- Effects of a gluten challenge in patients with irritable bowel syndrome: a randomized single-blind controlled clinical trial
- 50 IBS patients
- All patients were treated w/ low FODMAP + gluten free diet (GFD) x 6 weeks, then randomized to either:
- Gradual gluten reintroduction x 6 weeks (with dose-escalation each 2 weeks)
- Unrestricted gluten-containing diet
- Continued low FODMAP + GFD x 6 weeks
- The low FODMAP + GF diet led to improvements in all symptoms
- After 3 months, all groups had similar:
- Abdominal pain
- Bloating
- IBS symptom score
- Quality of life
- Low FODMAP + GFD led to the greatest reduction in anxiety
- Commentary: While a low FODMAP and GFD was effective for improving IBS symptoms, the introduction of gluten did NOT worsen IBS symptoms.
- The effect of low FODMAP diet with and without gluten on irritable bowel syndrome: A double blind, placebo controlled randomized clinical trial
- 49 IBS patients treated w/ low FODMAP diet (LFD), randomized to:
- Placebo (gluten free rice flour)
- Gluten powder
- After 6 weeks, both groups experienced statistically significant improvements in:
- IBS symptom score (-32% gluten group, -49% placebo group)
- Abdominal pain intensity (-45% vs -52%)
- Abdominal pain frequency (-26% vs -46%)
- Abdominal distension (-29% vs -63%)
- Quality of life (+23% vs +32%)
- Commentary: LFD was helpful for IBS patients with or without the restriction of gluten.
However, there was a trend towards greater improvement in the LFD + gluten free group.
- 49 IBS patients treated w/ low FODMAP diet (LFD), randomized to:
Final Commentary: These two studies show similar results; gluten avoidance may lead to additional improvements in GI and non-GI symptoms compared to low FODMAP diet alone. However, it’s important to not be dogmatic with gluten-free recommendations and help your patients determine their individual response to a gluten-free trial, and eventually get them to the broadest diet possible.
- Gastric intestinal metaplasia: Long-term follow-up results
- 156 patients w/ intestinal metaplasia, 150 healthy controls
- Average followup of 4 years
- Of those w/ intestinal metaplasia:
- Gastric cancer found in 3 participants (0 in healthy controls)
- Gastric dysplasia found in 9 (2 in healthy controls)
- Of those who were followed up in 5-10 years, NO difference in dysplasia and cancer development between two groups (metaplasia vs healthy controls)
- Commentary: Gastric adenoma rates are very low. A longer followup interval may be appropriate for those w/ intestinal metaplasia.
- The association between helicobacter pylori infection and erosive gastroesophageal reflux disease; a cross-sectional study
- Cross-sectional study of 1,916 patients w/ dyspepsia
- All had endoscopy to assess for H pylori and erosive GERD
- Results:
- 46% had GERD
- 75% had H pylori
- NO association between H pylori and:
- BMI
- Age
- Sex
- Smoking status
- Hiatal hernia
- Risk factors for GERD:
- Smoking
- Increased BMI
- Older age
- Hiatal hernia
- Peptic ulcer disease
- H pylori was NOT associated w/ erosive GERD
- Impact of synbiotic supplementation on cardiometabolic and anthropometric indices in patients with metabolic syndrome: A systematic review and meta-analysis of randomized controlled trials
- 5 studies, 1,049 participants w/ metabolic syndrome
- Synbiotics led to improvements in:
- Insulin (-6.3 μU/mL)
- Triglycerides (-20.3 mg/dl)
- LDL-C (-9.0 mg/dl)
- Total cholesterol (-7.8 mg/dl)
- Weight (-9.4 lbs)
- Waist circumference (-4.0 cm)
- Systolic blood pressure (-1.8 mmHg)
- HDL-C (+2.3 mg/dl)
- NO improvements in fasting glucose or insulin resistance (HOMA-IR)
- Commentary: Synbiotics can improve metabolic markers associated with metabolic syndrome.
- Effect of Probiotic Supplementation on Glycemic Outcomes in Patients with Abnormal Glucose Metabolism: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
- 31 studies, 1,948 participants w/ prediabetes, type 2 diabetes or gestational diabetes
- Compared to control, probiotics led to improvements in:
- Fasting blood glucose (-5.7 mg/dl)
- HbA1c (-0.3%)
- Fasting insulin (-3.9 µIU/mL)
- Insulin resistance (HOMA-IR) (-0.8)
- Commentary: Similar results as last study.
- Safety and effectiveness of low-dose aspirin for the prevention of gastrointestinal cancer in adults without atherosclerotic cardiovascular disease: a population-based cohort study
- Matched cohort of 49,679 aspirin and non-aspirin users
- After an average of 10.4 years, the low-dose aspirin group had:
- Lower colorectal cancer rate (HR 0.83)
- Lower gastric cancer rate (HR 0.77)
- No change in esophageal cancer rates
- More GI bleeds (HR 1.15)
- Commentary: Aspirin use was correlated with less colon and gastric cancer rates, but more GI bleeding risk.
- Effect of Bifidobacterium longum 35624 on disease severity and quality of life in patients with irritable bowel syndrome
- Open label study of 233 IBS patients treated w/ probiotics
- After 1 month, probiotic supplementation led to improvements in:
- IBS symptom score
- Quality of life score
- 63.8% of patients were satisfied with their treatment
- Commentary: Probiotics reduce symptom severity and improves quality of life in patients with IBS. Keep in mind all patients knew they were getting probiotics and there was no control group.
