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Health News, Updates On: Depression, Gluten & Heart Disease, Thyroid & Weight, Probiotics & IBS, and more…
Dr. Michael Ruscio: Hey, everyone. Welcome to Dr. Ruscio Radio. This is Dr. Ruscio. Let’s jump in to another episode of Health News Updates, where I bring you some of the most important and, hopefully, interesting published research with a brief summary and my interpretation; trying to keep everything as evidence-based and as non-biased as I can.
All right. So, actually, let me start with a quick side note. At the time that this publishes, this will probably be somewhat irrelevant. But we had quite a hiccup with interfacing between the Printing Press and Amazon. And this was a powerful lesson for me in patience, because both of these companies are huge juggernauts with multiple levels of bureaucracy. And so to fix one simple problem, which to me seemed like something that should have been fixed within a day or two tops, actually took a week and a half.
So I do apologize for the fact that many or pretty much all of the books that were pre-ordered, they should’ve shipped on February 15th. At the time of me recording this, it’s February 27th. And I’ve been told that we have it almost guaranteed that the books should be shipping on the 28th. But this has been a terrible process in terms of me and my team had been working on this, calling these companies, literally, multiple times a day, every day, since the 15th trying to resolve this.
So I know that if you ordered the book, you might be a little bit irritated. Trust me, I am super irritated myself. And this was just an unforeseen glitch that occurred, from what I’ve been told, midstream and a policy update. And we actually ended up getting the short end of the stick of the policy update. And things took quite a while to get sorted out.
The good news is that the books are fine. They’re all in good working order. And people who’ve read the e-books have already been giving us some nice feedback, which has been great to hear, because e-books don’t require any printing, of course, and so those all released immediately on the 15th of February.
But the print book, I do have a copy here in my hands. I think it looks great. I think it will be well worth the wait. And again, I do apologize. One of these things that despite all the efforts we made, there was just too many big companies with layers of bureaucracy involved for us to really fix this quickly. So I apologize. But I have been told that once this problem is fixed, we will never have it again.
And so, thank you for bearing with me. And I do hope that it will be worth the wait. And now, we can jump into the Health News Updates.
Thyroid Disease on Testicular Function
So the first study here is entitled, “Impact of thyroid disease on testicular function.” And you probably caught before the recommendation that I’ve made per what the research is recommending that for women with subclinical hypothyroidism, they should probably undergo thyroid hormone therapy or thyroid hormone replacement. And for women who’ve had miscarriages, they should be screened for subclinical hypothyroidism or true frank hypothyroidism because that can definitely impair fertility in women.
Now, this study found that there is a considerable amount of thyroid imbalances in men. And men may be harboring either overt or subclinical thyroid disease who are infertile. So what applies for men seems to also apply for women. And in case you’re not familiar with what subclinical hypothyroidism is, it is essentially when you have, according to the conventional lab ranges, the normal lab ranges, you have flagged high TSH with normal T4.
Now, we’ve discussed another technique that may be able to suss out when someone is subclinical hypothyroid according to their labs, but may actually be true hypothyroid. And this is by using a more advanced method of screening thyroid hormones, namely of screening the T4 and/or the T3 fractions.
Remember, the brain makes TSH. That signals the thyroid to produce T4 and T3. And T4 and T3 can be tested via what’s known as an immunoassay methodology. And most labs are going to use this right out of the gate because it’s better for public health screening perspective because it’s less expensive. And it does the job, probably, for most people.
However, there can be some confounding of the results in certain populations. Essentially, the more ill you are, the more probable it may be. And also, more medications you’re on, the more probable it may be that you may need to essentially filter out some confounding proteins in the blood that may throw off your results. And there have been a number of papers published that have supported this. And this process is known as the dialysis/liquid chromatography with mass spectrometry. It’s a tongue twister. So that method is also available at all of the big box labs. But it will sometimes show someone as being true hypothyroid when they previously only appeared to be subclinical hypothyroid. So, a couple notes there on thyroid at large and also this study on thyroid and testicular function.
Vitamin D Supplementation on Cardiovascular Disease
Okay. So the next study, “Effect of monthly high-dose vitamin D supplementation on cardiovascular disease in a vitamin D assessment study: a randomized clinical trial.” So, essentially, they wanted to see what would happen if they gave people vitamin D in terms of the ability to prevent cardiovascular disease. So a monthly high-dose vitamin D supplement was not found to prevent cardiovascular disease. And they continued that their study does not support the use of monthly vitamin D supplementation for the purposes of preventing cardiovascular disease. Oral vitamin D was given initially at 2000 IUs in one dose per month and then, later, 1000 IUs per month or placebo for a median of 3.3 years.
So if you’re a vitamin D advocate, that may be disheartening to you. However, remember that the knee-jerk argument is going to be that, well, if they’re given physiological doses every day, let’s say, 2000 IUs or 4000 IUs per day, there would be a better study outcome. Maybe. I don’t find the argument overly compelling. What I do find compelling is the fact that we do have a number of studies showing that regular sun exposure may reduce all-cause and cardiovascular mortality.
