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CRC Prevention

CRC Prevention. The Most Obvious. An eating plan that is: low in fat <30 %of total daily calories With saturated fats being <10% High in fiber 25-35 grams per day Rich in fruits and vegetables, while grains, beans and legumes and lean protein

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CRC Prevention

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  1. CRC Prevention

  2. The Most Obvious • An eating plan that is: • low in fat • <30 %of total daily calories • With saturated fats being <10% • High in fiber • 25-35 grams per day • Rich in fruits and vegetables, while grains, beans and legumes and lean protein • A plan that will allow you to lose weight since obesity is a risk factor for CRC • Reduce red meat • Use dairy products due to calcium, Vit D, CLA • De-sugar your diet • Drink water, stay hydrated • Curb alcohol intake • Stop smoking

  3. Fiber is Special • Decreases bile acids in gut which decreases cells proliferation • Activates tumor suppressor gene • Speeds passage of stool in your colon • Food source for friendly bacteria • May prevent diverticulosis • Relieves constipation • Helps in weight management • Helps control Type II diabetes

  4. Chemoprevention….. …the use of medications, herbs, vitamins and mineral supplements to prevent, reverse, or suppress the progression of precancerous cells to full-blown cancer

  5. Supplements and Chemoprevention • Folic acid, 1000mcg/day • 15 yr supplementation reduced CRC risk by 75% • 5-10 yr supplementation decreased CRC by 20% • Regulates cell growth in UColitis which is risk factor for CRC • Acts via dec gene mutations, assist in gene repair, protect against errors in gene replication • Calcium, need 800mg/day • dec cell division of colon cells by binding with bile acids • In men Ca supp 1500mg/day and higher has been assoc. with prostate cancer • Vitamin D • Anti cancer, prevents cancerous cell growth and converts cancer cells into more normal cells • Selenium, 100-200 mcg/day • antioxidant and repairs damaged cells • Vitamin E • Alpha-tocopheral slightly protected, gamma-tocopheral slightly inc CRC risk • NSAIDS, Aspirin, Curcumin, red ginseng, rosemary [Kaprex], and catechins in green tea interferes with COX-1 and COX-2 • Estrogen • Decreases CRC by 20-30% • Fish oils • Olive oil, contains squalene that inhibits cancers in rats • Inulin, acts as a fiber and fosters beneficial bacterial growth in the gut • Conjugated linoleic acid • inhibits CRC as an antioxidant

  6. Folic Acid Adverse Reactions with Rx’s • Methotrexate • Colchicines • Trimethoprim • Pyrimethamine • Trimetrexate • Phenytoin • Chemotherapy agents • Aspirin interferes with FA absorption

  7. Natural NSAID = Curcumin • Inhibit angiogenic growth • emitted by tumor cells eliciting angiogenesis (growth and development of new blood vessels) • Inhibit cell cycles • inhibited cell proliferation and induced G2/M (cell cycle phase) arrest in HCT-116 colon cancer cells • inhibition of the promotion/progression stages of carcinogenesis • Via arrest of cancer cells in S, G2/M cell cycle phase and to the induction of apoptosis • Induces apoptosis • as evidenced by cleavage of PARP, caspase-3, and reduction in Bcl-XL levels • stimulated the activity of caspase-8 which initiates the Ras signaling pathway of apoptosis • exerts its anticarcinogenic properties by inhibiting proliferation and inducing apoptosis in certain gastric and colon cancer cells • lower rate of colorectal cancer in countries that use curcumin as a dietary substance • Anti-inflammatory medicine • inhibits lipooxygenase activity • is a specific inhibitor of cyclooxygenase-2 (COX-2) expression • Anticarcinogenic properties • inhibits the cytochrome P-450 enzyme activity and increases the levels of glutathione-S-transferase • inhibited the growth of DNA mismatch repair-defective colon cancer cells • curcumin may have value as a safe chemotherapeutic agent for the treatment of tumors exhibiting DNA mismatch repair-deficient and microsatellite-unstable phenotype • The American Health Foundation suggests curcumin should be considered a safe, nontoxic, and easy-to-use chemotherapeutic agent for colorectal cancers in the setting of chromosomal instability as well as microsatellite instability.

