Experience Better Sleep and Less Stress According to Research

Intro:

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Dr Ruscio:

Hey everyone. This is Dr. Ruscio, DC. Welcome back to Dr. Ruscio, DC Radio. And today we will be covering some research updates regarding diet, lifestyle, sleep health, hormone health and optimization. I’m trying to partition these [episodes] to probiotics as the one, gut health as the other, thyroid as yet another, and then one more [that’s] everything I feel pertinent and within my and the clinic’s area of focus with this podcast. So there’s a lot here to unpack, and I’m very excited to jump into this discussion with you.

Dr Ruscio:

And we’ll start off with an interesting topic we have discussed and actually had Scott Carney on the podcast. If you remember back, he was and is an investigative journalist who wanted to discredit the work of Wim Hof because he had written a couple of books and done some journalism regarding these false gurus. And so he went to study with Wim Hof with the intention of discrediting him and actually became a big fan of his work.

Dr Ruscio:

So this next study, a novel Wim Hof training program to reduce stress response during an Antarctic expedition looked at 13 healthy participants who were randomized to control or the Wim Hof method (which is essentially breathing exercises, cold exposure, and some meditation for 20 minutes per day). And after two months, the Wim Hof group experienced less depressive symptoms and a lower stress response than the control group. So pretty interesting to see more evidence for Wim Hof.

Dr Ruscio:

The next trial looked at vitamin D and its effect on mortality. This was a large study in over 21,000 individuals who are over 60 years of age. And this is of course where mortality prevention’s going to be the most relevant. And participants were randomized to placebo or vitamin D at 60,000 IUs per month, that’s about 2000 IUs per day, and after five years and 1100 deaths recorded, the vitamin D group had greater levels of vitamin D—46 as compared to 30, so I would consider that a significant improvement. There was no difference in overall mortality, no difference in cardiovascular disease, and no difference for cancer. So, disappointing to see this. I wouldn’t say this discredits any benefit one could gain from vitamin D.

Dr Ruscio:

How I account for this is, and we’ve discussed this in the podcast in the past, but always worth, I think, recapitulating this, there are health benefits from vitamin D levels that we see in association that are not replicated by vitamin D supplementation exclusively. There are some health benefits that have been documented from vitamin D supplementation. Yes. However, we don’t see the same amount of health benefits or improvements as we do when we say these people have normal vitamin D, they have healthy X, Y, Z. Then if we go and give people vitamin D supplementation, do we see all of those X, Y, Zs become the same as in the healthy individuals we observed with normal, healthy vitamin D? No, not all of the X Y Zs change (as this study does a pretty good job of articulating). Now, why is that? Well, in part, because there seems to be some benefit from sun exposure and hence the vitamin D that you get from sun exposure that’s independent of the vitamin D levels themselves. And I think that’s very important to keep in mind.

Dr Ruscio:

Our audience, I’m assuming, is fairly privy to this, but again, a good opportunity to remind ourselves of this, that vitamin D supplementation alone is not adequate to replace the lifestyle deficiency of not obtaining time in the sun. And remember, if you’re in the sun and you have sunblock on, then it doesn’t count. Now, if you will be in the sun for an extended period of time and you’re worried about burns then yes, of course, of course, of course, use sunblock. But if you’re trying to obtain 10 or 20 minutes per day [of] indirect sunlight during roughly the middle of the day, then that is a time when you don’t want to use sunblock. Perhaps, except for on your face for wrinkles. And perhaps, also as Dr. Michael Holick articulated, on the backs of your hands because that is one area where skin cancer tends to be a bit higher because people almost never use sunblock there. So, [an] interesting study on vitamin D and a good reminder of the limitation of supplementation, especially when the supplementation is trying to correct for a lifestyle deficiency.

Dr Ruscio:

The next study examined the severity between chronic urticaria, or hives, and sleep-disordered breathing. Now remember sleep disordered breathing is this broader term under which we can organize sleep apnea and also upper airway resistance syndrome. [They are] similar but different we could say. 37 patients with urticaria or hives were examined. And 19 of these had mild hives and 18 of them had moderate hives. They all had a sleep study and sleep apnea severity was higher in the severe hive group. So there was almost a severity-dependent relationship between hives (histamine-mediated) and sleep-disordered breathing.

