Probiotics: A Critical Review Book Reviews

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Review by
Martin H. Floch, M.D. Clinical Professor of Medicine Norwalk Hospital, Yale University School of Medicine, Norwalk, CT 06856, USA

J. Clin. Gastroenterology, September 1999

This is a fascinating monograph consisting of 10 chapters written by ten authors and edited by Dr. Tannock, who writes an Introduction, Conclusion and an outstanding chapter "Taking A Fresh Look At The Intestinal Microflora". There are nine other chapters, which review other techniques to measure the intestinal microflora. All of the new genetic and biochemical techniques that are available to identify organisms and which hold great promise to broaden our knowledge in this field are reviewed in detail. There are several review articles on the systemic effects of probiotics; such as, the effect on the immune system, including a review of some clinical trials and the present literature; the role of possible lactic acid bacteria in vaccines; and present and future clinical trials on their use in clinical medicine.

There is also an important chapter on prebiotics, which are chemical substitutes in foods that effect the intestinal microflora, as opposed to probiotics, which are bacteria that are used to alter the intestinal microflora. All of the information in the ten chapters is presented with a review of the literature and with scientific and intellectual honesty, and presents present knowledge and state-of-the-art information. It is a little disappointing that the authors do not make definite clinical recommendations for the use of probiotics. This may be due to the conclusions of the review of the literature, or it may be due to the lack of clinical data available to the authors.

The monograph is recommended to those interested in the subject, but may not be of use to the average practitioner, other than those who are taking an open mind to the practice of alternative medicine and who would like to have a more detailed review of the science available on probiotics.

In conclusion, this is an excellent monograph for use in gastrointestinal studies. It is up to date on probiotics and totally outlines the potential importance of these substances in the future of clinical medicine.

Review by
Glenn R. Gibson Institute of Food Research, Reading, UK

Microbiology Today 26: 145. August 1999

This book overviews a topical area of nutritional microbiology, namely the use of so-called probiotics. The Editor and authors are to be congratulated for assembling this highly proficient look at a rapidly moving field. The use of molecular approaches towards gut microbiological procedures are predominant in the book and serve to set the scene for progressing this important field of research further. Whilst the science of probiotics has, in the past, attracted some negative commentary, the authors are clear that much merit lies in their use, and a strong rationale for this is presented. The text will be of major interest to many varied scientific disciplines such as microbiology, gastroenterology, nutrition and general medicine. My only negative comment is that it could have been longer.

Review by
J.M.T. Hamilton-Miller Dept. Medical Microbiology, Royal Free and University College Medical School, London NW3 2PF, UK

J. Antimicrobial Chemother. 43: 849. August 1999

Do you buy bioyoghurt because (to quote a 1970s' TV advertisement for an alcoholic beverage) "it looks good, it tastes good and by golly it does you good"? Wrong! According to the Introduction of this book you buy it because its "organoleptic and rheological characteristics" are preferable to regular yoghurts, and you have a vague idea that "consumption of the product will contribute to... well-being".

Probiotics is, however, a serious subject that involves much more than bioyoghurts. The concept that the body flora can be modulated in a way beneficial to health is as old as the century, but is onlyjust emerging from the shadows of 'alternative medicine'. One only has to observe the proliferation of health food outlets and articles on 'healthy living' in the Sunday supplements to realize the importance of the topic. Think about it: the public is, in large numbers, seeking out viable bacteria in order to consume them on a regular basis. Surely this practice must be the concern of all microbiologists: is it safe, helpful, well regulated, desirable?

Some of the answers, or at least clues, will be found from reading this book. There are 10 chapters, written by acknowledged experts-food scientists, animal scientists, microbiologists and one representative from industry- from seven countries. Topics covered include several aspects of intestinal flora, probiotics in farm animals (a hot subject now that antibiotics as growth promoters appear to be being phased out), immunology, clinical trials and prebiotics (specific feeding of one's own 'friendly' bacteria). I missed comments on the usefulness of API kits for identifying lactobacilli and bifidobacteria; if one has to use molecular methods for all identifications, only specialist laboratories will be able to participate. This would be a pity, as if ever there was a field where the gifted amateur can still contribute, probiotics is it.

