Transcription
Inulin, a crucial prebiotic among the several I frequently recommend. This prebiotic is very beneficial for some people, but also very problematic for others. Perhaps you tried it in the past, only to be let down by the results. But if that's the case, you're not using it correctly, or you shouldn't be using it at all. We're all individuals with individual needs. I frequently get annoyed by these one-size-fits-all recommendations. When you're done with this presentation, you'll have a much better understanding of this critical prebiotic, and you're always welcome to purchase one of my protocols or schedule a consult on my website, themicrobiomeexpert.com. So, let's get started.
Inulin is found in over 36,000 species of plants, but the ones you're most likely to eat are onions, garlic, and asparagus. Inulin-based supplements usually come from foods we don't normally eat, like the Jerusalem artichoke, which is neither an artichoke nor from Jerusalem, or from chicory root. Like the other prebiotics, it is a series of bonded sugars that our digestive systems cannot access. We cannot unlock these bonds, and therefore, those polysaccharides make their way past our absorptive abilities but become fuel for our microbiome.
Now, you have to understand a couple of things. One is the rapidity of fermentation, which we'll get to shortly. The other is more fundamental: the definition of a prebiotic, which usually sounds like something like this: "feeds beneficial bacteria, thus conferring benefit upon the host." This is wrong. That's right. Like so many things in my presentations, I'm contradicting the majority. If you want to be a lemming, then listen to them. If you want to learn the facts and improve your health, then listen to me.
So, how are they wrong? Here we have one of my favorite papers of all time. These researchers use four different levels of acidity in a controlled in vitro environment to measure the growth of various bacteria using the common prebiotics inulin and pectin. Two of the prebiotics I recommend. At varying levels of acidity, different bacteria can outcompete others. They state that at pH values closer to neutrality, "our evidence suggests that other bacteria will tend to outcompete Bifidobacterium for inulin."
Now, we know that Bifidobacterium loves inulin, but we also know that there are other bacteria, some of whom are more or less neutral bystanders, while others are bad actors who possess the enzymatic machinery to also degrade inulin or another prebiotic and use it for themselves. It's not just the good guys who consume prebiotics. Although, on average, the health-promoting taxa favor these substrates, while the opportunistic pathogens tend to favor others, like protein. At higher pH values and at very low ones, the good guys get outcompeted. For example, in the second to last point, *Faecalibacterium prausnitzii*, which is incredibly beneficial, appears to be inactive or outcompeted by *Bacteroides* at a pH of 6.7, but it is very happy at a pH of 5.5. Therefore, prebiotics don't feed only health promoters. It depends on the overall environment.
The other thing you need to understand is the concept of rapidity of fermentation. The less complex a prebiotic is, the more rapidly it would be fermented. Let's take pectin, for example. If you eat an apple, the complex structure of pectin will ensure that the vast majority of it remains intact throughout much of the large intestine, i.e., the colon. But in order to arrive in the colon, it has to get past the small intestine. That's where most of our absorption takes place. But here, we also have a microbiome, like in the rest of our bodies.
So, if you're taking a supplement such as FOS, GOS, or XOS, which are snipped-up forms of more complex prebiotics, then you're making a mistake. Although the marketers of these products will tell you that their product increases Bifidobacterium, I could care less. Plenty of prebiotics increase Bifidobacterium. What I care about is where it's fermented and what other highly beneficial health promoters that you don't know about are increased by any given prebiotic. These snipped-up marketing tools will be rapidly fermented in the small intestine, which is a dumb idea, and especially for those with SIBO (small intestinal bacterial overgrowth). In fact, I just recently had a consult with a woman who had had a SIBO diagnosis, but her practitioner recommended a snipped-up oligosaccharide product for her, which is a terrible idea. You really should listen to the expert.
In my complete meta-analysis of all human and humanized in vitro studies looking at which prebiotics move which bacteria, we have this chart here. As you can see, in multiple studies, the prebiotic inulin has consistently been shown to significantly increase the abundance of various taxa. Number of species from the genus *Bifidobacterium* have tons of data. In fact, the column for *Bifidobacterium* could be three times higher, but then we lose perspective on the others. Bacterial species, especially *B. adolescentis* and *B. longum*, love inulin, but there are many more highly beneficial taxa set within the gut, and this is something very important you need to understand. For example, inulin consistently increases the abundance of the superhero of the gut, *Faecalibacterium prausnitzii*. I have a whole presentation dedicated to this amazing bacterium, so watch that if you're interested.
