Forget the diet shots, try working on gut health

 If you are like me, you may be curious about the new weight loss shots. I have certainly heard a lot of differing opinions. I am a bitt depressed with the weight gain that comes on during menopause and have wondered what I can do and if I should try the shots. I just really do NOT wish to be dependent on anything for  the rest of my life, if I can help it.

I love this article and it gives me hope that there may be a few things I can still do to change things.

WebMD Health News

Forget the Shots: Focusing on Gut Health Can Aid Weight Loss

Debbie Koenig

February 23, 2024 <https://www.medscape.com/s/viewarticle/forget-shots-focusing-gut-health-can-aid-weight-loss-2024a10003ld?ecd=mkm_ret_240310_mscpmrk_endo_obesity_etid6360686&uac=149193PV&impID=6360686>

Injectable weight loss drugs like Wegovy, Saxenda, and Zepbound have been getting all the glory lately, but they're not for everyone. If the inconvenience or cost of weight loss drugs isn't for you, another approach may be boosting your gut microbiome.

So how does one do that, and how does it work?

In theory, all you have to do is boost your gut microbiome.

"There are a lot of different factors naturally in weight gain and weight loss, so the gut microbiome is certainly not the only thing," said Chris Damman, MD, a gastroenterologist at the University of Washington. He studies how food and the microbiome affect your health. "With that caveat, it probably is playing an important role."

Trillions of Microbes

The idea that your gut is home to an enormous range of tiny organisms — microbes — has existed for more than 100 years, but only in the 21st century have scientists had the ability to delve into specifics.

We now know you want a robust assortment of microbes in your gut, especially in the lower gut, your colon. They feast on fiber from the food you eat and turn it into substances your body needs. Those substances send signals all over your body.

If you don't have enough microbes or have too many of the wrong kinds, it influences those signals, which can lead to health problems. Over the last 20 years, research has linked problems in the gut microbiome to a wide variety of conditions, including inflammatory bowel disease, autoimmune diseases like rheumatoid arthritis, metabolic ones like diabetes, and cardiovascular disease, asthma, and even autism.

Thanks to these efforts, we know a lot about the interactions between your gut and the rest of your body, but we don't know exactly how many things happen — whether some teeny critters within your microbiome cause the issues or vice versa.

"That's the problem with so much of the microbiome stuff," said Elizabeth Hohmann, MD, a physician investigator at the Massachusetts General Research Institute. "Olympic athletes have a better gut microbiome than most people. Well, sure they do — because they're paying attention to their diet, they're getting enough rest. Correlation does not causation make.”

The American Diet Messes With Your Gut

If you're a typical American, you eat a lot of ultra-processed foods — manufactured with a long ingredients list that includes additives or preservatives. According to one study, those foods make up 73% of our food supply. That can have a serious impact on gut health.

"When you process a food and mill it, it turns a whole food into tiny particles," Damman said. "That makes the food highly digestible. But if you eat a stalk of broccoli, a large amount of that broccoli in the form of fiber and other things will make its way to your lower gut, where it will feed microbes."

With heavily processed foods, on the other hand, most of it gets digested before it can reach your lower gut, which leaves your microbes without the energy they need to survive.

Rosa Krajmalnik-Brown, PhD, is director of the Biodesign Center for Health Through Microbiomes at Arizona State University. Her lab has done research into how microbes use the undigested food that reaches your gut. She describes the problem with processed foods this way:

"Think about a Coke. When you drink it, all the sugar goes to your bloodstream, and the microbes in your gut don't even know you've had it. Instead of drinking a Coke, if you eat an apple or something with fiber, some will go to you and some to the microbes. You're feeding them, giving them energy.”

Weight and Your Gut Microbiome

The link between gut health and body weight has received a lot of attention. Research has shown, for example, that people with obesity have less diversity in their gut microbiome, and certain specific bacteria have been linked to obesity. In animal studies, transplanting gut microbes from obese mice to "germ-free" mice led those GF mice to gain weight. This suggests excess weight is, in fact, caused by certain microbes, but to date there's scant evidence that the same is true with humans.

Krajmalnik-Brown's group did an experiment in which they had people follow two different diets for 23 days each, with a break in between. Both provided similar amounts of calories and macronutrients each day but via different foods. The study's typical Western menu featured processed foods — think grape juice, sandwiches made with deli turkey and white bread, and spaghetti with jarred sauce and ground beef. The other menu, what researchers called a "microbiome enhancer diet," included foods like whole fruit, veggie sandwiches on multigrain buns, and steak with a side of whole wheat spaghetti.