  8. Lastly, Anti-Angiogensis Therapies • Target the genomically stable cells of the tumor vasculature • GSH replacement • Block angiogenic factors, or induce endothelial apoptosis • C-statin • Avastin = anti-VEGF • Curcumin • ability to inhibit angiogenic growth signals emitted by tumor cells eliciting angiogenesis (growth and development of new blood vessels) • inhibited cell proliferation and induced G2/M (cell cycle phase) arrest in HCT-116 colon cancer cells

  9. Best way to Reach the Masses? Through their stomachs!

  10. Modify Foods • Well established mode of impacting public health • i.e., enriched bread, milk, eggs • all potentially allergic foods!! • Need to start early = kids • Remember Joe Camel on cigarettes. • What better food than breakfast cereal We got our food, now what chemoprevention do we add?

  11. How about Inulin? It was on our list!

  12. What Is Inulin? • A fructan and storage carbohydrate, inulin, belongs to a group of naturally-occurring carbohydrates containing non-digestible fructooligosaccharides. The nutrition industry refer to them as FOS. (1) • Inulin is a plant starch. (5) • Inulin is found naturally in more than 36,000 types of plants worldwide. It is estimated that approximately one-third of the earth's vegetation contain this substance. Because of its presumed health benefits, it is used as a food ingredient in a variety of processed foods. (1)

  13. Inulinn or m equal the number of fructose unitsG = glucose, F = fructose Inulin intake in the U.S. = from 1 to 4 grams daily. (6)

  14. Inulin Metabolism (6) • Only slightly digested in the small intestine • Fermented by a limited number of colonic bacteria • Which changes the colonic ecosystem in favor of some bacteria, such as bifidobacteria, which may have health benefits • Inulins are considered to be bifidogenic factors. • Their energy content is about half that of digestible carbohydrates or about 1 to 2 kcal/grams.

  15. Action of Inulin (6) • May have: • Antitumor - due to action of butyrate • Butyrate, the anion of the short-chain fatty acid butyric acid, is produced by bacterial fermentation of inulins in the colon. Some studies suggest that butyrate may induce growth arrest and cell differentiation and upregulate apoptosis, three activities that could be significant for antitumor activity. • Antimicrobial • May promote the growth of favorable bacterial populations, such as bifidobacteria, in the colon. Bifidobacteria may inhibit the growth of pathogenic bacteria, such as Clostridium perfringens and diarrheogenic strains of Escherichia coli. • Hypolipidemic • Some indication that they may lower serum triglycerides in some humans via decreased triglyceride synthesis in the liver • Inulins may lower cholesterol levels in some type 2 diabetics. There is less evidence that inulins lower cholesterol in those with hypercholesterolemia who do not have diabetes. Propionate, a product of inulin fermentation in the colon, may inhibit hydroxymethylglutaryl-CoA (HMG-CoA) reductase, the rate-limiting step in cholesterol biosynthesis. • In particular, inulin and oligofructose have been seen to significantly reduce serum triglycerides (19 percent and 27 percent, respectively).(28)

