Author: Superadmin

Intermittent fasting (IF) describes the restricting or eliminating of one’s caloric intake for specified periods [1]. The two primary types of IF regimes are whole-day fasting, wherein one fasts for at least an entire day, and time-restricted feeding, in which caloric intake is limited to specific hourly windows during the day [2]. Since its surge in popularity, many alleged advantages and disadvantages of IF have come to light, but in some cases, the evidence backing them is tenuous [3]. This article will discuss the pros and cons of intermittent fasting, along with the evidence supporting these points, to assess the efficacy of this dieting strategy. 

The claimed benefits of intermittent fasting are numerous. They include short-term weight loss, increased brain-derived neurotrophic factor (BDNF), improved metabolic outcomes, reduced cancer risk, and slowed aging [1, 2, 4]. However, some of the claims of the pros of intermittent fasting are not well supported by existing research, and there are also the cons to consider. While various studies support the idea that, at least in some populations, IF can result in significant reductions in weight [5], some researchers have identified no difference in metabolic outcomes between IF and standard caloric restriction diets [1]. Additionally, the evidence supporting BDNF secretion is also unclear. Although IF increases BDNF levels and, thus, can produce mental health benefits in nonhuman animals, this result has not consistently carried over to human studies [1]. Similarly, it remains unclear whether IF causes slowed aging and decreased cancer risk in humans, suggesting that IF’s central benefit may be limited to weight loss [4].  

It is important to note that different forms of intermittent fasting produce different benefits. For instance, some researchers have identified an association between periodic fasting and weight loss, improved insulin sensitivity, decreased blood pressure, and lowered postprandial lipemia [6]. Meanwhile, time-restricted feeding seemingly led to sustained muscle mass and decreased fat mass in resistant-trained males according to one study; another, however, found no significant changes in weight among participants, while their oxidative stress decreased and their insulin sensitivity rose [6]. In view of this conflicting data, more research is necessary to confirm the benefits of these respective forms of IF. 

Having discussed the potential pros of intermittent fasting, we can now look at the cons. Fortunately, the most common risks associated with intermittent fasting tend to be moderate in nature [6]. They include fatigue, headaches, weakness, irritability, and halitosis [1, 6]. Nevertheless, more serious risks are possible: They can range from malnutrition, hypotension, insomnia, and anxiety [1]. Hypoglycemia may also occur in patients with Type 2 diabetes [5]. And women may be particularly vulnerable to risks because of the potential link between IF and adverse effects on reproductive and bone health [1]. 

Along with the possibility of adverse events, another disadvantage of IF is backsliding. As a reward for adhering to an IF regime, or perhaps as a result of fatigue or excessive hunger, people may engage in compensatory overeating [1]. Pre-existing emotional dysregulation or baseline disinhibition may be indicators of a person’s likelihood to engage in binge eating while on an intermittent fasting diet [1]. With adherence rates being reportedly low according to some studies [5], the risk of overeating is non-negligible and may jeopardize the overall success of the diet. 

Before deciding whether to direct a patient to adopt an IF regime, medical professionals should consider the pros and cons of the strategy in light of a patient’s individual circumstances. While intermittent fasting may not be appropriate for everyone, it may be an alternative to traditional weight loss methods. 

References 

[1] S. Harding, “Intermittent Fasting: Clinical Considerations,” The Journal for Nurse Practitioners, vol. 17, no. 5, p. 545-548, May 2021. [Online]. Available: https://doi.org/10.1016/j.nurpra.2021.01.019.  

[2] R. L. Taft, “Intermittent Fasting for Weight Loss: Pros and Cons for People With Diabetes,” AADE in Practice, vol. 7, no. 4, p. 42-46, July 2019. [Online]. Available: https://doi.org/10.1177/2325160319853769. 

[3] G. M. Tinsley and B. D. Horne, “Intermittent fasting and cardiovascular disease: current evidence and unresolved questions,” Future Cardiology, vol. 14, no. 1, December 2017. [Online]. Available: https://doi.org/10.2217/fca-2017-0038.  

[4] “Not so fast: Pros and cons of the newest diet trend,” Harvard Health Publishing, Updated July 31, 2019. [Online]. Available: https://www.health.harvard.edu/heart-health/not-so-fast-pros-and-cons-of-the-newest-diet-trend.  

[5] S. Anton et al., “The effects of intermittent fasting regimens in middle-age and older adults: Current state of evidence,” Experimental Gerontology, vol. 156, p. 1-8, December 2021. [Online]. Available: https://doi.org/10.1016/j.exger.2021.111617.  

[6] R. Freire, “Scientific evidence of diets for weight loss: Different macronutrient composition, intermittent fasting, and popular diets,” Nutrition, vol. 69, p. 1-11, January 2020. [Online]. Available: https://doi.org/10.1016/j.nut.2019.07.001.  

