Targeted probiotic in personalized therapeutic plan for patients with diabetes shows promise
by Bianca Garilli, ND and Ashley Jordan Ferira, PhD, RDN
Type 2 diabetes (T2D) is no longer a Western world phenomena, but rather a global epidemic, with research revealing an association between higher T2D rates and a country’s wealth or economic growth.1 As a clear example, in a publication titled “Prevalence of type 2 diabetes in the Arab world: impact of GDP and energy consumption”, it was observed that the higher a country’s gross domestic product (GDP), the higher the T2D prevalence.1 T2D rates in these regions include Kingdom of Saudi Arabia- 31.6%, Oman- 29%, Kuwait- 25.4%, Bahrain- 25%, and United Arab Emirates- 25%.1
Recognizing the worldwide impact of T2D, it is critical to identify underlying causes and practical, implementable tools for prevention and treatment. It is well documented that T2D is a chronic, inflammatory condition. Higher levels of lipopolysaccharides (LPS) have been observed in diabetic vs. non-diabetic individuals.2 LPS are Gram-negative bacterial fragments that are considered endotoxins, and can, if left untreated, overgrow in the gastrointestinal tract leading to increased gut permeability.3 A “leaky gut” environment increases the opportunity for these endotoxins to migrate out of the gut and into the circulation, ultimately contributing to systemic inflammation.3
Probiotics have been studied in various models to determine their effects on LPS growth and proliferation and whether targeted probiotic administration aimed at mitigating LPS effects can reduce systemic inflammation, in particular in the T2D population.4-5 The limitations of previous research included short-term duration (≤3 months) and the utilization of mono-strain supplementation.3
To augment the current literature on this topic, a longer study (6 months) was conducted in a randomized, double-blind, placebo-controlled fashion to examine the impact of probiotics on endotoxemia, inflammation, and cardiometabolic disease risk in Arab patients with T2D.3 In this study, 61 Saudi adults (35 females) aged 30-60 years completed the 6-month trial: 30 in the placebo group and 31 in the probiotic group.3 The placebo and probiotic groups were randomly allocated to powder sachets, to be dissolved in a glass of water twice daily, before breakfast and bedtime. The probiotic intervention provided 2.5 billion CFU/g BID and included the following strains: Bifidobacterium bifidum W23, Bifidobacterium lactis W52, Lactobacillus acidophilus W37, Lactobacillus brevis W63, Lactobacillus casei W56, Lactobacillus salivarius W24, Lactococcus lactis W19, and L. lactis W58.3
No additional therapeutics such as exercise or dietary recommendations were included during the course of the study in either group.3
In the probiotic group, significant changes in glycemic indices, lipid profile, inflammatory markers, endotoxin levels, and adipocytokine profile were observed at 6 months vs. baseline:3
The improvements in endotoxin load, inflammation, and cardiometabolic profile over time in the probiotics group are noteworthy, but they were not clinically significant when compared to the placebo group.3 Comparing the probiotic intervention to the placebo group: There was a significant and clinically relevant decrease in HOMA-IR (↓64.2%) in the probiotic group.3 HOMA-IR is correlated with most other cardiometabolic indices measured, so one could posit a potentially broader cardiometabolic benefit from the probiotic intervention, but this and other hypotheses should be explored in a future study with an adequately powered sample size.
Why is this Clinically Relevant?
Targeted probiotic - a cornerstone of root-cause approach to disease management and wellness
by Melissa Blake, BSc, ND
The use of probiotics has grown substantially over the last several years. Propelled by development in sequencing methods and analytical techniques, there has been a significant increase in knowledge and understanding about the importance of a healthy microbiome.1
The currently accepted definition of a probiotic states they are “live microorganisms which when administered in adequate amounts confer a health benefit on the host”.2 Is this relatively broad definition sufficient for clinicians to guide treatment? Can we assume that any live organism in relevant doses will achieve positive clinical outcomes? We’ve been talking about the use of probiotics for over a hundred years,6 but when it comes to probiotic therapy, what do we really know?
