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Alex Manos: Stop taking probiotics (maybe)
State of Mind is a podcast hosted by Nutritional Therapist, Grace Kingswell, that interviews personalities in the health, wellness, arts and fitness industries talking health, food, state of mind, sustainability and everything in between.
2024
Abstract
Grace chats to Alex Manos about the human microbiome, how everything is interconnected and the systemic impact on our general health. They explore probiotic use for specific conditions as well as overall gut health and discuss whether the latter is really needed. They also dive into some really interesting topics such as SIBO, oral tolerance (what impacts and maintains resilience), diet and lifestyle factors for a healthy gut microbiome, how to build acquired resilience, the impact of restrictive diets and how to increase plant diversity for those individuals who struggle to tolerate fibre.
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Leveraging your microbiome for better skin, mood, and brain health, plus why most probiotics suck
Max Lugavere is a health and science journalist, filmmaker, and bestselling author. He is the author of the Genius trilogy of books, including the New York Times bestseller Genius Foods and Genius Kitchen. He hosts The Genius Life podcast, one of the top health and wellness podcasts in the U.S, with an audience of over 1.5 million followers across social media.
2024
Abstract
Kiran Krishnan is a research microbiologist who has been studying the microbiome for over 15 years. Prepare to be astounded as he chats to Max all about the human microbiome, how it makes the human species resilient and adaptable but also how decreasing microbial diversity may in turn lead to reduced resilience, genetic capabilities and a decline in the human species. We are basically eating to feed our microbiome to enable us to survive. They discuss quorum sensing where microbes can influence the overall diversity of species in the gut simply by sensing the signals of other microbes. Plus they debate the drivers of SIBO and how it may not actually be a condition but a symptom of dysfunction within the gut, and the importance of urolithin A for cellular function particularly mitochondria repair and how to cultivate this via our microbes. We know that probiotics can play a key role in promoting the growth of gut bacteria, but what happens in the digestive tract, do they survive? Krishnan delves into the probiotic world and highlights how spore based probiotics have been created to mimic nature and may increase their efficacy.
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A simple probiotic protocol to improve IBS & leaky gut
Dr Ruscio is a Doctor of Natural Medicine, Doctor of Chiropractic, clinical researcher and author. His podcast, Dr Ruscio Radio presents cutting edge information in health, nutrition and functional medicine distilled into practical advice that can be used to improve our health.
2024
Abstract
Dr Ruscio does a compelling and thorough review of the evidence available (all papers referenced are linked on the podcast) for probiotic use in Irritable Bowel Syndrome (IBS). He discusses a 4 point model that he uses to identify the root causes of IBS, namely microbial (SIBO & dysbiosis), lifestyle (predominantly stress), diet, and immune (integrity of the gut barrier i.e. leaky gut). Understanding the root cause of IBS can of course help target interventions which he also covers on the podcast. He suggests a probiotic protocol that could be used to treat IBS symptoms but also highlights the importance of utilizing a food first approach by inclusion of fermented foods such as sauerkraut, kimchi and kombucha if they are tolerated.
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The role of gut health in psoriasis
Alex Manos is one of the UK’s leading Functional Medicine practitioners who specialises in SIBO and gut-related disorders, as well as mould illness and mycotoxins. He is also very passionate about physical therapy, movement, resiliency, life coaching, nutritional therapy, and biohacking. He is a lecturer at various colleges and institutions including the Institute of Optimum Nutrition (ION) and on the MSc program at The Centre For Nutritional Education and Lifestyle Management (CNELM).
2022
Abstract
This is a really informative and concise presentation (with slides) from Alex summarising the research around the role of gut health in psoriasis. He covers dysbiosis, gut microbiome metabolites, gut inflammation, small intestinal bacterial overgrowth (SIBO), leaky gut and also coeliac and gluten sensitivity. He is quick to point out however that the gut is not the only thing that contributes to psoriasis, as there are many factors that can accumulate and contribute to psoriasis including infections, body composition, environmental toxins, medications, poor diet, and stress. He addresses testing options that are available to help determine which aspect of gut health could be targeted using nutrition and supplements to help alleviate the severity of psoriasis.
