August 13, 2022

New study investigates the association between vitamin D and allergic diseases in children

Atopic diseases have become more prevalent over the past decade. They are caused by immune system dysfunction, genetic factors, and inherited and acquired skin barrier defects.

Vitamin D deficiency is one of the most common nutritional deficiencies and plays a important role on many chronic diseases. Vitamin D receptors (VDR) are in many different tissues and present in almost all cells of the immune system. Vitamin D has significant immunomodulatory effect and has been shown to inhibit Th1 cells by reducing pro-inflammatory cytokines, such as IL-2, INF-gamma, and TNF-alpha.

According to a new study published last week in Nutrients, researchers investigated the association between vitamin D and allergic diseases in children.

This study included 75 children with an average age of seven with atopic dermatitis and/or asthma. The control group consisted of 37 children without symptoms of allergic disease and without signs of respiratory tract infections. All of the children in the study group were divided into three subgroups including children with mild, moderate, and severe allergic disease. Laboratory assessments included vitamin D levels, phenotype of blood lymphocytes, natural T-regulatory lymphocytes, and cytokines.

As a result, a vitamin D deficiency was significantly more frequent in the group of children with an allergic disease than in the control group. Also, statistically significant higher vitamin D concentrations were seen in children with mild disease compared to children with a severe clinical course. In addition, statistically significant lower percentages of NKT lymphocytes and T-regulatory lymphocytes were in children with a vitamin D deficiency. This demonstrates a potential weakness of the immune system in these individuals. There were also statistically higher levels of interleukin-22 were observed in the children with a vitamin D deficiency suggesting a pro-inflammatory state.

These results show that children with allergies had lower average vitamin D levels compared to that of healthy children. Since the pathophysiology of atopic diseases are multifactorial as with many chronic diseases, there are several nutrients that should be considered to modulate the underlying dysfunction and immune response.

Other nutrients to consider to include fish oil, magnesium, and probiotics. Previous research has shown the intricate interrelationships among magnesium levels and omega-3 fatty acid status on vitamin D concentrations.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS Source: Lipinska-Opalka A, Tomaszewska A et al. Vitamin D and Immunological Patterns of Allergic Diseases in Children. Nutrients 8 January 2021, 13(1), 177.

New review demonstrates the effects of omega 3 fatty acid supplementation on vitamin D levels

Vitamin D and omega-3 fatty acids are essential nutrients involved in numerous metabolic processes that play a significant role in many chronic health conditions. Over the past several years numerous studies have shown that omega-3 fatty acid supplementation can effect serum vitamin D levels, however, the results have been inconsistent. This may have been due to the dose, duration, or statistical power of the studies.

According to a review published two weeks ago in Critical Reviews in Food Science and Nutrition, researchers investigated the effect of omega-3 fatty acid supplementation on vitamin D levels.

This meta-analysis consisted of 10 randomized controlled trials with a total of 601 participants that reported circulating vitamin D levels before and after supplementation with omega-3 fatty acids. As a result, there was a significant increase in vitamin D levels following omega-3 fatty acid intake. Vitamin D levels were significantly increased by approximately 9 ng/ml when supplementation was longer than 8 weeks and when the baseline vitamin D level was less than 20 ng/ml. Also, dosing at 1 gram per day resulted in higher vitamin D levels compared to other dosages but all doses led to an increase in vitamin D levels.

The relationship between vitamin D and omega-3 fatty acids is unclear. Deficiencies or insufficiencies of these two nutrients are important health concerns in clinical practice. This review specifically looked at the effect of omega-3 fatty acids on vitamin D levels, however, it is still optimal to assess both of these nutrients and address accordingly. This study demonstrates the significance of the interrelationships different nutrients have with one another and importance of a comprehensive approach over monotherapies.

Previous research has shown these the intricate interrelationships among the fat soluble vitamins, magnesium and vitamin D levels, and omega-3 fatty acid status and B-vitamins. A study published in 2018 in the American Journal of Clinical Nutrition demonstrated that magnesium can also increase vitamin D levels similarly to omega-3 supplementation. Also, a study published in the Journal of Alzheimer’s Disease demonstrated that B vitamins had no effect on cognitive decline when omega-3 levels are low but when omega-3 levels were in a normal upper range, B vitamins slow cognitive decline and brain atrophy.