  16. Hypoglycemic actions • Some evidence that inulins may lower fasting blood sugar in type 2 diabetics via delay gastric emptying and/or shorten small-intestinal transit time • It may do this by its metabolic conversion to methylmalonyl-CoA and succinyl CoA, metabolites that may inhibit pyruvate carboxylase. Propionate may reduce plasma levels of free fatty acids. High levels of plasma free fatty acids lower glucose utilization and induce insulin resistance. Propionate may also enhance glycolysis via depletion of citrate in hepatocytes. Citrate is an allosteric inhibitor of phosphfructokinase • Help to improve mineral absorption and balance • Inulins may also aid in increasing the concentrations of calcium and magnesium in the colon. High concentrations of these cations in the colon may help control the rate of cell turnover. High concentrations of calcium may also lead to the formation of insoluble bile or salts of fatty acids. This might reduce the potential damaging effects of bile or fatty acids on colonocytes. • Inulins have also been seen to increase soy isoflavone • Antiosteoporotic activity. • Inulins, similar to dietary fiber, may bind/sequester such minerals as calcium and magnesium in the small intestine. The short-chain fatty acids (acetate, propionate, butyrate) formed from the bacterial fermentation of inulins in the intestinal tract may facilitate the colonic absorption of calcium and possibly also magnesium ions. This could be beneficial in preventing osteoporosis and osteopenia. • Inulins have also been seen to increase soy isoflavone preventing ostopenia(29)

  17. Pharmacokinetics (6) • Little digestion of inulins takes place in the stomach and small intestine following ingestion of inulins. • Inulins are fermented in the colon by bifidobacteria and some other bacteria to produce: • the short-chain fatty acids acetate, propionate and butyrate • the gases hydrogen, hydrogen sulfide, carbon dioxide and methane • and lactate, pyruvate and succinate. • Acetate, propionate and butyrate that are not metabolized in colonocytes are absorbed from the colon and transported via the portal circulation to the liver. These short-chain fatty acids are extensively metabolized in hepatocytes. • Acetate, propionate and butyrate that are not metabolized in hepatocyes are transported by the circulation to various tissues, where they undergo further metabolism. • Butyrate is an important respiratory fuel for the colonocytes and is metabolized in them to carbon dioxide and water. • Energy, in the form of ATP, is produced from the catabolism of butyrate. • Those with ileostomies may have a microbial population colonizing their ileums. In those cases, inulins could be fermented by some of the bacteria in similar fashion to the way they are fermented in the colon.

  18. Labeling Laws (1) • The Food and Drug Administration classifies inulin and oligofructose as food ingredients not as additives. They are considered to be safe to eat but must be declared on ingredient labels if used in processed foods. • For instance, if apple juice contains hydrolyzed inulin syrup, it must be labeled on the ingredients label.

  19. Why Is It Used? (1) • The key reasons inulin is used in processed foods are for fat replacement and fiber enrichment. As a fat replacement, it improves the taste, texture, and mouth feel of reduced-fat and fat-free dairy products. Cereal-based products such as cakes, bread, and breakfast cereals exhibit improved structure and crispness. • A hydrolysate of inulin, oligofructose, not only improves texture and mouth feel but also enhances taste and fruit flavors when used in low fat yogurt in combination with high-intensity sweeteners. It is also used in healthy dairy drinks to improve fiber content.

  20. Sources of Inulin (1) • Examples of natural-occurring sources of inulin include: • Asparagus • Banana • Chicory • Garlic • Leek • Jerusalem Artichoke • Onion • Salisfy • Wheat

  21. Herbs containing Inulin (2) • Burdock root • Dandelion root • Elecampane root • Chicory root • Chinese herb codonopsis

  22. Action of Herbs (2) • Botanically, inulin is a storage food in the plants of the Composite family. • Inulin when injected interacts with complement system, which has resulted in rumors in herbal circles that it is immunostimulant. • It is not digested or absorbed, except in micro amounts

  23. Examples of processed foods that may contain inulin include: (1) • Beverages • Breakfast cereals • Butter • Candies • Chocolate • Ice cream • Yogurt All the stuff kids like!

  24. Specific products that contain Inulin • Stonyfield Yogurt • Neosugar • Alant Starch • Atlanta Starch • Alantin • Dahlin • Helenin • Diabetic Sugar • Nature’s Plus dog food. • EnviroKidz Organic Cheetah Chomps Cereal from Nature’s Path Foods • Yoplait - Nouriche smoothies • Edge Protein Drinks • Power Bars • In the UK, Rice Krispies Muddles [Harry Potter anyone? I guess I’m thinking of Muggles!]

