Featured Study

• Early use of probiotics might prevent antibiotic-associated diarrhea in elderly (>65 years): a systematic review and meta-analysis
  • 8 RCTs, 4,691 elderly participants treated with antibiotics, randomized to:
    • Placebo
    • Probiotics (S. boulardii, lacto/bifido, strep thermophilus) 
  • Compared to placebo, probiotics led to:
    • NO difference in rates of antibiotic-associated diarrhea (AAD) when given after 48 hours of antibiotics
    • 29% reduced AAD when given within 48 hours of first antibiotic dose
  • Commentary: This study found the timing in which probiotics are given in relation to antibiotics is important in reducing AAD.

Gastrointestinal Studies

• Proton Pump Inhibitor Use and Risk of Gastric Cancer: Current Evidence from Epidemiological Studies and Critical Appraisal 
  • 13 observational studies, 10,557 stomach cancer patients
  • Increased risk of stomach cancer was associated with: 
    • PPI use (80% increased risk) 
    • GERD (84% increased risk) 
    • H. Pylori treatment (98% increased risk) 
  • PPI use longer than 3 years more than doubled the risk of stomach cancer 
  • Commentary: This study found an association between PPI use, duration of PPI use and risk of stomach cancer. 
    • Dr. R: association not necessarily caution

• Gut microbiota–derived metabolite trimethylamine-N-oxide and multiple health outcomes: an umbrella review and updated meta-analysis
  • Aim: Assess the association between elevated plasma TMAO and various health outcomes
  • Higher TMAO was associated with: 
    • 60% increased risk of all-cause mortality 
      • 37 studies, 38,862 participants
    • 74% increased risk major adverse cardiovascular events 
      • 36 studies, 39,314 participants 
    • 39% increased risk of hypertension
      • 15 studies, 18,854 participants 
    • 75% increased risk of diabetes 
      • 18 studies, 22,999 participants
    • Reduced kidney function (large effect size) 
      • 20 studies, 29,497 participants
  • Commentary: Elevations in TMAO are associated with multiple negative health outcomes. This highlights the connection between the gut microbiome and various cardiovascular and metabolic outcomes.

• Efficacy of synbiotic interventions on blood pressure: a systematic review and meta-analysis of clinical trials
  • 11 RCTs 
  • Synbiotic treatments led to improvements in systolic blood pressure (-3 mmHg), especially when used ≥ 3 months
  • Commentary: Synbiotics may improve blood pressure, although the effect size is small.

• Long-term Outcomes of Stool Transplant in Alcohol-associated Hepatitis-Analysis of Clinical Outcomes, Relapse, Gut Microbiota and Comparisons with Standard Care
  • 61 patients with alcohol-associated hepatitis, randomized to:
    • Standard of care
    • Fecal microbiota transplant (FMT)
  • Compared to standard of care, FMT led to: 
    • Less major hospitalizations
    • Fewer complications (e.g. ascites, sepsis, hepatic encephalopathy)
    • Less relapses of alcohol abuse (29% vs 54%)
    • Higher 3-year survival (66% vs 39%)  
  • Commentary: FMT led to greater outcomes as compared to standard of care, as well as reduced the prevalence of alcohol abuse. This illustrates the gut-liver and gut-brain connection.

• Effects of Lactobacillus supplementation on glycemic and lipid indices in overweight or obese adults: A systematic review and meta-analysis
  • 9 RCTs, 598 overweight participants 
  • Probiotics (Lactobacillus spp, ≥ 10 billion CFU) for >3 months led to improvements in: 
    • LDL-C (-5.3 mg/dl) 
    • Total cholesterol (-4.8 mg/dl) 
    • Fasting glucose (-1.8 mg/dl) 
    • Triglycerides (-14 mg/dl) 
  • Commentary: This study found probiotics led to minor improvements in cholesterol and glucose.

• Anti-obesity properties of probiotics; a considerable medical nutrition intervention: Findings from an umbrella meta-analysis
  • 29 meta-analyses, 14,366 participant 
  • Probiotic supplementation led to reductions in: 
    • BMI (small effect size)
    • Body weight (small effect size)
    • Waist circumference (small effect size)
  • These effects were greater when probiotics were given:
    • For longer than 3 months 
    • To obese participants
    • To participants with metabolic syndrome 
  • Commentary: While this paper makes the statement the weight loss effects are significant, they are not necessarily clinically meaningful.

