Transcript Professional Research Presentation

Dietary Supplements
Juanita Escamilla, MS
Sodexo Distance Education Dietetic Intern
Professional Research Presentation
December 11, 2012
Background and Research
BS, Food and Nutrition and MS Human Nutrition (Food
Biotechnology and Molecular Nutrition)
Thesis: Role of Gut Microflora in Colon Cancer Metastasis
Studied various strains of probiotic bacteria (L. casei, L.
rhamnosus GG, B. longum)
Looked at metastasis in vitro, using various assays such as
the Boyden Chamber, Western Blot, and Zymography
Community and Clinical Nutrition Experience
San Marcos, A Tu Salud (low-income Spanish speaking
women)
San Marcos, Nutrition 101, Hernandez Intermediate School
MEND (Mind, Exercise, Nutrition, Do It)
El Hospital Para el Niño Poblano
Gap in Knowledge
What is the Mechanism of Action of Probiotics, DMannose, and Cranberry? We know they work, but
how do they work?
Objectives
Audience will be able to:
State the definition of a Dietary supplement,
Nutraceutical, and a Functional Food
State the regulation of Dietary supplements in the
market
State the Mechanism of Action of Probiotics, Dmannose and Cranberry
State the recommended uses for Probiotics, Dmannose and Cranberry
Raise your hand if
you’ve taken a Dietary
Supplement?
Quick Facts
U.S. adult population. Over 40% used supplements in
1988–1994, and over 50% in 2003–2006
Multivitamins/multiminerals are the most commonly
used dietary supplements, with approximately 40%
of men and women reporting use during 2003–2006
Dietary supplements have been taken by more than
half of American adults; consumers spent $26.7
billion on supplements in 2009
2011 Survey found that 1 in 4 people take a fish oil
supplement
Reasons for Taking Dietary
Supplements
Definition of a Dietary
Supplement
As defined by Congress in the: Dietary Supplement Health and
Education Act (DSHEA), which became law in 1994, a dietary
supplement is a product (other than tobacco) that
is intended to supplement the diet;
contains one or more dietary ingredients (including vitamins;
minerals; herbs or other botanicals; amino acids; and other
substances) or their constituents;
is intended to be taken by mouth as a pill, capsule, tablet, or liquid;
and
is labeled on the front panel as being a dietary supplement.
Regulation of Dietary
Supplements
The Federal Government regulates dietary
supplements through the U.S. Food and Drug
Administration (FDA). The regulations for dietary
supplements are not the same as those for
prescription or over-the-counter drugs. In general,
the regulations for dietary supplements are
less strict.
Dietary supplements are not required by federal
law to be tested for safety and effectiveness
before they are marketed, so the amount of
scientific evidence available for various
supplement ingredients varies widely.
My Dietary Supplements
Mobile App
https://myds.nih.gov.
Modern Terms
Nutraceutical:
Coined from “nutrition” and “pharmaceutical”, 1989 by
Stephen DeFeleice, MD, founder and chairman of the
Foundation for Innovation in Medicine (FIM)
“a food (or part of a food) that provides medical or health
benefits, including the prevention and/or treatment of a
disease”, go beyond supplementation, more therapeutic.
Differ from dietary supplements by the following aspects:
Nutraceuticals must not only supplement the diet but should also
aid in the prevention and/or treatment of disease and/or disorder
Nutraceuticals are used as conventional foods or as sole items of
a meal or diet
Examples: Green Tea, Vitamin D, Lycopene, Phytochemicals,
Probiotics, etc
Pharmaceutical
Nutrition
Scientific
Evidence
Nutraceutical
Functional Foods:
Are similar in appearance to conventional foods
and consumed as part of a normal diet
Demonstrated physiological benefits and can
reduce the risk of chronic disease beyond basic
nutritional functions, including maintenance of
gut health
Academy of Nutrition and Dietetics Definition:
All foods as functional at some physiological level
because they provide nutrients or other
substances that furnish energy, sustain growth, or
maintain/repair vital processes. However,
functional foods move beyond necessity to
provide additional health benefits that may
reduce disease risk and/or promote optimal
health. Functional foods include conventional
foods, modified foods (ie, fortified, enriched, or
enhanced), medical foods, and foods for special
dietary use
Probiotics
Human Gut Microflora
Human GI tract is sterile at
birth, microflora develops
after birth
Colonization rate varies
according to factors:
Mode of Birth
Infant Nutrition
Antibiotic Use
Diet
Age
Microorganisms that
reside on and inside
humans outnumber
somatic cells
Influence host
metabolism, physiology,
gene expression
GI contains ~100 trillion
microorganisms that
represent 1000 separate
bacteria, yeasts, parasites
Increase in numbers from
the mouth to the anus
Probiotics and Gastrointestinal
Health
Probiotic bacteria are defined as : “live
microorganisms which when administered in
adequate amounts confer a health benefit on
the host”
Ingestion of probiotics has been shown to aid in
overall gastrointestinal health:
Modulating the intestinal flora
Decreasing the number of toxin (carinogenic)
producing bacteria in the large intestine.
