Episode 77
Podcast Summary
Featured Study
- Muscle-strengthening activities are associated with lower risk and mortality in major non-communicable diseases: a systematic review and meta-analysis of cohort studies
- 16 studies
- Cardiovascular disease risk was reduced by:
- 18% with 60 min/week of strength training
- 46% with strength training + aerobic training
- All-cause mortality risk was reduced by:
- 17% with 40 min/week of strength training
- 40% with strength training + aerobic training
- Total cancer risk was reduced by:
- 9% with 30 min/week of strength training
- 28% with strength training + aerobic training
- Diabetes risk was reduced by:
- 17% with strength training
- NO association was found between strength training and reduced risk of site-specific cancers
- Commentary: This large study found a combination of aerobic training and strength training led to a significantly reduced risk of all-cause mortality, cardiovascular disease and cancer risk. Strength training between 30-60 minutes was the most beneficial for risk reduction.
Gastrointestinal Studies
- Pro-, pre- and synbiotics for the prevention of incidental ventilator-associated pneumonia among critically ill patients: a systematic review and meta-analysis of randomized controlled trials
- 15 RCTs on critically ill patients
- Compared to control treatments, probiotics, prebiotics and synbiotics led to:
- 30% reduced risk of developing ventilator-associated pneumonia (VAP)
- Shorter duration of ventilation (-1.6 days)
- Fewer days in the ICU (-1.7 days)
- Commentary: Probiotics, prebiotics and their combination are effective for preventing VAP and shortening duration of ventilation and days spent in the ICU.
- Impact of Sarcopenia on Clinical Outcomes in a Cohort of Caucasian Active Crohn’s Disease Patients Undergoing Multidetector CT-Enterography
- 63 patients with active Crohn’s disease (CD)
- 68% of CD patients were sarcopenic, which was associated with a higher rate of infections compared to those without sarcopenia (42% vs 15%)
- Commentary: This study found an association between low muscle mass and strength with worse outcomes in Crohn’s disease. This highlights the importance of focusing on maintaining muscle mass.
- Randomized, direct comparison study of Saccharomyces boulardii CNCM I-745 versus multi-strained Bacillus clausii probiotics for the treatment of pediatric acute gastroenteritis
- 312 children (6 months – 5 years old) with acute diarrhea, randomized to:
- S. boulardii
- Bacillus clausii
- After 1 week, S. boulardii led to a shorter duration of diarrhea compared to B. clausii (65 hours vs 78 hours)
- Both probiotics were well tolerated and led to improved:
- Diarrhea severity
- Loose stool frequency
- Commentary: While S. boulardii led to quicker resolution of diarrhea, both probiotics were safe and improved diarrhea frequency and severity.
- 312 children (6 months – 5 years old) with acute diarrhea, randomized to:
- The preventive and therapeutic effects of probiotics on mastitis: A systematic review and meta-analysis
- 6 RCTs, 1,096 lactating women
- Probiotics (lactobacillus species) led to 51% reduced incidence of mastitis compared to control groups
- Commentary: Probiotics were effective in reducing risk of mastitis, a common problem in breastfeeding women.
- Effect of MED-02 Containing Two Probiotic Strains, Limosilactobacillus fermentum MG4231 and MG4244, on Body Fat Reduction in Overweight or Obese Subjects: A Randomized, Multicenter, Double-Blind, Placebo-Controlled Study
- 100 overweight and obese participants, randomized to:
- Placebo
- Probiotics (limolactobacillus strains)
- After 3 months, compared to placebo, the probiotic group experienced reduced:
- Fat mass (–2.5 lbs vs -0.8 lbs)
- Total weight (-4.5 lbs vs 2.6 lbs)
- Body fat percentage based on DEXA scan (-0.9% vs -0.1%)
- Commentary: Probiotics led to reductions in body fat and total weight.
- 100 overweight and obese participants, randomized to:
- Hypermobile Ehlers–Danlos syndrome and disorders of the gastrointestinal tract: What the gastroenterologist needs to know
- Aim: Assess frequency of gastrointestinal symptoms in patients with:
- Hypermobile Ehlers-Danlos syndrome (hEDS)
- Hypermobility spectrum disorders (HSD)
- Compared to participants without hEDS/HSD, those with hEDS/HSD have a higher prevalence of:
- Constipation (73% vs 16%)
- Abdominal pain (69% vs 27%)
- Diarrhea (47% vs 9%)
- Postprandial fullness (34% vs 16%)
- Commentary: Keep the diagnosis of hEDS/HSD in mind for patients with GI symptoms, as it may be underdiagnosed.
