Shifting the intestinal microbiome in people with type 2 diabetes

reference

Shin No., Gu N, Choi HS, Kim H. Combined effects of scutellaria baicalensis with metformin on the glucose tolerance of patients with type 2 diabetes by modulating the intestinal microbiota. at the J Physiol Endocrinol Metab . 2020; 318 (1): E52-E61.

Study goal

The aim of this study was to determine whether combination treatment with scutellaria baicalensis (SB) and metformin could have a positive effect on type 2 diabetes-related parameters by modulating the intestinal drobiota.

draft

This was a 20-week, double-blind, randomized crossover study. The test subjects were assigned according to the random principle 1 of the following 2 sequence groups: 1) SB + metformin in period 1, placebo + metformin in period 2; or 2) Placebo + Metformin in Periode 1 to SB + Metformin in period 2. There was a "wash -up phase" of 4 weeks before the participants "changed" to their next assigned sequence.

In the SB + Metformin treatment period, the test subjects received 4 capsules SB (3.52 grams of freezer-dried hot water extract SB Pro 12 capsules) together with their normal prescribed metformin dose (at least 500 mg) three times a day after the meals for 8 weeks.

participant

twelve subjects ended this study and were included in the analysis. The participants were men and women between the ages of 20 and 75, in which type 2 diabetes was diagnosed at least 3 months before the study began. They all took at least 500 mg metformin every day and had a sober blood sugar between 110 and 180 mg/dl or a glycated hemoglobin between 8.0 and 9.0.

study parameters evaluated

This study tried to evaluate changes in urine and serum biochemistry, oral glucose tolerance and chair microbiota in treatment and placebo groups.

primary result measurements

The researchers assessed the following primary result parameters: glucose tolerance, liver enzymes, gene expression of interleukin-2 (IL-2) and tumor necrosis factor alpha (tnfα) as inflammatory markers, gene expression of AMPK, glut4 and pi3k as markers of the glucose metabolism and the blood lipid.

important knowledge

A statistically significant improvement in oral glucose tolerance in the combined SB/metformin group compared to the placebo group was found.

The gene expression of tnfα (measured as a mRNA by real-time polymerase chain reaction [PCR] in the blood) showed a statistically significant decrease in the SB/metformin group. There was also a reduced gene expression of IL-6 in the SB/Metformin group, but the reduction was not statistically significant.

The stool samples from the SB/Metformin group showed significantly less bifidobacterium and significantly more lactobacilli and Akkermansia than the stool samples from the placebo group.

practice implications

It is fascinating how much the concept of the human intestine as a "ecosystem" has been in fashion in recent years with the examination of the effects of the intestinal microbiota on pretty much everything. It is very gratifying to see this trend, since "treat the intestine" has been a common chorus in naturopathy for decades.

Maybe we can now effectively use the power of the intestinal microbioma to improve the results of our patients with type 2 diabetes. Or maybe we have been doing this for years without knowing it? Like a child in the back seat of a car, I wonder: "Are we already there?" Can we give a patient with type 2 diabetes a probiotic nutritional supplement or a herb to change his intestinal microbiota and to exercise a positive effect on glycemic control?

Two earlier reviews that dealt with this topic essentially came to the conclusion that we were not that far. However, the current human study supports the idea that the shift in human intestinal microbiota is a viable way to improve glycemic control.

Maybe we can now use the power of the intestinal microbioma to improve the results in our patients with type 2 diabetes.

The usual tools with which diabetics have to work consist of nutrition, movement, medication, nutritional supplements, stress control, etc. Perhaps we are now at the time when we realize that we had another valuable tool all the time: manipulation of the intestinal microbiota through botanical medicine.

Bodogai et al. carried out an interesting animal study on "healthy aged" mice and macaques. ^{3 their data showed that the insulin resistance was caused by the accumulation of 4BL cells in the intestine. It was found that the 4BL cells are related to changes in the coming intestinal bacteria and a decrease in the bacterial metabolites known as a butyrat. Butyrat is a well-known substance in naturopathy and is sometimes used in "intestinal healing" plans for our patients.}

The proliferation of 4BL cells was caused by the interaction with CC chemocin receptor 2 (CCR2)+ monocytes, which was triggered by the hyperpermility of the intestine and the resulting infiltration of endotoxins into the blood circulation. The intestinal hyperpermeability was triggered by the exhaustion of Akkermansia muciniphila and reduced butyrat concentration in the intestine.

The interesting thing about the study by Bodogai et al. was that the resulting insulin resistance was reversible by adding the animals with supplemented Akkermansia muciniphila or with the antibiotic enrofloxacin (which the Akkermansia ). Treatment with Butyrat or antibodies against CCR2+monocytes and 4BL cells also had the same effect.

In contrast to the study by Bodogai et al. the current study showed that you could use a probiotic instead of administering scutellaria baicalensis in conjunction with metformin to postpone the intestinal microbiota (in particular lactobacilli and Akkermansia ) in a direction that has a positive effect on glycemic control and inflammatory markers. I would describe this as a "positive" interaction between medication and herbs. The fact that this drug/herbal combination also reduced the gene expression of TNFα is another bonus in view of the inflammatory nature of diabetes.