How This Gut-Protective Bacteria Can Help Prevent And Treat Chronic Disease

Mark Hyman, MD

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Narrator: Coming up on this episode of the Doctor's Farmacy. Dr. Mark Hyman: If you have good levels of it, it's a link to weight loss, to improve insulin sensitivity, to lower inflammation, to better metabolic health, to less autoimmune disease, better cholesterol, and so forth. Welcome to Doctor's Farmacy, I'm Dr. Mark Hyman. That's pharmacy with an F. And today we're going to talk about something really important, which is your gut, again, because it's probably the most important thing you need to figure out to create a healthy life and to avoid so many of the chronic diseases that we suffer from. And today, the form of this podcast is in a health bite, little bits of health information that can help you optimize your health in small ways that make big changes over time. So let's dive in and talk about our gut. And we're going to talk about something really important today that you may not have heard about, which is a very special bacteria, that is the keystone bacteria in your gut that protects you from so many diseases, from inflammatory diseases like autoimmune disease, from cancer, from things like diabetes, obesity, metabolic health issues, cholesterol problems. I mean, it's quite amazing how the gut microbiome is connected to everything. And this particular bacteria is one of the most essential, and it's only been recently understood to be so important. And it's actually really important to know how to take care of this bacteria, how to grow this bacteria in your gut, and how to take extra of this bacteria if you do have certain problems. So your gut is important. We have maybe a hundred trillion cells in our gut, estimates between 10 and a hundred trillion. That's more than cells than we have in our human body. We have a hundred times as much bacteria than DNA, as our own DNA. And it regulates everything from basic stuff like just helping digest our food and creating vitamins to regulating our immune system, our brain function, and even our metabolism and weight. And they're essential for our long-term health. In fact, one of the hallmarks of aging is degradation in our microbiome. So I wrote about this in my book, Young Forever, but the idea is that the gut microbiome has to be taken care of. If you have a garden or if you have flowers or something, you have to know how to take care of them. And we have a whole garden inside of us that we've basically neglected. So we've had some real trouble with our microbiome over the last century because of the advent of antibiotics, the increasing over hygienic way we live and not exposure to microbes when we grow up and evolve and have to deal with them. And so many of us have really depleted microbiomes. We're born by C-section. We take too many antibiotics, we take steroids, hormones, anti-inflammatory drugs, acid blockers, the list goes on, environmental toxins. All these destroy our gut microbiome. So I personally have had an experience with this, actually twice. Once when I had mercury poisoning and my gut biome got canned from the mercury, and I developed problems with digestion, leaky gut, inflammation, and on and on. The next time was quite a bit later, not that long ago in 2017 when I ended up getting a really serious gut problem and it taught me a lot more than I already knew. And I thought I knew a lot as a functional medicine doctor. Most of my career has been focused on helping people optimize their gut function, but when my gut went ka-fluey, I had to rethink everything. And so what happened was I had a bad root canal and I had it taken out and it was infected. So I took an antibiotic according to the dentist recommendations, which I thought was okay. I mean, I don't really take antibiotics that often, but he was an integrative dentist so I thought if he's telling me it probably is a good idea. And it was a particular bacteria killing antibiotic that also does a lot of damage. It's called clindamycin, and it increases the risk of something called C. diff colitis or C. difficile, which kills 30,000 people a year. It's a very terrible gut infection. It's hard to treat. And that's what happened. And I also had mold in my house at the time, so my immune system was working overtime, and I had a horseback accident, broke my arm, and basically everything fell apart, ended up having a full-blown colitis after C. Diff. I ended up in the hospital, in and out. I was going to bathroom 20 times a day, bloody diarrhea, bloating, mucus, nausea, vomiting. I lost 25 pounds, which is a lot for me because I'm already pretty skinny. I couldn't really eat that much and I was in bed for most of the time. So I figured my brain wasn't working, I was doing my best, but I really started to dig in and say, what am I not learning? What am I not thinking about? How do I have to reimagine my own approach to my health? So I started to do some more investigation. I did stool testing, which I do in a lot of my patients. And I found that while the C. diff resolved, I still had this full-blown colitis and my gut microbiome was the worst. And trust me, I've seen probably, I don't know, 