- How adding the abdominal massage to polyethylene glycol can improve symptom and quality of life in patients with functional constipation in comparison with each one of the treatment modalities alone: A randomized clinical trial
- 150 participants w/ functional constipation, randomized to 3 groups
- Abdominal massage (15 min/day)
- Polyethylene glycol (Miralax)
- Polyethylene glycol + abdominal massage
- After 14 days, the polyethylene glycol + abdominal massage had (compared to other groups):
- Lower straining
- Less incomplete evacuation
- Improved quality of life
- Commentary: A combination of abdominal massage and polyethylene glycol is safe, tolerable and more effective than each one of the treatments alone
- 150 participants w/ functional constipation, randomized to 3 groups
- A Review of the Role of Probiotic Supplementation in Dental Caries
- Review of the literature indicates that probiotics significantly reduced the risk of dental caries by:
- inhibiting cariogenic bacteria
- enriching commensal microbes in the oral cavity
- Review of the literature indicates that probiotics significantly reduced the risk of dental caries by:
- The efficacy and safety of probiotics for patients with constipation-predominant irritable bowel syndrome: A systematic review and meta-analysis based on seventeen randomized controlled trials
- 17 trials, 1,500 patients w/ IBS-C
- Overall, probiotics significantly:
- increased stool frequency by 1.29 bowel movements per week
- Improved stool consistency
- Shorter gut transit time by 12.5 hours
- Commentary: more proof of the efficacy probiotics in constipation
- Spore-forming Bacillus coagulans SNZ 1969 improved intestinal motility and constipation perception mediated by microbial alterations in healthy adults with mild intermittent constipation: A randomized controlled trial
- 80 patients w/ mild intermittent constipation received spore-forming probiotic or placebo
- After 8 weeks, the probiotic groups had
- Improved gut transit time
- More Complete bowel movements
- Less abdominal discomfort
- Elevated Faecal Calprotectin in Patients with a Normal Colonoscopy: Does It Matter in Clinical Practice? A Retrospective Observational Study
- 1,200 patients referred for colonoscopy, measured fecal calprotectin day before, followed for 3 years
- Of the 600 who had normal colonoscopy
- 34% had elevated calprotectin (>50 μg/g)
- 66% had normal calprotectin
- Association of elevated calprotectin and UPPER GI diseases (e.g. gastritis)
- BUT, this association was not seen after adjusting for NSAID, PPI, age, and gender
- No increased risk of LOWER GI disease in those w/ elevated calprotectin but had NORMAL colonoscopy
- Commentary: An elevated calprotectin does NOT indicate increased future risk of GI disease in those with NORMAL colonoscopy.
- Histamine Intolerance: The Current State of the Art
- Review of histamine intolerance
- In study of 27 headache patients, DAO deficiency in 85%
- After patients followed low histamine diet x4 weeks:
- Significant increase in DAO activity
- remission or reduction in frequency of headaches in 90%
- In another study of 137 migraine patients, 87% had DAO deficiency
- In a pediatric population under 15 years of age, DAO deficiency in 88% of patients with abdominal pain, diarrhea and vomiting
- Efficacy of low histamine diet ranges from 33-100%
- Majority of studies (10 of the 13) reviewed found an improvement in symptoms in >50% of patients
- Efficacy of DAO supplementation of 93% in one small study of 14 participants
- Commentary: Histamine may play a role in headaches/migraines/functional GI disorders. Most importantly, a low histamine diet can lead to clinical improvements.
- After patients followed low histamine diet x4 weeks:
- A Multicenter, Randomized, Double-blind, Placebo-controlled Trial of Saccharomyces boulardii in Infants and Children With Acute Diarrhea
- 100 infants, 3-36 months old with acute diarrhea
- Received standard of care plus S. boulardii (5 billion CFU BID) or placebo x5 days
- Time of recovery from diarrhea was significantly shorter in the probiotic group compared with the placebo (65.8 hours vs. 95.3 hours)
- Efficacy of zinc supplementation in the management of acute diarrhoea: a randomised controlled trial
- 86 children w/ diarrhea, received zinc glycinate (15 mg) or placebo
- The zinc group had::
- Reduced time to recovery (44 hours vs 52 hours in controls)
- Reduced number of stools (5 vs 7)
- Reduced average duration of IV fluid therapy (40 hours vs 56 hours)
- The duration of hospitalization was (60 hours vs 84 hours)
- Commentary: Zinc supplementation may lead to moderate improvement in acute diarrhea.
- Increased intestinal permeability with elevated peripheral blood endotoxin and inflammatory indices for e-waste lead exposure in children
- What are the effects of lead exposure on intestinal permeability in children?
- Cross sectional study, 187 children 3-6 years old (½ exposed, ½ not exposed)
- intestinal permeability measured via bacterial endotoxin and inflammatory cells (monocytes)
- Compared to non-exposed children, the exposed children had
- Higher blood lead levels
- Higher endotoxin levels
- Higher monocyte/inflammatory cells
- Slower growth levels
- Commentary: Toxins are a main driver of increased intestinal permeability and inflammation.