- Effects of prebiotics on postprandial GLP-1, GLP-2 and glucose regulation in patients with type 2 diabetes: A randomised, double-blind, placebo-controlled crossover trial
- Crossover study of 29 participants w/ type 2 diabetes, randomized to:
- Placebo (Maltodextrin)
- Prebiotics (Inulin)
- All participants took prebiotics or placebo for 6 weeks each, followed by 4 week washout period
- NO difference observed in fasting glucose or insulin between groups
- Commentary: Prebiotics were not effective in improving glucose regulation in type 2 diabetics. Keep in mind all participants consumed maltodextrin, which may negatively affect glycemic control.
- Crossover study of 29 participants w/ type 2 diabetes, randomized to:
- Acute and short-term effects of Lactobacillus paracasei subsp. paracasei 431 and inulin intake on appetite control and dietary intake: A two-phases randomized, double blind, placebo-controlled study
- Crossover study of 16 healthy men, randomized to:
- Placebo (Maltodextrin)
- Prebiotics
- Probiotics
- Synbiotics
- Each treatment was consumed on 4 separate test days with a standardized breakfast
- Prebiotic and probiotic supplementation led to the lower calorie intake over the following 24-hour period compared to placebo
- Commentary: In the short term, prebiotics and probiotics can reduce energy intake.
- Crossover study of 16 healthy men, randomized to:
- Probiotics Evaluation in Oncological Surgery: A Systematic Review of 36 Randomized Controlled Trials Assessing 21 Diverse Formulations
- 36 RCTs, 3,305 participants undergoing oncological surgery, randomized to control or various combinations of probiotics
- Probiotics were effective in preventing post-surgical infections in 70% of the studies
- The most effective combination of probiotics included BOTH lacto/bifido + saccharomyces boulardii
- Commentary: Probiotics were effective in preventing post-surgical infections, especially those containing multiple categories of probiotics.
- Prevalence of autoimmune thyroid disease in patients with psoriasis: a meta-analysis
- 11 studies, 253,313 psoriasis patients, 1.3 million controls
- Compared to healthy controls, patients with psoriasis had higher rates of:
- Autoimmune thyroid disease (OR 1.7)
- Positive TPO antibodies (OR 2.1)
- Positive thyroglobulin antibodies (OR 1.9)
- Commentary: Psoriasis patients have a higher risk of also being diagnosed with autoimmune thyroid disease.
- Efficacy of cognitive therapy and behavior therapy for menopausal symptoms: a systematic review and meta-analysis
- 14 RCTs, 1,618 menopausal patients randomized to:
- Control group
- Cognitive behavioral therapy (CBT)
- CBT led to significant improvements in:
- Hot flashes
- Night sweats
- Depression and anxiety
- Fatigue
- Quality of life
- Commentary: CBT may be an effective treatment for menopausal symptom relief.
- 14 RCTs, 1,618 menopausal patients randomized to:
- The effect of metformin and myoinositol on metabolic outcomes in women with polycystic ovary syndrome: role of body mass and adiponectin in a randomized controlled trial
- Open label study of 66 women w/ PCOS, randomized to:
- Metformin (1500 mg/d)
- Myo-inositol (4 g/d)
- After 6 months, BOTH groups experienced similar improvements in:
- Testosterone
- Sex hormone binding globulin
- Fasting glucose
- BMI
- Body composition
- Commentary: Myo-inositol may be an effective natural alternative to metformin for the treatment of PCOS.
- Open label study of 66 women w/ PCOS, randomized to:
- The effects of coenzyme Q10 supplementation on metabolic profiles and parameters of mental health in women with polycystic ovary syndrome
- 55 PCOS women, randomized to CoQ10 (100 mg/ day) or placebo
- After 3 months of supplementation, the CoQ10 group had:
- Reduced depressive symptoms
- Reduced CRP
- Decrease testosterone
- Less hirsutism
- Reduced oxidative stress
- Commentary: CoQ10 can reduce inflammation and improve PCOS symptoms.
- Association between the severity of chronic spontaneous urticaria and sleep-disordered breathing
- 37 patients w/ chronic spontaneous urticaria (CSU)
- 19 had mild CSU, 18 had moderate-severe CSU
- All had sleep study
- The sleep apnea severity was higher in the severe CSU group (18 vs 4 AHI)
- Moderate-severe sleep apnea was associated with moderate-to-severe CSU even after adjusting for the BMI (OR 22)
- Commentary: This small study sheds light on a possible connection between urticaria and sleep disordered breathing.
- 37 patients w/ chronic spontaneous urticaria (CSU)
- Traumatic Brain Injury and Risk of Dementia and Alzheimer’s Disease: A Systematic Review and Meta-Analysis
- 25 studies, 11.4 million participants w/ a history of traumatic brain injury (TBI)
- TBI was associated with an increased risk of dementia (OR 1.8), especially in individuals with:
- Asian ethnicity
- Male gender
- Less than 65 y/o
- NO association was found between TBI and risk of Alzheimer’s disease (OR 1.0)
- Commentary: TBI is associated with an increased risk of developing dementia Keep in mind this is an observational study.
