By Grace Benson Russell Sage College

1. The Use of Galactooligosaccharides and Fructooligosaccharides in Functional Foods to Promote Immune Function and Prevent Colon Cancer By Grace Benson Russell Sage College

2. Abstract The use of probiotics is increasing in popularity as people around the world become more health conscious. Though probiotics, the beneficial bacteria that inhabit out intestines and support our immune system are indeed important, attention is starting to turn toward the use of prebiotics as well. Studies have shown that prebiotics such as galactooligosaccharides and fructooligosaccharides can confer health benefits including support for the immune system and cancer prevention. It is for these reasons that GOS and FOS are likely components of functional foods. Though some people may experience GI distress after consuming prebiotics such as fructans, most people experience no such adverse effects. In fact, GOS and FOS are already abundant in natural and many commercial foods. Unfortunately, the use of GOS and FOS may not be helpful to people receiving enteral nutrition, a population who could benefit the most from them.

3. Introduction • Functional Food- “a food that is similar in appearance to a conventional food, consumed as part of the usual diet, with demonstrated physiological benefits, and/or to reduce the risk of chronic disease beyond basic nutritional functions” (Sangwan et al., 2011). • Probiotics- beneficial bacteria that help maintain balance of microflora in intestines (www.webmd.com) • Prebiotics- non- digestible polysaccharides that serve as food for probiotics (www.mayoclinic.com) • Prebiotics more viable- more stable, do not need refrigeration as probiotics do. • May confer health benefits such as: • -promoting immune function • -preventing colon cancer • - May have undesired side effects for some people such as stomach upset • - Most people experience no adverse effects! • Many widely consumed commercial foods already contain prebiotics

4. Galactooligosaccharides • Non- digestible, non- starch polysaccharide • Benefits • Promote immune function by acting as food source for healthy intestinal bacteria such as Bifidobacteria • Such “beneficial” bacteria inhibit the proliferation of pathogens (Munjal et al., 2009) • Inhibits adhesion of pathogenic bacteria to lining of large intestine (Sanwan et al. 2011) • Metabolism of Galactooligosaccharides synthesize substances called short chain fatty acids (SCFA) that may reduce the risk of cancer (Sanwan et al., 2011) • Can be more easily incorporated into foods than probiotics • Do not need to be refrigerated (Sangwan et al., 2011)

5. Galactooligosaccharides Cont’d • Depeint et al. study (2008) • 59 participants • Crossover design (2 phases) • Participants who consumed 57% GOS mixture had greater amounts of Bifidobacteria in stool compared with those who consumed a different mixture • Quantified using PI- equation based on changes in proportion of bacterial groups • First phase- PI score for GOS mixture .18 +/- .08, placebo - .16 +/- .12; p<0.05 • Second phase- PI score for GOS mixture .12 +/- .09, placebo -.03 +/- .19; p<0.001 • PI scores indicate that the GOS mixture increased numbers of beneficial bacteria • So, in other words…. • GOS found to have prebiotic properties

6. Fructooligosaccharides (Fructans) • Similar to Galactooligosaccharides in that they are: • non- starch polysaccharides • non- digestible by human digestive system • fermented by same beneficial Bifidobacteriumas GOS • - found in many natural foods such as onions and garlic • Benefits • Fructans remain undigested when they enter the large intestine. Therefore, they may play a role in preventing colon cancer • Fermentation of fructans produces beneficial short chain fatty acids, such as butyrate • Butyrate may help prevent cancer because it inhibits cancer cell growth, especially adenoma cells, which represent an early stage of cancer • Stimulates apoptosis, the process of selected cell deletion. (Munjal et al., 2009)

7. Fructans Cont’d • Munjal et al., Study (2009) • In vitro experiment • Fermented a mixture of inulin and oligofructose under anaerobic conditions on human fecal samples • Compared the samples with samples from same donors that were not fermented • 2.6 fold increase in amount of SCFA in samples fermented with mixture • Concentration of butyrate was 4 times higher in fermented samples

8. Table 1. Concentration of SCFA (mmol/l) and bile acids (mmol/l) in faecal blank (FB) and Synergy* fermentation supernatant fraction (SFS) FB SFS SCFA Acetate 26·8 80·7 Propionate 9·2 17·2 i-Butyrate 1·1 0·6 n-Butyrate 6·6 26·4 i-Valerate 1·4 0·8 n-Valerate 1·8 1·0 n-Capronate 1·2 0·9 Total 48·1 127·6 Bile acids Deoxycholic acid 12·3 3·6 Adapted from “Fermentation products of inulin- type fructans reduce proliferation and induce apoptosis inhuman colon tumour cells of different stages of carcinogenesis..” Munjal, U., Glei, M., Pool- Zobel, B.L. Scharlau, D. (2009 ) British Journal of Nutrition. 102.

