Vitamin D is a type of nutrient that the body produces when a person’s skin has exposure to direct sunlight. People can also consume vitamin D, but it is not naturally present in many foods. High quantities of vitamin D are present in oily fish and certain types of mushrooms.
It is present in egg yolks if the chickens laying them are free-range. Some mushrooms also contain vitamin D.
However, no other plant-based foods produce vitamin D. For people whose diets are mostly vegetarian or vegan, and for people who do not or cannot spend a lot of time outdoors, it can be difficult to get enough vitamin D.
If a person has concerns that they are not getting enough vitamin D from direct sunlight, consuming the following foods will help increase the overall amount they have in their bodies.
Oily fish
Oily fish, as well as oils from fish, have some of the highest quantities of vitamin D in food sources.
If a person does not like fish, or if they are vegetarian or vegan, specific mushrooms may be an option. Some types of mushroom contain high amounts of vitamin D.
Manufacturers add vitamin D to many commercially available foods. People describe these foods as being fortified with vitamin D, or other nutrients.
Common foods with extra vitamin D and other nutrients include:
cow’s milk
orange juice
various breakfast cereals
Vitamin D may provide resistance to some cancers and cardiovascular diseases.
Getting enough vitamin D
According to the ODSTrusted Source, if a person does not have enough vitamin D in their diet, they are at risk of developing weak bones. Symptoms of this might include pain in a person’s bones or weakness in their muscles. These symptoms can be subtle initially.
There is some research to suggest that vitamin D may contribute to other health benefits, such as:
However, according to the ODS, there is not yet enough evidence to know whether this is the case. Existing research has yielded mixed results.
The RDA of vitamin D for all people aged 1–70 is 600 IUTrusted Source. For children below the age of 1, it is 400 IU, and for adults over 70, it is 800 IU. This assumes that a person has the minimum amount of direct sun exposure.
The general assumption is that a person who spends some time outside a few times per week will produce sufficient vitamin D. However, according to the ODSTrusted Source, this can vary considerably depending on:
season
time of day
the presence of cloud cover or smog
the color of a person’s skin
whether a person is wearing sunscreen
Being in direct sunlight behind a window will not aid vitamin D production because glass cuts out the radiation that produces vitamin D.
Summary
Getting enough vitamin D is crucial to maintaining healthy bones. The easiest way of getting enough vitamin D is to regularly spend time outside, making sure that the arms, face, and legs have exposure.
Depending on a person’s dietary preferences, consuming enough vitamin D may be difficult. In this case, vitamin D supplements, which are available to purchase online, may be a beneficial choice.
However, if this is not possible, try to consume oily fish, some mushrooms, and free-range egg yolks.
Maintaining a good level of physical fitness is important. However, it can be difficult to determine what fitness entails.
Experts define physical fitness as “one’s ability to execute daily activities with optimal performance, endurance, and strength with the management of disease, fatigue, and stress and reduced sedentary behavior.”
This description goes beyond being able to run quickly or lift heavy weights. Despite being important, these attributes only address single areas of fitness.
This article provides details of the five main components of physical fitness.
Fast facts on fitness:
Maintaining good physical fitness can help prevent some conditions.
With exercise, body composition can change without changing weight.
Athletes’ hearts show different changes depending on their chosen sport.
Muscle strength increases due to fiber hypertrophy and neural changes.
Stretching to increase flexibility can ease a number of medical complaints.
Cardiorespiratory endurance indicates how well the body can supply fuel during physical activity via the body’s circulatory and respiratory systems.
Activities that help improve cardiorespiratory endurance are those that cause an elevated heart rate for a sustained period of time.
These activities include:
swimming
brisk walking
jogging
cycling
People who regularly engage in these activities are more likelyTrusted Source to be physically fit in terms of cardiorespiratory endurance. It is important to begin these activities slowly and gradually increase the intensity over time.
Exercising increases cardiorespiratory endurance in a number of ways. For example, the heart muscle becomes stronger so that it is able to pump more blood per heartbeat.
At the same time, additional small arteries grow within muscle tissue so that they can deliver blood to working muscles more effectively when needed.
How does heart health change with exercise?
The heart’s efficiency changes and improves after persistent training. However, recent research suggests that different types of activity change the heart in subtly different ways.
All types of exercise increase the heart’s overall size, but there are significant differencesTrusted Source between endurance athletes such as rowers and strength athletes such as football players.
The hearts of endurance athletes show expanded left and right ventricles, whereas those of strength athletes show thickening of the heart wall, particularly the left ventricle.
How does lung health change with exercise?
Although the heart steadily strengthens over time, the respiratory system does not adjust to the same degree. Lung size does not change, but the lungs do use oxygen more effectivelyTrusted Source.
In general, exercise encourages the body to become more efficient at taking on, distributing, and using oxygen. Over time, this improvement increases endurance and overall health.
There are a number of ways to measure muscular strength. Generally, lifting a set weight in a prescribed position and comparing the results against any given population is the best way.
In general, if a person works their muscles consistently and regularly, they will increase in strength.
There are various ways of putting the muscles through rigorous activity, but anything that works a muscle until it is tired will increase muscle strength over time.
How does muscle structure change with exercise?
Muscles consist of elongated muscle cells. Each muscle cell containsTrusted Source contractile proteins, called actin and myosin, that give the muscle its strength.
These fibers contract together, producing the so-called power stroke. The total force depends on the number of these units contracting in unison.
To build muscle, an individual must regularly exercise their muscles and take in enough protein.
Scientists do not fully understand the exact mechanism of muscle building, but the general principles are well known. Training causes the muscle cellsTrusted Source to expand, and there is an increase in actin and myosin production.
Also, in untrained muscles, fibers tend to fire in an asynchronous manner. In other words, they do not fire in unison. As a person trains them, however, they learn to fire together as one, thereby increasing maximum power output.
Fitness can also include muscular endurance, which is the ability of a muscle to continue exerting force without tiring.
As mentioned above, strength training builds bigger muscles. Endurance training, on the other hand, does not necessarily generate muscles of a larger size.
