Probioitcs Starter Guide-PRINT

PROBIOTICS
Starter Guide
DrRuscio.com
Will taking a probiotic supplement multiple cholesterol,
sclerosis, blood pressure,
improve your health? rheumatoid weight loss
arthritis
A large body of research shows that
probiotics are beneficial for a surprisingly
wide variety of conditions. I’ve
summarized evidence from more than Let’s take a closer look at each of these
500 studies in this chart. conditions:
Irritable Bowel Syndrome

(IBS)
Probiotics Improve These Conditions
High level of scientific support for: Probiotics have been shown helpful for
the symptoms of IBS, which include
constipation, loose stools, diarrhea,
IBS IBD Mood
Gas, bloating, Crohn’s and Depression and abdominal pain and gas.
diarrhea, ulcerative colitis anxiety
constipation,
● Two meta-analyses, involving more
abdominal pain than 1,100 patients, have shown
probiotics to be an effective
treatment for IBS, with no side
Gut Leaky gut Infections
Imbalances Gut damage & Vaginal effects. 1 2
SIBO, H. pylori, permeability infections, ● Another meta-analysis3, involving
candida/fungus, urinary tract
infections, tooth
1,404 patients showed
pathogens
decay improvement in global IBS
symptoms when compared to the
Limited, but encouraging, scientific support
placebo group.
for: Based on this compelling data, the
Canadian Association of Gastroenterology
Cognition Hormonal Allergies Clinical Practice Guideline for the
Cognitive Health Dairy Management of Irritable Bowel Syndrome
function, brain Thyroid health, intolerance,
fog seasonal
recommend a trial on probiotics for IBS.4
PCOS,
endometriosis, allergies
bone density
Autoimmune Metabolic Sleep

