Akkermansia muciniphila is proving to be a superstar among microbes inhabiting the human gastrointestinal tract. Although it is currently commercially unavailable as a probiotic, Akkermansia has been hailed as being among emerging “second generation” probiotic organisms that yield unexpectedly substantial health effects. It is likely to become available either singly or as part of a collection of probiotic microbes near-future.
Humans are typically first exposed to this microbial species via breastfeeding, with 95% of adults harboring some proportion of Akkermansia. This unique miccroorganism, the only member of the Verrucomicrobia phylum of bacteria, is exceptionally responsive to its environmental conditions. In response to prebiotic fiber ingestion, for instance, it can increase 100-fold in number.
In experimental models, Akkermansia administration was associated with less weight gain on a weight gain diet, along with markedly less visceral fat accumulation. Much of the benefit is believed to be due to strengthening of the intestinal mucous lining and a reduction in metabolic endotoxemia, i.e., entry of bacterial lipopolysaccharide, LPS, into the bloodstream. LPS is a potent inflammatory toxin and keeping it at low levels in the bloodstream is a great advantage. Under normal circumstances, Akkermansia helps support the integrity of the intestinal mucous lining, both directly and by supporting the intestinal immune response and the health of other bacterial species—Akkermansia is what I call a “foundational species,” i.e., its activity supports to health and proliferation of other desirable bacterial species.
The Akkermansia population diminishes with aging. (The reduction in Akkermansia is just one among a landscape of changes in the microbiome with aging, such as proliferation of a few other mucous-consuming Bacteroides species and increasing dominance of Proteobacteria, a group that includes the Enterobacteriaeceae that comprise the organisms of SIBO. This is an issue I shall be discussing in future, as it is becoming clearer and clearer that a considerable portion of the phenomena of aging are due to SIBO and SIFO and may therefore be at least partially reversible.)
Other interesting observations include:
- Akkermansia is substantially reduced in number in people with psoriasis, inflammatory bowel disease, appendicitis, children who’ve received repeated courses of antibiotics, type 2 diabetes and pre-diabetes
- Akkermansia is enriched in slender people and athletes
- Akkermansia numbers diminish with a short-term (3-week) low-FODMAPs diet. This should come as no surprise, as FODMAPs are essentially the same as prebiotic fibers.
- Akkermansia increases substantially on a ketogenic diet and, along with Parabacteroides, may be responsible for the reduction in seizures achieved with ketosis
The totality of evidence, the majority of it observational and thereby inconclusive, suggests that, while Akkermansia can comprise anywhere from 0% to 5% of the total microbial population of the gut, maximum benefit occurs when it constitutes 4-5%.
A pilot clinical trial in humans was recently reported, however, in which participants with metabolic syndrome were administered 10 billion CFUs of Akkermansia per day for three months; compared to participants taking placebo, those receiving Akkermansia experienced 28% improved insulin sensitivity, 34% reduction in insulin levels, 5 pound weight loss, along with improvement in markers of liver function and inflammation, largely consistent with the observational evidence. Should these effects be corroborated, this is huge, as it means that replenishment of this one microorganism provides benefits that exceed that achieved with the silly drugs for type 2 diabetes achieved without the huge side-effects, hypoglycemia, and costs of prescription drugs.
Unlike most other gut bacteria that obtain much of their nutrition from prebiotic fibers, Akkermansia has been shown to be stimulated to proliferate by some unusual factors, as well as by prebiotic fibers. Factors, foods, and strategies that have been shown to increase the population of Akkermansia in the intestinal tract include:
- Melatonin
- Fructooligosaccharides, FOS–An especially powerful trigger for Akkermansia, increasing its growth as much as one thousand-fold. (Inulin likely has a similar effect, though this has not been formally studied.) FOS are likely the “preferred” energy source for Akkermansia, as it is more vigorously consumed than any other potential nutrient.
