Abstract
Probiotics are live microorganisms that promote health benefits upon consumption, while prebiotics are nondigestible food ingredients that selectively stimulate the growth of beneficial microorganisms in the gastrointestinal tract. Probiotics and/or prebiotics could be used as alternative supplements to exert health benefits, including cholesterol-lowering effects on humans. Past in vivo studies showed that the administration of probiotics and/or prebiotics are effective in improving lipid profiles, including the reduction of serum/plasma total cholesterol, LDL-cholesterol and triglycerides or increment of HDL-cholesterol. However, other past studies have also shown that probiotics and prebiotics had insignificant effects on lipid profiles, disputing the hypocholesterolemic claim. Additionally, little information is available on the effective dosage of probiotics and prebiotics needed to exert hypocholesterolemic effects. Probiotics and prebiotics have been suggested to reduce cholesterol via various mechanisms. However, more clinical evidence is needed to strengthen these proposals. Safety issues regarding probiotics and/or prebiotics have also been raised despite their long history of safe use. Although probiotic-mediated infections are rare, several cases of systemic infections caused by probiotics have been reported and the issue of antibiotic resistance has sparked much debate. Prebiotics, classified as food ingredients, are generally considered safe, but overconsumption could cause intestinal discomfort. Conscientious prescription of probiotics and/or prebiotics is crucial, especially when administering to specific high risk groups such as infants, the elderly and the immuno-compromised.
Highlights
The WHO has predicted that by 2030, cardiovascular diseases will remain the leading causes of death, affecting approximately 23.6 million people around the World [1]
Prebiotics such as inulin and fructooligosaccharides are soluble, indigestible, viscous and fermentable compounds that contribute to hypocholesterolemia via two mechanisms: decreasing cholesterol absorption accompanied by enhanced cholesterol excretion via feces, and the production of short-chain fatty acids (SCFAs) upon selective fermentation by intestinal bacterial microflora [90]
Most members of lactobacilli and bifidobacteria are safe for consumption, some species such as L. rhamnosus, L. casei, L. paracasei, L. leichmannii, L. confuses and L. plantarum have been isolated from infectious sites
Summary
The WHO has predicted that by 2030, cardiovascular diseases will remain the leading causes of death, affecting approximately 23.6 million people around the World [1]. Prebiotics are ‘indigestible fermented food substrates that selectively stimulate the growth, composition and activity of microflora in gastrointestinal tract and improve hosts’ health and well-being’ [5]. New compounds with gut resistant properties and selective fermentability by intestinal microorganisms are continuingly being identified and developed as prebiotics [16] These include oligosaccharides (isomaltooligosaccharides, lactosucrose, xylooligosaccharides and glucooligosaccharides), sugar alcohols and polysaccharides (starch, resistant starch and modified starch) [17]. Prebiotics offer promising health benefits such as improving gastrointestinal microflora by selectively promoting the growth of probiotics and/or inhibition of pathogenic microorganisms [18], stimulation of the immune system [19], cancer prevention [20], stimulation of mineral absorption and bone stability [21] and treatment of irritable bowel-associated diarrhoeas [22]. The safety verification of probiotics used industrially and commercially is of utmost importance
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