Gut: Prebiotics and Probiotics

Will lead to a lower likelihood of Clostridium difficile, C. diff, and adverse impacts from antibiotics.

Consuming probiotics after taking antibiotics is extremely important for what reasons?

d. all of the above

Empirical evidence suggest that resistant starch can help with a. sleep and mood b. depression c. anxiety d. all of the above

vegetables fruit starchy tubers nuts seeds legumes

Fermentable fibers are found primarily in what six foods?

Regulates blood sugar PGX is the brand-name fiber can be taken in capsule or powder form, and there are many different brands but we tend to use the Now brand of glucomannan.

Glucomannan has what added benefit?

Treat the SIBO and slowly reintroduce the beneficial fibers over time.

If a patient has SIBO that is causing a fiber and FODMAP intolerance, how do you rebuild a healthy gut ecosystem?

c. 75

Jeff Leach from the American Gut Project lived with Hadza hunter-gatherers and found that they ate an average of a ________ grams per day of fiber. a. 50 b. 100 c. 75 d. 65

Kefir (made from milk, water, or coconut or young coconut water) yogurt sauerkraut kimchi beet kvass kombucha

Name 6 fermented foods?

RS1, indigestible (grains, seeds, legumes) RS2, starch with high amylose content, indigestible in raw state but digestible in cooked state (potatoes, green bananas, green plantains), resistant starch is removed when cooked but back in again when you cool them RS3, retrograde RS, forms after type 1 or 2 is cooked then cooled, can be reheated at low temperatures less than 130 Fahrenheit to maintain benefits of RS RS4 (synthetic), ie.) high maize resistant starch

Name four types of resistant starch?

Pectin Acacia

Name two other options for fiber someone could take.

cooked and cooled potatoes rice lentils green plantains, as long as they haven't been cooked.

Resistant starch is a particularly beneficial fermentable fiber and is found in what four foods?

a. 19

The average daily fiber intake in the US and in most of the industrialized world is _________ grams/day. a. 19 b. 10 to 15 c. 30 d. 25

True

True or False. Probiotics do not increase the numbers of beneficial bacteria.

True

True or false. While probiotics are beneficial, they don't work by quantitatively increasing the good gut bacteria.

1. We're adapted to getting microbes from these foods 2. Some evidence that probiotic bacteria in foods may be better able to survive the stomach acid. 3. It increases the bioavailability of mood-regulating B vitamins, magnesium, and zinc, and it may improve vitamin D status 4. The concentration of probiotic organisms is significantly higher in some fermented foods.

What advantages do fermented foods have over commercial probiotic products?

Endospore-formers, on the other hand, are biologically inactive and remain that way until environmental conditions allow resuming normal forms. PrescriptAssist does have endospore-formers but they simply pass out of the digestive system if they ever form in the gut of any mammal. Finally, Prescript- Assist microflora are recognized as class-one etiological agents, which means they're non-toxic and non-pathogenic.

What are endospore-formers?

The term "spore-former" refers to microflora that can form spores that are biologically active, in other words, that reproduce in the spore form and that are highly resistant to the environment and cause disease.

What are spore-forming microorganisms and are the dangerous?

fermentable vs. non-fermentable

What two classes are the most practical way of dividing fibers?

You may want to suggest a lactic acid probiotic for ongoing maintenance. Ther-Biotic Complete from Klaire Labs is a good choice, it's a broad spectrum of bacteria, relatively high potency, though not as high as VSL #3 and Elixa, which are more therapeutic-strength probiotics. VSL #3 in particular has been very well studied in inflammatory bowel disease, ulcerative colitis in particular, and other gut conditions, and it can be very effective when patients tolerate it well. These products, because they're lactic acid bacteria, do require refrigeration.

What would you recommend where patients can't tolerate fermented foods?

as part of an antimicrobial protocol to address a particular symptom like constipation or diarrhea to provide strains that may not be available in fermented foods. some patients don't tolerate fermented foods very well, and this is especially true for those that are amine intolerant or histamine or tyramine intolerant.

When are commercial probiotics necessary?

Because many species of probiotics that are taken are transient residents of the digestive tract. They don't colonize the gut and take up residence.

Why don't probiotics increase the numbers of beneficial bacteria?

Studies have shown that taking large amounts of resistant starch alone actually decreases the diversity of the gut flora.

Why don't you want to take large amounts of resistant starch?

