Fertility and Pregnancy: Extra helpings – Ep 5. Part of the ‘Food as Medicine’ online course series

Fertility and Pregnancy: Extra helpings – Ep 5. Part of the ‘Food as Medicine’ online course series


MELISSA ADAMSKI: Hi everyone. We’re here to discuss some
common questions that we get around the area
of the microbiome, probiotics and also gestational
diabetes risk. So Nic, can you tell us a little
bit more about about that? NICOLE KELLOW: Yes, thanks
for having me Mel. One of the topic — the hot topics at the moment
is the gut microbiota and can we change it in a positive way
during pregnancy to perhaps reduce that person’s risk
of developing gestational diabetes? Or if, if a person currently
has gestational diabetes, can we improve their blood
glucose level using probiotics to the point
where they may not need to take insulin or any
medications to control their blood glucose level during
their pregnancy. And there’s recently been
this onslaught of studies that have been conducted
in either pregnant women or women with gestational
diabetes where they’ve given the participants
in those trials a probiotic supplement and they’ve
monitored their blood glucose level, their insulin sensitivity
and the gestational outcomes as well. So, the problem with some
of these trials is that they’re very small
trials and they’ve all been provided in each individual
trial with different probiotic supplements
and they’re usually an attempt to “let’s just throw as many
bacteria that we believe are beneficial as we can
at these women in one dose and see what happens.” And the problem is that
it’s hard to interpret that information because each
of the trials involved different species and some
of the trials involved a number of different
species within the trial. And so if there is any benefit — beneficial effect of the
probiotics we don’t know which species was responsible — MELISSA ADAMSKI: And also how
much I guess — NICOLE KELLOW: And how much
of that particular species is needed. And it’s also possible
that some of the species that were provided may even
have a negative effect where they prevent the growth
of other beneficial bacteria in the gut just
by the mere presence in larger numbers. And so what these trials have
found is that overwhelmingly there seems to be an improvement
in what we call insulin sensitivity in the women
that took the probiotic supplements.
However, there was no subsequent
improvement in blood glucose level. So insulin sensitivity is not
something that’s measured routinely in practice
and it’s not really a patient
important endpoint, unless it then carries
on to have a beneficial effect on the blood glucose
level which it didn’t in any of these trials. The patient important
endpoint during pregnancy and also with respect
to preventing gestational diabetes
is to reduce the blood glucose level. That didn’t happen in those
trials. So, there may be some beneficial
effects in improving insulin sensitivity, in that a woman who’s already
got gestational diabetes may need less medication to control
their blood glucose level, but we still can’t be sure
of that because the trials that have been undertaken
were only undertaken in women who were not taking any
medications for their gestational diabetes. Another complicating factor
is that many women who have got gestational diabetes are put
on a medication called Metformin. And Metformin is a very good
medication for improving insulin sensitivity, but the other side effect
of Metformin is that it changes some of the composition
of the gut microbiota in a positive way. It encourages the growth of some
beneficial species to higher levels. And so we don’t know
if the probiotics having the effect or the Metformin. Now in these trials none
of the participants were taking Metformin
but it’s another complicating factor in
the in the day-to-day management of real-world
gestational diabetes. MELISSA ADAMSKI: So for example
the patient it’s probably sitting in front
of you asking a question. NICOLE KELLOW: That’s right
it may well be — you may well be considering
putting them on Metformin if they’ve got
gestational diabetes, they might be asking about
a particular probiotic supplement. And the bottom line is we don’t
know which probiotic supplement, or which even, which even species
is beneficial. MELISSA ADAMSKI: And that’s
that’s an interesting point Nic, because I know in practice
that’s a common question that I get
when you start to talk about probiotics, or the gut
in health et cetera, and patients usually
ask ‘‘which probiotic — probiotic supplement
would you recommend, or should I have.’’ And it’s an impossible sort
of question to answer because — NICOLE KELLOW: It is at
this stage. MELISSA ADAMSKI: At this stage.
Exactly. And one of the things
