Evidence-Based Interventions for Thyroid and Female Hormones - Dr. Michael Ruscio, DNM, DC

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Evidence-Based Interventions for Thyroid and Female Hormones

Surprising findings about herbs, probiotics, meditation, low carb diets, intermittent fasting, and more for weight loss, endometriosis, depression, menopause, and blood pressure

Typically, this podcast segment covers thyroid and female hormonal health research updates, but this episode also includes updates relevant to diet and lifestyle. Don’t miss out on hearing the unique relationships between: 

  • Polycystic ovary syndrome (PCOS) and heavy metals
  • Graves Disease and long-term antithyroid drug supplementation
  • Phytoestrogens and peri/post menopause
  • Meditation and depression
  • Fish intake and cognition 
  • Sauna therapy and athletic performance 
  • Red ginseng and chronic fatigue 

Tune in to the episode.

In This Episode

Intro… 00:08
Heavy metals in women with PCOS… 01:49
The effect of Methimazole on Grave’s remission… 05:14
Probiotics for menopause symptoms… 07:39
The effect of Levothyroxine on pregnancy outcomes… 09:58
Herbal support for hot flashes… 12:06
Intermittent fasting compared to caloric restriction… 13:09
Meditation for moderate depression… 16:08
The effect of fish intake on cognition… 17:34
Hibiscus for blood pressure… 18:54
Ginseng for fatigue… 23:27
DHEA supplementation on estradiol levels… 26:13
Periodization in a strength training plan… 29:30
The effect of CPAP on cognitive function in sleep apnea patients… 31:38
Vitamin D for endometriosis… 35:24
Omega-3 for depression… 37:17
Cortisol levels in women with unexplained symptoms… 38:09
Exercise outdoors versus indoors… 42:45
Close… 45:56

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Hey everyone. Welcome back to Dr. Ruscio radio. This is Dr. Michael Ruscio, and let’s do more on the research. And this time we’ll go into details on thyroid and female hormones. I decided to change my lumping, if you will, to include thyroid and female hormones together in one podcast. Mainly the info here will be on thyroid, but there is overlap between these two, especially in symptomatic presentation. And you will see, and we have discussed in the podcast in the past, some women for whom they’re working with a provider that has this hammer of thyroid and they become a nail. And it’s clear when they’ve come to see us at the clinic for a second opinion, that you don’t have hypothyroidism and you definitely have symptoms of female hormone imbalances that will resolve your non-responsive symptoms pretty quickly once we address those. So my hope is by tying these together, we won’t take away from the thyroid conversation, but we’ll accent it with the sprinkling on female hormones.

➕ Full Podcast Transcript

Intro:

Welcome to Dr. Ruscio radio, providing practical and science-based solutions to feeling your best. To stay up to date on the latest topics, as well as all of our prior episodes, make sure to subscribe in your podcast player. For weekly updates, visit DrRuscio.com. That’s DRRUSCIO.com. The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking with your doctor. Now let’s head to the show.

Dr Ruscio:

Hey everyone. Welcome back to Dr. Ruscio radio. This is Dr. Michael Ruscio, and let’s do more on the research. And this time we’ll go into details on thyroid and female hormones. I decided to change my lumping, if you will, to include thyroid and female hormones together in one podcast. Mainly the info here will be on thyroid, but there is overlap between these two, especially in symptomatic presentation. And you will see, and we have discussed in the podcast in the past, some women for whom they’re working with a provider that has this hammer of thyroid and they become a nail. And it’s clear when they’ve come to see us at the clinic for a second opinion, that you don’t have hypothyroidism and you definitely have symptoms of female hormone imbalances that will resolve your non-responsive symptoms pretty quickly once we address those. So my hope is by tying these together, we won’t take away from the thyroid conversation, but we’ll accent it with the sprinkling on female hormones.

Dr Ruscio:

So let’s jump in. The first study looked at changes in heavy metals as assessed in the blood in women with PCOS (polycystical ovarian syndrome). And what they found was, in this 40 women with PCOS as compared to 40 healthy controls, they found that PCOS patients had higher chromium, mercury, and copper. And also that the mercury was associated with higher androgens, which drives the PCOS. Which you don’t want. Now it’s important for me to mention here, this was a non-provoked blood sample. And this is also another area where I really want to give [Dr.] Joe Mather some credit for helping resurface the importance of looking at heavy metals based upon emergent evidence published over the past, maybe two years or so, that helped establish some guidelines and criteria for looking at these toxins in the blood and in the urine in a non provoked fashion, giving us some normative ranges to examine, and that therapies for these can clearly be helpful.

Dr Ruscio:

So the one thing to be cautious and I guess acknowledging of is that (and this is why I was not keen on heavy metal testing and treatment after a few years of experimentation early in my career) is because it was always a provoked test with a independent functional medicine lab that did not have good normative data on the ranges. And so everyone came back high. And after a while you had to ask yourself, how is it that I rarely see a negative test but I almost always see a positive test? Now this is guarded against by using a lab that’s based upon population-wide samples and prevents from becoming overwhelmed with this huge number of people that seem to have heavy metals that actually don’t—false positives. And this is why I was seeing a very poor amount of people who actually saw symptomatic improvement.

Dr Ruscio:

Because if you have a false positive test and you treat that test, your likelihood of improvement is extremely low. And just to tie this in, it’s easy when I see it here and now to understand it, but when you’re sick and you’re not feeling well and you have brain fog, fatigue, and depression and you see that positive that red, “high mercury,” “high copper,” it’s so easy to fall into thinking that that’s the thing. And this is where I’m hoping we’re turning the tide a little bit with these conversations on the podcast that you have to toggle over to that logical side of your mind and ask the question, “is this a validated test or am I getting pulled into these species tests that are so easy to fall in love with, so to speak, in terms of well, this must be the thing that’s wrong with me?” So there’s a balance here. The right testing helps ensure that you have a true positive and therefore you have a high likelihood of response from detoxification therapy.

Dr Ruscio:

Okay. The next study was looking at Graves. And this was a systematic review and what they found in Graves—so this is the auto immunity that underlies hyperthyroidism or the condition of hyperthyroidism that’s underlined by auto immunity, I should say—what they found was a longer treatment with Methimazole (which is this anti-iodine drug) a longer treatment duration led to a longer time in remission. And I think this study is important to put out there because one could say to themselves, “well, I was having symptoms of Graves, I was having elevated blood pressure, racing heart, fatigue, insomnia, sweating, what have you, I went on the Methimazole and a few months later, I feel back to normal and a couple months after that, I’ve been totally stable. Why is my endocrinologist saying stay on this longer?”