A brief history lesson
As early as the 1680's, long before the term probiotic was coined, Antonie van Leeuwenhoek was studying his oral and fecal microbiota. He noted striking differences in these microbes, as well as in samples collected from healthy vs. unhealthy people at both of these anatomical sites.3
The notion of natural, innate immunity furthered our understanding of gut bacteria. The concept, first discussed by scientist Élie Metchnikoff and for which he was awarded a Nobel Prize in 1908, encountered much resistance from the medical community.4 Metchnikoff insisted disease was more than the germ theory and highlighted the importance of a healthy host. The health of the host, he believed, was largely dependent upon having diverse intestinal flora.5 Metchnikoff’s research suggested that a diet rich in fermented dairy products, due to high content of Lactobacilli, had a positive influence on health and longevity.6 The concept of “probios” (pro-bios, conducive to life of the host) was born.
Research in gut microbiology has become a significant area of interest, including the establishment of the Human Microbiome Project (HMP) in 2008. The HMP has characterized the microbial communities found at several different sites on the human body: nasal passages, oral cavity, skin, gastrointestinal (GI) tract, and urogenital tract and has examined the role of these microbes in human health and disease.7 In 2012, the potential for a mammary microbiome was suggested and later confirmed in a study published in 2014, which identified widespread bacteria within the mammary glands, irrespective of lactation.8
The evidence continues to establish the diversity of the human microbiome, not only from one person to another, but also across specific body sites.9
The human microbiome
A balanced and diverse microbiota plays a role in human health during the lifecycle. Growing evidence supports a connection between maternal microbiome and pregnancy outcomes, including preterm birth, preeclampsia, gestational hypertension, and gestational weight gain, as well as having an impact on infant health.10
Infancy is a critical time in the development of commensal gut bacteria and is influenced by pre- and postnatal exposures, including the maternal microbiome, delivery method (C-section vs. vaginal birth), diet, and medical interventions.11 Such factors can negatively or positively influence the balance of an individual’s microbiome and may impact short- and long-term health outcomes.12
Modifications to the infant gut microbiota may impact childhood obesity risk,13 atopic disease,14 as well as various GI conditions.15 After initial colonization, factors such as age, gender, diet, environment, stress, and the use of antibiotics continue to influence the microbiome.
Changes in the GI and respiratory microbiome of adults have been implicated in the pathogenesis of chronic pulmonary diseases, including asthma and allergies.16 Dysbiosis has also been associated with psoriasis,17-18 psoriatic arthritis,18 and inflammatory bowel disease,19 suggesting a direct link between a balanced microbiome and the health of the GI and immune systems. Studies have also connected highly abundant levels of specific genera of bacteria with leanness and have shown they play a role in regulating blood sugar and insulin levels.20
Recent reports suggest that neuroinflammation is an important causal mechanism in cognitive decline. This inflammatory status could be triggered by changes in the gut microbiota composition.21 Evidence is connecting the dots between gut bacteria, altered intestinal permeability, and blood brain barrier integrity.22 A disruption in gut flora may, through several mechanisms, contribute to a “leaky brain”, making the brain more susceptible to circulating substances and contributing to cognitive dysfunction. Further research is warranted in this exciting area of scientific study.
As clinicians, we cannot erase the past or possibly impact all the factors that influence the microbiome of our patients. However, we can partner with our patients to help them make positive lifestyle changes. Diet and targeted probiotic therapy are powerful tools. Consumption of excess saturated fats and added sugar influences the microbiota composition, which may lead to an imbalanced microbial population in the gut.22 By modifying risk factors and targeting the microbiome, Functional Medicine practitioners have an opportunity to both prevent and manage disease with individualized nutrition and probiotic therapy at any age.
Evidence for an individualized approach
Convincing evidence of the human health implications of probiotics exists. Hundreds of well-controlled trials, systematic reviews, and meta-analyses have helped define the appropriate use of probiotics and their valuable benefits. The evidence suggests, however, that probiotic therapy is far from a one-size-fits-all approach. In fact, studies show clearly defined benefits are associated with specific strains of bacteria. Here we discuss several that have substantial evidence to support their targeted clinical uses in specific populations:
Lactobacillus acidophilus NCFM
Although we have much more to learn, advancements in our understanding of the human microbiome continue to provide exciting approaches to Functional and personalized medicine. Probiotic therapy is a cornerstone of a root-cause approach to wellness and disease management.