Dr Ruscio:

So this is a very interesting finding telling us that if you’re suffering from hives then, at least from this one smaller study, there’s a higher likelihood that something could be suboptimal with the health of your respiration while you’re sleeping. And this, in my opinion, is a halfway decent proxy for histamine. And so if you’re suffering with histamine issues, histamine intolerance issues—runny nose, hives, of course, other skin reactions, flushing, warmness, irritability, anxiousness, depression, lightheaded, dizziness, insomnia, joint pain—it’s a fairly broad constellation of symptoms but if as you’re getting to know your system you’re suspecting histamine intolerance, then looking into your sleep health might be something important to consider. And this is why we’ve taken a progressively astute look into sleep medicine.

Dr Ruscio:

In that same vein, a study was performed examining obesity, sex, snoring, and severity of apnea. And they looked at 233 individuals, gave them a sleep apnea test, and 45% were positive for apnea. And the apnea was associated with snoring, male gender, and obesity. Probably nothing surprising. There is this chicken or the egg. And from a few probes into the literature, I haven’t really been able to get a good answer on this in terms of does obesity tend to drive the apnea? Does the apnea tend to drive the obesity? It’s probably a little bit of both. And at the end of the day, we want to try to address both. The nice thing is remember there are some fairly simple—like the EMST—breath expiration/inspiration training device that have been shown to help with apnea. As one of a few on offer. So it’s not a Darth Vader CPAP or nothing.

Dr Ruscio:

And here’s another interesting study along the same vein. And this ties into something that I’m starting to see at the clinic now that we’re working with more and more patients, we’re seeing some patients who have apnea, they’re undergoing some treatment, and it’s interesting to be able to help them improve the level of efficacy of their treatment. And I think some of this is because they just get one out-of-the-box treatment without much follow-through from whoever diagnosed the apnea. So in this case they looked at mouth taping and the effect that mouth taping has when done in conjunction with a mandibular advancement device. The MAD, or mandibular advancement device, is one of the other therapies for apnea that’s on offer. This is a mouth guard that essentially helps push the lower jaw forward, thus opening the airway. It’s not necessarily my favorite treatment, nor where I would start, but it’s an effective option.

Dr Ruscio:

And interestingly, what they found was that sleep apnea improved in 76% of participants who had the mandibular advancement plus mouth taping compared to only 43% in the mandibular advancement alone. Also mouth taping alone did not significantly improve apnea. I think that’s important to keep in mind. If someone has full blown apnea, there’s likely something beyond just mouth breathing that needs to be fixed. Now, if you give them a mandibular advancement device, open up the airway, but they still breathe through their mouth—remember James Nester and his interview based upon his book “Breath” where he had his nose occluded for a week and his health fell apart—so if you can’t breathe through your nose, that’s problematic. If you have a problem with your oral airway and you breathe through your mouth at night [then] you fix [the] problem with [your] oral airway but you still breathe through your mouth, that’s going to be partially helpful. But [it is] not as helpful as if you also discouraged yourself from mouth breathing at night.

Dr Ruscio:

Some people in the clinic and in our paperwork, they report and we flag a propensity toward mouth breathing. And in some of these people—I would estimate maybe 25/30%—mouth taping is notably helpful. So it’s worth an experiment, especially because $5 or $10, you can get yourself some tape. But keep in mind that it may be insufficient if you’re snoring or you feel like you choke yourself awake or snore yourself awake in some instances.

Dr Ruscio:

And a different topic here, coming over to female hormones, “The effect of cognitive behavioral therapy for menopausal symptoms: a systematic review and meta-analysis.” So this is a great data point; 14 clinical trials looking at over 16,000 menopausal women randomized to control or CBT (cognitive behavioral therapy). So we’re going to guard against placebo here. Check this out: CBT led to significant improvements in hot flashes, night sweats, depression, anxiety, fatigue, and quality of life. So something to be said here for cognitive behavioral therapy and something to keep in mind if you’re suffering with those symptoms.

