A New IBS and SIBO Treatment for Tough Cases

A research-backed form of immunoglobulins.

My recommended first line of treatment for IBS and SIBO is a change in diet, potentially followed by probiotics, and then other steps I discuss in my gut health protocol in my book Healthy Gut, Healthy You. But what if you’ve followed these steps and are still facing health challenges? A new option to consider is immunoglobulins, which can help to restore the mucous membrane in your gut and support your immune system. In the latest research, about 70% of non-responsive patients were helped by taking a supplemental form of immunoglobulins! You’ll have the greatest likelihood of success if you use a research-backed formula, like Intestinal Support Formula. In this video, learn more about the research, other patients’ experiences, and if it’s right for you.

Dr. Michael Ruscio, DC: Hi, this is Doctor Ruscio. Let’s discuss an exciting new development in the treatment of IBS and SIBO. I’d like to tell you about my experience with immunoglobulins, which are essentially a way of taking a supplement that can help to restore the mucous membrane of your gut.

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The function of the mucous membrane in your gut, in part, is to bind toxins and irritants that can cause gut damage, irritation, leaky gut, and this whole cascade of inflammation and dysfunction. So, thankfully, there is a way now to take immunoglobulins in a supplemental form—orally, as a capsule or a powder—that can help to restore that vitally important gut barrier.

I’d like to tell you about my clinical experience with immunoglobulins. And there are a few points here that I think are worth expounding upon. I keep my ear to the ground in terms of what’s being published in the clinical research, and that’s an important first step. But it doesn’t stop there, because there are certain compounds that look favorable at first, but actually don’t end up being that effective.

This is known as publication bias or selection bias. When there’s a new therapy, usually you only see positive studies being published about that therapy, because no one really cares about a new study on a new compound that doesn’t show any benefit. It’s usually the novel findings that are published first. Then, over time, you see a leveling out of what is published in the literature.

So at first, there can be a skewing towards positive in the clinical literature. You want to first look at what’s being published in the clinical literature, but then also experiment with something in your practice, to determine if what happens with people when you’re actually trying this is representative of what’s being published in the clinical literature.

After watching the clinical literature, I was satisfied with what was being published there. There was at least enough evidence to justify a trial in my clinical practice. And after about four or five months of utilizing immunoglobulins in my clinical practice, I could clearly see that this was a therapy that stood out, relative to many others. It was clearly more effective than many, and makes me feel comfortable endorsing and telling you more about immunoglobulin therapy.

Supplement Can Help Stubborn Gut Issues

What’s especially helpful about immunoglobulins is they seem to be able to help patients who have been non-responsive to other therapies. So you may have improved your diet, you may have used probiotics. If you have a fungal overgrowth or a bacterial overgrowth, you may have even used an antibiotic or antifungal, or some type of herbal antimicrobial, and not really seen any results.

The missing piece here, in some cases, may be all of those therapies are trying to treat the microbiota—a colony of bacteria and fungus—which can be very helpful. However, the missing link may be this other avenue of therapy, which is supporting the immune system in the gut. This is where immunoglobulins are unique. Again, immunoglobulins are essentially what constitutes that secretory IgA lining in your gut. So you’ve heard of the mucous lining in your gut, the secretory IgA, there’s also IgG and IgM. That’s what immunoglobulins are.

So regarding the immune system, it’s important to contextualize this: one really needs to have both a healthy microbiota and a healthy immune system in order to have a healthy gut. In some cases, what I think happens is, a lot of work is done on the microbiota. So someone works with probiotics or diet, or they maybe even use antibacterial or antifungal agents for a suspected overgrowth. And they do a lot of work to modulate the balance of bacteria and fungus in a healthy way, but they miss the immune system.

These two have to live in harmony in order for there not to be inflammation, leaky gut, or other types of gut dysfunction or symptoms. This is where I feel the immunoglobulins are novel and helpful, in that they support the immune system and don’t solely focus on the microbiota.

