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Prebiotics & Probiotics
Dr. Azad A HaleemMBChB, DCH, FIBMS Pediatrics MBChB, DCH, FIBMS Pediatrics
Lecturer Lecturer
Pediatric department Pediatric department
Medical college/ Duhok universityMedical college/ Duhok university
Heevi Pediatrics Teaching Hospital Heevi Pediatrics Teaching Hospital
Physiology of Human GIT
Development of GIT Immunity.
PRObiotics.
PREbiotics.
My audience will STILL be AWAKE
by the end of the talk.
Goals of This Talk
The intestine is an extremely complex system that participates in protection of the host through strong defense mechanisms from the external environment;
Our Intestine = 400 square meter surface… i.e. the surface area of a tennis court
Defense task is based on three compartments that are in permanent contact and dialogue with each other:
1- The ecological barrier (normal inhabitant flora within intestine)
2- Mechanical barrier (mucous epithelia)
3- Immune barrier (GALT, secretory IgA, intraepithelial lymphocytes, macrophages, neutrophils, natural killer cells, Payer’s nodes and mesenteric lymph node) (Mohajer, 2000)
i.e. the surface area of a tennis court
Physiology
Trillions living bacteria exist in the human intestine
We have more bacteria in our bodies (10 times greater) than the total number of our somatic and germ cells We carry about 2 kg of bacteria !!!!!!!!
Over 500 species of bacteria present in human colon.
Lactobacillus Bifidis and Acidophilus comprise the majority of healthy bacteria in the colon along with other disease producing bacteria.
GIT Immunity
It starts with creating a healthy digestive system which plays a major role from infancy and throughout all our life (about 80% of our immune system is found in the GIT)
“ This immature immune system needs special measures for its
Protection and Support.”
“The intestine is not only a digestive absorptive organ but it is the
largest immune organ in our body.”
The gastrointestinal tract of a normal fetus is sterile.
During the birth process: the aseptic or sterile, digestive tract of the fetus is inoculated with bacteria (proximity of the birth canal and the anus).
Rapidly thereafter, effective methods of ensuring transmission of microbes to the sterile GIT:o parental expression of neonatal care: suckling, kissing and
caressing (mother’s flora) o Genetic factor o surrounding environment o Feeding pattern: the first biggest challenge is one the
intestine becomes inhabited by microbes which are characterized by instability and fragility. Later the microbiota will stabilize according to the type of feeding.
Early In Life ???
The first colonization of the intestine is one of the most profound immunological exposures faced by the newborn infant (during the first days of life).
The next great changes in the composition of the intestinal microbiota come with the introduction of solid food and weaning (Favier et al., 2002).
Hygiene Hypothesis: Decreased bacterial stimulation during infancy and childhood is asscociated with slower postnatal development and delayed maturation of the immune system. (L.E.M. Niers et al., 2005)
Relatively small changes will take place by after years of age where the child will have an adult-like microbiota and then it remains practically unchanged (Zoetendal et al., 2008).
Early In Life ???
HistoryThe concept of probiotics was first introduced in the 20th century by Noble prize winner, Elie Metchnikoff(1845-1916). He suggested that long and healthy life of Bulgarian peasants resulted from their consumption of fermented milk products.He himself introduced in his diet sour milk fermented with bacteria he called “Bulgarian Bacillus, later called as Lactobacillus delbrueckii subsp.” and found his health benefited.
““PROBIOTICSPROBIOTICS””
The root of the word ‘ probiotic’ comes from the Greek word pro, meaning “promoting” and biotic, meaning “life”. The Food and Agriculture Organisation of the United Nation (FAO) defines probiotics as“ live micro-organisms, which, when administered in adequate amount produce beneficial effect to the host when taken orally”.
• They Only Transiently colonize the Gut and do not typically become part of the permanent resident micro flora of the host.
PRObiotics
(Journal of the American Dietetic Assosciatio,2008)
List of probiotic List of probiotic
candidatecandidate: -: -Microorganisms Genus Species
Bacteria Lactobacillus L.acidophilus, L.brevis, L.reuteri, L.casei, L.rhamnosum, L.bulgaricus, L.cellobiosus, L.delbrueckii, L. fermentum.
Bifidobacterium B.thermophilus, B.infantis, B .longum, B.bifidum, B.animalis.
Streptococcus S.lactis, S.thermophilus, S.cremonis, S.alivarius.
