Future of Functional Medicine Review Clinical Newsletter

Research Briefs for Practitioners – June 2021

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 8

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Featured Study

Role of probiotics in prevention and treatment of enteric infections: a comprehensive review

  • Review of the literature of probiotics used for preventing and treating GI infections
  • Remember: dysbiosis makes it more suitable for pathogen growth
  • Mechanisms of antimicrobial effects of probiotics
    • “Displace” pathogenic organisms from GI lumen
    • Produce antimicrobial peptides
    • Modulate immune system
    • Improve barrier function
  • Clinical outcomes
    • All 3 categories of probiotics shown to improve pediatric diarrhea by 23 hours
    • Increase eradication rate of H pylori
      • “probiotics can be utilized as the first course of anti H. pylori therapy”
    • Multiple anti-parasitic effects

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Gastrointestinal Studies

  • Association Between Psychological Disorders and Irritable Bowel Syndrome
    • Cross-sectional study of 1,800 participants
    • IBS diagnosis (by ROME III) in 26% of the population
    • Anxiety was significantly more common in participants with IBS compared to participants without IBS (53% vs. 23%)
    • Depression was significantly more common in participants with IBS (50.6% vs. 21.5%)
    • Commentary: IBS is a very common disorder and is associated with poor mental health outcomes.

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Thyroid & Hormone Studies


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Autoimmunity Studies


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Diet & Lifestyle Studies

  • Effects of macronutrient intake in obesity: a meta-analysis of low-carbohydrate and low-fat diets on markers of the metabolic syndrome
    • Compare Low Carb (LC) and Low Fat (LF) diets
    • Both the LC and LF diets:
      • Reduce caloric intake at 6 months and 12 months
      • Lead to weight loss
      • Improve metabolic markers
    • Metabolic marker improvements did not depend on weight loss
    • LC and higher fat/protein intake improve metabolic markers independent of weight loss.
      • There is a slight advantage of LC diet over LF diet
    • An increase in protein intake appeared to be most relevant for reducing body weight
    • Increased fat intake and reduced carbohydrate intake appeared to be most relevant for improving metabolic markers
    • Caloric intake was not related to changes in body weight or metabolic markers
    • Commentary: Challenge your confirmation bias- both low carb and low fat diets can work.
  • The Effects of Curcumin on Diabetes Mellitus: A Systematic Review
    • 16 trials, 1,300 participants w/ type 2 diabetes (T2DM)
    • Curucmin significantly reduces:
      • A1C
      • Fasting blood glucose
      • Triglycerides
      • Total cholesterol
      • LDL-C
      • CRP
      • Systolic and diastolic blood pressure
      • Depression/anxiety
    • Commentary: curcumin may be a useful tool in those w/ T2DM

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Episode 7

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Featured Study

The Effectiveness and Safety of Multi-Strain Probiotic Preparation in Patients with Diarrhea-Predominant Irritable Bowel Syndrome: A Randomized Controlled Study

  • 50 patients w/ IBS-D given placebo or multi-species probiotic (lactobacillus, bifidobacterium, streptococcus) at 2.5 billion CFU
  • After 8 weeks, the probiotic group had:
    • Greater improvement in IBS symptoms
    • Less abdominal pain
    • Better quality of life
  • Commentary: This study gives more proof of concept of multi species/strains of probiotics for IBS and other functional GI disorders.

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Gastrointestinal Studies

  • Measurement of fasting breath hydrogen concentration as a simple diagnostic method for pancreatic exocrine insufficiency
    • 60 patients w/ chronic pancreatitis or pancreatic cancer underwent hydrogen breath test WITHOUT glucose/lactulose
    • Fasting breath hydrogen levels was higher in the exocrine pancreatic insufficiency (EPI) group
      • EPI: 15.70 (1.4 to 77.0) ppm
      • non-EPI group 2.80 (0.7 to 28.2) ppm
    • Fasting breath hydrogen cutoff of 10.7 ppm to diagnose EPI
      • Sensitivity: 73%
      • Specificity 83%
    • Commentary: this study highlights a possible novel diagnostic tool to diagnose EPI. However, this study is limited by small sample size and subjects with a specific diagnosis of either chronic pancreatitis or pancreatic cancer.
  • Effects of Probiotics in Preterm Infants: A Network Meta-analysis
    • Are probiotics safe and effective for infants with necrotizing enterocolitis (NEC)?
    • 5 studies, 12,000 preterm infants
    • Probiotics associated with lower rates of mortality and NEC mortality
    • Commentary: Even though many of us do not see preterm infants, this study points to the safety and efficacy of probiotics in high-risk populations.

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Thyroid & Hormone Studies


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Diet & Lifestyle Studies

  • The associations of phthalate biomarkers during pregnancy with later glycemia and lipid profiles
    • Higher urinary phthalate concentrations during pregnancy were associated with worse metabolic function at 8 year followup after delivery
      • Higher insulin
      • Higher A1C
      • More insulin resistance
      • Lower HDL-C
      • Higher triglycerides
    • Commentary: remember, phthalates are found in food and synthetic products such as cleaning products, detergents, plastics, flooring material, fragrances, and nail polish.

