ArticlePDF Available
Volume 3 • Issue 1 • 1000e124
Vitam Miner
ISSN: VMS, an open access journal
Vitamins & Minerals
Eck and Friel, Vitam Miner 2013, 3:1
http://dx.doi.org/10.4172/vms.1000e124
Editorial Open Access
Should Probiotics be considered as Vitamin Supplements?
Peter Eck and James Friel*
Human Nutritional Sciences, University of Manitoba, Winnipeg, R3T 2N2, Canada
*Corresponding author: James Friel, Human Nutritional Sciences, University of
Manitoba, Winnipeg, R3T 2N2, Canada, Tel: 204-474-8682; Fax: 204-474-7552;
E-mail: james.friel@ad.umanitoba.ca
Received October 24, 2013; Accepted October 24, 2013; Published October 27,
2013
Citation: Eck P, Friel J (2013) Should Probiotics be considered as Vitamin
Supplements? Vitam Miner 3: e124. doi:10.4172/vms.1000e124
Copyright: © 2013 Eck P, et al. This is an open-access article distributed under
the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and
source are credited.
Denition of Probiotics
e denition of probiotics that is widely accepted [1] describes
probiotics as “living microorganisms that on ingestion in certain
numbers exert health benets beyond inherent basic nutrition”. e
important aspects of the denition of probiotics are that probiotics need
to be a live microorganism, such as yeast or bacteria, and probiotics
need to have a health benet. erefore, these microorganisms need
to have undergone in vitro and experimental studies in order to
be properly named a benecial strain of probiotics, and to prove its
health benet and safety. An extensive body of evidence demonstrates
that probiotics have a clinical use and can be recommended in the
treatment of certain diseases, such as antibiotic induced diarrhoea,
infectious diarrhoea of adults and children and prevention of atopic
eczema and cow’s milk allergy [2]. Naming the species is important
are there are multiple microorganisms that can be classied under
the general term “probiotics” yet each may have a dierent eect on
metabolism. us, knowledge of which organism is used is crucial in
designing experiments or making claims of function. As they become
more popular and easily available, we need specic knowledge of
function. New sequencing techniques that seem to evolve year by year
are revealing more and more species of bacteria in the human body that
previously we were unaware of.
Microbiome
e Microbiome is a heterogeneous system consisting of millions
of microbes that share our body space, leading some to suggest it is
a “newly discovered organ”. It has been shown that the interaction
between the microbiome and its host play a major role in immune
modulation, as well as in several metabolic functions. Colonization of
the gut starts before birth, and is dependent on known factors such as
mode of delivery, type of feeding and gestational age. Disequilibrium
between the benecial and pathogenic bacteria of the gut will lead to
alteration in the defence barrier mechanisms and in immune functions,
and is associated with a number of acute and chronic conditions, such
as sepsis, NEC, inammatory bowel disease (IBD), type 2 diabetes,
allergy and obesity. Supplemental bacteria have been demonstrated
to modulate a variety of disorders in children and adults, including:
inammatory bowel diseases [3]; bowel cancer [4], ulcerative colitis
[5]; irritable bowel syndrome [6], obesity [7], cholesterol levels [8] and
diarrhea, secondary to oral antibiotics [9].
Microorganisms in the Gut and its Function
Bacteria in the lumen of the digestive system can be classied
accordingly: (a) benecial; (b) potentially pathogenic; and (c)
pathogenic bacteria. Probiotics are within the pool of benecial bacteria.
Two of the most common benecial bacteria are Lactobacillus sp. and
Bidobacter sp. With respect to the gastrointestinal environment,
the benecial microora has three important functions: metabolic,
trophic and protective [10]. For example, bacteria produce short-
chain fatty acids and vitamins and participate in mucosal epithelial cell
proliferation and dierentiation.
