Diabetes is a growing health concern affecting millions of people worldwide, with estimates suggesting its prevalence could reach 642 million by 2040. Type 2 diabetes (T2DM) accounts for 90% of cases. With over 1 million annual deaths, diabetes is a leading cause of mortality. Recent research highlights the connection between gut health and diabetes, suggesting the digestive system plays a role in metabolic disorders. This understanding has led to new approaches in managing diabetes, focusing on gut health as a key component.
[signup]
Understanding the Gut-Diabetes Connection
T2DM is a chronic condition marked by high blood sugar levels due to insulin resistance and reduced insulin production. Insulin helps cells use glucose for energy. In T2DM, cells resist insulin's effects, and the pancreas can't produce enough insulin to overcome this resistance. The development of T2DM involves genetic, lifestyle, and environmental factors. Genetic predisposition can contribute to insulin resistance, while sedentary lifestyles, poor dietary choices, and obesity can worsen the condition. Excess body fat, especially around the abdomen, is linked to substances that interfere with insulin signaling.
Beyond genetic and lifestyle factors, gut health may also play a role in diabetes. The gut microbiome, a complex community of microorganisms, is important for maintaining health. Dysbiosis, or an imbalance in these microorganisms, is linked to various health issues. In T2DM, dysbiosis is associated with increased inflammation and insulin resistance. Studies suggest a link between changes in gut microbiome composition and diabetes. An imbalance in the Bacteroidetes/Firmicutes phyla, for example, is associated with inflammation and T2DM, while bacteria such as Lactobacillus plantarum, Roseburia intestinalis, Akkermansia muciniphila, and Bacteroides fragilis may support metabolic health.
The gastrointestinal (GI) tract acts as a barrier, keeping digestive contents separate from the body's internal environment. Normally, the mucosal lining prevents harmful substances in the gut from entering the bloodstream. Dysbiosis can lead to increased intestinal permeability, sometimes called leaky gut. This allows large molecules like undigested food particles, toxins, and bacteria to enter the bloodstream, potentially triggering inflammation.
Short-chain fatty acids (SCFA) are produced by the gut microbiome through the fermentation of dietary fibers. Acetate, propionate, and butyrate are the major SCFAs produced. Low SCFA production, especially low butyrate, is linked to insulin resistance. Butyrate may support blood sugar metabolism by promoting the production of glucagon-like peptide-1 (GLP-1) and peptide YY (PYY), which can stimulate insulin secretion. Insufficient SCFA levels may contribute to inflammation and affect the intestinal barrier, leading to increased permeability.
There is a relationship between gut health and diabetes that can complicate matters. High blood sugar levels, common in diabetes, can encourage the growth of harmful bacteria while reducing beneficial strains. Chronic hyperglycemia can also trigger inflammation that affects the gut lining, increasing permeability and potentially leading to systemic inflammation and insulin resistance.
Functional Medicine Lab Testing for Gut and Diabetic Analysis
Blood tests, like fasting plasma glucose and hemoglobin A1c (HbA1c), are used to diagnose diabetes. Additional functional medicine lab testing can provide insights into gut and metabolic health, offering a comprehensive view of microbiome balance, inflammation, and blood sugar metabolism.
CardioMetabolic Panel
The Doctor's Data Cardiometabolic Panel assesses markers related to cardiovascular and metabolic health. This panel includes lipid measurements, markers of inflammation, insulin resistance, and other indicators relevant to heart health and metabolic function. Monitoring these markers is important in diabetes management due to the increased risk of cardiovascular disease (CVD). Markers of inflammation, like high-sensitivity C-reactive protein (hs-CRP), are included in the panel. Elevated inflammation levels may contribute to insulin resistance and increase the risk of cardiovascular complications. Insulin resistance markers like fasting insulin and HOMA-IR (Homeostatic Model Assessment of Insulin Resistance) are also included.
Comprehensive Stool Test
Genova's GI Effects is a stool test that provides insights into gastrointestinal function, including microbial balance, digestive function, inflammation, and SCFA.
Cyrex Intestinal Permeability
Cyrex’s Array 2, or Intestinal Antigenic Permeability Screen, measures biomarkers related to intestinal barrier function. Antibodies to components of the intestinal barrier, such as zonulin and tight junction proteins, may indicate intestinal permeability.
Oxidative Stress
Oxidative stress refers to an imbalance between reactive oxygen species (ROS) and the body's antioxidant defenses. While ROS can have useful functions, high levels can damage proteins, lipids, and DNA. In diabetes, oxidative stress is linked to insulin resistance, where elevated ROS levels interfere with insulin signaling, affecting glucose uptake. Pancreatic beta-cells, which produce insulin, are vulnerable to oxidative damage, affecting their function and glucose regulation. Oxidative stress also affects mitochondrial function, impacting energy metabolism.
