NMDF211 Nutritional Biochemistry · PDF fileNMDF211 Nutritional Biochemistry ... raw potato, high amylose corn, ... • fibre rich foods have lower energy density and higher volume

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NMDF211

Nutritional Biochemistry

Nutrients that resist digestion

Effects of gut microbiota on digestion, nutrient status

Intolerance and malabsorption syndromes

Session: 5


Session Overview

o Nutrients that resist digestion

• Dietary fibre

• Functional fibre

o Effects of GUT microbiota on digestion, nutrient status

and systemic physiology

• Prebiotic and microbiota synergy

o Intolerance and malabsorption syndromes


COMPLEX CARBOHYDRATES - FIBRE

The term “dietary fibre” was coined in 1953.

In 430 BC, Hippocrates described the laxative effects of coarse

wheat in comparison with refined wheat, and in the 1920’s Kellogg

published extensively on the attributes of bran for its beneficial

effects such as laxation, increased stool weight and prevention of

disease.

Denis Burkitt, is usually credited with re-popularising the idea that

dietary fibre protects against the development of non-

communicable diseases, such as diabetes, CVD, and some

cancers after observing that western diseases were rare in Africa

where the diet was rich in dietary fibres.

(Slavin, 2013)


Plants

>95% of fibres are from cell wall

Primary wallSecondary wall

Fibre-related components

CelluloseHemicelluloseLigninPectin'sSuberinCutin

SOURCE OF FIBRE IN PLANTS

(Gropper & Smith 2016)


o Dietary fibre – non-digestible CHO & lignin that are intact

& intrinsic in plants

o Functional fibre – non-digestible CHO that are isolated,

extracted, or manufactured & known to have

physiological benefits

Dietary Fibre & Functional Fibre



Classification of Fibre - Solubilityo Traditionally dietary fibre was classified according to its

solubility in water:

o Classifications:

• Soluble - dissolve in hot water, delay gastric emptying,

increase transit time (through slower movement), decrease

nutrient absorption in small intestine (adequate

microbiome allows reabsorption of many nutrients that

may have been initially sequestered). E.g – legumes, oats,

barley, bananas, broccoli, onions, apples

• Insoluble - don’t dissolve in hot water, decrease transit

time, increase fecal bulk. E.g – wholegrains, nuts, seeds,

corn bran

• NOTE: Typically we eat foods with a mixture of both soluble and insoluble

fibres therefore the effects on physiological processes are complex (Gropper & Smith 2013)


Classification according to

Solubility

o Gropper & Smith (2013) pg 112

(Gropper & Smith, 2013, p. 117)


Sources of Dietary Fibre (Gropper & Smith, 2013 p. 116)

Cellulose All plant foods, esp. wheat bran, legumes, nuts, peas, root vegetables

(e.g. carrots), brassica’s, celery, covering of seeds & apples

Hemicellulose Whole-grains, esp. bran, nuts, and legumes

Lignin Whole-grains, esp. wheat bran, mature root vegetables, fruits with

edible seeds (e.g. strawberries), broccoli (esp. stalks)

Pectin Citrus, strawberries, apples, raspberries, legumes, nuts, some

vegetables (e.g. carrots), oats

Gums Oats, barley, legumes

Beta-glucans Oats, barley, and some mushrooms

Resistant starch RS1 partially milled grains and seeds, RS2 unripe bananas, legumes,

raw potato, high amylose corn, RS3 rice, pasta, cold cooked

potatoes, and high amylose corn

Fructans Chicory, asparagus, onion, garlic artichoke, tomatoes, bananas, rye

and barley

Chitosan &

Chitin

Shells of crabs, shrimp, lobster


RECOMMENDED FIBRE INTAKE

(Gropper & Smith, 2013)


An overview of the relationship between transit of food through the human gastrointestinal tract

and the digestion of nutrients in the small intestine and fermentation in the cecum and colon.

(Topping & Clifton 2001)

©2001 by American Physiological Society


Degradability/Fermentability

o Fermentable Fibres

Fermentable fibres as prebiotics

Short-chain fatty acid generation

Increased water/sodium absorption in the

colon

Mucosal cell differentiation and proliferation

Acidification of luminal environment

Provision of energy



Degradability/Fermentability

Inhibition of cholesterol synthesis

Improved colonic blood flow

Enhanced immune function

Trophic effects and prevention of abnormal

cell populations

o Non-fermentable fibres• Detoxification

• Increased fecal volume (bulk)

(Gropper & Smith, 2013)


Role of Fibre in Disease Prevention &

Managemento Cardiovascular Disease

• Lower cholesterol, CRP and blood pressure.

