- Diagnosing Small Intestinal Bacterial Overgrowth: A Comparison of Lactulose Breath Tests to Small Bowel Aspirates
- Retrospective study of 106 patients who underwent both a lactulose breath test (NA Consensus- positive if increase H2 20+ ppm within 90 minutes or methane 10+ ppm anytime) and duodenal aspirate
- Results:
- 16.5% SIBO+ on aspiration
- 31.1% SIBO+ on LBT
- Risk factors for SIBO:
- PPI (62% vs 29%)
- Diabetes (94% vs 71%)
- Aspiration and LBT results agreed in only 63.5% of the time
- Commentary: The agreement of aspiration and LBT for the evaluation of SIBO was poor. GBT is more sensitive and specific to assess SIBO.
- Efficacy and safety of probiotics and prebiotics in liver transplantation: A systematic review and meta-analysis
- 6 studies, 345 patients undergoing liver transplantation who were given probiotics/prebiotics
- Pro/prebiotics lead to less:
- Overall infection rate (RR 0.29)
- UTI (RR 0.14)
- Hospital stay
- Time on antibiotics
- Commentary: This findings corroborates other studies suggesting probiotics can improve outcomes of GI infections.
- Impact of Different Helicobacter Pylori Eradication Therapies on Gastrointestinal Symptoms
- 140 patients w/ H pylori colonization
- Randomized to:
- Concomitant therapy (PPI, amoxicillin, clarithromycin, Flagyl x14 days)
- Hybrid therapy (PPI, amoxicillin for 14 days, with added Flagyl and Clarithromycin in last 7 days)
- Results:
- Both groups had reduced GI symptoms
- Slightly better improvement w/ hybrid therapy
- Commentary: H pylori eradication therapy could alleviate GI symptoms regardless of treatment used, but small favorable effect for hybrid therapy.
- A polyphenol-rich dietary pattern improves intestinal permeability, evaluated as serum zonulin levels, in older subjects: The MaPLE randomized controlled trial
- Cross-over study, 51 adults w/ increased intestinal permeability (increased serum zonulin levels)
- Randomized to polyphenol-rich diet or control diet x8 weeks w/ 8 week washout period
- Greater reduction in polyphenol-rich diet
- Commentary: Generally improving one’s diet quality can improve intestinal permeability.
- Association between serum zonulin level and severity of house dust mite allergic asthma
- 48 w/ house dust mite allergic asthma, 48 healthy controls
- Measured serum zonulin as proxy for intestinal permeability
- The mean serum zonulin was 258.3 ng/ml in the asthmatic group and 80 ng/mL in the control group
- Higher serum zonulin associated with increased asthma severity
- Commentary: Increased intestinal permeability contributes to pathogenesis of allergic asthma
- Effect of synbiotics and probiotics supplementation on autoimmune diseases: A systematic review and meta-analysis of clinical trials
- 10 RCTs, 440 participants w/ autoimmune disease
- Probiotics lead to:
- Reduced IL-6, TNF-α
- Reduced CRP (-0.58)
- Improved insulin resistance (-0.7 HOMA-IR)
- Commentary: Probiotics can improve metabolic and inflammatory markers in those w/ autoimmune disease
- Calcium Intake and Iron Status in Human Studies: A Systematic Review and Dose-Response Meta-Analysis of Randomized Trials and Crossover Studies
- Does calcium intake affect iron status?
- The negative effect of calcium intake on iron absorption was statistically significant, but the effect magnitude was low
- Calcium intake lowers ferritin w/ no statistically significant reduction in hemoglobin levels
- Commentary: Calcium supplementation MAY impact ferritin levels without a reduction in hemoglobin levels. Consider having patients separate intake of iron and calcium-containing supplements.
- Association between abuse and neglect with functional constipation and irritable bowel syndrome in adolescents
- 265 adolescents, 28% w/ IBS-C
- Emotional stressors associated with higher risk of IBS-C:
- Violence in 83%
- Physical abuse in 91%
- Emotional abuse in 93%
- Neglect in 54%
- Commentary: History of abuse and neglect are associated w/ IBS. Consider asking about adverse childhood events as part of your intake process.
- Efficacy of a curcumin extract (Curcugen™) on gastrointestinal symptoms and intestinal microbiota in adults with self-reported digestive complaints: A randomized, double-blind, placebo-controlled study
- 79 w/ general digestive symptoms, randomized to curcumin (500 mg QD) or placebo
- After 8 weeks, the curcumin group had:
- Greater improvement of GI symptoms
- Greater improvement of anxiety
- NO greater adverse effects
- Commentary: Curcumin may have beneficial effects for functional GI disorders and other digestive issues.
- Seronegative autoimmune atrophic gastritis is more common in elderly patients
- To assess the occurrence and clinical features of seronegative (absence of parietal cell antibodies (PCA)) compared to seropositive autoimmune gastritis (AAG)
- Cross-sectional study of 516 adults (mean age 60 yo) w/ biopsy proven AAG in last 10 years
- 21% were seronegative (had NO antibodies)
- Older AAG patients had lower rates of being seropositive (having PCA)
- 70-79 yo= 5% positive
- 80+ yo= 21% positive
- Patients over 50 yo had 2.4x increased risk of being seronegative
- Commentary: Roughly 21% of patients in this study had no PCA despite biopsy-proven AAG diagnosis. Keep AAG in your differential even if seronegative, especially in the elderly.
- Prevalence and impact of Rome IV versus Rome III irritable bowel syndrome in patients with inflammatory bowel disease
- Cross-sectional study of 973 IBD patients
- Prevalence of IBS:
- 31% per ROME III criteria
- 18% per ROME IV criteria
- Co-presence of IBS associated w/ mood imbalances and lower quality of life
- Compared to ROME III criteria, those w/ ROME IV IBS had higher rates of anxiety, depression, and lower quality of life
- Commentary: This study exemplifies 2 major points:
- There is a substantial concomitant presence of IBS in those w/ IBD
- Presence of IBS is associated with mood imbalances and worse quality of life
- A Low-FODMAP Diet Improves the Global Symptoms and Bowel Habits of Adult IBS Patients: A Systematic Review and Meta-Analysis
- 10 studies, 511 participants
- A low FODMAP diet was associated with:
- Improvement in global symptoms (RR 1.54)
- Improvement of stool consistency
- NO change in IBS quality of life
- NO difference in anxiety or depression scores
- Commentary: Overall, a low FODMAP diet shows benefit for IBS patients.
- Mass eradication of Helicobacter pylori to reduce gastric cancer incidence and mortality: a long-term cohort study on Matsu Islands
- 4,584 adults treated for H pylori colonization over course of 14 year period
- H pylori treatment associated with:
- Reduced gastric cancer (-53%)
- Reduced mortality (-25%)
- Effect of resveratrol administration on ovarian morphology, determined by transvaginal ultrasound for the women with PCOS
- 41 PCOS patients randomized to resveratrol (1 g/d) or placebo
- After 3 months, resveratrol group had improved ovarian morphology and improved folliculogenesis
- Commentary: Resveratrol may be helpful in those w/ PCOS.
