Without a doubt one of the most common questions I get asked is, ‘can you recommend a probiotic?’ And I would love to say the answer to that is ‘yes, sure!’ but it’s not quite as simple as that. Probiotics, along with their very close friend prebiotics, serve distinct functions within the body. Whilst probiotics and prebiotics are terms that are often confused, there’s a number of key differences to be aware of.
In this piece, we will delve into the differences between probiotics and prebiotics, explore their respective benefits, and discuss how they can impact various aspects of our health.
First things first, what actually are probiotics and prebiotics?
Probiotics are live bacteria that are promoted as having a multitude of health benefits, particularly gut health. They are often found in fermented foods like yoghurt, kefir, and sauerkraut, as well as in dietary supplements. Prebiotics, on the other hand, are non-digestible food ingredients that feed the live bacteria living in the gut. So essentially, prebiotics are the food for probiotics, and can be found in high-fibre foods such as garlic, onions, bananas, leeks, asparagus, and whole grains.
So, can I recommend a Probiotic?
In some ways, being asked if I can recommend a probiotic is an amazing question; it indicates the huge increase in awareness and interest we are seeing around the health of the microbiome. (If you’re not familiar with the microbiome, it’s the ecosystem of organisms that live alongside us – predominantly in the gut but we also have skin, vaginal, and urinary microbiomes, among others.)
The question around probiotics requires somewhat of a reframe, though.
Rather than asking me if I can recommend one, let’s take a step back and instead question if you even should be taking a probiotic.
Whilst probiotics are often touted as good for everyone, that isn’t quite the case. Different strains of probiotics offer different benefits, meaning the blanket recommendation of probiotics is rarely appropriate. It’s important to know which strain addresses which issue. However, we only have research on a fraction of probiotics, and what we do know from this is that not all probiotics are created equal. Probiotic supplements and their benefits are incredibly strain specific, and a lot of what is available to buy isn’t shelf stable or hasn’t been tested in any meaningful way.
If you’re working with a practitioner they’ll have picked one out that’s relevant to your particular health goals, and will have factored in multiple things, such as:
Do you have eczema or psoriasis?
Are you lactose intolerant?
If you experience bloating, is it upper abdominal or lower abdominal?
Do you experience constipation?
There can also be some negative side effects if you take the wrong probiotic, hence why the aforementioned questions are so important. The wrong probiotic can exacerbate skin conditions, worsen constipation, or even negatively impact the immune system in those who are immunocompromised.
Furthermore, anyone taking immunosuppressant drugs, or someone with a low white blood count, more specifically low neutrophils, should avoid taking probiotics as there can be a risk of infection, as their immune systems are not robust enough to handle the introduction of live bacteria.
Despite their benefits, probiotics are rarely my go-to recommendation or first line of intervention. I’d suggest getting your probiotics through food to start (they’re found in sauerkraut, kimchi, kefir and live yoghurt), and turning to prebiotics as your first port of call instead.
Prebiotics: Now We’re Talking
Prebiotics are generally more broadly beneficial than probiotics, and I much prefer starting with these. They feed and nourish the good bacteria already present in the gut, enhancing their ability to flourish and maintain a healthy balance. They have a much broader impact, as the particular types of fibre will benefit multiple colonies of beneficial bacteria at the same time. If someone has undertaken some microbiome testing and they’re trying to influence particular families of bacteria, then they can be more selective with the prebiotic that they take, e.g. deciding between GOS (galacto-oligosaccharides) or FOS (fructo-oligosaccharides), and a practitioner can advise on which is most suitable.
What’s great about prebiotics is that we can choose ones that have a much lower chance of contributing to bloating and discomfort; the one that I love for this is PHGG (partially hydrolysed guar gum), this one in particular I recommend to a lot of my clients.
There’s also a natural way to boost prebiotics in the food you already eat, by eating foods rich in resistant starch. Resistant starch is a carbohydrate that resists digestion in the small intestine and ferments in the large intestine. As this process of fermentation happens, it acts as a prebiotic to feed the good bacteria in the gut. An easy way to build these into your diet is to cook foods such as potatoes or pasta and allow them to cool before eating, which will increase the resistant starch content.
Other foods that are a good source of prebiotic fibre include Jerusalem artichoke, asparagus, garlic, leeks, unripe bananas and oats.
If you want to go straight out and buy a prebiotic, do exercise caution when you start taking it. Less is more in the beginning; I always encourage clients to start with a fraction of the suggested dose and slowly build up. This is because there could well be a significant shift in the makeup of the gut bacteria and this can contribute to bloating, gas and discomfort. If you notice this, lower the dose until you don’t have symptoms, but keep going. Your body should adjust after 10 – 14 days of consistency.
All of this is not to say don’t take probiotics, but I highly recommend that they are used with care and ideally under the guidance of a healthcare professional, particularly if you are dealing with specific health conditions. For most people, enhancing the diet with prebiotic foods, and possibly a low dose prebiotic supplement to start, is a safer and often more effective approach to supporting gut health. Prebiotics offer a more universally beneficial approach to improving your gut health and, by extension, multiple other areas of your health, including your skin. By understanding and using the right strategies when it comes to prebiotic and probiotics, you can support your body’s natural processes and enjoy a healthier, well-functioning system as a result.