- Obesity, Sex, Snoring and Severity of OSA in a First Nation Community in Saskatchewan, Canada
- 233 participants who underwent sleep apnea testing
- 45.1% tested positive for sleep apnea
- 5.2% diagnosed w/ severe sleep apnea
- 39.9% diagnosed w/ mild or moderate sleep apnea
- Sleep apnea diagnosis was associated with:
- Snoring
- Male gender
- Obesity
- Commentary: Sleep apnea was a common diagnosis in the general population.
- Benefits and Harms of Levothyroxine/L-Triiodothyronine Versus Levothyroxine Monotherapy for Adult Patients with Hypothyroidism: Systematic Review and Meta-Analysis
- 18 RCTs comparing combined therapy (LT4/LT3) versus monotherapy (LT4) for adult patients with hypothyroidism
- NO difference for:
- Thyroid function
- Depressive symptoms
- Fatigue
- Quality of life
- Adverse effects
- Patients had a higher preference for combined therapy (43% vs 23% monotherapy)
- Commentary: This meta-analysis showed no benefit of combined therapy for those w/ hypothyroidism.
- Low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet versus traditional dietary advice for functional dyspepsia: a randomized controlled trial
- 184 patients w/ functional dyspepsia
- Randomized to low FODMAP or traditional diet advice x4 weeks
- After 4 weeks, the low FODMAP diet had :
- Trend towards better symptom response rate (67% vs 57%)
- Those w/ bloating had statistically significant better response to low FODMAP
- Trend towards better symptom response rate (67% vs 57%)
- Commentary: This study showed a trend towards better improvement w/ low FODMAP diet for functional dyspepsia.
- Beneficial Effects on Abdominal Bloating with an Innovative Food-Grade Formulation of Curcuma longa and Boswellia serrata Extracts in Subjects with Irritable Bowel Syndrome and Small Bowel Dysbiosis
- 67 IBS patients randomized to:
- Low FODMAP diet (LFD)
- Combo of LFD + Curcumin (500 mg BID) + Boswellia
- After 30 days of supplementation, the combo group had:
- Greater improvement of bloating, abdominal pain
- Greater global symptom improvement
- Commentary: Addition of curcumin and Boswellia led to greater improvements to a LFD compared to a LFD alone.
- 67 IBS patients randomized to:
- Quality of life and sleep in individuals with irritable bowel syndrome according to different diagnostic criteria and inflammatory bowel diseases: A comparison using data from a population-based survey
- Cross-sectional study of 4,420 participants:
- 3.5% had IBS
- 0.8% had IBD
- Individuals w/ IBS had:
- Lower mental quality of life
- More sleep problems (OR 1.74)
- Commentary: IBS is associated w/ worse quality of life and sleep.
- Cross-sectional study of 4,420 participants:
- Saccharomyces boulardii CNCM I-745 supplementation modifies the fecal resistome during Helicobacter pylori eradication therapy
- Compared composition of antibiotic resistance after H pylori therapy between:
- Triple therapy + S. boulardii
- Triple therapy alone
- In the triple therapy + S boulardii group, the number of antibiotic resistance expression was lower
- Commentary: S boulardii may improve H pylori eradication rate by lowering antibiotic resistance.
- Compared composition of antibiotic resistance after H pylori therapy between:
- Efficacy and Safety of Lactobacillus plantarum K50 on Lipids in Koreans With Obesity: A Randomized, Double-Blind Controlled Clinical Trial
- 81 obese participants randomized to placebo or probiotic (L plantarum)
- After 12 weeks, the probiotic group had:
- Reduced total cholesterol (209 to 203 mg/dL)
- Reduced triglycerides (135 to 114 mg/dL)
- Commentary: Probiotic led to statistically, yet clinically insignificant improvement in the lipid profile.
- Bifidobacterium breve CCFM1025 attenuates major depression disorder via regulating gut microbiome and tryptophan metabolism: A randomized clinical trial
- 45 patients w/ depression randomized to placebo or probiotic
- After 30 days of supplementation, the probiotic group had improved mood
- Pepsinogen II in gastritis and Helicobacter pylori infection
- 39 studies
- Pepsinogen II (PgII) levels were associated with:
- Non-atrophic gastric inflammatory lesions
- H pylori positivity
- PgII levels decreased after H pylori eradication
- Commentary: PgII levels may be related to gastritis and H pylori.
- Efficacy and safety of adjuvant curcumin therapy in ulcerative colitis: A systematic review and meta-analysis
- 6 RCTs, 385 participants w/ ulcerative colitis
- Addition of supplemental curcumin led to improvement in clinical remission (RR 2.1)
- No change in endoscopic remission
- Green tea extract to prevent colorectal adenomas, results of a randomized, placebo-controlled clinical trial
- 879 participants w/ prior colon adenomas in past 6 months
- Randomized to:
- Green tea extract (EGCG 150 mg BID)
- Or placebo
- After 3 years of supplementation, the green tea group had a non-statistically significant lower rate of adenomas (54.3% vs 48.3%)
- There was a significant lower rate of adenomas in men (-7.5% absolute risk reduction)
- Commentary: This study had a smaller sample size for a short amount of time to show possible statistically significant improvement of colon cancer rates.
- Efficacy of Fecal Microbiota Transplantation in Irritable Bowel Syndrome: A Meta-Analysis of Randomized Controlled Trials
- 7 RCTs, 472 participants w/ IBS
- After 12 weeks, FMT had:
- NO improvement in global symptoms (RR 0.75)
- Improved quality of life (RR 9.4)
- No difference in adverse effects
- FMT did NOT significantly improve global symptom in IBS at 1-year follow-up compared with placebo
- Commentary: There is weak evidence to support FMT for IBS.