Dr Ruscio:

I do feel this is important to echo, there is clearly a subset of patients for whom they have all of these symptoms, or most of these symptoms, but the depression, anxiety, fatigue, and low quality of life will be focused in on. And it’s a bit alarming how many providers don’t queue in on hot flashes and night sweats and [instead focus on] depression, anxiety, fatigue, low quality of life thyroid and they just shoehorn people onto thyroid. And [these patients] come into the clinic oftentimes not responding—as you’re probably not shocked to hear when someone’s given thyroid hormone who doesn’t need it—and we look at their symptoms and probe into […] estrogen insufficiency. Has anyone done anything for this? No. So in some cases it’s remarkably easy to be of assistance to patients who are suffering with this constellation of symptoms. So don’t forget about the importance of female hormones. And we typically start with diet, lifestyle, and gut health. This will remedy a decent subset of female hormone imbalance symptoms. However, if not, this is where the Estro-Harmony and Progest-Harmony herbal blends have been quite helpful. And there’s a good body of research supporting their use also.

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Dr Ruscio:

The next study looked at dietary sodium and potassium intake and the risk of nonfatal cardiovascular disease. This was a prospective, so looking back in time, analysis of 180,000 participants followed for eight years. A higher sodium intake was associated with a higher risk of cardiovascular disease and a higher potassium intake was associated with a lower risk of cardiovascular disease. Now, one important point here to put in the table is— at least according to my speculation, I haven’t drilled down into the details of this study—but knowing the sample size was this large, I’m [questioning] that the ability to separate out [if participants were] obtaining that sodium via process foods and essentially poor quality foods (mainly processed foods that have added sugar, salt, and fat) or […] moderate to lower carb whole foods [salted] liberally.

Dr Ruscio:

The other side of this here is many fruits and vegetables are higher in potassium. And so another way one could interpret this is higher sodium (AKA higher processed) food was associated with higher cardiovascular disease and higher potassium (AKA higher fruits and vegetables) was protective. It’s important to keep this in mind. And actually, I think Chris Kresser recently released an article that was outlining how the guidelines regarding sodium intake are being revisited. I didn’t get too deep into that because for me it wasn’t something I felt was necessarily going to change our recommendations in the clinic. If someone’s on a high processed foods diet, you will remedy this and this will be adequately addressed in a second order outcome as you address, upstream, their diet. And then there are some people for whom they are under-eating and/or too low-carb for whom electrolyte supplementation, including salt, can be quite helpful.

Dr Ruscio:

Okay. Another study on vitamin D, and this was looking at supplementation and sleep. A systematic review of 19 studies and they found that vitamin D supplementation led to improved sleep quality. So this is great. Interesting. And this is something that Dr. Stasha Gominak discussed on the podcast, vitamin D and B vitamins. I’m not sure if the clinical signal there is super strong, as I’ve been doing some tinkering with this, but there may be something there that I’m not seeing. But I just do want to flag my perspective. I’m tenuous if vitamin D and vitamin D supplementations are going to be demonstrably helpful for sleep quality in otherwise healthy (healthy diet and healthy lifestyle) cohorts, which is who we predominantly see, right? If someone has vitamin D in the tank and might be eating a poor diet and have a poor lifestyle, that’s when I think you probably have the largest opportunity for improvement—this is my speculation—and when you’re seeing people like you, listening to this, who care so much about their health that they’re listening to a podcast, they’re probably not going to see a demonstrable benefit in their sleep from vitamin D because their vitamin D’s probably not too far off to begin with. Again, my speculation. Take that with a grain of salt.

Dr Ruscio:

The next study looked at vitamin D supplementation and fractures in adults. This was a even more impressive systematic umbrella review of meta-analyses and control trials. So sometimes when you have so much data, you can actually do a review of meta-analyses in this umbrella review. The vitamin D plus calcium reduced the risk of hip fracture and any fracture in most of the studies. There was 19 studies that looked at vitamin D alone and there was no reduction in fracture. So this is actually quite important, I think, to unpack. Now there’s other data suggesting that calcium supplementation may increase cardiovascular disease risk, or the risk of some negative cardiovascular outcome or episode. That’s concerning to me. This might be one of the areas in healthcare and medicine where you have to pick the path that is going to have the best risk/reward for you.

Dr Ruscio:

If you are someone who’s taking calcium just because—you have no osteoporosis, no osteopenia—and you’re taking a bunch of vitamins [including calcium because you heard it’s good for you] and you have a history of cardiovascular disease or you’ve had a prior cardiovascular episode or you have lipids that are very high, I would stop the [calcium]. If, let’s say you’re a dainty woman in her forties/fifties and you have osteopenia or osteoporosis and especially if you have no family history or no history yourself of cardiovascular disease or warning signs of, then the calcium supplementation probably makes sense. So this is one of those areas where the treatments that can be effective, in this case vitamin D plus calcium, don’t come without any risk. And that’s sometimes the way these things play out. So knowing what you’re trying to do and making an educated decision based upon what supplements to use would be the best way to handle this.