Inulin also consistently significantly increases two other health promoters. Since they don't yet have their own dedicated presentations, let's look at them. The genus *Anaerostipes* is a very interesting one. It's a genus of only six species, and three of them can convert lactate directly to butyrate. Now, I know you can't appreciate the significance of that, but there are only these three, plus one other to my knowledge, that exists so that they can do this, and this is very important. For more on this, watch my presentation entitled "Lactobacillus Probiotics: A Dumb Idea in Those Who Are Dysbiotic." It talks about lactate accumulation where these species are key. As you can see from this chart in my meta-analysis over the years, most of the time when a significant difference was found between healthy controls and subjects with a given condition/disease, the healthy subjects had higher levels of the species from this genus, *Anaerostipes*, in their microbiomes, regardless of condition. The unhealthy cohorts had significantly lower levels than their matched healthy controls. This is one of a number of taxa where the data is so consistent like this.
And here is another, which is even more consistent. In fact, this is not a genus, but it's an individual species: the species *Eubacterium rectale*, which was reclassified as a species *Agathobacter rectus*. Given that most microbiome data is 16S, and the vast majority of 16S data only drills down to the genus level, it's even more amazing that we have so much data for this one species. And obviously, by the nearly 100% presence of green, it's incredibly health-promoting. *E. rectale* is generally speaking the second most prolific butyrate producer in the microbiome, only to be preceded by the superstar *F. prausnitzii*. So, if inulin is consistently increasing the abundance of these three amazing health promoters, then inulin would be a good idea, right?
Well, according to the uneducated nuts, and there's a lot of them, who promote the low FODMAP diet, inulin is a bad idea. Now, first, I'm not saying this diet doesn't work. It does. It alleviates your symptoms. There is plenty of data to prove that. However, this is not a solution; it's symptom treatment. It doesn't resolve the underlying issue. My philosophy is to get to the root cause. Low FODMAP gets you on a path of food avoidance. The inflamed, dysbiotic gut is always going to react to foods. I've seen many people who have drastically limited their food over the years as they worsen, and in extreme, are left with eating white rice and chicken breast. Low FODMAP is good in the short term, but in the long term, it's a bad idea. Why? Because other than the fact that it eliminates many of the healthiest foods that we know of, it also eliminates the fibers or prebiotics on which your microbiome feeds.
This slide, we're going to consider inulin. The positive association between inulin and *Bifidobacterium* has been proven concretely. In low FODMAP, inulin is eliminated. Most notably in artichoke, asparagus, garlic, and the onion family. We've already established that the amazing health promoters *Bifidobacterium*, *F. prausnitzii*, *Anaerostipes*, and *E. rectale* all love inulin, which has been shown in a number of studies. So, why would you want to reduce the fuel for these amazing bacteria?
Here are all of the published studies I could find over the years which analyze the microbiome changes in the low FODMAP diet. As you can see, in the column labeled "decreased," *Bifidobacterium* and *F. prausnitzii* come up frequently. *F. prausnitzii* is within the family *Ruminococcaceae*, at least until very recently. So, when you see a significant decrease in this family, also known as Clostridium cluster IV, a great many health-promoting taxa have been reduced, likely to include *F. prausnitzii*. Also a bad thing is when you see a reduction in what's called Roman numeral number 14a, that's also known as *Lachnospiraceae*, the other main family which is full of health-promoting taxa such as *E. rectale* and *Anaerostipes*. If you want to learn much more about this topic, watch my presentation entitled "Low FODMAP is Not a Great Long-Term Solution."
Now, the scenario when I don't recommend inulin is for those with diarrhea or tendencies towards diarrhea. While working with people in my role as Director of Medical Education for a microbiome firm, I've learned over the years that it's simply a bad idea. And this study here confirms my experience. As you can see in Figure 1, for these diarrhea-predominant subjects, the inulin (technically, in this case, FOS) worsened a host of symptoms. Well, that's not the goal. And as we just discussed, the use of the low FODMAP diet in this study improved a number of symptoms, but again, realize this: it's symptom treatment, not root cause therapy. Because these same researchers highlighted that the low FODMAP diet significantly decreased key beneficial bacteria such as *Bifidobacterium* and *F. prausnitzii*.
