Do Probiotics Work For Kids With IBS?

Episode Intro :

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Dr. Michael Ruscio :

Hey everyone. Welcome back to Dr. Ruscio Radio. This is Dr. Ruscio. Let’s jump in on more research updates regarding probiotics. Lots and lots of research is being published on probiotics and hopefully you are finding it as interesting as I am. We are keeping abreast of what’s being published and using that to fine tune our approach regarding probiotics. I just better appreciate how multifaceted the beneficial impacts from probiotic supplementation can be.

1st Study: IBS & Probiotics in Children

DrMR:

The first study: ‘Efficacy of probiotic adjuvant therapy for irritable bowel syndrome in children: A systematic review and meta-analysis.’ This looked at nine randomized control trials of children with IBS. Probiotics significantly reduced abdominal pain and improved GI symptom scores. This is a high quality data point showing how important probiotics are for children. I always want to try to flag this for parents so that they don’t make the mistake of thinking you need a special probiotic for kids, per se, or that you need to be cautious with giving children probiotics. In fact, I think the most cautious thing one perhaps could do is use probiotics in children because they have a myriad of benefits.

2nd Study: Atopic Dermatitis & Probiotics

DrMR:

The next study: ‘Efficacy of a probiotic supplement in patients with atopic dermatitis: a randomized, double-blind, placebo-controlled clinical trial.’ 80 patients with mild to severe atopic dermatitis were randomized to either a placebo or a probiotic. And after 60 days, the probiotic group had improved skin smoothness and decreased atopic dermatitis scores. As the old saying in naturopathic medicine goes, the skin is often a reflection of the gut. And here we’re seeing one of the most foundational gut therapies – probiotics – improve the skin through that gut-skin connection.

3rd Study: Acute Gastroenteritis & Probiotics in Children

DrMR:

The next study here: ‘Use of a probiotic mixture containing Bifidobacterium animalis subsp. lactis BB-12 and Enterococcus faecium L3 as prophylaxis to reduce the incidence of acute gastroenteritis and upper respiratory tract infections in children.’ 203 healthy children were randomized to probiotics or no treatment at all. The probiotic group had reduced acute gastroenteritis (food poisoning is another way of saying that.) The group that took the probiotics saw a reduction in the incidence and a 45% reduction in the duration. So, food poisoning was notably decreased. There were also reduced upper respiratory tract infections – an 84% reduction in the incidence and a 50% reduction in the duration. What this is saying is your kids will have less food poisoning and get less colds (or respiratory tract infections) if they use a probiotic. It’s important to mention that the incidence of things doesn’t go down to zero. So, if you’re giving your kids probiotics and they get food poisoning or they get an upper respiratory tract infection, you shouldn’t say, “Oh, the probiotics didn’t work.”

DrMR:

Here we’re seeing about a 50% reduction in the duration when they do occur. It’s less likely they will occur, but also the duration will be cut in half (at least according to this study they’ll be reduced by 50%.) I think that’s important to keep in mind. Sometimes when you have a cold and you’re maybe four days into a cold and you’re not feeling that great, you’ll think, “I don’t think these probiotics are doing anything.” That’s the emotion — not feeling well… frustrated that you’re not feeling well. It’s important to toggle over and say, “Okay. What does the science tell us? Good reminder. I’m not expecting to never have a problem. I’m acknowledging the fact that even though I’m not feeling well in this moment, I am most likely going to be experiencing a shorter duration of this ill feeling due to this support that I’m using.”

4th Study: Athletic Performance & Probiotics

DrMR:

Another study: ‘Impact of Probiotics on the Performance of Endurance Athletes: A Systematic Review.’ This examined nine studies. Three studies reported improvements of sports performance. Six studies reported improvements in oxidative stress, increased immune system function, and decreased upper respiratory tract infections. Endurance athletes — especially if they’re really pushing hard — can have increased IBS symptoms and also increased cold and flu (or upper respiratory tract) infections. We know that low FODMAP can be helpful for athletes and endurance athletes who are having IBS-like symptoms and here we’re seeing some evidence that probiotics can help reduce the upper respiratory tract infections.

