1. HEALTHY DIET FOR THE GUT
1st ASEAN Conference on Healthy Ageing
Ageing – Challenges, Successes and the Journey Ahead
HEALTHY DIET FOR THE GUT
Datuk Dr. Jayaram Menon
Head of Department of Medicine,
Hospital Queen Elizabeth,
Kota Kinabalu

3. Outline What are healthy diets? The Gut Microbiome
Health implications of the Gut Microbiome
Modulation of the Gut Microbiome
The Gut health diet
Aging and the Gut
Conclusion

4. Mediterranean and MIND Diets
The Mediterranean diet encompasses the tenets of healthy eating .
Heavy in fruits, vegetables, fish, whole grains, and healthy unsaturated fats (olive oil), and low in processed foods, red meat, and saturated and trans fats.
Numerous studies have confirmed the health benefits which include protection against heart disease, stroke, and dementia.
Leads to greater long-term weight loss than a traditional low-fat diet( American Journal of Medicine 2016).

5. Pyramidal representation of Mediterranean dietary patterns (MDPs) and the frequency of recommended intake.
Chierico, F.D., Int. J. Mol. Sci., 2014

6. Associated with lower risk of developing Alzheimer disease
The MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) diet
Combines Mediterranean-style eating with the DASH (Dietary Approaches to Stop Hypertension) diet used to lower blood pressure
Associated with lower risk of developing Alzheimer disease
Focuses on fruits, vegetables, fish, poultry, and olive oil, and it limits sweets, meats, and processed foods

8. Detox and Cleanse Diets
The premise behind detox diets is to rid the body both of the environmental toxins (pollution, chemicals in foods and household products, etc) to which it is continually exposed or those that are by-products of metabolism.
Detox diets
typically means eating a strict diet of fruits, vegetables, whole grains, and raw nuts and seeds, plus lots of water.
eliminate processed foods and sugar, as well as foods to which some people are sensitive, such as dairy, gluten, eggs, and red meat.
Cleanse diets
limit intake to such fluids as lemonade or green smoothies for a period of several days.

9. No evidence detox and cleanse diets actually rid the body of toxins, or that they're necessary.
can lead to nutrient deficiencies; fatigue; or gastrointestinal issues, such as nausea and cramps.
The best advice you can give patients who are interested in detox and cleanse diets is to work with a dietitian to make sure they get the right balance of nutrients and calories to keep them healthy.

10. Paleo and High-Protein Diets
Paleo diet
Stick to protein sources, such as poultry, fish, and meat, along with vegetables and fruits.
Eliminate dairy, grains, legumes, sugar, and salt.
Helped with weight loss, improved cholesterol, triglycerides, blood pressure, and other measures of metabolic syndrome( American Journal of Clinical Nutrition 2015)
Patients can become deficient in such minerals as calcium and vitamin D, and they may not get their daily requirement of healthy carbs

12. 5 Major Criteria for Healthy GI System
Effective digestion and absorption of food Absence of GI illness Normal and suitable intestinal microbiota Effective immune system Status of well-being

13. The Father of Modern Medicine “All disease begins in the gut”
Hippocrates
The Father of Modern Medicine “All disease begins in the gut”
Slides adapted from Marzeea Ahmad Raka, North South University, Dhaka

14. OUR GUT 90% of the cells in the human body are of bacterial origin.
The microbiota and the microbiome, its collective genomes, is estimated to be 100-fold greater in size than the human genome.
It is an extremely complex ecosystem harbouring more than trillion micro-organisms
There are thought to be around 30 – 40 different species of bacteria.
Slides adapted from Marzeea Ahmad Raka, North South University, Dhaka

15. symbiotic relationship with us – and help to keep less beneficial
Many of these have a
symbiotic relationship with us –
and help to keep less beneficial
strains at bay.
A healthy gut in an adult human
has somewhere in the region of
2 kg of these bacteria in the gut.
They play a vital role in the body
- without them we would not
survive.
Slides adapted from Marzeea Ahmad Raka, North South University, Dhaka