- Intestinal permeability in spondyloarthritis and rheumatoid arthritis: A systematic review of the literature
- Is intestinal permeability part of the pathogenesis of spondyloarthritis (SA) and rheumatoid arthritis (RA)
- Systematic review of 23 studies
- Increased permeability in:
- large majority of studies for SA regardless of the method used
- Effect seen independent of NSAID use
- only ½ of studies looking at RA
- large majority of studies for SA regardless of the method used
- Commentary: Increased intestinal permeability may play a role in the pathogenesis of some autoimmune disease, some more than others.
- Nutraceuticals in Patients With Heart Failure: A Systematic Review
- 40 studies over 6 months w/ at least 50 patients
- Decreased mortality for use of
- CoQ10
- Polyunsaturated fatty acids (PUFAs)
- Underpowered or too small of studies to show benefit:
- Magnesium
- Thiamin
- Vitamin E
- L-carnitine
- Beetroot juice
- L-arginine
- Vitamin D
- Commentary: Good evidence exists for using CoQ10 and PUFAs in those w/ heart failure.
- Snoring and environmental exposure: results from the Swedish GA2LEN study
- Study published in British Medical Journal
- Cross-sectional analysis, 25,000 healthy participants in Sweden
- Of the 4,000 (16%) habitual snorers, there was a higher rate of reported
- water damage (8.3% vs 7%)
- floor dampness (4.6% vs 3.8%)
- And visible mold (5.2% vs 3.8%) in their homes when compared to non-snorers
- Compared to non-snorers, habitual snorers had higher reports of:
- Annoyed/irritated by air pollution
- sometimes 16.2% vs 13.9%
- daily 4.6% vs 3.1%
- Annoyed by traffic fumes
- somewhat 19% vs 18.5%
- very 5% vs 3.6%
- Annoyed/irritated by air pollution
- Commentary: This study points to the possible CLINICAL EFFECT that mold exposure has on non-specific health outcomes such as snoring/apnea/sleep health. Those who snored, had higher rates of possible mold exposure and chemical sensitivity. However, the percent differences of snorers vs non-snorers is not that different and we should be careful w/ confirmation bias.
- Efficacy and Safety of Omega-3 Fatty Acids in Patients Treated with Statins for Residual Hypertriglyceridemia: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial
- Multi-center RCT of 215 patients who were on statins w/ goal LDL-C but elevated triglycerides (Tgs) >200 mg/dL
- Continued statin use and randomized to 4 g omega-3 or placebo
- After 8 weeks, the omega-3 group had improvement in:
- Triglycerides (-30% vs 3.6% in placebo)
- non-HDL-C (-10% vs -5%)
- Higher rate of those reaching triglyceride target of <200 mg/dL (63% vs 22%)
- Commentary: Addition of high dose omega 3 (4 g EPA + DHA) to those on statin with increased Tgs lead to significant improvement in metabolic markers.
- The correlation between lipoprotein(a) and coronary atherosclerotic lesion is stronger than LDL-C, when LDL-C is less than 104 mg/dL
- To investigate the correlation of Lp(a) and coronary atherosclerotic lesion, and find out the balance point in LDL-C and Lp(a) control
- 3,500 patients divided into atherosclerosis or non-atherosclerosis groups depending on angiography test
- The correlation between Lp(a) and atherosclerosis was stronger than LDL-C when LDL-C < 104 mg/dl.
- Commentary: Consider residual risk of high Lp(a) in those with goal LDL-C.
- Aspirin in the primary prevention of cardiovascular disease on diabetic patients: Systematic review and meta-analysis
- 7 RCT, 28,000 patients
- Aspirin used in the primary prevention of cardiovascular disease (CVD) in diabetic patients associated with:
- NO significant reduction in all-cause mortality
- 8% reduction in major adverse cardiovascular events (MACE)
- 30% relative increase in major bleeding and 40% relative increase in major GI bleeding
- Commentary: Aspirin use among diabetic patients in primary prevention appears to be associated with increased risk of major bleeding, a modest decrease of MACE, but lack of mortality benefit.
- Remnant lipoproteins: are they equal to or more atherogenic than LDL?
- Review the potential harmful effects of remnant lipoproteins (e.g. remnant VLDL)
- Main findings:
- Remnant VLDL particles accumulate significantly in those with high triglycerides and are cleared very slowly
- Remnant VLDL particles may increase cardiovascular risk
- In randomized trials involving statin-treated patients with cardiovascular disease, remnant cholesterol levels were associated with atherosclerosis independently of LDL-cholesterol.
- Commentary: Overall findings from multiple types of studies indicate that remnant lipoproteins are a major contributor to atherosclerosis.
- Statin use increased new-onset diabetes in hypercholesterolemic individuals: Data from the Korean National Health Insurance Service-National Health Screening Cohort database (NHIS-HEALS)
- NHANES analysis of 21,000 participants (half were statin users, other half had high cholesterol but not on statin), followed over 12 years
- Measured new onset diabetes
- Compared to non-users, statin users had a significantly higher risk of new onset diabetes (HR 1.43 in men, 1.86 in women)
- Commentary: Statin use may modestly increase risk of diabetes. This effect was greater in women than men.
- Levothyroxine Treatment and Cardiovascular Outcomes in Older People with Subclinical Hypothyroidism: Pooled Individual Results of Two Randomized Controlled Trials
- Does treating subclinical hypothyroidism (SCH) improve cardiovascular outcomes in older adults?