While the study wasn't designed for weight loss, an interesting thing happened when researchers analyzed participants' bowel movements.

"We found that when you feed subjects a diet designed to provide more energy to the microbes and not to the [body], our subjects lost a little weight," Krajmalnik-Brown said. "It looks like by feeding your microbes, it seems to make people healthier and potentially even lose a little."

Another possible mechanism involves the same hormone that powers those injectable weight loss drugs. The lower part of your gut makes hormones that tell the entire gut to slow down and also help orchestrate metabolism and appetite. Among them is GLP-1. The drugs use a synthetic version, semaglutide or tirzepatide, to trigger the same effect.

According to Damman, you can stimulate your gut to make those helpful hormones with the food you eat — by giving your microbes the right fuel.

Eat to Feed Your Microbes

The foods you eat can affect your gut microbiome and so your weight. But don't go looking for that one perfect ingredient, experts warn.

"Oftentimes we get this micro-focus, is this a good food or a bad food?" warned Katie Chapmon, a registered dietitian whose practice focuses on gut health. "You just want to make sure your microbiome is robust and healthy, so it communicates that your body is running, you've got it."

Instead, try to give your body more of the kinds of food research has shown can feed your microbiome, many of which are plant-based. "Those are the things that are largely taken out during processing," Damman said. He calls them the "Four Fs":

• Fiber: When you eat fiber-rich foods like fruits, vegetables, whole grains, nuts, and beans, your body can't digest the fiber while it's in the upper parts of your GI tract. It passes through to your lower gut, where healthy bacteria ferment it. That produces short-chain fatty acids, which send signals throughout your body, including ones related to appetite and feeling full.
• Phenols: Phenolic compounds are antioxidants that give plant-based foods their color — when you talk about eating the rainbow, you're talking about phenols. The microbes in your gut feed on them, too. "My goal for a meal is five distinct colors on the plate," Chapmon said. "That rounds out the bases for the different polyphenols."
• Fermented foods: You can get a different kind of health benefit by eating food that's already fermented — like sauerkraut, kimchi, kefir, yogurt, miso, tempeh, and kombucha. Fermentation can make the phenols in foods more accessible to your body. Plus, each mouthful introduces good bacteria into your body, some of which make it down to your gut. The bacteria that are already there feed on these new strains, which helps to increase the diversity of your microbiome.
• Healthy fats: Here, it's not so much about feeding the good bacteria in your microbiome. Damman says that omega-3 fatty acids, found in fatty fish, canola oil, some nuts, and other foods, decrease inflammation in the lining of your gut. Plus, healthy fat sources like extra-virgin olive oil and avocados are full of phenols.

Eating for gut health isn't a magic bullet in terms of weight loss. But the benefits of a healthy gut go far beyond shedding a few pounds.

"I think we need to strive for health, not weight loss." Krajmalnik-Brown said. "Keep your gut healthy and your microbes healthy, and that should eventually lead to a healthy weight. You'll make your microbes happy, and your microbes do a lot for your health.”

SOURCES:

• Christopher Damman, MD, clinical associate professor, Division of Gastroenterology, University of Washington Medical School, Seattle.
• Journal of Experimental Medicine: "The gut microbiome: Relationships with disease and opportunities for therapy.”
• Elizabeth Hohmann, MD, physician investigator, Massachusetts General Research Institute; associate professor of medicine, Harvard Medical School, Boston.
• Rosa Krajmalnik-Brown, PhD, director, Biodesign Center for Health Through Microbiomes, Arizona State University, Phoenix.
• World Journal of Gastroenterology: "Gut microbiota in obesity.”
• Nature Communication: "Machine learning prediction of the degree of food processing," "Host-diet-gut microbiome interactions influence human energy balance: A randomized clinical trial.”
• Obesities: "Gut Microbiota and Obesity: The Chicken or the Egg?”
• Katie Chapmon, registered dietician, Los Angeles.
• Foods: "Health Benefits and Side Effects of Short-Chain Fatty Acids.”
• Nutrients: "Fermented Foods, Health and the Gut Microbiome."

Why is Gut Health Important?

