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NUTRACEUTICAL PAPER

EFFECTIVITY OF YAKULT TO TREAT CONSTIPATION IN

PHARMACY FACULTY OF SANATA DHARMA UNIVERSITYS

STUDENT

Disusun Oleh:

Bonaventura Sukintoko Pramudyo NIM: 118114006

Maria Patrisia Triyasary Nala NIM: 118114007

Marselinus Alberto Moa NIM: 128114011

Karla Violetta NIM: 128114012

Liliana NIM: 128114026

Vinsensia Septima Ria Yovita NIM: 128114123

FAKULTAS FARMASI

UNIVERSITAS SANATA DHARMA

2014


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Chapter I: Introduction

1. Constipation Case

Constipation

Constipation is a condition in which a person has fewer than three bowel

movements a week or has bowel movements with stools that are hard, dry, and small,

making them painful or difficult to pass. People may feel bloated or have pain in their

abdomenthe area between the chest and hips. Some people think they are constipated if

they do not have a bowel movement every day. Bowel movements may occur three times a

day or three times a week, depending on the person. Most people get constipated at some

point in their lives. Constipation can be acute, which means sudden and lasting a short

time, or chronic, which means lasting a long time, even years. Most constipation is acute

and not dangerous. Understanding the causes, prevention, and treatment of constipation

can help many people take steps to find relief.

Gastro Intestinal tract

The GI tract is a series of hollow organs joined in a long, twisting tube from the

mouth to the anus. The body digests food using the movement of muscles in the GI tract,

along with the release of hormones and enzymes. Organs that make up the GI tract are the

mouth, esophagus, stomach, small intestine, large intestine, which includes the appendix,

cecum, colon, and rectum, and anus. The intestines are sometimes called the bowel. The

last part of the GI tract, called the lower GI tract, consists of the large intestine and anus.

The large intestine absorbs water and any remaining nutrients from partially

digested food passed from the small intestine. The large intestine then changes waste from

liquid to a solid matter called stool. Stool passes from the colon to the rectum. The rectum

is located between the last parts of the coloncalled the sigmoid colonand the anus. Therectum stores stool prior to a bowel movement. During a bowel movement, stool moves

from the rectum to the anus, the opening through which stool leaves the body.

Epidemiology of Constipation

Constipation is one of the most common GI problems in the United States,

affecting an estimated 42 million people, or 15 percent of the population. People of any

age, race, or gender can get constipated. Those reporting constipation most often arewomen, adults ages 65 and older, non-Caucasians, and people in lower socioeconomic


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classes. Constipation is also a common problem during pregnancy, following childbirth or

surgery, or after taking medications to relieve pain from things such as a broken bone,

tooth extraction, or back pain. In 2004, 6.3 million outpatient visits were due to

constipation and 5.3 million prescriptions for constipation medications were written.

Risk Factor of Constipation

Constipation is caused by stool spending too much time in the colon. The colon

absorbs too much water from the stool, making it hard and dry. Hard, dry stool is more

difficult for the muscles of the rectum to push out of the body.

Common factors or disorders that lead to constipation are

diets low in fiber

lack of physical activity

Medications

life changes or daily routine changes

ignoring the urge to have a bowel movement

neurological and metabolic disorders

GI tract problems

functional GI disorders

Diets Low in Fiber

The most common cause of constipation is a diet with too little fiber. Fiber is a

substance in foods that comes from plants. Fiber helps stool stay soft so it moves smoothly

through the colon. Liquids such as water and juice help fiber to be more effective. Older

adults commonly do not get enough fiber in their diets. They may lose interest in eating

because food does not taste the same as it once did, they do not feel hungry as often, they

do not want to cook, or they have problems with chewing or swallowing. These factors

may lead an older adult to choose foods that are quick to make or buy, such as fast foods or

prepared foods, which are often low in fiber.

Lack of Physical Activity

A lack of physical activity can lead to constipation, although scientists do not know

why. For example, constipation often occurs after an accident or during an illness when a

person must stay in bed and cannot exercise. Lack of physical activity is thought to be one

of the reasons constipation is common in older adults.


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Medications

Constipation can also be caused by overuse of over-the-counter laxatives. A

laxative is medication that loosens stool and increases bowel movements. Although people

may feel relief when they use laxatives, they usually must increase the dose over time

because the body grows reliant on laxatives to have a bowel movement. Overuse of

laxatives can decrease the colons natural ability to contract and make constipation worse.