Probiotics and VitaminProduction
Vitamins are essential micronutrients that are necessary for vital
reactions in all living cells. We humans are incapable of synthesizing
most vitamins in amounts required to meet our physiological needs,
and so they consequently have to be obtained exogenously. One of
the multiples benets that probiotics have is the capacity to synthesize
vitamins. We have known for some time that commensal bacteria
produce vitamins, particularly B vitamins, and play a major role in
meeting our needs for these essential nutrients. What we now have to
consider with the advent of probiotics as a player in achieving optimal
health is how much of a role do they play as vitamin supplements?
is is uncharted territory and indeed, while we know vitamin K is
produced by bacteria in the gut, recent evidence indicates vitamin D
is as well [11]. In vitro and studies in humans have documented the
capacity of some probiotic strains to synthesize vitamin K, folic Acid,
vitamin B2 and B12. As we are able to identify more and more strains
in the human microbiome, it may be only a matter of time until we
identify new species that produce all the known vitamins, and may I
daresay newly discovered vitamins as well!
To remind you: ere are two dierent forms of vitamin K,
Phylloquinone or vitamin K1, present in all photosynthetic plants and
menaquinons, or Vitamin K2 which is primarily of bacterial origin
[12]. It has been demonstrated in vitro that strains of Lactobacillus
produce high levels of folate (about 100 µg/L). e same is possible
with bidobacteria strains, which may contribute to folate intake,
due to the synthesis and secretion of folates in the human intestine
by bidobacteria [13]. It has been demonstrated in human and piglet
that the quantity of folate produced in the intestine aects folate status
[14]. e production of vitamin B1 and B2 by bacteria contributes to the
total intake of vitamin B1 and B2 [15]. It was reported that Lactobacillus
reuteri CRL1098 was able to produce B12 [16].
Although it is very clear that microbes can synthesize most likely all
known vitamins, it is far from clear how much they can be a source of
vitamins. Important issues are: a) the microbes might produce vitamins,
but they might not be excreted, or might not survive the challenges of
the other microora, and therefore, be catabolized before they can be
absorbed. b) is raises the second issue, absorption: most transporters
for vitamins are in the duodenum and ileum, not in places where most
of the microbes are found. erefore, it needs to be established if the
vitamins, even if produced in high amounts and not metabolized, are
bioavailable. For example, the special case of Vitamin B12, which needs
intrinsic factor to be absorbed. e vitamin B12 which is produced in
the colon will never be in touch with intrinsic factor, and will never get
in touch with the receptors for intrinsic factors in the ileum.
Clearly residential bacteria and now probiotic supplements play
a role in vitamin production and metabolism. How much of a role
needs to be studied, particularly in vulnerable groups, such as newborn
Eck P, Friel J (2013) Should Probiotics be considered as Vitamin Supplements? Vitam Miner 3: e124. doi:10.4172/vms.1000e124
Page 2 of 2
Volume 3 • Issue 1 • 1000e124
Vitam Miner
ISSN: VMS, an open access journal
infants, premature infants, the elderly and those with chronic or acute
illnesses. e use of vitamin-producing microorganisms may represent
a more natural alternative to fortication using synthesised molecules,
and may permit production of foods with elevated concentrations of
vitamins that are less likely to cause undesirable side-eects.
In conclusion, the possibilities are endless. A whole new
methodology for delivering vitamins to those in need may present
itself in bacteria as a new carrier. Furthermore, once bacteria take up
residence, they keep producing these essential microorganisms, until
they are displaced. A nutrigenetic approach may yield huge benets, if
we can modify bacteria to produce vitamins in quantities that meet our
needs. Instead of vitamin supplements, we can consider seeding the gut
with our new vitamin producing microbes! We even have to change
our denition of “vitamin” and “essential”, if our needs are met by a
healthy microbiome. At the very least those of us in vitamin assessment
must now take into account the potential contributions of probiotics.
References
1. Guarner F, Schaafsma GJ (1998) Probiotics. Int J Food Microbiol 39: 237-238.
2. Floch MH, Walker WA, Guandalini S, Hibberd P, Gorbach S, et al. (2008)
Recommendations for probiotic use. J Clin Gastroenterol 42: S104-S108.
