In my GI-MAP test from Diagnostic Solutions Laboratory, I had “no detectable levels” of the commensal (beneficial) bacterial family known as Akkermansia muciniphila. My Australian practitioner from The Functional Gut Clinic told me that she believed I probably did have some of this bacteria, but that it was simply below a threshold where it was likely to show up on a test. She believed that if I incorporated foods that akkermansia could eat, I would be able to regrow this population in my microbiome and experience benefits.
This leads to a great many questions which I will endeavor to answer here, including how one’s akkermansia population might be depleted, the consequences of its depletion, and how one might build it back up.
Akkermansia Muciniphila
Wikipedia says, “A. muciniphila is found in about 90% of healthy humans, and makes up 1% to 3% of the fecal microbiota and colonizes the gut during the first year of life. Its prevalence can decrease with age or in disease states.” And, “A. muciniphila is able to use mucin as its sole source of carbon, nitrogen and energy, and is hence considered a specialist.” This is why “mucin” is in the name! While akkermansia muciniphila is “eating” your mucin – your mucosal lining in your intestines – it produces beneficial products such as short chain fatty acids which aid in growth of other bacteria which overall leads to a healthy mucus turnover.
What Causes “No Detectable Akkermansia Muciniphila?”
A lack of detectable Akkermansia muciniphila (sometimes called A. muciniphila) in a microbiome test could suggest significant gut microbiome dysbiosis because it is a keystone bacterium that plays a crucial role in gut barrier integrity, metabolism, and immune regulation. Without it, you may be in for some deep doo-doo.
There are several reasons why Akkermansia levels could drop to the point of being undetectable, which I’ll now innumerate.
Akkermansia thrives on mucin and certain prebiotic fibers. Without the right polyphenols and resistant starch, your akkermansia populations can starve.
For example, akkermansia likes the polyphenols present in berries, pomegranate, green tea, and cacao (plain chocolate bean either in whole form or powdered). If you were embarking on a GAPS diet or carnivore diet, you may be healing one condition whilst simultaneously starving your akkermansia populations, which could be why some people develop issues after persisting on these diets long-term. (For those who thrive on these diets long-term, they likely have a microbiome balance which manages to do well even in the absence of akkermansia.)
A diet high in refined sugars and processed foods can reduce akkermansia populations. As usual, a diet with a wide variety of colorful fruits and vegetables, and generally as much variety as possible – without that variety extending to chemical factory-made concoctions – is going to support a diverse, robust ecosystem living in your gut. Although, many healthy foods, such as broccoli, cabbage and eggs, can be taken off the table if you develop an overgrowth of desulfovibrio. Thus, just because “variety is good” doesn’t mean that everyone from all walks of life can or should eat an omnivorous diet with hundreds of different foods. But if your microbiome is already very healthy, then variety will help keep it that way.
Antibiotics (and some medications), of course, can wipe out akkermansia, particularly if there’s repeated or long-term use. In my case, it’s possible that all the antibiotics I was prescribed as a child may have wiped this species out when I was young. If this species is truly absent for me, rather than merely at “very low levels that can’t be detected,” this could explain some of my lifelong struggles (which led me to become the most health-disciplined person almost anyone has ever met). When we look at the serious consequences for low akkermansia populations, you may begin to see why.
NSAIDs may negatively impact Akkermansia levels by altering the gut microbiota and reducing mucus layer integrity. In fact, in Dr. Steven Gundry’s book, The Plant Paradox, he specifically advises against ever taking a NSAID if you don’t absolutely have to. Nonsteroidal anti-inflammatory agents (usually abbreviated to NSAIDs) are a group of medicines that relieve pain and fever and reduce inflammation – and almost all of us have taken them at some point. These include things like Aleve and ibuprofen. These things are known to be highly detrimental to one’s microbiome, which is a critical part of your ability to ward off disease, produce neurotransmitters, and absorb nutrition. It’s serious stuff to go around killing off your microbiome – especially when we’re just talking about some temporary pain relief.
Even without antibiotics or NSAIDs involved, you may still end up with depleted akkermansia through having gut inflammation from other causes. A poor diet combined with a viral infection (such as Epstein Barr) could begin a microbial imbalance which could become increasingly worse over time – particularly if your akkermansia population is simultaneously being starved. Diarrhea can compound this trend, as high gut motility can decrease Akkermansia’s ability to colonize and persist. Although whether this ever happens without any antibiotics or NSAIDs ever being part of the picture is unsure – it’s purely an educated guess that it could happen.
