All about the millions of bacteria and molds that live in us and their role in our health

1. Probiotics
By
Dr M. Sen

2. Learning Objectives
 To learn what are probiotics
 Their effects on our health
 Sources
 Side effects

3. Introduction
 The World Health Organization defines
probiotics as “live microorganisms, which
when administered in adequate amounts
confer a health benefit on the host.”
 The most common types of these
beneficial bacteria are
Lactobacilli and Bifidobacteria.

4.  Our body contains millions
of bacteria living naturally in
various parts. These are
called “Commensals.”
 However, in the past few
decades, many of these
commensals were seen to
produce actual beneficial
effects on the body.
 They were then renamed
“probiotic” bacteria.

5.  There are several reasons that people are
interested in probiotics for health purposes.
 Friendly bacteria are vital to proper development
of the immune system, to protection against
microorganisms that could cause disease, and to
aid the digestion and absorption of food and
nutrients.
 Each person's mix of bacteria varies.
 Interactions between a person and the
microorganisms in his body, and among the
microorganisms themselves, can be crucial to the
person's health and well-being.

6. Recent findings
 It is known that an imbalanced intestinal
microbiota predisposes to Cl. difficile infections,
IBD and IBS.
 The complex role of intestinal microbiota to
maintain health, however, is a newer concept that
is being increasingly studied.
 The microbiome plays an important role in cellular
immunity and energy metabolism and has been
implicated in the pathogenesis of non-GI
autoimmune diseases, chronic fatigue syndrome,
obesity and even some neuropsychiatric disorders.
 Curr Opin Gastroenterol. 2013;29(1):79-84.

7. History

8.  The original observation of the positive role played
by certain bacteria was first introduced by Russian
scientist and Nobel laureate Élie Metchnikoff, who
in the beginning of the 20th century suggested
that it would be possible to modify the gut
flora and to replace harmful microbes with useful
microbes.
 The term "probiotics" was first introduced in 1953
by Werner Kollath.
 In 1989, Roy Fuller suggested a definition of
probiotics that has been widely used: "A live
microbial feed supplement which beneficially
affects the host animal by improving its intestinal
microbial balance".

9. The bacteria and yeasts
 The probiotics come from two groups,
 Bacteria: Lactobacillus and Bifidobacterium.
 Within each group, there are different species (for
example, Lactobacillus acidophilus and
Bifidobacterium bifidus), and within each species,
different strains (or varieties).
 Yeasts and fungi: Saccharomyces boulardii and
Rhizopus.

10. Actions and Effects

11.  Diarrhea
 Some probiotics have been shown to treat various
forms of gastroenteritis.
 Fermented milk products (such as yogurt) reduce
the duration of symptoms, the duration of illness
and the frequency of stools.
 Antibiotic-associated diarrhea
 (AAD) results from an imbalance in the colonic
microbiota caused by antibiotic therapy.
Microbiota alteration changes carbohydrate
metabolism with decrease short-chain fatty
acid absorption and an osmotic diarrhea as a
result.

12.  Another consequence of antibiotic therapy
leading to diarrhea is overgrowth of
potentially pathogenic organisms such
as Clostridium difficile.
 Probiotic treatment might reduce the incidence
and severity of AAD.
 For example, treatment with probiotic-formulations
including Lactobacillus rhamnosus may reduce the
risk of antibiotic-associated diarrhea, improve stool
consistency during antibiotic therapy, and
enhance the immune response after vaccination.

13.  Lactose intolerance
 As lactic acid bacteria
actively convert lactose
into lactic acid, ingestion of
certain active strains may help
lactose intolerant individuals
tolerate more lactose than
they would otherwise have
tolerated.
 Having yoghurt is a good way
for a lactose intolerant person
to get calcium.

14.  Colon cancer
 In laboratory investigations, some
strains of LAB have demonstrated
anti-mutagenic effects thought
to be due to their ability to bind
with heterocyclic amines, which
are carcinogenic substances
formed in cooked meat.
 Animal studies have
demonstrated that some LAB
have evidence for acting
against colon cancer.

