In addition, the expansion of the entire ‘–biotics’ category, including terms such as postbiotic 10 and pharmabiotic 11, almost certainly further contributes to confusion. A general misunderstanding might have been, in part, because the original definition itself - that is, “mixtures of probiotics and prebiotics that beneficially affect the host by improving the survival and implantation of live microbial dietary supplements in the gastrointestinal tract, by selectively stimulating the growth and/or by activating the metabolism of one or a limited number of health-promoting bacteria, thus improving host welfare” - was too wordy and lacked precision 5. Despite the availability of similarly worded definitions, confusion exists among stakeholders, including scientists, about what constitutes a synbiotic 6, 7, 8, 9. The term itself was formed from the Greek prefix ‘syn’, meaning ‘together’ and the suffix ‘biotic’, meaning ‘pertaining to life’. Thus, synbiotics were loosely defined as mixtures of “probiotics and prebiotics that beneficially affect the host” 5. When the synbiotic concept was first described 25 years ago, the notion that selectively fermentable non-digestible food ingredients (prebiotics) could be combined with probiotics was envisioned 5. Several strategies have been proposed to modulate the composition and/or function of the gut microbiota, including faecal microbiota transplants, the application of probiotics and other live microorganisms, and the use of non-digestible dietary substrates such as prebiotics 3, 4. Nonetheless, disruptions occur owing to dietary shifts, antibiotic use, age or infection, leading to a gut microbiota that can contribute to a range of inflammatory, pathogenic and metabolic conditions such as inflammatory bowel diseases, colorectal cancer, metabolic syndrome and atopy 2. A stable gut community protects the host against invading microorganisms and helps maintain homeostasis, including immune regulation. Notable properties of the gut microbiota include its functionality and resilience 1. This Consensus Statement further explores the levels of evidence (existing and required), safety, effects upon targets and implications for stakeholders of the synbiotic concept. A synergistic synbiotic is a synbiotic for which the substrate is designed to be selectively utilized by the co-administered microorganisms. #REMEDIOS PARAISO GOMEZ PEER REVIEW PLUS#Rather, the panel clarified that a complementary synbiotic, which has not been designed so that its component parts function cooperatively, must be composed of a probiotic plus a prebiotic, whereas a synergistic synbiotic does not need to be so. Requiring that each component must meet the evidence and dose requirements for probiotics and prebiotics individually could also present an obstacle. The panel concluded that defining synbiotics as simply a mixture of probiotics and prebiotics could suppress the innovation of synbiotics that are designed to function cooperatively. The panel updated the definition of a synbiotic to “a mixture comprising live microorganisms and substrate(s) selectively utilized by host microorganisms that confers a health benefit on the host”. In May 2019, the International Scientific Association for Probiotics and Prebiotics (ISAPP) convened a panel of nutritionists, physiologists and microbiologists to review the definition and scope of synbiotics.
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