Help your customers take good care of their gut.
They say you are what you eat. If you eat well, you’ll probably feel well and if you eat poorly, you probably won’t. For this reason, digestive health is an excellent reflection of your personal well being. However, while it’s easy to generalize symptoms such as constipation, nausea, diarrhea or signs of a bad meal or a compromised immune system such as from a cold, everyone’s gut is unique and therefore a one-size-fits-all approach won’t cut it. Help your customers figure out what works best for them.
The Bacterial Colony
The probiotic category has seen genuine growth in recent years, as supplements and in food. Consumers are not wrong to be drawn to these items for the sake of their digestive health, but when a concept becomes prevalent, it can also become generic and the products being purchased can vary greatly in quality. As always, education is key.
Friendly bacteria. The human microbiome is as diverse as it is immense, both within each person and among different individuals. “Everybody has a totally unique microbiome, not even identical twins have the same microbiome,” explains Kiran Krishnan, chief scientific officer, Thrive Probiotic, Park Ridge, IL. “It is virtually impossible to get an accurate reading of which 1,000-3,000 strains exist in your gut among the over 100 trillion bacteria that reside there.”
For this reason, companies do their best to provide users with the most useful bacteria. “As a rule, it is best to supplement at least the two primary classes of probiotics; Lactobacillus, found mostly in the lower small intestine and upper large intestine, and Bifidobacteria, found mostly in the large intestine,” says Dallas Clouatre, Ph.D., consultant for R&D, Jarrow Formulas, Inc., Los Angeles, CA.
These are the two most prominent and studied probiotic classes in both supplements and food, providing much needed support to the body. Jay Levy, director of sales, Wakunaga of America Co., Ltd., Mission Viejo, CA, explains that Lactobacillus bacteria are “responsible for producing lactase, the enzyme needed to break down lactose. They also ferment carbohydrates in the gut, producing lactic acid as a result.” Lactic acid is important, says Levy, because it maintains an acidic environment (low pH) in the digestive tract, so that it is inhospitable to unwanted pathogens and increases calcium, copper, magnesium and iron absorption.
Bifidobacterium bacteria also produce lactic acid, providing “70% of the energy required by cells that line the intestinal wall, enhancing the natural protective barrier in the gut,” explains Levy. Their role in maintaining an acidic environment that wards off pathogens and harmful bacteria make these two species important to the body’s immune response. Of these, a variety of bacterial species support one another. L. acidophilus, B. bifidum and B. longum, for example, are permanent residents of the gut, while others such as L. bulgaricus and Streptococcus thermophilus, seen commercially in yogurt, are transient organisms that require
L. bulgaricus and Streptococcus thermophilus encourage an acidic environment in the gut, inhibit harmful bacteria and help produce lactase (1). B. bifidum and B. longum, two permanent gut microbes, encourage acidity in the bowels to fight the colonization of yeast, viruses and harmful bacteria, manufacture B vitamins and assist in the weight gain of infants (1). There are also more specific functions such as that of L. gasseri to reduce diarrhea, especially in combination with B. longum, says Levy.
Another combination, of L. gasseri, B. bifidum and B. longum, was found in a 2015 study to reduce inflammatory cytokine profile in older adults, “possibly due to the changes in the microbial communities, which more closely resembled those reported in healthy younger populations” (2). Levy dubs this the “friendly trio.”
Just how many bacterial strains or CFUs a product should have is hard to say, since “the microbiome differs from person to person and is influenced by many factors such as diet, antibiotic use and overall health,” says Sue Hewlings, chief science officer, IgY Nutrition, Oklahoma City, OK. Clouatre explains that a common range is three to eight species and/or strains, but to “Keep in mind that these species and strains must be compatible both in the delivery format and when administered.”
However, if you have a customer seeking a probiotic, chances are there is a reason. “Consumers should look for a specific strain if they are looking for a specific structure/function application or they could look for a wide spectrum product with multiple strains to cover many areas,” says Trisha Sugarek MacDonald, BS, MS, senior director of research and development/national educator, Bluebonnet Nutrition Corporation, Sugar Land, TX.
