September–October 2022

Nutrition

and

Dear Readers:

Welcome to the September–October 2022 issue of Nutrition Health Review (NHR). And welcome autumn! We kick off this issue with an article on the importance of balance training, particularly among older individuals, who are at higher risk of falls. Following this, we provide a brief guide to different methods of healthcare practice: conventional, alternative and complementary (CAM), and integrative. In particular, we focus on CAM, as this method comprises a number of different practices and therapies one may routinely encounter when seeking healthcare advice; however, it is important to note that many CAM therapies lack rigorous scientific study and thus should be followed with caution and under guidance of a qualified healthcare provider.

Next, we review the causes, symptoms, and management of gastroesophageal reflux disease (GERD), a chronic condition in which the contents of the stomach travel up the esophagus. It’s important to prevent or manage this condition to avoid its potential complications, including esophageal ulcers and even asthma.

This issue’s Know Your Nutrient focuses on folate, a watersoluble B vitamin that is essential to the production of red blood cells and cell division (among other important processes). And the star of this issue’s Superfood Spotlight is yogurt, an excellent source of protein, calcium, and certain strains of bacteria that are important for maintaining gut health.

We also review the myriad of health benefits that come from eating spicy foods, including gastrointestinal, cardiovascular, and metabolic effects, to name a few. Many of these health benefits are attributed to capsaicin, the compound in peppers that makes them spicy hot. Following this, we provide an informative article on the nine essential amino acids our body requires to maintain health, which is followed up nicely by a primer article on the muscular system.

And finally, we wrap up the issue with an article on adaptogens, a term you’ve probably been hearing a lot lately in preventative healthcare. Adaptogens are plant-based compounds that are thought to improve the body’s response to stress, anxiety, and fatigue. Traditionally used in Chinese and Ayurvedic medicine, products containing these medicinal herbs have been making their way into mainstream grocery and health food stores, touting a number of health benefits. In this article, we take a look at the science behind these claims.

As always, we hope you enjoy the issue and we welcome your feedback. Enjoy the wonderful fall season!

With warm regards,

Elizabeth A. Klumpp Executive Editor

NHR EDITORIAL STAFF

Elizabeth Klumpp

Executive Editor

Julia Eckert

Associate Editor

Austin Vitelli

Associate Editor

Amanda Tolvaisa

Assistant Editor

Gannon Vitelli

Assistant Editor

BUSINESS STAFF

Robert Dougherty

President/Group Publisher

Giselle Geddes, MD

Chief Medical Officer

Joseph Morris

Senior Vice President

Elizabeth Klumpp

Vice President/Editorial Director

Ali Kinnie

Publisher, Director of Media Relations

E. Patrick Scullin

Director of Finance

Emily Scullin

Associate Director of Business Development

Kimberly Hooven

Project Manager

Nutrition Health Review: The Consumer’s Medical Journal© ISSN 0164-7202 is published 6 times a year by Matrix Medical Communications © 2022 all rights reserved. Opinions expressed by authors, contributors, and advertisers are their own and not necessarily those of Matrix Medical Communications, the Vegetus Foundation, the editorial staff, or any member of the editorial advisory board. Matrix Medical Communications and the Vegetus Foundation are not responsible for accuracy of dosages given in the articles printed herein. The appearance of advertisements in this journal is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality, or safety. Matrix Medical Communications and the Vegetus Foundation disclaim responsibility for any injury to persons or property resulting from any ideas or products referred to in the articles or advertisements.

Subscriptions and address changes: Subscriptions are $18.00 annually. International print subscriptions are not available. To subscribe, please visit https://tinyurl.com/ y8q72dw5 and complete the online subscription form, or complete and return the subscription form found in the magazine by faxing (when paying with credit card) or mailing (when paying by check made payable to Vegetus Foundation) to Matrix Medical Communications, 1595 Paoli Pike, Suite 201, West Chester, PA 19380; Toll-free 866.325.9907; Phone 484.266.0702; Fax 484.266.0726. Address changes should be mailed to above or emailed to info@matrixmedcom.com

Editorial queries: Elizabeth Klumpp, Vice President/ Editorial Director, Matrix Medical Communications, 1595 Paoli Pike, Suite 201, West Chester, PA 19380; Phone: (484) 266-0702; E-mail: eklumpp@matrixmedcom.com

VETERANS CORNER

offers benefit debt relief to Veterans affected

hurricanes. The Department of Veterans

offering a suspension of debt repayments for Veterans and family members affected by Hurricane

or Hurricane Ian. For suspension of benefit

the VA Debt Management Center at

(select Veterans Affairs-Debt as the category) or call 800-827-0648. For suspension of medical care and pharmacy copayment debt, contact the Health Resource Center at 866-400-1238. Veterans can also check the status of their VA debt online on VA’s debt portal (https://www.va.gov/manage-vadebt/).

VA offers more than $11M in grant funding to provide legal services for homeless Veterans. As a part of ongoing efforts to end Veteran homelessness, the Department of Veterans Affairs published a Notice of Funding Opportunity for more than $11 million in legal services grants for Veterans experiencing or at risk of homelessness. The funds are available through VA’s new Legal Services for Veterans Grant Program at https://www.va.gov/HOMELESS/LSV.asp.

VA Program of Comprehensive Assistance for Family Caregivers expands to Veterans of all eras. VA’s Program of Comprehensive Assistance for Family Caregivers is expanding to include eligible Veterans and family caregivers of all eras. This expansion opens the program to eligible Veterans of all eras, including those who served after May 7, 1975, and before Sept. 11, 2001. Visit https://www.va.gov/opa/pressrel/ pressrelease.cfm?id=5829 for more info.

VA opens health care eligibility for Vietnam, Gulf War, post-9/11 Veterans under PACT Act. On October 1, the Department of Veterans Affairs expanded and extended eligibility for VA healthcare for certain Veterans of the Gulf Wars and post9/11 era. The VA has already expanded healthcare eligibility for certain Veterans of the Vietnam War. More detailed information about this expansion can be found at https://www.va.gov/resources/the-pactact-and-your-va-benefits/.

Exercise Tips and Techniques BALANCE TRAINING: An Important Addition to Any Workout

Balance training is an important part of any workout routine, especially among older adults, who might be at a greater risk for falls.1 However, balance training isn’t just for older folks; it can also benefit those who have had a stroke,1 athletes,2 and, really, anyone who wants to improve their resistance to falls.

WHAT IS BALANCE TRAINING?

The Physical Activity Guidelines for Americans, 2nd edition defines balance training as, “Static and dynamic exercises that are designed to improve individuals’ ability to resist forces within or outside of the body that cause falls while a person is stationary or moving.”3 Balance training focuses on strengthening the core, legs, glutes, and back.4,5 Some examples of balance exercises include walking heel-to-toe, walking backward, using a wobble board, lateral leg lifts, yoga poses (e.g., tree pose), and Tai Chi1–5

At its core, balance training focuses on improving stability. One major benefit of balance training is that it reduces the risk of falls; as such, it is recommended that older adults and others at risk of falls incorporate balance training into their lives.1–3,5 The American Heart Association recommends that older adults participate in balance training at least three days per week.1

A 2019 mini-review found that, in addition to improving postural control, balance training could also benefit cognitive performance in areas such as memory, spatial cognition, and attention. The authors concluded that an eight-week balance and coordination exercise program could be used to improve quality of life in older adults.6

Various studies have shown the benefits of balance training in preventing athletic injuries. Among soccer players, incorporating balance training, either alone or in combination with an injury prevention program, significantly reduced the risk of ankle injuries.7 A study

focusing on high school basketball and soccer players found that rates of ankle sprains were lower among players who participated in a balance training program, compared to those who did not undergo balance training. The authors noted that the implementation of balance training could reduce the risk of ankle sprains among this population by 38 percent.8

Having a stroke often causes balance issues due to impairments in motor and cognitive functions.9 As such, balance training is essential to improve quality of life and prevent falls and other balance-related injuries among individuals who have had a stroke. In one study, conventional balance training and wobble board training with or without visual feedback were found to be effective in improving balance in people with ambulatory stroke; wobble board training with visual feedback was found to be especially beneficial, as providing visual feedback increased the individual’s awareness and allowed them to correct their positioning.9 In another study, authors demonstrated that both conventional balance training and rapid movement training improved overall balance and reduced the risk of falls in people with chronic stroke.10

EXERCISES

Here are three simple, adaptable exercises you can do to improve your balance:

1. One-leg balance

Position yourself beside a wall or behind a chair. Raise your leg and hold for 10 to 15 seconds, grabbing the chair or wall for support if needed. Repeat on the other side.

2. Sit to stand

Sit on a kitchen chair (or any other hard, immobile chair).

Stand up without using your hands to assist you. Repeat several times.

3. Lateral leg lifts

While standing, slowly left one leg up and to the side,

holding onto a chair for balance. Slowly lower the leg and repeat on the other side.

Editor’s note: Please consult with a qualified healthcare professional to determine what type of exercise is right for you.

SOURCES

1. American Heart Association. Balance exercise. Reviewed 18 Apr 2018. https://www.heart.org/en/healthy-living/fitness/fitness-basics/ balance-exercise. Accessed 27 Sep 2022.

2. Watson S. Balance training. WebMD. Reviewed 23 Nov 2020. https:// www.webmd.com/fitness-exercise/a-z/balance-training. Accessed 27 Sep 2022.

3. United States Department of Health and Human Services. Physical Activity Guidelines for Americans, 2nd edition. US Department of Health and Human Services; 2018.

4. Achauer H. Can you pass the 10-second balance test? New York Times. 12 Aug 2022. Updated 13 Aug 2022. https://www.nytimes.

com/2022/08/12/well/move/balance-exercises.html. Accessed 27 Sep 2022.

5. Fletcher J. What are the best balance exercises for different ages and fitness levels? Medical News Today. 8 Jul 2022. https://www. medicalnewstoday.com/articles/balance-exercises#benefits. Accessed 26 Sep 2022.

6. Dunsky A. The effect of balance and coordination exercises on quality of life in older adults: a mini-review. Front Aging Neurosci 2019;11:318.

7. Al Attar WSA, Khaledi EH, Bakhsh JM, et al. Injury prevention programs that include balance training exercises reduce ankle injury rates among soccer players: a systematic review. J Physiother 2022;68(3):165–173.

8. McGuine TA, Keene JS. The effect of a balance training program on the risk of ankle sprains in high school athletes. Am J Sports Med 2006;34(7):1103–1111.

9. Valodwala KC, Desai AR. Effectiveness of dynamic balance training with and without visual feedback on balance in ambulatory stroke patients. J Clin Diagn Res. 2019;13(5):1–4.