- Aim: Assess frequency of gastrointestinal symptoms in patients with:
- Transcutaneous vagal nerve stimulation protects against stress-induced intestinal barrier dysfunction in healthy adults
- 16 healthy participants were randomized to one of the following after induced intestinal permeability:
- Placebo stimulation
- Auricular vagal nerve stimulation
- Compared to sham stimulation, vagal nerve stimulation led to:
- Reduced intestinal permeability as measured by lactulose:mannitol ratio (0.03 vagal vs 0.06 placebo)
- NO change was observed in intestinal fatty-acid binding protein (I-FABP)
- Commentary: This small study in healthy individuals found vagal nerve stimulation reduced intestinal permeability. This highlights the connection between the brain-gut connection.
- 16 healthy participants were randomized to one of the following after induced intestinal permeability:
- Probiotic effects on sexual function in women with polycystic ovary syndrome: a double blinded randomized controlled trial
- 40 women with PCOS and sexual dysfunction, randomized to:
- Letrozole (fertility drug)
- Letrozole + synbiotics (lactobacillus species + FOS)
- All patients were given oral folic acid supplementation
- After 2 months, compared to letrozole alone, the addition of synbiotics led to improved:
- Pregnancy rate (10% vs 0%)
- Sexual funtion
- Body dysmorphia
- Commentary: The addition of probiotics led to better clinical outcomes in women with PCOS, most notably in pregnancy rate, sexual function and even perception of body image.
- 40 women with PCOS and sexual dysfunction, randomized to:
Diet & Lifestyle Studies
- How nature nurtures: Amygdala activity decreases as the result of a one-hour walk in nature
- 63 healthy adults were randomized to:
- 1-hour urban walk
- 1-hour forest walk
- Before and after walks, participants underwent stressful tasks during fMRI
- Compared to an urban walk, walking in nature led to reduced amygdala activity as determined by fMRI
- Commentary: A 1-hour walk in nature led to reduced amygdala activity, a key brain structure involved in the stress response.
- 63 healthy adults were randomized to:
- Comparative efficacy of exercise regimens on sleep quality in older adults: A systematic review and network meta-analysis
- 35 studies, 3,519 participants
- Aerobic training + walking led to the greatest improvement in sleep quality compared to:
- Strength training + walking
- Sleep hygiene
- Walking alone
- Commentary: The combination of aerobic training (running, biking, rowing, swimming etc) and walking led to better quality sleep, even compared to sleep hygiene recommendations.
- Effects of Exercise on Patients with Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis
- 9 RCTs, 444 patients with sleep apnea, randomized to:
- Exercise
- Control group (general health guidance + stretching)
- Compared to control group, exercise led to improvements in:
- Sleep apnea severity (AHI) (-6.7 points)
- Oxygen saturation (large effect size)
- VO2 max (moderate effect size)
- Sleep quality score (-2.1 points)
- Sleepiness scale (-1.6 points)
- NO change in body mass index (BMI)
- Aerobic exercise + resistance training led to the greatest reduction in AHI compared to aerobic exercise alone (-7.4 points vs -4.4 points)
- Commentary: Exercise, specifically aerobic + resistance training, led to significant improvements in sleep apnea severity without a reduction in BMI, suggesting the improved sleep apnea was not due to weight loss.
- 9 RCTs, 444 patients with sleep apnea, randomized to:
- Efficacy and safety of vitamin K2 for postmenopausal women with osteoporosis at a long-term follow-up: meta-analysis and systematic review
- 9 RCTs, 6,852 postmenopausal women with osteoporisis Supplementation with vitamin K2 led to
- Increased lumbar bone mineral density (Large effect size)
- 1.3x increased side effects
-
- Commentary: Vitamin K2 was effective in improving bone mineral density in women with osteoporosis.
- 9 RCTs, 6,852 postmenopausal women with osteoporisis Supplementation with vitamin K2 led to
- Effects of different physical activities on brain-derived neurotrophic factor: A systematic review and bayesian network meta-analysis
- 39 RCTs, 2,031 healthy and unhealthy participants, randomized to:
- Control group
- Aerobic training (AT)
- High intensity interval training (HIIT)
- Resistance training (RT)
- Combined training (CT)
- AT + RT
- RT led to the greatest increase in serum brain-derived neurotrophic factor (BDNF) compared to all other forms of exercise (large effect size)
- The ranking of greatest to lowest increase in BDNF were:
- RT > HIIT > CT > AT + RT > AT > Control
- Commentary: Resistance training and HIIT workouts led to the greatest improvements in BDNF, which illustrates the importance of incorporating these routines for brain health.
