What parents should know about probiotics

Has you child recently had a course of antibiotic? Is he or she under a lot of stress? Does you child feel excessively tired? Does your child suffer frequent colds or flues? If so, perhaps you should consider supplementing his/her diet with probiotics.

What are probiotic bacteria?

Usually when we think about bacteria we associate them with having detrimental effects on our health, causing numerous problems or diseases. But in fact, only a relatively small group of bacteria is responsible for inducing pathogenic conditions, while the remaining ones either remain neutral (saprophytic) or can even be beneficial to our health. Probiotic bacteria belong to the second group.

Probiotics are naturally occurring intestinal bacteria with numerous beneficial properties. There are two main groups of these bacteria: Lactobacillus, inhabiting the small intestine andBifidobacterium, residing in the large intestine (the colon).

The term “probiotic” microorganisms is based on the Greek expression“ pro bios”, meaning “for life”.

Currently, probiotic supplements are defined as: “Live microorganisms, indigenous to the human intestinal tract, which, when consumed in adequate amounts, improve the intestinal microbial balance and positively affect the functioning of the human intestinal tract and general health”.

What are the properties of probiotic bacteria?

Probiotics bacteria have an impressive number of health-promoting characteristics, the most important being:

1. To maintain a correct microbial balance in the human intestines;
2. To kill a large number of disease-causing bacteria, yeasts and viruses;
3. To stop diarrhoea and constipation;
4. To suppress inflammation of the epithelial tissue lining the internal wall of the intestines;
5. To maintain the integrity and functionality of the intestinal mucosa;
6. To stimulate (and control) the functions of the human immune system;
7. To produce a number of vitamins;
8. To alleviate the symptoms of lactose intolerance;
9. To improve the absorption of some nutrients;
10. To inactivate mutagens (substances inducing mutations) and carcinogens (substances inducing cancer);
11. To prevent some forms of colon cancer;
12. To lower the serum cholesterol level;
13. To prevent and treat some forms of food allergies;
14. To decrease flatulence.

The characteristics listed above have been confirmed in more than 180 clinical trials. No adverse effects were reported in any of the 7 526 subjects studied during the period from 1961 to 1998.

So, Do you suspect their immune systems are at a physical low? Maybe it’s time to add probiotics to their diet

Our skin and the mucosal surfaces of the nose, mouth and digestive tract, as well as certain parts of the urogenital tract, are covered by myriads of microorganisms, which although they compete for nutrients and space, live more or less in harmony with each other and with us. The highest number of bacteria and other microbes is found in the gut, particularly in the colon, where we “carry” on average 1,5 kg of pure bacteria, comprising about 500 different species.

The intact surfaces of our skin and mucosal membranes, as well as the correctly functioning immune system, do not allow this microflora to enter our bloodstream or internal organs. Such a “peaceful” and mutually beneficial coexistence between microorganisms and the host (the human body) is called symbiosis. It is mutually beneficial because we feed them and in turn they protect us (to a degree) from the invasion of harmful bacteria, viruses or fungi. An important group among the symbiotic microorganisms is a group of intestinal bacteria referred to as probiotic bacteria.

Until recently, the benefits associated with probiotic bacteria were considered predominantly with regard to their application for the treatment of various gastro-intestinal disorders. However, the results obtained in a number of recent clinical trials aimed at investigating the therapeutic role of probiotic bacteria in non-intestinal infectious/pathological conditions significantly altered this perception. The additional beneficial effects of probiotics are currently believed to include effects on the urogenital tract where these bacteria (or preparations based on them) have been found to restore the natural balance of the local microflora and possibly prevent the entry of a range of pathogens. It has been established that probiotic bacteria administered as oral or vaginal preparations are able to colonize the vaginal epithelium. Once established on the vaginal epithelium, probiotic microorganisms can prevent and inhibit infections within the urogenital tract. Their prophylactic effects are no longer questioned. Furthermore, on the basis of the evidence accumulated in a number of clinical trials in which the extent of their therapeutic potential has been evaluated, it appears that probiotics could provide a safe and convenient means to reduce recurrences of vaginosis, vaginitis and lower urinary tract infections – frequent problems for women.