• The Effect of Vitamin D Supplementation on the Severity of Symptoms and the Quality of Life in Irritable Bowel Syndrome Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
  • 6 studies, 616 patients with IBS +/- vitamin D deficiency, randomized to:
    • Placebo
    • Vitamin D (ranging from 2,000 IU/day to 7,000 IU/day) 
  • Compared to placebo, vitamin D led to:
    • NO improvement in IBS symptom score
    • Improved quality of life
    • Improved vitamin D levels
  • However, when studies were looked at with known vitamin D deficiency (< 20 ng/ml), vitamin D supplementation did lead to improvements in IBS symptoms 
  • Commentary: While this study did not find a benefit of Vitamin D on IBS symptoms, one problem with it is that half of the studies either 1) didn’t have data on initial vitamin D status, or 2) patients had normal vitamin D levels. The trend in the data in this study supports vitamin D improving IBS when the patients have low vitamin D.

• Washed microbiota transplantation stopped the deterioration of amyotrophic lateral sclerosis: the first case report and narrative review
  • Case study on treating amyotrophic lateral sclerosis (ALS) with FMT
  • After 1 year of FMT treatment, FMT led to improvements in:
    • Walking
    • Climbing stairs
    • Cutting food
    • Handwriting
    • Swallowing
    • Muscle tone and spasticity 
  • During FMT treatment, the patient had to receive a round of antibiotics that led to a worsening of many of her ALS symptoms that were improving with FMT
  • Commentary: FMT led to clinical improvements in this one patient with ALS, which is known as an incurable disease.

• Fecal Microbiota Transplantation and Health Outcomes: An Umbrella Review of Meta-Analyses of Randomized Controlled Trials
  • 26 RCTs on the health outcomes of FMT
  • FMT led to: 
    • 1.7x increase in IBD clinical remission 
    • 1.8x increase in clinical remission of C. diff infections in patients with IBD
    • Improved antibiotic resistance 
    • Improved constipation
  • FMT did NOT show benefit in patients with:
    • IBS 
    • Metabolic syndrome
  • Commentary: Another study confirming the benefits of FMT for IBD and C. diff infections. This study did NOT find benefit for those with IBS, which is consistent with this previous meta analysis.

Thyroid & Hormones Studies

• Efficacy and Safety of Human Chorionic Gonadotropin Monotherapy for Men With Hypogonadal Symptoms and Normal Testosterone
  • 31 patients with hypogonadal symptoms and normal testosterone (> 300 ng/dl), treated with human chorionic gonadotropin (hCG)
  • After an average of 10 months, hCG led to: 
    • Improved erectile dysfunction in 86% 
    • Improved libido in 80% 
    • NO changes in total testosterone, LH, FSH, PSA, hematocrit or estradiol 
    • NO side effects 
  • Commentary: This small study found hCG to be effective in treating symptoms of low T without side effects.

• Evaluation of Bedtime vs. Morning Levothyroxine Intake to Control Hypothyroidism in Older Patients: A Pragmatic Crossover Randomized Clinical Trial
  • 118 hypothyroid patients (≥60 years old), previously on LT4, randomized to taking Levothyroxine in the morning or at night x3 months. Then crossed over to other group x3 months.
  • After 6 months, TSH levels were similar between dosing strategies 
  • Commentary: This study found LT4 therapy in the evening can lead to similar efficacy for hypothyroidism as morning LT4 dosing. This may lead to greater compliance in some patients.

• Heart Failure and Stroke Risks in Users of Liothyronine With or Without Levothyroxine Compared with Levothyroxine Alone: A Propensity Score-Matched Analysis
  • 5,342 patients on thyroid hormone replacement, categorized by:
    • LT4 alone
    • LT3 +/- LT4 
  • Compared to LT4 alone, taking LT3 was associated with: 
    • 1.6x increased heart failure risk 
    • 1.7x  increased stroke risk
    • These risks were greater in those taking LT3 for ≥ 1 year 
  • Commentary: This observational study found an association between LT3 therapy and worse cardiovascular outcomes.

Diet & Lifestyle Study

• Morning Exercise Reduces Abdominal Fat and Blood Pressure in Women; Evening Exercise Increases Muscular Performance in Women and Lowers Blood Pressure in Men
  • 56 healthy participants were randomized to: 
    • Morning exercise (8:00-10:00 am) 
    • Evening exercise (6:30-8:30 pm)
  • Morning exercise led to greater improvements in:
    • Fat loss (-2 lb morning vs 0.6 lb evening) 
    • Blood pressure (-12 mmHg vs -2 mmHg) 
  • Evening exercise led to greater improvements in: 
    • Strength (e.g. greater bench press, pushups, squats) 
    • Fatigue
  • Commentary: This small study found the exercise time of day may have a different effect on various health outcomes. For most patients, we don’t need to get this specific, as finding a time that is most convenient for them is likely best for their needs. 

