Probiotics, Prebiotics và Postbiotics – The important role in helping children’s healthy digestive system

14/06/2023

The microbiome consists mostly of living microorganisms, such as bacteria, viruses and fungi, and is found throughout your body. However, most of these microorganisms, particularly bacteria, reside in your intestines, referred to as your gut microbiome. This microbiome plays an important role in many bodily functions, ranging from stimulating the immune system to nutrient absorption. Every individual has a unique makeup of microbiome microorganisms that are affected by many factors, such as overall lifestyle, diet, medications, weight, age, environment and genetics.

Studies around the world over the past years have shown certain strains of bacteria can have beneficial effects, while an imbalance of gut microbiota is linked to gastrointestinal conditions (like irritable bowel syndrome), an autoimmune system.

That’s -biotics. Each of the “biotics” can make a difference in the environment of your gut microbiome—and therefore your overall health and well-being.

Each of the “biotics” can make a difference in the environment of your gut microbiome—and therefore your overall health and well-being (Photo: Well+Good)

Definition

The International Scientific Association of Probiotics and Prebiotics (ISAPP) defines Probiotics as “live microorganisms that, when administered in adequate amounts, confer a health benefit on the host.”

The main job of Probiotics, or good bacteria, is to maintain a healthy balance in your body. Think of it as keeping your body in neutral. When you are sick, bad bacteria enters your body and increases in number. This knocks your body out of balance. Good bacteria works to fight off the bad bacteria and restore the balance within your body, making you feel better. Good bacteria keeps you healthy by supporting your immune function and controlling inflammation. Some types of good bacteria can create vitamins.

In nutraceutical science, ingestible living microorganisms known as “probiotics” are valued for their capacity to provide customers with a variety of health benefits (Photo: Medical News Today)

Meanwhile, Prebiotics as “a substrate that is selectively utilized by host microorganisms conferring a health benefit.” Simply put, prebiotics are a group of nutrients that are degraded by gut microbiota. Through a fermentation process, they produce short-chain fatty acids in the gut that help promote the growth of good bacteria.

And Postbiotics are byproducts of probiotic bacterial fermentation. ISAPP defines postbiotics as “a preparation of inanimate microorganisms and/or their components that confers a health benefit on the host”  . When probiotics feed on certain types of fiber molecules in order to thrive, they leave behind “waste products” that are collectively called postbiotics. Being a waste product might not sound too impressive, but more research is now showing that postbiotics might play an essential role in gut health.

Why is the child’s intestinal microbiota imbalance?

Imbalance of intestinal microflora is a change in the composition and quantity of microorganisms in the intestinal tract, causing beneficial bacteria to decrease and harmful bacteria to increase.

Causes of intestinal microflora imbalance in children:

– Due to the birthing process: the intestinal microbiota of children born by cesarean and vaginal birth is completely different

– Infection and exposure to antibiotics When a child has an infection, antibiotics are needed. This is one of the most common causes of an imbalance in the microbiome. The effect of antibiotics in addition to killing bacteria also makes a part of beneficial bacteria affected.

– Other diseases acquired when young children have gastrointestinal diseases such as peptic ulcers or some young children have gastrointestinal surgery or radiation therapy.

– Nutrition and child care Nutritional diet and child rearing is also a decisive factor for the diversity of the intestinal microbiota in young children: In the early life period, the most important determinant of infant gut microbial colonization is breastfeeding. Studies in 2020 had shown that breastfeeding is associated with higher levels of Bifidobacterium , and the percentages of Lactobacillus  and Bacteroides  also were significantly increased, and Enterobacteriaceae   also decreased sharply with time compared to formula-fed groups. The researchers also added: There were differences in bacterial composition in infants according to different feeding types, and even different formulas had different effects on microbiota . In addition to the child’s nutrition when growing up, it also affects the intestinal microflora. Unsecured and unreasonable nutrition, parents giving their children a poor variety of food, foods that are difficult to digest, or giving their children a diet that is not healthy, this is one of the causes leading to an imbalance in the microbiological system.

