Guide adds new indications as evidence base for probiotics continues to grow

Canada’s Clinical Guide to Probiotic Products, which is widely used by pharmacists for evidence-based probiotic recommendations, has added new disease indications for 2026—as it continues to expand in scope as evidence grows for strain-specific indications.“This year, we added pediatric asthma, adult acne, and adult atopic dermatitis as new indications because the evidence was strong and the products became available in Canada,” said Dragana Skokovic-Sunjic, clinical pharmacist with Hamilton Family Health Team in Hamilton, Ont., and author of the guide, which was created and is maintained by the Alliance for Education on Probiotics (AEProbio). The new 2026 indications are listed as Ped. Asthma, ACNE, and Adult AD.When the Canadian Probiotic Guide launched in 2008, it consisted of a single page listing nine products and about 18 references. The latest edition, courtesy of, spans about 24 pages, includes roughly 100 products, and cites nearly 200 studies.Healthcare providers can access the guide online here. Using the search icon, followed by the filter icon, practitioners can access the study-backed recommendations for everything from bacterial vaginosis to irritable bowel syndrome to colic to oral health. They can also access the mobile and PDF versions here and also get the U.S. or U.K. versions. "The guide translates new research into practical, unbiased guidance for clinics and pharmacies," said Skokovic-Sunjic. "From the beginning, a group of experts has reviewed the evidence to determine which studies show clinically relevant outcomes—such as symptom improvement or prevention—and which strains, doses and products match those studies and are available in Canada. “In other words, we translate the science into clinical practice.”Products can be recommended as “adjunctive treatment, not a substitute for standard treatment” or as “alternative to standard therapy.” Brand names are used intentionally, Skokovic-Sunjic said. “We use brand names because that’s what patients and prescribers recognize. If you tell someone to buy a specific bacterial strain, most people won’t know what that means.”At the same time, Skokovic-Sunjic says she doesn’t like to talk publicly about specific brands for new or existing indications. “Focusing only on those products could be perceived as promotion, which I want to avoid. I prefer to talk about the guide in general and mention the new indications in context.”Expanding evidence, crowded marketSkokovic-Sunjic said the guide’s growth mirrors both the rapid expansion of probiotic research and increasing complexity at the pharmacy level. She emphasized that the guide is designed to support pharmacists navigating an evidence-heavy but often confusing category.Annual updates are critical because formulations can change even when brand names do not, she said. “Sometimes the brand name stayed the same, but the contents changed completely,” she said. “That could have a major impact on outcomes.”Probiotic mythsAs microbiome research expands, Skokovic-Sunjic said pharmacists play a key role in dispelling common myths about probiotics.“People think probiotics permanently colonize the gut, which usually isn’t true in adults,” she said, adding that claims around refrigeration or special coatings are often marketing-driven rather than evidence-based.Different strains—even within the same bacterial family—can produce very different clinical effects."There are hundreds of bacteria with proven effects on humans, and hundreds that can be harmful. To be considered a probiotic, strains must meet strict criteria, including safety and proven benefit. Only a small number have strong evidence.”The guide remains deliberately selective, Skokovic-Sunjic said. “Today, the guide includes far more products than it did initially, but still probably less than 5% of what’s on the market.” She stressed the importance of recommendations with strain-level precision. “When someone says ‘Lactobacillus,’ that’s like saying ‘I’m from Ontario.’ It’s not specific enough. You need the full strain designation.”Throughout the year, the team led by Skokovic-Sunjic review the research. “If there’s a strong study but no matching product in Canada, we set it aside for the future,” Skokovic-Sunjic said. “If stronger evidence emerges (for a product), we may revise or even remove an indication.”For example, some indications have been removed when products were discontinued, including past listings for diabetes and mastitis.While the project receives industry funding, she said strict governance rules apply. “Sponsors cannot influence what’s listed.”Practical tool for pharmacistsSkokovic-Sunjic said the guide’s evolution—from a small informal project to a national digital resource—has been driven by pharmacist and clinician demand for unbiased, usable information.“When clinicians and patients tell us how helpful the guide is,” she said, “it reminds us why we do this.”

Guide adds new indications as evidence base for probiotics continues to grow

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