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Prebiotics and probiotics


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Prebiotics and probiotics

  1. 1. Dr Soumya Junior Resident
  2. 2. Overview • Introduction • History • Concept of probiotics • MOA and examples of probiotics • Prebiotics and its examples • Clinical applications of pre/pro biotics • Synbiotics • Current status of probiotics in India • References
  3. 3. Intestine is a Paradise of disease • Death sits in the bowels; a bad digestion is the root of all evil” - Hippocrates, 400 BC
  4. 4. History of Probiotics • At the start of the 20th century, Russian Nobel prize winner and father of modern immunology, Elie Metchnikoff , a scientist at the Pasteur Institute, was the first to conceptualize “Probiotics”
  5. 5. History contd. • In early 1930’s, in Japan, Minoru Shirota developed a fermented milk product called Yakult with a special strain of Lactobacillus casei shirota. • The word “probiotic” (origins: Latin pro meaning “for” and Greek bios meaning “life”) was first used to indicate substances that were required for a healthy life • Probiotics term coined in 1965 by Lilly And Stillwell.
  6. 6. 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 (GALT, secretory IgA, intraepithelial lymphocytes, macrophages, neutrophils, natural killer cells, Peyer’s patches and mesenteric lymph nodes) • Our Intestine = 400 square meter surface… i.e. the surface area of a tennis court
  7. 7. Facts about Intestine • Trillions living bacteria exist in the human intestine • We have more bacteria in our bodies (10 times greater) than the total number of our somatic and germ cells • We carry about 2 kg of bacteria !!!!!!!! • Over 500 species of bacteria present in human colon. • Lactobacillus,Bifidobacterium and Acidophilus comprise the majority of healthy bacteria in the colon along with other disease producing bacteria.
  8. 8. 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 Chlorinated water
  9. 9. Gut Flora in Breast Fed vs Formula Fed Babies
  10. 10. 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
  11. 11. Nutraceuticals  The term “Nutraceutical” was coined from “Nutrition” & “Pharmaceutical” in 1989 by Stephen De Felice.  Nutraceutical can be defined as  “ A food or part of food or nutrient, that provides health benefits, including the prevention and treatment of a disease.”  Includes :- GE foods, cereals supplemented with vitamins or minerals, genetically manipulated soybean and canola oil without trans-fatty acids
  12. 12. 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, evening primose oil – Dietary Supplement :- products that contain a dietary ingredient intended to add something to the foods we eat such as prebiotics, probiotics
  13. 13. Defining a probiotic  ‘‘Live microorganisms which when administered in adequate amounts confer a health benefit on the host’’ (WHO)
  14. 14. 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
  15. 15. 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 in field condition.  Able to modulate immune response and provide resistance to disease through improved immunity or by the production of antimicrobial substance in the guts. Contd….
  16. 16. Key properties of probiotic  Good adhesion/ colonization to human intestinal tract and influence on gut mucosal permeability.  Antagonistic against carcinogenic/ pathogenic organisms.  Clinically proven health benefit, e.g. gastrointestinal disorders, diarrhoea, clostridium difficle colitis, antibiotics associated diarrhoea, acute gastroenteritis.  Technologic properties for commercial viability such as stability of desired characteristics during processing, storage and transportation.
  17. 17. Examples of probiotics Bifidobacterium species B. bifidum B. longum B. breve B. infantis B. lactis B. adolescentis Others Bacillus cereus Non pathogenic Escherichia coli Saccharomyces cerevisiae (yeast) Enterococcus faecalis Streptococcus thermophilus Lactobacillus species L. acidophilus L. casei (rhamnosus) L. reuteri L. bulgaricus L. plantarum L. johnsonii L. lactis
  18. 18. Mechanism of action  Bioconversion of, for example, sugars into fermentation products  Production of growth substrates, like vitamins B and K, for other bacteria  Direct antagonism by antimicrobial substances: – hydrogen peroxide – organic acids – Bacteriocin – acidophilin
  19. 19. Mechanism of action  Competitive exclusion for binding sites  Improved barrier function  Production of β- D- galactosidase enzymes that break down lactose .  Reduction of inflammation, thus altering intestinal properties  Stimulation of innate immune response
  20. 20. PROBIOTICS Normalise Intestine 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)
  21. 21. Foods containing Probiotics • Milk • Soya milk • Tofu • Milk products- Sour cream, Butter milk, Yoghurt • Fermented Indian foods like  Idlis  Dosas, uttapam  Dhoklas  Vadas  Kadhi
  22. 22. Probiotic products marketed in India  India is an emerging market for probiotic products, being the largest producer of milk.  Amul , Mother dairy, Nestle Nesvita (first India’s Dahi with probiotics) and Yakult are the major brands.
  23. 23. Streptococcus faecalis T-110 30 million Clostridium butyricum TO-A 2 million Bacillus mesentericus TO-A 1 million Lactobacillus sporogenes 50 million
  24. 24. “PREBIOTICS”
  25. 25. 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."
