I get asked this almost every week. "If I take Akkermansia, will it work like my GLP-1 shot?" And my answer is no, not the way you're thinking. But your gut was built to make its own GLP-1, and for a lot of people that system has just gone quiet. That Akkermansia GLP-1 connection is what we dug into on this episode of The Trusted Pharmacist.
Ever since compounded GLP-1s went away, people have been looking for whatever comes next. And if you're in perimenopause or menopause and you keep saying "I just can't lose weight anymore," I want you to hear this one. Something changed in your gut, and nobody ever explained it to you.
My guest was Christina O'Connor. She's a registered clinical dietitian and a senior healthcare account manager at Pendulum Therapeutics, and she got her start in the NICU working with preterm babies, a lot of them born with guts that weren't even working yet. That's where she fell in love with the microbiome. I first heard about Akkermansia back in my A4M fellowship about eight years ago, long before you could buy it in a capsule, so I'd been wanting this conversation for a while.
The Akkermansia GLP-1 Connection Most People Never Hear About
Most people think GLP-1 comes in a pen. It doesn't. It's a hormone your own gut makes, and it needs certain bacteria to make it.
Christina explained it in a way I really liked. Some of your gut bacteria make short chain fatty acids, and butyrate is the big one. Butyrate latches onto receptors on cells in your intestine called L cells, and that's what flips GLP-1 production on. Akkermansia makes propionate, which your body turns into butyrate. So if those bugs are missing, nothing's there to flip the switch.
Why are so many people missing it? Akkermansia can't handle oxygen. One molecule of it and the bacteria's gone. So you're not getting it from yogurt or sauerkraut, and you're not picking it up out in the garden either. You get it from your mom, through a vaginal birth and breastfeeding. Breast milk is the only food anyone has ever found it in.
It's a sensitive little bug, too. Antibiotics knock it down, which most people would guess. But Christina said even a regular round of other medications can disrupt it, and so can travel or the junk in our food supply. Women also tend to lose Akkermansia in perimenopause and menopause. On the other end, people who live past 100 and are still out hiking and swimming tend to have plenty of it.
The usual fix for blood sugar and weight is to add a drug. Sometimes that's the right move. But hardly anyone stops to ask what your body used to have that it's missing now. Christina put it simply. Look at your symptoms, figure out what your body is missing, and give it back what it needs to do its job.
What You Actually Need to Know About Akkermansia
It Keeps Your Gut Lining Fresh
The full name is Akkermansia muciniphila, and muciniphila means it loves mucin. It lives in the mucus layer that sits between your gut and the rest of your body. That layer is supposed to refresh itself every five to seven days, and Akkermansia is basically the cleanup crew. It eats the old, worn-out mucin, and that tells your goblet cells it's time to lay down a fresh, thick layer.
Christina compares a healthy layer to flypaper. Toxins and bad bacteria get stuck there instead of slipping through into your bloodstream and stirring up inflammation. Once that layer gets thin and patchy, you're dealing with what most people call leaky gut.
I see this play out at the pharmacy all the time. Somebody comes in with a rash or hives, and they're expecting me to hand them a cream. A lot of times I'll tell them, let's work on your gut first, and the skin usually calms down on its own. Christina said there's a whole group of integrative dermatologists who look at eczema, psoriasis and acne as gut barrier problems for that exact reason.
The Glucose Control Study That Caught My Attention
Pendulum's Glucose Control formula has five strains in it: Akkermansia muciniphila, Clostridium butyricum, Clostridium beijerinckii, Anaerobutyricum hallii and Bifidobacterium infantis. They tested it in people with type 2 diabetes using a double-blind, randomized, placebo-controlled trial, which is about as solid as research gets. Nobody was told to change their diet or how they lived.
After 90 days, people taking Glucose Control dropped their A1C by 0.6. To put that in perspective, metformin usually lowers A1C somewhere in the 0.7 to 1.2 range. Their after-meal glucose spikes came down almost 33%, and Christina said metformin typically lands around 20% there.
