396
if the immune system is malfunctioning. In 2011 the Agency for Healthcare
Research and Quality assessment studied the safety of probiotics and pointed out
the lack of evidence for the negative side effects of probiotics. However, the data on
long-term effects and other side effects are limited.
As per the evidence in the technology report by the Agency for Healthcare
Research (2011), which studied the safety of probiotics, most of the research indicated an absence of adverse events. Further studies are necessary for impact of different strains, either singly or in groups. More research will provide data about the
use of probiotics to treat disease and the long-term impact. Probiotics are not regulated by the FDA as are drugs and are treated as dietary supplements. The method
of preparation and mode of action of various probiotic supplements vary among
different brands and different preparation. The only negative effects recorded are
temporary gas formation and bloating. Very rare cases of side effects such as allergic reactions and infections were also reported, which happens only with patients
having severe health problems (Gasser 1994; Saxelin et al. 1996; Husni et al. 1997).
Patients with a compromised immune system could be vulnerable to infection but
evidence for infection after consumption of probiotics is lacking. Overgrowth of
commensal lactobacilli may lead to lactic acidosis in patients with short bowel syndrome (Bongaerts et al. 1997). Strains that exclusively produce l-lactate cannot
pose a problem for such patients (Vanderhoof et al. 1998).
Detailed analysis is needed for evaluating the host–microbial interaction, which
is important for in-depth understanding of the mechanism of translocation, infection, and survival of microbes in the human system. More evidence is needed for the
desirable effects of probiotics in the treatment of diseases. Better understanding of
the mode of action of probiotic dietary supplements is highly significant in the present scenario. So, research should be focused for improved probiotic strains that can
be used for targeted therapeutic approach or as therapeutic adjuncts together with
improvement of probiotics for vaccine delivery. To ensure commonality, it is necessary to identify the optimal strain and mode of action with molecular
characterization.
Some rare cases of negative impact of probiotics have been reported. Malkov
et al. (2006) reported the death of cancer patients who had consumed a Bacillus
oligonitrophilus-containing product from unexpected liver failure and pulmonary
edema. Carlsson et al. (2009) reported adverse effects of Lactobacillus and
Lactococcus in two dementia patients, and some other patients needed antibiotics
after probiotic intervention (Mego et al. 2006; Reid et al. 2001).
The term probiotics is used worldwide without any legally recognized definition
or any identifiable standard. So, probiotic-labeled products are not required to meet
any quality standards that are unique to probiotics. Products currently available in
the market that are labeled as probiotic are unfortunately not well defined or established with human trials.
Generally, probiotic-labeled products should follow the guidelines fixed by a
working group of the FAO (FAO/WHO 2002), but surveys have suggested that most
of these products do not meet these criteria (Drisko et al. 2005; Temmerman et al.
2003a, b; Yeung et al. 2002). Probiotic products must have labeling about the shelf
T.S. Swapna et al.
if the immune system is malfunctioning. In 2011 the Agency for Healthcare
Research and Quality assessment studied the safety of probiotics and pointed out
the lack of evidence for the negative side effects of probiotics. However, the data on
long-term effects and other side effects are limited.
As per the evidence in the technology report by the Agency for Healthcare
Research (2011), which studied the safety of probiotics, most of the research indicated an absence of adverse events. Further studies are necessary for impact of different strains, either singly or in groups. More research will provide data about the
use of probiotics to treat disease and the long-term impact. Probiotics are not regulated by the FDA as are drugs and are treated as dietary supplements. The method
of preparation and mode of action of various probiotic supplements vary among
different brands and different preparation. The only negative effects recorded are
temporary gas formation and bloating. Very rare cases of side effects such as allergic reactions and infections were also reported, which happens only with patients
having severe health problems (Gasser 1994; Saxelin et al. 1996; Husni et al. 1997).
Patients with a compromised immune system could be vulnerable to infection but
evidence for infection after consumption of probiotics is lacking. Overgrowth of
commensal lactobacilli may lead to lactic acidosis in patients with short bowel syndrome (Bongaerts et al. 1997). Strains that exclusively produce l-lactate cannot
pose a problem for such patients (Vanderhoof et al. 1998).
Detailed analysis is needed for evaluating the host–microbial interaction, which
is important for in-depth understanding of the mechanism of translocation, infection, and survival of microbes in the human system. More evidence is needed for the
desirable effects of probiotics in the treatment of diseases. Better understanding of
the mode of action of probiotic dietary supplements is highly significant in the present scenario. So, research should be focused for improved probiotic strains that can
be used for targeted therapeutic approach or as therapeutic adjuncts together with
improvement of probiotics for vaccine delivery. To ensure commonality, it is necessary to identify the optimal strain and mode of action with molecular
characterization.
Some rare cases of negative impact of probiotics have been reported. Malkov
et al. (2006) reported the death of cancer patients who had consumed a Bacillus
oligonitrophilus-containing product from unexpected liver failure and pulmonary
edema. Carlsson et al. (2009) reported adverse effects of Lactobacillus and
Lactococcus in two dementia patients, and some other patients needed antibiotics
after probiotic intervention (Mego et al. 2006; Reid et al. 2001).
The term probiotics is used worldwide without any legally recognized definition
or any identifiable standard. So, probiotic-labeled products are not required to meet
any quality standards that are unique to probiotics. Products currently available in
the market that are labeled as probiotic are unfortunately not well defined or established with human trials.
Generally, probiotic-labeled products should follow the guidelines fixed by a
working group of the FAO (FAO/WHO 2002), but surveys have suggested that most
of these products do not meet these criteria (Drisko et al. 2005; Temmerman et al.
2003a, b; Yeung et al. 2002). Probiotic products must have labeling about the shelf
T.S. Swapna et al.