Impact of Early Life Nutrition on Children’s Immune System (Photo: Freepik)

Supplementing with Probiotics, Prebiotics and Postbiotics helps the digestive system in healthy children

The American College of Gastroenterology had shown that probiotic strains can aid digestion, prevent respiratory diseases, diarrhea, prevent autoimmune diseases, alleviate skin diseases, fight a variety of infections…

In 2013, the report of Amara AA and Shibl A showed that role of Probiotics in health improvement, infection control and disease treatment and management.  Another research in 2017 has shown that a yeast-based probiotic called Saccharomyces boulardii can reduce the risk of developing antibiotic-associated diarrhea .

Besides, “An example includes the strain Lactobacillus rhamnosus GG, which has been tested in numerous trials and shown to be supportive [for Irritable bowel syndrome – IBS] without causing any notable significant side effects” . 

Studies at 2018 had found that probiotics are effective in decreasing necrotizing enterocolitis (NEC), a serious health condition that is one of the leading causes of complications and death in preterm infants. NEC is characterized by intestinal injury and inflammation. It develops in about one out of 10 preterm infants and is considered a medical emergency .

In Vietnam, the probiotic strain L. Casei 431TM -one of the beneficial bacteria with high survival ability to reach the appropriate position in the digestive tract and promote its uses- has been clinically researched and proven by the National Institute of Nutrition (NIN) to help increase resistance. Specifically, in 2013, according to the NIN, the group of children (24 – 47 months old) using live yeast (Probi) yogurt containing beneficial bacteria L.Casei 431TM tended to improve the concentration of IgA antibodies after three months. According to the survey data, the IgA immune index tended to increase by more than 30% compared to the non-user group (increased 19.97 mg/dL; compared to 14.98 mg/dL).

While probiotics are currently considered “the most promising therapy on the horizon for this devastating disease,” researchers are now turning to prebiotics and postbiotics as potential alternatives or adjunctive therapies to probiotics. Probiotic and postbiotic bacteria are essential infants for digestion, absorption, storage of nutrients, development and immunity (like adults). However, some infants cannot tolerate supplementing with live microorganisms (probiotic bacteria) but may respond well to prebiotics and postbiotics . 

Suzie Finkel, a registered dietitian who specializes in digestive health and practices at New York Gastroenterology Associates explained: “There are a variety of health benefits associated with consistent prebiotic consumption, though the research on the health benefits tends to be specific to the type of prebiotic,”. For example, a research in 2018 on a type of prebiotic called galactooligosaccharide (GOS) found reductions in complaints of gas, bloating and abdominal pain in subjects compared to the placebo.

Prebiotics and Postbiotics as potential alternatives or adjunctive therapies to probiotics (Photo: Lindsey Elmore)

A 2014 report published in Clinics in Perinatology explains:  “The infant/host provides an hospitable, temperature-stable, nutrient-rich environment for bacteria while receiving, in return, benefits from the commensal bacteria.”   

One study about Postbiotics in 2015 found the treatment of inflammatory cells in vitro with dried fermentate (a type of yeast) derived from Saccharomyces cerevisiae resulted in reduced inflammatory responses . The more chronic inflammation in the body, the higher the risk for infection. Another pilot study in 2017 of 80 subjects with gastrointestinal discomfort and constipation revealed that a daily dose of 500 milligrams of EpiCor fermenate (a type of postbiotic) resulted in improvement of constipation-associated symptoms due to a change in the composition of the gut microbiome 

