How Effective are Multi-Strain Probiotics for IBS?

Intro:

Welcome to Dr. Ruscio radio, providing practical and science-based solutions to feeling your best. To stay up to date on the latest topics as well as all of our prior episodes, make sure to subscribe in your podcast player. For weekly updates visit DrRuscio.com. The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking with your doctor. Now let’s head to the show.

DrMichaelRuscio:

Hey everyone, this is Dr. Ruscio. If you’re hearing this announcement, it’s not going to be the same audio read. Every time you hear this announcement the excerpt of the audio will be different. Over the past year, especially as things at the clinic have grown, I’m trying to spend more time now focusing on clinician training, refining the model, teaching what I’ve learned, making sure that we are all really congealing together in the clinic and operating more effectively as one than just me as a clinician by myself, and the various research initiatives that we’re piloting at the office, at the clinic, at the center, it’s been difficult to keep pace with that. So I said to myself, “Self, what if I taught someone how to do that hour of reading every night?” So I’ve spent a few months working with Gavin from our team, teaching him and kind of honing that methodology, and I’m very excited to say that we’re making that available as a subscription through our FFMR or The Future of Functional Medicine Review clinical newsletter. This will be the FFMR Plus where once per week you will get about a 10-page brief, but it’s very high-level and very summative. A written brief of the best or the most impactful and relevant to functional medicine studies summarized very, very concisely, really only one or two bullets. What is the bottom line? We’re all busy clinicians; we’re busy people. There’s a time and a place for really unpacking studies in more detail, but that’s different. This is, “I just need to keep my pulse on what’s going on, and then here’s a link if I want to learn more.”

DrMR:

So that five to seven hours of reading and then note-taking per week is now done for me, and it’s been phenomenal by the way. It’s such a time save. Gavin will also be doing a weekly audio read. So about 10 pages of summative, high-level text takes maybe 10 minutes to skim. There’s also going to be a corresponding audio read so that if you are busy, you can go through the audio and make a mental note, like, “Okay. There was an important study on TPO antibodies and their association to quality of life. There’s another study, let’s say this Danish cohort study following 400 patients that found that once again, subclinical hypothyroidism did not show that patients had any additional symptoms than healthy controls, so even more reason why we shouldn’t be treating subclinical hypothyroidism.” And you can say, “Those two studies, I really want to know more about. I’ll open up the written brief when I have a moment and look at the short summary, grab the reference link for the abstract,” what have you.

DrMR:

So we’ll put a few of these out there, with no fee required. And if it is something that you think would benefit you, I hope you will join and pay to subscribe to the FFMR. Only if it benefits you, but I can say for me, this has been a tremendous time save because there are important studies being published every week, and it’s important that clinicians be aware of these. It’s not easy to do; it takes time. So now here’s a way of doing this in much less time.

DrMR:

So we’ll have a few of these that we’ll put out there for free with no subscription required, and Gavin here will follow shortly with what we’re calling the FFMR Plus. So this is the “Plus” aspect, the research brief, the research updates, and please let me know what you think. Again, for me at least, and I am admittedly a nerd, this has been huge because it allows me to be brushing my teeth in the morning and going through the audio and saying, “Oh, okay. This one and that one are two studies that I really need to make note of,” and what have you. Okay, well, I hope you enjoy it. Please let me know what you think.

GavinGuard:

Hello this is Gavin Guard with the Ruscio Institute and welcome to the FFMR Plus, keeping you on the cutting edge of functional and integrative medicine. Dr. Ruscio and I have been hard at work sifting through the latest published research in order to bring you important updates. In today’s research digest, we cover the efficacy of multi-strain probiotics for IBS, parasitic infection as a cause of exocrine pancreatic insufficiency, research supporting the use of berberine and functional GI disorders, and much, much more.

