Probiotic
Encyclopedia
Probiotics are live microorganism
s thought to be beneficial to the host organism. According to the currently adopted definition by FAO
/WHO
, probiotics are: "Live microorganisms which when administered in adequate amounts confer a health benefit on the host". Lactic acid bacteria
(LAB) and bifidobacteria are the most common types of microbes used as probiotics; but certain yeasts and bacilli
may also be helpful. Probiotics are commonly consumed as part of fermented foods with specially added active live cultures; such as in yogurt, soy yogurt
, or as dietary supplement
s.
Etymologically, the term appears to be a composite of the Latin preposition pro ("for") and the Greek adjective βιωτικός (biotic), the latter deriving from the noun βίος (bios, "life").
At the start of the 20th century, probiotics were thought to beneficially affect the host by improving its intestinal microbial balance, thus inhibiting pathogens and toxin producing bacteria. Today, specific health effects are being investigated and documented including alleviation of chronic intestinal inflammatory diseases, prevention and treatment of pathogen-induced diarrhea
, urogenital infections, and atopic diseases.
To date, the European Food Safety Authority
has rejected most claims that are made about probiotic products, saying they are unproven.
Élie Metchnikoff, who in the beginning of the 20th century suggested that it would be possible to modify the gut flora
and to replace harmful microbes with useful microbes. Metchnikoff, at that time a professor at the Pasteur Institute
in Paris
, proposed the hypothesis that the aging process results from the activity of putrefactive
(proteolytic) microbes producing toxic substances in the large bowel. Proteolytic bacteria such as clostridia
, which are part of the normal gut flora, produce toxic substances including phenols
, indols
and ammonia
from the digestion
of proteins. According to Metchnikoff these compounds were responsible for what he called "intestinal auto-intoxication", which caused the physical changes associated with old age.
It was at that time known that milk fermented with lactic-acid bacteria inhibits the growth of proteolytic bacteria because of the low pH
produced by the fermentation of lactose
. Metchnikoff had also observed that certain rural populations in Europe, for example in Bulgaria
and the Russian steppes who lived largely on milk fermented by lactic-acid bacteria were exceptionally long lived. Based on these facts, Metchnikoff proposed that consumption of fermented milk would "seed" the intestine
with harmless lactic-acid bacteria and decrease the intestinal pH
and that this would suppress the growth of proteolytic bacteria. Metchnikoff himself introduced in his diet sour milk fermented with the bacteria he called "Bulgarian Bacillus" and found his health benefited. Friends in Paris soon followed his example and physicians began prescribing the sour milk diet for their patients.
Bifidobacteria were first isolated from a breast-fed infant by Henry Tissier who also worked at the Pasteur Institute. The isolated bacterium named Bacillus bifidus communis was later renamed to the genus Bifidobacterium
. Tissier found that bifidobacteria are dominant in the gut flora
of breast-fed
babies and he observed clinical benefits from treating diarrhea in infants with bifidobacteria. The claimed effect was bifidobacterial displacement of proteolytic bacteria causing the disease.
During an outbreak of shigellosis
in 1917, German professor Alfred Nissle isolated a strain of Escherichia coli
from the feces of a soldier who was not affected by the disease. Methods of treating infectious diseases were needed at that time when antibiotics were not yet available, and Nissle used the Escherichia coli Nissle 1917 strain in acute gastrointestinal infectious salmonellosis
and shigellosis
.
In 1920, Rettger demonstrated that Metchnikoff's "Bulgarian Bacillus", later called Lactobacillus delbrueckii subsp. bulgaricus, could not live in the human intestine, and the fermented food phenomenon petered out. Metchnikoff's theory was disputable (at this stage), and people doubted his theory of longevity.
After Metchnikoff's death in 1916, the centre of activity moved to the United States. It was reasoned that bacteria originating from the gut were more likely to produce the desired effect in the gut, and in 1935 certain strains of Lactobacillus acidophilus
were found to be very active when implanted in the human digestive tract. Trials were carried out using this organism, and encouraging results were obtained especially in the relief of chronic constipation
.
The term "probiotics" was first introduced in 1953 by Werner Kollath
(see Hamilton-Miller et al. 2003). Contrasting antibiotics, probiotics were defined as microbially derived factors that stimulate the growth of other microorganisms. In 1989, Roy Fuller suggested a definition of probiotics that has been widely used: "A live microbial feed supplement which beneficially affects the host animal by improving its intestinal microbial balance". Fuller's definition emphasizes the requirement of viability for probiotics and introduces the aspect of a beneficial effect on the host.
In the following decades, intestinal lactic acid bacterial species with alleged health beneficial properties have been introduced as probiotics, including Lactobacillus rhamnosus
, Lactobacillus casei
, and Lactobacillus johnsonii.
in immune function, cancer, and antibiotic-associated diarrhea
, travellers' diarrhea, pediatric diarrhea, inflammatory bowel disease
and irritable bowel syndrome
. Testing of a probiotic usually applies to a specific strain under study.
. They might reduce both the duration of illness and the frequency of stools. Fermented milk products (such as yoghurt
) also reduce the duration of symptoms.
Antibiotic-associated
Antibiotic-associated diarrhea
(AAD) results from an imbalance in the colonic microbiota
caused by antibiotic
therapy. Microbiota alteration changes carbohydrate metabolism
with decreased short-chain fatty acid absorption and an osmotic diarrhea as a result. Another consequence of antibiotic therapy leading to diarrhea is overgrowth of potentially pathogenic organisms such as Clostridium difficile
.
Probiotic treatment might reduce the incidence and severity of AAD as indicated in several meta-analyses. For example, treatment with probiotic formulations including Lactobacillus rhamnosus
may reduce the risk of antibiotic-associated diarrhea, improve stool consistency during antibiotic therapy, and enhance the immune response after vaccination.
However, further documentation of these findings through randomized
, double blind, placebo-controlled trials are required to confirm specific effects and attain regulatory approval, which currently does not exist.
Potential efficacy of probiotic AAD prevention is dependent on the probiotic strain(s) used and on the dosage. Up to a 50% reduction of AAD occurrence has been found in preliminary studies. No side-effects have been reported in any of these studies. Caution should, however, be exercised when administering probiotic supplements to immunocompromised individuals or patients who have a compromised intestinal barrier
.
into lactic acid
, ingestion of certain active strains may help lactose intolerant individuals tolerate more lactose than they would have otherwise.
levels, presumably by breaking down bile
in the gut
, thus inhibiting its reabsorption (which enters the blood as cholesterol).
A meta-analysis that included five double blind trials examining the short term (2-8weeks) effects of a yoghurt with probiotic strains on serum cholesterol levels found a minor change of 8.5 mg/dL (0.22 mmol/L) (~4% decrease) in total cholesterol concentration, and a decrease of 7.7 mg/dL (0.2 mmol/L) (~5% decrease) in serum LDL concentration.
A slightly longer study evaluating the effect of a yoghurt with probiotic strains on twenty-nine subjects over six months found no statistically significant differences in total serum cholesterol or LDL values. However, the study did note a significant increase in serum HDL from, 50 mg/dL (1.28 mmol/L) to 62 mg/dL (1.6 mmol/L) following treatment. This corresponds to a possible improvement of LDL/HDL ratio.
Studies specifically on hyper-lipidemic subjects are still needed.
, an effect possibly related to the ACE inhibitor
-like peptides produced during fermentation.
(i.e., by competing for growth) and there is evidence to suggest that they may improve immune function by increasing the number of IgA
-producing plasma cells, increasing or improving phagocytosis as well as increasing the proportion of T lymphocytes and Natural Killer cells. Clinical trials have demonstrated that probiotics may decrease the incidence of respiratory tract infections and dental caries
in children. LAB products might aid in the treatment of acute diarrhea, and possibly affect rotavirus
infections in children and travelers' diarrhea in adults, but no products are approved for such indications.
A 2010 study suggested that antibiotics may turn the immune system "off" while probiotics turns it back on "idle", possibly more able to quickly react to new infections.
infections (which may cause peptic ulcers) in adults when used in combination with standard medical treatments, but there is no standard in medical practice or regulatory approval for such treatment.
and hypersensitivity
responses, an observation thought to be at least in part due to the regulation of cytokine
function. Clinical studies suggest that they can prevent reoccurrences of inflammatory bowel disease
in adults, as well as improve milk allergies. They are not effective for treating eczema
, a persistent skin inflammation. How probiotics may influence the immune system remains unclear, but a potential mechanism under research concerns the response of T lymphocytes to pro-inflammatory stimuli.
improved some symptoms of irritable bowel syndrome
in women. A separate small study showed that a strain of Lactobacillus plantarum
, may also be effective in reducing IBS symptoms. A study focused on Bifidobacterium animalis showed a reduction in discomfort and bloating in individuals with constipation-predominant IBS, as well as helping to normalize stool frequency in said individuals.
For maintenance of remission of ulcerative colitis, Mutaflor
(E.coli Nissle 1917) randomized clinical studies showed equivalence of Mutaflor
and mesalazine (5-ASAs).
or Actimel
over a 6-week exam period (3 weeks of studying, 3 weeks of exams) tested 19 different biomarkers. Of these 19 biomarkers, only 2 were shown to be different between the two groups, increased production of lymphocyte
s, and increased production of CD56
cells. The tests were not blind and show that certain probiotic strains may have no overall effect on the immune system or on its ability.
A 2007 study at University College Cork in Ireland
showed that a diet including milk fermented with Lactobacillus
bacteria prevented Salmonella
infection in pigs.
