A Beginner’s Guide to Prebiotic Use

If you’ve been following health trends lately then you probably have some degree of confusion – even frustration – regarding where to begin when making health changes.

I get it.

“Should I fast? Maybe I should do the ketogenic diet… But what about all the great benefits of juicing celery??”

See what I mean?

Well today’s topic is here to stay! And I’ll be trying to help you make sense of it all.

Enter Prebiotics.

In this article I’ll discuss what prebiotics are and what they aren’t. We’ll talk about which foods contain prebiotics and about prebiotic supplements with specific beneficial actions. Finally, we’ll explore what conditions prebiotics might have a big impact on!

But first, let’s define what a prebiotic actually is.

What is a Prebiotic?

The most recent definition of a prebiotic is:

“ A substrate that is selectively utilized by host microorganisms conferring a health benefit”.

That’s a mouthful! Let’s break this down bit by bit.

First, a substrate in this context is anything our bacteria may eat or transform – so basically a food.

Host microorganisms – These are simply the bacteria that normally reside within us!

Selectively. This implies that only specific bacteria are able to use these foods. Pathogenic or harmful bacteria, for example, cannot consume prebiotics. If they can, then the substance is not a prebiotic!

The last part: “conferring a health benefit” simply means that in order to meet the criteria of being a prebiotic, it must provide a health benefit for us, the host.

These benefits are plenty and may include increasing the strength or response of our immune system during the winter. It could simply mean decreasing pathogenic or “bad” bacteria in the gut. It could also mean improving our mood!

We’ll talk more about this exciting research later!

Unlike probiotics, which I wrote about in my last article, prebiotics are food your healthy gut bacteria use to strengthen themselves and the environment around them.

To really see what I’m talking about let’s use a simple analogy to explore the differences between probiotics and prebiotics.

Imagine a Garden…

In this garden, probiotic species represent the plants. Prebiotics are like the soil. Just like soil provides a proper environment for plants to grow, prebiotics do the same for our gut bacteria. This keeps our good bugs happy and in turn, keeps us happy.

Hopefully I didn’t lose you there.

Let’s take that simple comparison further and consider what would happen if we neglected to use good quality soil and just invested in beautiful plants. Well the plants, beautiful as they are, would eventually wither and die due to poor soil quality.

So instead of continuing to buy beautiful plants, wouldn’t it make more sense to buy some high-quality soil first?

If you read my article on probiotics then you know that probiotics often don’t stay around for long.

So If we only use probiotics and don’t focus on our own “soil” and nurturing the bacteria we already have with prebiotic foods, then we’re missing the big picture.

Where Can We Get Prebiotics?

I used to think prebiotics were just fiber containing foods. While this was on overly simplistic view, many fiber-containing foods do have significant prebiotic effects.

White or whole-wheat bread on the other hand has little prebiotic content. Sorry guys!

Beyond simply eating your bran in the morning, there are far more healthy foods that are considered prebiotics!

Let’s start with the type of foods that contain prebiotics.

Breastmilk – The Original Superfood?

Breastmilk contains human milk oligosaccharides (HMOs), which are important prebiotics that are consumed when baby breastfeeds. They feed babies’ bacteria and are critical to helping them build a strong immune system.

No need to fret if you can’t breastfeed, as many formulas now contain HMOs. Although breastfeeding should be encouraged as much as possible, the addition of HMO to formulas has been shown to improve the immune system of formula-fed babies to the same degree as their breast-fed counterparts!

Polyphenols: Eat the Rainbow!

Polyphenols are plant compounds found in green tea, grapes, chocolate, blueberries and basically any other colourful food. Bacteria feed on these and in turn transform them into other compounds that have significant health benefits.

Paint your plate with as many different coloured vegetables and fruits as you can.

Food for thought:  Antibiotics, because they wipe out our bacteria, will affect our ability to extract some of the healthy compounds from plants!

Saccharides:

Many prebiotics include the term –saccharide in their name so it’s worthwhile to take a moment and discuss what this is.

A saccharide is a sugar molecule. When you have a mono- saccharide you have a lone sugar molecule (ex: glucose). Most prebiotics are oligo-saccharides meaning they are composed of a short group of sugars bound to one another.

Bacteria love eating this stuff!

To be clear, this is not the same as sugar. In fact, many oligosaccharides may even improve the glycemic response to foods!

Here are some of the superstars in the oligosaccharide family:

Fructo-oligosaccharide (FOS) – Found in foods such as onions, garlic and asparagus. It’s also commonly found in probiotic supplements to support colonization of the bacteria. Be warned though, FOS can be really gas forming. This one might be an experiment worth reserving for weekends!

Iso-malto-oligosaccharides (IMO) – Sometimes used as a sugar replacement, IMO is low-glycemic and has good probiotic effects. It’s sometimes used in manufacturing as a syrup for protein bars and health foods. It’s fairly well tolerated by most.

