PROBIOTICS

What are Probiotics?• As defined by the Food and Agriculture Organization of the

United Nations (FAO) and the World Health Organization (WHO) in 2002, probiotics are: “Live microorganisms which when administered in adequate amounts confer a health benefit on the host.”

• Probiotics (literally “for life”) are friendly bacteria or yeasts and are a concept in contrast to antibiotics. Lactobacilli and bifidobacteria are the most common probiotic bacteria, but the yeast Saccharomyces cerevisiae and some Escherichia coli strains are also used as probiotics.

• Probiotics can be found in the form of food or dietary supplements in the United States. Potential health benefits from probiotics may vary depending on the type of probiotics consumed.

RATIONALE

HISTORY• At the start of the 20th century, Russian noble prize winner and father of modern

immunology, Elie Metchnikoff, a scientist at the Pasteur institute, was the first conceptualize “probiotics”.

• In 1907 Metchnokoff proposed that the acid producing bacteria in fermented milk products could prevent “fouling” in the large intestine and if consumed regularly, lead to a longer, healthier life.

• In early 1930’s, in Japan, Minoru shirota developed a fermented milk product called Yakult (probiotic yogurt like product made by fermenting a mixture of skimmed milk with a special strain of Lactobacillus casei shirota).

• Probiotic term coined in 1965 by Lilly and Stillwell.

GUT MICROFLORA

Human gastrointestinal tract contains 10 times more bacteria than there are eukaryotic cells in the body. These probiotic bacteria have:

(1) protective, (2) immunomodulatory and (3) metabolic functions.

1. Gut bacteria form a protective layer, competitively inhibit the bad bacteria, synthesize mucus, tighten intercellular junction, thus protecting the intestinal mucosa.

2. They help in boosting host immunity by inhibiting proinflammatory mediators, stimulating release of antiinflammatory cytokines and releasing bacteriocins.

3. The metabolic functions are digesting carbohydrates to produce short-chain fatty acids, synthesizing vitamin K, aiding in absorption of minerals and converting primary bile acids to secondary bile acids

INTESTINAL MICROFLORA

• Rare in the esophagus

• Uncommon in the stomach• primarily gram (+)• 102 - 104

• 105 in the jejunum – primarily aerobes

• 1010 – 1012 in the colon • primarily anaerobes• 1000x more anaerobes than

aerobes

FACTORS AFFECTING INTESTINAL ECOSYSTEMAntibiotics and other drug intake

Microbial infections

Diet (highly processed, low fiber foods)

Chronic diarrhea

Stress

Radiation and chemotherapy

Colonic therapies for detoxification

A SUCESSFUL PROBIOTIC MUST..

Able to survive the passage through the digestive system. Should survive intact at low pH of stomach.

Able to attach to the intestinal epithelia and colonise.

Able to maintain good viability.Able to utilise the nutrients and substrates in a

normal diet. Non pathogenic and non toxic.Capable of exerting a beneficial effect on the

host.Stability of desired characteristics during

processing, storage and transportation.Anti-inflammatory, antimutagenic,

immunostimulatory.

In respect of the probiotic definition of FAO/WHO

products claiming probiotic effects should contain a

sufficient number of viable cells to confer efficacy. This

is generally higher than 10^6–10^8 cfu/g or 10^8–

10^10 cfu/day (Champagne et al., 2011).

Microorganism Strain Company (product)Bifidobacterium adolescentis ATCC 15703

Bifidobacterium animalis Bb-12 Chr. HansenBifidobacterium bifidum Bb-11 Chr. HansenBifidobacterium essencis Danone® (Activia)Bifidobacterium infantis Shirota Immunitas® Yakult Danone®

Bifidobacterium lactis Bb-02, LaftiTM B94 DSM

Bifidobacterium CRL 431Bifidobacterium longum BB536

SBT-2928UCC 35624

Morinaga Milk IndustrySnow Brand Milk ProductsUCCork

Bacillus lactis DR10 Danisco (Howaru™)Lactobacillus acidophilus LA-1/LA-5 Chr. HansenLactobacillus bulgaricus Lb12

STRAINS

1. Culture activation in Lab

2. Preparing and measuring materials

3. Media preparation,

sterilization in fermentation vessel

4. Inoculation

5. Fermentation6. Ultrafiltration7. Loading to Freeze dryer or Spray dryer

8. Collection of dry powder

9. Grinding, mixing, weighing, packaging 10. Storage at -18°C Innoculation in

suitable matrix

PRODUCTION OF PROBIOTICS

FROZEN OR DRIED PREBIOTIC CONCENTRATRESProbiotics are delivered as food supplements, generally in caplets or capsules

containing dried cells, or in processed foods.

