Blackwell Publishing, Ltd.

REVI EW
The nutrition and health benefits of yoghurt
MIC HELLE C MC KIN L E Y*
The Dairy Council, 164 Shaftesbury Avenue, London WC2H 8HL, UK

Yoghurt is one of the most popular fermented milk products worldwide and has gained widespread
consumer acceptance as a healthy food. It provides an array of nutrients in significant amounts, in
relation to its energy and fat content, making it a nutrient-dense food. In particular, yoghurt can provide
the body with significant amounts of calcium in a bioavailable form. Furthermore, yoghurt has many
health benefits beyond the basic nutrition it provides, such as improved lactose tolerance, a possible role
in body weight and fat loss, and a variety of health attributes associated with probiotic bacteria.
Keywords Body weight, Calcium, Gastrointestinal health, Lactose intolerance, Probiotics, Yoghurt.

acceptance as a healthy and nutritious food, has led

*Author for correspondence. E-mail: m.mckinley@dairycouncil.org.uk

I N T RO D U C T I O N
The introduction of fermented milk products into
the diet of man is thought to date back to the dawn
of civilization, as reference is made to them in both
the Bible and the sacred books of Hinduism
(Nakazawa & Hosono 1992). Research from Britain
(Copley et al. 2003) has recently demonstrated the
presence of dairy fat residues in pottery fragments
from Neolithic, Bronze Age and Iron Age settle-
ments, thus indicating that the practice of dairying
existed in Britain as far back as 6500 years ago.
Although it is not certain, it is likely that consump-
tion of fermented or cultured milk products, such
as yoghurt, butter and cheese, also occurred around
this time as they were an effective means of pro-
longing the shelf-life of milk.
Yoghurt is a product of the lactic acid fermenta-
tion of milk by addition of a starter culture contain-
ing Streptococcus thermophilus and Lactobacillus
delbrueckii ssp. bulgaricus. In some countries less
traditional microorganisms, such as Lactobacillus
helveticus and Lactobacillus delbrueckii ssp.
lactis, are sometimes mixed with the starter culture
(Tamime 2002). Although fermented milk products
such as yoghurt were originally developed simply
as a means of preserving the nutrients in milk,
it was soon discovered that, by fermenting with
different microorganisms, an opportunity existed
to develop a wide range of products with different
flavours, textures, consistencies and, more recently,
health attributes. The market now offers a vast
array of yoghurts to suit all palates and meal occa-
*Author for sions. Yoghurts come in a variety of textures (e.g.
correspondence. liquid, set, smooth), fat contents (e.g. luxury, low-
E-mail: info@
fat, virtually fat-free) and flavours (e.g. natural,
dairycouncil.org.uk
fruit, cereal), can be consumed as a snack or part of
© 2005 Society of a meal, as a sweet or savoury food, and are available
Dairy Technology all year-round. This versatility, together with their
to their widespread popularity across all population
subgroups.
Table 1 shows the consumption of yoghurt and
fermented milk products in 10 European countries
according to data collected recently from nearly
36 000 participants in the European Prospective
Investigation into Cancer and Nutrition (EPIC)
study (Hjartåker et al. 2002). The largest con-
sumers are Sweden, France and the Netherlands,
who consume more than twice that of the UK and,
in general, women throughout Europe tend to con-
sume more yoghurt than men. Although the UK
is by no means the biggest yoghurt consumer in
Europe, it still makes a very valuable contribution
to our diet.
N U T R I T I O NA L P RO F I L E
In terms of its nutritional profile, yoghurt has a
similar composition to the milk from which it is
made but will vary somewhat if fruit, cereal or
other components are added (Table 2). Its nutri-
tional similarity with milk means that yoghurt is an
excellent source of protein, calcium, phosphorus,
riboflavin (vitamin B2), thiamin (vitamin B1) and
vitamin B12, and a valuable source of folate, niacin,
magnesium and zinc. The protein it provides is of
high biological value (i.e. it contains all the amino
acids essential to heath), and the vitamins and min-
erals found in milk and dairy foods are bioavailable
(i.e. available for absorption and use by the body).
Milk and dairy products such as yoghurt, par-
ticularly the low-fat varieties, provide an array of
important nutrients in significant amounts in rela-
tion to their energy and fat content, therefore mak-
ing them a nutrient-dense food. Table 3 shows the
contribution that one small pot of yoghurt makes to
the nutrient requirements of various age groups.

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 Vol 58, No 1 February 2005

Table 1 Reported daily consumption of yoghurt and other fermented milk products in 10 European countries obtained
using 24-h dietary recalls (n = 35 955)

Contribution Contribution Contribution

of yoghurt Total dairy of yoghurt and Total dairy of yoghurt and
and fermented intake fermented milk intake fermented milk
Total milk products (g/day) products to total (g/day) products to total
dairy intake to total dairy —men dairy intake —women dairy intake
Country (g/day) intake (%) (n = 13 031) (%)—men (n = 22 924) (%)—women

Greece 189.3 14.8 189.8 13.5 188.7 16.1

Italy 203.6 9.0 206.5 7.4 200.6 10.6
Germany 248.3 17.5 245.2 15.3 251.4 19.7
Norway 288.7 12.6 — — 288.7 12.6
France 290.9 26.1 — — 290.9 26.1
UK 301.5 8.5 301.2 7.5 301.8 9.5
Denmark 325.8 16.4 352.5 13.7 299.1 19.0
Spain 364.9 10.6 332.3 8.9 397.5 12.3
Sweden 370.1 24.0 404.2 21.6 335.9 26.4
the Netherlands 375.3 17.3 369.7 13.9 380.8 20.7

Source: Hjartåker et al. (2002)

Table 2 Nutritional compositiona of common varieties of yoghurt (per serving)

Whole milk, Whole milk, Low-fat, Low-fat, Virtually fat Greek style, Drinking
plain fruit plain fruit free, fruit plain Twinpot yoghurt
Nutrient (150 g) (150 g) (150 g) (150 g) (150 g) (150 g) (175 g) (200 g)

Protein (g) 8.6 6.0 7.2 6.3 7.2 8.6 7.2 6.2
Folate (µg) 27 15 27 24 12 9 23 24
Niacin (mg) 2.3 1.3 1.7 1.7 1.7 2.5 2.0 1.6
Riboflavin (mg) 0.40 0.24 0.33 0.32 0.44 0.20 0.33 0.32
Thiamin (mg) 0.09 0.18 0.18 0.18 0.06 0.18 0.11 0.06
Vitamin B12 (µg) 0.3 0.5 0.5 0.5 0.3 0.3 0 0.4
Calcium (mg) 300 183 243 210 195 189 228 200
Magnesium (mg) 29 20 24 23 20 20 23 22
Phosphorus (mg) 255 144 215 180 165 207 186 162
Zinc (mg) 1.1 0.6 0.9 0.8 0.6 0.8 0.7 0.6

a
Food Standards Agency (2002)

Eating dairy products, such as yoghurt, helps to
improve the overall quality of the diet and increases
the chances of achieving nutritional recommenda-
tions. Research has shown that milk consumption
is positively associated with the likelihood of
children and teenagers achieving the recommended
intakes for vitamin A, folate, vitamin B12, calcium
and magnesium (Ballew et al. 2000). Consuming
extra milk has also been shown to improve the diet
quality of older adults. Researchers assessed the
effects of advising a group of adults to add three
230 mL glasses of milk to their daily food intake.
They reported that, compared to the control group,
the milk group increased their intake of vitamin A,
riboflavin, vitamin B12, vitamin D, calcium, phos-
phorus, potassium, magnesium and zinc (Barr
et al. 2000). Conversely, individuals who consume
diets that exclude milk and dairy products tend to
have poor nutrient intakes, which can affect growth
and bone health. Henriksen et al. (2000) conducted
a study to assess the nutrient intake of children on
cow’s milk-restricted diets. In this study, parents
of 34 children aged 2.5–3 years completed a 4-day
weighed record of their child’s food intake. They
found that children on milk-free diets had signific-
antly lower intakes of energy, fat, protein, niacin,
calcium and riboflavin. Although the use of milk
substitutes improved the nutritional quality of the
milk-free diets to some extent, the recommenda-
tions for riboflavin and calcium were still not met.
The authors of the study concluded that children on
cow’s milk-free diets could be at risk for malnutri-
tion unless precautions were taken to replace the
valuable nutrients from milk in the diet. Further

2 © 2005 Society of Dairy Technology

 Vol 58, No 1 February 2005

2001; Buchowski et al. 2002; Di Stefano et al.

