031-Probiotics- My interview with Eamonn Quiqley Part 2

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In the second part of my interview with Dr Quiqley we continue to discuss the value of probiotics for our health.

We start with my question on how effective are probiotics for digestive health especially irritable bowel syndrome (IBS). He feels the most benefit of probiotics proven so far is for people with digestive problems. 

We then talk about Small Intestinal Bacterial Overgrowth (SIBO) and whether people with this condition should use or avoid probiotics. You will remember I talked about this in my podcast interview with Dr Mark Pimental and he implied people with SIBO should avoid probiotics. 

Dr Quigley certainly reminds us after using antibiotics for SIBO, probiotics might provide benefit for the patient. 

We then talk about possible side effects of taking probiotics. He points out there may be an adjustment period when you first start probiotics. Dr Quiqley says he has never seen anybody allergic to probiotics. 

We talk about using probiotics in children and animals.  He points out that probiotics prevents and treats “Day-care diarrhea” in children. 

Like the good scientist he is Dr Quiqley is really insistent that studies be done on probiotics to prove that they provide benefits. But I believe that since there is no harm in giving probiotics that it is worth a trial in patients with the relevant symptoms.

We talk about Rifaximin in the treatment of SIBO. He points out that there is a lot of trial and error in the treatment of SIBO.

The low FODMAP diet is used a lot in people with gas and bloating. Diet and IBS is discussed and Dr Quigley calls for more research in this area. 

Everybody has their own set of friendly bacteria in their intestines when you get down to the details.

We also talk about fecal transplantation and its use in hospitals especially for the treatment of C. Difficile infections.

Dr Quigley has done a lot of research on Bifidis Infantis and talks about his research. This organism seems to be able to reduce inflammation. It does this by working with the cytokines which are the inflammatory molecules in our body. 

We talk about his book and the DVD on Microwarriors-The Power of Probiotics –see below 

His website:  For more information about Dr Quigley’s work go to the Alimentary Pharmabiotic Centre.

You can get Dr Quigley’s book Probiotics and Digestive Health here

and on Kindle here

and the DVD called Microwarriors-The Power of Probiotics that he consulted on is here

You can watch a trailer of the DVD HERE

Dr Quigley does have a financial relationship with Proctor and Gamble.

Please leave your comments below or send questions which I will answer on my podcast to me at questions@askdrsoram.com . You can also leave voicemail questions at 310 499 0275.


 

Dr. Soram: Well welcome everybody today I have a very special guest coming speaking to us from Cork Ireland, Dr. Eamonn Quigley. Dr. Quigley is a Professor of Medicine in Human Physiology at University College in Cork Ireland; he's a Principle Investigator at the Alimentary Pharmabiotic Centre, at the National University of Ireland, he's past President of the World Gastroenterology Organization in American College of Gastroenterology. His areas of research include; Motility, Functional Gastrointestinal Disease which you and I will call Irritable Bowel Syndrome, Neurogastroenterology, Gastro esophageal Reflux Disease which we call GERD and Probiotics in Health and Disease. Dr. Quigley is the author of several books on probiotics including his most recent one called ‘Probiotics and Digestive Health; A Gastroenterologist Perspective’. He also was the chief medical reviewer for a new DVD that is out called ‘Micro Warriors; The Power of Probiotics’. So with that introduction Dr. Quigley welcome to my podcast today.

Dr. Quigley: Well thank you very much it’s a great pleasure to be with you.

Dr. Soram: You’ve done tremendous amount of work throughout your career on probiotics and today we are going to focus on probiotics. Tell us what is a probiotic?

Dr. Quigley: Well for now we have to use the definition that is developed by the FAO which is a branch to the World Health Organization a number of years ago, and that definition defines a probiotic as a microbe which is live and which when given to man transfers a health benefit. Now that very definition deserves careful scrutiny because first of all it insists that a probiotic organism should be live which I interpret to mean that it should be live for the duration of the shelf life of that product.

Dr. Soram: Yes.

Dr. Quigley: And secondly it also means that there should be good evidence which to me means from good clinical studies that any health benefit that is claimed for the product has actually been demonstrated.

Dr. Soram: Excellent, excellent so tell us how exactly do probiotics work and are they safe?