Featured Study: Multi-Strain Probiotics and IBS-D

GG:

We will begin today with our featured study titled “The Effectiveness and Safety of Multi-Strain Probiotic Preparation in Patients with Diarrhea-Predominant IBS: A Randomized Controlled Study.” This is a study of 50 patients with IBS type D or diarrhea. They were either given a placebo or a multi-species probiotic of lactobacillus, bifidobacterium, and streptococcus, albeit at a low dose of 2.5 billion CFU. After eight weeks, the probiotic group showed greater improvement in IBS symptoms, less abdominal pain and better quality of life. Again, the probiotic group, given the multi-species probiotic had greater improvement in IBS symptoms, less abdominal pain and better quality of life after eight weeks of supplementation. And this study gives more proof of concept of a multi-species or a multi-strain of probiotics for functional GI disorders such as IBS. Another study to support that use of multi-strain probiotics.

GI Studies

GG:

Let’s move into our GI studies, and we have a lot to cover here. A lot of great, great studies to talk about. The first one is “Chronic Giardia, a Rare Cause of Exocrine Pancreatic Insufficiency.” This is a case report of, you guessed it, a patient with chronic Giardia parasitic infection and exocrine pancreatic insufficiency. The reason I included this study was because of what happened to the patient once the clinician treated the Giardia parasitic infection. What we see here is this patient’s symptoms of exocrine pancreatic insufficiency resolved with the treatment of Giardia, and their labs, indicative of exocrine pancreatic insufficiency, also improved. And this hones in on the Ruscio Institute philosophy of treating dysbiosis first, before treating specific GI secretions, such as pancreatic secretions and/or gastric secretions.

GG:

The next study is a meta-analysis of 19 randomized control trials of 1,600 children. And the use of probiotics in different categories can reduce the occurrence of acute rotavirus diarrhea in children. Again, the use of probiotics is showing proof that it can help reduce the diarrhea caused by acute rotavirus infections.

GG:

The next study is “High FODMAP Consumption Among Endurance Athletes in Relationship to GI Symptoms.” What they show here is that the average endurance athlete eats a higher FODMAP diet, both at baseline and around workouts. And the reason that this is important is given the frequent reports of GI symptoms that are common in endurance athletes. So this low FODMAP diet may be something you would want to try with an endurance athlete.

GG:

The next study is a literature review and meta-analysis of 23 randomized control trials, 1,600 participants with IBS, IBD, and other GI symptoms. And they’re looking at the efficacy and safety of biophenols, including curcumin, resveratrol, and peppermint oil. What they say here is that biophenols, including these supplements, may improve GI symptoms, inflammation, oxidative stress, and quality of life in patients with IBD and IBS. Regarding the quality of the studies included in this meta-analysis, they point to a higher certainty of evidence for the use of peppermint oil in IBS and resveratrol for IBD. Again, peppermint oil for IBS and resveratrol for IBD showing higher quality of evidence. However, this study was limited by the small sample sizes of the individual studies and the small number of studies looking at the individual biophenols in question.

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GG:

Alright, the next study is titled “Measurement of Fasting Breath Hydrogen Concentration as a Simple Diagnostic Method for Pancreatic Exocrine Insufficiency. This is a study of 60 patients with chronic pancreatitis or pancreatic cancer. So this is not the general population, it’s 60 patients with chronic pancreatitis or pancreatic cancer who underwent a hydrogen breath test without a sugar substrate. So they did not have glucose or lactulose before they did this hydrogen breath test. The fasting breath hydrogen levels were higher in the exocrine pancreatic insufficiency group. Specifically the EPI group, the exocrine pancreatic insufficiency group, had a mean level, a mean hydrogen level of around 16 with a very high range of anywhere from one to 77 parts per million. We compare that average of 16 to the non-EPI group, which is an average of about three, 2.8 specifically. So again, the EPI group had an average of 16 and the non-EPI group had an average around three parts per million.

