Health News Updates December 2017

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Health News Updates: Red Meat & Ill Health, Probiotics for Weight Loss, Thyroid Autoimmunity and Quality of Life, Low Carb and Leaky Gut, and Elimination Diets and Dysbiosis in Autism

In another edition of health new updates, we will discuss:

  • Red meat & ill health
  • Probiotics for weight loss
  • Thyroid autoimmunity and quality of life
  • Low carb and leaky gut
  • Elimination diets and dysbiosis in autism
  • And more…

Dr. R’s Fast Facts

Digestion-resistant maltodextrin effects on colonic transit time and stool weight: a randomized controlled clinical study.

  • Resistant starch improved constipation, stool volume, stool consistency, and some intestinal functions in a healthy population.

A diet low in FODMAPs reduces symptoms in patients with irritable bowel syndrome and a probiotic restores bifidobacterium species.

  • There was no effect of the low FODMAP diet on microbiota diversity in fecal samples.

Neurological disorders associated with gluten sensitivity.

  • This study indicates that in some people, gluten sensitivity can manifest only as a neurological reaction – including incoordination, brain fog and polyneuropathy.

A review on the relationship between gluten and schizophrenia: Is gluten the cause?

  • Several studies presented evidence to suggest that symptoms associated with schizophrenia were minimized when gluten was excluded from patients’ diet.

Subclinical Hypothyroidism: Should we treat?

  • SCH is when your TSH is elevated above normal range yet T4 is normal
    • Thyroid function normalizes spontaneously in up to 40% cases.
    • Therefore, the decision of whether to treat or not to treat subclinical hypothyroidism should be made after careful consideration of the patient’s age, the presence of symptoms, the presence of thyroid antibodies, and other risk factors, such as cardiovascular disease.

Elevated C-reactive protein levels in women with bipolar disorder may be explained by a history of childhood trauma, especially sexual abuse, body mass index, and age.

  • Increased inflammation (hs-CRP) levels in Bipolar Disorder patients are more related to Childhood trauma, especially sexual abuse, age, and body mass index (BMI) than to a diagnosis of Bipolar Disorder (BD).
  • “These data suggest that peripheral inflammation may underpin the well-known detrimental effects of childhood maltreatment and obesity in the course of BD.”

Intestinal dysbiosis and yeast isolation in the stool of subjects with autism spectrum disorders.

  • Kids with autism were more likely to have yeast in their guts, along with gut inflammation, leaky gut and digestive symptoms.

Lubiprostone improves intestinal permeability in humans, a novel therapy for the leaky gut: a prospective randomized pilot study in healthy volunteers.

  • Lubiprostone (aka amatiza, a laxative) may help combat leaky gut. More research is needed.

Step-up empiric elimination diet for pediatric and adult eosinophilic esophagitis: the 2-4-6 Study.

  • We may be able to use elimination diets in a ‘step-up’ approach wherein 2 foods are eliminated for 2 weeks, and then another 2 for 2 weeks and so on.  This may be a better approach to pinpoint food allergies for those who are not highly motivated to eliminate all potentially problematic foods at once.

Calprotectin in serum and zonulin in serum and feces are elevated after introduction of a diet with lower carbohydrate content and higher fiber, fat, and protein contents.

  • This study showed a higher fat/lower carb diet increased leaky gut, however Dr. Ruscio questions the clinical significance of these findings.

Patients with subclinical hypothyroidism before 20 weeks of pregnancy have a higher risk of miscarriage: a systematic review and meta-analysis.

    • Subclinical hypothyroidism (SCH) is a risk factor for miscarriage in women before 20 weeks of pregnancy
    • Early treatments can reduce the miscarriage rate
  • Dr. Ruscio’s Notes
    • If you have a TSH above normal before getting pregnant, it is a good idea to speak with your doctor about taking thyroid hormone.

Autoimmunity affects health-related quality of  life in patients with Hashimoto’s thyroiditis.

  • Study revealed that higher thyroid antibody levels were negatively correlated with life quality scores. Thus, patients who had higher thyroid antibodies (anti-TPO and anti-Tg) had significantly lower quality of life scores.

Health risk factors associated with meat, fruit, and vegetable consumption in cohort studies: a comprehensive meta-analysis.

  • This meta-analysis shows that people who have unhealthy habits may be more prone to eat red meat.
    • People who consume more red meat tend to have accompanying lifestyle choices that detract from one’s health (overweight, smoker and low level of physical activity) and people who are eating less red meat typically tend to smoke less, be more educated, and are more physically active.
    • This may be because of the dogma to reduce consumption of red meat as part of a “healthy diet”
  • Intake of fruits and vegetables was positively associated with
    • People who are non-smokers, have high education and high physical activity, and similar results were found when examining fruit and vegetable consumption separately.

Effect of probiotics on body weight and body-mass index: a systematic review and meta-analysis of randomized, controlled trials.

  • Probiotic consumption reduced body weight by 1.3 lbs (59 kg) and BMI by 2 (0.49 kg/m).
    • A greater reduction in BMI was found with multiple species of probiotics.

The role of oxidative stress, inflammation, and acetaminophen exposure from birth to early childhood in the induction of autism.

