- Clinical Outcomes After Discontinuation of Thyroid Hormone Replacement: A Systematic Review and Meta-Analysis
- 17 observational studies, 1,100 patients (86% women)
- Tapering regimens included:
- Discontinuing therapy within 2 weeks:
- First halving dose at week 1 and discontinuing the remaining dose at week 2
- Halving dose successively every 4 weeks until a dose ≤12.5 mcg/day was reached and therapy was then discontinued
- 25 mcg reductions until discontinuation
- Discontinuing therapy within 2 weeks:
- Results at median 5 year followup:
- 34.1% remained biochemically euthyroid after discontinuation of medication
- Subgroup analysis showed that patients with a previous diagnosis of overt hypothyroidism were less likely to remain euthyroid (11.8%)
- “A deprescribing framework focusing on adequate selection of patients for deprescribing LT4 and a systematic process is warranted to guide clinicians in re-evaluating the need for LT4 in their patients.”
- Commentary: Inappropriate use of thyroid medication is common and more studies are being conducted to bring more understanding to deprescribing unnecessary medication. Once thyroid hormone replacement is started, 90% w/ subclinical hypothyroidism will continue medication indefinitely. This is why it’s so important to correctly identify patients who truly need and don’t need thyroid replacement.
- The effectiveness of rotating versus single course antibiotics for small intestinal bacterial overgrowth
- 223 patients w/ diagnosed SIBO (glucose breath test)
- Randomized to:
- Single antibiotic (quinolone or azole)
- Rotating antibiotics (quinolone and azole, one after the other) for 10 consecutive days/month for 3 months
- After treatment, measured breath test, IBS score, and quality of life (QoL)
- After treatment:
- Remission higher in rotating antibiotic group (70% vs 51%)
- Remission associated w/ improved QoL and bloating
- Commentary: Treatment of SIBO using rotating antibiotics was more effective than treatment using a single course of antibiotic
- Probiotics for Celiac Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
- 6 RCTs, 5,300 participants
- Probiotics improved GI symptoms (-29%)
- Commentary: This meta-analysis gives proof-of-concept for probiotics in Celiac Disease
- Dental enamel defects and oral cavity manifestations in Asian patients with celiac disease
- 118 w/ Celiac disease (CD), 40 controls
- Those w/ CD has higher incidence of:
- Tooth enamel defects (67% vs 20%, OR 8.1)
- Recurrent aphthous ulcers
- Commentary: Highlights the importance of lower GI health on oral health
- Current status of fecal microbiota transplantation for irritable bowel syndrome
- Review 7 RCTs examining effect of FMT for IBS
- 4 of 7 studies showed positive effect
- 3 studies showed no effect
- Commentary: Majority of studies showed beneficial effect of FMT on IBS
- Empiric Versus Clarithromycin Resistance-Guided Therapy for Helicobacter pylori Based on Polymerase Chain Reaction Results in Patients with Gastric Neoplasms or Gastric Mucosa-Associated Lymphoid Tissue Lymphoma: A Randomized Controlled Trial
- 72 patients w/ confirmed H pylori colonization
- Randomized to either:
- Empiric triple therapy (esomeprazole, amoxicillin, and clarithromycin)
- Tailored therapy (esomeprazole, metronidazole, tetracycline, +/- bismuth) if clarithromycin resistant genes (via biopsy and PCR) present
- After 10 days treatment:
- Higher rate of eradication in tailored therapy (97% vs 82%)
- Commentary: Tailored H pylori therapy via PCR is an effective strategy in areas w/ high prevalence of clarithromycin resistance.
- Up-to-Date says “In the United States, given the limited information on antimicrobial resistance rates, we generally assume clarithromycin resistance rates are ≥15% unless local data indicate otherwise.”
- Be especially cautious of clarithromycin if a macrolide is used at any time in the past.
- Sleep disturbances in the irritable bowel syndrome and functional dyspepsia are independent of psychological distress: A population-based study of 1322 Australians
- Cross-sectional study, 1,300 participants
- Measured functional GI disorders (FGID)
- 10% had IBS
- 18% had functional dyspepsia
- Higher prevalence of sleep disorders in FGID vs controls (42% vs 32%)
- Greater sleep problem severity in those w/ FGID independent of other variables (age, sex, stress)
- OR 1.7 for IBS-D and IBS-M (not IBS-C)
- OR 1.8 for functional dyspepsia
- Commentary: Sleep disorders may be part of the gut-brain sequelae in those w/ FGID
- Probiotics for the Prevention of Antibiotic-associated Diarrhea in Adults: A Meta-Analysis of Randomized Placebo-Controlled Trials
- 36 studies, 9,600 participants
- Probiotics reduced the incidence of antibiotic-associated diarrhea (AAD) by 38%
- Protective effect seen despite:
- Reasons for antibiotics treatment
- Probiotic duration
- Probiotic dosage
- Time from antibiotic to probiotic
- Commentary: Probiotics are safe and effective for AAD regardless of type, timing, and dosages
- Daily, oral FMT for long-term maintenance therapy in ulcerative colitis: Results of a single-center, prospective, randomized pilot study
- 12 ulcerative colitis patients
- Received FMT via colonoscopy, then randomized to 12 weeks of:
- Encapsulated FMT
- Placebo
- 2 subjects in FMT group achieved clinical remission vs none in the placebo group
- NOT statistically significant
- Commentary: Low power study given low sample size
- Physical activity and quality of life of patients with inflammatory bowel disease
- Assessed association of physical activity (PA) and quality of life (QOL) in 158 IBD patients
- Increased PA levels were associated with improved QOL
- Clinical effects and gut microbiota changes of using probiotics, prebiotics or synbiotics in inflammatory bowel disease: A systematic review and meta-analysis
- 38 studies
- Probiotics, prebiotics and synbiotics can
- induce/maintain IBD’s remission (RR 1.13)
- reduce ulcerative colitis (UC) disease activity index
- Multiple strain probiotic has greater beneficial effect
- Adjunctive treatment with probiotics partially alleviates symptoms and reduces inflammation in patients with irritable bowel syndrome
- 45 IBS patients, randomized to standardized care + probiotics or no probiotics
- After 28 days, the probiotic group had:
- Lower IBS symptom score
- Lower IL-6 and TNF-α
- Long-term effects of increasing omega-3, omega-6 and total polyunsaturated fats on inflammatory bowel disease and markers of inflammation: A systematic review and meta-analysis of randomized controlled trials
- 83 RCTs, 42,000 participants
- Increasing omega-3 fatty acid intake associated with:
- Reduced risk of IBD relapse (RR 0.85)
- Decrease erythrocyte sedimentation rate
- The effect of cinnamon supplementation on glycemic control in women with polycystic ovary syndrome: A systematic review and meta-analysis
- 5 RCTs
- Cinnamon supplementation (1-6 g/d) improves insulin resistance (-0.84 HOMA-IR) in those w/ PCOS
