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 HistoryEllie 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

• 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…

Largest immune organ

• Trillions living bacteria exist in the human intestine

• Lactobacillus,Bifidobacterium and Acidophilus comprise the majority of healthy bacteria in the colon along with other disease producing bacteria.

Facts about Intestine

Factors affecting the intestinal micro ecosystem

• During infancy : Mother’s microbiology Mode of delivery Feeding practices

• Later in life :Antibiotics and other drug intakeMicrobial infectionsDiet (highly processed, low fiber)Chronic diarrheaStress

Gut Flora in Breast Fed vs Formula Fed

Babies

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

Dysbiosis

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.”

Nutraceuticals

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

Alcohol consumption

Stress

Destroy the gut micro flora

Problems in digestion

Problems in absorption of

nutrients in the body

Emergence of antibiotic

resistant strains

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.

Bifidobacterium species

B. bifidum

B. longum

B. breve

B. infantis

B. lactis

B. adolescentis

OthersBacillus cereusNon pathogenic Escherichia coliSaccharomyces cerevisiae (yeast)Enterococcus faecalisStreptococcus thermophilus

Examples of probioticsLactobacillus species

L. acidophilus

L. casei (rhamnosus)

L. reuteri

L. bulgaricus

L. plantarum

L. johnsonii

L. lactis

Mechanism of actionStimulation of innate immune response

Decrease luminal pH

Secrete antimicrobial peptides

Inhibit bacterial invasion

Block bacterial adhesion to epithelial cells

BENEFITS PROBIOTICS

NormalizeIntestine Immunomodulation Metabolic

effects

Suppression of PPMs

Intestinal mucosal integrity

Regulation of bowel movement

IBS

Strengthens immunity

Alleviate food allergy symptoms

Control of IBD

Production of vitamins; improves digestion

Lactose tolerance

Lowers cholesterol(Bile acid deconjugation

& Secretion)

“PREBIOTICS”

PrebioticsThe 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- examplesGarlic, OnionsAsparagusWheat Rye , Barleybreast milktomatoes, berriesbananas

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

IBDUlcerative colitisCrohn’s diseasePouchitis

Constipation

Lactose Intolerance

H. pylori Eradication

DiarrheaAcute infectiousAntibiotic-associated C. difficile

Antibiotic associated diarrhea

(2006) 3, 606-607

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 ProbioticsPrebiotics Probiotics

Prebiotics are defined as nonliving non-digestible special form of fiber or carbohydrates.

Probiotics are referred to as live active microorganisms that when administered in adequate amount will have beneficial effects to its

host.The powder form of prebiotics can survive heat, cold, acid.

• more fragile.• vulnerable to heat. • may be killed over time.

Prebiotics perform their role by nourishing the bacteria that live in the intestines.

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.

Synbiotic = Probiotic + Prebiotic Potential synergy between pro- &

prebiotics Improve survival in upper GIT More efficient implantation Eg: Bifidobacteria and fructo-oligosaccharides (FOS)

Synbiotics

Probiotic marketIncreased 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