16th World Congress on Insulin Resistance, Diabetes & Cardiovascular Disease :

Personalized Diets Informed by Gut Microbiome Improve Health Outcomes

With Eran Segal, PhD, and Harvey Weingarten, MD

To physicians, the scenario is familiar but perhaps puzzling: Two patients with diabetes or pre-diabetes may follow the same diet, or similar ones, yet have very different results on their blood glucose testing and disease management.

That's not a surprise to Eran Segal, PhD, professor of computer science and applied mathematics at the Weizmann Institute of Science, Rehovot, Israel. In seeking an answer, he has found that individuals have very different blood glucose responses to foods, but that their distinctive responses remain stable over time.1

Dr. Segal and his team have developed an algorithm that can predict a person’s individualized response to food based on their gut microbiome, which may be then be used to provide patients with a diet tailored to achieve better blood sugar control and perhaps weight loss.1

"Personalizing our patients’ nutrition is as important as personalizing their medicine," Dr. Segal said based on the evidence from his lab,1,3 which he shared at the 16th World Congress on Insulin Resistance Diabetes and Cardiovascular Disease in Los Angeles, California.

Patient-Centered Advances in Blood Glucose Response

The human gut microbiome, recognized more and more as having a fundamental role in human health and physiology, has been shaped by multiple factors. But Dr. Segal argued that the microbiota of individuals appears less driven by genetics but rather by environmental factors that shape the microbiome.2

Postprandial hyperglycemia is linked with a variety of downsides, including not just an increased risk of diabetes but obesity, weight gain, depression, energy dips, damage to eyes and nerves, increased triglycerides and increased risk of dementia, cancer, and cardiovascular disease, said Dr. Segal. For his research on personalized nutrition, he focused on this postprandial glucose measure.1

Dr. Segal’s team enrolled 1,000 individuals who did not have diabetes; they consumed 50,000 meals and had two million glucose measurements taken by a continuous glucose monitor over the course of one week. Participants were required to log their food intake.

In addition, the researchers created a medical profile of each participant by gather data such as physiological measurements, laboratory test results, results of food frequency questionnaires, and measurements of their gut microbiota.

For the study, participants were given standardized meals containing 50 grams of available carbohydrates.1 Then the researchers looked at individual responses to these identical meals across several days and found the responses surprising.

Different people who ate the same meal had widely different responses, Dr. Segal said. For example, when he plotted four individual responses to bread, the two-hour post-prandial blood glucose ranged from about 80 mg/dl to 200 mg/dl.1

"When the same person ate the same meal on two days, the results are highly reproducible," he said, "In contrast, when different people consumed exactly the same meal, there were dramatically different results."

"We realized these findings may have immense implications," he told EndocrineWeb. What it suggests is that ''as far as controlling blood glucose, any universal recommendation [for a specific diet] would have limited efficacy for balancing glucose level.'' It also implies that concepts such as the glycemic index may help some but not others.

"We found many different correlations between blood markers and physical measures and the microbiota response," he said. Of greatest finding was confirmation of variability in post-prandial glucose response in different individuals that was linked to individual microbiota composition and function.1

Intestinal bacteria useful in devising individualized diet to improve blood glucose control.

Personalizing Diabetes Diet Based on Individual Gut Microbiome

The Segal research team developed an algorithm accounting for the food/microbiome correlations, which they then validated the model in an independent 100 person cohort study with favorable results.3

That led them to the next question: Could a personally tailored dietary intervention actually improve postprandial glucose response? With 26 new participants, the researchers randomized these individuals to a prediction arm, where the model was applied, or to the expert arm, with input from dietitians. Then the participants were switched to the other arm.

The personally tailored diet achieved lower post-prandial glucose levels, Dr. Segal said. In addition, favorable changes in the microbiota were evident after subjects followed this diet for one week.3

Individualized diets derived by the algorithm appeared to reduce spikes in blood glucose levels, as well as a dramatic reduction in the glucose time above 140 mg/dL. At baseline, the average glucose time above range was 2.5 hours.3 "We reduced that time to five minutes" for those following a personalized diet,” Dr. Segal said.

Practitioner Ready to Recommend Gut Microbiome Testing in Select Patients

Harvey Weingarten, MD, a family practice physician at Robert Wood Johnson Medical Center and St. Barnabas Hospital in Kendall Park, New Jersey, attended the WCIR session and said he planned to suggest this approach to his patients. He indicated having many patients with prediabetes and diabetes who have struggled with weight loss and for which this individualized dietary plan might be beneficial.

As such, He anticipated returning to his practice and recommending that patients who are interested and financially able to pay out-of-pocket for a gut microbiome analysis and personalized diet plans to try it.

He has followed the evolving research in the relationship of the gut microbiome and obesity in recent years. Already, he said, "I've been teaching my patients to build up their gut health." He has suggested to patients, for instance, that they incorporate organic fruits and vegetables and wild caught fish in their diets on a regular basis.

When patients have followed that advice, he told EndocrineWeb, "I have seen them achieve lower blood sugar levels with all else equal." But he reinforced the importance of making such changes as the benefits may go beyond blood glucose levels; it's about realizing better overall health. And he voiced optimism that individual microbiome-informed personalized diets may help enhance not just diabetes parameters but other health outcomes as well.

Microbiome testing is now offered by companies such as Viome and Day 2. Dr. Segal licensed his research technology to Day 2 and is a scientific consultant for the company. Dr. Weingarten has no financial conflicts. 

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