Author: Superadmin

Magnesium is a mineral that plays several key roles in the body [1]. It is necessary for glycolysis and energy production; assists with the development of bone and muscle; regulates blood glucose, blood pressure, and protein synthesis; and influences the maintenance of healthy heart rhythm [1]. Magnesium’s role in health is pivotal, as is an understanding of the role of nutrition in acquiring magnesium — the requisite levels, key sources, and health consequences. 

The daily Recommended Dietary Allowance (RDA) of magnesium is 400-420 mg for adult men and 310-320 mg for adult women [2]. Approximately 10 to 30% of people do not consume enough of the nutrient [3]. To correct this problem, medical professionals encourage people to focus on nutrition, eating a diet that features leafy greens, mineral water, and certain fortified breakfast cereals, among other sources, to maintain their health [1, 2]. It is important to note, however, that some forms of processing may strip foods of their magnesium content, so foods meant to contain magnesium may lose their nutritional value after cooking in some cases [1].  

The modern Western diet generally features a decreased presence of magnesium, meaning that it may be advisable for people fitting into those food habits to take magnesium supplements, like magnesium oxide, chloride, and citrate, to round out their nutrition and health [1, 4]. Before taking magnesium supplements, though, one should note the various side effects of supplements. For one, they may have a laxative effect [2]. Magnesium supplements may also reduce blood pressure or antibiotic absorption [5]. Moreover, there is a lack of a consensus within epidemiological literature concerning whether magnesium supplements can correct the diseases often characteristic of magnesium deficiency [2]. These caveats illustrate why people should not take magnesium supplements without consulting their doctor. 

By taking the appropriate level of magnesium, people may better avoid severe health conditions. Research demonstrates a lack of magnesium can result in various cardiac, neurological, and other issues [6]. Researchers also suggest that magnesium helps prevent or treat type 2 diabetes, high blood pressure, osteoporosis, heart disease, and migraine headaches [3]. In the elderly, researchers have identified an association between magnesium deficit and hyperemotionality, sleep disorders, cognitive disorders, and asthenia [7]. These occurrences demonstrate the importance of satisfying nutrition guidelines for magnesium in order to optimize health. 

Along with taking sufficient magnesium, it is also important for people not to consume too much magnesium. The Tolerable Upper Intake Level for magnesium ingested via supplementary sources is 350 mg [2]. An overdose of magnesium can have negative consequences, including nausea, cramping, and diarrhea [2]. More serious health effects, such as low blood pressure, depression, cardiac arrest, and heartbeat irregularities, may also be indicative of excessive magnesium intake [3]. Fortunately, these negative effects are attenuated by the kidneys, which dispel excess amounts of magnesium through urine [2]. As a result, otherwise healthy people rarely exhibit signs of magnesium overdose, but those with kidney impairments should be more cautious [3]. 

Given the various health issues associated with magnesium deficiency and overdose, the importance of consuming enough but not too much magnesium cannot be overstated. With magnesium naturally occurring in many consumable goods, along with easily accessible supplements, the RDA can be satisfied with simple adjustments in one’s diet and routine. 

References 

[1] National Institutes of Health, “Magnesium,”  Updated June 2, 2022. [Online]. Available: https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/.  

[2] Harvard T.H. Chan School of Public Health, “Magnesium,”  Updated March 2023. [Online]. Available: https://www.hsph.harvard.edu/nutritionsource/magnesium/.  

[3] J. Leonard, “Can you take too much magnesium?,” Medical News Today, Updated October 16, 2018. [Online]. Available: https://www.medicalnewstoday.com/articles/323349.  

[4] D. Fiorentini et al., “Magnesium: Biochemistry, Nutrition, Detection, and Social Impact of Diseases Linked to Its Deficiency,” Nutrients, vol. 13, no. 4, pp. 1-44, Mar. 2021. [Online]. Available: https://doi.org/10.3390/nu13041136.  