10. Junata M, Cheng KCC, Man HS, et al. Kinect-based rapid movement training to improve balance recovery for stroke fall prevention: a randomized controlled trial. J Neuroeng Rehabil. 2021;18(1):150. NHR

Healthy Lifestyle

Conventional, Complementary and Alternative, and Integrative Medicines:

A Brief Guide to the Different Methods of Healthcare Practice

Itis important to stay informed about the different types of healthcare in order to make the best decisions for your health. Here, we give a brief overview on different methods of healthcare and their potential benefits.

CONVENTIONAL MEDICINE

Conventional medicine is a system of medical care wherein healthcare professionals, such as medical doctors, doctors of osteopathy, nurses, and pharmacists, utilize treatment methods based on scientific research in order to treat

symptoms and diseases. Examples of conventional medicine include pharmaceutical medication, radiation therapy, and surgery.1,2

COMPLEMENTARY AND ALTERNATIVE MEDICINE

As the name suggests, alternative medicine is practiced in place of conventional medicine. Homeopathy, naturopathy, and acupuncture are examples of alternative medicine. Many forms of alternative medicine lack rigorous scientific evidence supporting their efficacy or safety in treating medical conditions.1,3,4

According to a 2017 survey by the Pew Research Center, 20 percent of adults in the United States (US) have used alternative medicine in lieu of conventional medicine.3

Complementary medicine is the use of alternative medicine alongside conventional medicine. Complementary medicine is often used to relieve side effects of conventional medicine, such as cancer treatment, and might improve wellbeing and quality of life.1,5 Twenty-nine percent of US adults reported using complementary medicine in 2017.3

The National Cancer Institute

divides complementary and alternative medicine (CAM) into five categories: mind-body therapies, biologically based practices, manipulative and body-based practices, energy healing, and whole medical systems.1

Mind-body therapy. Mind-body therapies use a combination of mental focus, breathing, and body movement to induce relaxation of the body and mind.1,6 Some of the most well-known forms of mind-body therapy include yoga, meditation, and Tai Chi. The 2017 National Interview Health Survey showed that yoga and meditation were practiced by 14.3 and 14.2 percent of US adults, respectively.7 Meditation utilizes techniques that revolve around maintaining mental focus using specific techniques, such as breathing, repeating a mantra, and maintaining a mental image. It can also involve mindfulness, which is the practice of focusing on the present moment without making judgments.1,8 Yoga is a practice that aims to balance the mind and body through poses, stretches, meditation, and breathing techniques.1,9 Tai Chi combines slow, gentle movements and poses with meditation and controlled breathing.1,10

Various studies on meditation, yoga, and Tai Chi have shown them to have beneficial effects on a number of different health conditions, including stress, anxiety, depression, acute and chronic pain, and hypertension, but results are mixed, and more highquality studies need to be done in order to fully understand the role of these practices in certain health conditions.8–10 The American College of Physicians recommends yoga, Tai Chi, and mindfulness-based stress reduction as first-line treatment for chronic low back pain, but also

notes that there is moderate-quality evidence supporting the use of mindfulness-based stress reduction and low-quality evidence supporting the use of yoga and Tai Chi.11

Other examples of mind-body treatments include biofeedback, hypnosis, and music therapy.1,6

Biologically based practices. Biologically based treatments are products, such as vitamins, dietary supplements, and botanicals, that include substances found in nature.1,6

In a 2020 mini-review,12 researchers found that patients with cancer used biologically based CAMs to improve well-being; alleviate symptoms such as nausea, insomnia, and vomiting; treat cancer; and improve the immune system. However, there is little longterm data supporting the use of such products in patients with cancer. Some studies have shown the potential for certain biologically based CAMs to be used in cancer treatment and prevention. For example, antioxidants, ginseng, and green tea might have the potential to decrease the risk of developing certain cancers. Ultimately, the lack of long-term, controlled human trials makes it inadvisable to recommend these treatments.12

One crucial aspect to note about biologically based CAMs is the lack of US Food and Drug Administration (FDA) oversight on these products. According to FDA guidelines, biologically based CAMs, depending on the product’s intended use and composition, may be labeled as drugs, cosmetics, foods, or dietary supplements.13 When a product is labeled as a food rather than a drug, it does not need to undergo the same FDA testing or approval, allowing for some products to be sold without knowing of their safety or efficacy.1,6 Some natural therapies might not

be safe if taken in large doses, by themselves, or alongside certain medications. For example, the herb kava kava might cause liver damage,1 and antioxidants have the potential to interfere with radiation and certain types of chemotherapy.12

Manipulative and body-based practices. These practices involve moving/manipulating one or more parts of the body. Examples include massage therapy, chiropractic treatment, and reflexology.1,6 In massage therapy, soft tissues are manipulated to relieve pain and tension in the body. Multiple techniques exist, focusing on utilizing varying amounts of pressure and targeting different areas of the body.14,15 Chiropractic treatment includes spinal manipulation, wherein a practitioner applies a controlled thrust to a joint of the spine, moving the joint more than it would on its own, and spinal mobilization, which is less forceful and is performed within the joint’s normal range of motion.16,17 Research has shown weakto-moderate benefits of massage therapy and chiropractic treatments on neck and low-back pain, and more research is needed to understand their effects on other conditions.14–17 Reflexology is similar to massage therapy, in that pressure is applied to specific areas of the feet or hands that are believed to correspond to organs and systems of the body. Reflexology might improve pain, stress, and sleep.18

Energy healing. Energy healing stems from the belief that energy flows through the body, and this energy flow must be balanced. Therapeutic/healing touch involves moving hands over the energy fields of the body or gently touching the body. In reiki therapy, a practitioner

will “channel energy” into a person to enhance their healing response.1,6,19 No high-quality evidence exists to support these practices, although some researchers believe it may work due to providing a placebo effect.19

Whole medical systems. Whole medical systems (sometimes referred to as ancient or traditional medical systems) include healing systems that have developed in different cultures. Traditional Chinese medicine, Ayurvedic medicine, homeopathy, and naturopathy are all considered whole medical systems.1,6

Traditional Chinese medicine is based on the belief that illnesses and diseases are caused by imbalances in one’s vital life force, or qi. Treatment methods include acupuncture, massage, cupping, herbal remedies, moxibustion, and Tai Chi.20

Originating in India, ayurvedic medicine aims to restore balance between the mind, body, and spirit to prevent or treat diseases, increase energy, and decrease stress. It involves the diet, herbal medicine, meditation, breathing, and physical therapy, among other treatment methods.1,21

The two main beliefs of homeopathy are that like cures like, or that a disease can be cured by a substance that produces similar symptoms in a healthy individual, and that medications with lower doses are more effective at treating diseases. Homeopathic products are often so diluted, the original substance is barely or no longer present, and remedies are highly individualized. No high-quality, scientific evidence suggests that homeopathy is beneficial.22,23

Naturopathic practitioners believe in using a variety of lifestyle changes and natural remedies (e.g. nutrition,

homeopathy, herbal remedies), but not drugs or surgery, to help the body heal itself.1,6 Although certain treatment approaches, such as improving nutrition, has been shown through research to be beneficial, on the whole, there is not sufficient scientific evidence to support the use of naturopathic medicine in the treatment of disease.24–26

INTEGRATIVE MEDICINE

Integrative medicine is the combination of conventional and complementary medicines, with a focus on treating the whole person, as opposed to just focusing on a disease or illness. It involves the coordination of different healthcare providers, such as physicians, acupuncturists, nutritionists, and chiropractors, among others.7,27

BOTTOM LINE

Making well-informed decisions about your health is a crucial aspect to any long-term healthcare plan. Be sure to consult with a qualified healthcare professional to see what treatments methods may be right for you.

SOURCES

1. National Cancer Institute. Complementary and alternative medicine. Updated 21 21 Mar 2022. https://www.cancer.gov/aboutcancer/treatment/cam. Accessed 29 Sep 2022.

2. Cronkleton E. Conventional vs. complementary medicine: differences. Medical News Today. 29 Jun 2022. https:// www.medicalnewstoday.com/articles/ difference-between-bconventional-andcomplementary-medicine#conventional. Accessed 29 Sep 2022.

3. Pew Research Center. 2. Americans’ health care behaviors and use of conventional and alternative medicine. 2 Feb 2017. https:// www.pewresearch.org/science/2017/02/02/ americans-health-care-behaviors-and-useof-conventional-and-alternative-medicine/. Accessed 29 Sep 2022.

4. American Cancer Society. What is alternative medicine? Revised 31 Aug

2021. https://www.cancer.org/treatment/ treatments-and-side-effects/treatmenttypes/alternative-medicine/what-isalternative-medicine.html. Accessed 29 Sep 2022.

5. American Cancer Society. What are complementary and integrative methods? Revised 25 Aug 2021. https://www.cancer. org/treatment/treatments-and-sideeffects/treatment-types/complementaryand-integrative-medicine/complementaryand-alternative-methods-and-cancer/ what-are-complementary-and-integrativemethods.html. Accessed 29 Sep 2022.

6. Leukemia and Lymphoma Society. Types of complementary therapies. https://www. lls.org/treatment/integrative-medicineand-complementary-therapies/typescomplementary-therapies. Accessed 29 Sep 2022.

7. National Center for Complementary and Integrative Health. Complementary, alternative, or integrative health: what’s in a name? Updated Apr 2021. https:// www.nccih.nih.gov/health/complementaryalternative-or-integrative-health-whats-ina-name. Accessed 29 Sep 2022.

8. National Center for Complementary and Integrative Health. Meditation and mindfulness: what you need to know. Updated Jun 2022. https://www.nccih.nih. gov/health/meditation-and-mindfulnesswhat-you-need-to-know. Accessed 29 Sep 2022.

9. National Center for Complementary and Integrative Health. Yoga: what you need to know. Updated Apr 2021. https://www. nccih.nih.gov/health/yoga-what-you-needto-know. Accessed 29 Sep 2022.

10. National Center for Complementary and Integrative Health. Tai Chi: what you need to know. Updated Mar 2022. https://www. nccih.nih.gov/health/tai-chi-what-youneed-to-know. Accessed 29 Sep 2022.

11. Qaseem A, Wilt TJ, McLean RM, et al. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med 2017;166:514–530.

12. Knecht K, Kinder D, Stockert A. Biologicallybased complementary and alternative medicine (CAM) use in cancer patients: the good, the bad, the misunderstood. Front Nutr. 2020;6:196.

13. United States Food and Drug Administration. Complementary and alternative medicine products and their regulation by the Food and Drug Administration. Feb 2007. https://www.fda. gov/regulatory-information/search-fdaguidance-documents/complementary-andalternative-medicine-products-and-theirregulation-food-and-drug-administration. Accessed 29 Sep 2022.