 

Everyone needs to understand the importance of gut health not only because there are trillions of  microbes in the gut  but because they play many roles in the body. This collection of microbes is called the microbiota and a person’s entire well-being depends on how well it functions..

The world we live in is full of microorganisms, so it’s natural that our body is home to some of them too. Human bodies carry millions of bacteria, fungi, and viruses which together create a microbiome, especially in the guts or intestines. While many of these microorganisms are associated with diseases, the majority of the ones your gut naturally supports are crucial for the proper functioning of the digestive system, the immune system, and even the nervous system.
So, keeping your gut microbiome thriving and healthy is very important for key body functions and overall health. However, there are situations where the gut microbiome can be jeopardized and its balance disrupted, which can have immense adverse effects on your health.

The microbes (gut microbiome) present in the body can also change as a person grows older. As soon as a baby enters the world, these organisms are already present. As they age, the number of microbes also increases, especially when they reach three years old. During this time, the microbiome is already similar to that of an adult.
They can also differ depending on where they thrive. The bacteria on the cheeks are different from the ones that live in the intestines, for example, the profile of the bacteria will continue to modify, but they have the tendency to dwindle in number as you age.

There is a strong connection between the gut bacteria and the Immune system. The gut flora can also influence the way the immune system behaves. These bacteria teach the immune system to learn to h. good and harmful microorganisms. This way, it doesn’t flare up or create an abnormal response every time it comes across “threats” such as dust, pollen, and other types of microbes.

The Gut Microbiome may also affect mental health.

The Effects of Gut Microbiota Dysbiosis

A study published in the International Journal of Environmental Research and Public Health in 2018 reveals that this disruption in the gut microbiota is called dysbiosis, and the condition is linked to intestinal illnesses like irritable bowel syndrome (IBS), celiac disease, and inflammatory bowel disease (IBD). Moreover, the study shows that dysbiosis can also cause other issues like obesity, metabolic disorders, cardiovascular syndrome, allergies, and asthma. 

A 2019 study published in Nutrients shows that gut microbiota dysbiosis is now also linked to colorectal cancer, diabetes, and even neurological disorders. The study suggests that there are reciprocal interactions between gut microbiota and the brain - popularly known as the gut-brain axis - and changes in this interaction due to dysbiosis can trigger the onset of neurological issues. Overall, studies indicate that dysbiosis is a condition that can affect your health and quality of life immensely and should be prevented at all costs.

Read more here:

https://well.org/healthy-body/gut-health/ 

Sleep Dysfunction and the Microbiome

 

Sleep Dysfunction & the Microbiome: Emerging Treatments

Sleep is a dynamic process that affects every system of the body, and the interplay of different environmental and lifestyle factors influences sleep quality and architecture.1 

Recent research suggests that some of these factors may influence sleep via the microbiota-gut-brain axis, both directly and indirectly.1-3 What is the connection between lower sleep quality and quantity and a dysbiotic gut microbiome? What emerging interventions targeting the microbiota-gut-brain axis may be beneficial for the treatment of impaired sleep patterns?

From a young age, microbial communities within the body interact with the sleep-wake cycle in a complex manner.1The gut microbiome, which produces a variety of metabolites and compounds with neuroactive and immunomodulatory properties, including short-chain fatty acids, secondary bile acids, and neurotransmitters, may affect brain function and behavior through the microbiota-gut-brain axis.4 These microbial products are also involved in sleep physiology.3 While the mechanisms underlying the microbiota-gut-brain axis are not fully understood, some evidence has suggested that neuroendocrine, immune, and metabolic pathways may regulate interactions.3

Growing evidence reports a positive correlation between sleep efficiency and the diversity of the gut microbiota from childhood through adulthood.3 For example, a recent study of 143 largely Caucasian children ages 3-4 found that children with a high total nighttime sleep duration (average 9.48 hours), greater sleep efficiency, and less time awake at night showed a higher relative abundance of Bifidobacterium and Bacteroides.5 Both bacteria have been linked to sleep-related neurochemicals in previous studies, such as serotonin and its precursors tryptophan and gamma-aminobutyric acid. In the 2022 study by Wang et al, five taxa showed greater abundance in children who had shorter night-time sleep duration, less sleep efficiency, and longer waking time, including Blautia, Coprococcus, and other Lachnospiraceae.5

