Probiotics: Things need to Know


What are Probiotics?

 Probiotics are “Live microorganisms, which, when consumed in adequate amounts, confer a health benefit on the host.”

This is the modern definition of probiotics, drafted by joint expert consultation of the Food and Agricultural Organization and the World Health Organization in Argentina (2001).

Concept of Probiotics

Let’s first know about Microbiome…

Collection of all the microorganisms, living in association with the human body is known as human Microbiome. Microbiome is generally not harmful to human; in fact they are essential for maintaining health.

How Microbiome helps

  • They produce some vitamins that humans do not have the genes to make.
  • Microbiome breaks down food to nutrients that human need to survive.
  • Teach human immune systems to recognize foreign invaders.
  • Microbiome also has some anti-inflammatory functions to eliminate other disease causing microbes.

Disruption of the Microbiome renders patients prone to severe infection with not only one, but also several pathogenic microorganisms. A strategy to restore a host-supportive Microbiome involves the use of probiotics. Live microorganisms are known to influence production of immunoglobulins and thus altering the body’s immune defence. They are also able to contribute to a specific immune response against pathogenic bacteria. When human body lose parts of Microbiome, like after taking antibiotics, after diarrhea etc probiotics can be used to replace them. Probiotics can be used to balance Microbiome and “bad” bacteria to keep body working the way it should.

Probiotics, Prebiotics & Synbiotics

Let’s start with definitions:

Probiotics are live microorganisms, which, when consumed in adequate amounts, confer a health benefit on the host.

Prebiotics are metabolic fuel that microorganisms in the gastrointestinal tract use for their survival.

When Probiotic organisms and prebiotics are served as composition it’s often called synbiotics.

By definition Pro, Pre & Synbiotics are not same. That’s why; Probiotics should not be confused with prebiotics or Synbiotics.
There is disagreement about whether dead or deactivated microorganisms or microbial products should be included in the term “Probiotics”.

Commonly Used Probiotic Strains

Health benefits have mainly been demonstrated for specific probiotic strains of the following genera: Lactobacillus, Bifidobacterium, Saccharomyces boulardii, Enterococcus durans, Enterococcus faecium, Streptococcus thermophilus, Lactococcus lactis, Bacillus subtilis, Escherichia coli Nissle 1917 etc.

How Probiotic works?

In Gastrointestinal tract Probiotics reduce growth of pathogenic microorganisms,

  • By fostering colonization resistance,
  • By improving intestinal transit,
  • By helping normalize a perturbed microbiota.

Probiotics helps in

  • Production of bioactive metabolites (e.g., short-chain fatty acids)
  • Reduction of luminal pH in the colon

Probiotics also helps in

  • Vitamin synthesis,
  • Gut barrier reinforcement,
  • Bile salt metabolism,
  • Enzymatic activity, and
  • Toxin neutralization.

Through all of these mechanisms, probiotics have wide range of impacts on human health and disease.

Natural or Commercial Probiotics

Probiotics are present in some foods naturally by their process of food making. Foods those are preparing by the process of fermentation are usually rich in probiotics. The term probiotics comprises a number of microbes rather a single one. Healthy individuals can benefit from taking these foods regularly. But for a person who needs to be treated for a specific disease that need specific strain of probiotics in a calculated dose, commercial preparation of probiotics came in front.

Probiotics used to Prevent or Treat health conditions:

Atopic Dermatitis

Available evidence suggests that the use of probiotics might reduce the risk of developing atopic dermatitis and lead to significant reductions in atopic dermatitis SCORAD scores. But these probiotics might provide only limited relief from the condition. Furthermore, the effects of probiotics vary by the strain used, the timing of administration, and the patient’s age, so it is difficult to make recommendations.

Pediatric Acute Infectious Diarrhea

The European Society for Pediatric Gastroenterology, Hepatology, and Nutrition identified two probiotic supplements, Lactobacillus rhamnosus GG and Saccharomyces boulardii for which evidence supported use as adjuncts to rehydration for managing acute infectious diarrhea in pediatric patients. Recent studies suggest that probiotics might not be efficacious in developed country emergency departments because most episodes of acute infectious diarrhea are self-limiting and require no treatment other than rehydration therapy.

Antibiotic-associated Diarrhea

Available evidence suggests that starting probiotic treatment with Lactobacillus rhamnosus GG or Saccharomyces boulardii within 2 days of the first antibiotic dose helps reduce the risk of AAD in children and adults aged 18 to 64, but not in elderly adults. There is no evidence to suggest that the benefits are greater when more than one probiotic strain is used.

Irritable Bowel Syndrome

With probiotics or placebo for 4 weeks to 6 months, pain scores improved significantly with administration of probiotics containing Bifidobacterium breve, Bifidobacterium longum, or Lactobacillus acidophilus species. The abdominal distension scores improved with use of probiotics containing Bifidobacterium breve, Bifidobacterium infantis, Lactobacillus casei, or Lactobacillus plantarum species. Flatulence declined with use of all tested probiotics, but the studies showed no positive effect of probiotics on quality of life. Overall, the available evidence indicates that probiotics might reduce some symptoms of IBS.