A 2007 clinical study at Imperial College London
showed that preventive consumption of a commercially available probiotic drink containing Lactobacillus casei
DN-114001 and yoghurt bacteria can reduce the incidence of antibiotic-associated diarrhea
and C difficile-associated diarrhea
.
The efficacy and safety of a daily dose of Lactobacillus acidophilus
CL1285 in affecting AAD was demonstrated in one study of hospitalized patients.
A 2011 study found that mice given Lactobacillus rhamnosus
JB-1 showed lower levels of stress and anxiety than controls
Current research is focusing on the molecular biology
and genomics
of Lactobacillus strains and bifidobacteria. The application of modern whole genome approaches is providing insights into bifidobacterial evolution, while also revealing genetic functions that explain their presence in the particular ecological environment of the gastrointestinal tract.
Bacteria can respond to stressful environments by the induction of various stress tolerance mechanisms. One of them is the induction of stress proteins by exposure of the cells to sublethal stresses so they can condition probiotics to better tolerate environmental stresses in food production, storage, and gastrointestinal transit. Different probiotic strains have their own intrinsic tolerances to environmental conditions, including how the culture is prepared, and some cross-protection can be observed, providing protection against other stresses by the exposure to only one stress. Stress responses can be explored to make probiotic strains more resilient and likely to survive in food matrices, with significant industrial importance.
Regarding to fruit juices (pH 3.5–4.5) commercially successful products have been produced, such as Gefilus (Valio Ltd, Finland), which contains Lactobacillus rhamnosus GG. The viability at low pH can be improved with carriers such as dietary fibers. Survival of lactobacilli in low pHs has also been enhanced in the presence of metabolizable sugars, that allow cell membrane proton pumps to operate and prevent lowering of intracellular pH. This can improve survival during gastric transit, but may not be applicable to improving probiotic survival over the time stages of shelf-storage.
There may be technological limitations to reducing water activity to low levels for improving survival. These include the energy costs of drying, adverse impacts on the taste of foods and difficulties in wetting and dispersing powders. Moisture barrier packaging may be applied to prevent the development of moisture from the environment during storage. Maintaining probiotic viability in moderate water activity foods (0.4–0.7) is a great challenge and solutions such as microencapsulation or incorporation of probiotics into fat phases of products can provide improved survival.
For oxygen sensitive strains, some strategies can be used to prevent oxygen toxicity in food products. Antioxidant ingredients have been shown to improve probiotic survival, as well as the use of oxygen barrier or modified-atmosphere packaging. Therefor, it is advisable to minimize processes that are highly aerating, particularly when using bifidobacteria.
.
In a clinical trial conducted at the University of Western Australia
, aimed at showing the effectiveness of probiotics in reducing childhood allergies, researchers gave 178 children either a probiotic or a placebo
for the first six months of their life. Those given the good bacteria were more likely to develop a sensitivity to allergens.
Some hospitals have reported treating lactobacillus septicaemia, which is a potentially fatal disease caused by the consumption of probiotics by people with lowered immune systems or who are already very ill.
There is no published evidence that probiotic supplements are able to replace the body's natural flora when these have been killed off; indeed bacterial levels in feces disappear within days when supplementation ceases.
Probiotics taken orally can be destroyed by the acidic conditions of the stomach. A number of micro-encapsulation
techniques are being developed to address this problem.
Recent studies indicate that probiotic products such as yogurts could be a cause for obesity trends. However, this is contested as the link to obesity, and other health related issues with yogurt may link to its dairy and calorie attributes.
Some experts are skeptical on the efficacy of many strains and believe not all subjects will benefit from the use of probiotics.
are available in fermented dairy products and probiotic fortified foods. However, tablets, capsules, powders and sachets containing the bacteria in freeze dried form are also available.
In the table below, only preliminary evidence exists for the health claims stated. Few of the strains presented have been sufficiently developed in basic and clinical research to warrant application for health claim status to a regulatory agency such as the Food and Drug Administration
or Europfean Food Safety Authority.
Some additional forms of lactic acid bacteria include:
Some fermented products containing similar lactic acid bacteria include:
has so far rejected 260 claims on probiotics in Europe due to insufficient research and thus no conclusive proof. This includes:
Incomplete list of supplement products that contain more than one strain.
Review articles
Microorganism
A microorganism or microbe is a microscopic organism that comprises either a single cell , cell clusters, or no cell at all...
s thought to be beneficial to the host organism. According to the currently adopted definition by FAO
Food and Agriculture Organization
The Food and Agriculture Organization of the United Nations is a specialised agency of the United Nations that leads international efforts to defeat hunger. Serving both developed and developing countries, FAO acts as a neutral forum where all nations meet as equals to negotiate agreements and...
/WHO
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
, probiotics are: "Live microorganisms which when administered in adequate amounts confer a health benefit on the host". Lactic acid bacteria
Lactic acid bacteria
The lactic acid bacteria comprise a clade of Gram-positive, low-GC, acid-tolerant, generally non-sporulating, non-respiring rod or cocci that are associated by their common metabolic and physiological characteristics. These bacteria, usually found in decomposing plants and lactic products, produce...
(LAB) and bifidobacteria are the most common types of microbes used as probiotics; but certain yeasts and bacilli
Bacilli
Bacilli refers to a taxonomic class of bacteria. It includes two orders, Bacillales and Lactobacillales, which contain several well-known pathogens like Bacillus anthracis .-Ambiguity:...
may also be helpful. Probiotics are commonly consumed as part of fermented foods with specially added active live cultures; such as in yogurt, soy yogurt
Soy yogurt
Soy yogurt, also referred to as Soya yogurt, Soygurt or Yofu , is yogurt prepared with soy milk.-Ingredients:...
, or as dietary supplement
Dietary supplement
A dietary supplement, also known as food supplement or nutritional supplement, is a preparation intended to supplement the diet and provide nutrients, such as vitamins, minerals, fiber, fatty acids, or amino acids, that may be missing or may not be consumed in sufficient quantities in a person's diet...
s.
Etymologically, the term appears to be a composite of the Latin preposition pro ("for") and the Greek adjective βιωτικός (biotic), the latter deriving from the noun βίος (bios, "life").
At the start of the 20th century, probiotics were thought to beneficially affect the host by improving its intestinal microbial balance, thus inhibiting pathogens and toxin producing bacteria. Today, specific health effects are being investigated and documented including alleviation of chronic intestinal inflammatory diseases, prevention and treatment of pathogen-induced diarrhea
Diarrhea
Diarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and...
, urogenital infections, and atopic diseases.
To date, the European Food Safety Authority
European Food Safety Authority
The European Food Safety Authority is an agency of the European Union that provides independent scientific advice and communication on existing and emerging risks associated with the food chain, created by European Regulation 178/2002....
has rejected most claims that are made about probiotic products, saying they are unproven.
History
The original observation of the positive role played by certain bacteria was first introduced by Russian scientist and Nobel laureateNobel Prize
The Nobel Prizes are annual international awards bestowed by Scandinavian committees in recognition of cultural and scientific advances. The will of the Swedish chemist Alfred Nobel, the inventor of dynamite, established the prizes in 1895...
Élie Metchnikoff, who in the beginning of the 20th century suggested that it would be possible to modify the gut flora
Gut flora
Gut flora consists of microorganisms that live in the digestive tracts of animals and is the largest reservoir of human flora. In this context, gut is synonymous with intestinal, and flora with microbiota and microflora....
and to replace harmful microbes with useful microbes. Metchnikoff, at that time a professor at the Pasteur Institute
Pasteur Institute
The Pasteur Institute is a French non-profit private foundation dedicated to the study of biology, micro-organisms, diseases, and vaccines. It is named after Louis Pasteur, who made some of the greatest breakthroughs in modern medicine at the time, including pasteurization and vaccines for anthrax...
in Paris
Paris
Paris is the capital and largest city in France, situated on the river Seine, in northern France, at the heart of the Île-de-France region...
, proposed the hypothesis that the aging process results from the activity of putrefactive
Putrefaction
Putrefaction is one of seven stages in the decomposition of the body of a dead animal. It can be viewed, in broad terms, as the decomposition of proteins, in a process that results in the eventual breakdown of cohesion between tissues and the liquefaction of most organs.-Description:In terms of...
(proteolytic) microbes producing toxic substances in the large bowel. Proteolytic bacteria such as clostridia
Clostridia
The Clostridia are a class of Firmicutes, including Clostridium and other similar genera. They are distinguished from the Bacilli by lacking aerobic respiration. They are obligate anaerobes and oxygen is toxic to them. Species of the genus Clostridium are all Gram-positive and have the ability to...
, which are part of the normal gut flora, produce toxic substances including phenols
Phenols
In organic chemistry, phenols, sometimes called phenolics, are a class of chemical compounds consisting of a hydroxyl group bonded directly to an aromatic hydrocarbon group...
, indols
Indole
Indole is an aromatic heterocyclic organic compound. It has a bicyclic structure, consisting of a six-membered benzene ring fused to a five-membered nitrogen-containing pyrrole ring. Indole is a popular component of fragrances and the precursor to many pharmaceuticals. Compounds that contain an...
and ammonia
Ammonia
Ammonia is a compound of nitrogen and hydrogen with the formula . It is a colourless gas with a characteristic pungent odour. Ammonia contributes significantly to the nutritional needs of terrestrial organisms by serving as a precursor to food and fertilizers. Ammonia, either directly or...
from the digestion
Digestion
Digestion is the mechanical and chemical breakdown of food into smaller components that are more easily absorbed into a blood stream, for instance. Digestion is a form of catabolism: a breakdown of large food molecules to smaller ones....
of proteins. According to Metchnikoff these compounds were responsible for what he called "intestinal auto-intoxication", which caused the physical changes associated with old age.
