Iodine, Thyroid, Hashimoto’s, and Sleep Research Updates
The latest research findings in sleep apnea, subclinical hypothyroidism, mold toxicity, kidney disease, diabetes, and more
This podcast episode covers a wide range of research topics, inviting you to learn about the potential connections between:
- Iodine deficiency and hypothyroidism
- Vitamin D and erectile dysfunction
- Sleep apnea and anxiety and depression
- Subclinical hypothyroidism and bone health
- Low carb diets and kidney disease
- Omega 3s and blood pressure
- Mold exposure and fatigue
Tune in to hear what the research reveals.
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➕ Dr. Ruscio’s Notes
- Iodine Deficiency in Patients with Hypothyroidism: A Pilot Study
- 24 hypothyroid patients, 24 euthyroid patients
- Iodine deficiency was more common in the hypothyroid group compared to euthyroid group (54% vs 44%)
- However, there was NO correlation between iodine status and TSH level
- Subclinical Hypothyroidism and Cognitive Impairment
- 1,118 euthyroid patients, 283 subclinical hypothyroid (SCH) patients
- All >60 years old
- After 3 years, there was NO difference in cognitive function between the euthyroid and SCH group, even when SCH patients had a TSH >10 mIU/L
- Commentary: This study did NOT find an association between SCH and worse cognitive outcomes in an older patient population.
- 1,118 euthyroid patients, 283 subclinical hypothyroid (SCH) patients
- Bone geometry in older adults with subclinical hypothyroidism upon levothyroxine therapy: A nested study within a randomized placebo controlled trial
- 98 participants with subclinical hypothyroidism (≥65 years old), randomized to:
- Placebo
- Levothyroxine (LT4)
- After 1 year, both groups experienced loss of bone mass (-0.2% placebo vs -0.5% LT4)
- Commentary: Treating SCH did NOT improve bone mineral density. There was a slight trend in worsening of bone health in those treated with LT4.
- 98 participants with subclinical hypothyroidism (≥65 years old), randomized to:
- Uterine Fibroid Patients Reveal Alterations in the Gut Microbiome
- 42 uterine fibroid patients, 43 healthy controls
- Compared to healthy controls, those with fibroids had:
- Lower diversity of gut microbiome
- Increased pathogenic bacteria (Pseudomonas, Prevotella)
- Reduced normal bacteria (Bifidobacteria, Lactobacillus, Lactococcus)
- Commentary: Uterine fibroids may be associated with dysbiosis in the gut.
- Factors influencing the levothyroxine dose in the hormone replacement therapy of primary hypothyroidism in adults
- Aim: Narrative review to identify causes of elevated TSH despite adequate compliance with LT4 medication in hypothyroid patients
- Factors that can lower thyroid medication efficacy:
- Reduced stomach acid (H. pylori, PPI, antacids, autoimmune gastritis, gastric bypass)
- Leaky gut (Celiac disease, GI pathogen, lactose intolerance, etc)
- Malabsorption (ulcerative colitis, Celiac disease, autoimmune gastritis, etc)
- SIBO
- Hashimoto Thyroiditis, Anti-Parietal Cell Antibodies: Associations With Autoimmune Diseases and Malignancies
- 840 participants diagnosed with Hashimoto’s thyroiditis (HT) based on positive TPOabs and/or positive TgAbs
- Of those with HT, the prevalence of other autoimmune diseases was:
- 21% anti-parietal cell antibodies (APCA)
- 9.4% one or more organ-specific autoimmune disease
- E.g. type 1 diabetes, vitiligo, etc
- 7.3% systemic autoimmune disease
- E.g. SLE, Rheumatoid arthritis, Sjogren’s syndrome, etc
- Commentary: About 1 in 5 individuals with HT will have APCA antibodies.
- The effect of vitamin D replacement in patients with lower urinary tract complaint/erectile dysfunction resistant to Tadalafil 5 mg treatment: A pilot clinical study
- 84 patients with urinary symptoms/erectile dysfunction and low vitamin D, who did NOT respond to Tadalafil therapy (Cialis) alone
- All treated with Vitamin D (100,000 IU/week) + Tadalafil
- After 1 month, patients experienced improved:
- Erectile function score (+13.5)
- International Prostate Symptom Score (-6)
- Commentary: Improving vitamin D deficiency may improve urinary symptoms and erectile dysfunction.