A series of clinical studies in children demonstrated its safety and postbiotic properties, such as modulation of the gut microbiota to be closer to that of breastfed infants , reduction in the severity of acute diarrhea , improved inflammatory and immune markers, which might be related to some features of gastrointestinal tolerance , reduction in digestive and respiratory events in infants at high risk of allergy  and the induction of positive effects on thymus size and stool pH in healthy term infants . In a broader approach, postbiotics were systematically reviewed in relation to the prevention and treatment of common infectious diseases among children younger than 5 years. Seven RCTs  involving 1740 children met the inclusion criteria. For therapeutic trials, supplementation with heat-killed Lactobacillus acidophilus LB reduced the duration of diarrhea. For preventive trials, the pooled results from two RCTs showed that heat-inactivated L. paracasei CBA L74 reduced the risk of diarrhea, pharyngitis and laryngitis .

In conclusion, Postbiotics may help the infant’s intestine protect itself from bacterial pathogens that cause inflammation, encourage the growth of beneficial bacteria, control epithelial immune responses and maintain intestinal homeostasis.

How to get Probiotics, Prebiotics and Postbiotics?

Prebiotics occur naturally in many plant-based foods and are thus easy to consume on a regular basis. High-fiber foods, such as bananas, asparagus, onions, leeks, garlic, Jerusalem artichokes, chickpeas, lentils, barley and oats, are good sources of prebiotics. In some instances, prebiotics such as inulin (often from chicory root) and oligosaccharides are sold as supplements, and prebiotics can be added to probiotic supplements.

Finkel expert also thinks that: “Most healthy individuals need not go out of their way to supplement their diet [with prebiotics], though those with specific GI conditions or restricted diets may consider supplemental forms,”. 

Prebiotics occur naturally in many plant-based foods, high-fiber foods (Photo: Live Science)

In addition, supplements and fermented foods contain probiotics. Fermentation is a process in which bacteria or yeast break down sugar, preserving beneficial enzymes. The most common fermented foods that naturally contain probiotics or have probiotics added to them include yogurt, kefir, kombucha, sauerkraut, pickles, miso, tempeh, kimchi and sourdough bread. However, to be a true probiotic, a food must contain live and active bacterial cultures in amounts that have been shown to have health benefits, and it should indicate this on its packaging.

“Food and beverage sources of probiotics, such as those from fermented foods, are valuable for adding diversity to the ecosystem within your gut,” says Landau-a registered dietitian at Gut Feeling and nutrition advisor for the Global Prebiotic Association. “However, most only add value for a short period of time while they move through your GI tract (kefir being an exception, containing strains of probiotics that are able to attach to the gut wall and continue to grow and thrive).”

There is some emerging evidence suggesting gastrointestinal and anti-inflammatory benefits of consuming fermented foods, and stronger evidence for probiotic supplementation for a few specific conditions, such as antibiotic-associated diarrhea and pouchitis,” adds Finkel.

 

Supplements and fermented foods contain probiotics (fermentation is a process in which bacteria or yeast break down sugar, preserving beneficial enzymes) (Photo: Healthy Mom & Baby)

True postbiotics are almost exclusively offered through dietary supplements, or food fortified with a postbiotic, because in order to achieve the desired health benefit of postbiotics, you would need to consume a guaranteed amount per day. There is no guarantee for the amount of postbiotics consumed from food alone.

Postbiotics and Probiotics: What’s the difference?

Postbiotics help support growth of probiotics. One of the most promising things about using postbiotics in place of probiotics is due to how postbiotics mimic the beneficial and therapeutic effects of probiotics while avoiding the risk of administering live microorganisms to patients who cannot tolerate them, such as those with immature intestinal barriers or impaired immune defenses.

Additionally, there’s some evidence that probiotic bacteria that are killed due to heat in the gastrointestinal tract may function as postbiotics. These microorganisms seem to retain their structure and continue to have beneficial effects on the host, such as accelerating intestinal barrier maturation and healing. 

Final Thoughts

While use of prebiotics, probiotics and postbiotics can certainly make a big difference in terms of improving digestive health and other symptoms, simply taking these in supplement form likely won’t be enough to solve all your problems.

