Prebiotics

Probiotics are live microorganisms that are found naturally in yogurt and other fermented foods but are also manufactured as capsules to be taken as a daily supplement. The term ‘probiotics’ itself means bacteria with beneficial properties. Probiotics are the third most commonly used dietary supplement among adults in the United States.

The premise behind taking probiotic supplements is to “reset” the guts natural microbiota. The gut is estimated to contain over 35000 bacterial species. The gut microbiota has metabolic, immunological and gut protective functions in a healthy person. Baeteroides thetaiotaomicron is a specific type of bacteria which helps in lipid metabolism as well as protein metabolism. Bacteria of the genus Bacteroides in general have been associated with synthesis of vitamin K and parts of vitamin B in the gut.

Probiotic supplements mostly contain Lactobacillus and Bifidobacterium. Different bacteria can be used to different conditions. Probiotics are mostly used for gut-related conditions like diarrhea or constipation. Studies have shown that Lactobacillus GG can reduce the length of course of infectious diarrhea in infants and children. Probiotics have also been studied for use during antibiotic courses to reduce the incidence of antibiotic-associated diarrhea. Studies have shown that probiotics can reduced antibiotic-associated diarrhea by 60% when compared with placebo. Probiotics may also help with constipation with studies showing that they can increase the number of weekly bowel movements by 1.3 and made stools easier to pass. Probiotics have also been experimented with for maintenance of remission of ulcerative colitis although the benefit is unclear.

References:

Health benefits of taking probiotics. Harvard Health. https://www.health.harvard.edu/vitamins-and-supplements/health-benefits-of-taking-probiotics. Published April 13, 2020. Accessed March 29, 2022.

Jandhyala SM, Talukdar R, Subramanyam C, Vuyyuru H, Sasikala M, Nageshwar Reddy D. Role of the normal gut microbiota. World J Gastroenterol. 2015;21(29):8787-8803. doi:10.3748/wjg.v21.i29.8787

Probiotics: What you need to know. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/probiotics-what-you-need-to-know#:~:text=Probiotics%20are%20live%20microorganisms%20that,dietary%20supplements%2C%20and%20beauty%20products. Accessed March 29, 2022.

Prebiotics

Probiotics are bacteria, and prebiotics are food for these bacteria in the digestive system. Taking prebiotics and probiotics together is called microbiome therapy. Some products contain both prebiotics and probiotics, and this combination is called a symbiotic. It is not necessary to take prebiotics and probiotics together, but together, it may make the probiotics more effective. However, it is found that the use of prebiotics alone is not beneficial.

Prebiotics should be resistant to acidic pH of the stomach, cannot be hydrolyzed by mammalian enzymes and should not be absorbed in the gastrointestinal tract. Also, prebiotics can be fermented by intestinal microbiota, and can selectively stimulate the growth and activity of the intestinal bacteria, which then provides health benefits.

Prebiotics come from different types of carbohydrates. There are two important groups of prebiotics that have beneficial effects: fructo-oligosaccharides and galacto-oligosaccharides. However, humans are not able to digest these. The good bacteria, on the other hand, can digest them, by turning them into short chain fatty acids, including lactic acid, butyric acid and propionic acid. These short chain fatty acids are released into the blood circulation, which affects not only the gastrointestinal tract, but also other distant organs. This provides nutrients that support healthy digestion and immune function.

It is found that prebiotics may have a beneficial effect on irritable bowel syndrome and Crohn’s disease. It may also have protective effects against the risk and progression of colorectal cancer, and help prevent necrotizing enterocolitis. Besides these, it may also help decrease the risk of developing severe allergic skin diseases such as atopic dermatitis, decrease the risk of cardiovascular diseases, and increase immunity functions. It may also enhance calcium absorption and prevent obesity.

Many foods naturally have prebiotics, as they are fiber found in vegetables, fruits and legumes. Some fibers have prebiotic effects, but some do not. Some foods that are high in prebiotic fiber are beans and peas, oats, bananas, berries, Jerusalem artichokes, asparagus, dandelion greens, garlic, leeks and onions. However, there is only a low concentration of prebiotics in these foods, therefore, prebiotics are manufactured on industrial large scales as they play a crucial role in health maintenance. Some can be produced by using lactose, sucrose and starch.

