Episode 85
Podcast Summary
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
- Clinical response rates (67% FMT vs 66% controls)
- 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.
- 59 participants with post-infectious IBS, randomized to:
Gastrointestinal Studies
- Changes in Gut Microbiota and Systemic Inflammation after Synbiotic Supplementation in Patients with Systemic Lupus Erythematosus: A Randomized, Double-Blind, Placebo-Controlled Trial
- 46 patients with lupus, randomized to:
- Placebo
- Synbiotics (lacto/bifido with FOS)
- After 2 months, compared to placebo, synbiotics led to improved:
- Lupus disease activity scores (-4 vs 0 points)
- Inflammatory markers (hs-CRP, IL-6)
- Commentary: Synbiotics led to greater improvements in lupus disease activity and inflammatory markers.
- 46 patients with lupus, randomized to:
- Efficacy and Safety of the Adjuvant Use of Probiotic Bacillus clausii Strains in Pediatric Irritable Bowel Syndrome: A Randomized, Double-Blind, Placebo-Controlled Study
- ~340 pediatric IBS patients were randomized to:
- Placebo + conventional treatment
- Soil based probiotic + conventional treatment
- After 2 months, there was NO difference between groups regarding number of patients with:
- Symptomatic improvement (74% probiotic vs 79% placebo)
- Complete symptomatic relief (19% vs 21%)
- Commentary: Soil based probiotics provided no additional benefit to conventional IBS treatment compared to placebo.
- ~340 pediatric IBS patients were randomized to:
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.
- 24 observational studies, 3.4 million patients (ages ranged from 18 to 70+ years old)
Diet & Lifestyle Studies
- Is the combination of exercise therapy and health education more effective than usual medical care in the prevention of non-specific back pain? A systematic review with meta-analysis
- 4 RCTs, 1,235 patients with non-specific low back or neck pain, randomized to:
- Control groups (usual care, health education)
- Exercise therapy (strength training, stretching, yoga) + health education
- Exercise therapy + health education led to greater improvements in:
- Pain intensity (moderate effect size)
- Disability (small effect size)
- Pain catastrophizing (making it worse in one’s mind)
- Kinesophobia (fear of moving)
- Commentary: The addition of exercise led to significant improvements in back and neck pain. It’s also noteworthy that exercise led to psychological benefits, specifically relating to one’s fear of moving and their thoughts about their pain.
- 4 RCTs, 1,235 patients with non-specific low back or neck pain, randomized to:
- Maternal antenatal vitamin D supplementation and offspring risk of atopic eczema in the first 4 years of life: evidence from a randomized controlled trial
- 703 pregnant women randomized to the following during pregnancy:
- Placebo
- Vitamin D (1,000 IU/day)
- Compared to placebo, the children in the vitamin D group experienced a 45% reduced risk of eczema at 1 year old
- However, the vitamin D group only experienced benefit when the infants were breastfed >1 month, NOT <1 month
- Commentary: Vitamin D supplementation during pregnancy was found to reduce the risk of pediatric eczema, but only when the baby was breastfed for >1 month.
- 703 pregnant women randomized to the following during pregnancy:
- 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.”
- 24 RCTs, 1,753 healthy weight and overweight participants, randomized to:
Episode 86
Podcast Summary
Featured Study
- Effectiveness of a Novel Food Composed of Leucine, Omega-3 Fatty Acids and Probiotic Lactobacillus paracasei PS23 for the Treatment of Sarcopenia in Elderly Subjects: A 2-Month Randomized Double-Blind Placebo-Controlled Trial
- 60 older sarcopenic adults, randomized to:
- Placebo
- Lactobacillus probiotic (30 billion CFU), Omega-3 fatty acids (500mg) and leucine (2.5g)
- After 2 months, compared to placebo, the intervention group experienced improved:
- Weight (+ 3 lbs vs -3.2 lbs)
- Body mass (+0.54 vs -0.60 kg/m2)
- Muscle mass and strength
- Physical performance (mobility, balance, gait speed)
- Activities of daily living
- Commentary: The combination of omega-3 fatty acids, leucine, and probiotics improved physical function in older adults with low muscle mass.
- 60 older sarcopenic adults, randomized to:
- 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.
