Gerry Gajadharsingh writes:
“The article below was sent to me by one of my lovely patients, Ann, who was recently diagnosed with Type II diabetes. She’d had a variety of health challenges over the past few years including the diagnosis of non-alcoholic fatty liver disease (NAFLD), a rheumatological condition, bone density problems, indigestion/ reflux, hypercholesterolaemia, acute musculoskeletal pattern, fatigue and with a BMI of 30 (categorised as obese). Her GP had found her fasting blood glucose was quite high at 12 mmol/L (it should be less than 6) as was her three months glucose marker HbA1C at 8.2% or 64 mmol/mol (it should be 4-6% or 20-42 mmol/mol). She was advised to start Metformin, a first line diabetic drug at 500mg.
It’s interesting to note that a meta-analysis by Hirst, Farmer et al, published in Diabetic Care in February 2012, looked at over 40 research trials with the use of metformin in diabetic patients, from 1950 to 2010. The conclusion was that over a minimum period of three months the best reduction in HbA1C, when using metformin, was 1.12%.
Ann had decided to consult me to see if I could help. I’m getting increasing numbers of Type II diabetic patients where I find putting them on a Metabolic Balanceâindividualised nutritional program is resulting in significantly better glucose management, than just medication alone.
We are three months into her programme, where in addition to her nutritional program, I’ve provided hands-on osteopathic manual treatment, breathing and autonomic nervous system re-education, an exercise program and nutritional supplementation.
Ann has been exemplary in following her program and, as a consequence, the results, so far, have been impressive.
A follow-up blood test by her GP, after just two months of following the Metabolic Balanceâindividualised nutritional program, showed that HbA1C had reduced from 8.2% to 6.7%, given it’s a three-month glucose marker this is extremely encouraging. Her fasting blood glucose is averaging between 5.5 and 6, therefore now in the normal range. She has lost 16 kg, her BMI has reduced from 30 to 24, approximately 18% of her body weight. The medical definition of a successful weight loss program is losing 5% or 1 BMI over one year (it is set so low because most diets are completely useless in the long term, people simply go back to what they have been eating before!!).
More importantly, Ann feels so much better in herself on numerous levels. She’s found the program far easier than she initially envisaged and really likes what she now eats. I will see her in three-months’ time to repeat her blood tests (to generate a Metabolic Balanceâprogram we do a comprehensive blood test to help generate a bespoke nutritional program). I tend to repeat these blood tests at the end of six months and often we see changes in abnormal blood parameters after successfully following our program.
I am familiar with Prof Spector’s work, the main focus of the article below and the gut microbiome. Clinically it is apparent that a healthy gut plays a profound part in the health of many people. Modern life seems to have significantly altered the microbiome of many people. With childhood inoculations, travel vaccinations, some pharmaceutical drugs, overuse of antibiotics, general lifestyle factors, high sugar diets, the list goes on. Given human nature people seem to want a quick fix, and the plethora of “probiotics” now available in the market it’s quite astounding. As with many things in life optimizing health is not as simple as just taking a probiotic (which vary in their effectiveness anyway, depending on the type and brand) to recolonize your gut.
Your gut health affects your whole body, driving your digestion, immune system, energy metabolism and more. Here, Tim Samuels explores why we need to be gut happy.
Place your hand on your belly. Summon the inner resolve that this year things are going to be different. Promise to transform what lies beneath – or maybe spills between – your fingers. And then celebrate with a glass of red wine, a hearty wedge of pungent cheese and a stroke of the nearest dog.
For this transformation is not the usual forlorn foray into physical perfection. This is about effecting a change with the potential to impact your entire metabolism and state of mind. One that’s rooted in discoveries that are upending our understanding of how the body works. And will require a far more diverse – and dog-friendly– lifestyle than the abs would demand.
This year, you can pour your energies into trying to expose six sections of the rectus abdominis; or you might wish to work on pleasing the 100 trillion tiny organisms packed into your gut. Because if those guys are happy, the chances are that you’ll be too.
The gut barely used to get a look-in at medical school. It was viewed as the functional yet unexciting passage that took in food at one end and deposited waste at the other. The Plain Jane of physiology. But now Jane – if she were seven or so metres of tubing – is now the hottest belle above the balls. The gut is so hot that it’s gone from being an anatomical afterthought to home to the newest and most exciting organ in the body.
