Investigating the Impacts of Polyphenols and Dietary Fibre ...

Integria Healthcare Symposium 2021Restoring the Seat of Health 1

Investigating the Impacts of Polyphenols and Dietary Fibre on the Microbiome and Functional Gut HealthDr Elizabeth Steels

Investigating the Impacts of Polyphenols and Dietary Fibre on the Microbiome and Functional Gut Health

Dr Elizabeth SteelsPhD, GradDip(Nutr), GradCert(Ed), BSc(Hon)

Adjunct Senior Research Fellow, School of Pharmacy, UQ

Evidence Sciences Pty. Ltd.



Topics for Today

• Constipation and the functional axis of constipation

• Impact of dietary fibre and polyphenols

• Clinical study

Functional Constipation



Functional Constipation (FC)

• Is a primary disorder without underlying cause (excludes those with acondition that affects bowel motions)

• <3 stool motions per week on average

• Mostly type 1 and type 2 stools (Bristol Stool Chart)

• Having to strain during during evacuation and may have bloating,discomfort and pain

Chronic constipation. Nat Rev Dis Primers 3, 17096 (2017). https://doi.org/10.1038/nrdp.2017.96



Constipation: Underlying Considerations

https://www.grepmed.com/images/13083/differential-constipation-diagnosis-causes

Concomitant Considerations

• Mechanical: Colon, rectal or anal stricture, megacolon rectocele, intestinal pseudoobstruction, injured tissues, diverticulosis, abnormal narrowing of intestine or rectum

• Organic stenosis: Cancer or cancer-related causes, diverticulitis, sigmoid or caecalvolvulus, intestinal masses, inflammatory and ischemic or surgical stenosis

• Psychological conditions: Depression, anxiety, eating disorders

• Enteric neuropathies: Hirschsprung disease

• Neurological disorders: MS, Parkinson’s, stroke, spinal cord injury, paraplegia,spina bifida, autonomic neuropathy

• Endocrine/metabolic conditions: T2D, hypercalcaemia, porphyria,hypo/hyperthyroidism, pregnancy

• Myopathic disorders: Scleroderma and amyloidosis

• Connective tissue disorders: Lupus

Forootan M, Bagheri N, Darvishi M. Chronic constipation: A review of literature. Medicine. 2018;97(20). doi: 10.1097/MD.0000000000010631



Medication Considerations and Subtypes of Constipation

Forootan M, Bagheri N, Darvishi M. Chronic constipation: A review of literature. Medicine. 2018;97(20). doi: 10.1097/MD.0000000000010631

Bristol Stool Chart

Slow

transit

Rapid

transit

• Types 1, 2 and 3 are hard or

impacted

• Types 4 and 5 are normal

and optimal

• Type 6 is subnormal

• Type 7 is diarrhoea

• Colour and shape can be

red flags



FC More Than Just Poor Stool Output

Social Work Mood Health

Functional Axis of Constipation



Kastl Jr AJ, Terry NA et al. The structure and function of the human small intestinal microbiota: current understanding and future directions. Cell Mol Gastroenterol Hepatol.

2020;9(1):33-45. doi.10.1016/j.jcmgh.2019.07.006

Grenham S, Clarke G et al. Brain–gut–microbe communication in health and disease. Front. Physiol. 2011;2:94. doi 10.3389/fphys.2011.00094.

Factors that Support GIT Motility

• Factors that are vital to normal GIT motility are:

• Immune function

• Nervous system function

• Bile acid metabolism and mucus secretion

• GIT microbiota

• GIT fermentation

• An imbalance or dysfunction in any of these components may contribute to:

• Altered gut motility

• Symptoms of constipation

Ka

stl J

r A

J, Te

rry N

A e

t a

l. T

he

str

uctu

re a

nd

fu

nctio

n o

f th

e h

um

an s

mall

inte

stin

al

mic

rob

iota

: cu

rre

nt u

nd

ers

tandin

g a

nd

fu

ture

dire

ctio

ns. C

ell

Mo

l G

astr

oe

nte

rol H

ep

ato

l.

20

20

;9(1

):33

-45. d

oi.1

0.1

016/j.jcm

gh.2

019.0

7.0

06

Gre

nh

am

S,

Cla

rke G

et a

l. B

rain–

gu

t–m

icro

be c

om

mu

nic

ation

in h

ea

lth

an

d

dis

ea

se

. F

ron

t. P

hysio

l. 2

011;2

:94. d

oi 1

0.3

389/f

ph

ys.2

011.0

0094.



Colonic Transit is Linked to Gut Microbiota Diversity and Microbial Fermentation

Müller M, Hermes GD et al. Distal colonic transit is linked to gut microbiota diversity and microbial fermentation in humans with slow colonic transit. Am J Physiol Gastrointest Liver Physiol. 2020;318(2):G361-9. doi.10.1152/ajpgi.00283.2019

Constipation and Gut Microbiome

• Study 1: FC patients had:

• Relative decrease in obligate bacteria(Lactobacillus, Bifidobacterium/Bacteroides spp.)

• Parallel increase of potentially pathogenic microorganisms(Pseudomonas aeruginosa/Campylobacter jejuni)

• Study 2: FC patients had:

• Decreased Prevotella and increased representation in several generaof Firmicutes

• No change in genera Lactobacillus and Bifidobacteria

1. Zhao Y, Yu YB. Intestinal microbiota and chronic constipation. Springer plus. 2016;5(1):1130. doi:10.1186/s40064-016-2821-12. Ahmadi S, Nagpal R et al. Prebiotics from acorn and sago prevent high-fat-diet-induced insulin resistance via microbiome–gut–brain axis modulation.

J Nutr Biochem. 2019;67:1-3. doi.10.1016/j.jnutbio.2019.01.011



Gut Dysbiosis Complications

Fukui H. Gut microbiome-based therapeutics in liver cirrhosis: basic consideration for the next step. J Clin Transl Hepatol. 2017;5(3):249. doi.10.14218/JCTH.2017.00008

Stress and heightened emotional

states can affect GIT motility (as

well as increase abdominal pain and

the ANS modulates these effects).

The long-term effects of stress have

functional effects; altering GIT

motility and secretions, reducing the

capacity of gastrointestinal mucosa

to regenerate, which in turn can

impact on the health of the gut

microbiome.

