The Latest in Probiotics for Kids, COVID, Stress, and More - Dr. Michael Ruscio, DNM, DC

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The Latest in Probiotics for Kids, COVID, Stress, and More

Surprising Findings Reveal Which Conditions May or May Not Benefit From Supplementation

The latest research offers important insights into what health conditions may benefit from probiotics and how probiotics measure up to other therapies like antibiotics and steroids. Listen in to hear if probiotics may reduce symptoms and inflammation associated with H. Pylori, migraines, type 1 diabetes, asthma, COVID, IBS, and more.

In This Episode

Intro … 00:08
The effect of quadruple probiotic therapy for H. Pylori … 01:14
Probiotics to prevent spontaneous preterm delivery … 05:04
Symbiotic supplementation for inflammation and migraines … 08:02
The effect of probiotics on non-alcoholic fatty liver disease … 08:56
The influence of probiotics on GI tract infections among children … 11:21
Probiotics for children with vancomycin-resistant enterococcus …12:33
The effect of probiotics on upper respiratory tract infections … 16:40
Probiotic drinks for plaque psoriasis … 19:27
Probiotics for children with type one diabetes … 20:36
Probiotics with steroid inhalers for asthma … 21:25
Probiotics for reducing abdominal pain in children with IBS … 22:07
The impact on rheumatoid arthritis and spondyloarthritis … 22:33
Probiotics for COVID … 23:32
Probiotics with the flu vaccine show no effects … 25:03
Probiotics for wound healing … 26:20
The effect of probiotics on the growth of children from low/middle income countries … 26:44
What about ulcerative colitis? … 27:58
We’re creating a probiotic formula for kids! … 29:58
Outro … 32:50

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➕ Full Podcast Transcript

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. That’s 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.

Dr Ruscio:

Hey everyone. Welcome back to Dr. Ruscio Radio. This is Dr. Michael Ruscio and today let’s do yet another episode of updates on probiotic research. And a big shout out and thank you to our team for helping to sift, organize, [and] collate what is a body of evidence that is hard (I would say impossible) to keep pace with if you’re just one person. Okay.

Dr Ruscio:

So the first study looked at the effect of quadruple therapy for H. Pylori when combined with Saccharomyces Boulardii probiotic or Limosilactobacillus reuteri probiotic, and the impact on the eradication of H. Pylori. This was a double-blind placebo-controlled trial. So the pinnacle of scientific evidence. 156 patients with H. Pylori received either quadruple therapy (which is essentially antibiotics plus some soothing agents and acid suppressing agents) plus placebo or quad therapy plus S. Boulardii. What do you think they found knowing everything that we’ve covered thus far and how I’ve really harped on the need to evolve our understanding of probiotics beyond a specific formula or species or strain and have more of a broad view? Because as more and more data pours in, and as we cover on this podcast, you see similar results using different probiotics.

Dr Ruscio:

And what do you know? After six weeks of intervention, both the quad therapy plus S. Boulardii and the quad therapy plus L. reuteri had greater eradication rates of H. Pylori. And you’re looking at a 94 and 92% success rate with S. Boulardii versus L. reuteri. Essentially the same exact outcome using two different probiotics. Now there’s been more evidence published using Saccharomyces Boulardii, but that doesn’t mean it’s the better probiotic. And that would be an example of being evidence-based while also being evidence-limited if you were to say, “well, this person could benefit from probiotics but instead of giving them triple therapy (as we advocate for) we’re just going to use Saccharomyces Boulardii because there’s the most evidence there.” So this is just one great example of how effective probiotics are in conjunction with antibiotics, for treating H. Pylori and how it doesn’t really matter which one you use.

Dr Ruscio:

The other really neat thing here is that only when using probiotics was there a lessoning of side effects from the quadruple therapy. And what’s interesting here is the lessening of side effects was only documented for S. Boulardii, it was not documented for the L. reuteri. I don’t chalk too much up to that because I wouldn’t recommend using one Lactobacillus type strain in isolation, given the fact that, as we’ve discussed in the past, there’s at least a trend that a combination lactobacillus and bifidobacterium formula—meaning multiple species—works better than a single formula. So if we’re trying to mitigate antibiotic-associated side effects, a broader spectrum probiotic would likely work. But in all, this study, my feeling illustrates the most important finding of different types of probiotics can work the same to enhance the clearance rate of antibiotics for H. Pylori and can also mitigate some of the antibiotics (AKA quadruple therapy side effects).

