Dysbiosis is the abnormal microbial colonization of the intestine , where changes in Quantity and Quality of flora become Pathological & Harmful

Common causes of dysbiosis:

• Antibiotic therapy
• Autoimmune conditions , IBD
• Others are fast paced lifestyle, stress, food habits, Alcohol intake and cigarette smoking

Nutraceuticals

The term “Nutraceutical” was coined from “Nutrition” & “Pharmaceutical” in 1989 by Stephen De Felice.

Nutraceutical can be defined as

“ A food or part of food or nutrient, that provides health benefits, including the prevention and treatment of a disease.”

Includes :- GE foods, cereals supplemented with vitamins or minerals, genetically manipulated soybean and canola oil without trans-fatty acids

Classification of nutraceuticals

Based on chemical constituents:

• Nutrients :- Substances with established nutritional functions, such as vitamins, minerals, amino acids and fatty acids
• Herbals :- Herbs or botanical products as concentrates and extracts, such as aloe vera juice, evening primose oil
• Dietary Supplement :- products that contain a dietary ingredient intended to add something to the foods we eat such as prebiotics, probiotics
• Defining a probiotic“Live microorganisms which when administered in adequate amounts confer a health benefit on the host” (WHO)

Key properties of probiotic

• Non-pathogenic, non-toxic and non-allergic.
• Capable of surviving and metabolizing in upper G.I. tract e.g. Resistant to low pH, organic acids, bile juice, saliva and gastric acid
• Human in origin, genetically stable and capable of remaining viable for long periods in field condition.
• Able to modulate immune response and provide resistance to disease through improved immunity or by the production of antimicrobial substance in the guts.
• Good adhesion/ colonization to human intestinal tract and influence on gut mucosal permeability.
• Antagonistic against carcinogenic/ pathogenic organisms.
• Clinically proven health benefit, e.g. gastrointestinal disorders, diarrhea, clostridium difficle colitis, antibiotics associated diarrhea, acute gastroenteritis.
• Technologic properties for commercial viability such as stability of desired characteristics during processing, storage and transportation

Mechanism of action

• Bioconversion of, for example, sugars into fermentation products
• Production of growth substrates, like vitamins B and K, for other bacteria

Direct antagonism by antimicrobial substances:

• hydrogen peroxide
• organic acids
• Bacteriocin
• acidophilin
• Competitive exclusion for binding sites
• Improved barrier function
• Production of β- D- galactosidase enzymes that break down lactose .
• Reduction of inflammation, thus altering intestinal properties
• Stimulation of innate immune response

Foods containing Probiotics

• Milk
• Soya milk
• Tofu
• Milk products- Sour cream, Butter milk, Yoghurt

Fermented Indian foods like

• Idlis
• Dosas, uttapam
• Dhoklas
• Vadas
• Kadhi
• The concept of prebiotic was introduced by Gibson & Roberfroid, in 1995
• “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.”

Prebiotics- examples

• Garlic, Onions
• Chicory root
• Asparagus
• Wheat
• Rye , Barley
• breast milk
• tomatoes, berries
• bananas

Breast Milk Oilgosachharides – They represent the third largest component of Human Milk 20 – 23 gm/l in colostrum & 12 – 14 gm/l in mature milk.

Clinical application of probiotics and prebiotics Proven Benefits

• Diarrheal Illness – treatment and prevention
• Prevention of antibiotic-associated diarrhea (AAD)
• Treatment of Clostridium difficile infection
• Inflammatory bowel disease (ulcerative colitis,CD)
• Lactose intolerance
• Necrotizing Enterocolitis (NEC)

Suggested Benefits

• Food allergies
• Eczema

Holds Promise

• Allergic rhinitis
• Asthma
• Colic
• Colon cancer prevention
• Obesity
• Hypertension
• In elderly
• Cystic fibrosis
• Dyslipidemia/ Cardiovascular diseases
• Rheumatoid arthritis
• Traveller’s diarrhea / bacterial enteritis
• Genitourinary tract infections

Probiotics in the Treatment of Gastrointestinal Disorders

• Diarrhea
• Acute infectious
• Antibiotic-associated
• C. difficile
• H. pylori Eradication
• Lactose Intolerance
• Constipation
• IBD
• Ulcerative colitis
• Crohn’s disease
• Pouchitis

Antibiotic associated diarrhea

• Disease
• Antibiotic treatment
• Probiotics
• Disturbance of intestinal microbiota
• Microbiota in balance
• Clostridium overgrowth produces toxin

Lactose intolerance

• Lactase digests lactose commonly present in milk and milk products.
• Lactose is not digested when there is a deficiency in lactase and results in diarrhea.
• Supplementation with probiotics has been shown to mitigate the symptoms of lactose intolerance by enzyme β- D- galactosidase.
• Having yoghurt is a good way for a lactose intolerant person to get calcium.

Helicobacter pylori Infections

• Chronic gastritis, Peptic ulcers, Gastric adenocarcinoma, and a number of non-gastrointestinal disorders.
• Bifidobacteria and B. subtilis may inhibit the growth or attachment of H. pylori.
• Possible mechanisms eradicates H. pylori include
• the ability of the probiotics to bind to gastric epithelial cells,
• to produce a high quantity of lactic acid, and
• to proliferate rapidly.

Probiotics and Cancer

Enzymes (Glycosidase, B- glucuronidase , azoreductase , and nitroreductase) of the intestinal flora convert the precarcinogens to active carcinogens giving rise to colon CA. Probiotics reduce

• Faecal concentrations of enzymes
• Reduce absorption of harmful mutagens that may contribute to colon carcinogenesis.
• Activity of L. acidophilus and L. casei supplementation in humans helps to decrease levels of these enzymes

Dosage of Probiotics

• The dose of probiotics is usually expressed as the number of colony forming units (CFUs).
• Due to the multitude of strains, the FDA has not approved any specific health claims for probiotics. The varying strains also make it impossible to establish an RDA for a probiotic.
• Probiotic effects should be considered dose-specific
• Dose listed on the label are based on studies that show a beneficial health effect in humans.

Prebiotics vs Problotics

Adverse effects

• Probiotics side effects, if they occur, tend to be mild and digestive symptoms. (such as gas or bloating).
• May cause infections, especially in immuno- compromised patients.
• Diabetic patients should be doubly cautious about taking probiotic drinks available in the market as they contain high level of sugar.
• Probiotic products taken as a dietary supplement are manufactured and regulated as functional foods, not drugs

Are probiotics supplements necessary?

• Probiotics supplements are not necessary for normal, healthy individuals.
• • In healthy individuals, daily consumption of probiotics rich foods, particularly fermented dairy products like yoghurt adequately supplies the amount of probiotics required to maintain a healthy digestive system and overall wellbeing.
• A diet high in starches and fibre provide prebiotics, which keep a healthy population of probiotics in our intestines.

Synbiotics

Synbiotic = Probiotic + Prebiotic

The concept of synbiotics has been proposed to characterize health-enhancing foods and supplements used as functional food ingredients in humans

Potential synergy between pro- & prebiotics

Improve survival in upper GIT

More efficient implantation

Bifidobacteria and fructo-oligosaccharides (FOS)

Health benefits of Synbiotics

• Improved survival of live bacteria in food products, prolonged shelf life
• Increased number of ingested bacteria reaching the colon in a viable form
• Stimulation in the colon of the growth and implantation of both exogenous and endogenous bacteria
• Activation of metabolism of beneficial bacteria, antagonistic toward pathogenic bacteria