Health News Review – Updates Regarding SIBO, Vitamin D, Thyroid Autoimmunity, Probiotics, Gluten-Free Diets, Ulcerative Colitis, Autoimmunity, Heart Disease, and Leaky Gut

Today I would like to try something a little different. This podcast will contain a brief summary of the most important research that has been published over the last few weeks. We will cover some important updates regarding SIBO, vitamin D, thyroid autoimmunity, probiotics, gluten-free diets, ulcerative colitis, autoimmunity, heart disease, and leaky gut.

Dr. R’s Fast Facts

Today we will cover a brief summary of the most important research that has been published over the last few weeks. We will cover some important updates regarding SIBO, vitamin D, thyroid autoimmunity, probiotics, gluten-free diets, ulcerative colitis, autoimmunity, heart disease, and leaky gut.

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Dr. Ruscio Radio
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Topics:
Episode Intro 00:00:42
The Efficacy of Probiotics in IBS … 00:03:47
SIBO & H. Pylori (Breath Tests)  … 00:07.20
Dual Role of E. Coli … 00:09:38
Vitamin D & Sexual Hormones … 00:11:30
Autoimmune Thyroiditis … 00:12:43
Hydrogen Sulphide & SIBO/IBS … 00:17:05
Probiotic Yogurt Mitigates Small Bowel Injuries … 00:20:25
Mode of Infant’s Birth & Gut Microbiota … 00:21:44
Gluten-Free Diet Consequences … 00:24:37
Hypothyroidism Risks Cardiovascular Events … 00:26:10
SIBO & Celiac Disease … 00:28:42
Probiotics & Body Fat … 00:33:55
Diabetes, Low-Carb Vs Plate Method Diet … 00:36:30
Episode Wrap Up … 00:38:43

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Links:

  1. https://www.ncbi.nlm.nih.gov/pubmed/27595104 Trusted SourcePubMedGo to source
  2. https://www.ncbi.nlm.nih.gov/pubmed/27586816 Trusted SourcePubMedGo to source
  3. https://www.ncbi.nlm.nih.gov/pubmed/27724868 Trusted SourcePubMedGo to source
  4. https://www.ncbi.nlm.nih.gov/pubmed/28074679 Trusted SourcePubMedGo to source
  5. https://www.ncbi.nlm.nih.gov/pubmed/28171686 Trusted SourcePubMedGo to source
  6. https://www.ncbi.nlm.nih.gov/pubmed/21621331 Trusted SourcePubMedGo to source
  7. https://www.ncbi.nlm.nih.gov/pubmed/14674722 Trusted SourcePubMedGo to source
  8. https://www.ncbi.nlm.nih.gov/pubmed/27163246 Trusted SourcePubMedGo to source
  9. https://www.ncbi.nlm.nih.gov/pubmed/28052291 Trusted SourcePubMedGo to source
  10. https://www.ncbi.nlm.nih.gov/pubmed/27475754 Trusted SourcePubMedGo to source
  11. https://www.ncbi.nlm.nih.gov/pubmed/28166100 Trusted SourcePubMedGo to source
  12. https://www.ncbi.nlm.nih.gov/pubmed/28148249 Trusted SourcePubMedGo to source
  13. https://www.ncbi.nlm.nih.gov/pubmed/28191721 Trusted SourcePubMedGo to source
  14. https://www.ncbi.nlm.nih.gov/pubmed/27810310 Trusted SourcePubMedGo to source
  15. https://www.ncbi.nlm.nih.gov/pubmed/28193599 Trusted SourcePubMedGo to source
  16. Future of Functional Medicine Review

Health News Review – Updates Regarding SIBO, Vitamin D, Thyroid Autoimmunity, Probiotics, Gluten-Free Diets, Ulcerative Colitis, Autoimmunity, Heart Disease, and Leaky Gut

Episode Intro

Dr. Michael Ruscio: Hey, everyone. Welcome to Dr. Ruscio Radio. This is Dr. Ruscio. And today, I’m excited about a little bit of a different approach to the podcast.

So back story on this—gosh! I read a lot of research, and I’m always struggling with the best way to communicate research to other people because there are some research studies that are, I would say, class A, meaning they are incredibly important, and they deserve a lot of attention.

There are others that are maybe class B. They’re important, they deserve some attention, but maybe not my or your full attention. And then there’s class C, which are interesting, worth a mention. And that’s kind of it.

