Probiotic Research Updates

• Austin Functional Medicine
• Support Your Gut With Probiotics
• Dr. Ruscio Resources

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, please make sure to subscribe in your podcast player. For weekly updates, 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 to your doctor. Now let’s head to the show.

DrMichaelRuscio:

Hello everyone. In today’s podcast, I speak with myself. So…..probably a good one to skip! (Ha) Actually, I have some fun stuff to share with you. I talk about some personal health challenges that I learned quite a bit from. I will share some announcements about expanding and relocating the clinic. We also go through a number of updates to the comprehensive probiotic guide. As you can imagine, I’m always following the research and there are a number of updates related to these studies that I wanted to make to the guide, so I will go through all of those as well. If you have the comprehensive probiotic article bookmarked anywhere, you’ll see that we’ve made all these updates in the article, but for those in our audience who only do the audio, I wanted to make sure that I narrated them here also. So that’s today’s episode. Some personal stuff, what I learned from the updates, the clinic including its relocation and expansion, and also a number of updates to the body of research on probiotics. Okay, here we go.

DrMR:

Hi everyone. Welcome back to another episode of Dr. Ruscio radio. This is Dr. Ruscio and boy, do I have some stuff to share with you! It’s been a while since I’ve done a solo podcast and a lot has happened in the past two to three months. The main impetus behind this recording is to provide some updates to our probiotics cornerstone article. As you can imagine, I am constantly staying aware of what’s being published and because of that constant stream of science, even the highly comprehensive article that we wrote a number of months ago requires us to add maybe 20 references at this point. We won’t go through every one, but we’ll give you the consensus, some of the main thrusts of anything new and novel regarding probiotics. If that’s all you care about, skip maybe the next 15 minutes, because I’d like to also tell you about some life challenges that have been happening. Things that happened at the clinics, personal health issues. I wouldn’t call them challenges, but they were challenging. At the same time, I actually learned quite a bit from the experiences. , So if you want just the science, skip forward a bit, otherwise, I’ll take you on a little bit of a story here.

Clinic Updates: Moved to Austin, TX

First, the clinic in California has now been relocated to Austin as have I. This is something I had been thinking about doing for a little while. I really loved being in the suburbs outside of San Francisco and Walnut Creek. However, I had this growing feeling that it was time for a change and I was becoming a little bit complacent there. So I had been thinking about this for quite some time. Then life threw me some lemons, and I tried to make the best glass of lemonade that I could out of that. The “lemons” so to speak were some challenges with my clinical office staff at the Walnut Creek clinic. Two staff members, Jasmine and Miriam are both single moms and due to everything that happened with COVID including loss of school and loss of daycare, presented some huge challenges. We tried to make it work with remote working and flexible hours, and while my clinical care didn’t change, the quality of our feedback to patients, and all the stuff surrounding that, how timely we were to respond to phone calls and emails and how organized some of the logistics were started to really suffer. It was a challenging spot to be in because as their “boss” I couldn’t really have a heavy hand on performance because it was a challenging time that no one chose to be in. I really tried to find a way to make it work, but at a certain point, I had to close down temporarily and restaff because they just weren’t able to do what they needed to do. It was something that we were all kind of in agreement regarding while we were taking that period to restaff. I figured, well, if there’s ever going to be a time for me to make a move now would be that time. However during that time, for our patients or those who applied to become patients, there may have been a bit of a slowness in our response, and for that I apologize.

DrMR:

It was really a kind of a powerful example for me regarding how important our people on a team are and how really, even if you’re someone who considers himself a pretty good clinician, you’re highly dependent upon the other people on the team. It is our job to work synergistically to make sure that patients have a pleasurable, engaged experience. So my apologies for any of the challenges that patients experienced as we tried to compensate for the challenges we were facing. On to the good news! The clinic has been relocated to Austin and I’m very excited because at that same time we updated our health record systems. The closure of the office allowed us time to update many of our systems as well. We now have new staff on board who I am extremely happy about, Jasmine and Morgan who are both intelligent and very engaged. Jasmine is our administrator and patient care coordinator and Morgan is our new health coach. Yes, we are now offering health coaching as part of the clinic. We’ve also modified some of the flows in the clinic to make things even more efficient for our patients. One thing that you’ll be hearing more about is the fact that the clinic has now expanded in terms of doctors. I have added two additional doctors, and will likely bring on a third, perhaps within six months or so. These doctors are very well trained in my model. The great thing about this is that now if you’re looking for the model that I practice, progressive, but circumspect cost-effective, patient centered, GI focused, but not GI dogmatic model we have more providers to help you.