- Relationship between serum total testosterone and prostate volume in aging men
- Examined relationship between serum testosterone and prostate volume
- 416 men over 51 yo, w/ NO prostate issues
- Men w/ low testosterone had significantly:
- Larger prostate volume
- Higher BMI
- Higher waist circumference
- Higher insulin
- Increasing volume of prostate over 4 years was associated w/ low testosterone
- There was a clear linear trend w/ lower testosterone and increasing prostate size
- Commentary: This study highlights the common misconception w/ higher testosterone and prostate size
- The impact of menopausal hormone therapy on overall mortality: A comprehensive review
- Review, 31 studies, 3 meta-analysis
- HRT leads to a significant reduction in all-cause mortality
- Greater benefit for women who:
- Initiate HRT soon after menopause
- Cardiovascular risk factors
- Commentary: High degree of heterogeneity of individual studies
- Low testosterone and cardiometabolic risks in a real-world study of US male firefighters
- Cross-sectional study, 300 firefighters
- Measured total testosterone (TT), categorized as:
- Low (< 264 ng/dL)
- Borderline (264-399 ng/dL)
- Reference (400-916 ng/dL)
- Risk factors for low TT:
- Fatty liver (OR 4.1)
- A1C >5.7% (OR 2.7)
- Triglycerides >150 mg/dL (OR 6.6)
- Commentary: This study highlights a few major points:
- Consider testosterone screening in those w/ obesity, cardiometabolic risk factors
- Low TT may be a result of poor glycemic control and insulin resistance
- Association of serum 25-hydroxyvitamin D with metabolic syndrome and type 2 diabetes: A one sample Mendelian randomization study
- Cross-sectional, mendelian randomization, 2,400 participants
- Examined 2 SNPs for Vit. D synthesis, 2 SNPs for Vit. D metabolism
- Those w/ Vit D deficiency had OR of:
- 1.52 for metabolic syndrome
- 1.54 for type 2 diabetes
- Commentary: This Mendelian randomization study suggests that independent of other confounding variables, Vit D deficiency has a causal role in metabolic syndrome and type 2 diabetes.
- Effects of low fructose diet on glycemic control, lipid profile and systemic inflammation in patients with type 2 diabetes: A single-blind randomized controlled trial
- 50 patients w/ type 2 diabetes (T2D)
- Randomized to:
- Standard diabetic diet
- Standard diabetic diet + low-fructose diet (e.g. limiting artificially sweetened beverages)
- After 8 weeks, low-fructose diet had:
- Lower fasting blood glucose
- Lower A1C
- Lower LDL-C
- Higher HDL-C
- Lower hs-CRP
- Long-Term Glucose Variability and Incident Cardiovascular Diseases and All-Cause Mortality Events in Subjects with and without Diabetes: Tehran Lipid and Glucose Study
- Is variability of fasting plasma glucose (FPG) associated with cardiovascular diseases (CVD) and all-cause mortality in individuals with and without type 2 diabetes (T2D)?
- 4,800 participants, measured glycemic markers at two subsequent visits a few years apart
- Long-term visit to visit of FPG is significantly associated with:
- Increased risk of CVD among participants without T2D
- All-cause mortality among participants with T2D
- Commentary: Long-term glucose variability is associated w/ higher CVD and all-cause mortality
- Flexible vs. rigid dieting in resistance-trained individuals seeking to optimize their physiques: A randomized controlled trial
- 23 healthy healthy males, performing resistance training
- Randomized to:
- Flex diet (meal template w/ general food groups)
- Rigid meal plan (with specific food recommendations)
- After 10 weeks:
- Similar loss of weight (-2.6 kg)
- Similar body fat % reduction (-2.4%)
- Commentary: Given that a flexible meal template allows for less restrictions, it may be the better option. Dr. Ruscio and our clinical team find the same thing with diets for gut health.
- A randomized controlled trial to isolate the effects of fasting and energy restriction on weight loss and metabolic health in lean adults
- 24 healthy adults
- Randomized to:
- Alternate day fasting (eat regularly x24 hrs, fast 24 hrs)
- Alternate day fasting w/ energy restriction
- Daily caloric restriction (eat a little less each day)
- Energy restriction groups matched for calories (75% of total calories eaten per day)
- After 3 weeks:
- Daily energy restriction lost almost all their weight from fat loss (-1.9 kg)
- Fasting w/ energy restriction had more lean mass loss than the daily energy restriction group (AKA more of their weight loss came from reduced muscle)
- No weight loss in fasting without energy restriction group
- Commentary: In this study, an alternate day fasting protocol lead to suboptimal loss of muscle mass compared to daily energy restriction
- Risk of atrial fibrillation in athletes: A systematic review and meta-analysis
- 13 studies
- Risk of developing AF was significantly higher in athletes than in non-athlete controls (OR: 2.46)
- Greater risk for:
- Mixed sport athletes compared to endurance
- Younger vs older athletes
- Commentary: Reminder that intense physical activity can increase risk of Afib
- Effect of the intake of dietary protein on insulin resistance in subjects with obesity: A randomized controlled clinical trial
- 80 obese participants w/ insulin resistance (HOMA-IR >2.5)
- Randomized to one of 4 groups:
- Normal animal protein diet
- Normal vegetable protein
- High animal protein
- High vegetable protein
- After 1 month, both high protein diets had:
- Better improvement in insulin sensitivity (60-90% improvement)
- Independent of weight loss
- Lower fat mass, increased muscle mass
- Lower triglycerides
- Lower CRP
- Better improvement in insulin sensitivity (60-90% improvement)
- Commentary: Consider higher protein diets for those with insulin resistance. It can improve insulin sensitivity independent of weight loss.
- Comparative effectiveness of levothyroxine, desiccated thyroid extract, and levothyroxine+Liothyronine in hypothyroidism
- Comparing the use of levothyroxine, desiccated thyroid hormone, and combined T4 + T3 therapy
- Prospective, randomized, double-blind, crossover study of 75 hypothyroid patients
- 61% had autoimmune thyroiditis
- Randomized to one of 3 groups and treated for 22 weeks in each group, then moved to other group for another 22 weeks:
- Levothyroxine (LT4)
- LT4+LT3 (combined)
- Desiccated thyroid extract (DTE)
- Measured thyroid symptom questionnaire, quality of life, memory, depression scores, treatment preference
- Results:
- TSH remained within reference range across all treatment arms
- NO differences for outcomes
- Except for a minor increase in heart rate caused by DTE
- NO treatment preference
- Of the 25 who were most symptomatic, combined therapy was preferred, had better thyroid symptom score, quality of life, and memory score
- Commentary: Overall, there wasn’t a big difference between the 3 groups. Those that remain symptomatic may benefit from combined therapy ONLY AFTER you have worked through the thyroid algorithm.