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Episode 6

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Featured Study

Romanian Guidelines for Nonpharmacological Therapy of IBS

  • A low FODMAP diet may be offered to IBS patients to improve abdominal pain, bloating, and/or diarrhea, for a minimum of 4 weeks (elimination phase). If no symptom improvement occurs within 4 weeks, the diet should be stopped.
  • In IBS  patients where symptoms improved during the elimination phase,  recommend gradual reintroduction of  FODMAPs  (during the next  3  months)  to identify triggers,  followed by a personalized diet.
  • Soluble fibers are recommended for overall symptom improvement in patients with mild to moderate  IBS  symptoms, especially in type IBS-C.
  • Soluble fibers are well tolerated, have a low cost, and therefore represent a reasonable first-line treatment in IBS.
  • No recommendation can be made regarding the gluten-free  diet  in  patients  with IBS.
  • The assessment of HLA DQ2/8 for GFD in IBS-D is not recommended.
  • Recommend peppermint oil to improve overall symptoms, as well as abdominal pain in IBS patients.
  • Recommend the use of probiotics as an alternative therapy in trials of limited duration.
  • Physical exercise may be useful in Regular exercise can help manage some symptoms in IBS and can be a primary treatment in IBS-C.
  • Psychotherapy should be considered for people with IBS who do not respond to pharmacological treatments after 12 months and who develop a refractory IBS.

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Gastrointestinal Studies

  • Micronutrient deficiencies in children with coeliac disease; a double-edged sword of both untreated disease and treatment with gluten-free diet
    • 15 micronutrients analyzed in 100 blood samples of newly diagnosed Celiac Disease patients and patients on gluten-free diet (GFD)
    • At diagnosis, deficiencies of the following micronutrients were noted:
      • vitamins E (88%)
      • B1 (71%)
      • D (24%)
      • K (21%)
      • A (20%)
      • B6 (12%)
      • ferritin (79%)
      • zinc (33%)
    • After 12 months of GFD, repletion of vitamins E, K, B6, and B1 was observed
    • BUT, vitamins D, A, and zinc did not change significantly post-diagnosis.
    • Increased tTg-IgA Abs at follow-up were associated with low vitamins A and B1
    • Commentary: Several micronutrient deficiencies in CD respond to a GFD but others (A, D, zinc) need to be monitored long-term and supplemented where indicated.
  • The influence of rifaximin on diverticulitis rate and quality of life in patients with diverticulosis
    • Prospective study of 250 patients w/ diverticulitis
    • 150 received Rifaxmin prophylaxis
    • Rifaximin group had:
      • No difference in diverticulitis rate at 6 months
      • But, lower rate of diverticulitis at 6-12 months
      • Higher quality of life
    • Other findings: Rifaxmin can be safely given for prevention of diverticulitis every 3 months
    • Commentary: Antimicrobial therapy is effective for improving diverticulitis and quality of life.
  • Antibiotic treatment for small intestinal bacterial overgrowth: Is a cocktail better than a single?
    • Expert narrative review
    • Study noted:
      • 223 patients w/ SIBO using GHBT
      • Given single antibiotic (quinolone or azole) or rotating antibiotics (quinolone and azole, one after the other) for ten days every month x3 months
      • Rotating antibiotics had:
        • More SIBO resolution (70% vs. 51%)
        • More improvement in bloating
        • Better quality of life
      • Commentary: Rotating antibiotics may be better than a single antibiotic at remediating SIBO.

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Thyroid & Hormone Studies

  • The Status of Iodine Nutrition after Removing Iodized Salt in High Water Iodine Regions: A Cross-sectional Study in China
    • Cross-sectional analysis of 1,300 adults in 4 regions in China with different iodine concentrations in water
    • High iodine concentration in water associated with higher prevalence of:
      • Thyroid autoimmunity
      • Subclinical hypothyroidism
      • Thyroid nodules
      • Thyroid dysfunction
    • High urinary iodine concentration associated with more:
      • Thyroid nodules
      • Thyroid dysfunction
    • Iodine concentrations still elevated in high iodine areas even after discontinuation of iodized salt
    • Commentary: Too much iodine is also harmful to the thyroid. Removing iodized salt may not be sufficient to prevent harmful effects of too much iodine.

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Diet & Lifestyle Studies


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Episode 5

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Featured Study

  • British Society of Gastroenterology guidelines on the management of irritable bowel syndrome
    • Recommendations for IBS patients:
      • No breath testing
      • No food sensitivity (IgG) test
      • CRP, calprotectin, celiac serology for first time workup
      • Workup for bile acid malabsorption if nocturnal diarrhea or history of cholecystectomy
      • Low FODMAP diet for 1st line therapy
      • Endorses trial of non-strain specific probiotics for up to 12 weeks before deciding benefit vs no benefit
      • Endorses peppermint oil for global symptoms

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Gastrointestinal Studies


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Thyroid & Hormone Studies


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Diet & Lifestyle Studies

  • Exercise for Weight Loss: Further Evaluating Energy Compensation with Exercise
    • 3-arm RCT of overweight adults
      • 6 training sessions/wk
      • 2 training sessions/wk
      • Sedentary control
    • Measured energy expenditure, ghrelin, leptin, insulin
    • The 6 sessions/wk group expended more energy and exercised longer per week than the 2 sessions/wk group, resulting in greater fat loss
    • Commentary: Find an exercise routine your patients enjoy and can be consistent with.
  • Constrained Total Energy Expenditure and Metabolic Adaptation to Physical Activity in Adult Humans
    • Does more exercise = more calories burned?
    • 330 adults in free-living conditions in 5 different populations
    • Total energy expenditure (calories burned) measured by doubly labeled water method
    • Results:
      • Fat-free mass accounted for #1 determinant of calories burned
      • Physical activity only accounted for 7% of variability of the calories burned
      • Resting metabolic rate was NOT associated with physical activity
      • Amount of calories burned increased with increasing physical activity but plateaued at upper range of physical activity
      • Reduced non-physical activity (less fidgeting, sitting instead of standing, reduced reproduction) may be the reason that energy expenditure stays the same despite increased activity
    • Commentary: In other words, you cannot run marathons to eat Oreos and expect to lose weight. Pursue lean body mass increase to yield sustained results for body composition.

Discussion

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