The Role of Probiotics in Diabetes Management: What You Need To Know

May 17, 2023

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Whether you have a keen interest in nutrition or if you are just another digital user sucking in the plethora of information that is being thrown at you, I am sure you have seen a surge in references to the D word and the P word. Don’t roll your eyes, you dirty mind. I am talking about Diabetes and Probiotics. The onset of industrialization also marks the silent beginning of not one, but many chronic metabolic diseases, for industrialization, simply did not just change the way things were produced, but the absolute lifestyle of a human. Of the many changes that industrialization - specifically food industrialization, brought to the human body, perhaps the most crucial and disastrous change is the changes in our gut microbiome - particularly the depletion of healthy colonies in our gut. As humankind struggles to thrive at the apogee of chronic diseases, it becomes crucial for us to bring back ancestral practices and norms that can help reverse chronic diseases and live in our best health. In this article, we will dive deeper into probiotics, a class of live microorganisms that are essential and have a strong impact on the overall health of a person.

Diabetes – Factors

Diabetes, being clinically defined as a chronic disease that sets in as a result of the pancreas’ inability to produce enough insulin or when the body is unable to effectively use the insulin it produces, is often linked to genetics, epigenetics, obesity, hormonal imbalances, poor physical activity, and diet.

Another key factor that has been gaining traction recently is the gut microbiota and its role in regulating metabolism and immune functions. The gut microbiome which is defined by a person’s food habits and lifestyle has a significant impact on patients with diabetes, not only in terms of the criticality of just diabetes, but also in terms of co-morbidity determining the impact on other organs as well.

The Gut-Diabetes connection

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a) Gut Inflammation

Scientific investigations [1] have concluded that there are specific classes of microbes such as Bifidobacterium, Bacteroides, Faecalibacterium, Akkermansia, and Roseburia that help combat diabetes. However, people with diabetes commonly have a gut microbiota depleted of the classes as mentioned above and systemic inflammation. In addition, butyrate-producing bacteria are also present in low numbers in people diagnosed with diabetes, specifically T2DM, thus affecting homeostasis. On the contrary, it has also been concluded that certain classes such as Ruminococcus, Fusobacterium, and Blautia contribute to furthering diabetes, and are thus usually present in large numbers in diabetics. With such stark evidence of the impact of the gut microbiome in diabetics, it does become imperative to pay attention to gut health as part of a holistic approach to diabetes.

b) Homeostasis of Glucose Metabolism

One of the key functions of the gut microbiota as part of maintaining overall homeostasis is homeostasis of glucose metabolism [2]. While there is a deficit in knowledge regarding which compositional and/or functional characteristics of the gut microbiota are relevant for metabolic health, and through which mechanisms they affect host glucose homeostasis, plenty of studies indicate the dysbiosis of gut microbiome does impact the metabolism of glucose, through mechanisms such as a) increased systemic lipopolysaccharide (LPS), b) changes in bile acid metabolism, c) alterations in short chain fatty acid (SCFA) production, d) alterations in gut hormone secretion, and d) changes in circulating branched-chain amino acids which are made possible through the intestinal permeability and metabolic outputs produced by the gut microbiota.

c) Change in microbiome composition

Another key evidence of the role of the gut microbiome in chronic metabolic diseases is the change in the microbiome composition along the digestive tract [3]. It is a common misconception that the gut microbiome primarily resides in the intestines and the mouth. While the largest colonies are indeed present in the intestines, the microbiome is present across the human body and more specifically along the entire length of the digestive tract. Small intestinal bacterial overgrowth popularly known as SIBO is commonly witnessed in diabetic, and to a certain degree pre-diabetic individuals as well and is known to act as a causative factor for diabetes and other metabolic diseases. SIBO results in the breaking down of complex carbohydrates and bile acid in the upper gastrointestinal (GI) tract as opposed to the lower GI tract, which leads to the deprivation of the colon bacteria as well.

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Balancing the gut

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With enough given scientific evidence that the gut microbiome does impact diabetes, here are a few ways to ensure a healthy gut microbiome, particularly in the realm of diabetes.
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Fermented foods: Every culture has its own kind of unique fermented food that enables the production of short-chain fatty acids that feed the good bacteria in the gut. Some classic examples are coconut curd, sauerkraut, apple cider vinegar (with the "mother"), dietary supplements kimchi, etc. Adding a locally fermented food of your choice does great good to your gut and overall health. However, if you have an ongoing incident of SIBO, stay away from fermented foods of any kind as it can aggravate SIBO further.

Bone broth: A healthy home makes way for happy bacteria. Bone broth is a functional food that is rich in a plethora of minerals like calcium, manganese, potassium, zinc, iron, boron, etc., and amino acids like glycine and arginine that can help protect and heal the mucosal lining of the digestive tract, heal inflammation, and keeps intestinal permeability in check.[4]

Probiotic supplements: A good store-bought probiotic supplement that is high on the count in Bifidobacterium, Bacteroides, and Akkermansia can help restore your gut microbiome. Studies have shown that probiotics have a positive effect in lowering fasting blood glucose in Type 2 Diabetes Mellitus patients, specifically on those with poorly controlled diabetes and not on any insulin therapy. The effect of probiotics on glucose homeostasis likely stems from changing the composition of the host gut microbiota. Altering the gut microbiota can improve intestinal barrier integrity to reduce circulating bacterial endotoxin, and ultimately, reduce systemic inflammation.[5],[6] Ensure you speak to a practitioner to get access to a good probiotic.

Digestive bitters and herbs: These are specifically for when your gut is out of balance and you have a case of dysbiosis. The incorporation of bitters in a cyclic fashion will help in the reduction of bad microbes. Some classic digestive bitters and herbs that specifically work on the gut microbiome are licorice, dandelion roots, neem, oregano, ginger, garlic, and grapeseed. Start with a small quantity of a single herb, stay put for a couple of weeks, and then cycle it with a different herb. The kind of herb that will work best for you, depends on what type of SIBO you are experiencing - methane dominant vs hydrogen dominant. Work with a functional health practitioner to determine what single herbs/herbs in combination work best for your case. [7]

Sugar: This is something to avoid, for sugar is a favorite food of non-beneficial bacteria in the microbiome. Recent research has concluded consumption of dietary sugar leads to gut inflammation and the growth of non-beneficial bacteria [8]. Lower your dietary sugar and hidden sugar intake to as low as possible, enabling a good microbiome balance.

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