- The effect of resistance training on sleep in Chinese older adults: A randomized controlled trial
- 62 older adults in assisted living facility
- Randomized to resistance training (1-hr sessions 3x/wk) or placebo
- After 12 weeks, the resistance training group had better sleep efficiency compared to control group
- Protein supplementation increases adaptations to endurance training: A systematic review and meta-analysis
- 19 studies, 1,162 participants
- Protein supplementation associated with:
- Improved aerobic capacity
- Improved endurance race times
- Greater muscle mass (+0.32 kg)
- Improvement of Executive Function after Short-Term Administration of an Antioxidants Mix Containing Bacopa, Lycopene, Astaxanthin and Vitamin B12: The BLAtwelve Study
- 80 healthy older adults (>60 yo) randomized to antioxidants (bacopa, lycopene, astaxanthin, and B12) or placebo
- After 8 weeks, the antioxidant group had better cognitive results compared with placebo
- The effect of meal frequency on biochemical cardiometabolic factors: A systematic review and meta-analysis of randomized controlled trials
- Compared high vs low meal frequency in 21 RCTs, 686 participants
- Higher meal frequency associated with:
- Improved total cholesterol (-6 mg/dL)
- Improved LDL-C (-6.8 mg/dL)
- Improved triglycerides
- No difference in ApoB
- Commentary: Intermittent fasting is NOT a magical metabolic cure for all patients. However, these differences may not be that clinically significant.
- Association between Breakfast Skipping and Body Weight: A Systematic Review and Meta-Analysis of Observational Longitudinal Studies
- 9 studies
- 11% increased relative risk for overweight/obesity when breakfast was skipped on ≥3 days per week
- Commentary: Note that this is nutritional epidemiology (low-quality evidence) but it does throw shade on intermittent fasting as a weight loss intervention.
- The effect of intermittent energy restriction on weight loss and diabetes risk markers in women with a history of gestational diabetes: A 12-month randomized control trial
- 62 overweight women w/ history of gestational diabetes
- Randomized to continuous energy restriction (CER) or intermittent fasting (2 days at 500 kcal)
- After 12 months, NO differences in:
- Weight reduction
- A1C
- Fasting glucose
- Insulin resistance
- Commentary: More proof of non-superiority of intermittent fasting compared to continuous energy restriction.
- Effect of omega-3 and vitamin D co-supplementation on psychological distress in reproductive-aged women with pre-diabetes and hypovitaminosis D: A randomized controlled trial
- 168 women w/ pre-diabetes and low Vit D
- Randomized to:
- Placebo
- Omega-3
- Vitamin D
- Omega-3 + Vitamin D
- After 8 weeks, the omega-3 + Vitamin D group had:
- Reduction in anxiety and depression
- Better sleep quality
- Interaction between APOE ε4 and dietary protein intake on cognitive decline: A longitudinal cohort study
- Prospective study of 3,029 Chinese participants (mean age 77 yo)
- Those carrying the APOE ε4 allele had faster cognitive decline (OR 1.19)
- Regular fish intake reduced cognitive decline in those carrying APOE ε4 allele (OR 0.43)
- Commentary: APOE ε4 allele is associated w/ a small but notable increased risk of cognitive decline (but be careful not to cast fear/worry to patients). Regular fish intake can reduce this risk.
- The impact of vitamin D supplementation as an adjuvant therapy on clinical outcomes in patients with severe atopic dermatitis: A randomized controlled trial
- 86 pediatric patients w/ severe atopic dermatitis
- Randomized to steroid cream plus Vit D (1,600 IU/d) or placebo
- The Vit D group had lower dermatitis scores compared to placebo
- Diagnostic yield of endoscopy in irritable bowel syndrome: A nationwide prevalence study 1987-2016
- Compared 21,944 IBS patients vs 81,000 without IBS who had colonoscopy + biopsy
- Also compared 10,000 IBS patients vs 46,000 without IBS who had endoscopy + biopsy
- For those receiving colonoscopy
- IBD higher in CONTROLS (1.6% IBS vs. in 5.9% controls)
- Precancerous polyps higher in CONTROLS (4.1% vs 13%)
- Colon cancer higher in CONTROLS (0.8% vs 6.3%)
- For those receiving endoscopy
- Celiac disease higher in CONTROLS (1.9% vs 3.4%)
- Microscopic colitis higher in IBS (2.9% vs 1.7%)
- Especially for older patients
- Commentary: The diagnostic yield of colonoscopy and endoscopy for those w/ IBS remains low, but increases with age.
- Impact of nutraceuticals on markers of systemic inflammation: Potential relevance to cardiovascular diseases – A position paper from the International Lipid Expert Panel (ILEP)
- Expert consensus on anti-inflammatory nutraceuticals
- Results:
- Omega-3 fatty acids (2.5 g/d) recommended w/ high-quality evidence
- CRP reduction (up to -38%)
- IL-6 (-12-13%)
- IL-18 (-0.5-7%)
- Red yeast rice recommended w/ high-quality evidence
- CRP reduction (-28-50%)
- Should be considered w/ moderate-quality evidence:
- Flavonoids
- Curcumin
- May be considered w/ moderate-quality evidence:
- Garlic (1,200-3,600 mg/d)
- Berberine
- Meta-analysis of 5 RCTs showed that serum levels of CRP were significantly decreased after berberine supplementation (−0.64 mg/L)
- Omega-3 fatty acids (2.5 g/d) recommended w/ high-quality evidence
- Commentary: Highest-quality evidence for high-dose (2.5 g/d) omega-3 fatty acids as anti-inflammatory agents.
- Efficacy of Bifidobacterium breve CECT7263 for infantile colic treatment: An open-label, parallel, randomised, controlled trial
- 150 infants w/ colic, randomized to probiotics (bifidobacterium) or standard treatment (Simethicone)
- After 28 days, the probiotic group had:
- More reduction in crying (-69% vs -60%)
- Better sleep
- Improved mood per parents’ report
- Commentary: Another study to justify and support the use of probiotics in infants/pediatric populations.
- Probiotics and synbiotics show clinical efficacy in treating gestational diabetes mellitus: A meta-analysis
- 12 RCTs, 894 participants
- Compared to the placebo, patients administered probiotics/synbiotics supplements benefited more with regards to:
- Glucose
- Insulin
- Lipid metabolism (VLDL -5 mg/dL)
- Inflammation (hsCRP -1.23)
- Probiotics also reduced risk of:
- Fetal hyperbilirubinemia (RR 0.26)
- Fetal macrosomia (RR 0.47)
- Newborn weight (effect size -0.29)
- Commentary: Probiotics given to mothers w/ gestational diabetes not only affect the mother but lowered the risk of fetal adverse events.
