Probiotics for Type 2 Diabetes: A Clinically-Shown Way to Manage Your Symptoms
*This article was originally published on Pendulum Therapeutic’s blog
Our guide shares what's known and what's commercially available.
Alongside physical activity and healthy eating, cultivating a diverse gut microbiome is an important part of controlling type 2 diabetes.
The gut microbiome is a microscopic ecosystem teaming with unseen life. Like most ecosystems, the gut microbiome appears to be at it’s healthiest when it contains a diversity of species (in this case, bacterial species).
Over the past few decades, researchers have found that people with type 2 diabetes often have a less diverse gut microbiome compared to people without diabetes. This suggests that one way to manage type 2 diabetes (or possibly to prevent it) is through the use of probiotics.
The term “probiotics” describes live microorganisms that provide a benefit to the host. These microorganisms can be found in both foods and supplements that help increase the presence of certain bacteria in the gut microbiome.
Here’s a guide to help you understand what is known about probiotics in the management of type 2 diabetes and how you can evaluate different commercially available probiotics.
Note: Looking for a probiotic that has been clinically shown to reduce a1c and blood sugar levels? Pendulum can help. Pendulum Glucose Control is not intended to cure T2D or replace drug therapy recommended by your doctor or health care professional.
The gut microbiome and type 2 diabetes
Type 2 diabetes is a condition where a person’s body struggles to properly remove sugar from the bloodstream, resulting in chronically elevated blood sugar levels. Over the past few decades, it’s become increasingly clear that the loss of diversity in the gut microbiome may lead to type 2 diabetes1,2,3.
The gut microbiome
The human gut is home to a thriving ecosystem. Compared to a jungle or ocean habitat, the length of the human intestine in which the gut microbiome develops is extremely small.
Despite its size, however, the gut microbiome is home to trillions of microorganisms each of which are continually competing or cooperating with one another to secure food, space, and survival.
And, like all other ecosystems, the gut microbiome appears to be at its healthiest when it consists of a diverse number of species 1,2,3.
Each species of bacteria is unique, having adapted to life in the intestine in their own way.
Some bacteria specialize in thriving in the harsh mucus layer that coats the inner lining of the intestines. Others specialize in the types of food they consume.
One important difference that can exist between species is the mixture of waste products—essentially bacteria poop—and signaling molecules that they release into their environment.
It’s these molecules that can have either positive, negative, or neutral effects on the microbiome and the person’s health 4,5, 6, 7.
For example, one species of bacteria in the gut microbiome known as Clostridium butyricum (c. butyricum) feeds on dietary fibers—a certain type of carbohydrate that human cells cannot easily digest.
As these bacteria dine on fiber, they produce a molecule known as butyrate which nearby human cells can use for energy (like gas in a car) 4,5, 6,.
The molecules released by bacteria in the gut can be beneficial for both human cells and other bacteria, or they can be harmful. A molecule known as lipopolysaccharide (LPS), for example, can be released from certain bacteria and signals to the human body that a potential infection has taken place, resulting in activation of the immune system and inflammation1,2,3,7.
For this reason, it’s important to cultivate a microbiome with potentially beneficial bacteria (such as c. butyricum) and to limit the spread of potentially harmful bacteria.
This may be particularly important in type 2 diabetes.
The gut microbiome and type 2 diabetes
The relationship between the gut microbiome and type 2 diabetes is complex and not yet fully understood. But research suggests there are multiple ways in which a healthy gut microbiome may protect us from type 2 diabetes.
One of the most likely links between the gut microbiome and type 2 diabetes lies in chronic inflammation1,2,3.
Large-scale studies have found that people with type 2 diabetes often exhibit a prolonged, low level of inflammation.
When activated, certain immune cells will prompt the body to release sugar into the bloodstream because they’ll need the energy to fight off any would-be invaders.
However, if this continues over a long period of time, it may contribute to chronically elevated blood glucose levels and type 2 diabetes8.
Research also shows that people with type 2 diabetes may have lost some bacteria in their gut microbiome—such as Akkermansia muciniphila.
Through multiple potential methods, these bacteria are believed to play a role in protecting the inner lining of the gut which prevents bacteria from entering the body9.
Loss of these bacteria could lead to a weakening of this barrier, enabling bits of dead bacteria or molecules released by bacteria to enter the body. When they do, immune cells recognize a potential threat and become activated—resulting in a low level of inflammation1,2,3.
Exactly why there is a decrease in beneficial bacteria as type 2 diabetes develops is unclear. But, a large amount of evidence suggests that a loss of diversity in the gut microbiome leads to a loss of potentially beneficial bacteria and a growth in potentially harmful bacteria.1,2,3
Fortunately, probiotics and prebiotics make it possible to restore diversity in the gut microbiome and help your body manage it’s blood glucose levels.
