The Gut Dictionary: Probiotics, Prebiotics and Postbiotics Explained.

Episode Transcript
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Kate Scarlata, MPH, RDN (00:00):
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(00:23):
Healthcare provider, you are inthe right place.
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Dr. Megan Riehl (00:38):
Hello friends, and welcome to the Gut Health
Podcast, where we talk about allthings related to your gut and
well-being.
We are your hosts.
I'm Dr Megan Riehl, a GI healthpsychologist.

And I'm Kate Scarlata, a GI expert,
dietician, and today we'rediving into the world of biotics
, probiotics, prebiotics andpostbiotics.
You've probably seen theseterms on yogurt labels and
supplements or even health blogs, but do you really know what
they mean?
Are they different?

(01:10):
Do you need all of them?
Most importantly, how do theyactually affect your digestion,
your immune system and youroverall well-being?
We'll unpack the science, busta few myths and give you some
easy takeaways that can supportyour gut health for every day.

So our guest today is going to help us with
many of these answers.
Dr Mary Ellen Sanders, welcome.
She is a consultant in the areaof probiotic microbiology.
She works internationally withfood and supplement companies to
develop new probiotic productsand offers perspective on paths
to scientific substantiation ofprobiotic product label claims.

(01:49):
She was the founding presidentand executive science officer
for the International ScientificAssociation of Probiotics and
Prebiotics, the ISAPP.
You can check out very valuableinformation at www.
isappscience.
org.
This is an organization devotedto advancing the science of

(02:11):
probiotics, prebiotics,symbiotics, postbiotics and
fermented foods.
Through ISAPP, she participatedin many scientific efforts, as
reflected in her over 140 peerpublications, and led many
communication efforts in thebiotic space.
Dr.
Sanders lives in Colorado withher husband, where she enjoys

(02:34):
time with her two grandchildrenhiking and riding her
26-year-old Morgan horse.
Welcome, Dr Sanders.

Dr. Mary Ellen Sanders (02:42):
Thank you so much, Megan.

Love that you have a horse.
I actually love horsebackriding.
I don't do it that often, Idon't own one, but any chance I
get to ride one I find it justthe most peaceful, relaxing
activity.
So I love that.

It's been a great hobby and I've
really enjoyed sharing it withmy grandkids and my daughter, of
course, while she was growingup.

Yeah, that's awesome.
Really enjoyed sharing it withmy grandkids and my daughter, of
course, while she was growingup.
Yeah, that's awesome.

So we're going to get right into the
definition of probiotics.
What is it?
So?
Probiotics are livemicroorganisms that, when
administered in adequate amounts, confer a health benefit on the
host, and this is a very broaddefinition.
And it's important to realizethat probiotics, even though we
know them mostly in foods anddietary supplements, the
definition is broad enough thatit really encompasses not just

(03:31):
food for people.
So there are probiotic productsthat are made for agricultural
animals and even some, forexample, for my horse.
You know you can buy probioticsfor your horse, you can buy
them for your pets.
They're not just foods youmentioned dietary supplements
already but they could also bepotentially formulated into
drugs, into medical products,and they're not just orally

(03:52):
consumed.
So, in addition to not beingjust foods, they could, for
example, be applied as aprobiotic on your skin.
There's also some preparationsthat are intravaginal.
So there are different waysthat probiotics can be
administered, and so I justpoint that out, because it is a
very broad, all-encompassingdefinition.
And one other point I think thatwe don't want to leave behind

(04:13):
in this introduction toprobiotics is how important it
is that the microorganisms thatare in a pro or that comprise a
probiotic are defined to thestrain level.
And what that means is that youhave a genus of a microorganism
, a species, and then there'salways a strain designation,
because even within the samespecies you can have genetic

(04:35):
variation that will identifydifferent strains among the same
species.
So one popular probiotic isLactocaceae bacillus rhamnosus
GG, so the Lactocaceae bacillus,which incidentally used to be
Lactobacillus, but thenomenclature changed.
So Lactocaceae bacillus is thegenus, rhamnosus is the species

(04:55):
and GG is the strain designation.
And then one last reallyimportant point about that
definition is that thesemicroorganisms need to be
well-defined to the strain level, but they also have to be
tested for a health benefit tobe able to legitimately be
called a probiotic.

Yeah, I think it's also confusing.
Sometimes people don't realizethey're alive.
They have to be alive.
You know what I mean.
In your body they are alive.
So when we're talking about,like, even fermented foods and I
know they don't, we've had anepisode on that If something's
baked, it's not going to be asource of a probiotic because
that microorganism has beenkilled.

(05:34):
So when consumers are lookingfor a probiotic, what should
they be looking for when they'reselecting one?

