Why Women Get More Fibromyalgia, IBS, and Anxiety Than Men

By Dr. David M. Brady and Danielle Moyer, MS

The occurrence of fibromyalgia is 10 to 20 times higher in women than in men [1]. Those women are also more likely than men to have severe tender points of pain, “pain all over”, sleep disturbances, and fatigue [2]. 

The incidence of Irritable Bowel Syndrome (IBS) is higher in women when compared to men. Internationally, the prevalence of IBS is 67% higher in women [3].

Anxiety disorders are more than twice as likely to occur in women when compared to men [4].

The question is: why?

Though the reasons are still being studied, research suggests that an interaction between biology, psychology, and sociocultural factors leads to higher occurrences of these diseases in women [5]. Of particular interest is the role of women’s hormonal and nervous systems, which respond somewhat differently to stress and trauma than those of men [1].

Research by the American Psychological Association looked at 290 studies between 1980 and 2005 to determine if men or women were more at risk for potentially traumatic events and PTSD (Post-traumatic Stress Disorder). The results concluded that, although men experience more traumatic events on average than women, women are more likely to meet diagnostic criteria for PTSD. PTSD is an anxiety disorder caused by a traumatic event and symptoms include “re-experiencing the trauma, avoidance and numbing and hyperarousal [6].” PTSD occurs in 10-12% of women and 5-6% of men, making the rate in women almost double [7]. Women’s PTSD also tends to last longer (on average four years), whereas men’s lasts one year on average [8]. 

The types of trauma men and women experience are different as well. Men are more likely to experience trauma from natural disasters, human-caused disasters, accidents, and combat, whereas women are more likely to experience trauma from domestic violence, sexual abuse, and sexual assault [6]. Sexual trauma has been shown to be particularly toxic to mental health, and can typically begin at a young age when the brain is still developing [8]. This can impact a woman's fear and stress response well into adulthood.

Trauma, stressors, and/or PTSD alter pain processing and incoming stimuli in an individual. They can frequently cause an excessive stress response, significant and chronic pain, and central sensitization disorders [1]. Central sensitization disorders cause a person’s nervous system to become regulated in a highly persistent state of reactivity, making their threshold to pain and touch incredibly low. This is associated with consistent and chronic pain [9]. Trauma, stressors, and/or PTSD can also affect the brain’s functioning by increasing hyperarousal, hypervigilance, and increased wakefulness and sleep disruption (learn more about sleep’s relationship to fibromyalgia here) [10]. 

Due to this, stressors or catastrophic events have been found to trigger the development of fibromyalgia, IBS, and anxiety. The intensity, multitude, or period of time of the “stressor” may even be a predictor of adverse health outcomes because they can lead to permanent changes in the human stress response systems [11]. 

In fact, studies show that “patients with fibromyalgia and related conditions may be more likely than nonaffected individuals to have experienced physical or sexual abuse in childhood. [11]” This intricate relationship can also cause an unfortunate domino effect. For example, increased hypervigilance from past traumas or stressors can cause a greater level of threat detection, which can then lead to increased anxiety, which can then increase hypervigilance yet again, and so on, creating a classic “feed-forward cycle”. Furthermore, increased hypervigilance has been shown to increase visceral pain perception in women with IBS and chronic pain states in women with fibromyalgia [12-14]. 

Female predominance in these syndromes and disorders can also be influenced by gender differences in… [15]

  • Sociocultural reactions to pain/coping mechanisms
  • Access to healthcare
  • Research and resources on women’s health conditions  
  • Physiological reactions to pain sensitivity and pain amplification to sensory stimuli
  • Hormonal and nervous systems stress and trauma responses, as described above 

More research is needed to explore this important connection between women’s trauma and subsequent health issues. We know that women are strong, but their vulnerability to developing fibromyalgia, IBS, and anxiety is unfortunately strong too. 

To learn more about PTSD, please visit the National Institute of Mental Health’s website.

References

  1. Brady DM, Schneider, MJ. Pain and Fatigue: When It’s Fibromyalgia and When It’s Not. Townsend Letter. October 2012;351:44-50.
  2. Forbes D, Chalmers A. Fibromyalgia: revisiting the literature. J Can Chiropr Assoc. 2004;48(2):119-131.
  3. Canavan C, West J, Card T. The epidemiology of irritable bowel syndrome. Clin Epidemiol. 2014;6:71-80. doi:10.2147/CLEP.S40245
  4. Anxiety Disorders. Office on Women’s Health website. https://www.womenshealth.gov/mental-health/mental-health-conditions/anxiety-disorders. Published January 30, 2019. Accessed April 14, 2021. 
  5. Yunus MB. The role of gender in fibromyalgia syndrome. Curr Rheumatol Rep. 2001;3(2):128-134. doi:10.1007/s11926-001-0008-3
  6. Tolin DF. Women Are Diagnosed with PTSD More than Men, Even Though They Encounter Fewer Traumatic Events, Says Research. American Psychological Assocation website. https://www.apa.org/news/press/releases/2006/11/ptsd-rates. Published 2006. Accessed April 14, 2021. 
  7. Olff M. Sex and gender differences in post-traumatic stress disorder: an update. Eur J Psychotraumatol. 2017;8(sup4). doi:10.1080/20008198.2017.1351204
  8. Greenberg M. Psychology Today website. https://www.psychologytoday.com/us/blog/the-mindful-self-express/201809/why-women-have-higher-rates-ptsd-men. Published September 25, 2018. Accessed April 14, 2021.
  9. McAllister MJ. What is Central Sensitization? Institute for Chronic Pain website. https://www.instituteforchronicpain.org/understanding-chronic-pain/what-is-chronic-pain/central-sensitization. Published March 23, 20213. Reviewed May 29, 20217. Accessed April 20, 2021. 
  10. Sherin JE, Nemeroff CB. Post-traumatic stress disorder: the neurobiological impact of psychological trauma. Dialogues Clin Neurosci. 2011;13(3):263-278.
  11. Harris RE, Clauw DJ. Newer treatments for fibromyalgia syndrome. Ther Clin Risk Manag. 2008;4(6):1331-1342.
  12. Kimble M, Boxwala M, Bean W, et al. The Impact of Hypervigilance: Evidence for a Forward Feedback Loop. J Anxiety Disord. 2014;28(2):241-245. doi:10.1016/j.janxdis.2013.12.006
  13. Meleine M, Matricon J. Gender-related differences in irritable bowel syndrome: Potential mechanisms of sex hormones. World J Gastroenterol. 2014;20(22):6725-6743. doi:10.3748/wjg.v20.i22.6725
  14. Behavioral and Neuronal Investigations of Hypervigilance in Patients with Fibromyalgia Syndrome. Accessed April 14, 2021. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0035068
  15. Kim SE, Chang L. Overlap between functional GI disorders and other functional syndromes: what are the underlying mechanisms? Neurogastroenterology & Motility. 2012;24(10):895-913. doi:https://doi.org/10.1111/j.1365-2982.2012.01993.x

mitochondrial-health-and-energy

Mitochondrial Health and Energy

By Dr. David M. Brady and Danielle Moyer

 

If there is one thing we remember from middle school biology, it is that the mitochondria are the powerhouses of the cell. 

But, let’s break that down a little. 

We get energy from the food we eat. That is why humans tend to be more productive, be physically active, or work better together when they are well fed. However, a piece of broccoli does not just magically turn into energy when you put it in your mouth. Instead, your body initiates a complex set of reactions that convert protein, fats, and carbohydrates into usable forms of energy called ATP, or adenosine triphosphate. The mitochondria are the organelles in the cell that perform this energy conversion. 

Here is some useful information to know about mitochondrial energy production [1]: 

  • Our mitochondria can never “turn off”. Our cells must create energy every second of the day to survive because we have no storage for ATP! 
  • The mitochondria produce over 90% of our energy. 
  • Mitochondria are inherited entirely from your mother. Thanks mom!
  • Each cell in our body can contain anywhere between 1,000 to 2,500 mitochondria per cell. 
  • Different bodily cells will have different amounts of mitochondria depending on how much energy production they require. For example, cells found in the muscle and liver contain some of the highest number of mitochondria per cell.
  • The brain uses up about 70% of our energy production. Talk about brain power!
  • A single cell produces 10 billion ATP per day.
  • In one day, a healthy person will produce the equivalent of 1200 watts of energy in ATP.

Our bodies are designed to produce fast, efficient energy from our mitochondria. Unfortunately, mitochondria are not invincible. They are incredibly susceptible to damage from poor diets, nutrient deficiencies, or environmental toxins (e.g. heavy metal exposure, alcohol, pollutants, or prescription drugs), which affects our energy levels [1]. 

