FAQs 1. WHAT IS MICROBIOME PLUS+ GASTROINTESTINAL? Microbiome Plus+ Gastrointestinal is a more complete gastrointestinal health dietary supplement that provides natural prebiotic fiber (scFOS) and the probiotic L. reuteri NCIMB 30242 which work together to maintain the balance of healthy bacteria in your gut, normal enzymatic function, intestinal barrier function and gut integrity.* 2. WHAT ARE THE BENEFITS OF MICROBIOME PLUS+ GASTROINTESTINAL? •Supports gastrointestinal and immune health.* •Maintains balance of healthy bacteria* •Supports normal inflammatory response* •Supports healthy bile metabolism* •Synbiotic formulation with pre and probiotics* 3. WHO SHOULD I RECOMMEND MICROBIOME PLUS+ GASTROINTESTINAL TO? Microbiome Plus+ Gastrointestinal is intended for patients looking to support their gastrointestinal health with a more complete natural dietary supplement. 4. HOW DOES MICROBIOME PLUS+ GASTROINTESTINAL WORK? The probiotic in Microbiome Plus+ Gastrointestinal has been shown in clinical trials to help support normal inflammatory response in addition to supporting digestive health.*1-3 scFOS is a natural prebiotic fiber that supports a healthy gastrointestinal tract by promoting digestive function, immune health, the growth of healthy bacteria, natural intestinal mechanical barriers, and gut integrity.* 4-10 Microbiome Plus+ Gastrointestinal combines these two ingredients to provide more complete gastrointestinal health support.* Not only does scFOS support digestive function but as a prebiotic helps L. reuteri NCIMB 30242 to support normal gastrointestinal function.* 5. WHAT IS L. REUTERI NCIMB 30242? L. reuteri NCIMB 30242 is a next generation probiotic developed using the science of the microbiome. L. reuteri NCIMB 30242 is the only probiotic with a targeted and proven mechanism of action supported by gold standard clinical evidence. L. reuteri NCIMB 30242 is a patent protected probiotic that was selected from hundreds of probiotic strains for its ability to produce bile salt hydrolase (BSH) and support healthy bile metabolism. L. reuteri NCIMB 30242 is the only natural probiotic that has been shown in peer reviewed and published clinical trials to safely reduce LDL (“bad”) cholesterol by 11.6 percent in adults with moderately elevated cholesterol.3, 11 L. reuteri NCIMB 30242 has also shown significant clinical benefits in inflammation as well as probiotic digestive benefits.1, 2 L. reuteri NCIMB 30242 is also the only probiotic that has been clinically proven to increase vitamin D.12 6. WHAT MAKES THE SHORT CHAIN FRUCTOOLIGOSACCARIDES (SCFOS) IN MICROBIOME PLUS+ GASTROINTESTINAL THE RIGHT PRODUCT FOR MY PATIENTS? Microbiome Plus+ Gastrointestinal provides the highest quality, bioavailable natural source of short chain fructooligosaccarides (scFOS). scFOS is a natural non-digestible prebiotic fiber that supports a healthy gastrointestinal tract by promoting digestive function, immune health, the growth of healthy bacteria, intestinal barrier function and gut integrity.*4-10 The scFOS in Microbiome Plus+ Gastrointestinal is a gentle, well tolerated fiber that has no aftertaste and like all Microbiome Plus+ active ingredients is non-GMO and allergen free. 7. WHY IS HEALTHY BILE METABOLISM IMPORTANT TO GASTROINTESTINAL HEALTH? The gut microbiota is the exclusive pathway for transforming bile acids into factors responsible for regulating intestinal homeostasis by managing pathogenic bacterial invasion, inflammation and cell integrity.13-17 The metabolism of bile acids is linked to changes in the microbiome and gastrointestinal function.18-20 There is convincing evidence demonstrating that a decrease in bacterial production of bile salt hydrolase (BSH) activities is associated with IBS and IBD.1820 One way to restore bile acid metabolism and intestinal homeostasis