Evaluating individuals with healthy sleep quality, a 2020 pilot study of 28 young adults by Grosicki et al found higher proportions of the abundance of Blautia and Ruminococcus (belonging to Firmicutes), lower proportion of Prevotella(belonging to Bacteroidetes), and higher ?-diversity of the gut microbiota among individuals reporting superior sleep quality.6 Researchers hypothesize that sleep quality may be positively correlated with the ratio of Firmicutes/Bacteroidetes and microbial diversity.3,6

A 2021 cross-sectional pilot study found that adult short sleepers have different microbial composition, such as an increased abundance of the bacteria Pseudomonas (0.14% vs. 0.08%) in feces and a lower abundance of Sutterella(0.38% vs. 1.25%) compared to normal length sleepers.1,7 Interestingly, Sutterella has been associated with lower relative abundance in patients with depression and may play a role in the microbiota-gut-brain axis.7 Several other studies indicate that a lower sleep quantity and quality are associated with a dysbiotic gut microbiome characterized by a lower microbial diversity, an increase of pathogenic microbiota, or the loss of beneficial microbes.4,8-9

Sleep-Related Disorders & the Microbiome

 OBSTRUCTIVE SLEEP APNEA (OSA)

OSA leads to fragmented night sleeping and daytime sleepiness due to episodes of obstruction of the upper airway; it is accompanied by repeated sleep fragmentation and forced awakening from sleep due to airway collapse.1,3Studies suggest that those suffering from OSA may have a prolonged N1 stage and a shortened REM sleep stage.3

Evidence suggests that intermittent hypoxia may result in changes to the gut microbiota, including increased Firmicutes richness and decreased Bacteroidetes richness, as well as decline in ?-diversity.3,10 A 2020 pilot study in children with OSA showed a significant decrease in gut microbial diversity compared to healthy children and an increase of inflammation and gut barrier disruptor–related strains.1,3,11 In 2019, Ko et al found gut microbial dysbiosis, in varying degrees, in adults with OSA-hypopnea syndrome.1,12 Specifically, short-chain fatty acid–producing bacteria was decreased and the level of interleukin-6 was increased compared to controls.1,12

More recently, a 2023 prospective case control study of 48 Chinese adults age 18-65 found that the severity of OSA was related to differences in the structure and composition of the fecal microbiome.13 Enriched Fusobacterium, Megamonas, and Lachnospiraceae_UCG_006 and reduced Anaerostipes was found in patients with severe OSA. Enriched Ruminococcus_2, Lachnoclostridium, Lachnospiraceae_UCG_006, and Alloprevotella was found in patients with high intestinal barrier biomarkers. Lachnoclostridium and Lachnospiraceae_UCG_006 were the common dominant bacteria of OSA and intestinal barrier damage. Fusobacterium and Peptoclostridium were independently associated with apnea-hypopnea index. The dominant genera of severe OSA were also associated with glucose, lipids, neutrophils, monocytes, and BMI.13

INSOMNIA

A range of psychiatric and inflammatory disorders as well as metabolic syndromes are comorbid with insomnia.2,14Marked changes in gut microbiota diversity and composition was found by Liu et al in 2019 among 10 chronic insomnia patients compared to 10 healthy controls.1,15 A later study by Li et al observed a decrease in microbiome diversity in acute and chronic insomnia patients, with greater effects on bacterial diversity found in patients with disordered sleep.1,13 These individuals also show an increase in the inflammatory cytokine interleukin-1?.13 Both of these studies noted that an increase of Bacteroidetes phylum could be a biomarker to identify insomnia.1

A 2022 multiomics analysis reveals that the composition and structure of gut microbiota and metabolism in insomnia patients differs from healthy controls.14 Compared to healthy controls, the relative abundances of Lactobacillus, Streptococcus, and Lactobacillus crispatus were significantly increased in people with insomnia. (Lactobacilli possess several health-ameliorating attributes, including alleviation of chronic diseases, immune system stimulation, pathogen protection, and nutritional physiology.)14 Five metabolic pathways in patients with insomnia differed between the two groups as well, including glycerophospholipid metabolism; glutathione metabolism; nitrogen metabolism; alanine, aspartate, and glutamate metabolism; and aminoacyl-tRNA biosynthesis.15Researchers also found that IL-1? levels were significantly higher in insomnia patients while TNF-? was significantly reduced; the changes in the level of IL-1? and TNF-? were associated with some specific bacteria and metabolites, such as Prevotella amnii, Prevotella buccalis, Prevotella timonensis, and Prevotella colorans.15