This is because the body focuses more on the cardiovascular system, ensuring that the muscles receive the oxygenated blood they need to keep functioning.
Another important change in muscles that people specifically train for endurance concerns the different types of muscle tissue: fast twitch and slow twitchTrusted Source fibers.
Fast twitch fibers contract quickly but get tired quickly. They use a lot of energy and are useful for sprints. They are whitish, as they do not require blood to function.
Slow twitch fibers are best for endurance work, as they can carry out tasks without getting tired. They are present in core muscles. These fibers appear red, as they rely on a good supply of oxygenated blood and contain stores of myoglobin.
Different exercises will promote fast twitch fibers, slow twitch fibers, or both. For example, a sprinter will have comparatively more fast twitch fibers, whereas a long distance runner will have more slow twitch fibers.
Body composition measures the relative amounts of muscle, bone, water, and fat an individual has.
A person can potentially maintain the same weight but radically change the ratio of each of the components that make up their body.
For instance, people with a high muscle (lean mass) ratio might weigh more than those with the same height and waist circumference who have less muscle.
How is body composition calculated?
There are several methodsTrusted Source for calculating body composition. For example, a doctor can measure a person’s body fat using tools such as calipers or through bioelectrical impedance analysis to detect fat cells.
The above methods are prone to inaccuracies, however.
Flexibility refers to the range of movement across a joint.
Flexibility is important because it improves the ability to link movements together smoothly and can help prevent injuries. It is specific to each joint and depends on a number of variables, including the tightness of ligaments and tendons.
Various activities that stretch the joints, ligaments, and tendons can increase flexibility.
Dynamic stretching: This refers to the ability to complete a full range of motion in a particular joint. People use this type of stretch in standard warmup exercises, as it helps prepare the body for physical activity.
Static-active stretching: This refers to holding the body or part of the body in a stretched position and maintaining that position for a period of time. One example of static-active stretching is the splits.
Ballistic stretching: People should only engage in ballistic stretching when the body is already warmed up and limber from exercise. It involves stretching in various positions and bouncing.
There are a number of ways to improve flexibility. Having a daily stretching regimen can be the simplest and most efficient way of achieving whole body flexibility.
In general, fitness means different things to different people.
The important message is that embarking on any regular exercise will be of benefit to a person’s health. The more exercise they do, the healthier they will look and feel.
What is cultural competency, and how does it fit in with healthcare? A recent survey among physicians in the United States shows that cultural competency is a key issue both for healthcare practitioners and their patients, so what are the obstacles to efficient cross-cultural communication in a healthcare setting?
Since the time of the Ancient Greeks, medical professionals have sworn the Hippocratic Oath, through which they commit to providing their patients with the best care possible. This includes patients of all different ethnic groups, religions, sexual orientations, and cultures.
But not all people feel the medical community understands their unique needs. For example, a study from Stanford University found that Black men were more likely to talk about their health concerns with a Black doctor. Another study found that Hispanic people in the United States delay going to the doctor because they do not understand the healthcare system.
And not all doctors may believe they are capable of serving patients of all backgrounds. Past research shows that doctors from minority backgrounds, as well as female doctors, are more likely to serveTrusted Source minority, financially precarious, and Medicaid-eligible populations.
Furthermore, a study from 2015 found that physicians and medical students felt underpreparedTrusted Source when seeing patients who identified as lesbian, gay, bisexual, transgender, or queer. These are some of the reasons why cultural competency plays a large role in patient care.
A new survey conducted by Healthgrades — an online resource offering comprehensive information about physicians and hospitals — found that 31% of responding physicians agreed that their level of cultural competency affected their ability to provide the best possible care for their patients either somewhat or a lot.
Additionally, the survey found a generational difference when it comes to a doctor’s willingness to improve their cultural competency. Younger doctors, with fewer years of practice experience, appeared more interested in additional cultural competency training when compared to older doctors.
Cultural competency is the ability to understand and respect the beliefs, values, and histories of individuals of all cultural backgrounds.
“For medical professionals, cultural competency is essential in providing effective quality care to patients of diverse backgrounds, particularly people from historically marginalized communities,” said Dr. Luz Maria Garcini, assistant professor in the Department of Psychological Sciences at Rice University, faculty scholar for the Center of the United States and Mexico, Baker Institute for Public Policy, and affiliate faculty at the Center for Research to Advance Community Health at UT Health San Antonio.
“Cultural competence improves interpersonal interactions, helps to build trust, conveys respect, reduces biases that may lead to inaccurate diagnoses and treatments, and increases the chances that patients may be more compliant with the medical recommendations given,” she told Medical News Today.
Dr. Arlette Herry, assistant dean of multicultural affairs at St. George’s University, agreed that cultural competence is of paramount importance in the healthcare system.
“We know that it leads to improved patient outcomes, reduced care disparities and inefficiencies, and ultimately, decreased costs,” she explained. “The social determinants of health are not the same for everyone, so health inequities create a serious challenge for patients and healthcare workers alike.”
“Cultural competence, in combination with cultural humility, is a powerful tool in addressing these disparities that people from diverse backgrounds experience, whether that diversity is culture, race, sexual orientation, socioeconomic status, religion, gender, disability — invisible or visible — to name a few,” Dr. Herry added.
Additionally, Dr. Herry pointed out that cultural humility acknowledges the historical realities — such as the Tuskegee studyTrusted Source and the Stanford Prison experimentTrusted Source — that have given rise to a lack of trust in the healthcare system among vulnerable populations.
“It also requires healthcare professionals to develop an awareness of their implicit biases and how they affect patient care as well as interactions with their colleagues,” she continued. “This can only happen with a continuous process of introspection, reflection, and self-evaluation.”
In the Healthgrades survey, 831 United States doctors were asked if a person’s personal identity traits — including language, race, gender, sexual orientation, and religion — had ever stopped them from providing the best possible care to them.
More than half — 54% — of responding physicians said none of these had affected their ability to provide care. Of the individual traits, language was the largest reason at 31%.
