Germ theory: How probiotic products are flying off the shelves
Probiotics gain demand in the new millennium but there is still a lot of grey area around the science of ingesting good bacteria.
Her current research is focused on finding alternatives to the usual medicines that deal with problems related to the human digestive system. Her team is researching how the source of discomfort in the tummy might actually lie in the brain (think tummy aches before exams). Bhatia elucidates the problems she faces on the use of probiotics, live cultures of human gut bacteria, and bacterial spores, in treatment.
Back in 1989, research by a group of doctors, led by Bhatia, had showed lactobacillus acidophilus, the socalled good bacteria usually found in the human gut, destroyed another bacteria, campylobacter pylori, often blamed for causing acid peptic disease. However, when the good bacteria were used to treat patients’ symptoms, there weren’t enough positive results. Bhatia explains that, like her own research, much of the research around probiotics are far from providing a clinching evidence of the medicinal ability of probiotics.
Bhatia uses probiotics sparingly, for treating noninfective diarrhoea and antibiotics-induced diarrhoea. However, probiotics have moved beyond such limited uses. Plenty of over-the-counter (OTC) probiotic products are available as curd or fermented. ed milk or other kinds of drinks. The market is burgeoning. According to Varun Suri, CEO of consumer division of Morepen Laboratories, ethical (drugs that need a prescription) probiotics market is Rs 1,100 crore, while the OTC market could be many times bigger.
A reputed gastroenterologist, who spoke to ET Magazine on condition of anonymity, says patients often put pressure on him to prescribe probiotics. The doctor, who practises at a top private hospital in Mumbai, says there are far-fetched claims about bacteria found in the human body that can be used to induce diabetes, obesity and even autism.
Doctors agree that research findings, as of today, are inadequate regarding specific benefits of probiotics (beneficial bacteria), the efficacy of different strains and the quantity to be used. It will take another decade for clarity to emerge, they add. There could be scenarios where probiotics might be harmful. Indian pharma companies are, however, keen to make the most of the market. Suri of Morepen adds: “In the ethical market, probiotics are mostly yeast-based or spores-based, which is limiting. Live bacteria cultures, which add variety to the flora of the gut and body, are few. Also, those live bacteria do not survive stomach acids completely, so efficacy is a question.”
Probiotics and prebiotics (material that allow gut bacteria to thrive) are being consumed for all kinds of reasons, including for taste. Introduction of healthy gut bacteria harvested from the stool of a healthy donor, either through an enema or orally, has also gained ground. Stool donation by super donors — whose bodies have specific strains of useful bacteria — might soon be in vogue in India. It is already prevalent in other markets. Super donors can earn up to $40 per sample, according to one estimate. Morepen is gearing up to meet the challenges of the probiotic market and solve the key problem of delivering live bacteria into the right part of the human body, and in adequate quantity. Suri says Morepen has tied up with Vesale Pharma of Belgium to overcome the delivery challenges of probiotics, and will be launching their products in India in a few months.
Mankind Pharma is another company betting big on probiotics. “I think probiotics have a role to play in fighting all diseases,” says Rajat Singhal, senior manager-medical affairs, Mankind Pharma. “Over the years, it has evolved for different therapy areas. Doctors have started prescribing it with antibiotics to deal with cardiology-related issues and diabetes. We, at Mankind, are looking at respiratory and peadiatric applications.” Some pharma companies that have older probiotic products are keen to repackage them and try and fight other diseases.
Yakult, a popular brand of probiotic fermented milk, marketed in India by Yakult Danone India, has put up many research papers on its website for anyone who cares to check. Back in 2011, the Indian Council of Medical Research released a set of guidelines for use of probiotics in food, through a report prepared by a committee of experts. The scene has changed rapidly since then, and multiple bodies of probiotics industry are already active in India now.
Kefir Milk and Kombucha are two of the probioticbased health drinks that have caught the fancy of the Indian urban market. Kefir is a grain found in the mountains of east Europe. When the grain is fermented, it is believed to produce lactic acid, which is also produced by lactobacillus. In the past four years, kefir-based brands such as MO’s and Kefir Life have reached the Indian market. Abhimanyu Singh Rathore, who launched KefirLife in the National Capital Region, says he is targeting just about 1% of the OTC probiotic market. In some cases, probiotics have gone beyond treatment and have emerged as a fad. But, as experts say, there are too many grey areas for comfort.
GREY AREAS OF THE GUT
Lack of definitive research on effectiveness of probiotics treatment, especially comparative studies between different cultures of bacteria.
Uncertainty over whether probiotics may harm patients, as administered bacteria might leak out of the digestive system and into other organs
Lack of monitoring of patients and how probiotics are being bought or ingested, with or without prescriptions.
Uncertainty over effectiveness of imported cultures
A brief history on INGESTING BACTERIA
John Harvey Kellog
The American doctor and nutritionist (also the inventor of breakfast cereals), was an early proponent of probiotics or use of intestinal flora or bacteria for well-being. His late 19th century method used a pint of yogurt, half of it administered orally and the other half as enema.
Russian scientist and Nobel Prize winner in 1906, for his theories on phagocytosis, suggested senility was an effect of chemicals produced by bacteria that reside in the human gut. He proposed a diet of fermented milk containing bacilii that produced lactic acid. This diet became hugely popular
Ismar Isidor Boas
a contemporary of both Kellog and Mechnikov, identified lactobacillus acidophilus, the lactic acid producing bacteria.
Since the 1980s, doctors started prescribing lactobacillus for a whole range of conditions.
The new millennium saw an information explosion, linking human body bacteria with obesity to fatty livers and even autism and use of probiotics for treatment.
Faecal microbiota transplant (donor stool administered as enema or orally in small quantities in capsules), which introduced healthy gut bacteria into the intestine, is now used for treating some forms of ulcerative colitis.
POPULAR PROBIOTIC PRODUCTS
Brands like Vizylac, Vibact or Nutrolin B Plus are often prescribed, along with antibiotics like amoxicillin, to prevent the onset of diarrhoea.
Brands like VSL 3 or Enterogermina are expensive, contain live bacteria, need refrigeration and can be used for inflammatory bowel diseases.
Probiotic yogurt containing live spores of bacteria and fermented milk, by brands such as Amul or Yakult, is available over the counter.