14. National Center for Complementary and Integrative Health. Massage therapy: what you need to know. Updated May 2019.

https://www.nccih.nih.gov/health/massagetherapy-what-you-need-to-know. Accessed 29 Sep 2022.

15. Cleveland Clinic. Everything you need to know about massage therapy. 11 Nov 2021. https://health.clevelandclinic.org/benefitsof-massage/. Accessed 29 Sep 2022.

16. National Center for Complementary and Integrative Health. Spinal manipulation: what you need to know. Updated Sep 2022. https://www.nccih.nih.gov/health/spinalmanipulation-what-you-need-to-know. Accessed 29 Sep 2022.

17. Morris R. What is spinal manipulation? Healthline. Updated 15 Mar 2016. https:// www.healthline.com/health/back-pain/ spinal-manipulation. Accessed 29 Sep 2022.

18. Bauer BA. What is reflexology? Can it relieve stress? Mayo Clinic. 15 Dec 2020. https:// www.mayoclinic.org/healthy-lifestyle/ consumer-health/expert-answers/whatis-reflexology/faq-20058139. Accessed 29 Sep 2022.

19. Atkins A. Will exercise, meditation or reiki help if you can’t find a therapist? Washington Post. 29 May 2022. https://www.washingtonpost.com/ health/2022/05/29/alternative-therapiesmental-health/. Accessed 29 Sep 2022.

20. Johns Hopkins Medicine. Chinese medicine. https://www.hopkinsmedicine.org/health/ wellness-and-prevention/chinese-medicine. Accessed 29 Sep 2022.

21. Cancer Research UK. Ayurvedic medicine. Reviewed 14 Jun 2022. https://www. cancerresearchuk.org/about-cancer/cancerin-general/treatment/complementaryalternative-therapies/individual-therapies/ ayurvedic-medicine. Accessed 29 Sep 2022.

22. National Center for Complementary and Integrative Health. Homeopathy: what you need to know. Updated Apr 2021. https:// www.nccih.nih.gov/health/homeopathy. Accessed 29 Sep 2022.

23. National Health Service. Homeopathy. Reviewed 7 Apr 2021. https://www.nhs.uk/ conditions/homeopathy/. Accessed 29 Sep 2022.

24. Caulfield T, Rachul C. Supported by science?: what Canadian naturopaths advertise to the public. All Asth Clin Immun 2011;7:14.

25. Murdoch B, Carr S, Caulfield T. Selling falsehoods? A cross-sectional study of Canadian naturopathy, homeopathy, chiropractic and acupuncture clinic website claims relating to allergy and asthma. BMJ Open. 2016;6(12):e014028.

26. Canadian Cancer Society. Naturopathic medicine. https://cancer.ca/en/treatments/ complementary-therapies/naturopathicmedicine. Accessed 30 Sep 2022.

27. Cleveland Clinic. Integrative medicine. Reviewed 7 Aug 2022. https:// my.clevelandclinic.org/health/ treatments/21683-integrative-medicine. Accessed 30 Sep 2022. NHR

Health Conditions

Gastroesophageal Reflux Disease (GERD)

Symptoms, Causes, and Treatments

gastroesophageal reflux for 12 to 14 months, they might have

the esophagus. About 20 percent of people United States (US) have GERD. Although anyone can experience gastroesophageal reflux, individuals with GERD experience symptoms at least twice per week and/or suffer from damage to the esophagus over time.1,2

The most common symptoms of GERD are heartburn (i.e., a burning sensation behind the breastbone) and regurgitation (i.e., the feeling of fluid or fluid from the stomach coming into the chest).1,3 Other symptoms include nonburning chest pain, difficulty or pain while swallowing, nausea, chronic cough, sore throat, increased salivation, and shortness of breath.3,4

Gastroesophageal reflux is not uncommon in infants, but if your baby experiences symptoms that prevent them from feeding (e.g., vomiting, gagging, difficulty breathing), is fussy around mealtimes, has an inability to gain weight, has hiccups, or experiences

CAUSES

GERD is typically caused by weakness of the lower esophageal sphincter (LES). The LES is located at the bottom of the esophagus, and it opens to let food into the stomach and closes to prevent food and fluids from escaping the stomach. However, a weak LES might relax too long or too often, thus allowing stomach acid to flow back up the esophagus.6

Complications of the diaphragm, such as a hiatal hernia, which is a condition that allows the upper part of the stomach to move into the chest through the opening in the diaphragm, can also cause or worsen GERD.3

RISK FACTORS

Conditions that can increase the risk of developing GERD include pregnancy, obesity, asthma, Down syndrome, neuromuscular disorders (e.g., cerebral palsy, muscular dystrophy), heart defects, neural tube defects, and autoimmune

disorders (e.g., scleroderma, rheumatoid arthritis).3,6–9

Certain medications can also impact GERD. Asthma medications, especially theophylline,8,10 calcium channel blockers, benzodiazepines, nonsteroidal anti-inflammatory drugs (NSAIDs), tricyclic antidepressants, and anticholinergics are examples of medications that can cause or worsen GERD symptoms. Smoking and/or being exposed to secondhand smoke can further increase the risk of GERD.3,6,9,10

Diet also plays a role in the expression of GERD. Foods high in fat, fried foods, mint, and chocolate can lead to GERD.6,7,9,11 These foods are thought to affect the muscle tone of the LES, thereby causing it stay open longer than is typical.6 Acidic foods, such as citrus and tomatoes, caffeinated food and beverages, and alcohol, have also been associated with GERD.6,7,9,11

COMPLICATIONS

In addition to the discomfort and pain of heartburn and regurgitation, GERD can lead to the development of several complications, such as esophagitis, Barret’s esophagus, and asthma.

Esophagitis, or inflammation of the esophagus, can cause ulcers, sores, and bleeding to form in the esophagus.2,6 Chronic esophagitis can lead to another complication of GERD, esophageal or peptic strictures. This complication occurs when the esophagus narrows, and it can cause difficulty swallowing and a feeling of food sticking to the esophagus.1,2

Barrett’s esophagus is a condition in which the cells lining the esophagus change to match the lining of the intestines. This condition

is especially worrisome, as individuals with Barrett’s esophagus have a 30-fold increased risk of developing esophageal cancer.1

Acid reflux caused by GERD can aggravate the airways and lungs, thereby worsening asthma and potentially triggering allergic reactions and increasing the sensitivity of the airways to environmental conditions.1,8 GERD can also cause asthma in adults who previously did not have the condition.1

TREATMENT

GERD can be treated with a combination of lifestyle changes and medications. Quitting smoking, decreasing alcohol intake, avoiding foods that can trigger reflux or damage the lining of the esophagus, and weight loss can alleviate GERD.1,7,8,12

Strategies to reduce symptoms of GERD at night include raising the head of the mattress 6 to 10 inches, not lying down for two to three hours after eating, eating a lighter evening meal, and not eating within two hours of bedtime.1,8

Infants should be burped a few times throughout feeding, as reflux can be more common when burping on a full stomach, and kept upright for 30 minutes after feeding. Additionally, when bottle-feeding, keep the nipple filled with milk to prevent them from swallowing excess air.6

Over-the-counter (OTC) antacids can be used to treat mild symptoms of GERD, but they are not recommended for severe symptoms or everyday use.12 H2 receptor antagonists, or H2 blockers, work by reducing stomach acid production. Proton pump inhibitors (PPIs) are

more effective at treating severe GERD than antacids and H2 blockers. PPIs reduce stomach acid production and help heal the esophageal lining. Both H2 blockers and PPIs can be prescribed or purchased OTC.1,7,12

In individuals whose GERD does not improve with lifestyle changes and medications or who cannot take medications due to adverse events, surgery is an option. Fundoplication is the most common surgical procedure for GERD. During this procedure, the surgeon adds pressure to the LES by sewing the top of the stomach around the end of the esophagus. This helps prevent reflux, often leading to long-term symptom improvement. In individuals with obesity, bariatric surgery (i.e., weightloss surgery) has been shown to be beneficial in reducing symptoms of GERD.12

Editor’s note: Please consult with a qualified healthcare professional if you experience symptoms of gastroesophageal reflux.

SOURCES

1. American College of Gastroenterology. Acid reflux. https://gi.org/topics/acid-reflux/. Accessed 28 Sep 2022.

2. National Institute of Diabetes and Digestive and Kidney Diseases. Definition and facts for GER and GERD. Reviewed Jul 2020. https://www.niddk.nih.gov/healthinformation/digestive-diseases/acid-refluxger-gerd-adults/definition-facts. Accessed 28 Sep 2022.

3. National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms and causes of GER and GERD. Reviewed Jul 2020. https://www.niddk.nih.gov/healthinformation/digestive-diseases/acidreflux-ger-gerd-adults/symptoms-causes. Accessed 28 Sep 2022.

4. Johns Hopkins Medicine. Gastroesophageal reflux disease (GERD). https://www. hopkinsmedicine.org/health/conditionsand-diseases/gastroesophageal-refluxdisease-gerd. Accessed 28 Sep 2022.

5. Boston Children’s Hospital. Gastroesophageal reflux disease. https:// www.childrenshospital.org/conditions/

gerd#symptoms--causes. Accessed 28 Sep 2022.

6. Johns Hopkins Medicine. GERD (gastroesophageal reflux disease) in children. https://www.hopkinsmedicine. org/health/conditions-and-diseases/ gerd-gastroesophageal-reflux-disease-inchildren. Accessed 28 Sep 2022.

7. RWJ Barnabas Health. Gastroesophageal reflux disease (GERD). https://www.rwjbh. org/treatment-care/surgery/thoracicsurgery/thoracic-surgery-diseases-andconditions/gastroesophageal-refluxdisease-gerd-/. Accessed 28 Sep 2022.

8. American Academy of Allergy, Asthma, and Immunology. Gastroesophageal disease. https://www.aaaai.org/ Conditions-Treatments/related-conditions/ gastroesophageal-reflux-disease. Accessed 28 Sep 2022.

9. Palmyra Surgical LLC. Risk factors for GERD. https://www.palmyrasurgical.com/gastricreflux-guide/understanding-reflux-disease/ risk-factors-for-gerd. Accessed 28 Sep 2022.

10. Picco MF. GERD: can certain medications make it worse? Mayo Clinic. 6 Jan 2022. https://www.mayoclinic.org/diseasesconditions/gerd/expert-answers/heartburn-

Know Your Nutrient

gerd/faq-20058535. Accessed 28 Sep 2020.

11. National Institute of Diabetes and Digestive and Kidney Diseases. Eating, Diet, and Nutrition for GER and GERD. Reviewed Jul 2020. https://www.niddk.nih.gov/healthinformation/digestive-diseases/acid-refluxger-gerd-adults/eating-diet-nutrition. Accessed 28 Sep 2022.