How do probiotic bacteria suppress/control the pathogenic microflora?

One of the most effective mechanisms through which probiotic bacteria maintain our health and exert beneficial effects is their ability to prevent the invasion and/or control the growth of pathogenic bacteria. They achieve this control through:

1. The in situ production of various anti-microbial substances (lactic, acetic and butyric acids, hydrogen peroxide) and the production of a range of antibiotic-like compounds called bacteriocins (e.g. lactocin, acidocin);
2. Their ability to compete for space (competing for the receptor-binding sites on the intestinal and vaginal epithelium);
3. Their ability to compete for nutrients;
4. Their ability to adhere to epithelial cells, as well as to secrete compounds that prevent the adhesion of pathogens.

Through these mechanisms and if present in appropriate numbers, probiotic bacteria are able not only to prevent or limit the entry of intestinal and other pathogens (vaginal, urogenital), but also to control the growth of microbes in the human digestive tract and on other mucosal surfaces.

How do we acquire probiotic bacteria?

Following its development under completely sterile conditions in the mother’s womb, the newborn infant has to confront the highly contaminated and infected environment in which we all live. How does the infant deal with this harsh reality?

The skin, mouth and the digestive tract of the newborn are rapidly colonized by millions of microorganisms originating from the mother’s birth canal*), from her skin, as well as from the air and the hospital personnel.

Not all bacteria that come into contact with the infant will be able to colonize its body and a number of factors, such as the infant’s general health, his or her genetics and the degree of immunological protection conferred by the mother, will play an important role in determining the degree of such colonization. It has been established that, in general, microorganisms from the mother have a better chance of becoming firmly established within the infant’s body than those originating from the environment. Furthermore, those that are initially established remain there for much longer that those acquired at a later stage. So it follows that if they are present in the mother’s body, beneficial bacteria can be transferred to the infant. Once they have established themselves there, they not only give the infant initial protection against many diseases, but can also contribute to its future health. It has also been established in a number of clinical trials and other scientifically conducted investigations that that the most beneficial bacterium for infants is Bifidobacterium infantis.

How do infants benefit from probiotic bacteria?

Probiotic bacteria have been found to benefit infants in a number of ways, including:

1. Prevention and treatment of various types of diarrhoea;
2. Prevention of gastric and urogenital infections with various pathogenic bacteria, viruses and yeasts;
3. Treatment of nappy rash;
4. Prevention and treatment of some food allergies and some digestive disorders, e.g. colic;
5. Maturation of the mucosal immune system and stimulation of cellular and antibody-based immune reactions;
6. Reduction in lactose intolerance;
7. Improvement in nutrient digestion;
8. Improvement in the absorption of various nutrients, particularly of minerals such as calcium;
9. Increase in the infant’s appetite.

Probiotic bacteria restore and maintain the correct microbial balance in the mouth, digestive system and parts of the urogenital tract of infants, particularly after antibiotic therapy.

Why do our probiotic bacteria sometimes disappear?

The extensive use of antibiotics, stress, incorrect diet, an unhealthy lifestyle and the frequent use of cortisone all lead to the loss of these beneficial bacteria. Their depletion or disappearance upsets the delicate balance between the various groups of microbial flora within the human body and can result in a number of disturbances of the digestive system (diarrhoea, constipation, spastic colon, flatulence, etc.) and/or the overgrowth of Candida albicans (oral or vaginal thrush).

How can we replenish our probiotic bacteria?

By far the easiest and most effective way of replenishing our probiotic bacteria and restoring the microbial balance in various parts of our bodies is by using probiotic supplements. The commercially available preparations are usually based on the use of lyophilised (dried from the frozen state) bacteria and come in a variety of forms: tablets, capsules and/or pessaries. Depending on the degree of the acid- and bile-resistance of the probiotic strains, entero-coating or micro-encapsulation of the probiotic bacteria can be applied.

Potential users should focus on two main aspects:

1. The composition of the preparation, i.e. does the supplement contain “true” probiotic bacteria or mainly the lactic acid bacteria used in the dairy industry?
2. The guaranteed number of viable bacteria/not the number established at the time of production.