50,000 of these tests over my career or maybe more. I've seen more poop tests than probably anybody on the planet, and mine was one of the worst I'd ever seen. And one of the things that was really interesting was a very, very low level, actually non-existent level of a very important bacteria. The one I mentioned at the beginning. It's called akkermansia muciniphila, and it's a very special bacteria that is a mucus producing bacteria. That's why I call it muciniphila because of mucus, and it counts for about one to 5% of our entire microbiome. It's supposed to, but I had none. And I needed to do a full gut reboot and get out the bad guys, put in the good guys. So when I finally saw what the root was, was this sort of disturbance in this keystone species that was causing me to have an ongoing leaky gut, I really started to work on building my akkermansia levels up, and I'll explain how we did that in a minute. And I think I started digging into the research and I was just shocked at how much research there is on this particular bacteria and how it's so important across a whole spectrum of diseases and why if you have good levels of it, it's linked to weight loss, to improve insulin sensitivity, to lower inflammation, to better metabolic health, to less autoimmune disease, better cholesterol and so forth. So we're going to take a deep dive into akkermansia, hang in there because it's worth that, I promise. What role does it play in chronic disease prevention and what can you do personally to up your levels of akkermansia and keep your inner garden healthy? So how does it work? Well, akkermansia muciniphila feeds on mucin, which is this glycoprotein, basically a sugar protein that regulates the thickness of our gut's intestinal mucus layer. Now, the mucus layer is basically preventing you from having a leaky gut. Now, just imagine what's in your gut. There's all this bacteria, there's all this poop, there's all this food you put in there every day, all these foreign molecules, and your gut has to be a filter. Think of it like a coffee filter. It lets the right things in, but keeps the rest of the stuff out. So what happens is when that coffee filter gets holes in it, you get coffee grinds in your coffee. Well, that's not good. And those coffee grinds in your body are like the little proteins from bacteria, lipopolysaccharide toxins and food antigens that actually get absorbed into your bloodstream through the cells and in between the cells that actually cause inflammation and activate your immune system. Now, 60 to 70% of your immune system is in your gut. So that's because that's where you come into contact with the outside world and so it's the first line of defense. And when that lining is broken down, it leads to a whole host of chronic illnesses. Pretty much everything you can imagine, including mental health issues, autoimmune diseases, allergies, asthma, depression, as I mentioned, Alzheimer's, cancer, diabetes, heart disease, and the list goes on. So it's really, really important. Now, the akkermansia produces something called acetate and propionate and other short chain fatty acids, and they feed the other gut bacteria to make a really important short chain fat, which is butyrate. Now, butyrate is a really key source of energy for the intestinal cells and for the epithelial cells. So you basically are using the akkermansia to feed the gut lining and keep it in integrity 'cause it needs a lot of energy to keep the cells together. They're stuck together like Legos and when those junctions are like... They're called tight junctions, but those junctions are held together on an energy dependent basis. And when you are not having enough energy in your gut from the butyrate, 'cause your body runs on glucose or it can run on fat, but the intestinal cells run on short chain fatty acids or butyrate, that's like the fuel. And when those tight junctions come apart, that's when the food and bacterial proteins leak in and it creates a huge problem. So when you have short chain fatty acids at the right level, and we measure short chain fatty acids, we don't just measure bacteria. So when I do a stool test, it's not just measuring the microbiome and there's a lot of microbiome tests out there, but they don't test the full spectrum of things you want to look at, which is not just what's the microbiome, but what are the byproducts of the microbiome? How are those being produced at the levels that you need to actually create health? And one of the byproducts is actually the short chain fats. So these short chain fatty acids help strengthen the tight junctions. This is little glue that holds our cells together. It's only one cell thick. So imagine you're one cell thick layer away from a sewer all the time, and if that cell layer breaks down, you're screwed. So you want to let the good stuff in and keep the bad stuff out. And the bad stuff is food allergens, endotoxins, poop, fecal matter, food particles. And the good stuff is all the vitamins, minerals, macronutrients, amino acids, sugars, fatty acids that you need to absorb to run your body. All the phytochemicals, all that stuff is good. You want that in, but you want to keep the bad stuff out. Now, when the bad stuff's sort