Reduce the risk of colorectal cancer
Decrease intestinal permeabilty
Stimulation of immune functions
Improved digestion and absorption of nutrients
Synthesis of vitamins
Large Intestine Microflora
Ps. aeruginosa
Intestinal
putrefaction
Production of
carcinogens
Diarrhea,
constipation,
infections, liver
damage, cancer,
toxigenesis.
Proteus sp.
Staphylococci
2 Inhibition of growth
of exogenous and
harmful bacteria
(diarrhoea, IBD, UC,
Crohn’s disease, colon cancer)
Clostridia
Veillonellae
Enterococci
Digestion/ absorption
of undigested foods
and minerals
E. coli
Lactobacilli
Stimulate
Streptococci
immune
Bifidobacteria
function
Bacteroides
Lipid lowering
11
No./g faeces (log scale)
Mechanism of Action in
the Context of Cancer
1. Disruption of TJ proteins
Primary Tumor
2. Invasion through the ECM
(increase MMP-9 activity)
Extracellular Membrane
3. Entrance into circulation
4. Metastasis
into
liver and lungs
•
Separation of single tumor cells from primary tumor
•
•
Tight junctions regulate the epithelial barrier function by
the apical intercellular junctions formed in normal
epithelial cells and tumor cells.
Decreased expression of ZO-1 been implicated in cancer
metastasis
Claudin
ZO-3
Occludin
ZO-1
JAM
ZO-2
Actin
Paracellular Space
Lactobacillus sp. Decrease MMP-9 Protein Levels
Control
L. casei
L. rhamnosus
MMP-9
Ponceau S
MMP-9 Protein (% Control)
120
100
74.22%
*
80
61.38%
*
60
40
20
0
Control
*Indicates (P = < 0.05)
L. casei
L. rhamnosus
Lactobacillus sp. Increase ZO-1 Protein Levels
Control
L. casei L. rhamnosus
ZO-1
β-actin
250
ZO-1 Protein (% Control)
170.15%
*
200
134.06%
P = 0.060
150
100
50
0
*Indicates (P = < 0.05)
Control
L. casei L. rhamnosus
What does the Data mean?
Probiotics play a role in gene expression!!!!!
Probiotics can decrease intestinal permeability which has
been implicated in autoimmune disorders such as
Thyroid disorder, Celiac Disease, Parkinson’s, Type 1 Diabetes
D-Mannose and
Cranberry
Urinary Tract
Works with the lungs, skin, and
intestines to excrete wastes to
maintain homeostasis in the body.
Urinary tract infections can occur
and are caused by bacteria in the
urinary tract.
CAUTI, Cystitis (bladder),
pyelonephritis (kidney)
In the United States, 1 in 5 women
report reoccurring UTI, eleven
million women receive medication
for UTIs annually
Treatments include: antibiotics,
increasing fluid intake to flush out
bacteria
Urinary Tract and Infection
“Bacterial adherence to the uroepithelium is recognized as an
important mechanism in the initiation and pathogenesis of urinary
tract infections (UTI). The uropathogens originate predominantly in
the intestinal tract and initially colonize the periurethral region and
ascend into the bladder, resulting in symptomatic or asymptomatic
bacteriuria.”
D-mannose and Cranberry
d-Mannose is the end product of the
digestion of various polysaccharides
and glycoproteins found in the diet.
d-Mannose is a monosaccharide found
in fruits such as apples, blueberries,
and cranberries.
Cranberries (Vaccinium macrocarpon)
contain high levels of d-Mannose as
well as proanthocyanins (PACs).
Both d-Mannose and PACs have been
shown to prevent and treat UTI
infections in both men and women
Mechanism of Action
E. coli
d-Mannose Receptor
d-Mannose
Cranberry
Eroepithelial Cells
Summary
Dietary Supplements, nutraceuticals, and functional
foods fall under DSHEA and are regulated by the
federal government with more lenient standards.
Probiotics aid in overall GI Health by mechanisms
that affect gene expression, specifically through
Tight Junction Proteins and MMP-9 in the context of
cancer.
D-mannose and Cranberry have been shown to
prevent and treat urinary tract infections by
preventing pathogenic bacteria from binding to
uroepithelium.
THANK YOU!!!!
Grazie
Merci
Gracias
Resources
Dietary Supplement Health and Education Act of 1994. U.S. Food and Drug Administration
Web site. Accessed at http://www.fda.gov/RegulatoryInformation/Legislation/ on November
24, 2012.
Dietary supplements: background information. Office of Dietary Supplements Web site.
Accessed at ods.od.nih.gov/factsheets/DietarySupplements_pf.asp on November 20, 2012.
Dietary supplements: overview. U.S. Food and Drug Administration, Center for Food Safety
and Applied Nutrition Web site. Accessed at www.fda.gov/Food/DietarySupplements/ on
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Natural Medicines Comprehensive Database. Product monographs. Accessed at
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