It is estimated that an astonishing one out of every three adults has pre-diabetes or diabetes. Recognizing the worldwide impact of type 2 diabetes (T2D), it becomes crucial to identify the underlying causes and practical strategies for preventing and addressing this issue. A number of studies have indicated that probiotics could be advantageous for individuals with Type 2 Diabetes (T2D). Here are several potential pathways through which probiotics might influence T2D:

Gut Microbiota:

Studies have shown that individuals with T2D may have differences in their gut microbiota, such as elevated lipopolysaccharides (LPS), compared to healthy individuals.

Most bacteria are considered gram-negative or gram-positive. This classification is based on the type of cell wall they have. Why is this important? Gram-negative bacteria contain and release lipopolysaccharides (LPS), which are considered endotoxins. These endotoxins cause gut lining permeability (aka Leaky Gut) and inflammation, i.e., you don’t want LPS in circulation! Patients with T2D have been shown to have higher levels of LPS or endotoxemia than non-diabetic individuals. Changing the composition of the gut microbiome by reducing overgrowths of gram-negative bacteria could improve metabolic health.

2. Inflammation and Metabolism:

In addition to reducing LPS, as mentioned above, some strains of probiotics have anti-inflammatory properties, which could potentially benefit individuals with T2D. These strains reduce inflammation by producing short-chain fatty acids like butyrate and also blocking the production of inflammatory cytokines. There are many, but three to note I commonly see in research include Akkermansia muciniphila, Lactobacillus plantarum, and Faecalibacterium prausnitzii.

T2D is a disease of chronic inflammation. By modulating gut microbiota, probiotics may play a role in reducing inflammation, including insulin resistance, as insulin resistance is associated with chronic low-grade inflammation.

3. Glucose Regulation:

Some studies have suggested that certain probiotic strains positively impact glucose regulation by improving insulin sensitivity and reducing fasting blood sugar levels. In a review of twenty-two studies conducted on humans, ten probiotic interventions showed positive effects on glucose control, ten demonstrated no specific impact on blood sugar, and two showed negative results. However, there were limitations in some of these studies, including short duration of probiotics usage and also studying only one bacterial strain compared to multiple strains.

One keystone species that shows a lot of promise with regard to insulin sensitivity is Akkermansia muciniphila. As noted above, the bacterium's presence might also have anti-inflammatory effects that could benefit metabolic health.

4. Lipid Profile:

Probiotics might also influence lipid metabolism, which is dysregulated in individuals with T2D. Some research has indicated that probiotic strains could help improve lipid profiles by reducing triglycerides and increasing HDL cholesterol levels.

The gut microbiome houses trillions of microorganisms. Like a beautiful rainforest, there are numerous species of bacteria, fungi, and even viruses. As we know, some of these organisms due a lot of good, while others contribute to inflammation.

We are just beginning to identify and understand the impact of specific bacterial strains on our health. Probiotics are one method being studied to improve metabolic markers in individuals with T2D.

Here are a few tried and true methods to support your gut health and blood sugar!

Reduce sugar consumption.

To support gut health, reduce the consumption of added sugars, especially those found in beverages, processed foods, and desserts.

Read labels! 4g of sugar equals one teaspoon.

Instead, focus on a diet rich in whole foods, including fiber from fruits, vegetables, and legumes, as well as lean proteins and healthy fats. Remember: excess sugar consumption can lead to an overgrowth of certain harmful bacteria and yeast in the gut, disrupting the balance of the gut microbiota…AND high sugar intake has been linked to chronic low-grade inflammation.

Eat your fiber first…and a lot of it.

First, order matters!

If you eat foods high in starches or sugars on an empty stomach, your blood sugar will increase rapidly and more than if you eat the same foods after you've had some fiber. When you're having a meal, eat your vegetables first, then have your protein and fats, and save the starches for last. This will make it take longer for the glucose to enter your bloodstream, giving you a more steady increase rather than a dramatic spike.

This strategy is especially helpful when you plan to eat foods likely to raise your blood sugar quickly, like those with a lot of starch or sugar. For example, if you're going out for pizza, start with a small salad with vinegar and olive oil first. When it comes to dessert, the best time to have something sweet is after a meal.

