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Fact-Checking The 4 Most Popular Akkermansia Claims

Akkermansia Sounds So Promising, But What Does the Research Tell Us?

If you’ve read or watched something about a new probiotic called Akkermansia recently, you might think you’d stumbled on the holy grail of gut health.

Akkermansia muciniphila, often abbreviated as A. muciniphila is a gram-negative (thin-walled) gut microbe that was only discovered within the human gut microbiome in 2004. However, since then, some substantial human health claims have come out about it, thanks largely to a company called Pendulum Therapeutics that produces and markets it as a supplement.

A. muciniphila (or just Akkermansia, as I’ll call it throughout this article) is part of the normal gut microbiota composition in about 90% of healthy individuals [1]. An interesting thing about this microorganism is that it resides entirely within the mucus layer, or mucosa, of the gut wall (muciniphila literally means mucus-loving) rather than in the feces. In the mucosa, Akkermansia can directly interact (cross-talk) with human intestinal cells, aka epithelial cells.

Notably, Akkermansia thrives throughout both the small and large intestines, which is different from other significant gut bacteria. For example, Lactobacillus species tend to have greater relative abundance in the small intestine than the large intestine, and Bifidobacteria concentrations are denser in the large intestine [1]. 

Akkermansia’s ability to populate the mucosal lining of both the small and large intestines is one of the main reasons the health and wellness industry is buzzing about this probiotic. The implication is that the bacterium’s main role in the human gut microbiota may be to maintain a strong gut lining [2]. 

A couple other things of note about Akkermansia are:

  1. It acts as a mucin-degrading “cross feeder.” This means it converts mucin (the gooey substance that lines our gut) into metabolites (byproducts) called short-chain fatty acids (e.g. butyrate) that support the growth of other beneficial bacteria [1]. 
  2. In animal models, Akkermanisa appears to stimulate the secretion of a hormone known as glucagon-like peptide-1 (GLP-1). In humans, GLP-1 plays the important role of helping us feel full and may aid in weight management, so the animal data suggest the possibility that Akkermansia could help people lose weight [3].

For all the reasons I’ve outlined above, it’s likely that Akkermansia can contribute to a balanced and healthy gut microbiome and may have beneficial effects. In other words, ensuring a microbial ecosystem that supports the gut bacterium Akkermansia is a good idea.

But does this mean you should make Akkermansia your first probiotic choice? Not so fast. 

The Truth Behind ‘Akker-mania’

Akkermansia may be the fashionable probiotic right now, but there’s a lot of hype we need to cut through to get to the actual science behind it. 

First, most Akkermansia studies have been conducted on animals or in vitro (petri dish) laboratory studies, making it difficult to apply the findings to humans directly. 

Second, there’s a certain amount of novelty bias around next-generation therapeutics like Akkermansia. Novelty bias is a phenomenon in science that occurs when researchers unintentionally exaggerate the positive things about a treatment when it is new. As a result, positive studies tend to be published first, while more negative ones may be yet to come [4].

There are even some hints at more worrying downsides—for example, in animal models, too much Akkermansia in a diseased gut (like one affected by colitis) has impaired the gut lining and worsened gut inflammation [5]. We don’t know if this is true for humans, but the potential exists.

To understand this in more detail, let’s evaluate the 4 main claims made for Akkermansia, weighing them up against what the current research tells us.

Claim 1: Low Levels of Akkermansia Are Associated With Poor Health

While it’s true that lower levels of Akkermansia have been associated with (but not found to cause) some health conditions, this is only half the picture. In other conditions, Akkermansia levels can be high. Check out this table to see what conditions fall into which camp:

Akkermansia Levels Typically HigherAkkermansia Levels Typically Lower
Diet-induced obesity✔ [6]
Inflammatory bowel disease, such as ulcerative colitis✔ [7]
Type-2 diabetes✔ [8]
Irritable bowel syndrome (IBS)✔ [9]
Parkinson’s disease✔ [10]
Multiple sclerosis (an autoimmune condition)✔ [11]

It’s worth noting that these relationships are associations only. This means that we cannot be sure or say with any certainty that low Akkermansia levels cause inflammatory bowel disease (IBD) or high Akkermansia causes irritable bowel syndrome (IBS).