Constipation and Gut-Brain Axis

Rhee SH, Pothoulakis C, Mayer EA. Principles and clinical implications of the brain–gut–enteric microbiota axis. Nat Rev Gasteroenterol Hepatol. 2009;6(5). doi: 10.1038/nrgastro.2009.35

Gu

t D

ysb

iosis

C

om

pli

ca

tio

ns

Fu

ku

i H

. G

ut

mic

rob

iom

e-b

ased th

era

pe

utics in liv

er

cirrh

osis

: b

asic

co

nsid

era

tion fo

r th

e n

ext ste

p. J C

lin T

ran

sl H

ep

ato

l. 2

01

7;5

(3):

249

. d

oi.1

0.1

42

18/J

CT

H.2

017.0

0008

Str

ess a

nd

he

igh

ten

ed

em

otio

na

l

sta

tes c

an a

ffect G

IT m

oti

lity

(as

we

ll a

s in

cre

ase

ab

do

min

al p

ain

an

d

the

AN

S m

od

ula

tes th

ese

effe

cts

).

Th

e lo

ng

-te

rm e

ffe

cts

of str

ess h

ave

fun

ctio

na

l e

ffe

cts

; a

lte

rin

g G

IT

mo

tilit

y a

nd

se

cre

tio

ns, re

du

cin

g th

e

ca

pa

city o

f g

astr

oin

testin

al m

uco

sa

to r

eg

en

era

te, w

hic

h in

tu

rn c

an

imp

act o

n th

e h

ea

lth

of th

e g

ut

mic

rob

iom

e.

Co

nsti

pati

on

an

d G

ut-

Bra

in A

xis

Rhe

e S

H, P

oth

ou

lakis

C, M

aye

r E

A.

Prin

cip

les a

nd

clin

ical im

plic

atio

ns o

f th

e b

rain–

gu

t–ente

ric m

icro

bio

ta a

xis

. N

at R

ev G

aste

roe

nte

rol H

ep

ato

l.

20

09

;6(5

). d

oi: 1

0.1

038/n

rgastr

o.2

009.3

5



Constipation, Gut-Brain Axis and Gut Microbiome

• It is now recognised that the gut-brainaxis plays a pivotal role in:

• Stress related disorders andgastrointestinal motility

• This may be related to the gutmicrobiome

Carco C, Young W et al. Increasing evidence that irritable bowel syndrome and functional gastrointestinal disorders have a microbial pathogenesis. Front. Cell. Infect. Microbiol. 2020. doi.10.3389/fcimb.2020.00468

Microbiota Regulation of Neuroinflammation and HPA Axis Activity

Rea K, Dinan TG, Cryan JF. The microbiome: a key regulator of stress and neuroinflammation. Neurobiol Stress. 2016;4:23-33. doi.10.1016/j.ynstr.2016.03.001

Co

nsti

pati

on

, G

ut-

Bra

in A

xis

a

nd

Gu

t M

icro

bio

me

•It

is n

ow

recognis

ed t

hat th

e g

ut-

bra

in

axis

pla

ys a

piv

ota

l ro

le in:

•S

tress r

ela

ted d

isord

ers

and

gastr

oin

testin

al m

otilit

y

•T

his

may b

e r

ela

ted t

o the g

ut

mic

robio

me

Carc

o C

, Y

ou

ng W

et

al. In

cre

asin

g e

vid

en

ce

th

at irrita

ble

bo

we

l syn

dro

me

an

d fu

nction

al ga

str

oin

testin

al d

isord

ers

ha

ve

a m

icro

bia

l p

ath

oge

nesis

. F

ron

t.

Cell.

In

fect.

Mic

rob

iol. 2

02

0. d

oi.1

0.3

389/f

cim

b.2

02

0.0

04

68

Mic

rob

iota

R

eg

ula

tio

n o

f N

eu

roin

fla

mm

ati

on

an

d H

PA

Axis

A

cti

vit

y

Rea

K,

Din

an

TG

, C

rya

n J

F. T

he

mic

rob

iom

e: a

ke

y r

egu

lato

r o

f str

ess a

nd

ne

uro

inflam

mation

. N

eu

rob

iol S

tre

ss.

20

16;4

:23

-33.

do

i.1

0.1

01

6/j.y

nstr

.20

16.0

3.0

01



Words for figure

• Schematic for microbiota regulation of neuroinflammation and HPA axis activity.Communication within the microbiota-gut-brain axis involves the complex co-ordination ofa number of factors and systems. The microbiota can govern events in the periphery andCNS by various means of communication including vagal nerve activation, cytokineproduction, neuropeptide and neurotransmitter release, SCFA release and microbial by-products, and by utilising the lymphatic and systemic circulation. Once these signalspenetrate the blood brain barrier and reach the brain, they can influence the maturationand activation state of the microglia. Once activated, microglia play a key role in immunesurveillance, synaptic pruning and clearance of debris. They also facilitate a number ofeveryday functions in the brain, including the regulation of HPA axis activation state. Therelease of glucocorticoids (cortisol) as a consequence of HPA axis activation can in turnregulate the activation state of brain microglia, as well as influence cytokine release andtrafficking of monocytes from the periphery to the brain. HPA Hypothalamic-Pituitary-Adrenal; BDNF Brain derived neurotrophic factor; LTP Long term potentiation; BBB Blood-brain barrier; GC Glucocorticoids; GR Glucocorticoid receptor; FFAR Free fatty acidreceptor; SCFA Short chain fatty acid; NP Neuropeptide; NT Neurotransmitter; DCDendritic cell; EEC Enteroendocrine cell.

Rea K, Dinan TG, Cryan JF. The microbiome: a key regulator of stress and neuroinflammation. Neurobiol Stress. 2016;4:23-33. doi.10.1016/j.ynstr.2016.03.001

Gut-Metabolic Axis

Moreno-Indias I, Cardona F et al. Impact of the gut microbiota on the developmhttps://doi.org/10.3389/fmicb.2014.00190ent of obesity and type 2 diabetes mellitus. Front. Microbiol. 2014;5:190. doi 10.3389/fmicb.2014.00190

Gu

t-M

eta

bo

lic

Ax

is

Mo

ren

o-I

ndia

s I,

Ca

rdo

na F

et a

l. I

mp

act o

f th

e g

ut

mic

rob

iota

on

th

e d

eve

lop

mhtt

ps:/

/doi.org

/10.3

389/f

mic

b.2

014.0

01

90en

t o

f o

be

sity a

nd

typ

e 2

d

iab

ete

s m

elli

tus. F

ron

t. M

icro

bio

l. 2

01

4;5

:190

. d

oi 1

0.3

389

/fm

icb.2

014.0

0190



Summary of Functional Constipation

Clinical insights:

• Diet: fibre, prebiotics, water

• Disrupted microbiome

• Neurological: acute anxiety

• Conditioning: neurological,childhood?

