Det er først i de senere år, at Danmark har fået probiotika på helsehylderne. En fuldstændig fjollet sag mellem fødevarestyrelsen og lægemiddelstyrelsen fik nærmest over en nat gjort mælkesyrebakterier til et lægemiddel – vel at mærke som det eneste land i verden, men nu er de tarmvenlige bakterier igen landet som kosttilskud, og oven i købet, hvor det er muligt at få specifikke produkter til specielle problemstillinger.
Kvaliteten af produkterne er generelt høj, og her får du en gennemgang af de krav, som du skal kunne stille til en producent baseret på Symbioflor +, som er udviklet her i Danmark i et samarbejde mellem Biosym og Danisco. Hele fordøjelseskanalen – fra mundhule til endetarm – er koloniseret af mikroorganismer, dog med en tiltagende koncentration jo længere man når ned i tarmsystemet – størst i tyktarm og endetarm.
I menneskets fordøjelseskanal lever der gennem-snitligt ca. 100.000.000.000.000 – hundredetusind milliarder – bakterier fordelt på over 400 arter. Tarmfloraen kan alene i tyktarmen nå en vægt af mere end et par kilo. De gavnlige (probiotiske) og de sygdoms-fremkaldende (patogene) bakterier lever i en skrøbelig balance, hvor de hele tiden konkurrerer med hinanden om at vedhæfte sig til tarmvæggen og i at formere sig – og gerne på bekostning af nogle andre arter.
Mælkesyre og bakteriociner
De fleste probiotika producerer eddike- og/eller mælkesyre, når de koloniserer tarmen, som sænker tarmmiljøets pH-værdi. En lavere pH-værdi hæmmer væksten af de skadelige mikroorganismer. Probiotika producerer også såkaldte bakteriociner i tarmen, som er proteiner eller kemiske stoffer, der virker hæmmende på skadelige mikroorganismer i tarmmiljøet.
WHO har for nyligt defineret probiotika som:
”Levende mikroorganismer der, når de tilføres i tilstrækkelige mængder, bevirker en gavnlig helbredseffekt på modtageren” Et kvalitetspræparat med probiotika defineres som: ”Et præparat som indeholder levedygtige, veldefinerede mikroorganismer i tilstrækkelige mængder, som ændrer tarmfloraen i gunstig retning, og dermed bevirker en gavnlig helbredseffekt på modtageren”.
Valg af de rette probiotika
Der er seks vigtige egenskaber, som probiotika skal opfylde:
- De skal være resistente over for nedbrydning fra mavesyre og galdesafter, så de når frem til tarmen i levedygtig stand
- De probiotiske stammer skal besidde en effektiv vedhæftningsevne til tarmens slimhinder, så de forhindrer vækst af sygdomsfremkaldende mikroorganismer, som ellers vil hæfte sig på tarmslimhinden
- De skal effektivt og hurtigt kunne formere sig
- De skal effektivt producere antimikrobielle substanser, som bekæmper skadelige (patogene) mikroorganismer i tarmen – en egenskab, som varierer fra stamme til stamme
- De skal beviseligt være sikre at indtage og må ikke have erhvervet antibiotikaresistens
- Deres virkninger skal være veldokumenterede i form af kliniske forsøg af høj kvalitet
- Det er krav, som mange, men ikke alle, produkter kan leve op til.
Alle producenter vælger en sammensætning ud fra de områder af sygdomssegmenter, de gerne vil dække. Nogle vælger at fokusere udelukkende på den såkaldte turistmave med diarre forårsaget af, for den danske krop, ukendte bakterier på fremmede himmelstrøg. Andre vælger at fokusere bredt på de problemstillinger, som en dansk tarm skal tage stilling til, lige fra forstoppelse til diarre og de hyppige vekslende afføringer, som ofte er en del af en tarmkatar, eller blot den helt almindelige oppustethed, fordi vi ikke helt spiser, som vi burde. Producenter, som vælger disse faktorer, har også meget ofte en målsætning om, at produktet skal kunne forebygge en række tilstande, som en dårligt fungerende tarm ellers kan forårsage.