Clinical Applications: Microecological Therapy

A novel treatment strategy referred to as microecological therapy has emerged, featuring several potential interventions targeting the gut microbiota to improve sleep quality and quantity.3 The targets of this therapy include regulating the abundance of specific bacterial groups, microbial metabolites, intestinal barrier function, and host immune response. Evidence suggests that microbiota manipulations like dietary interventions and the use of probiotics may be beneficial for the treatment of impaired sleep.3

PROBIOTICS

Although probiotics are transient visitors, they play a role in shifting the overall balance of the microbiome, modulating the immune system, and decreasing inflammation.18 Consuming probiotics in foods or supplements may encourage colonization of commensal organisms over time.18 Studies suggest that probiotics may improve sleep latency, sleep quality and duration, sleepiness upon wakening, and recovery from fatigue.19-21

A 2023 systematic review and meta-analysis of six studies showed significant improvement in sleep quality of 343 healthy adults with mild to moderate stress as an effect of daily consumption of L. gasseri compared to controls (-0.77, 95% CI -1.37 to-0.16, P=0.01).21 In addition to the cumulative beneficial effect shown using the PSQI global score, four of six studies reported a statistically significant positive effect of L. gasseri on sleep quality as indicated by at least one of the Pittsburgh Sleep Quality Index component scores (sleep latency, duration of sleep, sleep disturbance, and daytime dysfunction due to sleepiness).21

In a group of 94 healthy medical students from Japan studying for national exams, researchers found that sleep latency prolongation was less in the intervention group that received Lacticaseibacillus casei strain Shirota.4,19 EEG measurements also showed that, as the examination approached, the time spent in NREM stage 3 sleep was reduced in the placebo group but maintained in the intervention group. In this double-blind, randomized, placebo-controlled trial, researchers also found a reduction of the mean Pittsburgh Sleep Quality Index (PSQI) score, indicating improved sleep quality among the intervention group compared to the placebo group.4,19 

In a 2018 randomized crossover study, 40 adults aged 20-64 consumed either Lactobacillus helveticus or placebo for four weeks.4,20 Sleep efficiency was measured as the total time spent in REM and NREM sleep divided by the total time from sleep onset to awakening. The researchers found that sleep efficiency significantly improved in the intervention group compared with placebo, including improved sleepiness on awakening, onset and maintenance of sleep, dreaming, and recovery from fatigue. It is important to note that the intervention group also received theanine, which has stress-reducing effects, while the placebo group did not.4,20

MEDITERRANEAN DIET

Nutritional imbalances are potential contributors or causes of several chronic conditions, and nutrition-based interventions are fundamental components of many therapeutic strategies used to combat chronic illness and restore optimal health. These personalized treatments may include therapeutic food plans like the Mediterranean diet, a plant-based, antioxidant-rich, unsaturated fat dietary pattern that has been consistently associated with lower rates of disease and total mortality.22 Studies indicate that greater adherence to the Mediterranean diet may be associated with adequate sleep duration and with several indicators of better sleep quality. For example:

• In 2018, Castro-Diehl et al found that a Mediterranean-style diet was associated with adequate sleep duration and fewer insomnia symptoms.23,24 This cross-sectional, multi-ethnic study of 2,068 adults with atherosclerosis found that compared with individuals who currently reported a low aMed score, those with a moderate-high aMed score were more likely to sleep 6-7 vs. <6 hr/night (p <0.01) and less likely to report insomnia symptoms occurring with short sleep (vs. no insomnia or short sleep alone; p <0.05). An increase in aMed score over the preceding 10 years was not associated with sleep duration or insomnia symptoms. However, compared with those with decreasing aMed score, individuals with an unchanging score reported fewer insomnia symptoms (p ?0.01).23,24

• In a 2019 cross-sectional study of 1,314 Southern Italian adults, a higher adherence to the Mediterranean diet was associated with a higher likelihood of adequate overall sleep quality (highest vs. lowest quartile, OR=1.82, 95% CI: 1.32, 2.52).25 Interestingly, in a sub-analysis of this study, researchers found the benefit of the Mediterranean diet on sleep latency was observed in normal and overweight individuals (highest vs. lowest quartile of adherence score, OR=2.30, 95% CI: 1.49, 3.54) but was not evident in the obese (highest vs. lowest quartile of adherence score, OR=1.12, 95% CI: 0.33, 3.79).22,25

