Researchers from the National University of Singapore (NUS) have created new fermented coffee and tea drinks. These drinks, invented by a professor and two doctoral students, are being labeled as “probiotic coffee and tea drinks that are packed with gut-friendly live probiotics.” They claim that the drinks can be stored for three months without altering the probiotics.
“Coffee and tea are two of the most popular drinks around the world, and are both plant-based infusions. As such, they act as a perfect vehicle for carrying and delivering probiotics to consumers. Most commercially available probiotic coffee and tea drinks are unfermented. Our team has created a new range of these beverages using the fermentation process as it produces healthy compounds that improve nutrient digestibility while retaining the health benefits associated with coffee and tea,” explained NUS Associate Professor Liu Shao Quan.
Read more (Science Daily)
The coronavirus continues to drive sales of fermented drinks. Lifeway’s kefir, Farmhouse Culture’s kraut juice, Probitat’s fermented planted-based smoothies, Flying Ember’s hard kombucha and Buoy Hydration’s fermented drinks all report increased sales as consumers take a bigger interest in the immune-enhancing benefits of fermented beverages.
“As demand ramps up for immune-enhancing products, manufacturers have an opportunity to innovate with immune-supporting ingredients and flavors,” says Becca Henrickson, marketing managed of Wixon, a flavor and seasoning company. “When flavoring beverages with immune support ingredients, selecting flavors that increase or complement a product’s health perception is optimal.”
Read more (Food Business News)
Kombucha and cosmetics are driving growth in the probiotic and prebiotic markets by making products that use non-classic strains of bacteria.
The e-commerce market for probiotic supplements was estimated at $973 million across 20 countries in 2020. America accounts for almost half of those sales. Ewa Hudson, director of insights for Lumina Intelligence, shared this info at the Probiota Americas 2020 Conference. (Lumina and Probiota Americas are parts of William Reed Business Media, the parent company for FoodNavigator.com.) The session, New Horizons for Prebiotics & Probiotics, included Lumina’s insight into non-classic bacteria strains and a panel discussion with leaders in the probiotics field.
In 2020, 32% of all probiotics in America — and 41% of the best-selling ones — contained non-classic species. Hudson said this species classification is a messy space, especially from a consumer’s perspective, because there are so many species. Kombucha includes the most non-classic probiotic species — of those products with probiotics, 93% include non-classic bacteria .
Most products with probiotics include one of the four common bacteria species: lactobacilli, bifidobacterium, bacillus and saccharomyces. Lumina excluded these four from their research to focus on the growth of the non-classic probiotic strains. These include: streptococcus thermophilus, kombucha culture, lactococcus lactis, bifida ferment lysate, enterococcus faecium, streptococcus salivarius, clostridium butyricum and streptococcus faecalis.
Though probiotics are often used in supplements, more fermented food and beverage manufacturers are using probiotic strains in their products, especially in the growing alternative protein market.
Synbiotics are also becoming more widely used; the study found synbiotics were the most prevalent formulate in probiotics. Synbiotics are a combination of both prebiotics and postbiotics. A synbiotic ensures that probiotics will have a food source in the gut.
(Probiotics are live microorganisms, friendly bacteria that provide health benefits. Probiotics can be found in fermented food and taken as supplements. Prebiotics are dietary fibers that feed the probiotics. Postbiotics are an emerging concept in the “biotics” space — postbiotics are the waste byproduct of probiotics.)
“With probiotics, we are really only starting to scratch the surface with the development of synbiotics,” says Jens Walter, PhD, professor of ecology, food and the microbiome at APC Microbiome Ireland.
The new generation of probiotics will depend on strains that are “efficacious in the gut,” Walter noted.
“If you look into the probiotic market, most of the lactobacillus species — and also species like bifidobacterium lactis — are not inherent organisms of the human gut. We’re using a lot of organisms that I would argue have an ecological disadvantage in the gut,” Walter says. “If you’re talking about next generation probiotics, I think what will become is we are looking for the key players in the gut, specifically key players that are underrepresented or linked to certain benefits, and then we are trying to put them back in the ecosystem.”
It’s challenging to find a prebiotic or postbiotic that is precise, he continues.
“Every human has a distinct microbiome. So it’s likely a synbiotic designed for one human may not be as functional in another human,” Walter says. “The opportunities here are tremendous.”
