Addition of Probiotics to Anti-Obesity Therapy by Percutaneous Electrical Stimulation of Dermatome T6. A Pilot Study

Abstract

Obesity is becoming a pandemic and percutaneous electrical stimulation (PENS) of dermatome T6 has been demonstrated to reduce stomach motility and appetite, allowing greater weight loss than isolated hypocaloric diets. However, modulation of intestinal microbiota could improve this effect and control cardiovascular risk factors. Our objective was to test whether addition of probiotics could improve weight loss and cardiovascular risk factors in obese subjects after PENS and a hypocaloric diet. A pilot prospective study was performed in patients (n = 20) with a body mass index (BMI) > 30 kg/m2. Half of them underwent ten weeks of PENS in conjunction with a hypocaloric diet (PENS-Diet), and the other half was treated with a PENS-Diet plus multistrain probiotics (L. plantarum LP115, B. brevis B3, and L. acidophilus LA14) administration. Fecal samples were obtained before and after interventions. The weight loss and changes in blood pressure, glycemic and lipid profile, and in gut microbiota were investigated. Weight loss was significantly higher (16.2 vs. 11.1 kg, p = 0.022), whereas glycated hemoglobin and triglycerides were lower (−0.46 vs. −0.05%, p = 0.032, and −47.0 vs. −8.5 mg/dL, p = 0.002, respectively) in patients receiving PENS-Diet + probiotics compared with those with a PENS-Diet. Moreover, an enrichment of anti-obesogenic bacteria, including Bifidobacterium spp, Akkermansia spp, Prevotella spp, and the attenuation of the Firmicutes/Bacteroidetes ratio were noted in fecal samples after probiotics administration. In obese patients, the addition of probiotics to a PENS intervention under a hypocaloric diet could further improve weight loss and glycemic and lipid profile in parallel to the amelioration of gut dysbiosis.

Effect of Lactobacillus kefiri, in Conjunction with PENS T6 and a Hypocaloric Diet, on Weight Loss, Hypertension and Laboratory Glycemic and Lipid Profile

“…microbiota, and phylum Bacteroidetes (Prevotella spp. ), and a reduction in Firmicutes/Bacteroidetes ratio; clinically, they induced a further reduction in body weight and plasma A1C, triglycerides, and HDL-cholesterol [36].…”

A systematic review on neuromodulation therapies for reducing body weight in patients with obesity

“…Most clinical series and RCTs have been conducted comparing active PENS + diet versus diet alone or against other neuromodulation strategies 30,33–35 . One study showed that adding probiotics to PENS + diet may improve outcome 75 . Even though significant differences were reported when PENS + diet was compared to diet alone, these studies presented a confounding factor of patients receiving Pstim through a needle placed in specific dermatomes, whereas controls were not given a sham intervention.…”

“…The risk of bias was moderate in a case series using occipital nerve stimulation 29 and critical for two PENS studies in which stimulation was given along with a hypocaloric diet. 35,76 Of the six RCTs included, five had a high risk of bias 30,31,33,34,75 because controls were not given sham neuromodulation or patients were unblinded towards treatment. One RCT raised serious concerns because obesity was not the primary outcome.…”

“…Seventeen studies using VNS or percutaneous stimulation for the treatment of obesity were included in this review (eight case series and nine RCTs; Table 4). [27][28][29][30][31][32][33][34][35][68][69][70][71][72][73][74][75] Commonly reported comorbidities were type 2 diabetes, hypertension, and dyslipidemia. Follow-up ranged from 1 day to 2 years.…”

“…30,[33][34][35] One study showed that adding probiotics to PENS + diet may improve outcome. 75 Even though significant differences were reported when PENS + diet was compared to diet alone, these studies presented a confounding factor of patients receiving Pstim through a needle placed in specific dermatomes, whereas controls were not given a sham intervention. In most studies, BMI reduction in patients receiving Pstim-T6d was around 5-15%.…”