 Hi, this is Dr. Ruscio, and did you know that many cases of anxiety can actually be caused by your gut? And let's discuss a systematic review that reviewed all of the available randomized control trials establishing, thankfully, that treatments for your gut can actually improve your anxiety. Now, here's a study by Yang et al. published in the Journal of General Psychiatry, and I'll put the abstract up here on the screen entitled, Effects of Regulating Intestinal Microbiota on Anxiety Symptoms, a Systematic Review. Now again, a systematic review will oftentimes review the available randomized control trials and summarize the findings. So this is arguably the highest level of scientific evidence, and thankfully, what they've concluded as I'll outline here in a moment, is that treatments for the gut can improve anxiety. So let's dig into some of the details. Now to quote, more and more basic studies have indicated that gut microbiota can regulate brain function through the gut brain access, and dysbiosis of intestinal microbiota was related to anxiety. However, there is no specific evidence to support treatment of anxiety by regulating intestinal microbiota. Well, I would not agree with that, but this is what they're trying to rectify. So the aim of their study, to find evidence supporting improvements in anxiety symptoms by regulating intestinal microbiota. Now intestinal microbiota is another way of saying the world of bacteria and fungus and other like organisms in your gut. So let's continue. Methods. This systematic review of randomized control trials looked through 3,334 articles, and only 21 were high quality enough to be included in this analysis with a total of about 1,500 patients over the 21 studies. Now here's where things get really exciting. Let's look at the effect of the treatment study. 14 studies chose probiotics as an intervention, and six chose non-probiotics, mostly diet The diet most often used, although not exclusively, was what's known as the low FODMAP diet, a diet that helps to starve bacterial overgrowth, which can be problematic, can cause gut symptoms, can cause inflammation, and through the gut-brain connection, can cause anxiety. Now regarding probiotics, you'll hear claims that a certain special probiotic is the best for anxiety or depression. And for years now, I've been saying that probiotics are not that specific. Probiotics are not like drugs that operate on a very narrow pathway or mechanism, but rather probiotics in helping to heal and rebalance the gut can have a wide array of improvements that they lead to because they are oftentimes treating the underlying cause, gut imbalances of multiple symptoms. This is how we can see different probiotic formulas show improvements in things like skin, various skin conditions, various allergic conditions, various neurological conditions, as we're discussing here, anxiety, but also other evidence showing improvements in things like depression, and the ability to fight various bacteria and fungus in the gut and improve symptoms of IVS, gas, bloating, constipation, luscious, and diarrhea. And thankfully, regarding the probiotics, again, a specific special probiotic formula was not needed. These probiotic formulas from single strain all the way up through multiple strain probiotics all showed benefit. So what that tells you is you don't have to be highly prescriptive or specific with the probiotic that you use, and you don't have to be held hostage necessarily by marketing claims that you must use only this probiotic or that probiotic in attempts to improve your gut brain connection and therefore your anxiety. And here's where things get really exciting. And I'll quote, 56% of studies could improve anxiety symptoms. So 56, over half of the studies, whether they're using probiotics or diet, most namely the low-fat net diet, show the ability to improve anxiety. That is huge. If you look at the outcome of many medical interventions, a 50% response rate is pretty darn good, especially for conditions that can be multifactorial in cause as anxiety can. So let me now redo their conclusion, and I'll quote, we find that more than half of the studies included showed it was positive to treat anxiety symptoms by regulation of the intestinal microbiota, or just treating your gut. There are two kinds of interventions, probiotic and non-probiotic. Remember that the most oftenly used, although not exclusive, non-probiotic intervention was a diet known as a low-fat net diet, to regulate intestinal microbiota, and it should be highlighted that the non-probiotic interventions were more effective than the probiotic interventions. This makes sense. It makes sense that diet should come first before using a supplement. So great. More studies are needed to clarify this conclusion, since we still cannot run meta-analyses so far. So a little bit of caution there, meaning that a meta-analysis would mean there's many like studies that can be summarized to give a specific numeric score of the efficacy or effectiveness of the treatment. So we're still short of that. However, for those who are looking to an anti-anxiety or an antidepressant medication or natural therapies, it certainly seems tenable to start, at least with a reasonable trial, on diet and probiotics, see if your symptoms improve, and if not, then consider medication. And I would always do this under the guidance of your doctor when keeping your doctor in the loop. But great news here that those who are suffering with anxiety have some great natural nutritional and supplemental options that have at least some high-level preliminary evidence supporting their effectiveness. Now, what can you do? Well, we want to improve the health of your gut or improve the health of your intestinal microbiota. And there are really three things I'd recommend here specifically in light of both my clinical experience and what this study has found. One, improve your diet. You don't necessarily have to go to the low-fog-map diet right out of the gate. That's a little bit more of a specialty diet. If you haven't gotten sodas and sweeteners and sugars and processed foods out of your diet, of course, start there. Focus on cooking all of your own food and consuming whole, fresh foods. Nothing prepackaged, nothing processed, buying meat, vegetables, fruit, fish, eggs. Start there. Now, if you're already doing that, then you can go to a trial on the low-fog-map diet. And I will put our low-fog-map diet up here on the screen and also link to it. And I believe this to be one of the most up-to-date low-fog-map diets available because we do follow the research literature here closely and update continuously our low-fog-map diet as new evidence becomes available regarding the Fog-map content of various foods. So basic dietary changes, if you're already there, low-fog-map diet, and you only need a couple weeks to start seeing improvements from this diet if it will work for you. Now if you've given this diet a few weeks and you're not noticing any movement of your symptoms, any improvement, then you can go on a probiotic protocol. Now again, the probiotics are not highly specific. However, I have found it very effective to try a well-rounded probiotic protocol. Some people will not fully respond to just one probiotic or one strain of probiotic because they need more of a litany of healthy probiotics. And that is why I've developed the three category system, which ensures that you will have one good probiotic formula from the three major categories. And I've linked to all the information here. I'll also put just a quick screenshot of what that looks like up here on the screen. But essentially, when we look at the probiotic research, we see that amongst all the hundreds of studies, we can organize most probiotics into one of three categories. And you want to try all three of these categories in combination to help give you about the broadest, healthiest probiotic stimulus possible. And this can be the difference between the sex and failure for some people. You also want to make sure that you're using a quality probiotic. Of course, some companies will cut corners and not put very much bacteria in there. We'll put a lot of filler in there for be able to have a very cheap probiotic. However, you're getting what you pay for. It's also not to say that the most expensive probiotic is the best. There is a balance here to be struck. And I think we've really achieved that in the three category probiotic protocol that we recommend. So in close, if you have anxiety, fortunately, there's some very high quality preliminary evidence showing that various treatments for your gut, most namely a low FODMAP diet and probiotics, can be effective and can improve your anxiety. And so if you're suffering with anxiety, don't suffer another day. Take some steps to perform these simple interventions that can not only improve your anxiety, but if you, let's say, have constipation or abdominal pain and anxiety, these dietary changes or probiotics could help with all of those symptoms. So when we use natural medicines that treat the cause, we often time see side benefits rather than side effects and you are positioning all the rewards of that. So again, this is Dr. Ruscio reporting in on a very exciting systematic review on the power of the gut brain connection and how you can use this to improve your anxiety. And I hope this information helps you get healthy and get back to your life.