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Welcome to Seminar
on
The Role of Dietary Fibre and
Probiotics (Synbiotics) in the
Management of GI Diseases
by
Meera Kaur, PhD, RD
kaur@cc.umanitoba.ca
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Objectives of the Seminar
• Recognize functions of dietary fibre and probiotics
• Understand the role of fibre and probiotics in GI
diseases and the new term Synbiotics
• Learn the clinical indications for a altered fibre and
probiotics diet
• Understand the role of diet in IBD
Meera Kaur, PhD, RD
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Outline of the Seminar
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GI responses to Fibre and Probiotics
Food Sources of Fibre and Probiotics
Fibre Requirements, Fibre in GI Disease
Management of Constipation/Diarrhea
IBS and IBD
Drug Nutrient Interactions
Common Problems and Suggestions
Role of probiotics in GI health and diseases
Checklist, Question and Answer session
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Fibre: A True Multitasker
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Hypoglycemic effect
Hypolipidemic effect
Slows absorption of CHO
“Anti-toxic” effect ( colon cancer mortality)
Apparent reduction or control of GI disorders
(diverticulitis,
gallstones,
IBS,
IBD,
constipation)
• Satiety effect (helps some individuals better
maintain their ideal body weight)
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Fibre: Soluble or Not
• Soluble Fibres: “Soluble non-cellulosic
polysaccharides” = Pectin, gums, mucilage
and hydrocolloids) (i.e. guar gum, oats, barley
• Insoluble
Fibre:
“Insoluble
cellulosic
polysaccharides” = lignin and cellulose (i.e
bran)
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GI Response to Insoluble Fibre...
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 Fecal bulk
 Intraluminal pressure
 Frequency of defecation
 Intestinal transit time
 Postprandial satiety
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GI Response to Insoluble Fibre...
•  Glucose absorption
• Changes in pancreatic and intestinal enzyme
activity
•  Bile-acid secretion (sequestering agent)
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Food Sources of Fibre
• Whole grains
• Fruits
• Vegetables
• Pulses and Legumes
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Fibre Requirements
• 21 - 38 gm fibre a day (Harshman and
Aldoori, 2006)
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• Both types are important -- soluble and
insoluble
* Harshman and Aldoori (2006), New dietary reference intakes for
macronutrients and fibre, Can Fam Physician. 2006 February
10; 52(2): 177–179
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Fibre in GI Disease
• Clinical Indications: Gastrointestinal
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constipation
diarrhea
diverticulitis
IBS
IBD
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Management of Constipation
• Nutrition
Habits
– high fibre diet
regular meal schedule
• coarse wheat bran
– decreased diuretic beverages
bowel re-education
– Increased water
Regular exercise
• 1-1.5 L per day additional
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Management of Diarrhea...
• Nutrition...
– avoid foods likely to cause diarrhea
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dietetic foods
excessive coffee, tea, cola, alcohol
spicy food
?lactose
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Management of Diarrhea
• Nutrition
– avoid foods likely to cause cramps
• legumes, nuts, popcorn, onions, cabbage,
radishes, Brussels sprouts, cauliflower, broccoli
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low fat diet
consider food hypersensitivity
discontinue laxative, cathartics
Mucilage or Bran can be used (bulk)
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Irritable Bowel Syndrome
• Treatment Includes
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management of constipation and/or diarrhea
ease of spasms
reduction of intraluminal pressure
management of possible food intolerance
ease of mental stress
regulation of lifestyle with regard to rest, work,
fluid intake, meal regulation, and elimination.
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Inflammatory Bowel Disease
• Crohn’s Disease
• Ulcerative Colitis
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Nutrition and IBD...
• Malnutrition
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nutrients lost through bleeding and diarrhea
medications take for IBD interact with nutrients
surgical removal of part of intestine
decreased intake due to pain
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Nutrition and IBD...
• Mild Symptoms
– normal diet
• Moderate Symptoms
– modifications may be required
• Severe Symptoms
– supplements may be necessary
• Extreme Symptoms
– enteral or parenteral feeding may be required
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Nutrition and IBD...
• Carbohydrate
– avoid simple sugars: diarrhea
– avoid sugar alcohol: diarrhea
– choose complex carbohydrates
• Protein
– due to losses, may need increased protein
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Nutrition and IBD
• Fat
– concentrated form of energy
– if part of the bowel is rejected, possibility of fat
malabsorption and steatorrhea
– MCT oil and/or low fat diet
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Drug Nutrient Interactions
• Drug
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Interactions
pain killers, tranquillizers
constipation
Sulfasalazine
 absorption of folic acid
Cholestyramine
 absorption of vitamins A/D/E/K
Corticosteroids
 absorption of protein and calcium
Antibiotics
 absorption of vitamin K and biotin
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Common Problems: IBS/IBD...
• Problems
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Feeling full
pain
inflammation
strictures
• Solutions
– small frequent meals
– snacks of nutritional supplements
– not missing meals
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Common Problems: IBS/IBD...
