Probiotics

Hayley Aanestad
Nutrition 220
March 9, 2012

Probiotics
Probiotics have been defined as viable non-pathogenic microorganisms
which, when ingested, exert a positive influence on host health (Marteau). For
human adult use, this includes fermented milk products as well as over-thecounter preparations that contain lyophilized bacteria. The microorganisms
involved are usually lactic acid producers such as lactobacilli and bifidobacteria
(Collins). They have been shown to support the digestive and immune systems
and help with gastrointestinal disorders, such as inflammatory bowel disease,
Crohns Disease, Ulcerative Colitis, and Colon Cancer. They are also beneficial to
reduce ones risk of gastrointestinal disorders, along with promote overall wellbeing.
Probiotics were first introduced in 1907 by Russian scientist Elie
Metchnikoff. Metchnikoff based his theory on Bulgarians, whose diet consisted of
fermented dairy products, which may have contributed to their longer life-spans.
He theorized that bacteria in dairy products could be beneficial to the large
intestine and contribute to prolonged life. Metchnikoff believed that when
consumed, the fermenting lactobacillus positively influenced the microflora of the

colon, decreasing toxic microbial activities. The historical association of probiotics

with fermented dairy products stems from these early observations.
Investigations in the probiotic field during the past several decades have
expanded beyond bacteria isolated from fermented dairy products to those of
intestinal origin.
Probiotic bacteria are shown to promote the host defense mechanisms.
They have been shown to enhance immune responses and thereby promote the
intestine's immunologic barrier. Moreover, probiotic bacteria have been shown
to stimulate nonspecific host resistance to microbial pathogens and thereby aid in
immune elimination (Isolauri). The bacteria in probiotics are categorized by
genus, species, and strain names. For example, Lactobacillus rhamnosus GG, the
genus is Lactobacillus, the species is rhamosus, and the GG is the strain name.
Although there are many kinds of probiotic bacteria, the probiotic bacteria most
commonly studied include members of the genera lactobacillus and
bifidobacterium (Sanders). These bacteria naturally occur in some foods, such as
yogurt with active cultures, tempeh, and miso. They can also be added into
supplements and other dairy products. Some known beneficial effects of
probiotics include the following: 1) reduction in the severity and duration of
rotavirus diarrhea, 2) reductioin in the risk of traveler's diarrhea, 3) reduction in

the risk of relapsing after the occurrence of Clostridium difficileassociated

diarrhea, and 4) reduction in the risk of antibiotic-associated diarrhea in children
(Vanderhoof).
The gastrointestinal tract functions as a barrier against antigens from
microorganisms and food (Isolauri). Microflora is very important to health
because many of the bacteria species that live in the intestines depend on the
substrates given to them (through the diet) for growth and survival. Microflora of
the large intestine complete digestion through fermentation, protects against
pathogenic bacteria, and stimulates development of the immune system.
Probiotics and prebiotics in the diet can modify the composition and some
metabolic activities of the microflora (MacFarlane). An effective probiotic should
1) exert a beneficial effect on the host, 2) be nonpathogenic and nontoxic, 3)
contain a large number of viable cells, 4) be capable of surviving and metabolizing
in the gut, 5) remain viable during storage and use, 6) have good sensory
properties, and 7) be isolated from the same species as its intended host.
Postulated health advantages associated with probiotic intake are the 1)
alleviation of symptoms of lactose malabsorption, 2) increase in natural resistance
to infectious diseases of the intestinal tract, 3) suppression of cancer, 4) reduction

in serum cholesterol concentrations, 5) improved digestion, and 6) stimulation of

