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Malaya Journal of Biosciences 2014, 1(3):181–195

ISSN 2348-6236 print /2348-3075 online

Significance of Probiotics and Prebiotics in Health and Nutrition Copyright © 2014 MJB 181

RESEARCH ARTICLE

Open Access Full Text Article

Significance of Probiotics and Prebiotics in Health and

Nutrition

Monika Jain1*, Khushboo Gupta1, Payal Jain1

1Department of Food Science and Nutrition, Banasthali Vidyapith, Rajasthan, India * For correspondence e-mail:

[email protected]

Article Info: Received 30 Sep 2014; Revised: 23 Nov 2014; Accepted 12 Dec 2014

ABSTRACT

The positive effects of probiotics and prebiotics on human health are being widely promoted by health and nutrition professionals in today’s scenario. Probiotic and prebiotic treatment has been shown to be a promising therapy to maintain and repair the intestinal environment. Consumption of healthy live micro-organisms (lactic acid bacteria) with prebiotics (inulin, galactooligosaccharide and oligofructose, etc.) may enhance healthy colonic microbiota composition. This combination might improve the survival of the bacteria crossing the upper part of the gastrointestinal tract, thereby boosting their effects in the large bowel. In addition, their effects might be additive or even synergistic. The objective of this paper is to review existing literature concerning the effects of probiotic and prebiotic food in promoting health and treating diseases.

Keywords: Functional food, Microbiota, Prebiotics, Probiotics

1. INTRODUCTION

Functional foods or functional food ingredients exert

a beneficial effect on host health and/or reduce the

risk of chronic disease beyond their nutritive value

[1,2]. Probiotics (i.e., living microbial food

supplements) and prebiotics (i.e., non-digestible

carbohydrates which stimulate the growth of

intestinal probiotic bacteria) considered as functional

food, have received much attention and they target

the gastrointestinal microbiota. It is well documented

that the large intestine is one of the most densely

populated ecosystem in nature consisting of over

500-1,000 different species of bacteria [3,4] of which

Bifidobacteria are generally considered to be health

promoting and beneficial [5]. The equilibrium of the

ecosystem is dynamic and may be negatively affected

by ageing, daily diet and other environmental factors

[6]. It is believed that the maintenance of the gastro-

intestinal bacterial population, which mainly contains

beneficial species, is important for overall gastro-

intestinal health and wellbeing. Research has focused

on the ability of probiotic bacteria to ferment

prebiotics and produce short-chain fatty acids (SCFA)

which is thought to be beneficial to gut health [6,7].

Probiotics are living microbial food components

that beneficially affect the host by improving its

intestinal microbial balance [8]. The most common

probiotics currently used, belong to the genera

Bifidobacterium and Lactobacillus [9,10]. Intake of

probiotic foods has been associated with a number of

health benefits [11], because probiotics do not

permanently colonize in the intestine. Hence,

sufficient quantities (>1 X 1010/day) of probiotics

must be taken, to maintain adequate amounts in the

colon [9]. It is important that the ingested bacteria

reach the large intestine in an intact and viable form.

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Monika Jain et al., 2014 / Malaya Journal of Biosciences 2014, 1(3):181-195

Significance of Probiotics and Prebiotics in Health and Nutrition 182

Fermented foods and foods that contain live bacteria

are known throughout the world. The most

commonly consumed probiotics are fermented dairy

products such as yoghurt and butter milk [12].

Prebiotics are more recent concept. Here, the

selective growth of indigenous gut bacteria is

required. Prebiotics are indigestible food ingredients

that beneficially affect the host by selectively

stimulating the growth and/or activity of one or a

number of health-promoting colon/ probiotic bacteria

and thus improve host health [1,8,13]. This definition

was updated in 2004 and prebiotics are now defined

as ‘‘selectively fermented ingredients that allow

specific changes in the composition and/or activity in

the gastrointestinal microbiota that confers benefits

upon host well-being and health” [14]. Prebiotics

should escape digestion in the upper gut by

pancreatic and brush-border enzymes, reach the large

bowel (especially, the cecum), and be utilized

selectively by a restricted group of micro-organisms

that have clearly identified, health promoting

properties, i.e., the probiotic bacteria, usually

Bifidobacteria and Lactobacilli [15].