Because of the mitochondria’s essential role in cellular life or death, mitochondrial damage or dysfunction can cause or aggravate some common diseases. These include diabetes, cardiovascular disease, Alzheimer’s disease, chronic fatigue syndrome, Parkinson’s disease, migraine headaches, cancer, autism, and/or dementia [1-3]. Additionally, as we grow older our mitochondrial damage can accumulate, which can explain why people tend to “lose energy” when they hit around 55 years old [1]. 

Nevertheless, we are not doomed! 

One key strategy to improve or maintain mitochondrial health is to provide the body nutrients that facilitate ATP production and/or protect the body from toxins that would damage the mitochondria. For example, our mitochondria require nutrients including magnesium, vitamin B2 (riboflavin), and vitamin B3 (niacin) to properly create ATP [1]. This means magnesium, vitamin B2, and vitamin B3 can be considered “cofactors” to energy production and should be consumed every day. 

Any type of food you eat will give your body the opportunity to convert that food into energy. However, your body’s level of specific nutritional cofactors will determine how well your body will successfully or efficiently convert the food into energy. Essentially, we need to provide the right tools for the machinery to work. 

Other ways to improve mitochondrial function is to decrease toxin exposure, which can lower mitochondrial damage, and to build muscle mass, which can increase ATP production due to muscular cells having large amounts of mitochondria [1]. Having a well-rounded, nutrient-dense diet that supplies the body with essential cofactors begins with our food choices, but can be supplemented with a high-quality multivitamin and multimineral, or in a better way with a targeted mitochondrial nutrient formulation such as Mitochondrial-NRG, formulated by Dr. Brady, which includes the required activated B-vitamins, along with energy co-factor nutrients such as CoQ10, ribose, L-carnitine, and more. 

One vitamin that has emerged as a focus for mitochondrial health is niacin, or vitamin B3. Niacin can be found naturally in chicken, tuna, turkey, salmon, beef, peanuts, lentils, lima beans, and fortified foods [4]. Niacin converts into NAD+, or nicotinamide adenine dinucleotide, in the body. NAD+ is required for all living cells and their mitochondrial energy production, DNA repair, and cell survival [4-5]. Considering this, my practice has been using a supplemental form of niacin called nicotinamide mononucleotide (NMN) called Liposomal NMN Synergy to rebalance the energy biochemistry and respiration in the body at a cellular level for those with Long Haul COVID [6]. To learn more about Long Haul COVID, click here: https://drdavidbrady.com/long-haul-covid-syndrome/

Now that we have refreshed our memories of middle school biology (and hopefully not too much else about middle school) we remember just how important our mitochondria are for our cell’s energy and survival. It is no surprise that the powerhouses of the cell have such a powerful reputation.

References: 

  1. Pizzorno J. Mitochondria—Fundamental to Life and Health. Integr Med (Encinitas). 2014;13(2):8-15.
  2. Javadov S, Kozlov AV, Camara AKS. Mitochondria in Health and Diseases. Cells. 2020;9(5). doi:10.3390/cells9051177 
  3. Kramer P, Bressan P. Our (Mother’s) Mitochondria and Our Mind. Perspect Psychol Sci. 2018;13(1):88-100. doi:10.1177/1745691617718356
  4. Cantó C, Menzies K, Auwerx J. NAD+ metabolism and the control of energy homeostasis - a balancing act between mitochondria and the nucleus. Cell Metab. 2015;22(1):31-53. doi:10.1016/j.cmet.2015.05.023
  5. Hidgon J. Niacin. Linus Pauling Institute website. Published 2000. Reviewed March 2018. Accessed March 23, 2021. https://lpi.oregonstate.edu/mic/vitamins/niacin 
  6. Liposomal NMN SynergyTM. Designs for Health website. Accessed March 23, 2021. https://shop.designsforhealth.com/liposomal-nmn-synergy?quantity=1&custcol_dfh_size=8 

 


fibro-better-sleep

Better Sleep for Those with Fibromyalgia

By Dr. David M. Brady and Danielle Moyer

 

What would be the perfect storm for disrupted sleep? Probably some combination of widespread pain, abnormal pain perception, and heightened awareness and sensitivity to stimuli (touch, light, and sound), and anxiety [1]. Unfortunately, these are the exact symptoms of fibromyalgia, a syndrome that impacts over 4 million US adults every day - about 2% of the population [2]. Sleep disturbances affect 90% of fibromyalgia patients, whose complaints include, “nocturnal restlessness, involuntary leg movements, frequent awakenings and a perception that sleep is light and non-refreshing, with fatigue and stiffness upon waking”[3].

To understand this more, sleep can be broken down into different stages. Approximately 5% consists of wakefulness, 25% is spent in the REM cycle, 50% in the “light” and “intermediate” sleep stage, and 20% in the short-wave sleep. Short-wave sleep is believed to be crucial for restoration, as that is where heart rate, blood pressure, energy use, and stress hormones are decreased, while growth hormone is released. Patients with fibromyalgia, as compared to healthy individuals, have been shown to have reduced short-wave sleep, impacting their quality of sleep. Additionally, during the non-REM portion of sleep, the abnormal pain processing of fibromyalgia triggers something called “alpha-wave intrusion” sleep patterns. Alpha-wave intrusions are associated with wakefulness during deep delta-wave sleep, reinforcing the “nonrestorative” sleep pattern and daytime fatigue in fibromyalgia patients [3].

Looking more closely at the relationship of fibromyalgia and sleep, researchers have found that sleep and pain have a bidirectional role in their progression. On one hand, poor sleep quality can worsen or even initiate symptoms of fibromyalgia, resulting in increased pain, altered pain processing, worsened physical functioning, and altered mood [4]. On the other hand, the abnormal pain processing of fibromyalgia correlates to the reduced deep short-wave sleep and triggered alpha-wave intrusion frequencies explained above. Studies have shown that the interaction of pain and sleep disturbances are associated with the prevalence of depression, anxiety, and stress in patients with fibromyalgia as well [4].

Essentially, studies show that fibromyalgia patients who experience intense pain also tend to experience poor sleep, and vice versa. As a result, therapeutic approaches capable of reducing or eliminating sleep disruptions should have a similar effect on the pain and fatigue symptoms in patients with fibromyalgia [5].

So, how does one break this vicious cycle?

Approaches to improving sleep begin with education around sleep hygiene and management [5]. Here are some tips that would help anyone, including patients with fibromyalgia, improve their sleep through time:

  • Set a regular sleep pattern where you go to bed and wake up at the same time every day (including weekends) [6]. One should allow their body 7-8 hours of sleep to repair itself, physically and mentally. This includes considerations of “sleep opportunity” and sleep itself. For example, someone’s sleep opportunity may be the 8 hours they lay in bed, despite actually sleeping for only 6 hours.
  • Make your bedroom a relaxing environment. Keep the room dark, quiet, and cool (65 degrees Fahrenheit) [7]. Invest in a comfortable mattress and bedding. Use your bed for sleep – avoid doing work, watching TV, reading, or checking your phone once you’re in bed. Avoid having pets in bed with you that may disturb your sleep.
  • Make time to relax every day. Relax with deep-breathing exercises, meditation, listening to soft music, taking a warm bath, and getting out into nature. This can reduce stress and improve sleep quality.
  • Exercise frequently, but not within 3 hours of bedtime. With fibromyalgia, exercising can be difficult at first due to the pain. However, studies show that regular exercise and movement can often reduce pain symptoms and fatigue in fibromyalgia. Even walking around one’s neighborhood or home can help to relieve symptoms. Start low and slowly increase the activity through time. Working with a physical therapist, chiropractic physician, trainer, or other knowledgeable health professional can be beneficial. Additionally, exercise is best done earlier in the day to not interfere with sleep [6].
  • Avoid drinking caffeine or alcohol, using nicotine, or eating large meals before bedtime [8]. Avoiding any large amount of liquids before bed can lower the chances of having to go to the bathroom in the middle of the night. Caffeine can be snuck into desserts (chocolate), medications, and tea. Alcohol contributes to frequent waking and increased trips to the bathroom during the night. Nicotine in cigarettes acts as a stimulant, which can further disrupt sleep problems [6].
  • Lower exposure to stimulating activities right before bed. No scary or intense movies, books, or projects that might make it difficult to fall asleep. The more you can avoid electronic screen exposure within 2-hours of bedtime the better. 
  • Consider Cognitive Behavioral Therapy (CBT). This encourages patients to change their thought patterns for the better, letting go of negative thoughts that might be inhibiting their ability to sleep [9].
  • Research whether your medications may be affecting your sleep as a side effect. Some medications worsen sleep, whereas others improve sleep. Knowing which one you have is important.

There are also other agents, such as supplements, that have been shown to improve sleep overall for people and patients with fibromyalgia. Before taking any supplements, please talk with your doctor, nutritionist, or other healthcare practitioner to see if they are right for you.

