Diabetes and Your Microbiome

Metabolic disorder trends including type 2 diabetes, obesity and cardiovascular disease have grown at alarming rates in the wealthiest countries. Over 600,000 Americans die of heart disease every year. Type 2 diabetes remains prevalent as a precursor to cardiovascular disease and its complications. According to The World Health Organization, “Type 2 diabetes will be one of the top potent reasons for death worldwide by 2030.” This ultimately results from heart attack, stroke, cardiac arrhythmias and heart failure. Likewise, obesity levels could be one reason. An estimated report states, “42% of US adult population will be considered obese by 2020.” A BMI of 30 kg/m2 or higher indicates obesity. Other related medical problems include hypertension, elevated triglycerides, dyslipidemia (low HDLs and high LDLs). Current research is now pointing to another possible reason for metabolic disorders such as obesity, type 2 diabetes and heart disease; all related to your current gut microbiome.

How Can Type 2 Diabetes/Obesity/Heart Disease Be Related to the Gut?

Obesity, type 2 diabetes and heart disease show lack of microbial diversity in the stool; the gut microbiome limited in friendly bacteria but overwhelmed by bad bacteria. This has been studied but more systemic studies must deliver the greatest potential of information. Eventually, on the horizon, you will see glucose lowering treatments, “targeting the gut” to get the real benefits of improving gut health and how it relates to diabetes. The microbiome will become part of the practice of taking care of these and other common metabolic diseases. Read on to further understand.

What Is the Gut Microbiome?

Bacteria cells live on your skin, in your nose, your mouth and in your digestive tract. Your GI tract has multiple microbes called the gut microbiome. Included are bacteria, fungi, viruses and parasites. Due to high amounts of acid in the stomach, these organisms generally exist only in the large intestine or colon. The friendly gut bacteria try to keep the bad bacteria in check; they constantly multiply to make less space for the bad guys. The good bacteria hold a role in vitamin production, neurotransmitters such as serotonin and constantly educate the immune system.

They vary from person to person and there is no true consensus of what makes the “perfect human microbiome.” The microbiome is really the study of, “The Genetics of Bacteria.” Your biome may function well for you and not anyone else. So that, understanding the microbiome may give answers for conditions ranging from obesity to type 2 diabetes and cardiovascular heart disease. It has even been associated with type 1 diabetes.

What Does an Adult Have in Their Microbiome?

A healthy adult, “harbors 500-1000 bacterial species or 6 pounds of microbes in the gut.” We have 39 trillion bacteria in the human body; we have more microbes than cells. Furthermore, the break down is about 23% of Bacteroidetes used for processing proteins and carbohydrates in the gut and 64% Firmicutes processing dietary fat in the gut. There are other smaller types and amounts of microbes. Those with diabetes tend to have a change in the balance of their biomes, with less Firmicutes and more Bacteroidetes; with out of balance microbes comes disease. In a proper balance, gut bacteria can regulate hormones, synthesize vitamin K, folate and vitamin B12.

What Affects the Gut Microbiome?

• It starts with your DNA and a process called colonization.
• Entering the world via vaginal delivery versus C-section. Vaginal delivery earns the mother’s microbes and a C-section receives the hospitals microbes.
• Being breast feed furthers the microbiome developed by the mother. It is different with formula.
• The gut biome usually stabilizes by age 2-3 but is always changing.
• Antibiotics – especially when taken in early childhood disrupts the microbiome. Antibiotics kill both the bad and good microbes.
• Dietary components – the modern Western diet- refined, processed and sugary foods lead to a negative change in the microbes. High fat and red meat, animal based diet, lead to poor changes in the gut microbes; it allows more permeability and gut leaking leading to obesity and insulin resistance.
• Non-steroidal anti-inflammatories (NSAIDS) affect the microbiome.
• Possible negative effects from artificial sweeteners (research still being done on this topic).
• High physical and mental stress levels disrupt the biome.
• Disturbed sleep cycles and interrupted Circadian rhythms.
• Anti-bacterial soaps and hand sanitizers delete both bad and good bacteria.

Ultimately, it is based on genetics, diet, age, environment, lifestyle and antibiotic exposure throughout life.

What Have We Learned?

Several important studies have reported gut microbiome “dysbiosis” or disturbance can be a factor of obesity, insulin resistance and type 2 diabetes. Stress, drugs, toxic agents, genetic factors and age affects the gut microbiome. It is also affected by the environment, previous and current infections, GI surgery and certain foods. We know that early in our life, microbes may affect progression to disease later in life. Our microbiome remodels as life exposures change gut diversity. We also know probiotics point to being very helpful, but each person will respond differently to the probiotic. Some microbes form toxins and enter the gut. A bad gut biome can lead to leaky gut, intestinal inflammation, a decrease in insulin sensitivity and a change in metabolism.

Less variety and diversity in gut bacteria can also lead to ulcerative colitis, Crohn’s, IBS- inflammatory bowel disease, colon cancer, food allergies, arthritis, migraines and liver disease-NASH. Heavy yeast formation and bad bacteria in the gut can lead to skin ailments, vaginal and urinary tract infections and colds. Beneficial gut biome diversity helps maintain intestinal integrity. For instance, it provides protection against pathogens and improves the immune system to fight off disease. It helps you metabolize your medications properly and digest and absorb complex foods, getting all the nutrients and energy from them.

What About Probiotics?