Dr Ruscio:

It’s a fair question. Especially if you have a suspicious view—which I don’t think is fair, but just entertain it—a suspicious view of your endocrinologist. They’re going to lean too heavily on drugs. They’re not going to be open minded about natural therapeutics. Maybe the not being open minded about natural therapeutics is partially fair, but I don’t think it’s fair to say, “well, they just want me on drugs because they’re like the monopoly man in the corner trying to get a commission check from the drug companies.” Don’t think that’s fair. And this would be a good example of where your endocrinologist, if privy to this and looking at this literature, would be advising you to stay on the Methimazole longer because it’s going to increase your likelihood of remaining in remission once you come off.

Dr Ruscio:

So for those with Graves, just something to keep in mind. And what they found, specifically, was that treatment over five years led to a remission free rate at a four-year follow up of 85% as compared to 50%. So [the] standard is 12 to 18 months and that led to about a 50% remission rate. But if you stayed on longer than five years, you had a 85% chance that you would stay in remission. So important study there for those with Graves.

Dr Ruscio:

The next study looked at the effect of a lactobacillus probiotic on mild menopausal symptoms in middle aged women. So 80 women between 40 and 60 years of age with mild menopausal symptoms received either placebo or probiotic. And what do you think they found? Even going back now to when I wrote “Healthy Gut, Healthy You’ years and years ago, I discussed my observations clinically that women with gut symptoms oftentimes have female hormone symptoms and they do really well, those female hormones respond very nicely, to gut care. After six months on the probiotics, the probiotic group had a overall symptom relief of 75% as compared to 25% in the placebo group, an improvement in global menopausal symptoms, vaso motor (or hot flashes and hot flushes), and also psychological or mood scores.

Dr Ruscio:

So another great example of why it’s so vitally important to start with your gut. And in this case, a woman could have been prevented from going on HRT or maybe even birth control to help with these symptoms and the probiotic was sufficient to address those symptoms. So it’s very, very important to mention this. And as a step one, step two; level one [is] diet, lifestyle, gut health, including probiotics. If a woman is still exhibiting symptoms of female hormone imbalances, this is where I love using in combination our Estro-Harmony and our Proges–Harmony (two herbal blends that have a number of clinical trials substantiating that their ingredients) can improve menopausal symptoms. So women especially, men aren’t so lucky in having herbal therapies that are as effective for testosterone mediated symptoms, but women are lucky in that. There are some great herbs out there.

Dr Ruscio:

Remember though, start with the gut interventions, namely but not exclusively probiotics, and then reevaluate. And this is a great study, great study showcasing that yes, you can impact female hormones through the gut vis-a-vis probiotics.

Dr Ruscio:

The next study was a systematic review and meta-analysis of pregnancy outcomes and the effect that Levothyroxine had. This was nine studies looking at just under 3000 women with subclinical hypothyroidism—now remember, that subclinical hypothyroidism is when the TSH is above 4.5—and this group is the group that is one of the exceptional cases where treatment should be considered, whenever you get above 4.5. They found that compared to control, the treatment with Levothyroxine (or thyroid hormone) lowered the risk of preterm birth, abortion, postpartum hemorrhage, and low birth-weight infants.

Dr Ruscio:

So just one of the reasons why we made this recommendation. And this is again, one of the exceptional cases where if you have this subclinical hypothyroidism (TSH of 5, 6, 7, 8) then you want to undergo treatment with thyroid hormone. Now, if you’re a non-pregnant person or you’re not trying to get pregnant and you have no history of infertility, you’re just normal person walking around and you have a 5, 6, 7, 8, 9, let’s say there’s a good likelihood, 60-70ish percent that within two to three months, and you do a retest, you will see that mild elevation of TSH that subclinical hypothyroidism go back to normal. You can bolster that effect with the use of things like vitamin D, and namely selenium and Myoinositol. But we want to be really careful not to fall into the ploy of, “well, see higher symptoms are coming from this TSH, it’s 6.3 and it should really be below 2.5.” This is not true. This is not what the overwhelming majority of data support. And it’s important that you understand this because the promise is appealing. But if the promise fails to lead to the effect that you want, that is a problem.

Dr Ruscio:

And the next study looked at essentially an herbal blend to help with hot flashes. And they found when using either the placebo or these phytoestrogens, that at three months in the natural herbal estrogen supplement group, there was an improvement in hot flashes, sexual complaints, insomnia, sadness, hot flashes. So yes. Great evidence here. A lot of options for women, either probiotics or herbal in nature to help with some of those symptoms.

Dr Ruscio:

Now I’m realizing that my thread of thyroid and hormone studies is short. So I’m going to pivot us over to some dietary and lifestyle research. Sorry to combine these here, but I have no more studies for you on thyroid and female hormones. So let’s talk about some diet/lifestyle studies.

Dr Ruscio:

This first study looked at the effect of intermittent fasting and its effect as compared to caloric restriction, a meta-analysis of 43 randomized control trials. So they’re looking at intermittent fasting as compared to continuous calorie restriction. And they found the intermittent fasting led to lower weight (with a fairly large effect size), lower BMI with a (moderate effect size), higher fat-free mass, presumably muscle, (with a medium effect size), better insulin sensitivity (with a small effect size), and lower triglycerides and cholesterol (also with a small effect size). So pretty good data here showing that if you could choose between continuous, lower calorie consumption or intermittent fasting—meaning you’re going to have a somewhat normative calorie intake but you’re going to have a condensed feeding window and longer time without food—that’s probably a better approach, at least according to this 43 randomized control trial, 2,400 participant, meta-analysis. Pretty good data point. And this is one of the reasons why we build into most of our dietary recommendations a degree of intermittent fasting for the individuals that we work with.

Dr Ruscio:

Now, it’s not a good choice for everyone. If you’re underweight, burnt out, if you’ve maybe been undereating because you’ve read all of the guru books on lectins and oxalates and solicitate and histamine and FODMAP and gluten and dairy, then, okay, we need to replete you a little bit. And the fasting might not be the best for you. So it’s important to keep that in mind. You have to make this on a case-by-case basis decision.