And we’ve reviewed a few of these studies, both in the newsletter—and also in our monthly clinical newsletter, we actually detailed three of these studies to-date that have been very good analyses of sun exposure and their impact on health. So there is evidence showing that a lifestyle modification of more time in the sun does seem to protect your heart and your overall chance of death.
Adding Oats to a Gluten-Free Diet
The next study, “Safety of adding oats to a gluten-free diet for patients with celiac disease: a systematic review and meta-analysis of clinical and observational studies.” So oats are purported to be bad for people with gluten sensitivity or celiac because they may either cross react or be contaminated with gluten. So this study wanted to assess that. And more importantly, this study, being a systematic review with meta-analysis, will give us a summary of what the available clinical and observational data show. This is a very heavy study in terms of it carries a lot of authoritative weight.
So, 433 studies were identified, 28 were eligible for analysis. And of these, six were randomized control trials and two were not randomized control trials for a total of 661 patients remaining in the studies or being summarized in the studies and their findings. In a systematic review with meta-analysis, we found no evidence that the addition of oats to a gluten-free diet affects symptoms; histology, meaning the health of the intestinal tissue; immunity; or, essentially, blood markers of patients with celiac disease. They do caution that there were a few studies and there were many endpoints with limited distribution of geography, so we could have better data here. But to the best data we have available, which is not bad—it’s not amazing, but it’s not bad—we see that the addition of oats to those with celiac disease does not seem to have any negative discernable effect.
Now, that’s important on the one hand. But we want to balance that out with not going to any extreme and always remembering to listen to your body. There are some people that may not do well on any type of grains. So what I would encourage you to do is not go to either extreme, not go to one extreme of saying, gluten and grains are the devil incarnate and no one should ever have any of them. But not also to go to the other extreme and say, well, gluten-free is a fad. It’s BS. It’s not necessary. And there’s no evidence to support it.
What I would recommend you do is take a trial of elimination. See how you feel. And then reintroduce and see if you feel better when you avoid grains, including oatmeal, or if you feel better or no different when you’re on them. And find what seems to be the effect for you and proceed in that way.
Vitamin D and Musculoskeletal Pain
The next study, “Is there really a relationship between serum vitamin D levels and musculoskeletal pain associated with statin or cholesterol lowering medication intake: a systematic review.”
In conclusion, this displays evidence suggesting a significant association between vitamin D levels in the blood and the presence of musculoskeletal pain in patients on statin therapy. So, they’re not showing causality here, necessarily. But they’re showing an association between low levels of vitamin D in the blood and musculoskeletal pain in those on statins.
Now, there’s a couple different ways to look at this and to interpret this. One could be that giving vitamin D therapy to those who are on statins and have musculoskeletal pain may help decrease their musculoskeletal pain. That’s one potential theory. And just as background, one of the documented side effects of statins is rhabdomyolysis or subclinical rhabdomyolysis, which essentially damages the muscle tissue and that can manifest as musculoskeletal pain.
Now, the other way to look at this or interpret this is that those who have low vitamin D may have a preexisting health impairment or disease activity or inflammatory activity that may be lowering their vitamin D. Because some of the research now, and I think the majority of the research, is positing that low vitamin D may more so be a marker of ill health than it is something that denotes a frank deficiency. Although, again, to play the other side of the card here or the coin here, you can make the remark that, from a lifestyle perspective, the majority of us are deficient in vitamin D with the sun being the predominant way of obtaining vitamin D.
So, there’s a couple different ways to look at this. I do not know offhand if vitamin D—I want to say, there has been a high-level study looking at vitamin D for musculoskeletal pain. I can’t recall what way this went. I want to actually say, and I could be wrong in this, that vitamin D supplementation has been shown to help with musculoskeletal pain in those who are in statins. But I’m not positive.
Now, do you need a lot of evidence to go on a reasonable dose of vitamin D and increase your sun exposure to the point to which you get your vitamin D levels to between 40 and 50? No. I don’t think so. It’s inexpensive, cheap, safe. So I would do that irrespective of if you have pain or not. But if you do have pain associated with your statin use, then this may be a therapy to consider.
Administration of the Lactobacillus Gasseri Strain
“The effects of administration of lactobacillus gasseri strain CP2305 on quality of life, clinical symptoms, and changes in gene expression in patients with irritable bowel syndrome.” The aim of this study was to clarify the effects of a Lactobacillus probiotic, Lactobacillus gasseri, which is one strain of Lactobacillus, on quality of life and clinical symptoms and the functional mechanisms that underlie those in patients with irritable bowel syndrome. Irritable bowel syndrome, typically manifests as abdominal pain and bloating and altered bowel function, meaning constipation, diarrhea, or an oscillation between the two.
