The Best of Both Worlds

The bacteria inside of us is as unique as our fingerprints, according to the Human Microbiome Project, a research project that aims to characterize the microbial communities that live in and on us. Were not at the stage of science when the bacteria we leave behind at a crime scene will help nab a guilty party, but we do know how some of these bacteria affect human health. We also know dietary habits change the bacterial balance in our guts.

Probiotics are microorganisms, mostly bacteria, that may confer a health benefit on the host. These health benefits most notably imparted to the digestive tract, leading to improved digestive, immune and skin health. The probiotics that give us these health benefits feed on what is available in the gastrointestinal (GI) tract, aka, the food we eat, and they thrive on nondigestible foods known as prebiotics. Prebiotics, mostly fibers, not only feed the probiotics, but have also been shown to help the GI on their own.

Savvy health product companies have combined the two into synbiotics, which deliver the benefits of both. "According to research, synbiotics may have anti-microbial, anti-carcinogenic, immune-modulatory, anti-diarrheal, anti-allergenic, hypolipidemic and hypoglycemic activities," said Albert Dahbour, vice president/chief sales officer, Wakunaga of America. "Improvement in mineral absorption and balance and anti-osteoporotic activity have also been shown. Since prebiotics could improve the survival of probiotics by providing a specific substrate for its fermentation, they are expected to amplify the health benefits of probiotics."

Charles LaBelle, business development, Probionov, said his company's lactobacillus Lcr35® probiotic offers more gut, immune, women's and children's health benefits when added to prebiotics (as 3Biotic®) than when its used on its own. The combination of all these elements acts synergistically, yielding a probiotic whose mechanisms of actions are enhanced."

Like Lcr35, many probiotics offer multiple benefits to human health, but the best recognized benefit of probiotics is digestive support, a health effect also seen with prebiotics on their own. Synbiotics can amplify the effects. Traditionally, probiotic/prebiotic products have been marketed to support digestive health," said Ingmar Middelbos, product manager for Stratum Nutrition. In these applications, probiotics and prebiotics offer benefits both alone and together. Specific probiotics can enhance the endogenous bacteria in the gut by producing necessary digestive enzymes to facilitate break down of food and absorption of vital nutrients."

Health Pros of Synbiotics

Scientific studies have reported on the health benefits of synbiotics. A research paper from Japans Osaka University Graduate School of Medicine published in January 2013 found synbiotic therapy significantly reduced septic complications in the guts of critically ill patients, such as those who had major abdominal surgery, trauma or were in the intensive care unit (ICU).¹ They also noted pro-, pre- and synbiotic treatments are promising therapies to maintain and repair gut microbiota and gut environment.

When children are born, their first helping of friendly gut bacteria comes from the birth canal, and these help keep them healthy through their development, so it makes sense that synbiotic supplementation feeds the benefits. Supplementing with synbiotics resulted in a 24-hour earlier normalization of stool consistency in children (n=111) who were treated for acute gastroenteritis in a 2012 trial.² The Belgian researchers found the supplement, which contained the prebiotic fructo-oligosaccharides (FOS) and the probiotic strains Streptoccoccus thermophilus, Lactobacillus rhamnosus, Lactobacillus acidophilus, Bifidobacterium lactis and Bifidobacterium infantis, reduced health care costs by 25 percent due to the reduced need of other medications and medial consultations.

And a 2012 review of three synbiotic studies using childrens formula as a delivery device, reported they increased stool frequency, but had no impact on stool consistency, colic, spitting up/regurgitation, crying, restlessness or vomiting.³

Having a healthy gut influenced by synbiotics can impart benefits beyond digestion, as the bacterial balance of the gut also helps boost the immune system. Another typical application for probiotics is related to the improvement of immunity," said Jamie Spell, managing director, Nutraceuticals International Group. Probiotics indeed promote the indirect immunity response through activation of the cytokines cascade and modulation of inflammation, thus improving the natural body reaction to adverse events."

While Spell said prebiotics do not have the same immune effect, Sergio Pumarola, co-founder and main shareholder, BioGlane, S.L.N.E., said his companys research results on the prebiotic d-fagomine, suggested a direct link between non-digestible carbohydrates, gut microbiota and mucosal immune response. There is large bibliography on the possible relationship in these areas, but, as far as we know, there was not any direct evidence on this relationship, and also there was not any previous molecular (dose-response) explanation to these activities."

Whether prebiotics have a direct effect or just help the probiotic may be unknown, but research has shown the two together boost immune health. Three months of supplementation with a synbiotic preparation (Lactobacillus helveticus R0052, Bifidobacterium infantis R0033, Bifidobacterium bifidum R0071, and FOS) for three months decreased the risk of common infectious diseases in children and reduced the amount of time they missed school.⁴ The study was conducted in 135 children, aged 3 to 7 years, during a winter period and involved supplementation with either ProbioKid® (n=62), from Institut Rosell, or a placebo (n=73). Results showed kids who took the probiotic had a 25-percent lower risk of sickness compared to the placebo group.

Younger children also received immune health benefits in a 2010 study.5 Children, 1 to 3 years of age, were randomly assigned to receive either control milk (n=312) or milk fortified with 2.4 g/d of prebiotic oligosaccharide and 19 million colony forming units (CFU)/d of Danisco's DR10 probiotic, Bifidobacterium lactis HN019 (n=312).⁵ Incidence of dysentery episodes decreased by 21 percent, pneumonia by 24 percent and severe acute lower respiratory infection by 35 percent in the intervention group, compared to controls. Further, children taking the synbiotic milk had a 16-percent and 5-percent reduction in days with severe illness and high fever, respectively.

Another study found regular, long-term intake of BIFIVIR® (from Pharmachem) reduced the incidence and severity of respiratory diseases during the cold season.⁶ BIFIVIR, developed by Probiotical, is a synbiotic of five probiotic strains (Lactobacilli plantarum LP01, Lactobacilli plantarum LP02, Lactobacilli rhamnosus LR04, Lactobacilli rhamnosus LR05 and Bifidobacteria lactis BS01), the prebiotic FOS and other non-digestible soluble dietary fibers. In this study, researchers studied synbiotic supplementation over three cold and flu season. In the 2003 to 2004 cold and flu season healthy volunteers who took probiotics and FOS had reduced bloating, more regular intestinal motility, shorter acute respiratory infections and fewer upper respiratory tract infections (URTIs) than a control group. In 2005 and 2006, those who took the synbiotic had improved bowel functions, fewer cases of colds and fewer UTRIs. In 2006 and 2007, volunteers who took BIFIVIR had improved bowel functions and a decrease in the length of respiratory, cough, cold and flu episodes.

A 2009 study found a synbiotic combination of Daniscos probiotic, L. acidophilus NCFM®; and Daniscos lactitol, a prebiotic disaccharide polyol derived from lactose, increased the level of beneficial gut bacteria, improved immune and mucosal function and enhanced bowel movements in subjects older than 65 years.⁷

Synbiotics can also play a health-boosting role in patients who undergo, or are wishing to avoid, surgery. A March 2013 review found probiotics and synbiotics reduced the incidence of postoperative sepsis in elective general surgery; the effects were more pronounced with the use of synbiotics than with probiotics alone.⁸ Synbiotics also reduced the length of postoperative antibiotic use.

In a different March 2013 study from Latvia, oral administration of synbiotic (n=30) and prebiotic (n=28) supplements was associated with lower infection rates, lower rates of surgical interventions, and shorter ICU and hospital stays in patients with severe acute pancreatitis compared the control group (n=32).⁹ Synbiotics were also linked to reduced mortality rates.

Researchers from another review from 2012 were encouraged by results that showed pro-, pre- and synbiotics had a protective role against chemoradiation-induced diarrhea and had an ability to improve post-colectomy GI-related quality of life.¹⁰

Synbiotics might be able to increase liver function capacity in patients after liver resection, but patient numbers were too small and the clinical courses too heterogeneous to draw any definite conclusions, according to researchers who conducted the pilot trial.¹¹ Patients received either a combination of four probiotics and four prebiotics right after surgery or only fiber starting the day before surgery and continuing for 10 days. Complications from surgery had a negative impact on liver function, so the researchers performed a subanalysis. In uncomplicated cases, liver function capacity was better in the patients who took synbiotics.

Popular Prebiotics

According to the International Scientific Association for Probiotics and Prebiotics (ISAPP), the most widely accepted prebiotics are fructooligosaccharides (FOS) and galactooligosaccharides (GOS), and the organization suggests consumers look for FOS, inulin (a type of FOS), GOS or TOS (transGOS) on product labels.

But that is by no means the end of the list. A few other popular prebiotics are:

Popular Probiotics

Latin nomenclature helps categorize probiotics by genus and species, such as Lactobacillus acidophilus (L. acidophilus) or Bifidobacterium lactis (B. lactis), and when it comes to health benefits strains are important. Many probiotic companies have established strains, and this is a short list of just a few with research.

Find the studies behind these pre- and probiotics, as well as a list of ingredient suppliers in INSIDER's Pre-and Probiotic Buyers Guidebook.

References are listed on the next page.

1. Gibson GR, Roberfroid MB. "Dietary modulation of the human colonic microbiota: introducing the concept of prebiotics." J Nutr. 1995 Jun;125(6):1401-12.

2. Vandenplas Y, De Hert S; Probiotical study group. Cost/benefit of synbiotics in acute infectious gastroenteritis: spend to save." Benef Microbes. 2012 Sep;3(3):189-94. doi: 10.3920/BM2012.0007.

3. Mugambi MN et al. Synbiotics, probiotics or prebiotics in infant formula for full term infants: a systematic review." Nutr J. 2012 Oct 4;11:81. doi: 10.1186/1475-2891-11-81

4. Cazzola M et al. Efficacy of a synbiotic supplementation in the prevention of common winter diseases in children: a randomized, double-blind, placebo-controlled pilot study." Ther Adv Respir Dis. 2010 Oct;4(5):271-8.

5. Sazawal S et al. Prebiotic and Probiotic Fortified Milk in Prevention of Morbidities among Children: Community-Based, Randomized, Double-Blind, Controlled Trial." PLoS One. 2010 Aug 13;5(8):e12164.

6. Pregliasco F et al. "A new chance of preventing winter diseases by the administration of synbiotic formulations." J Clin Gastroenterol. 2008 Sep;42 Suppl 3 Pt 2:S224-33. doi: 10.1097/MCG.0b013e31817e1c91.

7. Ouwehand AC et al. " Influence of a combination of Lactobacillus acidophilus NCFM and lactitol on healthy elderly: intestinal and immune parameters." Br J Nutr. 2009 Feb;101(3):367-75. doi: 10.1017/S0007114508003097.

8. Kinross JM et al. A meta-analysis of probiotic and synbiotic use in elective surgery: does nutrition modulation of the gut microbiome improve clinical outcome?" JPEN J Parenter Enteral Nutr. 2013 Mar;37(2):243-53. doi: 10.1177/0148607112452306. Epub 2012 Jul 2.

9. Plaudis H et al. Early low volume oral synbiotic/prebiotic supplemented enteral stimulation of the gut in patients with severe acute pancreatitis: a prospective feasibility study." Acta Chir Belg. 2012 Mar-Apr;112(2):131-8.

10. Peitsidou K, Karantanos T, Theodoropoulos GE. Probiotics, prebiotics, synbiotics: is there enough evidence to support their use in colorectal cancer surgery?." Dig Surg. 2012;29(5):426-38. doi: 10.1159/000345580.

11. Rayes N et al. Effect of pre- and probiotics on liver regeneration after resection: a randomised, double-blind pilot study." Benef Microbes. 2012 Sep;3(3):237-44. doi: 10.3920/BM2012.0006