Table 3 Contribution of one pot (150 g) of fruit yoghurt to the daily nutritional needs
2002).
of population subgroups
One of the nutrients that yoghurt and other dairy
Percentage of daily reference products supplies in abundance is calcium, which
nutrient intake (RNI)b is vital for the development and maintenance of
Nutrient content bone health. As illustrated in Table 4, one pot of
per 50 g pot 5-year-old 14-year-old Adult Adult
yoghurt would provide a 5-year-old with 41%
Nutrient yoghurt a girl girl man woman
of their daily calcium requirements and an adult
Protein 6.0 g 31 14 11 13 or teenage girl with about a quarter of their daily
Folate 15.0 µg 15 8 8 8 calcium needs.
Niacin 1.3 mg 12 11 8 10 Milk and dairy foods are rich sources of calcium
Riboflavin 0.24 mg 30 22 14 22 because they contain significant amounts of cal-
Thiamin 0.18 mg 26 26 18 23
cium in a bioavailable form. Although other foods
Vitamin B12 0.5 µg 63 42 33 33
also contain calcium, they may not necessarily be
Calcium 183 mg 41 23 26 26
good sources because their calcium content per
Magnesium 20 mg 17 7 7 7
Phosphorus 144 mg 41 23 26 26
serving is low, or the calcium they provide is not
Zinc 0.6 mg 9 7 6 9 available for absorption and use by the body (i.e.
bioavailable), or as a result of both these factors.
a
Food Standards Agency (2002) Table 4 illustrates this concept; for example, while
b
Department of Health (1991) spinach has a high calcium content on a per serv-
ing basis, its bioavailability is poor, and hence it
would be necessary to eat 11 servings, or 963 g, of
spinach to absorb the same amount of calcium that
studies have also found that dairy avoidance in is available from one small pot of yoghurt.
children is associated with poor nutrient intake,
small stature, impaired growth and poor bone
E F F E C T O N H E A LT H
health (Isolauri et al. 1998; Black et al. 2002;
Christie et al. 2002). Furthermore, lactose intoler- Lactose intolerance
ance is associated with a low calcium intake and Lactose, the main carbohydrate found in milk and
bone mineral density in a variety of age and ethnic dairy products, is a disaccharide sugar composed
groups due to unnecessary avoidance of milk and of two monosaccharides, glucose and galactose,
dairy products (Stallings et al. 1994; Corazza et al. joined together by a condensation reaction. It can
1995; Honkanen et al. 1996; Jackson & Savaiano be hydrolysed in the body by the enzyme lactase

Table 4 Number of servings of selected calcium-containing foods that it would be necessary to consume in order to absorb
the same amount of calcium as that available from one pot of low-fat yoghurt

Number of
Calcium Estimated servings Total quantity
content Fractional absorbable needed to (g) needed
Serving per serving absorption calcium/ equal 150 g to equal 150 g
size (g)a (mg)b (%)c serving (mg) yoghurt yoghurt
Low-fat plain yoghurt 150 243 32.1 78.0 1.0 —
Kidney beans 70 (2 heaped 25.9 17.0 4.4 17.7 1239
(dried, boiled) tablespoons)
Kidney beans (canned) 70 (2 heaped 49.7 17.0 8.5 9.2 644
tablespoons)
Broccoli (boiled) 85 34.0 52.6 17.9 4.4 374
Sprouts (frozen and boiled) 90 26.1 63.8 16.7 4.7 423
Cabbage (boiled) 95 31.4 64.9 20.4 3.8 361
Spinach (boiled) 90 144 5.1 7.3 10.7 963
Watercress (raw) 20 (1/4 bunch) 34 67.0 22.8 3.4 68
Almonds 26 (12 whole) 62.4 21.2 13.2 5.9 153

Source: Adapted from Weaver and Plawecki (1994)

a
Ministry of Agriculture, Fisheries & Food (1993). Serving size shown equates to a medium portion unless otherwise
indicated
b
Food Standards Agency (2002)
c
Weaver and Plawecki (1994)

