Episodes 93 & 94
Probiotics
- Do topical vaginal probiotics improve genitourinary symptoms in pre/postmenopausal women?
- RCT: 70 pre/postmenopausal women received:
- Control
- Topical probiotics (Lactobacillus)
- After 1 month, topical probiotics led to:
- Improved genitourinary symptoms in ~70% (symptoms such as dryness, odor, incontinence, etc)
- Improved overactive bladder in 92%
- Reduced vaginal pathogenic bacteria
- Do probiotics improve complications of liver disease?
- Summary: 17 studies, participants with liver cirrhosis received:
- Placebo
- Standard treatment
- Probiotics (varied across studies, included Lactobacillus, Bifidobacterium, Streptococcus)
- Probiotics led to:
- 60% reduced incidence of hepatic encephalopathy
- Lower serum ammonia
- NO change in all-cause mortality
- Do probiotics improve labs associated with liver disease?
- RCT: 46 adults with liver disease (NASH) received:
- Placebo
- Probiotics (lacto/bifido)
- After 6 months, compared to placebo, probiotics did NOT improve:
- Liver enzymes (AST, ALT, GGT)
- A1c
- Insulin resistance
Efficacy of probiotics in the management of halitosis: a systematic review and meta-analysis.
- Do probiotics help with halitosis (bad breath)?
- Summary: 7 RCTs, participants with halitosis received:
- Placebo
- Probiotics (formulas varied across studies, included Lactobacillus, Streptococcus salivarius)
- Probiotics led to a reduction in mouth odor (medium effect size)
- Does Saccharomyces boulardii improve SIBO and IBS symptoms?
- Clinical Trial: 48 participants with SIBO and IBS-D received:
- Dietary advice
- S. boulardii + diet
- After 2 weeks, probiotics led to reduced:
- IBS symptom score (-134 S. boulardii vs -93 points diet)
- Diarrhea incidence (26% vs 48%)
- Hydrogen gas levels (-40% vs -30%)
- Note: Not a placebo-controlled study
- Does low grade bowel inflammation correlate with IBS-D symptoms in those with quiescent IBD?
- Observational study: 27 participants with quiescent Crohn’s disease
- IBS-D symptoms were present in 44% of Crohn’s disease patients
- Fecal calprotectin of 125 mg/kg or higher was associated with increased risk of IBS-D symptoms (73% sensitivity, 92% specificity)
- NO difference in intestinal permeability markers between symptomatic and asymptomatic IBD patients
- How do probiotics or prebiotics compare to dietary recommendations for weight loss?
- RCT: 45 obese participants treated with:
- Low carb + low calorie diet
- PREbiotics
- PRObiotics (bifidobacterium, lactobacillus + lactococcus + strep thermophilus)
- All 3 groups experienced a reduction in:
- Weight (-5.5 lb diet, -4 lb prebiotic, 3.7 lb probiotic)
- Depression
- Anxiety
- Stress
- PREbiotics led to the greatest reduction in:
- Insulin (-9 prebiotics vs – 4 probiotics vs -3 diet)
GI
- Do stress-reducing techniques improve IBS outcomes?
- 60 children with IBS received:
- Standard IBS treatment
- Breathing technique + meditation
- Compared to standard treatment, 3 weeks of the stress-reducing techniques improved:
- IBS symptom severity
- Quality of life
- Do SIBO patients have higher levels of negative emotions?
- 26 participants with SIBO, 24 healthy controls, assessed for mental health status
- Participants with SIBO were more likely to experience:
- Stress (large effect size)
- Anxiety (large effect size)
- Neuroticism (large effect size)
- Note: Do negative emotions/stress contribute to SIBO, or does dysbiosis contribute to negative emotions?
Thyroid & Hormones
- Does N-acetyl cysteine (NAC) improve hormonal imbalance in women with PCOS?
- Summary: 18 RCTs, 2,185 participants with PCOS received:
- Placebo
- NAC
- Treatment led to:
- Reduced total testosterone (-25 ng/dl)
- No effect on:
- Number of ovarian cysts
- Estrogen
- Progesterone
- LH/FSH
- Does magnesium supplementation improve PCOS?
