Does This Parasite Influence IBS?

Intro:

Welcome to Dr. Ruscio radio, providing practical and science-based solutions to feeling your best. To stay up to date on the latest topics as well as all of our prior episodes, make sure to subscribe in your podcast player. For weekly updates visit DrRuscio.com. The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking with your doctor. Now let’s head to the show.

DrMichaelRuscio:

Hey everyone, this is Dr. Ruscio. If you’re hearing this announcement, it’s not going to be the same audio read. Every time you hear this announcement, the excerpt of the audio will be different. A lot of what I like to think I’m trying to bring to our audience to help keep them on the cutting edge is really a derivative of me staying plugged into the stream of research. I’d love to say that these ideas are all my own, but as I’m constantly referencing different papers and those are crafting my position. So it’s really important to disclose that this stream of knowledge in large part informs the positions I take and the way that I practice.

DrMR:

If you remember back, there’s been a few times on the podcast I’ve mentioned that one of the ways in which I’ve stayed abreast of new papers being published, therefore new findings, and therefore how I think about, talk about, and practice has been via, what’s known as a PubMed saved search. So I’ve been honing this series of saved searches in PubMed for many years now. And what’s wonderful about this is it keeps me abreast of what’s going on. So you may also have heard me say that it sums out to about an hour of reading every night. Over the past year, especially as things at the clinic have grown, I’m trying to spend more time now focusing on clinician training, refining the model, teaching what I’ve learned, making sure that we are all really congealing together in the clinic and operating more effectively as one than just me as a clinician by myself, the various research initiatives that we’re piloting at the office, the clinic, the center, it’s been difficult to keep pace with that. And so I said to myself, self, what if I taught someone how to do that hour of reading every night?

DrMR:

So I’ve spent a few months working with Gavin from our team, teaching him and honing him that methodology. And I’m very excited to say that we’re making that available as a subscription through our FFMR. The FFMR is The Future of Functional Medicine Review clinical newsletter. So this will be the FFMR Plus, where once per week you will get about a 10 page brief, but it’s very high-level and very summative. So a written brief of the best or the most impactful and relevant to functional medicine studies summarized very, very concisely, really only one or two bullets, like what is the bottom line? We’re all busy clinicians; we’re busy people. There’s a time and a place for really unpacking studies in more detail, but that’s different. This is, “I just need to keep my pulse on what’s going on, and then here’s a link if I want to learn more.”

DrMR:

So that five to seven hours of reading per week and then note taking is now done for me. And it’s been phenomenal by the way; it’s such a time save. And also Gavin will be doing a weekly audio read. So about 10 pages of text, summative high-level takes gosh, maybe 10 minutes to skim. And there’s also going to be a corresponding audio read so that if you are busy, you can go through the audio and make a mental note. “Okay, there was an important study, let’s say on TPO antibodies and their association to quality of life. There’s another study, let’s say this Danish cohort study following 400 patients that found that once again, subclinical hypothyroidism did not show that patients had any additional symptoms than healthy controls. So even more reason why we shouldn’t be treating subclinical hypothyroidism.” And you can say, “Hmm, I really want to know more about those two studies. I’ll open up the written brief when I have a moment and look at the short summary, and grab the reference link for the abstract,” what have you.

DrMR:

So we’ll put a few of these out there with no fee required. And if it is something that you think would benefit you, I hope you will join and pay to subscribe to the FFMR. Only if it benefits you, but I can say for me, this has been a tremendous time save because there are important studies being published every week, and it’s important that clinicians be aware of these. It’s not easy to do; it takes time. So now here’s a way of doing this in much less time. So we’ll have a few of these that we’ll put out there just for free with no subscription required, and Gavin here will follow shortly with what we’re calling the FFMR Plus. So this is the Plus aspect, the research brief, the research updates. And please let me know what you think. Again, for me at least, and I am admittedly a nerd, this has been huge because it allows me to be brushing my teeth in the morning and going through the audio and saying, “Oh, okay. This one, and that one are two studies that I really need to make note of,” and what have you. Okay, well, I hope you enjoy it. Please let me know what you think.

