Eran Segal (Solve grantee): Personalised microbiome-based diets for blood glucose regulation

[Skippa]

I like this as a counter-balance to the one size fits all approach of the GI dieting advice that has become so ubiquitous.

 

[Sasha]

It's my hope that the forums will become established as a place for researchers to visit and see their work being discussed.

Perhaps Dr Segal might come along one day and join in. The forums will become more widely known soon and I hope that more researchers might join generally.

I think sometimes we have a tendency to talk as though they're not here, but who knows... It would be good to get a constructive dialogue going.

 

[Skippa]

It's my hope that the forums will become established as a place for researchers to visit and see their work being discussed.

Perhaps Dr Segal might come along one day and join in. The forums will become more widely known soon and I hope that more researchers might join generally.

I think sometimes we have a tendency to talk as though they're not here, but who knows... It would be good to get a constructive dialogue going.

The more their names get dropped, the more they are likely to notice us

If it is favourable, they may just pop in for an ego massage

 

[adreno]

One problem I have with this is that it is basing the diet on the existing microbiome. But what if the existing microbiome is suboptimal, or partly responsible for keeping you unhealthy? In that case you wouldn't want to maintain it, but rather change it.

Then comes the problem of how you would want to modulate your microbiome, because we don't know what the "optimal" microbiome is. And this is likely also personal, and would depend on factors such as your genes. So many questions still.

Furthermore, the glucose response of otherwise healthy people might not be relevant to PwME at all, as our metabolism could be entirely different.

 

[Keela Too]

The only consistent factor for my fasting blood sugar being high in the morning (I have diabetes now) is how much I've over-exerted recently.

Okay that is interesting. I didn't track that aspect. I'm not diabetic - but as said above I had some high morning readings that would suggest at least pre-diabetic. (T2)

One problem I have with this is that it is basing the diet on the existing microbiome. But what if the existing microbiome is suboptimal, or partly responsible for keeping you unhealthy? In that case you wouldn't want to maintain it, but rather change it.

Yes, but perhaps it is easier to start with foods that are not putting excess sugars into your blood. Later perhaps there might be change in a better direction - maybe adding foods known to promote the better biome bacteria?

Then comes the problem of how you would want to modulate your microbiome, because we don't know what the "optimal" microbiome is. And this is likely also personal, and would depend on factors such as your genes. So many questions still.

Furthermore, the glucose response of otherwise healthy people might not be relevant to PwME at all, as our metabolism could be entirely different.

Indeed. Plenty of future to this type of research I suspect.
Anecdotally I find my mood stays better if I eat kefir daily - which suggests that the bacteria in your gut can change things like mood. Yet it also suggests that the kefir bacteria are not establishing in my gut, as I seem to do best if I keep taking it.

 

[Sasha]

One question I have is that your response to certain foods presumably depends on your current microbiome but if you alter your diet to the foods that spike your blood sugar less, then presumably your microbiome changes in response. Does the new microbiome cause different foods to spike your blood sugar?

 

[adreno]

One question I have is that your response to certain foods presumably depends on your current microbiome but if you alter your diet to the foods that spike your blood sugar less, then presumably your microbiome changes in response. Does the new microbiome cause different foods to spike your blood sugar?

Yes, in that way their argument is kind of circular. The microbiome determines the diet, which determines the microbiome, which determines ...

 

[Sasha]

Yes, in that way their argument is kind of circular. The microbiome determines the diet, which determines the microbiome, which determines ...

I don't think it's necessarily circular, but it may be dynamic. It may converge on something. I'd be curious to know what Dr Segal thinks about this.

I suspect it may be hard to determine computionally but the proof of the pudding (no pun intended) would be on the clinical response (in terms of blood sugar measurements before, after, and longer after).

 

[Keela Too]

I wonder if there are certain foods that are predictable across multiple people/genotypes/biomes - either in their ability to produce a sugar spike or in their reliability at NOT producing said spike. This information could lead to general lists of useful starting points for everyone - as is currently the norm.

Or is he saying that there are very few foods that are predictable generally?

Leading on from this, I wonder which foods are the most variable across the population in the strength of the response they produce? These might be the foods that those of us attempting to work things out for ourselves would be best to test first. (Or at least we could look at what we regularly eat on a list like this, and search out which are our worst sugar spike culprits with blood sugar testing.)

I do find the whole idea interesting. And @Sasha 's question on what happens over time, and how we can help steer our biome in a better direction, is interesting too.

