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GOING WITH YOUR GUT:
Corrie Whisner, PhD
School of Nutrition and Health Promotion
Arizona State University
Building Healthy Lifestyles Conference
March 18-19, 2016
INSIGHTS ON PREBIOTICS, PROBIOTICS, SUPERBUGS AND HEALTH
WHAT IS THE HUMAN MICROBIOME?
WE ARE OUTNUMBERED!
Bacterial cells outnumber human cells 10 to 1
10% of total body volume is microbial cells
>
MICROBIOTA FUNCTIONS
Clarke et al. Molecular Endocrinology. 2014.
PROTECT
NOURISH
STRENGTHEN
WHAT INFLUENCES THE MICROBIOME?
Ottman N, et al. Front. Cell. Inf. Microbio. 2012.
WHAT INFLUENCES THE MICROBIOME?
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MICROBIOME AND IMMUNE FUNCTION DISEASE BURDEN HAS CHANGED
Nat Rev Microbiol. 2011;9[4]:281
Increased rates of:
• Inflammatory bowel diseases
• Allergies• Celiac disease• Obesity• Cardiovascular disease• Diabetes
“IF GUT BACTERIA ARE MAKING YOU ILL, CAN SWAPPING THEM MAKE YOU HEALTHY?”
Me, myself, us. The Economist. 2012; p69.
MICROBIOME AND OBESITY
Clarke et al. Molecular Endocrinology. 2014.
WHAT DO THESE ITEMS HAVE IN COMMON? DIY FECAL TRANSPLANTS
According to www.thepowerofpoop.com, a website devoted
to matching donors and recipients for fecal transplants, this
is all you need to perform a DIY fecal microbial transplant!
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SUPER BUGS AND FECAL TRANSPLANTS
MICROBIOME AND DISEASE
www.npr.org
“People infected with Clostridium difficile suffer debilitating diarrhea, but the bug often defies antibiotics.”
Welcome Trust Sanger Institute
MICROBIOME AND DISEASE
Alang N et al. Open Forum Infectious Diseases. 2015.
• Weight prior to treatment: 136 pounds; BMI=26
• Treated with feces from her 16 year-old daughter (140 pounds; BMI=26.4)
• 16 months after FMT – gained 34 pounds (BMI=33)
• 36 months after FMT – gained 41 pounds (BMI=34.5)
PROBIOTICS
WHAT ARE PROBIOTICS?
“Live microorganisms that when administered in adequate
amounts confer a health benefit on the host”
International Scientific Association for Probiotics and Prebiotics
COMMON PROBIOTICS
Bifidobacteria
adolescentis
animalis
bifidum
breve
longum
Lactobacillus
acidophilus
casei
fermentum
gasseri
johnsonii
paracasei
plantarum
rhamnosus
salivarius
Saccharomyces
boulardii
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PROBIOTICS - IRRITABLE BOWEL SYNDROME
• A total of 18 RCTs (n=1,650
patients)
• Irritable bowel syndrome
patients taking probiotics
• Lactobacillus
• Bifidobacterium
• Streptococcus
• Symptoms improved
significantly (RR of not
improving 0.71, 95% CI 0.57 to
0.88)
Moayyedi P, et al. Gut 2010; 59(3): 325-332.
PROBIOTICS–INFLAMMATORY BOWEL DISEASE
• A total of 18 RCTs (n=1,650
patients)
• Irritable bowel syndrome
patients taking probiotics
• Lactobacillus
• Bifidobacterium
• Streptococcus
• Symptoms improved
significantly (OR 1.6, 95% CI
1.2 to 2.2)
Moayyedi P, et al. Gut 2010; 59(3): 325-332.
UP-AND-COMING PROBIOTICS
Akkermansia muciniphila
Faecalibacterium
prausnitzii
Roseburia spp.
Eubacterium hallii
Human commensals
associated with healthy
intestines
PREBIOTICS
WHAT ARE PREBIOTICS?
Basic criteria for selection of prebiotics:
Resistance to digestion
Hydrolysis and fermentation by intestinal bacteria
Selective stimulation or growth of good bacteria
Beneficial health effects
Lactobacillus
Bifidobacteria
PREBIOTICS BOOST GOOD BACTERIA
Escherichia
Enterococcus
Good Microbes Bad Microbes
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• Found in fruits, vegetables and other plants
• Leeks
• Artichokes
• Chicory Root
• Wheat
• Asparagus
• Bananas
• Naturally occuring
• Inulin
• Fructooligosaccharides
• Can be synthetic
• Galactooligosaccharides
• Lactulose
WHAT ARE PREBIOTICS? WHEAT IS A GOOD SOURCE OF PREBIOTICS
71%
24%
2%2%
1%
Oligofructose
69%
23%
3%3%
2%
Inulin
Wheat Onion Banana Garlic Other
Moshfegh AJ, et al. J Nutr. 1999.
OSTEOPOROSIS IS COSTLY
• Low bone mass and deterioration of bone micro-
architecture
• 54 million Americans have osteoporosis and low bone
mass
www.nof.orgwww.webmd.com
OSTEOPOROSIS PREVENTION
Jasminka, et al. J Am Coll Nutr 2000; 19: 715.
