To download the presentation pdf, please click here.
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Presenter Joanna Scott-Lutyens has kindly answered the following questions, which were asked during the webinar:
Any interactions with warfarin?
Warfarin (brand names including Coumadin and Jantoven) is an anticoagulant prescribed to prevent the blood from clotting. It may be prescribed to people with irregular heartbeats, prosthetic heart valves, people who have suffered heart attacks, and people with thrombosis. If you are taking warfarin you should consult your doctor or pharmacist before taking any other medicines, supplements or vitamins. As live cultures are thought to help the body’s production of Vitamin K, which can thicken the blood, there is theoretical concern that taking natural bacteria or live cultures supplements will reverse the effects of taking warfarin. However, there is currently no clinical evidence showing that probiotics lead to thickening the blood. Although live cultures have been shown to help production of Vitamin K, the body should not absorb more levels of Vitamin K than required.
In addition the omega 3 flaxseed oil capsules in the ‘For your cholesterol’ product may initially ring alarm bells for those taking warfarin, as flaxseed is considered a blood thinner. However, although the dose of omega 3 is significant enough to have cholesterol lowering effects (300mg alpha-linolenic acid contributing to a total of 2g daily), it shouldn’t be high enough to affect those taking warfarin. In fact 300mg omega 3 daily is similar to having a few nuts and seeds daily. For example a small handful of 5 walnut halves contains 1g alpha-linolenic acid.[i]
NB: Individuals taking Warfarin should tell their doctor immediately if they experience unusual bleeding, skin changes, ulcers or immediate and severe pain in any area of the body.
What are the consequences of those who are taking statins that a GP has prescribed and we have put them on ‘For every day’ probiotics?
There should be no detrimental consequence and the strains in the ‘For every day’ product would be supporting your client’s gut health and therefore overall health. However, the strains in ‘For every day’ have no research behind them suggesting they help reduce cholesterol. The strains Lactobacillus plantarum CECT 7527, Lactobacillus plantarum CECT 7528, Lactobacillus plantarum CECT 7529 in the product ‘For your cholesterol’ do.
I have heard that too high HDL is also bad, e.g. 2.7, is this true and if so why would this be please?
HDL is cholesterol however it is thought to be a healthy cholesterol. The aim is to have a high ratio of HDL within the overall, total cholesterol level. Meaning that the majority of the cholesterol is actually a healthy version than not. An HDL level of over 1mmol/L is considered positive. As far as we are aware there isn’t any research to suggest extremely elevated HDL is associated with any risks. However if you have found such papers demonstrating this please forward to us for review. We advise that cholesterol results should be interpreted in context of each other, not each figure in isolation e.g. HDL, LDL, TC & triglycerides all compared to each other, instead of just looking at TC or HDL as individual figures. If you have cause for concern please check it out with the GP.
What is more important -TC or the ratio between HDL and LDL?
The ratio between TC and HDL is considered to be a more important reading than purely a reading of TC. This is because it allows us to know how much of the cholesterol is HDL as opposed to LDL – both types of cholesterol have different functions, with HDL having a proportionately more positive effect on the body than the negative effect of elevated LDL
Were these 60 patients (30 with probiotics and 30 placebo) taking statins alongside the probiotics?
No, not in this study.
Do you have individual leaflets on each product particularly ‘For your cholesterol’?
We do have a leaflet aimed at practitioners on this product. Should you wish to be sent one or anything else on our products, please do contact Christina on christina.georgallou@wrenlabs.com. Should you be interested, you can check our research page on this product here.
Would taking an every day probiotic along with the cholesterol probiotic be beneficial?
Do they support gut issues or would we need to give a separate probiotic alongside this?
Can you take this specific OptiBac product for cholesterol with another OptiBac probiotic such as ‘For everyday EXTRA Strength’?