That being said, Sugarek MacDonald says, “In a probiotic formula…more strains is not always better. Too many beneficial bacteria in one supplement may find the bacteria competing against each other before they can establish themselves in separate areas of the intestinal tract. So, it’s important to look for a group of probiotics that work well together for a specific structure function application. “
Michael Bush, senior vice president, Ganeden, New York, NY, echoes this sentiment when he says, “While one strain may show immune modulation benefits at 500 million CFUs per day, another may require 50 billion CFUs per day to see similar benefits…The bottom line is that safety, efficacy and inclusion rates are all dependent upon the strain used and the documentation supporting the use at that level.” Using his company’s patented probiotic (GanedenBC30) as an example, he explains that 500 million CFUs per day will support immune health, while one billion CFUs of the same product will also support digestive health and protein utilization. Therefore, not all products are created equal and dosage requirements of a single product are dependent on the user’s needs.
The main point is quality, not quantity. Tina Anderson, CEO/co-founder of Thrive Probiotic, cites a study by the University of California that tested 16 Bifidobacterium probiotic products and found only one that perfectly matched its label claims. Among the other 15, researchers found lot-to-lot and even pill-to-pill variation between products (3).
That is why responsible manufacturers use genetic testing to identify strains and therefore ensure the safety and efficacy of probiotic cultures, says Neil E. Levin, CCN, DANLA, NOW Foods’ nutritional education manager, Bloomingdale, IL, using his own company as a prime example. He states, “This confirms that we are consistently using the desired strains and amounts so we can therefore appropriately craft label claims for each product.”
Other manufacturers differentiate themselves by taking a different approach. Just Thrive Probiotics, for example, uses an all spore-based probiotic of four strains: Bacillus Subtilis HU58, Bacillus Indicus HU36, Bacillus Clausi and Bacillus Coagulans at three billion CFUs. Anderson describes this as a “reconditioning probiotic” that creates optimal conditions in the microbiome to favor the growth of good bacteria by eliminating bad bacteria. Contrary to most probiotic formulas, rather than introducing additional bacteria, this supplement makes it easier for the gut to work optimally.
Another company that takes a unique approach is IgY Nutrition. Made from a hyperimmune egg powder, its product (IgY Max), says Hewlings, eliminates non-beneficial bacteria to allow beneficial bacteria to flourish. IgY Nutrition puts an emphasis on immune response, as the product contains antibodies that coat the mucosal membrane to create a protective barrier against bacteria entering the nose and mouth, explains Hewlings.
Feeding friendly bacteria. Fiber is well known to support digestion, regularity and even satiety in relation to weight management. Fiber can also be a prebiotic. More specifically, “A prebiotic is generally a short or long-chain, non-digestible carbohydrate—classified as a fiber—that ferments in the digestive tract and preferentially or selectively feeds friendly bacteria,” says Sugarek MacDonald. She goes on to explain that the three criteria for a prebiotic are that it resists host digestion, absorption and adsorption (adhesion to a surface), must be fermented by the microflora that colonize the gastrointestinal tract and must stimulate the growth and activity of friendly bacteria.
Levin explains that fructo-oligosaccharides and inulin are the predominant commercially available prebiotics, but that glucans and arabinogalactans also show prebiotic properties. Just like food is our predominant source of probiotics, so it is for fiber as well. Michel Sirgent, senior vice president of Bio-K+, Armand-Frappier Laval, QC, Canada, explains, “A diet rich in a variety of fruits, vegetable, legumes and whole grains can have a major impact on the quality and diversity of gut bacteria.” According to Levy, dandelion greens, garlic, onions, asparagus and bananas have good prebiotic value, however, “supplements that contain prebiotic fibers can ensure a steady supply of the ‘food’ that probiotics need to flourish.”
Mark Thurston, president of AIDP, City of Industry, CA, says that xylo-oligosaccharides are an ideal prebiotic “due to the small effective dosage required, which minimizes gastrointestinal side effects and allows them to be easily incorporated into both functional foods and dietary supplements at a competitive cost per dose for the formulator.”
