Immunoglobulins: New development in the treatment of IBS and SIBO
One really needs to have both a healthy microbiota and a healthy immune system in order to have a healthy gut. Immunoglobulins help to restore the mucous …
Hi, this is Dr. Ruscio.
Let's discuss an exciting new development
in the treatment of IBS and SIBO.
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 mucous membrane of your gut.
The function of the mucous membrane in your
gut, in part, is to bind toxins and irritants
that can cause gut damage, irritation, leaky
gut, and this whole cascade of inflammation
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.
I'd like to tell you about my clinical experience
And there are a few points here that I think
are worth expounding upon.
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.
This is known as publication bias or selection
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 new compound that doesn't
show any benefit.
It's usually the novel findings that are published
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.
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
After watching the clinical literature, I
was satisfied with what was being published
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 patients who
have been non-responsive to other therapies.
So you may have improved your diet, you may
have used probiotics.
If you have a fungal overgrowth or a bacterial
overgrowth, you may have even used an antibiotic
or antifungal, or some type of herbal antimicrobial,
and not really seen any results.
The missing piece here, in some cases, may
be all of those therapies are trying to treat
the microbiota—a 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.
This is where immunoglobulins are unique.
Again, immunoglobulins are essentially what
constitutes that secretory IgA lining in your
So you've heard of the mucous lining in your
gut, the secretory IgA, there's also IgG and
That's what immunoglobulins are.
So regarding the immune system, it's important
to contextualize this: 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 diet,
or they may even use antibacterial or antifungal
agents for a suspected overgrowth.
And they do a lot of work to modulate the
balance of bacteria and fungus in a healthy
way, but they miss the immune system.
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.
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
Now, what kind of evidence do we have for
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
So there's certainly a wealth of preliminary
To date, there have been nine quality trials
in humans that have shown immunoglobulins
Now, could the data here be better?
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 you've been
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 are then showing benefit.
This is the most challenging subgroup to obtain
results with, and it's really one of the most
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 been looked at for similar patients and
shown benefit roughly 70% of the time, in
the research that's been published.
Again, some of these studies have put patients
on diet, probiotics, soothing agents, antispasmodics,
and shown failure to all these therapies,
and then seen about a 70% response rate with
Again, it's likely because of the immune system
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.
In this patient group, patients were diagnosed
with either SIBO, IBS, or both, then offered
a few different treatment options in a double-blinded
So they may have been given a low-FODMAP 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 recalcitrance of this group.
Now, there's also more science.
There is one randomized placebo control trial,
which is our gold standard, that showed benefits,
and also one large survey of 595 patients.
And in that study, a 67% response rate was
noted from Intestinal Repair Formula (re-named
Intestinal Support Formula).
In the double-blind study, immunoglobulin
caused 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
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
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 EnteraGam
Over the past couple of years, this compound
has now become available as a dietary supplement.
There are many different versions out there.
There are only a couple that are research-verified,
meaning using the same formula that's been
used in the research.
This is where Intestinal Repair Formula comes
in (or ImmunoLin, or MegaIgG 2000).
These are the products I would recommend.
The Intestinal Repair Formula is a version
that I've developed, I've been using in 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 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
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
I would use what's the most proximal—in
this case, exactly as has been used in the
clinical research—to documented benefit.
Now, these immunoglobulins are derived from
If you're a vegetarian, there are some vegetarian
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
But if you are vegetarian, there are 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.
Again, what is the immunoglobulin formula
I've been using, Intestinal Repair Formula?
It's a supplemental form (derived from bovine
serum) of immunoglobulins: The immunoglobulins
that constitute the lining of your gut, your
gut mucosal membrane.
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.
By taking the Intestinal Repair Formula, you
help to bind toxins and irritants in the gut,
as we'll expand upon in a moment.
I should also mention that the immunoglobulin
formulas are hypoallergenic, they're devoid
of casein, whey, lactose, soy, gluten and
So, how specifically does something like Intestinal
Repair Formula help where other formulas have
Well, we know, again, that Intestinal Repair
Formula binds to irritants like bacterial
fragments and other toxins in the gut, and
there've been a few papers that have documented
Now, what happens is, 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 is 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
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
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.
These are just a capsule form, so a simple
And you dose these with or without food, with
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 Intestinal Repair Formula,
and by one or two weeks, you should notice
Not necessarily your entire improvement 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 if you wanted to, but most patients
will notice a difference within one to two
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
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
Do reactions occur?
In a very small number of patients, reactions
It's fairly rare.
So Intestinal Repair Formula, generally well-tolerated,
even for sensitive patients.
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.
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.
There are a few different diets out there,
paleo-type diets or an elimination diet, the
low-FODMAP diet, probiotics and potentially
treating any type of dysbiosis with either
pharmaceuticals or herbal medications of various
I would start there, at the very least, with
diet and probiotics, before considering Intestinal
Because there is a foundation you should lay,
in my opinion, before using these.
Okay, now, let's move onto a case study with
This was a great case study.
When Matt came in, he had been previously
diagnosed with inflammatory bowel disease,
and many therapies that we utilized together
Diet was helpful, an elimination diet combined
with a low-FODMAP diet was helpful.
Probiotics were also helpful.
Antimicrobial therapy was very helpful.
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 an 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
Again, it's likely because we were previously
working to modulate dysbiosis or the microbiota,
the bacteria and fungi, which did help.
But the missing component that needed to be
administered in tandem with that was support
for his immune system, which the Intestinal
Repair Formula achieved.
If you want to see the full case with Matt,
we recorded a patient conversation where we
talk through his case.
Very interesting case, and 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.
It's important to realize that you're not
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
going to have ups and downs, but you're going
to be trending upward the entire way, then
it helps you see through those low points.
Matt's case was a beautiful example of that
kind of psychological perspective, but also
the utility, clinically, of Intestinal Repair
Also, Victoria came in with food reactivity
and histamine intolerance.
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
foods that she was eating.
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 as saying, "There is something
magical about Intestinal Repair Formula."
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
So, in close, immunoglobulins can help where
other therapies have failed, And this is ostensibly
by supporting the immune system in stopping
that whole cascade of inflammation and damage
in the gut.
Now, it's not a guarantee, but there's a fairly
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
There are other formulas out there, but really,
I can only vouch for the ones that have been
through the rigor of scientific examination.
You can learn more about Intestinal Repair
Formula at DrRuscio.com/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.
Since releasing this product, the response
that we've gotten from our followership on
the internet, our readers and our listeners,
has been pretty remarkable.
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.
This is Dr. Ruscio, and I hope this was helpful.