So after the patients were administered this probiotic, this Lactobacillus gasseri, daily for 4 weeks, the IBS severity score was significantly improved compared to the placebo group. So more improvement compared to placebo. And this improvement was accompanied by a reduction in health-related worry and changes in the intestinal microbiota.
Interestingly, the expression of 23 genes was exhibited by the use of probiotic and were associated with improvements in IBS severity. So they conclude that the Lactobacillus gasseri CP2305 administration or probiotic is a potential candidate and therapeutic option for those with IBS. And they conclude or they continue that—and I will give you some commentary here in a moment—they conclude that, “Although probiotics have been proposed to benefit IBS patients, objective clinical evidence and elucidation of the functional mechanism remains insufficient.”
I don’t really agree with that. But potentially, mechanism, although we do have a decent amount of mechanism data regarding probiotics and we certainly have some nice clinical trials showing improvements in those with IBS. So I can appreciate cautious conservative language. But there does seem to be this reticence the research community regarding probiotics. So I’m not sure where all these comes from.
But, clearly, probiotics seem to be safe. They’re fairly inexpensive and they can certainly help in IBS. They’re not guaranteed to help, but they can definitely help.
And also, if you’re wondering about specific probiotics, I laid this out on the book in terms of simplifying all probiotics into three to four categories and in our clinic store or the store you can access through our website, you can see that different probiotic products that I recommend.
Long-term Response to Gluten-free Diet
“Long-term response to gluten-free diet as evidence for non-celiac wheat sensitivity in one third of patients with diarrhea-dominant and mixed-type irritable bowel syndrome.” Essentially, they are looking at the association between gluten-free diet and IBS. And there’s just one thing here in particular I wanted to bring to your attention, which is the expression of a commonly recommended gene marker, which is HLA-DQ2 and 8. So HLA-DQ2 and HLA-DQ8 are not useful as a diagnostic marker for wheat sensitivity or gluten sensitivity, so not celiac or for wheat or gluten sensitivity. And they continue that long-term adherence to a gluten-free diet is high and can sustain symptomatic improvements.
So they’re essentially showing that a gluten-free diet can help patients with IBS, which shouldn’t be a huge surprise. And that this gene marker, HLA-DQ2 and 8 was not useful. Now, essentially, the way this works is if you have HLA-DQ2 and 8 testing negative, your gene negative for risks for celiac, but you still may have non-celiac gluten sensitivity.
Now, we reviewed a paper in our clinician’s newsletter that essentially found that—and this was the study of, I believe, it was 1225 patients. And they found that the most common marker associated with non-celiac gluten sensitivity, I believe was found positive in approximately 60% of patients. I’m estimating there. But they found that anti-gliadin antibodies of the IgG fraction were the most commonly predictive or associated with non-celiac gluten sensitivity. So there may be a lab marker that can help with this. However, elimination and redirection is probably going to be the most practical way to get there.
So there are some circles that harp very heavily on doing the gene testing. I am open to the gene testing. But the gene testing seems to have utility for telling you if you are at risk for celiac. It does not diagnose celiac. You can have HLA-DQ2 and 8 positive gene testing and still not have celiac. But it puts you at risk for having celiac. If you do not have those genes, the probability of celiac is extremely low. However, you may have non-celiac gluten sensitivity. So you still want to consider that.
Low FODMAP Diet for IBS
Continuing on. “A systematic review: quality of trials on the symptomatic efforts of the low FODMAP diet for irritable bowel syndrome.” They state that the randomized clinical trials on the low FODMAP diet are characterized by a high-risk of bias. The diet has not been studied in a randomized controlled setting for more than six weeks. And trials examining the effects of the important reintroduction period are lacking. There is a risk that symptomatic effects reported in the trials are driven primarily by a placebo response.
Now, I do not agree with this. There has been at least one trial I know of. There may be more but I was able to find one—I don’t have the reference handy, so I apologize—that did used the low FODMAP diet for longer than six weeks. Also, I would agree that the placebo effect is important to be aware of. And I agree with being cautious and conservative. But this to me seems like it’s being overly cautious. This is a diet that has clearly shown to be helpful for many patients with not only IBS, but also IBD. So I interpret this cautious interpretation with caution myself, in the sense that, sure, we could have better evidence. However, I think this diet has clearly risen to be one of the better diets—one of the best diets to consider for those who have IBS. So we could have better data. But I don’t know if we need to be highly critical in potentially trying this diet in lieu of the evidence.
Fecal Microbiota Preparation
Next study, “Single delivery of a high-diversity fecal microbiota preparation by colonoscopy”—so this is where they are going to give a sick recipient a healthy donor stool as an FMT—Fecal Microbiota Transplant Therapy—is safe and effective in increasing microbial diversity in active ulcerative colitis. Now, why this study is important is because sometimes the recommendation, if someone has inflammatory bowel disease or ulcerative colitis being a subset of inflammatory bowel disease, they should not undergo the FMT until they are no longer in a flare.
