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

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Future of Functional Health Review Clinical Newsletter

Research Briefs for Practitioners – December 2022

by the Ruscio Institute for Functional Health Clinical Team

Medically reviewed & fact checked by a
board-certified doctor
Medically reviewed & fact checked by a
board-certified doctor
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Episode 77

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Podcast Summary


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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.

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Gastrointestinal Studies

 

 

 

 

 

 

  • 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.

 

  • 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.

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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. 

 

 

  • 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.

 

 

  • 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.

 

  • 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.

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Episode 78

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Podcast Summary


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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.

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Gastrointestinal Studies

 

 

 

 

  • 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.

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Thyroid & Hormones Studies

 

  • 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.

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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.

 

  • 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.

 

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Episode 79

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Podcast Summary


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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
    • 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.

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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.

 

  • 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.

 

  • 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.

 

  • 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.

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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.

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Diet & Lifestyle Studies

 

 

 

 

 


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Episode 80

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Podcast Summary


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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.

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Gastrointestinal Studies

 

 

 

 

  • 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.

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Thyroid & Hormones Studies

 


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Diet & Lifestyle Studies

 

  • 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.

 

 

  • 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.

 

 


Discussion

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