A new study comparing a specific probiotic to a placebo for symptoms associated with multiple sclerosis showed the probiotic alleviated pain and fatigue after four months of use.
Multiple sclerosis (MS) can cause a range of symptoms that can greatly impact quality of life, as the disorder causes the body’s immune system to attack myelin, the coating that insulates nerve fibers. Damaged myelin affects the nerve signals traveling to and from the brain and spinal cord.
Previous research has found that people with MS have a distinct gut microbiome, meaning the community of bacteria, viruses, fungi, and other microorganisms in MS patients was distinct when compared to that of healthy people. The microbiome is a significant component of the gut-brain axis involving the interplay of the nervous system, endocrine system, and immune system.
Generally speaking, probiotics may improve the immune system and inflammatory responses by introducing more beneficial gut microbiota to the community. Previous studies have shown benefits from different probiotic combinations for various MS symptoms.
Single Probiotic Yields Promising Outcome
In a study published on Oct. 30 in Scientific Reports, 40 MS patients were given only Saccharomyces boulardii (S. Boulardii) —a “friendly” probiotic yeast—and were compared to a group taking a placebo. Those taking S. Boulardii had significantly decreased inflammatory marker high-sensitivity C-reactive protein and had increased their serum antioxidant capacity.
C-reactive protein tests can detect a small increase in the protein, which is made by the liver and rises when there’s inflammation in the body. These screenings don’t indicate the source of increased inflammation but are often used to gauge heart attack risk.
Total antioxidant capacity tests show the balance of antioxidant/oxidant status at a cellular level. MS patients have significantly lower scores, indicating a high level of oxidative stress associated with toxicities that could be chemical, physical, or microbial in nature and may lead to premature cellular and tissue damage.
In addition to the physiological tests, the study assessed symptoms on various scales for pain, fatigue, and quality of life, among others. Those who took the probiotic reported “significant improvement in some quality of life scales,” as well as significant decreases in pain intensity and fatigue severity compared to patients taking the placebo.
S. boulardii Dominates Pathogenic Gut Bugs
S. boulardii was first discovered in 1923 by French scientist Henri Boulard in certain fruits. He isolated it after noting those who were drinking tea from lychee fruit skins weren’t dying from a cholera epidemic. Cholera is marked by severe diarrhea.
In the years since, S. boulardii’s ability to protect against gastrointestinal diseases has been proven in studies related to the treatment of food-borne diarrhea, irritable bowel syndrome, inflammatory bowel disease (IBD), acute gastroenteritis, side effects of Helicobacter pylori infection treatments, and diarrhea caused by Clostridium difficile and other pathogenic enterobacteria.
One reason for its efficiency is that it can survive in a range of conditions, including thriving at human body temperature and in the acidic environment of the stomach—known for killing many probiotics. It’s also shown to proliferate in bile salts.
This is good because S. boulardii is associated with the eradication of a broad spectrum of disease-causing microorganisms and also is anti-inflammatory, according to a 2020 study published in Frontiers Nutrition. It’s the only commercially available yeast used for humans.
The yeast is also antimicrobial to pathogenic yeasts such as Candida. It’s sometimes mistaken for S. cerevisiae, a strain found in baker’s yeast that doesn’t offer the same protections.
S. boulardii is available as a supplement and can be cultured in fruit to make kombucha, or fermented, tea. It’s also being considered as an ingredient in functional processed foods. It can achieve a steady concentration in the colon within three days, but it’s cleared from stool samples within two to five days of discontinuation.
A Bit of Warning
Although widely considered safe, S. boulardii has been implicated in registered cases of fungemia, a fungal bloodstream infection associated with Candida species. For that reason, it’s not recommended for those who are immunocompromised, critically ill, or using a central venous catheter.
There are some sweeping cautions made against probiotics that also apply to S. boulardii. The National Center for Complementary and Integrative Health said that probiotics have a history of safe use despite a lack of studies that look deeply into safety based on frequency of use and severity of side effects.
“When probiotics are being considered for high-risk individuals, such as premature infants or seriously ill hospital patients, the potential risks of probiotics should be carefully weighed against their benefits,” the agency states on its website.
Cedars-Sinai Medical Center warns patients to be wary of supplements, which would include probiotics, because they’re understudied and could pose a threat to people with MS. Probiotics can be found in food or taken in supplements, which aren’t regulated by the U.S. Food and Drug Administration.
“MS is an imbalance in the immune system. If a supplement claims to boost or activate the immune system, that raises red flags because we don’t know how it will impact MS,” Dr. Marwa Kaisey, a neurologist and MS specialist, says in a Cedars-Sinai article.
Cedars-Sinai advises patients with MS to follow the same dietary guidelines as the general population—a balanced diet rich in fruits, vegetables, whole grains, and lean protein, and low in processed foods, salt, and saturated fat.
“It’s important for people who have MS to separate the science from potentially harmful marketing claims,” Dr. Kaisey says. “I have patients come in my office and cry out of relief when I tell them they don’t have to stick to a restrictive diet that someone told them will cure their disease.”
MS Linked to Metabolic Syndrome
The gut microbiome’s role in MS offers insight into the disease’s pathology.
MS is a chronic autoimmune disorder with both inflammatory and neurodegenerative components, as well as both genetic and environmental risk factors. Oxidative stress—at play in MS—can cause a breakdown in metabolic functions. The gut microbiome offers a key way to reduce this oxidative stress and arrest some portion of its consequences.
A 2021 article in Neural Regeneration Research noted that studies have found people with MS have metabolic alterations.
“Studies examining the relevance of these metabolic pathways to MS pathophysiology are beginning to identify novel targets for therapeutic intervention,” it stated.
One such target may be the microbiome and treatments such as S. boulardii that aim at the unusual characteristics of the MS microbiome.
Key factors affecting the microbiome—diet, environmental exposures, and stress—are also fueling the rise of metabolic syndrome, a collection of co-occurring conditions including high blood pressure, abdominal obesity, and high blood sugar. Researchers are now looking at whether S. boulardii can be used to address these issues as well.
A June review in the International Journal of Molecular Sciences notes that the yeast “has been associated with several beneficial health effects (including modulation of the intestinal microbiota and improvement of the inflammatory, antioxidant, antibacterial, anti-tumor, and anti-inflammatory profiles).”
It looked at eight studies—five animal and three human—and found modulation of intestinal microbiota, gene expression, and lipid profile were all favorably impacted by S. boulardii.
The findings bolster the latest study specifically targeting MS with the yeast, as well as what a 2020 Cureus article calls a link between MS and IBD that’s been suspected for decades.
The review in the International Journal of Molecular Sciences stated that “probiotic microorganisms have been included in the daily routine of the population that seeks a healthy life, and the yeast S. boulardii is a probiotic that has shown potential to protect the gastrointestinal tract from inflammatory processes.”