Vitamin D and Prebiotics May Benefit the Intestinal Microbacteria and Improve Glucose Homeostasis in Prediabetes and Type 2 Diabetes.
Endocr Pract. 2013 Jan 21:1-40.
Section of Endocrinology, Department of Medicine, University of Illinois Medical Center and Jesse Brown VA Medical Center, Chicago, Illinois.
Objective: To review the role of human large bowel microbacteria (microbiota) in the glucose homeostasis, to address vitamin D (VD) and prebiotics interactions with microbiota, and to summarize recent randomized clinical trials (RCT) of VD and prebiotics supplementation in prediabetes and T2DM.
Methods: Primary literature was reviewed in the following areas: composition and activity of human microbiota associated with prediabetes and T2DM, the mechanisms of the interactions between microbiota and glucose homeostasis, the interaction of microbiota with VD/prebiotics, and RCT of VD/prebiotics use in prediabetes and T2DM.
Results: The human microbiota comprise 100 trillion bacteria with the genome that is 150 fold larger t[han the human genome. Data from the animal models and human studies reveal that "obesogenic" diet results into the initial event of microbiota transformation from symbiosis to dysbiosis. The microbial antigens e.g. Gram(-) bacteria and lipopolysaccharide translocate to the host interior and trigger increased energy harvesting and Toll-like receptor activation with subsequent inflammatory pathways signaling. The "double hit" of steatosis (ectopic fat accumulation) and "-itis" (inflammation) and contribution of "co-risks" (e.g. vitamin D deficiency) are required to activate molecular signaling including impaired insulin signaling and secretion that ends with diabetes and diseases associated with T2DM. Dietary changes (e.g. prebiotics, vitamin D supplementation) may ameliorate this process if started at the time prior to the process becoming irreversible.
Conclusion: The emerging evidence suggests the important role of microbiota for glucose homeostasis. The vitamin D supplementation and prebiotics use may be considered for improving prediabetes and T2DM management.
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