Daniel Ramon Vidal, vice president of research and development and health and wellness at the American food processing company Archer-Daniels-Midland (ADM), also spoke. He noted that the human body is made up of trillions of microbial cells, but we know little about these microbial worlds.
“There is an enormous amount of possibilities to isolate new strains that are living in our body,” Daniels says. “We need as much science as possible, that’s my message”
The panel agreed that postbiotics has become one of the next great concepts that scientists, manufacturers and gastroenterologists have latched onto. But consumers are not as familiar with postbiotics as they are with probiotics and prebiotics , notes Justin Green, PhD, director of scientific affairs for EpiCor, a postbiotic ingredient produced by Cargill.
“This causes more confusion, so I think that’s going to be another interesting aspect of postbiotics — both the identity of what postbiotics are and how it confers its benefits and (how that will be) communicated to the consumer,” Green says.
A major scientific announcement was made this week, creating a global definition for fermented foods. A team of 13 interdisciplinary scientists (including TFA Advisory Board members Maria Marco and Ben Wolfe) spent over a year discussing the issue in order to reach a consensus. An official definition has long been debated, especially in recent years as fermentation has experienced a renaissance in the modern diet. This definition, the first of its kind, hopes to provide clarity to scientists, producers and consumers.
Below is a press release from the International Scientific Association for Probiotics and Prebiotics (ISAPP) on the definition. The full research paper was published in Nature. Marco also wrote a blog on the ISAPP website, further detailing the work that led to the definition.
Humans have consumed different types of fermented foods — from kimchi to yogurt — for thousands of years. Yet only recently, with the availability of new scientific techniques for analyzing their nutritional properties and microbiological composition, have scientists begun to understand exactly how the unique flavors and textures are created and how these foods benefit human health.
Now, 13 interdisciplinary scientists from the fields of microbiology, food science and technology, family medicine, ecology, immunology, and microbial genetics have come together to create the first international consensus definition of fermented foods. Their paper, published in Nature Reviews Gastroenterology & Hepatology, defines fermented foods as: “foods made through desired microbial growth and enzymatic conversions of food components”.
The authors take care to note the difference between probiotics and the live microbes associated with fermented foods. The word ‘probiotic’, they say, only applies in special cases where the fermented food retains live microorganisms at the time of consumption, and only when the microorganisms are defined and shown to provide a health benefit, as demonstrated in a scientific study.
“Many people think fermented foods are good for health — and that may be true, but the scientific studies required to prove it are limited and have mainly focused on certain fermented food types,” says first author Maria Marco, Professor in the Department of Food Science and Technology at the University of California, Davis.
Co-author Bob Hutkins, Professor in the Department of Food Science and Technology at University of Nebraska, Lincoln — who has authored a well-known academic textbook on fermented foods — says, “We created this definition to cover the thousands of different types of fermented foods from all over the world, as a starting point for further investigations into how these foods and their associated microbes affect human health.”
The consensus panel discussion was organized in 2019 by the International Scientific Association for Probiotics and Prebiotics (ISAPP), a non-profit organization responsible for the published scientific consensus definitions of both probiotics (in 2014) and prebiotics (in 2017).
Mary Ellen Sanders, Executive Science Officer of ISAPP, says, “To date, different people have had different ideas of what constitutes a fermented food. The new definition provides a clear concept that can be understood by the general public, industry members and regulators.”
Currently, evidence for the positive health effects of fermented foods has relied more on epidemiological and population-based studies and less on randomized controlled trials. The authors expect that, in the years ahead, scientists will undertake more hypothesis-driven research on how different fermented foods from around the globe — derived from dairy products, fruit, vegetables, grains, and even meats — affect human physiology and enhance human health.
Probiotics are the third most popular health product ingredient, with 62% of American consumers buying or wanting to buy them. However, only one-third of consumers say they understand probiotics. That confusion is evident in the courts, where consumer class action lawsuits are continually filed against probiotic food and beverages.
Meanwhile, the probiotics industry is pushing to update 25-year-old dietary supplement laws, there’s a new head of the Food and Drug Administration (FDA) and the lactobacillus taxonomy has been overhauled.
What does all this mean for fermented food and beverage brands? Ivan Wasserman, an attorney with expertise in foods and dietary supplements, says now is the time to plan for legal roadblocks, whether a new product or an existing brand. Wasserman shared his legal expertise during a Natural Products Insider webinar on probiotics regulations and class-action lawsuits.
