Research Briefs for Practitioners – February 2023 - Dr. Michael Ruscio, DC

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Future of Functional Health Review Clinical Newsletter

Research Briefs for Practitioners – February 2023

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 85

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Podcast Summary


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Featured Study

  • Fecal microbiota transplantation in patients with post-infectious irritable bowel syndrome: A randomized, clinical trial
    • 59 participants with post-infectious IBS, randomized to:
      • Control (low FODMAP diet, Lacto/Bifido + S. boulardii probiotic, antispasmodic medication)
      • Fecal microbiota transplantation (FMT)
    • After 3 months, BOTH groups experienced improved:
      • Clinical response rates (67% FMT vs 66% controls)
        • Clinical response determined by >50 pt. reduction on IBS-SSS
      • IBS symptom severity score (-120 vs -126 points)
      • Fatigue 
      • Quality of life
    • After treatment, stool testing revealed dysbiosis improved to a greater extent in the FMT group vs control group
    • Commentary: Both FMT and a more conservative approach of a low FODMAP diet, probiotics and an antispasmodic medication were equally effective for improving post-infectious IBS symptoms. Despite FMT improving dysbiosis to a greater extent, there was NO difference in symptom improvement.

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Gastrointestinal Studies

 


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Thyroid & Hormones Studies

  • Hormone Therapy for the Primary Prevention of Chronic Conditions in Postmenopausal Persons: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force
    • 23 studies, 1.2 million postmenopausal women (50-79 years old) followed over an average of 5-7 years
    • Compared to placebo, estrogen-only hormone replacement led to: 
      • Reduced diabetes risk (-1.5%) 
      • Reduced fracture risk (-3.9%) 
      • Increased gallbladder disease risk (+3.7%) 
      • Increased stroke risk (+0.8%) 
      • Increased blood clot risk (+0.8%) 
      • Increased urinary incontinence risk (+8.5%)
    • Compared to placebo, estrogen+progestin hormone replacement led to: 
      • Reduced colorectal cancer risk (-0.34%)
      • Reduced diabetes risk (-0.8%)
      • Reduced fracture risk (-2.3%)
      • Increased breast cancer risk (+0.5%) 
      • Increased gallbladder disease risk (+2.6%)
      • Increased stroke risk (+0.5%)
      • Increased blood clot risk (+1.2%)
      • Increased dementia risk (+0.9%)
      • Increased urinary incontinence risk (+5.7%)
    • Commentary: Hormone replacement therapy led to a most notable benefit of reduced fracture risk, but also led to an increased risk of multiple health concerns, including stroke, blood clots, urinary incontinence, gallbladder disease and breast cancer.

 

  • Sex differences in major cardiovascular outcomes and fractures in patients with subclinical thyroid dysfunction: a systematic review and meta-analysis
    • 24 observational studies, 3.4 million patients (ages ranged from 18 to 70+ years old)
      • 58% of studies did not report if participants were taking thyroid hormones
    • Subclinical hypothyroidism was associated with an increased risk for: 
      • Major adverse cardiovascular events (MACE) (2.4x) (males only) 
      • Cardiac death (1.4x) (females only) 
      • All-cause mortality (1.4x) 
    • Subclinical hypothyroidism was NOT associated with an increased risk for: 
      • Coronary heart disease
      • Atrial fibrillation
      • Heart failure
      • Stroke
    • Commentary: Subclinical hypothyroidism was associated with an increased risk of MACE in men, as well as a general increased risk of all-cause mortality. It’s important to keep in mind these observational studies used a wide range of ages, and more than half the studies did NOT report whether patients were taking thyroid hormones.