And even if there were a causal relationship, it could be reverse causation—i.e. having intestinal inflammation and IBD results in Akkermansia levels falling, rather than lower Akkermansia levels causing IBD.

Akkermansia levels could also just be a marker for other aspects of your health and lifestyle, such as the diet you eat or how well your immune system functions. At this point, research has a ways to go before finding out.

Key Takeaway: The potential links between Akkermansia and various diseases are interesting, but it’s too early to draw conclusions. We don’t know if low Akkermansia levels actually cause illness or not.

Claim 2: Akkermansia Is Good For Weight Loss

There’s been a lot of buzz around Akkermansia and weight loss, but only one small randomized controlled trial has addressed it. In the trial, 32 people with obesity or overweight and insulin resistance took a placebo or 10 billion CFU of live or pasteurized Akkermansia each day. They were not required to make any specific dietary or lifestyle changes.

After 3 months, various aspects of metabolic health, including significant weight loss, improved in those who took Akkermansia (more on this below). On average [11]: 

  • Body weight decreased by 5 lbs more in the Akkermansia group than in the placebo group; and
  • Participants given Akkermansia lost, on average, 3 lbs of fat mass and approximately 1 inch of hip circumference.

How does this compare with other more widely studied probiotics? One meta-analysis of 25 randomized controlled trials showed that probiotics containing blends of Lactobacillus and Bifidobacteria also helped with weight loss. However, the average weight loss with these probiotics was less, at 1.3 lbs per person over study times of 2–6 months [12].

This would suggest Akkermansia could be the best probiotic we have for managing weight, but do keep in mind that this is comparing just one small Akkermansia study with a much larger set of studies involving traditional probiotics. Furthermore, a loss of 5 lbs in 3 months is pretty minimal [11].

In short, it’s too early for proclamations—we need a lot more research to replicate the claims around Akkermansia’s benefits for weight loss.

Key Takeaway: It’s too soon to say with certainty that Akkermansia is the best probiotic for weight loss. Much of the hype relies on one small study, but this probiotic is still a good one to watch.

Claim 3: Supplementing With Akkermansia Improves Metabolic Disorders

Two randomized controlled trials have suggested that Akkermansia supplements may help people maintain healthy blood sugar levels and manage or reduce the risk of metabolic diseases like type-2 diabetes and poor insulin sensitivity.

In the first study (the same one involving 32 patients with metabolic syndrome and higher body weight), 3 months of Akkermansia supplementation led to [11]:

  • A 0.56-point drop in HOMA-IR score (a higher score indicates insulin resistance, which is when your cells don’t respond properly to the insulin your body produces, and your blood sugar levels can rise as a result);
  • A 30% decrease in fasting (between-meal) levels of insulin;
  • Improved total cholesterol (reduction of 8.9 mg/dL) and beneficial trends (not statistically significant) on other lipids (LDL-cholesterol and triglycerides); and
  • Reductions in markers of liver dysfunction and inflammation, with no changes to the overall intestinal microbiota composition.

These outcomes suggest that Akkermansia may contribute to metabolic improvements that nudge the needle toward a lower risk of type-2 diabetes and cardiovascular disease.

In the second study, 76 people already receiving medication (metformin) for type-2 diabetes took either a 3-strain probiotic (Bifidobacterium infantis, Clostridium butyricum, and C. beijerinckii), a 5-strain probiotic (including Akkermansia and Anaerobutyricum hallii plus the previous three strains), or a placebo.

After 12 weeks [13]:

  • The 5-strain probiotic with Akkermansia decreased post-meal glucose by 15 mg/dL on average, while the 3-strain group saw an 11 mg/dL increase; and
  • Hemoglobin A1C levels (average blood glucose over the past 3 months) went down with the Akkermansia probiotic, though not significantly, which may be due to the relatively short trial period.

The Akkermansia-containing probiotic also produced 12% fewer gastrointestinal tract side effects compared to placebo. 