- RCT: 62 women with PCOS received:
- Placebo
- Magnesium
- Magnesium did NOT improve
- Testosterone
- Hair growth (hirsutism)
- Sleep quality
- How often is combination therapy recommended to those on LT4 with normalized TSH, but persistent symptoms?
- Survey of 272 endocrinologists
- For hypothyroid patients with normal TSH on LT4, but have persistent symptoms, 40% of doctors said they would also recommend LT3 alongside LT4 (combination therapy)
- Authors conclusion: “Willingness to consider prescribing combined levothyroxine and liothyronine, for hypothyroid symptoms which persist despite normalized TSH, has increased in comparison to previous international surveys, despite inconsistent evidence of benefit.”
Diet & Lifestyle
- Does exercise improve clinical outcomes in women with fibromyalgia?
- RCT: 41 women with fibromyalgia received:
- Control (stretching)
- Aerobic exercise + stretching
- Strength training + stretching
- After 3 months, the aerobic and strength training groups experienced:
- Improved fibromyalgia severity in 81% of participants
- ~40% reduction in pain levels
- Improved depression
- Does resistance training improve mood in fibromyalgia?
- RCT: 28 women with fibromyalgia treated with:
- Low-intensity resistance training (2x/week)
- High-intensity resistance training (2x/week)
- After 2 months, there was NO benefit on mood
- Do exclusion diets for gut conditions increase the risk of an eating disorder?
- Observational study: 410 adults, 129 children with GI disorders
- History of elimination diets were associated with a 3x increased risk of developing a restrictive eating disorder (excessive restriction of food choices)
- Most common dietary elimination diets were:
- Dairy free (45%)
- Gluten free (36%)
- Does meditation improve stress and mental health?
- Summary: 10 studies, 958 college students, received:
- Control
- Mindfulness meditation (via various smartphone apps)
- Compared to control, meditation led to improved:
- Mindfulness (large effect size)
- Stress (small effect size)
- Anxiety (small effect size)
- Overall wellbeing (small effect size)
- No effect on depressive symptoms
- Is conservative treatment comparable to antidepressants in treating anxiety?
- RCT: 208 participants with anxiety, treated with:
- Antidepressants (SSRI)
- Mindfulness based stress reduction
- After 2 months, BOTH groups experienced reduced anxiety scores (moderate → mild)
- Dropout rates was greater in the medication group (0% mindfulness vs 8% drug
- Do ketamine infusions and a ketogenic diet improve disordered eating?
- 5 adults with a history of anorexia, currently struggling with persistent disordered eating thoughts, treated with:
- Ketogenic diet x1 month, followed by:
- Ketamine infusions (x 6 sessions)
- Treatment improved:
- Eating disorder symptoms
- Body image
- Note: Only 1 participant had relapsed at 4 months post-treatment
- Does vitamin D improve inflammatory markers in IBD?
- Summary: 15 studies on participants with IBD, treated with:
- Control
- Vitamin D
- Vitamin D led to improved inflammatory markers, including:
- C-reactive protein (-6.5 mg/L)
- Erythrocyte sedimentation rate (ESR) (-8 mm/h)
- Note: Greatest benefit seen at doses >2,000 IU for 3 months
- Is heavy metal exposure linked to osteoporosis?
- Meta-Analysis: 5 studies, 7,759 postmenopausal women assessed for urinary cadmium levels
- Increased risk of osteoporosis was associated with:
- High cadmium (2x increased risk)
- Low cadmium levels (1.9x increased risk)
- “The present study adds support to the evidence that environmental Cd exposure, even at low levels, is a risk factor for osteoporosis in postmenopausal women”
Episodes 95 & 96
Probiotics
- Do synbiotics improve IBS outcomes?
- RCT: 67 participants with IBS, received:
- Placebo
- Synbiotic (lactobacillus + prebiotic)
- After 1 month, synbiotics led to greater response rates for:
- Overall IBS symptoms (52% synbiotics vs 24% placebo)
- Abdominal pain (82% vs 59%)
- Psychological well-being (61% vs 26%)
- Synbiotics had NO effect on gas/bloating
- Note: Placebo groups had a relatively high response rate
- Do probiotics, prebiotics, and synbiotics improve cardiometabolic health in PCOS?