By Michael Jurgelewicz, DC, DACBN, DCBCN

Source: Alhabeeb H, Kord-Varkaneh H, et al. The influence of omega-3 supplementation on vitamin D levels in humans: a systematic review and dose-response meta-analysis of randomized controlled trials. Crit Rev Food Sci Nutr. 2020 Dec 25;1-8.


New review demonstrates the effectiveness of nutritional interventions for the prevention of cognitive impairment

Alzheimer’s disease and related disorders (ADRD) are a group of conditions that cause mild cognitive impairment (MCI) or dementia. These conditions affect one’s ability to function socially, personally, and professionally. It’s important to recognize that Alzheimer’s disease begins long before symptoms start just like many other conditions. There is evidence that simple prevention strategies can reduce the risk of ADRD by as much as 50%.

According to a new review published two weeks ago in Critical Reviews in Food Science and Nutrition, researchers investigated the current evidence on nutritional interventions for the prevention of dementia.

This review included 18 randomized controlled trials. Nutritional interventions of cognitive impairment were identified including micronutrients supplementation, nutritional and lifestyle counseling, and fish supplementation. The sample size ranged from 20 to 640 participants with a duration of two weeks to 6 months. As a result, fifteen studies demonstrated significant beneficial effects on cognition. These results were with essential fatty acids (EPA/DHA) and micronutrient supplementation on specific cognitive domains including attention and orientation, perception, verbal functions, and language skills. Greater effects were seen in older subjects with cognitive impairment. In addition, supplementation with B-vitamins specifically folate and vitamin B12 and essential fatty acids demonstrated promising effects to minimize age-related cognitive decline.

Most of the studies using supplementation with micronutrients were based on the hypothesis that lowering homocysteine plasma levels with B-vitamin supplementation could prevent cognitive impairment. Homocysteine levels are an indicator of a potential vitamin B6, folate or B12 deficiency and are a modifiable risk factor for cognitive decline.

Other brain supportive nutrients to consider are GPC, CDP-choline, gingko biloba, and phosphatidylserine, and curcumin. GPC and CDP-choline are water soluble forms of choline that can cross the blood brain barrier and support brain health. These help make more acetylcholine, neurotransmitters, as well as phosphatidylcholine in the cell membranes.

Each person’s biochemical individuality exerts a major influence on his or her health. Lifestyle choices and environmental exposures filtered through genetic predisposition are fundamental factors in the expression of disease, and a successful treatment approach must include investigation into these factors.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: McGrattan A, van Aller C, et al. Nutritional interventions for the prevention of cognitive impairment and dementia in developing economies in East-Asia: a systematic review and meta-analysis. Critical Reviews in Food Science and Nutrition. 2020. Dec 18;1-18.doi: 10.1080/10408398.2020.1848785.



New study demonstrates the efficacy of the Specific Carbohydrate Diet in patients with Crohn’s disease

Inflammatory bowel disease (IBD) is an autoimmune condition where in most cases there are multiple triggers chronically stimulating the immune system over a long period of time in multiple ways and the immune system gets into overloaded, overwhelmed state and loses its ability to function leading to chronic inflammation causes symptoms such as diarrhea, abdominal pain, and other debilitating symptoms and anemia.

Traditional IBD treatments focus on altering immunological function with minimal investigation on the microbiome and intestinal barrier function.

According to a study published last week Nutrients, researchers investigated the efficacy of 3 versions of the specific carbohydrate diet (SCD) in active Crohn’s disease. The SCD was created by Sydney Haas MD, a pediatrician, to treat celiac disease. This diet eliminates all grains, sugars (except honey), all milk products (except for hard cheeses and fermented yogurt) and most processed foods.