Testosterone is one of the more famous hormones, mainly known for its crucial role in male puberty and reproduction. During puberty, adolescent males experience a surge in testosterone, which induces key physiological changes such as growth of facial/pubic hair, deepening of voice, increased muscle mass, bone growth, and sperm production.¹ Following puberty and throughout the reproductive period, testosterone is responsible for maintaining libido and overall sexual function.¹ Lack of testosterone, either due to a medical condition or as part of a willful gender transition, can lead to physical symptoms of demasculinization and loss of sexual function/sperm production. Despite the reputation of testosterone as a “male hormone,” people of both sexes require testosterone to maintain good health.  

Testosterone, within certain levels, is a normal part of female physiology and health. In fact, the ovaries produce 100-400 µg per day, which is 3-4 times the amount of estrogen (the parallel “female hormone”) produced.² Testosterone’s role in driving female sexuality has been well documented: like in men, it is a key contributor to libido, arousal, and orgasms.² Moreover, it is thought to work synergistically with estrogen to promote adequate bone density and muscle mass.² A decrease in the levels of both estrogen and testosterone associated with menopause are thought to contribute to adverse symptoms. In fact, research showed that a surgically-induced menopause (oophorectomy) decreased testosterone levels by as much as 50 percent within only a few days.³ This drop was associated with a number of negative changes in mood, energy level, and overall well-being. Testosterone treatment, or exogenous replacement of testosterone following an oophorectomy, has shown promise in mitigating some of these effects when used in parallel with estrogen treatment.^4,5  

Men experience a more graduate decline in testosterone levels (an approximate 1 percent decrease per year) over time, starting at around the age of thirty.⁶ Decreased testosterone levels in men can also be linked to obesity or other comorbid health conditions that affect androgen production.⁶ Physicians will often look for symptoms of low sex drive or chronic fatigue when diagnosing male hyperandrogenism.⁶  

While inadequate testosterone in both male and female patients has been associated with a number of undesirable changes in health, elevated levels outside of the context of hormone replacement therapy have similarly striking implications, particularly for women. High levels of testosterone in women are associated with increased masculinization, acne, hair loss, mood disorders, and weight gain or inability to lose weight. These changes can also result from exogenous steroid use. Elevated levels of endogenous testosterone in both men and women can be indicative of a number of different conditions, including malfunction of the adrenal gland, ovarian or testicular tumors, polycystic ovary syndrome, and hirsutism.⁷ Some of these conditions are surprisingly common: for example, polycystic ovary syndrome is estimated to affect between 4-20 percent of women of reproductive age worldwide.⁸ 

As with all hormones, testosterone only contributes to overall health and wellbeing when levels are regulated and in balance. For patients who are experiencing relevant symptoms, or for those who are older and experiencing declining reproductive hormones, checking testosterone levels may prove a helpful diagnostic tool.  

References 

¹ Testosterone – what it does and doesn’t do. Harvard Health. (2019, August 29). Retrieved January 17, 2023, from https://www.health.harvard.edu/medications/testosterone–what-it-does-and-doesn’t-do  

² Panay, N., & Fenton, A. (2009). The role of testosterone in women. Climacteric : the journal of the International Menopause Society, 12(3), 185–187. https://doi.org/10.1080/13697130902973227 

³ Davison, S. L., Bell, R., Donath, S., Montalto, J. G., & Davis, S. R. (2005). Androgen levels in adult females: changes with age, menopause, and oophorectomy. The Journal of clinical endocrinology and metabolism, 90(7), 3847–3853. https://doi.org/10.1210/jc.2005-0212 

⁴ Kingsberg S. (2007). Testosterone treatment for hypoactive sexual desire disorder in postmenopausal women. The journal of sexual medicine, 4 Suppl 3, 227–234. https://doi.org/10.1111/j.1743-6109.2007.00449.x 

⁵ North American Menopause Society (2005). The role of testosterone therapy in postmenopausal women: position statement of The North American Menopause Society. Menopause (New York, N.Y.), 12(5), 496–649. https://doi.org/10.1097/01.gme.0000177709.65944.b0 

⁶ Cleveland Clinic (2022, October 20). Why are testosterone levels declining? Retrieved January 17, 2023, from https://health.clevelandclinic.org/declining-testosterone-levels/  

⁷ TTFB – Overview: Testosterone, total, bioavailable, and free, serum. TTFB – Overview: Testosterone, Total, Bioavailable, and Free, Serum. (n.d.). Retrieved January 17, 2023, from https://www.mayocliniclabs.com/test-catalog/overview/83686#Clinical-and-Interpretive  

⁸ Deswal, R., Narwal, V., Dang, A., & Pundir, C. S. (2020). The Prevalence of Polycystic Ovary Syndrome: A Brief Systematic Review. Journal of human reproductive sciences, 13(4), 261–271. https://doi.org/10.4103/jhrs.JHRS_95_18 

Neck pain is a common yet broad diagnosis which encompasses a wide range of injury and disease pathologies. Despite the fact that literature on neck pain has increased exponentially in recent years, the number of interventions utilized by health care providers has stagnated. Moreover, those interventions which have gained acceptance by the medical community err on the side of more, rather than less, invasive, which in turn may contribute to poor prognosis. For these reasons, authors Hurwitz et al. published a comprehensive literature review detailing the most promising non-invasive interventions for neck pain spanning the past two decades of literature. The author’s inclusion criteria were a minimum of 20 study participants with neck pain of various etiologies, including whiplash-associated disorders, work-related pain or strains, and unknown causes.¹ 

Hurwitz et al. separated the evaluated non-invasive neck pain interventions into several categories: exercise, medications, manual therapies, physical modalities, and collars. 