What are probiotics?
A probiotic is a live microorganism (typically bacteria) naturally found in the human body and which may provide some sort of health benefit11.
Probiotics can come in many forms, such as foods or as supplements that were deliberately designed to help manage specific health conditions (such as type 2 diabetes).
What are prebiotics?
Prebiotics are compounds—such as dietary fibers—that serve as food for specific species of good bacteria (or in some cases, fungi)12.
Because they cannot be digested or absorbed by human cells, prebiotics can be digested by specific forms of beneficial microorganisms.
The link between probiotics and type 2 diabetes
Certain probiotics may help people with type 2 diabetes control their blood sugar levels. They do this, in part, by stimulating growth of bacteria in the gut that are known to decrease gut permeability and inflammation.
Many researchers have studied if and how probiotics may help people with type 2 diabetes and have found mixed results13,14,15,16,17.
The gut microbiome is home to many different bacterial species and there are likely more that we haven’t discovered yet18.
Deciphering what effect, if any, each of these species has on the development and progression of type 2 diabetes typically starts by studying the differences between people with type 2 diabetes and those without it.
If one species of bacteria is present more or less often in people with type 2 diabetes, then it’s reasonable to assume that this species of bacteria may be linked to type 2 diabetes (in either a protective or causative role).
Rodent models for type 2 diabetes have helped researchers identify a number of different bacterial species that may seem to be involved in protecting us from type 2 diabetes or, conversely, making us vulnerable to type 2 diabetes.
Such studies have been done many times, resulting in several species of bacteria being linked to type 2 diabetes.
For example, the species Akkermansia muciniphila has been found to be much less common in microbiome samples taken from people with type 2 diabetes, suggesting that the absence of this bacterial species may lead to type 2 diabetes2,19.
Rodent models also help scientists study the effect of probiotics on type 2 diabetes.
In animals with type 2 diabetes, administration of probiotics containing Bifidobacterium infantis has been shown to improve insulin signaling—the body’s system for helping cells remove sugar from the blood— in models of type 2 diabetes.
Similarly, mice given Akkermansia muciniphila demonstrated improvements in glucose tolerance, insulin signaling, and signs of inflammation7,21,22.
With evidence of a potentially positive effect in rodent models, probiotics can then be tested in humans. Studies in humans have shown promising results for probiotics containing various combinations of species, such as:
Akkermansia muciniphila
Clostridium beijerinckii
Clostridium butyricum
Bifidobacterium infantis
Bifidobacterium breve
Bifidobacterium lactis
Bifidobacterium longum
Eubacterium hallii
Lactobacillus rhamnosus
Lactobacillus paracasei
Lactobacillus plantarum
Streptococcus thermophilus7
It’s worth noting though that only Bifidobacterium infantis, Akkermansia muciniphila, Clostridium beijerinckii, Clostridium butyricum, and Eubacterium hallii have been clinically-shown to reduce a1c and blood sugar levels when administered via a probiotic.
Through a combination of DNA testing, in vitro studies, rodent models, and a clinical trial, these bacteria have been shown to help manage blood glucose levels.
Most likely, they do this by helping establish a healthy mucus lining in the gut, establishing an environment that allows many diverse species of bacteria to grow in the microbiome, and by increasing the amount of protective molecules—such as butyrate—released by the gut microbiome.
What is the best probiotic supplement for people with type 2 diabetes?
When searching for a probiotic to help with type 2 diabetes, many supplements may be suggested to you.
However, it’s important to note that most of them are meant to improve your health overall and are not targeted to help with type 2 diabetes.
In fact, only probiotics with scientific and clinical rigor can make these types of claims.
As more probiotics for type 2 diabetes become available, though, it’s important to know how to sift through them to find one that is safe and most likely to be effective.
While there is no established criteria for evaluating probiotics specific to type 2 diabetes, there are some general guidelines you can follow to help you:
Safety: Safety is paramount, so there should be overt statements indicating if a probiotic has been tested for safety in humans and what the results of those studies were.
Clinical evidence: The best probiotics are backed by clinical trials showing that they’re effective in humans. Without clinical evidence, it is difficult to know if the claims made by a probiotic will be accurate in humans. In the case of probiotics intended to manage diabetes, there should be clinical evidence that it can manage blood A1C levels, glucose spikes, or similar measures in people with type 2 diabetes.
Targeted: A good probiotic should be specific and targeted, meaning the bacterial strains and prebiotics (if any are included) are specifically chosen due to their known and documented role in reducing symptoms of type 2 diabetes.