Healthgrades reportedly conducted a separate survey with the public at large. When asked if any of their personal identity traits prevented them from receiving proper care from their doctor, 10% of the participants who identified as people of color stated “yes.”
When doctors were asked to rate their readiness to care for people of different cultural or racial backgrounds, 87% rated themselves as “excellent” or “very good.”
However, only 68% of individuals who identified as people of color rated their doctor’s rate of readiness care as either “excellent” or “very good” in the parallel survey.
A combined 31% of responding doctors agreed their level of cultural competency impacts their ability to provide medical treatment either “a lot” or “somewhat.”
Responses to this question also showed a generational difference as younger doctors — in practice for less than 10 years — made up more of that 31% than older doctors who have been in practice for over 20 years.
And when asked if additional training would help a doctor improve the care they provide to people with different cultural backgrounds, a generational difference emerged yet again.
A combined 55% of younger doctors in practice for 10 years or less said more training would help them care for people from different cultural and racial backgrounds, and people of a different gender or sexual orientation.
And 63% of doctors in practice for 20 or more years said they did not need any additional training.
According to Dr. Herry, the process to ensure healthcare workers are sufficiently culturally literate when treating patients of different cultural backgrounds has begun, but we are not there yet.
“But we are not there yet because cultural competence is a dynamic, life-long process,” Dr. Herry noted.
“Dimensions of diversity are fluid so to provide equitable and inclusive care means that healthcare workers, organizations, and health systems have to continuously explore relevant content.”
– Dr. Arlette Herry
And Dr. Garcini added that the shortage of providers from historically marginalized backgrounds makes it particularly challenging for patients who want to see providers that understand their background, life experiences, and culture.
In the U.S., more than half of all active physicians in 2018 identified as white. However, census population projections estimate that combined so-called minority groups will become the dominant population in 2045.
“Cultural competence is not something that can be learned overnight,” Dr. Garcini emphasized.
“[Cultural competency] requires time, self-awareness, and systemic change within our organizations. Also, [it] is an ongoing and continuous process that all of us need to be constantly working on. It requires humility and a willingness to listen and to learn from diverse perspectives, including learning from patients and community members.”
What can medical schools do to help ensure new doctors are entering the medical field with cultural competence?
Dr. Herry said creating culturally competent and humble medical care workers starts from the recruitment process.
“Universities and medical schools should create mechanisms to hire diverse faculty and recruit a diverse student body,” she detailed. “Students should ‘see’ themselves reflected in their faculty. These practices foster a sense of [belonging] and allow for learning and sharing ideas in a safe, inclusive space.”
“Curricular strategies for cultural competency training must move beyond the lecture modality,” Dr. Herry continued. “The use of small group discussions and simulated patients where the nuances of diverse identities, such as disabilities, rurality, spirituality and end of life, gender and sexual minorities, and age, can be explored is a powerful learning and teaching tool.”
And for both new and current doctors, Dr. Garcini said the best way to build cultural competence is through exposure to diverse environments and communities.
“This is why systemic change to diversify our organizations and institutions is key,” she explained. “We need to learn, listen, and consult with each other [in] our everyday lives.”
“An important way to do this is for providers to immerse themselves into the communities that they serve,” Dr. Garcini added. “Providers need to engage in community activities, serve on community boards, talk to people in the community, collaborate with community leaders, and listen to what is important and what matters to the community. Then change may slowly begin to take place.”
Chronic pain, a disease process that is so complex that we are only just beginning to understand its triggers, has recently been gaining recognition as a medical condition on its own. But how does living with chronic pain feel? And how do the body and brain deal with it?
These are just some of the words people tend to use to describe their pain.
Now imagine you had to endure a bit of this every waking day until you don’t know what it’s like to go about your day without this baseline of pain slowly depleting your mental and physical energy in the background.
That is the reality for many people who deal with chronic pain.
Some days may be great, some days bad; the signs may not always be visible and it may be an inward battle hidden behind gritted teeth and forced smiles.
But how does chronic pain become, well, chronic?
In the latest installment of our In Conversation podcast dedicated to Pain Awareness Month, Medical News Today dives into the science behind chronic pain with Dr. Hilary Guite and Dr. Tony L. Yaksh, professor of anesthesiology and pharmacology at the University of California, San Diego, as Joel Nelson, longtime psoriatic disease and arthritis patient and advocate, shares his personal journey with pain.
Chronic pain may often be dismissed as purely a symptom of a larger problem or not taken as seriously because it is not life threatening. However, the burden of chronic pain is not only personal but also societal.
StudiesTrusted Source show that people with chronic pain may have difficulty in going about their daily lives and doing activities, as well as have poorer overall health. People with chronic pain may also have to deal with job insecurity or unemployment.
According to the World Health Organization (WHO), chronic pain is now classified into two categories: chronic primary pain and chronic secondary pain.
Primary pain, according to this classification, refers to pain that is not caused by or cannot be explained by another medical condition. Some examples may be fibromyalgia or chronic primary low back pain.
“Fibromyalgia [is] a condition that varies from person to person, but is a widespread pain condition affecting at least 4 to 5 regions of the body and lasts at least 3 months but usually longer. No other cause is found for the pain and it is, therefore, a type of primary chronic pain,” Dr. Guite explained.
Secondary pain, on the other hand, is secondary to or caused by an underlying medical condition. Arthritis, cancer, or ulcerative colitis-related pain would fall within this umbrella.
“[M]y chronic pain started around 10 years old. And [since] then, chronic pain has kind of been an intermittent part of my life right through to the present day,” Joel Nelson told MNT‘s In Conversation.
Joel is now 38 years old, which means he’s been living with chronic pain for a good few decades.
“[M]y first experience with pain was [when] I got a pain in my hip; it was like a gravelly sort of burning feeling. And it just progressed; the more I used the joint, the [more it got] worse, it got to the point where I [was] sort of losing mobility,” he said.
That was the point he decided to reach out for help—as most people do.
Joel said one word to describe his chronic pain is “noise.”
