Gut Microbiome Part 4:
What are Probiotics?

We’ve discussed the gut microbiome, touching on what exactly it is, why it’s important, and what it does in the body. We’ve introduced prebiotics, the first “biotic” on a chain of 3. We’ve delved deeply into why we’re talking about this in the first place, how inflammation drives most modern diseases, and why the missing link may be in the gut microbiome. 

Now, we’re back on the biotics chain, and the second “biotic” is under scrutiny. 

Bear with me for a moment for a tangent.

Imagine you’re hosting a party. Maybe it’s a tailgate, maybe it’s a fancy sit down affair. It’s you and 50 friends. It’s a great time, but the next morning, you find your toilet clogged, your freezer wide open and full of spoiled food, your TV cracked, and a line of ants following a trail of crumbs and soda residue through the wide open front door. Do you blame the toilet? TV? Freezer? If it were me, I’d call each of those 50 friends another word that starts with “F” and demand answers.

You and I are the hosts, and those 50 friends are countless microorganisms living it up in our bodies. 

This is your gut microbiome. 

Microorganisms, bacteria being the best defined, outnumber you, more bacterial cells than human in your own body. They’re amazing friends when things go right, but when your lock doesn’t work and you’re out of town for the weekend, they’ll trash your place & turn from friends to another “F” word. The lock in modern society is as broken as it’s ever been. Ultraprocessed foods, microplastics, and a host of other toxins have permanently rusted the lock.

So, what are probiotics?

Let’s start with the boring answer. The World Health Organization (WHO) defines probiotics as “live microorganisms which, when administered in adequate amounts, confer a health benefit on the host.” 

Yawn.

More interestingly, these microbes process carbohydrates, breaking down fiber human guts can’t process and forming energy sources through short-chain fatty acids (SCFAs) for the cells lining our small intestine. They make vitamins and micronutrients we can’t make on our own. They break down protein for us, and they do the same for bile acids which then help the liver “digest” fat. 

The gut is the single largest immune organ in the body, housing ~70-80% of our immune cells, and the resident microbes train our immune system. They protect against inflammation, heart disease, obesity, high cholesterol, insulin resistance, metabolic syndrome, certain types of dementia, and even cancer.

Cool, right? Didn’t we talk about countless microbes earlier? How do we know which ones to choose to optimize health?

I thought you’d never ask.

It depends on what the goal is. The ultimate action of probiotics comes from what they make after gorging themselves on the right kind of “food.” These downstream chemicals, called postbiotics, are what we ultimately care about, and different bacteria produce different chemicals. More on this in the next blog post.

Say you care about heart disease. Now, we target metabolic syndrome, the broad cluster of things that increase risk of heart disease. This means cholesterol management, insulin sensitivity, weight loss, and blood pressure control. 

Let’s start with cholesterol management. LDL, the “bad” cholesterol activated by inflammation that clogs arteries, is significantly reduced in multiple randomized controlled trials with Lactobacillus plantarum supplementation. Let’s take a close look here. People who followed a healthy diet with regular exercise who also supplemented with L plantarum compared with people who followed the same healthy diet with regular mild-to-moderate level exercise saw a significant reduction in LDL ranging from 17.4 to 24.4%, along with a significant reduction in total cholesterol. 

Holy shit.

Doctors prescribe medications to lower LDL all the time. The most common type is statins. However, up to a third of patients can’t tolerate statins due to side effects. For these patients, short of big gun injectable therapies which insurance won’t pay for unless you’ve had an “event” (a fancy way to say heart attack), there are 2 options: Ezetimibe and Bempedoic acid. 

Ezetimibe lowers LDL on average by 19%, while bempedoic acid lowers LDL on average by 15.9%. 

One more time for the people in the back:

• Probiotic supplementation with certain bacteria lowers LDL by 17.4 to 24.4%
• Pharmaceutical options (ezetimibe & bempedoic acid) lower LDL by 15.9 to 19%

If it’s not clear yet, on a background of diet and exercise (healthy living), probiotics can lower bad cholesterol that can clog arteries by the same amount, in general, as pharmaceutical options. 

What if you care about weight loss and insulin resistance?

Find me someone with access to a screen who doesn’t sing along when they hear “O-o-ozempic,” and I’ll pat you on the back or something. GLP-1 agonists are touted as miracle drugs, good for diabetes and good for weight loss and insulin resistance in people without diabetes. What if a probiotic could do the same?

Turns out, Akkermansia muciniphila, a probiotic already living in our guts, activates GLP-1 just like Ozempic and other medications do. In fact, randomized controlled trials in overweight people with insulin resistance show significant weight loss and improve insulin sensitivity with Akkermansia muciniphila supplementation compared with the same type of people with the same type of lifestyle who didn’t supplement. 

Have you guessed the punchline yet?

In real-world analyses of pharmaceutical GLP-1 agonists, at 6 months, average weight loss was 10.1 pounds (ranging from 2.9 to 19.1 pounds). Insulin resistance decreased by an average of 32%. 

What about weight loss & effects on insulin resistance with Akkermansia muciniphila supplementation?

Granted, much more data exist for pharmaceutical GLP-1 agonists. Akkermansia muciniphila supplementation hasn’t been studied nearly as much. It’s the new kid on the block. Despite this, average weight loss was 5 pounds, and insulin resistance decreased by an average of 28.6%.

To recap,

• Pharmaceutical GLP-1 agonists reduced weight by ~10 pounds and decreased insulin resistance by 32%
• Probiotic supplementation with Akkermansia muciniphila reduced weight by ~5 pounds and decreased insulin resistance by 28.6%

Let’s bring it home now.

Probiotics live in our guts already. It turns out that supplementing with specific probiotics can lower bad cholesterol (LDL), promote weight loss, and decrease insulin resistance on par with pharmaceutical options. I’m a no bullshit guy, so here’s the catch. Probiotics haven’t been studied head-to-head against pharmaceutical options, and the science is early enough that we don’t know if this pans out in all the types of patients pharmaceuticals have been studied in.

The point stands. 

We live in a world where microbes that already live alongside (or rather inside) us can achieve health benefits on par with medications. So, why aren’t they being gobbled up by Big Pharma? You can’t patent bacterial strains (yet). That’s good news.

Stop by more often if you learned something. If you want to learn more, read some shorter pieces on our blog or even shorter pieces through our newsletter. Sign up for our newsletter for ultra-bite sized education, or read our blog at www.lylahhealth.com/blog/ for regular bite-sized education. Dr. Bilal Ahmed MD MBA & Zoya Ahmed are great resources too.

Until next time.