- Combo of 2 RCTs
- 700 patients ≥65 years, 100 patients ≥80 years with SCH (median TSH 6.4)
- Randomized to levothyroxine (median dose 50 mcg) or placebo
- Levothyroxine did NOT reduce:
- cardiovascular events
- atrial fibrillation
- heart failure
- all-cause mortality
- Commentary: Treatment of SCH (w/ TSH <10) in older adults is not well-supported by the latest evidence
- The low FODMAP diet for IBS: A multicentre UK study assessing long term follow up
- 205 IBS patients following low FODMAP diet, followed over 3.7 years
- 60% noticed symptom improvement at follow-up
- Laryngopharyngeal Reflux Disease is More Severe in Obese Patients: A Prospective Multicenter Study
- 260 patients w/ reflux disease
- Obese patients reported more and higher degree severity of reflux symptoms than normal weight patients
- Commentary: Consider weight loss for 1st line therapy in those suffering from reflux.
- Histamine Intolerance Originates in the Gut
- Bloating found in 90% of those with histamine intolerance (HIT)
- Diarrhea 70%
- Abdominal pain 65%
- Constipation 55%
- Study gives standardized survey for evaluating HIT
- Bloating found in 90% of those with histamine intolerance (HIT)
- Evaluation of glutathione reductase activity in colon tissue of patients with irritable bowel syndrome
- 15 IBS patients, 15 controls
- Colon biopsies, measured glutathione reductase activity
- IBS group had significantly reduced glutathione reductase activity compared to controls
- Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement
- Consensus statement
- USPSTF now recommends colon cancer screening for low-risk adults starting at 45 years old
- The USPSTF concludes with moderate certainty that screening for colon cancer in those ages 76-85 years who have been previously screened has small net benefit
- Oral Administration of S-Adenosylmethionine (SAMe) and Lactobacillus Plantarum HEAL9 Improves the Mild-To-Moderate Symptoms of Depression: A Randomized, Double-Blind, Placebo-Controlled Study
- 90 patients with mild-moderate depression, randomized to 200 mg SAMe + probiotic or placebo
- After 6 weeks, the SAMe + probiotic group saw greater reduction in depression and anxiety symptoms
- Effects were seen within 2 weeks
- Bisphenol: A removal and degradation pathways in microorganisms with probiotic properties
- In-vitro test
- Assessed toxin-removal properties of various probiotics (all 3 categories)
- ALL strains exhibited BPA-removal ability
- Commentary: This corroborates other studies supporting the detoxification properties of probiotics
- Serum Zinc and Selenium in Children with Inflammatory Bowel Disease: A Multicenter Study in Japan
- Retrospective study of pediatric patients w/ IBD in Japan
- 98 w/ Crohn’s disease (CD)
- 118 w/ ulcerative colitis (UC)
- 43 healthy controls
- Measured serum zinc and selenium
- Rates of zinc and selenium deficiency were much more common in CD compared to UC and controls
- Selenium deficiency:
- CD: 15%
- UC: 6%
- Controls: 0%
- Zinc deficiency:
- CD: 60%
- UC: 52%
- Controls: 37%
- Commentary: I suspect that since CD can affect the small bowel, nutrient absorption can be impaired much more compared to UC which solely affects the large bowel.
- Selenium deficiency:
- Retrospective study of pediatric patients w/ IBD in Japan
- Effect of disease duration on the association between serum albumin and mucosal healing in patients with ulcerative colitis
- Cross-sectional study of 270 patients w/ ulcerative colitis (UC)
- Measured serum albumin and stratified patients into those w/ mucosal healing or no mucosal healing
- High serum albumin (>4.4 mg/dL) was associated with mucosal healing (OR 2.3) in those w/ UC <7 years
- NO association in those w/ UC >7 years
- Commentary: Low serum albumin may be a sign of chronic inflammation. Therefore, higher levels may be associated with less inflammation and thus, mucosal healing.
- A Clinical Perspective on the Dietary Therapies for Pediatric Eosinophilic Esophagitis: The Gap Between Research and Daily Practice
- Review of 20 studies examining dietary therapies for pediatric eosinophilic esophagitis (EoE)
- Endorses elemental diet
- 8 studies
- Remission rate 75-100%
- Used elemental diet 4-8 weeks exclusively
- Should repeat endoscopy in 4-8 weeks
- 8 studies
- Commentary: Highly consider use of elemental diet in those w/ EoE.
- Cardiovascular outcomes and rates of fractures and falls among patients with brand-name versus generic L-thyroxine use
- 200,000 treated w/ L-thyroxine:
- 87% generic
- 17% brand
- Compared rates of cardiovascular disease and falls
- No significant differences between patients treated with brand vs generic for:
- atrial fibrillation
- myocardial infarction
- congestive heart failure
- stroke
- spine fracture
- hip fractures
- thyroid cancer
- Commentary: There were no differences in generic vs brand for these outcomes. However, some patients will respond better to brand.
