Probiotics from foods to supplements a scientific point of vie · 2015-12-03 · dietary...
Transcript of Probiotics from foods to supplements a scientific point of vie · 2015-12-03 · dietary...
“The Global Voice of Probiotics”“The Global Voice of Probiotics”
Probiotics from foods to supplements a scientific point of view
“The Global Voice of Probiotics”“The Global Voice of Probiotics”
Arthur OuwehandResearch Manager/Technical Research FellowDuPont Nutrition & Health, Kantvik, FinlandIPA/IPA Europe Scientific Advisory Board
ILSI Europe Probiotic Task Force
DuPont Nutrition & HealthLegacy Danisco, Legacy Solae
Probiotics, starter cultures, Prebiotics, Fibre, Sweeteners, Soy Proteins
“The Global Voice of Probiotics”
Todays topics:� When is a product or microbe a probiotic and when not
� What to expect from these products and what not
� Combining probiotic strains
� Modulating microbiota with probiotics
“The Global Voice of Probiotics”“The Global Voice of Probiotics”
Live microorganisms that, when administered in adequate amounts, confer a health benefit on the host (Hill et al. 2014)
☺ Lactobacillus sp.
☺ Bifidobacterium sp.
☺ E. coli, Enterococcus, yeast, Bacillus, .........
What are probiotics?
“The Global Voice of Probiotics”“The Global Voice of Probiotics”
Faecal
transplant
Fermented
foods
Probiotic
foods
Probiotic
dietary supplements
Probiotic
medical foods
Probiotic
medical device
Probiotic
pharmaceuticalsprobiotic
not
probiotic
Yogurt
Cheese
Sourkraut
Tempé
Natto
.............
• Foods that contain live microbes are not necessarily probiotic• These foods may be healthy, but that does not make them probiotic
When is a product a probiotic
and when not?
“The Global Voice of Probiotics”“The Global Voice of Probiotics”
Faecal
transplant
Fermented
foods
Probiotic
foods
Probiotic
dietary supplements
Probiotic
medical foods
Probiotic
medical device
Probiotic
pharmaceuticalsprobiotic
not
probiotic
probiotic
• Maintain health
• Promote/support health
• Reduce risk for disease
(not prevent)
• Prevent disease
• Cure disease
• Mitigate disease
When is a product a probiotic
and when not?
“The Global Voice of Probiotics”
Example of risk reductionRespiratory tract infection (duration)
King et al. Br. J. Nutr. 2014
“The Global Voice of Probiotics”
Example of risk reductionRespiratory tract infection (incidence)
West et al.Clin. Nutr. 2013
“The Global Voice of Probiotics”
Example of risk reductionRespiratory tract infection (incidence)
Respiratory tract infection
Respiratory tract infection
Respiratory tract infection
Placebo
Probiotic
“The Global Voice of Probiotics”
Example of risk reductionAntibiotic Associated Diarrhoea
Pattani et al. Open Med. 2013
“The Global Voice of Probiotics”
Example of risk reductionAtopic Dermatitits
Wickens et al. Clin. Exp. Allergy2013
“The Global Voice of Probiotics”
Example of risk reductionAtopic Dermatitis; reduced severity
Wickens et al. Clin. Exp. Allergy2013
“The Global Voice of Probiotics”
Summarise� Probiotics are live microbes; not all live microbes are
probiotics
� Probiotics can be drugs, here we talk about dietary supplements and functional foods
� Maintain health, reduce risk (not prevent)
“The Global Voice of Probiotics”
Probiotics; alone or together?
� Mono-strain probiotics
� Multi-strain probiotics
� Multi-species probiotics (is also multi-strain)
“The Global Voice of Probiotics”
Probiotics; why mix?
� Combine the benefits of different strains
� More diversity is better
� Seek synergies
� ..........
� Up to each manufacturer to document this
“The Global Voice of Probiotics”
Probiotics; why mix?
Chapman et al. 2011
“The Global Voice of Probiotics”“The Global Voice of Probiotics”
Antimicrobial activity; single or multipleC. difficile E. coli S. Typhimurium
Lactobacillusmix vs. single
No difference Mix>single(p>0.01)
No difference
Bifidobacteriummix vs. single
Mix>single(p>0.0001)
Mix>single(p>0.05)
No difference
Multigenusmix vs. Lactobacillus
Mix>single(p>0.0001)
No difference Mix>single(p>0.0001)
Multigenusmix vs. Bifidobacterium
Mix>single(p>0.0001)
No difference Mix>single(p>0.0001)
Chapman et al. 2012
“The Global Voice of Probiotics”
Probiotics; why mix?
� Combine the benefits of different strains
� More diversity is better
� Seek synergies
� ..........
� Up to each manufacturer to document this
� Antagonism?
“The Global Voice of Probiotics”
Antimicrobial effect of probiotics
Wells et al. 1997
Lactobacillus fermentum
Streptococcus bovis
“The Global Voice of Probiotics”
Antagonism between mixed probiotics?
