By Whitney Crouch, RDN, CLT

Probiotics. We’ve all heard the buzzword, and many are now familiar with the term the “good guys” in the gut…but what do they do? What are they, exactly?

Do prebiotics act alongside probiotics?
How are they beneficial to the host or their gut microbiota? These are questions that have been explored recently, and the answers are only the beginning of where the science of prebiotics and probiotics will go.

Probiotics

• It has been known for some time that the human body is inhabited by at least 10 times more bacteria than the number of human cells in the body, and that the majority of those bacteria are found in the human gastrointestinal tract.1-2
• According to the Food and Agriculture Organization of the United Nations (FAO) and the World Health Organization (WHO), probiotics are “live microorganisms which when administered in adequate amounts confer a health benefit on the host.”3
• Health benefits have mainly been demonstrated for specific probiotic strains of the following genera: Lactobacillus, Bifidobacterium, Saccharomyces, Enterococcus, Streptococcus, Pediococcus, Leuconostoc, Bacillus, Escherichia. Health benefits are strain- and dose-specific and include a wide range of support including (but not limited to) skin, gut, immune, and vaginal health.4
• The body of scientific evidence is growing rapidly to support the use of probiotics in health management, including approaches to increase the efficacy of probiotics. One such method is using prebiotics at the same time.

Prebiotics

• In 2016, a panel of experts convened to update the definition of prebiotics—substrates that are selectively utilized by host microorganisms conferring a health benefit.5 Prebiotics are more diverse than you may know, including certain kinds of fats (conjugated linoleic acid [CLA] or polyunsaturated fatty acids [PUFAs]), phenolics, and phytochemicals, to name a few; however, the most well-known and studied prebiotics are typically derived from nondigestible fibers and include a family of compounds called oligosaccharides.
• Prebiotics are not only the familiar carbohydrates that we once knew, like fructans (fructooligosaccharides [FOS] and inulin), galactans (galactooligosaccharides [GOS]), and isomaltooligosaccharides (IMOs);5 the definition has expanded to include new names on the market and even includes human milk oligosaccharides (HMOs), a natural component of human breastmilk.

To be considered a prebiotic, these bioactives need to fit three criteria:5

1. Ability to resist host digestion (for example gastric acidity, hydrolysis by mammalian enzymes, and gastrointestinal absorption)
2. Fermented by intestinal microorganisms
3. Selectively stimulate the growth and/or activity of intestinal bacteria associated with health and wellbeing

The two most investigated prebiotics are fructans and galactans. Fructans include inulin and FOS, which can be found in many common foods, including blue agave, chicory root, garlic, onion, Jerusalem artichokes, leeks, asparagus, dandelion greens, and bananas.6 GOS, a functional alternative to HMOs, are found in infant formulas and are also found in seaweed and legumes like chickpeas, lentils, kidney beans, and green peas.7

Whereas the average dietary fiber supports the health of both the “good” and “bad” microbiota in our guts, prebiotics are more targeted in that they selectively support the microbiota that support the host—the humans or animals that the microorganisms live in.

How do prebiotics work to support probiotics and human health?
Prebiotics are fermented by human gut microbiota (remember: probiotics help colonize the gut with healthy microbes) into short-chain fatty acids (SCFAs) acetate, propionate, and butyrate. SCFAs are increasingly recognized as signaling molecules that mediate the interaction between the diet, the gut microbiota, and the host.8 Locally in the gut, SCFAs serve as energy substrates for cells of the colon and play a role in host metabolism.8-9 A fraction of the colon-produced SCFAs reach the systemic circulation and directly affect the function and metabolism of peripheral organs and tissues, such as the liver, the pancreas, adipocytes, immune cells, and skeletal muscle tissue. Studies show that the permeation of SCFAs throughout the body are involved in maintaining glucose and lipid metabolism and may provide an important target for other facets of health as well.9

There are health benefits to be had for individuals consuming probiotics with prebiotic compounds; however, there may be contraindications for some patients. It should be noted that people with sensitivities to fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) should use caution and consult a knowledgeable healthcare practitioner before incorporating higher amounts of prebiotic foods or supplements.

The market for supplements containing prebiotics or pre-/probiotic combinations and the body of research science supporting their clinical use are both growing, with more discoveries and targeted approaches to be revealed. It’s important to choose high-quality supplements to ensure the best symbiotic relationship between pre- and probiotic strains, which in turn can increase the efficacy of this combination.