Vriesman, Mana H et al., 2020. Management of functional constipation in children and adults. Nature reviews. Gastroenterol Hepatol, 17(1), pp.21–39.

Impact of Dietary Fibre and Polyphenols

Su

mm

ary

of

Fu

nc

tio

na

l C

on

sti

pa

tio

n

Clin

ical in

sig

hts

:

•D

iet:

fib

re, pre

bio

tics,

wate

r

•D

isru

pte

d m

icro

bio

me

•N

euro

logic

al: a

cute

anxie

ty

•C

onditio

nin

g:

neuro

logic

al,

ch

ildh

oo

d?

Vrie

sm

an

, M

an

a H

et

al., 2

02

0. M

an

age

men

t o

f fu

nctio

nal co

nstip

atio

n in c

hild

ren

an

d a

du

lts. N

atu

re r

evie

ws.

Ga

str

oe

nte

rol H

ep

ato

l, 1

7(1

), p

p.2

1–

39.



Function of the Intestinal Microbiome

Grenham S, Clarke G et al. Brain–gut–microbe communication in health and disease. Front. Physiol. 2011;2:94. doi 10.3389/fphys.2011.00094.

Probiotics versus Prebiotics



Key Definitions

• Probiotics: microorganisms that alter the microflora of the host, availableas supplements or through diet1

• Prebiotics: nondigestible dietary components that selectively stimulate thegrowth and/or activity of host bacteria1

• Synbiotics: contain both probiotics and prebiotics1

• Postbiotics: According to the International Scientific Association ofProbiotics and Prebiotics (ISAPP), a postbiotic is defined as a “preparationof inanimate microorganisms and/or their components that confers ahealth benefit on the host” 2

1. Patel RM, Denning PW. Therapeutic use of prebiotics, probiotics, and postbiotics to prevent necrotizing enterocolitis: what is the current evidence?Clinics in Perinatology. 2013;40(1):11-25. DOI: 10.1016/j.clp.2012.12.002.

2. Salminen, S., Collado, M.C. et al. The International Scientific Association of Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of postbiotics. Nat Rev Gastroenterol Hepatol. 2021;18, 649–667. doi.10.1038/s41575-021-00440-6

Pre- Pro- and Postbiotics

Patel RM, Denning PW. Therapeutic use of prebiotics, probiotics, and postbiotics to prevent necrotizing enterocolitis: what is the current evidence? Clinics in Perinatology. 2013;40(1):11-25. DOI: 10.1016/j.clp.2012.12.002.



Effect of Prebiotics on Gut Function and Health

Mohajeri, M.H., Brummer. et al. The role of the microbiome for human health: from basic science to clinical applications. Eur J Nutr. 2018;57,1–14. doi.10.1007/s00394-018-1703-4

Dietary Fibre & Prebiotics

• The human body needs a variety of fibre for:

1. Transit time support

2. Microbiome composition support (prebiotic)

• If the microbiome only has access to fibre from a single source such asrefined flour, there will be a reduction in microbiome diversity and someGIT issues

• The fruit and vegetables in the diet also provide an importantprebiotic that is not a chained CHO (polyphenols)

Expert consensus document: The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of prebiotics (2017)

Eff

ect

of

Pre

bio

tic

s o

n

Gu

t F

un

cti

on

a

nd

He

alt

h

Mo

ha

jeri, M

.H.,

Bru

mm

er.

et

al. T

he

role

of

the

mic

rob

iom

e fo

r h

um

an h

ea

lth

: fr

om

ba

sic

scie

nce

to

clin

ica

l a

pp

licatio

ns. E

ur

J N

utr

. 2

01

8;5

7,1–14.

do

i.1

0.1

00

7/s

003

94

-01

8-1

703-4



Variety of Fibre is Essential

Low-Residue and Low-Fiber Diets in Gastrointestinal Disease Management - Scientific Figure on ResearchGate. Available from: https://www.researchgate.net/figure/Overview-of-possible-effects-of-different-fibers-on-gastrointestinal-digestion-and_fig1_283790366 [accessed 3 Aug,

2021]

Impact of Dietary Fibre, SCFAs & Inflammation

Keshteli AH, Madsen KL, Dieleman LA. Diet in the pathogenesis and management of ulcerative colitis; A review of randomized controlled dietary interventions. Nutrients. 2019;11(7):1498. doi.10.3390/nu11071498

Imp

act

of

Die

tary

Fib

re,

SC

FA

s

& In

flam

mati

on

Ke

sh

teli

AH

, M

ad

se

n K

L, D

iele

ma

n L

A. D

iet in

th

e p

ath

oge

nesis

an

d m

an

agem

ent o

f u

lcera

tive

co

litis

; A

re

vie

w o

f ra

nd

om

ize

d c

on

tro

lled d

ieta

ry

inte

rve

ntio

ns. N

utr

ien

ts. 2

01

9;1

1(7

):149

8. d

oi.1

0.3

39

0/n

u110

71498



Dietary Fibre & SCFAs Influence Detoxification

Spanogiannopoulos P, Bess EN et al. The microbial pharmacists within us: a metagenomic view of xenobiotic metabolism. Nat Rev Microbiol. 2016;14(5):273-87. doi.10.1038/nrmicro.2016.17

Dietary Fibre, SCFAs & Systemic Circulation

Dalile B, Van Oudenhove L et al. The role of short-chain fatty acids in microbiota–gut–brain communication. Nat Rev Gasteroenterol Hepatol. 2019;16(8):461-78. doi.10.1038/s41575-019-0157-3

Die

tary

Fib

re

& S

CF

As

Infl

ue

nc

e

Deto

xif

icati

on

Sp

an

ogia

nnop

oulo

s P

, B

ess E

N e

t a

l. T

he

mic

rob

ial p

ha

rma

cis

ts w

ith

in u

s: a

me

tage

nom

ic v

iew

of xe

no

bio

tic m

eta

bo

lism

. N

at R

ev

Mic

rob

iol.

20

16

;14(5

):2

73-8

7. d

oi.1

0.1

03

8/n

rmic

ro.2

016.1

7

Die

tary

Fib

re,

SC

FA

s &

Sy

ste

mic

Cir

cu

lati

on

Dalil

e B

, V

an

Ou

de

nhove

L e

t a

l. T

he

role

of sh

ort

-ch

ain

fa

tty a

cid

s in m

icro

bio

ta–gut–

bra

in c

om

mu

nic

ation

. N

at R

ev G

aste

roe

nte

rol H

ep

ato

l.