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The Influence of Small Intestinal Bacterial Overgrowth in Digestive and Extra-Intestinal Disorders.
Losurdo, G, Salvatore D'Abramo, F, Indellicati, G, Lillo, C, Ierardi, E, Di Leo, A
International journal of molecular sciences. 2020;21(10)
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The importance of the gut microbiome in health and disease is a rapidly growing area of research. Small intestinal bacterial overgrowth (SIBO) is a condition in which bacteria that typically exists only in the colon becomes concentrated in the small intestine. SIBO has wide-ranging clinical implications and the aim of this study was to review the current research to assess existing links between SIBO and various diseases. Examining the current literature, the authors found SIBO may be involved in several diseases. SIBO was found to be strongly associated with irritable bowel syndrome (IBS). While the link between SIBO and celiac disease has been studied extensively, findings remain inconsistent. Additionally, SIBO was found to be a potential underlying factor in hepatic encephalopathy. Based on these findings, the authors conclude the scientific hypotheses and the clinical findings are not consistent. While it is widely accepted that alterations in the gut microbiota can influence disease, there is not enough clinical evidence to draw conclusions. The authors conclude the evidence is promising but future research is needed.
Abstract
Small intestinal bacterial overgrowth (SIBO) is a condition hallmarked by an increase in the concentration of colonic-type bacteria in the small bowel. Watery diarrhea, bloating, abdominal pain and distension are the most common clinical manifestations. Additionally, malnutrition and vitamin (B12, D, A, and E) as well as minerals (iron and calcium) deficiency may be present. SIBO may mask or worsen the history of some diseases (celiac disease, irritable bowel disease), may be more common in some extra-intestinal disorders (scleroderma, obesity), or could even represent a pathogenetic link with some diseases, in which a perturbation of intestinal microbiota may be involved. On these bases, we performed a review to explore the multiple links between SIBO and digestive and extra-intestinal diseases.
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Small Intestinal Bacterial Overgrowth in Children: A State-Of-The-Art Review.
Avelar Rodriguez, D, Ryan, PM, Toro Monjaraz, EM, Ramirez Mayans, JA, Quigley, EM
Frontiers in pediatrics. 2019;7:363
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Small intestinal bacterial overgrowth (SIBO) occurs when microorganisms overpopulate the small intestine and is characterised by gastrointestinal symptoms such as abdominal pain, diarrhoea, and flatulence. This review focuses on paediatric SIBO, known to be increasing, with emphasis on the impact on gut microbiota. The gut microbiota is influenced by several factors including genetics, vaginal delivery, exercise and diet. SIBO in children has been studied in the context of stunting, irritable bowel syndrome (IBS), obesity, and related to use of proton pump inhibitors (PPIs). This review analysed 149 studies published since 2000 through till May 2019 with the aim of presenting the most up-to-date information. Risk factors included gastric acids and medications which suppress this activity, intestinal motility disturbances leading to bacterial overgrowth, anatomical anomalies where there is an absence of one or more intestinal valves, and poor socioeconomic status and diet. The review concluded that the recommended diagnosis is by methane and hydrogen breath testing and that Gold Standard treatment is antibiotic ‘rifaximin’ at 1,200 mg/d, reduced to 600 mg/d for 1 week in children. Alternative treatments discussed include FODMAP diets and probiotic protocols with best results coming from combining antibiotic and probiotic protocols. It concludes that SIBO in children is heterogenous and poorly understood and that a better diagnostic criteria is necessary in paediatrics.
Abstract
Small intestinal bacterial overgrowth (SIBO) is a heterogenous and poorly understood entity characterised by an excessive growth of select microorganisms within the small intestine. This excessive bacterial biomass, in turn, disrupts host physiology in a myriad of ways, leading to gastrointestinal and non-gastrointestinal symptoms and complications. SIBO is a common cause of non-specific gastrointestinal symptoms in children, such as chronic abdominal pain, abdominal distention, diarrhoea, and flatulence, amongst others. In addition, it has recently been implicated in the pathophysiology of stunting, a disease that affects millions of children worldwide. Risk factors such as acid-suppressive therapies, alterations in gastrointestinal motility and anatomy, as well as impoverished conditions, have been shown to predispose children to SIBO. SIBO can be diagnosed via culture-dependant or culture-independent approaches. SIBO's epidemiology is limited due to the lack of uniformity and consensus of its diagnostic criteria, as well as the paucity of literature available. Antibiotics remain the first-line treatment option for SIBO, although emerging modalities such as probiotics and diet manipulation could also have a role. Herein, we present a state-of-the-art-review which aims to comprehensively outline the most current information on SIBO in children, with particular emphasis on the gut microbiota.