By using probiotic supplements, particularly after antibiotic therapy, we can restore the necessary microbial balance and prevent a large number of intestinal and other problems.

Author’s details: Ela Johannsen (MSc Microbiol., Lodz, Poland; PhD Microbiol., Rhodes University, Grahamstown)

Address: 45, Idol Road, Lynnwood Glen, Pretoria, 0081)

e-mail address: bioflora@lantic.net elaj@lantic

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*) In Caesarean deliveries, the colonization of the infant’s digestive system with the protective microflora originating from the mother does not take place. In these cases, the infant should receive supplementation with a suitable probiotic preparation as soon as possible.

Probiotic preparations are nutritional supplements based on live, lyophilized microorganisms, originating from human indigenous intestinal microflora. When administered in adequate doses, they improve the microbial balance in the digestive tract, positively affect the functioning of this tract, stimulate the immune system and have beneficial effects on general human health.

Bacterial strains selected for manufacturing probiotic preparations should fulfill a number of requirements. They:

1. should be of human origin;
2. should be safe, i.e. should not be pathogenic or virulent;
3. should not be capable of transferring antibiotic resistance or drug resistance to pathogens;
4. should be able to colonize the human intestinal tract, i.e. be resistant to gastric acid and bile, and be capable of adhering to and multiplying on the intestinal mucosal surfaces;
5. should be able to control and/or inhibit the growth of pathogens by producing a variety of anti-microbial substances (lactic, acetic, and butyric acids, hydrogen peroxide, bacteriocins), and by competing for nutrients and space;
6. should be able to stimulate the immune system.

The probiotic preparations themselves should have the correct composition of the required bacteria, with viable counts in the range of 10⁸ to 10⁹ per dose.

In healthy individuals, two groups of naturally occurring bacteria are responsible for maintaining a “correct” microbial balance and keeping pathogens under control. These are:Lactobacillus and Bifidobacterium. The first group resides mainly in the small intestine and the second in the colon. These bacteria usually maintain the beneficial microbial balance through the mechanisms listed under point v) above.

Although nature provided us with these beneficial indigenous bacteria, they are frequently depleted or even disappear completely from our intestines and mucosal membranes due to:

1. excessive and prolonged stress;
2. overuse of antibiotics;
3. long-term use of hormonal preparations;
4. long-term use of corticosteroids;
5. incorrect diet, e.g. a diet low in fruit and vegetables;
6. impaired peristalsis;
7. general nutritional deficiencies;
8. a suppressed or deficient immune system;
9. the process of aging.

Lack of the appropriate microbial balance can easily lead to a number of intestinal disorders (e.g. diarrhoea, constipation, some inflammatory bowel diseases) and other disorders, most commonly oral and vaginal thrush. In order to restore the impaired microbial balance, supplementation with suitable probiotic preparations is necessary.

The prophylactic and therapeutic properties of probiotic preparations have been confirmed in numerous clinical trials (currently over 200). These properties include the ability to:

i) normalize bowel functions by correcting both constipation and various types of diarrhoea;

ii) suppress pathogenic microflora, i.e., bacteria, viruses and the overgrowth of yeasts such as Candida albicans;

3. decrease flatulence and abdominal distension;
4. decrease lactose intolerance;

5. neutralize carcinogens and if permanently present in the colon, may prevent cancer of the colon;

6. enhance the functions of the immune system;
7. reduce the blood cholesterol level;
8. enhance the absorption of nutrients (minerals);
9. prevent and correct some food allergies;
10. help in the treatment of inflammatory bowel diseases;
11. correct some disorders of the urogenital tract;
12. produce vitamins of the B-group.

On the basis of the above, it can be concluded that probiotic preparations offer a natural and effective method of restoring and maintaining HUMAN HEALTH

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*) From a Greek expression “pro bios”, meaning: for life.