  • The use of acetaminophen (tylenol) in babies and young children may be more strongly associated with autism than its use during pregnancy
    • Perhaps because of well-known deficiencies in the metabolic breakdown of pharmaceuticals during early development
  • No support for the hypothesis. More research is needed.

The long-term effects of probiotics in the therapy of ulcerative colitis: a clinical study.

  • This study evaluated if probiotics (lacto and bifido probiotic) plus drug therapy (mesalazine) was better for preventing relapse in Ulcerative Colitis than drug therapy alone
    • Probiotics plus drug therapy worked better than drug therapy alone

Esophageal and Small Intestinal Mucosal Integrity in Eosinophilic Esophagitis and Response to an Elemental Diet.

  • What type of effect does the elemental diet have on the membrane integrity of the throat and small intestine in patients with Eosinophilic Esophagitis (EoE) condition?
    • The elemental diet restored esophageal integrity which suggests that the diet reduces allergen exposure
    • Small intestinal (duodenal) integrity did not benefit from the diet and does not seem to be effective in EoE

Effect of Probiotics and Prebiotics on immune response to influenza vaccination in adults: a systematic review and meta-analysis of randomized controlled trials.

  • Probiotics may be synergistic with the influenza vaccine

In This Episode

Digestion-Resistant Maltodextrin Effects on Colonic Transit Time … 00:00:39
Low FODMAP Diets Reduce IBS Symptoms … 00:02:43
Neurological Disorders Associated with Gluten Sensitivity … 00:06:30
Gluten and Schizophrenia … 00:07:52
Knowing when to Treat Subclinical Hypothyroidism … 00:10:45
Elevated C-Reactive Protein Levels in Women with Bipolar Disorder … 00:14:52
Intestinal Dysbiosis in Subjects with Autism Spectrum Disorders … 00:17:19
Lubiprostone Improves Intestinal Permeability in Humans … 00:18:58
Step-Up Empiric Elimination Diet for Eosinophilic Esophagitis … 00:21:10
Calprotectin and Zonulin are Elevated on a Low-Carb Diet … 00:28:15
Subclinical Hypothyroidism and Risk of Miscarriage … 00:29:49
Autoimmunity and Quality of Life in Patients with Hashimoto’s Thyroiditis … 00:30:54
Risk Factors Associated with Meat, Fruit, and Vegetable Consumption … 00:33:04
Effect of Probiotics on Body Weight and BMI … 00:36:43
How Oxidative Stress, Inflammation, and Acetaminophen Exposure Affect Autism … 00:38:59
Effects of Probiotics in the Therapy of Ulcerative Colitis … 00:40:04
Esophageal Mucosal Integrity and Response to an Elemental Diet … 00:41:07
Effect of Probiotics on Immune Response to Influenza Vaccination … 00:42:57

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Dr. Michael Ruscio: Hey, everyone. Welcome to Dr. Ruscio Radio. Let’s jump into another edition of Health News Reviews.

Digestion-Resistant Maltodextrin Effects on Colonic Transit Time

And we’ll start off with the study entitled “Digestion-Resistant Maltodextrin Effects on Colonic Transit Time and Stool Weight: A Randomized Controlled Clinical Study.”

Essentially, they took 28 patients on placebo and 28 treatment patients. And they showed that resistant maltodextrin—so a form of a resistant starch—improved colonic transit time (so the speed at which bulk stool feces moves through your colon), stool volume, stool consistency, and some intestinal functions in this healthy population.

So this isn’t really surprising. Probably the best research for resistant starch, fiber, and/or prebiotics, all very similar, is for constipation by helping with bulk, volume, and just having a general laxation effect because of that.

So certainly not surprising. Something to consider, especially in people that have constipation or constipation-type IBS. And for some people, something like an addition of fiber, prebiotic, or resistant starch will be enough to get them over the hump of a little bit of constipation.

But also, don’t let the fact that some intestinal functional markers can improve with things like prebiotics, as we’ve talked about, because sometimes what you’ll see is a functional marker improve, yet someone’s symptoms regress. So these therapies—fiber, prebiotics, resistant starch—are all viable. But always take into account someone’s response or your own personal response. And if you’re not responding well, don’t force feed these things because you’re trying to improve “leaky gut” or butyrate or whatever marker du jour is the topic of focus. Make sure to be pragmatic in looking for a good response yourself or in those that you’re working with.

Low FODMAP Diets Reduce IBS Symptoms

Next thing, entitled, “A Diet Low in FODMAPs Reduces Symptoms in Patients with IBS, and a Probiotic Restores Bifidobacterium Species: A Randomized Controlled Trial.” The context here is that low FODMAP diets, while the effect on the microbiota is debatable in terms of negatively impacting diversity, it has been shown that Bifidobacterium—probably the clearest potentially negative effect on bacteria is onto the population of Bifidobacterium.

So what this study did was it put patients on a low FODMAP diet for four weeks. And then it put them on a Bifidobacterium probiotic. And what they showed is that the abundance of Bifidobacterium species was lower in fecal samples from patients on a low FODMAP diet compared to the sham diet (so no diet at all), but higher in patients given a  probiotic. So that’s not really anything surprising there.

