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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. 

Prebiotics are a relatively new concept in nutrition science. Prebiotics were first introduced and defined in 1995 as food components that are not digested by the one eating but by the microbes living in their gut (1). They can be thought of as food for probiotics (2). Although the study of prebiotics is still ongoing, this field has attracted significant attention due to our growing knowledge of the importance of a healthy gut microbiome (1,3,4). The benefits of prebiotics include increasing the production and absorption of vitamins and minerals, as well as indirectly leading to the benefits of probiotics by stimulating probiotic growth (1,5). 

Using the original, strict definition of prebiotics, only one class of compounds fit the criteria: fructooligosaccharides (FOS), which are short- or medium-length carbohydrates and can be further divided into oligofructose or inulin. Garlic, onion, artichoke, and asparagus contain high levels of FOS (1). Studies show that FOS encourages the growth of bifidobacteria, a genus of gut inhabitants that is important for normal digestive health and is thought to help control the levels of pathogenic microbes in the gut (1,3,4,6). Bifidobacteria are often used as probiotics (1,3,4). 

Specifically, bifidobacteria seem to compete with and even directly inhibit the growth of other types of gut microbes that can be harmful, including clostridia, E. coli, and salmonellas (1,3,6). In addition, they can stimulate immune defenses and facilitate the production, absorption, and/or digestion of various nutrients (1,3,6). Prebiotics thus also carry these benefits by supporting the growth of bifidobacteria in particular.   

Furthermore, the fermentation of prebiotics by gut microorganisms produces short-chain fatty acids (SCFAs), which have antipathogenic effects, serve as metabolic fuel and modulators throughout the body, and are thought to improve the absorption of several minerals in the colon (1,3,6). 

Over the years, there has been significant debate as to the most useful definition of prebiotics. The original definition specifies that the compound a) is not digestible (by the host), b) selectively stimulates the growth of gut bacteria, and c) thus improves health. Other researchers have proposed expanding prebiotics to include compounds that positively impact microbiomes across the body and not just in the gut, that are not necessarily fermented by gut microorganisms, or that change the composition of the gut microbiome (3). Under alternative definitions, t-galactooligosaccharides (tGOS), lactulose, and dietary fibers broadly may be considered prebiotics as well (3). All prebiotics and prebiotic candidates so far are carbohydrates (3,6). 

Our understanding of prebiotics is evolving as additional research is performed. Depending on the exact definition used, prebiotics may be considered to have a narrower or broader range of benefits toward health, but in general, they support the normal, healthy functions of the gut microbiome. These include protection against pathogens and symbiotically assisting with nutrients and digestion. Currently established prebiotic compounds fall under the umbrella of dietary fibers, and further research may find that the broad benefits of dietary fibers – for example, lower risk of cardiovascular disease and diabetes – may be connected to prebiotics (6). Many fruits and vegetables contain prebiotics or candidate compounds, especially those that contain high levels of complex carbohydrates, and some supplements are also available (2,5).  

References 

1. Gibson, G. R., & Roberfroid, M. B. (1995). Dietary modulation of the human colonic microbiota: introducing the concept of prebiotics. The Journal of Nutrition, 125(6), 1401-1412. doi: 10.1093/jn/125.6.1401 

2. Villines, Z. (2018). “What is the difference between prebiotics and probiotics?” Medical News Today. https://www.medicalnewstoday.com/articles/323490 

3. Bindels, L. B., Delzenne, N. M., Cani, P. D., & Walter, J. (2015). Towards a more comprehensive concept for prebiotics. Nature Reviews Gastroenterology & Hepatology, 12(5), 303–310. doi:10.1038/nrgastro.2015.47 

4. Roberfroid, M. (2007). Prebiotics: The Concept Revisited. The Journal of Nutrition, 137(3), 830S–837S 

5. Mayo Clinic Staff. (2021). “Prebiotics, probiotics and your health.” Mayo Clinic. https://www.mayoclinic.org/prebiotics-probiotics-and-your-health/art-20390058 

6. Slavin, J. (2013). Fiber and Prebiotics: Mechanisms and Health Benefits. Nutrients, 5(4), 1417-1435. doi:10.3390/nu5041417 

Prebiotics and probiotics are two related components of food and nutrition with major benefits for health. Probiotics are living microorganisms that can live in your gut and have a positive impact on digestion and other physiological processes. A normal, healthy gut contains an incredibly large number of microbes, most of which are beneficial – together, this is referred to as the gut microbiome. Prebiotics, in contrast, are a relatively newer concept and are defined as substances that provide food for probiotics (1,2). 