Dr. Quigley: Well these are two separate questions so I’ll take them separately the first with regard to how probiotics work, the answer to that is actually a very complex one and my simple answer will be the probiotics work in many different ways and the way in which they work will differ for different probiotics and also for different indications. So for example if we are talking about a probiotic in diarrhea in day care centers; in this particular instance the anti-bacterial, anti-viral, anti-pathogen effects of probiotics maybe most important. However if we look at another situation like in an inflammatory condition it maybe derails specific effects of probiotics in the immune system that are more important or if we take another example the growing interest in probiotics in metabolic conditions, it maybe the metabolic activities of these probiotic organisms that are most important. So I think we need to be very careful here in trying to dissect out different effects of probiotics in different situations and also different effects for different species and strains of probiotics.

Dr. Soram: Yes so I’ll just for my audience because most of my audience is lay people I just want to say that commonly you don't know what probiotic is, it’s what some people call acidophilus which is a specific probiotic but in America it’s used generically like go get some acidophilus. I just wanted all our users to understand that but probiotics is a bigger word that encompasses many of these different strains of friendly bacteria, that we kind of summarize as “oh go get some acidophilus”. Now Dr. Quigley, are probiotics safe for us to take?

Dr. Quigley: The answer is with very few exceptions yes but there are some exceptions for example if you have a severe Immune Deficiency particularly…

Dr. Soram: Such as AIDS or something?

Dr. Quigley: Well AIDS is one that may not be a good example but I'm thinking here of children who are born with severe deficiencies in their immune system to is theoretically possible but never proven that probiotics could be harmful in that situation. With regard to AIDS probiotics has actually been used to treat diarrhea and patients with AIDS I don’t know how beneficial they were but certainly it didn't seem to be dangerous. The other situation which is very unusual one is a report recently from a groups of researchers in Holland who used probiotics to try and prevent infections in patients who are critically ill with pancreatitis; inflammation of the pancreas gland, now these were a very extreme group of patients in that they were all in the intensive care unit they all needed ventilator support, these are gravely ill people and they were given a probiotic cocktail through a tube directly into their intestine and they actually had a higher mortality than those who are not given the probiotic. And why they died is from an unusual complication which is very difficult to explain in terms of the probiotics so I just mentioned that because you will find it out there in the literature and in the lay press, whether this is really related to the probiotic it is unclear but one needs to know about it. But apart from these rather unusual and very rare circumstances probiotics seems to be very safe.

Dr. Soram: Excellent, now I'm a healthy person why should I take probiotics?

Dr. Quigley: Well that's the most difficult question of all, it is much easier to deal with evidence for or against use of probiotics in specific health conditions with regards to ‘boosting’ your immune system or preventing you from getting infections the data here is a lot trickier. It’s very difficult to make a healthy person more healthy; the first thing you have to say. And secondly well there is some evidence for example a very nice study which is done in a group of factory workers which show that you are less likely to get the common cold. So there are some pieces of evidence out there to suggest…

Dr. Soram: Could you say that one more time Dr. Quigley, it broke up?

Dr. Quigley: This was a study done in a group of factory workers in Europe, one group is given a probiotic, the other group were given a dummy; and the group with the probiotic had a lower likelihood of getting colds and flu’s during the winter season. 

Dr. Soram: Very interesting, you see a lot of that talked about on the internet in the lay articles.

Dr. Quigley: But there aren’t a lot of those type of studies so I guess I would be fairly cautious in terms of the evidence for immune boosting effects now having said that, we ourselves here in Cork recently published a study in normal people where we showed that a protective probiotic could boost your immune system through stimulating chemical transmitters which suppressing inflammation so there are strands of evidence t which suggest that probiotics might help to boost your immune system to stay off infections but the data is not as complete as you would like it to be.

Dr. Soram: Okay but it sounds like your study that you did in Cork was encouraging in that direction.

Dr. Quigley: Correct but there are other studies out there that provide similar data but you need to do very big studies in large number of people before you can conclusive you say that everybody should be taking probiotic because it w ill do A, B or C.

Dr. Soram: Yes, so now are all probiotics the same we see in America we have so many brands of probiotics and they are all advertising now they are even on TV you go to the store you see an entire wall of probiotics with all sorts of claims, are they all the same?

Dr. Quigley: Absolutely not.

Dr. Soram: Okay.

