Why is Fiber so Important?

Fiber is an essential component of a healthy diet, yet many people struggle to get enough of it from their food. Fiber is a type of carbohydrate that the body cannot digest and absorb, so it passes through the digestive system without being broken down. This makes it beneficial for a variety of reasons, including improved digestion, weight management, and overall health. Supplementing with fiber can help people get the dietary fiber they need for optimal health. The benefits of fiber supplementation are numerous.

First and foremost, fiber helps to promote regular bowel movements. It adds bulk to the digestive system, which helps to move food more quickly and efficiently through the body. This can reduce constipation and help prevent conditions like hemorrhoids, diverticulitis, and irritable bowel syndrome. Fiber can also help to lower “bad” cholesterol levels and reduce the risk of heart disease.

Fiber can also help with weight management because it helps to keep you feeling fuller longer. This can help to reduce snacking and cravings throughout the day, which can help you to maintain a healthy weight. Additionally, research suggests that fiber can help to boost metabolism, which can also contribute to weight loss.

Fiber has also been linked to improved blood sugar control. Eating fiber-rich foods has been shown to slow the absorption of sugar in the bloodstream, which can help to regulate blood sugar levels. This is especially beneficial for people with diabetes or pre-diabetes. Additionally, fiber can help to reduce inflammation throughout the body, which can help to reduce the risk of chronic diseases like cancer and heart disease.

Of course, fiber supplementation isn’t without its drawbacks. For one, it can cause bloating, gas, and abdominal discomfort in some people. Additionally, too much fiber can interfere with the absorption of other important nutrients, such as minerals and vitamins. It’s important to always speak to a doctor or nutritionist before supplementing with fiber to make sure it’s the right choice for you.

Overall, fiber supplementation can be a great way to get the dietary fiber you need for optimal health. It can help to improve digestion, reduce constipation, and control blood sugar levels. It can also help to reduce inflammation, lower cholesterol, and promote weight loss. Just make sure to speak to a doctor or nutritionist first to make sure it’s the right choice for you.

Red Light Therapy

Red Light Therapy (RLT), also known as low-level laser therapy (LLLT), is a non-invasive treatment that uses low wavelength red light to promote healing, reduce inflammation, and improve cellular function. Research on RLT is still developing, but several studies suggest it may offer a wide range of therapeutic benefits. However, limitations exist due to variability in methodology and lack of long-term data. Below is an overview of the potential benefits, who might benefit, and risks, along with guidance on proper dosing.

Benefits of Red Light Therapy

• Wound Healing and Tissue Repair: RLT has been shown to accelerate wound healing and tissue repair. It stimulates fibroblast production and enhances collagen synthesis, both of which are critical for skin repair. A review of clinical studies indicated that RLT improves healing times in acute wounds and even chronic conditions such as diabetic ulcers.

• Pain Reduction and Inflammation: One of the well-established uses of RLT is in managing pain and inflammation. Studies show it can help reduce pain associated with conditions like arthritis, muscle soreness, and joint pain. Research suggests it reduces oxidative stress, promoting anti-inflammatory responses in damaged tissues.

• Skin Health: RLT is frequently used in dermatology for improving skin tone, reducing fine lines and wrinkles, and treating conditions like acne, psoriasis, and eczema. It promotes collagen production, which may reduce signs of aging and improve skin elasticity.

• Muscle Recovery and Athletic Performance: Athletes might benefit from RLT due to its ability to improve muscle recovery and reduce fatigue. Several studies suggest that it enhances mitochondrial function, leading to better energy production (ATP), which accelerates muscle recovery post-exercise.

• Hair Growth: RLT has shown promise in stimulating hair growth in people with androgenetic alopecia (male or female pattern baldness). It may increase blood circulation to the scalp and encourage the hair follicles’ activity.

• Mood and Sleep: Some research points to the ability of red light to improve sleep quality and mood by affecting circadian rhythms and boosting melatonin production.

Who Might Benefit?

• Individuals with Chronic Pain Conditions: People suffering from arthritis, tendonitis, or back pain may experience reduced pain and inflammation.

• Patients with Skin Conditions: Those with acne, psoriasis, or aging-related skin concerns could see improvements in skin appearance and health.