15.  Cholesterol
 Some studies have demonstrated the efficacy of
some strains of LAB to be able to lower
serum cholesterol levels, presumably by breaking
down bile in the gut, thus inhibiting its reabsorption
(bile aid is synthesized from cholesterol).
 Obesity
 Recent research has shown that probiotic
bacteria can reduce the inflammatory effects of
abdominal fat and also reduce appetite by
enhancing incretin effects.

16.  Blood pressure
 Some studies have indicated that consumption
of milk fermented with various strains of LAB may
result in modest reductions in blood pressure, an
effect possibly related to the ACE inhibitor-
like peptides produced during fermentation.

17.  Immune function and infections
 Some strains of LAB affect pathogens by means
of competitive inhibition (i.e., by competing for
growth).
 There is also evidence to suggest that they may
improve immune function by increasing the
number of IgA-producing plasma cells (B cells)
 They also help by increasing or improving
phagocytosis as well as increasing the proportion
of T lymphocytes

18.  Clinical trials have demonstrated that probiotics
may decrease the incidence of respiratory tract
infections and dental caries in children.
 LAB products might aid in the treatment
of rotavirus infections in children and travelers'
diarrhea in adults.
 Antibiotics seem to reduce immune system
activity as a result of killing off the normal gut
bacteria.

19.  Helicobacter pylori
 Some strains of LAB may affect Helicobacter
pylori infections (which may cause peptic ulcers
and GERD) in adults when used in combination
with standard medical treatments, but there is
no standard in medical practice or regulatory
approval for such treatment.

20.  Inflammation
 Some strains of LAB may modulate
inflammatory and hypersensitivity responses.
 Clinical studies suggest that they can prevent
recurrences of inflammatory bowel disease in
adults.
 How probiotics may influence the immune system
remains unclear, but a potential mechanism
under research concerns the response of T-
lymphocytes to pro-inflammatory stimuli and in
part due to the regulation of cytokine function.

21. Absorption of Iron and Calcium
 Probiotics + prebiotics(insoluble starches) can
increase iron and calcuim absorption from the
intestines.
 There is increased solubility of minerals because of
 1. increased bacterial production of short-chain
fatty acids;
 2. an enlargement of the absorption surface by
promoting proliferation of enterocytes;
 3. increased expression of calcium-binding
proteins;
 4. degradation of phytic acid.

22. Uses

23. Uses for health purposes
 Antibiotic associated diarrhoea (AAD): antibiotics
kill friendly bacteria in the gut along with unfriendly
bacteria.
 Some people use probiotics to try to offset side
effects from antibiotics like gas, cramping,
or diarrhea.
 Lactose intolerance: this is a condition in which the
gut lacks the enzyme needed to digest the major
sugar in milk, lactose, and this causes
gastrointestinal symptoms. Probiotics can help by
fermenting the lactose and breaking it down to
lactic acid and water.

24.  Infectious diarrhea.
 To treat diarrhea this is the strongest area of
evidence with diarrhoeas due to Clostridium
difficile and Rotavirus.
 Irritable bowel syndrome. Probiotics have been
associated with an improvement in IBS symptoms
compared with placebo. Studies suggest
decreases in some patients’ abdominal pain,
bloating, and gas.
 Bifidobacterium and Lactobacillus strains have
both been studied for their potential use in
preventing and managing IBS symptoms.

25.  Patients with constipation-predominant IBS have
been shown to increase population of sulphate-
reducing bacteria compared with healthy
controls.
 Probiotics can restore the intestinal microbiota in
patients with IBS and result in improvement of
postinfectious IBS.
 Fecal Microbiome Transfer (FMT), however, may
prove more beneficial, as donated feces, in a
sense, are the ultimate human probiotic.
 Olga C. Aroniadis, Lawrence J. Brandt, Curr Opin
Gastroenterol. 2013;29(1):79-84.

