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Health News Reviews – Updates On: Hypothyroid vs Thyroid HRT, Vanity & Health, Iodine & Thyroid, CoQ10 & Skin, FODMAPs Gut Health, Paleo Diet & Heart Disease and more…

Another edition of Health News Updates!  Today we discuss:

  • Hypothyroid vs Thyroid HRT
  • Vanity & Health
  • Iodine & Thyroid
  • CoQ10 & Skin
  • FODMAPs & Gut Health
  • Paleo Diet & Heart Disease

If you need help using this information to become healthier, click here.
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If you are a healthcare provider looking to sharpen your clinical skills, click here.

Dr. Ruscio Radio

The Importance of Case Studies … 00:00:42
Episode Intro … 10:58:00
Hypothyroid vs. Hormone Replacement Therapy … 00:15:40
Vanity & Health … 00:19:23
H. Pylori Eradication … 00:21:56
Hypothyroxinemia in Pregnancy … 00:23:46
Iodine & Thyroid … 00:24:40
Coenzyme Q10 & Skin … 00:26:26
Prebiotics Improve Sleep … 00:27:13
(click gray Topics bar above to expand and see full outline/time stamp)
Biochemical Testing of Thyroid … 00:28:44
Fecal Fermentation in IBS … 00:35:15
Ad-Libitum Paleolithic vs. Australian Guide … 00:37:34
Probiotics Managing H. Pylori … 00:40:28
Autoimmune Gastritis & H. Pylori … 00:41:06
Vitamin D Status in Autism … 00:43:58
B Vitamins & Cognitive Function … 00:44:23
Excess Iodine & Thyroid Disease … 00:45:23
Investigational Treatments for Gastroparesis … 00:47:24
Abdominal Pains & Quality of Life in Women … 00:48:22
Fermented Milk & Gastrointestinal Discomfort … 00:49:00
Episode Wrap Up … 00:49:44

Download Episode  (Right click on link and ‘Save As’)

The Importance of Case Studies

Dr. Michael Ruscio, DC: Hey, everyone! Welcome to Dr. Ruscio Radio. This is Dr. Ruscio, DC. Let’s talk about, briefly, the importance of case studies. I’ve repeatedly expressed my concern, of course, regarding the lack of cost effectiveness in functional medicine. And one reason for this problem, amongst several, is education.

While I believe all educators are well-intentioned, I’m concerned that sometimes the plans they recommend are disconnected from reality. And this manifests as plans that sound great on paper, but are not practical in the real world because someone is doing thousands of dollars’ worth of lab testing or taking handfuls of supplements or doing a diet that is incredibly restrictive and just daunting to try to adhere to.

And this is one of several reasons why I am so excited to now be offering the Future of Functional Medicine Review clinical newsletter, because in each edition, there’s a case study from a patient in my office that illustrates how, with not a lot of testing and not a lot of rigmarole in terms of treatment or dietary changes, we’re able to get really good results.

In fact—and this is kind of sad—but I think we’re at a point now, where half of functional medicine, half of what you need to know to be good at functional medicine requires understanding what not to do. I’ve just seen so many cases. I’ve spoken with so many patients and providers who have gotten pulled into irrelevant, unnecessary testing and treatment that I really think half of the key to success in functional medicine is knowing what not to do, because there is just so much information and so much noise that you’ve got to be able to focus on what’s important.

Now, in January, we covered a case study that I think showcases this nicely. Essentially, a patient came in that had had SIBO previously diagnosed and treated. And she presented as what looked symptomatically very much like a SIBO relapse. But when we did some testing, we did some poking around, and we listened to the patient’s response throughout the course of treatment. This is one of the, I think, most important aspects of this case study.

The real gem, key, whatever you want to call it, in this case study was presenting points for histamine intolerance, and detecting the histamine intolerance, and making the appropriate reasonable recommendations for managing histamine intolerance, essentially in this case, avoiding probiotics and a low-histamine diet. We saw terrific improvements, and we didn’t chase down things like hydrogen sulfide SIBO, or SIFO, or additional treatment, or additional testing.

We, again, understood what not to do. And we focused on what to do. And this resulted in someone that didn’t have to do lots of testing, lots of treatment, and go down a rabbit hole only for no results. So great case study in that January edition of the Future of Functional Medicine Review. It illustrates the importance of detecting histamine intolerance.

Now, we did another case study in the February edition. And this was a good example of when to stop treating H. pylori and Epstein-Barr virus in the patients with Hashimoto’s. Now, treatment of H. pylori has been shown to, according to one study, help dampen Hashimoto’s thyroid autoimmunity. And there’s been quite a bit of correlation data published between Epstein-Barr virus activation or reactivation and Hashimoto’s.

So this patient had Hashimoto’s, had Epstein-Barr, had H. pylori. And this is according to pretty conservative diagnostic criteria, this is not like a left field airy-fairy, me making up the diagnosis. This is pretty standard diagnostic criteria for EBV and for H. pylori. Now, we had already achieved pretty good clinical response with her. But we decided we wanted to try to see if we could further her improvement, both in terms of her objectives or her symptoms, and also her Hashimoto’s antibodies, her TPO antibodies.