is to re-establish the BSH gene within the microbiome.1-3 8. WHAT IS THE MICROBIOME AND WHY IS IT IMPORTANT? The community of naturally occurring bacteria in your body, called the microbiome, plays a vital role in maintaining your day-to-day health.21 The microbiome develops through a dynamic process in which the accumulation of genes vertically (passed from mother to child at birth) and horizontally (passed from environmental factors) is balanced with host genetics and diet.22 Changes in the microbiome, often the result of the mode of birth delivery,23 disease,24 antibiotic use,25 and/or poor diet26 are associated with certain disorders, including a wide range of allergic,21, 27 gastrointestinal,28, cardiovascular29-31 and metabolic disorders.26, 27 Additionally, current research suggests that the makeup of microorganisms has a negative impact on certain inflammatory pathways in IBD and IBS and can have detrimental influence on gastrointestinal health.18-20 The only way to balance the microbiome and restore its essential physiological functions is through strict and permanent dietary changes.32-34 * This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. © Micropharma Limited 2013 DOC201330202 www.microbiomeplus.com 1-800-370-5570 FAQs 9. IS MICROBIOME PLUS+ GASTROINTESTINAL A DRUG? No. Microbiome Plus+ Gastrointestinal is a more complete dietary supplement that does not require a prescription. 10. HOW CAN MY PATIENTS GET MICROBIOME PLUS+ GASTROINTESTINAL? Online at www.microbiomeplus.com. Provide your Healthcare Professional Referral Number for your patients to receive a discount. 11. WHAT IS A HEALTHCARE PROFESSIONAL REFERRAL NUMBER? A recommendation number is a 6-digit unique number that can be input for savings when purchasing Microbiome Plus+ products. It helps us help patients and healthcare professionals. If you already have a recommendation number you can provide it to your patients today. 12. HOW DO I GET A HEALTHCARE PROFESSIONAL REFERRAL NUMBER? To request a Healthcare Professional Referral Number Email HCP@microbiomeplus.com Visitwww.microbiomeplus.com Call 1-800-370-5570 16. WHAT SHOULD I DO IF MY PATIENTS EXPERIENCE AN UNEXPECTED REACTION TO MICROBIOME PLUS+ GASTROINTESTINAL? Report any unexpected reaction after starting Microbiome Plus+ Gastrointestinal by calling 1-800-214-0031. 17. HOW DO MY PATIENTS TAKE MICROBIOME PLUS+ GASTROINTESTINAL? Microbiome Plus+ Gastrointestinal should be taken twice daily with meals for best results (e.g. with lunch and dinner) but can be taken without food as well. 18. WHAT MAKES MICROBIOME PLUS+ GASTROINTESTINAL PROFESSIONAL GRADE? Microbiome Plus+ Gastrointestinal uses professional grade and quality ingredients: •Full recommended daily dose •Sourced from nature and allergen free •Bioavailable formats •From renewable and sustainable sources •Developed by doctors 19. HOW SHOULD MICROBIOME PLUS+ GASTROINTESTINAL ALLERGEN FREE? Yes. 13. IS MICROBIOME PLUS+ GASTROINTESTINAL SAFE? The ingredients in Microbiome Plus Gastrointestinal have been shown to be safe in clinical trials.35, 36 All active ingredients in Microbiome Plus Gastrointestinal have undergone Generally Recognized as Safe (GRAS) Notification with the FDA with no objection.5, 37 14. IS THERE ANYONE WHO SHOULD NOT TAKE MICROBIOME PLUS+ GASTROINTESTINAL? Microbiome Plus+ Gastrointestinal should not be used if pregnant, trying to get pregnant or nursing. Microbiome Plus+ Gastrointestinal is not intended for those under 18 years of age. Discuss with your patients if they have nausea, fever, vomiting, bloody diarrhea, severe abdominal pain, an immune-compromised condition. 20. HOW SHOULD MICROBIOME PLUS+ GASTROINTESTINAL BE STORED? Microbiome Plus+ Gastrointestinal does not require refrigeration and should be stored in a cool dry place. 