Exercise: While the efficacy of exercise alone was not evaluated in any of the included studies, exercise was a common component of intervention programs. Patients with neck pain relating to whiplash were shown to benefit from eye fixation and other active exercises.² Significantly, supervised exercise was shown to confer more benefit than at-home exercise, which suggests the importance of consistency in both movement and practice.³ 

Medications: Only two studies investigated the efficacy of medications for the treatment of neck pain: primarily, corticosteroid injections, which were not effective for acute zygapophysial joint pain.^4,5 Methylprednisolone infusions resulted in fewer sick days and reduced pain; however, the authors were unable to assess whether these effects were curative or merely symptom masking. 

Manual therapies: Hurwitz et al. reported that manual therapeutic interventions which involved mobilization (i.e., cervical mobilization) were generally more effective than more passive interventions (i.e., general advice or soft collars).^6,7,8 On a similar note, patients who received more intensive manual therapies experienced shorter periods of disability and self-reported improved satisfaction with recovery. 

Physical modalities: The authors reported that electromagnetic force therapy reduced pain and need for analgesics. As with manual therapies, active physical modalities tended to outperform passive in terms of pain management and treatment outcome. 

Collars: The examined studies demonstrated that soft collars conferred little to no benefit, or even reduced benefit when compared directly to more active interventions.⁹ Additionally, in cases of whiplash, rigid immobilization collars did not outperform active mobilization 72 hours after the incident occurrence.¹ 

Overall, non-invasive techniques for management of neck pain appear to be a promising avenue of exploration for healthcare providers. However, as Hurwitz et al. demonstrated, not all techniques are created equal, and further investigation is required to determine which are candidates for increased incorporation. 

References 

¹ Hurwitz, E.L., Carragee, E.J., van der Velde, G. et al. Treatment of Neck Pain: Noninvasive Interventions. Eur Spine 2008; https://doi.org/10.1007/s00586-008-0631-z 

² Cassidy JD, Carroll LJ, Coˆ te´ P, et al. Does multidisciplinary rehabilitation benefit whiplash recovery? Results of a population-based incidence cohort study. Spine 2007;32:126 –31. DOI: 10.1097/01.brs.0000249526.76788.e8 

³ Bunketorp, L., Lindh, M., Carlsson, J., & Stener-Victorin, E. (2006). The effectiveness of a supervised physical training model tailored to the individual needs of patients with whiplash-associated disorders–a randomized controlled trial. Clinical rehabilitation, 20(3), 201–217. https://doi.org/10.1191/0269215506cr934oa 

⁴ Barnsley L, Lord SM, Wallis BJ, et al. Lack of effect of intraarticular corticosteroids for chronic pain in the cervical zygapophyseal joints. N Engl J Med 1994;330:1047–50. DOI: 10.1056/NEJM199404143301504 

⁵ Pettersson K, Toolanen G. High– dose methylprednisolone prevents extensive sick leave after whiplash injury. A prospective, randomized, doubleblind study. Spine 1998;23:984. DOI: 10.1097/00007632-199805010-00004 

⁶ Mealy K, Brennan H, Fenelon GC. Early mobilization of acute whiplash injuries. Br Med J (Clin Res Ed). 1986;292:656 –7. DOI: 10.1136/bmj.292.6521.656 

⁷ Provinciali L, Baroni M, Illuminati L, et al. Multimodal treatment to prevent the late whiplash syndrome. Scand J Rehabil Med 1996;2. PMID: 8815995 

⁸ Rosenfeld M, Gunnarsson R, Borenstein P. Early intervention in whiplash associated disorders: a comparison of two treatment protocols. Spine 2000; 25:1782–7. DOI:10.1097/00007632-200007150-00008 

Stress levels have reached an all-time high. Ongoing events have amplified existing issues; for example, a recent study revealed that nearly 40% of participants had experienced some degree of distress as a result of COVID-19, and that an additional 16% were highly distressed “and likely in need of mental health services” ¹. In many places, fast food and ultra-processed foods are a growing portion of the average person’s diet. However, diet has a significant impact on stress and immune health.  

Humans experience stress and other emotions that affect their feeding behaviors and selection of diet ². Stress triggers an individual’s drive for soda and sweet or fatty comfort foods ³. Concurrently, during times of stress, individuals tend to lower their intake of fruits, vegetables, and whole foods. This, in turn, leads to a higher risk of insulin resistance, excess visceral fat, and type 2 diabetes—and overall stress ⁴. 