Chemotherapy and immunosuppressants overall alter microbiome composition, generally in a way that includes reducing akkermansia.
It’s hard to say which came first in some cases – did low akkermansia levels contribute to causing a condition, or did a condition cause low akkermansia? While that’s unclear, low akkermansia levels are associated with diabetes (type two), obesity, rheumatoid arthritis, multiple sclerosis, irritable bowel syndrome, and leaky gut.
Repercussions of No/Low Akkermansia
Akkermansia helps stimulate mucin production, which strengthens your gut lining. Without it, your gut barrier may become compromised, increasing the risk of intestinal permeability – usually simply called “leaky gut.” From there, you end up with chronic low-grade inflammation, food sensitivities, and autoimmune activation.
Low levels of akkermansia are associated with obesity and diabetes (type two – which is the kind you develop during your life, rather than the ‘from birth’ kind). Because higher levels of akkermansia have been found in “skinny people” there has been a bit of a buzz about this particular gut bug, leading to probiotic companies beginning to advertise akkermansia content. Unfortunately, this may not be all it is cracked up to be, as I’ll discuss later in this article.
Akkermansia has anti-inflammatory properties, and, thus, unsurprisingly, low levels of akkermansia are linked to chronic conditions like: Inflammatory Bowel Disease (IBD), Multiple Sclerosis (MS), and Rheumatoid Arthritis (RA). You can think of the microbes living inside you as an essential part of your immune system. They work in cooperation with your own defensive mechanisms, but more than that, your commensal microbes are your first line of defense. Akkermansia is a great friend to have on your side.
Without akkermansia working with your immune system, there seems to be a tendency for your immune system to become overactive, increasing the risk of autoimmune diseases and allergies.
Feeding Your Akkermansia
When it comes to complex cases like my own, feeding akkermansia sounds a bit challenging. One of its primary food sources, galacto-oligosaccharides, is a specific trigger for extreme bloating, gas-pains, and constipation. If you’re on a low FODMAP diet for the same reason as myself, you may be starving your akkermansia, which may lead to further complications down the line. For this reason, when it comes to certain foods, it may be better to eat extremely small amounts that are within your comfort threshold, rather than fully eliminating them. When it comes to genetically modified organisms or additives like maltodextrin, absolutely eliminate these things completely. But maybe when it comes to beans, the answer might be to eat one bite, or even one bean, rather than none.
Galacto-oligosaccharides (GOS) are particularly high in jerusalem artichokes – 7.5 grams per 100 grams. In lentils, it’s 3.8 grams per 100 grams, and lima beans come in at 2.9 grams. It strikes me that lima beans were my favorite food as a kid. Maybe I was craving them in order to feed the akkermansia that I still had at the time!
Garbanzo beans come in after limas at 1.2 grams per 100 grams, and onions and butter beans both at 0.2 grams per 100 grams. These numbers, of course, are just based on some particular samples which were tested – the amounts will vary depending on growing conditions and preparation. In fact, part of why soaking and cooking beans helps is because it reduces GOS content. Some people even recommend soaking beans with baking soda to reduce it even further. If digestive distress from galacto-oligosaccharides is really so bad and so common, maybe we should be simply reducing the amount of beans we eat dramatically – without eliminating them entirely. I’m really not kidding about “maybe eat just one bean.”
Beyond feeding akkermansia the particular sort of fermentable saccharides it desires, you can also improve the favorability of the environment of your digestive system. Many polyphenols (which is basically a class of antioxidants, which I demonstrate in this essay) indirectly help akkermansia.
Ellagic acid from pomegranates is converted into urolithins, which have been shown to promote akkermansia muciniphila growth. Also, ellagic acid (and the catechins in green tea) have been linked to increased mucin production – which is where akkermansia lives and eats. And if you haven’t noticed already, the notion from a decade or two ago that you wanted a “mucus-free body” has basically been debunked. Having a healthy, regenerating mucosal lining in your intestines is really important, and it’s one of the key roles that akkermansia has for us.