Precision Point’s Advanced Oxidative Stress test measures % reduced glutathione, oxidized glutathione, and total glutathione. It also measures 8-OHdG and F2-Isoprostane. 8-OHdG is a biomarker for oxidative DNA damage. F2-isoprostanes are compounds formed through the peroxidation of arachidonic acid, a fatty acid in cell membranes. Glutathione is an important antioxidant. GSH is the active form that neutralizes ROS. GSH becomes oxidized to GSSG during this process. Assessing the levels of reduced glutathione, oxidized glutathione, and total glutathione, along with the GSH/GSSG ratio, provides insight into the redox status within cells (48).
Systemic Inflammatory Markers
Systemic inflammation can be linked to gut health and diabetes. Markers such as c-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are used to monitor inflammation. The liver produces CRP in response to inflammation. ESR measures how quickly red blood cells separate from a blood sample. Inflammation increases the tendency of red blood cells to clump together, causing a higher ESR.
Micronutrient Panel
Compromised gut health can affect digestion and absorption. Certain nutritional insufficiencies are also associated with diabetes. The Spectracell Micronutrient Test measures 31 vitamins, minerals, and other nutrients to identify any deficiencies.
Salivary Adrenal Panel
In diabetes, persistent high blood sugar can be influenced by stress-induced hormonal releases, leading to elevated blood sugar levels. Stress triggers the release of catecholamines and glucocorticoids, like cortisol, increasing insulin requirements and promoting insulin resistance. Genova's Adrenal Stress Profile with Cortisol Awakening Response measures the diurnal rhythm of cortisol with four salivary measurements throughout the day. It also measures the Cortisol Awakening Response (CAR), which can provide more information on how the body is responding to stress.
[signup]
Addressing Gut-Related Complications in Diabetes
People with diabetes may experience gut-related issues. One common problem is gastroparesis, where the stomach empties slowly, causing symptoms like bloating, nausea, and erratic blood sugar levels. High blood sugar levels in diabetes can affect nerves, impacting stomach muscles (14). Intestinal dysbiosis and permeability are also concerns, potentially affecting insulin resistance and metabolic function.
Functional medicine uses comprehensive and personalized approaches to address the root causes of diseases, considering the interconnectedness of various bodily systems. In the context of diabetes, functional medicine considers gut health to be a fundamental component in the multifaceted management of this condition, using tools like dietary changes, lifestyle modifications, and targeted supplements to optimize function.
Dietary Strategies for Gut Health in Diabetic Patients
Specific dietary modifications can be used to both improve gut health and support blood sugar regulation in individuals with diabetes. A low-glycemic diet, which focuses on consuming carbohydrates that have a minimal impact on blood sugar levels, may help regulate glucose and insulin responses. The glycemic index ranks carbohydrates on a scale from 0 to 100 based on their impact on blood sugar levels. Foods with a low GI are digested and absorbed more slowly, leading to a gradual and steady increase in blood glucose levels. By choosing low-GI foods, individuals can better manage their blood sugar levels, avoiding rapid spikes and crashes. This can contribute to sustained energy levels, increased satiety, and improved insulin sensitivity. Carbohydrate foods with a low GI typically include whole, minimally processed foods such as whole grains, legumes, non-starchy vegetables, and certain fruits.
The Diabetes Plate Method is a simple and visual approach to meal planning designed to help individuals with diabetes manage their carbohydrate intake and maintain balanced meals. It involves dividing a plate into specific portions to guide the distribution of different food groups: half the plate with non-starchy vegetables, one-quarter for lean proteins, and one-quarter of the plate for whole grains or starchy vegetables. By visually dividing the plate in this manner, this method helps individuals manage their carbohydrate intake and maintain stable blood sugar levels.
High-fiber foods, such as whole grains, legumes, and vegetables, not only contribute to blood sugar balance but also support a healthy gut microbiome by promoting the growth of beneficial bacteria. Probiotic-rich foods, like yogurt and fermented foods, can also be used to introduce beneficial bacteria to the gut, fostering microbial diversity and enhancing digestive function. An antioxidant-rich diet, emphasizing polyphenols and phytonutrients primarily through foods like vegetables and fruits, may help combat oxidative stress associated with diabetes and support microbiome composition (50, 66).
