Podcast Summary

Download Episode

Featured Studies

• Subclinical Hypothyroidism and Cognitive Impairment
  • 1,118 euthyroid patients, 283 subclinical hypothyroid (SCH) patients
    • All >60 years old 
  • After 3 years, there was NO difference in cognitive function between the euthyroid and SCH group, even when SCH patients had a TSH >10 mIU/L
  • Commentary: This study did NOT find an association between SCH and worse cognitive outcomes in an older patient population.

• Bone geometry in older adults with subclinical hypothyroidism upon levothyroxine therapy: A nested study within a randomized placebo controlled trial
  • 98 participants with subclinical hypothyroidism (≥65 years old), randomized to: 
    • Placebo
    • Levothyroxine (LT4)
  • After 1 year, both groups experienced loss of bone mass (-0.2% placebo vs -0.5% LT4)
  • Commentary: Treating SCH did NOT improve bone mineral density. There was a slight trend in worsening of bone health in those treated with LT4.

• Commentary: These two studies highlight the need to be selective in treating SCH. Not everyone benefits from treatment, especially those who are older.

Gastrointestinal Studies

• Safety and efficacy of fecal microbiota transplantation for treatment of systemic lupus erythematosus: An EXPLORER trial
  • 20 lupus patients, all treated with fecal microbiota transplantation (FMT)
  • After 3 months, treatment with FMT led to: 
    • Lower disease activity 
    • Reduced lupus antibodies (anti-dsDNA)
    • Reduced inflammation markers (IL-6) 
    • Favorable gut microbiome profile 
    • NO serious side effects 
  • Commentary: This study highlights the importance of treating the gut for autoimmune diseases.

• Probiotics Supplementation Improves Quality of Life, Clinical Symptoms, and Inflammatory Status in Patients With Psoriasis
  • 46 psoriasis patients, randomized to: 
    • Placebo
    • Probiotics
  • After 2 months, probiotics led to improvements in: 
    • Psoriasis severity scores
    • Quality of life
    • hsCRP (-1.7 vs -0.7 mg/L) 
  • Commentary: Probiotics were effective in improving psoriasis symptoms, inflammation, and quality of life.

• Probiotics for Reduction of Examination Stress in Students (PRESS) study: A randomized, double-blind, placebo-controlled trial of the probiotic Lacticaseibacillus rhamnosus HN001
  • 391 healthy participants, randomized to:
    • Placebo
    • Probiotics 
  • There was NO difference in stress or anxiety levels between groups
  • Commentary: Probiotics did NOT lead to improved psychological health in a group of healthy college students.

• Probiotics are a good choice for the treatment of bacterial vaginosis: a meta-analysis of randomized controlled trial
  • 20 RCTs on patients with bacterial vaginosis 
  • In treating bacterial vaginosis: 
    • Antibiotics + probiotic were 23% more effective than antibiotics alone 
    • Probiotics were 12% more effective than antibiotics 
    • Probiotics were 150x more effective than placebo
  • Commentary: Probiotics are an effective therapy for treating bacterial vaginosis.

• The effect of probiotics on the clinical status of adult patients with atopic dermatitis: a systematic review
  • 7 studies on patients with eczema
  • Compared to placebo, probiotics led to improvements in: 
    • Skin itching
    • Severity of eczema 
  • Commentary: This study highlights the gut-skin connection.

• Internet-Delivered Cognitive Behavioral Therapy in Patients With Irritable Bowel Syndrome: Systematic Review and Meta-Analysis
  • 9 RCTs on patients with IBS
  • Internet-based cognitive behavioral therapy (CBT) led to improved: 
    • IBS symptoms (moderate effect size) 
    • Quality of life (moderate effect size) 
  • Commentary: Internet-based CBT may be a cost-effective treatment option for patients with IBS.