- 200,000 treated w/ L-thyroxine:
- Positive effects of selenium supplementation in women with newly diagnosed Hashimoto’s thyroiditis in an area with low selenium status
- 29 women w/ new diagnosis of Hashimoto’s thyroiditis but were euthyroid or had subclinical hypothyroidism
- Given selenium 100 mcg/d for 6 months
- Selenium supplementation significantly decreased level of TPO Abs
- Oxidative stress and neuroinflammation should be both considered in the occurrence of fatigue and depression in multiple sclerosis
- 98 patients w/ MS, 35 healthy controls
- Measured CRP and uric acid (as marker of oxidative stress)
- Also measured depression and fatigue through validated questionnaires
- Compared to controls, MS patients had lower uric acid levels (indicating chronic oxidative stress)
- CRP levels higher during relapse (compared to remitting)
- Higher CRP and lower uric acid levels were correlated with higher depression scores and fatigue
- Adherence and Dietary Composition during Intermittent vs. Continuous Calorie Restriction: Follow-Up Data from a Randomized Controlled Trial in Adults with Overweight or Obesity
-
- Compared intermittent caloric restriction (ICR) to continued caloric restriction
- 98 overweight or obese randomly assigned to ICR or CCR, followed for 2 years
- No difference in weight loss
- ICR had less dietary adherence at follow up
- CCR: 32% rarely followed diet
- ICR: 71% rarely followed diet
- Commentary: In terms of weight loss, intermittent fasting does NOT lead to better outcomes than continuous calorie restriction. However, this does NOT mean that there are other possible benefits of intermittent fasting.
- Hemoglobin A1C Levels are Independently Associated with the Risk of Coronary Atherosclerotic Plaques in Patients without Diabetes: A Cross-Sectional Study
- 1,000 non-diabetic participants, measured atherosclerotic plaque by CT scan
- After adjusting for comorbidities, independent risk factors found for predicting coronary plaque:
- Higher Age
- Male Gender
- Higher BMI
- Higher A1C
- Higher HbA1c levels are independently associated with the presence and severity of atherosclerosis in non-diabetic subjects, even when LDL-C levels are tightly controlled.
- Commentary: Blood sugar control is an independent risk factor for heart disease independent of diabetes and LDL-C values.
- The effect of cocoa/dark chocolate consumption on lipid profile, glycemia, and blood pressure in diabetic patients: A meta-analysis of observational studies
- 8 trials, 400 patients w/ diabetes
- Cocoa/dark chocolate associated with significant reduction in
- LDL-c levels (-15.49 mg/dl)
- Fasting blood sugar (-6.88 mg/dl)
- Association between high-sensitivity C-reactive protein levels and depression: Moderation by age, sex, obesity, and aerobic physical activity
- Cross-sectional study of 10,000
- Measured CRP and depressive scores
- Adults with high hsCRP levels were more likely to have depressive symptoms (OR 1.41) and suicidal ideation (OR: 1.39)
- Commentary: Inflammation may be a part of the pathogenesis of depression.
- Dietary choline and betaine intake and risk of hypertension development: A 7.4-year follow-up
- Cohort of 2,800 participants followed over 7 years
- 22% developed hypertension (HTN) over the 7 years
- Risk of developing HTN decreased by 16% per every 100 mg increase in dietary choline
- NO significant association was observed between dietary intake of betaine and the risk of HTN
- Commentary: Remember that you can get choline from eggs and liver.
- Iron deficiency without anaemia: a diagnosis that matters
- 2 billion people with iron deficiency anaemia (IDA), 2.4 billion people with iron deficiency without anaemia (IDWA)
- Iron deficiency (ID)= refers to low iron stores, regardless of whether anaemia is present or not
- Symptoms of anemia such as fatigue can be present without anaemic hemoglobin levels
- Causes of iron deficiency:
- inadequate dietary intake
- increased body needs
- reduced absorption
- chronic inflammation
- chronic blood loss
- Gut-iron connection
- gastric acid is required for the reduction of Fe3+ to Fe2+, which is more readily absorbed
- pylori infection may cause ID due to reduced iron absorption and blood loss
- Celiac disease and inflammatory bowel disease can lead to ID secondary to chronic inflammation
- Accurate diagnosis:
- Ferritin is an indicator of iron stores and is the most sensitive and specific biomarker for assessing ID.
- Cutoff: <30 μg/L
- But, cut-off values for ferritin in ID are increased to 100 μg/L in states of chronic inflammation
- Transferrin saturation (TSAT) levels below 20% are also diagnostic of ID
- Serum iron levels fluctuate throughout the day and should not be used for diagnosis
- Other markers
- Serum transferrin receptor (sTFR) is a valuable indicator of ID
- it is unaffected by inflammation (unlike ferritin)
- Would be HIGH in iron deficiency
- When hemoglobin levels are normal, a low reticulocyte hemoglobin count (RHC) indicates early ID
- Serum transferrin receptor (sTFR) is a valuable indicator of ID
- “Clinicians should consider the fact that normal hemoglobin ranges have been set using population data. Essentially, what may be a normal hemoglobin level for one person may be abnormal for another, especially if a patient has a hemoglobin level in the low-normal range but their usual hemoglobin levels are higher.”
- Ferritin is an indicator of iron stores and is the most sensitive and specific biomarker for assessing ID.
- Treatment of ID
- “A recent systematic review concluded that iron supplementation in IDWA improves subjective measures of fatigue.”
- ID (even without anemia) should be treated when identified, with a target ferritin of 100 mg/L
- Using single doses on alternate days as opposed to multiple doses on consecutive days has been shown to result in higher absorption
- The recommended oral dose is 28–50 mg iron daily or 100 mg on alternate days for 25 days
- Once ferritin levels have corrected, patients should be followed up with blood tests every 6–12 months
- Commentary: Save this algorithm in your notes. Iron deficiency (even without frank anemia) is worth diagnosing accurately and treating when indicated but don’t forget the gut-iron connection.