Author’s details: Ela Johannsen (MSc Microbiol., Lodz, Poland;

PhD Microbiol., Rhodes University, Grahamstown)

Address: 45 Idol Road, Lynnwood Glen, Pretoria, 0081

e-mail address: elaj@lantic.net

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Special feature

The good guys

Are your kids constantly feeling tired? Do you suspect their immune systems are at a physical low? Maybe it’s time to add probiotics to their diet

AUTHOR: Shereen Suckerman

DATE: 28th April

ISSUE: August

APPROVAL NEEDED: NO

TITLE: The good guys

SECTION: Special Feature

WORD COUNT: 2427

Probiotics has become one of the latest buzzwords in the healthcare industry, and an increased number of parents have begun to realise the potential health benefits it has for their children. Although people have enjoyed the benefits of probiotics throughout history, by eating yoghurt and other diary products, only now with the advancements of medical technology has it become possible to harness the goodness of probiotics to make it available, in high doses, in our food as well as in supplemental form. Here’s why probiotics are one of the most necessary forms of supplementation your children can take.

What are probiotics?

Probiotics are quite simply good bacteria, that can be administered into the body, in order to protect it from harmful bacteria. Every person has up to 500 different species of bacteria in their gut. And, a small part of the 100 trillion bacterial cells in our body are in fact the good bacteria that every person needs in order to fight off infection and disease, which is caused by harmful micro organisms. Good and bad bacteria as well as other microbes are in constant competition with each other for space and nutrients in the digestive system. There is only a limited supply of nutrients in your body, and by consuming probiotics you will ensure that there is an increased chance that the good guys will utilise these substrates (food by-products) and survive, thereby improving your health. Good bacteria will thus be stimulated to grow on the internal walls of the small intestine and the colon while bad bacteria will have no space to grow. It will ensure that our bodies, and the bodies of our children, are protected from invasion by harmful disease causing bacteria (pathogens) and viruses.

There are different strains of bacteria such as Lactobacillus, which looks after your small intestine and Bifidobacterium, which looks after your colon (Bifidobacterium infantis has been established, through various clinical trials, as the most beneficial strain of bacterium for babies). If there is not enough of the ‘good stuff’ in your digestive system, the bad micro organisms will take control of both of your intestines which can lead to a host of minor side-effects such as diarrhoea, constipation, allergies, poor digestion and gas, and eventually more serious illnesses and diseases.

“Why does my child need good bacteria? Isn’t bacteria supposed to be bad for you?”

While many parents cringe at the idea of their children eating food with harmful additives, there is no need for you to worry when you see the word probiotics listed on the packaging of your children’s food. Medical studies show that giving probiotics to your kids, whether in supplemental form or in their food results in them enjoying a host of health benefits, ranging from the treatment of lactose intolerance and diarrhoea to treatment following antibiotic therapy. A newborn is, in fact, born totally sterile and will acquire his first dose of bacteria as he passes through his mom’s birth canal. Secondary sources of bacteria will come from his moms’ skin, as well as his immediate hospital environment. The first bacteria that baby is exposed to is generally of the harmful sort, and this needs to be counteracted with probiotics. Gradually as he becomes more exposed to the outside world, he will come into contact with other forms of bacteria which are vitally important in building his immune system.

In a twist of irony, as a result of increased sterile environments, urbanised children do not come into contact with enough bad and good bacteria and are not afforded the opportunity to build-up their immune systems. The reason why bad bacteria are needed, is because pathogens stimulate the immune response to produce more white blood cells, which is important to fight infections and combat disease. Certain forms of bacteria will also become more aggressive and resistant as they have survived the many disinfectants used in hospitals. This results in a more aggressive attack, by these ‘Super-Bugs,’ on a child’s immune system. As a child gets older he will also be exposed to factors such as unhealthy lifestyles, antibiotics and junk food, which will affect the balance of the good and bad bacteria in his intestinal tract (see the box, ‘Helping young bodies’). Sterile environments and unhealthy lifestyles will thus contribute to a greater need for probiotics.

According to Johannesburg GP Dr Farrel Tobiansky, many parents should give probiotics to their children not only after a course of antibiotics or a bout of flu, but on a regular day-to-day basis. Taking probiotics during winter is especially important, as it is the time of year when the occurrence of colds and flu climax and most people are at a low-ebb, physically. Children can get their daily dose of probiotics from food sources such as probiotic yoghurts, juices, cereals, infant feeds as well as from supplements, which are available at leading pharmacies and health shops nationwide.

