Sunday, April 28, 2013

Do You Have the Gut(s) to Lose 8% Belly Fat in 12 Weeks? Lactobacillus gasseri (LG2055) Can Fix Your Gut Problems

As a diligent student of the  SuppVersity, you'll obviously know that beer is not the main cause of the eponymous belly (Bobak. 2003). Although..., when when you come to think about it: For every glass of beer you drink, you're probably drinking a glass of probiotic yogurt less ;-)
You've done everything you could and still feel like a whale? You've been low-carbing, even have made sure you are in ketosis by consuming an only 10% protein diet and still the fat won't disappear? Well, I guess it sounds unfair, if I do now tell you that you YOU JUST DON'T HAVE THE GUTS it takes to get rid of that pouch that blocking the view on your toes, when you are standing.

Now calm down, I am not talking about not being able to curb your insatiable appetite or skipping 90% of your workouts, here. I am talking about your gut(s), literally! Your digestive tract and it's inhabitants. Those critters which are also at the heart of the soon-to-be-published paper by scientists from the Milk Science Research Institute in Fukoaka, Japan (Kadooka. 2013) - a paper, the results of which I am about to present in the next few paragraphs.

Probiotic in fermented milk shred visceral fat

I am not telling you something new, when I say (or write) that scientists have long identified the modulation of the gut microbiome, i.e. the bacterial ecosystem in your intestines, could be the long-sought-for lever to get rid or at least ameliorate the negative effects of the way we live and eat promotes the expansion of the highly inflammatory "stress fat" that fills the room between the organs in your trunk. Most of the hitherto published peer-reviewed research has yet been conducted in rodents. The existing evidence from well-controlled human studies, on the other hand is scarce.

Suggested read: "Probiotics for Athletes: The Supplemental 10 Billion CFS Leaky Gut Solution for the Fermented Food Refusinek?" (read more)
One of these studies has been conducted by Kadooka et al. in 2010 (Kadooka. 2010). In the pertinent paper the researchers from the Milk Science Research Institute in Japan reported that the provision of 200g/day of fermented milk containing 10^8 colony-forming units (cfu)/g of Lactobacillus gasseri strain SBT2055 (LG2055) led to significant reductions in visceral fat in male and female subjects with " higher body mass index" (BMI: 24.2-30.7 kg/m²) who had been randomized to the active arm of the study. Now, roughly three years later, are about to publish a follow-up paper with great practical relevance, as it summarizes the results of what Kadooka et al. say is the first human trial that examines the effect of different doses of probiotics on abdominal adiposity.

"We know that it works, but we don't know how much we need to elicit the desired effects"

The design of the study at hand is essentially identical with the one in the 2010 trial. It is based ona multi-centre, double-blind, parallel-group RCT with 210 healthy Japanese adults with large visceral fat areas (80.2–187.8 cm²), who were now randomly assigned to three instead of two groups who consumed 200g of fermented milk with either 1,000,000 CFU (1m), 10,000,000 CFU (10m) or just the normal yogurt probiotics (control) per gram for 12 weeks.

The intention was to determine whether the effect of LG2055, which is by the way a probiotic lactic acid bacterium that originates from the human intestine, would be observed with lower / more realistic dosage regimen as well and whether possible reductions in the effect size would be dose-dependent.
Figure 1: Reduction in visceral and subcutaneous adipose tissue, as well as waist circumference after 8 and 12 weeks on 1,000,000 CFU/g or 10,000,000 CFU/g yogurt drink; data expressed relative to group baseline (Kadooka. 2013)
If you take a look at the results, the first thing that strikes the eye in figure 1 is that the lactobacilli did their job and that in both the low and high dose group:
  • Even in the 10x and 100x lower dosages there was a significant reduction in the amount of visceral fat the  33/36 respectively 36/35 men and women in the in the 1 million and 10 million CFU/day groups, respectively.
  • The effect size of both dosages of LG2055 was identical, so that it would not actually matter if you consume just 100g or 1kg of an imaginary commercially available milk drink with 1,000,000 CFU of LG2055 per 100g.
In view of the >8% reduction in visceral fat mass, it should not come as a surprise that the reduction in waist size was likewise statistically significant - both on its own, as well as in comparison to the control group, What is yet not so obvious and probably somewhat disappoint for you is the fact that the reduction in the ugly, but benign subcutaneous fat was statistically and practically non-significant.

"Visceral fat loss, only? But what about my thigh fat?"

