Probiotics,

prebiotics,
and
symbiotic
Dr. Buthaina Alkhatib

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Introduction
• Various types of microorganisms, known as gut microbiota,
are inhabitants of the human
• gastrointestinal tract. It has been reported that there are
1010–1012 live microorganisms per gram in the human
colon.
• The resident microbial groups in the stomach, small, and
large intestine are crucial for human health.
• The majority of these microorganisms, which are mostly
anaerobes, live in the large intestine

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Probiotics
• The word “Probiotics” is derived from the Greek word meaning “for life”.
These are non-pathogenic live organisms when given in adequate amounts
will have beneficial effects on the hosts. Kollath in 1953 was the first one to
use this term. He claimed that different organic and inorganic supplements
can restore the health of malnourished patients.
• In 1962, Lily and Stillwell published an article in Science wherein they
added to the definition of probiotics: “substances secreted by one
microorganism which stimulates the growth of another.”
• Parker in 1974, described “probiotic” as not only microbial organisms, but
also ‘other substances’ that help in the intestinal microbial balance.

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4
Classification
and Selection
Criteria

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Probiotic Guidelines:
1. Probiotic organisms must be living;
2. Identify the organism(s) to species level;
3. Have proven safety data;
4. Show physiological benefits when using a defined viable
count of probiotics in a defined delivery vehicle (food, capsule
or whatever) in a defined patient population, controlled by a
placebo and/or standard therapy option if the end outcome is
treating a disease.

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 Strain identification

Guidelines (2) Strain characterization of safety and probiotic

to evaluate attributes

probiotics (3) Health benefits validation

in various (4) Labeling of potency claims and compositions for

food the entire shelf life.

products WHO, FAO, and EFSA (the European Food Safety

Authority) suggested that probiotic strains in their
selection process, must meet both safety and
functionality criteria, as well as those related to their
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technological usefulness
 (a)fermented foods

Commercial (b) supplements. Both dairy and

Forms vegetable origin belong to fermented
foods, with the most commonly known
of each being yogurt and sauerkraut,
respectively
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Mechanism of action of probiotic
• Probiotics affect epithelial cells, dendritic cells,
monocytes/ macrophages, T cells, and B cells of the
gastrointestinal tract differently.

• There are several mechanisms that may explain many of

their positive effects, such as: modifying gut pH,
antagonizing pathogens through the production of
antimicrobial compounds, competing for pathogen
binding and receptor sites as well as for available
nutrients and growth factors, stimulating
immunomodulatory cells, and producing lactase.

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Mechanism of action cont.
• Probiotics can also activate the immune response by secreting
immunoglobulins like IgA, or increasing the number of natural killer
cells, and even enhancing phagocytic activity of macrophages.
• Probiotics also digest food and compete for nutrients with pathogens.
Probiotics decrease programmed cell death in intestine and/or
increase the production of mucin.

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 Probiotic strains like Saccharomyces boulardi, Lactobacillus
rhamnosus GG are used in the prevention of antibiotic-
associated diarrhea.

Saccharomyces boulardii, Lactobacillus rhamnosus GG or both

Therapeutic can be used for preventing Clostridium difficile infection (CDI).

Uses of Lactobacillus rhamnosus GG, Saccharomyces boulardii

Probiotics prevent recurrence after first CDI.

A mixture of Lactobacillus rhamnosus GG, Saccharomyces

boulardii, Lactobacillus acidophilus cans eradicate
Helicobacter pylori completely. Escherichia coli Nissle 1917,
VSL#3 are helpful in treatment of Ulcerative Colitis.

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 Lactobacillus rhamnosus GG (LGG), Lactobacillus johnsonii
LA1 are used successfully in Crohn’s Disease.

Bifidobacterium infantis is prescribed in Irritable Bowel

Syndrome. Lactobacillus plantarum 299 can be taken in
Acute Pancreatitis.
Bifidusbacterium spp. and Lactobacillus acidophilus are
Cont. used in Necrotizing Enterocolitis successfully.

VSL is used to treat Multi-Organ Dysfunction Syndrome

(MODS).

Lactobacillus rhamnosus GG is given in ventilator

associated pneumonia, allergy and immune response

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Prebiotics
Dr. Buthaina Alkhatib

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 • They defined prebiotics as “a non-
digestive food ingredient that
beneficially affects the host by
selectively stimulating the growth
and/or activity of one or a limited
number of bacteria in the colon, and
thus improves host health.”
Introduction
• FAO/WHO defined prebiotics as non-
viable food component extending
health benefits of the host through
modulation of gut microbes.