Conditions Health Sleep quality
Type 1 diabetes, Blood sugar, and disruption
3
1 https://www.ncbi.nlm.nih.gov/pubmed/18461650
https://www.ncbi.nlm.nih.gov/pubmed/28166427
4
2 https://www.ncbi.nlm.nih.gov/pubmed/31294724
Gut Imbalances: SIBO, Leaky compared to those who have IBS without
SIBO. 8
Gut, Fungus, H. pylori & Leaky Gut
Infection One small clinical trial found that
probiotics helped to promote intestinal
Small Intestinal Bacterial repair in humans.9 Another trial found
Overgrowth (SIBO) positive effects of probiotics when used
to treat intestinal impairment after a GI
Some claim you should not take
infection. 10
probiotics for SIBO because you already
have too much bacteria. However,
Fungus, Candida and Parasites
probiotics have been CLEARLY shown to
be effective in treating SIBO, both in Probiotics don’t just fight bad bacteria.
improving symptoms and in improving They are antifungal and antiparasitic:
lab values.5 ● In a study of 181 infants, probiotics
● One study found probiotics to be were as effective as Nystatin (a
more effective than the antibiotic standard antifungal medication) in
metronidazole (a standard reducing fungal infection and
treatment for SIBO). 6 improving food intolerances.11
● A meta-analysis summarizing 18 ● Two studies show that probiotics
clinical trials concluded that can be more effective than
probiotics are an effective
standard antiparasitic drug
treatment for SIBO.7 Specifically,
treatment in Blastocystis hominis
probiotics reduce bacterial
and Giardia infections.12 13
overgrowths and hydrogen
concentrations, and improve
symptoms including abdominal Inflammatory Bowel Disease
pain. (IBD)
Another exciting study found that Research shows that probiotics are very
probiotics work substantially better in helpful for IBD (ulcerative colitis or
patients with both IBS and SIBO, as Crohn’s disease):
5 10
https://www.ncbi.nlm.nih.gov/pubmed/28267052 https://www.ncbi.nlm.nih.gov/pubmed/24501384
6 11
7 12
8 13
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5561432/
● One review found that probiotics why probiotics can aid with mood
worked as well as the anti- problems like depression and anxiety. We
inflammatory drug, mesalamine, in call this the gut-brain connection. Here’s
maintaining remission for Crohn’s the research:
disease. 14 Best results were for a
● In a meta-analysis of 10 clinical
combination of probiotics and
trials with a total of 1,349 subjects,
mesalamine.
probiotics were associated with
● Another review found the best
significant improvements in the
approach for treating active ulcerative
moods of individuals with mild to
colitis was a probiotic supplement
moderate depressive symptoms. 19
combined with an anti-inflammatory
This effect was not seen in healthy
drug. 15
individuals.
● Other reviews have found probiotics
to be equally effective for ulcerative ● Another systematic review with
colitis as anti-inflammatory drugs like meta-analysis of clinical trials has
mesalamine.16 found probiotics lead to a
● One systematic review has found significant reduction in
probiotics do not help maintain depression. 20
remission, but overall the data ● There is also data showing anxiety
suggest probiotics are helpful.17 can be improved from probiotics.
The data here are not as strong,
Antibiotic-Associated but still have documented an anti-
Diarrhea
anxiety effect, in human clinical
trials. 21
The prestigious Journal of the American So, if you have depression or anxiety,
Medical Association published a meta- probiotics may help. If your mood is fine,
analysis of 82 randomized control trials. then they won’t.
They found that probiotics work to reduce
antibiotic-associated diarrhea.18 Brain Fog
Mood, Depression & Anxiety Data here are preliminary but
encouraging:
Inflammation in the intestines can also
cause inflammation in the brain. That’s
14 17
15 18
https://pdfs.semanticscholar.org/df7f/8622f435e39a0425
19
92994306e919b5d9711c.pdf?_ga=2.116836934.19601667 https://www.ncbi.nlm.nih.gov/pubmed/29197739
86.1562104584-2099317289.1562104584 20
16
21
https://gpsych.bmj.com/content/32/2/e100056
● Research has found increased brain results were not seen for constipation-
fog, aka lack of coherence, in those type mixed-type IBS patients. 29
with IBS.22 ● An additional study of subjects with
● Since there’s impressive evidence that depression showed that the group
probiotics can improve, we can draw a taking probiotics had less sleep
tenable inference that if IBS occurs disruption than the placebo group.30
with brain fog, reducing IBS could
reduce brain fog. Autoimmunity
Brain fog, or fuzzy thinking, isn’t usually
This is another area where data is sparse
studied in isolation but we can look at
but encouraging. These are highlights
other disease-model studies where
from a research review that explored
probiotics have improved cognition,
probiotic treatment and autoimmune
including:.
disease. 31
● Alzheimer's 23 24
● Bipolar disorder25 Type 1 Diabetes
● Fibromyalgia 26
● In a large study of 7,473 children at
Sleep risk for type 1 diabetes, early probiotic

supplementation was shown to
The research data for probiotics and reduce the risk of autoimmunity when
sleep quality is limited but encouraging: compared to children who had not
taken probiotics early in life.32
● In a 2 year trial of medical students,
those who took probiotics showed
superior sleep quality during times of Multiple Sclerosis (MS)
exam stress. 27 A double-blind study of 60 MS patients,
● In a clinical trial, participants reported found that patients treated with
that their sleep quality improved after probiotics showed less disability, lower
6 weeks of taking probiotics.28 insulin resistance and fewer inflammatory
● Another clinical trial of IBS patients markers.
showed sleep improvements for
diarrhea-type IBS patients. The same
22 28
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6445894
23
29
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5105117 https://www.ncbi.nlm.nih.gov/pubmed/26586385
24 30
25 31
26 32
https://www.nature.com/articles/s41598-018-29388-5
27
Rheumatoid Arthritis (RA) ● Two other studies suggest that
methane-producing bacteria, M.
● Three different studies found mixed smithii (found in SIBO patients), may
results for probiotics in RA disease help you to extract extra calories from
activity. One study did not show your diet, leading to weight gain.40 41
significant improvement while two ● Finally, preliminary evidence that
other studies did show shows treating SIBO may help
improvements.33 34 35 improve blood sugar, cholesterol, and
The authors of this research review noted even reduce weight. 42
that intestinal dysbiosis is seen in This is a semi-inferential connection,
autoimmune disease. 36 Specifically, however the evidence seems to suggest
autoimmune patients have: that SIBO patients who use probiotics
● Decreased bacterial function and may achieve metabolic improvements
diversity and weight loss.
● Impaired gut barrier function
● Increased inflammation Food Allergy & Seasonal
Allergy
● Autoimmunity
Metabolism There’s good news for people who suffer