• Exocrine Pancreatic Insufficiency is Undiagnosed in Some Patients with Diarrhea-Predominant Irritable Bowel Syndrome Using the Rome IV Criteria
  • 140 patients with IBS-D, all tested for exocrine pancreatic insufficiency (EPI)
    • Fecal elastase-1 <100 µg/g was considered positive
  • In the 5% of patients that tested positive for EPI, dyspepsia was the most common symptom
  • Treatment with pancreatic enzymes led to improved:
    • IBS severity
    • Abdominal pain 
    • Bloating
    • Stool consistency
  • Commentary: EPI is relatively rare (5%) in patients with IBS-D, however it may be an important differential diagnosis to consider in patients with non-responsive diarrhea and dyspepsia.

• Probiotics for the prevention of atopic dermatitis in infants from different geographic regions: a systematic review and meta-analysis
  • 22 studies on infants
  • Probiotics reduced the risk of infants developing eczema by 24%
  • Commentary: Probiotics may be an effective preventative measure for eczema in infants.

• Efficacy of fecal microbiota transplantation for patients with irritable bowel syndrome at three years after transplantation
  • 125 IBS patients randomized to: 
    • Placebo
    • Single FMT 
  • After 3 years, patients who received FMT experienced:
    • Higher response rates (68% FMT vs  27% placebo)
    • Less fatigue
    • Greater quality of life 
    • NO side effects
  • Commentary: FMT led to long-term, sustained improvement in patients with IBS.

Thyroid & Hormones Study

• Iodine Deficiency in Patients with Hypothyroidism: A Pilot Study
  • 24 hypothyroid patients, 24 euthyroid patients
  • Iodine deficiency was more common in the hypothyroid group compared to euthyroid group (54% vs 44%) 
  • However, there was NO correlation between iodine status and TSH level 
  • Commentary: While this small study does show an association between iodine status and thyroid function, it did NOT directly correlate with TSH levels.

Diet & Lifestyle Studies

• Effects of Resveratrol on Metabolic Indicators in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis
  • 19 studies, 1,151 patients with type 2 diabetes, randomized to: 
    • Placebo
    • Resveratrol (≥1,000 mg/day) 
  • Resveratrol led to improvements in:
    • Fasting blood sugar (-19 mg/dl) 
    • Systolic blood pressure (-8 mmHg)
  • NO changes occurred in triglycerides or HDL-C 
  • Commentary: Resveratrol was effective in significantly improving blood sugar and blood pressure.

• Correlation of Dyslipidemia and Inflammation With Obstructive Sleep Apnea Severity
  • 328 patients with sleep apnea
  • Compared to mild or moderate sleep apnea, severe sleep apnea was associated with: 
    • Metabolic syndrome
    • Higher lipids
    • Higher liver enzymes
    • High inflammatory markers (CRP, ESR) 
  • Commentary: Severe sleep apnea may be a risk factor for poor metabolic health and increased inflammation.

• Prevalence of Obstructive Sleep Apnoea and Its Association With Atherosclerotic Plaques in a Cohort of Subjects With Mild-Moderate Cardiovascular Risk
  • 966 patients with heart disease, all tested for sleep apnea
  • 73% of these patients tested positive for sleep apnea
  • Commentary: Sleep apnea was very common in those with heart disease.

• Benefits of continuous positive airway pressure on blood pressure in patients with hypertension and obstructive sleep apnea: a meta-analysis
  • 19 RCTs, 1,904 participants with sleep apnea and high blood pressure
  • All participants randomized to: 
    • Control
    • CPAP 
  • CPAP therapy led to a reduction in systolic blood pressure (-5 mmHg)
  • Commentary: CPAP led to a mild reduction in blood pressure

Podcast Summary

Download Episode

Featured Study

• Levothyroxine treatment for subclinical hypothyroidism improves the rate of live births in pregnant women with recurrent pregnancy loss: a randomized clinical trial
  • 1,736 pregnant women, categorized by TPO antibodies and thyroid function: 
  • Each group was randomized to placebo or Levothyroxine 
  • Compared to placebo, treatment with levothyroxine led to improved outcomes for the baby in those with history of pregnancy loss and either +TPOAb/euthryoid or subclinical hypothyroid: 
    • Higher rate of live births:
      • +TPOAb/euthryoid (90% LT-4 vs 68% placebo) 
      • Subclinical hypothyroid (70% vs 47%) 
    • Lower rate of miscarriage:
      • +TPOAb/euthryoid (7% vs 27%) 
      • Subclinical hypothyroid (21% vs 40%) 
  • NO difference in pregnancy outcomes in women with no history of pregnancy loss
  • Commentary: Women with a history of recurrent pregnancy loss with SCH and/or +TPOAb (even if euthyroid) will likely benefit from LT-4 therapy.  Remember that TSH cutoffs differ in pregnancy according to trimester.