- Metformin–This drug commonly used as first-line treatment of type 2 diabetes increases Akkermansia and reduces lipopolysaccharide entry into the bloodstream, thereby reducing inflammation.
- Various flavonoids/polyphenols–Black tea, red wine/Concord grape juice, and rhubarb increase the Akkermansia population.
But, like many other good things, too much of a good thing may also be bad. It’s name–“muciniphila” means mucous-lover—referring to its unique capacity to also feed on the mucous lining of the intestine. When deprived of prebiotic fibers, for example, Akkermansia will survive by overconsuming the mucous lining of the intestinal tract, thinning it to almost nothing, a survival advantage that most other bacteria lack. In this situation, there is a marked reduction in the numbers of non-mucous consuming species, a reduction in species diversity, as well as more-than-usual proliferation of Akkermansia. Degradation of the mucous lining, whether achieved by synthetic emulsifying agents such as polysorbate 80 or hydroxymethcylcellulose, deprivation of prebiotic fibers, or over-proliferation of Akkermansia, has been associated with inflammation of the intestines, increased LPS entry into the bloodstream, autoimmune conditions, neurodegenerative conditions such as multiple sclerosis and cancers.
I don’t believe that we have to obsess over managing the precise proportion of Akkermansia in our guts, but I believe it is a powerful reminder that prebiotic fibers, consumed every day, are a critical component of an overall health effort, including not allow Akkermansia to convert from friend to foe.
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I was finding with the 8 qt Instant Pot that the one I have holds the “yogurt” cycle at a fairly stable 104°-105° with the water bath technique, but the yogurt was “breaking” after about 9-12 hours (even with regular “true” yogurt). Switching to a system that keeps the culturing temperature closer to body temp has really solved that.
that did not work….
the re: was to Bob’s “My setup tends to hold 97-102°F but I’m comfortable with 95-105.”
Bob…
I get that, that the 4 hours doesn’t work for you. All I was saying that it’s essentially the same kind of schedule as working with an oven.
The one other thing I’ve seen about yogurt making here concerns heating the milk — yay or nay. In more traditional yogurt making the heating of the milk is not so much about pasteurization as it is about denaturing the proteins so that the yogurt will setup better — hence the mentions on some sites about holding it for 20 minutes at 180°. Because the Cosori/IP tend to have times built in that aren’t that long, I always run the “boil” function at least twice, but generally three times; and the additional time at high temperatures has made a huge difference in how well the yogurt firms up without any additions beyond the starter. I have found that the yogurt with the crushed l-reuteri tablets is working exactly like the yogurt I have been making previously. I also bought some of the capsules with the single strain, and that also responded the same… and I liked the flavor much more than the batch made with the flavored tablets.
One last thing… if people are having the dairy getting a skin when heating, just quickly whisk the warming milk a bunch so the surface gets covered in bubbles… and they will prevent the film. You’ll still want to occasionally stir the milk to keep the bottom of the pot from developing a layer of milk stuck to the bottom… but with the bubbles it doesn’t take nearly so much tending… especially for the second and third “boil” sessions. Once the bubbles are well set, they seem to stay until the milk has cooled and the starter is added. Then they magically vanish.
Heather wrote: «I get that, that the 4 hours doesn’t work for you. All I was saying that it’s essentially the same kind of schedule as working with an oven.;»
It is, and that’s what Dr. Davis used to do for the not-a-yogurt. He’s now using a sous vide. In my house we used to make goat cheese in a similar fashion, wrapping the stove-top double boiler in towels between heat pulses. It works, but it’s annoying.
re: «The one other thing I’ve seen about yogurt making here concerns heating the milk — yay or nay.»
