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Weight Management BEGINS in the GUT

Southern Spinal Care
Thank you METAGENICS for this article.

The Obesity Epidemic

Obesity is a major global health concern. With 63% of Australians overweight or obese (2014-15);5 this worldwide epidemic results in increased prevalence of disorders such as type 2 diabetes, non-alcoholic fatty liver disease, atherosclerosis, Alzheimer’s disease and certain types of cancer.6 As well as delivering an increased healthcare burden for society, obesity reduces quality of life for the individual and increases risk of premature death.7 Now is the time to support your patients in maintaining healthy weight.

Obese and Lean People are Different Right Down to Their Microbiomes

Obese individuals have been shown to have significant differences in both the genomic content and diversity of their microbiome, when compared with lean people.8 These differences in the microbiota have been associated with numerous pro-obesity mechanisms, including increased energy harvest from food resulting in increased energy storage as fat;9 altered satiety signalling leading to overeating; and endotoxaemia resulting in inflammation and consequent weight gain, insulin resistance,10 and metabolic syndrome.11

Poison from Within

Endotoxaemia is the infiltration of one of the most inflammatory agents known – endotoxin, also known as lipopolysaccharide (LPS) – through the intestinal mucosa and into the blood stream. This process is more able to occur if the integrity of the intestinal mucosal barrier is compromised. This breach of defensive barriers triggers signaling mechanisms such as TLR-4 to produce a protective inflammatory response, which can induce insulin resistance and predispose to weight gain and other metabolic problems.12 Emerging research is demonstrating that, as per traditional naturopathic principles, “the gut is the seat of all disease.”§ Diet also plays a major role in the disease process; high-fat and high-fructose diets, for instance, have been shown to increase endotoxins, which result in increased inflammatory responses in the body.13, 14

Zonulin Unzips Tight Junctions

Gut inflammation, whether from an immune reaction to food constituents such as gliadin in wheat, or due to LPS exposure from dysbiosis, results in the release of zonulin from enterocytes; this protein modulates intestinal permeability and may also be produced by dysbiotic bacteria.

Intestinal integrity is maintained by tight junctions between mucosal cells. These are composed of integral transmembrane proteins (claudins, occludin and junctional adhesion molecules [JAM]-A, -B and -C). It is thought that the production of zonulin ‘unzips’ these tight junctions (producing intestinal permeability or ‘leaky gut’) in an attempt to flush away the toxins (e.g. gluten).15 Accordingly, high levels of circulating zonulin are a marker for intestinal permeability, and by inference, for gut inflammation and dysbiosis, the processes driving insulin resistance and associated metabolic disorders leading to overweight and obesity.16 Recent research suggests changes to epithelial barrier function can result in changes to body weight and glucose homeostatis.17

B-420 Keeps Things Tight

Among the plethora of organisms that constitute the gut microbiome, one has been discovered which actively reduces circulating zonulin levels,18 thereby helping to maintain mucosal integrity. The specific strain, Bifidobacterium animalis ssp lactis (B-420) has been shown to not only prevent intestinal permeability,19 but also to support digestive health, and reduce gut and systemic inflammation.20 Furthermore, it also appears to prevent weight gain, possibly by reducing the energy harvested from food.21 This promising new strain is available in Bifidobacterium animalis ssp lactis (B-420for Healthy Gastrointestinal Function.

A Multi-Skilled Microbe

B-420 has demonstrated efficacy for various metabolic health markers, including body fat and glucose homeostasis. The use of this strain in healthy overweight or obese volunteers has shown its ability to increase faecal short-chain fatty acid concentrations, significantly reduce energy intake, and instigate significant changes to total body fat mass, trunk fat mass and android fat mass, thus demonstrating the ability to assist in weight management, especially in the abdominal region.22 Animal studies have also demonstrated the reduction in fat mass, glucose intolerance and insulin resistance with the use of B-420.23, 24

B-420 Stops the ‘Yo-Yo’