12. National Institute of Diabetes and Digestive and Kidney Diseases. Treatment for GER and GERD. Reviewed Jul 2020. https://www. niddk.nih.gov/health-information/digestivediseases/acid-reflux-ger-gerd-adults/ treatment. Accessed 28 Sep 2022. NHR

FOLATE

Folate, also known as vitamin B9, is a watersoluble vitamin that is involved in the synthesis of DNA and RNA.1–3 Folate is needed to break down homocysteine, an amino acid that can be harmful when present in high amounts.1,2,4 Additionally, folate is essential to the production of red blood cells1,4 and the process of cell division, making it a crucial nutrient for periods of rapid growth, such as prenatal and adolescence.1–4

RECOMMENDED INTAKE AND SOURCES

The amount of folate an individual needs varies with age. The National Institutes of Health (NIH) recommends that children aged 14 to 18 years and adults over 18 years of age receive 400µg of dietary folate equivalent (DFE) per day. Pregnant individuals should receive 600µg DFE per day, and lactating individuals should receive 500µg DFE per day.3

Both the NIH and the United States (US) Centers for Disease Control and Prevention (CDC) recommend that individuals of reproductive age who can get pregnant receive at least 400µg DFE per day to reduce the risk of neural tube defects, since about half of all pregnancies

in the US are unplanned, and neural tube defects often occur about 3 to 4 weeks after conception.3,5

The CDC recommends that those who have already had a pregnancy involving a neural tube defect take at least 4,000µg of folic acid per day for at least one month before and throughout the first three months of future pregnancies.5

Folate is measured in DFEs because folic acid, the synthetic form of folate that is used in supplements and fortified foods,5 is better absorbed than folate found in food;1,3 as such, less folic acid is required to reach dietary needs, compared to folate. For example, 400µg DFE is equivalent to 400µg of folate and 240µg of folic acid.3

Sources of folate include dark leafy green vegetables (e.g. spinach, mustard greens), broccoli, Brussel sprouts, asparagus, fruits and fruit juices, beans, sunflower seeds, beef liver, and peanuts.1–3 Since 1998, the US Food and Drug Administration (FDA) has required manufacturers to add 140µg folic acid/100g to enriched grain products, which includes breads, cereals, flours, cornmeals, and rice. Folic acid can also be found in multivitamins, prenatal vitamins, and other dietary supplements.2,3

DEFICIENCY AND DISEASE

Insufficient folate intake prior to pregnancy increases the risk of neural tube defects, such as spina bifida and anencephaly.1–3,6,7 In spina bifida, a portion of the spinal cord and surrounding structures form outside the body. In anencephaly, parts of the brain are absent due to improper formation of the brain and skull bones.6 Inadequate folate intake is also associated with low infant birth weight, premature birth, fetal growth retardation, and placental abruption, wherein the placenta separates from the uterus.2,7

Folate deficiency is rare in the US, but it can lead to serious health concerns. Low levels of folate can cause megaloblastic anemia, in which red blood cells are larger and oval-shaped.2,7,8 In some cases, infants are born with the inability to absorb folic acid, which further increases the risk for megaloblastic anemia.8 Symptoms of megaloblastic anemia include weakness, fatigue, pale skin, irritability, decreased appetite, and shortness of breath.2,8

Several factors can contribute to folate deficiency. Excessive alcohol consumption interferes with folate absorption, and poor-quality diets in individuals with alcohol use disorder puts them at even greater risk for folate deficiency.2,3,7,8 Certain malabsorptive disorders, such as celiac disease and inflammatory bowel disease, can inhibit folate absorption.2,3,7,8 Taking certain antiseizure and ulcerative colitis medications can interfere with folate absorption as well.7,8 Other risk factors for folate deficiency include hemolytic anemia, overcooking fruits and vegetables, and kidney dialysis.7

Individuals with a MTHFR polymorphism struggle to convert folate to its active form, 5-methyl-THF; these individuals should take supplements containing 5-methyl-THF in order to prevent folate deficiency.

Although some studies suggest that folate supplementation decreases the risk of cancer, others show that taking high doses of folate or folic acid might promote the progression of cancer, especially colon cancer.1–3 The NIH notes that the effects of folic acid supplementation on cancer risk remain unclear, particularly in individuals with a history of colorectal adenomas.2

Several studies have shown that supplementation with folic acid alone or combined with other B vitamins can reduce the risk of stroke by 12 to 25 percent, with the most notable risk reduction seen in those with lower baseline folate levels.2

Adults 19 years of age or older should not exceed 1,000µg DFE per day, as excessive amounts of folate can hide a vitamin B12 deficiency, which can lead to irreversible neurological damage.1–3

Editor’s note: Please consult with a qualified healthcare professional to determine what kind of folate intake is right for you.

SOURCES

1. Harvard T.H. Chan School of Public Health. Folate (folic acid) –vitamin B9. https://www.hsph.harvard.edu/nutritionsource/folicacid/. Accessed 26 Sep 2022.

2. United States National Institutes of Health Office of Dietary Supplements. Folate: fact sheet for health professional. Updated 29 Mar 2021. https://ods.od.nih.gov/factsheets/FolateHealthProfessional/. Accessed 26 Sep 2022.

3. United States National Institutes of Health Office of Dietary Supplements. Folate: fact sheet for consumers. Updated 22 Mar 2021. https://ods.od.nih.gov/factsheets/Folate-Consumer/. Accessed 26 Sep 2022.

4. Mount Sinai. Vitamin B9 (folic acid). https://www.mountsinai.org/ health-library/supplement/vitamin-b9-folic-acid. Accessed 26 Sep 2022.

5. United States Centers for Disease Control and Prevention. Folic acid. Reviewed 15 Jun 2022. https://www.cdc.gov/ncbddd/folicacid/ about.html. Accessed 26 Sep 2022.

6. Stanford Medicine Children’s Health. Folic acid for a healthy baby. https://www.stanfordchildrens.org/en/topic/default?id=folic-acidfor-a-healthy-baby-134-2. Accessed 26 Sep 2022.

7. Cleveland Clinic. Folate deficiency. Reviewed 14 Dec 2021. https:// my.clevelandclinic.org/health/diseases/22198-folate-deficiency. Accessed 26 Sep 2022.

8. Johns Hopkins Medicine. Folate-deficiency anemia. https://www. hopkinsmedicine.org/health/conditions-and-diseases/folatedeficiency-anemia. Accessed 26 Sep 2022. NHR

COFFEE DRINKING IS ASSOCIATED WITH INCREASED LONGEVITY

In a recent study published in the European Journal of Preventive Cardiology, researchers observed that drinking 2 to 3 cups of instant, ground, or decaffeinated coffee per day was associated with decreased risk of death from any cause and incident cardiovascular disease, compared to not drinking coffee. Additionally, drinking ground and instant coffee was linked to a lower risk of arrhythmia.

Source: Science Daily. Coffee drinking is associated with increased longevity. 26 Sep 2022. https://www.sciencedaily.com/ releases/2022/09/220926200838.htm. Accessed 30 Sep 2022.

Turn up the HEAT!

The Benefits of SPICY Foods

Over the years, research has shown that consuming spicy foods has a myriad of beneficial effects on health. Many of these health effects are attributed to capsaicin, which is the compound responsible for making peppers spicy. One study from 2015 found that eating spicy food everyday reduced the risk of death by 14 percent; the authors noted an inverse association between spicy food consumption and deaths due to cancer, ischemic heart diseases, and respiratory diseases.1 In this article, we provide a brief overview of some of the health benefits of spicy foods.

GASTROINTESTINAL HEALTH

It is a common misconception that spicy foods can cause stomach ulcers; however, the real culprit is more commonly nonsteroidal antiinflammatory drug (NSAID) use or the bacteria Helciobacter pylori (H. pylori).2,3 In fact, capsaicin can protect against stomach ulcers by inhibiting H. pylori growth.2 Furthermore, capsaicin aids in inhibiting acid production in the stomach,3,4 which promotes the healing of ulcers.

In addition to helping with ulcers, eating spicy foods has a positive effect on the gut microbiome. Research has shown that capsaicin can increase the growth healthy gut flora while decreasing the presence of bad bacteria.5,6

CARDIOVASCULAR HEALTH

In one review, researchers observed that individuals who ate chili pepper had a 26-percent relative reduction in cardiovascular mortality, compared to those who rarely or never ate chili peppers;7 however, only four studies were included in the review, which limits the generalizability of their findings.

Consuming spicy foods has been associated with lower levels of low-density lipoprotein (LDL, or “bad”) cholesterol and higher levels of high-density lipoprotein (HDL, or “good”) cholesterol.5,8

Capsaicin is known to release calcitonin gene-related peptide (CGRP), which plays a role in decreasing blood pressure.2,9 In animal models, spicy foods have been found to reduce the risk of high blood pressure,2,6 though more research must be done to confirm this effect in humans.

DIABETES

Many studies have described the role of capsaicin in diabetes. Research has shown that regularly eating chili peppers can ameliorate hyperglycemia and hyperinsulinemia following meals.2,4 Additionally, capsaicin can increase glucose absorption, thus playing an important role in lowering blood glucose levels.2,4,10

Capsaicin has the potential to improve glucose homeostasis, though evidence for this largely comes from animal models.2,4,9,10 As such, more research needs to be done on capsaicin role in glucose homeostasis and its potential to decrease the risk of Type 2 diabetes in humans.

CANCER

Researchers have uncovered an association between spicy food and reduced risk of certain types of cancer. One study involving Chinese adults found that spicy food consumption was significantly associated with reduced risk of esophageal cancer, as well as reduced mortality from esophageal cancer. There was also a weaker correlation between spicy food

intake and reduced risk of stomach and colorectal cancers.11

Capsaicin has been observed to regulate the cell cycle, including apoptosis and autophagy (normal processes of cell death), which can prevent the proliferation of various types of cancers.2,12 However, some animal studies have observed a co-carcinogenic effect in capsaicin,2 so further research is needed to fully understand its role in cancer development and treatment.

PAIN

The benefits of spice aren’t just limited to food! Topical formulations of capsaicin can be used to treat a variety of painful conditions.

In one study among individuals with diabetic peripheral neuropathy, the use of topical capsaicin resulted in significant pain relief.10 Another study showed that an 8% capsaicin patch significantly reduced localized neuropathic pain, and of the study participants who experienced a 30-percent or greater reduction in pain intensity, 26 percent reached almost complete pain relief.13

Topical capsaicin can also improve itch, although it may cause side effects, such as a slight burning sensation.2,14 Topical capsaicin

can also be used to relieve pain from osteoarthritis, muscle sprains or strains, and post-herpetic neuralgia.6,15

BOTTOM LINE

If you can tolerate a little heat, spicy foods can be a great addition to your diet.