This has not been studied robustly yet, with allergies:
but from the preliminary data we do ● A systematic review of 15 clinical trials
have, it does appear that SIBO affects found that probiotics can improve
metabolism: dairy tolerance.43
● Two studies support the connection ● A meta-analysis of 22 randomized
between SIBO and metabolism. In control trials concluded that
these studies, patients who tested probiotics can improve seasonal
positive for SIBO had higher BMI allergy. 44
scores than patients without SIBO. 37 38 ● Other high-quality studies support
However, not all the data show SIBO similar findings. 45
correlates to weight gain.39
33 39
40
http://www.diabetesforecast.org/2012/nov/certain-
34
https://www.ncbi.nlm.nih.gov/pubmed/24673738 bacteria-might-make-type-2-more-likely.html
35 41
36 42
http://www.ncbi.nlm.nih.gov/pubmed/26833719
43
37
44
38
45
There is also data, albeit mixed, One very recent meta-analysis confirms
suggesting that probiotics given to that we are on the right path with these
children may prevent or reduce formation inferences.52 The authors looked at 13
of allergy. 46 studies involving 855 women and found
that probiotic use improved hormonal
Female Hormones and inflammatory markers for women
with PCOS.
We don’t have good data regarding
female hormones and probiotics, but we
can make some inferences based on
Blood Pressure & Cholesterol
other research: When it comes to blood pressure and
cholesterol, we have five meta analyses
● We know that the gut microbiota is
(the highest quality of research data
involved in regulating estrogens and
available), so this is worth a look. The
that gut dysbiosis can disturb
results are a bit mixed, however the
estrogen levels. 47
majority of results do show benefits
● A research review and one additional
study indicates that women with ● Four meta analyses involving 68
PCOS, obesity, endometriosis, clinical trials and 3885 patients found
cardiovascular disease, and breast that probiotic supplements can
cancer have lower diversity in their improve overall cholesterol
intestinal bacteria. 48 49 All of these profiles. One of these studies also
conditions are all associated with shows significant improvements to
unbalanced estrogen levels. blood pressure.53 54 55 56
● One study found that probiotics plus ● Another meta analysis evaluated 9
soy isoflavones improved bone clinical studies with 678 pre-diabetic
density. 50 participants and found probiotics had
● Preliminary evidence suggests that a significant effect on reducing LDL
these types of health conditions can Cholesterol . However, there was no
improve when bacterial diversity in effect on blood pressure or any other
the gut increases.51 This is where cholesterol readings. 57
probiotics may come in. ● Anotherstudy found that probiotics
can lower homocysteine, 58 which is
46 52
https://www.ncbi.nlm.nih.gov/pubmed/31256251#
53
47
54
48
55
49
56
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4554191/ https://www.ncbi.nlm.nih.gov/pubmed/28594860
50 57
51 58
an independent risk factor for heart
disease.
Skin Health
The amount of improvement found in Is there a gut-skin connection? Here’s a
these studies is usually small, but look at the evidence:
favorable. So, probiotics should not be ● The skin and the gut have
viewed as the primary therapy for high similarities in their structure, they
cholesterol or blood pressure. play similar roles in immune
function and both host a diverse
Thyroid Function bacterial population.62
● Evidence suggests that intestinal
There is significant research that health and skin health are closely
demonstrates a gut-thyroid connection: linked.63 64
● A large and fascinating study ● A recent review paper summarized
investigated the health conditions that the research into acne and the
are most commonly found in patients microbiome and confirms the
with SIBO.59 Being hypothyroid or on connection.65
thyroid medication were the most ● 2 clinical trials showed that topical
highly associated with SIBO. probiotic treatments were
effective for treating acne.66 67
● Another study 60 also found that
● Another study compared
thyroid autoimmunity was higher in
traditional antibiotic therapy for
those with SIBO as compared to
acne with a probiotic supplement.
healthy controls. Thyroid
The young women in both groups
autoimmunity is the underlying cause
showed significant improvement
in most cases of hypothyroidism.
after 4 weeks. A third group that
● A recent meta-analysis concluded that was treated with both antibiotics
there is an association between the and probiotics had the best
bacteria H. pylori and thyroid results.68
autoimmunity. 61
Since we know that probiotics are
effective for treating gut imbalances like
SIBO and H. pylori, probiotics may be an
effective therapy for improving thyroid
health.
59 64
60 65
61 66
62 67
63 68
Infant & Mom Health Why Do Probiotics Help So
Researchers have found benefits from Many Different Conditions?
probiotic use for infants, including:69
● Less colic and irritability The Journal of Clinical Gastroenterology 75
● Less diarrhea and the journal Trends in Microbiology76
● Fewer spitting episodes offer insights regarding how probiotics
● Fewer respiratory infections make you healthier.
Women who took probiotics during Probiotics can:

pregnancy had fewer incidences of:70 ● Increase bacterial diversity, or
● Gestational diabetes health, of your bacterial
● Pre-eclampsia (high blood community77
pressure during pregnancy) ● Fight pathogens (harmful bugs)
● Excessive weight gain and their toxins
● Vaginal bacteria infections ● Promote a more rapid recovery
from imbalances in your gut
More studies show that probiotics: organisms
● Appear to be safe for infants and ● Promote a healthy immune
even preterm infants71 72 response in your gut78 79
● Protect infants against intestinal ● Reduce gut inflammation
fungus (candida) overgrowth73 (remember excessive
● Reduce the risk of ear and inflammation is part of an
respiratory infection in babies 74 overzealous immune response)80
● Reduce colic ● Encourage the growth of healthier
microbes in your gut 81
● Reduce leaky gut aka damage to
your gut lining.82 83 84
69 77
70 78
79
71
80
72
81
73
82
74
83
75
84
76
Said simply, probiotics can help improve results of these investigations into
the balance of organisms in your gut, probiotic quality:
reduce overzealous immune system
● Of 26 commercial probiotics
activity and reduce the inflammation
assessed in this study, none fully
which many of us suffer with.
supported label claims, and some
Unhealthy Gut Bacteria = of them contained unacceptable
Inflammation microorganisms. 85
● These researchers conclude that
Inflammation = Symptoms
two common problems in
You may be surprised to know how many probiotic supplements are a low
common conditions are caused by concentration of viable cells (ie
inflammation. Modern-day inflammatory your getting ripped off) and the
conditions include): presence of undesired (potentially
● Fatigue harmful) organisms.86
● Depression or Anxiety ● One study found only half of the
● Brain Fog probiotics examined had the
● Insomnia specific strain listed on the label.87
● Acne or Other Skin Conditions
● Another study found 43% of the
● Female Hormone Imbalances
probiotics assessed contained less
● Male Hormone Imbalances
than half the amount of probiotic
● Hypothyroid Symptoms
listed on their labels.88
● Immune System Dysregulation and
Autoimmunity If a company follows quality assurance
practices, a probiotic supplement will
meet its label claims and not contain
Quality Matters - Don’t Buy potentially harmful organisms.
What to Look for in a Probiotic