In general, probiotic concentrates are stored until incorporation in the final products.

Microencapsulation is one of the best storage technique used for probiotics.

Microencapsulation can be done either by Gel entrapment (in alginates) or by Spray coating.

Nutrient Synthesis and Bioavailability1. Fermentation of food with lactic acid bacteria has been shown to

increase folic acid content of yogurt, bifidus milk and kefir and to increase niacin and riboflavin levels in yogurt, vitamin B12in cottage cheese and vitamin B6 in Cheddar cheese.

2. In addition to nutrient synthesis, probiotics may improve the digestibility of some dietary nutrients such as protein and fat.

3. Short-chain fatty acids such as lactic acid, propionic acid and butyric acid produced by lactic acid bacteria may help maintain an appropriate pH and protect against pathological changes in the colonic mucosa.

DRUG INTERACTIONSSince probiotics contain live microorganisms, concurrent

administration of antibiotics could kill a large number of the organisms, reducing the efficacy of the Lactobacillus andBifidobacterium species.

Patients should be instructed to separate administration of antibiotics from these bacteria-derived probiotics by at least two hours.

 Similarly, S. boulardii might interact with antifungals, reducing the efficacy of this probiotic.

 Probiotics should also be used cautiously in patients taking immunosuppressants, such as cyclosporine, tacrolimus, azathioprine, and chemotherapeutic agents, since probiotics could cause an infection or pathogenic colonization in immunocompromised patients. 

SAFETY AND ADVERSE EFFECTS

When ingested orally, probiotics are generally considered safe and well tolerated. The most common adverse effects include bloating and flatulence; however, these are typically mild and subside with continued use.

 Constipation and increased thirst have also rarely been associated with S. boulardii.

 One theoretical concern associated with probiotics includes the potential for these viable organisms to move from the gastointestinal tract and cause systemic infections. Although rare, probiotic-related bacteremia and fungemia have been reported.

 It is estimated that the risk of developing bacteremia from ingested lactobacilli probiotics is less than 1 per 1 million users, and the risk of developing fungemia from S. boulardii is estimated at 1 per 5.6 million users.

 Another theoretical risk associated with probiotics involves the possible transfer of antibiotic resistance from probiotic strains to pathogenic bacteria; however, this has not yet been observed.

SIDE EFFECTS

• Since probiotics contain live microorganisms, there is a slight chance that these preparations might cause pathological infection, particularly in critically ill or severely immunocompromised patients.

• Probiotic strains of Lactobacillus have also been reported to cause bacteremia in patients with short-bowel syndrome, possibly due to altered gut integrity.

• Caution is also warranted in patients with central venous catheters, since contamination leading to fungemia has been reported when Saccharomyces capsules were opened and administered at the bedside.

• S. boulardii is contraindicated in patients with a yeast allergy.• No contraindications are listed for bifidobacteria, since most species are

considered nonpathogenic and nontoxigenic.

DOSAGE

• Minimum Consumption: 100g of a probiotic food with 107 cfu/ g.

• most probiotics do not permanently adhere in the intestine, but exert their effects as they metabolize and grow during their passage through the intestine (colonization). Thus, daily consumption of these bacteria is probably the best way to maintain their effectiveness

STABILITY

ACID TOLERANCEIn vitro tests of acid tolerance (A) can be predictive of survival of probiotic strains in yogurt (B). In A, the viable counts of 3 strains of bifidobacteria were measured at time 0 (□) and after incubation for 105 min at 37°C in 0.2 mol HCl-KCl/L buffer, pH 2.0, plus 0.1% peptone (▪)

BILE TOLERANCEThe effect of bile on the growth of Lactobacillus amylovorus CSCC 5442 (A) and Lactobacillus amylovorus CSCC 5197 (B). •, control (MRS broth); □, treatment (MRS broth containing 0.3% ox bile).

