Colonic fermentation: a neglected topic in human physiology education

Jrgen Valeur and Arnold Berstad

Advan in Physiol Edu 34:22, 2010. doi:10.1152/advan.00103.2009 You might find this additional info useful... This article cites 9 articles, 1 of which can be accessed free at: http://advan.physiology.org/content/34/1/22.full.html#ref-list-1 This article has been cited by 1 other HighWire hosted articles The colon is a digestive organ! Jrgen Valeur and Arnold Berstad Advan in Physiol Edu, September , 2010; 34 (3): 162. [Full Text] [PDF] Updated information and services including high resolution figures, can be found at: http://advan.physiology.org/content/34/1/22.full.html
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Advances in Physiology Education is dedicated to the improvement of teaching and learning physiology, both in specialized courses and in the broader context of general biology education. It is published four times a year in March, June, September and December by the American Physiological Society, 9650 Rockville Pike, Bethesda MD 20814-3991. Copyright 2010 by the American Physiological Society. ISSN: 1043-4046, ESSN: 1522-1229. Visit our website at http://www.the-aps.org/.

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Adv Physiol Educ 34: 22, 2010; doi:10.1152/advan.00103.2009.

Colonic fermentation: a neglected topic in human physiology education

Jrgen Valeur and Arnold Berstad
Institute of Medicine, University of Bergen, Bergen, Norway

The large bowel has seemingly never been very attractive (2). As stated by Sir Arthur Hurst (3a):
No organ in the body is so misunderstood, so slandered and maltreated as the colon.

Human physiology textbooks tend to limit their discussion of colonic functions to those of absorbing water and electrolytes and storing waste material. However, the colon is a highly active metabolic organ, containing an exceedingly complex society of microbes (1). By means of fermentation, gastrointestinal microbes break down nutrients that cannot be hydrolyzed by mammalian host enzymes and thus play an important role in digestive physiology, not only in plant-eating animals (herbivores) but also in humans (omnivores). A substantial amount of energy, otherwise lost in feces, is conserved by colonic salvage of calories, mainly derived from complex carbohydrates (grass). The microbial ora may consume enough grass to cover 5 10% of our daily energy demand (5). In fact, energy obtained from microbial fermentation products may contribute to the development of obesity (9). Colonic fermentation yields both gases (e.g., hydrogen, methane, and carbon dioxide) and short-chain fatty acids (SCFAs; e.g., acetic, propionic, and butyric acids), which exert several effects of major physiological and pathophysiological importance. The production and absorption of SCFAs facilitate the uptake of electrolytes and water and reduce the osmotic effect of unabsorbed carbohydrate molecules. Hence, diarrhea will ensue if colonic fermentation capacity is impaired (e.g., antibiotic-associated diarrhoea) or overwhelmed (e.g., lactase deciency) (6). Colonocytes rely mainly on nutrition from the colonic lumen (the milieu exte rieur) and have a preference for using butyrate as an energy
Address for reprint requests and other correspondence: J. Valeur, Institute of Medicine, Univ. of Bergen, Haukeland Univ. Hospital, NO-5021 Bergen, Norway (e-mail: jorgen.valeur@med.uib.no).

substrate. Starvation colitis may develop if access to SCFAs is hindered, and failure of -oxidation of SCFAs has been proposed as a pathogenetic mechanism for ulcerative colitis (7). SCFAs, especially butyrate, display antineoplastic properties and may prevent the development of colorectal cancer (3). Furthermore, microbial fermentation products inuence gastrointestinal motility and sensitivity and may play a role in the pathogenesis of irritable bowel syndrome (4, 8). Unfortunately, comparative physiology is no longer a part of the medical curriculum. The microbial contribution to mammalian digestion is a well-recognized concept in veterinary medicine, but humans also eat grass. We feel that time has come to acknowledge the human colon as a digestive organ. A description of colonic fermentation and its consequences should be included in every textbook of human physiology.
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