University of Health Sciences

Faculty of Pharmacy

Probiotic & Prebiotic

Summarized by Group 4, Fourth Year (42th Generation)

Academic Year: 2020-2021
Content

I. Principles application of microflora of upper GI and lower GI tract (Page 3)

II. Definition and Health Benefits of Prebiotics & Probiotics (Page 4-5)

III. Food Source of Probiotics (Page 6-7)

IV. Food Source of Prebiotics (Page 8)

V. Synbiotics and Health Benefits (Page 9)

VI. Risks and Side Effects of Probiotics and Prebiotics (Page 9)

VII. Multiple Choice Questions + Answers (Page 10-16)

1
Intentionally left blank

2
I. Principles application of microflora of upper GI and lower GI tract
Upper Gastro-Intestinal (GI)
★ The stomach contains few bacteria because of its high acidity.
★ Helicobacter Pylori, now are proven to be the cause of most (greater than
95%) cases of gastritis and peptic ulcers.

Lower Gastro-Intestinal (GI)

★ The small intestine usually contains small numbers of Streptococci,
Lactobacilli, and yeasts, particularly Candida Albicans.
★ Larger numbers of these bacteria are found in the terminal ileum.
★ The large intestine, or colon, is the main site for bacteria in the body. Roughly
twenty percent of the faeces of a normal person consists of bacteria.
★ The main bacteria in the colon are Bacteroides, Bifidobacterium,
Eubacterium, Coliforms (e.g. E. coli), Streptococcus, Lactobacillus and
Clostridium.

Intestinal Flora of Breastfeed Infant

★ The breast milk is rich in prebiotic oligosaccharide and probiotics that play
an essential role in the composition of gut microbiota in the newborn.
★ Some prebiotic can be beneficial for infants by promoting the growth of
healthy gut bacteria, supporting the immune system, stimulating bowel
movement and softer stool.
★ The most widely used probiotics are live bacteria such as lactobacillus and
bifidobacterium.
★ Human breast milk contains an average of 5–15g of oligosaccharides per
liter.
★ The total number of microbial genes in the human body is 1000-10000
bacteria per milliliter.

Human milk oligosaccharide (HMO)

★ HMO gives newborn multiple layers of protection:
-Protect against pathogenic infections
-Promote the development of health
-Help establish the gut microbiota
-Stimulate the maturation of immune system
★ HMO content in colostrum 15-32 double level of mature milk.
★ Through their action on the gut, HMOs positively influenced the infant’s
mucosal and systemic immunity.

3
II. Definition and Health Benefits of Prebiotics & Probiotics:
1. Definition of Probiotics:
➢ They are live microorganisms that provide health benefits.
➢ They are created by the process of fermentation in foods.
➢ They are classified into two groups:
★ Lactobacillus: is found in yogurt and other fermented foods. It helps for
infectious diarrhea, antibiotic-associated diarrhea and also for general
digestion problems.
★ Bifidobacterium: In some dairy products for treating the irritable bowel
syndrome (IBS), preventing constipation and reducing of certain carcinogenic
enzymes.

Health Benefits of Probiotics

Probiotics may play a beneficial role in several medical conditions, including
diarrhea, gastroenteritis, irritable bowel syndrome, inflammatory bowel disease,
cancer, depressed immune function, infant allergies, failure to thrive,
hyperlipidemia, hepatic diseases, Helicobacter pylori infections, and others.

4
2. Definition of Prebiotics:
★ Prebiotic fiber is a non-digestible part of foods.
★ They are presented in fiber-rich foods like bananas, onions, garlic, asparagus,
barley, apple, etc.
★ It is fermented in the large colon to feed beneficial bacteria colonies.
★ Fructooligosaccharides, inulin, oligofructose, lactulose,
galactooligosaccharides and oligosaccharides is also prebiotic due
characteristics such as resistance to gastric acidity and hydrolysis by
mammalian enzymes.

Health benefit of prebiotics

Prebiotics are helpful in increasing the helpful bacteria already in the gut that reduce
disease risk and improve general well-being.

5
III. Food Source of Probiotics

Yogurt is one of the best sources of probiotic which is made from milk that has been
fermented by lactic acid bacteria and bifidobacteria. The benefit of yogurt includes:
Improved bone health, Beneficial for people with high blood pressure, help reduce
the diarrhea caused by antibiotics, suitable for people with lactose intolerance…. etc.

