1.
The Influence of Nutritional Intervention in the Treatment of Hashimoto's Thyroiditis-A Systematic Review.
Osowiecka, K, Myszkowska-Ryciak, J
Nutrients. 2023;15(4)
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Hashimoto’s thyroiditis is an autoimmune disorder characterized by the presence of antibodies in the thyroid gland such as thyroid peroxidase (TPO) and thyroglobulin (TG) antibodies. Immune-mediated inflammatory responses eventually lead to the progressive destruction of the gland and impaired thyroid function. The disease has a strong genetic disposition but is also influenced by environmental factors, including diet. Hence diet has been considered a complementary tool to manage thyroid function and disease progression by harnessing the benefits of certain nutrients and anti-inflammatory properties. This systematic review examined the effects of nutrients and dietary interventions on Hashimoto’s disease in current literature. Using antibody levels, thyroid hormone levels and body weight to measure outcomes. The review included 9 studies, all of which compared the intervention group to the control groups. The trials included looked at gluten-free, lactose-free and energy-restricted diets, with or without selected nutrients and foods supplements (ie. Nigella sativa, iodine). The intervention duration ranged from 3 weeks to 12 months. Despite the small number of trials, the data from those studies included in this review showed promising results. Improvements in disease parameters were observed in diets that were energy deficient, eliminated gluten, lactose and goitrogens or added Nigella sativa. Iodine restrictions did not show any improvements. In the discussion section, the authors presented the results in the wider context and the findings from other studies. Ultimately there appears to be a wide variance in outcomes, usually ranging from beneficial to neutral. The authors contributed to such variability due to the complexity of the condition and many influencing factors. Often participants in trials have highly variable thyroid status and function, and differences in regular dietary intakes of nutrients critical to thyroid health can easily distort the results. Hence much more specific research is needed to make firmer conclusions. Whereby no clear conclusions in larger groups could be drawn, potential benefits of dietary interventions in Hashimoto's disease may be much more apparent in clinical settings with personalized approaches that account for such individual variances.
Abstract
Diet can be a complementary treatment for Hashimoto's disease by affecting thyroid function and anti-inflammatory properties. It is still unclear which dietary strategy would be the most beneficial. The aim of this systematic review is to examine all the data currently available in the literature on the effects of nutritional intervention on biochemical parameters (anti-thyroid antibody and thyroid hormones levels) and characteristic symptoms in the course of Hashimoto's thyroiditis. This systematic review was prepared based on PRISMA guidelines. Articles in PubMed and Scopus databases published up to November 2022 were searched. As a result of the selection, out of 1350 publications, 9 were included for further analysis. The nutritional interventions included the following: elimination of gluten (3 articles) or lactose (1 article), energy restriction with or without excluding selected foods (n = 2), consumption of Nigella sativa (n = 2), or dietary iodine restriction (n = 1). The intervention duration ranged from 21 days to 12 months and included individuals with various thyroid function. Of the nine studies, three studies were female only. An improvement was observed during an energy deficit and after the elimination of selected ingredients (e.g., gluten, lactose, or goitrogens), as well as after the intervention of Nigella sativa. These interventions improved antibody levels against peroxidase (anti-TPO), (thyrotropin) TSH, and free thyroxine (fT4). No improvement was seen on the iodine-restricted diet. Varied outcomes of analyzed dietary interventions may be due to the heterogeneous thyroid condition, high variability between patients, and differences in habitual intake of critical nutrients (e.g., iodine, selenium, and iron) in different populations. Therefore, there is a great need for further experimental studies to determine whether any nutritional interventions are beneficial in Hashimoto's disease.
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The correlation between selenium levels and autoimmune thyroid disease: a systematic review and meta-analysis.