In practice, combined mixtures of probiotics and

prebiotics are often used because their synergistic

effects are conferred onto food products, such

mixtures are known as synbiotics. Synbiotic food is

defined as “a mixture of probiotics and prebiotics

[16,17] that beneficially affects the host by, i)

improving the survival and implantation of live

microbial dietary supplements in the gastro-intestinal

tract, and ii) selectively stimulating the growth and

activity of one or a limited number of health-

promoting bacteria, and thus improving host health

and welfare” [8]. It is expected that adding prebiotic

would benefit the survival of Bifidobacteria during

the shelf life of the dairy products. Synbiotic products

often are composed of a combination of inulin-type

fructans, Bifidobacteria, and lactulose in conjunction

with Lactobacilli [18]. Currently, only limited variety

of synbiotic products such as probiotic yoghurt and

dairy drinks are available in the market.

2. PROBIOTICS

The word ‘probiotic’ means ‘for life’ and is derived

from the Latin ‘pro’, which means ‘for’, and the

Greek ‘biotikos’, which means ‘living’. According to

Preidis and Versalovic [19] probiotics are “live

microorganisms, which, when consumed in requisite

amounts, confer a health benefit on the host”.

Probiotics are nonpathogenic organisms (lactic

acid bacteria) in foods that can exert a positive

influence on the host’s health and modulate the GI

tract [20]. The theory is that live microorganisms

with in foods or in the form of a supplement improve

the microbial balance of the intestinal tract. These are

all gram positive, facultative bacteria that are normal

inhabitants of the human colon and constitute a

predominant part of the anaerobic flora. Fermented

milk products such as yoghurt are the most familiar

probiotic products [21]. For use in foods, probiotic

micro-organisms should not only be capable of

surviving passage through the digestive tract but also

have the capability to proliferate in the gut [22].

Lactic acid bacteria (LAB) is the most important

group of microorganisms commercially used as

starter cultures for the manufacture of dairy based

probiotic foods [23] and have been established as a

natural consumer. Strains of the genera Lactobacillus,

Bifidobacterium, and Propionibacterium are the most

widely used and commonly studied probiotic

bacteria. LAB satisfy the criteria that have to be met

by the organisms to be selected as probiotics like

resistance to the enzymes in the oral cavity, survival

through the GI tract, arrival at the site of action in a

viable physiological state and adherence to the host

cell surface [24].

2.1 Mechanism of action of probiotics

Experimental models have suggested that probiotics

greatly differ in their mechanism of action. However

the molecular details of probiotic mechanism remain

unresolved. Sartor [25] illustrated in his research

study that beneficial effects of probiotics may be

direct or indirect through (A) adherence and

colonization of the gut:- the competition for space to

adhere between indigenous and exogenous bacteria

result in competitive exclusion of exogenous

pathogens [26]. Microbes, i.e., Bifidobacteria and

Lactobacilli adhere to the mucosal tissues in a strain

explicit manner [27,28,29,30]. It enhances intestinal

endurance of probiotics and limits pathogen access to

the epithelium. (B) Modification of local gut micro-

environment:- probiotics are receptive to intestinal

conditions and metabolically active in vivo [31,32].

Probiotics mediate antimicrobial compounds by

reducing the lumen acidity [33] that can directly

inhibit pathogens and enhance the richness and

heterogeneity of beneficial components of intestinal

microflora [34]. (C) Improvement of intestinal barrier

function:- a variety of intestinal disorders cause

alterations in epithelial transport and barrier functions

[35]. Some probiotics have been indicated in

preservation of epithelial barrier function, prevention

and reconstruction of mucosal damage triggered by

food antigens, drugs, enteric pathogens and pro-

inflammatory cytokines [29,36,37,38]. These

protective effects are intervened by following

mechanisms (i) induction of mucus secretion by



goblet cells [39], (ii) maintenance or enhancement of

cytoskeletal and tight junction protein

phosphorylation [40], (iii) restoration of chloride

secretion, (iv) augmentation of trans-epithelial

resistance [34]. (D) Suppression of intestinal

inflammation:- pathogenic micro-organisms cause

proinflammatory response in gut cells by activating

the transcription factor NF-KB. In contradiction,

nonpathogenic micro-organism can weaken this

response by secreting the counter regulatory factors

IKB [41]. This phenomenon was seen in

nonpathogenic bacteria that attenuated Interleukin-8

secretion elicited by pathogenic S. typhimurium [42].

(E) Stimulation of mucosal and systemic host

immunity:- signals induced by commensal bacteria

are essential for optimal mucosal and immune

development and to maintain and repair gut [43,44].