  • Vitamin D. Vitamin D can reduce pain in patients with conditions such as fibromyalgia, and it has also been shown to improve sleep hygiene in patients with fibromyalgia [10]. It is recommended to get your vitamin D levels checked at your doctors, as it can depend on your geographic location, exposure to sun, and time of the year.
  • Melatonin. Melatonin is a natural hormone that the body produces to regulate sleep cycles, but the production of it declines as we age. As a result, taking it in supplemental form can benefit people with fibromyalgia by improving sleep quality and reducing fatigue, as well as reducing pain [11-12].
  • 5-HTP (5-Hydroxytryptophan). 5-HTP is converted to the hormone serotonin in the body, which helps us fall asleep. Clinical evidence has shown that taking 100 mg of 5-HTP orally three times a day for 30 to 90 days can improve pain, tenderness, sleep, anxiety, fatigue, and morning stiffness in people with primary fibromyalgia syndrome [13-14].
  • Botanical Herbs. Herbs have been used as remedies to improve sleep for decades, and some of the most researched and well tolerated are below [15]. One can find them individually packaged in supplements, or often in combination supplements.
    • Valerian (Valeriana officinalis)
    • Passionflower (Passiflora incarnata)
    • Chamomile (Matricaria chamomilla)
    • Lavender (Lavandula angustifolia)
    • Lemon Balm (Melissa officinalis)
  • L-theanine. L-theanine is a compound found in tea leaves and has been shown to promote relaxation, decrease stress, and relax the mind to promote better sleep, without causing drowsiness or acting as a sedative [16].

When working with a healthcare provider to improve sleep with fibromyalgia, the first step to any therapeutic approach would be to get the patient’s sleep history. This includes factors about their sleep hygiene: Activities done before bed (physical exercise), attitude towards sleep (anxiety present), daytime activities that can impact sleep, dietary and lifestyle factors (caffeine, alcohol, and nicotine use), medications that affect sleep, and any other sleep-disrupting disorders [5].

Improving a person’s sleep is important for anyone, but especially for those with fibromyalgia. Look at the recommendations above and identify one or two that you can start right away. Not only will you feel more rested, but your pain may be lowered as well. Win, win.

 

References:

  1. Schneider MJ, Brady DM, Perle SM. Commentary: differential diagnosis of fibromyalgia syndrome: proposal of a model and algorithm for patients presenting with the primary symptom of chronic widespread pain. J Manipulative Physiol Ther. 2006;29(6):493-501. doi:10.1016/j.jmpt.2006.06.010
  2. Fibromyalgia. Centers for Disease Control and Prevention website. https://www.cdc.gov/arthritis/basics/fibromyalgia.htm. Reviewed January 6th, 2020. Accessed February 23, 2021. 
  3. Choy EHS. The role of sleep in pain and fibromyalgia. Nature Reviews Rheumatology. 2015;11(9):513-520. doi:10.1038/nrrheum.2015.56
  4. Keskindag B, Karaaziz M. The association between pain and sleep in fibromyalgia. Saudi Med J. 2017;38(5):465-475. doi:10.15537/smj.2017.5.17864
  5. Spaeth M, Rizzi M, Sarzi-Puttini P. Fibromyalgia and Sleep. Best Practice & Research Clinical Rheumatology. 2011;25(2):227-239. doi:10.1016/j.berh.2011.03.004
  6. Amigues I. Fibromyalgia. American College of Rheumatology website. https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Fibromyalgia. Reviewed March 2019. Accessed February 23, 2021. 
  7. Pacheco D. The Best Temperature for Sleep. Sleep Foundation website. https://www.sleepfoundation.org/bedroom-environment/best-temperature-for-sleep. Reviewed October 29, 2020. Accessed February 23, 2021. 
  8. Clauw D. Fibromyalgia. Office of Women’s Health website. https://www.womenshealth.gov/a-z-topics/fibromyalgia. Reviewed April 1, 2019. Accessed February 23, 2021. 
  9. Bennett R, Nelson D. Cognitive behavioral therapy for fibromyalgia. Nat Clin Pract Rheumatol. 2006;2(8):416-424. doi:10.1038/ncprheum0245
  10. Oliveira DL de, Hirotsu C, Tufik S, Andersen ML. The interfaces between vitamin D, sleep and pain. Journal of Endocrinology. 2017;234(1):R23-R36. doi:10.1530/JOE-16-0514
  11. Hussain SA-R, Al-Khalifa II, Jasim NA, Gorial FI. Adjuvant use of melatonin for treatment of fibromyalgia. J Pineal Res. 2011;50(3):267-271. doi:10.1111/j.1600-079X.2010.00836.x
  12. Citera G, Arias MA, Maldonado-Cocco JA, et al. The effect of melatonin in patients with fibromyalgia: a pilot study. Clin Rheumatol. 2000;19(1):9-13. doi:10.1007/s100670050003
  13. Caruso I, Sarzi Puttini P, Cazzola M, Azzolini V. Double-blind study of 5-hydroxytryptophan versus placebo in the treatment of primary fibromyalgia syndrome. J Int Med Res. 1990;18(3):201-209. doi:10.1177/030006059001800304
  14. Sarzi Puttini P, Caruso I. Primary fibromyalgia syndrome and 5-hydroxy-L-tryptophan: a 90-day open study. J Int Med Res. 1992;20(2):182-189. doi:10.1177/030006059202000210
  15. Guadagna S, Barattini DF, Rosu S, Ferini-Strambi L. Plant Extracts for Sleep Disturbances: A Systematic Review. Evid Based Complement Alternat Med. 2020;2020. doi:10.1155/2020/3792390

Rao TP, Ozeki M, Juneja LR. In Search of a Safe Natural Sleep Aid. J Am Coll Nutr. 2015;34(5):436-447. doi:10.1080/07315724.2014.926153


woman wearing mask

Long-Haul COVID Syndrome

By Dr. David M. Brady and Danielle Moyer

 

It has been over a year since the COVID-19 virus unleashed a pandemic onto the world. We have witnessed the catastrophic effects of the virus on the individual, varying case-by-case. Some were asymptomatic, some only got mildly sick, some had severe cases with acute illness or respiratory distress syndrome, and some sadly succumbed to the disease. A year later, there exists a large group of COVID victims that have not been as recognized as they so rightfully deserve – the COVID long-haulers.

“Long-haulers” refers to those who had COVID-19 and have recovered from the acute symptoms of the virus. Yet, they experience long-term symptoms that extend far beyond the two-week viral infection period or what the “normal” time of recovery would be. These symptoms could last for weeks or, in some cases, more than 6 months after initial  COVID-19 infection [1].

Long-haul COVID is not well-defined or understood, as research limitations can only evolve as time progresses. The symptoms are sometimes vague and nonspecific, and the variety and commonality of them make it hard to make a confirmed COVID-related diagnosis. These non-specific symptoms are often described as intermittent, where improvement in health is quickly followed by recurring suffering [1].

I have witnessed these long haulers in my medical practice and personal life. In fact, my lovely wife is one of them.

At the World Health Organization’s international “Long-COVID Forum” on December 9, 2020, it was proposed that probably more than five million people on the planet have long-haul COVID. “Many of (the five million) are living and suffering in the U.S.” [1]. One study looked at all the COVID-19 hospitalizations in Bergamo, Italy, and revealed that more than 50% of the patients reported ongoing chronic symptoms significant enough to alter their daily lives months after being infected [2]. A more recent, larger study surveying thousands of patients from 56 countries now suggests that this chronic dysfunction is experienced by an even larger percentage of those who have had COVID than in the Bergamo study. This includes those who never had a positive COVID test despite showing all the hallmark symptoms of COVID-19. In fact, 96% of respondents in this study had some remaining symptoms after 90 days [3].

King’s College in London created a self-reporting app from the health-sciences company ZOE, where 4 million users in the UK tracked and monitored their COVID-symptoms over time. Since March 24, 2020, data from this app and similar studies have been used to study the patterns and durations of COVID-19 symptoms. The researchers state that their understanding of long-haul COVID is still in the early stages, but provided the following as the most common reported symptoms cited in various studies from a few days to a few months post infection [4].

  • Excessive fatigue and exhaustion (the most commonly reported long-haul symptom)
  • Breathlessness
  • Headache
  • Insomnia
  • Muscle fatigue/pains
  • Chest pains
  • Persistent cough
  • Loss of taste and smell
  • Intermittent fevers
  • Skin rashes
  • Post-exercise malaise (overtraining leads to symptoms coming back)

There are some fewer common symptoms that have been self-reported by long-haul sufferers that have yet to be confirmed in studies [4]…

  • Hearing problems
  • Cognitive issues, such as “brain fog”
  • Mental-health problems
  • Hair loss

In my practice, I have seen my long-haul patients with the symptoms above, as well as specifically…

  • Inflammatory pain. Predominantly in the small joints of the hands, fingers, and wrists, as well as the rib cage
  • An electric, buzzing sensation in the body, which is quite strange and unique to COVID-19
  • Excessive fatigue
  • Tachycardia, or intermittent, rapid heartbeat

For the patients who have experienced erratic heartbeats, some echograms and stress tests of patients show seemingly normal function. However, despite its label as a respiratory disease, we know that the virus can also impact organs beyond just the lungs. It has a particular affinity for the heart. After COVID-19, one can see a physical or physiological change to the cardiac muscle, or myocardium. Damage to the heart from the virus can help to explain some of the frequently reported long-haul COVID symptoms, such as shortness of breath, chest pain, and heart palpitations [4].

