Dietary supplements and functional foods

Food supplements are foodstuffs intended to supplement the normal diet, the constitute a concentrated source of nutrients or other substances having, alone or in combination, a nutritional or physiological effect. They are marketed in many forms (capsules, pastilles, tablets, powder packets or ampoules).

The nutritional or health claims they claim have, since July 2007, been very strictly regulated under the European Regulation 1924/2006, which requires scientific proof to be provided to the European Medicines Agency (EMA).

Functional foods are not defined by legislation. They are considered common foods intended for consumption as part of a balanced and varied diet. Their particularity lies in the fact that they contain biologically active compounds that have beneficial effects on one or more target functions of the body, beyond the basic nutritional effects, in order to improve health and well-being and/or reduce the risk of disease.

Dairy products, especially yogurts, are the most abundant probiotic foods, with Danone’s Activia® and Actimel® products leading the way.

Like many foods, functional foods and probiotics are subject to safety and labeling rules, in particular with regard to claims used by the food industry as a selling point.

Recently, new guidelines have tightened the regulations around these probiotic foods because their health benefits were difficult to recognize.

European Union Regulation No 432-2012 of 16 May 2012 establishes a list of authorized health claims on foods and specifies that health claims must be based on generally accepted scientific evidence.

Probiotics fall into two types of claims: function claims and therapeutic claims:

Claim Any representation that states, suggests or implies that a food has particulate qualities related to its origin, nutritional properties, nature, processing, composition or any other quality.

Health claim refers to any representation in labeling and advertising that states, suggests or implies that there is a relationship between the consumption of a food or food constituent and a person’s health.

Functional claim refers to a health claim that describes the physiological effects of food or food constituents on the body’s normal functions or biological activities associated with health or performance. Functional claims can be made about the physiological effects of probiotic microorganisms in foods (e.g., “promotes regularity” and “improves nutrient absorption and aids digestion”). Function claims must include a specific, scientifically substantiated physiological effect associated with good health or performance and providing useful information to consumers.

Therapeutic claim refers to the treatment or mitigation of a disease or health disorder or related to the recovery, correction or modification of bodily functions. For example,”[name of food or food constituent] lowers blood cholesterol”.

The assessment of probiotics for food use is described in the report of the Joint FAO/WHO Expert Consultation (Food and Agriculture Organization of the United Nations and World Health Organization).

Specific labeling guidelines are outlined in the Canadian Food Inspection Agency’s (CFIA) Guide to Food Labelling and Advertising, which applies to all products containing probiotic microorganisms. According to the appropriate description of a probiotic product, as indicated on the label, should include the following points:

  • Strain Identification: Any claim for a probiotic must be accompanied by the Latin name of the microorganism (i.e. genus and species), as well as the name of the strain of the microorganism. For consistency, it is recommended that the strain should be identified by the number assigned by an internationally recognized culture bank, such as the American Type Culture Collection.
  • Quantity declaration: The quantity of the probiotic microorganism(s) present in the product must be indicated in colony-forming units (CFU) in a specified portion of the food. This statement must appear next to the Nutrition Facts table or ingredient list, or in close proximity to the claim.
  • List of ingredients: Any food containing probiotic microorganism(s) must display a list of ingredients in accordance with the sections of the Food Regulations. The probiotic microorganism must be designated by its common name or by the class name.



Probiotics

The notion of probiotics has recently developed and most pharmacists have not been trained in these new food supplements.

From birth, our gastrointestinal tract is colonized by many microorganisms that constitute the digestive microbiota. This complex and diversified ecosystem, unique to each individual, contributes to the proper functioning of the intestine through the many activities it carries out. However, the balance of the microbiota is sensitive and its rupture occurs in the pathophysiology of various intestinal disorders, hence the idea of positively modulating a microbiota unbalanced by the administration of probiotics.

The term “probiotic” means “for life” and refers to living microorganisms that, when ingested in appropriate amounts, produce a benefit to the health of the host that goes beyond basic nutritional functions.

Probiotics are often lactic acid bacteria (lactobacilli and bifidobacteria) or yeasts introduced into the diet in the form of fermented milk products or food supplements.

These microorganisms strengthen the intestinal and vaginal flora. Their presence makes it possible to fight against the proliferation of pathogenic bacteria.

Several clinical studies have already demonstrated the efficacy of certain probiotics in the treatment of systemic and infectious diseases such as acute diarrhea and Crohn’s disease.

Other studies have suggested a potential application for the treatment of urogenital infections, colon cancer, atopic dermatitis and allergic diseases including food allergy such as lactose intolerance.

History

The definition of probiotics has evolved over time according to researchers, scientific knowledge and technological advances.