Now, what kind of evidence do we have for this claim? It’s one thing to conjecture at these mechanisms, but we really have to have evidence showing that supporting this mechanism, the immune system, can be efficacious for humans in interventional trials. So there’s certainly a wealth of preliminary clinical literature. To date, there have been nine quality trials in humans that have shown immunoglobulins can help.

Now, could the data here be better? Yes. We could have 15 clinical trials summarized in a meta-analysis. But I feel we at least have enough preliminary evidence to say this is a therapy which is worth consideration, especially if you’re a patient who’s been through other treatments and hasn’t seen the results that you’ve been looking for.

Now, what’s exciting about this is—in some of the research—these immunoglobulins are being used in patients who haven’t responded to other therapies, and are then showing benefit. This is the most challenging subgroup to obtain results with, and it’s really one of the most exciting findings. Which is to say that if you’re someone who’s been using other therapies and not seeing the response that you’re looking for, immunoglobulins have been looked at for similar patients and shown benefit roughly 70% of the time, in the research that’s been published.

Again, some of these studies have put patients on diet, probiotics, soothing agents, antispasmodics, and shown failure to all these therapies, and then seen about a 70% response rate with immunoglobulin therapy. Again, it’s likely because of the immune system support that’s occurring there, and this is really worth repeating.

I think the most exciting study here was performed by Leonard Weinstock, who is a gastroenterologist. In this patient group, patients were diagnosed with either SIBO, IBS, or both, then offered a few different treatment options in a double-blinded fashion. So they may have been given a low-FODMAP diet, probiotics, antibiotics, antispasmodics, soothing agents, and none of the patients really saw a full response from any of these therapies. Then they were given immunoglobulin therapy. And in this study in particular, a 75% response rate was noted, which is pretty remarkable given the recalcitrance of this group.

Now, there’s also more science. There is one randomized placebo control trial, which is our gold standard, that showed benefits, and also one large survey of 595 patients. And in that study, a 67% response rate was noted from Intestinal Support Formula. In the double-blind study, immunoglobulin caused significant improvement in abdominal pain, flatulence, urgency, loose stools, bloating, or any other symptom that was not on the symptom inventory issued by the researchers.

So we certainly see that there is some compelling evidence. Here is a table summarizing that compelling evidence, the nine trials, the RCT is the one I’ve circled for you. And the RCS means a retrospective case series or case study. So, yes, there is some good preliminary scientific evidence to support the approach of immunoglobulin therapy.

Research-Backed Immunoglobulin Formula

Now, what products are available? Well, this is where there’s more good news. Initially, immunoglobulins were only available as a prescription medical food known as EnteraGam or ImmunoLin. Over the past couple of years, this compound has now become available as a dietary supplement.

There are many different versions out there. There are only a couple that are research-verified, meaning using the same formula that’s been used in the research. This is where Intestinal Support Formula comes in (or ImmunoLin, or MegaIgG 2000). These are the products I would recommend. The Intestinal Support Formula is a version that I’ve developed, I’ve been using in the clinic, and I’ve been very happy with. There are also other over-the-counter versions.

Now, there’s an important caveat here, which is, these other over-the-counter versions are not the same formula that’s been used in the research. It’s similar, and it’s likely similar enough still to yield benefit for someone using it. But if you can just as easily use something like Intestinal Support Formula or one of these other over-the-counter versions, my recommendation would be to use the version that’s the exact research-verified formula. Again, the difference here is probably not huge, but if I were a patient trying to improve my health, I really wouldn’t leave this to chance. I would use what’s the most proximal—in this case, exactly as has been used in the clinical research—to documented benefit.

Now, these immunoglobulins are derived from bovine material. If you’re vegetarian, there are some vegetarian options. There has been one study showing an egg-based formula can work. I haven’t vetted all the literature on the vegetarian formula, so I can’t say how effective they are. But if you are vegetarian, there are a number of vegetarian compounds to consider. I’m currently experimenting with some of these in the clinic, and hopefully I’ll be able to report back on what my preferred one is in the future.

