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The Gut and Pre and Probiotics Candace Becker, APRN, CNS-BC, Rx, CHFH

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The Gut and Pre and Probiotics Candace Becker, APRN, CNS-BC, Rx, CHFH 4/15/2018 The gut and pre and probiotics Candace Becker, APRN, CNS-BC, Rx, CHFH Objectives: Review the gut pathophysiology and inflammatory process Investigate process of gut inflammation Discuss pre and probiotics and their influence on gut health Evaluate content of common pre and probiotics 1 4/15/2018 Definitions Probiotic – “for life”- nonpathogenic organisms that have no necessary phylogenic (evolutionary) reaction. Considered “good” bacteria that help keep digestive system healthy by controlling growth of harmful bacteria. Prebiotics - carbohydrates that cannot be digested by the human body, but feed probiotics; "a selectively fermented ingredient that allows specific changes, both in the composition and/or activity in the gastrointestinal microflora that confers benefits upon host well being and health." They are dietary fibers with a well- established positive impact on the intestinal microflora. Microflora/microbiome - bacteria and microscopic organisms, especially those living in a particular site or habitat Definitions (cont.) Symbiots – pre and probiotics designed to improve survival of ingested “live microorganisms which, when administered in adequate amounts, confer health benefit on host…” Commensal organisms -- Living in a relationship in which one organism derives food or other benefits from another organism without hurting or helping it. Dysbiosis - microbial imbalance or maladaptation on or inside the body Stress – anything that threatens homeostasis 2 4/15/2018 Some basics… GI tract is home to >500 bacterial species. Bacteria + virome = microbiota Microbiota are responsible for digestion, acquiring nutrients, immune system Bacterial cells outnumber human cells 10:1 Some of the B vitamins, vitamin K, folate and short chain fatty acids are produced by gut bacteria Up to 10% daily energy needs come from gut fermentation Yeast Nutr Metab (London). 2010; 7:79 3 4/15/2018 Gut lining pathophysiology Normal microbial and yeast balance Process of protection and absorption Barrier function of gut to reduce apoptosis and/or increase mucin production Production of antimicrobial substances, such as defensins, bacteriocins, hydrogen peroxide, and short chain fatty acids which alters organisms membrane Competition for adherence to reduce bacterial influx into body Immune modulation (70% of immune function comes from gut) by increase IgA, down regulation of cytokines and chemokines Interference with quorum sensing signaling which reduces cell communication and reduces colonization Barrier function Regulation of intestinal microbial homeostasis Reduced apoptosis Competition for adherence Alter ability of pathogens to colonize and infect mucosa Increased mucin production Interference with quorum sensing signaling >> decreases cell communication >> decreases colonization Stabilization/maintenance IG barrier function Production of antimicrobial substances (defensins, bacteriocins, H2O2, NO, short chain fatty acids) which alter organism membrane 4 4/15/2018 Good barrier function Immunomodulatory response Modulation of local and systemic immune responses by increased IgA, down regulation of cytokines and chemokines and adherance molecules, and up or down regulation of interleukin, interferon and tumor necrosis factor 5 4/15/2018 Major effects of stress on gut physiology alterations in gastrointestinal motility; increase in visceral perception; changes in gastrointestinal secretion; increase in intestinal permeability; negative effects on regenerative capacity of gastrointestinal mucosa and mucosal blood flow; and negative effects on intestinal microbiota. Konturek, PC, Brzozowski, T, Konturek, SJ. Stress and the gut: pathophysiology, clinical consequences, diagnostic approach and treatment options. 2011 Dec 62(6) 6 4/15/2018 Is there a role for addition of probiotics for gut health/healing? 7 4/15/2018 Probiotic stats Growing global market; $21.6 billion in 2010, $35 billion in 2014, projected growth to $52 billion by 2020 Classified as supplements, thus less stringent requirements for safety, efficacy and purity. Not subject to FDA oversight. The European Union has banned the use of the word “probiotic” in marketing unless a product receives approval for a health claim. No such approvals have been granted. Claims of improving digestive health, improved immunity, treatment of diabetes and obesity, treatment of inflammatory bowel disease, constipation, diarrhea, eczema, tooth decay MOA probiotics postulated mechanisms of action of probiotics on stressed gastrointestinal mucosa include: improvement of the barrier function suppression of the growth and binding of pathogenic bacteria