Editor’s note: Please consult with a qualified healthcare professional to determine if you should add spicy foods to your diet.

SOURCES

1. Lv J, Qi L, Yu C, et al. Consumption of spicy foods and total and cause-specific mortality: population based cohort study. BMJ. 2015;351:h3942.

2. Fattori V, Hohmann MS, Rossaneis AC, et al. Capsaicin: current understanding of its mechanisms and therapy of pain and other pre-clinical and clinical uses. Molecules. 2016;21(7):844.

3. McDonald E. A hot topic: are spicy foods healthy or dangerous? UChicago Medicine. 23 Sep 2018. https://www. uchicagomedicine.org/forefront/healthand-wellness-articles/spicy-foodshealthy-or-dangerous. Accessed 28 Sep 2022.

4. Xiang Y, Xu X, Zhang T, et al. Beneficial effects of dietary capsaicin in gastrointestinal health and disease. Exp Cell Res. 2022;417(2):113227.

5. Cleveland Clinic. Is spicy food good for you? 2 Aug 2021. https://health. clevelandclinic.org/is-spicy-food-goodfor-you/. Accessed 28 Sep 2022.

6. Armstrong L. Is spicy food good for your health? GoodRx. 19 Jan 2022. https:// www.goodrx.com/well-being/diet-

HOMEMADE CAYENNE PEPPER SAUCE

nutrition/is-eating-spicy-food-good-foryou. Accessed 28 Sep 2022.

7. American Heart Association. People who eat chili pepper may live longer? ScienceDaily. 9 Nov 2020. https://www.sciencedaily.com/ releases/2020/11/201109074114.htm. Accessed 28 Sep 2022.

8. Xue Y, He T, Yu K, et al. Association between spicy food consumption and lipid profiles in adults: a nationwide population-based study. Br J Nutr 2017;118(2): 144–153.

9. Sun F, Xiong S, Zhu Z. Dietary capsaicin protects cardiometabolic organs from dysfunction. Nutrients. 2016;8(5):174.

10. Wang P, Yan Z, Zhong J, et al. Transient receptor potential vanilloid 1 activation enhances gut glucagon-like peptide-1 secretion and improves glucose homeostasis. Diabetes. 2012;61(8):2155–2165.

11. Chan WC, Millwood IY, Kartsonaki C, et al. Spicy food consumption and risk of gastrointestinal-tract cancers: findings from the China Kadoorie Biobank. Int J Epidemiol. 2021;50(1):199–211.

12. Adetunji TL, Olawale F, Olisah C, et al. Capsaicin: a two-decade systematic review of global research output and recent advances against human cancer. Front Oncol. 2022;12:908487.

13. Vieira IF, de Castro AM, Loureiro MDC, et al. Capsaicin 8% for peripheral neuropathic pain treatment: a retrospective cohort study. Pain Physician 2022;25(4):E641–E647.

14. Malewicz NM, Rattray Z, Oeck S, et al. Topical capsaicin in poly(lacticco-glycolic)acid (PLGA) nanoparticles decreases acute itch and heat pain. Int J Mol Sci. 2022;23(9):5275.

15. Mayo Clinic. Capsaicin (topical route). https://www.mayoclinic.org/drugssupplements/capsaicin-topical-route/ description/drg-20062561. Accessed 28 Sep 2022. NHR

Yogurt: we’ve been eating it for centuries, and for good reason. It can be eaten on its own as a snack, added to a breakfast smoothie, or used to make delicious dip or dressing—the possibilities seem endless!

Yogurt is made by combining heated milk with certain bacteria, then letting it sit for several hours at 110 to 115 degrees Fahrenheit.1 The bacteria converts lactose into lactic acid, which provides yogurt’s distinct, tart flavor.1–3 Although yogurt can be an excellent source of nutrients, not all yogurts have equal benefits.

NUTRITION

Yogurt is a good source of protein, calcium, phosphorous, riboflavin, and vitamin B12.1–4 One cup of plain yogurt made with low fat milk contains 12.9g of protein, 448mg of calcium, 353mg of phosphorus, 0.524mg of riboflavin, and 1.37µg of vitamin B12.5

TYPES OF YOGURT

Whole-fat, low-fat, and nonfat yogurt. Yogurt can be made with whole-fat, low-fat, or skim milk. The Dietary Guidelines for Americans

YOGURT

recommends eating low- or nonfat yogurt6,7 due to the saturated fat content of whole-fat yogurt. However, research has shown that consuming whole-fat dairy products does not increase the risk of cardiovascular disease or metabolic risk factors.8–11 One study found that whole-fat dairy consumption decreased the risk of metabolic syndrome,11 and some studies suggest that whole-fat yogurt intake might offer protective effects against cardiovascular disease and Type 2 diabetes.12 Ultimately, the decision of whether to eat whole-fat, low-fat, or nonfat yogurt depends on personal preferences and nutritional needs. Greek yogurt. Greek yogurt is strained to remove the whey, which gives it a thicker, creamier texture.1,2,4,7,13 This straining process results in a higher protein content of around 15g to 20g in one 6-ounce serving. But Greek yogurt has lower calcium content than traditional yogurt.2,7,13 The increased protein of Greek yogurt can promote feeling fuller long, which might aid in appetite management.3,4 Greek yogurt also contains less carbohydrates than traditional

yogurt.13 Although traditional yogurt has a lower lactose content than other dairy products,1,2 some individuals with lactose intolerance might still find traditional yogurt difficult to digest. For these individuals, Greek yogurt may be a good alternative, as its lower sugar content means it also contains less lactose than traditional yogurt.7,13

Plant-based yogurt. As with many dairy products, yogurts come in a variety of plant-based options. These yogurts can be made from ingredients such as almonds, coconuts, soy, cashews, and oats.1,4,7,14 However, pay careful attention to the nutrient profiles of these nondairy alternatives. Without fortification, nondairy yogurts have little to no calcium, and even those with added calcium tend to have less than traditional yogurt.14 Coconut milk yogurt can be higher in saturated fat than traditional yogurt,4,14 and certain almond milkbased yogurts can have higher amounts of unsaturated fat than their dairy counterparts. Soy-based yogurt typically offers a comparable amount of protein to traditional yogurt; additionally, some plantbased yogurts are fortified with soy,

peas, or fava beans to increase their protein content.14

Sweetened versus unsweetened. Experts suggest avoiding yogurt sweetened with added sugars, as one eight-ounce cup of sweetened yogurt can have as much as 30g of sugar.15 A better alternative to these sugary snacks is buying plain yogurt and adding your own flavor enhancers, such as fresh or frozen fruit and honey.2,4,7,15 Plain yogurt can also be used in savory recipes, making it a versatile kitchen staple.

HEALTH BENEFITS

Yogurt has been associated with a variety of health benefits. Research has shown that eating yogurt can help alleviate irritable bowel disease and antibiotic-associated diarrhea.3,16 Certain varieties of yogurt contain probiotics, or live bacteria, which can improve gastrointestinal health and immunity.2–4

Yogurt has also been found to have a positive effect on cardiovascular health through its ability to reduce serum cholesterol levels, lowering the risk of cardiovascular disease and promoting healthy blood pressure.1,3,4,16,17 Furthermore, regular yogurt consumption can help protect against Type 2 diabetes.1,16,17

With its high calcium content, yogurt also allows for the formation and maintenance of healthy bones.2,16,17 For elderly individuals, yogurt could be a key source of calcium to help maintain bone mineral density.17

BOTTOM LINE

Whatever variety you choose, yogurt is an excellent, healthy addition to any diet; just be sure to

HOMEMADE YOGURT

Makes 4 cups Ingredients

• 4 cups milk (whole, 2%, 1%, or skim)

• ½ cup yogurt (or package of powdered yogurt starter)

Directions

1. Place milk over medium heat and heat until it reaches 180 degrees F, stirring periodically

2. Let the milk cool to 115 degrees F

3. Once milk is cooled, stir in yogurt/yogurt starter until fully incorporated

4. Pour into a glass container, bowl, Dutch oven, etc. and cover with a lid or towel

5. Place into oven with oven light on (do NOT turn on the oven itself) and let rest for 8 to 12 hours; the longer it rests, the tangier and thicker the yogurt will be.*

6. Refrigerate for up to 2 weeks.

*After this step, you will notice liquid whey pooled at the top of the yogurt. For Greek yogurt, strain the yogurt with a cheesecloth or colander to get rid of this liquid.

Nutrition Information (per cup)

Calories: 146; Total Fat: 7.9g; Saturated Fat: 4.6g; Cholesterol: 24mg; Sodium: 98mg; Total Carbohydrate: 11g; Dietary Fiber: 0g; Total Sugars: 12.8g ; Protein: 7.9g; Vitamin D: 98mcg; Calcium: 276mg; Iron: 0mg; Potassium: 349mg

stick to unsweetened varieties to reap the most nutritional benefits.

Editor’s note: Consult with a qualified healthcare professional to determine how much, if any, yogurt consumption is right for you.

SOURCES

1. Harvard T.H. Chan School of Public Health. Yogurt. https://www.hsph.harvard.edu/ nutritionsource/food-features/yogurt/. Accessed 26 Sep 2022.

2. Ware M. Everything you need to know about yogurt. Medical News Today. 11 Jan 2018. https://www.medicalnewstoday. com/articles/295714. Accessed 26 Sep 2022.

3. Elliott B, Ramburger L. 6 impressive health benefits of yogurt. Healthline. Updated 6 Apr 2022. https://www.healthline.com/ nutrition/benefits-of-yogurt. Accessed 26 Sep 2022.

4. Cleveland Clinic. Is yogurt good for you? 9 Nov 2020. https://health.clevelandclinic.

org/is-yogurt-good-for-you/. Accessed 26 Sep 2022.

5. FoodData Central. Yogurt, low fat milk, plain. https://fdc.nal.usda.gov/fdc-app. html#/food-details/1097559/nutrients. Accessed 26 Sep 2022.

6. United States Department of Agriculture. Dietary Guidelines for Americans, 2020–2025, 9th edition. Dec 2020. https:// www.dietaryguidelines.gov/sites/default/ files/2020-12/Dietary_Guidelines_for_ Americans_2020-2025.pdf. Accessed 26 Sep 2022.

7. Ellis E. What to look for in yogurt. 8 Jun 2022. https://www.eatright.org/food/ nutrition/healthy-eating/what-to-look-forin-yogurt. Accessed 26 Sep 2022.

8. Ducharme J. Why whole-fat milk and yogurt are healthier than you think. 11 Sep 2018. https://time.com/5391756/dairywhole-fat-milk-yogurt/. Accessed 26 Sep 2022.

9. Benatar JR, Sidhu K, Stewart RA. Effects of high and low fat dairy food on cardiometabolic risk factors: a meta-analysis of randomized studies. PLoS One 2013;8(10):e76480.