This was a single center, double-blind study in 10 pediatric patients with mild to moderate Crohn’s disease between the ages of 7 to 18. Each Patient was randomized to either the SCD, a modified SCD including both oats and rice, or a whole foods diet. Patients were evaluated at baseline, 2, 4, 8 and at 12 weeks. Assessments included the Pediatric Crohn’s Disease Activity Index (PCDAI), CBC, C-reactive protein, ESR, albumin, stool testing, and multi-omics analysis. For the first 2 weeks, all patients went on a strict SCD after and were placed onto their randomized diet. Each Patient received nutritional counseling by a dietitian. Before each visit, patients completed a 3-day food diary to ensure compliance to the diet. Patient meals were provided and prepared by a study chef. Also, patients received a list of SCD allowed foods during the study.

As a results, at twelve weeks all of the participants achieved clinical remission. C-reactive protein levels significantly decreased in all three groups. In addition, the microbiome composition shifted in every patient over the twelve-week period. These results emphasize the significant impact diet and nutrient play in Crohn’s disease. Each diet had a significant effect on disease severity as well as on inflammatory biomarkers. The more restrictive diets were associated with the largest reductions in inflammation.

For additional support, high dose probiotics, fish oil, curcumin, glutamine, and mucilaginous botanicals can be helpful in immunomodulation and for their anti-inflammatory properties. Other common insufficiencies include magnesium, vitamin D, and iron.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Suskind D, Lee D, et al. The Specific Carbohydrate Diet and Diet Modification as Induction Therapy for Pediatric Crohn’s Disease: A Randomized Diet Controlled Trial. Nutrients 6 December 2020, 12(12), 3729

New review demonstrates the effects of omega-3 fatty acids on muscle mass, strength and performance in the elderly

Aging is associated with chronic low-grade inflammation, sarcopenia and functional decline. The loss of muscle mass between the ages of 40 and 80 is approximately between 30% and 60% and is associated with disability, illness, and death. Age-related musculoskeletal decline is a significant risk for falls in the elderly.

Exercise and nutritional supplementation are currently recommended as preventative against the loss of muscle and muscle strength, however, most of the nutritional studies have focused on protein supplementation. Since sarcopenia is associated with increased inflammation and impaired glucose homeostasis, omega-3-fatty have also been investigated. The musculoskeletal health benefits have been inconclusive.

According to a new review published last week in Nutrients, researchers investigated the effects of omega-3 fatty acids on sarcopenia related performances in the elderly.

This meta-analysis included 10 randomized controlled trials on the effects of increasing omega-3 fatty acids in the diet or supplementation on specific muscle outcomes in 552 individuals 60 years and older. The number of study participants ranged from 24 to 126 and the durations were between 10 to 24 weeks. Also, the omega-3 fatty acid doses ranged from 0.16 to 2.6 grams of EPA and from 0 to 1.8 grams of DHA. One study provided 14.0 grams of ALA. Muscle strength was evaluated by hand grip strength and physical performance by gait speed or time up and go test.

As a result, there were minor improvements in muscle mass gain of 0.726 lb as well as timed up and go performance. Subgroup analyses of muscle mass and walk speed demonstrated that omega-3 fatty acid intake greater than 2 grams per day may contribute to muscle mass gain (1.47 lb) and improve walking speed especially for individuals consuming omega-3 fatty acids in the diet or from supplementation for more than 6 months. Omega-3 fatty acids increase the rate of muscle protein synthesis, reduce inflammation, and increase the omega-3 fatty acid composition of the phospholipids in the skeletal muscle membranes.

These findings demonstrate a role of the effects of omega-3 fatty acids on muscle mass and improvement in walking speed. Other nutrients to consider patients with sarcopenia include vitamin D, magnesium, vitamin C, collagen, BCAAs, tocotrienols, and probiotics.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Huang Y, Chiu W, et al. Effects of Omega-3 Fatty Acids on Muscle Mass,Muscle Strength and Muscle Performance among the Elderly: A Meta-Analysis. Nutrients 4 December 2020, 12(12), 3739.

New review investigates the effect of DHEA supplementation on biomarkers of diabetes

Type II diabetes affects more than 30 million individuals. It is a preventable condition that can be reversed through lifestyle changes, proper nutrition, supplements, exercise, and stress management.

