4_5Probiotics

Question 1

Define probiotic?

Answer 1

live microorganism that confers a health benefit to the host when given in adequate amounts

Question 2

Define prebiotic.

Answer 2

nondigestable food ingredients to stimulate growth of limited colon bacteria

Question 3

What are prebiotic substances?

Answer 3

oligofructose, inulin, galactooligosaccharides, lactulose

Question 4

Define synbiotic

Answer 4

product containing probiotics and prebiotics

Question 5

Define postbiotic

Answer 5

metabolic byproduct of a probiotic that influences biological host function

Question 6

Who defined all the probiotic terms?

Answer 6

FAO/WHO joint working group in Ontario. No legal authorities.

Question 7

What does probiotic technically mean, and when was the term first used?

Answer 7

“for life” in the 1960s

Question 8

What percentage of the human microbiota are in the GI?

Answer 8

70%

Question 9

Density of bacteria in the stomach?

Answer 9

10^3 CFU/g contents

Question 10

Density of bacteria in the small intestine?

Answer 10

10^6 - 10^7

Question 11

Density of bacteria in large intestine?

Answer 11

10^11

Question 12

What are the functions of probiotics?

Answer 12

1) compete for binding sites and nutrients; 2) bacteriocidal; 3) immunomodulatory; 4) strengthen intestinal barrier; 5) enhance GI function

Question 13

How are probiotics bacteriocidal?

Answer 13

secrete acid (lactic, acetic, propionic, organics); secrete bacteriocins and H2O2

Question 14

How are probiotics immunomodulatory?

Answer 14

1) increase phagocytic activity; 2) stimulate IgA production; 3) stimulate cytokine production

Question 15

How do probiotics strengthen the intestinal barrier?

Answer 15

1) stabilize TGs; 2) decrease permeability; 3) increase mucin production

Question 16

How do probiotics enhance GI function?

Answer 16

1) aid digestion, 2) synthesize vitamins, 3) increase absorption, 4) detox carcinogens

Question 17

Why is probiotic evidence not comparable/standard?

Answer 17

1) method of delivery varies; 2) strain and dose-specific effects; 3) varied length of treatment, age of patient, combos, post-biotics

Question 18

Culturelle

Answer 18

LGG (lactobacillus rhamnosus GG)

Question 19

Florastor

Answer 19

Saccharomyces boulardii

Question 20

DanActive

Answer 20

Lactobacillus casei DN 114 001

Question 21

Align

Answer 21

Bifidobacterium infantis

Question 22

What are the common probiotic organisms?

Answer 22

1) LGG; 2) Bifidobacterium; 3) E. coli Nissle; 4) Strep thermophiles; 5) Enterococus faecalisa and faeciuma; 6) Saccharomyces boulardii; 7) bacillus cereus

Question 23

effects of LGG

Answer 23

decreased duration of acute diarrhea in kids

Question 24

How do probiotic strains differ?

Answer 24

1) ability to withstand acid; 2) ability to colonize GI

Question 25

What probiotic for acute diarrhea?

Answer 25

LGG, S. boulardii

Question 26

What probiotic for Abx-associated diarrhea?

Answer 26

LGG, S. boulardii

Question 27

What probiotic for C. dif diarrhea?

Answer 27

Lactobacillus, S. boulardii, L. casei

Question 28

What probiotic for traveler's diarrhea?

Answer 28

S. boulardii

Question 29

What probiotic for IBS?

Answer 29

B. infantis

Question 30

What probiotic for IBD?

Answer 30

UC VSL #3

Question 31

What probiotic for Crohn's?

Answer 31

none

Question 32

What probiotic for atopic dermatitis?

Answer 32

L. fermentum, LGG, B. lactis

Question 33

What probioti for H. pylori?

Answer 33

can only treat symptoms

Question 34

What probiotic for lactose intolerance?

Answer 34

yogurt - has fermented milk proteins and enzymes

Question 35

What probiotic for vaginitis/candidiasis?

Answer 35

Lactobacilli

Question 36

What probiotic for weight loss?

Answer 36

Lactobacillus gasseri, Candians showed LGG + prebiotic 30 mins before breakfast and dinner for 12 weeks

Question 37

What probiotic for periodontitis?

Answer 37

L. reuteri (Periobalance lozenge BID)

Question 38

What probiotic to decrease LDL?

Answer 38

L. reuteri (NCIMB 30242)

Question 39

How may probiotics affect CNS disorders?

Answer 39

may produce neurochemicals

Question 40

Other probiotic effects in children?

Answer 40

may stimulate IgA (probiotic formulas not recommended by AAP, however)

Question 41

What are the ADRs of probiotics?

Answer 41

mild/transient gas and bloating; rare, severe eosinophilic syndrome; rare eosinophilic esophagitis

Question 42

What are the symptoms of eosinophilic syndrome?

Answer 42

sudden malaise, arm/leg weakness, numbness

Question 43

How is eosinophilic syndrome treated?

Answer 43

IV corticosteroids and months of immunosuppression

Question 44

What are the effects of eosinophilic syndrome?

Answer 44

permanent motor and sensory deficits

Question 45

What is eosinophilic esophagitis?

Answer 45

hives and itching due to allergens

Question 46

Where should probiotic use be cautioned/avoided?

Answer 46

1) immunosuppressed; 2) short-bowel syndrome; 3) central venous catheters; 4) pregnant/breastfeeding; 5) infants;kids; 6) elderly

Question 47

What are probiotic interactions?

Answer 47

Abx - space 2 hours

Question 48

How do supplements differ from food?

Answer 48

food must be safe for all ages in any amount with a cumulative effect; supplement can specify dose/age/duration

Question 49

What components are included in best-practice product labeling?

Answer 49

1) scientific name; 2) best-by date; 3) dose based on evidence; 4) safety; 5) storage; 6) contact info

Question 50

How should an appropriate probiotic be chosen for a specific use?

Answer 50

1) use same genus/species/strain and formulation as the study; 2) base dose on CFUs; 3) choose product with best-by date

Question 51

What are the two viability dates that can be provided on a label?

Answer 51

1) CFUs at time of manufacture; 2) best-by date

Question 52

How can probiotics be marketed as a drug?

Answer 52

file NDA with the microbiologic characterization through CBER (biologic regulation)