Can Probiotics Help You Lose Weight?

Because of my work, lately my instagram has been inundated with ads from a company called Pendulum which claims that, in addition to improving gut health, their probiotics have GLP-1 like activity, and that taking them can lead to weight loss. GLP-1s are making a huge wave in medicine right now because while they are fantastic diabetes drugs, they also commonly are associated with causing weight loss. These medications (common names: Ozempic, Zep Bound, Monjuaro, Wegovy) are injected once a week and are being widely used for weight loss by your favorite celebrities and are helpful to treat common conditions that are linked to obesity, like hypertension and hyperlipidemia (high blood pressure and high cholesterol). Pendulum is the first company to produce a probiotic containing Akkermansia muciniphilia, which is the therapeutic bacteria that we are interested in for its potential weight-modifying capabilities.

PLEASE READ: Before I go any further, obesity has been vilified in medicine and many women who are “overweight” or “obese” by their BMIs experience having their very valid health concerns and symptoms minimized by the medical community at large. Doctors and other healthcare practitioners tend to blow off any concern in a person with obesity and attribute it to their weight, which is absolutely not the case in the majority of patients. Please continue to advocate for yourselves and do not allow this trend to continue. I know that I will do my part to make my patients feel heard and to speak with my physician colleagues about these biases whenever possible. In fact, obesity has actually been shown to have protective effects in conditions like breast cancer, folks who are obese have a 10-15% lower chance of getting breast cancer than non-obese patients. Moreover, BMIs are not a very valid health metric, they do not account for muscle mass and healthy lifestyles. Because of this, I do not require weight measurements on my patients unless they request it specifically or it directly pertains to the issue for which they have come to me. You are perfect the way you are, you do not need to lose weight from a medical perspective if your blood pressure is normal, your cholesterol is controlled with your diet and lifestyle, and you do not have elevated blood sugar. Many folks who happen to be in bigger bodies live the healthiest lives, and their weight does not negatively impact their health. 

That said, if you are finding that your weight is affecting your health markers or limiting your ability to lead a lifestyle that would positively impact your health (for example, knee pain that limits your ability to exercise or do the things you love to do), or you just plain want to feel comfortable in your body and losing weight is part of your own personal journey, you may be looking for ways to lose weight safely without the aid of pharmaceuticals. I am so interested in this topic because I see people who meet these criteria nearly every day in my practice, and the idea of a probiotic offering a solution that avoids the need for an injected medication is extremely exciting. I was curious to learn more, so I did a deep dive on Akkermansia-containing probiotics and the research behind them. 

Akkermansia muciniphilia is a bacteria that lives in our digestive tract and has been linked to gut lining integrity, which is important for maintaining a healthy barrier between our GI tract and the rest of our body. When our gut lining breaks down, larger-than-normal food particles pass through our intestinal membranes, getting picked up by the blood stream. If these food particles are interpreted as foreign by the immune cells that patrol our body, keeping us safe from pathogens like viruses and harmful bacteria, we can have reactions to foods that we used to tolerate well, which can cause all kinds of symptoms from bloating and abdominal pain to skin changes and fatigue. There are innumerable bacteria that have these activities in our body, which is why it is important to eat a diet rich in many different types of plants to keep a diverse and healthy gut microbiome. Akkermansia is generally stable in probiotic form and you can generally meaningfully increase Akkermansia populations by taking a probiotic that contains it. 

Another claim made about Akkermansia is the central theme of this post: it helps with weight loss and metabolism in mice and human subjects in some clinical studies. Rodrigues et. al. found in a mini-review (compiling data from available studies and gleaning the clinical and statistical significance of the findings) that obese individuals that were sampled had relatively low Akkermansia populations than in non-obese individuals. They also found that in obese human study subjects who volunteered to participate, there was significant weight loss after taking an Akkermansia-containing probiotic for 3 or more months. The mechanisms are not completely fleshed out, but the studies they reviewed found reduced inflammation in adipose (fat) tissue and improved insulin sensitivities in these study subjects. While more research must be done to confirm these findings and establish a clear cause-effect relationship, this is certainly compelling! The risks of probiotic use are generally very low, they are safe and typically very easy to tolerate. The risks of GLP-1 medications are significantly higher - they are associated with a small but statistically significant increased risk of thyroid cancer and are commonly associated with adverse effects like abdominal pain, indigestion, and loose stools. Patients taking GLP-1s have also been shown in multiple studies to regain weight after stopping the medication or to hit a plateau after several months of taking it. A clinical question that I hope is researched further: does the same happen with taking Akkermansia? 

After reviewing the research available, I believe that a select population could stand to benefit from trying Akkermansia-containing probiotics. These folks should have demonstrated low levels of Akkermansia in their stool (Integrative & Functional Medicine doctors use expanded-panel stool studies that test the microbiome all the time, for those interested in learning more!) and have the financial ability to afford the probiotic, which is $50-60 per month in most cases. They should be willing to commit to taking the Akkermansia-containing probiotic for at least 3 months, as that is when subjects recorded significant weight loss. For those interested in boosting the Akkermansia colonies that already are living in their gut lining, foods high in polyphenols like pomegranate, grapes, and cranberries have been demonstrated to boost Akkermansia populations without taking a probiotic. Through comprehensive stool testing, I discovered that my own Akkermansia population was relatively low, so I’ve been focusing on polyphenol intake for a handful of months now to help establish a stronger colony of this beneficial bacteria. 

These research findings are fascinating, and while this certainly is not a cure-all and takes time to have a meaningful effect, it is promising. I am hopeful that the more we discover about our amazing, diverse, and personal microbiome and how it impacts us individually, the more we can use it to our therapeutic benefit.