**2.3 Standardization of probiotics**

In Europe health claims of probiotics are assessed by the "European Food Safety Authority" (EFSA). For the selection guidance of probiotics European Commission published probiotics health claims [10] this meant that probiotics are not considered as nutrition claim but it is a health claim. It is further clarified that this general health claim is not mention for any body functions because the health claim of probiotics and strain specific. Consequently, probiotics term is banned with regard to advertising and labelling as food supplement in Europe.

**7**

*Therapeutic Potential of Probiotics and Prebiotics DOI: http://dx.doi.org/10.5772/intechopen.86762*

In USA probiotic companies face legal encounters. In the research of probiotics, there are also FDA's restrictions for human trials. The study with regard to human trial must be filed as "Investigative New Drug," which appears redundant and costly obligation. In Canada, the government has also issued regulatory documents for the use probiotics in food. Canada has a list of 17 probiotic species that can make nonspecific health claims, but no strain-specific probiotic claims have been approved [11].

In 2012, the Chinese Food and Drug Administration (CFDA) issued "Requirements on and a Guide to the Naming of Health Foods" and this year, provision for health food registration and filing was released. Currently, there are 27 health food categories based on health effects recognized in China, including enhancing immunity, the maintenance and relief of constipation, and modulating the intestinal bacteria. The health claim of any probiotics are governed an approval process involving technical review of safety, scientific substantiation of the health effect (based on animal and/or human studies), quality control, quantitative assess-

A portion of the widely utilized probiotic microorganisms are *Lactobacillus rhamnosus, Lactobacillus reuteri, bifidobacteria* and certain strains of *Lactobacillus casei*, *Lactobacillus acidophilus*-groups, *Bacillus coagulans, Escherichia coli* strain Nissle 1917, certain enterococci, particularly *Enterococcus faecium (SF68)*, and the yeast *Saccharomyces boulardii*. Bacterial spore formers, for the most part of the class Bacillus influence the scene. The given probiotics are being used in variety of food products such as fermented milks either independently or in mixes. With the new research endeavors new genera and strains of probiotics are being developed.

Probiotic can either include a single stain or a blend of at least two strains. For example, VSL3 is a probiotic that comprises of blend of eight different strains. The effects of probiotics are strain specific and cannot be summed up. A one strain may display diverse advantages when utilized exclusively and in mix. The benefits arising from the use of probiotics vary according to patient group. Constrained studies

FAO and WHO have mutually introduced advanced rules with a specific end goal to establish the systematic outlook for a successful Probiotic assessment probiotics in nourishments to support the health cases and other advantages. The standard rules on probiotics developed by FAO/WHO could be used worldwide for assessing probiotics in nourishment that can lead to the supporting of health claims.

4.Labeling of the adequacy claims and the shelf life of the substance must be

The probiotics have most imperative and recorded helpful impacts that incorporate the prevention from various diseases including diarrhea, increasing the

ment and assessment of the product formulation [12].

showed the adequacy of use of multiple probiotic strains [13].

According to the rules following activities must be fulfilled:

2.Functional portrayal of the strains and safety properties.

3.Proving the medical advantages in human examinations.

honest and should not be deceiving.

**2.5 Therapeutic potential of probiotics**

**2.4 Commonly used probiotics**

1.Identification of strain.

#### *Therapeutic Potential of Probiotics and Prebiotics DOI: http://dx.doi.org/10.5772/intechopen.86762*

*Oral Health by Using Probiotic Products*

adequate amount confer health benefits.

can easily be passed through it.

**2.2 Probiotics: mechanism of action**

However, generally it includes [8].

**2.3 Standardization of probiotics**

• Adherence and colonization of the gut.

• Improvement of intestinal hindrance work.

• Controlled exchange of dietary antigens.

**2.1 Probiotics: selection criteria**

fulfilled:

of probiotics be reached out to microbial water added substances. Administering probiotics in water has been appeared to enhance water quality by decreasing the centralizations of nitrogen and phosphorus [4]. Probiotics directed in water or eating routine likewise may hinder the development of pathogenic microorganisms, contribute stomach related proteins to expand feed usage, give other development advancing components, and restoring the immune response of the living beings. Hill et al. [5] updated the probiotics as live microorganisms when given in

For the living organisms to be termed as probiotics the given criteria should be

4.It ought to have the capacity to survive the conditions gastrointestinal tract and

5.During storage, greater number of practical microscopic organisms must have

Mechanisms for the advantages of probiotics are not completely understood.