  25. Health Benefits of Inulin (1) • The use of inulin and oligofructose are considered health boosters because they may help increase calcium and magnesium absorption, and may improve fat metabolism and function of the gastrointestinal tract. (1)

  26. Colon Health Benefits of Inulin (2) • Inulin is a preferred food for the lactobacilli in the intestine and can improve the balance of friendly bacteria in the bowel • Subjects in one trial were give 15 grams of inulin a day for fifteen days. • Lactobacillus bifidobacteria increased by about 10% during that period. • Gram-positive bacteria associated with disease declined. • Bifidobacteria digest inulin to produce short chain fatty-acids, such as acetic, propionic, and butyric acids. • The first two may be used by the liver for energy production • while butyric acid has cancer-preventing properties within the intestine (Spiller, 1994). • Recent animal research also shows that inulin prevents precancerous changes in the colon (Reddy, 1997). (18)

  27. Chinese Sources of Inulin (2) • Echinacea has not been traditionally consumed as a decoction or eaten in food quantities, and thus the amount of inulin ingested would not be significant. It would not necessarily be desirable to prepare it as a tea, because key immune-stimulating constituents are only soluble in alcohol. • Saussurea is commonly used in traditional Chinese medicine as a "spleen tonic" or digestive tonic. In some regions of China, Inula helenium <D>is freely substituted for saussurea (Hsu). • Note that elecampane, although pigeonholed by modern North American herbalists as a lung tonic, was used by the Eclectics both as a lung and digestive tonic (Felter). • Another common Chinese digestive and "spleen" tonic that contains inulin is codonopsis, an ubiquitous ginseng substitute in contemporary traditional Chinese medicine

  28. Plants with highest amounts of Inulin (3) • Cichorium intybus L. -- Chicory, Succory, Witloof; 110,000 - 580,000 ppm in Root; • Arctium lappa L. -- Burdock, Gobo, Great Burdock; 190,000 - 500,000 ppm in Root; • Inula helenium L. -- Elecampane; 200,000 - 440,000 ppm in Root; • Taraxacum officinale WEBER EX F. H. WIGG. -- Dandelion; 250,000 - 400,000 ppm in Root; • Echinacea spp -- Coneflower, Echinacea; 59,000 - 200,000 ppm in Root; • Saussurea lappa C. B. CLARKE -- Costus, Kuth; 180,000 ppm in Root; • Arnica montana L. -- Leopard's-Bane, Mountain Tobacco; 90,000 - 120,000 ppm in Rhizome; • Artemisia vulgaris L. -- Mugwort; 100,000 ppm in Root; • Punica granatum L. -- Granado (Sp.), Granatapfelbaum (Ger.), Granatapfelstrauch (Ger.), Grenadier (Fr.), Mangrano (Sp.), Pomegranate, Romanzeiro (Port.), Zakuro (Jap.); 10,000 ppm in Petiole; • Achillea millefolium L. -- Milfoil, Yarrow; in Plant; • Arnica montana L. -- Leopard's-Bane, Mountain Tobacco; in Flower; • Asparagus officinalis L. -- Asparagus; in Root; • Calendula officinalis L. -- Calendula, Pot-Marigold; in Root; • Centaurea calcitrapa L. -- Star-Thistle; in Plant; • Cichorium endivia L. -- Endive, Escarole; in Root; • Cynara cardunculus subsp. cardunculus -- Artichoke; in Flower; • Gentiana lutea L. -- Gentian, Yellow Gentian; in Root; • Helianthus tuberosus L. -- Jerusalem Artichoke; in Tuber; • Lactuca scariola L. -- Prickly Lettuce; in Root; • Menyanthes trifoliata L. -- Bog Myrtle, Bogbean, Buckbean, Marsh Clover, Marsh Trefoil, Water Trefoil; in Root; • Petasites japonicus (SIEBOLD & ZUCC.) MAXIM. -- Butterbur; in Root; • Platycodon grandiflorum (JACQ.) A.DC. -- Balloon Flower, Chieh-Keng, Jie-Geng; in Root; • Solidago virgaurea L. -- European Goldenrod, Woundwort; in Root; • Taraxacum mongolicum HAND.-MAZZ. -- Mongoloid Dandelion; in Plant; • Tragopogon porrifolius L. -- Salsify; in Root; • Tussilago farfara L. -- Coltsfoot; in Flower; in Root; • Phytochemical Database, USDA