- 200 participants with COVID-related sarcopenia, randomized to:
- 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.
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.
- 59 IBD patients in remission who met the criteria for IBS, all treated with a low FODMAP diet (LFD)
- Low FODMAP diet reduces gastrointestinal symptoms in irritable bowel syndrome and clinical response could be predicted by symptom severity: A randomized crossover trial
- 29 participants with IBS were randomized to:
- Control diet (moderate FODMAP diet)
- Low FODMAP diet (LFD)
- Lactulose breath test was performed prior to the intervention
- After 1 week, a LFD led to improved:
- IBS symptom scores (-64 LFD vs -10 points control)
- Stool consistency and frequency
- Abdominal pain frequency and severity
- High levels of H2 and CH4 after lactulose breath testing did NOT predict who would respond positively to a LFD
- Commentary: LFD led to improvements in IBS symptoms after just 1 week. This study highlights the importance of treating the person and not the test, as the test results did not help inform who would benefit from the LFD.
- 29 participants with IBS were randomized to:
- Supplementation of Probiotics in Pregnant Women Targeting Group B Streptococcus Colonization: A Systematic Review and Meta-Analysis
- 5 RCTs on pregnant women, randomized to one of the following during pregnancy:
- Placebo
- Probiotics (lactobacillus species)
- Compared to placebo, probiotic supplementation led to NO significantly reduced risk for vaginal group-B strep positivity (39% placebo vs 32% probiotic)
- 5 RCTs on pregnant women, randomized to one of the following during pregnancy:
- Preventive Effect of Probiotics on Oral Mucositis Induced by Cancer Treatment: A Systematic Review and Meta-Analysis
- 7 RCTs, 708 cancer patients undergoing cancer treatment, randomized to:
- Control
- Probiotics (lacto/bifido, soil based)
- 5/7 studies administered probiotics as mouthwash or lozenges
- Probiotics led to a lower incidence of severe oral mucositis (34% probiotic vs 57% control)
- Commentary: Probiotics were effective in reducing the risk of oral mucositis, a painful side effect of chemotherapy.
- 7 RCTs, 708 cancer patients undergoing cancer treatment, randomized to:
- 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.
- 11 RCTs, 392 participants with NAFLD, 349 healthy controls, randomized to:
- 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.
- 60 young adults with IBS and insomnia, randomized to:
- Live and Heat-Killed Probiotic Lactobacillus paracasei PS23 Accelerated the Improvement and Recovery of Strength and Damage Biomarkers after Exercise-Induced Muscle Damage
- 114 healthy participants randomized to:
- Control
- Live Lactobacillus probiotic (20 billion CFU)
- Heat-killed Lactobacillus probiotic (20 billion CFU)
- After 6 weeks, post-exercise, BOTH live and heat-treated probiotics led to:
- Faster muscle strength recovery
- Decreased physical fatigue
- Decreased markers of muscle damage
- Decreased inflammatory markers
- Commentary: Both live and heat-killed probiotics can improve exercise-induced muscle damage and recovery.
- 114 healthy participants randomized to:
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.
- 7 RTCs, 447 participants with PCOS, randomized to:
- Correlation between Hashimoto’s thyroiditis and polycystic ovary syndrome: A systematic review and meta-analysis
- 20 studies, 7,857 participants with PCOS
- Women with PCOS had a 2.3x higher risk of developing Hashimoto’s thyroiditis
- However, a prior diagnosis of Hashimoto’s was NOT associated with an increased risk for PCOS
- Commentary: This observational study shows that women with PCOS have a higher risk of developing Hashimoto’s thyroiditis.
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.
- 10,233 older participants (≥65 years old), categorized by:
- Effects of vitamin D supplementation on depression and some selected pro-inflammatory biomarkers: a double-blind randomized clinical trial
- 56 patients with mild-moderate depression were randomized to:
- Placebo
- Vitamin D (50,000 IU x 2 doses)
- After 2 months, compared to placebo, the vitamin D group experienced:
- Reduced depression severity scores (-12 vs -3.6 points)
- Increased Vitamin D levels (+16 vs +2 ng/ml)
- NO difference in inflammatory markers (hsCRP, IL-6)
- Commentary: High dose vitamin D supplementation led to improved depressive symptoms.
