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Pre-Pro: Everything you need to know about these 'biotics'

  • Haley Overby, Ph.D.
  • Jan 7, 2020
  • 13 min read

Updated: Jan 13, 2020

Both Prebiotics and Probiotics have become a very hot marketing term in the health, food, and even beauty industry. But as a consumer, a healthy dose of skepticism and plenty of online "research" is key to understanding what these terms mean and what they can (or can't) do for you! In this brief post, I will discuss what these terms encompass, what the literature says, and what to look for in a food or supplement.



I. DEFINING THE TERMS, HEALTH CLAIMS, TYPES OF, AND FOOD SOURCES


I.A.1. WHAT ARE PROBIOTICS?

Probiotics can be defined as bacterial microorganisms, normally living within a host, providing a synergistic relationship, also known as mutualistic symbiosis (the host provides a home and food, and the bacteria provide many benefits in return, as discussed below). Although the human body is covered with microorganisms, including various types of bacteria, viruses, archaea, and fungi, the primary sight for these microorganisms is within the gastrointestinal system, including the large and small intestines with the greatest density residing within the colon.


I.A.2. HEALTH CLAIMS OF PROBIOTICS

These bacteria play countless roles and provide a large number of benefits for their host, including, but not limited to:

1. Aide in digestion and absorption of essential nutrients within our food.

2. Help limit number of bad bacteria.

3. Provide critical nutrients for colonocytes (epithelial cells lining the colon) as well as other cells found in the body both locally and systemically.

4. Strengthen the gut integrity and immune system.

5. Provide a large source of essential nutrients our bodies are unable to make otherwise (i.e. vitamin K and B12).

6. Some, but more recent and less substantiated evidence to show they help with: mental health, weight, inflammation, and heart health.


I.A.3. TYPES OF PROBIOTICS

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The above diagram displays large families of healthy bacteria. Within these families lies various strains. This is by no means an exhaustive list, but rather, gives a "face to the name".

The human body has billions of bacteria comprised of more than 500 different species.(1) With that said, the two major phyla of bacteria within the gut is the anaerobic Firmicutes and Bacteroidetes, which make up about 99% of the gut bacteria. There is relatively recent evidence to suggest a variation within this ratio can be reflective of body composition (i.e. obese vs lean), which is discussed further in this post.


Interestingly, there are many factors which can alter the composition of our gut bacteria. Genetics, gender, activity level, body composition, environment, geographic location, disease state, antibiotic use, and of course diet can all contribute to the variations in amount and type of bacteria, and what they are able to make as a byproduct of their fermentation.




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I.A.4. FOOD SOURCES OF PROBIOTICS:

  • Manufacture-Added or Fermented Foods

  • Yogurt

  • Kambucha

  • Sour Cream

  • Kefir

  • Probiotics Milk (i.e. Sweet Acidophilis Milk)

  • Sauerkraut

  • Kimchi

  • Miso

  • Tempeh

  • And More!




I.B.1. WHAT ARE PREBIOTICS?

Simply put, prebiotics = fiber.

Fiber, although non-digestible and non-caloric for humans, are broken down by gut flora and can cultivate an environment supportive of beneficial bacteria.

Fiber is one of those "nutrients" that nutritionists all over the world constantly dote over. There are countless benefits of consuming adequate fiber (with proper hydration to accompany it), concerning numerous organ-systems and diseases.


I.B.2. HEALTH CLAIMS OF PREBIOTICS

The most renowned benefits include reduced risk of:

1. Heart Disease: Helping to lower cholesterol re-uptake in the small intestine, thereby lowering "bad" (LDL) and overall cholesterol, reducing risk of heart diseases. Heart disease is the leading cause of death in the U.S., with most of that being attributed to diet, lifestyle, and genetics.

2. GI disorders and diseases: Prebiotics promote GI health by increasing fecal bulk (insoluble fiber) and softening stool by bringing water into the lumen and stool (soluble fiber). This can help reduce risk, symptoms, or incidence of constipation, irritable bowel syndrome (IBS), diverticulitis, hemorrhoids, etc.

3. Colon Cancer: Increased fecal bulk and transit speed can also help to reduce time the GI lining and colonocytes are exposed to stool and other toxic materials found in waste. Fibers can also help to ensure proper sloughing off of intestinal lining (preventing buildup and synthesis of polyps). These, among others, help to reduce risk of colon cancer, among the leading killers of Americans.