Zuo, Y, Li, Y, Gu, X, Lei, Z
Annals of palliative medicine. 2021;10(4):4398-4408
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Autoimmune thyroid disease (AITD) encompasses several autoimmune conditions affecting the thyroid gland. Genetics, environmental and lifestyle factors influence the condition. Part of the clinical presentation is an abnormal function of the thyroid and the presence of antibodies against thyroid proteins, such as antithyroglobulin antibody (TGAb) and anti-thyroid peroxidase antibody (TPOAb). Selenium is a trace mineral essential to the human body and an important building block for a particular family of proteins called Selenoproteins. This protein family exerts enzymatic functions and plays a major role in thyroid health, furthermore, also in hormone synthesis and managing oxidative stress. Previous research noted that supplemental selenium had beneficial effects on thyroid hormones and antibodies. This systematic review and meta-analysis sought to collectively examine the effect of selenium supplementation on hormone and antibody levels in people with AITD. Blood values investigated were TSH (thyroid stimulating hormone), FT3 (free triiodothyronine), FT4 (Thyroxine), TPOAb, and TGAb. The review included 17 randomised controlled trials, with a total of 1,095 subjects with AITD, plus controls. The cumulated results demonstrated that selenium can notably decrease blood levels of FT3, FT4, and TPOAb in patients with AITD. However, levels of TSH and TGAb seemed not to be significantly affected by selenium supplementation. The authors highlighted that the review was not specific to a particular AITD and that there was limited literature available concerning TGAb levels. More research is needed to clarify the benefits of selenium in AITD.
Abstract
BACKGROUND This investigation systematically evaluated the selenium levels and the effects of selenium supplementation in patients with autoimmune thyroid disease (AITD). METHODS Randomized controlled trials (RCTs) related to selenium supplementation in patients with AITD were selected from the PubMed, Medline, Web of Sciences, Embase, Cochrane Library, and Spring databases. All related literature published between January 2000 and November 2020 were included. The RCT bias risk assessment was conducted according to the Cochrane Handbook 5.0.2. The Review Manager 5.3 software was applied for meta-analysis of the included literature. RESULTS A total of 17 articles meeting the requirements were selected, including a total of 1,911 subjects. Meta-analysis results showed that the serum free triiodothyronine (FT3) levels in patients was greatly reduced after selenium supplementation compared to placebo treatment (MD =-0.40; 95% confidential interval (CI): -0.70--0.10; Z=2.61; P=0.009). Serum free thyroxine (FT4) levels and anti-thyroid peroxidase antibody (TPOAb) levels were also significantly reduced (MD = -0.76; 95% CI: -1.58--0.07; Z=1.79; P=0.07), and anti-thyroid peroxidase antibody (TPOAb) level was decreased observably (MD =-150.25; 95% CI: -04.06--96.43; Z=5.47; P<0.00001). The thyroid stimulating hormone (TSH) levels (MD =0.06; 95% CI: -0.53-0.66; Z=0.21; P=0.83) and anti-thyroglobulin antibody (TGAb) levels (MD =17.19; 95% CI: -254.86-289.25; Z=0.12; P=0.90) were not significantly different between the experimental group and the control group. CONCLUSIONS Selenium-containing drugs were effective in treating AITD patients, and greatly reduced the levels of FT3, FT4, and TPOAb in AITD patients. These results suggested that selenium level had a great effect on AITD and selenium supplementation showed a very important effect on AITD.
3.
Lifestyle changes for treating psoriasis.
Ko, SH, Chi, CC, Yeh, ML, Wang, SH, Tsai, YS, Hsu, MY
The Cochrane database of systematic reviews. 2019;7:CD011972
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Psoriasis is an inflammatory skin disease that results in patches of dry, scaly skin that can be itchy or sore. This Cochrane Database Systematic Review aimed to review and assess the effects of lifestyle factors such as diet, smoking, obesity, alcohol consumption and exercise on the severity of psoriasis. The study authors examined the research evidence up to July 2018. 10 randomised controlled trials (RCTs) with a total of 163 participants were included in the qualitative analysis, and 6 studies in the meta-analysis. Most of the studies included co-interventions such as medication or light therapy. The authors didn’t find any RCTs for smoking cessation or reduced alcohol consumption. Dietary interventions (low-calorie diets, based on the Ornish diet or South Beach diet) were likely to result in a 75% improvement in severity of psoriasis symptoms in obese people after 6 months. A combined low-calorie diet and exercise programme improved the severity of psoriasis compared to providing information on weight loss to improve psoriasis, although the difference wasn’t statistically significant. Participants generally adhered well to the lifestyle interventions assessed in the review. The authors concluded that the body of evidence regarding the effects of lifestyle changes for treating psoriasis is limited. More trials are needed on the effects of different dietary interventions such as vegetarian or ketogenic diets, different types of exercise programmes (e.g. yoga, walking, jogging) and whether other lifestyle changes such as reducing smoking and alcohol consumption, or stress management techniques are effective.
