Opportunities in Digestive Wellness

Alan GreensmithHead, US CommercialMonash University

§ Australia’s largest university (75,000 students)

§ Ranks among the top 100 universities in the world

§ One of the world’s leading research institutions – Inventor of the car safety belt– Developed in vitro fertilization– Creator of the Low FODMAP Diet for the Management of Irritable Bowel Syndrome

§ Recognized as the world leader in diet and gut health

Monash University…Who are we?

§ Digestive Wellness (gut health) is an important trend and a lucrative consumer opportunity for food and ingredient companies

§ Irritable Bowel Syndrome (IBS) is the most common functional gut disorder and often what consumers are trying to solve when they seek digestive wellness

§ The Monash FODMAP Diet is a scientifically proven answer for managing the symptoms of IBS and recommended first by the ACG for IBS

§ Kellogg’s and other leading food and ingredient companies are providing Monash Certified Low FODMAP foods and ingredients to an appreciative and loyal audience

§ Solving IBS symptoms through the FODMAP diet allows many consumers to achieve digestive wellness

Opportunities in Digestive Wellness

Digestive Wellness (gut health) is an Important Trend

Gut Health and Functional Foods Top Charts of Food Trends

Digestive health a top trend heading into new year

Top 11 Wellness Trends:Nurturing your gut

10 Food and Wellness Trends We Think Will Be Big in 2020:Gut Health and Prebiotics

Top 10 Nutrition Trends for 2020Prebiotics, gut health and the microbiome

9 Science backed Wellness Trends we are taking into the 2020s:Better Understanding of WHAT is going on in our Guts

Digestive Diseases impact Digestive Wellness

Irritable Bowel Syndrome“The Gut”50M Americans• Abdominal pain• Bloating• Distention• Diarrhea or

constipation or both

Celiac Disease2M Americans• Diarrhea• Abdominal

pain/bleeding• Food intolerance• Weight loss• Vomiting

GERD (Reflux) Esophagus60M Americans• Dry cough• Weezing• Nausea• Vomiting • Sore throat• Painful swallowing

Inflammatory Bowel Disease (Chrohn’s, Ulcerative Collitis)1.4M Americans• Diarrhea• Rectal bleeding• Urgent bowel• Abdominal pain• constipation

Gastroparesis5M Americans• Acid reflux• Stomach pain• Abdominal bleeding• Lack of appetite

Digestive Diseases*

* Gastrointestinal Specialists, Inc. (Https://www.gastrova.com/

Digestive Diseases impact Digestive Wellness

Irritable Bowel Syndrome“The Gut”50M Americans• Abdominal pain• Bloating• Distention• Diarrhea or constipation

or both

Celiac Disease2M Americans• Diarrhea• Abdominal

pain/bleeding• Food intolerance• Weight loss• Vomiting

GERD (Reflux) Esophagus60M Americans• Dry cough• Weezing• Nausea• Vomiting • Sore throat• Painful swallowing

Inflammatory Bowel Disease (Chrohn’s, Ulcerative Collitis)1.4M Americans• Diarrhea• Rectal bleeding• Urgent bowel• Abdominal pain• constipation

Gastroparesis5M Americans• Acid reflux• Stomach pain• Abdominal bleeding• Lack of appetite

Digestive Diseases*

* Gastrointestinal Specialists, Inc. (Https://www.gastrova.com/

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Digestive Diseases…Irritable Bowel Syndrome§ IBS Symptoms: Abdominal Pain, bloating, distension, change in

bowel habit

§ Most common gastrointestinal complaint affects 10-15% of community (50M Americans)

§ Significantly reduced quality of life¡ Patients would sacrifice 10-15 years of their life for immediate

cure¡ Economic burden is high– Direct costs in US $1,562 - $7,547 per patient/per year

§ Therapy palliative à no drug quick-fix

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Digestive diseases and IBS. The Answer is the Low FODMAP diet!

Key RCTs: 1. Halmos, E. P., V. A. Power, S. J. Shepherd, P. R. Gibson and J. G. Muir (2014). "A diet low in FODMAPs reduces symptoms of irritable bowel

syndrome." Gastroenterology 146(1): 67-75 e65.2. Ong DK, Mitchell SB, Barrett JS, et al. Manipulation of dietary short chain carbohydrates alters the pattern of gas production and genesis of

symptoms in irritable bowel syndrome. J Gastroenterol Hepatol. 2010;25(8):1366–1373.3. Shepherd SJ, Parker FC, Muir JG, Gibson PR. Dietary triggers of abdominal symptoms in patients with irritable bowel syndrome: randomized

placebo-controlled evidence. Clin Gastroenterol Hepatol. 2008;6(7):765–771.4. Staudacher HM, Lomer MC, Anderson JL, et al. Fermentable carbohydrate restriction reduces luminal bifidobacteria and gastrointestinal symptoms

in patients with irritable bowel syndrome. J Nutr. 2012;142(8):1510–1518.5. Pedersen N, Andersen NN, Vegh Z, et al. Ehealth: low FODMAP diet vs Lactobacillus rhamnosus GG in irritable bowel syndrome. World J

Gastroenterol. 2014;20(43):16215–16226.6. Böhn L, Störsrud S, Liljebo T, et al. Diet low in FODMAPs reduces symptoms of irritable bowel syndrome as well as traditional dietary advice: a

randomized controlled trial. Gastroenterology. 2015;149(6):1399–1407.e1392.

