Enhancing Digestive Health

Supporting GI wellness with nutraceuticals bolsters whole-body health

by Heather Granato

The foods that prolong life and increase purity, vigor, health, cheerfulness and happiness are those that are delicious, soothing, substantial and agreeable. ... Foods that are bitter, sour, salty, over-hot, pungent, dry and burning produce unhappiness, repentance and disease.

-Henry Wadsworth Longfellow

Americans turn to many types of food—some agreeable and some less so—but never give much thought to the why and how food turns into metabolic fuel. Digestion may be one of the most misunderstood of bodily functions, and yet digestive dysfunction is the most common malady affecting U.S. consumers. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) estimates between 60 million and 70 million people are affected by digestive diseases, while the American College of Gastroenterology reports more than 95 million Americans experience some kind of digestive problem annually.

“People don’t really think about digestion,” said Michael Shahani, director of marketing with Nebraska™ Cultures. “We think about muscles and skin, but we don’t think about digestion unless it’s a problem. And people just accept digestive discomfort unless it’s really bad.”

Grace Ormstein, M.D., medical director with Himalaya USA, agreed with Shahani’s assessment. “Many people do not fully understand the function of the complex and multi-sectional digestive system, nor do they equate the way they look and/or feel to what they put in their bodies,” she said. “Society caters to busy lifestyles and emphasis is placed on how quickly food can be prepared, delivered or consumed rather than how easily it can be digested.”

While the process of digestion can be simplified to taking food from point A to point B while extracting out nutrients necessary to sustain life, it is actually a complex procedure. If the way to a man’s heart is through his stomach, the way to the stomach begins with the senses. Scent, sight and feel of foods and beverages kick the digestive organs into gear. The salivary glands produce moisture for lubrication and amylase, a digestive enzyme that begins to break down starches in the mouth. In addition, the action of chewing is critical to starting the mechanical breakdown of larger molecules that will continue with the powerful muscles of the stomach.

“Most Americans skip the first step of digestion—chewing,” said Catherine Wilbert, president and formulator with PhytoCeutical Formulations. “They’re not only not breaking down food mechanically, but limiting the chemical processes in which saliva and amylase begin the digestion of food components.”

Food heads through the esophagus, propelled by muscular action, into the stomach. Here, it is macerated into a liquid state and combined with hydrochloric acid to form a liquid substance called chyme. Also in the stomach, substrate-specific enzymes called proteases break down proteins into amino acids. When the consistency of the chyme is ideal, it heads into the small intestine, composed of the duodenum, jejunum and ileum. The small intestine contains the majority of the body’s digestive enzymes, which are secreted by the pancreas, to further break down nutrients into particles that can be absorbed through the microvilli into the circulatory system.

Following transport and nutrient absorption in the small intestine, the remaining mass moves into the large intestine, the primary home to the body’s bacteria. There are between 400 and 500 bacterial types that exist in the human digestive system, and they compose up to 50 percent of the weight of the colon. The gut flora work to salvage nutrients, support immune health and protect the body against pathogenic microbes.¹ A research review from London Medical School noted probiotics help to reduce or eliminate potentially pathogenic organisms, eliminate toxins, modulate immune responses, promote apoptosis, and release nutrient and growth factors necessary for recovery from illness.²

Supplemental probiotics may be useful in treating dysfunctions as transient as diarrhea or constipation, or as serious as inflammatory bowel disorders (IBD) and irritable bowel syndrome (IBS). In connection to diarrhea, a meta-analysis from the University of Wales, England, reviewed 23 studies with a total of 1,917 patients and found probiotics were a useful adjunct to rehydration therapy in treating diarrhea in adults and children.³

Additional research has shown probiotics reduce the overall risk of antibiotic-associated diarrhea,⁴ and enhance recovery after fasting or malnutrition.⁵ And in patients with constipation, probiotics have also been beneficial. In a German study of 70 patients with chronic constipation, administration of 65 mL/d of a probiotic beverage with Lactobacillus casei Shirota significantly improved severity of constipation and stool consistency.

