Research Briefs for Practitioners - April 2023 - Dr. Michael Ruscio, DC

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Future of Functional Health Review Clinical Newsletter

Research Briefs for Practitioners – April 2023

by the Ruscio Institute for Functional Health Clinical Team

Medically reviewed & fact checked by a
board-certified doctor
Medically reviewed & fact checked by a
board-certified doctor
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Episodes 93 & 94

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Evaluation of the efficacy of Lactobacillus-containing feminine hygiene products on vaginal microbiome and genitourinary symptoms in pre- and postmenopausal women: A pilot randomized controlled trial.

  • 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


Alterations of gut microbiome and effects of probiotic therapy in patients with liver cirrhosis: A systematic review and meta-analysis.

  • 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


Oral 24-week probiotics supplementation did not decrease cardiovascular risk markers in patients with biopsy proven NASH: A double-blind placebo-controlled randomized study.

  • 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)


Impact of Saccharomyces boulardii CNCM I-745 on bacterial overgrowth and composition of intestinal microbiota in IBS-D patients: results of a randomized pilot study

  • 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


Diarrhea-predominant Irritable Bowel Syndrome-like Symptoms in Patients With Quiescent Crohn’s Disease: Comprehensive Analysis of Clinical Features and Intestinal Environment Including the Gut Microbiome, Organic Acids, and Intestinal Permeability

  • 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


A clinical trial about effects of prebiotic and probiotic supplementation on weight loss, psychological profile and metabolic parameters in obese subjects.

  • 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)

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The effect of Benson relaxation technique on the severity of symptoms and quality of life in children with irritable bowel syndrome (IBS): a quasi-experimental study.

  • 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


Personality, Anxiety, and Stress in Patients with Small Intestine Bacterial Overgrowth Syndrome. The Polish Preliminary Study

  • 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?

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Thyroid & Hormones

The effects of N-acetylcysteine on ovulation and sex hormones profile in women with polycystic ovary syndrome: A systematic review and meta-analysis.

  • 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


Effect of magnesium supplementation in improving hyperandrogenism, hirsutism, and sleep quality in women with polycystic ovary syndrome: A randomized, placebo-controlled clinical trial.

  • Does magnesium supplementation improve PCOS?
  • RCT: 62 women with PCOS received:
    • Placebo
    • Magnesium 
  • Magnesium did NOT improve
    • Testosterone
    • Hair growth (hirsutism)
    • Sleep quality


Use of thyroid hormones in hypothyroid and euthyroid patients: A THESIS questionnaire survey of UK endocrinologists.

  • 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.”

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Diet & Lifestyle

Effects of different types of exercises on pain, quality of life, depression, and body composition in women with fibromyalgia: A three-arm, parallel-group, randomized trial.

  • 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 


Can different degrees of resistance training improve mood states in patients with fibromyalgia? A randomized controlled trial.

  • 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

History of trying exclusion diets and association with avoidant/restrictive food intake disorder in neurogastroenterology patients: A retrospective chart review.

  • 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%) 


Effects of Mobile Mindfulness Meditation on the Mental Health of University Students: Systematic Review and Meta-analysis.

  • 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 


Mindfulness-Based Stress Reduction vs Escitalopram for the Treatment of Adults With Anxiety Disorders: A Randomized Clinical Trial.

  • 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


Ketogenic diet and ketamine infusion treatment to target chronic persistent eating disorder psychopathology in anorexia nervosa: a pilot study.

  • 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


Vitamin D therapy in pediatric patients with inflammatory bowel disease: a systematic review and meta-analysis.

  • 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


Association between Environmental Cadmium Exposure and Osteoporosis Risk in Postmenopausal Women: A Systematic Review and Meta-Analysis.

  • 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”

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Episodes 95 & 96

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Efficacy of a Synbiotic Containing Lactobacillus paracasei DKGF1 and Opuntia humifusa in Elderly Patients with Irritable Bowel Syndrome: A Randomized, Double-Blind, Placebo-Controlled Trial.

  • 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


Effects of probiotics, prebiotics, and synbiotics on polycystic ovary syndrome: a systematic review and meta-analysis.

  • 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)


Long-term use of probiotics for the management of office and ambulatory blood pressure: A systematic review and meta-analysis of randomized, controlled trials.

  • 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


Effect of short-term, high-dose probiotic supplementation on cognition, related brain functions and BDNF in patients with depression: a secondary analysis of a randomized controlled trial.

  • 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


Postoperative Probiotics Administration Attenuates Gastrointestinal Complications and Gut Microbiota Dysbiosis Caused by Chemotherapy in Colorectal Cancer Patients.

  • 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


Efficacy and Safety of MED-01 Probiotics on Vaginal Health: A 12-Week, Multicenter, Randomized, Double-Blind, Placebo-Controlled Clinical Trial.

  • 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

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Faecal microbiota transplantation is a simple, effective and safe treatment in the management of C. difficile infection in daily clinical practice

  • 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 


Fecal Microbiota Transplantation in Patients Co-Infected with SARS-CoV2 and Clostridioides difficile.

  • 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


“Effects of abdominal massage applied with ginger and lavender oil for elderly with constipation: A randomized controlled trial”.

  • 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

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Thyroid & Hormones

Review of menopausal hormone therapy with estradiol and progesterone versus other estrogens and progestins.

  • 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
  • Bioidentical and synthetic progesterone were equally effective for preventing endometrial cancer


Inositol is an effective and safe treatment in polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trials.

  • 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%)


Associations between exposure to phthalates and subclinical hypothyroidism in pregnant women during early pregnancy: A pilot case-control study in China.

  • 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


Dyslipidemia Is a Risk Factor for Hypothyroidism in Women: A Longitudinal Cohort Study from South Korea

  • 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

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Diet & Lifestyle

Does Omega-3 Fatty Acid Supplementation Have Favorable Effects on the Lipid Profile in Postmenopausal Women? A Systematic Review and Dose-Response Meta-Analysis of Randomized Controlled Trials.

  • 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. 


Omega-3 Polyunsaturated Fatty Acids in the Treatment of Non-Alcoholic Fatty Liver Disease: An Umbrella Systematic Review and Meta-analysis.

  • 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


The Effects of Exercise for Cognitive Function in Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

  • 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


Dietary fiber intake, depression, and anxiety: a systematic review and meta-analysis of epidemiologic studies.

  • 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


Vitamin D protects against depression: Evidence from an umbrella meta-analysis on interventional and observational meta-analyses.

  • 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


Positive Impacts of a Four-Week Neuro-Meditation Program on Cognitive Function in Post-Acute Sequelae of COVID-19 Patients: A Randomized Controlled Trial.

  • 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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