Can they be taken alongside with other strains of probiotic, such as Lactobacillus and Bifidobacterium
It depends on what you are wanting to achieve. If your client has other digestive issues then yes, taking another product containing alternative strains of bacteria may be beneficial. As mentioned in the webinar, research is showing that strain specificity is of great importance. Some strains are particularly helpful at reducing bloating, others diarrhoea and so on. Therefore if your client has high cholesterol but also IBS you may want to suggest taking both the ‘For your cholesterol’ product as well as ‘For every day EXTRA Strength’ for the IBS. You can definitely take more than one product at a time and can therefore take ‘For your cholesterol’ alongside other strains of Lactobacillus and Bifidobacterium. We have a few bits of website material which you may like to link to e.g. ‘Can I take 2 OptiBac supplements at the same time?’ and ‘FAQ: Is it possible to overdose on probiotics?’
Would kefir or fermented foods be an alternative to a probiotic product? Would they be effective in lowering cholesterol?
Both kefir and fermented foods are beneficial for gut health. We know diversity of bacteria is good for overall digestive health. However whether these foods are purchased in a shop or fermented at home, the live cultures they contain will vary from batch to batch depending on the growing conditions. In this way the live cultures content in fermented foods is much less certain compared to a probiotic food supplement, which has been created to contain the strains stated on the packaging. One cannot comfortably compare a fermented food to a high quality probiotic supplement which has been shown in clinical trials to give particular health benefits, such as lowering cholesterol. In case you are interested, this topic is covered in our ‘Probiotic Myths’ guide on our website.
Will it work in case increased LDC during menopause?
The AB-life strains were trialled on participants with high cholesterol or medium-high cholesterol. Whatever the reason for high cholesterol it was found to have a statistically beneficial effect (a reduction of 17% in those with high cholesterol and a decrease of 9% in those with medium high cholesterol). During menopause the body is going through a time of great change. As we discussed in the webinar, increased inflammation in the body is a common cause for increased endogenous production of LDL cholesterol. If symptoms of the menopause are severe this is a sign there is likely to be strain on the endocrine and immune systems, hence creating a certain level of inflammation. In this case the probiotic strains in ‘For your cholesterol’ should be globally supportive by modulating inflammation as well as having a direct effect on LDL. However it’s also worth noting that a simple association could be going on here – the age of the menopause is similar to the age we often see cholesterol levels rise, due to the natural aging process. Also during menopause there may be increased sugar cravings due to direct hormonal changes or reduced energy, and a re-distribution of stored fat is common, all of which should be considered. You could certainly consider recommending ‘For your cholesterol’ to your client alongside your protocol to help manage menopausal symptoms.
If you see a probiotic just named as Lactobacillus or whatever – does it contain all the individual strains – of that particular probiotic
When products only have the name Lactobacillus on the pot, it is not known which actual strains of bacteria the product contains. There are thousands of strains of bacteria within the genus Lactobacillus, so even though the product may be generally beneficial, you can’t know what it may target. For example the strain Lactobacillus reuteri RC-14® is known to target the female intimate area whereas Lactobacillus acidophilus NCFM® is known to help alleviate IBS symptoms in the gut. In general also, a good quality probiotic product would list the strain names, so looking for particular strain names helps you choose quality as well.
Are there any side effects
There are no detrimental side effects of these strains of bacteria. This is a natural product which harnesses the body’s own cholesterol management. This is a gradual process that allows the body to adjust and find the right balance again.
Could these probiotics be taken alongside statins?
Yes, this product can be taken alongside statins. As discussed the strains Lactobacillus plantarum CECT 7527, Lactobacillus plantarum CECT 7528, Lactobacillus plantarum CECT 7529 bacteria harness the body’s natural regulation system so it can’t over reduce cholesterol levels
The research only showed the benefits to TC, but what about research on LDL
The graphs only show the benefits to TC, however the research paper goes into this in more detail. You can read it here. However just to summarize: After 12 weeks, in the group with highest initial cholesterol levels, the L. plantarum (list strains) group showed a reduction compared to the placebo group of TC 17.4%, LDL 17.6% and oxidised LDL15.6%.
Can you overdose on the probiotics if you have taken it say twice instead of once a day?
No, you can’t overdose on probiotics. We have billions of bacteria in our gut and excrete as much daily. Taking this product twice by mistake would not be a problem. You may find the FAQ Can I take two OptiBac supplements at the same time?, on our website interesting
Could clients stop taking statins?