And so we treated her for H. pylori, Epstein-Barr virus. And I walk you through the case study where I approach this very objectively, where essentially, she was already doing fairly well up until that point. We decided, “Let’s see, if we treat for the H. pylori and for the Epstein-Barr, we can have you feel any better or further improve your antibodies.” What we found was additional treatment did not yield any improvement, according to her symptoms or her lab work. Yet, her H. pylori and her Epstein-Barr still remained positive.

This is a good lesson of when it’s time to stop treating the labs, and start more so treating the patient, because she was looking good from every measurable parameter other than she had some positivity for H. pylori and for Epstein-Barr virus. But again, you can’t always focus exclusively on treating the labs. And sometimes you’ll have a positive or a partial positive in a very healthy patient. And it’s not something to be overly concerned about. So I thought that was a very insightful case study. I learned a lot from treating that patient. And hopefully, from reading the case study, you guys will learn a lot from that also.

Now, in March, there was another case study that was, I think, a great learning opportunity. A patient that had had chronic SIBO had even been down to Cedars and worked with Pimentel. And when she came into my office, it seemed pretty clear that what was really needed at this point in time was a referral for abdominal pelvic adhesions. And it was partially to her credit for listening to our podcast on the issue. So I have to credit her with part of this realization.

But making this referral had a massive impact on how she was feeling from pretty much every measurable parameter. And again, it really detracted from the amount of SIBO testing, SIBO treatment, and gut work that we had to do, just recognizing that the opportune time to make this referral. And so it was a good learning experience for me to sharpen my skills for when it’s the best time or when it’s time to consider making a referral for therapy, for abdominal pelvic adhesions. So that was a good case study.

Now, there are two other case studies that we’ve covered in the Future of Functional Medicine Review. One was a thyroid nodule that was becoming so progressed that it may require surgery. And again, this can be a little intimidating. But this case study, I think, illustrates the importance of not overlooking the power of the basics. We made some basic changes for her diet and other changes for general gut health, and saw rapid and marked improvement in her thyroid nodule. So it really illustrated the importance of starting with a foundation and starting with the gut.

And then, in June, we covered a case study where a hypothyroid patient who was on thyroid hormone, and her thyroid hormone levels were normal, but she was still exhibiting symptoms. We found yeast on her lab work. However, the way I set things up, and you see this in the case study, is while we’re waiting for the lab results to come in, we already start on some treatment. And just in the foundational treatments that we started with this gal, she was pretty much asymptomatic, meaning all of her symptoms were gone. And so we didn’t need to further treat the yeast. And so this was another example of how we could have easily gone into over treatment by treating the lab, and not treating the patient. But in this case, we did have lab findings. But we had already achieved the endpoint of this person having no symptoms after just utilizing some of our basic frontline therapies.

So again, in learning about functional medicine, whether you’re a patient or a provider, if you’re a patient trying to piece some of this together, this is valuable, or to evaluate the practitioner you’re thinking about working with or, of course, if you’re a practitioner, case studies are really important. And again, in every edition of the Future of Functional Medicine Review clinical newsletter, which is a monthly publication, we have one case study.

And during the month of July, if you would like to sign up for access to the Future of Functional Medicine Review, you can purchase your first month of access for only $1.00. I know we’ve had a lot of new people, thankfully—and thank you guys so much for the support—who’ve joined our audience over the past few months. So I wanted to make sure that everyone, especially the newbies, are aware of this tool. We’ve gotten some great feedback on it. We’ll give you a chance to jump in for a month. You’ll get access to every edition that’s been published to date only for $1.00. And I think you guys will see the value in that.

So hopefully, that helps you. Help me help you, I guess, or whatever, or however it’s said. But anyway, that is the importance of case studies. The Future of Functional Medicine Review, plug in for $1.00 for the month of January. To sign up, head over to That’s And yeah, now we can get on to the rest of the show. Okay, thanks, guys.

Episode Intro

Hey, everyone! Welcome to Dr. Ruscio Radio. Gosh it feels like it’s been a long time since I’ve recorded. It probably doesn’t feel that way to you because the podcasts gets released on a weekly cadence. But I was away for a little while. I was actually in Australia, down under, at the International Congress on Natural Medicine. And the topic this year was the microbiota.

And they invited me down there to speak. So apparently, they think I’m a lot smarter than I actually am. But it was cool to go down there. And all kidding aside, the message of efficient, efficacious, and cause-effective, practical functional medicine was incredibly well-received. And it was validating to be able to speak to a room—in this case, I think there were 601 people in the audience—and just be able to see in people’s faces and interact with them afterwards. And just see the impact, the positive impact and how much this type of work really resonates with people. So that was really cool.

And additionally, Professor Rob Knight was there. You may know Professor Rob Knight as like one of the leading scientists, arguably, in the research regarding the microbiota. He has published a number of papers regarding microbiota or various topics on the microbiota. And he’s come up with essentially the technology and the analysis for American Gut.