Featured Study

• Levothyroxine treatment and gastric juice pH in humans: the proof of concept 
  • 61 Hashimoto’s thyroiditis patients with upper GI symptoms on LT4, categorized by:
    • Normal stomach acidity (pH ≤ 2) 
    • Low stomach acidity (pH > 2) 
  • Compared to normal stomach acidity, patients with low stomach acidity were associated with: 
    • 23% higher doses of LT4 required
    • Higher prevalence of H. pylori infections (92%) 
  • H. Pylori infections were associated with higher: 
    • Serum gastrin (357 + H. pylori vs 39 pg/ml – H. pylori)
    • Positive anti-parietal cell antibodies (83% vs 22%)  
    • 20% higher LT4 dose required
  • Commentary: This study highlights the importance of improving gut health when treating thyroid disease. Improving the gut may allow patients to reduce their LT4 dose due to enhanced absorption.

Gastrointestinal Studies

• Physical activity for treatment of irritable bowel syndrome
  • 11 RCTs, 622 participants 
  • This meta-analysis found physical activity, such as yoga or treadmill, led to:
    • Improved IBS symptoms
    • NO improvement in quality of life
    • NO improvement in abdominal pain  
  • Commentary: This study found exercise provides benefit for patients with IBS, which reinforces the use of lifestyle as foundational for treating IBS.

• Dysbiosis in the Gut Microbiota in Patients with Inflammatory Bowel Disease during Remission
  • 98 IBD patients in remission, 97 healthy controls
  • Stool samples were collected on all participants
  • Compared to healthy controls, IBD patients had:
    • Lower microbiome alpha diversity 
    • Less beneficial bacteria (Akkermansia, Coprococcus, Oscillibacter) 
    • More pathogenic bacteria (Enterobacteriaceae family)
  • Commentary: Even in remission, IBD patients have more dysbiosis than healthy controls. Dr. Ruscio wanted me to add this is why we don’t treat numbers only; a patient in remission is the win and there is not need to make dysbiosis ‘perfect’.

• No Effect of Lactobacillus rhamnosus GG on Eradication of Colonization by Vancomycin-Resistant Enterococcus faecium or Microbiome Diversity in Hospitalized Adult Patients
  • 48 elderly hospital patients with vancomycin-resistant enterococcus infection, randomized to:
    • Placebo
    • Lactobacillus probiotic (60 billion CFU/day)
  • After 4 weeks, compared to placebo, probiotics did NOT lead to a significant difference in infection clearance (56% placebo vs 57% probiotic) 
  • Commentary: While probiotics have been beneficial in pediatric patients with this infection, there was NO benefit in an older population

• Overlap of Gastroesophageal Reflux Disease and Functional Dyspepsia and Yield of Esophagogastroduodenoscopy in Patients Clinically Fulfilling the Rome IV Criteria for Functional Dyspepsia
  • 439 patients with reflux or functional dyspepsia (FD), all underwent upper GI endoscopy 
  • 21% of patients had positive endoscopic findings, including: 
    • Esophageal inflammation (17%) 
    • Gastroduodenal ulcers (3%)
    • Barrett’s esophagus (1%)
  • The prevalence of gastroduodenal ulcers was more common in those with just FD vs FD + reflux (5% vs 0.6%) 
  • Commentary: About 1 in 5 patients with reflux or dyspepsia may have positive upper GI endoscopic findings, with inflammation being the most common finding. Barrett’s esophagus was a rare finding in this study.

• Probiotic Supplementation Attenuates Binge Eating and Food Addiction 1 Year After Roux-En-Y Gastric Bypass: A Randomized, Double-blind Placebo-Controlled Trial
  • 101 gastric bypass patients, randomized to placebo or probiotic for 3 months after surgery
    • 33% of these had an eating disorder (e.g. food addiction, binge eating) prior to surgery 
  • After 1 year, compared to placebo, probiotics led to greater improvements in: 
    • Food cravings
    • Overeating 
  • Commentary: This study found probiotics may help with food cravings and consuming less food.

• Comparison of the Effects of Abdominal Massage and Oral Administration of Sweet Almond Oil on Constipation and Quality of Life among Elderly Individuals: A Single-Blind Clinical Trial
  • 90 elderly participants with constipation, randomized to: 
    • Control (no intervention)
    • Oral sweet almond oil 
    • Abdominal massage
  • After 2 weeks, compared to control, both almond oil and abdominal massage led to similar improvements in:
    • Constipation 
    • Quality of life
  • Commentary: Abdominal massage and sweet almond oil are both cost-effective and useful interventions for treating constipation. 