“I always have described it as noise because on the days when that pain is intense, my ability to absorb other information, deal with multiple things at a time, it’s just gone,” he said.
“Living with my condition today, I think the most important takeaway about the experience is the fluidity of it. [U]ltimately, [my limits and mobility] can range from anything to where I can do more than walking, and I might be able to do a bit of running and cycling like I am currently, to next week I might be back on crutches. [A] lot of that is dictated by pain. So with arthritis, I get a lot of morning stiffness, but it’s the pain that limits my ability to do things.” — Joel Nelson
Likening it to “a series of chapters,” Joel said it’s not easy to anticipate what will happen next with his chronic pain.
Behind acute pain becoming chronic, scientists have found that a gateway receptor called Toll-like receptor 4Trusted Source (TLR4) may be a controlling factor.
“We know that under a tissue [or nerve] injury of various sorts that we can activate signaling that normally is associated with what we call innate immunity. And one of the mediators of that is something called the toll-like receptor and it turns out that while those are normally there to recognize the presence of foreign bugs, for example, E. coli, those bugs have in their cell membrane, something called lipopolysaccharide, or LPS. We don’t have that normally in our system, but it comes from bacteria,” said Dr. Yaksh.
“You’re born with it, you don’t have to develop it. It’s there all the time. What we’ve come to find out over the last years [t]hat there are many products that your body releases that will [a]ctivate those very same toll-like receptors,” he added.
Toll-like receptors may prime the central immune system for heightened states of pain. In response to harmful stimuli, stressors, or tissue injury, especially in the microbiome or the gastrointestinal tract, the body starts to release products from inflammatory cells.
“When this happens, these products that are released from our own body can [a]ctivate these toll-like receptors, and there’s [one] we call TLR4 [which] is present on inflammatory cells, and it’s also present on sensory neurons,” he explained.
Dr. Yaksh said that activating TLR4 itself doesn’t cause as much pain, but that it sets the nervous system up to become more reactive.
Coupled with this priming, if there are other stressors present at the time—such as a bad diet or psychological distress, pointed out Dr. Guite— this can set off a whole cascade that can fuel this transition to chronic pain.
“[The activation of TLR4] sets up a whole series, a cascade in which there will be an increased expression of a large number of receptors and channels that are able to drive an enhanced response of the system. When this happens, you get this enhanced response downstream to the initial tissue injury. It’s not so much that [it] causes the pain condition, it just sets the system up to be more reactive.” — Dr. Tony Yaksh
He said Joel’s situation fits within the notion that a person can transition from one type of pain to another.
“[T]hat can be exacerbated by the stresses that are ‘psychological’ which can exacerbate a pain state to one that may, in fact, have an underlying physiological component that we may not really understand,” he added.
In Joel’s case, for example, Dr. Yaksh suggested it was likely that the stress (and joy) of becoming a father and all the other aspects played a role in what exacerbated Joel’s condition, and made it harder to keep the pain under control. He stressed that this did not make the pain any less real.
“I think that probably there was this very strong, emotive component that’s associated what Joel’s situation was, […] that the pain condition and the events that were associated with the psoriatic diagnosis and other aspects, perhaps, in fact, did establish the transition from one state to another— [what] we call a transition or an acute to chronic, or the chronification of the pain state,” he elaborated.
Theories so far suggest pain happens at the intersection of where the body meets the brain.
“[Y]our comment about pain [being] in the brain is absolutely the correct way to think about it; the output function of anything comes from the higher centers,” said Dr. Yaksh.
It all boils down to how the brain registers pain when there is tissue damage.
Pain is a crucial function for our survival; it is essentially a warning system that alerts our bodies that there is damage or illness to deal with. After an illness or injury, the nerves surrounding the area start sending signals up to the brain through the spinal cord, which encourages us to get help and stop further damage.
After the body sustains an injury, the damage to the body’s organs and tissues triggers an acute inflammatory response that involves immune cells, blood vessels, and other mediators. However, sometimes, even after this initial injury phase passes and the body heals, the nervous system may stay in this state of distress or reactivity.
When this happens, the body may become hypersensitive to pain. If this increased sensitivity is to heat or touch around the injured area, this is called “peripheral sensitizationTrusted Source.”
“[I]f I were to jam my finger, or if I were to develop, in Joel’s case, an event that leads to a local autoinflammation of the joint, then, in fact, that inflammation leads to the release of factors, which now sensitize the innervation of that joint,” Dr. Yaksh elaborated.
Dr. Yaksh said this is something all people experience, regardless of whether it is chronic pain. He explained that after an injury, however, an innocuous activity such as wiggling one’s finger can “[become] extraordinarily noxious.”
He described this as a sensitization generated by peripheral injury and inflammation, where this information is then relayed to the brain through the spinal cord.
“The brain is now seeing what is otherwise an innocuous event, generating a signal that looks as if, as we would say, hell has frozen over, bad news is coming up the pipe.” — Dr. Tony Yaksh
However, sometimes this prolonged response to the initial injury may cause the lingering pain to be widespread, rather than localized to the injured area. This is called “central sensitizationTrusted Source.”
“[I]t’s interesting in [Joel’s case], that you clearly have a peripheral issue, whether it’s the inflammation of a joint, inflammation of the skin, or changes in peripheral nerve function. And so not only do you get changes in joint morphology and things of that sort, but you actually get changes that lead to changes in the way that the information that goes into the spinal cord, and then to higher centers,” Dr. Yaksh explained, “and you’ve activated specific populations of sensory fibers that are normally activated only by severe injury.”
“[I]t’s possible for that spinal cord, which is now, in a sense, organizing the input-output function from the periphery to the brain can become reorganized very much like if I were to take a radio and turn the volume up—the signal to the radio hasn’t changed, but the volume gets louder. So, think of the spinal cord as a volume regulator.” — Dr. Tony Yaksh
“And it says, bad news has happened. But we now know actually, that some of that input that comes up the same pathway [g]oes to areas of the brain that has nothing to do with where that pain [comes] from—only that it is intense,” he said.
