{"id":976,"date":"2020-02-18T11:20:07","date_gmt":"2020-02-18T05:50:07","guid":{"rendered":"https:\/\/medicineplexus.com\/?p=976"},"modified":"2020-02-18T11:20:07","modified_gmt":"2020-02-18T05:50:07","slug":"probiotics","status":"publish","type":"post","link":"https:\/\/medicineplexus.com\/probiotics\/","title":{"rendered":"Probiotics"},"content":{"rendered":"\n<p><strong>Probiotics<\/strong><\/p>\n\n\n\n<p><strong>Definition- \u2018\u2018<\/strong>Live microorganisms which when administered in adequate amounts confer a health benefit on the host\u2019\u2019 (WHO)<\/p>\n\n\n\n<ul><li><strong>Prebiotic <\/strong>&#8211; a substance (usually an oligosaccharide) that cannot be digested but does promote the growth of beneficial bacteria or probiotics<ul><li>E.g. Oligofructose, Inulin, Galacto-oligosaccharides, Lactulose, Breast milk oligosaccharides<\/li><\/ul><\/li><li><strong>Symbiotic <\/strong>&#8211; a substance containing both a prebiotic and probiotic.<\/li><li><strong>Ellie Metchnikoff,<\/strong> the first scientist who proposed the therapeutic use of lactic acid bacteria.<\/li><\/ul>\n\n\n\n<p><strong>Why are Probiotics important for Human health?<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"480\" height=\"239\" src=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2020\/02\/image-437.png?w=480\" alt=\"\" class=\"wp-image-1001\" srcset=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2020\/02\/image-437.png 480w, https:\/\/medicineplexus.com\/wp-content\/uploads\/2020\/02\/image-437-300x149.png 300w\" sizes=\"(max-width: 480px) 100vw, 480px\" \/><\/figure>\n\n\n\n<p><strong>&nbsp; <\/strong><strong>Key properties of probiotic<\/strong><\/p>\n\n\n\n<ul><li><strong>Non-pathogenic<\/strong>, non-toxic and <strong>non-allergic.<\/strong><\/li><li>The organism must be fully identified: genus, species and strain<\/li><li>Capable of surviving and metabolizing in upper G.I. tract e.g. <strong>Resistant to low pH, organic acids, bile juice, <\/strong>saliva and gastric acid<\/li><li>Human in origin, <strong>genetically stable<\/strong> and capable of <strong>remaining viable for long periods<\/strong> in field condition.<\/li><li>Able to <strong>modulate immune response<\/strong> and provide resistance to disease through <strong>improved immunity<\/strong> or by the <strong>production of antimicrobial substance<\/strong> in the guts.<\/li><li><strong>Good adhesion\/ colonization<\/strong> to human intestinal tract and influence on gut mucosal permeability.<\/li><li><strong>Antagonistic against pathogenic<\/strong> organisms.<\/li><li>Clinically proven health benefit, e.g. gastrointestinal disorders, diarrhoea, clostridium difficle colitis, antibiotics associated diarrhoea, acute gastroenteritis.<\/li><li>Technologic properties for commercial viability such as stability of desired characteristics during processing, storage and transportation.<\/li><\/ul>\n\n\n\n<p><strong>Examples of probiotics<\/strong><\/p>\n\n\n\n<p><strong><em>Lactobacillus <\/em>species &#8211;<\/strong><em>L. acidophilus, L. casei (rhamnosus), L. johnsonii, L. bulgaricus, L. plantarum, L. lactis<\/em><\/p>\n\n\n\n<p><strong><em>Bifidobacterium species<\/em><\/strong><em>&#8211; B. bifidum, B. longum, B. infantis, B. lactis, B. adolescentis.<\/em><\/p>\n\n\n\n<p><strong><em>Others-<\/em><\/strong><em> Bacillus cereus, Non-pathogenic Escherichia coli, Saccharomyces cerevisiae (yeast), Enterococcus faecalis<\/em><\/p>\n\n\n\n<p><em>Streptococcus thermophilus.<\/em><\/p>\n\n\n\n<p><strong><em>FMT (Faecal Microbiota Transplant) <\/em><\/strong><strong><em>cannot be considered probiotic, because this involves an undefined mixture of micro-organisms.