 Hi, this is Dr. Urschel, and let's discuss how probiotics can reduce flatulence and improve constipation by reducing levels of unwanted bacteria in your gut. Now, we'll be talking about a study that was recently published, and I'll put the abstract of the study up here on the screen. The study was entitled Methanobreverbacter attenuation via probiotic intervention reduces flatulence in adult humans, a non-randomized, paired design clinical trial of efficacy. So specifically in the study, 21 subjects were given a probiotic that contained a mixture of lactobacillus and bifidobacterium strains, and they found the abundances of citrobacter, clebsiella, and methanobreverbacter were reduced. So these are three bacteria that may not be great to have in high quantities in the gut, and the probiotics showed the ability to reduce the abundance of each one of these. Now, more specifically regarding symptoms, as the methanobreverbacter decreased, they did show that as this bacteria decreased, and technically this is not methanobreverbacter is not a bacteria, technically it's an archaea, you can think of it like a cousin of a bacteria, but for simplicity's sake we can call it a bacteria. Essentially as this organism, methanobreverbacter decreased, there was a corresponding decrease in flatulence. Also for women only, there was a reduction of constipation. Why this is salient is this methanobreverbacter archaea organism has been correlated with reducing the motility in the intestines and has been highly correlated to constipation. So it's no surprise that we see reduced gas because these organisms produce gas and an improvement in constipation because this organism methanobreverbacter in particular has been highly correlated with constipation. So what does this mean? A few notes for you. Probiotics exerts antibacterial effects. This is often times overlooked, but probiotics, in fact one of the main strengths or utilities of probiotics may not be that they colonize you, most probiotics do not. However they have a transient impact, one of which is secreting antibacterial and antifungal peptides that can help reduce fungal or bacterial overgrowth in the gut. So there are other mechanisms, but one important mechanism is the mechanism of reducing unwanted bacteria and fungus in the gut by being ironically antibacterial and antifungal. By decreasing these levels of unwanted bacteria and fungus in the gut then we can have a reduction of flatulence and improvement in constipation or bowel regularity amongst other things. Now something else here to be cognizant of is being careful not to get pulled too into marketing claims regarding probiotics. Probiotics can certainly be helpful and I encourage people to experiment with probiotics as long as it's from a reputable company and you know it's a safe tested form of probiotic that isn't filled with a bunch of garbage. But you also have to be wary of some of the health claims because now everyone seems just trying to one up each other in saying that our probiotic is the new, improved, the best, what have you. And one of the things I continually try to bring us back to is looking at the evidence and looking at how we see similar results with with different probiotics and in many studies you're seeing different perturbations on a certain mixture and they're all having similar results. For example there have been many studies that have shown a ability to reduce gas and or improve constipation with a lactobacillus and bifidobacterium predominant blend of probiotic. Is there one special blend or one special strain that will only vector those benefits? No, it doesn't appear to be the case. Many different formulas with different strains of lactobacillus and different strains of bifidobacterium have been shown to have these positive effects. Now that's just one class of probiotic. There are, in my opinion, three other classes. You have a saccharomyces bilardi probiotic which is actually a healthy fungus. You have a soil based probiotic or a spore forming probiotic and this will oftentimes have various strains of the bacillus family. And finally you have E. coli NISL1917 and that is another class. There are a few other probiotics that are potentially slightly different from those categories but if you look at the brunt of the research that has been done it is with one of these four categories. And you will see, for example, multiple studies showing improvement in constipation with probiotics and rarely is it the same formula it's always used. So certainly there may be a time and a place to become more prescriptive with probiotics but I try to prevent us from making things unnecessarily complicated. So in this case we see that a lactobacillus bifidobacterium blend has the ability to reduce flatulence and improve constipation. The constipation improvement was in women only but other studies have shown with a similar probiotic improvements in constipation in men and women. So if you're someone who has flatulence and or has constipation a trial of a lactobacillus bifidobacterium predominant probiotic is certainly worth a trial. Experimenting with other probiotics to try to improve your gut health or for other health conditions is certainly warranted. Just be cautious of health claims and make sure that you're listening to your own body and clearly noticing a benefit from a probiotic in order to qualify it being something that you should use in the long term. If you're not noticing a clear benefit from it I wouldn't continue to use a probiotic because you've read how great it was or what have you. So probiotics can certainly be helpful. We just have to be a little bit tempered in getting swept up in some of the excitement some of the marketing having a practical approach in terms of how we use and apply probiotics. In this case good news for those with flatulence and or women with constipation. So this is Dr. Ruscio and I hope this information helps you get healthy and get back to your life. Thanks.