Dr Ruscio Resources:

Hi. This is Erin Ryan from the Dr. Ruscio team. We get lots of questions about Elemental Heal – our gut supporting meal replacement shake. So, I thought it would be helpful to answer a couple of those questions now. Let’s talk about the investment. Some people wonder – Is it worth the cost? What if it doesn’t agree with me? What then? Well, there’s a lot of different ways to think about it. In terms of offsetting costs, you’re using this shake as a meal replacement so you’re not paying for food while you’re using it as a meal replacement. That helps with the cost. It could also offset future costs for ongoing therapies. So if Elemental Heal is really helping you and you only need to use it in combination with one or two other therapies, you’re offsetting costs of more doctor’s appointments, more testing, and so on. In terms of the sourcing, every ingredient is impeccably sourced by Dr. Ruscio himself. There is nothing in this product that he wouldn’t put into his own body. In terms of the taste, it tastes great! I love the chocolate, but there’s also peach and vanilla. We also have a money back guarantee in case you order too much or if it doesn’t agree with you. Just let us know and we’ll help you out. There’s a lot more info on the website @ www.drruscio.com. There are customer reviews, research, and scientific evidence all about Elemental Heal. You can save 15% off Elemental Heal when you use code: GETEH. Visit drruscio.com and use code GETEH.

5th Study: IBS & Strain-Specific Probiotics

DrMR:

For this next study, there’s much more to unpack. I’m going to touch on it briefly here. It’s entitled: ‘Strain-specific and outcome-specific efficacy of probiotics for the treatment of irritable bowel syndrome: A systematic review and meta-analysis.’ This looked at 32 randomized control trials, and they found efficacy for a few different probiotics. They go all the way down to the specific strain designation. Bacillus coagulans is one of the species in our soil-based formula, but this one is the species designation: MTCC 5260. There is also evidence for Lactobacillus plantarum strain designation: 299v. There is evidence for Saccharomyces boulardii strain designation: CNCM I-745 and also for Saccharomyces cerevisiae: CNCM 1-3856. They also found some efficacy for global IBS outcomes. And there were some positive findings for single ingredient probiotics (single strain/single species formulas. )

DrMR:

And there was also some efficacy found for multi-species (or multi-strain) formulas. I hesitate with how much I want to go into this here until I’ve had a chance to fully collect my thoughts and all the supporting evidence. But one of the challenges is this budding strain specificity that some advocate for regarding probiotics. I think this is well intentioned. However, to give you one of the points here that I’ll be developing in a future podcast, video and/or paper that we’re going to submit for journal publication — What I don’t think enough people realize is that major pharmaceutical companies own the strains that have the most research because they have the most funding. And I still have to do some additional fact checking, but my hypothesis here is that a lot of the perceived need to use a specific strain is actually due to market forces.

DrMR:

And I think there’s been enough parroting of this to where it’s now being accepted as truth. I’ve come to believe this because if you look at some of these formulas (this is one of the exercises I went through when reviewing this paper), you can trace back each specific strain to a major pharmaceutical house. I’m not implying there’s malevolent monkey business going on behind the scenes, but I think it’s rather just a simple market force. If you’re Abbott (just as an arbitrary example) and you own the plantarum 299v, it behooves you to promote that; to have that written into the abstract and to have that be the message that clinicians and researchers are parroting because you own that strain. There’s not really any incentive to do anything other than proclaim the strain that you own to be the best strain.

DrMR:

However, when I juxtapose that (and I’ve mentioned this in the podcast before) with one of the data tables we put together for probiotics that have been used for IBS, we took a few of the most well studied formulas. We put them in a side-by-side comparison table. And what you see is that for a given species — let’s just say lactobacillus plantarum — different formulas use different strains. Abbott has one strain… Salix has another… And so what you see is the different pharmaceutical houses have different strains that they own. And you look at that in juxtaposition with the fact that both of these different strains produce beneficial results. My interpretation is that we should be careful not to let market influences trickle down and confine the thinking of clinicians that we need to use an uber specific strain because as you watch the body of probiotic evidence grow, you see new strains being created and research being published.

DrMR:

And what do you know? A new finding showcases this difference strain also has benefit. This is similar in keeping with the other philosophical remark that I’ve made. There’s a much less tenable thinking on this now, but there was a formula that was best for constipation – as just one example. The outcomes for probiotics are formula specific. And I’ve been saying this for years, and now there’s really ample evidence to support this (and even clinical trials that do direct head-to-head comparisons) that different formulas can benefit constipation. Different formulas can benefit SIBO. These different formulas have different species and they have different strains. So, it’s very hard for me to wrap my head around how we can be making the proclamation that we need to have highly specific strains that get beneficial outcomes.