The combination of stress and poor diet is particularly dangerous to health. An animal model study in which chronically stressed rodents were fed a junk food diet found that junk food alone did not result in an increase in visceral fat among the rodents—but when the animals were also stressed, the combination of poor diet and stressincreased visceral fat and the risk of early metabolic disease ⁵.  

Research has also found data in humans that aligns with animal studies. A recent study demonstrated that, over several years, highly stressed maternal caregivers exhibited more frequent compulsive eating behaviors and had increased abdominal fat ⁶. 

Conversely, research has shown that certain types of diets may help alleviate stress. Population-based studies have found that diets rich in whole foods were associated with not only lower levels of stress, but lower levels of anxiety and depression as well. In contrast, a typical Western diet was linked to a greater propensity for poor mental health ⁷.  

More specifically, a range of vitamin C- or magnesium-rich foods may help reduce stress levels ⁸. Certain foods such as polyunsaturated fats, including various vegetables and omega-3 fats, may further help regulate cortisol levels ⁹. 

The gut microbiome impacts brain function, but also moods and behaviors; brain areas and neurotransmitters that are involved in mood and appetite are likely to mediate this relationship. A slew of other mechanisms have been laid forth, but much remains to be studied in future research ¹¹. 

Finally, the way we eat is equally as important as what we eat. Mindful eating during pregnancy, particularly among overweight, low-income women, has the potential to reduce stress eating and improve overall control of glucose levels ¹⁰. 

Though existing knowledge holds a lot of potential for improving nutrition and stress, research on the influence of diet on stress remains somewhat limited to date, with some studies so far being less rigorous than is preferred. In the future, additional research is required to be able to develop clear, evidence-based guidelines. 

References  

1. Taylor, S. et al. COVID stress syndrome: Concept, structure, and correlates. Depress. Anxiety (2020). doi:10.1002/da.23071 

2. Fradin, D. & Bougnères, P. T2DM: Why epigenetics? Journal of Nutrition and Metabolism (2011). doi:10.1155/2011/647514 

3. Lim, S., Tellez, M. & Ismail, A. I. Chronic Stress and Unhealthy Dietary Behaviors among Low-Income African-American Female Caregivers. Curr. Dev. Nutr. (2020). doi:10.1093/CDN/NZAA029 

4. Nutrition and Cognitive Health A Webinar | National Academies. Available at: https://www.nationalacademies.org/event/11-19-2020/nutrition-and-cognitive-health-a-webinar. (Accessed: 8th December 2022) 

5. Aschbacher, K. et al. Chronic stress increases vulnerability to diet-related abdominal fat, oxidative stress, and metabolic risk. Psychoneuroendocrinology (2014). doi:10.1016/j.psyneuen.2014.04.003 

6. Radin, R. M., Mason, A. E., Laudenslager, M. L. & Epel, E. S. Maternal caregivers have confluence of altered cortisol, high reward-driven eating, and worse metabolic health. PLoS One (2019). doi:10.1371/journal.pone.0216541 

7. Lewis, N. A. & Oyserman, D. When Does the Future Begin? Time Metrics Matter, Connecting Present and Future Selves. Psychol. Sci. (2015). doi:10.1177/0956797615572231 

8. Diet for Stress Management: Carbs, Nuts, and Other Stress-Relief Foods. Available at: https://www.webmd.com/diet/ss/slideshow-diet-for-stress-management. (Accessed: 8th December 2022) 

9. Soltani, H., Keim, N. L. & Laugero, K. D. Diet quality for sodium and vegetables mediate effects of whole food diets on 8-week changes in stress load. Nutrients (2018). doi:10.3390/nu10111606 

10. Epel, E. et al. Effects of a Mindfulness-Based Intervention on Distress, Weight Gain, and Glucose Control for Pregnant Low-Income Women: A Quasi-Experimental Trial Using the ORBIT Model. Int. J. Behav. Med. 26, 461–473 (2019). doi: 10.1007/s12529-019-09779-2. 

11. Bremner, J. D. et al. Diet, stress and mental health. Nutrients (2020). doi:10.3390/nu12082428 

Gluten is a protein that stores important nutrients and is technically a mixture of complex proteins; similar storage proteins are found in a variety of foods, including rye, barley, and oats, and are collectively referred to as “gluten.” Because it can be a binding and extending agent, it is often added to processed foods for improved texture and flavor [1]. Chewier bread products are high in gluten, such as pizza dough and other leavened bread. Historically, gluten has been associated with the development of gastrointestinal symptoms; it is also the root cause of the immune response in celiac disease [2]. Gluten is also thought to have negative effects on cognition. 

