All About Probiotics with Founding Father of Probiotic Research, Professor Gregor Reid

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All About Probiotics with Founding Father of Probiotic Research, Professor Gregor Reid

Episode Intro

Dr. Michael Ruscio: Hey, everyone. Welcome to Dr. Ruscio Radio. This is Dr. Ruscio. And today, I am here with Dr. Gregor Reid, whom I met at the International Congress on Natural Medicine in Australia in mid-2017. And he is a very knowledgeable gentleman, researcher in the realm of probiotics. And so I thought he’d be a perfect person to have on the show.

And so, Gregor, thanks for taking the time out and being on the show.

Dr. Gregor Reid: Very nice to get the opportunity. And hopefully, your listeners will get something out of it.

DrMR: I think they will, because we have a lot of people who follow the show who are interested in gut health. And of course, when we’re talking about gut health, one of the first things that comes up is probiotics. And I know you’ve done quite a bit of work with probiotics.

And maybe that’s a good place for us to start, which is just telling our audience a little bit about your background, training, and what you’re involvement with probiotics is at current.

DrGR: So yeah, I guess I was one of the pioneers in the modern era at least, probably by chance because at the end of my Ph.D. I joined Dr. Andrew Bruce, who was urologist in Toronto. And at the time, he was interested in the Lactobacilli in the vagina as a potential mechanism to stop someone getting a urinary tract infection.

Anyway, in 1982 we started to work on this. And the long and the short of it, it was very difficult because people essentially laughed at us. But we stuck with it and felt like beneficial microbes had a role to play in health. And everyone else, it seemed, was studying the disease processes.

Anyway, we continued our work. And in 2001, I was asked to chair the World Health Organization United Nations panel on probiotics. And essentially, what happened is Argentina’s government said, “We hear of this term, but we don’t know what it means. Could you get someone or a panel together and come up with a definition?” So we did that.

And since then, that definition has pretty much stuck around the world. And we have continued to do research. And finally, people don’t laugh at us anymore.

And currently, we’ve got a number of different projects, some of which are looking at offsetting the environmental chemicals that we’re exposed to and using Lactobacilli particularly as a means of reducing their uptake. But we can get to that later on.

DrMR: Sure. Sure. Okay, so yeah, you’ve been involved with this from early on. And I guess, even when probiotics weren’t the cool thing to be researching, you were involved with them.

What is a Probiotic

And why don’t we talk about defining probiotics? And not to get too into the nomenclature, but I know you do draw some pretty clear distinctions, which I think will be helpful, maybe more so for clinicians when discussing what is a probiotic and what isn’t a probiotic. So why don’t why go into the definition that you’ve developed?

DrGR: Well, I don’t want to take the credit for developing it. So it was international experts. And since then, other experts have pretty much agreed with this.

DrMR: Gotcha.

DrGR: So it has to be live. And people talk about dead probiotics. And they don’t exist. That’s like saying a human being can be dead and alive at the same time. It’s either dead or alive. And probiotics have to be alive.

And it can be microorganisms. So it doesn’t need to be bacteria. It could be fungi, for example. As long as it confers a health benefit—and there are many, many different types of benefits—on the host.

So therefore, the host, in fact, could also be an animal or a fish—

DrMR: Or maybe even a helminth, like some of the worms that are being used.

DrGR: Yeah.

DrMR: Okay.

DrGR: Yeah. Well, no. A helminth in that case would be an organism that was being used to help a human. And then the question then becomes, “Could the helminth be called a probiotic?” I guess it could. No one has ever asked me that before. I guess it could if you defined it as a living organism that provided benefits. So I think it has potential to be that.

And the definition was purposely left general, because you have to remember people were talking about probiotics being consumed. But in fact, you could put them on your skin. You could put them in the vagina. You could just use them through your mouth. So they don’t necessarily need to be consumed.

Conferring a health benefit—well, how do you prove that? And so unfortunately, there are a lot of testimonials out there that—I think it’s wonderful that things help people. A testimonial doesn’t prove it. So you have to do an appropriate human study, in the case of humans. And that might be a randomized, placebo-controlled. Or it might be comparing with the standard treatment.

I go on the web. And I think people mean well. But there’s a lot of confusion still. So you get so-called experts who say, “How do you know which probiotic to take?” Well, they say the first thing you have to do is it has to be formulated by a doctor.

Well, to be honest, you have a Ph.D. or an M.D. Yes, you’ve got qualifications. But it doesn’t necessarily mean that you know how to formulate a probiotic.

And then they say it has to be multi-strain. Well, in fact, that’s not true either. It doesn’t have to be multi-strain. And unfortunately, lots of products on the market are multi-strain for really no reason except that somebody wants to put lots of strains in the product. So if you’ve got multiple strains, you have to prove that they’re in there for a specific purpose, that when you put them altogether they are better than just them being on their own. So one is better than two. Two is not as good as three. Three is not as good as four.