• Soluble and insoluble (specifically, beta-glucan, psyllium, pectin, and guar gum) were most effective for lowering serum LDL, without affecting HDL

o Diabetes• Improved glycemic control and insulin sensitivity

• Hypoglycemic & hypolipidemic effects of soluble fibres

o Obesity and weight control• fibre rich foods have lower energy density and higher volume

which can promote satiety

• May impact satiety inducing hormones

– Glucagon-like peptide 1, Ghrelin, Peptide YY



Management

o Weight

o n=50 intervention studies found increasing fibre intake by 14 g per day was associated with a 10% decrease in energy intake and a 2 kg weight loss over about a 4-month period

o Gastrointestinal disorders

o Inadequate intake related to diverticular disease, colon cancer and constipation• Consume diet rich in insoluble fibre

• May not prevent formation of new diverticula



Management

o Proposed mechanisms • Adsorb bile acids, promote excretion

• Decreases inter-luminal pH

• Increase fecal bulk

• Provide fermentable substrates for bacteria in colon

• Shortened fecal transit time

• Fermentation may release fibre-bound calcium

• Butyric acid appears to hinder cancer cells

• Insoluble fibres bind carcinogens


Maintaining optimal gut health

o In a randomized study of 142 patients with Clostridium difficile –

associated diarrhoea receiving oligo fructose or placebo for 30 days

in addition to specific antibiotic treatment, the recurrence rate was

lowered from 34.3% in controls to 8.3% in the oligo fructose

recipients (Patel, 2015).

o In a randomized study of 20 participants showed consumption of

Wheat bran 12gm + 22gms/d resistant starch (WBRS) from Maize

compared to Wheat bran 12gms/d (WB) alone, the WBRS diet

resulted in greater faecal output, shorter transit time, lower faecal

pH, higher daily excretion of SCFAs increases in Butyrate, a higher

faecal ratio of butyrate to total short-chain fatty acids, and lower

concentrations of total phenols and ammonia (Muir et al., 2004).


Characteristics and Functions o Fructans (inulin, oligofructose, and fructooligosaccharides)

• Inulins fructose chain contains from 2 to 60 units, with (2-1)

linkages and a glucose molecule linked to the C-2 position of the

terminal fructo-furanose unit to create a non reducing unit at the end

of the molecule.

• Digestive enzymes are not able to hydrolyse the (2-1), some

bacteria, such as bifidobacteria, produce -fructosidase.

– People with low levels of biofidobacteria are more prone to

digestive disturbance (gas) when fructans are introduced into the

diet.

• Oligofructose is formed from partial hydrolysis of inulin and has

between 2 to 8 fructose units

• Fructo-oligosaccharides are similar to oligofructose, except that

polymerisation of fructo-oligosaccharides ranges from 2 to 4 units

• Fructo-oligosaccharides and other fructans, are bifidogenic and

are classed as prebiotics


Characteristics and Functions

o Resistant Starch (RS)

• RS is one type of carbohydrate to reach the colon undigested.

The 3 main types of RS are RS1 (physically inaccessible starch),

RS2 (ungelatinised starch granules), and RS3 (retrograded starch

polymers).

• The major physiologic effects of RS on the colon of humans

include increased concentrations of SCFAs, lowered pH, and

lowered concentrations of ammonia, phenols, and secondary bile

acids.

o Research has found that fermentation of RS produces

more butyrate than does fermentation of non-starch

polysaccharides, including cereal brans (Muir et al., 2004).


Prebiotics


Prebioticso “A selectively fermented ingredient that allows

specific changes, both in the composition and/or

activity in the gastrointestinal microflora, that confer

benefits” (Slavin 2013).

o All prebiotics are fibre, however not all fibre are

prebiotics!

o Classification of food ingredient as prebiotic must

demonstrate:

• Resist HCL, hydrolysis by human enzymes, and absorption in

upper GIT

• Is fermented by intestinal microflora

• Selectively stimulates the growth and/or activity of intestinal

bacteria potentially associated with health and wellbeing (Slavin,

2013).