- Meta-analysis: 17 RCTs, 1,049 participants with PCOS, treated with:
- Control
- Probiotics, prebiotics, or synbiotics
- Probiotics, prebiotics and synbiotics all led to improved:
- Decreased fasting glucose (large effect)
- Total cholesterol (large effect)
- Triglycerides (large effect)
- LDL-C (large effect)
- Insulin (medium effect)
- Does long-term use of probiotics improve blood pressure in healthy and hypertensive populations?
- Meta-analysis: 26 RCTs, 1,624 normotensive and hypertensive participants received:
- Control
- Probiotics (varied across studies, included lactobacillus, bifidobacterium, s. Cerevisiae, enterococcus)
- After ≥ 2 months, probiotics led to a reduction in systolic blood pressure (-3.5 mmHg)
- Note: Important example of statistically significant vs effect size
- Do probiotics improve cognitive function in those with depression?
- RCT: 43 participants with major depression, received:
- Placebo
- Probiotic (lacto/bifido, Streptococcus thermophilus)
- After 1 month, probiotics led to:
- Improved short-term memory (medium effect)
- NO effect on Intermediate or long-term memory
- NO effect on BDNF levels
- Do probiotics reduce chemotherapy side effects?
- RCT: 100 post-surgical colon cancer patients on chemotherapy, treated with:
- Placebo
- Probiotics (lacto/bifido, soil-based)
- After 6 weeks, probiotics led to reduced chemotherapy side effects, such as:
- Diarrhea (16% probiotics vs 40% placebo)
- Constipation (8% vs 28%)
- Abdominal pain (6% vs 24%)
- Stool analysis showed:
- Normalization of chemotherapy-disturbed bacterial diversity
- Greater production of SCFAs
- Do probiotics improve vaginal dysbiosis and related symptoms?
- RCT: 76 women with vaginal dysbiosis, received:
- Placebo
- Oral probiotics (lactobacillus)
- After 3 months, compared to placebo, probiotics led to:
- Improved vaginal dysbiosis
- NO difference in symptoms, such as:
- Discharge
- Burning
- Dysuria
- Odor
GI
- Is fecal microbiota transplantation effective and safe for treating recurrent C. diff?
- Observational study: 13 older participants with recurrent C. diff infections
- Fecal microbiota transplantation led to an 85% success rate
- Success defined as: Diarrhea resolution in <72 hrs with no relapse at 2-months
- NO complications at 2-year follow-up
- Is fecal microbiota transplantation superior to traditional antibiotic therapy in C. diff and COVID-19 co-infection?
- Observational study: 86 participants with COVID-19 + C. diff coinfection, received:
- Control (antibiotics)
- FMT + antibiotics
- FMT plus antibiotics led to:
- Lower relapse rates (2% FMT vs 42.5% control)
- Resolved abdominal symptom (91% vs 18%)
- Reduced Inflammatory markers
- Does abdominal massage improve constipation?
- RCT: 40 older adults with constipation, received:
- Control (no treatment)
- Aromatherapy abdominal massage (ginger and lavender massaged on abdomen)
- After 1 month, aromatherapy massage led to improved:
- Stool consistency
- Constipation severity
The clinical value of breath ammonia determination in patients with irritable bowel syndrome.
- Does antibiotic treatment normalize symptoms in IBS patients with positive breath tests?
- Clinical trial: 80 participants with IBS, 40 healthy controls underwent lactulose and ammonia breath testing
- Baseline breath ammonia levels were elevated in IBS participants:
- IBS-D (20.8 ppm)
- IBS-C (10.4 ppm)
- Healthy Controls (5.2 ppm)
- Rifaxamin (1200mg) x 2 weeks led to reduced:
- IBS symptoms
- Ammonia levels
Thyroid & Hormones
- Are bioidentical hormones better than synthetic hormones?
