Gut feeling

The fermented milk drink with a tangy flavour tastes good and the thought of the friendly bacteria cleansing your stomach is gut-warming.

The occasion is the second annual meeting of the Celiac Society for Delhi at the India Habitat Centre, where Yakult Danone India (a 50:50 joint venture between Japanese firm Yakult Honsha Co. Ltd and Groupe Danone from France) is handing out samples of its probiotic milk, to be launched this October.

Probiotics, for the uninitiated, are live microorganisms which, when administered in adequate amounts, confer a health benefit on the host. While bad bacteria cause gastro-enteritis, there are quite a few good bugs that aid digestion. At a table nearby, Abbot Healthcare is handing out leaflets for its PediaSure, a gluten-free product that contains probiotics. So, one wonders, is probiotics the new flavour of the health food community in India? Especially, as the taste of Amul’s probiotic wellness ice cream launched a few months ago is fresh in one’s mind. “It’s a new concept here in India—and it is old as well," says New Delhi-based nutritionist Ishi Khosla, who points out that desi dahi (curd) is one of the best examples of natural probiotic products that Indians consume.

Also, medically, probiotic brands have been around in India for a long time. As Sarath Gopalan, senior consultant, paediatric gastroenterology, Pushpawati Singhania Research Institute, New Delhi, points out, there are 30-odd probiotic brands available at the retail chemist that are prescribed by doctors—usually for management of gastro-intestinal diseases or to combat the side effects of antibiotics.

But it’s only now that probiotics are entering the Indian commercial health food category through ice creams, milk drinks, etc. In the West, probiotic products such as flavoured milks, cultured yoghurts, ice creams, capsules, tablets and powders abound in grocery and health food stores.

How probiotics work

There are trillions of bacteria thriving within the human body, but most live within the digestive system. About 400 different species of bacteria form what is called the gut flora. The good bacteria aid digestion and keep the body healthy by discouraging harmful bacteria and yeasts from setting up home.

In 1907, Elie Metchnikoff, a Russian scientist who studied Bulgarian mountain peasants, ascribed their good health to their yoghurt-rich diet. He felt that the friendly bacteria in their diet had a beneficial effect on their gut flora and this, in turn, improved their overall health. Since then, firms have been experimenting with good bacteria, isolating powerful strains and introducing them live through fermented foods.

“It is unquestionable that good bacteria in the gut play a big role in building immunity, absorption of certain vitamins, facilitating good gut function and correcting the pH factor," says Khosla.

Medical uses

Gastro-enterologists have been prescribing probiotics to patients with irritable bowel syndrome, Crohn’s disease, rotavirus infection, ulcerative colitis, inflammatory bowel disease and even lactose intolerance. Specialists have also been trying out probiotics as an adjutant treatment for hepatic encelopathy (caused by disorders of the liver).

In 2000, Dr Gopalan, along with some nutritionists, carried out a study in which cultured curd containing lactobacillus acidopholus was administered to 50 children with gastro-intestinal disorders. The results of this study were published in a 2002 issue of Nutrition journal, the important message of which, says Dr Gopalan, was: “With regular food, if a concentrated extract of probiotics is administered to children, then there are definite benefits in terms of diarrhoeal morbidity as well as accelerated growth."

Most doctors today also prescribe probiotics (such as Vizylac, Sporlac, Econorm or Bifilac) to be taken along with an antibiotic. That’s because an antibiotic usually ends up killing or inhibiting the good bacteria in the stomach, leading to side effects such as upset tummies. Theoretically, a probiotic will neutralize this.

“But a dose of probiotics taken over three to four days, which is what most GPs prescribe, is not going to help," says Dr Gopalan, adding how you need a long window for probiotics to work.

As research hots up, other benefits are emerging. In 2004, a British study on autistic children revealed a high prevalence of toxins in their gut flora. Researchers felt that toxic byproducts of the bacteria might play a role in autism because of how they are absorbed into the blood and travel to the brain. Following this lead, doctors, including those at the Amrita Institute of Medical Sciences and Research Centre in Kochi, have begun administering probiotics to autistic patients, and though conclusive evidence is not yet out, there are reports of beneficial effects.