It was at that time known that milk fermented with lactic-acid bacteria inhibits the growth of proteolytic bacteria because of the low pH
PH
In chemistry, pH is a measure of the acidity or basicity of an aqueous solution. Pure water is said to be neutral, with a pH close to 7.0 at . Solutions with a pH less than 7 are said to be acidic and solutions with a pH greater than 7 are basic or alkaline...
produced by the fermentation of lactose
Lactose
Lactose is a disaccharide sugar that is found most notably in milk and is formed from galactose and glucose. Lactose makes up around 2~8% of milk , although the amount varies among species and individuals. It is extracted from sweet or sour whey. The name comes from or , the Latin word for milk,...
. Metchnikoff had also observed that certain rural populations in Europe, for example in Bulgaria
Bulgaria
Bulgaria , officially the Republic of Bulgaria , is a parliamentary democracy within a unitary constitutional republic in Southeast Europe. The country borders Romania to the north, Serbia and Macedonia to the west, Greece and Turkey to the south, as well as the Black Sea to the east...
and the Russian steppes who lived largely on milk fermented by lactic-acid bacteria were exceptionally long lived. Based on these facts, Metchnikoff proposed that consumption of fermented milk would "seed" the intestine
Intestine
In human anatomy, the intestine is the segment of the alimentary canal extending from the pyloric sphincter of the stomach to the anus and, in humans and other mammals, consists of two segments, the small intestine and the large intestine...
with harmless lactic-acid bacteria and decrease the intestinal pH
PH
In chemistry, pH is a measure of the acidity or basicity of an aqueous solution. Pure water is said to be neutral, with a pH close to 7.0 at . Solutions with a pH less than 7 are said to be acidic and solutions with a pH greater than 7 are basic or alkaline...
and that this would suppress the growth of proteolytic bacteria. Metchnikoff himself introduced in his diet sour milk fermented with the bacteria he called "Bulgarian Bacillus" and found his health benefited. Friends in Paris soon followed his example and physicians began prescribing the sour milk diet for their patients.
Bifidobacteria were first isolated from a breast-fed infant by Henry Tissier who also worked at the Pasteur Institute. The isolated bacterium named Bacillus bifidus communis was later renamed to the genus Bifidobacterium
Bifidobacterium
Bifidobacterium is a genus of Gram-positive, non-motile, often branched anaerobic bacteria. They are ubiquitous, endosymbiotic inhabitants of the gastrointestinal tract, vagina and mouth of mammals and other animals. Bifidobacteria are one of the major genera of bacteria that make up the colon...
. Tissier found that bifidobacteria are dominant in the gut flora
Gut flora
Gut flora consists of microorganisms that live in the digestive tracts of animals and is the largest reservoir of human flora. In this context, gut is synonymous with intestinal, and flora with microbiota and microflora....
of breast-fed
Breastfeeding
Breastfeeding is the feeding of an infant or young child with breast milk directly from female human breasts rather than from a baby bottle or other container. Babies have a sucking reflex that enables them to suck and swallow milk. It is recommended that mothers breastfeed for six months or...
babies and he observed clinical benefits from treating diarrhea in infants with bifidobacteria. The claimed effect was bifidobacterial displacement of proteolytic bacteria causing the disease.
During an outbreak of shigellosis
Shigellosis
Shigellosis, also known as bacillary dysentery or Marlow Syndrome, in its most severe manifestation, is a foodborne illness caused by infection by bacteria of the genus Shigella. Shigellosis rarely occurs in animals other than humans and other primates like monkeys and chimpanzees...
in 1917, German professor Alfred Nissle isolated a strain of Escherichia coli
Escherichia coli
Escherichia coli is a Gram-negative, rod-shaped bacterium that is commonly found in the lower intestine of warm-blooded organisms . Most E. coli strains are harmless, but some serotypes can cause serious food poisoning in humans, and are occasionally responsible for product recalls...
from the feces of a soldier who was not affected by the disease. Methods of treating infectious diseases were needed at that time when antibiotics were not yet available, and Nissle used the Escherichia coli Nissle 1917 strain in acute gastrointestinal infectious salmonellosis
Salmonellosis
Salmonellosis is an infection with Salmonella bacteria. Most people infected with Salmonella develop diarrhea, fever, vomiting, and abdominal cramps 12 to 72 hours after infection. In most cases, the illness lasts four to seven days, and most people recover without treatment...
and shigellosis
Shigellosis
Shigellosis, also known as bacillary dysentery or Marlow Syndrome, in its most severe manifestation, is a foodborne illness caused by infection by bacteria of the genus Shigella. Shigellosis rarely occurs in animals other than humans and other primates like monkeys and chimpanzees...
.
In 1920, Rettger demonstrated that Metchnikoff's "Bulgarian Bacillus", later called Lactobacillus delbrueckii subsp. bulgaricus, could not live in the human intestine, and the fermented food phenomenon petered out. Metchnikoff's theory was disputable (at this stage), and people doubted his theory of longevity.
After Metchnikoff's death in 1916, the centre of activity moved to the United States. It was reasoned that bacteria originating from the gut were more likely to produce the desired effect in the gut, and in 1935 certain strains of Lactobacillus acidophilus
Lactobacillus acidophilus
Lactobacillus acidophilus is a species in the genus Lactobacillus. L. acidophilus is a homofermentative species, fermenting sugars into lactic acid, which grows readily at rather low pH values and has an optimum growth temperature of 37 °C . L...
were found to be very active when implanted in the human digestive tract. Trials were carried out using this organism, and encouraging results were obtained especially in the relief of chronic constipation
Constipation
Constipation refers to bowel movements that are infrequent or hard to pass. Constipation is a common cause of painful defecation...
.
The term "probiotics" was first introduced in 1953 by Werner Kollath
Werner Kollath
Werner Georg Kollath was a German bacteriologist, hygienist and food scientist. He is considered a pioneer of whole foods.-Biography:...
(see Hamilton-Miller et al. 2003). Contrasting antibiotics, probiotics were defined as microbially derived factors that stimulate the growth of other microorganisms. In 1989, Roy Fuller suggested a definition of probiotics that has been widely used: "A live microbial feed supplement which beneficially affects the host animal by improving its intestinal microbial balance". Fuller's definition emphasizes the requirement of viability for probiotics and introduces the aspect of a beneficial effect on the host.
In the following decades, intestinal lactic acid bacterial species with alleged health beneficial properties have been introduced as probiotics, including Lactobacillus rhamnosus
Lactobacillus rhamnosus
Lactobacillus rhamnosus is a bacterium that was originally considered to be a subspecies of L. casei, but later genetic research found it to be a species of its own. Some strains of L. rhamnosus are being used as probiotics. The species is sometimes used in yogurt and other dairy products. Some...
, Lactobacillus casei
Lactobacillus casei
Lactobacillus casei is a species of genus Lactobacillus found in the human intestine and mouth. As a lactic acid producer, it has been found to assist in the propagation of desirable bacteria. This particular species of Lactobacillus is documented to have a wide pH and temperature range, and...
, and Lactobacillus johnsonii.
Preliminary research and potential effects
Experiments into the potential health effects of supplemental probiotics include the molecular biology and genomics of LactobacillusLactobacillus
Lactobacillus is a genus of Gram-positive facultative anaerobic or microaerophilic rod-shaped bacteria. They are a major part of the lactic acid bacteria group, named as such because most of its members convert lactose and other sugars to lactic acid. They are common and usually benign...
in immune function, cancer, and antibiotic-associated diarrhea
Diarrhea
Diarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and...
, travellers' diarrhea, pediatric diarrhea, inflammatory bowel disease
Inflammatory bowel disease
In medicine, inflammatory bowel disease is a group of inflammatory conditions of the colon and small intestine. The major types of IBD are Crohn's disease and ulcerative colitis.-Classification:...
and irritable bowel syndrome
Irritable bowel syndrome
Irritable bowel syndrome is a diagnosis of exclusion. It is a functional bowel disorder characterized by chronic abdominal pain, discomfort, bloating, and alteration of bowel habits in the absence of any detectable organic cause. In some cases, the symptoms are relieved by bowel movements...
. Testing of a probiotic usually applies to a specific strain under study.
Diarrhea
Some probiotics have been shown in preliminary research to possibly treat various forms of gastroenteritisGastroenteritis
Gastroenteritis is marked by severe inflammation of the gastrointestinal tract involving both the stomach and small intestine resulting in acute diarrhea and vomiting. It can be transferred by contact with contaminated food and water...
. They might reduce both the duration of illness and the frequency of stools. Fermented milk products (such as yoghurt
Yoghurt
Yoghurt, yogurt or yogourt is a dairy product produced by bacterial fermentation of milk. The bacteria used to make yoghurt are known as "yoghurt cultures"...
) also reduce the duration of symptoms.
Antibiotic-associated
Antibiotic-associated diarrhea
Antibiotic-associated diarrhea
Antibiotic-associated diarrhea results from an imbalance in the colonic microbiota caused by antibiotic therapy. Microbiota alteration changes carbohydrate metabolism with decreased short-chain fatty acid absorption and an osmotic diarrhea as a result...
