Review Article | DOI: https://doi.org/10.31579/2639-4162/223

Pre/Pro-Biotics in Health & Diseases

  • K. Suresh

Family Physician & Public Health Consultant, Bengaluru, India. 

*Corresponding Author: Family Physician & Public Health Consultant, Bengaluru, India.

Citation: K. Suresh, (2024), Pre/Pro-Biotics in Health & Diseases, J. General Medicine and Clinical Practice, 7(17); DOI:10.31579/2639-4162/223

Copyright: © 2024, K. Suresh. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Received: 03 September 2024 | Accepted: 25 September 2024 | Published: 30 September 2024

Keywords: curds; buttermilk; pre-biotics; probiotics- diet; supplements &- probiotic particles loaded dressings; inflammatory bowel- diseases /syndrome (ibd/ibs); burns

Abstract

Probiotics and prebiotics are a hot topic these days. The Western world sees many ads on television and online for supplements and foods that promise to deliver helpful bacteria and their benefits. The same culture is creeping in Urban India to an extent that educated urbanites are slowly moving to buying Greek Yogurt or commercial Probiotic products

Probiotics are microorganisms which confer a series of innate health benefits to the host, having a wide range of applications and are seen worldwide as miraculous advancement in nutrition and health besides their promising therapeutic benefits and negligible side effects. Indian probiotic industry is achieving its pace at steady rate with opportunities for rapid growth in near future. Indian probiotic market was valued at $12 million in 2011 and is estimated to be around USD 93.20 million in 2024 and expected to grow at a CAGR of 5.71% to reach USD 123.01 million by 2029. 

There has been an increased influx of probiotic products in the Indian market during the last decade, in the form of Drinks, Supplements and Foods. The recent trends of incorporating probiotics into everyday food items like snacks, juices, and cereals, making it easier for consumers to incorporate probiotics into their daily diets. The rising popularity of veganism and lactose intolerance concerns, plant-based probiotics derived from sources like soy, almond, and coconut are gaining attraction and catering to the dietary preferences.  The future of probiotic foods is promising, as modern consumers are making all out efforts for their personal health and expect their diet must be not only healthy but also capable of preventing illness. Currently they are available mainly in supermarkets of districts and larger cities, Pharmacies and a few online retailers. However, there has been no systematic approach for evaluation of probiotics in food to ensure their safety and efficacy.

Materials & Methods: This article is a review of changing physicians’ prescription practices, with 4 case reports spread over 60 years. It also covers changes in dietary cultural practices, from Curd, butter milk in each meal, to more refined and costly commercial products called Probiotics. The author’s observation as family physician since 1968 and as public health practitioner and consultant since 1978. The clinical practices of family physicians from advising curds and butter milk for diarrhea, to prescribing commercial probiotics for various health intervention trials. The article is complimented by literature review on production, distribution, marketing consumption trends and projected future for probiotics.

Introduction

The research in the last decade is pointing to probiotic foods as beneficial against a range of health conditions, like allergies, arthritis, asthma, cancer, depression, hair growth, heart disease, and gastrointestinal (GI) problems and even helping in weight loss! Therefore, Probiotics & prebiotics are a hot topic of discussions & media advertisements these days [1]. 

Probiotics are microorganisms which confer a series of innate health benefits to the host, having a wide range of applications and are seen worldwide as miraculous advancement in nutrition and health besides their promising therapeutic benefits and negligible side effects. They are available in abundance in foods like yogurt and sauerkraut. Supplements [2].

Prebiotics are high-fiber foods that act as food for human microflora and are used with the intention of improving the balance of these microorganisms. They are available in whole grains, bananas, greens, onions, garlic, soybeans and artichokes. In addition, probiotics and prebiotics are added to some foods and available as dietary [2].  Traditionally most Indian households serve curd on its’ own or curd rice, Butter milk /Chaas or Lassi at the end of every meal. It is even distributed by religious philanthropists free of charges in hot season to working class laborers to combat the heat waves. Commercial Yogurt is invading stores and supermarkets in the last 2 decades. Globally, come summer it is time to consume cold beverages, Yoghurt, and food items to beat the scorching heat. Curd is made by whisking some old Curd or lemon juice (yields several type Lactobacilli) with warm milk, kept overnight and consumed the next day [3]. 