Dr. Quigley: If there is anything that I’ve said that is of any importance today it is this that no two probiotics are the same. And I’ll give you a very good example; one of my colleagues here in cork who is a molecular microbiologist he took a probiotic which we’ve studied at [large] which we have shown has anti-inflammatory effects which we have shown is beneficial in some gastro-intestinal conditions, he took this probiotic and he deleted just one gene from the genome of this probiotic and showed that it had lost all of its effects.

Dr. Soram: Oh my gosh, was that the Bifidus…, was that the Infantis?

Dr. Quigley: Bifidobacteria Infantis 35624 yeah, So that’s an example of how the most subtle change in a probiotic can alter its function, and I think this is one of the big problems of the consumer faces that as you said they’re deluged with claims some of which are based on the actual probiotic that they’re looking at, some of which are extrapolated from other probiotics, not even from the same strain from a different species and that’s totally inappropriate.

Dr. Soram: Okay, yes I just want to explain to my audience that what your colleague did was to change one gene in that particular strain of probiotic and just with that one change in one gene it lost its effectiveness?

Dr. Quigley: Correct.

Dr. Soram: So that’s how subtle these differences are. So if they’re not all the same, how do I differentiate probiotic strains and what do I do when I go to the health food store?

Dr. Quigley: Well I think unfortunately right now because of the way these products are regulated the consumer has a tough time. We know also and this may sound scary that researchers have gone out there to stores, taken samples of probiotics or claimed to be probiotics off the shelf, taken them to the laboratory and studied them and found that first of all they didn’t contain any live organisms which they were supposed to.

Dr. Soram: Wow.

Dr. Quigley: And secondly that they didn’t even contain the strain that they were supposed to contain.

Dr. Soram: Oh my Gosh, okay.

Dr. Quigley: So like the only words of advice I can tell you are; firstly I think if you stick to reputable manufacturers or reputable companies. 

Dr. Soram: Yes

Dr. Quigley: My feeling is that they’re unlikely to risk having a faulty product out there.

Dr. Soram: Right.

Dr. Quigley: Because it will be a damage to their reputation and secondly try and get as much information as you can about a particular product from reputable sources, and there are reputable sources out there, whether they’ll be medical organizations, consumer organization that give you some background information.

Dr. Soram: In our country there’s just not a lot of regulation of the natural food industry and as my listeners know, I wrote a book on vitamin D and have my own brand of Vitamin D and the Multiple Sclerosis Consortium in America bought 10 brands of vitamin D, just a simple vitamin D from the health food store and found that none of them contain the amount of vitamin D stated on the label, and they average 34% of the label. So this regulation is very challenging to make sure we’re actually getting what the label says, so Dr. Quigley do probiotics- we‘ve touched on this- so what are your thoughts about its ‘stimulating the immune system’? If you have a proper probiotic can it do that? 

Dr. Quigley: Well again, it will depend on the particular strain and it will depend if the strain has been studied under proper scientific situations, if it has been studied and if it’s been shown to affect the immune system, then yes, but again one has to be very careful, one has to look at this very critically and one has to be absolutely sure that the proper studies have been done and that the effects which are claimed were demonstrated.

Dr. Soram: Yes, so now are there particular strains that you are able to mention to us that have had demonstration of their effectiveness?

Dr. Quigley: Well I will just mention some of the strains that are being worked on here in Cork, which have been Bifidobacteria Infantis, Bifidobacteria breve, but even within those there have been individual strains which have been studied more than others and a number of these have been shown to have effects on the immune system. But it would involve getting in to a lot of details to really lay this out completely so I think it’s just… I feel the bottom line is that, yes specific strains have been shown to have effects on human immune system and in some cases that has been to translate in to clinical benefits, but they’re very restricted examples.

Dr. Soram: Fantastic yes and in your book which I loved, it’s actually a booklet, so it very concisely says Probiotics and Digestive Health, there are some specific strains mentioned which have been shown to be effective and I will put a link to Dr. Quigley’s book in the short notes for today, so people can finds it easily. Now we can also get probiotics from food sources such as yoghurt, is it more effective to get probiotics from food, or is it more effective to get it in supplements?

Dr. Quigley: Well again it comes back to the particular strains, some strains are delivered optimally in certain formats, others are delivered optimally in other formats. And here again we get in to a lot of technical issues, you know?

