The Role of Prebiotics, Probiotics, and Postbiotics in Healing and Harmony
The longer that I have practiced medicine, the more aware I have become of the importance of what we eat. I particularly noticed the gravity of this effect in relation to surgical outcomes. The healthier the patient, the more predictably they would heal.
At first glance the astute reader says, “well No shi..”.
I could not agree more with sentiment, however what defines “healthy”? Is it body mass index, blood pressure, blood glucose level, lipid panel or one of the other myriad of biometrics? Well doc its all of them says the medical student. An easy out for sure, but are they all related and do we have agency over them? The answer may surprise you.
The health of your gut is more critical than you might think. It’s not just about avoiding an upset stomach; the gut is the powerhouse of our body’s immune response and overall well-being. As strange as it may sound, humans are often called “walking bacteria” because our bodies are home to trillions of microorganisms. In fact, there are more bacterial cells in and on us than human cells, making our health deeply intertwined with the health of our microbial communities.
At the heart of this relationship are three key players: prebiotics, probiotics, and postbiotics. While the names might sound like jargon, they represent a holistic approach to gut health that can alleviate conditions like leaky gut and chronic inflammation, cardiovascular disease, improving overall vitality and ability to heal and recover.
The Gut: An Internal Ecosystem
Inside your digestive system lies an ecosystem of microorganisms known as the gut microbiome. This community, comprising over a thousand bacterial species, plays a crucial role in breaking down food, producing essential nutrients, regulating immunity, and even influencing mood. When this ecosystem becomes imbalanced- due to factors like poor diet, stress, or illness- it can lead to “leaky gut syndrome.” This condition occurs when the gut lining becomes permeable, allowing harmful substances to escape into the bloodstream. These unwanted invaders can spark widespread inflammation, which is linked to chronic conditions such as arthritis, diabetes, atherosclerosis, and even mental health disorders like depression.
Fortunately, maintaining a healthy balance in the gut can prevent these problems. Prebiotics, probiotics, and postbiotics work together to restore harmony within the gut, creating a stronger barrier and reducing inflammation.
Probiotics: The Friendly Soldiers
Probiotics are live microorganisms, often referred to as “good bacteria,” that confer health benefits when consumed in adequate amounts. Commonly found in fermented foods like yogurt, kefir, and sauerkraut, probiotics include species such as Lactobacillus and Bifidobacterium.
Fun fact is that your individual microbiome is determined more by your environment than genetics. You acquire this microbiota and nurture it from birth.
In fact, babies delivered vaginally have a microbiota that is similar to the vaginal cavity while those delivered via Cererian section have one that is more similar to the mother’s skin. As babies and children sample their environment and interact with pets, they continue to evolve their microbiota. This is one of the main reasons why there are geographical differences in respective microbiota and why you might not feel so well after eating in a foreign country. You are wondering while on the toilet “what the hell did I eat” and your buddy is out fishing. His microbiota is adapted to his type of food and woefully yours is not.
These friendly bacteria have an important job. They directly compete with harmful microorganisms, effectively crowding out invaders like E. coli. Probiotics also produce short-chain fatty acids (SCFAs) such as butyrate, which strengthen the gut lining by promoting the production of protective proteins. Another SFA propionic acid inhibits an enzyme in the liver called HMG CoA reductase. This enzyme is the target of many statin drugs. Therefor you can lower your cholesterol through proper nutrition.
Research shows that probiotics are particularly effective in reducing symptoms of irritable bowel syndrome (IBS) and may even improve mental health by enhancing communication along the gut-brain axis. However, not all probiotics are created equal. Their efficacy depends on the specific strain, dosage, and whether they can survive the acidic environment of the stomach to reach the gut.
Prebiotics: Fuel for Good Bacteria
While probiotics are the workers, prebiotics are their fuel. Prebiotics include soluble and insoluble fiber. Higher fiber diets are not just to make you more regular; the fiber is the food for the microbiota and it blunts the glucose load and thus insulin response. The way that it works is that the insoluble fiber acts like a fence or lattice work on the interior of the gut lining. The soluble fiber like pectin and inulin are more globular and fill in the holes in the fence and allow the food to be passed down to the microbiota where they can make the short chain fatty acids. This fiber wall on the interior of the gut, slows the uptake of nutrients such as glucose and thus decreases the insulin response. Fewer spikes in insulin leads to less insulin resistance and diabetes.
Postbiotics: The Secret Weapon
Postbiotics might be the least familiar of the trio, but they are just as important. These are the byproducts of probiotic activity, including SCFAs, peptides, and antimicrobial compounds. Think of them as the “final product” of fermentation, packed with health benefits.
One of the most remarkable roles of postbiotics is their ability to strengthen the gut barrier. They stimulate the production of mucin, a protein that forms a protective gel layer in the gut lining, helping to prevent toxins and harmful bacteria from slipping through. Additionally, postbiotics have potent anti-inflammatory properties, as they can regulate immune cells and suppress overactive inflammatory responses.
