Probiotics – Friendly Bacteria with a Host of Benefits

“Let food be thy medicine and medicine be thy food,” the age-old quote by Hippocrates, is certainly the
tenet of today. With the growing interest in self-care and integrative medicine coupled with our health-
embracing baby boomer population, recognition of the link between diet and health has never been
stronger. As a result, the market for functional foods, or foods that promote health beyond providing basic
nutrition, is flourishing. Within the functional foods movement is the small but rapidly expanding arena
of probiotics – live microbial food supplements that beneficially affect an individual by improving
intestinal microbial balance. The consumers’ overwhelming interest in and demand for functional foods,
including probiotics, make it imperative that health professionals stay abreast of the latest research
findings and available products. This monograph provides a summary of research on the health benefits of
probiotics and offers practical information to help the clinician make appropriate recommendations to clients.

History
Microbial cultures have been used for thousands available in a variety of food products and
of years in food and alcoholic fermentations, and supplements. In the United States, food products
in the past century have undergone scientific containing probiotics are almost exclusively dairy
scrutiny for their ability to prevent and cure a products – fluid milk and yogurt – due to the
variety of diseases. This has led to the coining of historical association of lactic acid bacteria with
the term probiotics, or “pro-life.” The first clinical fermented milk. The most frequently used bacteria
trials in the 1930s focused on the effect of in these products include the Lactobacillus and
probiotics on constipation, and research has Bifidobacterium species. Table 1 lists other
steadily increased since then. Today probiotics are commercially available probiotic species.

Nutritional Effects
Table 2 lists some of the alleged health benefits S. thermophilus. Because diarrhea is a major
of consuming probiotics. Those that have cause of infant death worldwide and can be
significant research to back up the claims are incapacitating in adults, the widespread use of
discussed in more depth below. probiotics could be an important, non-invasive
Intestinal tract health means to prevent and treat these diseases,
particularly in developing countries. Probiotic
A number of studies have found probiotic bacteria have also been shown to preserve
consumption to be useful in the treatment of many intestinal integrity and mediate the effects of
types of diarrhea, including antibiotic-associated inflammatory bowel diseases, irritable bowel
diarrhea in adults, travellers’ diarrhea, and syndrome, colitis, and alcoholic liver disease (4-
diarrheal diseases in young children caused by 6). In addition, lactic acid bacteria may improve
rotaviruses (1-3). The most commonly studied intestinal mobility and relieve constipation,
probiotic species in these studies have been particularly in seniors (7).
Lactobacillus GG, L. casei, B. bifidum and

Nutrient synthesis and bioavailability

Fermentation of food with lactic acid bacteria has dietary nutrients such as protein and fat (10).
been shown to increase folic acid content of Short-chain fatty acids such as lactic acid,
yogurt, bifidus milk and kefir and to increase propionic acid and butyric acid produced by lactic
niacin and riboflavin levels in yogurt, vitamin B12 acid bacteria may help maintain an appropriate pH
in cottage cheese and vitamin B6 in Cheddar and protect against pathological changes in the
cheese (8,9). In addition to nutrient synthesis, colonic mucosa.
probiotics may improve the digestibility of some

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Immune system
Evidence from in vitro systems, animal models killer cell activity, and/or increasing levels of
and humans suggests that probiotics can enhance immunoglobulins (11). In spite of limited testing
both the specific and nonspecific immune in humans, these results may be particularly
response, possibly by activating macrophages, important to the elderly, who could benefit from
increasing levels of cytokines, increasing natural an enhanced immune response.

Lactose intolerance
Several lines of evidence show that the stomach. Because lactose intolerance affects
appropriate strains of lactic acid bacteria, such as almost 70% of the population worldwide,
S. thermophilus, L. bulgaricus and other consumption of these products may be a good way
lactobacilli in fermented milk products, can to incorporate dairy products and their
alleviate symptoms of lactose intolerance by accompanying nutrients into the diets of lactose
providing bacterial lactase to the intestine and intolerant individuals.

