The Digest

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 its 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 Type 2 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 (e.g. yogurt, kefir, sauerkraut) and supplements (e.g. Pendulum Glucose Control; Pendulum Akkermansia, and Butyricum) 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 gut health.

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.

This can result 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 diabetes^1,2,3.

The human gut microbiome is home to a thriving ecosystem of trillions of microorganisms—each of which are always competing or cooperating with one another to secure food, space, and survival. 
 
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 feeds on dietary fiber—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. ^4,5, ^6,

Research suggests there are multiple ways in which a healthy gut microbiome may protect us from Type 2 diabetes. 

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.

Exactly why there is a decrease in beneficial bacteria as Type 2 diabetes develops is unclear. However, 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-sugar levels. 

What are probiotics?

A probiotic is a live microorganism (typically bacteria) naturally found in the human body that 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

Many researchers have studied if (and how) probiotics may help people with Type 2 diabetes, and have found mixed results^{13,14,15,16,17}.

The gut microbiome is home to many different bacterial species and there are likely more that we have not yet discovered.¹⁸

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. 

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 diabetes^2,19.

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
• Anaerobutyricum hallii
• Lactobacillus rhamnosus
• Lactobacillus paracasei
• Lactobacillus plantarum
• Streptococcus thermophilus⁷ 

It’s worth noting though that only the folllowing have been clinically-shown to reduce A1c and after-meal blood-sugar levels in people with Type 2 diabetes who were also taking metformin when administered via a probiotic: 

• Bifidobacterium infantis
• Akkermansia muciniphila
• Clostridium beijerinckii
• Clostridium butyricum, and
• Anaerobutyricum hallii 

Through a combination of DNA testing, in vitro studies, rodent models, and a clinical trial, these bacteria have been shown to help manage blood-sugar levels. 

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. 

Only probiotics with scientific and clinical rigor can make these types of claims.

Pendulum Glucose Control is only medical probiotic available that has demonstrated clinical efficacy for the dietary management of Type 2 diabetes in people taking metformin.

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.

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 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 diabetes^{1,2,3,12,13,14}.

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 

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.

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