Is it just me or have you also been hearing more about Akkermansia muciniphila recently?
I suspect that the increased chatter about this microorganism has something to do with the emergence and expansion of direct-to-consumer gut microbiome testing companies such as Ubiome.
More specifically, I have encountered several individuals with IBS and/or SIBO whose Ubiome results show nonexistent or low levels of A. muciniphila.
Many individuals in the gut health community have been eager to submit poo samples in exchange for a report that provides a glimpse into the composition of critters living in their gut.
The test is quite easy to perform. But it’s mildly graphic to describe.
The company mails you a kit that contains a swab resembling a long Q-tip. You rub it against soiled toilet paper, then twirl it around in a mini test tube sorta thing. Close the lid, put the tube in a little plastic bag, and send it back in the provided mailer. Voila!
A few (or more) weeks go by and you receive an email that your results are ready! Login to your account, and you will see a report that resembles the above (if ordering the SmartGut test). Akkermansia muciniphila is also measured on the more basic “Gut Explorer” test.
Intro to Akkermansia muciniphila
Akkermansia muciniphila (A. muciniphila) is a gram-negative bacteria that is present in the gut of approximately 90 percent of adults.
In healthy adults, A. muciniphila comprises 1-3% of the gut microbiota [1].
A. muciniphila is a mucin-degrading microbe. Meaning that it feeds on mucin. Mucin is a part of the mucus gel layer of the gut lining. It serves as a barrier between bacteria living in the gut and human cells residing on the other side.
Roles of A. muciniphila
It is believed that A. muciniphila may play the following roles in the gut:
- Maintaining tolerance to beneficial microorganisms [2]
- Stimulating mucus renewal [2]
- Maintaining integrity of the gut lining (protecting against leaky gut) [2]
- Increasing intestinal levels of endocannabinoids (which has downstream effects on metabolism and insulin sensitivity) [3]
Related Conditions
The following conditions have been found in research to be associated with low levels of A. muciniphila:
- Obesity [3]
- Type 2 diabetes [3]
- Appendicitis [4]
- Autism [5]
- Crohn’s disease [5]
- Ulcerative colitis [5]
- Elderly population [5]
- Psoriasis [8]
Low FODMAP Diet & A. muciniphila
Compared to a moderate FODMAP diet, consuming a low FODMAP diet results in five times less A. muciniphila [6].
Lower consumption of FODMAP-containing foods among those with IBS/SIBO could potentially be a reason why these individuals have very little A. mucinphila on their Ubiome results. However, I can tell you that all three of my personal Ubiome tests have shown ZERO growth of A. muciniphila and I actually eat quite a bit of FODMAPs nowadays so I would have expected to see some growth on the second and third tests. That’s why I suspect there is more to the story (keep reading!).
There is some concern that long-term consumption of a low FODMAP diet may be problematic due to potentially decreasing the level of A muciniphila in the gut.
Strategies to Increase A. muciniphila
The following substances and procedures are associated with increased levels of A. muciniphila:
- Curcumin [3]- found in turmeric
- EGCG [3]- found in green tea
- Phytochemicals [3]- compounds found in plants
- Prebiotics [3]- such as are found in high FODMAP foods
- Bariatric surgery [7]- for those suffering from obesity
- Metformin [7]- for those with type 2 diabetes or metabolic syndrome
- Human breast milk [7]- this organism is present in breast milk and may provide further support for the beneficial role of breastfeeding in building an infant’s microbiome
- Polyphenols [9]- found in cranberries, pomegranates, blueberries, dark chocolate, and other deep-colored foods
It may seem like common sense that if you have low levels of A. muciniphila, you should try to increase it. But it might not be that simple. Keep reading…
More Questions than Answers?
It is important to remember that gut microbiome testing is still quite new. And we don’t fully know what to do with it yet.
So to is the research on A. muciniphila. The microbe was only discovered in 2004. While the majority of research points toward this microbe being beneficial, there are still lots of questions.