Abstract
BACKGROUND Psoriasis is an inflammatory skin disease that presents with itching, red, scaling plaques; its worsening has been associated with obesity, drinking, smoking, lack of sleep, and a sedentary lifestyle. Lifestyle changes may improve psoriasis. OBJECTIVES To assess the effects of lifestyle changes for psoriasis, including weight reduction, alcohol abstinence, smoking cessation, dietary modification, exercise, and other lifestyle change interventions. SEARCH METHODS We searched the following databases up to July 2018: the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We also searched the China National Knowledge Infrastructure, the Airiti Library, and five trials registers up to July 2018. We checked the references of included trials for further relevant trials, and we asked the authors of the included trials if they were aware of any relevant unpublished data. SELECTION CRITERIA We included randomised controlled trials (RCTs) of lifestyle changes (either alone or in combination) for treating psoriasis in people diagnosed by a healthcare professional. Treatment had to be given for at least 12 weeks. Eligible comparisons were no lifestyle changes or another active intervention. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. The primary outcome measures were 'Severity of psoriasis' and 'Adherence to the intervention'. Secondary outcomes were 'Quality of life', 'Time to relapse', and 'Reduction in comorbidities'. We used GRADE to assess the quality of the evidence for each outcome. MAIN RESULTS We included 10 RCTs with 1163 participants (mean age: 43 to 61 years; 656 men and 478 women were reported). Six trials examined the effects of dietary intervention (low-calorie diet) in 499 obese participants (mean age: 44.3 to 61 years; where reported, 395 had moderate-to-severe psoriasis). One trial assessed a combined dietary intervention and exercise programme in 303 obese participants with moderate-to-severe psoriasis who had started a systemic therapy for psoriasis and had not achieved clearance after four weeks of continuous treatment (median age: 53 years). Another trial assessed a walking exercise and continuous health education in 200 participants (mean age: 43.1 years, severity not reported). Finally, two trials included education programmes promoting a healthy lifestyle in 161 participants (aged 18 to 78 years), with one trial on mild psoriasis and the other trial not reporting severity.Comparisons included information only; no intervention; medical therapy alone; and usual care (such as continuing healthy eating).All trials were conducted in hospitals and treated participants for between 12 weeks and three years. One trial did not report the treatment period. Seven trials measured the outcomes at the end of treatment and there was no additional follow-up. In two trials, there was follow-up after the treatment ended. Five trials had a high risk of performance bias, and four trials had a high risk of attrition bias.We found no trials assessing interventions for alcohol abstinence or smoking cessation. No trials assessed time to relapse. Only two trials assessed adverse events; in one trial these were caused by the add-on therapy ciclosporin (given in both groups). The trial comparing two dietary interventions to a no-treatment group observed no adverse events.The results presented in this abstract are based on trials of obese participants.Outcomes for dietary interventions versus usual care were measured 24 weeks to six months from baseline. Compared to usual care, dietary intervention (strict caloric restriction) may lead to 75% or greater improvement from baseline in the Psoriasis Area and Severity Index (PASI 75) (risk ratio (RR) 1.66, 95% confidence interval (CI) 1.07 to 2.58; 2 trials, 323 participants; low-quality evidence). Adherence to the intervention may be greater with the dietary intervention than usual care, but the 95% CI indicates that the dietary intervention might also make little or no difference (RR 1.26, 95% CI 0.76 to 2.09; 2 trials, 105 participants; low-quality evidence). Dietary intervention probably achieves a greater improvement in dermatology quality-of-life index (DLQI) score compared to usual care (MD -12.20, 95% CI -13.92 to -10.48; 1 trial, 36 participants; moderate-quality evidence), and probably reduces the BMI compared to usual care (MD -4.65, 95% CI -5.93 to -3.36; 2 trials, 78 participants; moderate-quality evidence).Outcomes for dietary interventions plus exercise programme were measured 16 weeks from baseline and are based on one trial (303 participants). Compared to information only (on reducing weight to improve psoriasis), combined dietary intervention and exercise programme (dietetic plan and physical activities) probably improves psoriasis