These actions make B-420 the perfect adjunct to the Shake It Practitioner Weight Management Program. A major problem in weight management programs is preventing ‘yo-yo’ fat regain when patients transition to an ongoing healthy maintenance diet. The microbiome can significantly influence weight gain through its control of the amount of energy extracted from food. People with a propensity to weight gain can actually be seen to have a more efficient gut microbiota, capable of harvesting more energy from a given amount of food (improved transfer and absorption of calories in the gut)25 – this is a great survival characteristic, however any energy not used immediately is stored as fat. In the context of an energy-replete Western diet; if your patient’s microbiome extracts more energy, they will store more fat. Probiotics such as B-420 can help control this process, thereby improving the overall results of fat loss programs.

Like all probiotics, the primary arena in which Bifidobacterium animalis ssp lactis (B-420) performs is the gut, but the echoes of its action reverberate throughout the body. By reducing the production of zonulin, it decreases intestinal permeability, reduces bacterial translocation and consequent inflammation. This in turn reduces the insulin resistance that drives metabolic conditions such as overweight, obesity, and type 2 diabetes. It is truly a bacterium whose time has come.

*BMI = common index of body weight. Calculated by dividing weight (in kilograms) by height (in metres squared), i.e., BMI=Wt (Kg)/Ht x Ht (m).

Endotoxin or liposaccharide (LPS) – highly inflammatory remnants of the cell walls of Gram-negative and certain Gram-positive dysbiotic bacteria

TLR4 is a transmembrane protein, a member of the toll-like receptor (TLR) family, which belongs to the pattern recognition receptor (PRR) family. Its stimulation leads to activation of nuclear factor kappa-B (NF-κB) and inflammatory cytokine production, which is responsible for activating the innate immune system. It is best known for recognising LPS, a component present in many dysbiotic bacteria.

§Hippocrates, 460-370 BCE.

