There has never been a better time to focus on maintaining and improving your immune health.
Hi everyone. Welcome to Dr. Ruscio Radio. Today we will be discussing upper respiratory tract infections, what benefit may be held by probiotics and also how probiotics impact common cold and influenza for obvious reasons (people being worried about Coronavirus and COVID19). Let me lead by saying that we know that there is currently no known cure for COVID19 and I want to be very careful to try to represent the information that we’ll discuss today as carefully as possible and not fall into a category of natural medicine enthusiasts who are making claims that are not supported given the state of the current kind of viral pandemic and associated scare. That being said, I have known for a while and we’ve discussed maybe a couple of years ago now, one interesting preliminary study that grabbed my attention wherein influenza virus vaccinations were found to be more effective when co-administered with probiotics.
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In This Episode
Episode Intro … 00:00:40
Impact of social distancing recommendations … 00:
A look at the evidence … 00:
Benefits of probiotics … 00:
Other items that show antiviral activity … 00:
Supporting your immune system … 00:
Reframing and reprioritizing … 00:
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Knowing everything that we know and that we’ve discussed about probiotics for other types of infections. I was curious to give the research a closer look to see if probiotics are something to consider as part of a preventative plan for a viral infection or associated, viral respiratory or even secondary bacterial issues in the lungs. Which is one of the things that make COVID19 problematic because of the acute respiratory syndrome that it induces. So again, wanting to be very careful to delineate that none of these things that we will discuss are known to be cures. Obviously they have not been studied with Coronavirus or COVID19. However, if we can look to things that can help keep an individual as healthy as possible, look at what has been published for proximal issues like influenza and also for upper respiratory tract infections, then we can at least give people a, “here’s something to consider.”
Impact of social distancing recommendations
Please do not misconstrue this as you are now bulletproof. You should, continue of course to follow the social distancing recommendations, keep abreast of the news and what is being recommended at both the state and federal level because things here are changing quickly. And as I’m sure many of you now have heard, it does not appear to be that most people are in overt harm from COVID19. However, there are at risk populations, of course, the elderly and those with pre-existing conditions like any type of diabetes, high blood pressure, pre-existing respiratory conditions, those over the age of 60-65, and definitely those over the age of 80. For those who are younger and in good health, the risk seems to be minimal and even the broad death rate I most recently heard in an address was that 0.7%. Again, these things are changing every couple of days, so take it with a grain of salt.
But from everything that I’ve been able to put together, and I am by no means an expert here, however, I have been keeping my ear to the ground. The main reason for these, maybe disconcerning recommendations of social distancing, and avoiding travel and such, are not because we’re all in overt danger. But rather because, the dangerous issue would be if this ran through the population very quickly and overwhelmed the medical system and there were not enough hospital beds, respirators, IVs to care for the people who were more immuno-compromised or at risk and someone who would otherwise be able to be helped died because of a lack of availability of medical intervention. That’s the main reason. Again, it doesn’t mean that unfortunately as some young people feel they have nothing to lose, are potentially disregarding the social distancing recommendations. And that’s very foolish because it’s not them that are at risk. It is the elderly people they will eventually come into contact with or how they vector the virus through the population.
A look at the evidence
So anyway, with all that being said, let’s look at the evidence regarding probiotics and what kind of utility they may or may not have here. Approaching this evidence as objectively as I can, but it is pretty straightforward. To lead with the summary and kind of give you the bottom line. Multiple reviews have found that probiotics are more effective than placebo in reducing the duration of upper respiratory tract infection and/or preventing them to begin with, and the amount of antibiotics needed to treat those. These are usually as found in the model of common cold, so there are some vagaries here. We’re not always able to get a highly definitive diagnosis. I think we’re still in the realm of proximity where hopefully there is some overlay between multiple types of viral cold flu illnesses that also upper respiratory tract infections.