Prebiotic and Probiotic Synergyo Probiotics are living non-pathogenic organisms, used as food

ingredients to benefit the hosts’ health. They may be lactic acid

bacteria, Bifidobacteria, or yeasts, such as Saccharomyces

cerevisiae.

o Lactobacilli and bifidobacteria are the usual target genera for

prebiotics.

o Changes in Bifidobacteria are more likely to occur, possibly due to

higher concentrations in the colon and they have a preference for

oligosaccharides.

o Probiotics can be used in the treatment of hepatic encephalopathy,

inflammatory bowel diseases, infections, hypertension, cancer, and

atopic dermatitis in children (Zhang, 2015).


• Fermentation of polyphenols through biotransformed

products stimulated proliferation of Bifidobacteria and

decreased the ratio of Firmicutes to Bacteroidetes and

also stimulated short chain fatty acid production (Parkar,

2013).

• Mechanism of action for dietary fibre and prebiotics is

fermentation in the colon and changes in gut microflora.

• Gut immune system, colonic and mucosal microflora

provide a barrier that prevents pathogenic bacteria from

invading the gastrointestinal (GI) tract.

PREBIOTIC AND PROBIOTIC SYNERGY


Foods high in prebiotics have been consumed since

prehistoric times.

• Substrates are resistant starch, non-starch polysaccharides

(e.g., celluloses, hemicelluloses, pectins, and gums), non-

digestible oligosaccharides, and sugar alcohols. The main

fermentation pathway generates pyruvate.

• Colonic bacteria generate energy and lead to an increase in

bacterial mass and consequently fecal mass and, thus have

a stool bulking effect. (Slavin, 2013).

• Colonic bacteria use a range of carbohydrate hydrolysing

enzymes to produce hydrogen, methane, carbon dioxide,

SCFAs – (mainly acetate, propionate, and butyrate) and

lactate.




• Colonic epithelial cells preferentially use butyrate as an

energy source, even when competing substrates such as

glucose and glutamine are present.

• Butyrate is considered as protective factor for metabolic

activity and growth of colonocytes.

• Fermentation and SCFAs production also inhibit the

growth of pathogenic organisms by reducing luminal and

faecal pH.

• Inhibits formation of toxic compounds, ammonia, amines,

phenolic compounds and decreases undesirable bacterial

enzymes (Slavin, 2013).

•


Health benefits of Prebiotics

o Reduce the prevalence and duration of infectious and

antibiotic-associated diarrhoea;

o Reduce the inflammation and symptoms associated with

inflammatory bowel disease;

o Exert protective effects to prevent colon cancer;

o Enhance the bioavailability and uptake of minerals,

including calcium, magnesium, and possibly iron;

o Lower some risk factors for cardiovascular disease; and

o Promote satiety and weight loss and prevent obesity (Slavin, 2013)


Dietary fibre Fermentability (%)

Cellulose 20-80

Hemicelluloses 60-90

Pectins 100

Guar gum 100

Ispaghula 55

Wheat bran 50

Resistant starch 100

Inulin, oligosaccharides 100 (if they are not in excess)

Colonic fermentability of dietary fibres in humans

Source: Food and Agricultural Organisation of the United Nation (FAO)

http://www.fao.org/docrep/w8079e/w8079e0l.htm



Human studies with fibres that show

prebiotic effects o Acacia gum was shown to produce a greater in

bifidobacteria and lactobacilli than an equal dose of inulin,

with few GIT symptoms.

o Wheat dextrin has been shown to lactobacilli and reduce

Clostridium perfringens and bifidobacteria

o Study n=40 females, wheat dextrin supplementation (8 g per

day) for 14 days not only bacteroides, the predominant

beneficial saccharolytic genus of a normal gut flora but also

the numbers of pathogenic bacteria.

o Psyllium was found to have prebiotic potential in a small (n =

11) study in women (Slavin, 2013)


Food sources of prebiotics

o Inulin and FOS is naturally present in many different

foods, such as Jerusalem artichokes, asparagus, leek,

onions, banana (green cooked is very high in Resistant

starch), wheat, garlic, barley, chicory root, dandelion

root.

o The ‘superfoods’ for intestinal health - rye, barley and

legumes - contain all fibre types and therefore improve

several outcomes/symptoms.


Revision questions

1. Define the terms prebiotic and probiotic.

2. Describe the differences between insoluble and soluble fibres in

relation to intestinal health.

3. What is the best type of dietary fibre for laxation? Provide two food

sources.

