NUTRI-BITES Webinar Series Digestive Health, Gut Microbiota and Fermented Foods: what does the science say? December 6, 2018 Presenter: Joanne Slavin, PhD, RD Professor Department of Food Science and Nutrition University of Minnesota Moderator: James M. Rippe, MD Leading cardiologist, Founder and Director; Rippe Lifestyle Institute Approved for 1 CPE (Level 2) by the Commission on Dietetic Registration, credentialing agency for the Academy of Nutrition and Dietetics.
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Today s Faculty Joanne Slavin, PhD, RD Professor Department of Food Science and Nutrition University of Minnesota Moderator: James M. Rippe, MD Leading cardiologist. Founder and Director, Rippe Lifestyle Institute
Digestive Health, Gut Microbiota and Fermented Foods: what does the science say? NUTRI-BITES Webinar Series Learning Objectives Participants will understand accepted measures for digestive health Participants will appreciate the challenges to measuring effects of dietary fiber, prebiotics, probiotics, and FODMAPs on digestive health Participants will learn about processing methods to improve digestive health with food, such as fermentation practices including sourdough Participants will be able to apply clinically relevant strategies that may help their clients make dietary changes that are associated with gut health.
Digestive health, gut microbiota, and fermented foods: What does the science say? Joanne Slavin Professor University of Minnesota December 6, 2018
Competing interests Dr. Slavin thanks the following organizations for providing research funds for her laboratory the past 5 years. American Pulse Association, ILSI NA, MNDrive Global Food Ventures, United States Department of Agriculture, the Mushroom Council, GSK, Pepsico, Coca Cola, Danone, Welch s, Nestle Health Sciences, DSM, Nexira, and Taiyo. These research projects are in the areas of dietary fiber, whole grains, legumes, FODMAPS, nutrient losses in deep winter greenhouses, mushrooms, digestive health, protein needs, carbohydrate needs, and snacking. She serves on the scientific advisory board for Tate and Lyle and Atkins Nutritionals. She owns a 1/3 share of the Slavin Sisters Farm LLC, a 119 acre farm in Walworth, WI that is currently rented.
What is digestive health? Absence of digestive disease Normal bowel function subjective Regular bowel movements Between 3/day and 3/week normal Stool weight above 200 g/day considered diarrhea, but many vegetarians have stool weights of 300 g/day and greater Absence of symptoms bloating, gas, noises, pain Quality of life suffers greatly when gut health is compromised
What reaches the large intestine? Normal subjects: Undigested carbohydrates (fiber, oligosaccharides, lactulose) 5% of ingested fat 8% of ingested protein Unabsorbed minerals, vitamins Unabsorbed phytochemicals
2 days in the gut = Absorption of water, electrolytes Bacterial breakdown of carbohydrates, protein, phytochemicals (phytoestrogens, phenolic compounds) Production and absorption of short chain fatty acids, other bacterial metabolites Feces are 75% water, undigested fiber, bacteria, other unabsorbed nutrients
Limitations to fecal samples Not practical in epidemiological studies No accepted standard Stool weight (grams/day) Stool chemistry Microflora methods, what is best Stool frequency (easy to collect) Quality of life (used in IBS trials)
Non dietary factors that affect laxation Stress Exercise (Oettle. Gut 1991;32:941) Smoking Coffee drinking Drugs (laxatives) (Lembo A, Camilleri M. New Eng J Med 2003;349:1360) Personality (Tucker et al. Gastroenterology 1981;81:879)
Fiber agreement Marker of a healthy diet whole grains, fruits, vegetables, legumes Concept carbohydrates and lignin that escape digestion in the upper GI tract but may be fermented in the gut Nutrient according to 2002 Dietary Reference Intakes (DRIs) Regulated On the Nutrition Facts panel 25 g current Daily Value (DV), proposed to increase to 28 g DV Health claims oat bran, barley bran, and psyllium and CVD in US
Fiber: Effects throughout the GI tract Increased chewing and more saliva production Delayed nutrient absorption, blunted glucose and insulin response Change in gut hormones (GLP-1, PYY, ghrelin) Increased gastric distention and delayed emptying Fermentation: SCFAs, microbiota changes, ph
Fiber in the human gut Fibers (pectin, inulin) can be extensively fermented (> 90%) or poorly fermented (purified cellulose, <10%) Even fibers that are extensively fermented can increase fecal biomass since bacterial mass increases and that also binds water Feces are about 75% water so surviving fiber or bacteria will increase fecal weight
Fiber and laxation Different fibers have different effects on stool weight, but a properly powered study will show differences in stool weight with fiber intake Stool frequency generally does not change if frequency is already normal (1/day) If transit time is normal (2 days, 48 hours), additional fiber will not change transit time (Marlett et al. Am J Clin Nutr 2000;72:784 789). Fiber intakes will normalize transit times to 2 4 days (Harvey et al. Lancet 1973;1:1278 1280).