© 2005 Society of Dairy Technology 3

 Vol 58, No 1 February 2005
(β-galactosidase) and the resultant simple sugars
can then be absorbed in the small intestine and
used as fuel by the body. Lactose maldigestion is
difficulty in digesting the disaccharide lactose due
to insufficient amounts of the enzyme lactase. If
lactose passes into the large intestine undigested,
it can be fermented by the colonic microflora,
causing adverse gastrointestinal symptoms in
some individuals, such as flatulence, diarrhoea
and abdominal pain. This is known as lactose
intolerance, that is the occurrence of symptoms
after persons with clinically diagnosed lactose
maldigestion consume a trigger amount of lactose
(British Nutrition Foundation 2002).
Research has shown that lactose in yoghurt is
tolerated better by individuals with hypolactasia
than an equivalent quantity in milk (Gallagher et al.
1974; Kolars et al. 1984; McDonagh et al. 1987;
Dewit et al. 1988; Marteau et al. 1990a; Rosado
et al. 1992). Various explanations have been put
forward in an attempt to explain this phenomenon.
The presence of live bacteria in the yoghurt was
thought to be important (Gilliland & Kim 1984;
Savaiano et al. 1984; Lerebours et al. 1989). Some
studies, however, have failed to find any difference
in the tolerance of heat-treated vs. fresh yoghurt
containing live bacteria (Marteau et al. 1990a;
Savaiano et al. 1984; Hove et al. 1999). Similarly,
it has been proposed that the bacterial enzyme
β-galactosidase, which partly resists luminal
hydrolysis and can be detected in the duodenum
and terminal ileum after yoghurt consumption, is
available to hydrolyse lactose and therefore results in
improved tolerance (Kolars et al. 1984; McDonagh
et al. 1987; Pochart et al. 1989; Marteau et al.
1990b; Martini et al. 1991). β-Galactosidase is an
intracellular enzyme and so will remain active as
long as the cell wall of the bacteria (whether viable
or nonviable) remains intact. This theory is,
however, confounded by the results of a study that
found no difference in digestion and tolerance to
lactose following ingestion of three fermented
dairy products that had a fourfold difference in
their β-galactosidase activity (Vesa et al. 1996).
These results suggest that factors in addition to
lactase (β-galactosidase) activity may be contribut-
ing to the improved lactose tolerance associated
with yoghurt. For example, the different viscosity
of yoghurt compared to milk may result in slower
gastric emptying and thus a longer transit through
the gastrointestinal tract, which, in turn, may
improve the absorption and reduce the lactose load
in the colon (Vesa et al. 1996).
Whatever the explanation, the science consist-
ently shows that yoghurt is well tolerated by indi-
viduals who have lactose intolerance. As lactose
maldigestion or intolerance is associated with a
low calcium intake and bone mineral density, prob-
ably because of the unnecessary exclusion of milk
4 © 2005 Society of Dairy Technology
and dairy from the diet (Stallings et al. 1994;
Corazza et al. 1995; Honkanen et al. 1996; Jackson
& Savaiano 2001; Buchowski et al. 2002; Di
Stefano et al. 2002), there is a clear need to better
educate and inform individuals with this condition
that the complete avoidance of dairy products is
not usually necessary. Research shows that milk
with meals, hard cheese and yoghurt are well toler-
ated (Johnson et al. 1993; Suarez et al. 1995, 1997,
1998; Pribila et al. 2000), and so calcium intake
need not be compromised.
Weight control
Obesity is an increasing public health problem
in the UK, with one in five adults now classed as
obese (National Audit Office 2001). Fears about
weight gain are often cited as a reason to cut down
on the consumption of milk and dairy products.
However, there is little evidence to suggest that the
consumption of milk and dairy products leads to
excess weight gain and an emerging body of evid-
ence suggests that this may even be counterpro-
ductive. Preliminary research from in vitro animal
and human studies suggests that consumption of
milk and dairy products may help to encourage
weight, and fat, loss as part of a calorie-controlled
diet.
Numerous observational studies in adults (Davies
et al. 2000; Lin et al. 2000; Zemel et al. 2000;
Periera et al. 2002; Jacqmain et al. 2003; Teegarden
2003; Zemel 2003a), children and adolescents
(Carruth & Skinner 2001; Novotny et al. 2003;
Skinner et al. 2003) have demonstrated a signific-
ant inverse relationship between calcium, or dairy
consumption, and both body weight and body fat.
For example, a longitudinal study of infants who
were followed until they were 8 years old (Skinner
et al. 2003) found that a higher dietary calcium
intake from calcium-rich foods like milk, cheese
and yoghurt was associated with a lower percent-
age of body fat.
To date, two randomized controlled trials have
been published in this area, one in abstract form
(Zemel et al. 2003, 2004). In one of the studies
(Zemel et al. 2004), 32 healthy but obese subjects
were maintained for 24 weeks on low-energy diets
(500 kcal /day deficit) and randomized to either the
control group (0–1 serving dairy/day + 400–500 mg
supplemental calcium /day), the high calcium group
(control diet + 800 mg supplemental calcium/day)
or the high dairy group (3–4 servings low-fat dairy
foods/day, providing a total calcium intake of
1200–1300 mg/day). The weight loss was 6.4%,
8.6% and 10.9% for the control, high calcium and
high dairy regimens, respectively; corresponding
figures for fat loss in the trunk region were 19%,
50.1% and 66.2%, respectively. In the other study,
Zemel et al. (2003) randomly assigned 34 healthy
but obese women to receive 1100 mg calcium/day
Vol 58, No 1 February 2005
(in the form of three servings of fat-free yoghurt)
or 500 mg calcium/day, both groups following
a calorie-controlled diet. After 12 weeks, the
researchers found that the yoghurt group lost 22%
more weight (average loss 13 lb), 61% more body
fat and 81% more trunkal fat than the group of
dieters who simply reduced calories.
The results of both these studies indicate that
calcium appears to help weight and fat loss, in addi-
tion to calorie restriction, and increase percentage
fat loss from the trunk region. They also indicate
that dairy products, such as yoghurt, appear to exert
a substantially greater effect on both fat loss and fat
distribution compared to an equivalent amount of
supplemental calcium.
Various mechanisms to explain this effect have
been proposed and are discussed in detail in several
review papers (Parikh & Yanovski 2003; Zemel
2003a,b). In vitro and animal studies have shown
that intracellular calcium levels play a pivotal
role in fat metabolism. High blood parathyroid
hormone (PTH) and 1,25-dihydroxyvitamin D levels,
such as those that result from a low-calcium intake,
have been shown to stimulate the influx of calcium
into human adipocytes in cell culture experiments.
This, in turn, switches the cell metabolism from
lipolysis to lipogenesis, so that fat is stored rather
than burnt (Zemel 2003a,b). Keeping concentra-
tions of calcitrophic hormones low, by increasing
calcium intake, should therefore lower intradipocyte
calcium concentration and switch cell metabolism
in the opposite direction, that is decreased lipogen-
esis and increased lipolysis.
Obesity is recognized as a multifactorial disease
and, consequently, various strategies are needed
to address the problem. While it is unlikely that
ensuring an adequate intake of dairy foods will
prove to be the magic bullet that solves the prob-
lem, this emerging research indicates that such a
strategy may make an important contribution to
an individual’s ability to control their body weight
when undertaken in combination with other dietary
measures and adequate physical activity. Further
research is urgently required in this area.
Probiotics
Professor Elie Metchnikoff, Director of the Pasteur
Institute, was one of the first to propose that
yoghurt had beneficial health effects because of the
bacteria it contained. In 1907 he postulated that
the bacteria involved in yoghurt fermentation,