There is a lot to absorb in this book, but it is worth the effort. For beginners, I recommend reading it as a main course after you have experienced the aperitif of the contents of Supplement 2 to the British Journal of Nutrition, volume 80 (1998).

Review by
R. Sieber Federal Dairy Research Institute, Liebefeld, CH-3003 Berne, Switzerland

Food Science and Technology. October 1999

The probiotic concept is based on the generally accepted definition that a probiotic is a live microbial feed supplements which beneficially affects the host animal by improving the intestinal microbial balance. This definition can easily applied to the human situation and implicit that consumption of probiotic affects the composition of the intestinal microflora and impacts in some beneficial way on the consumer. Because a very poor understanding of the intestinal microflora exists, fundamental knowledge of intestinal bacteria and their interactions with each other and with the human or other animal host are a prerequisite for successful probiotic research and development. This book contains state-of-the art commentaries on different aspects of the intestinal microflora and probiotics. For a modern concept of the intestinal microflora and microflora-host relationship a working basis for probiotic research has to be developed. This basis has to answer the following questions: what microbes are really present, will the real intestinal microflora please stand up and what happens to intestinal strains when a probiotic or a prebiotic is consumed (chapter 1). This requires methods for analysis of the intestinal microflora (chapter 3) and also the accurate identification of lactobacilli and bifidobacteria which are the two bacterial groups most commonly incorporated in probiotic products (chapter 4). The probiotic microbes are mainly selected on the basis of their potential health-associated properties, although choice of strains of recognised safety and probiotic efficacy, size of inoculum, incubation conditions, microbial interactions and survival of bacterial strains during storage of a probiotic product are of prime importance from industrial perspectives (chapter 5). Other chapters concern with the use of probiotics for farm animals (chapter 2), with genetic modification of intestinal lactobacilli and bifidobacteria (chapter 6), with the influence of probiotics on the immune system (chapter 7) and with the efficacy of lactic acid bacteria as live vaccines (chapter 8). A number of potential benefits arising from changes to the intestinal milieu through the agency of probiotics have been proposed, but the basis for the claims is often weakened by a lack of proven reliability of the preparations, and an inability to proveconclusively that the contents are safe and efficacious. For that reason rigorous clinical trials have to be underwent (chapter 9). Further the balance of the intestinal microflora can be modified by a range of non-digestible dietary supplements by stimulating the growth andlor activity of beneficial organisms and suppressing potentially deleterious bacteria. These selective dietary components were named prebiotics (chapter 10). The editor concludes that probiotic research and development is poised to make great advances during the next five years because molecular technologies are applied increasingly to analysis of intestinal communities, in conjunction with the use of biochemical and bacteriological methodologies. Unfortunately a discussion on the probiotic products available on the market and on their probiotic bacteria such as La1, L.GG, L.reuteri, L.casei Shirota or L. plentarum is missing.

This book provides an authoritative review of important areas of probiotic research. It can be recommended to all microbiologists, health professionals, biotechnologists, dairy and food scientists as well as to nutritionists and even to clinical doctors because each chapter affords a critical insight into a particular topic, reviews current research and considers future direction.

Review by
Italian Journal of Food Science

Italian Journal of Food Science 11(3): 278. September 1999

Probiotics are credited with an impressive list of therapeutic and prophylactic attributes. The probiotics industry is flourishing, and interest in establishing scientific credibility has attained importance for many companies and scientists. Fundamental knowledge of intestinal bacteria and their interactions with each other and with the host are a prerequisite for successful probiotic research and development. Of particular interest are the ufflisation of molecular biological tools in the analysis of these systems, the scientific rigour of clinical trials, the accurate identification of intestinal bacteria, assessment of safety risks, genetic modification of intestinal bacteria, studies of microbial ecology and of beneficial host-microbe relationships, and the potential for modulatlon of the intestinal microflora using dietary additives (prebiotics).