Bacillus B.Coagulans
Pediococcus P.acidilactici
Leuconostoc L.mesenteroides
Enterobacter E.faecium, E.faecalis.
Fungi Aspergillus A.niger, A.oryzae.
Yeast Saccharomyces S.boulardii, S.cerevisiae, S.carlsbergensis.
Properties of probiotics
It should be safe to the host.It should be safe to the host.It should not produce any pathogenic or toxic It should not produce any pathogenic or toxic effect.effect.It must be resistance to hydrochloric acid, bile and It must be resistance to hydrochloric acid, bile and pancreatic juice.pancreatic juice.It should have anti-carcinogenic activity.It should have anti-carcinogenic activity.It should produce lactic acid.It should produce lactic acid.It should retain viability during storage and use.It should retain viability during storage and use.It should stimulate the immune system of the body.It should stimulate the immune system of the body.It should have the ability to colonize the It should have the ability to colonize the gastrointestinal tract.gastrointestinal tract.
Beneficial effects of probiotics in human:-Diarrhoea:- Probiotic have preventive and curative effects on diarrhoea.
Irritable Bowel Syndrome(IBS):- It can be prevented by the Lactobacillus plantarum 299V.
Heicobacteriosis:-Probiotic had an in vitro inhibitory effect reduce gastric inflammation.
Necrotising Enterocolitis:- Treating with B.infantis and L.acidophilus to new born result in reduction of NEC.
Urogential infection:-It can be prevented by taking L.fermentum and L.rhamnosus.
Colon cancer:-Lactic bacteria may act against colon cancer.
Blood pressure:-Milk fermented by lactic acid bacteria may result in the reduction of this sickness.
The term prebiotic was introduced by Gibson and Roberfroid 1995 who exchanged “PRO" for “PRE" which means “Before“.
“Non-digestible food ingredients that beneficially affect the host by selectively stimulating the growth and/or activity of one or a limited number of bacteria in the colon that can improve host health."Gibson et al., 2004)
PREbiotics
(Journal of the American Dietetic Assosciatio,2008)
Facts about PREbiotics Prebiotics; are simply speaking the preferential
“FOOD” for Friendly Beneficial Bacteria colonizing the digestive tract.
“colonic food” They are dietary supplements that play a role in
Balancing the Intestinal Mucosal Immune System
Limited hydrolysis and absorption in the upper GIT(gastro-intestinal tract).
Selective growth stimulation of beneficial bacteria in the colon.
Immuno stimulation.
Stimulation of beneficial flora that promotes colonization resistance.
Criteria for eligibility as PREbiotic
(Gibson et al., 2007)
Established PREbioticsBreast Milk oligosaccharides Original they represent the
third largest component of Human Milk 20 - 23 gm/l in colostrum & 12- 14 gm/ in mature milk.
Polydextrose – Fructans Inulin Wheat, banana, onions, garlic, leek, chicory.
FOS (Fructo-oligosaccharides or oligofructose) plants.
GOS (Galacto-oligosaccharides) milk. Lactulose - Lactosucrose SOS (soy-oligosaccharides) XOS (xylo-oligosaccharides) IMO (isomalto-oligosaccharides) corn & wheat.
Lactitol
(Journal of the American Dietetic Assosciatio,2008)
Top 10 food containing Top 10 food containing prebioticsprebiotics
Food content by weight
Raw Chicory root 64.6 %
Raw Jerusalem artichoke 31.5 %
Raw Dandelion greens 24.3 %
Raw Garlic 17.5 %
Raw Leek 11.7 %
Raw Onion 8.6 %
Cooked Onion 5 %
Raw Asparagus 5 %
Raw Wheat bran 5 %
Raw Banana 1 %
How do they workHow do they work??Increase a number of bifidobacterium Increase a number of bifidobacterium and lactic acid bacteria.and lactic acid bacteria.
Effect on the metabolism of lipids.Effect on the metabolism of lipids.Suppression of putrefactive bacteria.Suppression of putrefactive bacteria.
Growth of bifidobacteria.Growth of bifidobacteria.
It helps to lower colon cancer risk.It helps to lower colon cancer risk.
Role of prebioticPrebiotic factor Origin Microbes stimulated Effects
Oligosaccharides Onion,garlic, chicory root, burdock, asparagus, Jerusalem artichoke, soybean, wheat bran.
Bifidobacterium species Increase in bifidobacterium, suppression of putrefactive bacteria, prevention of constipation and diarrhea.