4. Obesity: Fiber slows down digestion, helping one to feel fuller longer, possibly assisting in reduced food intake and weight loss. 2/3 American adults are overweight or obese, while 1 out of 3 are considered obese. Obesity related diseases top the list of preventable diseases and death in America. Therefore, fiber may help to reduce risk of obesity and its comorbidities.


There are numerous other benefits on human health not listed here of fiber, however, for this article, I wanted to discuss how they may provide advantages to our microflora, helping us as a byproduct of this relationship.

Our intestinal bacteria help to break down our undigested food, primarily including the fibers found in plant-foods. The byproduct of this breakdown are short chain fatty acids (SCFA) (i.e. propionate, acetate, and butyrate). As previously mentioned, these SCFA are the primary source of energy for both the bacteria and the local cells lining the intestines. SCFA are also released into circulation, allowing for use systemically by other organs. Some evidence even suggest that the high concentration of some SCFA (i.e. butyrate) in these colonic-crypts help to prevent growth of cancerous tumors.(2)

Interestingly, the effects of prebiotics on health are dependent on both the type of food eaten (type/source of prebiotic) and the composition of the gut flora.


The following classifications help to differentiate fiber from "prebiotics". A fiber can be classified as a "prebiotic" IF:

1. It is not broken down (resistant to acidic pH and enzymatic digestion) and are not absorbed.

2. Fermentable by gut flora.

3. Fermentation of which promotes growth and activity of a select population of microbiota which promotes health of the host.


I.B.3. TYPES OF PREBIOTICS (3)

  • Fructo-oligosaccharides (FOS)

  • Galacto-oligosaccharides (GOS)

  • Trans-Galacto-oligosaccharides (TOS)

  • Inulin


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I.B.4. SOURCES OF PREBIOTICS:

  • Fruits and Vegetables!!

  • Bananas

  • Onions

  • Asparagus

  • Garlic

  • Apple

  • Legumes

  • Whole wheat foods









II. DOES THE LITERATURE SUPPORT HEALTH CLAIMS??


II.A. Probiotics Supplements

The research on how healthy gut bacteria is crucial for digestive health and how it may be beneficial to a variety of diseases is boundless and is well accepted within the scientific community.(4) Epidemiological evidence first assisted in the revelation that certain populations are more prevalent in healthy individuals as compared to their disease-ridden counterparts. For example, studies consistently show that the higher ratio of the Firmicutes as compared to Bacteroidetes is associated with obesity, whereas the inverse is shown in weight loss and lean individuals.(5) Another example of this includes the therapeutic use of FMT (fecal microbiota transfer - healthy donor stool transplanted within unhealthy patient to restore normal microbiome) in the treatment of clostridium difficile infection.(6) There is even evidence to suggest FMT can temporarily assist with weight loss, and could potentially be used as a therapy for the treatment of obesity and metabolic syndrome.(7)


As always, supplementation becomes the questionable aspect of whether the benefits seen within the GI tract can be translatable when consumed. There are some obvious obstacles encountered with probiotics supplementation. For one, the majority of bacteria within the GI are anaerobic, making isolation and cultivation next to impossible. Next, like all supplements, probiotic supplements are not regulated by the FDA or other government organizations, therefore, what is advertised (i.e. type and amount of bacteria) on the label may not be accurate. As living organisms, shelf-life and storage conditions also comes into question with supplements. Finally, if all of these obstacles are overcome (i.e. a trusted brand, tested for microbe liveliness, etc), the question of whether the bacteria will make it through the harsh acidic gut environment is a looming possible downfall. Many companies have come up with various special coatings which claims to assist in probiotic survival. Finally, even if this large obstacle is overcome, literature suggests that the majority of bacteria ends up being released within the small intestines, where they still may be digested or destroyed before making it to the real target, the colon.(8)


Regardless of these major obstacles, literature seems to support the use of probiotic supplementation in some major disorders and diseases, especially those concerning the GI.(9) As with any supplementation, the claims concerning other diseases are conflicting and require more studies to be conducted.


II.B. Prebiotics Supplements

As far as prebiotic supplementation goes, the evidence is also a mixed bag.(3) As an example, what is typically seen with vitamin and mineral supplementation, results of experiments conducted when an individual obtains all of their nutrients from whole foods (fruits and vegetables, grains, lean meats, etc.) alone, typically have greater health outcomes than with supplementation and a base-line/typical American diet alone. A similar outcome is seen with fiber from food and fiber from supplementation. These results are typically confounded by the fact that the nutrients found in food are found in complex with a bounty of other nutrients, which may work synergistically together. There are also other nutrients not accounted for in most over the counter supplements, such as, but not limited to, phyto-nutrients and other bio-active compounds which provide a myriad of health benefits.


