Health News Reviews. Updates On The Paleo Diet, Adrenal Fatigue, Weight Loss, UTIs And Yoga For Weight Loss.

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Health News Reviews.  Updates On The Paleo Diet, Adrenal Fatigue, Weight Loss, UTIs And Yoga For Weight Loss.

Episode Intro

Dr. Michael Ruscio: Hey, everyone. Welcome to Dr. Ruscio Radio. This is Dr. Ruscio. Let’s jump into another edition of Health News Reviews. This type of episode is an episode wherein I review some of what I feel to be the most important and relevant research that’s been published over the past several weeks or several months, give you a quick kind of purview and summary of what the study found and what it means.

Before I go into some of those details, I did want to answer one question that I’ve been asked numerous times in different ways, which is essentially, how is it I’ve come to have an objective way of looking at things? And oftentimes people have remarked that there seems to be so much strong opinion or dogmatism regarding X, Y, or Z, it’s refreshing to see an objective perspective. How did I come to that objective perspective? So I just wanted to briefly kind of take a tangent to a little bit of a background story on that.

So this all really started probably in college. And when I was in college, I kind of had a little bit of a cathartic, where I finally kind of figured out what I wanted to do, which was something in medicine. I started off being young. I always did consider myself a high-level, over-achiever, borderline obsessive compulsive, type A. And so I wanted go into conventional medicine. I got everything lined up to try to strive for a 4.0 GPA. I fell slightly short of that. But I really plugged into conventional medicine going through all the premed requisites. And that was kind of how I started on the path.

At the same time though, I never was a huge person to rely solely on my regular education. Not because I didn’t have any problems with the conventional education system, at least not at this point, but because I always wanted to know more than I would learn in class. So I would actively participate in my education, whatever it was. And I started reading and going to some seminars and doing courses. I came across some of these pivotal works, I forgot the gal’s name off at the top of my head, but she was a former editor at the New England Journal of Medicine and she wrote a book that really showcased the heavy amount of influence that pharma has had on conventional medicine. And of course, once you start pulling on that string, there’s a rabbit hole that goes pretty deep.

And so I admittedly fell into a little bit of dogmatism where I got really into some of these functional nutritional circles, functional exercise, functional nutrition. I was super high on the whole mission and vision and I had drank the Kool-Aid. And I was definitely one of the types of people that I criticize now. I was very, probably, undereducated and overly opinionated. I was always open and I was always tactful, but I think I was, just very early on, in the road or down the road. And so it’s easy to be a bit naïve. So that started me down the path. I have my own personal health experience, which really further reinforced and completely drove me out of wanting to go into conventional medicine, having a great experience, actually, with Dr. Dan Kalish, who diagnosed a parasite that I had.

Gold’s Gym Experience

And so, as all this is happening, I started kind of figuring this out after a year or so. So it didn’t take me very long. I started realizing that some of these exercise and nutrition gurus that I’m learning from, seem to have these super overzealous approaches. And what was interesting was I was working as a personal trainer, I actually had a small personal training company that operated out of Gold’s Gym in Amherst, Massachusetts. And I was operating out of an office there. And there was another gentleman who was, at early stages, was kind of a mentor to me, because he was someone who was five, seven, ten, I don’t know, years, into the field of study with kind of holistic nutrition and exercise therapy that I was getting really interested in.

And so I’m very grateful to this gentleman for opening my eyes to some of the early works in that field that really plugged me into some of these non-academic system channels for learning. But I also quickly kind of learned that some of the educators there were in violation of the warning that Brian Tracy gives, if you guys remember me saying “Never get your education from someone who makes a living selling education.”

Well, I started to kind of get the sense that some of the educators that this gentleman was getting his education from, and I was going to get my education from, were making a living off of making things overly complicated. And I started to question some of this and I started to look for the simplicity. Because I think I’ve always had the halfway decent BS meter. And looking at some of the stuff and going through some of these highly elaborate exercise rehab assessments and programs that I was doing at the time, I was doing this while I was in school and doing all my premed studies.

I took a step back and I said, “I go through this incredibly in-depth assessment. And then people end up having these programs that have 70%, 80% similarity”. So like go through this incredibly arduous assessment only to come back to some of the same fundamentals. Yes, there are small amounts of nuance differences, but I can really simplify this. And so that’s what I did.

And what I was being taught was this, “if we’re not assessing, we’re guessing” sort of thing, where you’ve got to assess. And I used to use a goniometer to measure someone’s hip angle and spinal curvatures. And I mean, it was intense. It was very in-depth and it was impressive, I think, to the people I was working with. But I eventually learned to simplify that.

And long story short, what ended up happening was, my business within the gym grew and the gentleman who had kind of formerly been my mentor, his didn’t grow at the same pace. And what I noticed was very interesting, where I was willing to almost have a free market economics perspective on my training, which was I need to make this more cost-effective, more simplified. And if I require people to go a through a three-hour assessment before they even get started, if I do that for everyone, if I make everyone into a complex case, even people who aren’t, I’m going to make the barrier to entry higher than it has to be. I’m going to make this more expensive than it has to be.

So I modified my approach and I was able to help more people, very similar to what I discussed in regard to functional medicine. And now this gentleman didn’t. And he was very convinced that people had to do it his way or the highway, which I understand. But what’s unfortunate is, when you fast-forward about another year, the gym owner eventually said, “Well, this guy has to go. And, Mike, we’re going to give you his office.” Which, really made me uncomfortable, because that was the last thing that I wanted. But it was an example of if you’re making things more expensive and more elaborate than it has to be, from a business perspective, a business will suffer. Because it’s harder to find people who are willing to expose themselves to that level of expense and rigor to try to get healthier.