These opposing digestive dilemmas are common in patients with IBS. While not a life-threatening condition, IBS affects 20 percent of Americans, causing symptoms such as abdominal pain and cramping, bloating, constipation and diarrhea. These consumers are increasingly turning to probiotics to shore up gut health. A study conducted at the Mayo Clinic in Rochester, Minn., examined the effect of VSL#3 (a probiotic formula from VSL Pharmaceuticals) or placebo in 25 IBS patients.⁶ While there were no significant differences in gastrointestinal (GI) transit measurements or bowel function, there was reduction in abdominal bloating. A review of studies on VSL#3 noted there have been “encouraging results” in IBS patients, as well as those with IBDs.⁷

IBDs include Crohn’s disease and ulcerative colitis, which are both characterized by inflammation—in the small intestine in Crohn’s, and in the large intestine in colitis. It does appear that probiotics may benefit patients with IBDs. A French research review noted, “intestinal bacteria play a key role in inflammatory bowel disease ... [and] some data exist that possibly show an efficacy of probiotics as maintenance therapy in chronic relapsing pouchitis.”⁸ A similar review from Imperial College, London, found probiotics may be efficacious in treating certain aspects of IBDs, but stated there is a need for large controlled trials to elucidate the dose, duration, frequency of treatment, mechanism of action and use of single or multiple strains.⁹

While many consumers may turn to yogurt or other fermented foods such as sauerkraut as probiotic sources, foods generally don’t contain large quantities of organisms. “Consuming probiotics as a dietary supplement has the advantage of delivering a much higher level of beneficial bacteria easily, assuming the products are responsibly formulated, stored and packaged properly,” said Tim Gamble, vice president of sales and marketing with Nutraceutix. “Unfortunately, there is no foolproof way for consumers to know which dietary supplements are responsibly formulated, manufactured, stored and packaged properly.”

These are important issues for consumers, as these anaerobic bacteria are highly susceptible to heat, oxygen and moisture. Many dietary supplement companies are investigating methods to ensure delivery of live organisms through the harsh stomach environment into the intestines, where they are needed.

One simple suggestion is to take probiotics with meals. “We recommend consumers take probiotics with food,” Shahani said. “Because they naturally grow on food, it can assist in transport into the intestines.”

However, other companies are investigating novel technologies, such as enteric coating. “Most of the probiotic products available on the market don’t provide enteric coating or any kind of protection against stomach acidity,” said Caroline Arnaud, product manager, innovative technologies with Institut Rosell. Arnaud’s company has developed two technologies intended to increase the survival of probiotics in the stomach. STAR™ is an enteric coating process applied to capsules, whereas Probiocap™ is a microencapsulation of freeze-dried bacteria designed for use in various types of food supplement and food products.

In contrast, Nutraceutix developed its patentpending BIO-tract™ G.I. system that protects the bacteria through the stomach and delivers the probiotics directly into the intestines without enteric coating. “Nutraceutix developed an effective delivery system for probiotics rather than genetically engineering probiotic strains that could survive the stomach acid, or applying existing technologies such as enteric coatings that are not well suited to biological payloads,” said Randy Schoenfeldt, Nutraceutix’s vice president of business development.

Another technology that addresses several delivery challenges including acid-, moisture-, and heat-induced degradation is a patented seamless encapsulation technology by Tokyo-based Morishita Jintan Co. Ltd. The customizable delivery system, which consists of a two-to five-layer, seamless, one-piece, protective sphere, is designed to shield probiotics through the stomach. In addition, it facilitates survival of the original number of CFUs stated on the label for 18 months of shelf life. According to Tony Serra, sales representative for New York-based Mitsui & Co. (U.S.A.) Inc., Jintan’s U. S. representative, the technology has two main benefits: the end user is guaranteed the amount of viable bacteria stated on the label and the manufacturer need not include more colony forming units (CFUs) than stated on the label to provide for the possibility that some of the bacteria might die.

Encapsulation is one of the possible formulation options. S.K. Dash, Ph.D., founder of UAS Laboratories, stated capsules are a superior delivery method to powders since they provide a barrier against atmospheric contamination. He added capsules are also excellent for children and the elderly, who often have difficulty swallowing pills.

Capsules, however, can have drawbacks. According to Gamble, capsules typically have a moisture content of over 10 percent to ensure they remain pliant. “This moisture can prematurely animate probiotics and, due to the lack of a fertile environment within the capsule, the organisms quickly expire,” he said. Instead, Nutraceutix developed a patented process, LiveBac®, for tableted probiotics that ensures sustained viability even at room temperature storage.