Lactobacillus delbrueckii ssp. bulgaricus and Stre-
ptococcus thermophilus, suppressed putrefactive-
type fermentations by the intestinal flora, and
that the consumption of these yoghurts played a
role in maintaining health and prolonging life
(Metchnikoff 1907).
Since then, nutritional approaches to disease
prevention have become a priority for consumers,
© 2005 Society of Dairy Technology
and the demand for products that have benefits
beyond the basic nutrition they provide has driven
an explosion in the market for functional foods.
Fermented dairy products account for the majority
of the European functional food market (Stanton
et al. 2001). They have the ability to support the
viability of probiotic cultures and thus provide a
suitable vehicle for their delivery into the body
(Stanton et al. 2002) and are easily incorporated
into the diet.
Numerous definitions exist for ‘probiotics’
(Sanders 2003). For example, they are commonly
defined as ‘living microorganisms, which upon
ingestion in certain numbers, exert health benefits
beyond inherent basic nutrition’ (Guarner &
Schaafsma 1998); and, more recently, as ‘viable
nonpathogenic microorganisms which, when
ingested, exert a positive influence on host health
or physiology’ (Schrezenmeir & de Vrese 2001).
Whatever the exact definition, there is general
agreement regarding the key selection criteria for
use of probiotic cultures in human food, that is
they are generally of human origin, considered
nonpathogenic, acid and bile tolerant, have the
ability to withstand technological processes (e.g.
food production), remain viable during their shelf-
life period and exert beneficial health effects
(Shortt 1999). In order to be effective, therefore,
probiotic bacteria must not only be present in a
viable form and in sufficient numbers at the time
of consumption but also be able to survive passage
through the harsh conditions of the gastrointestinal
tract so that they reach their target site in live form.
Furthermore, on arrival at their target site they
need to be able to colonize the target area. Probiotic
bacteria will be at a distinct advantage if they can
compete for substrates effectively, be versatile in
terms of the substrates they use, use substrates
efficiently, have the ability of adhere to the gut
epithelium and possibly also the ability to produce
bacteriocins (such as short-chain fatty acids,
hydrogen peroxide and antimicrobial peptides)
that adversely affect the growth of certain bacteria
already in the gut (Fooks & Gibson 2002). The bac-
teria already inhabiting the gut are highly adapted
to their environment and so represent tough com-
petition for the incoming bacteria.
The key concept underlying the proposed health
benefits of probiotics is that the gut microflora
plays an important role in resistance to disease and
promotes normal intestinal function (Salminen et al.
1998). It is thought that factors such as changing
lifestyles, changing dietary patterns, increasing
stress and antibiotic consumption all have a harm-
ful effect on the balance of the gut microflora,
causing a shift away from potentially beneficial
or health-promoting microorganisms, such as the
lactobacilli and bifidobacteria, towards an increase
in harmful or pathogenic microorganisms (Fooks
5
 Vol 58, No 1 February 2005
Table 5 Potential health benefits of probiotics
Shortened duration of rotavirus diarrhoea
Reduced incidence and severity of traveller’s diarrhoea
Reduced incidence of antibiotic-associated diarrhoea
Reduced incidence of radiation-induced diarrhoea
Relief of symptoms of lactose intolerance
Immune modulation
Fewer relapses, reduced use of steroids and improved quality of life in association with
inflammatory bowel disease
Fewer relapses in association with chronic pouchitis
Reduced incidence and mortality from necrotizing enterocolitis
Reduction of symptoms associated with irritable bowel syndrome
Alleviation of constipation
Reduced Helicobacter pylori colonization and inflammation
Reduced faecal enzyme activity (which may reduce levels of carcinogens in the
faeces)
Reduced recurrence of superficial bladder cancer
Enhancement of effect of radiotherapy on cervical cancer
Reduced incidence nasal allergy
Reduced severity atopic dermatitis
Reduced prevalence atopic disease
Reduction in total and low density lipoprotein (LDL) cholesterol
Reduction in systolic and diastolic blood pressure
Reduced incidence urinary infections
Reduced episodes of bacterial vaginosis
Reduced vaginal Candida infection rate
Reduced symptoms and recurrence vaginitis and cystitis
Reduced recurrence of otitis media
Alteration of gut flora influencing oxalate degradation and thus kidney
stone formation
Prevention of small bowel bacterial overgrowth
Reduced recurrence of chronic recurrent hypertrophic sinusitis
Inhibition of endotoxin-producing intestinal microflora associated with alcoholic
liver disease
Reduced cariogenicity
Source: Ouwehand et al. (2003); Sanders (2003)
& Gibson 2002). This, in turn, is thought to predis-
pose to a number of clinical diseases such as bowel
cancer and inflammatory bowel disease and also
to make the host more susceptible to infections
(Fooks & Gibson 2002). It has been suggested
that under such conditions, probiotics can exert a
positive effect on health by redressing the balance
of health-promoting and pathogenic bacteria in the
gastrointestinal tract.
The microorganisms most commonly used as
probiotics are lactic acid bacteria such as Lacto-
bacilli (e.g. L. acidophilus, L. casei, L. rhamnosus,
L. reuteri, L. plantarum) and Bifidobacteria (e.g.
B. longum, B. bifidum, B. breve and B. infantis)
(Fooks & Gibson 2002), which are both found
naturally in the gut. The array of health benefits
potentially attributable to probiotics is vast (see
Table 5) and it is beyond the scope of this paper to
discuss each of them in turn. Many excellent review
papers have been published in this area (de Roos
& Katan 2000; Meydani & Ha 2000; Marteau
6 © 2005 Society of Dairy Technology
et al. 2001, 2002; Isolauri et al. 2002; Shanahan
2002; Feagan 2003; Floch 2003; Goossens et al. 2003;
Ouwehand et al. 2003; Sanders 2003), and this
article simply gives a brief overview of some selected
health effects.
Diarrhoea
From time to time, the balance of the intestinal flora
can be disturbed by pathogenic bacteria, viruses
and antibiotics, often resulting in diarrhoea. The
treatment of diarrhoea has traditionally been one
of the main application areas for probiotics. Best
documented evidence exists for the shortening of
rotavirus diarrhoea in children by selected probiotic
strains such as L. rhamnosus GG (Guandalini et al.
2000), L. reuteri (Shornikova et al. 1997), L. casei
Shirota (Sugita & Togawa 1994), L. acidophilus
LB (Simakachorn et al. 2000), B. bifidum and
S. thermophilus (Saavedra et al. 1994), L. delbrueckii
ssp. bulgaricus and S. thermophilus (Boudraa et al.
2001), and Bacillus coagulans (Chandra 2002).
In addition, prevention and treatment of antibiotic-
associated diarrhoea appears to be feasible for
selected probiotic strains including L. acidophilus,
L. delbrueckii ssp. bulgaricus and B. longum, with
good evidence for Enterococcus faecium SF68,
L. rhamnosus GG and Saccharomyces boulardii
(Marteau et al. 2001, 2002). Many of the trials in
this area to date have, however, been poorly con-
trolled and used low numbers of subjects. Further
well-designed studies are therefore needed. In the
interim, it may be prudent to attempt prophylaxis
via probiotics in vulnerable groups such as elderly
people.
For traveller’s diarrhoea it is less clear whether
probiotics can reduce the incidence. A few trials
using L. rhamnosus GG (Oksanen et al. 1990;
Hilton et al. 1997) and S. boulardii (von Kollaritsch
et al. 1993) have suggested a potential for prevent-
ive efficacy, but more are required before such an
approach can be medically recommended.
Immunologic effects
The immune system is an important contributor to
diseases such as cancer, infection, gastrointestinal
disorders, allergy and asthma. Many sections of the
population may be immunocompromised, such
as infants, the elderly, surgical patients, trauma
