The human gutThe human gastrointestinal (GI) tract harbours a complex and dynamic population of microorganisms (known as the gut microbiota), which play a vital role in our physiology, both in health and in disease. Diet is considered as one of the main drivers in shaping this complex microbial community across one's lifespan. .Intestinal bacteria in our body play a crucial role in maintaining the immune system and metabolic homeostasis and protecting us against pathogens. The disruption of a working microbiome is referred to as dysbiosis and is a condition whereby the fine balance between the microbial communities and the host is disrupted. An altered gut bacterial composition has been associated with the pathogenesis of several infections as well as an inflammatory and metabolic disease. Deranged characteristics of the microbiota can lead to many diseases such as cancer, irritable bowel syndrome, rheumatoid arthritis, acne, gastric ulcers, obesity, hypertension and Diabetes. The pathogeneses of some pulmonary disorders, digestive complications and neurological abnormalities can be traced to the imbalance in the constituents of the microbiome.The following diagram tries to succinctly explain the plethora of medical diseases, which are linked to an impairment of gut microbiota..We are facing a tsunami of Diabetes!The skyrocketing prevalence and a rapidly rising incidence of Diabetes worldwide pose a great challenge to mankind. Recent research studies investigating the underlying mechanisms involved in the disease development in Diabetes indicate the role of abnormal regulation of the intestinal barrier. Blood sugar imbalance and related diseases such as Diabetes, obesity, neuropathy and heart disease have a well-established relationship to dysfunction within the gut. The intestinal barrier and microbiome have a bi-directional relationship with blood sugar levels. Blood sugar can impact the health of the gut, which in turn, can also alter blood sugar. Changes to the gut (intestine) and the gut microbiota, including inflammation and intestinal permeability (a "leaky gut") are causally associated with Type 1, Type 2 and Gestational Diabetes, insulin resistance and obesity. Scientists are now looking into whether gut microbiota can be used for the prevention or treatment of these diseases.The intestinal walls of people with Type 1 Diabetes are more permeable (leaky) than people without Type 1 Diabetes. Also, their intestinal immune system seems to be more active due to local inflammation.Differing gut microbes are also found in people with Type 1 and Type 2 Diabetes, compared to people without Diabetes.The leaky gut syndromeLeaky gut can be described as "intestinal hyper-permeability". In simpler terms, it means that certain toxins in our gut can pass through our intestinal cells and circulate in our bodies. As can be expected, this can cause several health hazards.Contributing factorsThe diagram above vividly explains the mechanism and causes of dysbiosis in our gut. Prominently, high carbohydrate and processed diets are often associated with obesity and gut dysfunction.Carbohydrates from wheat, corn, sugar, high-fructose corn syrup, etc. are broken down during digestion. By the time they are fully digested, they have been broken into single sugar molecules (also known as monosaccharides), the most common being glucose.Merabsorption, glucose enters the bloodstream, and as a result, blood sugar levels increase. And if this sugar can't be taken up by the body cells efficiently, it stays in the blood maintaining high blood sugar.Consumption of sugar, even in the absence of high blood sugar is found to cause harm to intestinal cells. This means that it is not just high blood sugar that can cause a leaky gut and let harmful chemicals and microbes enter the blood, but even a diet full of excess carbohydrates can put a person at a higher risk of developing metabolic perturbations. Hyperglycaemia causes significant changes in the microbiome within the gut, independent of the translocation of bacteria into the circulation.Does leaky gut cause blood sugar problems?Following translocation due to a leaky gut, altered gut microbiota, on entering the bloodstream, release endotoxins which can cause not only insulin resistance in the liver (a major risk factor for non-alcoholic fatty liver disease) but also high blood sugar levels and weight gain. Research studies suggest that gut microbes contribute to the onset of low-grade inflammation, which