prebiotic

Probiotics. Are they all the same?

We all know that probiotics are great for digestive health, but how do you know which one your gut needs? The bottle lists the various species of bacteria (or yeasts) contained within and offers a vague description of what they do, which really doesn’t give away a lot unless you know what to look for! This article is all about what to look for in a probiotic and in addition, I will dispel some common myths about how they work.

Let’s start basic. What is a probiotic?

The World Health Organisation officially defines a probiotic as “live microorganisms which when administered in adequate amounts confer a health benefit on the host” (1). Probiotics can be bacteria, such as the commonly seen Bifidobacterium or Lactobacillus species, or yeasts such as Saccharomyces boulardii. You will find probiotics in health food stores, chemists and health clinics, sold as capsules or powders, either alive or freeze dried (alive, but sleeping). Proper storage of probiotics is essential in ensuring they are still alive and healthy by the time they reach your gut, so always follow the storage instructions on the bottle and be mindful when transporting your probiotics.

How do probiotics work?

Myth number 1 – probiotics permanently make our gut their new home. It is a common misconception that we take probiotics to replace healthy bacteria that have been lost, for example, following antibiotic treatment or during times of stress. Probiotics work their magic while they are in transit through our gut and are eventually flushed with the stool (2). They may stay in there a bit longer than our food, but it isn’t forever.

Myth number 2 – all types of probiotics fight off bad bugs. Many (not all) probiotics do have the ability to compete with bad bugs and stop them from taking over, however the beneficial action of probiotics goes far beyond (3). Additional examples of how they work includes:

  • Reducing inflammation in the gut
  • Speeding up or slowing down the time it takes for food to travel along the digestive tract
  • Reducing how sensitive our gut is to internal gas
  • Repair and strengthen the gut lining
  • Interacting with immune cells (think allergies as well as infections)
  • Influence intestinal secretions
Naturopath in Melbourne

Why are probiotics named the way they are?

As probiotics are living organisms, they are given latin names just like all plants and animals. In order to differentiate probiotics, you need to understand the terminology around their naming. I will use an example of the probiotic bacteria Lactobacillus rhamnosus GG.

  • The first word is the genus – Lactobacillus
  • The second word is the species – rhamnosus
  • At the end of the latin name is the strain – GG

The strain may be a combination of letters, numbers or both.

How important is the strain?

The strain is very important when it comes to treating a particular complaint or condition. You could compare strains of probiotic to breeds of dog – all dogs are the same species, but they come in a range of shapes, colours and designs. Likewise in probiotic species, different strains can have a different effect in our guts (1). For example, some strains of Escherichia coli cause intestinal or urinary tract infections, whereas the strain Escherichia coli Nissle 1917 is protective against infections (4).

The strain is commonly omitted from probiotic labels and left out of the discussion when talking probiotics. A good quality probiotic will always include the strain, just like a good clinical trial (a human study) will always state which strain has been tested. Unfortunately, many strains that have been studied are not yet available in Australia.

Which probiotic should I take?

If you wish to treat a specific health condition with probiotics, it is best to do your research and find some positive human studies, then use the same strain. It may be more expensive, but at least you can be sure your money is going into something that will work. There are many articles out there on probiotics, particularly in treating digestive, skin and immune issues such as IBS, traveller’s diarrhoea, inflammatory bowel conditions, asthma and eczema(5).

To give you a few examples, Lactobacillus plantarum CJLP133 can reduce the severity of eczema (6). Lactobacillus rhamnosus GG and Bifidobacterium breve Bb99 can increase the eradication rate of Helicobacter pylori, an infection that causes stomach ulcers (7). At Narayani Wellness, we use Bifidobacteria lactis HN019 to treat SIBO, just one of the probiotics that we keep in our supplement toolbox.

If you are healthy and just looking for a probiotic to support general health, my recommendation is to get stuck into some fermented foods, such as yoghurt, kimchi, sauerkraut, kefir or kombucha. Strictly speaking, fermented foods are not considered a probiotic as the exact microorganisms are typically not known, nor can they be measured. However fermented foods that have been stored correctly are considered safe and beneficial to consume as they increase overall diversity in the gut when consumed regularly, which has been linked to a lower incidence of disease (5). Fermented foods also contain compounds that help to break down your food and keep your digestion working optimally.

If you are still unsure, take the hard work out of your shopping and make an appointment with us today to help find the right probiotic for you.

By Lucy Mason, Naturopath

Are prebiotics good or bad in SIBO?

Since my previous blog about IBS and SIBO I have had so many questions from my patients wanting to know more about SIBO. What stands out to me the most is a confusion around what to eat, with the most common questions surrounding prebiotic, fibre rich foods and if they help or hinder SIBO.

