Nutrition Considerations for Microbiota Health in Diabetes

Meghan Jardine

doi:10.2337/ds16-0003

Departments

Nutrition Considerations for Microbiota Health in Diabetes

Meghan Jardine

Physicians Committee for Responsible Medicine–Nutrition, Washington, DC

Corresponding author: Meghan Jardine, mjardine{at}pcrm.org

Diabetes Spectrum 2016 Nov; 29(4): 238-244. https://doi.org/10.2337/ds16-0003

Article Figures & Tables

Tables

TABLE 1.

Criteria for Prebiotic Classification (26)

For a food or substrate to be considered a prebiotic, it must be able to:
1. Resist digestion in the small intestine
2. Be fermented by the microbiota in the large intestine
3. Stimulate the growth and metabolic activity of beneficial species to improve the health and well-being of the host

TABLE 2.

Dietary Sources of Prebiotics and Their Documented Health Outcomes

Dietary Sources of Prebiotics (25,26)
Prebiotics are found in: • Breast milk • Leeks Asparagus • Chicory • Jerusalem artichokes • Garlic • Onions • Whole-grain wheat • Oats • Soybeans • Bananas

Evidence-Based Health Outcomes from Prebiotic Intake (25,30)

Prebiotic intake:
• Increases the abundance of beneficial microorganisms
• Suppresses the proliferation of pathogenic microorganisms
• Provides treatment for diarrhea
• Helps with inflammatory bowel disease
• Prevents colon cancer
• Improves the absorption of minerals, including calcium, magnesium, zinc, and possibly iron, thus improving bone mineral density (via enhancement of SCFA production)
• Reduces cardiovascular disease risk
• Promotes satiety and helps with weight loss
• Lowers colonic pH

TABLE 3.

SCFAs (4,30)

SCFAs include butyrate, acetate, and propionate. They are produced by fermentable prebiotics and other soluble dietary fiber and provide the host with many health benefits. SCFAs:
• Serve as a main fuel source for colonocytes, which strengthen the epithelium, potentially decreasing the translocation of antigens and LPS, and reduce endotoxemia and insulin resistance (butyrate)
• Reduce colonic pH, which inhibits the growth of pathogenic bacteria (butyrate)
• Enhance mineral absorption
• Stimulate the release of PYY and GLP-1, which decreases appetite and improves insulin sensitivity (propionate, acetate, and butyrate)
• Are metabolized in the liver and may play a role in reducing serum cholesterol levels (propionate)
• May enhance fatty acid oxidation and thermogenesis (butyrate)
• May activate intestinal gluconeogenesis, contributing to weight loss and glucose control (butyrate, propionate)

TABLE 4.

Criteria for Probiotic Classification (32)

For a probiotic to be effective, it must:
1. Resist gastric, bile, and pancreatic digestion
2. Adhere to the mucosal and epithelial surfaces
3. Once colonized, remain metabolically active
4. Provide the host with protection from pathogens by secreting antimicrobial substances or preventing their adhesion and colonization
5. Demonstrate bile salt hydrolase activity

TABLE 5.

Sources of Probiotics and Reported Strains (36)

	Reported Strains
Plant-Based Probiotics
Sauerkraut (fermented cabbage)	Lb. plantarum Lb. brevis P. acidilactici P. cerevisiae Leuc. mesenteroides
Kimchi (Korean spicy cabbage)	Lb. plantarum Leuc. mesenteroides L. brevis
Tempeh (a fermented soybean product), soy sauce, miso	Lb. plantarum Lb. brevis L. acidophilus
Water kefir	Lb. casei Lb. hilgardii Lb. hordei Lb. nagelii Leuc. citreum Leuc. mesenteroides Ac. fabarum Ac. orientalis Yeasts: Hanseniaosporavalbyensis Lachancea fermentati Saccharomyces cerevisiae Zygotorulaspora florentina
Dairy-Based Probiotics
Yogurt	Lb. bulgaricus Lb. acidophilus S. thermophilus Bifidobacterium spp.
Kefir	Lb. kefir Lb. kefiranofaciens Lb. brevis

Note: strains may vary depending on processing technique. Reprinted from Ref. 34 with permission from the Academy of Nutrition and Dietetic Diabetes Care and Education Dietetic Practice Group. Ac., Acetobacter; L., Lactococcus; Lb., Lactobacillus; Leuc., Leuconostoc; P., Pediococcus; S., Streptococcus.