Let's look at Dr. Alex Vasquez's insight on how to support a healthy internal metabolism as well as address and optimize the gut microbiome, specifically for weight loss, diabetes, inflammatory conditions (autoimmune), and neuropsychiatric problems with a gut-brain component. These factors have a reciprocal relationship so inflammation and metabolism must be addressed at the same time the microbiome is addressed.

Diabetes in the United States of America

According to the CDC’s (Centers for Disease Control) National Diabetes Statistics Report for 2020 cases of diabetes in the U.S. have risen to an estimated 34.2 million people, or 10.5% of the U.S. population. And there are millions more with undiagnosed diabetes and pre-diabetes (1).

Diabetes is caused by the body’s inability to create or effectively use its own insulin, which is produced by islet cells found in the pancreas. Insulin helps regulate blood sugar (glucose) levels – providing energy to body cells and tissues. Without insulin, the body’s cells would be starved, causing dehydration and destruction of body tissue (1).  

What's Driving the Diabetes-Obesity (Diabesity) Epidemic?

Diet plays a major role in the diabetes-obesity epidemic. 60% of the American diet is low in fiber, low in phytonutrients, low in nutrients in general, really high in calories, and full of chemicals (2).

The United States of America has the highest consumption of high fructose corn syrup (HFCS) per capita in the world! HFCS is a very dense source of carbohydrates without any protein, fat, vitamins or minerals. Diabetes prevalence was 20% higher in countries with higher availability of HFCS compared to countries with low availability. HFCS has a different metabolic response in the body, leading to inflammation. To lose weight, you must remove all fructose or you’re fighting an uphill battle. The opposite of HFCS is a plant-based diet with a lot of vitamins and minerals.

When it comes to lifestyle of Americans, there are a handful of overlooked habits that can drive the diabetes-obesity epidemic. Many people are making low wages at their job, yet they’re faced with a higher cost of living. People are working longer work weeks (50 hours) + commuting 1-2 hours per day. All of this results in less free time for exercise, relaxation, food cultivation (gardening) and food preparation (cooking). Over 70% of the United States is overweight and those statistics continue to grow year by year.  

The Role of Dysbiosis

What is dysbiosis? It's an imbalance in the good and bad bacteria in the gut and the loss of bacterial diversity int the gut. Dysbiosis is often associated with an impaired epithelial barrier (aka: leaky gut), bacterial translocation, inflammation in the gut, and decreased regulatory T cells (Tregs) in the gut mucosa.

By 2016, the data on dysbiosis and diabetes mellitus was already irrefutable, demonstrating causality and reciprocity. Metabolic endotoxemia initiates obesity and insulin resistance (4).

What are the Problems Around Dysbiosis?

1. Gut dysbiosis and metabolic inflammation are driving many of the disease’s physicians see in clinical practice.
2. Obesity and Diabetes (Diabesity). They're not always exclusive together, but commonly if someone is obese, they have diabetes and vice versa.
3. There are dysbiosis-driven systemic and inflammatory problems, including SIBO, IBS and various gut-driven systemic fatigue related problems.

What are the Dietary Solutions Around Dysbiosis?

1. Phytonutrient-rich & fiber-rich (ie: TONS of colorful fruits and vegetables)  
2. Omega-3 fatty acids for metabolic, brain and microbiome benefits.
3. High-potency multivitamin supplement.
4. Digestive enzymes to facilitate assimilation and utilization. This will help smooth digestive processes in the gut especially with an increase in dietary fiber.
5. Adequate protein.