(AAD) results from an imbalance in the colonic microbiota
Gut flora
Gut flora consists of microorganisms that live in the digestive tracts of animals and is the largest reservoir of human flora. In this context, gut is synonymous with intestinal, and flora with microbiota and microflora....
caused by antibiotic
Antibiotic
An antibacterial is a compound or substance that kills or slows down the growth of bacteria.The term is often used synonymously with the term antibiotic; today, however, with increased knowledge of the causative agents of various infectious diseases, antibiotic has come to denote a broader range of...
therapy. Microbiota alteration changes carbohydrate metabolism
Carbohydrate metabolism
Carbohydrate metabolism denotes the various biochemical processes responsible for the formation, breakdown and interconversion of carbohydrates in living organisms....
with decreased short-chain fatty acid absorption and an osmotic diarrhea as a result. Another consequence of antibiotic therapy leading to diarrhea is overgrowth of potentially pathogenic organisms such as Clostridium difficile
Clostridium difficile
Clostridium difficile , also known as "CDF/cdf", or "C...
.
Probiotic treatment might reduce the incidence and severity of AAD as indicated in several meta-analyses. For example, treatment with probiotic formulations including Lactobacillus rhamnosus
Lactobacillus rhamnosus
Lactobacillus rhamnosus is a bacterium that was originally considered to be a subspecies of L. casei, but later genetic research found it to be a species of its own. Some strains of L. rhamnosus are being used as probiotics. The species is sometimes used in yogurt and other dairy products. Some...
may reduce the risk of antibiotic-associated diarrhea, improve stool consistency during antibiotic therapy, and enhance the immune response after vaccination.
However, further documentation of these findings through randomized
Randomized controlled trial
A randomized controlled trial is a type of scientific experiment - a form of clinical trial - most commonly used in testing the safety and efficacy or effectiveness of healthcare services or health technologies A randomized controlled trial (RCT) is a type of scientific experiment - a form of...
, double blind, placebo-controlled trials are required to confirm specific effects and attain regulatory approval, which currently does not exist.
Potential efficacy of probiotic AAD prevention is dependent on the probiotic strain(s) used and on the dosage. Up to a 50% reduction of AAD occurrence has been found in preliminary studies. No side-effects have been reported in any of these studies. Caution should, however, be exercised when administering probiotic supplements to immunocompromised individuals or patients who have a compromised intestinal barrier
Leaky gut
Leaky gut is a name used to describe intestinal or bowel hyperpermeability. Tight junctions represent the major barrier within the pathway between intestinal epithelial cells that line the digestion tract...
.
Lactose intolerance
As lactic acid bacteria actively convert lactoseLactose
Lactose is a disaccharide sugar that is found most notably in milk and is formed from galactose and glucose. Lactose makes up around 2~8% of milk , although the amount varies among species and individuals. It is extracted from sweet or sour whey. The name comes from or , the Latin word for milk,...
into lactic acid
Lactic acid
Lactic acid, also known as milk acid, is a chemical compound that plays a role in various biochemical processes and was first isolated in 1780 by the Swedish chemist Carl Wilhelm Scheele. Lactic acid is a carboxylic acid with the chemical formula C3H6O3...
, ingestion of certain active strains may help lactose intolerant individuals tolerate more lactose than they would have otherwise.
Colon cancer
In laboratory investigations, some strains of LAB (Lactobacillus delbrueckii subsp. bulgaricus) have demonstrated anti-mutagenic effects thought to be due to their ability to bind with heterocyclic amines, which are carcinogenic substances formed in cooked meat. Animal studies have demonstrated that some LAB have evidence for acting against colon cancer in rodents, though human data are inconclusive. Some human trials hypothesize that the strains tested may exert anti-carcinogenic effects by decreasing the activity of an enzyme called β-glucuronidase (which can generate carcinogens in the digestive system). Lower rates of colon cancer among higher consumers of fermented dairy products have been observed in one population study, but confirmation of such an effect does not exist.Cholesterol
Animal studies have demonstrated the efficacy some strains of LAB to be able to lower serum cholesterolCholesterol
Cholesterol is a complex isoprenoid. Specifically, it is a waxy steroid of fat that is produced in the liver or intestines. It is used to produce hormones and cell membranes and is transported in the blood plasma of all mammals. It is an essential structural component of mammalian cell membranes...
levels, presumably by breaking down bile
Bile
Bile or gall is a bitter-tasting, dark green to yellowish brown fluid, produced by the liver of most vertebrates, that aids the process of digestion of lipids in the small intestine. In many species, bile is stored in the gallbladder and upon eating is discharged into the duodenum...
in the gut
Gut (zoology)
In zoology, the gut, also known as the alimentary canal or alimentary tract, is a tube by which bilaterian animals transfer food to the digestion organs. In large bilaterians the gut generally also has an exit, the anus, by which the animal disposes of solid wastes...
, thus inhibiting its reabsorption (which enters the blood as cholesterol).
A meta-analysis that included five double blind trials examining the short term (2-8weeks) effects of a yoghurt with probiotic strains on serum cholesterol levels found a minor change of 8.5 mg/dL (0.22 mmol/L) (~4% decrease) in total cholesterol concentration, and a decrease of 7.7 mg/dL (0.2 mmol/L) (~5% decrease) in serum LDL concentration.
A slightly longer study evaluating the effect of a yoghurt with probiotic strains on twenty-nine subjects over six months found no statistically significant differences in total serum cholesterol or LDL values. However, the study did note a significant increase in serum HDL from, 50 mg/dL (1.28 mmol/L) to 62 mg/dL (1.6 mmol/L) following treatment. This corresponds to a possible improvement of LDL/HDL ratio.
Studies specifically on hyper-lipidemic subjects are still needed.
Blood pressure
Although not a confirmed effect, some studies have indicated that consumption of milk fermented with various strains of LAB may result in modest reductions in blood pressureBlood pressure
Blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs. When used without further specification, "blood pressure" usually refers to the arterial pressure of the systemic circulation. During each heartbeat, BP varies...
, an effect possibly related to the ACE inhibitor
ACE inhibitor
ACE inhibitors or angiotensin-converting enzyme inhibitors are a group of drugs used primarily for the treatment of hypertension and congestive heart failure...
-like peptides produced during fermentation.
Immune function and infections
Some strains of LAB may affect pathogens by means of competitive inhibitionCompetitive inhibition
Competitive inhibition is a form of enzyme inhibition where binding of the inhibitor to the active site on the enzyme prevents binding of the substrate and vice versa.-Mechanism:...
(i.e., by competing for growth) and there is evidence to suggest that they may improve immune function by increasing the number of IgA
IGA
Iga or IGA may stand for:-Given name:* a female given name of Polish origin. The name originates from the female given name Jadwiga and stands for gia,or gina in the USA....
-producing plasma cells, increasing or improving phagocytosis as well as increasing the proportion of T lymphocytes and Natural Killer cells. Clinical trials have demonstrated that probiotics may decrease the incidence of respiratory tract infections and dental caries
Dental caries
Dental caries, also known as tooth decay or a cavity, is an irreversible infection usually bacterial in origin that causes demineralization of the hard tissues and destruction of the organic matter of the tooth, usually by production of acid by hydrolysis of the food debris accumulated on the...
in children. LAB products might aid in the treatment of acute diarrhea, and possibly affect rotavirus
Rotavirus
Rotavirus is the most common cause of severe diarrhoea among infants and young children, and is one of several viruses that cause infections often called stomach flu, despite having no relation to influenza. It is a genus of double-stranded RNA virus in the family Reoviridae. By the age of five,...
infections in children and travelers' diarrhea in adults, but no products are approved for such indications.
A 2010 study suggested that antibiotics may turn the immune system "off" while probiotics turns it back on "idle", possibly more able to quickly react to new infections.
Helicobacter pylori
Some strains of LAB may affect Helicobacter pyloriHelicobacter pylori
Helicobacter pylori , previously named Campylobacter pyloridis, is a Gram-negative, microaerophilic bacterium found in the stomach. It was identified in 1982 by Barry Marshall and Robin Warren, who found that it was present in patients with chronic gastritis and gastric ulcers, conditions that were...
infections (which may cause peptic ulcers) in adults when used in combination with standard medical treatments, but there is no standard in medical practice or regulatory approval for such treatment.
Inflammation
Some strains of LAB may modulate inflammatoryInflammation
Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...
and hypersensitivity
Hypersensitivity
Hypersensitivity refers to undesirable reactions produced by the normal immune system, including allergies and autoimmunity. These reactions may be damaging, uncomfortable, or occasionally fatal. Hypersensitivity reactions require a pre-sensitized state of the host. The four-group classification...
responses, an observation thought to be at least in part due to the regulation of cytokine
Cytokine
Cytokines are small cell-signaling protein molecules that are secreted by the glial cells of the nervous system and by numerous cells of the immune system and are a category of signaling molecules used extensively in intercellular communication...
function. Clinical studies suggest that they can prevent reoccurrences of inflammatory bowel disease
Inflammatory bowel disease
In medicine, inflammatory bowel disease is a group of inflammatory conditions of the colon and small intestine. The major types of IBD are Crohn's disease and ulcerative colitis.-Classification:...
in adults, as well as improve milk allergies. They are not effective for treating eczema
Eczema
Eczema is a form of dermatitis, or inflammation of the epidermis . In England, an estimated 5.7 million or about one in every nine people have been diagnosed with the disease by a clinician at some point in their lives.The term eczema is broadly applied to a range of persistent skin conditions...
, a persistent skin inflammation. How probiotics may influence the immune system remains unclear, but a potential mechanism under research concerns the response of T lymphocytes to pro-inflammatory stimuli.