of getting through, you get this thing called increased intestinal permeability or leaky gut. Now, people used to laugh at me, specifically doctors when I used to talk about leaky gut 20 or 30 years ago. Now if you Google it or go on PubMed, the National Library of Medicine, there's thousands and thousands of articles, and now there's even the word dysbiosis in the medical literature. So I think we've come a long way, but this leaking gut phenomena is at the root cause of so many chronic diseases, and it creates the immune system to go haywire to create an inflammation, both in things that we are familiar with, like allergies and asthma, autoimmune diseases, but also things that are maybe surprising. Like most of the chronic diseases that we see associated with aging, heart disease, diabetes, cancer, dementia, they're all inflammatory diseases. It's not just autoimmune diseases or asthma or allergies that are connected to inflammation. It's all the chronic diseases have this chronic, silent, hidden inflammation. And so that's what your gut does, is it protects you against this hidden inflammation. And when your gut's leaky, you end up creating more of this systemic inflammation. So we're learning lots more about akkermansia every day. The research is exploding, but reading the research, talking with my colleagues, working with patients, I've consistently seen that higher akkermansia levels are linked to better metabolic health, better gut function, better immune health. And understanding akkermansia, identifying deficiencies, fertilizing the akkermansia, taking akkermansia probiotics can be really critical in treating chronic disease and increasing your levels in your gut using the power of food. And this can really be powerful. So I think getting a healthy microbiome is really important in order for you to have a healthy weight, to have a healthy immune system and to live a long, healthy life. So let's get into the specifics. What role does akkermansia play in chronic disease prevention? Well, it's very effective in chronic disease prevention and even treatment because the short chain fatty acid metabolites that akkermansia produces feeds the intestinal cells, strengthens the gut barrier. It prevents these unwanted materials like food antigens and bacterial toxins from passing through your gut and activating and pissing off your immune system. And as a result, you get lower levels of inflammation in your body and a better balance of your immune system. Now, what are the things that we know are connected to an activated immune system? Obesity. And most people think, oh wait, you mean obese or overweight? Is that an inflammatory condition? But it absolutely is. If you're overweight, you're inflamed. Why did COVID kill more people with obesity and metabolic issues like diabetes? Because those people are pre-inflamed. So when something like COVID hits, it's like putting a match on gasoline and boom, your immune system goes crazy and you end up with a cytokine storm. And that's really what killed so many people from COVID. But we're in trouble because 75% of Americans are overweight, 42% are obese, and 93% are metabolically unhealthy, which means they have some degree, even if they're not overweight, between 75 and 93, there's about a 20 point spread. Those 20% of people are not necessarily overweight, but they're under lean and over fat, and so they look skinny, but they are fat inside and they're metabolically like someone who's diabetic or over or obese, even though they're thin. And that person is also pre-inflamed. So when you look at obesity, it's just killing us for so many reasons, but when we eat processed food, which is what drives us to gain weight, ultra processed food, refined carbs, sugars, and so forth, it doesn't do a good job on our gut bug. It basically destroys our microbiome. Even for example, food additives like emulsifier, sticker nerves, [inaudible 00:13:43] and [inaudible 00:13:44] gums and other things, they actually are damaging to the gut lining and they cause a leaky gut. So one study, for example, found that obese adults who had higher akkermansia levels had healthier metabolic status and better clinical outcomes like blood sugar, body fat distribution, insulin sensitivity after six weeks of calorie restriction than those with lower akkermansia levels. So in other words, if you had high akkermansia levels, your metabolic health got better as you tried to lose weight. Also, it had a better effect on lowering things you wouldn't even think. How does taking something that increases akkermansia also lower cholesterol and improve weight loss and lower tissue inflammation and help insulin resistance? So basically it's pretty impressive. So you basically get this powerful change in your metabolic health of cholesterol, blood sugar, weight, insulin sensitivity simply by having higher levels of akkermansia. What about type 2 diabetes? Well, it has a great effect on blood sugar. Another study found that type 2 diabetics who had a hard time keeping their A1C under control despite being on diabetes medication, had far less akkermansia than diabetics who were responding to medications. And it was interesting is actually metformin, which is one of