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This section gives an overview of developments in this area including opportunities for novel functional foods. The rare involvement of lactobacilli and starter bacteria in human infections is mentioned and a summary of traditional microbiological approaches to the enumeration of probiotic bacteria is included.

The last major update to this article was published in February 2008, since then there have been a number of significant developments. These include the failure of major European dairy companies to obtain ratification by the EFSA of health claims for probiotic products, the deaths of patients on a probiotic trial in the Netherlands, evidence that perhaps some bacteria designated as probiotics may have the potential to aggravate allergies in neonates. Additionally one major researcher has questioned where any strain of Lb. acidophilus has been shown to meet the criteria for a probiotic! However, there has been other more positive research indicating that particular strains of bacteria, in particular lactic acid bacteria, do have the potential to enhance immunity, reduce allergy, and to alleviate distant site infection. This work has very clearly shown that dairy companies and others have a responsibility to use only well characterised strains that have been shown to have probiotic effects in medical trials. Interesting Reid (2007) has stated "a potential major problem for probiotics is the misuse of the term. This can arise from products being poorly manufactured, or being referred to as probiotic without any relevant documentation. The net effect, deleterious to the overall field of probiotics, might be that such products are found to be ineffective, when in fact they were not even probiotic in the first place." Interestingly there is now a growing consensus that there is a world-wide, critical shortage of well qualified food scientists and technologists in commercial food manufacturing. These developments will be taken into consideration in the next major update to this article.

The next major update will summarise recent work on the gut flora and how this complex flora is thought to influence health. Recent research suggests that the gut flora can influence mood e.g. depression and its modification may have the potential to influence body mass and obesity. The main evidence for the latter has come from animal studies and anecdotal accounts of the consequences of faecal microbiota transplants also known as a stool transplants. This work suggests very significant potential for new generation probiotic products.

Gut problems e.g. dyspepsia (indigestion) are common and the Internet has many sites advocating probiotics for treating a range of symptoms. This article, while it may be of interest to the general public, does not promote the medical use of commercial yoghurt products, none of which currently have EFSA endorsements as probiotics in Europe, to treat gastrointestinal problems. I am aware of people experiencing dyspepsia who treated their symptoms with commercial yoghurt products and subsequently found that they had a range of physical medical conditions ranging from ulcers, hiatus hernia to more malign conditions that required surgical intervention. I am positive about the potential health benefits of probiotics but urge readers with health issues to discuss their problems with physicians, who certainly in Europe, take care not to do harm before self treating with yoghurt type products.

Living microorganisms are widely used for several therapeutic purposes and their beneficial effects as biotherapeutic agents are well known. While certain strains of lactic acid bacteria and bifidobacteria are used as probiotics in pharmaceutical preparations, feed additives and so-called functional foods yeasts also possess some medicinal efficiency.

"Pro" means "for" or "in favour of," "biotic" means "life." Thus, probiotic means "for/in favour of life." It contrast directly with "anti," "biotic" or "killing life." The Nobel Prize winning Russian scientist Elie Metchnikoff first conceptualised probiotics; defined as viable microorganisms that are beneficial to human health, at the turn of the 20th century. He believed that the fermenting bacillus (now called Lactobacillus bulgaricus) contained in the fermented milk products consumed by Bulgarian peasants positively influenced the micro flora of the colon, thus decreasing toxic microbial activities. Lilly and Stillwell probably first introduced the term “probiotics” in 1965, as growth promoting factors produced by microorganisms. However, the term ‘probiotic’ was popularised by R. Fuller in 1989 and defined as a live microbial feed supplement, which beneficially affects the host by improving its intestinal microbial balance. This definition was later extended to include other beneficial effects such as immunomodulation. There is a popular view that probiotics are the "medicine" of the twenty first century. The World Health Organization (FAO/WHO, 2002) has defined probiotics as live microorganisms, which when administered in adequate amounts confer a health benefit.

Following E-mail requests to provide a list of refereed citations or references to quality scientific literature covering definitions, prebiotics and synbiotics, the classification, isolation, enumeration of probiotic microorganisms; clinical trials including their effect on human fertility and reproductive health, gut development and function, topical gut infections e.g. Clostridium difficile; health of infants, people with AIDS, and the elderly; and distant site infection a ‘downloadable’ list has been prepared.

The list of references is in rich text format (RTF) and can be viewed and edited using most word processing software on PCs using Microsoft, Mac and Linux operating systems.

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