DrMR:

Now, that being said, should we skew in the direction of using strains that have been published — or the ones that have been most highly publicized? Yes. However, if there are some restrictions or limitations that pharmaceutical houses are putting out there to prevent other smaller companies from using their strains, then that’s where this no longer becomes in the best interest of patients. If we’re being evidence limited and it stifles the ability to use or create new formulas/new combinations (and there’s not really good evidence to suggest that), then that actually is antithetical to the evolution of probiotic formulas and to the betterment of clinical care. It’s putting unnecessary restrictions in the way. Now, quality assurance measures are important. And you do want to make sure you know what you’re getting, and that there aren’t probiotics being used that don’t have any research to support them.

DrMR:

But when we get down to the level of strain specificity, my suspicion is that’s beyond the level of detail that has relevance. And there is an optimum level of resolution. I apologize if this is an overly trite analogy, but if you’re trying to navigate from one state to another, a magnifying glass level of focus is the wrong frame. It’s the wrong lens. To achieve a certain outcome, you need to have the right lens of analysis. My argument is strain specificity is too zoomed in of a lens. And that resolution actually is antithetical to navigating to the clinical outcome of patient betterment. But this is currently a project that’s in process. I’ve shared with you some of my thoughts, some of the evidence. I’d say we’re 70% of the way through all of those fact checks and data minings that are needed. Expect a comprehensive (probably) video on this in the future because of the visual overlays where you can see a side-by-side comparison. There were actually eight different formulas for IBS that were Lactobacillus bifidobacterium blends. And you see these strains differ wildly between formulas. They’re owned by different pharmaceutical companies and they all show benefit. Maybe what we’re seeing with a lot of the hubbub regarding strain specificity is market influence. There may be some need to be strain-specific with certain species. I leave that open. I think that may have its most relevance with the bacillus strains, although I’m still not sure if it permeates all the way down to the strain and it may just be relevant at the level of the species.

DrMR:

A rough parallel analogy could be — We know that dogs increase happiness. It doesn’t matter if you have a Labrador or a Cocker Spaniel or a Pit bull. So, it’s akin to saying, “Well, if you have depression, you need to get a Maltese and if you have diarrhea, you need to get a Labradoodle because there was one study on the Maltese for depression and there was one study on diarrhea with Maltipoos.” I think that’s where we’ve gotten, but I don’t think people have enough frames of reference to translate from this uber niche nomenclature of strain specificity, and look at that in parallel to an analogy like the specific breeds of dogs to reveal how silly and how overly zoomed in that may be. Again, 70% the way they’re fact checking these claims to make sure they are keeping with a solid and supportive scientific argument, but as of right now, that’s how I’m thinking through that.

6th Study: Urinary Tract Infections & Probiotic Use in Children

DrMR:

Okay. Sorry for that long tangent there. The next study: ‘Non-antibiotic interventions for prevention of urinary tract infections in children: a systematic review and meta-analysis of randomized controlled trials.’ 16 randomized control trials, 1400 individuals, and the finding that probiotic therapy was more effective in reducing UTI (urinary tract infection) recurrence, and lowering antibiotic resistance, when compared to placebo. On our last updates podcast, I believe we covered that in adults, probiotics were not preventative for UTIs. This is showing they can be preventative for UTIs in children. So, still some disparities in the findings here. I’m not drilling too deeply into UTIs. It’s not something we see a lot of in the clinic. And my perspective has been treat the individual and UTIs generally seem to take care of themselves.

DrMR:

That would include the diet, lifestyle, gut health foundations model that tends to get you very far. It includes probiotics amongst other things. There are some select cases where a female hormone imbalance may be needed to be addressed to further improve UTIs. Recently moreso on my radar screen, there may be some cases that have a sensation that feels like a UTI, but this could actually be nerve impingement due to pelvic floor dysfunction. And this is where we’re getting progressively astute at knowing when and where to make a good pelvic floor therapy referral.

7th Study: Micronutrient Status & Probiotics

DrMR:

Next study: ‘Probiotic Supplementation and Micronutrient Status in Healthy Subjects: A Systematic Review of Clinical Trials.’ 14 studies. The finding was that the intake of probiotics in healthy subjects was associated with the beneficial impact on certain micronutrient levels — namely vitamin B12, calcium, folate, iron, and zinc.

DrMR:

At the clinic, this is part of the reason why we address gut health before attempting to optimize micronutrient levels. And with a recent research review we performed on micronutrient testing, that even further supported the de-emphasis on direct concern with micronutrient assessment. The testing there for the majority of markers was very ambiguous. There are some keystone symptoms – symptoms combined with historical findings that may flag for someone to do an empiric trial on a vitamin. That seems to be the best approach and we’re using that in tandem with the diet, lifestyle, and gut health foundations model first and this analysis second. This is with the exception of a few nutrients like vitamin D (although it’s really a hormone) or iron that have demonstrated testing is accurate and can lead to interventions that improve the health of the host and that also correlates with rectification of the insufficiency on the lab value.

