Probiotics The Best of The Bugs Theresa Greenwell Scientific Research Associate Market America

The statements in this presentation have not been evaluated by the Food and Drug Administration. Probiotics are not intended to diagnose, treat, cure or prevent any disease.

Probiotics “Live microorganisms that, when consumed in adequate amounts, confer a health benefit on the host.” -The World Health Organization (WHO) and the Food and Agriculture Association (FAO)

Dr. Eli Metchnikoff ‘Father of Immunology’ Received Nobel Prize 1908 First scientist to discover health benefits of probiotics

Probiotics Probiotics means ”for life” in Latin Probiotics are often live bacteria with health benefits 10x more bacterial cells in the human body than there are human tissue cells Gastrointestinal tract is largest immune organ in human body (80% of Immune System)

Probiotics- A Quick Overview Bacteria that live in the gastrointestinal tract known as microflora Often referred to as the "friendly", "beneficial", or "good" bacteria Symbiotic relationship with their human host Human provides food (nutrition) and shelter to bacteria; bacteria provide their host with a variety of benefits Contribute to the health and microflora balance of the intestinal tract

Microflora Distribution in Gut

Interesting Facts Colonization occurs at birth with similar species to maternal species Specific organisms vary during first year Become established by 1 year In children and adults, “successful” use of probiotics leads to temporary colonization only Levels of beneficial bacteria constantly need to be replenished *Source: Probiotics Rescue, Allison Tannis, 2008 p.3

Probiotic Benefits Immune support Help metabolize food and the absorption of nutrients Better nutrition from improved absorption of vitamins & minerals Help internal generation of important vitamins Improve acid and bile tolerance Gut colonization Bowel regularity (improvements in constipation or diarrhea) Promote overall GI health

Probiotics in Action Probiotics Strengthen the immune system Inhibit adhesion of pathogen cells Produce surface- active substances Produce hydrogen peroxide Inhibit growth of pathogen cells acids Produce bacteriocins Inhibit growth of pathogens Work as co-aggregation molecules Block the spread of pathogens Strengthen the immune system Modulates cytokine production Probiotics

Why Is There A Need? Thousands of people have depleted levels of good bacteria When good bacteria are depleted- digestion, absorption, and the production of nutrients are affected When good bacteria are depleted- the overgrowth of harmful bacteria can occur 60 – 70 million people (adults & children) in the U.S. are afflicted with digestive problems

Influences On ‘Good’ Bacteria Disease or illness Medications Unhealthy lifestyle habits Smoking Excessive alcohol Poor diet High in meats and fats Low fiber intake Eating Processed Food Decreases friendly bacteria Fewer good natural bacteria Low fiber Stress Environmental and Emotional

What is a CFU? What is a CFU? CFU = Colony Forming Units One CFU = one live bacteria cell “Live” defined as being able to multiple and thereby form a colony

Probiotics: Proposed Uses Diarrhea Constipation Gastrointestinal conditions (IBS, Crohn’s, ulcerative colitis) Bacterial vaginosis Yeast-overgrowth Recurrent UTI’s Atopic diseases Immune system enhancement (esp. AIDS, MS, lupus, rheumatoid arthritis) Hellicobacteria (H pylori) infections Dental caries Cardiovascular risk and cholesterol reduction And much more…..

Lactobacillus acidophilus One of the most highly studied and widely used strains Found in yogurts and cheeses Resides primarily in the small intestine and vagina Produces vitamin K, lactase, B vitamins (folic acid, B6, B3) and natural antibiotics (lactocidin & acidophilin)

Lactobacillus acidophilus In the intestinal tract Stimulates protective mucus production Inhibits pathogenic bacteria Studies have shown that it can help to improve digestive functions and boost the immune system Facilitates digestion in lactose-intolerant subjects

Lactobacillus acidophilus Research In Children Oral administration, in conjunction with standard therapy (topical steroid ointment) significantly improved symptoms of atopic dermatitis in Japanese children. -Torii, S., et al. Effects of oral administration of Lactobacillus acidophilus L- 92 on symptoms and serum markets of atopic dermatitis in children. International Archives of Allergy and Immunology. 154(3): 236-245, 2011. Daily dietary probiotic supplementation for 6 months reduced the occurrence and duration of fever, running nose and cough, antibiotic prescription use, as well as the number of missed school days attributable to illness, for 3-5 years of age. - Leyer, G., et al. Probiotic effects on cold and influenza-like symptoms incidence and duration in children. Pediatrics. 124(2): 172-179, 2009. Lactobacillus acidophilus and Bifidobacterium bifidum shortened the duration of diarrhea and hospital stay, and normalized stool frequency of acute diarrhea in young children. - Kianifar, H., et al. Probiotics in the treatment of acute diarrhea in young children. Pediatrics. 34(3): 204-207, 2009.