• Athletes and Active Individuals: RLT may benefit those seeking faster muscle recovery and improved performance post-exercise.

• Individuals Experiencing Hair Loss: Those with early-stage alopecia or thinning hair may benefit from hair regrowth.

• Those Seeking Improved Sleep or Mood: People struggling with sleep disorders or seasonal affective disorder may benefit from the mood-regulating effects of red light therapy.

Contraindications and Risks

While RLT is considered safe, there are some risks and contraindications to consider:

• Eye Safety: Direct exposure of the eyes to RLT should be avoided. Protective eyewear is recommended to prevent potential damage to the retina.

• Cancer Patients: Some experts caution against using RLT on cancerous lesions or tumors, as it may stimulate cell growth. Individuals with a history of cancer should consult a physician before using RLT.

• Photosensitivity: People with conditions that cause photosensitivity or those taking medications like isotretinoin (Accutane) may experience adverse reactions to light exposure.

• Pregnancy: There is limited research on RLT’s effects during pregnancy, so it’s best to consult with a healthcare provider before use.

Proper Dosing for Red Light Therapy

The proper dosing of RLT depends on factors like the condition being treated, the wavelength used, and the duration and frequency of exposure. Here are general guidelines:

• Wavelength: The most effective wavelengths for red light therapy are typically in the 600 to 700 nm range for surface-level treatments like skin rejuvenation. For deeper tissue repair (e.g., muscle recovery or joint pain), wavelengths in the 800 to 1000 nm range are recommended.

• Duration and Frequency: Treatment times typically range from 10 to 20 minutes per session. Frequency varies depending on the condition, with many protocols suggesting 3 to 5 sessions per week. For acute pain or inflammation, daily treatments may be necessary initially, while maintenance may require fewer sessions.

• Energy Dosage: The recommended dosage is often expressed in joules (J/cm²). For most skin conditions, 3 to 6 J/cm² is sufficient. For muscle recovery or deeper tissues, 8 to 12 J/cm² may be more appropriate.

Conclusion

Red light therapy offers numerous potential benefits, from pain relief and wound healing to improved skin health and muscle recovery. However, the variability in research methodologies and lack of long-term data make it important for individuals to approach RLT with reasonable expectations and consult healthcare professionals, especially if they have underlying conditions.

REFERENCES

Hamblin, M. R. (2016). “Mechanisms and applications of the anti-inflammatory effects of photobiomodulation.” APL Photonics, 1(6), 061603. This review highlights how RLT stimulates cytochrome c oxidase in the mitochondria, leading to increased ATP production and enhanced cellular function.

Pastore, D., Greco, M., Passarella, S. (2000). “Specific helium-neon laser sensitivity of the purified cytochrome c oxidase.” International Journal of Radiation Biology, 76(6), 863-870. This study explores how red light directly influences mitochondrial enzymes, particularly cytochrome c oxidase, to boost ATP production.

Silveira, P. C. L., Silva, L. A., Pinho, R. A. (2011). “Effects of low-level laser therapy on oxidative stress and fibrosis in rat lungs.” Journal of Photochemistry and Photobiology B: Biology, 105(1), 58-64. This paper discusses how RLT reduces oxidative stress markers and promotes antioxidant defenses in cells.

Avci, P., Gupta, A., Sadasivam, M., Vecchio, D., Pam, Z., Pam, N., Hamblin, M. R. (2013). “Low-level laser (light) therapy (LLLT) in skin: stimulating, healing, restoring.” Seminars in Cutaneous Medicine and Surgery, 32(1), 41-52. This review emphasizes RLT’s effect on fibroblasts, leading to increased collagen production and improved skin health.

Schindl, A., Schindl, M., Schindl, L., Jurecka, W., Honigsmann, H., Breier, F. (1999). “Increased dermal angiogenesis after low-intensity laser therapy for a chronic radiation ulcer determined by a video measuring system.” Journal of the American Academy of Dermatology, 40(3), 481-484. The study shows how RLT enhances angiogenesis and improves tissue regeneration in skin.

Almeida-Lopes, L., Rigau, J., Zangaro, R. A., Guidugli-Neto, J., Jaeger, M. M. (2001). “Comparison of the low-level laser therapy effects on cultured human gingival fibroblasts proliferation using different irradiance and same fluence.” Lasers in Surgery and Medicine, 29(2), 179-184. This paper presents findings on how red light modulates inflammation by affecting cellular signaling pathways.