Gastrointestinal Studies

• Clinical, gut microbial and neural effects of a probiotic add-on therapy in depressed patients: a randomized controlled trial
  • 47 patients with depression, randomized to standard care plus either probiotics or placebo. 
  • After 1 month, treatment with probiotics led to reduced depressive symptoms
  • Commentary: Probiotics may improve depressive symptoms. This highlights the gut-brain axis. 

• Effect of Compound Lactic Acid Bacteria Capsules on the Small Intestinal Bacterial Overgrowth in Patients with Depression and Diabetes: A Blinded Randomized Controlled Clinical Trial
  • 60 SIBO+ patients with depression, randomized to: 
    • Antidepressant (Lexapro) 
    • Antidepressant + probiotics 
  • Probiotics + antidepressants led to: 
    • Reduced anxiety 
    • Reduced depression
    • Lowered inflammatory markers
    • Fewer medication side effects (constipation, nausea, dry mouth)
  • Commentary: Similar to the study above, probiotics were shown to improve depressive symptoms, while reducing antidepressant medication side effects.

• Uterine Fibroid Patients Reveal Alterations in the Gut Microbiome
  • 42 uterine fibroid patients, 43 healthy controls
  • Compared to healthy controls, those with fibroids had:
    • Lower diversity of gut microbiome 
    • Increased pathogenic bacteria (Pseudomonas, Prevotella)
    • Reduced normal bacteria (Bifidobacteria, Lactobacillus, Lactococcus) 
  • Commentary: Uterine fibroids may be associated with dysbiosis in the gut.

• Effects of Synbiotics, Probiotics, and Prebiotics on Liver Enzymes of Patients With Non-alcoholic Fatty Liver Disease: A Systematic Review and Network Meta-Analysis
  • 26 RCTs, 1,389 patients with fatty liver disease randomized to: 
    • Placebo
    • Prebiotics
    • Probiotics
    • Synbiotics  
  • Synbiotics led to the greatest improvements in: 
    • AST (-13 IU/L)
    • Total cholesterol (-22 mg/dl) 
    • LDL-C (-18 mg/dl)
    • Fasting blood sugar (-6.7 mg/dl) 
  • Probiotics led to the greatest improvements in:
    • ALT (-14 IU/L)
    • Triglycerides (-21 mg/dl)
  • Commentary: Probiotics and synbiotics led to improvements in markers associated with fatty liver disease.

• The Efficacy and Safety of Probiotics for Allergic Rhinitis: A Systematic Review and Meta-Analysis
  • 28 studies
  • Probiotics led to improved:
    • Allergic rhinitis symptoms (small effect size) 
    • Improved quality of life (moderate effect size) 
  • NO change in total serum IgE 
  • Commentary: Another meta analysis showing probiotics are beneficial for allergic rhinitis and quality of life.

• Prevalence of Coeliac Disease in Omani Adults with Iron Deficiency Anaemia of Unknown Cause: Case-finding study
  • 104 participants with iron deficiency anemia of unknown cause 
  • 7.7% tested positive for celiac disease 
  • Commentary: Celiac disease may be more common in those with iron deficiency anemia compared to 0.5% prevalence in the general population.

• The effectiveness of microencapsulated sodium butyrate at reducing symptoms in patients with irritable bowel syndrome
  • 2,990 IBS patients, treated with sodium butyrate (150 mg twice/day) 
  • After 3 months, butyrate led to improved: 
    • Abdominal pain 
    • Gas
    • Diarrhea 
    • Constipation
    • Stool urgency
    • Nausea 
    • Quality of life
  • 94% of participants reported they would continue using butyrate 
  • Commentary: Butyrate supplementation led to improvements in IBS symptoms. Keep in mind there was no placebo group, and we know there is a strong placebo-response in this patient population.

