The Microbiome: Demanding a seat at the metabolic table
The gut microbiome is demanding a seat at the table, especially when it comes to insulin resistance and metabolic health.
Main takeaways:
There is no miracle pill - Medications called GLP-1RA, commonly known as Ozempic, Victoza, and Trulicity may be helpful for many but not for everyone.
Gut health matters - In particular the diversity of bacteria in your gut can influence how we respond to certain diets and medications.
Calories count but not all the same way - Interestingly in the mentioned study, carbs and calories were kept constant but one group responded differently. Meaning there is more to the weight loss story than we already know.
Semaglutide (also known as Ozempic) is a drug used for diabetes and is gaining promise as an obesity drug. It is in the class of GLP-1 RAs (Glucagon-like peptide-1 receptor agonists), meaning it activates the this GLP-1 receptor which in turn has multiple actions such as stimulating insulin production, decreasing appetite, slowing gastric emptying (food exits the stomach slower), and regulates blood sugar among several other actions. These drugs work work both centrally (in the brain) to suppress appetite and decrease hunger and also peripherally (in the body - stomach, intestines, pancreas, etc.) to impact blood sugar levels and metabolism.
As novel as this drug class sounds, our body already makes this molecule, and our microbiome may be playing a significant role in how we respond to it. Our gut contains certain cells (L-cells) that release hormones like GLP-1 (and GLP-2), and our microbiome can determine how well, or not, we respond to the effects of GLP-1 and other similar hormones. GLP-1 and GLP-2 also play an active role in maintaining the integrity of our gut lining and preventing intestinal permeability, which we suspect may also be playing a role in intestinal inflammation which trickles down to the rest of the body.
A recent study published in Frontiers in Endocrinology (2021), searched to find why is it that some people do not respond to GLP1-RAs like semaglutide, liraglutide or dulaglutide - in other words, why do some people benefit from these drugs and why is it that others notice minor or no benefit. They found that non-responders might have a unique microbiome signature that impacts their response to this drug class. Those who responded well (improved HbA1c%) had higher levels of Bacteroides and Lachnoclostridium species, where the non-responders had higher levels of Prevotella copri and Mitsuokella multacida.
The research continues to show that there is some type of pattern in individuals with diabetes or insulin resistance compared to healthy groups of people. We even see improvements in these patterns of microbial diversify when people tend to lose weight, improve their diabetes and overall metabolic health. It is quite clear that this also strongly correlates with an increase in bacteria that make SCFA (short chain fatty acids) like butyrate - which the literature and scientific community can all agree is a positive finding and aligns with good health, reduced risk of diabetes, and strengthens the gut barrier (reduced risk of intestinal permeability).
So what should we do to increase or decrease these specific microbes? It is not that simple as it usually never comes down to just one thing. The goal should be to improve microbial diversity, promote commensal bacteria to outcompete many pathogenic and opportunistic bacteria.
Actionable next steps:
A few tips to shift your microbiome and improve your odds in beating insulin resistance and improving metabolic health:
Take in more prebiotics like inulin, pomegranates, green tea and cocoa.
Support the gut lining with colostrum, vitamin A, slippery elm, turmeric and collagen peptides.
Eliminate alcohol. Alcohol is one of the largest disruptors of the microbiome and does double damage to metabolic health.
Taking a comprehensive approach by identifying which foods may act as triggers and impair the gut lining and microbiome. Elimination and elemental diets can be incredibly helpful here.
More fermented foods like kimchi, sauerkraut, kefir, miso, and kombucha.