Alissa Marrapodi

July 16, 2009

18 Min Read
Digestion is the Cornerstone of Health

Diabetes, obesity, metabolic syndrome and immunity. What do all these terms have in common? Digestion. Digestion is the basic, most fundamental part of human health. Without functional digestion, we can gain weight, leading to health conditions such as diabetes, obesity and metabolic syndrome; feel discomfort such as heartburn, acid reflux and ulcers; or get sick and the immune system attenuates. Digestion may be one of the most important functions the body performs.

Many digestive disorders exist, from serious to less debilitating. Crohns disease is a chronic disorder that causes inflammation of the digestive or gastrointestinal (GI) tract, according to the Crohns and Colitis Foundation of America (CCFA). Ulcerative colitis is a similar autoimmune disease that affects only the colon, whereas Crohns can impact the large and small intestine as well as the GI tract. Both of these are identified as inflammatory bowel diseases (IBD).

The CCFA estimates as many as one million Americans have IBDwith that number evenly split between Crohn's disease and ulcerative colitis. Crohn's disease may occur in people of all ages, but it is primarily a disease of adolescents and young adults, affecting mainly those between 15 and 35. Ten percent of those affectedor an estimated 100,000are under the age of 18.

Irritable bowel syndrome (IBS) and gastroesophageal reflux disease, or GERD, are two common digestive dysfunctions. GERD affects millions of people and is clinically referred to as acid reflux disease, which occurs when the lower esophageal sphincter (the valve separating the esophagus and stomach) does not close properly, allowing acid to back up into the esophagus. IBS exudes symptoms such as abdominal bloating, irregular bowels and pain in the abdominal area.

Luckily, natural ingredients can address digestive woes. Consumers have become more open about digestive ailments and companies are catering to their needs with continual product launches. In the probiotic sector alone, U.S. consumer awareness of the term probiotics skyrocketed in 2008 to 48 percent, up from 31 percent in 2007 and up from 20 percent in 2006, according to the Natural Marketing Institutes (NMI) Health and Wellness Trends Survey (2008 HWTD). These numbers show promise for the future of probiotics and the digestion market as a whole.

Probiotics are getting a sunburn from being in the health limelight so frequently and, in this case, too much of a good thing is great thing. Probiotics not only benefit gut health, but are also proving to be advantageous in immune health,1 allergies,2 infant diarrhea,3,4 inflammatory bowel conditions,5,6 antibiotic-induced diarrhea,7 cholesterol management,8 gut transit time/bowel function,9,10 lactose maldigestion,11 colic in infants,12 bacterial vaginosis,13 irritable bowel syndrome14 and respiratory infections15.

Current research is backing up the direct correlation between digestion and immunity. Ganeden Biotech offers a researched probiotic strain, GanedenBC30 (Bacillus coagulans), in which a 2009 eight-week study found GanedenBC30 effectively relieved abdominal pain and bloating in patients with IBS.16 Another study confirmed its use in immune response in the March issue of Postgraduate Medicine. Researchers said, The patented GanedenBC30 (as Sustenex®) probiotic may be a safe and effective therapeutic option for enhancing T-cell response to certain viral respiratory tract infections.17

An eight-week pilot study investigated whether daily ingestion of Nutraceutixs four-species proprietary probiotic using its patented delivery technology BIO-tract® would enhance innate immune function in a nonelderly adult population.18 Ten volunteers served as their own controls. Immune parameters were measured at baseline and during treatment at three, five and eight weeks. A statistically significant increase in the percentage of phagocytic monocytes (P=0.0005) and neutrophils (P=0.0122) occurred during the eight-week treatment period. No statistically significant increases of natural killer cell activity or salivary immunoglobulin A levels were observed.