According to a new review published last month in Complimentary Therapies in Medicine, researchers investigated the effect of DHEA supplementation on fasting glucose levels, insulin levels, and the homeostatic model assessment-estimated insulin resistance (HOMA-IR).

DHEA is mainly secreted by the adrenal cortex and is known to effect changes in cardiovascular tissues, immune function, insulin sensitivity, female fertility, central nervous system functions, and anti-inflammatory properties. The production of DHEA is age dependent and decreases with age. This reduction may be involved in the development of type II diabetes.

This meta-analysis included 14 studies published between 1998 and 2012 in individuals over 18 years of age. The treatment duration ranged between 8 weeks to 12 months with a daily dosage of DHEA between 50 mg to 400 mg. The number of participants ranges from 15 to 87 individuals. Ten arms with 613 patients described fasting glucose levels as an outcome measure. As a result, there was a significant decrease in fasting glucose levels with DHEA supplementation in doses at 50 mg per day. There were no significant effects on fasting insulin or the HOMA-IR index. In addition, it is important to note that there was a more significant reduction in fasting glucose levels in individuals over 60 years of age.

Several mechanisms have been proposed on the associate between DHEA and type II diabetes. DHEA increases the glucose uptake in adipocytes, mitigates oxidative stress, and the production of advanced glycation end products. It improves endothelial function, reduces insulin resistance, and decrease inflammation.

Several studies have demonstrated an association between low levels DHEA levels and the development of complications with type II diabetes. In addition, DHEA supplementation prevented oxidative stress in diabetic patients given 50 mg per day.

All chronic conditions are multifactorial and DHEA levels should be evaluated and supplemented accordingly in older adults. Other nutrients that can support dyslgycemia include alpha lipoic acid, zinc, chromium, taurine, carnosine, inositol, tocotrienols, magnesium, and fish oil.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS Source: Wang X, Feng H, et al. The influence of dehydroepiandrosterone (DHEA) on fasting plasma glucose, insulin levels and insulin resistance (HOMA-IR) index: A systematic review and dose response meta-analysis of randomized controlled trials. Complement Ther Med. 2020 Oct 3;55:102583.

New review investigates the effect of Lactobacillus probiotic supplementation on blood pressure

According to a new review published last month in Complimentary Therapies in Medicine, researchers investigated the potential benefits of Lactobacillus supplementation on blood pressure. Previous clinical trials have shown inconsistent results. I have also recently shared research on the role of dysbiosis and probiotic supplementation on cardiovascular health and its impact on dyslipidemia.

This meta-analysis consisted of 18 randomized controlled trials published between 2012 and 2018. These studies included between 28 to 164 participants over a 3 to 24-week period. As a result, Lactobacillus supplementation significantly reduced systolic blood pressure and diastolic blood pressure compared to the placebo. This was consistent with the results from a previous meta-analysis. This reduction was modest, however, even small reductions in blood pressure can significantly reduce stroke, myocardial infarction, and mortality.

An additional subgroup analysis demonstrated patients with type 2 diabetes, Asian individuals, or patients with borderline hypertension had a more significant effect from the Lactobacillus supplementation. Also, the effect of Lactobacillus supplementation on blood pressure was more significant when it was delivered in a capsule form with the dose over 5 billion CFUs per day and longer than an 8-week duration. Furthermore, a subgroup analysis of Lactobacillus strains demonstrated that L. plantarum showed a slight decrease in blood pressure compared to other species.

Although, the underlying mechanisms of Lactobacillus on blood pressure has not been fully determined, animal studies have demonstrated Lactobacillus supplementation improves endothelial function preventing vascular inflammation and oxidative stress. In addition, L. plantarum can inhibit angiotension convert enzyme (ACE) activity as well as produce nitric oxide in the gastrointestinal tract.

