SYNBIOTICS


Definition
A product that contains both probiotics and prebiotics is called as

synbiotic

. (1) Prebiotics are usually in the form of oligosaccharides - fructo-oligosaccharides (FOSs), inulin, galacto-oligosaccharides (GOSs) whereas probiotics are live organisms mainly of the genera Lactobacillus and Bifidobacterium.

Actions of Synbiotics


Recognition of self and non-self-antigens begins early in life. The immunoresponsiveness of the digestive system is significantly affected by the child's diet, state of bacterial colonization, and early exposure to potential infectious pathogens and antibiotics as well as the infant's genotype. (2) It is thought that the occurrence of many diseases, both intestinal and non-intestinal such as atopy (asthma, eczema, and allergic rhinitis) or autoimmune (multiple sclerosis, type 1 diabetes mellitus, and chronic inflammatory bowel disease) is related to dysregulation or interference with the early development of the intestinal mucosal defense system. (3) Toll-like receptors located in the surface membrane of T lymphocytes are triggered by nucleotides and oligosaccharides when bound to bacterial breakdown products which is important for innate and acquired immunity. Thus they play an important role in preventing gastrointestinal illness. Probiotic bacteria are believed to exert positive effects on the development of the mucosal immune system. (3)

Uses of Synbiotics


There is evidence that combined prebiotics and probiotics help in preventing allergic diseases in pregnant women and their infants. (4) A randomized controlled trial where addition of oligosaccharides at a concentration of 1 g/dL to preterm infant formula for 1 month (90% GOSs and 10% FOSs) increased the stool bifidobacteria counts in the oligosaccharide-supplemented group increased significantly compared with the non-supplemented group. (5) Similarly addition of prebiotic in infant formula had led to increased counts of bifidobacteria as well as lactobacilli in their stools. (6)

Safety
To date, prebiotic and probiotic combinations seem to be safe for healthy infants and children. The Committee on Nutrition of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition has stated that more studies should be done to establish the safety. (7)

References
1. Food and Agriculture Organization of the United Nations; World Health Organization. Guidelines for the evaluation of probiotics in food: joint FAO/WHO Working Group report on drafting guidelines for the evaluation of probiotics in food. Available at: ftp://ftp.fao.org/es/esn/food/wgreport2.pdf. Accessed October 1, 2010
2. Thomas DW, Greer FR; American Academy of Pediatrics Committee on Nutrition; American Academy of Pediatrics Section on Gastroenterology, Hepatology, and Nutrition. Probiotics and prebiotics in pediatrics. Pediatrics. 2010 Dec;126(6):1217-31
3. Matsuzaki T, Takagi A, Ikemura H, Matsuguchi T, Yokokura T. Intestinal microflora: probiotics and autoimmunity. J Nutr. 2007;137(3 suppl 2):798S-802S
4. Kukkonen K, Savilahti E, Haahtela T, et al. Probiotics and prebiotic galacto-oligosaccharides in the prevention of allergic diseases: a randomized, double-blind, placebo-controlled trial. J Allergy Clin Immunol. 2007;119(1):192-198
5. Boehm G, Lidestri M, Casetta P, et al. Supplementation of a bovine milk formula with an oligosaccharide mixture increases counts of faecal bifidobacteria in preterm infants. Arch Dis Child Fetal Neonatal Ed. 2002;86(3):F178-F181
6. Moro G, Minoli I, Mosca M, et al. Dosage-related bifidogenic effects of galacto- and fructooligosaccharides in formula-fed term infants. J Pediatr Gastroenterol Nutr. 2002;34(3):291-295
7. Agostoni C, Axelsson I, Braegger C, et al. Probiotic bacteria in dietetic products for infants: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr. 2004;38(4):365-374
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