- Changes in serum zonulin in individuals with morbid obesity after weight-loss interventions: a prospective cohort study
- 160 adults w/ morbid obesity
- Tracked serum zonulin at baseline, 6 months after diet/lifestyle interventions, and 6 months after bariatric surgery
- Zonulin reduced after the conservative weight loss intervention, and further reduced after bariatric surgery.
- Reduction in zonulin was associated with improvement of diarrhea, markers of glucose intolerance and liver disease, but not associated with the change in BMI
- Commentary: Higher quality diet and improved blood sugar control may improve leaky gut independent of weight loss.
- Gluten-induced Neurocognitive Impairment: Results of a Nationwide Study
- Survey of 1,400 individuals w/ gluten intolerance (celiac or NCGS)
- 89% of CD and 95% of NCGS reported some type of neurocognitive impairment
- Most common symptoms: difficulty concentrating, forgetfulness, and grogginess
- Commentary: brain fog is a common symptom of gluten intolerance
- Faecal bile acids and colonic bile acid membrane receptor correlate with symptom severity of diarrhoea-predominant irritable bowel syndrome: A pilot study
- Measured bile acid receptors and fecal bile acids in those w/ IBS-D compared to healthy controls
- Reactivity of bile acid receptors was higher in IBS-D patients than controls
- The patients with more severe or more frequent abdominal pain had significantly higher bile acid receptor levels
- Fecal bile acids were significantly increased in IBS-D patients and associated with more diarrhea
- Commentary: fecal bile acid levels and bile acid receptors are higher in those w/ IBS-D. Consider bile acid malabsorption in those with IBS-D.
- Postinfection Irritable Bowel Syndrome Following Clostridioides difficile Infection: A Systematic-review and Meta-analysis
- What is the prevalence of post-infectious IBS (PI-IBS) following C. difficile infection (CDI)?
- 15 studies, 1,200 participants
- Pooled prevalence of PI-IBS after CDI was 1%
- 3% IBS-D
- 3% IBS-M
- Commentary: PI-IBS is somewhat common after CDI
- Effect of Multi-Strain Probiotic Supplementation on URTI Symptoms and Cytokine Production by Monocytes after a Marathon Race: A Randomized, Double-Blind, Placebo Study
- 14 healthy male marathon runners received 5 billion CFU of a multi-strain probiotic or placebo x30 days before marathon
- Subjects self-reported upper respiratory tract infection (URTI)
- URTI symptoms were significantly lower in the probiotic group compared to placebo
- Efficacy of probiotics in multiple sclerosis: a systematic review of preclinical trials and meta-analysis of randomized controlled trials
- 3 RCT (173 MS patients), 22 preclinical studies
- Clinical studies
- significant beneficial effects of probiotic supplementation on mental health
- BUT, low quality of evidence
- probiotic intake improved insulin resistance, inflammatory markers, and oxidative stress markers
- significant beneficial effects of probiotic supplementation on mental health
- Preclinical studies
- reduces the incidence and severity of MS
- delays MS progression (15 studies)
- improves motor impairment (3 studies)
- favorable alterations of immune and inflammatory markers (20 studies)
- Improvement of intestinal microbiome composition (4 studies)
- Commentary: Probiotics show promise in MS.
- What is the appropriate cut-off value of CRP to predict endoscopic remission in patients with ulcerative colitis in clinical remission?
- Conventionally, a CRP <0.3 is the cutoff of clinical remission in those with ulcerative colitis
- 132 patients w/ ulcerative colitis who underwent endoscopic evaluation, measured CRP values
- CRP levels significantly lower in those in remission (0.05) vs. those not in remission (0.14)
- CRP cutoff <0.09 to predict remission
- Sensitivity: 71%
- Specificity: 72%
- Commentary: this study suggests that a much lower CRP level of <0.09 is needed to accurately predict clinical remission in those with ulcerative colitis. In UC patients in remission, it may be helpful to lower the CRP cut-off value that predicts remission other than 0.3 mg/dL, which is usually considered normal.
- Gluten and FODMAPs Relationship with Mental Disorders: Systematic Review
- 13 trials
- limiting or ruling out gluten or FODMAPs in the diet might be beneficial for symptoms such as:
- depression
- anxiety (all 7 studies found a positive effect)
- cognition deficiency (improvements in cognition in 1 trial)
- schizophrenia and autism spectrum (to a lesser degree)
- Commentary: this review highlights the gut-brain axis and exemplifies the improvement in symptoms when treating the gut.
- Dietary Management of Eosinophilic Esophagitis: Tailoring the Approach
- Efficacy (histologic remission) of diet in EoE
- 2 food elimination: 43%
- 4 food elimination: 53%
- Six food elimination: 72%
- Elemental diet: 90% (according to meta-analysis)
- Efficacy (histologic remission) of diet in EoE
- Seven Weeks of High-Dose Vitamin D Treatment Reduces the Need for Infliximab Dose-Escalation and Decreases Inflammatory Markers in Crohn’s Disease during One-Year Follow-Up
- 40 patients w/ Crohn’s Disease randomized to 4 groups:
- Biologic + vit. D
- Biologic + placebo
- Placebo + Vit D
- Or Placebo + placebo
- D at 20,000 IU bolus then 2,000 IU/d x7 weeks
- Groups w/ Vit D. had:
- less need for later biologic dose escalation during follow-up
- Reduced calprotectin
- Lower CRP (2.2x lower)
- Commentary: Vit. D may be helpful in regulating the immune system in IBD and this high-quality clinical trial gives proof to this concept.