Here's what I'd add as a pharmacist. When you keep those after-meal blood sugar spikes down, you're keeping the insulin spikes down with them. And those insulin spikes are what drive insulin resistance, which is underneath most of the metabolic problems I see.
Live and Pasteurized Akkermansia Are Not the Same Product
You've probably seen Akkermansia ads all over your feed by now. What most folks don't know is that a lot of those products are pasteurized, so the bacteria inside are dead. A probiotic has to be alive to be a probiotic. Pasteurized Akkermansia is really a postbiotic. It does a little something, just nowhere near what the live bacteria can do.
Think about it. Dead bacteria can't eat that old mucin, so your body never gets the message to rebuild the lining. It also doesn't make any P9, a protein that plays a direct role in metabolism. Live Akkermansia makes plenty of it. Pendulum grows its strain without oxygen, freeze-dries it, and puts it in a capsule that holds up against stomach acid and releases slowly, so it actually makes it to your colon.
I'll be upfront with you. We carry Pendulum at Magnolia, and it's one of our go-to products because we've seen it work. But whoever's bottle you buy, check whether it's live.
Yes, You Can Take It With Semaglutide or Tirzepatide
People ask me this one constantly. Christina said a lot of the providers Pendulum works with pair Akkermansia and Clostridium butyricum with shots like semaglutide and tirzepatide. Patients seem to have fewer GI side effects and fewer cravings. Some providers say their patients end up needing a lower dose of the shot, and others use the strains to help people step down off it.
Just keep your expectations realistic. I like to put it this way, and Christina said Pendulum's chief medical officer, Dr. Perlman, uses the same comparison. If the GLP-1 your body makes is a 1, the drugs are more like a 100. They're not really in the same league. What the bacteria do is help your body make more of its own.
If You Have SIBO, Go Low and Slow
If you've got SIBO or SIFO, probiotics can be rough on you. Christina's advice is to start every other day instead of every day and see how your body handles it. She also likes Pendulum's Metabolic Daily for these folks. It has Akkermansia and the same butyrate makers, but no inulin, which is the chicory root fiber that tends to flare SIBO.
A couple of groups should hold off. Very sick ICU patients with sepsis shouldn't be on any probiotic, and Pendulum hasn't studied safety yet in kids or in women who are pregnant or breastfeeding.
Two Things to Check Before You Buy Another Probiotic
Start by reading the label. You're looking for live Akkermansia muciniphila, not pasteurized, and you want to give it at least three months. That's Pendulum's minimum, and plenty of people stay on it once they see their A1C and after-meal numbers coming down.
Next, think about what you're feeding it. Akkermansia lives on polyphenols, and fiber helps too. When Pendulum tested their strain in the lab, it went for green tea extract and red grape seed, and pomegranate was on its list as well. Those are the same polyphenols they put in their booster product.
Not sure if you have any Akkermansia of your own? A stool test can tell you. Either way, feeding it is how you keep it around.
Good Bacteria Need the Right Environment. So Do You.
That Glucose Control study had one more detail I keep thinking about. Once people stopped taking it, most of them lost the strains within a month. The few who held on probably had something going for them every day that kept those bacteria fed.
People are a lot like that. When a new supplement or a new habit doesn't stick, it usually wasn't a bad idea. There just wasn't anything around it to keep it going.
What makes a change last is having somebody to check in with, and somewhere to ask that question that pops up three weeks in.
That's what the Magnolia Inner Circle is.
You can ask our pharmacists the kind of things you'd normally save for when you're standing at the counter. Maybe it's a probiotic label that makes no sense, or a lab result that doesn't line up with how you feel. You'll get an honest answer from people who do this every day.
Members also get challenges to keep you consistent, trainings that go further than a blog post can, a community working on the same things you are, supplement discounts, and resources you'll keep coming back to.