• Suppression of development or epithelial authoritative/intrusion by pathogenic

In Europe health claims of probiotics are assessed by the "European Food Safety Authority" (EFSA). For the selection guidance of probiotics European Commission published probiotics health claims [10] this meant that probiotics are not considered as nutrition claim but it is a health claim. It is further clarified that this general health claim is not mention for any body functions because the health claim of probiotics and strain specific. Consequently, probiotics term is banned with regard

microscopic organisms and generation of antimicrobial substances.

• Stimulation of host mucosal and systematic immunity [9].

to advertising and labelling as food supplement in Europe.

1.It must get separated from the same species from its expected host.

2.It ought to have an clear favorable impact on its host.

the capacity to endure extended lengths of time [6, 7].

3.It should not produce any symptoms of disease.

**6**

In USA probiotic companies face legal encounters. In the research of probiotics, there are also FDA's restrictions for human trials. The study with regard to human trial must be filed as "Investigative New Drug," which appears redundant and costly obligation.

In Canada, the government has also issued regulatory documents for the use probiotics in food. Canada has a list of 17 probiotic species that can make nonspecific health claims, but no strain-specific probiotic claims have been approved [11].

In 2012, the Chinese Food and Drug Administration (CFDA) issued "Requirements on and a Guide to the Naming of Health Foods" and this year, provision for health food registration and filing was released. Currently, there are 27 health food categories based on health effects recognized in China, including enhancing immunity, the maintenance and relief of constipation, and modulating the intestinal bacteria. The health claim of any probiotics are governed an approval process involving technical review of safety, scientific substantiation of the health effect (based on animal and/or human studies), quality control, quantitative assessment and assessment of the product formulation [12].

## **2.4 Commonly used probiotics**

A portion of the widely utilized probiotic microorganisms are *Lactobacillus rhamnosus, Lactobacillus reuteri, bifidobacteria* and certain strains of *Lactobacillus casei*, *Lactobacillus acidophilus*-groups, *Bacillus coagulans, Escherichia coli* strain Nissle 1917, certain enterococci, particularly *Enterococcus faecium (SF68)*, and the yeast *Saccharomyces boulardii*. Bacterial spore formers, for the most part of the class Bacillus influence the scene. The given probiotics are being used in variety of food products such as fermented milks either independently or in mixes. With the new research endeavors new genera and strains of probiotics are being developed.

Probiotic can either include a single stain or a blend of at least two strains. For example, VSL3 is a probiotic that comprises of blend of eight different strains. The effects of probiotics are strain specific and cannot be summed up. A one strain may display diverse advantages when utilized exclusively and in mix. The benefits arising from the use of probiotics vary according to patient group. Constrained studies showed the adequacy of use of multiple probiotic strains [13].

FAO and WHO have mutually introduced advanced rules with a specific end goal to establish the systematic outlook for a successful Probiotic assessment probiotics in nourishments to support the health cases and other advantages. The standard rules on probiotics developed by FAO/WHO could be used worldwide for assessing probiotics in nourishment that can lead to the supporting of health claims. According to the rules following activities must be fulfilled:


#### **2.5 Therapeutic potential of probiotics**

The probiotics have most imperative and recorded helpful impacts that incorporate the prevention from various diseases including diarrhea, increasing the

effectiveness of antibacterial activity, reduction in the symptoms of constipation, changes in the conjugation of bile and salts. Moreover, they are also involved in nutrient formation and in enhancing their utilization by the body; a few probiotics are thought to have anti-oxidant action as entire cells or lysates. Probiotics have additionally exhibited their intrinsic impacts in reducing manifestations of allergy, cancer AIDS, various infections of respiratory system and urinary tract. There are different random reports on their advantageous impacts on autism, fatigue, type 2 diabetes, aging, fatigue, obesity and osteoporosis [14].

#### *2.5.1 Diarrhea*

The Diarrhea is defined by World health Organization as three to four watery stools in the period of 24 hours. Over the period of more than 20 years several examinations have been done on the microorganisms by several in vitro studies, animal models and some other suitable clinical investigations have confirmed the role of probiotics in reducing the severity of various type of diarrhea [15] *Saccharomyces boulardii* is the only yeast probiotic that is used for treating the diarrhea.