16. Microbiome
A collection of different microbes and their functions or genes found in an environmental habitat. Different parts of the body have different microbiomes, for example, the skin microbiome is different to the gut microbiome, but they are all part of the human microbiome.
Microbiota
The types of organisms that are present in an environmental habitat, whether they are bacteria, viruses or eukaryotes .
Marchesi et al., Gut, 2015;
Lynch, N Engl J Med, 2016

17. Figure: Distribution of gut flora in digestive tract
Slides adapted from Marzeea Ahmad Raka, North South University, Dhaka

18. Development of human gut microbiota from prenatal to elderly
Development of human gut microbiota from prenatal to elderly. It is believed that infants are born with a sterile gastrointestinal track. During birth, the infant gut is exposed to microbes from the mother’s reproductive tract and environment and the gut microbiota starts colonizing. Up to the first two years of life, the composition of the gut microbiota often varies. After two years, when children are started to eat solid food (e.g. fibers and complex carbohydrates), the gut microbiota becomes more diverse and stable. In old age, the gut microbiota alters drastically and shows less diversity compared to younger age.
Kumar et al., Gut Microbiota for Healthy Ageing, 2016

19. At birth levels of bifidobacteria are found to be at their highest
At birth levels of bifidobacteria are found to be at their highest. In cases of natural chidbirth the numbers are highest at birth. In contrast, they are lower in C sectioned babies. Various diseaes such as obesity, diabetes and allergies have been associated with lower numbers of bifidobacteria at various stages of life. When weaned onto solid foods diet if more of an intervening factor and an adult-like (stable) microbiota develops. In this figure the authors hypothesize with regard to the relative abundance of bifidobacteria present at each stage of the life cycle, based on the literature cited in the following review by Voreades et al. (2014)
Arboleya, S. et al., Front. Microbiol., 2016

20. Mechanisms of action of the intestinal microbiome on the gastrointestinal barrier. Commensal bacteria support the digestion of
fibres and other nutrients, thereby contributing to energy and substrate supply. They regulate epithelial functions such as mucus production in goblet cells, defensin release from Paneth cells and tight junction protein synthesis in normal epithelial cells. They prevent colonisation of pathogens in the gut and regulate the mucosal immune system, for example, by inducing and maintaining gut-associated lymphoid tissue and by stimulating mucosal immunoglobulin A production. For details and references, see text ‘Underlying mechanisms’.
Bischoff, S.C., BMC Medicine, 2011

21. BODY IMMUNITY
They play a crucial role in our immune system, keeping the body’s immunity active. Around 83% of our immunity is located in the gut wall. Beneficial flora imbalance will have an immediate impact on immune system.
Slides adapted from Marzeea Ahmad Raka, North South University, Dhaka

22. Representative dietary inputs and metabolic functions of intestinal microbiota. Metabolic functions are indicated in italics. Closed and open arrows indicate flow of specific metabolites and dietary residues, respectively. Dotted lines illustrate negative feedback of hepatic bile acid synthesis under the regulation of intestinal farnesoid X receptor (FXR), which is antagonized by conjugated bile acids.
Krishnan, S. et al., Curr Opin Biotechnol, 2015

23. The intestine’s impact on health
The intestine’s impact on health. The gastrointestinal tract contributes to health by ensuring digestion and absorption of nutrients, minerals and fluids; by induction of mucosal and systemic tolerance; by defence of the host against infectious and other pathogens; and by signalling from the periphery to the brain. For details and references, see text ‘Underlying mechanisms’.
Bischoff, S.C., BMC Medicine, 2011

24. Impact of the diet on the human gut microbiota composition
Impact of the diet on the human gut microbiota composition. Diet is one of the most influential factors for altering the composition of the gut microbiota. Animal-based diets promote the growth of bile-tolerate microorganisms. In contrast, plant-based diets elevate the abundance of polysaccharides-digesting bacterial species.
Kumar et al., Gut Microbiota for Healthy Ageing, 2016