8th Study: Saccharomyces Boulardii & C. Diff Infections

DrMR:

The next study: ‘The Effect of Saccharomyces boulardii Primary Prevention on Risk of Hospital-onset Clostridioides difficile (C. Diff) Infection in Hospitalized Patients Administered Antibiotics Frequently Associated With C. difficile Infection.’ Essentially — Can Saccharomyces boulardii prevent people from getting C. Diff when they go to the hospital and they take antibiotics? They found there was a fairly notable reduction in how often patients came down with C. diff if they were given a probiotic. So, 0.56% of those who were given S. boulardii obtained a C. diff infection, whereas 0.82% obtained a C. diff infection if they were just given the antibiotics. So, a reduction from 0.82 down to 0.56 for those who are going to the hospital and taking antibiotics who were given S. boulardii. That’s a really important point to make. And to echo one of the challenges I’ve pointed to on the podcast — When a patient says that they’re taking probiotics and asks if they should stop, the surgeon/the attending will reflexively say, “Yes. Stop taking them.”

DrMR:

I want to leave the door open for staying in my lane and not speaking too far out of turn regarding hospital care and the nuances of what could be happening in the hospital, but I also want to juxtapose that with data such as this; that could reduce the likelihood of someone coming down with an infection. I think the best way to navigate this is to have a follow-up with your provider and say, “Do you know of any evidence showing I will be harmed by taking a probiotic?” And if they say no, then you can say, “I’ve heard some evidence that probiotics can help with post-operative outcomes and a reduction of post-operative infections. So, unless you know of any evidence suggesting I shouldn’t take it, I’d like to be clear that perhaps you’re reverting to caution, but you don’t have any data that suggests I should not do this (or something to that effect.)” Don’t be combative, but you just want to clarify: Is your opinion here based upon a data point or points ? Or is this more that you’re not really sure and you’re reverting to this cautious negative?

9th Study: Fecal Microbiota Transplants & Probiotics

DrMR:

Next study: ‘Microbiota shaping – the effects of probiotics, prebiotics, and fecal microbiota transplant (FMT) on cognitive functions: A systematic review.’ 23 papers were examined and both probiotic supplementation and FMT (Fecal Microbiota Transplant) were found to improve cognition.

10th Study: Respiratory Tract Infections & Gut Microbiota

DrMR:

Next study: ‘Modulation of gut microbiota protects against viral respiratory tract infections: a systematic review of animal and clinical studies.’ 58 studies were examined. Nine were randomized control trials in humans. In those human studies, six of eight studies showed that probiotics were associated with reduced respiratory tract infections. And this was in about 700 individuals. Interestingly, the animal data found improved survival rates in 20 of 22 studies. I’m just referencing this because I’m assuming some of these studies infected animals with highly pathogenic viral pathogens to see who would live and who would not. And we can’t really do this in humans, but the interesting data point here (albeit in animal data) is that 20 of 22 studies found improved survival. So even more reason in cold & flu season to be considering a probiotic.

11th Study: Antibiotic Therapy & 3-Strain Lactobacillus

DrMR:

Next study: ‘Enhanced Clostridioides difficile Infection Prevention With a Pharmacy-Controlled Policy That Adds a 3-Strain Lactobacillus Probiotic Concomitantly to Antibiotic Therapy.’ This is a prospective study going back in time. This is looking at over 8,000 patients in the hospital with signs of possible C. diff infection who received antibiotics + either a probiotic or a placebo (effectively, no treatment.) The C. diff infection rate decreased by about half in those who took the probiotic – from 1.5% down to 0.9%. So, even more evidence here that if you are going to be in the hospital and taking an antibiotics, using probiotics can help. Remember the study before this with Saccharomyces Boulardii and we’re showing that a 3-Strain Lactobacillus mixture was helpful. And again, I should clarify here that they’re saying strain, but a better way of describing this is probably species. I haven’t checked this down to this detail, but about 95% of the time, this is how it plays out. There are actually three different species, but they just say strain. There could be Lactobacillus acidophilus, Lactobacillus plantarum, and Lactobacillus reuteri.