[5] J. Kubala, “Health Benefits of Magnesium,” Health, Updated March 13, 2023. [Online]. Available: https://www.health.com/magnesium-7229399.  

[6] R. Swaminathan, “Magnesium Metabolism and its Disorders,” The Clinical Biochemist Reviews, vol. 24, no. 2, pp. 47-66, May 2003. [Online]. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1855626.  

[7] M. Barbagallo, N. Veronese, and L. J. Dominguez, “Magnesium in Aging, Health and Diseases,” Nutrients, vol. 13, no. 2, pp. 1-20, Jan. 2021. [Online]. Available: https://doi.org/10.3390/nu13020463.

Vegan diets have become increasingly popular in recent years as people are choosing to eliminate animal food products for environmental, ethical, and health reasons. Consuming a nutritionally balanced vegan diet may result in numerous positive health effects, including protection against liver disease, obesity, and certain kinds of cancer (5). However, those consuming a strictly vegan diet can be at risk of nutritional deficiencies that have a detrimental effect on overall health. 

Plant-based diets, including vegan diets, have repeatedly been linked to favorable blood lipid profiles and a lower risk of cardiovascular disease (1). Meat and animal products are higher in low-density lipoprotein cholesterol and saturated fats, contributing to plaque build-up. On the other hand, plant-based foods that are rich in monounsaturated fats and polyunsaturated fats help regulate blood lipoprotein levels (1). 

As a result, consuming more plant-based foods and reducing or eliminating meat and animal products results in lower levels of low-density lipoprotein cholesterol—a type of cholesterol that contributes to plaque build-up in blood vessels. Plaque build-up in arteries reduces the supply of oxygen-rich blood tissue to vital organs, increasing the risk of heart attack or stroke (1).  

Another of the positive health effects of a vegan diet is that nutritionally balanced plant-based diets can be rich in phytonutrients, including vitamins, antioxidants, and dietary fiber (4). Soluble fiber from fruits, vegetables, whole grains, and legumes helps facilitate cholesterol being flushed out of the body and reduces the synthesis of liver cholesterol (1). Fiber-rich foods may also help lower inflammation and reduce levels of leptin—a hormone that regulates appetite and body weight—protecting those who consume more plant-based foods against obesity and cardiovascular disease (2). 

The health effects of a vegan diet on cognitive function and brain health are less conclusive. Consuming a balanced vegan diet that is abundant in vitamins and antioxidants may help fight cognitive decline as we age (4). However, vegans who are not taking supplements can be deficient in key nutrients like vitamin B12, vitamin D, and DHA—an omega-3 fatty acid that serves as the main structural component of our brains (4). These deficiencies may increase the risk of Alzheimer’s disease and mental illnesses like depression (3). 

Those consuming vegan diets are also at risk of being deficient in nutrients that are less bioavailable in plant foods (6). Bioavailability refers to the percentage of a particular nutrient that the body is able to absorb and utilize. For example, although many plant-based foods are plentiful in iron, plants provide the non-heme form of iron, which is less bioavailable than heme-iron from animal products (6). As a result, vegans and vegetarians can have lower levels of ferritin and hemoglobin (6). Similarly, vegans can suffer from zinc deficiency due to low zinc bioavailability in plants, putting them at greater risk of depression, diarrhea, dermatitis, and alopecia (6). 

Many of the benefits of consuming a vegan diet also result from following other plant-based diets, including vegetarian and pescatarian diets. Low-fat, reduced animal-product omnivorous diets that are rich in whole grains, legumes, fruits, and vegetables have also been shown to provide many of the same benefits regarding lipoprotein profiles and the risk of cardiovascular disease (7). Plant-based diets that reduce the intake of animal products but do not necessarily completely eliminate them also have a much larger body of scientific literature to support their benefits compared to exclusively vegan diets (4). A non-vegan plant-based diet that incorporates some amount of animal products may be a better fit for some people depending on the desired health effects and the ability to intake essential nutrients. 