CALCIUM REQUIREMENTS DON’T MATCH INTAKE
• Adolescent girls consume approximately 700-800 mg/d
• Adolescent boys consume approximately 800-900 mg/d
International Osteoporosis Foundation, www.iof.orgErvin RB, et al. Adv Data. 2004.
Calcium Requirements
STUDY DESIGN
• Double-blind, randomized controlled crossover
• Two, 3-week metabolic balance periods
• Controlled diets with 600 mg/d calcium
and 15 g/d fiber
• PROMITOR® Soluble Corn Fiber in fruit snacks
12 g/d delivered as
Soluble Corn Fiber
Control
12 g/d delivered as
Soluble Corn Fiber
Control
3 week
intervention
3 week
intervention
1 week
washout
Subject
Randomization
N = 24
Whisner et al. BJN. 2013.
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ENHANCED MINERAL SOLUBILITY
SCFAH
2+
Ca2+
Ca
2+
Ca
SCF + pH
Ca
2+
Ca
Blood
Lumen
SCF = Soluble Corn Fiber (prebiotic)SCFA = Short chain fatty acids
:)
H
HH
HH
SCF INFLUENCED LATE PHASE ABSORPTION
•Calcium absorption
increased by 12% with SCF
consumption compared to
Control
•Time effect consistent with
lower gut absorption
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0-24 h 24-48 h
Fra
cti
on
al
Calc
ium
A
bso
rpti
on
24 Hour Urine Pools
SCF Control
*P = 0.02
Whisner et al. BJN. 2013.
Ca ABSORPTION CORRELATED WITH FERMENTERS
-0.6
-0.4
-0.2
0
0.2
0.4
0.6
0.8
Co
rre
lati
on
wit
h C
ha
nge
in C
a A
bso
rpti
on
***
**
* *
*
Bacteroidetes
Firmicutes
* P < 0.05
** P < 0.01
Change in Microbial Communities (Genus Level)
Whisner et al. BJN. 2013.
BENEFIT OF SCF DIFFERED BY PERSON
0
0.2
0.4
0.6
0.8
1
1.2
Control SCF
Fra
ctional
Calc
ium
Ab
sorp
tion
• Responder: • Increase in calcium
absorption by ≥ 3% with SCF compared to control
• Non-responder:• Change in calcium
absorption < 3% with SCF compared to control
Whisner et al. (unpublished data)
CHANGE IN Ca ABSORPTION DIFFERED BY GROUP
-15
-10
-5
0
5
10
15
20
25
30
35
Non-responder Responder
Chang
e i
n C
a A
bsorp
tion (
%)
P < 0.05
Whisner et al. (unpublished data)
HABITUAL DIET AND FUNCTIONAL FOODS
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DIET, THE MICROBIOME AND OBESITY GLOBAL INSIGHTS INTO DIETARY INTAKE
Schnorr SL et al. Nature Comm. 2014
WESTERN DIETS = MORE FIRMICUTES
De Fillipo C et al. Proced Natl Acad Sci. 2010
Burkina Faso Italy
MICROBIOME-CENTRIC VIEW OF FOOD INTAKE
REFINED GRAINS AND BUTYRATE
Lappi J, et al. J Nutr. 2013.
VS.
WG CEREAL INCREASES GOOD BACTERIA
9.3
9.4
9.5
9.6
9.7
9.8
9.9
Whole Grain Cereal Non-Whole Grain Cereal
Bif
ido
bac
teri
um
/ g
ram
of
fece
s
Pre-intervention Post-intervention
Carvalho-Wells et al. Brit J Nutr. 2010.
*P = 0.001
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WHEAT POLYPHENOLS IMPROVE OBESITY-RELATED
INFLAMMATION VIA GUT BUGS
Vitaglione P, et al. Am J Clin Nutr. 2015.
• Wheat polyphenols decreased inflammation over 8 weeks
• Increase in beneficial bacteria Bacteroides and Lactobacillus
• Decrease in inflammation correlated with increase in beneficial bacteria
INFLAMMATION
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GOING GLUTEN-FREE? THINK AGAIN
De Palma G, et al. Br J Nutr. 2009.: )
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Celiac PatientHealthy Patient: (
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De Palma G, et al. Br J Nutr. 2009.
Greater diversity
More pathogens
--~~
Opportunistic infections
GLUTEN-FREE AND THE HEALTHY GUT
1 month of gluten-free
De Palma G, et al. Br J Nutr. 2009.
Beneficial bacteria• Bifidobacteria• Lactobacillus• Faecalibacterium
prausnitzii• Clostridium lituseburense
Pathogenic bacteria• Enterobacteriaceae• Escherichia coli
FERMENTED FOODS TO BOOST GUT BUGS?
• Kombucha
• Miso
• Kimchi
• Tempeh
• Saurkraut
• Yogurt
• Kefir
• Etc…
TAKE-AWAY MESSAGES
• Eat more plants including grains
• Focus on fiber and polyphenol-rich foods
• Avoid DIY fecal transplants
• Make evidence-based decisions for probiotics…don’t flush away your money!
WE HAVE WORK TO DO
• Critical question: Can functional foods, prebiotics and
probiotics remodel disease or illness-prone microbiota
patterns?
• Age, gender and race / ethnicity
• Optimal strain and dose
• Using formulas appropriate for responsive populations
• Understanding how dietary components interact with
functional foods, pre- and pro-biotics
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THANKS!
XKCD Comic
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