immunomodulatory effect positive effect on visceral hypersensitivity 8 4/15/2018 Common bacterial strains in probiotics Lactobacillus Bifidobacterium E coli Nissle 1917 Streptococcus species Lactococcus lactix Some enterococcus Probiotic yeasts: saccharomyces boulardii Common sources of pre and probiotics Active cultures Yogurt Acidophillus milk, Buttermilk Sauerkraut (unpasteurized), kimchi Sour pickles (no vinegar) Miso soup, tempeh Kombucha (bubble tea) Kvass (fermented drink made from beets) Sourdough bread Fermented soft cheese (cheddar, swiss, gouda, parmesan) Fiber Undigestible (pre-biotic) – apple cider vinegar, dark chocolate Supplements Available pill/capsule form (freeze dried) 9 4/15/2018 Common probiotics Trade Name Manufacturer Comments Contains B. animalis lacis Bb-12 in addition to S. thermophilus abd L. Yo-Plus yogurt Yoplait Inc bulgaricus per serving. DanActive Contains S. thermophilus and L. bulgaricus in addition to L. casei DN-114 001. Dannon Inc Cultured milk Each serving contains 10 billion CFUs. Contains B. breve, B. infantis, B. longum, L. acidophilus, L. bulgaricus, L. casei, VSL#3 packets Sigma-Tau Pharmaceuticals L. plantarum and Streptococcus thermophiles. Each packet contains 450 billion CFUs. Lemon flavored and is consumed by mixing in atleast 4 oz of cold water. Includes Lactobacillus gasseri KS-13, Bifidobacterium bifidum G9- Philips Colon Health capsules Proctor & Gamble 1 and Bifidobacterium longum MM-2. Each capsule contains 1.5 billions cells. Florastor capsules Biocodax, inc Contains Saccharomyces boulardii. Each 250 mg capsule contains 5 billion CFUs. Florastor Kids Biocodex Inc Contains Saccharomyces boulardii. Available as powder. Contains Koshar Lactobacillus acidophilus NCFM, L. casei Lc- Attune nutrition bars Attune Foods 11 and Bifidobacterium lactis HN019. Contains 3g fiber. Each serving contains 6.1 billion CFUs. Contains Bifidobacterium infantis 35624 in a vegetarian capsule shell. Each Align capsules Proctor & Gamble capsule contains 1 billion bacteria. Contains Bacillus coagulans GBI-30, 6086 (BC30). Available as capsules, chewies Sustenex Schiff Nutrition International and gummies. Contains Lactobacillus acidophilus and Lactobacillus helveticus (bulgaricus). Lactinex Becton, Dickinson, and Co Available as capsules and packets. Contains Lactobacillus reuteri RC-14, Lactobacillus rhamnosus GR-1. Available as Fem-Dophilus Jarrow formulas capsules. Culturelle Digestive Amerifit Nutrition, Inc Contains L. rhamnosus GG. Each capsule contains 10 billion CFUs. Adult Formula Contains five probiotic strains: L. Acidophilus, L. Rhamnosus,L. Plantarum, B. Custom Probiotics Inc CP-1 Lactis and B. Bifidum. Each capsule has 50 billion CFUs. Contains B. longum, B. breves, B. infantis, L. plantarum, L. rhamnosus, and L. OWP probiotics One Wellness Place acidophilus. Each capsule has 15 billion CFUs. Good Belly fruit drink NextFoods Contains L. plantarum 299v. Each serving contains 20 billion CFUs. Supplements Amount of active culture Bacterial blend Indications Precautions Should survive gastric acid and bile 10 4/15/2018 Probiotics tested in specific disease states Disease Probiotic Strain Comments Number needed to treat (NNT) is 10.2 to prevent one case S. boulardi [37,38] Prevention of antibiotic associated of AAD. diarrhea (AAD) Lactobacillus rhamnosus GG (LGG) [39-41] Effective on adults and children in RCT’s. Prevention of Clostridium S. boulardii, LGG, or both [52] Study results are not statistically significant. difficile Infection (CDI) Prevention of recurrence after first CDI S. boulardii [53] Reduction of recurrence of CDI by half. Moderate evidence for improving eradication but good Lactobacillus rhamnosus GG (LGG), S. boulardii, L Helicobacter pylori eradication evidence of reduction in side effects leading to improved acidophilus [55] compliance. Ulcerative Colitis E coli Nissle 1917 [68] Promising role in maintenance of remission. VSL#3 [70] Role in induction and maintenance of remission of UC. Lactobacillus rhamnosus GG (LGG) [71,72], Lactobacillus Crohn’s Disease No role in induction or prolonging of remission of CD. johnsonii LA1[73] Irritable Bowel Syndrome Bifidobacterium infantis 35624 [80], VSL#3 [81] Significant improvements in IBS symptoms. But PROPATRIA trial showed an increased incidence of Acute Pancreatitis Lactobacillus plantarum 299 [88] infection, MODS and bowel ischemia. Bifidusbacterium spp and Prophylactic probiotics reduced NEC and mortality. Necrotizing Enterocolitis (NEC) Lactobacillus acidophilus [148] Increased infection is noted among VLBW (<750 g). Increased systemic IgA and IgG concentrations are noted Multi-Organ Dysfunction Syndrome VSL#3 [118] but MODS scores were not significantly affected by (MODS) probiotic treatment. Alone when given to mothers during pregnancy did decrease Allergy and Immune
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