Probiotics are often delivered with prebiotics, such as inulin or fructooligosaccharides (FOS). The differences among prebiotics are primarily seen in the length of the fructoseterminated chain, with inulin primarily longer chain and FOS shorter. In general, short chain FOS ferment faster than longer-chain inulin, though both are beneficial for gut bacterial growth.¹⁰

Combinations of prebiotics with probiotics have been investigated in IBDs. In one study using a rat model of colitis, administration of a combination inulin/probiotic formula significantly increased the diversity of gut microflora.¹¹ A similar study using germinated barley (as a prebiotic fiber) plus probiotics found the prebiotic treatment significantly reduced colonic inflammation.¹² Finally, a study of FOS in a rat colitis model found ingestion of FOS significantly reduced intestinal inflammation, primarily by increasing the growth of lactic acid bacteria.¹³

As noted earlier, digestive enzymes play a critical role from the start of digestion well into the intestines. The body produces a range of enzymes, each specific to a substrate (protease for proteins, for example). However, the body was never meant to have to supply all the enzymes for digestion alone. While most foods in their raw state contain enzymes for digestion, heating and processing break down those enzymes, forcing the gut to use more of its endogenous supply to digest food.

“Most of the food we eat today is cooked and processed and is really hard to digest,” said Rohit Medhekar, Ph.D., director of research and development with National Enzyme Co. (NEC). “Our digestive system, including the pancreas, is overworked, which leads to numerous digestive ailments.”

Therefore, many consumers could benefit from supplemental enzymes. “Many people think it’s normal to feel sleepy or, worse, have gas, bloating and belching after a meal,” said Donna Werner, D.C., director of technical services for Enzymes Inc. “Actually, it is often a sign of ineffective digestion, resulting from enzyme deficiency.”

Supplemental enzymes, therefore, can improve the function of the digestive system. “Enzymes improve digestion and assimilation of proteins and other nutrients,” said Mark L. Anderson, Ph.D., director of research and development for Triarco Industries. “They function as biological catalysts, helping to break down proteins, carbohydrates and fats. This can help relieve gastric reflux, heartburn, indigestion and flatulence. They may also help decrease the risk of food allergies and certain cancers by decreasing acid reflux and decreasing the amount of material that releases toxins by fermentation in the lower intestine.”

To determine whether supplemental enzymes do, in fact, assist in nutrient digestion and absorption, NEC conducted a collaborative research project with TNO Nutrition & Food Research in Zeist, The Netherlands. TNO used a computer controlled dynamic gastrointestinal model (TIM) to stimulate the digestive conditions in the human stomach and intestines in both a healthy and an impaired digestive model. The results showed broad spectrum fungal enzymes improved the digestibility and bio-accessibility of proteins and carbohydrates in the small intestines.

“Fungal enzymes have a broad pH range and they work in the stomach as well as the small intestine,” Medhekar explained. “Fungal enzymes not only survive the harsh and varying environment of the GI tract, but they also work in each and every section. Thus, by taking fungal enzyme supplements, one ensures that no matter where food is in the GI tract, one or more of the fungal enzymes will be able to digest it.”

Enzymes are also a great supplemental product for any consumer following a low carb diet. “Low carb diets usually result in a significant increase in the amount of protein consumed,” Anderson said. “Increased protein consumption may lead to the saturation of endogenous proteases, causing some undigested protein to end up being fermented in the colon.” Anderson recommended supplementation with clinically researched protease formulas, such Triarco’s Aminogen®, which specifically acts on protein during digestion.

Enzymes work not only in the intestines, but also in the stomach. Enzymes and hydrochloric acid together are critical to breaking down food; however, if the stomach mucosal lining is not strong, the corrosive contents can damage the stomach lining. One in 10 Americans will suffer a peptic ulcer—a sore on the lining of the stomach—during his lifetime, according to NIDDK. Ulcers can develop from long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) or as a result of bacterial infection— most often by Helicobacter pylori (H. pylori).

Nutrition researchers have sought ways to eradicate H. pylori in the body and strengthen the stomach. Antioxidants have been one focal area. In a study of guinea pigs infected with H. pylori, six weeks of supplementation with vitamins A, C and E plus selenium showed a significant recovery from infection.14 A follow-up study found the combination also lowered the incidence of severe gastritis in the animals.

