Probiotics Supplementation:
What Pharmacists Need To Know
Ali Alhammad, PhD CandidateDepartment of Pharmacotherapy and Outcome
ScienceVCU School of Pharmacy
January 31, 2012
Overview
What are probiotics Probiotics Prebiotics Mymbiotics Efficacy How they work?? Possible health benefits Some products Regulations Safety How to choose the high quality products? Conclusions
Introduction
How many of you are currently taking a probiotics or probiotics containing products?
What is Probiotics ???
“for life” in Greek Probiotics are live microorganisms, which,
when administered in adequate amounts, confer a health benefit on the host. FDA
Modify the endogenous microflora Have a positive effect on the host
Prebiotics
Nondigestible food ingredients Fructo-oligosaccharides (chicory, inulin) Lactulose
Positively affect the endogenous micro flora
Stimulate the growth of one or a limited number of bacterial species FOS Bifidobacteria Lactulose Lactobacilli
Synbiotics
A probiotic organism in combination with its prebiotic food
Providing both the organism and substrate at the time of ingestion may offer improved chance of survival in GI tract
Able to survive the passage through the digestive system
Able to attach to the intestinal epithelia and colonize
Able to Maintain good viability and stability of formulation
Able to utilize the nutrients and substrates in a normal diet
Non-pathogenic and non-toxic
Capable of exerting a beneficial effect on the humans
Characteristics of Effective Probiotics
Species
Bacteria Lactobacillus
Acidophilus, reuteri, casei, planatarum, rhamnosus “GG”
Bifidobacteria Bifidum, breve, infantis, longum
Streptococcus
Yeast Saccharomyces bulardii
History
Metchnikoff (1907) Observed that lactic fermentation of milk
stopped putrefaction Suggested that consumption of fermented
products would offer the same benefit to humans
The term probiotic was first used in the 1960s
“Death sits in the bowels; a bad digestion is the root of all evil” - Hippocrates, ca. 400 BC
Intestinal Flora
1014 viable CFU More than 10-times total
cells in the human body More than total humans
who have ever lived
At least 50 genera > 500 species in any
single adult 30 to 40 species
account for 99%
maintaining the balance of 85% beneficial and 15% harmful is key to personal wellness and health.
How they work ??
Competition with the pathogen for binding sites Bacteriocidal actions
Lowering intestinal pH Production of organic acids Immunomodulation Metabolic mechanisms including: Aiding digestion Synthesizing vitamins Increasing mineral absorption Detoxifying carcinogens
Possible Health Benefits
GI Disorders Antibiotics Associated Diarrhea (AAD) Irritable Bowel Syndrome (IBS) Clostridium difficile Infection (CDI) Ulcerative Colitis (UC) Pouchitis Lactose Intolerance Infection with Helicobacter pylori (H. pylori)
Boosts Immune System Other
Some Probiotics products
Activia™ Yogurt Align® Culturelle®
Lactinex®
Florastor®
Probiotic All-Flora®
Nutraelle®
Activia™ Yogurt Claim: “Regulates digestive system” Content: Bifidobacterium animalis Recommended dose: 1-3 servings (4 oz)/d Possibly effective:
Helicobacter pylori infection IBS Necrotizing enterocolitis Pouchitis Rotaviral diarrhea Traveler’s diarrhea Ulcerative colitis
Claim: several claims (GI, immune, diarrhea) Content: Lactobacillus rhamnosus GG, inulin Recommended dose: 1-2 capsules once or
twice daily Possibly effective:
AAD Chemotherapy-associated diarrhea CDI Nosocomial diarrhea Traveler’s diarrhea Prevention of allergies
Culturelle®
Claim: “Helps support digestive balance” Content: Bifidobacterium infantis Recommended dose: 1 capsule daily Possibly effective:
Helicobacter pylori infection IBS Necrotizing enterocolitis Pouchitis Rotaviral diarrhea Traveler’s diarrhea Ulcerative colitis
Align®
Regulation of DS
1994, Dietary Supplement, Health and Education Act (DSHEA)
Not FDA regulated FDA bas the “Burden of Proof” Must prove that product is “unsafe” No FDA enforcement unless can prove
supplement is “unsafe” (significant or unreasonable risk of injury)
Quality control is poor 80% of preparations tested had 1% or less of the
bacterial concentration on the label
Safety
Generally Recognized as Safe (GRAS) status Lactic acid producing bacteria (included) Bifidobacteria (not included) Safe in literature
Very rare Endocarditis and Bacteremia
Enterococci Greater threat of Endocarditis and Bacteremia
Several reports of fungemia associated with use of yeast-based probiotics (S. boulardii)
How To Choose…
How To Choose…
How To Choose…
Consult your pharmacist and/or doctor
Supplement Facts
Type of bacteria Amount Storage
Expiration/“Best by” date
Where it is made Prebiotics
How To Choose …
Look for standardized supplements (USP or ConsumerLab certification) Contamination
Introduction
How many of you are currently taking a probiotics or probiotics containing products?
Summary
An old concept, with a new formulations
Potential therapy for many GI related diseases and other
Largely unproven, but growing body scientific evidence
Patients need guidance as to which ones to use, when to use them, how to use them