Type 2 diabetes affects about one in ten adults and anti-diabetic medications are the fourth most commonly prescribed medications. Could the bacteria in our guts hold the key to restoring a healthy blood sugar metabolism?
Type 2 diabetes affects about one in ten adults and anti-diabetic medications are the fourth most commonly prescribed medications. Could the bacteria in our guts hold the key to restoring a healthy blood sugar metabolism?
Nutrition Diva is hosted by Monica Reinagel. A transcript is available at Simplecast.
Hello everyone. I'm Monica Reinagel and you're listening to the Nutrition Diva podcast. Welcome. This week we're talking about some new research on the relationship between our microbiome, the beneficial bacteria that hang out in our intestines and our ability to process sugar. As you probably know, in type 2 diabetes, the body's ability to regulate blood sugar levels is gradually degraded.
And this condition typically develops in midlife, but it is now often seen in children or young adults. And if left unchecked, type 2 diabetes, which now affects about 1 in 10 Americans, can lead to a host of serious, even deadly consequences. Blindness, loss of limbs, kidney failure, heart disease, even premature death.
So it's not surprising that a lot of time and money is spent screening and treating people for this disease. Metformin, this is a drug used to lower high blood sugar, is the fourth most commonly prescribed drug in the U.S. But of course, restoring the body's ability to deal with blood sugar naturally would be far preferable to treating it for the rest of your life with drugs.
Doctors screen for type 2 diabetes by testing your fasting blood glucose levels. A reading of 99 milligrams per deciliter is considered normal. A reading between 100 and 125 is considered pre diabetes. And a fasting blood sugar over 125 signals type 2 diabetes. Although diabetes can lead to severe complications, it's largely asymptomatic in its early phases.
And so this elevated blood glucose reading is usually the first indication of trouble. At that point, it is sometimes possible to turn things around with diet and lifestyle modifications, losing weight if you need to, getting more exercise, eating a healthy diet. All of these can help you restore your body's ability to process carbohydrates.
Now I want to make sure to point out that type 1 diabetes is a completely different disease in which the body's immune system attacks the pancreas. Although the consequences of poorly controlled type 1 diabetes are similar to those of type 2 diabetes, it cannot be prevented or treated just with diet and lifestyle modification.
Type 1 diabetics will always require insulin to manage their condition. Now, we used to think that eating too much sugar would eventually result in developing type 2 diabetes. A sort of, “If you keep on making that face, it's gonna freeze that way”, comeuppance for dietary indiscretions. We now understand that eating a lot of sugar doesn't necessarily increase your risk of type 2 diabetes unless it leads to obesity because that does increase your risk.
However, type 2 diabetes also develops in people who are not overweight. A family history of type 2 diabetes increases your risk and your risk also just goes up with age. Recent research into the microbiome has revealed another interesting clue here. People with type 2 diabetes tend to have a different array of bacteria in their guts.
Among other things, they seem to have a scarcity of the type of bacteria that produce butyrate as a byproduct of their metabolisms and butyrate is directly involved in glucose and insulin metabolism. It's hard to say whether the changing gut bacteria is the chicken or the egg here. Does the disease cause these alterations in the gut microbiome or do changes in the gut microbiome give rise to the disease?
And even if we were to know for sure that the second scenario were true, it might still be hard to say whether those differences in the gut bacteria were the result of genetic predisposition or environmental factors such as diet. Very likely, it would be a combination of both of those things. But even without knowing the answers to any of those questions, these observations raise another more answerable question.
If we alter the composition of gut bacteria in people with type 2 diabetes or pre diabetes, would it improve their ability to metabolize sugar? This was the question that Colleen Cutcliffe set out to answer in a recent study.
Colleen holds doctorates in biochemistry and molecular biology, and she's an expert in the formulation and manufacture of probiotic supplements. Her company, Pendulum, produces probiotic supplements that target various conditions. Last year, they created a new probiotic designed to restock the gut with those specific types of bacteria that are known to be scarce in people with type 2 diabetes.