DrMR:

Those are three different species, but they’re saying they’re different strains. They do contain different strains, but really you’re describing a species level differentiation. I just point this out because this nomenclature of saying strain when really the differentiation is occurring at the species level, further leads to some of this mistaken thinking that it’s all about the strains. Like I said, I’m still fact checking some of this, but it’s the best read. I’m 70% of the way of really articulating the evidence underlying that argument. But in any case, these two different probiotics all led to the same outcome, so even more reason why I’m encouraging the field to get away from this species or strain dependent thinking — it makes the utilization of probiotics unnecessarily daunting.

Dr. Ruscio Resources:

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 and help them along their path. Health coaching support calls every other week. We also offer health coaching independent of the clinic, for those perhaps reading the book and/or looking for guidance with diet, supplementation, et cetera. 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.

12th Study: Chronic Diarrhea & Lactobacillus Plantarum

DrMR:

Final study here: ‘Lactobacillus plantarum CCFM1143 Alleviates Chronic Diarrhea via Inflammation Regulation and Gut Microbiota Modulation: A Double-Blind, Randomized, Placebo-Controlled Study.’ The species is Lactobacillus plantarum and the strain designation is CCFM1143. 55 patients with chronic diarrhea were randomized to a probiotic or placebo. And after four weeks, the probiotic group had improvements of symptoms. However, in this case they were not statistically significant. It’s really a null finding here, even though there was a trend. If they’re within significance, then it could have been mathematical chance. It’s really important to clarify that here.

DrMR:

That’s a number of updates in probiotics. I hope that is helpful to continue the appreciation for how helpful, safe, and multifaceted a probiotic can be. I’m also trying to steer us in a better direction where we’re not getting unnecessarily bogged down in these very specific strain dependent details and zooming out the correct lens of analysis so that we can see the forest that we’re trying to navigate and not get lost in the weeds.

DrMR:

And I am always more than willing to change my hypothesis on these things. However, given everything we’ve continually discussed on the podcast, I cannot really see where the highly meticulous narrative regarding how to use probiotics can be justified. I think it’s (as in most cases) probably well intentioned, but my suspicion is that perhaps those who are supporting that argument are at the incorrect lens of examination and they may not be going through the volume of studies that I am. I should really say ‘we’ are because now it’s truly a team of people working behind the scenes who are sifting through the probiotic literature. There are a number of studies that we filter out that just don’t have applicability. A – Going through the fire hose of published research studies is a part-time task in and of itself. B – Filtering for things that are relevant, as compared to those that are not relevant, is another part-time job. C – Someone who is looking at all this filtered information as it’s coming through to really interpret it on the meta-level (rather than the micro level) is how you come away with that “see the clinical forest – navigate to the solution” perspective and don’t get lost in the examining the tree in minute detail in the weeds. Interesting weeds though they are, they are not allowing you to navigate through the forest into the goal end point that you’re trying to get to. In any case, there are some ruminations on probiotics and I hope it’s helpful. I will talk to you guys next time.

Outro:

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• Efficacy of probiotic adjuvant therapy for irritable bowel syndrome in children: A systematic review and meta-analysis
  • 9 RCTs of children w/ IBS
  • Probiotics significantly reduced abdominal pain and improved GI symptom score
  • Commentary: High-quality study validating probiotics for IBS in kids.

• Efficacy of a probiotic supplement in patients with atopic dermatitis: a randomized, double-blind, placebo-controlled clinical trial
  • 80 patients w/ mild-severe atopic dermatitis, randomized to to placebo or probiotic
  • After 60 days, the probiotic group had:
    • Improved skin smoothness
    • Decreased atopic dermatitis symptom score

• Use of a probiotic mixture containing Bifidobacterium animalis subsp. lactis BB-12 and Enterococcus faecium L3 as prophylaxis to reduce the incidence of acute gastroenteritis and upper respiratory tract infections in children
  • 203 healthy children randomized to probiotic or no treatment
  • The probiotic group had:
    • Reduced acute gastroenteritis (82% reduction in incidence, 45% reduction in duration) 
    • Reduced upper respiratory tract infection (84% reduction in incidence, 50% reduction in duration) 
    • x3 increased salivary sIgA levels
  • Commentary: Probiotics can reduce both GI and respiratory tract infections by bolstering the immune system.

