Probiotics and prebiotics: how to support gut health

Probiotics and prebiotics are folk remedies for the treatment of intestinal diseases, which are widely used in their practice by family doctors, general practitioners, gastroenterologists and even surgeons.Because of the similarity of the names, many people think that they belong to the same pharmacotherapeutic group, but this is not the case. Probiotics and prebiotics differ not only in their composition, but also in their mechanism of action, as well as in the indications for use.They can be bought in a pharmacy and "found" in ordinary food.About what probiotics and prebiotics are, how useful they are for the intestine and how to choose the best ones for adults and children - read in our article.

What are probiotics and prebiotics?

Probiotics are live microorganisms that can be helpful to the body if taken in adequate amounts. Their second name is eubiotics. Commonly used probiotics are:

• Lactobacillus;
• bifidobacteria;
• Saccharomyces yeast;
• certain strains of Escherichia coli.

Please note: certain types of lactic acid bacteria (including lactobacilli) are used not only for healing the body, but also for fermenting foods to help extend their shelf life. Examples of fermented foods are yogurt, kefir, pickled cabbage, kimchi and some cheeses (Cheddar, Mozzarella, Camembert). They have a pleasant flavor, are easier to digest and are good for the gastrointestinal tract due to their high content of 'probiotic' bacteria.

Prebiotics are not living organisms but food substances, usually non-starchy carbohydrates (oligosaccharides and polysaccharides). They are often found in food, but can also be synthetic (e.g. lactulose).

The main benefit of prebiotics for digestion is to stimulate the growth and reproduction of beneficial gut microflora, which in turn helps to displace pathogenic bacteria, restore normal microbiota and overall gut health.

In addition, prebiotics are fermented by colonic bacteria into beneficial short-chain fatty acids, which improve intestinal barrier function by 'strengthening' the intestinal walls.

The best known natural prebiotic is inulin, and the synthetic prebiotic is lactulose. Other prebiotics include fructooligosaccharides (FOS), galactooligosaccharides (GOS) and soy oligosaccharides.

Despite their different mechanisms of action, prebiotics and probiotics have the same function - maintaining the balance of microflora and gut health. This is why special combination products - synbiotics - have been developed to simplify their work . They contain both components whose beneficial effects are synthesized.

What are the benefits of probiotics and prebiotics for children and adults?

Probably everyone is familiar with the main beneficial effects of probiotics. They improve digestion by restoring normal gut microflora, especially after antibiotics. Once installed in the gastrointestinal tract, lacto- and bifidobacteria grow, multiply and expel pathogenic bacteria from the intestines. They can reduce flatulence and bloating, as well as provide some relief of symptoms of inflammatory digestive diseases (such as ulcerative colitis or Crohn's disease).

Because of their ability to restore normal gut microbiota, probiotics are widely used to prevent and treat certain types of diarrhea (e.g. rotavirus-induced or antibiotic-associated diarrhea, travelers' diarrhea).

In addition, probiotics may have a positive effect on the body's defense system. Although the gut's main function is digestion, it also has Peyer's plaques (lymphoid follicles), organs of the immune system. Probiotic' foods are thought to stimulate the activity of lymphocytes and macrophages, thus promoting immunity.

Other beneficial effects of probiotics:

• A positive effect on the female reproductive system - specifically, the vaginal microflora. Bacterial vaginosis and candidiasis (thrush) are typical manifestations of vaginal dysbacteriosis. Although certain drugs are used to treat it (e.g. antifungal agents), probiotics also play an important role in restoring the vaginal microflora;
• Supporting skin health. Dermatologists use probiotics to help treat acne, eczema and rosacea;
• Improving mental health. This is influenced by probiotics through what is known as the 'gut-brain axis'. The gut is known to produce neurotransmitters that affect a person's mood and anxiety levels (serotonin, GABA), so attempts have already been made to use probiotics as an adjuvant therapy for depression and anxiety. Their effectiveness has been observed in some studies, but now needs more conclusive confirmation;
• Normalization of cholesterol levels (healthy gut microbiota may have an indirect effect on lipid profiles by reducing bad cholesterol levels);
• weight control. The effects of some probiotics (e.g. Lactobacillus gasseri) on metabolism and body weight are under study. Preliminary evidence suggests that they may control appetite and reduce abdominal obesity.

Like probiotics, prebiotics are good for digestion and immunity. They may also improve the absorption of beneficial minerals (iron, calcium and magnesium) and may be used to prevent some bowel diseases - such as irritable bowel syndrome - although these properties have yet to be confirmed.

Probiotics and prebiotics to improve gut function

Although the usefulness of probiotics and prebiotics for immunity is only just being studied, they have been used for intestinal disorders for many years. In the last century, Ilya Mechnikov suggested that lactic acid bacteria improve the health of the gut and the whole body, prolonging its longevity. Alfred Nissle isolated a non-pathogenic strain of Escherichia coli, and the French pediatrician Tissier isolated bifidobacteria (Bacillus bifidus) and suggested their use to treat diarrhea in newborns.

In the 20th century, probiotics were widely used to treat 'intestinal dysbiosis'. However, such a diagnosis is now excluded from the international classification of diseases, and these drugs are prescribed by doctors for

• antibiotic-associated diarrhea, including for its prevention;
• infectious diarrhea (e.g. stool disturbance in rotavirus infection)
• irritable bowel syndrome (as an adjunct);
• chronic inflammatory bowel disease (e.g. Crohn's disease as part of complex therapy);
• treatment of Helicobacter pylori (gastric infection) - probiotics do not affect this bacteria, but may reduce the side effects of antibiotic combination therapy;
• functional constipation in children and the elderly.