Not all probiotics are created equal: As the scientists emphasize in the discussion, the "it is also worth noting that the test FM containing both LG2055 and yogurt cultures reduced abdominal adiposity when compared with the control FM containing yogurt cultures alone, even though the bacterial counts of LG2055 (106 and 107 cfu/g) were lower than those in the yogurt cultures (109 cfu/g)." (Kadooka. 2013) The observed superiority of this particular strain of bacteria stands in line with previous rodent studies and is imho one of the reasons we are seeing so much research in this area. How's that? Well, easy: If you came up with a particularly potent strain and patented that, this would be the literary cash machine.
If you are no newbie to the SuppVersity you will yet be aware that it is by no means extra-ordinary that "healthy fat burners", which work their weight loss magic mostly by modulating local and/or whole body inflammation, have little or no effects on the amount of subcutaneous body fat.

If you discarded any statistical shenanigan and simply went by the height of the small bars in the middle of figure 1, you could yet probably argue that it appears as if there was a trend towards greater subcutaneous fat loss in the high(er) dose LG2055 group. If you went a step further and made the unwarranted assumption that you could simply compare the results from the study at hand to those of the aforementioned 2010 study b Kadooka et al. you could support this argument by stating that there was a clear trend here with 1.2%, 2.6% and 3.3% reductions in subcutaneous fat with LG2055 at concentrations of 1, 10 and 100 million CFU per gram of the fermented milk drink.

In the overall context it is yet important to point out that it is as of yet unknown whether the composition of colonic microbiota has a direct influence on abdominal and/or subcutaneous adipose tissue (Hildebrandt. 2009; Conterno. 2011). Moreover, ...
"[...] environmental factors, including genetics and age, makes it difficult to discuss the causal relationship between adiposity and intestinal microbiota." (Kadooka. 2013)
The latter are particularly difficult to access in a study like this, where the subjects maintain their habitual mode of living, including diet, and no strict dietary control is applied. Kadook et al. are thus right to point out that "the relation ship between adiposity and intestinal microbiota" has to be investigated more closely "under a strict diet, together with the latest methodology" (Kadooka. 2013) to finally make some progress in our understandings of the intricate interaction between the human gut microbiome and our metabolism.



Even the nicest subtenants can become a real problem, when they come over without being asked. Unfortunately, all sorts of gut bacteria (even the "good" ones) have a similarly nasty habit of translocating through a leaky gut wall into parts of your body, where you don't wont them (learn more)!
Bottom line: In view of the fact that the subjects shed the superfluous body fat in the absence of a reduced energy intake and/or exercise / increases in physical activity, the results are unquestionably impressive. To speak of "probiotic fat burner" would yet still not be warranted. After all, the subjects were all overweight and had an average body fat content of 32%, the baseline diet does - at least by the available data - not look really optimal (protein intakes of 0.8g/kg; macro-composition of 15/57/28% from protein, carbs and fats) and the non-disclosed insulin and HbA1c levels as well as the markers of inflammation will probably have left more than enough room for the "get healthy lose weight" effect.

Against that background I have my doubts that you can expect anywhere similar effects in lean, let alone athletic individuals. This does yet not negate the general usefulness of probiotics, after all, health is something you take for granted only, when you've never been sick - if you want to avoid that, the incorporation of fermented foods makes sense for everyone from the sedentary slob to the elite level athletes*...

* Note: I am writing the above although it gives me tummy aches (pun intended). Specifically with respect to the use of high dose probiotic supplements, I am asking myself, whether we really know enough about the potential downstream effects of long-term / high dose supplementation. In that, I am particularly concerned about shifting the balance from an "A"-dominant and unhealthy state in which the attributes "good" and "bad" are all of the sudden reversed and the previously dominant "bad" strain X gets totally replaced by the allegedly "good" strain Y that will then turn out to be just as nasty as X, once its natural arch enemy X is no longer present.

References:
  • Bobak M, Skodova Z, Marmot M. Beer and obesity: a cross-sectional study. Eur J Clin Nutr. 2003 Oct;57(10):1250-3.
  • Conterno L, Fava F, Viola R, et al. Obesity and the gut microbiota: does up-regulating colonic fermentation pro- tect against obesity and metabolic disease? Genes Nutr. 2011; 6:241–260.
  • Hildebrandt MA, Hoffmann C, Sherrill-Mix SA, et al. High-fat diet determines the composition of the murine gut microbiome independently of obesity. Gastroenterology. 2009; 137:1716–1724.
  • Kadooka Y, Sato M, Imaizumi K, Ogawa A, Ikuyama K, Akai Y, Okano M, Kagoshima M, Tsuchida T. Regulation of abdominal adiposity by probiotics (Lactobacillus gasseri SBT2055) in adults with obese tendencies in a randomized controlled trial. Eur J Clin Nutr. 2010 Jun;64(6):636-43. 
  • Kadooka Y, Sato M, Ogawa A, Miyoshi M, Uenishi H, Ogawa H, Ikuyama K, Kagoshima M, Tsuchida T. Effect of Lactobacillus gasseri SBT2055 in fermented milk on abdominal adiposity in adults in a randomised controlled trial. Br J Nutr. 2013 Apr 25:1-8. [Epub ahead of print]
     

23 comments:

  1. Interesting article for sure - thank you!

    This seems to have some potential for the more "active" visceral fat - but what about the subcutaneous stuff? What's the protocol to shed that? My visceral fat has disappeared nicely with a Paleo lifestyle but the subcutaneous stuff is incredibly stubborn!