- Efficacy of a Multi-Strain Probiotic Formulation in Pediatric Populations: A Comprehensive Review of Clinical Studies
- 28 studies, pediatric population
- Beneficial effects of multistrain probiotics for:
- Diarrhea (12 studies)
- Immune system (8 studies)
- Reduced risk of infections (2 studies)
- Improved iron-deficiency anemia (3 studies)
- Commentary: Multi-strain probiotics are effective and SAFE in a pediatric population
- Association between physical activity and digestive-system cancer: An updated systematic review and meta-analysis
- 47 studies, 5.8 million participants, and 55,000 cancer cases
- High physical activity associated w/ reduced risk of:
- Overall GI cancers (RR 0.8)
- Colorectal cancer (RR 0.77)
- Gastric cancer (0.83)
- Pancreatic cancer (RR 0.85)
- Commentary: Basic lifestyle interventions like regular exercise are associated w/ decreased risk of major GI cancers.
- A non-viable probiotic in irritable bowel syndrome – a randomized, double-blind, placebo-controlled, multi-center study
- 30 multi-center site, 389 IBS patients
- Randomized to non-viable probiotic, or placebo
- After 26 weeks:
- Similar positive symptom response rate (17.4% probiotics, 14.4% placebo)
- Similar abdominal pain improvement (42% vs 35%)
- On further analysis, probiotics were found to have greater improvement on IBS-D subtype
- Association of Coffee and Caffeine Intake With Irritable Bowel Syndrome in Adults
- Cross-sectional study, 3,300 Iranian participants
- Coffee and caffeine consumption was associated with increased odds of IBS (OR:1.44)
- Association between periodontal disease and inflammatory bowel disease: A systematic review and meta-analysis
- 9 studies, 33,000 participants
- Periodontitis is associated w/ IBD (RR 2.78)
- Crohn’s Disease (RR 3.41)
- Ulcerative Colitis (RR 3.98)
- Commentary: Highlights systemic effects of oral health.
- Exposure Assessment of Multiple Mycotoxins and Cumulative Health Risk Assessment: A Biomonitoring-Based Study in the Yangtze River Delta, China
- Measured 23 urine mycotoxins in 227 Chinese adults
- 8 mycotoxins were detected in 110 urine samples
- Multiple mycotoxins co-occurred in 23% of urine samples
- Most common:
- Deoxynivalenol (DON)
- Fumonisin B1 (FB1)
- Zearalenone (ZEN)
- Methane positive small intestinal bacterial overgrowth in inflammatory bowel disease and irritable bowel syndrome: A systematic review and meta-analysis
- What is the prevalence of methane positive SIBO in IBS and IBD compared with controls?
- 17 studies assessing IBS, 1,600 IBS participants, 700 controls
- 7 studies assessing IBD, 600 IBD participants, 500 controls
- For IBS:
- Methane SIBO was NOT associated w/ overall IBS
- BUT, was significantly more prevalent in IBS-C compared to IBS-D (OR 3.1)
- Methane SIBO was NOT associated w/ overall IBS
- For IBD:
- Methane SIBO 3x higher in controls than IBD (24% vs 7%)
- Quality of evidence is low (due to heterogeneity)
- Commentary: Methane SIBO is associated with IBS-C and inversely associated w/ IBD.
- Frequency of Eosinophilic Esophagitis among Patients with Gastroesophageal Reflux Symptoms in an Academic Hospital of Bangladesh: A Cross Sectional Study
- What is the prevalence of eosinophilic esophagitis (EoE) in those w/ GERD?
- 133 patients w/ reflux
- 7 patients (5.3%) had EoE
- Nocturnal cough was a strong indicator of EoE
- Commentary: Although overall prevalence is low, EoE should be considered as a differential diagnosis in those w/ GERD
- Efficacy of stem cells therapy for Crohn’s fistula: A meta-analysis and systematic review
- 29 studies, 1,200 Crohn’s Disease patients
- Stem cell group had a higher rate of fistula healing compared to placebo group (62% vs 40%)
- Commentary: Stem cell therapy may be a promising last-line of therapy after you’ve exhausted all other therapies.
- The Effect of Lactobacillus Consumption on Human Blood Pressure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
- 18 studies
- Lactobacillus probiotics reduced systolic (-2.7 mmHg) and diastolic (-1.5 mmHg) blood pressure
- Greater effect seen in those w/ type 2 diabetes, Asian ethnicity, and borderline hypertension, supplementation >8 weeks
- Food avoidance and restriction in irritable bowel syndrome: Relevance for symptoms, quality of life and nutrient intake
- Cross-sectional study, 950 IBS patients
- Of the 13% reported severe food avoidance/restriction:
- Lower quality of life
- More anxiety/psychological symptoms
- Greater GI symptoms
- Lower total energy intake
- Lower protein and carb intake
- Commentary: Increased restriction around food is common in those w/ IBS and is associated with lower quality of life, more anxiety, and reduced nutrient intake
- Low-Dose Naltrexone Use for Patients with Chronic Regional Pain Syndrome: A Systematic Literature Review
- 29 studies
- Low-dose naltrexone treatment was associated with:
- Less chronic pain
- Less dystonia
- Improved sleep
- Commentary: LDN may be a promising therapy for those w/ chronic fatigue/chronic pain.
- The Effect of Psychological Interventions on the Quality of Life in Women with Fibromyalgia: A Systematic Review
- 16 studies
- Interventions: Cognitive behavioral therapy, counseling, hypnosis, meditation, music therapy, journaling
- 12 of 16 studies showed improvement in quality of life
- Commentary: Limbic retraining and other mind-body therapies are a promising tool for those w/ fibromyalgia and chronic fatigue/pain.
- Is there an association of cortisol, DHEA-S and cortisol/DHEA-S ratio with obesity and selected metabolic parameters?
- 91 obese, 50 healthy controls
- Measured morning cortisol, DHEA-S, and cortisol/DHEA-S ratio
- NO association was found between cortisol, DHEA-S, and BMI
- Commentary: Cortisol may not have a dramatic effect on body weight as one would like to believe.
- HbA1c is inversely associated with thyroid cysts in a euthyroid population: A cross-sectional study
- 1,700 euthyroid participants, 564 had thyroid cysts
- Higher A1C was associated with thyroid cysts
- Independent of thyroid related hormones (e.g. TSH) and cardiovascular risk factors
- Commentary: Worse glycemic control is associated with increased risk of thyroid cysts
- A systematic review and dose-response meta-analysis of exposure to environmental selenium and the risk of type 2 diabetes in nonexperimental studies
- It is known that high levels of selenium increases risk of type 2 diabetes (T2D)
- But, what is the relationship to the dose of selenium and this risk?