it would depend on is what is the health
outcome you’re trying to improve? You certainly need to think
about that before answering. But the other thing
that I find interesting as well is that each of our gut
microbiomes is very individualised as well. So you know I have
heard about previous research that had you know —
it’s very, very initial research but it
was just an interesting point that I thought happened — is that after taking
antibiotics and being given probiotics, which is a common recommendation
for many health care professionals
is it while they were most likely beneficial probiotics
that person was taking, it stopped the natural
gut flora coming, or it prevented the natural
gut flora growing back, quick — NICOLE KELLOW: A delay. MELISSA ADAMSKI: Delay. Yes.
I think it delayed — NICOLE KELLOW: The
natural recovery. MELISSA ADAMSKI: The recovery
of the gut. And so is that a good
or is that a bad thing? That’s one of the question marks
that we don’t have it is a similar thing I suppose
with the probiotics the gestational diabetes. Are we trying to change
the gut microflora to something specific for that
point or are we trying to help the, the natural
one along? We don’t know the person’s
natural one. NICOLE KELLOW: We don’t know. And I think it all
comes down to, the bottom line is preventing
gestational diabetes or managing gestational
diabetes well comes down to your overall health
and your overall diet. And rather than taking
probiotic supplements we should be just focusing
on improving gut health in general. And again dietary guidelines
come into play here. It’s a variety of of wholegrain,
wholegrain cereals, fruits and vegetables, reducing the saturated fat
content of your diet and also where possible engaging
in physical activity and they’re all very good
strategies for improving the health of your existing
gut microbiota rather than adding a new species
that we’re not sure about at this stage. MELISSA ADAMSKI: At this stage.
That’s right. And also just to clarify
wholegrain cereals we’re not talking cereal box whole grains. NICOLE KELLOW: No,
grains which contain a variety of fibers. MELISSA ADAMSKI: Exactly.
I know sometimes we just get questions about that Nic. So yeah I think there
are very good points for practice
because it’s certainly something that a lot
of health care professionals would get
questions around probiotics, gut health. NICOLE KELLOW: Mel one final
thing that that you did mention is that we don’t know what the
composition of our gut microbiota is and
while there’s many similarities between
people there are overwhelmingly many
differences in the composition of the gut
microbiota between individuals. However, for a price
and this is, this is something that I’m
recommending against, for a price you can
go out and send a stool sample to a company — there’s a proliferation of these
companies now emerging — where they will do an analysis
of your stool sample that you send away
and give you some dietary advice. However the problem is that
that technology is too — is in its infancy. So, even though you you can
get the composition — first of all, assuming that your stool sample
doesn’t degrade too much in the process of getting your
stool sample to the laboratory, it’s expensive
and the information that they get, well what do you do
with that information? We still don’t know, like we’re starting to learn
about who’s living in the gut, what types of bacteria
are there, but we still don’t know
what most of them are doing, what their actual function is.
So to, even if you knew the composition
of your gut microbiota, what do you do
with that information? The science isn’t there
yet to say “based on these species,” and you probably wouldn’t even
get a species-level analysis because we’re not at that level, we don’t have the technology
to get down, to drill down
to the species-level. But even if you knew that, “do we need more of these
species or less of these species” and we don’t
know those answers yet. MELISSA ADAMSKI: It could differ
between people different cultures, different
population groups, tend to have different
in general microbiotas as opposed to what they might
not good for one population group might not be great
for another depending on their diet that then matches
that as well. So complex questions
and something that we’re very interested to always learn
more about and we always look to the research as it continues
to grow and how we can translate
that into practice but we hope for now that this is just some
helpful tips around how you can start to have those
discussions with patients and help answer
some of those frequently asked questions that we do get.
Great. Well thank you everyone. NICOLE KELLOW: Thank you.

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