This process of curdling & inducing probiotic bacteria to form Curd, gives this dairy product a unique taste and texture. On the other hand, Yogurt is prepared by fermenting the milk with artificial acids, commercially and needs an optimal temperature to get that perfect taste and smooth texture [4].

While both Curd and Yogurt contain probiotic bacteria, the quantity of bacteria in Yogurt is higher as compared to Curd, because of the way of fermentation over a period. Yogurt is made by commercial fermentation of milk by introducing a specific type of bacteria, resulting in a product with a type of bacteria, belonging to a similar family. Homemade curd on the other hand, has a comparatively lesser number of bacteria, not necessarily of the same or similar type of biological family.  Modern consumer’s efforts for their personal health are highly appreciable and their expectations that their diet must not only be healthy but also capable of preventing illness, has changed the clinical practices of family physicians from advising curds and butter milk for diarrhea, to prescribing commercial probiotics.  This article is a review of changing physicians’ prescription practices, with 4 case reports spread over 60 years. It also covers changes in dietary cultural practices, from Curd, butter milk in each meal, to more refined and costly commercial products called Probiotics. The article includes a literature review on production, distribution, marketing, consumption trends and projected future until 2029-30. Finally, It summarizes evidence based current therapeutic value and emerging guidelines for use of Probiotics and is expected to be a good guide to population and Physicians alike.

Anecdotal Case Reports from family Physicians in India:

  1. Buttermilk therapy for Young Infant with Traveler’s Diarrhea 1969:  The authors’ first ever experience of prescribing butter milk as a therapy goes back to May 1969. My cousin had come with her two kids to my rural PHC from Bhilai (Steel plant fame) Madhya Pradesh travelling by train in hot summer of temperature ranges between 380 -420C for nearly 36 hours. After about 8 hours journey her son aged about 18 months developed diarrhea, and Railway Medical officer enroute had prescribed Bismuth subsalicylate (a stool binding suspension), and antibiotics (Rifaximin oral suspension) and an antiparasitic (Flagyl Oral suspension) along with oral rehydration. On arrival she was worried as the child continued to have diarrhea, was not feeding well. After reviewing his general condition and finding no dehydration I asked her i) to stop all drugs ii) Put the boy on a cup of butter milk (100ml) with a pinch of salt and a spoon of sugar every 3 hours. In just 24 hours, the miracle happened, Diarrhea diminished, appetite improved and in another 48 hours the child was normal.
  2. Trial of two Probiotics on patients with Diarrhea 2015: 

In an urban health center, I tried on 2 well to do outpatients prescribing Lactobacillus Buchneri (SU) for 4 weeks & mixed probiotics (NS) for the following 4 weeks. Another 2 patients were given the same probiotics in reverse order (NS for 4 weeks at first and SU for the following 4 weeks). Fecal samples were collected before and after the outpatients took each of the two probiotics and analyzed in the district public health laboratory. While one child benefited (% of beneficial bacteria) after SU and another only after NS. Both patients in NS first order showed improved beneficial bacteria first and which decreased after SU. It was a lesson that Probiotics should be selected not only for their quality but also for compatibility with each intestinal bacterial flora.

  1. Shifting to Local Manufacturers Probiotics:

One of my IBD patients aged 45 years male, was referred to a Gastroenterologist in late 2023, who had prescribed an International Brand Probiotics (blend of Lactobacilli) for nearly 2 years with consistent satisfaction. As the cost was higher, I as his family physician suggested to try a total lactic acid bacterium and a total yeast counts probiotic manufactured locally. The cost is half of the brand he was already using. The result was consistent and satisfied gastroenterologist, me and our client. The patient continued to use the local brand, and the Gastroenterologist now comfortably prescribes the local brand probiotic for other patients for economic reasons.