Immune response was studied in 30 malnourished preschool-aged children, 3 to 5 years old, and categorized into three groups, A, B and C.19 Groups A and B were given Lactobacillus supplementation (as Unique IS-2, from Pharmacenter USA) 1.0 x 108 million viable spores/d/child and 2.0 x 108 million of viable spores/d/child for 90 days, respectively. Group C served as control. The results revealed Lactobacillus supplementation at a level of 1.0 x 108 million viable spores/d/child for 15 days along with regular diet significantly improved the serum adenosine deaminase (ADA) levels of preschool children.

Probiotics were also found to prevent chronic stress-induced intestinal abnormalities, exerting beneficial effects in the intestinal tract. In Canada, researchers subjected male rats to either water avoidance stress (WAS) or sham stress for one hour/d for 10 consecutive days, in addition to administering seven days of Lactobacillus helveticus and L. rhamnosus (as Rosell-11 and Rosell-52, from Institut Rosell) in the drinking water prior to stress.20 Rats remained on these probiotics for the duration of the study. All animals remained healthy for the duration of the study. Chronic WAS induced excess ion secretion and barrier dysfunction in both the ileum and colon, associated with increased bacterial adhesion and penetration into surface epithelial cells. Approximately 70 percent of rats subjected to WAS had bacterial translocation to mesenteric lymph nodes while there was no bacterial translocation in controls. Probiotic pretreatment alone had no effect on intestinal barrier function. However, WAS-induced increases in ileal short circuit current was reduced with probiotics; there was no impact on altered conductance. Pretreatment of animals with probiotics also completely abrogated WAS-induced bacterial adhesion and prevented translocation of bacteria to mesenteric lymph nodes.

Many consumers are afflicted with travelers diarrhea, as it occurs on approximately 25 to 30 percent of vacations. A total of 70 persons participated in three studies in which each person received two Lactobacillus acidophilus DDS-1 (from UAS Labs) before breakfast for a week before their trip and during the entire period of the trip to Guatemala, Mexico and Nepal.21 The probiotic provided substantial protection against travelers diarrhea to the individuals who received the supplementonly two reported digestive disorders.

In conjunction with probiotics, prebiotics such as inulin, psyllium and oligosaccharides deliver notable effects on digestive health. In Croatia, researchers found Lactobacillus helveticus M92 in combination with inulin showed the best synbiotic effect on intestinal and faecal microflora and immune system of mice.22 An English study administered strains of Bifidobacterium longum, Lactobacillus casei and Lactobacillus acidophilus to rats fed a purified high-starch diet, under a variety of treatment protocols, including daily gavage, via the drinking water and in the diet.23 In general, no consistent significant changes in aberrant crypt foci (ACF) numbers were detected in these experiments. In one study, the basal diet of the rats was changed to one containing a higher level of fat (corn oil). Under these conditions, a significant decrease in azoxymethane-(AOM) induced colonic ACF was seen in rats given L. acidophilus or inulin. In a concurrent group of animals fed a low-fat diet, no significant decrease in ACF was observed. The results indicated the type of diet fed can influence the detection of protective effects of LAB and oligosaccharides and that against the background of a diet with a level of fat typical of a Western diet, evidence for a protective effect of L. acidophilus and inulin toward colon cancer was obtained.

Another study found dietary fructooligosaccharides (FOS) supplementation changed the intestinal environment of microflora and lead to upregulation of IgA secretion in CD4+ PP cells in intestinal mucosa, and to suppression of the systemic immune response to type 2 helper T dominant.24 A study at Duke University also confirmed fibers ability to aid digestion, concluding, daily intake of a high-fiber diet may prevent stress- and corticotropin releasing factor-induced acceleration of colonic transit and diarrhea.25

A study in Japan found Konjac mannan (KM; as LuraLean, from AHD International) significantly increased Bifidobacterium spp. and had an inhibitory effect on liver tumorigenesis in addition to suppressing the development of colon cancer after supplementation with 5 percent KM.26

Friesland Foods Domo USA Inc. produces a dairy-derived prebiotic ingredient, Vivinal® GOS. According to the company it is tolerated well in humans versus other prebiotic ingredients and it stimulates of growth of bifidobacteria, inhibits the growth of certain pathogenic bacteria, supports immunity, improves calcium absorption and supports digestive health.

