Prebiotic, Probiotic, Synbiotic Supplements Help Bridge Nutrition Gaps

Pharmacy TimesMarch 2023
Volume 89
Issue 3

Few Americans' diets meet the FDA's dietary guidelines; minerals and vitamins can pick up the slack to contribute to digestive health.

The human digestive system is incredibly complex. It takes nutrients consumed and breaks them down into particles the cells of the body use for energy, growth, and repair. The digestive system starts at the mouth and follows a twisty tunnel through the esophagus, stomach, small intestine, large intestine, and anus. In addition to this tunnel called the gastrointestinal (GI) tract, solid organs contribute to digestion. These organs include the gallbladder, liver, and pancreas.

The organs of the digestive system are controlled by hormones and nerves, which trigger the release of enzyme-containing digestive juices from the gallbladder, liver, pancreas, and stomach, which work together to break down nutrients. When the nutrients reach the small intestine, they are absorbed along with water and directed through the bloodstream. Any unused nutrients are then moved along to the large intestine as waste.

In addition to digestive enzymes, the digestive system is full of bacteria and other microbiota that aid in digestion. This gut flora has taken the spotlight in recent decades as a major contributor to digestive health. Ideally, the body keeps a delicate balance of good microbiota and digestive enzymes. When this balance is disturbed for whatever reason, commercially available supplements are available to pick up the slack.

Digestive Enzymes

There are 5 main digestive enzymes. Amylase is made in the mouth via saliva and the pancreas and is responsible for the breakdown of complex carbohydrates, such as whole wheat products. Lactase, made in the small intestine, is necessary for the breakdown of lactose, a sugar found in milk products. Lipase, also from the pancreas, is important to break down fats. Protease, from the pancreas, breaks down proteins. Finally, there is sucrase, also from the small intestine, responsible for the breakdown of sucrose, a simple sugar found in fruits.1

Many foods contain natural digestive enzymes. These include avocados, bananas, ginger, honey, kefir, kiwi, mangos, papayas, pineapples, and sauerkraut.1 There are no data to suggest that the digestive enzymes from these foods are powerful enough to aid in digestion.

Prescription digestive enzymes are available for patients with a diagnosis of enzyme insufficiency. This supplement, pancreatic enzyme replacement therapy, contains amylase, lipase, and protease. This helps in the digestion of carbohydrates, fats, and proteins.2

Nonprescription digestive enzymes are available as a combination of enzymes or as single-enzyme preparations. Dosage forms include liquids, pills, and powders. These are not FDA regulated and therefore do not have to meet regulatory requirements.

Digestive enzyme supplements may be labeled as having natural ingredients and are considered safe. They can, however, still interfere with other medications, such as blood thinners and oral diabetes medications. Patients should always check with a health care provider before starting on supplements.1


Probiotics are defined as microorganisms introduced into the body for their beneficial qualities. These organisms can be bacteria; fungi, including yeast; protozoa; and viruses. To be classified as a probiotic, a microbe must be isolated from a human, be safely consumed, have a proven benefit, and survive in the intestine after digestion.3

The 7 core genera of microbial organisms most often used in probiotic products are Bacillus, Bifidobacterium,Enterococcus, Escherichia, Lactobacillus, Saccharomyces, and Streptococcus.4 But remember that not all probiotics are equal and more research is required to understand the benefits of each.

Research on probiotics has not told us everything but has provided important information. Probiotic supplements are understood to be safe for most individuals, though consistent dosing has not been established.5 Good bacteria in the gut can help the body absorb and break down medications, control harmful bacteria, create vitamins, and digest food.5

The controversy about whether to take a probiotic with antibiotic treatment cannot be answered definitively. The argument for taking a probiotic with antibiotic treatment stresses the replenishment of good bacteria that are killed off by the antibiotic. The argument against this is that the gut microbiota returns to normal more quickly when probiotics are not used.6


Prebiotics are specialized plant fibers found in many fruits and vegetables. They are especially prevalent in plants containing complex carbohydrates, such as fiber and resistant starch (which resists digestion). Prebiotics are generally found in different food sources, such as almonds, artichokes, barley, chia seeds, chicory, dandelion greens, flaxseeds, garlic, oats, onion, and many other plants.

Prebiotics function as a food source for probiotics. Therefore, they need to bypass digestion and make it to the colon. In the colon, the microbiota metabolizes and ferments prebiotics as food. This results in the formation of different short-chain fatty acids, depending on the kind of prebiotic being metabolized.7

The short-chain fatty acids are then used by the body to aid in immunity and inflammation, help produce mucus, and provide energy to cells.

Most high-fiber foods naturally contain prebiotics. How the food is prepared, however, can change the fiber content. When trying to maximize the prebiotic benefit from foods, raw foods contain the most fiber and are the most beneficial.

Prebiotic supplements are no match for the nutrients contained in real foods. When a single nutrient is taken from a whole food and put into a supplement, the synergistic benefits of the whole food are lost. Prebiotic supplements are not a good substitute for a balanced, fiber-rich, whole-food diet.

In addition, prebiotic supplements can produce unpleasant GI adverse effects, such as bloating and gas. When starting prebiotic supplements, patients should begin at a low dose and titrate as tolerated.


Although a relatively new concept, the definition of a synbiotic has been determined by the International Scientific Association for Probiotics and Prebiotics. A synbiotic is a mixture of prebiotics and probiotics that beneficially affects the host by improving the activity and survival of beneficial microorganisms in the gut.8


The more we learn about nutrition and the way the body uses it, the healthier we can become. Prebiotic, probiotic, and synbiotic supplements are available to help bridge the gaps in nutrition left when we fail to meet the dietary guidelines outlined by the FDA. Digestive enzymes are available to help patients suffering from enzyme insufficiency.


1. What are digestive enzymes and how do they work?Healthline.Updated September 2, 2021. Accessed February 12, 2023.

2. Creon. Prescribing information. Solvay Pharmaceuticals Inc; 2009. Accessed February 23, 2023.

3. Probiotics: what you need to know. National Center for Complementary and Integrative Health. Updated August 2019. Accessed February 13, 2023.

4. Probiotics. National Institutes of Health. Updated June 2, 2022. Accessed February 13, 2023.,Enterococcus%2C%20Escherichia%2C%20and%20Bacillus

5. What’s the connection between probiotics and digestive health? Healthline. Updated September 29, 2018. Accessed February 13, 2023.

6. Should you take probiotics with antibiotics? Updated November 7, 2022. Accessed February 13, 2023.

7. Davani-Davari D, Negahdaripour M, Karimzadeh I, et al. Prebiotics: definition, types, sources, mechanisms, and clinical applications. Foods. 2019;8(3):92. doi:10.3390/foods8030092

8. Prebiotics. International Scientific Association for Probiotics and Prebiotics. Accessed February 13, 2023.

About the Author

Kathleen Kenny, PharmD, RPh, is a clinical medical writer for Healthline Media in Colorado Springs, Colorado.

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