Dr. Melissa Blake is a clinical specialist on the Medical Information team at Metagenics. She completed her pre-medical studies at Dalhousie University in Halifax, Nova Scotia and obtained her naturopathic medical training from the Canadian College of Naturopathic Medicine. Dr. Blake has over 10 years of clinical experience, specializing in the integrative and functional management of chronic diseases.
Whether its an experiment or doctor’s orders, going gluten-free is an adjustment. Removing gluten may mean eliminating not only some of your favorite foods, but possibly a good portion of your current diet. What foods will you eat in their place? How will you fill the gluten void?
Most likely, there’s no lack of “gluten-free” versions of your favorite foods on your grocer’s shelves. In fact, the number of gluten-free packaged foods is exploding to keep up with consumer demand. Going gluten-free may be as easy as buying and opening a different box—or bag or carton.
But are gluten-free packaged foods the answer? Possibly not. In fact, they may be the surprising reason behind many go-gluten-free resolutions. Here’s why.
There’s a better way. Don’t just swap out one package for another. Relying on gluten-free packaged foods can be taxing on your budget, blood pressure, waistline, and digestion. Rather, consider this an ideal time to shift your diet away from processed foods and toward more whole foods. Instead, give your diet a bona fide upgrade.
Financial Times, Going gluten free: one of 3 trends shaking up commodities https://www.ft.com/content/5348432e-1a13-11e7-bcac-6d03d067f81f, Accessed December 9, 2017.
By Noelle Patno, PhD
When you get “the runs,” you need to know what is actually causing the excess stool and how to control it. Diarrhea (“flow through” from the Greek), by definition, is frequent loose stools of small to moderate volume typically during waking hours, in the morning or after meals.1 Often there is a feeling of extreme urgency along with the sense of incomplete evacuation. If diarrhea is accompanied by blood or grease or is of large volume, this is cause for extra concern, and you should consult your doctor as soon as possible. Diarrhea may be due to multiple causes such as dysbiosis or alteration of the intestinal microbiota which lead to changes in the usual bacterial composition.
The ABCs and more of diarrhea causes
Chronic diarrhea is a decrease in fecal consistency lasting for four or more weeks, which requires further investigation by medical personnel. If you have any concerns related to diarrhea, you should discuss them with your healthcare practitioner.
Do you enjoy kimchi or sauerkraut? Did you know these fermented foods are beneficial for your health?
Kimchi and sauerkraut, along with other fermented foods such as kombucha and tempeh, are full of good bacteria called probiotics, which help promote a healthy gut microbiome.1
Also known as the digestive tract, the gut consists of roughly 100 trillion bacteria and microbes.1 Taking care of these microorganisms can help support general health.1,2,3
If improving your health sounds appealing, you may want to incorporate more fermented foods into your diet.
How do fermented foods work in the gut?
Fermentation is a hot topic in the nutrition space.
During fermentation, yeast, bacteria, and other microorganisms convert carbohydrates such as sugars into alcohols or acids.4 These alcohols and acids not only serve as natural preservatives, but they also give fermented foods their unique flavor.
Common fermented foods and beverages include:
What are the health benefits of fermented foods?
Fermented foods offer a number of health benefits, including better absorption of nutrients and immune protection.4 They are ideal for:
1. Digestive health
The probiotics in fermented foods re balance the healthy bacteria in the gut.4 This means they can reduce the symptoms of many digestive issues.4
So, if you’re grappling with bloating, gas, diarrhea, constipation, or irritable bowel syndrome, think about eating more tempeh or sauerkraut.4
Fermentation also promotes easier digestion.
2. Nutrient absorption
Fermented foods support easier digestion and better nutrition by allowing nutrients to be absorbed and not just eliminated as waste. Since fermentation breaks ingredients down into simpler parts, foods that have gone through this process are generally easier to digest.4
And easier digestion may support better nutrient absorption.