- Proton pump inhibitors may reduce the risk of high-grade dysplasia and/or esophageal adenocarcinoma in Barrett’s esophagus: a systematic review and meta-analysis
- 15 studies, 26,291 Barrett’s esophagus (BE) patients
- 8 cohort studies – PPIs significantly reduce the risk of esophageal cancer and high-grade dysplasia (RR 0.46)
- 6 case-control studies – PPIs had NO benefit
- Commentary: The benefit of PPIs for BE is inconclusive.
- A Systematic Review and Meta-Analysis: Lactobacillus acidophilus for Treating Acute Gastroenteritis in Children
- 15 RCTs, 1,765 pediatric patients w/ acute gastroenteritis
- Lactobacillus acidophilus was associated with a reduced duration of diarrhea
- But the effect was not statistically significant when only the L. acidophilus strain was used
- Commentary: This study suggests that a multi-strain probiotic may be more effective than a single-strain.
- Evaluating tolerability of resistant starch 2, alone and in combination with minimally fermented fibre for patients with irritable bowel syndrome: a pilot randomised controlled cross-over trial
- Cross-over study of 6 IBS patients, 5 healthy controls
- Participants consumed fibers in escalating doses lasting 3 d each:
- Resistant starch (10, 15 and 20 g/d)
- Sugarcane bagasse (5, 10 and 15 g/d)
- And combo of both (20, 25 and 30 g/d)
- For IBS patients, all resistant starch doses led to increased bloating
- Commentary: IBS patients may be particularly sensitive to resistant starch.
- Effectiveness of diet, psychological, and exercise therapies for the management of bile acid diarrhoea in adults: a systematic review
- 8 prospective studies, 192 patients w/ bile acid diarrhea (BAD)
- Benefit found for:
- Carbohydrate modification (1 study, n=2)
- Dietary fat intake reductions (5 studies, n=181)
- Exclusive elemental diet therapy (2 studies, n=9)
- Commentary: Dietary modification, including an elemental diet, may improve BAD.
- Omega-3 fatty acids and blood-based biomarkers in Alzheimer’s disease and mild cognitive impairment: A randomized placebo-controlled trial
- 163 patients w/ mild cognitive impairment (MCI) or Alzheimer’s disease (AD)
- Randomized to:
- Placebo
- DHA (0.7 g/d)
- EPA (1.6 g/d)
- EPA (0.8 g) + DHA (0.35 g)
- After 24 months of supplementation, NO difference in cognitive, functional, or mood parameters
- Commentary: This study failed to show an improvement of omega-3s in AD and MCI.
- Vitamin D Supplementation and Sleep: A Systematic Review and Meta-Analysis of Intervention Studies
- 19 studies
- Vit D supplementation led to improvement in sleep quality
- Tapioca Resistant Maltodextrin as a Carbohydrate Source of Oral Nutrition Supplement (ONS) on Metabolic Indicators: A Clinical Trial
- 2 phases
- Phase 1: Cross-over study of 17 healthy adults given low or high dose tapioca maltodextrin (a resistant starch)
- High-dose maltodextrin led to a decreased in area under the curve of insulin by 33%
- Phase 2: 22 healthy adults given high-dose maltodextrin
- After 12 weeks, A1C decreased (5.5% to 5.2%)
- No change in glucose, insulin, or lipids, body composition
- Commentary: Resistant starch improves some glycemic markers.
- Dietary Sodium and Potassium Intake and Risk of Non-Fatal Cardiovascular Diseases: The Million Veteran Program
- Prospective study of 180,000 participants, followed x8 years
- Higher sodium intake was associated w/ higher risk of cardiovascular disease (HR 1.1)
- Higher potassium intake was associated w/ a lower risk of CVD (HR 0.87)
- The effect of vitamin D supplementation on glycemic status of elderly people with prediabetes: a 12-month open-label, randomized-controlled study
- 90 elderly participants w/ prediabetes
- Open-label randomization to placebo or Vit D (25,000 IU/wk)
- After 6 months of supplementation, the Vit D group had:
- Lower fasting glucose (96 vs 103 mg/dL)
- A1C (5.82 vs 5.87%)
- Commentary: Vit D led to small improvements in glycemic variables. Remember, this was an open-label study (participants knew what they were getting).
- Investigating the effect of quadruple therapy with Saccharomyces boulardii or Lactobacillus reuteri strain (DSMZ 17648) supplements on eradication of Helicobacter pylori and treatments adverse effects: a double-blind placebo-controlled randomized clinical trial
- 156 patients with H. pylori infection, randomized to 2 weeks of:
- Quadruple therapy + placebo
- Quadruple therapy + L. reuteri
- Quadruple therapy + S. boulardii
- Each treatment followed by 2 weeks of PPI alone, followed by 2 weeks of no treatment
- After 6 weeks, the addition of S. boulardii and L. reuteri led to greater eradication rates compared to quadruple therapy + placebo (94.2% S. boulardii, 92.3% L. reuteri, 86.5% placebo)
- Compared to quadruple therapy + placebo, the addition of S. boulardii led to less frequent side effects, including:
- Headaches (0% patients vs 13.5% patients)
- Abdominal pain (5.8% vs 15.4%)
- Anxiety (7.7% vs 15.4%)
- Diarrhea (0% vs 13.5%)
- Nausea (21.2% vs 38.5%)
- Commentary: The addition of probiotics to quadruple therapy led to greater eradication of H. pylori and reduced side effects.