Each client is individual with not only different cholesterol levels, but also overall health. Some clients with high cholesterol, or other cardiovascular risk factors may be advised by the Dr to remain on statins. It is advisable to keep checking cholesterol levels. It may be possible for the client to come off their statins completely, or at least lower their dosage, if they have such a wish, or are suffering side effects. However this should be a long term plan, not rushed, and the doctor should be kept in the loop. Allow at least 6 months if not a year. Initially ‘For your cholesterol’ should be taken alongside the statins for at least 3 months. Thereafter, if the cholesterol readings are looking good, the GP may be willing to prescribe a lower dose, or be agreeable to the client taking the statins every other day. In the following months the cholesterol levels should be carefully monitored to ensure they are on track, as the statins are gradually reduced and possibly stopped. Please counsel your client that ‘For your cholesterol’ is not a short term fix – just as statins are to be taken every day, essentially for the rest of your life, the same applies to ‘For your cholesterol’, unless circumstances drastically change such that cholesterol levels are so well managed by diet and lifestyle that no other interventions are required.
You mentioned AAD, would we use the product ‘For every day’?
For a client with AAD we would recommend taking either ‘For those on antibiotics’. This product contains two strains, Lactobacillus acidophilus Rosell-52 and Lactobacillus rhamnosus Rosell-11 which have a lot of clinical research behind them showing they help reduce symptoms of AAD
Are there any contra indications?
There are no specific contraindications for the product ‘For your cholesterol’. We do however issue the follow caution when taking probiotics in general. ‘Live cultures are not recommended for those with serious medical conditions e.g. those who are severely immunosuppressed, have pancreatitis, are in the ICU, have melaena, have a central venous catheter, infants with short bowel syndrome, or to patients with open wounds following major surgery; unless under a doctor’s care. Furthermore, pregnant or breastfeeding women should consult their doctor before taking Saccharomyces boulardii, ‘For travelling abroad’, or natural plant extracts as in ‘For daily immunity’’
Will OptiBac Probiotics ‘For your cholesterol’ work on familial hypercholesterolaemia?
Familial hypercholesterolaemia is a genetic disposition which runs in the family – it effectively means that the liver is already in over drive producing cholesterol. Even children can have this and people in their twenties can have a total cholesterol level of 10 or even more. This is a very complex medical condition which is difficult to manage and even statins don’t necessarily control it. There are no known ways of managing it well. Probiotics may possibly be a useful part of an overall protocol but there is at the moment no research behind this and it is not clinically trialled. In fact it would make quite an interesting addition to the trials on probiotics and cholesterol.
How do we know the correct quantity to recommend, depending on client condition?
The clinical trial discussed used 1.2 billion of the three strains Lactobacillus plantarum CECT 7527, Lactobacillus plantarum CECT 7528, Lactobacillus plantarum CECT 7529. This had a statistically relevant result on both the group with high cholesterol and the group with medium high cholesterol. This is the daily amount in the product and the amount we would recommend taking. The condition of the clients’ health would not change this recommendation. It might however influence our overall approach and cardio vascular protocol.
What brands of probiotics to use for cholesterol?
We recommend that you look for a brand that has clinical research behind the strains in the product, showing an efficacy in the reduction of cholesterol. OptiBac Probiotics ‘For your cholesterol’ is clinically trialled showing clinically statistical results in lowering LDL cholesterol in participants with high and medium high cholesterol.
Will this product either benefit or be detrimental to those with gall bladder issues, or removed gall bladder?
Because in the main these probiotics work (adhere to gut and repopulate) in the distal ileum, the bile salts have already done their work in terms of digestion and the absorption of a lot of the fats have already taken place. It works further down and only increases the elimination of bile salts slightly. As mentioned from 5 – 6% – but remember that is a 20% increase on what is happening. So it won’t over reduce bile salts so to speak. It also cannot effect of be affected by a lack of gall bladder or an over active gall bladder as the liver will automatically adapt to either of those scenarios. You might find this info from the FAQs for reps doc helpful:
Can someone who has had their gall bladder removed take FYC?