- Small Intestinal Bacterial Overgrowth In Various Functional Gastrointestinal Disorders: A Case-Control Study
- 244 participants, 186 w/ functional GI disorders (FGID), 58 healthy controls
- All had glucose breath test
- FGIDs had a higher prevalence of SIBO compared to controls (16% FGIDs vs. 10% controls)
- Even higher rate of SIBO in IBS-D (24%)
- NO difference for prevalence of methane-positive SIBO between chronic constipation compared to controls (9% vs. 7%)
- Commentary: Higher rates of SIBO are found in those w/ FGID, especially in those w/ IBS-D. This study surprisingly found NO association between methane-positive SIBO and constipation.
- Relationship between Helicobacter pylori infection and nonalcoholic fatty liver disease: What should we expect from a meta-analysis?
- 17 studies, 91,958 participants
- H pylori infection was associated with increased risk of NAFLD (OR 1.38)
- Commentary: Highlights the GI-Liver connection.
- Placebo Response Rates in Trials of Licensed Drugs for Irritable Bowel Syndrome with Constipation or Diarrhea: Meta-Analysis
- 17 RCTs of drugs used for IBS-C (4,600 participants), 17 RCTs of drugs used for IBS-D (3,900 participants)
- For IBS-C trials, placebo response rate:
- Abdominal pain: 35%
- Stool improvement: 30%
- For IBS-D trials, placebo response rate:
- Abdominal pain: 40%
- Stool improvement: 16%
- Commentary: There is a strong placebo effect in IBS literature. This corroborates a prior FFMR+ meta-analysis of 73 RCTs suggesting a positive response in 27% of those in the placebo arm. This also highlights the role of limbic retraining/distress tolerance in patients w/ IBS.
- Risk factors for gastric cancer: A large-scale, population-based case-control study
- 215 gastric cancer cases, 645 healthy controls
- Risk factors for gastric cancer:
- Smoke (OR 3.1)
- Drink alcohol (OR 1.7)
- Family history of gastric cancer in 1st degree relative (OR 4.3)
- Systematic review and meta-analysis of the role of Faecalibacterium prausnitzii alteration in inflammatory bowel disease
- 16 studies, 1669 subjects (427 CD patients, 560 UC patients, and 682 healthy controls)
- Both UC and CD patients had LOWER counts of F. prausnitzii in the stool
- Counts were especially lower during active IBD flares
- Commentary: Consider looking at this marker in common GI stool tests (e.g. GI Map). Lower levels indicate inflammation.
- Long-term personalized low FODMAP diet improves symptoms and maintains luminal Bifidobacteria abundance in irritable bowel syndrome
- 18 IBS patients put on personalized low FODMAP diet
- After 12 months, 67% had adequate relief of symptoms
- NO change in bifidobacterium counts
- Multispecies probiotics promote perceived human health and wellbeing: Insights into the value of retrospective studies on user experiences
- Retrospective study of 584 participants (no controls) taking a multi-species probiotic
- After 2 weeks, multi-species probiotic supplementation associated with:
- Improved GI symptoms
- Increased quality of life
- Improved stool consistency
- Commentary: More evidence to justify the use of multispecies probiotics
- Morning and evening salivary cortisol levels in patients with chronic widespread pain and those at high risk
- 19 fibromyalgia patients, 20 participants at risk for fibromyalgia, 17 healthy controls
- Measured morning and evening salivary cortisol levels
- Cortisol levels were higher in fibro and at-risk groups, compared to the controls
- Sleep and major life events (emotional stressors) were major contributors to altered cortisol levels
- Commentary: This puts another hole in the “adrenal fatigue” hypothesis
- Androgens and hirsutism score of overweight women with polycystic ovary syndrome improved after vitamin D treatment: A randomized placebo controlled clinical trial
- 60 PCOS patients w/ Vit D deficiency randomized to Vit D (50,000 IU per week) or placebo
- After 12 weeks, the Vit D group had:
- Reduced testosterone and lower androgens
- Less hirsutism
- Reduced parathyroid hormone
- More regulated menstrual cycle (90% at baseline to 7% w/ irregular cycles)
- Commentary: Consider Vit D for those w/ PCOS.
- Association Between Testosterone Treatment and Risk of Incident Cardiovascular Events Among US Male Veterans with Low Testosterone Levels and Multiple Medical Comorbidities
- Background: controversy remains around testosterone replacement therapy (TRT) and the risk of cardiovascular disease (CVD)
- Prospective study of 204,857 men 40+ years old, w/ multiple chronic health conditions, WITHOUT history of stroke, myocardial infarction, prostate cancer
- All on TRT and followed x4.3 years
- TRT use was NOT associated w/ risk of CVD (HR 0.89)
- In those w/ CVD risk factors, TRT was associated w/ less CVD (HR 0.8)
- Low-fat diets and testosterone in men: Systematic review and meta-analysis of intervention studies
- 6 studies, 206 participants
- Low fat diets associated with:
- Lower total testosterone (effect size -0.52)
- Lower DHT (effect size -0.3)
- Commentary: Low fat diets are associated w/ impaired sex hormone levels in men.
- Vitamin D and thyroid disorders: A systematic review and Meta-analysis of observational studies
- 42 studies
- Serum Vit D was lower in:
- Hashimoto’s (-6 ng/dL)
- Autoimmune thyroid disease (-3 ng/dL)
- Hypothyroidism (-13 ng/dL)
- Graves’ disease (only in those 40+ years old)
- Commentary: Studies consistently showed lower vit D levels in hypothyroid and AITD.
- Elevated thyroid-stimulating hormone levels are associated with poor sleep: A cross-sectional and longitudinal study
- 168 subclinical hypothyroid patients, 119 healthy controls
- Those w/ SCH had higher rates of poor sleep (70% vs 50%)
- Of those w/ SCH at baseline, TSH normalization was significantly higher in those who slept better than in those w/ poor sleep (85.42% vs. 6.45%)
- Commentary: Poor sleep is associated w/ SCH. Furthermore, TSH can normalize w/ improvement of sleep
- Dr. R added: If they did not control for age, we could be seeing the association between age and sleep deterioration
- Vitamin D and Cancer Survival: Does Vitamin D Supplementation Improve the Survival of Patients with Cancer?
- Narrative review
- “Meta-analyses of observational studies showed that higher blood 25-hydroxyvitamin D levels in patients with cancer at a variety of sites were associated with lower cancer-specific and overall mortalities.”
- Commentary: Higher Vit D levels may be considered for those w/ cancer.
- Dr. R: But, not clear if this is causal or associative
- Omega-3 polyunsaturated fatty acid supplementation improves lipid metabolism and endothelial function by providing a beneficial eicosanoid-pattern in patients with acute myocardial infarction: A randomized, controlled trial
- 60 patients w/ myocardial infarction (MI) post PCI randomized to:
- Omega-3 (2g/day) + standard post-MI therapy
- Standard post-MI therapy alone
- After 3 months, the omega-3 group had:
- Lower triglycerides (-6.3%)
- Lower ApoB (-5%)
- Lower Lp(a) (-37%)
- Increased NO levels (+62%)
- Commentary: Higher-dose omega-3 supplementation may improve lipid and endothelial function status post MI.