Because prebiotics encourage probiotic growth in the gut, some companies provide formulas that combine the two. One example is Sanutra Wellness, which offers a product that combines Bacillus coagulans and a prebiotic called Fenumannans, obtained from fenugreek seeds. Shaheen Majeed, marketing director of Sabinsa, America’s Finest, Inc. parent company, East Windsor, NJ, explains that the probiotic in the formulas is “a gram- positive, rod-shaped, spore-forming bacteria producing only L (+) Lactic Acid,” and the prebiotic consists of mainly galactomannans, which “are a good source of carbon that promotes the growth and sporulation [of Bacillus coagulans].” Besides its beneficial relationship to the product’s probiotic, the prebiotic’s galactomannans “are highly viscous and form a gel in the stomach thereby slowing gastric emptying and thickening intestinal contents,” explains Majeed.
Given this synergistic relationship, it’s important to inform customers of the best way to utilize such supplements. If someone purchases a probiotic, encourage that person to supplement with prebiotics as well or at the very least, consume more prebiotic fibers from the foods previously mentioned. This will optimize the probiotics and keep them coming back for more when they achieve positive results.
Enzymes. One cannot talk about digestive health without getting into enzymes. Maile Combs, senior nutritional scientist and nutrition scientific affairs at American Health, Ronkonkoma, NY, explains, “Enzymes break down the nutritional components of food, making nutrients available for the body’s energy needs, cell growth and other vital functions.” Of the 4,000 essential biochemical reactions enzymes are involved with, half of them involve digestion, adds Levy. Therefore, says Combs, “Insufficient enzyme production by the body may lead to improper digestion and absorption, reducing availability of nutrients from food.” Additionally, enzyme production slows with age, which is why digestive issues are prevalent among the old.
Specific enzymes such as protease, lipase and amylase, are responsible for breaking down protein into amino acids, fat into fatty acids and carbohydrates into simple sugars, respectively, explains Combs. Deficiencies in digestive enzymes can contribute to a variety of issues, such as gas, bloating, food allergies, indigestion and heartburn. For many people, these symptoms can be rather generalized, for which Levy recommends a supplement with a blend of digestive enzymes to ensure complete digestion. However, some individuals experience digestive difficulties after eating certain foods, such as dairy, which would benefit from a more specialized enzyme to confront that specific problem.
It is important to note that while such enzymes may ease the negative symptoms of sensitivities or digestive intolerance, they do not cure any condition or stop allergies. As Sugarek MacDonald explains, intolerances to lactose or gluten are not the same as allergies because they do not affect autoimmune function. In people with lactose intolerances, their bodies either do not produce any or an insufficient amount of lactase, the enzyme responsible for digesting lactose sugars, says Sugarek MacDonald. For this, she recommends supplementing with a digestive enzyme rich in lactase, protease and lipase before meals that contain dairy so that the body is better of digesting the food.
Gluten intolerance has become very prevalent and feared, as reflected by consumers’ desire for clearly labeled gluten-free products. However, the term “gluten intolerance” is highly generalized, lumping together those with sensitivity to gluten and those diagnosed with celiac sprue, which is a genetic condition classified as a chronic inflammatory disorder of the small intestine, explains Sugarek MacDonald. Gluten sensitivity is therefore not the same as celiac sprue because it is not an autoimmune condition, which is an important distinction, as there are some enzymes that people can take to aid gluten digestion if they do not have celiac disease. Shoppers should, however, confirm diagnosis with a medical professional.
These enzymes include aspergillopepsin (ASP), dipeptidyl peptidase (DPP-IV) and cysteine endoprotease (EP-B2), says Sugarek MacDonald, who hopes they can open the door to finding similar solutions for those with celiac sprue. In the meantime, though, if you have a customer who’s lamenting having to give up some favorite foods because of a negative reaction, by all means, recommend some great gluten-free products, but also let them know about these enzymes in case they want to give them a try.
Enzymes can also help ease unpleasant symptoms, such as heartburn, which is common and occurs in people with or without digestive conditions. However, because consistent heartburn is a symptom of a few underlying conditions, it is important for consumers to know what can be causing this symptom and how to ease it. David Winston, RH (AHG), founder and president of Herbalist & Alchemist, Washington, NJ, explains that two causes of heartburn are hyperchlorhydria, too much stomach acid which is composed of hydrochloric acid (HCl), and hypochlorhydria, too little stomach acid.