And then the other thing that comes up is they have to be in the billions. And maybe that’s a North American concept. Everything has to be big.

DrMR: Right?

DrGR: Well, no, it doesn’t. I think probably if you’re going to swallow it, you do need to have a billion, just because it’s going into your gut where there’s organisms.

But the ultimate test of anything is, does it provide a benefit? And if it provides a benefit with a billion, then so be it. It doesn’t need to be in 50 billion. It’s interesting how it came from nowhere. And then suddenly everyone becomes an expert. And they’re, in some cases, making things up through, perhaps, a misunderstanding.

DrMR: There’s no shortage of that, unfortunately from my perspective, which is why I appreciate your conservative, thoughtful, and evidence-based approach in this area.

Vaginal Probiotics

A few different directions I’d like to go—you mentioned vaginal probiotics. And I’ve seen some studies showing that oral consumption or oral dosing of probiotics confer benefit to UTIs and other vaginal dysbiosis, to put it loosely. I’ve also seen the suppository, the vaginal inserts. And I’m wondering, in your perspective—obviously, a woman’s not going to want to have to do a vaginal insert if she doesn’t have to unless it’s shown to be clearly beneficial over just taking a probiotic orally. Do you have thoughts in terms of what the best method of administration is?

DrGR: Yeah, it’s a good question. So when we started off doing this in the early 80s, the real intent was to develop a vaginal probiotic. That’s what we thought would be necessary. And the reason for that was that uropathogenics, or the E. coli that were causing the urinary tract infection, were coming from the rectum. And essentially, the short distance to the perineum and then the urethra and the bladder and the vagina is an anatomical thing. So it’s nothing to do with hygiene. It’s just that’s the way it is.

And so we thought if we populated that area with Lactobacilli, then we could prevent infection. I think there is merit to that. And I think if someone has recurrent, particularly vaginal infections or bacterial vaginosis, then I think there is merit to applying something vaginally.

We didn’t pursue it to that extent essentially because it costs so much money to develop a vaginal product because it’s seen by the FDA and other agencies as a drug. And so actually at the time, my wife said, “Well, if E. coli can get from the rectum to the vagina, why couldn’t Lactobacilli?” And so we decided to look at that.

And I think that for general maintenance, the oral route is okay. I think it is worth applying that. But I wouldn’t expect lots of the Lactobacilli to go from the rectum to the vagina. You’re asking a lot of that organism to make it all the way through the gut, multiplying, and then get in high numbers to the vagina.

However, in studies that we’ve done, we have shown that if you take them orally, it can still improve the health of the vagina. And a couple of the studies were particularly interesting. We gave the combination therapy of an antibiotic plus the probiotic. And the patients in two studies we did had a higher cure rate of bacterial vaginosis.

And we thought, “Well, when we look in the vagina, we’ll find that there are probiotics strains there in the millions. And so that’s the reason that they had a better cure rate.” But in fact, that wasn’t what happened. The patients’ own Lactobacilli came back more quickly. And in some ways, I think that’s a better outcome if the patients’ own Lactobacilli recover and if they’re able to then help defend that area against other harmful bacteria.

So I think you have to realize what you’re expecting. And if you’re expecting heavy colonization by Lactobacilli, then you would have to use a vaginal suppository. Having said that, I don’t know of too many products that have proven to be good vaginal suppositories. In fact, in the U.S. there’s only one strain that I’m aware of. And it has not been approved yet. It’s still in clinical studies. So that means that if there are products out there that are intravaginal probiotics, so called, then I would want to see the data proving that they have been tested and they work.

Co-Administration of Antibiotics with Probiotics

DrMR: A few things you said make a lot of sense to me. One that I think is most notable and it’s something that I’ve reiterated with regard to different gastrointestinal infections, which is the co-administration of antibiotics has clearly shown to enhance the effectiveness of drug therapy, antibiotic therapy, or anti-fungal therapy for fungus, antibiotic therapy for bacteria like H. pylori. And so sometimes I think a common misconception that you should not take a probiotic with an antibiotic because, “Well, won’t the antibiotic just kill the probiotic?”

And it seems there’s some synergy probably in part due to the antibacterial action of probiotics, but also of the ability for probiotics to help the resident commensal microbiota rebound more quickly after a perturbation from antibiotics.

DrGR: Yeah, I think it’s absolutely essential. If you’re taking antibiotics you should take probiotics. And it depends on the antibiotic. You’re quite right. If you’re taking penicillin, then that would probably kill Lactobacilli. And if that was the case, then you would take the probiotic two hours apart so that they’re not in the stomach at the same time.

But I think for sure, especially nowadays with Clostridium difficile infections being so rampant, you have to try to prevent antibiotic-associated diarrhea and essential taking over the intestine by a very nasty organism, Clostridium difficile. So I do think that we need to take probiotics with all antibiotic therapy.