- 39 RCTs, 2,031 healthy and unhealthy participants, randomized to:
- An anti-inflammatory and low fermentable oligo, di, and monosaccharides and polyols diet improved patient reported outcomes in fibromyalgia: A randomized controlled trial
- 46 fibromyalgia patients, randomized to:
- General healthy eating (control)
- Anti-inflammatory diet (gluten-free, dairy-free, no added sugar) + low FODMAP (LFD)
- Compared to the control diet, the anti-inflammatory + LFD led to greater improvements in:
- Fibromyalgia impact questionnaire score (-20 vs -2 points)
- Quality of life (+10.2 vs +3.6 points)
- Pain score (-2.3 vs -0 points)
- GI symptom score (-2 vs -0.9 points)
- Sleep quality score (-3.5 vs -1.2 points)
- Fatigue score (-1.1 vs -0.5 points)
- Commentary: Compared to a general healthy eating, an anti-inflammatory diet + LFD led to improvements in fibromyalgia, especially in quality of life and overall impact of symptoms on daily life.
- 46 fibromyalgia patients, randomized to:
Episode 78
Podcast Summary
Featured Study
- A combination of green tea, rhodiola, magnesium and B vitamins modulates brain activity and protects against the effects of induced social stress in healthy volunteers
- 100 healthy volunteers, randomized to one of the following ~30 minutes before a social stress test:
- Placebo
- Green tea, Mg, B-complex
- Rhodiola (222 mg), Mg, B-complex
- Green tea, Rhodiola, Mg, B-Complex (Combination)
- Patients were monitored for 3-4 hours after the stress test
- Following the initial stress response from the test, the combination treatment led to the quickest recovery in:
- Subjective stress response
- Tension/Anxiety
- Total mood disturbance
- Depression/dejection
- Fatigue
- NO difference was noted in salivary cortisol levels
- Commentary: The combination of green tea, magnesium, B-complex and rhodiola led to better recovery from acute stress despite NO difference in salivary cortisol levels.
- 100 healthy volunteers, randomized to one of the following ~30 minutes before a social stress test:
Gastrointestinal Studies
- Efficacy and safety of fecal microbiota transplant for recurrent Clostridium difficile infection in inflammatory bowel disease: a systematic review and meta-analysis
- 11 studies on IBD patients with recurrent C. diff infections (rCDI), treated with fecal microbiota transplantation (FMT)
- FMT led to cured rCDI in:
- 80% IBD patients after initial treatment
- 90% of IBD patients after 2 or more treatments
- 85% in ulcerative colitis patients
- 79% in Crohn’s disease patients
- Recurrence rate after FMT was 25%
- NO serious adverse events occurred
- Commentary: FMT is a safe and effective treatment for rCDI in patients with IBD. The cure rate is higher with 2 or more treatments.
- Efficacy and safety of fecal microbiota transplant in irritable bowel syndrome: An update based on meta-analysis of randomized control trials
- 8 studies, 472 patients with IBS, randomize to:
- Placebo
- FMT
- Compared to placebo, FMT led to:
- NO difference in IBS symptom scores
- Improved quality of life
- Increased side effects, including:
- 5.7x more constipation
- 3.7x more abdominal pain
- Commentary: While FMT did NOT improve IBS symptoms and led to more side effects, it did improve quality of life.
- 8 studies, 472 patients with IBS, randomize to:
- Effectiveness and safety of colonic and capsule fecal microbiota transplantation for recurrent Clostridioides difficile infection
- 269 patients with recurrent C. diff infections (rCDI), treated with:
- FMT delivered via colonoscopy
- FMT delivered via oral capsule
- After 2 months, FMT delivered via oral capsules and colonoscopy led to the same cure rates (81%) and similar safety profiles
- Commentary: Oral FMT was found to be as effective as colonoscopy-delivered FMT for the treatment of rCDI.
- 269 patients with recurrent C. diff infections (rCDI), treated with:
- Methanogens and Hydrogen Sulfide Producing Bacteria Guide Distinct Gut Microbe Profiles and Irritable Bowel Syndrome Subtypes
- Patients with IBS-C and IBS-D, all underwent stool microbiome testing and breath testing for H2, CH4 and H2S
- IBS-C patients had increased:
- CH4 gas levels
- Methanobrevibacter smithii
- IBS-D patients had increased:
- H2 and H2S gas levels
- Fusobacterium and Desulfovibrio spp
- Commentary: IBS-C and IBS-D have distinct patterns of gas production and bacteria species present.
- Salivary Calprotectin Is not a Useful Biomarker to Monitor Disease Activity in Patients with Inflammatory Bowel Disease
- 63 patients with IBD, 11 healthy controls
- Fecal and salivary calprotectin levels were measured
- Compared to healthy controls, patients with IBD had:
- NO difference in salivary calprotectin
- Higher fecal calprotectin
- Salivary calprotectin was NOT different when comparing patients in remission or active IBD
- Commentary: This small study found salivary calprotectin is NOT clinically useful as it does not correlate with fecal calprotectin, a well-validated clinical marker for IBD.
