1. Dr.T.V.Rao MD PROBIOTICSPROBIOTICS DR.T.V.RAO MD 1

2. HISTORY OF PROBIOTICS- 1900’S At the start of the 20 th century, Russian Nobel prize winner and father of modern immunology, Elie Metchnikoff, a scientist at the Pasteur Institute, was the first to conceptualize “Probiotics” DR.T.V.RAO MD 2

3. Death sits in the bowels; a bad digestion is the root of all evil” - Hippocrates, ca. 400 BC INTESTINE IS A PARADISE OF DISEASES DR.T.V.RAO MD 3

4. UNDERSTANDING THE DEFINITIONS DR.T.V.RAO MD 4 Prebiotic - (greek - before life) a substance (usually an oligosaccharide) that cannot be digested but does promote the growth of beneficial bacteria or probiotics Probiotic - (for life) a substance that contains microorganisms or bacteria that are beneficial to the host organism. Symbiotic - (plus life) a substance containing both a prebiotic and probiotic.

5. The term probiotic comes from the Latin or Gree pro, “before, forward”, and bios, or “life” — thus probiotics are life-promoting. In this case, we use the term probiotics to refer to beneficial bacteria DEFINING A PROBIOTIC DR.T.V.RAO MD 5

6. HISTORY OF PROBIOTICS Bulgarian yoghurt ( sour milk ), commonly consumed plain, is popular for its taste, aroma, and quality. The qualities arise from the Lactobacillus bulgaricus and Streptococcus thermophilus culture strains used in Bulgaria In 1907 Metchnikoff proposed that the acid producing bacteria in fermented milk products could prevent “fouling" in the large intestine and, if consumed regularly, lead to a longer, healthier life. DR.T.V.RAO MD 6

7. HISTORY OF PROBIOTICS- 1930’S In early 1930’s, in Japan, Minoru Shirota developed a fermented milk product called Yakult In 1935 he started marketing Yakult as a probiotic yogurt-like product made by fermenting a mixture of skimmed milk with a special strain of Lactobacillus casei shirota DR.T.V.RAO MD 7

8. HISTORY OF PROBIOTICS- 1965 Probiotics term coined in 1965 by Lilly And Stillwell Probiotics defined as microorganisms that have a beneficial effect on the host intestinal microbial balance Probiotics, which means “for life” was meant to contrast “antibiotics”, popularly prescribed and known to also destroy beneficial organisms and impact the immune system. DR.T.V.RAO MD 8

9. In ancient Indian society, it became commonplace (and still is) to enjoy a before- dinner yogurt drink called a lassi. These Indian traditions were based on the principle of using sour milk as a probiotic delivery system to the body. PROBIOTICS IN INDIAN FOODS DR.T.V.RAO MD 9

10. CHARACTERISTICS OF EFFECTIVE PROBIOTICS Probiotic microorganisms are: Able to survive the passage through the digestive system Able to attach to the intestinal epithelia and colonize Able to Maintain good viability Able to utilize the nutrients and substrates in a normal diet Non-pathogenic and non-toxic Capable of exerting a beneficial effect on the host DR.T.V.RAO MD 10

11. WHAT ARE PROBIOTICS Probiotic organisms are live microorganisms thought to be beneficial to the host organism. According to the currently adopted definition by FAO/WHO, probiotics are: "Live microorganisms which when administered in adequate amounts confer a health benefit on the host". Lactic acid bacteria (LAB) and bifidobacteria are the most common types of microbes used as probiotics; but certain yeasts and bacilli may also be used. DR.T.V.RAO MD 11

12. PROBIOTICS ARE PART OF THE INTESTINAL TRACT Probiotics are bacteria that help maintain the natural balance of organisms (microflora) in the intestines camera. The normal human digestive tract contains about 400 types of probiotic bacteria that reduce the growth of harmful bacteria and promote a healthy digestive system. The largest group of probiotic bacteria in the intestine is lactic acid bacteria, of which Lactobacillus acidophilus, found in yogurt with live cultures, is the best known. Yeast is also a probiotic substance. Probiotics are also available as dietary supplements DR.T.V.RAO MD 12

13. PREBIOTICS DIFFERS FROM PROBIOTICS A prebiotic is a nondigestible component which beneficially affects the host by selectively stimulating the growth and/or activity of one or a limited number of colonic bacteria, thereby improving the health of the host, prebiotics are nutrients that the bacteria use as a fuel source; these include dietary fiber and carbohydrates DR.T.V.RAO MD 13

14. POSSIBLE MODES OF ACTION OF PROBIOTICS  production of inhibitory compounds  competition for chemicals/available energy  competition for adhesion sites (exclusion)  enhancement of the immune response  improvement of water quality  interaction with phytoplankton  a source of macro- and micro-nutrients  enzymatic contribution to digestion DR.T.V.RAO MD 14

15. Probiotics are commonly consumed as part of fermented foods with specially added active live cultures; such as in yogurt, soy yogurt, or as dietary supplements PROBIOTICS ARE PRESENT MANY CONSUMABLES DR.T.V.RAO MD 15

16. PROBIOTICS ARE USED IN SEVERAL CLINICAL CONDITIONS Probiotics were identified to beneficially affect the host by improving its intestinal microbial balance, thus inhibiting pathogens and toxin producing bacteria. Today, specific health effects are being investigated and documented including alleviation of chronic intestinal inflammatory diseases, prevention and treatment of pathogen-induced diarrhoea, urogenital infections, and atopic diseases. DR.T.V.RAO MD 16

17. OUR GUT IS A COMPLEX PLACE LOADED WITH MICROBES DR.T.V.RAO MD 17 Huge amounts of microorganisms exist just about everywhere you can think of.. Humans and all animals are host to microbes that live on our skin and inside our bodies. It has been estimated that more microbial cells exist in the body than human cells. There are trillions of microorganisms in your gut. There are trillions of microorganisms in your gut. These microorganisms are collectively called your gut flora, micro flora, or beneficial bacteria and are estimated to make up about 3 pounds of your body weight. These bacteria include many different microbes both friendly and harmful.