These outputs that travel up the spinal cord inform the brain of where and how intense the pain is. One area these are processed in is the limbic system, or “the old smell brain,” said Dr. Yaksh.
“These are areas of the brain that are, in fact, associated in humans with the input associated with emotionality,” he added.
This stress can also modulate how pain is perceived by the body; it can cause muscles to tense or spasm, as well as lead to a rise in the levels of the hormone cortisol. This may cause inflammation and pain over time.
Although treatments for acute pain often involve taking various medications such as acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), or opioids, treatment and management strategies for chronic pain are quite limited.
“[W]e started out this conversation by saying pain is in the brain. And your perceptions of what the world is about impact you very directly, and in a way that is actually experimentally definable, changes the way your brain reacts. So when I say pain is in the brain, I am not saying it’s, it’s any less real in any way, shape, or form. It’s a real thing,” said Dr. Yaksh.
“We now teach medical students that, you know, just because you don’t see the primary diagnosis as being a swollen joint doesn’t mean the patient doesn’t have something,” he pointed out.
Dr. Yaksh said mindfulness is often used in therapy to treat or manage fibromyalgia. He said that this doesn’t mean there is no physiological component of fibromyalgia and indeed, recent research has shown that it is very likely to be an autoimmune condition — “just as real as the presence of antibodies that define the presence of an arthritic joint,” he said.
“Mindfulness, in a way, can help the individual respond to the nature of the afferent traffic that’s coming up the spinal cord; it’s not something you could become mindful enough to say have surgery done. But it might [t]ake the edge off of some of the things that are, in fact, driving this exaggerated response. Fibromyalgia is a perfect example.” — Dr. Tony Yaksh
“[Mindfulness] doesn’t make the pain state any less real [but it] demonstrates that changing the way you think about your pain condition [can] help you deal with that pain condition,” he said.
Joel added that, from the perspective of someone with chronic pain, it is a journey to see how the brain and the body work together to maintain pain:
“….[I]t is a really delicate conversation when you talk about pain and it residing in the brain and, as somebody who’s gone full circle through that journey of being horrified when that was first suggested to going through pain management, and then understanding it so that I could process it better. It changed everything for me.“
What the future holds for treating chronic pain currently remains unclear. However, hope is that drugs might be developed to impact receptors such as TLR4 in a way that might not result in the pain going from acute to chronic, and that our understanding of how psychological processes interact with the neuro-immuneTrusted Source interface increases over time.
While there are endless diets, supplements, and meal replacement plans claiming to ensure rapid weight loss, most lack any scientific evidence. There are, however, some strategies backed by science that do have an impact on weight management.
It is important to remember that there are no quick fixes when it comes to weight loss.
The best way to reach and maintain a healthy weight is to eat a nutritious, balanced diet.
This should include 10 portions of fruit and vegetables, good-quality protein, and whole-grains. It is also beneficial to exercise for at least 30 minutes every day.
These strategies include exercising, keeping track of calorie intake, intermittent fasting, and reducing the number of carbohydrates in the diet.
In this article, we consider nine effective methods of weight loss.
Methods of weight loss that scientific research supports include the following:
1. Trying intermittent fasting
Intermittent fasting (IF) is a pattern of eating that involves regular short-term fasts and consuming meals within a shorter time period during the day.
Several studiesTrusted Source have indicated that short-term intermittent fasting, which is up to 24 weeks in duration, leads to weight loss in overweight individuals.
The most common intermittent fasting methods include the following:
The 5:2 Diet: Fast on 2 out of every 7 days. On fasting days eat 500–600 calories.
The 16/8 method: Fast for 16 hours and eat only during an 8-hour window. For most people, the 8-hour window would be around noon to 8 p.m. A study on this method found that eating during a restricted period resulted in the participants consuming fewer calories and losing weight.
If someone wants to lose weight, they should be aware of everything that they eat and drink each day. The most effective way to do this is to log every item that they consume, in either a journal or an online food tracker.
Researchers estimated in 2017 that there would be 3.7 billion health app downloads by the end of the year. Of these, apps for diet, physical activity, and weight loss were among the most popular. This is not without reason, as tracking physical activity and weight loss progress on-the-go can be an effective way of managing weightTrusted Source.
One studyTrusted Source found that consistent tracking of physical activity helped with weight loss. Meanwhile, a review studyTrusted Source found a positive correlation between weight loss and the frequency of monitoring food intake and exercise. Even a device as simple as a pedometer can be a useful weight-loss tool.
3. Eating mindfully
Mindful eating is a practice where people pay attention to how and where they eat food. This practice can enable people to enjoy the food they eat and maintain a healthy weightTrusted Source.
As most people lead busy lives, they often tend to eat quickly on the run, in the car, working at their desks, and watching TV. As a result, many people are barely aware of the food they are eating.
Techniques for mindful eating include:
Sitting down to eat, preferably at a table: Pay attention to the food and enjoy the experience.
Avoiding distractions while eating: Do not turn on the TV, or a laptop or phone.
Eating slowly: Take time to chew and savor the food. This technique helps with weight loss, as it gives a person’s brain enough time to recognize the signals that they are full, which can help to prevent over-eating.
Making considered food choices: Choose foods that are full of nourishing nutrients and those that will satisfy for hours rather than minutes.
4. Eating protein for breakfast
Protein can regulate appetite hormones to help people feel full. This is mostly due to a decrease in the hunger hormone ghrelin and a rise in the satiety hormones peptide YY, GLP-1, and cholecystokininTrusted Source.
ResearchTrusted Source on young adults has also demonstrated that the hormonal effects of eating a high-protein breakfast can last for several hours.
Good choices for a high-protein breakfast include eggs, oats, nut and seed butters, quinoa porridge, sardines, and chia seed pudding.
5. Cutting back on sugar and refined carbohydrates
The Western diet is increasingly high in added sugars, and this has definite links to obesityTrusted Source, even when the sugar occurs in beveragesTrusted Source rather than food.
Refined carbohydrates are heavily processed foods that no longer contain fiber and other nutrients. These include white rice, bread, and pasta.