And certainly, there may be some good logic there in their recommendation. And I would refer to someone who is a specialist in FMT to get the final take on that. However, this study challenges that. And they found that of the 20 patients enrolled in the study, seven patients or 35% achieved a clinical response within four weeks. Four patients, 20%, were in remission at week four. And two of these patients or 10% achieved mucosal healing. Three patients or 15% required escalation of their care. No serious events were reported. And microbiome analyses revealed that the low diversity of the recipients was significantly higher after they received the donor stool.
So if you have inflammatory bowel disease that has not responded to other front line therapies, FMT is something to consider. I would definitely recommend exhausting your other options first. And in my book, we give you a number of options that you can utilize to help you with this. In fact, one person, one reader with, I believe, specifically ulcerative colitis, already left us a very nice review on Amazon saying how helpful the book was for him.
So, certainly, there are other things you can do first with diet, like a low FODMAP diet with probiotics, with herbal anti-microbial, with elemental diets that can be used first, leaving FMT as a last resort. And I also frame it as such in the book. But it can definitely be helpful, FMT that is, for inflammatory bowel disease.
Hashimoto’s Thyroiditis and Thyroid Cancer
Okay. “Association between Hashimoto’s thyroiditis and thyroid cancer in 64,628 patients.” So we identified 36 studies, including 64,628 subjects published between 1995 and 2016 from 13 countries.
Conclusion: We report an association between Hashimoto’s thyroiditis and papillary thyroid cancer and between thyroid lymphoma. So Hashimoto’s was associated with both papillary thyroid cancer and thyroid lymphoma. But no association was found between follicular, medullary, and anaplastic thyroid cancer.
So this is important to understand. However, as I dug into this issue a little bit more deeply, we covered, I believe it was in January’s edition of The Clinical Newsletter, that current recommendations or current screening recommendations do not advise screening non-symptomatic patients for thyroid cancer.
So what constitutes a systematic patient? Well, I’ll give you the outline here or the guidelines. So these would qualify that you should consider a screening for thyroid cancer. And if you do not, then you may not want to undergo a screening for thyroid cancer. Because it’s been found that in non-symptomatic patients—and again, the definition of symptomatic to follow here in a moment—screening in those populations actually seems to have a slight increased risk. So it is not a good idea to screen a non-symptomatic patient.
Here’s what constitutes symptomatic patients. Persons who experienced hoarseness, pain, difficulty swallowing, or other throat symptoms, or persons who have lumps, swelling, or asymmetry of the neck, or other reasons for a neck examination. Persons at risk for thyroid cancer because of history of exposure to ionizing radiation, i.e., medical treatment or radiation fallout, particularly, persons with a diet low in iodine and inherent genetic syndrome associated with thyroid cancer. For example, familial adenomatous polyposis or a first-degree relative with a history of thyroid cancer.
So this is something that, as a patient, you probably not going to want to take this on alone. But what I recommend you do is leave this up to your clinician to qualify if you have history or presentation factors present that would dictate you should have the screening. What I would not do and what I hope does not happen is people start blindly saying, if you have normal thyroid function and no other symptoms but you have Hashimoto’s, that they demand a screening for thyroid cancer.”
Now, I pointed out that there is an association between the two. However, I tried to be very cautious. And I haven’t mandated that people—or haven’t recommended that people definitely get a thyroid cancer screening. What I have recommended is that people defer to the judgment of their endocrinologist to consider whether or not they should have a thyroid cancer screening, knowing that thyroid cancer is increased or risk is increased in those with Hashimoto’s. I brought that to people’s attention.
However, you have to know what you don’t know. And I was not familiar with the current guidelines in terms of thyroid cancer screening. Now that I have taken some time to familiarize myself with these, I see that you have to have certain symptoms or history or presentation that would make you considered symptomatic and, therefore, the thyroid cancer screening would make sense.
So, again, this is why I think this is very important not to speak on a topic or speak specifically on an issue that you haven’t taken time to look into. Because sometimes, what logic would suggest, in this case, logic would suggest that people with Hashimoto’s, thyroid autoimmunity, should be screened for thyroid cancer. However, it seems that if you’re asymptomatic, screening actually may increase your risk. So this is why it’s important to have knowledge on a topic and specific niches and nuances of a topic before commenting on them. And if you don’t, simply don’t comment. Something, I think, we can bring forward in all aspects of our lives.
Vitamin D in Children with Autism
Okay. “Randomized control trial of vitamin D supplementation in children with autism spectrum disorder.” Quoting, “This study is the first double blind, randomized control trial proving the efficacy of vitamin D3 in autism spectrum disorder patients. Depending on the parameters measured in the study, oral vitamin D supplementation may safely improve signs and symptoms of autism and could be recommended for children with autism. At this stage, this is a single randomized control trial with a small number of patients. And a great deal of additional wide-scale studies are needed to critically validate the efficacy of vitamin D in autism.