How Does the FDA Define Probiotics?
It wasn’t until 1994 that probiotics were allowed to be sold as an FDA-approved dietary supplement. But the Dietary Supplement and Health Education Act (DSHEA) of 1994 does not directly define probiotics in their definition of supplements.
“You’ll notice there’s nothing in there about live microorganisms,” Wasserman says.
A line interpreted as a “catch-all” provision covers probiotics. It says a dietary substance can be anything “to supplement the diet by increasing the total dietary intake.” The FDA reviewed DSHEA in 2019, but new draft guidelines don’t provide additional clarification. The draft states: “Bacteria that have never been consumed as food are unlikely to be dietary ingredients.”
Wasserman says that’s not a correct assessment of probiotics. During the review, he noted government leaders who were around during DSHEA’s first passing said dietary supplement should not “be limited to things that are already in the food supply. That would really kill innovation, new strains of probiotics for example that were never in the food supply. It didn’t make sense to them that that would be the intent of congress. It would stifle innovation.”
As the FDA’s time is overwhelming focused on coronavirus, there has been no resolution to the definition of probiotics.
What are the Challenges in Labeling Probiotics?
Current regulations call for labeling probiotics in terms of weight. There is no special provision for live microorganisms; probiotics must be labelled like a vitamin or mineral.
“Unlike milligrams of calcium or vitamin C, we all know weight really isn’t that relevant (for probiotics) because dead bugs have weight, the size of the bug really doesn’t affect its efficacy,” Wasserman says. “It’s really how many live microorganisms you’re getting taking as part of a dietary supplement. That’s how all research is published, that’s how the government refers to it. So CFUs, or colony forming units, has become sort of a defacto way consumers and companies will recognize how much of a live microorganism a probiotic is in a live, dietary supplement.”
The International Probiotics Association petitioned the FDA on this measurement rule, asking for probiotics to be listed in terms of CFUs, not milligrams. The FDA said yes, CFUs would be allowed, but milligrams must also be included.
“It’s just confusing and silly,” Wasserman says.
False Advertising Claims Can Cost Brands Millions
In the past decade, the Federal Trade Commission (FTC) has actively sent warnings to brands making unverified probiotic health claims. The FTC’s first charge for probiotic advertising was filed in 2010 against Nestle BOOST Kid Essentials. Nestle did not have the scientific evidence to back up their health labelling. The FTC said Nestle used “deceptive advertising claims about the health benefits of the children’s drink,” like claiming it would reduce the risk of colds, flu and other respiratory tract infections, claims unproven by the FDA. Nestle also claimed BOOST would reduce children’s sick-day absences and decrease the duration of diarrhea, claims unverified “by at least two well-designed human clinical studies,” the FTC said.
“You have to be extremely careful not to imply or state disease prevention,” Wasserman says. “Probiotics certainly give a boost to the immune system, but…to the FTC, that was too strong of a claim, that this product can literally prevent children from getting sick. You can get in trouble for both imagery and claims. Be very careful.”
Other deceptive advertising cases include:
- In 2010, the largest truth in advertising lawsuit was settled against Dannon yogurt. Dannon claimed their Activia and DanActive yogurt products were “clinically” and “scientifically proven” to regulate digestion and boost the immune system. However, Dannon never proved their claims. Dannon had to pay $45 million in damages, and remove the words “clinically” and “scientifically proven” from their labels.
- In 2018, a class-action lawsuit was filed against Tropicana for marketing the added health benefits in their Essentials Probiotics fruit juices. The drink, though, included nearly the same amount of sugar as soda, and Tropicana did not have adequate scientific evident to support the nutritional claims.
- In 2019, a lawsuit was filed against Brew Dr Kombucha, alleging the kombucha was “falsely advertised and labeled as having a significantly higher amount of probiotic bacteria than the products sold actually contained.” Brew Dr’s kombucha bottle advertised billions of bacteria per bottle, but the plaintiff’s research found only 50,000 CFU’s of probiotic bacteria per bottle. The case is still pending.