However, this is an important point from the study. There was no effect of the low FODMAP diet on microbiota diversity in fecal samples. And we’ll be talking more about this. There have been a number of studies.

I actually think this was for a review paper that goes out maybe in the December edition of The Future of Functional Medicine Review. Actually, I’m fairly certain now that I’m thinking about it. In the December edition of The Future of Functional Medicine Review clinical newsletter, I detail a review on low FODMAP mechanisms.

And you clearly see that the impact on diversity has not been substantiated. So it’s really sad when people get scared about the low FODMAP diet because they think they’re going to have a negative impact on their diversity. Yes, there has been shown the ability to show a dwindling or a decrease of Bifidobacterium. But that happens in patients that see quite a remarkable improvement in their symptoms and sometimes in other functional and clinically relevant markers. So this study found that you can negate the effect of decreasing Bifidobacterium in the stool from a low FODMAP diet if you take a Bifidobacterium probiotic.

What is the most important question is, were the patients who were taking the probiotic any better off than the patients who are not taking the probiotic? And I don’t believe that they did show any additional benefit. I’m not positive on that. But I wanted to mainly illustrate this study because it showed—and it’s one of many that have shown that there was no impact on microbiotal diversity.

So certainly, if there are negative impacts from the low FODMAP diet, we want to be cognizant of that and try to incorporate that into our recommendations. However, it seems that the fear has gotten ahead of itself or ahead of the recommendations in terms of people are concerned that the low FODMAP diet is going to cause this deleterious effect on their microbiota.

And I really don’t think that’s founded, especially when you consider that, again, when alpha beta diversity scores have been tested (so different ways of showing diversity in the gut), there hasn’t been conclusively shown a decrease in diversity. And we see a whole bunch of improvements in symptoms in these patients.

And remember that what you test and see in the stool is a fairly immediate response to what you’re feeding those bacteria. So the second these people go back on more FODMAPs, they’re going to see those Bifidobacterium counts go up again. It’s not like you’re going to lose your Bifidobacterium forever.

It’s just, what you feed grows, and what you don’t feed doesn’t grow. So it makes sense to me that if you starve something yet you feel a lot better, then that’s probably a win for your gut and for your immune system. So moving on.

Neurological Disorders Associated with Gluten Sensitivity

Next study. “Neurological Disorders Associated with Gluten Sensitivity.” This review considers the pathogenic clinical and therapeutic aspects of neurological disorders associated with gluten sensitivity.

Here’s what’s important. Gluten ataxia—meaning this feeling of incoordination, some may say you feel a little bit goofy, where you feel like you can’t walk or you feel—not literally can’t walk, but you feel a little bit shaky, a little bit imbalanced, a little bit uncoordinated; you may also have slurred speech, which has to do with other parts of the brain that control motor function in the tongue, so that’s ataxia—and polyneuropathy, which is essentially damage to nerve tissue, were two of the most common neurological side effects associated with gluten sensitivity.

Now, this paper was in a different language, so I couldn’t define if they meant gluten sensitivity to mean celiac, and it’s just a translation issue, or if they literally meant non-celiac gluten sensitivity. In any case, it’s not a stretch to say that some people will have the only reaction be, to gluten, a neurological reaction. And they will have no digestive reactions but only neurological. And that may happen for those with celiac, of course, and those even with non celiac gluten sensitivity. So it’s something to keep in mind.

The Relationship Between Gluten and Schizophrenia

Next paper. “A Review on the Relationship between Gluten and Schizophrenia: Is Gluten the Cause?” So another paper here looking at gluten and neurological symptoms.

“Several studies presented evidence to suggest that symptoms associated with schizophrenia were minimized when gluten was excluded from the patient’s diet. Immunological searches revealed that most schizophrenic patients had an increase in anti-gliadin antibodies and did not possess celiac.” So they had an increase in the antibodies, but they weren’t full blown celiac. So this, again, may be on that spectrum of gluten sensitivity where they are non-celiac gluten sensitive or even going a little bit further, potentially celiac light.

And they continue: “Yet, the presence of increased antibodies against gliadin can be the share point of the immunological abnormalities found in both of these diseases.” So this is nothing I would call super definitive. But it’s suggestive certainly.

If we come at this from a reasonable perspective, I think it would be very hard for anyone to take issue with the recommendation of said reasonable perspective. Meaning, go off gluten for 30 days and reevaluate how you do. If you notice clear benefit, then that’s suggestive you may have a problem with gluten. Go into a reintroduction. If you notice a regression, then that’s fairly definitive. We may want to run that experiment one or two more times and avoid accordingly. That we can justify.

Scarring the bejeezus out of people and making everyone think they have to avoid gluten all the time irrespective of any evidence to support that is what fuels the resistance against the acceptance of a gluten-free or gluten-reduced diet. It’s those who are overzealous are not helping really the movement move forward, because you’re only going to get acceptance from the extreme fringe unfortunately. And the larger body of people who are looking for a little bit more of a reasonable perspective before they can get behind it are going to push back on that. And that includes just lay people and all the way through people in the medical community.

So if you come at this from a more reasonable perspective, we’re going to get a deeper buy in. And also, it’s going to be better for people.