And that's a great question and it's
quite difficult, I think, forconsumers to weed through
everything that's on the marketthat has the word probiotic on a
label.
You know just some tips fordoing that.
If you're looking for aprobiotic in a food product, I
think one helpful thing to do isto make sure that the product
lists the strain designation onthe label.
And I was involved in a surveyproject with a colleague of mine

(06:04):
and we looked at the differentproducts in the refrigerated
section of the grocery store andlooked at what kind of
information was given on thelabels and what we found was the
products that contain thestrain designations were more
likely to be able to be linkedthen to health benefits.
So I think it's a good idea tojust make sure that the company
is putting the straindesignation.

(06:24):
That also says that they'rebeing sophisticated about their
approach to the field.
You know they recognize that notall probiotics are the same.
So that's just one hint I wouldthrow out there.
And I think if you're lookingat supplements and it's not
quite as common in food products, unfortunately, but make sure
if you're looking for a dietarysupplement, that it does show
the dose that's in the productand, very importantly, the

(06:47):
product should not say at timeof manufacture.
So the dose should not be attime of manufacture, it should
be indicated to be through theend of shelf life, and so if the
use by date on the product isthere, you should be able to get
the indicated dose all the waythrough that use by time.

(07:07):
And so it's important to makesure that your product does not
say at time of manufacture.

Absolutely.
You know it's so funny that andI want to hear more of these
tips and tricks because you knownow that we're doing this
podcast and we've had really thebenefit of having some amazing,
world-renowned experts but I'mnow getting more and more of my
friends and family that they'relike hey, it makes sense that a
probiotic is at the pharmacy.
But, exactly to your pointearlier, I've had a friend reach

(07:34):
out and she's like I was at myOBGYN, she's offering probiotics
.
Does my vagina really need aprobiotic?
And it's like it feels likethere is something for
everything these days.
So to hear you bringing up allthe products that are available,
these tips and tricks are sohelpful.

Good, you know.
One other tip I will give yourlisteners is that because again
it is so difficult to wadethrough you know the type of
evidence that's available for aspecific strain that's listed on
a label.
There is a guide out there andit can be found at www.
usprobioticguide.
com, and this is a guide that isupdated yearly and it lists

(08:15):
products available in the UnitedStates and what it does.
That's different from prettymuch any other resource you have
out there is.
It specifies products and ittells you what strains are there
, what the dose is and what thetested evidence is for, and so
it's really worth looking at andif you can find products on
that list, at least you knowthat a group of independent
reviewers said that there wasevidence to show that this

(08:37):
product was tested for thatbenefit.
But what I would caution youabout that guide is that it
includes three levels of benefit.
It has level one evidence,level two evidence and level
three evidence, and I wouldpretty much ignore the level two
and three evidence and just gowith products that have level
one evidence, because it startsgetting pretty.
The level of evidence once theyget to the level three is not

(08:59):
that strong.

Okay, I think that's really important
and that's what I tell mypatients.
That strong Okay, I thinkthat's really important and
that's what I tell my patientsIf they're coming in with
constipation.
I'm going to try to findevidence for a probiotic strain
that helps with constipation,right?
So it's not necessarily likelactobacillus.
What is it?
Kci whatever the newnomenclature.

The new name is lactacta Caseyi Bacillus
.
I know it's such a mouthful, Iknow.

It is a mouthful, my goodness so.
But you do want to like selectthe right one for the right
indication, and I think that'swhy a health professional can be
a good guide and you knowcertainly online guidance as
well but think about why you'retaking it and then see if
there's an indication for aspecific probiotic strain, for
that indication.

And I do think another important point
is that people will be their owndeterminers of a success, and
you know, what we sometimes failto communicate well, I think,
is that you know, we do theseresearch studies.
They are all composed, or atthe end of the study, what you
have is aggregate data, andwithin that aggregate of data,
there are all composed, or atthe end of the study, what you
have is aggregate data, andwithin that aggregate of data,

(10:10):
there are always responders andnon-responders that then get
averaged out into the wholething, and we are at a point in
the field where we don'tunderstand what really drives
response and non-response tocertain probiotics, and that's
certainly true in the medicalfield, with drugs as well, and
so I think people can be theirown titrators of is this working
for me or not?

I love that advice.
I mean, we think our gutmicrobiome is personal to us, so
why wouldn't our response be alittle bit different, right?
We're all different genes,different microbiome.
I love that advice.

So if we've been on something for three
years and you still areconstipated, probably not the
right probiotic for you.

Right, exactly, and in fact I will say,
without any evidence for sayingthis.
I will usually tell people whojust ask me at a party what
should I do, and I'll say try itfor a month and if you see no
benefit then try something else.
Maybe probiotics aren't goingto be a solution, or maybe
you've got the wrong strain.

That's perfect.
This kind of leads into ournext question here Should we all
be using probiotics?
Are there adverse effects tousing them?
Let's start with that.