Sponsor:

Hey, everyone. We’ve had a number of people reach out and ask how to refer someone to our clinic. And to make this easy, we created a page: DrRuscio.com/referrals. And our office is happy to provide a referral source for challenging patients or clients. Working with people in a clinical setting is really at the core of what we do. So again, happy to help however we can. Simply enter the person’s contact information and our office will take care of the rest. This probably goes without saying, but you can rest assured that the client or patient that you are referring will obtain progressive yet cautious care, care that is cost-effective. We will not order unnecessary lab work. We will not use copious amounts of supplements. Also, our care is devoid of overzealousness and fear-mongering. And we use treatments that are science-based and cause-focused. That URL again is DrRuscio.com/referrals. And, again, more than happy to help however we can.

Dr Ruscio:

The next study looked at the effect of a meditation-based lifestyle intervention for moderate depression. 81 patients with mild/moderate depression either took an antidepressant medication or they had this meditation-based lifestyle modification. And at two months there was a significantly better improvement in depression in the meditation group. So this is really important, I think, to keep in mind that meditation has a powerful impact and probably most of us in the audience are privy to this. And also the fact that for mild to moderate depression, the data on the efficacy and the effectiveness of antidepressants is pretty poultry. And this is where other therapeutics, like probiototics we’ve talked about in the past, and here meditation should really be considered. And it’s sad when people who have depression are told they’re depressed as if it’s this condition that requires a certain medication to fix it, rather than reframing that (at least initially, not in a dogmatic way) but at least initially in a, this is a symptom that’s downstream of something up stream that we need to address.

Dr Ruscio:

The next study looked at fish intake and omega three fatty acid status as it pertains to cognitive decline: a systematic review and a dose response meta-analysis. So they’re trying to see a zero a dose relationship here to the effect, and they found that fish intake up to two portions per week led to a 10% reduction in all cause dementia and a 30% reduction in Alzheimer’s. Important to flag because this comes up every once in a while. “Well, don’t fish contain mercury, aren’t our oceans polluted, and shouldn’t we be cautious of mercury and other heavy metals?” Well, this is what’s nice about outcome data, because we have an answer to that question. Now, does that answer if someone is having five servings per week? No. So maybe there’s something there, but at least to prevent one from avoiding fish completely because they are concerned about heavy metals. This would give you a have two portions per week and you will have a reduced risk of dementia and Alzheimer’s.

Dr Ruscio:

Okay. The next study was a systematic review and meta-analysis of the effects of hibiscus on blood pressure. 17 studies found that hibiscus is effective at lowering systolic blood pressure as compared to controls. And it wasn’t a huge difference, well actually, fairly large. So what they found was that hibiscus led to a negative 14.9 point reduction, so 15 points lowering with hibiscus, and the medication led to a 17 point reduction. So depending on how you look at this, pretty impressive. A two point difference between hibiscus or blood pressure lowering medication. So, interesting. And again, this is not cherry picking. This is a meta-analysis of 17 studies, so important to keep this in mind.

Dr Ruscio:

Now also important to keep in mind that if you have a 60 point gap you’re trying to close then, okay, probably not going to be enough. But I’m also not clear on if that’s even likely to be achieved from one medication, unless a dose is awfully high or someone would need two medications. So anyway, something to keep in mind as a natural intervention to lead to a marginal improvement in systolic blood pressure.

Dr Ruscio:

The next study looked at the effect of intermittent fasting on cardio metabolic risk factors. This was a meta-analysis of 14 clinical trials and when compared with controls, intermittent fasting led to reduced body weight— 1.7 kilograms. So what’s that, maybe three to four pounds, probably 4.5 pounds. Waist circumference improved, fat mass improved, blood pressure improved, and fasting insulin improved. So a number of markers here again, showing improvement from intermittent fasting.

Dr Ruscio:

Okay. So the next study looked at a comparative analysis, vis-a-vis a meta-analysis, of low-carb diets versus low-fat diets for type two diabetes. 12 randomized control trials, 761 patients. And what they found was that low-carb diets had a better reduction in hemoglobin A1C, reduction in weight, reduction in triglycerides, and no difference in total or LDL cholesterol. And the weight was three kilograms, which I believe is 6.6 pounds. I think it’s 2.2 to one ratio there. So significant weight difference. Now the one thing here that I’m not clear on, and I did not dig deeply enough into the methods on this paper to figure this out is [whether] this a fair apple-to-apple diet quality comparison. Christopher Gardner’s analysis, as we talked about before, the DIETFITS trial, really tried to quantify looking at a healthy low-carb diet versus a healthy low-fat diet.

Dr Ruscio:

And I think there has been some biasing of the data for when people are going on a low-fat diet, they’ve been akin to this crap-itarian diet where people were eating lots of processed carbs. They were eating low fat, but they weren’t doing it in a context of a fruit and vegetable emphasis. So that should be considered. I still think there’s probably a lean in the direction of favorability for a lower carb diet for most people, but there’s going to be some metabolic nuance there and some who do better, at least on a moderate fat and carb intake.

Dr Ruscio:

And this was interesting, an open label, so placebo effect is in effect here, but looking at ginseng in chronic fatigue syndrome, fibromyalgia, and post-viral fatigue in these 188 patients. They found that after 30 days of supplementation with gingseng there was a 67% increase in energy, a 48% increase in mental clarity, a 46% improvement in sleep, a 72% increase in physical stamina, and a 33% decrease in pain. I would cut all those numbers at least in half, because this is an open label trial and there’s no reduction of placebo. But still, this is fantastic, right? And in those with fatigue and fibromyalgia and post-viral fatigue, really important to keep in mind that this simple intervention just based upon the fact that they were tired, had a lack of mental clarity, were not sleeping well, had poor stamina, had some pain—that was treated. Not a “well, you have low energy and poor sleep, it must be your adrenals. Let’s test your adrenals. We need the specific testing data before we can treat your adrenals.” And again, I’ll give any provider the benefit of the doubt. We have to start better realizing that a lot of that comes from lab company influenced marketing. And if we get enough of a tipping point reached, it becomes accepted as fact.

Dr Ruscio:

And what I’ve continually tried to showcase on this podcast is there’s not great data to really support the fact that you need to do any adrenal testing. In fact, just recently we had on Ari Whitten and he did a very good job of pointing this out. He really went deep into his analysis on adrenal testing and made a good counter argument, excuse me, even to my trying to give some testing the benefit of the doubt, he had a good counter argument against my devil’s advocate position. So, just keep this in mind that if you’re not feeling well, the utility of testing is small. Conventional medicine probably has a fairly higher degree of utility because many of those tests like blood sugar, cholesterol, blood pressure have been validated. When we get into the new-age realm of testing, a lot of these labs, remember they have not gone through adequate validation. So you don’t know if what you see on the lab report actually has any meaning, even though it seems so real.