If you scare people into thinking that they can never have gluten again for the rest of their lives—Like patients who come into my clinic who have read other people’s books and are just a mess with fear. And we actually show them, “Hey, you can go out to dinner tomorrow night with your husband. And you can have a slice of pizza. And let’s see how you do.” And they do that, and they go, “Oh, you know what? I actually felt okay.” Great. So now, you can get back to having a normal life.

Would we recommend that this person have gluten as a staple every day? Probably not, depending on what they have going on. But we want to personalize the recommendation to the person so as not to create these overzealous recommendations.

Knowing when to Treat Subclinical Hypothyroidism

Next study. “Subclinical Hypothyroidism: Should We Treat?” So a few notes from the study. It is common, affecting about 10% of women above the age of 55. About 2.5% of patients with subclinical hypothyroidism progress to clinical, overt hypothyroidism each year. The rate of progression is higher in patients with thyroid antibodies and with higher TSH levels.

And again, remember. Subclinical hypothyroidism is when your TSH is elevated above the normal range, yet your T4 is normal. So they continue. And this is important. It’s very important for you to be aware of this. “However, thyroid function normalizes spontaneously in up to 40% of cases.” Now, that 40% will vary a little bit from study to study.

But essentially, we’re seeing a fair number of people who have subclinical hypothyroidism who will spontaneously go back to normal. So not something that we have to, again, get super concerned about if you’re a lay person or be super aggressive regarding if you’re a clinician. Let’s just be practical and give people reasonable recommendations, not scare them.

Now, continuing, subclinical hypothyroidism symptoms: “Only a small minority of patients with subclinical hypothyroidism have symptoms. And the evidence to support that levothyroxine will ameliorate the symptoms in these patients is weak.”

Continuing, and this is regarding age and quantification of risk. “In younger patients, subclinical hypothyroidism is associated with an increased risk of coronary heart disease, heart failure, and cerebrovascular disease. The risk increases with increasing levels of thyroid-stimulating hormone and is particularly high in patients with a TSH above 10.”

So you’ve heard me say that the older you get, the more your TSH will naturally creep up. So this is essentially stating the inverse of that which is, the younger you are, if you have this elevation of TSH, the more concerning it is, especially if it’s above 10. And this is why you’ve probably heard me say before that a clearer, more definitive, not universally agreed upon but more agreed upon level for which we should start the treatment with thyroid hormone for subclinical hypothyroidism is TSH above 10.

Okay, they remark on treatment, “There was a lack of evidence from randomized control trials as to whether levothyroxine treatment can prevent these risks, although a large observational study of the UK General Practice Research Database has shown that levothyroxine may reduce risk of coronary heart disease in younger patients.”

So they continue, “Therefore, the decision whether to treat or not should be made after careful consideration of the patient’s age, presence of symptoms, the presence of antibodies and other risk factors such as cardiovascular disease.”

Now again, the TPO antibodies, they give you some clarity there. If we see TPO antibodies above 500, I think that is when we want to be a little bit more concerned. And also when they say, “The other symptoms,” consider if someone is non-responsive to other lines of treatment. Then that would make me lean much more heavily toward the importance of treating the subclinical hypothyroidism.

Thank You for the iTunes Reviews

And just quickly, I want to thank you guys again for the iTunes reviews. We’ve really been skirting up nicely in the iTunes reviews. And we’re actually seeing the more reviews that are left, the more people start seeing the podcast. And it has been super helpful. So I just want to thank you guys again for taking a moment.

If you haven’t, quickly take a moment. Write us a quick review on iTunes. It’s super helpful for getting this information to more people and helping make sure they don’t get pulled into any of the craziness that people can sometimes fall victim to on the internet. So thank you if you’ve done it. And if you would do one if you haven’t, I would appreciate it. Okay, moving on.

Elevated C-Reactive Protein Levels in Women with Bipolar Disorder

Elevated C-Reactive Protein Levels in Women with Bipolar Disorder May Be Explained by a History of Childhood Trauma, especially Sexual Abuse, Body Mass Index, and Age.” So we’ve discussed before with Kevin Geary amongst others that early trauma, especially physical or emotional trauma, may make one more sensitive to stress later in life. And so we see potentially a biomarker of this C-reactive protein, which is an inflammatory marker, as one of the ways of potentially indicating that.

A few notes from their study. “Our results show that increase in C-reactive protein levels in bipolar disorder patients are more related to childhood trauma (especially sexual abuse), age, and BMI than to a diagnosis of bipolar per se. These data suggest that peripheral inflammation may underpin this well known detrimental effect of childhood maltreatment and obesity in the course of bipolar.”

And they continue that the CRP data are difficult to interpret if they are not adjusted for the effects of BMI and age, so just essentially saying you’ve got to factor in age and weight to get a more accurate read.

So what this is showing us in terms of what do we do with this information—if you or if you’re a clinician working with someone and you’ve done a lot of the physiological stuff and you still don’t feel like you’ve fully responded, looking into ways of creating an environment that is more suitable to you may be helpful.

So oftentimes, we’re trying to optimize someone’s gut environment for their individual gut. And in this case, we may want to or may need to optimize someone’s mental, emotional stress load environment so as to help buffer the effects of some of what has occurred early on in childhood.

