What are probiotics?
- Probiotics are good bacteria that live in the human gut. People can carry 100 trillion bacteria in their intestines.
- There are hundreds of different kinds of helpful bacteria that live in our gut.
- These bacteria can change energy levels, affect how nutrients are absorbed, and improve the health of the gut lining. They can also protect against infections, prevent allergies, and affect how our immune system works. 1 Dysbiosis happens when the different types of bacteria get out of balance. Certain kinds of bacteria overgrow and can cause symptoms such as diarrhea, abdominal pain, bloating and gas.
- Small intestinal bacterial overgrowth (SIBO) is an example. Up to 10% of people with celiac disease have SIBO. It is among the most common causes of ongoing symptoms after going gluten-free. 2 , 3
- If the bacteria in the gut lose their balance it can increase inflammation and autoimmunity. Autoimmunity is involved in many chronic diseases such as: 4
- Ulcerative colitis
- Crohn's disease
- Celiac disease
- Irritable bowel syndrome
- Taking antibiotics can disrupt the balance of good bacteria in the gut. It is key to restore this balance during or after the use of antibiotics by using probiotics.
- Fermented food is a major source of probiotics in the diet. Fermented foods include:
- Yogurt (if bacterial strains known to be probiotics are added)
- Raw kimchi (fermented Korean cabbage)
- Prebiotics are types of fiber that feed the probiotics. Prebiotics can be as important as probiotics for health. The gluten-free diet tends to be low in fiber. So, it can also be low in prebiotics. 5
- A few examples of gluten-free prebiotics:
- Jerusalem artichoke
- Garlic, leeks, onions
- Symbiotics are supplements that contain prebiotics AND probiotics. The right probiotic or symbiotic can improve gas, bloating, diarrhea or constipation often within a few doses.
TAKE HOME MESSAGES:
- You need healthy bacteria in your gut to prevent digestive symptoms. They also keep your immune system strong.
- Talk to your doctor or dietitian if you think probiotics and/or prebiotics might help you.
- People with celiac disease are at high risk of dysbiosis. This can cause ongoing symptoms even after going gluten-free. 6
- The gluten-free diet lacks prebiotics. This increases the risk of bacterial dysbiosis. 7
- Use probiotics (in your diet or in a supplement) and prebiotics (gluten-free fiber sources) to help prevent dysbiosis.
- If you take antibiotics, make sure to replace the probiotics with a supplement or in your diet.
1. Guarner F, Malagelada JR. Gut flora in health and disease. Lancet. 2003 Feb 8;361(9356):512-9.
2. Tursi A, Brandimarte G, Giorgetti G. High prevalence of small intestinal bacterial overgrowth in celiac patients with persistence of gastrointestinal symptoms after gluten withdrawal. Am J Gastroenterol. 2003 Apr;98(4):839-43.
3. Rubio-Tapia A, Barton SH, Rosenblatt JE, Murray JA. Prevalence of small intestine bacterial overgrowth diagnosed by quantitative culture of intestinal aspirate in celiac disease. J Clin Gastroenterol. 2009 Feb;43(2):157-61.
4. Brown K, DeCoffe D, Molcan E, Gibson DL. Diet-induced dysbiosis of the intestinal microbiota and the effects on immunity and disease. Nutrients. 2012 Aug;4(8):1095-119.
5. Roberfroid M, Gibson GR, Hoyles L, McCartney AL, Rastall R, Rowland I, Wolvers D, Watzl B, Szajewska H, Stahl B, Guarner F, Respondek F, Whelan K, Coxam V, Davicco MJ, LŽotoing L, Wittrant Y, Delzenne NM, Cani PD, Neyrinck AM, Meheust A. Prebiotic effects: metabolic and health benefits. Br J Nutr. 2010 Aug;104 Suppl 2:S1-63.
6. Collado MC, Calabuig M, Sanz Y. Differences between the fecal microbiota of coeliac infants and healthy controls. Curr Issues Intest Microbiol. 2007 Mar;8(1):9-14.
7. De Palma G, Nadal I, Collado MC, Sanz Y. Effects of a gluten-free diet on gut microbiota and immune function in healthy adult human subjects. Br J Nutr. 2009 Oct;102(8):1154-60.
Revision Date: May 16, 2013
Author: Christine Doherty, N.D.
Editors: Melinda Dennis, MS, RD, LDN, Toufic Kabbani MD, MPH