- 60 patients w/ myocardial infarction (MI) post PCI randomized to:
- The why, when and how to test for obstructive sleep apnea in patients with atrial fibrillation
- Up to 62% of those w/ Afib have obstructive sleep apnea (OSA)
- Treatment of OSA can reduce Afib recurrence
- All Afib patients should be screened for OSA
- Exposure to Aluminum, Cadmium, and Mercury and Autism Spectrum Disorder in Children: A Systematic Review and Meta-Analysis
- 18 studies on Aluminum, 18 on Cadmium, and 23 on Mercury
- Significant associations between all the metals and autism, but the associations were not always in the same direction
- Mercury: higher hair, urine, blood levels associated w/ autism
- Aluminum: higher hair and urine, and LOWER blood levels associated w/ autism
- Cadmium: LOWER hair and urine associated w/ autism
- Commentary: Despite these toxins being neurotoxic, toxin testing remains inconsistent and inconclusive.
- A 1-week diet break improves muscle endurance during an intermittent dieting regime in adult athletes: A pre-specified secondary analysis of the ICECAP trial
- 26 resistance-trained athletes went on 12 weeks of time-restricted feeding, then did 1 week of maintenance calories (by increasing carbs)
- The 1-week diet break:
- Had NO significant effect on fat mass
- Led to small but significant increases in mean body weight (0.6 kg) and fat-free mass (0.7 kg)
- Small increase in resting energy expenditure (+200 Cals/d)
- Improved muscle endurance in the legs (but not arms)
- No change in muscle strength
- Lower sensation of hunger and irritability
- Better mental alertness
- Commentary: A 1-week diet break to maintenance calories can be a powerful physical and psychological “reset” button to use for patients who are dieting.
- The effect of omega-3 fatty acids supplementation on social and behavioral disorders of children with autism: A randomized clinical trial
- 54 children w/ autism, randomized to omega-3 (1 g/d) or placebo
- After 8 weeks, the omega-3 group had:
- Significantly better behavior
- Lower autism severity
- Better social communication
- Commentary: Omega-3 supplementation improved some traits of autism in this small trial.
- Clinical Efficacy of Vitamin D3 Adjuvant Therapy in Allergic Rhinitis: A Randomized Controlled Trial
- 127 patients w/ allergic rhinitis (AR), randomized to antihistamine nasal spray with and without vitamin D
- After 4 weeks, the Vit D group had:
- Lower AR symptoms
- Better efficacy (97% w/ vit D, 84% without vit D)
- Vitamin D and nonalcoholic fatty liver disease in children: a randomized controlled clinical trial
- 109 children w/ fatty liver, randomized to vit D (2,000 IU/d) or placebo
- After 6 months, the vit D group had:
- Reduced liver steatosis on biopsy
- Reduced liver inflammation on biopsy
- Reduced liver function tests
- Commentary: Consider vit D for fatty liver.
- United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus on gastroparesis
- Consensus of 40 GI experts from 19 European countries
- Definition of gastroparesis: symptoms associated w/ delayed gastric emptying absent of mechanical blockage
- Symptoms include:
- Postprandial fullness/early satiation
- Epigastric pain
- Bloating
- Belching
- Vomiting
- Reflux (in 50%)
- Nausea (in 95%)
- Symptoms include:
- Risk factors
- Diabetes
- Acute GI infection (post-infectious gastroparesis)
- Bariatric surgery
- Hypothyroidism
- Connective tissue disease
- Opioids
- Diagnosis
- Upper GI endoscopy is required (usually before gastric emptying test)
- Abnormal gastric emptying test (scintigraphy)
- Treatment
- Diet
- Small meals
- Symptom control
- PPI for reflux symptoms
- Antiemetics (e.g. Zofran) for nausea
- Prokinetic (e.g. Metoclopramide) most appropriate first-line therapy
- Not to use for more than 12 weeks secondary to side effects (extrapyramidal side effects, tardive dyskinesia)
- Diet
- Commentary: This is a nice review of gastroparesis clinical presentation, diagnosis, and treatment. It was unfortunate that they did not review dietary interventions more. Nonetheless, you can work through the GI algorithm as you normally would to assess response and calibrate therapies.
- Effect of probiotic and synbiotic supplementation on inflammatory markers in health and disease status: A systematic review and meta-analysis of clinical trials
- 167 studies using probiotics
- Probiotics/synbiotics associated with the following in healthy participants:
- Reduced CRP
- Reduced TNF-α
- No change in IL-1
- No change in IL-10
- No change in IL-6
- Commentary: Probiotics reduced some (but not all) inflammatory markers in healthy individuals.
- Effects of ID-HWS1000 on the Perception of Bowel Activity and Microbiome in Subjects with Functional Constipation: A Randomized, Double-Blind Placebo-Controlled Study
- 30 patients w/ functional constipation, randomized to probiotics (lacto-biff) or placebo
- After 4 weeks, the probiotic group had more improvement of:
- Bowel frequency
- Straining
- Abdominal discomfort
- Correction of Dyssynergic Defecation, but Not Fiber Supplementation, Reduces Symptoms of Functional Dyspepsia in Patients with Constipation in a Randomized Trial
- 50 patients w/ functional dyspepsia and dyssynergic constipation
- Randomized to fiber or biofeedback (measured anal manometry for real-time feedback) to correct dyssynergic defecation
- After 4 weeks:
- Biofeedback treatment corrected dyssynergic defecation in 76% of patients
- Of those who corrected dyssynergic constipation:
- Postprandial fullness was reduced by 22%
- Fiber supplementation did NOT reduce postprandial fullness
- Commentary: Diagnosis and correction of dyssynergic defecation reduces dyspeptic symptoms by more than 20% in patients with functional dyspepsia and associated constipation.
- The effect of faecal microbiota transplantation on abdominal pain, stool frequency, and stool form in patients with moderate-to-severe irritable bowel syndrome: Results from a randomised, double-blind, placebo-controlled study
- 52 patients w/ moderate-to-severe IBS, randomized to FMT capsules or placebo x12 days
- After 6 months:
- NO differences in stool frequency, abdominal pain, or stool form
- Commentary: FMT remains a last-line therapy for those w/ IBS.
- Assessment of small intestinal bacterial overgrowth in chronic pancreatitis patients using jejunal aspirate culture and glucose hydrogen breath test
- Measured for SIBO in 48 newly diagnosed chronic pancreatitis patients
- Results:
- Jejunal aspirate: 37.5% SIBO prevalence
- Glucose breath test: 29% SIBO prevalence
- Commentary: About ⅓ of these chronic pancreatitis patients also had SIBO. Glucose breath test had low sensitivity but high specificity when compared to aspirate.