GavinGuard:

Hello. This is Gavin Guard with the Ruscio Institute and welcome to the FFMR Plus, keeping you on the cutting edge of clinical care in Functional and Integrative Medicine. Dr. Ruscio and I have been really hard at work sifting through the latest published research in order to bring you important updates. In today’s research digest we cover new guidelines for managing IBS, the association of Blastocystis hominis and IBS, efficacy of rotating anti-microbials, and much, much more. So let’s jump right into it.

Guidelines for Non-Pharmacological Therapy of IBS

GG:

For our featured study this week, it is the Romanian guidelines for non-pharmacological therapy of IBS. So this is a consensus statement focusing just on non-pharmacological therapy rather than medications for IBS. And here are a few of their key points that they made in this document. Number one, a low FODMAP diet may be offered for IBS patients to improve abdominal discomfort, bloating, and diarrhea for a minimum of four weeks as to complete the elimination phase. So elimination phase of four weeks on the low FODMAP diet. If no symptom improvement has occurred within that four week timeframe, the diet should be discontinued.

GG:

Number two, in those patients where symptoms improved during the elimination phase of the low FODMAP diet, they recommend a gradual reintroduction of FODMAPs over the course of the next three months. And this should be personalized to the patient with the clinician’s help. Number three, soluble fibers are recommended for overall symptom improvement, especially in those with constipative-type IBS.

GG:

The next one is soluble fibers are well tolerated, have a low cost, and therefore represent a reasonable first line therapy. Their next recommendation is that they do not endorse, in other words they do not recommend, starting a gluten-free diet in those with IBS. They also do not recommend HLA-DQ2 and DQ8 testing to recommend a gluten-free diet in those with IBS. They endorse a peppermint oil supplementation to improve global symptoms as well as abdominal pain. They recommend and endorse probiotics, and to perform a trial with probiotics. They also endorse physical exercise, and they say that can be a primary treatment, especially for those with constipative-IBS. And finally, they recommend psychotherapy should be considered for those with IBS, especially for those who do not respond to other treatment.

GI Studies

GG:

We’ll now dig into our GI studies. The first one is titled “Micronutrient Deficiencies in Children with Celiac Disease.” What the researchers did here is they analyzed 15 micronutrients in a hundred blood samples for pediatric patients with newly-diagnosed celiac disease and patients who are on a gluten-free diet. So at diagnosis of celiac disease, deficiencies of the following micronutrients were noted. Number one is vitamin E, 88% of patients were deficient in vitamin E. B1, or thiamine, 71% were deficient. Vitamin D, 24% were deficient. Vitamin K, 21% were deficient. Vitamin A, 20%. B6, 12%. Iron, 80%, as noted by low ferritin, iron at 80%, and zinc at 33%.

GG:

After 12 months of a gluten-free diet, repletion or correction of these deficiencies were noted for vitamins E, K, B6, and B1, but vitamins D, A, and zinc did not change significantly after a proper diagnosis of celiac disease. So several micronutrient deficiencies in celiac disease do respond to a gluten-free diet, but others, including A, D, and zinc need to be monitored long-term and supplemented when indicated.

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GG:

The next study is looking at whether single strain or multi-strain probiotics are better. And long story short here is that the authors make some good points and note some good research on the superior efficacy of multi-strain probiotics as compared to single-strain probiotics. Specifically, they state the following. While single-strain probiotics are beneficial to health, multi-strain probiotics may be more helpful because of synergy in additive effects among the individual isolates. This corroborates our view here at the Ruscio Institute of utilizing multi-strain probiotics for a myriad of gastrointestinal disorders.

GG:

The next study I’m really excited to share with you is titled “Blastocystis Species Carriage and Irritable Bowel Syndrome.” It’s examining the question is Blastocystis hominis colonization associated with irritable bowel syndrome? This is a cross-sectional analysis of 36 IBS patients and 36 controls, and they measured the parasite Blastocystis hominis using both PCR and microscopic evaluation. When comparing the presence of the parasite Blastocystis hominis between healthy controls and IBS patients, no significant differences were noted. Again, the colonization rates between those with IBS and those without IBS are similar.

GG:

The next study is looking at 150 children with atopic dermatitis and cow’s milk protein allergy. This is a double-blinded, placebo-controlled, randomized controlled trial. It’s a multi-center study, and all of the 150 children received cow milk protein elimination diet plus or minus a probiotic. In this case, it was a lactobacillus rhamnosus. After three months, the probiotic group had a greater improvement in symptoms, an odds ratio of improvement of around 2.5.

