Happy New Year everyone!

I’ve been researching the possible role of prebiotics (different from probiotics) in the treatment of IBD and IBS. Those of you familiar with prebiotics may also be aware of a controversy between advocates of their use in digestive diseases, and those that believe prebiotics would be harmful in such conditions (Elaine Gotschall and the SCD community).

I was curious to see what the research had to say about this argument, and after reviewing more than 40 studies and scientific reviews, I’m convinced that prebiotics should be included in natural treatment protocols for IBD & IBS. This does not mean that the research is 100% unequivocal (it almost never is, because human beings are vastly complex), but simply that the overwhelming majority of evidence supports the use of prebiotics in treating digestive disorders.

Prebiotics are non-digestible carbohydrates (primarily oligosaccharides) that alter the composition of the intestinal microflora. Prebiotics selectively stimulate the growth of beneficial bacteria such as bifidobacteria and lactobacilli while inhibiting the growth of pathogenic bacteria and yeast. Fermentation of prebiotics in the colon results in the production of short chain fatty acids (SFCAs). SFCAs provide fuel for ileal and colonic epithelial cells, which may help maintain the integrity of the gut mucosal barrier. SFCAs also improve the absorption of water and electrolytes, which in turn reduces diarrhea. One of the SFCAs produced by prebiotic fermentation, butyrate, has been shown to have several anticarcinogenic effects and thus reduces the risk of colon cancer. Fermentation of prebiotics also produces lactic acid, which in turn lowers the pH of the colon and creates a less hospitable environment for pathogenic bacteria.

There are many, many studies which document the beneficial effect of prebiotics on intestinal microflora. There are also many studies which establish a link between IBD/IBS and an imbalance in the intestinal flora. Most recently, studies have been done which specifically investigate the effect of prebiotics on IBD & IBS. While more research needs to be done on the specific effect of prebiotics on these conditions, early results are very promising. As the link between the intestinal flora and IBD/IBS becomes better and better accepted, the use of prebiotocs and probiotics as treatment options for these syndromes is also becoming more accepted.

Elaine Gotschall and others within the Specific Carbohydrate Community (SCD) have warned against the use of prebiotics because of their belief that they may feed candida and other pathogenic microbes. There is no evidence to support this claim. In contrast, there are two studies which specifically document the reduction of candida albicans in the digestive tract after the ingestion of prebiotics. One researcher I corresponded with suggested that “...the increase of beneficial lactobacilli and bifidobacteria stimulated by prebiotics alters the intestinal environment, making it less suitable for candida and other pathogens.”

Perhaps most relevant to those of us pursuing Jini’s treatment protocols are the studies which reveal certain adverse effects of enteral (elemental) diets and document the ability of prebiotics to significantly reduce or even eliminate these effects. Parenteral nutrition and elemental diets have been shown to cause bacterial translocation (the movement of bacteria from the lumen of the gut, where it belongs, to places outside the gut where it doesn’t belong), immune dysfunction, and increased infection in laboratory animals. Several recent studies have shown that adding prebiotics to elemental formulas mitigated these adverse affects and corresponded with clinical improvements in patient outcomes. Major manufacturers of elemental nutrition formulas are aware of this research and have begun to include prebiotics in their products.

The dosage of prebiotics used in these studies ranged from as little as 8g/day to upwards of 20g/day. Above 20g/day was inadvisable because it tended to cause gas and bloating in the test volunteers. I would suggest starting with a dose of 8g/day and building up to perhaps 12g/day (3 teaspoons), which was a median dose in the studies I reviewed. I am currently doing more research on prebiotic brands available to consumers, and will report back with recommendations. One product I like so far is called Innuflora, and it can be obtained from various online sources.

As always, I’d love to hear your comments and questions.

Best,
Chris

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PARTIAL LIST OF ABSTRACTS

Fermentation of fructooligosaccharides by lactic acid bacteria and bifidobacteria.
Appl Environ Microbiol 2000 Jun;66(6):2682-4

"Lactic acid bacteria and bifidobacteria were screened of their ability to ferment fructooligosaccharides (FOS) on MRS agar. Of 28 strains of lactic acid bacteria and bifidobacteria examined, 12 of 16 Lactobacillus strains and 7 of 8 Bifidobacterium strains fermented FOS. Only strains that gave a positive reaction by the agar method reached high cell densities in broth containing FOS."

"Recently, it has been suggested that the ability of probiotic bacteria to ferment oligosaccharides may be an especially important characteristic. This is because the availability of carbohydrates that escape metabolism and adsorption in the small intestine have a major influence on the microflora that become established in the colon".