victims, people under stress and HIV-positive indi-
viduals. The intestine is the body’s largest immune
organ and probiotics therefore present an opportun-
ity to influence the response of the immune system
to foreign antigens. The results of human studies
indicate that yoghurt consumption can increase
cytokine production, phagocytic activity, antibody
production, T-cell function and natural killer
cell activity, and there is some evidence that this
yoghurt-induced immune enhancement is associ-
ated with a lowered incidence of conditions such as
Vol 58, No 1 February 2005
cancer, gastrointestinal disorders and allergic symp-
toms (Meydani & Ha 2000; Isolauri et al. 2002).
Inflammatory bowel disease
The term inflammatory bowel disease (IBD)
encompasses disorders such as Crohn’s disease,
ulcerative colitis and pouchitis. These disorders
are characterized by chronic or recurrent intestinal
inflammation and, while their exact aetiology is
unknown, the main theory is that IBD may result
from abnormal host responses to some members of
the intestinal flora or from a defective mucosal bar-
rier in genetically susceptible individuals (Ruseler
van Embden et al. 1994; Sartor 1995; Marteau
et al. 2001). Current therapy for IBD involves
suppression or modulation of the host immuno-
inflammatory response with corticosteroids to
induce remission, or surgery to remove the dis-
eased section of the bowel. It does not, however,
address the contribution of the intestinal microflora
to the pathogenesis (Shanahan 2002), which is an
area where a probiotic intervention may prove
beneficial. In theory, probiotics have the potential
to interrupt immuno-inflammatory responses
induced by commensal bacteria that may be
responsible for damage to the intestinal mucosa
(Guarner et al. 2002).
Several well-designed trials of probiotic therapy
in human subjects with various IBD-related
conditions have been published. Some experts in
the field believe that the evidence is now strong
enough to prescribe VSL#3, a mixture of four strains
of lactobacilli (L. casei, L. plantarum, L. acidophilus
and L. delbrueckii ssp. bulgaricus), three strains
of bifidobacteria (B. longum, B. breve, B. infantis)
and one strain of S. thermophilus for pouchitis;
Esherichia coli Nissle 1917 (a nonpathogenic
E. coli) for ulcerative colitis; and S. boulardii (a
nonpathogenic yeast) for Crohn’s disease (Marteau
et al. 2002).
Three double-blind randomized-controlled trials
have found treatment with the probiotic E. coli
Nissle 1917 to be as effective as the standard drug
treatment mesalazine for maintaining remission
in ulcerative colitis (Kruis et al. 1997, 2001;
Rembacken et al. 1999). A recent randomized con-
trolled study examined the effect of supplementa-
tion with 100 mL bifidobacteria-fermented milk
daily for 1 year as a dietary adjunct in the treatment
of ulcerative colitis. Exacerbation of symptoms
was seen in 27% of the bifidobacteria fermented
milk group compared to 90% of controls. The
authors concluded that probiotic supplementation
was successful in maintaining remission and had
possible preventive effects on the relapse of ulcer-
ative colitis (Ishikawa et al. 2002). The probiotic
cocktail VSL#3 has been shown to be highly
effective in maintaining remission in patients with
chronic relapsing pouchitis (Gionchetti et al. 2000;
© 2005 Society of Dairy Technology
Mimura et al. 2004) and for the prophylaxis of
pouchitis in patients who had ileo-pouch anal
anastomosis for ulcerative colitis (Gionchetti et al.
2003). If other investigators replicate this finding,
it will radically change current clinical practice in
relation to maintenance therapy for patients with
ulcerative colitis (Shanahan 2002). Promising
results have also been obtained in Crohn’s disease
with a variety of probiotics including S. boulardii
(Guslandi et al. 2000), VSL#3 (Campieri et al.
2000) and E. coli Nissle 1917. All were associated
with a reduced rate of relapse when used as a
replacement for (Campieri et al. 2000), or dietary
adjunct to (Guslandi et al. 2000), mesalazine, or
when compared to a placebo (Malchow 1997).
Further well-designed intervention trials inves-
tigating the therapeutic potential of probiotics in
IBD are currently under way in Europe (Abbott
2004).
Irritable bowel disease
Irritable bowel syndrome (IBS) is a gastrointestinal
condition characterized by abdominal pain, bloat-
ing, excessive flatus, constipation and diarrhoea.
The type and severity of symptoms experienced
varies widely between individuals and, in general,
the condition is poorly understood. No test currently
exists for IBS; therefore it can only be diagnosed
by excluding the presence of other gastrointestinal
anomalies.
The gut microflora is thought to contribute to
the development of IBS because microbiological
studies indicate that IBS sufferers have irregular-
ities in their colonic microflora, such as lower
numbers of coliforms, lactobacilli and bifidobacteria,
compared with healthy individuals (Madden &
Hunter 2002). Irrespective of whether this change
in microflora is a cause of IBS, or simply a symp-
tom of the condition, the quantitative changes in
bacterial species suggest that a probiotic approach
may be beneficial.
To date, there have been few studies involving
probiotics and IBS, possibly because IBS sufferers
are a very diverse group and are therefore difficult
to study. The studies that have been conducted so
far have produced conflicting results. For example,
Halpern et al. (1996) demonstrated a statistically
significant difference in clinically defined gastro-
intestinal function of IBS patients who were given
an antidiarrhoeal drug containing L. acidophilus
compared with patients who received a placebo. A
symptomatic improvement was observed in 19 out
of 28 patients with high volume diarrhoea follow-
ing administration of Enterococcus faecium PR88
(Hunter et al. 1996). Likewise, some trials using
L. plantarum 299v have resulted in symptomatic
improvements (Niedzielin et al. 2001; Nobaek
et al. 2000), but not all studies using this probiotic
organism have proved successful (Sen et al. 2001).
7
 Vol 58, No 1 February 2005
The role of L. rhamnosus GG was studied in
a randomized, double-blind, placebo-controlled,
cross-over trial (O’Sullivan & O’Morain 2000) of
24 patients with IBS. Nineteen patients completed
the study but there was no significant difference in
pain, urgency or bloating between the two groups.
There was, however, a reduction in diarrhoea in the
probiotic group.
Although the use of probiotics in the treatment
of IBS is currently not justified, more research in
this area is certainly warranted because abnormal-
ities seen in the colonic microflora of IBS suggest
that a probiotic approach will ultimately be justi-
fied (Madden & Hunter 2002).
THE FUTURE
There is likely to be further growth and innovation
in the yoghurt sector of the dairy market on
the basis of taste, for example new products in
the children, luxury and smoothie sectors and the
introduction of new and more exotic flavours to
keep consumers interested. In terms of nutrition
and health, an area with massive growth potential
because of its appeal to the health-conscious
consumer is the functional yoghurt sector. Market
growth in this sector will be driven by the science,
as all health claims made in relation to these foods
will need to be thoroughly substantiated. It is likely
that emphasis will be placed on target-specific
products containing well-characterized bacteria
with specific health-enhancing characteristics.
Another potential growth area for the functional
dairy sector developments is the concept of pre-
biotics and synbiotics.
The term ‘prebiotic’ was introduced in 1995
(Gibson & Roberfroid 1995). Prebiotics are defined
as ‘nondigestible food ingredients that beneficially
effect the host by selectively stimulating the growth
and/or activity of one or a limited number of bac-
teria in the colon’. The most likely prebiotics are
nondigestible carbohydrates, such as oligosaccha-
rides (MacFarlane & Cummings 1999). For example,
fructo-oligosaccharides and inulin, found prim-
arily in onions, chicory, garlic, leeks and artichokes,