Some studies have shown that high intakes of resistant starch with no other fibers can actually decrease the diversity of beneficial bacteria species in the gut, which is definitely the opposite direction than we want to go.

Why should resistant starch be part of a wider spectrum of fiber intake?

They work by transiently, meaning temporarily as long as you're taking them, tuning and regulating the immune system, promoting anti-inflammatory pathways and creating a favorable environment for beneficial bacteria. Another way to think about it is that prebiotics increase what's already there and probiotics regulate what's already there.

How do probiotics work?

Gel-like substance coats the digestive tract and that's what can make it helpful in cases of both constipation and diarrhea and with other digestive symptoms like gas and bloating.

Most soluble fibers form a gel-like substance, they're mucilaginous, so they help with the digestive tract in what way and help with what symptoms?

directly protect the intestinal barrier they influence local and systemic antioxidant status they have direct microbial-produced neurochemical effects (increase GABA levels) they have an indirect influence on neurotransmitter and neuropeptide production they can prevent stress- induced changes to the overall gut flora they can activate neural pathways between the gut and the brain (gut-brain axis) they limit inflammatory cytokine production, so they're anti- inflammatory they limit carbohydrate malabsorption so they can help with FODMAP intolerance they can improve nutritional status, can help with omega-3 fatty acid absorption, mineral absorption, and absorption of phytochemicals they can limit small intestinal bacterial overgrowth they can reduce amines, like histamines, certain probiotics degrade histamine they can limit gastric or intestinal pathogens like H. pylori, we talked about how Saccharomyces boulardii is effective for the treatment of parasites and pathogens like H. pylori they have pain-relieving properties

Name 5 benefits of probiotics?

We already have some studies showing that the long-term low-FODMAP diet reduces levels of beneficial bacteria in the colon. This is obviously not ideal; we may end up fixing one problem, like SIBO or IBS, and causing another, which could be increased susceptibility to a wide variety of chronic modern diseases.

The low-FODMAP diet reduces the intake of many of these fibers and has been shown to relieve symptoms, but what are the long-term consequences of the low-FODMAP diet?

soluble fiber non-starch polysaccharides resistant starch Most insoluble fibers (i.e. bran fiber) are not significantly fermented.

There are three different classes of fermentable fibers we typically suggest rotating between . What are they?

It's a broad-spectrum probiotic with 29 different strains it's shelf-stable so it doesn't require refrigeration very easy to travel with survives the stomach acid it's high-potency, it contains a prebiotic called leonardite it's supported by long-term, peer- reviewed, double-blind, placebo-controlled trials, which is more than most probiotics can say for themselves. Note that soil-based organisms in general and Prescript-Assist in particular are often well tolerated even with patients that don't do well with lactic acid probiotics.

What are the advantages of the PrescriptAssist soil based probiotic?

It's rich in beneficial microbes contains fat- soluble vitamins like vitamin A and K2, and natural trans-fats. Even patients with lactose intolerance can often tolerate kefir when it's been fermented for 24 hours because that virtually eliminates the lactose. Also, studies have shown that kefir may be able to reverse lactose intolerance; in other words, the patient is lactose intolerant and they consume small amounts of kefir and gradually ramp it up over time, and they actually become able to tolerate lactose. So if a patient is intolerant to the proteins in dairy, however, they probably still won't be able to tolerate kefir because the fermentation doesn't change the proteins significantly to change the antigenicity of the milk, but they can make kefir from water or coconut water or other beverages.

What are the benefits of kefir?

e. all of the above

What are the benefits of short-chain fatty acids? a. promote cell differentiation and proliferation b. they regulate sodium in water absorption c. they enhance the absorption of calcium and other minerals d. fermentable fiber also improves gut barrier function and host immunity. e. all of the above

Prebiotics do increase the beneficial bacteria over time because they provide food for those beneficial species, which can then multiply so that a patient could increase their beneficial bacteria over time, stop taking the prebiotic, and those numbers would stay increased provided they're still consuming enough fermentable fiber to feed those bacteria.

What does increase the number of beneficial bacteria over the long run?

pure organic psyllium online, which I think is better than Metamucil, which has sugar and artificial flavours. (can cause bloating)

What form of psyllium is best to buy?

SIBO patients and people with FODMAP intolerances. Many of these are FODMAPs, so they're the most likely to cause gas, bloating, and GI distress, especially in patients that are FODMAP-intolerant. They could contribute to a recurring SIBO condition, but you could try starting a low dose and building slowly. You really just have to have them experiment with the different fibers and choose the ones that they are able to tolerate most and eat more of those types of fiber, and of course continue to address the underlying conditions as much as possible. I recommend two products, BiotaGen and GalactoImmune from Klaire Labs, and if you take both of these products, it covers the entire spectrum of non-starch polysaccharides, so you can use them together or you can rotate them back and forth.

What group of patients should you not give non-starch polysaccharides to?

A good maintenance dose with Prescript-Assist is one capsule per day.

What is a good maintenance dose for PrescriptAssist?

It's an insoluble fiber that is fermented by the colonic bacteria. It is not broken into glucose and it doesn't hit the blood stream, so it doesn't have any effect on blood sugar.

What is resistant starch?

Rotating them to mimic and ancestral diet

What is the best strategy to take when supplementing with fibers?

People who are most likely to need them are also the least likely to tolerate them.

What is the biggest clinical challenge regarding probiotics and fermentable fiber?

gluten-free unmodified potato starch—Bob's Red Mill is a good brand (2 to 4 TBSPs/ days BUT starting slowly at 1/4 - 1/2 tsp and maybe less depending on the severity) or green banana flour or green plantain flour. (Prebiotic Plus with potato starch and green banana flour) So you could add this to smoothies, but not soups because you don't want to cook it; that would inactivate the resistant starch.

What is the easiest way to supplement with resistant starch above and beyond the foods that I just mentioned?

how much fermentable fiber people consume

What is the one of the biggest differences between modern day diet and our ancestral diet?

stimulates the growth of beneficial species like Bifidobacteria and Lactobacillus increases the concentration of short-chain fatty acids like butyrate and propionate shown to protect against colon cancer improve metabolic health reduce fasting blood sugar and body weight improve insulin sensitivity

What is the positive impact of RS?

I typically suggest plenty of fermented foods, fermentable fiber, soil-based organisms like Prescript-Assist and something with Saccharomyces boulardii in it; either take it alone or in a product like ABX Support from Klaire Labs, which has Saccharomyces boulardii, Lactobacillus rhamnosus, Bifidobacterium bifidum, and Bifidobacterium breve. All of these have been shown to support the normal gut flora after antibiotics. I recommend taking them during antibiotic therapy, away from when the patient is taking the antibiotics, so if the antibiotics are taken with meals, the probiotics should be taken away from meals, as well as taking them afterwards for several weeks. In addition to all of this, I'd suggest plenty of bone broth to help nourish the gut, enterocytes, and generally provide a more favorable environment for the re-establishment of healthy gut bacteria.

What is the probiotic recommendations for antibiotic recovery?

Lactobacillus, Bifidobacteria and Streptococcus.

What strains of bacteria are in huge amounts in fermented foods vs. commercial probiotics?

Kefir (especially home made kefir made from pasture-raised organic milk; if a patient can tolerate it)

What tends to be the most beneficial fermented food clinically and therapeutically?

they're not FODMAPs they tend to have a soothing effect on the digestive tract.

What two reasons are soluble fiber best tolerated by patients with gut issues?

green plantain green bananas potatoes white parboiled rice lentils ALL cooked and cooled

Which foods could you eat to get resistant starch?

PHGG

Which soluble fiber does not turn viscous/gel-like, mixes well with water, less likely to cause boating compared to other fibers and tends to be the best tolerated of all fibers.

Glucomannan (konjac root) Partially hydrolyzed guar gum.

Which two soluble fibers does Chris recommend using?

Up until very recently, all humans—and still today, most humans that live in rural areas on farms and in the developing world—consumed milligram quantities of these types of bacteria that are found in soil and water. (Primal Flora, Primal Defense, AOR3, and Prescript- Assist)

Why are soil based probiotics recommended?

A healthy gut flora plays a significant role in maintaining health and preventing disease, and eating enough fermentable fiber is important in maintaining a healthy gut flora.

Why could not eating enough fermentable fiber be hugely responsible for the epidemic of modern chronic disease?

d. all of the above

Why is fermentable fiber so important to restoring the gut ecosystem? a. it selectively stimulates a limited number of favorable species, in particular Lactobacillus and Bifidobacterium. b. Fiber increases the production of short-chain fatty acids c. increases the acidity of the colon, and makes it less hospitable to pathogens and more hospitable to the beneficial species of bacteria, which is why it's so important in that step two of the healing the gut protocol, which is where we rebuild and restore a healthy gut ecosystem. d. all of the above