20

19

;16(8

):4

61-7

8. d

oi.1

0.1

03

8/s

415

75

-019-0

157-3



Metabolic Effects of Dietary Fibre & SCFAs

Li X, Watanabe K, Kimura I. Gut microbiota dysbiosis drives and implies novel therapeutic strategies for diabetes mellitus and related metabolic diseases. Front Immunol. 2017 Dec 20;8:1882. doi.10.3389/fimmu.2017.01882

Dietary Fibre & SCFAs Shape Gut-Brain Connection

Dalile B, Van Oudenhove L et al. The role of short-chain fatty acids in microbiota–gut–brain communication. Nat

Rev Gasteroenterol Hepatol. 2019;16(8):461-78. doi.10.1038/s41575-019-0157-3

Me

tab

oli

c

Eff

ec

ts o

f D

ieta

ry F

ibre

&

SC

FA

s

Li X

, W

ata

nabe

K,

Kim

ura

I.

Gu

t m

icro

bio

ta d

ysb

iosis

drive

s a

nd

im

plie

s n

ove

l th

era

peu

tic s

tra

tegie

s fo

r d

iab

ete

s m

elli

tus a

nd

re

late

d m

eta

bolic

dis

ea

se

s.

Fro

nt Im

mu

no

l. 2

01

7 D

ec 2

0;8

:188

2. d

oi.1

0.3

389/f

imm

u.2

01

7.0

18

82

Die

tary

Fib

re

&

SC

FA

s S

ha

pe

G

ut-

Bra

in

Co

nn

ecti

on

Da

lile

B,

Va

n O

ud

en

hove

L e

t a

l. T

he

role

of sh

ort

-ch

ain

fa

tty a

cid

s in m

icro

bio

ta–gut–

bra

in c

om

mu

nic

ation. N

at

Re

v G

aste

roe

nte

rol H

ep

ato

l. 2

01

9;1

6(8

):461

-78.

do

i.1

0.1

03

8/s

415

75-0

19-0

157-3



Aim for Variety of Prebiotics/Polyphenols in Diet

• Process of “Cross-feeding”

• Products produced from fermentation of a polysaccharide by one bacterialspecies provide substrates for growth of other bacteria

• Dietary fibre promotes extensive metabolic interactions among bacterialspecies in the GIT microbiota

• Indirect stimulation of the growth of other microbes within the communitythrough the utilisation of by-products of other community members

• Dietary modulation of GIT microbiota via fibre or prebiotic consumption canresult in metabolic consequences that are different from results of singleculture-based experimentations that assess bacterial growth on isolatedsubstrates

Individual Responses to Prebiotics/Polyphenols

• Microbiota response to dietary modulation via fibre is influenced by:

• Host genetics

• Adequate dosages of the dietary polysaccharide of interest

• Individual microbiota composition

• Individuals could be categorised into responders and non-responders

• 2.5 g/d FOS or GOS did not increase Bifidobacteria, while doses of 10 g/d did

• Up to 7.5 g/day of agave inulin produced no response in people without Bifidobacteria

• Composition of individual microbiota and keystone species influences fibre fermentation

• Ruminococcus bromii had a reduced capacity to ferment the supplemented resistantstarch, resulting in 20–30% fermentability compared to 100% fermentability in thosewithout it

Holscher HD. Dietary fiber and prebiotics and the gastrointestinal microbiota. Gut Microbes. 2017;8(2):172-184. doi:10.1080/19490976.2017.1290756



Importance of Fibre Polyphenol Ratio

• Consider fibre intake in context ofentire diet

• Dietary fibre per kilocalorie hasbeen shown to be positively relatedto both Bifidobacterium spp.abundance and faecal butyrateconcentrations

Makki K, Deehan EC, et al. The impact of dietary fiber on gut microbiota in host health and disease. Cell Host Microbe. 2018;23(6):705-15.

Chemical Structure of Polyphenols

• Dietary polyphenols arenatural compoundsoccurring in plants,including foods such asfruits, vegetables, cereals,tea, coffee and wine

• Chemically, polyphenolsare a large heterogeneousgroup of compoundscharacterized byhydroxylated phenylmoieties

Beconcini D, Felice F et al. (2020). Antioxidant and anti-inflammatory properties of cherry extract: nanosystems-based strategies to improve endothelial function and intestinal absorption. Foods. 2020;9(2):207. doi 10.3390/foods9020207.

Imp

ort

an

ce

of

Fib

re

Po

lyp

hen

ol R

ati

o

•C

on

sid

er

fib

re in

take

in

co

nte

xt

of

en

tire

die

t

•D

ieta

ry f

ibre

per

kilo

calo

rie h

as

be

en s

how

n t

o b

e p

ositiv

ely

rela

ted

to b

oth

Bifid

ob

acte

riu

m s

pp.

ab

undance a

nd f

aecal buty

rate

co

ncentr

ations

Ma

kki K

, D

ee

ha

n E

C, e

t a

l. T

he

im

pa

ct o

f d

ieta

ry f

ibe

r o

n g

ut

mic

rob

iota

in h

ost h

ea

lth

a

nd

dis

ea

se. C

ell

Host M

icro

be

. 2

01

8;2

3(6

):7

05

-15.

Ch

em

ica

l S

tru

ctu

re o

f P

oly

ph

en

ols

•D

ieta

ry p

oly

ph

en

ols

are

na

tura

l com

pou

nd

s

occurr

ing

in

pla

nts

, in

clu

din

g fo

od

s s

uch a

s

fru

its,

ve

ge

tab

les,

ce

rea

ls,

tea,

coffe

e a

nd w

ine

•C

he

mic

ally

, po

lyph

en

ols

are

a la

rge h

ete

roge

ne

ou

s

gro

up

of

co

mp

ou

nd

s

cha

racte

rized

by

hyd

roxyla

ted p

hen

yl

moie

tie

s

Be

co

ncin

i D

, F

elic

e F

et a

l. (

20

20

). A

ntio

xid

ant a

nd

an

ti-inflam

mato

ry p

rop

ert

ies o

f ch

err

y e

xtr

act:

na

no

syste

ms-b

ased

str

ate

gie

s to

im

pro

ve

en

do

thelia

l fu

nctio

n a

nd

inte

stin

al a

bso

rption. F

oo

ds. 2

02

0;9

(2):

207

. d

oi 1

0.3

390

/food

s90202

07.



