Science Friday - Yellow Fever and Ebola, Trans-boundary Aquifers, Probiotics. Aug 24, 2018, Part 2

Episode Date: August 24, 2018

From 1976 to 2017, the Democratic Republic of the Congo experienced eight outbreaks of the deadly Ebola virus. Then, for 10 weeks earlier this year, the virus reemerged in the country, killing 33 people. Ministry of Health officials finally declared the crisis over on July 24. But just one week later, on August 1, the DRC reported a new outbreak of the Ebola virus in North Kivu province. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the The National Institutes of Health, joins Ira for an update on the latest outbreak of the Ebola virus in the Democratic Republic of the Congo. Plus, public health officials may not be able to control when and where a viral outbreak will occur. But, with the right strategy, they can keep it from becoming an epidemic. One of these strategies was used on yellow fever, a virus that emerged in Brazil last year and threatened major population centers like Sao Paulo and Rio de Janeiro. Nuno Faria of the University of Oxford describes how his team used real time genome sequencing of the Yellow Fever virus to track where it came from and which groups might be at risk. In the Southwest, water is at a premium, with every drop in demand from agriculture, industry, and growing populations. The Mexico-Texas border is no exception. Strict rules govern who can take water from the Rio Grande, with each country owing a certain amount of water to the other as the river winds back and forth. But the surface water isn’t the only liquid in play. Far below the surface, hidden aquifers straddle the border—and the water within them is largely unregulated. Rosario Sanchez of the Texas Water Resources Institute and Zoe Schlanger, environment reporter for Quartz discuss the water regulations and border disputes.  Plus, are probiotics good for you? A new study suggests too much "good bacteria" could poison your brain. Subscribe to this podcast. Plus, to stay updated on all things science, sign up for Science Friday's newsletters.

This is Science Friday. I'm Ira Flato. The Democratic Republic of the Congo has experienced 10 outbreaks of the deadly Ebola virus since 1976. For 10 weeks earlier this year, the virus reemerged in the country, killing 33 people. Ministry of Health officials finally declared the crisis over on July 24th. But just one week later, on August 1st, the DRC reported a new outbreak of the Ebola. Ebola virus in the northern part of the country. Here to tell, give us an update on the situation in the DRC is Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the NIH and recipient of the Presidential Medal of Freedom. Welcome back to Science Friday. Good to be with you, Ira. Tell us about this current outbreak. Give us some of the ABCs of it, please.

Well, it's in a totally different location than the first outbreak that we had earlier in the year that you mentioned, Ira, which was in the western part of the country. This is 2,500 kilometers to the east of this, is in the northeast part of the country right by the border of Uganda and Rwanda. It is already considerably larger than the first outbreak earlier in the year. They have been now, as of last night, 103 total cases with 63 deaths. The situation there is a bit more problematic than we're used to. Democratic Republic of the Congo, as you said, has considerable experience over the years. This is their 10th outbreak. The problem is that the outbreak is occurring right at or near the area of rebel fighting with a number of different rebel groups, making it a real security

issue of being able to do the kind of identification, contact tracing, and the contacts of the contacts, which is the way that you put down these kinds of epidemics. So it is still in the escalating phase. We have to watch it very carefully. We've deployed the vaccine that we use with some success in the West Africa outbreak already in the ring vaccination approach, which means vaccinating the contacts and the contacts of the contacts of people who are known cases. There have been 2,625 vaccinations thus far. And we've also deployed some experimental drugs that are being given their monoclonal antibodies and other drugs that have been developed. So there's some good news in the sense that we have interventions that we didn't have a few years ago with the West Africa

outbreak. But the sobering news is the location of where it's occurring, which is in a high security place. So you're actually using some of the new vaccine to try it? Yes, the vesiculostomatitis virus, the VSV-vectored vaccine that we did the and are still involved in a clinical trial to determine immunogenicity and safety that we utilized in a ring vaccination program in Guinea back a couple of years ago during the 14, 15, 16 outbreak. That is being deployed now. on the contacts and the context of the context. And that's the 2,600 plus vaccinations that we were using right now, literally as we speak. And how long do you think this outbreak might run its course? You know, Ira, it really is impossible to say because the way that you can put these down and get

control of them is if you identify the cases themselves, put them in isolation, because, as you well know from the previous outbreaks, the most susceptible people are the people who are taking care of the individuals who are sick, either family members or health care providers, people who bury the bodies when people die. And the situation is we're seeing that same sort of thing. We're seeing a number of health care workers who've gotten infected. Having said that, it's impossible to predict until you get the cases all accounted for who are the contacts. You know, it's a 21-day incubation period, and to say that something is over, you have to go through two cycles of 21 days without a new case. So it would have to be 42 days from the last identified case, and we're still in the upswing of the outbreak.