Prebiotics are found to be generally safe, lacking life threatening or severe side effects. The side effects of prebiotics are mostly related to the result of their osmotic functions, such as osmotic diarrhea, bloating, cramping and flatulence. A daily dose of 2.5 -10 g of prebiotics is required to have beneficial effects on human health. But low doses of 2.5-10 g/day and high doses of 40-50 g/day may cause flatulence and osmotic diarrhea, respectively. This indicates that prebiotics within their therapeutic doses may cause mild to moderate side effects. Therefore, most prebiotic products in the market have doses of 1.5-5 g.

References:

1. Davani-Davari D, Negahdaripour M, Karimzadeh I, et al. Prebiotics: Definition, Types, Sources, Mechanisms, and Clinical Applications. Foods. 2019;8(3):92. Published 2019 Mar 9. doi:10.3390/foods8030092

2. Lewis, Sarah. “Probiotics and Prebiotics: What's the Difference?” Healthline, Healthline Media, 9 Sept. 2020, https://www.healthline.com/nutrition/probiotics-and-prebiotics.

3. Holscher HD. Dietary fiber and prebiotics and the gastrointestinal microbiota. Gut Microbes. 2017;8(2):172-184. doi:10.1080/19490976.2017.1290756

One of the most common indications that make patients seek self care is gastrointestinal health. It is one of the most common problems that patients in the community face. These symptoms can often impact a patient’s quality of life. No one wants to go about their day and wonder when they are going to have to use the bathroom, if their stomach will bother them, or how they will be able to fit their bathroom routine in their day. Patients often seek help from pharmacists to regulate gut health. Many patients have been placing an increased emphasis on probiotics. But what exactly does that mean, and how can patients work these things into their daily routine? Probiotics are only the start of the gastrointestinal health world. There are also prebiotics. There has been extensive research over the past few years, and the amount of information that is available for patients is extensive as well.(1)

Probiotic, the word itself, was derived from the Greek word meaning “for life.” It is used to identify certain non-pathogenic bacteria that have been living within the host body. It is very important that these bacteria prove to be non-pathogenic, as introducing harmful bacteria into the body can be counter productive. There are, however, certain bacteria that are known to be helpful in patients. Some of the common bacteria that are incorporated into the probiotic formula are Lactobacillus rhamnosus, Lactobacillus reuteri, bifidobacteria, certain strains of Lactobacillus casei, Lactobacillus acidophilus-group, Bacillus coagulans, Escherichia coli strain Nissle 1917, and certain enterococci. Probiotics can contain either a single strain or a combination of strains of bacteria. Probiotics help to maintain a healthy balance in the gut. Although probiotics can be found in many foods, people often hope to supplement these helpful bacteria when they do not eat enough of the good foods.(2)

Prebiotics are different from probiotics, but they are often confused. While probiotics aim to introduce healthy bacteria into the gut, prebiotics are mainly different kinds of macronutrients that help to stimulate the gut. Prebiotics are fibers and non-digestible ingredients that help to stimulate the growth or activity of certain bacteria. There are different things that help to make an efficient prebiotic. Prebiotics must make it past the acidic barrier of the stomach, and should make it past the upper gastrointestinal tract without being broken down. They should also be able to be easily fermented by the gut bacteria, which is how they cause their effects.

Both probiotics and prebiotics help the gastrointestinal tract benefit from the bacteria that help us digest and breakdown our food. There have been many studies evaluating the use of probiotics and prebiotics. People who have uncontrolled bowel movements should speak with their doctor about incorporating probiotics and prebiotics into their healthcare routine. With a few pills a day, patients might have relief from the sudden urge to use the bathroom after eating certain foods and taking certain medications. Gastrointestinal can be some of the most common and some of the most disruptive symptoms patients can face. If patients are for consultations from their pharmacist, pharmacists should be able to guide them into the correct direction to help regulate their gastrointestinal system.(3)

1. Pandey KR, Naik SR, Vakil BV. Probiotics, prebiotics and synbiotics- a review. J Food Sci Technol. 2015;52(12):7577-7587.

2. Shi LH, Balakrishnan K, Thiagarajah K, Mohd Ismail NI, Yin OS. Beneficial Properties of Probiotics. Trop Life Sci Res. 2016;27(2):73-90.

3. Davani-Davari D, Negahdaripour M, Karimzadeh I, et al. Prebiotics: Definition, Types, Sources, Mechanisms, and Clinical Applications. Foods. 2019;8(3):92. Published 2019 Mar 9.