4. What are the major physiologic effects of RS on the colon of

humans? Why is this beneficial?

5. What types of fibre would you recommend to lower blood

triglycerides and cholesterol? Provide dietary suggestion for three

meals.

6. What class of prebiotics are Bifidogenic?


MICROBIOME


Microbiome

o Although microbes have historically been viewed only as

pathogens, many microorganisms live in a symbiotic

relationship with the host and protect the host from

harmful pathogens.

o The microbial genome exceeds the human genome by a

100-fold, and adult human cells are outnumbered 10:1

by microbial cells.

o The human genome interacts with, and has evolved

alongside, the genomes of 10 to 100 trillion bacterial

cells (Mysorekar & Cao, 2014).


Human Microbiome Project (HMP)

The HMP plans to sequence 3000 genomes from both

cultured and uncultured bacteria, plus several viral and small

eukaryotic microbes isolated from human body sites (DACC

HMP, 2014).


Microbiota

o There is no clear consensus of what constitutes a

“normal” microbiota, or the ratio and locations of specific

bacterial species within the GI tract necessary to

maintain health.

o Up to 1000 different species of bacteria reside in the

colon with microbial populations comprising

approximately 1011 – 1012 cfu/g of contents.

o Generally bacteria having an almost exclusive

saccharolytic (e.g. not proteolytic activity) metabolism

are beneficial (Slavin, 2013)

o It is estimated that this bacterial population exceeds the

population of human cells by nearly 10 fold.


Microbiota

o Different qualitative and quantitative population

throughout GIT segments.

• Bacteria from the mouth, mainly anaerobes, Streptococci,

Bacteroides, Lactobacilli, and some yeasts

• In the stomach, the acid environment most oral micro-organisms

resulting in mostly gram positive and aerobic bacterium at very

low levels (103 CFUml−1).

o Concentrations of bacteria found in the small intestine

are also comparatively limited, ranging between 103 and

104 CFUml−1; both facultative anaerobes and aerobic

bacteria, including Lactobacilli, Streptococcus and

Bacteriodes are present.

(Encyclopaedia of Human Nutrition, 2013)


Microbiotao The microbiota of the colon dramatically increases to

concentrations of 1011 -1012 CFUg−1. This bacterial load

accounts for up to 50% of the volume of colonic content.

Although the bacterial species are too numerous to

count, the colonic microbiota are predominately

anaerobic including Bacteroides, Fusobacterium,

Bifidobacterium, Lactobacilli, Enterobacter, coliforms and

other facultative anaerobes (Staphlococcus and Candida

species).


Stool composition

Source: Encyclopaedia of Human Nutrition


Development of microbiota throughout life



The Placenta Harbors a Unique

Microbiome

o There is new evidence that microbes can reside in the

placenta, which transfer to the foetuses GIT which was

once though sterile (Indira et al., 2014).

o The placental microbiome has not been robustly

interrogated, despite recent demonstrations of

intracellular bacteria with diverse metabolic and immune

regulatory functions.

o Aagaard et al. (2014) characterised a unique placental

microbiome niche, composed of non-pathogenic

commensal microbiota from the Firmicutes, Tenericutes,

Proteobacteria, Bacteroidetes, and Fusobacteria phyla.


The placental microbiome has a taxonomic

profile that is similar to the oral microbiome

The thicker the

connecting line,

the greater the

similarity of the

taxonomic profile.

Strong phylum-

level similarity was

observed between

the placenta and

tongue, tonsils,

saliva, and

subgingival plaque.

The colours of dots

reflect the vicinity

of the body sites

(Aagaard, 2014)


Potential health implications

o The in utero infants GUT is no longer thought to be

sterile as microorganisms have been isolated from the

placenta. Possible effects:

• Influences development of the immune system

• Protects from allergies and infections early in life

• Specific microorganisms may play a role in pre term <37 weeks

(P = 0.001).

Urinary tract infection in the first trimester.

Potential for testing to determine microbial population during

pregnancy and ability positively influence microbial populations

(Aagaard et al., 2014)


Reducing the Risk and Alleviation of

Symptoms of Allergic Disease

o Lactobacillus rhamnosus strain GG (LGG) given

prenatally to mothers, and during the first months to

infants with a high risk of atopic disease has reduced the

prevalence of atopic eczema to approximately half in the

infants receiving the strain.

o Extensively hydrolysed whey formula supplemented with

LGG or Bifidobacterium lactis Bb-12 is more effective

than unsupplemented formula in eczema alleviation in

infants with atopic eczema.



