probiotics by dr sarma

8/15/2019 Probiotics by Dr Sarma

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Prof. Dr. R.V.S.N. Sarma,MD., M.Sc (Canada), RCGP, FCGP, FIMSA,Senior Consultant P !sician,Cardio"Meta#olic and C est S$ecialist

%onorar! National Professor ofMedicine (CGP)

visit: www.drsarma.inwww.youtube.com/user/drsarmaji

http://www.drsarma.in/http://www.youtube.com/user/drsarmajihttp://www.youtube.com/user/drsarmajihttp://www.drsarma.in/


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Anti#otics

Pro#iotics

S!n#iotics

Pre#iotics


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3

Potential #ene&ts of'acto#acillus *+ !rs a o - +/ Conce$t of Pro#iotics


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Starts immediatel! after #irtPlace of #irt0!$e of Deli1er!

Feedin / 0ime, 0!$ePre"lacteals 1s 23clusi1e #reast feed.Premature 1s. Full termSic4 #a#ies

4


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st 5ear6/ 7 * #acterial s$ecies

Adult / + "8 #acterial s$ecies

2lderl!/ 9 :act. S$ecies

C r. Intestinal disorders

5


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For conte3t ; 0otal Cells0 eirs , #illion.


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Sta$ . Aureus, al#us Nose = s4in

Mout , Colon, Va ina 'acto#acilus S$, :i&do#act..

Candida al#icans Mout , Colon, Va ina

Va ina, uncti1a

Pseudomonas aeru inosa Colon = s4in

Facultati1e Anaero#es Strict anaero#es

LACTOBACILLUS: BIFIDOBACTERIA: SACCHAROMYECES:


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Probiotics%Friendly "acteria&

'ormalise(ntestine (mmunomodulation )etabolic e ects

*u++ression oPP)s

(ntestinalmucosal inte#rity

,e#ulation obowel movement

("*

*tren#t!ensimmunity

-lleviateood aller#y sym+toms

onrol o ("

Production o vitamins0im+roves di#estion

1actose tolerance

1owers c!olesterol%"ile acid deconju#ation

*ecretion&


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In i#it Potentiall! Pat o enic Microor anisms (PPMs)

Reduction in Intestinal $% ( t rou $roduction of

SCFAs)

Production of #acteriocins

Com$etiti1e #loc4in of ad esion sites

Com$etition for nutrients


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Most a#undant Pro#iotic inGI'acto#acillus/

Acido$ ilus,

R amnosus, GGPlantarum,Reuteri,:ul aricus,S$oro ensCasei

Action onl! in Small intestine

4


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:i&do#acteria

9* di?erent s$ecies / 'on um, :i&dum, infantis etcMost a#undant $ro#iotic ne3t to lacto#acilli S$. int e GI0

Action / 'ar e Intestine

5


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A$art from t e eneral Pro#iotics e?ect ,

:i&do#acteria el$s is Glutamine s!nt esis

Glutamine el$s in maintainin t e mucosalinte rit!

N%9 @ Glutamic acid """"""""""""7 Glutamine:i&do#acteria


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Saccharomyeces:

Boullardii,

Salivarium,Thermophilus

Non colonising yeast – so needsrepeated readministration

Action in large intestine7


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. )ust be o !uman ori#in

3. 6ert a bene icial e ect on t!e !ost

. "e non+at!o#enic and nonto6ic to t!e !ost

7. ontain a lar#e number o viable cells and remain viable

durin# stora#e and use

4. a+able o survivin# coloni8in# and +roli eratin# in t!e

#ut %s!ould not be 9illed by #astric juice / bile acids&

2. "e anta#onistic to +at!o#ens

5. -ble to in!abit in t!e * 1 intestine


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:i&do#acteria is an Im$ortant Pro#iotic as itmaintains t e mucosal inte rit!

%ence :i&do#acteria su$$lementation is useful inconditions li4e Gastroenteritis ere t e GI mucosais se1erel! dama ed

%o e1er, all t e mar4eted $re$aration contains onl! ; 9 s$ecies of :i&do#acteria as a ainst 9*reBuired

%ence it is ideal to su$$lement it $ro#iotic ici1e nutrient to :i&do#acteria so all 9* s$ecies can$roliferate


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• Non-digestible dietary supplements, which provide‘’nutrition’’ for Probiotics

• Oligosaccharides (fructo-oligosaccharides or O!",#nulin, $actulose, $actitol

• %utated &acterial !pecies (!treptococcus faecalis ,'lostridium butyricum , &acillus mesentericus "

• dvantage of Prebiotics in bacterial form ) ddl*Probiotic activity ( #ntrinsic Probiotic activity"


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*!ould +romote t!e +roli eration o bene icialbacteria %1actiobaccillus "i idobacteria&

*u++ly nutrient to bene icial bacteria

*!ould esca+e di#estion in t!e stomac! and reac!(ntestine


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Pro#iotics Pre#ioticsNatureof t ePre$

Microor anism Food su$$lement(e / F


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F


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. (n ective diarr!ea %viral bacterial&2. -ntibiotic associated diarr!ea

3. 1actose intolerance

4. ,ecurrent a+!t!ous ulcers and stomatitis

. (n lammatory (" %Ulcerative colitis ro!n s&

7. (rritable bowel syndrome

5. ;ravelers diarr!ea

$. Pouc!itis


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Due to #acteria, Virus or Proto oa