The King’s College self-reporting app interestingly found that a person’s COVID-19 experiences during the active two-week viral stage can correlate to how likely they are to experience long-haul COVID symptoms as well. For example, if a person experienced a “persistent cough, hoarse voice, headache, diarrhea, loss of appetite and shortness of breath in the first week,” they were two to three times more likely to get long-haul COVID symptoms [4]. The researchers also determined that long-haul COVID syndrome is twice as common in women as in men, and the average age of a long hauler is 45 years old, though young people can be long haulers too. One study from the US found that one in five people between the ages of 18 to 34 years old without preexisting chronic medical conditions reported cases of long-haul COVID after their initial infection [4].

Through self-reporting, these sufferers are demonstrating that long-haul COVID is real and can cause chronic health manifestations. The symptoms can be debilitating, and have been shown to affect mental health, physical function, and ability to work [3].

What are these long-haulers doing? Due to the limited research, the answer can be boiled down to “trying their best”. Often, they find solace in online support groups on Facebook [1]. Here they can share their stories, discuss what has been helping their symptoms, report what hasn’t been helping, and simply, feel less alone in their experiences. There is one Facebook support group called “Long Covid Support Group'' with 35.1K members as of February 2021 [5] . 

There are multiple different theories on the origin of long-haul COVID syndrome. Most agree that it is not an active COVID-19 infection, but rather it is a re-programmed immune response that occurred because of the virus. The initial infection of the virus changes immunity patterns, which can put someone into a more aggressive immunity stance. Some have even speculated (and I would not be surprised if it were true) that the virus has created an autoimmune attack of the body against its own tissues. The exact pathophysiology is unknown.

Currently, there are no proven treatments for long-haul COVID syndrome. We are learning and rushing to figure out the best way to  provide relief to those who are suffering. The sheer number of long haulers is terrifying and will only continue to grow,  indicating that this pandemic will remain in us much longer than hoped. Potentially, ailments may remain for a lifetime in those affected. The toll this takes on our healthcare system is incalculable at this time.

Right now, I want to share what I am using with my patients and my wife to help with some of their long-haul symptoms. This is not intended to be direct advice on what to do or what to take. One must really work with their doctor or healthcare provider. Instead, I offer these suggestions to discuss with your provider as options to explore in the hopes that they may help you.

Studies have shown that it is possible for the SARS-CoV-2 virus to directly impair mitochondrial energy metabolism by targeting the action of oxygen availability and utilization in the cell [6]. This can cause a breakdown in energy production, particularly around a pathway involving NAD+, or nicotinamide adenine dinucleotide [6-10].

To address this, we are using NAD+ precursors to rebalance this energy biochemistry and respiration in the body at a cellular level. This includes administering products containing nicotinamide riboside (NR) or nicotinamide mononucleotide (NMN) to assist in mitochondrial production. Other well-known nutrients that support mitochondrial energy production are Co-enzyme Q10 (CoQ10) and ribose. CoQ10 is especially helpful for the cardiac muscle, which is beneficial for the rhythm or beating of the heart.

When a patient is experiencing shortness of breath, lung irritation, or respiratory issues, we are using nebulized glutathione or oral glutathione, or a medicinal peptide called Thymosin-Alpha-1. Thymosin-Alpha-1 is a prescription peptide that has been previously used in autoimmune conditions and in immune deregulatory symptoms. Essentially, it talks to the immune system to get it back on track, quelling any hyper response of the immunity system.  

If you are a long hauler suffering, I hope this article serves as acknowledgement and recognition of you. Many of us in the medical and health fields are doing everything we can to figure this out and trying to find viable ways to make your experience better. In the meantime, I highly encourage you to get involved with the online support groups. You will learn from others and will not feel so isolated in your experience.

Please listen to the video I made on “Long-Haul” if you have any interest in the topic, knowing that it was recorded with all of those who are suffering in mind: 

https://www.youtube.com/watch?v=lHewi7W1Qps

To read more information about Long-Haul COVID, please see this excellent article in Scientific American: https://www.scientificamerican.com/article/the-problem-of-long-haul-covid/

Again, if any of you are suffering from COVID in the short or long term, we are thinking of you. 

 

References

  1. Barber C. The Problem of ‘Long Haul’ COVID. Scientific American website. https://www.scientificamerican.com/article/the-problem-of-long-haul-covid/. Published December 29, 2020. Accessed February 10, 2021. 
  2. Harlan C, Pitrelli S. Italy’s Bergamo is calling back coronavirus survivors. About half say they haven’t fully recovered. The Washington Post website. https://www.washingtonpost.com/world/2020/09/08/bergamo-italy-covid-longterm/?arc404=true. Published September 8, 2020. Accessed February 10, 2021. 
  3. Davis HE, Assaf GS, McCorkell L, et al. Characterizing Long COVID in an International Cohort: 7 Months of Symptoms and Their Impact. medRxiv. Published online December 27, 2020:2020.12.24.20248802. doi:10.1101/2020.12.24.20248802
  4. Sleat D, Wain R, Miller B. Long Covid: Reviewing the Science and Assessing the Risk. :18.
  5. Long Covid Support Group. Facebook website. https://www.facebook.com/groups/longcovid/. Accessed February 10, 2021. 
  6. Stefano GB, Ptacek R, Ptackova H, Martin A, Kream RM. Selective Neuronal Mitochondrial Targeting in SARS-CoV-2 Infection Affects Cognitive Processes to Induce ‘Brain Fog’ and Results in Behavioral Changes that Favor Viral Survival. Med Sci Monit. 2021;27:e930886-1-e930886-4. doi:10.12659/MSM.930886
  7. Omran HM, Almaliki MS. Influence of NAD+ as an ageing-related immunomodulator on COVID 19 infection: A hypothesis. Journal of Infection and Public Health. 2020;13(9):1196-1201. doi:10.1016/j.jiph.2020.06.004
  8. Kouhpayeh S, Shariati L, Boshtam M, et al. The Molecular Story of COVID-19; NAD+ Depletion Addresses All Questions in this Infection. Published online March 23, 2020. doi:10.20944/preprints202003.0346.v1
  9. Heer CD, Sanderson DJ, Voth LS, et al. Coronavirus infection and PARP expression dysregulate the NAD Metabolome: an actionable component of innate immunity. bioRxiv. Published online October 6, 2020:2020.04.17.047480. doi:10.1101/2020.04.17.047480
  10. Miller R, Wentzel AR, Richards GA. COVID-19: NAD+ deficiency may predispose the aged, obese and type2 diabetics to mortality through its effect on SIRT1 activity. Medical Hypotheses. 2020;144:110044. doi:10.1016/j.mehy.2020.110044

Woman running on treadmill

How to Get the Best Bang from Exercise for the Investment in Time

By Dr. David M. Brady and Danielle Moyer

 

Before performing any of the following physical exercises, please consult with your doctor about whether this is appropriate for you. 

Some of us have heard the saying “sitting is the new smoking.” Such a bold statement hints that our sedentary lifestyles of sitting at our computer, taking Zoom calls, and watching television have enormous impacts on our health. But how? We know that exercise can help with weight loss, but it can also help to prevent chronic diseases such as Parkinson’s and Alzheimer’s, improve your mood, boost your immunity, improve cardiovascular function, and promote a healthy gut and microbiome.1-5

So, if exercise is so good for us… Why don’t we do it?

One word: Time.

Trying to find time for work, family, self-care, healthy eating, errands, and being a normal human can be exhausting some days! If one isn’t familiar with exercise, it seems like a daunting, frustrating, and time-consuming task.

The World Health Organization recommends that adults engage in moderate-intensity exercise for 150 minutes per week to maintain proper cardiovascular health.6 But let’s face it. Most of us need 150 more minutes of sleep.

Unsurprisingly, the number of adults that remain sedentary is high. This can increase the risk of mortality, cardiovascular disease, cancer, and diabetes. In fact, one out of five adults are physically inactive across the globe.6 

There is some good news. Since so many people face this issue, in the last two decades we found a solution: High-Intensity Interval Training (HIIT).

HIIT consists of short, intense exercises that last around 10 to 30 minutes. It is designed to alternate consistently between two modes: an intense “work period” and a “recovery period”.