Thyroid & Hormones Study

• Effect of omega-3 fatty acids on premenstrual syndrome: A systematic review and meta-analysis
  • 8 studies, 676 women with PMS 
  • Omega-3 fatty acid supplementation reduced the severity of PMS symptoms (large effect size)  
  • The effect of omega-3 supplementation was enhanced when used for 6+ months
  • Commentary: Omega 3 supplementation may improve PMS symptoms, likely by reducing inflammation.

Diet & Lifestyle Studies

• Omega-3 Polyunsaturated Fatty Acids Intake and Blood Pressure: A Dose-Response Meta-Analysis of Randomized Controlled Trials
  • 71 RCTs, 4,973 individuals with high blood pressure randomized to: 
    • No treatment
    • Omega-3 supplementation (2.8 g/day)
  • Omega 3 supplementation led to a reduction in systolic blood pressure (-2.6 mm Hg) 
  • Commentary: Higher dose omega-3 supplementation leads to very minor reductions in blood pressure.

• Meta-Analysis of the Effect of Aerobic Training on Blood Pressure in Hypertensive Patients
  • 14 studies, 1,027 patients randomized to no treatment or aerobic exercise
  • Compared to control, aerobic training reduced systolic blood pressure (-10 mm Hg) 
  • Commentary: Compared to the study above on fish oil, aerobic exercise is significantly more effective for those with high blood pressure.

• Efficiency of oro-facial myofunctional therapy in treating obstructive sleep apnoea: A meta-analysis of observational studies
  • 13 studies
  • Oral myofunctional therapy (MFT) led to improved: 
    • Sleep apnea scores 
    • Oxygen levels during sleep
    • Sleepiness scores 
  • MFT was more effective in patients with mild to moderate sleep apnea (NOT severe sleep apnea). 
  • Commentary: MFT is an effective therapy for mild to moderate sleep apnea. A cheaper/more practical alternative to guided  is an app called Airway Gym.

• Vitamin D and Asthma: a Systematic Review of Clinical Trials
  • 17 studies
  • Increasing vitamin D levels did NOT help improve asthma symptoms 
  • Commentary: Improving asthma likely requires a multi-factorial approach, not just vitamin D supplementation.

Podcast Summary

Download Episode

Featured Study

• Factors influencing the levothyroxine dose in the hormone replacement therapy of primary hypothyroidism in adults
  • Aim: Narrative review to identify causes of elevated TSH despite adequate compliance with LT4 medication in hypothyroid patients
  • Factors that can lower thyroid medication efficacy: 
    • Reduced stomach acid (H. pylori, PPI, antacids, autoimmune gastritis, gastric bypass)
    • Leaky gut (Celiac disease, GI pathogen, lactose intolerance, etc) 
    • Malabsorption (ulcerative colitis, Celiac disease, autoimmune gastritis, etc) 
    • SIBO
  • Commentary: In many cases, working through a gut-centric approach can help improve thyroid medication absorption and efficacy.

Gastrointestinal Studies

• Effectiveness of elemental diets to prevent oral mucositis associated with cancer therapy: A meta-analysis
  • 9 studies, 445 patients undergoing chemotherapy or radiotherapy
  • Elemental diet reduced the risk of oral mucositis for patients undergoing treatment for: 
    • Esophageal cancer (60% reduction)
    • Gastrointestinal cancer (90% reduction) 
    • Oral cancer (70% reduction)
  • Commentary: Elemental diet is an effective therapy for preventing oral mucositis, a common side effect of cancer treatment.

• The Prevalence and Associated Risk Factors of Erectile Dysfunction in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-analysis
  • 14 studies, 32,858 participants with IBD 
  • Erectile dysfunction was found in 27% of IBD participants, and was associated with: 
    • Depression (330% increase)
    • Worse disease activity (200% increase)
  • Commentary: Erectile dysfunction was common in patients with IBD, especially if concomitantly experiencing depression and worse IBD symptoms.

