PEN eNews 12(1) January 2022

the Top 10 PEN^® Content Alerts and the Top 10 PEN My Favourites of 2021

Below are the top 10 PEN Content Alerts and PEN My Favourites for 2021. As a PEN Subscriber, you can sign up for content alerts for your preferred knowledge pathways on a weekly, monthly or quarterly basis - you choose!  You can read more about Content Alerts and My Favourite features in previous newsletter articles.  

Top 10 Content Alerts

Gastrointestinal System - Irritable Bowel Syndrome
Healthy Lifestyle
Malnutrition
Weight/Obesity - Dietary Approaches
Weight/Obesity
Pregnancy
Child and Youth Nutrition
Allergic Disease - Probiotics and Prebiotics
Diabetes/Glucose Intolerance
Gastrointestinal System - Irritable Bowel Syndrome: FODMAP

Top 10 My Favourites

PEN Handout Collection - Health Conditions    
PEN Handout Collection - Food Sources and Nutrients (Canada)
Pregnancy Summary of Recommendations and Evidence
Sports Nutrition Summary of Recommendations and Evidence
Gastrointestinal System: Irritable Bowel Syndrome (IBS) Toolkit
Weight/Obesity Practice Guidance Toolkit
Food Sources of Iron
Diabetes: Balancing Meals with Carbohydrate Counting
Eating Guidelines for Managing Reflux
Eating Guidelines on How to Choose a Probiotic

Constipation and Probiotics: What is the Latest?

Are probiotics effective in the treatment of constipation in adults?

For healthy adults with functional constipation, probiotics may help to alleviate some associated symptoms including bloating, cramping and gas, with a small improvement in stool frequency, and no improvement in stool consistency. Bifidobacterium and Lactobacillus strains appear to be the most effective compared to other strains. However, this evidence is based on limited and mixed results. Additional and better quality designed studies are required, including those that examine strain-specific probiotics, dose regimes and standardized approaches to diagnosing functional constipation. 

Overall, probiotics were well tolerated with no significant side-effects. 

See Additional Content:
Are there any safety concerns with the use of probiotics?
Are probiotics recommended for the treatment of functional constipation in infants and children?

To see the full practice question, including the Evidence Summary, Evidence Statements, Remarks and References, click here.

Looking for more probiotics content? There are:

• 4 Knowledge Pathways
• 5 Practice Questions
• And much more!

Want to know what else is new and updated? Bookmark these pages:
New Knowledge Pathway Content (Knowledge Pathways, Practice Questions, Summary of Recommendations and Evidence, Practice Guidance Toolkits, Backgrounds)
Tools and Resources.

Add being a PEN^® Reviewer to your 2022 goals!

Did you know that all PEN Practice Questions are peer reviewed by experts in the field, just like journal articles? Being a reviewer plays a vital role in contributing to and building the dynamic PEN System, which helps support dietitians in practice. We rely on more than 400 PEN Reviewers to keep our content up-to-date for everyday dietetic practice.

Why not consider reviewing PEN content in 2022? Here are some answers to frequently asked questions about being a PEN reviewer:

How does reviewing for the PEN System help dietitians in practice?

Reviewing PEN content contributes to a growing evidence-based platform to translate knowledge for dietitians in practice. Your review provides essential feedback to the author regarding the relevance, currency and acceptability of the content in the PEN System. Your feedback ensures dietitians can continue to use the PEN System to support decision-making in everyday practice.

How does the PEN System recognize my contribution as a reviewer?

With your permission, you will be acknowledged for your role as a reviewer once the content is published. Furthermore, you can download a letter of contribution signed by PEN's Director of Knowledge Translation acknowledging your contributions to the PEN System once the content has been published. This can be used to support your professional portfolio, including continuing education objectives and activities. Dietitians Australia, Dietitians of Canada, and the British Dietetic Association also recognize the voluntary efforts of those who contribute to PEN.  

Who can review PEN Content?

The PEN System looks for individuals with expertise (academic and/or applied) on a wide range of topics related to nutrition practice. This may include:

• Researchers who are actively researching a topic area
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• Masters or doctorate students who are researching a topic area
• Dietetic learners (students)/interns/stagiaire working in the practice area (with supervisory support).