Yes, there is no interference. The gall bladder collects bile salts which have been produced by the liver and concentrates them. When a meal is consumed the gall bladder receives the signal to empty the concentrated bile salts into the gut to digest the food. For someone who has had their gall bladder removed the same amount of bile is produced, and it just drips constantly into the gut, unconcentrated. ‘For your cholesterol’ probiotics do not interfere with the gall bladder whatsoever. The only difference may be that the probiotics will come into contact with the bile salts constantly throughout the day in very small amounts, whereas in people who still have the gall bladder the probiotics will come into contact with the bile salts in larger amounts as each meal comes through. No negative effects involved.
Do the specific strains only work on cholesterol levels or are there other benefits to them?
All strains of bacteria will have a holistically beneficial effect on your gut and therefore ultimately systemically as well. However, as we know, each strain of bacteria have particular benefits too. The AB-life strains have been found to be particularly effective at reducing cholesterol. We do know however that they produce SCFAs, are anti-inflammatory etc so will be generally beneficial. However, if you are looking to achieve bigger results for eg gut dysbiosis, we would recommend considering different strains which are more focussed on this area.
What happens to cholesterol if you stop taking probiotics after 3 months? And what happens if you take them for longer than 3 months?
Just as when taking anything for cholesterol management, it needs to be a long term approach, as cholesterol is always being produced by the body, so always needs to be kept in check. If ‘For your cholesterol’ is stopped after 3 months the same can be expected as if any intervention to manage cholesterol is stopped after 3 months – cholesterol levels will rise again, unless drastic changes have taken place in the diet and lifestyle to reduce the rate of production of cholesterol. It’s advised to take ‘For your cholesterol’ for longer than 3 months, in fact just like any intervention for managing cholesterol, it’s pretty much a lifelong effort. This way cholesterol levels can be maintained at optimal levels in the long term. There are no negative effects to taking ‘For your cholesterol’ for longer than 3 months. 3 months was the duration of the clinical trial, the length of time it took to see significant improvements, but in order to see lasting benefits it should be taken on an ongoing basis.
Shouldn’t you focus more on particle size of LDL instead of just LDL-C? Also TG/HDL ratio is a stronger predictor of extensive coronary disease?
LDL particle size is certainly an important consideration as smaller LDL particles are more open to oxidation. In the clinical trial discussed in the webinar those who had higher initial cholesterol levels demonstrated a statistically significant improvement in ox-LDL compared to the placebo group after 3 months. A similar trend was shown in the medium high cholesterol group, although non-significant.
The TC:HDL ratio is more commonly used by clinicians here than the TG:HDL ratio, but you’re absolutely right the balance of triglycerides is very important. In the clinical trial discussed in the webinar a trend towards decreased triglycerides was seen, though non-significant. Perhaps with longer term use a significant decrease would be seen? This is where your dietary protocol would be likely to include oily fish in the diet as a nice way to keep triglycerides in check.
Does thyroid medication have an impact on how well the client can tolerate probiotics or would it be because they have SIBO?
It sounds like you might be referring to a specific client who has had difficulty tolerating probiotics, and they are on thyroid medication as well as demonstrating symptoms of SIBO. It’s difficult to assess this case without going into more detail. There are no known interactions of probiotics with thyroid medication. We actually often find OptiBac Probiotics ‘Bifidobacteria & fibre’ helpful for the constipation that often comes with underactive thyroid. SIBO would have to be assessed by the specific symptoms experienced by the client. Please feel free to contact Christina in our CAM practitioner support team, to chat through this case in more detail, so we can give thorough suggestions on what could be going on here.
Does these strains of probiotics lower the large particle LDL too?
Particle size per se wasn’t measured in this clinical trial, but oxidised LDL was. In those who started off with higher cholesterol there was a statistically significant decrease in ox-LDL. In future trials it would be great if we can distinguish LDL particle size to get a better idea of the exact picture.
Why was there a decrease in cholesterol in the placebo group?
That’s the placebo effect! Amazing that – just knowing we’re taking something that may or may not be improving our health can be enough to give a benefit. That’s exactly why we include a placebo group, and why we compare the results of the treatment group to the placebo group, to look for improvements between the groups.
[i] nutritiondata.self.com/facts/nut-and-seed-products/3138/2