  1. Probiotic Dressings of Burn wounds: In November 2023 A boy was referred and admitted to a public sector tertiary hospital with post-crackers bursting burns (20%). The surgeon used Lactiplantibacillus plantarum strain of a probiotic strain loaded microparticles with proven wound-healing properties as dressings which turned out to be more effective.  Histological investigations showed that the probiotic-loaded particles functioned exactly as efficaciously as silver sulfadiazine ointment. However, despite the effectiveness of probiotics in burn wound healing, their administration and stabilization are challenging because of the need for protection against Gram-positive and Gram-negative bacteria which requires the use of different forms of dosage as hydrogels, films ointments and gels.

Discussions:

Human large intestine contains 100 trillion "good" bacteria that are essential to health. They are called the gut microbiome, and they help maintain healthy bowel function, and may even help with conditions like inflammatory bowel disease. Research suggests they may even play a role in regulating weight and mood. In a healthy state, the gut microbiota has multiple positive functions, such as energy recovery from metabolism of nondigestible components of foods, protection of a host from pathogenic invasion, and modulation of the immune system. Imbalance of the normal gut microbiota also known as a dysbiotic state have been linked with gastrointestinal conditions like inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS), and wider metabolic conditions like obesity, type 2 diabetes, and atopy. Specific contribution of the gut microbiota in these diseases is still unclear [1]. The heterogeneous etiology of metabolic and gastrointestinal diseases has been associated with different microbes, but the causal association is yet to be established.

Some of the best ways to add healthful bacteria to our microbiome i) Yogurt and kefir, one need to be sure to look for the words "live and active cultures" on the label to make sure of getting live cultures and ii) Fermented foods- Beneficial microbes are the "cooks" for some familiar foods as they turn cabbage into sauerkraut, cucumbers into sour pickles, soybeans into miso, and sweetened tea into kombucha. The best solution is to buy from producers who do the pickling themselves or carry fermented foods or make our own.  It's best to stick with dietary sources rich in pre- and probiotics by including i) plenty of foods rich in insoluble fiber, which tend to contain the most prebiotics. We can find them in whole-grain products such as oatmeal and whole-grain breads, as well as in vegetables like asparagus, leeks, onions, and garlic, and starchy vegetables like sweet potatoes and corn. Beans, lentils, and peas are also good sources, ii) limiting sugar, saturated fat, and processed foods. These can deplete the good bacteria in the gut. The common difference between yogurt and curd are i) the way they are prepared, ii) amount of lactose iii) Nutritive value and iv) Flavors. [7]

Method of Preparation: The curd is made by coagulating milk with edible acids like lemon curd, juice and vinegar in a process known as curdling. Curd, known as Dahi in India, is made by fermenting milk with the help of Lactic Acid bacteria. This bacterium reacts with casein, a globular protein found in milk and then produces energy, Lactic acid is produced as a byproduct of such energy formation. This lactic acid then reacts with the globular proteins present in milk, denatures them, and results in the formation of a thick texture i.e., curd. 

Sl. No.VariablesCurdYogurt
1PreparationFermentation of milk using Lactic Acid BacteriaFermentation of milk using live strains of Lactobacillus bulgaricus & Streptococcus thermophilus.
2Amount of LactoseLower than fresh milkLess lactose than curd
3Nutrition ValueCalcium, Iron, Vitamin B 6 & Potassium, Vitamin 12, Calcium, Phosphorus 
4FlavorsUnsweetened & UnflavoredPlain or sweetened, and variety of flavors.

                                                                                       Table-1 Comparison of Curds & Yogurt Characteristics.

Basic Steps of making curd at home:

  1. Take a thick bottom pan, rinse it with clean water
  2. Add half a liter of clean and safe water, keep the pan on stove top and begin heating in low /medium flame
  3. Stern the milk 2/3 time while heating to avoid burning or browning from the bottom
  4. Frothing and bubbling of the milk indicates it’s boiling
  5. Turn off the stove and keep the milk aside to cool to room temperature till it is just warm (39-440C), checking with your finger (touch method) or a food thermometer.
  6. Add one (in summer) or two spoons (in winter) of curd starter to the milk.
  7. Then stir it well with a spoon or a wired whisk and leave it to settle.
  8. This mix can be poured into cups or vessels of Terracotta, steel etc.
  9. Cover with appropriate lids and leave it overnight or 6-8 hrs., the curd will be ready.