Dr. Soram: Yes.

Dr. Quigley: Has the manufacturer shown that the probiotic survives in that particular format that they’re selling it in, have they shown that it will survive under refrigerated conditions only or on the shelves and at room temperature or in the extremes of temperature. So as long as the manufacture has shown that, that is the optimal condition in which that for which to present that particular probiotic to the consumer, that’s fine. So yes probiotics can be presented in whole variety formats, buy the question I would always ask is, and have they actually done the quality control? 

Dr. Soram: So basically what I’m getting a picture of this is that, we take a probiotic whether it’s in the food or capsule, there’s a lot of variables between the time we put it in at hand to take it, and the time that it reaches the large intestine, which is its ultimate goal, is that correct?

Dr. Quigley: Correct.

Dr. Soram: Okay so…

Dr. Quigley: It actually could be the smaller intestine or the larger intestines, that’s one of the areas that needs a lot more study, but it is possible.

Dr. Soram: For my listeners lets look at the areas where things could perhaps not work out not work out. For example you said that the product they bought in the store doesn’t have any living organisms obviously dead on arrival so to speak…?

Dr. Quigley: Correct, we’ll put.

Dr. Soram: But other things, for example suppose it has some living organisms and they swallow it, what happens for example with stomach acid, is it possible you can get deactivated by stomach acid?

Dr. Quigley: Very good question, not only stomach acid but bile or the normal digestible enzymes, all of these can destroy organisms. So one of the fundamental parts of the process of development of a probiotics product is to demonstrate that it will survive stomach acid and bile and digestive enzymes, the term that we use for this, we say it will survive transit through the intestine. 

Dr. Soram: Yes okay and so then it reaches the small intestine perhaps which I want to talk a lot about with you and then but ultimately the large intestine where they normally lives and then does it have o be in a particular form for the large intestine to receive it or to utilize it, or once it gets to the large intestine its home free? 

Dr. Quigley: Well again it depends on-that’s a very interesting question-, and there’s quiet a lot of science I hope behind the answer I will give you. 

Dr. Soram: Yes.

Dr. Quigley: Here when it gets to the intestine, a lot of it’s properties will vary, if for example you want the probiotic to engage with your immune system and to boost your immune system or affect your immune system or decrease information, then obviously it will be very important that the probiotic gets directly onto the lining of your intestine. 

Dr. Soram: Yes okay.

Dr. Quigley: So its ability to do that would be critical.

Dr. Soram: Yes okay.

Dr. Quigley: In other circumstances where you want the probiotics to perhaps affect your digestion or ability to deal with the products of food that will happen in what we call the lumen and other words in the fluid of the intestine, so attachment will not be important. So again it will depend on the specific effects but once the probiotic organism reaches the lower parts of the small intestine or the colon the large intestine, then the biggest you’d have to deal with are all the bugs that are normally in there. Can it survive there, can it have the right conversation with the other bugs, without the other bugs kind of knocking it out, these are important issues.

Dr. Soram: Yes, now what about things that people eat regularly like yoghurt and kefir? We’re always told get our probiotics take yoghurt, I have some of my colleagues will tell their patients when they give an antibiotics for sinuses, eat some yoghurt or have some kefir, is that helpful? Does yoghurt and kefir and those kinds of fermented products have bacteria which are likely to get through and be able to affect the lower smaller intestines and the large intestine?

Dr. Quigley: Some of them will some of them won’t.

Dr. Soram: Okay.

Dr. Quigley: Again it will depend so we get back to the same story it depends on how well studied they are and whether they have been well studied et cetera.

Dr. Soram: Okay and do at least in Ireland or in Europe have you seen- I have not seen it in America-the yoghurt companies study this type of thing or they just tell people to assume it’s getting through?

Dr. Quigley: Oh absolutely like some of the yoghurt companies have extensively studied their products. I’m not going to mention particular companies but I know of a number of companies that have done extensive studies on a number of strains and shown not only that they survive and get all the way to where they are supposed to but actually have clinical benefits. 

Dr. Soram: Fantastic so I would encourage my readers those kinds of studies which certainly show up on the websites of these yoghurt companies they would be proudly talking about them and so people eating yoghurt and kefir for the benefit of the probiotics might want to look things up before they buy a particular brand?