As for other drugs, I think, yeah, you could well have a point. And people are now starting to publish papers on the interaction between the bacteria in our gut and the drugs that we take. And clearly in some people, drug uptake has been diminished because of the organisms in their intestines. In other cases, the organisms in the intestine are quite good at allowing the drug to be transferred. And that’s because of some mechanisms inside the gut.

So the more we do research on these interactions, I think the better we will be to align, for example, the right probiotic with the right drug that we’re taking. That’s going to be close to personalized medicine. We’re not there yet. But I think hopefully one day we will align the types of drugs we take with the organisms and as a probiotic supplement.

HRT Helped to Reduce Frequency of UTI

DrMR: Yeah, I agree. I hope we get there sooner rather than later, because it would be nice to have that very high level of precision when administering these different therapies.

Something else I wanted to ask you about, which is one study has found that HRT (hormone replacement therapy) for menopausal women actually helped to reduce the frequency of UTIs. And the believed mechanism was because it actually improved the vaginal microbiota.

And this makes sense, because we know that hormones, especially estrogen and progesterone, have an impact on vaginal pH and therefore the vaginal microflora. Any thoughts on this? Or have you come across anything similar to this in your research?

DrGR: Actually, we studied hormone replacement therapy quite a number of years ago. And our thinking was—or what everyone had informed us was that Lactobacilli disappear from the vagina after menopause because there’s no estrogen and there’s no glycogen. That’s not what we found. The Lactobacilli were still there. And they may be in reduced numbers, but they were still there.

I think that there’s one product in Europe, for example, that has a small dose of estrogen along with the Lactobacilli. And the thinking behind it is exactly what you said, that you stimulate that environment.

Now, people have been hesitant to take these hormone replacement therapies because of the link between some hormones and cancers. So the idea of a low dose applied locally to the vagina was trying to get around that fear. I’m not sure we know the true mechanism yet of estrogen and glycogen and Lactobacilli, etc., because some Lactobacilli can’t break down glycogen. And it requires amylase. And the host produces that. So it may be estrogen is having an effect on the amylase and then indirectly the Lactobacilli.

What I do know is that infections and dryness in the vagina are much more common in postmenopausal women. And so I think if probiotics can help them in some way, whether it’s again trying to compete with the organisms that cause the infection or whether possibly even helping with hydration or something else, then it’s certainly worth trying, because the alternatives, as you know—we’ve really not developed any new antimicrobials for about 40 years. The options for a woman are so limited. I think many of them are trying probiotics out of—not desperation, but certainly trying to find a solution when the pharmaceutical route isn’t really doing much for them.

Sponsored Resources

DrMR: Hey, guys. I just wanted to take a quick moment to thank the sponsors that helped make this podcast possible. Equip Foods and Perfect Keto are two companies that are owned and operated by Dr. Anthony Gustin, who was on the podcast before. And he discussed the great lengths he had to go through to ensure that his product line was clean and devoid of fillers, sweeteners, and especially excipients. And he has a line of protein powders, pre-workout powders, carb powders, medium-chain triglyceride powders, exogenous ketones, and a lot of cool products.

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So, I was very impressed with this line. I definitely recommend checking them out. Equip Foods and Perfect Keto, you’ll find all those powders and products there. I highly recommend them.

Prebiotics

DrMR: Now, to transition us out of the female hormones niche of vaginal dysbiosis, what are the other areas of your research or other areas of your research that you feel are the most developed, because I’d like to go in a few other directions? I know you’ve done a number of studies. So what would you say are maybe two or three of the areas that you have the research situated and we could dig into?

DrGR: Well, a couple of areas that interest me are still in the vaginal area. It would be looking at prebiotics. So that’s compounds that stimulate the growth of beneficial bacteria. And so I think we should be thinking of that, because if there are Lactobacilli there, for example—you gave the postmenopausal women as an example—if you had them have a nutrient that wasn’t utilized by the host but was utilized by Lactobacilli and it brought the numbers back up, then that could be beneficial. So that was one area we looked at.

Environmental Toxins

The other thing is there was a study done in Canada not that long ago that showed that pregnant women had high levels of mercury. And in fact, 15% of the women they studied in Canada had levels of mercury that were high enough to cause neurological developmental damage in the fetus.

And that got me thinking to the whole issue of heavy metals and pesticides and aflatoxins and other compounds that are in the environment, often through mining or the need to produce so many foods for the world. And it turns out that Lactobacilli, certainly that we have looked at, have properties that I think can diminish the uptake of these toxins.

And we did one study in Africa where we showed that fish that are essentially part of the daily diet of many, many people was almost caked in mercury from Lake Victoria. And we’ve done studies in Kenya looking at aflatoxin, which is produced by Aspergillus on maize. And it’s in peanuts. And the kids had levels that were not healthy at all. And that’s a compound that can cause liver cancer later on.