And so, unfortunately, this gentleman never fully connected the dots that we shouldn’t be making everyone into a complex case. I understand that it’s enjoyable to learn more and have these deeper tools, should you need them. But if we try to make everyone into the most complicated case, if we try to treat every patient who has low-level gluten intolerance like they have celiac, that’s doing them an awesome disservice. So, unfortunately, I was put into his office and that created a little bit of tension. But I reflected on that and it was one of those examples of where simplification in an approach can be very helpful.

So then you fast-forward into doing my studies in conventional medicine, and I started seeing some of the same stuff. I started seeing these gurus, these figureheads who—‘you can never have gluten. And here’s a thousand and one reasons why. And it causes this. And it does that. And it kills people.’ Which, in itself, is true. But you have to look at that in the context of what percentage of the population do these severe problems actually happen. And if maybe something around 1% or so, for example, celiac—just using some arbitrary numbers, very low. So we shouldn’t be treating everybody like they have to live like they’re celiacs. So I saw the same thing starting to happen in functional medicine.

But what was interesting was, the gurus now were doctors and people who lectured internationally. And it was almost a little bit harder to question some of these figureheads, especially earlier in my career. But I found the same thing applied where there was this model of excess and I repeatedly saw people around me doing way more than needed to be done. And so I just started asking some simple and practical questions. And it’s refreshing now to see the same thing happening on a more grand scale in my clinical practice where I have patients who may fly across the country to come see or do Skype visits if they’re not wanting to fly, and thanking me for saving them from the other option that they had, which was $5,000 worth of lab testing before we can even get started.

So this applies on a micro scale and I think on a macro scale, in terms of it just a small personal training company inside of a Gold’s Gym in Amherst, Massachusetts—great time by the way—or if it’s a functional medicine clinic in Northern California. So those were some things that were helpful to me. And I just share those in case people are struggling with those things. Especially when you’re learning, I think it’s easy to get swept into this modeled excess, because you learn every detail, and it makes you almost feel as if every detail is relevant, every detail needs to be tested, every detail needs to be treated. But again, in my experience, that really has not been the case at all. In fact, as I’ve made the arguments several times, the opposite may be true.

All right, enough story time. Let’s jump into some Health News Research Reviews.

How Exercise Affects Mitochondria

The first study I wanted to talk about is entitled “Training Enhances Immune Cells Mitochondria Biosynthesis, Fission, Fusion, and Their Antioxidant Capabilities Synergistically with Dietary Docosahexaenoic Acid Supplementation.” It’s a mouthful. Essentially, what they’re saying is exercise improves your mitochondria. They say here just one part I want to pull out in particular—and actually, I’m sorry, I should mention, the mitochondria are the cells or part of your cells that produce energy. So having good mitochondrial function is important for energy and also for cellular energy, which can then be important for organ function and overall health.

So mitochondria are important not only for energy, like I-have-a-lot-of-energy-today-type energy, but also for proper organ function. So in conclusion, they comment that training induced mitochondrial adaptations, which may contribute to improve mitochondrial function.  So why that’s important is because training, exercise is a way to improving and increase the health of your mitochondria. So if fatigue is a complaint of yours and you’re not exercising, I would strongly encourage you to begin exercising.

Now, there may be some cases—there’s a condition known as post-exertional fatigue syndrome, where people become much worse after exercise. In that case, you want to work with clinician and work on this slowly. But outside of that smaller subset of people who have a clear aversion to exercise and need to probably ramp up to that slowly under the guidance of a clinician, for most people, if your energy is not where you’d like it to be and you’re busy and what-have-you, remember that one of the cheapest things you can do to actually improve the cellular machinery that makes energy is exercise. And I wouldn’t get overly meticulous about what form, just start exercising and that’ll get you moving down this path in the right direction.

Paleo and Mediterranean Diet’s Effect on Inflammation

Okay. The next study is entitled “Paleo and Mediterranean Diet Pattern Scores Are Inversely Associated with Biomarkers of Inflammation and Oxidative Balance in Adults.” Essentially, this study is looking at Paleo and Mediterranean diets and how they pertain to or affect inflammation. So to quote, “These findings suggest that diets that are more Paleolithic- or Mediterranean-like may be associated with lower levels of systemic inflammation and oxidative stress in humans.” High sensitivity C-reactive protein, an acute inflammatory protein, and F2-isoprostane, a reliable marker of lipid peroxidation, both improved. And this was in a study of 646 men and women from age 30 to 74.

Why this is important is mainly to showcase an answer to the criticism that meat and fat are bad for you. If meat and fat were bad for you, the relatively higher amount of meat and fat that is often consumed in a Paleo-like diet would cause negative changes in inflammatory markers. We’d be most prone to think that would happen anyway. So if meat and fat were bad for you, then we’d probably see in this study, the Paleo diet increase inflammation while the Mediterranean diet decrease inflammation. However, that didn’t happen of course, both of these diets, Paleo-like and Mediterranean-like, improved inflammation. When we pair these findings with the Paleo diet with the number of clinical trials that have shown benefit from the things like body composition, thyroid function in one study, metabolic syndrome, diabetes, and even one study in colorectal adenomas or colorectal cancer, we see a rich canvass developing, where we have a pretty good case for the Paleo diet. And it’s unfortunate that sometimes people in anti-meat canvass try to paint meat, universally, as a dietary ill or fat as a dietary ill. And it’s really misguided.