severity, but the 95% CI indicates that the intervention might make little or no difference (PASI 75: RR 1.28, 95% CI 0.83 to 1.98). This combined intervention probably results in a greater reduction in BMI (median change -1.10 kg/m², P = 0.002), but there is probably no difference in adherence (RR 0.95, 95% CI 0.89 to 1.01; 137/151 and 145/152 participants adhered in the treatment and control group, respectively). There were no data on quality of life. These outcomes are based on moderate-quality evidence. AUTHORS' CONCLUSIONS Dietary intervention may reduce the severity of psoriasis (low-quality evidence) and probably improves quality of life and reduces BMI (moderate-quality evidence) in obese people when compared with usual care, while combined dietary intervention and exercise programme probably improves psoriasis severity and BMI when compared with information only (moderate-quality evidence). None of the trials measured quality of life.We did not detect a clear difference in treatment adherence between those in the combined dietary intervention and exercise programme group and those given information only (moderate-quality evidence). Adherence may be improved through dietary intervention compared with usual care (low-quality evidence). Participants generally adhered well to the lifestyle interventions assessed in the review.No trials assessed the time to relapse. Trial limitations included unblinded participants and high dropout rate.Future trials should reduce dropouts and include comprehensive outcome measures; they should examine whether dietary intervention with or without an exercise programme is effective in non-obese people with psoriasis, whether an additional exercise programme is more effective than dietary intervention alone, whether the time to relapse prolongs in people who receive dietary intervention with or without exercise programme, and whether smoking cessation and alcohol abstinence are effective in treating psoriasis.
4.
Nutritional strategies for psoriasis: current scientific evidence in clinical trials.
Zuccotti, E, Oliveri, M, Girometta, C, Ratto, D, Di Iorio, C, Occhinegro, A, Rossi, P
European review for medical and pharmacological sciences. 2018;22(23):8537-8551
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Psoriasis is an inflammatory skin disease that results in patches of dry, scaly skin that can be itchy or sore. This review looked at the evidence for a variety of nutritional and herbal strategies for reducing the risk and severity of psoriasis. Obesity is associated with both an increased risk of psoriasis, and increased severity of the disease, with obese patients being twice as likely to suffer from psoriasis as people of normal weight. Abdominal obesity in particular is associated with chronic low-grade inflammation that contributes to immune dysregulation. In obese patients, weight reduction via a low-calorie diet has been shown to reduce the severity of psoriasis. A Mediterranean-style diet, rich in extra virgin olive oil, fish, fruit vegetables, legumes, nuts and seeds is associated with a lower incidence of psoriasis. In contrast, a diet high in simple carbohydrates, high in arachidonic acid, and a low omega 3: omega 6 ratio is likely to drive inflammation, worsening severity of the disease. The microbiota plays a role in the development of psoriasis, with disruption of the gut and skin microbiomes both associated with psoriasis. In particular, psoriasis patients have a reduced abundance of Akkermansia muciniphilia in their gut. Several Lactobacillus strains have demonstrated potential for therapeutic effects in psoriasis patients when taken as a supplement. Common nutritional supplements used by psoriasis patients are fish oil, selenium, and zinc. In a review of the efficacy of fish oil supplementation, 12 of 15 trials showed a benefit. The evidence for zinc supplementation is less robust. There is limited data on the effectiveness of selenium supplementation, however low serum selenium levels are associated with increased psoriasis severity. Vitamin D levels are lower in psoriasis patients and correlate with disease severity. In individuals who are deficient, supplementing with vitamin D may prevent psoriasis-related comorbidities. Amongst the herbal and botanical remedies studied, neem, turmeric, Tripterygium wilfordii (Thunder God Vine), and the carotenoid-rich alga Dunaliella bardawil may reduce the severity of psoriasis. The review authors concluded that an integrated multidisciplinary approach should be considered for the management of psoriasis patients. Education to modify lifestyle and environmental risk factors is important. A collaboration between nutritionists and medical specialists with a holistic approach may be useful for psoriasis patients.