#### *2.5.1.1 Acute infantile diarrhea*

Rotavirus is the major cause of acute infantile diarrhea and is the most concentrated gastrointestinal condition and it requires quick oral rehydration as an essential treatment. Along with the oral rehydration therapy Probiotics are thought to have beneficial effects. Although further data is needed to confirm the investigations however 10 billion CFU is the minimum potent dose in kids within the 48 hours [16]. A trial was conducted on *C. difficile*-related colitis and results showed that *S. boulardii* reduce the onset of infection in the patients who had more than one consecutive *C. defficile* disease. *S. boulardii* is yeast which produces proteases that inhibit the *C. defficile* toxins and also blocks its receptors in the intestines. The yeast *S. boulardii* discharges a protease that separates *C. difficile* poisons and hinders the poison intestinal receptors. The Probiotic additionally found to activate particular antitoxin A which is an immunoglobulin that attacks the factor involved in increasing the risk of diarrhea [17, 18].

#### *2.5.1.2 Antibiotic associated diarrhea*

Disruption of the natural micro flora is due to the use of anti-microbial medications, i.e., antibiotics frequently prompts diarrhea. The principle component by which antimicrobials cause loose bowels is through weakened protection against pathogens because of disruption of gut micro flora and as a result there is a modification in the digestion of sugars bile acids and unsaturated fatty acids resulting modifications in the digestion of sugars, short-chain unsaturated fats, and bile acids [19]. Probiotics are more powerful in reducing the onset of diarrhea as a result of use of antibiotic medications and these includes strains of *L. acidophilus*, yeast *S. boulardii, L. delbrueckii, L. rhamnosus GG, L. fermentum,* etc. [18]. However, further studies are needed to confirm the beneficial role of probiotics in various diseases, which probiotic is more potent and their recommended dosages [20].

#### *2.5.1.3 Traveler's diarrhea*

It has been assessed that around 20–60% of the people traveling around the world are affected by this type of diarrhea. It especially influences individuals those

**9**

*Therapeutic Potential of Probiotics and Prebiotics DOI: http://dx.doi.org/10.5772/intechopen.86762*

*and Streptococci* and *Enterococci* [18].

*2.5.2 Inflammatory bowel disorder (IBD)*

who travel from the developed or industrialized areas to the backward or remote areas, specifically traveling between tropical regions and other non-tropical areas. The major cases that are recognized are due to the microscopic organisms which accounts for approximately 60–85% of the cases and most causative bacteria for causing this is *E. coli* and *Compylobacter jejuni* and some other species of *Salmonella* and *Shigella* disease is also caused by parasites and viruses which accounts for around 10% and 5% toward causing the infection [21]. It was observed that the bacteria that was effective against Bacterial diarrhea is *S. boulardii* whereas the activity of Lactobacillus *GG* was observed to be more potent against diarrhea caused by the virus and the idiopathic diarrhea [22–24]. Bacterial Strains that are thought to have preventive effect on the traveler's diarrhea include the *Bifidobacteria, Lactobacilli,* 

IBD is a long term degenerative disease which involves the severe irritation of G.I.T

tract that leads of watery and bloody diarrhea along with the abdominal pain IBD affects the small intestines and a portion of large intestines that is colon and it includes three different conditions which are Crohn's disease, ulcerative colitis (UC) and pouchitis. The other factors that are associated with the onset of disease include the genetic factors, ecological factors, oxidative stress and the weakened immune system [25]. Crohn's disease and ulcerative colitis are long term diseases of the gastro-intestinal tracts that are associated with the inflammation of the immune and likely are because there is absence of balance of the natural immunity with the surroundings and the with the advancement of the culture [26]. Intake of probiotic bacteria can possibly balance out the immunological boundary in the gut mucosa by diminishing the production of nearby proinflammatory cytokines [27–29]. *Bifidobacterium infantis* 35,624 helps in elevating the symptoms of abdominal pain, bloating, passage of gas, straining, bowel dysfunction and incomplete evacuation in the patients of IBD. It has been observed through recent studies that Probiotic supplementation is very helpful in elevating the symptoms of IBD and in some cases even the medical therapy can be replaced by probiotic supplementation. However it is not recommended for the Crohn's disease as the data does not support the use of probiotics. Therefore Probiotics have shown promising role in reducing the symptoms of

Ulcerative colitis like Irritable bowel disorder fundamentally influences the inner layer of the rectum and that of large intestines. Long-term ulcerative colitis can lead to the development of colon cancer. Use of different probiotics including *S. boulardii, L. casei, Bifidobacterium bifidum* has demonstrated beneficial results in terms of this disease [31]. A Study was conducted and the results demonstrated that the addition of probiotics bacterial strains of *L. acidophilus, B. bifidum*, and *B. breve* in the fermented milks was helpful in mitigating the diseases in patients [32].