3. Guandalini S (2010) Update on the role of probiotics in the therapy of pediatric
inammatory bowel disease. Expert Rev Clin Immunol 6: 47-54.
4. de Moreno de Leblanc A, Perdigón G (2010) The application of probiotic
fermented milks in cancer and intestinal inammation. Proc Nutr Soc 69: 421-
428.
5. Sang LX, Chang B, Zhang WL, Wu XM, Li XH, et al. (2010) Remission induction
and maintenance effect of probiotics on ulcerative colitis: A meta-analysis.
World J Gastroenterol 21:1908-1915.
6. Moayyedi P, Ford AC, Quigley EM, Foxx-Orenstein AE, Chey WD, et al.
(2010) The American College of Gastroenterology irritable bowel syndrome
monograph: Translating systematic review data to clinical practice.
Gastroenterology 138: 789-791.
7. Luoto R, Isolauri E, Lehtonen L (2010) Safety of Lactobacillus GG probiotic in
infants with very low birth weight: Twelve years of experience. Clin Infect Dis
50: 1327-1328.
8. Ramasamy K, Abdullah N, Wong MC, Karuthan C, Ho YW (2010) Bile salt
deconjugation and cholesterol removal from media by Lactobacillus as
probiotics in chickens. J Sci Food Agric 90: 65-69.
9. Kale-Pradhan PB, Jassal HK, Wilhelm SM (2010) Role of Lactobacillus in the
prevention of antibiotic-associated diarrhea: A meta-analysis. Pharmacotherapy
30: 119-126.
10. Guarner F, Malagelada JR (2003) Gut ora in health and disease. Lancet 361:
512-519.
11. Jones ML, Martoni CJ, Prakash S (2013) Oral supplementation with probiotic
L. reuteri NCIMB 30242 increases mean circulating 25-hydroxyvitamin D: A
post hoc analysis of a randomized controlled trial. J Clin Endocrinol Metab 98:
2944-2951.
12. Thijssen HH, Vervoort LM, Schurgers LJ, Shearer MJ (2006) Menadione is a
metabolite of oral vitamin K. Br J Nutr 95: 260-266.
13. Strozzi GP, Mogna L (2008) Quantication of folic acid in human feces after
administration of Bidobacterium probiotic strains. J Clin Gastroenterol 42:
S179-S184.
14. Kim TH, Yang J, Darling PB, O’Connor DL (2004) A large pool of available
folate exists in the large intestine of human infants and piglets. J Nutr 134:
1389-1394.
15. Fabian E, Majchrzak D, Dieminger B, Meyer E, Elmadfa I (2008) Inuence of
probiotic and conventional yoghurt on the status of vitamins B1, B2 and B6 in
young healthy women. Ann Nutr Metab 52: 29-36.
16. Taranto MP, Vera JL, Hugenholtz J, De Valdez GF, Sesma F (2003)
Lactobacillus reuteri CRL1098 produces cobalamin. J Bacteriol 185: 5643-
5647.
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Citation: Eck P, Friel J (2013) Should Probiotics be considered as Vitamin
Supplements? Vitam Miner 3: e124. doi:10.4172/vms.1000e124
... Generally, it is acknowledged that the fermentation process replenishes the food substrate with vitamins and improves protein availability besides reducing antinutritional content (Sahlin, 1999). In vitro experiments and studies on humans have documented the capacity of some probiotic strains to synthesize vitamin K, folic Acid (vitamin B 9 ), vitamin B 2, and B 12 (Eck and Friel, 2013). Therefore, including fermented foods in vegetarian diets, will help in overcoming vitamin deficiencies, specially vitamin B 12 being the limiting micronutrient (Agnoli et al., 2017) provided the right microorganisms are used in their fermentation. ...
... Vitamin B 12 being one of the heat stable B group vitamins, it is likely that it will be available even in cooked fermented foods provided that the right microorganisms are there. For instance, at least one strain of the probiotic species Lactobacillus reuteri is known to produce vitamin B 12 (Eck and Friel, 2013). Harnessing this effect in cooked fermented foods will be useful for a primarily vegetarian diet. ...