Obesity Has Changed

• Obesity and overweight is different and more complex now from what it was in the past. It seems our body’s default is now metabolically pulled to be overweight even while living healthy lifestyles. Thin is no longer the default.
• Obesity in the past was rare and caused by:
• Exceptional overeating / under moving
• Hormonal imbalances such as hypothyroidism, hypogonadism
• Genetic disorder such as Prader-Willi
• Modern overweight-obesity has strong metabolic and inflammatory components, including hepatic inflammation and fibrosis. It’s not simply calorie’s in and calorie’s out.
• We've probably all heard about the dangers of eating too much fructose. Most countries have restricted consumption of high-fructose corn syrup, but the USA has not. In the Seventies and Eighties, people ate a lot of sugar, but it was sucrose. Today, there’s much more fructose in our food system and it has a very different metabolic and inflammatory effect on the body than sucrose and glucose. Obesity from sucrose-excess is very different than obesity from fructose-excess. Fructose causes most of the dysmetabolic and inflammatory changes we see in modern obesity and diabetes, including the dysbiosis, endotoxemia, and lipogenesis.
• Pesticides: Unregulated pesticide contamination of the food supply and food chains promotes hepatic fibrosis, dysbiosis, inflammation, and pro-estrogenic effects, which is another aspect of diabetes and obesity.
• You must stop toxic insults from entering the body in order to reduce the body's toxic load and toxic burden. Toxins include various chemicals, xenoestrogens, drugs, pollutants, waste, solvents, etc. and the insults can happen via inhalation, absorption, and ingestion from work exposures, hobby exposures, etc. Here's how you're ingesting xenoestrogens. Here's how you're absorbing xenoestrogens. Here's how you're inhaling xenoestrogens.
• Along with minimizing your toxic exposure, it's important to support detoxification pathways, exercise regularly and sweat (ie: via sauna) in order to detox toxic metals and chemicals. Choose organic, non-GMO foods to reduce your intake of pesticides. I refer to the Environmental Working Group's Dirty Dozen and Clean Fifteen list for guidance on purchasing produce. Pesticides and toxic exposure are all connected to body weight and health.

A 3-Part Plan to Target the Diabetes-Obesity Complex

Diabetes and Obesity is a complex phenomenon. To address the cause, let’s look at 3 main areas to focus on: food, gut microbiome, and metabolism and systemic inflammation. As Dr. Vasquez says, “We improve the diet to improve the gut microbiome, and we improve the gut microbiome to change our immune-inflammatory-metabolic status.”

#1: FOOD

A person must address what they’re eating in order to successfully manage the diabetes-obesity complex. Food is something that can be changed immediately and have immediate results on the gut. This is absolutely the most important factor when it comes to improving your metabolism! The foods and beverages you consume impact the gut microbiome immediately. The two go hand-in-hand, so as dietary intake improves, the gut microbiome will also improve, which will improve the body’s metabolism. The main goal is to improve metabolism! When we improve the gut microbiome, we also change the body’s immune-inflammatory-metabolic status.

A person’s metabolism responds negatively when there’s a high about of inflammation and an unhealthy gut.

Essentially, issues with metabolism is the result of poor intake and a messed up, unhealthy microbiome.

SOLUTIONS

• Ideal Food Choices: adequate protein, fiber-rich, moderate fats (less omega-6’s and more omega-3’s), minimized carbohydrates, and abundant amounts of vitamins, minerals, and phytonutrients.
• Aim for really high quality, which means fresh, real foods (Paleo-Mediterranean diet).
• Avoid pesticides in industrialized farming and ultra-processed foods. Buy organic as much as possible.
• Eliminate any and all high fructose corn syrup from the diet.
• Eliminate white, processed carbohydrates and sugars (dried up grains and seeds and flour). Instead choose starchy plants (root vegetables), nuts and seeds, and whole fruits and vegetables.
• Eat more fruits and vegetables. Only 1 in 10 Americans eat enough fruits and vegetables. One of the key ways to favorably change the gut microbiome is to increase the intake of plant-based fibers and phytonutrients. However, with that said, people know they should eat more, but telling them to eat more fruits and vegetables isn’t working. If you want to increase your intake of fruits and vegetables but just can’t make it happen every day, consider a fruit and vegetable powder blend or a greens blend to supplement your diet (5).
• Consume adequate fiber. Eating more fruits and vegetables will add fiber, but 30 grams/day is recommended. Upward of 50-60 grams/day is even better. If you need a fiber supplement, try Fiber Best which provides 5 grams of fiber per scoop.
• Take an omega-3 fatty acid supplement for metabolic, brain, and microbiome benefits.
• Consume enough, good fat. Don’t overly restrict fat.
• Consume enough protein. If you need a quick, convenient protein, try a whey protein powder, such as this grass-fed whey protein. 
• Take a high potency multi-vitamin and mineral supplement.
• Use digestive enzymes to facilitate assimilation and utilization of nutrients.
• Exercise and movement: rather than thinking of exercise as an expenditure, we could revision it as a gift and a health necessity. Aim to exercise for 1 hour per day.
• Supplements: choose nutrients to support metabolic function and to break some of the vicious metabolic cycles.
• Get happy, stay relaxed…as much as possible!! :)

Implementing these food and nutrition solutions would ideally lead to a weight loss of 1-2 pounds/week and insulin can lower by 50% in 5 days! This is even more important than the actual weight loss, and seeing a drop in insulin can be a motivating factor even more so than weight loss, which is harder to accomplish and can discourage people if it doesn’t happen quickly (6).