DrMR:

I have put a painstaking amount of time into developing this system and to training the new clinicians in our office to be proficient in this model. Now you can have the same kind of care as if you’re working with me, except you don’t need to to wait six to eight months to be seen, in fact, I’m happy to say that we’re now able to see most patients within a couple of weeks. That’s probably the most exciting part to me. Also, we have improved systems in a multitude of ways, from communication all the way through the new patient programs. One of the most important aspects built into these system updates is the ability to, in a more streamlined fashion, collect data from our patient population so that we can publish research much more easily. One of the main purposes behind this expansion, outside of just being able to help more patients and help patients in a more timely fashion was to have more clinicians operating in the same model. So now we have a higher sample size. My objective over the next few years is to really make a dent in the direction of this field by answering questions that people now claim that there is no evidence. We’re going to use our best clinical reasoning, which is sometimes fine, but if I’m being very candid, that oftentimes is a dodge for people who aren’t willing to question if what they are doing is actually helpful. Just to clarify every new therapy we bring into the office, I am constantly interrogating including mast cell activation and mold therapies.

DrMR:

Currently, I am trying to verify the ability of these therapies to help from every angle, which is so crucially important. I’ll share how this ties into my personal health in a moment. You should see much more from me, over the next year or two in terms of papers being published. This ties into some personal health stuff but before I jump to that, let me make one other kind of clinically related reminder here.

Health Coach Services Available

DrMR:

At the clinic we now have health coaching, but from the questions I see trickle in from social media, on our website, through our store, there is a facet of our audience who do not need a doctor, but do need some guidance in diet. Perhaps how diet and probiotics interface, how to use probiotics, how to use the elemental diet, how to use immunoglobulins, or maybe all of these things. Maybe you’re not sure which one you should use, or if you should use any. Or perhaps have questions about whether you have overlooked something in living a healthy lifestyle that really needs to be addressed. This is why I’m so excited to have a health coach available for our broader website audience. So if you’re someone listening to this or reading this, and you feel like you need some help and some guidance from a health coach who’s been trained in my model and knows the nuances of the positions that I take I’d encourage you to reach for a generalized health coaching visit to allow you to have that guidance.

Dr. Ruscio’s Personal Health: Oral Health & Sleep

DrMR:

Okay, let’s shift gears to my health debacle. I should have actually done this podcast with them in, but I’m currently wearing, most of the time, this retainer-like device called a Crozat. If you were to take braces and put braces on the inside of your teeth, rather than the outside, that’s kind of what a Crozat is. They help to expand the oral arch so that if you had braces and headgear like I did, and there is a chance that you may have crowded the tongue by pushing the teeth backwards and confining the oral arch, the Crozat can help to open that up. A confined oral arch is a problem because tongue crowding may cause issues with sleep. So my Aura sleep data has gotten much better as I’ve tended to my time to bed and prebed activities. However, I still don’t get much above the low eighties. I’m trying not to read too much into the specifics of the score, because I may a bit of a fidgety sleeper, and that may be something that doesn’t manifest as any appreciable impediment to my sleep quality. The Aura data may not be able to adequately factor that into its algorithmic analysis. So I’m not fretting over this, but knowing that I had braces and headgear, and that my sleep quality has gotten better, but has hit this low ceiling, I’m running this experiment of using the Crozat to expand my oral arch. This will theoretically give my tongue more space, prevent my tongue, when it’s relaxed from sloughing into my throat and causing interfered respiration at night and therefore ostensibly decreasing sleep quality.

