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Getting to the guts of the matter - how changing the gut microbial population using diet may improve quality of life in a care home setting Dr Kirsty Hunter

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Getting to the guts of the matter - how changing the gut microbial population using diet may improve quality of life in a care home setting Dr Kirsty Hunter. Sport Science at Nottingham Trent University. 2. 01 August 2014. What causes ageing?. The two main theories of ageing are: - PowerPoint PPT Presentation

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Page 1: Sport Science at Nottingham Trent University

Getting to the guts of the matter - how changing the gut microbial population using diet may improve quality of life in a care home setting

Dr Kirsty Hunter

Page 2: Sport Science at Nottingham Trent University

22 April 2023 222 April 2023 2

Sport Science at Nottingham Trent University

Page 3: Sport Science at Nottingham Trent University

22 April 2023 3

What causes ageing?

• The two main theories of ageing are:1. Programmed cell death – cell death is a genetically programmed

event2. Cellular wear and tear – ageing caused by an accumulation of

cellular damage• Cell death is probably caused by a combination of both• Rate of ageing determined by genetics, environment, and lifestyle• Generally accepted that genes only account for 25% of the

determinants of life length

Page 4: Sport Science at Nottingham Trent University

22 April 2023 4

What is ageing?• Ageing results from impaired immune, genetic, neurological,

hormonal or antioxidant functions• These changes accumulate over time and are responsible for

increased susceptibility to disease and death

Ability of organs to perform

physiological functions decreases

Increased risk of malnutrition e.g.

PEM

Increase in disease

Number of cells and cellular

function decreases

Page 5: Sport Science at Nottingham Trent University

22 April 2023 5

So, can we influence the rate at which we age?

• Yes, the ageing process is malleable – it may be possible to enhance the body’s natural mechanisms for protection and repair

• Human lifespan may be extended by decreasing exposure to damage, or by enhancing repair, perhaps through improved nutrition, improved lifestyle and modified environment

• Goals of successful ageing are:1. To increase life expectancy2. To increase the number of healthy years i.e. delay the onset

of age-related diseases/disorders• Nutrition is an important factor in achieving both of these goals

Page 6: Sport Science at Nottingham Trent University

22 April 2023 6

How do physiological changes impact on nutritional status?

Influence of ageing on nutritional status

Appeal of food - reduction in sight, smell,

taste

Digestion and absorption

Nutritional requirements

Ability to obtain food

Page 7: Sport Science at Nottingham Trent University

22 April 2023 7

The causes and consequences of malnutrition are interlinked

Decreased nutrient intakeIncreased nutrient need

Increased illness

Increased use of medications

Decreased immune function

MALNUTRITION

Decreased accessibility and safety of

food

Decreased muscle mass

Page 8: Sport Science at Nottingham Trent University

22 April 2023 8

Nutrition has a significant impact on ageing

• Poor nutrition can contribute to a number of health problems including:

• Constipation and other digestive disorders

• Anaemia• Diabetes mellitus• Muscle and bone disorders

including osteoporosis, osteomalacia and osteoarthritis

• Overweight and obesity• Cardiovascular diseases • Declining mental health• Changes to the nervous system

and the immune system• Cataract • Some cancers e.g. breast,

prostate

Page 9: Sport Science at Nottingham Trent University

22 April 2023 9

Another component of the body which changes are the microorganisms which live in the gut

Page 10: Sport Science at Nottingham Trent University

22 April 2023 10

The Gastrointestinal Tract

• In our bodies there are 20 x more bacteria than human cells

•We carry around 1kg of bacteria•Gut problems take up significant GP time

Page 11: Sport Science at Nottingham Trent University

22 April 2023 11

Gut microfloral profile

Page 12: Sport Science at Nottingham Trent University

22 April 2023 12

Caecum

Ascendingcolon

Transverse colon

Descendingcolon

Rectum

Page 13: Sport Science at Nottingham Trent University

22 April 2023 13

Distribution of bacteria on the gut wall

Page 14: Sport Science at Nottingham Trent University

22 April 2023 14

Factors affecting colonisation and growth of bacteria in the gut

Physicochemical•Amount and type of

substrate•pH of gut contents•Redox potential

Microbial•Competition • Inhibition through end

products•Specific inhibitor

substances•Bile salts• Immunity

Page 15: Sport Science at Nottingham Trent University

22 April 2023 15

F erm en ta tion b y C o lon ic B ac teria

O rg an ic A c id s(ac e ta te , p rop ion a te ,

b u tyra te , lac ta te , su cc in a te )A lcoh o ls

G as es(e .g . h yd rog en , m eth an e,ca rb on d ioxid e , s u lp h id es )