- Systematic review: 74 studies that compared bioidentical vs synthetic estrogen or progesterone
- Compared to synthetic hormones, bioidentical hormones led to:
- Better outcomes for:
- Cognitive decline
- Fracture risk
- Similar or better risk profile for:
- Blood clots
- Cardiovascular events
- Breast cancer
- Better outcomes for:
- Bioidentical and synthetic progesterone were equally effective for preventing endometrial cancer
- Does inositol improve lab markers and clinical outcomes in PCOS?
- Meta-analysis: 26 RCTs, 1,691 women with PCOS, received:
- Control (placebo or metformin)
- Inositols (Including D-chiro-inositol, myoinositol, or both)
- Compared to placebo, inositols led to:
- 1.8x increased chance of normalized menstrual cycle
- Reduced total testosterone (-20 ng/dl)
- Reduced insulin levels
- Inositols were similarly effective to metformin for improving:
- Menstrual cycle
- Glucose regulation
- Total testosterone
- Inositol had lower side effects compared to metformin (7% vs. 53%)
- Does exposure to environmental plastics correlate with thyroid dysfunction?
- Observational study: 42 pregnant women with SCH, 84 euthyroid controls assessed for urinary phthalates
- Increased phthalates in the urine was associated with a ~76% increased risk of subclinical hypothyroidism
- Do lipid abnormalities increase the risk for developing hypothyroidism?
- Observational study: 1,665 participants with dyslipidemia, followed over 5 years
- Baseline dyslipidemia in women was associated with:
- 5.3x increased risk for severe subclinical hypothyroidism (TSH ≥10.0 mU/L) or overt hypothyroidism
- 2x increased risk for hypothyroidism (TSH >4.2)
- TSH levels spontaneously normalized in 45% of those who developed hypothyroidism
Diet & Lifestyle
- Do omega-3 fatty acids improve lipid levels in postmenopausal women?
- Meta-analysis: Postmenopausal women received:
- Control
- Omega-3 fatty acids
- Omega-3 fatty acids led to:
- Reduced triglycerides (-20 mg/dL)
- Increased LDL-C (+4.1 mg/dL)
- Increased HDL-C (+2.1 mg/d)
- NO effect on total cholesterol
- Note: Triglyceride reductions were greatest in doses ≥1 g/day and for a duration of ≤3 months.
- Do omega-3s improve liver function in those with liver disease?
- Umbrella meta-analysis: 8 studies, 6,561 participants with NAFLD
- Omega-3s led to improved:
- ALT (-6.2 IU/L)
- AST (-3.7 IU/L)
- GGT (-4.20 IU/L)
- Fatty infiltration
- Does exercise improve cognition in older adults?
- Meta-analysis: 10 RCTs, older participants with and without cognitive impairment, treated with:
- Control
- Aerobic exercise or resistance training
- BOTH types of exercise led to improved:
- Overall cognition
- Memory
- Reasoning skills
- Intelligence
- “This meta-analysis recommended that patients perform at least moderate-intensity aerobic exercise and resistance exercise on as many days as possible”
- Is fiber intake associated with better mental health outcomes?
- Meta-analysis: 18 observational studies, unknown # of participants
- For every 5 gram increase in total daily fiber intake, there was a 5% lower risk of depression
- Depression risk was lowest when fiber was consumed as:
- Vegetables (-27% reduced risk)
- Soluble Fiber (-20% reduced risk)
- Note: These are based on observational studies, so healthy-user bias may be contributing to the findings
- Does vitamin D protect against depression?
- Umbrella meta-analysis: 10 meta-analyses of RCTs, participants received:
- Placebo
- Vitamin D
- Vitamin D led to a reduction in depressive symptoms (small effect)
- Participants with low serum vitamin D were 60% more likely to have depression
- Do mind-body interventions improve clinical outcomes in those with long-COVID?
- RCT: 34 participants with long-COVID received:
- Control
- Guided meditation + color therapy (via Rebalance program)
- After 5 weeks, participants experienced improved:
- Physical fatigue (-13 points intervention vs -1 points control)
- Depression (-5 points vs -1 points)
- Anxiety (-4 points vs -1.5 points)
- Overall mood disturbance (-31 points vs -3.3 points)
- Sleep quality
- Cognitive function
- Musculoskeletal pain
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