Well, the adverse effects is an
excellent question and I thinksometimes in the food and
dietary supplement world weforget to ask that question and
we need to realize that productsthat are on the market as foods
and dietary supplements aredesigned you know, it's a legal
category of product to sell inthe US and they're designed for
the general population that'sgenerally healthy, and so if you

(11:37):
have underlying health concerns, you have to recognize that
these products have notnecessarily been tested and
shown to be safe in whatevercondition you happen to have.
Now, having said that, there'sbeen many clinical conditions
that have been tested forprobiotics, but nothing is ever
100% safe.
We have to recognize that.
But I will say, with thestandard probiotics the

(11:59):
lactobacillus umbrellaprobiotics, the bifidobacteria,
the saccharomyces and some othergenera that have been used for
a long time we see really goodtolerance for those and there
are very few side effectsassociated with them.
But again, if you're severelyimmunocompromised or if you have
some other underlyingconditions, you for sure check
with a medical professionalbefore engaging in them.

Okay, let's say I'm in my 40s.
I eat a pretty wide range offruits and vegetables.
My bowel habits are typicallypretty normal.
I have the stressors of being aworking mom.
Do I need a probiotic?

There's very little evidence to say that
yes, you do.
That's just not really how thestudies have been done.
I think I was involved inanother project not too long ago
.
We really looked at theliterature in certain areas for
certain clinical indications forprobiotics and we asked the
question like is thereconvincing evidence that healthy
people should take a probiotic?
And the end of our assessmentnow keep in mind, we used a very

(13:02):
high level of evidence.
In other words, we wereapproaching this as if we were
the United States, the USPreventive Services Task Force,
who makes recommendations on youknow, recommendations for
healthy people and they say whatyou can recommend and what you
isn't there yet to reallysubstantiate that you're going
to necessarily benefit if youhave no underlying concern that

(13:30):
you're trying to address.
I do think that there's emergingevidence to suggest that adding
live microbes to your diet mayprovide some benefit, and those
could come from fermented foods,those could come from probiotic
foods or supplements.
But you know, I think the wayto look at probiotics is to
really focus on where theevidence shows that they seem to

(13:51):
be beneficial, and I thinkprobably top of the list is to
support gut function duringantibiotic use.
You know it helps to decreasesymptoms associated with
antibiotic use.
There is some good evidence notexcellent evidence, but good
evidence to show that it canreduce the risk of respiratory
tract infections and again, I'msaying this very generally.
Obviously there are certainstrains that have been tested

(14:12):
for these conditions.
Another one that I think isvery interesting with your
potential stressed mom, is thatthere's really good evidence I
would say this is very highlevel evidence that one specific
strain of lactobacillus reuterican reduce crying time in
colicky breastfed babies.

And that's a great one actually.

Then we also, you know, to allude to the
further point I mean sorry, aprevious point that was made is
that there's reasonable evidencethat you can reduce vaginal and
urinary tract infections inwomen with using probiotics,
evidence that you can reducevaginal and urinary tract
infections in women with usingprobiotics.
And there are some digestivecomplaints like constipation,
bloating, those types of thingsthat I think it can do, and so,

(14:52):
you know, those are the areasthat I think I would focus on.
But, again, if you have somereason that you have a concern,
then you should be able to findout if it's working for you or
not.
Right, If you?
take a probiotic so there's verylittle harm in taking a
probiotic and seeing if it.

Well, I would have loved that probiotic about
eight years ago with myfirstborn you had a colicky baby
, so did I yeah.

I think it reduced crying time by about
an hour.
I can't remember an hour perday or something like that, and
I'm thinking that's such awonderful endpoint to study
because people don't care howmany lactobacillus reuteri you
have in your gut or they don't.

You know, they don't care about any of that.

Like my baby's not crying as much.
That's a good one.

Yeah, that's a good one.
Yes, I know my mental healthprobably would have been better
at that point if I had lesscrying and more sleep.
So let's turn to your thoughtson this term psychobiotics.
What does the science tell usabout these?

Well, first of all, personally I'm not
a fan of the term Okay.
I say that only because there'sjust so many terms that people
throw out there, and I think itcauses more harm than good.
I think people get veryconfused about what do all of
these?
You see immunobiotics, you seepsychobiotics.
You see pharmabiotics.
You see immunobiotics.
You see psychobiotics, you seepharmabiotics.

(16:17):
There's all these differentterms and they aren't robustly
defined.
And you know, I would much,rather, much, much rather have
someone say we have a probioticthat has been studied for mental
health issues or brain functionor whatever, and that's my own
personal bias.
I do think that this is areally interesting evolving area
.
We're not there yet to be ableto strongly say that these

(16:40):
specific strains are going toshow big benefits for anxiety or
mild depression or issues likethat.
But there are a few studiesthat have been conducted that
show signals.
You know that, show that theremight be something there.
Great animal research showsignals, you know that, show
that there might be somethingthere.
Great animal research, greatpreclinical research, is behind

(17:01):
a lot of this.
But I think the translation ofthat research into humans has
been tough to do and I think welack high quality, properly
powered human trials to reallyget at this.
And I will say you know thosetrials are expensive to do and
until we better understandmechanisms and things like that,
it's really hard to know who'sgoing to benefit, who's not, as
we mentioned earlier.
So it's hard to know who torecruit into your study in order

(17:22):
to give yourself a chance ofreally seeing a better signal.
But I think it's a veryexciting area and again, I know
there are some products on themarket already with those
endpoints.
You can give them a try and ifthey work for you, great.