the diabetes drugs that is now being looked at for longevity, some of it's anti-diabetic action could be the upregulation of certain intestinal cells, the goblet cells that thicken the mucosal layer in the gut and promote a healthy barrier and provide this anti-inflammatory effect like akkermansia. So one of the ways that metformin may work is by actually helping the microbiome, which is very fascinating. Metabolic health, just in terms of metabolic syndrome, which is pre-diabetes. So we've got obesity, diabetes, and pre-diabetes. And that metabolic syndrome is basically what 93% of Americans are suffering from to some degree or another, some level of insulin resistance, obesity, cholesterol issues, high blood pressure, these all increase your risk of heart disease, diabetes, and stroke. Even if you don't get diabetes, even if you don't have a full-blown diabetes, this is still highly dangerous for you. There was actually an interventional study, which is in other words, not just saying, oh, did people have akkermansia or not? But actually they gave akkermansia supplements to obese, overweight adults with insulin resistance for three months, and they saw improvements in insulin sensitivity, fasting insulin levels, total cholesterol. It also helped them drop body weight, drop fat mass, get their hips to get smaller, so hips circumference strength, your liver got better and other inflammatory markers got better. So that's pretty impressive when you think about it. I mean, taking a probiotic helps you lose weight, but actually it does. In fact, they've done studies where they've taken poop, basically done fecal transplants from people who are thin and healthy into people who are diabetic and their diabetes gets better, which is crazy, just by doing a poop transplant. That doesn't sound as much fun as taking a probiotic. And so this is a very safe and effective treatment. It can help you predict against cardiometabolic diseases and heart disease and so forth. What about your brain? Your brain also is really important when it comes to your overall health and your gut plays a big role in your brain health. If you see the data on Alzheimer's, for example, we see low levels of akkermansia in those people. Is it a coincidence? I don't know. I don't think so because now we're calling Alzheimer's type 3 diabetes. It's insulin resistance in the brain for many people. And you see inflammation, you see insulin resistance. You see you got dysbiosis in people with Alzheimer's. And in mouse studies, they found the lower your akkermansia was, the higher your amyloid beta plaques are, which is what's characteristic of Alzheimer's disease. That's a sign of inflammation in the brain. So lower bacteria that are healthy, worse brain health. I think it's important to think about how you take care of your gut to also take care of your brain. What about cancer? Well, cancer is another one that's kind of interesting. It shows when you look at certain immunotherapies, like the checkpoint inhibitors that have been used that are really a new advance in cancer, they don't work uniformly across all patients. And it's unclear why some patients don't respond dramatically and when their cancer will be cured in weeks, others just don't respond. And it turns out that akkermansia might be part of the answer. When they looked at lung and kidney cancer patients, those who had an abundance of akkermansia responded really well to immunotherapy than people who had taken antibiotics, for example, in the past. What they also did to double check their studies, the researchers transplanted the stool of patients with lots of akkermansia to antibiotic treated mice and found that the effectiveness of immunotherapy and treatment and positive outcomes was just as good. In other words, when they took mice with low akkermansia and they took a fecal transplant with akkermansia and put it in those mice, they actually did better and responded better to the cancer therapies. There's a friend of mine, William Lee, who's been on the podcast whose mother had uterine cancer. She wasn't responding to immunotherapy. Dr. Lee knew about akkermansia and he did a stool test, found she had low akkermansia and gave her all the foods that helped to grow. You can fertilize akkermansia with the right foods. And she ended up doing that, built her akkermansia up, and then responded to the immunotherapy and was completely cured from stage four uterine cancer. That's a pretty dramatic story, and I think there are many, many cases like that where we actually treat the gut to treat the cancer. What about irritable bowel? Well, yeah, inflammatory bowel for sure. These are all diseases of inflammation in the gut. And when you look at this phenomenon we call gut dysbiosis or imbalances in the microbiome, the ecosystem in the gut, it's pretty much involved in the development of almost every chronic disease. But people with inflammatory bowel disease, like me, I had it. Now I don't have anything. I'm fine, perfect, by the way. I think most people with inflammatory bowel disease or autoimmune disease typically are told that this is a lifetime condition that we can manage it, but you might need to be on medication your whole life. I think it's