And now, we’ve been looking at pesticides. And of course, we’re in a society where there are vast amounts of pesticide used because we want to have blackberries all year round. When I was a kid in Scotland, I loved August because we could eat melons in August. And we certainly can do that because they’re grown in Scotland.

But the point was that there was seasonal eating. And now, there’s not seasonal eating. And I think the world has gone away from that. There’s been such a globalization of food that would increase amounts of chemicals that we’re using to create that food supply. And I definitely worry about that and think that you’re not going to stop those things from being produced, but maybe we can diminish the impact it has on the health of people. And so that’s formed quite a bit of our recent studies on probiotics.

Probiotics to Aid in Detoxification or Binding of Toxins

DrMR: It’s curious to wonder if part of the benefit that’s been shown in various conditions, because I’ve seen everything from neurological impact through skin improvements through of course gastrointestinal improvements from the administration of probiotics. And I think a lot of this is, yes, probably coming from the profound gut-to-other-system-of-the-body connection.

However, I wonder if part of the benefit is also coming from the ability of probiotics to aid with detoxification or binding of toxins. And there’s an old theory I remember from years and years and years ago in my training. And it was a little bit of an anecdotal, far field concept. But it always stuck in the back of my head, which was people who have high levels, I believe it was of Candida, may actually have high levels of Candida because Candida can bind mercury. And so the Candida overgrowth was actually an adaptation by the host. And I’ve never seen a lot that’s highly credible. There are maybe a few mechanism studies that hint at that.

But what you’re saying certainly gets me curious about that same line of thinking. So I’d love for you to expand upon that more in terms of how the probiotics may be helping and what specifically you’re seeing in some of your research.

DrGR: Well, I think one of the things, apart from binding to heavy metals and basically excreting them, I think that the gut membrane essentially keeps us alive. So if you can imagine, the intestinal tract has a lining of epithelial cells. And if it wasn’t for them we’d be dead because the organisms inside us could kill us. So therefore, I always give the example if you’re stabbed by a knife, yeah, you might die from blood loss. But you’re much more likely to die from sepsis because the organisms get into your blood supply.

So this barrier function is really important. And when it’s damaged or impaired, we tend to get sicker. And I just wonder if the probiotics are somehow—people have shown that it improves barrier function. But it’s always difficult to prove that in a human situation because we don’t yet have the technology to go right inside the small intestine in real time and look that those barrier function proteins.

Although, having said that, there was a really neat study done in the Netherlands by Willem de Vos. And he got some student volunteers. And essentially, they put down a tube into the stomach and then applied probiotics and then took little biopsies and looked at what the response of the host was. So those kinds of studies are really, really interesting.

So going back to the point about the gut barrier function, if the barrier is really good, maybe there’s less uptake of those chemicals. And that could be one mechanism. The other thing is inflammation. And inflammation impairing that gut barrier function means that some of the molecules can get into the bloodstream and, I think, can get to the brain and other sites.

And a recent study came out. I think there have been a couple now showing that probiotics can reduce depression. And the most recent one I think was in post-delivery of pregnant women. And we don’t really know the mechanism of this yet. But clearly, there’s something going on that’s linking the bacteria in our gut and I think the other sites, because they always say it’s the vagus nerve. Well, the vagus nerve is also linked to the urogenital tract. It’s linked to respiratory tract.

Probiotics and Postpartum Depression

DrMR: And you know something there, Gregor, that may be interesting? I’ve heard the theory put forward that women have transient leaky gut around the time of childbirth. And part of that may be to help further inoculate the child. And perhaps what’s happening with these postpartum probiotic administration helping with depression is the probiotics are helping to alleviate that leaky gut and therefore helping with the blood-brain barrier and therefore depression.

DrGR: Yeah, you’re right because the leaky gut might help the beneficial microbes get to the breast milk and then passed onto the baby.

I think we’re in the early days of understanding how it works. But I think that the clinical studies are starting to say, “You know what? There is something to this.” And it really reminds me of back in the 80s when people laughed at us. And they’re not laughing now because I think this is real. And it’s like we now have a completely new view of a human being.

And I tell the students we’re essentially skeleton, tissue, and microbes. And pretty much everything that we’ve done up to now, whether it’s surgical practice or administering drugs, has been geared around the skeleton and the tissues, except for when we’re treating an infectious disease. And clearly, you’re going after the microbes. We’ve never considered the important role of microbes in the overall health. Nor in the nutrients that we’re taking for the tissue and skeleton, we should also be thinking what they’re doing for the microbes.

So I think we’re at a new era. It’s not a blip—not, everyone will talk about the microbiome; then it will go away. I don’t think this is going away at all. When you then add the chemicals that are in our environment, we need to learn how we’re coping with them or not coping with them. As you say, trying to understand how those organisms in our gut and in our fermented foods and in probiotics are interacting with those chemicals.