The purported benefits of prebiotics and probiotics are wide-ranging, from digestive health to mental health. Some of the benefits are well-supported by rigorous research, whereas others are so far only supported by small observational studies or anecdotal accounts. This article will focus on probiotics, with a companion article discussing prebiotics. 

Probiotics can be found in many fermented foods, such as yogurt, kimchi, kombucha, and fermented cheeses. Probiotic supplements are also widely available. In terms of digestive health, researchers have found some evidence that probiotics can help patients with irritable bowel syndrome (IBS) and infectious or antibiotic-associated diarrhea (3-7). 

IBS is difficult to treat, as the underlying cause is not well understood. Patients with IBS have been found to have a different gut microbiome profile, but it is not clear whether that is a cause or an effect (3,5). Trials of probiotics have reported conflicting results, but a review by Moayyedi et al. concluded that the overall evidence suggests probiotics have a benefit for IBS patients, though further research is needed to determine what the best treatment protocol is, given that there are many different types of probiotics and given the heterogeneity of IBS itself (3-5). 

The link between probiotics and diarrhea caused by a disruption to the normal gut microbiome is more intuitively clear. Dysbiosis, caused by either being infected by a harmful gut microorganism or by antibiotics that broadly kill gut microorganisms and leave space for harmful ones to proliferate, can be improved by adding beneficial microbes back into your system. Probiotics can improve recovery in infectious diarrhea and can also help prevent diarrhea in patients taking antibiotics (3,4,6,7). 

Other purported benefits of probiotics include reducing lactose intolerance, improving mental health, treating inflammatory bowel disease, reducing the risk of colorectal cancer, combating side effects of radiation therapy and chemotherapy, and improving immune function (2-4,8). However, research in several of these areas is still in early stages or has not found much support. Current knowledge is limited by the fact that this field of research is relatively young, many existing studies were not appropriately designed to be able to provide high quality evidence for either the benefits of probiotics or lack thereof, and the gut microbiome is an extremely rich and complex ecosystem (1,3,4). 

Probiotics can be a healthy addition to your nutritional plan. They have known benefits for the digestive system and may have benefits for other areas of health as well. In particular, recent research has found a link between the gut and the nervous system, and one major question in this field is whether probiotics may improve neurological, mental, and/or cognitive health (3,4). Anyone with questions about whether to add probiotics to their nutritional plan should consult a trained professional, such as a dietitian or chiropractor with training in nutrition. 

References 

1. Mayo Clinic Staff. (2021). “Prebiotics, probiotics and your health.” Mayo Clinic. https://www.mayoclinic.org/prebiotics-probiotics-and-your-health/art-20390058 

2. Villines, Z. (2018). “What is the difference between prebiotics and probiotics?” Medical News Today. https://www.medicalnewstoday.com/articles/323490 

3. Sanders, M. E., Guarner, F., Guerrant, R., et al. (2013). An update on the use and investigation of probiotics in health and disease. Gut, 62(5), 787–796. doi:10.1136/gutjnl-2012-302504 

4. Gareau, M. G., Sherman, P. M., & Walker, W. A. (2010). Probiotics and the gut microbiota in intestinal health and disease. Nature Reviews Gastroenterology & Hepatology, 7(9), 503–514. doi:10.1038/nrgastro.2010.117 

5. Moayyedi, P., Ford, A. C., Talley, N. J., et al. (2010). The efficacy of probiotics in the treatment of irritable bowel syndrome: a systematic review. Gut, 59, 325-332. doi:10.1136/gut.2008.167270 

6. Guarino, A., Vecchio, A. L., Canani, R. B. (2009) Probiotics as prevention and treatment for diarrhea. Current Opinion in Gastroenterology, 25(1), 18-23. doi:10.1097/MOG.0b013e32831b4455 

7. Goldenberg, J. Z., Yap, C., Lytvyn, L., et al. (2017). Probiotics for the prevention of Clostridium difficile‐associated diarrhea in adults and children. Cochrane Database of Systematic Reviews, 12. doi:10.1002/14651858.CD006095.pub4 

8. Shaukat, A., Levitt, M., Taylor, B. C., et al. (2010). Systematic Review: Effective Management Strategies for Lactose Intolerance. Annals of Internal Medicine, 152(12), 797-803. doi:10.7326/0003-4819-152-12-201006150-00241 

Mobile phone use is ubiquitous in modern society and affords a wide range of benefits, such as connecting people and providing access to information. However, mobile phones have also been linked to a number of health issues. For example, many researchers and clinicians within psychology argue that extreme and problematic mobile phone use can fit the criteria of a behavioral addiction (1). Mobile phones have also been associated with joint problems, particularly in the hands and neck. This issue warrants the attention of several professional fields for research, prevention, and treatment, including primary care doctors, ergonomic specialists, orthopedic doctors, and chiropractors. 