References

1. Peterson J et al. NIH HMP Working group. The NIH Human Microbiome Project. Genome Res. 2009;19:2317–2323.
2. Savage DC. Microbial ecology of the gastrointestinal tract. Annu Rev Microbiol. 1977;31:107–133.
3. Hill C et al. Expert consensus document: The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat Rev Gastroenterol Hepatol. 2014;11(8):506-14.
4. Fijan S. Microorganisms with claimed probiotic properties: an overview of recent literature. Int J Environ Res Public Health. 2014;11(5):4745-4767.
5. Gibson GR et al. Expert consensus document: The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of prebiotics. Nat Rev Gastroenterol Hepatol. 2017;14(8):491-502.
6. Korczak R et al. Fructooligosaccharides and appetite. Curr Opin Clin Nutr Metab Care. 2018;21(5):377-380.
7. Muir J et al. Measurement of short-chain carbohydrates in common Australian vegetables and fruits by HPLC. J Agric Food Chem. 2009;57:554-565.
8. van der Beek CM et al. The prebiotic inulin improves substrate metabolism and promotes short-chain fatty acid production in overweight to obese men. Metabolism. 2018;Jun 25:pii: S0026-0495(18)30151-3.
9. Hamer HM et al. Review article: the role of butyrate on colonic function. Aliment Pharmacol Ther. 2008;27:104–119.

Go with Your Gut: A Guide to Probiotics
In recent years, the number of gut-related doctor visits has been as high as 30 million annually.1 And more and more people are turning to probiotics to help support gastrointestinal (GI) health. What many do not know is that these tiny, “friendly” bugs can be beneficial for more than just gut health.

Why Probiotics?
Your body contains a delicate balance of diverse bacteria. Probiotics act as “friendly” bacteria and are an important ally to help support your intestinal ecosystem. It’s important to know, however, that these microscopic organisms do not all share the same personality.

Strain Identification and Why It Matters
Many probiotic formulas on the market are nonspecific about their applications. And that’s no surprise—considering many of these formulas contain organisms that are not strain-identified. This makes it even more difficult to choose the right formula. In fact, only a handful of probiotic strains have been researched extensively.

Make sure you pay attention to the product label, and look for a genus, species, and strain (e.g., Lactobacillus acidophilus NCFM). This should appear as two long Latin words (genus first and species second) followed by a series of capitalized letters and/or numbers (the strain). Keep this tip in mind when you shop for a probiotic formula.

Different Strains for Different “Gains”
There is no one-size-fits-all formula. Scientific evidence has indicated that the effectiveness of probiotics for targeted areas of health support depends on the strain.2 That’s why it’s important to consult your healthcare practitioner before starting a probiotic regimen.

Refer to this quick guide for a better understanding of probiotic strains and their health benefits.
Gastrointestinal health

• Digestive health is the most studied area of probiotic research, and GI support is one of the most common reasons people seek probiotics. Many commercial-grade formulas such as probiotic drinks, yogurts, and other fermented food products claim to benefit gut microbiota. Unfortunately, it’s impossible to know what strains you are receiving in these products if they’re not listed.
• Some strains, such as Bifidobacterium lactis Bi-07® and Lactobacillus acidophilus NCFM®, have been extensively researched to beneficially influence your gut microbiota and act as general maintenance probiotics for gut health.3,4 The yeast Saccharomyces boulardii has been found to help provide targeted relief from acute symptoms—which may be used when you experience occasional digestive distress rather than a probiotic for daily support.5*

Immune health

• A whopping 70% of your immune system is located in your gut.6 Bacteria in the intestine may help regulate immune cell activity, 7 which allows probiotics to be potentially helpful for supporting immune function.
• Although it is commonly believed that probiotics exert their benefits by directly impacting gut composition and supporting the physical gut barrier, the interaction between these friendly bugs and immune cells also deserves a special note.8*

Weight maintenance

• Body weight maintenance is an important consideration for any lifestyle.9 Clinical research on probiotic strain Bifidobacterium lactis B-420™ has indicated it may help contribute to body weight maintenance.10*

Children’s health

• Children can also benefit from probiotics. Probiotic strains like Bifidobacterium animalis ssp. lactis BB-12® and Lactobacillus rhamnosus GG® have a long history of use in infants. And for children, Lactobacillus acidophilus NCFM® and Bifidobacterium lactis Bi-07® have been shown to help support healthy immune function.11*

Women’s health

• Clinically researched strains Lactobacillus rhamnosus GR-1® and Lactobacillus reuteri RC-14® may help maintain vaginal microbiota and support urogenital health.12-16*
• Before you decide to start a probiotic regimen, determine the reasons you’d like to start taking one. With so many options on the market, it’s important to pay attention to strain identification and look for proof of scientific research that backs health claims. And remember, your healthcare practitioner is best equipped to recommend protocols that fit your unique health needs.