Basic Steps of making Commercial Yogurt: 

Yogurt, on the other hand, is made by fermenting milk using live strains of two bacteria- Lactobacillus bulgaricus and Streptococcus thermophilus.

It is practically impossible to do it at home. 

These bacteria react with the sugar present in milk and then produce lactic acid which then reacts with the protein in the milk and forms yogurt.

 Yogurt is produced for commercial purposes and is artificially sweetened and made available in a variety of flavors. 

The chemical reaction involved in the formation of Lactic acid is as follows: 

C12H22O11 (Lactose) + H2O (Water) -> 4CH3CHOHCOOH (Lactic Acid)

2. Amount of Lactose: Curd contains more lactose than yogurt but significantly less amount of lactose when compared to fresh milk. Therefore, lactose intolerant individuals can consume it, particularly Greek yogurt. 

3. Nutritional Value: Curd is rich in calcium, iron, potassium, and vitamin B6, whereas yogurt is a wonderful source of calcium, phosphorus, and vitamin B12. Consuming yogurt lowers the risk of high blood pressure and cholesterol. On the other hand, curd is known to stimulate the brain and aids in the digestion process.

4. Flavours Available: Curd is traditionally consumed simply without any flavors. In Indian households, it is taken with either salt, sugar, jaggery, or neither or even as Lassi slated or sweetened. It is white in colour and has a sour or acidic flavor and is consumed as a crucial component of Indian cuisine. Yogurt comes in a wide variety of flavors, such as strawberry, mango, and blueberry. Yogurt has a less sour/acidic taste than curd. There are sweetened as well unsweetened yogurt available in the market. 

Yogurt vs Curd! While Yogurt and curd are good for health and have nutritional values. 

Yogurt is a great source of protein, potassium, molybdenum, pantothenic acid, or Vitamin B5. Because it is protein-rich, yogurt is beneficial for weight loss. It is advised for Hypertensive people due to its potassium content. Yogurt also contains probiotics, which help in maintaining healthy gut health. Curd is a great choice for people with indigestion issues as it helps in better digestion. The digestive system can easily absorb the nutrients in curd. The good bacteria present in curd help in maintaining a strong and healthy immune system. It is a strong source of calcium and phosphorus, which is good for overall bone health. Curd also has beauty benefits as it is beneficial for skin and hair. 

General Uses of curd: Curd is a staple food in many cultures and is used for multiple purposes: 

As a condiment: Curd is often used as a topping for dishes such as biryani. 

In cooking: It is used to marinate meats and can also be used as a base for sauces and dips. 

As a beauty product: Curd is often used by many people as a face mask and hair mask to improve the overall health and appearance of the skin or hair. 

General Uses of yogurt

As a food item: Yogurt is a popular breakfast food that is either taken plain or with toppings such as fruits, nuts, granola, among others.

In cooking: Yogurt is sometimes used as a substitute for sour cream or cream in making sauces and dressings. 

For health: Yogurt is rich in probiotics, which can improve gut health.

The Effects and Therapeutic Use of Probiotics

The effect of probiotics on human health has been studied in a wide range of conditions, focused on gastrointestinal conditions, atopic eczema, allergies, respiratory tract infections, obesity, metabolic disease/type 2 diabetes, cardiovascular, cognitive, and mental diseases, bone health, nonalcoholic fatty liver disease (NAFLD) and hepatic encephalopathy, tumor necrosis factor (TNF-α), autism, burn wounds, and gynecological diseases.

                                                                                         Figure 2. Action mechanisum of probiotics. Source. Ref

History and Benefits of Probiotic for Human Health:

The history of probiotics began in early civilization, when humans started to consume fermented foods. The first documented uses were around 2000 BC [1]. The first food producers turned milk into fermented dairy products using bacteria and yeasts. Our ancestors used yeast to make beverages as early as 3500 BC. It is believed that probiotics may treat or prevent different diseases both in children and adults. Ever since the early 2000s, probiotic-based fermented foods have had a resurgence in popularity, mostly due to claims made regarding their health benefits. Fermented foods have been associated with the prevention of irritable bowel syndrome, lactose intolerance, gastroenteritis, and obesity, chronic diarrhea, allergies, dermatitis, and bacterial and viral infections, all of which are closely related to an unhealthy lifestyle. An expanding range of candidate probiotic species is emerging that can lead to new variants of microbiome-modulating interventions like including prebiotics, symbiotics, postbiotics, microbial consortia, live biotherapeutic products, and genetically modified organisms, with renewed interest in polyphenols, fibers, and fermented foods to ensure human health [1].