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Multiple Nutritional Factors and the Risk of Hashimoto’s Thyroiditis

The next study, “Multiple Nutritional Factors and the Risk of Hashimoto’s Thyroiditis.” Just as a quick refresher, Hashimoto’s thyroiditis is an autoimmune attack in which your immune system attacks your thyroid gland. It is the leading cause of hypothyroidism in most Westernized countries. So there’s one item here in particular I wanted just pull out. Hashimoto’s patients are frequently iron deficient, as autoimmune gastritis, or autoimmunity cancer stomach cells, impairs iron absorption as a common co-morbidity.

So, essentially, this is stating that damage to the stomach cells is a common co-occurrence with Hashimoto’s. And interestingly, treatment of iron anemic women who had an impaired thyroid function with iron improved their thyroid hormone concentration. So even without giving these women thyroid hormone, their thyroid hormone levels improved after they repleted an iron deficiency.

Now, about 20% to 40% of patients with Hashimoto’s who also have autoimmunity against their stomach—and we’ve discussed two studies both by the same group, their initial study and then a follow-up several years later, that showed injectable but not oral B-12 can actually arrest that stomach autoimmunity. The stomach autoimmunity can be assessed with a marker that’s available at most labs known as anti-parietal cell antibodies. And weekly injection of vitamin B-12 can arrest that stomach autoimmunity. And then once that stomach autoimmunity has been arrested, meaning the antibody blood test has returned into the normal range, you can revert to monthly injections to maintain the improvement.

So that’s something I think is a novel therapy that is deserved of further exploration. And that vitamin B-12 therapy may help prevent the loss of these cells in the stomach that produce HCl, that then cause you to malabsorb iron and B vitamins and cause these subsequent anemias that can be associated with the stomach autoimmunity that has about a 20% to 40% association to Hashimoto’s.

So something to keep in mind, if you’re struggling with your thyroid and you’ve potentially been diagnosed with hypothyroid, you’ve gone on thyroid medication, and you’re still fatigued—fatigue being one of the main symptoms, but not the only symptom—you may want to be evaluated for an anemia, either B vitamin anemia or iron anemia, because it may not just be the thyroid that needs to be addressed. It’s important because there’s so much marketing regarding thyroid on the internet that people are often just tunnel-visioned into thinking about thyroid and they miss some other simple fixes.

Paleolithic and Australian Guide to Healthy Eating

The next study entitled, “Compliance, Palpability and Feasibility of the Paleolithic and the Australian Guide to Healthy-Eating Diets in Healthy Women: A 4-Week Dietary Intervention.” So they’re essentially comparing two diets. The Australian healthy diet, which is similar to the kind of low-fat, higher-carb, higher-grain recommendations that you get from many nutritional associations in the United States compared to the Paleo. So, the Australian group reported a greater daily consumption of discretionary items. Meaning, there wasn’t as much dietary restrictions, so they ate more kind of—you can kind of say off-plant foods. Or we could say this another way where people on the Paleo diet stuck more to the diet because they probably felt like the diet had a little bit stricter of guidelines.

Now, compared to the Australian diet, the Paleo group reported significantly greater number of events of diarrhea, 23% of people on the Paleo diet reported diarrhea compared to on the Australian diet. Now, people on the Paleo diet also reported a greater cost associated with grocery shopping and the belief that the diet was not healthy. So it is important to showcase both sides of the evidence here. There’s a lot of great research regarding Paleo, but the Paleo was perceived to be less healthy, less unnecessary without big of a finding, because that may just be indoctrination. But being more expensive is something that we should be aware of when we’re recommending this diet and, also, the increased incidence of diarrhea. I’ll come back to you with some thoughts in just a second, but let me read you the conclusion. “Compliance to both diets was high but the potential side effects and increased cost suggest that the Paleolithic diet may not be practical in clinical/public health settings.”

So if you’re hearing this and you’re maybe getting a little bit irritated, remember, your irritation does nothing to help you be better in the world. What would help anyone be better in the world would be being cognizant of this data being there so you can have a well-informed opinion and try to reconcile how you can make this diet work for someone or know when this diet may not work for someone.

Now, there may be an inadvertently higher consumption of FODMAPS in the Paleo diet, which is why some may have reported the diarrhea. And what’s funny is 23% is very proximal to the number of people in the population that will report IBS. IBS has anywhere from about a 15% to a 25%, maybe even up to 30% prevalence in the United States. So what’s interesting is maybe the people who had IBS who went on the Paleo diet inadvertently had a higher consumption of FODMAPS, and that’s what caused the diarrhea.

So I’m hoping that you see that when you don’t ignore findings that challenge your paradigm, you can actually be better equipped to defend your paradigm or to find a solution for someone that may not fit within your paradigm’s recommendation. In this case, if you’re a die-hard Paleo, hopefully, this opens you up to realizing that Paleo for patients with IBS—potentially, I am speculating—may provocate IBS and cause diarrhea. And for those people on modified Paleo diet, a Paleo low-FODMAP diet, or even a more Mediterranean-like diet may be a better fit. Now, it also may be if the people in this group had an increase of very dense fibrous insoluble fiber that may have also provocated their diarrhea, which happens, again, oftentimes in an IBS subset.

So again, it’s not to say Paleo diet, good or bad. But we should be aware the cost may be an objection and something that we need to be cognizant of when making the recommendation of Paleo, and then also diarrhea may be a side effect. And one thing you can take away from this if you are a clinician, letting someone know that a small number of people may report diarrhea as a reaction and, if so, that doesn’t mean anything is wrong or broken, but rather that we need to modify things. If you let someone know that before they go on a diet and before they have a reaction of diarrhea, you will have much higher faith. They will have much higher faith in you and you will have much better compliance. So, really, there’s no downside, in my opinion, to looking at both sides of the evidence.