So as I’ve codified that A, B, C class, I’ve organized how to address or to communicate these studies according to that list. Class A studies will be going into that Future of Functional Medicine Review, which is that training tool for practitioners, because those studies, I think, are highly clinically relevant and they’re things that can really help clinicians or patients, because it’s also open to the lay public to read that if they like. But those are things that require or deserve some attention.

And then class C goes into our Weekly Wrap Ups. You’ve probably seen our Weekly Wrap Ups, which go out on Friday, and there are, I think, six to eight studies that are mentioned there in brief.

So what about class B? Well, that’s today. What I am planning on doing, unless people have overwhelmingly negative feedback on this, is a monthly episode that will be health research news.

And it’s an aggregation of all these studies that I come across that aren’t quite important enough to go into the Future of Functional Medicine Review but more important and deserve more of an elaboration than we can do in the Weekly Wrap Up, which is usually a sentence or two.

So, I’m going to try to give this a go here where I’m simply going to go through a number of studies and give you a short little synopsis and some of my thoughts. And then we’ll go to the next one.

And I’m hoping this will be light and fun, kind of like political news or what have you where you get a little bit about a lot of different topics and it gets you up to speed pretty quickly, pretty easily.

So let’s jump in. We will put the references in the transcript. If there’s not a reference in there, it means that I don’t have it. I’m going to mention these specific studies. I may go on a few tangents, mentioning other things. For those mentioned, I don’t have the studies handy. So just keep that in mind.

I know people sometimes in the comments section want every reference, and I try to supply every reference. But for the ones I have, I’ll put them in there.

But for the other ones, it’s hard for me to carve out the time to go sifting through my few hundred pages of notes and Word documents to find some of the other ones that just come to my mind when I’m going on a tangent.

The Efficacy of Probiotics in IBS

First study entitled, “A Randomized, Double Blinded, Placebo-Controlled Trial: The Efficacy of Multispecies Probiotic Supplementation in Alleviating Symptoms of Irritable Bowel Syndrome Associated with Constipation” (1).

Essentially, it’s a clinical trial looking at probiotics in constipative-type IBS. And essentially, what was found was that multi-species probiotic supplements were effective for IBS-C, or constipative-type IBS.

And they tracked a variety of symptoms in this study. And there was a general improvement in symptoms and a general improvement in constipation.

And what was nice was that two different probiotic mixtures were used. And so it wasn’t just one, what you could maybe call a super special probiotic strain. They found this general positive effect using two different strains.

Why I think this study is important is because some people are against using probiotics in IBS because of SIBO. And I, for a while, have been voicing my disagreement with that. I certainly don’t think probiotics are something to be used in every case.

But to claim that we shouldn’t use probiotics in IBS because of SIBO, I think, is really misguided, and I think it may reflect a little bit of a bias in some of the research community that contributes to this body of evidence, who I think do pretty amazing work on the whole.

But there may be a couple areas where there’s a little bit of an inherent bias against probiotics. And I think a study like this is actually a pretty strong admonition of that.

The other thing I think this is helpful for is sometimes—and I see this more so coming from gastroenterologists, and I understand where they’re coming from—is being open to probiotics but not knowing what the best strain to use is.

And I could see coming from a more conventional model, you’re thinking, “We have one specific drug that was used in this specific study. We can get that from the pharmacy. We know exactly what it is, what it’s called. There’s quality assurance and regulations around this. So I don’t have to worry about what my patient is going to take.”

Probiotics may be a little more challenging in that regard, but when you look at much of the probiotic literature, there are different probiotics, similar in class and in composition, but multiple different ones that have shown all this type of positive effect in IBS.

So what I think is reassuring about this is two different mixtures both showed a positive impact. So what I would offer to a gastroenterologist or a conventional medical provider struggling with this is to find a well-respected supplement company that follows good manufacturing practices.

And have them try a Lactobacillus/Bifidobacterium blend of some sort. There are many different types of probiotics that fit that profile.

But have a patient try one or two of those. And the worst thing that’s going to happen is they may have a slight reaction. Bloating is probably the most common. And if they discontinue the probiotic, that reaction will go away, and they should be just fine in a number of days. Best case scenario will be what was found in this randomized control trial, which is a general improvement in IBS-C.