DrMR:

Now, the other thing that’s interesting about this, and this was not my objective, but I just share this because I found it to be quite interesting. I went to the office of Dr. Brian Hockel who’s in Walnut Creek and came highly recommended. It was actually kind of serendipitous that he was in the same town that I was. But what I noticed was that people’s faces and smiles actually look better once they’ve gone through this work. It’s not really something that requires a ton of explanation to understand. When you look at someone and go, wow, they have a nice smile. That, in part, is their tooth structure, but also has to do with how wide is their smile, right? I don’t think anyone ever looked at a narrow mouth and said, gosh, that’s a beautiful smile. A wide, glowing smile is what tends to be more attractive. It really struck me looking at many of the before and after cases that were shared with me by Dr. Hockel. As part of his process, he takes measurements and photos pre- and post treatment and, of course, has patients sign a release that gives permission to share. It was quite remarkable, especially in children. I really hope for any parents who at any point have to consider braces for their children, you will consider an oral airway friendly orthodontist. These children not only run the risk for sleep problems for their entire life like apnea, but with consideration of the palette, and this is obviously not nearly as important, there is an appearance component. An oral airway friendly orthodontist will consider alternatives to treatments that would compress down their teeth, and shrink their smile and also alter the aesthetics of their lips, because the lips are pulled by muscles over the teeth. Not only are the alternatives better from a respiration perspective, but also from the perspective of aesthetics. So just something to launch us into the Crozat discussion. And when the Crozat is in, I have a lisp and it is pretty remarkable how debilitating a lisp can be. As you can imagine on a clinic day, I’m talking all day and per Dr. Hockel’s recommendations, I wore the retainer 24/7 for the first two weeks. Now I do question the necessity of that and I’m politely going to criticize Dr. Hockel a little bit in that. I’m assuming that you don’t have to wear this thing 24 / 7 in order to see results. I mean, if I was in junior high school or middle school, this would be less of an issue. It would still be unpleasant, but it’d be less of an issue. I’m not sure if Dr. Hockel appreciates for a working professional such as me what a challenge the lisp creates. But if someone waits eight months to see me, and they’re really looking at me like their last hope, it does seem hard to justify me having a lisp and a hard time articulating words while that patient is really looking at me as someone who every word could potentially hold valuable insights to help them resurrect their health. I take my clarity of communication very seriously. And that two weeks when I did not remove this Crozat was very, very challenging because of this lisp. So to help with the lisp, I took one of Dr. Hockel’s recommendations which is to put braces wax or one of those malleable silicone earplugs on the roof of your mouth.

DrMR:

So I did that and unbeknownst to me, I had a reaction to both of these things. Much more so the silicone, but the braces wax is also petroleum derived. I actually looked for bees wax derived ones, and I couldn’t find any. As you may know, silicone can be toxic. Women who have silicone implants, even ones that don’t rupture, there may be, I’m assuming here, I don’t know this for a fact, but there may be a slow amount of leakage that for some women is enough to cause fairly pronounced and chronic health issues. Well, for me, the reaction was obvious. I’m gonna be a little bit graphic with some of the description. I had diarrhea out of the blue, which I never have. I had gas and some abdominal pain, probably most notably was some brain fog. For me, unfortunately, much of the stuff in my gut tends to manifest neurologically. Also, fatigue and joint pain. I’m going to get a little more graphic here. So one of my good buddies in Walnut Creek, we had this kind of ongoing “I’m faster than you”, “No, I’m faster than you” kind of back and forth when it comes to running a 1500 yard sprint. We had been trash talking for years which culiminated in a rematch from literally now about five years ago. So this is two days into this reaction, and as I’m warming up for sprints, normally I feel like I have a very high degree of power off the line when I’m warming up. I feel very balanced, in tune, strong. I’m noticing I’m passing gas as I’m warming up, my left hip feels very tight, I don’t feel very engaged. Oftentimes when you’re getting warmed up for a sprint, you kind of feel like your back muscles and your glute muscles are just kind of pumping with blood, the kind of the pump that bodybuilders referred to when they’re doing bicep curls. Well, this applies other parts of the body too, and I’ve found the better health I’m in the more of that kind of pump feeling I get probably due to circulation. None of that. So this reminded me that the mouth truly is the first section of the gut, is just so crucially important, gut health, including oral health, all of it being tied to the gut. If I didn’t piece this together who knows the length I would have gone to try to figure out why I was having this joint pain, this migratory kind of inflammatory joint pain. This type of joint pain, there’s no rhyme or reason behind it. There was no hard workout. There was no reason why I’d have pain only in my left hip that didn’t feel like the glute muscle, it like the joint itself. So that combined with fatigue and some brain fog and GI issues just made me a different person.