GG:

The next study is titled “The Influence of Rifaximin on Diverticulitis Rate and Quality of Life in Patients with Diverticulosis.” This is a prospective study of 250 patients with diverticulitis, and 150 of the 250 diverticulitis patients received Rifaximin prophylaxis. The Rifaximin group had no difference in diverticulitis rate at six months, however, the Rifaximin group had a lower rate of diverticulitis in between six and 12 months. So after six months, the Rifaximin group had a greater improvement in their diverticulitis. The Rifaximin group also had higher quality of life. Other findings include that Rifaximin can be safely given for the prevention of further diverticulitis flares every three months. So anti-microbial therapy is effective for improving diverticulitis and quality of life.

GG:

The next study is looking at the efficacy of using rose oil on those with GERD and comparing it with omeprazole. This is a double-blinded controlled trial of 70 patients with GERD, and they were either randomized to omeprazole or rose oil. And in this study, they showed that rose oil was equivalent to the PPI Prilosec or omeprazole in reducing GERD symptoms. Again, rose oil was equivalent to omeprazole in reducing GERD symptoms.

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GG:

The next study is titled “Do Antibiotics Cause Obesity Through Long-term Alterations in the Gut Microbiome?” This is a review, and the researchers here noted that the association of antibiotics and obesity is noted if the following parameters are found. One, if antibiotics are given during the first six months of life. Two, repeated exposure of antibiotics for three or more courses. And three, treatment with broad spectrum antibiotics. Again, this research lies out some variables for if antibiotics are associated with being overweight or having obesity.

GG:

The next study is looking at the use of various diagnosis criteria for celiac disease. The researchers here note that in those with DQ2 and DQ8 positive alleles, a TTG IGA, tissue transglutaminase IGA tighter above 10 times the upper limit of normal had a sensitivity and specificity of 100% to correctly diagnose celiac disease. So a TTG IGA above 10 times the upper limit of normal may be sufficient to diagnose celiac disease without a biopsy in those who are DQ2 DQ8 positive, however more evidence may be necessary.

GG:

All right, the next few studies here. “Antibiotic Treatment for Small Intestinal Bacterial Overgrowth: Is a Cocktail Better than a Single?” This is an expert narrative review, and one of the studies that the author noted was a study of 220 patients with SIBO as identified by glucose breath test. They were either given a single antibiotic or rotating antibiotics for 10 days every month for three months. So the patients either got a single antibiotic or rotating antibiotics. The rotating antibiotics had better resolution of SIBO, 70% versus 51%, more improvement in bloating, and better quality of life. So rotating antibiotics may be better than a single antibiotic at remediating SIBO.

GG:

Finally here, “Celiac Disease in Pediatric Patients According to HLA Genetic Risk Classes.” This is a retrospective study, and they found here that each HLA-DQ2 and DQ8 alleles were not associated with any specific symptoms in those with celiac disease. So just because someone has DQ2 or DQ8, those alleles are not associated with any symptoms in those with celiac disease.

Thyroid and Hormone Studies

GG:

All right, let’s move on to our thyroid and hormone studies. The first one is titled “Investigating the Prevalence of Primary Thyroid Dysfunction in Obese and Overweight Individuals.” This is a study of 5,000 participants, and a higher prevalence of hypothyroidism was found in those who were obese. For example, overall hypothyroidism was 12% if someone was obese as compared to 8%. In overt hypothyroidism it was 4% if you were obese versus 1%. Subclinical hypothyroidism 8% versus 7%, and having TPO antibodies, 17% versus 12%. There were no differences found in hyperthyroidism.

GG:

Alright, the next study is “The Status of Iodine Nutrition After Removing Iodized Salt in High Water Iodine Region.” This is a cross-sectional study in China, and it’s an analysis of 1,300 adults in four different regions in China with different iodine concentrations in the water. So within four different regions in China, each region had either high, medium, or low concentrations of iodine. And what they found was that a high iodine concentration in the water was associated with higher prevalence of the following: thyroid auto-immunity, subclinical hypothyroidism, thyroid nodules, thyroid dysfunction, and a high urinary iodine concentration was associated with more thyroid nodules and thyroid dysfunction. They also found that iodine concentrations were still elevated in the high iodine areas, even after discontinuation of iodized salt. So too much iodine is also harmful to the thyroid. Too much iodine is also harmful to the thyroid. Removing iodized salt may not be sufficient to prevent the harmful effects of too much iodine.