Dr. Quigley: Absolutely, it involves a little bit of work but I think it’s worth it. 

Dr. Soram: Yes now Dr. Quigley how effective are probiotics for actual digestive problems and here I particularly I want to talk about the ubiquitous and so common Irritable Bowel Syndrome and that so many people have IBS. How effective are probiotics for that? 

Dr. Quigley: Well I’ll start with maybe just saying a few words about probiotics and digestive disorders.

Dr. Soram: Yes.

Dr. Quigley: By making a simple statement I think overall the best evidence for clinical when I say clinical I mean for benefits for probiotics in people with symptoms, with complaints, with problems isn’t digestive disorders.

Dr. Soram: Yes.

Dr. Quigley: Which makes sense.

Dr. Soram: Of course.

Dr. Quigley: If you think about it.

Dr. Soram: Yes.

Dr. Quigley: Now with regard to Irritable Bowel Syndrome I will make a few simple statements again. Overall as if you take all of the data out there from all of the probiotic studies in Irritable Bowel Syndrome and throw them all together you’ll find that overall there is the benefits from probiotics.

Dr. Soram: Okay.

Dr. Quigley: But that’s an over simplification because when you throw them all together you’ve got some studies which are positive some which are negative, some which were very positive and some maybe kind of so-so. But overall and this has been done there is a scientific way that this is done it’s called a meta-analysis.

Dr. Soram: Yes.

Dr. Quigley: And there have been several meta-analyses done on probiotics and IBS and they have all come up with the same answer.

Dr. Soram: Yeah.

Dr. Quigley: They seem work.

Dr. Soram: Okay now a big subject tied in with the Irritable Bowel Syndrome. I treat many patients for what's called Small Intestinal Bacterial Overgrowth we abbreviate it SIBO and I’m on the staff at [Cytosiner] and I have been taught by the doctors at [Cytosiner] who specialize in this they tell patients never to take a probiotic because they say it can start up their SIBO again. But based on what we’ve been saying so far that may not be true and I’d really like your thoughts about this. Do you agree with this or there are some probiotics that might actually help these patients with SIBO?

Dr. Quigley: Well first of all I’m struggling to think of any scientific basis for that contention.

Dr. Soram: Okay.

Dr. Quigley: Like Small Intestinal Bacterial Overgrowth and the symptoms that relate to that arise from the presence of certain bacteria in the small intestine which actually can damage the small intestine. 

Dr. Soram: Yes.

Dr. Quigley: Whereas probiotics by definition shouldn’t do that.

Dr. Soram: Okay. So a bacterium is not a bacterium that is what you’re saying?

Dr. Quigley: Yeah it’s just not all bacteria are the same which is the same thing so the issue with Small Intestinal Bacterial Overgrowth is that, yes probiotics that actually been studied in the Small Intestinal Bacterial Overgrowth.

Dr. Soram: Yes.

Dr. Quigley: They haven’t been particularly effective but I think they at least theoretically could be effective. Where I would think and I will emphasize here this is purely theoretical I have no evidence to support this. 

Dr. Soram: Yes.

Dr. Quigley: Where I would see that if you have somebody with Small Intestinal Bacterial Overgrowth and you treat him with an antibiotic then of course you have to stop the antibiotic at some stage.

Dr. Soram: Right.

Dr. Quigley: And it would make sense to me that giving a probiotic at that stage might be a good idea because it might prevent the bad bacteria from coming back.

Dr. Soram: Okay.

Dr. Quigley: But I will emphasize that that is purely my hypothesis I have no data to support that. So I would have thought that the antibiotic probiotic sequence would make a lot of sense in bacterial overgrowth.

Dr. Soram: Okay. Excellent to know and the probiotics because they are not going to be the strain of bacteria that’s in the Small Intestinal Bacterial Overgrowth should not be harmful or kind of reignite the bacterial overgrowth in your body?

Dr. Quigley: Unless they know something that I don’t know but I have never heard of this before.

Dr. Soram: Excellent, I think that would be very information for all my listeners and also for my patients because we have gone round and round on this in my practice so to continue on. Are there any side effects from taking probiotics?