The intense work period should be performed at 80% to 95% of a person’s estimated maximal heart rate. The recovery period is performed at 40% to 50% the person’s estimated maximal heart rate.7-8 Estimating your maximal heart rate will vary person-to-person depending upon your level of fitness. The objective during the intense work period is to feel your heart pumping such that you would have trouble carrying on a normal conversation. The active recovery period is when you are able to speak full sentences, but would have trouble singing.8

*Note: To make your HIIT workouts really work efficiently and maximally, begin to monitor your heart rate variance during your “work” and “recovery” periods. This can be done via a heart rate monitor on your chest or wrist. For example, one person may only need to run at speed 4 on a treadmill to get their heart rate in the 80% to 95% zone, whereas someone else may need to go to speed 7. It is individualized to you. Monitoring your heart rate variance during HIIT gives your workout even more intent and purpose.

HIIT is a class of exercise first largely used by elite athletes.9 Now, even the AARP dubs HIIT as the ‘miracle’ workout that everyone should be doing.10 HIIT is not only designed to be short and time-effective, but studies show that HIIT may result in even more health benefits than moderate intensity “aerobic” exercises.9-12 Additionally, it is found to be enjoyable, safe and tolerable for most adults.12

One of the best benefits of HIIT is its effect on heart-rate variability (HRV).7  Heart rate variance is a way to evaluate your cardiovascular health non-invasively. It has been shown that people who have high HRV have greater cardiovascular fitness and are more resilient to stress, and this can improve with time the more one works out.13 It’s a good idea to track your heart rate variance when exercising to track your performance, such as using a heart rate monitor chest strap. HIIT has been shown to be superior to typical moderate exercises in improving HRV in physically inactive adults.7

Other benefits of HIIT include…6-12,14-16

  • Improves blood pressure
  • Improves cardiovascular health
  • Improves insulin sensitivity
  • Burns more calories than traditional workouts in same amount of time
  • Helps burn fat
  • Increases muscle mass for non-active individuals
  • Increases metabolism for hours after exercising
  • Improves cellular function

 

Here are some quick guidelines for HIIT:

1)      How long should each HIIT workout be?

HIIT is designed to consistently alternate between work and recovery periods, totaling anywhere from 10 to 30 minutes, depending on your goals and exertion levels.

The nice part about HIIT is you can easily modify your preferred difficulty level and workout time. Experiment with different time durations and repetitions to find what is best for you. Here are two methods to get your started:

The 4x4 method7

True to its name, it is called the 4x4 method because it involves 4 rounds of burst high intensity exercise for 4 minutes, with 3 minutes of active recovery in-between each. The workout is bookended by 3-minute moderate intensity warm-up and cool-off periods, bringing us to a grand total of about 30 minutes.7

The Wingate Method7  

This method includes shorter, higher intensity bursts of energy. After warming up with 3 minutes of moderate intensity, one would work for 30 seconds at vigorous intensity, followed by a recovery period for 2-5 minutes. Repeat 6 to 8 times.7

After reading those, you may be tempted to start out with a beginner workout. Try the 10-minute model HIIT workout one time a week. This would include a 3-minute moderate intensity warm up, a work period of 20 seconds and a moderate recovery period for 1-2 minutes. Repeat those repetitions two more times.10

2)      How many times a week do I have to do HIIT workouts?

Again, this is up to you. You can begin with one time a week for 10 minutes, and slowly increase to two to three times a week for 30 minutes. Because it is more exhausting than endurance workouts, such as going for a 30-minute light jog, it is recommended to spread the HIIT workouts throughout the week to optimize longer recovery periods (at least 24 hours between sessions).8

3)      What exercises can be done with the HIIT model?

Another excellent thing about HIIT is you can tweak aerobic exercises you do now to match the HIIT model. No fancy machines are necessary - just a timer and commitment to ratchet-up the intensity of the workout to achieve the desired maximal heart rate for the intended duration! 

This includes running, walking, jogging, rowing, biking, swimming, cycling, elliptical training, stair-climbing, dancing, kickboxing, spinning, hiking, or any other exercises (burpees, jump squats) that get your heart pumping. However, probably the most often used exercise to accomplish high intensity burst training is sprinting on a treadmill, followed by walking during the recovery period, and then repeating this pattern the desired number of times. 

Overall…

As with any exercise, there are potential risks of injuries, so speak with your doctor before starting any new routine. If you are low on time, high-intensity interval training (HIIT) can be considered the best exercise for time management and to attain the best “bang for your buck”! Start slowly and build it up through time. When it comes to HIIT, every second counts!  

 References:

  1. Cheng S-T. Cognitive Reserve and the Prevention of Dementia: the Role of Physical and Cognitive Activities. Curr Psychiatry Rep. 2016;18(9):85. doi:10.1007/s11920-016-0721-2
  2.  Aylett E, Small N, Bower P. Exercise in the treatment of clinical anxiety in general practice - a systematic review and meta-analysis. BMC Health Serv Res. 2018;18(1):559. doi:10.1186/s12913-018-3313-5
  3.  Healthy Mind, Healthy Body: Benefits of Exercise. Harvard Medical School website. https://hms.harvard.edu/sites/default/files/assets/Sites/Longwood_Seminars/Exercise3.14.pdf. Updated March 13, 2014. Accessed January 8, 2021.
  4. Warburton DER, Nicol CW, Bredin SSD. Health benefits of physical activity: the evidence. CMAJ. 2006;174(6):801-809. doi:10.1503/cmaj.051351
  5.  Johannesson E, Simrén M, Strid H, Bajor A, Sadik R. Physical activity improves symptoms in irritable bowel syndrome: a randomized controlled trial. Am J Gastroenterol. 2011;106(5):915-922. doi:10.1038/ajg.2010.480
  6. Alansare A, Alford K, Lee S, Church T, Jung HC. The Effects of High-Intensity Interval Training vs. Moderate-Intensity Continuous Training on Heart Rate Variability in Physically Inactive Adults. Int J Environ Res Public Health. 2018;15(7). doi:10.3390/ijerph15071508
  7. Ito S. High-intensity interval training for health benefits and care of cardiac diseases - The key to an efficient exercise protocol. World J Cardiol. 2019;11(7):171-188. doi:10.4330/wjc.v11.i7.171
  8. ACSM Information on… High Intensity Interval Training. American College of Sports Medicine website. https://www.acsm.org/docs/default-source/files-for-resource-library/high-intensity-interval-training.pdf?sfvrsn=b0f72be6_2. Accessed on January 8, 2021.
  9. Mekari S, Earle M, Martins R, et al. Effect of High Intensity Interval Training Compared to Continuous Training on Cognitive Performance in Young Healthy Adults: A Pilot Study. Brain Sci. 2020;10(2). doi:10.3390/brainsci10020081
  10. Furchgott R. High-Intensity Interval Training: Why It Just May Be a ‘Miracle’ Workout. AARP website. https://www.aarp.org/health/healthy-living/info-2018/high-intensity-interval-training-workout/. Published November 7, 2018. Accessed January 8, 2021
  11.  Kong Z, Fan X, Sun S, Song L, Shi Q, Nie J. Comparison of High-Intensity Interval Training and Moderate-to-Vigorous Continuous Training for Cardiometabolic Health and Exercise Enjoyment in Obese Young Women: A Randomized Controlled Trial. PLoS One. 2016;11(7). doi:10.1371/journal.pone.0158589
  12. Garber CE, Blissmer B, Deschenes MR, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334-1359. doi:10.1249/MSS.0b013e318213fefb
  13. Campos M. Heart rate variability: A new way to Track well-being. Harvard Health Publishing: Harvard Medical School website. https://www.health.harvard.edu/blog/heart-rate-variability-new-way-track-well-2017112212789. Published November 22, 2017. Accessed January 8, 2021.
  14. Wewege M, van den Berg R, Ward RE, Keech A. The effects of high-intensity interval training vs. moderate-intensity continuous training on body composition in overweight and obese adults: a systematic review and meta-analysis. Obes Rev. 2017;18(6):635-646. doi:10.1111/obr.12532
  15. Damas F, Phillips S, Vechin FC, Ugrinowitsch C. A review of resistance training-induced changes in skeletal muscle protein synthesis and their contribution to hypertrophy. Sports Med. 2015;45(6):801-807. doi:10.1007/s40279-015-0320-0
  16. Falcone PH, Tai C-Y, Carson LR, et al. Caloric expenditure of aerobic, resistance, or combined high-intensity interval training using a hydraulic resistance system in healthy men. J Strength Cond Res. 2015;29(3):779-785. doi:10.1519/JSC.0000000000000661

Woman with lower back pain

Common Risk Factors Associated with Fibromyalgia

By Dr. David M. Brady and Danielle Moyer

Fibromyalgia syndrome (FMS) is hallmarked by complex symptoms and difficulty of diagnosis. Studies show that fibromyalgia is properly diagnosed in as low as 34% of cases, meaning that the other 66% were due to other symptoms that mimicked fibromyalgia.1 What causes such an alarmingly high number of misdiagnoses?