These foods are quick to digest, and they convert to glucose rapidly.
Excess glucose enters the blood and provokes the hormone insulin, which promotes fat storage in the adipose tissue. This contributes to weight gain.
Where possible, people should swap processed and sugary foods for more healthful options. Good food swaps include:
whole-grain rice, bread, and pasta instead of the white versions
fruit, nuts, and seeds instead of high-sugar snacks
herb teas and fruit-infused water instead of high-sugar sodas
smoothies with water or milk instead of fruit juice
6. Eating plenty of fiber
Dietary fiber describes plant-based carbohydrates that it is not possible to digest in the small intestine, unlike sugar and starch. Including plenty of fiber in the diet can increase the feeling of fullness, potentially leading to weight loss.
Every individual has different varieties and amounts of bacteria in their gut. Some types can increase the amount of energy that the person harvests from food, leading to fat deposition and weight gain.
Some foods can increase the number of good bacteria in the gut, including:
A wide variety of plants: Increasing the number of fruits, vegetables, and grains in the diet will result in an increased fiber uptake and a more diverse set of gut bacteria. People should try to ensure that vegetables and other plant-based foods comprise 75 percent of their meal.
Fermented foods: These enhance the function of good bacteria while inhibiting the growth of bad bacteria. Sauerkraut, kimchi, kefir, yogurt, tempeh, and miso all contain good amounts of probiotics, which help to increase good bacteria. Researchers have studied kimchi widely, and study results suggest that it has anti-obesity effects. Similarly, studies have shown that kefir may help to promote weight loss in overweight women.
Prebiotic foods: These stimulate the growth and activity of some of the good bacteria that aid weight control. Prebiotic fiber occurs in many fruits and vegetables, especially chicory root, artichoke, onion, garlic, asparagus, leeks, banana, and avocado. It is also in grains, such as oats and barley.
8. Getting a good night’s sleep
Numerous studies have shown that getting less than 5–6 hours of sleep per night is associated with increased incidence of obesityTrusted Source. There are several reasons behind this.
Research suggestsTrusted Source that insufficient or poor-quality sleep slows down the process in which the body converts calories to energy, called metabolism. When metabolism is less effective, the body may store unused energy as fat. In addition, poor sleep can increase the production of insulin and cortisolTrusted Source, which also prompt fat storage.
How long someone sleeps also affects the regulation of the appetite-controlling hormones leptin and ghrelin. Leptin sends signals of fullness to the brain.
9. Managing your stress levels
Stress triggers the release of hormones such as adrenaline and cortisol, which initially decrease the appetite as part of the body’s fight or flight response.
However, when people are under constant stress, cortisol can remain in the bloodstream for longer, which will increase their appetiteTrusted Source and potentially lead to them eating more.
Cortisol signals the need to replenish the body’s nutritional stores from the preferred source of fuel, which is carbohydrate.
Insulin then transports the sugar from carbohydrates from the blood to the muscles and brain. If the individual does not use this sugar in fight or flight, the body will store it as fat.
Researchers foundTrusted Source that implementing an 8-week stress-management intervention program resulted in significant reduction in the body mass index (BMI) of children and adolescents who are overweight or have obesity.
Antibiotic treatment for bacterial infections can reduce the abundance and diversity of gut bacteria, leading to potentially severe diarrhea and gastrointestinal symptoms.
Previous studies suggest that taking probiotics can reduce the risk of antibiotic-associated diarrhea.
A recent study reviewing data from randomized controlled trials suggests that supplementing with probiotics could help prevent or attenuate the changes in the diversity and composition of gut microbiota associated with antibiotic treatment.
Probiotics may be able to offset the negative effects of antibiotics.
A recent systematic review published in the Journal of Medical Microbiology suggests that supplementing with probiotics could prevent or diminish the negative effects of antibiotics on the composition and diversity of gut microbiota while reducing the risk of antibiotic-associated diarrheaTrusted Source.
The study’s lead author Dr. Elisa Marroquín, a professor at Texas Christian University, said that the study could help assuage concerns among healthcare professionals about co-prescribing probiotics with antibiotic treatments.
“Although there is a concern about shifting the initial gut microbial composition by taking probiotics while on antibiotic interventions, based on the available human evidence, we suggest health professionals continue recommending probiotics when antibiotics are prescribed,” she said.
Dr. Arthur Ouwehand, technical fellow at International Flavors and Fragrances, Finland, who was not involved in the study, said there were many systematic reviews and meta-analyses that have documented the benefits of probiotics, especially in reducing the risk/duration/severity of antibiotic-associated diarrhea.
“The assumed mechanism by which probiotics achieve this is thought to be through the stabilization of the intestinal microbiota. This [study] convincingly shows that things indeed work the way we thought they did. The study also convincingly shows that it is indeed a stabilization of the intestinal microbiota and not just a ‘replenishment’ of the microbiota with the probiotic organisms.” — Dr. Arthur Ouwehand
Although antibiotics are effective against potentially life threatening pathogenic bacteria, they can simultaneously disrupt the composition and function of the gut microbiota. Specifically, antibiotic use can reduce the diversity and abundance of gut bacteria and allow infection by or the proliferation of pathogenic bacteria.
These antibiotic-associated changes in gut microbiota can lead to diarrhea and other gastrointestinal symptoms in about 5- 35%Trusted Source of patients. Although the symptoms of antibiotic-associated diarrhea are generally mild and self-limiting, severe cases are associated with discontinuation of antibiotic use and an increase in morbidity and mortality.
In addition, evidence from animal studies also suggestsTrusted Source that the disruption of gut microbiota composition due to antibiotics could have lasting effects, such as an increased risk of obesity and allergies.
Probiotics are live microorganisms, typically belonging to the genera Lactobacillus, Bifidobacterium, and Saccharomyces, that produce beneficial health effects upon their oral intake.
Studies have shown that the co-administration of probiotics with antibiotics can reduceTrusted Source the risk of antibiotic-associated diarrhea.
