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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:
drmonikajain2000@gmail.com
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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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
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Significance of Probiotics and Prebiotics in Health and Nutrition 183
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
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Significance of Probiotics and Prebiotics in Health and Nutrition 184
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
Monika Jain et al., 2014 / Malaya Journal of Biosciences 2014, 1(3):181-195
Significance of Probiotics and Prebiotics in Health and Nutrition 185
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
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Significance of Probiotics and Prebiotics in Health and Nutrition 186
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
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Significance of Probiotics and Prebiotics in Health and Nutrition 187
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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