Do Probiotics Help Children’s Respiratory Infections?

Episode Intro:

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Dr. Michael Ruscio, DC:

Hi everyone. Welcome back to another episode of Dr. Ruscio, DC Radio. This is Dr. Ruscio, DC. Today, let’s go into another round of updates on probiotics and what the research is saying. Before we jump into that specifically, a reminder about the levels of scientific evidence – As I’m sure you know, but is always worth repeating, not all science is equal in its level of rigor and quality. What we will go through here are mostly either clinical trials and/or summaries of clinical trials, meta-analyses and/or systematic reviews. These are the two main formats for which one would see a summary of clinical trials. And that’s important because (as one of the studies that we’ll touch on here illustrates) a clinical trial found good evidence for hives, which are histamine mediated, and benefit from supplementing with probiotics. You will sometimes hear people say, “Well, don’t you need a special histamine-free or low-histamine probiotic?”

DrMR, DC:

This is based upon mechanism and mechanism data is part of the scientific process. It is science, but it is less compelling/less important science than would be a clinical trial. And this is one of the techniques you can use to help parse some of the disparities you may see online where different thought leaders in the space may have different opinions. The person who has the best quality of science will have recommendations that are most likely to help you. So, just a brief reminder on that.

DrMR, DC:

What we’ve done here, of course, in the podcast on probiotic updates is really filtered to only that highest quality science. Thankfully, with probiotic research, there is so much science that we have the luxury of being able to filter to only the highest quality type of science; to deliver that to you so you can make the most informed healthcare decisions possible. Let’s go into a number of study updates.

First Study: Probiotics, Synbiotics, and Antioxidant Capacities

DrMR, DC:

The first study examined the effect of probiotics and/or synbiotics (probiotics combined with prebiotics), compared them to placebo, and examined the impact on biomarkers of oxidative stress. This was a systematic review and meta-analysis of randomized control trials. 31 trials with a total of about 1600 patients. Interestingly, they found that probiotics and/or synbiotics resulted in increased total antioxidant capacity and increased glutathione. Now, what I don’t know here is the magnitude of the effect, but I just wanted to share this study to impress upon you the multi-fold benefits that probiotics can have in improvement on antioxidant capacity.

Second Study: Bifidobacterium animalis & Infant Colic

DrMR, DC:

The next study looked at the effect of Bifidobacterium animalis combined with a lactobacillus species probiotic on infantile colic. This was a randomized, double-blinded, placebo-controlled study that looked at 192 neonates with colic who received either probiotic or placebo. After three weeks on placebo or probiotic, only the probiotic group showed a noticeable reduction in crying/fussing, better sleep, and (no surprise here) better quality of life for the parents. I think it’s important to echo this, especially if you’re a parent and your child is a neonate. You may be concerned and rightfully so, as a small child could appear fragile. Well, good news there. This is an intervention that can be quite health promoting for that child.

Third Study: Lactobacillus Reuteri & Infant Colic

DrMR, DC:

The next study looked at the evidence for Lactobacillus reuteri to reduce colic in breastfed babies. This was a systematic review and meta-analysis looking at 10 randomized control trials of 477 infants with colic. And – no surprise – probiotics led to a significant reduction in crying.

DrMR, DC:

One of the things I’m hoping you’re taking away from this is that the first study looked at a different probiotic and colic. And then another study here (in both meta-analyses) looked at a specific species of probiotic and they both found an improvement in the same measure, which was infant colic. It’s important to flag that so people understand and don’t get pulled into thinking you have to have a special formula for colic or for kids. Parents, especially, may be a bit concerned with what to give a child. And yes, we do want to make sure we’re using probiotics that have been studied, but there is this appropriate balance. And I fear some of the field has drifted into this “you must have this specific strain…” even past the level of species going down to strain.