Lactobacillus acidophilus Research In Children The administration of live or killed probiotic for 2 weeks can decrease the results of a BHT in children with lactose malabsorption. -Rampengan, N., et al. Comparison of efficacies between live and killed probiotics in children with lactose malabsorption. The Southeast Asian Journal of Tropical Medicine and Public Health. 41(2): 474-481, 2010. After administration of probiotics, 37% of preterm infants had good colonization in the GI tract and improved feeding tolerance. -Lee, S., et al. Effects of probiotics on enteric flora and feeding tolerance in preterm infants. Neonatology. 91(3): 174-179, 2007.

Lactobacillus acidophilus Research In Adults Probiotics twice a day improved symptoms of bloating in patients with functional bowel disorders (FBDs). Data supports role for probiotic bacteria in the management of FBDs. -Ringel-Kulka, T., et al. Probiotic Bacteria Lactobacillus acidophilus NCFM and Bifidobacterium lactis Bi-07 Versus Placebo for the Symptoms of Bloating in Patients With Functional Bowel Disorders: A Double-blind Study. Journal of Clinical Gastroenterology. 45(6): 518-525, 2011. 40 patients with irritable bowel syndrome (IBS), after 4 weeks of supplementation, had reduced scores for abdominal pain or discomfort. -Sinn, D., et al. Thereapeutic effect of Lactobacillus acidophilus- SDC 2012, 2013 in patients with irritable bowel syndrome. Digestive Diseases and Science. 53(10): 2714-2718, 2008. Prenatal and postnatal supplementation with probiotics mixture is an effective approach in preventing the development of eczema in infants at high risk of allergy during the first year of life. -Kim, J., et al. Effect of probiotic mix (Bifidobacterium bifidum, Bifidobacterium lactis, Lactobacillus acidophilus) in the primary prevention of eczema: a double-blind, randomized, placebo-controlled trial. Pediatric Allergy and Immunology. 21(2p2): e386- e393, 2010.

Lactobacillus acidophilus Research In Adults Ingestion of L. acidophilus by type 2 diabetics (45 males) for 4 weeks resulted in insulin sensitivity preservation when compared with placebo. -Andreason, A., et al. Effects of Lactobacillus acidophilus NCFM on insulin sensitivity and the systemic inflammatory response in human subjects. British Journal of Nutrition. 104(12): 1831-1838, 2010. The daily administration of a lactobacilli-fermented milk was safe and effective in the prevention of antibiotic-associated diarrhea in hospitalized patients. -Beausoleil, M., et al. Effect of a fermented milk combining Lactobacillus acidophilus CL1285 and Lactobacillus casei in the prevention of antibiotic-associated diarrhea: A randomized, double-blind, placebo-controlled trial. The Canadian Journal of Gastroenterology.. 21(11): 732- 736, 2007.

Lactobacillus rhamnosus One of the most extensively researched strains One of the most abundant bacteria in the intestinal tract – prolific growth Very stable over a wide range of temperatures and pH levels Resistant to stomach acids and bile salts

Lactobacillus rhamnosus Relieves hypersensitivity reactions and intestinal conditions in individuals with eczema and food allergies Enhances immune system's resistance Inhibits the adhesion and growth of pathogens Beneficial in treating and preventing diarrhea

Lactobacillus rhamnosus Research In Children Results showed less dental caries and significantly reduced risk of caries. The effect was particularly clear in the 3– to 4–year–olds. -Pessi, T., et al. Effect of long-term consumption of a probiotic bacterium, Lactobacillus rhamnosus GG, in milk on dental caries and caries risk in children.. Caries Research. 35(6): 412-420, 2001. Enhanced interleukin-10 (IL-10) generation by host immune cells substantiates the anti-inflammatory properties of specific probiotic bacteria strains while providing an additional reason for considering such treatments for children with intestinal inflammation. -Rubzcznski, M., et al. Interleukin-10 generation in atopic children following oral Lactobacillus rhamnosus GG. The Southeast Asian Journal of Tropical Medicine and Public Health. 41(2): 474-481, 2010.

