Transcription
Hey everyone, let's discuss Acromania muciniphila, a new probiotic. I want to assess some of the claims about this probiotic against the evidence and attempt to come away with a practical, reasonable, and scientifically informed perspective on Acromania. To share my perspective going into reviewing the research, I tend to be constitutionally suspicious. The reason for this is that early in my career, I may have had, you could say, rose-colored glasses on, where I assumed everything in natural health was good, effective, and could do no harm. Over the years, and upon fact-checking many product claims, tests, etc., I've more often than not become disappointed. This is why the perspective I take with you is one that's more guarded—certainly open-minded and wanting to explore any therapeutic that could alleviate suffering and optimize health—but also seeing how many people can waste money or chase a frivolous diagnosis and suffer the psychological turmoil that is connected to that. I try to be scrupulous with fact-checking the things that we discuss and delivering to you a reasonable and evidence-informed perspective when we have evidence. As I've said many times, there are some areas in healthcare where there's not much research, and clinicians are kind of in the trenches doing the best they can, trying to take anecdotes and use those to inform how to practice. Nevertheless, let's review Acromania and give you what I feel to be the most reasonable perspective on this new and potentially novel probiotic.
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A few definitions: What is Acromania? It's a commensal bacteria, so it's normal to the human gut, discovered in 2004 by Muriel Darian and colleagues at the University of Netherlands. One interesting aspect is that it lives in the mucus lining of the gut and can therefore interact with the immune cells, which may provide more benefits. However, we want to be careful not to take something interesting mechanistically and draw assumptions from that.
While we're on the topic of mechanism, because it can live in the gut lining, Acromania tends to use mucus to produce short-chain fatty acids. This sounds really good because, if you know anything about short-chain fatty acids, these are fuel for the enterocytes or for the intestinal cells. However, there are some conditions, such as some subsets of IBS, that have too much short-chain fatty acids. Some populations that are overweight may have too much short-chain fatty acid as well. So, we want to be careful again to contextualize that mechanism; it doesn't automatically translate to something that's clinically helpful.
Because of where Acromania resides, it may support the gut barrier and make the gut barrier thicker. It also has metabolic implications in that Acromania stimulates GLP-1 (glucagon-like peptide 1). As you can imagine, with glucagon being a fasting hormone, it's associated with the promotion of satiety and lowering of blood sugar. So, there's the background context. Now, let's look at some of the claims in terms of what it might do to help you and fact-check those against the evidence. Probiotics, as we've been discussing on the show for quite a while now, are a pretty remarkable tool. There is a lot of research categorically on probiotics demonstrating benefits across a wide array of conditions. This is where I think the fact-checking is going to be quite helpful. By the way, if this has been helpful, please subscribe, comment, and if there's one person you think this might help, please share it.
Okay, so coming to the Acromania claims: the first one, and the one that might be the most novel, is that Acromania is the only strain that lives in and regulates the gut lining. This sounds fantastic; it's actually incorrect. We can quickly pull up, for example, a 2022 study that found 25 species that live in the lining of the gut, and there's even a term for this already: the mucosa-associated microbiome. So, that's one claim that I think is pretty easy to set the record straight on. It does live in the lining of the gut; it's definitely not the only species that lives in the lining of the gut.
The second claim is that Acromania is a major part of the gut microbiome. I find this claim to be misleading, and let me give you the data that informs my perspective on this. The total gut microbiome contains 1 to 5% Acromania; comparatively, it contains 2 to 14% Bifidobacteria. Additionally, if we zoom in on the small intestine—which, for reasons we've elaborated on ad nauseam in the past, is probably the most important area of the gut since you absorb 90 to 95% of calories there—this is where you have the most opportunity for leaky gut to occur, the most immune activation, and the most gut receptors. It's really the most important area of the gut. Not to say the other areas are not important, but again, nutrient absorption and immune regulation are predominantly occurring here. So, Acromania here represents less than 0.5% of the microbiome, and comparatively, Lactobacillus represents 6% of the small intestinal microbiome. To say it's a major regulator? Maybe, but I think it's a bit of a stretch. If someone were to hear that claim, they might think, "Oh, well, if it's a major regulator, it's got to be better than the other probiotic that I'm currently taking that might contain Lactobacillus and Bifidobacterium." When we represent it as such, I think it's more correct to say it's a part; I wouldn't say it's a major part.
Another claim here is that low levels of Acromania are associated with poor health. Again, this is misleading; it's really only giving you part of the data set here. Yes, lower levels of Acromania have been associated with obesity, type 2 diabetes, and inflammatory bowel disease, but conversely, higher levels have been associated with irritable bowel syndrome, Parkinson's, and multiple sclerosis. This hearkens back to a concept I had written about in "Healthy Gut, Healthy You" years ago, which is that we should be careful not to micromanage an ecosystem. We shouldn't say, "Well, some healthy populations and cohorts have higher Acromania; now we're just going to target Acromania and try to increase it or decrease it." I think that misses the bigger picture of the ecosystem that is the gut. I'll reinforce that concept here more in just a moment.