The Mediterranean diet emphasizes whole, nutrient-dense foods, including fruits, vegetables, whole grains, legumes, fish, olive oil, nuts, and seeds, making it a great option for patients with diabetes and those wanting to support gut health. Rich in fiber, antioxidants, and healthy fats, the Mediterranean diet has been associated with improved glycemic control, reduced inflammation, better microbiome diversity, and enhanced cardiovascular health (43, 47).
The Role of Probiotics and Prebiotics
Probiotics are supplements that contain beneficial microorganisms like bacteria and yeast. Probiotics may support gut function by increasing microbiome diversity, enhancing intestinal barrier function, and helping prevent pathogens from colonizing in the GI tract. Prebiotics are non-digestible dietary compounds that promote the growth and activity of important microorganisms in the gut. These compounds are found naturally in certain foods like fruits, vegetables, whole grains, and legumes or can also be taken in supplemental form. Common prebiotic supplements include inulin, fructooligosaccharides (FOS), resistant starch, and galactooligosaccharides (GOS).
Probiotic supplementation may influence the composition of the gut microbiota, countering dysbiosis and supporting SCFA production. These microorganisms may exert anti-inflammatory effects, potentially reducing chronic low-grade inflammation associated with insulin resistance. Probiotics may also impact glucose metabolism, supporting insulin sensitivity and helping manage fasting blood sugar levels. Probiotics such as Lactobacillus, Bifidobacterium, and Akkermansia have been studied in patients with metabolic disorders. Prebiotics have also been shown to influence gut microbiome composition, potentially affecting glucose levels, inflammation, and insulin resistance.
Integrative Therapies and Lifestyle Modifications
Integrative and complementary therapies, including practices such as acupuncture, stress reduction techniques, and physical activity, are increasingly recognized as valuable additions to support diabetes and gut health.
.png)
Acupuncture
Acupuncture is a traditional Chinese practice that involves inserting thin needles into specific points on the body to stimulate various physiological responses. These acupuncture points are believed to be associated with channels of energy flow, known as meridians. The goal of acupuncture is to restore balance and harmony to the body's energy, known as Qi. It has been used as a complementary treatment in a variety of gastrointestinal disorders and is thought to support GI function by regulating GI motility, barrier function, visceral sensitivity, and the gut-brain axis. It has also been studied for its potential effects on fasting plasma glucose and HbA1c levels in diabetic patients.
Physical Activity
A sedentary lifestyle is a risk factor for the development of metabolic disorders like diabetes. Physical activity may help reduce obesity, support antioxidant mechanisms in the body, reduce inflammation, and improve insulin sensitivity and glucose control. Exercise has also been shown to support microbiome diversity. A combination of aerobic exercise, such as brisk walking, jogging, or cycling, and resistance training, like weightlifting, to address both cardiovascular fitness and muscle strength is optimal. The American Diabetes Association recommends at least 150 minutes of moderate-intensity aerobic activity per week, spread over at least three days, along with two or more sessions of resistance training per week.
Stress Management
Chronic stress triggers the activation of the sympathetic nervous system (SNS) and hypothalamic-pituitary-adrenal (HPA) axis, which can negatively impact glucose regulation and insulin sensitivity. Stress also alters the composition of the microbiome and can trigger intestinal permeability. Mind-body practices, like mindfulness, breathing, yoga, and biofeedback, may help restore balance to the neuroendocrine system and reduce feelings of stress. Mindfulness-Based Stress Reduction (MBSR) therapy has been studied for its potential effects on blood glucose regulation in individuals with diabetes.
Monitoring and Personalized Adjustments in Treatment
Routine blood test monitoring is a fundamental component of diabetes management, providing information on glycemic control, potential complications, and overall health status. HbA1c should be retested every 3-6 months. Other health markers like lipids, estimated glomerular filtration rate (eGFR), and blood pressure can also be utilized to monitor for the development of any diabetes-related complications (2).
Functional medicine practitioners use specialized lab tests not only to formulate personalized treatment plans but also to monitor progress and make necessary adjustments to treatments. Beyond just routine markers looking at glucose control, providers can also monitor changes to microbiome composition, inflammation, oxidative stress, and hormones. This proactive and personalized approach ensures that adjustments are made based on individual responses, fostering more precise and effective strategies for managing both gut health and diabetes.
[signup]
Managing Gut Health in Patients with Diabetes: Key Takeaways
The development of diabetes involves a complex interplay of genetic, environmental, lifestyle, and metabolic factors. Gut health, including microbiome composition and barrier function, can impact inflammation and metabolic function. Functional medicine testing offers an in-depth understanding of an individual's unique health landscape, enabling tailored interventions to support diabetes management.
%201.svg){kind=logo}
.avif)