- The Relationship between Helicobacter pylori Infection of the Gallbladder and Chronic Cholecystitis and Cholelithiasis: A Systematic Review and Meta-Analysis
- 20 studies, 1,735 participants
- H pylori colonization was associated w/ higher rates of cholecystitis and cholelithiasis (OR 3.1)
- Commentary: H pylori colonization is associated w/ biliary dysfunction.
- Dr. Ruscio wanted me to remind you of our clinical rule ‘treat dysbiosis before functional problems (EPI, biliary stasis, ect…)’.
- Effects of Colesevelam on Bowel Symptoms, Biomarkers, and Colonic Mucosal Gene Expression in Patients with Bile Acid Diarrhea in a Randomized Trial
- Background: ~⅓ of IBS-D patients have high bile acid excretion or malabsorption
- 30 IBS-D patients randomized to coselevelam (Welchol) or placebo
- After 4 weeks:
- NO differences in stool frequency, stool consistency, or intestinal permeability
- Commentary: Bile acid sequestrants should remain as later therapies in the GI hierarchy.
- Comparative effectiveness of probiotic strains for the treatment of pediatric atopic dermatitis: A systematic review and network meta-analysis
- 22 studies
- Most probiotic-strain mixtures studied improved atopic dermatitis in a pediatric population w/ a moderate effect size.
- Fecal elastase levels in children diagnosed with functional abdominal pain-not otherwise specified
- 110 children (<17 yo) w/ functional abdominal pain of unknown etiology, 80 healthy controls
- Measured fecal elastase levels
- The functional abdominal pain group had significantly lower elastase levels
- Commentary: Consider a trial of pancreatic enzyme supplementation after more foundational therapies (diet, probiotics, elemental dieting) in those who still suffer from bloating, abdominal discomfort, and “IBS-like” symptoms.
- Probiotics as a New Regulator for Bone Health: A Systematic Review and Meta-Analysis
- 44 studies
- Probiotics resulted in:
- Higher serum calcium levels (+3.82 mmol/l)
- Lower parathyroid hormone levels (-5.53 ng/L)
- NO difference in bone mineral density
- Meta-analysis of randomized controlled trials of the effects of probiotics on functional constipation in adults
- 15 RCTs
- Probiotics improve stool consistency, bloating, and stool frequency for those w/ constipation
- More improvement for multi-strain probiotics compared to single strain probiotics.
- Commentary: High quality data supporting probiotics for constipation
- The Probiotic Strain H. alvei HA4597 ® Improves Weight Loss in Overweight Subjects under Moderate Hypocaloric Diet: A Proof-of-Concept, Multicenter Randomized, Double-Blind Placebo-Controlled Study
- 236 overweight participants, randomized to probiotics (100 billion CFU) or placebo
- After 12 weeks, more individuals in the probiotic group reached weight loss of 3% or more (55% vs 41%)
- Commentary: Not sure if this is clinically significant.
- Quantitative changes of Veillonella, Streptococcus, and Neisseria in the oral cavity of patients with recurrent aphthous stomatitis: A systematic review and meta-analysis
- 12 studies
- Bacteria counts of Veillonella, Streptococcus, and Neisseria species shift during ulcerative phases of aphthous ulcers
- Commentary: Oral dysbiosis may play a part of the etiology of recurrent aphthous ulcers.
- Risk of autoimmune diseases in recurrent aphthous ulcer patients: A nationwide population study
- 9,000 participants, 4,6000 of which had recurrent aphthous ulcers (RAU)
- RAU increases risk of overall autoimmune diseases (HR 1.2)
- Behcet’s disease (HR 32)
- Lupus (HR 1.7)
- Ankylosing spondylitis (HR 1.5)
- Gout (HR 1.5)
- Hashimoto’s (1.4)
- Graves’ (1.4)
- Rheumatoid arthritis (1.2)
- Commentary: RAU may be an early sign of autoimmune disease.
- Adherence to the Dietary Approaches to Stop Hypertension (DASH) dietary pattern reduces the risk of colorectal cancer: A systematic review and meta-analysis
- 8 studies
- Higher adherence to a DASH diet was associated with lower colorectal cancer (CRC) risk (RR 0.80)
- Commentary: Perhaps said more broadly, better dietary quality is associated w/ lower CRC risk.
- Effect of resistant starch type 2 on inflammatory mediators: A systematic review and meta-analysis of randomized controlled trials
- 8 studies
- Resistant starch had NO significant effect on inflammatory markers (hs-CRP, IL-6, and TNF-α)
- Fecal calprotectin levels in Helicobacter pylori gastritis in children
- 89 children w/ upper GI symptoms who had endoscopy
- 58% had H pylori colonization
- Fecal calprotectin levels differed depending on H pylori status
- 75 μg/g in H pylori + group
- 53 μg/g in H pylori – group
- Commentary: Fecal calprotectin levels can be mildly elevated in H pylori colonized individuals. However, they are not at a level indicating an IBD diagnosis.
- Serum level of antioxidant vitamins and minerals in patients with vitiligo, a systematic review and meta-analysis
- 13 studies, 570 vitiligo cases, 580 controls
- Higher serum zinc levels decrease risk of vitiligo (OR 0.29)
- Higher serum selenium levels increase risk of vitiligo (OR 4.31)
- Commentary: Zinc insufficiency and selenium excess in the serum may be risk factors for vitiligo.
- Appropriate dose of levothyroxine replacement therapy for hypothyroid obese patients
- Retrospective study of 200 hypothyroid patients
- The recommended daily dose of LT4 is 2.3 mcg/kg of lean body mass that could be applied for all ranges of BMI
- Commentary: You can use 2.3 mcg/kg of LBM for obese patients whose bodyweight may give inaccurate prediction of required T4 therapy. In order to get LBM, multiply total weight by (100 – body fat percentage).
- Comparative efficacy of oral insulin sensitizers metformin, thiazolidinediones, inositol, and berberine in improving endocrine and metabolic profiles in women with PCOS: A network meta-analysis
- 22 trials w/ 1,079 patients with PCOS
- Compared to Metformin alone:
- Myo-inositol + D-chiro-inositol was associated with a greater improvement in menstrual frequency (odds ratio 14.70), improving insulin resistance, and reducing total testosterone levels
- Commentary: Myo-inositol (~2g BID) + D-chiro-inositol (1g QD) is better than metformin alone for improving PCOS.
- A randomized placebo-controlled trial of using B vitamins to prevent cognitive decline in older mild cognitive impairment patients
- 279 older (>65 yo) patients w/ mild cognitive impairment (MCI) and homocysteine ≥10.0 μmol/L
- Randomized to methylcobalamin (500 μg daily) + folic acid (400 μg daily) or placebo
- After 24 months, the B vitamin group had :
- Reduced serum homocysteine (mean 13.9 μmol at baseline to 9.3 μmol/L at month 24)
- NO difference in clinical dementia scores
- Commentary: Combined B12 + folic acid supplementation did NOT improve MCI in older adults despite a reduction in serum homocysteine levels.