• A Low-FODMAP Diet Provides Benefits for Functional Gastrointestinal Symptoms but Not for Improving Stool Consistency and Mucosal Inflammation in IBD: A Systematic Review and Meta-Analysis
  • 9 studies, 446 participants with IBD 
  • Compared to control groups, the low FODMAP diet (LFD) led to improved:
    • IBD symptom score (large effect size) 
    • Crohn’s disease symptom score (large effect size) 
  • LFD did NOT improve:
    • Stool consistency 
    • Ulcerative colitis symptom score 
    • Fecal calprotectin 
  • Commentary: LFD led to improved overall symptoms of IBD, but NOT stool consistency or fecal calprotectin.

• Effect of Oral Intake of Lactiplantibacillus plantarum APsulloc 331261 (GTB1 TM) on Diarrhea-Predominant Irritable Bowel Syndrome: A Randomized, Double-Blind, Placebo-Controlled Study
  • 27 participants with IBS-D, randomized to placebo or probiotics
  • After 6 weeks, probiotics led to improved:
    • Overall IBS symptom relief (94.4% probiotics vs 62.5% placebo)
    • Diarrhea frequency (-46% vs -27%)
    • Abdominal pain
    • Bloating
  • Commentary: Another study showing the efficacy of probiotics on IBS. Note the significant effect of placebo on symptom improvement.

• Ranitidine Use and Gastric Cancer Among Persons with Helicobacter pylori
  • 279,505 patients with H. Pylori on various acid-suppression medication
  • Ranitidine (Zantac) did NOT  increase the risk of stomach cancer, whereas other antihistamine acid-suppression medications did increase risk (80% increase)
  • H. Pylori eradication was associated with a reduced risk of stomach cancer (80% decrease)
  • Commentary: Ranitidine is not associated with increased stomach cancer risk.

• Synbiotic containing extensively hydrolyzed formula improves gastrointestinal and atopic symptom severity, growth, caregiver quality of life, and hospital-related healthcare use in infants with cow’s milk allergy
  • 29 infants with cow’s milk allergy (CMA), all treated with synbiotic-containing whey formula
  • After 1 month, synbiotic formula led to improved: 
    • Abdominal pain (in 57%) 
    • Burping (in 46%)
    • Gas (in 79%) 
    • Constipation (in 14%) 
    • Rhinitis (in 41%)
    • Itchy eyes (in 73%) 
  • Commentary: Synbiotics may improve clinical outcomes in infants with CMA.

• Nasal administration of a probiotic assemblage in allergic rhinitis: A randomised placebo-controlled crossover trial
  • 24 patients with allergic rhinitis, randomized to placebo or nasal probiotics 
  • After 3 weeks, nasal probiotics had NO effect on: 
    • Allergic rhinitis symptoms
    • Quality of life
  • Commentary: Nasal probiotics did NOT improve allergic rhinitis.

• Predictive value of faecal calprotectin in ulcerative colitis – single centre experience
  • 126 adults with ulcerative colitis 
  • This study found that fecal calprotectin  < 154 μg/g was associated with clinical remission
  • Every 10 μg/g increase in fecal calprotectin was associated with 8% lower chance of achieving remission 
  • Commentary: FC levels were effective in predicting ulcerative colitis remission.

Thyroid & Hormones Study

• Environmental arsenic exposure and its toxicological effect on thyroid function: a systematic review
  • Arsenic exposure and urine concentrations were associated with:
    • Lower T4
    • Lower T3
    • Higher TSH 
  • Commentary: This observational study shows a correlation between arsenic exposure and risk of hypothyroidism.

Diet & Lifestyle Studies

• Alcohol as an independent risk factor for obstructive sleep apnea
  • 688 sleep apnea patients, 108 healthy controls
  • After adjusting for age, BMI and cardiovascular disease, alcohol consumption was associated with higher risk of: 
    • Sleep apnea (200% increase)
    • Hypoxia (200% increase) 
  • Commentary: Alcohol consumption may be an independent risk factor for sleep apnea.