Celiac disease (CD) is an illness causing certain cells in the intestine to die, leading to inflammation and nutritional deficiencies [3]. The only currently available treatment for CD is abstinence from gluten. An imbalanced gut microbiome (dysbiosis) is thought to be an important factor in causing CD [4]. On a molecular level, exposure to gliadin, one of the proteins in gluten, indirectly increases the passage of antigens into the gut mucus membranes. Undigested fragments from gluten-containing foods trigger an increase in T-cell response against some of the body’s own tissues, creating most of the secondary symptoms associated with CD [5]. A clinical study demonstrated CD patients showed increased activity in a type of cell that is involved in cell death [6]. Another feature of CD pathology is the upregulation of the pro-inflammatory cytokine IL-15, which promotes the destruction of intestinal epithelial cells [5]. Gluten is known to have a detrimental effect on health for patients with celiac disease, however, it may also be linked to negative effects on cognition in the general population. 

A recent systematic review closely examined 13 studies (n = 526) and compared the association between gluten intake and cognitive function, looking specifically at depression, anxiety, autism, schizophrenia, or memory impairment [7]. The researchers concluded restricting gluten may be helpful in reducing cognitive impairment in people with IBS, CD, schizophrenia and fibromyalgia; however, in the case of patients with autism disorder, a gluten-free diet did not significantly enhance cognition [8]. Other research studies have also examined the association between gluten intake and neurological/psychological impairment through symptoms of peripheral neuropathy, depression, anxiety, and ataxia [9]. Ataxia is the most common neurological complication related to gluten intake; this is characterized by cerebellum dysfunction, increased production of certain antibodies, and ataxic symptomology [10]. Furthermore, one study showed CD patients were more likely to have anxiety but exhibited a significant improvement in these scores after one year on a gluten-free diet [11]. Similarly, a Scandinavian population study showed elderly patients with gluten sensitivities were twice as likely to have depressive symptoms than controls [12], but this difference improved after a gluten-free diet was imposed [13]. In mouse macrophages treated with gliadin, there was a significant increase in pro-inflammatory genes such as TNF-α, IL-12, IL-15 and IFN-β iNOS, suggesting gliadin and other gluten components may be capable of inducing excessive inflammation, interfering with brain signaling and contributing to neurological and cognitive impairments [9,14].   

Accumulating evidence indicates the gluten-mediated immune response is detrimental to overall health but especially to cognition. In many cases, neurological and psychiatric manifestations may arise from gluten-related illnesses. Additional research is needed to determine what the exact link between gluten, health, and cognition is. 

References  

1. Biesiekierski, J. R. (2017). What is Gluten? Journal of Gastroenterology and Hepatology, 32 Suppl 1, 78–81. https://doi.org/10.1111/jgh.13703  

2. Alun Jones, V., Shorthouse, M., Mclaughlan, P., Workman, E., & Hunter, J. O. (1982). Food Intolerance: A Major Factor in the Pathogenesis of Irritable Bowel Syndrome. The Lancet, 320(8308), 1115–1117. https://doi.org/10.1016/S0140-6736(82)92782-9  

3. Hill, I. D., Fasano, A., Guandalini, S., Hoffenberg, E., Levy, J., Reilly, N., & Verma, R. (2016). NASPGHAN Clinical Report on the Diagnosis and Treatment of Gluten-related Disorders. Journal of Pediatric Gastroenterology & Nutrition, 63(1), 156–165. https://doi.org/10.1097/MPG.0000000000001216  

4. Mohan, M., Chow, C.-E. T., Ryan, C. N., Chan, L. S., Dufour, J., Aye, P. P., Blanchard, J., Moehs, C. P., & Sestak, K. (2016). Dietary Gluten-induced Gut Dysbiosis is Accompanied by Selective Upregulation of MicroRNAs with Intestinal Tight Junction and Bacteria-binding Motifs in Rhesus Macaque Model of Celiac Disease. Nutrients, 8(11), 684. https://doi.org/10.3390/nu8110684  

5. Campagna, G., Pesce, M., Tatangelo, R., Rizzuto, A., Fratta, I. L., & Grilli, A. (2017). The Progression of Coeliac Disease: Its Neurological and Psychiatric Implications. Nutrition Research Reviews, 30(1), 25–35. https://doi.org/10.1017/S0954422416000214  

6. Meresse, B., Chen, Z., Ciszewski, C., Tretiakova, M., Bhagat, G., Krausz, T. N., Raulet, D. H., Lanier, L. L., Groh, V., Spies, T., Ebert, E. C., Green, P. H., & Jabri, B. (2004). Coordinated Induction by IL-15 of a TCR-independent NKG2D Signaling Pathway Converts CTL into Lymphokine-activated Killer Cells in Celiac Disease. Immunity, 21(3), 357–366. https://doi.org/10.1016/j.immuni.2004.06.020  

7. Rouvroye, M. D., Zis, P., Van Dam, A.-M., Rozemuller, A. J. M., Bouma, G., & Hadjivassiliou, M. (2020). The Neuropathology of Gluten-related Neurological Disorders: A Systematic Review. Nutrients, 12(3), 822. https://doi.org/10.3390/nu12030822 

8. Aranburu, E., Matias, S., Simón, E., Larretxi, I., Martínez, O., Bustamante, M. Á., Fernández-Gil, M. del P., & Miranda, J. (2021). Gluten and FODMAPs Relationship with Mental Disorders: Systematic Review. Nutrients, 13(6), 1894. https://doi.org/10.3390/nu13061894  