- Effect of omega-3 and vitamin D co-supplementation on psychological distress in reproductive-aged women with pre-diabetes and hypovitaminosis D: A randomized controlled trial
- 168 women w/ low Vit D and pre-diabetes, randomized to 4 groups:
- Placebo
- Omega-3 (1 g/d)
- Vit D (50,000 IU every 2 weeks)
- Omega-3 + Vit D
- After 8 weeks of supplementation, the omega-3 + Vit D group had:
- Improved anxiety
- Improved depression
- Improved sleep quality
- Commentary: Omega-3 + Vit D supplementation improved depression, anxiety, and sleep in those w/ low baseline Vit D.
- 168 women w/ low Vit D and pre-diabetes, randomized to 4 groups:
- Antibiotic treatment during early childhood and risk of type 1 diabetes in children: A national birth cohort study
- Cross-sectional study, 75,615 mother-child dyads
- NO association between antibiotic exposure and risk of type 1 diabetes
- NO association seen w/ 1, 2, or 3 or more courses of antibiotics
- Commentary: This study failed to show an association between antibiotic exposure and T1D.
- Safety and efficacy of very low carbohydrate diet in patients with diabetic kidney disease-A randomized controlled trial
- 30 type 2 diabetic patients w/ kidney disease randomized to:
- Very low carb (<20g carbs/d)
- Or low protein, low salt diet
- After 12 weeks, the low carb group had:
- No change in serum creatinine
- More decrease in A1C (-1.3% vs -0.7%)
- More reduction in insulin dose (-39 IU vs +0 IU)
- Reduction in LDL-C
- Reduction in inflammatory markers (IL-6)
- More weight loss (-4.0 kg vs +0.2 kg)
- Commentary: This study demonstrated that a very low carb (e.g. ketogenic) and higher protein diet is both safe and can ameliorate glycemic abnormalities in those w/ kidney disease.
- 30 type 2 diabetic patients w/ kidney disease randomized to:
- Mandibular advancement devices in patients with severe OSAHS
- 271 severe sleep apnea patients treated with a mandibular advancement device (MAD)
- Treatment with MAD led to:
- Complete response in 19.3%
- >50% reduction in sleep apnea severity in 71%
- Sleep apnea/hypopnea index <15/h in 59%
- 9.6% patients discontinued therapy due to ineffectiveness and rarely intolerance
- Commentary: MAD led to significant improvements in severe sleep apnea patients with a high tolerability.
- The home environment in a nationwide sample of multi-family buildings in Sweden: associations with ocular, nasal, throat and dermal symptoms, headache, and fatigue among adults
- Cross-sectional study, 5,775 participants in Sweden
- Of all the participants:
- 8.3% had ocular symptoms
- 11.9% nasal symptoms
- 7.1% throat symptoms
- 11.9% dermal symptoms
- 8.5% headache
- 23.1% fatigue
- Risk factor for symptoms
- Buildings constructed from 1961-1985
- Mold and mold odor
- Building dampness
- Lack of mechanical ventilation system
- Tobacco smoke exposure
- Commentary: This observational study suggested a link between environmental toxicity and symptoms.
- Effect of continuous positive airway pressure on symptoms of anxiety and depression in patients with obstructive sleep apnea
- 468 sleep apnea patients who received CPAP therapy
- After an average of 5 weeks, anxiety and depression scores decreased (small effect size)
- Commentary: Treating sleep disordered breathing may improve mood imbalances.
- Quality of life in upper airway resistance syndrome
- Retrospective study of 888 sleep PSG studies
- 10.5% had upper airway resistance syndrome (UARS)
- 90.5% had sleep apnea
- Compared to 641 healthy controls
- UARS had 5.5x and OSA patients had 6.2x greater probability of having a low quality of life score (compared to the healthy controls)
- Commentary: Those w/ sleep disordered breathing are more likely to suffer from lower quality of life.