Average increase in fecal weight per gram fiber fed Wheat bran Oats Legumes Pectin/novel fibers Inulin 4.9 5.4 g/g fiber* 3.4 4.5 g/g fiber* 2.2 g/g fiber fed* 1.2 g/g fiber fed* 1.0 g/g fiber fed Slavin & Feirtag. Food Funct 2011;2:72 77 *Cummings JH. 1993. CRC Handbook of Dietary Fiber in Human Nutrition
Summary of tolerance data (Grabitske & Slavin, 2009) Dietary fiber up to 80 g/d in vegetarians no UL Resistant starch 80 g Fructo oligosaccharides 10 15 g diarrhea at 40 g FODMAP fermentable oligo, di and monosaccharides and polyols Most of published studies from Australia interest with low gluten and IBS patients
FODMAPs Acronym that stands for Fermentable Oligo, Di, and Monosaccharides, And Polyols (FODMAP) Term coined in 2005 by Australian researchers who theorize that foods containing these carbohydrates worsen symptoms of digestive disorders: Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD) * Gibson PR, Shepherd SJ. Aliment Pharmacol Ther 2005; 21: 1399 1409
Fermentation by microflora Some evidence suggests fiber fermentation provides physiological benefit such as Increased mineral absorption Stimulation of beneficial microbes (prebiotic) Decrease survival of pathogenic bacteria through reduction in ph Providing nourishment to colonocytes (SCFAs, butyrate) for increased cell growth & maintenance
Prebiotic: a substance that is selectively utilized by host microorganisms conferring a health benefit (2017 ISAPP Consensus Statement, 2017)
Probiotics WHO Definition: Live microorganisms that when administered in adequate amounts confer a health benefit on the host
Microbial Probiotic Species Probiotics are live microbes that can be formulated into many different products, such as food, drugs, or dietary supplements. Examples: Lactobacillus Bifidobacterium Saccharomyces cerevisiae (yeast) E. coli Bacillus
Fermented Foods & Beverages Typically do not contain live cultures due to heat treatment, filtration or food processing to improve shelf life hence, not true probiotics: Sourdough bread Fermented meat Sauerkraut Wine & beer Vinegar
Other Fermented Food Sources Acidophilus milk Sour cream Cottage cheese with active culture Miso (fermented soybean paste) Tempeh (fermented soybean)
Live & Active Cultures Fermented dairy products Some yogurts Some natural cheese Buttermilk Kefir Cultures may or may not be considered probiotic, depending on bacteria levels when eaten & whether bacteria have been shown to confer health benefits.
Probiotics Known: 1. Some probiotics are helpful preventing diarrhea caused by infections and antibiotics, and improving symptoms of irritable bowel syndrome 2. The U.S. Food and Drug Administration has not approved any probiotics for preventing or treating any health problem 3. If people are generally healthy, probiotics have a good safety record. However, there have been reports linking probiotics to severe health effects, such as dangerous infections, in people with weakened immune systems Unknown: 1. Which probiotics are helpful and which are not not all probiotics have the same effect, effects are likely strain specific 2. How much of the probiotic people should take 3. Who would most likely benefit from taking probiotics
The Human Microbiome We are a composite of species: eukaryotic, bacterial, viral up to 10x more microbial cells than human Gut Microbiota = microbes in our GI tract, ~100 trillion organisms Microbiome= their collective genome, >100 times as many genes as human genome
What microbes do in the body Produce additional energy otherwise inaccessible to the host short chain fatty acids Produce vitamins in colon Biotin. Vitamin K Metabolize carcinogens Provide ability to harvest nutrients Enhance calcium absorption Prevent colonization by pathogens Assist in the development of a mature immune system
Microbiome Revolution Gut Microbes Associated with Obesity 360 B.C. 12 Unrelated obese subjects on fat or carbohydrate restricted diet Monitored for one year Increase in Bacteroidetes correlates with change in weight (Ley at al. Nature, 2006)
Microbiota changes over the life span Dominguez Bello M et al. Gastronenterology 14:1713 1719, 2011 Kostic et al. Genes and Development 27:701 718, 2013
Diet may change gut microbial profiles in humans Evidence From: Observational studies Globally distinct populations Long term food pattern consumption Enterotypes Short term dietary interventions Low versus high fiber diets Animal versus plant food sources Macronutrient ratios Arora and Backhed, J. Int. Med., 280:339, 2016