are frequently studied and have been shown to
selectively stimulate the growth of bifidobacteria
(Hidaka et al. 1986; Gibson & Roberfroid 1995;
Gibson et al. 1995).
The prebiotic concept has largely been devel-
oped because the viability of live probiotic bac-
teria, both in food products and during their transit
through the gastrointestinal tract, can be variable.
This has given rise to the development of syn-
biotics: ‘mixtures of pro- and prebiotics that benefi-
cially affect the host by improving the survival and
implantation of live microbial dietary supplements
in the gastrointestinal tract’ (Gibson & Roberfroid
1995). A natural symbiotic partnership could be a
8 © 2005 Society of Dairy Technology
fructo-oligosaccharide with bifidobacteria. In
theory, the end result of administering a synbiotic
would be improved survival and colonization of the
probiotic and, in turn, increasing health benefits
(Fooks & Gibson 2002).
Finally, an exciting proposition is that probiotic
bacteria could be genetically modified and used
as drug-delivery vehicles, expressing vaccines,
enzymes, antimicrobials or therapeutic proteins
within specific target areas of the gastrointestinal
tract. In theory, microorganisms can be genetically
engineered to produce almost any protein, which,
in turn, could be used therapeutically if it could
reach the appropriate target in the body. There is
already some evidence that this type of therapy
could be feasible. Steidler et al. (2000) demon-
strated a therapeutic benefit in animal models of
colitis using a bacterium genetically engineered
to secrete the inflammatory cytokine interleukin-
10 (IL-10). IL-10 is a potent immune modulator,
capable of dampening down excessive immune
reactions. A version of this genetically modified
bacterium that includes safety features to prevent
the escape of the inserted gene into the environ-
ment has been developed for humans (Steidler
et al. 2003). The first human trial investigating the
potential of a genetically engineered bacterium as
a therapeutic agent will take place in Amsterdam
(Abbott 2004). Researchers hope that the engineered
bacterium will deliver a steady stream of IL-10
directly to the gut wall and so suppress the abnormal
immune response associated with inflammatory
bowel disease.
REFERENCES
Abbott A (2004) Gut reaction. Nature 427 284–286.
Ballew C, Kuesters S and Gillespie C (2000) Beverage choices
affect adequacy of children’s nutrient intakes. Archives
of Pediatrics and Adolescent Medicine 154 1148–
1152.
Barr S I, McCarron D A, Heaney R P, Dawson-Hughes B,
Berga S L, Stern J S and Oparil S (2000) Effects of
increased consumption of fluid milk on energy and nutri-
ent intake, body weight, and cardiovascular risk factors in
healthy older adults. Journal of the American Dietetic
Association 100 810–817.
Black R E, Williams S M, Jones I E and Goulding A (2002)
Children who avoid drinking cow milk have low dietary
calcium intakes and poor bone health. American Journal
of Clinical Nutrition 76 675–680.
Boudraa G, Benbouabdellah M, Hachelaf W, Boisset M,
Desjeux J-F and Touhami M (2001) Effect of feeding
yoghurt versus milk in children with acute diarrhea and
carbohydrate malabsorption. Journal of Pediatric Gastro-
enterology and Nutrition 33 307–313.
British Nutrition Foundation (2002) Enzyme defects and food
intolerance. In Adverse Reactions to Food, pp 104–111.
Buttriss J, ed. Oxford: Blackwell Science.
Buchowski M S, Semenya J and Johnson A O (2002) Dietary
calcium intake in lactose maldigesting intolerant and
Vol 58, No 1 February 2005
tolerant African-American women. Journal of the American
College of Nutrition 21 47–54.
Campieri M, Rizzello F, Venturi A, Poggioli G, Ugolini F,
Helwig U, Amadini C, Romboli E and Gionchetti P
(2000) Combination of antibiotic and probiotic treatment
is efficacious in prophylaxis of post-operative recurrence
of Crohn’s disease: a randomized controlled study vs
mesalamine. Gastroenterology 118 G4179 (abstract).
Carruth B R and Skinner J D (2001) The role of dietary
calcium and other nutrients in moderating body fat in pre-
school children. International Journal of Obesity 25 559–
566.
Chandra R K (2002) Effect of Lactobacillus on the incidence
and severity of acute rotavirus diarrhoea in infants. A pro-
spective placebo-controlled double-blind study. Nutrition
Research 22 65–69.
Christie L, Hine R J, Parker J G and Burks W (2002) Food
allergies in children affect nutrient intake and growth.
Journal of the American Dietetic Association 102 1648–
1651.
Copley M S, Berstan R, Dudd S N, Docherty G, Mukherjee A J,
Straker V, Payne S and Evershed R P (2003) Direct
chemical evidence for widespread dairying in prehistoric
Britain. Proceedings of the National Academy of Sciences
of the United States of America 100 1524–1529.
Corazza G R, Benati G, DiSario A, Tarozzi C, Strocchi A,
Passeri M and Gasbarrini G (1995) Lactose intolerance
and bone mass in postmenopausal Italian women. British
Journal of Nutrition 73 479–487.
Davies K M, Heaney R P, Recker R R, Lappe J M, Barger-
Lux M J, Rafferty K and Hinders S (2000) Calcium intake
and body weight. Journal of Clinical Endocrinology and
Metabolism 85 4635–4638.
Department of Health (1991) Dietary Reference Values for
Food Energy and Nutrients for the United Kingdom:
Report of the Panel on Dietary Reference Values. Report
on Health Social Subjects 41. Committee on Medical
Aspects of Food Policy. London: HMSO.
de Roos N M and Katan M B (2000) Effects of probiotic
bacteria on diarrhea, lipid metabolism, and carcinogenesis:
a review of papers published between 1988 and 1998.
American Journal of Clinical Nutrition 71 405–411.
Dewit O, Pochart P and Desjeux J F (1988) Breath hydrogen
concentration after lactose, milk, fresh or heated yoghurt
ingestion by healthy young adults with or without lactose
malabsorption. Nutrition 4 131–135.
Di Stefano M, Veneto G, Malservisi S, Cecchetti L, Minguzzi L,
Strocchi A and Croazza G R (2002) Lactose malabsorp-
tion and intolerance and peak bone mass. Gastroenterology
122 1793–1799.
Feagan B G (2003) Maintenance therapy for inflammatory
bowel disease. American Journal of Gastroenterology 98
S6–S17.
Floch M H (2003) Probiotics, irritable bowel syndrome, and
inflammatory bowel disease. Current Treatment Options
in Gastroenterology 6 283–288.
Food Standards Agency (2002) McCance and Widdowson’s
the Composition of Foods, Sixth Summary Edition.
Cambridge: Royal Society of Chemistry.
Fooks L J and Gibson G R (2002) Probiotics as modulators of
the gut flora. British Journal of Nutrition 88 S39–S49.
Gallagher C R, Mollesson A L and Caldwell J H (1974)
Lactose intolerance and fermented dairy products. Journal
of the American Dietetic Association 65 418–419.
© 2005 Society of Dairy Technology
Gibson G R and Roberfroid M B (1995) Dietary modulation
of the human colonic microbiota. Introducing the concept
of prebiotics. Journal of Nutrition 125 1401–1412.
Gibson G R, Beatty E R, Wang X and Cummings J H (1995)
Selective stimulation of bifidobacteria in the human colon
by oligofructose and inulin. Gastroenterology 108 975–
982.
Gilliland S E and Kim H (1984) Effect of viable starter culture
bacteria in yoghurt on lactose utilization in humans. Jour-
nal of Dairy Science 67 1–6.
Gionchetti P, Rizzello F, Venturi A, Brigidi P, Matteuzzi D,
Bazzocchi G, Poggioli G, Miglioli M and Campieri M
(2000) Oral bacteriotherapy as maintenance treatment in
patients with chronic pouchitis: a double-blind, placebo
controlled trial. Gastroenterology 119 305–309.
Gionchetti P, Rizzello F, Helwig U, Venturi A, Lammers K M,
Brigidi P, Vitali B, Poggioli G, Miglioli M and Campieri M
(2003) Prophylaxis of pouchitis onset with probiotic
therapy: a double-blind, placebo controlled trial. Gastro-
enterology 124 1202–1209.
Goossens D, Jonkers D, Stobberingh E, van der Bogaard A,
Russel M and Stockbrugger R (2003) Probiotics in
gastroenterology: indications and future perspectives.
Scandinavian Journal of Gastroenterology Supplement
239 15–23.
Guandalini S, Pensabene L, Zikri M A, Dias J A, Casali L G,
Hoekstra H, Kolacek S, Massar K, Micetic-Turk D,
Papadopoulou A, de Sousa J S, Sandhu B, Szajewska H