Vitamin C has been the leading nutritional compound investigated in H. pylori infection and eradication. Data from a population study of more than 6,700 U.S. adults found higher serum levels of ascorbic acid were associated with a decreased incidence of H. pylori infection.¹⁵ And in a five-year intervention study in Japan with 244 subjects receiving low-dose (50 mg/d) or high-dose (500 mg/d) vitamin C, both groups showed significant protection against progression of gastric mucosal atrophy and infection rates compared to placebo.¹⁶

Also in the field of gastric support, a chelate complex of L-carnosine with zinc (sold in the United States as PepZin GI™ from Lonza Inc.) has been patented in Japan and extensively studied for its ability to support mucous secretion and exert antioxidant effects. A review of drugs for GI ulcers found this chelate complex directly suppressed the growth of H. pylori and inhibited the activity of urease produced by H. pylori infection.¹⁷ Additional research found PepZin GI inhibited H. pylori-associated GI inflammation and leukocyte activation;¹⁸ enhanced mucosal growth factor expression to heal lesions;¹⁹ and further protected the stomach against NSAID-induced mucosal injury, probably through antioxidant and anti-inflammatory properties.²⁰

“PepZin GI plays a unique role in digestive health in that it supports the stomach and the natural defense mechanism rather than altering the normal digestive process,” said Dan Murray, Lonza’s associate nutrition director. “By strengthening the stomach’s mucosal lining, we can enhance our natural defense system, which protects against harmful bacteria and acidic digestive juices.”

Strengthening the cells that form the lining of the stomach and intestines ensures they are primed for nutrient uptake. One less well-known beneficial nutrient in this area is glutamine. “Glutamine is probably one of the most important amino acids in the body,” Wilbert said. “It’s important for immunity because the intestinal epithelial cells use glutamine as their primary metabolic fuel. Without that fuel, the mucosa and microvilli in the intestines would atrophy and be unable to absorb nutrients.”

A number of clinical trials have investigated the impact of glutamine on GI health. Recently, researchers from Hacettepe University in Ankara, Turkey, released results from a study in 128 children with acute diarrhea.²¹ Those who received 0.3 g/kg/d of glutamine had a significantly shorter duration of diarrhea, which was attributed to glutamine’s effects on GI mucosa. Similar results were reported in a study of AIDS patients with diarrhea, which was found to dose-dependently reduce diarrhea while also increasing levels of antiretroviral drugs.²² Glutamine was also shown in a mouse study of enterocolitis to reduce the intestinal injury of the condition.²³

Wilbert noted the body generally absorbs only 30 percent to 50 percent of glutamine ingested; however, combining the amino acid with other specialty compounds can overcome that difficulty. For example, PhytoCeutical offers a glutamine together with a trademarked compound, Immunosorb™, which includes Dmannitol and FOS to feed the beneficial bacteria in the gut to produce butyrate— another fuel for digestion.

Another well-studied compound for intestinal health is hydrolyzed white fish protein concentrate. Intestinal permeability testing and symptom assessment indicated 3 g/d of a hydrolyzed white fish protein concentrate (as Seacure® from Proper Nutrition Inc.) strengthened intestinal integrity in 20 IBD patients after six weeks.²⁴ Further, a study of 15 IBD patients given 3 g/d of Seacure showed improvements in intestinal permeability and symptom assessment.²⁵

At the far end of the digestive tract is the colon. Depending on the strength of the rest of the digestive process, the colon can be exposed to toxins for several days or longer. Fortunately, the colonic mucosal layer is a defensive barrier, which is supported by the intake of both soluble and insoluble fiber.²⁶ “Fiber provides the structural medium for probiotic bacteria to flourish, as well as creating bulk, maintaining hydration, absorbing dietary cholesterol, bile salts and toxins, and keeping the gut and colon linings healthy,” said Kim Jacobsen, vice president of marketing and new products with Renutra.

Jacobsen noted it is important for consumers to ingest different types of fiber— both soluble (which forms a gel in the intestines to absorb toxins and promote bowel movement) and insoluble (which adds bulk). To meet that need, Renutra developed Clockworks™ Daily Fiber, a 50/50 combination of soluble-to-insoluble fibers, plus glutamine and flaxseed; an enhanced version of the product is also available with added probiotics and enzymes.