So that’s study number one. Moving along…

SIBO & H. Pylori (Breath Tests)

So this one’s a little bit of a teaser. But “Functional 13C-urea and Glucose Hydrogen/Methane Breath Tests Reveal Significant Association of Small Intestinal Bacterial Overgrowth in Individuals with Active Helicobacter pylori Infection” (2).

So essentially, this study found that H. pylori infection was found to be significantly associated with the presence of SIBO as determined by a breath test. And even more interesting is that SIBO rates appear to have increased after complete eradication therapies for H. pylori.

This study we will be featuring in the Future of Functional Medicine Review because I think there are some more important clinical points to go into. But I did want to at least make people aware of this one.

Short of going into all the clinical particulars, the take home on this one is H. pylori and SIBO are associated. And I do see a decent amount of H. pylori co-presenting with SIBO, because we fairly routinely test for both.

So they do seem to go together. It’s very plausible how one would be connected to the other. H. pylori throws off stomach acidity. H. pylori can either increase or decrease stomach acidity, depending on the region of the stomach that it’s infecting—or I shouldn’t say infecting. It’s inhabiting. It’s not truly a pathogen, so we don’t want to say infecting.

And then post-eradication, you can also see oscillations or perturbations in acid levels. And that has been correlated with SIBO. So certainly, there’s some plausibility there.

And at some point, we’ll probably do a much more in depth either article or podcast on H. pylori because there’s some really interesting stuff there.

But in short, this study shows that H. pylori and SIBO can oftentimes present together and that there’s a chance that with SIBO eradication therapies—in this study, they were looking at traditional either triple or quadruple antibiotic therapy.

But after H. pylori eradication with antibiotics, you can increase the presence of SIBO. So it’s definitely something to be cognizant of when trying to improve the health of someone’s gut.

Dual Role of E. Coli

The next study, “The Dual Role of Escherichia coli in the Course of Ulcerative Colitis” (3). And oftentimes, we hear about E. coli like a strict pathogen, but there are actually many species of E. coli that are very healthy for the gastrointestinal tract. In fact, it’s one of the main inhabitants, as I understand it, of the gastrointestinal tract.

So E. coli—there are many different types. And yes, there are some—0157, I believe is the more pathogenic one that was associated with that outbreak of, I think it was spinach food poisoning a number of years ago.

So yes, there are pathogenic strains, but it’s not to say that every strain is pathogenic. In fact, one of the more beneficial probiotics for inflammatory bowel disease, more so namely ulcerative colitis, is Mutaflor, which is E. coli Nissle 1917.

So essentially, this study was finding that E. coli eliminates substrates associated with iron metabolism and hydrogen peroxide production. And E. coli can essentially inhibit hydroxyl radical formation, thus reduce inflammation, and prolong the remission stage of ulcerative colitis.

So this is just interesting to keep in mind because E. coli is oftentimes vilified, and there are a few stool tests that report on E. coli.

And I’ve seen a number of practitioners who I think are a little bit new to reading stool tests. And they see that there’s a moderate or abundant amount of E. coli growth and they freak out, like that means that there’s something highly pathogenic there that needs to be addressed. And oftentimes, it’s just reporting on normal growth of commensal bacteria. So, thought that one was worth throwing in the mix.

Vitamin D & Sexual Hormones

We’ll switch over to vitamin D. “Vitamin D Treatment Improves Levels of Sexual Hormones, Metabolic Parameters and Erectile Function in Middle-Aged Vitamin D Deficient Men” (4).

So this study took a group of vitamin D deficient men and administered 600,000 IUs per month, which breaks down, if you were going to do daily dosing, to 20,000 IUs per day, until the levels reached above 30 ng/mL, which is the typical reference range used in the United States, and then reverted to 600,000 IUs every other month, which breaks down to 10,000 IUs per day.

And what they found essentially was an increase in testosterone and an increase in erectile function.

So, what’s nice about this study is they adjusted the dose downward once the normative range of vitamin D was achieved and this seemed to still maintain a positive benefit on testosterone and erectile function.

So it may be something to consider fooling around with if you’re not feeling quite the pep in your step sexually.

Autoimmune Thyroiditis

Next study, “The Relationship Between Procalcitonin and Thyroid Autoantibodies in Patients with Autoimmune Thyroiditis” (5).