As already stated, probiotics seem to be helpful to the microbiome but not all probiotics work the same way on every person. Different strains of probiotics treat different health problems. At this point, there is no specific recommended daily intake of probiotics. Systemic studies are out there but they are still lacking definitive information. Things we already do know include: probiotics are live microorganisms that can offer health benefits; they seem to eliminate diarrhea caused by antibiotic use. They are also given to improve problems with constipation, instead of stool softeners and laxatives.

What May Probiotics Do for Diabetes?

• Be able to modulate or change blood sugar levels and insulin levels.
• Decrease systemic inflammation – inflammation drives insulin resistance, the beginnings of type 2 diabetes.
• Reduce C-reactive protein (CRP) levels which indicate inflammation.
• Decrease stress in pancreatic cells and boost the immune system.
• Assist in weight loss.
• Improve heart health.
• Improve mental health – depression, poor memory and anxiety.

Furthermore, probiotics have enough bacteria that survive food processing. Probiotics include plain yogurt with live cultures (bifidobacterial and lactobacilli) and certain aged cheeses (gouda, mozzarella, brie, feta, gruyere, cheddar and cottage cheese). Fermented foods are excellent for providing friendly bacteria. The fermenting process creates lactic acid; this helps preserve the food and promotes the making of beneficial enzymes, Omega 3 fatty acids and friendly bacteria. It takes one kind of food and transforms it into another. Examples would be milk to buttermilk, soybeans to miso and tempeh, cucumbers to pickles and cabbage to sauerkraut. Other fermented foods are sour dough bread, Kefir, Kombucha (tea drink) and kimchi (Korean cabbage). Pickled gherkins and pickled onions are also fermented and very beneficial to the gut. Food sources seem to work better than probiotic supplements.

If you do decide to take a probiotic supplement, always first check with your physician. Choose one with multiple strains, at least 10-30 billion CFUs (colony forming units). Make sure it is USP (United States Pharmacopeia) verified, since that tells you it contains the actual ingredients listed on the label. FDA does not verify or checked dietary supplements like prescription medications. Buy brands from well-established companies. Some very popular ones are Culturelle and Align. Mostly found in grocery stores, drug stores, big box stores or online. Read labels, look at expiration dates, check for proper dosing and how to store it; some specifically need refrigeration. There are usually no ill side effects from probiotics, but some people do develop gas. They can also become costly since you pay out-of-pocket.

And Prebiotics?

Prebiotics are natural plant fibers that the intestinal tract won’t digest. They are also a food source for the bacteria living in your colon. Prebiotics are usually found in fruit and vegetables. They also help the body grow friendly bacteria in the gut and assist in calcium absorption. Prebiotics improve your metabolic health. Some great food sources of prebiotics include bananas, garlic, onions, soybeans, peas, Jerusalem artichokes, jicama, soy sauce, chicory root (inulin), asparagus, oats, apples, flaxseeds, leeks, dandelion greens, whole wheat foods and wheat bran.

Other Possible Dietary Aspects with Diabetes

Many people with diabetes try to eliminate carbohydrates completely or eat a diet extremely low in carbohydrates since they do affect blood sugars. This often leads to a diet high in animal fats. Unfortunately, this diet limits dietary fiber which is crucial for gut function and friendly bacteria growth. We already know that fiber reduces appetite by making and keeping you feeling full, prevents spikes in blood sugars and helps with insulin resistance. Fiber rich carbohydrates also assist with producing friendly bacteria. People with diabetes often have “dysbiosis” an overgrowth of bad bacteria and not enough good bacteria in the gut.

Bariatric Surgery

Cleveland Clinic has been studying diabetes and the impact of bariatric surgery. Obese people tend to have a non-diverse limited microbiome. The surgery took the weight off and gave the pancreas the ability to secrete more insulin; this was due to a hormonal change in the gut with more friendly bacteria. Not all cases of bariatric surgery have produced improved gut biome, but more studies are needed. Surgeons have also recommended dietary changes and probiotics after bariatric surgery for more gut diversity.

Possible Ways to Improve Gut Health: Diabetes or Not

• Eat a plant based diet. A high fiber/low saturated fat diet helps furnish gut diversification. Indigestible carbohydrates stimulate growth of friendly bacteria.
• Eat nutrient rich foods and purchase organic, when possible, including grass fed meats, wild fish and pasture raised eggs.
• Add fiber rich foods – legumes, nuts, seeds, berries and low starch vegetables.
• Add fiber powder such as Benefiber or psyllium powder to cereals, soups or drinks.
• Eat Omega 3s such as wild salmon, ground flaxseeds or walnuts to decrease inflammation.
• Play outdoors – go to the country, camp, garden; any outdoor activities can diversify gut health.
• Stop smoking.
• Avoid refined and simple sugars. Avoid processed foods with long shelf lives.
• If you really have food sensitivities, avoid gluten and dairy.
• Sleep well, lower stress levels and become more physical.
• Metformin – an often-prescribed diabetes pill has “therapeutic effects” on microbial composition.
• Polyphenols – foods high in polyphenols – green tea, berries, grapes, olive oil, coffee and wine may diversify gut microbiome.
• Wash with plain soap and water, avoid hand sanitizers.

Yes, there is a connection between diabetes and your present gut flora. More studies need to be done targeting the gut, type 2 diabetes and its management. Consideration of a personalized gut microbiome may be on the horizon to help reduce states of disease. There are many things still unproven and more research needs to be done, but we do know there are many solid connections.