 

What is a prebiotic food and what does our gut do to it?

A prebiotic is a non-digestible food ingredient that it is not broken down or absorbed in the higher parts of our gastrointestinal tract(1). There are a lot of foods with prebiotic properties including chickpeas, legumes, leeks, rye bread, garlic and cashews(2). They play a special role in our health - they act as food to our gut's good bacteria, increasing their numbers (lactobacilli and bifidobacteria(3)) and improving our overall health(1).  

 

Why do these healthy foods cause discomfort?

In SIBO, the overgrowth of bacteria causes inflammation and hurts your gut wall affecting your ability to breakdown and digest food. The bugs themselves play havoc with your own enzymes and body processes. For example there is loss/decrease in an enzyme called disaccharideses, which is important for breaking down carbohydrates and sugars. This means that any food, like a prebiotic food that contains fructose, lactose and sorbitol, may not be digested properly, resulting in those uncomfortable symptoms you experience(4).

 

Treating SIBO… with prebiotics?!

You may notice that some of the foods that cause your discomfort are also considered to be high FODMAP foods. FODMAP describes a group of of short-chain carbohydrates and sugar alcohols comprising of fructose, lactose, fructo- and galactooligosaccharides (fructans, and galactans), and polyols(5).

To provide symptom relief from SIBO we may suggest avoiding these high FODMAP prebiotics foods (looking at you apples, onions and garlic!) for a short period of time. It is really important to know that excluding these foods long term is not the answer and will not fix SIBO(6). A healthy gut is dependant on you eating a fibre rich, highly diversified diet so restricting these foods for a long period of time will only worsen your situation and increase your sensitivity to more foods(7). It's not uncommon that we see patients tolerating only a handful of foods and it's best to avoid this! 

Garlic, a wonderful prebiotic food.

Garlic, a wonderful prebiotic food.

As part of our treatment for SIBO we use certain types of prebiotics in combination with probiotics and specific antimicrobials (bug killers). These types of prebiotics have beneficial roles in our gut health that are important for restoring your gut health.

The following are four common prebiotic supplements on the market, three of which we use regularly in the treatment of SIBO. The fourth is not advised!

1. Lactulose

Lactulose is made up of two sugars, galactose and fructose, which is not broken down or absorbed in our small intestine. Lactulose increases our good bugs like bifidobacteria(8) and decreases the bad ones like clostridia(9). It is generally well tolerated, however you can take too much of it and end up with loose bowels(8)

2. Partically Hydrolysed Guar Gum (PHGG)

PHGG is a natural water soluble fibre that has been broken down by an enzyme to make it smaller and to decrease the amount of galactomannon (10). PHGG increases the good bugs Bifidobacterium and Lactobacillus species and decreases nasty waste products such as ammonia(11). PHGG can also give softer stools to assist constipation(12). Studies also show that PHGG in combination with an antibiotic to treat SIBO was more useful in eradicating SIBO compared with the antibiotics alone(13), how amazing!

3. Galacto-oligosaccarrides (GOS)

GOS is formed by breaking down lactose, a common sugar found in dairy. GOS is known to increase the good bugs bifidobacteria and reduce the bad bugs, clostridia and bacteroides. Another benefit of GOS alone or in combination with a probiotic is that it can support our immune system. GOS used in its recommended dosage range is well tolerated. Again, too much of a good thing can lead to problems; abdominal discomfort, cramping, flatulence and diarrhoea(14)

4. Inulin

Inulin is beneficial to out gut because it supports our good bugs bifidobacteria. However, because it is made up fructans(15), it can be really uncomfortable to consume if you have SIBO. Studies have found inulin increases flatulence, rumbling, stomach and gut cramps, and bloating(16). So best to avoid this one! 

Take home messages

Prebiotics are very powerful and beneficial for SIBO. But remember, not all prebiotics are the same.

If certain foods are causing you pain, bloating, constipation, or diarrhoea, this is your body communicating to you that your digestion system is struggling. Ironically the foods that cause discomfort are the same foods that are important to your health. Instead of excluding these foods, we need to improve your digestive system so you can tolerate these and improve your health in the long run. This can be impossible to navigate by yourself so get a professional on board to help correct your bugs, restore your gut wall and find the diet and fibre that is right for you.

After this, you may even be able to handle eating delicious lentils, onion, garlic and apples!

By Rachel Larsson

BHSc (Naturopathy), BPH (Nutrition)

Prebiotics for health

The exciting possibilities of prebiotics for a variety of digestive, immune and mood related complaints are only just being discovered. Prebiotics are receiving more attention with the increasing understanding of the human microbiota (all of the bacteria, viruses and fungi that live on and in us), as the two together can have an incredible impact on our health.

