The 2015 Digestive Health Coaching Guide: Focus on Prebiotics

Digestive health is now in the mainstream. What do you tell your clients?

Within the last decade, the importance of digestive health went from the fringes of health and wellness straight to the heart of mainstream medicine. With the publication of a few seminal studies and reviews in peer-reviewed journals1,2,3,4, physicians are now prescribing prebiotics and probiotics as part of a comprehensive health care plan.

The National Institute of Health has even created The NIH Human Microbiome Project.5 Registered dietitians, nutritionists, and health and wellness coaches have known for decades what medical science is now proving through large clinical studies and projects: the health of the digestive system profoundly affects overall health. We have assembled a digestive health coaching guide to highlight recent research on the gut microbiome and the beneficial effects of prebiotic supplements.

Prebiotics Promote Satiety

Most of your clients are going to be asking about the effects of prebiotics on healthy weight management. Dr. Oz has discussed the importance of taking prebiotics, as have The Doctors. Therefore, you can count on a spike in client awareness and interest in digestive health.

Prebiotics such as oligofructose and inulin help people lose weight or maintain a healthy weight in several ways. Oligofructose has been shown to promote satiety in clinical studies, helping people control portion size and caloric intake.6 Oligofructose and inulin increase blood levels of hormones that signal satiety.7 While satiety promotion is easy to explain to clients during digestive wellness counseling (for example, prebiotics help you feel fuller, faster), it is perhaps the least impressive way that prebiotics help people lose weight.

Prebiotics in the colon

Prebiotics Pressure the Gut Microbiota to Contain “Skinny” Bacteria

In 2006, researchers demonstrated that the types and proportions of bacteria in the gut are different between obese people and lean people.1 As a person loses or gains weight, the proportion of bacteria in the gut changes in the same way. In other words, obese individuals who lose weight start to have the type of gut bacteria of skinny people.1 This groundbreaking work, published in Nature, set off a medical revolution. It was the first time scientists had identified a microbiological cause for obesity.

If you’re a dietician who provides nutrition counseling for digestive health, this means that your clients can potentially treat their obesity by changing their gut microbiota. Oligofructose and inulin can selectively change the composition of bacteria in the gut of obese women, shifting their proportion towards “skinny” bacteria.8,9 In fact, this may be the most straightforward way to incorporate this information into your digestive wellness counseling: Prebiotics promote “skinny” bacteria in the gut.

Prebiotics Decrease Short Chain Fatty Acids in the Colon

Short chain fatty acids can be difficult to explain when providing nutrition counseling for gut health. Short chain fatty acids are fermentation products of partially or non-digestible polysaccharides.10  In the colon, short chain fatty acids can induce reactive oxygen species, alter gut integrity, and promote virulence genes in enteric pathogens.11 In other words, fecal short chain fatty acids can cause a number of digestive health problems. It’s safe to say that clients of digestive wellness counseling should be made aware of the beneficial effects of prebiotics, specifically inulin-type prebiotics. Inulin decreases the amount of short chain fatty acids in the digestive system, which provides multiple digestive health benefits.12

Prebiotics and Type 2 Diabetes

Obesity is certainly a major risk factor for Type 2 diabetes, and perhaps no single illness is more responsive to changes in weight. However, prebiotics can help individuals with Type 2 diabetes beyond simply aiding weight loss. Inulin supplementation has positive, beneficial effects on glycemic control.13 Individuals with Type 2 diabetes who consumed 10 g per day of inulin for two months saw an 8.5% reduction in fasting plasma glucose and a 10.4% reduction in hemoglobin A1C.13

If part of your practice involves coaching clients with digestive diseases, especially Type 2 diabetes, a prebiotic regimen should be a component of comprehensive digestive wellness counseling. The soluble fiber is an easy and safe addition to any diabetic diet plan.14,15

Prebiotics and Atherosclerosis

How many of your digestive wellness counseling clients are at increased risk for atherosclerosis because of hypercholesterolemia and hypertriglyceridemia? Dietary oligofructose has been shown to lower triglyceride and serum cholesterol levels.16,17 The effects seem to be particularly profound in individuals with hyperlipidemia, and the greatest reductions appear to occur on triglyceride levels.18

Since statin drugs are most effective in reducing LDL and increasing HDL cholesterol with weak triglyceride-lowering ability, prebiotics may serve as a useful addition in clients with elevated cholesterol and triglyceride levels.

Prebiotics Combined With Antibiotics

While most antibiotics are prescribed for short-term use, some individuals are on long-term, prophylactic antibiotics. In either case, prebiotics should be considered standard of care. All antibiotics can decimate the bacteria in the gastrointestinal tract and greatly increase the likelihood of Clostridium difficile infection.

Ideally, clients who seek nutrition counseling for gut health should take both prebiotics and probiotics. Unfortunately, people who take prophylactic antibiotics may not be able to take actual bacteria (i.e., probiotics). Therefore, prebiotics such as inulin and oligofructose should be prescribed at the same time as oral antibiotics.