- 34 observational studies
- Majority of studies show higher levels of serum/urine selenium and increased risk of T2D
- Higher risk anything over an intake of 80 μg/day selenium
- Serum selenium of >160 μg/day corresponds to risk ratio of 1.96 (compared to 90 μg/day)
- Commentary: This is why we only supplement for selenium for a shorter period of time (3-6 months)
- Association Between Levothyroxine Treatment and Thyroid-Related Symptoms Among Adults Aged 80 Years and Older With Subclinical Hypothyroidism
- What’s the association of levothyroxine treatment for subclinical hypothyroidism (SCH) with quality of life (QoL) in adults over 80 years old?
- 250 adults 80+ yo w/ SCH, randomized to levothyroxine or placebo
- After 12 months of treatment:
- NO difference in QoL or fatigue between groups
- Commentary: Levothyroxine is not indicated in most w/ SCH, especially those who are elderly.
- Subclinical Thyroid Function and Cardiovascular Events in patients with Atrial Fibrillation
- 2,400 Afib patients >65 yo
- 8.4% had subclinical HYPOthyroidism, 2.3% had subclinical HYPERthyroidism
- Subclinical thyroid dysfunction was NOT associated w/ cardiovascular event at 2 year followup
- Low-carbohydrate diets lead to greater weight loss and better glucose homeostasis than exercise: A randomized clinical trial
- 45 participants, randomized to low carb diet (<50 g/d) or exercise (>30 min/d)
- After 3 weeks, low carb diet had:
- Larger weight loss (-3.6 vs 1.2 kg)
- Larger reduction in fat mass (-2.1 vs -1.25 kg)
- Larger reduction in waist circumference (-5.2 vs -3.5 cm)
- Greater increase in LDL-C
- Same amount of triglyceride reduction
- Comparison of human bone mineral densities in subjects on plant-based and omnivorous diets: A systematic review and meta-analysis
- Do vegetarians have a higher risk of osteoporosis and low bone mineral density (BMD) when compared to omnivores?
- 17 studies, 13,900 participants
- Those on vegetarian diets had the following compared to those on omnivorous diet:
- Lower lumbar spine BMD diets (- 0.04)
- Lower femoral neck BMD (- 0.04)
- Reduced whole-body BMD (- 0.03)
- Commentary: Vegetarian diets may be prone to nutrient deficiencies that can increase the risk of osteoporosis.
- Determining the effect size of aerobic exercise training on the standard lipid profile in sedentary adults with three or more metabolic syndrome factors: a systematic review and meta-analysis of randomised controlled trials
- 48 studies, 3,000 participants w/ metabolic syndrome
- Aerobic exercise of 12+ weeks lead to improvement in:
- Total cholesterol (-11 mg/dL)
- Triglycerides (-16 mg/dL)
- HDL-C (+3.9 mg/dL)
- LDL-C (-7.7 mg/dL)
- Commentary: Aerobic fitness can lead to clinically significant changes in cholesterol metrics.
- Do the combined blood pressure effects of exercise and antihypertensive medications add up to the sum of their parts? A systematic meta-review
- 12 RCTs, 13 meta-analysis, 29,000 physically inactive participants
- Exercise alone leads to greater blood pressure reductions than does medication alone
- Exercise + medication elicited BP reductions LESS than the sum of their parts
- Commentary: Combined BP effects of exercise and medications are not additive. Exercise leads to greater reductions than medications alone.
- A cohort study and meta-analysis of isolated diastolic hypertension: Searching for a threshold to guide treatment
- Is isolated diastolic hypertension (>80 mmHg diastolic but <130 mmHg systolic) associated w/ worse cardiovascular outcomes?
- 5,1000 participants 40+ years old, 7.5% had isolated diastolic hypertension (IDH)
- NO statistically significant associations with cardiovascular disease over 13 year followup
- Commentary: In this study, there were NO cardiovascular risks of IDH. Systolic blood pressure is more important to measure and manage.
- Effects of melatonin supplementation on diabetes: A systematic review and meta-analysis of randomized clinical trials
- 16 studies
- 9 of the 16 studies (56%) showed benefit of melatonin supplementation
- Significant improvement in:
- Fasting blood glucose (-4.6 mg/dL)
- A1C (-0.38%)
- Reduced insulin resistance (-0.58 HOMA-IR)
- Effects of whey protein and dietary fiber intake on insulin sensitivity, body composition, energy expenditure, blood pressure, and appetite in subjects with abdominal obesity
- Double-blinded placebo-control trial of 65 obese adults, randomized to:
- Whey protein (60g) + high fiber cereal
- Whey protein + low fiber cereal
- Maltodextrin + high fiber cereal
- Maltodextrin + low fiber cereal
- After 12 weeks:
- Whey protein groups had lower subjective ratings of hunger
- NO differences in insulin sensitivity, body composition, or blood pressure
- Double-blinded placebo-control trial of 65 obese adults, randomized to:
- Effects of dietary macronutrients on liver fat content in adults: A systematic review and meta-analysis of randomized controlled trials
- Do macronutrients have differing effects on liver fat development?
- 26 RCTs
- Replacing dietary fat w/ carbohydrates (low fat) did NOT result in changes in liver fat (12 studies)
- Replacing saturated fat w/ unsaturated fat REDUCED liver fat (4 studies)
- Replacing carbohydrates with protein (low carb) REDUCED liver fat (5 studies)
- Commentary: A higher protein (lower carb) and higher unsaturated fat (lower saturated fat) diet may have beneficial effects on liver fat content
- Systematic review with meta-analysis of partial enteral nutrition for the maintenance of remission in Crohn’s disease
- Can a partial elemental diet (part liquid elemental diet, part regular diet) help w/ Crohn’s disease (CD)?
- 8 prospective controlled studies, 429 CD patients
- Those receiving partial elemental diet had:
- Lower relapse at 2 year followup (RR 0.67, NNT=5)
- Higher frequency of remission (67% vs 48%)
- No increased side effect profile
- Commentary: This high quality review suggests that a partial elemental diet can be effective for those w/ CD and has a very low number needed to treat (NNT).
- Small Intestinal Bacterial Overgrowth in Functional Dyspepsia: A Systematic Review and Meta-Analysis
- Does SIBO play a role in functional dyspepsia?
- 7 studies, 260 patients w/ functional dyspepsia, 84 controls
- Patients w/ functional dyspepsia were 4.3x more likely to have SIBO compared to controls
- This finding was w/ high degree of heterogeneity (some studied were 4x more likely, some 8x more likely)
- SIBO prevalence in those w/ functional dyspepsia depended on type of test
- Lactulose: 53%
- Glucose: 17%
- Commentary: This meta-analysis suggests a modest association between SIBO and dyspepsia although the evidence is generally weak and largely depends on the type of SIBO breath test used to identify the prevalence rate.
- The effect of vitamin D on the occurrence and development of colorectal cancer: A systematic review and meta-analysis
- 21 studies, 900,000 participants
- Use of vitamin D was associated with a lower incidence of CRC (OR = 0.87)
- 4 studies examined survival rate of vit D users vs non-vit D users
- vitamin D potentially improved the long-term survival of CRC patients (HR = 0.91)
- Commentary: Vit D not only modestly lowers incidence of CRC but also improves survival in those w/ established CRC.