9. Jackson, J. R., Eaton, W. W., Cascella, N. G., Fasano, A., & Kelly, D. L. (2012). Neurologic and Psychiatric Manifestations of Celiac Disease and Gluten Sensitivity. Psychiatric Quarterly, 83(1), 91–102. https://doi.org/10.1007/s11126-011-9186-y  

10. Bhatia, K. P., Brown, P., Gregory, R., Lennox, G. G., Manji, H., Thompson, P. D., Ellison, D. W., & Marsden, C. D. (1995). Progressive Myoclonic Ataxia Associated with Coeliac Disease: The Myoclonus is of Cortical Origin, but the Pathology is in the Cerebellum. Brain, 118(5), 1087–1093. https://doi.org/10.1093/brain/118.5.1087  

11. Addolorato, G. (2001). Anxiety but not Depression Decreases in Coeliac Patients after One-year Gluten-free Diet: A Longitudinal Study. Scandinavian Journal of Gastroenterology, 36(5), 502–506. https://doi.org/10.1080/00365520119754  

12. Ruuskanen, A., Kaukinen, K., Collin, P., Huhtala, H., Valve, R., Mäki, M., & Luostarinen, L. (2010). Positive Serum Antigliadin Antibodies Without Celiac Disease in the Elderly Population: Does it Matter? Scandinavian Journal of Gastroenterology, 45(10), 1197–1202. https://doi.org/10.3109/00365521.2010.496491  

13. Corvaglia, L., Catamo, R., Pepe, G., Lazzari, R., & Corvaglia, E. (1999). Depression in Adult Untreated Celiac Subjects: Diagnosis by the Pediatrician. The American Journal of Gastroenterology, 94(3), 839–843. https://doi.org/10.1016/S0002-9270(99)00011-8  

14. Thomas, K. E., Sapone, A., Fasano, A., & Vogel, S. N. (2006). Gliadin Stimulation of Murine Macrophage Inflammatory Gene Expression and Intestinal Permeability are MYD88-dependent: Role of the Innate Immune Response in Celiac Disease. The Journal of Immunology, 176(4), 2512–2521. https://doi.org/10.4049/jimmunol.176.4.2512

Sufficient sleep quantity and quality are essential to good health and quality of life.^1,2 Poor sleep, in contrast, can lead to neck and back pain, affecting many people across the globe in this day and age.³ However, back and neck health can be maintained using a variety of different approaches, including correct posture while sleeping.⁴ This has led to the field of ergonomics for sleep. 

In order to maintain a healthy back and neck, it is important to sleep on one’s back or side rather than stomach whenever possible: Sleeping on one’s back results in the least amount of pressure, followed by sleeping on your side.  

When sleeping on one’s back, a pillow should ideally be used to support the neck and knees. When sleeping on one’s side, however, pillows should ideally be used under one’s ear and between one’s knees in order to maintain maximal spine alignment.⁵ Finally, a stomach sleeper should use a small pillow to maintain their head in a neutral or aligned position.  

When moving around during sleep, it is important to try to move one’s entire body as a unit, keeping ears, shoulders and hips aligned.⁶ Excessive twisting can strain the body and lead to discomfort or pain after waking up. 

Ergonomics experts also recommend having a mattress that is firm enough to provide substantial back support and alignment during sleep; in addition, stomach sleepers require firmer mattresses than back or side sleepers. In general, mattresses with convoluted foam (which is soft but resilient) tend to provide sufficient support and comfort, while coils do not affect the quality of a mattress much. Any mattress should be replaced every 8-10 years.⁵  

In the end however, choosing a mattress remains a highly personal endeavor: Individuals should always test out mattresses to ensure personal comfort.  

Since a pillow should fully support the head and fill the neck curve, selecting a pillow should take into account one’s preferred sleeping position, the firmness of one’s mattress, and the depth of one’s neck curve.  

For back sleepers, the pillow should fill in the space between the neck and bed. If an individual can see their feet though, the pillow is too big. For side sleepers, the pillow should fill in the space between the ear and bed. Finally, for stomach sleepers, a small pillow should be used to simply level the head. 

In general, the softer the mattress, the thicker the pillow has to be to meet these criteria – fortunately, a pillow can easily be modified by removing or adding foam padding or towels. 

Getting good, consistent sleep is also crucial to overall health. To this end, it is important to go to bed and wake up at around the same time daily, ensure one’s bedroom is dark and quiet, hide away any electronics, and avoid stimulants or alcohol before going to sleep.⁷ 

Sleep ergonomics is key to maintaining good back and neck health. Abiding by specific guidelines when selecting a bed or pillow and sticking to good sleeping habits will prevent unnecessary pain and maximize back and neck health down the road.  