How can I get involved in reviewing PEN Content?

There are two primary ways you can get involved in contributing to the PEN System:

• Provide input on scoping a PEN Knowledge Pathway: When developing new or updating existing PEN content, we look for input on the practice questions that make up a knowledge pathway. This means that you’ll have an opportunity to review current questions for dietetic practice relevance while identifying any missing practice questions that should be considered.
• Review PEN Content: As a PEN Content Reviewer, your primary task is to determine the acceptability of PEN content based on the quality of evidence, accuracy of synthesis and relevance for practice. Reviewing PEN content asks for your input on everyday practice situations dietitians face. PEN Content review requests can be for Backgrounds, Practice Questions or Tools/Resources.  

If you are interested in learning more, please reach out to us at coordinator@pennutrition.com for more information! Current review opportunities are updated regularly on the PEN website and featured in PEN eNews.

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Last year, #bluepoopchallenge was promoted in the media to encourage people to test their gut health by eating blue muffins. This was right up my alley (my graduate work has been called my feces thesis) so I was keen to take on the challenge.  

The idea was sparked by a group in the U.K. that was looking into a novel, inexpensive marker of gut transit time that could be used in large population studies to examine associations between gut microbiota and health. The study was a single-arm, single-blinded study involving healthy adults (n=866, mean age 45 years) (1). Participants initially completed a food frequency questionnaire, a questionnaire on stool form and frequency, and had microbiome analyses of a stool sample along with blood analyses. At the clinic visit, participants consumed two ‘blue’ muffins (containing food colouring paste) and then self-reported their first appearance of ‘blue poo’ to identify their gut transit time. Results showed that gut transit time clustered into three groups: <14 hours (fast), 14-58 hours (normal), >58 hours (slow). Researchers found that the blue dye measure of gut transit time correlated with:

• reported stool consistency and frequency (i.e. longer gut transit correlated with harder stools and decreased stool frequency) 
• gut microbiome (i.e. longer gut transit time linked with specific microbial species such as Akkermansia muciniphila, Bacteroides spp. and Alistipes spp.)
• cardiometabolic health (i.e. longer gut transit correlated with higher postprandial lipid and glucose responses and greater visceral fat, but no association with inflammatory markers, blood pressure or diet quality was identified) 

The authors concluded that the blue-dye method provided more information about microbiome function than traditional self-reported measures of stool consistency and frequency (1). However, results need to be interpreted cautiously given that the method of gut transit was not compared to a validated method and that there was no recording of the stool consistency or appearance of dye in subsequent stools.  

What did my blue poop challenge reveal? 

I felt compelled to modify the original blue muffin/cake recipe to add some healthy ingredients (e.g. oats and currants) and could not find any blue paste, so I used liquid blue food colouring instead. This worked just fine and no surprises from my usual stool pattern emerged (i.e. I could have guessed my gut transit time!). I entered my demographic and dietary information into the website to be assigned my ‘poop personality’ and got paired with my microbiome ‘gut twin’ to see the potential ‘good’ bugs that may inhabit my gut and receive a gut health tip. Ultimately, the researchers are looking for more participants to analyze and are enticing users to sign up to learn about gut microbiome and health – it’s not available in Canada, so I can’t comment on that. It was a fun and interesting way to affirm my transit time and I still have a few muffins left to test my gut transit again…

Reference

1. Asnicar F, Leeming ER, Dimidi E, Mazidi M, Franks PW, Al Khatib H, Valdes AM, Davies R, Bakker E, Francis L, Chan A, Gibson R, Hadjigeorgiou G, Wolf J, Spector TD, Segata N, Berry SE. Blue poo: impact of gut transit time on the gut microbiome using a novel marker. Gut. 2021 Sep;70(9):1665-1674. doi: 10.1136/gutjnl-2020-323877. Epub 2021 Mar 15. PMID: 33722860; PMCID: PMC8349893. Abstract available from: https://pubmed.ncbi.nlm.nih.gov/33722860/ 

By Dawna Royall, MSc, RD, FDC, PEN Senior Evidence Analyst

2021 PEN^® Year in Review

Now that 2021 has come to an end and a new year begins, we invite you to take a look at our annual PEN Year in Review Infographic.