DrMR:

My energy levels were lower. My reactivity of food was higher and obviously, I had joint pain. It’s amazing to me, the difference that that makes. I want to connect that further to where I am currently living in Austin. I thought it had mold when I first got here. The reason why I thought it had mold was because there were still some residual from the reactions I was having to the silicone and I then switched to the braces wax that still caused a reaction. It was lesser but there were still a reaction. And it’s amazing to me how your mind can mess with you and this is why I think it’s just so crucially important that clinicians have a light handed approach when they dole out diagnoses and with the type of prognosis that they paint. The example here is that an overzealous mold Clinician may have jumped to thousands of dollars worth of lab testing, and may have very easily been able to kind of unintentionally coherce me into thinking there’s this elusive mold problem in my residence. Again, I remember in the morning when the AC would kick on, I wouldn’t be feeling well or mentally clear. It turns out it was just kind of, for me when I’m not in good health, the mornings tend to be the most foggy time. And I thought, Oh my God, it’s the mold because the AC is kicking on now and it’s all hitting me and you know, your mind just runs away. This is where it’s clear to see why some who’ve been exposed to issues in their environment, need limbic retraining, because it can, it’s such an elusive thing that you can really have your mind play tricks on you.

DrMR:

Now I already had it assessed actually for mold because I do know, and thankfully we have a great mold analysis and air quality analysis referral for our Austin patients, that due to the heat and humidity in the summer, obviously the AC is running all the time, it can create a mold issue. If an HVAC system isn’t maintained, especially if the filter isn’t changed, then you may just have some more than the filter and/or some dust and particulate matter built up in the filter that the filter is not filtering. It doesn’t have to be the end of the world. But it taught, even though I wasn’t that concerned about anything in the home, and it wasn’t a bad idea to get an evaluation, that I needed to first focus on my gut. If I didn’t take care of my issue in the gut, the issue in my mouth, I could have gotten pulled so deep into this wild goose chase for the red herring of mold that I may have never really achieved the end point of feeling better that I wanted to feel. This is not to say that mold and MCAS and these things do not exist. I’m somewhat confident that they do. However it reinforces how crucially important it is that we start with the gut and we don’t overlook that as a causative factor because I’m going to go out on a limb here and say that problems in the gut are far more common. To those who say, and I forget what the exact stat is, something like half the buildings in the U S may have mold damage. Okay. Maybe. At the same time I question how much of an environment versus host issue this is knowing that droves of patients have less food and less environmental allergy, and I’ll actually share a couple of studies later that support this, even a systematic review, as the improve the health of their gut.

DrMR:

It seems so incredibly justifiable to start with optimizing someone’s gut health first, so that you make sure you are not trying to achieve a near impossible level of perfection in the environment because the person is so reactive. Again, I’m not saying that it’s one or the other, it can be both, but this is where the algorithm comes in and why it’s so important for a clinician to really have a training like the clinicians in my office in how to sequence these things. Cause even the best training and mold devoid of this information on the gut may provide a very suboptimal outcome.

Recent Probiotics Research

DrMR:

So I think that is most of the hot air I wanted to blow here before we go into the updates on probiotics. Let me start by looking at all the notes here on the updates that we made.

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DrMR:

Let start with the bit on histamine intolerance. The reason why I want to start here is because it ties into that point that I just made regarding the the gut and the environment. The healthier the gut the more attenuated the reaction to the environment is. So the references I’m looking at here are a meta-analysis and also a more recent clinical trial found that probiotics significantly reduce the symptoms and clinical markers in patients with allergic rhinitis. There are many studies here, this is one a meta analysis. So this tells us that there are numerous clinical trials finding that allergic rhinitis, which is an environmental, allergy, histamine in-part mediated condition, actually improves with the use of probiotics. This is because the health of your gut has a massive impact on the tone of your immune system. As we know, the highest density of immune cells resides in the lining of your small intestine. So getting the gut right, seems to have a large impact on not only environmental, but also on food allergies. So keep that in mind. This answers the question, and this is more kind of robustly outlined in the article, Do you need to be on a special histamine, reducing probiotic, or can you use kind of standard histamine free or low histamine probiotic? And the answer to that, in my clinical experience, is that you do not need a low histamine probiotic. This is a good example of how looking at mechanism can lead one to really miss the bigger picture.