Dr Ruscio:

The next study looked at DHEA supplementation on estradiol levels, a form of estrogen, in women in a dose response meta-analysis. 21 studies, about 1200 participants. And they found that DHEA supplementation led to higher estradiol levels in women, especially when used at 50 milligrams per day for more than 26 weeks. That’s a decent dose, 50 milligrams, but important to mention that in a population of aging women. I should clarify that this occurred in women who were above 60. So in a population of aging women, 50 micrograms per day led to a favorable impact on estradiol levels. And just maybe to tie in one other piece here, if you have a woman with hot flashes, meditation may help, probiotics may help, and DHEA may help as may herbal therapy. So there’s a lot of options for women with female hormone imbalances. Bioidentical HRT is an option, but I think it should be put toward the end of the list, kind of like Rifaximin for SIBO. It’s an option, but I think we have gentler, more natural, or more supportive agents that can be used.

Dr Ruscio:

Okay. The next study looked at three-week passive acclimatization to an extreme environment using dry sauna in football players. And sorry, some of these titles, let me read you the exact title. I’m trying to parse out for you what was done while I’m looking at this. 3-Week passive acclimation to extreme environmental heat (100± 3 °C) in dry sauna increases physical and physiological performance among young semi-professional football players

Dr Ruscio:

Just a lot there to try to parse out for you and give you a simple summary. So with 36 male football players randomized to no therapy or sauna for three weeks, and they found that the sauna group had decreased body weight and body fat, increased hamstring flexibility and work capacity (nice benefit), and better respiratory fitness. I say this as my sauna is about 20 minutes away from being at temperature. And I do sauna pretty much everyday. Every once in a while, I’ll miss a session, but it is my pre-dinner routine or part of my end of day pre-dinner routine. And I am a huge fan of sauna. And I would recommend that if you’re going to buy something, put off that Louis Vuitton bag and buy yourself a sauna because you’ll have—if you use it every day—you’ll have daily joy from it and improvements in your all-cause mortality as well as improved hamstring flexibility, amongst other things. So definitely a great intervention that I think everyone should try to do.

Dr Ruscio:

The next study looked at the effect of periodized (or planned change) in a strength training exercise plan. Well, let me reframe this. Periodization is planning change in your strength training program, whereas you can just do the same thing all the time with no periodization. And they found that a periodized […] strength training had better strength, but no difference in muscle size. So for whatever it’s worth, you’ll get a little bit stronger if you had this planned change, this periodization in your exercise training, but may not have any impact on your muscle size. And this was a meta-analysis of 35 studies, so important to keep that in mind. And one of the reasons why I think this is important is because, and I’m definitely an outsider here without a ton of clinical experience other than my own self experimentation, but sometimes you see these very elaborate recommendations in the exercise world. And what does this sound like? Pretty much everything else, right? Diet, gut care, healthcare in general, thyroid care.

Dr Ruscio:

It’s just a human constant where making things more complicated than they need to be seems to be marketable. And that’s what some like to do. And this is a good example of another data point mooring us to simple and practical interventions tend to work just as well, if not perhaps better. In fact, we discussed a study a while ago, gosh, maybe five years ago now, that found that just a general strength and conditioning plan had the same level of impact on joint pain function and mobility as a meticulously crafted personalized exercise plan or rehab plan.

Dr Ruscio:

Okay. So let’s talk about sleep. This study looked at 162 sleep apnea patients, they measured cognitive function and EEG. And after six months of CPAP, they found that all cognitive domains improved and they had improved EEG (the electroencephalogram). Essentially think, EKG:heart EEG:head. So, brainwaves. This is why it’s really important that if someone is suffering with non-responsive fatigue and brain fog, two of the primary flags, they could have SBD (sleep disordered breathing). And this involves apnea, but not always apnea specifically. And remember that the therapies here can be so simple. The EMST (the expiration muscle strength training device), the EMST 150—we had the podcast guest a couple of months ago and this $55 device where you breathe against resistance for 5 sets of five per day, takes 10 minutes max—has been shown in a handful of clinical trials to reduce apnea.

Dr Ruscio:

So I understand that an overnight sleep study is not an attractive proposition. You don’t necessarily have to do that. And also that the Darth Vader or CPAP is probably even less attractive and you don’t have to do that. There are so many other great therapies. So if you are someone who’s struggling with some of these symptoms, namely fatigue and brain fog, although chronic pain can be another or paradoxically elevated blood pressure or cholesterol, these are all signs that apnea may be present. Now, if you wake up with a dry mouth in the morning, drool your pillow, you notice that you snore, there’s a family history of apnea, these all bolster that case that apnea could be present. And this is also something that we’re doing more and more with at the clinic. So please, if you’re in this group and you’re suspicious, feel free to reach out to the clinic.

Dr Ruscio:

I’m very happy that we now have a really nice sleep algorithm, where we have a number of therapies that can be used. In fact, we have one of our doctors right now testing this myofunctional therapy app. So instead of having to do a course or meet with a therapist—and the courses aren’t expensive but they’re not $5 like this app is—you can just do this app on your phone. And there’s at least one clinical trial with this app, because this is where we’re pulling a lot of these therapies, the primary literature, not the back of a cereal box or something like that. And I got a note from one of our doctors and he said, “boy, after doing the first day of this, the day after, my mouth was sore.” Surprise, surprise, what do you think’s happening? You’re toning all that musculature that while you’re sleeping and you’re not breathing and you’re having these potentially hypoxic events.

Dr Ruscio:

And why do you think you have brain fog? Well, in that case, this could be what’s the culprit and potentially—we still have to do a little more probing on this, in particular—but a $5 app where you do 10-15 minutes of physical therapy for your mouth per day may be an adequate resolution of the brain fog and fatigue and joint pain and other symptoms that could be driven from the apnea, if present already.

Dr Ruscio:

The next study looked at the effect of vitamin D on clinical symptoms and metabolic profiles in women with endometriosis. 60 women with endometriosis were randomized to 50,000 IUs every two weeks of vitamin D or placebo. After 12 weeks of vitamin D supplementation that group, and not the placebo, had reduced pelvic pain, reduced CRP, and increase in their total antioxidant capacity. So this is something to keep in mind. And also we’re going to be having Yondra Mueller back on the podcast to discuss in a deeper fashion, because this would be her second time on, the association between endometriosis and non-responsive either bloating, or more accurately I think to say, abdominal distension.

