“All disease begins in the gut,” is one of the many maxims attributed to Hippocrates, the Father of Medicine, nearly 2,500 years ago. He was onto something.
We now know that poor gut health is associated with many diseases, including diabetes. For decades, the focus in type 2 diabetes and digestive problems has been on neuropathy—nerve damage that can cause pain, bloating, diarrhea, constipation, and other digestive issues.
More recent research, however, is looking at it from a different angle. Rather than asking how diabetes affects the digestive system, scientists are exploring how the digestive system affects the risk and progression of diabetes.
Gut Microbiome & Diabetes
The linchpin between your gut health and diabetes isn’t your nerves or even the digestive tract, per se. Rather, it’s the gut microbiome—the trillions of bacteria, fungi, viruses, and other microorganisms that live in the intestines.
The gut microbiome (also called gut microbiota or gut flora) is involved in much more than digestion and elimination, impacting:
- Fermentation of carbohydrates and production of short-chain fatty acids that are used for energy.
- Synthesis of nutrients such as vitamins B12 and K.
- Conversion of toxins into safer compounds that can be excreted.
- Maintenance of the integrity of the intestinal barrier and reduction of leaky gut.
- Protection against pathogens and infections.
- Development, function, and “training” of the immune system.
- Production of substances that communicate with the brain and affect mood and appetite.
Given all these varying functions, you can see why gut dysbiosis (imbalances and disruptions in the microbiome) plays a role in your susceptibility to everything from infections and allergies, to depression, anxiety, obesity, and diabetes.
The Obesity Connection
The greatest risk factor for type 2 diabetes is obesity. Poor diet and inactivity are the primary causes, but did you know alterations in gut flora can also influence your weight?
Distinctive differences have been documented in the gut microbiota of lean versus obese individuals. Obese people tend to have higher ratios of bacteria that efficiently metabolize carbohydrates and produce short-chain fatty acids—which, if not used for energy, are stored as fat.
Plus, there is a great deal of biochemical “crosstalk” between your gut and brain. The microbes in your gut trigger nerve signals to the brain that affect taste receptors, food cravings, and “feel-good” reward behaviors. In other words, your gut bacteria influence what, when, and how much you eat.
Gut Health & Blood Sugar
An imbalance of gut flora also affects your blood sugar in more direct ways. Connections between imbalanced gut microbiota and type 2 diabetes include:
- Inflammation: Leaky gut (intestinal permeability) allows toxins, microbes, and partially digested food to escape the intestinal barrier and enter the bloodstream. This triggers an immune response that results in systemic inflammation and contributes to chronic diseases, including diabetes and obesity.
- Insulin sensitivity: Gut dysbiosis modifies metabolic pathways that are related to insulin resistance in the liver, muscles, and other organs and tissues throughout the body.
- Glucose metabolism: Microbial imbalances affect the release of bile acids, gut hormones such as incretin, and other compounds that influence glucose metabolism and blood sugar levels.
Our scientific understanding of these complex processes is still unfolding, but it leads to an obvious question. What can you do to support your gut health, improve blood sugar control, and protect against diabetes?
How to Support Gut Health
Everybody knows that antibiotics disrupt the gut microbiome, but lifestyle factors such as inactivity, inadequate sleep, stress—and especially poor diet—also take a toll.
Artificial sweeteners have particularly harmful effects—including encouraging the growth of bacteria associated with weight gain and elevated blood sugar. Therefore, they can actually contribute to the very conditions they’re supposed to be helping!
An unprocessed, whole-foods diet, on the other hand, nurtures healthy gut flora. Such a diet will naturally include lots of fiber, which has been shown to not only boost microbial diversity and balance but also lower blood sugar. All fiber-rich foods are great, but try to squeeze in some raw onions, garlic, asparagus, jicama, and artichokes. These foods are good sources of prebiotics, a type of fiber that promotes the growth of beneficial gut bacteria.
Fermented foods like yogurt, kefir, kombucha, and unheated sauerkraut and kimchi are also recommended because they contain probiotics—live, active bacteria and other microorganisms that help balance and diversify the gut microbiota.
Probiotics & Berberine Can Help with Diabetes & Gut Health
For extra protection, take supplemental probiotics. Probiotics are a given for digestive and immune disorders, but for all the above reasons, I also recommend them if you are dealing with diabetes, prediabetes, and/or weight problems.
I want to mention berberine as well. When I first started using this botanical extract for my patients with diabetes 10 years ago—with incredibly positive results for lowering blood sugar—we knew that it activated an enzyme called AMPK that helps regulate glucose and fatty acid metabolism.
Since then, research on berberine has grown by leaps and bounds, and we now know that it also exerts its beneficial effects via the gut microbiome. This goes a long way towards explaining the wide breadth of berberine’s therapeutic uses, which include reducing cholesterol and triglycerides, lowering blood pressure, improving fatty liver disease, treating intestinal disorders, and facilitating weight loss.
This new understanding of the microbiome-diabetes connection has increased my enthusiasm for probiotics and berberine. If you have diabetes or are among the one in three US adults with prediabetes, consider adding these supplements—along with diet and lifestyle changes that support gut health—to your daily regimen.
- Probiotics: Look for a supplement with Bifidobacterium and Lactobacillus and at least 2 billion CFUs (colony-forming units, the guaranteed number of viable microorganisms). If it contains prebiotics such as fructo-oligosaccharides (FOS) or inulin, which boost the activity of probiotics, so much the better.
- Berberine: The suggested daily dose of berberine for diabetes is 500 mg three times a day, taken before each meal. A dose of 500 mg once or twice a day may be sufficient for prediabetes or general support.