 

What are prebiotics?

Essentially, prebiotics are ingredients found in whole, unprocessed vegetables, fruits, legumes, grains, nuts and seeds which are not digestible to us, but provide the perfect food for beneficial gut bugs living within us(1). These ingredients are broken down by the microorganisms in the digestive tract into compounds that have a beneficial effect in multiple areas of the human body, which can include altering the activity of the same bugs that created them! Most prebiotics are carbohydrate fibres, and it’s the knock-on effect of eating them that makes them so special.

 

How do they relate to probiotics?

I often hear prebiotics being confused with probiotics. While they act very similarly in the gut, they are in fact different. Probiotics are live organisms that we take in supplement form, where the species of bacteria are known and measured(2) Much like the gut bugs that have been living in us since the first few days of life (our microbiota), probiotics also love to munch on prebiotics. You will often find probiotics and prebiotics in combination in a supplement to enhance the products therapeutic quality. A lot of the research around prebiotics looks at how they interact with two of the most common probiotics, Lactobacilli and Bifidobacteria(3).

 

What’s the difference between fibre and prebiotics?

Most prebiotics are fibre, however not all fibres are prebiotic. Fibre is often classified as insoluble or soluble, which also provides a good basis for distinguishing which ones are prebiotic.

Insoluble fibres do not get broken down by us or by our gut bugs, however they do bulk out the stool, helping to keep us regular(4). These are the stringy fibres that give a lot of foods their rough texture, such as the skin of nuts, seeds, fruits and vegetables.

Soluble fibre, found in a variety of whole foods, cannot be broken down by us, but are easily fermented by bacteria. Those that exert a proven beneficial effect on us are termed prebiotics.

 

Types of prebiotics

Here is a little bit of extra information for the science lovers out there. A clear cut catagorisation of what is and what isn’t a prebiotic has not yet been established as it is still a young area of science. If we consider what has the potential for prebiotic activity, the following fibres and their respective foods are included:

  • Non-starch polysaccharides such as beta-glucans (mushrooms), pectins (pear, apple, plum, citrus), gums (guar gum, xanthum gum), hemicellulose (psyllium husk) and cellulose (broccoli, cabbage, kale, cauliflower).
  • Non-digestible oligosaccharides such as galactans (legumes) and fructans, primarily inulin (onion, garlic, artichoke, asparagus, leek, chicory root, banana).
  • The disaccharide lactulose (only found in supplement form).
  • Sugar alcohols including sorbitol (pears, plums, dried fruits) and mannitol (button mushrooms).
  • Resistant starch, which is starch that resists digestion in the small intestine, making it available in the large intestine for fermentation (potatoes, legumes, whole grains).
Prebiotic gut health

How do prebiotics improve our health?

Prebiotics selectively stimulate the growth of beneficial bacteria that are indigenous to our guts, including the well-studied Bifidobacteria and Lactobacilli species. These bacteria, when thriving, help to seal the barrier between the intestine and bloodstream, improve our immunity and keep potential bad bacteria/fungi (such as clostridia and candida) to a minimum.(3). With a healthy microbiota, improvements are noted in mood, skin, allergies and autoimmune conditions, just to name a few.

In addition, bacteria create short chain fatty acids (e.g. butyrate, propionate and acetate) from prebiotic fibres, which have beneficial effects throughout the body. For example, butyrate, made by Lachnospiraceae and Ruminococcaceae bacteria, is a major energy source for the cells that make up our colon. Propionate acts at the liver to suppress cholesterol synthesis and acetate is utilised by the heart, brain, kidneys and muscles(1).

 

When prebiotics can be problematic

For people that have certain intestinal issues, such as Small Intestinal Bacterial Overgrowth (SIBO) or Irritable Bowel Syndrome (IBS), eating the wrong types of prebiotics can make symptoms worse. For example, fructans and sugar alcohols (which are both considered FODMAP foods) are known to cause bloating, flatulence and discomfort in certain people(5). However, complete avoidance of prebiotics deprives healthy gut bugs of food and can make the situation worse in the long run. If you fall into the SIBO or IBS, or are unsure, an appointment with us can help minimise symptoms while still making sure your good bugs are fed! 

By Lucy Mason

BHSc (Naturopathy)

How your gut is connected to hay fever and allergies

I bet you are wondering, ‘how can my water eyes, running nose and sneezing be connected to my gut?’. As you may have noticed today, there are studies coming out linking all sorts of conditions and diseases to the health of your gut. Allergic rhinitis, commonly known as hay fever, is no different. 