- 40 patients w/ Crohn’s Disease randomized to 4 groups:
- Lifestyle is associated with thyroid function in subclinical hypothyroidism: a cross-sectional study
- Cross-sectional study, 160 w/ subclinical hypothyroidism (SCH), 160 euthyroid
- Patients with SCH were more likely to have poor overall sleep quality (15.1 vs. 25.8 %)
- Effects of synbiotic supplementation and lifestyle modifications on women with polycystic ovary syndrome
- Randomized, double-blind, placebo controlled trial of obese/overweight women w/ PCOS, given probiotic or placebo
- The probiotic group had greater reduction in testosterone (32 vs 6%)
- Commentary: dysbiosis is a major contributor to PCOS.
- Acetyl-L-Carnitine Ameliorates Metabolic and Endocrine Alterations in Women with PCOS: A Double-Blind Randomized Clinical Trial
- 150 women w/ PCOS split into 2 groups:
- Combo group: metformin, pioglitazone, and L-carnitine (1,500 mg BID)
- Control group: metformin, pioglitazone, and placebo
- significant improvement in body circumference (p < 0.001) in the combo group
- regular menstrual cycles were found (97.2%) in the carnitine group, but in only 12.9% of the other group.
- 150 women w/ PCOS split into 2 groups:
- Risk of All-Cause Mortality in Levothyroxine-Treated Hypothyroid Patients: A Nationwide Korean Cohort Study
- 500,000 w/ overt hypothyroidism on levothyroxine, 1.5 million healthy controls
- Followed over 6 years
- Hypothyroidism was significantly associated with increased all-cause mortality (HR 1.14) even w/ levothyroxine treatment
- This association was independent of age, sex, and cardiovascular disease
- Commentary: all-cause mortality was significantly higher in levothyroxine-treated hypothyroid patients than in non-hypothyroid controls.
- Insulin resistance attenuates the impact of levothyroxine on thyroid autoimmunity and hypothalamic-pituitary-thyroid axis activity in women with autoimmune subclinical hypothyroidism
- Does insulin sensitivity impact thyroid replacement therapy’s effect on thyroid antibodies?
- 100 women w/ subclinical hypothyroidism w/ similar levels of antibodies split into 3 groups:
- 1) no metformin but insulin resistance
- 2) no metformin and insulin sensitive
- 3) on metformin
- All women treated with levothyroxine
- Although levothyroxine reduced thyroid antibody titers & decreased TSH levels in all studied groups, the effect was more-pronounced in the groups who were insulin sensitive or were on metformin
- Commentary: the beneficial impact of levothyroxine on thyroid function and thyroid antibody titers may be dependent on insulin sensitivity.
- Women with Polycystic Ovary Syndrome have an increased risk of major cardiovascular events: a population study
- 220,000 women w/ PCOS, 175,000 healthy controls
- risk of cardiovascular disease is increased in those w/ PCOS
- Major adverse cardiovascular event (HR 1.26)
- Myocardial infarction (HR 1.38)
- Angine (HR 1.60)
- Revascularization (1.50)
- Commentary: This may be due to poorer metabolic markers and insulin resistance associated with PCOS. Weight and blood sugar control are modifiable risk factors in those w/ PCOS.
- Children with Hashimoto’s Thyroiditis Have Increased Intestinal Permeability: Results of a Pilot Study
- 30 adolescents with Hashimoto’s (HT), 30 controls w/ congenital hypothyroidism (CH)
- Zonulin levels were significantly higher in patients with HT than patients with CH (59.1 ng/mL vs. 43.3 ng/mL)
- Commentary: Intestinal barrier permeability (as measured by serum zonulin) was elevated in those with autoimmune thyroiditis. This study further supports the gut-thyroid connection.
- Probiotic baths for atopic dermatitis
- Randomized, double-blind trial of 22 patients w/ atopic dermatitis
- Applied 10 minute partial bath in probiotics (4.5 billion CFU/liter) every day
- After 14 days, probiotic lead to:
- Significant reduction in atopic dermatitis symptoms (baseline score: 63, day 7: 47, day 14: 35)
- Reduction in dry skin and itchiness
- Reduction in aureus gene copy numbers by 83%
- Commentary: This study shows a few points:
- Probiotic have an antimicrobial effect
- Probiotics can be safely given topically and can correct dermal dysbiosis
- Probiotics should be considered in atopic diseases
- Serum Ferritin Correlates With Liver Fat in Male Adolescents With Obesity
- Adolescent males; 44 w/ fatty liver, 15 without fatty liver
- Measured various biomarkers and MRI of liver
- ferritin was associated with MRI liver fat
- “Our data indicate that serum ferritin in male adolescents with obesity is mainly determined by liver fat content and inflammation but not by body iron status.”
- Commentary: remember that ferritin usually is increased in chronic inflammation.