According to Khosla, “An emerging school of thought also suggests that probiotics could have a role to play in diabetes and cholesterol management."

Is it overhyped?

Gastro-enterologist Vivek Raj of Max Healthcare, New Delhi, says that while probiotics are definitely useful in treating several gastro-intestinal disorders, the whole area of probiotic foods as supplements is overhyped. “It is like taking a multivitamin supplement. If your body is weak and needs it, it will give you a boost, otherwise it will not make much difference," he says. “At the same time, it will not harm you."

But there are others, especially nutritionists, who feel that given our modern lifestyles and the exposure to toxic chemicals and pollution, probiotics taken daily can keep the gut healthy, which in turn improves immunity.

Home-made curd

Some nutritionists feel that as a “nutritional supplement", curd can be as good as any marketed probiotic product. Others feel that curd will not serve the purpose. The reason is that among the good bacteria, there are some that are more powerful. Scientists have been isolating the good ones and trying each out to find out which are the better ones.

The curd that we normally make at home usually contains multiple cultures of bacteria. “It’s a good thing," feels Khosla. She says ice creams and fermented milk drinks have sugar that promotes yeast growth, while curd has no such thing.

But others who disagree feel that different probiotic bacteria have different effects on the intestine. And it is important to use the right probiotic for the right patient. Also, in curd, lactobacillus bulgaricus dominates, which, according to Dr Gopalan, is probably the weakest of the good bacteria.

Some of the really good bacteria, according to researchers, are lactobacillus acidopholus, lactobacillus plantarum, lactobacillus sporogenes, lactobacillus casei and also many from the bifidobacterium genera (said to benefit the large intestine). Saccharomyces boulardii, a tropical strain of yeast isolated from lychee and mangosteen fruit, is another good bug.

Companies that promote probiotic drinks obviously stress the benefits of their products, which usually contain the above-mentioned powerful bacteria, and in concentrated doses.

“In a 65ml drink, you are getting at least 6.5 billion lactobacillus casei strain into your gut," says Sapra. Swedish drink ProViva claims it serves up to 25 million lactobacillus plantarum in one serving. One capsule of Bifilac contains 30 million streptococcus faecalis, two million clostridium butyricum, one million bacillus mesentericus and 50 million lactobacillus sporogenes.

As more and more companies jump on the probiotic bandwagon, expect a deluge of good bacteria to hit your gut.

Lactose intolerance

Are you prone to frequent stomach aches, diarrhoea and flatulence? A common reason is believed to be lactose intolerance. “Sixty per cent of Asians are believed to be lactose intolerant," declares Neelam Mohan, paediatric gastro-enterologist at Sir Ganga Ram Hospital, New Delhi.

Most mammals cannot drink milk in adulthood, but the human body is more evolved. Lactase phlorizin hydrolase (LPH), the enzyme that breaks down lactose (the major sugar in milk), is expressed in us as adults. In most other mammals or people with lactose intolerance, the expression of this enzyme is switched off or repressed. It is widely believed that Europeans are able to digest milk better due to constant gene mutations, while lactose intolerance continues to remain high among Africans and Asians.

But at the same time, most of the studies on the subject are highly debatable, given the kind of political, economic and environmental lobbying that surrounds milk. Some believe that the studies showing the high degree of lactose intolerance among Indians is the result of political propaganda against a free mid-day milk scheme introduced by western nations in India a few decades ago. Others believe that vegans also have a vested interest in such studies.

Whatever the accuracy of these theories, most gastro-enterologists admit that they see a fair number of lactose intolerant patients, and that it is an uncomfortable problem. However, the degree of intolerance is usually not too high and managing it is fairly easy— most people can consume up to 250ml of milk without any problem and they could be tolerant to dairy products such as cheese and curd.

Lactose intolerance is not to be confused with allergy to milk proteins, which affects 2-7% of all infants, and is linked to immune system response. Symptoms for that include hives, respiratory problems and so on. But that’s another story.

(Write to us at businessoflife@livemint.com)

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