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Dietary Fiber, Prebiotics, &

Probiotics

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MICROECOLOGY

Gut Secretions Microflora Foods

Gut Wall

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Definitions

• Dietary Fiber  = Nonstarchpolysaccharides of plant foods poorlydigested by human enzymes

• Prebiotics = Nonstarch polysaccharide orother substance supplements poorlydigested by human enzymes that nurtureprobiotic organisms

• Probiotics = human microorganisms fed assupplements that benefit the host

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Dietary Fiber

• By chemical analysis fiber can be

broken into soluble  and inso lub le  

components (resistant starch identified by other chemical method)

• Soluble  components are pectic substances, some hemicelluloses,gums and mucilages and are completely fermented by the bacterialflora

• Insoluble  components are cellulose, some hemicelluloses, waxes, andlignin primarily in plant cell walls as well as resistant starch are onlyslightly fermented

• Wheat  is 90% insoluble and 10% soluble

Oats  are 50% insoluble and 50% soluble

Psyl l ium   10% insoluble and 90% soluble

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Dietary Fiber

Physiologic Properties

1. Slows transit in small bowel

2. Increases stool bulk

3. Holds on to water4. Forms gels

5. Binds minerals and organic substances

6. Stimulates bacterial growth

7. Metabolized to SCFA (SHORT CAHINFATTY ACID)

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SCFA (SHORT CHAIN FATTY

 ACID) Production in Colon

Starch Bacterial Butyric (22)+ Acetic (56)

Non-starch Enzymes Propionic(61)

Polysaccharides

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Benefits of Dietary Fiber

• Large Literature on Benefits. Some Conflicts But GeneralConsensus Is:

• Intake of greater than 25 to 35 gm/day associated with:

1. Prevention of Coronary Heart Disease and

Hyperlipidemia Control2.Decrease Stroke in Males

3.Prevention and Treatment of Diabetes

4.Treatment of Dietary Constipation

5.Prevention and Treatment of Diverticular Disease6.Inverse Relationship with Colon Cancer Development

(AGA consensus)

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Fiber in Cancer Prevention

• Numerous epidemiologic studies• Prospective Decosse study in human

familial polyposis of the colon showed that

subjects on bran supplementation had lesspolyp formation

•  Animal studies show that Lactobacilli

degrade carcinogens.• Bifidobacteria with and without prebiotics

decrease carcinogen activity and tumor

development in numerous animal studies.

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PREBIOTICS

Supplements not digested by human enzymes thatstimulate growth of beneficial bacteria

• Fructo-oligosaccharides

• Inulin

• Galacto-,galactosyllactose-,xylo-,isomalto-andsoya oligosaccharides

• Pyrodextrins (glucose oligosaccharides)

• Lactulose

• Breast milk oligosaccharides

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Oligosaccharides

• Usual pleasant slight sweet taste

•  Add texture to foods

• Naturally occurs in artichoke, onion,garlic,chicory, leek, and to a lesser degree in

cereals

• Raffinose and stachynose are major CHOof beans and peas

• Commercially produced (FOS)

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Benefits of Oligosaccharides

• Promote the growth of bifido-and

lactobacilli

• Lower colon pH

• Discourage growth of Clostridia

• Prevent constipation and diarrhea

• Have low glycemic index• Water-soluble and of low viscosity

• Do not bind minerals

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Inulin

• Naturally occurs in fruits and vegetables

• Longer chain length than FOS

• Provides a fat mimicking texture whenadded to food

• Now available in a supplement

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Hepatic Encephalopathy

• Lactulose as a prebiotic alters the enteric

flora and successfully reduces

encephalopathy

• Lactobacillus acidophilus has also been

used and associated with a decrease in

urease and amino-acid-oxidase activity

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Prebiotic Substances Available

Commercially

In USA

FOS (Ross),

Guar (Novartis)Lactulose (Solvay and Bartek)

Inulin (Fibersourse,P & G)

In Japan and Europe many of the otheroligosaccharides

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PROBIOTICS

• Live microbial food supplements which

beneficially affect the host animal by

improving its intestinal microbial balance.

• Usually strains of bacteria (lactobacilli or

bifidobacteria) or yeasts (Saccharomyces)

•  Administered in yogurts or capsules

• Survive passage thru the gut

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PROPERTIES of PROBIOTICS

• Human origin

• Resist upper GI tract secretions

•  Adhere to human intestinal cells

• Colonize the human intestinal tract• Production of antimicrobial substances

•  Antagonize carcinogenic/ pathogenic flora

• Safe in clinical use at > 1010 

• Stimulate immune process

• Fermentation

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Probiotics Used in Human Studies

•  Analysis of 186 published human studies [1980-2004]

• 171 controlled, 79 RDBPC (Montrose- JCG ’05) 

- 173* used single organism

- 82* used multiple organisms

- 84% reported significant benefit

• Most common used single areL.acidophilus,L.reuteri,L.plantarum,L.GG, B.bacterium,B.brevi, E.coli Nistle etc

• Most common multiple are combo of L.acidophilus &Bifidobacterium.

• VSL#3 has 8 organisms

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Treating Infection

 Antibiotic AssociatedDiarrhea (A)•  Associated with C.difficile which may cause

pseudomembraneous colitis

• 3.2-29% of hospitalized patient

• Freeze dried lactobacillus not successful

• Lactobacillus GG successful in eradicating C.difficile

• Saccharomyces boulardii in DBC study reducedrecurrence from 22% to 9.5%

• BMJ “02 of nine studies revealed probiotics may prevent

C.difficile diarrhea• Probiotics used in prevention and as adjuvant therapy in

 AAD.

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CHILDHOOD DIARRHEA (A)

• Metanalysis revealed length of courseof childhood diarrhea reduced one day

when probiotic added to treatment

• Several species of lactobacilli effective• B.bifidum reduces risk of diarrhea when

added to acidified milk or formula

TRAVELLER’S DIARRHEA (B) 

• Incidence reduced from 71 to 43% in

tourist study with S.boulardii

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Probiotic Organisms in USE

• Bifidobactor sp.

(bifidum, longum,

breve,animalis,

infantis,adolescentis)• Streptoccus

thermophilus

• Saccharomyces

boulardii,cerevisiae

• Enerococcus faecium

• Lactobaciilli sp.

(casei, acidophilus,

bulgaricus, gaseri)

• L.rhamnosus, GG• Lactococcus sp.

(lactis,cremaris)