Global Population Differences: Children in Rural Africa (BF) versus Urban Europe (EU) Different dietary intake results in differences in gut bacteria: A: Burkina Faso, Africa Dietary intake, ages 1 6 672.2 996.1 kcal/day Protein: 30.9 40.2 g Fat: 18.9 31.2 g Carbohydrate: 102.6 148.6 g B: European Union, Italy Dietary intake, ages 1 6 1068.7 1512.7 kcal/day Protein: 41.9 66.7 g Fat: 56.1 73.9 g Carbohydrate: 190.0 290.0 g De Filippo et al. Proc Natl Acad Sci USA, 107:14691 14696, 2010
Dietary components that alter gut bacteria Most of the human published studies: Dietary fiber Fermentation not accepted as physiological benefit in new FDA fiber definition; fermentation is accepted in Canada Prebiotics oligosaccharides Probiotics Fermented foods, yogurt, sauerkraut, kefir, sourdough
Dietary components altered by the gut bacteria Fermentable carbohydrates Proteins Vitamin synthesis Bile acids Phytochemicals/polyphenols Phenolic acids, flavonoids, stilbenes, lignans, secoiridoids Rowland et al (2017) Eur J Nutr (09/04/17 online)
Dietary Fiber and Bacterial Diversity Martens E. Nature 529:158 159, 2016 Sonnenburg, E. et al. Nature 529: 212 215, 2016
1. Organisms living on and within food may be either friends or foes to the consumer. 2. The human microbiome may decrease in diversity due to exposure to antibiotics, the consumption of a high fat and highsugar diet and decreased consumption of dietary fiber 3. Decreased diversity can increase susceptibility to invasive foodborne pathogens such as Clostridium, Staphylococcus aureus, Escherichia coli and Listeria monocytogenes 4. These organisms have greater potential to colonize and outcompete the host associated community during dysbiosis 5. Some bacteria that are normal constituents of the microbiome and are sold as probiotics may become pathogenic such as Escherichia coli Josephs Spaulding et al. Appl Microbiol Biotechnol epub April 22, 2016
Recent findings from American Gut Project Diversity of microbes in the gut is much more vast than originally thought Migration from a non westernized nation to the US is associated with a loss of gut microbiome diversity Subjects who ate more than 30 types of plant foods weekly had more diversity than subjects who ate only 10 types of plant foods Diversity has not been linked to a health outcome
Conclusions The microbiome is integral to human physiology, maintenance of health and development of disease. Dietary fiber is known to alter gut health, including changes in the microbiota Fermented foods and probiotics can also alter gut health Gut health is difficult to measure; besides stool chemistry measure, subjective measures of digestive comfort important to consumers Many developing links between changes in the microbiota and health outcomes, but no accepted healthy microbiota
Recommendations to Clients Most evidence resides with increasing dietary fiber from a diverse set of foods Typical fiber intakes need to be doubled Too much fermentation can lead to digestive distress FODMAPs Emerging evidence on effect of dietary components on gut health and microbiome A variety of plant foods increase diversity of microbiota
Questions?
Digestive Health, Gut Microbiota and Fermented Foods: what does the science say? NUTRI-BITES Webinar Series Based on this webinar the participant should be able to: Participants will understand accepted measures for digestive health Participants will appreciate the challenges to measuring effects of dietary fiber, prebiotics, probiotics, and FODMAPs on digestive health Participants will learn about processing methods to improve digestive health with food, such as fermentation practices including sourdough Participants will be able to apply clinically relevant strategies that may help their clients make dietary changes that are associated with gut health.
Conagra Nutrition Nutri-Bites Webinar details A link to obtain your Continuing Education Credit certificate will be available on our website and emailed within 2 business days Today s webinar will be available to download within 2 business days at: www.conagranutrition.com For CPE information: acontinelli@rippelifestyle.com Recent CEU webinars archived at the Conagra Nutrition website: Does Tomato or Lycopene Intake Reduce the Risk of Prostate Cancer? Obesity isn t Simple: Identifying Complex, Evidence-based Strategies to Treat Obesity Seriously What s New in Obesity Treatment Exploring the Evidence on Dietary Patterns: The Interplay of What We Eat and Health
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