So I think we're, you know, far away from saying that this is over by any stretch of the imagination. Well, I want to thank you again, Dr. Fauci, for keeping us up to date and coming on Science Friday. And we'll be following it with you. Good to be with you. Thank you. Anthony Fauci, director of the National Institute of Health, his Institute of Allergy and Infectious Diseases at the NIH. Public health officials may not be able to control when and where an outbreak occurs, but with the right strategy, they can keep it from becoming an epidemic.

Researchers are testing a new strategy out on yellow fever, a virus that emerged in Brazil last year and threatened major population centers like Sao Paulo and Rio de Janeiro. Dr. Nuno Faria is Royal Society Research Fellow at the University of Oxford in the UK. His team was the first to use real-time genome sequencing of yellow fever virus to track where it came from and which groups might be at risk. He joins me now. Dr. Faria, welcome to Science Friday. Oh, thank you. Thank you very much for an invitation.

Well, we know that yellow fever is different from Ebola in that it's carried by a mosquito, and I understand there are two ways of transmitting it. Can you explain what those are? Yes, so there is a sylvatic or jungle yellow fever transmission, and there's the urban yellow fever transmission. So the jungle yellow fever transmission is the transmission of the virus between non-human primates, for example, monkeys and mosquito species that are found in the forest canopies. And those normally are the emigogos and the subbeded mosquitoes.

So this virus is then transmitted by the mosquitoes from non-human farmers to humans when humans are visiting or working in the forest. So in contrast, urban yellow fever transmission involves a transmission of the virus between humans and urban mosquitoes, primarily the very commonly found aid is Aegean, which is the same mosquito that transmit Zika, Chikungunya, and many other infectious diseases. So in this case, the virus usually enters the urban area when it's introduced from a varyamic human that was infected in the dungo. So how are you able to use genetic sequencing to tell this was a jungle transmission

and not the urban transmission? So we actually combine different sources of information. Genetic data is one of the information that we use. So we know that viruses like yellow fever, Zika, HIV, or Ebola, sort of accumulate mutations over time. Sometimes we find mutations accumulated in viruses that have been collected from patients only a few weeks apart, or sometimes months or years, depending on how fast that virus mutates or evolves.

That depends on several factors, including the own replication machinery of the virus. For example, for yellow fever, we know that a yellow fever virus evolves, that roughly accumulates roughly one to ten mutations in their genome. over year at the population level. So we use these information as the number of mutations accumulating per genomes over time to actually reconstruct

phylogenetic trees, so the genealogy of the virus or the evolutionary history. And based upon that, I mean, based on the evolutionary history of yellow fever, not only humans but also non-human humans, we were able to reconstruct the ancestral, let's say,

the ancestral species being non-human primates in this case, and we were able to reconstruct the spillover events between non-human primates and humans over time. Knowing this genetic history, is it getting you any closer to treating people with the disease or preventing it? So what we can find with this sort of information, we can find the origins of the outbreak, we can find the source populations of the outbreak, and we can ultimately trace how and when the spillover events were maximum, in which location.

did this happen and in which specific seasons did it happen most frequently. And how does that help in treating people? Well, ideally, we could incorporate this information. Obviously, this esteems from the more general goal of improved surveillance in not only humans but also non-human climate populations and vector population. So if we increase surveillance in all different populations at the same time, we can definitely benefit from that in the sense that we can target vaccination in key areas where there is increased transmission. That's interesting.

So how fast is this technology moving? Is this the first time it's been used this way? No, so genomic sequence, in portable genomic sequence, and using minar, and has been actually first used in Ebola outbreak back in 2015 in Guinea. And then later we brought that technology to the Zika virus outbreak, during our Zeba project in which we drove 2,000 kilometers in most affected areas in northeast Brazil with several of these portable handheld iron sequencers to capture a little bit better the Zika virus epidemic at its epicenter. And now we have used it for yellow fever.

We extended these protocols for yellow fever. It's very easy to extend these protocols to other viruses, and we are currently trying and testing this protocol also for dengue, or push other mosquito-borne infections that might be the next big Zika or yellow fever epidemics in Brazil. So you're limited, from what I hear you saying, to applying this to mosquito-borne infections. Why eliminate it? You know, because we were just talking about Ebola. Could you use it for Ebola?

