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

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