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8/15/2019 Probiotics by Dr Sarma
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Prof. Dr. R.V.S.N. Sarma,MD., M.Sc (Canada), RCGP, FCGP, FIMSA,Senior Consultant P !sician,Cardio"Meta#olic and C est S$ecialist
%onorar! National Professor ofMedicine (CGP)
visit: www.drsarma.inwww.youtube.com/user/drsarmaji
http://www.drsarma.in/http://www.youtube.com/user/drsarmajihttp://www.youtube.com/user/drsarmajihttp://www.drsarma.in/
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Anti#otics
Pro#iotics
S!n#iotics
Pre#iotics
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Potential #ene&ts of'acto#acillus *+ !rs a o - +/ Conce$t of Pro#iotics
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Starts immediatel! after #irtPlace of #irt0!$e of Deli1er!
Feedin / 0ime, 0!$ePre"lacteals 1s 23clusi1e #reast feed.Premature 1s. Full termSic4 #a#ies
4
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st 5ear6/ 7 * #acterial s$ecies
Adult / + "8 #acterial s$ecies
2lderl!/ 9 :act. S$ecies
C r. Intestinal disorders
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For conte3t ; 0otal Cells0 eirs , #illion.
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Sta$ . Aureus, al#us Nose = s4in
Mout , Colon, Va ina 'acto#acilus S$, :i&do#act..
Candida al#icans Mout , Colon, Va ina
Va ina, uncti1a
Pseudomonas aeru inosa Colon = s4in
Facultati1e Anaero#es Strict anaero#es
LACTOBACILLUS: BIFIDOBACTERIA: SACCHAROMYECES:
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Probiotics%Friendly "acteria&
'ormalise(ntestine (mmunomodulation )etabolic e ects
*u++ression oPP)s
(ntestinalmucosal inte#rity
,e#ulation obowel movement
("*
*tren#t!ensimmunity
-lleviateood aller#y sym+toms
onrol o ("
Production o vitamins0im+roves di#estion
1actose tolerance
1owers c!olesterol%"ile acid deconju#ation
*ecretion&
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In i#it Potentiall! Pat o enic Microor anisms (PPMs)
Reduction in Intestinal $% ( t rou $roduction of
SCFAs)
Production of #acteriocins
Com$etiti1e #loc4in of ad esion sites
Com$etition for nutrients
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Most a#undant Pro#iotic inGI'acto#acillus/
Acido$ ilus,
R amnosus, GGPlantarum,Reuteri,:ul aricus,S$oro ensCasei
Action onl! in Small intestine
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:i&do#acteria
9* di?erent s$ecies / 'on um, :i&dum, infantis etcMost a#undant $ro#iotic ne3t to lacto#acilli S$. int e GI0
Action / 'ar e Intestine
5
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A$art from t e eneral Pro#iotics e?ect ,
:i&do#acteria el$s is Glutamine s!nt esis
Glutamine el$s in maintainin t e mucosalinte rit!
N%9 @ Glutamic acid """"""""""""7 Glutamine:i&do#acteria
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Saccharomyeces:
Boullardii,
Salivarium,Thermophilus
Non colonising yeast – so needsrepeated readministration
Action in large intestine7
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. )ust be o !uman ori#in
3. 6ert a bene icial e ect on t!e !ost
. "e non+at!o#enic and nonto6ic to t!e !ost
7. ontain a lar#e number o viable cells and remain viable
durin# stora#e and use
4. a+able o survivin# coloni8in# and +roli eratin# in t!e
#ut %s!ould not be 9illed by #astric juice / bile acids&
2. "e anta#onistic to +at!o#ens
5. -ble to in!abit in t!e * 1 intestine
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:i&do#acteria is an Im$ortant Pro#iotic as itmaintains t e mucosal inte rit!
%ence :i&do#acteria su$$lementation is useful inconditions li4e Gastroenteritis ere t e GI mucosais se1erel! dama ed
%o e1er, all t e mar4eted $re$aration contains onl! ; 9 s$ecies of :i&do#acteria as a ainst 9*reBuired
%ence it is ideal to su$$lement it $ro#iotic ici1e nutrient to :i&do#acteria so all 9* s$ecies can$roliferate
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• Non-digestible dietary supplements, which provide‘’nutrition’’ for Probiotics
• Oligosaccharides (fructo-oligosaccharides or O!",#nulin, $actulose, $actitol
• %utated &acterial !pecies (!treptococcus faecalis ,'lostridium butyricum , &acillus mesentericus "
• dvantage of Prebiotics in bacterial form ) ddl*Probiotic activity ( #ntrinsic Probiotic activity"
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*!ould +romote t!e +roli eration o bene icialbacteria %1actiobaccillus "i idobacteria&
*u++ly nutrient to bene icial bacteria
*!ould esca+e di#estion in t!e stomac! and reac!(ntestine
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Pro#iotics Pre#ioticsNatureof t ePre$
Microor anism Food su$$lement(e / F
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F
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. (n ective diarr!ea %viral bacterial&2. -ntibiotic associated diarr!ea
3. 1actose intolerance
4. ,ecurrent a+!t!ous ulcers and stomatitis
. (n lammatory (" %Ulcerative colitis ro!n s&
7. (rritable bowel syndrome
5. ;ravelers diarr!ea
$. Pouc!itis
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Due to #acteria, Virus or Proto oa
Viral diarr oea /Rota1irusM3 /
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:acteriocin
:ioacti1e $e$tides
S ort c ain fatt! acids
Neutrali ation of
dietar! carcino ens
Free amino acids