  29. Inulin Uses (1) • Since inulin has a mildly sweet taste; is filling like starchy foods; is not absorbed; and does not affect blood sugar levels it is recommended sometimes for diabetics.

  30. ADVERSE REACTIONS (6) • Doses up to 10 grams daily are well tolerated. Higher doses may cause such gastrointestinal symptoms as flatulence, bloating and diarrhea. • Occasional allergic reactions have been reported. Could Inulin be one of these “additives” in foods that some people are allergic to?

  31. Inulin May Trigger an Allergic Reaction (1) • Researchers at the University Hospital in Geneva, Switzerland, warn inulin may trigger a serious allergic reaction. In a May 4, 2000 issue of The New England Journal of Medicine, doctors reviewed the case of a 39-year-old man who suffered allergic reactions from foods that contained inulin four separate times within a two-year period. Three times the reactions occurred after ingestion of inulin-containing foods. Merely touching an artichoke set off symptoms another time. The reactions that were triggered included throat swelling, nasal itching, coughing, and breathing difficulty. • The doctors used skin-prick tests to gauge his sensitivity to inulin-containing foods. He showed strong reactions to them. • Although there are no other reports on inulin reactions, there is concern because of the widespread use of inulin in processed foods. Inulin may be the culprit behind more food allergies than is currently recognized.

  32. Haemagglutination-inhibition assay for Inulin (29) • A simple, low-cost novel assay has been developed for the detection of inulin and oligofructose. • The assay principle involves the inhibition by inulin and oligofructose of the agglutination of red blood cells with the lectin concanavalin A. • The objective of this study was to explore a new approach based on a simple haemagglutination-inhibition assay. • All the inulin- and oligofructose-containing test samples were successfully detected using the assay and specificity and sensitivity data are presented.

  33. PRECAUTIONS (6) • Those who develop gastrointestinal symptoms with the use of dietary fiber should exercise caution in the use of inulins. • Those with irritable bowel syndrome should exercise caution in the use of inulins. • Those receiving whole body-radiation or radiation to the gastrointestinal tract should avoid supplementation with inulins.

  34. Dosage and Administration (6) • Inulins are available in: • Tablets • Powder • Functional foods. • Dosing is variable and ranges from 4 to 10 grams daily. • Those who use more than 10 grams daily should split the dosage throughout the day. • Doses higher than 30 grams daily may cause significant gastrointestinal discomfort.

  35. Research Summary (6) • There is the suggestion from animal research that inulins may help prevent colon carcinogenesis by stimulating growth of bifidobacteria. In experiments with rats, dietary administration of inulins inhibited the development of colonic aberrant crypt foci, putative preneoplastic lesions that are believed to give rise to colonic adenomas and carcinomas. Oligofructose, a partial enzymatic hydrolysate of inulins, also inhibited these crypt foci but not as effectively as inulins. • Recently, 12 healthy male volunteers ate a breakfast cereal containing 18% inulin for several weeks. At the end of the trial, plasma total cholesterol and triacylglycerol levels were significantly decreased. (7)