Dr Ruscio:

Okay. The next study looked at the association of hypoglossal nerve stimulation and how this mapped onto improvements in treatment for sleep apnea. This was a retrospective review, looking back in time—and sorry, I think a moment ago I said prospective was looking back in time; I should clarify that prospective is forward in time, retrospective is back in time—and these patients who had sleep apnea, 85 patients received hypoglossal nerve stimulation [and] roughly 200 patients received CPAP therapy. And after treatment the nerve stimulation group had a greater improvement in depression scores. At a one year follow up the nerve stimulation group had comparable improvements in depression scores and in improvements in daytime sleepiness and comparable improvements in sleep quality. So this is interesting and this suggests that yet another therapy for apnea, that I wasn’t aware of until now, is available and might be as effective as CPAP.

Dr Ruscio:

And a similar device, one that Gabe and I have both experimented with, is this Excite OSA. It’s essentially this mouthguard-like device that is almost like a tens unit that zaps on your muscles. Well, it zaps awake your tongue and you do it for 20 minutes, I believe it’s three times per week, and it’s not unpleasant. But I mean, just picture a tens unit that is an electrical stimulation of your tongue causing your tongue to contract. So you feel it. Not unpleasant, but notable, certainly. And that device has been shown in a couple trials to improve apnea. Now that device, I believe is roughly $750, maybe a touch more and can be covered by insurance in some cases—to my understanding, I’m a little bit hazy on how robust the coverage there is—but all of that to say there is another therapy available for apnea.

Dr Ruscio:

And so if you have apnea and the prospect of the Darth Vader CPAP is besetting to you, you could put a mouth guard in for 20 minutes per day, three days per week and within a month or so have improvements in apnea because you’ve improved the tone of your tongue. And this might be a good therapy for someone who says (actually, like me) “I’m busy, I think a lot all day, I’ve got many, many things to do, and I’m just quite mentally taxed on a day-to-day basis…I don’t want to have to have an appointment with a myofunctional therapist a couple times per week or go through a self-study course where I have to learn practice exercises,” even though that’s really not too bad. I can say for me, I just didn’t want to do it.

Dr Ruscio:

So, okay. I’d rather spend a little bit more money and preserve my time. And this way I could have the Excite OSA mouth guard in and be washing dishes, doing a few chores. For me, I was able to do the therapy while being freed up for other things. I mean, you can’t have a phone call, right? But you can do anything that doesn’t require talking. And this is again, how we think about these things at the clinic, which is the [patient] is in position X [so] this would be the best therapy given where they are and what they need.

Dr Ruscio:

Now, coming back to the mandibular advancement device. Only one or two more on sleep guys. So if sleep is putting you to sleep, then don’t worry, we’ve only got a couple more. But I want to share these. Resolution of fibromyalgia was documented (so this is chronic fatigue and chronic pain, essentially) by using a mandibular advancement device. Now, this was just a case study, but it was very interesting to see that there was a significant improvement in fatigue, fibromyalgia, depression, and sleep apnea scores from using the mandibular advancement device. And probably not surprising that problems with sleep can manifest in a wide array of symptoms, but important for me to maybe to clarify that daytime sleepiness—meaning you’re not super tired when you need to be but you’re tired during the day—brain fog, low mood, and pain are some of the hallmark symptoms of having apnea so important to keep that in mind.

Dr Ruscio:

And this is one of the things that when we’re reviewing someone’s symptoms when they are first coming into the clinic and really studying their symptoms and trying to translate that into our problems list. If we’re seeing this signature, we’re going to be making notes about potentially apnea based upon their symptoms. And especially if the other part of our paperwork corroborates they had braces, they have drool on their pillow in the morning, they wake up with a dry mouth, they snore, or, even more obvious still, they have a family history of apnea. All these things really help build us out the successful problems list that allows patients to get to the bottom of their symptoms and feel better as quickly as possible and without going on a [cortisol] goose chase […].