Yeah, we're just not there.

We're not there yet, and you know, so often
there's still a lot of stigmaaround taking medication,
pharmaceutical medication formental health, and we see this
similarly in gastroenterologypatients, right.
So you know, I think, that theyoftentimes would rather try a
prebiotic than a pharmaceutical,and so this again may open some

(18:01):
doors for people in the mentalhealth space for additional
options.
But our takeaway today is thescience just isn't there to yet
totally replace your SSRI oryour neuromodulator.

Well, and I think the other point that
you alluded to but didn't sayovertly was the medications that
do exist can be laden withserious side effects.
That's right, you know these arenot medications that are just
take it and you never, you knowyou see a benefit or nothing at
all.
They might be that you see abenefit, but you also see some
real downsides to them, andthat's where I think probiotics

(18:40):
really have.
You know, there's a door openthere because we don't seem to
see the adverse effectsassociated with taking them, and
that's because they're actingmechanistically in different
ways than these other drugs are,and so I think there's real
potential there and I hope thatthat continues.
I know there's so many goodscientists interested in this
area.
You know we'll make someprogress.

Yeah, definitely, it is very
interesting.
And again, when you think back,you know the gut and brain and
microbes creatingneurotransmitters and how does
that all make out in thisprobiotic, psychobiotics or
whatever we want to call?

them.

We're going to call them probiotics
for gut brain health.
That's what we're going to callit.

Either that or just make sure you
define what you mean by yourterm.

I hear you.
I think it is very confusingfor the consumer to hear all
these different terms and whatthe heck they mean.
So I think, keep to probiotic,but then qualify what it's for.
So we're going to switch toprebiotics, so I'd like to hear
the definition of prebiotics.
And then, where are we findingthese prebiotics?

Well, I'll start with the scientific
definition of prebiotics andthen I will go from there.
A prebiotic has been defined asa substrate that is selectively
utilized by host microorganisms, conferring a health benefit,
and that's a big mouthful.
But, in short, what that reallymeans is that prebiotics
typically serve as food for thebeneficial microorganisms that

(20:05):
reside in your body.
Okay, and like probiotics, theyalso have to be tested and
shown to have a health benefit.
So just because we have asoluble fiber that you can show
that might have some impact ongut microbes, we won't call that
a prebiotic until someone doesa study and shows some endpoint
that's been improved byconsuming it.

(20:27):
If that makes sense, yeah.

It totally does.
I love that this conferring,that's the big word, conferring
it's confers.

I was on the panels that came up with
these definitions, and it's alot harder to do than you might
think, because every single wordhas a meaning and you have to
make sure it's not going to bemisunderstood or somehow have a
separate meaning that you didn'tintend.

Exactly , exactly, but it just it does
kind of crack me up.
So when we think aboutprebiotics, you know I know this
definition's changed a littlebit over the years because I've
been in the science for a whileand you know kind of was always
about carbohydrates as beingsort of a prebiotic, and now
it's kind of slid intopolyphenols and maybe some other

(21:13):
food components too that canact this way.
Can you just touch on that alittle bit?

Yeah, you're absolutely right.
Initially they talked aboutthem being carbohydrates and
then usually fibers, andtypically soluble fibers, and so
it was a very, very specifickind of a box, a chemical
structure box, that they wereputting prebiotics in initially.
The way the field has gone isthat they started recognizing
that.
Maybe the value here is to lookat what we're looking at in

(21:38):
terms of mechanism of action,like what substances can be
utilized by the microbes in yourgut and then have some changes
that are in your gut microbesand then can that lead to a
benefit?
And what we found is it's morethan just soluble fibers that
can do that.
And I am far from an expert onpolyphenols, so I'm not going to
say much at all about them.

(21:58):
I know that they're very, veryinteresting compounds.
They've got antioxidantproperties.
They have all these propertiesthat are beyond just their
ability to be utilized by themicrobiota.
I think that's a very excitingarea that will be developed, but
you're right.

You don't have to be a carbohydrate
anymore to fit into theprebiotic category.
Yeah, which is great, becauseyou know we see these
polyphenols in a lot of fruitsand vegetables extra virgin
olive oil, so you know some goodthings.

And I think that one of the things
that we did keep in mind as wewere developing definitions is
that we really wanted them to bebroad enough to encourage
innovation.
You know, we didn't want topaint these substances into a
box that wouldn't allow theclever scientists of the future
to be able to think of somethingthat we wouldn't have
anticipated, right.

Yeah, that's excellent.
So what do you think?
Should we be getting prebioticsfrom a supplement, or do we get
them from food, or as a mix?
What's the jury?