Dr Ruscio:

The next study looked at Clostridium butyricum and tetracoccus in Bacillus subtilis. So this would be a three species combination, soil-based (or spore-forming) probiotic to prevent spontaneous preterm delivery. This study was looking back in time, so retrospective, of 51 pregnant women with a history of spontaneous preterm delivery compared to 255 pregnant women who did not have this history, and all had been taking probiotics for about three months prior to delivery. Check this out. The rate of recurrence of preterm delivery was lower in the probiotic group, 10% to about 30%. So pretty cool to see that a soil-based probiotic reduced preterm delivery. Again, I want to flag, as I always do, sometimes pregnant mothers are told to avoid lots of stuff due to fear of not knowing and I think probiotics is one area where we really want to be careful not to shun mothers away from using probiotics due to a lack of understanding of data like this.

Dr Ruscio:

The next study looked at a four-species probiotic formula for ventilator-associated pneumonia (a little bit more timely, unfortunately). And in looking at 112 ventilated ICU patients who received either placebo or probiotics, there was a vastly reduced rate of ventilator associated pneumonia from 11% to 28%. And also less sepsis 6% to about 24%. So even more evidence showing the benefit of probiotics. And in this case, for those who are in the ICU, and I flag this because, again, when there’s potentially unknowns and/or fear, it can lead people to do nothing because of the unknown. And this is understandable, but gosh, there is just more and more data coming in showing that probiotics [help], from pregnant mothers with a risk of preterm births to, as we discussed in the past, children in the NICU (neonatal intensive care unit) to those in the ICU on ventilators.

Dr Ruscio:

The next study looked at symbiotic supplementation (meaning a combination of probiotics plus prebiotics) and how they impact inflammation and migraines. And they did not find any improvement in migraine frequency when using probiotics, but they did notice a significantly reduced need for pain medication and a reduction in gastrointestinal symptoms, as well as a reduction in zonulin and CRP. So not all outcomes here are where we would want them to be. The migraine frequency didn’t really change much, unfortunately. But less pain medication, less GI symptoms, and a decrease in inflammatory markers.

Dr Ruscio:

The next study examined the effect of probiotics on non-alcoholic fatty liver disease. And this was the really coveted systematic review and meta-analysis of nine clinical trials looking at just under 400 patients who were randomized to either probiotics or a placebo control. And probiotics led to a reduction in liver enzymes (AST and ALT), and also total cholesterol. And remember, this is a meta analysis of nine clinical trials showcasing, as we discussed before, the ability of probiotics to improve non-alcoholic fatty liver disease. And tells us or showcases or reminds us of the gut-liver connection.

Dr Ruscio:

Now up until now, we’ve discussed essentially three different types of probiotics: Saccharomyces Boulardii, we’ve discussed a soil-based probiotic, and we’ve discussed one or two studies that have used your traditional lactobacillus bifidobacterium-based probiotics. This is one of the reasons why I’m so excited about triple therapy, because in the clinic for years and years and years I had struggled to know which formula [to] use. Do I use the traditional lactobacillus bifidobacterium-based? Do I use a soil-based? Do I use a Saccharomyces Boulardii? And I started testing combining all three, meaning three different formulas (three different bottles, so to speak). And that seemed to work better than just one bottle alone, which makes sense. This has been documented for antibiotics in SIBO, in H. Pylori, and multiple models of infection, that more than one antibiotic works better than one antibiotic. The same seems pretty reasonable to conclude, we would see, for probiotics.

Dr Ruscio:

So this is really where I pull the idea from, in terms of seeing all this literature for different conditions for lactobacillus bifidobacterium products, for Saccharomyces Boulardii products, and for soil-based products. And because of that, again, it seems like a fairly reasonable inference to draw. Maybe we can get better effect by combining all three. So I just want to plant that reminder there about probiotic triple therapy.

Dr Ruscio:

The next study looked at the influence of probiotics on gastrointestinal tract infections among children attending childcare. And again, this is the highest quality data point, a meta-analysis of 15 randomized control trials. And as you would expect, probiotic supplementation led to an overall reduced risk of gastrointestinal infections in children by 26%. So pretty interesting there. And one of the other things to queue in here when looking at a meta analysis, oftentimes (in fact, almost all of the time) different formulas are used in the different trials. This is 15 different clinical trials and the probiotics usually differ from trial to trial to trial. Hence the reason why I keep encouraging the field, and thankfully this is really seeming to start to catch on, to move away from the slightly myopic view of the one formula that’s best or the one strain that is best for a given condition.