DrMR, DC:

I’ve mentioned this in the past and this is one of the projects we’re working on, but at some point will be at the top of the large list that we have. It’s my sense that most (not all, but most) of what you see in here regarding the strain specificity importance, you can trace back to market influence from the pharmaceutical house that makes the strain. We want to use science to inform probiotics and make sure we’re using ones that are safe and effective. However, when we go as far as going down to strain specificity, I think we make this harder than it has to be. We likely reduce outcomes, we reduce cost, and this is likely partially due to a market influence from the big companies that have done larger trials with a specific strain. They make it, they patented it, and now they’re trying to push that science out there. I don’t think enough people are reading in between those lines. Like I said before, my confidence level on this at current is 70%. We have not finished the fact-checking yet, but just want to echo that. If we find something after we get through the fact-check completely, then I will amend my opinion. But as of right now, everything we have looked at has pointed to that direction that there is not this strain specificity.

Dr. Ruscio’s, DC Resources:

Hi. This is Erin Ryan from the Dr. Ruscio, DC 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. So 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, DC himself. There is nothing in this product that he wouldn’t put in 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: drruscio.com. There’s customer reviews, research, and scientific evidence all about Elemental Heal.

Fourth Study: Probiotics & Necrotizing Enterocolitis

DrMR, DC:

Another study – ‘The effect of daily probiotics on the incidence and severity of necrotizing enterocolitis in infants with very low birth weight.’ This was a retrospective study that essentially found those who received probiotics had similar rates of necrotizing enterocolitis and similar rates of mortality in hospital stays, but the benefit for probiotics was a reduced infection rate. Not every measure here improved, but there was a nice signal of reduced infection rate.

Fifth Study: Chronic Urticaria & Dietary Strategies

DrMR, DC:

As I alluded to at the open, another study looked at dietary strategies for chronic, spontaneous urticaria (or hives.) This was an evidence-based review and they were looking at non-pharmacological and dietary interventions for urticaria. They found Grade A evidence (as opposed to Grade B or Grade C) so the best evidence was for an elimination diet. This was not from testing. This was just an elimination diet based upon the foods we know are common triggers (probably with a degree of personalization), vitamin D supplementation, DAO supplementation, and probiotics.

DrMR, DC:

Again, I want to flag with the probiotic piece that we are not talking about special, low-histamine, or no-histamine probiotics. We’re talking about standard probiotics, meaning things that have a lot of research documenting their benefit as we’ve already gone through a number of. We can see, in this case, Grade A evidence that probiotics can improve this histamine mediated condition because probiotics are net antihistamine.

DrMR, DC:

Now, this doesn’t mean that someone may not react to a probiotic. Reactions are somewhat rare, but this is why our formulas are broken down into the blend of lactobacillus and bifidobacterium as one type, saccharomyces boulardii as another, and soil-based as a third. If someone is sensitive and display a history of reactivity, they can start on one formula independently, give that a few days, and then add in the second and the third. If they have a reaction to a one, they can just maintain the two that are tolerable. And if they react well to all three, then I would make life easier and use the Triple Therapy Probiotic Powder Sticks we’ve recently released. That takes three capsules of the lactobacillus/bifidobacterium combined with two capsules of the saccharomyces boulardii and two capsules of the soil-based and puts this into a single serving stick. It makes it much easier to use probiotic triple therapy.

Sixth Study: Viable & Non-Viable Probiotics on Dermatitis

DrMR, DC:

The next study here asked if there is a difference between live probiotics or dead probiotics, essentially. Or organisms that have been heat-killed in treating atopic dermatitis in children and adolescents. Said loosely, atopic dermatitis is skin irritation and pimples. They looked at 90 kids with atopic dermatitis. They were given either placebo, heat-killed (or dead) probiotics, or live probiotics. And after 12 weeks of supplementation, both the live probiotics and the dead probiotics group had improved symptoms.

DrMR, DC:

I discussed this in Healthy Gut, Healthy You. There seems to be benefit from both live and dead probiotics. Why is that? I don’t know that this has been fully determined, but one of the underlying reasons why could be because even if a probiotic is dead, the probiotic itself helps to tune the immune system. The dead body can stimulate these receptors in the lining of the gut that are surveying the contents of the food that’s in the tube that is your intestine.