Dr Ruscio:

I’m partially jesting and teasing that, but this was something I did for years and thankfully learned my way, I think to a shorter path to help patients get well. Because I just don’t see the merit in meticulously documenting someone’s cortisol patterns for a whole array of reasons we discussed—they don’t tend to match, they change from day to day, if people are not drinking caffeine on the day of their test they’re going to be causing a false positive in a lot of cases, and probably most importantly, along with the questionable accuracy, is doesn’t really tell you how to fix the person. And if you think you need a lab test to tell you how to use adrenal, adaptogenic herbs, Pregnenolone DHEA or Phosphoserine, I just would reply that you’re probably too successfully educated by lab companies who have convinced you that you can’t do this with good clinical decision making and listening skills from what the patient is saying.

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Dr Ruscio:

Here’s another interesting study looking at fracture recurrence—hip fracture—in menopausal hormone therapy versus a (essentially) calcium drug. And what they found is after four years there was no difference in the fracture rates between groups. And there was a slight favorability of bone mineral density increasing in the hormone therapy group, as compared to essentially the drug Actonel, which is supposed to help with bone density or at least prevent bone loss. So that’s interesting and supports that we should be looking tentatively to a female’s hormones. And I’m going to make an assumption here that these postmenopausal women likely had some degree of symptoms. I could be wrong here, but I’m assuming that there were symptoms that were improved by the topical estradiol and the oral progesterone that these women were given.

Dr Ruscio:

The next study looked at the effect of vitamin D on recurrence of uterine fibroids. It was a randomized placebo control trial; 99 women who had undergone uterine fibroid removal [were] then given either placebo or vitamin D. At a one year follow up, the vitamin D supplementation led to reduced recurrence size of the fibroids by 50% and reduced size of any other recurrent fibroids. So reduced recurrent of the fibroids and reduced size of any that did recur. So the earlier meta-analysis that we discussed didn’t find prevention of or reduction of mortality, but here’s another data point that’s interesting regarding uterine fibroids.

Dr Ruscio:

This next study is a nice reinforcement of what we do at the clinic, which is start with the diet-lifestyle-and-gut-health foundation model and then if a woman is still exhibiting symptoms of female hormone imbalance including (as this study examined) menopausal symptoms, specifically, we will use a herbal formula. This study in particular, looked at soy plus black cohosh plus chaste tree (AKA Vitex) plus evening primroses oil. Now we don’t use soy, and that’s, I guess, a different topic on the merits of soy. Although there are merits to soy for estrogen receptor modulation. But whether or not you like soy, we use black cohosh and we use chaste tree. And this study did something similar.

Dr Ruscio:

Now, at three months when compared to placebo—so again, we’re protecting against the placebo effect by having a placebo group—the women in the herbal group experienced less severe hot flashes, improvements in insomnia, depression, and irritability—all to a statistically significant extent. So great evidence here that some women really do benefit from some gentle and simple herbal support. And we’re seeing more and more evidence that has documented that there was already a pretty good body of evidence supporting cohosh, chaste tree, and similar compounds. This is just one more data point to add to that body of evidence.

Dr Ruscio:

The next study looked at the association of insomnia and sleep apnea and how it associates to cardiovascular disease and cardiovascular events. They found that having both insomnia and apnea, listen to this, was associated with a two times higher risk of cardiovascular disease. Now, this association might have been confounded by weight because when weight was controlled for, that association was diminished and essentially attenuated. But nonetheless, important to point out the importance of addressing your sleep in terms of insomnia, being able to fall and stay asleep, and your apnea (breath quality) during sleep.

Dr Ruscio:

This next study looked at the effect of low carbohydrate versus balanced carbohydrate diets for reducing weight and cardiovascular disease risk. This was the esteemed Cochran database or a esteemed Cochran database analysis. And they looked at a low carbohydrate diet being defined as anywhere from 50-150 grams of carbohydrates per day. And the balanced carb being 45-65% of carbohydrates in the diet, which equates out to maybe 300 ish grams. So the low carb could have been lower carb, but I still think this should be adequate to get a signal.

Dr Ruscio:

And what they found was that in overweight and obese individuals, low carb diets had little to no difference in changes in body weight over a three to nine month period. So, that’s one data point. I want to offer some thoughts, but I’ll just say this, my feeling is that it’s not necessarily the macronutrient composition that’s the most important, it is what diet tends to prevent someone from overeating. Christopher Gardner has hinted at this with some of his work. And I like what Melissa Hartwig says, which is “food with no breaks.” For some people they will overeat healthy fats. Some people will overeat healthy carbs. The healthfulness of the foods—meaning you’re focusing on healthy sources of fat and healthy sources of carbs and protein—is probably going to be the most important at the end of the day, which is part of the reason why I’m dietarily agnostic outside of looking for what clues can we uncover that might tell us or help us predict what diet you would respond best to. And really trying to stay out of the sandbox of the different diets [that are] trying to discredit one another.

