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//-->Probiotics, prebiotics, and synbiotics—approaching a definition1–3Jürgen Schrezenmeir and Michael de VreseABSTRACTDefinitions of different pro-, pre-, and synbioticssuggested by different investigators are critically discussed. On thebasis of this analysis, the probiotic concept is confined to effectsexerted by viable microorganisms but is applicable independent ofthe site of action and route of administration. It therefore mayinclude sites such as the oral cavity, the intestine, the vagina, andthe skin.Am J Clin Nutr2001;73(suppl):361S–4S.KEY WORDSProbiotic, prebiotic, synbiotic, health claims,definitions, historydescribe “substances secreted by one microorganism which stimu-lates the growth of another” and thus was contrasted with the termantibiotic.It may be because of this positive and general claim ofdefinition that the termprobioticwas subsequently applied to othersubjects and gained a more general meaning. In 1971 Sperti (15)applied the term to tissue extracts that stimulate microbial growth.Parker (16) was the first to use the termprobioticin the sense that itis used today. He defined probiotics as “organisms and substanceswhich contribute to intestinal microbial balance.” Retaining thewordsubstancesin Parker’s definition of probiotics resulted in awide connotation that included antibiotics. In 1989 Fuller (17)attempted to improve Parker’s definition of probiotic with the fol-lowing distinction: “A live microbial feed supplement which bene-ficially affects the host animal by improving its intestinal microbialbalance.” This revised definition emphasizes the requirement of via-bility for probiotics and introduces the aspect of a beneficial effecton the host, which was, according to his definition, an animal. In1992 Havenaar et al (18) broadened the definition of probiotics withrespect to host and habitat of the microflora as follows: “A viablemono- or mixed culture of microorganisms which applied to animalor man, beneficially affects the host by improving the properties ofthe indigenous microflora.” Salminen (19) and Schaafsma (20)broadened the definition of probiotics even further by no longer lim-iting the proposed health effects to influences on the indigenousmicroflora. According to Salminen, a probiotic is “a live microbialculture or cultured dairy product which beneficially influences thehealth and nutrition of the host.” According to Schaafsma, “Oralprobiotics are living microorganisms which upon ingestion in cer-tain numbers, exert health effects beyond inherent basic nutrition.”There are 2 aspects in Salminen’s definition that in our opinionneed revision. First, the definition given by Salminen includes bene-ficial influences on “nutrition of the host” in addition to health effects.It is not clear what the termnutritionshould imply in this context,which would not be covered by the termhealth.In our opinion, majoreffects on nutrition also imply effects on health, whereas minor alter-ations are of no relevance to the definition “for life.” Therefore, thetermnutritionmight be best omitted from the definition.In contrast with previous definitions, Salminen’s definition (19)considers cultured dairy products and microbial cultures to beFrom the Institute of Physiology and Biochemistry of Nutrition, FederalDairy Research Center, Kiel, Germany.2Presented at the symposium Probiotics and Prebiotics, held in Kiel, Ger-many, June 11–12, 1998.3Address correspondence to J Schrezenmeir, Institute of Physiology andBiochemistry of Nutrition, Federal Dairy Research Center, Hermann-Weigmann-Straße 1, D-24103 Kiel, Germany. E-mail: schrezenmeir@bafm.de.1Downloaded fromajcn.nutrition.orgby guest on November 23, 2014HISTORY OF HEALTH CLAIMSThere is a long history of health claims concerning livingmicroorganisms in food, particularly lactic acid bacteria. In a Per-sian version of the Old Testament (Genesis 18:8) it states that“Abraham owed his longevity to the consumption of sour milk.”In 76 BC the Roman historian Plinius recommended the adminis-tration of fermented milk products for treating gastroenteritis (1).Since the advent of the microbiology era, some investigators [eg,Carre (2), Tissier (3), and Metchnikoff (4)] attributed such healtheffects to shifts of the intestinal microbial balance. Metchnikoff(4) claimed that the intake of yogurt containing lactobacilliresults in a reduction of toxin-producing bacteria in the gut andthat this increases the longevity of the host. Tissier (3) recom-mended the administration of bifidobacteria to infants sufferingfrom diarrhea, claiming that bifidobacteria supersede the putre-factive bacteria that cause the disease (3). He showed that bifi-dobacteria were predominant in the gut flora of breast-fed infants.Indeed Rettger et al (5, 6) and Kopeloff (7) showed thatLacto-bacillus acidophilusmay survive in the human gut but the “Bulgar-ian bacillus” did not. Attempts to implant non–lactic acid bacteriasuch asEscherichia colifor “causal fighting against pathologicalintestinal flora” were undertaken by Nissle (8) in 1916.The significant role of the intestinal microflora for resistanceto disease was shown by Bohnhoff et al (9), Freter (10–12), andCollins and Carter (13). Oral administration of antibiotics tomice rendered the animals more susceptible to infection withSalmonella typhimurium, Shigella flexneri,andVibrio cholerae.Thus,≤1 101Salmonellae enteritidiswere sufficient to killgerm-free guinea pigs, whereas 1 109bacteria were required tokill animals with complete intestinal microflora.HISTORY OF THE TERMPROBIOTICThe termprobiotic,meaning “for life,” is derived from the Greeklanguage. It was first used by Lilly and Stillwell (14) in 1965 toAm J Clin Nutr2001;73(suppl):361S–4S. Printed in USA. © 2001 American Society for Clinical Nutrition361S362SSCHREZENMEIR AND DE VRESEin large numbers such that the microorganisms can be culturedregularly from various regions. If these definitions were used,“improving the properties of the indigenous microflora” wouldunnecessarily confine the definition of probiotics. The positiveeffect of lactobacilli on the infection outcome by pathogenicbacteria (28–32) could be called probiotic only if the effect isachieved beyond implantation of the administrated bacteria ordue to a change in the colonizing indigenous microflora. A directinhibitory effect exerted by bacteria transiently passing throughthe gastrointestinal tract would fail to meet the definition.Because the transient state is the most common condition underwhich probiotics are used, we prefer the expression “microflorain a compartment of the host” to “indigenous microflora.”The above definition confines the probiotic concept to effectsproduced by viable microorganisms but is applicable indepen-dent of the probiotic site of action and the route of administra-tion. Therefore, this definition may include such sites as the oralcavity, the intestine, the vagina, and the skin. In the case of pro-biotic foods, the health effect is usually based on alteration of thegastrointestinal microflora and, therefore, based on survival dur-ing gastrointestinal transit.probiotic. Indeed the matrix of a product may affect the activity ofmicrobes and therefore the survival and effect of the microbes, andthus deserves consideration. However, because nondairy products,(eg, sauerkraut, fermented cereals and other plant-based foods,and salami) may contain viable probiotic microorganisms [eg,Lactobacillus plantarum(21)], the limitation of the definition todairy products is not justified. Furthermore, cultured dairy prod-ucts include products that are cultured and then pasteurized orsterilized, which results in the loss of viable microorganisms. Infact there is evidence for health effects beyond nutritional value ofsuch products, eg, anticarcinogenic and immunomodulatingeffects have been exerted by yogurt fractions and cell-wall com-ponents of lactobacilli and bifidobacteria (22–25).Abandoning the viability of microorganisms or omitting thesurvival of the microbes and their effects on the indigenousmicroflora as prerequisites for the claim probiotic has conse-quences for what may be called probiotic. The definitions givenby Salminen (19) and Schaafsma (20) would include yogurt con-taining usual cultures (StreptococcusthermophilusandLacto-bacillus delbrüecki,subsp.bulgaricus)because these culturesmay compensate for lactase insufficiency in lactose maldigestion(26). This substitution may be even more pronounced when bac-teria that do not survive in the small bowel are ingested andrelease their -galactosidase into the upper intestine. This sub-stitution may as well be achieved by bacteria that have beenkilled by irradiation, which leaves their cell walls intact andtherefore enables protection during gastric transit (26).Downloaded fromajcn.nutrition.orgby guest on November 23, 2014REVISION OF THE DEFINITIONPROBIOTICConsidering the various arguments, particularly the discrimi-nation of usual yogurt cultures and products derived from probi-otic cultures and products, we propose the following definitionas the one that is closest to the definition of the termprobioticgiven by Havenaar and Huis In’t Veld (18): “A preparation of ora product containing viable, defined microorganisms in suffi-cient numbers, which alter the microflora (by implantation orcolonization) in a compartment of the host and by that exert ben-eficial health effects in this host.” Reasons for the revision ofHavenaar and Huis In’t Veld definition are as follows:1)the need to include products in addition to microorganisms,or preparations of microorganisms;2)the requirement of sufficient microbial numbers to exerthealth effects;3)preference for the phrase “alteration of the microflora” over“improving the properties of the…microflora,” because theoptimal properties of the indigenous microflora were notdefined until now and the evidence of benefit can be shownonly by health effects; and4)definition of the termindigenous microflorarefers to “the usu-ally complex mixture of bacterial population that colonizes agiven area in the host that has not been affected by medical orexperimental intervention, or by disease” (27) and use oftocolonizeto describe a bacterial population that establishes insize over time without the need for periodic reintroduction ofthe bacteria by repeated oral doses or other