Probiotics and prebiotics: how to support intestinal health

Probiotics and prebiotics are popular means for treating intestinal diseases, which are widely used in their practice by family physicians, therapists, 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 composition, but also in the mechanism of action, as well as indications for use.They can be bought in a pharmacy and “found” in ordinary food products.About what probiotics and prebiotics are, how useful they are for the intestine and how to choose the best for adults and children - read in our article.

What are probiotics and prebiotics?

Probiotics are live microorganisms that can be useful for the body if administered in adequate amounts. Their second name is eubiotics. Commonly used probiotics are:

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

Please note: certain types of lactic acid bacteria (including lactobacilli) are used not only for healing the body, but also for fermenting food to help extend its shelf life. Examples of fermented foods are yogurt, kefir, sauerkraut, 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 dietary substances, usually represented by non-starchy carbohydrates (oligosaccharides and polysaccharides). They are often found in foods, but can also be synthetic (e.g., lactulose).

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

In addition, prebiotics are fermented by colonic bacteria to 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. They also include fructooligosaccharides (FOS), galactooligosaccharides (GOS), and soy oligosaccharides.

Despite their different mechanisms of action, prebiotics and probiotics share the same function - maintaining microflora balanceandgut health. That is why special combination products - synbiotics - were created to simplify their work . They contain both components, the beneficial effects of which, respectively, are summarized.

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

With the main beneficial effects of probiotics are familiar, perhaps, everyone. They improve digestion by restoring normal intestinal microflora, especially after taking antibiotics. Once settled in the GI tract, lacto- and bifidobacteria grow, multiply and displace pathogenic bacteria from the intestines. They can reduce flatulence and bloating, as well as provide some relief from 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 defenses. Although the primary function of the gut 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 genital system - more specifically, on the vaginal microflora. Bacterial vaginosis and candidiasis (thrush) are typical manifestations of vaginal dysbacteriosis. And while certain medications are used to treat it (e.g., antifungal agents), probiotics also play an important role in restoring vaginal microflora;
• Supporting skin health. Dermatologists use probiotics as an aid in the treatment of acne, eczema and rosacea;
• Improving mental health. It 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 are already being made to use probiotics as adjunctive therapy for depression and anxiety. Their efficacy has been noted in some studies, but now requires more conclusive confirmation;
• Normalization of cholesterol levels (healthy gut microbiota may have an indirect effect on lipid profile by reducing levels of bad cholesterol);
• Weight control. The effects of certain probiotics (e.g., Lactobacillus gasseri) on metabolism and body weight are currently being studied. Preliminary evidence suggests they may be able to 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 be used to prevent some intestinal diseases - such as irritable bowel syndrome - although these properties still need to be confirmed.

Probiotics and prebiotics to improve intestinal function

While the usefulness of probiotics and prebiotics for immunity is only being studied, they have been used for intestinal disorders for many years. Back in the last century, Ilya Mechnikov suggested that lactic acid bacteria improve the health of the intestines and the entire body, prolonging its longevity. Alfred Nissle isolated a non-pathogenic strain of E. coli, and French pediatrician Tissier isolated bifidobacteria (Bacillus bifidus) and suggested their use for treating 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 disorder in rotavirus infection);
• irritable bowel syndrome (as an adjuvant);
• 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 bacterium, but may reduce the side effects of combined antibiotic therapy;
• functional constipation in children and the elderly.

In addition, neonatologists use probiotics to prevent the development of necrotizing enterocolitis in premature newborns.

Prebiotics (especially lactulose) are widely used for the treatment of constipation in children and adults. They are most effective in functional disorders of intestinal motility. Also, together with probiotics, these agents are used to restore normal intestinal microflora.

Prebiotics effectively reduce such unpleasant “intestinal” symptoms as bloating, flatulence, difficult defecation, in this regard, 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, kefirs and fermented milk drinks - they are easily digested by the body and do not cause bloating or abdominal pain. These drinks are most beneficial if they contain live active microorganisms, so it is better to make them yourself - for example, with the help of special bacterial starter;
• sauerkraut - few people suspect that this delicious fall and winter snack refers to products with probiotics, but it is true. It's also high in fiber, vitamins and minerals;
• miso - a fermented paste made from soybeans, it is often used in Japanese dishes (such as soups);
• tempeh - another fermented soybean product, rich not only in probiotics but also in protein;
• kimchi - it is familiar to all lovers of Korean cuisine. Kimchi is a spicy tasty appetizer made from fermented vegetables (cabbage and radish);
• some cheeses - like Gouda, Cheddar and Mozzarella - made by fermentation may contain probiotics.

Natural prebiotics are:

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

Intestinal drugs and supplements

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

On the Internet, people are often interested in how to choose the best probiotic or prebiotic, sharing experiences and names of specific drugs. However, you should not rely on other people's experience - a remedy that helps one person is very often ineffective in 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

10

13.80 €

Buy

Linex Forte, 28 capsules, Sandoz

13.90 €

Buy

Lacium JUNIOR 25 billion CFU, 10 capsules, Zdrovit

8.30 €

Buy

Duphalac Fruit 667 mg / ml x 1 vial x 200 ml oral sol.

6.60 €

Buy

Solaq Lactulose, syrup, 500 ml

11.40 €

Buy

Inulin FOS powder, 120 g, Zenyth

4

8.70 €

Buy

SymbioLact Comp, 2 gx 30 sachets

33.30 €

Buy

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

• Age - the “probiotic” needs of children of different ages may differ. For example, infants and toddlers are more 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, immunity strengthening, treatment of allergic disease), different strains of bacteria are used. For example, for the prevention of antibiotic-associated diarrhea are effective Saccharomyces boulardii , treatment of acute stool disorder - Lactobacillus rhamnosus GG, development of microflora in newborns - Bifidobacterium infantis.

Do not choose a probiotic for your child yourself, it should be done by a pediatrician.

How to choose a quality probiotic:

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

How to take probiotics and prebiotics

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

For example, to maintain gut health, the drug is taken 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 to recover from antibiotics. When treating irritable bowel syndrome or other specific GI diseases, gastroenterologists sometimes increase daily dosages of probiotics even further and recommend taking them long-term.

General recommendations for 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 can last six months or even longer.

Tips for taking probiotics and prebiotics together:

• when taking probiotics in the form of dietary supplements, prebiotics can be obtained with food (the list of “prebiotic” products is described above);
• this therapy must 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, and the effectiveness and tolerability of prebiotics are not affected by food;
• the duration of pro- and prebiotics for the same condition (e.g., antibiotic-associated diarrhea) may vary, so you should consult your doctor before taking them;
• if both probiotics and prebiotics are needed as dietary supplements/medications, it is much more convenient to take synbiotics.