In the alimentary canal immunosensory cells (i.e.,

enterocytes, M cells and dendritic cells) are

constantly sampling and responding to intestinal

bacteria [45]. Oral administration of probiotics is

related to immune engagement and demonstrable

systemic immunologic changes [46]. Complex

carbohydrates rich in prebiotics pass through the

small intestine to the lower gut where they become

available for some colonic bacteria but are not

utilized by the majority of the bacteria present in the

colon [47].

2.2 Impact of probiotics on health

The microbiota within the human distal gastro

intestinal tract (GIT) are the largest body community

and it provides an excellent milieu to investigate

inflammatory processes. Evidence suggests that the

bacterial load and the products of the intestinal

microbiota might positively influence inflammatory

disease pathogenesis [48,49].

2.2.1 Diarrhoea

Diarrhoea is a major world health problem which

has its impact on several million deaths each year.

Rotavirus is main cause of diarrhoea in young

children [50]. Probiotics can potentially provide an

important means to reduce the occurrence of

diarrhoea. Some probiotics are useful in prevention

and treatment of acute diarrhoeal conditions. The

ability of probiotics to decrease the incidence or

duration of certain diarrhoeal illnesses is perhaps the

most substantiated health effect of probiotics. Co-

administration of probiotics to patients on antibiotics

significantly reduced antibiotic-associated diarrhoea

in children [51,52,53,54]. Children with acute

gastroenteritis who received a probiotic supplement

(Lactobacillus rhamnosus, Lactobacillus reuteri,

Lactobacillus casei) also had significantly decreased

duration of diarrhoea [55].

2.2.2 Inflammatory bowel disease (IBD)

Inflammatory bowel disease (IBD) is clinically

characterized by two overlapping phenotypes,

Crohn’s disease (CD) and ulcerative colitis (UC),

which predominantly affect the colon (UC and CD)

and/or the distal small intestine (CD). The intestinal

bacterias are now believed to be involved in the

initiation and perpetuation of IBD. Resident bacterial

flora has been suggested to be an essential factor in

driving the inflammatory process in human

inflammatory bowel diseases [56]. Environmental

factors such as the composition and metabolic

activity of the gut flora, immune system reactivity

and genetic factors are all believed to play a role in

the progression of IBD states [57]. Strain of

Lactobacillus casei is able to reduce the number of

activated T-lymphocytes in the lamina propria of

Crohn’s disease, which may restore the immune

homeostasis [58].

2.2.3 Irritable bowel syndrome (IBS)

The pathophysiology of irritable bowel syndrome

(IBS) is not well known; however, alteration in the

intestinal flora has been postulated as one of the

etiologies. There is also no cure, so the treatment is

mainly focused on symptom relief, and probiotics

have been tried as a therapeutic modality. Probiotics

may have a significant benefit in preventing and

treating IBS. Several controlled trials of probiotics in

IBS have been published [59,60,61,62,63]. IBS

symptoms, such as flatulence, bloating and

constipation have been alleviated by organisms, such

as Lactobacillus GG, Lactobacillus plantarum,

Lactobacillus casei, Lactobacillus acidophilus, the

probiotic ‘cocktail’ VSL#3 and Bifidobacterium

animalis. However, only a few products have been

shown to affect pain and global symptoms in IBS

[64,65,66,67,68]. Numerous factors, including a

reduction in gas production [60,69], changes in bile

salt conjugation, an antibacterial or antiviral effect (in

the case of post-infectious IBS), the promotion of

motility [70], effects on mucus secretion or, even an

anti-inflammatory effect, could be relevant to the

benefits of specific probiotic strains in IBS.

2.2.4 Lactose intolerance

Worldwide many millions of people experience

lactose malabsorption. The frequency of the disorder

increases with age. Lactose intolerance is a

physiological state in human beings where they lack

the ability to produce an enzyme named lactase or β-

galactosidase. This lactase is essential to assimilate

the disaccharide in milk and needs to be split into

glucose and galactose. Individuals lacking lactase

will not be able to digest milk and it often poses a



problem in newborn infants [71]. This decline in

activity results in lactose malabsorption. This

incomplete absorption causes flatus, bloating,

abdominal cramps, and moderate to severe diarrhoea.

A major consequence of this sequence of events is a

severe limitation in consumption of dairy products,

which is particularly pronounced in the elderly [72].

