#1 WHAT ARE PROBIOTICS?

Probiotics are the good bacteria. This word was used to describe the production of a substance by one microorganism that triggers the development and growth of other useful microorganisms and promotes intestinal flora balance to the hosts’ intestinal flora balance (1). They are live microorganisms that have health benefits when consumed (2). Meanwhile, according to the Food Agriculture Organization (FAO) of the United Nations World Health Organization (WHO), probiotics are defined as living microorganisms that give health benefits to the consumer when administered in an adequate amount. This definition refers to probiotics in food products and it emphasizes the amount of food consumed (3).  

The relation between probiotics and human well-being has been discussed over the years. Decades have passed since the first time scientists discovered in the gut of healthy breast fed infants there is domination of Bifidobacteria (a type of probiotic) which were absent from infants who drink formula milk. This finding reveals the function of probiotics in maintaining our health. In 1995, Gibson and Roberfroid introduced probiotics as food supplements that are nondigestible but still able to offer many health benefits especially in the intestine (4).

#2 PROBIOTICS SPECIES

The most common probiotics species are Lactococcus and Bifidobacterium. Both of these species are classified as lactic acid bacteria (5). Lactic acid bacteria have various nutritional benefits that can improve our health, such as controlling intestinal infections, enhancing digestion of lactose, managing some types of cancer, controlling serum cholesterol level, improving immune response and upgrading food’s nutritional value (6). Below is the classification of microorganisms of Lactobacillus and Bifidobacterium species that are considered as probiotics (5): 

LACTOBACILLUS SPECIES	BIFIDOBACTERIUM SPECIES
L. acidophilus L. casei L. crispatus L. gallinarum L. gasseri L. johnsonii  L. paracasei L. plantarum L. reuteri L. rhamnosus	B. adolescentis B. animalis B. bfidum B. breve B. infantis B. lactis² B. longum

Species recognition is important as probiotics activities are strain-related. Thus, strain identification is recommended in order to have the maximum suitability and performance of the probiotics. Other than that, for the probiotics to exert its desirable properties to our health, the dose levels should also be based on the individuals. Therefore, it is advisable to consult with the certified pediatrician first for the best prescription of probiotics for your kids.

#3 HEALTH BENEFITS OF PROBIOTICS

After decades, research and studies have shown adequate evidence that probiotics offer several health benefits:

• Antibiotic-Associated Diarrhea:

  This condition refers to the passing loose and watery stools more than three times a day that happens after taking any form of antibiotics. This happens because antibiotics often interfere with the natural balance of nonpathogenic bacterial flora in our intestine. This will cause bad bacteria to grow and reproduce rapidly and eventually will cause diarrhea (7,8). Meanwhile, probiotics consist of good bacterias that encourage the immune system of the gut, thus, helping in preventing antibiotic-associated diarrhea from happening. 

• Infectious Diarrhea:

  The most common contagious virus that causes infectious diarrhea is Rotavirus among infants. The virus developed in the small intestine area and the normal microflora of the gut plays an important role to fight the infection (9). Therefore, consuming the right dosage probiotics supplements or food can help increase the growth of the good bacteria in the intestine. It is proven from well-controlled clinical research that certain types of probiotics can reduce the duration of acute rotavirus diarrhea (10). Based on the studies, probiotics work as a blockage agent for the secretory and motility defenses from the virus as well as boosting the immune response of the intestine and produce certain substances that directly disable the viral fragment.
  
  

• Lactose Intolerance:

  Lactose intolerance is a genetic condition. It refers to when our body cannot transform lactose into monosaccharides and galactose. When lactose travels to the large bowel, our body will recognize this substance as bacterial enzymes.  This will cause the person with lactose intolerant to have diarrhea, abdominal discomfort and flatulence after consuming dairy products (1). Probiotics with the correct concentration and specific species may help individuals with lactose intolerance to reduce the symptoms (11).

• Allergy:

  For infants, probiotics can be a safe alternative to stimulate microbial response in order to develop their immune systems against allergen. Probiotics help to improve mucosal barrier function which helps to control the allergic response. These health benefits of probiotics involve food allergy and atopic dermatitis or eczema (1). Certain types of probiotics have been proven to lower the eczema severity and prevent the recurrence of the eczema especially in high risk babies. However, research shows that probiotics have little effect on allergies such as rhinitis and asthma (12).