Bacterial growth under stress
In a study done to see the effects of stress on intestinal flora, rats that were fed probiotics had little occurrence of harmful bacteria latched onto their intestines compared to rats that were fed sterile water.Irritable bowel syndrome and colitis
In one study, a commercial strain of bifidobacterium infantisBifidobacterium longum
Bifidobacterium longum is a species of Gram-positive anaerobic branched rod-shaped bacterium which can be found in the intestines of infant humans. They inhibit the growth of Gram-negative bacteria by producing lactic acid, and digest the complex sugars in human breast milk. Due to its importance,...
improved some symptoms of irritable bowel syndrome
Irritable bowel syndrome
Irritable bowel syndrome is a diagnosis of exclusion. It is a functional bowel disorder characterized by chronic abdominal pain, discomfort, bloating, and alteration of bowel habits in the absence of any detectable organic cause. In some cases, the symptoms are relieved by bowel movements...
in women. A separate small study showed that a strain of Lactobacillus plantarum
Lactobacillus plantarum
Lactobacillus plantarum is a widespread member of the genus Lactobacillus, commonly found in many fermented food products as well as anaerobic plant matter. It is also present in saliva . It has the ability to liquefy gelatin. L...
, may also be effective in reducing IBS symptoms. A study focused on Bifidobacterium animalis showed a reduction in discomfort and bloating in individuals with constipation-predominant IBS, as well as helping to normalize stool frequency in said individuals.
For maintenance of remission of ulcerative colitis, Mutaflor
Mutaflor
Mutaflor is a probiotic consisting of a viable non-pathogenic bacteria strain named Escherichia coli Nissle 1917. "The Escherichia coli strain Nissle 1917-designated DSM 6601 in the German Collection for Microorganisms in Brauschweig is one of the best-examined and therapeutically relevant...
(E.coli Nissle 1917) randomized clinical studies showed equivalence of Mutaflor
Mutaflor
Mutaflor is a probiotic consisting of a viable non-pathogenic bacteria strain named Escherichia coli Nissle 1917. "The Escherichia coli strain Nissle 1917-designated DSM 6601 in the German Collection for Microorganisms in Brauschweig is one of the best-examined and therapeutically relevant...
and mesalazine (5-ASAs).
Other
A study in 2004 testing the immune system of students given either milkMilk
Milk is a white liquid produced by the mammary glands of mammals. It is the primary source of nutrition for young mammals before they are able to digest other types of food. Early-lactation milk contains colostrum, which carries the mother's antibodies to the baby and can reduce the risk of many...
or Actimel
Actimel
Launched in Europe in 1994, Actimel is a 'probiotic' yoghurt-type drink produced by the French company Danone. It is sold in 100ml bottles, typically as an 8, 6 or 4 pack, but more recently as a 12 or 16 pack...
over a 6-week exam period (3 weeks of studying, 3 weeks of exams) tested 19 different biomarkers. Of these 19 biomarkers, only 2 were shown to be different between the two groups, increased production of lymphocyte
Lymphocyte
A lymphocyte is a type of white blood cell in the vertebrate immune system.Under the microscope, lymphocytes can be divided into large lymphocytes and small lymphocytes. Large granular lymphocytes include natural killer cells...
s, and increased production of CD56
Neural Cell Adhesion Molecule
Neural Cell Adhesion Molecule is a homophilic binding glycoprotein expressed on the surface of neurons, glia, skeletal muscle and natural killer cells...
cells. The tests were not blind and show that certain probiotic strains may have no overall effect on the immune system or on its ability.
A 2007 study at University College Cork in Ireland
Ireland
Ireland is an island to the northwest of continental Europe. It is the third-largest island in Europe and the twentieth-largest island on Earth...
showed that a diet including milk fermented with Lactobacillus
Lactobacillus
Lactobacillus is a genus of Gram-positive facultative anaerobic or microaerophilic rod-shaped bacteria. They are a major part of the lactic acid bacteria group, named as such because most of its members convert lactose and other sugars to lactic acid. They are common and usually benign...
bacteria prevented Salmonella
Salmonella
Salmonella is a genus of rod-shaped, Gram-negative, non-spore-forming, predominantly motile enterobacteria with diameters around 0.7 to 1.5 µm, lengths from 2 to 5 µm, and flagella which grade in all directions . They are chemoorganotrophs, obtaining their energy from oxidation and reduction...
infection in pigs.
A 2007 clinical study at Imperial College London
Imperial College London
Imperial College London is a public research university located in London, United Kingdom, specialising in science, engineering, business and medicine...
showed that preventive consumption of a commercially available probiotic drink containing Lactobacillus casei
Lactobacillus casei
Lactobacillus casei is a species of genus Lactobacillus found in the human intestine and mouth. As a lactic acid producer, it has been found to assist in the propagation of desirable bacteria. This particular species of Lactobacillus is documented to have a wide pH and temperature range, and...
DN-114001 and yoghurt bacteria can reduce the incidence of antibiotic-associated diarrhea
Pseudomembranous colitis
Pseudomembranous colitis, a cause of antibiotic-associated diarrhea , is an infection of the colon. It is often, but not always, caused by the bacterium Clostridium difficile. Because of this, the informal name C. difficile colitis is also commonly used. The illness is characterized by...
and C difficile-associated diarrhea
Diarrhea
Diarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and...
.
The efficacy and safety of a daily dose of Lactobacillus acidophilus
Lactobacillus acidophilus
Lactobacillus acidophilus is a species in the genus Lactobacillus. L. acidophilus is a homofermentative species, fermenting sugars into lactic acid, which grows readily at rather low pH values and has an optimum growth temperature of 37 °C . L...
CL1285 in affecting AAD was demonstrated in one study of hospitalized patients.
A 2011 study found that mice given Lactobacillus rhamnosus
Lactobacillus rhamnosus
Lactobacillus rhamnosus is a bacterium that was originally considered to be a subspecies of L. casei, but later genetic research found it to be a species of its own. Some strains of L. rhamnosus are being used as probiotics. The species is sometimes used in yogurt and other dairy products. Some...
JB-1 showed lower levels of stress and anxiety than controls
Current research is focusing on the molecular biology
Molecular biology
Molecular biology is the branch of biology that deals with the molecular basis of biological activity. This field overlaps with other areas of biology and chemistry, particularly genetics and biochemistry...
and genomics
Genomics
Genomics is a discipline in genetics concerning the study of the genomes of organisms. The field includes intensive efforts to determine the entire DNA sequence of organisms and fine-scale genetic mapping efforts. The field also includes studies of intragenomic phenomena such as heterosis,...
of Lactobacillus strains and bifidobacteria. The application of modern whole genome approaches is providing insights into bifidobacterial evolution, while also revealing genetic functions that explain their presence in the particular ecological environment of the gastrointestinal tract.
Factors affecting viability in foods
Some factors, both intrinsic and extrinsic, may influence the survival of probiotics in food, and so have to be considerated in all stages of probiotic food manufacturing.- physiological state of the added probiotic in the food
- physicochemical conditions of food processing
- physical conditions of product storage, like temperature
- chemical composition of the product, such as content of nutrients, oxygen or pH
- interactions with other product components, that can be inhibitory or protective
Physiological state
The physiological state of bacteria when prepared and remaining in a product itself are important factors for survival of the probiotics. Dryness in a food product keeps the bacteria in a relatively quiescent state during storage, while a wet product establishes potentially active metabolism. Temperature affects shelf life of the bacteria, with low temperature providing conditions for possible long term survival.Bacteria can respond to stressful environments by the induction of various stress tolerance mechanisms. One of them is the induction of stress proteins by exposure of the cells to sublethal stresses so they can condition probiotics to better tolerate environmental stresses in food production, storage, and gastrointestinal transit. Different probiotic strains have their own intrinsic tolerances to environmental conditions, including how the culture is prepared, and some cross-protection can be observed, providing protection against other stresses by the exposure to only one stress. Stress responses can be explored to make probiotic strains more resilient and likely to survive in food matrices, with significant industrial importance.
Temperature
The temperature at which probiotic organisms grow is an important factor in food applications where fermentation is required, is also a critical factor influencing probiotic survival during manufacture and storage. As it is told above, the lower the temperature the more stable probiotic viability in the food product will be. During processing, temperatures over 45–50°C will be detrimental to probiotic survival, this means that the higher the temperature, the shorter the time period of exposure required to severely decrease the numbers of viable bacteria, ranging from hours or minutes at 45–55°C to seconds at higher temperatures. Therefore it is obvious that probiotics should be added downstream of heating/cooking/pasteurization processes in food manufacture to avoid the high temperatures. Elevated temperature also has a detrimental effect on stability during the product process of shipping and storage. Again, the cooler a product can be maintained, the better probiotic survival will be, like in vegetative probiotic cells in liquid products, where refrigerated storage is usually essential. If the product is dried, the bacteria will be in a quiescent state, so acceptable probiotic viability can be maintained in dry products stored at ambient temperatures for 12 months or more. Producing and maintaining low water activities in the foods is the key to maintaining probiotic viability during nonrefrigerated storage because there is a remarkable interaction between temperature and water activity.pH
Some bacteria like Lactobacilli and bifidobacteria can tolerate lower pH levels because produce organic acid and products from carbohydrate metabolism. Indeed, numerous in vitro and in vivo studies have demonstrated that in gastric transit where the cells are exposed to low pH values and with a time of exposure relatively short, some probiotic organisms can survive. In fermented milks and yogurts with pH values between 3.7 and 4.3. lactobacilli are able to grow and survive, while Bifidobacteria tend to be less acid tolerant, with most species surviving poorly in fermented products at pH levels below 4.6. B. animales subsp. lactis is most commonly used in acidic foods because is more acid tolerant than human intestinal species, and B. thermoacidophilum, is even more tolerant to low pH (and heat), but has not yet been characterized thoroughly for probiotic traits and is not used commercially.Regarding to fruit juices (pH 3.5–4.5) commercially successful products have been produced, such as Gefilus (Valio Ltd, Finland), which contains Lactobacillus rhamnosus GG. The viability at low pH can be improved with carriers such as dietary fibers. Survival of lactobacilli in low pHs has also been enhanced in the presence of metabolizable sugars, that allow cell membrane proton pumps to operate and prevent lowering of intracellular pH. This can improve survival during gastric transit, but may not be applicable to improving probiotic survival over the time stages of shelf-storage.