I am a big food person, you know, try
to get your dietary needs metthrough food rather than
supplements.
But what I will say is thatmost of the studies done in
prebiotics have been done atlevels of about five grams or
more per day, and that's toughto get out of foods.
The other thing you have is wealways talk about onions and

(23:15):
garlic, and maybe bananas have afew prebiotics in them and, you
know, maybe a Jerusalemartichoke if you can find that
in your grocery store, right.
But you know it's not that easyto find the food sources and be
able to eat enough of themwhere you're going to get the
benefits that have been shown inthese studies and I think
that's where the supplementedfoods come in.
It does at least allow you totap into a product that reflects

(23:41):
the evidence that was developedin a controlled human study.

So you brought up a lot of foods and,
being a GI dietitian, the foodsthat you brought up are fructans
primarily, and those are aknown prebiotic.
But what aboutgalacto-oligosaccharides in
beans?
Is that controversial?

No, I don't think it is, and it's
interesting you say that,because when I think of the top
line foods that always getthrown out there about where do
you get your prebiotics, youknow it's always the ones that I
already mentioned.
Beans are certainly a greatsource of fiber, and fiber is
wonderful.
I mean we don't eat enough ofit.
We know that.
You know, if you more beans,well I can't say the more beans

(24:21):
the better, but I mean you knowthose are all great foods, to
the extent that they're.
What levels of prebiotics?
Unfortunately, I just don'tknow.
I'm sorry.

That's okay, I'm just curious.
I was just curious because theywere mostly fructan sources and
when we look at supplementsthey're also fructans, so it's
inulin chicory root extract.

Those are the ones that you're seeing
mostly, yeah you do seegalactooligosaccharides, but I
don't know the commercial namesfor those either.
But the GOS is definitelyaround as well.
But you're probably right,you're more familiar with the
products actually than I am onthose.
But yeah, but goss is.
I think there's a lot ofevidence on GOS as well, and
yeah.

If you can stand the farting and the
gas, well, that's the thing.
Yeah, go, gentle go, gentle.

I was going to beans.
Beans, the magical fruit.
The more you eat the more youtoot.
We say that a lot at the RiehlHouse.
There's a lot of tooting andthat's okay.

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You mentioned five grams in the research.
Is there a gram amount per dayof prebiotics we should be
aiming for in adults.

That's what you're looking for is the
five grams.
If you want to tap into thebenefits, I should say five
grams per day.
If you want to tap into thebenefits that have been studied,
five grams per day.
If you want to tap into thebenefits that have been studied.
That's pretty much how they'vebeen studied.
But we have to keep in mindthat the research is just so
piecemeal that you know no one'sdone a study on six and a half

(27:07):
grams or you know what I'msaying.
Like we don't really know, orprobably four and a half grams.
Like we know that in thestudies done there's zero,
there's five grams, there's 10grams and I'm making this up,
but you know what I mean.
Like you have these verydistinct amounts that have been
tested and the evidence isn't sobroad that we're really clear
on exactly what the doses are,and not all prebiotics are the

(27:29):
same, and so it depends on ifyou are doing your study on
fructooligosaccharide versus agalactooligosaccharide versus a
polyphenol, and you know it'sjust really hard.
So I just know, when I'vepressed the prebiotic, people
that know this literature waybetter than I do, you know the
five grams is what they come to,is like they're just, and I

(27:49):
think that that comes from that.
There just haven't been studiesconducted that have shown
benefits below that.

Yeah, and I just want to interject
quickly here because there'sreally interesting emerging
evidence in IBD looking atfructans in a subset of patients
being inflammatory.
So I wonder just again to thispersonal nature of even
prebiotics, and we see in IBSpatients that fructans are a

(28:18):
common, common, common triggerto their GI distress.
So again I would just say youknow, work with your healthcare
provider.
Listeners, because we've beenstudying this for a long time,
but still it's still really kindof in its infancy and it's not
going to be a one size fits all.

No, but I do think what's interesting
about a prebiotic and I don'tthink we have this robust of
evidence with probiotics in thatdietary fiber there's a lot of
evidence and a lot of consensusthat that's a good thing.
And prebiotics many of theprebiotics fit into that and so
to the extent you get one or twograms of a prebiotic along with

(28:58):
your other fibers that you'regetting through your diet, I
just can't help but think thatthat's a good thing, absolutely.
With the fibers I don't worryquite as much about hitting the
exact dose on the nose.

Yeah, I think fiber is important.

It's an umbrella term, so there's going
to be so many different types offibers and it's, you know,
listening to your body, but yeah, fiber, but we're going to go
to postbiotics.
What is it?
Has this term been sufficientlydefined yet, or is it a moving
target at this time?
Talk to us about where we're atright now.