  In addition, probiotics also good for adult with milk hypersensitivity. Milk hypersensitivity is a cow’s milk allergy where our immune system reacts differently to certain type of protein found in the milk, this condition is different than lactose intolerant.  Adults with milk hypersensitivity (allergy to cow’s milk) show positive response toward probiotics treatment, nevertheless more research is still needed (13). 
  
  
  

# 4 WHAT FOOD CONTAIN PROBIOTICS

Probiotics usually live in fermented food. However, hot temperatures might kill these good bacteria. It best serves in cold or room temperature. Some of daily food that we can consume for the benefits of probiotics including:

1. Pickle
2. Yogurt
3. Miso
4. Kimchi
5. Tempeh
6. Unpasteurized Sauerkraut
7. Kombucha
8. Cultured milks such as Vitagen, Yakult and others
   
   
   

REFERENCES

1. Kechagia M, Basoulis D, Konstantopoulou S, Dimitriadi D, Gyftopoulou K, Skarmoutsou N, Fakiri EM. Health benefits of probiotics: a review. 2013. ISRN Nutrition. DOI: 10.5402/2013/481651
   
   
2. FAO/WHO. 2002. Guidelines for the evaluation of probiotics in food. Internet: http://www.who.int/foodsafety/fs_management/en/probiotic_ guidelines.pdf
   
   
3. FAO/WHO. 2001. Report on Joint FAO/WHO Expert Consultation on Evaluation of Health and Nutritional Properties of Probiotics in Food Including Powder Milk with Live Lactic Acid Bacteria. https://www.fao.org/3/a0512e/a0512e.pdf
   
   
4. G.R. Gibson & M.B. Roberfroid. 1995. Dietary modulation of the human colonic microbiota: introducing the concept of prebiotics. Journal of Nutrition 125(6): 1401-1412. DOI: 10.1093/jn/125.6.1401
   
   
5. W.H. Holzapfel, P. Haberer, R. Geisen, J. Björkroth & U. Schillinger. 2001. Taxonomy and important features of probiotic microorganisms in food and nutrition. American Journal of Clinical Nutrition 73(2): 265S-373S. DOI: 10.1093/ajcn/73.2.365s
   
   
6. Gilliland S. E. 1990. Health and nutritional benefits from lactic acid bacteria. FEMS microbiology reviews 7(1-2):175–188. DOI: 10.1111/j.1574-6968.1990.tb04887.x
   
   
7. Madsen KL. 2001. The use of probiotics in gastrointestinal disease. Can J Gastroenterol. 15(12):817-822. DOI: 10.1155/2001/690741
   
   
8. Saavedra JM. 1999. Probiotics plus antibiotics: regulating our bacterial environment. J Pediatr. 135(5):535-537. DOI:https://doi.org/10.1016/S0022-3476(99)70046-6
   
   
9. S.Salminen, C. Bouley, M. C. Boutron-Ruault et al. 1998. Functional food science and gastrointestinal physiology and function. British Journal of Nutrition 80(1): S147-S171. DOI: 10.1079/bjn19980108
   
   
10. N.P. Shah. 2007.Functional cultures and health benefits. International Dairy Journal 17(11): 1262-1277. DOI: https://doi.org/10.1016/j.idairyj.2007.01.014
    
    
11. K.M. Levri, K. Ketvertis, M. Deramo, J.H. Merenstein & F. D’Amico. 2005. Do probiotics reduce adult lactose intolerance? A systematic review. Journal of Family Practice 54(7): 613-620. https://pubmed.ncbi.nlm.nih.gov/16009090/
    
    
12. J.G. Wheeler, S.J. Shema, M.L. Bogle et. al. 1997. Immune and clinical impact of Lactobacillus acidophilus on asthma. Annals of Allergy, Asthma and Immunology 79(3): 229-233. DOI: 10.1016/S1081-1206(10)63007-4
    
    
13. L. Pelto, S.J. Salminen & E. Isolauri. 1996. Lactobacillus GG modulates milk-induced immune inflammatory response in milk-hypersensitive adults. Nutrition Today 31(6): 45S-46S. DOI: 10.1046/j.1365-2222.1998.00449.x