Probiotics help encourage microbial diversity, especially if the probiotic supplement is of mixed species. In ecological terms, it is more stable to have diverse populations in any ecosystem. The same is true for the gastrointestinal microbiome. This study demonstrates that Lactobacillus supplementation over 5 billion CFUs in a capsule given for more than 8 weeks can decrease systolic and diastolic blood pressure in patients with type 2 diabetes, borderline hypertensive patients or Asian individuals. Previous meta-analyses showed similar findings with supplementing over 100 billion CFUs.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Liu J, Zhang D, et al. The Effect of Lactobacillus Consumption on Human Blood Pressure: a Systematic Review and Meta-Analysis of Randomized Controlled Trials. Complement Ther Med. 2020 Nov;54:102547. Epub 2020 Sep 2.

New study investigates Bacillus subtilis DE111 spore probiotic on lipid metabolism and endothelial function

Emerging research has demonstrated a role of dysbiosis in the gut microbiome and its impact on cardiovascular health.

According to a new study published this week in Beneficial Microbes, researchers investigated the cardiovascular effects of prebiotic and probiotic supplementation in healthy individuals.

This was a randomized, double-blind, placebo-controlled, four-arm intervention study in 88 healthy individuals between 18 to 65 years of age with a body mass index (BMI) between 20 and 34.9. Assessments included anthropometric measures, a lipid profile, blood pressure, pulse wave analysis, endothelial function, and a medical health history questionnaire. These were taken at baseline and at the end of the study. Everyone was instructed to maintain their regular exercise and dietary habits throughout the study. Each participant supplemented with Bifidobacterium animalis subsp. lactis strain BL04, with and without Escherichia coli-targeting bacteriophages, Bacillus subtilis strain DE111 or a maltodextrin-based placebo over a 4-week period.

As a result, there were no significant changes on the cardiovascular biomarkers in the individuals consuming B. lactis with or without bacteriophages. However, supplementation with B. subtilis demonstrated a significant reduction in total cholesterol as well as non-HDL cholesterol. This is most likely due to its effect that short chain fatty acids (SCFA) have on cholesterol metabolism. B. subtilis is known to stimulate the production of lactic acid by enhancing the growth of Lactobacillus spp. and SCFAs have been shown to inhibit the synthesis of hepatic cholesterol leading to a reduction in LDL and non-HDL cholesterol levels.  In addition, there was a trend showing improvements in LDL cholesterol and a modest increase in reactive hyperaemia index (RHI), a measure of endothelial function.

This study demonstrates that B. subtilis supplementation may be beneficial for improving risk factors associated with cardiovascular disease. Other nutrients to consider for dyslipidemia include delta and gamma tocotrienol isomers and fish oil supplementation.

It is also important to look deeper into the cardiovascular system. Health care providers have many tools to assess cardiovascular health and support the body’s physiology. It is essential to perform a thorough assessment for these patients. This may include looking at an advanced lipid profile, inflammatory markers, nutrient status, oxidative stress factors, heavy metals, and a fatty acid profile.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Trotter R.E, Vazquez A.R., et al. Bacillus subtilis DE111 intake may improve blood lipids and endothelial function in healthy adults. Beneficial Microbes, 2020; 1(7):621-630.


New study investigates the impact of dietary histamine intake in children with asthma

Asthma has become more prevalent over the past decade. Many patients have managed their asthma with medication and avoiding environmental triggers.

Previous research has demonstrated that diet can play a significant role in the development and symptoms in asthma. Histamine is an inflammatory mediator that has been associated with inflammation in asthma patients but its exact impact is not clear as the histamine content of food can vary significantly by a product’s maturity, time in storage, and processing. In addition, it is important to note that histamine secreting bacteria have been found at higher frequency in stool samples of asthmatic patients.

According to a new study published last week in Nutrients, researchers investigated the effect of controlling dietary histamine intake and its impact on respiratory symptoms in children with asthma.

This was a randomized crossover dietary intervention, two-period study including 18 children (10 boys and 8 girls) with mild to intermittent asthma. The research team investigated the impact of dietary histamine intake on asthma symptoms. Each child was randomized to either a high- or low-histamine diet for an 8 week-period. Following a 2-week washout period, each child was switched to the other diet for 8 weeks. Foods were ranked according to their histamine content and a dietitian advised parents to select foods specifically from the food list provided. Dietary intake was assessed from eight random 24 hour recalls with Food-Processor Nutrition Analysis Software. Asthma symptoms were assessed at baseline and after each diet period. Daily symptom scores as well as peak flow were recorded throughout the diet. The best out of 3 morning and evening Peak Expiratory Flow Rate (PEFR) were measured with flow meter and recorded on the food diary cards.

