The Effects of Synbiotic Supplementation on Fatigue Management and Mental Health Status in Levothyroxine-Treated Patients with Hypothyroidism: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial Study

Document Type : Original Article (s)

Authors

1 MSc Student, Student Research Committee, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran

2 Endocrinologist, Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

3 Assistant Professor, Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran

4 PhD in Nutrition, Food Security Research Center AND Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran

5 Associate Professor, Food Security Research Center AND Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: No studies thus far have addressed the efficacy of probiotics, especially synbiotics, on management and improving the symptoms of hypothyroidism. The aim of this study was to investigate the effects of synbiotic supplementation in fatigue management and mental health status in patients with hypothyroidism on levothyroxine treatment.Methods: This study was conducted as a randomized, double-blind, placebo-controlled clinical trial. Sixty patients with levothyroxine-treated hypothyroidism were randomly divided into two groups to receive either 500 mg/day of synbiotic (n = 30) or a placebo (n = 30) for 8 weeks.Findings: Synbiotic supplementation led to a significant decrease in general fatigue (P = 0.002) in synbiotic group. In the synbiotic group, other aspects of fatigue showed a decreasing trend, whereas the changes were not statistically significant. In addition, synbiotic supplementation significantly reduced the anxiety score in the synbiotic group at the end of the study (P = 0.028), while no significant effect was found from probiotics on depression, anxiety, and stress score in the intervention group compared to the placebo group.Conclusion: Synbiotic supplementation for 8 weeks may have beneficial effects on general fatigue and anxiety among the patients with hypothyroidism, whereas these effects were not statistically significant between the two groups. Synbiotic supplements can be considered as a therapeutic strategy to improve the symptoms of patients with hypothyroidism. Further studies with larger sample size and longer duration are needed to confirm the current findings.