- New insights into the interactions between Blastocystis, the gut microbiota, and host immunity
- Narrative review of B. hominis in pathogenesis of GI disorders
- “Most reports indicate that Blastocystis is a common component of the healthy gut microbiome”
- Commentary: B. hominis may be a normal part of the microbiome and may NOT need to be eradicated in all patients.
- Dietary Practices of Women with Endometriosis: A Cross-Sectional Survey
- 480 women w/ endometriosis
- 44% used dietary management for symptoms
- Most common dietary strategies:
- Eliminate gluten
- Eliminate dairy
- Low FODMAP template
- Participants reported a 6.4/10 effectiveness score for reduction in pelvic pain with dietary changes
- NO difference in pain reduction between the various diets used
- Commentary: Dietary management of endometriosis seems to be an (moderately) effective strategy.
- Effect of multispecies probiotic on gut microbiota composition in individuals with intestinal constipation: A double-blind, placebo-controlled randomized trial
- 35 patients w/ constipation, randomized to multispecies probiotic or placebo
- After 30 days, probiotic group had:
- More complete bowel movements
- Less blockage sensation
- Commentary: Another piece of evidence for multispecies probiotics.
- Low FODMAP diet significantly improves IBS symptoms: An Irish retrospective cohort study
- 164 IBS patients, started on low FODMAP diet
- Baseline symptoms
- lethargy (92%)
- bloating (91%)
- flatulence (91%)
- abdominal pain (89%)
- At followup:
- Only 25% had continued low FODMAP diet at 12 months
- ALL symptoms improved to some degree at 3 months
- 66% satisfied w/ symptom control at 12 months
- After re-introduction of the high FODMAP foods, ALL patients maintained their symptomatic response
- The best symptom improvement was seen in those who were fully adherent to the FODMAP diet
- Is Bacillus coagulans supplementation plus low FODMAP diet superior to low FODMAP diet in irritable bowel syndrome management?
- 50 IBS patients, randomized to low FODMAP + placebo or low FODMAP + soil-based probiotic
- After 8 weeks:
- Improved symptoms and quality of life in both groups
- Low FODMAP + probiotic group had significantly better improvement in IBS symptom severity score
- Commentary: Probiotics can have a synergistic effect w/ dietary changes
- Use of probiotics in the treatment of functional abdominal pain in children-systematic review and meta-analysis
- 9 RCTs, 702 children, 506 with functional abdominal pain
- Looked at specific lactobacillus species (Lactobacillus rhamnosus GG and Lactobacillus reuteri)
- Probiotics led to reduced abdominal pain
- The placebo response rate in pharmacological trials in patients with irritable bowel syndrome: A systematic review and meta-analysis
- Published in Lancet
- 73 RCTs looking at IBS
- 27% of participants in placebo arm of IBS trials experienced positive response
- Commentary: This speaks to the psychological-gut axis. We should let go of confirmation bias when approaching positive results in IBS literature. In addition, consider limbic retraining in those who are “overly stressed” about their health.
- Effects of probiotics or broccoli supplementation on Helicobacter pylori eradication with standard clarithromycin-based triple therapy
- 183 patients w/ chronic gastritis from H pylori infection
- Randomized to one of 3 groups:
- Triple therapy (Proton Pump Inhibitor or PPI, clarithromycin, amoxicillin) alone
- Triple therapy + probiotics
- Triple therapy + sulforaphane
- Assessed H pylori eradication w/ urea breath test 4 weeks after completion
- Eradication rates similar between groups (all around 85%)
- Commentary: The triple therapy + probiotics group trended toward a slightly higher eradication rate (89%) but this did NOT reach statistical significance. This may be due to low sample size. Don’t avoid antibiotic treatment when indicated.
- Fecal Lactoferrin for Assessment of Inflammatory Bowel Disease Activity: A Systematic Review and Meta-Analysis
- How good of a marker is fecal lactoferrin for assessing IBD activity?
- 10 studies, 770 patients
- Fecal lactoferrin accuracy:
- Ulcerative colitis:
- Sensitivity: 81%
- Specificity: 82%
- Crohn’s disease:
- Sensitivity: 82%
- Specificity: 71%
- Ulcerative colitis:
- Commentary: Lactoferrin is a fair marker for assessing IBD activity and is more accurate in UC compared to CD.
- Efficacy of probiotics on stress in healthy volunteers: A systematic review and meta-analysis based on randomized controlled trials
- 7 studies, 1,100 participants
- Probiotics reduce the subjective stress level of healthy individuals
- NO effect on cortisol levels
- Commentary: Probiotics (and more generally, treating the gut) can improve stress parameters independent of changing cortisol levels.
- Effects of Proton Pump Inhibitors on Glycemic Control and Incident Diabetes: A Systematic Review and Meta-Analysis
- Do PPIs affect diabetes or onset of diabetes?
- 12 studies, 245,000 participants
- For those who already have diabetes, add-on PPI associated with reduced A1C (-0.36%) and fasting blood glucose (-10 mg/dL)
- NO reduction in risk of diabetes onset
- Commentary: PPIs may improve glycemic control w/ NO improvement in diabetes incident rates.
- Helicobacter Pylori Infection is Associated with Neurodegeneration in Cognitively Normal Men
- Cross-sectional study, 822 men received endoscopy (biopsy for H pylori) and brain MRI
- Men with H. pylori infection had overall brain cortical thinning (especially in the parietal and occipital lobes)
- This finding was independent of other biomarkers
- Commentary: Could gut disturbances play a role in neurodegeneration?
- Therapy with probiotics and synbiotics for polycystic ovarian syndrome: A systematic review and meta-analysis
- 9 RCT, 600 patients w/ PCOS
- Probiotic/synbiotic use was associated w/ significant improvement in:
- Fasting blood glucose
- Fasting insulin
- Insulin resistance
- BMI
- Testosterone
- hsCRP
- PCOS score
- Commentary: Dysbiosis plays a major role in PCOS pathogenesis. Correcting gut imbalances can lead to improvements in metabolic markers and symptom improvement in those w/ PCOS.
- Birth control pills and risk of hypothyroidism: A cross-sectional study of the National Health and Nutrition Examination Survey, 2007-2012
- NHANES analysis, 3,000 women w/ history of birth control, 2,000 controls
- Women who had history of birth control for more than 10 years use were 3.8x more likely to have hypothyroidism independent of other variables
- Vitamin D for treatment of non-alcoholic fatty liver disease detected by transient elastography: A randomized, double-blind, placebo-controlled trial
- 200 fatty liver patients, given vitamin D (1,000 IU) or placebo
- After 12 months, vitamin D group had:
- Improved liver steatosis (liver fat) scores
- Lower uric acid (-17.9 μmol/L)
- Lower GGT (-8.9 IU/L)
- Insulin resistance score
- Commentary: Vit D at lower doses may be effective therapy for fatty liver.