In the 20th century the Nobel Prize winner, Elie Metchnikoff, observed that a surprising number of people in Bulgaria lived for more than 100 years. This longevity could not be explained by the advances in modern medicine, because Bulgaria, one of the poorest countries in Europe at that time, did not benefit from such advances. Dr. Metchnikoff found that Bulgarians consume large quantities of yogurt, he associated the increase in longevity observed with the consumption of living microorganisms from fermented dairy products. Although Metchnikoff saw germs as rather harmful to human health, he considered it beneficial to replace bacteria in the gastrointestinal tract with yogurt, including the Bulgarian bacillus. He then explained the better beneficial effect of this bacteria by the absence of alcohol production (harmful to longevity), compared to bacteria present in other fermented milk such as kefir or kumys. In addition, he assumed that the lactic acid produced, as well as other unidentified factors, would act synergistically to inhibit the growth of putrefaction bacteria in the colon.

At the same time, in 1906, the French pediatrician Henry Tissier observed that the stools of children with diarrhea contained a small number of bifidobacteria compared to the stools of healthy children. He then suggested that these bacteria be administered to diarrheal patients to help them restore a healthy intestinal microbiota.

Metchnikoff and Tissier are therefore the first to put forward the idea of administering exogenous microorganisms to compensate for a possible dysfunction in our intestinal ecosystem. The concept of “probiotics” was born.

Nevertheless, it was not until 1954 that the term probiotics was introduced into the literature by Ferdinand Vergin in a paper entitled “Anti-und Probiotika”. This term derived from the Greek “pro bios”, which literally means “for life” as opposed to the harmful effects of antibiotics

In 1965, Lilly and Stilwell, in the journal Science, defined probiotics as substances produced by microorganisms capable of stimulating the growth of other microorganisms.

In 1989, Fuller highlighted the microbial nature of probiotics by redefining the term as a “living microbial nutritional supplement that has a positive effect on the host animal by improving its intestinal balance”.

In 1992, Havenaar and Huis in’t Velt further refined the term to “a viable culture composed of one or a mixture of bacteria that, when applied to animals or humans, has a beneficial effect on the host by improving the properties of native flora. ».

In 1998, Guarner and Schaafsmaa specified that probiotics are “living microorganisms, which, when consumed in adequate amounts, have a beneficial effect on the health of the host”.

In 2002, the World Health Organization (WHO) and the Food and Agriculture Organization of the United Nations (FAO) formalized the definition of probiotics to avoid any drift.

Probiotics are therefore defined as “living organisms that, when ingested in sufficient quantities, have a beneficial effect on the health of the host”.

History, therefore, underlines that the current definition could still evolve, as there are still many fields of research to better understand and understand the action of probiotics.

Regulation

The conditions and marketing authorization of probiotics are defined according to their drug or food application. Most probiotics are functional foods or are used as food supplements. These “healthy foods” are at the border between the drug and the traditional food and are governed by food legislation.

Probiotic foods

The global market of probiotic foods has been growing rapidly since the early 2000s, particularly in Europe. This dynamic is supported in particular by the link between food and health benefits.

Probiotics used as food supplements, as well as functional foods, are considered as food and are governed by the relevant legislation. They are different from dietary foods that are intended for a particular food and require a specific formulation or manufacturing process to differentiate them from the common food, and from medicinal products.




Probiotics May Cause Detox Symptoms

Probiotics are living bacteria and yeasts. The health advantages of probiotic supplements and foods have been well documented, for instance, they help losing weight, maintaining good heart health, improving digestion, enhancing immune function and more. Overall probiotics are a beneficial addition to most people’s diet.

However, probiotics may cause symptoms similar to those experienced in a Detox diet.<fn>https://www.medicalnewstoday.com/articles/323821.php</fn>

Gas and Bloating

The human gastrointestinal tract is colonized by complex bacterial strains. While most people do not experience side effects, the most frequently reported response to bacteria-based probiotic supplements is a temporary increase in gas and bloating.

The initial feelings were bloating, gas, slight constipation, and mild indigestion. This probably can occur when you take an onset of a large dosage of probiotics. During the first few days, your gut is transitioning by ridding your colon of all the bad bacteria and slowly replacing with new good bacteria. Needless to say, your gut may not be used to it.
Lactose intolerant individuals may develop diarrhea, abdominal discomfort and flatulence after consumption of probiotics. If the gas bloating or any other side effects continue for more than a few weeks stop taking the probiotic and consult your doctor or diet professional.

Skin

In few and far between cases, probiotics may cause skin rashes or itchiness.

Allergies

The immunomodulatory effect of immunological bacteria which includes probiotic bacteria is based on 3 supposedly contradictory phenomena:

  • induction and maintenance of the state of immunological tolerance to environmental antigens
  • nutritional and inhalatory induction and control of immunological reactions against pathogens of bacterial and viral origin
  • inhibition of auto-aggressive and allergic reactions

Infections

While there are numerous health advantages linked to taking probiotics there can also be some adverse effects especially in people with serious diseases or compromised immune systems who may experience severe complications such as chronic and recurrent infections and inflammations of the intestine.

