Can probiotics help improve the glucose control of people with Type 2 diabetes? A company named Pendulum is betting that they can, and they say that they have the science to prove it.
Doctors increasingly believe that the gut microbiome—the complex microscopic world of bacteria, fungi, viruses and protozoa that live in the human gastrointestinal tract—may play a significant role in the development and progression of diabetes. Most people with Type 2 diabetes exhibit “gut dysbiosis”—essentially, an imbalance in the gut microbiome which, in various complex ways, contributes to insulin resistance and chronic inflammation. Accordingly, many researchers are investigating therapies that adjust the microbiome with the hopes of improving glucose control.
The possibility has been the subject of much study, and several surveys have found that probiotic supplementation can help reduce fasting glucose level and A1c in patients with Type 2 diabetes, in addition to some other perks, such as improved blood pressure or lipid profiles. The probiotics industry, though, is also well-known for vague and inflated marketing claims; many probiotics are sold as food ingredients or dietary supplements, which unlike pharmaceuticals do not require FDA approval. To put it simply, there is an awful lot of snake oil on the shelves in the probiotics section.
Pendulum hopes to distinguish itself as a “Medical Probiotic” for dietary management of Type 2 diabetes, and has voluntarily subjected its product to the same type of clinical testing that real medicines are required to go through. Dr. Colleen Cutcliffe, Pendulum’s CEO and co-founder, states that “unlike ‘off-the-shelf’ probiotics with general ‘gut health’ claims, our medical probiotic has been clinically tested and shown to deliver meaningful benefits for managing blood sugar levels.”
A new study of Pendulum’s signature product was recently published in the British Medical Journal’s Open Diabetes Research & Care journal. The Pendulum team tested two different probiotic blends against a placebo group. The product showed real improvements: A1c was reduced by 0.6 compared to the placebo group, and post-prandial glucose “area under the curve” was also significantly reduced. As fasting blood sugar was unchanged, it appears that the probiotic achieved the A1c drop mostly or entirely by shrinking after meal blood sugar spikes.
The imbalanced microbiome of the average person with Type 2 diabetes often creates a reduced ability to metabolize dietary fiber; fiber slows the absorption of glucose, reducing blood sugar spikes. Five different strains of bacteria in the product, “Pendulum Glucose Control,” include three strains known to produce butyrate, which has been shown to improve insulin sensitivity, and two strains known to consume oligosaccharides, a type of vegetable fiber that has been called “antidiabetic.” The probiotic blend also aims to help strengthen the gut lining, which helps prevent inflammation. Pendulum’s product is actually a blend of probiotics and one prebiotic—chicory inulin, a dietary fiber intended to feed the beneficial bacteria in the gut.
We recently reported on an ADA symposium regarding the microbiome in Type 1 diabetes. Patients with T1D exhibit a similar impairment to their ability to metabolize fiber. Leading scientists believe that someday in the future we may have highly personalized probiotic therapies—perhaps delivered via fecal microbiota transplant—that will attenuate or even prevent the progression of the disease. But they cautioned listeners to not expect any “blockbuster” treatments; the science is still in its infancy and the microbiome itself is still largely a mystery.
If there’s a good reason to doubt the Pendulum results, it’s a single line down at the bottom, buried under the references:
Competing interests: All authors are employees and stock/stock option shareholders of Pendulum Therapeutics, Inc.
We have no reason to suggest that there is any evidence of foul play, or even of bias, on the part of the authors. Nevertheless, the perils of industry-backed science are well-established. Many reviews and exposés have shown that when a business funds the study of its own products, it is more likely to find favorable outcomes. And when the business has itself designed the trial and evaluated the results, as in the present case, there is even more reason for skepticism.
Pendulum is available online—members pay $165 per month for the twice daily pills, and the package includes a free A1c test every 90 days. A one-time purchase of a single bottle costs $198, and the company offers a money back guarantee.