Probiotics
More details and specifics on probiotics
Ever since Louis Pasteur formulated the germ theory of disease in the late 1800s, humans have been locked in mortal combat with microorganisms. The zealous use of antibiotics, disinfectant chemicals and sanitary packaging attests to our fear and loathing of all things microbial. In this age of antisepsis, it seems ironic that each of our intestinal tracts harbors tens of trillions of bacteria. This number, by some estimates, exceeds the total number of cells making up the human body. Even more ironic is that many of these bacteria are beneficial. Probiotic-or life-enhancing-organisms within the intestinal tract perform such a wide variety of physiological functions that they have been likened to an accessory organ.

To understand how probiotics influence health, it is important to understand how they function within the intestinal tract. The following is an overview of several major characteristics and functions of probiotic organisms.

Pathogen antagonism
Perhaps the most important function of probiotic organisms is to limit the growth of pathogenic organisms. These potentially harmful microbes naturally reside in the human intestinal tract but do not overpopulate when sufficient numbers of probiotic organisms are present. Probiotic bacteria not only compete with these pathogens for nutrients and space, they also secrete substances-lactic acid and other organic acids, hydrogen peroxide, and potent antibiotic agents known as bacteriocins-that inhibit the growth of harmful organisms.1,2 Many studies demonstrate the ability of probiotics to antagonize pathogenic microbes3,4 and treat the intestinal infections caused by these harmful organisms. 5-7

Lactobacillus bacteria reside mainly in the small intestine, bifidobacteria in the large.

Food digestion
Probiotic organisms contribute to the digestive process by secreting enzymes that help break down foods.8,9 Probiotics help digest food in the gut in the same way they partially digest the carbohydrates, proteins and fats in milk to create yogurt (in fact, people who are lactose intolerant can often tolerate yogurt because the lactose has already been partially broken down). Improved digestion can benefit anyone with impaired secretion of hydrochloric acid, bile, and pancreatic or intestinal enzymes.

Short-chain fatty acid (SCFA) production.

Among the most important by-products of probiotic metabolism are SCFAs. SCFAs, such as lactic acid, provide up to 70 percent of the energy required by intestinal epithelial cells and have been used therapeutically for disorders such as inflammatory bowel disease.10 Intestinal cells appear less capable of being a protective barrier without the energy provided by SCFAs.

SCFAs provide additional health benefits by making intestinal pH more acidic. Because most intestinal pathogens do not grow well in an acidic environment, their populations are kept in check. In addition, lower intestinal pH facilitates absorption of minerals such as calcium, magnesium and zinc.11,12 Lowering intestinal pH may also help lower colon-cancer risk. Studies have shown that low-risk groups typically have a lower fecal pH, while high-risk groups tend to have a higher fecal pH. 13,14

Immune enhancement
Probiotic flora have a profound effect on immune function by enhancing both the cell-mediated and humoral branches of the immune system. Research studies show that probiotic organisms increase numbers of circulating white blood cells,15 stimulate phagocytosis,16 elevate levels of antigen-specific antibodies17 and increase production of such cytokines as gamma-interferon.18 One recent Lancet study of 4,718 women associates low levels of lactobacilli in the vaginal tract with increased incidence of HIV-1 in younger women.19 Findings like these drive home the importance of maintaining healthy flora to ensure proper immune function.

Food-allergy reduction
The intestinal lining prevents movement of toxic/allergenic materials into the bloodstream. An imbalance of intestinal flora can contribute to increased intestinal permeability-the so-called "leaky gut syndrome." Intestinal hyperpermeability has been implicated in a variety of diseases including hypersensitive reactions to foods. 20 A recent landmark study in the Journal of Allergy and Clinical Immunology made clear the connection between intestinal flora and food allergy. Using a strain of Lactobacillus rhamnosus, researchers observed clinical improvements in a test group of 10 infants with food-allergy-related dermatitis. After a one-month trial, infants on the probiotic supplement showed significant improvements in their condition compared to infants given placebo. The authors conclude that enhanced intestinal barrier function leading to decreases in antigen translocation were responsible for the clinical improvements seen in the infants. 21

Anti-carcinogenic activity
Research is uncovering anti-carcinogenic activities that can be partially explained in terms of functions already discussed, such as lowering intestinal pH, reducing populations of toxin-producing bacteria, and enhancing immune function. The organic acids produced by probiotics also have a mildly stimulating effect on gut peristalsis,22 hastening the removal of potentially carcinogenic toxins from the intestinal tract. Recent research has even shown that cell-wall components of certain probiotic organisms may promote specific immunological activity against malignant cells.23 In one animal study, Bifidobacterium longum was shown to inhibit mammary and liver carcinogenesis.24 This study is exciting because it suggests the anti-carcinogenic activity of probiotics may extend beyond the intestinal tract.