GG:

When they used a cutoff of 10.7, a cut-off of 10.7 or higher to diagnose EPIs compared to a normal control, there was a sensitivity of 73%, and a specificity of 83%. A sensitivity of 73% and specificity of 83% when using a cut-off of hydrogen at 10.7 parts per million or higher to diagnose EPI. So this study highlights a possible new diagnostic tool to diagnose EPI. However, the study is limited by a small sample size of only 60 patients and patients with specific diagnoses of pancreatic co-morbidities including chronic pancreatitis and pancreatic cancer. But it’s something for us to consider and be on the lookout for more studies.

GG:

The next study is “Effects of Probiotics in Preterm Infants, a Meta-Analysis.” This is looking at the question: are probiotics safe and effective for infants with necrotizing enterocolitis? Now, you may not be dealing with newborn infants. Chances are you’re not, but these are five studies of 12,000 preterm infants. Probiotics were associated with lower rates of mortality and necrotizing enterocolitis related mortality. So even though you may not be working with this population, what the study does reflect is the safety and efficacy of probiotics in a high-risk population.

GG:

The next study is an in vitro study showing that probiotics can bind to various mycotoxins and reduce mycotoxin production. In one of the previous FFMRs, one of the Ruscio Institute doctors, Dr. Joe, gave some good research on probiotics and their use in mycotoxin related illness. So I would refer you back to that in case you want to know more, but this is another study proving this point.

GG:

The next study is a systematic review of 18 studies looking at the role of prucalopride in treating constipation and gastroparesis. Of the 18 studies, two trials using prucalopride at around four weeks showed improvement in gastric emptying and gastroparesis compared to placebo. Another seven trials using prucalopride for up to 12 weeks, or three months, of medication showed that prucalopride is effective for chronic constipation. So we are seeing that prucalopride is well-tolerated, even when used for longer durations of time up to three months.

GG:

The next study is “The Role of Berberine Supplementation in Reducing Diarrhea in Those with Functional Disorders.” This is a retrospective study of only 39 patients with functional diarrhea. After 30 days of treatment, the berberine group significantly reduced diarrhea by up to 50% to 70%, up to 50% to 70% in the berberine group. After 90 days of supplementation, this reduction improves to 70% to 80%. So after 30 days, we’re seeing 50% to 70% reduction, and after 90 days, or three months, we’re showing an improvement of up to 70% to 80%. And this is alongside the fact that up to and over 50% of the study participants, so around 20 of the 40 patients, achieved total normalization of symptoms. So these improvement rates are similar, or perhaps more, than what is seen in some large-scale Rifaximin trials. We should also make a note that berberine was given without prior breath testing. It was empirically based off the patient’s symptoms. So something to consider.

GG:

All right, the next study is a randomized clinical trial of 88 type D IBS patients with vitamin D deficiency randomized to either vitamin D at 50,000 IUs a week or placebo. So around 90 IBS type D patients with vitamin D deficiency, either given placebo or vitamin D. After nine weeks, the vitamin D group had greater improvement in symptoms and less inflammatory markers. Vitamin D showed greater improvement in IBS symptoms and less inflammatory markers.

GG:

The next study is a prospective study of 120 patients with functional dyspepsia in H. pylori colonization. They were randomized to either eradication therapy or the same eradication therapy plus a prokinetic. This prokinetic was itopride, a hydrochloride, and the combined eradication and prokinetic therapy is more effective in the treatment of functional dyspepsia than eradication therapy alone. Eradication plus prokinetic is more effective than eradication alone in those with H. pylori and functional dyspepsia.

GG:

Alright, the next study is “Two-Day Enema Antibiotic Therapy for Parasite Eradication and Resolution of Symptoms.” It was a study of 54 patients who were positive for B. hominis and D. fragilis, two common parasitic infections, and a lot of these patients had functional GI symptoms. They received triple antibiotics that were infused over two consecutive days through a rectal enema. Not a typical route of antibiotic medication, but novel nonetheless. After six weeks, around 80% of patients cleared the parasites. So eradication of parasites was also associated with improvement of clinical outcomes, showing some proof of not only eradicating the parasites with this novel approach, but also improving the symptoms, which we are all most concerned with.

