PROBIOTIC FOODS-

HEALTHY WAY TO HEALTHY LIFE

Dr. Nguyen Van Toan (PhD)

Overview of Probiotics
Common issues of interest

What are probiotics and how do they work?

 What are current proposed uses of probiotics ?
 Probiotics: definitions
❖ Probiotics are live bacteria and yeasts that are good for our health,
especially our digestive system.
❖ We usually think of bacteria as something that causes diseases. But
our body is full of bacteria, both good and bad.
❖ Probiotics are often called "good" or "helpful" bacteria because
they help keep our gut healthy.
❖ Probiotics are naturally found in our body. we can also find them in
some foods and supplements.
❖ A bacterial strain that:
➢ Survives the stomach acid and bile
➢ Adheres to intestinal lining
➢ Grows and establishes temporary residence in the intestines
➢ Imparts health benefits
 Types of Probiotics
▪ Many types of bacteria are classified as
probiotics. They all have different benefits, but
most come from two groups: Lactobacillus and
Bifidobacterium
▪ Lactobacillus. This may be the most common
probiotic. It’s the one that can be found in
yogurt and other fermented foods. Different
strains can help with diarrhea and may help with
people who can’t digest lactose, the sugar in
milk.
▪ Bifidobacterium. can also be found in some
dairy products. It may help ease the symptoms
of irritable bowel syndrome (IBS) and some
other conditions.
Probiotics
✓ Colonization at birth
✓ Similar to maternal species
✓ Specific organisms vary by age in first year
✓ Become established by 1 year
✓ In children and adults, “Successful” treatment with probiotics
leads to temporary colonization only
Probiotics: proposed mechanisms
❖ Adherence and subsequent stimulation of gut immune system
➢ Up-regulation of mucin gene
➢ Enhance secretory IgA (Immunoglobulin A)
➢ Maintain normal macrophage function
❖ Competition for essential nutrients
❖ Production of antimicrobial factors
❖ Provide favorable environment for growth of other beneficial
bacteria
❖ Production of short-chain fatty acids with anti-inflammatory
properties
 Probiotics: Proposed uses
➢Immune system enhancement
➢ Infectious diarrhea
➢ Antibiotic-associated diarrhea➢H pylori infections
➢ IBD, IBS, and pouchitis*** ➢Dental caries
➢ Necrotizing Enterocolitis
➢Radiation induced diarrhea
➢ Bacterial vaginitis
➢ Recurrent UTI’s ➢Cardiovascular risk reduction
(urinary tract infections)
➢Constipation
➢ Atopic diseases
➢Rheumatoid arthritis

***Pouchitis is generally considered a nonspecific inflammatory condition in

the ileal pouch reservoir
Probiotics: Proposed uses
Ratings: A: strong B: good C: fair

Rating the Evidence Floch et al (2006) Natural Standard (2006)

Infectious diarrhea A B
Antibiotic-associated A C
diarrhea
Diarrhea prevention B B
IBS C B
Atopic dermatitis/Allergy B? B/C

Floch, et al. Recommendations for Probiotic Use. J Clin Gastro. 40(3). 2006 www.naturalstandard.com
Probiotics: prescribing
▪ Which organism to use?
▪ Which product?
▪ For what conditions?
▪ What dose?
▪ For How long?
▪ Any side effects to be aware of?
▪ How much does it cost?
 History of Health Claims
➢ Persian version of the Old Testament (Genesis 18:8) states “
Abraham owed his longevity to the consumption of sour milk.”
➢ In 76 BC the Roman historian Plinius recommended the
administration of fermented milk products for treating
gastroenteritis .
➢ Metchnikoff (1845-1916) claimed that the intake of yogurt
containing lactobacilli results in a reduction of toxin-producing
bacteria in the gut and this increases the longevity of the host.
 Probiotic Concept
❖ Probiotic ( Greek Language) “ for life” .
❖ It was first used by Lilly and Stillwell in 1965 to describe
“substances secreted by one microorganism which stimulates
the growth of another”.
❖ Parker was the first to use the term probiotic in the sense that
it is used today “organisms and substances which
contribute to intestinal microbial balance”.
❖ In 1989, Fuller attempted to improve Parker’s definition of
probiotic with the following distinction:
“A live microbial feed supplement which beneficially
affects the host animal by improving its intestinal
microbial balance.”
The probiotic concept:
➢ effects exerted by viable microorganisms applicable
independent of the site of action and route of administration.
➢ include sites such as the oral cavity, the intestine, the vagina,
and the skin.
➢ In the case of probiotic foods, the health effect is usually
based on:
✓ alteration of the gastrointestinal microflora , and

✓ therefore, based on survival during gastrointestinal transit.