In the next article the authors wanted to get a closer look at the selective fermenting dynamics of FOS on human bacterias as found in feces. They continually cultured with FOS and discovered that both lactobacillus and bifidobacteria selectively fermented the FOS and substantially grew in number relative to the other fecal bacterias. At the point that lactic acid dominated the Ph of the culture medium the preferential shift switched away from the bifidobacterias toward the lactobacillus. These findings are consistent with the observed stratification of lactobacillus being prevalent in the stomach and small intestine and bifidobacteria being prevalent in the colon.

Continuous culture selection of bifidobacteria and lactobacilli from human faecal samples using fructooligosaccharide as selective substrate.
J Appl Microbiol 1998 Oct;85(4):769-77

"The human large intestine contains a large and diverse population of bacteria. Certain genera, namely Bifidobacterium and Lactobacillus, are thought to exert health-promoting effects. Prebiotics such as fructooligosaccharides (FOS) have been shown to stimulate the growth of endogenous bifidobacteria. In this study, changes of lactic acid producing bacteria in continuous culture fermentors (semi-defined, anaerobic medium containing 5 g 1(-1) FOS, dilution rate of 0.1 h-1, pH 5.5) were followed over a 21 d period after inoculation with blended human faeces from four healthy adults. Samples were also taken every 3 d for influent/effluent FOS, short chain fatty acid (SCFA), lactate and microbiological analyses. Results showed that SCFA concentrations decreased abruptly 1 d after inoculation while lactate concentrations increased. Classical methods of enumeration using selective media showed that the proportion of total culturable count represented by bifidobacteria and lactobacilli increased from 11.9% on day 1 to 98.1% on day 21. However, molecular methods using genus-specific 16S rRNA oligonucleotide probes indicated that the bifidobacterial population maintained a level between 10 and 20% of total 16S rRNA during the first 6 d and disappeared rapidly when the maximum concentration of lactate was reached. Lactobacilli, which were initially present in low numbers, increased until day 9 and remained at high levels (20-42% of total 16S rRNA) to day 21, with the exception of day 18. Although FOS has usually been regarded as a selective substrate for bifidobacteria, these observations suggest that: (1) lactobacilli are also able to use FOS, (2) lactobacilli can out-compete bifidobacteria in continuous culture at pH 5.2-5.4 when FOS is the primary carbon and energy source, and (3) bifidobacteria can grow faster on FOS than lactobacilli under controlled conditions."

The next article indicates that bifidobacterias are more tolerant of biles salts if they have usable carbohydrates available to them including FOS. As any oral probiotic administration requires that bifidobacteria pass through the small intestine where bile salts are most concentrated, this is an important point. Blending bifidobacteria with FOS is expected to increase the survivability of the bacteria in their travels to the colon where they are desired residents.

Effects of fructooligosaccharides and their monomeric components on bile salt resistance in three species of bifidobacteria.
J Appl Microbiol 2000 Jun;88(6):968-74

"The influence of fructooligosaccharides (FOS) and their monomeric components on bile salt resistance of Bifidobacterium breve ATCC 15700, Bif. longum ATCC 15707 and Bif. animalis ATCC 25527 was examined. The neosugars induced fructofuranosidase activities for the degradation of these saccharides. For the three strains tested the growth was identical and bile salts had the same inhibitory effect on growth whatever the carbohydrate used. The survival of Bif. breve and Bif. longum, in the presence of glycodeoxycholic acid depended, however, on carbohydrates: the toxic effects of the bile salt could be partly alleviated by the addition of a metabolizable C-source. For Bif. animalis, the presence of any carbohydrate in the incubation medium did not enhance the viability of the strain. But in the three deconjugating strains of bifidobacteria studied, the presence of neosugar during the growth led to improved resistance to the bactericidal effect of the bile salt compared with the monomeric components of these neosugars (glucose and fructose)."

In the next study we can begin to see the "proof is in the pudding". 34 grams of FOS is quite a lot to take at once and will cause gas in most people. Nonetheless, there is demonstrated a significant increase in bifidobacteria in humans as a result of feeding inulin, a constituent of FOS extracted from chicory roots.