Dr Ruscio:

And this next study looked at self-monitored glucose versus continuous glucose monitoring (CGM) to improve glucose balance. In those with type two diabetes, they looked at 114 type two diabetics who either had to use a finger stick or a CGM. And at four months they found that the CGM group had a better reduction in hemoglobin A1C and reduced hypoglycemic episodes. And there was actually similar improvements in glucose variability. So, not surprisingly, a CGM might be a better way to improve awareness but I’m still not sure how beneficial this is for otherwise healthy people who are trying to really fine tune their carb intake. I used them for a little bit and I can’t say I had any hugely insightful observations other than juices really tend to spike your blood sugar, which I knew, I guess it just drove it a little bit deeper when I saw the spike. But then again, I’m not sure if that was a bad thing because I was doing it post workout and presumably that’s better for muscle protein synthesis and recovery. Although I will say I was surprised that when I had a kombucha in the morning, semi-fasted, I was surprised how much my blood sugar jumped up from that. But it was also a very temporary excursion so [I’m] still not sold that these are hugely helpful for most people, but I’m certainly willing and open. That’s just my take at this point in time.

Dr Ruscio:

Okay. And final study here, Association between helicobacter pylori infection and subclinical atherosclerosis: A systematic review and meta-analysis of 18 studies in over 6,700 participants who had H. pylori Versus 7,700 controls. And interestingly H. Pylori positive subjects did demonstrate a significant association with increased subclinical athero sclerosis. And this was per a CIMT or carotid intima-media thickness score. So this is interesting. And it’s more evidence to make sure that your gut is healthy. As we’ve discussed before, there is this gut-cardiovascular health connection. This might be part of the reason why Saccharomyces boulardii probiotic supplementation has been shown to have favorable effects on cardiovascular outcomes.

Dr Ruscio:

And remember another meta-analysis we’ve discussed in the past found about a 30% clearance rate when using Saccharomyces boulardii alone for treatment of H pylori. So maybe that’s part of where that finding is coming from or part of what the mechanism might be underlying that.

Dr Ruscio:

So anyway, that’s a number of updates on this potpourri of sleep, stress, breath work, diet, [and] hormones. And I hope that you guys found that interesting. And just one more time, I want to plug that if you’re in need of help for how you apply these things, I’m extremely proud of the work that we’re doing at the clinic and would invite you to reach out if you wanted to learn more.

Dr Ruscio:

I’m also happy to announce, in that same vein, that we’re now offering free discovery calls with our nurse Eliza. So if you’ve been thinking about pulling the trigger for a while but you’d really like to talk with a human before doing so, even though I think we’ve provided adequate information at ruscioinstitute.com, which is the clinic website, then that is something that is available to you. And if you go to the “become a patient” page, you can find some information for how to book a consult with our nurse, Eliza, to have any of your questions answered if you had cold feet. But otherwise, again, I hope these insights and updates from the research are helpful. And we are here at the clinic if you need us. I will look forward to speaking with everyone next time. All right. Thanks guys.

Outro:

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A novel Wim Hof psychophysiological training program to reduce stress responses during an Antarctic expedition

• 13 healthy participants, randomized to:
  • Control
  • Wim Hof Method (breathing exercise, cold exposure, meditation) x 20 minutes per day
• After 2 months, the Wim Hof Method group experienced reduced:
  • Depressive symptoms 
  • Stress response
• Commentary: Wim Hof Method may be a simple, cost effective option for reducing stress.

 

The D-Health Trial: a randomised controlled trial of the effect of vitamin D on mortality

• 21,315 participants over 60 years old
• Randomized to placebo or vitamin D (60,000 IU per month)
• After 5 years of supplementation and 1,100 recorded deaths, the vitamin D group had:
  • Greater serum vitamin D levels (46 ng/mL vs 30 ng/mL)
  • No difference in overall mortality
  • No difference in cardiovascular disease
  • No difference for cancer
• Commentary: Administering vitamin D indiscriminately to older individuals did not change the risk of all-cause mortality, cardiovascular disease, or cancer after 5 years of supplementation.