Hypothesised mechanisms that reduce

the risk of allergic disease

o Maturation of gut barrier

• Lactobacillus rhamnosus GG

o Th1/Th2 balance

• Lactobacillus casei

• Bifidobacterium bifidum/infantis

• Bifidobacterium longum

o Down regulate IgE

• Bifidobacterium lactis Bb-12/bifidum

• Lactobacillus acidophilus


o Reduce serum inflammation


(Ozdemir, 2010)


Effect of Intestinal Microbiota on Immune

Responseo One of the most important functions of the intestinal

microbiota is activation of the mucosal immune

response.

o The intestinal microbiota profoundly influences the

development of specific and nonspecific host immune

response – 80% of all immunologically active cells of the

body are in gut-associated lymphoid tissue (GALT).

o The development of IgA producing plasmablasts is

influenced by intestinal bacterial.

o Secretory immunoglobulin A (sIgA) activity – protects

against antigens, potential pathogens, toxins, and

virulence factors (Encyclopaedia of Human Nutrition, 2013)


Effect of Intestinal Microbiota on Immune

Response

o Certain bacterial species will also have a significant

effect on mucosal T cell response. In the infant, intestinal

colonisation induces modulation of the ratio of T helper

type 2 (Th2-pro allergic) to T helper type 1 (Th1-

suppressive) responses, which decrease the chances for

immune hyper reactivity, such as in allergic disease later

in life.

o Thus, inadequate bacterial colonisation, such as in

infants born by caesarean section, or receiving

antibiotics repeatedly early in life, can increase

propensity for allergic conditions (Encyclopaedia of Human Nutrition,

2013).


Altering Gut Microbiotao Bifidobacteria, Lactobacilli and S. thermophilus have

been the most recognised and studied probiotics

because of their ability to survive the upper GI tract and

proliferate the colonisation, although transiently, in the

colon. The health benefits that these and other probiotics

include:

• prevention and treatment of diarrhoea (particularly

rotaviral and antibiotic associated),

• improved lactose digestion,

• enhanced gut immune function,

• prevention and treatment of food allergy and its

systemic effects (atopic dermatitis and possibly GI

allergic disease).


Probiotic adhesion and

replacement of pathogenic bacteria

(Encyclopaedia of Nutrition, 2013)


Role of Microbiota in Health and

Disease

o Specific variations in the intestinal microbiota may

predispose to disease.

o Differences in Clostridium content and composition have

been reported to be predisposing factors for both

inflammatory gut diseases and rotavirus diarrhoea.

o Microbiota differences have also been reported in

rheumatoid arthritis, juvenile chronic arthritis, and

irritable bowel syndrome (IBS) patients.


Pathways involved in bidirectional communication

between the gut microbiota and the brain

o Multiple pathways exist whereby gut

microbiota can modulate the gut–

brain axis, such as endocrine

immune, and neural pathways.

Under conditions of stress the HPA-

axis regulates cortisol secretion, and

cortisol can affect immune cells, alter

gut permeability and barrier function,

and change gut microbiota

composition. Conversely, the gut

microbiota and probiotic agents can

alter the levels of circulating

cytokines, and this can have a

marked effect on brain function

(Petschow, 2013).


Alterations of the gut microbiota and low-grade inflammation

may contribute to a cycle of events that induces a chronic

state in immune-mediated diseases. Interventions that target

the combined modulation of gut microbiota and inflammation

may be the most effective way to manage such conditions.

(Petschow, 2013)


Review questions

1. Name 5 health benefits associated with probiotics

2. Name 2 genera, species and strains of probiotic

microorganisms when given prenatally and in the first

few months of life reduce the incidence of atopic

disease and eczema.

3. Name 3 possible health effects of the placental

microbiome.


FOOD ALLERGY AND FOOD INTOLERANCE


Food allergy is an adverse immune-mediated response,

occurs reproducibly on exposure to a given food and is

absent during avoidance.

• A diagnosis requires evidence of sensitisation and specific

symptoms on exposure to a particular food.

• Classified into IgE-mediated, non-IgE-mediated or a mixture

of both.

• IgE-mediated food allergy - food allergen sensitisation (with

the development of serum specific IgE antibody to a food

allergen), development of signs and symptoms on exposure

to that food.