 

[Jenny TipsforME]

I’m too migrainey to read coherently right now but I wrote about the Israeli research last year, and my home version, keep meaning to write a follow up post. I’ve stuck with the diet changes.

See https://tipsforme.wordpress.com/2016/02/16/resource-home-hacking-blood-glucose/

 

[arewenearlythereyet]

Well I watched it all. I thought it was interesting, although I was a little concerned by some of the apparent "leaps of faith" conclusions that he drew from the results. These sounded a bit like marketing spin for a commercial proposition.

"If you are fat or have a bad diet it's not your fault...it's your unique make up ...you just haven't found the right diet for you" etc.

This just sounded like a blatent attempt at selling something...presumably an app, glucose meter and faecal testing package for £600 a pop. May be I'm old fashioned but I like to see more tangible results before you do the dragons den pitch.

The data did look interesting...and it ties in with other studies showing how high protein and fibre can reduce feeling hungry. I think more work in this area could help in other areas such as reducing cholesterol etc.

The bit that I think is a little disingenuous is saying that everyone is unique and needs a tailored diet solution.

The bit that's missing is ...what happens in the long term ....say if you adjust your diet and by consequence your micro biome, how long is it before you can eat a different diet ? 8 weeks? Or perhaps you may need a "re-tailoring" session? I doubt that anyone will end up needing a fixed long term solution, rather they need nudging in the right direction, then nature takes over.

I think what is more likely to be happening is that because we are an ominviorous animal that has successfully colonised the planet, we perhaps have a flexible digestive system that adapts to our environment ....this includes diet and microbiome. So he's right ...we don't have a perfect diet ...we have many that all of us can enjoy depending upon what food is available to us. Our microbiome should adapt along with what we eat...that just makes sense.

This is the opposite of tailoring...in fact what would be a more interesting question is ...how long does it take us to adapt to a different diet and how many different diets can we choose from once we have our microbiome and food synced properly?

I suspect that a lot more work will need to be done in this area to get to the truth of the matter. I just hope that they actually do the work before going off half cocked selling tailored diet plans that end up just being a con.

Perhaps I'm too cynical?

 

[Sasha]

Perhaps I'm too cynical?

I think it's right to be cautious with these things. But what interests me is that there's empirical data supporting the claim that the algorithm can predict what diet will bring down people's blood glucose (algorithm derived from 800 and confirmed in 100, if I've understood correctly). I haven't read the paper yet so perhaps there are issues I'm not aware of but it's interesting.

I'll be interested to read your account properly tomorrow, @Jenny TipsforME - thanks for posting.

 

[arewenearlythereyet]

I think it's right to be cautious with these things. But what interests me is that there's empirical data supporting the claim that the algorithm can predict what diet will bring down people's blood glucose (algorithm derived from 800 and confirmed in 100, if I've understood correctly). I haven't read the paper yet so perhaps there are issues I'm not aware of but it's interesting.

I'll be interested to read your account properly tomorrow, @Jenny TipsforME - thanks for posting.

Yes that is interesting ...it's the "so what" that needs some more work. I suspect that actually the problem we all have is eating too much of the bad things and not enough if the good things ...and probably inconsistency in eating and sleeping patterns. Add on top of that the boom in consumption of cheap food made with highly processed carbohydrates with global distribution and you have a pretty unhealthy mix. It will be interesting to track obesity in developing economies to see what happens there.

I doubt that we are all unique to the extent we each need a different diet plan....after all we weren't all obese until relatively recently in our evolution.

 

[Jenny TipsforME]

@Sasha still too bad to concentrate I’m afraid. The key thing that came across is individual differences in response to the same foods. This did apply to me and my partner when we tried it at home. Unfortunately we’re not the same type :disappointed:

I was able to correct high glucose by reducing carb quantity (especially flour based carb eg half the pasta) but for my partner adding fat worked. Everyone wants to be in that croissants and ice cream category

A question I have which I’m not well enough to explain is if this diet change alters the microbiome (which they say it does), would that then mean my response would be different now a year on? For us, altering the microbiome could be as interesting as reducing blood glucose.

How I did this with a simple home glucose monitor is in the blog. I didn’t do any algorithms or stool samples, it’s a cheap, simple version.

 

[Jenny TipsforME]

I realise I could answer that question by retesting though don’t feel up to it for the foreseeable.

 

[Sasha]

A question I have which I’m not well enough to explain is if this diet change alters the microbiome (which they say it does), would that then mean my response would be different now a year on? For us, altering the microbiome could be as interesting as reducing blood glucose.

I've just been listening to the very interesting videos linked to from your blog and in one of the (not sure which) Egan or his colleague say that you might indeed need to retest and tweak. That's been my question, too.