Dr Ruscio:

And we were having a conversation about this just recently wherein you don’t always have the classical endometriosis symptoms. And so I want to probe a little bit deeper into what should women be aware of who have cleaned up their gut and gotten most everything in good working order, but they still have distension. What are some flags or other indicators that are non-classic endometriosis symptoms that they may want to consider? And we’re also going to have a guest on the podcast to discuss how some distension might be due to faultiness or weakness in the abdominal wall. And she’s actually a PT from, I believe, Duke. So very excited for that conversation to come down the pike soon also.

Dr Ruscio:

Okay. The next study looked at omega-3s supplementation or placebo on risk of depression or changes in mood, a randomized clinical trial. Wow. 18,000 adults (huge trial) looking at vitamin D, omega-3, or placebo. And they found that on average 5.3 years of supplementation led to no difference in mood or depression risk. So important to keep in mind that vitamin D and omega-3s are not a cure-all and they can help with some things but we should not be looking at any of these things as effective all the time or necessary for all people.

Dr Ruscio:

And this next study, beautiful study. This ties in with the point I was making earlier, [I] did not plan this out, but hair cortisol levels in women with medically unexplained symptoms. Four groups of women, 33 with somatic syndrome, chronic fatigue, fibromyalgia, IBS, 23 with semantic disorder, excessive thought and feeling about their symptoms. This is why I’m just not a huge conventional medicine guy because these syndromes…It’s just not how my mind works. 27 with depression and 30 who are healthy controls. So, essentially: four groups of women, three that had a various constellation of symptoms, one group that were healthy controls, and the hair cortisol was measured in all groups. And there were no differences in hair cortisol levels between any of the groups. And childhood trauma nor chronic stress correlated with hair cortisol levels.

Dr Ruscio:

Now hair cortisol is not, at least from my understanding, proclaimed to be the best way of measuring cortisol but just one more data point in keeping with my earlier comment and Ari Whitten’s earlier comments that cortisol and symptoms don’t tend to correlate. So it’s incredibly important that we don’t treat the cortisol numbers, but we rather treat the person like the ginseng study found, right? These people weren’t feeling well, give them ginseng they feel better now. That’s not the way we do everything. And in certain cases we do want to treat a biomarker, but this is not the majority of functional medicine. The majority of functional medicine is treating biomarkers that have no validity and patients confused as to why they have lackluster results. Or someone who gets lucky and they clean up their diet quality, they’re told to exercise, go to bed on time, take ginseng, vitamin D, and fish oil, and they feel better. And they’re told it’s because we treated your MTHFR and your adrenal fatigue. And it’s like, well, we could have done the same thing, but for $800 less and for three less fictitious diagnoses that are going to hound you psychologically for the rest of your life.

Dr Ruscio:

So, this is why I think these things are really important for me to keep iterating on the podcast. Again, want to be careful to say, I assume zero ill will on the behalf of any providers who are doing this. It’s taken me nearly 10 years to get to the point where I figured this out after a heavy investment in learning, meaning days where I do nothing but this, and building a research team to help assist with learning and accelerating that learning now, even further yet still with the clinical team, all operating in the same clinical model and being leveraged by the research team. So it’s not pointing a finger, but it is trying to point out what we have to do better and try not to say it so tactfully that it doesn’t register. Okay.

Sponsor:

Hi, everyone. If case you are in need of help, or would like to learn more, I wanted to quickly point out what resources are available to you. “Healthy Gut, Healthy You”, my book and your complete self-help guide to healing your gut. If you’re not a do-it-yourselfer there is always the clinic and myself or any one of our doctors would be more than happy to help you. And as a quick aside there, we just had accepted for peer review a six-part case series where in we demonstrated the gut-thyroid connection and how crucially important it is to make sure you are not overlooking someone’s gut health as it pertains to thyroid health and thyroid symptoms more broadly. Through the clinic we also offer health coaching and, independent of the clinic, if you’re reading the book or need some general advice, we offer health coaching also. There’s our store where you can find our Elemental Diet line, our probiotic line, and other health and gut-supportive supplements. And finally, there is our clinician’s newsletter, the FFMR, AKA the Future of Functional Medicine Review database with research reviews, case studies, and other helpful resources for healthcare providers. Everything for any of these resources can be found at the overview page DrRuscio.com/resources. That’s DrRuscio.com/resources.

Dr Ruscio:

Oh man, this is another great study. I just love it when these studies support things that I discuss in “Healthy Gut, Healthy You” or that we routinely recommend at the clinic. Benefits of performing exercise in nature as compared to indoors. And this is a meta-analysis, 49 studies comparing indoor exercise compared to indoor exercise. Outdoor training was associated with better cognitive performance, lower ratings of perceived exhaustion, and higher levels of vigor. Now, if you can’t go outside, go inside. Exercising in the closet would be better than exercising not at all. But especially for someone who’s dealing with mood issues, stress, life challenges, then exercise in nature or just walking in nature. Fantastic. Also keep in mind that if you can do this with a friend, then that can give you both the therapeutic effect of exercise, of nature, and of time with another person in connection.

Dr Ruscio:

So keep that in mind, and I will say personally, when there is a stretch when I’m just getting the S-H-I-T kicked out of me by life, and it doesn’t happen often but it did happen recently—and I’ve been contemplating if I want to share this story in the podcast or not, so reach out on social media to tell me that you would like to hear that and I’ll do the podcast and if I hear nothing, then I won’t bother—but I took about a week off from exercise other than just going for walks in nature. And by the way, with just shorts on and no sunblock in direct sun. I wear an ugly sun hat, but outside of that I want to make sure to get the sun because, to be totally honest, it just feels great to me. But protect your face because no one wants to have tons of wrinkle on their face, but get full body exposure without sunblock.

Dr Ruscio:

Now I’m not going out for four hours. And I walk in nature and I get some sun and that is incredibly helpful. So these little things, right, if I stayed inside and took a break from work and was just sitting there festering in all that stress, mindlessly scrolling through Facebook or Instagram or online shopping, or just sitting on the couch and watching TV, I unquestionably would have felt worse. So it’s really important to keep these things in mind. Not hard, in fact, quite easy to just go for a walk outside nature. So if you’re ever finding yourself in that rut, just get yourself up, get yourself moving, get yourself outside, that can do a whole heck of a lot. And I’m speaking from experience of recent. Okay.