- 56 patients with mild-moderate depression were randomized to:
Episode 87
Podcast Summary
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.”
- 21 RCTs, 2,551 participants with mild to moderate depression, randomized to:
Gastrointestinal Studies
- Impact of probiotics on muscle mass, muscle strength and lean mass: a systematic review and meta-analysis of randomized controlled trials
- 24 RCTs
- Compared to placebo, probiotics led to increased:
- Strength (moderate effect size)
- Muscle mass (small effect size)
- NO difference in lean mass (muscles, bones, organs,etc)
- Commentary: Probiotic supplementation was helpful for improving muscle mass and strength.
- Probiotics for the improvement of metabolic profiles in patients with metabolic-associated fatty liver disease: A systematic review and meta-analysis of randomized controlled trials
- 15 RCTs, 772 patients with fatty liver disease, randomized to:
- Control
- Probiotics (lacto/bifido, streptococcus)
- Compared to control, probiotics led to improvements in:
- ALT (-11.8 U/L)
- AST (-9.1 U/L)
- GGT (-5.7 U/L)
- Insulin resistance (-0.6)
- NO improvement was noted for cholesterol, LDL-C, CRP, triglycerides or TNF-a
- 15 RCTs, 772 patients with fatty liver disease, randomized to:
- Adjuvant probiotic Bifidobacterium animalis subsp. lactis CP-9 improve phototherapeutic treatment outcomes in neonatal jaundice among full-term newborns – A randomized double-blind clinical study
- 83 newborns with jaundice (high serum bilirubin), randomized to:
- Placebo + phototherapy
- Probiotic (bifidobacterium, 10 billion CFU/day) + phototherapy
- Compared to placebo group, the probiotic group experienced:
- Shorter duration of phototherapy needed (43 vs 58 hours)
- Quicker reduction in serum bilirubin
- NO adverse effects
- Commentary: The addition of bifidobacterium probiotic to phototherapy led to quicker resolution of jaundice in newborns. Bifidobacterium at 10 billion CFU/day was safe for infants.
- 83 newborns with jaundice (high serum bilirubin), randomized to:
- Effects of Resistant Starch on Symptoms, Fecal Markers, and Gut Microbiota in Parkinson’s Disease – The RESISTA-PD Trial
- 57 parkinson’s disease (PD) patients, randomized to:
- Control (increased dietary fiber recommendations)
- Resistant starch (10g/day)
- After 2 months, resistant starch led to:
- Improved non-motor symptoms
- Improved depressive scores
- NO change in constipation
- Commentary: Prebiotics in the form of resistant starch led to improvements in various clinical features associated with PD.
- 57 parkinson’s disease (PD) patients, randomized to:
- Metformin with Versus without Concomitant Probiotic Therapy in Newly Diagnosed Patients with Type 2 Diabetes or Prediabetes: A Comparative Analysis in Relation to Glycemic Control, Gastrointestinal Side Effects, and Treatment Compliance
- 156 participants with prediabetes or type 2 diabetes, randomized to:
- Metformin
- Metformin + probiotic (bifidobacterium)
- After 3 months, compared to metformin alone, those taking probiotics had:
- Higher rates of compliance (92% probiotics vs 71% control)
- Greater reduction in HbA1c (-0.9% vs -0.4%)
- Probiotic use also led to lower rates of medication-related GI symptoms:
- Abdominal pain (9% vs 0%)
- Nausea (17% vs 0%)
- Bloating (29% vs 9%)
- Commentary: Probiotics in addition to metformin increased treatment adherence, likely related to reduced medication-related side effects.
- 156 participants with prediabetes or type 2 diabetes, randomized to:
- 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.
- 56 RCTs on participants with allergic rhinitis, randomized to:
Diet & Lifestyle Studies
- What Parameters Influence the Effect of Cold-Water Immersion on Muscle Soreness? An Updated Systematic Review and Meta-Analysis
- 44 RCTs on physically active participants, randomized to:
- Control
- Cold-water immersion (CWI)
- Compared to control, CWI led to a reduction in muscle soreness
- These effects were observed with the following parameters:
- Moderate or severe cold temperatures
- Intermittent or continuous immersion
- Short or medium immersion times
- Commentary: This study found a variety of cold-immersion strategies work to improve muscle soreness post-exercise.
