New Research on IBS, Probiotics, Selenium, Thyroid, and More

Intro:

Welcome to Dr. Ruscio radio, providing practical and science-based solutions to feeling your best. To stay up to date on the latest topics, as well as all of our prior episodes, make sure to subscribe in your podcast player. For weekly updates, visit DrRuscio.com. That’s D R R U S C I O dot com. The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking with your doctor. Now let’s head to the show.

DrMichaelRuscio:

Hey everyone. This is Dr. Ruscio. So if you’re hearing this announcement, it’s not going to be the same audio read. Every time you hear this announcement, the excerpt of the audio will be different. A lot of what I like to think I’m trying to bring to our audience to help keep them on the cutting edge is really a derivative of me staying plugged into the stream of research. I’d love to say that these ideas are all my own, but as you know, I’m constantly referencing different papers and those are crafting my position. So it’s really important to disclose that this stream of knowledge in large part informs the positions I take in the way that I practice. If you remember back, there’s been a few times on the podcast I’ve mentioned that one of the ways in which I’ve stayed abreast of new papers being published and therefore new findings, and therefore how I think about, talk about, and practice, has been via what’s known as a PubMed saved search.

DrMR:

So I’ve been honing this series of saved searches in PubMed for many years now. And what’s wonderful about this is it keeps me abreast of what’s going on. So you may also have heard me say that sums out to about an hour of reading every night, and over the past year, especially as things the Clinic have grown, I’m trying to, spend more time now focusing on clinician training, refining the model, teaching what I’ve learned, making sure that we are all really congealing together in the Clinic and operating more effectively as one than just me as a clinician by myself. With the various research initiatives that we’re piloting at the office, at the Clinic, at the Center, it’s been difficult to keep pace with that. And so I said to myself, “Self, what if I taught someone how to do that hour of reading every night?”

DrMR:

So I’ve spent a few months working with Gavin from our team, teaching him and kind of honing him that methodology. And I’m very excited to say that we’re making that available as a subscription through our FFMR. So the FFMR, The Future of Functional Medicine Review clinical newsletter. So this will be kind of the FFMR Plus, where once per week you will get a about a 10 page brief, but it’s very high-level and very summative. So a written brief of the best or the most impactful and relevant to functional medicine studies summarized very, very concisely, really only kind of one or two bullets, like what is the bottom line? We’re all busy clinicians; we’re busy people. There’s a time and a place where we’re really unpacking studies in more detail, but that’s different. This is, “I just need to keep my pulse on what’s going on. And then here’s a link if I want to learn more.”

DrMR:

So that five to seven hours of reading per week and then note taking is now done for me. And it’s been phenomenal by the way; it’s such a time save. And also Gavin will be doing a weekly audio read. So about 10 pages of text, summative high-level takes gosh, maybe 10 minutes to skim. And there’s also going to be a corresponding audio read, so that if you are busy, you can go through the audio and make a mental note. “Okay, there was an important study let’s say on TPO antibodies and their association to quality of life. There’s another study, let’s say this Danish cohort study following 400 patients that found that, once again, subclinical hypothyroidism did not show that patients had any additional symptoms than healthy controls. So even more reason why we shouldn’t be treating subclinical hypothyroidism.” And you could say, “Hmm, those two studies, I really want to know more about. I’ll open up the written brief when I have a moment and look at the short summary, grab the reference link for the abstract, what have you.”

DrMR:

So, you know, we’ll put a few of these out there with no fee required, and if it is something that you think would benefit you, I hope you will join and pay to subscribe to the FFMR. Only if it benefits you, but I can say for me, this has been a tremendous time save because there are important studies being published every week, and it’s important that clinicians be aware of these. It’s not easy to do; it takes time, so now here’s a way of doing this in much less time. So we’ll have a few of these that we’ll put out there just kind of for free with no subscription required. And Gavin here, will follow shortly with what we’re calling the FFMR Plus. So this is the Plus aspect, the research brief, the research updates. And please let me know what you think. Again, for me at least, and I am admittedly a nerd, this has been huge because it allows me to be brushing my teeth in the morning and going through the audio and saying, “Oh, okay, this one and that one are two studies that I really need to make note of, and what have you.” Okay, well, I hope you enjoy it. Please let me know what you think.

GavinGuard:

Hello. This is Gavin Guard with the Ruscio Institute and welcome to the FFMR Plus, keeping you on the cutting edge of clinical care in functional and integrative medicine. In today’s research digest, we cover the new European guidelines for managing IBS, selenium’s effect on thyroid markers, using probiotics to improve metabolic markers, and much, much more.