Fructooligosaccharides (inulin, oligofructo)
Same as for oligosaccharides
Bifidobacterium species Lactobacillus acidophilus, Lactobacillus casei, Lactobacillus plantarum
Growth of bifidobacteria and acid promotion.
Fructan Ash-free white powder from tubers of Jerusalem artichoke.
Bifidobacterium species Growth of bifidobacteria
Human kappa casein and derived glycolmacropeptide
Human milk: chymotrypsin and pepsin hydrolysate.
Bifidobacterium bifidum Growth promotion.
Stachyose and raffinose Soybean extract Bifidobacterium species Growth factor.
Casein macropeptide Bovine milk Bifidobacterium species Growth promotion.
Lactitol(4-O-β-D-galactopyranosyl)D-glucitol
Synthetic sugar alcohol of lactose
Bifidobacterium species Growth promotion.
Lactutose(4-O-β-D-galactopyranosyl)D-fructose
Synthetic derivative of lactose
Bifidobacterium species Growth promotion.
USES OF PREBIOTICUSES OF PREBIOTICImprove immune function in both the gut and body.Establish a healthier balance of bacteria in the gut.Promote regular bowel movements.Reduces the risk of an intestinal infection.Modulation of gastro-intestinal peptides production, energy metabolism and satiety.Initiation (after birth) and regulation/modulation of immune functions. Enhance bone density and increase Calcium absorption.Increase in mineral absorption and improvement of bone health.
Side effectExcessive consumption of prebiotics
particularly those in the oligosaccharides category may cause abdominal discomfort and distension, as well as significant levels of flatulence. The Nutrition Information Centre of South Africa's University of Stellenbosch, recommends that daily consumption of prebiotics be held below 20 grams.
What are the health benefits of prebiotics in What are the health benefits of prebiotics in infant Formula ? infant Formula ? Researches Review
Nine studies are cited in the literature, investigating the effect of different types of prebiotic OS supplementation in infants.
These studies showed that depending on the age of the infant, and the prebiotic OS used,
1- effects may be seen on immune cells,in particular IgE levels. 2- Results on the prevention and management of diarrhoea and
constipation are varying with four out of six studies showing positive results.
3- The role of prebiotics in reducing respiratory tract infections, fever and use of antibiotics also looks promising with less infections reduced use of antibiotics and reduced episodes of fever seen in infants supplemented with prebiotic OS than those who did not receive any supplementation.
1. American Journal of Clinical Nutrition, Vol. 69, No. 5, 1035S – 1045S, May 1999.
2. Gastroenterology and Nutrition in infancy (GNI).3. International Food Information Council (IFIC).4. International Food Information Foundation’s Media Guide on Food Safety and
Nutrition.5. Nutrition Information Centre University of Stellenbosch (NICUS).6. HEALL: Health Education Alliance for Life and Longevity.7. Can J Gastroenterol. 2004 Mar;18(3):163-7 Redefining lactose as a conditional
prebiotic. 8. Daniells, Stephen, Prebiotics Could Reduce Artery Hardening, Boost Heart
Health, NutraIngredients.com, 2 January 2007. 9. Hamilton-Miller, JMT, Probiotics and Prebiotics in the Elderly, 20 January
2004.10. Marco ML et al; Towards understanding molecular modes of probiotic action. Curr Opin Biotechnol 2006; 17:204–210.
References
11. Prebiotics Could Improve Heart Health, NPICenter.com, 22 December 2006.
12. Saavedra, J.M. and Tschernia, A., Human Studies With Probiotics and Prebiotics: Clinical Implications, British Journal of Nutrition, Volume 87, Supplement s2, 1 May 2002, pp. 241-246(6).
13. Rodrigo B., Mathieu M., Chieh J. : Gut Microbiota, Obesity and Diabetes; (1/2009) Annales Nestle.
14. Roberfroid MB : Prebiotics and probitoics are they functional ? Am J Clin Nutr; (2000) 71: 1470-1481.
15. Ley RE, Backhed F, Turnbaugh P, et al: Obesity alter gut microbial ecology. Pro Natl Acad Sci USA 2005;102: 11070-11075.
16. Turnbaug PJ, Backhed F, Fulton L, Gordon JI: Diet –induced obesity is linked to marked but reversible alteration in mouse distal gut microbiome. Cell Host Microbe 2008; 3: 213-223.
17. Weickert MO, Pfeiffer AF: Metabolic effects of dietary fiber consumption and prevention of diabetes. J Nutr 2008;138:439-422.
References