Dietary fibre: an old concept in new light Megan Rossi, PhD RD Kindly sponsored by an education grant from Alpro UK. www.alpro.com/healthprofessional @TheGutHealthDoctor
Evolution of dietary fibre From this To this
Overview Practical tips
your body absorbs @TheGutHealthDoctor exactly is fibre? @berlin_soulfoods
exactly is fibre? Carbohydrates that are indigestible by human enzyme Still provides some energy! Dietary fibre Community of microbes (Gut microbiota) Lignin Non-starch polysaccharide Nondigestible oligosaccharides (degree of polymerisation 3) Small intestine Resistant starch (colon) Large intestine
do we find it? 44% pasta, rice, pizza & white bread 34% wholemeal & brown breads & High fibre breakfast cereals Over 1/3 rd from potatoes esp. fried & chips UK Cereals & cereal products, 38% Vegetables & potatoes, 30% Meat & products 12% Fruit, 8% Other, 11% @ElpheeSense @NutriWebinar IRELAND Cereals & cereal products, 45% Vegetables & potatoes, 30% 6% Fruit, 10% Other, 10% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 43% from potatoes & potato products 58% from breads (type not specified) 9% from breakfast cereals (high/low fibre not specified) Wholegrain Council
much SHOULD we be having? OLD: 18g/day (NSP) = 23g/day (new definition) Age groups (years) Recomm. AOAC g/d UK @ElpheeSense @NutriWebinar Intakes AOAC g/d % below recomm. Recomm. AOAC g/d IRELAND Intakes AOAC g/d % below recomm. 2-3 15 10.3-31% - - - 4-5 15 14-7% - - - 5-11 20 14-30% 10-16 12.5 0.25% to -22% 11-16 25 15.3-39% 16-21 15.4-4% to -27% 16-18 30 15.3-49% 21-23 15.4-27% to -33% 19-64 30 19-37% 25 19.2-23% 65-74 30 18.4-39% 25 18.9-24%
does it work? 1) Physical properties 2) Effect on gut microbiota
Not all fibres have the same effect Included 64 studies, n=2099 participants RCT with added food or supplement Fibre intervention higher Bifidobacterium p<0.001 higher Lactobacillus p=0.020 higher faecal butyrate p=0.05 Prebiotic fibres higher Bifidobacterium p<0.001 higher Lactobacillus p=0.002 Other fibres nil differences in microbiota
Gut microbiota Not just bacteria Weighs as much as our brain More microbes than human 100+ x more genes than humans WHAT IS IT. WHAT DOES IT DO. Produces vitamins & hormones Harvest energy from food Talks to our brain Fights off infection
Gut:brain axis n=36 MRI 4 weeks Live yoghurt (B. lactis, Streptococcus thermophiles, L.bulgaricus, & Lactococcus lactis lactis) Yoghurt No Product MRI Tillisch et al. 2013
Communication pathway Koh et al. 2016
Beyond fibre in plant-based eating Resveratrol Isoflavones Anthocyanins Gibson et al. 2017
Beyond fibre in plant-based eating +fibre + polyphenols We eat whole foods not single nutrients Singh et al 2017
Health benefits For every 7g increase in fibre: 9% lower risk of cardiovascular disease 7% lower risk of colon cancer 7% lower risk of stroke 6% lower risk of type 2 diabetes does 7g look like? SCAN 2015 15
Gut:brain axis- role in mental health n=67 7 sessions over 12 weeks???? 32% 8% Jacka et al. 2017
Closer look at the diet Omega 3 50g fibre! B12 Selenium Folate Hydration Jacka et al. 2017
Economic benefit If 10% of the total population commit to a high adherence of: Mediterranean diet, societal cost savings in UK over 20 y= 7.53 billion Soy-containing diet, societal cost savings in UK over 20 y= 10.91 billion
Environmental benefit Wholegrain Council, 2018
Translation in practice: barriers
Translation in practice: strategies
Side effects n=16 healthy people Glucose (placebo, 40g) Fructans (40g) MRI repeated hourly- 5 hrs Colonic gas volume Murray et al, Am J Gastro. 2014; 109: 110-119 Glucose Fructans
is IBS?