                                                                                            Table 2: Functions of Probiotics (source [1,2,5]

Lactose intolerance (LI): LI is a common problem globally and specifically in India in which people are allergic to dairy based products. In the context of Curd, it contains a lower amount of lactose as compared to fresh milk. The level of lactose intolerance may vary from person to person, and for such people curd is not highly recommended. Whereas the Greek-style Yogurt is highly recommended by experts for people suffering from lactose intolerance.

Benefits of probiotics for skin Health: These include protecting the delicate skin barrier to reduce the risk of inflammatory conditions like acne, eczema, and rosacea. By maintaining a balanced microbiome, probiotics help soothe irritation and regulate the skin response to external triggers such as UV rays and pollution. They also stimulate skin cell turnover, promoting a smoother and brighter skin tone over time. In addition to their anti-ageing properties, probiotics can diminish wrinkles and fade blemishes, offering you youthful skin. Probiotics can also hydrate and nourish your skin, combating skin dryness. Oral & topical use of probiotics can help 6 health conditions or diseases, according to Indian dermatologist:

  1. Help deal with acne: Acne is caused by clogged pores, inflammation, and bacterial growth, often exacerbated by an imbalance in the skin’s microbiome. According to a research paper published in 2020 by Clinical and Experimental Dermatology, probiotics, especially strains like Lactobacillus and Bifidobacterium, exhibit antimicrobial properties that can help inhibit the growth of acne-causing bacteria such as Cut bacterium acnes.  By reducing bacterial load and inflammation, probiotics may help in preventing and managing acne breakouts. Avoid the urge to pop your pimples since it can lead to permanent acne scars [11].
  2. Reduce signs of ageing: As we age, the skin undergoes several changes that may result in reduced collagen production, diminished elasticity, and increased visibility of wrinkles and fine lines. Probiotics offer anti-ageing benefits by stimulating collagen synthesis and improving skin barrier function. A 2016 study published in the Journal of Drugs in Dermatology inferred that using probiotics for the skin can restore skin pH balance, reduce damage caused by UV light, and lower oxidative stress
  3. Help to deal with Atopic dermatitis: Atopic dermatitis (AD), also known as eczema, is a chronic disease that causes inflammation, itching, redness, and irritation of the skin. Topical use of probiotics can reduce the number of S. aureus and AD symptoms. Applying probiotic-containing skin care products reduces acne outbreaks and help manage dry skin & eczema.
  4. Control psoriasis: Psoriasis is an autoimmune condition, in which the immune system becomes overreactive and causes rapid turnover of skin cells, leading to thick, scaly patches on the surface of the skin. These inflamed patches can be mostly seen on the scalp, elbows, and knees; however, other body parts can also be affected. A study published by the British Journal of Dermatology, inferred that oral probiotics are effective in managing psoriasis.
  5. Rosacea: Chronic inflammation, stress, shifts in skin pH, and dietary choices, among other factors, can disrupt microbial balance. This imbalance may lead to infections or skin conditions such as acne, eczema, and rosacea. Rosacea, specifically, is a chronic inflammatory skin disorder primarily affecting the face and causing redness, visible blood vessels, and sometimes pimples or bumps. Unlike acne-related redness around acne spots, rosacea typically causes flushing that occurs more commonly at the center of the face. A recent review published in Frontiers in Microbiology suggests that using probiotics could significantly alleviate rosacea symptoms.
  6. Wound healing: Probiotics may also be effective in promoting wound healing by accelerating the repair process and reducing the risk of infection. Older research published by Clinical Microbiology and Infection found that using Lactobacillus plantarum probiotics can accelerate the healing of wounds and burns as was referred in our case of burns. However, more research is needed to support this benefit                                                                                                                                                                                                                                                                     Figure 3: Acn

Best probiotics for the skin: When looking for skincare products containing probiotics, dermatologist advise to look for something with one or more of the following ingredients:

Lactobacillus: Effective in reducing redness and acne. 