Technological and behavioral changes have outpaced the rate at which the human body can evolve. In the musculoskeletal system, for example, the adverse effects of sitting for long periods (such as at a desk job) and some types of repetitive motion (such as in assembly line work and sports training) are well established. With mobile phones, users often engage in several unnatural positions or movements that can cause joint problems: the majority of the weight is often supported by just the pinkie finger, the arm may be bent in the same position for long periods, the thumbs or another preferred typing finger is used over and over, and the neck is often bent in a suboptimal position. Common problems related to mobile phones include pain, stiffness, or numbness, which can occur in the finger, hand, wrist, or neck joints depending on the individual (2,3).  

Awareness of this issue has been increasing through anecdotal reports and a growing body of research. Orthopedic doctors in Madrid reported two adults in their thirties with osteoarthritis of the trapeziometacarpal joint, a joint at the base of the thumb. Osteoarthritis is caused by gradual wear and tear of joints; it is uncommon in younger adults. Trapeziometacarpal joint osteoarthritis is even more uncommon but can be caused by repetitive thumb activities. Other studies have also reported inflammation of tendons, synovial sheaths, and fascia due to mobile phone use (4).  

Another group of researchers performed a retrospective analysis of 70 individuals who reported pain related to extensive use of handheld devices (mobile phones, tablets, game controllers), were diagnosed with a musculoskeletal disorder of the upper extremities, and underwent rehabilitation. Patients were more likely to have symptoms in their dominant hand. The diagnosed conditions included tendinosis and myofascial pain syndrome. Data suggested that the joint problems were linked to the predominant usage of a specific finger/thumb. Fortunately, patients recovered with rehabilitation, which is a positive sign for other providers seeking to design treatment plans for joint problems associated with mobile phones (5). 

In addition to data linking joint problems to mobile phones based on reported symptoms, studies looking for a mechanistic explanation have examined how muscles are used during phone use in symptomatic and healthy individuals. Xie et al. used electromyography on postural muscles in the neck and shoulders, and muscles controlling hand and thumb movement. Participants with neck/shoulder pain had higher muscle activity in postural muscles than healthy controls. Results suggest that unbalanced neck positioning is related to neck/shoulder pain, though whether the relationship is causal could not be determined. In addition, one-handed texting was associated with higher muscle load than two-handed texting (6). 

Individuals who frequently use mobile phones should try to stay aware of their head, neck, and upper back posture to prevent strain. Using two hands when possible may be beneficial for hand and finger joint health, while adding a device to change how you grip your phone (such as a pop grip) may also help (2,3). Ice and splinting, physical therapy, and chiropractic may be appropriate for treating pain. Overall, the best prevention strategy is to avoid phone overuse. 

References 

1. Gutiérrez, J. D.-S., de Fonseca, F. R., and Rubio, G. Cell-Phone Addiction: A Review. Frontiers in Psychiatry, 2016;7:175. DOI:10.3389/fpsyt.2016.00175 

2. Waston, K. “How to Prevent Smartphone Finger and Smartphone Thumb.” Healthline, 2021. https://www.healthline.com/health/smartphone-finger 

3. Moyer, M. W. “Text Neck, Pinkie Pain and Other Ways Phones Can Wreck Our Bodies.” The New York Times, 2022. https://www.nytimes.com/2022/04/28/well/live/neck-joint-pain-phone.html 

4. Canillas, F., Colino, A., and Menéndez, P. Cellular Phone Overuse as A Cause for Trapeziometacarpal Osteoarthritis: A Two Case Report. Journal of Orthopedic Case Reports, 2014;4(4):6-8. DOI: 10.13107/jocr.2250-0685.213 

5. Sharan, D., Mohandoss, M., Ranganathan, R., and Jose, J. Musculoskeletal Disorders of the Upper Extremities Due to Extensive Usage of Hand Held Devices. Annals of Occupational and Environmental Medicine, 2014;26:22. 

6. Xie, Y., Szeto, G. P. Y., and Madeleine, P. A comparison of muscle activity in using touchscreen smartphone among young people with and without chronic neck–shoulder pain. Ergonomics, 2015;59(1). DOI: 10.1080/00140139.2015.1056237