Chow, R. T., Johnson, M. I., Lopes-Martins, R. A., Bjordal, J. M. (2009). “Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomized placebo or active-treatment controlled trials.” The Lancet, 374(9705), 1897-1908. This meta-analysis confirms the anti-inflammatory and analgesic effects of RLT, particularly for pain management in neck conditions.

Mitchell, U. H., Mack, G. L. (2013). “Low-level laser treatment with near-infrared light increases venous nitric oxide levels acutely: a single-blind, randomized clinical trial of efficacy.” American Journal of Physical Medicine & Rehabilitation, 92(2), 151-156. This study examines how RLT increases nitric oxide production, leading to vasodilation and improved circulation.

Tuby, H., Maltz, L., Oron, U. (2006). “Modulations of VEGF and iNOS in the rat heart by low-level laser therapy are associated with cardioprotection and enhanced angiogenesis.” Lasers in Surgery and Medicine, 38(7), 682-688. This paper highlights how RLT induces the release of nitric oxide and promotes angiogenesis, aiding in tissue repair and healing.

Cold Water Immersion

Cold water plunging, or cold water immersion (CWI), has gained attention for its potential health benefits, including aiding recovery, reducing inflammation, and boosting mental well-being. Let’s explore how this practice works, the benefits it offers, and how to do it safely.

How Cold Water Plunging Works

When the body is exposed to cold water (typically between 50°F to 59°F or 10°C to 15°C), the temperature shock causes physiological changes. These include vasoconstriction, where blood vessels narrow to preserve core body temperature, and the release of endorphins, which are feel-good chemicals. The cold also triggers the production of norepinephrine, a hormone and neurotransmitter that helps regulate inflammation and pain.

Benefits of Cold Water Plunging

• Reduces Inflammation and Speeds Recover: Cold water immersion can help reduce muscle soreness and inflammation, particularly after intense physical exercise. The cold reduces tissue temperature, slows down metabolic processes, and helps minimize swelling and tissue breakdown. A 2016 study in The Journal of Physiology suggested that CWI can be effective for reducing delayed onset muscle soreness (DOMS) after exercise . By reducing blood flow to the affected muscles during the plunge and increasing it post-immersion, CWI aids in the removal of metabolic waste that accumulates after intense activity.

• Mental Health Benefits: Cold exposure triggers the release of norepinephrine, which has been linked to improved mood, attention, and focus. It may also reduce symptoms of anxiety and depression. A small study published in Medical Hypotheses in 2008 proposed that cold showers and immersion could be helpful as a treatment for depression, though more extensive research is needed to solidify this claim .

• Boosts Immune Function: There is evidence that cold exposure might stimulate the immune system. One study found that individuals who regularly engaged in cold water swimming had higher counts of white blood cells and a stronger antioxidant defense system . This suggests that cold exposure might help improve immune function, making the body more resilient to infections.

• Improved Circulation: When you immerse yourself in cold water, your heart rate increases, and blood flow is redirected to the core to maintain warmth. Over time, regular cold exposure can improve circulation by encouraging blood flow back into your extremities when you warm up afterward.

• Enhanced Mood and Stress Resilience: The cold activates the body’s “fight-or-flight” response, releasing stress hormones like adrenaline and cortisol, which may, paradoxically, help reduce chronic stress over time by making the body more resilient. Additionally, the release of endorphins and dopamine can help improve mood and promote a sense of well-being.

Cold Water Immersion and Inflammation

Cold water immersion is particularly effective at controlling inflammation by triggering vasoconstriction. When blood vessels constrict, less blood is delivered to the affected area, reducing swelling. After leaving the cold environment, vasodilation (the reopening of blood vessels) occurs, which helps flush out toxins and promote healing. Norepinephrine, released during cold exposure, also plays a key role in reducing inflammatory markers such as TNF-alpha.

Other Potential Benefits

• Improved Sleep: Some people report better sleep quality after cold plunging, possibly due to the calming effect on the nervous system.

• Fat Loss: Exposure to cold may activate brown fat, a type of fat tissue that burns calories to generate heat, leading to potential weight loss.