Probiotics and Inflammatory Bowel Disease

Next study, “Probiotics Are a Good Choice in Remission of Inflammatory Bowel Disease: A Meta-Analysis and Systematic Review.” Essentially one thing I just want to pull out here is that this meta-analysis and systematic review concluded that probiotics are beneficial in IBD, especially the combination ones in ulcerative colitis, meaning, broad-spectrum having more than one strain. So that’s just important to mention, because every once in a while, you hear someone say that there’s no evidence showing that probiotics can be helpful for inflammatory bowel disease. And that’s really a travesty. Now, the poorest evidence is for inducing remission in Crohn’s disease and the evidence there is really sparse, yes. There is definitely evidence showing prolonged time in remission and there are some evidence showing that, for inducing remission in ulcerative colitis, probiotics can be equivalent to many of the frontline therapy drugs known as 5-ASA class drugs. Mesalazine is one of them.

And regarding inflammatory bowel disease, there’s inducing remission, meaning someone is actively in a flare and we want to get them out of that flare. So that’s inducing remission. And then we want to keep someone in remission and that’s maintaining remission, so just to clarify those two. But, again, high-level scientific evidence is showing that probiotics can be beneficial in IBD. Now, does this mean that everyone with IBD is going to benefit from probiotics and no one’s going to have a negative reaction? Of course not. But it means that this is something that is definitely a therapeutic consideration in those with IBD. And if people tell you otherwise, I really doubt they have an evidence-based opinion.

Quick Side Note – Thank You For Reviews

One quick side note, thank you guys for leaving reviews. I’ve already seen a nice jump in reviews, so thank you guys for taking a moment to leave the show a review. And just quickly, if you haven’t left the show a review yet, please take a quick moment, head over to iTunes, leave us a review. I deeply, deeply appreciate it. It really helps the show reach more people.

Yoga vs. Resistance Exercise

Okay. Next study entitled, “Comparing a Yoga Class with a Resistance Exercise Class: Effects on Body Satisfaction and Social Physique Anxiety in University Women.” So to quote, “Both types of exercise class were associated with improvements in body image, but there were greater improvements after the yoga class.” So to continue, “This study provided evidence of the positive effects of yoga for reducing state social physique anxiety and increasing state body satisfaction, adding to correlational evidence suggesting that yoga is particularly beneficial for improving body image-related outcomes in women.”

So what does this mean? It means that women may perceive that their bodies look better from doing yoga compared to doing resistance training. Now, some of that might just be indoctrination where our society, through misinformation, has led women to believe that if they lift weights, they will bulk up or they will look too big or what-have-you. And that may not be true, but it doesn’t change the way that this group of women felt. And so, this is, again, something that may be counter to what even some of the evidence shows, which I’m not saying it is the case. But rather it’s important to understand the psychological profile of women regarding exercise. And especially if you’re advising people on exercise regimes, you may want to be patient and tactful in trying to convert the women into resistance training, because you may be working against body image indoctrination of our society.

Probiotics for Treatment and Prevention of Urogenital Tract Infections in Women

The next study entitled, “Probiotics for Treatment and Prevention of Urogenital Tract Infections in Women: A Systematic Review.” So, fortunately, the study is focused on bacterial vaginosis: three on UTIs, and two on vulvovaginal candidiasis, and one on human papillomavirus. These studies were what’s called heterogeneous in terms of design, intervention, and outcomes, meaning that they don’t pool quite as strongly. The more homogeneous the studies are, meaning, the more alike they are, the more we can pool the findings. The more heterogeneous means they’re different from study to study, so we can’t build on top of them quite as much and pool the findings for as strong as an argument.

But nonetheless, four studies were of good quality, nine of fair quality, and seven of poor quality. When looking at all this information in performing this systematic review, they found that probiotic interventions were effective for treatment and prevention of bacterial vaginosis, prevention of reoccurrence of Candidiasis or vaginal candida and UTIs, and in clearing HPV lesions. No study reported significant adverse events related to the probiotic intervention. So, some encouraging findings there. And I didn’t dig into the details on this, but I’m assuming that the probiotics that were used in the studies were not all the same, probably part of the reason why the systematic review of the studies was labeled as heterogeneous, meaning, not every study was the same.

So what this probably suggests is that the precise formula may not be hugely impactful. With time and further research, we may find a certain formulation does tend to perform better than others. But I think it’s reasonable right now to have someone try a couple different formulas of probiotics and see how they respond and go from there. I don’t think we have to be incredibly meticulous in our prescription. And I certainly don’t think there’s any evidence to support that treating someone’s lab findings for what deficient probiotics they have in their stool has any warrant or any merit to it at all. So I would not recommend that at all.

Effects of Macronutrient Distribution on Weight and Related Cardiometabolic Profile in Healthy Non-Obese Chinese

Next study, and this one’s actually really interesting and it’s to my earlier point of not being a dietary dogmatic, “Effects of Macronutrient Distribution on Weight and Related Cardiometabolic Profile in Healthy Non-Obese Chinese: A 6-month, Randomized Controlled-Feeding Trial.” In this study, participants were assigned to one of three diets: a low-fat diet, a moderate-fat diet, or a higher-fat diet. And over 245 women who completed the study. So, a decent sample size. Now, the low-fat, high-carb diet had 20% fat, 60% carbs. And the moderate-fat and moderate-carb diet had 30% fat, 56% carbs. And this is calories. And a higher-fat, lower-carb diet contained 40% fat and 46% carbs. And protein was 14% and pretty much consistent across all diets.