just a whole fallacy. I can't tell you how many people with ulcerative colitis I've helped who were about to get their entire colon removed. That's one of the treatments for colitis when nothing else works. When they've taken all the drugs and nothing else works, they're told they have to get their entire colon removed and have a bag or basically have their stomach connected to their small intestine. And it creates a really miserable life for people. I mean, it saves their life, but it's still pretty miserable. And what I've done over and over again is people who are about to have these treatments and surgeries, I use a functional medicine approach, build up their gut microbiome, get rid of the things that are bothering their gut, do a whole gut reset, which we've talked about on the podcast called the 5R program and these people get better. And one was a young woman who was 32 years old, she was referred to me by someone who was a friend of the Cleveland Clinic. And she was kind of skeptical, but she didn't really want to have her colon removed, so she was willing to try what I said. And after I reset her gut and six weeks later we had our follow-up call and she said, "Well, I'm all better. I really didn't believe what you were telling me, but I tried it and now my symptoms are all gone and I'm off of medications and I feel great." And I just checked on her after three or four years and she's still doing great. So I think we really need to rethink our whole approach. Anyway, getting back to inflammatory bowel disease, I think people with these diseases have some of the worst microbiomes on the planet, including the one I had. And so the question is, can we use akkermansia as part of the treatment? Well, one study they administered fecal transplants from healthy donors to people with irritable bowel, and they found an increased diversity of bacteria species and a lower level of abdominal pain and bloating, the more akkermansia they had. So the higher the akkermansia, the less irritable bowel symptoms. Another study looked at how we could protect ourselves against ulcerative colitis by using akkermansia. So researchers found that when they had mice models or mouse models of colitis, they found improvement in weight loss and improvement in the barrier function, so less intestinal permeability and leaky gut, fewer inflammatory molecules than in the group that was a controlled group. So really important stuff. This is a really important bacteria. This is just one of many, many bacteria, obviously, but it's at what we call a keystone species. So it's critical to measure, to understand and to treat if you have a problem. So one of the best ways to increase your akkermansia is to feed it the right stuff. And it loves polyphenols, it loves certain plant foods, but just generally having more prebiotics and probiotic foods in your diet and particularly polyphenols are really important. So polyphenols, what are those? Those are these phytochemicals and plants and akkermansia loves, for example, something called ellagic acid, which is prevalent in berries and nuts. It also love catechins from green tea, tannins from green tea, but what are the foods that naturally increase? This is what I did personally. There wasn't an akkermansia probiotic, which there is now in the market from Pendulum Therapeutics, but I actually couldn't get it because didn't exist at the time when I had this. It was very hard to grow. And by the way, we've had folks talking about akkermansia on Instagram lives, but it also increases GABA. Secretion of the akkermansia bacteria produces a metabolite called GABA, which is like a natural Valium, so it has a lot of benefits. But when I had to fix my akkermansia, I made sure I use things like pomegranate cranberries, green tea, also other berries like raspberries, blackberries, berries, apples, walnuts, pecans, grapes. All these things can help to fuel the growth of the akkermansia, it's like feeding them the food they like. So you have to culture them literally and you can do that. Until really recently, like I said, there's been no probiotics out there that you can buy and take, but now there is one, and it's called Pendulum Therapeutics. And they have straight akkermansia. They have ones with the other combinations of things, glucose control one, and it's now available in capsule or powder form. And it's just incredible way to support your health, and I take it regularly. So encourage people to learn about their gut, to fix their gut, to understand how to not do the bad things for your gut and do the good things for your gut and actually help your akkermansia grow. We all have to learn how to tend to our inner garden, and hopefully this has been a helpful health bite for you because it saved my life knowing about this one. Be sure to share this podcast with your friends and family on social media. Leave a comment, have you helped your own gut? Have you heard about akkermansia? Have you used it? What has been your experience? And we'll see you next time on the Doctor's Farmacy. Narrator: Hi everyone. I hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their Find a Practitioner database. It's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health.