I have mentioned anti-inflammatory many times now and it is definitely a key buzz word in the health and wellness space, but how is the gut involved? About 70-80% of the immune cells surround the gut mainly in locations called Peyer’s patches in the lymphatic system. It makes sense that God designed us this way because we don’t want bad actors escaping the sewer that is our gut and getting into our bodies. We have two other barriers in the gut which are the mucous gel layer and the epithelial gut lining cells. This epithelial layer is really just one cell thick but the surface area is huge. Spread out the gut lining is the size of a tennis court. There are tight junctions in between those epithelial cells that are critical maintaining the barrier. By protecting and nourishing the epithelial cells with prebiotic, probiotics and postbiotics, we prevent foreign material from getting into the blood stream and lymphatic system and stimulating an immune response.
On the contrary, consuming highly processed food with added sugars (fructose) damage the tight junctions. Lectins such as gluten can damage the tight junctions as well and this creates “leaky gut”. When the lymphatic or immune system is exposed to these leaked substances, it creates inflammatory signals like IL-1, IL-6, and TNF which circulate in the blood stream creating systemic inflammation which is correlated with insulin resistance and diabetes, heart disease and high blood pressure and even dementia. Foreign proteins can leak through as well and the immune system will recognize them as invaders and will create antibodies to them. If those proteins are similar to yours, then those antibodies can attack your you body. This is one of the proposed mechanisms of autoimmune diseases of the skin and joints and why many patients realize improvement in their disease with improvement of their diet and microbiota.
Prebiotics, probiotics, and postbiotics work synergistically to combat leaky gut. Probiotics reinforce the gut lining by promoting the production of tight junction proteins that seal the gaps between intestinal cells. Postbiotics, particularly SCFAs like butyrate, further support this process by reducing oxidative stress and enhancing the structural integrity of the gut barrier. Meanwhile, prebiotics fuel the beneficial bacteria that maintain microbial balance and produce these crucial postbiotic compounds.
What can I do?
Ok, that was a lot of science. I feel that it is important to bring the receipts when you make a statement. The real question is, how do I incorporate this into my daily routine?
First, avoid highly processed foods that contain added sugars which is basically fructose. Fructose inhibits mitochondrial function (the little organelles iwwn your cells that make energy) and cause insulin resistance. Fructose also damages the tight junctions in the gut contributing to “leaky gut” and inflammation. Highly processed foods are calorically dense and cause you to eat about 25% more as well.
For what it is worth, I have been drinking smoothies for 15 years or more. It is what is in the smoothie that matters. The diversity of the smoothie counts. It should look like a rainbow of colors and here is why. Light skin berries like raspberries, blackberries and blueberries are chocked with soluble fiber and polyphenols and flavonoids which are potent antioxidants. Bananas, apples, and pears have soluble and insoluble fiber and multiple vitamins. Mango, oranges and pineapple also have insoluble fiber and soluble fiber and vitamin C which is important for collagen production, immune function, and it is also an antioxidant. Spinach not only has fiber but thylakoids which are a natural GLP-1 agonists. GLP-1 is glucagon like peptide which has become all the rage as it increases satiety. In addition, the amino acids valine and glutamine are also GLP-1 agonists which is why I add a scoop of collagen powder and whey protein isolate.
I also add 10-15 grams of creatine for cellular energy. I try to get 50 grams of protein with 25 grams of fiber in the smoothie. Pomegranate juice (prostate health) and Naked drinks or almond milk can act as the base. Snacks throughout the day include various nuts and berries and jerky to try to get 60 grams of fiber per day and maximize my protein intake.
I start out my day with yerba mate and espresso and kombucha. The yerba mate tea is full of antioxidants and it is also a natural GLP-1 agonist. The kombucha is an acquired taste. To be honest the SFA’s in the postbiotics are sour like vinegar. Ever heard of an old-timer saying that a tablespoon of vinegar was good for? Well they were right. Acetic acid or vinegar is a postbiotic. I can’t tolerate some of it like kimchi. Can’t get it past the nose. However there are many types of kombucha that are really not bad. I have to credit my wife Tracey for turning me on to them.
The Future of Gut Health
As research into prebiotics, probiotics, and postbiotics continues to grow, so does their potential to revolutionize health care. These compounds may hold the key to treating chronic conditions like inflammatory bowel disease, metabolic disorders, and even mental health challenges.
The personalized approach to gut health is particularly exciting. As we learn more about the unique composition of each individual’s microbiota, treatments tailored to specific microbial profiles could become a reality. Imagine a future where a simple microbiome analysis could guide diet and supplement recommendations to optimize your health.
Investing in your gut health is one of the best things you can do for your overall well-being. By embracing the power of prebiotics, probiotics, and postbiotics, you’re not just supporting your digestion—you’re fostering a healthier, more resilient body and mind.