However, not all yogurt contains live prebiotic, in some cases the live bacteria have
been killed during processing. Making sure to choose yogurts with an active or live
culture and always read the label on yogurt before buying it.

Kefir contains several major strains of friendly bacteria and yeast, making it a diverse
and potent probiotic. The benefits of kefir include: Well tolerated by people who are
lactose intolerant, improve bone health, help with some digestive problems and
protect against infection.

Sauerkraut is rich in fiber as well as vitamin C, B and K. It is also high in sodium

and contains iron, manganese, antioxidant lutein and zeaxanthin, which are important
for eye health, pregnancy…etc.

Tempeh is originally from Indonesia but has become popular worldwide because of
containing vitamin B12. This makes tempeh a great choice for vegetarians as well as
anyone looking to add a nutrition probiotic to their diet.

6
Kimchi is a fermented, spicy Korean side dish cabbage is usually the main
ingredient. It contains the lactic acid bacteria, high in some vitamins and minerals,
including vitamin K, riboflavin and iron also may benefit digestive health.

Miso is a Japanese seasoning. It is a good source of protein and fiber, also high in
various vitamins, minerals and plant compounds, including vitamin K, manganese
and copper. Miso has been linked to some health benefits.

Natto is a fermented soybean product, it is rich in protein, vitamin K2 which is

important for bone and cardiovascular health. Consuming natto on a regular basis
was associated with higher bone mineral density.

7
VI. Food Source of Prebiotics

The easiest and the commonest way of getting our daily dose of probiotic
is by having onions. Onions are rich in inulin which helps in boosting the
immunity of the gut.

Rich in pectin, apples help in maintaining the right pH of the stomach

and prevent the growth of bad bacteria. An apple a day can really keep
the stomach happy.
it.

Honey also contains a mix of oligosaccharides, which have been shown

to promote the growth of bifidobacteria and lactobacilli, two important
probiotic strains.

Your gut loves bananas. It is not only rich in fibre and potassium but is
indeed a very good source of prebiotic.

Wholegrains like oats, barley, wheat, etc. are also very rich in prebiotics.

Consuming whole grains will not only keep your gut healthy but also help
your body in absorbing calcium and even prevent bloating.

Bean is rich in oligosaccharides (a form of carb needed for feeding the

good gut bacteria). Beans are strong digestive boosters. Do not forget to
include them in your diet.

8
VI. Synbiotics and Health Benefits
Synbiotic is a combination of probiotics and prebiotic. Example: Bifidobacteria
strains + fructo-oligosaccharides (FOS).

Health benefits
➔ Improved survival of live bacteria in food product, prolonged shelf life.
➔ Stimulation in the colon of the growth and implantation of both exogenous
and endogenous bacteria.

VII. Risks and Side Effects of Probiotics and Prebiotic

★ They are not recommended: in patient who have sensitive with symptoms of
irritable bowel syndrome and SIBO (intestinal bacterial overgrowth)
★ They are generally safe for healthy people.
★ They are nott regulated according to drug standards by FDA, it means that
being used in probiotics has not been evaluated according to strict safety
measures.

Side effects
➔ Allergic reaction
➔ Upset stomach, gas, diarrhea, or bloating (the first time you consume).

9
Multiple Choice Questions (MCQs + Answers)

1. The main bacteria in the lower gastro-intestinal are, except:

a) Bacteroides
b) Clostridium
c) Corynebacterium
d) Lactobacillus

2. Human breast milk contains ___ of oligosaccharides per liter.

a) 5-10 g
b) 5-15 g
c) 5-25 g
d) 5-30 g

3. All the following are prebiotic fiber foods, except:

a) Apple
b) Garlic
c) Brined olives
d) Tomatoes

4. Where's prebiotics and probiotics end up?

a) Duodenum
b) Jejunum
c) Ileum
d) Colon

5. What is the bacteria infection in upper grastro-intestinal give cause gastritis and
peptic ulcers?
a) Escherichia Coli
b) Staphylococcus aureus
c) Helicobacter pylori
d) Salmonella & Shigella