  36. European Union is ahead of US on Inulin (30) • ORAFTI`s 4th Research Conference has demonstrated once again, the extraordinary potential for chicory inulin and oligofructose to make a real impact on our health and well-being.  • The Conference, which took place in February ’04 at the Cité des Sciences et de l`Industrie in Paris, gathered together the world`s experts in prebiotics and gastrointestinal health, and an invited audience of around 200 scientists from the fields of health, nutrition, food and beverage development, and the press. • Papers were presented on subjects as varied as • `Inulin, Oligofructose and Resistance to Gastrointestinal Infections` • `Application of Prebiotics in Infant Foods` • `Inulin, Oligofructose and Immunomodulation` • `Inulin, Oligofructose and Bone Health` • as well as the latest consumer research on the communication of the benefits of inulin and oligofructose in every day foods. • One of the highlights was a report of the latest results from the SYNCAN project. • The SYNCAN project is an EU-sponsored research programme co-ordinated by ORAFTI.  • The aim of the project is to investigate whether pro-, pre- and synbiotics (a combination of prebiotics and probiotics) can reduce the risk of colorectal cancer. 

  37. A key part of the project is a human volunteer study, the results of which were presented at the ORAFTI Research Conference by Dr Jan Van Loo, the project co-ordinator, and Professor Kevin Collins of University College Cork in Ireland.  • The double-blind, placebo-controlled study involved 80 human volunteers who had either had intestinal polyps (precancerous lesions) removed or had been treated for colon cancer.  The synbiotic treatment consisted of 10g of Raftilose®Synergy1 and probiotic bacteria in capsule form which was administered each day for 12 weeks. • The results, presented for the first time at this conference are extremely positive.  Several bio-markers for colon cancer risk were positively modulated by the synbiotic treatment.  The volunteers in the trial`s synbiotic group showed significantly decreased genotoxic damage, that is, damage to the cells DNA, compared with those who consumed the placebo.  The results suggest that the consumption of this synbiotic composition may provide a protective effect against colorectal cancer. • Professor Collins predicted that the prophylactic use of synbiotics, like those used in the SYNCAN project, could lead to a dramatic change in the morbidity and mortality pattern of colorectal cancer in the developed world. • The positive results from the SYNCAN project also justify additional in-depth human studies using only a prebiotic ingredient, such as Raftilose®Synergy1, rather than a synbiotic.  This would allow researchers to further investigate the effects of this ingredient in improving resistance to colon cancer.

  38. Other highlights from the conference: • Data were presented on the role inulin and oligofructose play in improving mineral absorption and bone health.  This included news of Professor Steve Abrams` latest study which is looking at the optimisation of calcium absorption and bone formation in adolescents. This is to follow up previous studies and to demonstrate persistent benefit of Raftilose®Synergy1 in improving the absorption of calcium from the diet.  Other areas included the potential synergy between inulin/oligofructose and isoflavones in improving bone mineral density. • Results were also presented on the effects of inulin and oligofructose on improving immunity, reaction to inflammation and resistance against infections.  • Professor Glenn Gibson from the University of Reading (UK) presented data showing how prebiotic ingredients can help the body to resist pathogens in the intestines such as E. coli and Salmonella. • About Raftilose®Synergy1 • Raftilose®Synergy1 (patent pending) is an enriched form of inulin which contains a specific distribution of carefully selected chain lengths of inulin and oligofructose.  • About ORAFTI Group • ORAFTI Group is a subsidiary of the Belgian agro-food group Raffinerie Tirlemontoise/ Tiense Suikerraffinaderij and is part of the ORAFTI/ PALATINIT Ingredients Group of Südzucker (Germany). • ORAFTI Group`s head office is in Tienen, Belgium and the company operates in more than 70 countries world wide, with production units in Oreye (Belgium), Wijchen (Netherlands) and Wijgmaal (Belgium).