Thyroid & Hormones Studies
- The relationship between body mass index and primary dysmenorrhea: A systematic review and meta-analysis
- 12 studies, 29,647 participants
- Being underweight was associated with a 1.4x increased risk of primary dysmenorrhea (painful menses)
- NO association was found for being overweight
- Commentary: Low body weight may be a risk factor for primary dysmenorrhea.
- Effects of L-carnitine supplementation for women with polycystic ovary syndrome: a systematic review and meta-analysis
- 9 studies, 995 participants with PCOS
- Compared to control groups, the addition of L-Carnitine (250 mg-3g/day) to various PCOS treatments (Clomid and/or metformin) led to reduced:
- Glucose (-5 mg/dl)
- LDL-C (-12 to -25 mg/dl)
- Total cholesterol (-21 to -24 mg/dl)
- Triglycerides (-9 to -19 mg/dl)
- There was NO improvement in pregnancy or ovulation rate
- Commentary: L-Carnitine used as an adjunctive therapy to other PCOS treatments led to improved metabolic markers, but NO improvement in pregnancy outcomes.
Diet & Lifestyle Studies
- Efficacy of Transcendental Meditation to Reduce Stress Among Health Care Workers: A Randomized Clinical Trial
- 80 healthcare workers, randomized to:
- Control group (Mindfulness-based stress reduction, journaling, etc)
- Transcendental meditation (TM) (20 min/day)
- After 3 months, compared to the control group, TM led to:
- NO greater improvement in psychological distress (-5.6 points TM vs -3.8 points control)
- Reduced emotional exhaustion (-8 points vs 2.6 points)
- Improved insomnia (-4.1 points vs -1.9 points)
- Reduced anxiety (-3.1 points vs -0.8 points)
- Commentary: TM was effective for improving emotional wellbeing in participants who experience higher levels of stress due to their jobs.
- 80 healthcare workers, randomized to:
- Hyperbaric oxygen therapy improves neurocognitive functions and symptoms of post-COVID condition: randomized controlled trial
- 73 long-covid patients (symptoms >3 months) were randomized to:
- Placebo
- Hyperbaric oxygen therapy (HBOT) (5 sessions/week, 2 ATA, 90 min sessions)
- Compared to the placebo group, HBOT led to improvements in:
- Energy scores (+18 HOBT vs +6 points placebo)
- Memory (+8 vs +7 points)
- Emotional wellbeing (+14 vs +4 points)
- Depression (-3.2 vs -0.8 points)
- Anxiety (-2.5 vs -0.5 points)
- Pain levels (moderate effect size)
- Sleep quality (small effect size)
- Commentary: HBOT led to improvements in multiple areas affected in patients with long-covid, including fatigue, sleep, pain, mood and cognitive functioning.
- 73 long-covid patients (symptoms >3 months) were randomized to:
- Systematic Review and Meta-analysis Seem to Indicate that Cannabinoids for Chronic Primary Pain Treatment Have Limited Benefit
- 8 RCTs, 240 patients with chronic pain
- Compared to placebo, cannabinoids did NOT improve:
- Pain
- Anxiety
- Depression
- However, cannabinoid treatment > 4 weeks led to a reduction in pain compared to placebo (large effect size)
- Commentary: Longer-term use of cannabinoids led to a reduction in pain.
Episode 79
Podcast Summary
Featured Study
- Screening for thyroid dysfunction with free T4 instead of thyroid stimulating hormone (TSH) improves efficiency in older adults in primary care
- Aim: Is fT4-based screening for thyroid dysfunction in older adults (>65 years old) more efficient than TSH for diagnosing overt hypothyroidism?
- “Subclinical hypothyroidism (SCH) is defined as a consistently elevated thyroid stimulating hormone (TSH) with a free T4 (fT4) within the reference range.”
- “This diagnosis may lead to:
- additional monitoring
- levothyroxine therapy and
- increased patient concerns, despite lack of evidence of treatment benefit in older adults”
- Screening for fT4 only instead of TSH led to:
- Increased positive-predictive value (PPV) for hypothyroidism (17% to 52%)
- PPV = probability patient truly has hypothyroidism
- Increased negative-predictive value (NPV) for hypothyroidism (96.1% to 97.8%)
- NPV = probability patient does not have hypothyroidism
- Increased positive-predictive value (PPV) for hypothyroidism (17% to 52%)
- Increasing the TSH cutoff value from 4.2 to 6.5 mU/L increased PPV for hypothyroidism (17% to 31%)
- Commentary: This study found screening older adults for hypothyroidism using fT4 or increasing the cutoff of TSH to 6.5 mU/L was more efficient in diagnosing overt hypothyroidism.