• Problems
– Gas and bloating
• Solutions
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avoid gas causing foods
eat slowly
avoid stress
reduce fats
avoid ingesting air (gum, straws…
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Common Problems: IBS/IBD
• Problems
– Lactose Intolerance
• Solutions
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Try low lactose foods
Foods containing probiotics
Lactaid
Lactose free products
Calcium supplements or alternate source of calcium
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Other Suggestions for IBS/IBD
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Avoid alcohol
Avoid caffeine, or have only with meals
Include multi vitamins
Elemental supplements for crohn’s
Vitamin B12 injections if ileum removed
TPN if required
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Probiotics
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Definition
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Probiotics are live microorganisms which when
administered in adequate amount confer a
health benefit on the host (FAO, 2001).
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Food Sources of Probiotics
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Yogurt
Fermented soy products
Other fermented foods
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How do Probiotics work?
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Modify GI Ecology because of its ability to
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survive the harsh travel condition of upper GI
tract
adhere to the epithelial of the intestine and
colonize
compete with the pathogenic microorganisms for
nutrient and colonization sites
secrete
antibiotic-like
substances
called
bacteriocins, and
provide nutritional services via synthesis of
vitamins
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Why Probiotics?…
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Research Suggests Probiotics Bacteria can
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help reduce the risk of certain diarrhea, cancer,
allergy, helicobacter pylori, UTIs
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assist in managing lactose intolerance, IBD,
hepatic encephalopathy, and
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enhance the immune functions, overall health
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Why Probiotics?
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Probiotics, GI-tract Functionality and
Human Health Cluster -- experiences and
prospects
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Nutrition Checklist...
• Has there been a loss of more that 10% usual
weight in the past 6 months?
• For children and adolescents: Is growth slower
than others of the same age?
• Is the diet being limited in some way that may
result in missing nutrients and energy?
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Nutrition Checklist
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Is fibre being avoided?
Are milk or milk products being avoided?
Is a non-prescribed diet being followed?
Are meals or snacks being skipped, or is food
consumption less than usual?
• Are caffeine, alcohol, sugar or fat being
substituted for other foods?
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Discussion
Use of Synbiotics (probiotics+ plant fibre):
Evidence of Significant Positive Outcome
Topping (2007) :  risk of bowel cancer and ulcerative colitis
Bengmark (2006) : Pancreatitis, trauma   immunoparalysis
Bengmark (2005) : Critically ill  unwanted pathogens (c. diff)
Bengmark (2005) : Clinical Medicine  reinforce immune system
Rayes et al. (2005): Liver transplant   bacterial infection rate
Bengmark (2004) : ITU   in septic morbidity
Bengmark (2003) : Critically ill  research limited, but great
hope for future; confirmed for LAB
Olah et al. (2002 ): Acute pancreatitis   pancreatic sepsis,
 no. of surgical interventions
Meera Kaur, PhD, RD
My Mom
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• 70 year old widow, vegetarian. Since last 8 months she is
suffering from episodes of copious diarrhea followed by
constipation. Increasingly developed resistance to
antidiarrhal medications. She is Diabetic (NIDDM) +BP
and on medications. Poor GI functions. Can not tolerate
most of the foods especially vegetables and fruits (cooked
or raw). Oral Intake is always poor. My brother phoned
me describing her chronic illness and asked dietary
advise. What I did? Discussed with her doctor. We put her
on a synbiotic capsule (one/day) for 40 days. Then I
suggested to add plain yogurt (1-2 tsp) in most of the
foods that she eats (rice, lentil, milk, stew,soup etc). Did
it work?
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Implications for the Practitioners
• Dietary fibre and probiotics (from natural sources
such as yogurt) may be considered for the
management of GI functions in health and
diseases.
• Whenever possible and applicable, LAB
containing yogurt may be included in the diet of
patients to improve liver function & to manage
lactose intolerance, IBD and IBS.
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References
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Topping, D (2007). “Cereal complex carbohydrates and their contribution to human
health,”Journal of Cereal Science 46(3); 220-229
Bengmark, S. (2006), “Aggressive management of surgical emergencies,” Annals of
the Royal College of Surgeons of England 88(7); 624-629.
Bengmark, S.(2005), “Synbiotics and the mucosal barrier in critically ill patients,”
Current opinion in gastroenterology 21(6); 712-716
Bengmark, S. and Martindale R. (2005), “Prebiotics and synbiotics in clinical
medicine,” Nutrition in Clinical Practice 20(2); 244-261
Rayes N., Seehofer D. and Theruvath T., et al.(2005) , “Supply of pre- and probiotics
reduces bacterial infection rates after liver transplantation - A randomized, doubleblind trial,” American Journal of Transplantation 5(1); 125-130
Bengmark, S.(2004), “Bio-ecological control of perioperative and ITU morbidity,”
Langenbecks Archives of Surgery 389(2); 145-154
Bengmark S.(2003), “Use of some pre-, pro- and synbiotics in critically ill
patients,”Best Practice & Research in Clinical Gastroenterology17(5); 833-848
Olah A., Belagyi T., Issekutz A., Gamal M. E. and Bengmark S.(2002), “ Randomized
clinical trial of specific lactobacillus and fibre supplement to early enteral nutrition in
patients with acute pancreatitis,”The British journal of surgery 89(9); 1103-1107
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Thank you
for gracing the seminar!
Any question?
Meera Kaur, PhD, RD