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Prebiotics vs. Probiotics: What Actually Works for Your Gut · Bryan Health Podcasts

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  Melanie Cole (Host): Welcome to Brian Health Podcast.
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  I'm Melanie Cole, and today we are really gonna learn a lot about gut
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  health, prebiotics, and probiotics.
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  We hear these terms a lot.
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  We're gonna learn about them today with Dr.
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  Alexander PRAs.
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  He's a gastroenterologist with Gastroenterology Specialties pc.
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  Dr.
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  PRUs, I'm so glad to have you join us today.
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  So start by telling us a little bit about what that means when we hear the term
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  gut microbiome what does it even mean?
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  The bacteria, the general role of it.
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  Give us a little, you know, physiology lesson if you would.
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  Dr Alex Praus: Yeah, thanks for having me.
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  Really excited to talk about this today.
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  This is something that we get a lot of questions on and.
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  a little bit of disinformation about the gut microbiome and stuff.
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  We're gonna talk today, so we're gonna kind of set the record straight.
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  So the gut microbiome is the collective group of all microorganisms in
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  your gut, starting from really your stomach all the way to your colon.
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  And this includes all the bacteria, fungi, viruses, a group called ArcHa.
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  And these all reside in the gut.
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  And kind of make the jungle of the microbiome.
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  and there are about 38 trillion of these, and it's roughly the same number as the
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  total number of human cells in the body.
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  So you have 38 trillion of these things living inside your gut,
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  and it's extraordinarily diverse.
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  there's.
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  thousands of different species of these different bacteria, and they're
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  not uniformly distributed, so it's not like, oh, it's, all throughout the gut.
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  It's predominantly in the middle and distal part of your
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  small intestine and colon.
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  And the colon is the one that really houses most of the
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  bacteria in kind of microbiome.
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  it's really, dominated by five different kinds of bacteria.
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  the two major ones are formic, qts, and BACTER royalties, and those make up about
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  70 to 90% of the total bacteria with the other types kind of fill in the gaps.
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  it is really kind of developed when we're young, when we're children
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  and infants and stuff like that.
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  And then as we grow older it becomes kind of more and more constant.
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  So it's important when you're young to kind of set a good microbiome in your gut.
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  now this can be disrupted by a variety of things.
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  It can be disrupted by illness.
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  It can be, influenced by diet.
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  It can be disrupted or influenced by antibiotics, or different kind of
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  diseases or illnesses and stuff like that.
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  it has a variety of different, uses So, it helps with immune system, it helps with
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  digestion, it helps with, fermentation of different things, that we eat, and kind
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  of making vital nutrients for our, diet.
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  because we can't process, those alone.
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  So we use this microbiome to help, give us energy and nutrition.
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  Melanie Cole (Host): Well, thank you for that.
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  And I'm glad you said the name of those bacteria and I didn't have to, but so
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  there's so many theories today, Dr.
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  PRUs about autoimmune diseases that we're seeing on the uptake
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  and you know, these kinds of.
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  Things going on in our body, and some have this theory that we have, done some
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  damage and sanitized those gut microbiome that you just explained to us about.
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  So conversely, we're learning more about ways to help combat that, whether it was,
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  antibiotic use or the built environment, whatever is the reason, which we could
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  do a podcast just strictly about that, So tell us about prebiotics and probiotics.
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  Most people have heard of probiotics, but not prebiotics.
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  Tell us a little bit about the difference and how they're supposed to work, what
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  they're supposed to be doing in the body.
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  Dr Alex Praus: Okay, This is great because we get a lot of questions
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  about this, specifically probiotics, And then we start to talk about,
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  Hey, don't forget about prebiotics.
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  So we'll start with prebiotics.
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  So prebiotics are really just fibrous, non-digestible material and kind of,
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  soil or nutrients for your microbiome.
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  And when I reference a microbiome.
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  I call it a jungle or a rainforest because how diverse it is
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  and how it helps each other.
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  And there's competition for resources and prebiotics are really
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  the food for that rainforest.
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  Now, some people may garden or some people may be into plants where, some plants.
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  Require a more acidic environment or an acidic soil to thrive.
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  other's require a more basic, environment or, more soil with, magnesium or iron or
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  something like that to help them thrive.
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  And if they don't have that, they really struggle.
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  Same thing with her microbiome.
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  we eat food and certain bacteria in our gut, like different
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  kinds of food more than other's.
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  And let's say you feed a certain bacteria with high fiber
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  foods like beans or lentils.
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  very fibrous, very nutritious and healthy for us, And that's gonna
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  promote what we would consider a more healthy microbiome, and feed those good
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  bacteria so that they can outcompete what we would consider bad bacteria.
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  And so when we talk about prebiotics, we're saying, all right, how are we
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  going to enrich this soil or enrich this microbiome with, food for good
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  bacteria so they can outcompete?