• Beneficial Effects of Repeated Washed Microbiota Transplantation in Children With Autism
  • 42 autistic children treated with 2-6 fecal microbiota transplants (FMT) 
  • FMT led to improvements in:  
    • Autism behavior scores
    • Sleep disturbances
    • Constipation 
  • Children that had more FMTs saw greater improvement in symptoms
  • Commentary: FMT led to improvements in autism and associated symptoms. This highlights the gut-brain connection. Keep in mind that there was no control group. 

• The impact of treatment with bile acid sequestrants on quality of life in patients with bile acid diarrhoea
  • 47 patients with chronic diarrhea and positive for bile acid malabsorption (BAM)
    • 51% with bile acid diarrhea alone (BAD)
    • 23% with Crohn’s disease with ileal resection (CD) 
    • 26% with post-cholecystectomy (PC) 
  • Treatment with WelChol led to positive responses in: 
    • 82% with CD
    • 58% with PC
    • 42% with BAD
  • Those with CD had the most severe BAM based on a SeHCAT test
  • Commentary: Those with Crohn’s Disease and no terminal ileum (where bile is reabsorbed) experienced the greatest response to treatment and also had the worse degree of bile acid malabsorption. This highlights the importance of terminal ileum function health and improving BAM.

• A Systematic Review and Meta-Analysis of Randomized Controlled Trials of Fecal Microbiota Transplantation for the Treatment of Inflammatory Bowel Disease 
  • 14 RTCs on patients with IBD, randomized to placebo or FMT  
  • Compared to placebo, FMT led to 44% greater clinical remission
  • Fresh FMT led to greater clinical remission compared to frozen (41% vs 32%) 
  • Commentary: FMT is a safe and effective therapy for IBD.

• Effect of Probiotic Bifidobacterium breve in Improving Cognitive Function and Preventing Brain Atrophy in Older Patients with Suspected Mild Cognitive Impairment: Results of a 24-Week Randomized, Double-Blind, Placebo-Controlled Trial 
  • 115 older patients with suspected mild cognitive impairment (MCI), randomized to: 
    • Placebo
    • Probiotic (Bifidobacterium breve) 
  • After 6 months, compared to placebo, probiotics led to:
    • Improved cognitive function (i.e. orientation to person, place, time, writing) 
    • Slowed progression of brain atrophy based on MRI 
  • Commentary: Probiotics improved cognition and had a positive effect on the physical structure of the brain as determined by MRI.

• A No-Biopsy Approach for the Diagnosis of Celiac Disease in Adults: Can It Be Real?
  • Retrospective study, 269 patients with confirmed Celiac disease (CD)
  • The sensitivity and specificity of utilizing tissue transglutaminase antibodies (tTG-IgA) for diagnosing CD were tested by using the following cutoffs: 
    • ≥ 100 U/mL (sensitivity 72%, specificity 100%)
    • ≥ 52.7 U/mL (sensitivity 90%, specificity 100%) 
    • ≥ 29.4 U/mL (sensitivity 100%, specificity 99.5%)
  • Commentary: Using various cutoffs for tTG-IgA can help determine likelihood of CD.

• Will Proton Pump Inhibitors Increase the Risk of Diabetes Mellitus? A Systemic Review and Meta-Analysis
  • 8 studies, 850,019 participants treated with proton pump inhibitors (PPI)
  • NO association was found between PPI use and risk of diabetes 
  • Commentary: This large study did not find an increased risk of PPI use and developing diabetes.

Thyroid & Hormones Studies

• Association of antibiotics exposure within the first 2 years after birth with subsequent childhood type 1 diabetes
  • 63,434 children
  • There was NO association between risk of developing type 1 diabetes and:
    • Number of antibiotics used in first 2 years of life
    • Age of first antibiotic prescription
    • Type of antibiotics used
  • Commentary: This observational study failed to show an association between antibiotics and risk of developing type-1 diabetes.

• The impact of vitamin D on thyroid autoimmunity and hypothalamic-pituitary-thyroid axis activity in myo-inositol-treated and myo-inositol-naïve women with autoimmune thyroiditis: A pilot study
  • 62 women with Hashimoto’s thyroiditis and high-normal TSH or subclinical hypothyroidism, treated with: 
    • Vitamin D alone (4,000 IU/day) 
    • Myo-inositol alone (2 g/day)
    • Myo-inositol (2 g/day) + Vitamin D (4,000 IU/day)
  • Women on myo-inositol were taking it for 6 months prior to the study
  • After 6 months, compared to myo-inositol and vitamin D alone, the combination of vitamin D + myo-inositol led to greater reductions in:
    • TPO and thyroglobulin antibodies
    • TSH levels
  • Commentary: The combination of vitamin D and myo-inositol is more effective compared to either alone in patients with Hashimoto’s thyroiditis.