Effects of inulin on faecal bifidobacteria in human subjects.
Br J Nutr 1999 Nov;82(5):375-82

"A controlled study with eight healthy free-living subjects was carried out, in which energy intake was adjusted to the individual energy requirements. On administration of inulin, blood lipids, the faecal microflora, short-chain fatty acids and accompanying gastrointestinal symptoms were characterized in order to investigate the long-term effect of inulin. During the run-in phase (8 d), subjects received a typical Western diet providing 45% energy as fat and 40% energy as carbohydrate. Subsequently, the subjects consumed a fat-reduced diet which provided 30% energy as fat and 55% energy as carbohydrate for a period of 64 d using inulin as a fat replacer. The amounts of inulin consumed by the subjects (up to 34 g/d) were based on individual energy requirements with the aim to keep the diet isoenergetic with that used in the run-in period. To assess the effects of inulin administration, a control study (run-in and intervention) was carried out in which subjects consumed the same diet but devoid of inulin during the whole course of the study. To investigate the effect of inulin on faecal flora composition total bacteria and bifidobacteria in the faeces were enumerated by in situ hybridization with 16S rRNA targeted oligonucleotide probes. Inulin significantly increased bifidobacteria from 9.8 to 11.0 log10/g dry faeces and caused a moderate increase in gastrointestinal symptoms such as flatulence and bloatedness, whereas blood lipids and short-chain fatty acids remained essentially unaffected."

In the next study we again see that FOS preferentially ferments and increases the resident friendly bacterias in the colon.

Dietary modulation of the human gut microflora using the prebiotics oligofructose and inulin.
J Nutr 1999 Jul;129(7 Suppl):1438S-41S

"Although largely unproven in humans, better resistance to pathogens, reduction in blood lipids, antitumor properties, hormonal regulation and immune stimulation may all be possible through gut microflora manipulation. One approach advocates the oral intake of live microorganisms (probiotics). Although the probiotic approach has been extensively used and advocated, survivability/viability after ingestion is difficult to guarantee and almost impossible to prove. The prebiotic concept dictates that non viable dietary components fortify certain components of the intestinal flora (e.g., bifidobacteria, lactobacilli). This concept has the advantage that survival of the ingested ingredient through the upper gastrointestinal tract is not a prerequisite because it is indigenous bacterial genera that are targeted. The feeding of oligofructose and inulin to human volunteers alters the gut flora composition in favor of bifidobacteria, a purportedly beneficial genus. Future human studies that exploit the use of modern molecular-based detection methods for bacteria will determine the efficacy of prebiotics. It may be possible to address prophylactically certain gastrointestinal complaints through the selective targeting of gut bacteria."

The next article raises the flag against simply taking FOS and forgetting the probiotics when a person is suffering from a dysbiosis. Though it is not objectively confirmed in this study, we suspect that "pseudohypolactasia" persons have a dysbiosis and likely at least in part a candida dysbiosis. We think this because all sugar sources gave this group of people intestinal problems even though they were in fact digesting lactose properly. Elsewhere we have found evidence that the undesirable bacteria Klebsiella can also utilize FOS for energy. Other studies not included in this review indicate that lactobacillus, bifidobacteria and other non-pathogenic bacterias create environments inhospitable to pathogenic bacterias by modifying Ph, emitting surficants that keep pathogens from binding to the epithlium, and compounds that are toxic to the undesired bacterias. We feel people with disbiosis should take a full course of probiotics with FOS before using straight FOS.

This study would have been much more informative if they had attempted to classify the flora of these groups before subjecting them to the different sugars. These researchers also verify that 25 grams of FOS taken in a single dose will cause gas in almost anyone. We recommend taking FOS by the single teaspoon which weighs 5 grams.

Fructooligosaccharides and lactulose cause more symptoms in lactose maldigesters and subjects with pseudohypolactasia than in control lactose digesters.
Am J Clin Nutr 1999 May;69(5):973-9

"BACKGROUND: Many lactose maldigesters tolerate more lactose in experimental studies than in everyday life, in which their symptoms may result from other carbohydrates as well. OBJECTIVE: The question of whether the symptoms caused by large quantities of carbohydrates are more severe in lactose maldigesters than in control lactose digesters or in lactose digesters who report milk to be the cause of their gastrointestinal symptoms (pseudohypolactasic subjects) was studied in a randomized, double-blind, crossover study. Comparisons between commonly used diagnostic methods for lactose maldigestion were also made. DESIGN: The subjects were 40 women aged 20-63 y from 3 groups: lactose maldigesters (n = 12), pseudohypolactasic subjects (n = 15), and control lactose digesters (n = 13). The subjects were given either 50 g lactose, 50 g sucrose, 25 g lactulose, or 25 g fructooligosaccharides. After carbohydrate ingestion, urine was collected and the breath-hydrogen concentration was measured every 30 min for 3 h. Blood glucose was measured every 20 min for 1 h and subjective gastrointestinal symptoms were monitored for 8 h with a questionnaire. RESULTS: When lactulose and fructooligosaccharides were ingested, the lactose maldigesters (P = 0.04 and 0.09, respectively) and the pseudohypolactasic subjects (P = 0.006 and 0.01, respectively) reported more symptoms than did the control lactose digesters. Sucrose caused more symptoms in the lactose maldigesters than in the control lactose digesters (P = 0.05). CONCLUSIONS: Lactose maldigesters and lactose digesters with pseudohypolactasia experience more symptoms than control lactose digesters after a single intake of large amounts of indigestible carbohydrates. Lactose maldigesters also experience more symptoms after ingesting sucrose."

