Updated on February 2, 2023
For patients with gastrointestinal disorders like inflammatory bowel disease (IBD), ulcerative colitis (UC), and irritable bowel syndrome (IBS), nutritional supplementation can often make an important difference in quality of life. A growing body of evidence is now showing these therapies can address the underlying pathophysiology of these disorders, provide nutritional support for gastrointestinal symptoms, or address the indirect effects of the disorders on other body systems. However, when nutrients are not absorbed as they pass through the digestive system, the opportunity for a supplement to have a therapeutic impact is significantly limited. For clinicians and patients, it is important to understand why this is a concern for individuals who have gastrointestinal disorders and examine the possibilities optimizing bioavailable nutrients.
Due to the nature of inflammatory and functional bowel disorders like IBS, IBD, and UC, the bioavailability of nutrients plays a greater role in the effectiveness of a supplement than for healthy patients. Here are a few key reasons why patients with a gastrointestinal disorder should be concerned about the bioavailability of the supplements they take to better manage their condition, address symptoms, and/or respond to secondary complications:
There are several gastrointestinal conditions that can interfere with nutrient absorption, making it critical to ensure that patients with these disorders take bioavailable forms of nutrients. For instance, inflammation in the gut of patients with IBD and UC can disrupt absorption of a wide range of nutrients, including iron, calcium, vitamin B12, vitamin A, folic acid, magnesium, and zinc. Compounding inflammation-related absorption issues is Small Intestine Bacterial Overgrowth (SIBO), a common contributor to GI symptoms among IBD and IBS patients. Studies suggest that the metabolites produced by “bad” bacteria in the gut of patients with SIBO competitively inhibit the absorption of key nutrients like vitamin B12. Not only can a vitamin B12 deficiency have direct consequences on cellular function, it can also contribute to some of the inflammation-associated malabsorption issues in IBD patients, such as iron-deficiency anemia. Another common nutrient deficiency resulting from malabsorption in IBD patients is vitamin D, which is particularly concerning because a low level of vitamin D can lead to inflammation, which further exacerbates symptoms and leads to higher rates of morbidity.
While nutrient deficiency can have a negative impact on gastrointestinal symptoms and overall health, certain nutritional supplements can also produce undesirable effects due to absorption issues. One of the most well-known culprits is iron. According to one recent study, about 20 percent of IBD patients with iron-deficiency anemia experience constipation, diarrhea, abdominal pain, or other gastrointestinal side-effects when they take iron. This is because gut inflammation can interfere with absorption and the unabsorbed iron remains in the gut, creating gastrointestinal disturbances. Providing iron in a more bioavailable form can prevent a cache of unabsorbed iron from remaining in the gut, reducing the risk of negative gastrointestinal effects. This could be especially beneficial for patients whose malabsorption issues have already led to deficiencies in nutrients that normally support iron absorption, such as vitamin C and vitamin B12.
Although rigorous research studies have produced mixed evidence on the effectiveness of restricted and/or elimination diets for patients with gastrointestinal disorders, anecdotal evidence indicates it is not uncommon for patients with gastrointestinal disorders to find dietary restrictions help with their symptoms, whether via gluten-free diets, low FODMAPs diets, or individualized dietary guidelines that eliminate certain “trigger” foods specific to that patient. The restrictive nature of these diets, however, can often lead to nutritional deficiencies, which makes it more important for bioavailable nutrients to be provided in supplement form.
Moreover, some studies suggest that restrictive diets themselves can limit the absorption of critical nutrients. For example, a study in colon cancer patients indicated that low fiber intake can limit the bioavailability of short-chain fatty acids, such as butyrate. This is a significant concern for patients with gastrointestinal disorders because butyrate can act in multiple capacities to modulate gut inflammation and support normal gastrointestinal function. In fact, the essential role butyrate plays in gut health is a growing area of interest for researchers, clinicians, and patients looking to alleviate gastrointestinal distress. As such, dietary restrictions that limit fiber intake and thereby impede the body’s ability to absorb butyrate might end up effectively alleviating some symptoms while exacerbating others. For patients who wish to continue a low-fiber diet, a highly bioavailable butyrate supplement would be necessary to compensate for diminished absorption and maintain gut health. Formulating an ideal diet-based therapy is thus often a delicate balancing act that must take into account the unique challenges of patients, the broad impact of dietary interventions, and the bioavailability of key nutrients.