- 44 RCTs on physically active participants, randomized to:
- Efficacy of a food supplement based on S-adenosyl methionine and probiotic strains in subjects with subthreshold depression and mild-to-moderate depression: A monocentric, randomized, cross-over, double-blind, placebo-controlled clinical trial
- 80 participants with subclinical or mild to moderate depression, randomized to:
- Placebo
- SAMe (200mg/day) + probiotics (lacto/bifido) + Magnesium + B6
- After 3 months, SAMe + probiotic therapy led to greater reduction in depression scores (-5 points SAMe/probiotic vs -1 point control)
- Commentary: SAMe + probiotic supplementation can improve depressive symptoms in those with mild to moderate depression.
- 80 participants with subclinical or mild to moderate depression, randomized to:
- Effects of inspiratory muscle training in patients with obstructive sleep apnoea syndrome: a systematic review and meta-analysis
- 7 RCTS, 365 participants with mild to severe OSA, randomized to:
- Control
- Inspiratory muscle training (IMT)
- After 1-2 months, IMT led to improved:
- Inspiratory muscle strength (large effect)
- Sleep quality (large effect)
- Daytime sleepiness (large effect)
- Lung function (moderate effect)
- There was NO benefit seen with sleep apnea severity
- Commentary: IMT significantly improved sleep quality and daytime sleepiness despite NO improvement in sleep apnea severity.
- 7 RCTS, 365 participants with mild to severe OSA, randomized to:
Episode 88
Podcast Summary
Featured Study
- Efficacy and Acceptability of Dietary Therapies in Non-Constipated Irritable Bowel Syndrome: A Randomized Trial of Traditional Dietary Advice, the Low FODMAP Diet, and the Gluten-Free Diet
- 99 participants with IBS without constipation, randomized to:
- Control (traditional IBS diet)
- Low FODMAP diet (LFD)
- Gluten-free diet
- After 1 month, compared to controls, ALL groups had similarly reduced IBS symptom severity scores:
- LFD (-163 points)
- Traditional diet (-131 points)
- Gluten-free diet (-119 points)
- All 3 diets led to a reduction in total FODMAP intake
- Commentary: LFD, gluten-free diet, and standard dietary advice similarly improved IBS symptoms. This may suggest less restrictive diets may be used as a first-line diet for those with IBS before using a LFD.
- 99 participants with IBS without constipation, randomized to:
Gastrointestinal Studies
- Probiotics modulate gastrointestinal microbiota after Helicobacter pylori eradication: A multicenter randomized double-blind placebo-controlled trial
- 276 patients with H. pylori, randomized to:
- Quadruple therapy + placebo
- Quadruple therapy + probiotics (lacto/bifido, enterococcus, soil-based)
- After 2 weeks, the addition of probiotics led to reduced side effects:
- Vomiting (2% vs 7%)
- Bloating (12% vs 27%)
- Nausea (13% vs 25%)
- There was NO difference in H. pylori eradication rates
- Commentary: Probiotics can reduce treatment-related side effects with no difference in H. pylori eradication rates.
- 276 patients with H. pylori, randomized to:
- Effects of a Low-Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyol Diet on Symptoms of Functional Abdominal Pain in Pediatric Patients
- 50 pediatric participants (3-18 years old) with IBS and functional abdominal pain treated with a low FODMAP diet (LFD)
- After 2 months, a LFD led to:
- 84% response rate
- >50% improvement in pain (33% of participants)
- >30-50% improvement in pain(44% of participants)
- Improved quality of life
- NO difference in stool quality
- 20% dropout rate
- Commentary: A low FODMAP diet reduced pain and improved quality of life in children with IBS, irrespective of the IBS subtype. Note the relatively high dropout rate.
- The effect of multistrain probiotics on functional constipation in the elderly: a randomized controlled trial
- 60 older participants with functional constipation, randomized to:
- Placebo
- Probiotic (lacto/bifido drops, 1 billion CFU)
- After controlling for laxative use, 3 months of daily probiotics led to more frequent bowel movements (30 vs 17 cumulative bowel movements)
- Commentary: Low dose probiotics may improve constipation in older adults.