DrMR:

Why? Because the net impact of probiotics, irrespective, if they contain some histamine seems to be anti-histamine. Remember probiotics, albeit containing some histamine in them, are antibacterial, antifungal, antiparasitic, antiprotozoal, anti-leaky gut, pro-motility and anti-histamine. All that leads to this net anti-histamine effect. Now, if you’re someone who feels they are histamine intolerant and you’ve reacted to a probiotic, it doesn’t mean that it’s the histamine per se. I would recommend you go through the 3 for BALANCE protocol and individualize the probiotic to your gut. Some people will react to lactobacillus and bifidobacterium blends. Some people will react to Saccharomyces boulardii and some people will react to soil based probiotics. Rarely will people react to all three and please clinicians, with all due respect, do not hide behind the “I see a sensitive population” guise. We see some very sensitive individuals but that is rare and it is exceedingly rare that someone cannot tolerate at least one of those three.

DrMR:

So remember for probiotics, you do not need to use a special histamine free probiotic. Now I’m open to the occasional, maybe someone somewhere, some of the time notices they do better, but I’m much more inclined to believe that this is more a coincidence. Let’s say someone reacted to one probiotic. They went out and they bought a low histamine probiotic, and they did not react to that. I’m much more inclined to think that’s just coincidence or placebo or the low histamine probiotic was the categorical type that that person would not react to. I’m not dogmatic on this, but I also like to call out when there is such a infantile, criminally, low probability that it should be considered coincidental rather than something that’s actually factual. So that is a one area of updates. There’s further research on probiotics for IBS and a fairly large trial of 330 patients. This was a double blind randomized control trial. Oh, by the way, let me just slip this in here really quick and I’ll do a follow up. This is important. There was a 60 minutes documentary where I believe her name was Patricia Hibbard, who is a professor of medicine at some fairly large university. She was asked point blank, is there any evidence that probiotics help with IBS? Her answer was no. Unfortunately, a very ill informed opinion there, especially when looking at this gold standard, fairly large RCT not to mention, we’ve also discussed the handfuls of meta-analyses concluding the same thing. So one somewhat large 330 patients trial with probiotics and IBS finding a significant reduction in abdominal pain and distension in IBS patients and also a normalization, consistency and improvement in quality of life when compared to placebo.

DrMR:

Ok, on to H. pylori. A review published in 2020 determined that probiotics are a useful compliment to traditional treatments for H. pylori and not only do the probiotics improve the efficacy of the antibiotics to eradicate H. pylori, but they also reduce the antibiotic associated side effects for those who don’t do well with dairy. Good news, a systematic review found that probiotics improve lactose tolerance. And remember a systematic review is usually a summary of the available clinical trials. Meta analyses are limited to clinical trials in terms of what they summarize systematic reviews aren’t limited to only clinical trials, but they usually focus on clinical trials. Then they may also add in some other lower quality data like open label studies or observational studies. Another systematic review of 12 studies for reflux found that 79% of studies reported positive outcomes for GERD. When treated with probiotics, this included reduced regurgitation, improvements and reflux, heartburn, indigestion, nausea, and gas related symptoms like burping. Well, what if you think you have SIBO and that’s the cause of your reflux, please remember that the data here are pretty clear that probiotics help with SIBO. I’m shifting gears for just a second to constipation, I guess not really shifting because we’re still in the GI camp, no matter what gear we’re in here, but two recent and very high quality studies looked to summarize what, in this case was 17 randomized control trials with over 1400 patients and concluded that probiotics significantly increased stool frequency compared with placebo. The other, a meta analysis of 15 randomized control trials showed that probiotics increased the stool frequency and reduced gut transit. Again, significantly. Also the research found that a multi-strain probiotic was more effective than a single strain probiotic for improving constipation and the associated bloating.