References  

1. Sezgin, M. et al. Sleep quality in patients with chronic low back pain: A cross-sectional study assesing its relations with pain, functional status and quality of life. J. Back Musculoskelet. Rehabil. (2015). doi:10.3233/BMR-140537 

2. Mukherjee, S. et al. An official American Thoracic Society statement: The importance of healthy sleep: Recommendations and future priorities. Am. J. Respir. Crit. Care Med. (2015). doi:10.1164/rccm.201504-0767ST 

3. Dionne, C. E. et al. Back to the Future: A Report From the 16th International Forum for Back and Neck Pain Research in Primary Care and Updated Research Agenda. Spine (Phila. Pa. 1976). 47, (2022). doi: 10.1097/BRS.0000000000004408. 

4. Back and Neck Pain | Johns Hopkins Medicine. Available at: https://www.hopkinsmedicine.org/health/conditions-and-diseases/back-pain. (Accessed: 15th September 2022) 

5. Sleeping Posture | Back Safety | Ergonomics | Environmental Health & Safety | DePaul University, Chicago. Available at: https://offices.depaul.edu/environmental-health-and-safety/ergonomics/back-safety/Pages/sleeping-posture.aspx. (Accessed: 15th September 2022) 

6. Good Sleeping Posture Helps Your Back – Health Encyclopedia – University of Rochester Medical Center. Available at: https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=1&ContentID=4460. (Accessed: 16th September 2022) 

7. Sleep Ergonomics – ACA Hands Down Better. Available at: https://handsdownbetter.org/sleep-ergonomics/. (Accessed: 16th September 2022)

Recovery after exercise is an essential element of any training program or workout routine. Athletes, coaches, and healthcare practitioners look to the recovery period between training and competition to maximize performance gains. Intense bouts of exercise can lead to dehydration, fatigue, soft tissue damage, and increased body temperature; altogether, these effects can disrupt many of the body’s physiological systems, like the nervous, cardiovascular, and immune systems (Peake, 2019). The overall goals of post-exercise recovery are to “restore homeostasis, replace fuels and fluids, repair the body’s tissues, and rest” (Peake, 2019). There are various nutritional and physical interventions that can help individuals achieve these goals, including rehydration, hydrotherapies, massage, and sleep. Joint manipulation is one of the many other techniques being discussed in the research domain of post-exercise recovery. 

Joint manipulation is a manual therapy performed by chiropractors and physical therapists (PTs) that involves applying force to one’s spinal or peripheral joints to relieve restriction and improve joint function (Sears, 2021). There are several different techniques that a practitioner may use or favor. Osteopathic manipulative therapy (OMT) is a similar technique (often used to treat chronic pain) that also involves “moving and manipulating a person’s muscles and joints to help diagnose, prevent, and treat certain conditions” (Rowden, 2022). Doctors of osteopathy (DOs) are qualified to perform OMT as part of their medical training. In recent years, OMT has also garnered some discussion as a physical intervention to aid recovery after intense training or physical exertion. 

A study published in the Journal of Manipulative and Physiological Therapeutics in 2021 investigated the effects of OMT on cardiovascular autonomic parameters after a rugby match (Carnevali et al., 2021). Researchers assessed measures of heart rate, heart rate variability, and mean arterial pressure in 23 male players after one session of OMT, “both 18 to 20 hours after a rugby match and in a corresponding no-match condition, in a randomized, sham-controlled, crossover study design” (Carnevali et al., 2021). Compared with the no-match condition, “signs of reduced heart rate variability and elevated mean arterial pressure and heart rate were found 18 to 20 hours after a rugby match” (Carnevali et al., 2021). Significant increases in heart rate variability and a significant reduction in mean arterial pressure were observed after OMT in both conditions. And while heart rate and heart rate variability responses to reactivity were not affected by previous match competition, they were “significantly larger after OMT compared with sham treatment” (Carnevali et al., 2021). Overall, the study suggested cardiovascular autonomic changes in rugby players post-competition, which may be indicative of “prolonged fatigue and incomplete recovery.” In these players, researchers observed that a single session of OMT was followed by favorable changes in cardiovascular autonomic parameters, suggesting that joint manipulation may be a positive part of post-exercise recovery. 

Without proper recovery, athletes may experience under-recovery or even “overreaching,” which is the “buildup of training and/or training stress leading to temporary impairment of performance capacity, with (or without) psychophysiological indicators of maladaptation” (Peake, 2019). When overreaching occurs, it can take days or weeks to completely restore performance capacity. Adequate recovery, however, can allow for a greater tolerance for training and positive physiological adaptations that bolster improvements in athletic performance. Further research into joint manipulation and OMT could lead to the development of additional physical interventions for the post-exercise recovery period.  

References 

Carnevali, Luca, Francesco Cerritelli, Franco Guolo, and Andrea Sgoifo. “Osteopathic Manipulative Treatment and Cardiovascular Autonomic Parameters in Rugby Players: A Randomized, Sham-Controlled Trial.” Journal of Manipulative & Physiological Therapeutics 44, no. 4 (May 1, 2021): 319–29. https://doi.org/10.1016/j.jmpt.2020.09.002. 