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Effect of a Preparation of Four Probiotics on Symptoms of Patients with Irritable Bowel Syndrome: Association with Intestinal Bacterial Overgrowth.
Leventogiannis, K, Gkolfakis, P, Spithakis, G, Tsatali, A, Pistiki, A, Sioulas, A, Giamarellos-Bourboulis, EJ, Triantafyllou, K
Probiotics and antimicrobial proteins. 2019;11(2):627-634
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Irritable bowel syndrome (IBS) is the most common functional gut disorder with symptoms primarily of bloating and diarrhea. Recently these symptoms have been associated with small intestinal bacterial overgrowth (SIBO), which occurs when bacteria from the colon resides in the small intestine. The aim of this study was to determine the efficacy of probiotics in improvement of symptoms of IBS patients with SIBO. In this prospective trial, five patients with IBS and SIBO and 21 patients with IBS without SIBO were given probiotic capsules twice a day for 30 days. Participants completed an IBS severity questionnaire at three visits throughout the trial. At the end of the trial, a 71.3% decrease of the total IBS score was detected in patients with IBS and SIBO, compared with those without SIBO. This study found there are clinical benefits from probiotic supplementation in IBS patients with SIBO. Based on these findings, the authors conclude larger, randomised studies be undertaken based on this prospective design.
Abstract
The effect of probiotics on small intestinal bacterial overgrowth (SIBO) in irritable bowel syndrome (IBS) has never been studied so far. In this prospective trial, five patients with IBS and SIBO and 21 patients with IBS without SIBO were administered an oral capsule containing Saccharomyces boulardii, Bifidobacterium lactis, Lactobacillus acidophilus, and Lactobacillus plantarum (Lactolevure®) every 12 h for 30 days. SIBO was defined by quantitative culture of the third part of the duodenum; IBS was defined by the Rome III criteria. Severity of symptoms was graded by the IBS severity scoring system (SSS). The primary study endpoint was the efficacy of probiotics in improvement of symptoms of IBS in patients with SIBO. Thirty days after the end of treatment, a 71.3% decrease of the total IBS score was detected in patients with IBS and SIBO compared to 10.6% in those without SIBO (p 0.017). A similar decrease was achieved among patients with constipation-predominant IBS without SIBO. Post-treatment satisfaction from bowel function was greater in patients with SIBO. Similar satisfaction improvement was found among patients with diarrhea-predominant IBS irrespective from SIBO; pain intensity score decreased in patients with constipation-predominant IBS irrespective from SIBO. The benefit of probiotics was greater among patients with a pro-inflammatory cytokine pattern in the duodenal fluid. This is the first study that prospectively demonstrated superior clinical efficacy of probiotics in patients with IBS with SIBO. Analysis also showed considerable benefit from probiotic intake regarding certain symptoms of patients with diarrhea-predominant and constipation-predominant IBS.Trial registration: ClinicalTrials.gov identifier NCT02204891.
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Does Irritable Bowel Syndrome Exist? Identifiable and Treatable Causes of Associated Symptoms Suggest It May Not
Ben Brown is a naturopath, nutritionist, science writer and speaker. He is author of The Digestive Health Solution and contributes regularly to industry magazines and scientific journals. Ben is Editor of the Journal of Orthomolecular Medicine, Contributing Editor of Integrative Healthcare and Applied Nutrition, Director of Clinical Education for Pure Encapsulations (UK), and is on the Advisory Board of the BCNH College of Nutrition and Health where he is also a lecturer. He regularly features at public speaking events and international conferences.