26.  Inflammatory bowel disease (e.g., ulcerative
colitis and Crohn's disease) Probiotics have shown to
reduce the symptoms of inflammatory bowel
disease, along with mesalazine.
 Patients with IBD have an abundance of
Enterobacteriaceae and paucity
of Faecalibacterium.
 IBD patients also have 30–50% reduction in the
biodiversity of their intestinal microbiota.
 FMT for refractory ulcerative colitis has been
described in four publications, comprising nine
patients, all of whom had severe, active
longstanding ulcerative colitis (mean, 8.6 years)
refractory to treatment with corticosteroids, 5-
aminosalicylates and azathiaprine.

27.  FMT was administered as retention enemas and
resulted in the complete resolution of all symptoms
with cessation of ulcerative colitis medications
within 6 weeks without relapse.
 FMT may be efficacious in managing refractory
ulcerative colitis, however, multiple infusions seem
to be required to maintain remission.
 Curr Opin Gastroenterol. 2013;29(1):79-
84. © 2013 Lippincott Williams & Wilkins

28.  Infection with Helicobacter pylori (H. pylori), a
bacterium that causes most ulcers and many
types of chronic stomach inflammation.
 The routine treatment for H, pylori infection is
antibiotics but some patients may have difficulty
getting rid of the infection with standard
antibiotic therapy.
 There is evidence to suggest that adding
probiotics to the treatment regime may help to
increase the chances of H. pylori eradication.

29. Treatment of Non-gastrointestinal
Diseases
 Studies in germ-free animals suggest that intestinal
microbiota may contribute to pathogenesis of
non-GI diseases.
 Germ-free animals exhibit dysregulation of their
hypothalamic–pituitary–adrenal axis leading to an
exaggerated stress response, impaired cardiac
output, altered brain derived hormones (e.g.,
norepinephrine and tryptophan) and increased
caloric intake to maintain body weight.

30.  Moreover, the microbiota may play a role in
pathogenesis of various neurologic disorders and
data support the concept of the brain–gut–
microbiota axis.
 Microbiota residing on the skin and mucosal
surfaces of the nose and mouth may determine
the development of acne, common cold,
periodontal disease, meningococcemia and
allergic rhinitis.

31. Probiotics may be useful in the
management of:
 Vaginal infections
 Stomach and respiratory infections that children
acquire in day-care
 To prevent and treat infections of the urinary
tract or female genital tract.
 To reduce recurrence of bladder cancer.
 To prevent and manage atopic dermatitis
(eczema) in children.
 To Prevent tooth decay and periodontal disease.

32. Still being studied
 Idiopathic Thrombocytopenic purpura
 Multiple sclerosis
 Parkinson’s disease
 Obesity
 Chronic fatigue syndrome
 Autism
 Auto-immune disorders

33. Prevents Radiotherapy side-effects
 Researchers from the Washington University
School of Medicine in St. Louis, USA, have found
that radiation therapy patients who take
probiotics prior to getting blasted can gain
intestinal radio-protective benefits.
 They found that those who had received a
probiotic mix that included Lactobacillus
rhamnosus before exposure were protected
against radioactive damage to their intestines.

34. Sources of Probiotics

35. From food
 Since early times, traditions spanning the globe
have been fermenting or culturing foods for
nutrition, preserving the amazing taste sensations
of these health supporting food ferments.

36. Strains
 Live probiotic cultures are available in
fermented dairy products and probiotic
fortified foods.
 However, tablets, capsules, powders and
sachets containing the bacteria in freeze
dried form are also available.