Fiber is another digestive supplement that can be targeted to low carb dieters. “One of the most common complaints of people on low carb diets is constipation, due to lack of fiber,” said Marci Clow, M.S., R.D., product information manager with Rainbow Light. “The digestive system relies on dietary fiber to aid in the movement of digested foods through the GI tract.” Rainbow Light offers its Everyday Fiber System with soluble fibers such as psyllium and apple pectin, together with plant-sourced enzymes and supportive herbs.

The botanical world offers many beneficial compounds to support digestive health. “Herbal supplements can play an important role in helping ease the discomfort of symptoms like constipation, diarrhea and bloating that often result from a malfunctioning digestive system,” Ormstein said. Himalaya USA offers several herbal formulations that have been studied for their impact on GI wellness. They include GastriCare, a combination of black pepper, ginger, mint, triphala and lemon; LaxaCare, which uses Indian jalap, Cassia occidentalis, wild chicory, hartaki, ginger and licorice; and DiarCare, formulated with Guduchi, nut grass, bael tree and conessi tree.

A clinical study of 35 patients with plaster spica and symptoms including irregular bowel habits and flatulence who received two tablets of GastriCare daily for two weeks found the treatment relieved symptoms in all patients, most within 72 hours.²⁷ Another study using LaxaCare in 45 patients with chronic constipation found the treatment was efficacious in some patients after only three days; there were no side effects nor recurrence during follow up.²⁸ And two clinical studies examining the impact of DiarCare on symptoms of IBS²⁹ and chronic diarrhea³⁰ found significant improvement in patients over the treatment period with no adverse effects.

Another food-based option is green foods. Products such as chlorella, wheat grass and algae are concentrated sources of whole-food nutrition with multiple benefits. “First, green foods help build alkaline potential in the body, helping to control gas,” said Dave Sandoval, president and chief executive officer of Organic by Nature. “They oxygenate the body, helping to eliminate certain bacteria, and help in the digestive process due to their enzyme complexes.”

A review from the Medical College of Virginia, Richmond, found the green food chlorella was able to reduce inflammation and improve quality of life in nine patients with colitis.³¹ According to Michael E. Rosenbaum, M.D., scientific advisor to Sun Chlorella USA, chlorella has many positive effects in the GI tract. “The cell wall material included in natural chlorella products has a highly important effect in the intestines,” he said. “It has the capability of improving bowel function, it stimulates the growth of aerobic, friendly bacteria, and the cell walls act to absorb poisons within the intestine and promote normal peristalsis.”

Green foods can serve as a good adjunct to a diet that promotes digestive wellness. “A diet that is rich in raw and unprocessed foods, fruits and vegetables, and cultured and fermented foods can provide a lifetime of good digestive health,” Jacobsen said. “However, few consumers have the discipline to live this lifestyle and should supplement their diet with a complex fiber and probiotics supplement.”

Retailers have the opportunity to supply their customers with products that can have an immediate beneficial effect. “The simplest thing a retailer can do to help customers is to supply information on the basics—increasing the fiber intake through food or supplements and adding a simple digestive enzyme,” Wilbert said. “This alone nets tremendous results.” The fast impact of digestive enzymes makes them ideal for sampling; Anderson suggested offering consumers sample-sized packets of enzymes, suggesting the consumer take one to two capsules per meal and note the effects.

Information offerings can take the form of in-store seminars or simple education materials. “Retailers can partner with local health care experts and conduct in-store seminars,” Werner suggested. “Display educational fliers and pamphlets near supplement products, or install computer kiosks where consumers can look up information online.”

There are a host of off-line resources as well, with a number of books focusing on digestive health in general and individual nutrients specifically. Nebraska Cultures is publishing a book in early 2005 geared toward consumers that will explain the basics of probiotics and digestive health, while Basic Health Publications recently debuted its User’s Guide to Probiotics by Earl Mindell, Ph.D.

It may also benefit sales to draw more attention to the product section. “Consumers are busier than ever and are looking for convenience in all of their purchasing decisions, including supplements,” Clow said. “Address their demands by featuring digestive products prominently in your store. End caps, case stacks and appealing signage all direct attention to these products. It’s important for retailers to communicate the action of these digestive formulas to the many health food consumers that don’t understand these products are a natural alternative to the mass market products they automatically reach for when experiencing digestive disturbance.”

Taking the time to educate consumers about healthy digestion and the host of nutraceutical compounds that can benefit their GI tract—and their overall wellness—can pay off in long-term customer loyalty and repeat sales.

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November 2004 Health Supplement Retailer
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