Mimi Tang Peanut Allergy Study

DrMR: Now, to ask you a very admittedly specific question, there seem to be some people who are very sensitive to environment toxins. And there are different theories that part of this may be genes, or there’s something known as the dreaded gene trio in mold exposure, for example.

So I’m wondering. Are there are specific probiotic strains or mixtures that have been shown to be helpful for people with this new building syndrome or environmental hypersensitivity? Because for people with those conditions, I think they’re always looking for additional palliative measures. So if there anything specific there that you could recommend…

DrGR: To be honest, I didn’t know much about the building syndrome until the conference we were at. And I find it very fascinating. I know my wife gets one little sniff of mold, and she knows there’s mold there. And so there definitely is something to this. And when we’re adults, it becomes difficult to change things. And I was quite taken by the work of Mimi Tang in Australia, who showed that you could almost prevent peanut allergies by giving very low exposure to the peanuts in early life along with probiotics.

And one wonders if in adulthood there was some way that we could somehow look at the combination of probiotics and small amounts of the allergens over a period of time and see if we can help adults get over this sensitivity to mold and building syndrome, which is very debilitating for people who suffer from it.

So I think the answer is “no” right now. We haven’t anything that we can absolutely recommend. There are lights on the horizon based on work like Mimi is doing and others probably that says, “Yes, let’s pursue it and see what works.”

And I’m a great believer in finding out what works and what doesn’t, because even negative trials tell you that you’re going up the wrong line of thinking or you have the wrong probiotic or you theory isn’t right. So there should be no harm in trying different things.

Honey Bee Study and Pesticide Exposure

DrMR: And what about for mercury or for other organochlorines or similar type environmental contaminants? Are there any probiotics there that have been shown to be helpful?

DrGR: No, and this is a new field. And actually, it’s interesting. Our study has been focusing on the honey bee. And as you know, it’s responsible for pollination of about a third of the world’s food supply. So it’s hugely important.

And we looked at neonics, which are the pesticides that people have been saying are causing bee colony collapse. I think they are a problem. And I think they’re not the only thing that causes bee colony collapse. But they’re important.

So anyway, we’ve been doing work in a fly model, which is quite similar to a bee. And it turns out that the neonics were not killing the bees, per se. What they were doing was they were significantly affecting their immune response. And then the bees were dying from pathogenic bacteria that were either inside the bee already or came and infected them.

And I wonder, in fact, if that’s what happens in humans, too, that exposure to these chemicals is somehow affecting our immune response and making us more susceptible to other things. And in that case, if we could intervene with probiotics, it’s not the solution, but it might help us to fight off the adverse effects of these compounds.

Fecal Transplant

Maybe one day we’re going to realize that a probiotic is not enough. You need a complete fecal transplant. That’s very extreme. And I don’t think there’s a case to be made for that yet. But the interesting work with fecal transplant shows that if you take a whole community of bacteria en masse already working and living together and you put them into someone else, then it can take off and do a good job.

So that concept, I think we’re going to find is going to be useful in the future where people will design probiotic complexes based on what those organisms do in their function. And they might pick—for example, supposing they pick 12 strains. And they said, “Three of them we want to have detox functions. Three of them we want to improve gut barrier function. Three of them we want to somehow modulate immunity.” Then I think that has merit, because now it’s based on science rather than, “Well, I’d like to have a Lactobacillus rhamnosus in this product. And I’d like to have a Bifidobacterium bifidum in this product.” And so then they’re just picking any old strain.

The other thing that’s going to be tough, which is that when you look at the fecal transplants and you look at the artificial stool preparations that people are making—Emma Allen-Vercoe here in Canada designed a study three-strain fecal transplant. They tend not to be organisms that are in our food supply.

And that’s a problem for FDA and the regulators, because now you’re not taking a Lactobacillus and Bifidobacterium that have a long history of safe use. You’re starting to look at organisms. Akkermansia has been toted in Europe. And there might even be strains of Bacteroides, which we normally think of would be pathogenic, or Enterococcus, which we normally think of as pathogenic. Maybe one day we’ll need to have them in this mix. And that creates regulator issues that I don’t think the authorities are close to being ready to handle.

Recommendation for Vaginal Probiotics

DrMR: Good point. Good point. Coming back to the vaginal dysbiosis issue. Are there any specific strains or blends for a woman listening who is suffering from either UTIs or candidiasis or bacterial vaginosis that you have found to be, or the research has shown to be particularly helpful?