Studies also suggestTrusted Source that probiotic microorganisms can suppress the growth of pathogenic or harmful bacteria, produce metabolites that alter gut microbiota composition, modulate the human immune system, and protect gut barrier integrity.
However, clinicians have been hesitant about prescribing probiotics due to concerns that probiotics can alter the gut microbiome composition in the long term.
In addition, studies examining the impact of probiotic coadministration on antibiotic-induced changes in gut microbiota composition have reported mixed results.
To gain clarity on the impact of probiotic supplementation on gut microbiota composition, researchers at Texas Christian University recently conducted a systematic review to synthesize the results from these studies.
The current study included data from randomized clinical trials assessing the impact of antibiotics and probiotics in isolation or when prescribed together on fecal gut microbiota composition and gastrointestinal symptoms.
The review included 22 studies involving either the use of antibiotics (n=11) or probiotics (n=11) alone and seven studies involving the use of probiotics in conjunction with antibiotics.
Among the studies involving the co-administration of probiotics with antibiotics, the antibiotic treatment ranged from 3 to 14 days, with most studies including a 7-day treatment period. Treatment with probiotics ranged from 28 days to up to 6 months.
All 11 studies involving antibiotics as a stand-alone intervention reported changes in gut microbiota composition and a decline in the microbiota diversity, i.e., the total number of types of microbial species present in the gut.
Among the seven studies involving the use of probiotics in combination with antibiotics, five studies reported a decline in diarrhea and other gastrointestinal symptoms. Four of these studies found that supplementation with probiotics prevented the antibiotic-induced decline in microbial diversity.
In contrast, three studies showed an absence of an effect of probiotic coadministration on microbiota diversity. In two of these three studies, the researchers noted that the short duration of antibiotic treatment may have produced limited changes in the gut microbiota, potentially resulting in a small, unnoticeable impact of probiotics.
Moreover, all four studies that reported data on gut microbiota composition found that concomitant use of probiotics with antibiotics helped restore the baseline or pre-antibiotic microbiota composition.
For instance, the use of antibiotics was associated with a decrease in gut bacteria belonging to the Firmicutes phylum and an increase in those from the Proteobacteria phylum.
Bacteria from the Firmicutes phylum are involved in the fermentation of undigested dietary fiber and tend to have beneficial effects on human health. In contrast, an overabundance of Proteobacteria is associated with an imbalance in the gut microbiota composition and a diseased state.
The use of probiotics along with antibiotic treatment was able to attenuate, but not completely reverse, the changes in the Firmicutes and Proteobacteria phyla. Similarly, the coadministration of probiotics with antibiotics also helped restore the levels of other bacteria associated with gut health, such asFaecalibacterium prausnitziiTrusted Source.
Studies examining the impact of probiotics in isolation produced more variable results, with only four out of the eleven studies reporting an increase in gut microbiome diversity. These results could be due to the involvement of subjects with an already healthy gut microbiota composition, thus limiting the impact of probiotics.
Dr. Marroquin noted that their research further supports the use of probiotics to ameliorate the negative effects of antibiotics on gut microbiome composition and the digestive system.
“In addition to our findings, research has also shown that adding probiotics while on antibiotic interventions protects the intestinal barrier and the host’s immune system, helps with infection eradication, and decreases the appearance of antibiotic-resistant bacteria,” Dr. Marroquin said.
“[U]p to this point and based on human research, there is no reason to withhold probiotic interventions while on antibiotics as this practice could preclude patients from the protective effects that probiotics may confer at this crucial point.” — Dr. Elisa Marroquín
Dr. Marroquin also noted that most studies reporting the beneficial effects of the coadministration of probiotics involved the continuation of probiotics for about a week after the end of antibiotic use.
Extending probiotics use after the discontinuation of antibiotic treatment may thus be necessary to ensure the protective effects of probiotics on gut microbiota health and gastrointestinal symptoms.
Dr. Bradley Johnston, a professor at Texas A&M University, said, “Marroquin and colleagues have mapped the variety of study designs, probiotic interventions, and microbiome outcomes, noting the extensive variability across the 29 studies, and have identified the gaps in knowledge and suggested areas for future research.”
“The implications for clinical practice based on this study are very limited based on the variability of study designs, populations, and interventions, and the limitations of the biochemical outcomes [gut microbiome composition] for patient and family decision-making. Further, while patients don’t tend to care about biochemical outcomes, the study results provide more incentive to consider probiotics when prescribed an antibiotic,” added Dr. Johnston.
“We still don’t know the dosage, frequency, length of intervention, and bacteria composition that would be most beneficial for probiotic interventions during antibiotic treatment. Therefore a lot more research in the area is highly needed.” — Dr. Elisa Marroquín
It is present in egg yolks if the chickens laying them are free-range. Some mushrooms also contain vitamin D.
However, no other plant-based foods produce vitamin D. For people whose diets are mostly
Many people use the word eczema when referring to atopic dermatitis, which is the most common type. The term atopic refers to a collection of conditions that involve the immune system, including atopic dermatitis, asthma, and hay fever. The word dermatitis refers to inflammation of the skin.
Certain foods, such as nuts and dairy, can trigger symptoms of eczema. Environmental triggers can include smoke, pollen, soaps, and fragrances. Eczema is not contagious.
About a quarter of children in the U.S. have the condition, as well as 10% of African Americans, 13% of Asian Americans and Pacific Islanders, 13% of Native Americans, and 11% of people who are white.
Some people outgrow the condition, while others will continue to have it throughout adulthood. This article will explain what eczema is and discuss its symptoms, treatments, causes, and types.
Symptoms
The symptoms of atopic dermatitis can vary depending on a person’s age and the condition’s severity and can vary by individual.
People with the condition will often experience periods of time when their symptoms worsenTrusted Source, followed by periods of time when their symptoms will improve or clear up.
The following sections will outline some of the potential differences in symptoms in more detail.
General eczema symptoms
In most cases eczema symptoms are mild. The most common symptoms of atopic dermatitis include:
dry, scaly skin
skin flushing
itching
open, crusted, or weeping sores
People with severe eczema may need more intensive treatment to relieve their symptoms. Continuous rubbing and scratching can also lead to skin infections.