And it’s not something that I think should be looked at in a bad way. It’s the hand you’ve been dealt. If you were given antibiotics as a child and not breastfed and now you’re FODMAP sensitive, okay. Let’s just move forward. Let’s not overly indulge in FODMAPs. And once you get your gut cleaned up, you’ll probably be okay going forward.

I see something similar here where you may just have to work a little harder at some of these lifestyle factors. And if you do, you should be pretty okay going forward.

Intestinal Dysbiosis in Subjects with Autism Spectrum Disorders

Another study. “Intestinal Dysbiosis and Yeast Isolation in the Stool of Subjects with Autism Spectrum Disorders.” “High frequency of gastrointestinal yeast presence in autism spectrum disorder subjects was shown through a simple culture approach.”

So they showed Candida species in 57.5% of patients and in no controls. They also showed that low-to-mild gut inflammation and augmented intestinal permeability were documented together with the presence of GI symptoms. Makes sense. Inflammation, intestinal permeability, and gut symptoms all here are functioning together. Totally makes sense.

And they also showed a significant linear correlation between their autism severity scores and calprotectin and Clostridium species in the gut. So the next thing that we would like to add to this is treatment of these imbalances showing improvement in autism. And we’re starting to see some evidence trickle in. I believe there was one probiotic study showing improvement in autism symptoms.

And I know there was one FMT (fecal microbiota transplant) where you take healthy donor stool and transplant that via an enema or similar route of administration to someone with autism. And they showed significant improvements in these autistic kids with an FMT. So we’re definitely showing imbalances and, more importantly, showing that treatment of those imbalances can lead to a clinical improvement.

Lubiprostone Improves Intestinal Permeability in Humans

All right, next study. “Lubiprostone”—also known as amitiza—“Improves Intestinal Permeability in Humans, a Novel Therapy for Leaky Gut: A Prospective Randomized Pilot Study in Healthy Volunteers.”

So what they did was a baseline test, then 14 days on non steroidal anti-inflammatories to induce leaky gut. And then they retested. Now, half of the group was given Amitiza. And the other half was given no treatment at all. Amitiza, again, is another way of saying lubiprostone.

Now, when they ran the test for leaky gut (it was the lactulose/mannitol test) after essentially 28 days of treatment, there was a significantly lower leaky gut score in the lubiprostone (aka Amitiza) group than in the untreated group. So they concluded that lubiprostone (or Amitiza) may improve leaky gut.

Now, this isn’t the best model because they induced damage with NSAIDs, and then they gave a drug to try to unwind that damage. But I’ve become much more open-minded looking at some of the research over the past several months of some of the medications for constipation. And conversations with Dr. Satish Rao and Dr. Lenny Weinstock have opened my eyes to this.

It’s certainly not where I would start for leaky gut, of course. But there does seem to be a subset of patients that may have other mechanisms underlying their constipation where drugs like lubiprostone or lubiprostone itself may be indicated.

I can’t recall if it was Weinstock or Rao who mentioned that lubiprostone seems to work better for older individuals. And I’m assuming “older,” he means geriatric, 65-ish or above. And for younger individuals, he likes Linzess (or linaclotide). So just some interesting findings there for lubiprostone, a medication in leaky gut.

Step-Up Empiric Elimination Diet for Eosinophilic Esophagitis

Now, here’s an interesting study. And gosh! There are a lot of details here, so bear with me. “Step-Up Empiric Elimination Diets for Pediatric and Adult Eosinophilic Esophagitis: The 2-4-6 Study.”

So EOE (or Eosinophilic Esophagitis) is essentially this: have you ever eaten something and felt like it got stuck in your throat? And you just feel like there’s something in your throat? Well, for most people, that’s not actually something in their throat. It’s some inflammation. And it’s the immune system causing irritation in that spot that makes it feel like there’s something there. But there’s actually nothing there other than residual inflammation that was initiated by the food that you ate.

So elimination diets can get rid of those foods causing the irritation and thus undue the eosinophilic esophagitis. And if you break down that name, that’s eosinophils (immune cells) in the esophagus.

So you’ve probably heard me talk about six-food and eight-food elimination diets. Well, they wanted to see what would happen if, instead of going all the way to six or eight elimination diets, we went to a two and then reevaluated. And for non-responsive patients, gave them a four-food elimination. And then for non-responsive patients, gave them a six.

So they started off with a two-food elimination. And that two-food included milk and gluten. And then after that, for people who were non responsive, they additionally had them restrict eggs and legumes. And then finally, for people who were still non responsive, they additionally eliminated nuts, fish, and seafood.

So what they showed was that the two-food elimination diet of just milk and gluten-containing foods achieved a 43% remission. So that’s not bad. And milk was the problematic food in 52% of patients. Gluten was the problematic food in 16% of patients. And both foods were the problem in 20% of patients.

Now, the remission rates for the four- and the six-food elimination diets brought us to 60 and then 79%. So of course, with the more foods that you reduce, the higher the likelihood of a response.

I think what these researchers wanted to do was see if they could potentially have higher compliance by giving people a lower barrier to entry. And this is something I think is very important for functional and natural and complementary and alternative medicine to keep in mind. If we want to reach and help more people, we can’t always be leading with the most overzealous recommendation.