Now, what type of probiotics have been used. Mainly lactobacillus and bifidobacterium predominated blends. So our category one type of probiotic. There may be benefit from other types of probiotics; Saccharomyces boulardii, soil-based. With the lactobacillus and bifidobacterium blends being the most popular and most commonly used, it’s more likely a derivative of the fact that those are the most studied. I haven’t seen one study looking at the other two categorical types of probiotics. So it’s not to say there are studies with those disproving they have any benefit rather again likely because the lacto bifido blends are so popular, those are what have been studied.
Benefits of probiotics
The dosage form has varied; sometimes in foods like fermented milk, sometimes dose via capsules, sometimes dose via pounders have all been used. Unsurprisingly there is not universal agreement in the data. There are some studies showing no benefit, but there is a clear trend of beneficial effect from probiotics. So going into some specifics, there is a Cochrane database systematic review. Reminder that the Cochrane database reviews really set a very high bar for filtering out bias. This Cochrane database systematic review was entitled “Probiotics for preventing acute upper respiratory tract infections.” Probiotics were found to be better than placebo in reducing the number of participants experiencing episodes of acute upper respiratory tract infections. The mean duration of an episode and the amount of antibiotics that were used in this kind of cold/flu related way. So their conclusion, “This indicates that probiotics may be more beneficial than placebo for preventing acute URTIs. However, the quality of the evidence was low or very low.”
So something there to keep in mind. Moving on to an additional review. This is a systematic review with meta-analysis from the British Journal of Nutrition entitled “Effectiveness of probiotics on the duration of illness in healthy children and adults who develop common acute respiratory infectious conditions: a systematic review and meta-analysis.” In this study they looked at evidence from a number of high quality randomized control trials and they found that the duration of illness of common acute respiratory infections in otherwise healthy children and adults was reduced. Additionally, 10 of these studies were conducted in adults of which two were conducted in elderly. So this finding does seem to permeate all age groups. Again, corroboration of the findings here. I’ll just read one line to quote, “This systematic review provides evidence from a number of good-quality RCT that probiotics reduce the duration of illness (common acute respiratory infectious) in otherwise healthy children and adults.” So again, important to remember that these things will not necessarily prevent you from having any illness, but they will reduce either the severity and/or the length of time or the duration.
Then one more review paper here, “Prevention and Treatment of Influenza, Influenza-Like Illness, and Common Cold by Herbal, Complementary, and Natural Therapies” published in the Journal of Evidence-based Complementary and Alternative Medicine. “Probiotics were found better than placebo in reducing the number of episodes of acute upper respiratory tract infections, the rate of episodes of acute upper respiratory tract infection and reducing antibiotic use.” So pretty uniform in the findings.
And I did want to go over just one randomized control trial that I found to be interesting. “Bifidobacterium bifidum R0071 results in a greater proportion of healthy days and a lower percentage of academically stressed students reporting a day of cold/flu: a randomised, double-blind, placebo-controlled study.” And essentially to kind of paraphrase their findings here, “The proportion of participants reporting a cold on any given day was lower […] in the B. bifidum and B. infantis than with placebo for the average level of stress and the most commonly reported number of hours of sleep.” So what they did there was they tried to control for stress and sleep. Obviously this is a great setup because increased stress and sleep deprivation could certainly confound the results. So by kind of stratifying the participants into tiers of sleep and of stress and looking at the effect of the intervention versus the control amongst those groups, we have a more apple to apple comparison. Leading them to conclude, “Daily intake of bifidobacteria provides benefit related to cold/flu outcomes during acute stress.”
And then one final study here I wanted to touch on, and this is definitely more of an inference, but I found it interesting. “The influence of prebiotic or probiotic supplementation on antibody titers after influenza vaccination: a systematic review and meta-analysis of randomized controlled trials.” This was published just in 2018 in the Journal of Drug Design, Development and Therapy. Essentially they found a better immune system response to influenza vaccination, (so very important to make that clarification) when subjects were using probiotics. Leading them to thus conclude, “Concomitant prebiotics or probiotics supplementation with influenza vaccination may hold great promise for improving vaccine efficacy. However, high heterogeneity was observed and further studies are warranted.” So that is a summary of the impact of probiotics.