Polyphenols Interactions with the Gut

• Microbial glucuronidase andsulphatase activity may alsodeconjugate the phase II metabolitesextruded via the bile throughout theenterohepatic circulation, enabling theirreuptake and affect bioavailability

• Clostridium and Eubacterium involvedin metabolism of phenolics such asisoflavones, flavones and flavan-3-ols

• Firmicutes possess less glycan-degrading enzymes than Bacteroideteswhich also suggests that intake ofdifferent polyphenols could reshape thegut microbiota differently

Cardona F, Andrés-Lacueva C et al. Benefits of polyphenols on gut microbiota and implications in human health, J Nutr Biochem. 2013;24(8):1415-22. doi 10.1016/j.jnutbio.2013.05.001.

Polyphenols and Gut Microbiota• Phenolics alter gut microbiota and alter Bacteroides / Firmicutes balance1

• Catechin inhibits growth of Clostridium histolyticum and enhances growth of E. coli andmembers of Clostridium coccoides–Eubacterium rectale group, while growthof Bifidobacterium and Lactobacillus spp. remain relatively unaffected2

• Proanthocyanidin-rich extract from grape seeds given to healthy adults for 2 weeks wasable to significantly increase the number of Bifidobacteria3

• Monomeric flavan-3-ols and flavan-3-ol-rich sources (chocolate, green tea, blackcurrant,grape seed extracts may modulate the intestinal microbiota, producing changes inbeneficial bacteria such as Lactobacillus spp. but inhibiting other groups such asClostridium spp. in both in vivo and in vitro studies4

• A cocoa dietary intervention in a rat model showed a significant decrease in the proportionof Bacteroides, Clostridium and Staphylococcus genera in the faeces of cocoa-fedanimals5



References for Previous Slide

1. Tzounis X, Rodriguez-Mateos A et al. Prebiotic evaluation of cocoa-derived flavanols inhealthy humans by using a randomized, controlled, double-blind, crossover interventionstudy. AJCN. 2011;93(1):62-72. doi.10.3945/ajcn.110.000075

2. Yamakoshi J, Tokutake S et al. Effect of proanthocyanidin-rich extract from grape seedson human fecal flora and fecal odor. Microb Ecol Health Dis. 2001;13(1):25-31.doi 10.1080/089106001750071672

3. Molan AL, Liu Z. Kruger M. The ability of blackcurrant extracts to positively modulatekey markers of gastrointestinal function in rats. World J MicrobiolBiotechnol. 2010;26(10):1735-43. doi 10.1007/s11274-010-0352-4

4. Viveros A, Chamorro S et al. Effects of dietary polyphenol-rich grape products onintestinal microflora and gut morphology in broiler chicks Poult Sci. 2011 Mar1;90(3):566-78. doi 10.3382/ps.2010-00889

5. Massot-Cladera M, Pérez-Berezo T et al. Cocoa modulatory effect on rat faecalmicrobiota and colonic crosstalk. Arch Biochem Biophys. 2012;527(2):105-12.doi 10.1016/j.abb.2012.05.015

Polyphenols Inhibit Pathogenic Microbes

• Variety of potential mechanisms of action of polyphenols on bacterial cellsand pathogenic species:

• Bind to bacterial cell membranes disturbing membrane function andinhibiting cell growth (catechins inhibit K. pneumonie, S. choleraesis,P. aeruginosa, S. aureus)

• Interfere with bacterial quorum sensing, which is achieved byproducing, releasing and detecting small signal molecules identified asautoinducers (green tea sensitises MRSA to B-lactum antibiotics, redwine/green tea polyphenols inhibit VacA in H.pylori)

• Inhibitory action on DNA and RNA synthesis (quercetin binds DNAE.coli subunits)

Cardona F, Andrés-Lacueva C et al. Benefits of polyphenols on gut microbiota and implications in human health. J Nutr Biochem. 2013;24(8):1415-22. doi10.1016/j.jnutbio.2013.05.001



Polyphenols Reduce Inflammation

• Bacterial fermentation of cocoa fractions increases Bifidobacteria,Lactobacilli and butyrate production and reduces plasma triacylglyceroland CRP

• Regular intake of red wine polyphenols/cocoa decreases BP andtriglycerides, increases HDL and growth of Bacteroides, also decreasesuric acid levels

• Hypothesised that reduction in CRP is due to increase in Bifidobacterium

V. Fogliano, M.L. Corollaro, et al. In vitro bioaccessibility and gut biotransformation of polyphenols present in the water-insoluble cocoa fraction. Mol NutrFood Res, 55 (1) (2011), pp. 44-55

M.I. Queipo-Ortuño, M. Boto-Ordóñez, et al. Influence of red wine polyphenols and ethanol on the gut microbiota ecology and biochemical biomarkers

Summary

Kumar Singh A, Cabral C, et al. Beneficial effects of dietary polyphenols on gut microbiota and strategies to improve delivery efficiency. Nutrients. 2019;11(9):2216. doi 10.3390/nu11092216

Su

mm

ary

Ku

ma

r S

ingh

A,

Cab

ral C

, e

t a

l. B

en

eficia

l e

ffe

cts

of d

ieta

ry p

oly

ph

en

ols

on

gu

t m

icro

bio

ta a

nd

str

ate

gie

s to

im

pro

ve

de

live

ry e

ffic

iency.

Nutr

ien

ts.

20

19

;11(9

):2

21

6. d

oi 1

0.3

39

0/n

u110

92216



Summary - Polyphenols and Gut Health

• Bioavailability and effects of polyphenols greatly depend on theirtransformation by components of the gut microbiota

• Studies are determining gut microbiota transformation of particularpolyphenol types and identifying responsible microorganisms

• Dietary polyphenols and their metabolites exert prebiotic-like effects tomaintain gut health; stimulating growth of beneficial bacteria and inhibitingpathogenic bacteria

• New techniques of metagenomic and metabolomic studies will providemore insight into health effects of polyphenols

Insights from a Prebiotic Intervention Study on Functional Constipation



Clinical Study Rationale• Treatment with a polyphenol/prebiotic formulation for 3 weeks in a group of

people with:

1. Functional constipation and associated GIT symptoms and

2. Self-reported low intake of fruits, vegetables and whole grains

• Will result in positive health benefits including:

• Improved bowel motions (frequency and consistency)

• Reduction in GIT symptoms and improvement in QOL

• Gut microbiome modulating effects *

• Safe (RBC and E/LFT) and well tolerated

* Results are still being analysed

Constipation-related Symptoms

PAC-SYM questionnaire

• 12 questions about constipation

• The symptoms rated from none (0) to

severe (4)

