Gut Health, Probiotics, and Atopic Dermatitis

Raja Sivamani, MD, MS (00:07):

I am Raja Sivamani. I'm a board certified dermatologist. I'm actually an integrative dermatologist because I have training in Ayurvedic medicine as well. And I practice in Sacramento, California, we have a private practice there. We see a lot of Medi-Cal patients as well, so I really am interested in treating the underserved. And as such, I also do a lot of clinical research. So I get to play in both worlds of clinical care and clinical research.

(00:32):

When it comes to atopic dermatitis, probably one of the most commonly asked questions I get is, how does my gut health affect AD? And as time has gone along and research has built, we now have some newer knowledge in this area. There's this concept of leaky gut, and the way I look at it is gut permeability. We know that the skin is already leaky. We already know this, that the skin barrier is not so great when it comes to AD. But guess what? That's true in the gut too. The newer studies are now showing that the gut permeability is actually increased when it comes to AD. And so we have to find ways to treat the gut as well.

(01:10):

So one of the questions I get is how does the gut microbiome shift when it comes to AD? And we're still learning, but one of the things that I think is similar to the skin is when you look at the skin, we know that there's more staph aureus that grows on the skin. It overgrows. Basically, you have over-representation of staph aureus and that correlates with disease activity. Well, it turns out in some studies, staph aureus overgrows in the gut too. And so now people are looking at, can I do probiotics that can help control that? And how do we approach that? So this is really exciting. There are more and more studies now emerging looking at probiotics, and it really does matter what strains that you're using and what species you're using.

(01:54):

So here's the main takeaway. For all of you that are thinking about what probiotic can I utilize or what should I be thinking about? A probiotic is not a probiotic is not a probiotic. You can't just pull a garden variety probiotic off the shelf and think that that has evidence for AD. There are specific species, and I'll mention a couple of them, bifidobacterium breve, L. salivarius, L. rhamnosus GG. These all have high quality, double-blind placebo-controlled evidence for their effects in AD. You can't just go to the local grocery store and pull any probiotic and say, "Oh, let me try this for AD." You could, but would it actually work? I don't know. I like to stick to where the science meets the gut and not just pull anything off the shelf.

(02:41):

So I think this is an exciting area and we're building more and more evidence. And for sure probiotics are here to stay, but just remember to pick the right one when you're thinking about treating the gut.