How to counsel patients in probiotics for diabetes

As the interest in natural alternatives continues to rise, many patients may be considering probiotics for potential health benefits. Patients with diabetes, in particular, may be curious about whether they can take probiotics and how probiotics may affect their blood sugar levels. As it turns out, research has shown several potential benefits of probiotics for diabetes. 

For patients who have questions about probiotic use for diabetes, it’s important for pharmacy professionals to stay up-to-date and guide patients on the effectiveness and safety of probiotics. This post will address questions such as: Can a diabetic take probiotics, do probiotics help diabetes, and what types of probiotics are best for diabetes management?

Probiotics and how they work for diabetes

Probiotics are live microorganisms that are believed to provide health benefits when consumed in adequate amounts. They are typically found in fermented foods such as yogurt, kefir, kimchi, and sauerkraut—as well as in dietary supplements. Probiotic supplements are typically taken with or without food daily, although it’s important for patients to read the supplement labels to determine the best way to use a specific product. 

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Various strains of bacteria in probiotics may help support a healthy balance of microorganisms in the gut. Different strains may be recommended depending on the intended use. They may work through different mechanisms for Type 2 diabetes, such as improved glucose metabolism and decreased insulin resistance. They may also help support the gut lining, reduce inflammatory markers, and regulate the digestion of carbohydrates. 

Research on probiotics for diabetes management

Several clinical studies have investigated the potential benefits of probiotics for diabetes management. These studies have assessed the effects of various species and strains of probiotics. The main genera of bacteria studied were Lactobacillus and Bifidobacterium.

One study published in Advances in Nutrition found that probiotics can contribute to glycemic control in patients with Type 2 diabetes. The study showed that probiotics could improve glycemic control by reducing fasting blood glucose levels and HbA1c levels. The study found that probiotics reduced fasting blood glucose (FBG) more than the placebo group by an average of around 13 mg/dL over the short term and around 3 mg/dL over the long-term. However, the effect of probiotics on glucose levels was more pronounced in patients with poorly controlled diabetes or those not on insulin therapy. 

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Another meta-analysis published in Translational Medicine found that probiotic treatment may reduce HbA1c, fasting blood glucose levels, and insulin resistance levels in Type 2 diabetes patients. The study assessed 15 randomized controlled trials with almost 1,000 participants and found that probiotics significantly improve metrics used to monitor Type 2 diabetes. The researchers concluded that probiotics could be a safe and effective adjunct therapy for managing Type 2 diabetes.

A recent study published in Diabetes evaluated the use of a specific bacteria known for generating a fatty acid called butyrate. The study found that the genus Coprococcus was associated with increased insulin sensitivity and decreased dysglycemia. Supplementation with this bacteria may be considered a potential treatment pathway for Type 2 diabetes patients. On the other hand, Flavonifractor and Anaerostipes were found in higher levels in people with poorly controlled diabetes and linked to decreased insulin sensitivity. 

Types of probiotics used for diabetes management

The types of probiotics used in research studies varied, but some of the most commonly used strains include Lactobacillus acidophilus, Bifidobacterium lactis, and Streptococcus thermophilus. These strains have been shown to improve glucose homeostasis, reduce inflammation, and improve insulin sensitivity in patients with diabetes.

Other types of bacteria that may be beneficial as probiotics for diabetes include: 

  • Coprococcus comes
  • Oscillibacter sp. CAG 241
  • Alistipes finegoldii
  • Faecalibacterium prausnitzii
  • Akkermansia muciniphila
  • Lactobacillus casei
  • Lactobacillus rhamnosus
  • Lactobacillus bulgaricus
  • Lactobacillus salivarius
  • Lactobacillus plantarum
  • Bifidobacterium breve
  • Bifidobacterium longum
  • Bifidobacterium infantis
  • Bacillus coagulans

These bacteria may also be beneficial for other health uses. For example, studies have shown that probiotics may reduce triglycerides, total cholesterol, LDL, and hs-CRP levels. Therefore, they could be helpful for patients with cardiovascular conditions and metabolic disorders in addition to diabetes. 

When choosing a probiotic supplement for diabetes management, it is important to look for strains that have been shown to be effective in clinical studies. It is also important that patients choose a supplement that contains a sufficient number of live bacteria. The recommended dosage for probiotics varies depending on the strain and the condition being treated. 

Safety and potential side effects

While probiotics are generally considered safe, there are some potential side effects that patients with diabetes should be aware of. These include bloating, gas, and diarrhea. Although these side effects are generally mild and temporary, patients should monitor for any discomfort and discontinue probiotic use if side effects persist or worsen. 

Patients with diabetes who have a weakened immune system or are immunocompromised may need to avoid probiotics or use them with caution. These groups of people may include older patients, those with HIV/AIDS, or people with certain chronic health conditions like short gut syndrome. Serious adverse effects may include pneumonia, endocarditis, and sepsis. 

Research suggests that probiotics are not a serious health risk in women who are pregnant or breastfeeding. Of 100 studies on women who were pregnant or breastfeeding, 11 of them found that probiotics caused mild side effects, such as nausea and headache, but no serious side effects. 

Guiding patients in choosing the right probiotic

When counseling patients on choosing the right probiotic, it’s important to discuss the quality of the supplement, the dosage, and the potency. 

Quality

Different factors can affect the quality of a probiotic supplement, including the strain of bacteria used, the manufacturing process, and the handling and storage conditions. Patients should only use reputable brands that adhere to strict quality control measures and are transparent about their ingredients, manufacturing processes, and testing procedures. This helps to ensure that the probiotic contains the specific strains and amounts listed on the label and that the product is free from contaminants.

Dosage

The dosage and the number of colony-forming units (CFUs) should also be considered, as different strains may require different amounts to be effective. Patients should consult with their healthcare providers to determine the most appropriate probiotic strains, dosages, and formulations to support their health goals and ensure the probiotic does not interfere with any ongoing medications or treatments.

Potency

The potency and effectiveness of probiotics can decrease over time, so it is important for patients to check the expiration date and choose a product that is well within its shelf life. Using expired probiotics may result in reduced effectiveness or even potential harm.

Do probiotics help to treat diabetes?

Probiotics are not regulated by the FDA as drugs. Instead, they are classified as dietary supplements, which don’t need FDA approval. However, they can’t be marketed for specific medicinal uses, such as the treatment or prevention of medical health conditions. For this reason, many patients may turn to pharmacists for more information about their potential uses. 

The research suggests that probiotics could be an effective and safe treatment option for managing diabetes, especially when used with conventional treatments like medication. However, patients should not be recommended probiotics as a cure for Type 2 diabetes. More research is needed to determine the optimal dosage, duration, and type of probiotic for diabetes management. 



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