Regular HealthBeat News readers know that we believe a healthy G.I. (digestive) system is vital to the healthy functioning of all parts of the body. In our recent HealthBeat article “Pearls From Recent Medical Conferences” we mentioned that even conventional medicine has come to realize that supporting digestive function and the ability to digest and assimilate nutrients is essential to good health. Unfortunately there is some confusion around the buzzwords that are being tossed around with regard to digestive enzymes, prebiotics, and probiotics. Just what is each of these things, and what do they do?

Digestive Enzymes
The initial breakdown of the dietary macronutrients carbohydrate, fat, and proteins is accomplished by digestive enzymes that are produced by the the pancreas and the small intestine. The main enzymes responsible for breaking down these macronutrients are pepsin, pancreatic amylase, lipase, and protease. The production of these enzymes frequently slows with aging, and insufficient production or secretion of them can lead to reduced G.I. function and digestive complaints like bloating, gas, and irregularity.

Prebiotics
Prebiotics are dietary fibers from carbohydrates that are resistant to hydrochloric acid and digestive enzymes and so avoid being broken down until they reach the colon where they are acted upon by colonic microbes – those good gut bacteria that we have discussed before. Prebiotics are found in complex carbohydrates such as inulin, fructooligosaccharides (FOS), galactooligosaccharides (GOS), and resistant starches.

When these prebiotic dietary fibers arrive in the colon they serve as food for beneficial colonic microbes such as bifidobacterium. Through a process of fermentation they produce the short-chain fatty acids (SCFAs) acetate, butyrate, and propionate. Butyrate is the main energy source for the cells that line the colon. Acetate is primarily utilized by skeletal and cardiac muscles, and propionate is metabolized by the liver and is important in cholesterol synthesis. SCFAs promote the growth of bifidobacterium strains in the intestinal tract and by helping these beneficial microbes proliferate they inhibit the growth of other less beneficial (or even harmful) microbes.Including prebiotics in the diet has also been shown to increase fecal bulking, improve stool consistency, and promote the bowel mobility called peristalsis. Absorption of minerals like calcium, selenium, and magnesium is also improved with prebiotic use due to SCFAs’ ability to breakdown phytic acid complexes and release these minerals in their free form.

Besides promoting G.I. health, prebiotics have been shown to support satiety (the feeling of fullness after eating), insulin secretion, and cellular responsiveness. G-protein coupled receptors for short-chain fatty acids have been found on enterocytes, leukoycytes, and enteroendocrine cells, giving SCFAs the ability to stimulate GLP-1 secretion. Poor fiber intake is common among all age groups, with fiber intake barely averaging half of the Dietary Reference Intake(DRI). (But be careful: Even though most people may need to increase their fiber intake, an abrupt addition of large amounts of fiber-rich prebiotic foods can cause abdominal discomfort – like exercise, start slow and work up!) So, prebiotics serve as food for probiotics and they get their name from this function. Prebiotics are of interest to both researchers and clinicians because carefully choosing a prebiotic may lead to the proliferation of certain probiotics – and that is what we call a “positive wellness outcome”!

Probiotics
The microbiotic “garden” that resides in the human gastrointestinal tract contribute to a great many of metabolic, nutritional, physiological, and immunological functions. Although different gut bacteria have different jobs, their health benefits are mainly derived from their antimicrobial effects, immune modulation activity within the gut-associated lymphoid tissue (GALT), and their contribution to intestinal barrier integrity through increased IgA production and expression of adhesion proteins in the tight junctions. Gut microbes have also been studied for their role in glycemic function and supporting lipids within normal limits.

The proportion of beneficial microbes in the gut can be influenced by the addition of probiotics — that is, live gut bacteria taken in oral supplement form. The most widely used and studied probiotics are Lactobacillus and Bifidobacterium. In spite of their extensive clinical application, it is necessary to be aware of certain cautions when using probiotics since probiotic benefits are genus and species specific and their therapeutic use should be tailored for each individual person.

There are specific factors that suggest the need for digestive support with probiotics and it is important to remember that each person is unique in their needs, and that needs may change for each person over time. A skilled Naturopathic doctor will use assessments that can include testing of breath, stool, blood, and urine but usually the first assessment tool to determine the use of enzymes, prebiotics, and probiotics, is a detailed interview and health questionnaire.

With proper use, enzymes, prebiotics, and probiotics can optimize digestive function, ensure the assimilation of vital nutrients, promote healthy immune function, and lay a strong foundation for better overall health.

Resources and references:

Useful supplements:

35 Billion Probiotic: https://www.drmyattswellnessclub.com/supremadophilus.htm

Prebiotics (fiber): https://www.drmyattswellnessclub.com/MaxiFiber.htm

Digestive enzymes: https://www.drmyattswellnessclub.com/similase.htm , https://www.drmyattswellnessclub.com/betainehcl.htm

HealthBeatNews article:

Pearls From Recent Medical Conferences http://healthbeatnews.com/pearls-from-recent-medical-conferences/

Scholarly references:

Ianiro G, Pecere S, Giorgio V, Gasbarrini A, Cammarota G. . Digestive Enzyme Supplementation in Gastrointestinal Diseases.  Current Drug Metabolism. 2016. 17:187-93.

Roberfroid M, Gibson GR, Hoyles L, McCartney AL, Rastall R,  et al. Prebiotic effects: metabolic and health benefits.  Br J Nutr. August 2010. 104. 2:S1-63.

Scholz-Ahrens KE, Ade P, Marten B, et al.. Prebiotics, Probiotics and Synbiotics Affect Mineral Absorption, Bone Mineral Content and Bone Structure.  J Nutr.. March 2007. 137. 3 Suppl. 2:838S-46S.

Walker AW, Duncan SH, McWilliam Leitch EC, Child MW, Flint HJ. pH and Peptide Supply Can Radically Alter Bacterial Populations and Short-Chain Fatty Acid Ratios within Microbial Communities from the Human Colon. Applied and Environmental Biology. July 2005. p. 3692-700.

Niittynen L, Kajander K, Korpela R Galacto-oligosaccharides and bowel function. Scand J Food Nutr. June 2007. 51(2):62-6.

Jones JM. Dietary Fiber Future Directions: Integrating New Definitions and Findings to Inform Nutrition Research and Communication. Adv Nutr. Jan 1 2013. 4(1):8-15.

Saulnier DM, Ringel Y, Heyman MB, Foster JA, Bercik P, et al. The intestinal microbiome, probiotics and prebiotics in neurogastroenterology. Gut Microbes. January/February 2013. 4:1, 17-27.

Yoo J, Kim S. Probiotics and Prebiotics: Present Status and Future Perspectives on Metabolic Disorders. Nutrients. 2016. 8:173.

Doron S, Snydman DR. Risk and safety of probiotics. Clin Infect Dis. 2015 May 15;60 Suppl 2:S129-34.

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