 

Association between the severity of chronic spontaneous urticaria and sleep-disordered breathing

• 37 patients w/ chronic spontaneous urticaria (CSU)
  • 19 had mild CSU, 18 had moderate-severe CSU
• All had sleep study
• The sleep apnea severity was higher in the severe CSU group (18 vs 4 AHI)
• Moderate-severe sleep apnea was associated with moderate-to-severe CSU even after adjusting for the BMI (OR 22)
• Commentary: This small study sheds light on a possible connection between urticaria and sleep disordered breathing.

 

Obesity, Sex, Snoring and Severity of OSA in a First Nation Community in Saskatchewan, Canada

• 233 participants who underwent sleep apnea testing
• 45.1% tested positive for sleep apnea
  • 5.2% diagnosed w/ severe sleep apnea
  • 39.9% diagnosed w/ mild or moderate sleep apnea
• Sleep apnea diagnosis was associated with:
  • Snoring
  • Male gender
  • Obesity 
• Commentary: Sleep apnea was a common diagnosis in the general population.

 

Mouth Closing to Improve the Efficacy of Mandibular Advancement Devices in Sleep Apnea

• Cross-over study, 21 participants w/ sleep apnea randomized to:
  • No treatment
  • Mandibular advancement device (MAD)
  • Mouth tape
  • MAD + mouth tape
• Sleep apnea improved in 76% of participants in the MAD + mouth tape group compared to 43% in the MAD alone group 
• Mouth taping alone did NOT significantly improve sleep apnea
• Commentary: MAD + mouth taping led to greater improvements in sleep apnea compared to MAD or mouth taping alone.

 

Efficacy of cognitive therapy and behavior therapy for menopausal symptoms: a systematic review and meta-analysis

• 14 RCTs, 1,618 menopausal patients randomized to:
  • Control group
  • Cognitive behavioral therapy (CBT)  
• CBT led to significant improvements in: 
  • Hot flashes
  • Night sweats
  • Depression and anxiety
  • Fatigue
  • Quality of life
• Commentary: CBT may be an effective treatment for menopausal symptom relief.

 

Dietary Sodium and Potassium Intake and Risk of Non-Fatal Cardiovascular Diseases: The Million Veteran Program

• Prospective study of 180,000 participants, followed x8 years
• Higher sodium intake was associated w/ higher risk of cardiovascular disease (HR 1.1)
• Higher potassium intake was associated w/ a lower risk of CVD (HR 0.87)

 

Vitamin D Supplementation and Sleep: A Systematic Review and Meta-Analysis of Intervention Studies

• 19 studies
• Vit D supplementation led to improvement in sleep quality

 

Vitamin D Supplementation and Fractures in Adults: A Systematic Umbrella Review of Meta-Analyses of Controlled Trials

• Vitamin D + calcium reduced the risk of: 
  • Hip fractures (RR 0.6-0.8) in 8/12 studies
  • Any fracture (RR 0.7-0.9) in 7/11 studies
• 19 studies, vitamin D alone led to NO reduction in fracture risk
• Commentary: The addition of calcium to vitamin D supplementation led to reduced risk of fractures in adults.

 

Association of Hypoglossal Nerve Stimulation With Improvements in Long-term, Patient-Reported Outcomes and Comparison With Positive Airway Pressure for Patients With Obstructive Sleep Apnea

• Retrospective study of obstructive sleep apnea (OSA) patient:
  • 85 patients received hypoglossal nerve stimulation (NHS)
  • 217 patients received CPAP therapy
• After treatment, the NHS group had:
  • Greater improvement of depression score
• At 1 year follow up, the NHS group had, comparable improvement in:
  • Depression score (29% vs 24% response rate)
  • Comparable improvement in daytime sleepiness (65% vs 55% response rate)
  • Comparable improvement in sleep quality (59% vs 31%)
• Commentary: This study showed the similar efficacy rate of hypoglossal nerve stimulation to CPAP therapy for those w/ OSA. A device that is more cost-effective and may act in a similar fashion can be found here.