Dr Ruscio:

And we mentioned the NICU a moment ago, and there’s another study here looking at lactobacillusm rhamnosus administration for children, unfortunately, who found their way into the NICU and were colonized via a vancomycin-resistant enterococcus . And what they found was in the 55 children that were studied and randomized to either receive an antibiotic or probiotics, the six month effect was that the probiotic group had a higher eradication rate, 95% versus 52%. So picture yourself as a parent who has a child with a vancomycin resistant gut infection. That could be very admittedly super scary. Important here to be moored by data. In this case, there was almost a doubling of the clearance rate by using a probiotic. And again, I want to keep flagging this so as to help arm patients with the knowledge not to fall victim to what would be more of, I’m assuming most, hospitalists lean toward antibiotics, especially if they’re not part of a team who is combing through the literature to see these cases.

Dr Ruscio:

And it’s also not to say it’s an all-or-none. You could start with probiotics and say, how about we start here and give this a few weeks and check back in and see how my kids doing. And if they’re not doing any better, we can do the other antibiotic that you’re recommending. And if they are, we stay the course, right? So I just want to also be careful not to represent probiotics as a proxy for never using any medicine or any antibiotics ever. But especially with children, the earlier an antibiotic is administered, the more of a deleterious effect they have. So again, it’s not all-or-none. But let’s put these in a sequence; start with things that are less invasive, and in this case more effective, and then consider the more invasive therapies second to that.

Dr Ruscio:

Okay. The next study, pretty interesting, found there was decreased subjective—meaning self-assessed—stress in healthy adults when subjected to academic stress (said differently, people were less stressed about school) when they were on probiotics. 92 healthy college students who had to give a public speech randomized to a placebo drink or a probiotic drink. After four weeks, the probiotic group had less stress and anxiety scores. They had similar rates of salivary cortisol. So remember, placebo control. People didn’t know what they were getting. And there was a significant signal that those who were having the probiotics were less stressed, even though their salivary cortisol was the same. And remember, I am not a fan of salivary cortisol because this does not seem to be a very accurate measure. And we’ve discussed a meta-analysis in the past that found over about half the time, the individual’s symptoms and their salivary cortisol levels, or really any cortisol testing, do not match. So this is a good case where the person felt better and the labs didn’t change. And this is not, in my opinion, any other reason than the fact that the labs should not be the primary point of examination due to questionable accuracy.

Dr Ruscio:

The next study looked at the effect of probiotics (in this case, a lacticaseibacillus rhamnosus again) on upper respiratory tract infections. This was a double-blinded placebo-controlled trial. So essentially [the] common cold. And in this placebo controlled trial, 619 children were given a placebo or a probiotic. After four months, there was no significant difference in the incidence of upper respiratory tract infections. However, probiotic intake was associated with less severe infection.

Dr Ruscio:

So as we’ve discussed in the past, and I share this because I went through this exact same thought process, if you’re taking probiotics and you get sick, it’s incorrect to think or to say, darn it, the prob didn’t work. Because there’s evidence showing that the duration and the severity can be shortened. There’s some evidence showing that you’re less likely to get sick. Yes, but it’s not across the board. So keep that in mind that the probiotics have a chance to decrease the likelihood of getting sick, according to some of the research. But other research, as this study showcases, don’t show [that] you are less likely to get sick but it will be shorter and less severe, which is still a win. [It] still sucks, getting sick, but at least it’s not going to be quite as bad.

Sponsor:

Hi, everyone. If you are in need of help, we have a number of resources for you. “Healthy Gut, Healthy You”, my book and your complete self-help guide to healing your gut. If you’re not a do-it-yourselfer there is the clinic—the Ruscio Institute for Functional Medicine—and our growing clinical and supporting research team will be happy to help you. We do offer monthly support calls for our patients where I answer questions and help them along their path, health coaching support calls every other week, and also we offer health coaching independent of the clinic for those perhaps reading the book and/or looking for guidance with diet, supplementation, etc. There’s also the store that has our Elemental Diet line, our probiotics, and other gut health and health-supportive supplements. And for clinicians, there is our FFMR—the Future of Functional Medicine Review—database which contains case studies from our clinic, research reviews, and practice guidelines. Visit DrRuscio.com/resources to learn more.

Dr Ruscio:

And coming to something a little bit more so superficial, so to speak. [We’re] looking at a randomized control trial in the treatment of patients with plaque psoriasis. 50 patients who had psoriasis were given a probiotic drink for eight weeks and what they were documented to have, as compared to the placebo group, [was] improved mood, improved quality of life, reduced symptom scores, increased antioxidant capacity, and decreased CRP (an inflammatory marker). Not surprising knowing that meta-analyses have found that probiotics can reduce depression. And also, like we just talked about, reduced stress. And, seemingly so, if you have plaque psoriasis, you might be a little bit stressed about that. So if your quality of life improves, if your psoriasis symptoms improve, it’s likely your mood’s going to improve. So, you know, nice showcasing of some of the multifold benefits of probiotics yet again.