Dr Ruscio:

So I think we can pin it there and, again, sorry to switch gears from the thyroid hormone then over to diet and lifestyle, but hopefully it all helps you […] with this conglomeration of recommendations to improve your health. And hopefully you’re enjoying the podcast. And I guess I’ll just close with a reminder that “Healthy Gut, Healthy You” ties a lot of this together. So if you haven’t yet read that, I think it’ll really help fill in a lot of the gaps in terms of this complete health picture that we try to paint. And yeah, again, hopefully this helps. Get off the couch, get outside, and I will talk to everyone next time. And I’m going to go hop in the sauna. All right, bye.

Outro:

Thank you for listening to Dr. Ruscio Radio today. Check us out on iTunes and leave a review. Visit DrRuscio.com to ask a question for an upcoming podcast, post comments for today’s show, and sign up to receive weekly updates. That’s DRRUSCIO.com.

 

➕ Dr. Ruscio’s Notes

Changes in serum heavy metals in polycystic ovary syndrome and their association with endocrine, lipid-metabolism, inflammatory characteristics and pregnancy outcomes

  • 40 PCOS patients, 40 healthy controls
  • Measured serum heavy metal concentration
  • PCOS patients had higher serum chromium (Cr), mercury (Hg) and copper (Cu) 
  • Hg was associated with higher androgens (e.g. testosterone)

 

Appropriate duration of antithyroid drug treatment as a predictor for relapse of Graves’ disease: a systematic scoping review

  • Aim: Identify optimal duration of antithyroid drug (ATD) treatment for preventing Graves’ disease relapse
  • Treatment with methimazole for > 5 years led to: 
    • Persistent normalization of TSH-receptor antibodies
    • 4-year remission rate of 85% (compared to 50% remission after conventional length of treatment 12-18 months) 
  • Commentary: Long-term ATD treatment should be considered in patients with Graves’ disease. 

 

Effects of Lactobacillus gasseri CP2305 on Mild Menopausal Symptoms in Middle-Aged Women

  • 80 women (40-60 y/o) with mild menopausal symptoms, randomized to: 
    • Placebo
    • Probiotic 
  • After 6 months, the probiotic group had improved:
    • Overall symptom relief (75% probiotic vs 55% placebo) 
    • Global menopausal symptom score
    • Vasomotor score
    • Psychological score
  • Commentary: Probiotics may improve menopausal symptoms. Note the high placebo response. 

 

Systematic review and meta-analysis of the efficacy and pregnancy outcomes of levothyroxine sodium tablet administration in pregnant women complicated with hypothyroidism

  • 9 studies, 2,873 pregnant women w/ subclinical hypothyroidism 
  • Compared to control, treatment with levothyroxine lowered the risk of: 
    • Preterm birth (OR 0.4)
    • Abortion (OR 0.3)
    • Postpartum hemorrhage (OR 0.4)
    • Low birth weight infants (OR 0.1)
  • Commentary: This study illustrates an important patient population that significantly benefits from treating subclinical hypothyroidism.

 

Effects of a Cereal Bar with a Combination of Phytoestrogens on the Climacteric Symptoms: A Placebo-Controlled, Randomized Trial

  • 48 women with climacteric symptoms, randomized to: 
    • Placebo bar
    • Phytoestrogen bar (containing soybean and flaxseed phytoestrogens) 
  • After 3 months, the phytoestrogen bar in peri/postmenopausal women led to improvements in: 
    • Hot flashes
    • Sexual complaints
    • Insomnia
    • Sadness
    • Paresthesia
  • Commentary: Phytoestrogens may improve menopausal symptoms.

 

Effects of Intermittent Fasting in Human Compared to a Non-intervention Diet and Caloric Restriction: A Meta-Analysis of Randomized Controlled Trials

  • 43 RCTs with 2,483 participants
  • Compared to continuous calorie restriction, intermittent fasting led to:
    • Lower weight (large effect size)
    • Lower BMI (medium effect size)
    • Higher fat-free mass (medium effect size)
    • Better insulin sensitivity (small effect size)
    • Lower triglycerides and cholesterol (small effect size)

 

Meditation-based lifestyle modification in mild to moderate depression-A randomized controlled trial

  • 81 patients with mild to moderate depression, randomized to: 
    • Antidepressant medication (control) 
    • Treatment as usual (TAU) 
      • Includes medication, movement therapy, psychotherapy, relaxation techniques
    • Meditation-based lifestyle modification (MBLM) 
      • Includes whole-food diet, sleep hygiene, yoga, meditation, breathing exercises, mindset etc
    • After 2 months, compared to control and TAU, MBLM led to a greater reduction in depression scores (-13.1 MBLM vs -3.3 TAU vs -1.7 control) 
    • Commentary: A comprehensive lifestyle-based approach was more effective in improving depression than medication.

Fish intake, n-3 fatty acid body status, and risk of cognitive decline: a systematic review and a dose-response meta-analysis of observational and experimental studies

  • Systematic review and meta-analysis 
  • Fish intake up to 2 portions per week led to:
    • 10% reduction in all-cause dementia
    • 30% reduction in Alzheimer’s disease risk 
  • Commentary: Fish intake is associated with lower risk of cognitive decline.

 

A systematic review and meta-analysis of the effects of Hibiscus sabdariffa on blood pressure and cardiometabolic markers

  • 17 studies 
  • Hibiscus is effective at lowering systolic blood pressure compared to: 
    • Medication (-14.9 hibiscus vs -17 mmHg medication)
    • Placeo (-10 vs -1 mmHg placebo)
  • Commentary: Hibiscus lowers blood pressure nearly as effective as medication. 

 

Effect of Epidemic Intermittent Fasting on Cardiometabolic Risk Factors: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

  • 14 RCTs
  • Compared to controls, intermittent fasting lead to reduced:
    • body weight (-1.78 kg)
    • waist circumference (-1.2 cm)
    • fat mass (-1.26 kg)
    • blood pressure (-2.1 mmHg)
    • fasting insulin g (-0.8 mIU/L)
  • NO clinical change in triglycerides, fasting glucose, LDL-C, A1C
  • Commentary: Intermittent fasting leads to improvement of some but not all cardiometabolic markers compared to controls. 