 Probiotics:
An edge over Antibiotics
❖ Antibiotics:
➢ Emergence of antibiotic resistance micro-organisms.
➢ Unpleasant side effects
❖ Probiotics:
▪ Non- invasive
▪ Preventive
▪ Free from undesirable side effects
Where do Probiotics come from?
➢ The micro biota of a newborn develops rapidly after the birth .
It is initially dependent mainly on :
 the mother’s micro biota,
 mode of delivery,
 birth environment ,and
 rarely genetic factors .
➢ The maternal vaginal and intestinal flora constitutes the source
of bacteria, which colonizes the intestine of the newborn.
➢ After infancy, probiotics are supplied to, by raw foods; lactic
acid fermented foods such as yogurt and cheese; and
probiotic supplements.
 Gut Microflora
❑ Microbiologically, the gut has three principal regions: the stomach,
small intestine, and colon.
➢ The stomach has very low bacterial numbers
➢ Facultative anaerobes such as lactobacilli, streptococci, and
yeast are present at 100 colony forming units (CFU) per millilitre
due to the low environmental pH .
➢ The small intestine has a larger bacterial load that consists of
facultative anaerobes such as:
✓ lactobacilli,
✓ streptococci, and
✓ enterobacteria as well as anaerobes such as Bifidobacterium
spp., Bacteroides spp., and clostridia at levels of ;104–108
CFU/ml.
➢ However, the colon, has a total population of 1011–1012 CFU/ml of
contents
 Factors affecting the intestinal
micro ecosystem
Any actions that take to kill ‘bad’ bacteria essentially
kills ‘good’ bacteria as well are considered as affecting
factors
✓ Antibiotics and other drugs intake
✓ Microbial infections
✓ Diet (highly processed, low-fiber foods)
✓ Chronic diarrhea, and
✓ Stress
Imbalance of intestinal micro
flora results in:
✓ Poor nutritional response
✓ Reduced efficacy of medications
✓ Physiological dysfunction
✓ Accelerated aging
✓ Cancer
✓ Deficient immune response
✓ Susceptibility to infection
✓ Physical discomfort
 Therapeutic Modulation of Gut
Microflora
❖ The gut microflora is an important constituent in the intestine's
defence barrier.
❖ Specific aberrancies in the intestinal microbiota may predispose the
host to disease.
❖ The normal gut microbiota can prevent the overgrowth of potential
pathogens in the GI tract.
❖ The protective and immune barrier of the human gastrointestinal (GI)
tract is diverse.

Contd….
 It includes :
➢ the epithelial layer
➢ the mucous layer
➢ the mechanics of peristalsis
➢ desquamation
➢ actions of secretory IgA
All of which impact bacterial attachment
❖ After attachment, colonic bacteria are prevented from
mixing with the host’s eukaryotic cells by the epithelial
layer, which acts as a vital barrier to invasion.
Selection of probiotic organism
➢ Safety
➢ Origin
➢ Functional aspects
➢ Survival
➢ Adherence, colonisation
➢ Anti-microbial products
➢ Immune stimulation
➢ Genetic stable
➢ Prevention of pathogens

(Mullan, 2002)
Major pre-requisite properties for a microbe to
be accepted as a probiotic are:

❖ It should be non-pathogenic, non-toxic and non-allergic.

❖ It should be capable of surviving and metabolizing in upper G.I.
tract secretion in the gut environment e.g. Resistant to low pH,
organic acids, bile juice, saliva and gastric acid.
❖ It should be human in origin, genetically stable and capable of
remaining viable for long periods in field condition.
❖ It should be able to modulate immune response and provide
resistance to disease through improved immunity or by the
production of antimicrobial substance in the guts.

