Amy Doyle, MS, CNS
Prebiotics, Probiotics, and Enzymes
A healthy gastrointestinal system is the cornerstone of proper functioning of all the other systems in the body. By supporting the intestinal mucosal function and ability to digest and assimilate nutrients, we can optimize overall health. In reviewing multiple body systems it is critical to assess the digestive function and possible need for targeted support from digestive enzymes, prebiotics, and/or probiotics.
In reviewing multiple body systems it is critical to assess the digestive function and possible need for targeted support from digestive enzymes, prebiotics, and/or probiotics.The degradation of dietary carbohydrates, fats, and proteins is accomplished by the secretion of digestive enzymes from the intestinal brush border and the pancreas. The main enzymes responsible for the breakdown of these macronutrients are pepsin, pancreatic amylase, lipase, and protease. Insufficient production or secretion of these enzymes can lead to reduced gastrointestinal function and increased digestive complaints.1 Digestive enzymes are normally produced by the body whereas prebiotics are not produced by the body but rather ingested.
Prebiotics are dietary fibers from carbohydrates that avoid absorption until they reach the colon where they are acted upon by colonic microbes, a fermentation process which is thought to promote health.* Prebiotics exist in a variety of complex carbohydrates including inulin, fructooligosaccharides (FOS), galactooligosaccharides (GOS,) and resistant starches.
These dietary fibers pass through the gastrointestinal tract undigested due to their resistance to hydrochloric acid and digestive enzymes.2 Serving as food for beneficial colonic microbes, Bifidobacterium, their fermentation produces the short-chain fatty acids (SCFAs) acetate, butyrate, and propionate. Butyrate is the main source of fuel for colonic epithelial cells and contributes to the structural integrity of the colon.*3 Acetate is primarily utilized by skeletal and cardiac tissue, while propionate is metabolized by the liver and is being explored for its effect on cholesterol synthesis.2 SCFAs promote the proliferation of Bifidobacterium strains in the intestinal tract and inhibiting the growth of other microbes by reducing the luminal pH and competing for adhesion to the mucosal lining.*4
The consumption of prebiotics has also been shown to increase fecal bulking, improve stool consistency, and promote peristalsis.*5 Absorption of certain minerals like calcium, selenium, and magnesium is also improved due to SCFAs' ability to breakdown phytic-acid complexes and release these minerals in their free form.3
In addition to intestinal health, prebiotics have been shown to support satiety, insulin secretion, and cellular responsiveness.*6 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.*2,7,8 Poor fiber intake can be found worldwide and among all age groups, with fiber intake barely averaging half of the Dietary Reference Intake(DRI).6 Even though most individuals may need to increase their fiber intake, an abrupt addition of large amounts of fiber-rich prebiotic foods can cause abdominal discomfort. As noted, prebiotics not only function to feed probiotics, they owe their name to this function. Prebiotics are of interest to both researchers and clinicians as choosing a prebiotic may offer selectivity or preference to the proliferation of certain probiotics.
The microbiota that reside in the human gastrointestinal tract contribute to a wide array of metabolic, nutritional, physiological, and immunological functions. Although different genera have different applications, 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.*7 Gut microbes have also been studied for their role in glycemic function and supporting lipids within normal limits.*8
The proportion of beneficial microbes in the gut can be influenced by the addition of probiotics—live microorganisms in consumable 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. Probiotic benefits are genus- and species-specific and their therapeutic use should be evidence-based when possible and tailored for each individual.9
There are specific factors that suggest the need for digestive support with these therapies.* It is important to clarify the current experiences of the client. Also valuable to consider is the context of those experiences including variables such as history, timing, duration, and the effects on quality of life. Further assessments can include testing of breath, stool, blood, and occasionally urinary analytes. Oftentimes, the first assessment tools to determine the use of enzymes, prebiotics, and probiotics, are a quality interview and simple questionnaires.
With proper use, enzymes, prebiotics, and probiotics can optimize digestive function and lay a foundation for better overall health.*
1. Ianiro G et al. Current Drug Metabolism. 2016. 17:187-93.
2. Roberfroid M et al. Br J Nutr. August 2010. 104. 2:S1-63.
3. Scholz-Ahrens KE et al. J Nutr.. March 2007. 137. 3 Suppl. 2:838S-46S.
4. Walker AW et al. Applied and Environmental Biology. July 2005. p. 3692-700.
5. Niittynen L et al. Scand J Food Nutr. June 2007. 51(2):62-6.
6. Jones JM et al. Adv Nutr. Jan 1 2013. 4(1):8-15.
7. Saulnier DM et al. Gut Microbes. January/February 2013. 4:1, 17-27.
8. Yoo J et al. Nutrients. 2016. 8:173.
9. Doron S et al. Clin Infect Dis. 2015 May 15;60 Suppl 2:S129-34.
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