I emailed CODEAGE company and confirmed that their Akkermansia is live, not pasteurized. This makes it more affordable than Pendulum’s Akkermansia and suitable for long-term supplementation, with one bottle lasting 90 days.
There’s a distinction as to whether the bacteria were alive at the time of packaging and whether they will be alive by the time they reach the intestine / colon. I think the best bet is to supplement with the Pendulum product for a month or so then stop and transition to consuming the kind of prebiotics Akkermansia loves: metformin, green tea, rhubarb, fructooligosacchaeides, on top of the regular inulin.
This is what I’m doing. I took Akkermansia for 3 months and now trying to sustain the benefits. I had a definite improvement in my gut function and my HbA1c.
It is known that the impairment of homeostasis and the integrity of the intestinal barrier result in the development of metabolic and gastrointestinal disorders (18, 19 ). The intestinal mucosal barrier has evolved to maintain a balance between the absorption of essential nutrients and the prevention of pathogen translocation (20). The integrity of the intestinal epithelium is maintained by tight junctions (TJs), adherens junctions (AJs), and desmosome complexes of the epithelium, whose expression can be increased by probiotics or compounds produced by them, such as extracellular vesicles (EVs) or outer membrane microvesicles (OMVs) in the case of Gram-negative bacteria (21–23).
Interestingly, several studies have indicated that the outer membrane compounds of A. muciniphila , or pasteurized bacteria, have greater therapeutic potential for metabolic, inflammatory, and autoimmune diseases than live A. muciniphila (36–38).
It looks like it is not the bacterium itself that provides the benefits, but its outer membrane. So live or pasteurized may not affect the ability to provide health benefits.