Gastrointestinal Studies
- Associations between food-specific IgG antibodies and intestinal permeability biomarkers
- 111 participants with and without GI symptoms
- Common food IgG antibodies, including to eggs, wheat and dairy, were:
- Associated with increased intestinal permeability markers (anti-LPS, anti-occludin)
- NOT associated with anti-vinculin or anti-CdtB
- There was NO difference in IgG food antibody levels or intestinal permeability markers when comparing symptomatic and asymptomatic participants
- Commentary: While this study found an association between food IgG antibodies and increased intestinal permeability, neither of these lab tests were associated with GI symptoms.
- Probiotics treatment for Parkinson disease: a systematic review and meta-analysis of clinical trials
- 8 studies on Parkinson’s disease (PD) patients
- 4/8 studies were on PD patients with constipation
- Treatment with probiotics (lacto/bifido) led to:
- Improved bowel movement frequency (+1/week)
- Improved stool consistency (moderate effect size)
- Reduced hs-CRP (-1.6 mg/L)
- Commentary: Probiotics improved bowel movement frequency, consistency and slightly reduced inflammation in patients with PD.
- Dr. R adding
- Most of the probiotic regimens were based on Lactobacillus and Bifidobacterium.
- Although the probiotic compositions varied, probiotic treatment significantly attenuated constipation for PwP and exhibited possible systematic effects on inflammation and metabolism.
- 8 studies on Parkinson’s disease (PD) patients
- Antimicrobial treatment improves tryptophan metabolism and mood of patients with small intestinal bacterial overgrowth
- 120 participants with anxiety and depression, categorized by:
- SIBO + IBS-D
- SIBO + IBS-C
- All participants were treated with rifaximin (1,200 mg/d for 10 days x 3 months)
- After 3 rounds, treatment with rifaximin led to improvements in:
- Constipation (92.5% resolution in IBS-C)
- Diarrhea (100% resolution in IBS-D)
- Depression (-5.7 points IBS-D, -2 points IBS-C)
- Anxiety (-14 points IBS-D, -4 points IBS-C)
- Commentary: Rifaximin led to improvements in anxiety, depression, diarrhea and constipation. Note the greater improvement in mood and GI symptoms in those with IBS-D compared to IBS-C.
- 120 participants with anxiety and depression, categorized by:
- Randomised controlled trial: effects of gluten-free diet on symptoms and the gut microenvironment in irritable bowel syndrome
- Crossover study, 20 IBS patients, randomized to each of the following for 2 weeks:
- Gluten free diet (GFD) + gluten flour
- GFD + Rice flour
- Compared to the gluten-containing diet, GFD led to greater improvements in:
- IBS symptom score (-53 vs -31 points)
- Abdominal pain intensity
- Daily interference of symptoms
- IBS-D vs IBS-C patients (20% vs 0% response rate)
- GFD did NOT lead to greater improvements in:
- Abdominal pain frequency
- Bloating
- Commentary: A gluten-free diet led to improvements in some IBS symptoms, particularly those with IBS-D.
- Crossover study, 20 IBS patients, randomized to each of the following for 2 weeks:
- A Low FODMAP Diet Reduces Symptoms in Treated Celiac Patients With Ongoing Symptoms-A Randomized Controlled Trial
- 70 celiac-disease (CD) patients in remission with persistent GI symptoms, currently on a gluten-free diet (GFD) were randomized to:
- Usual GFD (control)
- Low FODMAP + GFD
- After 1 month, the addition of a low FODMAP diet led to greater reductions in:
- GI symptom score (-11 vs -0.7 points)
- Abdominal pain (-1 vs -0.1 points)
- Bloating (-1.5 vs -0.1 points)
- Diarrhea (-0.6 vs 0 points)
- Commentary: CD patients with persistent GI symptoms, despite currently following a gluten-free diet, may benefit from a low FODMAP diet.
- 70 celiac-disease (CD) patients in remission with persistent GI symptoms, currently on a gluten-free diet (GFD) were randomized to:
Thyroid & Hormones Studies
- Menopausal hormone therapy does not improve some domains of memory: A systematic review and meta-analysis
- 10 RCTs, 2,818 healthy postmenopausal women without cognitive decline, randomized to:
- Placebo
- Hormone replacement therapy (HRT) (e.g. estrogen alone or estrogen-progestin combination)
- Compared to placebo, all forms of HRT did NOT improve overall memory, even when categorized by:
- Early administration (<5 years post-menopause)
- Late administration (>5 years post-menopause)
- Commentary: Regardless of hormone type, both early and late use of HRT showed NO benefit for improving memory in postmenopausal women.