Dr. Quigley: Very good question. I wouldn’t say side effects but what I would say is that when you go on a probiotic which means that you’re possibly introducing a new strain of bacterium into your intestine or you’re introducing more of a strain that you normally have there maybe what I would call an adjustment period. In other words, for…

Dr. Soram: Yes. What does that mean?

Dr. Quigley: What I mean and this has been our experience is that for a couple days or so there maybe a little bit more gas a little bit more bloating et cetera. As your system gets used to the new bacterium but that is usually very short lived and I wouldn’t call it a side effect I would call it an adjustment. 

Dr. Soram: Okay great. Have you ever seen anybody ‘allergic’ to a probiotic?

Dr. Quigley: Never.

Dr. Soram: Okay I wouldn’t think so either but patients asks me that question.

Dr. Quigley: Yeah.

Dr. Soram: Now how safe and effective are probiotics for children and even for pets?

Dr. Quigley: Actually we have done quite a bit of work in animals. 

Dr. Soram: How great, yes.

Dr. Quigley: For probiotics and one of the reasons for this is that one of our research partners here in Ireland is the National Animal Research Facility of our Department Of Agriculture.

Dr. Soram: Beautiful.

Dr. Quigley: So they do if they mostly do work on farm animals but they also do work on domestic animals and so they are very interested in probiotics and factored some lovely data to show the probiotics for example can help to treat and prevent mastitis in cattle diarrhea in other farm animals et cetera. And in fact we did work a few years ago to show that probiotics have benefits for dogs.

Dr. Soram: Wow! Fantastic.

Dr. Quigley: Yes so that one response. The other side of it with regard to children,

Dr. Soram: Yes

Dr. Quigley: Probiotics are certainly safe for children and there are two pieces of evidence I would like to talk about with regard to children and probiotics.

Dr. Soram: Yes.

Dr. Quigley: The first is probably of all the conditions which probiotics have been tested. The best most consistence evidence is in the treatment or prevention of daycare diarrhea. 

Dr. Soram: Yes.

Dr. Quigley: There have been many studies which have looked to this and they show that probiotics can shorten the duration of diarrhea and all these viral infections that kids pick up in daycare and can prevent them from getting severe so that’s the first thing. The second thing which is completely different and at the totally end of the scale in terms of severity of illness is in a very severe and often tragic condition that occurs in tiny little infants that are born prematurely and that the condition called necrotising enterocolitis.

Dr. Soram: Yes.

Dr. Quigley: And it’s a devastating condition.

Dr. Soram: Yes.

Dr. Quigley: And there is no very good evidence that probiotics can help to reduce the mortality and the illnesses related to this condition in these infants. So there are two examples from children. 

Dr. Soram: Fantastic so now for pets because a lot of my listeners have pets and dogs and cats I would it be the same strains that would give a human or would there be different pet probiotics so to speak? 

Dr. Quigley: Again I’m going to say boring here but I just said it’s almost like a mantra like it could be it is you have to see what strains have been tested in that animal and have been shown to be beneficial and as I mentioned earlier some work that we did in conjunction with a company that makes animal food in the US and show that a particular strain was beneficial in dogs and that strain is available commercially but again I don’t want to mention specifics because I don’t want to sound as if I’m pushing any particular product.

Dr. Soram: Yes re you able to mention the strain without saying the brand name?

Dr. Quigley: It won’t mean anything without mentioning the brand name unfortunately.

Dr. Soram: Okay, good fine. Now do you have any other thoughts on SIBO Treatment, standardly now in America we’re using Xifaxan, sometimes we combine it with Neomycin if the patients have a lot of methane gas in their small intestine.

Dr. Quigley: Yes.

Dr. Soram: Do you have any other thoughts on the treatment of SIBO since you’ve studied …your research in your neurogastroenterology and so on; I’d really like your thought on that Dr. Quigley.

Dr. Quigley: First of all the first point I have to make is that Rifaximin which is the scientific name for Xifaxan is not available in most countries in Europe. It has not yet been approved; it’s available in Italy where the drug was originally developed and its available in Spain but not in Ireland or Britain or the rest of Europe. So my experience with Xifaxan is very limited, and unfortunately one of the problems with Small Intestinal Bacterial Overgrowth is that there have been very, very few good studies of any regime so when I’m treating Small Intestinal Bacterial Overgrowth I test something to see if works. If it works fine, if it doesn’t I try something else. So unfortunately there’s a lot of trial and error here.