Now, let's go to Acromania and its impact on metabolism and its claims that Acromania is pro-metabolic, if you will, and promotes gut health. I feel these claims to be partially true, although there are a couple of caveats. The data are really early, and in some cases, I feel that the data are ahead of what the science is showing. Huge credit here to our research team for distilling this down into a table. If you're just listening to this, I'll narrate. What you're seeing here is a comparative table looking at one trial—one randomized control trial that administered Acromania plus a few other species like Clostridium butyricum. We're going to compare that to a meta-analysis of 15 clinical trials that administered Lactobacillus and Bifidobacterium blend-type probiotics. This is not an apple-to-apple comparison; it's a meta-analysis versus one clinical trial. Nevertheless, you see equivalent results comparing the probiotics regarding hemoglobin A1c impact—that's the average of your blood sugar over roughly two months. You see superior results with the Lactobacillus and Bifidobacterium blend-type probiotic for both fasting glucose and for insulin resistance, so that's blood sugar.
Moving on to lipids, weight loss, and leaky gut, here we can compare one randomized control trial administering Acromania alone, comparing this to Lactobacillus and Bifidobacterium probiotic research, wherein we have two meta-analyses summarizing 51 clinical trials. You see equivalency for impacts on LDL cholesterol. You see better results with Acromania for triglycerides and for weight loss, and you see better results with the Lactobacillus and Bifidobacterium blend probiotics for leaky gut in the sense that there's more data showing that the Lactobacillus-Bifidobacterium blend probiotics can improve LPS, a direct marker of leaky gut, and can improve zonulin via blood testing and lactulose-mannitol ratio testing. Taken collectively, it's interesting to see some of these impacts from Acromania, and hopefully, further data will reinforce that there's this sort of pro-metabolic effect, at least pertaining to triglycerides and to weight loss.
That being said, I should acknowledge that there's something known as positive publication bias for new therapeutics. Papers tend to get granted access for publication when they're showing a positive finding because it's more interesting. So, when a therapeutic is new, there tends to be one or a couple of positive studies that first appear in the research journals, and then with more time, you see a better sampling where you'll have some of the null findings or some negative studies. This is why this comparison is so salient because we're looking at one randomized control trial compared to 20 to 50 randomized control trials. A real-world analogy for this would be if you had a friend who went to a restaurant and this person really loved the restaurant. Well, that's one person's perspective; you may or may not agree with your friend's perspective. But if you asked 50 people what they thought of the restaurant, you would get a more accurate representation of what the experience at the restaurant was likely to be because you had a larger sample.
So again, interesting, and I would not say by any stretch this means we're disqualifying Acromania as something to potentially try, but I would be bridled with the claims that represent this as super novel on the gut and this really important, almost "holy grail" probiotic due to the impact on GLP-1 and therefore on metabolism. Interesting, but I think we're still a little bit early in this conversation.
I wanted to make sure to point out to you that we have other probiotic research—really meta-analyses on either Lactobacillus and Bifidobacterium blend probiotics or Saccharomyces boulardii or soil-based probiotics—showing improvements in leaky gut, IBS, IBD, constipation, SIBO, and depression. So again, it's not to take anything away from Acromania, but my concern is that you may be hit with claims about Acromania that represent it as being better than the current probiotics that we have, and I just don't see the case for that.
Now, again, it's not to say you couldn't trial Acromania, but I want you to have a balanced perspective on what the research is showing. Additionally, there are ways that you can naturally increase Acromania that do not require you to take Acromania as a supplement. This comes back to the ecosystem analogy, meaning as a general observation, things that improve host health tend to improve the richness, diversity, and balance of the microbiota. So, if we intervene upstream and do things that are health-promoting—sleep, exercise, stress management, fermented food consumption, healthy diet regarding polyphenols, fiber, proteins, and fats—then we tend to see these downstream impacts of a healthy microbiota, and we can even add to that probiotic supplementation.
Let me loop in a few things here. Firstly, two studies have shown that eating a diet rich in prebiotics—these are the things that feed bacteria—prebiotics and FODMAPs actually increase Acromania levels. So, on the one hand, this is great; if you eat essentially more fruits and vegetables, then you can feed your gut bacteria and see improvements in Acromania levels. However, as we've discussed many times on the show in the past, especially if someone has gut symptoms, a diet high in fruits and vegetables, and most specifically prebiotics and FODMAPs, might flare their symptoms and be deleterious for their microbiota.