• In a 2021 cross-sectional study of 2,169 Costa Rican adults (1,600 men and 569 women), the association between sleep duration and adherence to the Mediterranean diet differed between men and women. In women only, a lower adherence to the Mediterranean diet was associated with shorter sleep duration, a finding that researchers say was primarily driven by lower consumption of fruits, vegetables, and legumes.26 However, the literature is inconsistent regarding whether associations between sleep and diet are gender based. For example, a 2020 study conducted among young adults 21 to 30 years old found that men with lower fruit and vegetable intake had a higher risk of insomnia as compared to women.26,27

Functional Medicine Considerations

Taken together, these studies illustrate the important connection between the gut microbiome and sleep patterns. Screening patients for sleep disorders is encouraged as a regular practice in functional medicine, and there are a range of effective lifestyle interventions for patients suffering from poor sleep. A close working relationship between clinician and patient can help identify sleep troubles early on so that they may be targeted with behavioral and lifestyle therapies to prevent or reverse further damage.

References:

1. 1) Wang Z, Wang Z, Lu T, et al. The microbiota-gut-brain axis in sleep disorders. Sleep Med Rev. 2022;65:101691. doi:1016/j.smrv.2022.101691
2. 2) Sen P, Molinero-Perez A, O’Riordan KJ, et al. Microbiota and sleep: awakening the gut feeling. Trends Mol Med. 2021;27(10):935-945. doi:1016/j.molmed.2021.07.004
3. 3) Han M, Yuan S, Zhang J. The interplay between sleep and gut microbiota. Brain Res Bull. 2022;180:131-146. doi:1016/j.brainresbull.2021.12.016
4. 4) Haarhuis JE, Kardinaal A, Kortman GAM. Probiotics, prebiotics and postbiotics for better sleep quality: a narrative review. Benef Microbes. 2022;13(3):169-182. doi:3920/bm2021.0122
5. 5) Wang Y, van de Wouw M, Drogos L, et al. Sleep and the gut microbiota in preschool-aged children. Sleep. 2022;45(6):zsac020. doi:1093/sleep/zsac020
6. 6) Grosicki GJ, Riemann BL, Flatt AA, Valentino T, Lustgarten MS. Self-reported sleep quality is associated with gut microbiome composition in young, healthy individuals: a pilot study. Sleep Med. 2020;73:76-81. doi:1016/j.sleep.2020.04.013
7. 7) Agrawal R, Ajami NJ, Malhotra S, et al. Habitual sleep duration and the colonic mucosa-associated gut microbiota in humans—a pilot study. Clocks Sleep. 2021;3(3):387-397. doi:3390/clockssleep3030025
8. 8) Matenchuk BA, Mandhane PJ, Kozyrskyj AL. Sleep, circadian rhythm, and gut microbiota. Sleep Med Rev. 2020;53:101340. doi:1016/j.smrv.2020.101340
9. 9) Simkin DR. Microbiome and mental health, specifically as it relates to adolescents. Curr Psychiatry Rep. 2019;21(9):93. doi:1007/s11920-019-1075-3
10. 10)  Zhang X, Wang S, Xu H, et al. Metabolomics and microbiome profiling as biomarkers in obstructive sleep apnoea: a comprehensive review. Eur Respir Rev. 2021;30(160):200220. doi:1183/16000617.0220-2020
11.  11) Valentini F, Evangelisti M, Arpinelli M, et al. Gut microbiota composition in children with obstructive sleep apnoea syndrome: a pilot study. Sleep Med. 2020;76:140-147. doi:1016/j.sleep.2020.10.017
12.  12) Ko CY, Liu QQ, Su HZ, et al. Gut microbiota in obstructive sleep apnea-hypopnea syndrome: disease-related dysbiosis and metabolic comorbidities. Clin Sci (Lond). 2019;133(7):905-917. doi:1042/cs20180891
13.  13) Li Q, Xu T, Shao C, et al. Obstructive sleep apnea is related to alterations in fecal microbiome and impaired intestinal barrier function. Sci Rep. 2023;13(1):778. doi:1038/s41598-023-27784-0
