Getting To Know Your Gut Bugs: Akkermansia Muciniphila

Our gut bacteria regulate many of our bodily functions, from creating vitamins to regulating our immune system, our brain function, and of course, our metabolism and weight. They are critical to our long-term health.

As a Functional Medicine doctor, I’ve been trained to always look to the gut first. Most of our modern ailments can be traced back to poor gut function. However, it wasn’t until 2017 when I got really sick that I truly understood what it meant to cultivate a healthy gut microbiome.

It was the combination of antibiotic use after a tooth infection, mold exposure, and a horseback riding accident that led to the most challenging months of my life. I had bloody diarrhea throughout the day with full-blown colitis. I lost 25 pounds (which is frightening considering how lean I am). I couldn’t stomach most foods and I was bedridden for months.

It was around this time that I did a deep dive into my own health, starting with all of the basics of Functional Medicine, including stool testing. I discovered that I had some gut infections and really low levels of beneficial bacteria. One of them was Akkermansia muciniphila, a mucus-loving bacteria that accounts for 1-5% of our gut microbiome (1)(2)—or at least it’s supposed to! I had virtually none, so I knew that it was time to do a complete gut overhaul, starting with removing the bad guys and building up the good guys.

Lactobacillus and bifidobacterium are considered the superstars (or should I say, “superbugs”?) of gut microbiome research because their abundance is linked to better health outcomes and less risk of chronic diseases like obesity, Alzheimer’s disease, type 2 diabetes, and cancer.

However, emerging research shows promise for Akkermansia as the next generation of beneficial gut microbes. Increasing my Akkermansia levels was a key part of restoring my gut function and getting my health back on track.

We are on the cusp of an explosion in Akkermansia research, which I’m personally very excited about. It’s been linked to positive health outcomes like weight loss, improved insulin resistance, lower inflammation, and more(3)(4)(5).

What is Akkermansia and how does it work?

Named after its preferred energy source, Akkermansia muciniphila feeds on mucin, a glycoprotein that regulates the thickness of our gut’s intestinal mucosal layer (6). As a byproduct of munching on mucin, Akkermansia produces propionate and acetate, two short-chain fatty acids (SCFAs) that feed other beneficial gut bacteria to make butyrate, a SCFA and vital energy source for mucus-secreting goblet cells and intestinal epithelial cells. Scientists call this cross-feeding.

SCFAs strengthen tight junctions (the glue that holds our intestinal cells together) and prevent unwanted materials from passing through and into circulation. Think of your gut lining as a coffee filter, it lets the good stuff (coffee) in and keeps the bad stuff (coffee grinds) out. Here, the “bad stuff” represents allergens, endotoxins, fecal matter, and food particles, and the “good stuff” represents macro and micronutrients from real whole foods.

When bad stuff is getting through, we see what’s called intestinal hyperpermeability or “leaky gut”—the root cause of so many chronic diseases. Having a leaky gut causes the immune system to go haywire and become hypersensitive, constantly reacting to antigens (foreign proteins from food and bacteria) that enter the bloodstream unannounced.

We are learning more every day about how Akkermansia works. Through my own experience, working with patients, talking with colleagues, and reading the research, I’ve seen that higher Akkermansia levels are linked to better metabolic health, gut function, and immune health in most people (8); however, many are deficient or have undetectable levels.

Akkermansia can play a pivotal role in treating chronic disease, and you can increase your levels naturally (using the power of real food!) for a healthy and balanced gut microbiome.

Akkermansia in Chronic Disease

Your intestinal epithelial cells are the only thing separating your immune system (and body) from what’s going on inside your gut. Poor diet and lifestyle choices, antibiotics, and stress can damage these cells and create a leaky gut.

This is why Akkermansia is effective in chronic disease prevention and treatment. Its SCFA metabolites feed intestinal cells and therefore strengthen the gut barrier to prevent unwanted materials from passing through. As a result, this leads to the production of anti-inflammatory molecules and reduced inflammation (2)(3)(7).

Most Akkermansia studies have been on animals, but studies show that high levels of Akkermansia are also consistent with positive health outcomes in humans. However, there are some instances where Akkermansia needs further research, like in certain autoimmune conditions.

Obesity

There is an epidemic of obesity in our country, which is now even trickling into remote parts of the world who are eating a Westernized diet. Processed foods rob us of our health in multiple ways, one of which is by destroying our good gut bugs.

I think it makes sense, then, that Akkermansia is inversely correlated with body weight and BMI in human and animal studies (4).

One study found that obese adults who had higher Akkermansia levels had healthier metabolic status and better clinical outcomes (fasting blood sugar, body fat distribution, and insulin sensitivity) after 6-weeks of calorie restriction compared to those with lower Akkermansia levels (9).

Increasing Akkermansia has also demonstrated effectiveness at lowering blood lipid levels, weight loss, adipose tissue inflammation, and insulin resistance in mice (4)(10)(11).

Type 2 Diabetes

Yet another epidemic, type 2 diabetes used to be reserved for adults but now affects all age groups. During the COVID-19 pandemic, rates of type 2 diabetes in children actually doubled (12). Once again, a poor diet rich in processed foods that are high in refined carbohydrates and sugar is to blame.