- Efficacy of a Smart Antisnore Pillow in Patients with Obstructive Sleep Apnea Syndrome
- 30 patients w/ obstructive sleep apnea (OSA) given “smart antisnore pillow” (SAP)
- Results:
- Mild-to-moderate OSA: SAP significantly improved the snore frequency, oxygen desaturation, and total AHI
- NO difference in severe OSA
- Commentary: A SAP looks like a promising tool for mild-to-moderate OSA. An example of a SAP can be found here.
- Omega-3 polyunsaturated fatty acids supplementation and cardiovascular outcomes: do formulation, dosage, and baseline cardiovascular risk matter? An updated meta-analysis of randomized controlled trials
- 16 RCTs, 81,000 participants
- Supplementation of omega-3 fatty acids was associated with a significant risk reduction of:
- Cardiac mortality by 10%
- Major adverse cardiac event by 10%
- Myocardial infarction by 17%
- Only giving 1 gram or more of EPA + DHA was effective
- The effect of barberry (Berberis vulgaris L.) supplementation on blood pressure: A systematic review and meta-analysis of the randomized controlled trials
- 5 RCT, 350 participants
- Barberry (berberine) supplementation did NOT have a significant effect on systolic blood pressure (-4.15 mmHg)
- Association of types of dietary fats and all-cause and cause-specific mortality: A prospective cohort study and meta-analysis of prospective studies with 1,164,029 participants
- 29 prospective studies, 1.1 million participants
- Results:
- Higher amount of total fat (HR 0.9), MUFA (HR 0.94), and PUFA (HR 0.9) associated w/ lower all-cause mortality but NO association w/ cardiac mortality
- Higher saturated fat intake associated w/ higher cardiac mortality (HR 1.1)
- Commentary: Type of dietary fat intake matters but don’t major in the minors- these effect sizes are relatively small. Remember that this study did NOT account for food quality so interpret results carefully.
- Effects of Vitamin C Supplementation on Glycemic Control and Cardiovascular Risk Factors in People with Type 2 Diabetes: A GRADE-Assessed Systematic Review and Meta-Analysis of Randomized Controlled Trials
- 28 studies, 1,574 participants including type 2 diabetics
- Vitamin C supplementation associated w/:
- Improved A1C (-0.54%)
- Lower systolic blood pressure (-6.3 mmHg)
- Commentary: Vitamin C supplementation can improve cardiometabolic markers.
- Association of Serum 25-Hydroxyvitamin D Concentrations with All-Cause and Cause-Specific Mortality Among Individuals with Diabetes
- 6,329 adult diabetics from NHANES analysis
- Higher serum Vit D levels associated with:
- Lower blood glucose, insulin, lipids, CRP, and insulin resistance (HOMA-IR)
- Lower cardiovascular and all-cause mortality
- Compared to those w/ <25 nmol/L, those w/ Vit D levels >75 nmol/L had 40% reduced risk of all-cause and 50% reduced risk of cardiovascular mortality
- Commentary: Those w/ higher Vit D levels had better cardiometabolic markers and reduced risk of cardiovascular and all-cause mortality. However, we cannot tell from this study alone whether this is a correlation or association.
- Effect of Low FODMAPs Diet on Irritable Bowel Syndromes: A Systematic Review and Meta-Analysis of Clinical Trials
- 22 studies
- A low FODMAP diet group showed:
- Moderate reduction in symptom severity (effect size -0.53)
- Slight improvement in quality of life (effect size 0.24)
- Decrease in stool frequency for IBS-D (-5.6 stools/week)
- Improvement in stool consistency
- Improvements were consistent across IBS types (e.g. IBS-C, IBS-D)
- Commentary: This meta-analysis showed that a low FODMAP diet significantly improved symptoms and quality of life in all IBS subtypes.
- Naturally-occurring dietary salicylates in the genesis of functional gastrointestinal symptoms in patients with irritable bowel syndrome: Pilot study
- Cross-over study of 10 IBS patients
- Randomized to 2 weeks of low-salicylate or high-salicylate diet, then switched to other group
- Results: NO significant differences between interventions
- Commentary: A low-salicylate diet did NOT improve IBS symptoms in this small study.
- Efficacy of a low FODMAP diet in irritable bowel syndrome: Systematic review and network meta-analysis
- 13 RCTs, 944 IBS patients
- Compared low FODMAP diet vs other standard IBS diets
- Low FODMAP was superior for:
- Abdominal pain severity
- Bloating
- Distension
- Gut Microbiota Profiles and the Role of Anti-CdtB and Anti-vinculin Antibodies in Patients with FGID
- 22 healthy controls, 65 patients w/ functional GI disorders (FGID); includes IBS-C, IBS-D, dyspepsia
- Anti-CdtB or anti-vinculin antibodies positivity:
- IBS-C: 77%
- IBS-D: 40%
- Dyspepsia: 60%
- Healthy controls: 63%
- Dysbiosis was more common in those w/ anti-CdtB antibodies
- No other bacteria markers showed significant differences between FGID subgroups and healthy controls.
- Commentary: No statistical difference in anti-CdtB and anti-vinculin antibodies between those w/ FGID and healthy controls. However, there was more dysbiosis in those w/ anti-CdtB antibodies.
- Dr. Ruscio wanted me to mention that his clinical suspicion has been this is not a marker that is highly influential in patient care, which is why he and we at the clinic do not routinely use it. We will keep an open mind, and an eye on the data, but so far we recommend against it.
- Small intestinal bacterial overgrowth in patients with inflammatory bowel disease: A case-control study
- 86 IBD patients (45 ulcerative colitis [UC] and 41 Crohn’s disease [CD])
- Measure prevalence of SIBO w/ glucose breath test
- IBD patients had higher rates of SIBO (18.6%) vs healthy controls (1.5%)
- SIBO more common in CD than UC (34% vs 4.4%)
- Commentary: SIBO is more common in those w/ IBD- especially those w/ CD. Refer to FFMR+ episode #15 (July 5th) that showed lower rates of methane SIBO in those w/ IBD. Dr. Ruscio notes that this makes sense given that bowel regularity impacts methane levels and those w/ diarrhea have less hydrogen hanging around in the gut to feed methane.
- Concomitant Irritable Bowel Syndrome Does Not Influence the Response to Antimicrobial Therapy in Patients with Functional Dyspepsia
- What is the efficacy of antimicrobial therapy (e.g. Rifaximin) in those w/ functional dyspepsia with and without IBS?
- 21 functional dyspepsia patients, 14 also had IBS
- Received rifaximin (550 mg BID x10 days)
- After 6 weeks: Rifaximin lead to significant improvement in GI symptom score (34 at baseline to 26 at 6 weeks)
- The presence of concomitant IBS did NOT affect the improvement after antimicrobial therapy.
- Commentary: Antimicrobial therapy can help alleviate dyspepsia regardless of the presence of IBS.