The next study is a side by side trial of probiotics, FOS, and probiotics blended with FOS in preventing colon cancer in cancer induced animals. Mixing bifidobacteria with FOS was the only combination that produced significant improvement over controls. Other complex carbohydtrates did not produce as clear a result as FOS.

The effect of synbiotics on colon carcinogenesis in rats.
J Nutr 1999 Jul;129(7 Suppl):1483S-7S

"Evidence indicates that consumption of probiotic microorganisms such as bifidobacteria reduces the risk of colon cancer in animal models. Feeding certain fructans such as oligofructose and inulin, which are thought to selectively increase the growth of intestinal bifidobacteria (i.e., a prebiotic effect), also has been shown to reduce colon cancer risk. The objective of our study was twofold, i. e., to determine whether the combination of bifidobacteria and oligofructose would have an additive effect (i.e., synbiotic) in reducing colon cancer risk in rats, and to determine whether other oligosaccharides would also be effective as part of a synbiotic combination. The development of colonic preneoplastic lesions (aberrant crypts) was used as an index of colon cancer risk. In one series of experiments, rats were given the carcinogen 1, 2-dimethylhydrazine (DMH) and administered one of the following treatments: skim milk (control), bifidobacteria (bifido), oligofructose (OF) or bifido + OF. Neither bifido nor OF alone significantly reduced aberrant crypt number. Bifido + OF reduced aberrant crypt number in five of six experiments, although the reduction was significant in only one. However, a paired comparison of the six experiments indicated a significant overall reduction in aberrant crypts by bifido + OF (P = 0.039). Soybean oligosaccharide (SBO) and wheat bran oligosaccharide (WBO) were also fed in combination with bifidobacteria. In two other experiments, SBO did not alter the number of aberrant crypts compared with the control, whereas WBO reduced aberrant crypt number in one experiment but not in another. Of OF, SBO and WBO, only SBO reduced the colonic mucosa proliferation compared with the control. These results suggest that the combination of bifidobacteria and oligofructose reduces colon cancer risk in carcinogen-treated rats, but the effect of other oligosaccharides is uncertain."

In the next study a blend of lactobacillus and FOS made a significant transformation of bacterias in piglets compared to controls and compared to piglets given just the bacteria.

Study of the effect of Lactobacillus paracasei and fructooligosaccharides on the faecal microflora in weanling piglets.
Berl Munch Tierarztl Wochenschr 1999 Jun-Jul;112(6-7):225-8

"The influence of administration of Lactobacillus paracasei alone and mixture of Lactobacillus paracasei and fructooligosaccharide on faecal bacteria counts in the weanling pigs was investigated. The administration of Lactobacillus paracasei alone significantly decreased Clostridium (p < 0.05) and Enterobacteriaceae (p < 0.05) counts as compared to the control. Lactobacillus paracasei administered in combination with fructooligosaccharide significantly increased Lactobacillus (p < 0.01-p < 0.05), Bifidobacterium (p < 0.05), total anaerobes (p < 0.05), and total aerobes (p < 0.05) counts compared to control group as well as Lactobacillus paracasei group and significantly decreased Clostridium (p < 0.05) and Enterobacteriaceae (p < 0.01) counts compared to control group. The results obtained point out to a synergic effect of the combination of Lactobacillus paracasei and fructooligosaccharide on numbers of bacterial populations observed in the faeces of the weanling pigs."

Hi, Chris.

Jini consistently says that when we're deciding what treatments to follow, supplements to take, etc., we need to use our own judgment. If we have a strong feeling that differs from her opinion, she encourages us to listen to ourselves, rather than to her. I agree with that approach and that is one of the reasons I bought Listen to Your Gut.

So the following is not to argue with the information you found, but just to present the other side of the coin. That way, people who read the discussion thread can consider both sides and then decide for themselves what they want to do.

The following is one of the criteria Jini includes in choosing a probiotic formula and is quoted from page 168 of Listen to Your Gut:

Some companies package their probiotics with fructooligosaccharides (FOS) and/or inulin - indigestible substances referred to as prebiotics, which they claim feed the bacteria, thereby improving performance. Keep in mind though, that many bacteria (both good and bad) can feed on these substances. So if you have a predominantly bad bacterial flora (as most, if not all people with IBD do) consuming prebiotics is probably going to exacerbate your symptoms. Also, most FOS is manufactured via chemical synthesis and in many instances has been shown to cause abdominal pain, bloating and gas. I especially don't recommend it for people with IBS or IBD. Also avoid FOS and inulin in vitamin/mineral supplements, whey protein powders, etc. Be sure to read labels as it's become popular to add it to all kinds of products. For perfectly healthy people with an established good bacterial flora, prebiotics are probably okay, especially if they are not able to obtain these substances naturally through a good diet.

