the first 1000 days - ntoi · the first 1000 days – the role of the microbiome Éva hill hamilton...
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The First 1000 days – the role of the microbiome
Éva Hill Hamilton DipNT (Dist) mBANT mNTOI
Nutritional Therapist, Lecturer
NTOI AGM 18th April 2015
www.first1000days.ie
“This short timeframe offers a unique window of opportunity to shape healthier futures by having a profound impact on the child’s ability to grow & develop and improve educational achievement.” – Ita Saul, Paediatric Dietitian.
Roles of the gut flora in humans
Protection from invaders
production of anti-microbial substances increase acidity
Roles of the gut flora in humans
Initiate tight junction protein formation SCFA to nourish enterocytes
Roles of the gut flora in humans
Immunity – Upregulate SecIgA and T reg cells
Detoxification – Phase III antiporter system, inhibition of Beta-glucoronidase
Vitamin production & activation - Vitamin K2 & Vitamin B’s
Role in stress response & mental health
Collins, S M – Bercik P, The Relationship Between Intestinal Microbiota and the Central Nervous System in Normal Gastrointestinal Function and Disease GASTROENTEROLOGY 2009;136:2003–2014
Granham S. et al (2011) Brain-gut-microbiome communication in health and disease Front Psysiol. 2:94 Epub PubMed PMID: 22162969
Obesity link
(Caniet al 2007)
Inflammatory signalling has emerged as a potentially important mediator of leptin resistance. (Guyenet, S.J & Schwartz, M.W (2012) J Clin Endocrin Metab 97)
Diversity is keyOver 100 trillion microbial cells, outnumbering human cells 10 to 1 and adding over 8 million
genes to our set of 22,000
More than 500 species have been noted, each with numerous strains identified by molecular probes.
Studies demonstrate that bacteria differentially colonize the intestines based upon a number of environmental factors:
i. mode of delivery ii. hygiene measures iii. environmental contaminants iv. type of feeding v. maternal microflora
Gill SR. et al. (2006) Metagenomic analysis of the human distal gut microbiome. Science 312: 1355–1359. doi: 10.1126/science.1124234Whitman WB, Coleman DC, Wiebe WJ (1998) Prokaryotes: the unseen majority. Proc Natl Acad Sci U S A 95: 6578–6583. Heavey PM, RowlandIR The gut microflora of the developing infant:microbiology and metabolism. Microbial Ecol Health Dis. 1999;11:75-84Harmsen HJ, et al. Alalysis of intestinal flora development in breast fed and formula fed infants. J Pediatr. Gastroenetrol Nutr. 2000; 30:61-67
Colonisation
• While the general dogma is that the placental barrier keeps infants sterile throughout pregnancy, increasing evidence suggests that an infant's initial inoculum can be provided by its mother before birth and is supplemented by maternal microbes through the birthing and breastfeeding processes.
DiGiulio DB, Romero R, Amogan HP, Kusanovic JP, Bik EM, et al. (2008) Microbial prevalence, diversity and abundance in amniotic fluid during preterm labor: a molecular and culture-based investigation. PLoS ONE 3: e3056 doi:10.1371/journal.pone.0003056.
DiGiulio DB (2012) Diversity of microbes in amniotic fluid. Semin Fetal Neonatal Med 17: 2–11. doi: 10.1016/j.siny.2011.10.001 Jimenez E, Fernandez L, Marin ML, Martin R, Odriozola JM, et al. (2005) Isolation of commensal bacteria from umbilical cord blood of healthy neonates born by cesarean section. Curr Microbiol 51:
270–274. doi: 10.1007/s00284-005-0020-3 Jimenez E, Marin ML, Martin R, Odriozola JM, Olivares M, et al. (2008) Is meconium from healthy newborns actually sterile? Res Microbiol 159: 187–193. doi: 10.1016/j.resmic.2007.12.007
The developing brain and immune system
The evolving cognitive activity is critically dependent on the microbiota and its metabolic outputs.Recent studies have demonstrated a clear association between changes in the microbiota and cognitive behaviour, including learning and memory.M. G. Gareou (2014) Microbial Endocrinology: The Microbiota-Gut-Brain Axis in Health and Disease Advances in Experimental Medicine and Biology 2014, pp 357-371
At birth the immune system is Th2 biased –environmental microbes influence balance
Maternal microflora influence
Microflora stimulates the development of the immune system in infants (Forchielli & Walker, 2005) 75% of gut bacteria in breast fed infants is Bifidobacteria, compared to 3% in
adults (Macfarlane, 1995) Alterations in this level is associated with higher risk of atopic eczema and atopic
sensitisation later in life (Suzuki et al, 2007)Short term administration of Lactobacilli species in late pregnancy increased
Bifidobacteria levels in infants (Lahtinen et al, 2009)Enomoto et al (2014) have found that perinatal probiotic supplementation can
reduce immune problems during the first 18 months of life
Maternal microflora influenceCaesarean delivery increase risk of developing atopy and allergic rhinitis by two-
fold (Pistiner M. et al, 2008) due to preoperative prophylactic antibiotic administration (Baaquel, H. et al 2012)In two long-term studies by Kalliomaki et al (2007) and Kuitanen et al (2009)
decreased frequency of eczema and IgE associated diseases were found in Caesarean delivered babies when supplemented with probiotics both pre- and postnatal. They speculated that antenatal supplementation is required for best effects.Luoto et al (2012) compared dietary intervention on its own or with added
probiotics compared to control group during pregnancy and their effect on colostrum adiponectin levels – and found significant difference in the intervention groups. The frequency of gestational diabetes was significantly lower in the probiotic
group.