- Ubiquinol Improves Endothelial Function in Patients with Heart Failure with Reduced Ejection Fraction: A Single-Center, Randomized Double-Blind Placebo-Controlled Crossover Pilot Study
- 14 patients with stable systolic heart failure were randomized to ubiquinol 400 mg/day or placebo for 3 months
- After a 1-month washout period, patients were crossed over to the alternative treatment
- Measured endothelial function before and after
- Endothelial function significantly improved with ubiquinol treatment but not with placebo
- Commentary: QoQ10 shows promise to be used in those with heart failure or endothelial dysfunction (e.g. hypertension, small vessel disease).
- Association between Single Nucleotide Polymorphisms and Weight Reduction in Behavioural Interventions-A Pooled Analysis
- “No consistent evidence for statistically significant associations of genetic SNPs with anthropometric changes during a behavioural intervention.”
- Commentary: performing genetic tests to optimize weight loss is not backed by the latest evidence.
- Exposure to endocrine disruptors and risk of breast cancer: A systematic review
- What’s the association between human exposure to endocrine disruptors (EDs) and the risk of breast cancer?
- 37 studies
- Most studies reported that exposure to organochlorine pesticides, phthalates, heavy metals, and polycyclic aromatic hydrocarbons was associated with increased breast cancer risk.
- Commentary: remember that EDs can be found in plastics, cleaning products, personal care products, and some food.
- 5-10% of Hashimoto patients experience symptoms despite being biochemically euthyroid
- Review of the relationship between thyroid antibodies and symptoms
- 30 studies
- 5 of 7 case cross-sectional studies found an association between thyroid autoimmunity and more symptoms or lower quality of life (QoL)
- 16 of 23 prospective studies found a comparable association.
- However, the total number of people studied in the other 7 studies showing no association between symptoms and thyroid autoimmunity was much higher (20,000 in no association studies, 8,000 in association studies)
- Commentary:
- In total, the majority of included studies reported an association between thyroid autoimmunity and persisting symptoms or lower QoL in biochemically euthyroid patients.
- The negative association between antibodies and symptoms was calculated after correcting for TSH and thyroid function
- In other words, higher antibodies are associated with more symptoms independent of TSH or fT4
- Thyroid antibodies may affect brain tissue, hence the continuation of low thyroid symptoms.
- Long-term Intake of Gluten and Cognitive Function Among US Women
- Prospective study, 13,500 women without celiac disease
- NO significant differences in standardized cognitive scores were found across highest and lowest quintiles of gluten intake
- Commentary: In this study, gluten consumption was not associated with cognitive function in absence of celiac disease.
- Role of microbial dysbiosis in the pathogenesis of esophageal mucosal disease: A paradigm shift from acid to bacteria?
- Dysbiosis may play a key role in the pathogenesis of GERD secondary to setting off an inflammatory cascade response
- The interplay between pancreatic enzymes insufficiency and irritable bowel syndrome
- Expert editorial reminding us that up to 6% of those with IBS also have low fecal elastase, indicating exocrine pancreatic insufficiency.
- Pancreatic enzyme supplementation results in improvement in IBS symptoms in patients with low fecal elastase levels, but not normal elastase levels.
- Comparison of Connective Tissue Manipulation and Abdominal Massage Combined With Usual Care vs Usual Care Alone for Chronic Constipation: A Randomized Controlled Trial
- 60 patients w/ chronic constipation, randomized to connective tissue manipulation (CTM), abdominal massage, or control 5x/wk
- After 4 weeks:
- patients in the CTM and abdominal massage groups had a greater percentage of normal stool (80% and 70%, vs 25% in controls) and a lower percentage of the feeling of incomplete evacuation than those in the control group (40% and 55%, vs 95% in controls)
- However, no significant difference was found in the self-reported improvement between the CTM and abdominal massage groups
- Commentary: abdominal massage or CTM show promise for those suffering from constipation.
- Association between Dietary Fibre Intake and Colorectal Adenoma: A Systematic Review and Meta-Analysis
- 21 observational studies, 160,000 participants
- Protective effect of dietary fibre intake against colorectal adenoma
- Effect Size 0.71
- The protective effect was larger in men
- Combination of a Probiotic and an Antispasmodic Increases Quality of Life and Reduces Symptoms in Patients with Irritable Bowel Syndrome: A Pilot Study
- 55 IBS patients
- Randomized to 3 arms:
- Probiotic
- Probiotic plus antispasmodic
- Placebo
- After 6 weeks:
- Quality of life improvement
- 50% probiotic
- 68% probiotic + antispasmodic
- 17% placebo
- Abdominal pain improvement
- 39% probiotic
- 58% probiotic + antispasmodic
- 17% placebo
- Commentary: probiotics and antispasmodics may work better together than in isolation.
- Quality of life improvement
- Meta-analysis of the efficacy of probiotic-supplemented therapy on the eradication of H. pylori and incidence of therapy-associated side effects
- What’s the efficacy of probiotic supplementation on the eradication rate of H. pylori infection and incidence of therapy-related side effects?
