Can you ”hack” into your gut to obtain the slimming effects of a drug for diabetes?

Could you talk about the claims made on the video from a clinical perspective?

This drug increases GLP-1, which is a hormone primarily produced by the endocrine cells (also called enteroendocrine cells) in the gut. It boosts the secretion of insulin (incretin effect), slows down gastric emptying and stimulates the sensation of being full, making you feel less hungry.

What about fibre and taking a probiotic?

It is well known that dietary fibre, especially soluble fibre, can slow down gastric emptying, making you feel full and help control your appetite. Fibre can also help stabilise blood sugar levels by slowing down the absorption of carbohydrates, which can be beneficial in diabetic patients. What’s more, fibre-rich food often has a lower energy density, which can help reduce the overall calorie intake and potentially help patients to lose weight when eaten as part of a balanced diet. In terms of the gut microbiota, I agree with Dr. DeDecker about the fact that most fibre has a prebiotic effect and will nourish certain gut bacteria, which are then able to produce short-chain fatty acids (SCFAs) through fermentation, and these SCFAs can increase GLP-1 levels.

I would, however, qualify the statements about the bacterium she mentions, Akkermansia muciniphila, which she credits with tremendous benefits in terms of regulating energy metabolism and insulin sensitivity, as some studies have suggested it plays an indirect role in regulating the secretion of intestinal peptides such as GLP-1. However, this is preclinical data, and the link could be a fairly indirect one. Thus, there is no evidence to claim that supplementation with this bacterium could increase GLP-1 secretion and lead to weight loss.

Why do you think that this video has attracted so much attention? 

In my opinion, it was very easy for this video to create a buzz because it deals with weight loss, and in the West with our high rates of overweight and obese people (50-60% of the population), there are many who dream of being able to lose weight without changing their lifestyle, particularly their diet. So if you suggest that a natural method exists to lose 20% of your bodyweight without taking a drug, you can easily see why it appealed to so many people.

Would you give this information to your patients?

What could be the risks and/or pitfalls? That’s my personal opinion and I think that Dr. DeDecker’s comments are somewhat misleading, because neither taking any kind of probiotic nor increasing dietary fibre has shown any benefit in terms of weight loss, let alone a 20% one. However, despite these misgivings, I do think what she has to say is interesting as it could have the positive effect of reducing the misuse of anti-diabetic medication, as well as raising public awareness of the impact of the gut microbiota on our health. And, more importantly, she is encouraging people to eat more fibre. The current consumption of fibre in Western countries (less than 20 g/day) is well below the World Health Organisation’s recommendations (25-30 g/day), and only 5% of Americans eat enough fibre.