It is estimated that only about 1/1000000 people who take probiotics containing Lactobacilli bacteria will develop an infection.

Small intestine bacterial overgrowth (SIBO)

Considering the fact that a probiotic is essentially active in the small and large intestine, the effect of a prebiotic is observed mainly in the large intestine, however, it is not digested or only partially digested, not absorbed in the small intestine poorly fermented by bacteria in the oral cavity, well fermented by apparently beneficial intestinal bacteria, poorly fermented by potential pathogens.

SIBO (Small intestine bacterial overgrowth) occurs when bacteria from the large intestine start growing in the small intestine, causing similar symptoms to those caused by IBS, including gas, bloating, and diarrhea. SIBO may also be responsible for brain fogginess and short-term retention problems.

Antibiotic resistance

Probiotic bacteria scarcely ever could contain antibiotic-resistant genes. They can transfer these genes to other strains of bacteria, including the harmful strains that cause infections.

 




Probiotics for Chronic Constipation

There are approximately 3.8·1013 single-celled microorganisms for every single “reference man”  weighing 140 pounds, and their total mass is about 200 grams (ncbi.nlm.nih.gov).

Intestinal microbiota aids in the breakdown of food products into absorbable nutrients, stimulates the host immune system, suppress inflammation [source], prevents the expansion of pathogenic bacteria and produces a substantial variety of biologically major compounds such as short-chain fatty acids that nourish the gut.

Gut Bacteria
Gut Bacteria

The concept behind probiotics was introduced in the early 19th century when Nobel laureate Elie Metchnikoff (1845–1916), known as the father of probiotics <fn>Front Public Health. 2013; 1: 52. Published online 2013 Nov 13. Prepublished online 2013 May 30. doi: 10.3389/fpubh.2013.00052 </fn>.

Elie Metchnikoff (1845–1916)
Elie Metchnikoff (1845–1916)

Probiotics are given or attenuated microorganisms defined as, when administered in adequate amounts, being able to confer health benefits on their host when they are given in.

Lactobacillus acidophilus, for example, lives in our digestive, urinary and genital systems and can be found in some fermented foods like yogurt. It may help reduce cholesterol, prevent Diarrhea, prevent Vaginal Infections, promote Weight Loss and improve symptoms of irritable bowel.

Lactobacillus acidophilus
Lactobacillus acidophilus

Studies suggest that taking probiotic supplements may shift the balance of gut bacteria in a way that increases your body’s defenses against allergies, infections, and cancer.

Probiotics and constipation

Chronic constipation is a symptom-based gastrointestinal disorder most common among the elderly, it is characterized by bowel movements that occur more frequently than normal. Constipation is most likely multifactorial. According to Harvard Medical School, it is more frequent than diarrhea and affects approximatively 14% of adults each year.

Researchers have shown an increased interest in the potential therapeutic applications of Probiotics to prevent or treat a variety of health problems including constipation and diarrhea. They also found a favorable effect in stool consistency and relief in abdominal discomfort making them increasingly used as alternative treatment options.

Although Probiotics have still been widely used nowadays for the treatment of constipation, the industry still has serious concerns about the long-term safety of probiotics which remain still partly unclear.

Mechanism of action

Several mechanisms have been proposed by which probiotics may benefit chronic constipation. Probiotics may modify the altered intestinal microbiota, and may eventually influence gut sensory-motor functions (Kawabata et al.). A healthy gut can benefit the regularity of your digestion as well as cognitive function like mood. One in vitro study (Bar et al.) suggested that Escherichia coli Nissle 1917 Supernatants (clear liquid overlying material deposited by settling, precipitation, or centrifugation) (Mutaflor®) could effectively enhance colonic contractility by direct stimulation of smooth muscle cells.

A recent study reported that methane and carbon dioxide, which are principal end products of bacterial fermentation could increase stool bulk and promote colonic transit (Lopez).

Which probiotic strains are best for constipation?

Proven probiotics available for constipation and bloating in adults are:

  • Lactobacillus casei Shirota (or L. Casei), which has effects on constipation and stool hardness, but not necessarily on flatulence and bloating
  • Lactobacillus plantarum LP01 (or L. Plantarum), which would facilitate stool evacuation
  • Bifidobacterium breve BR03 (or B. Patent), which would also improve the consistency of stool, helping to expel it
  • Bifidobacterium lactis DN-173 010 (or B. Lactis)
  • Bifidobacterium lactis B94 
  • Bifidobacterium lactis HN019
  • Bifidobacterium longum W11 (or B. Longum) 
  • Escherichia coli Nissle 1917 (or E. Coli), which allowed treated patients to go from 2 to 6 trips to the toilet per week

Proven probiotics available for constipation and bloating in children are:

  • Lactobacillus reuteri (or L. Reuteri), which has been shown to have an effect on chronic constipation in infants
  • Lactobacillus Casei rhamnosus Lcr35 or L, Casei), which relieves constipation while reducing abdominal pain