Thanks, as always, for sharing the research you do. I'm sure all of the people who read your posts appreciate them!

Nicole

Nicole,

I agree that we all have to make our own choices based on our intuition and our knowledge. Thanks for posting Jini's paragraph on prebiotics, as I had not read that for a while.

My research contradicts what Jini has written, so I'll be curious to see how she weighs in on this. Later on I will post more links to the studies I reviewed and provide a couple of the full texts in case anyone is inclined to dive deeper into this topic.

The prebiotics I've investigated and will use are made with a solvent-free, water-based extraction process and do not involve chemicals. There are more and more of these available on the market now. Some of them are even completely organic.

There are many studies which demonstrate that inulin and FOS selectively feed bifidobacteria and lactobacilli in the gut. This means good bacteria increase and pathogenic species decrease. There are also two studies, which I mentioned in the last post, which indicate that prebiotics reduce candida levels in the gut by up to 50%.

Here is a graphic representation of a recent study done on prebiotics:



As you can see, prior to the study bifidobacteria only comprised 17% of the gut flora. After the study, it composed 82%. (In some studies bifidobacteria has been shown to increase by as much as 400%.) You will also notice that clostridia, fusobacteria and bacteroides (several of which species' are prone to cause human disease) were all reduced.

And here is a study which shows the selective effect of prebiotics on gut flora:

Continuous culture selection of bifidobacteria and lactobacilli from human faecal samples using fructooligosaccharide as selective substrate.
J Appl Microbiol 1998 Oct;85(4):769-77

"The human large intestine contains a large and diverse population of bacteria. Certain genera, namely Bifidobacterium and Lactobacillus, are thought to exert health-promoting effects. Prebiotics such as fructooligosaccharides (FOS) have been shown to stimulate the growth of endogenous bifidobacteria. In this study, changes of lactic acid producing bacteria in continuous culture fermentors (semi-defined, anaerobic medium containing 5 g 1(-1) FOS, dilution rate of 0.1 h-1, pH 5.5) were followed over a 21 d period after inoculation with blended human faeces from four healthy adults. Samples were also taken every 3 d for influent/effluent FOS, short chain fatty acid (SCFA), lactate and microbiological analyses. Results showed that SCFA concentrations decreased abruptly 1 d after inoculation while lactate concentrations increased. Classical methods of enumeration using selective media showed that the proportion of total culturable count represented by bifidobacteria and lactobacilli increased from 11.9% on day 1 to 98.1% on day 21. However, molecular methods using genus-specific 16S rRNA oligonucleotide probes indicated that the bifidobacterial population maintained a level between 10 and 20% of total 16S rRNA during the first 6 d and disappeared rapidly when the maximum concentration of lactate was reached. Lactobacilli, which were initially present in low numbers, increased until day 9 and remained at high levels (20-42% of total 16S rRNA) to day 21, with the exception of day 18. Although FOS has usually been regarded as a selective substrate for bifidobacteria, these observations suggest that: (1) lactobacilli are also able to use FOS, (2) lactobacilli can out-compete bifidobacteria in continuous culture at pH 5.2-5.4 when FOS is the primary carbon and energy source, and (3) bifidobacteria can grow faster on FOS than lactobacilli under controlled conditions."

As you said, Nicole, ultimately we have to "follow our gut" to decide whether we want to take a particular supplement. But I also think educating ourselves about our bodies, the conditions we're dealing with and the various treatment options available. That's how we all got to this great message board! I post this information in the same spirit you posted yours: in case it might be helpful to those who are exploring this topic.

Warmly,
Chris

Here is some information about larch arabinogalactan (LA), a prebiotic and immune enhancing supplement (it is the main active compound in echinacea) that is receiving a lot of attention in the food science world now.

This form of arabinogalactan from larch trees is a significant new pre-biotic and, to a lesser degree, a valuable immune enhancer. Human studies have demonstrated its ability to increase the population of anaerobic bacteria in the colon by anywhere from 40% to 1000% depending on lifestyle factors.

Increased anaerobes in the colon are beneficial because additional fermentation lowers colon pH and increases the production of short chain fatty acids (butyric and propionic.) Lower pH is known to protect against colon cancer and disorders of the bowel. Short chain fatty acids nourish colonocytes (cells lining the colon) and are the major food source for hepatocytes (liver cells) in the liver.

