Prebiotics, probiotics and symbiotics
Prebiotics, probiotics and symbiotics
There is no need for a complete change in diet to induce a shift in the composition of the gut microbiota. It is also possible to eat specific nutrients to favor certain microbes above others, or introduce new microbes to the gut. This is exactly what is done with respectively prebiotics and probiotics. Then there is a third possibility, the use of symbiotics, which is actually just the combination of pre- and probiotics. There is however way less documented about the use of symbiotics.
Prebiotics
Prebiotics are
nutrients that are not digestible by the host, typically fibers and polysaccharides,
that stimulate the growth of the microbiota (namely lactobaccili and
bifidobacteria). The prebiotics should be able to survive the way to the gut,
so resist gastric acid and hydrolysis by enzymes. Another requirement is that
they should be fermented by gut microbiota and selectively stimulate the growth
or activity of beneficial microbiota. The most commonly used prebiotics are
inulin, fructooligosaccharides, falactooligosaccharides, lactulose and
polydextrose [5].
Probiotics
Probiotics are believed to be live organisms that give a health benefit when
they are administered in adequate amounts. Probiotics are selected on their capacity to survive
their way through the digestive system, on their ability to adhere to
epithelial cells and they should be able to inhibit (the effects of) pathogens [8]. There are lot of probiotics available on the free market, Yakult or
Actimel are examples of them. But it does not have
to be a dairy drink, probiotics are available in a variety of forms: capsules
of freeze-dried cultures, heat-dried culture supernatants or mixed in foods
(yogurt, cheese, kefir, chocolate, wafers).
How does it work?
The rationale behind
probiotics is that through administration of new microbes, you increase the
diversity of your gut microbiota and increase the amount of beneficial strains
in the gut. Commonly used strains are lactobacilli and bifidobacteria for their
ability to produce short-chain fatty acids (SCFAs) [2], which are linked with health benefits. But they are also used because they
can resist industrial process [8]. Another beneficial effect of the gut
microbiota was the production of vitamins [2,8]. You could of course select
specific strains for their ability to produce certain vitamins. Most
lactobacilli and bifidobacteria are not able to produce vitamins, but there is
increasing amount of evidence that certain strains of these two groups are able
to produce vitamins. One of those strains is L. rhamnosus GG, which is able to synthesize B1, B2 and B9 [2].
What is it used for?
The use of probiotics
for prevention and treatment of disease is rapidly increasing. Studies have shown positive results in multiple
diseases, like IBS. They were able to show a significant improvement in
symptoms in a trial where they used a multi-strain probiotic in
diarrhea-predominant IBS patients [1]. Another indication where probiotics
might be used for, is the prevention of Clostridium
Difficile infection in patients receiving antibiotics [4].
Dutch researcher Remco Kort recently published a guide for the use of probiotics in prevention of antibiotic-associated diarrhea, in which he provides a list of probiotics with recommendations based on evidence from 32 trials [7].
However, not all studies point at the same direction. One study of Suez et al., 2018 suggest that probiotic use for prevention of antibiotic-associated dysbiosis might not be that beneficial. They even implicate that gut mucosal microbiome reconstitution after antibiotic use is impaired by probiotics. They did find an effective alternative: an autologous fecal microbiota transplantation (FMT) (link naar FMT) [9]. This shows that there is still a lot to learn about probiotics and if it really is that beneficial.
Symbiotics
One of the big upsides
of using symbiotics, is that the probiotic strain you introduce immediately has
nutrients to metabolize. This has been described in a study where they used Lactobacillus rhamnosus strain GG (LGG)
in combination with a prebiotic. They showed that this strain was able to
metabolize this prebiotic leading to SCFAs production [2].
Written by Pepijn Gossink
posted on 14 oct 2018
[1] Ishaque SM, Khosruzzaman SM. A randomized placebo-controlled clinical trial of a multi-strain probiotic formulation (Bio-Kult) in the management of diarrhea-predominant irritable bowel syndrome. BMC Gastroenterology 2018
[2] LeBlanc JG, Chain F et al. Beneficial effect on host energy metabolism of short-chain fatty acids and vitamins produced by commensal and probiotic bacteria. Microbial Cell Factories 2017
[3] Landete JM, Pilar G. Probiotic bacteria for healthier aging: immunomodulation and metabolism of phytoestrogens. BioMed Research International 2017
[4] Goldenberg JZ, Dominik M et al. Probiotics to prevent Clostridium difficile infection in patients receiving antibiotics. JAMA 2018
[5] Patel S, Goyal A. The current trends and future perspectives of prebiotics research: a review. Biotech 2012
[6] Anadón A, Martínez-Larrañaga MR et al. Probiotics: safety and toxicity considerations. Nutraceuticals 2016
[7] Agamennone V, Krul CAM, Rijkers G, Kort R. A practical guide for probiotics applied to the case of antibiotic-associated diarrhea in The Netherlands. BMC gastroenterology 2018
[8] Derrien M, Veiga P. Rethinking diet to aid human-micro symbiosis. Trends in Microbiology 2017
[9] Suez J, Zmora N et al. Post-antibiotic gut mucosal microbiome reconstitution is impaired by probiotics and improved by autologous FMT. Cell 2018