Fermented milk products have been observed to be

tolerated well by lactose maldigesters as compared to

milk. This can be explained by the presence of β-

galactosidase in the bacteria fermenting the milk.

Upon ingestion, the bacteria are lysed by bile in the

small intestine, the enzyme is released and degrades

lactose. In addition to this, the more viscous

properties of fermented milks, compared to plain

milk, gives them a longer gastro-caecal transit time,

thus further aiding digestion of lactose [73]. This

beneficial effect is usually more associated with

products fermented with Lactobacillus delbrueckii

subsp. bulgaricus and Streptococcus thermophilus.

Martini et al [74] conducted a research to evaluate the

ability of different species of lactic acid bacteria to

digest lactose in vivo, yoghurt (containing mixtures

of strain of Streptococcus salivarius subsp.

thermophilus and Lactobacillus delbrueckii subsp.

bulgaricus) and fermented milks (containing

individual species of S thermophilus, L bulgaricus, L

acidophilus or Bifidobacterium bifidus) that varied in

microbial β-gal activity were produced and were fed

to healthy people who cannot digest lactose and

breath hydrogen production was monitored. All

yoghurts dramatically and similarly improved lactose

digestion regardless of their total or specific β-gal

activity.

2.2.5 Other potential health benefits

Probiotics may exert a beneficial effect on allergic

reaction by improving mucosal barrier function. In

addition, probiotic consumption by young children

may beneficially affect immune system development.

Probiotics such as Lactobacillus GG may be helpful

in alleviating some of the symptoms of food allergies

such as those associated with milk protein [71].

Probiotic consumption may thus be a means for

primary prevention of allergy in susceptible

individuals. They may help to prevent or treat

infections such as postoperative infections,

respiratory infections and the growth of Helicobacter

pylori, a bacterial pathogen responsible for type B

gastritis, peptic ulcers and perhaps stomach cancer

[75,76]. Regular intake of probiotics (i.e., a

fermented milk drink containing a mixture of L.

rhamnosus GG, Bifidobacterium, L. acidophilus, and

S. thermophilus) has been demonstrated to reduce

potentially pathogenic bacteria in the upper

respiratory tract of humans [77]. They could have a

potential effect on bone accretion independent of

prebiotics. This could occur via microbial production

of metabolites or enzymes or synthesis of vitamins

[78,79] because several vitamins are also involved in

calcium metabolism and are required for bone matrix

formation and bone accretion as are vitamin D, C, or

K [80] or folate.

Hepatic encephalopathy (HE) is a life threatening

liver disease. Various probiotics, i.e., Streptococcus

thermophilus, Bifidobacteria, Lactobacillus

acidophilus, Lactobacillus plantarum, Lactobacillus

casei and Lactobacillus delbrueckii bulgaricus

contain therapeutic effects that could disrupt the

pathogenesis of HE and may make them superior to

conventional treatment and lower portal pressure

with a reduction in the risk of bleeding

[55,56,81,82,83]. Acute pancreatitis is a serious

condition with an incidence that continues to increase

worldwide [84]. It ranges from a mild, self-limiting

illness to pancreatic necrosis and infected pancreatic

necrosis with a mortality rate of up to 30%.

Colonization of the lower gastrointestinal tract and

oropharynx with gram-negative organisms often

precedes contamination of the inflammed pancreas.

Systemic antibiotic prophylaxis is used to prevent

secondary infection in acute pancreatitis [85]. Human

studies in which patients with acute pancreatitis

received L. plantarum 299v showed a decrease in

occurrence of pancreatic infection/abscess and a

shorter hospital stay [86,87]. Probiotics have also

been tried with some success in the prevention of

uncomplicated diverticular disease [88] and

diverticulitis [89], reduction of symptoms from

collagenous colitis [90], treatment of functional

constipation [91], prevention of necrotizing

enterocolitis in preterm infants [92] and treatment of

functional abdominal pain disorders in children [93].

Probiotics are used to control Candida infection

and risk of hypo-salivation and feeling of dry mouth

in elderly patient. Elderly are more prone to Candida

infection provoked by chronic diseases, medications,

poor oral hygiene, reduced salivary flow and

impaired immune response. Bacteria like

Lactococcus lactis, Lactobacillus helveticus,

Lactobacillus rhamnosus GG (ATCC53103),

Lactobacillus rhamnosus LC705 when used in one of

the study, showed significant reduction of Candida

infection [94]. It should also be noted that as most

probiotics are in dairy forms containing high calcium,

they possibly reduce demineralization of teeth.