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    1. How could you possibly tell that you lost visceral fat mass??

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    2. Why can't he see that his waist is trimming, but the caliper measurements remain the same?

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    3. much of the inter-organ fat disappears if you get healthy and reduce inflammation. Subq. fat won't vanish by just eating healthy You got to diet, to let go off that and the OPs first post does not suggest he did that

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  2. So Dr.,
    sauerkraut or kefeir and how much?

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    1. honestly, I have no idea =) After all, I said in the box to the right that the effects are strain-specific, so calculating the equivalent is pointless, because you don't have any idea how this "designer strain" can compete with the natural fermentation bacteria in sauerkraut and kefir.

      From a practical point of view every other day appears to be realistic and will certainly have certain benefits

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  3. "In that, I am particularly concerned about shifting the balance from an "A"-dominant and unhealthy state in which the attributes "good" and "bad" are all of the sudden reversed and the previously dominant "bad" strain X gets totally replaced by the allegedly "good" strain Y that will then turn out to be just as nasty as X, once its natural arch enemy X is no longer present."

    Probiotics are usually gram-positive bacteria and pathogenic bacteria are more likely to be gram-negative which is the source of the LPS endotoxin, Also probiotic bacteria tend to have low persistence further down the colon and don't eliminate other species there. What they might do is decrease the translocation of LPS, perhaps because similar but less inflammatory fragments of the probiotic bacteria can be used instead to maintain the tone of the immune system.
    Probiotic overgrowth is a rare event in people with severe immunosuppression.

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    1. wait till people start popping these products chargewise in the false hope to get lean ... ;o)

      I see, where you are coming from, but my gut simply tells me that disturbing an ecosystem always leads to problems

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  4. I found some information that seems to indicate that kefir may, depending on the origin of the kefir starter culture, contain L. gasseri, although it does not give any quantitative data wrt to this strain:

    "Kefir grains are particular dairy starters in that their microflora is embedded in a polysaccharidic matrix produced in situ. Kefir grains contain a complex microflora of lactic acid bacteria (LAB) and yeasts, sometimes associated with other microorganisms (e.g., acetic acid bacteria and molds). Their microbial composition has been reported to show species variation depending on the origin of the grain (1). The number of LAB species that have been isolated from a single grain varies from I to 6, showing a diversity that includes Lactobacillus kefir, L. fennentum, L. casei, L. brevis, L. viridescens, L. acidophilus, L. gasseri, L. kefiranofaciens, L. parakefir, L. plantarum, L. delbrueckii, L. helveticus, L. curvatus, Leuconostoc mesenteroides, L. lactis, Lactococcus lactis, and Streptococcus thermophilus (2-8). Quantitatively, lactobacilli have most often been reported to be dominant in the LAB population of grains (7, 9-11)."

    http://business.highbeam.com/408580/article-1G1-174593683/identification-lactic-acid-bacteria-within-consortium

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    1. nice find, but as I said before, if the effects are strain specific that's not really telling you much. That being said, I suspect that the EFFECT SIZE is the variable here, so eating kefir will help - the question would thus only be to which degree

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  5. The idea of using this exact strain or that strain for a particular physiological response is intriguing, however, I think the concern is that we have such a poor understanding of the overall picture of the digestive system ecology that we should be careful of "megadosing" any particular strain.

    Let's just say, for sake of conversation, that you are a person with "healthy" digestive system flora, and you introduce L. gasseri in large quantities. How does this affect all the other bacteria and yeasts in your digestive system? Does it throw something off? Does it create one beneficial response at the expense of something else?

    I'm pretty sure that we do not know, in which case it seems prudent to err on the side of caution and use *high quality* natural sources of probiotics, such as raw milk kefir and lacto-fermented vegetables (not the sauerkraut in a jar or bag you find at the supermarket), and provide the right "food" for the good guys (to attract and support) with a wide variety of fibers from various fruits and vegetables, while not eating excessively high protein or low carb (or too high carb/sugar!), and eating high quality organic foods.

    We could consider an anology using the fat soluble vitamins: Vitamin D is good, yay! Let's take a good amount of it. Wait! You need true vitamin A to balance out the vitamin D so you don't get side effects; cool! No, wait again, we need vitamin K2 (oh wait, which form? MK7 or MK4?) in a balance there as well so they all function properly so you don't get soft-tissue calcification. No wait again! Maybe vitamins E play a role in there as well....now wait a minute, now that I'm supplementing all of these together, what amounts and ratios should I use? Now take a step back; couldn't you have just got some sun, ate some liver and kidney and eggs from pastured animals instead? You know, something that has been tested for thousands of generations of humans and is proven to support health for many generations (something which is rarely addressed)?