So there’s some limited early evidence showing that vitamin D supplementation may help with the symptoms associated with Autism. So it’s certainly something to try and something to consider.
FODMAPs and Patients with IBS
FODMAPs alter symptoms and metabolome of patients with IBS: a randomized controlled trial. And if you remember, a moment ago, there were some criticism of the evidence for the low FODMAP diet, yet here is a randomized control trial. So we performed a controlled, single blind study of patients with IBS, randomized to a low FODMAP diet or a high FODMAP diet for three weeks. But to their point, this was only a three-week trial.
Symptoms were assessed using the IBS symptom severity score. And the metabolome was evaluated using a lactulose breath test and metabolic profiling in urine using mass spectrometry.
And the results, the IBS signs and symptoms were reduced in the low FODMAP diet group but not in the high FODMAP diet group. No shocker there. Lactulose breath testing showed a minor decrease in hydrogen production in the low FODMAP group compared with the high FODMAP group. And metabolic profiling in the urine showed groups of patients with IBS differed significantly after a diet with three metabolites in particularly changing: Histamine, p-hydroxybenzoic acid, and azelaic acid. And Histamine is a measure of immune activation. And that was reduced eightfold in the low FODMAP diet group.
So in conclusion, IBS symptoms are linked to FODMAP content and associated with alterations in the metabolome. In subsets of patients, low FODMAP modulates histamine levels in the microbiota, both of which could alter symptoms.
So this is something that I spoke on at the Ancestral Health Symposium at my lecture there in 2017 that there may be more to a low FODMAP diet than just bacteria and gas pressure. But there may be this aspect of immune activation. And this study showed, amongst other things, some of those, being other things that is, an improvement in symptoms. There was an eightfold reduction in histamine.
So what may be happening there, I would theorize, is that the bacteria that are being partially starved by a low FODMAP diet may not be getting along well with the immune system. This is a theory I’ve had for a while. And I think we see a growing evidence supporting this. And it’s not the only mechanism underlying IBS. But that your gut immune system may not get along well or be well-calibrated to handle your gut bacteria.
So if you have normal or high normal levels of gut bacteria, even healthy gut bacteria, that may cause an anxiolytic effect, an irritation effect to the immune system, and cause the immune system to react with some histamine.
And so, by reducing the quantity of bacteria in the gut by reducing FODMAPs, which feed bacteria, you can reduce the amount of agitation to the immune system and, therefore, lower histamine. So it’s just my posit, my theory on this. But I certainly think that that may be one of the mechanisms that underlies this.
Probiotic Supplementation for H. Pylori
Okay. Moving on. “Efficacy of probiotics supplementation therapy for H. Pylori eradication: a meta-analysis of randomized controlled trials.” Thirteen randomized controlled trials involving 2306 patients were included in the analysis.
Conclusion: Probiotic supplementation during anti-H. pylori treatment—most mainly your antibiotics—may be effective for improving H. pylori eradication rates, minimizing the incidence of therapy-related adverse events—side effects—and alleviating most disease-related clinical symptoms.
So you’ve heard me say before that not taking a probiotic while taking an antibiotic is often times a mistake, because the probiotics are synergistic with the antibiotics. Here are some of that high-level meta-analysis data supporting that.
Root Canal Endotoxin Levels
Okay. “Increased root canal endotoxin levels are associated with chronic apical periodontitis, increased oxidative and nitrosative stress, major depression, severity of depression, and a lower quality of life.” So to quote, “Dental health and leaky teeth—kind of like leaky gut, leaky teeth—may be intimately linked to the etiology and course of depression, while significantly impacting quality of life.”
So oral health, definitely important. The first section of your gut is really your mouth. And if you want to learn more on oral health, we’ve had two dentists on: Dr. Mark Burhenne, that’s spelled B-U-R-H-E-N-N-E, if you want to look that up on our search box, and Dr. Steven Lin. Both talked about and both have books about oral health and how important that is for one’s overall health. So, definitely, taking steps to improve your oral health is important.
Remember also that sometimes—and this is one of the biggest things I took away from some of these interviews with these two dentists—is that—well two things. One, from Burhenne that I found very insightful and interesting was that, sometimes, sleep disordered breathing, partial sleep obstructions, sleep apnea, subclinical sleep apnea, or known differently as “sleep disordered breathing”, that can cause you to mouth breathe. Mouth breathing can throw off the pH in the mouth. That can alter the bacteria in the mouth, damage your gums, and can potentially cause leaky teeth or leaky gums. And then, that can have a wide range of negative health effects. One of the key things to pinpoint there is that if people have sleep disorders or they have impaired oral health, they may have a sleep disorder and not know about it that’s causing these changes that’s impairing their oral health. So that was one of the most interesting things.