Water activity
For quiescent probiotic bacteria, water activity is a crucial determinant of survival in food products during storage. The higher moisture levels and water activity, the lower survival of probiotics. There is a substantial interaction between water activity and temperature with respect to their impact on the survival of quiescent probiotics. As the storage temperature is increased, the detrimental impact of moisture is magnified. Here, the osmotic stresses appear to play a role, with the presence of smaller molecules resulting in poorer bacterial survival, although the exact cell death mechanisms have not been elucidated yet.There may be technological limitations to reducing water activity to low levels for improving survival. These include the energy costs of drying, adverse impacts on the taste of foods and difficulties in wetting and dispersing powders. Moisture barrier packaging may be applied to prevent the development of moisture from the environment during storage. Maintaining probiotic viability in moderate water activity foods (0.4–0.7) is a great challenge and solutions such as microencapsulation or incorporation of probiotics into fat phases of products can provide improved survival.
Oxygen
Both bifidobacteria and lactobacilli are considered strict anaerobes and oxygen can be detrimental to its growth and survival. However, the degree of oxygen sensitivity varies considerably between different species and strains, for example, lactobacilli, which are mostly microaerophilic, are more tolerant of oxygen than bifidobacteria, to the point where oxygen levels are not an important consideration in maintaining the survival of lactobacilli. Most probiotic bifidobacteria do not grow well in the presence of oxygen, although, many bifidobacteria have enzymatic mechanisms to limit the oxygen toxicity.For oxygen sensitive strains, some strategies can be used to prevent oxygen toxicity in food products. Antioxidant ingredients have been shown to improve probiotic survival, as well as the use of oxygen barrier or modified-atmosphere packaging. Therefor, it is advisable to minimize processes that are highly aerating, particularly when using bifidobacteria.
Toxicity of ingredients
Interactions between probiotics and other ingredients could happen and those interactions can be protective, neutral, or detrimental to probiotic stability. Obviously, the inclusion of antimicrobial preservatives can inhibit probiotic survival and elevated levels of ingredients such as salt, organic acids, and nitrates can inhibit probiotics during storage, while starter cultures can sometimes inhibit the growth of probiotics during fermentation through the production of specific bacteriocins.Growth factors, protective, and synergistic ingredients
Probiotic lactobacilli and, in particular, bifidobacteria are only weakly proteolytic and grow relatively slowly or poorly in milk. The growth of bifidobacteria can be improved by the presence of suitable companion cultures, which can aid in protein hydrolysis and through the production of growth factors. Some growth substrates such as carbon sources, nitrogen sources, and growth factors or antioxidants, minerals, and vitamins can be added to improve growth. Finally, the food matrix itself can be protective like in the cheese, where the anaerobic environment, high fat content and buffering capacity of the matrix helps to protect the probiotic cells both in the product and during intestinal transit.Freeze–thawing
The damages made to cell membranes freezing probiotics is detrimental to survival, and also can make the cells more vulnerable to environmental stresses. To prevent or at least mitigate cell injury, protectants are usually added to cultures to be frozen or dried. Once frozen, probiotics can survive well over long shelf lives in products such as frozen yogurts and ice-cream. Using alternative methods of freezing, such as slow-cooling rates or pre-freezing stress, can significantly improve cell survival. Repeated freeze–thawing cycles are highly detrimental to cell survival and should be avoided.Shear forces
Probiotic lactobacilli and bifidobacteria are Gram-positive bacteria with thick cell walls that are able to tolerate the shear forces generated in most standard food production processes such as high-speed blending or homogenization, that may result in cell disruption and losses in viability.Side-effects
In some situations, such as where the person consuming probiotics is critically ill, probiotics could be harmful. In a therapeutic clinical trial conducted by the Dutch Pancreatitis Study Group, the consumption of a mixture of six probiotic bacteria increased the death rate of patients with predicted severe acute pancreatitisAcute pancreatitis
Acute pancreatitis or acute pancreatic necrosis is a sudden inflammation of the pancreas. It can have severe complications and high mortality despite treatment...
.
In a clinical trial conducted at the University of Western Australia
University of Western Australia
The University of Western Australia was established by an Act of the Western Australian Parliament in February 1911, and began teaching students for the first time in 1913. It is the oldest university in the state of Western Australia and the only university in the state to be a member of the...
, aimed at showing the effectiveness of probiotics in reducing childhood allergies, researchers gave 178 children either a probiotic or a placebo
Placebo
A placebo is a simulated or otherwise medically ineffectual treatment for a disease or other medical condition intended to deceive the recipient...
for the first six months of their life. Those given the good bacteria were more likely to develop a sensitivity to allergens.
Some hospitals have reported treating lactobacillus septicaemia, which is a potentially fatal disease caused by the consumption of probiotics by people with lowered immune systems or who are already very ill.
There is no published evidence that probiotic supplements are able to replace the body's natural flora when these have been killed off; indeed bacterial levels in feces disappear within days when supplementation ceases.
Probiotics taken orally can be destroyed by the acidic conditions of the stomach. A number of micro-encapsulation
Micro-encapsulation
Micro-encapsulation is a process in which tiny particles or droplets are surrounded by a coating to give small capsules many useful properties. In a relatively simplistic form, a microcapsule is a small sphere with a uniform wall around it...
techniques are being developed to address this problem.
Recent studies indicate that probiotic products such as yogurts could be a cause for obesity trends. However, this is contested as the link to obesity, and other health related issues with yogurt may link to its dairy and calorie attributes.
Some experts are skeptical on the efficacy of many strains and believe not all subjects will benefit from the use of probiotics.
Strains
Live probiotic culturesMicrobiological culture
A microbiological culture, or microbial culture, is a method of multiplying microbial organisms by letting them reproduce in predetermined culture media under controlled laboratory conditions. Microbial cultures are used to determine the type of organism, its abundance in the sample being tested,...
are available in fermented dairy products and probiotic fortified foods. However, tablets, capsules, powders and sachets containing the bacteria in freeze dried form are also available.
In the table below, only preliminary evidence exists for the health claims stated. Few of the strains presented have been sufficiently developed in basic and clinical research to warrant application for health claim status to a regulatory agency such as the Food and Drug Administration
Food and Drug Administration
The Food and Drug Administration is an agency of the United States Department of Health and Human Services, one of the United States federal executive departments...
or Europfean Food Safety Authority.
| Probiotic Research and Producer Information | |||
|---|---|---|---|
| Strain | Brandname | Producer | Claimed potential effect in humans |
| Bacillus coagulans Bacillus coagulans Bacillus coagulans is a lactic acid-forming bacterial species within the genus Bacillus. The organism was first isolated and described in 1932 and was elaborated in the fifth edition of Bergey's Manual of Determinative Bacteriology. It was initially considered to be a spore-forming Lactobacillus... GBI-30, 6086 |
GanedenBC30 | Ganeden Biotech Ganeden Biotech Ganeden Biotech, Inc. is a privately held consumer healthcare company based in Mayfield Heights, Ohio. It is the largest seller of over-the-counter probiotics in the United States through its Digestive Advantage and Sustenex brand line of products.-History:... |
May improve abdominal pain and bloating in IBS patients. May increase immune response to a viral challenge. |
| Bifidobacterium LAFTI B94 Bifidobacterium sp | LAFTI B94 | Institut Rosell-Lallemand | Protects against Salmonella typhimurium in mice. Uses prebiotics for improved colonization. Facilitates apoptotic response when used in combination with resistant starch in a colon cancer model. Reduces inflammation and incidence of diarrhea in an animal IBS model. Reduces allergic responses in an allergy model. May reduce the severity of H. pylori infection of the stomach mucosa. Inhibits pathogenic bacteria, including H. pylori, monocytogenes, E. coli, and Salmonella typhimurium. Adheres to human intestinal cells. Synthesizes folate from yogurts. |
| Lactobacillus acidophilus LAFTI L10 Lactobacillus acidophilus | LAFTI L10 | Institut Rosell-Lallemand | Enhances clearance of Candida albicans Candida albicans Candida albicans is a diploid fungus that grows both as yeast and filamentous cells and a causal agent of opportunistic oral and genital infections in humans. Systemic fungal infections including those by C... by induction of an immune response. Reduces allergic responses in an animal allergy model. Protects against Listeria monocytogenes in the gastrointestinal tract of mice. Reduces the incidence of tumor formation and the size of intestinal tumors in rats. Reduces inflammation in an animal IBS model. Inhibits pathogenic bacteria, including H. pylori, monocytogenes, E. colim, and Salmonella typhimurium. Adheres to human intestinal cells. Produces antimicrobial substances like H202. |
| Lactobacillus casei LAFTI L26 Lactobacillus casei | LAFTI L26 | Institut Rosell-Lallemand | Protects against Salmonella typhimurium in mice. Reduces inflammation in an IBS model. Reduces allergic responses in an allergy model. Reduces the severity of H. pylori infection of the stomach mucosa. Inhibits pathogenic bacteria, including H. pylori, monocytogenes, E. coli, and Salmonella typhimurium. Adheres to human intestinal cells. |
| Bifidobacterium animalis subsp. lactis BB-12 | Probio-Tec Bifidobacterium BB-12 | Chr. Hansen Chr. Hansen Chr. Hansen A/S is a global company based in Denmark which produces natural ingredients to the food, beverage, dietary supplements, and agricultural industries. The company is a leading supplier of food cultures, probiotics, enzymes and natural colors... |
Human studies have shown that BB-12 alone or in combination may have an effect on the gastrointestinal system. |
| Bifidobacterium breve Yakult | Bifiene | Yakult Yakult is a Japanese probiotic milk-like product made by fermenting a mixture of skimmed milk with a special strain of the bacterium Lactobacillus casei Shirota. It was created by Minoru Shirota who graduated from the Medical School of Kyoto University in 1930. In 1935, he started manufacturing and... |
|
