If you knew that the food on your plate was awash with bacteria, would you eat it? At one time the answer would be a resounding no. Nowadays, people are actually ready to pay more to eat food with a healthy dose of bacteria — because these happen to be friendly bacteria or “probiotics”. Foods such as yoghurt, fermented milk, cottage cheese, buttermilk, dhokla, idli, snack bars, energy drinks and even baby food can contain probiotics. And packaged probiotic foods such as Amul Flaavyo (probiotic vitamin fortified flavoured yoghurt), Amul Prolife probiotic Lassi, Nestle Actiplus Dahi, Laloo’s Goat Milk Ice Cream (frozen yoghurt), Attune Granola Bars, Yakult Dairy Drink (fermented milk) and Kashi Vive Cereal are making steady inroads into the Indian market. But the question is: do we really need such probiotic food or is it a fad arising from a marketing gimmick?

“Friendly bacteria are indeed vital for our immune system, digestion and absorption of food and nutrients and they are naturally present in the human gut. However, research on probiotics has not yielded very conclusive results. In patients treated with antibiotics for a pathological condition, probiotics might help replenish beneficial bacteria in the intestine but clinical trials with placebo controls do not indicate any strong statistical significance (of eating probiotic food) in a healthy individual,” says US-based microbiologist Kausiki Datta. In fact, Datta feels the whole probiotic thing has been “extremely hyped by alternative medicine”. “A consumer should find out why and when they need to take probiotics and if at all they need to,”she says.

Each person has a different mix of bacteria in his or her body. Interactions between a person and the micro organisms in his body as well as among the microorganisms themselves, can be crucial to health and well-being. “Just prescribing probiotic food across the board is not scientific,” adds Datta. However, the increased stress and the rampant use of antibiotics these days tend to disrupt the good-bad bacterial balance. Thus probiotic food, which can help correct this balance, is gaining popularity among health conscious consumers.

What consumers might be unaware of is that probiotics has side effects too. “Mild gas or bloating and even serious effects like overstimulation of the immune system, or even gene transfer has been seen in people with a history of unhealthy metabolic activities,” says city-based gastroenterologist Dr Saurabh Sen. “So one has to be careful about consuming such products daily. We usually prescribe probiotic food along with antibiotics, which damage naturally occurring good bacteria in the human gut and bad bacteria begin to dominate, leading to common ailments like flatulence and even diarrhoea. If probiotics are taken in the daily diet — either in the form of probiotic food or as supplements prescribed along with antibiotics — many of these side effects can be warded off.”

A recent report by the National Center for Complementary and Alternative Medicine (NCCAM) and American Society for Microbiology indicates that probiotics can be used to treat diarrhoea, infections of the urinary tract and female genital tract, irritable bowel syndrome, even reduce recurrence of bladder or colon cancer or atopic dermatitis in children, seasonal allergies, sinusitis and bronchitis. The National Institute of Cholera and Enteric Diseases (Niced), Calcutta, has also recently carried out research on more than 3,500 children in the age group of 1- 5 years to evaluate the role of Lactobacillus casei strain Shirota (used in Yakult Dairy Drink) in preventing acute diarrhoea. The results of the study were encouraging, says Dr Sen, with the probiotic playing a significant protective role to prevent acute diarrhoea.

But for probiotics to be of use to consumers, they would need to have a clear idea of the administration schedule, procedure and amount that is needed. But clear information on these points is still not available. Consumer activist Ranita Ray points out that it is not mentioned on the product whether the probiotic bacteria added to the food lose their ability to survive or grow after they pass through the acidic stomach. “Labels do not mention how the probiotics should be administered, as well as the best doses, schedules and the dos and don’ts to be followed. While consumers think they are consuming a certain amount of good bacteria (the number of bacteria present is usually given), in reality a major part of the bacteria might get destroyed by gastric juices and never reach the intestine,” adds Ray.

Dr Neerja Hajela , head, science, at Yakult Danone India, which markets a fermented milk “loaded with 6.5 billion beneficial bacteria”, does not agree with Ray. “Yakult contains the Lactobacillus casei strain Shirota, which has been tested for its tolerance to gastric acid, bile and biliary juices and transits the GI tract to reach the intestine alive and give the desired benefit of building immunity and improving digestion,” she says. “We use probiotic bacteria that can thrive in an acid environment, unlike the bacteria usually seen in traditional dahi and can therefore survive the passage through the acidic stomach, remaining intact in the intestinal tract to provide its beneficial effects,” says Himangshu Manglik of Nestle India, which markets Nestlé Actiplus Probiotic Dahi.

A major problem with probiotic food in India is the lack of correct labelling and guidelines on their storage. Most such products available on supermarket (or chemist shop) shelves do not mention whether the products should be refrigerated or not and even what they actually contain. The guidelines framed by the Indian Council of Medical Research (ICMR) and the Department of Biotechnology (DBT) in 2011 to ensure correct labelling ask that the genus, species and strain of the probiotic bacteria be mentioned on the label, as well as the viable count of bacteria (including level at which it is effective) and storage conditions. Yoghurt and fermented milk, for example, require refrigeration. “But how many probiotic foods have such information on their labels,” asks Ray. Some companies such as Yakult do follow the labelling guidelines and also mention the shelf life as well as the serving size for efficacy but that is more the exception that proves the rule.

Probiotics seem to be good if taken in the right dose at the right time. But it is still not clear how safe such products are for young children, elderly people, and people with compromised immune systems. Research is still in the nascent stage in India. As Manglik says, “Probiotics is a relatively new phenomenon in India and consumers do not understand the benefits fully. This has kept the market relatively small.” Still, brands like Yakult and Amul have seen a 30 per cent year on year growth in sales since the launch of their probiotic products.

Only time will tell if probiotics is another passing fad or a life-changing habit.