So, procalcitonin, just as a refresher, is a neurotransmitter—I believe actually it’s a neurotransmitter. Oh, no, I’m sorry. It’s not a neurotransmitter, it’s just part of the hormonal cascade. And forgive me, I’m not sure actually how procalcitonin is classified. I believe it’s just considered a steroid or a peptide hormone.

But irrespective of that, when there’s too much stress, stress can deplete dopamine. Dopamine tonically inhibits prolactin, meaning you need to have dopamine in order to inhibit prolactin. And when people are under too much stress, stress can actually deplete dopamine and increase prolactin.

And then prolactin, amongst other things, can signal some of your steroid hormones, but also may have a relationship to thyroid autoimmunity.

So in this study, prolactin was found to be correlated with thyroid autoantibodies and found to be an independent risk factor for Hashimoto’s thyroiditis.

Now, the Hashimoto’s thyroiditis patients had higher median prolactin levels than controls—34 units compared to 27 units. Now, the difference between those two groups is not tremendous. What I’m a little unclear on is the units because this study used pg/mL. In the United States, for example LabCorp, uses ng/mL.

I went through a conversion. And I don’t know if I’m missing something on this, but when I converted these levels, it came to even below the normal reference range. So I didn’t dig too deeply into this because the particulars aren’t incredibly important.

But what is, I think, important is that a slightly higher prolactin level is correlated with an increased chance of thyroid autoimmunity as an independent risk factor.

Now, why that’s relevant is there are studies supporting that stress increases prolactin. And I’ll put two in here for you. (6 Trusted SourcePubMedGo to source, 7 Trusted SourcePubMedGo to source).

So this is perhaps a very strong reason why we should not overly fear people regarding thyroid autoimmunity, because if you have very fear mongering sort of approach regarding thyroid autoimmunity with your patients and that increases stress in them, it has been shown that that stress increases prolactin.

And it has been shown, according to this study we’re talking about right now, that higher prolactin is correlated with worsening or higher chance of thyroid autoimmunity.

So this is another reason why I’m not huge into the super dogmatic, overzealous thyroid autoimmunity, or autoimmunity in general, approach.

And I think if we can be a little bit honest, I think some of that comes down to marketing. And I hate to have to call out the field like this. But I get it. You’re a provider trying to help people in this more progressive model of thyroid care. Great!

But it doesn’t mean that we have to go over the top with making people think that if they don’t take action with you and what you’re offering for more comprehensive thyroid care that they’re going to suffer some irrevocable harm.

We want to perhaps be a bit more progressive and robust in our thyroid care than just a medication, yes. But do we have to make people think that if they have no discernible reaction to gluten, for example, they have to live like they have celiac disease? Or if their antibodies are 225, that they need to be concerned about all these other health interventions to drive those antibodies down to zero or below 30, 35?

So we’ve discussed this in the past, but I think that’s a really misguided approach. This study gives some nice evidence of how increasing someone’s levels of stress surrounding their thyroid autoimmunity may actually make the thyroid autoimmunity worse.

So now we’ve gone past just theoretical speculation on this and we have some more concrete data to show that that may be a bad idea.

Hydrogen Sulphide & SIBO/IBS

Another interesting one—“Hydrogen Sulfide in Exhaled Breath: A Potential Biomarker for Small Intestinal Bacterial Overgrowth in IBS” (8 Trusted SourcePubMedGo to source).

So essentially, this group of researchers found a breath test for hydrogen sulfide SIBO. And this explained symptoms of IBS in those who are negative for traditional SIBO tests.

Now, what’s exciting about this is up until this study, I don’t think anyone knew you could assess hydrogen sulfide via the breath.

In fact, I was just writing this morning in the Future of Functional Medicine Review, reviewing a review paper by Dr. Pimentel where he commented that there’s no way to assess hydrogen sulfide in the breath. So even one of the researchers at the forefront of SIBO isn’t aware of this. So this is very exciting.

I’m intending to reach out to this group to see what the situation with this test is and if it’s something that can be made commercially available already or if it may be soon, because this may be a nice secondary test should initial screening be negative and then someone still has IBS symptoms but their SIBO test is negative.

So perhaps how we can start to paint this into an algorithm, if you will, is you start off with initial standard SIBO testing. Then maybe at your secondary testing, you screen for hydrogen sulfide SIBO and/or SIFO.