In addition, both of these can coincide with gastroesophageal reflux disease (GERD), otherwise known as acid reflux disease. This means that the same symptom has completely opposite causes, making the issue of how to confront heartburn more complicated. According to Winston, the decreased gastic acid secretion of hypochlorhydria is more typical of individuals older than 45 years of age, but has been known to occur in younger people as well.
Sugarek MacDonald says that in such cases, along with gastric acid, the body also secretes less proteolytic enzymes, such as pepsin, which digests protein. Because of this, she recommends supplementation with betaine HCl and pepsin to help replenish both the gastric acid and enzymes in the stomach.
Krishnan says that lipase is another enzyme that may help with heartburn, even from GERD, as fat malabsorption has been indicated to be part of the condition.
Supplementing with HCl is in contrast with typical remedies such as antacids or medications like proton pump inhibitors, which neutralize acid and inhibit gastric acid production. They may relieve the symptoms, but only contribute to the underlying problem of hypochlorhydria. Clouatre says, “Retailers should try to find ways to highlight the contrast between easing symptoms of poor digestion and actually improving digestion.”
Herbal remedies can also help ease heartburn. For deficits of gastric acid, Winston recommends a balanced bitters formula of warming and cooling bitters such as orange peel and angelica, which promotes gastric HCl secretion. If excess acid is the problem, Winston says that marshmallow, slippery elm, meadowsweet, chamomile and lemon balm will help ease discomfort. There is also ginger, which Wellington Quan, general manager of the American Market Division at Prince of Peace Enterprises, Inc., Hayward, CA, says has an alkalizing effect.
Because of the different possibilities for heartburn, knowing the cause is half the battle. While age is a good rule of thumb, the best way to confirm the cause is to visit a physician. In the meantime though, if your customers would like to get a hint about what may be causing their heartburn, Winston provides an easy method to do so. He says that taking some apple cider vinegar during heartburn will either help or make it worse. If it helps, chances are you have too little gastric acid, but if the opposite is true, then you probably have too much.
Diet is often a culprit of heartburn and its underlying conditions, so Quan explains, “A person must know his/her body and take the appropriate steps in bringing balance to it, for which supplementation is only one aspect.”
The importance of pH. Now that we’ve established the value of enzymes in the body, we must acknowledge that they are dependent on pH balance. “Different enzymes are more effective at different pH levels,” explains Sugarek MacDonald. “If the pH levels are too high or too low for a particular enzyme, it might become denatured and will no longer perform its function.” Different areas of the digestive tract have varying pH levels, which means varying acidity. The lower the pH, the more acidic and the higher the pH, the more alkaline or neutral.
The stomach, prior to meals, would normally have a very low pH, at around two, since acidity is needed to digest proteins and create a protective barrier against bacterial invasion of the GI tract, explains Clouatre. Breaking it down further, he says that the upper small intestine would reach a more neutral pH of six, which is needed for the digestions of fats and the actions of pancreatic enzymes before gradually decreasing as it approaches and reaches the large intestine where the higher acidity produces peristalsis in order to maintain the proper passage of food through the bowel.
Supplementation with HCl can help support a balanced pH in the digestive system, says Levy, resetting the natural pH levels, as well as reducing candida and other fungi that can accumulate in an alkaline GI tract. Because a dysfunctional pH reduces nutrient absorption, Levy also explains that plant-based digestive enzymes will work in conjunction with HCl because they are typically active in a wide range of pH levels, therefore allowing them to aid digestion throughout the GI tract. “The best formulas contain a variety of enzymes capable of digesting all the major nutrient groups at different pH levels,” he says. Plant enzymes are ideal for many people because, as Levin explains, “animal-derived enzymes are more targeted to functioning in specific narrow pH ranges.”
Probiotics and prebiotics will also support pH balance, as friendly bacteria are crucial to a properly functioning GI tract by metabolizing carbohydrates to produce short-chain fatty acids (SCFAs), explains Thurston. These SCFAs, which include acetate, propionate and butyrate, each have their own function as well. Butyrate is a significant energy source for colonocytes, while propionate is mostly absorbed by the liver. Acetate, the principal SCFA in the colon, has been shown to increase cholesterol synthesis, says Thurston.
Levin also explains that it’s important for customers to know that acidity in the stomach should not be confused with systemic pH because the latter “refers to the pH of circulating blood and serum and reflects dietary rather than digestive factors.”