Why we care about weight loss:

FACT: adipose tissue generates inflammation and adipokines.

FACT: adipose tissue generates estrogen.

FACT: adipose tissue generates leptin, which promotes more inflammation while suppressing immune function; note that COVID risk was especially pronounced among obese and diabetic.

#2: MICROBIOME

The biggest influence on the gut microbiome is what you eat, which we can change immediately. The gut microbiome reflects a person’s food, fiber, and phytonutrient intake (or lack thereof), along with the person’s inflammatory climate and immune status. Dysbiosis within the microbiome occurs when there is any sort of interruption in its balance.  

For all diabetic-obese individuals, gut dysbiosis must be addressed to make improvements in the metabolism. You have to do what you have to do when it comes to making changes to optimize gut health.

The gut microbiome of a diabetic and obese person is different. In fact, you can take the gut microbiome of a diabetic-obese individual and transplant it into a healthy animal and that animal will become diabetic and obese (experimental studies & accidental results of fecal transplants). Reference: Alang N and Kelly C. Weight gain after fecal microbiota transplantation. Open Forum Infect Dis. 2015 Jan; 2(1).

There are both beneficial and unbeneficial microbes capable of living in the gut microbiome. Here are a few in particular that impact diabetes-obesity both negatively and positively.

• Microbes within the gut produce short-term fatty acids, with one of those being acetate. Excess quantities of acetate reproduce many of the manifestations we see with diabetes such as hyperinsulinemia (aka: you want less acetate).
• Another microbe that’s produced by short-chain fatty acids is propionate, which promotes neuroinflammation and mitochondrial dysfunction, both which promote diabesity (aka: you want less propionate).
• Lipopolysaccharide (LPS) from gut bacteria promotes systemic inflammation, adipose inflammation, and insulin resistance.
• Superantigens from skin bacteria from obese and diabetic individuals are absorbed through the skin and synergize with LPS from gut bacteria to promote systemic inflammation and insulin resistance.
• “Bad” bacteria in a dysbiotic gut fail to provide pleasing feelings to the vagus nerve; when your vagus is not happy, you are not happy.
• As detrimental as the "bad" bacteria are, it's also detrimental to lack good bacteria. A lack of the microbe-derived short-chain fatty acid butyrate is characteristic of diabetes, obesity, and most other untreated inflammatory metabolic disorder (aka: you want more butyrate, such as this.)

#3: METABOLISM & SYSTEMIC INFLAMMATION

Dysregulation of the metabolism can actually be seen as the effect – the result – from negative intakes and dysbiosis. Both of these factors (diet and dysbiosis), must be addressed in order to fully support the metabolism, which is the main goal. Of course, we do not ignore major hormonal imbalances, especially hypothyroidism, which effect metabolism.

So….we improve food intake to improve the gut microbiome and metabolism, and we improve the gut microbiome to change our immune, inflammatory and metabolic status. 

Supporting the metabolism is addressed with a carb deficient, fat-sufficient protein-sparing intake, adding regular exercise, and feeding your body the right nutrients. See “#1: Food” for the details about optimal intakes.

References:

Dr. Alex Vasquez, DO, DC, ND is an international expert on diet, nutrition, microbiome, and inflammation. He's the author of more than 100 articles/letters in various journals, and the author of over 25 books, including the 1200-page Inflammation Mastery: Textbook of Clinical Nutrition and Functional Medicine.

1. National Diabetes Statistics Report for 2020

2. BMC Medicine 2019;17:78.

3. Diabetes 2007 Jul; 56(7): 1761-1772. 

4. Cani PD et al.

5. cdc.gov/media/releases/2017/p1116-fruit-vegetable-consumption.html

6. Vasquez, A. Revisiting the five-part nutritional wellness protocol: the supplemented Paleo-Mediterranean Diet.