• Thyroid Disorders and Dementia Risk: A Nationwide Population-Based Case-Control Study
  • 7,843 adults with dementia, 7,843 healthy controls
  • The risk of developing dementia was:
    • 81% greater if they had a history of hypothyroidism
    • 3x greater if they had a history of hypothyroidism and required thyroid hormone replacement
  • Commentary: This observational study found an increased risk of dementia in those with a history of hypothyroidism. 

• Using ginseng for menopausal women’s health care: A systematic review of randomized placebo-controlled trials
  • 15 RCTs on women with menopausal symptoms, randomized to placebo or ginseng
  • Ginseng led to: 
    • Improved overall menopausal symptoms (small effect size) 
    • Less hot flashes (small effect size) 
    • Improved quality of life (small effect size) 
    • NO improvements in overall sexual function or female hormone levels 
  • Commentary: Ginseng improves menopausal symptoms and overall quality of life in women with menopause.

• Add-On Effect of Selenium and Vitamin D Combined Supplementation in Early Control of Graves’ Disease Hyperthyroidism During Methimazole Treatment
  • 40 Graves’ disease patients with low vitamin D and selenium, randomized to: 
    • Methimazole (MMI) alone
    • Methimazole + vitamin D (1,000 IU/day) + selenium (100 mcg/day) 
  • After 6 months, compared to MMI alone, combination therapy led to greater: 
    • Reduction in fT4 (-3.7 ng/dl combo vs -2.2 ng/dl methimazole) 
    • Improvements in quality of life
  • NO difference in TRAb or fT3
  • Commentary: The addition of selenium and vitamin D led to greater improvements in fT4 and quality of life in patients with hyperthyroidism.

• The effect of transdermal 17β-estradiol combined with norethisterone acetate treatment on the lipid profile in postmenopausal women: A meta-analysis and systematic review of randomized controlled trials
  • 7 RCTs on postmenopausal women, randomized to:
    • Control group 
    • Topical estradiol and synthetic progesterone 
  • Hormone therapy led to improvements in:
    • Total cholesterol (-13 mg/dl) 
    • LDL-C (-14 mg/dl) 
    • Triglycerides (-21 mg/dl)  
  • Commentary: Hormone replacement therapy in menopausal women has a positive impact on lipids.

• The Frequency of Subclinical Hypothyroidism in Obese Children and Adolescents and Its Relationship with Metabolic Parameters and Atherogenic Index
  • 1,130 obese children, divided into 2 groups:
    • Euthyroid
    • Subclinical hypothyroidism (SCH)
  • Compared to the euthyroid group, those with SCH had higher levels of: 
    • Fasting insulin (22 SCH vs 18 μIU/mL euthyroid) 
    • Insulin resistance (76% vs 24%) 
    • Dyslipidemia (68% vs 32%) 
    • Atherogenic index 
    • ALT (33.5 vs 24 U/L) 
    • AST (28 vs 24 U/L) 
  • Commentary: In this study, obese children with SCH had worse cardiometabolic profiles compared to euthyroid children.

Diet & Lifestyle Studies

• Effect of Physical Exercise on Cognitive Function of Alzheimer’s Disease Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trial
  • 22 studies, 1,647 participants with Alzheimer’s disease 
  • Physical activity, including aerobic and resistance training, led to: 
    • Significant cognitive benefit in 59% of studies
    • NO cognitive benefit in 41% of studies
  • Commentary: This study shows an overall positive trend towards improving cognitive symptoms in those with Alzheimer’s disease.

• The Effects of Resistant Starch on Biomarkers of Inflammation and Oxidative Stress: A Systematic Review and Meta-Analysis 
  • 16 studies, 739 participants 
  • Resistant starch led to: 
    • Reduced inflammatory markers (TNF-α, IL-6) (moderate effect size) 
    • Increased total antioxidant capacity (large effect size) 
    • NO change in CRP
  • Commentary: Resistant starch may help improve inflammation markers, likely through modulating the gut microbiome.