SIFO testing is not really available yet, but as Dr. Satish Rao mentioned a few podcasts back, there is potentially going to be a smart capsule that will be able to take small intestinal regional samples and then culture those for SIFO.

So, we are going to write about this also in the Future of Functional Medicine Review. I’m just waiting to get a few more details back from the group that used this test. So that’s coming there if you’re on our list.

The other thing I should mention is—and this is more so my opinion than something that has a lot of, or any, to my knowledge, studies to support it—but if you’re working with a good, savvy clinician, if you have hydrogen sulfide SIBO, you should be able to sort it out.

You’ve probably heard me say that if someone’s tests are negative and they’re still symptomatic, I am totally for an empiric trial of SIBO treatment. I’m assuming that SIBO treatments, like antibiotics or anti-microbials, elemental diets, probiotics, low FODMAP diets, will help with hydrogen sulfide.

I’m assuming that hydrogen sulfide does not follow this incredibly different set of rules than the rest of the gut. I may be wrong in that assumption, but I’m assuming that SIBO treatments for the other types of SIBO would also be effective for hydrogen sulfide.

So if you test negative according to the classical SIBO breath test and you have a clinician who is open-minded and willing to work with you empirically, you’ll likely still obtain a positive outcome.

I just make that point because I don’t want to fuel this over reliance on testing that’s fairly prevalent in functional medicine. If you don’t have access to a hydrogen sulfide test but you have access to a good clinician, you’ll still be able to figure this out just fine in my opinion.

Probiotic Yogurt Mitigates Small Bowel Injuries

Another interesting study—“Yogurt Containing Lactobacillus gasseri Mitigates Aspirin-Induced Small Bowel Injuries: A Prospective, Randomized, Double-Blind, Placebo-Controlled Trial” (9).

So essentially, what this study found was that for people who were taking aspirin—in that aspirin has a chance to cause small bowel injury—using a yogurt with probiotic it in actually mitigated the damage to the small intestine.

So, maybe another reason why I think probiotics can be favorable for things like SIBO and other conditions is because they do have multiple benefits.

And I believe this study found both a symptomatic and histological improvement. So, when the gastroenterologists went into the small intestine via endoscopy, they found the histology, or the tissue, of the small intestines looked healthier. And then also the symptomatic scores improved for those receiving the yogurt.

So just more evidence here that probiotics have a beneficial role for many different gastrointestinal conditions. That’s not to say they’re going to work for everyone all the time, but just something to be aware of.

Mode of Infant’s Birth & Gut Microbiota

Here’s the really interesting one. “Mode of Delivery Affects the Diversity and Colonization Pattern of the Gut Microbiota During the First Year of Infant’s Life: A Systematic Review” (10).

So essentially, they found that the diversity and colonization pattern of the gut microbiota were significantly associated with the mode of delivery. The effect lasted during the first three months of life, and those differences disappeared after six months of life.

So if you’re born cesarean section compared to being born vaginally, the microbiota is different up until six months, and then the differences are somewhat nonexistent.

What’s interesting to think about here is that we do know—and this has been well documented. And I review this in the book. Cesarean section births are correlated with many diseases and many diseases that don’t develop until later in life—allergy, eczema, atopic dermatitis, food allergies, I believe also overweight, seasonal allergy, food allergy also, I believe.

So there are a number conditions that correlate with birthing method. But the effect doesn’t occur until 6, 7, 8, 9, 10+ years of age. So what this tells us is that perturbations in the microbiota during the first six months of life may have an impact on the immune system for the rest of one’s life.

This shouldn’t really be much of news for many people who follow the podcast, because we have discussed how these early life factors are very important and how the earlier the event is, the more impactful it tends to be.

And we’ve talked about antibiotics being used at 3, 6, 9, or 12 months of life. The later the antibiotics are used, the less detrimental they are.

Conversely, other studies have shown that probiotics used earlier have more of a beneficial effect than probiotics used later. And I think there was one study in particular that was really interesting, and I believe it was for type 1 diabetes.

And they showed when probiotics were used before 27 days of life, they decreased the incidence of type 1 diabetes later in life. Whereas if they were used post-27 days of life, then they did not.

So we see this timing piece is incredibly important. And even if the microbiota signature isn’t different after six months, that first six months of perturbation in the microbiota may impact the immune system for the rest of one’s life. So definitely something very interesting there.