Contd….
❑ It should have a good adhesion/ colonization to human
intestinal tract and influence on gut mucosal permeability.
❑ It should be antagonistic against carcinogenic/ pathogenic
organism.
❑ It should posses clinically proven health benefit, e.g.
gastrointestinal disorders, persistant diarrhoea, clostridium
difficle colitis, antibiotics associated diarrhoea, acute
infantile gastroenteritis.
❑ It should have technologic properties for commercial
viability such as stability of desired characteristics during
processing, storage and transportation.
Established effects of probiotics

➢Aid in lactose digestion

➢ Resistance to enteric pathogens
➢ Anti-colon cancer effect
➢ Anti-hypertensive effect
➢ Small bowel bacterial overgrowth
➢ Immune system modulation
➢ Blood lipids, Heart disease
➢ Urogenital infections
➢ Hepatic encephalopathy

(Roberfroid, 2000)
Mechanism for the benefit of Probiotics:

▪ Adherence and colonization of the gut

▪ Suppression of growth or epithelial binding/invasion by pathogenic

bacteria and production of antimicrobial substances

▪ Improvement of intestinal barrier function

▪ Controlled transfer of dietary antigens

▪ Stimulation of mucosal and systemic host immunity

(Harish and Varghese, 2006)

 Advantages of Probiotics

➢ Produce lactic acid- lowers the pH of intestines and inhibiting

bacterial villains such as Clostridium, Salmonella, Shigella, E. coli,
etc.

➢ Decreases the production of a variety of toxic or carcinogenic

metabolites.

➢ Aid absorption of minerals, especially calcium, due to increased

intestinal acidity.
➢ Production of β- D- galactosidase enzymes that break down lactose

Contd….
➢ Produce a wide range of antimicrobial substances -acidophilin and
bacteriocin etc. help to control pathogenic bacteria .

➢ Produce vitamins (especially Vitamin B and vitamin K)

➢ Act as barriers to prevent harmful bacteria from colonizing the

intestines

(Roberfroid, 2000)
Effects of probiotics on pathogenic bacteria
➢ Probiotics reduce plasma levels of bacterial endotoxin
concentrations, by inhibiting translocation of bacteria across the
GI lumen into the bloodstream.
➢ Decreases in translocation of bacteria may occur as a result of the
ability of probiotics to tighten the mucosal barrier.
➢ There are several ways probiotic microflora can prevent
pathogenic bacteria from adhering and colonizing gut mucosa.
➢ Probiotics disallow colonization by disease-provoking bacteria
through competition for nutrients, immune system up-regulation,
production of antitoxins, and up-regulation of intestinal mucin
genes.

contd…
➢ Probiotics lower colon luminal pH and foster growth of non-
pathogenic commensal bacteria by SCFA (Short Chain Fatty
Acid) production. One SCFA, acetic acid, has antimicrobial
activity against molds, yeasts, and bacteria.

➢ Probiotics exert protective effects through production of

hydrogen peroxide and benzoic acid, which inhibit many
pathogenic, acid-sensitive bacteria .

(Sanders, 2003)
Antibiotic associated diarrhea
 Probiotics and Cancer
❑ Enzymes (Glycosidase, B- glucuronidase , azoreductase , and
nitroreductase ) of the intestinal flora convert the precarcinogens to
active carcinogens
❑ Probiotics reduce:
✓ Faecal concentrations of enzymes
✓ Secondary bile salts
✓ Reduce absorption of harmful mutagens that may contribute to
colon carcinogenesis.
✓ Several mechanisms have been proposed as to how lactic acid
bacteria may inhibit colon cancer:
✓ Enhancing the host’s immune response
✓ Altering the metabolic activity of the intestinal microflora
✓ Binding and degrading carcinogens
✓ Producing antimutagenic compounds
✓ Altering the physiochemical conditions in the colon

(Harish and Varghese, 2006)

 Hepatic Diseases
Mechanisms by which probiotics may treat Hepatic Encephalopathy:
➢ Decreased portal blood ammonia by reduced bacterial urease activity
➢ Decreased pH due to less ammonia absorption
➢ Less intestinal permeability and improved gut epithelium
➢ Decreased inflammation and oxidative stress due to reduced
ammonia toxins
➢ Reduced uptake of other toxins
 Use of probiotics beyond GIT

▪ Allergy: Probiotics have the potential:

➢ To modify the structure of antigens

➢ Reduce their immunogenicity

➢ Reduce intestinal permeability
➢ Generation of pro-inflammatory cytokines that are
elevated in patients with a variety of allergic disorders
Probiotics in Pregnancy:
✓ Bacterial vaginosis , increases the risk of preterm labour
and infant mortality .
✓ Probiotics decrease the risk of bacterial vaginosis and
maintain normal lactobacilli vaginal flora
✓ Studies using L. rhamnosus GG and B. lactis BB12 have
shown that atopic dermatitis, a condition that causes
severe skin rashes in up to 15% of babies, can be
prevented in 50% of cases if mothers ingest probiotics
during pregnancy and newborns ingest them during the
first 6 months of life
 Use of probiotics
➢ All probiotics works effectively, if taken after meals, when
stomach acid is lowest.
➢ Stomach acid destroys up to 99.9% of probiotics, if taken before a
meal but only about 90%, if taken after meal.
➢ Thus, after meal intake ensures maximum delivery to the small
intestine, where they reproduce rapidly, populating the colon.
➢ They do most of their good work in the small and large intestines,
but they also help the mouth and esophagus to remain uninfected.
 Probiotic Strains
▪ A total of 169 Lactobacillus strains from 12 species
(L. acidophilus, L. brevis, L. buchneri, L. casei, L.
delbrueckii subsp. bulgaricus, L. delbrueckii subsp.
delbrueckii, L. delbrueckii subsp. lactis, L.
fermentum, L. helveticus, L. paracasei subsp.
paracasei, L. plantarum and L. rhamnosus) isolated
from raw milk and various milk products.
Probiotic strains currently used
Lactobacillus species
▪ L. acidophilus
▪ L. plantarum
▪ L. casei subspecies rhamnosus
▪ L. brevis
▪ L. delbreuckii subspecies bulgaricus
Bifidobacterium species
▪ B. adolescentis
▪ B. bifidum
▪ B. longum
▪ B. infantis
▪ B. breve
 Others
▪ Streptococcus salivarius ssp. thermophilus
▪ Lactococcus lactis ssp. lactis
▪ Lactococcus lactis s ssp. cremoris
▪ Enterococcus faecium
▪ Leuconostoc mesenteroides ssp. dextranicum
▪ Propionibacterium freudenreichii
▪ Pediococcus acidilactici
▪ Saccharomyces boulardii
Strains of bacteria one should look for in
a probiotic:

▪ It is important to choose a high quality formula that contains the

right strains of bacteria for optimum results .
▪ It is best to choose a probiotic that contains the entire family of
lactobacillus bacteria.
▪ The family members are : L. acidophilus, L. delbrueckii, L.
casei, L. bulgaricus, L. caucasicus, L. fermenti, L. plantarum, L.
brevis, L. helveticus, L. leichmannii, L. lactis, L. bifidus, and
L.sporogenes.
▪ It is important that the complete family of 13 strains is present.
Most people don’t realize this family works in harmony only if
the complete family is present.
▪ A good probiotic should have most of these strains
▪ Bifidobacterium bifidum - Protects the body against invasive
pathogens, salmonella and rotavirus. Helps suppress tumors
and reduce inflammation. Helps protect against diarrhea and
intestinal infections and strengthens immune system.
▪ Bifidobacterium breve - Helps prevent rotavirus-induced
diarrhea and activates our immune system. Also helps IBS.
▪ Bifidobacteria infantis - Inhibitory effect on some strains of
E. coli. Protects against gastroenteritis (inflammation of the
stomach and bowels) and is useful in the prevention and
therapy of solid tumors (breast tumors).
▪ Bifidobacteria lactis - Enhances resistance to oral salmonella
typhimurium. Enhances natural immune function. Helps
alleviate constipation, prevents diarrhea and decreases chronic
inflammation of the colon.
▪ Bifidobacterium longum - Able to eliminate harmful
nitrates commonly found in foods. Inhibits the
development and growth of colon, liver and breast cancers
in laboratory animals. Helps prevent diarrhea caused by
antibiotic use, helps constipation and reduces fecal odor.
▪ Lactococcus lactis - A natural antibiotic that reduces the
ability of pathogenic microbes to grow and cause
infection.
▪ Lactobacillus salivarius - Produces a high amount of lactic
acid, thus completely inhibiting the growth of Helicobacter
pylori (H. pylori) bacteria, which are now known to be the
major cause of peptic ulcers. It is also effective against
Salmonella typhimurium
▪ Lactobacillus casei- Provides protective activity against Listeria
bacteria which have been found to cause the inflammation and
infection of the brain and spinal cord (Spinal Meningitis). Inhibits
activity in tumor cells and stimulates beneficial activity in normal
cells.
▪ Lactobacillus reuteri - Controls Cryptosporidium parvum (C.
Parvum), a parasite that survives the chlorination process, sometimes
found in springs or water wells, infection causing nausea, diarrhea,
fever and abdominal cramps. Beneficial in the treatment of diarrhea
associated with rotavirus, E. coli and Salmonella.
▪ Lactobacillus sporogenes – Can reduce LDL (harmful) cholesterol
levels, while increasing HDL (healthy).
▪ Streptococcus thermophilus -Its antioxidant activity scavenges the
body for free radicals. Effective in maintaining vaginal and intestinal
health.
 Prebiotics
❖Prebiotics are substances that induce the growth or
activity of microorganisms (e.g., bacteria and fungi) that
contribute to the well-being of their host.
❖ The most common example is in the gastrointestinal
tract, where prebiotics can alter the composition of
organisms in the gut microbiome.
❖ The term prebiotic was introduced by Gibson and
Roberfroid who exchanged “pro” for “pre,” which means
“before” or “for.”
▪ A non-digestible food ingredient
➢Beneficial effects
• Selective stimulation
• Improved host health
➢ Prebiotics acts as cofactors for probiotics.
▪ Complex carbohydrates pass through the small intestine to
the lower gut where they become available for some
colonic bacteria but are not utilized by the majority of the
bacteria present in the colon.
▪ The main end products of carbohydrate metabolism are
short-chained fatty acids, namely acetate, butyrate and
propionate, which are further used by the host organism as
an energy source.
Concept of Probiotics and Prebiotics