While the science of digestive health has certainly advanced, herbal remedies will always stand the test of time. Utilized for generations to ease digestive discomfort and support good health, herbals, whether we realize it or not continue to play a large role in our daily lives, ginger being a prime example. Many can relate to being given ginger ale to sooth an upset stomach as a child and without thinking about it, doing the same for one’s own children. This, despite the fact that most ginger ale, unless it’s natural, does not contain actual ginger. So, acquaint your customers with the real thing and show them how even herbal remedies have made huge leaps forward.
Ginger. The use of ginger to support digestive health is prolific. Majeed explains that “ancient Greeks ate ginger wrapped in bread to prevent nausea from a huge feast,” and for centuries, “Chinese sailors have taken ginger to avoid sea sickness.” Besides nausea and motion sickness, ginger has also been utilized for heartburn, stomach cramps and loss of appetite. Majeed cites one study by the University of Rochester that measured the severity of nausea among patients on day one of chemotherapy, taking either placebo, 0.5 g of ginger, 1.0 g of ginger or 1.5 g of ginger in conjunction with an antiemetic drug (4). Results showed the most significant reduction of nausea in subjects taking 0.5 and 1.0 g of ginger (4).
The researchers in the study speculate that ginger alleviates nausea through a combination of anti-inflammatory and anti-spasmodic activities (4). Antiemetic drugs, such as the 5-HT3 used in the study, are receptor antagonists for specific receptors in the GI tract, and ginger can bind 5-HT3 receptors, thereby enhancing antiemetic effects and increasing detoxification enzymes to counteract oxidative damage to tissues (4). Sugarek MacDonald echoes a possible anti-inflammatory effect when she explains that while the mechanism of action is not confirmed, “it has been suggested that the gingerols inhibit aggregation of platelets and attenuates inflammation in the body by inhibiting an enzyme known as COX-2.”
Select Digestive Health Products
AIDP: Preticx Xylo-oligosaccharides, Inulin, Fructo-oligosaccharides, Galacto-oligosaccharides.
In the University of Rochester study, ginger supplementation began three days prior to the chemotherapy, thus priming the gut for antiemetic action (4). Researchers say this approach is similar to how ginger is often implemented to avoid motion sickness. This can be an important detail for customers who are preparing for a flight, cruise, long distance road trip or any other activity that may create motion sickness.
Lynda Doyle, vice president of global marketing, OmniActive Health Technologies, Morristown, NJ, says that because most dosage requirements are so high to make ginger effective, ranging from 1,000 to 3,000 mg, most supplements require multiple daily doses, which may reduce consumer compliance. Therefore, she describes a high-potency extract (Gingever) that contains 25% gingerols, the active compound of ginger. High-potency extracts can reduce the amount of doses that need to be taken to be effective, thus making them more appealing for consumers.
Combos. While individual herbal ingredients may be helpful on their own, combinations are certainly beneficial. “Combining appropriate herbs can help create a synergy of activity that enhances activity, improves absorption and reduces incidence of adverse effects,” says Winston.
Majeed describes a formula from America’s Finest, Inc. that provides deglycyrrhizinated licorice (DGL) with ginger. DGL, he says, is considered a natural antacid and when used as a supplement, can support the integrity of the stomach lining, stimulating the normal defenses that fight ulcer formation.
Carminative herbs, such as a formula (Carminative Compound) with fennel seed, chamomile, peppermint, wild yam and ginger, says Winston, eases gas, stomach rumbling and abdominal bloating. For children suffering from an upset stomach, Winston recommends a formula (Kid’s Tummy Relief) containing chamomile, catnip, ginger, lemon balm, dandelion root, which promotes normal bowel and liver function, and peppermint essential oil.
Sometimes, no matter how careful a person is, life will just happens. That means getting hit with occasional diarrhea, which no doubt will mean a parent, husband or wife will come into your store urgently looking for something that could help. Winston explains that diarrhea can have a number of causes, including viral, bacterial or related to conditions like irritable bowel syndrome and celiac disease.