- 156 patients with H. pylori infection, randomized to 2 weeks of:
- Pediatric allergic rhinitis with functional gastrointestinal disease: Associations with the intestinal microbiota and gastrointestinal peptides and therapeutic effects of interventions
- 80 kids w/ allergic rhinitis & functional GI disease (FGID)
- Kids w/ allergic rhinitis & FGID randomized to:
- Conventional drug (H1 blocker, intranasal steroids, prokinetic)
- Conventional drug + glutamine + probiotics
- After 3 months, the drug + glutamine + probiotics group had higher response rate (95% vs 77.5%)
- Commentary: This study showed that treating the gut w/ foundational GI therapies on top of conventional drugs led to better improvements as compared to drugs alone.
- Probiotics including Clostridium butyricum, Enterococcus faecium, and Bacillus subtilis may prevent recurrent spontaneous preterm delivery
- Retrospective study of 51 pregnant women w/ history of spontaneous preterm delivery (sPTD), compared to 255 pregnant women w/o history of sPTD
- All had been taking probiotics >14 weeks before delivery
- The rate of recurrent sPTD was significantly lower in the probiotics group (9.8% vs 31%)
- Commentary: Probiotics may be able to reduce the rate of sPTD.
- Meta-analysis of randomized controlled trials of the effects of probiotics on type 2 diabetes in adults
- 33 studies, 1,927 type-2 diabetics
- Compared to placebo, probiotics led to greater improvements in:
- HbA1c (-0.2%)
- Fasting glucose (-18 mg/dl)
- Fasting insulin (-0.8 uIU/ml)
- Insulin resistance (HOMA IR -1)
- Multi-dose strain and high-dose probiotics had the greatest effect on glycemic control compared to single-strain and low-dose probiotics
- Commentary: High-dose and multi-strain Probiotics have a beneficial effect on glucose control.
- Association between irritable bowel syndrome and Parkinson’s disease: A systematic review and meta-analysis
- 6 studies, 58,645 Parkinson’s disease patients
- IBS was associated with an increased risk of Parkinson’s disease (OR = 1.5)
- Commentary: IBS may be a risk factor for Parkinson’s disease. This study highlights the gut-brain connection. Keep in mind this is an observational study.
- Proton pump inhibitors’ use and risk of iron deficiency anaemia: a systematic review and meta-analysis
- 14 studies
- PPIs use increased risk of iron deficiency anemia (RR 2.56)
- Postinfection Irritable Bowel Syndrome Following Clostridioides difficile Infection: A Systematic-review and Meta-analysis
- 15 studies, 1,218 patients w/ previous C. diff infection
- 22.1% of patients developed post-infectious IBS after C. diff infection
- 46.3% diarrhea-predominant IBS
- 33.3% mixed-IBS
- Commentary: C. diff infection may be a risk factor for onset of IBS.
- Effects of Bifidobacterium animalis ssp. lactis 420 on gastrointestinal inflammation induced by a nonsteroidal anti-inflammatory drug: A randomized, placebo-controlled, double-blind clinical trial
- 50 healthy participants, randomized to NSAID plus placebo or probiotic:
- After 1 month, compared to placebo, the probiotic group experienced less:
- Diarrhea (2 participants vs 4 participants)
- Nausea (0 vs 5)
- Fecal calprotectin slightly increased in both groups
- Commentary: The probiotic group experienced LESS GI symptoms from NSAID use despite increased levels of calprotectin. This supports our clinic’s observation that labs are only part of the decision making and it’s more important to focus on outcome data, i.e. symptomatic improvement.
- Efficacy of i3.1 Probiotic on Improvement of Lactose Intolerance Symptoms: A Randomized, Placebo-controlled Clinical Trial
- 48 lactose-intolerant patients randomized to placebo or probiotic
- After 2 months, the probiotic group experienced:
- Reduced total GI symptom scores upon lactose reintroduction compared to placebo (-5.1 vs -1.0)
- NO improvement in lactose hydrogen breath test
- Commentary: Probiotic supplementation can improve lactose intolerance. It’s important to note how symptoms improved WITHOUT any change in labs, which is why labs are only 1/4th of data used to make clinical decisions.
- The Clinical, Microbiological, and Immunological Effects of Probiotic Supplementation on Prevention and Treatment of Periodontal Diseases: A Systematic Review and Meta-Analysis
- 64 RCTs on patients with periodontal disease
- Probiotic supplementation improved many clinical outcomes associated with periodontal disease, including reduced:
- Oral pathogens
- Gingival inflammation
- Plaque
- Commentary: Probiotic supplementation has a beneficial effect on both oral health and oral microbiome.
- Effects of probiotics on nonalcoholic fatty liver disease: a systematic review and meta-analysis
- 9 RCTs, 352 patients w/ NAFLD, randomized to control or probiotic
- Probiotics led to improved:
- AST
- ALT
- Total cholesterol
- Commentary: This study highlights the microbiome-liver connection.
