Microbiome determinants of shape and body composition - Dr. Davis

Transcript

1. William Davis, MD Microbiome Determinants of Shape and Body Composition
2. • Conventional weight loss strategies yield near-term success, long-term failure • Conventional weight loss methods impair health, shorten lifespan • Replacing factors lost in modern people restores control over weight and body composition—L. reuteri, collagen, hyaluronic acid, carotenoids Let’s discuss why:
3. Not only are overweight and obesity epidemic . . . They are also: • Physically and socially crippling • Embarassing, demoralizing • Accompanied by metabolic disorders • Life-shortening • “Ectopic fat”—fat in locations that accelerates disease Lim 2014
4. Conventional weight loss solutions are flawed • Preferential loss of subcutaneous over visceral fat • Inevitable loss of muscle mass • Reduced basal metabolic rate • Weight regain • Cost • Complications Conventional weight loss methods impair health
5. The Problem With Excess Weight: Abdominal Visceral Fat Insulin resistance Inflammatory cytokines
6. BMI 24 Kong 2022
7. 1. Reduced calorie diet 2. GLP-1agonists 3. Bariatric proc. Subcutaneous fat > Abd visceral fat Conventional weight loss methods Merlotti 2017 Calorie reduction
8. Weight loss = muscle loss 25% of weight lost is muscle Willoughby 2018
9. Can muscle loss be mitigated by exercise? Super obese, 30 weeks reduced calorie diet, 2 hours aerobic/resistance training per day 6 days/week Johannsen 2012 -23 lbs muscle (17%) 29% reduction in BMR
10. Fothergill 2016 Muscle loss means reduced BMR “Biggest Loser Study” 500 kcal/day (27%) reduction in basal metabolic rate x 6 years Regain of weight is assured— even with reduced calorie intake
11. • Reduced calorie diet • GLP-1 agonists • Bariatric proc. Reduced basal metabolic rate 25% loss of muscle mass Conventional weight loss has a major problem: Loss of Muscle and Weight Regain Low-calorie diet
12. Can you measure abdominal visceral fat? • BMI • Calipers • Waist circumference • Waist-hip ratio • Bioimpedance—InBody, Tanita, Withings, GE • DEXA—with visceral fat calc • CT, MRI Correlate with metabolic markers: • Triglycerides • HDL • Small LDL • Fasting glucose, insulin • Blood pressure • C-reactive protein • Uric acid
13. Wilding 2022 GLP-1 agonists: What happens when stoppped? • Increased insulin resistance • Increased pre-diabetes, type 2 diabetes • Increased BP • Increased triglycerides • Increased fatty liver • Increased cardiovascular risk • Increased risk for cognitive impairment • Increased risk breast cancer Weight regain is nearly all fat, not muscle
14. What If We Preferentially Target Abdominal Visceral Fat And Preserve Muscle? • Greater health benefits—glucose, insulin resistance, inflammation • Preserve or increase lean muscle mass • Faster weight loss • No weight regain Circumventing all the problems associated with calorie reduction
15. • Never cut calories • Reduce foods that trigger blood glucose + insulin • Address nutrients that influence insulin resistance—Mg, vit D, iodine/thyroid, omega-3s • Lactobacillus reuteri—high dose • Collagen peptides • Hyaluronic acid • Carotenoids—esp. astaxanthin Target Abdominal Visceral Fat, Preserve Muscle Restoring factors lost from modern people
16. 1. Increased endogenous oxytocin production 2. Increased growth hormone 3. Increased testosterone in males 4. Reduced LPS endotoxemia 5. Reduced “hedonic” eating 6. Reduced serum cortisol Lactobacillus reuteri: Lost by nearly everyone • Increased myocyte volume/muscle mass • Reduced insulin resistance • Reduced levels of inflammatory cytokines Six Body Composition-Modifying Effects ATCC PTA 6475
17. Lactobacillus reuteri Stimulates oxytocin release via vagus nerve
18. L. reuteri: Experimental evidence Varian 2017
19. Oxytocin: Muscle Elabd 2014 Elabd 2014
20. L. reuteri: Muscle Varian 2016
21. L. reuteri: Upper GI-colonization, bacteriocin production L. reuteri Upper & Lower GI Colonization Bacteriocins Reduced LPS endotoxemia Reduced fecal microbes in small intestine
22. L. reuteri: SIBO and endotoxemia • Decreased insulin resistance, inflammation • Decreased blood sugar • Decreased blood pressure • Decreased triglycerides • Decreased abdominal visceral fat • Increased muscle mass • Decreased skin inflammation, rash
23. Non-microbial synergistic factors lacking in modern people • Collagen peptides • Hyaluronic acid • Astaxanthin
24. • L. reuteri LRDR 40 B CFUs • Marine-sourced collagen peptides • High-MW hyaluronic acid • Astaxanthin Collagen peptides Marine-sourced enriched in di- and tri-peptides Gly-Pro-Hyp
25. • N = 97, males with sarcopenia, mean age 72 years • Collagen peptides 15 grams/day (bovine, porcine, marine) over 90 days • 3x/week resistance training Collagen and body composition -3.4 cm in waist circumference Zdzieblik 2015
26. Hyaluronic acid Marinho 2021
27. Hyaluronic acid Hyaluronic acid Prebiotic fiber • Faecalibacterium prausnitzii • Akkermansia muciniphila • Bifidobacteria spp. • Eubacteria • Lachnospiraceae • Ruminococcaceae • Reduced Proteobacteria • Increased mucin production • Reduced endotoxemia • Reduced serum IL-1β, IL-6, and TNF-ɑ Butyrate • Reduced waist circumference • Increased butyrogenic species • Reduced insulin resistance, fasting glucose, reduced inflammatory cytokines
28. Astaxanthin • Increased fatty acid mobilization/utilization • Decreased reliance on hepatic glycogen • GI microbiota: decreased Proteobacteria, Bilophila, Desulfovibrio, Parabacteroides; increased Akkermansia • GLP-1 agonist • Enhanced aerobic capacity/speed Nakanishi 2022
29. Astaxanthin 8 mg/day, n = 44 type 2 diabetics, 8 weeks
30. Human Clinical Study N = 25 12 weeks No change in diet, exercise 92% of participants lost 7.2 cm (2.84 inches) off waist circumference
31. L reuteri + marine collagen + hyaluronic acid + a
32. • Specific targeting of abdominal visceral fat Preservation or increase in lean muscle mass Preservation or increase in BMR Age-reversing effects An Updated Approach to Improving Body Composition
33. William Davis, MD Microbiome Determinants of Shape and Body Composition