Allergy
Probiotics may exert a beneficial effect on allergic associated with milk protein (12). Probiotic
reaction by improving mucosal barrier function. consumption may thus be a means for primary
In addition, probiotic consumption by young prevention of allergy in susceptible individuals.
children may beneficially affect immune system This could play a key role in minimizing allergy
development. Probiotics such as Lactobacillus GG at a time when the prevalence of allergic disease
may be helpful in alleviating some of the in Western societies has increased dramatically
symptoms of food allergies such as those over the past 40 years.

Cancer
Studies of the effect of probiotic consumption on increased recurrence-free period in subjects with
cancer appear promising. Animal and in vitro bladder cancer (13). Results, however, are too
studies indicate that probiotic bacteria may reduce preliminary to develop specific recommendations
colon cancer risk by reducing the incidence and on probiotic consumption for preventing cancer in
number of tumors. One clinical study showed an humans.

Future Implications
There is considerable potential for the benefits of probiotics consumption over a wide range of clinical
conditions. On-going research will continue to identify and characterize existing strains of probiotics,
identify strain-specific outcomes, and determine optimal doses needed for certain results. According to
Barry Goldin, Ph.D., professor at Tufts University School of Medicine, “The full potential of probiotics
can only be realized when their benefits can be established scientifically. It is highly likely that benefits
from current and future probiotics have gone undetected and, therefore, full utilization of these organisms
has not been achieved.”
Daniel O’Sullivan, Ph.D, assistant professor in the Department of Food Science and Nutrition at the
University of Minnesota, says regarding yogurt consumption, “At best, your intestinal health is greatly
improved and the immune system is strengthened. At worst, there are no adverse effects and you get some
nutrients in the bargain.”
With the current focus on disease prevention and the quest for optimal health at all ages, the probiotic
market potential is enormous. Health professionals are in an ideal position to help guide their clients
toward appropriate prophylactic and therapeutic uses of probiotics that deliver the desired beneficial
health effects.

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Commonly asked Questions & Answers on Probiotics
Q: Is it better to get probiotics from foods or from supplement sources?
Foods are a better choice due to the synergistic effect between components of foods and
probiotic cultures. The natural buffering of stomach acid by food also enhances the
stability of consumed probiotics. Dairy products containing probiotics provide a number
of high quality nutrients including calcium, protein, bioactive peptides, sphingolipids, and
conjugated linoleic acids. Taking supplements, although convenient, has always posed
the problem of long-term compliance, whereas incorporating foods containing probiotics
into daily food choices can become a lifestyle habit.

Q: What level of probiotic consumption is needed to realize the desired benefits?

Many studies of probiotic bacteria on physiological effects such as diarrhea, lactose
intolerance, and colon cancer biomarkers show an effect using a daily dose of 109 – 1010
organisms per day. This corresponds to an intake of about 3-1/2 cups of acidophilus milk
or yogurt per day, formulated at the typical level of 2 x 106 cfu/ml. Effects of consuming
lower levels have not been documented in research studies but may also be beneficial.
Encourage your clients to check labels or contact the manufacturer to determine levels of
probiotics that specific products provide.

Q: How long does one need to take probiotics for the effects to last?
It is believed that most probiotics do not permanently adhere in the intestine, but exert
their effects as they metabolize and grow during their passage through the intestine
(colonization). Thus, daily consumption of these bacteria is probably the best way to
maintain their effectiveness.

Q: What are some good food sources of probiotics?

Yogurt and milk to which probiotic bacteria have been added, such as acidophilus milk,
and fermented milk products, such as kefirs, are the primary food sources of probiotics in
the United States. Some researchers believe that a synergistic effect exists between
components in dairy foods and probiotic cultures, and that there are components in milk
that “turn on” the beneficial genes in probiotic bacteria, making dairy foods an excellent
vehicle for introducing these bacteria into the gut. Europe and Asia lead the rest of the
world in offering a variety of other food products containing probiotics. We will probably
see products such as probiotic-fortified energy bars, juices, cereals, and cheeses
introduced into the United States over the next few years as well.

Q: What kind of information on probiotics can be found on food labels?

