discover unmet needs, define the relevant health benefits of probiotics, and successfully implement probiotics in daily practice.
User experiences at Winclove
At Winclove Probiotics, we have recently finished a retrospective study on user experiences with four of our probiotic formulations. The results were analysed and published in collaboration with Vrije Universiteit (VU), Amsterdam (ref). In this study, we reviewed the impact experienced on the quality of life, on GI-complaints, on stool frequency, and stool consistency for our formulations, Ecologic®AAD, Ecologic®Relief, Ecologic®825, and Winclove®Adult. Health Care Professionals, such as general practitioners and dieticians, could opt for a free 14-day try-out package of any of the four probiotic formulations for their patients. Along with the free trial package, a single diary was sent, to serve as a self-assessment tool for the end-users to measure their experiences prior to, during and after use. The diary enabled users to assess the impact of probiotic supplementation on their health more objectively. Over 4.5 years, 8220 try-out packages were distributed in total, and from these, 584 diaries were returned and included in the study database. These diaries were split into two datasets whereby either a 5-point or a 10-point scale was used in the diary. Both datasets were analysed, whereby the 10-point scale diaries were used as confirmation of the findings with the 5-point scale set.
Insights in probiotic consumption
The results clearly show that in general all the formulations had positive effects on perceived frequency and severity of GI complaints. They further show that the selected probiotics were used for a wider variety of indications and target groups in practice than those they were originally developed for, which enables us to broaden the scope of specific formulations. In this study, we analysed the complete set of experiences overarching the products and the indications they were used for. In addition, analyses were performed per product, as well as for seven specific subgroups combining a product used for a specific indication, which provides even more specific insights into and view of what to expect when using a product in a specific situation.
Impact on GI symptoms
The results show that positive effects can be achieved on other aspects of health that have not previously been evaluated for these products. For example, a general improvement in GI complaints was clearly seen: a reduction of 8-18% in the frequency of different GI symptoms, including diarrhoea, constipation, abdominal ache, abdominal cramps, flatulence, bloating, abdominal growl, nausea and burping. Furthermore, after consuming probiotics, we also observed a significant reduction of 9-17% on the burden of the various GI symptoms. The study also analysed stool consistency and defecation frequency, as measured by the Bristol Stool Scale (BSS), focusing mainly on incidence of diarrhoea and constipation. Of the initial 27% of participants who had defined diarrhoea (according to the BSS) in the first week of probiotic consumption, we observed that 53% no longer had diarrhoea in the second week, and an additional 17% had diarrhoea for fewer days. Regarding the initial 18% of participants who had defined constipation (according to BSS) in the first week of probiotic intake, 37% were no longer constipated in the second week.
Impact on Quality of Life
The diaries also contained questions on the potential impact of probiotic use on various aspects of Quality of Life parameters, including general health status, social time, work time, work achievement, work type, energy, sleep, and happiness. Notably, end-users also reported a substantial 3-19% improvement on all the various aspects of Quality of Life. The most remarkable improvement reported among all users, independent of product or indication used for, was with regard to their energy level. This applied especially to those taking probiotics for chronic complications such as IBD.
Overall feeling on the use of the product
Finally, we also looked at the general perceived effectiveness of probiotic use. Nearly half (46%) of the population indicated that they experienced a positive effect of probiotic supplementation relevant to the primary health indication for which they used the product. Additionally, 8% reported a positive effect on a different health indication than originally using the probiotic for. For 26% of participants, the intervention was insufficiently effective in these 14 days of use. Remarkably, 64% of users indicated that they would like to continue using the formulation(s),the primary (80%) reason to do so was a perceived positive effect. Furthermore, consumers wanted to continue in order to see whether the positive effects continued over time and/or out of curiosity about the longer-term impact. Another factor in using the formulation(s) beyond the study period was treating physician recommendations. It is also worth noting that especially users with chronic complications such as IBD and IBS indicated their continued use, perhaps because their complaints might last longer. The likelihood of recommending the product to others was also high (62%). Although no formal safety assessments were performed in the study, the level of adverse effects reported by probiotic users indicates that oral consumption of the products was safe. Most users reported no adverse effects, and only 5% reported minor GI complaints. More commonly reported side effects included increased gas and bloating, which is consistent with previous studies and therefore expected.
This study's results help support the scientific rationale for the development of indication-specific probiotic formulations and provide insight into more general health effects of supplementation. The present study provides valuable insights into the direction and magnitude of probiotic effects. It might support managing the expectations of use for both users and healthcare professionals and help them choose the most effective probiotic product for their complaints, thereby fostering implementation in daily practice. Building upon probiotic users' feedback, our study demonstrates the importance of engaging end-users to discover unmet needs, define relevant health benefits, and identify key considerations for successful implementation in daily practice. This systematic analysis of user experiences is essential in terms of further validating the clinical evidence of probiotics in randomized controlled studies in more real-life settings and contributes to probiotics' societal impact in general.
If you have any specific questions regarding the outcomes of a particular probiotic formulation in this study, do not hesitate to contact us. Our research team will help you, answering questions on specific formulations extensively.