Yes, of course. So as I mentioned, it was first used actually to Ebola to tackle the Ebola outbreak back in 2015, and it was essential to track transmission change in air back in 2015. And it is being used in the galaxy current outbreak. So you think it could be using this current outbreak? Yeah, I'm sure it's already been used. So that's very portable and also very flexible. So it's not really being used for viruses, but also for bacteria.

and there's even reports of full genomes of humans being actually sequenced using the ninaic sequencer. So it's a very portable and very flexible machinery that can be very easily sort of expanded to a broad range of for the pathogens in ordinances. But is it expensive to use? Could countries that don't have a robust health system being able to afford it? So we were able to generate genomes for under $50 per genome. So that's quite cheap to other technologies. But indeed, for example, we've also excited our project to other countries in African settings, for example. Angola, where we have been recently, we were able inside without having to do ships or samples in the country,

we're able to generate some Zika virus genome data. So that's quite interesting. They bring the technology to these countries, train people which we have done in Brazil, in several different parts of Brazil, but also outside of Brazil, and then make surveillance improves the genomics of those specific. All right, we're going to have to say goodbye. We're running out of time, Dr. Nunafaria, Royal Society Research Fellow at the University of Oxford. We're going to take a break, and when we come back,

the squishy problem of water rights along our southern border. You know, this is about water that's being shared by Mexico and the U.S. and, you know, water is getting scarce, so fighting is talking fighting is broken out about this. I'm Ira Flato. This is Science Friday from WNYC Studios. This is Science Friday.

I'm Ira Flato. In the southwest, as you know, water is at a premium with every drop in demand from agriculture, industry, growing populations, and the Mexico-Texas border is no exception.

Strict rules govern who can take water from the real grant. with each country owing a certain amount of water to the other as the river winds back and forth. But the surface water is not the only liquid in play. Far below the surface, hidden aquifers straddle the border, and the water with them is largely unregulated. So what does that mean? Who owns the rights to that water?

Joining now to talk about it is Zoe Schlanger. She's an environment reporter with quartz, an author of Shallow Waters, a multi-part collaborator. with the Texas Observer. Welcome back. Thanks, Ira. Great to be here. Thank you. Rosara Sanchez.

She's a senior research scientist and associate graduate faculty with the Texas Water Resources Institute. That's at Texas A&M in College Station, Texas, and her work is the subject of one of Zoe's articles. Welcome to Science Friday. Good afternoon. Thank you for having me. You're welcome.

Okay, Zoe, set the stage, set the scene for us. How big a deal are the water rights in the region? They must be huge, right? Sure. Yeah, I think what's really important for people to understand is that the entire Texas-Mexico border is the river. And the Rio Grande is running out. The federal government acknowledges that by 2060, there won't be enough water there to sustain the growing populations in the region. And a lot of that's due to climate change, more droughts, also booming populations that will double in the next few decades.

But when we're thinking about service water, that running out means everyone will probably be, turning to groundwater. That will be the only other water in the region that's accessible to people. And we don't have a treaty for that. Right now, there's no international treaty between the U.S. and Mexico governing groundwater, and it's a free-for-all, more or less. On the Texas side, it's all about property rights. If you own some land, the water underneath it, that's yours. And on the Mexican side, it's all done by permits from the federal government. But neither side really acknowledges that those aquifers are the same on each side. It's the same source of water for U.S. Mexico. So that's something no one's really talking about, right? You don't hear a lot of discussion

about the water and the aquifers. You really don't. It's really hard to talk about water you can't see. It is, people say it's the least sexy water topic out there. But we don't want to wait too long. Once that river runs out, you're going to have a real run on groundwater. And you don't want to be negotiating these things in a moment of emergency. That's not a great way to do politics. And Rosario Sanchez, that's where you come. And your work involves mapping these underground on aquifers. How many of them are there? How much water are we talking about? We don't know how much water are we talking about. We know there's water and we know that water is being used already. We have been able to identify between Texas and Mexico only around 15

formations, hydrological units, because we haven't got all the data to come from that they are actually aquifers. But we know that there is good to moderate water quality in those regions. and it's being used. So people are already using that water. The problem, as Zoe mentions, is the regulation of that water used in the region. So from those 15 formations, you can say we have only been able to recognize as transboundary, only four of them. Why is it so hard to recognize the boundaries and where they are? You know, I know that drilling's been, oil oil drilling's been going on there for century, right?

Yes. So are there maps from oil drillers that might say, hey, here's an aquifer? The problem is the data. And actually there is no requirement, international requirement, or financial requirement, to actually collect that kind of data. So the private companies, that they do it, they do it because they require to do by their own, you know, status of their companies because of their own sustainability of their economic growth. but it has nothing to do with the condition of the aquifer, water quality uses, et cetera. So it's kind of complicated. Why is nobody taking attention?