Dr. Soram: Yes.

Dr. Quigley: I mentioned the benefit of probiotics but I have to immediately say that I don’t have any scientific evidence to back that up.

Dr. Soram: Yes and any particular diet, in America we have what’s called Low FODMAP diet, any particular diet that you recommend for people with SIBO?

Dr. Quigley: Well the Low FODMAP diet, I don’t know that there’s any link between that and Small Intestinal Bacterial Overgrowth, the FODMAP diet was developed in Australia by a dietician and a gastroenterologist that freed bloating and gas related symptoms in Irritable Bowel Syndrome. That could be related to bacterial effects I don’t know but I certainly have used that diet n people with a lot of bloating, not very extensively because at this moment in time in Ireland we don’t have a lot of dieticians who are trained in the use of this diet so my experience again has been limited but certainly I think this is very interesting. I’m convinced that diet is an important aspect of IBS, but it’s a complex issue.

Dr. Soram: Yes.

Dr. Quigley: And I think interactions with the gut microbes could well be important but we need a lot more research on the whole issue and Irritable Bowel Syndrome in terms of its role in causing symptoms, in terms of its role in treating people, in terms of its interaction with other treatments. There’s a lot we need to know about this.

Dr. Soram: Yes indeed and you’re doing research in that area, I’m I right?

Dr. Quigley: Yes, correct.

Dr. Soram: Fantastic. Now I’ve been reading in some of my literature about people with Ulcerative Colitis and Crohn’s disease, receiving bacteria from other healthy people’s colons. So I’d like you to comment on that and maybe tell us a little about that research and also this brings along the idea that kind of everybody has a unique set their micro-biome which is the friendly bacteria in their intestines is it unique to them or is there overlap between people? Please let us know some more information about that.

Dr. Quigley: Sure, okay. Well this is a very interesting question; the first issue is about the differences or similarities between bacteria from one individual to another.

Dr. Soram: Yes.

Dr. Quigley: There are some broad similarities but when you get down to the details, everybody is probably a little bit different but there are broad like if you look at bacteria are categorized in a very complex way into strains and species and phyla et cetera. In the same way that the animal kingdom is … and when you get to the very big categories then you do see similarities between groups of people. When you get down to the details you will, see it’s almost like a fingerprint.

Dr. Soram: That’s the way I think of it. Okay.

Dr. Quigley: That’s the first point. Now this whole… people call it fecal transplantation; this fecal transplantation issue has been around for sometime, it was originally developed by actually somebody who is good a friend of mine and we actually did work together many, many years ago, his name is Tom Borody and he works in Australia. And he came up with this idea and initially the idea is supposed to be used to treat people who had persistent infection with this Clostridium difficile bug which is such a problem in all of our hospitals.

Dr. Soram: Indeed.

Dr. Quigley: And it’s a cause of colitis, it’s unfortunately it’s a type of colitis that arises in people who get antibiotics. And it’s as if you knock out the good bacteria with the antibiotic and then these bad bacterium kinds of sneaks in and takes over and causes illness. And some people respond dramatically well to specific antibiotics for this treatment, some unfortunately do not how they keep on getting recurrent infections. So Dr. Borody came up with the idea that how about if you just change their bacteria completely and he did this and in fact several other research groups including number in the US have shown that this works in this particular instance. So obviously the question was asked well if it works in these particular situations could it work in other situations. And while it is certainly an attractive idea, my understanding at this moment in time is that there is not enough scientific evidence to recommend this as a treatment for any other condition other than this Clostridium Difficile colitis at the moment. But it’s a very interesting idea.

Dr. Soram: Yes, and in my own practice I’ve used Saccromyces boulardii with great results for C. difficile infections.

Dr. Quigley: Yes and there is considerable scientific data, there’s probably more data to support Saccromyces boulardii than any other probiotics in that arena.

Dr. Soram: Yes now…

Dr. Quigley: But I think the people who are doing intestinal transplantation, they’re really looking at a group of people who failed everything including Saccromyces boulardii it’s a small population but that’s really going way beyond the group.

Dr. Soram: Our conversation yes.

Dr. Quigley: Exactly yeah.

Dr. Soram: Okay, now I know you’ve spent sometime in researching Bifidobacteria Infantis with a special number I think it’s 3654 or … 

Dr. Quigley: 35624.