| Bifidobacterium infantis 35624 | Align | Procter & Gamble Procter & Gamble Procter & Gamble is a Fortune 500 American multinational corporation headquartered in downtown Cincinnati, Ohio and manufactures a wide range of consumer goods.... |
In one study, showed significant improvement for abdominal pain/discomfort, bloating/distention, and bowel movement difficulty. |
| Bifidobacterium animalis subsp. lactis HN019 (DR10) | Howaru Bifido | Danisco Danisco Danisco A/S is a Danish bio-based company with activities in food production, enzymes and other bioproducts as well as a wide variety of pharmaceutical grade excipients. It was formed in 1989 from the largest Danish industrial merger ever of the two old C.F... |
|
| Bifidobacterium longum Bifidobacterium longum Bifidobacterium longum is a species of Gram-positive anaerobic branched rod-shaped bacterium which can be found in the intestines of infant humans. They inhibit the growth of Gram-negative bacteria by producing lactic acid, and digest the complex sugars in human breast milk. Due to its importance,... BB536 |
Morinaga Milk Industry Morinaga Milk Industry is a milk products and sweets company in Tokyo, Japan, in operation since September 1, 1917. Their products include milk products, drinks, candy, confectioneries, and infant formula. Morinaga has distribution agreements with Kraft Foods. It is an affiliate company of Morinaga & Company... |
||
| Escherichia coli Escherichia coli Escherichia coli is a Gram-negative, rod-shaped bacterium that is commonly found in the lower intestine of warm-blooded organisms . Most E. coli strains are harmless, but some serotypes can cause serious food poisoning in humans, and are occasionally responsible for product recalls... M-17 |
ProBactrix | BioBalance | | |
| Escherichia coli Escherichia coli Escherichia coli is a Gram-negative, rod-shaped bacterium that is commonly found in the lower intestine of warm-blooded organisms . Most E. coli strains are harmless, but some serotypes can cause serious food poisoning in humans, and are occasionally responsible for product recalls... Nissle 1917 |
Mutaflor Mutaflor Mutaflor is a probiotic consisting of a viable non-pathogenic bacteria strain named Escherichia coli Nissle 1917. "The Escherichia coli strain Nissle 1917-designated DSM 6601 in the German Collection for Microorganisms in Brauschweig is one of the best-examined and therapeutically relevant... |
Ardeypharm | |
| Lactobacillus acidophilus Lactobacillus acidophilus Lactobacillus acidophilus is a species in the genus Lactobacillus. L. acidophilus is a homofermentative species, fermenting sugars into lactic acid, which grows readily at rather low pH values and has an optimum growth temperature of 37 °C . L... DDS-1 |
Nebraska Cultures | ||
| Lactobacillus acidophilus LA-5 | Chr. Hansen | Limited human studies have shown that LA-5 may have a beneficial effect on gastrointestinal health. | |
| Lactobacillus acidophilus NCFM | Danisco Danisco Danisco A/S is a Danish bio-based company with activities in food production, enzymes and other bioproducts as well as a wide variety of pharmaceutical grade excipients. It was formed in 1989 from the largest Danish industrial merger ever of the two old C.F... |
Shown in one study to reduce the side effects of antibiotic therapy. | |
| Lactobacillus casei Lactobacillus casei Lactobacillus casei is a species of genus Lactobacillus found in the human intestine and mouth. As a lactic acid producer, it has been found to assist in the propagation of desirable bacteria. This particular species of Lactobacillus is documented to have a wide pH and temperature range, and... DN114-001 (Lactobacillus casei Immunitas(s)/Defensis) |
Actimel Actimel Launched in Europe in 1994, Actimel is a 'probiotic' yoghurt-type drink produced by the French company Danone. It is sold in 100ml bottles, typically as an 8, 6 or 4 pack, but more recently as a 12 or 16 pack... /DanActive |
Danone | |
| Lactobacillus casei 431 | Chr. Hansen | Limited human studies have shown that L. casei 431 alone or in combinations may have a beneficial effect within gastrointestinal health | |
| Lactobacillus casei F19 | Cultura | Arla Foods Arla Foods Arla Foods is a Swedish-Danish cooperative based in Århus, Denmark, and the largest producer of dairy products in Scandinavia. Arla Foods was formed as the result of a merger between the Swedish dairy cooperative Arla and the Danish dairy company MD Foods on 17 April 2000.Arla Foods is the seventh... |
|
| Lactobacillus casei Shirota | Yakult | Yakult Yakult is a Japanese probiotic milk-like product made by fermenting a mixture of skimmed milk with a special strain of the bacterium Lactobacillus casei Shirota. It was created by Minoru Shirota who graduated from the Medical School of Kyoto University in 1930. In 1935, he started manufacturing and... |
|
| Lactobacillus paracasei St11 (or NCC2461) | Lactobacillus fortis | Nestlé Nestlé Nestlé S.A. is the world's largest food and nutrition company. Founded and headquartered in Vevey, Switzerland, Nestlé originated in a 1905 merger of the Anglo-Swiss Milk Company, established in 1867 by brothers George Page and Charles Page, and Farine Lactée Henri Nestlé, founded in 1866 by Henri... |
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| Lactobacillus johnsonii La1 (= Lactobacillus LC1, Lactobacillus johnsonii NCC533) | Nestlé Nestlé Nestlé S.A. is the world's largest food and nutrition company. Founded and headquartered in Vevey, Switzerland, Nestlé originated in a 1905 merger of the Anglo-Swiss Milk Company, established in 1867 by brothers George Page and Charles Page, and Farine Lactée Henri Nestlé, founded in 1866 by Henri... |
May reduce incidences of H pylori Helicobacter pylori Helicobacter pylori , previously named Campylobacter pyloridis, is a Gram-negative, microaerophilic bacterium found in the stomach. It was identified in 1982 by Barry Marshall and Robin Warren, who found that it was present in patients with chronic gastritis and gastric ulcers, conditions that were... -caused gastritis and reduces inflammation |
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| Lactococcus lactis Lactococcus lactis Lactococcus lactis is a Gram-positive bacterium used extensively in the production of buttermilk and cheese, but has recently also become famous as the first genetically modified organism to be used alive for the treatment of human disease. L... L1A |
Norrmejerier | Immune stimulation, improves digestive health, reduces antibiotic-associated diarrhoea | |
| Lactobacillus plantarum Lactobacillus plantarum Lactobacillus plantarum is a widespread member of the genus Lactobacillus, commonly found in many fermented food products as well as anaerobic plant matter. It is also present in saliva . It has the ability to liquefy gelatin. L... 299v |
GoodBelly / ProViva/ TuZen/ Bion Transit / ProbiMage | Probi | May improve symptoms of IBS; however, more research is required. |
| Lactobacillus reuteri Lactobacillus reuteri Lactobacillus reuteri is a Gram-positive bacterium that naturally inhabits the gut of mammals and birds. First described in the early 1980s, some strains of L. reuteri are used as probiotics. BioGaia AB in Sweden owns several commercially important strains and a large number of different patents... ATTC American Type Culture Collection The American Type Culture Collection is a private, not-for-profit biological resource center whose mission focuses on the acquisition, authentication, production, preservation, development and distribution of standard reference microorganisms, cell lines and other materials for research in the... 55730 (Lactobacillus reuteri SD2112) |
BioGaia | Diarrhea prevention and mitigation in children, eradication of H. pylori infection, amelioration of gingivitis Gingivitis Gingivitis is a term used to describe non-destructive periodontal disease. The most common form of gingivitis is in response to bacterial biofilms adherent to tooth surfaces, termed plaque-induced gingivitis, and is the most common form of periodontal disease... , general illness prevention in children and adults. |
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| Lactobacillus reuteri Protectis (DSM 17938, daughter strain of ATCC 55730) | BioGaia | ||
| Lactobacillus rhamnosus Lactobacillus rhamnosus Lactobacillus rhamnosus is a bacterium that was originally considered to be a subspecies of L. casei, but later genetic research found it to be a species of its own. Some strains of L. rhamnosus are being used as probiotics. The species is sometimes used in yogurt and other dairy products. Some... ATCC 53013 (Also strain number GG, discovered by Gorbach & Goldin) |
LGG, Gefilus, Vifit and others | Valio Valio Valio Ltd is one of the biggest companies in Finland and mostly produces dairy products such as cheese, powdered ingredients, butter, yogurt and milk. Valio is Finland's biggest milk processor, producing 86% of Finland's milk.... |
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| Lactobacillus rhamnosus LB21 | Verum | Norrmejerier | May cause immune stimulation, may improve digestive health, may reduce antibiotic-associated diarrhoea |
| Saccharomyces boulardii Saccharomyces boulardii Saccharomyces boulardii is a tropical strain of yeast first isolated from lychee and mangosteen fruit in 1923 by French scientist Henri Boulard. It is related to, but distinct from, Saccharomyces cerevisiae in several taxonomic, metabolic, and genetic properties. S... |
DiarSafe and others | Wren Laboratories and others | May protect against antibiotic-associated diarrhoea and infections of Clostridium difficile Clostridium difficile Clostridium difficile , also known as "CDF/cdf", or "C... and other clostridial species Clostridium Clostridium is a genus of Gram-positive bacteria, belonging to the Firmicutes. They are obligate anaerobes capable of producing endospores. Individual cells are rod-shaped, which gives them their name, from the Greek kloster or spindle... ; limited evidence shows it may help treat acute diarrhoea. |
| tested as mixture: Lactobacillus rhamnosus GR-1 & Lactobacillus reuteri RC-14 |
Bion Flore Intime Jarrow Fem-Dophilus | Chr. Hansen | In one study, oral ingestion resulted in vaginal colonisation and prevention of vaginitis. |
| tested as mixture: Lactobacillus acidophilus NCFM & Bifidobacterium bifidum BB-12 |
Florajen3 | American Lifeline, Inc | Reduction of C. difficile Clostridium difficile Clostridium difficile , also known as "CDF/cdf", or "C... –associated disease (CDAD). |
| tested as mixture: Lactobacillus acidophilus CL1285 & Lactobacillus casei LBC80R |
Bio-K+ CL1285 | Bio-K+ International | May affect digestive health. In vitro inhibition of Listeria monocytogenes and L. innocua, Escherichia coli, Staphylococcus aureus, Enterococcus faecalis and Enterococcus faecium. Reduction of symptoms of lactose intolerance and immune stimulation. |
| Lactobacillus plantarum HEAL 9 & Lactobacillus paracasei 8700:2 | Bravo Friscus/ ProbiFrisk | Probi | Is under study for common cold infections. |
| Lactobacillus reuteri Prodentis (L. reuteri DSM 17938 & ATCC PTA 5289) | GUM PerioBalance | BioGaia | |
| Lactobacillus helveticus R0052 & Lactobacillus rhamnosus R0011 | A'Biotica and others | Institut Rosell | |
| Lactobacillus casei var. rhamnosus MG001 & Lactobacillus acidophilus MG002 & Lactobacillus plantarum MG003 & Enterococcus faecium MG004 | Symprove Probiotic | Symprove Ltd. | |
Some additional forms of lactic acid bacteria include:
- Lactobacillus bulgaricus
- Streptococcus thermophilusStreptococcus salivarius subsp. thermophilusStreptococcus salivarius subsp. thermophilus is a Gram-positive bacteria and a homofermentative facultative anaerobe, of the viridans group. It tests negative for cytochrome, oxidase and catalase, and positive for alpha-hemolytic activity...
