 Hi, this is Dr. Ruscio, and let's discuss an exciting new development in the treatment of IBS and SIBO. And I'd like to tell you about my experience with immunoglobulins, which are essentially a way of taking a supplement that can help to restore the mucus membrane of your gut. The function of the mucus membrane in your gut, in part, is to bind toxins and irritants that can cause gut damage, irritation in the gut, and start this whole cascade of inflammation and dysfunction. And so, thankfully, there is a way now to take immunoglobulins in a supplemental form orally as a capsule or a powder that can help to restore that vitally important gut barrier. So I'd like to tell you about my clinical experience with immunoglobulins, and there's a few points here that I think are worth expounding upon. So I keep my ear to the ground in terms of what's being published in the clinical research, and that's an important first step. But it doesn't stop there, because there are certain compounds that look favorable at first, but actually don't end up being that effective. And what this is known as is publication bias or selection bias. When there's a new therapy, usually you only see positive studies being published about that therapy, because no one really cares about a new study on a compound, on a new compound that doesn't show any benefit. So it's usually the novel findings that are published first, and then over time, you see a leveling out of what is published in the literature. So at first, there can be a skewing towards positive in the clinical literature. So you want to first look at what's being published in the clinical literature, but then also experiment with something in your practice to determine if what happens with people when you're actually trying this is representative of what's being published in the clinical literature. After going through both of these, after watching the clinical literature, I was satisfied with what was being published there. There was at least enough evidence to justify a trial in my clinical practice. And after about four or five months of utilizing immunoglobulins in my clinical practice, I could clearly see that this was a therapy that stood out relative to many others. It was clearly more effective than many and makes me feel comfortable endorsing and telling you more about immunoglobulin therapy. What's especially helpful about immunoglobulins is they seem to be able to help with patients who have been otherwise nonresponsive to other therapies. You may have improved your diet. You may have used probiotics. You may have even used if you have a fungal overgrowth or a bacterial overgrowth, a antibiotic or a fungal or even some type of herbal antimicrobial and not really seen any results. And the missing piece here in some cases may be all of those therapies are trying to treat the microbiota, the colony of bacteria and fungus, which can be very helpful. However, the missing link may be this other avenue of therapy, which is supporting the immune system in the gut. And this is where immunoglobulins are unique. And again, immunoglobulins are essentially what constitutes that secretory IgA lining in your gut. So you've heard of the mucus lining in your gut, the secretory IgA. There's also IgG and IgM. That's what immunoglobulins are. And so regarding the immune system, it's important to contextualize this where one really needs to have both a healthy microbiota and a healthy immune system in order to have a healthy gut. In some cases, what I think happens is a lot of work is done on the microbiota. So someone works with probiotics or diets or they maybe even use antibacterial or antifungal agents for a suspected overgrowth. And they do a lot of work to modulate in a healthy way the balance of bacteria and fungus, but they miss the immune system. And these two have to live in harmony in order for there not to be inflammation, leaky gut, or other types of gut dysfunction or symptoms. And this is where I feel the immunoglobulins are novel and helpful in that they support the immune system and don't solely focus on the microbiota. Now what kind of evidence do we have for this claim? Because it's one thing to conjecture at these mechanisms, but we really have to have evidence showing that supporting this mechanism, the immune system, can be efficacious for humans in interventional trials. So there's certainly a wealth of preliminary clinical literature to date. There have been nine quality trials in humans that have shown immunoglobulins can help. Now, could the data here be better? Yes, we could have 15 clinical trials summarized in a meta analysis, but I feel we at least have enough preliminary evidence to say this is a therapy which is worth consideration, especially if you're a patient who's been through other treatments and hasn't seen the results that they've been looking for. Now, what's exciting about this is in some of the research these immunoglobulins are being used in patients who haven't responded to other therapies and then showing benefit. And this is the most challenging subgroup to obtain results with, and it's really one of the most exciting findings, which is to say that if you're someone who's been using other therapies and not seeing the response that you're looking for, immunoglobulins have looked at similar patients and shown benefit roughly 70% of the time in the research that's been published. So again, some of these studies have put patients on diet, probiotics, soothing agents, antispasmodics, and shown failure to all these therapies and then seeing about a 70% response rate with immunoglobulin therapy. And again, it's likely because of the immune support that's occurring there. And this is really worth repeating. I think the most exciting study here was performed by Leonard Weinstock, who is a gastroenterologist. And in this patient group, patients were diagnosed with either SIBO, IBS, or BOLF, then offered a few different treatment options in a double-blinded fashion. So they may have been given a low-fob-map diet, probiotics, antibiotics, antispasmodics, soothing agents, and none of the