Lactobacillus rhamnosus Research In Children LGG significantly reduces the frequency and severity of abdominal pain in children with IBS; this effect is sustained and may be secondary to improvement of the gut barrier. -Magista, A., et al. A randomized controlled trial of Lactobacillus GG in children with functional abdominal pain. Pediatrics. 126(6): e1445-e1452, 2010. Administration of L. rhamnosus (strains E/N, Oxy and Pen) to children receiving antibiotics reduced the risk related diarrhea. -Pessi, T., et al. Clinical trial: effectiveness of Lactobacillus rhamnosus (strains E/N, Oxy and Pen) in the prevention of antibiotic-associated diarrhoea in children. Alimentary Pharmacology & Therapeutics. 28(1): 154-161, 2008.

Lactobacillus rhamnosus Research In Adults Study showed efficacious use of lactobacilli and antibiotic in the eradication of bacterial vaginosis (BV). -Anukam, K., et al. Augmentation of antimicrobial metronidazole therapy of bacterial vaginosis with oral probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14: randomized, double-blind, placebo controlled trial. Microbes and Infection. 8: 1450-1454, 2006. Test subjects experienced a significant decrease in the levels of serum total cholesterol and triglycerides. Lactobacillus p. may help to regulate the blood lipid levels of hyperlipidemia subjects. -Hong, J., et al. Auxiliary effects of Lactobacillus plantarum ST-Ⅲ strain on blood lipids regulation. Pharmaceutical Care and Research. 2, 2010.

Lactobacillus plantarum Comes from the ingestion of vegetables; vegetable in origin Synthesizes: Vitamins K, A, B1, B2, B3, B5, and B6 Short chain fatty acids L-lysine (amino acid w/ anti-viral activity) Lactolin (natural antibiotic)

Lactobacillus plantarum Especially good for treating and preventing: GI pathogens GI related conditions Diarrhea Allergies Enhances the immune system functions: Stimulates production of immune cells Promotes repair of damaged cells

Lactobacillus plantarum Research in Children Feeding autistic children Lactobacillus p. significantly increased healthy bacteria counts, while significantly reducing pathogenic bacteria. Results indicated significant differences in stool consistency and behavior scores compared to baseline. -Parracho, H., et al. A double-blind, placebo-controlled, crossover-designed probiotic feeding study in children diagnosed with autistic spectrum disorders. Journal of Probiotics and Prebiotics. 5(2): 69-74, 2010. The mean number of watery stools (diarrhea) per day was significantly lower in the group of children receiving probiotics. -Szymariski, H., et al. Bifidobacterium longum PL03, Lactobacillus rhamnosus KL53A, and Lactobacillus plantarum PL02 in the Prevention of Antibiotic-Associated Diarrhea in Children: A Randomized Controlled Pilot Trial. Digestion. 78:13-17, 2008.

Lactobacillus plantarum Research in Adults Probiotic treatment increased immune response, reduced infections, and lowered the mortality in elderly patients in a residential facility. -Marie, J., et al. A mixture of Lactobacillus plantarum CECT7315 and CECT7316 enhances systemic immunity in elderly subjects. A dose response, double-blind, placebo-controlled, randomized pilot trial. Nutricion Hospitalaria. 26(1): 228-235, 2011. L. plantarum decreased several immune markers related to allergy, and may have the potential to alleviate the severity of seasonal allergy symptoms. -Snei, J., et al. Strain-specific immunomodulatory effects of Lactobacillus plantarum strains on birch-pollen-allergic subjects out of season. Clinical & Experimental Allergy. 41(2): 232-242, 2011.

Lactobacillus plantarum Research in Adults 4 weeks of treatment with Lactobacillus plantarum was shown to be very effective for the relief of symptoms, particularly abdominal pain and bloating in IBS patients. -Prabha, D., et al. Evaluation of Lactobacillus plantarum 299v efficacy in IBS: results of a randomized placebo-controlled trial in 200 patients. Gastroenterology. 138(5, Supplement 1): s617-s617, 2010.

Points to Ponder Probiotics are more popular than ever before Research to support use is growing Good for adults and children In the future we may be using probiotics as we use many medications today: with specific strains used for certain clinical situations