European Guidelines for IBS Management

GG:

So as I alluded to, our featured study for this week is titled “British Society of Gastroenterology Guidelines on the Management of Irritable Bowel Syndrome.” This is a set of recommendations put forward by a European gastroenterology group, and they came to the following conclusions. Number one, they do not recommend breath testing. Number two, they also do not recommend food sensitivity testing, such as IgG testing. They do recommend C-reactive protein, calprotectin, and celiac testing for a first-time workup for those with IBS. They suggest that a provider work the patient up for bile acid malabsorption if nocturnal diarrhea or a history of cholecystectomy is present. They endorse the low-FODMAP diet as first-line therapy.

GG:

They also endorse a trial of non-strain specific probiotics for up to 12 weeks before deciding benefit versus no benefit. I’ll say that one again, because it’s important. They do endorse a trial of non-strain specific probiotics for up to 12 weeks, or three months, before deciding benefit versus no benefit. They also endorse the use of peppermint oil for global symptoms. That is our featured study for this week.

GI Studies

GG:

Let’s move into our gastrointestinal studies. First one is “Anti-H. pylori Treatment Can Effectively Improve the Clinical Remission Rates of IBS.” This is a meta-analysis of 10 studies, including 650 patients with IBS of which about 50% had H. pylori infection. And through this meta-analysis, they noted that after H. pylori treatment, the IBS remission rates were dramatically increased in those with IBS, pointing us to the fact that H. pylori treatment may be beneficial for those with IBS.

GG:

Next study is “Delayed Gastric Emptying is Not Associated With Diagnosis of Small Intestinal Bacterial Overgrowth,” a study of 73 participants who underwent a gastric emptying study, as well as a culture of their small bowel to diagnose SIBO. Again, these participants went through a study to look at their gastric emptying time and small bowel culture. What they found was that there was no significant association between the diagnosis of SIBO and delayed gastric emptying. We do have to note here that gastric transit time may be different from small bowel transit time. But again, there is no difference between gastric emptying time and the diagnosis of SIBO.

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GG:

The next study is looking at probiotic supplementation and its effectiveness to improve metabolic markers. This is a meta-analysis in Type 2 diabetics with hypertension. A total of 13 studies and 800 participants over eight countries showed that probiotics had a statistically significant reduction in fasting blood sugar of one milligram per deciliter, insulin resistance of 0.4 points, total cholesterol of around 0.2 milligrams per deciliter, triglycerides of 0.2 milligrams per deciliter, systolic blood pressure of 5.6 millimeters of mercury, and diastolic blood pressure of 3.4 millimeters meters per mercury. These effects were more pronounced with multi-species strains of probiotics given for at least eight weeks. Again, pointing us to the benefit of non-strain specific multi-species of probiotics. However, we should not get statistically significant confusion with clinically significant given the lack of drastic change in these metabolic markers in this meta-analysis.

GG:

However, this next study is looking at somewhat of the same question in hypertensive women. It was a randomized triple-blind placebo-controlled trial of 40 women with hypertension, and after eight weeks, the probiotic group had a statistically and clinically significant improvement in various metabolic markers. For example, the probiotic group had reduced fasting glucose of around 10 milligrams per deciliter, reduced total cholesterol of around 24 milligrams per deciliter, increased HDL cholesterol of 6.5 milligrams per deciliter, reduced systolic blood pressure of around five millimeters of mercury, and improvement in autonomic function. It was a much greater improvement in these metabolic markers as compared to the previous meta-analysis.

GG:

The next study is the AGA Clinical Practice Update on SIBO. An expert review by three authors, including Dr. Pimentel, came to the consensus of the following points. Number one, SIBO is a lab abnormality. Number two, elevated folate and B12 deficiency can occur from SIBO. Again, high folate, B12 deficiency or low B12 can occur from SIBO. The management of SIBO should revolve around fixing the underlying cause. No surprise there. Number four, diarrhea, not bloating had the strongest association to SIBO. Again, diarrhea, but not bloating had the strongest association to SIBO. They noted that calprotectin has no utility for the diagnosis of SIBO, and they also made the cutoff of anything over 10^3 CFU per milliliter as being diagnosed for SIBO.

GG:

The next study is looking at the anti-microbial resistance in Australia for C. diff infections. They looked at a thousand C. diff strains collected over the course of three years. What the results showed were that all strains were susceptible to Flagyl, or metronidozole, Rifaximin and Augmentin. There was some resistance to the following antibiotics, for example, vancomycin around 6%, ceftriaxone around 20%, and clindamycin coming up with a resistance of 85%. Again, I want to note that this study was done in Australia and the susceptibility and resistance may change depending on locality.

GG:

The next study is “The Effect of Pro and Synbiotics on Postoperative Infections in Colorectal Cancer Patients.” This is a systematic review and meta-analysis of 19 studies, 2,000 participants. And compared with the control group, the probiotic and synbiotic had reduced total postoperative infections. So probiotics may be helpful in reducing postoperative infections, specifically, GI surgeries.

