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Probiotics and Prebiotics in the Elderly J M T Hamilton-Miller

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Probiotics and Prebiotics in the Elderly J M T Hamilton-Miller 447 Postgrad Med J: first published as 10.1136/pgmj.2003.015339 on 5 August 2004. Downloaded from REVIEW Probiotics and prebiotics in the elderly J M T Hamilton-Miller ............................................................................................................................... Postgrad Med J 2004;80:447–451. doi: 10.1136/pgmj.2003.015339 Probiotics (usually lactobacilli and bifidobacteria) and probiotics did not become popular until the public embraced the idea of functional foods prebiotics (non-digestible oligosaccharides) have been (‘‘foods that provide physiological benefits or shown to be useful in preventing certain disease conditions reduce the risk of chronic diseases, over and as well as possibly promoting specific aspects of health. In above their basic nutritional value’’) during the last decade of the 20th century. Metchnikoff’s the present review, the evidence from clinical trials for theory that gut flora contribute in some way to benefits from probiotics and prebiotics to elderly aging was supported in the 1950s, by the finding populations is presented and discussed, specifically in that germ-free animals live longer than their conventional counterparts.7 respect of three common conditions found in the elderly. Today, probiotics are familiar to the public as Both probiotics and prebiotics may be helpful in the components of bioyoghurts and dietary malnutrition, particularly in lactose intolerance and calcium supplements, are widely available, and exten- sively purchased. In 1997, Europeans spent the absorption, and in constipation. Probiotics have been equivalent of almost $900 million on probiotic shown clearly to boost immunity in the elderly, but the yoghurts and milks, and this market is growing clinical significance of this remains to be clarified. These rapidly.8 Prebiotics are a more recent concept, first results are encouraging, and further large scale studies defined less than 10 years ago.9 They are che- seem justified to establish the place of probiotic and mical substances, usually oligosaccharides, that prebiotic supplements in elderly subjects. act as substrates specifically for the host’s intrinsic probiotic bacteria, and thus encourage ........................................................................... their growth. Prebiotics are selected as being non-digestible by the host and not metabolised robiotics—a word derived from Latin and by non-probiotic gut flora such as Bacteroides spp Greek meaning literally ‘‘for life’’—has been and Escherichia coli. Prebiotics are available defined in many ways since it was first naturally in breast milk and in certain vegetables P 1 coined 50 years ago. The most recent consensus (for example, Jerusalem artichokes and onions), is ‘‘defined, live micro-organisms administered and as synthetic oligosaccharides based on fruc- in adequate amounts which confer a beneficial tose or galactose, known as FOS and GOS http://pmj.bmj.com/ physiological effect on the host’’.2 While the respectively.10 The latter can be added to foods, concept that consuming large numbers of live or combined with a probiotic to make a synbiotic. bacteria can promote health and prevent and It is the purpose of this review to describe ways cure disease may at first seem strange, the in which use of probiotics, and possibly pre- usefulness of probiotics is rapidly becoming biotics, might benefit elderly subjects in res- apparent. pect of three commonly occurring conditions— Probiotics are usually bacterial components of namely, constipation, undernutrition, and the normal human intestinal flora, for example diminishing efficiency of the immune system. on September 29, 2021 by guest. Protected copyright. lactobacilli and bifidobacteria, that produce as end products of metabolism lactate and short AVAILABILITY OF PROBIOTICS AND chain fatty acids such as acetate and butyrate. PREBIOTICS Certain specific probiotic strains (for example, Probiotics Lactobacillus rhamnosus GG, L plantarum 299v, Products containing probiotic bacteria are readily L casei Shirota and L johnsonii La1) have well available to the public, the most common being defined and proven clinical effects for the treat- yoghurt. The standard type of yoghurt consists of ....................... ment and/or prevention of diseases of intestinal milk (usually from the cow, but milk from the and extraintestinal origin. These effects have goat or sheep may also be used) fermented by Correspondence to: been extensively reviewed recently.34 Professor J M T Hamilton- bacteria that convert lactose into lactic acid (see Miller, Department of Lactic acid producing bacteria (LAB) have table 1). Medical Microbiology, been