N itrog en ou s m etab o lites(e .g . p h en o lic c om p ou n d s ,

am m on ia , am in es )

S ta rch , N S P ,O lig os acc h arid es , P ro te in s

A m in o ac id s

Page 16: Sport Science at Nottingham Trent University

22 April 2023 16

Page 17: Sport Science at Nottingham Trent University

22 April 2023 17

Metabolic Fate of Principal Carbohydrate End Products

•Acetate: metabolised in muscle, kidney, heart, brain•Propionate: cleared by the liver•Butyrate: metabolised by the colonic epithelium,

regulates cell growth•Lactate, ethanol, pyruvate: absorbed, electron sink

products•Hydrogen: partially excreted in breath, metabolised by

bacteria

Page 18: Sport Science at Nottingham Trent University

22 April 2023 18

Metabolic Fate of Principal Protein End Products

Ammonia: formed by deamination of amino acids, detoxified by urea formation in the liver, induces quick cell turnover

•Phenols/indoles: produced from aromatic amino acids, may act as co-carcinogens

•Amines: formed by decarboxylation of amino acids, linked to migraine, cancer, schizophrenia

Page 19: Sport Science at Nottingham Trent University

22 April 2023 19

Different bacteria use different substances as food and generate different end products

Different bacteria have different effects on body functions

Different bacteria have different effects on disease

Page 20: Sport Science at Nottingham Trent University

22 April 2023 20

Page 21: Sport Science at Nottingham Trent University

22 April 2023 21

Enterococci

BifidobacteriaBacteroides

StreptococciLactobacilli

E. coli

ClostridiaSulphate reducers

Candida sp.Proteus sp.

Ps. aeruginosa2

11 No./g faeces (log scale)

Inhibition of growthof exogenous and harmful bacteria

Stimulate immune function

Digestion/ absorption of food ingredients &

minerals

Vitamin synthesis

Diarrhoea, constipation,infections, liver damage, cancer, toxigenesis,encephalopathy

Production ofcarcinogens

Intestinalputrefaction

Page 22: Sport Science at Nottingham Trent University

22 April 2023 22

Gut Disorders

•Acute inflammation•Diverticulitis• Inflammatory bowel disease•Bowel cancer•Constipation•Food poisoning• IBS•Systemic????

Page 23: Sport Science at Nottingham Trent University

22 April 2023 23

Balanced gut flora Dysbiosis

Page 24: Sport Science at Nottingham Trent University

22 April 2023 24

Age related changes in gut microflora are caused by:

•Greater permeability of the gut wall•Reduced transit times•Secretion of acids by the stomach lining

•Reduced numbers of beneficial bacteria–Bifidobacteria, Eubacterium

•Increased numbers of putrefactive bacteria–Clostridia, Enterobacteria

What kind of changes occur?

Page 25: Sport Science at Nottingham Trent University

22 April 2023 25

Could the microbial organisms that live in the gut impact on quality of life and disease in the elderly?

Can we beneficially change the types of gut microorganisms using food and drink?