GG:

“Association of Diabetes and Dental Caries Among U.S. Adolescents and the NHANES Dataset.” The NHANES analysis is of 25 million U.S. adolescents. This showed that diabetic adolescents were more than twice as likely to experience dental caries or cavities compared to non-diabetic adolescents.

GG:

The last study in our GI section is titled “The Specific Carbohydrate Diet and Diet Modification as Induction Therapy for Pediatric Crohn’s Disease, a Randomized Diet-Controlled Trial.” As such, there’s 18 pediatric patients with Crohn’s disease, and they were randomized to the following groups. Number one, specific carbohydrate diet, number two, a modified specific carbohydrate diet, or number three, a whole food diet. And after 12 weeks, regardless of the group, the C-reactive protein levels reduced or improved in all three groups. As well, symptoms also improved in all groups. So, whole food diet, specific carbohydrate diet, and a modified specific carbohydrate diet all showed benefit in not only reducing CRP levels in those with Crohn’s disease, but also improving symptoms.

Thyroid and Hormone Studies

GG:

The next section is thyroid and hormones. The first study is titled, “The Correlation Between Selenium Levels and Autoimmune Thyroid Disease.” This is a systematic review of 17 studies, 2,000 participants with either Graves’ or Hashimoto’s disease. Selenium supplementation was associated with the following metrics: reduced free T3, reduced free T4, reduced TPO antibodies without a change in TSH or thyroglobulin antibodies. Again, selenium supplementation is associated with a reduction of free T3, free T4, TPO antibodies with no change in TSH or thyroglobulin antibodies.

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GG:

The next study is, “Metformin Does Not Improve Insulin Sensitivity Over a Hypocaloric Diet in Women with PCOS.” A systematic review of 12 studies showed that there was no benefit to adding metformin to a hypocaloric diet in terms of improving fasting glucose, insulin, or insulin resistance. Diet and lifestyle measures should be first-line for those with polycystic ovarian syndrome.

Auto-immunity Studies

GG:

Next section is auto-immunity. Our study here is looking at dietary intake of women with fibromyalgia. It showed that there was a lower fibromyalgia symptom score associated with higher intakes of the following nutrients: phosphorus, iron, zinc, B1, B6, folate, and vitamin C. Again, there’s this inverse relationship between fibromyalgia symptoms and the nutrient density of the following nutrients: phosphorus, iron, zinc, B1, B6, folate, and vitamin C.

Diet and Lifestyle Studies

GG:

Onto our diet and lifestyle studies. The first one is “Coffee Consumption and the Risk of All Cause and Cause-Specific Mortality in a Korean Population.” It had 170,000 Korean participants, and those who consumed more than three cups per day had a reduced risk of all-cause mortality, however, those who ingested less than three cups had a reduced risk of cardiovascular specific mortality.

GG:

The next study is looking at the effect of cadmium exposure and the risk of adverse pregnancy and birth outcomes. A review of 18 prospective studies showed that maternal cadmium exposure resulted in significant reduction in birth weight, reduction in head circumference, and increased blood and urine cadmium levels. Again, maternal toxin exposure, specifically cadmium exposure, is associated with some of these adverse pregnancy and birth outcomes.

GG:

The next study is, “The Effect of Curcumin and Zinc Co-supplementation on Glycemic Parameters in Overweight Pre-diabetic Subjects.” This is a randomized placebo-controlled trial of 84 participants given either 500 milligrams of curcumin, 30 milligrams of zinc, or both curcumin and zinc. There were no differences in physical activity or dietary intake throughout the length of the study, and only the zinc and the zinc plus curcumin group had a decrease in their BMI compared to the placebo. Again, only those who are taking zinc or zinc plus curcumin, not the curcumin only group, had a decreased BMI. However, all three groups, the curcumin group, the zinc group, and the zinc plus curcumin group, had improved fasting glucose, A1C, and insulin sensitivity compared to placebo.

GG:

“The Effect of Low-Salicylate Diet on Clinical and Inflammatory Markers.” This is looking at seven patients, again, just seven patients with Aspirin-exacerbated respiratory disease, randomized to either a high or low-salicylate diet for just one week, and then they crossed over to the other intervention. So let’s say Participant A started on a high-salicylate diet, then after one week, they crossed over to a low-salicylate diet and vice versa. What the results showed was that the low-salicylate group had no difference in urinary creatinine, salicylate, or leukotriene levels, however, the low-salicylate diet did lead to improvement of symptoms. Again, a low-salicylate diet did show improvement of symptoms regardless of lower urinary salicylate levels.

GG:

The next study showed that CPAP therapy reduced lipid oxidation in those with sleep apnea.

GG:

The next study here is looking at 1,000 sex and age matched cohorts of newly-diagnosed hip fractures. It showed that those in the highest quartile of protein intake had the lowest risk of hip fracture. And this was noted in a dose dependent manner in both men and women. So the more protein an individual ate, that was associated with a lower risk of hip fracture in the elderly.

