Prebiotics or probiotics? What's best for illnesses

‘Gut health’ was once a term used only by naturopaths and others in pseudoscience realms.

But it has become commonplace in mainstream medicine, largely due to the rising number of patients presenting with abdomen problems and pain.

Mater Hospital director of gastroenterology Jakob Begun says Australia has some of the highest rates of gut illnesses in the world, particularly for chronic conditions such as inflammatory bowel disease, colorectal cancers and related allergic diseases.

With the rise in chronic conditions has also come a wave of people suffering general day-to-day stomach pain, discomfort and linked symptoms.

General practitioner Sue Raju said she had experienced a noticeable increase in patients presenting with gut problems at her Gold Coast clinic.

“Generally people in their 20s and 30s have lots of bloating, irritable bowel type symptoms,” Dr Raju said.

“And of course everyone wants a quick fix and I often find people have been taking lots of vitamins and supplements to help.”

But she said a healthy gut biome was the most important step towards recovery.

Dr Begun agreed.

He said the key to gut health was a diverse microbiome, or having many different species of bacteria in the gut.

Prebiotics over probiotics

Dr Begun said modern Western diets and health gimmicks impeded gut bacteria diversity.

He said probiotics did not work to restore a healthy gut, despite sufferers spending hundreds a year on the “$5 billion industry, with very little scientific data to back up any claims made by it”.

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Jakob Begun says Australia has some of the highest rates of gut illnesses in the world. (Supplied: Mater Hospital)

“There has been research in the field of manipulating the microbiome and unfortunately probiotics had a really negative experience,” Dr Begun said.

He said they did not treat an inflamed bowel very well.

“In some studies, for example, even after you take antibiotics, if you take probiotics, it delays the return of a normal microbiome,” Dr Begun said.

“So, if anything, it might actually be harmful to take probiotics, sometimes.”

Dr Begun said a healthy person might have more than 300 different species of bacteria in their gut and probiotics did little to replicate that scenario.

“Probiotics is either one species or a handful of species,” he said.

“You could see how that would not restore a wide variety of bacteria, and that is not necessarily a healthy state.

“So my current advice when patients ask me is that, based on current data that we have available to us, it doesn’t look like probiotics are helpful in restoring gut health.”

He said prebiotics were instead the way to go.

He said soluble and insoluble fibre and acid-resistant starches could be sourced in foods such as bananas, sweet potato and potato or in powdered store-bought form as well.

“Prebiotics are changing the food that the bacteria are using to grow and replicate, so that’s going to have a big, big shift in microbiome when you change your diet,” he said.

“They have proven in scientific studies to help restore your microbiome better than probiotics … and have a benefit on symptoms.”

Diets wreak havoc

Dr Begun and Dr Raju said people suffering irritable bowel type symptoms, such as constipation, diarrhoea, bloating, allergies and pain, should also look at their diet.

“Our Western diet is one thing that does cause lots of damage … or a combination of stress, work-environment, it all begins to manifest,” Dr Raju said.

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Sue Raju is encouraging other doctors to take an integrative approach to treating gut problems. (Supplied: Sue Raju)

Dr Begun, who has researched and treated patients in the space for more than a decade, said diets inclusive of highly processed foods were “doing a number on our gut”.

“That’s probably unleashing our susceptibility to these kinds of diseases,” he said.

“It wouldn’t be unusual for me to see someone in my clinic who says they have McDonald’s and a sausage roll for breakfast.”

Research suggested genetics, environmental pressures and immune systems also played a part.

Dr Raju, who has been a general practitioner for more than 20 years, said she suffered inflammatory bowel disease.

She encouraged other doctors to take on a more integrative approach when treating patients with gut problems and believed many modern methods fell short.

“To be honest, in medical school we never studied much about the gut biome,” Dr Raju said.

“Only in recent years, I think, there’s more medical attention and awareness of gut health.”

Gut health for the future

Dr Begun said while the industry had come a long way, there was still room for improvement,

He encouraged general practitioners to upskill in the space and make it a top treatment priority.

“Medicine is a constantly evolving field and, fortunately for us, we’re consistently making progress and learning new things and applying new techniques,” he said.

“But often it takes many years for new studies to be validated and then to be accepted by the medical community.”

He said it was important to upskill doctors to understand some of the data so they could understand why interventions might work and address some of the beliefs held in the medical community.

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