- Helminth-Induced Human Gastrointestinal Dysbiosis: a Systematic Review and Meta-Analysis Reveals Insights into Altered Taxon Diversity and Microbial Gradient Collapse
- 7 studies, 424 helminth-infected participants and 497 healthy controls
- Helminth infections were associated with increased microbiota diversity
- Methimazole plus levothyroxine for treating hyperthyroidism in children: a systematic review and meta-analysis
- 15 studies, 1,700 pediatric hyperthyroid patients
- Compared with methimazole alone (control group), methimazole + levothyroxine led to:
- No difference in TSH levels
- Lower adverse reactions (OR 0.28)
- Lower fT3, fT4
- Reduced thyroid volume
- Commentary: Using methimazole + levothyroxine to treat hyperthyroidism in children can lower the levels of fT3 and fT4, reduce the thyroid volume, and lower the adverse reaction rate of patients.
- Levothyroxine Supplementation in Euthyroid Pregnant Women With Positive Autoantibodies: A Systematic Review and Meta-Analysis
- 9 studies on pregnant euthyroid women w/ positive TPO antibodies
- Compared to no treatment, treatment w/ levothyroxine did NOT reduce the risk of adverse pregnancy outcomes (preterm birth, preeclampsia, placental abruption etc).
- Commentary: Treating euthyroid pregnant women w/ levothyroxine was NOT associated w/ a reduced risk of adverse pregnancy outcomes, despite having positive TPO antibodies.
- Untreated thyroid autoantibody-negative SCH increases the risk of spontaneous abortions
- Retrospective study, 1,344 pregnant women divided into 2 groups:
- Subclinical hypothyroidism (SCH) w/o antibodies, n=94
- 40% treated w/ levothyroxine
- 60% not treated
- Euthyroid, n= 1,250
- Subclinical hypothyroidism (SCH) w/o antibodies, n=94
- The SCH women who were not treated w/ levothyroxine had a higher risk of spontaneous abortion (OR 3.1)
- Commentary: Pregnant women who have SCH without antibodies who are NOT treated have a higher risk of spontaneous abortions. However, according to the previous study, euthyroid pregnant women with antibodies do NOT benefit from replacement therapy.
- Retrospective study, 1,344 pregnant women divided into 2 groups:
- Brain Fog in Hypothyroidism: Understanding the Patient’s Perspective
- 5,170 participants reporting brain fog while being treated for hypothyroidism
- 47% reported brain fog onset prior to the diagnosis of hypothyroidism
- Study on the Effect of Berberine, Myoinositol, and Metformin in Women with Polycystic Ovary Syndrome: A Prospective Randomised Study
- Women w/ PCOS randomized to one of the following:
- Berberine (500 mg BID)
- Metformin (500 mg BID)
- Myo-inositol (1,000 mg BID)
- After 3 months of treatment, compared to metformin:
- Berberine led to the greater improvements in weight, androgens and lipids
- Myo-inositol led to the greater improvements in glucose and insulin sensitivity
- Commentary: Myo-inositol and berberine were more efficacious than Metformin in the treatment of PCOS.
- Women w/ PCOS randomized to one of the following:
- Fracture recurrence in hip fracture with menopausal hormone therapy versus risedronate: a clinical trial
- 281 post-menopausal women with recent hip fracture, randomized to:
- Oral risedronate
- Hormone therapy (topical estradiol + oral progesterone)
- After 4 years, NO significant difference in new fracture rates observed between groups (8.6 vs 12.8 per 100 person-years)
- Hip bone-mineral density increased in the hormone therapy group, not the risedronate group (+2.8% vs 0%)
- Commentary: Hormone therapy improved hip bone-mineral density more than risedronate, but no difference was observed in incidence of new fractures.
- 281 post-menopausal women with recent hip fracture, randomized to:
- Effects of very low-carbohydrate ketogenic diet on lipid metabolism in patients with type II diabetes mellitus: a meta-analysis
- 10 studies using ketogenic diets in type 2 diabetic patients
- Ketogenic diet led to NO difference was found in total cholesterol, HDL, and LDL levels after 3, 6, and 12 months of treatment
- However, a ketogenic diet led to a decrease in triglycerides
- Commentary: A ketogenic diet may lead to improvements in triglyceride levels, and minimal changes in other lipid parameters in type 2 diabetics.
- Daily steps and all-cause mortality: a meta-analysis of 15 international cohorts
- 15 studies, 47,000 participants
- After 7 years, those who had higher daily step counts had lower all-cause mortality (HR 0.47 for those who walked 10,000 steps/day)
- Commentary: Accumulating adequate daily steps is an important pillar of foundational health.
- Mouth Closing to Improve the Efficacy of Mandibular Advancement Devices in Sleep Apnea
- Cross-over study, 21 participants w/ sleep apnea randomized to:
- No treatment
- Mandibular advancement device (MAD)
- Mouth tape
- MAD + mouth tape
- Sleep apnea improved in 76% of participants in the MAD + mouth tape group compared to 43% in the MAD alone group
- Mouth taping alone did NOT significantly improve sleep apnea
- Commentary: MAD + mouth taping led to greater improvements in sleep apnea compared to MAD or mouth taping alone.
- Cross-over study, 21 participants w/ sleep apnea randomized to:
- Omega-3 fatty acid, carotenoid and vitamin E supplementation improves working memory in older adults: A randomised clinical trial
- 60 healthy participants ≥65 y/o, randomized to:
- Placebo
- Treatment group
- Fish oil (1g/d)
- Carotenoids (22 mg/d)
- Vitamin E (15 mg/d)
- After 2 years, compared to placebo, participants in the treatment group experienced:
- Fewer errors in working memory tasks (-38% vs +1%)
- NO difference in overall cognitive function improvement (+3% vs +6%)
- Commentary: Long-term supplementation with fish oil, carotenoids and vitamin E led to improvements in memory in older adults.