Junk! Supplement
When it comes to buying probiotic Independent Laboratory Analysis
supplements, quality assurance practices All probiotic raw materials and final
do matter. Probiotic manufacturing is not products undergo independent
highly regulated and some labels claims laboratory analysis ensuring probiotic
do not stand up to scrutiny. Consider the quality and fulfillment of GMP
85 87
https://www.tandfonline.com/doi/full/10.1080/13102818. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6430388/
2019.1621208
88
https://labdoor.com/rankings/probiotics
86
https://www.tandfonline.com/doi/full/10.1080/13102818.
2019.1621208
requirements. This ensures the probiotic This usually indicates corners have been
meets its label claims. cut in the quality assurance standards.
Genetic Identification All three of the probiotic supplements
that I sell and also use in my practice,
To ensure the strain of probiotic meets
meet these quality standards.
the label claim, thus protecting you from
using frankenstein probiotics or harmful
How to Find the Right

organisms. Harmful organisms are one
of the most common problems with
probiotics.
Probiotic for You
Free of Major Allergens
Probiotics should be grown on media Taking probiotics doesn’t need to be
which are free of the common allergens: complicated. Yes, there are a lot of
wheat, gluten, milk, casein, eggs, fish, different probiotic strains, but all you
shellfish, tree nuts, peanuts and really need to know are the three main
soybeans. A quality probiotic will also be probiotic categories. Nearly every
free of artificial colors, flavors, or probiotic product can be classified into
preservatives. one of these categories89.
Validated Potency
CATEGORY 1 CATEGORY 2 CATEGORY 3
Probiotics should always meet their lab's
claims upon testing. Certain probiotics Lactobacillus & Saccharomyces Soil-Based
should be stored by the manufacturer bifidobacterium Boulardii Probiotics
and shipped in refrigerated conditions to species (a healthy using various
predominated fungus) Bacillus species
retain the potency list on the label claims. blends
Good Manufacturing Practices (GMP) in
Manufacturing These are the The second The third most
most well- most researched researched
GMP are a set of best practices for dietary researched, with probiotic, with category of
supplement manufacturing in the United over 500 trials over 100 probiotics is soil-
assessing their studies. based
States. This includes utilizing a state-of- validity. These Saccharomyces probiotics. This
the-art facility where temperature and air live boulardii (S. group has
quality are tightly controlled. This microorganisms boulardii for roughly 14
are also known short) is not a clinical trials
produced a consistent quality and purity as lactic-acid evaluating their
normal part of
of product. producing human effectiveness.
probiotic microbiota, This category is
You don’t need to purchase the most bacteria. They meaning it does also known as
expensive probiotic supplements. But, typically do not not colonize us spore-forming
colonize the but does bacteria. This
you should be wary of a probiotic that host, but do category of
improve the
is substantially cheaper than the rest. improve the probiotic can
89
http://internationalprobiotics.org/download/ipa-
guidelines-qualify-microorganism-probiotic/
health of the health of the colonize the all three probiotic categories. For many
host. host. host 90. patients who have tried probiotics in the
past, this approach makes all the
This is great news. This means you don’t difference.
need to try every probiotic strain on
the market , but rather you can pay What you need to do – easy as
attention to the category and pick one 1, 2, 3
quality formula from each.
1. Try a quality formula probiotic from
You also don’t need to match specific category 1, category 2 and category 3 -
probiotic strains to specific symptoms. All take all three together.
probiotics work in a similar way by 2. Monitor your symptoms for 3-4
addressing the underlying reasons for weeks. If you’re improving, stay on the
your symptoms. 3 for Balance protocol until your
improvements have plateaued.
Take Probiotics When It’s ● Once you’ve seen your maximum
Convenient for You