ü Numerous high quality RCTs (and observational studies), conducted across the globe, have consistently demonstrated a ~75% response rate to a low FODMAP diet

ü Studies have confirmed the diet is best delivered by specially trained dietitians

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Recommended for everyone with IBS by the American College of Gastroenterology

“We suggest a low FODMAP diet for overall symptom improvement in IBS”

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FODMAP Diet…What are FODMAPs?

§ FODMAP is an acronym that stands for ‘Fermentable, Oligosaccharides, Disaccharides, Monosaccharides And Polyols

§ ‘FODMAPs’ are a collection of short-chain carbohydrates (sugars) including fructans, galactooligosaccharides (GOS), lactose, excess fructose, sorbitol & mannitol

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§ FODMAPs are rapidly fermented by the bacteria living in the intestine to produce gas

§ FODMAPs can also pull water into the gut

§ Water and production of gas stretches and bloats the gut to trigger IBS symptoms

How do FODMAPs trigger IBS symptoms?

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Fructose

Fructose

Fructans

Fructans

Fructans

Fructans

Fructans

GOS

Polyols

Polyols

Polyols

Lactose

FODMAPs are found naturally in many foods.XS Fructose Lactose Fructans GOS Polyols

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What is a FODMAP diet?

§ A FODMAP diet is a 3 step diet designed to identify dietary symptom triggers in people with IBS

§ The diet is best delivered by a FODMAP Trained Dietitian

Measuring FODMAPs in foods and safe levels

Table 1: Low FODMAP criteria for food products (g per serve)

FODMAP Low (green) Oligosaccharides * (core grain products, legumes, nuts, and seeds) < 0.30

Oligosaccharides * (vegetables, fruits, and all other products) < 0.20

Polyols- Sorbitol or Mannitol < 0.20

Total Polyols < 0.40

Excess Fructose < 0.15

Lactose < 1.00 * Oligosaccharides = total fructans plus galacto-oligosaccharides (stachyose and raffinose)

Varney J et al FODMAPs: food composition, defining cutoff values and international application.Journal of Gastroenterology andHepatology. 2017;32 (Suppl 1) 53-61./

1. Collect food or product samples

2. Extract short-chain carbohydrates

3. Measure Fructans and other FODMAPs using Liquid Chromatography

4. Determine serving size that would be low, medium or high in FODMAPs

Understanding gluten- & wheat intolerance in non-celiacs

0 0.2 0.4 0.6 0.8 1 1.2 1.4

haricot beanswheat-cous cous

mueslirye bread

wheat -breadwheat- pasta

cornflakesrice bubbles

pasta-gluten freequinoa-pasta

gluten-free breadrice-noodles

rice- whiterice-brown

GOS

Fructan

Fructose

Gluten free

§ Gluten and FODMAPs are present ‘together’ in foods. So by going gluten-free you are also reducing your intake of FODMAPs.

§ Research suggests that people with gut symptoms (who do not have celiac disease but follow a gluten-free or wheat-free diet) are reacting to the FODMAP component of the wheat and not gluten.

§ So gluten is not the culprit and these people achieve greater relief from symptoms through following a low FODMAP diet.

Biesiekierski et al Gastroenterology 2013;145:320.

Skodje Gastroenterology 2018;154:529–539 .

Gluten-free foods are low in FODMAPs

FODMAPs

Gluten sensitivity is often really FODMAP sensitivity and a cause of IBS!

What are the benefits of low FODMAP product certification?• Licensing to use the official Monash

University Low FODMAP DietTM badge on your certified products – making them easy to spot in the supermarket.

• Inclusion in the Monash University Low FODMAP DietTM App – used by over 2 million people worldwide.

• Feedback on your products from the Monash University dietitians – the team that pioneered low FODMAP research.

Why test and certify your food or ingredients with Monash?

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Monash Certification Partners

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Monash FODMAP Diet support for companies, HCPs and consumers

monashfodmap.com

Monash University FODMAP Diet App§ #1 FODMAP App in the world. #1 Medical app in the world§ Proceeds from the sale of the app contribute to research

Monash Low FODMAP Product Certification Program

Online FODMAP Training for Dietitians and Consumers

Monash FODMAP Guide Booklet

§ Digestive Wellness or “gut health” is an important trend for the food industry§ Many of those seeking Digestive Wellness are often trying to solve the

symptoms of irritable bowel syndrome (IBS)§ The opportunity is huge! 50M Americans struggle with IBS§ FODMAPs are the cause of the symptoms of IBS § The Low FODMAP Diet is the dietary answer to the symptoms of IBS§ A large and loyal audience is seeking certified Low FODMAP Foods§ Leading companies like Kellogg’s are putting forward Monash Certified Low

FODMAP foods§ Up to 75% of those following a low FODMAP diet achieve relief of the

symptoms of IBS and achieve digestive wellness§ Consider joining us!

Opportunities in Digestive Wellness