The gut microbiome plays an important role in regulation of metabolic processes, including digestion, absorption, and synthesis of bioactive molecules that signal physiological host mechanisms. Changes in the human gut microbiome are associated with type 2 diabetes and insulin resistance. Water-soluble dietary fibres like inulin and beta-glucan are fermented in the colon, and beta-glucan increases viscosity. Blueberries improve insulin sensitivity through an antioxidant effect. A cobiotic, consisting of purified inulin, sugar-free blueberry pomace extract, and an oat preparation of purified beta-glucan was developed for twice a day (bid) consumption as a smoothie drink to repair the gastrointestinal dysbiosis in type 2 diabetes. A 30-year-old man presented with new onset type 2 diabetes and a fasting glucose (FBS) of 375 mg/dl. Metformin 500 mg bid was initiated and increased to 1 g bid after 1 week. During the first 9 days of metformin treatment, he developed diarrhoea, but his FBS only dropped to 325 mg/dl. The cobiotic bid was added on the 9th day of metformin treatment, and after 2 days, his FBS dropped to 175 mg/dl. After 8 weeks on metformin and the cobiotic, his blood sugar was 100 mg/dl and he lost 5.5 kg. His stools became soft and formed on the cobiotic, reverted to diarrhoea when off of it for 2 days, and returned to normal on resuming the cobiotic formulation. Metformin is a safe, effective and inexpensive generic medication favouring weight loss, recommended as initial treatment of type 2 diabetes by the American Diabetes Association. However, a 20% incidence of diarrhoea limits its tolerability. A safe food supplement that can increase the efficacy of metformin and its tolerability, as occurred in this case report, would have significant positive public health consequences. A controlled clinical trial of the cobiotic with metformin is planned.
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Anonymous, 2012. Standards of medical care in diabetes – 2012. Diabetes Care 35 Suppl. 1: S11-S63.
Bays, H., Frestedt, J.L., Bell, M., Williams, C., Kolberg, L., Schmelzer, W. and Anderson, J.W., 2011. Reduced viscosity barley beta-glucan versus placebo: a randomized controlled trial of the effects on insulin sensitivity for individuals at risk for diabetes mellitus. Nutrition and Metabolism 8: 58.
'Reduced viscosity barley beta-glucan versus placebo: a randomized controlled trial of the effects on insulin sensitivity for individuals at risk for diabetes mellitus ' () 8 Nutrition and Metabolism : 58.
Beckmann, L., Simon, O. and Vahjen, W., 2006. Isolation and identification of mixed linked beta-glucan degrading bacteria in the intestine of broiler chickens and partial characterization of respective 1,3-1,4-beta-glucanase activities. Journal of Basic Microbiology 46: 175-185.
'Isolation and identification of mixed linked beta-glucan degrading bacteria in the intestine of broiler chickens and partial characterization of respective 1,3-1,4-beta-glucanase activities ' () 46 Journal of Basic Microbiology : 175 -185.
Cani, P.D., Bibiloni, R., Knauf, C., Waget, A., Neyrinck, A.M., Delzenne, N.M. and Burcelin, R., 2008. Changes in gut microbiota control metabolic endotoxemia-induced inflammation in high-fat diet-induced obesity and diabetes in mice. Diabetes 57: 1470-1481.
'Changes in gut microbiota control metabolic endotoxemia-induced inflammation in high-fat diet-induced obesity and diabetes in mice ' () 57 Diabetes : 1470 -1481.
Dandona, P., Fonseca, V., Mier, A. and Beckett, A.G., 1983. Diarrhea and metformin in a diabetic clinic. Diabetes Care 6: 472-474.
'Diarrhea and metformin in a diabetic clinic ' () 6 Diabetes Care : 472 -474.
DeFronzo, R.A. and Abdul-Ghani, M., 2011. Type 2 diabetes can be prevented with early pharmacological intervention. Diabetes Care 34 Suppl. 2: S202-S209.
'Type 2 diabetes can be prevented with early pharmacological intervention ' () 34 Diabetes Care : S202 -S209.
