Nutrition Considerations for Microbiota Health in Diabetes
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Tables
- TABLE 1.
Criteria for Prebiotic Classification (26)
For a food or substrate to be considered a prebiotic, it must be able to:
1. Resist digestion in the small intestine
2. Be fermented by the microbiota in the large intestine
3. Stimulate the growth and metabolic activity of beneficial species to improve the health and well-being of the host - TABLE 2.
Dietary Sources of Prebiotics and Their Documented Health Outcomes
Dietary Sources of Prebiotics (25,26) Prebiotics are found in:
• Breast milk
• Leeks
Asparagus
• Chicory
• Jerusalem artichokes
• Garlic
• Onions
• Whole-grain wheat
• Oats
• Soybeans
• BananasEvidence-Based Health Outcomes from Prebiotic Intake (25,30) Prebiotic intake:
• Increases the abundance of beneficial microorganisms
• Suppresses the proliferation of pathogenic microorganisms
• Provides treatment for diarrhea
• Helps with inflammatory bowel disease
• Prevents colon cancer
• Improves the absorption of minerals, including calcium, magnesium, zinc, and possibly iron, thus improving bone mineral density (via enhancement of SCFA production)
• Reduces cardiovascular disease risk
• Promotes satiety and helps with weight loss
• Lowers colonic pH - TABLE 3.
SCFAs (4,30)
SCFAs include butyrate, acetate, and propionate. They are produced by fermentable prebiotics and other soluble dietary fiber and provide the host with many health benefits. SCFAs:
• Serve as a main fuel source for colonocytes, which strengthen the epithelium, potentially decreasing the translocation of antigens and LPS, and reduce endotoxemia and insulin resistance (butyrate)
• Reduce colonic pH, which inhibits the growth of pathogenic bacteria (butyrate)
• Enhance mineral absorption
• Stimulate the release of PYY and GLP-1, which decreases appetite and improves insulin sensitivity (propionate, acetate, and butyrate)
• Are metabolized in the liver and may play a role in reducing serum cholesterol levels (propionate)
• May enhance fatty acid oxidation and thermogenesis (butyrate)
• May activate intestinal gluconeogenesis, contributing to weight loss and glucose control (butyrate, propionate) - TABLE 4.
Criteria for Probiotic Classification (32)
For a probiotic to be effective, it must:
1. Resist gastric, bile, and pancreatic digestion
2. Adhere to the mucosal and epithelial surfaces
3. Once colonized, remain metabolically active
4. Provide the host with protection from pathogens by secreting antimicrobial substances or preventing their adhesion and colonization
5. Demonstrate bile salt hydrolase activity - TABLE 5.
Sources of Probiotics and Reported Strains (36)
Reported Strains Plant-Based Probiotics Sauerkraut (fermented cabbage) Lb. plantarum
Lb. brevis
P. acidilactici
P. cerevisiae
Leuc. mesenteroidesKimchi (Korean spicy cabbage) Lb. plantarum
Leuc. mesenteroides
L. brevisTempeh (a fermented soybean product), soy sauce, miso Lb. plantarum
Lb. brevis
L. acidophilusWater kefir Lb. casei
Lb. hilgardii
Lb. hordei
Lb. nagelii
Leuc. citreum
Leuc. mesenteroides
Ac. fabarum
Ac. orientalis
Yeasts:
Hanseniaosporavalbyensis
Lachancea fermentati
Saccharomyces cerevisiae
Zygotorulaspora florentinaDairy-Based Probiotics Yogurt Lb. bulgaricus
Lb. acidophilus
S. thermophilus
Bifidobacterium spp.Kefir Lb. kefir
Lb. kefiranofaciens
Lb. brevisNote: strains may vary depending on processing technique. Reprinted from Ref. 34 with permission from the Academy of Nutrition and Dietetic Diabetes Care and Education Dietetic Practice Group. Ac., Acetobacter; L., Lactococcus; Lb., Lactobacillus; Leuc., Leuconostoc; P., Pediococcus; S., Streptococcus.