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

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Future of Functional Medicine Review Clinical Newsletter

Research Briefs for Practitioners – July 2022

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

Medically reviewed & fact checked by a
board-certified doctor
Medically reviewed & fact checked by a
board-certified doctor
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Episode 60

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Featured Study


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Gastrointestinal Studies

  • Golden bifid might improve diarrhea-predominant irritable bowel syndrome via microbiota modulation
    • 21 IBS-D patients, all treated with probiotics 
      • 16/21 also diagnosed with SIBO 
    • After 1 month, probiotics led to improved IBS symptom scores, including: 
      • Abdominal pain (-1)
      • Abdominal distension (-0.7)
      • Diarrhea (-1.4)
      • Stool urgency (-1.1)
      • Incomplete evacuation (-1)
      • Depression (-2.9)
    • SIBO was eradicated in 25% 
    • Commentary: Probiotics led to improvements in IBS symptoms while also eradicating SIBO in a small proportion of patients.
  • Postinfection Irritable Bowel Syndrome
    • Narrative review
    • Post-infectious (PI) IBS develops in approximately 11.5% of acute gastroenteritis (AGE) cases
    • Infections most commonly associated with developing PI-IBS include:
      • Shigella
      • Vibrio cholerae
      • Giardia lamblia 
    • Commentary: A significant percentage of IBS diagnoses may be due to a history of GI infection.
  • Intestinal Dysbiosis in Patients with Histamine Intolerance
    • 12 histamine intolerant (HIT) patients, 14 healthy controls
    • Stool samples were collected on all participants
    • Compared to healthy controls, HIT patients had greater:
      • Diamine oxidase (DAO) deficiency (83% of HIT patients) 
      • Histamine-secreting bacteria (staphylococcus, proteus, clostridium perfringens, enterococcus faecalis, enterobacteriaceae)
    • Commentary: This small study showed patients with HIT have greater dysbiosis and lower DAO. This supports the hypothesis that HIT begins in the gut.
  • Effects of Lactobacillus gasseri CP2305 on Mild Menopausal Symptoms in Middle-Aged Women
    • 80 women (40-60 y/o) with mild menopausal symptoms, randomized to: 
      • Placebo
      • Probiotic 
    • After 6 months, the probiotic group had improved:
      • Overall symptom relief (75% probiotic vs 55% placebo) 
      • Global menopausal symptom score
      • Vasomotor score
      • Psychological score
    • Commentary: Probiotics may improve menopausal symptoms. Note the high placebo response.
  • Probiotic sepsis in preterm neonates-a systematic review
    • 1,569 studies on probiotics in preterm infants (<32 weeks old)
    • Sepsis caused by probiotics was confirmed in 25 cases
    • Commentary: This study showed a very small number of preterm infants developed sepsis from probiotics. Keep in mind that many other studies show significant benefit from probiotics for preterm infants in preventing necrotising enterocolitis, all-cause mortality and even sepsis.

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Thyroid & Hormones Studies


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Diet & Lifestyle Studies


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Episode 59

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Featured Study


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Gastrointestinal Studies

  • The effects of probiotics plus dietary fiber on antipsychotic induced weight gain: a randomized clinical trial
    • 113 schizophrenic and bipolar patients taking antipsychotics, randomized to: 
      • Placebo
      • Probiotics
      • Fiber
      • Probiotics + fiber
    • After 3 months, compared to placebo, probiotics + fiber led to the greatest improvements in: 
      • Weight loss (-5.2 lb probiotic/fiber vs +5.7 lbs placebo) 
      • BMI (-0.9 vs +1.0)
      • Insulin (-1.9 vs +4.6 µIU/mL) 
      • Insulin resistance (-0.4 vs +1.1) 
    • Commentary: Probiotics + fiber prevented weight gain and metabolic imbalances in those taking antipsychotics, which are known side effects. This highlights the gut-metabolism connection.
  • Systematic review and meta-analysis of probiotics in the treatment of allergic rhinitis
    • 30 RCTs, 2,708 patients with allergic rhinitis randomized to placebo or probiotics 
    • Probiotics led to improvements in: 
      • Quality of life score (-9.4)
      • Allergic rhinitis symptom score (-1.9)
    • NO change in blood eosinophils, allergic eye symptoms or antigen-specific IgE levels between groups
    • Commentary: Probiotics improved allergic rhinitis symptoms and quality of life.
  • Probiotic as an adjuvant therapy in chronic urticaria: a blinded randomized controlled clinical trial
    • 42 patients with chronic urticaria, randomized to: 
      • Antihistamines alone (control)
      • Antihistamines + probiotics (intervention)
    • After 2 months, antihistamines + probiotics led to greater improvements in:
      • Urticaria scores (-21 intervention vs -18.4 control)
      • Quality of life (+66% vs +44%) 
    • Commentary: Addition of probiotics to antihistamine medication led to better clinical outcomes in patients with urticaria.
  • Effect of Probiotic-Assisted Eradication of cagA+/ vacA s1m1 Helicobacter pylori on Intestinal Flora
    • 168 patients with cagA+/vacA H. pylori, randomized to:
      • Bismuth quadruple therapy (BQT)
      • BQT + S. boulardii
    • After 2 weeks, the probiotic group experienced: 
      • Greater eradication rates (82% vs 77%)
      • Fewer adverse events (8% vs 25%
      • Quicker resolution of symptoms
    • Commentary: Another study showing the synergistic effect of adding probiotics to antimicrobial therapy in treating H. pylori, especially in reducing side effects.