6. Which one is the correct answer of Upper Gl Anaerobic gram positive?

a) Lactobacillus & Bifidobacteria
b) Bacterioides
c) Staph spp & Strep viridians
d) Helicobacter pylori

7. Which one is the correct answer of Upper Gl Anaerobic gram negative?

a) Helicobacter pylori
b) Escherichia Coli
c) Bacterioides
d) Lactobacillus & Bifidobacteria

10
8. Which of the following is not the main bacteria in the colon?
a) Staphylococcus
b) Bacteroides
c) Bifidobacterium
d) Streptococcus

9. Bacteria, proven to be the cause of most cases of gastritis and peptic ulcers is?
a) Lactobacillus
b) Clostridium
c) Helicobacter pylori
d) E. coli

10. Why is human milk oligosaccharide important to newborns?

a) It tastes good
b) It gives newborns multiple layers of protection
c) It helps to form cell membrane
d) It provides energy

11. Small numbers of Streptococci, Lactobacilli, yeasts, and Candida Albicans are found
in:
a) Stomach
b) Terminal ileum
c) Duodenum
d) Colon

12. The main site for bacteria in the body is?

a) Large intestine or colon
b) Ileum
c) Duodenum
d) Stomach

13. The breast milk is rich in?

a) Prebiotic
b) Oligosaccharide
c) Probiotic
d) A B C are correct

14. Why does the stomach contain few bacteria?

a) Its high alkaline
b) Its high NaCl
c) Its high acidity
d) Its high virus

11
15. Prebiotic fiber could be found in the following foods except:
a) Bananas
b) Kimchi
c) Beans
d) Onions

16. Where will the prebiotic fiber be fermented?

a) Small intestine
b) Stomach
c) Large colon
d) Mouth

17. Which of the following is the benefit of prebiotic?

a) Lower number of desirable bacteria
b) Reduced disease risk
c) Fight probiotic bacteria
d) Feed beneficial bacteria

18. Which of the following statements is not true about probiotics?

a) Live beneficial virus
b) Obtained through process of fermentation
c) Commonly available in yogurt, sauerkraut, miso soup
d) Found mostly in group of Lactobacillus and Bifidobacterium

19. Probiotics could be retrieved from the following foods. Which one is not true?
a) Yogurt
b) Chicory root
c) Miso soup
d) Kimchi

20. Below is the property of Lactobacillus except:

a) Increase diarrhea
b) Digest milk sugar
c) A common probiotic
d) Help people with lactose intolerance

21. The following statements are the property of Bifidobacterium. Which one is not
true?
a) Prevent constipation
b) Boost immune system
c) Fight bacterial flora
d) Reduce concentration of certain carcinogenic enzymes

12
22. Fermented foods with the rich sources of probiotic bacteria are:
a) Kefir, sauerkraut, yogurt
b) Kefir, yogurt, garlic
c) Kefir, sauerkraut, apples
d) Sauerkraut, canola, olive

23. Based on a study in 2012, how many adults consumed probiotics?

a) More than 4 million adults
b) 4 million adults
c) 40 million adults
d) Almost 4 million adults

24. Probiotic is originated from Greek word meaning

a) For life
b) Antibiotics
c) Against life
d) Kill life

25. “Probiotics are substances and organisms which contribute to intestinal microbial
balance”. Who gives this definition?
a) Lilly and Stillwell in 1965
b) Fuller in 1989
c) Parker in 1974
d) Elie Metchnikoff in 1908

26. Lactobacilli and Bifidobacterium are:

a) Gram negative bacteria
b) Lactic acid-producing bacteria
c) Gram positive virus
d) Acid-fast bacillus

27. Yogurt is beneficial because:

a) Improve bone health
b) Provoke irritable bowel syndrome
c) Contain harmful bacteria
d) Aggravate irritable bowel syndrome

28. Kefir is:

a) A fermented prebiotic
b) A fermented probiotic milk
c) A protein supplements
d) A vitamin supplements

13
29. The amount of bacterial species in the human intestinal tract are:
a) Less than 400 species
b) Only 400 species
c) Less than 200 species
d) More than 400 species

30. Eating yogurt is associated with many health benefits except:

a) Improved bone health
b) Relieve the symptoms of irritable bowel syndrome
c) Protect against infection
d) Reduce diarrhea in chicken