Now, here is where this gets a little bit interesting. Reduction in body weight was significantly greater in the low-fat, high-carb group throughout the intervention compared to the two other groups. Weight changes at six months or as follows. A loss of 1.9 pounds in the high-fat, low carb group, 2.4 pounds in a moderate-fat, moderate carb group, and 3.5 pounds in the low-fat, high-carb group. Continuing, reduction in the waist circumference, total cholesterol, LDL cholesterol on the lower fat, higher-carb group diet were greater than those observed in the other two diet groups. So their conclusion is for Chinese women, a lower-fat, higher-carb diet may work better. And we see here that cardiometabolic markers and weight all look better on the higher-carb, lower-fat diet.

Now, this is I think a very important study because we’ve showcased how in the majority of the studies, we see all diets work but there being a slight edge for high-fat, low-carb diets. However, you’ve probably heard me say that no one diet is going to work the best for everyone, but we want to use the evidence to try to start our dietary recommendations with a diet that is most likely to be the most beneficial for a particular person. So this is why I like the starting point of Paleo and/or low carb, seeing how someone does, and then potentially transitioning to—it could be a Paleo-like diet or the Mediterranean diet that is then instead lower fat, higher carb if someone does not respond well to your initial dietary recommendations. This study reinforces that.

Now, what else is interesting is that those of Chinese descent, especially if there hasn’t been a lot of kind of cross-cultural breeding, may very much will have genetics that do better with a lower-fat, higher-carb diet. So it’s definitely something important to keep in mind. So again, we should be open-minded with different diets in this particular study. We see that Chinese population does better on a lower-fat, higher-carb diet.

Thumb-Sucking, Nail-Biting, and Atopic Sensitization, Asthma, and Hay Fever

 “Thumb-Sucking, Nail-Biting, and Atopic Sensitization, Asthma, and Hay Fever.” So this study looked to assess what association or what’s between thumb-sucking, nail-biting, and atopic sensitization, which is essentially you have environmentally-induced lesions to the skin, kind of like environmental allergies, or your skin is very easy to break out, and also asthma and hay fever. So 31% of children were frequent thumb suckers or nail biters at one year of age or over. These children had a lower risk of atopic sensitization at 13 years and 32 years of age. These associations persisted when adjusting for multiple confounding factors. So sometimes if someone comes from a higher or lower income family or has maybe a brother in the house or a dog, these things could affect the results. So they control for these confounding factors.

Now, they also found that children who had both habits had a lower risk of atopic sensitization than those who had only one. And there was no association found between nail-biting, thumb sucking, and asthma or hay fever. So no associations to asthma and hay fever, but there was atopic sensitization. So the conclusion, children who suck their thumbs or bite their nails are less likely to have atopic sensitization in childhood and adulthood.

What this part illustrates is that exposure to environmental dirt, bacteria, what-have-you has a training effect on the immune system. Those who suck their thumb and bite their nails are going to be exposed to more of these microbes. And that will help attune the immune system when done at a very early age. And since the immune system and the gut microbiota forms up until about three years of age and then it’s predominantly formed, you see what happens at around one year of life as in this study have an impact at 13 years of age, at 32 years of age. So there’s an interesting finding there.

Also, important to keep in mind that I’m sure if they had done an accompanying microbiota profile, they would have found that children who suck their thumbs and bite their nails have slightly different microbiota than children that don’t. So just important to keep that in mind so as to temper the people that try to look at everything in the microbiota window, because there are so many things that affect the microbiota. Just to say something affects the microbiota doesn’t mean it has any clinical relevance or any important meaning.

Dr. Ruscio Resources

Hey, everyone, in case you’re someone who is in need of help or would like to learn more, I just wanted to take a moment to let you know what resources are available. For those who would like to become a patient, you can find all that information at drruscio.com/gethelp.

For those who are looking for more of a self-help approach and/or to learn more about the gut and the microbiota, you can request to be notified when my print book becomes available at drruscio.com/gutbook. You can also get a copy of my free 25-page gut health eBook there.

And finally, if you’re a healthcare practitioner looking to learn more about my functional medicine approach, you can visit drruscio.com/review. All of these pages are at the drruscio.com URL, which is D-R-R-U-S-C-I-O dot com, then slash either ‘gethelp,’ ‘gutbook,’ or ‘review.’ Okay, back to the show.

Dietary Carbohydrate Restriction In Patients With Type 2 Diabetes

The next study entitled, “Systematic Review and Meta-Analysis of Dietary Carbohydrate Restriction in Patients with Type 2 Diabetes.” So essentially, they found that low-carb works better, but only slightly better. They identified 10 randomized trials comprised of 1,376 patients. Now, remember, a systematic review with meta-analysis essentially summarizes as many clinical trials as can be found. So in this case, 10 clinical trials with 1,300 patients. And the low-carb diet was followed by a 0.34% lowering of hemoglobin A1c compared to a high-carb diet. They also found that the greater the carbohydrate restriction, the greater the glucose lowering effect.

However, this is important. At one year or later, the hemoglobin A1c was similar in the two diet groups. And also, that the effect of the two diets on BMI, body weight, LDL cholesterol, and quality of life were similar throughout the intervention. So some may say that the reason why after a year or later, the hemoglobin A1c—and hemoglobin A1c is essentially a 60- to 90-day average of your blood sugar. It’s not a perfect marker, in my opinion, but it gives you about a 60- to 90-day average of what someone’s blood sugar has been. After a year, the two groups may become similar because dietary compliance weans. That may be true. But it’s also important to keep in mind that some of these diets may have their most utility early phase when you’re helping to regain insulin sensitivity.