Peake, Jonathan M. “Recovery after Exercise: What Is the Current State of Play?” Current Opinion in Physiology, Exercise Physiology, 10 (August 1, 2019): 17–26. https://doi.org/10.1016/j.cophys.2019.03.007. 

Rowden, Adam. “Osteopathic Manipulative Therapy: What to Know.” Medical News Today, February 28, 2022. https://www.medicalnewstoday.com/articles/osteopathic-manipulative-therapy. 

Sears, Brett. “Joint Manipulation in Chiropractic and Physical Therapy.” Verywell Health, December 17, 2021. https://www.verywellhealth.com/joint-manipulation-5207019. 

According to the Centers for Disease Control and Prevention (CDC), the adult obesity rate in the U.S. is over 40%.¹ Poor nutrition is an additional, related issue experienced by many. Dietary science and nutrition have grown more prominent in preventive medicine, for weight control as well as many other aspects of health. The efficacy of different dietary approaches, including calorie restriction (eating less than a specific number of calories each day) and time-restricted eating (eating at specific times of day), are particularly important. Indeed, both time-restricted eating and calorie restriction, in addition to the combination of the two, have shown health benefits.

Studies in a variety of animals, ranging from worms and flies to mice, rats, and primates, have shown that restricting calories can lead to a longer, healthier life. Such experiments report weight loss, improved metabolism, lower blood pressure, improved immunity,² and reduced inflammation.³ Fascinatingly, a key gene has even been found to mediate the effect between calorie restriction and longer life: sustained calorie restriction leads to it being down-regulated, which is a crucial factor to lowering inflammatory mechanisms and contributing to longevity.⁴ 

In parallel, certain studies have shown that time-restricted eating helps not only to reduce calorie intake but also to improve cognition and yield a number of anti-inflammatory effects.⁵

A randomized clinical trial from 2022 that studied nearly 140 patients across 12 months suggested that time-restricted eating was associated with a 1.9 kg difference in weight loss compared to calorie restriction on average, although the magnitude of the effect was not statistically significant. The results seemed to clearly point to a strategy of time-restricted eating combined with caloric intake restriction, as prescribed according to current dietary guidelines, as a viable and sustainable approach for obesity management. Furthermore, the study laid forth an important benchmark for a dietary lifestyle intervention combining quality, quantity, and timing of nutrition.⁶ 

A study from 2021 focused on mice showed that fasting drives the molecular, metabolic, and life-lengthening effects of a calorie-restricted diet. Using a series of feeding regimens, the researchers specifically dissected the effects of calories and fasting – clearly demonstrating that fasting alone results in many of the physiological and molecular effects of calorie restriction.  

A more recent study from 2022 that followed hundreds of mice over their lifespans found that calorie restriction combined with time-restricted eating boosted longevity. Indeed, the study’s results showed that eating only during the most active time of day substantially extended the lifespan of mice on a reduced-calorie diet.⁷ A reduced-calorie diet alone extended the animals’ lives by 10% . However, feeding mice when they were most active, i.e. only at night, extended their lives by about 35%. The particular combination of a reduced-calorie diet and a nighttime eating schedule added on nine months to the animals’ typical two-year median lifespan. (The analogous strategy in humans would be to limit eating to daytime hours.) 

Although they ultimately represent different strategies for supporting metabolic health and weight loss maintenance, both time-restricted eating and calorie restriction have benefits. Individuals should select a strategy that best suits their lifestyle, while keeping in mind that the quality of food, alongside its quantity and intake program, remains one of the important facets of healthy nutritional habits.

References 

1. Products – Data Briefs – Number 360 – February 2020. Available at: https://www.cdc.gov/nchs/products/databriefs/db360.htm. (Accessed: 29th August 2022) 

2. Spadaro, O. et al. Caloric restriction in humans reveals immunometabolic regulators of health span. Science (80-. ). 375, 671–677 (2022). doi: 10.1126/science.abg7292. 

3. Calorie restriction, immune function, and health span | National Institutes of Health (NIH). Available at: https://www.nih.gov/news-events/nih-research-matters/calorie-restriction-immune-function-health-span. (Accessed: 29th August 2022) 

4. Candels, L. S., Becker, S. & Trautwein, C. PLA2G7: a new player in shaping energy metabolism and lifespan. Signal Transduct. Target. Ther. 2022 71 7, 1–2 (2022). doi: 10.1038/s41392-022-01052-5. 

5. Stockman, M. C., Thomas, D., Burke, J. & Apovian, C. M. Intermittent Fasting: Is the Wait Worth the Weight? Current obesity reports (2018). doi:10.1007/s13679-018-0308-9 

6. Liu, D. et al. Calorie Restriction with or without Time-Restricted Eating in Weight Loss. N. Engl. J. Med. 386, 1495–1504 (2022). doi: 10.1056/NEJMc2207023. 

7. Acosta-Rodríguez, V. et al. Circadian alignment of early onset caloric restriction promotes longevity in male C57BL/6J mice. Science (80-. ). 376, 1192–1202 (2022). doi: 10.1126/science.abk0297.