31. The word “probiotic” come from Greek word “pro bios” which means:
a) For health
b) For life
c) For digestion
d) For animal

32. Kefir contain several major strains of:

a) friendly bacteria
b) Yeast
c) Friendly bacteria and yeast
d) Common yeast

33. _______are non-digestible parts of foods like bananas, onions and garlic:
a) Probiotics
b) Prebiotic Fibers
c) Proteins
d) Lipids

34. _______ are live beneficial bacteria that are naturally created by the process of
fermentation in food:
a) Probiotics
b) Prebiotic
c) Proteins
d) Lipids

35. Lactobacillus and bifidobacterium species are the most commonly used as:
a) Prebiotic fiber
b) Proteins
c) Probiotics
d) Lipids

14
36. Lactobacillus is the most common probiotic found in:
a) Breads
b) Fibers
c) Beans
d) Yogurt and other fermented foods

37. In children, yogurt may help reduce:

a) Fever
b) Cough
c) Diarrhea
d) Headache

38. Yogurt may be suitable for people with:

a) Fructose intolerance
b) Lactose intolerance
c) Lactose tolerance
d) Fructose tolerance

39. Prebiotics and probiotics have been suggested as treatment for:

a) Hypertension
b) Hyperglycemia
c) Hypoglycemia
d) Obesity

40. In addition to its prebiotic qualities, Sauerkraut is rich in

a) Fiber
b) Vitamins C, B and K
c) Sodium and ion
d) All of the above

41. Tempeh is
a) A fermented soybean product
b) A meat product
c) American Pickle
d) None of the above

42. Tempeh is well known as _____ .

a) High in lipid
b) High-protein meat substitute
c) Spicy flavor
d) A great choice for semi-vegetarian

15
43. Kimchi contains a kind of friendly bacteria called:
a) Lactobacillus kimchi
b) Escherichia coli
c) Salmonella
d) Botulism

44. The following statements are the property of Miso. Which one is incorrect?
a) High in various vitamins, minerals and plant compound
b) Made from soybeans
c) Fermented by Koji fungus
d) Contains Helicobacter pylori

45. Which of the following is the main source of probiotic?

a) Macaroni and peas
b) Bread and flour-based products
c) Mackerel, walnuts and Canola oil
d) Pickles, traditional buttermilk and Natto

46. Which of the following is fermented food?

a) Sauerkraut
b) Tempeh
c) Kimchi
d) All of the above

47. Why are prebiotics used for patients who are on antibiotic treatment?
a) To repopulate the colon with desirable bacteria
b) To wipe of bacteria
c) To reduce antibiotic efficacy
d) None of the above

48. What are the benefits of probiotics?

a) Fighting off bad bacteria
b) Improvement of immune system
c) Improvement of metabolism
d) All of the above

49. What are the roles of probiotics in immunomodulation?

a) Balanced immune response which helps control of IBD
b) Alleviate food allergy symptoms in infants
c) Strengthen innate immunity
d) All of the above

16
50. How do probiotics act in the body to improve metabolism?
a) Lower level of toxicogenic or mutagenic reactions in the gut
b) Lactose hydrolysis
c) Bile salt deconjugation and secretion
d) All of the above

51. What are the results of probiotics consumption on metabolism?

a) Lower serum cholesterol
b) Improved lactose tolerance
c) Reduction in risk factors for colon cancer
d) All of the above

52. What are prebiotics?

a) Indigestible fermented food substrates
b) It selectively stimulates the growth, composition, and activity of microflora in
gastrointestinal tract
c) Improve hosts’ health and well-being
d) All of the above

53. What are the new compounds that are developed as prebiotics?
a) Oligosaccharides
b) Sugar alcohols
c) Polysaccharides
d) All of the above

54. Where are prebiotics found?

a) Bananas, onions, garlic
b) Grains
c) Asparagus, honey, beans
d) All of the above

55. What are the benefits of prebiotics?

a) Help with various digestive problems
b) Boost the immune system
c) Improve metabolic health
d) All of the above

56. Synbiotics are:

a) Prebiotics and probiotics used in combination
b) The synthesis of probiotics
c) The synthesis of prebiotics
d) None of the above

17