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    1. I think you are overly concerned in both cases.

      First, I don't think that is is possible to overdose with probiotics in a way that would throw your gut flora permanently out of balance. If there's a certain strain that's "incompatible" with your flora, you will probably notice it quite immediately and rush to to toilet. On the other hand, probiotics have been around for centuries and even the most potent supplements (in terms of log CFU/ml) are but a drop in the massive pool bacteria inhabiting your large intestine. Moreover, an important property of a healthy gut flora is its relative stability compared to a more unfriendly one which causes frequent "trouble".

      If you look at the scientific literature, however, it seems that prEbiotics are actually much more potent in posetively changing your gut flora than prObiotics.

      Second, the concerns regarding the need for "adjunct" supplementation with vitamin D have been blown way out of every evidence-based proportion by, guess who - exactly, supplement sellers who want you to buy their new, thrice-as-expensive "Super D plus K2 synergy". Do you think that people attaining high vitamin D serum levels from sun exposure, in the range epidemiologically associated with favorable health status, also manufacture vitamin K2 in their skin? Furthermore, all the clinical trials which have shown benefits of vitamin D supplementation have been done without K2 - sometimes even involving patients taking vitamin K antagonists, with no apparent ill-effects.

      IMO, one should stop worrying too much, eat well and make sure that vitamin D levels are above 30ng/ml, preferentially through sun exposure and if that's not possible (like in the wintertime at a nothern latitude), through supplementation. If you want additional peace of mind, take a low-dose multivitamin/mineral as an insurance. If you need additional peace in your belly, try some pre- and possibly probiotics.

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    2. You don't manufacture vitamin K2 along with vitamin D, nor do you manufacture vitamin A along with the vitamin D, but that doesn't change that they all interact and require some level of balance in order to promote optimal functioning and health.

      Research on a vitamin is usually done with that vitamin in isolation, naturally, in order to try to determine the effects of the nutrient. Adding vitamin K2 to a vitamin D trial to determine the effects of vitamin D wouldn't make sense, and data does show that vitamin K antagonists (Coumadin) do increase the toxicity of vitamin D.

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    3. Actually you do in a way - most people are pretty good in converting beta-carotene to retinol or vitamin K1 to K2. Both are abundand in plant food and I wonder whether the according enzyme activity adapts to a changing demand.

      My point was, though, that there is really no evidence for ill-effects of vitamin D supplementation in common dosages because of interactions with other vitamins.

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    4. I agree, the scare of not having enough K with your D was probably another LEF invention to sell more supplements ;-) It is true that you need both, but honestly, I have not seen any reports saying "subject X developed a K deficiency in response to the D-intervention"....

      That being said, I fully subscribe to having second thoughts about the use of isolated bacteria in super-doses, although the chance that it will hurt you is just that a chance and a hypothesis that would be worth investigating.

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  6. I think my point was entirely lost. I was talking about how we learn about benefits of vitamin D, but then as we learn more, we learn that vitamin K2 and vitamin A are also important and they all interact in complex ways, and manipulating, in this case just vitamin D intake, without addressing vitamin A or K2 intake, isn't wise.

    The point is sometimes we learn some information about a particular system and think we can now manipulate it, but then by doing this we may end up with some effects that we did not anticipate. That was all. Sorry I made my point very poorly.

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  7. It's a wonder how anyone ever lived to be over 100 years old! /sarcasm.

    I think we need to focus moreso on the people who lived to over 100. Mimic as much as what they did while incorporating modern research without over analyzing it.

    I think a relatively safe way for the latter is to always analyze research in the context of how X or Y are found naturally in nature, especially for those who are already healthy and not metabolically compromised.

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    1. Unfortunately a lot of what determines longevity is genetic.

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    2. I agree that genetics are the limit of your potential, but maximizing your potential lies with lifestyle.

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    3. Very true JP. Nonetheless, someone with the right genes can smoke and drink and do everything wrong and live to be over 100, while the person with the short-lived genes can do everything right and die by 70.

      Also keep in mind the difference between life quality and quantity. Lifestyle factors contribute more to the former.

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    4. I guess the problem with focusing on what they do right is that the latter is so complex and may totally depend on their genes that we will hardly make progress with the comparatively few of us making it past 100 in a state I would like to be in... honestly, lying in bed all-day losing my mind is not what I am dreaming of.

      wrt to the genetics. Take fish oil for example. If you got the wrong gene allele it will give you a stroke and heart disease

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  8. Hi,

    Is there anyone that is offering Lactobacillus gasseri (LG2055)to purchase as a supplement?

    Thanks,

    Chris

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