- 10 RCTs, 2,818 healthy postmenopausal women without cognitive decline, randomized to:
Diet & Lifestyle Studies
- C-reactive protein could predict the efficacy of SSRIs in clinical practice: A cohort study of large samples in the real world
- 918 patients with depression on antidepressant medication, categorized by C-reactive protein (CRP) levels:
- Low CRP (< 1mg/L)
- High CRP (≥1 mg/L)
- SSRIs were 1.3x more effective in treating patients with a low CRP
- SNRIs were 1.7x more effective in treating patients with a high CRP
- Commentary: Levels of inflammation may predict which antidepressants patients will best respond to.
- 918 patients with depression on antidepressant medication, categorized by C-reactive protein (CRP) levels:
- Are Dietary Proteins the Key to Successful Body Weight Management? A Systematic Review and Meta-Analysis of Studies Assessing Body Weight Outcomes after Interventions with Increased Dietary Protein
- 37 RCTs on overweight participants, randomized to:
- Control (increased carbohydrates, fat, fiber, or no treatment)
- Increased protein intake (18 to 59% of total calories)
- Compared to controls, increasing protein intake led to a 3.5 lb reduction in weight
- Commentary: Increased protein intake led to a slight reduction in weight loss.
- 37 RCTs on overweight participants, randomized to:
- The Effects of Aerobic Exercise and Transcranial Direct Current Stimulation on Cognitive Function in Older Adults with and without cognitive impairment: A Systematic Review and Meta-analysis
- 68 RCTs in participants >60 years old, with or without cognitive impairment
- Aerobic exercise led to improved:
- Global cognition in adults with MCI (moderate effect size)
- Global cognition in healthy adults (small effect size)
- Transcranial direct current stimulation (tDCS) (a portable, wearable brain stimulation technique that delivers a low electrical current to the scalp) led to improved:
- Global cognition in adults with dementia (large effect size)
- Cognitive function in healthy adults (moderate effect size)
- Commentary: Both aerobic exercise and tDCS improved cognitive function, especially in those with MCI and dementia. The combination of these 2 therapies may provide a synergistic cognitive benefit.
- Acid suppressants use and risk of atherosclerotic cardiovascular disease in middle-aged and older adults
- 316,730 individuals (50-88 years old) on acid-suppressing medication, followed over 12.5 years
- Cardiovascular disease risk was:
- 1.1x increased with PPI use
- NOT associated with histamine-2 receptor medications
- Commentary: PPI use was associated with a small increased risk of CVD.
- Effect of Cholecalciferol Supplementation on Disease Activity and Quality of Life of Systemic Lupus Erythematosus Patients: A Randomized Clinical Trial Study
- 52 females with lupus (SLE), randomized to:
- Placebo
- Vitamin D (5,000 IU/day)
- After 3 months, compared to placebo, vitamin D supplementation led to:
- Increased serum vitamin D levels (+34 ng/mL vs +2 ng/mL)
- Decreased disease activity scores (-1.3 pts. vs -0.1 pts.)
- NO difference in quality of life scores
- Commentary: Vitamin D supplementation slightly reduced SLE disease activity with no effect on overall quality of life.
- 52 females with lupus (SLE), randomized to:
- The impact of coffee subtypes on incident cardiovascular disease, arrhythmias, and mortality: long-term outcomes from the UK Biobank
- 449,563 participants followed over 12.5 years, categorized by:
- Non-coffee drinkers
- Coffee drinkers
- Coffee consumption of 2-3 cups per day led to:
- 17% reduced risk of congestive heart failure
- 16% reduced risk of ischemic stroke
- 14% reduced risk of all-cause mortality
- 11% reduced risk of cardiovascular disease
- 9% reduced risk of arrhythmias
- Commentary: Coffee consumption, whether it was caffeinated or decaffeinated, led to reductions in all-cause mortality and various negative cardiovascular outcomes.
Episode 80
Podcast Summary
Featured Study
- Inspiratory muscle training as adjuvant therapy in obstructive sleep apnea: a randomized controlled trial
- 75 patients with sleep apnea, randomized:
- Control (sham therapy) +/- CPAP
- Inspiratory muscle trainer (POWERbreathe) +/- CPAP
- Compared to CPAP alone, CPAP + inspiratory muscle trainer led to greater reductions in:
- Sleep apnea severity (AHI) (-36/hour vs -6/hour)
- Sleepiness score (-8 vs -3 points)
- Sleep difficulty (-5 vs -1 point)
- Compared to CPAP alone, the inspiratory muscle trainer alone led to greater reductions in:
- Sleep apnea severity (AHI) (-9/hour vs -6/hour)
- Sleepiness score (-4 vs -3 points)
- Commentary: The inspiratory muscle trainer alone or in addition to the CPAP led to greater clinical improvements than CPAP alone.