Translation in practice: barriers n=29 healthy n=29 IBS >1 week washout Fructose (40g) Fructans (40g) Glucose (placebo, 40g) >1 week washout Fructose (40g) Fructans (40g) Glucose (placebo, 40g) Fructose (40g) Fructans (40g) Glucose (placebo, 40g) MRI repeated hourly- 5 hrs Colonic Symptom gas Intensity volume Major et al, Gut. 2014
Low FODMAP diet F ermentable Short chain CHO O D M A P ligo-saccharides many sugar units i-saccharides two sugar units ono-saccharides one sugar unit nd olyols Sugar alcohols Fructans, Galactooligosaccharides Lactose Fructose e.g sorbitol, mannitol
The low FODMAP process 3- step process Restriction (3-6 weeks) Re-introduction challenge (3 day/ challenges) @TheGutHealthDoctor Personalisation (long term) KEY: total FODMAP load
Low FODMAP diet... cautions Negatively impacts microbes Increases risk of nutrition deficiencies May trigger disordered eating May increase sensitivities Should not be someone s first resort
BDA guidelines for dietary management of IBS 1) Healthy eating and lifestyle Alcohol Caffeine Spicy food Fatty food Fluid intake Eating habits 2) Milk and dairy restriction 3) Dietary fibre Adapted from McKenzie. J Hum Nutr Diet. 2016; 29: 576-59 28 28
Fermentation profile of fibres High Rate fermentation low
Plant-based diet diversity Included 25 studies, nearly 2 million participants Observational studies For every 10g increase in total fibre 10% risk reduction in developing colon cancer For every 10g increase in cereal fibre 10% risk reduction in developing colon cancer Not significant for fruit fibre or vegetable fibre
Guess the grain Which grain is not featured above? a) Buckwheat b) Millet c) Barley d) Quinoa e) They re all featured
Translation in practice: things to consider
Take home messages @TheGutHealthDoctor : indigestible carbohydrates, many types : plant-derived foods, public are choosing lower fibre option much: >50% increase to reach target of 30g does it work: viscosity, solubility, fermentability; whole plant-based package : health, economic and environmental benefit Translation: know your client & be practical
@TheGutHealthDoctor Kindly sponsored by an education grant from Alpro UK. #letstalkfibre #plantpower For scientific and practical resources on fibre & plant-based eating from Alpro s Scientific and Nutrition Department visit us @ www.alpro.com/healthprofessional
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Different fibres have different benefits 38
Different fibres do different things Understanding the Physics of Functional Fibers in the Gastrointestinal Tract: An Evidence-Based Approach to Resolving Enduring Misconceptions about Insoluble and Soluble Fiber 39
Fibre and gene richness 40
Protein: plant vs animal replacing 1% of energy from animal protein with energy from plant protein is associated with a 18% decreased risk of developing T2D (38). Virtanen HEK, Koskinen TT, Voutilainen S, Mursu J, Tuomainen TP, Kokko P, Virtanen JK. Intake of different dietary proteins and risk of type 2 diabetes in men: the Kuopio Ischaemic Heart Disease Risk Factor Study. Br J Nutr 2017;117(6):882 93. 41
Essential amino acids Soya, quinoa and hemp are plant foods containing all the essential amino acids. Most other plant proteins provide some, with each plant providing a different combination. So, as long as you re eating a mixture of different plant proteins you ll be getting all the essential amino acids your body needs. 42
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Fibre and decreased risk of coeliac disease http://www.gastrojournal.org/article/s001 6-5085(18)30228-2/pdf 44
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Translation in practice: the barriers Lacy et al 2016
Mechanisms of actions FODMAPS
Role in stress management? Healthy n=45 3 weeks B-GOS (5.5g) FOS (5.5g) Placebo Schmidt et al. 2015