Viral diarr oea /Rota1irusM3 /


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:acteriocin

:ioacti1e $e$tides

S ort c ain fatt! acids

Neutrali ation of

dietar! carcino ens

Free amino acids


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1-P

IgA

Tumors

Th 0

Th 1

B

IL-2 ↑IFN- γ ↑

Th 2

ntibody mediatedresponse

'ell mediatedresponse

>iruses

TGF-β↓IL-4 ↓IL-10 ↓

+

IL-2 ↑

IFN-γ ↑

TNF-α ↑

IFN-α ↑

Natural iller cells

%acrophages

'ytoto.ic /-lymphocytes

111

#mmune 0esponse

)(ntestinal +it!elium

)icroor#anisms

B(#? @

(#) @

(# A

% 1 % cells of intestinal epithelium

$ 1 $ymphocytes

P' 1 ntigen presenting cells

/h 1 /-helper cells

#$ 1 #nterleu ines

/2 1 /umour growth factor # N 1 #nterferon

/N 1 /umour necrosis factor

#g 1 #mmunoglobulin


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Protection of intestinal e$it elial #arrierfunction

Re ulation of intestinal e$it elialomeostasis

Re ulation of intestinal micro#ial

en1ironment

Modi&cations to commensal and $ro#iotic#acteria to en ance diarr ea $re1ention


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)ost common antibiotics t!at cause diarr!ea

-lteration in com+osition o normal intestinal bacterial micro

lora by antibiotic ma9es t!e ?( tract susce+tible to in ection

by un#us % andida& or bacteria lostridium di icile

Fun#us alters absor+tive sur ace o ?( tract – diarr!ea


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3

Pseudomembranous olitisVolcano lesions in AAD

• Relati1e ris4 of diarr ea reduced #! J. :! 'GG Sacc• +" #illion 1ia#le or anisms K 9" times da!• Pro#iotics to #e se$arated from Anti#iotics #! cou$le of

http://www.nature.com/clinicalpractice/about_site/doi.html


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• 0 e incidence of AAD can o u$ to *8J of

$atients on anti#iotics,

• :road"s$ectrum anti#iotics are associatedit t e i est rate of AAD #ecause of

t eir disru$ti1e im$act on t e normal

intestinal Eora.

( 2 0 0 6 ) 3 , 6

0 6 - 6 0 7


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Diarr ea is a common ad1erse e?ect of anti#iotic

treatments .

Anti#iotic associated diarr ea occurs in a#out +"9 J

of $atients

Almost all anti#iotics, $articularl! t ose t at act on

anaero#es, can cause diarr ea, #ut t e ris4 is i er it

amino$enicillins,

a com#ination of amino$enicillins andcla1ulanate, ce$ alos$orinLs, and clindam!cin.

:M * *69* / 9 +" 9 8 ( ON2)


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1actase di#ests lactose commonly +resent in mil9 and mil9+roducts.

1actose is not di#ested w!en t!ere is a de iciency in lactaseand results in diarr!ea.

*u++lementation wit! +robiotics !as been s!own to miti#atet!e sym+toms o lactose intolerance.


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!uperficial ulcers or fissures inmucosa of mouth*

Painful condition*

3ach episode lasts 4 -56 days*

3.act etiology not nown*

!tress appears to play a role*

%. ) & comple. 7 multivitamin,probiotics and antiseptic ortetracycline mouth wash*


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- ects tourists travelin# 0 *!i#ella

;ransmission o in ection:

FecoBoral route / in#ers and lies.

;ravelers diarr!ea can be +revented by re#ular +ro+!ylacticinta9e o bene icial bacteria

Cne wee9 be ore travel durin# travel one wee9 a tercom+letion o travel.


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C ronic medical condition c aracteri ed #!

a#dominal $ain, discomfort and results in c an e

in t e #o el freBuenc! = consistenc! in t e stools

Cause / Alteration in t e #o el motilit! = transit (due to an3iet!)

S!m$toms / :loatin , as , d!s$e$sia ,

consti$ation, diarr ea , diarr ea alternatin itconsti$ation, d!senter!


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InEammation in GI 0ract

ro!n s isease

*mall 1ar#e intestine

Ulcerative olitis

1ar#e intestine %,ectum olon&

Ulcerative colitisro!n s disease


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S!m$tom / Diarr oea D!senter! fe1er t.loss

R3 / Sul$ asala ine , Steroids , Immuno"su$$resants

Rationale for Pro#iotic / I:D $atients a1e a

com$romised #o el Eora due to inEammation.

Su$$lementation it $ro#iotic el$s to normali e

t e #o el Eora and t ere #! reduces t e inEammation

Pro#iotics $romotes t e anti en s$eci&c I A immune

res$onse and s ortens t e diarr eal $ ase .Also reduces t e rela$se rate


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(n lammation o an internal +ouc! created in +atients w!o

!ave +art o t!eir colon removed to treat ulcerative colitis

D!y Probiotics : 1ow levels o bacterial lora in intestine


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iverticula B Formation o small bul#es / ba#s in t!e colon

iverticulitis – (n lammation/ (n ection in t!e diverticula


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Mi3ture of Pre and Pro#iotic

Pro#iotics ; %el$s in reducin t e PPMs

Pre#iotics ; %el$s in Pro1idin food forPro#iotics


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'acto#acillus sporogenes +

million ( Pro#iotic)

Stre$tococcus faecalis 0" 9 million (

Pre#iotic)

Clostridium butyricum 0


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Stre$tococcus faecalis 0" 9 million (

Pre#iotic)

Clostridium #ut!ricum 0


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On ingestion, 8 mutated

live bacteria continue to

proliferate in the 2# tract

by a process of!ymbiosis

!ymbiosis ) &iological

association of two or

more species to their

mutual benefit*


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probiotics by dr sarma

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