Also, Dr. Steven Lin informed us—and this is probably less shocking to our audience—that one’s diet is massively important on their oral health. And it was originally nutrition and physical degeneration by Dr. Weston A. Price that really looked at this. Showing that when Westernized foods made their way into indigenous populations, the indigenous people that had pretty pristine oral health previously, now started to express degeneration in their oral cavity.
But, again, the one thing that I think is very important here is to make sure that if you have something like bleeding gums, receding gums, sensitive teeth, chronic gum infections or bleeding gums, or you’ve needed gum grafting or what have you, that you consider that there may be some sort of sleep or airway impairment that’s impacting your mouth negatively at night or being caused by being a mouth breather and that may be negatively affecting your teeth. But also, remember that sleep problems are fairly devastating for one’s overall health. So the mouth is really a look into the gut and, also, a look into your sleep health and hygiene.
Dr. Ruscio Resources
Hey, everyone. This is Dr. Ruscio. I quickly wanted to fill you in on the three main resources that are available to you in case you need help or would like to learn more. Of course, I see patients both via telemedicine, via Skype, and also at my physical practice in Walnut Creek, CA.
There is, of course, my book Healthy Gut, Healthy You, which gives you what I think is one of the best self-help protocols for optimizing your gut health and, of course, understanding why your gut is so important and so massively impactful on your overall health.
And then, finally, if you’re a clinician trying to learn more about my functional medicine approach, there is the Future of Functional Medicine Review which is a monthly newsletter which is a training tool to help sharpen clinical skills.
All of the information for all three of these is available at the url, DrRuscio.com/resources. And in case you’re on the go, that link is available in the description on all of your podcast players. Ok. Back to the show.
Toxin B Antibodies in Subtypes of IBS
Okay. “Assessment of anti-vinculin and anti-cytolethal distending toxin B antibodies in subtypes of irritable bowel syndrome.” So if you haven’t heard of this, there are two tests, anti-vinculin and anti-cytolethal or known as CdtB toxin antibodies, that may underlie IBS. And these have been pioneered and developed by Mark Pimentel. He’s a very notable gastroenterologist in IBS research. And I think, he’s done a terrific thing here, putting together one of the mechanisms that underlies IBS. And this has been developed into a test.
Now, the test was available through Commonwealth Laboratories known as IBSchek. I’m not sure what’s going on with that lab. But right now, that test is not available. At least to my knowledge, it’s not. But it has been taken up by Quest or a copycat version has essentially been taken up by Quest, and that’s known as IBSDetex.
So what they found, when looking at how this test applies to different subtypes of irritable bowel syndrome is they found that these two antibody tests—and I’m sorry, let me back up and just state that these blood markers, test for antibodies, that may underlie IBS or irritable bowel syndrome. And essentially, what may happen is after someone has traveler’s diarrhea or food poisoning or a gut infection, this may initiate an autoimmune process that damages the motility apparatus in the gut or the ability to keep food in the way to the gut at an appropriate pace. And when motility slows, that can foster bacterial overgrowth, like small intestine bacterial overgrowth.
So this testing may be useful in determining one of the underlying causes of irritable bowel syndrome. So they found that these antibodies—the positivity rates differed in different subtypes of IBS. So you have constipated IBS on the one end of the spectrum. You have diarrheal IBS on the other hand of the spectrum. And you have mixed type in the middle, which are people who kind of go back and forth between the two.
And they found that higher antibody levels and positivity rates of these antibodies in diarrheal and mixed-type IBS and lower levels of these antibodies in those with constipation type IBS. So these antibodies appear useful in the diagnosis of mixed-type IBS and diarrheal-type IBS but not in constipation-type IBS. And I have made this criticism or this remark before. It’s just caution, I should say. It’s not a criticism. It’s just being cautious and trying to use lab testing responsibly. And they continue that—their findings suggest that the constipated-type IBS pathophysiology may be distinct from subtypes of diarrheal and mixed IBS. And that’s important.
Now, it’s also important to remember that you can have constipation and not have IBS. And the simple way to sort through this is if you have abdominal pain and bloating or other like symptoms like indigestion, gas, and constipation, that suggests you may have IBS constipation. Now, if you just have constipation or if you had those IBS-like symptoms and you’ve been treating yourself or working with a doctor and now all you have is constipation, then you may not have IBS constipation. You may have non-IBS constipation, which can have other causes and other treatments. And we’ve talked about that on the podcast previously.
But I also want to point out some of the limits with some of these testing. And in the March edition of the Future of Functional Medicine Review, the March 2018 edition, I highlight a case study where the patient had positive Cdt antibodies, but it did not impact the case. Now, she did have diarrheal-type IBS. So she is one who we can say, “Well, wow, maybe we need to do a certain treatment for this.”
By the way, we don’t really know what the best treatment is for these antibodies. And that’s a different topic altogether. But what I want to point out is that this patient had SIBO previously. She also, when we worked her up, had positivity for these antibodies. And she had diarrheal-type IBS. However, her symptoms were not being caused by SIBO, because we did retest that. So the SIBO had not relapsed. But she was overusing bile, supplementing too much with bile. And bile is often times included in enzymes. Digestive enzyme formulas can be helpful. But too much bile can also cause diarrhea.