Regardless, nutrients found in food and supplements are generally taken up and digested similarly for the most part, and supplementation of both prebiotics and probiotics may be beneficial to those who are deficient or are unable to get any or enough from food alone.



III. WHAT TO LOOK FOR IN FOODS OR SUPPLEMENTS


As previously discussed, type, brand quality, storage conditions, and coating (as well as the not yet mentioned, CFU) are all characteristics to take into consideration when trying to find the right supplement for you.


1. Type: Interestingly, it is suggested that some strains of bacteria are more effective at treating certain conditions/disorders than others. Again, this is not an exhaustive list, but helps give an idea:

  • Constipation and IBS-C: Anyone suffering or ever has suffered from constipation in some form or another knows the struggle, and also knows the limited treatment aside from diet and lifestyle changes includes: stool softeners, laxatives, enemas, etc. These can at times not work, and often, when/if they do, they can cause severe bloating, gas, pain, and sometimes even diarrhea. Recent evidence suggests probiotic supplementation is a promising alternative which can offer relief where the traditional treatments cannot.(10) One study claims supplementation of 1000mg of S. cerevisiae was able to reduce patient abdominal pain, discomfort, and bloating associated with constipation.(11) Other strains which were shown to reduce constipation or relief associated symptoms include B. longum, and a combination of L. acidophilus, L. reuteri, L. rhamnosus, L. plantarum, and B. animalis.(11-13)

  • Diarrhea and IBS-D: In somewhat opposition to the aforementioned, diarrhea effects many and can be similarly uncomfortable, and at times dangerous (i.e. side effect of dehydration). Diarrhea can be acute (i.e. infection-related (food poisoning, gastroenteritis)) or chronic in some cases (i.e. IBS-D). Probiotic supplementation has been shown to assist in relieving the acute infection-related diarrhea by reducing stool frequency.(14) The effective strains in this case include L. rhamosus GG, L. bulgaricus, and L. acidophilus.(15) Supplementation was also shown to assist relief of symptoms associated with antibiotic-use-associated diarrhea.(16) Strains, B. coagulans, S. boulardii, and a combination of several Lactobacillus and Bifidobacterium strains were shown to be effective treatment for IBS-D (diarrhea-predominant irritable bowel syndrome).(17-20)

  • Weight loss: As previously discussed, the gut flora composition has been shown to have a profound effect on one's weight and body composition.(21) Studies show that certain strains can reduce the number of fat and calories digested and absorbed, alter energy metabolism and body composition, as well as alter SCFA produced, leading to weight loss.(22-25) The strains effective for weight loss as shown by a 2014 meta-analysis of numerous studies include L. gasseri, L. rhamnosus, and the combination of L. rhamnosus and B. lactis.(26)

  • Immune Health: Probiotic supplementation has shown to boost immune health, ramping up the body's defenses against infections, allergies, and even cancer.(27) Strains associated with immune health include L. GG, L. crispatus, L. gasseri, B. bifidum, and B. longum, in studies, these strains were shown to reduce risk of respiratory illness and eczema in children and UTIs in adult women.(28-30)

  • There are other strains which are beneficial for other specific conditions/diseases, however this post will not go into depth. Please see other beneficial reviews of this topic if you are interested.(27,31)

2. Brand quality: It is important to search for brand quality when looking for supplements. As previously mentioned, supplement manufacturers are not required to go through government testing as our food and pharmaceuticals do. Therefore, it is important to purchase quality and trusted brands. There are some companies that opt to hire outside companies which can test and ensure quantity and quality of products prior to being sold in market. An example of this company that does the QA testing is USP (United States Pharmacopeia - check out the website here for more info: https://www.usp.org ). Therefore, make sure to look at the label for these tests of quality assurance prior to purchase. Otherwise, you may not be getting what is advertised on the label.