improvement (you’ve plateaued),
stay here for about a month to
allow your system to calibrate to
Despite advice that you might read these new improvements. Then
elsewhere, taking probiotics is simple: reduce your dose and find the
● You can take them with or without minimal effective dose. Stay on
food. the minimal effective dose.
● You can take them at any time of If you haven’t noticed any change in your
the day. symptoms after 3-4 weeks, you can stop
● You can (and should) take taking probiotics and feel confident that
probiotics with antibiotics. you have fully explored probiotic therapy.
There’s no need to go shopping for other
probiotic strains.
The 3 for BALANCE Probiotic
Protocol Graphic (3-legged Probiotics from Food
stool) Diet is a great source of probiotics. Below
Many people don’t seem to achieve is a table of common foods that are high
balance in their microbiota with just one in probiotics compared with probiotic
strain of probiotic. Some lucky people do, supplements. As you can see, a challenge
but for many, one probiotic won’t suffice. with diet is that it is difficult to obtain the
I have seen the best results with my same dose used in the research studies.
patients following a protocol that includes
90
Food Species Amount Equivalent Dose
Sauerkraut Leuconostoc mesenteroides 3 billion CFU ⅛ capsule

Lactobacillus brevis per cup Lacto-Bifido Blend
Pediococcus pentosaceus Probiotic
Lactobacillus plantarum
Yogurt91 92
Lactobacillus acidophilus 2.5 billion CFU 1/10 capsule
Streptococcus thermophilus per cup Lacto-Bifido Blend
Lactobacillus delbrueckii subsp. Probiotic
bulgaricus
Lacto-fermented Lactobacillus casei 1.3 billion CFU .05 capsule

Pickles93 94 Lactobacillus rhamnosus per pickle Lacto-Bifido Blend
Lactobacillus plantarum Probiotic
Lactobacillus brevis
Kefir 95 Lactobacillus brevis 2.5 billion CFU 1/10 capsule

Lactobacillus acidophilus per cup Lacto-Bifido Blend
Lactobacillus casei Probiotic
Lactococcus lactis
Saccharomyces cerevisiae
Kimchi 96 97
Weissella koreensis 11.5 billion CFU ½ capsule
Lactobacillus sakei per ½ cup Lacto-Bifido Blend
Lactobacillus graminis Probiotic
Weissella cibaria
Leuconostoc mesenteroides
For optimum results with probiotics, consider adding probiotic supplementation to your
diet.
91
92
https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2621.1993.tb06096.x
93
https://www.ars.usda.gov/ARSUserFiles/60701000/Pickle%20Pubs/p411.pdf
94
https://www.olivemypickle.com/blogs/news/probiotics-in-our-pickles-microbiology-lab-verified
95
http://www.ifrj.upm.edu.my/26%20(02)%202019/(05).pdf
96
https://www.frontiersin.org/articles/10.3389/fmicb.2016.01493/full
97
https://www.researchgate.net/profile/James_Daily_III/publication/259880932_Health_Benefits_of_Kimchi_Korean_Fermented_
Vegetables_as_a_Probiotic_Food/links/5746f02508ae298602fc05fd.pdf
Keep in Mind...
Probiotics can be very helpful for a variety of health conditions, however they are not a
cure-all and sometimes other, more advanced, therapies are needed. If this interests you,
please see Healthy Gut, Healthy You which provides a detailed guide for what else you can
do to heal your gut beyond probiotics.

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PROBIOTICS

Irritable Bowel Syndrome

Autoimmune Metabolic Sleep

Sleep risk for type 1 diabetes, early probiotic

Metabolism There’s good news for people who suffer

Women who took probiotics during Probiotics can:

What to Look for in a Probiotic

How to Find the Right

Convenient for You

Sauerkraut Leuconostoc mesenteroides 3 billion CFU ⅛ capsule

Lacto-fermented Lactobacillus casei 1.3 billion CFU .05 capsule

Kefir 95 Lactobacillus brevis 2.5 billion CFU 1/10 capsule

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