But, again, I would recommend using the research-verified version of an immunoglobulin, most namely Intestinal Support Formula, because that’s what I’ve been using in the clinic. Again, what is the immunoglobulin formula I’ve been using, Intestinal Support Formula? It’s a supplemental form (derived from bovine serum) of immunoglobulins: the immunoglobulins that constitute the lining of your gut, your gut mucosal membrane.

These are immunoglobulins that you have inside of you right now. In the lining of your gut, you have Immunoglobulin A, IgA, IgG, IgM and albumin, and that’s what’s in the Intestinal Support Formula. By taking the Intestinal Support Formula, you help to bind toxins and irritants in the gut, as we’ll expand upon in a moment. I should also mention that the immunoglobulin formulas are hypoallergenic, they’re devoid of casein, whey, lactose, soy, gluten and dye, as you can see here.

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I’d also like to thank and tell you about Intestinal Support Formula. Formerly known as Intestinal Repair Formula, we had to change the name because “only a drug can repair your intestines”. In any case, this is a must try if you’ve done everything else for your gut. Why? Because the immunolglobulins contained in Intestinal Support Formula address the often overlooked piece of your gut health, your immune system. These immunolglobulin’s bind to and deactivate toxins and irritants like bacterial fragments thus allowing your gut to heal, breaking the vicious cycle of inflammation and leaky gut. You can visit IntestinalSupportFormula.com to learn more.

How the Formula Works & Dosing

So, how specifically does something like Intestinal Support Formula help where other formulas have failed? Well, we know, again, that Intestinal Support Formula binds to irritants like bacterial fragments and other toxins in the gut, and there’ve been a few papers that have documented this. Now, what happens is, irritants initiate a cascade of damage and dysfunction, of intestinal lining damage, and this leads to further immune activation and inflammation, leading to further leaky gut, leading to further intestinal inflammation. So there is this self-feeding cycle that becomes initiated when one’s gut is not healthy.

What I feel to be novel about the Intestinal Support Formula is it disrupts this self-feeding cycle and allows you to get off of this gut damage, inflammation, leaky gut, further immune activation, further gut damage, this cycle that patients can get stuck in. It helps to disrupt and interrupt that cycle, thus allowing you to heal. Also excitingly, one study has found, or at least suggested, that due to its healing effect, Intestinal Support Formula may actually improve nutrient absorption.

Now, dosing and use. For mild cases, five grams a day is sufficient. For more severe cases, 10 grams per day. How do you identify what severity of case you are? I would quite simply do a self-assessment. If you feel like your symptoms are fairly mild, maybe they’re annoying but not debilitating, you would be more mild. If you feel that your symptoms are debilitating, they are significantly interfering with your quality of life or your daily activities, then more severe. These are just a capsule form, so a simple capsule. And you dose these with or without food, with water. It’s really as simple as that.

Now, what about duration? This is important. The initial response should be noted within one to two weeks. So you start on Intestinal Support Formula, and by one or two weeks, you should notice something. Not necessarily your entire improvement being realized, but you should be able to say, “Yes, I feel like this is working.” If you’re saying, “I’m not really sure, I don’t think so,” then the formula likely is not for you. You could always continue for a little while longer if you wanted to, but most patients will notice a difference within one to two weeks.

Now, a peak level of improvement is usually seen by six weeks. So my recommendation would be, once a peak improvement is noted, wait two to four weeks, and then gradually decrease your dose. Decrease your dose until you are off completely, or until you’ve been able to find the minimal effective dose. For some people, they’ll be able to come off, other people may notice they feel better on a minimal dose, but the goal is always to use the minimal effective dose to keep you feeling well.

Reactions. Do reactions occur? In a very small number of patients, reactions do occur. It’s fairly rare. So Intestinal Support Formula, generally well-tolerated, even for sensitive patients. Think of this as a gut detox, which can be used periodically to reduce inflammation and calm down an overactive immune system response in your gut.