DrMR, DC:

A couple of these receptors would be a Pattern Recognition Receptor (PRR) looking for the pattern on the surface of the probiotic or a Toll-like receptor (TLR). What’s likely happening here is that the probiotics don’t necessarily need to colonize. And we’ve talked about the shifting perspective on this, but the general consensus is still that most probiotics don’t seem to colonize you — although some do and to some extent. But irrespective if colonization is achieved, the dead probiotics can still trigger these Pattern Recognition and Toll-like receptors — these receptors in the gut — that likely help to calibrate the immune system and reduce inflammation and reactivity. This is important to keep in mind for practical purposes. If you’re concerned you left your probiotics out on the counter (by the way, we’ve transitioned our entire line to not require refrigeration) and you had a probiotic that required refrigeration, it’s probably not that big of a deal if it’s been out in the heat. Keep that in mind. People oftentimes will be concerned if a probiotic was shipped to them, it was left on their front steps, and it was in the sun for two days. This really does not seem to be something you need to be worried about. There’s more evidence of that here with this study.

Seventh Study: The Gut Microbiota & Depressive Symptoms

DrMR, DC:

The next study looked at the effect of interventions targeting the gut microbiota on depressive symptoms. And this was a systematic review and meta-analysis of 62 studies – probiotics, prebiotics, and also a combination of them (synbiotics). There was evidence for probiotics, for prebiotics, and/or for synbiotics all having a significant benefit for depressive symptoms. Interestingly, Fecal Microbiota Transplantation (FMT) had no effect. It’s important to keep that in mind. This, of course, supports the gut-brain connection.

Eighth Study: Probiotics & Respiratory Viral Infections

DrMR, DC:

The next study was a meta-analysis looking at probiotics and prebiotics against respiratory viral infections. In the human trials that were examined, probiotics reduced symptom scores and infection rate. And we’ve discussed this in the past, but it’s just important to echo this once again.

Ninth Study: Probiotics & Vitamin C

DrMR, DC:

In a similar vein, a study looked at probiotics with vitamin C for the prevention of upper respiratory tract symptoms in children from age three to 10. What they found was that after six months of supplementation with a probiotic + vitamin C, as compared to placebo, the treatment group (probiotic + vitamin C) had less coughing, less severe upper respiratory tract infections, less missed days of school, and less use of antibiotics. A great finding here. Again, give your kids probiotics and/or have them eat probiotic rich foods. Best yet, probably have them do both. Also note – there was less.

DrMR, DC:

I just want to flag here that it doesn’t mean there will be no coughing, no upper respiratory tract symptoms, no missed days of school, or never an infection that requires antibiotics, but there will be less of them. And this is important because if I’m being totally honest, there have been times when I’ve been taking probiotics… well, I’m always taking probiotics… and I feel a cold coming on and I’ll double up or triple up on my probiotics. However, there have been times where I’ve still gotten sick and I’ve heard that voice in my head saying “damnit, these probiotics didn’t do anything.” That’s where the other side of your brain toggles over and says that’s actually not fair for me to say. I know that the evidence shows a reduction of incidence, duration, and severity, so recalibrate your expectation. It’d be great if probiotics took you down to zero, but that’s not practical. However, it can reduce the severity.

Tenth Study: Probiotic Safety & IBS Remission

DrMR, DC:

In the next study, the effectiveness and safety of probiotics in the induction and maintenance of remission in inflammatory bowel disease was assessed. This was a meta-analysis. It looked at 20 randomized control trials in 777 IBS patients. Probiotics were found to induce remission in active ulcerative colitis, but had no effect on maintaining remission in ulcerative colitis or Crohn’s disease.

Eleventh Study: Probiotic Safety & Psoriasis

DrMR, DC:

The next study looked at the effectiveness and safety of probiotic supplementation for psoriasis. This was a systematic review and meta-analysis of randomized control trials. And in the three randomized control trials that were looked at with a total of 164 patients, two studies found that probiotics reduced psoriasis severity. One study found that probiotics lowered levels of inflammation. Although not complete, there’s some evidence here finding that probiotics can reduce some severity markers of psoriasis.