If using raw milk (and I have), it must be pasteurized, so that only authorized microbes are present. Re-pasteurizing other dairy is optional. I do it.
re: «…it is about denaturing the proteins…»
It does that, but I’m more interested in the sterility of my pot, the whisk and the inulin. So I re-past with all that in.
re: «Because the Cosori/IP tend to have times built in that aren’t that long, I always run the “boil” function at least twice…»
And check the temp when you do that. Your mention of it reminded me that when I ran that cycle on our CP016-PC, it never got above 135°F.
re: «…if people are having the dairy getting a skin when heating, just quickly whisk…»
In my process, it doesn’t arise as an issue. I heat the fermentation pot, with H&H, whisk, inulin and probe in, to 180°F or higher for 10 minutes, then move the pot to a cold water bath in a sink. It gets more whisking during the cool-down (to a target of 105°F). Set pot on towel. Add starter. Whisk again. By the time is goes into the incubator, it’s usually coasted down to 100°F or so.
re: «Switching to a system that keeps the culturing temperature closer to body temp has really solved that.»
Speaking of which, the batch in the cooler right now has been hold exactly 98.6°F for the last 36 hours.
re: «that did not work…»
Yep, you can’t use < and > in WordPress comments except from a very short list of HTML tags allowed, which case they are rendered and vanish entirely. That’s why I use angle quotes.
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Off topic reply re: https://drdavisinfinitehealth.com/2018/06/the-unique-probiotic-effects-of-l-reuteri/
To Bob Niland and Kevin and Debbie Stanley re Cosori machines.
I use my 6 quart Cosori choosing the “Hot Pot” setting, at a temperature to 99° (where it stays within a degree*). The yogurt comes out perfectly.
The machine’s timer for the HP setting maxes out at 4 hours, so you have to treat it a little like you would an oven and occasionally add time to the timer — but this can be done by just pressing the time button and increase it back up to 4 hours with the machine still on; easy peasy.
I prefer to make my “yogurt” in wide mouth pint jars (four at a time), using a water bath up to the neck of the lidded jars. I monitor the temperature, so I use the glass lid and stick the thin needle probe for a ThermoWorks thermometer though the hole in the lid with the tip in the water, and cover the whole thing with a towel to make sure that the heat doesn’t dissipate, especially if the kitchen is on the cold side. Then I set the thermometer to go off it the temperature goes higher than 102°, or below 96°… but whenever I check the high is 100° and the low is 99°! (* oddly, if I set the machine for 98° the temperature variation as measured by the Chef Alarm cycles from 96° to 101°.)
I do feel the Yogurt setting for the Cosori, and also the Instant Pot is too hot in general, even for regular yogurt, so I am VERY happy to be able to use the Hot Pot feature of the Cosori!
Heather Hoppe wrote: «The machine’s timer for the HP setting maxes out at 4 hours…»
And that, coupled with the too-high temp of it’s standard “yogurt” cycle, is why I gave up on our Corsori CP016-PC for making this not-a-yogurt, and switched to a primitive but effective CFL-in-a-cooler setup. Although not depicted there, I do use the Cosori’s stainless steel inner pot for both a re-pasteurization cycle, and the final ferment.
I would not recommend that anyone attempt to put up with a not-so-smart pot that doesn’t allow you to get at least 8 hours sleep. The sleep benefits of the yogurt can’t fix the consequences of circadian disruption.
re: «I do feel the Yogurt setting for the Cosori, and also the Instant Pot is too hot in general…»
That’s often the case. Peak growth rate for these strains is reportedly 97°F(36°C). Our Cosori ran as high as 115°F, and I suspect that local temps near the heater coil at the pot base went higher than that. Mass die-off happens at and above 122°F. Using jars in a water bath, as you do, would be a big help on avoiding hot spots.
re: «Then I set the thermometer to go off it the temperature goes higher than 102°, or below 96°… but whenever I check the high is 100° and the low is 99°! (* oddly, if I set the machine for 98° the temperature variation as measured by the Chef Alarm cycles from 96° to 101°.)»
My setup tends to hold 97-102°F but I’m comfortable with 95-105.
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