  39. ORAFTI Group produces from chicory roots : • Raftiline® (inulin) • Raftilose® (oligofructose) • Raftisweet® (fructose syrups) • The ORAFTI Group also includes REMY INDUSTRIES, world leading producer of rice starches • (Remyline®/ Remygel®) • rice flours (Remyflo®) • rice proteins (Remypro®).

  40. So too are other companies! (40) • 01/03/2004 - Belgian group Cosucra Warcoing is significantly increasing its inulin and oligofructose production capacity by converting a former sugar plant to chicory processing, as it aims to meet growing demand for the ingredients. • The Warcoing Group, which has been processing sugar beet since the mid-1800s, claims to be the first company in the world to produce inulin, beginning in 1986. Last year it announced that it was exiting the sugar beet processing business to concentrate entirely on added value ingredients for health foods. • The company will spend more than €60 million to convert a former sugar plant in the north of France, increasing its inulin and oligofructose production capacity to 45,000 tons per year. It will be operational by the end of 2004 and is expected to generate more than 100 jobs. • The move will boost Cosucra’s share of the dietary fibres market. Frost & Sullivan data show the prebiotics market, currently worth €87 million, will see annual growth of 9.7 per cent, bringing the European fructan market up to €179.7 million by 2010.

  41. Questions • Would changing our sugar from white beet cane sugar to a more natural product ie fructose from chicory decrease colon cancer as well as insulin resistance? • How would you incorporate this into Coke and Pepsi? • Why is the rest of the world ahead of us on this one?

  42. Making a Case Against Inulin (7) • Inulin may indeed promote the growth of lactobacillus bacteria, but what other potentially harmful bacteria are we encouraging? • And what does inulin do to yeast? Does anyone know? • Seems that the scientific literature shows Inulin encouraging the growth of Klebsiella, a bacterium implicated in Ankylosing Spondylitis and increasing intestinal permeability. • There are hundreds of different species of bacteria and several yeast strains living in our GI tracts. Studies have only looked at the effects of Inulin on a handful of these microbes.

  43. What Products Contain Inulin in the US? • The only high content Inulin supplement that I found was PhytoPharmica’s Fiber Delights. • 2 chewable tablets have 4 GM of fiber • 4 tablets/day would get you to goal • Metagenics had: • Sustain @ 1.4 GM/2 scoops • UltraMeal Bar @ 2.5mg/bar

  44. Maybe we need a cereal…. • Kellogg’s in the UK [ UK = CRC being the leading cause of cancer deaths] has developed Muddles containing 2g of inulin per 100g of cereal! • According to www.telegraph.co.uk the Food Standards Agency classifies 2g per 100g as a low sugar level and 10g as high: Muddles contains 20g of sugar per 100g, compared with 40g in Frosties. However, it is low in salt, high in fibre and has added vitamins and minerals, which leads Sarah Stanner, nutritionist at the British Nutrition Foundation, to give it her seal of approval. "It is a good fortified cereal with 8g of fibre, and lots of B vitamins and iron, which are important for children. I would have no problem in recommending it on this basis, rather than because it contains a prebiotic.“(41)

  45. “Pester Power” • In a letter to The Grocer magazine, John Dodds, who worked on the brand for the naming consultants Nomen, wrote: "How do you make children excited about breakfast and particularly healthy eating options? Nomen has realized that pester power is based on oral communication much more than the written word. Kids don't write shopping lists - they just shout out the name of what they want you to buy."

  46. So if anyone is listening….. “Inulin” …and if we don’t do it, big business will.

  47. References • 1.http://allergies.about.com/cs/inulin/a/aa051500a.htm • 2.http://www.medherb.com/92INULIN.HTM • 3. http://www.ars-grin.gov/cgi-bin/duke/chemical.pl?INULIN • 4.http://www.healingcrow.com/ferfun/conspiracy/conspiracy.html • 5. http://physchem.ox.ac.uk/MSDS/IN/inulin.html • 6.http://www.gettingwell.com/drug_info/nmdrugprofiles/nutsupdrugs/inu_0299.shtml • 7. Brighenti F, Casiraghi MC, Canzi E, Ferrari A. Effect of consumption of a ready-to-eat breakfast cereal containing inulin on the intestinal milieu and blood lipids in healthy male volunteers. Eur J Clin Nutr. 1999; 53:726-733.