Dr. Soram: That’s it, can you tell us a little about that unique very special probiotic?

Dr. Quigley: This is a probiotic which was isolated or which was discovered here in [IB] many years ago and it was actually an organism that was found in the intestine of a normal… it came from the small intestine of an individual. And over the years my microbiology colleagues had extensively studied this organism and looked in the laboratory at its ability to resist acid and bile and digestive enzymes but also its ability to engage with the immune system and to alter the immune system. And what has been shown in a variety of laboratory studies and also in human studies is that this probiotic organism seems to be capable of anti-inflammatory effect in other words it can reduce inflammation. In a situation of inflammation it can switch off the chemicals that are driving inflammations and switch on chemicals that will suppress inflammation. 

Dr. Soram: And that has to do with interleukins, is that right?

Dr. Quigley: Exactly it is these…

Dr. Soram: 10 and 12.

Dr. Quigley: These interleukins these cytokines… particularly it seems to be particularly effective t increasing the levels of interleukin 10 or IL-10 which is an anti-inflammatory cytokine.

Dr. Soram: Yes.

Dr. Quigley: And at least we’re suggesting this may be the basis it’s benefits in Irritable Bowel Syndrome because we’ve done a lot of research over the years and shown that kin Irritable Bowel Syndrome there is a very slight but very definite switching on of the inflammatory system.

Dr. Soram: That’s interesting, excellent. Well Dr. Quigley I personally have learned from you today and I know my listeners as well have learned about probiotics from our conversation today and I want to thank you so much. Is there a way for listeners to find out more about you, do you have a website or anything like that?

Dr. Quigley: Well the website to go to would be the website or our research centre, Alimentary Pharmabiotic Center and it’s a very simple website it’s  HYPERLINK "http://www.apc.ie." www.apc.ie.

Dr. Soram: Great I will put that in the show notes and your research and information about what you’re doing is on there?

Dr. Quigley: Exactly.

Dr. Soram: Okay, fantastic now as far as your books I saw that you’ve written several books for lay people. the one I mentioned at the beginning of the show is just recently up; Probiotics and Digestive Health; A Gastroenterologist Perspective, will they be able to get your books on that website or they can get on Amazon or where would they go?

Dr. Quigley: They’re on Amazon.

Dr. Soram: Okay and what…

Dr. Quigley: I just want to correct you it’s actually www.apc.ucc.ie.

Dr. Soram: Okay say that one more time then please.

Dr. Quigley: It’s www.apc.ucc.ie.

Dr. Soram: Okay.

Dr. Quigley: But if they just put in Alimentary Pharmabiotic Center, they’ll get it.

Dr. Soram: Okay, I will have a link in the show notes for my listeners. Now also this video; Micro Warriors- the Power of Probiotics which you were the medical advisor I think on; tell us just a little about this DVD.

Dr. Quigley: Well this is a very accessible and very well produced video which interviews a number of really the world experts on probiotics; I ever gave some advice with regard to this I’m not interviewed so I can say that there for people without sounding pompous but they really are world experts in the basic science and in clinical aspects of… and I think your audience will find it very exciting; very well presented.

Dr. Soram: Yeah, I personally enjoyed it very much.

Dr. Quigley: And a lot of very good information.

Dr. Soram: Yes and I understand there is a Micro Warriors2 coming out next year which I think you are interviewed in, is that right?

Dr. Quigley: I hope so.

Dr. Soram: Okay.

Dr. Quigley: I look forward to that.

Dr. Soram: Okay fantastic. Alright Dr. Quigley well I’m so grateful and I know my listeners are going to be so grateful for this wonderful interview and learned so much, I really appreciates so much your coming on all the way from Ireland for this interview and I hope to be able to remain in touch with you thank you so much for coming on with us today.

Dr. Quigley: It’s been my pleasure I really enjoyed and I say a big hello from Ireland to all your listeners.

Dr. Soram: Thank you so much very best wishes.

Quigley May 2012 Probiotics

About Dr. Soram Khalsa

As an MD, Dr Soram specializes in Integrative Medicine combining diet, nutrition, acupuncture, herbs and nutrition. Visit Dr Soram’s Healthy Living Store where you’ll find high-quality nutritional supplements: