Since I first started talking about this topic, about five years ago, more research continues to evolve connecting the dots between gut health and cardiovascular health. Cardiovascular health includes the health of your heart, vasculature, and blood. The number of potential threats to these three components of our cardiovascular system is numerous, but the organisms that live in our gut have not been high on the traditional cardiology radar as one of these threats. This is changing. This blog post revisits blood glucose and the gut microbiome.

I want to first just make the point that diabetes and heart disease are two peas in a pod. You can’t have diabetes without some cardiac risk and likely, if you have heart disease, you may have some level of insulin dysregulation.  Even this relationship of diabetes and heart health is only recently being made more public. If you watch any television, you've probably seen the commercial where a "diabetes expert" asks random people on the street if they realize that diabetes raises heart disease risk? The street actors are shocked to learn this connection between diabetes and the heart.

This isn't new information in medicine but the average person doesn't recognize it.  Not that TV commercials should dictate your health choices, but this time the message is valuable.

Enter the gut microbiome. The future of cardiovascular health will include some level of gut assessment. Back in 2012, Alex Rae MD, director of Columbia University’s medical center stated, “It is almost a certainty that microbiome-based clinical diagnostics and treatments will be available in the near future to identify patients who are at risk for developing CVD.”

Dr. Rae’s prediction was on track.

The gut microbiome and their metabolites impact nearly every aspect of our biology.  These metabolites can be measured in urine and stool and then researched in relation to individual biomarkers such as blood sugar or cholesterol. Such metabolites or byproducts include butyrate, histamine, tryptophan, and serotonin, to name just a few.  We don't even know all of the metabolites our gut microbiota produce but their consequences, in part, probably depends on their amount and location. 

A landmark 2016 study in Cell Science was the first to specifically demonstrate this association of postprandial glycemic response (PPGR), the organisms in our stool and the foods in our diet. Using a sophisticated algorithm, an 800-person cohort successfully predicted the foods that will best maintain a healthy blood sugar based on gut bacterial profiles and other more personalized characteristics.

In other words, the diets in the study, (which were created by RDs) were chosen based on a number of individual characteristics with a major factor being a person's gut bacterial profile. A smaller study by the Mayo clinic confirmed these results. https://bit.ly/33Szjme. These diets better-controlled blood sugar than conventional diabetes guidelines. This sentence bears repeating. Post-meal blood sugars were better managed when considering the bacterial profile of the individual.

DayTwo’s research is taking Dr. Rae's projections full circle. By eating the carbohydrates and diet that best match the organisms in your stool---you may be able to better control your blood sugar. And not everyone's choice of carbs will be the same--because we don't all have the same organisms in our gut. Plus our gut profile is influenced by our genes, medications and diet. A piece of bread may raise one person's blood sugar but not someone else’s because their gut flora is different.

DayTwo's research doesn't claim to know how to change your microbiota or claim that the foods that keep your blood glucose normal are necessarily healthy. However,they did use registered dietitians with the goal in mind of creating healthy meal plans. They are also able to combine certain foods based on your gut profile to better manage blood glucose. 

Is this information being used in mainstream medicine? Unfortunately, I haven’t seen any cardiologists considering this research. Yes, more people are manipulating their carbohydrates to manage their blood sugars and I have had good sucess with my own clients. But are cardiologists paying attention to gut health?

I discussed DayTwo’s research at length during two 2017 full day workshops that my colleague, Kate Scarlata, RDN and I gave on the Gut Microbiome. RDs and RNs are in a perfect position to learn this information and pass it on.

Recognize the Connection:

Our clients come to see us because they don’t feel well, they may feel “out of balance”. By doing a thorough medical history, you will gain clues that better describe this tip in balance. First, recognize the potential connection between gut health and cardiovascular health.

You might not ordinarily associate these symptoms with one another: GERD, diarrhea, constipation and SIBO. OR, hyperlipidemia, hypertension, elevated blood sugars and any gut dysbiosis. These may not be mutually exclusive presentations.

Connect the dots.

• GERD

• Insulin Resistance

• Constipation/Diarrhea

• Hyperlipidemia

• SIBO

• IBD

• Hypertension

Why focus on blood sugar? (and insulin).

Blood sugar regulation is a reflection of our metabolism.  An elevated blood sugar carries increased risk for lots of things--insulin resistance, diabetes, heart disease, metabolic syndrome, fatty liver disease and even changes in brain health.. Recognizing this association of blood sugar and our gut microbiome may give us more options for prevention and treatment. We want to maintain a healthy blood sugar with healthy foods--and manipulating the gut microbiota via healthy foods, prebiotics and probiotics is the direction this research is leading.

The biotech world is moving fast on this. Most companies today use advanced PCR (polymerase chain reaction) testing—testing the DNA of the organisms. Here’s a good review why all labs and physicians should be utilizing PCR testing. https://bit.ly/2MDypUY

Vedanta Biosciences and Viome are two different companies with a gut microbiome focus- both claiming that their sophisticated PCR testing will do wonderful things for you. Vendata is developing a class of drugs to positively manipulate your gut microbiome and Viome associates your gut profile with various disease risks. Many of these companies are taking what I call the 30,000 foot view of your gut flora. DayTwo also takes a global look. of your gut flora. They do not diagnose or use quantitative assessmen, however, they are the only ones who have been able to demonstrate in a cohort study a change in a specific biomarker—blood glucose based on bacterial profiles.

Other companies such as Diagnostic Solutions take a closer look at certain groups of organisms, including commensal and some pathogenic organisms. I call this the 10,000 ft view. This is more beneficial in targeting and treating gut dysbiosis. They are more quantatative in their PCR assessment. I use Diagnostic Solution’s, GI Mapping to assess my client’s gut health.

I believe this research is all good, though is in its infancy.  We are in somewhat uncharted territory here, not fully knowing the consequences of robustly and intentionally shifting the gut ecosystem or even exactly knowing what our individual gut microbiome is made of or the interactions with our unique genetic makeup. 

Our fast paced life, abundant medications/drugs and western diet has already shifted the gut microbiome of many people to a not so healthy place. The one thing you can control is the food you eat. Everything you eat affects your gut microbiome-carbs, protein, fat, alcohol --even artificial sugars. 

From a nutrient density perspective, we all should be striving to eat a balance of vegetables, fruits, whole grains, legumes, nuts/seeds, animal proteins and fats-- but the amounts and types will be different for each of us. We are all susceptible to changes in blood glucose management-even thin, lean people. Health can change for a variety of reasons.

Recognize the gut-heart connection. 

What keeps blood sugars in a healthy range?

1.   Eating a low- moderate carbohydrate diet with adequate protein, healthy fats and adequate, varied fibers.

2.  Maintaining a healthy gut microbiota.

3.  Avoiding belly or visceral body fat gain.

3.  Exercising:  aerobic and resistance training.

4.  Staying healthy: avoiding colds, flus, stomach bugs, autoimmune problems.

5.   Managing your medications.

6.  Managing stress.

7.  Getitng adequate sleep

Stay tuned ---personal diet prescriptions and the gut microbiome will be a routine part of future health care.