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Thyroid & Hormones Study


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Diet & Lifestyle Studies

  • Meditation-based lifestyle modification in mild to moderate depression-A randomized controlled trial
    • 81 patients with mild to moderate depression, randomized to: 
      • Antidepressant medication (control) 
      • Treatment as usual (TAU) 
        • Includes medication, movement therapy, psychotherapy, relaxation techniques
      • Meditation-based lifestyle modification (MBLM) 
        • Includes whole-food diet, sleep hygiene, yoga, meditation, breathing exercises, mindset etc
      • After 2 months, compared to control and TAU, MBLM led to a greater reduction in depression scores (-13.1 MBLM vs -3.3 TAU vs -1.7 control) 
      • Commentary: A comprehensive lifestyle-based approach was more effective in improving depression than medication.

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Episode 58

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Featured Studies


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Gastrointestinal Studies


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Thyroid & Hormones Studies

  • Different regimens of menopausal hormone therapy for improving sleep quality: a systematic review and meta-analysis
    • 15 studies, 27,715 menopausal women randomized to placebo or hormone therapy
    • Sleep quality was improved to a greater extent with: 
      • Hormone therapy in general vs placebo (small effect size) 
      • Estradiol vs conjugated equine estrogen (small effect size) 
      • Transdermal vs oral estrogen (small effect size)
      • Combined estrogen/progesterone vs estrogen alone (small effect size) 
    • Commentary: While hormone therapy does provide some benefit for sleep quality, the effect size is small.

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Diet & Lifestyle Studies

  • The Effects of Cold Exposure Training and a Breathing Exercise on the Inflammatory Response in Humans: A Pilot Study
    • 48 healthy males randomized to:
      • Control (no training)
      • Cold exposure 
      • Breathing exercise (Wim Hof breathing exercise)  
      • Cold exposure + breathing exercise 
    • All participants trained for 1 week before they were injected with lipopolysaccharide (LPS) to induce inflammation
    • Breathing exercise alone and combined with cold exposure led a reduction in proinflammatory cytokines, including: 
      • TNF-α (-32%)
      • IL-6  (-35%)
      • IL-8: (-30%)
    • Commentary: This is the second study to show the combination of breathing exercise + cold exposure can reduce inflammatory cytokines.

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Episode 57

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Featured Studies

  • Effect of Liothyronine Treatment on Quality of Life in Female Hypothyroid Patients With Residual Symptoms on Levothyroxine Therapy: A Randomized Crossover Study
    • 59 female patients with residual hypothyroid symptoms despite adequate levothyroxine (T4) or combined T4/T3 combo therapy
    • Randomized (non-blinded) to: 
      • T4 x 3 months, then T3 x 3 months
      • T3 x 3 months, then T4 x 3 months 
    • Patients initially on T4/T3 had to take 1 month of T4 alone prior to randomization
    • After 3 months, T3 treatment led to greater improvements in: 
      • Hypothyroid symptom (-12 T3 vs -2 T4)
      • Physical fatigue (-4 vs -0.5) 
      • Mental fatigue (-1.8 vs -0.4)
      • Cognitive complaints (-20 vs -9)
      • Quality of life (+11 vs +1) 
      • Depression (-10 vs +1) 
    • TSH levels remained within range in both groups
    • Commentary: Compared to the study above, this smaller study shows symptomatic hypothyroid patients may benefit from treatment with T3. Keep in mind these patients knew which medication they were getting as the study was unblinded.

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Gastrointestinal Studies

  • Probiotics in the Treatment of Inflammatory Bowel Disease in Adulthood: A Systematic Review
    • 22 studies on patients with IBD
    • Crohn’s disease: 
      • Probiotics alone had NO effect in 6/7 studies
    • Active ulcerative colitis:
      • Probiotics + standard treatment improved active ulcerative colitis compared to standard treatment alone in 5/9 studies
    • Inactive ulcerative colitis:
      • Probiotics were as effective as standard treatment in 3/7 studies
    • Commentary: While the results of this study are mixed, the overall trend suggests probiotics are beneficial especially in combination with other therapies.

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Diet & Lifestyle Studies

  • Obesity, Thyroid and OSA: An Intriguing Triangle
    • 65 patients w/ untreated sleep apnea, all underwent thyroid function tests
    • Overt hypothyroidism was diagnosed in 12.3% of patients (as compared to 1% of the general population)
    • Commentary: Hypothyroidism is associated with sleep apnea. Keep in mind this is an observational study.
  • Calorie Restriction with or without Time-Restricted Eating in Weight Loss
    • 118 obese participants randomized to: 
      • Calorie restriction (CR) 
      • Time restricted feeding (8:00 AM – 4:00 PM) (TRF) + CR
    • After 1 year, TRF group experienced greater weight loss compared to CR alone (18 lbs vs 14 lbs)
    • Commentary: The addition of TRF to CR may lead to small further improvement in weight loss.

Discussion

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