Gut Flora in Breast Fed vs Formula Fed Babies

Dr. Sanjay Agrawal
Leading Pharmaceutical consultant and editor-in chief of IJMToday

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


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
Name Obtained from/manufactured by
Inulin Extraction from chicory root, Wheat, Banana, Onions, Garlic, Leek
Fructo-oligosaccharides Tranfructosylation from sucrose, or hydrolysis of chicory inulin
Galacto-oligosacchaides Produced from lactose by b-galactosidase, Milk
SOS (soy-oligosaccharides Extracted from soya bean whey
XCOS (xylo-oligosucharides) Enzymic hydrolysis of xylan
MAO (isomalto oligosacchmides) Transgalaaosylaion of maltose
Pyrodextrins Pyrolysis ofpotato or maize starch

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

Prebiotics Probiotics
Prebiotics are defined as nonliving non• digestible special form of fiber or carbohydrates. Probiotics are referred to as live active microorgeniems tb,. when administered in adequate amount will have beneficial effects to its host.
The powder form of prebiotics can survive heat, cold, acid more fragile. vulnerable to heat. may be killed over time
Prebiotics perform their role by nourishing the bacteria that live M the intestines Probiotics fight the harmful bacterial species present in she gut.

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.


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

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