No mysteries: There should be no question about what’s in the probiotic. Part of designing an effective probiotic is carefully controlling what’s included in the final formula. A good probiotic should clearly define the species of bacteria that are in it (most often they are species that have Lactobacillus or Bifidobacterium in their names). Use of DNA sequencing technology to do this is a good sign as well because it means the bacteria have been screened for potentially harmful bacterial factors.
Satisfying these criteria requires that a company performed extensive research on their product and to establish rigorous and transparent manufacturing processes.
As of this writing, there is only one medical probiotic available, Pendulum Glucose Control, which has demonstrated clinical efficacy for the dietary management of type 2 diabetes showing a reduction blood A1C levels, has diligent characterization of the bacterial strains present (which are believed to have a positive impact on microbiome diversity) and which has been demonstrated to be safe for use in humans.
To see how Pendulum Glucose Control ranks against the above criteria, check out our science page.
Are there probiotic foods for type 2 diabetes?
Not all probiotics are supplements. Some foods naturally contain bacteria that may help your microbiome.
These include:
Fermented foods
Fermented foods are foods containing microorganisms (bacteria or yeast) and that have been changed by the actions of those microorganisms.
In other words, the bacteria or yeast in these foods have eaten some of the nutrients in the food and, in turn, have produced their own molecules.
This process accounts for the powerful flavors in kombucha, kimchi, sauerkraut, and tempeh.
It’s important to note that not all fermented foods contain microorganisms because sometimes they undergo a process to remove the microorganisms (that’s why you don’t have yeast strains floating in beer or wine)22.
Prebiotic foods
Prebiotic foods are foods that you can’t digest without the help of your gut microbiome and which promote growth of beneficial bacteria in your gut.
Dietary fibers are excellent for this because the human body struggles to digest fibers.
However, many species of bacteria in the gut are able to break down fiber and use it to churn out beneficial signaling molecules (such as butyrate)12.
There are prebiotic elements to many different foods including:
Asparagus
sugar beet
garlic
chicory
onion
Jerusalem artichoke
wheat
honey
Green banana
barley
tomato
rye
soybean
milk
peas
beans
seaweeds
microalgae
However, the amount of prebiotic compounds in these foods can be quite small.
This is why some probiotics contain the prebiotic inulin or other such prebiotic compounds. Including these in the probiotic can help ensure the bacteria grow once in the gut12.
Final Thoughts
Researchers continue to find connections between the gut microbiome and human health, and results from decades of study make one thing clear:
Cultivating a healthy microbiome is an important part of managing type 2 diabetes.
Additional FAQs
Can I take a probiotic with metformin?
It’s important to check with your doctor before incorporating a probiotic into your routine. The safety of combining metformin with a probiotic should be evaluated for each probiotic you’re interested in.
In a clinical trial for Pendulum Glucose Control, people with type 2 diabetes who were also taking metformin showed an additional improvement in A1C levels*.
Do probiotics affect blood sugar?
A clinical trial using 5 strains targeted to help with type 2 diabetes showed a significant reduction in blood A1C levels in people with type 2 diabetes.*
However, most commercially available probiotics have not been shown to affect blood sugar.
Are prebiotics good for people with type 2 diabetes?
Prebiotics can be helpful for people with diabetes because they encourage growth of potentially beneficial bacteria. Increasing fibers in your diet may help you cultivate a diverse microbiome and potentially improve symptoms of diabetes1,2,3,12,13,14.
Is it safe for people with type 2 diabetes to take probiotics?
In most cases, yes. The probiotic should have demonstrated safety in humans and clear dosing instructions. It is important to discuss probiotics with your doctor and work with them to determine a safe approach.
Which probiotics are best for type 2 diabetes?
Currently the only commercially available probiotic to have been clinically shown to reduce symptoms of type 2 diabetes is Pendulum Glucose Control24.
Can probiotics help insulin resistance?
It is likely that in the near future, there will be probiotics to directly help with insulin resistance. However, there are no commercially available probiotics that have been shown to directly affect insulin resistance. Pendulum Glucose Control has been shown to help manage blood A1C levels and to reduce glucose spikes which are related to insulin resistance.
Can people with type 2 diabetes take probiotic supplements daily?
Before making a decision about which probiotics you take, and how often you take them, you should have a conversation with your healthcare provider to determine what is likely to be the safest and most effective for you. Pendulum Glucose Control is designed to be taken twice daily.
What’s a medical probiotic?
A medical probiotic is a probiotic designed to target symptoms of a specific disease, has been rigorously characterized, and has clinical evidence of efficacy.
*A nutrition study demonstrated statistically and clinically significant reduction in A1C and blood sugar spikes in people with type 2 diabetes. It was randomized, double-blinded, placebo controlled, and across multiple sites in the U.S.
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