Page 26: Sport Science at Nottingham Trent University

22 April 2023 26

Influencing the ‘Balance’

PROBIOTICSA live microbial feed supplement which beneficially affects

the host

Examples: lactobacilli, bifidobacteria

Page 27: Sport Science at Nottingham Trent University

22 April 2023 27

Commercially available probiotics

• Bio yoghurts• Fermented milks• Fortified fruit juice

Fairly short shelf life

Need refrigeration

Debate on numbers of live organisms

• Powders• Capsules• Tablets• Sprays

Longer shelf life

Storage easy

Labels often misleading

Page 28: Sport Science at Nottingham Trent University

22 April 2023 28

The Alternative Approach

PREBIOTICS‘Non digestible food ingredients that selectively stimulate a

limited number of bacteria in the colon, to improve host health’

• (after Gibson and Roberfroid, 1995)

•Market leaders are the fructo-oligosacharides, galacto-oligosaccharides & the polysaccharide inulin

Page 29: Sport Science at Nottingham Trent University

22 April 2023 29

Prebiotics

1. Must be stable under acidic conditionsand small gut secretions

2. Must get tothe colon intact

3. Must beselectivelymetabolised

Page 30: Sport Science at Nottingham Trent University

22 April 2023 30

Vehicles for Prebiotics

•Beverages and fermented milks•Health drinks, spreads•Cereals•Biscuits*•Confectionery, cakes•Food supplements

Page 31: Sport Science at Nottingham Trent University

22 April 2023 31

Issues with probiotics

•Species variability•Viability in the product•Contradictory results

Why prebiotics may be better

•Heat stable•Increases the host’s own gut microbial population•Not a living product so no issues of viability

Page 32: Sport Science at Nottingham Trent University

22 April 2023 32

22 elderly subjects fed prebiotic powder for 10 weeks

Vulevic, 2008

• Increased numbers of Bifidobacterium spp., Lactobacillus spp, Enterococcus spp in faeces

•Lower numbers of Bacteroides spp, Clostridium spp, E. coli, Desulfovibrio spp.

Page 33: Sport Science at Nottingham Trent University

22 April 2023 33

Effects on markers of immune status

Page 34: Sport Science at Nottingham Trent University

22 April 2023 34

Synbiotics

Müller® Vitality® Apple & Prune 150g

Nutritional Values per 100g

Energy 415Kj (98kcal)

Protein 4.7g

Carbs 15.6g

Fat 1.9g

Calcium 150mg, 28% RDA per 150g serving

IngredientsYogurt, Sugar, Fruit (Apples (6%), Water, Prune Puree (4%), Inulin, Modified Maize Starch, Flavourings, Omega 3 from Refined Fish Oil, Acidity Regulators: Citric Acid, Sodium Citrates; Cultures: Sugar, Bifidobacterium sp., Lactobacillus acidophilus

Page 35: Sport Science at Nottingham Trent University

22 April 2023 35

Enterococci

BifidobacteriaBacteroides

StreptococciLactobacilli

E. coli

ClostridiaSulphate reducers

Candida sp.Proteus sp.

Ps. aeruginosa2

11 No./g faeces (log scale)

Inhibition of growthof exogenous and harmful bacteria

Stimulate immune function

Digestion/ absorption of food ingredients &

minerals

Vitamin synthesis

Diarrhoea, constipation,infections, liver damage, cancer, toxigenesis,encephalopathy

Production ofcarcinogens

Intestinalputrefaction

Page 36: Sport Science at Nottingham Trent University

22 April 2023 36

Potential uses of pro- & prebiotics in the elderly

Probiotics PrebioticsNutritionMalnutrition Possibly, based on results

from childrenCalcium absorption from the diet

GOS shown to be effective in PM women

Bowel problemsConstipation Helpful Lactulose well

established. Other substances show promise

Antiobiotic associated diarrhoea

Helpful Helpful

Immune system Some markers of immune function improved

Some markers of immune function improved

Page 37: Sport Science at Nottingham Trent University

22 April 2023 37

Why are pro- and prebiotics an attractive proposal for use in residential care?

•Can be incorporated into food (commercially available or cooked on site)

•Virtually tasteless •Prebiotics are heat stable•Food ingredients not drugs•Few side effects•Many potential beneficial effects

Page 38: Sport Science at Nottingham Trent University

22 April 2023 38

What do we need to do?

• Free-living versus residential care • Measure absence/presence of disease and functional markers• Quality of life markers• Nutritional status

Page 39: Sport Science at Nottingham Trent University

22 April 2023 39

Thank you for listening