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Asia Pacific J Clin Nutr (1996) Vol 5, No 1: 1

Editorial overview

Intestinal flora and human health -- introductory remarks

Paul Nestel, MD, FRACP

Baker Medical Research Institute, Melbourne, Australia

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This area of medical science began as a branch of microbiology- medical ecology, or the relationship between living beings and the microorganisms with which they coexist. That the colonic bacteria profoundly influence our health is a novel concept, intuitively grasped through food folklore long before medical scientists seriously tackled the question.

The discipline has made enormous progress in recent years and the health potential is being rapidly adopted by consumers and producers. As often happens in this era of mass communication, there is the danger that public expectation and the forces of the marketplace will exceed scientific consensus. This can harm an industry which in Australia is at a relatively early stage of product acceptance. It is therefore a credit to the industry for having sponsored this symposium. The program tackles the major issues and the scientific presentations contain new and exciting information, but couched carefully and conservatively. This is the only credible road to progress.

My role was to overview briefly the key issues which the speakers emphasised and these have been summarised in the following tables.

Table 1. Established and postulated functions of colonic microflora. Colonic microflora Postulated functions Metabolic, nutritive, immunologic, protective Energy conservation Carbohydrate, protein fermentation Metabolic regulation Bile acids, cholesterol, lignans, isoflavones Colonocyte proliferation/ differentiation Role of butyric acid 1000 Protection Bacteriostatic and bacteriocidal products Barriers to pathogenic bacteria Detoxification of carcinogens, etc Immunocompetence Clinical improvement of biomarkers Experimental Antimutagenic Epidemiologic & experimental evidence

Table 2. Therapeutic potential of probiotic microorganisms Therapeutic benefits Diarrhoeal diseases Infantile diarrhoea Lactose maldigestion Antibiotic related Future advances Improved Immunocompetence Needs: Better biomarkers Clinical trials Preventing colonic neoplasia Establish significance of: SCFA especially butyrate Detoxification of carcinogens Regulation of colonocyte biology Clinical trials Healing gastric ulcers H. pylori biology Adjuvants to radiotherapy, etc

Table 3. Product research and development Probiotics, prebiotics, symbiotics Probiotic bacteria Which bacteria? Need evidence for: Viability and survival Capability to colonise colon Therapeutic potential Candidate bacteria Lactobacilli (acidophilus, casei, gasseri, etc) Bifidobacteria, Enterococci etc Prebiotics Non-digestible food ingredients that promote bacterial growth Oligosaccharides Symbiotics Optimal combinations of prebiotics and probiotics Technological challenges Biological safety Microbiological functionality Substrate optimisation Product acceptance Responsible consumer information Clinical challenges Bioavailability Clinical efficacy, safety

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Revised: January 19, 1999 .

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