Originally posted by Dr. Davis on 2016-04-16
on the Wheat Belly Blog, sourced from and currently found at: Infinite Health Blog.
PCM forum Index of WB Blog articles.

The pain of prebiotics?

Here’s a question I hear on occasion: “I started the prebiotic fibers but I experienced a lot of bloating and abdominal discomfort and had to stop. Maybe they’re not for me.” As the Wheat Belly conversation is taken further into the mainstream population via the Wheat Belly 10-Day Grain Detox, I am hearing this more and more.

Giving up too soon because of encountering a problem without understanding why is a sure way to booby-trap your return to health. Should you encounter problems such as bloating or discomfort with your prebiotic regimen, it is due to dysbiosis, disrupted bowel flora from prior eating habits and other factors. In other words, your previous diet of wheat, grains, and sugars, along with chlorinated/fluoridated drinking water, prescription antibiotics, herbicides and pesticides in food, etc. changed the composition of bowel flora, perhaps even allowing unhealthy species to ascend up the small intestine, occasionally as high as the duodenum and stomach (“small intestinal bacterial overgrowth,” or SIBO). Undesirable species such as E. coli, Enterobacter, and various Clostridia species proliferate and muscle out desirable species such as Lactobacillus. This can happen with green bananas, raw white potatoes, inulin, FOS, galactooligosacchrides, or any other form of prebiotic fiber.

Dysbiosis at the start of your program is common. Even by lax criteria, 35% of people without abdominal symptoms can start with dysbiosis. Compared to the average person, as many as 85% of people with irritable bowel syndrome (IBS) can have some degree of dysbiosis (though estimates vary depending on the criteria used for “normal” vs. “abnormal”).

If you initiate a program of restoring prebiotic fibers (also called “resistant starch,” since these fibers resist digestion by humans but are metabolizable by bowel flora) but begin with a substantial degree of dysbiosis, the prebiotic fibers nourish both desirable as well as undesirable species—prebiotics can make dysbiosis worse. The latter situation is suggested by experiencing symptoms such as excessive bloating, abdominal discomfort, or diarrhea with a prebiotic fiber program.

How should you deal with this situation that suggests that you have substantial dysbiosis at the start, a situation that has adverse health consequences all of its own (impaired digestion, impaired nutrient absorption, body-wide inflammation, colon cancer risk)? Here is how I have managed this situation with good success:

• Everyone should begin with a several week course of a high-potency probiotic, e.g., 50 billion CFUs per day with at least a dozen species of Lactobacillus, Bifidobacteria, etc. Add lactate-fermented foods to add further to inoculating your colon with Lactobacillus, Leuconostoc and other species.
   
• If symptoms are experienced at the start of your prebiotic restoration program, stop the prebiotics while continuing the probiotic. Re-attempt prebiotics after 4 weeks of probiotics alone.
   
• If, after the 4-week course of probiotics, resumption of the prebiotics re-provokes unpleasant symptoms, then it is time to consider a formal evaluation from a functional medicine or integrative health practitioner to identify and treat severe dysbiosis. Solutions can include a FODMAPS program to essentially “starve” bowel microbes, or even a non-absorbable antibiotic to begin with a clean “slate,” wiping out all species, good and bad.

The average American obtains 3-8 grams of prebiotic fibers from their diet, about half from grains. We, of course, cut out all grains, compensate for the loss and increase prebiotic fiber intake (over time) to the ideal intake of around 20 grams per day for full health benefits.

Bottom line: prebiotic fibers are crucial to health. Properly managed, they help maintain bowel regularity, nourish the intestinal lining, reduce risk for colon cancer; exert mind/brain effects such as reduced anxiety, reduced depression, deeper, more restorative sleep; and exert metabolic benefits such as reduced total and LDL cholesterol, reduced triglycerides, reduced insulin and blood sugar, reduced insulin resistance, reduced blood pressure. Having an initial unpleasant experience does not mean “they’re not for you.” It means that there is something physiologically wrong that needs to be addressed before you can resume your path back to health.