Clinical Features of IBS with SIBO and Effectiveness of Rifaximin

Next study, “Clinical Features of Irritable Bowel Syndrome with Small Intestinal Bacterial Overgrowth and A Preliminary Study of Effectiveness of Rifaximin.” So 84 IBS patients and 22 healthy controls were enrolled. The prevalence of SIBO in IBS patients was 41%. Now, 77% of them were hydrogen-positive on their SIBO breath test, 14% were methane positive, and 8% were positive for both. This showcases the importance of testing for methane and hydrogen, because if you only tested hydrogen, you would have missed about 15% of these cases. What’s also important to know is that there were no significant differences found in orocecal transit time between IBS and non-IBS and healthy controls.

Now, sometimes when people want to criticize the SIBO breath test, they say, well, if someone has a rapid transit or a very short oral, meaning mouth, to cecal, which is a section of the first section of the large intestine, if they have a very rapid transit in a short time, then that would skew the results of the test. However, this study showed that among IBS, non-IBS, and healthy controls, that the times were the same. They also found out there was no linear relationship between hydrogen and methane concentrations among the groups. Meaning, you might expect that the healthy controls have low levels in the folks who have digestive symptoms but don’t fit the IBS diagnosis criteria. They may have certainly higher levels of gas, and then those with IBS, they may have the highest level of gas. There wasn’t a linear trend upward, which means that the levels may not mean that the higher your level, the worse your symptoms are, and I think we’ve discussed that before.

So it’s not to say that the higher levels, the worse the condition. It’s not to say that may not be the case, but it may not always be about the levels per se. You may have some patients with low-level positive, as we’ve discussed, who are completely symptom-free. And you may have someone who has just a mild case of SIBO and they’re very symptomatic, and when it’s treated their levels become normal and their symptoms all go away.

So there were eight patients who did not have IBS, so they’re IBS negative. And they received Rifaximin therapy and their stool consistency, frequency, and satisfaction of bowel movements all improved. So Rifaximin is FDA-approved to treat diarrheal-type IBS, but this study shows that even in people who don’t have IBS, but they do have some digestive symptoms, the Rifaximin may be helpful.

Why this is important is because we want to try to be evidence-based, we want to try to be conservative. But that doesn’t mean that if someone doesn’t fit a diagnostic criteria or test-positive for something, it doesn’t mean that we can’t try treatment empirically. And so this is an example of being evidence-based but not evidence-limited. Now there may not be evidence yet to show that people with digestive symptoms, sometimes it’s known as functional gastrointestinal disorders, which essentially means you have digestive symptoms but they don’t really fit to the box of IBS or dyspepsia or GERD or what-have-you. People with just kind of vague digestive symptoms may improve from Rifaximin. And I think many clinicians have probably noticed this if they use herbal medicines, because I think it’s a little easier to justify an experimental trial with herbal medicines, that oftentimes people improve when they undergo antimicrobials. And then one final note, about 42% of the patients, meaning the chrome IBS criteria, have SIBO. So that’s important to mention, because there are varying reports in terms of how many people with IBS actually have SIBO. From the lowest, I think they go to 4%, and the highest I think is 84%. So this shows that about 42% of patients with diarrheal IBS also have SIBO, so just a few notes there.

Effect of Narrowband UVB Phototherapy and Vitiligo

Next study, “Effect of Narrow Band Ultraviolet B Phototherapy as a Monotherapy or Combination Therapy for Vitiligo: a Meta-Analysis.” Essentially they concluded that narrowband UVB can be used to treat vitiligo. So for those of you with vitiligo, this is one condition I have found not to have a huge response to probiotics, diet, treating SIBO, what-have-you. Some response, yes. But it can’t say it’s been supreme. So looking into narrow band UVB therapy may be something to check out. And of course, when you have a meta-analysis showing this type of result, then it really strengthens the likelihood that you’ll have a positive benefit from that therapy.

Thyroid Dysfunction and Cardiovascular Disease

“Subclinical Thyroid Dysfunction and Cardiovascular Diseases: 2016 Update.” To quote, “The TSH threshold for initiating treatment is unclear,” this means treatment with thyroid hormone. “In the absence of large randomized controlled trials, the best evidence suggests that subclinical hypothyroidism therapy should be started at TSH equal to or above 10. And subclinical hyperthyroid therapy should be initiated for a TSH of less than 0.1.” And I think people are probably more attuned with the conversation regarding subclinical hypothyroid. But just as a quick primer, subclinical hypothyroid is where you have, according to the conventional ranges, elevated TSH and normal T4.

Now, there’s a debate in terms of when is the most opportune time to start or to administer thyroid hormone prescription or thyroid hormone replacement, and much of the evidence suggests that 10 or above is when treatment should be initiated. I’ll add one clarifying comment in here that there’s also much discussion about an age-associated gradient for TSH, meaning, that the older someone is, the more normal it will be to see an elevation of TSH. So an 85-year-old with a TSH of 11 may not require treatment. A 25-year-old with a TSH of 11 then I think is much, much more supported.

Effects of Levothyroxine Therapy on Pregnancy Outcomes in Women with Subclinical Hypothyroidism

Now, here’s one more and, yes, sometimes the nuances are really important. So hopefully this is not sounding contradictory, but, “Effects of Levothyroxine on Pregnancy Outcomes in Women with Thyroid Dysfunction: A Meta-Analysis of Randomized Controlled Trials.” Now, it’s important to clarify that these participants were infertile women who also had either subclinical hypothyroidism, which is conventionally elevated TSH according to conventional range, or had TPO antibodies positive. So infertile women who were also subclinical hypothyroid or had Hashimoto’s, TPO positive.