For example, not everyone is in agreement that simply increasing A. muciniphila is the answer to great gut health. In human studies, it has been shown that an increase in A. muciniphila is associated with increased abdominal pain in individuals with IBS [10]. Some researchers hypothesize that under certain conditions (such as in the presence of harmful microbes), A. muciniphila actually promotes intestinal inflammation [11]. This would explain why individuals with gut dysbiosis (such as is seen in many with IBS) would feel better on a diet that decreases A. muciniphila (low FODMAP, for example).
What are your thoughts? Did your Ubiome test show low levels of Akkermansia muciniphila? Have you tried increasing your intake of prebiotics and polyphenols? What was your experience?
References:
[1] Derrien M, Collado MC, Ben-amor K, Salminen S, De vos WM. The Mucin degrader Akkermansia muciniphila is an abundant resident of the human intestinal tract. Appl Environ Microbiol. 2008;74(5):1646-8.
[2] Earley H, Lennon G, Balfe A, et al. A Preliminary Study Examining the Binding Capacity of Akkermansia muciniphila and Desulfovibrio spp., to Colonic Mucin in Health and Ulcerative Colitis. PLoS ONE. 2015;10(10):e0135280.
[3] Bland J. Intestinal Microbiome, Akkermansia muciniphila, and Medical Nutrition Therapy. Integr Med (Encinitas). 2016;15(5):14-16.
[4] Van passel MW, Kant R, Zoetendal EG, et al. The genome of Akkermansia muciniphila, a dedicated intestinal mucin degrader, and its use in exploring intestinal metagenomes. PLoS ONE. 2011;6(3):e16876.
[5] Wang L, Christophersen CT, Sorich MJ, Gerber JP, Angley MT, Conlon MA. Low relative abundances of the mucolytic bacterium Akkermansia muciniphila and Bifidobacterium spp. in feces of children with autism. Appl Environ Microbiol. 2011;77(18):6718-21.
[6] Halmos EP, Christophersen CT, Bird AR, Shepherd SJ, Muir JG, Gibson PR. Consistent Prebiotic Effect on Gut Microbiota With Altered FODMAP Intake in Patients with Crohn’s Disease: A Randomised, Controlled Cross-Over Trial of Well-Defined Diets. Clin Transl Gastroenterol. 2016;7:e164.
[7] Cani PD, De vos WM. Next-Generation Beneficial Microbes: The Case of Akkermansia muciniphila. Front Microbiol. 2017;8:1765.
[8] Tan L, Zhao S, Zhu W, et al. The Akkermansia-muciniphila is a gut microbiota signature in psoriasis. Exp Dermatol. 2017;
[9] Roopchand DE, Carmody RN, Kuhn P, et al. Dietary Polyphenols Promote Growth of the Gut Bacterium Akkermansia muciniphila and Attenuate High-Fat Diet-Induced Metabolic Syndrome. Diabetes. 2015;64(8):2847-58.
[10] Zhou SY, Gillilland M, Wu X, et al. FODMAP diet modulates visceral nociception by lipopolysaccharide-mediated intestinal inflammation and barrier dysfunction. J Clin Invest. 2018;128(1):267-280.
[11] Ganesh BP, Klopfleisch R, Loh G, Blaut M. Commensal Akkermansia muciniphila exacerbates gut inflammation in Salmonella Typhimurium-infected gnotobiotic mice. PLoS ONE. 2013;8(9):e74963.
Very interesting and helpful information that 90% of pop has akkermansia. Do all adults missing akkermansia have stomach problems/IBS?
I just got back from meeting my gastroenterologist and discussing these results. I’m part of the 10% that doesn’t.
He proposed that if you don’t have any akkermansia to begin with (and my uBiome explorer showed 0%), then you won’t be able to cultivate it just from eating foods rich in polyphenols.
He didn’t seem to have an answer for how to grow akkermansia when there is none to begin with. I imagine one would need an FMT for it.
He only suggested eating berries and dark chocolate but acknowledged that it’s unlikely it’ll do anything if you don’t have the gut bacteria to begin with. He gave no other advice.
It makes sense that individuals who try to eat chocolate and berries and don’t have akkermansia would get stomach pain. You don’t have the right bacteria to digest such foods. How this gets remedied is beyond me, unless there’s a way to get akkermansia directly, diet should only hurt.