25. Factors responsible for inducing the variability in the human gut microbiota
Kumar et al., Gut Microbiota for Healthy Ageing, 2016

26. Faecal microbiota transplantation
Prebiotics
A seletively fermented ingredient that results in specific changes in the composition and/or activity of the GI microbiota, thus conferring benefit(s) upon host health. Prebiotics are usually non-digestible carbohydrates, oligosaccharides or short polysaccharides, with inulin, oligofructose, galactofructose, galacto-oligosaccharides and xylo-oligosaccharides being some of the most intensively studied.
Probiotics
Live microorganisms that, when adminitered in adequate amounts, confer a health benefit on the host. Examples include strains of the genera Bifidobacterium and Lactobacillus. Probiotics can have multiple interactions with the host, including competitive inhibition of other microbes, effects on mucosal barrier function and interaction with antigen presenting dendritic cells.
Faecal microbiota transplantation
The introduction of gut bacteria from a healthy donor into a patient, through transfer of an infusion of a faecal sample via nasogastric tube, nasoduodenal tube, rectal enema or the biopsy channel of a colonoscope.
Marchesi et al., Gut, 2015;

27. Alteration of the microbiota Prebiotics
Probiotics
Alteration of the microbiota
Prebiotics
Microbial activity
Selctive stimulation of microbiota
Prevention of bacterial infection
Immune regulation
Immune regulation
Illustration of major activities of probiotics and prebiotics.
Magrone, T. & Jirillo, E., Immunity & Ageing, 2013

28. GUT DYSBIOSIS
When gut flora is damaged or in imbalance it is called dysbiosis.
Opportunistic gut microbes including yeast, harmful bacteria, viruses and parasites start to take hold.
They can be very difficult to eradicate once they have moved in.
Slides adapted from Marzeea Ahmad Raka, North South University, Dhaka

29. Effects of a healthy gut microbiota and dysbiosis on the gut and metabolic health of the host. A healthy microbiota comprises a balanced representation of symbionts (bacteria with health-promoting functions) and pathobionts (bacteria that potentially induce pathology). A shift toward dysbiosis results from a decrease in symbionts and/or an increase in pathobionts and is likely to be triggered by environmental factors (such as diet, stress, antibiotics, and infections). Low bacterial gene counts have also been associated with altered gut microbial functions and dysbiosis and have been linked to increased fat accumulation, lipopolysaccharide-induced inflammation, insulin resistance, obesity, and the metabolic syndrome. Individuals with these characteristics are more likely to develop metabolic diseases (such as diabetes, cardiovascular diseases, and inflammatory bowel diseases). LBP LPS-binding protein, SCFA short-chain fatty acid
Boulangé, C.L. et al., Genome Medicine, 2016

30. Concepts of obesity and NAFLD pathogenesis are: classical (A) and (B) innovative gut-liver-axis-mediated. Classically, obesity is considered to be due to a surplus of energy intake over energy expenditure, resulting in storage of excess energy as a fat. Genetic, physiological, and environmental factors (e.g., high fat diet [HFD] and sedentary lifestyle) also play a significant role in the etiology of obesity and obesity-associated metabolic disorders. The gut-liver-axis-mediated concept suggests that the increased consumption of obesogenic foods (particularly those enriched in fat and fructose) may alter the gut microbiota and intestinal barrier function favoring the occurrence of metabolic endotoxemia and low-grade inflammation thereby contributing to the development of obesity and obesity-associated fatty liver disease.