So it’s important not to always be doing more, more, more, more, more to try to help someone. But remember that, sometimes, less is more. And in this case, one of the things that we have patients do is a trial of coming off of all their supplements when they start working with me at the office. And you will sometimes see miraculous improvements.
Something else that I do is I try to partition the initiation of different therapies. So if someone has a reaction, you can pinpoint that. And through that process of listening to this patient’s responses, I was able to pick this out. It was not from any lab test, which is another reason why I caution against over utilization of lab testing. Because this is something that even the research literature does not recommend, using testing to support or modulate the dose of bile or to initiate that therapy but, rather, someone’s clinical presentation and response treatment.
And so, in this case, by making sure that we didn’t do too much at once and by listening to and monitoring patients step-by-step, we were able to pick out that it was actually bile that was causing the diarrhea. And that simple change of doing less and taking less stuff was able to allow her to have no more diarrhea and no more worry about SIBO and SIBO retesting and more SIBO treatment. And she’s since been able to broaden her diet also.
So remember that more is not always better. Sometimes, it’s a simple catch of something that’s a problem. Even if it’s something that’s meant to help, that’s a problem that can really be the difference of success and failure, clinically.
Gluten Consumption in Patients with Functional Dyspepsia
Okay. “Impact of gluten consumption in patients with functional dyspepsia: a case-control study.” Functional dyspepsia is another way of saying indigestion, so heartburn, reflux, feeling full, that kind of feeling.
Among patients with functional dyspepsia, gluten-rich foods may lead to symptom onset, specifically early satiety, so feeling full early and prolonged feeling of fullness. Intestinal epithelial barrier dysfunction—so kind of a leaky barrier in the upper intestinal tract—characterized by decreased claudin-1 expression and mucosal immune activation demonstrated by intraepithelial lymphocyte infiltration—so this just means you’re essentially having lymphocytes or white blood cells getting into the lining of the gut—may contribute to the pathogenesis of functional dyspepsia.
So, foods are one of the major factors that can stimulate the immune system. And that may underlie why some patients eating gluten-rich foods may have problems with indigestion. Now, it may be the gluten for some. It may be the FODMAPs for others. Because we have shown previously, even in this podcast, that FODMAPs seem to stimulate immune activation. And it may be both for others. So it’s not a bad idea to try to experiment and try to get a bit granular on, do you have to avoid all grains? Do you have to avoid just gluten? Do you have to avoid all FODMAPs? None of that is hard. You can figure that out with many experiments of usually a couple weeks each in duration.
Thyroid Function Variation
Okay. “Thyroid function variation in the normal range, energy expenditure, and body composition in thyroid hormone treated subjects.” Subjects with low-normal and high-normal TSH levels did not differ in any of the outcomes measured. So, energy expenditure and body composition didn’t differ between two groups. However, across the entire group, serum free T3 levels were directly correlated with resting energy expenditure, body mass index, body fat mass, visceral fat mass, with clinically relevant variation in these outcomes.
Their conclusion: Variations in thyroid function within laboratory reference ranges have clinically relevant correlations with resting energy expenditure, BMI, and body composition in thyroid hormone treated subjects, key point.
Okay. So, probably nothing surprising here. But there are a few important notes. So how do we account for this? Well, first, it’s important to understand that this in subjects who are being treated with thyroid hormone. And I do not think that these results apply or are necessarily ones that we can carry over to the lab analysis in a non-thyroid hormone treated individual.
Now, a few other thoughts. Healthier subjects could have had better conversion of T4 to T3. And therefore, better levels of T3. So it’s hard to say … is the level of T3 driving the health or is it the health driving the level of the T3?
Also remember that genetics can play a role here. There are differences in genetics that allow people to more aptly or less aptly convert their T4 into T3. In either case, a trial on a T4/T3 combination therapy or simply adding T3 to your T4. So if you’re on Synthroid or levothyroxine, adding in Cytomel; or just trying something like Nature Throid or Armour, instead of Synthroid or levothyroxine, a trial there, I think, is warranted. And we’ve covered studies in the past that show roughly 40% of patients prefer T4 plus T3, while only about 20% of patients prefer T4 alone. So, certainly, we see some evidence here supporting the need for T3. And I think that’s reasonable.
Now, I’m still not convinced that obsessing over the ratios is warranted. But it is something to look at in those who don’t fully respond to T4 alone. Now, there is a way that I think shows a lot of promise here to help get some granularity on this. And that’s using the more sensitive methodology of testing T4 and T3 I mentioned a moment ago. That’s the dialysis with liquid chromatography with mass spectrometry—I got it that time—because that will help to elucidate a more true value of T4 and T3. And the nice thing about this is, instead of having to use a narrower reference range, you can use a standard reference range, because you filtered out the confounding variables that would require you to offset the standard range by making it more narrow.
