Digestive Health, Gut Microbiota And Fermented Foods: What Does The .

NUTRI-BITES Webinar SeriesDigestive Health, Gut Microbiota andFermented Foods: what does the science say?December 6, 2018Presenter:Joanne Slavin, PhD, RDProfessor Department of Food Science and NutritionUniversity of MinnesotaModerator:James M. Rippe, MD – Leading cardiologist, Founder and Director;Rippe Lifestyle InstituteApproved 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, RDProfessor Department of Food Science and NutritionUniversity 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 SeriesLearning Objectives Participants will understand accepted measures for digestive healthParticipants will appreciate the challenges to measuring effects ofdietary fiber, prebiotics, probiotics, and FODMAPs on digestivehealthParticipants will learn about processing methods to improvedigestive health with food, such as fermentation practices includingsourdoughParticipants will be able to apply clinically relevant strategies thatmay help their clients make dietary changes that are associatedwith gut health.

Digestive health, gut microbiota, andfermented foods: What does the science say?Joanne SlavinProfessorUniversity of MinnesotaDecember 6, 2018

Competing interestsDr. Slavin thanks the following organizations for providing researchfunds 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, digestivehealth, 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 considereddiarrhea, but many vegetarians have stoolweights of 300 g/day and greater Absence of symptoms – bloating, gas, noises, pain Quality of life suffers greatly when gut health iscompromised

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 fattyacids, 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 StressExercise (Oettle. Gut 1991;32:941)SmokingCoffee drinkingDrugs (laxatives) (Lembo A, Camilleri M. NewEng J Med 2003;349:1360) Personality (Tucker et al. Gastroenterology1981;81:879)

Fiber agreement Marker of a healthy diet– whole grains, fruits, vegetables, legumes Concept– carbohydrates and lignin that escape digestion in theupper 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 tractIncreased chewing andmore saliva productionDelayed nutrientabsorption, bluntedglucose and insulinresponseChange in gut hormones(GLP-1, PYY, ghrelin)Increased gastricdistention and delayedemptyingFermentation: SCFAs,microbiota changes, pH

Fiber in the human gut Fibers (pectin, inulin) can be extensivelyfermented ( 90%) or poorly fermented(purified cellulose, 10%) Even fibers that are extensively fermented canincrease fecal biomass since bacterial massincreases and that also binds water Feces are about 75% water so surviving fiberor bacteria will increase fecal weight

Fiber and laxation Different fibers have different effects on stool weight, but aproperly powered study will show differences in stool weightwith fiber intake Stool frequency generally does not change if frequency isalready normal (1/day) If transit time is normal (2 days, 48 hours), additional fiber willnot change transit time (Marlett et al. Am J Clin Nutr2000;72:784‐789). Fiber intakes will normalize transit times to 2 – 4 days (Harveyet al. Lancet 1973;1:1278‐1280).

Average increase in fecal weight per gram fiber fed Wheat branOatsLegumesPectin/novel fibersInulin4.9‐5.4 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 inHuman Nutrition

Summary of tolerance data(Grabitske & Slavin, 2009) Dietary fiber – up to 80 g/d in vegetarians – no ULResistant starch – 80 gFructo‐oligosaccharides – 10‐15 g – diarrhea at 40 gFODMAP – fermentable oligo, di and mono‐saccharides and polyols– Most of published studies from Australia – interest withlow gluten and IBS patients

FODMAPsAcronym that stands forFermentable Oligo‐, Di‐, and Monosaccharides, And Polyols(FODMAP)Term coined in 2005 by Australian researchers who theorize thatfoods containing these carbohydrates worsen symptoms ofdigestive disorders: Irritable Bowel Syndrome (IBS) andInflammatory Bowel Disease (IBD)* Gibson PR, Shepherd SJ. Aliment Pharmacol Ther 2005; 21: 1399 ‐ 1409

Fermentation by microflora Some evidence suggests fiber fermentationprovides physiological benefit such as– Increased mineral absorption– Stimulation of beneficial microbes (prebiotic)– Decrease survival of pathogenic bacteria throughreduction in pH– Providing nourishment to colonocytes (SCFAs,butyrate) for increased cell growth & maintenance

Prebiotic: a substance that is selectively utilized by hostmicroorganisms conferring a health benefit(2017 ISAPP Consensus Statement, 2017)

ProbioticsWHO Definition: Live microorganisms that whenadministered in adequate amounts confer ahealth benefit on the host

Microbial Probiotic Species Probiotics are live microbes that can beformulated into many different products, such asfood, drugs, or dietary supplements. umSaccharomyces cerevisiae (yeast)E. coliBacillus

Fermented Foods & Beverages Typically do not contain live cultures due to heattreatment, filtration or food processing toimprove shelf life – hence, not true probiotics: Sourdough breadFermented meatSauerkrautWine & beerVinegar

Other Fermented Food Sources Acidophilus milkSour creamCottage cheese with active cultureMiso (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 conferhealth benefits.

ProbioticsKnown:1. Some probiotics are helpful‐ preventing diarrhea caused by infections andantibiotics, and improving symptoms of irritable bowel syndrome2. The U.S. Food and Drug Administration has not approved any probioticsfor preventing or treating any health problem3. If people are generally healthy, probiotics have a good safety record.However, there have been reports linking probiotics to severe healtheffects, such as dangerous infections, in people with weakened immunesystemsUnknown:1. Which probiotics are helpful and which are not‐ not all probiotics havethe same effect, effects are likely strain specific2. How much of the probiotic people should take3. 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 thanhuman Gut Microbiota microbes in our GI tract, 100trillion organisms Microbiome their collective genome, 100 timesas many genes as human genome

What microbes do in the body Produce additional energy otherwise inaccessible tothe 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 immunesystem

Microbiome Revolution Gut Microbes Associated with Obesity 12 Unrelated obese subjects on fat or carbohydrate restricted diet360 B.C. Monitored for one year Increase in Bacteroidetes correlates with change in weight(Ley at al. Nature, 2006)

Microbiota changes over the life spanDominguez‐Bello M et al. Gastronenterology 14:1713‐1719, 2011Kostic et al. Genes and Development 27:701‐718, 2013

Diet may change gut microbial profiles in humansEvidence From:Observational studies Globally distinct populations Long‐term food pattern consumption‐ EnterotypesShort‐term dietary interventions Low‐ versus high‐fiber diets Animal versus plant food sources Macronutrient ratiosArora and Backhed, J. Int. Med., 280:339, 2016

Global Population Differences: Children in Rural Africa (BF) versus UrbanEurope (EU)Different dietary intake results in differences ingut 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 gB: 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 gDe 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 innew FDA fiber definition; fermentation is accepted inCanada– Prebiotics oligosaccharides– Probiotics Fermented foods, yogurt, sauerkraut, kefir, sourdough

Dietary components altered by the gut bacteria Fermentable carbohydratesProteinsVitamin synthesisBile acidsPhytochemicals/polyphenols– Phenolic acids, flavonoids, stilbenes, lignans,secoiridoids Rowland et al (2017) Eur J Nutr (09/04/17 online)

Dietary Fiber and Bacterial DiversityMartens E. Nature 529:158‐159, 2016Sonnenburg, E. et al. Nature 529: 212‐215, 2016