• Specific Alterations of Gut Microbiota in Chinese Patients with Hypertension: A Systematic Review and Meta-Analysis 
  • 16 studies, 2,372 hypertension patients, 849 healthy controls
  • Compared to healthy controls, patients with hypertension had: 
    • Increased dysbiosis (Firmicutes, E. Coli, Shigella and Klebsiella)
    • Reduced beneficial bacteria (Bacteroidetes, Bifidobacterium, Faecalibacterium and Ruminococcus)
    • Increased LPS
  • Commentary: The gut microbiome may be implicated in hypertension.

Podcast Summary

Download Episode

Featured Study

• Efficacies of prokinetics and rifaximin on the positivity to glucose breath test in patients with functional dyspepsia: randomized trial
  • 83 patients with SIBO and dyspepsia, randomized to: 
    • Prokinetic (mosapride)
    • Rifaximin 
    • Prokinetic + rifaximin 
  • All patients underwent a glucose breath test after treatment
  • After 2 weeks, there was NO significant difference in SIBO eradication rates: 
    • Prokinetic + rifaximin (35%) 
    • Rifaximin (32%) 
    • Prokinetic  (17%)
  • All treatments led to similar reductions in hydrogen and methane gas
  • Commentary: This study found that 1) there was NO difference in SIBO eradication rates when adding a prokinetic to rifaximin and 2) restoring normal gut motility can be as effective as rifaximin for eradicating SIBO in this study. 
    

Gastrointestinal Studies

• Effectiveness and Safety of Probiotics for Patients with Constipation-Predominant Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis of 10 Randomized Controlled Trials
  • 10 RCTs, 757 patients with IBS-C, randomized to:
    • Placebo
    • Probiotics (e.g. lacto/bifido, saccharomyces cerevisiae, strep thermophilus) 
  • Compared to placebo, probiotics led to: 
    • Improved stool consistency (moderate effect size) 
    • NO improvements in abdominal pain, bloating or quality of life
  • Commentary: Probiotics led to improved stool consistency without improving other GI symptoms.

• Intestinal Permeability and Dysbiosis in Female Patients with Recurrent Cystitis: A Pilot Study
  • 16 patients with recurrent cystitis, 15 healthy controls
  • Compared to healthy controls, patients with recurrent cystitis had: 
    • Increased intestinal permeability 
    • Worse GI symptoms
    • Reduced gut microbiome diversity 
  • Commentary: This small study highlights the gut-bladder connection. Be sure to address the gut in patients with chronic cystitis.

• Clinical and Metabolomic Effects of Lactiplantibacillus plantarum and Pediococcus acidilactici in Fructose Intolerant Patients
  • 14 fructose intolerant patients, treated with probiotics and a fructose free diet
  • After 1 month, probiotic treatment led to improvements in: 
    • Bloating 
    • Abdominal pain
  • Commentary: Probiotics may improve GI symptoms in those with dietary intolerances. Keep in mind these patients were also put on a fructose free diet.

• Effects of Lactobacillus curvatus HY7601 and Lactobacillus plantarum KY1032 on Overweight and the Gut Microbiota in Humans: Randomized, Double-Blinded, Placebo-Controlled Clinical Trial
  • 59 overweight participants randomized to:
    • Placebo
    • Probiotics
  • After 3 months, probiotics led to reduced:
    • Weight (-1 lb probiotics vs +2 lb placebo) 
    • Waist circumference (-0.4 cm vs +1.3 cm) 
    • Body fat (-0.2% vs + 0.1%)  
    • Visceral fat (-1.7 cm2 vs + 2.8 cm2)
  • Commentary: Although probiotics improved body composition, it’s not clinically meaningful.

• Efficacy and Outcomes of Faecal Microbiota Transplantation for Recurrent Clostridioides difficile Infection in Children with Inflammatory Bowel Disease
  • 396 pediatric patients with recurrent C. difficile infection (rCDI), treated with FMT
    • 37% also had IBD 
  • FMT led to successful resolution of rCDI (76-81%)
  • Commentary: FMT is an effective option for pediatric patients with rCDI, regardless of presence of IBD.

• Non-oesophageal eosinophilic gastrointestinal diseases are undersuspected clinically and underdiagnosed pathologically
  • 903,516 patients with suspected esophageal symptoms, all underwent biopsy
  • Eosinophilic esophagitis (EoE) was confirmed in 15% of patients 
  • Commentary: EoE is relatively common in patients with esophageal symptoms and may be under-diagnosed.

• Impact of shift work on irritable bowel syndrome and functional dyspepsia: A meta-analysis
  • 8 studies 
  • Night shift workers were 81% more likely to be diagnosed with IBS
  • Commentary: This study highlights the association between circadian rhythm disruption and GI health.