Abstract
OBJECTIVE Several nutritional strategies for the management of psoriasis are promising. Even if recent data support that nutrition may play a pivotal role in prevention and co-treatment and despite patient's concerns regarding the best nutritional habits, the consensus regarding the nutritional strategies to be adopted lacks in clinical settings. In this manuscript, the effects of several nutritional strategies for psoriasis patients such as hypocaloric diet, vitamin D, fish oil, selenium, and zinc supplementation were systematically reviewed. Randomized controlled trials (RCTs) on beneficial botanical oral supplements were also included in the analysis. MATERIALS AND METHODS For each topic, a search was conducted in MEDLINE electronic databases for articles published in English between January 1, 1990 and September 2018. Two independent reviewers assessed and extracted the data. Only controlled clinical trials were selected. RESULTS The evidence regarding the current nutritional strategies for psoriasis patients were summarized and translated into a global, comprehensible recommendation. CONCLUSIONS Weight loss combined with a healthy lifestyle was shown to be very beneficial for patients with moderate to severe disease with a significant reduction of the Psoriasis Area and Severity Index (PASI) score. Currently, oral vitamin D supplementation for prevention or treatment of psoriasis in adults with normal vitamin D levels is not recommended; however, psoriasis patients with a deficit in plasma vitamin D levels are advised to complement with oral supplements to prevent psoriasis-related comorbidities. Instead of zinc, selenium, and omega 3 supplements have been proven beneficial for psoriasis patients. Among botanical species, Dunaliella bardawil (D. bardawil), Tripterygium wilfordii (T. wilfordii), Azadirachta indica (A. indica), Curcuma longa (C. longa), and HESA-A are the most beneficial. In conclusion, a close cooperation between nutritionists and dermatologists may be useful for the management of psoriasis.
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Low-carbohydrate diets for type 1 diabetes mellitus: A systematic review.
Turton, JL, Raab, R, Rooney, KB
PloS one. 2018;13(3):e0194987
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Type 1 diabetes is an autoimmune condition that affects the ability to produce insulin, the hormone that regulates blood sugar levels. Patients with Type 1 diabetes manage their condition with daily insulin injections or patches, and the standard dietary advice is to continue to eat a normal diet, and adjust the insulin dose to keep blood sugar under control. This systematic review of 9 studies of varying types, aimed to examine the effects of low-carbohydrate diets on type 1 diabetes management. 8 of the studies reported a change in HbA1c (the blood marker used to assess long-term blood sugar management); 3 of these reported statistically significant reductions. 2 studies reported statistically significant reductions in daily insulin use whilst following a low-carbohydrate diet. The study authors were unable to conclude an overall effect due to the differences in design and methods used in the 9 studies included. They call for more primary research to be conducted.
Abstract
Type 1 diabetes is an autoimmune condition characterised by pancreatic beta cell destruction and absolute insulin deficiency. The strongest predictor of diabetes complications is glycaemic control and achieving HbA1c ≤ 7.0% is the primary management target. However, standard treatment appears to be lacking and adjunctive strategies require consideration. A systematic review was conducted to examine the effect of low-carbohydrate diets on type 1 diabetes management. Four databases were searched from inception until 28 March 2017: MEDLINE; CINAHL; Cochrane Library; and EMBASE. All primary studies containing a methods section (excluding cross-sectional) were included. Reports had to quantitatively measure the effect(s) of a dietary intervention or observed intake over at least two weeks where carbohydrate is below 45% total energy in adults and/or children with type 1 diabetes. The primary outcome was HbA1c and secondary outcomes were severe hypoglycaemia, total daily insulin, BMI, quality of life and mean daily glucose. Seventy-nine full-text articles were assessed for eligibility and nine were included (two randomised controlled trials, four pre-post interventions, two case-series, one case-report). Eight studies reported a mean change in HbA1c with a low-carbohydrate diet. Of these, four reported a non-significant change (P ≥ 0.05) and three reported statistically significant reductions (P < 0.05). Two studies reported severe hypoglycaemia, five reported total insulin, three reported BMI, and one reported blood glucose. Due to the significant heterogeneity of included studies, an overall effect could not be determined. This review presents all available evidence on low-carbohydrate diets for type 1 diabetes and suggests an urgent need for more primary studies.