Choosing the right probiotic
Helping customers choose a probiotic supplement can be tricky. Numerous products are on the market, all packaged differently, promising different benefits, containing different types and numbers of organisms, and all with different price tags. To make sense of the array of products, advise customers to consider the following:

Species
The most reliable and well-researched probiotic organisms belong to either the lactobacillus or bifidobacteria genera. I recommend products that contain one or more species from both genera for coverage in both the small and large intestine (see sidebar). Other beneficial species include Streptococcus thermophilus (an organism frequently found in yogurt) and Enterococcus faecium (not to be confused with the pathogenic Enterococcus faecalis). Products containing these organisms can be helpful but should also contain lactobacillus and bifidobacteria species.

Refrigeration
A recent study by the National Nutritional Foods Association in Newport Beach, Calif., found that about 50 percent of the probiotics available in retail stores contained significantly fewer viable bacteria than claimed on the label. 25 A big part of this problem is lack of refrigeration or lack of technology that is involved in making a probiotic that needs less refrigeration. Recent technology has found ways to allow probiotics to withstand short term periods outside the cold with no lack in quality or effectiveness. This does not mean non-refrigerated organisms will die immediately, but over the course of weeks or months, and especially at warmer temperatures, significant numbers of probiotic organisms will die.

Desiccants
Another factor that leads to rapid die-off in powdered probiotic products is moisture. Exposure to moisture occurs every time the container is opened. To help minimize moisture damage, some manufacturers add a small desiccant bag to the product. If the probiotic you sell does not contain a desiccant, I recommend you either carry another product, call the company and recommend they adopt this inexpensive practice or recommend customers add their own desiccant to the product after opening it. Desiccant can be found at some photographic equipment stores or industrial supply houses.

Stability
Freeze-drying is another method of maintaining product stability. This process, also called lyophilization, is a standard, accepted practice in the probiotics industry. Properly done it does not cause significant harm to the organisms. Products that are not freeze-dried, such as liquid probiotics supplements or yogurt, have a much shorter shelf life. If your customers think it will take longer than a few weeks to finish the supplements, recommend they purchase a powdered, freeze-dried product.

Potency
Probiotics are usually measured in numbers of organisms per gram. High-potency products typically contain 4 billion or more organisms per gram. If the product is encapsulated, the label should provide some indication of how many organisms each capsule contains. An expiration date on the label should indicate how long the product will retain its stated potency.

Fructo-oligosaccharides
Some probiotic products contain a type of non-digestible carbohydrate known as fructo-oligosaccharides (FOS). I believe these products have a distinct advantage over other products. FOS can be considered a prebiotic-a nutritional substance that preferentially feeds probiotic organisms, enabling them to outpace the pathogens and, ultimately, leads to a beneficial balance of good and bad flora. FOS are so effective at increasing numbers of intestinal bifidobacteria that some researchers believe taking a prebiotic is as effective at replenishing intestinal flora as is taking a probiotic. 26

Probiotic dosage tailored to the client
Once your customers have decided which product to buy, they'll probably want to know how to take it. How a probiotic is taken depends on why it is being taken. If the primary reason for taking the probiotic is to aid digestion, it should be taken with meals. But if the goal is to have the probiotic reach the lower intestinal tract, I recommend it be taken between meals with a full glass of water because water dilutes the acids of the stomach and moves the organisms quickly into the intestinal tract. Of course, probiotics can be used for both purposes by taking some with meals and some between meals.

The next question you are likely to hear is how much to take. Since probiotics are generally nontoxic, the dose can vary widely, but here are some guidelines to recommend. If the probiotic is being taken for maintenance or preventive purposes, a reasonable dose would be between 1 billion organisms two or three times weekly and 4 billion organisms daily. For therapeutic purposes, such as fighting an intestinal infection, coping with an illness, or after a course of antibiotics, an effective dose would be 5 billion to 10 billion organisms two or three times daily. These doses are for adults and children older than 12. For younger children, recommend your customer consult with a health care practitioner.

Given their broad spectrum of benefits, it seems likely that probiotic supplements will one day be considered as important to daily nutrition as vitamins, minerals and antioxidants.

Bacterial Strains
Of the estimated 400 species of bacteria living within the intestinal tract, the most important to human health belong to two genera: lactobacillus and bifidobacteria. Lactobacillus organisms reside mainly in the small intestine, bifidobacteria in the large. The lactobacillus genus contains approximately 60 species, including such organisms as L. acidophilus, L. plantarum, L. casei and L. rhamnosus. Members of the bifidobacteria genus include B. longum, B. bifidum and B. infantis. Many lactobacillus species used to be classified simply as L. acidophilus, thus "acidophilus" has become almost synonymous with probiotic organisms. Similarly, bifidobacteria used to be collectively referred to as Lactobacillus bifidus, but with improved microbiological differentiation, they have since been assigned their own genus. Probiotic organisms can also be found in several other genera, including enterococcus, bacillus and even streptococcus.