These results suggest a potential benefit of Akkermansia-containing probiotics on blood sugar control. However, an important caveat to this study is that the Akkermansia was part of a 5-species blend, so we can’t tease out what effects were from this bacterium specifically. 

Other Probiotics and Blood Sugar 

Although the above results seem promising, remember that they come from just two clinical trials that likely received disproportionate attention because Akkermansia is a novel probiotic. 

When we look at the effects of more established Lactobacillus-Bifidobacteria blends on metabolic health—particularly blood sugar control—we find the dataset is not only much bigger (yielding more trustworthy results) but also shows better effects.

For example, a meta-analysis of 15 randomized controlled trials found that Lacto-Bifido blends had greater beneficial effects than Akkermansia on fasting glucose and insulin resistance (HOMA-IR) in people with diabetes. Their effects on their A1C were similar to Akkermansia’s [14]. 

What this all amounts to is that we have ample data to show the benefits of Lacto-Bifido blends on metabolic health, whereas just a little evidence supports similar benefits of Akkermansia.

Key Takeaway: We need more research to get a clearer picture of Akkermansia’s metabolic and blood sugar benefits. For now, existing probiotics (like LactobacillusBifidobacterium blends) have more research and are more effective.

Claim 4: Akkermansia Helps Heal a Leaky Gut

Because Akkermansia thrives in the mucus layer of the gut wall throughout the intestines, there’s growing interest in its potential to heal a leaky gut. You can think of the gut wall as being like a wooden picket fence—if a few of those boards start coming loose, the fence stops acting as a proper barrier to outsiders.

Similarly, a damaged or leaky gut barrier (aka intestinal permeability) can allow toxins, bacteria, and food particles from the gut into the bloodstream. When these outsiders get into the bloodstream, they can cause unusual immune responses that promote inflammation. 

Just one randomized clinical trial has addressed Akkermansia’s effect on gut barrier function in humans [11]. It’s the same study we already examined in relation to weight loss and metabolic health. This study looked at intestinal barrier dysfunction in response to Akkermansia supplementation by measuring plasma lipopolysaccharides (LPS), which are a marker for gut leakiness. Basically, higher LPS suggests gut leakiness, and lower LPS indicates tighter intestinal wall junctions.

Fact-Checking The 4 Most Popular Akkermansia Claims - Lipopolysaccharide%20%28LPS%29%20Indicators%20of%20Leaky%20Gut L

After the participants took Akkermansia for 3 months, the researchers found they had lower serum LPS. This suggests that the gut wall had become less leaky, analogous to those fence boards fitting together more tightly.

Other Probiotics and Leaky Gut

Evidence showing the benefits of probiotics on leaky gut is much more plentiful when it comes to better understood, more established probiotics. 

For example, a meta-analysis of 26 randomized controlled trials testing mainly Lactobacillus and Bifidobacterium blends showed that people who took them, especially for 4 weeks or less, had lower levels of leaky gut markers. This suggests the probiotics may have helped knit together the tight junctions between intestinal cells [15]. 

Compared to the one Akkermansia study, the 26 studies in the meta-analysis examined the effects of Lacto-Bifido probiotics on more markers of gut leakiness. Whereas the lone Akkermansia study measured only LPS, the meta-analysis studies measured zonulin, ​​transepithelial resistance, and LPS levels, giving more weight to the results.

In terms of other well-studied probiotics, a meta-analysis of 9 randomized controlled trials showed that soil-based probiotics can also significantly reduce serum zonulin as a marker of leaky gut [16]. Though there’s less research on how Saccharomyces boulardii, a beneficial yeast, affects leaky gut, two randomized controlled trials showed that this science-backed gut support can reduce indicators of intestinal permeability [17].

It’s also worth noting that we don’t have data on Akkermansia’s effect on common GI conditions, such as dysbiosis and associated symptoms like reflux, bloating, and IBS-like symptoms. So, even though Akkermansia might help reduce gut permeability, we don’t know if this translates into symptom relief. 

By contrast, plentiful research shows that more common probiotics, including Lacto-Bifido blends, S. boulardii, and soil-based species (alone or combined) can benefit IBS-type symptoms [18, 19, 20, 21, 22, 23].

