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How Drugs Interact With Your Gut

The gut microbiome is a vital and important part of human health that touches so many aspects of our daily lives, yet it works in very unpredictable ways.

For example, consider how certain drugs interact with the human gut. Sometimes, they do work but not so well at other times, as we learned about statin drugs.

The very same thing may be true about metformin, the go-to drug prescribed for type 2 diabetic patients to control high blood sugar, according to a study appearing in EBiomedicine.

“For example, certain drugs work fine when given intravenously and go directly to the [blood] circulation, but when they are taken orally and pass through the gut, they don’t work,” says senior study author Dr. Hariom Yadav, a researcher at the Wake Forest School of Medicine.

As we’ve seen previously, metformin works well with the gut, although some patients who take it tend to experience more side effects (nausea, diarrhea and flatulence).

Based on their review of studies, Wake Forest researchers determined the metabolic capacity of a patient’s microbiome may influence how various drugs aimed at treating type 2 diabetes are absorbed and function in effective, inactive or even toxic ways.

“We believe that differences in an individual’s microbiome help explain why drugs will show a 90 or 50 percent optimum efficacy, but never 100 percent,” Dr. Yadav said.

Now, Wake Forest researchers are taking the next important gut-friendly step by testing prebiotics, a natural component of non-digestible plant fiber that feeds the good bacteria living in your gut, and probiotics that may help diabetes drugs work more effectively.

Could a multi-species probiotic containing 10 kinds of beneficial bacteria plus a handy prebiotic (FOS) like EndoMune Advanced Probiotic make gut-friendly difference in the way patients take their drugs?

The evidence is growing!

This Diabetes Drug may Benefit your Gut

In the past, we’ve discussed how some drugs — heartburn meds and antibiotics — harm the delicate balance of gut bacteria, making your body more vulnerable to serious health problems.

However, at least one very common drug used by type 2 diabetes patients to control their blood sugar — metformin (Fortamet and Glumetza are brand names) — may work primarily in the gut and be beneficial for gut health, based on findings of recent studies.

In the gut, not the bloodstream

Scientists at the University of North Carolina (UNC) School of Medicine discovered the connection between metformin and gut health, erasing some 60 years of assumptions that the type 2 diabetes drug worked primarily in the bloodstream, according to a Diabetes Care study.

This discovery was critical because some type 2 diabetes patients with kidney issues accumulate too much metformin in their blood, which may leave them vulnerable to other serious problems so they can’t take it.

“These findings create an opportunity to develop a new metformin treatment option for the 40 percent of patients that currently can’t take this first-line drug of choice,” says Dr. John Buse, lead author of the study and director of the Diabetes Care Center at the UNC’s School of Medicine, according to a press release.

Scientists compared the effect of three kinds of metformin — delayed-release (DR), extended-release (XR) and immediate-release (IR) — on healthy patients and those with type 2 diabetes in this two-phase study.

In phase 1 testing on 20 healthy patients, scientists found roughly half as much of the DR version of metformin in their blood compared to IR and XR forms.

Various doses of Metformin DR also performed well in phase 2 testing (comparing it to Metformin XR or a placebo in type 2 diabetes patients), as the potency of the delayed-release version increased by 40 percent.

Improved fatty acid production

A separate study conducted by European and Chinese researchers also observed the positive effects of metformin on the gut health of type 2 diabetics, even over healthy patients, featured in the journal Nature.

The gut microbiomes of type 2 diabetics from Europe and China who took metformin generated more specific kinds of beneficial short-chain fatty acids (butyric acid and propionic acid) that lowered blood sugar levels.

“We weren’t able to show that other types of anti-diabetic drugs had any actual impact on the gut microbiota,” says senior study author Dr. Olaf Borbye Petersen of the University of Copenhagen, according to a press release.

“When studying type 2 diabetes patients not being treated with metformin, we did, however, discover that they — irrespective of whether they were from Denmark, China or Sweden — had fewer of the bacteria which produce the health-promoting short-chain fatty acids.”

But, does this discovery mean the lack of fatty acid-producing bacterial species in the gut contributes to type 2 diabetes? Stay tuned for more research, says Dr. Petersen.

These findings may also explain why metformin patients experience increased flatulence and bloating, as those treated with the drug have more coliform bacteria in their gut.

Could taking a daily probiotic like EndoMune Advanced Probiotic that contains multiple strains of beneficial bacteria also make a difference in the treatment of type 2 diabetes?

Only time will tell…

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