Prebiotics

Prebiotics                  

Prebiotics are a group of nutrients that promote the flourishment of the human microbiota within the gut. The general clinical definition of a prebiotic is “a substrate selectively utilized by host microorganisms conferring a health benefit”. The International Scientific Association of Probiotics and Prebiotics (ISAPP) defines the criteria of prebiotics as a substance resistant to gastric pH and cannot by hydrolyzed by mammalian enzymes or absorbed in the gastrointestinal tract, has the ability to be fermented by gastrointestinal microbiota, and the substance greatly stimulates the activity of gastrointestinal flora. Prebiotics are most often nondigestible short- chain carbohydrates coming from plant sources, however, for a carbohydrate to be classified as a prebiotic, they must be a fiber with greater than 3 degrees of polymerization and cannot be hydrolyzed by endogenous gastrointestinal enzymes. Types of classified prebiotics include fructans, galacto- oligosaccharides (GOS), starch and glucose- derived oligosaccharides, pectin- derived compounds, and cocoa- derived flavanols. Prebiotics are naturally occurring in plants and cow’s milk, and thus can be obtained through a well- rounded and balanced diet (Davani- Davari D).

The health benefits of prebiotics are wide, ranging from improving gastrointestinal health and regulation, improving cognition, learning, and mental clarity, anti- inflammatory and endocrine regulation, including decreased water retention, and improved lipid metabolism. Multiple clinical studies have been conducted to study the effects. For Crohn’s disease and irritable bowel syndrome (IBS), prebiotics may have some benefit, and most notable can slow the progression of colon cancer. The effects of prebiotics on immune function are significant and multiple studies show a significant impact in aiding immune function and response. Prebiotics may also be neuroprotective and improve cognitive function. Prebiotics can also be beneficial in preventing dermatological conditions, such as atopic dermatitis. Cardiovascular protection can also be provided by promoting lipolysis of harmful lipids that increase risk of cardiovascular disease (Davani- Davari D, Yadav MK).

Prebiotics have little to no side effects, especially if they are consumed from food sources. Patients may experience gastrointestinal side effects such as diarrhea, bloating, and cramping, from the fermentation process that microflora cause as part of the digestive process (Yadav MK).

                  Despite the benefits prebiotics may bring, every individual has a unique composition of their gastrointestinal flora, which causes variations in responses between people. However, because prebiotics are digested and fermented by these bacteria, the effects that they exert are the same. Patients looking for health benefits from prebiotics may begin with incorporation of more foods containing these substances, including onions, garlic, cow’s milk, oat and wheat, and other foods. If needed, patients may buy supplements containing prebiotics as well, which can be sold on their own or as a symbiotic in combination with a probiotic (Davani- Davari D, Yadav MK).

Citations:

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

Yadav MK, Kumari I, Singh B, Sharma KK, Tiwari SK. Probiotics, prebiotics and synbiotics: Safe options for next-generation therapeutics. Appl Microbiol Biotechnol. 2022;106(2):505-521. doi:10.1007/s00253-021-11646-8

Prebiotics

Yu Feng Lin & Fawziya Twam 

Prebiotics, non-digestible dietary compounds, stand as crucial players in nourishing beneficial gut bacteria, ultimately contributing to overall health. Their influence spans across multiple facets, encompassing improvements in gastrointestinal conditions, impacts on skin health, cardiovascular well-being, calcium absorption, and potential effects on mental health. Prebiotics serve as essential components in the delicate balance of the gut microbiota. They possess the unique ability to selectively nourish beneficial bacterial strains, including Bifidobacteria and Lactobacilli, while concurrently inhibiting the proliferation of harmful pathogens. This selective nutritional support plays a pivotal role in fostering and sustaining a harmonious gut environment, a cornerstone of optimal health.