ADHESION TO INTESTINAL MUCOSAAdhesion of commercial probiotic strains in 2 in vitro models of the intestinal mucosa. □, adhesion to a differentiated Caco-2 cell monolayer; ▪, adhesion to intestinal mucins.

PROBLEMS• Probiotics are regulated as dietary supplements and not subjected to the same

rigorous standards as medications. • A challenge with these products involves the complexity of quality control with

live microorganisms. • As a result, individuals may obtain a product that is ineffective or that contains

varying quantities of bacteria or yeast. Published studies involving probiotics have often utilized small sample sizes and lacked appropriate randomization, blinding, or control groups.

• Therefore, the results from many probiotic studies should be interpreted cautiously due to methodological limitations. There is also heterogeneity among studies, since different probiotic doses, strains, treatment durations, and patient populations may have been used.

• Future research needs to encompass more well-designed clinical trials in larger populations and for longer durations to better evaluate the efficacy of probiotics.

 

Probiotics can be consumed in the form of capsules or through food.

Cheese, butter, powdered milk for infants, mayonnaise, meat, cereals, ice cream, fruits, vegetables can serve as vehicles for delivering probiotics.

Dairy products are regarded as the ideal carrier because dairy products buffer the bacteria in the stomach and contain functional ingredients that interact with the probiotics.

Encapsulated probiotics can be added to non dairy beverages.

The probiotics should remain viable during the manufacture of these food matrices without any loss in characteristics

PRODUCT DEVELOPMENT

PRODUCTS

Yogurt

• Usually made from milk (rarely, from cream) inoculated with Streptococcus thermophilus and either Lactobacillus acidophilus or Lactobacillus bulgaricus.

• Turkish in origin

• Available in innumerable forms and flavors

1. Low fat chocolate yogurt

2. Drinkable fruit-flavored goat yogurt

3. Neon-colored yogurt in squeeze tubes

An organic, non-dairy, rice “yogurt” with whole grains and live, active

cultures, including  Lactobacillus bulgaricus,

Streptococcus thermophilus, Lactobacillus

acidophilus and Bifidobacterium

bifidum.

RICERA RICE YOGHURT

Attune makes Wellness Bars in three chocolate

varieties and three yogurt and

granola varieties.

All products contain “more

than 5 times the live active cultures in

yogurt, with less sugar.

ATTUNES CHOCOLATE AND GRANOLA BARS

Vive contains one billion CFUs of

Lactobacillus acidophilus

per serving.

KASHI VIVE PROBIOTIC WELLNESS CEREAL

• First probiotic juice launched in the fall of 2007 by Next Foods.

• Goodbelly, organic fruit juice-based probiotic beverage , contains L.Plantarum 299v, has effects on irritable bowel syndrome

• Three initial flavors include Brilliant Blueberry, Peach Mango and Strawberry Rosehip

PROBIOTIC JUICE

DOSAGE FORMS

Standard forms:

– Capsules– Sticks– Powder blends– Chewable tablets

Individual customization:

– Capsules– Sticks– Chewable tablets– Sachets– Tablets

What are Prebiotics?

Prebiotics are non-digestible substances that when consumed provide a beneficial physiological effect on the host by selectively stimulating the favorable growth or activity of a limited number of indigenous bacteria.(Gibson and Roberfroid 1995)

New Definition (By Roberfroid 2007): Prebiotics are selectively fermented, dietary ingredients that result in specific changes in the composition and/or activity of the gastrointestinal microbiota, thus conferring benefits upon host health.

Prebiotics modify the balance of the intestinal microbiota by stimulating the activity of beneficial bacteria such as Lactobacilli and Bifidobacteria

CLASSIFICATION OF PREBIOTICS

STRUCTURES

SOURCES

Food Prebiotic Fiber Content by Weight

Raw Chicory Root 64.6%

Raw Jerusalem Artichoke 31.5%

Raw Garlic 17.5%

Raw Leek 11.7%

Raw Onion 8.6%

Raw Asparagus 5%

Raw Wheat bran 5%

Whole Wheat flour, Cooked 4.8%

Raw Banana 1%

While there is no broad consensus on an ideal daily serving of prebiotics, recommendations typically range from 4 to 8 grams (0.14–0.28 oz) for general digestive health support, to 15 grams (0.53 oz) or more for those with active digestive disorders.