Gluten-Free Diet Consequences

Another paper—this one is also going to go in the Future of Functional Medicine Review. I don’t mean to keep throwing these teasers out there, but I want people to know who are reading this or thinking about subscribing what we’re going to put in there.

So this one is entitled “The Unintended Consequences of a Gluten-Free Diet” (11). And this is one I need to dig into the details, which is why it’s going to go into the Future of Functional Medicine Review.

But essentially, this paper found that an unintended consequence of gluten-free may be increased heavy metal toxicity. And I believe the heavy metal in question was arsenic, because certain types of rice have a higher level of arsenic in them.

And so what this group essentially found was that inadvertently, by going gluten-free, you’re eating more grains that are higher in heavy metals. And that may be something that could be deleterious.

So, I’m going to look into some of the details on this, because I also want to make sure that this isn’t something that is significantly—the statistical significance is there, but the clinical significance is not. I want to make sure that we don’t fall into that problem.

So I’m going to be looking into some of the details on this and see if this is something that might be cause for concern or might not be. I’m more inclined to think it’s not going to be cause for concern, but we’ll certainly be reporting back on that one.

Hypothyroidism Risks Cardiovascular Events

Here is another interesting one. “What Is the Association of Hypothyroidism with Risks of Cardiovascular Events and Mortality: A Meta-Analysis of 55 Cohort Studies Involving 1,898,314 Participants” (12).

There are a few things here. But the salient take-homes are, yes, hypothyroidism is associated with increased cardiovascular events and mortality.

I think many of us have known that, which is why the treatment of frank hypothyroidism is important. And this means someone that has, according to the conventional ranges, high TSH and low T4. So I don’t think there’s much of an argument there.

What’s interesting here is that subclinical hypothyroidism was also associated with increased risk of ischemic heart disease and cardiac mortality. Now, they found the majority of the association—

And let me, I guess, step back and say subclinical hypothyroidism means you have TSH that is high according to the conventional range. So it’s usually 4.5 in the United States and normal T4.

So, they found that the TSH had to be above 10 for there to be the most significant effect. And this comes back to what we discussed in a previous podcast where we reviewed subclinical hypothyroid and we discussed that if someone is just over the 4.5 cutoff—let’s say they’re 6—and their T4 is normal, then that may not be something that’s cause for alarm, especially if you’re older.

There’s a study I read recently that the incidence of subclinical hypothyroidism dropped from, I think it was 15% of the population to 5% of the population when they applied an age-adjusted TSH range.

So if you had a TSH of 6, again, and you were 65, that wouldn’t be much cause for alarm. If you had a TSH of 6 and you were 25, then that would be something to look at more closely and treatment would be more of a consideration.

So in this case, you had to be above 10 in order for that to be highly associated with ischemic heart disease and cardiac mortality. So, there’s one on thyroid.

SIBO & Celiac Disease

Another study, “Small Intestinal Bacterial Overgrowth in Celiac Disease: A Systematic Review with Pooled-Data Analysis” (13) essentially found that SIBO is associated with celiac.

Now, this really shouldn’t be surprising. Why? Well, a number of reasons. We know that inflammation can cause problems with motility. So in my mind, one of the best things to do to recover appropriate intestinal motility is to allow the intestines to heal.

Prokinetics are one option. I do think that the clinical utility of prokinetics has been a bit overstated. In fact, in that study by Pimentel I was reviewing today for the March edition of the Future of Functional Medicine Review, I covered that the keynote study that has shown that prokinetics increase your days SIBO-free after SIBO treatment actually only showed a benefit for Tegaserod.

There was another medication that was used, erythromycin. But the erythromycin group was not statistically significant. It was approaching significance, but it actually wasn’t found to be significant compared to placebo.

I make that mention because, depending on the SIBO circle that you’re in, the potential utility of prokinetics, I think, is sometimes overstated.

Now, why that’s important or relevant is because some of the prokinetics have a bit more of a side effect profile. Some people have stronger or softer feelings on how warranted some of the side effects from prokinetics are.

But I just make mention of that because we want to be progressive and open minded. But we also don’t want to get too caught up in dogma. So we only have one study showing that. There may be a second study, but the population that was used in that second study is not a typical population.

So I say we only really have one study showing that prokinetics prolong your time SIBO-free.