<\/em><\/strong><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"480\" height=\"293\" src=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2020\/02\/image-438.png?w=480\" alt=\"\" class=\"wp-image-1002\" srcset=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2020\/02\/image-438.png 480w, https:\/\/medicineplexus.com\/wp-content\/uploads\/2020\/02\/image-438-300x183.png 300w\" sizes=\"(max-width: 480px) 100vw, 480px\" \/><\/figure>\n\n\n\n<p><strong><em>Mechanism of action<\/em><\/strong><\/p>\n\n\n\n<ul><li><strong><em>Bioconversion<\/em><\/strong><em> , for example, sugars into fermentation products<\/em><\/li><li><em>Production of growth substrates, like <strong>vitamins B and K,<\/strong> for other bacteria<\/em><\/li><li><em>Direct antagonism to antimicrobial substances:<\/em><ul><li><em>hydrogen peroxide<\/em><\/li><\/ul><ul><li><em>organic acids<\/em><\/li><\/ul><ul><li><em>Bacteriocin<\/em><\/li><\/ul><ul><li><em>Acidophilin<\/em><\/li><\/ul><\/li><li><em>Improve <strong>absorption of nutrients<\/strong><\/em><\/li><li><em>Production of <\/em><em>\u03b2- D- <strong>galactosidase&nbsp; enzymes that break down lactose<\/strong> .<\/em><\/li><li><strong><em>Reduction of inflammation<\/em><\/strong><em>, thus altering intestinal properties<\/em><\/li><li><em>Stimulation of <strong>innate immune response<\/strong><\/em><\/li><\/ul>\n\n\n\n<p><strong><em>Foods containing Probiotics<\/em><\/strong><\/p>\n\n\n\n<ul><li><em>Milk, Soya milk, <strong>Milk products<\/strong>&#8211; Sour cream, Butter milk, Yoghurt, <strong>Fermented Indian foods<\/strong> like Idlis, Dosas, uttapam, Dhoklas, Vadas, Kadhi.<\/em><\/li><\/ul>\n\n\n\n<p><strong>Genetically Engineered Probiotics<\/strong><\/p>\n\n\n\n<ul><li>A genetically modified <em>Bacteroides ovatus <\/em>and Xylan in small amounts&nbsp; as a therapy to animals with colitis.<\/li><li><strong>ViBact <\/strong>(which is made up of genetically modified <em>Bacillus mesentricus<\/em>), which acts as an <strong>alternate to B-complex <\/strong>capsules.<\/li><\/ul>\n\n\n\n<p>Benefits of Genetic engineering:<\/p>\n\n\n\n<ul><li>Strengthen the effects of existing strains<\/li><li>As vector for vaccines and growth hormones<\/li><\/ul>\n\n\n\n<p><strong>Clinical application of probiotics<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"463\" height=\"179\" src=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2020\/02\/image-439.png?w=463\" alt=\"\" class=\"wp-image-1003\" srcset=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2020\/02\/image-439.png 463w, https:\/\/medicineplexus.com\/wp-content\/uploads\/2020\/02\/image-439-300x116.png 300w\" sizes=\"(max-width: 463px) 100vw, 463px\" \/><\/figure>\n\n\n\n<p>results are promising but not yet conclusive.<\/p>\n\n\n\n<ul><li><img loading=\"lazy\" decoding=\"async\" width=\"463\" height=\"179\" src=\"\">Diarrheal Illness &#8211; treatment and prevention<\/li><li>Prevention of antibiotic-associated diarrhea (AAD)<\/li><li>Genito-urinary.<\/li><li>Inflammatory bowel disease (ulcerative colitis,CD)<\/li><li>Lactose intolerance<\/li><li>Cancers<\/li><li>Food allergies<\/li><li>Eczema<\/li><li>Necrotizing enterocolitis<\/li><\/ul>\n\n\n\n<p><strong>Allergy<\/strong><\/p>\n\n\n\n<ul><li>Atopic eczema, Dermatitis, Allergic rhinitis, Asthma, food allergies with peanuts, tree nuts, soy, wheat gluten, fish<\/li><li><strong>Atopic children<\/strong> tend to have a <strong>degree of dysbiosis<\/strong> with <strong>more clostridia and fewer bifidobacteria<\/strong>&nbsp;<\/li><li>\u00e9 IgE thought to be caused by a skewed balance between T helper type 1 and T helper type 2 cells<\/li><li><strong>Probiotics improving the Th1\/Th2 balance<\/strong> in favor of a <strong>predominance of Th1 cells<\/strong><\/li><\/ul>\n\n\n\n<p><strong>Genitourinary<\/strong><\/p>\n\n\n\n<ul><li><strong>Recurrent Candida Vaginitis and Bacterial Vaginosis<\/strong> have been successfully treated by administration of both <strong>oral and vaginal Lactobacilli<\/strong><\/li><li>Vaginal pessaries with 1 billion colony forming units<\/li><\/ul>\n\n\n\n<p><strong>IBD<\/strong><\/p>\n\n\n\n<ul><li>IBD is associated with <strong>a breakdown of the normal barrier function<\/strong> provided by the gut epithelial lining and its associated with <strong>decreased mucus commensal bacteria.