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Diet & Lifestyle Studies

 

 

  • A meta-analysis comparing the effectiveness of alternate day fasting, the 5:2 diet, and time-restricted eating for weight loss
    • 24 RCTs, 1,753 healthy weight and overweight participants, randomized to: 
      • Control (continuous calorie restriction)
      • Alternate day fasting
      • The 5:2 diet (5 non-fasting days + 2 fasting days)
      • Time-restricted eating 
    • Compared to control, all three IF methods led to NO difference in weight loss (-0.5 lbs)
    • Commentary: Intermittent fasting methods and calorie restriction are equally effective for weight loss. This likely indicates we can have a patient pick a fasting/dietary strategy that is sustainable for them instead of which one is “best.”
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Episode 86

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Podcast Summary


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Featured Study

 

  • The Contribution of Diet Therapy and Probiotics in the Treatment of Sarcopenia Induced by Prolonged Immobilization Caused by the COVID-19 Pandemic
    • 200 participants with COVID-related sarcopenia, randomized to:
      • Control (physical training 3x/wk + vitamin D 2,000 IU)
      • Dietary protein (1.2-1.5 g/kg) + Bifido/Lacto/Enterococcus probiotics + control
    • After 2 months, compared to controls, the addition of protein + probiotics led to:
      • Lower rates of sarcopenia (35% intervention vs 52% controls)
      • Increased skeletal muscle mass index
      • NO difference in BMI
    • Commentary: The addition of probiotics and increased dietary protein to resistance training and vitamin D improved muscle mass in those with infection-related muscle wasting.
  • Sarcopenia is a significant risk factor for all cause mortality in older adults. Weight training, increased quality protein and probiotics are likely important interventions for improving sarcopenia.

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Gastrointestinal Studies

  • Low-FODMAP Diet for the Management of Irritable Bowel Syndrome in Remission of IBD
    • 59 IBD patients in remission who met the criteria for IBS, all treated with a low FODMAP diet (LFD)
      • 81% SIBO positive
      • 19% SIBO negative
    • After 6 weeks, the LFD led to resolution of IBS symptoms in:
      • 66% of all patients
      • Both SIBO positive and SIBO negative patients (69% vs 54%)
    • Commentary: A low FODMAP diet led to resolution of IBS symptoms in more than half of patients, regardless of a SIBO diagnosis.

 

 

 

 

  • Influence of Helicobacter pylori infection and its eradication treatment on small intestinal bacterial overgrowth
    • 102 patients with abdominal symptoms, all underwent H. pylori and SIBO breath testing
    • SIBO positivity rate was nearly double in those with H. pylori compared to those without (60% vs 31%
    • Treatment for H. pylori with quadruple therapy led to:
      • 40% reduction in SIBO positivity
      • Improved constipation, abdominal distension, and diarrhea
    • Commentary: SIBO positivity was higher in those with H. pylori infection, and treatment of H. pylori led to a significant reduction in SIBO and improvement in GI symptoms.

 

  • The effects of supplementation of probiotics, prebiotics, or synbiotics on patients with non-alcoholic fatty liver disease: A meta-analysis of randomized controlled trials
    • 11 RCTs, 392 participants with NAFLD, 349 healthy controls, randomized to:
      • Placebo
      • Probiotics (lacto/bifido, enterococcus) 
      • Prebiotics (FOS, dextrin)
      • Synbiotics
    • After a duration of 2 months-1 year, compared to controls, supplementing with probiotics/prebiotics/synbiotics led to improved:
      • Fatty liver (hepatic steatosis) (medium effect)
      • Triglycerides (small effect)
      • Total cholesterol (small effect)
      • LDL-C (small effect)
      • ALT (small effect)
      • GGT (small effect)
    • There was NO effect on hepatic fibrosis, AST, or markers of glucose control
    • Commentary: Probiotics with or without the addition of prebiotics improves liver steatosis, markers of liver health, and lipid profiles in those with NAFLD.

