The prebiotic landscape: history, health and physiological benefits, and regulatory challenges - an IPA perspective...

Prebiotics are becoming increasingly recognized by consumers, health care professionals and regulators as important contributors to health. Nonetheless, the development, progress, and adoption of prebiotics is hindered by loose terminology, various misconceptions about sources and types of compounds that may be classified as prebiotics, and the lack of consensus on a definition that satisfies regulators. Evolving knowledge of the microbiome and its effects on host health has generated opportunities for modulation of the microbiota that can support host health. Various types of biotics - probiotics, prebiotics, and postbiotics, are compounds that either modulate the microbiota or arise from the microbiota, affecting health locally and distally. Each of these classes of biotic compounds have distinct, yet complementary benefits. While many scientists have proposed definitions for prebiotics, and there have been attempts by selected scientists to develop a 'consensus definition', the fact remains that globally, scientists, manufacturers, and marketers have adopted different definitions to suit their own interests and purposes, leading to confusion among consumers and health care professionals. The pathway to regulatory acceptance and to reduce/eliminate confusion is a definition that puts the focus on the consumer, and the benefits that consumers can realise from consumption of prebiotics. This consumer-focused approach, supported by science, will also align with regulators and support broader regulatory approval of prebiotics as a category. In this review, we discuss the history of prebiotics, and introduce criteria and a decision tree to classify compounds as prebiotics, supported by the scientific literature to date. This includes a summary of compounds that have been clearly recognised as prebiotics. We also review the microbiota, microbiome, and the various ways in which prebiotics can beneficially affect the microbiota and health. The safety and efficacy of prebiotics is also reviewed, along with effective doses and limitations associated with prebiotic use. This includes scientific tools and methods that help to establish the function, safe use and efficacy of a prebiotic. We also identify misconceptions that can be addressed in communications to consumers and health care professionals. Manufacturing guidelines and the current regulatory status of prebiotics in various jurisdictions are also reviewed. Collectively, this review provides an in-depth overview of the role for prebiotics to support the health of consumers. This consumer-focused approach provides clear criteria for the product category, safe use, effective communication of health benefits and limitations, and a pathway towards regulatory approval.