A Practitioner’s Guide to Prebiotics

The concept of “prebiotics” was first proposed in 1995 at which time they were defined as “nondigestible food ingredients that beneficially affect the host by selectively stimulating the growth and/or activity of one or a limited number of bacteria in the colon, thus improving host health”. (17)(82) Overtime, the definition has changed due to scientific exploration and our increased understanding of prebiotics and their effects on health. The modern definition now describes prebiotics as “a nondigestible compound that, through its metabolization by microorganisms in the gut, modulates composition and/or activity of the gut microbiota, thus conferring a beneficial physiologic effect on the host”. (17)  

While all prebiotics are fibrous carbohydrates, not all fibers can be classified as prebiotics. In order to be classified as a prebiotic, the following criteria must be met:

  • Resistance to gastric acidity, enzyme hydrolysis, and absorption in the gastrointestinal tract
  • Fermentation by intestinal microbes
  • Selective stimulation of growth and/or activity of intestinal microbes conferring health benefits to the host (77)(86)

Despite having established the definition and classifying criteria for prebiotics, there are still some inconsistencies as to which compounds can be classified as true prebiotics. (77)(86) This article includes compounds that have demonstrated prebiotic effects and associated benefits in the body.

Common dietary sources of prebiotics include onion, leek, banana, and asparagus.

The role of prebiotics in health

Through their fermentation, prebiotics provide a source of fuel for the intestinal microbiota (38) and promote a healthy microbial profile, which provides a number of benefits to the host.  It’s important to note that, unlike probiotics, prebiotics can only support the growth of bacteria already residing in the gut. (59)

Research has demonstrated numerous health benefits of prebiotics, primarily resulting from their fermentation within the gastrointestinal tract. Prebiotics have been shown to:

  • Promote changes in intestinal microbe composition, specifically increasing Bifidobacteria and Lactobacilli species
  • Produce beneficial metabolites, including short-chain fatty acids (e.g., acetate, propionate, butyrate)
  • Decrease fermentation of protein and amino acids, a process which may lead to the production of potentially harmful metabolites, such as sulfides, ammonia, and amines (17)(59)
  • Decrease or inhibit the growth of pathogenic bacteria in the gastrointestinal tract, such as E. coli, Salmonella spp, and Campylobacter
  • Improve immune health likely through the actions of fermentation metabolites
  • Improve mineral bioavailability and absorption (e.g., calcium, magnesium) (17)(86)
  • Improve intestinal permeability through the actions of SCFAs
  • Decrease the risk of allergies by improving microbial diversity (17)

The use of prebiotics has also been explored in many health conditions, particularly those related to digestive health, such as constipation, diarrhea, irritable bowel syndrome, and inflammatory bowel disease. (59) The table below summarizes research on ingredients that demonstrate prebiotic effects and the conditions or uses for which they have been shown to be beneficial.

Dietary sources of prebiotics

The table below provides examples of dietary sources of prebiotics included in this article.

Inulin and oligofructose content of foods

The information in the following table has been summarized from “TABLE 1: Inulin and oligofructose content of foods eaten by Americans” found in The Journal of Nutrition. (67)

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Safety considerations & contraindications

While the consumption of prebiotics through the diet or supplementation is generally well tolerated, the most common adverse effects associated with prebiotic intake include gastrointestinal discomfort, bloating, flatulence, and diarrhea. (25)(29)(32)(60)(88)

Furthermore, the low FODMAP diet, which restricts the intake of fermentable carbohydrates, specifically fermentable oligo-, di-, mono-saccharides and polyols, has been shown to improve symptoms of irritable bowel syndrome. While this suggests that prebiotics may be contraindicated for some individuals, further research examining the effects of prebiotics in relation to gastrointestinal conditions and the low FODMAP diet is needed. (105)

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