 

  • The Effects of Cognitive Behavioral Therapy for Insomnia among College Students with Irritable Bowel Syndrome: A Randomized Controlled Trial
    • 60 young adults with IBS and insomnia, randomized to:
      • Control (non-CBT-I)
      • Cognitive behavioral therapy for insomnia (CBT-I) 
    • After 1 month, CBT-I led to improved:
      • IBS symptom scores (-127 CBT vs +12 points control)
      • Time taken to fall asleep (-25 vs +5 minutes)
      • Negative thoughts pertaining to sleep
      • Insomnia severity 
    • Symptom improvements were maintained for 3 months after CBT-I treatment
    • Commentary: CBT-I is an effective and sustainable therapy for improving sleep and GI symptoms in young adults with IBS and insomnia. This highlights the gut-sleep connection.

 


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Thyroid & Hormones Studies

  • Therapeutic effect and safety of curcumin in women with PCOS: A systematic review and meta-analysis
    • 7 RTCs, 447 participants with PCOS, randomized to:
      • Control (placebo or metformin)
      • Curcumin (100-500mg) +/- metformin
    • After a duration of 2-6 months, compared to controls, curcumin intake led to decreased:
      • Total cholesterol (-15.6 mg/dl) 
      • BMI (-0.3 kg/m2)
      • Fasting blood glucose (-3.6 mg/dl)
      • Insulin (-1.8 uIU/mL)
      • Insulin resistance (HOMA-IR) (-0.6)
      • CRP (-0.8 mg/L)
    • There was NO difference in:
      • Testosterone
      • DHEA
      • FSH/LH
    • NO adverse effects were seen from curcumin supplementation
    • Commentary: Curcumin improved metabolic health, but did NOT improve hormonal imbalances associated with PCOS.

 


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Diet & Lifestyle Studies

  • Association of the interaction between physical activity and sitting time with mortality in older Japanese adults
    • 10,233 older participants (≥65 years old), categorized by:
      • High physical activity (≥21 min/day) 
      • Low physical activity (<21 min/day) 
      • High sit time (≥5 hours/day)
      • Low sit time (<5 hours/day
    • After 5 years, the all-cause mortality rates were: 
      • 14% for low activity, high sit time
      • 8% for low activity, low sit time 
      • 6% for high activity, low sit time 
      • 6% for high activity, high sit time 
    • Commentary: Lack of physical activity and prolonged sitting increased the risk of all-cause mortality. High physical activity is likely protective against the risk of prolonged sitting.

 


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Episode 87

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Podcast Summary


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Featured Study

  • Comparative effectiveness of exercise, antidepressants and their combination in treating non-severe depression: a systematic review and network meta-analysis of randomised controlled trials
    • 21 RCTs, 2,551 participants with mild to moderate depression, randomized to:
      • Control (placebo, stretching, no treatment)
      • Exercise
      • Antidepressants (Prozac, Zoloft, Cymbalta, Celexa)
      • Exercise + antidepressants 
    • Compared to controls, ALL interventions led to similar improvements in depressive symptoms:  
      • Exercise + antidepressants (small effect size)
      • Antidepressants alone (small effect size)
      • Exercise alone (small effect size) 
    • Commentary: This meta analysis found NO difference in benefit when comparing exercise to antidepressants. The authors conclude “Our findings align with the recommendations provided by European, Canadian, Australian and UK treatment guidelines supporting the use of exercise as an alternative treatment for non-severe depression.”

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Gastrointestinal Studies

 

 

 

 

 

  • Role of Probiotics in Patients with Allergic Rhinitis: A Systematic Review of Systematic Reviews
    • 56 RCTs on participants with allergic rhinitis, randomized to:
      • Placebo
      • Probiotics (Lacto/Bifido, E. coli, Tetragenococcus and/or Streptococcus)
    • Compared to controls, probiotics led to:
      • Reduced overall rhinitis symptoms (small to medium effect size)
      • Reduced allergic eye symptoms (medium to large effect size)
      • NO difference in allergic rhinitis incidence
    • Commentary: Probiotics reduced allergic rhinitis symptoms, but did NOT reduce the overall incidence.