Brain, heart, lungs, liver, kidneys – meet your new fellow organ, the microbiome: a collective of those 100 trillion microorganisms living in the gut. Two kilograms of bacteria, viruses and fungi – a whole other world we carry around inside ourselves, upon which it seems our world depends more than we ever thought. And one I’ve been diving into for my new BBC wellness podcast All Hail Kale.
Tim Spector, professor of Genetic Epidemiology at King’s College London, recalls the moment when he realised the centrality of the gut. As director of the country’s biggest twin registry, one question had been puzzling him: how can identical twins be so different? One fat, the other thin. One happy, the other sad. It didn’t make sense – they have exactly the same genes.
But his eureka moment struck when he compared the guts of twins: “One of the biggest factors was that their microbes were different,” he recalls. So, what had been causing one twin to be, say, obeseand the identical sibling to be a normal weight was down to the differing compositions of their guts. Genes were no longer all-powerful.
“Allergies, diabetes, IBS, arthritis and a whole host of conditions too are linked to the microbiome”
Research from around the world has been bringing to light the multifarious – and crucial – roles the gut microbes are playing down there. They drive our digestion, immune system, energy metabolism, nutrient absorption and appetite. “We couldn’t live without these microbes,” says Professor Spector. Allergies, diabetes, IBS, arthritis and a whole host of conditions too are linked to the microbiome.
Beyond the physical, it has also emerged that 90 per cent of the body’s serotonin – the chemical central to mental wellbeing – lies in the gut. The gut-mind link is what piqued my interest in the microbiome. Always looking to boost my serotonin levels to glass vaguely quarter-full, and having tried just about every mainstream and unconventional method under the sun, I then heard about some mice that were making serious sacrifices for human happiness. Truly taking one for our team.
In a lab in Ontario, Professor of Gastroenterology Premysl Bercik had been conducting a fascinating experiment on two very different types of mice: one was naturally very anxious and barely left the shadows the cage; the other was confident, gregarious and bounded around the cage without a care. Professor Bercik took stools from the different mice and put them inside each other’s stomachs: a poop swap known as faecal microbial transplantation. He then observed what happened – which was extraordinary. Three weeks later the mice had essentially swapped personalities: the once-shy mouse had become confident whilst the carefree mouse was now prone to hiding in the shadows. Through exchanging their gut bacteria he’d changed their personalities.
A breakthrough which, thanks to the mice, opens up a new potential frontier for treating mental health. A world of psychobiotics – where particular bacteria strains are prescribed to lift moods; where psychiatrists routinely run tests on your microbial health. Nascent steps are already being made in this direction. A team at Cork University has shown that a certain probiotic can lower stress and improve memory function. Professor Bercik has identified a strain of bacteria he says can impact depression – which he’s developing with a breakfast food company. Even cheerier Cheerios.
‘Sometimes when eating, I imagine the trillions of microbes down there are like a restive football crowd’
While scientists try to further understand everyone’s new favourite organ, the question arises: what can you do now to keep your gut happy – helping it to keep you happy and as healthy and robust as possible.
“Diversity is the number one factor,” says Professor Spector. Diversity of diet – which is what our hunter-gatherer ancestors enjoyed: as many different plants, and parts of plants, as possible. Whether that’s vegetables, nuts, fruits, or seeds. Have fermented foods, like keffir, kombucha, kimchi, sauerkraut, yoghurt and unpasteurised cheese. Increase your fibre. Red wine and dark chocolateseem to be beneficial. But avoid processed foods, artificial sweeteners, emulsifiers, and meat reared using antibiotics.
Diversity of the bacteria you come into contact with too. “Go on farms, get dirty, kiss your dog. Lots of swapping microbes is generally good.”
Since making the podcast, I have to confess I’ve developed a strange habit. Sometimes when eating, I imagine the trillions of microbes down there are like a restive football crowd. When I send down some kombucha, or a prebiotic piece of kale, they cheer and sing. Sauerkraut sends them giddy on the terraces. But when a Pringle or Diet Coke goes down the gullet, boos and jeers rise back up. Just a little reminder that we’re not alone. And you’ve got to keep your guests happy.