• Non-IgE-mediated food allergy - T-cell-mediated processes

predominate, histological evidence of an underlying immune

process such as eosinophilic inflammation of the

gastrointestinal tract.

FOOD ALLERGY


FOOD ALLERGY

• A food allergy can cause a serious or even life-threatening

reaction by eating a microscopic amount, touching or

inhaling the food.

• Symptoms of allergic reactions to foods are generally

seen on the skin (hives, itchiness, swelling).

• Gastro-intestinal symptoms may include vomiting and

diarrhoea.

• Respiratory symptoms may accompany skin and gastro-

intestinal symptoms, but don’t usually occur alone.

• Anaphylaxis is a serious allergic reaction that happens

very quickly.

• Most common food allergens are peanuts, tree nuts (such

as walnuts, pecans and almonds), fish, shellfish, milk,

eggs, soy and wheat.


Food Intoleranceo Any adverse reaction associated with food intake or

undesirable reactions to food. It may sometimes be directly

linked with one or more food constituents.

o Mainly involves digestive system rather than immune system.

o Some food intolerances involve an organic pathophysiological

process, such as lactose intolerance, fructose intolerance,

sensitivity to food additives, caffeine intolerance. Lactose

intolerance occurs as a consequence of deficiency in the

enzyme that breaks down lactose.

o Generally, people can eat small amounts of food without

causing problems.

o However, some food intolerances cannot be readily explained

by currently understood organic processes, e.g. many of the

food intolerances reported in irritable bowel syndrome (IBS)

patients.


FOOD ALLERGY AND FOOD INTOLERANCE

Aliment Pharmacol Ther 2015; 41: 3-25


Food Intolerance o Intolerances are NOT immunoglobulin driven - Key difference between

an intolerance and allergy. Intolerance can make person miserable but

allergy can be life threatening.

o Most common intolerant foods

• Wheat and other gluten-containing grains.

• Sugar found in fruits and honey.

• Cow’s milk and dairy products.

• Corn products.

o Food Intolerance – Pseudo-allergy

• Release of histamine due to large exposure to food chemicals

o Common foods within this class include:

• Caffeine

• Vasoactive amines in deli meats (ham, bacon, salami etc.)

• Tyramine in cheese, chocolate & red wine

• Mono-sodium glutamate (MSG) & sulphites used to preserve wine & dry

fruits


Malabsorption Syndromes

o Malabsorption can occur when any of the several steps in

nutrient digestion, absorption, and/or assimilation are

interrupted.

o Malabsorption can result from:

• Enzyme deficiencies

• Functional disorders such as hyper motility

• Food intolerances and allergy

• GIT irritation and inflammation

• GIT irritants, alcohol and certain drugs

• Dysbiosis

• Chronic diseases

o Primary symptom associated with malabsorption is

diarrhoea!


Intolerance and Malabsorption Syndromes

o The most common malabsorption syndromes are:

• Lactose intolerance – most common worldwide – lactase

deficiency

• Fructose intolerance

• Coeliac disease

• Irritable bowel syndrome

• Inflammatory bowel diseases,

o Others include: cystic fibrosis, short bowel syndrome, and a

range of congenital defects associated with nutrient assimilation.



Well-established probiotic effects are:

1. Prevention and/or reduction of duration and complaints

of rotavirus-induced or antibiotic-associated diarrhoea

and lactose intolerance.

2. Reduction of the concentration of cancer-promoting

enzymes and/or putrefactive (bacterial) metabolites in

the gut.

3. Prevention and alleviation of unspecific and irregular

complaints of the GIT in healthy subjects.

4. Beneficial effects on microbial aberrancies,

inflammation and other complaints in connection with:

inflammatory diseases of the gastrointestinal tract,

Helicobacter pylori infection or bacterial overgrowth.


Well-established probiotic effects are:

5. Normalisation of passing stool and stool consistency

6. Prevention or alleviation of allergies and atopic

diseases in infants.

7. Prevention of respiratory tract infections (common cold,

influenza) and other infectious diseases as well as

treatment of urogenital infections.

8. Improved lactose digestion. (Schrezenmeir, 2008)


Review Questions

o List five causes of food intolerances

o Name five potential causes of malabsorption

o In 200 words explain why fibre, prebiotics and probiotics

may improve both food intolerances and malabsorption.


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