And what was very reassuring was when, and also a little bit challenging, we were on a panel. So it was one of the question/answer panels. And Professor Knight is sitting right next to me. And someone asked, “What microbiota assays do you use in your clinic?” And they may have said, “Do you use things like American Gut?” Or what have you. And I made the point very clearly that I do not use any microbiota mapping, right. It’s different. It’s not using the term microbiota loosely. Like sometimes people will say, “Oh, the microbiota,” and they’re referring to candida or H. pylori or SIBO. I was referring to do I do any microbiota mapping like you would do via an American Gut or uBiome in the clinic. And I made a clear point that I don’t because that’s not clinically, actionable data. And it was great to have the guy who, essentially, made the test sitting right next to me, shaking his head in agreement.

So if anyone is still using these tests to steer clinical recommendations, they really need to stop. Maybe out of excitement and well-attention enthusiasm, some had started doing that. I just hope, at this point, it’s been clearly stated and people understand that and they update to no longer be using those tests for clinical purposes, because they don’t have any clinical meaning at this point.

So let’s jump in to an edition of Health News Reviews today. And before we get, I guess, into some of the particulars, there’s a couple things that I think will be interesting. Firstly, guys, thank you so much. The podcast continues to grow like crazy, which is awesome because it makes me feel good about all the time I spend pouring myself into this and that it’s actually helping people. So thank you.

And if you have learned a lot from the podcast, do me a huge favor. Take a couple of minutes, go to iTunes, and leave a review, because that increases how well we come up in the search results when people go to iTunes to try to find a podcast for learning about health. And why that’s so important is because, and I think we’re all in agreement on this, it’s important that practical information regarding functional medicine reaches people, because that can really help people.

And unfortunately, some of the overzealous information in functional medicine can, I think, maybe do as much harm as it does good, especially if it turns someone to this orthorexic-type, afraid of food, spending a ton of money on testing. So your review—if you haven’t done a review yet, do me a huge favor and take a minute. And if you’re listening to this and saying, “Oh, I’m busy. I can’t do it,” you’re the person that needs to do it because you’re the person that hasn’t done it yet. But that is so helpful because it’ll help the work that we go over weekly reach more people who I think really need it. So do me that solid. I would really appreciate it.

Hypothyroid vs Hormone Replacement Therapy

A little bit of event. Gosh. So there is a big difference between being hypothyroid and using thyroid as a hormone replacement therapy, as like a support, right. And it’s important that we make that clarification, because some patients get put on thyroid hormone who are not hypothyroid, but their clinician thinks they may benefit from some thyroid hormone support. It’s important that we distinguish that you are not hypothyroid. You don’t have thyroid disease. You don’t have a diagnosed disease. But rather, I’d like to use this as a hormonal support, similar to giving a woman estrogen, right. We don’t tell a woman she has ovarian failure when we put her on estrogen cream because she’s having hot flashes when she’s older. We shouldn’t tell someone they have hypothyroidism when they don’t, and we just want to put them on thyroid hormone as a support.

And I see this sometimes. But I’m unfortunately seeing it more and more where now I’m actually very suspicious. I shouldn’t say very suspicious. I’m somewhat suspicious of if someone’s actually hypothyroid when they come into my office if they’ve been told they’re hypothyroid. And I inquire about who made the diagnosis. And it’s unfortunate to say that, in the alternative field, there have been a number of people who have been told they’re hypothyroid. And they’ve either been very marginal, subclinical hypothyroid, which the majority of those cases actually spontaneously remit. Or they haven’t been hypothyroid at all. They’ve been euthyroid, normal thyroid, but been told that they’re hypothyroid. And now, they’re walking around thinking they have a disease when they don’t.

I’ve seen this a number of times. And why this is relevant, right? Here’s why this is really relevant, because if you go on thyroid hormone as a support, that’s all fine and good. I don’t have a problem with that. I think you could make a case for trying hormonal support, especially for a short-term boost or for a short-term aid.

But let’s say you later clean up other things in your body that may have led to the need for that hormone support. You clean up your diet. You clean up your lifestyle. Most likely, in a lot of cases, improving one’s gut health can also be an underlying factor that when addressed will now take away the need for that thyroid hormone support so you can come off the thyroid hormone. But if you were diagnosed as frankly hypothyroid, you don’t want to run that experiment, because what’s going to end up happening is your TSH is going to rocket up. Your T4 is going to plummet. And you’re going to feel terrible. So knowing what you’re dealing with, in terms of “Are you truly hypothyroid?” or “Are you normal thyroid, and we want to use some thyroid hormone support?” is important because of the end-phase decision of either trying to wean off and come off thyroid hormone or to stay on it.