Galacto-oligosachharide (GOS) – Also found in breastmilk, this prebiotic is foundational for building a healthy intestinal environment for the baby

B-GOS – A slightly modified version of GOS, this proprietary prebiotic supplement has anxiety and stress-reducing benefits! It has also been shown to improve symptoms of gas and bloating in IBS, and improve immunity in the elderly.

Others…

There are many other prebiotics out there but I’ll highlight some of the more important ones according to the research:

Resistant starch – most commonly found in starchy vegetable like potatoes and sweet potatoes. Resistant starch has anti-diabetic and blood sugar lowering benefits! Try purple sweet potatoes to get plenty of resistant starch and polyphenols!

Pro-tip: cooking then cooling your potatoes will increase the amount of resistant starch in them. Your bacteria will thank you!

Partially Hydrolyzed Guar Gum (PHGG) – PHGG is a prebiotic supplement designed to improve the effects of guar gum while minimizing the side effects associated with its consumption. PHGG can actually improve symptoms of gas and bloating. It’s considered a low-FODMAP prebiotic and has been shown to improve both diarrhea and constipation!

Oats – Oatmeal is a great source of beta-glucans, which are food for bacteria and immune cells. Also a great vehicle for delivering other prebiotic powders – if you’re feeling bold!

Xylitol – a great natural sweetener derived from hardwood trees. Xylitol has shown some good prebiotic effects. In fact, xylitol is an effective agent at preventing the recurrence of ear infections in children by modifying the immune system in the ear canals! It also goes well in your coffee too, just saying. Quick Caution: Xylitol is very toxic for dogs so make sure you’re careful!

Lactulose – Considered a pharmaceutical in North America, lactulose is a prebiotic that is used to treat constipation and chronic liver diseases. It’s also a substance used to test for small intestinal bacterial overgrowth (SIBO), which I wrote about here.

You Scratch My Back, I’ll Scratch Yours?

So to summarize: When we feed our gut bacteria prebiotics they grow. In return, they release by-products called metabolites, which then support our health – a win-win!

Prebiotics can significantly promote a healthy gut by reducing gas and bloating, normalizing stool patterns (constipation or diarrhea) and promoting the growth of beneficial bacteria. But the benefits stretch much further than the gut!

The following list is by no means exhaustive but includes some of the health conditions prebiotics have shown to be helpful in:

• Diabetes/Insulin Resistance
• Childhood Obesity
• Chronic liver disease
• Anxiety
• Colorectal cancer prevention
• Childhood ear infections
• After antibiotic usage
• Irritable bowel syndrome (IBS)
• Constipation
• Acute diarrhea

Final Thoughts

Although many people with a digestive disorder like IBS may struggle when they try to add in high-fiber or prebiotic foods in their diet, prebiotics can actually be very effective for symptoms like gas, bloating, diarrhea and constipation.

You just need the right one for the job!

Just a caution: if you start eating Jerusalem artichoke, and high amounts of other inulin-containing foods that you’re not use to then don’t be surprised if you get hit with gale force winds and gripping abdominal pain. Not a fun experience…trust me.

As a general rule, I tell my patients to start slow and to monitor symptoms closely. Increasing the dosage carefully over time has been a helpful strategy.

Not everyone will respond positively to all prebiotics – that’s a guarantee! But if you have a fairly restricted diet as it is then adding in a good prebiotic can be an excellent strategy and may even allow you more flexibility in your diet in the future. When in doubt, consult a healthcare practitioner.

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References:

Clark, Michelle J., Kim Robien, and Joanne L. Slavin. “Effect of prebiotics on biomarkers of colorectal cancer in humans: a systematic review.” Nutrition reviews 70.8 (2012): 436-443.

Gibson, Glenn R., et al. “Expert consensus document: The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of prebiotics.” Nature Reviews Gastroenterology and Hepatology 14.8 (2017): 491.

Goehring, Karen C., et al. “Similar to Those Who Are Breastfed, Infants Fed a Formula Containing 2′-Fucosyllactose Have Lower Inflammatory Cytokines in a Randomized Controlled Trial–4.” The Journal of nutrition 146.12 (2016): 2559-2566.

Kim, Y. A., J. B. Keogh, and P. M. Clifton. “Probiotics, prebiotics, synbiotics and insulin sensitivity.” Nutrition research reviews 31.1 (2018): 35-51.

Nicolucci, Alissa C., et al. “Prebiotics reduce body fat and alter intestinal microbiota in children who are overweight or with obesity.” Gastroenterology 153.3 (2017): 711-722.

Vulevic, Jelena, et al. “A Mixture of trans-Galactooligosaccharides Reduces Markers of Metabolic Syndrome and Modulates the Fecal Microbiota and Immune Function of Overweight Adults1–.” The Journal of nutrition143.3 (2013): 324-331.

Vulevic, Jelena, et al. “Effect of a prebiotic galactooligosaccharide mixture (B‐GOS®) on gastrointestinal symptoms in adults selected from a general population who suffer with bloating, abdominal pain, or flatulence.” Neurogastroenterology & Motility 30.11 (2018): e13440.