- 60 healthy participants ≥65 y/o, randomized to:
- Clinical effect of methimazole combined with selenium in the treatment of toxic diffuse goiter in children
- 103 kids w/ Graves’ disease (GD), randomized to:
- Methimazole alone
- Combined methimazole + selenium (50 mcg/d)
- The combined methimazole + selenium group had:
- Lower thyroid volume
- Lower IL-6 and IL-8
- Lower TRAb (-411 vs -105 μ/mL)
- Lower TPO Ab levels (-191 vs -97 μ/mL)
- Took less time for fT4 to return to normal level (90 vs 120 days)
- Commentary: Combined methimazole and selenium (even at a lower dose) is more effective than methimazole alone in managing GD, even in a pediatric population.
- 103 kids w/ Graves’ disease (GD), randomized to:
- Hydrogen-producing small intestinal bacterial overgrowth is associated with hepatic encephalopathy and liver function
- Prospective study of 107 hospitalized patients w/ liver dysfunction encephalopathy
- SIBO detected in 29% of participants
- NO difference in liver function between SIBO + and SIBO – participants
- But, H2 SIBO was associated w/ hepatic encephalopathy (50% H2 vs 24% CH4)
- 8 hepatic encephalopathy patients treated w/ Rifaximin
- H2 SIBO patients had higher response rate of breath test improvement (response rate 67% H2 vs 20% CH4)
- Commentary: H2 SIBO may be more closely associated with hepatic encephalopathy and liver function than CH4 SIBO.
- Effect of rifaximin on infections, acute-on-chronic liver failure and mortality in alcoholic hepatitis: a pilot study (RIFA-AH)
- Open label study of 63 patients w/ alcoholic hepatitis, allocated to standard care or Rifaximin (1,200 mg/d) + standard care
- After 90 days of treatment, the Rifaximin + standard care had:
- Less infections (0.29 vs 0.62 per patient)
- Lower rate of liver complication (0.43 vs 1.26 per patient)
- Lower mortality (14% vs 31%)
- NO serious adverse events
- Commentary: The addition of Rifaximin improves clinical outcomes and reduces mortality for those w/ alcoholic hepatitis.
- A randomised, double-blind, placebo-controlled trial of Bifidobacterium bifidum CCFM16 for manipulation of the gut microbiota and relief from chronic constipation
- 103 patients w/ chronic constipation, randomized to placebo or probiotic
- After 1 month of supplementation, the probiotic group had:
- Improved stool consistency
- No difference in overall symptoms
- No difference in quality of life
- No association between acid suppressant use and risk of dementia: an updated meta-analysis
- 17 studies, 1.2 million participants
- Compared to non-users, NO increased risk of dementia was associated with:
- PPI use (HR 0.98)
- H2-blocker use (HR 1.20)
- Commentary: PPI and H2 blockers are NOT associated w/ an increased risk of dementia. Keep in mind this is an observational study.
- Use of acid-suppressive drugs and risk of fracture in children and young adults: a meta-analysis of observational studies
- 6 studies, 900,000 children and young adults
- Compared to non-users, PPI use was associated with an increased risk of fractures in children (RR 1.1) and young adults (RR 1.2)
- NO association was found between fractures and H2-blockers (RR 1.0)
- Commentary: Children and young adults using PPIs have a slight increased risk of fractures.
- Fermentable oligo-, di-, monosaccharides, and polyols (FODMAPs), but not gluten, elicit modest symptoms of irritable bowel syndrome: a double-blind, placebo-controlled, randomized three-way crossover trial
- Cross-over study of 103 IBS patients, randomized to 1-week interventions of:
- Rice porridge (placebo)
- FODMAPs + rice porridge
- Gluten + rice porridge
- Each intervention was followed by a 1-week washout period
- FODMAP consumption led to the highest IBS symptom score (240) compared to placebo (198) and gluten (208)
- Commentary: High FODMAP consumption was associated with worse IBS symptoms compared to gluten or placebo.
- Cross-over study of 103 IBS patients, randomized to 1-week interventions of:
- Efficacy and Safety of Mecobalamin Combined with Prokinetic Agents in the Treatment of Diabetic Gastroparesis: A Meta-Analysis
- 24 RCTs, 1,878 patients w/ diabetic gastroparesis, randomized to:
- Prokinetic
- Prokinetic + methyl-B12
- Compared to prokinetics alone, the addition of methyl-B12 led to:
- Improved gastric emptying rate
- Less recurrence of gastroparesis
- Commentary: The addition of methyl-B12 led to greater improvement in diabetic gastroparesis compared to prokinetics alone.
- 24 RCTs, 1,878 patients w/ diabetic gastroparesis, randomized to:
- FODMAP dietary restrictions in the management of children with functional abdominal pain disorders: A systematic review
- 5 RCTs evaluating low FODMAP diet in pediatric functional abdominal pain disorders
- 2 trials showed improved abdominal pain
- Synbiotics to prevent necrotising enterocolitis in very preterm or very low birth weight infants
- Meta-analysis of 6 RCTs, 925 preterm or very low birth weight infants
- Synbiotics reduced the risk of:
- Necrotizing enterocolitis (NEC) (RR 0.18)
- All-cause mortality (RR 0.53)
- Commentary: Synbiotics may improve NEC and mortality in very high risk infants.