LA also increases populations of Lactobacilli and Bifidobacteria by 47% to 300% elsewhere in the gut. At the same time, pathogenic bacteria are reduced by 15.5 to 18.5%.

Here are a few studies:

Effects of dietary arabinogalactan on gastrointestinal and blood parameters in healthy human subjects.
Robinson RR, Feirtag J, Slavin JL.
Department of Food Science and Nutrition, University of Minnesota, St. Paul 55108, USA.

OBJECTIVES: Arabinogalactan (AG) is a non-digestible soluble dietary fiber that resists hydrolytic enzyme action and enters the large bowel intact where it is fermented by resident microflora. To determine whether AG has similar physiological properties to other soluble dietary fibers, we examined the effect of 15 and 30 g per day of a commercially available AG from Western Larch on several gastrointestinal and blood parameters. METHODS: Gastrointestinal parameters included fecal microflora, fecal enzyme activity, fecal short-chain fatty acids, fecal pH, fecal weight, transit time and bowel frequency. Blood parameters included total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, Apo-A1, Apo-B, glucose and insulin. The study consisted of two three-week diet treatments with no washout period. Participants (n=20, 11 males, 9 females) consumed their usual diet in addition to 15 or 30 g AG in a beverage sweetened with aspartame as compared to their usual diet with the control beverage. RESULTS: Significant increases in total fecal anaerobes were observed with 15 g (p=0.01) and 30 g AG (p=0.001). A significant increase (p=0.02) in Lactobacillus spp. was observed when subjects consumed AG for a total of six weeks regardless of dose. There were no significant changes in other microflora, fecal enzyme activity, transit time, frequency, fecal weight, fecal pH and short-chain fatty acids. Fecal ammonia levels decreased with 15 g (p=0.001) and 30 g (p=0.002) AG. No significant changes in blood lipids or blood insulin were observed. CONCLUSIONS: These data suggest that dietary AG is easily incorporated into the diet, well tolerated in subjects and has some positive effects on fecal chemistry.

Altern Med Rev. 1999 Apr;4(2):96-103. Links
Larch arabinogalactan: clinical relevance of a novel immune-enhancing polysaccharide.
Kelly GS.

Larch arabinogalactan is composed of greater than 98-percent arabinogalactan, a highly branched polysaccharide consisting of a galactan backbone with side-chains of galactose and arabinose sugars. Larch arabinogalactan is an excellent source of dietary fiber, and has been approved as such by the FDA. It has been shown to increase the production of short-chain fatty acids, principally butyrate and propionate, and has been shown to decrease the generation and absorption of ammonia. Evidence also indicates human consumption of larch arabinogalactan has a significant effect on enhancing beneficial gut microflora, specifically increasing anaerobes such as Bifidobacteria and Lactobacillus. Larch arabinogalactan has several interesting properties which appear to make it an ideal adjunctive supplement to consider in cancer protocols. Experimental studies have indicated larch arabinogalactan can stimulate natural killer (NK) cell cytotoxicity, enhance other functional aspects of the immune system, and inhibit the metastasis of tumor cells to the liver. The immune-enhancing properties also suggest an array of clinical uses, both in preventive medicine, due to its ability to build a more responsive immune system, and in clinical medicine, as a therapeutic agent in conditions associated with lowered immune function, decreased NK activity, or chronic viral infection.

Immunomodulating activity of arabinogalactan and fucoidan in vitro.
J Med Food. 2005 Winter;8(4):446-53.
Department of Biotechnology & Bioproducts Research Center, Yonsei University, Seoul, South Korea.

Many polysaccharides obtained from natural sources are considered to be biological response modifiers and have been shown to enhance various immune responses. Here, we investigated the immunomodulating effects of arabinogalactan and fucoidan in vitro. Mouse spleen lymphocytes became cytotoxic to tumor cells after culture with arabinogalactan and fucoidan at concentrations of 10-100 microg/mL. These data suggest that arabinogalactan and fucoidan are activators of lymphocytes and macrophages. This property may contribute to their effectiveness in the immunoprevention of cancer.

Here is a study which demonstrates that prebiotics are able to selectively feed health-promoting bacteria without feeding pathogenic organisms. See bold text at the bottom of the abstract.

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Anaerobe. 2005 Jun;11(3):145-53. Epub 2005 Feb 12. [In-Data-Review]

Prebiotic effects of oligosaccharides on selected vaginal lactobacilli and pathogenic microorganisms.

Rousseau V, Lepargneur JP, Roques C, Remaud-Simeon M, Paul F.

GENIBIO, ZI du Pradas, Voie Haussmann, 09190 Lorp-Sentaraille, France.