  26. 26. Prebiotics- examples Garlic, Onions Chicory root Asparagus Wheat  Rye , Barley breast milk tomatoes, berries bananas
  27. 27. Established prebiotics Name Obtained from/manufactured by Inulin Extraction from chicory root, Wheat, banana, onions, garlic, leek Fructo-oligosaccharides Tranfructosylation from sucrose, or hydrolysis of chicory inulin Galacto-oligosaccharides Produced from lactose by b-galactosidase, milk SOS (soy-oligosaccharides) Extracted from soya bean whey XOS (xylo-oligosaccharides) Enzymic hydrolysis of xylan IMO (isomalto oligosaccharides) Transgalactosylation of maltose Pyrodextrins Pyrolysis of potato or maize starch Breast Milk oligosaccharides They represent the third largest component of Human Milk 20 - 23 gm/l in colostrum & 12- 14 gm/l in mature milk
  28. 28. 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,CD) • Lactose intolerance • Necrotizing Enterocolitis (NEC) Suggested Benefits • Food allergies • Eczema
  29. 29. Clinical application of probiotics and Holds Promise prebiotics • Cystic fibrosis • Dyslipidemia/ Cardiovascular diseases • Rheumatoid arthritis • Traveller’s diarrhea / bacterial enteritis • Genitourinary tract infections • Allergic rhinitis • Asthma • Colic • Colon cancer prevention • Obesity • Hypertension • In elderly
  30. 30. Probiotics in the Treatment of Gastrointestinal Disorders IBD Ulcerative colitis Crohn’s disease Pouchitis Constipation Lactose Intolerance H. pylori Eradication Diarrhea Acute infectious Antibiotic-associated C. difficile
  31. 31. 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.
  32. 32. Antibiotic associated diarrhea Disease Antibiotic treatment Probiotics Disturbance of intestinal microbiota Microbiota Clostridium overgrowth in balance produces toxin
  33. 33. Lactose intolerance  Lactase digests lactose commonly present in milk and milk products.  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.  Having yoghurt is a good way for a lactose intolerant person to get calcium.
  34. 34. Helicobacter pylori Infections  Chronic gastritis, Peptic ulcers, Gastric adenocarcinoma, and a number of non-gastrointestinal disorders.  Bifidobacteria and B. subtilis may inhibit the growth or attachment of H. pylori.  Possible mechanisms eradicates H. pylori include  the ability of the probiotics to bind to gastric epithelial cells,  to produce a high quantity of lactic acid, and  to proliferate rapidly.
  35. 35. Hypercholesterolemia Lactic acid bacilli Increases production of Short chain Fatty Acid Inhibits cholesterol syn by liver Decreases blood chlesterol Increases bile . Bile syn. Increases More cholesterol is used up Decreases cholesterol
  36. 36. Probiotics and Cancer Enzymes (Glycosidase, B- glucuronidase , azoreductase , and nitroreductase) of the intestinal flora convert the precarcinogens to active carcinogens giving rise to colon CA. Probiotics reduce  Faecal concentrations of enzymes  Reduce absorption of harmful mutagens that may contribute to colon carcinogenesis. Activity of L. acidophilus and L. casei supplementation in humans helps to decrease levels of these enzymes
  37. 37. 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. The varying strains also make it impossible to establish an RDA for a probiotic.  Probiotic effects should be considered dose-specific  Dose listed on the label are based on studies that show a beneficial health effect in humans.
  38. 38. Prebiotics vs Probiotics Prebiotics 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.
  39. 39. 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.  Diabetic patients should be doubly cautious about taking probiotic drinks available in the market as they contain high level of sugar.  Probiotic products taken as a dietary supplement are manufactured and regulated as functional foods, not drugs.
  40. 40. 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 required to maintain a healthy digestive system and overall wellbeing.  A diet high in starches and fibre provide prebiotics, which keep a healthy population of probiotics in our intestines.
  41. 41. Synbiotics Synbiotic = Probiotic + Prebiotic  The concept of synbiotics has been proposed to characterize health-enhancing foods and supplements used as functional food ingredients in humans  Potential synergy between pro- & prebiotics  Improve survival in upper GIT  More efficient implantation  Eg: Bifidobacteria and fructo-oligosaccharides (FOS)
  42. 42. Health benefits of Synbiotics • Improved survival of live bacteria in food products, prolonged shelf life • Increased number of ingested bacteria reaching the colon in a viable form • Stimulation in the colon of the growth and implantation of both exogenous and endogenous bacteria • Activation of metabolism of beneficial bacteria, antagonistic toward pathogenic bacteria
  43. 43. 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%. Japan accounted for the largest share of total sales in 2007 with 39.5%, driven primarily by the country’s large and well-developed probiotic foods segment. Source: beverage/probiotics-market-fod035d.html
  44. 44. Status of Probiotics in India • Indian probiotic industry is in its infancy stage and presently accounts for only a small fraction i.e. less than 1% of the total world market turnover in the probiotic industry. • Apart from human use, also used as animal feed supplements for cattle, poultry and piggery. • The latest and recent addition to the list of probiotics in India is ViBact (which is made up of genetically modified Bacillus mesentricus), which acts as an alternate to B-complex.
  45. 45. Institutes engaged in Probiotic research in India Central Food Technology And Research Institute, Mysore, India National dairy research institute, Karnal, Haryana, India • Institute of microbial technology, Chandigarh, India • National dairy development board, Anand, Gujarat, India Nestle Pvt Ltd, Panipat, Haryana, India
  46. 46. Human Microbiome Project The Human Microbiome Project (HMP) 2008, aims to characterize the microbial communities found at several different sites in the human body, including nasal passages, oral cavities, skin, GI tract, and urogenital tract, and to analyze the role of these microbes in human health and disease.