- β-glucuronidase activity is associated with carbohydrate metabolism but not with androgen status in overweight and obese women with polycystic ovary syndrome
- Cross-sectional study of 56 overweight women w/ PCOS
- Measured food intake and fecal β-glucuronidase activity
- NO relationship between β-glucuronidase activity and androgen levels
- Commentary: This study failed to show an association between β-glucuronidase and androgen levels. We do not use this marker at the clinic.
- 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
- 100 IBS patients (non constipative), randomized to:
- Low FODMAP
- Gluten-free diet
- Traditional diet
- After 4 weeks, ≥50-point reduction in IBS-SSS was achieved in:
- 42% traditional diet
- 55% low FODMAP diet
- 58% gluten free diet
- Participants found that the traditional diet easier to incorporate
- Alterations in stool dysbiosis index were similar across the diets
- Commentary: This is why we at the clinic often start with a relaxed paleo diet before moving to a low FODMAP diet.
- 100 IBS patients (non constipative), randomized to:
- Lacticaseibacillus rhamnosus GG DSM 33156 effects on pathogen defence in the upper respiratory tract: a randomised, double-blind, placebo-controlled paediatric trial
- RCT of 619 children 2-6 y/o, randomized to placebo or probiotic
- After 4 months, NO significant difference in incidence of upper respiratory tract infections (URTI)
- However, probiotic intake was associated with less severe URTI symptoms
- Commentary: While probiotics did not lead to reduced incidence of URTI, they did help reduce the severity of symptoms.
- Gut permeability is associated with hypertension and measures of obesity but not with Endothelial Dysfunction in South African youth
- 151 participants (18-25 y/o) categorized by their blood pressure:
- 18% hypertensive
- 40% pre-hypertensive
- 42% normotensive
- Blood zonulin was measured to assess for increased intestinal permeability
- Increasing levels of zonulin correlated with higher:
- Blood pressure
- Body mass index
- Commentary: Intestinal permeability, based on elevated zonulin, was associated with hypertension and obesity. Keep in mind this is an observational study.
- 151 participants (18-25 y/o) categorized by their blood pressure:
- Evaluation of Intestinal Parasites and Some Clinical Symptoms in Children with Diarrhea
- 300 kids w/ diarrhea, 100 healthy control kids
- All had stool samples
- Intestinal parasites were found at a higher rate in the diarrhea group (35% vs 17%)
- Blastocystis hominis (13%)
- Cryptosporidium spp
- (3%)
- Giardia intestinalis (2%)
- The presence of parasites were also associated w/ abdominal pain and nausea
- Commentary: This study found an association of intestinal parasites and diarrhea.
- Association Between Generic-to-Generic Levothyroxine Switching and Thyrotropin Levels Among US Adults
- Observational study, 15,829 hypothyroid patients w/ normal TSH, taking generic levothyroxine for at least 3 months
- After 3 months:
- 82.4% continued taking the same generic levothyroxine (non-switchers)
- 17.6% switched to a different generic levothyroxine (switchers)
- Patients had follow up thyroid labs between 6 weeks and 1 year AFTER switching to a different generic levothyroxine
- Comparing switchers to non-switchers, NO significant difference was observed in the number of patients with:
- Normal TSH (84.5% vs 82.7%)
- Significantly abnormal TSH (<0.1 or >10.0 mIU/L) (2.5% vs 3.1%)
- Commentary: Switching between different generic levothyroxine medications is not associated with clinically meaningful changes in TSH.
- Excess use of thyroid hormone treatment among patients with fibromyalgia: a cross-sectional study in primary health care
- 16 fibromyalgia patients taking levothyroxine
- Initial TSH and T4 values were assessed prior to beginning levothyroxine
- 74% of patients taking levothyroxine initially had either:
- Normal thyroid function
- Subclinical hypothyroidism
- Only 25% had overt or central hypothyroidism
- Commentary: A significant number of fibromyalgia patients are inappropriately prescribed levothyroxine despite NO true hypothyroid diagnosis. Dr. Ruscio describes this as well-intended but inappropriate care.
- Sleep apnea in postmenopausal women is associated with joint pain severity and fatigability: a cross-sectional study
- 51 postmenopausal women assessed for obstructive sleep apnea (OSA) w/ home sleep test
- 14% diagnosed w/ OSA
- Higher RDI (marker of sleep disordered breathing) was associated w/ more joint pain
- Lower oxygen saturation at night was related to more fatigue
- Commentary: This study highlights the connection of sleep disordered breathing, joint pain, and fatigue.
- Vitamin D Supplementation and Fractures in Adults: A Systematic Umbrella Review of Meta-Analyses of Controlled Trials
- Vitamin D + calcium reduced the risk of:
- Hip fractures (RR 0.6-0.8) in 8/12 studies
- Any fracture (RR 0.7-0.9) in 7/11 studies
- 19 studies, vitamin D alone led to NO reduction in fracture risk
- Commentary: The addition of calcium to vitamin D supplementation led to reduced risk of fractures in adults.
- Vitamin D + calcium reduced the risk of:
- High-intensity interval training reduces blood pressure in older adults: A systematic review and meta-analysis
- 10 studies, 266 participants
- High-Intensity Interval Training (HIIT) led to a reduction in:
- Systolic blood pressure (-7.4 mmHg)
- Diastolic blood pressure (-5.5 mmHg)
- No differences found between HIIT and moderate-intensity continuous training
- Commentary: Remember that exercise is a powerful tool for combating hypertension.