Continued overuse of laxatives can damage nerves, muscles, and tissues in the large

intestine.

Life Changes or Daily Routine Changes

During pregnancy, women may be constipated because of hormonal changes or

because the uterus compresses the intestine. Aging can affect bowel regularity, because of

a gradual loss of nerves stimulating the muscles in the colon, which results in less intestinal

activity. People can also become constipated while traveling, because their normal diet and

daily routine are disrupted.

Ignoring the Urge to Have a Bowel Movement

People who ignore the urge to have a bowel movement may eventually stop feeling

the need to have one, which can lead to constipation. Some people delay having a bowel

movement because they do not want to use toilets outside their home, particularly public

restrooms, or they feel they are too busy.

Neurological and Metabolic Disorders

Neurological disorder which is caused by an accident or genetic dissability can lead

to constipaton because neuron that is stimulating colons muscle doesnt work as well as

normal peoples. Metabolic disorder can be caused by an accident or genetic disability,

this situation can lead to constipation because metabolic which help to disgest food cannot

digest the food as well as usual.

GI (Gastro-Intestine) Problems

People with GI problem can have constipation. For example someone who lack of

good microbacteri (probiotic) in their colon cannot having poops regularly because natural

microbe in our body help us to rot foods dregs so it can become fesses.

Functional GI Disorders

GI disorders causedby accident, infection of bad microbe, or gens disability. The

GI organ thats not normal cannot digest food as well as normal GI or even cannot digest


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food at all so the patient must have implant or transplantation GIs organ. Disability to

digest food by the broken GI organ can cause constipation.

Constipation Treatment

Treatment for constipation depends on the cause, severity, and duration of the

constipation and may include one or more of the following:

changes in eating, diet, and nutrition

exercise and lifestyle changes

medication

First-line treatments for constipation include changes in eating, diet, and nutrition;

exercise and lifestyle changes; and laxatives. People who do not respond to these first-line

treatments should talk with their health care provider about other treatments.

Eating, Diet, and Nutrition

The Academy of Nutrition and Dietetics recommends consuming 20 to 35 grams of

fiber a day for adults. People often eat too many refined and processed foods from which

the natural fiber has been removed. A health care provider can help plan a diet with the

appropriate amount of fiber. A list of high-fiber foods is shown below. People prone to

constipation should limit foods that have little or no fiber, such as ice cream, cheese, meat,

and processed foods.

Drinking water and other liquids, such as probiotic drinks or supplements, fruit and

vegetable juices and clear soups, may make fiber in the diet more effective in normalizing

bowel function and maintaining regularity. A health care provider can give advice about

how much a person should drink each day based on the persons health and activity level

and where the person lives.

Exercise and Lifestyle Changes

Engaging in daily exercise can help people with constipation. Another strategy is to

try to have a bowel movement at the same time each day. The best time is 15 to 45 minutes

after breakfast because eating helps stimulate the colon. People with constipation should

reserve enough time to have a bowel movement and be sure not to ignore the urge to have

a bowel movement.

Medication

When a medication is causing constipation, the health care provider may suggest

the person stop taking the medication or switch to a different medication. Laxative


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medications and enemas may be recommended for people who have made diet and

lifestyle changes and are still constipated. Laxatives taken by mouth are available in liquid,

tablet, powder, and granule forms.

2. Probiotic Agents

Probiotics

Probiotics are live microorganisms which when administered inadequate amounts

confer a health benefit on the host and help maintain the natural balance of microflora in

the intestines. The normal human digestive tract contains about 400 types of probiotic

bacteria that reduce the growth of harmful bacteria and promote a healthy digestive system.