and Weizman Z (2000) Lactobacillus GG administered in
oral rehydration solution to children with acute diarrhea:
a multicenter European trial. Journal of Pediatric Gastro-
enterology and Nutrition 30 54–60.
Guarner F and Schaafsma G J (1998) Probiotics. Inter-
national Journal of Food Microbiology 39 237–238.
Guarner F, Casellas F, Borruel N, Antolin M, Videla S,
Vilaseca J and Malagelada J-R (2002) Role of microecology
in chronic inflammatory bowel diseases. European Journal
of Clinical Nutrition 56 S34–S38.
Guslandi M, Mezzi G, Sorghi M and Testoni P A (2000)
Saccharomyces boulardii in maintenance treatment of
Crohn’s disease. Digestive Disease and Science 45 1462–
1464.
Halpern G M, Prindiville T, Blankenburg M, Hsia T and
Gershwin M E (1996) Treatment of irritable bowel syn-
drome with Lacteol Fort: a randomised, double-blind,
cross-over trial. American Journal of Gastroenterology 91
1579–1585.
Henriksen C, Eggesbø M, Halvorsen R and Botten (2000)
Nutrient intake among two-year-old children on cows’
milk-restricted diets. Acta Paediatrica 89 272–278.
Hidaka H, Eida T and Takizawa Teta I (1986) Effects of
fructooligosaccharides on intestinal flora and human
health. Bifidobacteria Microflora 5 37–50.
Hilton E, Kolakowski P, Singer C and Smith M (1997)
Efficacy of Lactobacillus GG as a diarrheal preventive in
travellers. Journal of Travel Medicine 4 41–43.
Hjartåker A, Lagiou A, Slimani N, Lund E, Chirlaque M D,
Vasilopoulou E, Zavitsanos X, Berrino F, Sacerdote C,
Ocké M C, Peeters P H M, Engeset D, Skeie G, Aller A,
Amiano P, Berglund G, Nilsson S, McTaggart A, Spencer
E A, Overad K, Tjønneland A, Clavel-Chapelon F,
Linseisen J, Schulz M, Hemon B and Riboli E (2002)
Consumption of dairy products in the European Pro-
spective Investigation into Cancer and Nutrition (EPIC)
9
 Vol 58, No 1 February 2005
cohort: data from 35 955 24-hour dietary recalls in 10
European countries. Public Health Nutrition 5 1259–
1271.
Honkanen R, Pulkkinen P, Jarvinen R, Kroger H, Lindstedt
K, Tuppurainen M and Uusitupa M (1996) Does lactose
intolerance predispose to low bone density? A population-
based study of perimenopausal Finnish women. Bone 19
23–28.
Hove H, Nrgaard H and Mortensen P B (1999) Lactic acid
bacteria and the human gastrointestinal tract. European
Journal of Clinical Nutrition 53 339–350.
Hunter J O, Lee A J, King T S, Barratt M E J, Linggood M A
and Blades J A (1996) Enterococcus faecium strain PR88—
an effective probiotic. Gut 38(Suppl 1) A62 (abstract).
Ishikawa H, Akedo I, Umesaki Y, Tanaka R, Imaoka A and
Otani T (2002) Randomized controlled trial of the effect
of bifidobacteria-fermented milk on ulcerative colitis.
Journal of the American College of Nutrition 22 56–63.
Isolauri E, Sutas Y, Salo M K, Isosomppi R and Kaila M
(1998) Elimination diet in cow’s milk allergy: risk for
impaired growth in young children. Journal of Pediatrics
132 1004–1009.
Isolauri E, Kirjavainen P V and Salminen (2002) Probiotics:
a role in the treatment of intestinal infection and inflam-
mation? Gut 50(Suppl 3) iii54–iii59.
Jackson K A and Savaiano D A (2001) Lactose maldigestion,
calcium intake and osteoporosis in African-, Asian-, and
Hispanic-Americans. Journal of the American College of
Nutrition 20 198S–207S.
Jacqmain M, Doucet E, Després J-P, Bouchard C and
Tremblay A (2003) Calcium intake, body composition,
and lipoprotein-lipid concentrations in adults. American
Journal of Clinical Nutrition 77 1448–1452.
Johnson A O, Semenya J G, Bucjowski M S, Enwonwu C O
and Scrimshaw N S (1993) Correlation of lactose maldi-
gestion, lactose intolerance, and milk intolerance. American
Journal of Clinical Nutrition 57 399–401.
Kolars J C, Levitt M D, Aouji M and Savaiano D A (1984)
Yoghurt—an autodigesting source of lactose. New
England Journal of Medicine 310 1–3.
Kruis W, Schultz E, Fric P, Fixa B, Judmaier G and Stolte M
(1997) Double-blind comparison of an oral Esherichia
coli preparation and mesalazine in maintaining remission
of ulcerative colitis. Alimentary Pharmacology and Ther-
apeutics 1 853–858.
Kruis W, Fric P and Stolte M (2001) Maintenance of
remission in ulcerative colitis is equally effective with
Esherichia coli Nissle 1997 and with standard mesalamine.
Gastroenterology 120 A139 (abstract).
Lerebours E, Ndam C N, Lavoine A, Hellot M F, Antoine J M
and Colin R (1989) Yoghurt and fermented-then-pasteurized
milk: effects of short-term and long-term ingestion on
lactose absorption and mucosal lactase activity in
lactase-deficient subjects. American Journal of Clinical
Nutrition 49 823–827.
Lin Y C, Lyle R M, McCabe L D, McCabe G P, Weaver C M
and Teegarden D (2000) Dairy calcium is related to
changes in body composition during a two-year exercise
intervention in young women. Journal of the American
College of Nutrition 19 754–760.
MacFarlane G T and Cummings J H (1999) Probiotics and
prebiotics: can regulating the activities of intestinal
bacteria benefit health? British Medical Journal 318
999–1003.
10 © 2005 Society of Dairy Technology
Madden J A J and Hunter A O (2002) A review of the role of
the gut microflora in irritable bowel syndrome and the effects
of probiotics. British Journal of Nutrition 88 S67–S72.
Malchow H A (1997) Crohn’s disease and Esherichia coli. A
new approach in therapy to maintain remission of colonic
Crohn’s disease? Journal of Clinical Gastroenterology 25
653–658.
Marteau P, Flourié B, Pochart P, Chastang C, Desjeux J F and
Rambaud J C (1990a) Effect of the microbial lactase (EC
3.2.1.23) activity in yoghurt on the intestinal absorption
of lactose: an in vivo study in lactase-deficient humans.
British Journal of Nutrition 64 71–79.
Marteau P, Pochart P, Flourié B, Pellier P, Santos L, Desjeux
F and Rambaud J (1990b) Effect of chronic ingestion of a
fermented dairy product containing Lactobacillus acido-
philus and Bifidobacterium bifidum on metabolic activ-
ities of the colonic flora in humans. American Journal of
Clinical Nutrition 52 685–688.
Marteau P R, de Vrese M, Cellier C J and Schrezenmeir J
(2001) Protection from gastrointestinal diseases with the
use of probiotics. American Journal of Clinical Nutrition
73 430S–436S.
Marteau P, Seksik P and Jian R (2002) Probiotics and intesti-
nal health effects: a clinical perspective. British Journal of
Nutrition 88 S51–S57.
Martini MC, Kukielka D and Savaino D A (1991) Lactose
digestion from yoghurt: influence of meal and additional
lactose. American Journal of Clinical Nutrition 53 1253–
1258.
McDonagh F E, Hitchins A D, Wong N P, Well P and
Bodwell C E (1987) Modification of sweet acidophilus
milk to improve the utilisation by lactose intolerant persons.
American Journal of Clinical Nutrition 45 570–574.
Metchnikoff E (1907) Prolongation of Life. London: William
Heinemann.
Meydani S N and Ha W-K (2000) Immunologic effects of
yoghurt. American Journal of Clinical Nutrition 71 861–
872.
Mimura T, Rizzello F, Helwig U, Poggioli G, Schreiber S,
Talbot I C, Nicholls R J, Gionchetti P, Campieri K and
Kamm M A (2004) Once daily high dose probiotic ther-
apy (VSL#3) for maintaining remission in recurrent or
refractory pouchitis. Gut 53 108–114.
Ministry of Agriculture, Fisheries and Food (1993) Food
Portion Sizes, 2nd Edition. London: HMSO.
Nakazawa Y and Hosono A (1992) Fermented milk in the
orient. In Functions of Fermented Milk: Challenges for
the Health Sciences, pp 61–78. Hosono A, ed. London:
Elsevier Science.
National Audit Office (2001) Tackling Obesity in England.
Report by the Controller and Auditor General. HC 220.
London: The Stationery Office.
Niedzielin K, Kordecki H and Birkenfeld B (2001) A con-
trolled, double-blind, randomised study on the efficacy
of Lactobacillus plantarum 299V in patients with irritable
bowel syndrome. European Journal of Gastroenterology
and Hepatology 13 1143–1147.
Nobaek S, Johansson M L, Molin G, Ahrne S and Jeppsson B
(2000) Alteration of intestinal microflora is associated
with reduction in abdominal bloating and pain in patients
with irritable bowel syndrome. American Journal of
Gastroenterology 95 1231–1238.
Novotny R, Acharya S, Grove J S, Daida Y G and Vogt T M
(2003) Higher dairy intake is associated with lower body