- 75 patients with sleep apnea, randomized:
Gastrointestinal Studies
- Lactobacillus complex capsules ameliorate aspirin-related small intestinal mucosal injury: a prospective, randomized, controlled clinical trial
- 53 patients with aspirin-induced small intestinal mucosal injury, randomized to:
- Aspirin only
- Aspirin + probiotics (lactobacillus species and enterococcus faecium)
- After 2 months, probiotic supplementation led to improved:
- Mucosal injury scores
- Small intestinal ulcers
- NO improvement was seen in the control group
- Commentary: Probiotics led to greater small intestinal healing despite still using aspirin.
- 53 patients with aspirin-induced small intestinal mucosal injury, randomized to:
- Fecal Microbiota Transplantation Combined with a Low FODMAP Diet for the Treatment of Irritable Bowel Syndrome with Predominant Diarrhea
- 80 IBS-D patients randomized to:
- Fecal microbiota transplants (FMT) + normal diet
- FMT + Low FODMAP diet (LFD)
- After 6 months, compared to FMT alone, FMT + LFD led to:
-
- Greater IBS symptom response rates (63% vs 28%)
- Better quality of life
- Similar improvements in anxiety and depression
-
- Commentary: The addition of LFD led to greater improvements in IBS-D compared to FMT alone.
- 80 IBS-D patients randomized to:
- Effectiveness and Safety of Saccharomyces Boulardii for the Treatment of Acute Gastroenteritis in the Pediatric Population: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
- 10 studies, 1,282 children with acute gastroenteritis, randomized to:
- Control
- S. boulardii
- Compared to control, S. boulardii led to:
-
- 48% reduced risk of diarrhea lasting more than 3 days after starting treatment
- 30% reduced risk of diarrhea lasting more than 1 day after starting treatment
- Reduced duration of diarrhea (-20 hours)
- Reduced hospital stay (-0.9 days)
-
- NO side effects occurred
- Commentary: S. boulardii is safe and effective for improving clinical outcomes in children with acute gastroenteritis.
- 10 studies, 1,282 children with acute gastroenteritis, randomized to:
- Probiotic supplementation induces remission and changes in the immunoglobulins and inflammatory response in active ulcerative colitis patients: A pilot, randomized, double-blind, placebo-controlled study
- 24 mild-to-moderate ulcerative colitis (UC) patients, randomized to:
- Placebo
- Probiotics (Lacto/bifido, 10 billion CFU/day)
- Compared to placebo, probiotics led to:
- Reduced UC severity score (1.3 points vs 3.4 points)
- <2 = clinical remission
- Reduced C-reactive protein
- Reduced stool frequency
- Improved anemia
- Reduced UC severity score (1.3 points vs 3.4 points)
- Commentary: Probiotics led to higher rates of clinical remission in patients with mild-to-moderate UC.
- 24 mild-to-moderate ulcerative colitis (UC) patients, randomized to:
- The Effects of Modifying Amount and Type of Dietary Carbohydrate on Esophageal Acid Exposure Time and Esophageal Reflux Symptoms: A Randomized Controlled Trial
- 98 participants with GERD, randomized to:
- High carb, high simple (high in mono/disaccharides) (HCHS)
- High carb, low simple (low in mono/disaccharides) (HCLS)
- Low carb, high simple (LCHS)
- Low carb, low simple (LCLS)
- After 2 months, despite HCLS leading to the greatest reduction in esophageal acid exposure time, the findings were inconsistent regarding which dietary intervention led to the greatest improvement in:
- GERD overall scores (LCHS > LCLS > HCLS)
- Heartburn (LCLS > HCLS > LCHS)
- Regurgitation (LCHS > LCLS, HCLS)
- Commentary: The overall trend in the data suggests a lower carb diet, irrespective of mono/disaccharide content, is best for improving GERD symptoms. Note the lab finding did not support which diet would improve patients symptoms.
- 98 participants with GERD, randomized to:
Thyroid & Hormones Studies
- Subclinical thyroid dysfunction and incident diabetes: a systematic review and an individual participant data analysis of prospective cohort studies
- 61,178 participants with subclinical hypothyroidism (SCH) or euthyroidism
- After following participants over 8 years, NO association was found between SCH and the risk of type 2 diabetes
- Commentary: This large study found participants with SCH are not at a greater risk for developing diabetes.