- Lactobacillus bifidusBifidobacteriumBifidobacterium is a genus of Gram-positive, non-motile, often branched anaerobic bacteria. They are ubiquitous, endosymbiotic inhabitants of the gastrointestinal tract, vagina and mouth of mammals and other animals. Bifidobacteria are one of the major genera of bacteria that make up the colon...
- became new genus Bifidobacterium
Some fermented products containing similar lactic acid bacteria include:
- Pickled vegetables
- Fermented bean pasteFermented bean pasteFermented bean paste is a category of fermented foods typically made from ground soybeans, which are indigenous to the cuisines of East and Southeast Asia...
such as tempehTempehTempeh , or tempe , is a traditional soy product originally from Indonesia. It is made by a natural culturing and controlled fermentation process that binds soybeans into a cake form, similar to a very firm vegetarian burger patty...
, misoMisois a traditional Japanese seasoning produced by fermenting rice, barley and/or soybeans, with salt and the fungus , the most typical miso being made with soy. The result is a thick paste used for sauces and spreads, pickling vegetables or meats, and mixing with dashi soup stock to serve as miso...
and doenjangDoenjangDoenjang is a traditional Korean fermented soybean paste. Its name literally means "thick paste" in Korean.-Production:... - KefirKefirKefir is a fermented milk drink that originated with shepherds of the North Caucasus region, who discovered that fresh milk carried in leather pouches would occasionally ferment into an effervescent beverage...
- Buttermilk or KarnemelkButtermilkButtermilk refers to a number of dairy drinks. Originally, buttermilk was the liquid left behind after churning butter out of cream. It also refers to a range of fermented milk drinks, common in warm climates where unrefrigerated fresh milk otherwise sours quickly...
- KimchiKimchiKimchi , also spelled gimchi, kimchee, or kim chee, is a traditional fermented Korean dish made of vegetables with varied seasonings. There are hundreds of varieties of kimchi made with a main vegetable ingredient such as napa cabbage, radish, green onions or cucumber. It is the most common...
- Pao caiPao caiPao cai is a type of pickle, usually pickled cabbage, often found in Chinese, and particularly Sichuanese cuisine. It is most common to northern and western China; however, there is also a unique form of pao cai, called suan cai, which is prominent in Northeast China.Chinese pao cai closely...
- SauerkrautSauerkrautSauerkraut , directly translated from German: "sour cabbage", is finely shredded cabbage that has been fermented by various lactic acid bacteria, including Leuconostoc, Lactobacillus, and Pediococcus. It has a long shelf-life and a distinctive sour flavor, both of which result from the lactic acid...
- Soy sauceSoy sauceSoy sauce is a condiment produced by fermenting soybeans with Aspergillus oryzae or Aspergillus sojae molds, along with water and salt...
- Zha caiZha caiZha cai is a type of pickled mustard plant stem originating from Sichuan, China. Other transliterations might include cha tsai, tsa tsai; or jar choy, jar choi, ja choi, ja choy, or cha tsoi...
EFSA opinions of probiotics
The European Food Safety AuthorityEuropean Food Safety Authority
The European Food Safety Authority is an agency of the European Union that provides independent scientific advice and communication on existing and emerging risks associated with the food chain, created by European Regulation 178/2002....
has so far rejected 260 claims on probiotics in Europe due to insufficient research and thus no conclusive proof. This includes:
- Lactobacillus paracasei LMG P 22043 does not decrease potentially pathogenic gastro-intestinal microorganisms or reduce gastro-intestinal discomfort.
- Lactobacillus johnsonii BFE 6128 . Immunity and skin claims all too general for consideration under the NHCR.
- Lactobacillus fermentum ME-3 not shown to decrease potentially pathogenic gastro-intestinal microorganisms.
- Lactobacillus plantarum BFE 1685. Immunity claim deemed too general for NHCR.
- Bifidobacterium longum BB536 does not improve bowel regularity; does not resist cedar pollen allergens; does not decrease pathogens.
- Bifidobacterium animalis ssp. lactis Bb-12 does not help maintain normal LDL-blood cholesterol; does not decrease pathogens or boost immunity.
- Lactobacillus plantarum 299v does not reduce flatulence and bloating or protect DNA, proteins and lipids from oxidative damage.
- Lactobacillus rhamnosus LB21 NCIMB 40564 does not help maintain individual intestinal microbiota in subjects receiving antibiotic treatment.
Multi-probiotic
Research is emerging on the potential health benefits of multiple probiotic strains as a health supplement as opposed to a single strain. As the human gut may contain several hundred microbe species, one theory indicates that this diverse environment may benefit from consuming multiple probiotic strains, an effect that remains unproved.Incomplete list of supplement products that contain more than one strain.
| Company | Product | Strains | Strain Qty |
|---|---|---|---|
| EMD Canada Inc. | Multibionta | Lactobacillus gasseri PA16/8, Bifidobacterium bifidum MF20/5, Bifidobacterium longum SP07/3 | 3 |
| OptiBac Probiotics | For daily wellbeing | Bifidobacterium longum Rosell-175, Lactococcus lactis Rosell-1058, Bifidobacterium breve Rosell-70, Lactobacillus rhamnosus Rosell-11, Lactobacillus acidophilus Rosell-52, Bifidobacterium bifidum rosell-71 | 6 |
| Symprove Ltd. UK | Symprove Probiotic | Lactobacillus casei var. rhamnosus MG001, Lactobacillus acidophilus MG002, Lactobacillus plantarum MG003, Enterococcus faecium MG004 | 4 |
| WN Pharmaceuticals Ltd. (Canada) | Webber Naturals Complete Probiotic | Lactobacillus casei (HA-108), Lactobacillus rhamnosus (HA111), Lactobacillus acidophilus (HA-122), Bifidobacterium longum (HA-135), Bifidobacterium breve (HA-129) | 5 |
Further reading
Books- Hattner, J.A.T./Anderes, S. ”Gut Insight: probiotics and prebiotics for digestive health and well-being”, 2009, Hattner Nutrition. ISBN 9780578026152
- Huffnagle, G.B/Wernick, S. “The Probiotics Revolution: The Definitive Guide to Safe, Natural Health Solutions Using Probiotic and Prebiotic Foods and Supplements”, 2008, Bantam. ISBN 9780553384192
- Lipski, E. “Digestive Wellness: Strengthen the Immune System and Prevent Disease Through Healthy Digestion”, 2011 (4. ed.), Mc-Graw Hill. ISBN 9780071668996
Review articles
- De Preter, V. et al. ”The impact of pre- and/or probiotics on human colonic metabolism: Does it affect human health?”, Molecular Nutrition & Food Research (2011),55(1):46-57.
- Prakash, S. et al. “Gut microbiota: next frontier in understanding human health and development of biotherapeutics”, Biologics: Targets & Therapy (2011), 5:71-86.
External links
- International Scientific Association for Probiotics and Prebiotics
- Probiotics: Considerations for Human Health
- Getting To Know "Friendly Bacteria"
- Probiotics: Friendly Bacteria With a Host of Benefits
- International Food Information Council
- WhyFiles.org: Web magazine feature about probiotics
- Probiotic may ease fatigue syndrome anxiety