Twelfth Study: Probiotics & Myocardial Infarction

DrMR, DC:

In the next study here, probiotic supplements were examined in relation to the ability to impact cardiac remodeling following myocardial infarction. This was a single-center, double-blinded, clinical study. In this study, they looked at 44 patients with myocardial infarction who underwent a percutaneous coronary intervention. They were randomized to either probiotic or placebo. A myocardial infarction is another way of just saying heart attack.

DrMR, DC:

After three months, they found the probiotic group had reduced markers of cardiac remodeling and greater improvements in echocardiogram findings. Essentially, they found that the probiotics improved heart recovery after a heart attack, so also quite interesting. To zoom this out for a moment and paint the perspective of how we’re using probiotics at the clinic — In sharing what is being published, I want to be careful not to portray that I/we at the clinic are probiotic zealots.

DrMR, DC:

It’s incredibly important to clarify this model that we use. We’re now terming this ‘The Diet, Lifestyle, and Gut Health Foundations Model.’ On the podcast, we’ve discussed the inverted tree representation of that model. If you picture in your mind a tree — flip it upside down and the trunk of that tree is something we work down. We then come to the branches as second phase. The trunk is the diet, lifestyle, and gut health foundations. As we work through this, and we personalize diet, lifestyle, and gut health therapeutics, we then see what symptoms remain. And that’s how we determine what second level branches we then pursue because we need to see what symptoms will respond to something like a low FODMAP diet and probiotic triple therapy. And as you’re seeing here, there are a number of things that may be positively impacted. As we work down the trunk and personalize these items, there are many symptoms that go away. There are some that persist. And it’s this weeding out that really helps us determine what to do next and when to take out of the toolkit something not everyone needs, but can be helpful in select cases.

DrMR, DC:

I don’t think anyone could argue that no one should undergo diet, lifestyle, and gut-supportive measures, but you could argue that not everyone needs female hormone support… not everyone needs a more niche gut support like hydrochloric acid… not everyone needs pelvic floor therapy… So, as we see all these conditions and syndromes and beneficial impacts probiotics can have, this is why it’s one of the core facets of our model as represented by the trunk.

DrMR, DC:

However, let’s say someone’s not responding. We don’t now go to a more exotic probiotic… or some type of experimental test to further convince us of why we need more/different probiotics… or tell the patient they just need to wait and give this time… It’s all very important to clarify that we’re using these tools effectively, but there’s also a certain cadence we want to hit with a patient.

DrMR, DC:

Typically, we will check in roughly on 30 day intervals, and we really obsess over how someone is doing. We’re looking for a certain cadence of symptomatic resolution to be achieved; for patterns in that cadence to help us to determine how we enhance and modify. If we do go to a second level or a branch item, what of those branches do we go to? Now we’ve reduced symptomatic noise and only a couple branches are likely left, and now we can be precise and pursue those.

DrMR, DC:

In any case, there are a few updates on probiotics. Really exciting stuff in terms of this growing body of literature supporting how helpful this simple intervention can be. And then a few closing thoughts in terms of how we’re taking all this and using it to integrate into our clinical model so that we can help people get as healthy as possible, as quickly as possible. I hope you find this helpful and I will talk to everyone next time. Thanks guys. Bye-bye.

Outro:

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• The effects of probiotic/synbiotic supplementation compared to placebo on biomarkers of oxidative stress in adults: a systematic review and meta-analysis of randomized controlled trials
  • 31 trials, 1,681 participants
  • Probiotics/synbiotics resulted in:
    • Increased total antioxidant capacity
    • Increased glutathione
  • Commentary: Probiotics can exert antioxidant effects. 
• Efficacy of Bifidobacterium animalis subsp. lactis, BB-12 ® on infant colic – a randomised, double-blinded, placebo-controlled study
  • 192 neonates w/ infant colic, randomized to probiotic or placebo
  • After 3 weeks of supplementation, the probiotic group had:
    • Greater reduction of crying/fussing
    • More sleep
    • Better quality of life for parents
  • Commentary: Probiotics can help alleviate infant colic. 