GG:

The next study is “A 2-strain Mixture of Lactobacillus in the Treatment of IBS.” This is a randomized clinical trial of 80 patients with IBS who were randomized to a multi-strain probiotic or placebo. And just like our featured study, after eight weeks of supplementation, the probiotic group had less flatulence and overall better IBS symptom score. I think the latter is more so what we’re concerned about. Overall, the probiotic group had better IBS symptom score. When you look specifically at the abdominal discomfort scores, there’s really no difference, but overall, the probiotic group had better IBS symptom score. And again, this is another study, another study and more proof of the use and efficacy of multi-strain and multi-species probiotics.

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GG:

The next study was quite interesting. It was looking at the cost savings of either using medications or lower risk IBS treatments, such as a low-FODMAP diet, cognitive behavioral therapy, et cetera, in terms of how much it saved both the patient and health insurers. And what they showed was that routinely using low-risk IBS treatments, again, such as diet or stress reduction, before medications resulted in a per patient cost savings of $9,000 for IBS type D and $3,000 for IBS type C in just one year. And the most important thing is that health outcomes were similar to either med first or a diet first approach. So some proof of concept for a functional medicine approach, not just in terms of efficacy, but also in cost savings.

GG:

All right, the next study is comparing the North American versus the modified Rome criteria for diagnosing SIBO. And to catch you up to speed and in case you forgot, the North American criteria for diagnosing SIBO is a rise in hydrogen of 20 parts per million or more, or a 10 parts per million rise in methane any time in the three hours or two hours of testing. Compare this to the modified Rome, which is a rise in hydrogen or methane of 12 parts per million or more. Compared to Rome criteria, the North American consensus criteria had better accuracy for diagnosing SIBO and more GI symptoms during the testing. So, the North American consensus, according to this study, may be a better criteria to use in the diagnosis of SIBO.

GG:

The last study here is a Saccharomyces boulardii, and it’s a review evaluating the efficacy of this yeast-based probiotic. Saccharomyces has shown usefulness in managing H. pylori, and specifically they included some studies that showed that Saccharomyces can increase the eradication rate and decrease diarrhea associated with eradication therapy for H. pylori. Saccharomyces has also showed efficacy for antibiotic-associated diarrhea, C. diff infection, inflammatory bowel disease, and IBS as shown by reduced symptoms and better quality of life for those using Saccharomyces.

Thyroid and Hormone Studies

GG:

All right, let’s move into our thyroid and hormone studies. And we just have two here today. The first one is “The Rationale for Selenium Supplementation in Patients with Autoimmune Thyroiditis.” We’ve been kind of on the roll looking at research of selenium for thyroid disorders, so if you want to get caught up to speed with some of the previous research, I would suggest that you go back to some of the previous FFMR Plus additions. But this study again is looking at selenium supplementations for those with autoimmune thyroiditis specifically. In euthyroid, subclinical, or overt hypothyroid autoimmune thyroid patients, selenium supplementation is associated with the following. One, decreased TPO antibodies. Two, lower TSH. Three, decreased free T4 and free T3 ratio. Four, reduced oxidative stress and inflammation. Five, better quality of life. Better quality of life is a big one there. And six, better thyroid ultrasound structure. Unfortunately, we were not able to get full access to this study, and we’re not able to grasp the full effect size, but this is in line with previous studies showing the efficacy of selenium supplementation in thyroid disorders.

GG:

And then finally, we have “Subtle Thyroid Dysfunction Is Not Associated with Cognitive Decline.” This is a study of around 5,000 adults over the age of 55 years old without overt hypothyroidism at baseline. So their free T4 was not below lab range and their TSH was not above lab range at baseline. The thyroid function and hormone levels were not associated with cognitive decline at the four year follow-up. In other words, the higher someone’s TSH was, was not associated with cognitive decline at the four year follow-up in those at baseline who did not have overt hypothyroidism. Again, in those without overt hypothyroidism, thyroid hormones do not correlate to cognitive function.