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 Cont.
• Most of the prebiotics that are used as food supplements are plant products like
inulin, fructo-oligosaccharides, lactulose, dietary fiber and gums wherein Inulin
and trans-galactooligosaccharides (TOS) are the two more common prebiotics
used.
• These two occur naturally in foods like the garlic, onions, leeks, shallots,
asparagus, spinach, Jerusalem artichokes, chicory, peas, beans, lentils, oats and
bananas.
• Oligosaccharides are the best-known prebiotics.
• Other commonly used prebiotics are Fructo-oligosaccharides (FOS), Mannan-
oligosaccharides (MOS), Inulin, Lactulose, and Xylo-oligosaccharides (XOS).
• Among these, xylooligosaccharides is commercially available.

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Selection criteria

(1) The first criterion infers that

In order to meet the since prebiotics are not digested
definition of prebiotics, a (or just partially digested) in the
dietary substance should upper segments of the GIT, they
have three main reach the colon and are selectively
fermented by potentially beneficial
physiological properties: endogenous bacteria (a
requirement of the second
criterion).
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Selection criteria cont.

(3) The last criterion of the

(2) Selectively stimulating classification assumes that a
the growth and/or activity of prebiotic should be unaffected by
the intestinal bacteria is the food processing conditions
potentially associated with and remains unchanged, non-
health protection and degraded, or chemically
wellbeing and is considered unaltered and available for
bacterial metabolism in the
another criterion. intestine

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Mechanism of Action

• Prebiotics are the non-digestible or low-digestible

dietary substances that help the host by favoring the
beneficial bacteria growth than harmful bacteria
growth selectively in the colon.

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 Mechanism of Action

Prebiotics enhance the following:

(1) formation of short chain fatty acids (SCFA) and lactic acid as a
fermentation product
(2) growth of the probiotic bacteria with an increase in the level of
minerals like calcium, magnesium etc. in the colon
(3) the host immunity (IgA production, cytokine modulation, etc.)

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Commercial products

• The current foodstuffs that can be fortified with prebiotics

are the following: dairy products, beverages and health
drinks, spreads, infant formulae and weaning foods, cereals,
bakery products, confectionery, chocolates, chewing gum,
savoury products, soups, sauces and dressings, meat
products, dried instant foods, canned foods, food
supplements, animal feeds and petfoods
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Therapeutic uses of prebiotics
Prebiotics are antimicrobial, anticarcinogenic, hypolipidemic in nature with few
benefits in diabetes mellitus.
It also possesses glucose modulatory and antiosteoporotic properties.

It is successfully used for curing constipation and inflammatory bowel diseases.

It exerts favorable lipid effects by absorption and balance of minerals and also
may promote the absorption of minerals in colon.
In supplemented infant formulas, it benefits an infant who is not receiving the
mother’s milk.
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Synbiotics
Dr. Buthaina Alkhatib

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Introduction

• When a product contains both probiotics and prebiotics it is

termed as “synbiotics”. This word implies synergy i.e., acting
together.

• The combination might be more active in preventing GIT

disorders compared to a probiotic or prebiotic when used
alone. Synbiotics therefore, were developed so that the
prebiotic component helps the probiotic microorganism grow
and overcome possible survival difficulties.

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Introduction cont.

• Synergism also acts to provide more efficient

implantation in the colon of live microbial dietary
supplements as well as stimulating the growth of
probiotics. A probiotic needs its food and a prebiotic fuel
for its perfect survival in the GIT.

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 Synbiotics act in two
ways:
Mechanism of (1)by augmenting the ability
Action of probiotics

(2) By providing defined

benefits for health.
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 acting as antimicrobials in pyogenic inflammation
and anticancerous, anti-allergenic, antidiarrhoeal
activities.

Therapeutic
Actions They can also be used for prevention of
osteoporosis and reduction of fat in serum and
sugar in blood; for improving immunomodulative
ability like immune system regulation and brain
functions; reduce nosocomial infections after a
post-operative procedure; and improve hepatic
function in patients suffering from cirrhosis.

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 Gastroint
Health Benefits Immune
system
estinal
System
and Clinical
Applications of Reproduct Respirator
Probiotics, ive system y System

Prebiotics and
Cardiovas
Synbiotics Urinary
System
cular
System

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 Diarrhea

Health IBS

Benefits of IBD (UC and CD)

Probiotics, Lactose intolerance

Prebiotics and Diabetes

Synbiotics in Obesity

Various Cancer

Diseases Allergy and immunity

High BP and CVD.

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