Gut Health Benefits of Prebiotics, Postbiotics and FODMAPs

The science of -biotics and their benefits

Prebiotics, probiotics, postbiotics, synbiotics... Oh my!

Term's around "-biotics" can start to sound like alphabet soup. Each has it's own unique definition and health benefit:

• Probiotic — live microbes that that deliver health benefits when administered in adequate amounts
• Prebiotic — non-digestible fibers (like fructans) that feed probiotics
• Synbiotic — probiotics and prebiotics combined (generally a supplement)
• Postbiotic — the by-products of prebiotic fermentation, including “waste” products like short chain fatty acids (SCFAs)

The gut microbiota represent the collection of bacteria, archaea and eukarya that colonize the digestive tract. Increasingly, alterations to their diversity and abundance in the microbiota are thought to contribute to irritable bowel syndrome (IBS) symptoms via a range of mechanisms.

This has led to an increased interest in ways to support and restore the health of the gut microbiota in IBS using prebiotics, probiotics, postbiotics and potentially synbiotics.

While evidence for the use of probiotics in IBS is too mixed to support recommending their broad use and scientific data on the role of prebiotic foods in IBS nutrition therapy is small, research remains ongoing and has promise. Similarly, though postbiotic supplements (eg. butyrate) are available and make claims around gut health, more research is needed on the benefits of postbiotic supplementation versus consumption of prebiotic-rich foods that support postbiotic production within the digestive tract.

Prebiotics: Fuel for Gut Microbiota

Sources of prebiotics include complex carbohydrates naturally present in food, such as fructans and galactooligosaccharides (GOS), as well as dietary supplements, often in the form of inulin or fructooligosaccharides (FOS). 

Prebiotics feed the microbiota. These microbiota ferment prebiotics which in turn produces short-chain fatty acids (SCFAs). SCFAs, also referred to as postbiotics, provide a range of benefits for digestive health.

SCFAs reduce the osmotic load of malabsorbed sugars, support a healthy intestinal barrier by feeding colonic cells and increased fecal weight. SCFAs have also been associated with reduced gut-associated inflammatory markers, regulation of intestinal motility, and stimulation of the gut-brain-axis through the enteric or vagal nerves.

Still, the same fermentation that produces SCFAs also leads to increased production of gas. For those with IBS, this gas production can cause significant gas and bloating, as well changes in bowel patterns and abdominal pain. 

Prebiotics: Foods and supplement sources 

Many fruits, vegetables, and whole grains are excellent prebiotic source. Prebiotic types include polysaccharides, oligosaccharides, resistant starch, conjugated linoleic acid and polyphenols.

Foods rich in naturally-occurring prebiotics are wide-ranging, such as buckwheat, kiwi, rhubarb, onions, bananas, legumes, honey, garlic and leeks. Foods particularly rich in polyphenols include apples, berries, buckwheat, certain lettuces, cilantro, cocoa, cranberry, extra virgin olive oil, grapes, green tea, nuts, onion, persimmons, pomegranates and turmeric.

When used to enrich foods, prebiotics are typically added in the forms of inulin, chicory root, guar or acacia gum, FOS, GOS, lactulose and human milk oligosaccharides (HMOs).

The connection between prebiotics and FODMAPs

Prebiotic-rich foods and supplements are often high FODMAP. For example, onion, garlic, asparagus, artichoke, legumes, wheat, inulin and chicory roots are all high FODMAP.

If poorly implemented, a low FODMAP may be low in fiber and particularly prebiotic fiber. Long-term and excessive avoidance of FODMAPs can negatively impact the microbiome, partly related to limited prebiotic intake. 

Low FODMAP Prebiotic Sources

For patients with IBS, low FODMAP, prebiotic foods like unripe banana, oats, quinoa, and kiwi can be great options. However, the list suitable prebiotic-rich sources for those on a low FODMAP diet can be small.

It's important to help patients reintroduce as many foods as possible while on a low FODMAP diet, particularly when it comes to high-fiber, prebiotic-rich foods.

Add more prebiotics with digestive enzymes

Digestive enzymes are a tool to support reintroduction of prebiotic-rich foods without triggering FODMAP-related symptoms.

Peer-reviewed research on FODZYME illustrates how use of digestive enzymes supports overall gut health. In a simulated model of the digestive tract, use of FODZYME with an otherwise triggering high FODMAP source (in this case inulin) both reduces gas while also supporting SCFA production. These findings suggest that FODZYME’s enzymatic approach may be more favorable to overall colonic health than avoiding FODMAPs altogether.

In other words, with FODZYME patients can get the best of both worlds: symptom control and the benefits of prebiotic-rich, high fiber diet.

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