9. Fructans Cont’d • Disadvantages • May not be effective for people receiving enteral nutrition • this population could benefit the most because it could be useful in preventing diarrhea • Study by Majid et al., (2011) • 41 hospitalized patients receiving enteral nutrition • Cross- sectional study • Given either standard formula with no fiber or fructooligosaccharides or a formula enriched with fiber or FOS for 12 days • Fecal samples taken to determine bacterial count • Only higher concentration of butyrate found in samples of patients given enriched (20.5 mmolg-1 compared to 4.6 mmolg-1 for standard formula • No increase in amount of fecal microbiota (Majid et al., 2011) • One- third of patients still had such low counts of Bifidobacteria that it was undetectable (Majid et al., 2011)

10. Benefits of Prebiotics as Functional Foods • Other than the health benefits that GOS confer, they have other characteristics that make them likely food additives • High temperature and acid stability • Long shelf life • Low glycemic index • Can easily be added to commercial foods such as baked goods that would be high in fiber and low in calorie (Sangwan et al., 2011) • FOS • Though some people may experience adverse effects such as stomach upset, most people do not • Fructans already present at high levels in common foods such as muesli and Kellogg’s All- bran • When a variety of grain products were subject to testing using liquid chromatography, fructans were found to be the most common carbohydrate present (Biesiekierski et al., 2011) • - Common and safe

11. Conclusion • There is evidence that galactooligosaccharides and fructooligosaccharides can be added to commercial foods to utilized their prebiotic benefits as a functional food • Prebiotics can confer many health benefits including • Promoting immune function • Protecting against colon cancer • Stability during storage • GOS and FOS are generally well- tolerated by most people • They are already present in a variety of natural and commercial foods • The drawback is that they may not confer the same benefit to patients receiving enteral feeding who could benefit most from the effects of prebiotics

12. References Biesiekierski, J.R., Rosella, O., Rose, R., Liels, K., Barret, J.S., Shephard, S.J., Gibson, P.R.,Muir, J.G. (2011). Quantification of fructans, galactooligosaccharides, and other short- chain carbohydrates in processed grains and cereals. Journal of Human Nutrition and Dietetics, 24 (2), 154- 76. Depeint, F., Tzartzis, G., Vuleric, J., I’anson, K., Gibson., G.R. (2008). Prebiotic evaluation of a novel galactooligosaccharide mixture produced by the enzymatic activity of bifidobacteriumbifidumncimb 41171 in healthy humans: a randomized, double- blind,crossover, placebo- controlled intervention study. American Journal of Clinical Nutrition,87 (3), 785- 91. Majid, H.A., Emery, P.W., Whelan, K. (2011). Faecalmicrobiota and short- chain fatty acids in patients receiving enteral nutrition with standard or fructo oligosaccharides and fiber- enriched formulas. Journal of Human Nutrition and Dietetics, 24, 260- 268. Munjal, U., Glei, M., Pool- Zobel, B.L., Scharlau, D., (2009). Fermentation products of inulin- type fructans reduce proliferation and induce apoptosis in human colon tumour cells of different stages of carcinogenesis. British Journal of Nutrition, 102 (5), 663- 71. Sangwan, V., Tomar, S.K., Singh, R.R.B., Ali, B. (2011). Galactooligosaccharides: novel components of designer foods. Journal of Food Science, 76 (4), 103- 11.

13. References Cont’d Webmd. (2011). Probiotics topic overview. Retrieved from http://www.webmd.com/digestive- disorders/tc/probiotics-topic-overview. Zeratsky, K. (2011). Is it important to include probiotics and prebiotics in a healthy diet? Mayo Clinic. Retrieved from http://www.mayoclinic.com/health/probiotics/AN00389