10. O’Sullivan TA, Schmidt KA, Kratz M.

Whole-fat or reduced-fat dairy product intake, adiposity, and cardiometabolic health in children: a systematic review. Adv Nutr. 2020;11(4):928–950.

11. Schaffer R. Consuming high-fat dairy tired to less metabolic syndrome, diabetes, and hypertension. Healio. 1 Jun 2020. https://www.healio.com/news/ endocrinology/20200601/consuminghighfat-dairy-tied-to-less-metabolicsyndrome-diabetes-hypertension.

Accessed 26 Sep 2022.

12. Hirahatake KM, Astrup A, Hill JO, et al.

Potential cardiometabolic health benefits of full-fat dairy: the evidence base. Adv Nutr. 2020;11(3):533–547.

13. The University of Tennessee Medical Center. The benefits of eating Greek yogurt. 15 Jul 2018. https://www. utmedicalcenter.org/the-benefits-ofeating-greek-yogurt/. Accessed 26 Sep 2022.

14. Harrar S. How nondairy yogurts stack up against the real thing. American Association of Retired Persons. 25 Feb 2022. https://www.aarp.org/health/ healthy-living/info-2022/nondairy-

yogurts.html. Accessed 26 Sep 2022.

15. Hasemann A. Yogurt: nutritious food or sugary treat? Pract Gastroenterol 2014;38(2):37–46.

16. Banerjee U, Halder T, Malida R et al.

Variety of yogurt and its health aspects–a brief review. Int J Innov Pract Appl Res 2017;7:56–66.

17. El-Abbadi NH, Dao MC, Meydani SN. Yogurt: role in healthy and active aging.

Am J Clin Nutr. 2014;99(5 Suppl):1263S–1270S. NHR

Essential Amino Acids

Amino

acids are organic compounds that contain both an amino group (-NH2) and carboxylic acid group (-COOH). When linked via peptide bonds, they function as the basic blocks used to construct a variety of different proteins. Hundreds of amino acids can be found in nature, but only about 20 to 22 are necessary to make the proteins present in the human body.1 Of these, nine are considered essential, meaning that they must be sourced from the diet. The human body can then synthesize the remaining (“non-essential”) amino acids using these nine amino acids.

The nine essential amino acids (EAAs) are histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine.

complete sources of protein because they contain all nine EAAs, while vegetarian sources of protein often must be combined with one another in a meal (e.g., rice and beans) to provide all nine EAAs, although some soy products like edamame and tofu do contain all nine EAAs.

The recommended protein digestibility-corrected amino acid scoring pattern (which is a method of evaluating the quality of a protein based on the amino acid requirements of humans and their ability to digest them) for individuals one year of age or older is as follows (in mg/g of protein): histidine, 18 mg/g; isoleucine, 25 mg/g; leucine,

55 mg/g; lysine, 51 mg/g; methionine + cysteine, 25 mg/g; phenylalanine + tyrosine, 47 mg/g; threonine, 27 mg/g; tryptophan, 7 mg/g; and valine, 32 mg/g.2 Up to 35 percent of the total daily energy intake may be from protein, but no tolerable upper intake level for either total protein or any of the amino acids exists due to insufficient data.2

IN THE BODY

Each of the nine EAAs plays unique roles in the human body. Histidine is biosynthesized into histamine, a chemical released by cells in response to an injury, allergen, or another inflammatory reaction that triggers the contraction of smooth muscle and vasodilation via a vitamin B–dependent decarboxylation reaction by histidine decarboxylase.3

Isoleucine, alongside the other two branched-chain amino acids (BCAAs) leucine and valine, participates in building and repairing muscle, with each having their own effects. One study suggests that isoleucine increases muscle mass by promoting myogenesis and intramyocellular fat deposition.4 Elsewhere, longterm supplementation with leucine improved acquired growth hormone resistance in rats with protein-energy malnutrition,5 and another rat study reported that leucine supplementation accelerated connective tissue repair of the injured tibialis anterior muscle.6 The metabolite of valine, β-aminoisobutyric acid, is also increased by exercise and acts on other tissues, such as white adipose tissue, to enhance energy expenditure.7 Isoleucine may additionally have a hypoglycemic effect by stimulating both glucose uptake in muscle and whole-body glucose oxidation, as well as reducing gluconeogenesis in the liver,8 potentially avoiding hyperglycemia; increased dietary leucine intake may improve glucose and cholesterol metabolism.9 Finally, isoleucine may induce the expression of peptides (i.e., β-defensins) that regulate host innate and adaptive immunity10 and, together with leucine and valine again, shifts the lymphocyte immune response toward a Th1 (proinflammatory) type.11

Most of the other EAAs are also involved in immune function, metabolism, and the production of hormones and/or energy. In addition, however, lysine significantly increases the intestinal absorption of calcium and may improve the renal conservation of absorbed

calcium,12 while methionine assists with the absorption of zinc.13 Lysine is required in collagen biosynthesis,14 as are other amino acids, such as glycine, of which threonine is a precursor.15 Finally, tryptophan is essential for the synthesis of serotonin,16 and phenylalanine is important for the production of other neurotransmitters, such as dopamine.17

The first step in the process of amino acid absorption is the mechanical breakdown of foods containing protein by the teeth.18 In the stomach, gastric juices containing hydrochloric acid and the enzyme pepsin initiate the breakdown of protein, and the partially digested protein is mechanically churned by stomach contractions into chyme.18 In the small intestine, digestive juice from the pancreas containing enzymes, such as chymotrypsin and trypsin, further breaks down the protein fragments into individual amino acids.18 Further along in the small intestine, the amino acids are transported from the intestinal lumen through the intestinal cells to the blood, then to the liver, which acts as a checkpoint for amino acid distribution throughout the body.18

EFFECTS OF INTAKE

Inadequate intake of EAAs through the diet, which typically leads to a lack of protein synthesis in the body, can cause a variety of symptoms, including emotional disorders (e.g., depression, anxiety), fatigue, weakness, anemia, loss of libido, increased rates of infections due to immune system impairment, cardiovascular diseases, and osteoporosis.1,19 In children,

inadequate EAA intake may disrupt the metabolic process, stunting their growth.20

Under certain circumstances, some amino acids that are not normally essential may become so. For example, glutamine becomes a conditionally EAA under conditions of severe stress to the body, such as critical illness, surgery, or trauma (i.e., when its endogenous use exceeds its endogenous production).21 Arginine may be a conditionally EAA in neonates and infants, where it helps to prevent necrotizing enterocolitis; cysteine is similarly believed to be a conditionally EAA in preterm neonates, who may be unable to convert methionine, its precursor, in the liver.21 By extension, taurine, which requires cysteine as a precursor, may also be conditionally essential in premature neonates.21

Excessive amino acid intake has emerged as a more significant problem in recent years with increased intake of dietary supplements to enhance physical performance or gain other health benefits. Some effects of high amino acid intake, such as nausea (various), are innocuous, but others like hepatic dysfunction (methionine) and alterations in visual acuity and mental state (histidine) can be more serious.22 Certain conditions, such as tyrosinemia II (tyrosine) and phenylketonuria (phenylalanine, may result in abnormally high amino acid levels due to genetic mutations that cause dysfunction of the enzymes required for amino acid processing.22 High levels of certain amino acids in the body may also correlate with disease states, such as the increased concentrations of BCAA found in insulin-deficient and

-resistant states, such as diabetes and obesity.23

AS THERAPEUTICS

Various studies have suggested therapeutic uses of the amino acids. For example, in a randomized crossover trial of 26 patients with multiple sclerosis, threonine reduced signs of spasticity on clinical examination, without the side or toxic effects associated with other treatments.24 Lysine may reduce the occurrence, severity, and healing time of recurrent herpes simplex virus infections.25 Tryptophan acts in a manner reminiscent of serotonergic antidepressants to induce a positive bias in the processing of emotional material and could benefit people with mild depression.26 In some cases, the abundance of a specific amino acid may have antitumor effects, while, in others, interfering with amino acid availability can selectively kill tumor cells.27 Finally, supplemental dietary administration of BCAAs was demonstrated to extend the average lifespan of middle-aged mice,28 and in yeast the restriction of methionine similarly facilitated an extension of the lifespan.29

Editor’s note: Please consult with a qualified healthcare professional to determine what kind of diet and supplements, if any, are best for you.

SOURCES

1. Lopez MJ, Mohiuddin SS. Biochemistry, essential amino acids. [Updated 2022 Mar 18]. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2022.

2. Panel on Macronutrients, Panel on the Definition of Dietary Fiber, Subcommittee on Upper Reference Levels of Nutrients, Subcommitee on Interpretation and Uses of Dietary Reference Intakes, and the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. 10 Protein and

Amino Acids. In: Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington DC: National Academies Press; 2005.

3. Kessler AT, Raja A. Biochemistry, histidine. [Updated 2022 Jul 18]. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2022.

4. Liu S, Sun Y, Zhao R, Wang Y, Zhang W, Pang W. Isoleucine increases muscle mass through promoting myogenesis and intramyocellular fat deposition. Food Funct. 2021;12:144–153.

5. Gao X, Tian F, Wang X, Zhao J, et al. Leucine supplementation improves acquired growth hormone resistance in rats with protein-energy malnutrition. PLoS One. 2015;10(4):e0125023.

6. Pereira MG, Silva MT, Carlassara EOC, et al. Leucine supplementation accelerates connective tissue repair of injured tibialis anterior muscle. Nutrients. 2014;6(10):3981–4001.

7. Kamei Y, Hatazawa Y, Uchitomi R, Yoshimura R, Miura S. Regulation of skeletal muscle function by amino acids. Nutrients. 2020;12(1):261.

8. Doi M, Yamaoka I, Nakayama M, Sugahara K, Yoshizawa F. Hypoglycemic effect of isoleucine involves increased muscle glucose uptake and whole body glucose oxidation and decreased hepatic gluconeogenesis. Am J Physiol Endocrinol Metab. 2007;292(6):E1683–E1693.

9. Zhang Y, Guo K, LeBlanc RE, Loh D, Schwartz J, Yu Y-H. Increasing dietary leucine intake reduces diet-induced obesity and improves glucose and cholesterol metabolism in mice via multimechanisms. Diabetes. 2007;56(6):1647–1654.

10. Gu C, Mao X, Chen D, Yu B, Yang Q. Isoleucine plays an important role for maintaining immune function. Curr Protein Pept Sci. 2019;20(7):644–651.

11. Negro M, Giardina S, Marzani B, Marzatico F. Branched-chain amino acid supplementation does not enhance athletic performance but affects muscle recovery and the immune system. J Sports Med Phys Fitness. 2008;48(3):347–351.