• Symptom subscales:

• Abdominal (Q1-4)

• Rectal (Q5-8)

• Stool (Q9-12)

• Study: Baseline results:

• Average score: 17 (max 48)

Range of scores 7 to 33

Discomfort in your abdomen

Pain in your abdomen

Bloating in your abdomen

Stomach cramps

Painful bowel movements

Rectal bleeding during or after a bowel movement

Incomplete bowel movement, like you didn’t “finish”

Bowel movements that were too hard

Bowel movements that were too small

Straining or squeezing to try to pass bowel movements



Constipation-related Quality of Life

PAC-Q

• Specific effects of constipation on how people function in daily life

• PAQ has been validated against and correlates with the PAC-SYM

DASS

• Focusses on the symptoms of depression, anxiety and stress in the person

on that day (overall mood)

Clinic insight:

• Functional constipation has a significant impact on quality of life

• Higher prevalence of anxiety/stress in those with functional constipation

than general population

Constipationrelated

QOL

PAC-QOL

Physical discomfort 1. Felt bloated to the point of bursting?

2. Felt heavy because of your constipation?

3. Felt any physical discomfort?

4. Felt the need to have a bowel motion but not able to?

Psychosocial

discomfort

5. Been embarrassed to be with other people?

6. Been eating less and less because of not being able to have bowel movements?

7. Had to be careful about what you eat?

8. Had a decreased appetite?

9. Choose what you eat (for example, at a friend’s house)?

10. Been embarrassed about staying in the bathroom for so long when you were away from home?

11. Been embarrassed about having to go to the bathroom so often when you were away from home?

12. Your daily routine (for example, traveling, being away from home)?

Worries and concerns 13. Felt irritable because of your condition?

14. Been upset by your condition?

15. Felt obsessed by your condition?

16. Felt stressed by your condition?

17. Felt less self-confident because of your condition?

18. Felt in control of your situation?

19. Been worried about not knowing when you are going to be able to have a bowel movement?

20. Been worried about not being able to have a bowel movement?

21. Been more and more bothered by not being able to have a bowel movement?

22. Been worried that your condition will get worse?

23. Felt that your body was not working properly?

Treatment satisfaction 24. Had fewer bowel movements than you would like?

25. Satisfied with how often you have a bowel movement?

26. Satisfied with the regularity of your bowel movements?

27. Satisfied with the time it takes for food to pass through the intestines?

28. Satisfied with your treatment?

Co

ns

tip

ati

on

rela

ted

Q

OL

PA

C-Q

OL

Ph

ys

ica

l d

isc

om

fort

1.F

elt

blo

ate

dto

the

poin

tofb

urs

tin

g?

2.F

elt

heavy

because

ofyour

constipation?

3.F

elt

any

ph

ysic

ald

isco

mfo

rt?

4.F

elt

the

need

toh

ave

ab

ow

elm

otio

nbutnotable

to?

Ps

yc

ho

so

cia

l

dis

co

mfo

rt

5. B

ee

n e

mb

arr

asse

d to

be

with

oth

er

pe

op

le?

6. B

ee

n e

atin

g le

ss a

nd

le

ss b

eca

use o

f n

ot b

ein

g a

ble

to

ha

ve

bo

we

l m

ove

me

nts

?

7. H

ad

to

be

ca

refu

l a

bo

ut w

ha

t yo

u e

at?

8. H

ad

a d

ecre

ase

d a

pp

etite

?

9. C

ho

ose

wh

at

yo

u e

at (f

or

exa

mp

le, a

t a

frie

nd

’s h

ou

se

)?

10

. B

ee

n e

mb

arr

assed

ab

ou

t sta

yin

g in

th

e b

ath

roo

m fo

r so

lo

ng

wh

en

yo

u w

ere

aw

ay f

rom

ho

me

?

11

. B

ee

n e

mb

arr

asse

d a

bo

ut h

avin

g to

go

to

th

e b

ath

roo

m s

o o

fte

n w

he

n y

ou

we

re a

wa

y f

rom

ho

me

?

12

. Y

ou

r d

aily

ro

utin

e (

for

exa

mp

le, tr

ave

ling

, b

ein

g a

wa

y f

rom

ho

me

)?

Wo

rrie

s a

nd

co

nc

ern

s1

3. F

elt irr

ita

ble

be

ca

use

of yo

ur

co

nd

itio

n?

14

. B

ee

n u

pse

t b

y y

ou

r co

nd

itio

n?

15. F

elt o

bsessed b

y y

our

conditio

n?

16

. F

elt s

tre

sse

d b

y y

ou

r co

nd

itio

n?

17

. F

elt le

ss s

elf-c

on

fid

en

t b

eca

use

of yo

ur

co

nd

itio

n?

18

. F

elt in

co

ntr

ol o

f yo

ur

situ

atio

n?

19

. B

ee

n w

orr

ied

ab

ou

t n

ot kn

ow

ing

wh

en

yo

u a

re g

oin

g to

be

ab

le to

ha

ve

a b

ow

el m

ove

me

nt?

20

. B

ee

n w

orr

ied

ab

ou

t n

ot b

ein

g a

ble

to

ha

ve

a b

ow

el m

ove

me

nt?

21

. B

ee

n m

ore

an

d m

ore

bo

the

red

by n

ot b

ein

g a

ble

to

ha

ve

a b

ow

el m

ove

me

nt?

22

. B

ee

n w

orr

ied

th

at yo

ur

co

nd

itio

n w

ill g

et w

ors

e?

23

. F

elt th

at yo

ur

bo

dy w

as n

ot w

ork

ing

pro

pe

rly?

Tre

atm

en

t s

ati

sfa

cti

on

24

. H

ad

fe

we

r b

ow

el m

ove

me

nts

th

an

yo

u w

ou

ld lik

e?

25

. S

atisfie

d w

ith

ho

w o

fte

n y

ou

ha

ve

a b

ow

el m

ove

me

nt?

26

. S

atisfie

d w

ith

th

e r

eg

ula

rity

of yo

ur

bo

we

l m

ove

me

nts

?

27. S

atisfied w

ith the tim

e it ta

kes for

food to p

ass thro

ugh the inte

stines?

28

. S

atisfie

d w

ith

yo

ur

tre

atm

ent?