14.  14) Rastogi S, Singh A. Gut microbiome and human health: exploring how the probiotic genus Lactobacillusmodulate immune responses. Front Pharmacol. 2022;13:1042189. doi:3389/fphar.2022.1042189
15.  15) Wang Q, Chen B, Sheng D, et al. Multiomics analysis reveals aberrant metabolism and immunity linked gut microbiota with insomnia. Microbiol Spectr. 2022;10(5):e0099822. doi:1128/spectrum.00998-22
16.  16) Liu B, Lin W, Chen S, et al. Gut Microbiota as an objective measurement for auxiliary diagnosis of insomnia disorder. Front Microbiol. 2019;10:1770. doi:3389/fmicb.2019.01770
17.  17) Li Y, Zhang B, Zhou Y, et al. Gut microbiota changes and their relationship with inflammation in patients with acute and chronic insomnia. Nat Sci Sleep. 2020;12:895-905. doi:2147/nss.s271927
18.  18) Mazziotta C, Tognon M, Martini F, Torreggiani E, Rotondo JC. Probiotics mechanism of action on immune cells and beneficial effects on human health. Cells. 2023;12(1):184. doi:3390/cells12010184
19.  19) Takada M, Nishida K, Gondo Y, et al. Beneficial effects of Lactobacillus casei strain Shirota on academic stress-induced sleep disturbance in healthy adults: a double-blind, randomized, placebo-controlled trial. Benef Microbes. 2017;8(2):153-162. doi:3920/bm2016.0150
20. 20)  Nakagawa M, Yamamoto H, Kawaji M, Miura N, Wakame K, Endo T. Effects of lactic acid bacteria-containing foods on the quality of sleep: a placebo-controlled, double-blinded, randomized crossover study. Funct Foods Health Dis. 2018;8(12):579-596. doi:31989/ffhd.v8i12.572
21.  21) Chu A, Samman S, Galland B, Foster M. Daily consumption of Lactobacillus gasseri CP2305 improves quality of sleep in adults – a systematic literature review and meta-analysis. Clin Nutr. 2023;42(8):1314-1321. doi:1016/j.clnu.2023.06.019
22.  22) Scoditti E, Tumolo MR, Garbarino S. Mediterranean diet on sleep: a health alliance. 2022;14(14):2998. doi:10.3390/nu14142998
23.  23) Qi X, Ye J, Wen Y, et al. Evaluating the effects of diet-gut microbiota interactions on sleep traits using the UK Biobank Cohort. Nutrient 2022;14(6):1134. doi:10.3390/nu14061134
24.  24) Castro-Diehl C, Wood AC, Redline S, et al. Mediterranean diet pattern and sleep duration and insomnia symptoms in the Multi-Ethnic Study of Atherosclerosis. Sleep. 2018;41(11):zsy158. doi:1093/sleep/zsy158
25.  25) Godos J, Ferri R, Caraci F, et al. Adherence to the Mediterranean diet is associated with better sleep quality in Italian adults. 2019;11(5):976. doi:10.3390/nu11050976
26.  26) Gupta K, Jansen EC, Campos H, Baylin A. Associations between sleep duration and Mediterranean diet score in Costa Rican adults. 2022;170:105881. doi:10.1016/j.appet.2021.105881
27.  27) Jansen EC, She R, Rukstalis MM, Alexander GL. Sleep duration and quality in relation to fruit and vegetable intake of US young adults: a secondary analysis. Int J Behav Med. 2021;28(2):177-188. doi:1007/s12529-020-09853-0

Multi-Strain Probiotic Improves Insulin Resistance in Patients with Diabetes

Multi-Strain Probiotic Improves Insulin Resistance in Patients 

with Diabetes

Targeted probiotic in personalized therapeutic plan for patients with diabetes shows promise

 Courtesy of metagenics Institute 

https://www.metagenicsinstitute.com/articles/probiotics-impact-diabetes-study/?_hsmi=270084925&_hsenc=p2ANqtz--12rgpeKxQk3oOUlQ3Qsa3SnjmN2H9hzOcemL-JVvNpOuQXu6cfFKwYJ0RYni6kOVxYkbcjvP3mi-8f_4VIVvjk7ni3Q

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

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Are Artificial Sweeteners Really Harmless?

Medscape Medical News - August 19, 2022

New research discounts the long-held notion that aspartame and other nonnutritive sweeteners (NNS) have no effect on the human body.