GG:

The next study is looking at 250 Type 2 diabetics in a smoking cessation program. After three months, one third of them were able to quit successfully. In those who did complete smoking cessation, the researchers noted an improvement of the following metabolic markers, such as a decrease in fasting glucose of around 10 milligrams per deciliter, a decreased A1C of around 0.3%, reduced systolic and diastolic blood pressure, reduced total cholesterol of around eight milligrams per deciliter without a change in body weight. Again, smoking cessation is associated with improved cardio-metabolic markers independent of weight loss.

RuscioResources:

Hi, everyone. This is Dr. Ruscio. In case you need help, I wanted to quickly make you aware of what resources are available to you. If you go to DrRuscio.com/resources, you will see a few links you can click through for more. Firstly, there is the Clinic, which I’m immensely proud of. The fact that we deliver cost-effective simple, but highly-efficacious functional medicine. There’s also my book, Healthy Gut, Healthy You, which has been proven to allow those who have been unable to improve their health, even after seeing numerous doctors, to be able to help them finally feel better. There’s also our store where there’s a number of products like our elemental heal line, our probiotic line, and other gut supportive and health supportive supplements. Health coaching. We now offer health coaching. So if you’ve read the book or listened to a podcast like this one, or are reading about a product and you need some help with how or when to use or how to integrate with diet, we now offer health coaching to help you along your way. And then finally, if you’re a clinician, there is our clinicians newsletter, The Future of Functional Medicine Review, which I’m very proud to say, we’ve now had doctors who’ve read that newsletter find challenging cases in their practices, apply what we teach in the newsletter, and be able to help these patients who are otherwise considered challenging cases. Everything for these resources can be accessed through DrRuscio.com/resources. Alrighty, back to the show.

GG:

The next study is looking at the ability for quercetin, resveratrol, and berberine to act as xanthine oxidase inhibitors. The same mechanism of action as allopurinol, which may show a possible benefit in reducing uric acid and preventing gout attacks.

GG:

The next study is looking at the age old question, “Well, doc, what’s better? Brown rice or white rice?” And they’ve actually done a study on this. It’s a meta-analysis of 13 randomized controlled trials comparing brown versus white rice. It showed that brown rice may lower weight more, but had no more beneficial effect on lipid or glycemic markers as compared to white race. So if we have the choice, brown rice may be a little bit better for lowering body weight, but did not have any additional benefit in improving lipid or glycemic markers.

GG:

The next study is looking at a meta-analysis of 11 studies total examining the beneficial effect of forest bathing and various markers, such as improvement of cardiovascular system, the immune system, and mental health, especially in the areas of stress, depression, and anxiety. Again, it’s time in nature. Specifically, forest bathing may be beneficial for not only our cardiovascular and our immune system, but also our mental health, especially depression, stress and anxiety.

GG:

The next study is, “Treatment of Non-alcoholic Fatty Liver Disease with Intermittent Calorie Restriction or Low-Carb, High-Fat Diet.” This is a randomized control trial of 74 patients with fatty liver. They were randomized to standard of care, dietary advice, intermittent fasting, or a low-carb, high-fat diet. So they’re split up into three different groups: standard of care, intermittent fasting, or low-carb, high-fat diet. And after 12 weeks, the intermittent fasting group, this is where the participants ate two days of a very low calorie diet followed by five normal eating days, both the intermittent fasting group and the low-carb, high-fat diet had more percent weight loss and improved liver stiffness, compared to the standard of care dietary advice. Furthermore, the researchers noted that the intermittent fasting had improved levels of LDL cholesterol and tolerated the diet better than did the low-carb, high-fat diet group.

GG:

The last study here is looking at the question of, “Does more exercise equal more calories burned?” In other words, can you run marathons to eat Oreos? And the researchers measured total energy expenditure, or in other words, calories burned, using the doubly labeled water method. What they showed was a few things. Number one is that fat-free mass accounted for the number one determinant of calories burned. Again, fat-free mass, or muscle mass, was the number one determinant of how many calories an individual burned in a given day. Physical activity, on the other hand, was only accounted for around 7% of the variability of calories burned. So if you did not exercise much as compared to if you did exercise a lot, there’s only a 7% variability between those two scenarios. Interestingly, the amount of calories burned increased with increasing physical activity. Well, no surprise there. However, the amount of calories burned plateaued at an upper range of physical activity. In other words, the more you exercise does not necessarily mean more and more calories burned. The researchers do suggest that we should have patients pursue lean body mass increase, or muscle mass increase, in order to yield sustained results.

GG:

Okay, that is it for this week’s research digest. Dr. Ruscio and I hope you’re enjoying these briefings and that they’re helping you practice more efficacious, practical, and cost-effective functional and integrative medical care. Until next time.

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