Because I don't think, I mean, it helps the political authorities at this point to acknowledge that there's something going on there. The interest is growing, however, it's not enough. Because the only way to recognize an aquifer as transbandries, do you have to prove that it's actually transboundary according to international standards, which are UN standards. So who's going to do that? Mexico or the U.S. who's going to take the first step?

Who's going to invest on that? There's no lot of money invested on these things so far. And the only institution that takes care of water, transboundary waters, so far is the ibupy. at International Boundary Water Commission. And they are not authorized by the treaty to regulate groundwater. So it's like a very gray, super gray area that nobody wants to touch. So you're nodding your head.

I am, yeah. I mean, it's complicated for all of those reasons that Dr. Sanchez just mentioned. But also because can you imagine if groundwater is thought of as a property right in Texas, what's going to happen when you tell people in Texas that the water they're taking from their well? is also reducing the water for a Mexican farmer across the border and that they need to abide by international laws as Gabriel Eckstein also at the same institute. As Dr. Sanchez told me, it'll be litigated like heck.

But we already have precedent. I mean, with the river water, don't we? You can't pump out all the water. You have to leave some of it for someone else, right? Yeah. Can we make sort of a similar regulation or some similar cooperation between the countries? Well, you can't do much of that

if you don't have the basic science. Right now, we really just don't know, as Dr. Sanchez said, what is there. And her work is quite remarkable because the U.S. and Mexico only acknowledge four aquifers as actually crossing the border. She's found in total along the whole border 36 and 15 are in Texas. Wow. So just agreeing what the facts are, Dr. Sanchez, is difficult because we don't have enough information. Exactly. It's easy to regulate surface water.

You can actually see surface water. You can actually measure easily, very easily, surface water. But it's not the same story for groundwater. Because you can definitely say on the surface, your water is X, your water is Y. But I imagine the layers underground, the formations, they're just not as easy to look at. Exactly. Yeah. And so go ahead.

I'm sorry, Dr. Sanchez. No, and I was only going to mention that if you don't know what's going on underneath, how can you regulate something that you actually haven't invested on? Nobody thinks about that. And this is not just an international or binational issue. I mean, within Texas, groundwater conservation districts, for example. I mean, they regulate groundwater according to their own administrative boundaries, not hydrological boundaries.

So they have the same issues within the state. because groundwater conservation districts don't talk to the other groundwater conservation districts about groundwater instructions that might be extracting from the same aquifers than its neighbor. So it's a problem not just internationally talking, but within domestically, it's also a challenge. I'd also just like to put it in the context globally. This is a border issue everywhere. There's more than 300 aquifers. that cross international borders all over the world. And there's only officially now, I believe, four treaties of any kind governing that.

So as the world is warming and water scarcity is becoming more of an issue everywhere, we're going to see this as a huge geopolitical issue. That's just simply not talked about right now. 844-724-8255 is our number. You can also tweet us at Cy Fry. I mean, I hate to make a pun out of it, that this really has float under the race. radar, really way under the radar in issues. The people on the ground, the people who live there, and the people who are neighbors, Mexico, U.S. borders, they must understand this as a problem.

Well, interestingly, actually, if you look at Yale did a great study of climate perceptions on a county level in 2016. And if you look at the state of Texas, most of the state doesn't have a favorable view of climate scientists, doesn't quite think climate science is credible. But if you look at the border counties, the ones right along the Rio Grande on the border, where the temperature is heating up very fast and water scarcity is part of their life.

They have a much clearer view that climate change is happening and some of the highest percentage of populations that believe climate change is directly harming them now. And some of the cities realize that they have a water shortage and they're doing, I was reading research from your own website about El Paso. Yeah, yeah, me and my colleague, Navina Sadassabam, at the Texas Observer, we wrote these pieces together. And she went and talked to farmers in the region and cities in the region that are buying water ranches, for example, to keep sustaining them in the future.

El Paso is a fascinating case. They are on the absolute cutting edge of water technology, partially because they have to be. They are extremely dry, nine inches of rain a year. That's drier than Namibia, which is the driest country in sub-Saharan Africa. And El Paso is getting way into the desalination game. They are desalinating brackish groundwater. They are reusing waste. They're planning in the next 10 years to open the largest plant in the U.S.

that will take human wastewater and treat it to drinking water standards and pipe it directly back into the water system, a closed loop water system. I was at the American Water Works Association meeting, and I met somebody involved in that process. Yeah. And he was pitching this story. I mean, I thought it was a great story. And I said to him, how do you know, is there a difference between the taste of the water, you know, that they're going to be drinking? He says, yes, there's a big difference.

