Probiotics side effects, Probiotics benefits               September 26, 2011
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Probiotics are live microorganisms (in most cases, bacteria) that are similar to beneficial microorganisms found in
the human gut. They are also called "friendly bacteria" or "good bacteria." Probiotics are available to consumers
mainly in the form of dietary supplements and foods. They can be used as complementary and alternative medicine

Key Points
* People use probiotic products as CAM to prevent and treat certain illnesses and support general wellness.
* There is limited evidence supporting some uses of probiotics. Much more scientific knowledge is needed about
probiotics, including about their safety and appropriate use.
* Effects found from one species or strain of probiotics do not necessarily hold true for others, or even for different
preparations of the same species or strain.
* Tell your health care providers about any CAM practices you use. Give them a full picture of what you do to
manage your health. This will help ensure coordinated and safe care.

What Probiotics Are
Experts have debated how to define probiotics. One widely used definition, developed by the World Health
Organization and the Food and Agriculture Organization of the United Nations, is that probiotics are "live
microorganisms, which, when administered in adequate amounts, confer a health benefit on the host."
(Microorganisms are tiny living organisms—such as bacteria, viruses, and yeasts—that can be seen only under a

Probiotics are not the same thing as prebiotics—nondigestible food ingredients that selectively stimulate the growth
and/or activity of beneficial microorganisms already in people's colons. When probiotics and prebiotics are mixed
together, they form a synbiotic.

Probiotics are available in foods and dietary supplements (for example, capsules, tablets, and powders) and in some
other forms as well. Examples of foods containing probiotics are yogurt, fermented and unfermented milk, miso,
tempeh, and some juices and soy beverages. In probiotic foods and supplements, the bacteria may have been
present originally or added during preparation.

Most probiotics are bacteria similar to those naturally found in people's guts, especially in those of breastfed infants
(who have natural protection against many diseases). Most often, the bacteria come from two groups, Lactobacillus
or Bifidobacterium. Within each group, there are different species (for example, Lactobacillus acidophilus and
Bifidobacterium bifidus), and within each species, different strains (or varieties). A few common probiotics, such as
Saccharomyces boulardii, are yeasts, which are different from bacteria.

Some probiotic foods date back to ancient times, such as fermented foods and cultured milk products. Interest in
probiotics in general has been growing; Americans' spending on probiotic supplements, for example, nearly tripled
from 1994 to 2003.

Uses for Health Purposes
There are several reasons that people are interested in probiotics for health purposes.
First, the world is full of microorganisms (including bacteria), and so are people's bodies—in and on the skin, in the
gut, and in other orifices. Friendly bacteria are vital to proper development of the immune system, to protection
against microorganisms that could cause disease, and to the digestion and absorption of food and nutrients. Each
person's mix of bacteria varies. Interactions between a person and the microorganisms in his body, and among the
microorganisms themselves, can be crucial to the person's health and well-being.
This bacterial "balancing act" can be thrown off in two major ways:

1. By antibiotics, when they kill friendly bacteria in the gut along with unfriendly bacteria. Some people use probiotics
to try to offset side effects from antibiotics like gas, cramping, or diarrhea. Similarly, some use them to ease
symptoms of lactose intolerance—a condition in which the gut lacks the enzyme needed to digest significant
amounts of the major sugar in milk, and which also causes gastrointestinal symptoms.
2. "Unfriendly" microorganisms such as disease-causing bacteria, yeasts, fungi, and parasites can also upset the
balance. Researchers are exploring whether probiotics could halt these unfriendly agents in the first place and/or
suppress their growth and activity in conditions like:
  * Infectious diarrhea
  * Irritable bowel syndrome
  * Inflammatory bowel disease (e.g., ulcerative colitis and Crohn's disease)
  * Infection with Helicobacter pylori (H. pylori), a bacterium that causes most ulcers and many types of chronic
stomach inflammation
  * Tooth decay and periodontal disease
  * Vaginal infections
  * Stomach and respiratory infections that children acquire in daycare
  * Skin infections

Another part of the interest in probiotics stems from the fact there are cells in the digestive tract connected with the
immune system. One theory is that if you alter the microorganisms in a person's intestinal tract (as by introducing
probiotic bacteria), you can affect the immune system's defenses.

What the Science Says
Scientific understanding of probiotics and their potential for preventing and treating health conditions is at an early
stage, but moving ahead. In November 2005, a conference that was cofunded by the National Center for
Complementary and Alternative Medicine (NCCAM) and convened by the American Society for Microbiology
explored this topic.