- Effects of a combination of resveratrol and alpha-lipoic acid on body weight and adipose composition in women with PCOS: a preliminary pilot study
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- 8 overweight PCOS patients, treated with resveratrol (77 mg) and alpha-lipoic acid (100 mg) (R+ALA)
- After 3 months, R+ALA led to reduced:
- BMI (35 → 32)
- Waist circumference (115 cm → 110 cm)
- Trunk fat % (45% → 41%)
- Visceral fat % (24% → 20%)
- Commentary: This small study found R+ALA led to improved body composition in overweight women with PCOS. It’s important to note there was no control group.
Diet & Lifestyle Studies
- Metabolic Efficacy of Time-Restricted Eating in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
- 17 RCTs, 899 participants engaging in time restricted eating (TRE) ≥ 4 weeks
- TRE led to improvements in:
- Weight loss (-3.5 lbs)
- Fat loss (-3.3 lbs)
- Triglycerides (-13 mg/dl)
- Total cholesterol (-6.45 mg/dl)
- LDL-C (-7 mg/dl)
- TRE had NO effect on:
- Waist circumference
- BMI
- A1c
- Blood pressure
- Commentary: TRE led to improvements in body composition and lipids.
- The effectiveness of emotional freedom techniques (EFT) on depression of postmenopausal women: a randomized controlled trial
- 88 postmenopausal women with mild-moderate depression, randomized to:
- Control (sham therapy)
- Emotional freedom technique (EFT)
- Method used to reduce stress and negative thoughts utilizing tapping
- After 2 months, compared to control, EFT led to:
- Complete resolution of depression in 63% vs 34% of participants
- Reduced frequency of moderate depression (-48% vs -21%)
- Reduced depression score (-10 points vs -2 points)
- Commentary: EFT is an effective therapy for relieving depression in postmenopausal women, completely resolving depressive symptoms in 63% of women.
- 88 postmenopausal women with mild-moderate depression, randomized to:
- Feasibility of time-restricted eating and impacts on cardiometabolic health in 24-h shift workers: The Healthy Heroes randomized control trial
- 137 shift workers, treated with time restricted eating (10 hour window)
- Time restricted eating led to:
- Improved quality of life
- Reduced A1c
- NO adverse effects
- Commentary: TRE led to an improved quality of life in shift workers. Consider this recommendation in your shift work patients to support their circadian rhythm and quality of life.
- Eicosapentaenoic Acid for Cardiovascular Events Reduction- Systematic Review and Network Meta-Analysis of Randomized Controlled Trials
- 17 RCTs, 141,009 patients randomized to:
- Control (mineral oil, corn oil, olive oil or standard of care)
- EPA
- EPA + DHA
- Compared to mineral oil, EPA led to:
- 20% reduced risk of cardiovascular death
- 27% reduced risk of heart attack
- 26% reduced risk of stroke
- However, compared to other oils or standard of care, EPA led to NO difference in cardiovascular disease outcomes
- Commentary: EPA supplementation only led to better cardiovascular outcomes when compared to mineral oil placeo, but NOT compared to standard of care or other placebos.
- 17 RCTs, 141,009 patients randomized to:
- Meditation-Based Therapy for Chronic Low Back Pain Management: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
- 12 RCTs, 1,153 patients with chronic low back pain, randomized to:
- Meditation-based treatments (e.g. meditation, mindfulness-based stress reduction, mindfulness-based cognitive therapy)
- Control
- Compared to controls, meditation-based treatments led to:
- Reduced pain intensity (small effect size)
- Reduced bothersomeness of pain (small effect size)
- Improved quality of life (small effect size)
- Commentary: Meditation-based therapies provide some relief for patients experiencing chronic low back pain.
- 12 RCTs, 1,153 patients with chronic low back pain, randomized to:
- Effects of curcumin and/or coenzyme Q10 supplementation on metabolic control in subjects with metabolic syndrome: a randomized clinical trial
- 88 participants with metabolic syndrome, randomized to:
- Placebo
- Curcumin (200 mg/day) + placebo
- CoQ10 (60 mg/day) + placebo
- Curcumin + CoQ10
- Compared to all other groups, 3 months of curcumin alone led to the greatest improvements in:
- Triglycerides (-58 mg/dL)
- Total cholesterol (-31 mg/dL)
- LDL-C (-14 mg/dL)
- HDL-C (+10 mg/dL)
- NO groups had improvements in:
- Blood pressure
- Fasting glucose
- Weight
- Commentary: Curcumin led to significant improvements in lipids, most notably triglycerides and total cholesterol.
- 88 participants with metabolic syndrome, randomized to:
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