 

Comparing the Efficacy and Safety of Low-Carbohydrate Diets with Low-Fat Diets for Type 2 Diabetes Mellitus Patients: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

  • 12 RCTs, 761 participants comparing low carb diets (LCD) and low fat diets (LFD)
  • Compared w/ LFDs, LCDs had better:
    • Reduction in A1C (-0.35%)
    • Reduced weight  (-3 kg)
    • Reduced triglycerides (-17 mg/dL)
    • No difference in total cholesterol or LDL-C
  • These differences lasted x1.5-2 years (except weight loss)

 

An Open-Label, Pilot Trial of HRG80™ Red Ginseng in Chronic Fatigue Syndrome, Fibromyalgia, and Post-Viral Fatigue

  • Open-label prospective study of 188 w/ chronic fatigue/fibromyalgia
  • All took red ginseng supplementation
  • After 30 days of supplementation:
    • 67% increase in energy
    • 48% increase in mental clarity
    • 46% improvement in sleep
    • 72% increase in physical stamina
    • 33% decrease in pain
  • Commentary: This study showed that red ginseng supplementation led to a significant improvement in chronic fatigue/fibromyalgia. Note that there was no testing performed before supplementation w/ this adaptogen.

 

The effect of dehydroepiandrosterone (DHEA) supplementation on estradiol levels in women: A dose-response and meta-analysis of randomized clinical trials

  • 21 studies, 1,223 participants
  • DHEA supplementation led to higher estradiol levels in women >60 yo (+9.56 pg/mL)
    • Especially when used at 50 mg/d and more than 26 weeks
  • Commentary: DHEA supplementation may improve estradiol levels in post-menopausal women. 

 

3-Week passive acclimation to extreme environmental heat (100± 3 °C) in dry sauna increases physical and physiological performance among young semi-professional football players

  • 36 male football players, randomized to no therapy or sauna therapy (3x/week for 9 total sessions)
  • The sauna group had:
    • Decreased body weight and body fat
    • Increased hamstring flexibility and work capacity
    • Better respiratory fitness
  • Commentary: Sauna therapy may have beneficial effects for fitness too. 

 

Effects of Periodization on Strength and Muscle Hypertrophy in Volume-Equated Resistance Training Programs: A Systematic Review and Meta-analysis

  • 35 studies comparing periodized vs non-periodized strength training
  • Periodized strength training had:
    • Better 1-rep max strength (effect size 0.31) in trained participants
    • NO difference in muscle hypertrophy
  • Commentary: Following a periodized (change in volume and intensity over time) strength training program may be better as compared to non-periodized training. However, this may not make a big difference in an untrained population. 

 

Improvements in Cognitive Function and Quantitative Sleep EEG in OSA after Six Months of CPAP Treatment

  • 162 sleep apnea patients, measured cognitive function and EEG measurements before and after CPAP
  • After 6 months of CPAP therapy
    • ALL cognitive domains improved
    • Enhanced EEG measurements
  • Commentary: Treating sleep disordered breathing may improve cognitive function. 

 

The effect of vitamin D supplementation on clinical symptoms and metabolic profiles in patients with endometriosis

  • 60 women w/ endometriosis, randomized to Vit D (50,000 IU every 2 weeks) or placebo
  • After 12 weeks of supplementation, the Vit D group had:
    • Reduced pelvic pain
    • Reduced CRP (-0.64 mg/L)
    • Increase in total antioxidant capacity
  • Commentary: Vit D may be beneficial for those w/ endometriosis. 

 

Effect of Long-term Supplementation With Marine Omega-3 Fatty Acids vs Placebo on Risk of Depression or Clinically Relevant Depressive Symptoms and on Change in Mood Scores: A Randomized Clinical Trial

  • 18,353 adults randomized to:
    • Vitamin D3 (2000 IU/d)
    • Omega-3 fatty acids (1 g/d)
    • Or placebo
  • After an average of 5.3 years of supplementation, no difference in mood or depression risk

 

Hair cortisol levels in women with medically unexplained symptoms

  • 4 groups of women::
    • 33 w/ functional somatic syndrome (chronic fatigue, fibromyalgia, IBS)
    • 23 w/ somatic symptom disorder (excessive thoughts and feelings about their symptoms)
    • 27 w/ depression
    • 30 healthy controls
  • Hair cortisol levels measured in all groups
  • No differences in hair cortisol were found between groups. 
  • Neither childhood trauma nor chronic stress was correlated with hair cortisol levels.
  • Commentary: This study challenges the concept of “adrenal fatigue”.

 

Benefits to Performance and Well-Being of Nature-Based Exercise: A Critical Systematic Review and Meta-Analysis

  • 49 studies comparing outdoor vs indoor exercise
  • Compared to indoor exercise, outdoor training associated with:
    • Better cognitive performance 
    • Lower ratings of perceived exhaustion
    • Higher levels of “vigor”
  • Commentary: You may suggest combining time in nature with exercise for your patients.

 

Effects of Intermittent Fasting in Human Compared to a Non-intervention Diet and Caloric Restriction: A Meta-Analysis of Randomized Controlled Trials

  • 43 RCTs with 2,483 participants
  • Compared to continuous calorie restriction, intermittent fasting led to:
    • Lower weight (large effect size)
    • Lower BMI (medium effect size)
    • Higher fat-free mass (medium effect size)
    • Better insulin sensitivity (small effect size)
    • Lower triglycerides and cholesterol (small effect size)

 

Meditation-based lifestyle modification in mild to moderate depression-A randomized controlled trial

  • 81 patients with mild to moderate depression, randomized to: 
    • Antidepressant medication (control) 
    • Treatment as usual (TAU) 
      • Includes medication, movement therapy, psychotherapy, relaxation techniques
    • Meditation-based lifestyle modification (MBLM) 
      • Includes whole-food diet, sleep hygiene, yoga, meditation, breathing exercises, mindset etc
    • After 2 months, compared to control and TAU, MBLM led to a greater reduction in depression scores (-13.1 MBLM vs -3.3 TAU vs -1.7 control) 
    • Commentary: A comprehensive lifestyle-based approach was more effective in improving depression than medication.

Fish intake, n-3 fatty acid body status, and risk of cognitive decline: a systematic review and a dose-response meta-analysis of observational and experimental studies

  • Systematic review and meta-analysis 
  • Fish intake up to 2 portions per week led to:
    • 10% reduction in all-cause dementia
    • 30% reduction in Alzheimer’s disease risk 
  • Commentary: Fish intake is associated with lower risk of cognitive decline.

