Research Briefs for Practitioners – August 2022 - Dr. Michael Ruscio, DNM, DC

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Future of Functional Medicine Review Clinical Newsletter

Research Briefs for Practitioners – August 2022

by Dr. Ruscio, DNM, DC, Gavin Guard, PA-C, MPAS, CISSN, Pn1, and the Ruscio Institute for Functional Medicine Clinical Team

Medically reviewed & fact checked by a
board-certified doctor
Medically reviewed & fact checked by a
board-certified doctor
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Episode 64

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

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Gastrointestinal Studies


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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.

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Diet & Lifestyle Studies


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Episode 63

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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.

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Gastrointestinal Studies

  • 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.

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Diet & Lifestyle Studies


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Episode 62

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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.

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Gastrointestinal Studies

  • 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.

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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.

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Episode 61

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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.

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Gastrointestinal Studies

  • 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.

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Thyroid & Hormones Studies


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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.

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Diet & Lifestyle Studies

  • 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. 

Discussion

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