DrGR: Yeah, so obviously, I’m not an M.D. I can’t give clinical advice. But vulvovaginal candidiasis is not the loss of Lactobacilli, just so that people know. I don’t think we fully understand why they Candida takes over and is in such high numbers. And therefore, when you’re treating with Lactobacilli—I don’t think that should be the treatment on its own. But it’s surprising to me that when we did the two studies with an antifungal and probiotics, we got a better cure rate.

And I say surprising because you would’ve thought because a woman already had Lactobacilli there that weren’t doing much, that if you gave a different Lactobacilli, it wouldn’t work. But maybe they do work in a different way.

And we looked at the mechanisms of the strain Lactobacillus rhamnosus GR1. And it was a colleague in the States. And he showed that that particular organism can penetrate some Candida biofilms and essentially be quite antagonistic to the Candida. So I think there’s some evidence that you could take the probiotic with an antifungal, and it may have an effect.

For UTI and bacterial vaginosis, really the definitive large studies aren’t done yet. So it’s really based on, I would say, smaller studies and mechanisms of action proven in vitro. I couldn’t be honest with myself and say, “We have absolutely proven that you can prevent urinary tract infection with probiotics.”

The Dutch study was very, very, I think, insightful. It was several hundred women. They were postmenopausal, which I didn’t think would work. But they gave the probiotic Lactobacillus GR1 and RC14 that we helped develop once a day for a year versus an antibiotic once a day for a year. And in both cases, they reduced the recurrence of bladder infections. And of course, in the antibiotic group, they had high rates of resistance. Within one month, it went almost up to 95% resistance. And of course, probiotics don’t create drug resistance. So I think those strains—

And I have to say right up front. I have no conflict of interest because I don’t get any, not one cent from the sale of these strains anymore. We developed them. And we had a small biotech company. And we sold it a long time ago, almost ten years ago. So I’m happy to say that I think those strains have the most documentation in this area.

DrMR: And can you give those strain names again?

DrGR: Yeah, so Lactobacillus rhamnosus GR1 and Lactobacillus reuteri RC14.

DrMR: And is there a commercial preparation that those are available in, if someone was looking for it?

DrGR: It’s sold by Metagenics in the States and Refresh Pro B and Fem Dophilus. I think there’s at least three, and there are probably more companies. As I say, I’m not really up to speed on all the companies that sell them.

But one thing we insisted when we did the studies, we said they have to be in a capsule together, because we proved that one strain on its own wasn’t enough. And we have to do the studies with the same formulation that is in the capsules that people eventually buy. And that was very important to us, because the last thing we wanted to do was, you do a study with one formulation. And then the company sells it as a different one. And you can never be sure that when you change the formulation, you may change the way things act.

So I think those strains potentially can help people. And I hope they do. If other people do research and find ones that are better or more specific, then I think I’ll credit them. It’s great. We started off doing this. We just wanted to help women. That was the driving force behind what we had been working on for years and years.

DrMR: That’s great. That’s really great. And I really commend you for wanting the formulas that eventually were sold to be true to what you used, because you are absolutely right that sometimes you will see one ingredient have an effect, and then you get 1/8 of that ingredient put into a formula with a bunch of other fill. And it’s marketed underneath the improvement that that one ingredient obtained. So you’re absolutely right. A lot of that trickery occurs in the supplement industry. And so good on you for that!

DrGR: Well, I also see it in the prebiotic field where really, from my reading of the literature, you pretty much need 5 grams of prebiotic. And so if you have inulin and you give 5 grams—and I call that a prebiotic. But if you have inulin and it’s 0.2 nanograms, that’s not a prebiotic. That’s just inulin. And that must be hard for consumers and even physicians to get their head around. But you can’t just simply add those compounds in and say it’s a prebiotic.

To be a prebiotic, it has to act by stimulating the microbes in that host. And if you’re giving that orally and you don’t have several grams of it, it’s not acting as a prebiotic.

Dr. Ruscio’s Resources

DrMR: Hey, everyone, in case you’re someone who is in need of help or would like to learn more, I just wanted to take a moment to let you know what resources are available. For those who would like to become a patient, you can find all that information at drruscio.com/gethelp.

For those who are looking for more of a self-help approach and/or to learn more about the gut and the microbiota, you can request to be notified when my print book becomes available at drruscio.com/gutbook. You can also get a copy of my free 25-page gut health eBook there.

And finally, if you’re a healthcare practitioner looking to learn more about my functional medicine approach, you can visit drruscio.com/review. All of these pages are at the drruscio.com URL, which is D-R-R-U-S-C-I-O dot com, then slash either ‘gethelp,’ ‘gutbook,’ or ‘review.’ Okay, back to the show

Prebiotic Side Effects in IBS and IBD

DrMR: Now, let me ask you this then, because one of the things that I’ve seen as I’ve gone through numerous studies on prebiotics is there’s clearly documented benefit for prebiotics. However, it does seem that in certain conditions, especially gastrointestinal conditions, IBS and IBD most namely, you appear to have the highest incidence of side effect. And it’s probably because the side effects that occur are usually the symptoms that flare in IBS and IBD. So that seems pretty logical.