patients really saw a full response from any of these therapies. Then they were given immunoglobulin therapy. And in this study in particular, a 75% response rate was noted, which is pretty remarkable given the recalcitrant of this group. Now there's also more science. There is one randomized placebo control trial, which is our goal standard that showed benefits, and also one large survey of 595 patients. And in that study, a 67% response rate was noted from an intestinal repair formula. And in a double-blind study, immunoglobulins cause significant improvement in abdominal pain, flatulence, urgency, loose stools, bloating, or any other symptom that was not on the symptom inventory issued by the researchers. So we certainly see that there is some compelling evidence. And here is a table summarizing that compelling evidence, the nine trials. The RCT is the one I've circled for you. And the RCS means a retrospective case series or case study. So yes, there is some good preliminary scientific evidence to support the approach of immunoglobulin therapy. Now what products are available? Well, this is where there's more good news. Initially, immunoglobulins were only available as a prescription medical food known as enterogam or immunolin. And over the past couple of years, this compound has not become available as a dietary supplement. And there's many different versions out there. There's only a couple that are research verified, meaning using the same formula that's been used in the research. This is where our intestinal repair formula comes in or immunolin or mega IGG 2000. These are the products I would recommend. The intestinal repair formula is the version that I've developed. I've been using the clinic and I've been very happy with. There are also other over the counter versions. Now there's an important caveat here, which is these over the counter, these other over the counter versions are not the same formula that's been used in the research. It's similar and it's likely similar enough still to yield benefit for someone using it. But if you can just as easily use something like intestinal repair formula or one of these other over the counter versions, my recommendation would be to use the version that's the exact research verified formula. Again, the difference here is probably not huge, but if I were a patient trying to improve my health, I really wouldn't leave this to chance. I would use what's the most proximal in this case exactly as it's been used in the clinical research to document benefit. These immunoglobulins are derived from cow material, bullvine material. So if you're vegetarian, there are some vegetarian options. There has been one study showing an egg-based formula can work. I haven't vetted all the literature on the vegetarian formula, so I can't say how effective they are. But if you are vegetarian, there's a number of vegetarian compounds to consider. I'm currently experimenting with some of these in the clinic and hopefully I'll be able to report back on what my preferred one is in the future. But again, I would recommend using the research verified version of an immunoglobulin, most namely intestinal repair formula, because that's what I've been using in the clinic. And again, the immunoglobulin formula I've been using, intestinal repair formula, what is it? It's a supplemental form derived from bovine serum of immunoglobulins, the immunoglobulins that constitute the lining of your gut, your gut mucosal membrane. And these are immunoglobulins that you have inside of you right now. In the lining of your gut, you have immunoglobulin A, IgA, IgG, IgM, and albumin. And that's what's in the intestinal repair formula. And by taking the intestinal repair formula, you help to bind toxins and irritants in the gut as we'll expand upon in a moment. And I should also mention that the immunoglobulin formulas are hypoallergenic. They're devoid of casein, whey, lactose, soy, and gluten and dye, as you can see here. So how specifically does something like intestinal repair formula help where other formulas have failed? Well, we know, again, that intestinal repair formula binds the irritants like bacterial fragments and other toxins in the gut. And there's been a few papers that have documented this. Now, if you look at this diagram here, you see what happens is these irritants initiate a cascade of damage and dysfunction of intestinal lining damage. And this leads to further immune activation and inflammation, leading to further leaky gut, leading to further intestinal inflammation. So there's this self-feeding cycle that becomes initiated when one's gut is not healthy. What I feel to be novel about the intestinal repair formula is it disrupts this self-feeding cycle and allows you to get off of this gut damage, inflammation, leaky gut, further immune activation, further gut damage. This cycle that patients can get stuck in, it helps to disrupt and interrupt that cycle, thus allowing you to heal. Also excitingly, one study has found, or at least suggested, that due to its healing effect, intestinal repair formula may actually improve nutrient absorption. Now, dosing and use. For mild cases, five grams a day is sufficient. For more severe cases, 10 grams per day, how do you identify what severity of case you are? I would quite simply do a self-assessment if you feel like your symptoms are fairly mild. Maybe they're annoying, but not debilitating. You would be more mild. If you feel that your symptoms are debilitating, they are significantly interfering with your quality of life or your daily activities, then more severe. And these are just a capsule form, so a simple capsule and you dose these with or without food with water. And it's really as simple as that. Now, what about duration? This is important. The initial response should be noted within one to two weeks. So you start on a intestinal repair formula and by one to two weeks, you should notice something. Not necessarily your entire improvements being realized, but you should be able to say, yes, I feel like this is working. If you're saying, I'm not really sure, I don't think so, then