Probiotics & Prebiotics- What are they all about? marketing

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Probiotics Prebiotics- What are they all about?

• marketing gimmick or tool?

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Background

• Probiotics are dietary supplements containing
  potentially beneficial bacteria or yeast, with
  lactic acid bacteria (LAB).
• LAB have been used in the food industry for many
  years, because they are able to convert sugars
  and other carbohydrates into lactic acid.
• This provides the characteristic sour taste of
  fermented dairy foods such as yogurt, and acts as
  a preservative, by lowering the pH

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And

• Prebiotics are a category of functional food,
  defined as 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, and
  thus improve host health eg. oligosacchirides

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The Theory

• The body contains a miniature ecology of
  microbes, collectively known as the gut flora
• The number of bacterial types can be thrown out
  of balance by a wide range of circumstances
  including the use of antibiotics or other drugs,
  excess alcohol, stress, disease, exposure to
  toxic substances, or even the use of
  antibacterial soap

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The Players

• BIFIDOBACTERIUM
• LACTOBACILLUS
• LACTOCOCCUS
• SACCHAROMYCES
• STREPTOCOCCUS THERMOPHILUS
• ENTEROCOCCUS

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How do they work?

• Probiotics may have antibacterial,
  immunomodulatory, anticarcinogenic,
  antidiarrhoeal, antiallergenic and antioxidant
  activities
• The antibacterial ability may partially be due to
  the ability to colonize the colon and reinforce
  the barrier function of the intestinal mucosa

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Also

• Lactobacillus casei has been demonstrated to
  increase levels of circulating IgA in infants
  infected with rotavirus
• Lactobacillus acidophilus and Bifidobacterium
  bifidum appear to enhance the nonspecific immune
  phagocytic activity of circulating blood
  granulocytes

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And

• S. boulardii has been found to secrete a protease
  which digests two protein exotoxins, toxin A and
  toxin B, which appear to mediate diarrhoea and
  colitis caused by Clostridium difficile
• Lactobacillus rhamnosus GG and Bifidobacterium
  lactis Bb12 produce significant improvement of
  atopic eczema in children the decrease in the
  signs and symptoms occurred in parallel with a
  reduction in the concentration of circulating
  CD4 T lymphocytes and an increase in TGF-beta1,
  indicating suppressive effects on T cell
  functions in this disorder

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Really?

• Do they survive in the acidic stomach
  environment, the alkaline conditions in the
  duodenum, as well as their ability to adhere to
  the intestinal mucosa of the colon and to
  colonize the colon. Some probiotics, such as
  Lactobacillus GG and Lactobacillus plantarum
  299v, do. After passage through the stomach and
  the small intestine, they become established
  transiently in the colon.

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The Fanclub

• Dr. Elie Metchnikoff, the father of modern
  immunology
• Dr. Minoru Shirota ,Yakult
• Dr Jean-Michel Antoine, science director at
  Danone
• All bar the first may have conflicts of interest
  but it does get better

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Evidence of effects

• Vandenplas et al in Eur J Paeds 2007 indicated
  selected strains of probiotics result in a
  statistically significant but clinically moderate
  benefit in shortening the duration of diarrhoea
  caused by acute infectious gastroenteritis
• Tellado in Cur Opin Crit Care 2007 indicate that
  they may contribute to better prognosis in
  pancreatitis

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Furthur papers

• Nomura et al in Hepatogastroenterology 2007
  showed probiotics reduce the rate of infection
  after Whipples procedure
• Moayeddi in EBM 2007 indicated that used of
  probiotics in H pylori eradication therapy
  improved efficacy and reduced s/e

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Now for us GPs

• Hickson et al BMJ 2007 indicated in a randomised
  double blind trial that consumption of a
  probiotic drink containing L casei, L bulgaricus,
  and S thermophilus can reduce the incidence of
  antibiotic associated diarrhoea and C difficile
  associated diarrhoea
• Cochrane indicate they may be of use in AAD and
  infective diarrhoea in conjunction with ORT

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So

• I suggest when giving antibiotics to all age
  groups apart from pregnant and breast feeding
• Anecdotal evidence so far less DV, lower
  incidence of vaginal thrush, controlled
  diverticulosis
• Potential s/e theoretically include flatulence/
  constipation/ Lactobacillus bacteraemia and
  endocarditis