“Oh, you have EOE? Autoimmune Paleo Diet!” For someone who’s not a health nut and not highly motivated, they’re going to go, “Pfft! I’m out of here. I’m not going to do this.” It’s too much for them. You’ve got to meet people where they are.

So in this case, 43% remission with the two-food. That’s not bad. It’s almost half of subjects. And then for those who don’t respond—and let’s see here. They had them—I’m trying to see here. I’m sorry. Bear with me for one moment. I believe that it was two weeks per diet. I could be wrong on that. This was a six week study total. So I’m assuming that each diet was given for two weeks. And then they were reevaluated.

So is two weeks on two foods that hard? And then adding in another two and then adding in another two? That seems very reasonable for me for trying to personalize and meet someone at a level of dietary intensity that it correspondent to their motivation level.

And so they continued that overall 90 essentially, 91% of responders had one or two food triggers. That, I think, is very significant. Over 90% of the subjects had one or two food triggers. So for something like EOE (eosinophilic esophagitis), you didn’t have to have someone go all the way to the extreme of a highly rigorous elimination of potential offending foods like an Autoimmune Paleo Diet. But you could rather have them start with two foods. Then add in two more, and then add in two more.

So this turns the whole argument upside down for the natural health community, because I think we like to go to, “Cut it all out! And then reintroduce.” But maybe we can come at this from a different perspective, at least for EOE. But I would think that the same rules would apply for some other conditions also.

And I should also continue that—and I’m sure the clinicians out there will be nodding their heads in agreement that sometimes you have a patient who can’t go full into the dietary recommendations that you want. So you say, “Okay, let’s start with a handful of these foods. Give it a week or two. See how you do. And then move on.”

So this ends up playing out sometimes in clinical practice in real life, because not everyone wants to go to this extreme. And this may not be a bad method to help people weed out the handful of foods that are a problem for them without having them cut out a drastic amount of foods from their diet to figure that out.

And they also continued that compared to the initial six-food elimination, a step-up strategy reduced endoscopic procedures and the diagnostic process time by 20%.

And they concluded that, “A two-food elimination diet achieves EOE remission in 43% of children and adults. A step-up approach identifies early a majority of responders to empiric diet with few food triggers, avoiding unnecessary diet restrictions, saving endoscopies, and shortening the diagnostic process.”

So clearly, I think there’s a deeper lesson embedded here, which is we don’t always have to go to the extreme and then reintroduce. For patients that are less motivated, we can just break this down into bite-sized chunks—couple foods, couple foods, couple foods. Reevaluate after a few weeks, and then personalize the diet from there.

Dr. Ruscio’s Resources

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

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

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

Calprotectin and Zonulin are Elevated on a Low-Carb Diet

Next study. “Calprotectin in Serum and Zonulin in Serum and Feces Are Elevated After Introduction of a Diet with Lower Carbohydrate Content and Higher Fiber, Fat, and Protein Contents.”

So calprotectin in serum tended to be increased after 12 weeks. Zonulin in serum and feces were elevated after 12 weeks and remained elevated in the serum after 28 weeks.

So why is this? This may run a little bit counter to some of what we talked about. This may indicate that for some people, a lower carb diet is not helpful. It may also be because of the higher fiber content of the diet, which can irritate some people. And like we’ve talked about, how a low FODMAP diet can lower leaky gut scores, it’s possible that a higher fiber diet was also inadvertently high FODMAP. And that may have provoked some of these leaky gut scores.

It may have also been because of poor quality fats and proteins if there were trans fats or not high quality protein. To tell you the truth, I didn’t take the time to dig too deeply into this study because I don’t feel like it’s really necessary. We don’t have to make diet that hard. We have a variety of diets that have all been shown to be helpful.

As long as we avoid major pitfalls like added sugar, trans fat, processed foods and we focus on fresh, whole foods, different people will do better on different spots on the spectrum. And we want to help people find where they may fall. And I wouldn’t get overly wrapped into what some of these lab markers say.

Subclinical Hypothyroidism and Risk of Miscarriage

Another study. “Patients with Subclinical Hypothyroidism Before 20 Weeks of Pregnancy Have a Higher Risk of Miscarriage: A Systematic Review with Meta-Analysis.”

So they conclude that subclinical hypothyroid is a risk factor for miscarriage in women before 20 weeks of pregnancy. And—important here, probably the most important—early treatment can reduce the miscarriage rate. We’ve talked about this in a recent video. Just important to make sure—and most women are probably having pretty routine thyroid evaluations.

And I’m assuming most of the monitoring physicians, your OB or whoever’s monitoring you, is going to be looking for this. But remember, if you have a TSH above 4.5 or I’m assuming most labs are going to be reporting that as a normal range. But if you have a flagged high TSH and you’re trying to get pregnant or you are pregnant, I would definitely speak with your doctor about getting on thyroid hormone, because that will reduce the rate of miscarriage.

