Health Benefits of FOSoligofructose Improves dietary fiber intake

1. Health benefits of FOS Key Highlights Fossenceisasolubledietary fiber. Fossenceintakecontributesto dietaryfiberintake. Dietaryfiberintakesupports bowelmovements. Dietaryfiberintakesupports managementofglycaemia. Solubledietaryfiberhelpsin the managementof hypertension Page 1 1 of 6 6

2. Mechanism of Action There is a growing interest in the role of the human gut microbiome in producing beneficial health effects and the role of the prebiotic dietary fibre in the same. This section reviews the health effects of the dietary fibres bringing out the position of prebiotics in the overall context of the dietary fibres. There is a general acceptance of the role of specific dietary fibres in positively impacting general defecation, reducing post-prandial glycemic response and reducing blood cholesterol. However, there is a debate on the other presumed health benefits. Effects of specific dietary fibres, especially prebiotics, which are not yet generally acknowledged nor completely understood, include (Verspreet et al. 2016):  Improvement in the integrity of the epithelial layer of the intestines.  Increase in the resistance against pathogenic colonization.  Reduction in the risk of developing colorectal cancer.  Increase in mineral absorption.  Resultant positive impact on the immune system. In the recent years, there is increased scientific evidence being accumulated, elucidating the health promoting effects of prebiotics. Thus, it calls for inclusion of prebiotic dietary fibre in the healthy day-to-day diet for boosting good health. Dietary fibre Dietary fibre Dietary fibre consists of remnants of edible portions of plant cells, polysaccharides, lignins and associated plant substances that are resistant to digestion. Hence, they cannot be digested by human digestive enzymes in our digestive tract but fermented in colon. (Figure 1 and 2) Dietary fibre can be broadly divided into two types: 1. Insoluble fibres are mainly derived from whole-grain products. 2. Soluble fibres are mainly derived from fruits, vegetables, pulses, and oats. Page 2 2 of 6 6

3. Dietary fibre and reduction of blood pressure Dietary fibre and reduction of blood pressure Not much is known about the potential mechanism by which dietary fibers may reduce blood pressure (BP). An earlier meta-analysis of randomized placebo control trials showed that an average fibre supplementation of 11.5g/d was able to change systolic BP by -1.13 mm Hg (95% confidence interval: -2.49 to 0.23) and diastolic BP by -1.26 mm Hg (-2.04 to -0.48). Thus an increase in fibre intake may contribute to supporting prevention of hypertension in populations where fibre intake is low (Streppel et al. 2005). Another biologically plausible mechanism is through an indirect effect on Insulin. It is known that dietary fibre reduces the glycemic index of foods, which in turn attenuates the insulin response. Insulin may be one of the factors responsible in BP regulation. Hyper-insulinemia leads to renal sodium and fluid retention based on the assumption that the kidneys of hypertensive patients maintain normal sensitivity to the antinatriuretic effect of insulin (Shimamoto et al. 1994). Some studies have shown dietary fibre to enhance insulin sensitivity and improve vascular endothelial function. Further, there is evidence to show that soluble diet ary fibre improves mineral absorption in the gastrointestinal system, which may have an indirect favorable effect on BP. Page 3 3 of 6 6

4. Other health benefits of dietary fibre Other health benefits of dietary fibre The nutrient requirements and recommended dietary allowances for Indians, ‘ICMR-NIN, 2010’ has mentioned that evidence is available to suggest that ‘fibre’ is essential to:  Maintain body weight and composition.  Maintain blood levels of sugar (since they have a low glycemic index).  Maintain triglycerides and cholesterol levels. Foods containing dietary soluble or insoluble fibres, are more slowly digested and metabolized, thus favoring a slow release & absorption of sugar into the small intestine, this results in a lower glucose. These are therefore termed as ‘low glycemic index (GI)’ foods (Figure 3). Such foods are useful in the management of diabetes and in the control of weight management and obesity. Regulatory bodies like Food and Drug Administration (FDA) also have approved health claims for many sources of good fibre. Recommendations/Guidelines for intake of dietary fiber Recommendations/Guidelines for intake of dietary fiber US Agencies have recommended that a minimum intake of 20- 35 g/day of fibre is conducive for long-term good health. The WHO Committee on chronic degenerative diseases has recommended a daily intake of 30 g/day. An intake in excess of 60 g of fibre over a day should be avoided as it can reduce the absorption of nutrients and may cause irritation in the bowel and also lead to diarrhea. On an average, recommendations of fibre intake for Indians are based on per day calorie intake and 40g of fiber intake per 2000kcal energy intake is recommended (ICMR-NIN, 2010). lower and slower rise in blood Page 4 4 of 6 6

5. Adults There exists a significant gap in the daily recommended amounts of fibre in the human diet (28-42 g/day) than that which is consumed (a median intake of 12-14 g/day). Less than 5 percent Americans meet the recommended dietary fibre intake (Thompson and Brick , 2016). To supplement the intake through regular food, there are available options of various dietary f ibres, including FOS, which have shown several health benefits (Verspreet et al. 2016). In a study (below) performed on elderly continuous ambulatory peritoneal dialysis (CAPD) patients patients, to examine the effects of FOS supplementation on constipation and biochemical parameters, a positive effect was observed on the intake of dietary fibre with the consumption of FOS (Meksawan et al. 2016). Study Results Study Results Dietary fibre intake was significantly increased upon FOS supplementation, compared with baselin e (p < 0.001) and placebo (p < 0.001) (Figure 4; Meksawan et al. 2016). Page 5 5 of 6 6

6. References References 1.The Indian Council of Medical Research (ICMR) & National Institutes of Nutrition (NIN). Nutrient requirement and recommended dietary allowances for Indians- a Report of the Expert Group of the ICMR, 2010. 2.Meksawan K. Effects of fructooligosaccharide supplementation on constipation in elderly continuous ambulatory peritoneal dialysis patients. Perit Dial Int. 2016 ; 36(1):60-6. 3.Shimamoto K. Insulin sensitivity and the effects of insulin on renal sodium handling and pressure systems in essential hypertensive patients. Hypertension 1994;23 (Suppl I):I -29-33. 4.Streppel MT. Dietary fibre and blood pressure: a metaanalysis of randomized placebo -controlled trials. Arch Intern Med. 2005;;165(2):150-6. 5.Thompson HJ, Brick MA. Perspective: Closing the Dietary Fibre Gap: An Ancient Solution for a 21st Century Problem. Adv Nutr, 2016;7(4):623-6. 6.Verspreet J. A critical look at prebiotics within the dietary fibre concept. Ann Rev Foo d Sci Technol, 2016;7:167-90. Page 6 6 of 6 6