DrMR:

This ties into something that I believe I’ve mentioned, but we’ve also added this article. Not only is a multi-strain probiotic better in constipation, but also for IBS. This has been found, we will link it as well, one systematic review and also one meta analysis. This is, in part, the basis for these 3 for BALANCE protocol, for which I advocate, which calls for using a lacto bifido blend plus a Saccharomyces boulardii plus a soil-based probiotic because there you’re going to have, let’s say 12 plus one plus three, right? So now, depending on the formula, you’re going to get roughly anywhere from 10, maybe even up to 16, 17, 18 species in a probiotic. This is a continuation of what the research has already found, which is a single strain is simply not as good as a multi-strain. Why is this? Well it’s likely because the more diverse the presentation is to the gut, the more likelihood you’ll see that there will be an ability to achieve a balancing effect. That’s likely why FMT seems to work even better in some cases then probiotics, because there’s far more bacteria in an FMT. Disclaimer, please do not go out and do an FMT willingly. There are definitely patients who do FMT for IBS and they’re not helped. And I think that’s because some people put the cart before the horse. The point I’m trying to make here is both in the constipation research and the IBSs research. There is a conclusion amongst the highest level of science, meta-analyses that multi-strain mixtures are better than single. This is also the reason why I’ve commented that probiotics should not be looked at like drugs. Meaning this one strain or species does this one thing. I think it’s coming from a good place, trying to be as scientific and discerning as we can, but it also reflects, in my opinion, a misread of the larger body of science, which is this trend. If you’re looking at this and your hypothesis is well, what’s the best species or the best strain for constipation, that’s what you end up looking for. But you miss the more obvious, bigger picture, clinically informative, algorithm simplifying observation, which is there’s not a special species or strain that dictates a best result. This is really what a honest review of the literature will find in the comprehensive probiotic guide. There’s a whole section that outlines this. One of the studies specifically for constipation looked at two different formulas and found that they both had equal effect. So it’s really challenging to substantiate one species or strain is best for one condition. And I’ll arm you with this bit of analysis. When you hear someone making the argument that it has to be a certain species or strain apply this filter to their argument, because what you are most likely going to be confronted with is a bunch of factoids and details that admittedly probably sound impressive.

DrMR:

Wow, this person knows a lot about XYZ, and there’s going to be likely a discussion of certain toll-like receptor proteins that are triggered or certain peptides that are released. Then what you’re going to get though, when you zoom out and cut through to the bottom line, you’re going to get a lot about mechanism and you’re not going to get a citation of the clinical outcome data. This is the most common ploy that is used to obfuscate from the truth or more likely someone honestly believes X, Y, or Z. They’re just ill-informed. But remember, if someone makes a compelling argument with lower level science, that is not a compelling argument. It may sound compelling. If someone says all these terms, you’ve never heard before, but that doesn’t really matter until we’ve filtered that through the higher level of scientific data, which is we take a group of people, we give them probiotic A with constipation, we then give them probiotic B with constipation. Does one have a better impact? I’ve heard some of the arguments trying to defend the position of a certain strain or species, what you almost always get is this zooming into the minutia and the minutia makes it sound like these probiotics or this strain or species are best, but there’s never any tying that into A and this has been demonstrated to be true, right? It’s all a compelling argument that requires a huge inference, right? If, let’s say, if we know that in constipated patients, there is a suppression of PYY peptide in the gut and we know that bifidobacterium infantis 01576 is more, or the most strongly prone to dock with or stimulate this receptor. This is why this probiotic is the best for constipation. That sounds really compelling except I just made most of that up. Okay. The point I’m making is the details sound compelling. It’s almost like you’re a kid going back to college. And the professor saying stuff that you don’t understand. So that makes you feel like the professor, what they’re talking about. There’s a difference between having tid bits of information and being disciplined to ensure that what’s you’re citing is from the highest level of evidence. The reason why that’s so important is because better evidence equals more likely that that evidence is truthful, factual, and going to be what you experienced as a consumer or as a clinician. So making an argument, even if it sounds very complicated and very compelling from observational or mechanism, science is a much less accurate argument than going to the clinical trials for the summaries of the clinical trial.

DrMR:

Sorry to beat that drum here for awhile, but that is a filter that you can apply to conversations you get or hear anywhere. And I’ll tell you that this is one of the most common tactics. Again, it is used to mislead people or just allow one person to make whatever kind of argument they want. It’s citing all the mechanism details and not being disciplined enough to subject your ideas to the harsh and sometimes cruel filter of what happens in a randomized control trial, and be very careful for the people who say that, “well there’s flaws in randomized controlled trials” or that criticize science or say there’s not enough data. Those oftentimes are also dodges, not trying to be overly pessimistic here or denigrating, but I just see so many people get misled because of the very compelling sounding argument derived from mechanisms.

Sponsored Resources:

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, 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.