I said, oh, what's that? He said, the processed water tastes much better. I mean, the regulations they have to adhere to to to make sewage water into drinking water. They're very tight regulations. It's a highly technological process. So I have not tasted myself, but I believe that. And Dr. Sanchez, if people have a world. well in their backyard. Did they actually think about where the water is coming from at any point?

It depends on who you talk to. If you're talking about farmers in the valley, for example, they might because they rely on that water for their business. If you think about people in San Antonio, you know, for example, they do think about that because they have the history of the Edwards Aquifer, which is the only regulated aquifer in Texas because of this species that was, you know, in danger. So, but if you talk about, for example, people here in Colostation, I mean, they barely think about that. And people, and we depend 100% on groundwater.

So it depends on your case. It's very localized. The way groundwater works for, and the perceptions on groundwater are very different from surface water. It's very localized. It's very attached to private property. So they don't have to, they don't, and people have said that to me personally. Like, why do I have to care about my neighbor? I have my water here.

It's mine. It's below my property. Why would I think about the other side? So, and very few of them, except if you're an academic or an expert, you would know which aquifer you're actually extracting from, but a regular person, they wouldn't think about that, not even the quality of the water they are extracting. They trust EPA and standards and all of that, but they don't think about future consequences because you can't see them. You can't see the water moving. You can't see where it's coming from.

So it's a rather interesting psychological issue, actually, because this is not just only between Mexico and U.S. or Texas in Mexico. It's all over the world. I mean, there's a reason why there's no one agreement or treaty that regulates or sets the standards of groundwater transbound or groundwater use along the world. It's changing. slowly. The interest is growing.

Yes, the interest is growing. IBWC has put a lot of effort in getting this, even though they don't have legally the authority to regulate groundwater. If somebody is going to regulate, it will be them, because that's the only institution we have financially. So they're very interested. I'm sorry, didn't interrupt, but I have to tell our listeners. I'm Ira Flato.

This is Science Friday from WNYC Studios. One last issue, you can't talk about the border between Mexico and the U.S. without talking about President Trump's wall idea. How does that play into the water discussion, Zoe, in the area? Well, one thing to visualize, again, that the Rio Grande is the border between Texas and Mexico. So when you talk about putting up a wall, you're talking about putting a wall on the U.S. side on the banks or near the banks of that river. And that river floods regularly, like most river systems. There's been a lot of back and forth about where that way.

wall would go, most of it would have to be put in or near a floodplain. We've already seen in parts of the wall that have gone up in Arizona, specifically in Nogales, Arizona, right across the border from Nogales, Sonora, that when there's heavy rains and flooding, the wall has acted like a dam. It just, debris builds up on one side, and that floodwater can't escape. And we saw in 2008, it caused $8 million worth of damage. And actually, two people drowned on the Mexican side, due to that wall acting as a dam. So it's a very touchy issue from a water engineering, civil engineering perspective, even, and trying to negotiate between the forces that want that wall in place

and the people on the ground to understand what would happen in that ecosystem is very tenuous. Dr. Sanchez, any comment? I'm glad so we respond to that question. Well, let me ask you the other political question. Are we just in a deadlock over discussions about the aquifers? I mean, it seems like it's such a hot potato. It's better left untouched, right? Yes.

You have described it the perfect way. But I think that's changing because there's a lot of interest, growing interest, because we have discussed this already. We're running out of surface water. Well, are we going to get one international treaty that everybody signed, or do you look for treaties for every different border for different countries? I think they will have to be different. I think there will have to be regional local agreements first

before even thinking about a binational agreement on groundwater, because it's so complex. And the histories among neighbors are different. I mean, the history between Mexico and Texas is completely different, compared to Mexico and Arizona, for example, or even California. Zally? But just to put this into some context, the IBWC, which is on the U.S. said it's run by the State Department and on the Mexican side, it's a federal negotiating body, it takes them

years to come up with a single minute to their treaty or an amendment to the main treaty that governs this water. And we really don't have several decades to wait to do this because we're looking at 2060 as an early deadline of that river not being able to solve. support the populations. Dried up. Dried up. Exactly. And our time is dried up. I want to thank Zoe Schellinger. She's an environment reporter with Quartz and one author of Shallow Waters.