The Forecast for 2015

At Prebiotin, we have been sharing the benefits of prebiotic supplementation for years. With a combination of inulin and oligofructose, Prebiotin is beneficial to a number of digestive health benefits and serves as a useful addition in the treatment of various metabolic diseases. When coaching your clients with digestive diseases or providing nutrition counseling for digestive health, you can now feel comfortable describing the latest science on prebiotics.

 

References

  1. Ley RE, Turnbaugh PJ, Klein S, Gordon JI. Microbial ecology: human gut microbes associated with obesity. Nature. Dec 21 2006;444(7122):1022-1023. doi:10.1038/4441022a
  2. Everard A, Lazarevic V, Gaia N, et al. Microbiome of prebiotic-treated mice reveals novel targets involved in host response during obesity. ISME J. 2014. doi:10.1038/ismej.2014.45
  3. De Preter V, Joossens M, Ballet V, et al. Metabolic profiling of the impact of oligofructose-enriched inulin in Crohn’s disease patients: a double-blinded randomized controlled trial. Clin Transl Gastroenterol. 2013;4:e30. doi:10.1038/ctg.2012.24
  4. Quigley EM. Gut bacteria in health and disease. Gastroenterol Hepatol (N Y). Sep 2013;9(9):560-569.
  5. Peterson J, Garges S, Giovanni M, et al. The NIH Human Microbiome Project. Genome Res. Dec 2009;19(12):2317-2323. doi:10.1101/gr.096651.109
  6. Cani PD, Joly E, Horsmans Y, Delzenne NM. Oligofructose promotes satiety in healthy human: a pilot study. Eur J Clin Nutr. May 2006;60(5):567-572. doi:10.1038/sj.ejcn.1602350
  7. Cani PD, Dewever C, Delzenne NM. Inulin-type fructans modulate gastrointestinal peptides involved in appetite regulation (glucagon-like peptide-1 and ghrelin) in rats. Br J Nutr. Sep 2004;92(3):521-526.
  8. Dewulf EM, Cani PD, Claus SP, et al. Insight into the prebiotic concept: lessons from an exploratory, double blind intervention study with inulin-type fructans in obese women. Gut. Aug 2013;62(8):1112-1121. doi:10.1136/gutjnl-2012-303304
  9. Zhao L. The gut microbiota and obesity: from correlation to causality. Nat Rev Microbiol. Sep 2013;11(9):639-647. doi:10.1038/nrmicro3089
  10. Tan J, McKenzie C, Potamitis M, Thorburn AN, Mackay CR, Macia L. The role of short-chain fatty acids in health and disease. Adv Immunol. 2014;121:91-119. doi:10.1016/b978-0-12-800100-4.00003-9
  11. Sun Y, O’Riordan MX. Regulation of bacterial pathogenesis by intestinal short-chain Fatty acids. Adv Appl Microbiol. 2013;85:93-118. doi:10.1016/b978-0-12-407672-3.00003-4
  12. Salazar N, Dewulf EM, Neyrinck AM, et al. Inulin-type fructans modulate intestinal Bifidobacterium species populations and decrease fecal short-chain fatty acids in obese women. Clin Nutr. Jun 11 2014. doi:10.1016/j.clnu.2014.06.001
  13. Pourghassem Gargari B, Dehghan P, Aliasgharzadeh A, Asghari Jafar-Abadi M. Effects of high performance inulin supplementation on glycemic control and antioxidant status in women with type 2 diabetes. Diabetes Metab J. Apr 2013;37(2):140-148. doi:10.4093/dmj.2013.37.2.140
  14. Bonnema AL, Kolberg LW, Thomas W, Slavin JL. Gastrointestinal tolerance of chicory inulin products. J Am Diet Assoc. Jun 2010;110(6):865-868. doi:10.1016/j.jada.2010.03.025
  15. Dehghan P, Pourghassem Gargari B, Asghari Jafar-abadi M. Oligofructose-enriched inulin improves some inflammatory markers and metabolic endotoxemia in women with type 2 diabetes mellitus: a randomized controlled clinical trial. Nutrition. Apr 2014;30(4):418-423. doi:10.1016/j.nut.2013.09.005
  16. Fiordaliso M, Kok N, Desager JP, et al. Dietary oligofructose lowers triglycerides, phospholipids and cholesterol in serum and very low density lipoproteins of rats. Lipids. Feb 1995;30(2):163-167.
  17. Ooi LG, Liong MT. Cholesterol-lowering effects of probiotics and prebiotics: a review of in vivo and in vitro findings. Int J Mol Sci. 2010;11(6):2499-2522. doi:10.3390/ijms11062499
  18. Pereira DI, Gibson GR. Effects of consumption of probiotics and prebiotics on serum lipid levels in humans. Crit Rev Biochem Mol Biol. 2002;37(4):259-281. doi:10.1080/10409230290771519

 

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