But remember, guys, it prolonged the time for a couple months, but people ended up having a relapse. So it’s not to say that a prokinetic or not a prokinetic is going to be this massive difference between you never having a relapse and you having a relapse. It’s just you may have a couple more months without relapse.

If you work with a good SIBO clinician—and this is something we do in the clinic with our more chronic SIBO cases. We find out what works, and then when someone has a relapse, we do a curtailed version of what worked before.

And it doesn’t have to be this huge thing, like, “Oh my God! I’m having a SIBO relapse! The sky is falling!” For most patients, they’re feeling great for a while. They start to regress a little bit. We do a little bit of a tune up. And they’re back to normal in no time. And everything is fine.

So a prokinetic may increase the time in remission by a couple months, but a lot of these people end up needing to have a little additional treatment as a tune up later down the line. Not the end of the world. Not a big deal.

It doesn’t mean anything is broken. It just means that the gastrointestinal tract needs some more time to heal. Or someone may have something that precludes them from ever being permanently in remission of SIBO.

And they occasionally need a little bit of tune up, which is not the worst thing in the world if you find out what works and it’s a conservative plan. And you have to do a short course of re-treatment occasionally. Not the worst thing in the world.

What that looks like on the patient end is someone comes in not feeling well. Months later, they’re feeling a lot better. They maintain that for a number of months. And then they start to feel like they are regressing a little bit. They check back in. You do a few tweaks and get them back to feeling great again. Not the worst thing in the world.

So where was I? I got so far on that tangent here. Oh, so with celiac—

So one of the things that is associated with impaired motility is inflammation, of course. If you have celiac, you’re going to have lots of inflammation.

It may also impact the secretion of enzymes, both from the intestinal brush border because the brush border may be damaged. That’s the grass-like microvilli projections. The tips of your microvilli, or your intestinal blades of grass, if you will, secrete some enzymes.

Now, there is also association with inflammatory conditions like celiac and impairment of pancreatic enzymes and bile. So as we get the inflammatory state improved, we will likely see the underlying factors associated with SIBO and the SIBO itself get better.

So, a systematic review has shown that SIBO is associated with celiac. Nothing surprising there.

Also, remember that if someone is celiac and they’ve gone gluten-free and they’re what’s known as nonresponsive celiac, there is some evidence showing that those patients have SIBO and, more importantly, that treatment of that SIBO yields full clinical improvement. So important to mention that also.

Probiotics & Body Fat

Here’s one about probiotics and your weight. “Probiotic With or Without Fiber Controls Body Fat Mass, Associated with Serum Zonulin, in Overweight and Obese Adults-Randomized Controlled Trial” (14).

So here’s the long-short on this study. I’ll read you the conclusion, I guess: “This clinical trial demonstrates that a probiotic with or without dietary fiber controls body fat mass.”

That’s fine. And if you’re used to reading scientific literature, you understand that that statement doesn’t necessarily have earth shattering implications one way or the other until you look into some of the details.

The challenge is this could easily be spun, making one think that probiotics are this huge thing for weight loss. And you’ve probably heard me make this criticism before.

But here’s another example of this because every time I come across one of these studies, I check the details to see if my opinion needs to be updated, my opinion being that probiotics don’t really do much in the way of weight loss.

They can be slightly helpful, but not really anything that I think anyone trying to lose weight would really think was anything significant.

So, this group using the probiotic saw 1.4 kg of weight loss over the placebo. So that translates to about 3-ish pounds. So not really anything great.

Certainly, I’m in favor of using a probiotic, but what I’m not in favor of is doing a non-clinically validated microbiota test and then giving someone a probiotic based upon that test with the intention of manipulating the microbiota for weight loss.

And unfortunately, that is sometimes what happens in this space when people aren’t a little more discerning with how they’re reading and interpreting research. So we see a little bit of loss, but nothing huge.

And what I think is a little more encouraging is that changes in zonulin levels and high sensitivity C-reactive protein were associated with those improvements and fat loss.

And so this probably comes down to a very basic concept, which is that probiotics have some anti-inflammatory effect in the gut. And as you’re less inflamed, you may lose some weight. But the amount of weight is not huge.

Diabetes, Low-Carb Vs Plate Method Diet

And then final study here, kind of a long title, but “An Online Intervention Comparing a Very Low-Carbohydrate Ketogenic Diet and Lifestyle Recommendations Versus a Plate Method Diet in Overweight Individuals With Type 2 Diabetes: A Randomized Controlled Trial” (15).

