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Probiotics are dietary supplements containing living beneficial microorganisms which help to maintain normal functioning of the digestive system. The best-studied probiotics are the lactic acid bacterial strains Lactobacillus acidophilus (which colonise the small intestine) and Bifidobacterium lactis (found in the large intestine), which are components of the natural intestinal flora. Probiotic bacteria are found in natural yoghurt, although in much lower numbers than in dietary supplements.

How do Probiotics work?

The digestive system typically contains both beneficial and harmful (pathogenic) bacteria. Supplementation with probiotics increases the number of beneficial bacteria, which compete with pathogenic bacteria in the gastrointestinal tract for nutrient resources, as well as producing chemical substances that inhibit the growth of undesirable bacteria. Probiotics therefore help to maintain a healthy digestive system by promoting unfavourable conditions in the digestive tract, where harmful bacteria thrive. Probiotic bacteria also help to maintain normal immune function, which is important for resistance to infection, prevention of allergies and autoimmune disease, and recognition of abnormal cancer cells within the body.

Immune function and the digestive system.

Most people are unaware of the importance of the digestion system to immune function. At birth, infants leave the sterile environment of the womb and their digestive tracts quickly become colonised by bacteria. The process of acquiring normal gut flora at this stage depends heavily on dietary intake (e.g. breast-feeding). Once initially colonised by bacteria in infancy, an individual?s gut flora remains remarkably constant throughout the rest of life. This is because the immune system quickly learns to recognise and tolerate the bacteria acquired during infancy, and so it is extremely important to acquire healthy bacteria early in life. These gut bacteria communicate with the immune system to programme the latter to respond appropriately during the rest of life, and inappropriate programming at this stage may lead to the development of allergic and inflammatory diseases.

In recent decades there has been a dramatic increase in immune-related disorders, including allergies (food allergies, eczema, asthma, allergic rhinitis), autoimmune disorders (diabetes, arthritis) and inflammatory disorders (Crohn's disease, ulcerative colitis). It is now estimated that one out of every three children born in industrialised countries will develop an allergic disorder. These disorders are thought to result in part (genetic factors may also be involved) from the presence of abnormal gut bacteria, which stimulate the immune system to release inflammatory substances when the immune system is not properly primed early in life by normal gut bacteria.

This in turn is thought to be related to increased levels of general hygiene (the "hygiene hypothesis"), the use of antibiotics and to changes in diet associated with modern Western society. The hygiene hypothesis of allergy links the frequency of allergic disorders with improved hygienic conditions and reduced early microbial exposure, and the use of antibiotics in the first year of life is associated with an increased risk of allergic disease in later childhood.

Probiotics and the digestive system

The potential benefits of administering probiotics to infants as early as practicable should be apparent, since healthy gut bacteria acquired in infancy are likely to be the most important determinants of allergies and diseases of chronic inflammation later in life. Breast-feeding is generally recommended during the first 4-6 months of life, and probiotics can be advantageously consumed by mothers during pregnancy and breast-feeding. To this end, infant food formulas manufactured in some European countries contain probiotics. Abnormal gut bacteria trigger the release of pro-inflammatory substances (inflammatory cytokines), which are responsible for allergic or inflammatory responses by the immune system. It is possible to "reprogramme" this situation even in later life, by the introduction of suitable probiotic bacteria. Probiotic bacteria restore gut homeostasis by inhibiting the release of inflammatory cytokines, secreting antimicrobial substances (bacteriocins) that inhibit the growth of disease causing bacteria, and enhancing immune system defences (IgA antibody levels, macrophage/killer cell levels) to invasive pathogens. Natural levels of probiotic bacteria in the gut may be reduced by aging, poor diet, drinking alcohol, environmental pollution, stress and certain types of prescription medicines (especially antibiotics).

What do you take Probiotics for?

Probiotics are beneficial for maintaining a healthy digestive system, during holiday travel, at times of stress, for individuals who take the contraceptive pill, and after courses of antibiotics. Levels of naturally occurring probiotic bacteria in the digestive tract decrease with age, which can be one of the reasons for poor digestion in the elderly.

Are there adverse effects from taking Probiotics?

Oral administration of probiotics is well-tolerated and safe. There are no reported drug interactions or adverse effects and no known risk of overdose. Probiotics can be taken by pregnant and lactating women. Probiotics can be given to young children as early as is practically possible in the correct strains.

How much Probiotic should you take?

It is recommended to take the equivalent of 10-20 billion viable probiotic bacteria per day. Probiotic supplements are best taken when encapsulated within an acid resistant gel matrix. The capsule is dissolved by acid in the stomach, but the viability of the bacteria is maintained by the protective gel, which in turn dissolves in the small intestine to release the beneficial bacteria. Many commercial probiotic formulations need to be stored in a refrigerator (inconvenient for travellers), contain relatively few viable bacteria (typically 0.1-2 billion), or are inactivated by the adverse environment of the stomach (before reaching the intestines).

If taken during antibiotic treatment, allow three hours after each antibiotic dose before taking probiotics.

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