- In May 2020, the National Advertising Division (NAD) recommended Benefiber remove the claims “100% natural,” “clinically proven to curb cravings” and “helps you feel full longer” from the Benefiber fiber supplements. Metamucil challenged Benefiber’s claims. Though Benefiber had tested their products and could provide scientific evidence, the NAD said the studies were not relevant to the consumer population. Benefiber’s studies were conducted on factory workers in China who live in a controlled living environment at the warehouse 24/7.
In the last few years, the FTC has been relatively quiet filing warnings against probiotic products. Wasserman theorizes it’s because the benefits of probiotics to digestive health have become well-accepted to the general public. Class-action lawsuits filed against probiotic products have also slowed down.
“That’s not to say they’re not being filed,” Wasserman adds. “We’re not seeing a letdown of those types of letters. Our little law firm is dealing with them on a daily basis for a wide variety of clients in a wide variety of industries. The good news is, because the benefits are so well known of probiotics, we haven’t seen a lot of cases actually being filed against probiotics.”
Summer Bock compares the gut microbiome to a forest. If a fire destroys the forest and forest restoration is attempted by just introducing a few animals, the forest would never rebuild.
“That’s what we’re missing with probiotic pills,” Bock says, adding that relying on a probiotic pill to fix the gut is like telling a few bacteria strains: “’You’re in charge of building our entire gut microbiome,’ you just can’t. if you’re just picking a few probiotics and saying ‘You’re the work horse, you’re going to do all of it,’ they can’t. You have to go think of this bigger picture ecosystem. When we use ferments, we’re bringing in some of the nutrition, the soil and even bringing in a greater variety of probiotics than what you find in most pills. …there’s a huge benefit of ferments that people are missing out on.”
A fermentationist, health coach and founder of Guts and Glory, Bock detailed how fermented foods can improve overall health at the Fairmentation Summit. She coined the word “gut rebuilding” and was the founder of the Fermentationist Certification Program.
Bock started fermenting after becoming incredibly sick. A trained herbalist, Bock began treating multiple food allergies, regular panic attacks and chronic exhaustion with herbs. This was long before terms like probiotics and gut microbiome were a regular part of diet discussions. But Bock was recommended by a naturopathic doctor to try taking probiotics, and “a lot of my symptoms started clearing up very quickly.”
Bock, though, is a purest, and wanted to know how she could ingest probiotics without taking a pill.
“What’s the whole food version of probiotics?” Bock said. “If I’m missing it and I’ve wiped it out with antibiotics, how did my ancestors get this into their body on a daily basis? That’s how I discovered fermented foods.”
So Bock started fermenting everything. During this experimentation process, Bock sold sauerkraut and kimchi from her fridge, launching her first sauerkraut company. She described sharing sauerkraut with her roommate’s friends, skeptics who would initially say “I don’t like it,” but would come back a week later and tell her “I have to come back and but it because I can’t stop thinking about that one bite.”
“This is an addictive healthy food, and I got fascinated by what is happening on your taste buds that makes your body go ‘I don’t like this right now,’ but your body recognizes that health benefit,” Bock said. “If there’s some communication happening through one little bite of food and that person can’t stop thinking about it and they want it, I’m still utterly fascinated by that today.”
Her favorite fermented food is kimchi “because it has all the benefits of lacto-fermented vegetables, it has all the great probiotics in it plus it has prebiotics, it has organic acids and the lactic acid which is a natural microbial.”
Studies during the avian flu outbreak found birds who ate kimchi were not contracting the bird flu. One microbiologist in South Korea found 11 of 13 chickens infected with avian flu who ate kimchi made a full recovery. All birds in the control group died.
“Fermented foods are really powerful, and I think that what’s fascinating about them for me is they differ from just probiotics. They contain probiotics, but they also have the prebiotics. They have the entire ecosystem,” she said. “We eat it because it’s delicious, but we also eat it because that food assists us in some way.”
Probiotic-rich ferments “acts as a fertilizer” for the gut microbiome, killing off pathogenic organisms. Microbes grow best at room temperature, a temperature the health department defines as a danger zone because it’s the best temperature for pathogenic, food-born illness to grow.
“What we’ve found is, when there’s that acidic environment, these pathogenic food-borne illnesses can’t exist there. They don’t grow,” she adds.
Multiple nutrients are produced through fermentation, like Vitamin B and Vitamin K. Only a few organisms produce these vitamins, Bock notes. They are critical vitamins because they’re not absorbed easily through food. Bok calls them the “star players” of the microbiome. People with an imbalanced microbiome are often lacking in vitamins B and K.