The purpose of this study was to select endogenous human vaginal lactobacilli strains on the basis of the main probiotic properties observed in the vaginal environment in order to use them for the evaluation of the potential prebiotic properties of oligosaccharides. From vaginal samples of 50 women with a normal flora, 17 lactobacilli strains were first isolated because of their high level of hydrogen peroxide production. Then six strains were selected mainly for their ability (i) to adhere to vaginal cells, (ii) to produce compounds in sufficient amount, such as lactic acid, having an inhibitory action on pathogens, and less importantly, (iii) to demonstrate arginine deiminase activity. These six strains were found to belong to three distinct species: Lactobacillus crispatus, L. jensenii and L. vaginalis. One strain of each species was chosen as a potential vaginal probiotic strain with regard to our criteria. These three strains were then used to evaluate the prebiotic properties of different oligosaccharide series: two fructooligosaccharide series (FOS Actilight((R)) and FOS Raftilose((R))) and two glucooligosaccharide series varying by their osidic linkages (alpha-1,6/alpha-1,4 GOS and alpha-1,2/alpha-1,6/alpha-1,4 GOS). The test was based on the ability of the oligosaccharides to promote the growth of the three beneficial strains selected but not of pathogenic microorganisms often encountered in urogenital infections such as Candida albicans, Escherichia coli and Gardnerella vaginalis. Oligosaccharide hydrolysis was followed by HPLC analysis. This revealed that two oligosaccharide series (FOS Actilight((R)) DP3 and all alpha-1,6/alpha-1,4 GOS DP4) were used only by the lactobacilli strains, the pathogenic microorganisms being unable to metabolise them. The selected lactobacilli and oligosaccharides are good candidates for incorporation in a formula to prevent vaginal infections.

I think there are a few points to keep in mind here:

1) The guidelines in my books are set up for people WITH IBS or IBD. Once you have healed your body and normalized your gut environment, the possibility for many other substances and treatments will open up for you (like prebiotics).

2) Also, there are new beneficial therapies being discovered all the time. And it is up to people like Chris to research, discover and test these. Some will work and some won't. That's what I spent seven years doing before I wrote "Listen To Your Gut". So I think any research and expansion of knowledge is good. But clinical trials on normal people may have little or no relavance to people with IBD - but at least they are a starting point. And we can get ideas from them, especially paying attention to ones that 'click' with our intuition.

3) So, one of the problems here, is that most of these trials were done on people with 'normal microflora'. So the way to proceed to see if this therapy is going to be of any use for people with IBD, is for Chris to test it on his own body first. Here's the method I use: You need to go on and off a substance a minimum of three times (for a 2-3 week duration) - leaving at least 3 weeks between trials - before you can reliably say that "this substance produced this result in my body". This helps to eliminate other factors that also produce effects in the body like stress, emotional problems, particular foods, drinks, environmental factors, etc.

Then, once Chris has trial tested this treatment, he can then post it here, with full instructions and get others to trial test it. Once you have about 20-30 people weighing in with their results, you'll be able to make some conclusions about whether this is a good therapy for people with IBS and IBD to try.

This is the procedure I followed in developing my newest Wild Oregano Oil Protocol (except the forums weren't set up then so I had my consultation clients test it).

4) As you pointed out, Chris, it's very important to get uncontanimated, food source prebiotics. The way you're going about it seems good to me. And I do look forward to hearing of your results.

5) The articles that show the translocation of bacteria following elemental and enteral diets are interesting as it makes sense. These are the most opportunistic creatures on the planets and if you take away their food source, it's logical that they will migrate elsewhere to feed. This is probably why people have found that doing the Wild Oregano Oil Protocol (and probiotic supplementation) at the beginning (and throughout) the IBD Remission Diet, yields the best results. Again, important to keep in mind that all clinical trials on elemental diets are done using pharmaceutical elemental products which have very little in common with Absorb Plus - sort of like comparing McDonald's to a home-cooked meal.

Research and theories are great, and they are the first layer of information gathering that trickles down and distills into our body wisdom to form our intuition of 'gut feeling'.

Chris, I do look forward to hearing your results from this experiment and hope that you've found a new useful therapy.

I will also forward this thread to Professor Glenn Gibson at Reading University in England - he's one of the founders of prebiotic therapy and provided me with plenty of info when I was researching the topic. Perhaps he will like to comment....

all the best,
Jini

Hi Jini,

I would love to hear what Professor Gibson has to say on this topic, as I have read all of his studies on prebiotics. Please do forward him this thread!

Actually, there have been four studies done (that I know of) to date specifically on the effects of prebiotics on IBD. Though they are small studies, and three of them were open label, the results were promising and definitely warrant further investigation. Here is a summary of those studies:



And here is the full text of a review of the last study above, which showed promising results for a trial of 15g of FOS/day for Crohn's patients.

http://chriskresser.com/images/FOSCD.pdf

I'll definitely let you all know how my "trial of one" (me!) goes, and how my research progresses.

