From the Guidelines
For promoting gut health and immune system function, I recommend a combination of prebiotics and probiotics, with a focus on the 8-strain combination of L paracasei subsp paracasei, L plantarum, L acidophilus, L delbrueckii subsp bulgaricus, B longum subsp longum, B breve, B longum subsp infantis, and S salivarius subsp thermophilus, as suggested by the AGA clinical practice guidelines 1.
Key Recommendations:
- For prebiotics, aim for 5-10 grams daily of inulin, fructooligosaccharides (FOS), or galactooligosaccharides (GOS), which can be found in supplement form or in foods like chicory root, Jerusalem artichokes, and bananas.
- For probiotics, effective strains include Lactobacillus acidophilus (1-10 billion CFU daily), Bifidobacterium lactis (1-10 billion CFU daily), Lactobacillus plantarum (1-10 billion CFU daily), and Saccharomyces boulardii (5-10 billion CFU daily), with the 8-strain combination being the most effective for certain conditions like pouchitis 1.
- Multi-strain formulations are often more effective than single strains.
- Take probiotics on an empty stomach, ideally 30 minutes before a meal, to maximize survival through stomach acid.
- Consistency is key—use these supplements daily for at least 4-8 weeks to notice benefits.
Rationale:
These recommendations work because prebiotics serve as food for beneficial gut bacteria, while probiotics introduce live beneficial microorganisms directly into your gut. Together, they help maintain intestinal barrier function, produce short-chain fatty acids that nourish colon cells, modulate immune responses, and compete with harmful pathogens for resources in the gut environment. The 8-strain combination has been specifically recommended for patients with pouchitis, and its use is supported by the AGA clinical practice guidelines 1. Additionally, bifidobacterial strains, such as B. infantis, have been shown to be effective in improving the gut microbiome in premature infants 1. However, it is essential to note that the quality of evidence for probiotics is often low, and more research is needed to fully understand their effects and optimal usage 1.
From the Research
Recommended Prebiotic and Probiotic Strains
- The most widely employed probiotic strains are lactic acid bacteria and bifidobacteria, which have been shown to have variable beneficial properties depending on the type of microbial strain utilized 2.
- Bifidobacteria are members of the intestinal microbiota of mammals and some strains are able to exert health-promoting effects, including the prevention and treatment of intestinal and extraintestinal pathologies 3.
- Lactobacillus acidophilus NCFM and Bifidobacterium lactis Bi-07 have been shown to improve symptoms of bloating in patients with functional bowel disorders 4.
- Bifidobacteria and lactobacilli are Gram-positive lactic acid-producing bacteria that constitute a major part of the intestinal microflora in humans and other mammals, and have been used as probiotics to maintain or reestablish the balance in the flora 5.
Dosages and Health Benefits
- The dosage of probiotics can vary depending on the specific strain and health benefit being targeted, but a common dosage is 2×10(11) CFU/d 4.
- Probiotics have been shown to have a range of health benefits, including:
- Supporting the health of the gut microbiota and preventing or delaying the onset of gastrointestinal tract disorders 2.
- Enhancing intestinal, nutritional, and oral health 2.
- Improving or restoring the gut microbiota, which has been linked to improved health 6.
- Preventing or treating diseases such as irritable bowel syndrome, lactose intolerance, gastroenteritis, and obesity 6.
- Boosting the immune system and preventing infections 6.
Prebiotics and Symbiotics
- Prebiotics are non-digestible fibers that can help promote the growth of beneficial microorganisms in the gut, and can be used in combination with probiotics as symbiotics 6.
- Symbiotics are products that contain both prebiotics and probiotics, and can have a synergistic effect on gut health 6.
- The use of prebiotics and symbiotics is an emerging area of research, and more studies are needed to fully understand their health benefits and optimal dosages 6.