Great question and theories, Jon! When writing this post, I did not come across any research to answer your question or confirm/deny your theories. What I can tell you from my personal experience is that after several tests with no Akkermansia, I tested again after this post and finally had some for the first time. Unfortunately, I don’t have any specific reason why that would be. Unless someone notices symptoms from eating chocolate or berries, it would be a shame to cut them out!
Thanks Riley. That’s interesting that you have some Akkermansia now. uBiome is known for sampling error. I’ve heard you could swab the same piece of fecal matter in two different places, and get two very different results. I’m curious to know the percentage of akkermansia in your latest sample.
In general, I get stomach pain when eating chocolate. And berries, but especially with chocolate. I haven’t had chocolate in years (not that I miss it), because it tends to put me in writhing pain a few hours later.
I’m going to slowly, slowly try to reintroduce these polyphenol foods, one at a time. My ability to reintroduce previously problematic foods is significantly improved, because in the last two months I’ve cleared up the majority of symptoms related to IBS-D and hydrogen-dominate SIBO. You could almost say I discovered a cure for SIBO, although I’d probably still be positive if I did a breath test tomorrow. (hint: neither antibiotics, herbal antibiotics, or probiotics provided relief). The answer was diet! And not just eliminating foods, but changing what foods I ate when.
It’s possible that if I eat small amounts of these polyphenol foods with a meal I’ll digest it better. Again, experiment, and observe.
Also, not even the leading expert in the field (I emailed him) replied that he doesn’t know whether the 90% with akkermansia and the 10% who don’t have it is genetic or whether it’s caused by something else.
Hi Jon,
Fascinating info- thank you for sharing!
The Akkermansia muciniphila level on my most recent test (Jan 2018) was 0.11%. Still “low” but at least present!
That’s interesting about chocolate causing pain for you. Since most chocolate contains sugar, I am curious whether you have the same reaction from something such as unsweetened cacao nibs?
I am a big fan of the scientific self-experimentation approach as well. Keep us posted how it works out for you!
Thank you,
Riley
My 13 year old daughter also has shown zero percent Akkermansia too, and has suffered from IBD type symptoms and many allergies as well as evidence of neural inflamation such as terrible insomnia as an infant, dyspraxia, sensory processing dysfunction and extreme irritability when having inflamatory response. I would love to find a way to supplement Akkermansia some way. It sounds like a great clinical study! Just need to find someone to do it!
Sorry to hear that your daughter is struggling with health issues! Ubiome has been partnering with many research institutions on various studies, so perhaps they are already working on it 🙂 I am optimistic about continued research to help individuals with chronic illnesses!
I would imagine that even at 0% you have undetectable levels. In chemical analyses for metals and organics, the analyte may be present even though it is not detected in the test. That is because all existing tests have a minimum level that they can dependably detect. So, it is highly likely that providing an environment conducive to the bacterium will cause it to increase it’s colonies and eventually become detectable. I would continue with your improved diet. Use the first test as a baseline and re-test a while later to see if you have had an increase in beneficial biota.
I have HIGH levels of A.Mucinophila…and my naturopath thinks it has caused my leaky gut by excessively eating away the mucinous layer. In searching for how to decrease my levels., i came to the realization that most morbidity stems from an Akkermansia deficiency… not an abundance… which leaves me in a precarious situation. Do I reduce the high FODMAP foods from my diet, and risk all the unhealthy consequences of a low FODMAP diet (i.e obesity, insulin resistance, diabetes, crohn’s, psoriasis, etc).
Hmm, interesting! I personally would be cautious about following low FODMAP just based on one stool test showing high Akkermansia mucinophilia- could have just been a reflection of what you ate the previous day or two?
This is super interesting. I really enjoy your blog!
Just a random thing from an annoying bilingual- “Wah-lah” comes from voìla, or “there it is.” People started saying Wah-lah, but it’s just a bastardization of the real French word. So, when you’re taking about the tube-o-poo, you’re really making “voila, there it is!”
Thanks for letting me know, Andréa! I’ll update it =)