Autoimmunity and Quality of Life in Patients with Hashimoto’s Thyroiditis

Another study here entitled, “Autoimmunity Affects Health-Related Quality of Life in Patients with Hashimoto’s Thyroiditis.” To quote, “Our study revealed that higher thyroid antibody levels were negatively correlated with life quality score.” So the higher the antibodies went, the worse someone felt from a quality of life perspective. “Thus, patients who had higher anti-TPO and anti-thyroglobulin [TG] levels had significantly lower quality of life domain scores. We believe that apart from hypothyroidism, a high antibody level was one of the contributing factors for the development of the Hashimoto’s-thyroiditis-associated symptoms leading to a lower quality of life.”

This should come as no surprise. We discussed this on the podcast before that antibodies do correlate with quality of life. My contention here is that the higher the antibodies go, the lower the quality of life goes. And it’s not something where if you have a low positive (meaning TPO antibodies, for example, shouldn’t be above—usually the cut off is 35), if you have a 200, that is not something to worry about, at least based upon the best evidence that’s available today.

Now, if you have a moderate-to-high elevation—something above 500 I consider a moderate elevation; something above 1000 I consider a high elevation—now that most likely is going to correlate with a lower quality of life score. And we should be acting to try to reduce the inflammation and autoimmunity that is driving that high level of TPO antibodies.

So the important takeaway, in my mind anyway, is that it’s not about if you’re positive or not positive. It’s not a light switch phenomenon. But rather, this is a gradient of risk. And if you’re low positive, below 500 probably a good benchmark, then you’re probably in pretty good shape.

This is important, unfortunately, because overtreatment for thyroid autoimmunity is fairly rampant. So this is another study that seems to be supporting my contention.

Risk Factors Associated with Meat, Fruit, and Vegetable Consumption

This is a great one actually. “Health Risk Factors Associated with Meat, Fruit, and Vegetable Consumption in Cohort Studies: A Comprehensive Meta-Analysis.” So this is going to give us a great summary as to what the literature says.

“Intake of red meat was positively associated with BMI, percentage of overweight and obese, low physical activity, and current and ever smoking status and inversely associated with percentage of non-smokers and highly physically active individuals.”

What does that mean? That means that people who have unhealthy habits may be more prone to eat red meat, which may mean—and you’ve probably caught this from me in the past—that when people try to vilify red meat, it may not be the red meat, but perhaps because people who are eating red meat are more prone to be a smoker and inactive.

And this may be because the dogma of health nutritional advice has been to reduce red meat and reduce fat. And so people who are trying to become healthier may be more inclined to start all these behaviors at once, meaning, “Okay, I’m John Johnson, and I’m trying to get healthy. And I’m just going to do what I’ve heard in the news and in the media and on TV and has been indoctrinated via societal dictates, which is cut fat, cut red meat, eat more fruits and vegetables, exercise, and stop smoking.”

That’s a pretty reasonable perspective. And a lot of that advice is right now. We just want to be careful not to throw the baby (the red meat) out with the bathwater (all the unhealthy practices that may accompany the red meat consumption).

And the study continues, “Intake of fruit and vegetables was positively associated with prevalence of non-smokers, high education, high physical activity. And similar results were found when examining fruit and vegetable consumption separately.”

So it’s important to bear this in mind, because—well, I’ll just read you their conclusion. “In conclusion, the distribution of health risk factors associated with high meat consumption may differ from those of lower consumers. So some of the differences may mediate, confound, or modify the relationship between diet and non-communicable disease risk.”

So essentially what they’re saying is some of what we think may be an association, where I don’t think the data here are great, but people try to pull from data showing that this population has a higher incidence of heart disease and they also have a higher incidence of red meat consumption. It’s very important to isolate for these other confounding variables like physical activity and smoking status, for example.

And in the book, I talk about this. And when you isolate these things out, you get a much more representative view for how the one item in question, in this case red meat, actually affects risk.

So in summary, a comprehensive meta-analysis that essentially has shown that people who eat red meat tend to have accompanying lifestyle choices that detract from one’s health—low physical activity and current smoking. And people who are eating less red meat typically tend to smoke less, be more educated, and be more physically active. So it’s important for us to keep in mind.

Effect of Probiotics on Body Weight and BMI

Effect of Probiotics on Body Weight and Body Mass Index: A Systematic Review and Meta-Analysis of Randomized, Controlled Trials.” 25 trials with 1931 participants were included in this meta-analysis. And you can probably guess without I’m going to say. They showed a significant reduction in body weight. However, the average amount of weight lost was 1.3 pounds. Now, they did find that a greater reduction in BMI was found with a multi-species probiotic. And for people taking probiotics over eight weeks and for the higher the BMI (or the more overweight someone was), the more the effect.

So you’ve probably heard me say in a number of places, and I’ll be reviewing this in the book also. Yes, probiotics can help with weight loss. Yes, people can market to you about a test and a product and what-have-you and make that claim. And that claim is technically true. However, there’s a difference between being statistically significant and being clinically meaningful.

1.3 pounds of weight loss—it’s something. But gosh! But I wouldn’t say it’s something that’s worth what may equate to a $400 stool test and a regime of probiotics and prebiotics personalized to that. You could just go out, go on a probiotic, try a prebiotic and a fiber supplement, and see how you do.