This is a terrific multi-part collaboration with Texas Observer. Thank you. Congratulations on that. And Rosario Sanchez, she's a senior research scientist and associate graduate facility faculty with the Texas Water Research Institute. That's at Texas A&M University and College Station. Thank you, too, Dr. Sanchez, for joining us. Thank you. Thank you. And hi, Zoe. We're going to take a break when we come back.

We're going to talk about probiotics. Or, you know, is there a downside to them? We'll be right back after this break. This is Science Friday. I am Ira Plato. Have you ever wondered whether probiotics are good for you? I take probiotics. I think they're good for me.

Maybe I have to rethink some of this stuff because, you know, there's new research coming out all the time on probiotics, and we're going to talk about some of it now. Of course, the name probiotics itself, right? The name seems baked right in to their name, probiotics. Bro, they must be good for you. And we've all heard about the benefits of a healthy microbiome. And probiotics are one way.

We try to give our digestive systems an extra dose of that good bacteria. But what do we really know about them? What do we really know so much about the microbiome itself? We know that studies have shown that probiotics can help preemie babies fight intestinal inflammation. Other studies suggest they can help older people from developing weaker bones. But what about everyone else? Even if we can't yet quantify the benefit, popping a few probiotics can't do any harm, right? Well, in fact, my next guess says the opposite could be true.

Too much of any bacteria, even the good kind, can be harmful to your digestive system. And if probiotic supplements headed for your colon, if they dump their contents too early, Bacteria in your small intestine can cause symptoms of brain fogginess. He says, so is it time to throw those probiotics into the trash? Not so fast. Dr. Satish Rao is Professor of Medicine and Director of the Digestive Health Clinic Research Center at Augusta University. Welcome to Science Friday. Thank you, I don't.

I want to give out our phone number 844-8255. Folks might be very interested in talking about that. Also, you can tweet us at the SciFRI. So, you know, most people who are familiar with probiotics, but for those who aren't, give us a small definition of what they are and why would somebody want to take one? So the WHO has defined probiotics as live microorganisms that confer health benefit if ingested in sufficient quantities.

Now, that is the WHO definition. So in simple terms, these are bacteria that hopefully will replenish our colonic microflora and give us health benefit. So when the probiotic is working properly, the bacteria should go into your large intestine, right? Your colon area. That is correct. Now, we have, what, about 500 billion bacteria and about 500 different species of bacteria in the colon. a very large population of bacteria and different species. But most probiotic formula that we have available now,

they probably have anything between two to 10 or 12 different types of bacteria. That's all we have in the probiotic group. Now, you say that the bacteria can go wrong. Things can go wrong with them. We don't want them in our small intestine, our upper GI tract. That's correct. So, I mean, they're designed or at least believed to, once we, ingested in a capsule form, they'll go unchanged through the stomach, through the small bowel,

and get into the colon and confer their health benefits. But that has not been very categorically and systematically proven. There is very little data to say that if you take a particular probiotic and then they've collected poop, if you like, at the other end, to see whether they are really culturing these bacteria coming out at the other end. Now, there are some very few studies, but the majority don't, and we have hundreds and hundreds of preparations out there with virtually no studies on them. So they're not regulated at all as if they were a drug? People are taking them thinking they're like, maybe like an herbal medication?

That's how most people are taking it. Most people believe that it confers health benefit just like taking a multivitamin pill. And it is not a multivitamin pill. You know, they are live bacteria that we are taking. And for the majority of folks, I suppose it doesn't do a lot. but for some, it can cause significant harm, and that's what we found in our study. Tell us about what you found. So I as a gastroenterologist usually see patients with belly problems, so they come to me with,

you know, belly pain, gas, bloating, distension, sometimes constipation, diarrhea, these are common problems. So I've been seeing these kind of patients for 20, 30 years of my career. But in the last five to seven years, we suddenly started seeing patients who are in a addition to these symptoms reporting brain fogginess. Now, that's a rare symptom for gastroenterologist. I guess if you have brain fogginess, you may see your internist, you may see a neurologist or a psychiatrist, but not a gastroenterologist. But these folks were really coming with this unusual symptom in addition to their belly problems. So we said, this is odd. Why are these guys having

brain fogginess? So we really set about to try and find out what is going on. Our initial hypothesis was that they were producing something in their gut that was getting absorbed into the body and somehow causing fogginess in the brain. And now we do see some patients, for example, we see patients with chronic liver disease. These are people with liver failure or kidney failure who do have some fogginess, and that's because of accumulation of ammonia or urea and so on. But this was very odd. We said these folks don't have liver failure, they don't have kidney failure yet they were foggy. So we then decided to start looking at a number of potential products that they may be producing in the body and then we found that these folks,

or a majority of them, were producing large amounts of de-lactic acid. And this de-lactic acid, normally we produce very little amount in the body. Mostly we produce L-lactic acid, which is the lactic acid that we all produce. Now, when we run or jog, we get cramps. And that cramps is because of lactic acid, lactic acid accumulation. But only very small amounts of de-lactic acid is produced in the body, mostly in the gut. Whereas these folks were producing large amounts, largely because of fermentation of sugary foods in the small bowel.