3. Storage conditions: Like many live specimens, probiotics are sensitive to light, temperature, moisture, oxygen, and time. Therefore, it is important to pay attention to manufacturer directions after opening (does it say to keep refrigerated after opening? Some say you don't have to, but if the storage conditions are slightly warmer than 70*F, then it may be conducive to store in refrigerator). Generally speaking, if kept in lower temperatures, they will last longer. However,

they are best kept at 39-41*F with low humidity levels (higher humidity reduces probiotics viability), with a coating which does not allow too much interaction with oxygen (oxygen exposure can lead to microorganism death).(32)


4. Coating: As previously discussed, recent developments have allowed for manufacturers to be able to incorporate special coatings to ensure the product makes it to the intended destination. Therefore, you may want to look for "G.I. coated" or other statement on the label which 'ensures' greater survival of the probiotics through the harsh G.I. conditions. There are some pit-falls to the use of enteric-coated capsules, including the use of platicizers and phthalates in the manufacturing process. There is also the option of using delayed-release supplements which do not use these ingredients.(33)


5. CFU: Probiotic supplements are typically quantified and/or measured in CFU (colony forming units). Studies suggest that a range of 1-2 billion or up to 20 billion CFU may be required daily in order to achieve desired health benefit effects.(34) Although not harmful at higher levels, there may be a threshold to the number of CFU which is considered beneficial (a study giving participants 1.8 trillion CFU per day did not see any deleterious nor added benefit, only added cost).(34)



IV. CONCLUSION

Try to get your daily need met through food, however, if you have a condition which may be benefited by probiotic or prebiotic consumption, you should consider supplementation. As always, do your 'research' beforehand, and if you have a disease or condition or are taking other medications, please consult your physician about taking these supplements. Make sure to read the label, check the brand quality, and ensure proper storage conditions. Review which strains may be more beneficial to that condition (not all strains are held equal). AND make sure there are enough of those strains by looking at the CFUs.


Thank you for the read. Please share with your friends and family, and let me know how you liked it!




REFERENCES:

For general information about probiotics, I used the following references:


For general information about prebiotics, I used the following references:


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  2. Han A, Bennett N, MacDonald A, Johnstone M, Whelan J, Donohoe DR. Cellular metabolism and dose reveal carnitine-dependent and -independent mechanisms of butyrate oxidation in colorectal cancer cells. J Cell Physiol. 2016;231(8):1804-1813.

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

  4. Jandhyala SM, Talukdar R, Subramanyam C, Vuyyuru H, Sasikala M, Reddy DN. Role of the normal gut microbiota. World J Gastroenterol. 2015;21(29):8787-8803.

  5. Mathur R, Barlow GM. Obesity and the microbiome. Expert Rev Gastroentero Hepatol. 2015;9(8):1087-1099.

  6. Rao K, Safdar N. Fecal microbiota transplantation for the treatment of Clostridium Difficile infection. J Hosp Med. 2016;11(1):56-61.

  7. Marotz CA, Zarrinpar A. Treating obesity and metabolic syndrome with fecal microbiota transplantation. Yale J Biol Med. 2016;89(3):383-388.

  8. National Center for Complementary and Integrative Health (NIH). Probiotics: what you need to know. USDHHS. Last updated: August 2019. https://nccih.nih.gov/health/probiotics/introduction.htm

  9. Williams NT. Probiotics. Am J Health Syst Pharm. 2010;67(6):449-458.

  10. Liu LW. Chronic constipation: current treatment options. Can J Gastroenterol. 2011;SupplB:22B-28B.

  11. Spiller R, Pelerin F, …, Peter Justen. Randomized double blind placebo-controlled trial of Saccharomyces cerevisiae CNCM I-3856 in irritable bowel syndrome: improvement in abdominal pain and bloating in those with predominant constipation. United European Gastroenterol J. 2017;5(2):304.

  12. Amenta M, Cascio MT, Di Fiore P, Venturini I. Diet and chronic constipation. Benefits of oral supplementation with symbiotic zir fos (Bifidobacterium longum W11 + FOS Actilight). Acta Biomed. 2006;77(3):157-162.

  13. Mezzasalma V, Manfrini E, Ferri E, et al. A randomized, double blind, placebo-controlled trial: the efficacy of multispecies probiotic supplementation in alleviating symptoms of irritable bowel syndrome associated with constipation. Biomed Res Int. 2016;2016:4740907.

  14. Allen SJ, Martinez EG, Gregorio GV, Dans LF. Probiotics for treating acute infectious diarrhea. Cochrane Database Syst Rev. 2010;10(11):CD003048.

  15. Sazawal S, Hiremath G, Dhingra U, Malik P, Deb S, Black RE. Efficacy of probiotics in prevention of acute diarrhea: a meta-analysis of masked randomized, placebo-controlled trials. Lancet Infect Dis. 2006;6(6):374-382.

  16. Hempel S, Newberry SJ, Maher AR, et al. Probiotics for the prevention and treatment of antibiotic-associated diarrhea: a systematic review and meta-analysis. JAMA. 2012;307(18):1959-1969.