Keywords


  1. Trifanescu RA, Poiana C. Diagnosis and management of hypothyroidism in adults. In: Llahana S, Follin C, Yedinak C, Grossman A, editors. Advanced practice in endocrinology nursing. Cham, Switzerland: Springer International Publishing; 2019. p. 581-92.
  2. Taylor PN, Albrecht D, Scholz A, Gutierrez-Buey G, Lazarus JH, Dayan CM, et al. Global epidemiology of hyperthyroidism and hypothyroidism. Nat Rev Endocrinol 2018; 14(5): 301-16.
  3. Aminorroaya A, Meamar R, Amini M, Feizi A, Tabatabae A, Faghih IE. Incidence of thyroid dysfunction in an Iranian adult population: The predictor role of thyroid autoantibodies: results from a prospective population-based cohort study. Eur J Med Res 2017; 22(1): 21.
  4. Talebi S, Ghaedi E, Sadeghi E, Mohammadi H, Hadi A, Clark CCT, et al. Trace element status and hypothyroidism: A systematic review and meta-analysis. Biol Trace Elem Res 2019.
  5. Wekking EM, Appelhof BC, Fliers E, Schene AH, Huyser J, Tijssen JG, et al. Cognitive functioning and well-being in euthyroid patients on thyroxine replacement therapy for primary hypothyroidism. Eur J Endocrinol 2005; 153(6): 747-53.
  6. Saravanan P, Chau WF, Roberts N, Vedhara K, Greenwood R, Dayan CM. Psychological well-being in patients on 'adequate' doses of l-thyroxine: results of a large, controlled community-based questionnaire study. Clin Endocrinol (Oxf) 2002; 57(5): 577-85.
  7. Wiley NC, Dinan TG, Ross RP, Stanton C, Clarke G, Cryan JF. The microbiota-gut-brain axis as a key regulator of neural function and the stress response: Implications for human and animal health. J Anim Sci 2017; 95(7): 3225-46.
  8. Alvarez-Mercado AI, Navarro-Oliveros M, Robles-Sanchez C, Plaza-Diaz J, Saez-Lara MJ, Munoz-Quezada S, et al. Microbial population changes and their relationship with human health and disease. Microorganisms 2019; 7(3): 68.
  9. Logan AC, Katzman M. Major depressive disorder: Probiotics may be an adjuvant therapy. Med Hypotheses 2005; 64(3): 533-8.
  10. Samsel A, Seneff S. Glyphosate, pathways to modern diseases III: Manganese, neurological diseases, and associated pathologies. Surg Neurol Int 2015; 6: 45.
  11. Mayer EA. Gut feelings: the emerging biology of gut-brain communication. Nat Rev Neurosci 2011; 12(8): 453-66.
  12. Foster JA, McVey Neufeld KA. Gut-brain axis: How the microbiome influences anxiety and depression. Trends Neurosci 2013; 36(5): 305-12.
  13. Mohammadi AA, Jazayeri S, Khosravi-Darani K, Solati Z, Mohammadpour N, Asemi Z, et al. The effects of probiotics on mental health and hypothalamic-pituitary-adrenal axis: A randomized, double-blind, placebo-controlled trial in petrochemical workers. Nutr Neurosci 2016; 19(9): 387-95.
  14. Messaoudi M, Lalonde R, Violle N, Javelot H, Desor D, Nejdi A, et al. Assessment of psychotropic-like properties of a probiotic formulation (Lactobacillus helveticus R0052 and Bifidobacterium longum R0175) in rats and human subjects. Br J Nutr 2011; 105(5): 755-64.
  15. Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI, et al. Clinical practice guidelines for hypothyroidism in adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid 2012; 22(12): 1200-35.
  16. Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, et al. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid 2017; 27(3): 315-89.
  17. International Physical Activity Questionnaires. Guidelines for Data Processing and Analysis of the International Physical Activity Questionnaire (IPAQ) – Short and Long Forms. IPAQ; 2005.
  18. Henry JD, Crawford JR. The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample. Br J Clin Psychol 2005; 44(Pt 2): 227-39.
  19. Smets EM, Garssen B, Bonke B, De Haes JC. The Multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue. J Psychosom Res 1995; 39(3): 315-25.
  20. Lee SH, Cho DY, Lee SH, Han KS, Yang SW, Kim JH, et al. A randomized clinical trial of synbiotics in irritable bowel syndrome: dose-dependent effects on gastrointestinal symptoms and fatigue. Korean J Fam Med 2019; 40(1): 2-8.
  21. Singh PK, Chopra K, Kuhad A, Kaur IP. Role of Lactobacillus acidophilus loaded floating beads in chronic fatigue syndrome: behavioral and biochemical evidences. Neurogastroenterol Motil 2012; 24(4): 366-e170.
  22. Loh HH, Lim LL, Yee A, Loh HS. Association between subclinical hypothyroidism and depression: an updated systematic review and meta-analysis. BMC Psychiatry 2019; 19(1): 12.
  23. Rao AV, Bested AC, Beaulne TM, Katzman MA, Iorio C, Berardi JM, et al. A randomized, double-blind, placebo-controlled pilot study of a probiotic in emotional symptoms of chronic fatigue syndrome. Gut Pathog 2009; 1(1): 6.
  24. Akkasheh G, Kashani-Poor Z, Tajabadi-Ebrahimi M, Jafari P, Akbari H, Taghizadeh M, et al. Clinical and metabolic response to probiotic administration in patients with major depressive disorder: A randomized, double-blind, placebo-controlled trial. Nutrition 2016; 32(3): 315-20.
  25. Ghorbani Z, Nazari S, Etesam F, Nourimajd S, Ahmadpanah M, et al. the effect of synbiotic as an adjuvant therapy to fluoxetine in moderate depression: A randomized multicenter trial. Arch Neurosci 2018; 5(2)e60507.
  26. Talbott S, Talbott J, Stephens B, Oddou M. Effect of coordinated probiotic/prebiotic/phytobiotic supplementation on microbiome balance and psychological mood state in healthy stressed adults. Funct Food Health Dis 2019; 9(4): 265-75.
  27. Jenkins TA, Nguyen JC, Polglaze KE, Bertrand PP. Influence of tryptophan and serotonin on mood and cognition with a possible role of the gut-brain axis. Nutrients 2016; 8(1): E56.
  28. Desbonnet L, Garrett L, Clarke G, Bienenstock J, Dinan TG. The probiotic Bifidobacteria infantis: An assessment of potential antidepressant properties in the rat. J Psychiatr Res 2008; 43(2): 164-74.
  29. Soltani Z, Jafari P, Azadegan Qhomi HR. The effect of lactobacillus casei td2, native iranian probiotic, on corticosterone hormone secretion in male wistar rats under chronic restraint stress condition. Journal of Animal Physiology and Development 2014; 7(1): 65-72. [In Persian].
  30. Sherman P. Probiotics and lactose maldigestion. Can J Gastroenterol 2004; 18(2): 81-2.
  31. Ledochowski M, Widner B, Bair H, Probst T, Fuchs D. Fructose- and sorbitol-reduced diet improves mood and gastrointestinal disturbances in fructose malabsorbers. Scand J Gastroenterol 2000; 35(10): 1048-52.
  32. Ledochowski M, Widner B, Propst-Braunsteiner T, Vogel W, Sperner-Unterweger B, Fuchs D. Fructose malabsorption is associated with decreased plasma tryptophan. Adv Exp Med Biol 1999; 467: 73-8.