- Seasonal Variations in Sex Steroids in a Young Male Population and Their Relationship with Plasma Levels of Vitamin D
- Are there seasonal variations in sex steroids and Vit D in a healthy male population?
- 29 healthy males, median age 34 yo
- Seasonal variation was noted between winter and summer:
- Lower Vit D in winter (18 vs 38 ng/mL)
- Higher total testosterone in winter (500 vs 400 ng/dL)
- Lower Vit D associated w/ higher total testosterone (r= -0.27)
- Commentary: Make sure to standardize sex hormone testing as much as possible. This applies to men too (e.g. get first 8 am levels x2 before coming to any conclusions).
- Concomitant Use of Levothyroxine and Proton Pump Inhibitors in Patients with Primary Hypothyroidism: a Systematic Review
- 7 studies
- Concomitant use of both PPI and levothyroxine increases TSH levels
- Commentary: Highlights the gut-thyroid connection. Make sure to check possible drug interactions and the presence of hypochlorhydria.
- Effects of vitamin D supplementation on core symptoms, serum serotonin, and interleukin-6 in children with autism spectrum disorders: A randomized clinical trial
- 43 children w/ autism spectrum disorder (ASD)
- Randomized to vitamin D drop (300 IU/kg up to a maximum of 6000 IU daily) or placebo
- 86% had vit. D deficiency (<20 ng/mL)
- After 15 weeks, vit D group had significantly improved symptom scores compared to placebo
- Folic acid and vitamin B12 supplementation in subjects with type 2 diabetes mellitus: A multi-arm randomized controlled clinical trial
- 80 diabetic patients on oral anti-diabetic drug (e.g. Metformin), randomized to one of following groups:
- Add-on folic acid (5 mg/day)
- Add-on methylcobalamin (500 mcg/day)
- Add-on Folic acid (5 mg/day) + Methylcobalamin (500 mcg/day)
- No add on (control)
- After 8 weeks:
- A1C significantly improved in B12 (-1.2%) and folate + B12 groups (-1.5%)
- B12 and folate + B12 groups also had improvements in insulin, adiponectin, and insulin resistance
- No improvement in lipids
- Homocysteine lowered in all B vitamin supplementation groups
- Commentary: Add on supplementation of select B vitamins may improve blood glucose when added on to conventional diabetic medications.
- 80 diabetic patients on oral anti-diabetic drug (e.g. Metformin), randomized to one of following groups:
- Effect of exercise intervention on primary insomnia: A meta-analysis
- 23 trials, 1,200 participants
- Exercise intervention had a significant effect on the treatment of primary insomnia
- Effects were greater for:
- Older individuals (>60 years old)
- Exercise for at least 8 weeks
- Exercise <60 minutes
- Exercise <4x/wk
- Effects were greater for:
- Commentary: Exercise regimen of 60 min/day 4-5 times a week for 8-12 weeks can improve sleep quality and treat the symptoms of primary insomnia.
- Micronutrient supplementation needs more attention in patients with refractory epilepsy under ketogenic diet treatment
- 39 children/adolescents w/ epilepsy on ketogenic diet (KD)
- Performed 3 day food log before and after starting KD
- KD did not provide enough content of the following micronutrients in ALL patients:
- Folate
- Calcium
- Magnesium
- Impact of Silymarin in individuals with nonalcoholic fatty liver disease: A systematic review and meta-analysis
- Is silymarin (active part of milk thistle) effective for treating fatty liver?
- 9 RCTs
- Silymarin led to a statistically significant greater reduction in the levels of liver function tests (AST, ALT) compared to placebo, irrespective of weight loss.
- Commentary: Milk thistle can improve liver function tests independent of weight loss
- Effect of wearables on sleep in healthy individuals: A randomized crossover trial and validation study
- 32 healthy adults, randomized to one of the following then crossed over to other group
- 1 week sleep log alone
- 1 week sleep log + WHOOP strap (sleep tracker wearable)
- Sleep wearable improved nighttime sleep quality
- When compared to simultaneous polysomnography, low amount of errors for measuring:
- Sleep duration
- Deep sleep
- Respiratory rate
- Heart rate
- Commentary: In healthy people, wearables can improve sleep quality and accurately measure sleep and cardiorespiratory variables.
- 32 healthy adults, randomized to one of the following then crossed over to other group
- Association of dietary acid-base load and psychological disorders among Iranian women: A cross-sectional study
- Cross-sectional study of 450 females
- Measured depressive/anxiety scores and dietary acid load by calculating Potential Renal Acid Load (PRAL)
- PRAL includes intake of protein, phosphorous, potassium, calcium, and magnesium
- Association between higher dietary acid load and depression and anxiety
- Commentary: Mild subclinical acidosis may play a part of mood imbalances
- Randomized crossover trial of a modified ketogenic diet in Alzheimer’s disease
- 26 patients w/ Alzheimer’s
- Randomized to ketogenic diet (KD) or low fat standard diet (SD) for 12 weeks→ 10 week wash out period→ switched to different group
- 21 (81%) finished KD diet
- For those on KD:
- Patients achieved ketosis
- Improved quality of life
- Improved daily function
- Commentary: This is the first RCT of a ketogenic diet in those w/ Alzheimer’s disease that shows mostly positive results.
- Dietary Interventions and Nutritional Supplements for Heart Failure: A Systematic Appraisal and Evidence Map
- Review of 14 meta-analysis including 122 total RCTs, 177,000 participants, assessing 14 interventions for heart failure
- CoQ10 was associated with lower all-cause mortality (RR 0.69)
- Low-certainty of evidence
- Beneficial effect on left ventricular ejection fraction
- Thiamine
- Vitamin D
- Iron
- L-carnitine
- Consensus for the management of pancreatic exocrine insufficiency: UK practical guidelines
- Consensus statement for managing pancreatic exocrine insufficiency (EPI)
- Symptoms of EPI:
- Steatorrhea
- Weight Loss
- Diarrhea
- Abdominal Pain
- Bloating
- Consensus summary points:
- Associated conditions
- Diabetes (20% prevalence)
- Elderly (20% prevalence)
- Celiac (30% prevalence)
- IBS-D (9% prevalence)
- IBD (30% prevalence)
- Alcohol-related liver disease (20% prevalence)
- Fecal pancreatic elastase-1 can be 1st line test for EPI
- <200 µg/g = moderate EPI
- <100 µg/g = severe EPI
- A repeat test should be considered when a watery sample is reported by the laboratory
- Markers of malnutrition (clinical history, anthropometric measurements or serum micronutrient levels) can be used to support diagnosis of EPI:
- Magnesium (<2 mg/dL)
- Vitamin E
- Retinol-binding protein/vitamin A
- Vitamin D
- An abdominal CT scan should also be performed when EPI is diagnosed, especially to exclude a neoplastic cause
- Commentary: you may not need to do this if no known risk factors given low prevalence of malignant causes.