DrMR:

So as we’ve gone through a argument crafted from the highest quality evidence, we’ll move on to a few other interesting studies. Probiotic consumption decreases the incidents of respiratory tract infections in children. Another study also found that probiotics helped in preventing recurrent urinary tract infections in women, and that probiotics are safe and beneficial for treatment of vaginal infection, as well as another study, finding that probiotics decreased oral pathogens that cause cavities, gingivitis, and periodontal disease. There’s been a few more trials finding that probiotics can improve mood in those suffering with major depressive disorder. It also dampens the negative effects that stress has on mood in adults, there are four trials on that finding and even one interesting study finding that men with mild insomnia found a beneficial impact on sleep when taking probiotics. I want to just slip in here, because sometimes when I’m going to these updates, I feel like a probiotic heretic touting that probiotics can help everything. I don’t think that it’s really the probiotics per se. I think it’s the fact that the probiotics have a novel and beneficial impact on the gut. And it’s really the gut that’s demonstrating this multi-system broad ability to affect sleep and mood. We’ll go over some research here about skin in a moment. It’s important that I clarify that because that helps make sure that we’re staying as close to the philosophical bedrock here as possible, which is a therapeutic that improves gut health is going to have likely a multitude of benefits for the individual. It’s not so much the therapy now in this case, what’s nice about probiotics is they are natural and they’re kind of working within the confines of the system and trying to coax it back to more of a normative equilibrium. It’s not a drug cooked up in a lab, although I have no problem with the drug, as long as it displays safety. This is just a nice therapy that has a long history of use. We seem to have evolved with a evolutionary need for some pressure from these microbes on our guts.

DrMR:

Okay. So we talked about histamine. One study that’s pretty exciting found that those with non-celiac gluten sensitivity, who went on a gluten free diet plus probiotics,had a greater level of symptomatic benefit than patients who just went on a gluten free diet. Remember that what happens in some of these cases, and it actually ties into the next similar study, celiac patients who are already on a gluten free diet, but who still had symptoms were found to experience symptomatic improvement from probiotics. So whether it’s non-celiac gluten sensitivity or full-blown celiac, there seems to be some dysbiosis that’s created in the wake of the inflammation that ensues from that gluten reactivity.

DrMR:

This is where probiotics are a beautiful therapy that can help with that dysbiosis. There were two clinical trials that found clinical improvements when probiotic supplements were used to treat dermatitis or just inflammation of the skin. So tying in the skin as i mentioned a moment ago,. What have probiotics fallen flat regarding? Well, there was a systematic review on probiotics for otitis media and that review concluded there’s no benefit for otitis media by using probiotics. So it’s also important that I disclose when the evidence doesn’t support something. It just so happens that most of the evidence finds benefit, although let’s all be careful not to overstate the effect size of that benefit, which is why I have kind of chided probiotics for weight loss as they are really pretty, pretty ineffective for weight loss. So same thing with otitis media in here, no benefit was demonstrated. For weight loss benefit has been demonstrated, but the benefit is so numerically small that it’s not really clinically significant. Continuing on. Regarding whether or not probiotics are a bad idea if you’re immunocompromised, I’ve always followed what the evidence here has showed. Although intuitively I said, knowing all of the benefits, especially for an immune related disorders that probiotics have been shown to convey, it seems odd that probiotics would not be a good idea for those who are immunocompromised, but, you know, I’m always wanting to check my bias and report to you what the evidence shows. I was pleased to see an analysis of 57 clinical studies that looked at probiotic administration in immune compromised adults and found that they were safe. This was across multiple strains, dosages and durations, and that there were no major safety concerns and that there was an overall reduction of averse events that occurred in the immunocompromised patients receiving probiotics when compared to controls.

DrMR:

So to me that was pretty encouraging to see an analysis of 57 clinical studies finding benefit, take this on a case by case basis because a lot of conditions can fall underneath the rubric of immunocompromised, but just something there to consider. And then finally, for mom and infant health, another review, which included data from 4,300 pregnant women. This found that prenatal probiotics resulted in lower death rates and lower rates of necrotizing enterocolitis, essentially an intestinal infection and a lack of circulation to intestinal tissue among babies. So the moms who took probiotics in this study in addition to that also had longer meaning more fuller term pregnancies. So as more and more data comes in, this is why I have a really hard time. Again, alluding to that 60 Minutes television piece that really missed the mark and misrepresented the science regarding probiotics.