So postbiotics are a fairly recent
concept.
The term's been around for overa decade but it's really kind
of coming to a head now becauseof some new research that's been
underway and has been completedon postbiotics and so you're
going to start seeing the termmore.
And what a postbiotic is is apreparation of inanimate

(30:06):
microorganisms and or theircomponents that confers a health
benefit on the host.
It confers a health benefit onthe host.
Now, to break that down intoeasier language, I think what we
consider a postbiotic is to bea preparation of dead
microorganisms and themicroorganisms may either be
intact dead microorganisms orthey may be cell components, so

(30:26):
the microorganism may have beenbroken apart through some kind
of treatment that thepreparation underwent, and the
preparation may or may notcontain microbial metabolites or
other microbial end products.
And so we're looking at kind ofthis combination.
It's not a purified preparationin the way that you might get
purified butyric acid, forexample, or something like that.

(30:47):
It's really a combination ofthe microbes or their components
and they may have cellfragments, they may have
metabolites and other thingsthrown in.
And I think that when you askabout is the definition
established?
I think the definition that Ijust gave you is a fairly clear
definition.
We have a very clear paper outthat talks about it, but I will

(31:08):
say there's not consensus onthat.
So I think that what we'reseeing in the marketplace
develop and this is the researchI alluded to some very
interesting studies that havelooked at heat killed
microorganisms and showing thatthey have health benefits, and
that's a game changer when youstart realizing that these
microorganisms, once they'redead, are not necessarily inert.

(31:29):
Okay, that's an importantdifference.
But where there's lack ofconsensus is that some people
want to say that the metabolitesthat are produced by the
microbes in the absence of themicrobes could also be called a
postbiotic, and we disagree withthat.
At ISSAP you mentioned themearly on in the podcast.
You know our definition was isno, what's key to a postbiotic

(31:50):
is to have the microorganismpresent, with or without those
metabolites.

And so that's where I think we still
need to sort it all out in thefield.
Yeah, because I was justreading a paper from the
Stanford group and they werereally kind of muddying that
definition a little bit, becauseI've always followed what
you've put out and then theirpaper was a little bit different
, you know, talking about likesourdough itself having
postbiotics.

Right and we can get into that.
Do you want to get into thatright?

Now, well, first, yeah, where do we
find these postbiotics?
I know there's somepreparations out there that have
been studied for IBS, forinstance, so I think it's really
interesting in a supplementform.
But you know just in generalwhere do we find them, and then
just maybe talk through thefermented food piece.

Dr. Mary Ellen Sand (32:35):
Postbiotics .
I think what's important torealize is that just because a
microorganism is dead doesn'tmake it a postbiotic, right.
So you have to then go to thatlast part of the definition
about doing a study that showsthat it confers a health benefit
.
Okay, so the postbiotics thatare on the market I am not up to
date or I'm not aware ofexactly what's on the market

(32:57):
right now.
I don't know who's marketingwhat in this area and putting a
postbiotic term on it.
My guess is you can find allkinds of things labeled as
postbiotics that would not meetthe definition and,
unfortunately, you might findall kinds of things labeled as
postbiotics that don't havestrong science behind them, and
we don't have guides in thisarea yet.
I think it's a really emergingfield.

(33:18):
So any product that you'relooking at that says postbiotic,
I guess I would dive deeper andfind out.
Well, what studies are theyclaiming that substantiate a
health benefit that wouldjustify my interest in their
product?
Basically is what I would do.
But to get to the fermentedfoods, I think the important
point here is that sourdoughbread is a great food.

(33:41):
Like we all love sourdoughbread, we all love our fermented
products, and I can lead aparade on that topic.
I love them.
But just because sourdoughbread is a great product doesn't
mean that it's providingpostbiotics.
Is it providing you deadmicroorganisms?
Yes, has anyone done a studyshowing that the dead

(34:02):
microorganisms that are thecomponent of sourdough bread
actually lead to a healthbenefit?
So, in other words, do you havea controlled study that has a
sourdough bread that was made,maybe with baking sodas?
You know some sourdoughcompared to the actual sourdough
you know.
Have you established a healthbenefit, you know, in any kind
of rigorous study?
And I don't know the studythat's done that.

(34:23):
So I would not use the termpostbiotic to describe sourdough
.
I would not say that sourdoughis a source of postbiotics.

So even though it's and I agree with
you, I mean I've read thedefinitions that have been put
out I just want to like clarifythis for our listeners.
So you have your sourdough andyou look at it in a lab like I
know that they've looked at someof these end products in the
bread and there's butyrate in itStill not a postbiotic, even

(34:53):
though we know butyrate could be.
The strain isn't characterizedor the health benefit hasn't
been proven.
Like, just walk the listenersthrough that a little bit.

First of all, I'm not sure I don't know
how beneficial the amount ofbutyrate in a bread is going to
be for you, and you know thisbetter than I.
Isn't butyrate going to bepretty much absorbed in the
proximal small intestine?
I mean, it's not making its waythrough your body.
It's basically going to be anenergy source, right?
So butyrate that's produced insitu in the gut is great.

