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What is the difference between a prebiotic and probiotic? Also, is yogurt an exceptable substitute for either/or? Is there natural foods that contain these bacteria in a potent enough dose? Thanks supplement users.
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A prebiotic is a substance that will selectively foster/enhance/give a growth advantage to  those bacteria in the intestinal mix that do not produce ammonia amd other toxins, but rather live of the offered prebiotics - mostly undigestable carbohydrates- and produce actually substances, like certain fatty acids that nourish the intestinal epithelial cells/ improving the intactness/functionality of that critical layer.. You could call them the good cows of the intestines.

Examples of excellent prebiotics are inulin ( a branched chain fructooligosacharide), FOS ( FructoOligoSacharide - not branched), and Lactulose, a monosugar that cannot be absorbed by the human intestinal tract and therefore provides food for the good bacteria.

You want as many of those as possible, because they push back/reduce the negative/unfriendly toxin and LPS producing bacteria, that can cause damage to the intestinal lining ("leaky gut syndrome"), can be flushed up to the liver themselves or their proinflammatory breakdown products can reach the liver eg LPS =Lipopolysacharide= extremely proinflammatory cell wall substance.

Furthermore any undigested protein/amino acids will foster these toxic bacteria that produce harmful metabolites like ammonia, but also a host of other problematic substances ( eg benzodiazepin-valium-like substances), which, if the liver is not capable of detoxification due to a reduced liver mass and processing capacity, can reach the general circulation and in particular the brain, often causing, even in compensated cirrhosis, a syndrome called subclinical encephalopathy, that can - and has been convincingly- shown by psychometric tests.

The effect of these toxic bacteria on the liver itself is enhanced inflammation and enhanced fibrosis.Thats why this is an integral part of an antifibrotic regimen, an important aspect  of the "do the least harm to the liver" strategy.

A probiotic is actually a preparation of "good bacteria" itself, not the food for the cows, but the cows themselves, so as to constantly reseed the intestines with a positive population.  it is important to understand that there is easily a pound of bacteria or more present in the intestines, therefore a 400mg "probiotic" capsule will not quickly make a big difference.

There are many offerings of "probiotic bacteria"  by the supplement industry, they are difficult to judge. In this situation those where university or governmental funded research has provided useful publications to support them could be selected. In that sense Lactobacillus GG has been well researched.
Since those are real live organisms, they need to be treated with care until use and the quality in their production seems important. As such products that are individually sealed in aluminum blister packages and are stored in the refrigerator until use probably deserve more confidence. If the bacteria that you swallow are dead, they are useless.

It is very difficult to say, how many probiotics are needed once a prebiotic is used anyway. It might or might not be overkill to swallow a prebiotic every day, once you are eg already using inulin.
But if someone can afford it, the extra safety margin from a combo of these measures might be worth it.

Yoghurt is in principal a probiotic, containing some life bacteria. But in a situation of liver disease/fiibrosis its effects are likely way too weak.

That answers it nicely! thank you.
ok, so I tried the lactulose, at half dose, 7 ml. and it messed with me gas wise pretty bad.
is that to be expected or will it decrease with time?

Also, so if I get the live yogurt at the health food store is that better than the capsules?
My question would be why would one go through the trouble of getting a script for Lactulose when inulin is readily available? Should one use both?  Thanks, jm
Orleans: My question would be why would one go through the trouble of getting a script for Lactulose when inulin is readily available?

Quite clearly you have not yet been blessed with the parfume of a rightious lactulose fart. You chase a couple kids out of a camper the way I did two nights ago - and you'll realize that, relatively speaking, it'was no trouble at all getting that script.

Merry - Start out taking it in the evening - every night for 3-4 weeks and the stinkbombs should let up - then you increase the dose and "Play it again, Sam"

Honestly - I don't understand what gets them going, and so quickly too - how could those bacteria produce that much stuff that fast? Oh well, sure is fun while it lasts.....   don't light a match though..
well, maybe I can answer my own question here, in that playing with dosing has helped to have somebenefit without overreactions on the lactulose.

We have a dairy here in oregon that uses the old fashioned process and LOTS of live bacteria in the culture, I don't think the yogurt they sell at most stores as having "live cultures" have a tenth as much, and anyone who has ever "made their own" knows what I mean.

Thanks for this again HR, if it turns out my hidascan Friday was negative I'm going to explore the idea of leaky gut with my doctor next. I do believe something besides the liver is causing the pain I'm having.

Your information again just saved me another long journey into the research abyss that might have taken me days or weeks to have discovered half as much.

Can I ask you two important questions?????????

1. Would it matter if someone has always been very regular...would they be just as likely to get this leaky gut given having HCV?

2. You mentioned valium and other type substances causing fibrosis. When I was taking Ultram "as directed" my liver enymes were double what they are now. Could the Ultram elevating enzymes be a likely reason to suspect it may also have been contribute to fibrosis?
thanks, MaryB  
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