Ultimately, reducing your consumption of animal-based foods like meat can reduce your risk of developing certain illnesses, including cardiovascular disease. However, consuming a well-rounded diet that prioritizes plant foods and ensures that you absorb the necessary nutrients for proper organ function is key to harnessing the positive health effects of eating plant based, including vegan. 

References 

1. Elliott, Patrick et al. “Plant-Based Diets and Lipid, Lipoprotein and Inflammatory Biomarkers of Cardiovascular Disease: A Review of Observational and Interventional Studies.” Nutrients, vol. 14, no. 24, 17 Dec 2022, doi: 10.3390/nu14245371 

2. Gogga, Patrycja et al. “Plant-based diets contribute to lower circulating leptin in healthy subjects independently of BMI.” Acta biochimica Polonica, vol. 69, no. 4, 2022, pp. 879-882., doi:10.18388/abp.2020_6388 

3. Jain, Rishika et al. “Association between vegetarian and vegan diets and depression: A systematic review.” Nutrition Bulletin, vol. 47, no. 1, pp. 27-49, 19 Jan 2022, doi:10.1111/nbu.12540 

4. Katonova, Alzbeta et al. “Effect of a Vegan Diet on Alzheimer’s Disease.” International journal of molecular sciences, vol. 23, no. 23, pp. 1494,, 29 Nov 2022, doi:10.3390/ijms232314924 

5. McManus, Katherine D. “With a little planning, vegan diets can be a healthful choice.” Harvard Health Blog, Feb 6 2020, www.health.harvard.edu/blog/with-a-little-planning-vegan-diets-can-be-a-healthful-choice-2020020618766 

6. O’Keefe, James H et al. “Debunking the vegan myth: The case for a plant-forward omnivorous whole-foods diet.” Progress in Cardiovascular Diseases, vol. 74, pp. 2-8, September-October 2022, doi: 10.1016/j.pcad.2022.08.001 

7. Turner-McGrievy, Gabrielle M et al. “Effect of a Plant-Based vs Omnivorous Soul Food Diet on Weight and Lipid Levels Among African American Adults: A Randomized Clinical Trial.” JAMA network open, vol. 6, no. 1, 3 Jan 2023, doi:10.1001/jamanetworkopen.2022.50626 

Complementary and integrative health approaches to pain management can offer a safer, more cost-effective, and less invasive alternative to pharmaceutical and surgical methods for some people. Integrative health approaches can be used in the management of both acute and chronic pain and can be combined with pharmaceutical interventions to achieve the best possible outcomes for a patient (3). These therapies include long-held Eastern medical practices such as acupuncture, yoga, and tai chi, as well as mind-body therapies, spinal manipulations, aromatherapy, and even music therapy. 

More robust research is required to fully understand the benefits of complementary health approaches to pain management. However, current clinical guidelines and research demonstrate an optimistic outlook for integrative health in the management of fibromyalgia, arthritis, migraines, cancer pains, labor pains, and other forms of acute and chronic pain (2). 

To illustrate, research suggests that acupuncture—a centuries-old healing practice from Chinese medicine—could be an effective form of pain management for neck and back pain, migraines, headaches, arthritis, and postoperative pain (3). Acupuncture is a therapy that involves inserting sterile needles into “acupoints” to stimulate the body’s intrinsic healing abilities and invigorate a person’s “chi” or life force. Under the right conditions, acupuncture produces analgesic effects similar to those of pharmaceuticals and may stimulate the release of endorphins, chemicals that act as the body’s natural pain killer (3). Current clinical guidelines from the Society of Integrative Oncology and the American Society of Clinical Oncology recommend acupuncture for adult patients who are suffering from joint pain related to aromatase inhibitors, a type of medication used in breast cancer treatment (2). Acupuncture may even help relieve cancer pain or other musculoskeletal pains (2). 