- Pancreatic enzyme replacement therapy (PERT) associated w/ improved survival, weight loss, quality of life, and nutritional status
- PERT should be started at a dose of at least 50,000 units lipase with meals and 25,000 units lipase with snacks
- patients should be encouraged to adjust their dose if this is ineffective
- No max dose but may have more side effects >100,000 units per meal (may even be safe in pregnancy)
- Consumption of pancreatic enzymes should be spread out throughout a meal
- A study examining the timing of PERT in 24 patients with chronic pancreatitis suggested that spreading the dose throughout the meal supported optimal absorption
- In those who cannot swallow pills
- Capsules can be opened and the contents taken on a spoonful of cold acidic food (fruit puree, apple sauce, jam or fruit yogurt) and swallowed immediately.
- Diet
- Avoid low-fat diets
- Can exacerbate malnutrition
- Low fiber diets are better (e.g. low FODMAP)
- Consider elemental diet
- Can use less PERT when taking elemental diet
- Avoid low-fat diets
- Differential Diagnosis
- Consider bile acid diarrhea in those non-responsive to PERT
- Associated conditions
- Psychobiotics for Patients with Chronic Gastrointestinal Disorders Having Anxiety or Depression Symptoms
- 83 patients w/ functional GI disorder and anxiety/depression
- Given multispecies probiotics x2 months, followed up after 1 and 2 months
- Probiotics lead to:
- Improved quality of life
- Less anxiety/depression scores
- <5% developed side effects
- Commentary: This study highlights the use of multistrain probiotics. You do NOT need to use a specific type of probiotic for a given condition.
- Long-term effects of fecal microbiota transplantation (FMT) in patients with irritable bowel syndrome
- 77 IBS patients who received FMT
- Response at 1-year mark:
- 30-gram dose
- 87% positive response
- 32% remission
- 60-gram dose
- 88% positive response
- 45% remission
- 30-gram dose
- Commentary: A higher dose FMT has a slightly higher remission rate.
- Mucosal biofilms are an endoscopic feature of irritable bowel syndrome and ulcerative colitis
- Presence of mucosal biofilms assessed in 1,4000 individuals receiving endoscopy
- Biofilms were present in:
- 57% of IBS
- 34% of ulcerative colitis (UC)
- 6% of controls
- Commentary: Biofilms are associated w/ IBS and IBD and could be part of pathogenesis of these diseases.
- Cumulative Effect of Psychological Alterations on Gastrointestinal Symptom Severity in Irritable Bowel Syndrome
- Is there a cumulative effect of psychological stressors/alterations in IBS?
- 106 patients w/ IBS, measured GI symptoms and “psychological alterations” (stressors/anxiety/depression/posttraumatic stress)
- Increased psychological alterations associated w/ more GI symptom severity
- Commentary: Limbic retraining can be a powerful tool for IBS and functional GI disorders
- Esophageal Hypervigilance and Symptom Specific Anxiety in Patients with Eosinophilic Esophagitis
- Retrospective study of 100 eosinophilic esophagitis (EoE) patients
- Measured EoE characteristics (e.g. endoscopy results) and anxiety scores
- 46% had hypervigilance and anxiety
- Esophageal symptom-specific anxiety was MOST IMPORTANT predictor of symptom severity
- Commentary: Another example of where limbic activation may be a contributing factor to symptoms.
- Probiotics treatment improves cognitive impairment in patients and animals: A systematic review and meta-analysis
- 7 human RCT, 11 animal studies
- Probiotics enhanced cognitive function in both human and animal studies
- Effects of probiotics on cognitively impaired individuals were greater than those on healthy ones
- Commentary: This study highlights the very important gut-brain axis
- A Randomized Open-Label Study of Two Methods of Proton Pump Inhibitors Discontinuation
- Is tapering better than abrupt discontinuation of PPI use?
- 38 patients w/ reflux randomized to abrupt discontinuation or slow taper
- NO difference between two groups at 12-month followup
- BUT taper group had less symptoms at 14, 18, 22, and 30 weeks after discontinuation
- Commentary: Gradual taper lead to less symptoms in the short-term and may be a better strategy to PPI discontinuation
- Utility of Routine Esophageal Biopsies in Patients With Refractory Reflux Symptoms
- 300 patients referred for endoscopy
- Only 4.7% met diagnostic criteria for eosinophilic esophagitis (EoE)
- Strongest risk factors for EoE:
- Dysphagia (trouble swallowing)
- Food bolus impaction
- Atopic disease history
- If patient does NOT have these symptoms, then risk of EoE diagnosis is 0%
- Commentary: It may not be necessary to receive endoscopy to diagnose EoE in the absence of these symptoms.
- Pharmacological and surgical interventions for the treatment of gastro-oesophageal reflux in adults and children with asthma
- To evaluate the effectiveness of GERD treatment in adults and children with asthma
- Cochrane review, 23 studies, 2,900 participants
- Medical treatment for GERD (e.g. PPI) might improve forced expiratory volume in one second (FEV₁) by a small amount and lower rescue medication use (-0.7 puffs per day)
- “It is important to note that these mean improvements did not reach clinical importance”
- Severe periodontitis is associated with the serum levels of hypersensitive C reactive protein and lipoprotein-associated phospholipase A2 in the patients of acute ischemic stroke
- 100 patients w/ ischemic stroke within 7 days
- 62% had severe periodontitis
- Of those that had periodontitis, there was higher levels of:
- CRP
- Lp-PLA2
- Commentary: Oral health can have a profound impact on systemic inflammation and cardiovascular health.
- An oral health optimized diet reduces the load of potential cariogenic and periodontal bacterial species in the supragingival oral plaque: A randomized controlled pilot study
- 14 participants, 5 controls, 9 went on “healthy diet” (less processed carbs, more omega-3 fatty acids, fiber, Vit. C/D, and antioxidants)
- After 4 weeks, the healthy diet participants had:
- Reduced oral dysbiosis (as measured by plaque bacterial counts)
- Commentary: Dietary habits can impact oral health.
- Probiotics Contribute to Glycemic Control in Patients with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis
- 28 RCT, 2,000 participants
- Compared to placebo, probiotics:
- Reduced fasting blood glucose (-13 mg/dL short-term, -3 mg/dL long-term)
- Greater effect if baseline blood glucose >130 mg/dL
- Reduced A1C (-0.2% short term, -0.14% long-term)
- But did NOT reach statistical significance
- Reduced cholesterol in both short and long term
- Reduced fasting blood glucose (-13 mg/dL short-term, -3 mg/dL long-term)
- Commentary: Optimizing gut health can impact metabolic markers. But, don’t forget to also address diet/lifestyle factors that may play a larger role in heart disease and metabolic management.