Probiotika påvirker dele af vores immunsystem
For helt at forstå nogle af virkemekanismerne bag probiotika er man nødt til at forstå dele af immunsystemets opbygning. Immunsystemet kontrolleres delvist af cytokiner. Cytokinerne (fx forskellige interleukiner) udskilles af immunsystemets celler og virker som signalstoffer til andre immunceller. Alt efter hvilke cytokiner, der bliver udskilt, kan immunsystemet blive opreguleret eller nedreguleret.
Symbioflor + er et nyt produkt på de danske helsehylder, som Danisco har været med til at sammensætte. Kigger man på det nye produkt, Symbioflor +, indeholder to kapsler: Lactobacillus acidophilus La-14 7,5 mia cfu Bifidobacterium lactis BI-07 1,0 mia cfu Lactobacillus rhamnosus Lr-32 0,5 mia cfu Inulin (FOS) 26 mg (FOS er udvundet af cikoriesyre, som er mad for bakterierne, den såkaldte prebiotika) Kigger man på de tre forskellige stammer, er de kendte for at kunne skabe et gunstigt forhold i tarmene ved at have indflydelse på følgende områder:
La-14 – Lactobacillus acidophilus findes normalt i tarmen, munden og vagina. De er brugt traditionelt til fermenterede mælkeprodukter, f.eks. A38, og bruges i utallige probiotiske produkter og tilskud. Mange studier viser La-14’s evne til at stimulere den del af immunforsvaret (interleukin-12), som har betydning for udvikling af infektioner, allergier eller kræft.
BI-07 – Bifidobakterier er nok den primære grund til, at ammede spædbørn har et bedre immunforsvar end flaskebørn. Bifidobakterier udgør en vigtig del af tarmfloraen gennem hele livet og opfattes som gavnlige for helbredet og er bl.a. vigtige, hvis en antibiotikakur er uundgåelig, og en evt. efterfølgende diarre skal forebygges. BI-07 øger interleukin-10 og interleukin-12 nogenlunde lige meget, hvilket er vigtigt for de samme problemer som beskrevet under La-14, men også for at undgå udviklingen af inflammationer, som især interleukin 10 er ansvarlig for. Man har også set, hvordan både La-14 og BI-07 fremmer det immunforsvar, som skal være klar, hvis der er en akut infektion på vej. De to stammer fremmer antistofferne IgA, IgG og IgM, hvilket er vigtigt i bekæmpelsen af influenza, bakterie-infektioner og til at forebygge allergier, men også til at skabe antistoffer, som ikke kun virker her og nu, men også kan skabe livsvarig immunitet.
Lr32 – Lactobacillus rhamnosus har været at finde i ost i hundrede af år og er en af de mest almindeligt forekommende lactobacilli hos ammede spædbørn. I laborato-rieforsøg har man set, hvordan Lr-32 øger udskillelsen af interleukin-10, hvilket tyder på, at Lr-32 har anti-inflammatoriske egenskaber. Det stemmer godt overens med det, man har set i museforsøg, hvor Lr-32 reducerer colitis symptomer (tarmbetændelse) væsentligt og beskytter mod tarminflammation (R-0091, R-0092). Referencer: R0091: Benoit F. et al; Correlation between in vitro and in vivo immunomodulatory properties of lactic acid bacteria; World J Gastroenterol 2007 January 14; 13(2): 236-243 R0092: Foligne et al; A Key Role of Dendritic Cells in Probiotic Functionality; plosone.org, March 2007, Issue 3, e313.
Ordet probiotika stammer fra græsk og betyder “for livet” i modsætning til antibiotika, som betyder ”mod livet”. Betegnelsen probiotika dækker over en række mikroorganismer med sundhedsfremmende egenskaber, fordi de ved deres tilstedeværelse kan have en gavnlig indflydelse på tarmfloraen.
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