In addition, neonatologists use probiotics to prevent necrotizing enterocolitis in premature infants.

Prebiotics (especially lactulose) are widely used to treat constipation in children and adults. They are more effective in functional disorders of intestinal motility. Together with probiotics, these agents are also used to restore normal intestinal microflora.

Prebiotics effectively reduce such unpleasant 'gut' symptoms as bloating, flatulence, difficult defecation, for which gastroenterologists recommend them as an adjunctive therapy for irritable bowel syndrome.

Probiotic / prebiotic foods and supplements

The best food sources of probiotics are fermented and fermented foods. These include:

• Yogurts, kephir and fermented milk drinks - these are easily digested by the body and do not cause bloating or abdominal pain. These drinks are more beneficial if they contain live active micro-organisms, so it's better to make them yourself - for example, with a special bacterial starter;
• pickled cabbage - few people suspect that this tasty fall and winter snack is one of the probiotic products, but it's true. It's also high in fiber, vitamins and minerals;
• miso - a fermented paste made from soybeans, often used in Japanese dishes (such as soups)
• tempeh - another fermented soy product, rich not only in probiotics but also in protein
• Kimchi is a spicy savory snack made from fermented vegetables (cabbage and radish);
• some cheeses - such as Gouda, Cheddar and Mozzarella - made by fermentation may contain probiotics.

Natural prebiotics are:

• onion (inulin);
• leek and asparagus (inulin + prebiotic fiber);
• garlic (inulin + fructooligosaccharides);
• chicory (inulin);
• bananas (resistant starch, especially abundant in unripe bananas)
• apples (pectin);
• oats and barley (beta-glucans);
• pumpkin, beans and other legumes (high in fiber);
• sweet potatoes or yams (fiber + resistant starch).

Bowel preparations and supplements

Pharmacies in any country usually have an impressive range of pro-, pre- and even synbiotics. These may be medicines or food supplements from different pharmaceutical manufacturers.

On the internet, people are often interested in how to choose the best probiotic or prebiotic, sharing their experience and the names of specific preparations. However, you shouldn't rely on other people's experience - a remedy that helps one person is very often ineffective for another.

Popular medications for restoring gut health:

• Probiotics - Enterogermina, Lacium, Biogaya, Linex;
• prebiotics - Lactulose, Dufalac, Inulin;
• synbiotics - Probiotic with prebiotic Mason Natural, Symbiolact Compositum, Lactiale.

BioGaia Protectis Baby, drops for children, bottle, 5 ml

£12.60

Buy

Linex Forte, 28 capsules, Sandoz

80

£12.70

Buy

Lacium JUNIOR 25 billion CFU, 10 capsules, Zdrovit

28

£6.10

Buy

Inulin FOS powder, 120 g, Zenyth

6

£8

Buy

SymbioLact Comp, 2 gx 30 sachets

£29.40

Buy

When choosing pro- or prebiotics for your child, it's important to consider a number of factors:

• Age - the "probiotic" needs of children of different ages may be different. For example, infants and toddlers are better suited to Bifidobacterium and Lactobacillus to support the digestive and immune system, while older children may benefit from other strains.
• dosage form - powders and drops are usually prescribed for young children, while chewable tablets and capsules are prescribed for older patients;
• purpose of therapy - depending on the diagnosis (antibiotic-associated diarrhea, prevention of necrotizing enterocolitis, functional constipation, strengthening immunity, treatment of allergic diseases), different strains of bacteria are used. For example, Saccharomyces boulardii is effective for the prevention of antibiotic-associated diarrhea, Lactobacillus rhamnosus GG for the treatment of acute stool disorders, Bifidobacterium infantis for the development of microflora in newborns .

You should not select a probiotic for your child yourself, this should be done by a pediatrician.

How to choose a quality probiotic:

• only buy the product from a pharmacy;
• pay attention to the CFU (colony forming units / number of live bacteria in the preparation) - this indicator ranges from 1-10 to 50 billion and more;
• consider the composition - preparations containing more than one strain have different effects on the body and may be more effective;
• check the drug's resistance to aggressive gastric juices - for example, capsules should have a special protective coating.

How to take probiotics and prebiotics

Dosages and duration of probiotics depend on the underlying diagnosis and treatment goals.

For example, to maintain gut health, the product is given at a dose of 1-5 billion CFU over a long period of time, while higher doses of 10-20 billion CFU may be needed for recovery after antibiotics. When treating irritable bowel syndrome or other specific gastrointestinal diseases, gastroenterologists sometimes increase daily doses of probiotics even further and recommend their long-term administration.

General recommendations on the duration of probiotics:

• prevention of intestinal diseases - up to 3 months;
• recovery from antibiotics - for at least 2 weeks after completion of antibiotic therapy;
• chronic gastrointestinal problems - the course of treatment may last six months or even longer.

Tips for taking probiotics and prebiotics together:

• when taking probiotics as dietary supplements, prebiotics can be obtained with food (the list of "prebiotic" products is described above);
• this therapy should be combined with a healthy diet;
• it is important to take them regularly (e.g. probiotics should preferably be taken at the same time);
• treatment with prebiotics requires sufficient drinking, otherwise intestinal problems will worsen;
• probiotics should be taken with meals or as recommended; the efficacy and tolerability of prebiotics are not affected by food;
• the duration of taking probiotics and prebiotics for the same condition (e.g. antibiotic-associated diarrhea) may vary, so consult your doctor in advance;
• if both probiotics and prebiotics are needed as food supplements/medicines - it is more convenient to take synbiotics.