Diet and Lifestyle Studies

GG:

All right, into our last section here, which is diet and lifestyle. The first one is “Association Between Age at Diabetes Onset and Subsequent Risk of Dementia.” This is a study of 10,000 participants followed over the course of 32 years. It found that younger age at onset of diabetes was associated with higher risk of dementia. So the earlier you were diagnosed with diabetes, the higher risk that you are to develop dementia.

GG:

The next study is a double-blind control trial looking at the question, what do different fatty acids do to cholesterol markers? And the patients received either high dose fish oil at three to four grams a day, or omega-6 fatty acids at 15 to 20 grams a day for seven days, or a week. They had a nine week wash-out period where the participants did not ingest anything, and here’s what they found. VLDL cholesterol decreased around 40% in those who took omega-3s versus a 16% increase in those taking omega-6s. Apolipoprotein B increased only 0.5% in those taking omega-3 versus a 6% decrease in those taking omega-6. Triglycerides, 16% reduction for omega-3 versus 3% reduction in omega-6. And total cholesterol, really no change in omega-3 and a 4% reduction in omega-6. So, omega-3 fatty acids at three to four grams a day had significant reductions in VLDL cholesterol and triglycerides with no difference in ApoB or total cholesterol. Overall, omega-6 fatty acids have relatively little impact on cholesterol or triglyceride content.

RuscioResources:

Hi everyone. This is Dr. Ruscio. In case you need help, I wanted to quickly make you aware of what resources are available to you. If you go to drruscio.com/Resources, you will see a few links you can click through for more. Firstly, there is the clinic, which I’m immensely proud of. The fact that we deliver, cost-effective, simple, but highly efficacious, functional medicine. There’s also my book, Healthy Gut, Healthy You, which has been proven to allow those who’ve been unable to improve their health, even after seeing numerous doctors, to be able to help them finally feel better. There’s also our store where there’s a number of products like our Elemental Heal line, our probiotic line, and other gut supportive and health-supportive supplements. We now offer health coaching. So if you’ve read the book or listened to a podcast like this one, or are reading about a product and you need some help with how or when to use, or how to integrate with diet, we now offer health coaching to help you along your way. And then finally, if you are a clinician, there is our clinicians’ newsletter, the Future of Functional Medicine Review. I’m very proud to say, we’ve now had doctors who’ve read that newsletter, find challenging cases in their practices, apply what we teach in the newsletter and be able to help these patients who were otherwise considered challenging cases. Everything for these resources can be accessed through drruscio.com/Resources. Alrighty, back to the show.

GG:

Next study, “High Protein, Low-glycemic Meal Replacement Decreases Fasting, Insulin and Inflammation.” This is a 12-month study of 450 obese patients. The intervention group ate a higher protein, low-carb diet. At 12 months, the high-protein group had significant reduction in insulin, greater weight loss, six versus three kilograms, and lower inflammation. Again, a higher protein low-carb group saw more significant reduction in insulin, greater weight loss, and lower inflammation.

GG:

Next study, the results here conclude that compared to animal fat, coconut oil leads to less of an increase in postprandial lipids and cholesterol. So after a meal, coconut oil when compared to animal fat, in this case, lard and butter, led to less of an increase in lipids and cholesterol.

GG:

The next study is a systematic review and meta-analysis that concluded that children with reduced maternal or neonatal vitamin D, so either the mom or when they were a baby did not have enough vitamin E, had 50% higher likelihood of developing autism.

GG:

Finally, “Inverse Association Between Dietary Vitamin A Intake and New Onset Hypertension.” This is a study of 12,000 participants followed over the course of six years. It found that those with higher vitamin A intake had a significantly lower risk of hypertension. And just as a reminder, some vitamin A rich foods include liver, eggs, milk, and most yellow, red, and orange vegetables, however, the plant sources are not as bioavailable as the animal sources.

GG:

Okay, that’s it for this week. Dr. Ruscio and I hope you’re enjoying these briefings and that they are helping you practice more efficacious, practical, and cost-effective functional and integrative medical care. Until next time.

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