The high percentage of misdiagnosed cases are referred to as “Pseudo Fibromyalgia” (pseudo meaning false, or having the appearance of).1 These constitute various disorders cause unknown or undetermined pain (not necessarily widespread pain), but are not FMS. Examples include anemia, hypothyroidism, Lyme disease, functional nutritional deficiencies, mitochondrial energy production deficiency, dysfunctional liver detoxification, joint dysfunction, muscle imbalance, and even postural distortion.2 Why does this occur so often? One significant reason may be that FMS is not based upon any specific laboratory or diagnostic tests. Rather, it is based on symptomatic criteria and medical history. And unfortunately, many conditions or diseases can be associated with fatigue and muscle tenderness, further confusing doctors.

The properly diagnosed cases are often called “Classic Fibromyalgia syndrome”, which follows the specific symptom patterns of FMS. These symptoms include “global” or widespread genuine pain, changes in pain processing, and heightened awareness and sensitivity to stimuli (touch, light, sound). The most pronounced symptom that differentiates FMS from other medical conditions is the pronounced widespread tenderness and extremely low tolerance to sensory stimulation. This is caused by an abnormality of the central nervous system, rather than a primary muscle or soft-tissue dysfunction.3

Separating “Classic FMS” from “Pseudo FMS” is challenging, yet crucial. Elements of diagnosing FMS include an in-depth patient history, physical examination, neurotransmitter evaluation, and differentiation of other diagnoses or pain-related disorders via comprehensive laboratory testing.1

Fortunately, the presence of common risk factors associated with FMS can act as a differentiators between “Classic” and “Pseudo” FMS. These risk factors include…

1. Common comorbidities/conditions

These include symptoms of persistent fatigue, sleep disorders (non-refreshing sleep), headaches, teeth grinding, cold sensitivity, exercise intolerance, cognitive deficits, Raynaud’s phenomenon, irritable bowel syndrome (IBS), and irritable bladder syndrome.3 All of these symptoms suggest increased sympathetic nervous system activity, hence their correlation. In fact, FMS exhibits almost 100% comorbidity with IBS, where FMS patients almost all have IBS.1 Additionally, about 20% to 50% of FMS patients experience significant depression or anxiety.2

When someone has a metabolic disorder masquerading as fibromyalgia, such as thyroid disorders, adrenal stress, or nutritional deficiencies, they typically do not have a sleep disorder, chronic anxiety, or irritable bowel syndrome, which are all associated with classic FMS.1 According to the American College of Rheumatology Diagnostic Criteria for Fibromyalgia, even if a person scores “high” on their FMS questionnaire, the source of their body pain and aches may not be from classic FMS if they do not have at least two symptoms of anxiety, depression, non-refreshing sleep, or irritable bowel syndrome (IBS).4

2. Family history

 

FMS almost always involves dysregulation and lower levels of serotonin. Evidence shows that individuals can have genetic mutations that impact serotonin levels passed down to them. Research also suggests that within FMS patients, there are associations with lower pain pressure thresholds in families.1

3. History of trauma, abuse, or chronic stress

Trauma can alter the processing of pain and incoming stimuli of an individual. As a result, trauma can frequently cause an excessive stress response, significant and chronic pain, and central sensitization disorders, such as FMS, anxiety and IBS.1 It has been shown that FMS patients have a “significantly higher prevalence of emotional, physical, or sexual trauma, associated with the onset of FMS symptoms.”1 A pattern of progression in classic FMS can be similar to the progression of depression, both of which can be latently triggered by emotional trauma such as a divorce or death in the family. Many FMS patients have experienced childhood trauma, neglect, verbal and emotional abuse, intense psychological trauma, or chronic stress. Lastly, the symptoms of FMS can be triggered by physical trauma, such as a severe car accident, botched surgery, or physical or sexual abuse.1

4. Being a woman

Disorders that cause low serotonin in the body are much more prevalent in women, where fibromyalgia syndrome is 10 to 20 times more common in women than in men. The suspected reason is due to women’s hormonal and nervous systems responding to stress and trauma differently than men’s.3 Research explored the impact of menstruation and hormonal changes as possible factors, but the data is lacking in supporting specific hormonal abnormalities unique to female FMS patients.2

5. Age

According to the Centers for Disease and Control (CDC), FMS can affect people of all ages, including children. However, most people are diagnosed during middle age.5 

These risk factors, including comorbidities and medical history, should be considered along with medical examination and appropriate lab screening tests to lower the alarmingly high trend FMS overdiagnosis in primary care medicine. If you are exhibiting FMS-like symptoms, it is recommended to seek the care of an experienced and specialized medical practitioner in this field to properly differentiate between “Classic FMS” and “Pseudo FMS”, which is easier said than done. 

Dr. Brady does accept and new patients through his Connecticut practice and can provide

remote video consultations via secure Zoom sessions. You can learn more about his practice and find contacts to the front desk for scheduling and to answer any questions on at: https://drdavidbrady.com/private-practice/ 

If that is not an option for you, your next best option is to try and find a clinician trained in the functional medicine model near you at: https://www.functionalmedicine.org/practitioner_search.aspx?id=117 

Because a healthcare provider is trained in functional medicine does NOT mean they understand the issues involved in fibromyalgia like Dr. Brady does, but it is probably your next best option and will assure the provider at least understand some of the more subtle metabolic issues that may be in-play in various cases.

 

References

  1. Brady DM, Schneider, MJ. Pain and Fatigue: When It’s Fibromyalgia and When It’s Not. Townsend Letter. October 2012;351:44-50.
  2. Brady DM, Schneider MJ. Fibromyalgia syndrome: A new paradigm for differential diagnosis and treatment. Journal of Manipulative and Physiological Therapeutics. 2001;24(8):529-541. doi:10.1067/mmt.2001.118202
  3. Schneider MJ, Brady DM, Perle SM. Commentary: Differential Diagnosis of Fibromyalgia Syndrome: Proposal of a Model and Algorithm for Patients Presenting with the Primary Symptom of Chronic Widespread Pain. Journal of Manipulative and Physiological Therapeutics. 2006;29(6):493-501. doi:10.1016/j.jmpt.2006.06.010
  4. 2011 Modification of the American College of Rheumatology Diagnostic Criteria for Fibromyalgia. https://cdn.shopify.com/s/files/1/1258/4853/files/Fibromyalgia_ACR_Diagnostic_Criteria_Questionnaire.pdf?130670129376981087. Accessed November 16, 2020.
  5. Fibromyalgia. Centers for Disease Control and Prevention website. https://www.cdc.gov/arthritis/basics/fibromyalgia.htm. Reviewed January 6, 2020. Accessed November 16, 2020. 

Fork and knife

Intermittent Fasting: What is it All About Anyway?

By Dr. David Brady

Danielle Moyer

Intermittent fasting has been happening long before it got the name “intermittent fasting”. For centuries, groups of people all over the globe have abstained from food for durations of time for cultural and religious reasons. So, why has intermittent fasting blown up so much in the world of nutrition? What is it all about anyway?

There are two concepts behind intermittent fasting that you may not have heard of: Migrating Motor Complex and Autophagy.

To begin, there are different paradigms of intermittent fasting. Typically, “Time Restricted Feeding” is when an individual will restrict their food intake for a window of 8 to 10 hours or less every day during the week. Examples of this are skipping a meal or reduced meal frequency. On the other hand, there are longer periods of intermittent fasting around 16 to 48 hours with little to no energy (food) intake. This includes “alternate day fasting”, the 16/8 method (eating only within an 8-hour period), fasting two days per week, or periodic fasting periods lasting anywhere between 2 to even 21 days. All of these constitute intermittent energy restrictions.

Performing short-term frequent fasting, or “Time Restricted Feeding”, allows one to achieve a Migrating Motor Complex (MMC).

Imagine you want to clean your floors. If you are having a party, you are going to hold off on cleaning! There is no point when more mess is constantly coming in. But what about a calm Sunday morning when you are home alone? That is the same concept for MMC. Essentially, MMC is the act of your gastrointestinal tract contracting and “cleaning” your gut. It can only happen when the party's over, or when you are not consuming any food. That is why MMC is called the “housekeeper” of the gut.

The duration of the entire MMC cycle length varies between individuals, but it ranges typically from 113 to 230 minutes (about 2 to 4 hours) of no food consumption. MMC allows us to empty our stomach and small intestine, and to send all remaining food into our large intestine to prepare for the next meal. When the body is unable to “clean” due to constant eating, this can leave our gastric content to stay for longer periods and potentially allow bacterial overgrowth or a variety of GI symptoms or occur. This has been correlated to small intestinal bacterial overgrowth (SIBO), as well as altered hunger signaling. Time restricted feeding encourages the full MMC cycle to complete.

