The future of cardiovascular health may be in Individualizing your carb and food intake to align with your poop and your blood sugar. By eating the carbohydrates and diet that best match the organisms in your stool---you may be able to better control your blood sugar. And not everyone's choice of carbs will be the same--because we don't all have the same organisms in our gut. A piece of bread may raise one person's blood sugar but not someone elses because their gut flora is different. A recent study in Cell Science demonstrates this association of our blood sugars with the organisms in our stool and the foods in our diet. Using a sophisticated algorithm, this 800-person cohort suscessfully predicted the foods that will best maintain a healthy blood sugar. The key components of the study include measuring blood glucose using a 24-hour glucometer, examining the organisms in the participants stool, and looking at other lifestyle factors. They validated their findings in a smaller 100-person cohort. Individualized diets based on this data were able to consistently predict and manage blood sugar response more accurately than traditional dietary blood sugar interventions.
The gut microbiome impacts nearly every aspect of our biology--but the cardiovascular impacts go somewhat under the radar. Even the relationship of diabetes and heart health goes under the radar. A frequent diabetes commercial on television shows a "diabetes expert" asking random people on the street if they realize that diabetes raises heart disease risk? The street actors in the commercial are shocked to learn this connection between diabetes and the heart. This isn't necessarily new information in medicine but the average person doesn't recognize it. Not that you should believe everything you hear on commercials but this time the message is valuable.
What's important with the Cell Science study is that is uses blood sugar as a biomarker for our gut microbiome. Sometimes we lose sight of the importance of a healthy blood sugar to our entire body's health. Blood sugar regulation is a reflection of our metabolism. An elevated blood sugar carries increased risk for lots of things--insulin resistance, diabetes, heart disease, metabolic syndrome, fatty liver disease and even brain health. One thing we do know---diabetes and heart disease are two peas in a pod. You can’t have diabetes without some cardiac risk and likely if you have heart disease, you have some level of insulin dysregulation. By most guidelines, a fasting blood sugar less than 70 mg/dl is considered low blood sugar (hypoglycemia) and up until a few years ago, too high was considered greater than 126 mg/dl (hyperglycemia). Now a normal fasting blood sugar should be between 70-100 mg/dl. The compelling reason for this change? Research was clearly showing that fasting blood sugar level over 100 mg/dl is related to a a higher cardiac risk, recognizing the inflammatory impact, particularly on our vessels of even just a little elevated blood sugar. https://www.ncbi.nlm.nih.gov/pubmed/18413158 https://www.ncbi.nlm.nih.gov/pubmed/24928433 The New England Journal of Medicine reported a study where non-diabetic men with fasting blood sugars of greater than 86 had a greater risk of developing diabetes than those with values less than 81 mg/dl. By any medical standard, a fasting blood glucose of 85 is considered a healthy blood sugar.
Recognizing this association of CVD risk, blood sugar and our gut microbiome may give us more options for prevention and treatment. The biotech world is moving fast on this. Here is a sample of what's out there: Vedanta Biosciences has created a probiotic drug that they describe as "bacterial consortia therapeutics" which targets immune response. Most research on probiotic supplements and CVD suggest that any reduced cardiac risk is a result of some kind of immune modulation. Vedanta drug goes a step further--here is a description from their website of what their drugs aim to do: "Unlike fecal transplants, which require use of donors and are an inherently variable procedure, bacterial consortia therapeutics are defined drug compositions produced from clonally isolated bacteria that can trigger targeted immune responses. And unlike reductionistic approaches such as single strain probiotics, they can robustly shift the gut ecosystem." Yes, a mouthful description but this is where medicine is headed and it is becoming a competitive space.
Check out Viome, another biotech company that claims that their sophisticated technology will more accurately identify your gut organisms and their metabolites, which will help your reduce your health risks depending on your symptoms and medical history.
Our gut organisms and their metabolites probably orchestrate our biology. Their metabolites or byproducts include butyrate, histamine, tryptophan and serotonin, to name just a few. We don't even know all of the metabolites our gut microbiota produce but their consequences probably depend on their amount and location. We are in somewhat uncharted territory here, not fully knowing the consequences of robustly and intentionally shifting the gut ecosystem or even exactly knowing what our individual gut microbiome is made up of and the interactions with our unique genetic makeup. But for sure--our fast paced life, abundant medications/drugs and western diet has already shifted the gut microbiome of many people to a place that is not so good.
Everything we eat affects our gut microbiome-carbs, protein, fat, alcohol --even artificial sugars but carbohydrates have the greatest potential for influence with our blood sugar because of their effect on insulin. The insulin and gut pathways of carbs are becoming better understood, but they are still spoken of separately as if they are mutually exclusive, which research is showing they are not. Thus far, in all of the gut microbiome research, poop sampling and labs claiming the importance of knowing your own gut microflora, the Cell Science study makes the most sense to me. They have taken a measurable biomarker in blood sugar that we know has significant effects on health risk and associated it with changes in diet and gut microflora. Essentially, their results reiterate questions that I proposed in my book, The Seductive Land of Carbs. Consider both you GI health and your blood sugar when trying to figure out the amount and type of carbs for you. We are all susceptible to changes in blood glucose management--even thin, lean people. Health can change for a variety of reasons.
What keeps blood sugars in a healthy range?
1. Eating a low- moderate carbohydrate diet with adequate protein, healthy fats and adequate, varied fibers.
2. Maintaining a healthy gut microbiota
3. Avoiding belly or visceral body fat gain.
3. Exercising: aerobic and resistance training
4. Staying healthy: avoiding colds, flus, stomach bugs, autoimmune problems.
5. Knowing your medications.
6. Managing stress.
We all should be striving to eat a balance of vegetables, fruits, whole grains, legumes, nuts/seeds, animal proteins and fats-- but the amounts and types will be different for each of us. Stay tuned ---personal diet prescriptions and the gut microbiome will be a routine part of future health care.