RuscioResources:

Hi everyone. This is Dr. Ruscio. In case you need help, I wanted to quickly make you aware of what resources are available to you. If you go to drruscio.com/Resources, you will see a few links you can click through for more. Firstly, there is the clinic, which I’m immensely proud of. The fact that we deliver, cost-effective, simple, but highly efficacious, functional medicine. There’s also my book, Healthy Gut, Healthy You, which has been proven to allow those who’ve been unable to improve their health, even after seeing numerous doctors, to be able to help them finally feel better. There’s also our store where there’s a number of products like our Elemental Heal line, our probiotic line, and other gut supportive and health-supportive supplements. We now offer health coaching. So if you’ve read the book or listened to a podcast like this one, or are reading about a product and you need some help with how or when to use, or how to integrate with diet, we now offer health coaching to help you along your way. And then finally, if you are a clinician, there is our clinicians’ newsletter, the Future of Functional Medicine Review. I’m very proud to say, we’ve now had doctors who’ve read that newsletter, find challenging cases in their practices, apply what we teach in the newsletter and be able to help these patients who were otherwise considered challenging cases. Everything for these resources can be accessed through drruscio.com/Resources. Alrighty, back to the show.

Diet and Lifestyle Studies

GG:

All right, let’s move into diet and lifestyle. The first study here showed that higher urinary phthalate concentrations during pregnancy were associated with worse metabolic function at a eight year follow-up after delivery. So in other words, the higher the urinary phthalate levels were in the mom, the worse the metabolic function was at eight year follow-up as noted by higher insulin, higher A1C, more insulin resistance, lower HDL cholesterol, and higher triglycerides. And just in case you forgot, the phthalates are found in food and pretty much in many synthetic products such as detergents, cleaning products, solvents, plastics, flooring materials, fragrances, and nail polish. Anything that you could think of that is man-made has some of these toxic compounds in them.

GG:

Next study, “Diabetes Increases Risk of Incident Dementia in APOEɛ4 Carriers.” This is a meta-analysis of 12 studies, including 16,000 participants. It showed that in APOEɛ4 carriers, diabetes increased dementia risk of an additional 35%. So in those carrying the APOEɛ4 genetical allele, the diagnosis of diabetes increased dementia risk by an additional 35%.

GG:

All right, “The Effects of Icosapent Ethyl,” which is pretty much omega-3, EPA specifically, “on the Progression of Coronary Atherosclerosis in Patients with Elevated Triglycerides on Statin Therapy.” So as the title suggests, this is a study of 80 patients on a statin with elevated triglycerides given EPA or placebo. EPA, omega-3, or a placebo. After 18 months of supplementation, the EPA group had reduced atherosclerotic plaque, specifically a highly-vulnerable type of atherosclerotic plaque. The EPA group reduced this plaque by 17%. Reduced plaque by 17% while in the placebo group, the plaque volume more than doubled after 18 months. So in those with high triglyceride levels and those treated on a statin, EPA supplementation may prevent and even reduce atherosclerotic plaque as shown in the study.

GG:

Alright, the next study showed that those with jet lag, or circadian disruption, had higher appetite and made poorer food choices compared to those who were just sleep deprived. So circadian disruption may be just as much, if not more of a problem than just low-quantity of sleep as shown in this study with higher appetite and worse food choices as compared to just sleep deprivation alone.

GG:

Finally, our last study here is looking at organic chlorine pesticides. Their concentrations were analyzed in the fat tissue of those with type 2 diabetes. What the researchers noted was that there was this positive dose dependent relationship between toxin levels and type 2 diabetes risk. Meaning the higher the toxin levels were in the fat tissue, the higher the risk was of type 2 diabetes. We have to remember that this is an association and not a causation, but interesting none the less.

Episode Wrap-Up

GG:

Okay, so that’s it for this week. Dr. Ruscio and I really hope you’re enjoying these briefings and that they’re helping you practice more efficacious, practical, and cost-effective functional and integrative medical care. Until next time.

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