The second element is induced by long-term fasting. It is called autophagy.

Autophagy literally translates to “eating of self” from the Greek meaning. Although that sounds alarming, autophagy is incredibly important for balancing our sources of energy, removing damaged cells, as well as eliminating potential pathogens. It is considered another “housekeeping” mechanism in our body. For that reason, autophagy has been associated in preventing diseases such as cancer, diabetes, autoimmune diseases, infections, liver disease, as well as neuroprotective effects in preventing diseases such as Alzheimer’s or Parkinson’s. In fact, autophagy is considered a promising target for cancer therapy, as it can play a role in inhibiting tumor growth.

The crucial element is that autophagy can only occur during states of starvation. It is an adaptive response of our cells and organisms during food-deprivation that promotes survival until energy is available again. However, this is not something that occurs in just 2 hours of no eating. It is difficult to assess exactly when autophagy is triggered, but one study found that it was significantly detected after 24 hours of food restriction. It was even more abundant after 48 hours of food restriction. Though that seems like a long time to go without eating, these periods allow cleansing throughout our entire body, including cleaning important organs, such as the heart and liver.

There are many other researched benefits of intermittent fasting. One, it is designed to prevent over-eating and increase your metabolic rate. This is associated with improvement in weight loss. Two, studies show it can improve cardiovascular effects, including improving insulin sensitivity and lipid profiles. Three, it has been shown to reduce oxidative stress and inflammation in the body.

Here are some guidelines on how to implement a fast:

  1. Analyze your schedule and determine which common method would be right for you, realistically. Choice considerations can be dependent on frequency per week or during a specific time frame of the day. Do you work at a high-paced job in the morning where it is best that you have breakfast? Do you get off work at 7 PM and can eat dinner only after that time? These are things to consider. 
    • Time-restricted feeding: An example of this is the 16/8 method, where you eat only within an 8-hour window. For example: 8 AM to 4 PM. The nice part about time-restricted feeding is it is the most flexible based upon your schedule. 
    • Whole day fasting: You can choose one to two days per week to do a complete fast, or choose to consume roughly 25% of your normal caloric intake. On the other days, you eat as you normally would. 
    • Alternate day fasting: On alternating days, you eat only one meal that provides about 25% of your normal caloric intake. For example, on Monday, Wednesday, Friday, you eat only one meal. On Tuesday, Thursday, Saturday, you would eat as you normally would. 
  1. Stay hydrated! A large percentage of our water intake on a daily basis comes from our food, so it is vital to drink water when you are not eating. This will lower the risk of fatigue, dry mouth, headaches, or thirst. Most people aim to drink 8.5 to 13 cups (2-3 liters) of water a day when fasting. 
  2. Find ways to entertain yourself that do not involve food. Eating is more than just consuming calories – people eat when they are bored, socializing, sad, angry, happy, etc. What can you do to stay calm and keep your mind engaged? You may be able to do a low-intensity exercise, such as walking or yoga, but be sure to ease into it at first. 
  3. During a fast, the feeling of “hunger” is expected. You may even feel tired or irritable. These are all normal! However, stop fasting if you ever feel unwell. If you feel faint, sick, nauseous, or concerned about your health, break your fast to nourish your body. 
  4. On your non-fasting days, do not “overeat” to compensate for the fasting days. Try to keep a normal diet inclusive of whole foods, lean protein, fiber, and fat. 

Though there are many benefits to intermittent fasting, it is important to remember that these can be offset from the potential psychological impacts of intermittent fasting. Episodes of fasting can potentiate disordered eating or eating disorders, specifically binge eating disorders. It is also important to consider if you have a medical condition or need to eat based on medication use. Therefore, it is best to consult with a healthcare professional first.

If you are interested in intermittent fasting, there are many ways to do it safely and effectively. Like learning a new hobby, it is wise to start slowly and progress to more advanced levels. Just think, you already “fast” every night while you are asleep! There is a reason breakfast is called break-fast as it is.

 

References:

Rynders CA, Thomas EA, Zaman A, Pan Z, Catenacci VA, Melanson EL. Effectiveness of Intermittent Fasting and Time-Restricted Feeding Compared to Continuous Energy Restriction for Weight Loss. Nutrients. 2019;11(10):2442. Published 2019 Oct 14. doi:10.3390/nu11102442

Takahashi T. Interdigestive migrating motor complex -its mechanism and clinical importance. J Smooth Muscle Res. 2013;49:99-111. doi:10.1540/jsmr.49.99

Deloose E, Tack J. Redefining the functional roles of the gastrointestinal migrating motor complex and motilin in small bacterial overgrowth and hunger signaling. Am J Physiol Gastrointest Liver Physiol. 2016;310(4):G228-G233. doi:10.1152/ajpgi.00212.2015

Glick D, Barth S, Macleod KF. Autophagy: cellular and molecular mechanisms. J Pathol. 2010;221(1):3-12. doi:10.1002/path.2697

Onorati AV, Dyczynski M, Ojha R, Amaravadi RK. Targeting autophagy in cancer. Cancer. 2018;124(16):3307 doi:10.1002/cncr.31335

Alirezaei M, Kemball CC, Flynn CT, Wood MR, Whitton JL, Kiosses WB. Short-term fasting induces profound neuronal autophagy. Autophagy. 2010;6(6):702 doi:10.4161/auto.6.6.12376

Glatigny M, Moriceau S, Rivagorda M, et al. Autophagy Is Required for Memory Formation and Reverses Age-Related Memory Decline. Current Biology. 2019;29(3):435-448.e8. doi:1016/j.cub.2018.12.021

Guelinckx I, Tavoularis G, König J, Morin C, Gharbi H, Gandy J. Contribution of Water from Food and Fluids to Total Water Intake: Analysis of a French and UK Population Surveys. Nutrients. 2016;8(10):630. Published 2016 Oct 14. doi:10.3390/nu8100630

Stockman MC, Thomas D, Burke J, Apovian CM. Intermittent Fasting: Is the Wait Worth the Weight?. Curr Obes Rep. 2018;7(2):172-185. doi:10.1007/s13679-018-0308-9


Cuman and other herbs

Black Cumin: Tiny Seed, Big Potential

The kitchen spice rack sometimes proves as powerful as the bathroom medicine chest. From turmeric and ginger’s ability to modulate a healthy inflammatory response, to the antioxidant effects of rosemary and oregano, it’s a win-win when herbs and spices that enhance a meal’s flavor also bring with them beneficial effects for health. A new kid on the block to be added to the category of highly effective and evidence-based botanical medicine is black cumin seed.

Don’t confuse black cumin (Nigella sativa) with the cumin we use more commonly in the West, particularly in Mexican and Tex-Mex cuisine (Cuminum cyminum). They come from different botanical families, and the seeds have distinct appearances and flavor profiles. However, like the cumin we are more familiar with, black cumin is used as a spice in Middle Eastern and Western Asian cooking. It is particularly favored for addition to pastries and breads (such as Indian naan), and is also part of panch phoron, a five-spice blend usually consisting of black cumin, fenugreek, fennel seed, black mustard seed, and the cumin we are more accustomed to.  

Black cumin is native to Southern Europe, North Africa, and Southwest Asia, but it is now cultivated throughout the Mediterranean, Middle East, and India. This spice—little known in the West beyond practitioners of traditional and naturopathic medicine—has been valued in the East for centuries. It is considered a “miracle seed” in Ayurvedic (traditional Indian) medicine. Ancient prophets are said to have claimed it can cure “every ailment except death itself.” We certainly can’t bank on that, but modern scientific research has corroborated a surprising amount of benefit for black cumin across a wide array of health concerns.   

The primary active compound in black cumin seed oil—called thymoquinone (TQ)—has been shown to support immune system function, and help the body mount a proper inflammatory response.  TQ supports the immune system by augmenting the activity of the specialized white blood cells capable of targeting a number of pathogens. Inflammation is the body’s natural response to damage—whether from physical trauma (such as a sprain or a burn), exposure to environmental toxins, or as a result of chronic exposure to food allergens (such as wheat or soy, in susceptible individuals). And acute, short-term inflammation is usually a helpful thing. But chronic, long-term inflammation is associated with many health complications. TQ and whole black cumin seed oil have been shown to inhibit production of some of the body’s internal inflammatory compounds. (In fact, they reduce production of cyclooxygenase [COX], which is the same compound inhibited by aspirin—sometimes referred to as a “COX inhibitor.”) Here we have modern scientific knowledge backing up black cumin’s ancient use as a pain reliever.

Because of its inflammatory/immune-mediating effects, TQ may be beneficial in giving the body natural support with autoimmune conditions. In a study looking at rheumatoid arthritis, patients supplemented with black cumin seed oil reported significant improvement in symptoms compared to those given a placebo. 