37. Bacillus coagulans GanedenBC30 Ganeden
Biotech
May improve abdominal pain and
bloating in IBS patients. May
increase immune response to a
viral challenge.
Bifidobacterium
animalis
Probio-Tec
Bifidobacterium
BB-12
Chr. Hansen
Human studies have shown that
BB-12 alone or in combination
may have an effect on the
gastrointestinal system.
Bifidobacterium
infantis
Align Procter &
Gamble
In one preliminary study, showed
possible improvement for
abdominal pain/discomfort and
bowel movement difficulty.
Lactobacillus
acidophilus NCFM Danisco Shown in one study to reduce the
side effects of antibiotic therapy.
Lactobacillus
paracasei
Lactobacillus
johnsonii
Nestlé
May reduce incidence of H pylori-
caused gastritis and may reduce
inflammation

38. Lactobacillus
reuteri BioGaia
Preliminary evidence for
diarrhea mitigation in
children, H. Pylori
infection possible effect
on gingivitis, fever in
children and number of sick
days in adults.
Saccharomyces
boulardii
Wren
Laboratorie
s
Limited evidence for
treatment of acute diarrhea.
Tested as
mixture:
Lactobacillus
rhamnosus
& Lactobacillus
reuteri
Bion Flore
Intime/Jarrow
Fem-Dophilus
Chr.
Hansen
In one study, oral ingestion
resulted in vaginal
colonisation and reduced
vaginitis.
Tested as
mixture:
Lactobacillus
acidophilus & Bifi
dobacterium
bifidus
Florajen3 American
Lifeline, Inc
Preliminary evidence for
reduced C. Difficile
associated disease (CDAD)

39. Tested as
mixture:
Lactobacillus
acidophilus
&
Lactobacillus
casei
Bio-K+
CL1285
Bio-K+
International
May affect digestive
health.
In vitro inhibition of Listeria
monocytogenes and L.inn
ocua, Escherichia
coli,Staphylococcus
aureus, Enterococcus
faecalis and Enterococcus
faecium.
Reduction of symptoms of
lactose intolerance and
immune stimulation.
Lactobacillus
plantarum &
Lactobacillus
paracasei
Bravo
Friscus/
ProbiFrisk
Probi Is under study for common cold
infections.

40. Yogurt
 Yogurt or yoghurt is a dairy product produced
by bacterial fermentation of milk.
 The bacteria used to make yogurt are known as
"yogurt cultures".
 Fermentation of lactose by these bacteria
produces lactic acid, which acts on milk protein to
give yogurt its texture and its characteristic tang.
 Worldwide, cow's milk is most commonly used to
make yogurt, but milk from water
buffalo, goats, sheep, horses, camels and yaks is
also used in various parts of the world.

41.  Dairy yogurt is produced using a culture
of Lactobacillus bulgaricus and Streptococcus
salivarius subsp. thermophilus bacteria.
 In addition, other lactobacilli and
bifidobacteria are also sometimes added during
or after culturing yogurt.

42. Cheese
 Select cheese products also contain probiotics,
including Kraft's LiveActive natural cheese snacks,
and Specially Selected Amish Yogurt Cheese
(prepared with the probiotic live cultures
Lactobacillus acidophilus and bifido bacterium).
 Other good sources of probiotics include blue
cheese and other aged cheeses.
 Probiotic-rich cheeses often feature words such as
"live culture," "active culture" or "probiotics" on the
packaging.

43. Buttermilk
 Buttermilk refers to a number of dairy drinks. Originally,
buttermilk was the liquid left behind after
churning butter out of cream. This type of buttermilk is
known as traditional buttermilk.
 The tartness of buttermilk is due to acid in the milk. The
increased acidity is primarily due to lactic
acid produced by lactic acid bacteria while
fermenting lactose, the primary sugar in milk.
 As the bacteria produces lactic acid, the pH of the
milk decreases and casein, the primary milk protein,
precipitates, causing the curdling of milk.
 This process makes buttermilk thicker than plain milk.

44. Kombucha
 Kombucha is a tangy/sweet "mushroom tea",
referred to as the "immortal health elixir" dating
back to the Chinese Qin Dynasty
 The "mushroom" culture is not technically a
mushroom, but a round pancake-like, firm jelly
structure, called "the mother."
 It is a membrane of yeasts and bacteria that
covers the top of the liquid.