This is where a wonderful 2022 meta-analysis in general gut health from Chris Black and colleagues at the University of Leeds is very relevant. To quote, the low FODMAP diet ranked first for abdominal pain severity, abdominal bloating or distension severity, and for bowel habits. So, coming back to the analogy of not wanting to micromanage the ecosystem, let's say you did a stool test, and your healthcare provider said you're low in Acromania. They might advise you to eat more fruits and vegetables, and you were already eating a decent amount of fruits and vegetables, so you weren't way under the norm of the standard American diet. If you also had gas, bloating, suspected leaky gut for whatever reason, abdominal pain, loose bowels, or constipation, and then you started eating more fruits, vegetables, prebiotics, and FODMAPs, your symptoms could get worse. This would be a good example of where treating a specific lab marker can actually lead you to undertake an intervention that might be the opposite of what's helpful for you.
That point aside, there are other dietary strategies that have also been shown to improve levels of Acromania. When a low-calorie diet is combined with exercise, in the appropriate context, this can be health-promoting if someone needs to lose some weight. Now, if someone is underweight, that wouldn't be a good idea. Other research has shown the same for a ketogenic diet or for intermittent fasting or for the consumption of polyphenols. This comes from animal data, so we should be a little bit bridled, but with the consumption of cranberry extract or Concord grape, they were able to demonstrate improvements in Acromania due to the polyphenol content. Lastly, a 2022 randomized control trial found that a Lactobacillus and Bifidobacterium blend probiotic increased Acromania levels.
So, we have a number of strategies here that not everyone needs to do. Not everyone should be ketogenic; not everyone should be fasting. But the point that I'm trying to make is there are multiple things that you can do to improve Acromania, some of which may make you feel good and some of which may flare you. So, we want to be careful not to just blindly try to increase levels of one bacteria in the gut absent your experience.
Another way of thinking about this is that Acromania, like many bacteria in the gut, might be a proxy for host health. Meaning, if we take people who don't exercise and we serially assess their microbiome over time, when they start exercising, their microbiome shifts and becomes more diverse and healthier. When they stop exercising, it becomes less diverse. We see the same thing with disruptions of sleep. So, I just want to be careful to tie that concept so that you don't treat the lab markers at the exclusion of listening to your body and using that biofeedback as the best way to determine what therapies work best for you. This happens all the time where people go low-carb and they don't feel well, but they keep doing it, or people go high-fiber and they don't feel well, and they keep doing it because they're treating a lab value and not listening to their body.
Okay, so then a few conclusions regarding Acromania muciniphila: it's new, and I think it's interesting. I do have some concerns that it's being misrepresented as a novel gut regulator, the only one that lives in the lining of the gut, that it's a major player in the GI tract, and that it's always low in disease states. I think these are either untrue or misleading. Again, reviewing the data, Acromania appears inferior for blood sugar; it might be better for weight loss and for lipids, although we should be cautious because it's one randomized control trial comparing to meta-analyses of several. It also appears to be helpful for leaky gut, at least for LPS, but again, based upon one study, and there's no research yet in gastrointestinal conditions like reflux, bloating, IBS, or IBD.
With all that said, I do think Acromania is worth a trial. I would advise trying a triple therapy probiotic first, or really any probiotic first, in the three categories that we often discuss. We've discussed many studies on the blends of Lactobacillus and Bifidobacterium; that would be a great place to start. That would be a better place to start, in my view, given all of the research on that type of probiotic, before Acromania. Second to that, if you've used this type of probiotic, I would trial a combination of the Lactobacillus and Bifidobacterium blend plus a soil-based probiotic plus a Saccharomyces probiotic. Why is that? This is our hypothesis, but there are many randomized control trials for each type of these three probiotics. By using them together, again, our hypothesis is that the triple therapy or the three formulas together is just combining where we have a lot of research and using those three at once synergistically.
If you've done that, then I think Acromania would be advisable. Now, you could try Acromania whenever you want; there's no reason that you couldn't. But just looking at where we have the best data of healthy outcomes, it would be with the three types of probiotics that we've discussed so many times in the past. From there, then a trial on Acromania I think makes sense because good job with the company publishing some papers and doing the science. I want to commend that, but I also want to be careful that you don't take some of these remarks out of context and think that this is the new and therefore the best probiotic. I think that would be a mistake.
If you do try Acromania, remember that most of the studies are showing benefit within one to three months, so that would be your time period to assess whether this probiotic is helping, yes or no. There are one or two exceptions to this, wherein longer than three months may be necessary for constipation specifically and for cognitive impairment. But as a simple practical method of assessing, usually if it's the right fit from a diet perspective and from a probiotic perspective, for many interventions, you'll have a sense that's working within the first month. But again, I think if you want to be more rigorous, up to three months is probably a reasonable interval to then re-evaluate: do I feel any better?
That's a really important thing to bear in mind—that there should be some indication that this is helping you. I hope this has been helpful, and I'll be curious to hear your thoughts and comments in the comment section. Otherwise, I hope this helps you make a decision on whether or when you want to trial Acromania.