• Impact of Probiotics on the Performance of Endurance Athletes: A Systematic Review
  • 9 studies
  • 3 studies reported improvement of sports performance
  • 6 studies reported improvements in oxidative stress, increased immune system function, and decreased upper respiratory tract infection

• Strain-specific and outcome-specific efficacy of probiotics for the treatment of irritable bowel syndrome: A systematic review and meta-analysis
  • Aim: to identify if there is a strain-specific outcome bias of certain probiotics
  • 32 RCTs, 3,856 participants
  • Four probiotics demonstrated significant reduction in abdominal pain relief: 
    • B. coagulans MTCC5260 (RR= 4.9)
    • L. plantarum 299v (RR= 4.6)
    • S. boulardii CNCM I-745 (RR= 1.5) 
    • S. cerevisiae CNCM I-3856 (RR= 1.3)
  • Commentary: Some may argue that clinicians need to use strains only used in clinical trials for specific conditions. However, this type of thinking is missing the big picture. That is, we have hundreds (if not thousands) of papers suggesting that multiple probiotics species and strains can improve various digestive health complaints. If one is to try to match a specific strain of probiotic with the main health concern of the patient, they may make two mistakes:
    • 1) Make clinical care too theoretical, and thus, too complicated.
    • 2) Miss potential benefits of using an empirical trial of triple probiotic therapy given the many studies showing multi-strain/species probiotics may be better than single strain/species (see other FFMR+ research briefs). 
  • Remember, to be evidence-based but not evidence-limited.
    

• Non-antibiotic interventions for prevention of urinary tract infections in children: a systematic review and meta-analysis of randomized controlled trials
  • 16 RCTs, 1,426 participants
  • Probiotic therapy was more effective in reducing UTI recurrence (RR 0.52) and lowered antibiotic resistance when compared with placebo.
  • Commentary: This meta-analysis suggests that probiotics may be a useful strategy for those w/ recurrent UTIs and should be used alongside conventional antibiotics.

• Probiotic Supplementation and Micronutrient Status in Healthy Subjects: A Systematic Review of Clinical Trials
  • 14 studies
  • With high degree of heterogeneity, intake of probiotics in healthy subjects was associated with a beneficial impact on certain micronutrient levels (vitamin B12, calcium, folate, iron and zinc)
  • Commentary: Dr. Ruscio wanted to remind everyone, This is why we at the Ruscio Institute for Functional Medicine (the clinic) address gut health before attempting to optimize micronutrient levels.

• The Effect of Saccharomyces boulardii Primary Prevention on Risk of Hospital-onset Clostridioides difficile Infection in Hospitalized Patients Administered Antibiotics Frequently Associated With C. difficile Infection
  • Retrospective study of 8,763 patients administered at least 1 course of antibiotics in the hospital
  • Hospital acquired C. diff infection was:
    • 0.56% for those who were also given S boulardii 
    • 0.82% for those just given antibiotics
  • HR for antibiotic + S boulardii= 0.57
  • Commentary: This large study showed a protective effect of S boulardii reducing C. diff infection rates for at-risk patients. Most benefit was seen when S boulardii was given within 24 hours of antibiotics.

• Microbiota shaping – the effects of probiotics, prebiotics, and fecal microbiota transplant on cognitive functions: A systematic review
  • 23 papers
  • Both probiotic supplementation and FMT improved cognitive function

• Modulation of gut microbiota protects against viral respiratory tract infections: a systematic review of animal and clinical studies
  • 58 studies (9 randomized controlled trials; 49 animal studies)
  • Human studies
    • 6 of 8 studies, 726 patients showed that probiotics was associated w/ reduced respiratory tract infections
  • Animal studies
    • Beneficial effects against influenza virus infection by:
      • improving survival (20/22 studies)
      • lowering symptoms (21/21 studies) 
      • decreasing viral load (23/25 studies)
  • Commentary: This study suggests a beneficial effect of probiotic on respiratory tract infections.

• Enhanced Clostridioides difficile Infection Prevention With a Pharmacy-Controlled Policy That Adds a 3-Strain Lactobacillus Probiotic Concomitantly to Antibiotic Therapy
  • Prospective study, 8,266 in-hospital patients w/ signs of possible C. diff infection who received antibiotics plus either 3-strain Lactobacillus probiotic or no additional treatment
  • C. difficile infection rate decreased by about half in those who took the probiotics (0.9% vs 1.5%)

• Lactobacillus plantarum CCFM1143 Alleviates Chronic Diarrhea via Inflammation Regulation and Gut Microbiota Modulation: A Double-Blind, Randomized, Placebo-Controlled Study
  • 55 patients w/ chronic diarrhea randomized to lactobacillus probiotic or placebo
  • After 4 weeks, the probiotic group trended towards better improvement of symptoms but results were not statistically significant.

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• Dr. Ruscio’s Additional Resources