31. The gut microbiota Dietary modulation Obesity Liver disease IBD
Focus
Insights
The gut microbiota
The gut microbiota is host-specific and variable
Loss of diversity has a negative impact on health, conservation of key
microbial functions is even more important
Dietary modulation
Indigestible carbohydrates are the ‘food’ of the gut microbiota
Probiotics, prebiotics and polyphenols can promote gut health via the microbiota
Obesity
The gut microbiome is an environmental factor in obesity
Unknown functions in the microbiome can be transferred and recapitulate or treat obesity
and its associated metabolic disorders
Liver disease
Bacterial dysbiosis can drive hepatitis
Bacterial products can cause inflammation in the liver
IBD
Alterations of the microbiota lie at the core of IBD pathogenesis; these may be driven by host
genetics and/or environmental factors
Targeting the microbiota remains an attractive option to treating the disease cause
Colorectal cancer
Pathobionts such as Fusobacterium nudeatum are overexpressed in adenomas and cancers
of the colon
‘High-risk’ (high fat, high protein) diets modulate this risk through gut microbiome
co-metabolic processes
The gut microbiota may drive the first DNA damage either via specific proteins or
metabolites
Diet can play a large role in shapping the composition of the microbiota and it thus affects
risk of developing the disease
Key insights into the influence of gut microbiota on GI and liver diseases
Marchesi et al., Gut, 2015

32. Gut Health Diet The gut health diet focuses on probiotics
They might also reduce gastrointestinal symptoms, such as gas and bloating, and reduce inflammation throughout the body.
Probiotic foods: such as cultured yogurt, kefir, kimchi, sauerkraut, miso, and tempeh
A healthful diet composed of fruits, vegetables, and whole grains has also been linked to higher levels of Bacteroidetes. These types of bacteria are particularly good at producing short-chain fatty acids, which help regulate gut inflammation.

33. Gut health diet
Three main food components are proposed to benefit gut health:
“Probiotics" (found in such foods as yogurt, kefir, and kimchi);
Nondigestible carbohydrates (eg, dietary fiber found in fruits, vegetables, and whole grains); and
Secondary plant metabolites, such as flavonoids (found in brightly colored fruits, vegetables, and red wine).
Western-style diet experience less of the protective benefits of plant foods and simultaneously provoke other metabolic disruptions through high fat and sugar consumption, which contribute to gut dysbiosis and inflammation

34. Gut health diet Exercise
Evidence suggests that exercise may increase the diversity of bacteria living in the gut.
Pre- and Probiotics and Fermented Foods
The anti-inflammatory benefits of fiber fermentation in the colon occur naturally during digestion of healthy, fiber-rich foods, resulting in metabolic by-products that include various vitamins and antioxidants.
Although some studies show promising results, larger, high-quality trials are needed to fully elucidate this relationship.

35. Sources of Probiotics Dairy products like yogurt and aged cheeses
Sources of Probiotics Dairy products like yogurt and aged cheeses. Look on the ingredients list for live cultures of bacteria like bifidobacteria and lactobacilli. Fermented vegetables, like kimchi and sauerkraut, and pickled vegetables, like onions and gherkins.

36. Prebiotics They’re found in fruits and vegetables like: Bananas Onions Garlic Leeks Asparagus Artichokes Soybeans Foods with whole wheat.

37. Kinross, J. & Nicholson, J.K., Nat. Rev. Gastroenterol. Hepatol, 2012

38. Intestinal health and aging
Reduction in the capacity of taste and smell.
decreased dentition, muscle mass, the use of frequently ill-fitting dentures and swallowing difficulty
diet becomes more nutritionally imbalanced
reduction in gastric acid production, coupled with increased basal gastric inflammation lead to lower micronutrient absorption from the diet.
general shift in dominant bacterial species.

39. Intestinal health and aging
Immunosenescence: the progressive decline in the integrity of both the innate and adaptive immune system with increasing age
In addition to affecting the composition of the microbiota in the aging intestine, immunosenescence can lead to a greater susceptibility to infection, malignancy
Probiotics are a vital tool in the battle to overcome imbalance and restore the health-promoting composition and function of the microbiota in older age, promoting and maintaining health and reducing the impact of age-related disease

40. Conclusion
Exercising moderately and consuming a varied diet of whole foods, including lots of fruit and vegetables, can benefit not only your physical health, but also gut health and the health of your brain.

41. “...the age of the gut microbiome is now”

42. Thank-you