 

[Jonathan Edwards]

I have listened to the talk and I am not impressed. He does not talk like a scientist who actually has some reliable new information. That sort of scientist would provide convincing data slides even in a lay audience talk. This is more like an advertisement I am afraid. The problem now is that so much communication about science is so poor - people seem to think it is OK not to put crucial data in abstracts of papers for instance. But someone with something that would convince critical colleagues would put the crucial data in the talk - after all there are likely to be some critical colleagues looking at it.

I have two specific problems with the claims that we could discuss.

The first is the idea that glucose levels after food indicate whether a diet is a good one. I don't think that makes sense. He does not even say what the diet is supposed to be for, but the presumption is that it is designed for weight loss and avoidance of insulin resistance. In that case what matters most is the total number of calories taken over 24hrs. Spikes in glucose may be features of pre-diabetes once you have it but that is not the point because the purpose of the diet is to reduce weight so that the spikes do not occur because of the weight loss. Whether they occur before you have achieved the weight loss is irrelevant. Glucose peaks are not an indication of the calorie load that will perpetuate overweight. If the food is digested slowly there will be no peak.

The second is the implication that people's handling of food is influenced by the microbiome. I may be wrong but this sounds wrong. The microbiome consists of large numbers of bacteria in the colon, which is where all the waste goes after food has been digested. I do not see why the microbiome should be involved in the digestive process and glucose handling. It seems much more likely that the specific microbiome of a person is the effect of either their diet or the way their digestive system handles foods. There could still be a correlation between microbiome and food handling but it would not be the microbiome have a causal impact on digestion but the other way around.

The microbiome seems to be what almost all researchers are looking at now and I cannot for the life of me think why because so far I have seen little reason to think it matters much. It just seems to be a fad in grant applications. In simple terms I see the main problem with what we eat is that many people eat more than they need - the only way to get overweight. The way to reverse that is to eat less. It really does not matter very much whether you eat sushi or curry or hamburgers or maize gruel.

 

[chrisb]

I only watched the first few minutes and decided that the language was all so vague, and showed such a clear lack of understanding of concepts, that it was unlikely to be worth spending time on. But I have never believed diet plays any significant part in my illness. I may, of course, be wrong.

 

[adreno]

The microbiome's role in metabolism is well established. I'm shocked to hear anyone say this is not the case.

Metabolism
As the gut microbiota encode a substantively larger number of genes than its human host, it follows that they are able to undertake a variety of metabolic functions that humans are unable to do or are only able to do in a limited capacity. The gut bacteria are able to produce a variety of vitamins, synthesize all essential and nonessential amino acids, and carry out biotransformation of bile.14 In addition, the microbiome provides the vital biochemical pathways for the metabolism of nondigestible carbohydrates, which include large polysaccharides, such as resistant starches, cellulose, hemicellulose, pectins, and gums; some oligosaccharides that escape digestion; unabsorbed sugars and alcohols from the diet15; and host-derived mucins.16 This functionality results in the recovery of energy and absorbable substrates for the host and a supply of energy and nutrients for bacterial growth and proliferation.17 Metabolism of carbohydrates is a major source of energy in the colon.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4566439/

 

[Jonathan Edwards]

The microbiome's role in metabolism is well established. I'm shocked to hear anyone say this is not the case.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4566439/

I cannot find anything definite in that paragraph that suggests that gut bacteria contribute significantly to digestion of foods in a way relevant to my comments.

They can do things we cannot do but as far as I know that do these things for their own benefit, not ours. Breaking down bile products may help but it is not a significant source of calories. Nor is vitamin synthesis. As far as I know most if not all vitamins are absorbed higher up, the last being B12 in the terminal ileum. Maybe some are absorbed in the colon but that is not going to involve calories. They may synthesise amino acids but as far as I know that is for their own use.

bacteria can break down cellulose and other large carbohydrates but again I am pretty sure this is just fr their own use. We are not like cows, deriving sugars from fermentation in a rumen.

The piece mentions recovery of energy and absorbable substrates for the host but that is not something I have heard as being significant. The piece is published in something called Integr Med, which does not sound like a scientific journal to me!

I may be wrong and there may be some absorption of sugars in the colon but I very much doubt this would have anything to do with glucose peaks after meals. It takes several hours for food to get to the colon normally, and any action there is likely to be slow. I assume that glucose peaks occur when sugars are split by amylase in the jejunum mostly.

Are there any more mainstream scientific sources for the claims in this paragraph?