• Efficacy of Fecal Microbiota Transplantation in the Treatment of Active Ulcerative Colitis: A Systematic Review and Meta-Analysis of Double-Blind Randomized Controlled Trials
  • 6 RCTs, 324 IBD patients, randomized to:
    • Placebo
    • Fecal microbiota transplant (FMT) 
  • Compared to placebo, FMT led to: 
    • 4x increased rate of clinical and endoscopic remission
    • NO difference in side effects  
  • Commentary: FMT is a clinically useful and safe therapy for patients with IBD.

• Ligilactobacillus salivarius PS11610 exerts an effect on the microbial and immunological profile of couples suffering unknown infertility
  • 17 couples with infertility and urogenital dysbiosis, treated with probiotics
  • After 6 months, probiotics led to improved: 
    • Urogenital dysbiosis in 67%
    • Uterine microbiome 
    • Pregnancy/delivery ratio 
  • Commentary: Probiotics have a positive effect not only on the gut, but also the urinary and reproductive microbiome.

Thyroid & Hormones Studies

• Cardiovascular Morbidity and Mortality in Men – Findings From a Meta-analysis on the Time-related Measure of Risk of Exogenous Testosterone
  • 10 studies, 179,631 men with low testosterone, randomized to:
    • Control (no treatment or placebo)
    • Testosterone replacement therapy (TRT)
  • Compared to control, TRT led to:
    • Reduced overall mortality by 30%
    • NO reduction in risk of cardiovascular events
  • Commentary: While TRT led to improved mortality risk, this meta-analysis found NO Improvements in risk of having a cardiovascular event.

• Is thyroid autoimmunity a predisposing factor for fibromyalgia? A systematic review and meta-analysis
  • 5 studies
  • Compared to healthy controls, patients with fibromyalgia were more likely to have positive: 
    • TPO antibodies (3.4x more prevalent)
    • Tg antibodies (2.2x more prevalent)
    • However, there was NO correlation between fibromyalgia severity and degree of thyroid antibody elevation
  • Those with fibromyalgia and thyroid antibodies were 2x more likely to be postmenopausal
  • Commentary: Fibromyalgia may be associated with thyroid autoimmunity and menopausal status.

Diet & Lifestyle Studies

• The effect of paleolithic diet on glucose metabolism and lipid profile among patients with metabolic disorders: a systematic review and meta-analysis of randomized controlled trials
  • 10 RCTs
  • Compared to control groups, a paleolithic diet led to improvements in: 
    • Fasting insulin (-12 μU/mL)
    • Insulin resistance (HOMA-IR) (-0.4) 
    • Total cholesterol (-6 mg/dl)
    • LDL-C (-6 mg/dl) 
    • Systolic blood pressure (-6 mmHg) 
    • CRP (-0.8 mg/l) 
  • Commentary: A paleo diet led to significant improvements in insulin, with minor improvements in lipids, blood pressure and CRP.

• The use of mandibular advancement devices in adult patients affected by obstructive sleep apnea syndrome: our experience with Thornton Adjustable Positioner® splint
  • 18 participants with sleep apnea, treated with a mandibular advancement device (MAD) 
  • Treatment with MAD led to significant reductions in sleep apnea severity scores 
    • AHI of 28 to 5 = moderate to minimal severity  
  • Commentary: Another study showing the impact of MAD on sleep apnea severity.

Podcast Summary

Download Episode

Featured Studies

• Effects of a low FODMAP diet on the colonic microbiome in irritable bowel syndrome: a systematic review with meta-analysis
  • 9 RCTs, 403 patients with IBS, randomized to:
    • Control diets
    • Low FODMAP diet (LFD)
  • Stool analysis was performed on all patients
  • Compared to control diets, the LFD led to: 
    • NO difference in overall microbiome diversity
    • NO difference in short chain fatty acid production
    • Lower abundance of bifidobacteria
  • Commentary: Despite a reduction in fermentable fiber, a LFD did NOT lead to lower SCFA or microbiome diversity. This puts a hole in the argument that a low FODMAP diet is not optimal because of lower SCFA production.

Gastrointestinal Studies

• Vitamin D supplementation for irritable bowel syndrome: A systematic review and meta-analysis
  • 8 studies, 685 patients with IBS 
  • Vitamin D supplementation led to improved: 
    • IBS symptom scores (moderate effect size) 
    • Quality of life (moderate effect size) 
  • Commentary: Vitamin D may be clinically beneficial in IBS patients.