means.Transplantationis considered to have occurred when theadministration of microorganisms results in colonization.Tran-sient invasionis defined as the administration of microorganismsA UNIFYING HYPOTHESIS FOR HEALTH EFFECTS?The health effects attributed to the use of probiotics are numer-ous. The following outcomes are well documented:1)lower frequencyand duration of diarrhea associated with antibiotics (Clostridiumdif-ficile),rotavirus infection, chemotherapy, and, to a lesser extent,traveler’s diarrhea;2)stimulation of humoral and cellular immu-nity; and3)decrease in unfavorable metabolites, eg, amonium andprocancerogenic enzymes in the colon. There is some evidence ofhealth effects through the use of probiotics for the following:reduction ofHelicobacter pyloriinfection;reduction of allergic symptoms;relief from constipation;relief from irritable bowel syndrome;beneficial effects on mineral metabolism, particularly bonedensity and stability;6)cancer prevention; and7)reduction of cholesterol and triacylglycerol plasma concen-trations (weak evidence).These numerous effects can hardly be explained by a unifyinghypothesis that is based on a single quality or mechanism andremains valid for all microorganisms exerting one or the othereffect mentioned above.1)2)3)4)5)STRAIN CHARACTERISTICS AND HABITATSPECIFICITIESDifferent strains of probiotic bacteria may exert differenteffects based on specific capabilities and enzymatic activities,even within one species (33, 34).Different microorganisms express habitat preferences thatmay differ in various host species (27). Lactobacilli are amongthe indigenous flora colonizing the chicken’s crop, the stomachof mice and rats, and the lower ileum in man. Bacteria coloniz-ing such high-transit-rate sites must adhere firmly to themucosal epithelium (35–37) and must adapt to the milieu of thisadhesion site. The competition for adhesion receptors betweenDEFINITION OF PROBIOTICprobiotic and pathogenic microorganisms, therefore, is depen-dent on such habitat specifics.On the other hand, bacteria are found in much higher numbersin the colon, particularly in the feces, than are lactobacilli. It isself-evident that effects bound to this luminal site of action maybe exerted even more efficiently by such microorganisms, whichdo not necessarily need to adhere to the mucosa. Moreover, pref-erences for microhabitats have to be considered. Four microhab-itats in the gastrointestinal tract were outlined by Freter (27) asfollows:1)the surface of epitheliums cells;2)the crypts of theileum, cecum, and colon;3)the mucus gel that overlays theepithelium; and4)the lumen of the intestine.As mentioned above, several indigenous, pathogenic, or pro-biotic microorganisms target the surface of the epithelium byspecific adhesion, often mediated by special organelles, eg, fim-briae (37, 38). The crypts are typically colonized by motile, spi-ral-shaped bacteria of the generaBorellia, Treponema, Spirillium(39, 40), and others, eg,H. pylori(41). The mucus layer canform a microbial habitat and can protect the host against colo-nization in some circumstances. As a result of its complex andvarying composition and for technical reasons, its function inthis context is least clarified.The luminal content of bacteria depends greatly on boweltransit. Therefore, the microbial density in the small bowel islow, whereas it is abundant in the lumen of the colon, whichgives space to microorganisms without adhesion molecules.When the great variety of species, strain characteristics, andthe habitat specifics are considered, it becomes clear that a provenprobiotic effect on a one strain or species can not be transferredto other strains or species.DEFINITION OFPREBIOTICThe termprebioticwas introduced by Gibson and Roberfroid(42) who exchanged “pro” for “pre,” which means “before” or “for.”They defined prebiotics as “a non-digestible food ingredient thatbeneficially affects the host by selectively stimulating the growthand/or activity of one or a limited number of bacteria in thecolon.” This definition more or less overlaps with the definitionof dietary fiber, with the exception of its selectivity for certainspecies. This selectivity was shown for bifidobacteria, which maybe promoted by the ingestion of substances such as fruc-tooligosaccharides and inulin (42–44), transgalactosylated oligo-saccharides (45–47), and soybean oligosaccharides (48, 49).DEFINITION OFSYNBIOTICThe termsynbioticis used when a product contains both pro-biotics and prebiotics. Because the word alludes to synergism,this term should be reserved for products in which the prebioticcompound selectively favors the probiotic compound. In thisstrict sense, a product containing oligofructose and probioticbifidobacteria would fulfill the definition, whereas a productcontaining oligofructose and a probioticLactobacillus caseistrain would not. However, one might argue that synergism isattained in vivo by ingestion of lactobacilli on the one hand andpromotion of indigenous bifidobacteria on the other hand.REFERENCES1. Bottazzi V. Food and feed production with microorganisms.Biotechnology 1983;5:315–63.363S2. Carre C. 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