Put simply, it is thought that fermentation makes nutrients more bio available to the body.4 The process can also enhance the nutritional value of specific foods, as it produces several B vitamins as a byproduct.2
3. Cognitive well being
Did you know the gut and the brain work together?5 Their connection is in the gut-brain axis, which includes signaling between the nervous system and the digestive tract.5
Consequently, emerging research suggests a healthy gut may support a healthy mind—and vice versa. Studies show that eating fermented foods may support mood and cognitive function.5
How can you add fermented foods to your diet?
Fermented foods ranging from cabbage to ginger deliver important vitamins, minerals, trace elements, and more.6
You can buy these foods at the grocery store or prepare fermented meals yourself. Focus on quality when possible, and monitor your intake of added sugars, salt, and fat.2
No matter your approach, it’s best to start slow when adding fermented foods to your diet.2 One to three servings per day may be just fine.2
Please consult a doctor or nutritionist for dietary guidance and remember that it may take a week or two before your body adjusts to your new eating habits.
Submitted by the Metagenics Marketing Team
Gut health is important for overall health, and there are many wide-ranging causes that can change and affect gut health. These changes can be from acute causes, such as gastrointestinal surgeries, to others, such as the normal aging process, which may affect gastrointestinal motility. Regardless of the cause, the intestines usually experience changes during the healing or aging process.1
That said, despite any shifts, it’s important to get back on track as soon as possible and make the gut the best it can be.1 Here are a few things to consider.
What are the implications of changes in the gut? The gut has trillions of bacteria that help to digest food, absorb nutrients, and manage our wellbeing.Many of these bacteria are beneficial, and evidence has shown that good gut health is linked to supporting general health, including the immune system and brain. However, certain gastrointestinal conditions can lead to changes in the gut’s microbial environment and result in poor health and wellness.2
Common sources of gut-health changes include shifts in gut immunity, stomach acid, and gastrointestinal flora (that is, the ecosystem of over 400 bacterial species that make up the microbiome).2,3
Some digestive changes—including compromised gut function—are simply caused by the aging process.3This is because our natural metabolic processes slow as we grow older.
Are there ways to support common gastrointestinal changes? You’ve probably heard the expression, “prevention is the best form of medicine.” Prevention is admittedly king in a healthcare setting, but it also involves hard work and dedication.
So how can we avoid intestinal changes that may affect gut health? Here are some preventive strategies that may help keep your gastrointestinal health in check:4
Which ingredients can enhance gut health?Many foods and supplements are connected to a healthy gut and a strong digestive tract.4 Some options to explore include:
Probiotics are “live microorganisms that, when administered in adequate amounts, confer a health benefit on the host.”6,7 They offer a number of benefits, including supporting digestion, and data suggests a gut-brain connection exists.8 While only strain-identified probiotics have been researched extensively for specific health benefits, fermented foods, such as kimchi, miso soup, kombucha, and kefir are popular dietary sources of probiotics.
Most probiotics come from one of the following genera of bacteria:8
Prebiotics are fibrous carbs the human body cannot digest (but certain bacteria in the gut can). They serve as food for probiotics and include oats, garlic, onions, apple skin, beans, and chicory root.5 Much like probiotics, prebiotics encourage healthy digestion.8
When it comes to improving our digestive health, fiber—also known as roughage—is crucial.13 It cannot be digested by the body; rather, it passes through the stomach, small intestine, and colon more or less intact.9
Fruits and vegetable, whole grains, beans, and legumes are all rich in fiber.14 Fibrous ingredients are generally full of nutrients as well, which may enhance our absorption abilities.13
There are two types of fiber, one of which is more closely linked to the digestive system:13
Be sure to discuss your fiber intake with your healthcare practitioner to minimize chances of discomfort.13
This amino acid provides both a source of fuel and precursors for growth to the rapidly dividing cells of the intestinal lining.15
5. Inner-leaf aloe
Sourced from the aloe vera plant, inner-leaf aloe has been shown in studies to support temporary digestive symptoms such as cramping, bloating, and flatulence.16 It has also been shown to a support a healthy intestinal lining.17
Ideal for gastric comfort, zinc-carnosine works by supporting the healthy ecology and integrity of the stomach lining.18,19
Always consult your healthcare practitioner before making any adjustments to your diet or adding any supplements.