45.  The yeast component of kombucha may contain
any of Saccharomyces cerevisiae, Brettanomyces
bruxellensis, or Candida stellata.
 The acidity and mild alcoholic element of
kombucha resists contamination by most airborne
moulds or bacterial spores.
 As a result, kombucha is relatively easy to maintain
as a culture outside of sterile conditions.
 The bacteria and yeasts in kombucha may also
produce antimicrobial defense molecules.

46.  It contains a compound called glucaric acid,
which enhances the liver’s secretions.
 Glucaric acid is being researched as a possible
cancer inhibitor.
 It helps to ensure acid/alkaline balance in the
body.
 This fermented drink is also rich in antioxidants
and other protein balancing amino acids, such
as L-threonine.

47. Sauerkraut/Khimchi
 Sauerkraut is the ancient art of culturing,
fermenting and pickling vegetables that
dates back thousand of years.
 The word “sauerkraut” comes from the
German language meaning “sour plants."
 It is commonly believed to have been
brought to Europe from China, where
fermented cabbage was eaten as an
ancient food.
 Today, it is popular all across Europe, as
well as in Asian cuisine and culture.
 The Korean version is known as "kimchee."

48.  Basically, it is shredded
cabbage fermented in its
own juice with salt.
 Other vegetables and
spices can be added for
extra flavour and variety.
 Over time, between 3-7
days, the vegetables
become sweeter, soft,
slightly pickled, tangy, and
incredibly tasty.

49.  The fermentation process allows for the
production of lactic acid and the proliferation of
beneficial bacteria, such as, Lactobacillus, and
Pediococcus.
 This also lowers pH, creating an acid environment,
where friendly flora can reproduce.
 Chinese workers building the Great Wall of China
consumed this food in great quantities.

50.  Kimchi contains a high concentration of dietary
fiber, while being low in calories.
 One serving also provides over 50% of the daily
recommended amount of vitamin
C and carotene.
 Kimchi is rich in vitamin A, thiamine (B1), riboflavin
(B2), calcium, and iron, and contains a number
of lactic acid bacteria, among those the typical
species Lactobacillus kimchii.
 “Health” magazine named kimchi in its list of top
five "World's Healthiest Foods" for being rich in
vitamins, aiding digestion, and even possibly
reducing cancer growth

51. Tempeh
 Tempeh: - is a rich whole bean cake; high in
protein because of its method of fermentation.
 Tempeh or fermented bean cake originated over
2,000 years ago in Indonesia and the island of
Java, where it is still a main food today.
 The white mycelium of the spore, Rhizopus
oligosporus, forms a solid bean cake, which can
be sliced, fried or steamed as an alternative to
meat.
 For those wanting to cut back on red meats or
chicken, it is a great substitute with no cholesterol.

52.  Tempeh is easy to digest because
the beans are pre-digested by the
spore culture, which also provides
beneficial micro-flora to the
intestinal tract.
 One of the main reasons why we
ferment foods is to make them
more digestible.
 So, for those who can not usually
handle eating beans, this is the
perfect solution. You can eat your
"bean cake" and digest it too!

53. Kefir
 Kefir:- originating in the Caucasus of Russia and
Turkey, kefir - is a fermented milk drink high in
probiotic cultures.
 It is a tart yogurt-like fermented food that
contains friendly bacteria and yeasts that work
together to provide natural antibiotic properties.

54.  Kefir has tremendous healing power.
 Its beneficial bacteria and yeast help control the
pathogenic yeast and repopulate the colon with
a favorable, new life force.
 It is made from sheep's, cow's or goat's milk or, as
an alternative to dairy, it can be made with
coconut milk.
 This "medicinal drink" coats the stomach lining and
contains tryptophan, an amino acid that works
with calcium and magnesium to relax the nerves.