Regular use of probiotics can help to control halitosis

[95]. After taking Weissella cibaria, reduced levels of

volatile sulfide components produced by

Fusobacterium nucleatum were observed by Kang et

al [96]. The effect could be due to hydrogen peroxide



production by Weissella cibaria, causing

Fusobacterium nucleatum inhibition.

Some preliminary evidence suggests that food

products derived from probiotics bacteria could

possibly contribute to blood pressure control [97,98].

This antihypertensive effect has been documented

with studies in spontaneous hypertensive rats. Two

tripeptides, valine- proline- proline and isoleucine-

proline- proline, isolated from fermentation of a

milk-based medium by Saccharomyces cerevisiae

and Lactobacillus helveticus have been identified as

the active components. These tripeptides function as

angiotensin-1-converting enzyme inhibitors and

reduce blood pressure [99]. Some experimental

animal and human investigations suggest that

probiotics may reduce the risk of heart disease by

their beneficial effects on blood lipid levels [100] and

alleviate kidney stones [101] and decrease

inflammation associated with arthritis [102].

3. PREBIOTICS

In 2010, the International Scientific Association for

Probiotics and Prebiotics Working Group defined

dietary prebiotics as “selectively fermented

ingredients that result in specific changes, in the

composition and/or activity of the gastrointestinal

microbiota, thus conferring benefit(s) upon host

health” [103]. Typically, prebiotics are low molecular

weight carbohydrates with 2-10 degrees of

polymerization [104]. The main characteristics of a

prebiotic are resistance to digestive enzymes in the

human gut but fermentability by the colonic

microflora, and bifidogenic and pH-lowering effects

[105,106]. By this last effect, prebiotics inhibit

certain strains of potentially pathogenic bacteria,

especially Clostridium, and prevent diarrhoea [107].

The most prevalent forms of prebiotics are

nutritionally classed as soluble fiber. Traditional

dietary sources of prebiotics include soybeans, inulin

sources (such as banana, Jerusalem artichoke, jicama,

and chicory root), raw oats, unrefined wheat,

unrefined barley, garlic, onion, raw wheat bran and

cooked whole wheat flour [108].

3.1 Types of prebiotics

The most widely described prebiotics are non-

digestible oligosaccharides like fructo-

oligosaccharides (FOS) [109]. The others include

polyols (xylitol, sorbitol, mannitol), disaccharides

(lactulose, lactilol), oligosaccharides (raffinose,

soybean), oligofructose, other non-digestible

oligosaccharides (palatimose, isomaltose,

lactosucrose) and polysaccharides (inulin, resistant

starch) [103].

Fructo-oligosaccharides (FOS) are a naturally

occurring oligosaccharide that is not digested in the

upper gastrointestinal tract but is degraded in the

colon by indigenous bacteria. It is a sweet product

derived from native inulin and is approximately 30-

60% as sweet as sugar [110]. Prebiotic (FOS) is

gaining increasing recognition as agents to modulate

the colonic microbiota in humans. It is mainly known

for its ability to stimulate the growth of beneficial

bacteria, especially Bifidobacteria, and thus improves

host health. Inulin, a polyfructan, occurs as a reserve

carbohydrate in many plant families, representing

more than 30,000 species. Inulin has excellent

nutritional and functional characteristics and can be

used to replace fat, flour and sugar. Inulin may offer

more health benefits than other fibers.

Galactooligosaccharides are digestion-resistant

oligosaccharides naturally found in both human and

cow’s milk [111]. Lactulose is a synthetic

disaccharide used as a drug for the treatment of

constipation and hepatic encephalopathy. Breast milk

oligosaccharides are present in breast milk. An

exclusively breastfed baby has flora dominated by

Lactobacilli and Bifidobacteria, which are part of the

baby’s defence against pathogens and which is an

important primer for the immune system [112,113].

These floras are nurtured by the oligosaccharides of

breast milk, which is considered to be the original

prebiotics.