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Diet & Lifestyle Studies

 

 


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Episode 88

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Podcast Summary


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Featured Study


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Gastrointestinal Studies

 

 

 

 

  • Probiotics for constipation in Parkinson’s: A systematic review and meta-analysis of randomized controlled trials
    • 4 RCTs, 287 participants with Parkinson’s-related constipation, randomized to:
      • Control (placebo, no treatment, trimebutine)
      • Probiotics/synbiotics (Enterococcus, lacto/bifido, Streptococcus, FOS) 
    • Compared to controls, the use of probiotics led to:
      • Increased bowel movements frequency (+1 per week)
    • There was NO difference between groups in:
      • Stool consistency
      • Abdominal pain or distention
      • Parkinson’s symptom scores
    • Commentary: The use of probiotics in Parkinson’s-related constipation may slightly increase the frequency, but not consistency, of bowel movements.

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Thyroid & Hormones Studies

  • Clinical usefulness of thyroid ultrasonography in patients with primary hypothyroidism
    • 114 patients with hypothyroidism (overt or subclinical) without suspicion of thyroid nodules
    • All participants underwent a thyroid ultrasound (US)
    • Thyroid US led to the diagnosis of: 
      • Chronic thyroiditis in 19% of those with NO thyroid antibodies
      • Large thyroid nodules in 19% 
    • Commentary: ~1/5th of hypothyroid patients were found to have both inflammation of the thyroid and large thyroid nodules. Note that almost 20% of those with thyroiditis had no thyroid antibodies.

 


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Diet & Lifestyle Studies

  • Inflammation, sauna bathing, and all-cause mortality in middle-aged and older Finnish men: a cohort study
    • 2,575 men, categorized by:
      • Sauna use frequency:
        • Low use (≤ 2 sessions/week)
        • High use (3-7 sessions/week)
      • hsCRP levels
        • Low (≤ 3 mg/L)
        • High (> 3 mg/L)
    • All-cause mortality risk was influenced by:
      • High vs low sauna use (14% decreased risk)
      • High vs low hsCRP (27% increased risk)
      • High hsCRP + low sauna use (28% increased risk)
      • High hsCRP + high sauna use (NO increased risk)
    • Commentary: High hsCRP was associated with an increased risk for all-cause mortality, which was attenuated with high-frequency sauna use.

 

 

  • The Effect of Chronic Exercise on Energy and Fatigue States: A Systematic Review and Meta-Analysis of Randomized Trials
    • 81 RCTs, 7,050 participants who chronically exercised (1+ bouts of exercise/week, for more than 3 weeks)
    • Exercise led to improved: 
      • Feeling of vitality (moderate effect size)
      • Energy (small-moderate effect size)) 
      • Fatigue (small effect size)) 
    • Fatigue was reduced to a greater extent with: 
      • Moderate intensity > light intensity 
    • Energy was increased to a greater extent with: 
      • Moderate and high intensity > light intensity 
      • Resistance + aerobic training > aerobic training alone 
    • Commentary: A combination of strength and aerobic training at a moderate-high intensity led to the greatest improvements in fatigue and energy levels. 

 

 

 

 

 

  • The RonchAP® palatinal device: A conservative approach in treating obstructive sleep apnea syndrome-a randomized, controlled study
    • 52 participants with moderate-to-severe sleep apnea and poor tolerability to CPAP, randomized to:
      • Control (no treatment)
      • Ronch palatal device 
        • Functions by opening and supporting the soft palate during sleep
    • After 1 month, compared to controls, use of the palatal device led to improved:
      • Sleep apnea severity (-16 events/hour treatment vs -1.5 events/hour control)
      • Sleep quality 
      • Daytime sleepiness 
    • Commentary: Conservative treatment with a palatal device led to significant improvements in apneic events after just 1 month.

Discussion

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