(35:22):
It fuels your epithelial cells.
I mean that's great.
But that's very different thanconsuming butyrate, right, right
, okay, so I think that would bea question that I would have
about that claim to a benefit.
But you're right, if there'ssolid evidence that some
microbial metabolite causes ahealth benefit on its own and
has been studied on its own andit's present in the bread, then

(35:47):
I would say, yes, that sourdoughbread.
You could reasonably make thecase that that sourdough bread
would deliver that benefitthat's associated with whatever
it has.
Would I call it at that point apostbiotic man?
I don't know, I'd have to thinkabout that.
I would have to think aboutthat because, again, the
postbiotic is a preparation ofthese microorganisms which the

(36:08):
sourdough reasonably could be,and if you could, then it's
killed in the oven, it's heatkilled and you know that there's
a benefit associated with acomponent.
Then yeah, I mean, it's a littleedgy there, right, I think you
probably could make the case,then I don't know that you would
necessarily have to do thestudy on sourdough, but you know

(36:29):
we talk about this a lot.
With all the biotics is themethod of delivery important.
So can you take that lactocacyibacillus rhamnosus GG, which
has been studied in, you know,across a variety of formats,
across a variety of clinicalendpoints, and just throw it
into whatever you want to throwit into and claim that same
benefit, and a lot of people dothat.

(36:49):
I mean, that's a lot in themarketplace, but people question
that, and so I think that'swhat these things might raise.
But wow.

Well, our listeners just got a front row
seat to what these consensusmeetings can look like, where
you put, you know, 15 to 20experts in the room, sometimes,
you know, asking in thesethoughtful ways, these questions
on definitions, and you eachhave your own experience with
this, and so it is it'sfascinating for me to listen,

(37:21):
and kind of have this front seat, to the two of you talking
about this concept.

Well, I think we have to stay curious,
right and learn from one another.
And then that's when thingsevolve and change, which is, you
know, exciting for sure, right.

No, and it's a great question, you know,
it's one that the field has toanswer.

Yes, I have one last question that I'm just now
thinking more and more so theconcept of a symbiotic is a
probiotic and a prebiotictogether.
Can you just give hey, I'm aone-stop shop kind of girl, if I
can a quick thought on theseand how our listeners may
benefit from some of theseproducts?

Yeah, symbiotics, that's a great
definition really.
We would define it with a lotmore words, but essentially
you're right pro and prebiotic.
And the complication withsynbiotics is I think there are
two ways to consider them.
One is is just a product thatdelivers two functional
ingredients.
You know that you have the proand the pre together and they
don't necessarily have tointeract with each other.

(38:22):
Another is is that theprebiotic is paired with the
probiotic, so that the prebioticactually, once you consume them
, is the food for the probiotic,and so in the absence of the
prebiotic in the symbiotic, theprobiotic isn't necessarily
going to do what it needs to do.
Does that make sense?
And so that's a much moresophisticated formulation of a

(38:43):
symbiotic, and I don't think wehave any on the market that
actually do that.
What we have on the market arecombinations and the ideas to
deliver two functionalingredients.
I don't know that we would knowthey don't interact, but we
don't have evidence that they do, that.
They're just kind of functionalin their own regard.

Okay, so you bring up a good point and
this is going back a little bitto a comment a moment ago but
there's so many products thatmight have known probiotics and
they put three of them togetherbut that product of those three
have never been tested.
That happens all the time.
Daughter sent me a probioticfrom one of her friends asking

(39:26):
me what I thought about it and Isaid well, all three of these
have known probiotic.
They're strain levelclassifications, but I don't
know how they're all workingtogether.
In that pill.
There was nothing on thewebsite and this is happening
all the time.
Can you just comment for ourlisteners, because it drives me
a little bit nuts and I bet itwas expensive, very expensive.

Yes, I mean, in an ideal world, if we
didn't have limited resources,all of these products would be
tested as formulated, at thedose, with the combinations that
they have.
And that's just not the reality.
And this is what I would callkind of the ingredient approach
to probiotic formulation.
So you've got a very strongresearch base, let's say on the

(40:10):
L.
rhamnosis GG.
You've got a strong research on.
They do different things.
Let's combine them and justgive those to our customers and
do you expect the benefits fromboth of them to be present once
the person consumes them?
And we've thought about this alot and in fact in the show
notes we can maybe reference oneof the papers that we put out

(40:32):
addressing this issue.
And I guess there's two ways tolook at it.
One is is no, we don't haveevidence that they are
necessarily delivering the samebenefits they would alone.
I think that you can go at itfrom the other way, saying would
we reasonably expect that thosebenefits would be neutralized
by combining them?
Yeah, right, and the more wethought about it, what we kind

(40:56):
of came to the conclusion of andagain, there's no guarantee on
this, but it's like can you comeup with a solid scientific
rationale is that when youconsider that these things are
taken, you've got a mixed diet.
It's going into your stomachwith food and all these other
things and then it's ending upin your gut with trillions of
other microorganisms.