12. Civitelli R, Villareal DT, Agnusdei D, Nardi P. Avioli LV, Gennari C. Dietary L-lysine and calcium metabolism in humans. Nutrition. 1992;8(6):400–405.

13. Lönnerdal B. Dietary factors influencing zinc absorption. J Nutr. 2000;130(5S Suppl):1378S–1383S.

14. Yamauchi M, Sricholpech M. Lysine posttranslational modifications of collagen. Essays Biochem. 2012;52:113–133.

15. Razak MA, Begum PS, Viswanath B, Rajagopal S. Multifarious beneficial effect of nonessential amino acid, glycine: a review. Oxid Med Cell Longev. 2017;2017:1716701.

16. Bamalan OA, Moore MJ, Al Khalili Y.

Physiology, serotonin. [Updated 2022 Jul 9]. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2022.

17. Lou HC. Dopamine precursors and brain function in phenylalanine hydroxylase deficiency. Acta Paediatr Suppl. 1994;407:86–88.

18. Byerley. 5.4 Protein Digestion, Absorption and Metabolism. Available at: https://med.libretexts.org/Courses/ American_Public_University/APUS%3A_ An_Introduction_to_Nutrition_(Byerley)/ APUS%3A_An_Introduction_to_ Nutrition_1st_Edition/05%3A_ Proteins/5.04%3A_Protein_Digestion_ Absorption_and_Metabolism. Accessed September 16, 2022.

19. Hou Y, Wu G. Nutritionally essential amino acids. Adv Nutr. 2018;9(6):849–851.

20. Maulidiana AR, Sutjiati E. Low intake of essential amino acids and other risk factors of stunting among under-five children in Malang City, East Java, Indonesia. J Public Health Res. 2021;10(2):2161.

21. Yarandi SS, Zhao VM, Hebbar G, Ziegler TR. Amino acid composition in parenteral nutrition: what is the evidence?. Curr Opin Clin Nutr Metab Care. 2011;14(1):75–82.

22. Garlick PJ. The nature of human hazards associated with excessive intake of amino acids. J Nutr. 2004;134(6 Suppl):1633S¬–1639S; discussion 1664S–1666S, 1667S–1672S.

23. Holeček M. Branched-chain amino acids in health and disease: metabolism, alterations in blood plasma, and as supplements. Nutr Metab (Lond). 2018;15:33.

24. Hauser SL, Doolittle TH, Lopez-Bresnahan M. An antispasticity effect of threonine in multiple sclerosis. Arch Neurol. 1992;49(9):923–926.

25. Griffith RS, Walsh DE, Myrmel KH. Success of L-lysine therapy in frequently recurrent herpes simplex infection. Treatment and prophylaxis. Dermatologica. 1987;175(4):183–190.

26. Murphy SE, Longhitano C, Ayres RE, et al. Tryptophan supplementation induces a positive bias in the processing of emotional material in healthy female volunteers. Psychopharmacology (Berl). 2006;187(1):121–130.

27. Butler M, van der Meer LT, van Leeuwen FN. Amino acid depletion therapies: starving cancer cells to death. Trends Endocrinol Metab. 2021;32(6):367–381.

28. D’Antona G, Ragni M, Cardile A, et al. Branched-chain amino acid supplementation promotes survival and supports cardiac and skeletal muscle mitochondrial biogenesis in middle-aged mice. Cell Metab. 2010;12(4):362–372.

29. Plummer JD, Johnson JE. Extension of cellular lifespan by methionine restriction involves alterations in central carbon metabolism and is mitophagy-dependent. Front Cell Dev Biol. 2019;7:301. NHR

Body Basics

The Muscular System

The muscular system is composed of different types of very specialized fibrous cells, all with the ability to contract. Muscle contraction is responsible for nearly all movement in the human body. The muscular system also plays an important role in circulation, digestion, posture, balance, heat production, and many other functions. There are three main types of muscles—skeletal, cardiac, and smooth—each with its own distinct set of functions.1

SKELETAL MUSCLE

Skeletal muscle is probably what comes to mind first when thinking about muscles in the body. That’s because these are the only muscles over which we have voluntary control, meaning we can move these muscles when we want to, so of course, we are very aware of them.1 As their name suggests, skeletal muscles are the muscles attached to our bones that allow us to move our bodies and appendages. In

addition to movement, skeletal muscles provide structural support to the body, help maintain body posture, act as a storage source for amino acids, play a central role in maintaining body heat, and can serve as an energy source during starvation.2 With exercise, we can make our skeletal muscles bigger and stronger, and with inactivity, we can make our skeletal muscles smaller and weaker.

Skeletal muscles are composed of multinucleic, striated (i.e., crossed with repeating bands of the proteins actin and myosin) fibers, each of which acts independently from its neighboring fibers.1 There are two main classifications of skeletal muscle—Type I (slow twitch) and Type II (a and b) (fast-twitch)—which allow for vast variations in our skeletal muscles’ speed of movement and length of contraction, depending on their specific function.3

Type I muscle fibers are referred to as slow twitch because they contract slowly. They are rich in mitochondria

(organelles in cells that convert oxygen to energy) and myoglobin (the protein that supplies the oxygen to the cells), which allows them to be very efficient in using oxygen to produce adenosine triphosphate (ATP), which hydrolyses and releases its energy for cellular needs. For this reason, muscles with Type 1 fibers are able to resist fatigue for a long time. These would be the muscles we would rely on, for example, if running a marathon.4

Type II muscle fibers are classified as either IIa or IIb. Type IIa fibers are also known as intermediate fibers because they fall somewhere in between slow twitch and fast twitch. Type IIa are rich in mitochondria and are able to produce ATP, but they lack myoglobin. Muscles with this fiber type are able to produce more forceful contractions than slowtwitch muscles, without fatiguing as quickly as fast twitch muscles, but they are not as fatigue-resistant as Type I muscle fibers nor as powerful as Type IIb muscle fibers.5 These

would be the muscles we would rely on, for example, if going for a walk around the neighborhood.

Type IIb muscle fibers, on the other hand, are referred to as fast twitch muscles because they contract quickly. These muscle fibers use anaerobic respiration to produce energy, meaning they convert sugar into energy instead of oxygen.4

Because they do not use oxygen to produce energy, they contain little mitochondria or myoglobin. Type IIb fibers use glucose to fuel very rapid, forceful contractions, but once the glucose is burned off, there is nothing to left to fuel the energy required for muscle contraction, which means Type IIb muscle fibers will fatigue quickly and can only be used for short periods of time. These are the muscles we would rely on, for example, when sprinting.4,5

CARDIAC MUSCLE

The cardiac muscle, or myocardium, comprises the thick middle layer of the heart, and is composed of cardiomyocytes, which are striated, single-nucleus cells that govern the myocardium functioning. These cells are interconnected via intercalated disks that allow the cells to receive rapid electrical transmissions and contract as a single unit. The cardiac muscle also contains cardiac pacemaker cells, highly specialized cells that spontaneously fire to trigger each heartbeat. The cardiac muscle is involuntary, meaning it fulfills its function without the conscious effort of the person.3

SMOOTH MUSCLE

Smooth muscles are involuntary muscles comprising spindle-shaped,

smooth (nonstriated), narrow cells with a single, centrally located nucleus. Using ATP as energy, smooth muscle serves multiple specialized functions in the body through its ability to contract and hold that force for long periods of time. Smooth muscle has been adapted for use throughout the body, such as in the cardiovascular and digestive systems, serving a critical role in nearly every autonomic function in the body. For example, smooth muscle lines every vein and artery, contracting and relaxing to help regulate the flow of blood. Smooth muscle also lines the gastrointestinal tract, moving food through the intestines; contracts the irises; moves fluids through organs; raises the hairs on your arm; and much more.6

NUTRIENTS THAT BENEFIT THE MUSCULAR SYSTEM

Protein. It should come as no surprise that protein is an essential nutrient for maintaining a healthy muscular system. Protein is one of the building blocks of body tissue, including muscle. Muscle makes up about 40 percent of a healthy human body’s weight, of which about 20 percent is muscle protein.7 Protein can also serve as an energy source. During periods of fasting or stress, the body uses skeletal muscle proteins to supply essential amino acids to other bodily systems. There are nine essential amino acids the human body cannot produce on its own: histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine. If an individual fails to take in the daily requirements of dietary protein, a negative balance will occur in the muscular system, resulting in

muscular atrophy, impaired muscle growth, and overall functional decline.8 A protein that contains all nine of the essential amino acids is called a complete protein. Dietary sources of complete proteins include fish, meat, dairy products, quinoa, hemp seeds, chia seeds, and soy. While most whole, plant-based foods contain some protein, very few plant-based foods contain all nine of the essential amino acids. However, different plant foods can be combined to make a complete protein. For example, kidney beans, which have leucine, lysine, and valine, can be combined with brown rice, which has a fair amount of all essential amino acids except lysine, to make a complete protein. Peanut butter on whole grain toast, hummus with whole grain pita bread, and lentil bean and barley soup are a few other examples of plant-based food combinations that make complete proteins.8

Calcium. Calcium is one of the most important minerals in the human body. We know that calcium is necessary for healthy bones and teeth. But calcium is also essential to the muscular system due to its critical role in the body’s ability to send and receive nerve signals to and from the brain, as well as in regulating muscle contractions, including the cardiac muscle.9 Calcium triggers the heart muscle to contract. When the body does not receive enough dietary calcium, it will pull it from the bones. A chronic state of calcium deficiency can result in bone loss and irregular heartbeat. Calcium can be found in many different types of food sources, including dairy (e.g., milk, cheese, yogurt), fortified plant-based milks, fortified orange juice, winter squash,

edamame, canned sardines with bones, almonds, and leafy greens (collard, mustard, turnip, kale, bok choy, spinach).9

Magnesium. Like calcium, magnesium is an essential mineral in the human body. It is required for over 300 enzymatic reactions in the human body that are needed to regulate protein and energy production, muscle contraction and relaxation, and mitochondria activity. Calcium and magnesium compete against each other. Calcium triggers the heart to contract, whereas magnesium triggers the heart to relax. A deficiency in magnesium can result in overstimulation of the heart by unchecked calcium. Magnesium helps regulate other muscles in the body as well. A deficiency in magnesium can result in muscle cramping and spasms. Dietary magnesium can be found in pumpkin seeds, boiled spinach, boiled Swiss chard, boiled beet greens, cooked black beans, almonds, cashews, dark chocolate, avocado, tofu, and salmon.10,11

Potassium. Potassium is vital to maintaining electrochemical balance across cell membranes and neurotransmission. It also is needed for electrolyte and pH homeostasis. Potassium relays signals to the brain to stimulate skeletal, cardiac,

and smooth muscle contraction and relaxation.12 Like calcium and magnesium, potassium is needed to regulate the heartbeat. Potassium deficiency can result in prolonged muscle contractions (cramping) and an irregular heartbeat.13 Dietary potassium is widely available in many foods, particularly fruits and vegetables, such as leafy greens, beans and lentils, nuts, dairy, and winter squash. Other sources include dried apricots and raisins, potatoes, avocado, bananas, cantaloupe, oranges, coconut water, tomatoes, chicken, and salmon.14

Editor’s note: Consult with a qualified healthcare professional or dietitian/nutritionist to determine a diet that best meets your nutritional needs.