In a nutshell, good bacteria help to break down toxins, replenishing the cells in the lining of the colon. Probiotics also help to break down the lactose in dairy products and therefore allow the digestive tract to absorb more simple diary sugars. This is especially helpful to children who are allergic to dairy products. Probiotics can help to treat children with Candida albicans. Candida is a yeast infection which can multiply and develop into vaginal and oral thrush, commonly found in children. It occurs as the result of an imbalance between good and bad bacteria, usually after a course of antibiotics. Probiotics such as Lactobacillus acidophilus help to reduce the occurrence of Candida by recolonising the gut with populations of good bacteria, and thus boosting the immune system and reducing the chance of contracting this fungal infection. A study conducted by Dr Berry Fitzsimmons into the inhibition of Candida albicansby Lactobacillus acidophilus has shown that hydrogen peroxide, which is produced by probiotic bacteria, can have a strong inhibitory effect on Candida albicans’ overgrowth.

Evidence supporting the consumption of probiotics

Nobel Prize laureate, Dr Eli Metchnikoff, first discovered the benefits of probiotics. Dr Metchnikoff noted that Bulgarian peasants had particularly long life-spans, and attributed this to the fact that they all consumed vast quantities of fermented yoghurt. Studies found that the key strain of bacterium in the yoghurt was Lactobacillus acidophilus, which is able to produce lactic acid. He theorised that these good strains of bacteria could protect the body and digestive tract against harmful micro-organisms.

Heather Picton of ADHASA (Attention Deficit and Hyperactivity Association of South Africa) believes that it is important for children with ADD to take probiotics in order to combat the effects of antibiotics, which they take in greater amounts compared to non-ADD children. She says, “We all know that the consumption of antibiotics, and the average eating lifestyle of children, does not help to re-establish the friendly bacteria. So, assistance in the form of probiotics is necessary, especially for children with ADD. I have seen how ADD children are frequently accused of feigning tummy aches to avoid going to school. After changing their eating lifestyle, and having a course of probiotics (sometimes two), their tummy aches, smelly breath and winds disappear.”

Dr Tobiansky says that probiotics have been shown to reduce the frequency and severity of diarrhoea – an inflammation of the intestinal tract by bad bacteria - by increasing the number of Lactobacillus and Bifidobacterium, which are one of the first good bacteria that a mother passes onto her baby during birth. A study by the Institut Rosell has noted that Bifidobacteria are present in higher concentration in a breast-fed infant’s faecal microflora than in a non-breast fed infant. ‘It is also well known that the risk of diarrhoea is lower if newborns are exclusively breastfed, as apposed to being fed with infant formulas.’

A study conducted by Weizman et al, published in Pediatrics, the official publication of the American Academy of Paediatrics, has shown that children who are given the probiotic strainsLactobacillus reuteri ATCC 55730 or Bifidobacterium lactis Bb are less likely to suffer from ‘crèche syndrome’ - a host of illnesses that children contract from each other at nursery school. In this study, both probiotic strains showed a decrease in illness symptoms like fever and diarrhoea, whilst the group on Lactobacillus reuteri ATCC 55730 had fewer clinics visits, less absenteeism from crèche and less antibiotics prescribed. In another study, children aged between six and 36 months, who were hospitalised with diarrhoea, were split into two groups. One group received a probiotic called Lactobacillus reuteri and the other a placebo - both groups also received an oral rehydration solution, essential for anyone with diarrhoea. By the second day of the study, the recovery rate of the probiotic group far surpassed the rate of the group only taking ORS and the placebo. Probiotics as a preventative treatment, along with ORS - oral rehydration solution (this is very important to prevent dehydration, which is fatal to many children who are not able to replace lost fluids), are important for children with diarrhoea.

