Presented by:

M.Shakil Mirza
0345-7267262
 Overview
• Introduction
• History
• Concept of probiotics
• MOA and examples of probiotics
• Prebiotics and its examples
• Clinical applications of pre/pro biotics
• Synbiotic
• Probiotics containing product in market.
Intestine is a Paradise of disease

• Death sits in
the bowels; a
bad digestion
is the root of
all evil” -
Hippocrates,
400 BC
 The Probiotic History
Ellie Metchnikoff, the first scientist who proposed the therapeutic
use of lactic acid bacteria.

•Lactic acid bacteria were first discovered by

Pasteur in 1857

•Their isolation from rancid milk

was reported in 1878 by Lister.

In 1889 Tissier
discovered
Bifidobacterium
spp.

The first stable cultures

of Lactobacillus casei
strain Shirota were made
in 1930 by Dr. Minoru
Shirota
 Largest immune organ

• It participates in protection of the host through strong

defense mechanisms from the external environment
• Defense task is based on three barriers:
• 1- The ecological barrier (normal inhabitant flora within intestine)
• 2- Mechanical barrier (mucous epithelia)
• 3- Immune barrier (IgA, intraepithelial lymphocytes, macrophages,
neutrophils, natural killer cells, and mesenteric lymph nodes)
• Our Intestine = 400 square meter surface…
Facts about Intestine
• Trillions living bacteria
exist in the human
intestine
• Lactobacillus,Bifidobacte
rium and Acidophilus
comprise the majority of
healthy bacteria in the
colon along with other
disease producing
bacteria.
 Factors affecting the intestinal micro
ecosystem
• During infancy :
 Mother’s microbiology
 Mode of delivery
 Feeding practices
• Later in life :
Antibiotics and other drug intake
Microbial infections
Diet (highly processed, low fiber)
Chronic diarrhea
Stress
 Gut Flora in
Breast Fed vs Formula Fed Babies
 Dysbiosis
 Dysbiosis is the abnormal microbial
colonization of the intestine ,
where changes in Quantity and
Quality of flora become
Pathological & Harmful.
 Common causes of dysbiosis:
• Antibiotic therapy

• Autoimmune conditions , IBD

• Others are fast paced lifestyle,

stress, food habits, Alcohol intake and
cigarette smoking
 Nutraceuticals

 Nutraceuticals can be defined as

 “ A food or part of food or nutrient, that
provides health benefits, including the
prevention and treatment of a disease.”
 Classification of nutraceuticals
Based on chemical constituents:

– Nutrients :- Substances with established nutritional

functions, such as vitamins, minerals, amino acids and fatty
acids

– Herbals :- Herbs or botanical products as concentrates and

extracts, such as aloe Vera juice.

– Dietary Supplement :- products that contain a dietary

ingredient intended to add something to the foods we eat
such as prebiotics, probiotics
Defining a probiotic

‘‘Live
microorganisms
which when
administered in
adequate amounts
confer a health
benefit on the host’’
(WHO)
Why are Probiotics important for Human health?

Antibiotics Destroy the Problems in

gut micro flora digestion

Alcohol
consumption Problems in
Emergence of absorption of
antibiotic nutrients in the
resistant strains body

Stress

Probiotics
 Key properties of probiotic
 Non-pathogenic, non-toxic and non-allergic.

 Capable of surviving and metabolizing in upper G.I.

tract e.g. Resistant to low pH, organic acids, bile juice,
saliva and gastric acid

 Human in origin, genetically stable and capable of

remaining viable for long periods .

 Able to modulate immune response and provide

resistance to disease through improved immunity or by
the production of antimicrobial substance in the guts.

Contd….
 Key properties of probiotic
 Good adhesion/ colonization

 Antagonistic against carcinogenic/ pathogenic

organisms.

 Clinically proven health benefit,

 Technologic properties for commercial viability such as
stability of desired characteristics during processing,
storage and transportation.
 Examples of probiotics
Lactobacillus species Bifidobacterium species
L. acidophilus B. bifidum
L. casei (rhamnosus) B. longum
L. reuteri B. breve
L. bulgaricus B. infantis
L. plantarum B. lactis
L. johnsonii B. adolescentis
L. lactis

Others
Bacillus cereus
Non pathogenic Escherichia coli
Saccharomyces cerevisiae (yeast)
Enterococcus faecalis
Streptococcus thermophilus
 Mechanism of action
 Stimulation of innate immune response
Decrease luminal pH