- Gastroesophageal reflux is associated with an increased risk of gastric cardiac polyps: a case-control study of 140 cases
- 140 patients w/ stomach polyps, 140 w/ gastritis
- GERD was independently associated w/ higher risk of gastric polyps (OR 2.8)
- Commentary: Reflux was associated with a 2.8x increased risk of stomach polyps.
- Psychological and Gastrointestinal Symptoms of Patients with Irritable Bowel Syndrome Undergoing a Low-FODMAP Diet: The Role of the Intestinal Barrier
- 20 IBS-D patients, given low FODMAP diet
- After 12 weeks:
- Improved quality of life
- Improved anxiety/psychological stress
- Improved intestinal permeability (measured by serum zonulin and sugar absorption test)
- Decreased dysbiosis
- Decreased inflammatory markers (IL-6, IL-10, LPS)
- Commentary: A low FODMAP diet can improve inflammation, intestinal permeability, dysbiosis, and most importantly, improve one’s quality of life.
- Are Probiotics and Prebiotics Safe for Use during Pregnancy and Lactation? A Systematic Review and Meta-Analysis
- 11 studies of probiotics used in pregnancy or lactation
- Probiotic and prebiotic products are safe for use during pregnancy and lactation
- One study reported increased risk of vaginal discharge and changes in stool consistency (relative risk 3.67)
- “Adverse effects associated with probiotic and prebiotic use do not pose any serious health concerns to mother or infant.”
- Commentary: There’s NO high quality evidence to suggest that probiotics can’t be used in pregnancy or during lactation.
- Probiotic Use in Celiac Disease: Results from a National Survey
- Cross-sectional survey of 1,160 Celiac disease patients
- 33% reported using probiotics
- Probiotic-users had lower pain scores on the SF-36 scale (64 vs 70)
- Effectiveness of probiotics and synbiotics in reducing duration of acute infectious diarrhea in pediatric patients in developed countries: A systematic review and meta-analysis
- 20 trials, 3,469 pediatric patients
- Probiotics have moderate effectiveness at reducing time of diarrhea in acute infectious diarrhea (effect size -0.38, -13.5 hours)
- Symptoms of anxiety/depression is associated with more aggressive inflammatory bowel disease
- 341 IBD patients (221 Crohn’s disease (CD) and 120 ulcerative colitis (UC))
- The prevalence of anxiety/depression in IBD was 33.1%
- More anxiety/depression associated w/ higher symptom severity and endoscopic results.
- A 12-month pilot study outcomes of vagus nerve stimulation in Crohn’s disease
- 9 Crohn’s disease (CD) patient, underwent vagal nerve stimulation (electrode on left cervical vagus nerve)
- After 12 months:
- 5 patients in clinical remission
- 6 patients in endoscopic remission
- 6 patients reduced CRP
- 5 patients reduced fecal calprotectin
- Commentary: Vagal nerve stimulation may be a promising (yet invasive) therapy for refractory CD cases after more minimally invasive therapies fail.
- Homemade Elemental Diet to Treat Intestinal Methanogen Overgrowth: A Case Report
- Cae report of a 47 yo female w/ methane-predominant SIBO confirmed via multiple lactulose breath test (average of 42 ppm)
- Refractory to diet/lifestyle/prokinetic therapy
- Performed a 14-day and 9-day homemade elemental diet 4 months apart.
- Methane levels reduced to 3 ppm (after 14-day course) and 23 ppm (after 9-day course).
- Commentary: The authors might have missed on the potential beneficial effects of a partial elemental approach.
- Metabolic syndrome is associated with higher rate of gastroesophageal reflux disease: A meta-analysis
- 15 studies, 103,048 patients w/ GERD
- Metabolic syndrome is a risk factor of GERD (OR 1.66)
- Commentary: Weight loss may be a powerful tool to help those w/ GERD.
- The Level of Zinc, Copper and Antioxidant Status in the Blood Serum of Women with Hashimoto’s Thyroiditis
- 42 women women w/ Hashimoto’s, 30 healthy women
- NO differences in serum zinc, copper, or antioxidant capacity
- Commentary: In this study, there were no differences between common nutrient markers in those w/ Hashimoto’s and healthy controls.
- Is thyroid autoimmunity a predisposing factor for fibromyalgia? A systematic review and meta-analysis
- 10 studies
- Thyroid autoantibody positivity was more common in fibromyalgia patients compared to healthy controls (TPO-Ab OR 3.4, Tg-Ab OR 2.2).
- However, the severity of fibromyalgia was NOT associated w/ antibody titer levels.
- Cognitive response to testosterone replacement added to intensive lifestyle intervention in older men with obesity and hypogonadism: Prespecified secondary analyses of a randomized clinical trial
- What is the effect of testosterone replacement therapy (TRT) PLUS lifestyle interventions
- 83 older, obese hypogonadal men with frailty, randomized to:
- Lifestyle therapy (weight loss + exercise) plus testosterone
- Or lifestyle therapy plus placebo
- After 6 months, the lifestyle + TRT group had more improvement in:
- Global cognition scores
- Attention
- Independent predictors in cognition improvement:
- Better peak oxygen consumption
- Strength
- Serum total testosterone levels
- Luteinizing hormone levels
- Commentary: TRT improves mental acuity/cognition in overweight, frail older men w/ hypogonadism.
- Subclinical hypothyroidism has no association with insulin resistance indices in adult females: A case-control study
- What is the association of subclinical hypothyroidism (SCH) and insulin resistance?
- 176 women, 91 w/ SCH
- NO association of SCH, TSH, or fT4 and insulin resistance
- Commentary: SCH was NOT associated w/ insulin resistance in this retrospective study.
- Association between low testosterone and anaemia: Analysis of the National Health and Nutrition Examination Survey
- Cross-sectional study of 5,888 men)
- Low testosterone was significantly associated with anemia (OR = 1.44)
- Commentary: Low testosterone may be a contributing factor to anemia in men.
- The Effect of Magnesium Supplementation on Endothelial Function: A Randomized Cross-Over Pilot Study
- 19 adults, given magnesium (150 mg)
- After 1 week, magnesium did NOT improve endothelial function
- Commentary: This was an under-powered and short study with a small dose.
- The centenary of the Harris-Benedict equations: How to assess energy requirements best? Recommendations from the ESPEN expert group
- Expert consensus
- What is the accuracy of calorie requirement calculations?
- Results: Low to moderate accuracy (70%) of most predictive equations
- Commentary: Many calorie requirement calculations are generally inaccurate and can lead to large eros in the actual need of our patients’ caloric intake. These common equations can be used as “starting points” but we should exercise a great deal of personalization for our nutritional recommendations.