For starters our digestive system plays a huge role in the balance of our immune system. Almost 70% of our entire immune system is located in our gut(1). For hay fever and other allergic diseases the ‘hygiene hypothesis’ was thought to have a role in the increase in allergies, with the lack of exposure to microbes in early life increasing the risk of allergies in later life(2). Now something called the 'microbiota hypothesis' is thought to play a role, meaning a change in our gut bugs influence the development of our immune system(3). Although allergies are also influenced by genetics, some of the environmental and lifestyle factors that change your gut bacteria and increase your risk for allergies include infant use of antibiotics, formula feeding and being born by caesarean section(4,5). Oppositely, growing up with pets(6), growing up on a farm(7), being born through vaginal delivery and being breast fed has been linked to positively influencing your gut’s flora to include more ‘protective strains’(4,5).

What your body does in an allergic reaction

For an allergy to exist, allergen sensitisation must first occur. Special immune cells present in the mucosal surfaces of the body such as nose, lungs and gastrointestinal tract, detect the allergen. One type of immune cells comes into contact with the allergen which are then displayed on the cell's surface. This cell then lets other immune cells know to produce antibodies (IgE) specific to the allergen. From then on, if you are exposed to that allergen, an allergic response is triggered. The allergen is identified by antibodies (IgE) causing immune cells to release inflammatory mediators, such as histamine (8). Histamine is responsible for the itchy nose and runny nose, red watery eyes and dry cough.

The gut-lung connection

The lining of your gut is structurally very similar to lining of your lungs. If you are someone with allergies, inflammation will tend to happen in both areas, as it is thought that leaky gut may have a role in 'leaky lungs'. Our gut flora are also likely have a major impact on the integrity of the lung tissue(9).

Histamine and your gut

You may think histamine is the bad guy because it is linked to your allergies, but in fact is extremely important for mood, stomach acid, blood vessels, and muscle functions (10). The problem with histamine is for some people they can be suffering from histamine intolerance. This means they produce excess histamine and/or have a deficiency in the enzyme that breaks it down. When it comes to our gut, some of our microbes are capable of producing histamine. These microbes produce an enzyme, which converts histidine into histamine. The more of these microbes you have, and the more histidine you consume, the higher the amount of histamine you can produce. Histamine can be then be absorbed and taken around the body, exacerbating allergic symptoms (11).

Balance Immune System

How to improve your allergy symptoms

1. Heal your gut. Gut health and healing isn't straight forward and may require a professional to guide you. There may be other gut issues at play, like Small Intestinal Bowel Overgrowth (SIBO) driving gut inflammation and increased intestinal permeability (leaky gut), which will also need to be addressed.

2. Balancing gut flora can balance your immune system. This means probiotics from capsules or fermented foods. Be careful with fermented foods if you are histamine sensitive though, as they are a source of histamine. If you feel worse on bone broths or foods like sauerkraut then get in touch with a trained professional to help you refine your diet and introduce these gut healing foods slowly. Some strains that can help reduce histamine include Bifidobacteria infantis and Lactobacillus plantarum (12, 13).

3. Eat fermentable fibre. Eat a diet full of complex, fermentable fibre as it helps intestinal microbiota make short chain fatty acids (SCFAs). SCFAs help regulate the immune system and decrease allergic airway inflammation (14). 

4. Try eating low-histamine diet. Following a low-histamine diet can help reduce the severity of allergy symptoms. Foods to avoids that are high in histamines include canned and ready meals, fermented foods, aged and matured foods like cheese, fish, shellfish, avocados, spinach, cocoa and leftover meat (15).

5. Eat foods high in quercetin or take a supplement. Quercetin is a natural antihistamine and can be found in foods like grapefruit, onions, apples, black tea, leafy green vegetables and beans. Some herbs like Ginkgo biloba and Sambucus spp. are also sources.

6. Zinc. Zinc is a key nutrient involved in maintaining a healthy immune system. It is also necessary in healing and maintaining a healthy gut wall. Supplementing with zinc could significantly help in the healing of leaky gut(16). To find out your zinc levels and get the safest, and get most appropriate zinc supplement, see one of our professionals. Eating foods rich in zinc can also help including grass-fed beef, oysters, lamb, chickpeas, pumpkin seeds, cashews, chicken, spinach and mushrooms.

7. Eat local, raw honey. Raw honey contains both beneficial bacteria and trace amounts of pollen picked up by the bees from local plants. By eating raw honey, you can 'educate' your immune system to tolerate these local pollens (16). By local we mean the neighbouring suburbs, postcode or city. Australian honey isn't considered 'local' as the plants in Perth are very different to that in Melbourne, for example. 

8. For symptom relief try clearing your nasal passage using a neti pot. If any allergens are stuck in the passage this can clear them out and give some temporary relief.