the formula likely is not for you. You could always continue for a little while longer. You want it to, but most patients will notice a difference within one to two weeks. Now, a peak level of improvement is usually seen by six weeks. So my recommendation would be once a peak improvement is noted, wait two to four weeks and then gradually decrease your dose. Decrease your dose until you are off completely or until you've been able to find the minimal effective dose. For some people, they'll be able to come off. Other people may notice they feel better on a minimal dose, but the goal is always to use the minimal effective dose to keep you feeling well. Reactions, do reactions occur? And a very small number of patients' reactions do occur. It's fairly rare. So intestinal paraphernalia generally well tolerated even for sensitive patients. And think of this as a gut detox which can be used periodically to reduce inflammation and calm down an overactive immune system response in your gut. Now, one study found an 82% response rate in digestive symptoms within six weeks. And what I've put up here for you is a Likert score from that study. And this is where I'm deriving some of my dosing and duration recommendations. As you can see, there's a large jump by two weeks and then people will start to level out around six to eight weeks. So this is where my recommendation is coming from in terms of your first window is one to two weeks and then you should be peaking in your improvement in around six to eight. Another important note is I would not recommend intestinal repair formula to be the first therapy that you try. Diet, there's a few different diets out there. Paleotype diet or elimination diet, low FODMAP diet. Probiotics and potentially treating any type of dysbiosis with either pharmaceuticals or herbal medications of various sorts. I would start there at very least with diet and probiotics before considering intestinal repair formula because there is a foundation you should lay in my opinion before using these. Okay, now let's move on to a case study with Matt. And this was a great case study. When Matt came in, he had inflammatory bowel disease or was previously diagnosed with inflammatory bowel disease. And many therapies that we utilize together had helped. Diet was helpful, an elimination diet combined with a low FODMAP diet was helpful. Probiotics were also helpful. Antimicrobial therapy was very helpful. And unfortunately while Matt was improving all along the way, he was still having setbacks and was still not getting to a point that we considered acceptable and acceptable level of improvement until we added intestinal repair formula. And that is when he saw long lasting improvements and a very significant jump in how he was feeling. And why? Again, it's likely because we were previously working to modulate dysbiosis or the microbiota or the bacteria in the fungus, which did help. But the missing component needed to be administered in tandem with that was support for his immune system which the intestinal repair formula achieved. And if you wanna see the full case with Matt, we recorded a patient conversation where we talked through his case. Very interesting case. I think a case that's very important because Matt had some ups and downs and on one's gut healing journey, invariably there will be ups and downs. So it's important to realize that you're not alone because when you hit a low point, it can be very discouraging. But if you have a good process that you're working through and you understand that you're gonna have ups and downs but you're gonna be trending upward the entire way, then it helps you see through those low points. And Matt's case was a beautiful example of that kind of psychological perspective but also the utility clinically of intestinal repair formula. And also Victoria who came in with food reactivity and histamine intolerance. And the big thing that Victoria was unable to do after doing quite a bit of gut work before seeing me was expand her diet. She was stuck in this very narrow realm of food that she was eating. And we gained some traction with other therapies but it really wasn't until we had her go and use intestinal repair formula and then after a few weeks report back and I quoted her here as saying there's something magical about intestinal repair formulas. She really felt like she was able to expand her diet finally and again likely because we were supporting the missing link in her case which was the immune system. So in close, immunoglobulins can help where other therapies have failed and this is ostensibly by supporting the immune system and stopping that whole cascade of inflammation and damage in the gut. Now it's not a guaranteed but there's a fairly high likelihood and this should not be the first therapy that you try but for people who have tried other foundational therapies like diet and probiotics then the intestinal repair formula can be a great adjunct and may be able to finally get you over the hump where you're feeling better and maintaining those improvements. There are many products out there the one I would recommend is intestinal repair formula because it uses exactly the same formula that has been used in the research studies. There are other formulas out there but really I can only vouch for the ones that have been through the rigor of scientific examination and you can learn more about intestinal repair formula at doctorusia.com slash IRF. I hope if you're someone who qualifies for this who has used other therapies and not seen the response that you're looking to that you'll try intestinal repair formula and since releasing this product the response that we've got from our followership on the internet our readers and our listeners has been pretty remarkable and we'll be releasing a number of case studies coming up in the near future. So this is one therapy that you can consider if you've done other foundational therapies that could help you heal your gut and reap the massive benefits that we can all achieve by having improved gut health. So this is Dr. Ruscio and I hope this was helpful.