(41:16):
Like, does it really matterthat you necessarily have
combined these two together andaren't they going to hit the gut
or hit the small intestine,wherever it is that they have
their effect and likely be ableto do what they would normally
do?
And that's kind of where welanded on it, which is it would

(41:37):
be harder we think it would beharder to you can never prove a
negative but it would be harderto really come up with a solid
reason why you would expect themto negatively interact and not
deliver the benefit.
All right Is kind of where weended it up, but it's you know.

Kate Scarlata, MPH, (41:55):
Complicated .

Well, it's complicated and we find
ourselves so often in this field, lacking the studies that allow
us to robustly answer thesequestions, so we just kind of
try to make our best guess.

All right, we're going to do something
called a speed round with youtoday and we'll go through these
as quick as possible, and Ithink this is the case.
We want to use your brain, yourknowledge.
We know we could probably argueon both sides, but we just want
to hear what your answer is.
But we just want to hear whatyour answer is.
And so, okay, we'll movethrough quick.
Prebiotic, probiotic sodas Arethese gut heroes or overhyped?

I'd say overhyped Love it.
How about kombucha?
Gut hero or overhyped?

I mean it's a good source of live
microbes, but I'd say overhyped.

Okay, Morning or night best time to take a
probiotic?

Whatever time that you're more likely to
take it.

Good answer

Showing that any particular timing is
better than another.

Okay.
What about probiotics during orafter antibiotic use?

I think best to take it with your
antibiotic.
Okay, the studies are typicallydone that way and you know, so
just go ahead and take them.
The worst that happens is theprobiotic doesn't survive as
well as it might once you stop.
But most of the studies havebeen have co-administered them
and then try to use one that'sbeen tested for AAD or for
antibiotic associated diarrhea.

Okay.
Are expensive probiotics betterthan less expensive probiotics,
yay or nay?

I would say not necessarily.
But I will say research isexpensive, so a responsible
company is going to have torecoup their investment.
But that does not mean thatirresponsible companies can't
sell very expensive products.

Okay, confusing out, there.
Are refrigerated probioticsmore effective than shelf-stable
ones?

I don't think you can say that out of
hand.
There's been a lot oftechnological development where
they remain stable at roomtemperature now and you
certainly don't want to get themhot.
They will die as thetemperature starts to climb, but
if you can keep them at roomtemperature, a lot of them are
stable.

All right, and our final question should we
consider these products forlong-term or short-term use?

Well, one thing I didn't get a chance
to say I'll bring up now, whichis absence of evidence is not
evidence of the absence of anybenefit.
So what I mean by that is is Ikeep saying, and you keep saying
, that we need more studies, butjust because we don't know that
we don't have evidence thatthings work, doesn't mean that
they don't work, and so that'swhy you have to be your best

(44:35):
advocate, and so if you find,over the course of a year, that
you're feeling a lot better youstarted out taking a probiotic
and you're sustaining it and youlike it I would say go for it.
I think most of the research onprobiotics, though, is focused
on more short-term types ofindications.

Okay, so we ask all of our guests what
they personally do for theirown gut, health and well-being.
So we'd love for you, outsideof horseback riding, which
sounds wonderful and probablygreat for your gut, what else do
you do?

Well, I don't have anything really
clever to say about that.
I mean I try to eat higherfiber foods and I try to eat
whole grains and fruits andvegetables, and you know it's
always a struggle to eat well,but I think that's the smart way
to do it.
But I mean overall health.
Of course you have to live alife that you can be grateful
for and you have to keep yoursense of humor right and express

(45:32):
love to people that you love,and you know all of those things
I think might be just asimportant and I've said already
I'm a big fan of fermented foods.
The evidence is not strongright now that it really matters
that we deliver unknownmicrobes in large amounts to our
gut, but it sure seems a lot ofpopulations have done this for
many years and you know not manyyears, I mean for millennia and

(45:54):
it seems like it could be agood thing to model, but we
don't have the data to beconfident in that.

I think that was a great answer.

Yeah, lots of endorphins coming from
relationships and food, sothat's a pretty perfect place
for us to wrap up today.
We thank you so much for yourtime, Dr.
Sanders.
We certainly have provided alovely Gut Dictionary for our
listeners and we are going towrap up for the day, so thank

(46:22):
you so much for joining us andthanks for all of your expertise
.
Thank you so much for joiningus and thanks for all of your
expertise and to everyone outthere, thank you so much for
liking, subscribing, sharing TheGut Health Podcast.
We appreciate your support, ourfriends.
Thank you for joining us as wegrow this gut health community.
We hope you enjoyed thisepisode and don't forget to

(46:44):
subscribe, rate and leave us acomment.
You can also follow us onsocial media at the Gut Health
Podcast, where we'd love for youto share your thoughts,
questions and experiences.
Thanks for tuning in, friends.

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The Gut Dictionary: Probiotics, Prebiotics and Postbiotics Explained.

On Purpose with Jay Shetty