The shelf life and species of probiotic bacteria included in dairy products are generally
listed on product labels. The specific strain and levels of viable cells, however, are not
typically shown. As the probiotic industry matures and the consumer requests more
detailed information, labeling will likely become more routine and even mandatory.
Major brand names generally can be counted on for higher reliability in formulation and
labeling of their products. On yogurt labels look for the “Live Active Culture” seal,
which assures the consumer that viable lactic acid bacteria are in the product. Yogurt
probably has the most reliable reported levels of probiotics due to its short shelf life and
because it is refrigerated.

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Table 1: Commercially used Table 2: Alleged health effects of probiotics
probiotic species
Intestinal effects
Lactobacillus species
! Relieve effects, promote recovery from diarrhea
L. acidophilus
(rotavirus, travelers’ and antibiotic-induced)
L. casei
! Produce lactase, alleviate symptoms of lactose
L. fermentum
intolerance and malabsorption
L. gasseri
! Relieve constipation
L. johnsonii
! Treat colitis
L. lactis
L. paracasei Immune system effects
L. plantarum ! Enhance specific and nonspecific immune response
L. reuteri ! Inhibit pathogen growth and translocation
L. rhamnosus ! Stimulate gastrointestinal immunity
L. salivarius ! Reduce chance of infection from common
Bifidobacterium species pathogens (Salmonella, Shigella)
B. bifidum Other effects
B. breve ! Reduce risk of certain cancers (colon, bladder)
B. lactis ! Detoxify carcinogens
B. longum ! Suppress tumors
Streptococcus species ! Lower serum cholesterol concentrations
S. thermophilus ! Reduce blood pressure in hypertensives
! Treat food allergies
! Synthesize nutrients (folic acid, niacin, riboflavin,
vitamins B6 & B12)
! Increase nutrient bioavailability
! Improve urogenital health
! Optimize effects of vaccines (e.g. rotavirus vaccine,
typhoid fever vaccine)

References
1. Siitonen S, Vapaatalo H, Salminen S, Gordin A, Saxelin M, Wikberg R, Kirkkola AL. Effect of Lactobacillus
GG yoghurt in prevention of antibiotic associated diarrhoea. Ann Med 1990;22:57-59.
2. Oksanen PJ, Salminen S, Saxelin M, Hamalainen P, Ihantola-Vormisto A, Muurasniemi-Isoviita L, Nikkari
S, Oksanen T, Porsti I, Salminen E. Prevention of travelers diarrhea by Lactobacillus GG. Ann Med
1990;22:53-56.
3. Isolauri E, Juntunen M, Rautanen T, Sillanaukee P, Koivula T. A human Lactobacillus strain (Lactobacillus
casei sp. Strain GG) promotes recovery from acute diarrhea in children. Pediatrics 1991;88:90-97.
4. Nanji AA, Khettry U, Sadrzadeh SMH. Lactobacillus feeding reduces endotoxemia and severity of
experimental alcoholic liver (disease). Proc Soc Exp Biol Med 1994;205:243-7.
5. Kruis W, Schutz E, Fric P, Fixa B, Judmaier G, Stolte M. Double-blind comparison of an oral Escherichia
coli preparation and mesalazine in maintaining remission of ulcerative colitis. Aliment Pharmacol Ther
1997;11:853-8.
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7. Seki M, Igarashi T, Fukuda Y, Simamura S, Kaswashima T, Ogasa K. The effect of Bifidobacterium cultured
milk on the "regularity" among an aged group. Nutr Foodstuff 1978;31:379-87.
8. Shahani KM, Chandan RC. Nutritional and healthful aspects of cultured and culture-containing dairy
foods. J Dairy Sci 1979;62:1685-94.
9. Alm L. Effect of fermentation on B-vitamin content of milk in Sweden. J Dairy Sci 1982;65:353-9.
10. Friend BA, Shahani KM. Nutritional and therapeutic aspects of lactobacilli. J Appl Nutr 1984;36:125-53.
11. Sanders ME. Probiotics. Food Technology 1999;53(11):67-77.
12. Majamaa H, Isolauri E. Probiotics: a novel approach in the management of food allergy. J Allergy Clin
Immun 1997;99:179-85.
13. Aso Y, Akazan H. Prophylactic effect of a Lactobacillus casei preparation on the recurrence of superficial
bladder cancer. Urol Int 1992;49:125-9.

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