If not fermenting their own food at home, consumers need to practice due diligence when purchasing fermented food brands, Bock says. Kombucha, she shares as an example, is a great “gateway ferment” for most people, but how much sugar is in it? Is it fermented naturally or are lab strains of probiotics added?
“You have to ask yourself, what is the major probiotic we’re talking about,” in the food you’re eating, Bock said. “Is it a naturally-occurring probiotic or a…patented, genetically-modified probiotic?”
Americans have a “Supersize” mentality, Bock said. People shouldn’t be consuming bowls of fermented foods every day.
“Remember that fermented foods are generally a condiment, especially the ones with live organisms, like kimchi and sauerkraut, natto,” she said. “So if you treat it as such, you’re maintaining the respect for these organisms and for these foods,” she said. “Your body knows what it needs.”
Spicy kimchi cures baldness and thickens hair, according to a new scientific report published in the World Journal of Men’s Health. Researchers from Dakook University in South Korea studied men in early stages of hair loss who consumed a kimchi probiotic drink twice a day. After a month, hair count increased from 85 per square centimeter to 90; after four months, hair count increased to 92. Results were even faster and prevalent for female patients with hair loss, who went from an average of 85 hairs per square centimeter to 92 after one month. Hair thickness also increased. This is exciting research for people suffering from hair loss; the kimchi and probiotic product is a natural, safer alternative to hair regrowth drugs. Current hair regrowth drugs have adverse side effects, like irregular heartbeat, weight gain and diarrhea.
Read more (World Journal of Men’s Health)
Farmhouse Culture is retooling their packaging, moving away from what the CEO calls “natural food cliches.” Using consumer research as their guide, the fermentation brand is using “always organic” on their labels, indicating quality to shoppers. Farmhouse Culture is also decreasing their emphasis on probiotics because, though shoppers want products with digestive health benefits, they’re confused over how to achieve digestive health. The Wisconsin-based brand makes sauerkraut, fermented veggie drinks and sauerkraut chips.
Read more (Nosh)
As more people battle digestive problems, they’re turning to brands offering gut health solutions. Digestive health is the third most sought after health benefit in the latest International Food Information Council Food & Health Survey, behind weight loss and energy.
Though it’s a hot topic, it’s a space challenged with unsupported health claims and confusing ingredient additives. During a panel hosted by Food Navigator, four industry leaders shared insight into the growing gut health category.
“What we’ve learned is that many of our consumers come into our brand typically with serious, long term digestive health challenges. Bloating, regularity challenges, IBS,” said Mitchell Kruesi, senior brand manager for Goodbelly, which creates probiotic drinks and snacks. “They’ve tried supplements in the past, but weren’t super enthusiastic about them because often times taking a supplement felt medicinal to them. After that, they continue to seek out other probiotic options that are both effective, but also food-based so that it’s easy to fit in their routine.”
Plagued with health issues and fed-up with pills, consumers are desiring food brands that aid digestive health. Flavor, though, is key.
“That delicious taste…it sets up an everyday usage routine, which is critical with probiotics,” Kruesi said.
Probiotics is a confusing territory for consumers. Should probiotics be consumed in pills or as a strain added to food? How much should be taken?
Elaine Watson, Food Navigator editor, quoted GT Dave, founder of GT Kombucha: “In my mind, anything raw and fermented deserves to use the term ‘probiotic.” Watson asked the panelists if there’s a perception that all fermented foods contain probiotics because they contain live, active cultures – and should food advertising probiotics be verified by clinically proven studies?
“I think consumers are quite confused still around the whole topic, in all honestly. Live, active cultures are used to make fermented food beverages – but unlink probiotics, they’re typically not studied and shown to provide a health benefit,” said Angela Grist, Activia US marketing director. Really in order to be considered a probiotic, they would need to meet the criteria of survival and research-validated health benefits and also this point around strain specificity.”
Grist said probiotics need to survive the passage through the digestive track to the colon. Activia has five survival studies showing the benefits of probiotics.
Ben Goodwin, co-founder of Olipop, added he’s conducted genetic assays around the underlying culture banks of fermented food and beverages and “there have definitely been organisms in the culture banks which are deleterious for human health. So not everything that’s fermented is automatically good for human health, there’s all sorts of different biological modes that organisms can interact with each other and some become parasitic or become determinantal to your probiotic when consumed, so something to keep in mind.”