Now, the intervention was that participants received levothyroxine supplementation or placebo. And the outcome or the outcomes were delivery rate, miscarriage rate, fertilization rate, pregnancy rate, preeclampsia, gestational diabetes, gestational hypertension, neonatal outcome of preterm delivery, low birth weight, intrauterine growth restriction, neonatal death, and cognitive malformations. So they’ve tried a number of things, essentially.

A total of 14 clinical trials involving over 1,900 patients were included in this meta-analysis. Compared with control treatments, levothyroxine supplementation significantly increased the delivery, clinical pregnancy, and fertilization rates. Moreover, levothyroxine therapy reduced the miscarriage rate, gestational diabetes, and gestational hypertension, but not preeclampsia. For neonatal outcome, a study found that the levothyroxine group had fewer preterm deliveries, low birth weights, deaths, and cognitive malformations.

Conclusion: “Levothyroxine supplementation showed beneficial effects in pregnancy outcomes among patients with thyroid dysfunction. Thus, levothyroxine should be recommended to improve clinical pregnancy outcomes in women with thyroid dysfunction.” So I think we’ve discussed this before, one of the populations that has shown the highest likelihood to benefit and probably the highest need to take thyroid hormone, if there’s subclinical hypothyroid or as the study shows that they have TPO antibodies aka Hashimoto’s, is pregnant women, especially if they have a history of infertility.

So that’s definitely something to keep in mind, a very important finding there. And if you’re pregnant or thinking about becoming pregnant, if you’ve been infertile in the past, definitely have a closer look at your TSH and T4 and your antibodies. And if you have elevations of those and you’re trying to get pregnant again, then you certainly should think about getting yourself on levothyroxine therapy under the supervision of your doctor. And if you’re trying to get pregnant, have a screening for your TSH and T4. If you see TSH above 4.5 or if you have positivity of TPO antibodies, both of these according to the conventional ranges, then it may be well advised to start on a course of levothyroxine.

Correlation of Tissue Transglutaminase with Modified Marsh Grading in Celiac Disease

Okay. “Correlation of Tissue Transglutaminase with Modified Marsh Grading in Celiac Disease: A Prospective Cohort Study.” Just a quick thing here, they found that serum transglutaminase levels can be used to predict villous atrophy, so essentially a blood test can be used to predict the damage of the intestines and may be used to avoid biopsy, especially if it’s a strongly suspected case. So you may be diagnosed celiac without needing a biopsy is what they’re saying, if it’s suspected enough and you have this elevation of the transglutaminase.

Fecal Microbiota Transplantation in Patients with Blood Disorders Inhibits Gut Colonization with Antibiotic-Resistant Bacteria

“Fecal Microbiota Transplantation in Patients with Blood Disorders Inhibits Gut Colonization with Antibiotic-Resistant Bacteria: Results of a Prospective, Single-Center Study.” Conclusion: “Fecal microbiota transplant therapy,”—which is essentially where we take healthy donor stool and, to say it simply, via an enema administer that to a sick patient—this therapy “in patients with blood disorders is safe and promotes eradication of antibiotic-resistant bacteria from the gastrointestinal tract.” So, another potential exciting application for FMT.

Preventing UTI’s After Menopause Without Antibiotics

The next study is entitled, “Preventing Urinary Tract Infections After Menopause Without Antibiotics.” Evidence shows that topical estrogen normalizes vaginal flora and greatly reduces the risk of UTIs. The use of intravaginal estrogens may be reasonable in postmenopausal women not taking oral estrogens. They also comment a number of other strategies have been used to prevent recurrent UTIs; probiotics, cranberry juice, and D-mannose have been studied.

So this showcase is for women with recurrent UTIs that you may want to consider using hormone replacement therapy, probiotics, cranberry juice, or D-mannose. But what I find to be the most interesting is that hormone support, or we may be able to argue that in women who may have a lower level of estrogen and then giving them estrogen, improves the microbiota in the vagina.

Why that’s important is because it reinforces the very important concept we’ve discussed before, and I will go into a lot of expansion regarding my book, which is the environment heavily influences the microbiota. So in this case, nothing was done to the vaginal microbiota when women were given estrogen. Yet, the microbiota in the vagina improved. This is because the microbiota isn’t this one-directional colony where you just have to feed it with prebiotics and it will flourish. The environment that you create in your body with sleep, hormone levels, stress, inflammation, sometimes even avoiding foods that feed bacteria because they may be flaring your immune system, all these things that create a healthier internal environment will improve the microbiota. So, it’s a very flawed line of thinking, in my opinion, to think that the microbiota is the ultimate cause of all disease.

Now, it’s involved in disease and it may directly cause some disease, but there are also many conditions wherein the microbiota is skewed because of other problems in the body that are negatively impacting the microbiota. So this is an example that extends even out of the gut into the vaginal cavity. And when women do not have a proper or appropriate balance of their female hormones, it changes the environment in the vagina. The pHs have been shown to change when hormones change, and that pH influences the microbiota.

Now, you could directly treat that vaginal dysbiosis with a probiotic. However, I’m willing to bet that many of these women that have skewing in their vaginal microbiota are also exhibiting signs of either estrogen or progesterone imbalance. And by treating those imbalances, you will see those symptoms go away and their vaginal microbiota improve, thus having less recurrence of UTIs. So this is an important non-gut example of how the environment in your body influences various microbiota of your body, and that treating the microbiota isn’t the only way to produce positive health outcomes.