21. WHAT ARE THE NUTRITIONAL VALUES OF MICROBIOME PLUS+ GASTROINTESTINAL? PROBIOTIC CAPSULE Supplement Facts Serving Size: 1 capsule Amount Per Capsule % Daily Value Lactobacillus reuteri 3.5 billion CFU NCIMB 30242 ** **Daily value not established. 15. ARE THERE ANY SIDE EFFECTS? As with other probiotic supplements patients may experience digestive discomfort, gas or bloating. OTHER INGREDIENTS: microcrystalline cellulose, silicon dioxide, magnesium stearate, vegetable capsule (hypromellose, titanium dioxide). * This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. © Micropharma Limited 2013 DOC201330202 www.microbiomeplus.com 1-800-370-5570 FAQs scFOS TABLET Supplement Facts Serving Size: 1 tablet Amount Per Tablet % Daily Value scFOS (Short-chain fructo oligosaccharides) 600mg ** **Daily value not established. OTHER INGREDIENTS: microcrystalline cellulose, dicalcium phosphate, stearic acid, magnesium stearate, croscarmellose sodium and silicon dioxide. REFERENCE LIST: 1. Jones M.L., Martoni,C.J., Ganopolsky,J.G., Sulemankhil,I., & Prakash,S. Improvement of gastrointestinal health status in subjects consuming L. reuteri NCIMB 30242 capsules: a post hoc analysis of a randomized controlled trial. Expert Opinion on Biological Therapy (accepted), (2013). 2. Jones,M.L., Martoni,C.J., & Prakash,S. Letter to the editor regarding the report of Duboc et al: connecting dysbiosis, bile-acid dysmetabolism and gut inflammation in inflammatory bowel disease. Gut(2012). 3. Jones,M.L., Martoni,C.J., & Prakash,S. Cholesterol lowering and inhibition of sterol absorption by Lactobacillus reuteri NCIMB 30242: a randomized controlled trial. Eur. J Clin. Nutr. 66, 1234-1241 (2012). 4. Campbell,J.M., Fahey,G.C., Jr., & Wolf,B.W. Selected indigestible oligosaccharides affect large bowel mass, cecal and fecal short-chain fatty acids, pH and microflora in rats. J Nutr. 127, 130-136 (1997). 5. Environ International Corporation. Short-Chain Fructooligosaccharide GRAS Notice. GRN000044. 2000. Ref Type: Report 6. Macfarlane,G.T. & Cummings,J.H. Probiotics and prebiotics: can regulating the activities of intestinal bacteria benefit health? West J Med 171, 187-191 (1999). 7. Oli,M.W., Petschow,B.W., & Buddington,R.K. Evaluation of fructooligosaccharide supplementation of oral electrolyte solutions for treatment of diarrhea: recovery of the intestinal bacteria. Dig. Dis Sci. 43, 138-147 (1998). 8. Cherbut,C., Michel,C., & Lecannu,G. The prebiotic characteristics of fructooligosaccharides are necessary for reduction of TNBS-induced colitis in rats. J Nutr. 133, 21-27 (2003). 9. Bouhnik,Y. et al. The capacity of nondigestible carbohydrates to stimulate fecal bifidobacteria in healthy humans: a double-blind, randomized, placebo-controlled, parallel-group, dose-response relation study. Am. J Clin. Nutr. 80, 1658-1664 (2004). 10. Bouhnik,Y., Raskine,L., Simoneau,G., Paineau,D., & Bornet,F. The capacity of short-chain fructo-oligosaccharides to stimulate faecal bifidobacteria: a dose-response relationship study in healthy humans. Nutr. J 5, 8 (2006). 11. Jones,M.L., Martoni,C.J., Parent,M., & Prakash,S. Cholesterol-lowering efficacy of a microencapsulated bile salt hydrolase-active Lactobacillus reuteri NCIMB 30242 yoghurt formulation in hypercholesterolaemic adults. Br. J. Nutr.1-9 (2011). 12. Jones,M.L., Martoni,C.J., & Prakash,S. Oral Supplementation With Probiotic L. reuteri NCIMB 30242 Increases Mean Circulating 25-Hydroxyvitamin D: A Post Hoc Analysis of a Randomized Controlled Trial. J Clin. Endocrinol. Metab 98, 2944-2951 (2013). 13. Yoon,S.S. & Sun,J. Probiotics, nuclear receptor signaling, and anti-inflammatory pathways. Gastroenterol. Res. Pract. 2011, 971938 (2011). 14. Sayin,S.I. et al. Gut microbiota regulates bile acid metabolism by reducing the levels of tauro-beta-muricholic acid, a naturally occurring FXR antagonist. Cell Metab 17, 225-235 (2013). 