Dikeman, C.L., Murphy, M.R. and Fahey Jr., G.C., 2006. Dietary fibers affect viscosity of solutions and simulated human gastric and small intestinal digesta. Journal of Nutrition 136: 913-919.
'Dietary fibers affect viscosity of solutions and simulated human gastric and small intestinal digesta ' () 136 Journal of Nutrition : 913 -919.
El Khoury, D., Cuda, C., Luhovyy, B.L. and Anderson, G.H., 2012. Beta glucan: health benefits in obesity and metabolic syndrome. Journal of Nutrition and Metabolism 2012: 851362.
'Beta glucan: health benefits in obesity and metabolic syndrome ' () 2012 Journal of Nutrition and Metabolism : 851362.
Goldberg, R.B., Temprosa, M., Haffner, S., Orchard, T.J., Ratner, R.E., Fowler, S.E., Mather, K., Marcovina, S., Saudek, C., Matulik, M.J. and Price, D., 2009. Effect of progression from impaired glucose tolerance to diabetes on cardiovascular risk factors and its amelioration by lifestyle and metformin intervention: the Diabetes Prevention Program randomized trial by the Diabetes Prevention Program Research Group. Diabetes Care 32: 726-732.
'Effect of progression from impaired glucose tolerance to diabetes on cardiovascular risk factors and its amelioration by lifestyle and metformin intervention: the Diabetes Prevention Program randomized trial by the Diabetes Prevention Program Research Group ' () 32 Diabetes Care : 726 -732.
Greenway, F., O’Neil, C.E., Stewart, L., Rood, J., Keenan, M. and Martin, R., 2007. Fourteen weeks of treatment with Viscofiber increased fasting levels of glucagon-like peptide-1 and peptide-YY. Journal of Medical Food 10: 720-724.
'Fourteen weeks of treatment with Viscofiber increased fasting levels of glucagon-like peptide-1 and peptide-YY ' () 10 Journal of Medical Food : 720 -724.
Inzucchi, S.E., Bergenstal, R.M., Buse, J.B., Diamant, M., Ferrannini, E., Nauck, M., Peters, A.L., Tsapas, A., Wender, R. and Matthews, D.R., 2012. Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 35: 1364-1379.
'Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) ' () 35 Diabetes Care : 1364 -1379.
Isaksson, G., Lundquist, I. and Ihse, I., 1982. Effect of dietary fiber on pancreatic enzyme activity in vitro. Gastroenterology 82: 918-924.
'Effect of dietary fiber on pancreatic enzyme activity in vitro ' () 82 Gastroenterology : 918 -924.
Licht, T.R., Hansen, M., Poulsen, M. and Dragsted, L.O., 2006. Dietary carbohydrate source influences molecular fingerprints of the rat faecal microbiota. BMC Microbiology 6: 98.
'Dietary carbohydrate source influences molecular fingerprints of the rat faecal microbiota ' () 6 BMC Microbiology : 98.
Manach, C., Scalbert, A., Morand, C., Remesy, C. and Jimenez, L., 2004. Polyphenols: food sources and bioavailability. American Journal of Clinical Nutrition 79: 727-747.
'Polyphenols: food sources and bioavailability ' () 79 American Journal of Clinical Nutrition : 727 -747.
Pendyala, S., Walker, J.M. and Holt, P.R., 2012. A high-fat diet is associated with endotoxemia that originates from the gut. Gastroenterology 142: 1100-1101.e2.
'A high-fat diet is associated with endotoxemia that originates from the gut ' () 142 Gastroenterology : 1100 -1101.e2.
Qin, J., Li, Y., Cai, Z., Li, S., Zhu, J., Zhang, F., Liang, S., Zhang, W., Guan, Y., Shen, D., Peng, Y., Zhang, D., Jie, Z., Wu, W., Qin, Y., Xue, W., Li, J., Han, L., Lu, D., Wu, P., Dai, Y., Sun, X., Li, Z., Tang, A., Zhong, S., Li, X., Chen, W., Xu, R., Wang, M., Feng, Q., Gong, M., Yu, J., Zhang, Y., Zhang, M., Hansen, T., Sanchez, G., Raes, J., Falony, G., Okuda, S., Almeida, M., LeChatelier, E., Renault, P., Pons, N., Batto, J.M., Zhang, Z., Chen, H., Yang, R., Zheng, W., Yang, H., Wang, J., Ehrlich, S.D., Nielsen, R., Pedersen, O. and Kristiansen, K., 2012. A metagenome-wide association study of gut microbiota in type 2 diabetes. Nature 490: 55-60.