PREBIOTIC MARKET

Reduced Constipation.As a soluble dietary fiber, inulin shortens fecal

transit time, slightly increases fecal bulk.

Barrier against pathogens. The SCFAs reduce lumenal pH in the colon to levels at which pathogens such as E. coli can’t

multiply effectively.In addition, increased populations of

bifidobacteria and lactobacilli can compete with other organisms for nutrients and receptors.

Cancer Prevention.Butyrate, a product of fermentation of prebiotics

by gut microflora, promotes the apoptosis of carcinogenic cells and is thought to be protective

against colon cancer.

Improved Calcium absorption.SCFAs cause a reduction in lumenal colonic pH

which is likely to increase calcium solubility and overall levels in the gut.

SCFA enter the colon in a protonated form and then dissociate in the intracellular environment.

The liberated proton is then secreted into the lumen in exchange for a calcium ion.

Cholestesterol Lowering effect.The prebiotic fiber bind with bile acids and

reduce solubilisation of cholesterol leading to a cholesterol lowering effect. This overall

cholesterol lowering effect could reduce the stiffness of large arteries and thus could

potentially reduce blood pressure.

Insulin resisistence lowering effect. Insulin resistance is a physiological condition where the natural hormone insulin becomes less effective at lowering blood sugars.The prebiotics have been found to improve postprandial glucose response and decreased secretion of insulin via lowered glycemic index.

HEALTH BENEFITS

HEALTH BENEFIT

S

Immune function

Colon Cancer

Microflora Modification

Blood Glucose

Lipid Metabolism

Mineral Absorption

Laxation

Diarrhoea Most of these effects possibly emanate from increased production of short-chain fatty acids by the stimulated colonic bacteria.

SIDE EFFECTSPrebiotics may cause unpleasant side effects like gas, bloating and increased bowel movements.

Prebiotics are not digested by our digestive system because of the beta-configuration of the bonds in their structure.

Inulin, oligofructose, and FOS are fully metabolized by the colonic microflora.

The end products of fermentation are gases(such as carbon dioxide and hydrogen), lactates, and short-chain fatty acids (like acetate, propionate, and butyrate).

The Degree of Polymerization(DP) influences the metabolism of specific inulin-type prebiotic compounds.

MOA

MECHANISM

PRODUCTION OF PREBIOTICS(1) direct extraction of natural oligosaccharides from plants;

(2) controlled hydrolysis of natural polysaccharides; and

(3) enzymatic synthesis using hydrolases and/or glycosyl transferases from plant or of microbial origin.

Prebiotic MethodInulin (FOS) Hot water extraction from Chicory root

followed by enzymatic hydrolysisGOS Enzymatic lactose TransgalactosylationXOS Enzymatic hydrolysis of plant xylansIsomaltooligosaccharide Transglucosylation of liquified starchlactulose Isomerization of lactose

1. Mainly fructooligosaccharides(FOS) are produced by this method.

2. The process is called transfructosylation.

3. The fungal enzyme beta-fructosidase, derived from Aspergillus niger is used.

4. Starting molecule used is sucrose, and the enzyme activity sequentially adds fructose units with new beta (2−1) linkages placed in the chain.

5. Unlike inulin and oligofructose, transfructosylation does not result exclusively in beta (2−1) fructosyl-fructose glycosidic bonds; other linkages occur in limited numbers.

6. DP ranges from 2-4.

ENZYMATIC PROCESS

Chicory Roots

Washing

SlicingSun Drying (30-

35°C) or Hot Oven Drying (80-90°C)

Grinding to get a chicory powder

Extraction by diffusion in hot water (70-80°c

for 1 hr)

Filtered using a double layer muslin cloth

Precipitation of filtrate using 20,40, 60%

ethanol

Inulin obtained by

centrifugation & dried at 45°C

INULIN

EMERGING PREBIOTICS1) LACTULOSE2) LACTOSUCROSE

FUNCTIONAL PROPERTIES

Food Products ApplicationsDairy Products Body and mouth feel; Sugar and fat replacement;

Synergy with sweeteners; Foam stability

Frozen Desserts Melting and texture; Sugar and fat replacement; Synergy with sweeteners