� Effect of probiotics on serum cholesterol
� Single strain (4 studies) -0.22 (95% CI; -0.65, 0.21)
� Multiple strain (6 studies) -0.31 (95% CI; -0.47, -0.16)***
� P-value between variables = 0.69
� Effect of probiotics on serum LDL-cholesterol
� Single strain (6 studies) -0.34 (95% CI; -0.68, 0.00)**
� Multiple strain (4 studies) -0.52 (95% CI; -0.85, -0.18)***
� P-value between variables = 0.47
� No difference between single and multiple strain
Sun & Buys 2015
“The Global Voice of Probiotics”
Antagonism between mixed probiotics?
� Effect of probiotics on diastolic blood pressure
� Single strain (4 studies) -0.28 (95% CI; -2.95, 2.39)
� Multiple strain (5 studies) -5.79 (95% CI; -8.66, -2.93)**
� P-value between variables <0.05
� Effect of probiotics on systolic blood pressure
� Single strain (4 studies) -1.99 (95% CI; -4.79, 0.81)
� Multiple strain (4 studies) -2.72 (95% CI; -4.35, -1.08)**
� P-value between variables <0.05
� Difference; multiple strain better
Khalesi et al. 2014
“The Global Voice of Probiotics”
Antagonism between mixed probiotics?
� Effect of probiotics on gastrointestinal diseases
� Single strain (51 studies) 0.63 (95% CI; 0.53, 0.76)**
� Multiple strain (33 studies) 0.73 (95% CI; 0.68, 0.79)**
� P-value between variables > 0.05
� No difference between single and multiple strain
Ritchie & Romanuk 2012
“The Global Voice of Probiotics”
Antagonism between mixed probiotics?
Pro-inflammatory and anti-inflammatory may cancel out in a mixture (in vitro). Biomarker, not clinical end-point
Timmerman et al. 2007
“The Global Voice of Probiotics”
Antagonism between mixed probiotics?� Effect of probiotics on experimental pancreatitis (= disease)
� Histopathology of pancreas
� Single strain (3 studies) -2.240 (-3.686, -0.794)**
� Multiple strain (3 studies) -0.503 (-1.893. 0.888)
� Bacterial translocation to pancreas
� Single strain (2 studies) 0.123 (0.011, 1.416)*
� Multiple strain (3 studies) 0.359 (0.047, 2.714)
� Bacterial translocation to mesenteric lymphe nodes
� Single strain (2 studies) 0.147 (0.041, 0.529)**
� Multiple strain (3 studies) 0.371 (0.122, 1.133)*
� Difference; multiple strain worse (only example)Hooijmans et al. 2012
“The Global Voice of Probiotics”
Single vs. Multiple strain
� What meta-analyses compare:
� Single strain (A) vs. Multiple strain (B + C)
� vs.
� What should be compared:
� Single strains (A, B) vs. their combination (A + B)
� vs. vs.
“The Global Voice of Probiotics”
Reduction in respiratory tract infection in children during the winter
Leyer et al. 2009
“The Global Voice of Probiotics”
Summarise� Combining probiotic strains does not affect efficacy in
most cases
� In some cases it may even improve efficacy
� In vitro, immune effects on defined biomarkers may cancel out each other
� Only in one case (disease), effects maybe reduced in a mixture
� Head-on comparisons are, however, few and do not show a negative interaction
“The Global Voice of Probiotics”
Probiotics:modulating intestinal microbiota
Durban et al. 2012
“The Global Voice of Probiotics”
Probiotics:modulating intestinal microbiota
Jalanka-Tuovinen et al. 2011
“The Global Voice of Probiotics”
Probiotics:modulating intestinal microbiota
Ottman et al. 2012
“The Global Voice of Probiotics”
Probiotics:modulating intestinal microbiota
� Intestinal microbiota is in practice faecal microbiota
� ’The intestinal microbiota’ does not exist
� Intestinal microbiota is highly personal
� Fairly stable over time (days-months), but changes during life
� Variation over time is smaller then variation between subjects
� Health benefits without modulating microbiota
� How to stabilise/improve/modulate the intestinal microbiota in healthy subjects?
“The Global Voice of Probiotics”
Maintain/restore microbiota during stress
Seven day antibiotic
treatment; influence
on selected
intestinal microbial
groups
Rashid et al. 2015
“The Global Voice of Probiotics”
Summarise� A healthy subject has a stable microbiota
� The microbiota is very personal
� What is a healthy microbiota?
� Probably the microbiota you have when you are healthy
� Improving the microbiota is probably not possible and possibly undesirable
� Feasible target: maintain microbiota during stress or restore after stress
� Other health targets?
“The Global Voice of Probiotics”
Conclusions� Probiotics are live microbes; not all live microbes are
probiotics
� Probiotics can be drugs, here we talk about dietary supplements and functional foods
� Maintain health, reduce risk (not prevent)
� Most cases, combining probiotics does not negatively affect activity
� Improving the microbiota of a healthy subject is challenging
� Instead, maintain or restore original microbiota
� Consider other health targets?