In a study, researchers found that these sugar substitutes are not metabolically inert and can alter the gut microbiome in a way that can influence blood glucose levels.

The study was published online August 19,20-22 in the journal Cell.

Gut Reaction? 

Several years ago, a team led by Eran Elinav, MD, PhD, an immunologist and microbiome researcher at the Weizmann Institute of Science, Rehovot, Israel, observed that NNS affect the microbiome of mice in ways that could affect glycemic responses.

They have now confirmed this observation in a randomized controlled trial with 120 healthy adults.

Before the study, all participants strictly avoided NNS. During the trial, some remained NNS-free, while others used saccharin, sucralose, aspartame, or stevia daily for 2 weeks in doses lower than the acceptable daily intake.

Each NNS "significantly and distinctly" altered stool and oral microbiome, and two of the sweeteners (saccharin and sucralose) significantly impaired glucose tolerance, the researchers report.

"Importantly, by performing extensive fecal transplantation of human microbiomes into germ-free mice, we demonstrate a causal and individualized link between NNS-altered microbiomes and glucose intolerance developing in non-NNS-consuming recipient mice," they say.

They note that the effects of these sweeteners will likely vary from person to person because of the unique composition of an individual's microbiome.

"We need to raise awareness of the fact that NNS are not inert to the human body as we originally believed. With that said, the clinical health implications of the changes they may elicit in humans remain unknown and merit future long-term studies," Elinav said in a news release.

For now, Elinav says it's his personal view that "drinking only water seems to be the best solution.”

Weighing the Evidence 

Several experts weighed in on the results in a statement from the UK nonprofit organization, Science Media Centre.

Duane Mellor, PhD, RD, RNutr, registered dietitian and senior teaching fellow, Aston University, Birmingham, United Kingdom, notes that the study does not show a link between all NNS and higher blood glucose levels in the long term (only after a glucose tolerance test).

"It did suggest, though, that some individuals who do not normally consume sweeteners may not tolerate glucose as well after consuming six sachets of either saccharin or sucralose mixed with glucose per day," Mellor says.

Kim Barrett, PhD, distinguished professor of physiology and membrane biology, University of California, Davis, School of Medicine, concurs, saying, "this well-designed study indicates the potential for NNS to have adverse effects in at least some individuals."

The study also does not provide any information about how people who normally consume sweeteners or people with either type 1 or type 2 diabetes respond to NNS.

"Therefore, for some people, it is likely to be a better option and more sustainable approach to use sweeteners as a 'stepping stone,' allowing them to reduce the amount of added sugar in foods and drinks, to reduce their sugar intake, and still enjoy what they eat and drink, on the way to reducing both added sugar and sweeteners in their diet," Mellor suggests.

Kevin McConway, PhD, with the Open University, Milton Keynes, United Kingdom, says it's "important to understand that the research is not saying that these sweeteners are worse for us, in heath terms, than sugar.

"But exactly what the health consequences of all this, if any, might be is a subject for future research," McConway adds.

Kathy Redfern, PhD, lecturer in human nutrition, University of Plymouth, UK, agrees.

"We still have a lot to learn about the human microbiome, and although this study suggests two of the sweeteners tested in this study (sucralose and saccharin) significantly affected glucose tolerance, these deviations were small," she says.

The International Sweeteners Association also weighs in, saying, "No conclusions about the effects of low/no calorie sweeteners on glucose control or overall health can be extrapolated from this study for the general population or for people who typically consume sweeteners, including people living with diabetes."

They add that "a recent review of the literature concluded that there is clear evidence that changes in the diet unrelated to low/no calorie sweeteners consumption are likely the major determinants of change in gut microbiota."

Nevertheless, Redfern says the results "warrant further investigation to assess how small changes in glucose tolerance in response to NNS consumption may influence longer term glucose tolerance and risk for metabolic complications, such as type 2 diabetes."

The study had no specific funding. Elinav is a scientific founder of DayTwo and BiomX, a paid consultant to Hello Inside and Aposense, and a member of the scientific advisory board of Cell. Mellor has provided consultancy to the International Sweetener Agency and has worked on projects funded by the Food Standards Agency that investigated the health effects of aspartame. Barrett, McConway, and Redfern report no relevant financial relationships. 

Cell. Published online August 19, 2022. <https://www.cell.com/cell/fulltext/S0092-8674(22)00919-9>