According to the conference report, some uses of probiotics for which there is some encouraging evidence from the
study of specific probiotic formulations are as follows:

* To treat diarrhea (this is the strongest area of evidence, especially for diarrhea from rotavirus)
* To prevent and treat infections of the urinary tract or female genital tract
* To treat irritable bowel syndrome
* To reduce recurrence of bladder cancer
* To shorten how long an intestinal infection lasts that is caused by a bacterium called Clostridium difficile
* To prevent and treat pouchitis (a condition that can follow surgery to remove the colon)
* To prevent and manage atopic dermatitis (eczema) in children

The conference panel also noted that in studies of probiotics as cures, any beneficial effect was usually low; a
strong placebo effect often occurs; and more research (especially in the form of large, carefully designed clinical
trials) is needed in order to draw firmer conclusions.
Some other areas of interest to researchers on probiotics are

* What is going on at the molecular level with the bacteria themselves and how they may interact with the body (such
as the gut and its bacteria) to prevent and treat diseases. Advances in technology and medicine are making it
possible to study these areas much better than in the past.
* Issues of quality. For example, what happens when probiotic bacteria are treated or are added to foods—is their
ability to survive, grow, and have a therapeutic effect altered?
* The best ways to administer probiotics for therapeutic purposes, as well as the best doses and schedules.
* Probiotics' potential to help with the problem of antibiotic-resistant bacteria in the gut.
* Whether they can prevent unfriendly bacteria from getting through the skin or mucous membranes and traveling
through the body (e.g., which can happen with burns, shock, trauma, or suppressed immunity).


PROBIOTICS BENEFITS - Research Highlights
The potential health benefits of probiotics include alteration of the intestinal micro-flora balance, inhibition of  the
growth of harmful bacteria, promotion of good digestion, boosting immune function, and increased resistance to
infection [1-4].

Probiotics benefits - on harmful bacteria
Lactobacilli and bifidobacteria are believed to produce beneficial compounds such as B vitamins, lactic acid,
hydrogen peroxide, and acetic acid to lower the pH of the intestine as to inhibit the growth of the harmful bacteria
[5,6]. They also produce bacteriocins or natural antibiotics to kill the harmful bacteria [7].

Recent Research Researchers from Universidad Nacional de Tucumán, Argentina, applied lactobacilli as probiotics
in burn treatment (to prevent the colonization of pathogenic bacteria). The result is encouraging but the number of
patient did not enable the application of a power statistical tests. [B1]

Probiotics benefits - detoxification
Study has showen that other Lactobacillus species such as L. rhamnosus and L. plantarum are involved in the
production of several nutrients such as short-chain fatty acids and amino acids [8]. They may also help detoxify the
gut [9]. Twice daily probiotics supplementation has been shown to  enhance  immune function [ [10,11].

Probiotics benefits - Inflammatory bowel disease
  Feillet H et al, Necker Hospital, Paris, France suggested that colitis onset could be prevented by bacteria,
bacterial extracts, or helminthes from murine studies. Pena JA et al, Baylor College of Medicine, Texas, reported
Probiotic Lactobacillus spp. diminish Helicobacter hepaticus-induced inflammatory bowel disease in interleukin-10-
deficient mice. [14,15]

Probiotics benefits - Phagocyte Enhancement
Lee Y and Lee TS, Seoul Women's University, Seoul, enhanced ex vivo phagocytic capacity of peritoneal leukocytes
in mice by oral delivery of various lactic-acid-producing bacteria. [16]

Probiotics benefits - Hepatic Encephalopathy / Liver Cirrhosis
Jia L and Zhang MH, First People's Municipal Hospital of Guangzhou, China found that probiotics may be safe and
useful for the long-term treatment of minimal hepatic encephalopathy from their study using rats. [17] Zhao HY et al,
Beijing Friendship Hospital Affiliated to Capital University of Medical Sciences, found Probiotics effectively increased
the Bifidobacterium count and reduced the level of fecal pH and fecal and blood ammonia from their clinical studies.