 Secrete antimicrobial peptides

 Inhibit bacterial invasion

 Block bacterial adhesion to epithelial cells

 BENEFITS PROBIOTICS

Normalize Metabolic
Immunomodulation
Intestine effects

Suppression of Production of
Strengthens
PPMs vitamins;
immunity
improves digestion

Intestinal Alleviate
mucosal integrity food allergy symptoms Lactose tolerance

Regulation of Lowers cholesterol

bowel movement Control of IBD (Bile acid deconjugation
IBS & Secretion)
“PREBIOTICS”
 Prebiotics
The concept of prebiotic was introduced by
Gibson & Roberfroid, in 1995

“Non-digestible food ingredients that

beneficially affect the host by selectively
stimulating the growth and/or activity of one
or a limited number of bacteria in the colon
that can improve host health."
 Prebiotics- examples
Garlic, Onions
Asparagus
Wheat
 Rye , Barley
breast milk
tomatoes, berries
bananas
 Clinical application of probiotics and
prebiotics
Proven Benefits
• Diarrheal Illness - treatment and prevention

• Prevention of antibiotic-associated diarrhea (AAD)

• Treatment of Clostridium difficile infection

• Inflammatory bowel disease (ulcerative colitis,)

• Lactose intolerance

Suggested Benefits
• Food allergies

• Eczema
Probiotics in the Treatment of Gastrointestinal
Disorders
Diarrhea
Acute infectious
Antibiotic-associated
C. difficile H. pylori
Eradication

Lactose
IBD
Intolerance
Ulcerative colitis
Crohn’s disease
Pouchitis
Constipation
Antibiotic associated diarrhea
 Broad-spectrum antibiotics are associated with
the highest rate of AAD because of their
disruptive impact on the normal intestinal flora.
 Commonly implicated antibiotics – broad spectrum
penicillins (ampicillin), Cephalosporins
(Cefixime,cefalexin), Clindamycin, Fluroquinolones.

Diarrhea is a common adverse effect of antibiotic treatments.

Antibiotic associated diarrhea occurs in about 5-30% of patients

Probiotics used in prevention and as adjuvant therapy in AAD.

Antibiotic associated diarrhea
Disease Antibiotic treatment

Probiotics
Disturbance of
intestinal microbiota

Microbiota Clostridium overgrowth

in balance produces toxin
 Lactose intolerance

 Lactose is not digested when there is a

deficiency in lactase and results in diarrhea.

 Supplementation with probiotics has been

shown to mitigate the symptoms of lactose
intolerance by enzyme β- D- galactosidase.
 Dosage of Probiotics
 The dose of probiotics is usually expressed as
the number of colony forming units (CFUs).

 Due to the multitude of strains, the FDA has

not approved any specific health claims for
probiotics.
 Probiotic effects should be considered dose-
specific

 Dose listed on the label are based on studies

that show a beneficial health effect in humans.
 Prebiotics vs Probiotics
Prebiotics
Prebiotics are defined as nonliving
non-digestible special form of fiber
or carbohydrates.
The powder form of prebiotics
can survive heat, cold, acid.
Prebiotics perform their role by
nourishing the bacteria that live
in the intestines.
Probiotics
Probiotics are referred to as live
active microorganisms that when
administered in adequate amount will
have beneficial effects to its host.
• more fragile.
• vulnerable to heat.
• may be killed over time.
Probiotics fight the harmful
bacterial species present in the
gut.
 Adverse effects
 Probiotics side effects, if they occur, tend to be mild
and digestive symptoms. (such as gas or bloating).

 May cause infections, especially in immuno-

compromised patients.ie (AIDS patients)

 Diabetic patients should be doubly cautious about

taking probiotic drinks available in the market as they
contain high level of sugar.
 Are probiotics supplements
necessary?
 Probiotics supplements are not necessary for normal,
healthy individuals.

 In healthy individuals, daily consumption of

probiotics rich foods, particularly fermented dairy
products like yoghurt adequately supplies the amount
of probiotics .

 A diet high in starches and fibre provide prebiotics,

which keep a healthy population of probiotics in our
intestines.
 Synbiotics
Synbiotic = Probiotic + Prebiotic
 Potential synergy between pro- & prebiotics

 Improve survival in upper GIT

 More efficient implantation

 Eg: Bifidobacteria and fructo-oligosaccharides (FOS)

 Probiotic market
Increased from $14.9 billion in 2007 to
an estimated $15.9 billion by the end of
2008. It is expected to reach $36.7
billion by 2018, a compound annual
growth rate (CAGR) of 6.2%.
Product in market contain Probiotic