Note that the panel did not feature a raw, fermented food brand; the companies included on the panel all add probiotic strains to their food and drink product.
In a separate interview with The Fermentation Association, Maria Marco, professor in the Department of Food Science and Technology at the University of California, Davis, said there is a lot of confusion around probiotics, even among industry representatives. Marco, though, agrees with Grist and Goodwin. She says clinical studies on fermented foods are necessary.
“Although it might be possible to separate out the individual components of foods for known health benefits (e.g. vitamin C), the benefits of many foods are likely the result of multiple components that are not easily separated,” Marco said. “Yogurt consumption is a great example of a fermented food that, through longitudinal studies, was shown to be inversely associated with CVD risk.”
In one of Marco’s studies at UC Davis titled “Health benefits of fermented foods: microbiota and beyond,” Marco and her research associates concluded that fermented foods: are “phylogenetically related to probiotic strains,” “an important dietary source of live microorganisms,” and the microbes in fermented foods “may contribute to human health in a manner similar to probiotics.” The study adds: “Although only a limited number of clinical studies on fermented foods have been performed, there is evidence that these foods provide health benefits well-beyond the starting food materials.”
The panel said that the food industry is responsible for displaying integrity in their marketing on probiotic benefits.
“We believe it’s critical for leading brands in the space…to really educate consumers on, first, what probiotics are,” said Kruesi with Goodbelly. Consumers are seeking out probiotics for a specific health benefit, but most don’t know what strain they need to address their issue, he noted.
Probiotics are live microorganisms that aid the digestive system by balancing gut bacteria.
Currently, the demographic of consumers buying products geared toward gut health are millennial females in coastal cities. Both Activia and Olipop sell to more women than men (Activia customers are 60 percent female and 40 percent male; Olipop customers are 55 percent female and 45 percent male).
Goodwin said Olipop is hoping to tap into the rapidly declining soda market. Soda is a $65 billion industry, with 90 percent household penetration. But more consumers are turning to healthier options than unnatural, sugar-filled soda.
“We’ve tried to take on the extra responsibility as a brand of formulating something that’s spun forward, delicious and really approachable so that we can meet a real health need in a way that’s actually supported by research,” Goodwin said. “(Olipop) is not only low sugar, low calorie, it also has this digestive health function but obviously doesn’t taste like vinegar because it’s not a kombucha.”
Solving Digestive Stress
Products by Activia, Goodbelly, Olipop and Uplift Food (the fourth panel member) are “meant to be a mass solution for the lack of fiber prebiotics and nutritional diversity in the modern diet,” Goodwin said. Fiber contains prebiotics, which aid probiotics.
The USDA’s dietary guidelines recommend adult men require 34 grams of fiber, while adult women require 28 grams of fiber (depending on age). The reality, though, is that most Americans get about half the recommended fiber a day, only 15 grams. According to the National Institute of Diabetes and Digestive and Kidney Diseases, 60-70 million Americans are affected by digestive diseases.
Compare that to the diet of hunter-gatherers, who eat about 100-150 grams of fiber each day and maintain incredibly healthy guts or microbiome. The microbiome is the community of commensal microorganisms in our intestines, fed by fiber, probiotics and prebiotics.
“As it stands now, basically we’re putting in a starvation system for a lot of the microorganisms currently in your gut,” Goodwin said. “The average industrialized consumer has about 50 percent less diversity and abundance of beneficial microorganisms than the hunger-gatherers alive on the planet tonight.”
Future of Gut Health Products
Grist with Activia said probiotics need to be consumed in adequate, regular amounts to provide health benefits, or else probiotics will not consume the digestive track.
Kara Landau, dietitian and founder for Uplift Foods which makes prebiotic foods, added that each individual has a unique bacterial make-up, and providing diverse food to support the microbiome is critical.
Landau said the future of gut health probiotics will be selling a specific probiotic strain, one that a consumer can target for their desired health benefit. Prebiotics – “the fuel for the probiotics” – are also key, and a new part of the digestive health puzzle that brands need to communicate and simplify for consumers.
“Prebiotics are still very much in their infancy when it comes to consumer understanding,” Landau said. “Seeing them alongside probiotics enhances the clarity of their benefits.”