3.2 Production of short chain fatty acids

It has been observed that anaerobic breakdown of

prebiotics and their subsequent fermentation by

probiotics not only enhances the growth of probiotics

(LAB) further but also leads to production of SCFA

like butyrate, acetate and propionate of varying

quantity as byproducts of fermentation. These SCFA

acidify the colon environment, which may contribute

to their anticancer action [114] and it is beneficial for

the development of bacteria such as Bifidobacteria

and Lactobacilli, and detrimental to the growth of

potential pathogenic species [115,116]. All the SCFA

are rapidly absorbed from the colon and then

metabolized by various tissues: butyrate by the

colonic epithelium, propionate and acetate (partly) by

the liver and acetate (partly) by muscle and other

peripheral tissues [8,116]. Out of the 3 SCFAs,

butyrate has been most extensively studied. Butyrate-

treated colon cells have been found to be more

protected against hydrogen peroxide-induced

oxidative damage than those of untreated ones

because this SCFA is an important protective fuel for

colon cells. In colon cells, butyrate has been found to

increase the formation of glutathione S-transferase pi,

which is an important enzyme involved in the

detoxification of both electrophilic products and



compounds associated with oxidative stress.

Evidences suggest that butyrate may inhibit the

genotoxic activity of nitrosomides and hydrogen

peroxide in human colon cells. In humans, ingestion

of probiotics have been found to decrease the

concentration of colonic genotoxic substances in

urine along with high levels of compounds which

induce oxidized DNA bases [114]. Short-chain fatty

acids play essential role in the growth and physiology

of intestinal tissue as well as in systemic metabolism

[117,118].

3.3 Health benefits of prebiotics

The nutritional properties of prebiotics are related

directly to the physiological changes they induce in

the host. Bacterial metabolites are probably the main

effectors of most observed effects. The most

important metabolites are the short-chain fatty acids

(SCFA) acetate, propionate and butyrate [15].

Prebiotic consumption can double the pool of SCFA

in the gastrointestinal tract. The postulated beneficial

effects of prebiotics are summarized below.

3.3.1 Anticarcinogenic effect

It has been suggested that prebiotics can be

protective against the development of cancer.

Secretion of carcinogens and tumor promoters by

some species of bacteria of the colon can occur

through the metabolism of certain types of food;

proteolysis in the colon is recognized as a mechanism

for production of potentially malignant end products

[103]. Modification of the gut microflora may

interfere with the process of carcinogenesis and this

opens up the possibility for dietary modification of

colon cancer risk. Prebiotics modify the microflora

by increasing numbers of Lactobacilli and/or

Bifidobacteria in the colon [104]. The development

of aggressive tumor cells in muscle tissue was

showed down and an increase in life span was

induced in the case of ascitic tumors [119]. More

pronounced effects were achieved by synbiotics and

long-chain inulin-type fructans compared to short-

chain derivates (sustained activity of the

saccharolytic fraction of the intestinal microbiota),

especially in the more distal parts of the colon

[120,121]. Colorectal cancer is the third most

common cancer, accounting for around 12% of

cancer deaths worldwide. It is estimated that altering

the gut microflora through diet towards

predominance of beneficial species could help in the

prevention of the disease. The roles of short chain

fatty acids, for example, acetate, propionate and

butyric acid are being extensively studied because

they have shown to inhibit the growth of colon tumor

cells, encourage cell turnover and support normal

gene expression [121,122].

3.3.2 Antiallergic effect

It is recognized that specific bacteria in the gut can

potentially promote anti-allergenic processes.

Different allergies affect different tissues and may

have local or general effects. Some beneficial effects

have been attributed to the consumption of these

prebiotics. It is believed that their beneficial effects

result from the metabolism of these compounds.

Fermentation of these oligosaccharides results in the

production of various organic acid and CO2 [123].

Delzenne and Roberfroid [124] have stated that the

balance of such a complex process is likely to

produce 40% SCFA, 15% lactic acid and 5% CO2.

3.3.3 Increased mineral absorption

Prebiotics have putative beneficial effects on

calcium bioavailability. Calcium is mainly absorbed

in the small intestine; however, some is also absorbed

in the colon [125]. Numerous animal studies have

indicated that prebiotics increase calcium, iron, zinc,

copper and magnesium absorption from the colon and

stimulated the bacterial hydrolysis of phytic acid

[126,127,128], resulting in an improvement of

absorption, in increased bone density and bone

trabecular structure [129,130,131]. Intake of

prebiotics acidifies the intestinal contents, which aids

the solubilisation of minerals [127]. Bacterial

fermentation products, predominantly lactate and

butyrate, enlarge the absorption surface by promoting

proliferation of enterocytes [132]. Other mechanisms

that have been proposed include suppression of bone

resorption rate relative to bone formation rate [133],

release of bone-modulating factors such as

phytoestrogens [129] and improvement in gut health

and gut-associated immune defense [17].

