Akkermansia on a Stool Test: What This Keystone Gut Microbe Means

Written by Dr. Ryan Kneessi, ND

Quick answer: Akkermansia muciniphila is a gut bacterium that lives in and feeds on the mucus layer lining the intestine, and a stool test estimates how much of it is present. Lower levels have been linked in research with less favorable blood sugar and body fat measures and are more common in older adults. A high level is not automatically better, so it is read alongside the rest of the microbiome.

Why would a single species of bacteria get its own line on a stool report? Akkermansia muciniphila is one of the few microbes that has earned that attention. It lives in the layer of mucus that coats the inside of the intestine and feeds on that mucus, which puts it right at the border between the gut bacteria and the cells of the gut lining. Researchers often call it a keystone microbe because its presence seems to tell us something about the health of that border and of the wider microbial community. This article looks at Akkermansia as a stool marker, meaning what the amount found in a sample may reflect, rather than at Akkermansia supplements. The habits most often discussed around this microbe are eating a varied, fiber-rich diet, keeping a healthy body weight, staying active and supporting the overall diversity of the gut microbiome.

This article is educational. It explains what the marker reflects and how researchers connect it to the deeper mechanisms of aging, so you can have a more informed conversation with your own provider.

What does the level of Akkermansia on a stool test tell you?

Akkermansia was first isolated from human stool in 2004 by Derrien and colleagues, who grew it on a medium in which gastric mucin was the only source of carbon and nitrogen. They described it as a strictly anaerobic bacterium that thrives on mucin, the main protein of the gut mucus layer. Because it depends so heavily on mucus, the amount of Akkermansia in a stool sample is often read as a rough window into the mucus layer and the conditions along the gut lining.

A study by Collado and colleagues in Applied and Environmental Microbiology found that Akkermansia is a common member of the human gut. Colonization starts early in life and reaches a level close to that of adults within the first year, and the researchers found that levels were lower in older adults. A lower result on a stool test is therefore often discussed as a sign that this mucus-dwelling community is thinner than expected, while a result in the expected range suggests it is well established. Stool tests report Akkermansia in different ways, so a result is best compared with the reference range of the specific test.

How is Akkermansia connected to aging and root causes?

Akkermansia sits at the meeting point of several processes linked with aging. The mucus layer it lives in is part of the gut barrier, and a barrier that weakens over time allows more microbial material to interact with the immune system, which can feed chronic low-grade inflammation. Akkermansia is also tied to metabolism. In a 2016 study in Gut, Dao and colleagues followed 49 adults with overweight or obesity through six weeks of calorie restriction and six weeks of weight stabilization. At the start, people with more Akkermansia had lower fasting glucose, a lower waist-to-hip ratio and smaller fat cells, and those who also had a richer microbiome showed the healthiest metabolic profile. People who started with more Akkermansia also showed greater improvement in insulin sensitivity markers during the program.

Studies of very old people add an interesting twist. Collado and colleagues found lower levels in older adults, yet a 2016 study in Current Biology by Biagi and colleagues found that people aged 105 to 109 had a higher abundance or prevalence of several health-associated groups, including Akkermansia, Bifidobacterium and Christensenellaceae. The authors suggested that these features might support health maintenance during aging, although a study like this shows association rather than cause.

From a root-cause perspective, the useful question is why Akkermansia might be low or high. Food quality and fiber shape the whole microbial community, and in mice a 2013 study by Everard and colleagues in PNAS found that Akkermansia was lower in obese and diabetic animals and that feeding prebiotic fiber brought its abundance back toward normal. Body weight and blood sugar regulation, movement, sleep, ongoing stress and antibiotic use can all shift the microbiome. Genetics, medications and everyday exposures that irritate the gut lining also play a role. Reading Akkermansia alongside diversity, short-chain fatty acids and inflammation markers usually says more than the single number.

Is a high Akkermansia level always a good sign?

Not necessarily. Akkermansia is often described as a beneficial microbe, but research shows that more is not automatically better. In a large 2022 study in Nature Communications, Wallen and colleagues sequenced stool from 490 people with Parkinson’s disease and 234 controls. The authors noted that most earlier studies have reported elevated Akkermansia in Parkinson’s disease, and their own cohort showed an elevated trend that did not reach statistical significance. That does not mean Akkermansia causes the condition, but it shows that a high level is best interpreted in the context of the rest of the microbiome, symptoms and overall health rather than as a simple score.

What does the research show about Akkermansia?

In a 12-week diet study, 49 adults with overweight or obesity followed 6 weeks of calorie restriction and 6 weeks of weight stabilization. People with more Akkermansia at the start had lower fasting glucose and waist-to-hip ratio, and they showed greater improvement in insulin sensitivity markers. The study was small and had no control group. (Dao et al., 2016)

A study of 65 women with severe obesity found Akkermansia was lower than in women with moderate obesity, but it was not linked with blood sugar markers. After gastric bypass, Akkermansia increased, yet the increase did not track with metabolic improvement. The follow-up groups were very small. (Dao et al., 2019)

Together, these studies suggest Akkermansia often travels with better metabolic health, but changing its level has not been shown to cause that improvement.

Related reading

If you would like to explore related topics, my articles on microbiome diversity, short-chain fatty acids and fasting insulin and HOMA-IR go deeper. You can also see the specialty tests I commonly recommend on my functional labs page.

Common questions about Akkermansia Stool Levels

Is a stool Akkermansia result the same as taking an Akkermansia supplement?

No. A stool result reflects how much Akkermansia is already living in your gut, while a supplement adds bacteria from outside, so the two answer very different questions.

Does Akkermansia change with age?

A study of infants, adults and older adults found that Akkermansia becomes established in the first year of life and is lower in older adults, although a study of people aged 105 to 109 found it more often in that group.

What shapes how much Akkermansia is in the gut?

Diet and fiber, body weight and blood sugar regulation, antibiotics and the overall diversity of the microbiome all appear to influence it, and in mice prebiotic fiber brought low levels back toward normal.

Sources

This article is for educational purposes only and is not medical advice. It does not replace an individual evaluation. Talk with your healthcare provider before making changes to your diet, exercise, supplements, or medications, especially if you are pregnant, nursing, or managing a health condition.