Digestive enzymes are becoming more popular, and the need for supplementation is becoming more prevalent. The human body produces more than 20 digestive enzymes in various organs and glands. The stomach glands produce gastric enzymes, including peptidase (for proteins), gelatinase (for gelatin/collagen from meats) and gastric lipase (for tributyrin, a butter fat). Meanwhile, the pancreas is responsible for secreting numerous proteases and amylases, including trypsin (a peptidase), pancreatic amylase (for starch and glycogen) and several elastases (for protein elastin). Then, the epithelium in the small intestines creates many peptidases and the more well-known amalyases that break disaccarides into monsaccaridessucrase for sucrose and glucose, lactase for lactose, and maltase for maltose.

Many digestive aliments, such as heartburn, lactose intolerance and celiac disease, are associated with a lack of digestive enzymes or an inability to metabolize certain sugars or proteins. A review of enzymes published in 2008 in the Alternative Medicine Review looked at the various forms of enzyme supplementation used clinically in digestive and absorption disorders, such as lactose intolerance.27 Lactose is a sugar found in milk and other dairy products; many people are intolerant or cannot metabolize lactose, often causing bloating, diarrhea and abdominal pain. Researchers noted, Enzyme supplementation plays an integral role in the management of various digestive disorders, particularly with regard to exocrine pancreatic insufficiency. However, application of enzymes may also be beneficial for other conditions associated with poor digestion, including lactose intolerance. Historically, porcine and bovine pancreatic enzymes have been the preferred form of supplementation for exocrine pancreatic insufficiency. Use of microbe-derived lipase has shown promise with studies indicating benefit similar to pancreatic enzymes, but at a lower dosage concentration and with a broader pH range. Safety and efficacy of enzymes derived from microbial species in the treatment of conditions such as malabsorption and lactose intolerance is promising. Plant-based enzymes, such as bromelain from pineapple, serve as effective digestive aids in the breakdown of proteins. Synergistic effects have been observed using a combination of animal-based enzymes and microbe-derived enzymes or bromelain.

Similarly, digestive enzymes have also been studied for their affect on celiac disease, an autoimmune disease that leads to an inability to digest gluten. A study published in Science found a component of gluten, gliadin, may be the cause of the inflammatory response and dietary enzymes made by bacterium may break down gliadin.28

In 2007, researchers examined whether pancreatic enzyme supplementation provided a symptomatic benefit in celiac patients with chronic diarrhea.29 Stool frequencies was reduced from four/d to one/d. In Minnesota, 18 subjects ingested 185 g of cookies (1,196 calories, 72 g of fat) microencapusulated with pancreatic (pancrelipase) enzymes or a placebo.30 The pancreatic supplements reduce postprandial symptoms in healthy subjects, suggesting these supplements also might be beneficial in irritable bowel syndrome.

While there is interesting research on the usefulness of enzymes in digestive health, delivering these physiologically active substances to the correct part of the gut can prove challenging. However, suppliers and formulators are looking to technology to ensure optimal deliver. CTC International produces Innova Shield Digestive Enzyme, which protects digestive enzymes from acidic gastric fluids in the stomach, enabling enzymes to reach the small intestine tract, according to an in-house, unpublished study. It uses two shields, known as Duo Zyma Shield technology. This coating delivery system (CDS) allows the enzymes to be mixed with wider recipients, including probiotics, protein powder, etc.

Aloe vera has also been touted for its effects on the digestive system. The National Institutes of Health (NIH), in its Medline Plus database, noted, Although few studies have been conducted to assess [the laxative] effect of aloe in humans, the laxative properties of aloe components such as aloin are well supported by scientific evidence. A double blind trial in Beer Sheva, Israel, evaluated the effect of a novel laxative preparation, composed of celandin, Aloe vera and psyllium in patients with chronic constipation.31 A total of 35 men and women were randomized to receive capsules containing celandin-Aloe vera-psyllium or placebo, for 28 days. In the treatment group, bowel movements became more frequent, the stools were softer and laxative dependence was reduced. In the placebo group, all these parameters were unchanged. Abdominal pain was not reduced in either group. Additionally, Aloe vera has also been studied for its ability to increase the bodys uptake of nutrients in the diet.32 Researchers examined plasma bioavailability of vitamins C and E when consumed alone or with 2 oz. of Aloe vera. Aloe significantly improved the absorption of vitamins and increased their retention in plasma.