That’s one of the main reasons why it’s important. Another reason why it’s important is we shouldn’t be leading people to believe they have a disease when they don’t. So it’s important to be clear in our language and let people know what they’re really dealing with, and not to tell people that they have hypothyroidism, if maybe some of their levels are a little bit low in the normal range, because people will take that hypothyroidism, read about it, and come to believe they have a diagnosed disease, when they actually don’t. So that is my vent on that. But that is an important one. And I have picked out a number of people who thought that they were hypothyroid and they really were not. So let’s stop doing that. That would be great.

Vanity & Health

Gosh, all right, this, I don’t want to go too into this. But I just, I’ve been reflecting a lot on vanity, right. I am admittedly judgmental against vanity. And I’ve been examining that belief lately, because I’ve been saying to myself, “Maybe, I’m too hard on those that are very vain,” meaning that they place a high level of importance on material things. And I said to myself, “Well, maybe I’m being a little bit too judgmental. Maybe I should take a step back on this.” I’ve been reflecting on it lately. Ruminating on it lately.

And a girlfriend of mine, we’ve been friends for a long time. Great gal, but she, gosh, she attracts the wrong type of guys. And she was telling me a story recently. And I’ll just be brief on this because it is off-topic, but I’ll tie it back to something that’s relevant in a second. I had a chance to go over to this gentleman’s house for the first time. And the thing that struck me that was just crazy is this guy had a showing room for his clothes. The clothes that he bought, they were apparently very expensive. Shirts, shoes, watches, that he never wore. But he had on display in his house. Okay, I don’t agree with that. And I don’t want to judge that.

But when you then fast forward to later in the house tour, where his kitchen cabinets also have clothes in them. Hmm, I still don’t love that. But the kicker is when—and this is meeting someone for the first time. And they’re going to be spending the weekend together at his house—opens the fridge. There is zero food. Like, it was a new refrigerator. And she said there was literally nothing in there. And in addition to that, he had only one towel for the two of them to use the entire weekend.

So I felt better about my judgements against vanity, because what has to be going on psychologically for someone to put so much emphasis on material things, but then, some basic amenities for the comfort of your guest are totally overlooked, as if your watch collection is nice enough, it doesn’t matter if you have no food.

So I still disagree with vanity, but I disagree with vanity because I think it oftentimes is accompanied by a litany of other character flaws. And unfortunately, I think what is happening is, of course, people are trying to possess their way out of whatever it is that they don’t feel good about themselves, inside of themselves. And it’s really an empty non-productive vehicle toward becoming a better person. So anyway, that’s my rant on vanity.

Okay. So let’s get into some health research stuff. Okay, the first study, “The Effect of Heliobacter Pylori Eradication on the Gastrointestinal Microbiota in Patients with Duodenal Ulcer,” “The presence of H. pylori in the stomach suppressed the colonization with lactobacillus.”

So essentially, what they’re showing is H. pylori in the stomach suppresses lactobacillus in the stomach. So this may be why lactobacillus probiotics, when taken along with antibiotics for H. pylori, greatly enhances the treatment, or the success rate of treatment, or the clearance rate of H. pylori, probably because H. pylori, it’s not something that has to be strictly eradicated, but rather, it’s overgrowing in the community, and we can use things like lactobacillus that will help police it out.

It’s also important because there’s this belief that needs to be updated in the field, also, regarding H. pylori, which is, “I have H. pylori. Does that mean my husband has it, too? Does he need to be tested and treated at the same time?” No, here’s why. Because it’s not an infection that’s either there or not there. You’re probably both never going to not have any H. pylori colonization in your stomach. Why? Because it can be a part of the natural residency. What we want to achieve is a balancing of the colonization.

So to think that you have H. pylori, yes, what that generally means is you have an overgrowth of H. pylori. We treat the H. pylori. Do we eradicate it? No, we reduce it. You kiss your husband. Does he reinfect you? No, because it’s not an infection being passed back and forth. It’s like SIBO that either grows or diminishes, depending on what’s going on in your body and how in balance you are. So a few things on H. pylori. Okay.

Hypothyroxinemia in Pregnancy

Next study. “Treatment of Subclinical Hypothyroidism or Hypothyroxinemia” —so low T3—“in Pregnancy.” They tracked IQ and death. And essentially, what they found was that the treatment of subclinical hypothyroid or low T3 in those who are pregnant did not affect neurocognitive outcomes or pregnancy outcomes. So that’s not the only study in this regard. And there have certainly been studies that have shown that the treatment of subclinical hypothyroidism is important in those who are pregnant.

However, I just want to show you that here’s a study showing the opposite, which is why when you hear me, perhaps oftentimes have a tempered opinion on things, it’s because you see studies that both support and refute a certain position on something. So that’s why you should never really be too hard driving on one position.

Iodine & Thyroid

Now, there’s another interesting study. “Iodine Deficiency and Excess Coexist in China and Induce Thyroid Dysfunction and Disease: a Cross-Sectional Study.” So here’s a couple of the important takeaways. Subclinical hyperthyroidism, so high, and overt hyperthyroidism are more likely in iodine deficient areas. And this is what’s more interesting. Subclinical hypothyroidism is more likely in high iodine intake areas.