Table Spreads Emulsion stability; Fat replacement; Spreadability and texture

Baked goods and breads

Retention of moisture; Sugar replacement

Breakfast Cereals Crispness and expansionFruit preparations Body and mouth feel; Sugar replacement; Synergy

with sweetenersMeat products Texture and stability; Fat replacementChocolates Heat resistance; Sugar replacement

NUTRIENT-NUTRIENT INTERACTION• Uptake of calcium and magnesium is crucial for bone structure and

increasing absorption can prevent conditions such as osteoporosis.• Chonan et al. (2001) have shown that adding GOS to the diet of rats

can increase calcium and magnesium absorption.• The mechanism for this is unclear but in this case the presence of a

colonic flora is required for GOS to have this effect, though the authors acknowledged that microbial mediated and nonmicrobial mediated mechanisms probably exist.

• FOS can also affect mineral absorption and in human studies 15g per day oligofructose or 40 g per day inulin increased the apparent calcium absorption

• Magnesium absorption has also been shown to increase when ingesting FOS

NUTRIENT-NUTRIENT INTERACTION• Prebiotics may also have an effect on lipid regulation. Although

the mechanism is currently unknown, studies have shown positive results and mechanistic hypotheses have been developed.

• A study on diabetic rats found that when XOS replaced simple carbohydrates in the diet, the serum cholesterol and triglyceride increases observed in diabetes were reduced and liver triglycerides increased to a comparable level seen in healthy rats (Imaizumi et al., 1991).

• Other studies have examined FOS, which was also found to reduce blood lipids (Bornet et al., 2002; Roberfroid, 2002). This was thought to be due to an inhibition of lipogenic enzymes in the liver, which may be a result of the action of propionate produced from the fermentation of prebiotics by gut bacteria

DRUG-NUTRIENT INTERACTION• Drug interactions include a reduction in the effectiveness of the

blood thinner warfarin and the arthritis medication sulfasalazine

Forms and Dosage• Isapghula husk as a loose powder. A good dose is 10 grams(= 2 heaped teaspoons) twice daily.

For IBS.

• FOS(fructooligosaccharides) loose powder. A good dose is 2.5 grams(= 1 level teaspoon) twice daily.

• Inulin powder/ syrups 2.5 grams(= 1 level teaspoon) twice daily( better prebiotic than FOS)

• GOS( Galactooligosaccharides) 5 grams daily

• Butyric acid capsules- Provide most of the benefits of probiotics, without actually taking probiotics for upset of gut.

• Start with lower doses for a few days, otherwise may experience some constipation.

• Caution is taken with antibacterial herbs or supplements that are taken along with, which may inhibit the good bacteria as well as the bad.

The wonders of prebiotic.Hip, Oct 6, 2010

SAFETYFructooligosaccharides:• Optimum intake : 10 gm/day• The doses upto 44gm for men and 49gm for women are

supposed to induce diarrhea

Inulin and oligofructose: • There is no evidence of toxic effects• The dose of intolerance is quite high, which allows for a broad

therapeutic dose range

PROBLEMS WITH PREBIOTICS• Overdose can cause intestinal bloating, pain, flatulence, or

diarrhea• Not as potent as antibiotics in eliminating specific pathogens• Overcomes the need for probiotic bacteria to compete with

intestinal bacteria that are well established in their niche

PROBIOTICS v/s PREBIOTICS

Stable in long shelf life foods and beverages

Physicochemical properties useful to food taste and texture

Resistant to acid, protease, and bile

Stimulate organisms already resident in the host

Stimulate fermentative activity of the microbiota and health benefits from SCFA

Lower intestinal pH and provide osmotic water retention in the gut

Safe for long-term consumption and prophylactic approaches

Do not stimulate side effects/ antimicrobial resistance genes

Not allergenic

PROBIOTICS v/s ANTIBIOTICS

60 CAPSULESRs 600/-

CONCLUSION• The healthful effects of pre- and probiotics factor in their potential

impact on the balance of the body’s microflora, and directly or indirectly in their enhancement of the function of the gut and systemic immune system.

• Although benefits vary, depending on the type and amount of a pre- or probiotic consumed, experts agree that daily consumption of foods containing these functional components is beneficial.

• In addition, effects of probiotics are strain-specific and must be demonstrated through appropriate clinical trials.