2019
Abstract
Irritable bowel syndrome (IBS) affects around 11% of the world population, making it one of the most common digestive disorders. In conventional medicine, it is generally diagnosed by excluding other digestive diseases and is treated based on the presenting systems, classified as constipation-predominant, diarrhoea-predominant or alternating between the two. This review article questions the existence of IBS per se, and explores the identifiable and treatable causes of typical IBS symptoms, including nutritional, lifestyle and environmental factors. The author examines a range of underlying causes and therapeutic options, including the role of stress, circadian rhythms and exercise; nutritional factors such as carbohydrate, gluten, lactose and IgG identified intolerance; and functional imbalances such as pancreatic insufficiency, low grade inflammation and intestinal hyperpermeability. For Nutritional Practitioners, this article will serve as a tool to assist in identifying the root causes of a client’s IBS symptoms, which will help with directing protocol options.
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Gut Microbiota-Based Therapies for Irritable Bowel Syndrome.
Stern, EK, Brenner, DM
Clinical and translational gastroenterology. 2018;9(2):e134
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Irritable bowel syndrome (IBS) is a common, complex disorder characterised by pain associated with changes in bowel habits. The gut micriobiome describes the collective bacteria that inhabit the gastrointestinal (GI) tract, and it is hypothesised that alterations in gut microbiota play a role in the development of IBS. This aim of this review is to provide an overview of the role of altered GI homeostasis in IBS and assess the available therapeutic options. The current literature suggests that gut microbiota contributes to IBS development through GI inflammation, gut permeability, intestinal motility, gut-brain communication and gas production. Many treatment options exist but have differing efficacy depending on IBS subtype. Based on this review, the authors suggest further research is warranted to better understand the mechanisms and benefits of IBS treatment options.
Abstract
Irritable bowel syndrome (IBS) is a common, heterogeneous disorder characterized by abdominal pain associated with changes in bowel habits. The pathogenesis of IBS is multifactorial and may relate to alterations in the gut microbiota, changes in visceral sensation and motility, and genetic and environmental factors. Administration of systemic antibiotics may increase the risk of IBS by altering gastrointestinal homeostasis. Therapeutic interventions for IBS with diarrhea that are thought to target alterations in the gut microbiota include the nonsystemic antibiotic rifaximin, the medical food serum-derived bovine immunoglobulin, prebiotics, probiotics, and dietary modification. SYN-010 is a modified-release statin formulation that reduces methane production by Methanobrevibacter smithii and is currently in development for the treatment of patients with constipation-predominant IBS. Use of these interventions in the management of patients with IBS may function to restore a healthy gut microbiota and ameliorate symptoms of IBS.
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The Gut-Brain Axis and the Microbiome: Clues to Pathophysiology and Opportunities for Novel Management Strategies in Irritable Bowel Syndrome (IBS).
Quigley, EMM
Journal of clinical medicine. 2018;7(1)
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Irritable bowel syndrome (IBS) is a common functional gut disorder that is seen to have a number of causes. Given the widespread interest in the gut microbiome in health and disease, the role of microbiota has now been explored in the gut-brain axis paradigm. This review explores the novel addition of microbiota to the gut-brain axis and its implications to the assessment and management of IBS. Current literature suggests that a disturbed microbiome or an aberrant immune response to the disturbed microbiome may impact the central nervous system. These findings have confirmed the microbiota is useful in understanding the development of symptoms in IBS. Based on the existing literature, the author concludes there is new insight for diagnostic and therapeutic approaches to IBS.
Abstract
Irritable bowel syndrome (IBS) is one of the most common of all medical disorders worldwide and, while for some it represents no more than a nuisance, for others it imposes significant negative impacts on daily life and activities. IBS is a heterogeneous disorder and may well have a number of causes which may lie anywhere from the external environment to the contents of the gut lumen and from the enteric neuromuscular apparatus and the gut immune system to the central nervous system. Consequently, the paradigm of the gut-brain axis, which includes the participation of these various factors, has proven a useful model to assist clinicians and patients alike in understanding the genesis of symptoms in IBS. Now, given the widespread interest in the gut microbiome in health and disease, in general, reports of disordered enteric bacterial communities in IBS, and experimental data to indicate that components of the gut microbiota can influence brain morphology and function, as well as behavior and cognition, this concept has been extended to encompass the microbiota-gut-brain axis. The implications of this novel concept to the assessment and management of IBS will be explored in this review.