- Retrospective study of 888 sleep PSG studies
- Impact of CPAP treatment for obstructive sleep apnea on visceral adipose tissue: a meta-analysis of randomized controlled trials
- 5 studies, 160 sleep apnea patients
- CPAP therapy led to NO reduction in visceral fat content
- Efficacy of the New Generation of Devices for Positional Therapy for Patients With Positional Obstructive Sleep Apnea: A Systematic Review of the Literature and Meta-Analysis
- 3 prospective cohorts, 4 RCTs of patients w/ positional sleep apnea (apnea that is worse in a supine or prone position).
- Positional sleep devices:
- Reduced time slept in supine position by 84%
- Reduced AHI by 54% (-11.3 events/hour)
- Commentary: Given that 56-75% of OSA is influenced by body position, this remains as a very practical first-line therapy. Examples of positional sleep devices can be found here and here.
- The effects of vitamin D supplementation on prognosis in patients with mild obstructive sleep apnea syndrome
- 19 adults w/ obstructive sleep apnea (OSA)
- Given 50,000 IU Vit D per week
- After 8 weeks, there was less obstructive apneas and hypopneas
- Commentary: Vit D may have a favorable effect on OSA.
- Association between obstructive sleep apnea syndrome and nocturia: a meta-analysis
- 13 studies, 406 OSA patients and 9,518 controls
- OSA was associated with a higher rate of nocturia (RR 1.5)
- Commentary: Nocturia may be an associated symptom of sleep apnea.
- Correlation of Dyslipidemia and Inflammation With Obstructive Sleep Apnea Severity
- 328 patients with sleep apnea
- Compared to mild or moderate sleep apnea, severe sleep apnea was associated with:
- Metabolic syndrome
- Higher lipids
- Higher liver enzymes
- High inflammatory markers (CRP, ESR)
- Commentary: Severe sleep apnea may be a risk factor for poor metabolic health and increased inflammation.
- Prevalence of Obstructive Sleep Apnoea and Its Association With Atherosclerotic Plaques in a Cohort of Subjects With Mild-Moderate Cardiovascular Risk
- 966 patients with heart disease, all tested for sleep apnea
- 73% of these patients tested positive for sleep apnea
- Commentary: Sleep apnea was very common in those with heart disease.
- Effect of omega-3 fatty acids on premenstrual syndrome: A systematic review and meta-analysis
- 8 studies, 676 women with PMS
- Omega-3 fatty acid supplementation reduced the severity of PMS symptoms (large effect size)
- The effect of omega-3 supplementation was enhanced when used for 6 months
- Commentary: Omega 3 supplementation may improve PMS symptoms, likely by reducing inflammation.
- Omega-3 Polyunsaturated Fatty Acids Intake and Blood Pressure: A Dose-Response Meta-Analysis of Randomized Controlled Trials
- 71 RCTs, 4,973 individuals with high blood pressure randomized to:
- Control
- Omega 3 supplementation (2.8 g/day)
- Omega 3 supplementation led to a reduction in systolic blood pressure (-2.6 mm Hg)
- Commentary: Omega 3 supplementation leads to very minor reductions in blood pressure.
- 71 RCTs, 4,973 individuals with high blood pressure randomized to:
- Meta-Analysis of the Effect of Aerobic Training on Blood Pressure in Hypertensive Patients
- 14 studies, 1,027 patients randomized to control or aerobic exercise
- Compared to control, aerobic training reduced systolic blood pressure (-10 mm Hg)
- Commentary: Compared to the study above on fish oil, aerobic exercise is significantly more effective for those with high blood pressure.
- Alcohol as an independent risk factor for obstructive sleep apnea
- 688 sleep apnea patients, 108 healthy controls
- After adjusting for age, BMI and cardiovascular disease, alcohol consumption was associated with higher risk of:
- Sleep apnea (200% increase)
- Hypoxia (200% increase)
- Dietary inflammatory potential and the incidence of depression and anxiety: a meta-analysis
- 17 studies, 157,409 participants
- Eating an inflammatory diet led to a higher prevalence of:
- Anxiety (70% increase)
- Depression (50% increase)
- This association was more common in women than men
➕ Resources & Links
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Discussion
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