 

Resolution of fibromyalgia by controlling obstructive sleep apnea with a mandibular advancement device

• Case study, 61 y/o female with sleep apnea and fibromyalgia 
• After 6 months of mandibular advancement device (MAD) therapy, the patient experienced significant reductions in: 
  • Fatigue score (20 vs 3)
  • Fibromyalgia symptom score (78.7 vs 8.1)
  • Depression score (26 vs 2) 
  • Sleep apnea score (69.8 vs 12.6)
• Commentary: Treatment of sleep apnea with a MAD led to significant improvements in fibromyalgia, depression and energy. Sleep apnea is a common comorbidity in patients with fibromyalgia, so keep sleep apnea in your differential diagnosis. Also, keep in mind this is a case study.

 

Fracture recurrence in hip fracture with menopausal hormone therapy versus risedronate: a clinical trial

• 281 post-menopausal women with recent hip fracture, randomized to: 
  • Oral risedronate
  • Hormone therapy (topical estradiol + oral progesterone)
• After 4 years, NO significant difference in new fracture rates observed between groups (8.6 vs 12.8 per 100 person-years)
• Hip bone-mineral density increased in the hormone therapy group, not the risedronate group (+2.8% vs 0%)
• Commentary: Hormone therapy improved hip bone-mineral density more than risedronate, but no difference was observed in incidence of new fractures.

 

The effect of vitamin D on recurrence of uterine fibroids: A randomized, double-blind, placebo-controlled pilot study

• 99 women who had undergone uterine fibroid removal, randomized to:
  • Placebo
  • Vitamin D (1,000 IU/day)
• After 1 year, supplementation with vitamin D led to: 
  • Reduced recurrence of fibroids by 50% 
  • Reduced size of recurrent fibroids (-7.7 mm)
• Commentary: Vitamin D supplementation was effective in preventing recurrence of fibroids and reducing the size of recurrent fibroids.

 

Efficacy and Safety of Nutraceutical on Menopausal Symptoms in Post-Menopausal Women: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

• 101 post-menopausal women, randomized to:
  • Placebo
  • Nutraceutical supplement
    • Soy isoflavone (100 mg) 
    • Black cohosh (520 mg) 
    • Chasteberry (400 mg) 
    • Evening primrose oil (500 mg) 
• After 3 months, compared to placebo, women in the the nutraceutical group experienced less severe:
  • Hot flashes (3 women vs 21 women)
  • Insomnia (6 vs 19)
  • Depression (2 vs 12)
  • Irritability (0 vs 11)
• Commentary: Herbal nutraceuticals, specifically containing soy isoflavones, black cohosh, chasteberry and evening primrose oil, are effective in the reduction of menopausal symptoms.

 

The association of co-morbid insomnia and sleep apnea with prevalent cardiovascular disease and incident cardiovascular events

• 4,160 participants, followed x11 years
• Having both insomnia + obstructive sleep apnea (OSA) was associated w/ a 2x higher risk of cardiovascular disease
  • However, after adjusting for other variables (e.g. weight), this association was not found
• Commentary: This study showed NO increased risk of cardiovascular disease in those w/ sleep apnea after correcting for other confounding variables.

 

Low-carbohydrate versus balanced-carbohydrate diets for reducing weight and cardiovascular risk

• Cochrane database analysis of low (50-150 g/d) to balanced (45-65%) carbohydrate diets
• 61 RCTs, 6,925 participants
• In overweight and obese participants, low-carb diets result in little to no difference in change in body weight over 3-9 months (mean difference -1.07 kg additional weight loss)
• Little to no change in LDL-C or A1C
• Commentary: Weight loss, independent of what kind of diet what used, results in improvement in many metabolic markers. Low carb diets can work but so can other types of diets.

 

Randomized comparison of self-monitored blood glucose (BGM) versus continuous glucose monitoring (CGM) data to optimize glucose control in type 2 diabetes

• 114 type 2 diabetics, randomized to either finger stick blood glucose measurements (4 times daily) or CGM (24/7)
• After 4 months, the CGM group had:
  • More A1C reduction (-1.1% vs -0.8%)
  • Reduced hypoglycemic episodes
  • Similar improvements in glucose variability
• Commentary: CGM may lead to better awareness and thus, improved glycemic control.

 

Association between helicobacter pylori infection and subclinical atherosclerosis: A systematic review and meta-analysis

• 18 studies, 6,776 participants w/ H pylori, and 7,795 participants without H pylori
• H. pylori positive subjects is significantly associated with increased subclinical atherosclerosis (per CIMT score)
• Commentary: H pylori is associated w/ subclinical atherosclerosis, highlighting the gut-cardiovascular connection.

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