Prebiotics have also been subjects of research aimed at managing gastrointestinal conditions, such as Irritable Bowel Syndrome (IBS) and Crohn's Disease. While certain studies suggest improvements in IBS symptoms with prebiotic consumption, the results remain heterogeneous due to variations in prebiotic types and doses. Conversely, regarding Crohn's Disease, the effects of prebiotics are less conclusive, with some studies failing to demonstrate significant clinical benefits. Colorectal cancer, a global health concern of substantial magnitude, is another area where prebiotics hold potential. Particularly, prebiotics that contribute to the production of butyrate exhibit promise in safeguarding against colorectal cancer risk and progression. They have the capacity to induce apoptosis in cancer cells and enhance the integrity of the epithelial barrier, contributing to a defense mechanism against this malignancy.

Prebiotics like FOS and GOS emerge as potential tools in preventing necrotizing enterocolitis (NEC), a severe condition predominantly affecting premature neonates. These prebiotics facilitate the growth of beneficial Bifidobacteria and enhance feeding tolerance, though further research is essential to confirm their effectiveness in reducing the risk of NEC. Immunity receives a significant boost from prebiotics as they elevate the population of protective microorganisms, simultaneously reducing pathogen colonization. These compounds also induce the expression of immune molecules, particularly cytokines, with maternal prebiotic metabolites even impacting the development of the fetal immune system.

The intricate "gut-brain axis" connects the gut and brain through neural, endocrine, and immune pathways, and prebiotics wield the potential to influence brain function. This can have implications for mood, memory, learning, and psychiatric disorders, all mediated by shifts in the composition and activity of the gut microbiota. Additionally, prebiotics have shown potential therapeutic applications in specific health conditions, such as autism and hepatic encephalopathy. Research suggests that prebiotics may impact autism by altering gut microbiota composition and neurotransmitter production, but further investigation is warranted. In the case of hepatic encephalopathy, lactulose, a prebiotic, effectively treats the condition by reducing ammonia levels and inhibiting glutaminase.

Shifting focus to skin health, prebiotics are also relevant. They offer potential benefits in reducing the risk and severity of skin conditions like atopic dermatitis, enhance skin barrier function, and counteract the effects of harmful phenols on the skin.

Cardiovascular health benefits from prebiotics as well, with the potential to reduce the risk of cardiovascular diseases (CVD) through the lowering of inflammation and improvement of lipid profiles. Nevertheless, their impact on cholesterol levels remains inconsistent, and certain short-chain fatty acids (SCFAs) produced by prebiotics may have negative implications. When it comes to calcium absorption, prebiotics may exert influence, albeit with variability depending on the specific type. While some prebiotics, such as lactulose, TOS, and inulin + oligofructose, have demonstrated the ability to enhance calcium absorption, others, like GOS or FOS, do not yield the same effect.

In terms of safety, prebiotics are generally considered safe for consumption, yet they can induce mild side effects like osmotic diarrhea, bloating, and flatulence. The severity of these side effects may hinge on factors like chain length and dosage, with low and high doses potentially resulting in mild to moderate side effects. Therefore, it is imperative to adhere to recommended therapeutic dose ranges when utilizing prebiotics. As for the future trajectory of prebiotic research, it holds immense promise for improving human health, but a more profound understanding of their mechanisms and substantiation of health claims is imperative. Rigorously designed clinical trials and genomics investigations will play pivotal roles in this endeavor. Furthermore, the concept of formulating population-specific prebiotics, tailored to the distinct gut microbiota of local communities, presents an intriguing standardized approach to enhancing health. 

Prebiotics emerge as versatile agents impacting a spectrum of health domains, ranging from the equilibrium of gut microbiota to potential influences on diverse health conditions. Although further research is indispensable to comprehensively comprehend their safety and effectiveness in varied contexts, prebiotics undeniably wield considerable potential in advancing overall well-being.

References:

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

Guarino MPL, Altomare A, Emerenziani S, et al. Mechanisms of Action of Prebiotics and Their Effects on Gastro-Intestinal Disorders in Adults. Nutrients. 2020;12(4):1037. Published 2020 Apr 9. doi:10.3390/nu12041037

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.