Maternal microflora influenceObesity connection: Bifidobacteria lower in children with subsequent obesity (Kalliomakiet al 2008).
Epidemiologic studies indicate an association of Caesarean section with the development of childhood obesity (Blustein et al., 2013; Huh et al., 2012; Li et al., 2013)
In particular, antibiotic exposure in early life, just when host adipocyte populations are developing has been associated with the development of adiposity in humans (Ajslev et al., 2011; Trasande et al., 2013).
Quality for therapeutic outcome
Probiotic strains in the product Viability (until the end of best before date) Survival Adherence to intestinal wall Colonisation Diversity
All Bio-Kult Probiotics
• The beneficial bacteria are coated with a cyto-protectant layer before the freeze drying process
– No refrigeration required (stable up to 250C for 2 years)– Guaranteed stability (and count) until end of 2 year shelf life– Protected from the harsh acid environment of the stomach
Acid Stability of Bio-Kult’s Probiotic Strains - In vitro growth at pH 2.0 for two hours
All Bio-Kult Probiotics
• Bio-Kult blister packs offer higher protection against moisture and fluctuating temperatures than pots
• moisture is known to be a main factor to spoiling viability & effectiveness
• 3 month stability testing for 27 months • using independent UKAS accredited laboratories
• Manufactured to a very high standard• cGMP (current Good Manufacturing Practice) accreditation ensures high
standard manufacturing• Audited by the MHRA
All Bio-Kult Probiotics
• Vegetarian Society Approved
• Gluten, Corn & Wheat Free
• Non-GMO
• Suitable for pregnant women & children (with HCP approval)
• Capsules can be pulled apart and added to food or drink
• Cellulose base (no longer maltodextrin or magnesium sterate)
• Contains traces of soya & milk at a level which would not affect lactose intolerant sufferers (but should be avoided by those with severe milk allergy)
Bio-Kult Advanced Multi-strain Formula
• Formulated by Dr Natasha Campbell McBride
• 14 different strains - 5 different genera – Bifidobacterium breve PXN 25 Bifidobacterium infantis PXN 27– Bifidobacterium bifidum PXN 23 Bifidobacterium longum PXN 30– Lactobacillus acidophilus PXN 35 Lactobacillus plantarum PXN 47– Lactobacillus helveticus PXN 45 Lactobacillus casei PXN 37– Lactobacillus rhamnosus PXN 54 Lactobacillus salivarius PXN 57– Lactobacillus Bulgaricus PXN 39 Lactococcus lactis PXN 63– Streptococcus thermophilus PXN 66 Bacillus subtilis PXN 21
• 2 billion CFU/capsule (2x109 CFU/capsule)– 10 billion CFU/g (1x1010 CFU/g)
Conditions where we recommend Bio-Kult During Pregnancy & Lactation
During and after Antibiotic / OCP use
Traveller's Stomach
Digestive complaints (including IBD)
Immune imbalances
Autism / ADHD
Sports nutrition
Bio-Kult
• Easy to swallow 160mg vegetable capsules
• Directions for use: 1-2 capsules once/twice daily with food• Children under 12, half adult dose – safe from birth
• No contraindications and no risk of overdose• Gradual build-up recommended in sensitive patients and children
• Boxes of 30, 60 and 120 Capsules
Bio Kult Infantis - for babies & young children
Multi-strain Probiotics (7) 1 billion CFU • Lactobacillus casei PXN 37 • Lactobacillus rhamnosus PXN 54 • Lactobacillus acidophilus PXN 35 • Lactobacillus bulgaricus PXN 39 • Streptococcus thermophilus PXN 66 • Bifidobacterium breve PXN 25 • Bifidobacterium infantis PXN 27
Added Vitamin D3 and Omega 3
Preplex® (FOS and guar gum)
Bio Kult Infantis - for babies & young children
Designed for young infants and children up to two years of age Safe from birth Tasteless soluble powder May be added to formula or any food or drinkMay be administered directly under the lip of the baby
Clinical studies:
Functional constipation Childhood constipation Acute gastroenteritis Atopic dermatitis Paediatric Helicobacter Pylori Infantile Colic Neonatal Pneumonia Reduce faecal Calprotectin in COPD Adjunct therapy in NASH, Metabolic syndrome & Bacterial Vaginosis
Bio-Kult ProbioticsThe experts in probiotics
Bio-Kult Candéa• For maintaining natural defences against Candida overgrowth• Probiotic – 7 strains
• Lactobacillus casei PXN 37
• Lactobacillus rhamnosus PXN 54• Lactobacillus acidophilus PXN 35
• Lactobacillus delbrueckii ssp. bulgaricus PXN 39
• Streptococcus thermophilus PXN 66• Bifidobacterium breve PXN 25
• Bifidobacterium longum PXN 30
• 1 billion CFU/capsule (1x109 CFU)• Garlic (60mg)• Grapefruit seed extract (130mg)
• 2 x 400mg capsules daily with food• Contraindications – pharmaceutical medication that warns against the consumption of grapefruit juice e.g. statins and some
blood pressure tablets
Introducing Bio-Kult Pro-CyanAdvanced formula for healthy urinary tracts
Per 2 capsule dose
1. Cranberry extract (Cranmax®) 36mg
2. Probiotics – 2 strains• Lactobacillus acidophilus PXN 35• Lactobacillus plantarum PXN 47• 1 x 109 CFU (1 billion)
3. Vitamin A (Retinol) 320 mcg
Dosage - 2 x 400mg capsules once or twice daily - 1/day maintenance
Lepicol Range
Psyllium husks (Plantago ovata forsk)
• Water retentive – absorbs 20-25 times its weight in water
• Forms a soft gel - induces peristalsis and eases the stool along the lower digestive tract
• Much gentler than some common fibres (such as wheat bran) that can be irritating to a sensitive bowel
Probiotics
• Probiotic strains: 5 strains • Lactobacillus rhamnosus PXN 54• Bifidobacterium bifidum PXN 23• Lactobacillus acidophilus PXN 35• Lactobacillus plantarum PXN 47• Lactobacillus bulgaricus PXN 39
(present in our superior probiotic Bio-Kult)
• Probiotic strength: • Minimum of 120 million CFU/g (1.2 x 108 CFU/g) • 600 million per 5g/1 tsp serving
Prebiotics
• Non-digestible carbohydrates (e.g. GOS, FOS and inulin) that selectively increase bacteria already present in the microflora
• Fermented by bacteria in the gut to aid their growth• Fermented by probiotic bacteria to aid their growth• Lactobacilli and especially Bifidobacteria are more efficient at this process than
pathogenic bacteria
• Lepicol’s prebiotic fibre is Inulin from chicory root
Consider recommending Lepicol Constipation
Diarrhoea
Alternating IBS
Diverticular disease
Weight loss regimes (satiety)
Detoxification
Cholesterol lowering protocols
Lepicol Powder
• Adults: 1-2 (5-10g) heaped teaspoons once or twice daily
• Children: 0.5-1 (2.5- 5g) heaped teaspoon once or twice daily Children under 11 years need to be monitored by a healthcare professional
• 200-250ml of liquid needs to be consumed for every 5g/heaped teaspoon and plenty of water throughout the day
• Take 30 minutes before meals – 2 hours apart from medications
DOSAGES
NOTE
Lepicol Capsules
• A different method of administration to suit preferences• The amount of fibre taken with the capsules is smaller due to it containing the fine (ground down) psyllium which is
very effective in small doses• It is slower to absorb water and form a gel like substance so the amount of fibre in the capsules is less weight wise
• 90 and 180 capsule pot• Vegetable capsule (Hydroxy-propyl-methane-cellulose)
• Adults: Take 2- 8 capsules once or twice daily
• Children: 2 - 5 capsules once or twice daily
• The capsules can be opened and the contents poured into water or juice if preferred
DOSAGES
Lepicol Plus
• 180g powder pot
• Added digestive enzymes & soothing herbs:• protease, betaine HCL, ginger root, papain, peppermint leaf, fennel seed,
bromelain
• Same directions for use as Lepicol original powder but most ideal to take 10 minutes before a meal
Thank you
Please find us at the SCOPE Healthcare Stand