In her article, Putting Good Bacteria to Work (www.nytimes.com), Jane E Brophy lists some of the benefits of good bacteria. These are “controlling food and skin allergies in children, bacterial vaginosis and premature labour in pregnant women, inflammatory bowel disease, recurrent ear infections and dental caries.” In the article, Brophy also discusses a study done in Finland where researchers administered the probiotic Lactobacillus GG to pregnant woman and their babies, who were considered high risk for developing allergies following six months after their birth. The study showed that by the time the children were two, the probiotic had cut the incidence of eczema in half. A Japanese study at the University of Hiroshima, published in the International Journal of Food Microbiology, has shown that Lactobacillus reuteri ATCC 55730 kills the main bug in the mouth that causes tooth decay. This may help to prevent tooth decay and future visits to the dentist!

G.P, Dr Kim Teversham, gives some important points about probiotics

1. Health benefits are species and strain specific. You cannot infer the benefits of one probiotic strain to another. For example, to draw an analogy, we know that brown wholewheat bread has proven health benefits over its white unrefined counterpart, so don’t just buy any bread, buy one that has proven health benefits.

2. Stomach acid is designed to kill bacteria. If the probiotic is sensitive to acid, the best way to get it to the intestine is either by megadoses (such as Combi 15 ) or by encapsulating it in an acid resistant capsule (Probiflora). Other strains have been shown to be able to live in the stomach acid and so do not need acid protection and can therefore work from the mouth (against thrush), all the way down the intestine.

3. Many products on the market in SA contain combinations of probiotics. The benefits of these combinations should be proven by clinical studies. If you add paracetamol, asprin and codeine, you need to prove that it is better than either one alone.

Box

Helping young bodies

The hygiene hypothesis theory has shown that sterile environments may have a negative effect on babies and children who are not exposed to any allergens and bacteria, and whose bodies haven’t had the chance to build-up a natural resistance. These ‘protected’ kids usually have more allergies and are more allergy-prone than children who have been exposed to bacteria found in the garden and the home. Dr Tobiansky emphasises how vital probiotics are, to children who need to build-up their immune systems so that they can fight off diseases, illnesses and allergies. He says that having a strong immune system will prevent allergy reactions to allergens from developing. It’s also a well-known fact that children do not consume enough fruits and vegetables in their diet, which has also resulted in their bodies not being strong enough to fight off infection. These young bodies naturally need a helping hand when it comes to building up a strong immune system and probiotics will definitely do the trick!

Box

A guide to help you find the right probiotic

1. Is the strain identified clearly?

Vague statements about AB cultures or good bacteria are not enough. The label should show a reference number from the American Type Culture Collection, egg. Lactobacillus reuteriATCC 55730, or other recognised culture collections.

2. Does it contain the right number of bacteria?

The scientific literature states that probiotics must deliver 108‹ to power of 8› (100 million) colony forming units (cfu) per daily dose to be effective. This is one area where a supplement is markedly superior to food sources such as yoghurt, since you can’t always be sure that the amount you’re eating is giving you a specific quantity of bacteria. In many cases the probiotic introduced into various types of food are dead due to being exposed to acids (present in yoghurt), and coming into contact with the oxygen in the air and moisture.

3. Can it survive in the stomach?

The stomach is a most unwelcoming place for all bacteria. Only robust probiotic bacterial strains are able to survive their passage to the stomach. It needs to be able to survive in the digestive tract where the acidity falls to as low as pH 2. Bifidobacterium are particularly sensitive to acid, so you will need a very high cfu of this particular strain in any probiotic. Probiotic strains must likewise be able to survive the exposure to bile in the digestive tract.

4. Does it have a good, proven safety record and shelf life?

The best probiotics will have provided doctors and pharmacies with validated scientific information that shows their efficacy and shelf life. One is assured of a very long shelf life with probiotic supplements, which come in capsule/tablet form. This is because the live bacteria are freeze-dried into a powder form and will become fully functional only on contact with water and nutrients.

Source: Thebe Pharmaceuticals

Quote:

“The benefits of probiotics in gut health are driving customers demand. And growth in probiotic sales is expected to reach 197 billion euros in 2007! “(Datamonitor)

With thanks to Dr F. Tobiansky, Dr K. Teversham, Dr Ela Johannsen, Mrs Heather Picton, Probiflora and Paula Wilson from Reuteri for their help in the compilation of this article.