Submitted by the Metagenics Marketing Team
​
References:

1. https://www.cdc.gov/nchs/fastats/digestive-diseases.htm. Accessed May 1, 2018.
2. McFarland LV et al. Front Med. 2018;5:124.
3. Ringel-Kulka T et al. J Clin Gastroenter. 2011;45:518-525.
4. Leyer GJ et al. Pediatrics. 2009;124:e172-179.
5. Kelesidis T. Therap Adv Gastroenterol. 2012;5(2):111–125.
6. Vighi G et al. Clin Exp Immunol. 2008;153(Suppl 1):3–6.
7. Bermudez-Brito M et al. Ann Nutr Metab. 2012;61(2):160-174.
8. https://isappscience.org/infographic-dispelling-myths/. Accessed April 13, 2018.
9. Loman T et al. BMC Public Health. 2013;13:259.
10. Stenman LK et al. EBioMedicine. 2016;13:190-200.
11. Leyer GJ et al. 2009;123(2):172-9.
12. Reid G. Appl Environ Microbiol. 1999;65(9):3763-3766.
13. Reid G et al. FEMS Immunol Med Microbiol. 2001;32(1):37-41.
14. Reid G et al. J Med Food. 2004;7(2):223-228.
15. Reid G et al. FEMS Immunol Med Microbiol. 2003;35(2):131-134.
16. Reid G et al. FEMS Immunol & Med Microbiol. 2006;30(1):49-52.

• NCFM® are Bi-07® are registered trademarks licensed by DuPont.
• BB-12® is a registered trademark of Chr. Hansen A/S.
• LGG® is a registered trademark of Chr. Hansen.

by Noelle Patno, PhD

For mild and occasional diarrhea, consider these approaches:

1. Diet. Mild diarrhea is accompanied by an inherent fluid loss, so it’s important to stay hydrated. Maintaining adequate water intake helps to ensure the diet is balanced and supports gastrointestinal health. The BRAT diet (bananas, rice, applesauce, and toast) has commonly been recommended to alleviate symptoms of diarrhea but is unnecessarily restrictive and does not provide adequate nourishment.1Loss of electrolytes is a major consequence of diarrhea, and replenishing these vital substances is critical to regain and maintain normal body functioning. Magnesium, calcium, sodium, and potassium are commonly depleted along with the fluid loss of diarrhea. Magnesium-rich foods like leafy greens (arugula, spinach, Swiss chard) and seeds (pumpkin, sesame, flaxseed, sunflower), tahini, summer squash, okra, salmon, beans, and cacao will help to replace the magnesium loss experienced with diarrhea, but if consumed in excess, they may actually promote excessive flow. Calcium-rich foods, such as dairy items, green leafy vegetables including kale, almonds, pistachios, blackstrap molasses, broccoli, figs, tofu, and sea vegetables or calcium-fortified foods can be increased in the diet relative to the magnesium-rich foods as one potential strategy.2Additionally, potassium-rich foods help with hydration, while sodium affects the extracellular water balance. Modulating the intake of potassium-rich foods (bananas, spinach, cantaloupe, carrots, beets, tomatoes, and others) versus sodium-rich foods (salt, processed foods, soups, sauces, soda, and pickled and cured foods) may improve gastrointestinal motility.2
2. Bentonite clay, activated charcoal, bismuth (commonly known as Pepto-Bismol®), fiber, and bile acid-binding resins. These compounds often can help fluid loss and intestinal cramping by working to absorb toxins and excessive fat but are temporary aids providing symptomatic relief.3 Assessing the sources of the toxins (bacteria) and fat (diet) and addressing underlying causes is beneficial in the long term. For example, if an unbalanced diet is the cause, then the approach would be to balance the fat, fiber, and mineral intakes to promote more normal and regular bowel movements.
3. Probiotics. Strong evidence exists to support the consumption of probiotics for gastrointestinal comfort and function.4 A recent meta-analysis determined that the efficacy of probiotics is strain-specific.5 While a universal consensus is lacking, healthcare practitioners can evaluate a whole patient’s unique situation to personalize their recommendations.

In conclusion, proper hydration, diet, and supplemental strategies may be an approach to consider for mild diarrhea cases. For severe or persistent diarrhea, contact your healthcare practitioner.

References:

1. King KC et al. Centers for Disease Control and Prevention. MMWR Recomm Rep. 2003;52:1-16. https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5216a1.htm. Accessed August 13, 2018.
2. Koff A. Integrative Gastroenterology. Mullin G. New York, NY: Oxford University Press, Inc; 2011.
3. Bonis P et al. Rutgeerts P and Grover S. www.uptodate.com. Topic last updated June 5, 2017. Accessed July 23, 2018.
4. Vitetta L et al. Inflammopharmacol. 2014;22(3):135-154.
5. McFarland et al. Frontiers in Medicine. 2018;5.