Probiotics commonly are isolated from human and animal intestinal tracts. Dead

bacteria, products derived from bacteria, or end products of bacterial growth also may

impart certain benefits, but these derivatives are not considered to be probiotics because

they are not alive when administered. Native bacteria are not probiotics until the bacteria

are isolated, purified, and proved to have a health benefit when administered. Probiotics

have been studied for both human and animal applications. Key microbial species used as

human probiotics are listed in Table 1. Worldwide, a diverse array of probiotic products is

on the market. Yogurt is perhaps the most common probiotic-carrying food, but the market

has expanded beyond yogurt. Cheese, fermented and unfermented milks, juices, smoothies,

cereal, nutrition bars, and infant/toddler formula all are food vehicles for probiotic

delivery. In addition to being sold as foods, probiotics are sold as dietary supplements,

medical foods, and drugs (although there are no probiotics currently sold as drugs in the

United States). Often these products are composed of concentrated, dried microbes

packaged into capsules, tablets, or sachets. This format is convenient for the delivery of

large numbers of microbes that, if manufactured and stored properly, can be quite stable

even at room temperature.


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Figure 1. genus and species microbes

Probiotic Market

The concept of probiotics (which means, for life) was introduced in early 20th

century by Elie Metschnikoff, it however gained momentum only recently with

considerable and significant advances in functional and health food market across the

world. India is also fast emerging as a potential market for probiotics in food. The global

probiotic market generated US $15.9 billion in 2008 and is expected to be worth US$ 32.6

billion by 2014 with a compound annual growth rate of 12.6% from 2009 to 2014.


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3. Nutraceutical Product : Yakult as probiotic

Yakult History

In 1930 Dr. Minoru Shirota, a Japanese scientist, was the first in the world to

isolate and culture a probiotic strain which reached the intestines alive in large numbers

and imparted health benefits to the host. He used this strain to make Yakult, a fermented

milk drink, so as to reach the benefits of the strain to people at large. Yakult was first

launched in Japan in 1935, and today with over 75 years of history, Yakult is a global

leader in the probiotic drinks market with the wide range of probiotic products using

Lactobacillus casei strain Shirota (LcS) and Bifidobacterium breve. The flagship product

Yakult contains over 6.5 billion beneficial bacteria (Lactobacillus casei strain Shirota)

which have proven health benefits. It helps improve intestinal function and build

immunity. It has been scientifically proven to be safe and effective.

Prevention is better than Cure - Emphasis should be placed on Prevention rather than Cure.

Healthy Intestine leads to a long life - Human beings absorb nutrients through their

intestine. Making the intestine strong leads a healthy and long life.

A price that anyone can afford - The goal of providing as many people as possible with

easy access toLactobacillus casei strain Shirota which protects the intestine.

Figure 2. Shirotaism

Epidemiology of Yakult


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Figure 3. Epidemiology of Yakult

Yakults global presence :

1.

Asia : Taiwan, Hongkong, Thailand, Korea, Philippines, Singapore, Vietnam,

Brunei, Indonesia, Malaysia, India, China, Japan.

2. Europe : France, Spain, Netherlands, Belgium, Luxemburg, UK, Ireland, Germany,

Austria, Italy.

3. America : USA, Canada, Mexico, Belize, Argentina, Brazil, Uruguay.

4.

Oceania : Australia, New Zealand.

Science behind Yakult

1. Fermented milk containing Lactobacillus casei strain Shirota reduces incidence of

hard or lumpy stools in healthy population.

The objective of the present study was to investigate the efficacy of fermented milk

containing Lactobacillus casei strain Shirota (LcS) in a healthy population. Healthy

subjects with Bristol Stool Form Scale (BS) score < 3.0 were randomized to fermentedmilk treatment for 3 weeks or non-intervention control. The primary endpoint was the

proportion of subjects that produced hard or lumpy stools (HLS) = 25% of bowel

movements (H-HLS). Secondary endpoints included changes in BS score, constipation-

related symptom scores and stool parameters. Efficacy was analyzed in 39 subjects. After 3

weeks of treatment the proportion of H-HLS subjects had significantly decreased from

73.7% to 36.8%, whereas in the control group the proportion had increased from 75.0% to

85.0% during the same period (P = 0.002). The BS score was significantly improved after


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the treatment compared with the control (P < 0.001). In conclusion, daily consumption of

fermented milk containing LcS reduced the incidence of HLS (Sakai, et al., 2011).

2. Effects of a probiotic fermented milk beverage containing Lactobacillus casei strain

Shirotaon defecation frequency, intestinal microbiota and the intestinal environment of

healthy individuals with soft stools.

