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Future of Functional Health Review Clinical Newsletter

Research Briefs for Practitioners – May 2022

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

Medically reviewed & fact checked by a
board-certified doctor
Dr. Ruscio and his team are committed to delivering content that is accurate and objective. Every new article is thoroughly fact-checked by a board certified doctor from our network.
Medically reviewed & fact checked by a
board-certified doctor
Dr. Ruscio, DC and his team are committed to delivering content that is accurate and objective. Every new article is thoroughly fact-checked by a board certified doctor from our network.
Published on April 12, 2022 by

Sections

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Episode 52

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Featured Studies

  • 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.

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.

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Gastrointestinal Studies

  • 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.
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Autoimmunity Study

  • 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.
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Thyroid & Hormones Studies

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Diet & Lifestyle Studies

  • 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.
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Episode 51

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Featured Study

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Gastrointestinal Studies

  • 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.
  • 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.
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Diet & Lifestyle Studies

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Episode 50

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Featured Study

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Gastrointestinal Studies

  • 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.
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Thyroid & Hormones Studies

  • 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
    • 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.
  • 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.
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Diet & Lifestyle Studies

  • 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.
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Episode 49

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Featured Study

  • 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.
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Gastrointestinal Studies

  • 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.
  • 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.
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Thyroid & Hormones Studies

  • 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.
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Diet & Lifestyle Studies

About the author

Dr. Ruscio

Dr. Michael Ruscio is a DC, Naturopathic Practitioner, researcher, and clinician. He serves as an Adjunct Professor at the University of Bridgeport and has published numerous papers in scientific journals as well as the book Healthy Gut, Healthy You. He also founded the Ruscio Institute of Functional Health, where he helps patients with a wide range of GI conditions and serves as the Head of Research.
Dr. Michael Ruscio is a DC, Naturopathic Practitioner, researcher, and clinician. He serves as an Adjunct Professor at the University of Bridgeport and has published numerous papers in scientific journals as well as the book Healthy Gut, Healthy You. He also founded the Ruscio Institute of Functional Health, where he helps patients with a wide range of GI conditions and serves as the Head of Research.

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