References
  1. Nicolucci AC, Hume MP, Martinez I, Mayengbam S, Walter J, Reimer RA. Prebiotics reduce body fat and alter intestinal microbiota in children who are overweight or with obesity. Sept 2017;153(3):711-722. DOI: http://dx.doi.org/10.1053/j.gastro.2017.05.055
  2. Zhang Q, Wu Y, Fei X. Effect of probiotics on body weight and body-mass index: a systematic review and meta-analysis of randomized, controlled trials. Int J Food Sci Nutr. 2015 Aug;67(5):571-80. doi: 10.1080/09637486.2016.1181156. Epub 2016 May 5.
  3. Stenman LK, Waget A, Garret C, Klopp P, Burcelin R, Lahtinen S. Potential probiotic Bifidobacterium animalise ssp. Lctis 420 prevents weight gain and glucose intolerance in diet-induced obese mice. Benef Microbes. 2014 Dec;5(4):437-45.
  4. Stenman LK, Waget A, Garret C, Briand F, Burcelin R, Sulpice T, et al. Probiotic B420 and prebiotic polydextrose improve efficacy of antidiabetic drugs in mice. Diabetol Metab Syndr. 2015;7:75.
  5. Australian Government. Australian Institute of Health and Welfare. Risk factors to health. [Internet]. 2017 [updated 2017 Aug 7;cited 2017 Sept 21]. Available from:https://www.aihw.gov.au/reports/biomedical-risk-factors/risk-factors-to-health/contents/risk-factors-and-disease-burden
  6. Harley ITW, Karb CL. Obesity and the gut microbiome: striving for causality. Molec Metab. 2012;1:21-31.
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  8. Yang J. National Human Genome Research Institute. The human microbiome project: Extending the definition of what constitutes a human [Internet]. 2012 [cited 2017 Sept 12]. Available from: https://www.genome.gov/27549400/
  9. Turnbaugh PJ, Ley RE, Mahowald MA, Magrini V, Mardis ER, Gordon JI. An obesity-associated gut microbiome with increased capacity for energy harvest. Nature. 2006;444(21/28):1027-1031.
  10. Tiexeira TFS, Collado MC, Ferreira CLLF, Bressan J, Peluzio MdCG. Potential mechanisms for the emerging link between obesity and increased intestinal permeability. Nut Res. 2012;32:637-647.
  11. Zhang D-M, Jiao R-Q, Kong L-D. High dietary fructose: direct or indirect dangerous factors disturbing tissue and organ functions. Nutrients. 2017 Feb;9:335.
  12. Tiexeira TFS, Collado MC, Ferreira CLLF, Bressan J, Peluzio MdCG. Potential mechanisms for the emerging link between obesity and increased intestinal permeability. Nut Res. 2012;32:637-647.
  13. Tiexeira TFS, Collado MC, Ferreira CLLF, Bressan J, Peluzio MdCG. Potential mechanisms for the emerging link between obesity and increased intestinal permeability. Nut Res. 2012;32:637-647.
  14. Zhang D-M, Jiao R-Q, Kong L-D. High dietary fructose: direct or indirect dangerous factors disturbing tissue and organ functions. Nutrients. 2017 Feb;9:335.
  15. Stenman LK, Lehtinen MJ, Meland N, Christensen JE, Yeung N, Saarinen MT, et al. Probiotic with or without fiber controls body fat mass, associated with serum zonulin, in overweight and obese adults-randomized controlled trial. EBioMedicine. 2016 Nov;13:190-200.
  16. Stenman LK, Lehtinen MJ, Meland N, Christensen JE, Yeung N, Saarinen MT, et al. Probiotic with or without fiber controls body fat mass, associated with serum zonulin, in overweight and obese adults-randomized controlled trial. EBioMedicine. 2016 Nov;13:190-200.
  17. Raubould HE. Gut microbiota, epithelial function and derangements in obesity. J Physiol. 2011 Dec;590(3):441-446.
  18. Stenman LK, Lehtinen MJ, Meland N, Christensen JE, Yeung N, Saarinen MT, et al. Probiotic with or without fiber controls body fat mass, associated with serum zonulin, in overweight and obese adults-randomized controlled trial. EBioMedicine. 2016 Nov;13:190-200.
  19. Lyra A, Saarinen M, Putaala H, Olli K, Lahtinen SJ, Ouwehand AC, et al. Bifidobacterium animalis ssp. lactis 420 protects against indomethacin-induced gasatric permability in rats. Gastroenterology Research and Practice. 2012;615051.
  20. Stenman LK, Lehtinen MJ, Meland N, Christensen JE, Yeung N, Saarinen MT, et al. Probiotic with or without fiber controls body fat mass, associated with serum zonulin, in overweight and obese adults-randomized controlled trial. EBioMedicine. 2016 Nov;13:190-200.
  21. Turnbaugh PJ, Ley RE, Mahowald MA, Magrini V, Mardis ER, Gordon JI. An obesity-associated gut microbiome with increased capacity for energy harvest. Nature. 2006;444(21/28):1027-1031.
  22. Stenman LK, Lehtinen MJ, Meland N, Christensen JE, Yeung N, Saarinen MT, et al. Probiotic with or without fiber controls body fat mass, associated with serum zonulin, in overweight and obese adults-randomized controlled trial. EBioMedicine. 2016 Nov;13:190-200.
  23. Stenman LK, Waget A, Garret C, Klopp P, Burcelin R, Lahtinen S. Potential probiotic Bifidobacterium animalis ssp. lactis 420 prevents weight gain and glucose intolerance in diet-induced obese mice. Benef Microbes. 2014 Dec;5(4):437-45.
  24. Amar J, Chabo C, Waget A, Klopp P, Vachoux C, et al. Intestinal mucosal adherence and translocation of commensal bacteria at the early onset of type 2 diabetes: molecular mechanisms and probiotic treatment. EMBO Mol Med. 2011;3:559-72.
  25. Million M, Lagier J-C, Yahav D, Paul M. Gut bacterial microbiota and obesity. Clin Microbiol Infec. 2013 Apr;19(4):305-313.