 

• Evidence of Lactobacillus reuteri to reduce colic in breastfed babies: Systematic review and meta-analysis
  • 10 RCTs, 477 infants w/ colic
  • Probiotics led to significant reduction in crying

 

• The effect of daily probiotics on the incidence and severity of necrotizing enterocolitis in infants with very low birth weight
  • Retrospective study of 665 infants w/ very low birth weight
  • Those who received probiotics had:
    • Similar rates of necrotizing enterocolitis
    • Similar rates of mortality and hospital stay
    • Reduced infection rate (27% vs 34%)
  • Commentary: Probiotics may reduce overall infection rates despite the null difference in necrotizing enterocolitis rates.

 

• Dietary strategies for chronic spontaneous urticaria: an evidence-based review
  • Review of nonpharmacologic strategies for chronic spontaneous urticaria
  • Grade A recommendations:
    • Elimination diet
    • Vitamin D
    • DAO supplementation
    • Probiotics 
  • Grade B recommendation:
    • Low-histamine diet
  • Grade C recommendation:
    • Gluten elimination

 

• Oral Administration of Live and Dead Cells of Lactobacillus sakei proBio65 Alleviated Atopic Dermatitis in Children and Adolescents: a Randomized, Double-Blind, and Placebo-Controlled Study
  • 90 kids w/ atopic dermatitis, randomized to:
    • Placebo
    • Non-viable/dead probiotics
    • Viable/live probiotics
  • After 12 weeks of supplementation, both live AND dead probiotics had improved symptoms
  • Commentary: Both live and dead probiotics can exert beneficial effects. 

 

• The effect of interventions targeting gut microbiota on depressive symptoms: a systematic review and meta-analysis
  • 62 studies
  • Probiotics, prebiotics, and synbiotics had significant benefit for depressive symptoms 
  • NO effect of FMT
  • Commentary: Another data point for the gut-brain connection. 

 

• A meta-analysis reveals the effectiveness of probiotics and prebiotics against respiratory viral infection
  • Pre-clinical studies: Probiotics reduced mortality rate (HR 0.7)
  • Human clinical studies: Probiotics reduced symptom scores and infection rate (RR 0.8)
  • Commentary: Probiotics may have favorable effects against respiratory viral infections.

 

• Probiotics with vitamin C for the prevention of upper respiratory tract symptoms in children aged 3-10 years: randomised controlled trial
  • 171 kids (ages 3-10 yo) randomized to probiotic + Vit C (50 mg) or placebo
  • After 6 months of supplementation, the probiotic + Vit C group had:
    • Less coughing
    • Less severe upper respiratory tract symptoms
    • Less missed days of school
    • Less use of antibiotics
  • Commentary: Probiotics + Vit C may have beneficial effects on upper respiratory tract health in kids. 

 

• Efficacy and safety of probiotics in the induction and maintenance of inflammatory bowel disease remission: a systematic review and meta-analysis
  • 20 RCTs, 777 IBD patients
  • Probiotics can induce remission in active UC
  • But had no effect on maintaining UC or CD remission

 

• The Effectiveness and Safety of Probiotic Supplements for Psoriasis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Preclinical Trials
  • 3 RCTs, 164 participants
  • 2 studies: probiotics reduced psoriasis severity
  • 1 study: probiotics lowered levels of inflammation
  • Commentary: Probiotics can improve psoriasis.

 

• Probiotics Supplementation on Cardiac Remodeling Following Myocardial Infarction: a Single-Center Double-Blind Clinical Study
  • 44 patients with myocardial infarction who underwent percutaneous coronary intervention 
  • Randomized to probiotic or placebo
  • After 3 months, the probiotic group had:
    • Reduced markers of cardiac remodeling
    • Greater improvements in echocardiogram findings
  • Commentary: Probiotics may have beneficial effects on cardiac remodeling, suggesting a gut-heart connection.

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