SOURCES

1. NIH National Cancer Institute website. SEER training modules. Muscle types. https://training.seer.cancer.gov/anatomy/ muscular/types.html. Accessed 4 Oct 2022.

2. Dave HD, Shook M, Varacallo M. Anatomy, skeletal muscle. 5 Sep 2021. StatPearls [internet]. NIH National Library of Medicine website. https://www.ncbi.nlm.nih.gov/ books/NBK537236/. Accessed 4 Oct 2022.

3. Noto RE, Leavitt L, Edens MA. Physiology, muscle. 8 May 2022. StatPearls [internet]. NIH National Library of Medicine website. https://www.ncbi.nlm.nih.gov/books/ NBK532258/. Accessed 4 Oct 2022.

4. Difference Between website. Difference between Type I and Type II muscle fibers. 23 Jul 2018. https://www.

differencebetween.com/differencebetween-type-1-and-type-2-muscle-fibers/. Accessed 4 Oct 2022.

5. Physiopedia website. Muscle fibre types. https://www.physio-pedia.com/Muscle_ Fibre_Types. Accessed 4 Oct 2022.

6. Biology Dictionary editors. Smooth muscle. 4 Oct 2019. Biology Dictionary website. https://biologydictionary.net/smoothmuscle/. Accessed 4 Oct 2022.

7. Britannica website. The muscle proteins. https://www.britannica.com/science/ protein/The-muscle-proteins. Accessed 5 Oct 2022.

8. Physiopedia website. Protein intake and muscle function in older adults. https:// www.physio-pedia.com/Muscle_Function_ and_Protein. Accessed 5 Oct 2022.

9. Harvard TH Chan School of Public Health website. Calcium. https://www. hsph.harvard.edu/nutritionsource/ calcium/#:~:text=Calcium%20is%20a%20 mineral%20most,heart%20rhythms%20 and%20nerve%20functions. Accessed 6 Oct 2022.

10. Gröber U, Schmidt J, Kisters K. Magnesium in prevention and therapy. Nutrients. 2015;7(9):8199–8226.

11. Raman R. What does magnesium do for your body? 9 Jun 2018. Healthline website. https://www.healthline.com/nutrition/ what-does-magnesium-do#other-benefits. Accessed 6 Oct 2022.

12. University of Rochester Medical Center website. Health encyclopedia. Potassium. https://www.urmc.rochester.edu/ encyclopedia/content.aspx?contenttypeid= 19&contentid=potassium. Accessed 6 Oct 2022.

13. Davidson K. Symptoms of low potassium (hypokalemia). Last updated 25 Jan 2022. Healthline website. https://www.healthline. com/nutrition/potassium-deficiencysymptoms. Accessed 6 Oct 2022.

14. Harvard TH Chan School of Public Health website. The nutrition source. Potassium. https://www.hsph.harvard.edu/ nutritionsource/potassium/. Accessed 6 Oct 2022.

BIDEN ADMINISTRATION TO PROPOSE NUTRITION LABELS ON FRONT OF FOOD PACKAGING IN PUSH TO IMPROVE HEALTH

The United States (US) Food and Drug Administration (FDA) plans to propose a measure to add nutrition labels to the front of food packages in the form of star ratings or traffic light imaging. The goal is to help consumers, especially those with low nutritional literacy, make healthy food choices.

Source: Richards Z. Biden admin to propose nutrition labels on front of food packaging in push to improve health. NBC News. 27 Sep 2022. https://www. nbcnews.com/politics/white-house/biden-administration-propose-nutritionlabels-front-food-packaging-pus-rcna49529. Accessed 30 Sep 2022.

Adopting Adaptogens:

Plants That May Improve Your Health and Well-being

Adaptogens are synthetic compounds or plant extracts that may help improve the body’s response (i.e., help you “adapt”) to stress, anxiety, and fatigue. Traditionally used in Chinese and Ayurvedic medicine, these types of medicinal herbs have been making their way into mainstream grocery and health food stores in North America and elsewhere. Modern interest in adaptogens appears to have first surfaced during World War II as scientists searched for ways to improve mental and physical performance in humans during periods of stress; indeed, several studies investigating the stimulating and tonic effects of berries from the Schisandra chinensis (S. chinesis) plant, a fruit-bearing vine native to China, were published in Russian (formerly the USSR) military journals in 1945.1 In the late 1950s, Russian

scientist Nikolay Lazarev formally introduced the term adaptogen to describe compounds that could increase “the state of nonspecific resistance” in stress.1 The study of adaptogens subsequently progressed further in Russia during the 1960s and 1970s, becoming a formal field of biomedical research geared toward developing products that could help humans maintain physical and mental performance during periods of stress.1

Today, a number of commercially available compounds marketed as adaptogens exist,2 but the criteria used to define a true adaptogen vary. The European Medicines Agency defines an adaptogen as 1) “almost non-toxic to the recipient”; 2) “non-specific in its pharmacological properties and acts by increasing the resistance of the organism to a broad spectrum of adverse biological, chemical, and

physical factors”; 3) “a regulator having a normalizing effect on the various organ systems of the recipient organism”; and 4) having an effect that is “as pronounced as deeper are pathologic changes in the organism.”3 Other research indicates there are three categories of adaptogens—primary, secondary, and companion— based on how many criteria they meet. For example, unlike primary adaptogens, secondary adaptogens cannot influence the hypothalamic–pituitary–adrenal axis directly but do affect the immune, nervous, and endocrine systems, whereas adaptogen companions do not function as adaptogens themselves but instead work synergistically with primary and secondary adaptogens to improve their effects.4 In the United States, adaptogens are considered dietary supplements under the purview of the U.S. Food

and Drug Administration (FDA).5

Research suggests that the stressprotective activity of adaptogens is associated with their selective reduction and enhancement of the expression levels of key mediators of the stress response common to all cells, helping to maintain or return these cells to a state of homeostasis.1 Adaptogens can also have stimulating and tonic effects, but differ from conventional stimulants in that they don’t possess addiction, tolerance, and abuse potentials and they don’t impair mental function or lead to psychotic symptoms with long-term use.1

Different adaptogens also have neuroprotective effects. Rhodiola rosea (R. rosea)—a flowering herb native to cold, high-altitude regions of Europe and Asia— has been shown to have an antidepressive effect in individuals with mild-to-moderate depression.6 Ashwagandha, an evergreen shrub that grows in Asia and Africa, has been shown to facilitate reductions in the Hamilton Anxiety Rating Scale and Depression, Anxiety, and Stress Scale-21 scores (scales used by physicians to measure the severity of depression and/or anxiety symptoms in their patients), as well as morning cortisol levels in stressed but otherwise healthy adults.7 In a multicenter U.S. trial of patients with early-stage Alzheimer’s disease,8 extract from Ginkgo biloba (G. biloba)—a coniferous tree native to China—showed efficacy in improving or delaying cognitive deficits. Panax ginseng (P. ginseng) extract—made from the roots of a type of ginseng native to the mountains of East Asia—demonstrated effectiveness in preventing the development of

locomotor deficits in a rat model of Parkinson’s disease.9

Some adaptogens also have cardioprotective effects. A preparation of dry extracts of Aralia mandshurica—a deciduous shrub native to the mountain woodlands of Asia and North and South Amercas—P. ginseng, R. rosea, and Eleutherococcus senticosus (E. senticosus)—a small, woody shrub native to Northeastern Asia— showed therapuetic promise by reducing contractility dysfunction in heart failure and preventing irreversible cardiomyocyte damage during ischemia and reperfusion.10 Extensive research has also shown that P. ginseng can normalize blood pressure, exerting both antihypertensive and antihypotensive effects.11

Adaptogens may also help to lessen the effects of infectious diseases. Evidence from preclinical and clinical studies reveals that different adaptogens may aid in prophylaxis and treatment of viral infections during all stages of illness, including post-infection recovery, by exerting direct antiviral effects, modulating the immune response, exhibiting antiinflammatory activity, and repairing oxidative stress in compromised cells.12 Indeed, along these lines, a meta-analysis of 14 studies reported that echinacea appeared to reduce the odds of developing the common cold by 58 percent,13 while a single study of patients with long COVID-19 reported that blood creatine levels were significantly reduced in patients who took a combination of R. rosea, E. senticosus, and S. chinensis, compared to the placebo group,

suggesting a prevention of renal failure progression.14

Editor’s note: Please consult with a licensed healthcare professional before taking any herbal supplements, especially if you are already taking medication. The National Center for Complementary and Integrative Health of the U.S. National Institutes of Health has published a “Herbs at a Glance” series of fact sheets that offer information on different adaptogens, including on potential side effects, which can be found at https://www.nccih.nih.gov/health/ herbsataglance.

SOURCES

1. Panossian A, Wikman G. Effects of adaptogens on the central nervous system and the mo-lecular mechanisms associated with their stress—protective activity. Pharmaceuticals (Basel). 2010;3(1):188–224.

2. Institute of Culinary Education. All about adaptogens: a natural gourmet center guide. https://ice.edu/blog/adaptogenslist-adaptogenic-mushrooms. Accessed 17 Sep 2022.

3. Liao L-Y, He Y-F, Li L, et al. A preliminary review of studies on adaptogens: comparison of their bioactivity in TCM with that of ginseng-like herbs used worldwide. Chin Med. 2018;13:57.

4. European Medicines Agency. Reflection paper on the adaptogenic concept. https:// www.ema.europa.eu/en/documents/ scientific-guideline/reflection-paperadaptogenic-concept_en.pdf. Accessed 17 Sep 2022.

5. United States Food and Drug Administration website. FDA 101: dietary supplements. https://www.fda.gov/ consumers/consumer-updates/fda-101dietary-supplements. Accessed 17 Sep 2022.

6. Darbinyan V, Aslanyan G, Amroyan

E. Clinical trial of Rhodiola rosea L. extract SHR-5 in the treatment of mild to moderate depression. Nord J Psychiatry. 2007;61(5):343–348.

7. Lopresti AL, Smith SJ, Malvi H, Kodgule R. An investigation into the stress-relieving and pharmacological actions of an ashwagandha (Withania somnifera) extract: a randomized, double-blind, placebo-controlled study. Medicine (Baltimore). 2019;98(37):e17186. NHR