Other items that show antiviral activity
Now, are there other items that show antiviral activity? Certainly vitamin C has been studied, zinc, echinacea. I have not gone through these yet. This is actually something I’ve had on my list for a while. And given these events, we might actually pick this up. One of the things I’d actually like to do is review the evidence on common natural immune boosters for cold/flu and actually create a custom formula based upon the items that have the best evidence for them. One of the things that I’ve been kind of shocked regarding is I’ll get an email ping every few weeks from a various supplement company, which I appreciate. However, I usually hand over the email to our research assistant and ask her to give me a summary of the evidence for the various items in the given immune formula. And you will oftentimes see that one or two ingredients has some evidence and then the others either have evidence showing no effect or have no evidence at all, which is kind of the big deal.
If there is evidence showing that a certain compound has no appreciable impact beyond comparing it to placebo, then why we would put that in a formula is hard for me to understand. So that’s something that I think we’ll be doing. This is a process that requires months of work, so please don’t ask us, you know, is it available next week? If we had this out by July, that would be us moving quickly. It’s just more so for your own edification and just something I want to mention in passing here.
Supporting your immune system
But one thing that certainly I would consider during this time of stress and this time in which we want to keep our immune system is in top working order would be to use a good probiotic protocol so as to reap some of these benefits. But again, please remember that none of these things are meant to represent a magical cure for Coronavirus or COVID19.
These are things that we can do to help support your immune system and keep you as healthy as possible and hopefully prevent the infection should you acquire it from becoming more severe or more prolonged. And also help protect against and reduce upper respiratory tract infections and or the need for associated antibiotics for those.
So be safe, continue to monitor the recommendations, take the recommendation seriously. I know a social distancing is a pain, however, we’re trying to flatten the curve of how quickly this moves through the population so as not to overwhelm the medical system. We will attempt to keep the podcast humming along here. So you’ve got something to do and to listen to during these times. And not a bad time actually, this is something I was thinking about as well. There are certain things that I’ve wanted to do as one example in case this provides anyone ideas.
Reframing and reprioritizing
My gym membership is now on pause obviously because the gyms here are closed, which at first was kind of a punch in the stomach. However, something that I’ve wanted to do is some type of dance class. And this was a good reminder for me that I could reframe this as, “Well, perhaps this is now life just handing me an opportunity. You wanted to learn a dance class and or do some of these dance workouts just to get your body and your brain moving and operating in a different way.” This is now a great chance to do that. There’s a few books I’ve been wanting to read now. A good chance to do that. And also following up with family, friends, and making a little more time for conversations, even if only via the phone, could be a good opportunity here.
So I think if we reframe this and look at the opportunities to do things that we haven’t been doing because we’ve been busy, it can make this feel like less of a deprivation and more of a, “I’m going to keep humming along with my life doing a lot of great things and I’m just going to reprioritize based upon the current environment.” Almost like there was a snow storm and you had to spend some time traveling less and being in more. What could you do with that time. That was helpful for me in reframing this, hopefully it’s helpful for you. Hopefully this information about probiotics helps you feel a bit protected or at least help you feel more confident that your immune system is getting everything it needs to run at optimal. Okay. That is it on this update and I will talk to you guys next time.
Links and Resources
- Latest Updates on COVID19
- Cochrane Database Syst Rev. 2015 Feb 3;(2):CD006895. doi: 10.1002/14651858.CD006895.pub3.
- Br J Nutr. 2014 Jul 14;112(1):41-54. doi: 10.1017/S0007114514000075. Epub 2014 Apr 29.
- J Evid Based Complementary Altern Med. 2017 Jan;22(1):166-174. Epub 2016 Apr 6.
- Br J Nutr. 2015 Feb 14;113(3):426-34. doi: 10.1017/S0007114514003997. Epub 2015 Jan 21.
- Drug Des Devel Ther. 2018; 12: 217–230.
- Functional Medicine Formulations Probiotics