3.3.4 Other potential health benefits

Prebiotics are helpful in modulating immune

system. It has been observed that consumption of

inulin-type fructans increases the phagocytic capacity

of macrophages [134]. There is increasing evidence

from animal studies that the addition of fermentable

fiber to the diet can modulate the type and function of

cells from different regions of the gut-associated

lymphoid tissue (GALT) [135]. Furthermore,

prebiotics improved the manifestations of atopic

dermatitis in children above two years [136] and

reduced the incidence of atopic dermatitis during the

first six months of life in high-risk infants [137].

Fructo-polysaccharides such as inulin are non-

digestible carbohydrate substrates in the diet that

target certain components of the gut microbiota in the

human large intestine such as Bifidobacteria and

Lactobacilli [7]. Inulin can stimulate the growth



and/or activity of these types of bacteria in the colon

and this stimulation can improve the intestinal flora

composition, enhance the immune system and

thereby contribute to the health of the host [138,139].

Prebiotics increase fecal bulk and optimize stool

consistency primarily by increasing fecal microbial

mass. All carbohydrates that reach the large intestine

have a laxative effect on bowel habit. It can be

predicted, therefore, that prebiotics will be laxative.

In carefully controlled studies it has indeed been

shown that prebiotics that are fermented completely

increase bowel frequency [140], bringing relief from

constipation in chronically constipated subjects.

Evidence suggests prebiotics can favorably influence

serum glucose and insulin levels in a variety of ways.

Digestion resistant oligosaccharides, i.e., inulin-type

fructans, galactooligosaccharides, lactulose,

isomaltooligosaccharides, xylooligosaccharides,

soyoligosaccharides, gentiooligosaccharides and

nigeroligosaccharides [141] and other prebiotics can

reduce the amount of glucose available for absorption

into the bloodstream. Prebiotics also prevent

excessive blood glucose elevations after a meal by

delaying gastric emptying and/or shortening small

intestine transit time. Bacterial fermentation yielding

short-chain fatty acids is another mechanism whereby

prebiotics can modulate glycemia and insulinemia

[142]. The gut acts like an endocrine organ,

producing a range of hormones that are devoted to

the regulation of behavioral and metabolic function,

by sending signals to the brain or other key target

organs (eg. liver and pancreas). This can affect

appetite, energy and nutrient metabolism. The

addition of inulin-type fructans [143] and

oligofructose [144] in animal diet showed beneficial

effect in experimental animals. In human studies,

inulin and oligofructose have had a favourable impact

on lipid and glucose metabolism [145].

4. CONCLUSION

The intestinal microbiota forms a diverse and

complex ecosystem. However, there is much

variability in bacterial numbers and populations

between the stomach, small intestine and colon. In

comparison with other regions of the GI tract, the

human colon is an extremely-densely-populated

microbial ecosystem. These gastrointestinal

microflora are important elements in the health of the

host animal. Environmental factors, diet, medication

and stress can all adversely affect the composition

and/or activity of the gut flora. The deficiencies

created can be repaired either by added viable

organisms (probiotics) or by stimulating specific

components (e.g. Bifidobacteria) of the flora with

chemical supplements (prebiotics).

Probiotics and prebiotics are gaining popularity

because of the innumerable benefits, e.g. treating

lactose intolerance, hyper cholesterol problems,

cardiac diseases and managing cardiac problems like

atherosclerosis and arteriosclerosis. Probiotic

microbiota can have a significant influence on the

treatment and prevention of various diseases.

Prebiotics have similarities with dietary fiber

functionality in that microbial fermentation of

carbohydrate occurs. In addition to their

physiological functions and health benefits, non

digestible oligosaccharides (NDOs) also provide

useful modifications to the physicochemical

properties of foods. At present, a number of

oligosaccharides have been used in foods and

beverages such as candies, confectioneries, bakery

products, fermented products, fruit juices, desserts,

and spreads as taste improver, sweetener, fat replacer,

emulsifier, viscosity increasing agent and stabilizer of

proteins, flavors and colors. Foods supplemented

with NDOs can have a potential to improve well-

being and/or reduce the disease risk. While the

mechanisms of their effects on gut bacteria are slowly

being unraveled, their effects on health are much

more difficult to demonstrate.

Conflict of Interest

The authors declare that they have no conflicts of

interest.

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