Clinical Aspects

1. Poor diet was a recognised probable cause (n=40; 66%)

2. Restricted diet (food sensitivities, major issue was dairy, gluten) (n=6, 10%)

3. Coffee used as a laxative (n=10, 13%) (why?)

4. Regular exercise (n=18, 29%) beneficial or not? Dehydration, electrolytes?

5. Possibly hormone related (n=3, 5%)

6. Experiencing stress and/or anxiety (n=21, 32%)

7. Wide variation in total energy intake (lowest 800 calories)

8. High consumption of foods that may increase constipation – gluten containingfoods, processed grains (bread, pasta, rice), milk and dairy products, red meat,fried or fast foods, alcohol

Study Design

• Study Group • Polyphenol/Prebiotic Formulation

Total Men Women

Prebiotic 28 8 (10.7%) 25 (89.3%)

Comparator 30 9 (30.0%) 21 (70.0%)

Ingredients Quantity

Partially hydrolysed Guar Gum (PHGG) 3 g

Acacia Gum 1 g

Slippery Elm 500 mg

Fruit Pectin 500 mg

Theobroma cacao (Cacao) 500 mg

Hylocereus polyrhizus (Red Dragon Fruit) 500 mg



Intervention Improves Stool Frequency

• Baseline • Day 21

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

4.50

5.00

Av Baseline Av week 1 Av week 2 Av week 3

Stool frequency (weeks total)


Group A – Prebiotic group Group B – Comparator group

Inte

rven

tio

n I

mp

roves S

too

l F

req

uen

cy

•B

ase

line

•D

ay 2

1




Stool frequency

Baseline P-value W1 P-value W2 P-value W3 P-value

Prebiotic 2.8 (1-4)

0.397

3.3 (2-6)

0.022

3.9 (0-7)

0.014

4.6 (0-7)

<0.001Comparator 2.9 (2-4) 2.9 (2-4) 3.2 (1-6) 3.0 (2-5)

*Significance similar using ANOVA and Mann-Witney U test

Intervention Improves Stool Composition

Baseline Days 1-7 Days 8-14 Days 15-21

Prebiotic Min 1.3 - 5.3 1.0 - 5.0 2.0 - 5.6 1.7 - 5.6

Av. (SD) 2.8 (1.2) 2.8 (1.0) 3.2 (0.8) 3.3 (0.9)

Comparator Min 1.3 - 6.3 1.3 - 5.5 1.3 - 5.5 1.0 - 4.5

Av. (SD) 2.7 (1.2) 2.6 (1.2) 2.7 (1.1) 2.5 (0.8)

P-value 0.8471 0.5475 0.1592 0.0014

Based on the Bristol Stool Chart

The results were calculated by dividing the sum of the stool compositions in each week by number of stools recorded

in that week. i.e 3 stools of a consistency of Bristol Stool Type 2, 1, & 3 respectively is (2+1+3)/3 = 2.

P=<0.05, significant; probability assessed by T-test



0.00

10.00

20.00

Significant reduction in symptoms and improvement in QOL in Prebiotic group (A) compared to comparator (B)

Intervention Improves QOL

0.00

5.00

10.00

15.00

20.00

25.00

30.00

35.00

40.00

45.00

PAC-SYM PAC-Q


PAC-SYM Sub-scores Baseline and Day 21

Baseline Completion (Day 21)

Prebiotic Comparator P value Prebiotic Comparator P value

Sub-scores

Abdominal symptoms 6.8 + 3.3 6.6 + 3.5 0.784 2.3 + 2.2 5.7 + 2.5 <0.001

Rectal Symptoms 2.2 + 2.3 2.0 + 2.0 0.815 0.6 + 1.0 1.4 +1.2 0.004

Stool symptoms 7.6 + 3.5 8.0 + 4.2 0.669 0.5 + 0.5 0.2 + 0.4 0.022



Intervention Improves QOL: PAC-SYM

Prebiotic Prebiotic

PAC-SYMBaseline

n= 28 (total)

Week 3

n = 28 (total)

1. Discomfort in your abdomen 27 (96%) 17 (61%)

2. Pain in your abdomen 21 (75%) 13 (46%)

3. Bloating in your abdomen 27 (96%) 19(68%)

4. Stomach cramps 22 (79%) 8 (27%)

5. Painful bowel movements 18 (64%) 7 (33%)

6. Rectal burning during or after a bowel movement 15 (54%) 4 (14%)

7. Rectal bleeding or tearing during or after a bowel movement 10 (36%) 4 (14%)

8. Incomplete bowel movement, like you didn’t “finish” 25 (89%) 12 (43%)

9. Bowel movements that were too hard 24 (86%) 17 (61%)

10. Bowel movements that were too small 24 (86% 8 (27%)

11. Straining or squeezing to try to pass bowel movements 24 (86%) 16 (57%)

12. Feeling like you had to pass a bowel movement but you couldn’t (false alarm) 22 (79%) 12 (43%)

0.00

1.00

2.00

3.00

4.00

5.00

6.00

Baseline Final

Depression

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

4.50

5.00

Baseline Final

Anxiety

0.00

1.00

2.00

3.00

4.00

5.00

6.00

7.00

8.00

9.00

10.00

Baseline Final

Stress

Reductions in Depression, Anxiety and Stress




Intervention Enhanced Diversity and Richness

ind

ex

Change Score = stool frequency

Outcome Summary

• Prebiotic treatment 16 g day:• More regular bowel motions and better formed stools• Reduced abdominal symptoms• Better quality of life• Better mood• Highly variable results observed

• Other Comments: Increased satiety/reduced hunger, reduced food intake,perceived weight loss, greater energy levels

• Link for prebiotics /polyphenols and neurological function and metabolism• Possibly through the gut microbiome (future analysis)



Too Much Fibre?

• The amount of fibre to support GIT health and healthy bowel motionsvaries from person to person

• Increasing fibre consumption may not make colonic transit normal

• Increasing fibre consumption may even worsen symptoms through theeffect of the fibre on microbiome metabolism and the gas produced withsymptoms of bloating, abdominal distension and pain

Plant based foods

Bulk fibre for stools

Contributes to fluid intake

Prebiotics to feed

microbiome

Polyphenols with positive

effects on GIT and

metabolism

Enhanced microbiome, diversity & richness

GIT symptoms & functional constipation

Improved sleep,

anxiety & stress

Altered microbiome, diversity

No improvement in GIT symptoms & functional constipation

No improvements in sleep, anxiety & stress

intake intake



Benefits of Prebiotics and Polyphenols for Functional Constipation

• Support transport time?

• Support gut health and reduceinflammation?