Along with its soothing smell and ability to freshen breath, peppermint also serves as a digestive aid. German researchers assessed the efficacy and safety of a herbal preparation STW 5-II containing extracts from bitter candy tuft, matricaria flower, peppermint leaves, caraway, licorice root and lemon balm for the treatment of patients with functional dyspepsia.33 A total of 120 patients with functional dyspepsia were randomly assigned to one of four treatment groups. Each patient received the treatment for three consecutive four-week treatment blocks. The first two treatment blocks were fixed. For the third treatment period, medication was based upon the investigator's judgment of symptom improvement during the preceding treatment period. In patients without adequate control of symptoms, the treatment was switched, or if symptoms were controlled, the treatment was continued. During the first four weeks, the gastrointestinal symptom score (GIS) significantly decreased in subjects on active treatment compared to the placebo. During the second four-week period, symptoms further improved in subjects who continued on active treatment or who switched to the active treatment, while symptoms deteriorated in subjects who switched to placebo. After eight weeks, 43.3 percent on active treatment and 3.3 percent on placebo reported complete relief of symptoms.

A separate double blind, placebo-controlled, mulitcentre trial randomly assigned 208 patients with IBS to receive one of four treatments: commercially available herbal preparation STW 5 (n=51), research herbal preparation STW 5-II (n=52), bitter candytuft mono-extract (n=53) or placebo (n=52).34 Two hundred and three patients completed the trial. STW 5 and STW 5-II were significantly better than placebo in reducing the total abdominal pain score and the IBS symptom score at four weeks. There were no statistically significant differences between the bitter candytuft mono-extract group and the placebo group.

A study published in the Journal of Pediatrics found peppermint oil to be therapeutic for children with IBS.35 In a randomized, double blind study, 42 children (between the ages of 8 and 17) with IBS were given either peppermint oil capsules or a placebo. After two weeks, 75 percent of those receiving peppermint oil experienced reduced pain associated with IBS, including bloating, constipation, abdominal cramps and diarrhea.

Ginger (Zingiber officinale) has a calming effect on the stomach and was recently highlighted in a 2009 study for its ability to calm the stomach of chemotherapy patients.36 The study results, released by the American Society of Clinical Oncology (ASCO), showed taking ginger capsules several days before chemotherapy can lessen the incidence and severity of nausea associated with the standard cancer treatment. A total of 644 patients from cancer centers around the nation who had suffered nausea during previous chemo rounds were given, in addition to their standard anti-sickness medicines, capsules containing one of three doses of ginger (0.5 g/d, 1 g/d or 1.5 g/d) or placebo capsules. The ginger supplementation began three days before chemo treatment and continued for three additional days. Results showed each dose of ginger decreased nausea, with the 0.5 g/d and 1 g/d doses proving most effective. On average, subjects taking ginger scored their nausea two points lower than did those taking placebo, who hardly noted any change in nausea. Researchers said timing of ginger supplementation may have been a primary factor in the beneficial results, as a previous study involving ginger taken only on the first day of, not before, chemo treatment produced no benefit.

Two previous studies both found ginger beneficial for nausea related to morning sickness, seasickness and chemotherapy-induced nausea; and as a possible preventive for postoperative nausea and vomiting.37,38

Digestion is the cornerstone to health. Without a strong digestive foundation, the everyday pleasure of eating can be painful and dreadful. But supplementing with digestive staples such as probiotics and enzymes can aid this intrinsic human process, and ease and prevent the stomach aches that are unsettling consumers today.

References on the next page.


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