15. Swann,J.R. et al. Systemic gut microbial modulation of bile acid metabolism in host tissue compartments. Proc. Natl. Acad. Sci. U. S. A 108 Suppl 1, 4523-4530 (2011). 16. Inagaki,T. et al. Regulation of antibacterial defense in the small intestine by the nuclear bile acid receptor. Proc. Natl. Acad. Sci. U. S. A 103, 3920-3925 (2006). 17. Hofmann,A.F. & Eckmann,L. How bile acids confer gut mucosal protection against bacteria. Proc. Natl. Acad. Sci. U. S. A 103, 4333-4334 (2006). 18. Duboc,H. et al. Connecting dysbiosis, bile-acid dysmetabolism and gut inflammation in inflammatory bowel diseases. Gut(2012). 19. Duboc,H. et al. Increase in fecal primary bile acids and dysbiosis in patients with diarrhea-predominant irritable bowel syndrome. Neurogastroenterol. Motil. 24, 513-517 (2012). 20. Ogilvie,L.A. & Jones,B.V. Dysbiosis modulates capacity for bile acid modification in the gut microbiomes of patients with inflammatory bowel disease: a mechanism and marker of disease? Gut 61, 1642-1643 (2012). 21. Clemente,J.C., Ursell,L.K., Parfrey,L.W., & Knight,R. The impact of the gut microbiota on human health: an integrative view. Cell 148, 1258-1270 (2012). 22. Blaser,M.J. & Falkow,S. What are the consequences of the disappearing human microbiota? Nat. Rev. Microbiol 7, 887-894 (2009). 23. Dominguez-Bello,M.G. et al. Delivery mode shapes the acquisition and structure of the initial microbiota across multiple body habitats in newborns. Proc. Natl. Acad. Sci. U. S. A 107, 11971-11975 (2010). 24. The Human Microbiome Project. Baylor College of Medicine . 2013. 8-82013. Ref Type: Electronic Citation 25. Palmer,C., Bik,E.M., DiGiulio,D.B., Relman,D.A., & Brown,P.O. Development of the human infant intestinal microbiota. PLoS. Biol. 5, e177 (2007). 26. Turnbaugh,P.J. et al. An obesity-associated gut microbiome with increased capacity for energy harvest. Nature 444, 1027-1031 (2006). 27. Brestoff,J.R. & Artis,D. Commensal bacteria at the interface of host metabolism and the immune system. Nat. Immunol. 14, 676-684 (2013). 28. Marchesi,J.R. et al. Rapid and noninvasive metabonomic characterization of inflammatory bowel disease. J Proteome. Res. 6, 546-551 (2007). 29. Holmes,E. et al. Human metabolic phenotype diversity and its association with diet and blood pressure. Nature 453, 396400 (2008). 30. Koeth,R.A. et al. Intestinal microbiota metabolism of L-carnitine, a nutrient in red meat, promotes atherosclerosis. Nat. Med 19, 576-585 (2013). 31. Tang,W.H. et al. Intestinal microbial metabolism of phosphatidylcholine and cardiovascular risk. N. Engl. J Med 368, 1575-1584 (2013). 32. Ley,R.E., Turnbaugh,P.J., Klein,S., & Gordon,J.I. Microbial ecology: human gut microbes associated with obesity. Nature 444, 1022-1023 (2006). 33. Walter,J. & Ley,R. The human gut microbiome: ecology and recent evolutionary changes. Annu. Rev. Microbiol 65, 411-429 (2011). 34. Wu,G.D. et al. Linking long-term dietary patterns with gut microbial enterotypes. Science 334, 105-108 (2011). 35. Jones,M.L., Martoni,C.J., Tamber,S., Parent,M., & Prakash,S. Evaluation of safety and tolerance of microencapsulated Lactobacillus reuteri NCIMB 30242 in a yogurt formulation: A randomized, placebo-controlled, double-blind study. Food Chem Toxicol. 2012. 36. Jones,M.L., Martoni,C.J., Di,P.E., Simon,R.R., & Prakash,S. Evaluation of clinical safety and tolerance of a Lactobacillus reuteri NCIMB 30242 supplement capsule: a randomized control trial. Regul. Toxicol. Pharmacol. 63, 313-320 (2012). 37. Micropharma Limited. Lactobacillus reuteri NCIMB 30242 GRAS Notice. GRN000440. 2012. Ref Type: Report * This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. © Micropharma Limited 2013 DOC201330202 www.microbiomeplus.com 1-800-370-5570
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