So, perhaps this is counter to what you think if you’re still operating under what I think is probably a fairly antiquated belief that you need to have copious intake of iodine for healthy thyroid function. If you have a more contemporary belief, you understand that a reasonable intake of iodine is good for your thyroid, but over a reasonable intake of iodine actually can cause Hashimoto’s, or thyroid autoimmunity, and subclinical, or even overt, hypothyroidism.

And we’ve reviewed this in the past. And you want to get—about 1,200 micrograms a day is pretty reasonable. 450 micrograms per day might be the sweet spot. And we did a two-part series on iodine where we went into all of this data. But I think iodine as this supremely, supremely helpful tool for thyroid has been supremely overstated. You want to have some iodine in your diet. But actually, with autoimmunity, low-iodine diets have been able to show to reduce autoimmunity. So anyway, there’s a study there.

Coenzyme Q10 & Skin

Okay, next study. “The Effect of Dietary Intake of Coenzyme Q10 on Skin Parameters and Condition: Results of a Randomised, Placebo-Controlled, Double-Blind Study.” So the intake of CoQ10 essentially limited seasonal deterioration of skin viscoelasticity and reduced some visible signs of aging. So they, also, determined that there was a significant reduction in wrinkles, and improvement in skin smoothness. So that’s fairly interesting to see that a dietary supplement of CoQ10 was actually able to improve skin health.

Prebiotics Improve Sleep

Okay, I didn’t grab the link for this. I wish that I did. But I was reading something. And essentially, the title of the paper or the entry was something along the lines of “Rah-rah-rah, Probiotics improve sleep.” Okay. So I am objective. And I said, “Great, let me have a look at this. Maybe there is something interesting here that can be helpful.” You read it, and it’s a study in 57 rats.

Okay, this is like the kind of stuff, guys, that needs to stop. Okay, because what will happen is someone with IBS or IBD who has insomnia will take a probiotic. They will flare their IBS or IBD. They’ll make their sleep worse. And they’ll be saying, “Why has this happened? Because I read the headline saying that prebiotics help with sleep.” This is what happens when you’re just looking for something flashy to say. And you’re citing animal data. This really, really needs to stop. We need to stop citing mechanism and citing animal data.

And as a healthcare consumer, when you read things like this, it doesn’t require any high level of scientific training. Just click through the references or read some of the paper if the paper is right there. And just look for 29 women, 155 women in this group of people compared to in a mouse model, or in rats, or in mice, or in a petri dish, or in a cell culture. If you see anything like that, then I would totally throw that out the window in terms of following whatever recommendations that they’re making. Okay.

Biochemical Testing of Thyroid

“Biochemical Testing of the Thyroid: TSH Is the Best and, Oftentimes, Only Test Needed – A Review for Primary Care.” So this is the title of the study. Okay. So I want to just quote this because I thought this was pretty informative. “A large part of this increasing difficulty in appropriate management is caused by patients requesting, and even demanding, certain tests or treatments that may not be indicated. Symptoms of thyroid dysfunction are non-specific and extremely prevalent in the general population. This, along with a growing body of information available to patients via the lay press and internet suggesting that traditional thyroid function testing is not reliable, has fostered some degree of patient mistrust. Increasingly, when a physician informs a patient that their thyroid is not the cause of their symptoms, the patient is dissatisfied and even angry.” Okay.

So that may sound counter to what some people believe. But I actually think there’s a grain of truth to this, because the increased awareness relative to certain items in the thyroid—and we’ll get into some of the specifics in a second—has improved some things. And then, it has made some things worse. So the increased awareness has been good for people to have an increased awareness about thyroid autoimmunity. That’s important because it changes our treatment. It may make someone more prone to use a diet that may be helpful for autoimmunity, namely a gluten-free diet, a grain-free diet, probably the most notable. Or a low-iodine diet like we discussed. It gets a little less press, but it’s also been clinically documented. Or use some practical treatments for autoimmunity. Vitamin D, selenium, CoQ10, magnesium have all been shown to be helpful. Potentially, also, the treatment of gut infections where there are some preliminary evidence showing that the treatment of gut infections can lower thyroid autoimmunity.

Also, what’s been helpful about increased awareness regarding thyroid, the addition of T3 to someone’s medication regime may be helpful. Okay. So I believe the way this breaks down is about 20% of patients, according to one study, twenty-ish percent of patients prefer T4 alone. And maybe 40%, 45%, if I’m remembering correctly, percent of patients prefer a T4 or T3 combination. And that did seem to correlate with other bio parameters like weight and energy. So the awareness about T3 has helped to showcase that the addition of T3 to a T4 can be helpful. And so T4 would be something like Synthroid, right. A T4/T3 would be something like Synthroid plus Cytomel or something like Nature-Throid or WP Throid or Armour or what have you. So that’s been good.

The damage, labeling—like we talked about before—labeling everyone as hypothyroid, even those who clearly don’t have it, that is a problem. Now, this sometimes happens. And this is coming exactly back to what this paper said. When we use these overly, narrow ranges, and we essentially create a diagnosis where there is none. And that’s a problem, guys.