Now, one study found an 82% response rate in digestive symptoms within six weeks. What I’ve put up here for you is a Likert score from that study, and this is where I’m deriving some of my dosing and duration recommendations. As you can see, there’s a large jump by two weeks, and then people will start to level out around six to eight weeks. So this is where my recommendation is coming from in terms of, your first window is one to two weeks, and then you should be peaking in your improvement in around six to eight.

Another important note is, I would not recommend Intestinal Support Formula to be the first therapy that you try. There are a few different diets out there, paleo-type diets or an elimination diet, the low-FODMAP diet, probiotics and potentially treating any type of dysbiosis with either pharmaceuticals or herbal medications of various sorts. I would start there, at the very least, with diet and probiotics, before considering Intestinal Support Formula. Because there is a foundation you should lay, in my opinion, before using these.

Case Studies for Intestinal Support Formula

Okay, now, let’s move onto a case study with Matt. This was a great case study. When Matt came in, he had been previously diagnosed with inflammatory bowel disease, and many therapies that we utilized together had helped. Diet was helpful, an elimination diet combined with a low-FODMAP diet was helpful. Probiotics were also helpful. Antimicrobial therapy was very helpful.

Unfortunately, while Matt was improving all along the way, he was still having setbacks and was still not getting to a point that we considered an acceptable level of improvement until we added Intestinal Support Formula. And that is when he saw long-lasting improvements and a very significant jump in how he was feeling. Why? Again, it’s likely because we were previously working to modulate dysbiosis or the microbiota, the bacteria and the fungus, which did help. But the missing component that needed to be administered in tandem with that was support for his immune system, which the Intestinal Support Formula achieved.

If you want to see the full case with Matt, we recorded a patient conversation where we talk through his case. Very interesting case, and I think a case that’s very important because Matt had some ups and downs. And on one’s gut healing journey, invariably there will be ups and downs. It’s important to realize that you’re not alone. When you hit a low point, it can be very discouraging. But if you have a good process that you’re working through, and you understand that you’re going to have ups and downs, but you’re going to be trending upward the entire way, then it helps you see through those low points. Matt’s case was a beautiful example of that kind of psychological perspective, but also the utility, clinically, of Intestinal Support Formula.

Also, Victoria came in with food reactivity and histamine intolerance. The big thing that Victoria was unable to do, after doing quite a bit of gut work before seeing me, was expand her diet. She was stuck in this very narrow realm of foods that she was eating. We gained some traction with other therapies, but it really wasn’t until we had her go and use Intestinal Support Formula, and then after a few weeks report back. And I quoted her here as saying, “There is something magical about Intestinal Support Formula.” She really felt like she was able to expand her diet, finally. And again, likely because we were supporting the missing link in her case, which was the immune system.

So, in close, immunoglobulins can help where other therapies have failed, And this is ostensibly by supporting the immune system in stopping that whole cascade of inflammation and damage in the gut. Now, it’s not a guarantee, but there’s a fairly high likelihood. And this should not be the first therapy that you try, but for people who have tried other foundational therapies like diet and probiotics, then the Intestinal Support Formula can be a great adjunct and may be able to finally get you over the hump, where you’re feeling better and maintaining those improvements.

There are many products out there. The one I would recommend is Intestinal Support Formula, because it uses exactly the same formula that has been used in the research studies. There are other formulas out there, but really, I can only vouch for the ones that have been through the rigor of scientific examination.

You can learn more about Intestinal Support Formula at DrRuscio.com/ISF. I hope, if you’re someone who qualifies for this, who has used other therapies and not seen the response that you’re looking to, that you’ll try Intestinal Support Formula. Since releasing this product, the response that we’ve gotten from our followership on the internet, our readers and our listeners, has been pretty remarkable. We’ll be releasing a number of case studies coming up in the near future.

So this is one therapy that you can consider—if you’ve done other foundational therapies—that could help you heal your gut and reap the massive benefits that we can all achieve by having improved gut health. This is Doctor Ruscio, and I hope this was helpful.

What do you think? I would like to hear your thoughts or experience with this.

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