It is a type of Irritable bowel syndrome which ordinarily influences the digestive system; however it may affect any organ from the mouth to the end of the end of digestive tract. Crohn's disease leads to the development of the ulcers and irritation that influences the capacity of the body to process food, assimilate nutrients and excretion of unwanted products in a healthful form. The Bacterial strains that

ulcerative colitis but not in the case of Crohn's disease [30].

*2.5.3 Ulcerative colitis (UC)*

*2.5.4 Crohn's disease (CD)*

#### *Therapeutic Potential of Probiotics and Prebiotics DOI: http://dx.doi.org/10.5772/intechopen.86762*

*Oral Health by Using Probiotic Products*

*2.5.1 Diarrhea*

diarrhea.

*2.5.1.1 Acute infantile diarrhea*

in increasing the risk of diarrhea [17, 18].

*2.5.1.2 Antibiotic associated diarrhea*

*2.5.1.3 Traveler's diarrhea*

diabetes, aging, fatigue, obesity and osteoporosis [14].

effectiveness of antibacterial activity, reduction in the symptoms of constipation, changes in the conjugation of bile and salts. Moreover, they are also involved in nutrient formation and in enhancing their utilization by the body; a few probiotics are thought to have anti-oxidant action as entire cells or lysates. Probiotics have additionally exhibited their intrinsic impacts in reducing manifestations of allergy, cancer AIDS, various infections of respiratory system and urinary tract. There are different random reports on their advantageous impacts on autism, fatigue, type 2

The Diarrhea is defined by World health Organization as three to four watery stools in the period of 24 hours. Over the period of more than 20 years several examinations have been done on the microorganisms by several in vitro studies, animal models and some other suitable clinical investigations have confirmed the role of probiotics in reducing the severity of various type of diarrhea [15] *Saccharomyces boulardii* is the only yeast probiotic that is used for treating the

Rotavirus is the major cause of acute infantile diarrhea and is the most concentrated gastrointestinal condition and it requires quick oral rehydration as an essential treatment. Along with the oral rehydration therapy Probiotics are thought to have beneficial effects. Although further data is needed to confirm the investigations however 10 billion CFU is the minimum potent dose in kids within the 48 hours [16]. A trial was conducted on *C. difficile*-related colitis and results showed that *S. boulardii* reduce the onset of infection in the patients who had more than one consecutive *C. defficile* disease. *S. boulardii* is yeast which produces proteases that inhibit the *C. defficile* toxins and also blocks its receptors in the intestines. The yeast *S. boulardii* discharges a protease that separates *C. difficile* poisons and hinders the poison intestinal receptors. The Probiotic additionally found to activate particular antitoxin A which is an immunoglobulin that attacks the factor involved

Disruption of the natural micro flora is due to the use of anti-microbial medications, i.e., antibiotics frequently prompts diarrhea. The principle component by which antimicrobials cause loose bowels is through weakened protection against pathogens because of disruption of gut micro flora and as a result there is a modification in the digestion of sugars bile acids and unsaturated fatty acids resulting modifications in the digestion of sugars, short-chain unsaturated fats, and bile acids [19]. Probiotics are more powerful in reducing the onset of diarrhea as a result of use of antibiotic medications and these includes strains of *L. acidophilus*, yeast *S. boulardii, L. delbrueckii, L. rhamnosus GG, L. fermentum,* etc. [18]. However, further studies are needed to confirm the beneficial role of probiotics in various diseases,

which probiotic is more potent and their recommended dosages [20].

It has been assessed that around 20–60% of the people traveling around the world are affected by this type of diarrhea. It especially influences individuals those

**8**

who travel from the developed or industrialized areas to the backward or remote areas, specifically traveling between tropical regions and other non-tropical areas. The major cases that are recognized are due to the microscopic organisms which accounts for approximately 60–85% of the cases and most causative bacteria for causing this is *E. coli* and *Compylobacter jejuni* and some other species of *Salmonella* and *Shigella* disease is also caused by parasites and viruses which accounts for around 10% and 5% toward causing the infection [21]. It was observed that the bacteria that was effective against Bacterial diarrhea is *S. boulardii* whereas the activity of Lactobacillus *GG* was observed to be more potent against diarrhea caused by the virus and the idiopathic diarrhea [22–24]. Bacterial Strains that are thought to have preventive effect on the traveler's diarrhea include the *Bifidobacteria, Lactobacilli, and Streptococci* and *Enterococci* [18].