Probiotics benefits - Colon Cancer
Approximately 70% of colorectal cancer is associated with environmental factors, probably mainly the diet. Saikali J
et al, Nutrition Research, Palaiseau Cedex, France, reported the protective role of milks fermented with probiotic
cultures in colon cancer risk reduction in their review article. [19] Rafter J., Karolinska Institute, Sweden, also got
similar results. [20]

Marotta F et al, University of Milan, Italy, found probiotics might exert significant antimutagenic properties against
colon cancer via decreased fecal pH, specific reduction of carcinogenetic bacterial enzymes, modulation of gut-
associated and systemic immune system from their animal studies [21]

Probiotics benefits - Major depressive disorder (MDD)
MDD patients have been shown to have elevated levels of pro-inflammatory cytokines, increased oxidative stress,
altered gastrointestinal (GI) function, and lowered micronutrient and omega-3 fatty acid status. Logan AC et al,
Nutrition Research Consulting, New York, suggested probiotics have the potential to lower systemic inflammatory
cytokines, decrease oxidative stress, improve nutritional status, and correct small intestinal bacterial overgrowth.
Consequently, probiotics can be used as an adjuvant therapy for people suffered from
MDD. [22]

Probiotics benefits - Abdominal bloating / Intestinal Gas
People have an imbalance in their normal colonic flora, as some bacterial taxa are more prone to gas production
than others. Upon colonization of probiotics, the probiotics seemed to be able to reduce gas formation. Two studies
are outlined as below:

Functional abdominal bloating is a condition dominated by a feeling of abdominal fullness or bloating and without
sufficient criteria for another functional gastrointestinal disorder. Di Stefano M et al, University of Pavia, Italy,
suggested that the administration of probiotics to modify the composition of colonic flora and thus the production of
intestinal gas. [23]

Probiotics weight loss
Some people claim probiotics as weight loss agents. They argue "Probiotics are microorganisms which are beneficial
to the human host.  These benefits can include improved digestion, increased immunity, enhanced  energy levels,
benefits to skin health, and thus, perhaps even weight loss." Do probiotics really promote weight  loss?

Here are the answers: Dr. Rastmanesh R., from Shahid Beheshti University of Medical Sciences, Iran, wrote  "The
relative proportion of Bacteroidetes to Firmicutes is decreased in obese people. This imbalance in gut  microbiota
generates signals controlling the expression of genes by the epithelial intestinal cells. Both dairy and non-dairy
probiotics increase body weight, reportedly through Lactobacillus species growth in the gut." in his article. [25] Dr.
Rastmanesh further suggested, "daily intake of some fruits and drinks such as three apples or three pears or
grapefruit, or green tea, which all are rich in polyphenols, can significantly reduce body weight in obese people". [25]

Here is an indirect evidence that probiotics actually help "weight gain" not "weight loss". In a study of rats, severe
head injury induced weight loss and decreased the serum concentration of D-xylose and the apparent protein
digestibility. Probiotics significantly improved gut absorptive capacity after severe head injury (SHI). The rats
receiving probiotics showed less weight loss than control group. SHI induced intestinal flora dysfunction and a
decrease in villus height and surface area. Digestive enzyme activities and gut motion were also depressed
significantly, and these changes were closely related to the decrease in severe head injury. Probiotics increased
villus height and surface area; Escherichia coli counts decreased significantly, and anaerobic counts increased. [26]

In another study, Bacillus coagulans ZJU0616 supplemented as probiotic was evaluated on growth performance in
Guangxi Yellow chicken. Chicken were randomly segregated into 12 groups so that 3 replicates were available for
each of the 3 treatments and control groups. The control groups were fed a basal diet without any probiotic and
other groups were fed the diets at different probiotics concentrations The lowest final weight and daily weight gain
were found in control groups and there were no significant differences among probiotic-treated
groups. [27]

People using antibiotics, eating a poor diet, or suffering from diarrhea are likely to have depleted colonies of
probiotics. Diarrhea flushes probiotics out of the GI tract, leaving the body vulnerable to opportunistic infections (by
the harmful bacteria). Antibotics may kill the good bacteria as well.

Replenishing the beneficial bacteria may help prevent the opportunistic infections. Use of probiotics supplements
may prevent traveler's  diarrhea, caused by the harmful bacteria in drinking water or raw foods [12]. They are also
important in the colonizing the intestine during and after antibiotic use. Finally, probiotics supplements may also aid
digestion since some of them produce lactase to digest milk sugar. Probiotics may be helpful to lactose-intolerant
people as they are in lack of this enzyme [13].

Probiotics have a long history of use without causing illness in human. Probiotics side effects may include mild and
digestive discomforts, such as gas or bloating. Theoretically, they can also cause infection under certain conditions.
They could also cause unhealthy metabolic activities, too much stimulation of the immune system, or gene transfer
(insertion of genetic material into a cell).Further, weight gain may be one of the probiotics side effects for some
users. Probiotic products are regulated as foods,not drugs, you still should consult with your medical doctor for its
advantages and side effects before taking them.