Mind-body therapies like meditation, mindfulness, and yoga are other forms of complementary health approaches to pain management with an array of benefits. Mind-body therapies work by creating a connection between the mind and body to improve both physiological and psychological health outcomes in patients (6). Yoga, for example, can help reduce the symptoms of rheumatoid arthritis, including morning stiffness, inflammatory markers, and joint pain (6). In particular, mind-body therapies may be beneficial for patients suffering from rheumatoid arthritis who also present with depressive symptoms. 

Complementary health pain management approaches have also demonstrated efficacy in labor pain management for birthing people. One cognitive behavioral approach to labor pain management is the use of relaxation and breathing techniques to lower both labor pain and labor anxiety (5). A combination of breathing and relaxation techniques can help relieve fear and anxiety around labor as well as pain perception and ultimately reduce the negative health outcomes of cesarean sections and related financial and emotional burdens for patients (5). 

Patients and providers alike are becoming more knowledgeable about complementary health approaches to pain management as more and more research emerges around integrative health methods and their benefits. These alternatives to surgical and pharmaceutical interventions offer the possibility of not only decreasing a patient’s experience of pain, but also improving their overall ability to function and quality of life (3). Not to mention, integrative pain management methods can help reduce or eliminate the use of opioids for patients suffering from both acute and chronic pain, reducing the incidence of opioid dependency and addiction (4). All in all, increased research around and implementation of complementary health approaches for pain management are essential for continuing to improve the quality of patient care. 

References 

1. “Complementary and Integrative Management of Pain.” National Center for Complementary and Integrative Health. www.nccih.nih.gov/about/nccih-strategic-plan-2021-2025/top-scientific-priorities/complementary-and-integrative-management-of-pain 

2. “Complementary Health Approaches for Chronic Pain: What the Science Says.” NCCIH Clinical Digest for Health Professionals. Sept 2022, www.nccih.nih.gov/health/providers/digest/complementary-health-approaches-for-chronic-pain-science 

3. Hamlin, Amy S and T. Michelle Robertson. “Pain and Complementary Therapies.” Critical Care Nursing Clinics of North America, vol. 29, no. 4, Dec 2017, pp. 449-460, DOI:10.1016/j.cnc.2017.08.005 

4. Haskins, Julia. “Managing pain differently: A look at alternative therapies.” AAMCNews, 26 March 2019 

5. Kaple, Gayatri S and Shubhangi Patil. “Effectiveness of Jacobson Relaxation and Lamaze Breathing Techniques in the Management of Pain and Stress During Labor: An Experimental Study.” Cureus, vol. 15, no. 1, 1 Jan 2023, doi:10.7759/cureus.33212  

6. Slagter et al. “The Effect of Meditation, Mindfulness, and Yoga in Patients with Rheumatoid Arthritis.” Journal of Personalized Medicine, vol. 12, no. 1, 15 Nov 2022, doi:10.3390/jpm12111905 

Chiropractic care consists of joint and spine adjustments that are used to treat various pains and aches around the body [1]. An open question in chiropractic care is whether it can treat all joints in the body. Evidence on this point is conflicting, especially given how chiropractic care may indirectly contribute to pain alleviation via undirected adjustments. It is important for both patients and practitioners to understand where a chiropractor’s limitations are and whether they can treat every joint. 

One pathway through which chiropractic care alleviates joint pain is spinal manipulation [2]. Specifically, a core belief of the field is that manipulating spinal vertebrae and releasing pressure helps reduce joint pain [2]. Theories as to how this occurs are wide-ranging. Some practitioners believe that this practice of extension causes fibrous adhesions between joints to break; another theory is that the manipulations change how excitable and active the central nervous system is, and others hold other views [2]. 