Dr Ruscio:

In the next study, they looked at a multi strain—which should really be said to be multi-species, because unless you’re using different strains of the same species, I think saying strain is the wrong way of terming this—but anyway, nomenclature aside, of a multi ingredient species/strain randomized control trial in children with type one diabetes. And after three months of using a probiotic, there was improvements in hemoglobin A1C (a marker of average blood glucose) and a higher number of children who achieved remission, interestingly. So really exciting finding for children with type one diabetes.

Dr Ruscio:

The next study looked at the ability of probiotics to improve the results of steroid inhalers for asthma. And in short, after three months, the probiotic group had greater symptom relief. And perhaps this is in part due to the fact that, as the last study found, probiotics can reduce inflammation. And in asthma there’s going to be some inflammation and overzealousness of the immune system, hence the use of steroids. And in this case, they likely compliment one another, the steroids and the probiotics.

Dr Ruscio:

And the next study was, again, a meta-analysis of seven randomized control trials in pediatric or infant patients (about 440 of them) looking at the effect of probiotics on abdominal pain. And, unsurprisingly, they found that probiotics were effective in reducing abdominal pain in children with IBS.

Dr Ruscio:

Another study looked at the impact on rheumatoid arthritis and spondyloarthritis, this was a systematic review and meta-analysis of 13 studies. And they used a lactobacillus bacillus combined with a spore-forming probiotic. So this is one of the few studies where you’ll see a category one and category three combined. And the supplementation of probiotics led to a decrease in C reactive protein, but no difference in inflammatory markers in those with spondyloarthritis. So some improvements in RA, but not so much with spondyloarthritis. And spondyloarthritis is essentially arthritis consolidated to some of the joints in the spine (or spinal arthritis, you could say).

Dr Ruscio:

Okay, the next study—ooh, controversial—probiotics improve symptomatic and viral clearance in COVID 19 outpatients. A randomized, quadruple-blinded placebo-control trial. In this study, 293 participants with COVID were randomized to probiotic or placebo. After 30 days, the probiotic group had a higher remission rate (53% versus 28%), reduced nasopharyngeal viral load (a virus in the nose), less digestive and nondigestive symptoms, and a higher antibody response against SARS-COVID2. So a really high-quality study here, reinforcing an inference I had made way back at the start COVID, borrowing from the fact that probiotics had shown a reduction in upper respiratory tract infections, as we discussed even earlier. And that it made sense, but I wanted to be careful, that it could probably help with COVID. And I said, because these are safe, relatively inexpensive, and have multiple health benefits, it seems arguable to use a probiotic as an adjunctive and prophylactic measure. Not to say that would be the standalone intervention. And now we’re seeing more evidence supporting my posit from early on in the pandemic.

Dr Ruscio:

And along a similar vein, another randomized control trial found, or looked to assess, [whether] probiotics [could] help an influenza vaccine work more effectively for elderly individuals. And in this case, a flu vaccine plus either probiotic or placebo was examined. The addition of probiotic to the flu vaccine had no impact on influenza antibody titers. The incidence of flu illness was not different between the probiotic versus the non probiotic group. So this is one study that found no effect. Important to point to this, because I try to do a good job of showcasing that while there’s a really strong trend, it’s impossible to make the claim that probiotics work for everything all the time. And hopefully showing you both the positive and null findings helps you realize how crucially important it is to look at the totality of evidence and not just one cherry-picked study.

Dr Ruscio:

Okay. And another systematic review looking at four studies around the question of [whether] probiotics enhance wound healing. And in the four studies examined, all studies reported positive effects of probiotics on wound healing.

Dr Ruscio:

And let’s do a couple more here. [There’s] one on the ability of probiotics to help with growth in children. Another meta-analysis. This one was a big one—I guess a little bit of a pun, big children growth—79 randomized control trials found that probiotics had a small effect on increasing weight and height. And the beneficial effect was only seen in low/middle income countries and not in high income countries. So this is really important to clarify why exactly this is. We can speculate, but, likely the higher income of the country, the better the food, the healthier the individuals may be, the more access they may have to some fermented foods. But irrespective of my speculation, a small effect on weight and on height in a beneficial direction but more so consolidated to low/middle income countries.