Some of the IBS review literature has shown that dosing between 3.5 to 5 grams of prebiotic tends to confer some benefit, but also with a minimal risk of side effects. So that seems to be right under the cusp of what you’re recommending.

But I guess the question I’m asking broadly is, with prebiotics being able to help but also being able to harm, do you find certain populations should be more careful or are not good candidates? Or how do you grapple with that disparity there?

DrGR: I think there are one or two prebiotic experts, like Glenn Gibson, in the world that would know the answer to this better than me. But I’ll give you my perception that if you have a bloating issue, then I could see why taking some prebiotics—and we can’t generalize and say all of them. But some of them, in fact, seem to increase bloating. In that case, you would have to be careful which prebiotic you took.

And part of this comes from our initial perception of prebiotics when Glenn Gibson and Roberfroid first came out with this a long time ago, was that they stimulated Bifidobacterium and Lactobacilli. I think we’ve now realized that that’s far too simplistic. And I think it is obvious that they do stimulate the growth of some other hopefully beneficial bacteria as well. And some of them might produce gases.

And if you are someone who is suffering from bloating and gases, then maybe prebiotics aren’t going to work. And that’s hard to predict up front. I think it’s probably a case of try and see and also the different options of a prebiotic. Maybe FOS is better than GOS. Maybe inulin is better than FOS, etc., etc. So it’s almost trial by trial and error really.

DrMR: Sure. And I think there’s nothing necessarily wrong with a little bit of cautious trial and error. And just my two cents here—I would much rather have somebody experiment with a prebiotic rather than running a test and then trying to treat the test, firstly because, to my knowledge, there is no good clinical documentation that shows that via a stool analysis or a microbiome mapping assay you can have a predictive answer to what prebiotics someone would benefit from. But also it’s probably cheaper just to do a trial and error than even to perform predictive testing.

DrGR: Yeah, the microbiome that we get in stool isn’t terribly insightful. I think the metabolome that we can analyze in the urine will be much more helpful in the future.

I agree with what you’re saying, and I think we’re getting to personalized medicine where we have to go. And some people will react differently than others.

DrMR: Yeah, agreed.

DrGR: I guess the challenge is going to be, how do you rule out the placebo effect? We need some kind of markers that—maybe it’s a bloating marker where it’s just essential a tape around the gut and showing that you get bloating, excess gas. Therefore, your abdomen comes out a couple of inches. I’ve seen people actually measure these things.

DrMR: Sure.

DrGR: And maybe you do that. And you give them the trial dose. And in fact, you prove that the bloating is not as large. And therefore, that’s not a placebo effect. So if you have a measure for it, then I think that really can help us design things that help us design things that help individuals rather than saying, “It has helped 98 out of 100.” Well, maybe the person you’re treating happens to be one of the two that it doesn’t help. So that’s not very good for them.

DrMR: And you’re right. With IBS, the placebo effect can be very, very large. And of course, another way around that would be to just do the testing and then administer the treatment to half of the subjects. And then the other half, give them an inert, non-active placebo and see if something like a self-reported subjective survey like an IBS severity score had a significant change between groups. But you’re right. Having a placebo arm in these trials would be very important.

DrGR: 100% agree. We need to have more trials like that. But at the end of the day, there’s also—and I’m assuming of the listeners to this program, there are people who are faced with an individual sitting in front of them. And in some cases, you have to think of what might be best for them. In that case, they may not be enrolled in a trial. You may be experimenting with them. I don’t say “on them.” I say “with them.”

And as you said, maybe you try 3 grams of an inulin. And then you show that the bloating goes down, or in fact, it doesn’t help it. And as long as you have a way to measure what you’re doing to the patient, then I think one-on-one is going to be—I don’t want to say “as useful,” because I don’t want to contradict myself in the testimonials.

But I am taken by some individual case studies that clearly people improved with the treatment. And we need to understand why they improved and if the findings for them are applicable to someone else or not.

Phages

DrMR: I agree. I agree. Okay, just a couple final questions for you. One is regarding bacteriophages. I’ve looked into this. And essentially, what I’ve seen, and I’d be very curious to get your thoughts on this, it seems that in some European countries there have been very specific phages used oftentimes with infectious diseases that have been cultured. And then the phages have been developed against the cultured infection and then treated as such. And it seemed this is very specific. It’s guided by identification of the pathogen, culturing, testing the phage against it, and then treating as such.

You see some phages available for consumer consumption in the U.S. And I just wonder if the only research, at least that I’ve been able to come across, that has shown benefit with phages has been used in these highly clinical settings, how can we just extrapolate that to a general, one-size-fits-all phage that we give to everyone?

So I’m certainly open, but I’m very cautious because of that observation. So I’m wondering what your thoughts on phages are.