And some people may say, “Well, if the ranges are narrower, then I can get the help that I need.” Not really, right. You can still do a therapeutic trial of thyroid hormone. And see if it makes you feel better. But if you’re not frankly hypothyroid, then the solution to your thyroid-like symptoms is probably not your thyroid. And that’s the key thing here. It’s probably something else. In many cases—not in all—the gut is a very good place to look.

And the same thing applies to SIBO, guys. We don’t want to use such narrow diagnostic criteria for interpretation of SIBO testing so that we label everyone positive with SIBO. This is not helpful. Now, the other area where this has been damaging, this thyroid information has been damaging, is the overzealous treatment of thyroid autoimmunity. And we’ve talked about this before.

So coming back to what this paper says. And I agree with this. “Arguably, the three most important biochemical tests of thyroid function are TSH, free-T4, and anti-TPO antibodies.” I would agree with that. Now, you may want to also measure free-T3. But to tell you the truth, guys, you could just have someone try T3. If they’re on T4, you can have them try T4 with T3. Or just add in the T3. The studies that have shown the patients, 45-ish percent prefer T4/T3 combination medication, did not use lab testing to determine that. They just switched the prescription and noted who felt better.

So maybe you can make an argument for T3. But the most important tests: TSH, T4, to distinguish if you’re overt hypothyroid and you need medication, and TPO to identify if you’re Hashimoto’s, and if you have autoimmunity. And the levels matter. All right. Very high levels, you want to act. In the low hundreds, you probably don’t want to act. Okay, so I’m in agreement with what this paper says. So they conclude, “It is important for primary care providers to have an understanding of the shortcomings and proper interpretation of these tests to be better able to discuss thyroid function with their patients.”

Okay. So this paper, we will be doing a write up of this paper for the Future of Functional Medicine Review clinical newsletter. So if you’re a part of that group, then you’ll see a breakdown of this paper with my comments to help people have a more responsible and practical conversation regarding their thyroid. Also, I should point out because we’re having a practical conversation does not mean that we’re not going to get better results. All right.

Sometimes people think, “Do more, and you’ll get better results.” And I would very strongly argue that in many cases when you do more, you actually may end up getting worse results, because if you do too much, you end up doing nothing well.

So it’s not to say, if you’re listening to this, and you’re sick and you’re not feeling well, and I’m criticizing some of these deeper thyroid assays or whatever, it’s not to say you can’t feel better. It’s just, you don’t have to go to these crazy lengths to feel better. Like, focus on the fundamentals. “He who has the best can do the most with the least.” I love that quote. And I find it to be more and more true with every passing day. Okay.

Fecal Fermentation in IBS

So the next study, “Fecal Fermentation in Irritable Bowel Syndrome: Influence of Dietary Restriction of Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols.” So essentially low FODMAP. “Sixty-three patients completed the study.” And let’s see here. Okay. So essentially, no surprise here, the IBS score improved significantly. Duh, that’s pretty well shown.

Here’s what I think is important. The total short-chain fatty acid levels were reduced. That shouldn’t necessarily be surprising to you, right. But they also conclude and continue that the fecal short-chain fatty acid levels and IBS symptoms were not correlated. So why that’s important is this: part of the dialogue that you will hear is that short-chain fatty acids feed your epithelial cells or your intestinal cells. And they’re good for your intestinal cells, which is true. This doesn’t mean that the way to fix your problems is to just blindly increase short-chain fatty acids, because you are more than a biochemical diagram. You’re more than a mechanism. Okay.

So what should be taken home from this is when people ate in such a way that decreased short-chain fatty acids, they felt better. So they had less of the compounds that are supposed to heal the gut. Yet, their gut health improved. And we’ve also shown that on low-FODMAP diets, you’ll have a decrease in inflammatory markers, right.

So we have to get out of this thinking that because you see a diagram of an intestinal cell and you see a green arrow with short-chain fatty acids labeled on the arrow going into the intestinal cell, and this being good, it doesn’t mean that you can take that mechanism and try to manipulate that mechanism in a human being and see a positive result. Okay.

So in this case, the beloved short-chain fatty acid decreased, yet the IBS improved. So okay, it’s just showing a flaw in some of the mechanistic thinking.

Ad-Libitum Paleolithic vs. Australian Guide

Next study. “Cardiovascular, Metabolic Effects and Dietary Composition of an Ad-Libitum”—so at your pleasure—“Paleo Diet vs. Australian Guide to Healthy Eating Diet,” kind of like a heart-healthy conventional dietary recommendation in the U.S. It was a four-week randomized trial. The Paleo diet produced better weight loss, but similar changes in other cardio and metabolic markers, compared to the Australian conventional healthy diet recommendations.

