Ask the Expert: "What is the connection between COVID-19, diabetes and the microbiome?"
In our new Ask the Expert series, we're sitting down with renowned science and medical professionals to get their insights into how to stay healthy.
In our first edition of Ask the Expert, Pendulum CEO and Co-Founder Colleen Cutcliffe chatted with Dr. Beverly Yates, a Doctor of Naturopathic Medicine whose area of specialty is helping women manage their blood sugar levels, reduce stress and improve sleep.
Watch their full conversation or read key quotes from their discussion below.
Why is diabetes something that you care about?Diabetes has become a worldwide crisis. The increase in the incidence of type 2 diabetes around the world is stunning and in my mind, one of the few chronic illnesses that has had a collective increase both here in the United States and in other countries around the world that we can actually do something about to put a stop to it, reverse it and make it much better. To do that we will have to address the causes, not just treat the symptoms of diabetes.
What are common questions she receives from patients who come asking about how to manage blood sugar? What is your general advice?
By the time people come to me they are typically terrified and confused. That’s never a good combination. I always tell people, let’s find what your secret sauce is going to be and let’s plant our flag on that one thing. I don’t want people to be even more overwhelmed. When people are overwhelmed, they don’t do anything and they just get worse. In our initial consultation we discuss, what’s the place to start for you. Is it nutrition? Is it sleep? Sleep can absolutely mess up your blood sugar. Is it stress? Stress might be the place to start for some people. Stress might be the on ramp for some people with type 2 diabetes. We pick one based on their symptoms. For people with high blood sugar, we’re going to work on your A1C and your fasting blood glucose.
How is diabetes linked to the microbiome and our immune system?When it comes to the microbiome and blood sugar there’s a lot of signaling and regulation that goes back and forth. This has a big impact on the immune system as well as the blood sugar numbers people have. Sometimes people make what they think are healthy changes, but if they haven’t been able to improve their gut microbiome and make it a healthier, more metabolically active and friendly microbiome, they won’t have the success that they’re looking for with getting better blood sugar control and getting their blood sugar numbers to go down, especially their A1C along with their fasting blood sugar.
What can a person with type 2 diabetes do right now to bolster their microbiome and immune system?The ways in which the microbiome often gets disrupted is repeated chronic use of things like antibiotics or eating foods that aren’t very healthy, or foods that your body doesn’t perceive as healthy. You could even be eating a healthy food, something that’s rich with fiber, which is great for a person with diabetes, ordinarily which helps lower blood sugar, but here’s the deal, some people don’t get the full benefit of a fiber rich diet because the organisms that currently reside in their gut, in that microbiome, aren’t the kinds that can metabolize the full benefit of the fiber. They do use the fiber, it can have other benefits, but it’s not going to help their blood sugar. They need a prevalence of certain kinds of organisms to really be effective. Chances are they had those organisms in their childhood, and now in their adult years, their microbiome is not the same.
If they want to improve their microbiome are there probiotics that you can take as someone with diabetes?In a generic sense the answer to that is no, only recently have there been scientific studies done to show that there are indeed probiotics that have proof, actual science and evidence showing that they improve the microbiome and help a person directly reduce their blood sugar by taking a probiotic. Generally speaking most probiotics do not get that result. There are a few that do.
What should someone look for when they are trying to evaluate whether a probiotic will help them with their diabetes or not?It’s helpful always to read labels. I always tell my patients, my friends and family, read the labels. You want to hold companies accountable to what is actually in the bottle. You’ll want to look to see if the FDA has recognized it as G-R-A-S, a Generally Recognized as Safe status. You should look to see if the strains that are in that probiotic are strains that are associated with having lowered blood sugar and improving the gut microbiome. You also want to see if they are the ones that will help you fully digest and benefit from fiber rich foods.
Can you tell us about the relationship between COVID-19, diabetes and the microbiome?One of the reasons why you hear on the news that COVID-19 is such a problem for people with diabetes is that having diabetes means that your immune system is not as functional as it otherwise would be. Having extra blood sugar really has a big impact on the immune system function and increases inflammation and all other risks. When that comes to your microbiome, which is there as a front line defense for your immune system, it too is being compromised. If you are taking a probiotic you want to know that it’s helping to boost your immune system and give you better function specifically so that it’s helping to increase something called butyrate. What butyrate does is help improve the immune support, the immune function, the immune defense in the gut intestinal lining. With that improved immune support, we would expect that it will help people with diabetes better defend against infections including COVID-19. The butyrate production that’s increased supports their immune system primarily and also helps lower their blood sugar so they get a double benefit there.
Can you talk about the role of butyrate production in immune response and diabetes?
Butyrate does a number of things. When it comes to short chain fatty acids and butyrate and what goes on in the gut, people need help making the gut lining much more robust and healthy which means the immune system that is sitting right there on the surface can now do its job. Everything you eat is going to have all types of microorganisms on it, some of which are very helpful and healthy for you, some of which can potentially cause disease. Your immune system is there doing its job to prevent us from getting sick, having said that, some people have a compromised immune system. If you have diabetes, you’re losing some of the power the immune system has to offer. When it comes to butyrate then you’re losing the integrity of the intestinal lining which means your immune system is not as able to help you.
To keep it simple, some of the things that butyrate is doing is helping with digestion and helping you benefit from all the fiber that you eat. It’s also helping with the mechanical integrity and the immune shield protection from the intestines. Butyrate is a really important thing to have available. It also helps lower blood sugar because you’re helping take the energy that the extra blood sugar glucose represents from that bloodstream and make it available inside the cell, so it’s coming across the cell wall with the help of insulin. Now the response between insulin and glucose, like a lock and key, works a lot better. You get the energy in the cell and now it’s available to serve you and chances are you might experience more energy.
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