Akkermansia may be a useful adjunct for treating type 2 diabetes. There is evidence that it has a beneficial effect on blood sugar in type 2 diabetics (13).

A study found that type 2 diabetics who had a hard time keeping their HbA1c under control despite being on diabetes medications had significantly less Akkermansia than diabetics who responded well to medications (14).

Interestingly enough, Metformin’s antidiabetic action could be due to its upregulation of goblet cells that thicken the mucosal layer, promote gut barrier function, and provide an anti-inflammatory effect, similar to Akkermansia (15).

Metabolic Syndrome

Metabolic syndrome is classified as a cluster of symptoms (insulin resistance, obesity, dyslipidemia, and hypertension) that increase your risk for heart disease, type 2 diabetes, and stroke.

The first Akkermansia interventional study in humans gave overweight/obese adults with insulin resistance daily pasteurized Akkermansia supplements for three months and saw significant improvements in insulin sensitivity, fasting insulin levels, and total cholesterol. It also decreased bodyweight, fat mass, hip circumference, improved liver function, and inflammatory markers (16).

These results demonstrate that Akkermansia is a safe and effective treatment strategy for protecting against cardiovascular and metabolic disease.

Alzheimer’s Disease

Similar to obesity and type 2 diabetes, Akkermansia levels are also low in Alzheimer’s disease—coincidence? I don’t think so! These metabolic disorders often go hand-in-hand and share many similarities (insulin resistance, inflammation, gut dysbiosis) (17).

Mouse studies report a negative relationship between Akkermansia and amyloid-beta plaques, a characteristic of Alzheimer’s disease (10)(18)(19).

Cancer

Research shows that Akkermansia may help improve the outcome of certain cancer immunotherapies (20)(21).

In a study of lung and kidney cancer patients, those with a relative abundance of Akkermansia had a better response to immunotherapy than patients who took antibiotics (20).

To confirm this, researchers transplanted the stool of patients with abundant Akkermansia to antibiotic-treated mice and found that the effectiveness of immunotherapy treatment and positive outcomes remained true (20).

Autoimmunity

The research of Akkermansia in autoimmunity is mixed with some studies reporting lower levels present in conditions like rheumatoid arthritis (22), psoriasis (23)(24), and type 1 diabetes (25) and others reporting higher levels in conditions like eczema and multiple sclerosis (22)(26)(27).

The reason why Akkermansia levels might be higher in certain autoimmune conditions could be due to it overeating the intestinal mucosal layer, which in turn creates a leaky gut (26). However, this link is largely based on observational evidence and doesn’t consider all factors that come into play in autoimmunity like heavy metal exposure, bacterial infections, food allergies and sensitivities, pathogens, antibiotics, genetics, stress, and so much more.

In my clinical practice where I’ve seen thousands of autoimmune patients, as well as in my own battle with autoimmune disease, increasing Akkermansia was pivotal in restoring my patient’s health, as well as my own.

It’s important to recognize there’s no “one-microbe-fits-all” approach when it comes to fixing the gut—it’s never that simple! Although Akkermansia is an important piece, we must consider the whole picture—the interplay of bacteria that make up our gut microbiome as well as the environment, diet, and lifestyle of the individual.

Irritable Bowel Disease (IBD)

Gut dysbiosis is involved in the development of almost every chronic disease, but IBD patients have some of the worst imbalances in their gut microbiome. Not surprisingly, there may also be a place for Akkermansia in the clinical treatment of IBS.

One study administered fecal transplants from healthy donors to patients with IBS and found increased diversity of bacteria species and a reduction in abdominal pain inversely related to Akkermansia abundance (28).

Another study demonstrated protection against ulcerative colitis in mice administered Akkermansia. Researchers found improvement in colitis-induced weight loss, enhanced gut barrier function, and fewer inflammatory molecules than the control group (29).

How do you increase Akkermansia?

One of the best ways to increase your levels naturally is by eating plenty of plant foods that contain prebiotics and polyphenols to feed and grow those good bugs.

We can’t break down the prebiotic fibers in plant foods, so the good bacteria in our guts do it for us. They benefit from having a fiber feast and we benefit from the SCFA gut-strengthening metabolites they produce. Plant foods also contain polyphenols, the phytochemicals that give fruits and vegetables their beautiful and vibrant colors. Polyphenols protect plants from predators and protect us from disease by upregulating our body’s natural antioxidant system and optimizing our gut flora.

Akkermansia loves ellagic acid, a polyphenol prevalent in berries and some nuts (29). It also loves catechins and tannins from green tea (31). Here’s a list of foods that naturally increase Akkermansia levels (8)(30-32):

  • Pomegranates
  • Cranberries
  • Raspberries
  • Blackberries
  • Blueberries
  • Strawberries
  • Grapes
  • Apples
  • Walnuts
  • Pecans

Increasing my Akkermansia levels was a key part of my health journey. It helped me repair my leaky gut and detoxify from heavy metals. Here’s a look at the gut repair shake I drank daily to increase my Akkermansia.