So essentially what they’re showing, or why this can be helpful, is that people tell you that a Paleo diet has more meat and more fat in it and that’s bad for your heart. Well, this study really contradicts that. In fact, the cardiometabolic improvements were similar between both groups, but the Paleo diet group lost more weight. And you could argue because weight is a risk factor for cardiovascular events then it’s probably even better.

And, of course, we’ve reviewed in the past the litany of studies that have looked at either Paleo or lower-carb diets compared to more traditional dietary advice. And for cardiometabolic markers or conditions, they definitely tend to shine superior. Again, all diets help, but they tend to have a slight edge. Okay.

One other random thought just popped in my mind. I should maybe share this. Rob Knight, at the Congress in Australia, made an excellent point. And we’ve discussed this. But I think he just termed it very nicely. Something known as effect size. Okay. And he talked about how there is a, I believe it was an analysis of NHANE’s data. And they essentially found that the most fattening food was french fries, and the most slimming food was yogurt.

Now, this can very easily be spun into an article about you should eat more yogurt and not eat any french fries because of these findings. “French Fries Are the Most Fattening Food.” “How to Fight Your Most Fattening Food and Eat Your Most Thinning Food.” That’s a very catchy article title or something like that. But when you look at the effect size—and I may be slightly off in the numbers, but I’ll be fairly proximal—“If for a year, you did not eat french fries and instead only ate yogurt, you would average 1.3 pounds of weight loss,” was I believe what he quoted.

Why is this important? Because we don’t want to take these media soundbites and make people afraid of food. If you’re out with some friends and you want to have some french fries, go ahead. You’re not going to die. All right. If you have a known aversion to potatoes, then don’t eat them. But the point I’m driving at here is these soundbites can be very misleading when you don’t give them the appropriate context or when they’re delivered in an overzealous context. Okay.

Probiotics Managing H. Pylori

“The Role of Probiotics in Managing of Helicobacter Pylori Infection: A Review.” So essentially, they conclude, “When probiotics are consumed in conjunction with antibiotics, the eradication rate may be improved.” Right. We’ve talked about this before. And that’s been pretty well-documented by systematic reviews and meta-analysis. So if you have H. pylori, and you’re going to take an antibiotic for it, you should take a probiotic at the same time. A Lactobacillus, Bifidobacterium blend has been determined to be helpful, as has Saccharomyces boulardii. Do you need the special probiotic called H. pylori blaster 2000 with the special strain? No because that would be B.S. because it’s not that specific. Okay.

Autoimmune Gastritis & H Pylori

“Autoimmune Gastritis: Relationships with Anemia and Helicobacter Pylori Status.” So they looked at data from 138 patients. And essentially, they looked for parietal cell antibodies. Now, parietal cell antibodies are antibodies to the parietal cells, which are cells in your stomach that produce hydrochloric acid. And they also help with intrinsic factor.

Now, 65% of these patients had anti-parietal cell antibodies. And they were all negative for H. pylori, which is interesting because there’s some evidence showing that the treatment of H. pylori may help improve anti-parietal cell autoimmunity. But the data’s not consistent. So this would be one of those “data not consistent” studies.

However, they did find pernicious anemia in 25% of these patients, iron deficiency in 29% of these patients, hypothyroidism in 23% of these patients. Remember, hypothyroidism, you have about a 20% to 40% chance of having anti-parietal cell antibodies if you have hypothyroidism. Type 1 diabetes in 7.9% and vitiligo in 2.8%. Okay.

Why does this matter? Because—and I think this is one of the most overlooked areas in functional medicine—if someone has anti-parietal cell antibodies, two studies have been performed showing that injectable B12 can lower the thyroid antibodies, and essentially arrest the, I’m sorry I think they said, stomach. Injectable B12 can arrest the stomach autoimmunity when administered once a week. And then once the autoimmunity has been arrested or is in the normal ranges, once monthly injection is enough to maintain that.

The follow-up study, the second of these two studies used oral B12 compared to the injectable B12 and did not find the effect for oral B12. Now, to be fair, the dose may not have been high enough I speculate a little bit. But I would say oral B12 probably won’t do it, but injectable B12 will.

Now, we’ve also talked about there are a few symptoms that tend to be very indicative of this anti-parietal cell autoimmunity. One study found that 90% of patients who experience a burning sensation in the mouth have parietal cell autoimmunity. Eighty percent of those with dry mouth have parietal cell autoimmunity. And the 60% of those with sore tongue have parietal cell autoimmunity. So guess what I’ve done? I’ve added these to my paperwork. Well, actually, technically I haven’t done it yet. It’s on my list. I’ll do it soon.

But this is a simple thing that you can do with your intake paperwork, if you’re a clinician, that would prompt you to perform the anti-parietal cell antibody test. Okay. See how simple. Like practical, functional medicine is simple. It doesn’t have to be crazily complicated. Okay.

Vitamin D Status in Autism

“Vitamin D Status in Autism Spectrum Disorders and the Efficacy of Vitamin D Supplementation in Autistic Children.” Essentially, they found that vitamin D supplementation improves autism. Collectively, 80% of the subjects who received vitamin D had significantly improved outcomes in various measures of behavior, eye contact, and attention span. So that’s reassuring.