- The effect of caloric restriction on blood pressure and cardiovascular function: A systematic review and meta-analysis of randomized controlled trials
- 32 RCTs, 1,722 participants
- Calorie-restricted interventions lasting 1-4 weeks had the largest effect on:
- Systolic (-5.5 mmHg) and diastolic (-2.9 mmHg) blood pressure
- Calorie-restricted interventions lasting 1.5-6 months:
- Reduced HR (-4.4 beats/minute)
- Improved VO2 Max
- Commentary: Calorie restriction improved blood pressure similar to that of medications.
- Correlation between lead exposure and cognitive function in 12-year-old children: A systematic review and meta-analysis
- 16 studies, 6,979 children, assessing the association of lead exposure and cognitive function
- Higher dose and duration of lead exposure is associated w/ worse cognitive function (r= -0.22)
- Long-term effects of resveratrol on cognition, cerebrovascular function and cardio-metabolic markers in postmenopausal women: A 24-month randomized, double-blind, placebo-controlled, crossover study
- Cross-over, randomized study125 post-menopausal women 45-85 years old
- Given resveratrol (75 mg BID) or placebo for 12 months, then crossed over for another 12 months
- Compared to placebo, resveratrol supplementation resulted a significant 33% improvement in overall cognitive performance
- Commentary: Supplemental resveratrol is a promising tool for age-related cognitive decline.
- Long-term effects of folic acid and vitamin-B12 supplementation on fracture risk and cardiovascular disease: Extended follow-up of the B-PROOF trial
- 1,298 participants, randomized to folic acid (400 μg) and vitamin-B12 (500 μg)
- After 1 year:
- NO differences in fracture risk
- NO difference in cardiovascular risk
- NO difference in cerebrovascular (stroke) risk
- However, there was a weak correlation (p =0.1) between fracture risk reduction of B vitamin supplementation and high baseline homocysteine levels (>15.1 μmol/l).
- Commentary: Overall, there was NO benefit of B vitamin supplementation on cardiovascular disease and fracture risk. However, those w/ high baseline homocysteine may benefit more.
- Folic Acid Supplementation Improves Glycemic Control for Diabetes Prevention and Management: A Systematic Review and Dose-Response Meta-Analysis of Randomized Controlled Trials
- 24 studies
- Folic acid supplementation resulted in:
- Reduced fasting blood glucose (-2.17 mg/dL)
- Reduced fasting insulin (-1.6 pmol/L)
- Reduced HOMA-IR (-0.4)
- No change in A1C
- Commentary: Folic acid results in statistically significant improvements in SOME glycemic biomarkers. However, these changes are most likely NOT clinically significant.
- Effects of Folic Acid Supplementation on Inflammatory Markers: A Grade-Assessed Systematic Review and Dose-Response Meta-Analysis of Randomized Controlled Trials
- 12 RCTs
- Folic acid supplementation resulted in:
- Reduced CRP (-0.59 mg/L)
- More reduction in CRP w/ higher folic acid dose
- No change in IL-6
- No change in TNF-α
- Reduced CRP (-0.59 mg/L)
- Commentary: Folic acid supplementation may lower some, but not all, inflammatory markers. More improvement is seen with higher doses.
- Association between plasma homocysteine levels and pancreatic islet beta-cell function in the patients with type 2 diabetes mellitus: A cross-sectional study from China
- 430 type 2 diabetes (T2D) patients
- Measured homocysteine levels and oral glucose tolerance test
- Higher homocysteine levels independently associated w/ worse insulin resistance
- Association between neuropathy and B-vitamins: A systematic review and meta-analysis
- 46 observational studies, 7 clinical trials
- Peripheral neuropathy was associated with lower B12 and higher homocysteine levels
- B vitamin supplementation associated with a non-significant improvement of peripheral neuropathy
- Greater benefit for B1 (thiamine)
- Commentary: The results of these studies are misleading since the clinical trials did NOT assess for B vitamin deficiency prior to treatment.
- Effect of Continuous Positive Airway Pressure on Symptoms and Prevalence of Insomnia in Patients With Obstructive Sleep Apnea: A Longitudinal Study
- 442 patients w/ obstructive sleep apnea (OSA), followed for 20 weeks
- CPAP therapy has a moderate effect size at reducing insomnia severity
- Proportion of patients with insomnia reduced from 51% at baseline to 33% at follow-up
- Commentary: CPAP therapy reduces insomnia prevalence and severity.
- Vitamin D and asthma occurrence in children: A systematic review and meta-analysis
- 24 studies, 5,700 children w/ asthma, 21,500 children w/o asthma
- Children w/ asthma had lower serum Vit D levels than those w/o asthma (22 vs 27 ng/mL)
- Commentary: Refer to FFMR+ episode #17 (July 19th) study that showed BENEFIT of vitamin D for asthma exacerbation.
- Habitual Caffeine Consumption Does Not Interfere with the Acute Caffeine Supplementation Effects on Strength Endurance and Jumping Performance in Trained Individuals
- Does habitual caffeine consumption influence its performance-enhancing effects on strength endurance?
- 36 trained individuals, broken down into different baseline caffeine consumption amounts
- Low consumer (20 ± 11 mg/day)
- Moderate consumer (88 ± 33 mg/day)
- High consumers (281 ± 167 mg/day)
- Measured vertical jump and strength endurance after caffeine supplementation (6 mg/kg) or placebo
- Acute caffeine supplementation improved countermovement vertical jump performance and strength endurance, regardless of caffeine habituation.
- Commentary: Habitual caffeine consumption does NOT affect caffeine’s acute ergogenic effect.
- Efficacy and safety of low-dose colchicine in patients with coronary disease: A systematic review and meta-analysis of randomized trials
- 5 RCTS, 11,816 patients w/ existing cardiovascular disease (e.g. atherosclerosis)
- Low-colchicine (0.5 mg) results in:
- Reduced major adverse cardiac events by 25%
- Reduced myocardial infarction by 22%
- Reduced risk of stroke by 46%
- Reduced risk of cardiovascular death by 18%
- NO difference in all-cause mortality
- Commentary: Low-dose colchicine may be a tool for secondary prevention of cardiovascular disease. It may act through anti-inflammatory effects.
- A novel evolutionary-concordance lifestyle score is inversely associated with all-cause, all-cancer, and all-cardiovascular disease mortality risk
- 17,465 participants followed over 10.3 years
- Measured evolutionary-concordance lifestyle (ECL) scores (e.g. “Paleo lifestyle”)
- Those w/ the highest ECL scores had reduced:
- All-cause mortality (HR 0.45)
- Cardiovascular mortality (HR 0.47)
- Cancer mortality (HR 0.42)
- Commentary: A paleolithic diet and lifestyle reduces all-cause mortality.
- Nutrient Adequacy Is Associated with Reduced Mortality in US Adults
- Cross-sectional study, 20,602 participants
- Evaluated for macronutrient and micronutrients
- Higher intakes of vitamin E, magnesium, iron, dietary fiber, omega-3 fatty acids, and potassium were associated with LOWER all-cause mortality
- Commentary: Better nutrition quality, and subsequent micronutrient status is associated w/ lower all-cause mortality.