Key Takeaway: Probiotics in general are useful for healing a leaky gut. We don’t have any information to say Akkermansia is special in this regard, so it makes sense to stick with probiotics that are well-researched for this condition and can help improve gut health in general. These include Lacto-bifido blends, S. boulardii, and soil-based species.

Akkermansia Is Part of a Microbial Ecosystem

Akkermansia is interesting, but given the relatively small amount of research on this bacterium to date, I don’t generally recommend it as your first line or your only probiotic therapy. 

This hearkens back to a concept I originally wrote about in Healthy Gut, Healthy You, which is that we should be careful not to try and micromanage the gut microbiome.

Rather than trying to raise levels of just one microbe (Akkermansia), it’s more helpful to think in terms of your microbiome being a whole ecosystem that needs nourishment and balance.

In the clinic, we’ve found that a successful probiotic regimen for most patients with gut symptoms usually involves multiple species to achieve balance in the gut.

One of the three probiotics our patients usually get started on is a blend of Lactobacillus and Bifidobacterium species. As I’ve noted throughout this article, this blend has a lot of research supporting it.

The other two species I recommend are:

  • Saccharomyces boulardii (a beneficial yeast) 
  • A soil-based probiotic blend, typically of Bacillus species

You can even get all three together in one product if you want to cut down on the capsules you take.

If you take these for several weeks and want to add Akkermansia to the mix as well, by all means, go ahead. But note that Akkermansia is an added expense to your supplement regimen (typically around $60–80 for a month’s supply of just this one strain) and less well-researched. Therefore, it’s worth seeing if you benefit from the above trio of better-researched probiotics first.

You Can Increase Akkermansia Without Supplementing

That’s right: You can actually increase the prevalence of Akkermansia and balance your microbiome in general without taking a specific Akkermansia supplement. 

This may be as simple as taking more established probiotics. For example, in a small study, people with type-1 diabetes who took Lacto-Bifido probiotics for 6 months also saw an increase in their Akkermansia levels [24].

Certain diet strategies and aerobic exercise may also increase Akkermansia, as the following table shows—make sure to read the cautions, too.

Ways to Increase the Abundance of AkkermansiaCautions
Eat foods high in prebiotic fibers and FODMAPs, e.g. onions, garlic, asparagus, pears, dried fruit [25].Take care if you have IBS, as FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) can exacerbate IBS symptoms.
Try a ketogenic diet [26]. Caveat: Though this recent study showed Akkermansia increasing with keto (type of high-fat diet), overall microbial diversity and number of Bifidobacteria decreased.Keto diets aren’t recommended for people whose mood and energy tank when they’re on a low-carb regimen.
Eat more dietary polyphenols from foods like cranberry and pomegranate juices and extracts, green tea and red grapes, or red wine [27]. Caveat: Data is from healthy mouse models; studies in humans and diet-induced obese mice haven’t shown a significant change in Akkermansia levels to date.Be aware of polyphenol-rich foods that also contain FODMAPs and fibers that might exacerbate gut symptoms.
Try intermittent fasting [28]. Intermittent fasting may not suit people with blood sugar issues.
Take up regular aerobic exercise that ideally mixes easier and higher intensity activities [29].Exercise within your capabilities to avoid burnout.

Remember, it’s never a good idea to try and micro-manage just one symptom or lab marker (e.g. your Akkermansia level) if it causes other imbalances or symptoms to arise.

Akkermansia: We Need More Research

In a nutshell, though it’s a promising probiotic, some of the claims made for Akkermansia are ahead of what the science says so far.

We’ll get more information on Akkermansia in time. But for now, it’s probably better and more cost-effective for your gut health to stick to the three well-studied probiotic categories. These are a Lactobacillus and Bifidobacteria blend, soil-based probiotics, and the beneficial yeast Saccharomyces boulardii.

Probiotics are only one part of gut healing, so if you’re serious about turning around poor gut health, you may want to follow my more comprehensive Great-in-8 approach as outlined in Healthy Gut, Healthy You. We also have clinic appointments available if your issues are more complex and you want to talk them through with an experienced health practitioner.

The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.

➕ References
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