- 60 older participants with functional constipation, randomized to:
- Clinical efficacy of synbiotics in children with allergic rhinitis: An observational cohort study from a private medical center in Peru
- 215 children with allergic rhinitis, categorized by:
- No treatment (controls)
- Synbiotics (lacto/bifido (5 billion CFU), fructooligosaccharides, vitamin C)
- After 3 months, compared to controls, synbiotic use led to:
- Decreased allergic disease severity
- Decreased nasal symptoms
- Improved quality of life
- Commentary: This observational study suggests that synbiotics improve symptoms and quality of life in children with allergic rhinitis.
- 215 children with allergic rhinitis, categorized by:
- 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.
- 4 RCTs, 287 participants with Parkinson’s-related constipation, randomized to:
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.
- The Influence of Levothyroxine on Body Composition and Physical Performance in Subclinical Hypothyroidism
- 25 women with subclinical hypothyroidism, all treated with levothyroxine (LT4)
- After 2 months, LT4 therapy led to:
- Improved muscle strength and mobility
- Normalized TSH levels (5.94 → 1.2 μIU/ml)
- NO difference in body composition or weight
- Commentary: The use of LT4 in subclinical hypothyroidism improved physical performance with no effect on body composition. Keep in mind there was NO placebo group.
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)
- Sauna use frequency:
- 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.
- 2,575 men, categorized by:
- Effects of exercise therapy on global cognitive function and, depression in older adults with mild cognitive impairment: A systematic review and meta-analysis
- 22 RCTs on adults with depression and mild cognitive impairment (MCI)
- Aerobic and strength training led to improvements in:
- Cognitive function (moderate effect size)
- Depression (small effect size)
- Commentary: Exercise can improve both cognitive function and depression.
- 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.
- Effects of structured exercise programmes on physiological and psychological outcomes in adults with inflammatory bowel disease (IBD): A systematic review and meta-analysis
- 15 studies, 637 participants with IBD, randomized to:
- Control (no exercise, alternative exercise, usual care)
- Exercise (walking, aerobic, resistance, yoga, and cycling at low-to-moderate intensities)
- Compared to controls, exercising for a minimum of 1 month led to:
- Reduced disease activity (small effect size)
- NO difference in quality of life
- Commentary: Exercise lowers IBD disease activity. It’s important to note 80% of these studies were based on participants with inactive to mild IBD.
- 15 studies, 637 participants with IBD, randomized to:
- Efficacy of Internet-based cognitive behavioral therapy on sleeping difficulties in menopausal women: A randomized controlled trial
- 80 menopausal women with poor sleep quality, randomized to:
- Control
- Internet-based CBT (1x/week)
- After 6 weeks, compared to controls, CBT led to:
- Increased total sleep time (+2.7 hours/night)
- Decreased time to fall asleep (-2 hours/night)
- Increased sleep efficiency >85% (time sleeping/time in bed)
- Commentary: CBT is an effective therapy for improving sleep quality in menopausal women.
- 80 menopausal women with poor sleep quality, randomized to:
- Potential Benefits of Selenium Supplementation in Reducing Insulin Resistance in Patients with Cardiometabolic Diseases: A Systematic Review and Meta-Analysis
- 10 RCTs, 526 participants with cardiometabolic disease, randomized to:
- Control (placebo, usual care)
- Selenium (200 μg/day)
- Compared to controls, 1-6 month of selenium use led to improved:
- HDL-C (large effect size)
- Insulin levels (medium effect size)
- Insulin sensitivity scores (medium effect size)
- There was NO difference in serum glucose or other lipid levels
- Commentary: Selenium supplementation improves insulin levels and resistance in those with cardiometabolic disease.
- 10 RCTs, 526 participants with cardiometabolic disease, randomized to:
- Efficacy of vitamin D supplementation as an adjunct therapy for improving inflammatory and oxidative stress biomarkers: An umbrella meta-analysis.
- 23 meta-analyses, 21,148 participants
- Vitamin D supplementation led to:
- Reduced inflammatory markers (small effect size)
- Reduced oxidative stress markers (small effect size)
- NO effect on antioxidant levels
- Commentary: The use of vitamin D reduces markers of inflammation and oxidative stress with no effect on total antioxidant status.
- 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.
- 52 participants with moderate-to-severe sleep apnea and poor tolerability to CPAP, randomized to:
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