“MicrObesity”: Obesity, the gut microbiome and a fresh approach to weight loss
29th May is World Digestive Health Day and this year (2021) is dedicated to raising awareness and support for obesity.
Few people are aware of the growing research linking obesity to specific imbalances in the gut microbiome. I explain the current research and the targeted steps to take in order to approach weight management from a fresh perspective.
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Obesity Statistics and Metabolic Conditions
Obesity in the UK is of enormous concern due to its health implications and costs to society as a whole. In 2019 it was estimated that 28% of adults were obese (BMI greater than 30) with a further 36% overweight (BMI 25-30); and the numbers continue to rise.
Obesity is not just a weight issue. It is linked to metabolic disease and systemic low grade inflammation that includes cardiovascular disease like hypertension; impaired glucose tolerance which can lead to insulin resistance and Type 2 Diabetes; NAFLD (non-alcoholic fatty liver disease); and chronic health outcomes associated with T2D like blindness and amputations.
What links the gut microbiome and obesity?
Rather than focus just on diet and exercise, there is a third factor that is relevant: the gut microbiome. As long ago as 2011, the microbiome was considered as a new therapeutic target against obesity but there is little sign yet of this being taken seriously by the medical community.
The microbiota consists of over 100 trillion microbes weighing 1-2kg consisting of a vast range of bacterial species. Whilst over 1000 species of gut microbes have been identified, most individuals have approx. 160 different species. And it is the make-up of these species that is the crucial factor.
We already know how certain strains influence progression to specific diseases and more research is showing how this can link to obesity and its related health conditions too.
“Good” vs “bad” bacteria
The composition of the gut microbiome consists of those known as commensals- the friendly, health promoting types that we want to find in abundance and in as a wide a diversity of strains as possible.
Then there are others that are more pathogenic in nature that include those called gram negative bacteria. The outer membrane of these bacteria shed compounds known as lipopolysaccharides (LPS) and these are very toxic to humans both inside the gut and around the rest of the body. These LPS compounds are known to damage the gut lining making it more permeable allowing toxins to pass through into the blood stream. Once in the bloodstream, LPS become inflammatory.
In studies on mice with increased plasma levels of LPS it resulted in increased fasting blood glucose levels, increased liver fats (triglycerides), liver insulin resistance and increased adipose tissue weight gain. In human studies high levels of LPS reduced insulin sensitivity, resulting in higher blood glucose and this can lead to fat storage. Not a pretty picture!
What Steps can be taken to reduce LPS producing bacteria?
A high fat diet- those from saturated fats – can lead to dysbiosis with an increase in the gram negative (LPS) bacteria and reducing beneficial strains. So those who follow a ketogenic diet may wish to reconsider the long-term implications. Whilst “keto” can certainly help shift weight in the short-term it should not be the diet of choice for long-term health.
At the same time, improved levels of certain beneficial strains that produce a substance called butyrate improves the gut mucosal lining (reducing gut permeability and therefore making it more difficult for toxins to pass through to the bloodstream). Butyrate is also a fuel for other beneficial strains of bacteria which help to lower systemic inflammation, improve insulin sensitivity and glucose tolerance, inhibit cholesterol synthesis and lead to weight loss and a healthier metabolic status.
And increasing beneficial bacteria helps to crowd out the pathogenic “LPS” ones too.
Dietary steps to fuel beneficial bacterial strains
Dietary fibres are of course an essential element. These are not digested by humans but are fermented by gut bacteria. A plant based diet (not vegetarian or vegan) with 30+ types of plant foods a week is the general “gut friendly” diet to follow.
To help boost levels of the butyrate bacterial strains, eat plenty of red polyphenol rich foods such as red rice, red legumes, plums, red apples, pomegranate, black and red currants, cranberries and all berries.
Increase intake of soluble fibre. It’s found in plant foods but rich sources are oats (preferred soaked), brown rice, apples (stewed is best for its pectin content).
Include resistant starch which is trapped in the plant cell walls. This is found in soaked (less in cooked) oats, cooked then cooled rice and baked potatoes, green bananas, legumes like chickpeas.
Do keep eating oily fish as it has an anti-inflammatory effect on the gut and the whole body.
What about probiotics and fermented foods?
Probiotic bacteria and fermented foods like Kombucha, Kefir and Sauerkraut have been shown to have a temporary effect on raising gut microbial diversity but not a long-term improvement. They can be helpful to do in conjunction with the dietary changes as the dietary approach alone may take longer to alter the gut microbial composition.
Just like most disease states in humans, the links between the gut microbiome and obesity and its associated metabolic conditions like T2D and CVD cannot be ignored. And just like most dietary advice I provide, the diet that best serves the gut, is the diet that best serves entire human health.
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