Irrespective of our understanding of how chiropractic care can treat joints, pockets of research suggest that this mode of treatment can have beneficial effects on worn or painful joints. In the context of Parkinson’s disease (PD), Chu et al. detailed a case study in which a patient demonstrated improved gait and posture after eleven weeks of chiropractic manipulation [3]. According to a meta-analysis of seven trials by Cheatham and colleagues, short-term joint range of motion has also been said to improve following instrument-assisted soft tissue mobilization, which is a type of chiropractic treatment [4]. And a 2018 JAMA Network Open study reported that chiropractic care helped alleviate back pain in a cohort of active-duty military personnel [5]. While all of these studies require supplementary evidence to ensure the replicability of their results, they do seem to indicate that, at least in some instances, chiropractic care can help patients with joint problems. 

Nevertheless, chiropractors can’t treat every joint in the body, as illustrated by the case of arthritis. Medical professionals generally advise against using spinal manipulation on inflamed joints because such methods could cause greater harm [6, 7]. As a result, traditional chiropractic care may not always be an appropriate treatment for arthritis-afflicted joints [6]. Alternative modes of treatment like soft tissue therapies do exist, however, and they may be able to improve the range of motion and/or pain for people who suffer from arthritis [6]. Chiropractors often can provide soft tissue therapy in addition to traditional manipulations. 

Moreover, chiropractic care can be used to indirectly treat arthritis patients. For instance, a 2015 study indicated that chiropractic care helped assuage a patient’s inflammatory pain [1]. It is important to note, however, that this positive result was owing to the chiropractor’s treatment of the patient’s mechanical injuries [1]. Those injuries stemmed from the compensatory movements she engaged in as a result of her rheumatoid arthritis, rather than rheumatoid arthritis itself [1]. As such, this study does not indicate that chiropractic can treat all sources of joint pain, but rather that it can help lessen stress on already-inflamed joints. 

There are other contraindications for chiropractic care as well, such as acute joint injuries and osteoporosis. Chiropractors can’t treat every joint, however, more research is needed to better understand when alternative therapies are preferred for joint-related issues. 

References 

[1] R. Zimlich, “Can Chiropractic Care Help Relieve Symptoms of Rheumatoid Arthritis?,” Healthline, Updated March 14, 2022. [Online]. Available: https://www.healthline.com/health/advancing-rheumatoid-arthritis/chiropractor-for-rheumatoid-arthritis.  

[2] E. Ernst, “Chiropractic: A Critical Evaluation,” Journal of Pain and Symptom Management, vol. 35, no. 5, pp. 544-562, May 2008. [Online]. Available: https://doi.org/10.1016/j.jpainsymman.2007.07.004.  

[3] E. C. P. Chu, A. Y. L. Wong, and L. Y. K. Lee, “Chiropractic care for low back pain, gait and posture in a patient with Parkinson’s disease: a case report and brief view,” AME Case Reports, vol. 5, no. 34, October 2021. [Online]. Available: https://doi.org/10.21037%2Facr-21-27.  

[4] S. W. Cheatham et al., “The efficacy of instrument assisted soft tissue mobilization: a systematic review,” The Journal of the Canadian Chiropractic Association, vol. 60, no. 3, pp. 200-211, September 2016. [Online]. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5039777/.  

[5] R. H. Shmerling, “Should you see a chiropractor for low back pain?,” Harvard Health Publishing, Updated August 16, 2019. [Online]. Available: https://www.health.harvard.edu/blog/should-you-see-a-chiropractor-for-low-back-pain-2019073017412.  

[6] S. Langmaid, “Chiropractic Care for Joint Problems: What to Know,” WebMD, Updated September 30, 2022. [Online]. Available: https://www.webmd.com/rheumatoid-arthritis/chiropractic-care-for-joint-problems.   

[7] D. M. Taibi and C. Bourguignon, “The Role of Complimentary and Alternative Therapies in Managing Rheumatoid Arthritis,” Family and Community Health, vol. 26, no. 1, pp. 41-52, January-March 2003. [Online]. Available: https://www.jstor.org/stable/44954079.

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