So I think there’s a lot of attractiveness to using this more narrowed range, because it takes some of the guess work out of it and it could get both the functional medicine community and the conventional medical community on the same page. So, that’s something I hope really takes off, because I think that could be a unifying piece rather than a dividing piece.
And those not being treated with thyroid hormone, I don’t think this applies, because conversion is not so much an issue because your body is not having to convert a foreign substance. You’re not intervening with a medicine that you need to make sure that that medicine can be converted. And so, I’m open if the right data is presented. But the question comes down to, okay, you’re a person who’s not truly hypothyroid or not subclinical hypothyroid. And you’re nitpicking their levels of T3 as being in the lower half of the reference range according to conventional testing. But what do you really do about that? Is something like selenium going to make a huge difference on all these parameters? Probably not.
I would recommend you go through the foundational factors of stress, sleep, and diet, which can all help to improve conversion by reducing thwarting factors like inflammation and problems with gut health. So that makes a lot of sense. But trying to cause or manipulate someone’s T3 levels with natural therapies, I think is a bit of a fool’s errand. Again, I’m open to it if the right evidence is there. But outside of using foundational factors like diet, lifestyle, and optimizing one’s gut health, and then maybe also looking at other areas that clearly needs some attention like a sleep disorder, like we mentioned earlier, or looking if they need some support for their female hormones.
Outside of those, I don’t think there’s really a lot that we can do to try to constantly bump up their T3. Especially when we look at certain studies like the—it’s essentially a Paleo lifestyle replication study that put people unto a Paleo diet and a Paleo lifestyle. And all of their markers, their anthropometric measures improved: Body composition, weight, well-being, waist circumference. All these measures improved yet their free T3 went down a little bit. So I don’t think the same rules apply to those being given a medicine as to those who have not been given a medicine. That’s the point I’m trying to make here.
So, certainly open to it. But coming back to this study and the main point that the study makes is that in those on T4 thyroid hormone medication, low T3 levels may be a problem. And so, what do you do about that? I’m sorry. They may be a problem and those problems may correlate with BMI, body mass, fat mass. And what you can do about that is consider the addition of T3 with their medication as well as trying to remove any thwarting factors that impair conversion. And that’s probably a pretty good way to come out on top. For those who are not on medication, I don’t think this has as much merit or as much bearing. But, again, open to if the right data were presented.
Adjunctive Nutraceuticals for Depression
Okay. “Adjunct nutraceuticals for depression: a systematic review and meta-analysis.” So positive results were found for the following compounds for depression: S-adenosylmethionine or SAMe for short, methylfolate, omega-3, vitamin D; and some positive effects for creatine, folinic acid, and amino acid combinations. Mixed results were found for zinc, folic acid, vitamin C, and tryptophan; and non-significant results for inositol. Fortunately, no major adverse effects were noted for any of the studies. And a further meta-analysis found that omega-3 versus placebo, omega-3 was effective. And conversely, another meta-analysis found that folic acid had a non-significant difference from placebo.
Gluten Consumption in Adults Without Celiac Disease
And our final study, “Long-term gluten consumption in adults without celiac disease and risk of coronary heart disease: a prospective cohort study.”
Conclusion: “Long-term dietary intake of gluten was not associated with a risk of coronary heart disease.” They continue, “however, the avoidance of gluten may result in reduced consumption of beneficial whole grains, which may affect cardiovascular risk. The promotion of gluten-free diets among people without celiac disease should not be encouraged.”
So I understand their perspective here in terms of not recommending a dietary restriction to a population that does not need it. But we want to be also sensitive to the population of non-celiac gluten sensitivity. And if you undergo a gluten elimination and then reintroduction in a non-biased way and you clearly identified that you feel better off gluten, then you are okay, in my opinion, to avoid gluten.
And as I talk about the book, we go through a copious review of dietary fiber intake and how that impacts different parameters of disease, including coronary heart disease. And the evidence clearly does not show that grain consumption is consistently associated with protection from heart disease. There are some data supporting. But there’s also an approximate equivalent amount of data showing no benefit from whole grain consumption and fiber consumption, in general, on coronary heart disease.
So if certain grains and fibers don’t work well for you, don’t be disheartened thinking that you need fiber and grains to prevent heart disease. The data does not really support that. And I think that’s just a bias that is slowly fading away. But is still there, nonetheless.
All right, folks, that is another episode of Health News Updates. Hope you enjoyed it. And I will talk to you guys next time.
What do you think? I would like to hear your thoughts or experience with this.
Dr. Ruscio is your leading functional and integrative doctor specializing in gut related disorders such as SIBO, leaky gut, Celiac, IBS and in thyroid disorders such as hypothyroid and hyperthyroid. For more information on how to become a patient, please contact our office. Serving the San Francisco bay area and distance patients via phone and Skype.