• Support gut microbiome diversity?

• Support neurological processes?

Polyphenol Prebiotic Powder




Partially hydrolysed Guar Gum (PHGG)

Acacia Gum

Slippery Elm

Fruit Pectin

Theobroma cacao (organic raw Cacao powder)

Hylocereus polyrhizus (Red Dragon Fruit)

Prebiotics PHGG & GA

• Emerging research from clinicaltrials evaluating prebioticproperties of partially hydrolysedguar gum (PHGG) and gum arabic(GA) suggest a potential benefit forthe treatment of constipation

• Increased beneficial microbes• Increased species diversity and

evenness• Reduced abundancies of

pathogenic bacteria in healthyhuman volunteers

Calame W, Weseler AR et al. Gum arabic establishes prebiotic functionality in healthy human volunteers in a dose-dependent manner. Br J Nutr. 2008;100(6):1269-75. doi: 10.1017/S0007114508981447.

Reider SJ, Moosmang S et al. Prebiotic effects of partially hydrolyzed guar gum on the composition and function of the human microbiota—Results from the PAGODA trial. Nutrients. MDPI AG; 2020;12(5):1257. doi.10.3390/nu12051257



Prebiotics Apple Pectin & Slippery Elm

• Slippery elm has been found to increaseLactobacillus spp. Bifidobacterium spp.,Bacteroides spp., and Eubacterium spp., anddecrease Klebsiella1

• Pectin influences the composition and diversity ofthe gut microbiota with in vitro studiesdemonstrating increases in Bifidobacterium andLactobacillus2

1. Peterson CT, Sharma V et al. Prebiotic potential of herbal medicines used in digestive health and disease. J Alt Comp Med. 2018;24(7):656-65.doi 10.1089/acm.2017.0422

2. Flint HJ, López Siles M et al. Cultured representatives of two major phylogroups of human colonic Faecalibacterium prausnitzii can utilize pectin, uronic acids, and host-derived substrates for growth. App Environ Ecol, 2012;15;78(2):420-8. doi 10.1128/AEM.06858-11

Constituents of Dragon Fruit & Cocoa

Cocoa powder contains:

• Alkaloids theobromine (2%) andcaffeine (0.5%)

• Catechin and epicatechin are themain polyphenols in cocoa powder

• Procyanidins

Red Dragon fruit:

• The pigment responsible for the redcolour of red dragon fruit pulp isbetacyanin

• Polyphenols include phenolic acid(386.09±1.52 mg/100g), flavonoids(210.02±0.83 mg/100g) andanthocyanins (81.75±1.43 mg/100g),Gallic acid and catechins



Dragon Fruit Boosts Akkermansia

• Betacyanin from red dragon fruit increasesthe growth of Akkermansia muciniphila,which has been inversely associated withobesity, diabetes, inflammation, andmetabolic disorders1

• The antioxidant action of polyphenols in reddragon fruit also protects Akkermansiamuciniphila, which is vulnerable to attack byfree radicals2

1. Frugé AD, Van der Pol W et al. Fecal Akkermansia muciniphila is associated with body composition and microbiota diversity in overweight and obesewomen with breast cancer participating in a presurgical weight loss trial. J Acad Nutr Diet. 2020;120(4):650-9. doi 10.1016/j.jand.2018.08.164

2. Daglia M. Polyphenols as antimicrobial agents. Curr Op Biotechnol. 2012;23(2):174-81. doi 10.1016/j.copbio.2011.08.007

Cocoa Improves Microbiome Composition

• Cocoa polyphenols interact bidirectionally withthe intestinal microbiota as the microbiotametabolises polyphenols producing secondarybioactive metabolites, which in turn increasesbeneficial intestinal species1

• Cocoa polyphenols enhance the growth ofLactobacillus and Bifidobacteria, E coli,Bifidobacterium spp., Bacteroides spp., andEubacterium spp. while reducing pathogenicspecies such as Clostridium perfringens2

1. Sorrenti V, Ali S et al. Cocoa polyphenols and gut microbiota interplay: bioavailability, prebiotic effect, and impact on human health. Nutrients.2020;12(7):1908. doi 10.3390/nu12071908

2. Tzounis X, Rodriguez-Mateos A et al. Prebiotic evaluation of cocoa-derived flavanols in healthy humans by using a randomized, controlled, double-blind, crossover intervention study. AJCN. 2011;93(1):62-72. doi.10.3945/ajcn.110.000075




Clinical applications:

• Dysbiosis

• Irritable Bowel Syndrome (IBS)

• Metabolic disease

• Constipation

Ingredients actions:

• Increases microbial diversity

• Improves intestinal mucosalintegrity via short-chain fatty acid(SCFA) production and reducedintestinal inflammation

• Improves bowel regularity

• Improves metabolic parameters

Polyphenol Prebiotic Formulation Clinical Applications

• Support gut motility (constipation)

• Support diet of those with reduced fruit/veg intake and/or very low fibreintake, and low calorie/low carbohydrate diets (to help increase microbiotadiversity and richness with overall health benefits)

• Support weight through increased satiety before meals and direct effect ofpolyphenols on glycan-degrading capability of Bacteroides

• Support the mucous membranes against colonisation of undesirables inGIT and help prevent more serious GIT disorders

• Support immune system

• Support people with high anxiety traits



FC Summary

• There are many pathophysiological factors in FC and careful investigationsare required before providing an individualised therapeutic strategy

• Establish the underlying cause or the contributing factors (if it is FC)

• Look for drug interactions especially in those with chronic pain

• Diet is a major factor in FC; fibre replaced by processed foods

• If FC has been present from childhood consider “conditioning” (trauma)

• A person with anxiety/stress/PTSD has a higher likelihood of FC

FC Summary

Low-Residue and Low-Fiber Diets in Gastrointestinal Disease Management - Scientific Figure on ResearchGate. Available from: https://www.researchgate.net/figure/Overview-of-possible-effects-of-different-fibers-on-gastrointestinal-digestion-and_fig1_283790366 [accessed 3 Aug, 2021]



Polyphenol Summary

• Functional constipation associated with poor diet; low fiber intake; and alack of fruit and vegetables can be supported by addition of prebiotic fibresapprox. 12-16 g per day

• Prebiotic fibres and polyphenols have a specific role in modulating andsupporting a healthy gut microbiome, as well as other health benefits

Date post:	11-Apr-2022
Category:	Documents
Upload:	others
View:	5 times
Download:	0 times

Investigating the Impacts of Polyphenols and Dietary Fibre ...

Documents