<\/strong><\/li><li>Use of probiotics and prebiotics giving good results in <strong>maintaining remission in UC but not of much in CD<\/strong><\/li><li><strong>Nissle strain &#8211; Only probiotic recommended in ECCO guidelines as effective alternative to mesalazine in maintenance of remission in UC patients.<\/strong><\/li><li>Good evidence for preventing an initial attack of <strong>pouchitis<\/strong>, and relapse of pouchitis after the induction of remission with antibiotics<\/li><li><strong>Can be recommended in mild pouchitis, or as maintenance therapy for those in remission<\/strong><\/li><li>Usually 1&#215;10<sup>9<\/sup>, or 1 billion colony forming units (CFU) is a good daily dose<\/li><\/ul>\n\n\n\n<p><strong>IBS<\/strong><\/p>\n\n\n\n<ul><li>Prebiotics <strong>relieve constipating symptoms-<\/strong><ul><li>I<strong>ncreased bacterial mass and osmotic water-binding capacity<\/strong>&nbsp; making stools bulky<\/li><\/ul><ul><li><strong>Increased stool frequency<\/strong> and <strong>make stools softer<\/strong><\/li><\/ul><\/li><li>A <strong>reduction in abdominal bloating and flatulence<\/strong> as a result of probiotic treatments is a consistent finding<\/li><li>Some strains <strong>may ameliorate pain<\/strong> and provide global relief (<em>B. infantis <\/em>35624)<\/li><li>Dose &#8211; 10<sup>8<\/sup> cfu of the freeze-dried probiotic bacteria B. infantis spec.<\/li><\/ul>\n\n\n\n<p><strong>Immunoregulation<\/strong><\/p>\n\n\n\n<ul><li>Probiotics helps to <strong>Increase IgA production by B- cells&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<\/strong><\/li><li>Has <strong>antiviral property, induce NO synthase<\/strong> (a virus infected cell death mechanism)<\/li><li><strong>Production of gamma intereferon, TNF-alph,IL-1 by mononuclear cells incubated with Lactobacillus.<\/strong> Increase cytotoxic potential of NK cells, increasing IL-10 synthesis thus preventing acute infectious disease<\/li><li>Adherant Lactobacilli and Bifidobacteria <strong>significantly increase phagacytosis.<\/strong><\/li><\/ul>\n\n\n\n<p><strong>Anticancer effects<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"490\" height=\"277\" src=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2020\/02\/image-440.png?w=490\" alt=\"\" class=\"wp-image-1004\" srcset=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2020\/02\/image-440.png 490w, https:\/\/medicineplexus.com\/wp-content\/uploads\/2020\/02\/image-440-300x170.png 300w\" sizes=\"(max-width: 490px) 100vw, 490px\" \/><\/figure>\n\n\n\n<ul><li>Probiotics have been shown to improve biomarkers associated with colorectal cancer<\/li><li>5-wk supplementation of probiotics reduced the urinary excretion of aflatoxin, a marker for hepatocyte carcinogenesis, and symbiotic consumption for 12 wk significantly reduced colorectal cancer risk<\/li><\/ul>\n\n\n\n<p><strong>Necrotizing Enterocolitis<\/strong><\/p>\n\n\n\n<ul><li>Reduces the risk of necrotizing enterocolitis <strong>in preterm neonates. <\/strong><strong><\/strong><\/li><li><strong>Meta-analyses have also shown a reduced risk of death in probiotic-treated groups<\/strong>, although not all probiotic preparations tested are effective.<\/li><li>NNT to prevent one death from all causes by treatment with probiotics is 20.<\/li><\/ul>\n\n\n\n<p><strong>Adverse effects<\/strong><\/p>\n\n\n\n<ul><li>Probiotics side effects, if they occur, tend to be <strong>mild and digestive symptoms. (such as gas or bloating).