As a result, there was significantly higher air flow obstruction and an increase in disease severity following the high-histamine diet compared to lesser symptoms and more symptom-free days during a low histamine intake. This study demonstrates that diet can have a direct impact on asthma symptoms.

Since the pathophysiology of asthma is multifactorial as with many chronic diseases, there are several nutrients that should be considered to modulate the underlying dysfunction and immune response.

Previous research has demonstrated Lactobacillus supplementation improves asthma severity. Individuals receiving Lactobacillus containing probiotics all had lower asthma severity and higher ACT scores. In addition, the group that received both Lactobacillus strains demonstrated increased peak expiratory flow rates and lower IgE levels.

Low serum vitamin D levels have also been linked to an increased risk of asthma. There was a previous study from the journal Allergy which demonstrated that Vitamin D could help manage asthma attacks. Asthma patients with a Vitamin D deficiency were 25% more likely than other asthmatics to have had at least one flare-up in the recent past.

We know vitamin D has significant immunomodulatory effects and it has been shown to have an effect on asthma. Vitamin D has been shown to promote T regulatory cells and has been proposed as one of the causes of the increased prevalence of asthma.

Other nutrients to consider to relax the airways and provide anti-inflammatory properties include fish oil, magnesium, vitamin C, and curcumin.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Vassilopoulou E, Konstantinou G, et al. The Impact of Food Histamine Intake on Asthma Activity: A Pilot Study. Nutrients 5 November 2020, 12(11), 3402.


New study demonstrates the effects of long-term fish oil supplementation in patients with nonalcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) has become an increasing epidemic. It is the most common cause of elevated liver enzymes and is associated with diabetes and obesity with advanced liver disease.

There are few guidelines for diagnostic and follow up methods and limited proven treatment options. Previous research of pharmacological agents to treat nonalcoholic fatty liver disease were performed with poor results.

According to a study just published this week in Nutrients, researchers investigated the effects of long-term fish oil supplementation in patients with nonalcoholic fatty liver disease (NAFLD).

This study was a randomized, double-blinded, placebo-controlled trial conducted between January 2018 and February 2020 including 24 patients over the age of 19 with ultrasound proven fatty liver disease. The patients were randomized to receive either fish oil supplementation (1,509 mg of DHA; 306 mg of EPA) or placebo (2,250 mg of oleic acid) over a six-month period. Assessments included circulating miR-122 expression, liver fibrosis (FibroScan®), RBC fatty acid profile, ALT, AST, alkaline phosphatase (ALP), GGT, fasting glucose, HA1c, and lipid profile were performed at baseline and after intervention.

As a result, there was a significant increase in the omega-3 index in the fish oil supplementation group. In addition, there was a significant decrease in ALP levels and liver fibrosis. ALP is commonly used as a marker of liver and bone pathology and is an independent risk factor for NAFLD. Also, increased levels of ALP have been shown in NAFLD patients in stages 1 and 2 of liver fibrosis. There was no difference in omega-3 index levels in the placebo group.

This study demonstrated that the fish oil supplementation was incorporated in the red blood cells after six months of supplementation and fish oil supplementation was effective in reducing liver fibrosis and ALP levels.

These individuals are in a chronic disease state and have increased demands then what could be obtained from the diet alone and therefore, dietary supplements should be considered to help prevent the progression as well as improve liver function. Other nutrients to consider include tocotrienols, phosphatidylcholine, fiber or resistant starch, n-acetylcysteine, and probiotics.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Cansancao K, Citelli M, et al. Impact of Long-Term Supplementation with Fish Oil

in Individuals with Non-Alcoholic Fatty Liver Disease: A Double Blind Randomized Placebo Controlled Clinical Trial. Nutrients 2 November 2020, 12(11), 3372.