My Akkermansia Gut Repair Shake

  • 1 scoop ImmunoG PRP by NuMedica or SBI Protect (dairy-free) by Orthomolecular Products (bovine immunoglobulins aka colostrum)
  • 1 scoop acacia fiber (a prebiotic)
  • 1 tablespoon pomegranate concentrate (I use Lakewood organic)
  • 1 tablespoon cranberry concentrate (I use Lakewood organic)
  • 1 teaspoon matcha green tea powder (I use Navitas)
  • 1 stick ProbioMax 350 DF by Xymogen (or your favorite high-potency probiotic)
  • 1 scoop collagen powder

Are there any risks of Akkermansia?

There are a few observational studies that show higher levels of Akkermansia in certain autoimmune diseases like MS, whereas other studies indicate lower levels. As stated before, we can’t draw definitive conclusions based on observational evidence because there are too many variables at play that can affect the outcome.

However, the one randomized controlled trial we have on Akkermansia in humans found that it was safe, well-tolerated, and effective at improving metabolic parameters like insulin sensitivity, inflammation, total cholesterol, body weight, and fat mass compared to the control group (16).

What’s the takeaway?

Based on my personal experience, the current research, and the clinical evidence I’ve gathered from working with patients, it’s clear that Akkermansia is an important member of our gut microbiota’s ecosystem by strengthening our gut barrier. A strong intestinal barrier is critical for restoring gut health (take it from me) and a cornerstone for chronic disease prevention and optimal health and longevity.

Give my Gut Repair Shake a try in addition to incorporating the above foods into your daily diet and see if you notice any benefits from increasing your Akkermansia levels. In doing so, you’re not only supporting your gut health, but you’re also helping lower your risk and severity of chronic diseases like obesity, type 2 diabetes, metabolic syndrome, IBS, cancer, and certain autoimmune conditions.

Up until now, there haven’t been any probiotic products that actually provide Akkermansia, but a new one that got my attention is from a company called Pendulum. It’s a simple but powerful blend of Akkermansia and prebiotic inulin that is available in capsule or powder form. You can check it out here.

 

References:

  1. Zhou K. Strategies to promote abundance of Akkermansia muciniphila, an emerging probiotics in the gut, evidence from dietary intervention studies. J Funct Foods. 2017;33:194-201. doi:10.1016/j.jff.2017.03.045
  2. Naito Y, Uchiyama K, Takagi T. A next-generation beneficial microbe: Akkermansia muciniphila. J Clin Biochem Nutr. 2018;63(1):33-35. doi:10.3164/jcbn.18-57
  3. Zhang L, Qin Q, Liu M, Zhang X, He F, Wang G. Akkermansia muciniphila can reduce the damage of gluco/lipotoxicity, oxidative stress and inflammation, and normalize intestine microbiota in streptozotocin-induced diabetic rats. Pathog Dis. 2018;76(4):10.1093/femspd/fty028. doi:10.1093/femspd/fty028
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  12. https://www.medscape.com/viewarticle/953816?src=WNL_mdpls_210702_mscpedit_wir&uac=401132CJ&spon=17&impID=3482285&faf=1
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  28. Cruz-Aguliar RM, Wantia N, Clavel T, et al. An Open-Labeled Study on Fecal Microbiota Transfer in Irritable Bowel Syndrome Patients Reveals Improvement in Abdominal Pain Associated with the Relative Abundance of Akkermansia Muciniphila. Digestion. 2019;100(2):127-138. doi:10.1159/000494252
  29. Bian X, Wu W, Yang L, et al. Administration of Akkermansia muciniphila Ameliorates Dextran Sulfate Sodium-Induced Ulcerative Colitis in Mice. Front Microbiol. 2019;10:2259. Published 2019 Oct 1. doi:10.3389/fmicb.2019.02259
  30. Evtyugin DD, Magina S, Evtuguin DV. Recent Advances in the Production and Applications of Ellagic Acid and Its Derivatives. A Review. Molecules. 2020;25(12):2745. Published 2020 Jun 13. doi:10.3390/molecules25122745
  31. Jeong HW, Kim JK, Kim AY, et al. Green Tea Encourages Growth of Akkermansia muciniphila. J Med Food. 2020;23(8):841-851. doi:10.1089/jmf.2019.4662
  32. Garcia-Mazcorro JF, Pedreschi R, Yuan J, et al. Apple consumption is associated with a distinctive microbiota, proteomics and metabolomics profile in the gut of Dawley Sprague rats fed a high-fat diet. PLoS One. 2019;14(3):e0212586. Published 2019 Mar 14. doi:10.1371/journal.pone.0212586

Wishing you health and happiness,
Mark Hyman, MD
Mark Hyman, MD

Host

Mark Hyman, MD

Mark Hyman, MD is the Founder and Director of The UltraWellness Center, the Head of Strategy and Innovation of Cleveland Clinic's Center for Functional Medicine, and a 13-time New York Times Bestselling author.

If you are looking for personalized medical support, we highly recommend contacting Dr. Hyman’s UltraWellness Center in Lenox, Massachusetts today.


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If you are looking for personalized medical support, we highly recommend contacting Dr. Hyman’s UltraWellness Center in Lenox, Massachusetts today.

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