gastrointestinal immunity (Collins).
In order for probiotics to be fully effective, prebiotics should be present.
Prebiotics are non-digestible oligosaccharides that can stimulate selectively the
growth of probiotic-like bacteria normally present in the gut (MacFarlane).
Prebiotics, like other low digestible carbohydrates, exert an osmotic effect in the
gastrointestinal tract as long as they are not fermented; when they are fermented
by the endogenous flora, i.e. at the place where they exhibit their prebiotic effect,
they also increase intestinal gas production. Prebiotics have therefore the
theoretical risk to increase diarrhea in some situations (because of the osmotic
effect) and to be poorly tolerated in patients with irritable bowel syndrome
(Marteau). For a food ingredient to be classified as a prebiotic, it must 1) neither
be hydrolyzed nor absorbed in the upper part of the gastrointestinal tract; 2) be a
selective substrate for one or a limited number of potentially beneficial
commensal bacteria in the colon, thus stimulating the bacteria to grow, become
metabolically activated, or both; and 3) be able as a consequence to alter the
colonic microflora toward a more healthier composition. Although any food
ingredient that enters the large intestine is a candidate prebiotic, it is the
selectivity of the fermentation in the mixed culture environment that is critical. At

present, most searches for prebiotics are directed toward the growth of lactic
acidproducing microorganisms. This is due to their purported health-promoting
properties (Collins). To be effective, prebiotics should escape digestion in the
upper gut, reach the large bowel, and be utilized selectively by a restricted group
of micro-organisms that have clearly identified, health promoting properties
(MacFarlane).
Probiotics have been known to help certain gastrointestinal diseases such
as inflammatory bowel disease, Crohns disease, ulcerative colitis, and colon
cancer. Inflammatory bowel disease refers to disorders of unknown cause that
are characterized by chronic or recurrent intestinal inflammation. Such disorders
include ulcerative colitis, Crohns disease, and pouchitis (Marteau). Although the
cause of the disease is still unknown, inflammatory bowel disease may result from
abnormal host responses to some members of the intestinal flora, causing
inflammation in the digestive tract. Symptoms for the disease include abdominal
cramps, bloody diarrhea, and fever. Because the causes for the disease are not
yet known, it is hard to find treatment for the symptoms. Probiotics are thought
to work by several different mechanisms. One mechanism involves altering the
composition of the intestinal microbiota by producing bacteriocins, which are
products that eliminate certain bacteria, or by altering pH, which will alter the

growth characteristics of certain bacteria. As a result of these changes, probiotics

could decrease the concentration and perhaps composition of gut bacteria that
preferentially cause inflammatory bowel disease (Sartor). A study was conducted
where twenty patients with active, moderate Crohns disease were randomly
assigned to receive either S. boulardii or a placebo for 7 weeks in addition to the
standard treatment. A significant reduction in the frequency of bowel movements
and in disease activity was observed in the group receiving S. boulardii but not in
the placebo group (Marteau). Another study that was conducted examined the
benefit of a particular protective organism called Faecalibacterium prausnitzii. In
this paper, investigators showed that the mucosal concentrations of F. prausnitzii
at the time of surgery predicted postoperative relapse in patients with Crohns
disease. Specifically, patients who had lower levels of F. prausnitzii had higher
relapse rates during the follow-up period. These researchers also performed
animal studies in which they showed that F. prausnitzii and its metabolites could
decrease experimental colitis. In theory, if clinicians could identify those patients
who have low mucosal levels of F. prausnitzii at the time of surgery, they might be
able to administer F. prausnitzii as a probiotic or suggest foods or prebiotics that
could stimulate growth of F. prausnitzii, and thus protect these patients against
relapse (Sartor). Colon cancer, which in a high proportion of the population is due

to somatic mutations occurring during the lifetime of an individual, could be

prevented by preventing these mutations. Probiotics and prebiotics have been
shown to deactivate genotoxic carcinogens (Wollowski). The endogenous flora
and the immune system play a role in the modulation of carcinogenesis. Both
may be influenced by probiotics and this has led to trials investigating the role of
probiotics in preventing or curing tumors. Several authors showed that some
probiotics may decrease the fecal concentrations of enzymes, mutagens, and
secondary bile salts that may be involved in colon carcinogenesis. Some but not
all epidemiologic studies also suggest that consumption of fermented dairy
products may have some protective effect against large colon adenomas or
cancer (Marteau). The ingestion of probiotics leads to the excretion of urine with
low concentrations of components that are genotoxic in human colon cells and
high concentrations of components that induce oxidized DNA bases (Wollowski).
There is still ongoing research for effects of probiotics on gastrointestinal
diseases. The proven medical indications of probiotics for gastrointestinal
disturbances are the following: 1) replace milk with yogurt in subjects with lactose
intolerance, 2) use freeze-dried S. boulardii or E. faecium to prevent AAD, 3) use
freeze-dried S. boulardii to prevent further recurrence of relapsing diarrhea
because of C. difficile, and 4) use fermented milk containing L. rhamnosus GG to