The effects of drinking a fermented milk beverage that contains Lactobacillus casei

strain Shirota (LcS) at 40 billion bacterial cells/bottle for 4 weeks (probiotics, 1 bottle/day)

on defecation frequency, intestinal microbiota and the intestinal environment of healthy

individuals with soft stools were evaluated. Thirty-four healthy adults who had soft stools

were randomised into 2 groups, and the effects of a regular 4-week intake of probiotics

were evaluated by a placebo-controlled, double-blind, parallel-group comparative design.

Defecation frequency significantly decreased after the 4-week intake period compared with

before the probiotic treatment. The stool quality significantly improved (hardened)

compared to the placebo. Also, the water content of the stools was lower in the probiotic

group than in the placebo group. Live LcS was recovered at 6.9 1.3 and 7.2 0.8 log

(10) CFU per 1g of stool after 2 and 4 weeks, respectively, of probiotic treatment. The

number of bifidobacteria in the stools also increased significantly compared with the level

before starting the probiotics. The organic acid levels (total, acetic acid, propionic acid,

and butyric acid) significantly increased compared with the level before intake in both the

probiotic and placebo groups, but they returned to the original levels after the end of the

intake period. These results suggest that probiotic fermented milk beverage has an

intestine-conditioning effect by improving the frequency of defecation and stool quality

and increasing the intrinsic bifidobacteria in healthy individuals with soft stool

(Matsumoto, et al., 2010).


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Chapter II: Description of Case related to Nutraceutical Product

In the modern era, the problem of constipation often experienced by people around

the world. Community tend to prefer eating foods that are practical, fast, does not require a

long process to cook, so do not waste too much time to work or on the move. This makes,

people around the world tend to eat unhealthy foods and without the fiber that will have an

impact on the incidence of constipation problems. Many ways in which the community

when experiencing constipation or to prevent the occurrence of constipation, for example

to increase the intake of foods rich in fiber, consume probiotic beverages and lifestyle

changes to exercise regularly.

In that case we lift, we tried to find out how effective the yakult product as

probiotic drink can prevent or treat constipation problems often experienced by people. As

we all know, Yakult probiotic drink became the best-selling products all over the world

because they are cheap and widely thought that yakult is very effective to overcome the

problems related to constipation. Community sometimes drink yakult to aid digestion and

prevent or treat constipation. There are also people who are regularly drinking yakult every

day.

In this simple study, we use the respondent is pharmacy students of Sanata Dharma

University. We chose pharmacy student of Sanata Dharma University as respondents

because most students often experience constipation due to lack of attention to daily food

intake, which is essential cheap and satiety. We take the questionnaire data at the

University of Sanata Dharma over the practicality and ease as there are in the same

university environment making it easier to obtain the data. We distributed questionnaires to

several students to answer three questions in the questionnaire. Questions in the

questionnaire include:

1. If you experience constipation, Do you drink yakult or not to resolve it? Give a

mark on one of the two options the following answer:

o Yes

o No

2. If you drink yakult, how effective, Yakult can resolve your constipation? Give a

mark on one of the following 4 possible answers:o Effective


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o Not Effective

3. If you do not drink yakult, What do you eat to resolve your constipation?

Chapter III: Result and Discusion

Research of yakults effectifity in Constipation involving 173 (responden) in

Sanata Dharma university student. The research is done by giving questioner to 173

respondent with 3 prime questions that consist of:

1.

If you experience constipation, Do you drink yakult or not to resolve it? Give a mark

on one of the two options the following answer:o Yes

o No

2. If you drink yakult, how effective, Yakult can resolve your constipation? Give a

mark on one of the following 4 possible answers:

o Effective

o Not Effective

3. If you do not drink yakult, What do you eat to resolve your constipation?

If respondent choose Yes in the 1st questions, then the respondent must

continue to the second questions and respondent also can answer the third questions but is

not ( wajib) ( only if there is another alternative to treat the constipation). If respondent

choose No in the first questions, so the respondent must answer the third question.