• Efficacy and Safety of High-dose Cholecalciferol in Patients With Inflammatory Bowel Disease Receiving Infliximab
  • 43 patients with IBD and vitamin D deficiency, treated with either: 
    • Low dose vitamin D (50,000 IU every 4-5 weeks)
      • =1,600 IU/d
    • High dose vitamin D (100,000 IU every 6-8 weeks)
      • = 2,000 IU/d
  • In both groups, vitamin D treatment led to:
    • Only 37% of patients achieving vitamin D sufficiency (≥ 30 ng/mL) 
    • NO difference in IBD symptoms 
  • Commentary: Patients with IBD likely require a higher dose of vitamin D, which may be because inflammatory conditions “utilize” more vitamin D.

• The effect of probiotics on the clinical status of adult patients with atopic dermatitis: a systematic review
  • 7 studies
  • Compared to placebo, probiotics led to improved:
    • Skin itching
    • Eczema severity

• Fecal Microbiota Transplantation for Patients With Irritable Bowel Syndrome: A Meta-Analysis of Randomized Controlled Trials
  • 7 RCTs, 489 participants with IBS, randomized to: 
    • Placebo
    • Fecal microbiota transplantation (FMT)
  • FMT did NOT improve IBS symptoms when compared to placebo 
  • Commentary: This meta-analysis did NOT show an overall benefit for treating IBS with FMT.

• Probiotic use in the prophylaxis of periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome: a retrospective cohort study
  • 111 children with a periodic fever inflammatory syndrome (PFAPA), randomized to: 
    • Control (no treatment)
    • Probiotics
  • After 4.5 months, 95% of kids taking probiotics experienced a reduction in flaring of symptoms
  • Commentary: Probiotics have anti-inflammatory and immune-modulating benefits.

• Isolated positive deamidated gliadin peptide-IgG has limited diagnostic utility in coeliac disease
  • 26 patients presenting with positive gliadin antibodies (DGP-IgG)
    • All were negative for tissue transglutaminase antibodies (tTG-IgA)
  • Of all the patients with +DGP-IgG, only 4% of patients had confirmed celiac disease on biopsy 
  • Commentary: DGP-IgG may not be very specific for diagnosing Celiac disease. Keep in mind the sample size of this study.

• The Microbiota in Eosinophilic esophagitis: a systematic review
  • 7 studies on patients with eosinophilic esophagitis (EoE) 
  • Compared to control groups, patients with EoE presented with greater imbalances in esophageal microbiome 
  • Commentary: Esophageal dysbiosis may be associated with increased risk of EoE.

• Links between Celiac Disease and Small Intestinal Bacterial Overgrowth: A Systematic Review and Meta-Analysis
  • 14 studies, 742 celiac disease (CD) patients, 178 healthy controls
  • 21% of patients with CD were diagnosed with SIBO
  • In CD patients with SIBO: 96% treated with antibiotics had improved GI symptoms
  • Commentary: SIBO may be present in about 1 in 5 CD patients, meaning a proportion of CD patients will likely benefit from antimicrobial treatment. 
    

Thyroid & Hormones Study

• The effect of oral vitamin E and omega-3 alone and in combination on menopausal hot flushes: A systematic review and meta-analysis
  • 9 studies, 1100 menopausal participants with hot flashes, randomized to:
    • Placebo
    • Vitamin E alone
    • Omega 3 alone
    • Vitamin E + Omega 3 
  • Compared to placebo: 
    • Combined vitamin E + omega 3 led to a reduction in hot flash intensity (small effect size) 
    • Vitamin E or omega 3 alone did NOT improve hot flashes 
  • Commentary: Vitamin E + omega 3 may slightly improve hot flashes in menopausal women. Consider adding in these nutrients in addition to basic lifestyle support and female hormone adaptogens for improving hot flashes.

Diet & Lifestyle Studies

• The Relationship Between Plant-Based Diet and Risk of Digestive System Cancers: A Meta-Analysis Based on 3,059,009 Subjects
  • 3 million participants 
  • Plant based diets were associated with lower rates of digestive cancers, including: 
    • Pancreatic cancer (-29%)
    • Colorectal cancer (-24%) 
  • Commentary: This large study shows an association between plant-based diets and reduced risk of GI cancers. Keep in mind this study is using data from observational studies, which introduces healthy user bias.

• Co-exposure to multiple air pollutants and sleep disordered breathing in patients with or without obstructive sleep apnea: A cross-sectional study
  • 2,524 participants with sleep disordered breathing
  • Poor air quality was associated with worse sleep apnea severity
  • Commentary: This observational study suggests an association between air quality and sleep disordered breathing.