  17. Majeed M, Nagabhushanam K, Natarajan S, Sivakumar A, Ali F, Pande A, Majeed S, Karri SK. Bacillus Coagulans MTCC 5856 supplementation in the management of diarrhea predominant irritable bowel syndrome: a double blind randomized placebo controlled pilot clinical study. Nutr J. 2016;15(21).

  18. Dolin BJ. Effects of a proprietary Bacillus coagulans preparation on symptoms of diarrhea-predominant irritable bowel syndrome. Methods Find Exp Clin Pharmacol. 2009;31(10):655-659.

  19. Abbas Z, Yakoob J, Jafri W, et al. Cytokine and clinical response to Saccharomyces boulardii therapy in diarrhea-dominant irritable bowel syndrome: a randomized trial. Eur J Gastroenterol Hepatol. 2014;26(6):630-639.

  20. Ki Cha B, Mun Jung S, Hwan Choi C, et al. The effect of multispecies probiotic mixture on the symptoms and fecal microbiota in diarrhea-dominant irritable bowel syndrome: a randomized, double-blind, placebo-controlled trial. J Clin Gastroenterol. 2012;46(3):220-227.

  21. Cardinelli CS, Sala PC, Alves CC, Torrinhas RS, Waitzberg DL. Influence of intestinal microbiota on body weight gain: a narrative review of the literature. Obes Surg. 2015;25(2):346-353.

  22. Kim M, Kim M, Kang M, et al. Effects of weight loss using supplementation with Lactobacillus strains on body fat and medium-chain acylcarnitines in overweight individuals. Food Funct. 2017;8(1):250-261.

  23. Omar JM, Chan YM, Jones ML, Prakash S, Jones PJH. Lactobacillus fermentum and Lactobacillus amylovorus as probiotics alter body adiposity and gut microflora in healthy persons. J Funct Foods. 2013;5(1):116-123.

  24. Kadooka Y, Sato M, Ogawa A, et al. Effect of Lactobacillus gasseri SBT2055 in fermented milk on abdominal adiposity in adults in a randomized controlled trial. Br J Nutr. 2013;110(9):1696-1703.

  25. Sanchez M, Darimont C, Drapeau V, et al. Effect of Lactobacillus rhamnosus CGMCC1.3724 supplementation on weight loss and maintenance in obese men and women. Br J Nutr. 2014;111(8):1507-1519.

  26. Mekkes MC, Weenen TC, Brummer RJ, Claassen E. The development of probiotic treatment in obesity: a review. Benef Microbes. 2014;5(1):19-28.

  27. Reid G, Jass J, Sebulsky MT, McCormick JK. Potential uses of probiotics in clinical practice. Clin Microbiol Rev. 2003;16(4):658-672.

  28. Hatakka K, Savilahti E, Ponka A, et al. Effect of long term consumption of probiotic milk on infections in children attending day care centres: double blind, randomized trial. BMJ. 2001;322(7298):1327.

  29. Kim HK, Rutten NB, Besseling-van der Vaart I, Niers LE, Choi YH, Rijkers GT, van Hemert S. Probiotic supplementation influences faecal short chain fatty acids in infants at high risk for eczema. Benef Microbes. 2015;6(6):783-790.

  30. Stapleton AE, Au-Yeung M, Hooton TM, et al. Randomized, placebo-controlled phase 2 trial of a Lactobacillus crispatus probiotic given intravaginally for prevention of recurrent urinary tract infection. Clin Infectious Disease. 2011;52(10):1212-1217.

  31. Spritzler F. How to choose the best probiotic supplement. Healthline. 2017. https://www.healthline.com/nutrition/best-probiotic-supplement

  32. Mahto N. Survival of probiotics: effect of processing and storage conditions. 2018. https://www.slideshare.net/NehaMahto5/survival-of-probiotics-effect-of-processing-and-storage-conditions

  33. Pavli F, Tassou C, Nychas GE, Chorianopoulos N. Probiotic incorporation in edible films and coatings: bioactive solution for functional foods. Int J Mol Sci. 2018;19(1):E150.

  34. Kligler B, Cohrssen A. Probiotics. Am Fam Physician. 2008;78(9):1073-1078.



Image Sources:

1. Probiotics Diagram: Made by Haley Overby, inspired by Yevgenij_D, image ID: 22324726 on vectorstock.com

3. Prebiotics Food Sources: https://www.bimuno.com/prebiotics




 
 
 

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