The result is:

Table 1. Result of the Questioners ( E: effective and NE: Not Effective)

Question

s

YES NO E NE ANSWER SU

M

1 61 112 173

2 32 29 61

Fruit (Pepaya, Banana) 62

Medicine (Dulcolax,

Analgesik)

17


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Figure 4. Ratio of respondent yhat consume Yakult and dont consume yakult for

constipation

64.74%

35.26%

Ratio of Respondent That Consume Yakult and Don't

Consume Yakult for Constipation

No

Yes

3

Fibre (Tempe, Tahu) 4

Vegetable 23

Water 20

Vegeta 16

Herbal Medicine (Jamu,

diapet)

15

Coffee 4

Milk, Yogurt 8

Adam sari 1

Consume Nothing 3

Not Answering 0


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Figure 5. The effectivity of yakult to treat constipation

Figure 6. Other alternative to Treat Constipation

From 173 respondent thats engaged in this research, the ones that consume

yakult when they have constipation is 61 people and the one that dont consume yakult

when they have constipation is 112 people. From the respondent that consume yakult when

they have constipation, 32 people answer question number 2 with effective, while the 29

people answer with not effective. The third questions in the questioner is answered as in

figure 6.

52.46%

47.54%

The Effectivity of Yakult to Treat Constipation

E

NE

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

Fruit(pepaya,

Medicine

Fibre

Vegetable

Water

Vegeta

Herbalmedicine

Coffee

Milk,Yogurt

AdamSari

Consumenothing

Noanswer

Other Alternative to Treat Constipation

Other Alternative to Treat

Constipation


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From the analisys of the problem, can be concluded that most of the student in

Sanata Dharma University dont consume yakult to treat constipation. This can be seen

from figure 4, where the ratio of student that consume yakult and dont consume yakult is

35% : 65%. Even so, this doesnt mean that yakult is not effective to treat constipation. In

order to see the effectivity f yakul, we must see figure 5. Repondent that answer

effective is 52,46% and the ones that answer not effective is 47,54%. Even if the one

that answer effectiv e is more than the ones that answer not effective, we cant take a

conclusion that yakult is effective to treat constipation because the different between the

ones that answer effective and not effective can be said as small ( not significant). Because

of that, the conclusion about the effectivity of yakult to treat constipation is fifty-fifty.

Chapter IV: Alternate Solution of Constipation

To solve constipation problem there are some other ways beside consume probiotic

beverages.

The other alternative to solve constipation problem are:

Fruits : manggo, papaya, etc.

Vegetable : spinach, kangkung, etc.

Medicine : microlax

Drink water

Stress management

Dont eat to many dairy product


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Chapter V: Conclusion

From the questioner, the effectivity of Yakult to treat Constipation is fifty-fifty

Other than using probiotiv product to treat constipation, people also can use:

o Fruits : manggo, papaya, etc.

o

Vegetable : spinach, kangkung, etc.

o Medicine : microlax

o Drink water

o Stress management

o Dont eat to many dairy product


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Chapter VI: References

Everhart, J., 2008, The Burden of Digestive Diseases in the United States, National

Institute of Diabetes and Digestive and Kidney Diseases, U.S. Dept. of Health and

Human Services, NIH Publication : 096433.

Higgins, P., Johanson, J., 2004, Epidemiology of constipation in North America: a

systematic review,American Journal of Gastroenterology, 99:750759.Matsumoto, K., et al., 2010, Effects of a probiotic fermented milk beverage containing

Lactobacillus casei strain Shirotaon defecation frequency, intestinal microbiota and

the intestinal environment of healthy individuals with soft stools, Journal of

Bioscience & Bioengineering, doi: 10.1016/j.jbiosc.2010.05.016.

National Digestive Diseases Information Clearinghouse, 2013, Constipation, National

Institute of Health, USA, p.2754.


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Sakai, T., et al, 2011, Fermented milk containing Lactobacillus casei strain Shirota reduces

incidence of hard or lumpy stools in healthy population, International Journal of

Food Sciences and Nutrition, 62(4): 423-430.

Sanders, M., et al., 2007, Probiotics: Their potential to impact human health, CAST Issue

Paper, 36 : 1-2.

Slavin, J., 2008, Position of the American Dietetic Association: Health implications of

dietary fiber,Journal of the American Dietetic Association, 108:17161731.

Toteja, G., 2011, Guidelines for evaluation of probiotics in food, Indian Council of

Medical Research, India, pp.1-2.

WHO, 2002, Guidelines for evaluation of probiotics in food,Report of a Joint FAO/WHO

Working Group on Drafting Guidelines for the Evaluation of Probiotics in Food,

London, Ontario, Canada, April 30 and May 1, 2002.

Yakult, 2014, Yakult, http://yakult.co.in/, diakses tanggal 3 Oktober 2014.

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