• Effect of Omega-3 Polyunsaturated Fatty Acids on Lipid Metabolism in Patients With Metabolic Syndrome and NAFLD
  • 60 patients with metabolic syndrome and fatty liver disease, randomized to:
    • Placebo
    • Omega 3 supplementation (3.6 g/day) 
  • After 1 year, compared to placebo, omega 3 supplementation led to reduced: 
    • Serum GGT (-51 U/L omega 3 vs -5 U/L placebo)
    • Liver fat (-1.1% vs +0.2%) 
    • Weight (-3.3 lb vs +3.3 lbs) 
  • NO change in ALT, AST or A1c was observed
  • Commentary: Omega 3 supplementation may be useful for patients with fatty liver disease.

• Dietary inflammatory potential and the incidence of depression and anxiety: a meta-analysis
  • 17 studies, 157,409 participants
  • Eating an inflammatory diet led to a higher prevalence of: 
    • Anxiety (70% increase)
    • Depression (50% increase)
  • This association was more common in women than men 
  • Commentary: This study suggests improving one’s diet may help with reducing anxiety and depression. Keep in mind this is an observational study.

• Cardiovascular and metabolic effects of a mandibular advancement device and continuous positive airway pressure in moderate obstructive sleep apnea: a randomized controlled trial
  • 54 patients with moderate sleep apnea, randomized to: 
    • Mandibular advancement device (MAD) 
    • CPAP
  • After 1 year, both groups experienced: 
    • NO improvement in cardiovascular risk factors
    • Similar improvements in sleep apnea severity 
  • Commentary: MAD is a viable alternative therapy to CPAP for sleep apnea.

Podcast Summary

Download Episode

Featured Study

• Hashimoto Thyroiditis, Anti-Parietal Cell Antibodies: Associations With Autoimmune Diseases and Malignancies
  • 840 participants diagnosed with Hashimoto’s thyroiditis (HT) based on positive TPOabs and/or positive TgAbs
  • Of those with HT, the prevalence of other autoimmune diseases was: 
    • 21% anti-parietal cell antibodies (APCA)
    • 9.4% one or more organ-specific autoimmune disease
      • E.g. type 1 diabetes, vitiligo, etc
    • 7.3% systemic autoimmune disease
      • E.g. SLE, Rheumatoid arthritis, Sjogren’s syndrome, etc 
  • Compared to -APCA, those with +APCA had a higher prevalence of: 
    • Gastric cancer (5 cases +APCA vs 0 cases -APCA) 
    • Organ-specific autoimmune disease (14% vs 8%)
  • Commentary: About 1 in 5 individuals with HT will have APCA antibodies.

Gastrointestinal Studies

• Effect of Helicobacter Pylori Eradication on Human Gastric Microbiota: A Systematic Review and Meta-Analysis
  • 9 studies, 546 participants with H. pylori, treated with either triple or quadruple eradication therapy
  • Eradication of H. pylori led to improved stomach microbiome diversity
    • these improvements persisted 6 months later
  • Commentary: Eradicating H. pylori may have beneficial effects on gastric dysbiosis.

• Association Between Gastrointestinal Symptoms and Depression in a Representative Sample of Adults in the United States: Findings From National Health and Nutrition Examination Survey (2005-2016)
  • 31,191 adults followed over 11 years
  • Compared to healthy controls, participants with moderate-to-severe depressive symptoms had higher rates of: 
    • Diarrhea (OR 1.7) 
    • Constipation (OR 2.7)
    • Stomach illness (OR 1.8) 
    • Bowel liquid (OR 2.1)
    • Bowel mucus (OR 2.8) 
  • Commentary: This large study highlights the gut-brain connection.

• An Association Between Blastocystis Subtypes and Colorectal Cancer Patients: A Significant Different Profile from Non-cancer Individuals
  • 100 patients with colorectal cancer, 100 healthy controls
  • Fecal samples collected on all patients 
  • Blastocystis species were more common in colorectal cancer patients compared to healthy controls (52% vs 42%) 
  • Blastocystis subtype 7 was only found in colorectal cancer patients
  • Commentary: While the prevalence of Blastocystis was similar in both groups, certain subtypes may be more associated with colorectal cancer.