Harish and Varghese, 2006

Food grade commercial prebiotics
➢ Lactulose
➢ Galactosaccharides
➢ Fructo-oligosaccharides
➢ Isomalto-oligosccharides
➢ Lacto-sucrose
➢ Gentio-oligosaccharides
➢ Xylooligosaccharides
Food grade oligosaccharides in
commercial production

Crittenden (1999) reported 12 food grade oligosaccharides, It includes:

▪ Lactulose
▪ Galacto-oligosaccharides (GOS)
▪ FOS
▪ Isomalto-oligosaccharides
▪ Maltooligosaccharides
▪ Palatinose oligosaccharides
▪ Glucosyl sucrose and Cyclodextrins
▪ Soybean oligosaccharides
▪ Lactosucrose
▪ Gentio-oligosaccharides and Xylo-oligosaccharides.
Characteristics of an ideal prebiotics

➢ It should not be hydrolyzed or absorbed in the upper part of G.I. tract.

➢ It should be a selective substrate for one or a limited number of potentially
bacterial commercial to the colon culture protagonist.
➢ It should be able to alter the colonic micro flora towards a healthier
composition or selectively stimulates the growth and/or activity of intestinal
bacteria associated with health and well being.
➢ It should help in increasing the absorption of certain minerals such as
calcium and magnesium.
➢ It should or may have a favorable effect on the immune system and provide
improved resistance against infection.
Human could consume nearly 10 g of non-
digestible fermentable carbohydrates without
noticeable side effects and recommended a
dose of 5 to 8 g of oligofructose and 10 g of
inulin per person.

(Coussement, 1999)
 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 (Gibson, 2004).
❖ Potential synergy between pro- & prebiotics
✓ Improve survival in upper GIT

✓ More efficient implantation

✓ Stimulating effect of Probiotics
Some of the major 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
▪ Production of antimicrobial substances (bacteriocins , hydrogen
peroxide, organic acids etc)
▪ Immunostimulation
▪ Anti-inflammatory, Anti-mutagenic, Anti-carcinogenic, and
production of bioactive compounds (enzymes, vaccines, peptides etc)

(Nagpal et al, 2007)

Probiotics based functional foods
Cultured Dairy Products Beneficial Bacteria

➢ Yogurt ▪ S. thermophilus, L. bulgaricus & L.

acidophilus
➢ Cheeses ▪ L. acidophilus, L. brevis, L. casei, L.
caucasicus, L. helveticus, L. lactis, L.
plantarum, S. cremoris, S. faecium

▪ L. acidophilus
➢ Acidophilus milk ▪ L. bulgaricus
➢ Bulgaricus milk ▪ L. casei,
➢ Yakult ▪ B. bifidum, B. longum
➢ Bifidus milk ▪ L. Lactis, S. cremoris
➢ Buttermilk ▪ S. cremoris
➢ Sour cream ▪ L. acidophilus, L. caucasicu

➢ Kefir
Probiotic Foods
 Conclusion

❑ Consuming Functional Dairy products with targeted

therapeutic benefits can be a tasteful and pleasurable way of
healthy life.
❑ Close network of medical experts, nutritionists and
microbiologists necessary to develop such foods.
❑ Flow of information from research to healthcare
professionals to consumers is necessary to derive maximum
benefits.
Thank you very much
for your attention!

Good luck to you!!!