And if you add a probiotic, assuming that the effects are cumulative—meaning, you can get 1.3 pounds from a probiotic. You might be able to get 1.8 pounds from a prebiotic. So prebiotic and probiotic may a pound and a half each generally speaking. And you get another maybe pound and a half from fiber. If all those things are cumulative, then okay, now we’re getting somewhere somewhat significant. But we don’t know if they are cumulative.

So you may see some weight loss benefit from probiotics. But compared to the other benefits of probiotics, I would say we have the least impact of all the things that probiotics can help on metabolism, unfortunately.

The data for prebiotic supplementation for lowering blood sugar is probably the strongest out of all those. And I will elaborate on that in my book.

How Oxidative Stress, Inflammation, and Acetaminophen Exposure Affect Autism

Next study. “The Role of Oxidative Stress, Inflammation, and Acetaminophen Exposure from Birth to Early Childhood in the Induction of Autism.” To quote, “The use of acetaminophen in babies and young children may be more strongly associated with autism than its use during pregnancy, perhaps because of well-known deficiencies in the metabolic breakdown of pharmaceutical during early development.

“Thus, one explanation for the increased prevalence of autism is that increased exposure to acetaminophen, exacerbated by inflammation and oxidative stress, is neurotoxic in babies and small children. This view mandates extreme urgency in probing the long-term effects of acetaminophen in babies and the possibility that many cases of infantile autism may actually be induced by acetaminophen exposure shortly after birth.”

They don’t say any data that supports this. I would love it if they did. I think this is more of just a hypothesis that’s being shared. However, it’s very interesting. And I wanted to share it. Again, this is not a review showing this. But they’re suspicious of this association and calling for more research in this regard.

Effects of Probiotics in the Therapy of Ulcerative Colitis

And we have just a couple more left. “The Long-Term Effects of Probiotics in the Therapy of Ulcerative Colitis: A Clinical Study.” Essentially, they followed patients for two years. And they were trying to prevent a relapse of ulcerative colitis. And patients were treated with either mesalamine, which is a 5-ASA class anti-inflammatory drug, fairly safe in my opinion, or mesalamine plus probiotics. And this was in a group of 60 patients.

And they concluded that all patients treated with combined therapy showed better improvements compared to the controls. In particular, the beneficial effects of probiotics were evident even after two years of treatment.

So certainly, there is some evidence for probiotics helping IBD. Now, can they help all forms of IBD? No, the weakest data is probably for induction of remission in Crohn’s disease. However, if your gastroenterologist is telling you that probiotics have no place in the treatment or management of irritable bowel disease, that is just not true. It’s not what the data shows.

Esophageal Mucosal Integrity and Response to an Elemental Diet

Esophageal and Small Intestinal Mucosa Integrity in Eosinophilic Esophagitis and Response to an Elemental Diet.” So essentially, what they wanted to do was see what type of effect in leaky—I guess you would say in this case—leaky throat and leaky small intestine, or just the membrane integrity of the throat and the small intestine, was achieved from an elemental diet in patients with this eosinophilic esophagitis condition.

And essentially, what they showed is that an elemental diet restores esophageal integrity, which suggests that the elemental diet reduces allergen exposure. However, duodenal (or small intestinal) integrity did not benefit from the therapy and does not seem to be affected in EOE.

So this makes sense. If it’s a condition of the throat, it makes sense that the problem may be in the throat. Now, sometimes, yes, something in the gut can cause a problem somewhere else. In this case, what may be happening here—and I’m speculating here—but it may be more of a contact-type sensitivity, almost like some people can’t have certain things on their skin or they get a rash. So this may be kind of like a rash in the throat.

Now, you can make the argument that if you improve the function of your small intestine or your colon, the deeper realms of the gut, that would modulate the immune system and reduce this pseudo contact allergy of foods in the throat. Yeah, it’s a theory. But things in the body don’t always fit nice and neatly into these theoretical boxes.

So in this case, what this study anyway is showing is that by reducing exposure to allergens by eating an elemental diet, you can see an improvement in esophageal integrity. And the small intestine doesn’t seem to be highly involved in this process in particular. Moving on.

Effect of Probiotics on Immune Response to Influenza Vaccination

Effects of Probiotics and Prebiotics on Immune Response to Influenza Vaccination in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.” So they looked at 20 randomized control trials with a sample size of 1,979 patients.

I’ll conclude and then give you my summary. “This meta-analysis suggested that probiotics and prebiotics are effective in alleviating immunogenicity by influencing seroconversion and seroprotection rates in adults inoculated with influenza vaccine.”

So essentially, they’re saying that probiotics may be synergistic with the influenza vaccination. And that makes sense. Probiotics have been shown, at least I believe in some small number of studies to reduce the incidence and duration of upper respiratory tract infections and recovery from cold and flu.

So certainly, it makes sense that a probiotic that does that would work synergistically with a vaccination which is also supposed to potentiate that.

Now, whether or not you’re a fan or a proponent of vaccinations, that is another discussion. However, this is something if a patient presents to a doctor’s office and the patient is asking should they or should they not get a vaccination or just wants some information on vaccination, you can let them know that the probiotic that they may be taking, or by taking a probiotic, that may help the vaccination work more effectively.

All right, guys. That brings us through another edition of health news reviews. Thank you again for your support. And I will talk to you next time. Bye.

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