Research suggests that the use of multiple probiotic strains in combination as well as of probiotics containing Lactobacillus acidophilus, a mixture of Lactobacillus acidophilus and Bifidobacterium lactis, or Lactobacillus plantarum might reduce total and LDL cholesterol levels. However, more research is needed to confirm these findings.


Taken together, these results indicate that the effects of probiotics on body weight and obesity might depend on several factors, including the probiotic strain, dose, and duration, as well as certain characteristics of the user, including age, sex, and baseline body weight. Additional research is needed to understand the potential effects of probiotics on body fat, body weight, and obesity in humans.

Probiotics may not always work, If:

  • If probiotics are not used in correct dose (too few CFU).
  • If probiotics strain is wrong. (Not all strains work for every symptom)
  • The product quality is poor (live cultures). One of the biggest challenges with probiotics is their fragile nature. They must survive the process of manufacturing, storage, and stomach acid of recipient in order to be effective in recipient’s intestines.
  • If not stored correctly as humidity, heat, and light can also affect probiotics negatively. Some may need to be refrigerated.

Probiotic Rich foods:


Yogurt is a food produced by fermentation of milk. Yogurt is made by heating milk to a temperature that denatures its proteins. Then it’s cooling to a temperature that will not kill the live microorganisms that turn the milk into yogurt. Inoculating certain bacteria usually Streptococcus thermophilus and Lactobacillus bulgaricus, into the milk, and finally keeping it warm for several hours. The microorganisms that turn milk into yogurt can tolerate higher temperatures than most pathogens.  A suitable temperature not only encourages the formation of yogurt, but inhibits pathogenic microorganisms.


Kefir is a fermented milk drink similar to a thin yogurt that is made from kefir grains. The kefir grains initiating the fermentation consist of a symbiotic culture of lactic acid bacteria and yeasts embedded in a matrix of proteins, lipids, and polysaccharides. Probiotic bacteria found in kefir products include: Lactobacillus acidophilus, Bifidobacterium bifidum, Streptococcus thermophilus, Lactobacillus delbrueckii subsp. bulgaricus, Lactobacillus helveticus, Lactobacillus kefiranofaciens, Lactococcus lactis, and Leuconostoc species. Lactobacilli in kefir may exist in concentrations varying from approximately 1 million to 1 billion colony-forming units per milliliter.

Traditional Buttermilk

Buttermilk is a fermented dairy drink. Traditionally, it was the liquid left behind after churning butter out of cultured cream; most modern buttermilk is cultured. Traditionally, before the advent of homogenization, the milk was left to sit for a period of time to allow the cream and milk to separate. During this time, naturally occurring lactic acid-producing bacteria in the milk fermented it. This facilitates the butter churning process, since fat from cream with a lower pH coalesces more readily than that of fresh cream. The acidic environment also helps prevent potentially harmful microorganisms from growing, increasing shelf-life.


Cheese is a dairy product derived from milk that is produced in a wide range of flavors, textures, and forms by coagulation of the milk protein casein. Hard cheeses, such as Cheddar have long ripening times of up to two years. Studies have demonstrated that Bifidobacteria survive well in Cheddar. Studies also involved the incorporation of a number of probiotic Lactobacillus strains into Cheddar cheese and assessment of their performance during ripening.

Probiotics Buying Guide:

Adding or added probiotics in fermented foods are not the thing that ensures it’s going to help in maintaining consumer’s positive health. Several factors determine how much effectiveness is going to be produce by those added probiotics. Those factors include:

  • The physiologic state of the probiotic organisms added (whether the cells are from the logarithmic or the stationary growth phase),
  • The physical conditions of product storage (eg, temperature),
  • The chemical composition of the product to which the probiotics are added (eg, acidity, available carbohydrate content, nitrogen sources, mineral content, water activity, and oxygen content)
  • Possible interactions of the probiotics with the starter cultures (eg, bacteriocin production, antagonism, and synergism).
  • Presence of Sufficient amount or CFU of friendly bacteria. Colony forming units (CFU) is the measuring unit of probiotics. Higher CFU counts do not necessarily improve the health effects.
  • Presence of appropriate strains of microbes for specific disease conditions.
  • Presence of sufficient amount of alive strains of microbes, as probiotics must be consumed alive to have health benefits.
  • Ensuring reach of live bacteria to the target area of body.
  • Using multiple bacterial strains for single disease condition or purpose.

Now a day’s use of Probiotics is increasing among peoples and doctors are also prescribing probiotics as adjunct to treatment. So many popular pharmaceuticals are manufacturing probiotic preparations and promoting their products. The  essential  measure  must  be  that  the  products  advertised  as being  probiotic,  and  not  just  the  probiotic  strains  added  to  the products,  have  indeed  been  shown  to  exhibit  probiotic  effects. As getting benefits from probiotic use, it’s necessary to use them in right way, it’s always better to consult with doctor before using of probiotics.


Dr Mohammad Shakiluzzaman (MBBS, FIPM)


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