And it was this excessive accumulation of de-lactic acid that was causing the brain fogginess. Wow, and that was because there was the probiotics were hanging out in the small intestine instead of being where they were, supposed to be. That is correct. So normally, as I said, you know, we see patients with bacterial overgrowth, and these bacteria usually don't produce de-lactic acid. You know, when they ferment sugars, they produce hydrogen, methane, and other gases, but they usually don't produce much de-lactic acid or very small amounts. But if you're gut is colonized, your small bowel is colonized with probiotic containing bacteria, such as lactic acid or bifidobacetalus or bifidobacterium, which is commonly present in most probiotics.

Then you have a different population in the small bowel, which now has the capacity or the ability to ferment the sugars, and in addition to producing hydrogen, methane, and other gases also produce de-lactic acid. That is what was happening in these patients. And you could see it actually happening in the patients? We could because, you know, what we did was we brought the patients into a lab, and then we gave them glucose as a drink, which is a standard drink we give as part of a glucose breath test, a test we use for detecting small intestinal bacterial bacterial bacterial back to lower growth or CBO.

So we gave them this drink, but before they consumed the drink, we measured their, blood and urine lactic acid levels, and we gave the drink, and then after the drink at one, two, and three hours, we once again measured their blood and urine lactic acid along with their breath samples. And we found that in a significant, almost 70% of these patients who were presenting with brain fogginess, there was a significant elevation or increase in lactic acid production. Wow. That's quite interesting. So should you prescribe me? I'm looking at my phone bank here,

some people aren't the way to the drugstore in their cards, they're saying, what probiotics should I get? I mean, should I not? I'm wasting my time. And is it a question of not getting the probiotic, or is it a question of making sure it stays encapsulated the delivery system until it gets to your large intestine? Well, I think if somebody can guarantee that,

I guess that would be a fantastic way of taking probiotics so that they exclusively delivered this product in the colon. But I don't think there's any methodology that I'm aware of that can guarantee that. Which I think is the unfortunate problem. So they can break down anywhere. But fortunately, you know, most of us have various defense mechanisms. You know, acid is a good defense mechanism in the stomach. The small bowel has fantastic motility. You know, it is the most active organ in the entire gut.

and it is bathed by acid, and it secretes, you know, about six to ten liters of fluid a day. So all of those tend to flush the small bowel and keep it sterile most of the time. But there are various things that may mess it up. Well, if you take too much a probiotics, and if your gut is slow, you don't have much acid, or your motility is a problematic, then you have set a potential stage where the bacteria can colonize the small bowel. Let me go to the phones to Yelena in Ventura, California. Hi, welcome. Hi, I was calling to see what your guest thinks about the probiotics

found in kombucha and other fermented foods. Yeah, good question, yogurt, whatever. So that's a very good question. You know, the amount of probiotics in fermented foods, particularly yogurt or kaffir and so on, is not as much as what is packaged in the probiotic capsules. Plus, you take a lot of other materials along with the food. So I believe that the natural probiotic foods are safe and good,

and I would encourage everybody to take it. They're probably good. But the way we are taking it, perhaps with the form of capsules with billions and billions of bacteria, may not be the best for everybody. What percentage of your patients do you think who take probiotics come down with, you know, these symptoms? I think it's just what we are seeing is just a tip of the iceberg is what I believe we are seeing. I'm sure there are millions out there who have this problem, but they have either not consulted or their doctors have not made the association.

I'm sure there are a lot of folks with this. But I don't want to say that probiotics is all bad. You know, it is good. I prescribe probiotics as well. I give it in highly selected conditions. There are patients in whom the gut flora has been damaged, altered, disturbed, particularly diarial situations. People who have taken antibiotics, people in whom they've had long diarrheal illness, where the colon bacteria have been flushed out. In those situations, it is appropriate to take it.

But to take it for any GI disorder, just because you have some pain, you've got some gas, you've got some bloating or constipation, and expecting these probiotics to really work miracles, I think is not the right way to. to move forward. And there is very, very, very little science to support it either. Amara Flato, this is Science Friday from WNYC Studios. Talking about probiotics with Dr. Satish Rao, professor of medicine at Augusta University. Let's go to the phones to Joy in San Jose. Hi, Joy. Yeah, hi, thank you for taking the call.