Best,
Chris

Here's a study that demonstrates a combination of prebiotics and probiotics (called "synbiotics") is effective for reducing inflammation in Ulcerative Colitis.

Gut. 2005 Feb;54(2):242-9. [MEDLINE]

Synbiotic therapy (Bifidobacterium longum/Synergy 1) initiates resolution of inflammation in patients with active ulcerative colitis: a randomised controlled pilot trial.

Furrie E, Macfarlane S, Kennedy A, Cummings JH, Walsh SV, O'neil DA, Macfarlane GT.

Microbiology and Gut Biology Group, University of Dundee, Ninewells Hospital Medical School, Dundee DD1 9SY, UK. e.furrie@dundee.ac.uk

BACKGROUND AND AIMS: Ulcerative colitis (UC) is an acute and chronic inflammatory disease of the large bowel with unknown aetiology. The immune response against normal commensal microorganisms is believed to drive inflammatory processes associated with UC. Therefore, modulation of bacterial communities on the gut mucosa, through the use of probiotics and prebiotics, may be used to modify the disease state. METHODS: A synbiotic was developed for use in UC patients combining a probiotic, Bifidobacterium longum, isolated from healthy rectal epithelium, and a prebiotic (Synergy 1), a preferential inulin-oligofructose growth substrate for the probiotic strain. Treatment was employed in a double blinded randomised controlled trial using 18 patients with active UC for a period of one month. Clinical status was scored and rectal biopsies were collected before and after treatment, and transcription levels of epithelium related immune markers were measured. RESULTS: Sigmoidoscopy scores (scale 0-6) were reduced in the test group (start 4.5 (1.4), end 3.1 (2.5)) compared with placebo (start 2.6 (2.1), end 3.2 (2.2)) (p=0.06). mRNA levels for human beta defensins 2, 3, and 4, which are strongly upregulated in active UC, were significantly reduced in the test group after treatment (p=0.016, 0.038, and 0.008, respectively). Tumour necrosis factor alpha and interleukin 1alpha, which are inflammatory cytokines that drive inflammation and induce defensin expression, were also significantly reduced after treatment (p=0.018 and 0.023, respectively). Biopsies in the test group had reduced inflammation and regeneration of epithelial tissue. CONCLUSIONS: Short term synbiotic treatment of active UC resulted in improvement of the full clinical appearance of chronic inflammation in patients receiving this therapy.

PMID: 15647189

Professor Glenn Gibson (PhD Microbiology at Reading University in the U.K. - one of the "founders" of prebiotics) emailed me this comment:

"Thanks for the chance to comment. I don't know who 'badly drawn boy' is but he certainly is a good researcher - up to date and accurate. Congratulations! If prebiotics are authentic (and beware there are lots of dietary ingredients being touted that do not meet the current criteria), then they should not stimulate the negative bacteria or yeasts in the gut - this includes candida. I'm also assuming that a rationale dose is given, which at the moment is 5-8g/d for most people but rising to about 15 in some. Sometimes data are produced showing microorganisms being touted as pathogens growing on prebiotics. These are largely pure culture based and are indicative rather than realistic. A better approach is mixed culture in vitro where the competitive nature of bifidobacteria tends to win out (again, if the dose is realistic). A better approach again is a human study of course. Maybe I can refer to a review of ours recently which sets out the criteria required for a prebiotic claim, the types which at the time met that and health aspects. It is a little old now and as you know the field is moving very quickly. Other articles may be more informative. Keep up the good work. Best wishes, Glenn.

Here's the review:

Gibson, G.R., Probert, H.M., van Loo, J.A.E., Rastall, R.A. and Roberfroid, M.B. 2004. Dietary modulation of the human colonic microbiota: Updating the concept of prebiotics. Nutrition Research Reviews 17, 259-275.

and here's a more recent book:

Gibson, G.R. and Rastall, R.A. 2006. Prebiotics: Development and Application. John Wiley & Sons Ltd., Chichester. "

take care, and Chris, we're all looking forward to hearing how your personal trial goes!

Jini

Jini,

Thanks so much for posting Professor Gibson's reply! It was very informative and it's nice to know that I've been on the right track in my research.

The prebiotic I'll be taking is called Synergy1, which is exactly the same product that was used in most, if not all, of the human clinical trials that demonstrates the prebiotic effect of inulin and oligofructose. It is made with only hot water and enzymes - no chemicals or synthetic processes are used in its production. I couldn't find a retail source of this product, but I was able to obtain a sample from the manufacturer for my "research" purposes.

I'll let you all know how it goes!

Best,
Chris