55.  The culture, or “Kefir grains", is a
blend of friendly yeast and
bacteria that form a mix of lipids,
sugars and proteins that gel up
into a thick, yogurt-like liquid
consistency.
 The "tara" grains of the Tibetan
peoples are a cousin to this
cultured grain, which has
provided them with a similar
fermented drink for eons.

56. Miso
 Miso:- a traditional Japanese food, miso is a rich
salty paste made from grains, beans and koji
spores.
 Its origins date back to China in 3rd century BC.
The version we know today was later adopted
by the Buddhist and Japanese cultures.
 Koji or Aspergillus oryzae spore is a B-12
synthesizing organism that is used to culture or
ferment the beans and grains, much
like kefir grains or kombucha mushroom.

57.  Natural miso is a living food containing many
beneficial microorganisms such as
Tetragenococcus halophilus and lactobaccilus
acidophilus which can be killed by over-cooking.
 For this reason, it is recommended that the miso
be added to soups or other foods being
prepared just before they are removed from the
heat.
 Using miso without any cooking may be even
better.

58. Tapai
 Tapai is a very popular fermented snack in Asian
countries. It can be prepared using either glutinous
rice (Oryza sativa glutinosa) or cassava tuber
(Manihot utilisima).
 Usually, saccharomyces fungi are used in the
fermentation process.
 After fermentation, the glutinous rice or cassava is
soft and juicy.
 Tapai is a popular dessert/snack with a sweet and
acidic taste with mild alcoholic flavour.

59.  Fermentation is performed by a variety of moulds
including Aspergillus oryzae, Rhizopus
oryzae, or Mucor species, and yeasts including
Saccharomyces cerevisiae, and
Saccharomycopsis fibuliger, and others.
 Tapai is made by inoculating a carbohydrate
source with the required microorganisms in a starter
culture.
 The culture can be naturally captured from the
wild, by mixing rice flour with ground spices cane
sugar or coconut water, slices of ginger, and water
to make a dough.

60.  The dough is pressed into round cakes, and left
to incubate on trays with banana leaves under
and over them for two to three days.
 They are then dried and stored. It is a perishable
product and has to be consumed immediately
(within 3 to 4 days) after the optimum stage of
fermentation.

61.  Soy sauce (also called soya sauce) is
a condiment produced by fermenting soybeans
with Aspergillus oryzae or Aspergillus
sojae molds, along with water and salt.
 After the fermentation, which yields fermented
soybean paste, the paste is pressed, and two
substances are obtained: a liquid, which is the
soy sauce, and a cake of (wheat and) soy
residue.

62. Side effects and risks
 Some live microorganisms have a long history of
use as probiotics without causing illness in people.
 Probiotics' safety has not been thoroughly studied
scientifically, however.
 More information is especially needed on how
safe they are for young children, elderly people,
and people with compromised immune systems.

63. Known side effects
 Probiotics' side effects, if they occur, tend to be
mild and digestive (such as gas or bloating).
 Probiotics might theoretically cause infections
that need to be treated with antibiotics,
especially in people with underlying health
conditions.
 They could also cause gene transfer (insertion of
genetic material into a cell).
 Probiotic products taken by mouth as a dietary
supplement are manufactured and regulated as
foods, not drugs.

64.  The available evidence in RCTs does not indicate
an increased risk; however, rare adverse events
are difficult to assess, and despite the substantial
number of publications, the current literature is not
well equipped to answer questions on the safety
of probiotic interventions with confidence.
 There are no reported ill consequences of natural
probiotic use in literature in-spite of centuries of
use.

65.  Are probiotics supplements necessary?
 Probiotics supplements are not necessary for
normal, healthy individuals.
 If you are healthy, daily consumption of
probiotics-rich foods, particularly fermented
dairy products like yoghurt and cultured milk
drinks, should adequately supply the amount of
probiotics required to maintain a healthy
digestive system and overall wellbeing.
 A diet high in Resistant starches and fibre
provide Prebiotics, which keep a healthy
population of probiotics in our intestines.

66. Thank you
Any Questions?