For more information on nutrition and gut health, please visit the Metagenics blog.
By Robert Silverman, DC, DACBN, DCBCN, MS, CCN, CNS, CSCS, CIISN, CKTP, CES, HKC, FAKTR
In a perfect world, we would garner all the vitamins and nutritional minerals we need from the foods we eat. We’d also be able to maintain robust, resilient immune systems to fight against all toxins and disease. Unfortunately, that’s not the world we live in. The nutrients we need to maintain our day-to-day health, like magnesium, vitamin D, and omega-3 fatty acids, are also critical for maintaining our health over the long term.1 Yet Americans on average get about 11 percent of their daily calories from low-nutrient fast food.2 Even when we skip fast food and junk food, we aren’t always as careful about our diet as we should be. Stress and poor lifestyle behaviors, including smoking and alcohol use, reduce our ability to absorb nutrients.
Taking a daily multivitamin can help when your food isn’t as nutritious as it should be, but is that enough—even if you lead a generally healthy lifestyle? Aside from specific dietary needs that should be addressed with your functional health practitioner, here are five instances when I recommend leveraging the power of supplements.
To aid healthy sleep patterns
Among the many reasons to get a good night’s sleep is the link between sleep deprivation and negative health consequences. For example, people with high blood sugar often don’t sleep well. There’s evidence that not sleeping well can increase your risk of developing more serious complications. When choosing supplements for quality, restorative sleep, look to ingredients that help ease tension, support deep sleep, and promote physical regeneration during sleep. L-theanine enables the body to produce other calming amino acids, such as dopamine, GABA, and tryptophan and helps support concentration, focus, deep muscle relaxation, and improved quality sleep. Ashwagandha, another sleep-supporting supplement, contains active constituents called glyco-withanolides, which mimic certain corticosteroids, supporting healthy cortisol levels and the circadian rhythm.
The best-known ingredient, melatonin, supports sleep onset, quality of sleep, increased REM time, deep sleep, and dreaming—all factors that lead to better quality sleep and produce greater mental, physical, and emotional rejuvenation. Melatonin can decrease the amount of time required to fall asleep, increase the number of sleeping hours, and support daytime alertness. I recommend taking just 5 mg of melatonin, as taking too much can impair the body’s natural production of it and may cause us to become dependent on the artificial form.
Magnesium, a calming nutrient, can also help induce a deeper sleep, especially when taken together with calcium. Research from the Biochemistry and Neurophysiology Unit at the University of Geneva, Department of Psychiatry indicates that higher levels of magnesium helped provide better, more consistent sleep.3 Other natural supplements containing lavender oil work to encourage a restful night’s sleep by modulating the metabolism of melatonin and promoting relaxation.4
To support your brain health
Getting consistent, sufficient sleep lays a solid foundation for your brain’s health, but how you feed your brain plays a critical role in its wellbeing over time. By combining a brain-healthy diet with nutritional supplements, you’ll provide your brain with the fuel it needs for optimum levels of functioning. Here are four supplements I’d recommend to support brain health:
To feed your gut
We all know the old adage: “go with your gut.” But it turns out listening to your gut is much more than following your natural instinct. To support your gut’s health, start first with prebiotics—ingredients that induce the growth of beneficial microorganisms in your gut. You’ll also want to consume foods packed with probiotics. The combination of prebiotics and probiotics can help keep your microbiome in a healthy balance, with a good diversity of intestinal bacteria in your gut. When you have plenty of good bacteria, the harmful ones get crowded out. Your digestion also improves, because your ability to absorb macronutrients and micronutrients is better when your beneficial bacteria are diverse and balanced.