- Association of Dietary Fiber, Fruit, and Vegetable Consumption with Risk of Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis
- 6 prospective studies
- Results:
- Higher vegetable intake associated w/ reduced ulcerative colitis
- Higher fruit intake associated w/ reduced ulcerative colitis and Crohn’s
- Higher fiber intake associated w/ reduced risk of Crohn’s disease only (not ulcerative colitis)
- Commentary: In general, higher fiber/fruit/vegetable intake is associated w/ reduced risk of IBD but these conclusions are not universal for all IBD subtypes.
- Elemental diet therapy for eosinophilic gastroenteritis and dietary habits
- Retrospective study of 4 children w/ INTRACTABLE eosinophilic esophagitis (EoE) not responsive to traditional therapy
- Given elemental diet x2 weeks
- ALL 4 patients had RESOLUTION of symptoms after 2 weeks
- 3 patients reintroduced food and returned to normal life
- No adverse effects
- Commentary: An elemental diet can be a game-changer for some patients. Consider the use of it especially in those w/ reflux and EoE.
- Increased risk of eosinophilic esophagitis with poor environmental quality as measured by the Environmental Quality Index
- To determine any association between risk of eosinophilic esophagitis (EoE) and environmental air quality
- 30,000 EoE participants, 600,000 healthy controls
- Risk of EoE were highest in the worst quintile of EQI (OR 1.25)
- Mostly explained by poor water quality
- Commentary: Could environmental toxins (especially from drinking water) play a role in EoE pathogenesis?
- Could Ferritin, Vitamin B 12, and Vitamin D Play a Role in the Etiopathogenesis of Fibromyalgia syndrome?
- Evaluate the connection between iron, B12, and Vit D w/ fibromyalgia
- 58 female fibromyalgia patients, 58 healthy controls
- Compared to healthy controls, fibromyalgia patients had lower:
- B12 (240 vs 290 pg/mL)
- Vitamin D (12.5 vs 20 ng/mL)
- Ferritin (21 vs 32 ng/mL)
- The lower the nutrient markers were, the higher number of tender points
- Evaluation of the application of TSH receptor stimulating autoantibodies and the optimization of detection strategy in Graves’ disease
- To evaluate difference between thyroid stimulating immunoglobulin (TSI) vs thyroid receptor antibody (TRAb) in diagnosing Graves’ disease
- 540 participants, 200 w/ Graves’ disease
- TSI
- Sensitivity: 98%
- Specificity: 92.3%
- TRAb
- Sensitivity: 94%
- Specificity: 96.7%
- Commentary: Both TSI and TRAb offer good sensitivity and specificity for the diagnosis of Graves’ disease
- Subclinical Hypothyroidism: Prevalence, Health Impact, and Treatment Landscape
- Review of subclinical hypothyroidism (SCH)
- “It is important to remember that a considerable proportion of SCH cases are transient and reversible in nature”
- “Despite significant evidence documenting the health impacts of SCH, the effects of levothyroxine treatment in patients with SCH remains controversial, especially [in older adults]”
- Commentary: Current evidence lacks for routinely treating SCH to get thyroid tests into “optimal ranges”
- Subclinical hypothyroidism and symptoms of depression: Evidence from the National Health and Nutrition Examination Surveys (NHANES)
- Is there an association of subclinical hypothyroidism (SCH) and depressive symptoms?
- NHANES analysis of 7,700 participants
- Of all the participants, 208 (2.7%) had SCH
- only 6 had depression
- SCH was NOT associated with depression nor with the specific depression symptoms
- Using lower criteria for SCH diagnosis resulted in similar findings.
- Commentary: SCH is NOT associated w/ depressive symptoms
- Does continuous positive airway pressure therapy benefit patients with coronary artery disease and obstructive sleep apnea? A systematic review and meta-analysis
- It remains controversial if CPAP therapy improves cardiovascular outcomes in those w/ obstructive sleep apnea (OSA)
- 9 studies, 2,6000 patients w/ OSA and coronary artery disease (CAD)
- There was a significant association of CPAP with reduced risk of:
- major adverse cardiovascular event (RR 0.73)
- all-cause mortality (RR 0.66)
- Cardiovascular-related death (RR 0.5)
- CPAP usage was associated with reduced risks of cardiovascular outcomes or death in patients with OSA and CAD
- Effect of Vitamin D and/or Marine n-3 Fatty Acid Supplementation on Changes in Migraine Frequency and Severity
- 26,000 participants, 1,000 w/ migraines
- Received Vitamin D (2,000 IU/d) + placebo OR omega-3 (1 g/d) + placebo
- NO differences in migraines frequency or severity
- ω-3 Ethyl ester results in better cognitive function at 12 and 30 months than control in cognitively healthy subjects with coronary artery disease: A secondary analysis of a randomized clinical trial
- Is omega-3 fatty acids helpful in preventing cognitive decline in healthy older adults?
- 285 adults w/ stable coronary artery disease (CAD) on statins
- Randomized 3.4 g EPA + DHA or nothing
- After 30 months, omega 3 group had:
- Better verbal fluency/language
- Improved memory
- Improved motor coordination
- Commentary: Omega 3 fatty acids can prevent cognitive decline in healthy older adults.
- Effect of Protein and Carbohydrate Combined with Resistance Training on Muscular Adaptation
- Does protein + carbohydrate supplementation increase effects of resistance training compared to protein supplementation alone?
- 17 untrained young men, given resistance training protocol (leg press, leg extensions) 3x/wk for 8 weeks
- Randomized to
- PRO (0.25g/kg whey protein) supplementation
- or PRO + CHO supplementation (0.25g/kg whey protein + 50g maltodextrin)
- Measured muscle strength and muscle mass before and after protocol
- After 8 weeks:
- NO differences in muscle strength or muscle mass
- Commentary: Added CHO to PRO supplementation may not yield additional benefits of resistance training in untrained individuals. Hitting an adequate protein threshold per day may be enough to stimulate muscle protein synthesis. However, a possible benefit may be seen in more trained individuals.
- The effect of psyllium supplementation on blood pressure: A systematic review and meta-analysis of randomized controlled trials
- 11 studies, 600 participants
- Psyllium husk supplementation lead to reduction of systolic blood pressure (-2 mmHg)
- This effect was stronger if high baseline blood pressure
- Commentary: This is not clinically significant. It may be more prudent to focus on diet, exercise, and other lifestyle factors to manage hypertension.
- Vitamin K2 (Menaquinone-7) supplementation does not affect vitamin K-dependent coagulation factors activity in healthy individuals
- Does Vitamin K2 supplementation impact bleeding parameters in healthy adults?
- 40 adults ages 25-40 years old, given MK2 90 mcg
- After 30 days supplementation, no changes in:
- Prothrombin time (PT)
- activated partial thromboplastin time (APTT)
- thrombin time (TT)
- Commentary: Vitamin K does NOT affect bleeding parameters and can be given safely to adult who are NOT on anticoagulation treatment