Bifidobacterium: Ideal for people with dry, irritated skin or eczema.

Vitreoscilla: Helps maintain skin moisture levels.

Streptococcus thermophilus: Boost ceramide levels, particularly for sensitive skin or eczema.

Bacillus coagulans: Can help combat skin ageing.

Staphylococcus epidermidis: Inhibit the growth of infection-causing bacteria on the skin.

Ways to use probiotics to improve skin health:

1.Diet: Incorporate probiotic-rich foods such as yoghurt, kefir, sauerkraut, and kombucha into your diet to promote a healthy gut microbiome, which indirectly supports skin health.

2. Supplements: Take oral probiotic supplements containing strains beneficial for skin conditions like acne or eczema. These supplements can help balance the gut microbiome, potentially improving skin appearance and reducing skin problems. 

3. Topical use: Use skincare products containing probiotics directly on the skin, such as creams, serums, masks, foundations, gels, cleansers, primers, etc. These topical treatments can help maintain the skin microbiome, support barrier function, and alleviate conditions such as acne or inflammation. Side effects of probiotics on the skin? While probiotics generally benefit skin health, some people may experience mild side effects such as temporary redness, itching, or irritation. These reactions are usually a result of an allergy to probiotics. Better to perform a patch test before full application and to start with lower concentrations to understand its effect on your skin [1, 11].

Efficacy of probiotics in hair growth and dandruff control:

A Meta-analysis of eight randomized clinical trials and preclinical studies recently reported a non-significant improvement in hair count (SMD = 0.32) and a significant effect on thickness (SMD = 0.92). In preclinical studies, probiotics significantly induced hair follicle count (SMD = 3.24) and skin thickness (SMD = 2.32,). VEGF levels increased significantly (SMD = 2.97), while IGF-1 showed a non-significant inducement (SMD = 0.53). For dandruff control, two studies demonstrated non-significant improvement in adherent dandruff (OR = 1.31) and a significant increase in free dandruff (OR = 5.39). Hair follicle count, VEGF, IGF-1, and adherent dandruff parameters were recorded with high heterogeneity. For the systematic review, probiotics have shown potential in improving hair growth and controlling dandruff through modulation of the immune pathway and gut-hair axis. The Wnt/β-catenin pathway, IGF-1 pathway, and VEGF are key molecular pathways in regulating hair follicle growth and maintenance [12].

Probiotics- Global & Indian Market and Future:

The global probiotics market was valued at USD 71.8 billion in 2023 [11,12]. The market has witnessed significant growth due to rising health consciousness, increasing disposable income, and the growing popularity of functional foods. Indian probiotic market was valued at $12 million in 2011 and is estimated to be around USD 93.20 million in 2024 and grow at a CAGR of 5.71% to reach USD 123.01 million by 2029 [13]. Major players in the Indian probiotics market include Yakult Danone India Pvt. Ltd., Nestle India Ltd., Amul, and Dr. Reddy’s Laboratories. 

The Indian government's emphasis on improving public health through various initiatives is fostering the growth of the probiotics market. For instance, the "National Nutrition Mission" aims to reduce malnutrition and promote healthy eating habits among the population.

The rise in the consumption and market share is attributed to i) Increasing Health Consciousness- In 2024, over 500 million people in India are actively seeking health-enhancing products, including probiotics, driven by growing awareness of the benefits of probiotics in improving digestion, boosting immunity, and preventing gastrointestinal issues. ii) Rise in Digestive Disorders: The prevalence of digestive disorders in India has increased substantially in recent years. Conditions like irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD), diarrhea are becoming more common due to changing dietary habits and lifestyle factors. Probiotics are being increasingly prescribed by doctors, especially Gastroenterologists as a therapeutic & preventive measure for these conditions. iii) Government Support for Probiotics: In 2024, the Department of Biotechnology (DBT) under the Ministry of Science & Technology released guidelines for the evaluation of probiotics in food to help conduct research and promote its use in the industry. In February 2024 the DBT also organized a workshop on "Biomanufacturing of Probiotics and Fermented Foods: A Step Towards Health Status and Social Well-Being" [5].