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1-P
IgA
Tumors
Th 0
Th 1
B
IL-2 ↑IFN- γ ↑
Th 2
ntibody mediatedresponse
'ell mediatedresponse
>iruses
TGF-β↓IL-4 ↓IL-10 ↓
+
IL-2 ↑
IFN-γ ↑
TNF-α ↑
IFN-α ↑
Natural iller cells
%acrophages
'ytoto.ic /-lymphocytes
111
#mmune 0esponse
)(ntestinal +it!elium
)icroor#anisms
B(#? @
(#) @
(# A
% 1 % cells of intestinal epithelium
$ 1 $ymphocytes
P' 1 ntigen presenting cells
/h 1 /-helper cells
#$ 1 #nterleu ines
/2 1 /umour growth factor # N 1 #nterferon
/N 1 /umour necrosis factor
#g 1 #mmunoglobulin
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Protection of intestinal e$it elial #arrierfunction
Re ulation of intestinal e$it elialomeostasis
Re ulation of intestinal micro#ial
en1ironment
Modi&cations to commensal and $ro#iotic#acteria to en ance diarr ea $re1ention
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)ost common antibiotics t!at cause diarr!ea
-lteration in com+osition o normal intestinal bacterial micro
lora by antibiotic ma9es t!e ?( tract susce+tible to in ection
by un#us % andida& or bacteria lostridium di icile
Fun#us alters absor+tive sur ace o ?( tract – diarr!ea
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Pseudomembranous olitisVolcano lesions in AAD
• Relati1e ris4 of diarr ea reduced #! J. :! 'GG Sacc• +" #illion 1ia#le or anisms K 9" times da!• Pro#iotics to #e se$arated from Anti#iotics #! cou$le of
http://www.nature.com/clinicalpractice/about_site/doi.html
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• 0 e incidence of AAD can o u$ to *8J of
$atients on anti#iotics,
• :road"s$ectrum anti#iotics are associatedit t e i est rate of AAD #ecause of
t eir disru$ti1e im$act on t e normal
intestinal Eora.
( 2 0 0 6 ) 3 , 6
0 6 - 6 0 7
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Diarr ea is a common ad1erse e?ect of anti#iotic
treatments .
Anti#iotic associated diarr ea occurs in a#out +"9 J
of $atients
Almost all anti#iotics, $articularl! t ose t at act on
anaero#es, can cause diarr ea, #ut t e ris4 is i er it
amino$enicillins,
a com#ination of amino$enicillins andcla1ulanate, ce$ alos$orinLs, and clindam!cin.
:M * *69* / 9 +" 9 8 ( ON2)
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3
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1actase di#ests lactose commonly +resent in mil9 and mil9+roducts.
1actose is not di#ested w!en t!ere is a de iciency in lactaseand results in diarr!ea.
*u++lementation wit! +robiotics !as been s!own to miti#atet!e sym+toms o lactose intolerance.
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!uperficial ulcers or fissures inmucosa of mouth*
Painful condition*
3ach episode lasts 4 -56 days*
3.act etiology not nown*
!tress appears to play a role*
%. ) & comple. 7 multivitamin,probiotics and antiseptic ortetracycline mouth wash*
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- ects tourists travelin# 0 *!i#ella
;ransmission o in ection:
FecoBoral route / in#ers and lies.
;ravelers diarr!ea can be +revented by re#ular +ro+!ylacticinta9e o bene icial bacteria
Cne wee9 be ore travel durin# travel one wee9 a tercom+letion o travel.
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C ronic medical condition c aracteri ed #!
a#dominal $ain, discomfort and results in c an e
in t e #o el freBuenc! = consistenc! in t e stools
Cause / Alteration in t e #o el motilit! = transit (due to an3iet!)
S!m$toms / :loatin , as , d!s$e$sia ,
consti$ation, diarr ea , diarr ea alternatin itconsti$ation, d!senter!
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InEammation in GI 0ract
ro!n s isease
*mall 1ar#e intestine
Ulcerative olitis
1ar#e intestine %,ectum olon&
Ulcerative colitisro!n s disease
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S!m$tom / Diarr oea D!senter! fe1er t.loss
R3 / Sul$ asala ine , Steroids , Immuno"su$$resants
Rationale for Pro#iotic / I:D $atients a1e a
com$romised #o el Eora due to inEammation.
Su$$lementation it $ro#iotic el$s to normali e
t e #o el Eora and t ere #! reduces t e inEammation
Pro#iotics $romotes t e anti en s$eci&c I A immune
res$onse and s ortens t e diarr eal $ ase .Also reduces t e rela$se rate
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(n lammation o an internal +ouc! created in +atients w!o
!ave +art o t!eir colon removed to treat ulcerative colitis
D!y Probiotics : 1ow levels o bacterial lora in intestine
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iverticula B Formation o small bul#es / ba#s in t!e colon
iverticulitis – (n lammation/ (n ection in t!e diverticula
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Mi3ture of Pre and Pro#iotic
Pro#iotics ; %el$s in reducin t e PPMs
Pre#iotics ; %el$s in Pro1idin food forPro#iotics
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'acto#acillus sporogenes +
million ( Pro#iotic)
Stre$tococcus faecalis 0" 9 million (
Pre#iotic)
Clostridium butyricum 0
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Stre$tococcus faecalis 0" 9 million (
Pre#iotic)
Clostridium #ut!ricum 0
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On ingestion, 8 mutated
live bacteria continue to
proliferate in the 2# tract
by a process of!ymbiosis
!ymbiosis ) &iological
association of two or
more species to their
mutual benefit*
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