In People of Color, an eczema rash may appear gray or brown. This can make outbreaks harder to see.
However, People of Color who get eczema may also get dark or light skin patches even after eczema symptoms go away. These can last a long time. Doctors call these patches hyperpigmentation and depigmentation or hypopigmentation.
A dermatologist can evaluate these patches, which may respond to treatments like steroid creams.
The following atopic dermatitis symptoms are common in babies under the age of 2:
rashes on the scalp and cheeks
rashes that bubble up before leaking fluid
rashes that can cause extreme itchiness, which may interfere with sleeping
Childhood eczema symptoms
The following atopic dermatitis symptoms are common in children age 2 and above:
rashes that appear behind the creases of elbows or knees
rashes that appear on the neck, wrists, ankles, and the crease between the buttocks and legs
bumpy rashes
rashes that can become lighter or darker
skin thickening, also known as lichenification, which can then develop into a permanent itch
Most people with the condition develop it before the age of 5 years. An estimated 60% of children will no longer show symptoms by adolescence.
African American and Hispanic children may have more severe eczema than children who are white.
Symptoms in adults
The following atopic dermatitis symptoms are common in adults:
rashes that are more scaly than those occurring in children
rashes that commonly appear in the creases of the elbows or knees or the nape of the neck
rashes that cover much of the body
very dry skin on the affected areas
rashes that are permanently itchy
skin infections
Adults who developed atopic dermatitis as children but no longer experience the condition may still have dry or easily irritated skin, hand eczema, and eczema on the eyelids.
The appearance of skin affected by atopic dermatitis will depend on how much a person scratches and whether the skin is infected. Scratching and rubbing can further irritate the skin, increase inflammation, and make the itching worse.
Treatments
There is currently no cure for eczema. Treatment for the condition aims to heal the affected skin and prevent flares of symptoms.
Doctors will suggest a treatment plan based on an individual’s age, symptoms, and current state of health.
For some people, eczema goes away over time. For others, however, it is a lifelong condition.
The sections below will list some treatment options.
Home care
There are several things that people with eczema can do to support skin health and alleviate symptoms.
air drying or gently patting the skin dry with a towel, rather than rubbing the skin dry after bathing or taking a shower
where possible, avoiding rapid changes of temperature and activities that cause sweating
learning and avoiding individual eczema triggers
keeping fingernails short to prevent scratching from breaking the skin
People can also try various natural remedies for eczema, including aloe vera, coconut oil, and apple cider vinegar.
Medications
Doctors can prescribe several medications to treat the symptoms of eczema, including:
Topical corticosteroid creams and ointments: These are anti-inflammatory medications and should relieve the main symptoms of eczema, such as inflammation and itchiness. People can apply them directly to the skin. Some people may benefit from prescription-strength medications.
Oral medications: If topical treatments are not effective, a doctor may prescribe oral medications like systemic corticosteroids or immunosuppresants. These are available as injections or oral tablets. People should only use them for short periods of time. Also, it is important to note that the symptoms may worsen upon stopping these drugs if the person is not already taking another medication for the condition.
Antibiotics: Doctors prescribe antibiotics if eczema occurs alongside a bacterial skin infection.
Antihistamines: These can reduce the risk of nighttime scratching, as they tend to cause drowsiness.
Topical calcineurin inhibitors: This drug suppresses the activities of the immune system. It decreases inflammation and helps prevent flares.
Barrier repair moisturizers: These reduce water loss and work to repair the skin.
Phototherapy: This involves exposure to UVA or UVB waves. This method can treat moderate dermatitis. A doctor will monitor the skin closely throughout the treatment.
Injected biologic drugs: These medications block proteins in the immune system to limit immune system response.
Even though the condition itself is not currently curable, each person should consult with a doctor to get a tailored treatment plan.
Even after an area of skin has healed, it is important to keep looking after it, as it may easily become irritated again.
Causes
Researchers do not know the definitive cause of eczema, but many health professionals believe that it develops from a combination of genetic and environmental factors.
Children are more likely to develop eczema if a parent has it or another atopic condition. If both parents have an atopic condition, the risk is even higher.
Some environmental factors may also bring out the symptoms of eczema. These include:
Irritants: These include soaps, detergents, shampoos, disinfectants, juices from fresh fruits, meats, and vegetables.
Allergens: Dust mites, pets, pollens, and mold can all lead to eczema. This is known as allergic eczema.
Microbes: These include bacteria such as Staphylococcus aureus, viruses, and certain fungi.
Hot and cold temperatures: Very hot and very cold weather, high and low humidity, and perspiration from exercise can bring out eczema.
Foods: Dairy products, eggs, nuts and seeds, soy products, and wheat can cause eczema flares.
Stress: This is not a direct cause of eczema, but it can make the symptoms worse.
Hormones: Females may experience increased eczema symptoms when their hormone levels are changing, such as during pregnancy and at certain points in the menstrual cycle.
Allergic contact dermatitis: This is a skin reaction that occurs following contact with a substance or allergen that the immune system recognizes as foreign.
Dyshidrotic eczema: This refers to irritation of the skin on the palms of the hands and soles of the feet. It is characterized by blisters.
Neurodermatitis: This leads to scaly patches of skin on the head, forearms, wrists, and lower legs. It occurs due to a localized itch, such as from an insect bite.
Discoid eczema: Also known as nummular eczema, this type presents as circular patches of irritated skin that can be crusted, scaly, and itchy.
Stasis dermatitis: This refers to skin irritation of the lower leg. It is usually related to circulatory problems.
Summary
Eczema is a common inflammatory skin condition. The most common type is called atopic dermatitis. Eczema is most common in children, but the majority of children will grow out of it by the time they reach adolescence.
Eczema can cause discomfort and can vary in severity. It can present differently depending on a person’s age. In people with darker skin tones, the symptoms may be harder to see.
Although there is currently no cure, people can treat and prevent eczema flares using home remedies, moisturizers, medications, and lifestyle changes.