To properly rehydrate after exercise
After exercising, proper fueling requires more than just replenishing calories and fluids; it also involves consistent and adequate electrolyte support. Electrolytes are substances that are utilized by the body to create electrically charged fluids. Many bodily functions depend on electrolytes, especially in muscle and nervous system tissue. Major electrolytes found in the body include sodium, chloride, potassium, magnesium, calcium, phosphate, and bicarbonate. The right rehydration supplements are scientifically designed to help support fluid balance; supply sodium and potassium to help replenish the electrolytes lost during exercise; deliver key electrolytes to help replace those lost through sweating during exercise, activity, or hot weather conditions; and support hydration during exercise.5
Whether you practice health-forward habits—like consuming gut-healthy prebiotics and probiotics and exercising regularly—or your diet consists of mostly empty calories and low levels of nutrients, incorporating supplements can help. In our fast-paced, modern world, supplements provide the support our bodies need to keep up—and sustain our health for the long run.
This content is not intended as a substitute for professional medical advice, diagnosis, or treatment. Individuals should always consult with their healthcare professional for advice on medical issues.
Inflammation is a popular buzzword these days. But what causes it exactly? How can you know you have it, and if it’s something your body does naturally to help you heal, then what’s the big deal?
We’ve all been there: It’s late, you’re tired, and you don’t feel like turning the lights on just to cross a room…then bam! Shin finds coffee table. The resulting egg-shaped lump is formed when blood flow increases to the area, bringing with it neutrophils and macrophages as part of the immune response.
Symptoms of this acute inflammation are typical: redness, swelling, heat, and pain. The swelling that occurs as fluid collects in the area is also called “edema.” The symptoms last for a limited period of time—minutes to days—as the body heals itself.
Acute inflammation vs. chronic inflammation
When the body isn’t given enough time, or if the body is unable to resolve the immune response due to deficiency of certain nutrients, it can lead to chronic inflammation. This can also be caused by untreated infectious pathogens such as bacteria or viruses, as well as the adverse effects of long-term exposure to pollutants or chemicals, including smoking.1,2 Stress and obesity are also known factors that lead to chronic inflammation.3,4
Common symptoms of chronic inflammation include:
What can we do?While acute inflammation is one way your body can heal itself, chronic inflammation should be avoided, as a prolonged inflammatory response can cause damage to healthy cells and tissue.
Consider adopting a few simple ways to decrease inflammation. If you have been experiencing the symptoms described herein and are concerned you may have chronic inflammation, make an appointment with your healthcare practitioner.
This content is not intended as a substitute for professional medical advice, diagnosis, or treatment. Individuals should always consult with their healthcare professional for advice on medical issues.
When your body’s gut microbiome falls out of balance, there are many ways it can affect your health.
What’s a microbiome? It’s the genetic material of all microbes—bacteria—that live on and inside your body. The good bacteria that contribute to your intestinal microbiome are essential to your health, development, immune function, and nutritional status.
Sound complex? It is! And it’s a delicate balance that can easily be disrupted. Here are five key ways your gut microbiome may be negatively impacted:1
*These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.
Nowadays, detoxing is on everyone’s mind, especially when living in increasingly toxic environments and experiencing negative health effects.
If you think that a detox might be right for you, there’s a way to do it right and ensure you are safely achieving the results you are looking for.
Here are three easy tips to keep in mind to make the most out of your detox:
In summary, if you feel tempted to try out the latest detox program, keep this checklist in mind. It’s designed to help you know how often to do a detox, the importance of targeted nutrients, and, most of all, how to ensure your chosen detox is safe and based on good science.
[i]Klein AV, Kiat H. Detox diets for toxin elimination and weight management: a critical review of the evidence. J Hum Nutr Diet. 2015 Dec;28(6):675-86. doi: 10.1111/jhn.12286. Epub 2014 Dec 18.
[ii]Lamb JJ, Konda VR, Quig DW, Desai A, Minich DM, Bouillon L, Chang JL, Hsi A, Lerman RH, Kornberg J, Bland JS, Tripp ML. Altern Ther Health Med. 2011 Mar-Apr;17(2):36-44.
[iii]Bland JS, Barrager E, Reedy RG, Bland K. Altern Ther Health Med. 1995 Nov 1;1(5):62-71.