used, unwittingly, for centuries to preserve Lactic acid gives the yoghurt its characteristic Royal Free and University food (for example, sauerkraut), and most coun- College Medical School, sharp taste (usually modulated with sweeteners tries developed their own characteristic type and flavouring) and also denatures and precipi- Rowland Hill St, London 5 NW3 2PF, UK; of fermented milk. The first deliberate use of tates casein, resulting in a semisolid consistency. j.hamilton-miller@ LAB for health reasons was by Metchnikoff So-called ‘‘bioyoghurts’’ are produced in a rfc.ucl.ac.uk early in the 20th century as a possible antidote to the aging process, proposed by him to be at Submitted Abbreviations: FOS, synthetic oligosaccharide based on 26 September 2003 least partly due to toxins produced by putrefac- fructose; GOS, synthetic oligosaccharide based on Accepted 20 January 2004 tive intestinal bacteria (that is, not LAB). After glucose; LAB, lactic acid producing bacteria; NK, natural ....................... some initial enthusiasm, interest waned,6 and killer (cells) www.postgradmedj.com 448 Hamilton-Miller Postgrad Med J: first published as 10.1136/pgmj.2003.015339 on 5 August 2004. Downloaded from Table 1 Examples of availability of probiotics in various forms Type of probiotic Example Biological effects Comments Yoghurt Classical type Lactobacillus delbrueckii Biological effects shown Products often pasteurised; var bulgaricus; (but limited); very palatable component bacteria cannot Streptococcus salivarius colonise gut; short shelf life; var thermophilus bacterial numbers not stated ‘‘Bio’’ type Lactobacillus acidophilus; Wide range of biological Short shelf life; bacterial numbers bifidobacteria may also effects; component bacteria not stated; component bacteria be present colonise gut; very palatable often not adequately identified Probiotic drinks Milks, fruit Lactobacillus casei; Component probiotic strains Short shelf life juices Lactobacillus plantarum; have proven beneficial Lactobacillus reuteri effects; accurate labelling, helpful package inserts; very palatable Supplements Capsules, Various: mainly Some brands contain Quality assurance issues: many tablets, Lactobacillus acidophilus, probiotics with proven brands contain contaminants, powders often with bifidobacteria beneficial effects; long lower than claimed numbers shelf life and/or strains with no proven beneficial effects; some tablets or capsules may be difficult to swallow similar way, but fermentation is carried out with different It is postulated that undernourishment leads to damage to probiotic strains, usually L acidophilus. the gut epithelium, causing decreased gut mediated immu- Drinks containing probiotic bacteria include fermented nity, reduced absorption of essential dietary components, and milks and fortified fruit juices. loss of appetite. A leaky gut allows intestinal flora to enter the There are many brands of yoghurts and probiotic drinks circulation (a phenomenon known as translocation); this available in supermarkets and other retail outlets. may predispose to septicaemia and infections at remote sites. A third source of probiotics is supplements consisting of Probiotics are helpful in normalising the nutritional status freeze dried bacteria in capsule, tablet, or powder form. Such of children, and the use of yoghurt has been suggested by the goods may be bought in health food shops and some World Health Organisation for nutritional recovery.15 pharmacies. Probiotic species proved to show a positive effect include L The constituents and relative merits of these types of acidophilus, yoghurt organisms (L delbrueckii var bulgaricus and probiotic products are summarised in table 1. Streptococcus salivarius var thermophilus), L plantarum 299v, and When choosing a probiotic product, an important caveat is Bifidobacterium lactis Bb12.11 16–18 It would be interesting and that many contain unknown or variable numbers of bacteria, instructive to determine whether such probiotic species can http://pmj.bmj.com/ and most have strains with no proven record of probiotic also help to correct malnutrition in the elderly. activity. There are many thousands of strains of lactobacilli, Lactose intolerance is a common condition, and the asso- all of which differ; while many of them may indeed show ciated symptoms seem to get worse with age.19 20 These can be beneficial activity, very few have actually been proven to do largely avoided by not consuming milk, but this strategy may so. severely limit intake of necessary dietary elements such as calcium. The condition is due to low levels of b-galactosidase Prebiotics (lactase) in the intestinal mucosal cells. It is commonly Some probiotic preparations also contain prebiotics such as observed that fermented milk products such as yoghurts are on September 29, 2021 by guest. Protected
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