characterises these metabolic disorders via mechanisms associated with gut barrier dysfunctions.TreatmentProbiotics, prebiotics, and synbiotics are potent therapeutic tools designed to re-establish the native microbiota. Probiotics such as lactobacillus spp help replenish and rejuvenate the microbiome while prebiotics like fructose oligosaccharides (FOS) are microbiome fertilisers akin to mineral supplements or energy nutrients aimed at promoting the proliferation of select microbes. Synbiotics is a combination of both probiotics and prebiotics in appropriate concentrations aimed at correcting dysbiosis.Probiotics benefit our health through a variety of smart actions:•\tStimulation of the immune response•\tRestoration of non-intestinal microflora•\tIncreased lactose tolerance and digestion•\tImproved intestinal functioning•\tTreatment and prevention of acute diarrhoea•\tCholesterol reduction•\tA positive influence in the intestinal microflora•\tReduction of intestinal pH•\tReduction of ammonia and toxins•\tProduction of vitaminsWhat does this mean to us?Most members of the scientific community do believe in the twin hypotheses that, leaky gut can lead to high blood sugar and/or obesity and also that high blood sugarlevels can cause leaky gut. Here are a few takeaway points, based on my humble experience of the past 37 years of active practice as a physician dedicated to the cause of persons with Diabetes and endocrine disorders:•\tA high-sugar diet, even in the absence of Diabetes and obesity is dangerous.Hence, consuming a low-carb diet helps to heal a leaky gut.•\tBlood sugar spikes, even without an elevated average blood sugar, increases the risk of developing a leaky gut. Thus, avoiding wide fluctuations (technically known as glycaemic variability) of one's blood sugar levels, while remaining for most of the day within the individualizedtarget range of blood sugar (generally 80-180 mg/dL of blood sugar, the Time-in-range or TIR), certainly helps most people with Diabetes in safeguarding their intestinal barrier.•\tLeaky gut increases the movement of toxic bacteria and their bi-products into circulation, which can lead to hyperglycaemia and obesity. Microbial toxins can lead to a vicious cycle of hyperglycaemia, Diabetes, obesity and heart disease.•\tA high-fat diet is less likely than a high carbohydrate diet to blame for the occurrence of leaky gut.•\tOptimal health of the damaged gut microbiota can be restored by judicious use of a combination of a high quality probiotic and a prebiotic. Probiotics helpmaintain our gut's ecosystem as well as the ecosystem of our respiratory tract and urogenital tract. We must try to limit the use of antibiotics. While they are necessary sometimes and can be lifesaving, most antibiotics are over-prescribed. It is advisable to take probiotics during antibiotic treatment to replenish one's gut with healthy bacteria.•\tEat the right food - this certainly matters! Our gut microbiome responds to what we feed it. When we regularly eat a variety of healthy, non-processed foods, our microbiome becomes programmed to work beneficially for us. The more varied our diet, the more flexible our microbiome becomes, allowing for that occasional dessert indulgence.•\tWe need to support our digestion. Unless one knows that one has high stomach acid, he or she should stop self-medicating with antacids. Instead, supplement with a digestive enzyme.This can help digest our food better and get rid of our symptoms, such as gas, bloating and heartburn.•\tGlutamine, an amino acid (a building block of protein), can also help to rebuild and maintain our digestive tract and support proper digestion. Occasionally, drinking lemon and water before each meal may improve the symptoms.•\tWe should learn to relax and meditate. Our gut is our second brain. If our microbiome is out of balance, we mayfeel anxious, depressed, or tired. We may also suffer from memory problems or brain fog. In addition to eating the right foods, we can try to get into a meditative state before eating. We can do this by removing all stressors, including stressful people while avoiding irritating or negative conversations.Every time we prepare to eat, we may take a deep breath, pause and express gratitude to all of the plants, animals and people who helped create our food, including God, and then dedicate the energy we will get from our food to a good cause, or to someone we love. Dr Vinod K Abichandani is a Diabetes and Endocrine Physician in Ahmedahad.