As the importance of providing bioavailable nutrients in nutritional supplements becomes increasingly clear, the research community is exploring ways to enhance the bioavailability of formulations. A standout study with particular relevance for patients with gastrointestinal disorders comes from the University of Tampa, where a group of researchers in the Department of Health Sciences and Human Performance examined the bioavailability of several different formulations of curcumin. Curcumin is the bioactive component of turmeric, and it can help address symptoms for patients with gastrointestinal disorders through a variety of mechanisms. However, curcumin is also well-known for its low level of bioavailability, limiting the therapeutic benefit of conventional formulas.
In the study, the researchers developed three different curcumin formulations:
To evaluate the bioavailability of these formulations, the researchers took blood samples from 15 volunteer subjects. Compared to an unformulated curcumin supplement, the researchers found that serum levels of curcumin in the patients were 45.9 times higher when the patients took the first formulation, 7.9 times higher when the patients took the second formulation, and 1.3 times higher when the patients took the third formulation. These data indicate that formulation plays a critical role in harnessing the potential of curcumin supplements that suffer from naturally compromised bioavailability, and developing formulations that enhance absorption is essential to optimizing therapeutic effects.
However, it is important to note there are also downsides to some bioavailability enhancement methods, including those chosen by the researchers who conducted this study. For instance, the first formulation is problematic because soy can trigger allergic reactions in some patients, and phytosomes are rapidly eliminated in the body, rendering them a suboptimal delivery method. Many patients might also shy away from stabilizers like polyvinylpyrrolidone because they are looking for more natural options. The third formulation included turmeric rhizome, which can cause stomach upset in some patients. Finally, although not explored in this particular study, many curcumin products on the market today use piperine, a pepper extract, to enhance absorption, but this can create micro-tears in the lining of the gut that can trigger inflammation and “leaky gut”.
Ultimately, this study did not cover the wide range of possible methods to enhance the bioavailability of dietary supplements of curcumin, but there are researchers exploring exceptional new delivery methods that do not rely on harmful additives or present concerning downsides for patients. For instance, beyond this clinical study, there is evidence from animal and in vitro studies that tetrahydrocurcumin, a biologically active metabolite of curcumin, is a more active antioxidant than curcumin that might be more readily absorbed in the gut. This has sparked interest in delivery systems focusing on tetrahydrocurcumin, as pairing the most promising variants of specific nutrients with specialized delivery formulations will allow patients to realize greater benefits.
Although each type of supplement can each have unique characteristics impacting bioavailability, studies like this provide deeper insight into the formulation strategies emerging in today’s biomedical community. However, greater bioavailability is not just theoretical. Already, cutting-edge delivery systems and bioactive ingredients, such as those offered by Tesseract Medical Research, are unlocking the potential of enhanced absorption for patients with gastrointestinal disorders. Using the most promising molecules and a range of sophisticated technologies—including liposphere-based approaches, colloidal delivery systems, nanodelivery systems, and new encapsulation techniques—these products are giving clinicians and patients opportunities to meaningfully integrate bioavailable nutrients in therapeutic plans. By paying close attention to bioavailability when selecting nutritional supplements, patients are more likely to reap the benefits of these therapies.
The power of Tesseract supplements lies in enhancing palatability, maximizing bioavailability and absorption, and micro-dosing of multiple nutrients in a single, highly effective capsule. Visit our website for more information about how Tesseract’s products can help support your gastrointestinal health.*
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