shorten the duration of the diarrhea during rotavirus enteritis in children

(Marteau).
Although probiotics are very helpful in treating disease, there are also
precautions that must be taken when using probiotics. Reports of frequent
isolation of bacteria used in probiotics from infection sources in recent years have
raised much debate over the safety of probiotics. The factors that must be
addressed in the evaluation of safety of probiotics include pathogenicity,
infectivity, and virulence factors comprising toxicity, metabolic activity, and the
intrinsic properties of the microbes (Ishibashi). There are rare reports of sepsis
due to probiotics, typically in patients who are already sick or immunosuppressed,
such as patients who are hospitalized with multiorgan failure or diabetic
complications. In the ambulatory gastroenterology setting, such reports are
extraordinarily rare, but the potential for serious side effects still exists in
immunosuppressed patients (Sartor). Probiotics should be administered carefully
and cautiously, and only on the basis of strong scientific evidence. Such evidence
should direct the cautious, deliberate addition of clinically proven probiotics to
commonly consumed food products to allow consumers to conveniently benefit
from these organisms (Vanderhoof).

Probiotics are most commonly found in dairy products. However, they are
also found in foods like fermented vegetables, tempeh, and miso. Yogurt is one of
the most common sources of probiotics. Yogurt is milk that has been fermented
by good bacteria such as Lactobacillus acidophilus and is a rich source of
probitotics. Kefir is a cultured milk product that is rich in enzymes, vitamin B and
protein. It is similar to cultured buttermilk and yogurt. Aspergillus and Rhizopus
are bacteria used to preserve vegetables, giving them an added boost of
probiotics. Tempeh is soybeans fermented into a compact white cake loaded
with nutrients. Miso is a fermented soybean paste. Tempeh and miso are
excellent sources of protein, isoflavones and probiotics (McGrath).
Probiotics are still being researched today. The biggest issues with
probiotic studies are the lack of research funding and the small number of
patients who are enrolled in clinical studies (Sartor). Funding directed to
probiotic research is a relatively new area. Another impediment has been the
lack of mechanistic components in clinical studies; large numbers of in vitro
studies have shown that various probiotics may have some therapeutic potential,
but researchers have not yet translated these findings into human studies
(Sartor). It is likely that many more probiotic organisms with a variety of different
therapeutic benefits will be discovered. Additional organisms may eventually be

developed through genetic engineering (Vanderhoof). Another major deficit of

current research into probiotics is that researchers are emphasizing the wrong
group of bacteria when they consider potential probiotics. Instead, researchers
should be emphasizing the protective bacteria that normally live in the body,
rather than looking at bacteria that do not normally reside in the gut. A problem
with traditional probiotics is that they disappear within 23 weeks after
administration. Because these probiotics do not colonize the gut, they remain
present only as long as the patient continues taking them. In contrast, organisms
that are normally found in the body are conceptually much more attractive as
probiotics because they could potentially result in permanent alterations of the
gastrointestinal microbiota (Sartor). The efficacy of probiotics in the treatment of
gastrointestinal disease is well established. As more probiotic organisms are
discovered or engineered and more data are accumulated it is likely that
probiotics may be used to treat and prevent other infectious disorders, allergic
diseases, and even cancer (Vanderhoof).
In conclusion, probiotics are very beneficial to humans. They help to
balance the natural microflora in the intestines, promoting a healthy immune
system. Probiotics are shown to help with certain gastrointestinal diseases, along
with reducing the risk of getting them. The volume of research on probiotics has

increased rapidly during the past decade and is continuing to gain momentum.
Currently the evidence is quite promising that probiotics may benefit a variety of
health conditions by normalizing immune responseup-regulating in some cases
and down-regulating in others (Brons). With the help of funding, future probiotic
research could lead to knowledge of more benefits and uses for probiotics for
humans.

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