• A systematic review of gut microbiota composition in observational studies of major depressive disorder, bipolar disorder and schizophrenia
  • 44 studies, 2510 psychiatric patients, 2407 healthy controls 
  • Compared to healthy controls, psychiatric patients had: 
    • NO difference in microbiota alpha-diversity between groups
    • Greater microbiota beta-diversity 
    • Lower levels of SCFA-producing bacteria
    • Higher levels of lactic acid-producing bacteria
  • Commentary: Mental health disorders may be related to the composition of the gut microbiome.

• Association of Celiac Disease and Inflammatory Bowel Disease: A Nationwide Register-Based Cohort Study
  • Retrospective study, 48,551 Celiac disease patients, 83,529 IBD patients and age and sex-matched controls
  • After 20 years of follow-up:
    • 2.5% of Celiac disease patients developed IBD
    • 1.3% of IBD patients developed Celiac disease 
  • Commentary: IBD and Celiac disease can co-occur, more frequently those patients with Celiac disease may develop IBD. This suggests a common underlying cause between the two conditions.

• Effects of Helicobacter pylori treatment on the incidences of autoimmune diseases and inflammatory bowel disease in patients with diabetes mellitus
  • Observational study of 79,181 participants with H. pylori or peptic ulcer disease
  • Compared to untreated H. pylori, those who received treatment experienced: 
    • Higher rates of autoimmune diseases (5.1% treated vs 3.56% untreated)
    • Higher rates of IBD (5.6% vs 3.21%)
    • Lower rates of all-cause mortality (HR 0.9)

• Randomised clinical trial: individual versus group hypnotherapy for irritable bowel syndrome
  • 119 IBS patients randomized to individual or group hypnotherapy 
  • After 6 months, both groups experienced:
    • Improved IBS symptom scores (-116 individual vs -98 group) 
    • Similar response rates (>50 point IBS symptom score) (69% vs 57%) 
    • Improved quality of life 
  • Commentary: Hypnotherapy can improve IBS symptoms whether in a group or individual setting.

• Mediterranean diet diminishes the effects of Crohn’s disease and improves its parameters: A systematic review
  • 5 studies, 83,564 Crohn’s disease (CD) participants 
  • Greater adherence to a mediterranean diet was associated with:
    • Improved CD symptoms
    • Lower fecal calprotectin
    • Lower hsCRP 
  • Commentary: A mediterranean diet may be a useful option for patients with CD.

• Probiotics improve renal function, glucose, lipids, inflammation and oxidative stress in diabetic kidney disease: a systematic review and meta-analysis
  • 10 RCTs, 552 participants with diabetic kidney disease, randomized to placebo or probiotics 
  • Compared to placebo, probiotics led to improved:
    • Serum creatinine (-0.17 mg/dl)
    • Blood urea nitrogen (-1.36 mg/dl) 
    • Cystatin C (-29.5 ng/ml) (marker of kidney dysfunction)
    • Urinary albumin/creatinine (-16 mg/g) 
    • Fasting glucose (-13.5 mg/dl) 
    • Insulin resistance (HOMA-IR) (-2) 
    • hsCRP (-1.5 mg/L)
  • Multi-species probiotics and >4 billion CFU/day led to greater kidney function improvement 
  • Commentary: Probiotics may be an important therapy for patients with diabetic kidney disease.

• Effect of Gastro-esophageal Reflux Symptoms on the Risk of Barrett’s Esophagus: A Systematic Review and Meta-analysis
  • 19 studies, 43,017 participants
  • Weekly symptoms of GERD was associated with 240% increased risk of Barrett’s esophagus 
  • Commentary: Frequency of reflux symptoms is associated with increased risk of BE.