DrGR: So phages are viruses that kill bacteria. And quite fortunately, I went to Georgia in former Soviet Republic. And that, in fact, was the heart of phage production. And they were telling me there that they used to provide, I think it was the Dutch or the Danish armed forces with phage when they went to countries that had higher levels of diarrhea. And so the practice has gone on for a long time.

And I like the idea, because if you’re going to treat an E. coli infection, then why not use a virus that just kills the E. coli. And then you don’t get this carpet bombing effect of killing every other organism around it.

I think to bring that to North America, I guess I’d want to know, what is the phage specifically against? And why am I taking it? We have lots of these viruses inside us right now. We’re trying to understand what they all mean. One day, we might get to the stage where we can say, “Yes, there are beneficial viruses. And there are not-so-beneficial viruses.” And I mean phage that are affecting our bacteria.

But I would be cautious if you were going to purchase phage in North America. I would be asking, “What’s it for? Where’s the documentation that this particular phage kills, for example, salmonella?”

I wouldn’t take a phage to kill salmonella unless I got a salmonella infection. It’s not like you would take it for a year just in case you got exposed to salmonella. I don’t see really the merit of that. And then if you get a salmonella infection where you’re really sick, maybe it helps you get over it much more quickly which is a good thing. And I would think it’s better than antibiotics. But I’m not sure I’d want to take it every day for the next 20 years in the off chance I might get salmonella.

Episode Wrap Up

DrMR: Sure. Yep, good point. Good point. Final question. What is the most fun, least healthy thing you’ve done lately? I ask this because we interview all sorts of health experts on the show. I also like to showcase the other side of people that they’re not these health nuts who never do anything fun. So I always ask this question.

DrGR: The least healthy. Yeah, having different single malt scotches is probably not terribly healthy for me. But, oy! It tastes incredible.

In terms of crazy things I’ve done, bungee jumping, I did and would never do it again, just because it scared the living daylights out of me. But it was incredibly exhilarating. And I was on the Devil’s Pool, sitting on the edge of Victoria Falls in Zambia. And I probably wouldn’t do that again. But it was an incredible buzz.

Both of those latter two examples probably took a few years off my life. But I figure you’re only young once. And it was incredible highs when you do them. Some people do para. I’ve done parachuting. And they’d only do it once. And they get an incredible high out of it. As long as that parachute comes out, I guess you’re fine.

But in terms of nutrition and stuff, the odd binge of potato chips and chocolate—

DrMR: Me, too.

DrGR: I’ve absolutely been guilty of.

DrMR: Awesome. Awesome! Well, thank you for sharing, Gregor. And where can people, if they wanted to, follow some of your work or just plug in with you? Do you have a website or somewhere good for people to try to connect with you?

DrGR: Yeah, my website, I’m pretty guilty of not keeping it as up to date as I should. There are only so many hours in the day. And my papers are all on Google Scholar under Gregor Reid. And at the Lawson Research Institute here in Canada, I’ve got a website.

The one other website I should tell your listeners is USProbioticGuide.com. And that’s for American listeners who would like to go to a list of probiotics that have been tested in humans. And it was prepared by a number of reputable people, including Eamonn Quigley, who is a very well known gastroenterologist in Houston. And that will help people, because it says, “Here’s the probiotic. Here’s the evidence that’s out there. And if it’s not on this list, then we haven’t found any human data on it.”

And the other thing—I do get questions. [email protected] is my email. It’s not like I want to be answering millions of emails, nor can I give clinical advice because I’m a Ph.D., not an M.D. But I’m happy to try to help people the best that I can.

DrMR: Awesome. Awesome. Well, thank you, sir, for taking the time. And it was a pleasure meeting with you and having a few beers after the conference and chatting down in Australia. And hopefully, I’ll run into you again sometime in the next couple of years here.

DrGR: Well, I have to say that one thing that disappointed me—we were in the wine district of Australia. And they never took us to one vineyard.

DrMR: Yeah, that’s true.

DrGR: Nor did they give us a wine sampling. And I’m beginning to realize that where you are now in California has some really exceptional wine. So better to go to California, I think maybe, than Australia next time.

DrMR: Yeah, well, if you ever come out, I’ll show you a few really good vineyards. You’re right. There’s some excellent wine drinking in this area.

DrGR: Yeah, there are. Okay, well, thanks. Nice to talk to you.

DrMR: You, too. Take care, buddy. Bye-bye.

What do you think? I would like to hear your thoughts or experience with this.

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Dr. Ruscio is your leading functional and integrative doctor specializing in gut related disorders such as SIBO, leaky gut, Celiac, IBS and in thyroid disorders such as hypothyroid and hyperthyroid. For more information on how to become a patient, please contact our office. Serving the San Francisco bay area and distance patients via phone and Skype.