So, why is inulin or inulin-based products a bad idea in diarrhea? Well, no one knows for sure, but it's most likely a question of fructose intolerance. You see, inulin is basically a long chain of a number of fructose units connected together by bonds that the GI tract can't break. However, there are many bacteria which can break those bonds. When they do, they release fructose, which is a sugar, like in fruit. In the previous study, they used FOS, which stands for fructo-oligosaccharides. It's just a smaller unit of inulin, even more rapidly fermented. Whether it's FOS or inulin, this release of large amounts of fructose in the small intestine, or perhaps as far as the proximal large intestine, overwhelms absorptive capacities of some people. Think lactose intolerance; it's similar but different. So, if you have dysbiosis, or don't harvest energy well, or have visceral hypersensitivity, then you may have an issue with inulin driving diarrhea via osmosis. In fact, it's estimated that some 24% of IBS patients are sensitive to fructose. In IBS diarrhea, I personally would put that number much, much higher.
So, then, when do I recommend inulin? Well, the opposite of what we just discussed: in constipation. It feeds some of the best bacteria in your gut, and they do things like produce butyrate, which positively impacts mucus production, serotonin function, gut motility, and much more. I never recommend just one prebiotic because then we run into other issues. My constipation protocol on my website has a blend of four different prebiotics, and at the right dose. There are multiple study failures using prebiotics, not just for constipation, but anything you can imagine, where the type, dose, and blend, if there was one, were not appropriate. My protocols are tested. Feel free to visit my testimonials on my website.
This is well exemplified in the study where the average fiber intake for the study population was 13 grams a day, which is less than the US average of 17 grams a day, and much less than the dietary fiber recommendations of 38 grams a day for men and 25 grams a day for women. Here we see two groups divided by their dietary fiber content. The top group consumed less than 13 grams a day of dietary fiber, and then those the FOS helped, but not as much as those with over 13 grams of fiber a day. And within this subgroup, when a higher dose of FOS was used at 10 grams a day, the benefits were significant, and at 15 grams a day, even more so. I don't recommend 15 grams a day of inulin because I use it in combination with other prebiotics, which work together synergistically to address the microbial fingerprint of a given condition. My dosing averages 35 grams a day because in those who are dysbiotic, which is about everybody I help, I need to quickly drive environmental change in the gut. See my presentation on pH for a better understanding of this concept.
The crucial benefit of eating high-inulin foods, or using it as a supplement, or both, is that it feeds key health-promoting bacteria. In this study of 30 obese women, the use of inulin increased levels of *Bifidobacterium* and *F. prausnitzii*. So, what's the end result of feeding these guys, plus like others like *E. rectale* and species like *Anaerostipes*? Well, good things happen, like shown here. Only in the inulin group was there a significant decrease in serum LPS. What's that? It's something I highlight often in my presentations, but in short, it's a marker for dysbiosis, inflammation, and gut permeability. Our immune system is highly reactive to this cell wall component from Gram-negative bacteria, and when it's floating around the body and in the serum, shown here, then many pro-inflammatory bad things can happen. When we feed the good bugs, and they are in charge of the gut health, this unhealthy cycle is significantly diminished.
Another use for inulin, whose actions are realized by feeding health-promoting bacteria, is in those who are diabetic. Soon I'll launch a video on metabolic syndrome. In this trial here, the administration of inulin significantly reduced total cholesterol, triglycerides, and, as shown here, blood glucose in the diabetic subjects. It's no surprise that as people around the globe eat more dead garbage food, devoid of nutrients, phytochemicals, and fiber, that rates of obesity and diabetes skyrocket. But instead of choosing to live healthy, they search for a drug which supposedly allows them to continue their bad habits. But drugs aren't cheap and have side effects. If you're not going to change your lifestyle, then try something more natural. I recommend inulin often. It's an excellent prebiotic in the right person, of course, in combination with other prebiotics and administered together at an appropriate dose.
As for inulin supplements on the market, they are commodities. They may come from three different sources, but they are all inulin. I always recommend a powder, as if you buy capsules, the pill burden will be way too high when using an efficacious dose. Again, I don't recommend FOS, which is snipped-up inulin, or even GOS or XOS. You don't want these guys fermenting away in the small intestine, especially for those with SIBO. If you think inulin may be right for you, then skip the trial and error phase and simply take a look at my protocols and select your condition, and you can purchase a protocol specific to the needs of your microbial fingerprint.
If you found this presentation informative, I have many more for free in my YouTube channel and also in the microbiome universe will be tapped on my website, themicrobiomeexpert.com. There you can select from a wide variety of topics, and if you or a loved one are struggling with a disease condition, I have condition-specific presentations as well, along with their microbiome protocols found within its respective tab on my website.