I’ve previously discussed how the unique microbial species, Akkermansia muciniphila, is an important inhabitant of the human gastrointestinal (GI) tract, a relatively recent discovery. Low numbers or absence of Akkermansia has been associated with numerous unhealthy phenomena, such as ulcerative colitis, obesity, type 2 diabetes, and endotoxemia. Many of these benefits hinge on Akkermansia’s potent effects on maintaining the integrity of the mucus lining of the intestines, as well as the intestinal lining itself. Akkermansia is so important to the health of the intestinal wall that noted Dutch microbiome researcher and discoverer of Akkermansia, Dr. Willem de Vos of Wageningen University, calls this species “the gatekeeper of the mucosa.” (“Mucosa” refers to intestinal cells just beneath the mucus barrier.)
A vivid illustration of the power of Akkermansia came from a pilot study in which 10 billion CFUs of Akkermansia were given to study participants for 3 months. Compared to participants taking placebo, those receiving Akkermansia experienced 28% improved insulin sensitivity, 34% reduction in insulin levels, 5 pounds weight loss, along with improvement in markers of liver function and inflammation. This is huge, as it means that replenishment of this one microorganism provides benefits that match or exceed the effects achieved with the silly drugs for type 2 diabetes without the side-effects, hypoglycemia, and extreme costs of prescription drugs.
But I call Akkermansia the “Goldilocks microbe,” as it likes things just right: Too little Akkermansia and you fail to enjoy the gut barrier-enhancing, insulin resistance-reducing, weight control benefits; too much Akkermansia and its other side comes out: its ability to, consistent with its name–muciniphila or mucus-lover–consume human mucus. In other words, take in the nutrients that Akkermansia prefers and its population increases to about 4-5% of total bowel flora, the ideal level with maximum health benefits and it leaves your mucus alone. Deprive Akkermansia of the nutrients it prefers and it turns to your mucus for sustenance, handily outmuscling non-mucus consuming species and proliferates to occupy 10% or more of total bowel flora.
We see Akkermansia overproliferation when it is deprived of prebiotic fibers. In kids with intractable seizures, for instance, put on ketogenic diets, there is a 50% or more reduction in seizure frequency, a powerful effect. But the lack of prebiotic fibers (and perhaps polyphenols) leads to overgrowth of Akkermansia. Excessive Akkermansia, coupled with reduced numbers of other species, causes the mucus barrier to erode that, in turn, leads to intestinal inflammation, increased endotoxemia, increased entry of bacterial pathogens into the intestinal wall, and increased susceptibility to pathogens. (In experimental animals, this effect can be fatal.) Long-term effects include diverticular disease, type 2 diabetes, kidney stones, osteopenia, colon cancer, and other conditions, many driven by the inflammation of endotoxemia.
The key is to therefore maintain a daily intake of nutrients that nourish Akkermansia that causes it to bloom. You cannot overdo these nutrients such as prebiotic fiber, as you are nourishing the entire community of microbes that keeps Akkermansia from overpopulating. It’s only when there are little to no nutrients from diet that Akkermansia becomes a mucus-consumer.
What foods nourish Akkermansia and keep it from expressing its mucus-consuming abilities? This list includes:
- Prebiotic fibers–Akkermansia especially prefers fructooligosaccharides, FOS, such as that provided by onions, garlic, green bananas, asparagus, leeks, jicama. FOS powders are also available.
- Polyphenols–These are the phytonutrients in vegetables and fruits that are poorly-absorbed in the human GI tract but have substantial effects on bowel flora. In particular, the polyphenols from cranberries, pomegranate, grapes, wine, rhubarb, green and black tea, and berries increase Akkermansia populations.
- Fish oil–In addition to the enhanced activity of intestinal alkaline phosphatase that disables bacterial lipopolysaccharide, LPS (an extremely important effect in reducing endotoxemia), the omega-3 fatty acids of fish oil also result in increased Akkermansia.
- Oleic acid–Oleic acid is richest in olive oil, comprising around 70% of its fatty acids. Meats, eggs, olives, and avocados are also rich in oleic acid.
Increasing Akkermansia populations is how the prescription agent metformin exerts its insulin- and blood sugar-reducing effects, a great illustration of the potency of this strategy.
If you are among the 5% of us, however, who completely lack Akkermansia, these nutrients, while healthy for many other reasons, will not cause a bloom in Akkermansia, just as not planting seeds for zucchini in your backyard garden will not yield zucchini no matter how much you water and fertilize. For these people, there is a new option: Take the new probiotic called Pendulum that contains, according to their medical director Dr. Orville Kolterman, between 1 and 100 billion CFUs of Akkermansia, along with four other butyrate-producing probiotic species. (The Pendulum group beat the Belgian group that was predicting release of a commercial Akkermansia probiotic by late 2021.) Unfortunately, the company has priced this almost like a drug at $198 for a 30-day supply.
If you have zero Akkermansia, I would therefore favor doing something like taking the probiotic intermittently, coupling it with a full effort to provoke Akkermansia bloom with FOS, polyphenols, omega-3s, and olive oil, assessing the effects with a stool analysis at some point to assess whether you have achieved colonization. If you are among the lucky 95% who begin with some Akkermansia present in your bowel flora, however, just including the above Akkermansia-nourishing foods is key.