'A metagenome-wide association study of gut microbiota in type 2 diabetes ' () 490 Nature : 55 -60.
Stull, A.J., Cash, K.C., Johnson, W.D., Champagne, C.M. and Cefalu, W.T., 2010. Bioactives in blueberries improve insulin sensitivity in obese, insulin-resistant men and women. Journal of Nutrition 140: 1764-1768.
'Bioactives in blueberries improve insulin sensitivity in obese, insulin-resistant men and women ' () 140 Journal of Nutrition : 1764 -1768.
Turnbaugh, P.J., Ley, R.E., Mahowald, M.A., Magrini, V., Mardis, E.R. and Gordon, J.I., 2006. An obesity-associated gut microbiome with increased capacity for energy harvest. Nature 444: 1027-1031.
'An obesity-associated gut microbiome with increased capacity for energy harvest ' () 444 Nature : 1027 -1031.
Vijay-Kumar, M., Aitken, J.D., Carvalho, F.A., Cullender, T.C., Mwangi, S., Srinivasan, S., Sitaraman, S.V., Knight, R., Ley, R.E. and Gewirtz, A.T., 2010. Metabolic syndrome and altered gut microbiota in mice lacking Toll-like receptor 5. Science 328: 228-231.
'Metabolic syndrome and altered gut microbiota in mice lacking Toll-like receptor 5 ' () 328 Science : 228 -231.
Vitaglione, P., Lumaga, R.B., Stanzione, A., Scalfi, L. and Fogliano, V., 2009. beta-Glucan-enriched bread reduces energy intake and modifies plasma ghrelin and peptide YY concentrations in the short term. Appetite 53: 338-344.
'beta-Glucan-enriched bread reduces energy intake and modifies plasma ghrelin and peptide YY concentrations in the short term ' () 53 Appetite : 338 -344.
| All Time | Past 365 days | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 823 | 247 | 29 |
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The gut microbiome plays an important role in regulation of metabolic processes, including digestion, absorption, and synthesis of bioactive molecules that signal physiological host mechanisms. Changes in the human gut microbiome are associated with type 2 diabetes and insulin resistance. Water-soluble dietary fibres like inulin and beta-glucan are fermented in the colon, and beta-glucan increases viscosity. Blueberries improve insulin sensitivity through an antioxidant effect. A cobiotic, consisting of purified inulin, sugar-free blueberry pomace extract, and an oat preparation of purified beta-glucan was developed for twice a day (bid) consumption as a smoothie drink to repair the gastrointestinal dysbiosis in type 2 diabetes. A 30-year-old man presented with new onset type 2 diabetes and a fasting glucose (FBS) of 375 mg/dl. Metformin 500 mg bid was initiated and increased to 1 g bid after 1 week. During the first 9 days of metformin treatment, he developed diarrhoea, but his FBS only dropped to 325 mg/dl. The cobiotic bid was added on the 9th day of metformin treatment, and after 2 days, his FBS dropped to 175 mg/dl. After 8 weeks on metformin and the cobiotic, his blood sugar was 100 mg/dl and he lost 5.5 kg. His stools became soft and formed on the cobiotic, reverted to diarrhoea when off of it for 2 days, and returned to normal on resuming the cobiotic formulation. Metformin is a safe, effective and inexpensive generic medication favouring weight loss, recommended as initial treatment of type 2 diabetes by the American Diabetes Association. However, a 20% incidence of diarrhoea limits its tolerability. A safe food supplement that can increase the efficacy of metformin and its tolerability, as occurred in this case report, would have significant positive public health consequences. A controlled clinical trial of the cobiotic with metformin is planned.
| All Time | Past 365 days | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 823 | 247 | 29 |
| Full Text Views | 83 | 21 | 0 |
| PDF Views & Downloads | 64 | 8 | 0 |