By Noelle Patno, PhD

If you’re having trouble with that more substantive trip to the restroom, there may be some simple behavioral habits to implement to resolve your issues. Most of the popular press, common opinion, or typical Google searches may suggest that constipation is difficulty in producing stool, having infrequent stool, or having hard and small stool, caused by 1) dehydration, 2) lack of fiber in the diet, or 3) a sedentary lifestyle. However, there may be more lifestyle reasons for consideration when there is an interruption in the motility of the intestine.2 Let’s examine in more detail common causes of what we may consider mild and occasional constipation.

Common causes of constipation

1. Dehydration. We all know we need water for daily life. It’s necessary for general health, especially when it’s hotter and as you perspire and lose more water. If you are dehydrated, the body may not have enough fluid for proper intestinal transit.
2. Electrolyte imbalance. Minerals are critical for the muscular function of the intestine to contract and relax. Calcium aids in contraction, and magnesium aids in relaxation. The intestine may be more likely to constrict rather than relax if your diet contains an imbalance of these combinations, such as excessive dairy, almond, pistachio, broccoli, or green leafy vegetables. Yes, there is such a thing as too much superfood kale, which has more calcium than magnesium in it! However, there is more potassium than sodium in kale3 (calcium-rich diet) versus magnesium-rich foods (leafy greens like arugula, spinach, Swiss chard, seeds, tahini, summer squash, okra, salmon, cacao). Additionally, sodium versus potassium levels will affect hydration levels; a potassium deficiency and sodium-rich diets (processed foods, soups, sauces, soda, pickled and cured foods like hot dogs, jerky, and adding salt) may lead to dehydration.2
3. Lack of fiber in the diet. Typically, people do not take in enough fiber, according to governmental guidelines and NHANES 2009-2010 data.4 The observation was that the average daily intake is 16 g/day, which is almost half the recommended intake.4 More than 70% of population do not consume vegetables or fruits, which are great sources of fiber, at the recommended dietary intake. Furthermore, the majority of people overconsume saturated fat, added sugars, and sodium,5 all of which may possibly contribute to imbalances in the overall digestive process. Fiber is known to add bulk to the intestinal contents,6 promoting flow through the intestine; the movement occurs from high- to low-pressure areas.
4. Lack of exercise. In the U.S., approximately 80 percent of adults fail to meet recommended physical activity guidelines,5 which may be a common reason for constipation. Exercising promotes blood flow and overall activity in the body, placing further demands on energy expenditure; the additional movement can promote the activity of the intestine as well. Why would your body want to hold on to extra weight in the intestine if you’re moving? It’s just like having all that junk in the trunk of your car—you’ll move faster without it.
5. Supplements and medications. Certain vitamins and minerals can impact bowel motility. For instance, iron supplementation can contribute to constipation, whereas concurrent intake of vitamin C intake may help with absorption of iron, thus minimizing its ability to cause constipation.2 Certain drugs can also cause constipation (check the labels of your medications or ask your doctor if you are taking medications that can cause constipation and what you can do to mitigate the side effects).

If you suffer from occasional or mild constipation, this list of contributing lifestyle factors might be worth a look. As always, you should discuss any concerns you may have with your healthcare practitioner.

References:

1. Haug TT et al. Are anxiety and depression related to gastrointestinal symptoms in the general population? Scand J Gastroenterol. 2002;37(3):294-298.
2. Koff A. Nutrition Strategies for the Treatment of IBS and the Prevention of Digestive Complaints. In: Integrative Gastroenterology. Mullin G. New York, NY: Oxford University Press, Inc; 2011.
3. Basic Report on Nutrient data for Kale, raw, 11233. USDA National Nutrient Database for Standard Reference Legacy April 2018 Software v.3.9.4.5 2018-07-24. https://ndb.nal.usda.gov. Accessed August 13, 2018.
4. S. Department of Health and Human Services and U.S. Department of Agriculture. 2015–2020 Dietary Guidelines for Americans. 8th Edition. December 2015. Available at http://health.gov/dietaryguidelines/2015/guidelines/. Accessed August 10, 2018.
5. Institute of Medicine. 2005. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington, DC: The National Academies Press.
6. Tungland BC, Meyer D. Nondigestible Oligo- and Polysaccharides (Dietary Fiber): Their Physiology and Role in Human Health and Food. Comprehensive Reviews in Food Science and Food Safety. 2002;1(3):90-109.