“The most important thing to know is whether a supplement has been demonstrated to offer a specific benefit for what you’re looking to improve,” says Finkel.

These treatments work best when combined with lifestyle changes, especially eating a healthy diet, reducing intake of toxins or unnecessary medications, and controlling stress.

Thus, remember that when it comes to supporting your microbiome and maintaining a healthy gut, keep your eye on the big picture. Eat a nutrient-dense diet, limit or avoid processed foods, and consider other lifestyle changes that you can afford to make in order to better your health.

References

1. Vinderola, G., Sanders, M. E., & Salminen, S. (2022). The Concept of Postbiotics. Foods, 11(8), 1077

2. Patel, R. M., & Denning, P. W. (2013). Therapeutic use of prebiotics, Probiotics, and postbiotics to prevent necrotizing enterocolitis: what is the current evidence?. Clinics in perinatology, 40(1), 11-25.

3. Jensen, G. S., Carter, S. G., Reeves, S. G., Robinson, L. E., & Benson, K. F. (2015). Anti-inflammatory properties of a dried fermentate in vitro and in vivo. Journal of medicinal food, 18(3), 378-384.

4. Pinheiro, I., Robinson, L., Verhelst, A., Marzorati, M., Winkens, B., den Abbeele, P. V., & Possemiers, S. (2017). A yeast fermentate improves gastrointestinal discomfort and constipation by modulation of the gut microbiome: results from a randomized double-blind placebo-controlled pilot trial. BMC complementary and alternative medicine, 17, 1-20.

5. Vulevic J, Tzortzis G, Juric A, Gibson GR. Effect of a prebiotic galacto oligosaccharide mixture (B-GOS®) on gastrointestinal symptoms in adults selected from a general population who suffer with bloating, abdominal pain, or flatulence. Neurogastroenterol Motil. 2018;30(11):e13440.

6. Salminen, S., Stahl, B., Vinderola, G., & Szajewska, H. (2020). Infant formula supplemented with biotics: current knowledge and future perspectives. Nutrients, 12(7), 1952.

7. Béghin, L., Tims, S., Roelofs, M., Rougé, C., Oozeer, R., Rakza, T., … & Turck, D. (2021). Fermented infant formula (with Bifidobacterium breve C50 and Streptococcus thermophilus O65) with prebiotic oligosaccharides is safe and modulates the gut microbiota towards a microbiota closer to that of breastfed infants. Clinical Nutrition, 40(3), 778-787.

8. Thibault, H., Aubert-Jacquin, C., & Goulet, O. (2004). Effects of long-term consumption of a fermented infant formula (with Bifidobacterium breve c50 and Streptococcus thermophilus 065) on acute diarrhea in healthy infants. Journal of pediatric gastroenterology and nutrition, 39(2), 147-152.

9. Campeotto, F., Suau, A., Kapel, N., Magne, F., Viallon, V., Ferraris, L., … & Butel, M. J. (2011). A fermented formula in pre-term infants: clinical tolerance, gut microbiota, down-regulation of faecal calprotectin and up-regulation of faecal secretory IgA. British journal of Nutrition, 105(12), 1843-1851.

10. Morisset, M., Aubert-Jacquin, C., Soulaines, P., Moneret-Vautrin, D. A., & Dupont, C. (2011). A non-hydrolyzed, fermented milk formula reduces digestive and respiratory events in infants at high risk of allergy. European Journal of Clinical Nutrition, 65(2), 175-183.

11. Indrio, F., Ladisa, G., Mautone, A., & Montagna, O. (2007). Effect of a fermented formula on thymus size and stool pH in healthy term infants. Pediatric research, 62(1), 98-100. 

12. Malagón-Rojas, J. N., Mantziari, A., Salminen, S., & Szajewska, H. (2020). Postbiotics for preventing and treating common infectious diseases in children: a systematic review. Nutrients, 12(2), 389.

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