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Prebiotics and Probiotics

Normal gut flora (bacteria) forms in the gastrointestinal tract during birth and the first few days after birth. They are obtained from the mother’s breast milk and the environment. The amount of flora depends on the mother’s hygiene and her intake of lactic acid bacteria.


Prebiotics are non-digestible food components like oligosaccharides (from carbohydrates) that stimulate the growth of normal gut flora. Oligosaccharides constitute a large component of the carbohydrates in breast milk and protect babies against illnesses such as diarrhoea, respiratory infections and middle-ear infections. Oligosaccharides inhibit the growth of pathogenic bacteria in babies and babies that breast feed have more normal gut flora than bottle fed babies.

Oligosaccharides do not get metabolised in the stomach or small intestine. They pass through to the colon and stimulate the growth or activity of one or a few flora in the colon. This improves the health of the host. These bacteria then improve the systemic and mucosal immunity of babies.

A daily prebiotic intake of 2-3g/serving is recommended to limit discomfort such as flatulence, bloating, colic or even loose stools.


Probiotics are viable bacteria with demonstrated benefits for the health of the host. Probiotics include lactic acid bacteria like Lactobacillis reuteri and Lactobacillis casei as well as a few Bifidobacterium.

Probiotics have to meet a few criteria. These are:
  • Human origin
  • Stability against acid and bile
  • Adherence to human intestinal cells
  • Colonisation of the human intestinal tract
  • Production of anti-microbial substances
  • Antagonism against pathogenic bacteria
  • Safety in food and clinical use

Patients that are able to eat normally and are not lactose intolerant can ingest probiotics through yoghurt with live bacteria. Patients that can not eat sufficiently, and where enteral sip feeds are indicated, may be given tablets or capsules with probiotics such as Reuteri tablets or drops.

It is best to take a probiotic supplement that contains prebiotics. An example of a probiotic supplement with prebiotics is Probiflora made by Nutrilida.

Supplementation with prebiotics only in a GIT overgrown with pathogenic bacteria has a slow and insufficient recolonisation as result. Supplementation with probiotics will secure a high and speedy recolonisation, and combined with prebiotics will facilitate the growth of the normal flora.

Probiotics will not cause infections. On the contrary, a well-balanced flora with probiotic supplementation will protect the host against bacterial translocation.

Probiotics and antibiotics

Critically ill children get treated with antibiotics often. Antibiotics, especially those with a broad spectrum are known to cause diarrhoea in children. Combining probiotics with antibiotics treatment is known to reduce the risk for diarrhoea.




More research on pre- and probiotics is necessary to establish their full potential but it is already clear that they can play a beneficial role in the medical treatment of ill children and adults.

By Melissa Pyle, BSc. in Dietetics, Registered Dietician (SA)

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