And then they recruited several independent clinics to carry out what they call a proof of concept trial involving several dozen people with type 2 diabetes. And the preliminary results, which were published in a peer reviewed journal, were extremely encouraging. After 12 weeks, people taking this new probiotic formula saw meaningful improvements in their blood sugar control compared with those taking a placebo.
Most of the subjects in this study were also taking metformin to control their blood sugar at the same time. And while this pilot study didn't test this, it certainly does raise the question of whether it might be possible for those people to then reduce or even eliminate that medication altogether.
At the very least, many of these subjects reported the addition of the probiotic to their regimen relieved some of the digestive discomfort that metformin frequently causes. For that matter, could this probiotic therapy keep people with prediabetes from ever having to start on medication in the first place?
And could that new population of beneficial bacteria, once established, could it be sustained, possibly without having to take that probiotic on a continual basis? Dr. Cutcliffe is currently designing and conducting research to further explore some of these other questions. In the meantime, the formula that was used in this research, it's called pendulum glucose control, is already available as an over the counter supplement.
Now, one problem is the cost. Although the company hopes that they'll eventually be able to lower the price as they scale up production, or maybe even succeed in getting it covered by health insurance. The supplement currently costs $200 a month, which is a lot more than metformin. In addition to this ongoing clinical research, the Mayo Clinic has established a national registry where people taking this particular formula can anonymously share their data, including the results of their blood tests.
Although that's certainly not a controlled clinical trial, this sort of crowdsourced information could add a lot to our understanding of how well this approach works in real world situations, which is where we actually need it to work. Now I want to underline the fact that whether you're taking metformin or maybe a probiotic to help control your blood sugar, neither one of those things is going to be a silver bullet.
And unfortunately, this is often an unintended consequence of pharmaceutical therapies. People taking statin drugs to control their cholesterol, for example, tend to be a lot less careful about their diets than those who don't. They may reason that as long as they've got a drug to manage their cholesterol, their dietary choices don't matter.
But of course, they do. And Dr. Cutcliffe cautions that it would be a mistake to think that just taking a probiotic would mean that you no longer have to worry about your diet or your lifestyle. Eating a healthier diet. Specifically, eating more high fiber foods can change the composition of the microbiome and improve blood sugar control all by itself.
And Cutcliffe reports that the combination of diet, exercise, and probiotic therapy produces far better results more quickly than just taking the probiotic or just altering your diet. With all the focus on the microbiome recently, probiotic supplements have become one of the fastest growing categories of nutritional supplements.
And there is research to support the targeted use of probiotics where the strains of bacteria are carefully matched to the condition. And tailoring a probiotic supplement to address blood sugar regulation is a really good example of this approach. Popping probiotics as a general preventive strategy on the other hand, doesn't really appear to make much sense.
If your goal is simply to encourage healthy gut flora, a better strategy is really just to focus on the quality of your diet. Think of it this way. If you want to attract pretty songbirds to your bird feeder, you put out the kind of bird seed that those birds really like. And if you want to roll out the red carpet for the beneficial bacteria in your gut, well then put out a buffet for them.
In particular, include a variety of legumes, whole grains, nuts, seeds, fruits, and vegetables. And take it easy on the red meat and the refined sugar. You'll find a transcript of today's show along with links to the research studies that I discussed on our website at quickanddirtytips.com. And if you have questions or comments about today's show or a suggestion for a future topic, you can send me an email at nutrition@quickanddirtytips.com. Or you can leave me a voicemail at 443-961-6206. I'd love to hear from you. Our show is written by me, Monica Reinagel. It's edited by Karen Hertzberg. Our producer is Nathan Semes. And our team at Macmillan Audio also includes Morgan Ratner, Emily Miller, Michelle Margulis, and our director, Kathy Doyle.
Thanks so much for listening. I'll see you next week.