Page 48 - Retail Pharmacy March 2021

46 HEALTH NUTRITION FROM PAGE 45 “There’s a whole host of these food groups that can play such a vital role in regulating the microbiota,” she said, “\[but\] we’ve got to take away the antinutrients.” She pinpointed sugar as a major antinutrient. “Sugar is the new smoking,” she said. “So we need to remove the sugar, we need to remove processed foods \[and\] increase the fibre and the vegetables to naturally support the microbiota in the gut.” Jane Freeman, accredited practising dietitian and spokeswoman for Dietitians Australia, says we must make sure we’re eating a diet that promotes “improved levels of good bacteria”. She echoes the above advice, asserting that the key is fibre and that the best way to get enough fibre is through adequate consumption of “fruit, vegetables, wholegrain cereals, nuts and seeds”. “All those food groups, of course, provide us with lots of good vitamins and minerals, but they’re also high in fibre,” she said. “They give our gut a bit of roughage.” She adds that our gut bacteria feed on fibre, which “keeps our bowel function working at its optimum”. Ms Freeman says that when fibre is consumed, “bacteria ferment \[the leftover, undigested roughage\]” in the large bowel. This fermentation process, she adds, “produces gas and wind” and also “certain short chain fatty acids that our body will absorb” and which have “been shown to reduce cholesterol and improve heart health”. Conversely, inasmuch as a healthy diet can promote a healthy microbiome, poor dietary choices can have an adverse effect. “Perhaps not too surprisingly, the dietary pattern linked most to an adverse change in bacterial species is the highly refined, typical Western diet that’s high in sugar and low in fibre,” Dr Crowe said. “Drinking too much alcohol also harms the gut microbiome. The good news is that a shift to a healthier diet can change the bacteria mix in a few days.” Mr Quigley added: “We know high sugar, high salt, high saturated fat alters our digestive system and, therefore, doesn’t keep the microbiome completely content. “It’s all about education. We know what we shouldn’t be eating ... we \[as pharmacists\] should be encouraging all our \[customers\] who come in with a particular issue, to gently try some options, \[rather than\] dousing them with information.” He gives the example of someone with osteoarthritis who enters a pharmacy. “A simple suggestion of perhaps focusing on omega-3 oils to reduce the inflammation – that’s not hard to do,” he said. “You’re just suggesting that, two to three times a week, they look at some sort of fish. We just need gentle suggestions to keep people on track.” Ms Freeman says inflammation plays a role in chronic disease, and she cites the benefits of an anti-inflammatory diet to optimise gut and overall health. “Firstly, being overweight is the biggest source of inflammation in the body,” she said. “So, trying to work towards a healthy weight by way of a healthy diet and regular exercise is probably one of the most important \[ways\] to help reduce issues of disease and ... inflammation. “Processed foods, sugar foods, high- fat takeaways, too much red meat all contribute to inflammation in the body, whereas your anti-inflammatory foods are ones high in antioxidants and phytonutrients: they help to protect our cells and reduce inflammation in the body. “It’s the same food prescription: vegetables, a bit more fruit, \[healthy\] portion sizes of wholegrain cereals, good quality meat, low fat dairy, healthy oils, nuts and seeds ... it’s making sure that you’re getting your recommended serves in a day.” She adds that pulses and beans and other alternative sources to meat and chicken, such as oily fish, are helpful, too. Role of the community pharmacist While nutrition counselling is largely the domain of dietitians, community pharmacists have an important role in this space as often the first health professionals a customer will see. “Pharmacists and pharmacy assistants have an important role to play in exploring the different types of over- the-counter probiotics and prebiotic fibre supplements that could benefit a person,” Dr Crowe said. “Such advice, though, doesn’t sit in isolation, as diet and lifestyle changes are the key to long-term gut health, and here a referral to a dietitian for tailored nutrition advice can be appropriate.” Ms Freeman agrees with Dr Crowe, adding that pharmacists and assistants can “explore the use of probiotics” with their customers. However, she also advises “referral to a dietitian” for tailored nutrition advice when it comes to the microbiome and its implications in chronic disease. “\[It’s\] better to try to fix your diet, if you’re not meeting your dietary requirements,” she said. According to Ms Dahia, “the pharmacist ... is very well placed to recommend probiotics, particularly in areas of antibiotic use ... in patients who have mental health \[issues\], patients who have cardiovascular health \[issues\], patients who have diabetes”. “A pharmacist is well placed to provide advice not only on diet but also on which probiotics would be most suitable for the particular patient,” she said. “And often you’ll find a patient having lots of, not only indigestion ... \[with\] the prescription of esomeprazole and all of those proton pump inhibitors that have shot up significantly, often you’ll ask these patients, what’s going on in their gut, and a lot of them will have bloating, constipation, diarrhoea ... so the pharmacist can actually advise patients to use food to access prebiotics and use food to access probiotics.” As a community pharmacist, Mr Quigley says those in the profession and their assistants have an “incredibly important and fundamental” role in providing healthcare advice on nutrition and chronic disease, while it’s also crucial that pharmacy staff practice what they preach and are examples of healthy eating and health for their customers. “We can’t be offering help if we don’t help ourselves,” he said. “It makes no sense.” He adds that those in healthcare are in a position of “privilege”. Pharmacy staff, he says, “have to be sensible in making recommendations to people that come in for help. “A refocus on gut health is a wonderful opportunity for a pharmacist to get involved.” References 1. Gunnars K. ‘Does all disease begin in your gut? The surprising truth’. Healthline, 2019. Available at: healthline.com/nutrition/does-all-disease-begin-in- the-gut \[Accessed 3/2/21\]. 2. Hills Jr R, et al. ‘Gut microbiome: Profound implications for diet and disease’. Nutrients, 2019; 11: 1613; doi:10.3390/nu11071613 RETAIL PHARMACY • MAR 2021 To find out more about nutrition and its role in gut health and chronic disease management, visit: canutrition.com.au/