Certain polyphenols (like those in berries and cacao) increase the fermentation of fibers into short-chain-fatty-acids, and others modulate the activity of butyrate-producing bacteria, and butyrate has been shown to enhance akkermansia abundance. Short-chain-fatty-acids and butyrate are both essential for healthy motility.
Hot take: fiber doesn’t move through your gut like a thousand brooms cleaning up! That’s what I used to believe when I was early in my health research sixteen years ago. I believe I even said such things about fiber at many talks and on the web. I was utterly wrong. Fiber feeds certain microbes, and it is actually your microbiome that determines how things are moving through your gut. In fact, more fiber does not always mean more motility; depending on your specific microbiome balance, certain prebiotics could make matters worse.
Furthermore, it’s not necessarily “the fiber” in a food that is increasing motility! If that were the case, then two foods containing the same amount of fiber should have the same motility impact. (That pun just keeps cropping – dumping? – up.) But blueberries have far more motility impact than high-fiber grains. That’s because of the antioxidants in blueberries feeding certain microbes which in turn generate other compounds.
Okay, so polyphenols (antioxidants) stimulate the intestinal epithelial cells to increase mucin secretion (a mucus layer lining the gut and helping it stay healthy). So which antioxidants in particular are helpful for akkermansia? If you’ve looked at my antioxidant chart, you’ll recognize these four classes of polyphenol: flavonoids (yes, that sounds like “flavor” because it is associated with the flavor of the food!), phenolic acids, stilbenes, and lignans (which you may have seen on your flax oil bottle advertising “highest lignan!”).
All of the following polyphenols are associated with higher levels of akkermansia.
Flavonoids
🟣 Catechins, which are important for cardiovascular health, weight management, and brain function.
✔ Cacao
✔ Green Tea Leaves
✔ Apricot
🟣 Anthocyanins, which are known for reducing oxidative stress and inflammation, supporting eye health, and improving cardiovascular health.
✔ Black Elderberries
✔ Black chokeberries (Aronia)
✔ Blackcurrants
✔ Blueberries
✔ Blackberries
🟣 Quercetin, known for helping liver regeneration, and it’s anti-inflammatory, antihistamine, and antiviral properties.
✔ Elderberries
✔ Capers
✔ Cranberries
✔ Red onions
✔ Lovage Leaves
✔ Radish Leaves
🟣 Isoflavones are phytoestrogens which are linked to reduced menopausal symptoms and a lower risk of certain cancers. Although there’s been some debate about how beneficial these are. Isoflavones are found in soy products, but you must be extra careful to only consume certified organic soy as conventional soy is a high-spray, high-glyphosate residue crop which is known for destroying your microbiome.
✔ Natto – a particular form of soy fermentation which creates a lot of K2, an essential missing nutrient in most modern diets. Having K2 or not is the difference between having dental plaque, osteoporosis, and heart disease, or having healthy teeth, bones, and arteries.
Phenolic Acids
🟣Ellagic Acid exhibits anti-carcinogenic and anti-inflammatory properties. Some studies have even investigated it for its ability to inhibit cancerous tumors.
✔ Pomegranate
✔ Cloudberries
✔ Blackberries
✔ Raspberries
🟣Ferulic Acid is associated with healthy skin and preventing skin damage.
✔ Tomatoes
✔ Oranges
✔ Spinach
🟣Chlorogenic Acid is associated with reduced blood pressure and improved glucose metabolism.
✔ Sunflower Seeds
✔ Blueberries
✔ Artichokes
Stilbenes
🟣Resveratrol is known for its potential in promoting heart health and longevity.
✔ Red wine
✔ Red grape juice
✔ Black grapes
✔ Mulberries
✔ Japanese knotweed (source for Itodori tea)
Lignans
🟣Secoisolariciresinol is correlated with a reduced risks of hormone-related cancers and improved heart health.
✔ Flax seeds
✔ Sesame seeds
Side note: Flax and sesame are some of the healthiest seeds for a wide variety of reasons. For example, sesame seeds are one of the only seeds with more calcium than phosphorus.
Of course, as always, nutritional content in foods varies based on cultivation practices, processing, and preparation methods. So just because something usually contains a lot of a given antioxidant doesn’t mean the particular cultivar (type) you’re getting, or the particular farm you’re sourcing from is conducive to being high in that antioxidant. Hence, a variety of nutrient-rich foods from a variety of sources with sustainable, regenerative, and wholesome practices will yield the best results for your microbiome.