References
2. Holo H, et al. Isolation and characterization of two bacteriocins of Lactobacillus acidophilus LF221. Appl Microbiol Biotechnol 1998; 49(5):606-12.
3. Apella MC, et al. In vitro studies on the inhibition of the growth of Shigella sonnei by Lactobacillus casei and L. acidophilus. J Appl Bacteriol 1992; 73(6):480-3.
4. Rani B, et al. Probiotic fermented food mixtures: possible applications in clinical anti-diarrhea usage. Nutr Health 1998; 12(2):97-105.
5. Siitonen S, et al. Effects of Lactobacillus GG yogurt in prevention of antibiotic associated diarrhea. Ann Med 1990; 22(1):57-9.
6. Gupta K, et al. Inverse association of H2O2-producing lactobacilli and vaginal Escherichia coli colonization in women with recurrent urinary tract infections. J Infect Dis 1998; 178(2):446-50.
7. Jack M, et al. Evidence for the involvement of thyocyanate in the inhibition of Candida albicans by Lactobacillus acidophilus. Microbios 1990; 62:37-46.
8. Hegazi FZ, et al. Proteolytic activity of crude cell-free extract of Lactobacillus casei and Lactobacillus plantarum. Nahrung 1987; 31(3):225-32.
9. el-Sawah MM, et al. Enzymatic properties of lipase and characteristics production by Lactobacillus delbrueckii subsp. bulgaricus. Antonie Van Leeuwenhoek 1995; 67(4):357-62.
10. Cummings JH, et al. Role of intestinal bacteria in nutrient metabolism. Clinical Nutr 1997; 16:3-11.
11. Scharrer E, et al. Effects of short-chain fatty acids and K on absorption of Mg and other cations by the colon and caecum. Z Ernahrungswiss 1990; 29:162-8.
12. Lopez HW, et al. Intestinal fermentation lessens the inhibitory effects of phytic acid on mineral utilization in rats. J Nutr 1998; 128(7):1192-8.
13. Segal I, et al. Fecal short chain fatty acids in South African urban Africans and whites. Dis Colon Rectum 1995; 38(7):732-4.
14. Kashtan H, et al. Manipulation of fecal pH by dietary means. Prev Med 1990; 19(6):607-13.
15. De Simone C, et al. Effect of Bifidobacterium bifidum and Lactobacillus acidophilus on gut mucosa and peripheral blood B lymphocytes. Immunopharmacol Immunotoxicol 1992; 14(1-2):331-40.
16. Moineau S, et al. Effect of feeding fermented milks on the pulmonary macrophage activity in mice. Milchwissenschaft 1991; 46(a):551-4.
17. Isolauri E, et al. Improved immunogenicity of oral Dx RRV reassortant rotavirus vaccine by Lactobacillus casei GG. Vaccine 1995; 13(3):310-2.
18. De Simone C, et al. The role of probiotics in modulation of the immune system in man and in animals. Int J Immunother 1993; IX(1):23-8.
19. Sewankambo N. HIV-1 infection associated with abnormal vaginal flora morphology and bacterial vaginosis. Lancet 1997; 350(9077):546-50.
20. Galland L. Intestinal toxicity: new approaches to an old problem. Alt Comp Therapy 1997 Aug: 288-95.
21. Majamaa H, et al. Probiotics: a novel approach in the management of food allergy. J Allergy Clin Immunol 1997; 99(2):179-85.
22. Kasper H. Protection against gastrointestinal diseases-present facts and future developments. Int J Food Microbiol 1998; 41(2):127-31.
23. Miller-Catchpole R. Bifidobacteria in clinical microbiology and medicine. In: A. Bezkorcvainy, editor. Biochemistry and physiology of bifidobacteria. Boca Raton (FL): CRC Press; 1989. p 179-99.
24. Reddy BS, et al. Inhibitory effect of Bifidobacterium longum on colon, mammary, and liver carcinogenesis induced by 2-amino-3methylimidazol-[4,4-f]quinoline, a food mutagen. Cancer Res 1993; 53(17):3914-8.
25. National Nutritional Foods Association. Minutes of the Probiotics Interest Group Meeting. Las Vegas, NV, 1993.
26. Gibson GR, et al. Dietary modulation of the human colonic microbiota: introducing the concept of prebiotics. J Nutr 1995; 125(6):1401-12.

Probiotics, Pg2