Dr Ruscio:

And what about ulcerative colitis? One of the subsets of inflammatory bowel disease. There was a trial that looked at 118 mild to moderate ulcerative colitis cases using the probiotic e coli nissle 1917 or placebo. And at eight weeks the probiotic group had no difference in inflammatory bowel disease scores, but they had a higher clinical response (39% versus 21%) and a higher endoscopic remission (46% compared to 27%). And another similar study, looking at antibiotics for induction and maintenance of remission of ulcerative colitis. This was a meta-analysis of 13 clinical trials. And compared to placebo, antibiotic administration resulted in clinical improvements in those with ulcerative colitis.

Dr Ruscio:

Now this is antibiotics, not probiotics, but I just wanted to pepper this in here to showcase that antibiotics or antimicrobials are another option. And this is why, let’s say in inflammatory bowel disease, ulcerative colitis, we would start with dietary changes. And second to that, guess what, probiotics. And third to that, antimicrobial therapy. Also elemental dieting, depending on where someone is. The more severe someone is, the more elemental dieting makes sense because it’s been shown to be similar in effectiveness as corticosteroids. And immunoglobulins can also be helpful. So a number of tools in the toolkit. And [I] just wanted to juxtapose the utility of antibiotics amidst all of this talk of probiotics.

Dr Ruscio:

Okay, well that takes us through another suite of updates from research on probiotics. A lot of this in children. And hopefully this is helping to arm you guys with a little bit more information on if you have kids or family with kids, why it is so important to consider probiotics for your children. And again, I want to echo that we are working on release of a children’s probiotic. I also want to be careful to mentioned, there’s not a magical children’s formula in terms of: if you give them these species versus those they’re going to work or not work or cause harm. It’s rather just getting the dosing to the correct level and then finding a formula that has the right flavor profile without also adding a bunch of sugar. And so that’s something we’re currently working on and hoping to release before the year is out, just to make it easy.

Dr Ruscio:

You can give your kids the probiotics that you are using as an adult. And at the clinic we recommend halving to fourthing the adult dose for the use in children. It’s really not rocket science. And as you’ve seen here in some of what we’ve covered in the research, various formulas have been used and all shown benefit. And even in some very potentially sensitive, for lack of a better term, cases. Neonatal intensive care, as one example. Or in adults in the ICU. So supporting the fact that even if someone is ill, we don’t have to be withholding of probiotics.

Dr Ruscio:

Ultimately, clear this with your doctor. But [I] also just want to flag that in some cases you might want to get a second opinion because some doctors will just give you the reflexive “no.” So make sure to follow up and say, “do you know of any data, any published science, that would make you recommend avoiding probiotics? Or are you doing this out of an abundance of caution?” And sometimes that right there can get you to a point where you feel better and they say, “well, I don’t know any reason why they should, necessarily, but I also want to make sure we don’t give [you] anything that could harm [you].

Dr Ruscio:

So anyway, a number of updates on probiotics, a lot of this on kids. And hopefully you’re finding this as interesting as I am and you are progressively seeing why I’m such an advocate of using probiotics as one of the core tenants of the model we use in the clinic. And what I discussed here on the podcast and discussed in “Healthy Gut, Healthy You,” because they are safe and they are effective at many, many things—from infection all the way through mood and even skin conditions. And with that, I will leave you with those updates and [I] look forward to speaking with everyone next time. Okay. Thanks guys.

Outro:

Thank you for listening to Dr. Ruscio Radio today. Check us out on iTunes and leave a review. Visit DrRuscio.com to ask a question for an upcoming podcast, post comments for today’s show, and sign up to receive weekly updates. That’s DRRUSCIO.com.

 

➕ Dr. Ruscio’s Notes

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  • Probiotic Supplementation for Promotion of Growth in Children: A Systematic Review and Meta-Analysis
    • 79 RCTs of probiotics used in kids 0-5 years old 
    • Probiotics had a small effect on increasing weight (effect size 0.26) and height (effect size 0.16)
    • This beneficial effect was only seen in low-middle income countries (not in high-income countries)
    • Commentary: Probiotics may be able to improve weight and height in kids who may be predisposed to malnutrition (e.g. kids who live in low-middle income countries). 

 

  • Additive effect of probiotics on 5-aminosalicylic acid therapy in patient with ulcerative colitis
    • 118 patients w/ mild-to-moderate ulcerative colitis (UC)
    • Randomized to E coli Nissle 1917 probiotic or placebo
    • After 8 weeks of supplementation, the probiotic group had:
      • NO difference in IBD symptom score
      • HIGHER clinical response (39.7% vs 21.7%)
      • HIGHER endoscopic remission (46.4% vs 27.1%)
    • Commentary: This study found that the probiotic, E coli Nissle 1917 was effective in improving UC.

 

➕ Resources & Links

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