So essentially, this study wanted to make one simple comparison. Would low carb work better? Or would the American Diabetes Association (which is a higher carb, lower fat) diet work better for people with type 2 diabetes who are also overweight?

And like many other comparative trials have found, the low carbohydrate diet actually worked better.

I’ll read the conclusion: “Individuals with type 2 diabetes improved their glycemic control and lost more weight after being randomized to a very low-carbohydrate ketogenic diet and lifestyle online program rather conventional low fat diabetes diet online programs.”

So we talked about this before also. But how things like the paleo diet and lower carb diets get called unhealthy, it baffles me. And again, it’s not to say that these diets are the only healthy diets.

But we have quite a few comparative trials now showing quite a bit of benefit, especially for those with metabolic conditions, with these diets. So it’s just important to, I guess, understand this, especially if you’re someone maybe listening to this podcast or coming to this conversation from a vegetarian perspective.

It’s not to say vegetarian is bad or wrong or anything else. But to be a vegetarian, trying to make the argument that a diet that’s higher in fat and/or protein is universally unhealthy is, I think, is quite a bit misguided and probably comes from a biased and skewed selection of studies that probably had more to do with other factors, like added sugar and trans fat, as part of a Westernized society diet than it does the actual fat or protein itself.

Episode Wrap Up

So just a few studies there that will get you current for some of the more impactful and important research that’s being published.

Let me know what you guys think about this format. I think it’s great, but it was my idea. so I’m certainly biased. But I like this format of touching on a bunch of the recently published studies, giving you a little bit of a snippet with my commentary, and then moving on.

But do let me know in the comment section if you like it or if you don’t like it, especially if you don’t like it, because if you don’t like something and you don’t let me know, I will never know.

And yeah, hopefully, you guys found this helpful. And I will see you next time. All right. Thanks a lot. Bye-bye.


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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.

Discussion

I care about answering your questions and sharing my knowledge with you. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you!

28 thoughts on “Health News Review – Updates Regarding SIBO, Vitamin D, Thyroid Autoimmunity, Probiotics, Gluten-Free Diets, Ulcerative Colitis, Autoimmunity, Heart Disease, and Leaky Gut

  1. I would like to understand why you wouldn’t cover the most important research, i.e. class A, in this podcast? Surely that is key information for us? Thanks.

    1. Hi Sarah,
      Good question, I do touch on class A in the podcast as you likely heard me say a few times ‘there will be a full write up on this in the Future of Functional Medicine Review Clinical Newsletter.’ Hope this clears that up 🙂

  2. Thanks this was an interesting podcast. It would be really helpful if you would either number the topics in your time-baed overview to correlate with the pubmed links, or, perhaps even better, just post the link immediately below the subject. I am counting to try to figure out which link is for what and keep hitting the wrong one–its just a bit of an annoying process.

  3. Thanks for keeping us up to date on all these topics. And I appreciate your take on the current marketing thyroid scares going around. It will help me let go of some of the recent stress I’ve felt about it.

  4. Thanks for keeping us up to date on all these topics. And I appreciate your take on the current marketing thyroid scares going around. It will help me let go of some of the recent stress I’ve felt about it.

  5. THANK YOU for studying and then sharing this knowledge!!! So important. Much gratitude. Keep revisiting this concept on a bi-weekly or weekly basis! Practitioners and clients can each benefit from these. Much gratitude. x

  6. THANK YOU for studying and then sharing this knowledge!!! So important. Much gratitude. Keep revisiting this concept on a bi-weekly or weekly basis! Practitioners and clients can each benefit from these. Much gratitude. x

  7. Thanks this was an interesting podcast. It would be really helpful if you would either number the topics in your time-baed overview to correlate with the pubmed links, or, perhaps even better, just post the link immediately below the subject. I am counting to try to figure out which link is for what and keep hitting the wrong one–its just a bit of an annoying process.

  8. I would like to understand why you wouldn’t cover the most important research, i.e. class A, in this podcast? Surely that is key information for us? Thanks.

    1. Hi Sarah,
      Good question, I do touch on class A in the podcast as you likely heard me say a few times ‘there will be a full write up on this in the Future of Functional Medicine Review Clinical Newsletter.’ Hope this clears that up 🙂

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