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  Because you can't go in and target, you know?
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  All right, well, I want to get rid of this bacteria completely We don't have
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  therapies or things that can do that, so we have to rely on, Hey, all right,
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  we gotta give 'em fuel to outcompete.
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  And so, prebiotics are made for That, is that we can take, prebiotics or
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  use different foods as prebiotics to.
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  Foster and feed good bacteria to outcompete kind of bad bacteria and
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  set a really good microbiome, So that's really what a prebiotic is.
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  It's just, fertilizer of food to help foster a good microbiome,
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  and using what you already had.
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  Probiotic on the other side is actually introducing what we would consider
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  healthy bacteria to your gut via capsule, or, I know there's yogurts and now
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  there's even soda, like a soda pop.
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  that's considered probiotic.
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  And so, it's just introducing bacteria to your gut that we know is healthy.
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  and That is truly what prebiotic and probiotics are, is, the prebiotic,
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  again, the soil that helps foster a good, microbiome and probiotic is
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  introducing additional bacteria or introducing good bacteria to your gut.
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  Melanie Cole (Host): What a great chemistry lesson that was talking
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  about pH and basic and all of that, because it really clicked
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  in my head when you said that Dr.
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  PRUs, that one is already there and we're just kind of keeping it
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  going and making sure we utilize it properly, And the other one is actually
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  introducing it into our system.
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  That was an excellent explanation.
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  So.
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  When we think of, Yogurt, and you talked about soda.
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  Well, there's kombucha.
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  There's, fermented foods.
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  There's all of these things.
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  So now tell us about the digestive benefits when we do introduce these
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  things, and we'll get into some of the more food sources and taking a probiotic
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  specifically, but tell us what you have seen as a gastroenterologist for digestive
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  benefits, whether it's immune system functioning or just digestion, bloating.
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  I mean, we all have so much of this.
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  Dr Alex Praus: let's talk about prebiotic.
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  First, because I think that That is where all the data is showing that there's
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  actually quite a bit of benefit in a variety of different places for that.
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  much more so than probiotic.
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  And we'll talk about that.
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  So the prebiotic, the use is currently for prebiotic are, Variety of things.
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  One helps us get essential nutrients, essential short chain fatty acids,
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  essential, amino acids, and helps kind of regulate our gut as well.
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  So the prebiotic part of This is that, these are at the basis non-digestible
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  food we don't make an enzyme.
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  Or anything that we can break down And we rely on these
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  bacteria to break it down, and.
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  take the nutrients from this so that we can use it.
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  And what's left is fibrous material.
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  And what this does is allows us to have formed bowel movements, helps
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  regulate our gut immune system.
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  It helps, create what's called a tight gut.
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  there's some terms out there called leaky gut, which can.
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  Be associated with inflammatory bowel disease, which can be
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  associated with autoimmune diseases.
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  And what these prebiotics do is help limit that, help improve gut
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  inflammation, with just everyday stuff or inflammatory bowel disease.
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  And so specifically like with.
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  The data that we currently have, there's a few specific uses for prebiotics,
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  for inflammatory bowel disease.
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  We know that a good diet with low to no processed foods, low sugar,
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  high fibrous diet, or prebiotic diet with a variety of different fibers.
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  Old world grains like barley and oats are really good for you and
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  just the essential prebiotic.
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  Those are all great, so we talked about a little bit of inflammatory bowel
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  disease help, but what about irritable bowel syndrome IBS, which is much more
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  common than inflammatory bowel disease.
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  And the results in this are a little more mixed there is evidence that it can
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  improve symptoms, in patient's with IBS.
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  So IBS, you have a little bit of abdominal discomfort or you're in
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  pain and changes in bowel movements And we know that adding in fiber.
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  To your diet helps with these symptoms, but specifically, prebiotic or kind
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  of varied fiber can help quite a bit more actually with symptomatic
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  day-to-day, IBS type symptoms.
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  That is probably the best role for prebiotics in a general population
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  is it's gonna improve your bowel health, that you're gonna have what
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  would be considered a more normal bowel movements and regularity.
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  And if you do have some IBS, it can help with symptoms, is
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  it gonna eliminate symptoms?
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  Probably not.
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  But it's gonna definitely help.
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  And then other things that prebiotics can help with.
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  Chronic constipation, which kind of runs with the IBS type symptoms.
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  You're gonna have better bowel movements, less episodes of constipation, And
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  then more, specifically there's one condition that we, can use prebiotics for.
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  And that's for, C Diff or Clostridium Difficile Infection Prevention.
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  There was one study that showed that it helped a little bit.
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  And so I think that, with this you can help prevent c Diff, which is.
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  unfortunately not uncommon.
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  more common in patient's with healthcare exposure,
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  hospitalizations, antibiotic exposure.