In a moment I’m going to recap which foods which may help akkermansia populations rise (as well as other lifestyle tips!). If you know you’re sensitive to some of these foods when consumed in large amounts, you may try incorporating very small amounts of them. One way to do this is to acquire a whole-foods supplement powder which contains trace amounts of a wide spectrum of whole vegetables and fruits. Often these trace amounts aren’t enough to trigger symptoms while still being enough to help support a diverse microbiome.
For example, I consume supplements that contain trace amounts of garlic, broccoli, radish sprouts, squash, and sweet potatoes and these supplements don’t bother me even though adding these foods to my meals creates severe adverse reactions. If you react to some of these foods too, you might investigate if it could be a less-known form of SIBO from “sulfur reducing” bacteria.
✔ Increase Polyphenol-Rich Foods, especially pomegranate, cranberries, blueberries, green tea, cacao, flax seeds, grapes, elderberries, aronia, red onions, and natto.
✔ Increase Prebiotic Fibers (if tolerated): including resistant starches such green bananas, cooked-and-cooled potatoes, and plantains; and chicory root. If you’re sensitive to FODMAPS, please be very careful with this suggestion. You don’t want to flood your body with problematic compounds like hydrogen sulfide and end up feeling like a mess of brain fog, dizziness, muscle cramps, bloating, and motility problems.
✔ Supplement for akkermansia if possible or practical. These probiotic supplements are just coming onto the market and seem to have limited effectiveness thus far. One insightful reviewer explained: “Recent studies showed benefits of Akkermansia Muciniphila at regulating GLP-1. The problem is that the dosages were significantly higher than the ones contained in Pendulum Akkermansia Probiotic.
“First understand the dosage notation. AFU stands for Active Fluorescent Units. It’s a method used to measure the viable cell counts in probiotic supplements. Unlike CFU (Colony Forming Units), which counts only the cells that can form colonies, AFU uses flow cytometry to count all viable cells, including those that might not form colonies but are still alive and potentially beneficial. Using the product’s metric for the sake of standardization of terms, we then can examine studied doses and protocols that showed effective outcomes.
“The studies used well over what is in this supplement (somewhere in the order of 100 times higher dose per day!) to achieve therapeutic benefits and weight loss. Most studies that have shown significant results used in the range of 10 billion AFU per day. That would require you to take a hundred of these tabs a day. This underscores the problem that has emerged from having no regulations or outcome expectations for supplements.”
Keep your eyes out for more potent and affordable akkermansia supplements, and message me on social media if you see something promising!
✔ Butyrate supplements or foods rich in butyrate may also be useful as this feeds beneficial bacteria that supports akkermansia.
✔ Other supplements, such as inulin, arabinogalactan, or pomegranate extract can promote akkermansia growth. Once again, be very tentative if you’re sensitive to prebiotics and/or FODMAPS.
✔ Avoid processed foods, refined sweaters, artificial sweeteners, and sugar alcohol additives which can negatively affect akkermansia.
✔ Some evidence suggests that regular physical activity and cold therapy (like cold showers) increase akkermansia levels.
✔ Avoid antibiotics and NSAIDs unless absolutely necessary.
✔ Manage your stress and sleep. You’re probably tired of hearing this, but it’s critical for every system in your body. Stress wreaks havoc on your microbiome – and everything else in your body.
Overview
In healthy individuals, akkermansia typically comprises 1-5% of the gut microbiome, but in those with chronic conditions, it can be nearly absent. A healthy gut microbiome maintains a balance between akkermansia and beneficial butyrate producers like Faecalibacterium prausnitzii. Some studies suggest that a significant percentage of individuals in modern societies have low or undetectable akkermansia, primarily due to diet, antibiotics, and medication use.
A complete absence of Akkermansia muciniphila is a strong indicator of gut dysbiosis, poor mucosal integrity, and potential metabolic or immune dysfunction. Akkermansia deficiency often coexists with other microbiome imbalances and should be addressed through dietary, lifestyle, and microbiome-restoring interventions. If you live in a country or region where it is possible to get a fecal transplant, this may be the most surefire way to get promising results.
As always, if you have health insurance and/or can otherwise afford a practitioner’s help, please get testing and guidance for how to best proceed with restoring your microbiome health.
— Raederle Phoenix