<\/strong><strong><\/strong><\/li><li>May cause <strong>infections, especially in immuno- compromised patients.<\/strong><strong><\/strong><\/li><li><strong>Diabetic patients should be cautious<\/strong> about taking probiotic drinks available in the market as they contain <strong>high level of sugar.<\/strong><\/li><\/ul>\n\n\n\n<p><strong>Probiotic products taken as a dietary supplement are manufactured and regulated as functional foods, not drugs.<\/strong><\/p>\n\n\n\n<ul><li>Probiotics supplements are <strong>not necessary for normal, healthy individuals.<\/strong><strong><\/strong><\/li><li>&nbsp;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.<\/li><li>A diet high in starches and fibre provide prebiotics, which keep a healthy population of probiotics in our intestines.<\/li><\/ul>\n\n\n\n<p><strong>Challenges<\/strong><\/p>\n\n\n\n<ul><li>Retention of viability of the probiotic bacteria &#8211; The numbers of <strong>viable bacteria continually decrease with time <\/strong>during refrigerated storage<\/li><li>A serious problem of <strong>shelf instability<\/strong> had been encountered with dried Cultures.<\/li><li>Manufacturer needs <strong>to incorporate an excess of cells at the time the tablets are manufactured<\/strong>. This practice <strong>increases the cost<\/strong> and makes the use instructions inaccurate<\/li><li>Extreme temperatures, high pressure, shear forces can destroy the preperations<\/li><li>Survival of most bifidobacteria in most dairy products is poor due to low pH and\/or exposure to oxygen<\/li><li><strong>Difficulty in assessment of efficacy of probiotics<\/strong><\/li><li>Currently in India, probiotics are characterized as functional food<\/li><li>Regulated by food laws &#8211; FSSA (eatables regulations covering nutraceuticals, foods and dietary supplements)<\/li><li>ICMR and DBT have formulated guidelines for probiotics being marketed as foods.<\/li><li>These guidelines specify the criteria when launching a probiotic food, labelling requirements<\/li><li>They describe parameters to define a product as &#8216;probiotic&#8217;.<\/li><li>May be used as a reference to establish probiotic standards in the country by the FSSAI<\/li><li>Probiotics delivered in food <strong>MAY NOT be tested in PHASE 3<\/strong> studies, unless the product makes a <strong>specific health claim wherein it becomes necesssary <\/strong>to carry out Phase 3 studies.<strong><\/strong><\/li><\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Probiotics Definition- \u2018\u2018Live microorganisms which when administered in adequate amounts confer a health benefit on the host\u2019\u2019 (WHO) Prebiotic &#8211; a substance (usually an oligosaccharide) that cannot be digested but does promote the growth of beneficial bacteria or probiotics E.g. Oligofructose, Inulin, Galacto-oligosaccharides, Lactulose, Breast milk oligosaccharides Symbiotic &#8211; a substance containing both a prebiotic[&#8230;]\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_seopress_robots_primary_cat":"","_seopress_titles_title":"","_seopress_titles_desc":"","_seopress_robots_index":"","footnotes":""},"categories":[3],"tags":[],"_links":{"self":[{"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/posts\/976"}],"collection":[{"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/comments?post=976"}],"version-history":[{"count":0,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/posts\/976\/revisions"}],"wp:attachment":[{"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/media?parent=976"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/categories?post=976"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/tags?post=976"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}