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  And this just gives evidence to say, Hey, if you have a really healthy
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  microbiome, you're gonna outcompete this gut bacteria called c diff
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  and it's gonna be quite helpful.
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  and that's really, the uses for prebiotics at this time.
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  So.
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  Can help with a variety of symptoms, And in the general population can help
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  with IB Slike symptoms, for probiotics, much less helpful, unfortunately.
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  so we talked about earlier, probiotics are the introduction of
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  a bunch of bacteria to your already.
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  very full gut.
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  So again, we have about 38 trillion different bacteria living in our gut and
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  a lot of these, probiotics introduce 7 billion, bacteria or so, in a capsules or
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  yogurt or drink or something like that.
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  And, in getting kind of ready to talk about this, I was like, all
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  right, so what are some of the experts saying about probiotics?
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  Because that's what I know.
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  We don't have a good probiotic yet really.
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  And someone likened it to, dropping a little drop of
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  food coloring into an ocean.
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  And I was like, wow, That is a great picture to say.
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  It is not gonna do really anything.
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  you're not gonna change the color of the ocean with one little drop.
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  And so unfortunately, probiotics, there's.
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  Hundreds of them on the market, And the data that we have shows
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  that none of 'em work well.
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  there are very specific, uses for a few different probiotics that in
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  our general population, it's very rare that we would run into 'em.
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  They're mostly, used in the pediatric and neonatal population
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  for very specific uses.
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  In the general population, a lot of people will use 'em for IBS or functional
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  GI disorders, And the data does not show that they really work well.
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  They can have some improvement in IB Slike symptoms.
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  But, after many, many studies and a lot of evaluation on these.
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  the data just says they probably don't work very well.
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  So if I were to make a recommendation on prebiotic or probiotic for
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  anything, I would lean more towards a prebiotic high fiber diet, varied
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  fiber, than any kind of prebiotic.
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  Melanie Cole (Host): Well, okay, so.
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  That was really interesting.
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  And coming from an expert such as yourself, even more so.
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  So what do we do with this information?
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  we wanna concentrate more on prebiotics than probiotics, although they do no harm,
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  so maybe they don't help as much as we might like, but they also do know harm.
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  What would you like us to take away from this episode today?
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  What do you want us to do?
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  Give us your best recommendations here about whether we should.
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  'cause there are, as you say, so many on the market.
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  Dr.
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  PRUs and some are behind the pharmacy counter, some are in the
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  refrigerator section, we don't know, and there's just tons of 'em.
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  But then they're also sort of being in many fermented foods, sauerkraut, kimchi,
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  kombucha, all of these great things.
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  But Those are prebiotic as well.
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  So what do you want us to do with this information?
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  Give us your best advice here.
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  Dr Alex Praus: You know when I talk with patient's who say,
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  Hey, I'm on this probiotic.
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  and they say, Hey, it helps.
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  I don't know why, But when I take it, my gut feels better, I feel better,
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  and I say, I don't have evidence that it doesn't, and keep taking it.
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  If you feel better and your symptoms, which you're seeing
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  me for are better on this.
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  I don't have evidence right now to say, to stop taking it because there are
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  people that are gonna respond a little differently, but in that same patient,
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  I say, Hey, make sure that you're getting a good fiber dose every day.
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  You know, the American diet right now has changed drastically over the past.
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  decades, 50, 60 years ago, and now we're very low fiber.
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  We don't get 10, 12, even 15 grams of fiber on a day on average, And
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  we really should be aiming for 25 or 38, so at least double of the
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  fiber intake we're getting daily.
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  And so my best recommendation is this.
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  If you are taking a probiotic and you find benefit from it.
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  Great.
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  I'm glad you find benefit.
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  I don't have evidence to say to stop it, but start a higher fiber diet.
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  Start, old world grains, fermented foods.
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  give your microbiome the nutrients and soil it needs to foster, a good
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  environment and outcompete, some of the bad bacteria and no, give
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  them a chance to cause problems.
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  So that's my recommendation.
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  High fiber diet.
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  Low to no processed foods, low sugar.
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  and if you are taking a probiotic and finding benefit, great.
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  If you're not, try stopping it and just continue with the prebiotic.
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  Melanie Cole (Host): Great advice.
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  What an excellent episode this was.
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  You gave us so much to think about And so much great information that we can trust.
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  Dr.
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  PRUs, that was just excellent.
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  Thank you again for joining us And in really sharing your incredible expertise.
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  And I'd also like to thank our Brian Foundation partner,
• 16:52
  Learfield Pinnacle Bank Arena.
• 16:54
  And to listen to more podcasts from our experts.
• 16:57
  Like Dr.
• 16:57
  Pros, you can always visit Brian health.org/podcasts.
• 17:02
  That concludes this episode of Brian Health Podcast.
• 17:05
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• 17:12
  Until next time, I'm Melanie Cole.