Thyroid & Hormones Studies

• Thyroid Dysfunction and Risk of Parkinson’s Disease: A Systematic Review and Meta-Analysis
  • 9 studies
  • Risk of developing Parkinson’s disease was associated with both hypothyroidism (OR 1.5) and hyperthyroidism (OR 1.6) 
  • Commentary: Thyroid disease is associated with an increased risk of developing Parkinson’s disease.
• TSH-receptor autoantibodies in patients with chronic thyroiditis and hypothyroidism
  • 245 hypothyroid patients with Hashimoto’s thyroiditis (HT), 123 healthy controls
  • TSH-receptor antibody (TRAb) was positive in 13% of HT patients
  • Positive TRAb correlated with higher TSH (51 IU/mL +TRAb vs 17 IU/mL -TRAb)
  • 10% of patients negative for TPOAb and TgAb were positive for TRAb only
  • Commentary: A proportion of hypothyroid HT patients may also have TRAb positivity, even in the absence of TPOAb or TgAb.

• Vitamin E supplementation improves testosterone, glucose- and lipid-related metabolism in women with polycystic ovary syndrome: a meta-analysis of randomized clinical trials
  • 8 RCTs on women with PCOS 
  • Vitamin E supplementation led to improved: 
    • Fasting glucose (-1.9 mg/dl) 
    • Fasting insulin (-2.2 µIU/mL)
    • Insulin resistance (HOMA-IR) (-0.4) 
    • Cholesterol (-18 mg/dl) 
    • LDL-C (-15.9 mg/dl) 
    • Triglycerides (121 mg/dl)
    • Total testosterone (-42 ng/dl) 
    • Sex hormone binding globulin (+7.4 nmol/L) 
  • Vitamin E had NO impact on hirsutism, BMI or female sex hormones
  • Commentary: Vitamin E led to improved metabolic and hormonal markers associated with PCOS.

Autoimmunity Study

• Gut dysbiosis in rheumatic diseases: A systematic review and meta-analysis of 92 observational studies
  • 92 observational studies, 11,998 participants
  • Compared to healthy controls, microbiome alpha-diversity was lower in patients with:
    • Systemic lupus erythematosus (large effect size) 
    • Rheumatoid arthritis (moderate effect size)
    • Gout (moderate effect size) 
    • Fibromyalgia (small effect size) 
  • Commentary: Dysbiosis is associated with various rheumatological diseases. Keep in mind this is an observational study.

Diet & Lifestyle Studies

• The effect of vitamin D replacement in patients with lower urinary tract complaint/erectile dysfunction resistant to Tadalafil 5 mg treatment: A pilot clinical study
  • 84 patients with urinary symptoms/erectile dysfunction and low vitamin D, who did NOT respond to Tadalafil therapy (Cialis) alone
  • All treated with Vitamin D (100,000 IU/week) + Tadalafil
  • After 1 month, patients experienced improved: 
    • Erectile function score (+13.5)
    • International Prostate Symptom Score (-6)
  • Commentary: Improving vitamin D deficiency may improve urinary symptoms and erectile dysfunction.

• The efficacy of vitamin D in treatment of fibromyalgia: a meta-analysis of randomized controlled studies and systematic review
  • 5 RCTs, 315 participants with fibromyalgia, randomized to placebo or vitamin D
  • Compared to placebo, vitamin D led to improved fibromyalgia symptom scores
  • Commentary: Vitamin D may be useful for improving fibromyalgia symptoms.

• Association between sleep disorder and atrial fibrillation: A nationwide population-based cohort study
  • Observational study, 193,288 people with sleep disorders, 193,288 healthy controls
  • Compared to healthy controls, atrial fibrillation was more prevalent in those with a sleep disorder, including: 
    • Sleep apnea (RR 1.2)
    • Insomnia (RR 1.3) 
  • Commentary: A-fib is more prevalent in those with sleep disorders such as sleep apnea.

• Mandibular advancement devices in patients with severe OSAHS
  • 271 severe sleep apnea patients treated with a mandibular advancement device (MAD)
  • Treatment with MAD led to: 
    • Complete response in 19.3% 
    • >50% reduction in sleep apnea severity in 71% 
    • Sleep apnea/hypopnea index <15/h in 59%
  • 9.6% patients discontinued therapy due to ineffectiveness and rarely intolerance
  • Commentary: MAD led to significant improvements in severe sleep apnea patients with a high tolerability.