- 40 studies, 5,800 participants
- Probiotic supplementation improved the eradication rate by approximately 10% relative to the control group (odds ratio 1.94)
- Probiotic group had less incidence of total side effects (OR, 0.56) and symptoms
- Treatment with a Probiotic Mixture Containing Bifidobacterium animalis Subsp. Lactis BB12 and Enterococcus faecium L3 for the Prevention of Allergic Rhinitis Symptoms in Children: A Randomized Controlled Trial
- 250 children w/ allergic rhinitis (AR), treated conventionally w/ steroids/antihistamines and randomized to probiotics or placebo
- After 3 months, the probiotic group had:
- Significant reduction in symptoms
- Less need for conventional medication
- Dietary Therapies and Eosinophilic Esophagitis
- Expert opinion
- Endorses elemental diet
- Elimination diet
- 6-food elimination diet (milk, wheat, soy, egg, nuts, and seafood): 70-74% effective over 6 weeks
- 4-food elimination diet (milk, wheat, soy, and egg): 45-60% effective over 6 weeks
- 2-food elimination diet (milk and wheat): 30-40% effective over 6 weeks
- High-Fat Foods and FODMAPs Containing Gluten Foods Primarily Contribute to Symptoms of Irritable Bowel Syndrome in Korean Adults
- Cross-sectional study of 857 adults
- 186 diagnosed w/ IBS (ROME III)
- The non-IBS group and IBS groups had similar intake of dietary fat and FODMAP
- Fat (76 g/d non-IBS, 86 g/d IBS)
- FODMAP (12.6 g/d non-IBS, 13.9 g/d IBS)
- Detection of Dysbiosis and Increased Intestinal Permeability in Brazilian Patients with Relapsing-Remitting Multiple Sclerosis
- Stool samples analyzed via 16S sequencing and PCR
- Multiple sclerosis patients had higher intestinal permeability (as measured by serum zonulin) than healthy controls
- Association between T2DM and the lowering of testosterone levels among Kashmiri males
- 300 males in India with type 2 diabetes
- 42% had testosterone deficiency
- Negative correlation w/ serum total testosterone and:
- Fasting plasma glucose levels (r = -0.25)
- HbA1c values (r = -0.697)
- Effects of very low-carbohydrate vs. high-carbohydrate weight loss diets on psychological health in adults with obesity and type 2 diabetes: a 2-year randomized controlled trial
- 120 w/ diabetes and obesity randomized to a low carb (LC) or low fat (LF) diet equal for calories (500-1,000 Cals/d)
- LC (14% carbs, 58% fat)
- LF (53% carbs, 30% fat)
- Only 60 completed study
- Weight loss was 9.1% after 12 months and 6.7% after 2 years with NO difference between diet groups.
- 120 w/ diabetes and obesity randomized to a low carb (LC) or low fat (LF) diet equal for calories (500-1,000 Cals/d)
- Vitamin D deficiency and cardiovascular risk in type 2 diabetes population
- 450 type 2 diabetics
- Measured vitamin D and metabolic markers (cholesterol, glucose, etc.)
- Those with vitamin D deficiency are likely to develop dyslipidemia
- EPA and DHA as markers of nutraceutical treatment response in major depressive disorder
- 158 patients w/ depression, randomized to combined supplementation or placebo
- Omega-3 (EPA 1 g/DHA 656 mg)
- SAMe
- Zinc
- 5-HTP
- folinic acid
- After 8 weeks of supplementation, higher levels of red blood cell EPA/DHA levels were associated with less depressive symptoms
- 158 patients w/ depression, randomized to combined supplementation or placebo
- Effects of n-3 Polyunsaturated Fatty Acid Supplementation in the Prevention and Treatment of Depressive Disorders-A Systematic Review and Meta-Analysis
- 20 studies
- Omega 3 supplementation lowered depressive symptoms as compared with placebo
- Publication bias may be present
- Blood Lead Level and Renal Impairment among Adults: A Meta-Analysis
- 43 studies
- Lead blood level definitions
- High= 42 µg/dL
- Moderate= 22 µg/dL
- Low= 2.9 µg/dL
- Mean lead levels of the exposed participants was higher than that of the non-exposed participants
- Renal markers (BUN, creatinine) were significantly higher in exposed vs non-exposed participants
- Commentary: This study shows that exposure to lead is associated with higher blood lead levels.
- Clinical Evidence in the Treatment of Obstructive Sleep Apnoea with Oral Appliances: A Systematic Review
- 17 RCTs
- Majority of evidence supports use of oral appliances lead in those with mild-to-moderate obstructive sleep apnea (OSA)
- Some evidence for use in severe OSA
- The effect of vitamin D and magnesium supplementation on the mental health status of attention-deficit hyperactive children: a randomized controlled trial
- 66 children w/ ADHD, randomly assigned to placebo or magnesium (6 mg/kg/d) + vitamin D (50,000 IU/wk)
- After 8 weeks of supplementation, Mg + Vit. D group had significant reduction in:
- emotional problems
- conduct problems
- peer problems
- social score
- total difficulties
- Commentary: Vit. D and magnesium show promise in ADHD.
- Anti-inflammatory effects of melatonin: A systematic review and meta-analysis of clinical trials
- 31 studies, 1,500 participants
- Melatonin had significant anti-inflammatory effects on:
- interleukin (IL)-1
- IL-6
- tumor necrosis factor (TNF)
- but NOT on C-reactive protein (CRP)
- High-Protein Plant-Based Diet Versus a Protein-Matched Omnivorous Diet to Support Resistance Training Adaptations: A Comparison Between Habitual Vegans and Omnivores
- 19 young male omnivores, 19 young male vegans, eating 1.6 g/kg protein per day
- After 12 weeks resistance training program, both groups had similar increase in leg muscle mass
- However, omnivore group had greater 1-rep max leg press (vegan 97 kg, omnivore 117 kg)