Vol 58, No 1 February 2005
fat during adolescence. Federation of American Societies
for Experimental Biology Journal 17 A453.8 (abstract).
O’Sullivan M A and O’Morain C A (2000) Bacterial supple-
mentation in the irritable bowel syndrome. A randomised
double-blind placebo-controlled crossover study. Digest-
ive and Liver Disease 32 294–301.
Oksanen P J, Salminen S, Saxelin M, Hamalainen P, Ihantola-
Vormisto A, Muurasniemi-Isoviita L, Nikkari S, Oksanen
T, Porsti I, Salminen E, Siitonen S, Stuckey H, Toppila A
and Vapaatalo H (1990) Prevention of traveller’s diarrhea
by Lactobacillus GG. Annals of Medicine 22 53–56.
Ouwehand A C, Blanchi Salvadori B, Fondén R, Mogensen
G, Salminen S and Sellars R (2003) Health effects of pro-
biotics and culture-containing dairy products in humans.
Bulletin of the International Dairy Federation 380 4–19.
Parikh S J and Yanovski J A (2003) Calcium intake and adiposity.
American Journal of Clinical Nutrition 77 281–287.
Periera M A, Jacobs D R Jr, Van Horn L, Slattery M L,
Kartashov A I and Ludwig D S (2002) Dairy consump-
tion, obesity, and the insulin resistance syndrome in young
adults: the CARDIA Study. Journal of the American
Medical Association 287 2081–2089.
Pochart P, Bissetti N, Bourlioux P and Desjeux J F (1989)
Effect of daily consumption of fresh or pasteurised yoghurt
in intestinal lactose utilisation in lactose malabsorbers.
Microecology and Therapy 18 105–110.
Pribila B A, Hertzler S R, Martin B R, Weaver C M and
Savaiano D A (2000) Improved lactose digestion and
intolerance among African-American adolescent girls fed
a dairy-rich diet. Journal of the American Dietetic Associ-
ation 100 524–528.
Rembacken B J, Snelling A M, Hawkey P M, Chalmers D M
and Axon A T (1999) Non-pathogenic Esherichia coli
versus mesalazine for the treatment of ulcerative colitis: a
randomised trial. Lancet 354 635–639.
Rosado J L, Solomons N W and Allen L H (1992) Lactose
digestion from unmodified, low-fat and lactose-hydrolysed
yoghurt in adult lactose maldigesters. European Journal
of Clinical Nutrition 46 61–67.
Ruseler van Embden J G H, Schouten W R and van Lieshout
L M C (1994) Pouchitis: result of microbial imbalance?
Gut 35 658–664.
Saavedra J M, Bauman N A, Oung I, Perman J A and
Yolken R H (1994) Feeding of Bifidobacterium bifidum
and Streptococcus thermophilus to infants in hospital for
prevention of diarrhoea and shedding of rotavirus. Lancet
344 1046–1049.
Salminen S, Ouwehand A C and Isolauri E (1998) Clinical
application of probiotic bacteria. International Dairy
Journal 8 563–572.
Sanders M E (2003) Probiotics: considerations for human
health. Nutrition Reviews 61 91–99.
Sartor R B (1995) Current concepts of the etiology and
pathogenesis of ulcerative colitis and Crohn’s disease.
Gastroenterology Clinics of North America 24 475–
507.
Savaiano D A El Anouar A A, Smith D E and Levitt M D
(1984) Lactose malabsorption from yoghurt, pasteurized
yoghurt, sweet acidophilus milk, and cultured milk in
lactase-deficient individuals. American Journal of Clin-
ical Nutrition 40 1219–1223.
Schrezenmeir J and de Vrese M (2001) Probiotics, prebiotics
and synbiotics—approaching a definition. American
Journal of Clinical Nutrition 73 361S–364S.
© 2005 Society of Dairy Technology
Sen S, Mullan M M, Parker T J, Woolner J T, Tarry S A and
Hunter J O (2001) Effect of Lactobacillus plantarum
299v on colonic fermentation and symptoms of irritable
bowel syndrome. Digestive Disease Science 47 2615–
2620.
Shanahan F (2002) Probiotics and inflammatory bowel dis-
ease: from fads and fantasy to facts and future. British
Journal of Nutrition 88 S5–S9.
Shornikova A V, Casas I, Mykkänen H, Salo E and Vesikari T
(1997) Bacteriotherapy with Lactobacillus reuteri in
rotavirus gastroenteritis. The Pediatric Infectious Disease
Journal 16 1103–1107.
Shortt C (1999) The probiotic century: historical and current
perspectives. Trends in Food Science and Technology 10
411–417.
Simakachorn N, Pichaipat V, Rithpornpaisam P, Kongkaew C,
Tongpradit P and Varavithya W (2000) Clinical evaluation
of the addition of lyophilized, heat-killed Lactobacillus
acidophilus LB to oral rehydration therapy in the treatment
of acute diarrhea in children. Journal of Pediatric Gastro-
enterology and Nutrition 30 68–72.
Skinner J D, Bounds W, Carruth B R and Ziegler P (2003)
Longitudinal calcium intake is negatively related to chil-
dren’s body fat indexes. Journal of the American Dietetic
Association 103 1626–1631.
Stallings V A, Oddleifson N W, Negrini B Y, Zemel B S and
Wellens R (1994) Bone mineral content and dietary
calcium intake in children prescribed a low-lactose diet.
Journal of Paediatric Gastroenterology and Nutrition 18
440–445.
Stanton C, Gardiner G, Meehan H, Collins K, Fitzgerald G,
Lynch P B and Ross R P (2001) Market potential for
probiotics. American Journal of Clinical Nutrition 73
S476–S483.
Stanton C, Coakley M, Murphy J J, Fitzgerald G F, Devery R
and Ross R P (2002) Development of dairy-based func-
tional foods. Science des Aliments 22 439–447.
Steidler L, Hans W, Schotte L, Neirynck S, Obermeier F,
Falk W, Fiers W and Remaut E (2000) Treatment of
murine colitis by Lactococcus lactis secreting interleukin-
10. Science 289 1352–1355.
Steidler L, Neirynck S, Huyghebaert N, Snoeck V, Vermiere
A, Goddeeris B, Cox E, Remon J P and Remaut E (2003)
Biological containment of genetically modified Lactococ-
cus lactis for intestinal delivery of human interleukin 10.
Nature Biotechnology 21 785–789.
Suarez F L, Savaiano D A and Levitt M D (1995) A comparison
of symptoms after the consumption of milk or lactose-
hydrolyzed milk by people with self-reported severe
lactose intolerance. New England Journal of Medicine
333 1–4.
Suarez F L, Savaiano D, Arbisi P and Levitt M D (1997)
Tolerance to the daily ingestion of two cups of milk by
individuals claiming lactose intolerance. American Jour-
nal of Clinical Nutrition 65 1502–1506.
Suarez F L, Adshead J, Furne J K and Levitt M D (1998)
Lactose maldigestion is not an impediment to the intake
of 1,500 mg calcium daily as dairy products. American
Journal of Clinical Nutrition 68 1118–1122.
Sugita T and Togawa M (1994) Efficacy of Lactobacillus
preparation biolactis powder in children with rotavirus
enteritis. Japanese Journal of Pediatrics 47 2755–
2762.
Tamime A Y (2002) Fermented milks: a historical food with
11
 Vol 58, No 1 February 2005
modern applications—a review. European Journal of
Clinical Nutrition 56 S2–S15.
Teegarden D (2003) Calcium intake and reduction in weight
or fat mass. Journal of Nutrition 133 249S–251S.
Vesa T H, Marteau P, Zidi S, Pochart P and Rambaud J C
(1996) Digestion and tolerance of lactose from yoghurt
and different semi-solid fermented dairy products con-
taining Lactobacillus acidophilus and bifidobacteria in
lactose maldigesters. Is bacterial lactase important?
European Journal of Clinical Nutrition 50 730–733.
von Kollaritsch H, Holst H and Grobara P and Wiedermann G
(1993) Prevention of traveler’s diarrhea with Saccharomyces
boulardii. Results of a placebo controlled double-blind
study. Forstchritte der Medizin 111 153–156.
Weaver C M and Plawecki K L (1994) Dietary calcium:
adequacy of a vegetarian diet. American Journal of
Clinical Nutrition 59 1238S–41S.
12 © 2005 Society of Dairy Technology
Zemel M B (2003a) Role of dietary calcium and dairy prod-
ucts in modulating adiposity. Lipids 38 139–146.
Zemel M B (2003b) Mechanisms of dairy modulation of
adiposity. Journal of Nutrition 133 252S–256S.
Zemel M B, Shi H, Greer B, DiRienzo D and Zemel P (2000)
Regulation of adiposity by dietary calcium. Federation of
American Societies for Experimental Biology Journal 14
1132–1138.
Zemel M B, Richards J D, Russell S M, Milstead A M and
Gebhardt L P (2003) Dairy (yoghurt) augments fat loss
and reduces central adiposity during energy restriction in
obese subjects. Federation of American Societies for
Experimental Biology Journal 17 A1088 (Abstract).
Zemel M B, Thompson W, Milstead A, Morris K and
Campbell P (2004) Calcium and dairy acceleration of
weight and fat loss during energy restriction in obese
adults. Obesity Research 12 582–590.