Vitamin D Status and Efficacy of Vitamin D Supplementation in Atopic Dermatitis

Next study, “Vitamin D Status and Efficacy of Vitamin D Supplementation in Atopic Dermatitis: A Systematic Review and Meta-Analysis.” So they looked at two analyses that were scoring systems for tracking the severity of atopic dermatitis. And they found that both of these scoring indexes improved after vitamin D supplementation. And they concluded that this meta-analysis showed that vitamin D levels were lower in those with atopic dermatitis and the vitamin D supplementation could be a new therapeutic option for atopic dermatitis. Atopic dermatitis is just essentially, to put it loosely, when people have lesioning sores, pimples, rashes of the skin. And oftentimes this can happen in those with celiac disease, potentially even with non-celiac gluten sensitivity, and perhaps even with various forms of IBS or with inflammatory bowel disease.

Coffee Consumption, Obesity, and Type 2 Diabetes

Next study is entitled “Coffee Consumption, Obesity and Type 2 Diabetes: A Mini-Review.” As of today, there are mounting evidences of the reduced risk of developing type 2 diabetes by regular coffee drinkers of three to four cups a day. The effects are likely due to the presence of cholinergic acids in caffeine, the two constituents of coffee in higher concentrations after the roasting process. So some encouraging findings there regarding coffee. I will elaborate quite a bit on coffee in the book. We will review how coffee affects digestion, how coffee affects autoimmunity, how coffee affects neurologic conditions, and how people come away with, I think, both sides of the evidence and all condition-inclusive opinion on coffee.

Adrenal Fatigue

And last but not the least, entitled, “Adrenal Fatigue Does Not Exist: A Systematic Review.” Conclusion: “This systematic review proves that there’s no substantiation that ‘adrenal fatigue’ is an actual medical condition. Therefore, adrenal fatigue is still a myth.” This study, we will be expanding upon in an episode of the future of Functional Medicine Review Clinical Newsletter. So if you want to get kind of the point-by-point on this study with my thoughts, then that is coming in a subsequent edition of that clinical newsletter.

However, there are one or two comments I do want to make. Cortisol awakening may be a better measure for what should be termed HPA dysfunction. So cortisol awakening is more concerned with what your cortisol looks like in the first couple of hours of the day than a four-point cortisol test, which essentially looks at your cortisol at 8, noon, 6, and I think it’s 10 o’clock. So this is important.

And I think over the next several years, the term adrenal fatigue is probably going to strongly drop off, especially by more evidence-based natural medicine providers. The term HPA dysfunction will be more heavily utilized. But I’m hoping we’ll go even a step further where people will start to realize that HPA dysfunction is somewhat irrelevant, because there is almost certainly always—not in every case, but certainly the strong majority—there is something else that’s driving this HPA dysfunction.

Unfortunately, there’s been a lot of public education, aka in a lot of cases, unfortunately, marketing around the symptoms of adrenal fatigue, which has created a very high level of public awareness around the symptoms and blaming their adrenals for them. In fact, it’s almost become a part of pop culture where people will say, “Oh, after this conference my adrenals are wiped out” or “After this weekend, my adrenals are wiped out.”

Or someone will say, “I have had a lot of stress at work, I can really feel it affecting my adrenals.” This really needs to stop, because it’s taking the wonderfully complex stress response in the body that is shouldered by many organs and systems and blaming it all on one. And what ends up happening is this leaves a very monotherapeutic testing and treatment, where people want to keep testing their adrenal rhythm, which has very poor clinical validity, and they want to keep treating that rhythm. And all the while they may be missing the underlying factors that are causing them to be more sensitive to stress. Because, really, when someone makes one of those remarks, they’re either exhibiting that they’ve overdone it and they require some rest, or they’ve beat their bodies up in another way and require some recovery, or they’re very sensitive to the effects of any type of stress. It might be dietary stress, sleep stress, psychological stress.

And then an intelligent move to determine what is causing the lack of resiliency in that person. But I will tell you that, almost certainly, the solution and the cause of that problem is not going to be found in a four-point cortisol test, or even the more accurate cortisol awakening test, because it’s quantifying a symptom of dysfunction that’s being driven somewhere else in the body.

So I hope you guys are with me on that. I hope you understand that. I can tell you, personally, I haven’t done an adrenal test except for maybe a rare occasion where a patient really feels strongly about one and I can’t talk them out of it. I haven’t done adrenal test probably in two years. But we certainly see fantastic results with many of the symptoms of adrenal fatigue: insomnia, fatigue, brain fog, exercise intolerance, depression, moodiness, low sex drive. Because, again, I don’t need to be running a test that’s quantifying—and with a four-point cortisol test, inaccurately quantifying a symptom of another dysfunction in the body.

Episode Wrap-up

So hopefully that helps you. Again, this paper will be appearing in a more thorough write-up. And I’m also working on having a podcast guest on who has quite a bit of review of the cortisol awakening test and that will be something that will hopefully be coming up soon also.

So this is another edition of Health News Reviews. I hope you guys enjoyed it and I will talk to you next time. Thanks.

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Dr. Ruscio is your leading functional and integrative doctor specializing in gut related disorders such as SIBO, leaky gut, Celiac, IBS and in thyroid disorders such as hypothyroid and hyperthyroid. For more information on how to become a patient, please contact our office. Serving the San Francisco bay area and distance patients via phone and Skype.