If your customer believes a virus was contracted, tell him or her to contact a healthcare provider. They may want to discuss the use of herbs like chamomile, turmeric, yarrow and cat’s claw, says Winston, adding that astringents like bayberry bark and cinnamon will help as well. For bacterial diarrhea, customers should first consult with a doctor, as this is essentially the product of food poisoning, but Winston recommends a formula of antibacterial herbs (AF Compound) with myrrh, yellow root and usnea. None of these will outright cure the diarrhea, but should help the body repair itself.
Essentially, the intention of a cleanse, which has become synonymous with detoxification, is to remove toxins from organs such as the colon, kidney and liver, which act as filters in the body (5). This allows them to work more efficiently and restore bodily equilibrium. Cleansing has become rather popular and therefore subject to great debate. Some question its efficacy and safety, while others swear by it. Of course, it all depends on the approach.
“Detoxification is a complex process involving a chain of chemical reactions wherein the toxin is converted into an inert, water-soluble form for excretion that occurs primarily within the liver, but also involving the intestine and kidneys,” explains Majeed. The body naturally eliminates toxins but because of a poor diet or systemic imbalance, it can use some help. However, this help requires a balanced and measured approach that Majeed says should address repairing damage to the intestinal lining to support proper nutrient absorption and digestion, removal of harmful microbes and free-radicals, replacement of important nutrients that have been lost along the way to result in the rejuvenation and optimal function of the liver and other excretory organs.
Alan Cheung, bacteria advocate at Belle and Bella, Lexington, MA, seconding the concepts of removal and replacement, says “Cleansing can help reset your digestive system, but it needs to be supplemented with a probiotic to replenish your digestive system.”
Levin explains that responsible cleansing formulas “are designed to naturally support the body’s own detoxification mechanism, making it easier to eliminate toxins from the body,” as opposed to using harsh laxatives. NOW Foods, for example, offers cleansing formulas (NOW Easy Cleanse) for morning and evening detox. The morning formula is a blend of herbs, nutrients and green foods and the evening formula uses gentle, bulking fibers that naturally bind to undesirable metabolic byproducts to facilitate the natural elimination of toxins.
Levy also advocates the use of fiber and key nutrients to support optimal intestinal function, as it is gentler and proactive by replacing toxins with healthy bacteria and nutrients. However, more critical than the intestines, says Levy, is the liver, “since that is where detoxification begins.” It not only works non-stop to filter toxins from our body, explains Levy, but also produces proteins, digestive enzymes and bile, which is essential for healthy digestion and proper immune response.
Winston places the emphasis on gentle. The cleanse (Restorative Cleansing Protocol) he designed has one week of deep cleansing and detox followed by a second week or rebalance cleanse and detox. This includes a formula (Gentelax) that combines mild laxative herbs with cholagogue, aperients and ginger. Cholagogues are herbs that stimulate the production and secretion of bile from the liver and aparients such as dandelion root to enhance normal liver and bowel function without acting like a stimulant laxative, explains Winston.
It is important for customers to understand that cleansing is not a quick fix, but rather part of an ongoing effort of self improvement that includes eating a balanced diet and exercising. WF
For more information, see WholeFoodsMagazine.com/supplements
1. A. Minocha, Natural Stomach Care. Avery. New York, NY, (2003).
2. S.J. Spaiser et al., “Lactobacillus gasseri KS-13, Bifidobacterium bifidum G9-1, and Bifidobacterium longum MM-2 Ingestion Induces a Less Inflammatory Cytokine Profile and a Potentially Beneficial Shift in Gut Microbiota in Older Adults: A Randomized, Double-Blind, Placebo-Controlled, Crossover Study.” J. Am. Coll. Nutr. 34 (6), 459–469 (2015).
3. Z.T. Lewis, “Validating Bifidobacterial Species and Subspecies Identity in Commercial Probiotic Products,” Pediatric Res. (2015). http://www.nature.com/pr/journal/vaop/
ncurrent/abs/pr2015244a.html, accessed 2/25/2016.
4. J.L. Ryan, “Ginger (Zingiber officinale) Reduces Acute Chemotherapy-Induced Nausea: A URCC CCOP Study of 576 Patients.” Support Care Cancer 20 (7), 1479–1489 (2012).
5. A. Lowry, “Detox: Healthy Habit or Fad,” WholeFoods Magazine 38 (12), 37–38 (2015).
Published in WholeFoods Magazine April 2016