Finally, the amount matters!

Fiber should be a major part of our diet. Fiber is food for our gut bacteria. It's believed that our Paleolithic ancestors consumed significantly more fiber compared to the average modern diet. Some estimates suggest that their daily fiber intake ranged from 70 to 100 grams or even more.

Their diet primarily comprised whole foods such as fruits, vegetables, nuts, seeds, roots, and some lean animal proteins. These foods are naturally rich in dietary fiber, as they were consumed in their whole, unprocessed forms.

In contrast, the typical modern Western diet, which is often characterized by highly processed foods, refined grains, and low fruit and vegetable intake, tends to be much lower in fiber. The average daily fiber intake for adults in the United States and other Western countries is often around 15 grams or less…falling majorly short!

One of my favorite ways to boost fiber intake is to add seeds to yogurt, smoothies and salads. Ground flax, hemp seeds, psyllium husk, and pumpkin seeds are great options. When adding fiber, go SLOW to allow time to adjust to any changes. Avoid cheap fiber products, like Metamucil and Benefiber, that come with many unnecessary additives.

Probiotics do help.

Many of you know, I am a huge fan of testing the gut microbiome with stool tests. However, even without testing, probiotics can be appropriate for many individuals. One product I feel comfortable recommending to many individuals is Megasporebiotic by Microbiome Labs. You can find it here in my Fullscripts store for 20% off retail. Probiotic choices can also be individualized, which is what I love about personalized nutrition. Call us to schedule a 20-minute complimentary consultation if this is something you are interested in exploring further.

References:

Gadelha, C. J. M. U., & Bezerra, A. N. (2019). Effects of probiotics on the lipid profile: systematic review. Jornal vascular brasileiro, 18, e20180124. https://doi.org/10.1590/1677-5449.180124

Gomes JMG, Costa JA, Alfenas RCG. Metabolic endotoxemia and diabetes mellitus: a systematic review. Metabolism. 2017;68:133-144.

Le, B., & Yang, S. H. (2018, March 2). Efficacy of lactobacillus plantarum in prevention of inflammatory bowel disease. Toxicology Reports. https://www.sciencedirect.com/science/article/pii/S2214750018300490#:~:text=plantarum%20LTA%20can%20significantly%20reduce,plantarum%20against%20inflammation.

Lenoir, M., Martín, R., Torres-Maravilla, E., Chadi, S., González-Dávila, P., Sokol, H., Langella, P., Chain, F., & Bermúdez-Humarán, L. G. (2020). Butyrate mediates anti-inflammatory effects of Faecalibacterium prausnitzii in intestinal epithelial cells through Dact3. Gut microbes, 12(1), 1–16. https://doi.org/10.1080/19490976.2020.1826748

Li, J., Yang, G., Zhang, Q., Liu, Z., Jiang, X., & Xin, Y. (2023, May 30). Function of Akkermansia Muciniphila in type 2 diabetes and related diseases. Frontiers. https://www.frontiersin.org/articles/10.3389/fmicb.2023.1172400/full#:~:text=Akkermansia%20muciniphila%20treatment%20improves%20host,lipid%2C%20and%20bile%20acid%20metabolism.

Sabico S, Al-Mashharawi A, Al-Daghri NM, Wani K, Amer OE, Hussain DS, et al. Effects of a 6-month multi-strain probiotics supplementation in endotoxemic, inflammatory and cardiometabolic status of T2DM patients: a randomized, double-blind, placebo-controlled trial. Clin Nutr. 2018:pii:S0261-5614(18)31351-7.

van Langevelde, P., Kwappenberg, K. M., Groeneveld, P. H., Mattie, H., & van Dissel, J. T. (1998). Antibiotic-induced lipopolysaccharide (LPS) release from Salmonella typhi: delay between killing by ceftazidime and imipenem and release of LPS. Antimicrobial agents and chemotherapy, 42(4), 739–743. https://doi.org/10.1128/AAC.42.4.739