18. PROBIOTIC MICROORGANISMS AND MODE OF ACTION Most commonly used Probiotics are lactic acid bacteria - Lactobacilli, Streptococci and Bifidobacteria Possible modes of Action: Competitive exclusion Production of Bacteriocins Production of organic acids Altered absorption of the intestinal mucosa DR.T.V.RAO MD 18

19. COMMON PROBIOTIC AGENTS USED AS THERAPEUTIC OPTIONS Lactobacillus acidophilus Lactobacillus ramnosus Lactobacillus paracasei Lactobacillus plantarum Lactobacillus bulgaricus Bifidobacterium infantis Bifidobacterium longum Bifidobacterium breve Streptococcus Thermophilus DR.T.V.RAO MD 19

20. COMMONLY USED OF PROBIOTICS IN CLINICAL CONDITIONS Lactobacillus and Bifidobacterium have been suggested to be associated with alleviation of lactose intolerance ; prevention and cure of viral, bacterial and antibiotic or radiotherapy induced diarrhoeas ; immunomodulation; antimutagenic and anticarcinogenic effects ; and even blood cholesterol reduction. The optimism associated with probiotics is, however, counter-balanced by scepticism as many “probiotic” products in the market are unreliable in content and unproven clinically DR.T.V.RAO MD 20

21. IDENTIFICATION OF STRAINS OF PROBIOTICS (available at http://www.the- icsp.org/) Effects of probiotics are strain specific. Strain identity is important to link a strain to a specific health effect as well as to enable accurate surveillance and epidemiological studies. Both phenotypic and genotypic tests should be done using validated standard methodology. Nomenclature of the bacteria must conform to the current, scientifically recognized names as per the International Committee on Systematics of Prokaryotes (ICPS) (available at http://www.the- icsp.org/) DR.T.V.RAO MD 21

22. Most probiotics are like what is already in a person's digestive system. Some probiotics have been used for a very long time throughout history, such as in fermented foods and cultured milk products. These don't appear to cause illness. But more study is needed on the safety of probiotics in young children, the elderly, and people who have weak immune systems. PROBIOTICS USE – IS IT SAFE ??? DR.T.V.RAO MD 22

23. PROBIOTIC RESEARCH Allergies - certain probiotics have an impact on the mucosal barrier function of the intestinal tract. This effects allergens entering the body and the activity of inflammation producing cells Cholesterol – regular consumption of certain probiotic dairy products may have an impact on cholesterol level and may affect the levels of “good” HDL in the blood Colon Cancer – Certain probiotics may help prevent colon cancer by preventing the breakdown of enzymes that contribute to the growth of cancer causing agents DR.T.V.RAO MD 23

24. PROBIOTIC RESEARCH Infant Health – Mother nature has long recognized the benefits of Probiotics. Human breast milk contains a protein that stimulates the growth of good bacteria to help with digestion. Therefore a way to create and maintain a perfect balance of gut bacteria in babies has been in existence for as long as babies have been born Probiotics in Infant Formulas with the added protective benefit of beneficial probiotic cultures like those naturally promoted by breast milk, help support Baby’s healthy immune system. High levels of Bifidobacteria in the digestive tract are thought to be one of the reasons why breastfed babies are generally so healthy DR.T.V.RAO MD 24

25. PROBIOTIC RESEARCH Continued clinical research to study the benefits of probiotics in the areas of : Obesity and Weight Management (exopolysaccharide producing probiotic strains) Prevention of osteoporosis (improved bioavailability and absorption of nutrients) Growth development in children (improved bioavailability and absorption of nutrients) Treating and preventing respiratory infections, specially in children (boost immune system) DR.T.V.RAO MD 25

26. PROBIOTIC RESEARCH Acne treatment and clearer skin (maintaining a healthy balance of beneficial intestinal micro flora) Cancer control (bind, block or remove carcinogens, activate the host’s immune system to antitumor genesis, inhibit bacteria that directly or indirectly convert procarcinogens to carcinogens) Animal health (boost immune system, maintain balance of intestinal microflora) DR.T.V.RAO MD 26

27. Identification of new strains of probiotic organisms Development of techniques to improve efficacy and viability of probiotics Development of probiotic compounds- “Lactoceuticals” New Product Research to offer consumers a choice of probiotic products NEW PROBIOTIC RESEARCH DR.T.V.RAO MD 27

28. Most probiotic products contain bacteria from the genera Lactobacillus or Bifidobacterium, although other genera, including Escherichia, Enterococcus, Bacillus and Saccharomyces (a yeast) have been marketed as probiotics. Some commercial probiotic products which contain Bacillus are incorrectly labelled with a name not recognized by the scientific community, 'Lactobacillus sporogenes MARKETING OF PROBIOTICS DR.T.V.RAO MD 28

29. The strongest evidence for the anti-cancer effects of probiotics comes from animal studies; evidence from human studies (epidemiology and experimental) is still limited. An important goal for the future should be carefully designed human clinical trials to corroborate the wealth of experimental studies. RESEARCH ON CANCER RESEARCH ON CANCER STILL EXPERIMENTAL DR.T.V.RAO MD 29

30. Programme Created by Dr.T.V.Rao MD for Medical and Premedical Students in the Developing World Email doctortvrao@gmail.com DR.T.V.RAO MD 30