 

A systematic review and meta-analysis of the effects of Hibiscus sabdariffa on blood pressure and cardiometabolic markers

  • 17 studies 
  • Hibiscus is effective at lowering systolic blood pressure compared to: 
    • Medication (-14.9 hibiscus vs -17 mmHg medication)
    • Placeo (-10 vs -1 mmHg placebo)
  • Commentary: Hibiscus lowers blood pressure nearly as effective as medication. 

 

Effect of Epidemic Intermittent Fasting on Cardiometabolic Risk Factors: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

  • 14 RCTs
  • Compared to controls, intermittent fasting lead to reduced:
    • body weight (-1.78 kg)
    • waist circumference (-1.2 cm)
    • fat mass (-1.26 kg)
    • blood pressure (-2.1 mmHg)
    • fasting insulin g (-0.8 mIU/L)
  • NO clinical change in triglycerides, fasting glucose, LDL-C, A1C
  • Commentary: Intermittent fasting leads to improvement of some but not all cardiometabolic markers compared to controls. 

 

Comparing the Efficacy and Safety of Low-Carbohydrate Diets with Low-Fat Diets for Type 2 Diabetes Mellitus Patients: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

  • 12 RCTs, 761 participants comparing low carb diets (LCD) and low fat diets (LFD)
  • Compared w/ LFDs, LCDs had better:
    • Reduction in A1C (-0.35%)
    • Reduced weight  (-3 kg)
    • Reduced triglycerides (-17 mg/dL)
    • No difference in total cholesterol or LDL-C
  • These differences lasted x1.5-2 years (except weight loss)

 

An Open-Label, Pilot Trial of HRG80™ Red Ginseng in Chronic Fatigue Syndrome, Fibromyalgia, and Post-Viral Fatigue

  • Open-label prospective study of 188 w/ chronic fatigue/fibromyalgia
  • All took red ginseng supplementation
  • After 30 days of supplementation:
    • 67% increase in energy
    • 48% increase in mental clarity
    • 46% improvement in sleep
    • 72% increase in physical stamina
    • 33% decrease in pain
  • Commentary: This study showed that red ginseng supplementation led to a significant improvement in chronic fatigue/fibromyalgia. Note that there was no testing performed before supplementation w/ this adaptogen.

 

The effect of dehydroepiandrosterone (DHEA) supplementation on estradiol levels in women: A dose-response and meta-analysis of randomized clinical trials

  • 21 studies, 1,223 participants
  • DHEA supplementation led to higher estradiol levels in women >60 yo (+9.56 pg/mL)
    • Especially when used at 50 mg/d and more than 26 weeks
  • Commentary: DHEA supplementation may improve estradiol levels in post-menopausal women. 

 

3-Week passive acclimation to extreme environmental heat (100± 3 °C) in dry sauna increases physical and physiological performance among young semi-professional football players

  • 36 male football players, randomized to no therapy or sauna therapy (3x/week for 9 total sessions)
  • The sauna group had:
    • Decreased body weight and body fat
    • Increased hamstring flexibility and work capacity
    • Better respiratory fitness
  • Commentary: Sauna therapy may have beneficial effects for fitness too. 

 

Effects of Periodization on Strength and Muscle Hypertrophy in Volume-Equated Resistance Training Programs: A Systematic Review and Meta-analysis

  • 35 studies comparing periodized vs non-periodized strength training
  • Periodized strength training had:
    • Better 1-rep max strength (effect size 0.31) in trained participants
    • NO difference in muscle hypertrophy
  • Commentary: Following a periodized (change in volume and intensity over time) strength training program may be better as compared to non-periodized training. However, this may not make a big difference in an untrained population. 

 

Improvements in Cognitive Function and Quantitative Sleep EEG in OSA after Six Months of CPAP Treatment

  • 162 sleep apnea patients, measured cognitive function and EEG measurements before and after CPAP
  • After 6 months of CPAP therapy
    • ALL cognitive domains improved
    • Enhanced EEG measurements
  • Commentary: Treating sleep disordered breathing may improve cognitive function. 

 

The effect of vitamin D supplementation on clinical symptoms and metabolic profiles in patients with endometriosis

  • 60 women w/ endometriosis, randomized to Vit D (50,000 IU every 2 weeks) or placebo
  • After 12 weeks of supplementation, the Vit D group had:
    • Reduced pelvic pain
    • Reduced CRP (-0.64 mg/L)
    • Increase in total antioxidant capacity
  • Commentary: Vit D may be beneficial for those w/ endometriosis. 

 

Effect of Long-term Supplementation With Marine Omega-3 Fatty Acids vs Placebo on Risk of Depression or Clinically Relevant Depressive Symptoms and on Change in Mood Scores: A Randomized Clinical Trial

  • 18,353 adults randomized to:
    • Vitamin D3 (2000 IU/d)
    • Omega-3 fatty acids (1 g/d)
    • Or placebo
  • After an average of 5.3 years of supplementation, no difference in mood or depression risk

 

Hair cortisol levels in women with medically unexplained symptoms

  • 4 groups of women::
    • 33 w/ functional somatic syndrome (chronic fatigue, fibromyalgia, IBS)
    • 23 w/ somatic symptom disorder (excessive thoughts and feelings about their symptoms)
    • 27 w/ depression
    • 30 healthy controls
  • Hair cortisol levels measured in all groups
  • No differences in hair cortisol were found between groups. 
  • Neither childhood trauma nor chronic stress was correlated with hair cortisol levels.
  • Commentary: This study challenges the concept of “adrenal fatigue”.

 

Benefits to Performance and Well-Being of Nature-Based Exercise: A Critical Systematic Review and Meta-Analysis

  • 49 studies comparing outdoor vs indoor exercise
  • Compared to indoor exercise, outdoor training associated with:
    • Better cognitive performance 
    • Lower ratings of perceived exhaustion
    • Higher levels of “vigor”
  • Commentary: You may suggest combining time in nature with exercise for your patients.

Sponsored Resources

Hey everyone. We’ve had a number of people reach out and ask how to refer someone to our clinic and to make this easy, we created a page DrRuscio.com/referrals. And our office is happy to provide a referral source for challenging patients or clients working with people in a clinical setting is really at the core of what we do. So again, happy to help however we can.

Simply enter the person’s contact information and our office will take care of the rest. This probably goes without saying, but you can rest assured that the client or patient that you are referring will obtain progressive yet cautious care, care that is cost effective. We will not order unnecessary lab work.

We will not use copious amounts of supplements. Also, our care is devoid of overzealousness and fear mongering, and we use treatments that are science based and caused focused. That URL again is DrRuscio.com/referrals. And again, more than happy to help, however we can.


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