Some Other Points To Consider
* If you are thinking about using a probiotic product as CAM, consult your health care provider first. No CAM therapy
should be used in place of conventional medical care or to delay seeking that care.
* Effects from one species or strain of probiotics do not necessarily hold true for others, or even for different
preparations of the same species or strain.
* If you use a probiotic product and experience an effect that concerns you, contact your health care provider.

Prebiotics is a recent novel food concept that includes food ingredients that are not digested in the human upper
intestinal tract and hence arrive in the colon where they are selectively fermented by a limited number of colonic
bacteria. It was demonstrated that prebiotic carbohydrates and probiotics consistently reduced processes of
carcinogenesis and tumorigenesis.

Prebiotics Benefits - Crohn disease
Nobaek S et al, Lund University Hospital, Sweden, reported that oral administration of Lb. plantarum with known
probiotic properties decreased pain and flatulence in patients with irritable bowel syndrome.  [24] Prebiotics benefits
may include the prevention and treatment of Crohn disease, pouchitis, and possibly ulcerative colitis. And, these
benefits may arise from its modulation of mucosal and systemic immune activities.  [A1, A2]

[A1] Sartor RB Curr Opin Gastroenterol. 2003 Jul;19(4):358-65][A2] Fedorak RN and Madsen KL Curr Opin Gastroenterol. 2004 Mar;
1. Smirnov VV, Reznik SR, V’iunitskaia VA, et al. Mikrobiolohichnyi Zhurnal 1993;55:92–112. 2. Mel’nikova VM,
Gracheva NM, Belikov GP, et al. Antibiotiki i Khimioterapiia 1993;38:44–8.  3. De Simone C, Vesely R, Bianchi SB, et al. Int J
Immunother 1993;9:23–8. 4. Veldman A. Tijdschrift voor Diergeneeskunde 1992;117:345–8. 5. Kawase K. Jpn J Dairy Food Sci
1982;31:A241–3.  6. Rasic JL. N Eur Dairy J 1983;4:80–8.7. Barefoot SF, Klaenhammer TR. Appl Environ Microbiol 1983;45:1808–
15. 8. Bengmark S. Clin Nutr 1996;15:1–10. 9. Bengmark S. Am J Gastroenterol 2000;95(1 Suppl):S5–7 [review].10. Arunachalam K,
Gill HS, Chandra RK Eur J Clin Nutr 2000;54:263– 11. Perdigon G, Alvarez S, Rachid M, et al J Dairy Sci 1995;78:1597–606. 12.
Scarpignato C, Rampal P. Chemotherapy 1995;41:48–81. 13. McDonough FE, Hitchins AD, Wong NP, et al. Am J Clin Nutr 1987;45:
570–4. [14] The protective effect was exerted via regulatory cytokines as observed from studies on cell cultures.  Curr Opin
Gastroenterol. 2004 Nov;20(6):560-4] Â   [15] Infect Immun. 2005 Feb;73(2):912-20] Â   Food [16]Curr Microbiol. 2004 Dec 21][17] World
J Gastroenterol. 2005 Feb 14;11(6):908-11] [18] Chin J Dig Dis. 2004;5(2):64-7].[19] Nutr Cancer. 2004;49(1):14-24]  [20] Best Pract
Res Clin Gastroenterol. 2003 Oct;17(5):849-59].[21] Hepatogastroenterology. 2003 Nov-Dec;50(54):1914-8] [22]Med Hypotheses.
2005;64(3):533-8] [23] J Clin Gastroenterol. 2004 Jul;38(6 Suppl):S102-3].[24] Am J Gastroenterol. 2000 May;95(5):1231-8] 9B1) Peral
MC, Martinez MA, Valdez JC. Bacteriotherapy with Lactobacillus plantarum in burns. Int Wound J. 2009 Feb;6(1):73-81. [25]
Rastmanesh R. High polyphenol, low probiotic diet for weight loss because of intestinal microbiota interaction.Chem Biol Interact.
2011 Jan 15;189(1-2):1-8. [26] Yu XY, Yin HH, Zhu JC. Increased gut absorptive capacity in rats with severe head injury after feeding
with probiotics. Nutrition. 2011 Jan;27(1):100-7. [27] Zhou X, Wang Y, Gu Q, Li W. Effect of dietary probiotic, Bacillus coagulans, on
growth performance, chemical composition, and meat quality of Guangxi Yellow chicken. Poult Sci. 2010 Mar;89(3):588-93.
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