I have a question that's a little bit different. I had my colon removed over 30 years ago, and I have been taking probiotics. because I thought it would be good for me to get some of those bacteria back into my system. But now you say it's bad in the small intestine, so I'm a little concerned that I haven't had any mental confusion or any of that, but I'm just curious if this is not something I should be doing. Good question. Yeah, I think it's a very good question.

I would be cautious about taking probiotics if you don't have a colon. In fact, we have seen a lot of patients, a paper that we reported, But earlier this year, are patients like yourself who have had colon removed who have a very high predisposition for SIBO, a small intestinal bacterial bacterial bacterial overgrowth. And in fact, many of these patients were presenting recurrent to the hospital with gas and bloating and distension because they either have a small rectum or small part of the colon that is left behind, which now has a long passage or a clear connection to the small bowel and bacteria from within that small one-foot rectum is now constantly contaminating the small

bowel and they're getting CBO. So I think it is a problem there. However, if you're getting benefit from taking probiotics, maybe I would let you carry on with it. 30 years is a long track record. Absolutely. One question we talk about, I wanted to ask you because we did a research story the other day on Archaia. You know, it's not quite a bacteria, but it's a form of life, the third form of life. And we heard it populates in a lot of different places.

I was wondering, do we have archaea in our gut, our own? Are there trillions of them in there? Yes, Ira, I listened to your program. I was very fascinated and educated a lot from that program as well. But it's an area that we've been researching for the last 10, 15 years. We do have RCA in the gut. and we have a few, one of them is methenobrevebacter smithi. There is a methanobrevebacter oralis, which is in the mouth,

and smithi is one of the big archaea, which is in the gut predominantly in the colon. And what is interesting is we found this association between this RCA, methanobreviabacter smithi, that tends to produce a lot of methane and constipation. It almost seems like a fingerprint for constipation, this particular RK that seems to exist in the colon. And we've seen that patients who have more refractory, more difficult to treat constipation, produce large amounts of methane. And also they have IBS-like symptoms. So both IBS constipation and chronic constipation seems to be associated with this. It is not to say that everybody with constipation has this archaic.

but those who have RCAA, they seem to have the more challenging, more difficult to treat constipation. So it's the archaea that's producing the gas in our gut? They are. So the RKHA has this methane brubarbakta, for example, has a unique ability to take in carbon dioxide, as your guest was saying last time, and hydrogen, and convert that into methane. So we don't know evolutionary why we've acquired this RK, but they probably do play an important role. One of the roles probably is to reduce the amount of gas production in the body.

I'm sure that is an important role they play. But whether at some stage they actually cause problems like constipation, I think that is our area of inquiry right now. And we do believe that it actually causes constipation. We've gone on to do one study where we have tried to decrease this RCA by giving antibiotics. And we had some marginal success. I wouldn't say we had great success, but we had some marginal success. And we are now just in the early stages of a clinical trial where we are using a novel statin company, the same statins that people take for cholesterol lowing.

There is one form of statin that seems to have an interesting role in inhibiting an enzyme that leads to RCA reproduction. And we are in the early stages of this to see whether this particular statin compound may decrease this RCA and may and thereby lead to resolution of this challenging constipation symptoms. Well, we'd love to follow the microbiome, so we'll be following your research, doctor. Thank you very much for taking time to be with us today. Dr. Satish Rao, Professor of Medicine, Director of the Digestive Health Clinic Research Center at Augusta University.

PJ Leiderman composed our theme music And if you're missing part of the program We subscribe to our podcast on your podcast vehicle of choice And if you have a smart speaker, You can ask it to play Science Friday whenever you want So every day now is Science Friday And you can email us Our Justice SciFri at ScienceFri.com

You just go to our website It makes it easy We've got all kinds of stuff, educational material, videos All kinds of things for you up on our website at Science Friday.com Have a great week I'm Ira Flato in New York. Hi, Ira here, saying thank you for subscribing and listening to our podcast.

Today, I have a request. Please join me in supporting independent journalism and public media by making a donation to Science Friday. We work hard to be your trusted source for honestly reported science, health, and technology news. Topics that impact your family, your planet, and your business. topics that have never been more important. So please consider making a donation at ScienceFriday.com slash give. And be sure to share this podcast and Science Friday's work with your friends and family. That's ScienceFriday.com slash give.

And thanks again.