B Vitamins & Cognitive Function

“B Vitamin Supplementation Improves Cognitive Function in Middle Aged and Elderly with Hyperhomocysteinemia.” So those with high homocysteine saw, in a placebo-controlled trial, saw an improvement in their cognition when they supplemented with folate, vitamin B6, vitamin B12. So that’s encouraging. And I wonder if they used folic acid. I didn’t actually check. I would be willing to bet they’re using the term folate there to represent folic acid.

And, of course, folic acid will kill you, right, because that’s what functional medicine tells us. I think that has been a bit overstated. And actually, I believe gosh, I believe there is a researcher I came across who did an excellent review on this. And I’m trying to get him on the podcast. But gosh, there’s so much going on that I may be misremembering that. So hopefully, that will come, but if not, don’t hate me too bad for that.

Excess Iodine & Thyroid Disease

All right, next study. “Effect of Excess Iodine Intake on Thyroid Diseases in Different Populations: A Systematic Review and Meta-Analyses Including Observational Studies.” Okay, so this is important. This is a systematic review and meta-analysis on iodine and thyroid, as if there hasn’t been enough to answer this question. But let’s be aware of this. It’s good to be aware of it.

So 50 articles were included: three intervention trials, six case-controlled trials, six follow-up studies, and 35 cross-sectional studies. So a lot of information here. Okay, so I’ll just quote. “Although universal salt iodization has improved goiter rates, chronic exposure to excess iodine from water or poorly monitored salt are risk factors for hypothyroidism….Monitoring of both iodine concentrations in salt as well as the iodine concentration in local drinking water are essential to prevent thyroid diseases.” Okay.

So it’s important to understand this, again, because I think the antiquated view on thyroid was that anyone with thyroid disease should be on iodine. And what’s really important to factor into this is that it’s not a very well, at all, supported position. So this is just another study of very high-level data showing that, if anything, too much iodine can be more detrimental than it can be beneficial. It doesn’t mean you may not know someone who’s taken iodine and feel like it helped them. Again, that could be placebo, right. Forty-five percent of effect in randomized-controlled trials is attributable to placebo. And it may have done nothing, right. But the chances of harm are fairly high, relatively speaking. So you want to be careful. Okay.

Investigational Treatments for Gastroparesis

“Investigational Drug Therapies for the Treatment of Gastroparesis.” I just wanted to use this study to illustrate gastroparesis, which essentially it’s very poor motility in your stomach, because your stomach has to contract to project food into the small intestine. And typical symptoms are nausea, vomiting, pain, early satiety, and bloating. All right.

But here’s the thing I actually really wanted to showcase here. And I’ll quote. “However, correlation between gastroparesis symptoms and rates of gastric emptying is poor.” Why does that matter? Because what they’re saying there is if you do a test or a motility study, the correlation between your motility and your symptoms is not poor. Why is that relevant? Because it showcases that sometimes test results don’t really mean anything. Okay. So just because we can test something, doesn’t mean it’s important. So this is an example of that.

Abdominal Pains & Quality of Life in Women

“Abdominal Pain, Cramping or Discomfort Impairs Quality of Life in Women: An Internet-Based Observational Pilot Study Focusing on Impact of Treatment.” Essentially, they compared a medication Buscopan—I believe that’s how it’s pronounced—to Iberogast. And they found that for these abdominal pain, cramping, and discomfort symptoms, 86% of patients felt an improvement from the Buscopan and 75 from the Iberogast. So that’s pretty encouraging. I think that’s a pretty good compound. The Iberogast, that is.

Fermented Milk & Gastrointestinal Discomfort

And last, but not least, “A Systematic Review and Meta-Analysis: The Effects of Fermented Milk with Bifidobacterium Lactis and Lactic Acid Bacteria on Gastrointestinal Discomfort in the General Adult Population.” So three trials with a total of 598 adults were included. And essentially, the meta-analysis show that the consumption of this fermented milk was associated with a modest but consistent improvement and outcomes related to gastrointestinal discomfort. So this is just nice evidence, high-level evidence showing that there seems to be a consistent, but modest benefit from the consumption of fermented milk.

Episode Wrap Up

So that takes us now to about 38 minutes. And I actually wish I had included a few more studies in here because I feel like I have a little more pep. But that’s all I got today. I’ll just ask you, guys, one more time. Please if you haven’t left an iTunes review for the podcast, please do me a huge favor. Take a second. You don’t have to write a poem. You could just say Dr. Ruscio’s really cool. All right. You could just say this is a great podcast.

Just the fact that we have a positive review in there, it just pushes us higher and higher up in iTunes. And I really think this information needs to reach more people. So I know it’s a pain in the butt and that we’re all busy. But I would deeply, deeply appreciate it. If you haven’t done it yet, take a moment and do it. Again, I would really appreciate that. All righty, guys, we’ll talk to you next time. Thanks. Bye.

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Dr. Ruscio, DC, 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.


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