Probiotics

1. ‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬
Probiotics
Prepared by
Mohammed Kamel Abo Yousef
IUG medical student

2. Outlines
 Definitions
 Mechanism
 Probiotic microorganisms
 Medical applications
 Safety
 Forms

3. Probiotics: definition
 World Health Organization:
 “live microorganisms which when administered
in adequate amounts confer a health benefit on
the host”.(1)
 They:
 Survive stomach acid and bile
 Establish residence in the intestines
 Impart health benefits

4. Prebiotics (functional food)
 Non-digestible food ingredients that
stimulate the growth and/or activity of
probiotics
 Typically oligosaccharides
 Found in: Jerusalem artichoke, chicory
root, raw dandelion greens, leeks,
onions, garlic, asparagus, whole grains,
beans, banana

5.  providing colonization resistance by which the
non-pathogen excludes the pathogen from
binding sites on the mucosa
 enhancing the immune response against the
pathogen
 Production of short-chain fatty acids with anti-
inflammatory properties
Probiotics: proposed
mechanisms

6. Probiotic microorganisms

7. :Probiotic strains
Lactobacillus species
L. acidophilus
L. plantarum
L. casei subspecies rhamnosus
L. brevis
L. delbreuckii subspecies bulgaricus
Bifidobacterium species
B. adolescentis
B. bifidum
B. longum
B. infantis (breast milk)
B. breve

8. Others:
Escherichia coli strain Nissle 1917 (Mutaflor)
of serotype O6:K5:H1
Streptococcus salivarius ssp. thermophilus
Lactococcus lactis ssp. lactis
Lactococcus lactis s ssp. cremoris
Enterococcus faecium
 Probiotic effects tend to be strain
specific(7).

10. ((9))

11. (9)

12. Probiotics forms(10)
 Probiotics are available as :
 Probiotic foods: e.g yogurt, milk,
fermented milk, desserts, fruit juices,
soy, ice cream, cheese, and chewing gum

13.  Capsules
 Powder blends
 Sticks
 Chewable tablets
Dosage Forms….For the Military

16. “You’ve been fooling around with alternative medicine, haven’t you?”

17. The safety of probiotics(3)
 ALWAYS REMEMBER ::: there is no drug or toxin ,
it’s a matter of concentration .
 There have been many controlled clinical trials on
the use of probiotics that demonstrate safe use
 Organisms that are generally regarded as safe
include lactobacilli, lactococci , Bifidobacterium,
and yeast.

18. Probiotic safety
 2% bloating, gas, diarrhea
 Case reports of bacteremia, fungemia,
endocarditis, meningitis in
immunocompromised patient.
 Food is safer than pills !

19. Probiotic in the world
 Probiotics are available as both foods and
drugs in Japan(8).
 Europeans consume probiotics in foods and
in food supplements, but some of probiotic
products are registered as drugs(10).
 In USA most probiotics are regulated as
dietary supplements, which were defined in
1994 by the FDA via the Dietary Supplement
and Health Education Act(7).
 There are currently no probiotics approved as
“drugs” in the United States(11).(2008)

20.  In the future we may be using probiotics as we use
antibiotics today: with specific strains used for certain
clinical situations guided by controlled studies

21. References
1. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3231924/
2. Mary Ellen Sanders. Probiotics: Definition, Sources, Selection, and
Uses. Clin Infect Dis. (2008) 46(Supplement 2): S58-S61. Jürgen
Schrezenmeir and Michael de Vrese. Probiotics, prebiotics, and
synbiotics—approaching a definition. Am J Clin Nutr 2001 73: 361s-
364s.
3. David R. Snydman. The Safety of Probiotics. Clin Infect
Dis. (2008) 46(Supplement 2): S104-S111.
4. Glenn R. Gibson and Marcel B. Roberfroid. Dietary Modulation of the
Human Colonic Microbiota:
Introducing the Concept of Prebiotics. J. Nutr. June 1995 125: 1401-
1412.
5. Review of Medical Microbiology & Immunology, Eleventh Edition,
Warren Levinson .
6. Wilhelm H Holzapfel, Petra Haberer, Rolf Geisen, Johanna
Björkroth, and Ulrich Schillinger. Taxonomy and important
features of probiotic microorganisms in food and nutrition. Am J
Clin Nutr 2001;73(suppl):365S–73S.

22. References
7. Jon A. Vanderhoof and Rosemary Young. Probiotics in the
United States. Clin Infect Dis. (2008) 46(Supplement 2): S67-
S72.
8. Harunobu Amagase. Current Marketplace for Probiotics: A
Japanese Perspective. Clin Infect Dis. (2008) 46(Supplement
2): S73-S75.
9. B. R. Goldin and S. L. Gorbach. Clinical Indications for Probiotics:
An Overview. Clin Infect Dis. (2008) 46(Supplement 2): S96-
S100.
10. Maija Saxelin. Probiotic Formulations and Applications, the
Current Probiotics Market, and Changes in the Marketplace: A
European Perspective. Clin Infect Dis. (2008) 46(Supplement
2): S76-S79.
11. Freddie Ann Hoffman. Development of Probiotics as Biologic
Drugs. Clin Infect Dis. (2008) 46(Supplement 2): S125-S127.