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To evaluate the efficacy of a Lactobacillus probiotic single-agent regimen in preventing antibiotic-associated diarrhea (AAD). Meta-analysis of 10 randomized, blinded, placebo-controlled trials. Patients. A total of 1862 pediatric and adult patients who received a Lactobacillus single-agent regimen or placebo for the prevention of AAD. The MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases were searched from inception through May 2008 by two investigators independently using the following key words: probiotic, Lactobacillus, antibiotic-associated diarrhea. Full reports published in English were included if the studies were randomized, blinded, and placebo-controlled trials that evaluated the efficacy of Lactobacillus single-agent regimens versus placebo in the prevention of AAD. Bibliographies of recent review articles and systematic reviews were hand searched. Quality of the studies was assessed by using the Jadad scoring system. Number of subjects, age, Lactobacillus regimen, follow-up period, and occurrence of AAD were extracted into a standardized data collection form. Overall impact of Lactobacillus on AAD was compared with placebo by using a random-effects model. Ten studies with a total of 1862 patients (50.4% male) met all criteria. Six studies included patients aged 18 years or older, whereas four included patients younger than 18 years (range 2 wks-14 yrs). Jadad scores ranged from 2-5 (out of 5). The total daily dose of Lactobacillus ranged from 2 x 10(9)-4 x 10(10) colony-forming units and was administered throughout the entire antibiotic treatment (5-14 days) for all patients. The follow-up period varied from 2 days-3 months after the end of the probiotic regimen. The combined risk ratio (RR) of developing AAD was significantly lower with Lactobacillus compared with placebo (RR 0.35, 95% confidence interval [CI] 0.19-0.67). In a subgroup analysis, this held true for adults but not pediatric patients (RR 0.24, 95% CI 0.08-0.75 and RR 0.44, 95% CI 0.18-1.08, respectively). Administration of a Lactobacillus single-agent regimen as a prophylactic agent during antibiotic treatment reduced the risk of developing AAD compared with placebo in adults but not pediatric patients.
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Folic acid, or vitamin B9, is involved in appropriate regulation of DNA replication, synthesis of purines and deoxythymidine (dTMP), conversion of homocysteine to methionine, histidine catabolism, and correct differentiation of the neural tube during fetal organogenesis. Folic acid from food sources is almost completely absorbed in the small intestine, mostly in the jejunum, and does not reach the large intestine. The administration of probiotic strains able to synthesize folates de novo and release them in the extracellular space may provide an additional, constant endogenous source of this important vitamin in the intestinal lumen of humans. A pilot study involving 23 healthy volunteers was conducted to evaluate the ability of 3 probiotic strains, Bifidobacterium adolescentis DSM 18350, B. adolescentis DSM 18352, and Bifidobacterium pseudocatenulatum DSM 18353, to produce folates in the human intestine. Volunteers were randomly assigned to 1 of 3 groups for treatment with a specific probiotic strain (5 x 10(9) colony forming units/d). Strain effectiveness was evaluated by determination of the folate concentration in feces evacuated within 48 hours before and after administration of the probiotics. Quantification of microorganisms belonging to the genus Bifidobacterium was performed in parallel to folate analysis. Ingestion of these probiotic strains resulted in a significant increase of folic acid concentration in human feces in all treated groups. Analysis of the fecal Bifidobacteria confirmed the potential of all strains, especially B. adolescentis DSM 18352, to colonize the intestinal environment. The demonstrated ability of the probiotic microorganisms B. adolescentis DSM 18350, B. adolescentis DSM 18352, and B. pseudocatenulatum DSM 18353 to synthesize and secrete folates in the human intestinal environment may provide a complementary endogenous source of such molecules, which is especially useful for the homeostasis of mucosal enterocytes of the colon and, unlike oral administration of the vitamin, ensures its constant bioavailability.