The growing probiotics market in India is contributing significantly to the country's overall health and wellness industry. It creates opportunities for local manufacturers, generating employment, promoting research and development activities in microbial & gut health [13].

North India is currently the dominant region in the Indian probiotic market, accounting for the largest market share. This dominance is attributed to the presence of major dairy companies and advanced distribution networks in North India. South India still has predominant practice of consuming curds in various recipes with each meal. Higher health awareness, better access to healthcare facilities, and higher disposable incomes in the region add to market value.

The future of probiotic foods is promising, as modern consumers are making all out efforts for their personal health and expect their diet must be not only healthy but also capable of preventing illness.

While there has been an increased influx of probiotic products in the Indian market during the last decade, there has been no systematic approach for evaluation of probiotics in food to ensure their safety and efficacy [3].

It's best to stick with dietary sources rich in pre- and probiotics. We can help our body produce healthy gut bacteria by a) Including plenty of foods rich in insoluble fiber, which tend to contain the most prebiotics. We will find them in whole-grain products such as oatmeal, whole-grain breads, vegetables like asparagus, leeks, onions, and garlic, and starchy vegetables like sweet potatoes and corn. Beans, lentils, & peas are also good sources. ii) Limiting sugar, saturated fat, and processed foods, because they deplete the good bacteria in the gut. 

                                                                                                            Figure 4: Source-ken research [12]

Summary:

Probiotics are microorganisms which confer a series of innate health benefits to the host, having a wide range of applications and are seen worldwide as miraculous advancement in nutrition and health besides their promising therapeutic benefits and negligible side effects. The rise in the consumption and market share is attributed to i) Increasing Health Consciousness of the benefits of probiotics in improving digestion, boosting immunity, and preventing gastrointestinal issues. ii) Probiotics are being increasingly prescribed by Specialist doctors, especially as a therapeutic & preventive measure for various conditions.

Indian probiotic market was valued at $12 million in 2011 and is estimated to be around USD 93.20 million in 2024 and grow at a CAGR of 5.71% to reach USD 123.01 million by 2029. 

The emerging guidelines for use of Probiotics include:

➢ Probiotics must be administered on an empty stomach.

➢Heat-dried formulations be kept at 4 °C, & lyophilized forms can be kept at room temp.

➢A probiotic is administered 1 or 2 times a day & the dosage 1 to 10 billion (108–109) CFUs.

➢ For patients who take antibiotics, the dosing time must be separated with an interval of two hours between them 

The future of probiotic foods is promising, as modern young consumers are making all-out efforts for personal health & expect their diet to be healthy & prevent illness.

References

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Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.

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Bernard Terkimbi Utoo

This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.

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Prof Sherif W Mansour

Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.

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Hao Jiang

As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.

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Dr Shiming Tang

Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.

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Raed Mualem

International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.

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Andreas Filippaios

Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.

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Dr Suramya Dhamija

Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.

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Bruno Chauffert

I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!

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Baheci Selen

"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".

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Jesus Simal-Gandara

I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.

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Douglas Miyazaki

We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.

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Dr Griffith

I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.

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Dr Tong Ming Liu

I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.

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Husain Taha Radhi

I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.

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S Munshi

Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.

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Tania Munoz

“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.

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George Varvatsoulias

Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.

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Rui Tao

Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.

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Khurram Arshad

Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.

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Gomez Barriga Maria Dolores

The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.

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Lin Shaw Chin

Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.

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Maria Dolores Gomez Barriga

Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.

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Dr Maria Dolores Gomez Barriga

Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.

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Dr Maria Regina Penchyna Nieto

Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.

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Dr Marcelo Flavio Gomes Jardim Filho

Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”

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Zsuzsanna Bene

Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner

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Dr Susan Weiner

My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.

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Lin-Show Chin

My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.

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Sonila Qirko

My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.

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Luiz Sellmann