  48. 8. Coussement PAA. Inulin and Oligofructose: Safe Intakes and Legal Status J. Nutr. 1999 129: 1412 • 9. Gibson GR; Beatty ER; Wang X; Cummings JH. Selective stimulation of bifidobacteria in the human colon by oligofructose and inulin. Gastroenterology, 1995 Apr, 108:4, 975-82 • 10. Green, Ceri J. Fibre in Enteral nutrition,  S A J Clin Nutr 2000 November Vol 13 No 4 • 11. Ingeborg M. Bovee-Oudenhoven, Mischa L. Wissink, Jan T. Wouters, and Roelof Van der Meer Dietary Calcium Phosphate Stimulates Intestinal Lactobacilli and Decreases the Severity of a Salmonella Infection in Rats J. Nutr. 1999 129: 607-612. • 12. Lin Meei-yn and Chung-ming Young. Biosynthesis of Folates by Streptococcus thermophilus and Lactobacillus delbruekii ssp. bulgaricus. Journal of Food and Drug Analysis, Vol. 8, No. 3, 2000, Pages 195-199 • 13. Marshall VM & Cole WM (1985): Methods for making kefir and fermented milks based on kefir. J. Dairy Res. 52, 451-456.

  49. 14. Menne E, Guggenbuhl N, Roberfroid M. Fn-type chicory inulin hydrolysate has a prebiotic effect in humans. J Nutr. 2000; 130:1197-1199. • 15. Mitsuoka T, Hidaka H, Eida T. Effect of fructo-oligosaccharides on intestinal microflora. Nahrung 1987;31:427-436 19. Niness KR. Inulin and oligofructose what are they? J Nutr 1999 Jul;129(7 Suppl)1402S-6S • 16. Nutritional and health benefits of inulin and oligofructose: proceedings of a conference, Bethesda, Maryland, USA, May 18-19, 1998. J Nutr 1999;129:Suppl:1395S-1502S. • 17. Ohta A et al. "A combination of dietary fructooligosaccharides and isoflavone conjugates increases femoral bone mineral density and equol production in ovariectomized mice." J Nutr. 132, 7:2048-54, 2002 • 18. Reddy BS, Hamid R, Rao CV. Effect of dietary oligofructose and inulin on colonic preneoplastic aberrant crypt foci inhibition. Carcinogenesis. 1997; 18:1371-1374.

  50. 19. Roberfroid MB, Delzenne NM. Dietary fructans. Annu Rev Nutr. 1998; 18:117-143. • 20. Roberfroid MB, Van Loo JA, Gibson GR. The bifidogenic nature of chicory inulin and its hydrolysis products. J Nutr. 1998; 128:11-19. • 21. Roberfroid M. Dietary fiber, inulin, and oligofructose: a review comparing their physiological effects. Crit Rev Food Sci 1993,33(2):103-48 • 22.Rummessen JJ, Bode S, Hamberg O et al: Fructans of Jerusalem artichokes: Intestinal transport, absorption, fermentation, and influence on blood glucose, insulin, and C-peptide responses in healthy subjects. Am J Clin Nutr 1990;52:675-681.23. Silver AA & Krantz JC: The effect of ingestion of burdock root on normal and diabetic individuals. A preliminary report. Ann Intern Med 1931; 5:274-284. 24. Valyshev AV, Kirillov VA, Kirillov DA, Bukharin OV. The effect of inulin on the biological properties of enterobacteria. Zh Mikrobiol Epidemiol Immunobiol. 2000 Jan-Feb;(1)79-80.

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