Another helpful aspect of black cumin is its ability to assist the body in replenishing its stores of antioxidants. Our bodies need a constant supply of antioxidants to help repair damage that happens at a cellular level from exposure to harmful substances, as well as completely normal byproducts of our own metabolism. Animal models have shown TQ to be helpful for recycling the enzymes involved in antioxidant activity and regeneration. Rampant oxidative stress is associated with numerous health complications, so black cumin’s efficacy across such a wide range of conditions might be due in part to this role in facilitating sufficient levels of antioxidants. 

Not bad for such a small seed!

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Edible flowers

Flower Power

Valentine’s Day is one of the most popular days of the year for flower sales. Bouquets of roses, lilies, gerbera daisies, baby’s breath and more fly out of florists’ shops, bringing smiles and feelings of love and appreciation to their recipients. But flowers do more than just look pretty and give off nice aromas. Whether they’re made into teas, sprinkled on salads, or used in other culinary applications, edible flowers supply meals with beauty and nutrients.

One edible flower is nasturtium. Nasturtium flowers are brightly colored, and all parts of the plant can be eaten: the petals, leaves and stems. The stems start out with a slightly sweet taste, but a peppery heat soon takes over. In fact, the name nasturtium, which means “nose-twister,” comes from the peppery zing, which is reminiscent of watercress—botanical name Nasturtium officinale. However, even though watercress has “nasturtium” in its scientific name, it is related to the flowering nasturtiums only at a higher level of classification; they belong to different families, genus, and species. 

The most common culinary application for nasturtium flowers is as an ornamental—but edible—decoration in salads. Other ways to prepare them include stir-frying, and horticultural experts also suggest stuffing them with a filling, like grape leaves. The flowers can be stuffed as well, similar to a common preparation for squash blossoms. Plus, the green, unripe seed pods can be pickled and used as a substitute for capers. As if those weren’t enough interesting ways to use this plant in the kitchen, the leaves and flowers can be made into pesto, which, according to Martha Stewart, makes a great garnish for nasturtium risotto. As for their nutrient content, nasturtium flowers provide vitamin C and lutein, plus small amounts of zeaxanthin and β-carotene. 

The compound in nasturtium primarily responsible for its peppery zing is a volatile mustard oil, benzyl isothiocyanate. Its ability to affect mucosal membranes and certain types of bacteria underlie the traditional use of nasturtium in herbal medicine as an expectorant and antibiotic, as well as a remedy for respiratory ailments and urinary tract infections. 

Another pretty flowering plant that has culinary uses is lavender. Dried lavender flowers are often included in blends for herbs de Provence, which can be used in any number of savory dishes, for meat and vegetables alike. The more common application for lavender flowers, however, is in sweet dishes, such as lavender shortbread cookies, lavender ice cream, and even a lavender-chamomile tequila cocktail. It’s important, however, to buy culinary lavender, as ornamental lavender may not be suitable for consumption.

Lavender flowers have a lovely purple color, and just as with nasturtium, they aren’t only nice to look at. Lavender has been employed for centuries as an anxiolytic—meaning, it helps people find calm. Compounds in lavender essential oil (LvEO) may help elevate serotonin levels in the brain, while decreasing their turnover rate. (Many antidepressant medications work via a similar mechanism.) LvEO is typically used in aromatherapy applications, but research in mice indicates that the olfactory route (being able to smell) is not actually required in order for LvEO to be effective. The anti-anxiety and calming effects occur even in mice who have had their sense of smell chemically removed. Studies suggest that LvEO may help patients remain calm before dental examinations, and perhaps this might apply to medical office visits in general. 

Other uses for edible flowers, their oils and extracts are endless. For example, rosewater, made by distilling rose petals, is a common ingredient in Middle Eastern and North African dishes. Rose petals are also edible, but the object of your affection will probably appreciate them much more in a vase than on a plate!

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Frankincense

The Gift of Frankincense

Frankincense, also known as olibanum, is often referred to as the “king of oils” and its very name means “high quality incense.” Historically, it was deemed an exquisite gift, and is most often referenced when the biblical magi of the east offered the gifts of frankincense and myrrh to the Christ child.  Frankincense originates from the Middle East and has often been used in various religious practices throughout the centuries as well as Chinese Medicine and Ayurveda, giving evidence to its sacredness in both health and religion. Even its French name, “franc encens,” which means “high quality incense,” demonstrates its historical intent. 

Frankincense oil is obtained from tapping the sticky resin of trees of the genus, Boswellia. The resin can be chewed like a gum, but more commonly, it is steam distilled into an essential oil.  The essential oil of frankincense has been widely used in aromatherapy and is a common constituent in perfumes, fragrances, diffuser blends, and body care products. Don’t be fooled into thinking its benefits are merely external. On the contrary, the therapeutic potential of this essential oil is one reason it is highly esteemed among health advocates. 

Antimicrobial

A variety of medicinal chemicals reside within the essential oil of frankincense, the most well-known being the family of boswellic acids. These therapeutic compounds provide several health benefits, including the ability to discourage the growth of numerous harmful organisms. As a result, frankincense has been a helpful addition to natural cleaners, dental hygiene products, and facial astringents to prevent the growth of microorganisms. It also helps support the body’s normal defenses against internal fungi, viruses, and unfriendly bacteria that may threaten to compromise health and vitality. The food industry has taken advantage of frankincense’s antimicrobial activity and uses it to naturally inhibit the growth of a dangerous fungal toxin, known as aflatoxin, commonly found on corn, soy, peanuts and other foods. 

Immune Support

Not only can frankincense help to constrain harmful microorganisms, but the boswellic acids are also able to support the immune system, thereby creating a strong defense against infections, injury, inflammation, and associated health conditions. Boswellic acids have been studied and found to interact with several cells and enzymes of the immune system so as to promote a healthy response from this critical system when it encounters infections and is dealing with health challenges. Numerous individuals suffer from health conditions associated with an impaired immune system that no longer identifies “friend” or “foe” and frankincense may be helpful in supporting a normal immune response. The immune system is also responsible for establishing a health inflammatory response to injury and illness. Studies have shown boswellic acids can support the action of several enzymes that are involved in these responses to establish a healthy inflammatory response, resulting in better pain management and injury. This dual action of supporting immunity and the inflammatory response makes frankincense an ideal health booster. 

Cell Growth and Health

Most recently, there has been an explosion of interest in frankincense’s support for cell health. A normal cell of the human body progresses through a lifecycle that includes growth and reproduction. Some cells, such as those of the skin, grow and reproduce very quickly as old cells die and must be renewed. Other cells, such as those of the brain and nervous system, grow very slowly. Frankincense supports the natural cell lifecycle of each body system and encourages normal cell growth and reproduction. It also helps the body recognize cells that are not growing properly and must be eliminated to ensure optimal health of the entire body. 

Antioxidant

Frankincense is among the most powerful essential oils with antioxidant properties. By fighting against damaging free radicals, frankincense can offer innumerable health benefits. Free radicals are generated by unhealthy diets, lack of exercise, environmental pollutants, and exposure to harmful electromagnetic fields, among other things. Further, the lack of antioxidant-rich foods in the standard American diet often leaves the body hungry for these critical nutrients. The effects of free radicals are far-reaching and include damage to delicate genetic material and cells of all organ systems, resulting in aging, loss of function, and deteriorating health. The antioxidant power of frankincense can combat free radical damage and provide a hedge of protection against future damage. 

In possessing the ability to fight infection, support the immune system, promote a healthy inflammatory response, and combat free radicals, frankincense lives up to its reputation as “king of oils.” Its usefulness not only reaches out to the small aches and pains of everyday life, but also extends to the most serious health challenges. Certainly, frankincense offers the invaluable gift of healing. 

Sources

Al-Yasiry, A.R. & Kiczorowska, B. (2016). Frankincense--therapeutic properties. Postepy Hig Med Dosw (Online), Jan 4(70), 380-91. 

Ammon, H.P. (2010). Modulation of the immune system by Boswellia serrata extracts and boswellic acids. Phytomedicine, 17(11),862-7. doi: 10.1016/j.phymed.2010.03.003.

Ammon, H.P. (2016). Boswellic acids and their role in chronic inflammatory diseases. Advances in experimental medicine and biology, 928,291-327.

Khan et al. (2016). Pharmacological evidences for cytotoxic and antitumor properties of Boswellic acids from Boswellia serrata. Journal of Ethnopharmacology, Sep 15(191), 315-23. doi: 10.1016/j.jep.2016.06.053

Ahmed et al. (2015). Phytochemical analysis and anti-cancer investigation of boswellia serrata bioactive constituents in vitro. Asian Pacific Journal of Cancer Prevention, 16(16), 7179-88.