This book contains state-of-the-art commentaries on all these aspects of the intestinal microflora and probiotics and provides m authoritative review of important areas of probiotic research. Written by leading experts in the field, each chapter affords a critical insight into a particular topic, reviews current research, considers future direction and aims to stimulate discussion. An essential text for all microbiologists, health professionals, biotechnologists, dairy and food scientists.

Review by
Dr. Simon Cutting School of Biological Sciences, Royal Holloway University of London

The Biochemist 22(3): 35

Probiotics is becoming a topical issue, best illustrated by the notable increase of TV adverts for "friendly bacteria" as dietary supplements. In the UK at least, probiotics cannot be sold as prophylactics for intestinal disorders, although this is certainly not the case in other countries where they are used routinely as antidiarrhoeal medicines. In the livestock industry probiotics have important implications as an alternative to antibiotics as growth promoters.

The question facing many scientists is whether there is any real science behind the phenomenon or does this represent 'snake-oil'? This book has attempted to address this and represents one of the first to do so exclusively. I found the book somewhat disorganized and this reflects, in part, the fact that this is an edited collection of papers by different research groups. Some of the chapters were interesting and very informative, such as those on the use of probiotics in farm animals and the section dealing with immune responses accompanying ingestion of probiotics.

However, one chapter on genetic engineering of Lactobacilli seemed irrelevant and more a misplaced advert for an EU consortium working with lactic acid bacteria. Further, a chapter on methods for identifying intestinal bacteria would have been better placed in a methods book.

Sadly, some information was hard to find, could have been presented easily and would have been very informative to the reader. For example, a summary of animal and human probiotics currently available, the bacteria in these preparations and reports of their efficacy in laboratory trials.

This book should be of interest to researchers and perhaps PhD/MD students but is probably too indepth for undergraduates. The book has few figures and lacks any colour plates and seems relatively expensive for the content.

Review by
S Peter Borriello Professor of Medical Microbiology and Director, Central Public Health, Laboratory, 61 Collndale Avenue, London, UK.

The Infectious Disease Review 2(2): 94. 2000

This is a gem of a book dealing in an objective and critical way with the subject and issues of probiotics and prebiotics. It is refreshing to see a book in this area of research, which concentrates on fact rather than anecdote and belief.

The ten chapters cover aspects such as a reappraisal of the complex intestinal microflora and methods of analysis of this ecosystem (particularly molecular) to determine normal flora and to monitor the fate and effect of probiotics (three chapters); an overview of probiotic use in farm animals; effects of probiotic administration on the immune system; the newly emerging field of use of lactic acid bacteria as live vaccines, and methods of genetic manipulation of probiotics (three chapters); a chapter on the often ovelooked topic of industrial perspectives on production of probiotic milk products and chapters on the issues surrounding clinical trials, and on the use of prebiotics. I would highlight for particular commendation, the chapters on methods of analysis of the intestinal flora (chapter 3), the careful overview of probiotics and the immune system (chapter 7) and the immensely useful chapter on genetic modification of lactobacilli and bifidobacteria (chapter 6).

Although the book is predominantly about oral probiotics and the intestinal flora, it is none the weaker for that, although one overview chapter on topical and vaginal probiotics would have been useful. The only minor irritation to this reviewer was the mixture of English and American spelling within the book, sometimes within the same chapter and sometimes even on the same page.

Overall, this is a well-balanced book and a must for those interested in the field. A recurring view expressed in the book is the importance of exposing probiotics (and prebiotics) to rigorous clinical trials to ensure credibility and mainstream acceptance. I echo those views, particularly as it will facilitate concentration of research efforts on mechanism of effect on those products, which have genuine effects on particular conditions. However, this reviewer is also aware that such a level of proof is not required for sales and marketing in the health food sector and that there is little commercial incentive to undertake expensive clinical trials.