5.1 Knowledge of probiotics
5.1.1 Knowledge components of questionnaire
44 CHAPTER 5
DISCUSSION
45 reports from Indonesia (9.2%) and Pakistan (15.1%), as the minority of healthcare professionals in these countries had good knowledge regarding probiotics (Rahmah et al., 2021; Arshad et al., 2021). The incongruity between our report and the previous studies may infer that Malaysian health science students were more aware of probiotics possibly due to great accessibility of probiotics products. It was evidenced by the probiotics market in Malaysia has a better annual growth rate that was driven by economic upswing and surging in consumer buying behaviour (Research and Markets, 2020). Majority of the respondents in current study chosen the correct definition of probiotics (97.7%), natural source of probiotics (99.1%) and probiotics strains (91.4%) that can be used in probiotics production. In addition, majority of the respondents (86.9%) agreed that probiotics can prevent the translocation of enteric bacteria and toxin into systemic circulation through strengthening the intestinal epithelial barrier.
However, more than half of the respondents (58.8%) were not familiar with the application of probiotics in improving skin barrier through reducing TEWL.
This may suggest that the undergraduate students did not learn much about the importance of probiotics in maintaining skin homeostasis through gut-skin axis despite knowing the general information about probiotics and the mechanism of probiotics on intestinal homeostasis. It also underlines the need for more evidence-based instructional and practical materials about the application of probiotics on gut-skin axis. According to O’Neill et al. (2016), intestinal bacteria and gut microbiome metabolites could be translocated to the systemic circulation, accumulate in the skin, and impact epidermal homeostasis. In addition, there was a research demonstrated that the respondents had experienced significant decreased in TEWL and significant increased corneal
46 hydration after ingestion of L. brevis SBC8803 oral supplements for 12 weeks (Ogawa et al., 2016). In addition, Salem et al. (2018) reported that probiotics supplementation may help with the restoration of disrupted intestinal barrier function by increasing the expressions of intestinal epithelial tight junctions and production of SCFAs. Moreover, there was only minority of the respondents (36.2%) believed that probiotics can act as adjuvant therapy in management of inflammatory skin problems. This can imply that most respondents have doubt on the application of probiotic supplementation for the management of skin disorders. Probiotics can help with the recovery of gut microbiota by replenishing the gut’s good microbiome after taking the course of oral antibiotics.
Oral antibiotics are commonly prescribed for patients with inflammatory skin disorder but this approach may result antibiotic resistance and derangement of gut microbiota. According to Kim et al. (2010), a 12-week study of 36 acne patients revealed that using a lactobacillus-containing fermented dairy beverage significantly reduced the total number of acne lesions through markedly decreased in sebum production. Another research also demonstrated that upon administration of L. rhamnosus and B. lactis, the severity of atopic dermatitis was markedly reduced (Manzotti et al., 2014). Notably, there was only minority of the respondents (33.5%) agreed that probiotics has immunomodulatory properties through upregulation of anti-inflammatory cytokines. This may infer that most respondents have not learned about the mechanism of probiotics in regulating host immune response. Research has shown that the application of probiotics can prevent the disturbance of tight junction proteins by lowering the number of lipopolysaccharides (LPSs). Hence, there will be less binding of LPSs with endothelial cells to toll-like receptors (TLR 2, 4), results a decreased of
47 inflammatory markers being released by activated dendritic cells and macrophage cells (Cristofori et al., 2021). Salem et al. (2018) reported that probiotics also help in increasing the number of anti-inflammatory cytokines (IL-10 and TGF-β) and inhibiting the formation of proinflammatory cytokines (IL-4, INFγ and IL-17). Furthermore, there were 67.0% of the respondents disagreed with the false statement, as only probiotics in pharmaceutical dosage form can work effectively in the body. This may suggest that the other half of the respondents might have a myth about probiotics in pharmaceutical dosage form works better than whole foods. However, a systematic review of several studies published in General Psychiatry reported that dietary interventions were more effective in managing anxiety symptoms when compared to consumption of probiotic supplements. The authors suggested that this result may be due to the greater availability of prebiotics found in whole foods that is essential for the growth of probiotics (Yang et al., 2019). Most respondents (84.6%) of this study believed that probiotics should be consumed regularly over a long period, 95.9%
of them also agreed that different species of probiotics provide different health benefits to human. Jung et al. (2013) demonstrated that those acne patients with combined treatment, daily consumption of probiotic supplement and antibiotic for 12 weeks had shown significantly improvement in total lesion count. A research review also evaluated the role of different probiotics strains on skin disease. For example, L. rhamnosus reduces severity of atopic dermatitis, L.
delbrueckii improves acne symptoms and B. longum reduces skin erythema (Lolou and Panayiotidis, 2019). Most respondents (92.8%) have chosen the correct optimal dosage (1 to 30 billion CFU) of probiotics consumption. Until now, there are no exact recommendation on the dosage of probiotic supplements.
48 Nevertheless, most probiotic supplements formulated with 1 to 10 billion CFU per dose, higher dosage does not necessarily show health benefits (National Institutes of Health, 2022).