DrMR:

Again, you can look to our full article on this, but just looking at all these studies makes me even more disheartened with the argument that was framed so poorly. There are multiple benefits. Benefits for mom, for offspring, no benefit for otitis media and not really much for obesity and overweight, but helpful for skin, gluten intolerance, histamine, sleep , mood, non-digestive infections, constipation, reflux, lactose intolerance, H. pylori infection and IBS. So this is one of the reasons why I harp on the importance of probiotics. Also one of the reasons why I am so happy that we now have other doctors, who I’ve trained, who are operating in this model because it is alarming how many patients come in and they have not adequately explored the therapy of probiotics, and that can lead to a big jump for some people. It’s not uncommon to see us make a couple tweaks to someone’s diet and then we’d get them on the right probiotic protocol. And they would see a 70 to 80% resolution in their symptoms after having had suffered for years. I know that sounds like a powerful statement to make, consider many of the stool tests, as we’ve discussed, are inaccurate. What you’ll often see on a stool test that purports your commensal or healthy bacterial populations in the gut, instead, is that populations are low. Not only is this inaccurate, meaning there’s no good data showing that those values correlate with IBS, IBD or what have you. There is a dysbiosis index that tells you that there’s an imbalance, but it doesn’t tell you necessarily, at least to my understanding, what specific probiotic species or strains are low.

DrMR:

So you have these tests that are built upon a fallacious foundation. This leads clinician XYZ, to tell someone to eat more fruits and vegetables in your diet, which oftentimes isn’t a bad recommendation, but for someone with progressed GI issues, it definitely can be a bad idea. Plus go on a probiotic plus only take the probiotic species or strains that your lab work shows to be low. So now you’ve made the wrong dietary choice cause the dietary choice was made upon erroneous lab. You had them go on a prebiotic because you still think that diversity is a byproduct of feeding gut bacteria. And you totally missed the fact that a wallowing of diversity is usually a indicator that there is inflammation in the gut and disease in the host, and it’s not something that needs to be directly treated. Then finally you put them on a prebiotic, but because you’re trying to force those lab values, which are incorrect and inaccurate upwards, not understanding that in this somewhat compromised host the likelihood that the prebiotic is going to flare them.

DrMR:

It’s actually going to kick up what the body is compensating for by keeping the commensals lower, thus reducing the amount of immune reactivity against them and you flare the individual. And so this is how we’ll see people. Who’ve gone to a few doctors and done lots of lab testing and said, well, yeah, I’ve tried probiotics. Nothing’s worked for my gut. Well, you know, when you wrap it into the rest of that story, that’s why someone may think probiotics don’t help them. Uh, you know, let me soften this a little bit by saying I, or we, or the clinic don’t have all the answers, but it is fairly remarkable. How, when you just look at these things objectively and you don’t fall into the false thinking or the humoristic that follows from looking at mechanism and not filtering appropriately, like we’ve talked about with the clinical outcome data, the results that you can get for people. So a lot there in that podcast. Gosh 52 minutes goes by really quick. I guess I’d be a bad dinner date cause I would just talk the whole time!. But I wanted to share some updates on what’s happened with the clinic now located in Austin as our wait to be seen as a new patient is very short. So if you’re someone in need of help, I invite you to come in and remember that the doctors in the clinic had been trained by me, we’re all operating the same model. So it will be all in the same family of thought, thinking research, cost effectiveness, all those things that I harp on. I had a bumpy road over the past few weeks. I learned a lot about how important your gut health is in this case oral health. And if you need some “non-doctor” guidance we have a health coach here who works to help people go through the various products or the various protocols from the book or on the website. And then finally a bunch of updates on probiotics and a little bit of a further elaboration as to why having multiple species in your probiotic is preferential over to one. So I hope that helped. I felt kind of good to catch up with you guys. One-to-one. I hope you’re enjoying the podcast, keep the feedback coming and the reviews on iTunes. They’ve been going up and up. So thank you guys so much for doing that. It helps us reach more people and procure the biggest names in the field. Thanks for letting me bend your ear here and share some of this stuff. I hope you learned and took away a few insights for how to navigate your own health, how to navigate health claims, and then if you need help, we have a growing body of resources over here to offer you. Okay, we’ll talk to you next time. Thanks guys.

Outro:

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