• Pain Management: CWI may provide temporary pain relief, especially for conditions involving chronic pain or injury.

How and When to Cold Plunge

• Duration: For beginners, it’s recommended to start with short sessions of 1-2 minutes. As you get more comfortable, you can gradually increase to 5-10 minutes. Most benefits are said to occur within that timeframe.

• Time of Day: There’s no hard rule, but many people find cold plunges beneficial in the morning as a wake-up tool or after workouts to aid recovery. Immersing in cold water after exercise can reduce soreness and speed up recovery time.

• Water Temperature: Optimal temperatures for cold plunging range from 50°F to 59°F (10°C to 15°C). You don’t want the water to be too cold initially, especially if you’re new to the practice, as it can be a shock to the system.

Risks of Cold Water Immersion

While cold water plunging can be beneficial, there are risks, especially for certain individuals. People with heart conditions, hypertension, or cold intolerance should avoid or be cautious with cold plunging, as the rapid changes in blood pressure can be harmful. Sudden immersion in cold water can also trigger a cold shock response, which may lead to hyperventilation or even drowning if not carefully managed. Prolonged immersion in extremely cold water can lead to hypothermia. Always ensure that you plunge safely, preferably with supervision or in a controlled environment.

Conclusion

Cold water plunging offers numerous potential benefits, from reducing inflammation and aiding recovery to boosting mental health and stress resilience. By understanding how it works and incorporating it safely into your routine, you may experience these advantages. However, it’s important to be mindful of the risks, especially if you have underlying health conditions. Always start with shorter plunges at milder temperatures, and listen to your body as you develop a tolerance for the cold.

REFERENCES

Peake, J. M., Roberts, L. A., Figueiredo, V. C., Egner, I. M., Bastiani, M., Aas, S. N., … & Coffey, V. G. (2016). The effects of cold water immersion and active recovery on inflammation and cell stress responses in human skeletal muscle after resistance exercise. The Journal of Physiology, 594(18), 5375-5388.

Shevchuk, N. A. (2008). Adapted cold shower as a potential treatment for depression. Medical Hypotheses, 70(5), 995-1001.

Kourtidou-Papadeli, C., Nikolaidis, M. G., & Mougios, V. (2003). Seasonal variation of stress responses and antioxidant defense in swimmers and cold water swimmers. Cell Stress & Chaperones, 8(4), 359-363.

Imaging: Significant finding or normal ‘Wear & Tear’?

On this edition, I’m excited to discuss another topic of conversation I frequently discuss. Radiographs (X-rays) and Magnetic Resonance Imaging (MRI’s) are very commonly used to get a better understanding as to what may be causing pain and/or dysfunction. When combined with a clinical or functional diagnosis, the use of imaging can be very reliable and paint a very accurate picture to help explain the problem in question. 

However, a clinical diagnosis is <usually> missing when determining best course of treatment. Unfortunately, our current healthcare system dictates that our Physicians see roughly 50-60 patients each day. This means they only have roughly 5-7 minutes to perform a complete examination, interpret the results of imaging, determine the best course of treatment, and discuss this with the patient for their consent. At no fault of their own, this system does not allow them to fully evaluate the patient at a functional level. They must rely primarily on the findings of imaging to determine the next steps. Often times, this can lead to unnecessary interventions, such as surgery and injections, that don’t work or leave a matter of the problem left unresolved. 

‘But if a doctor sees arthritis on my X-ray, isn’t that obviously the reason for my knee pain?’

The short answer: possibly! But not guaranteed. Why is this? What we often forget to consider is what’s considered ‘normal wear and tear’, and what is pathological. In a 2014 study published by Brinjikji et al., they looked at Lumbar MRI’s of 3,110 asymptomatic patients across 33 different studies, meaning these patients had no history of low back pain. What they found is that 37% of 20-year-old individuals displayed signs of degenerative discs (aka ‘Arthritis’ of the spine), increasing to 96% of 80-year-old individuals. 

What about something more serious like bulging or herniated discs? That can’t possibly be ‘normal’… 

In fact, it is. They found 30% of 20-year-olds showed disc bulging increasing to 84% of 80-year-olds and protruding discs in 29% of 20-year-olds and 43% of those in their 80’s. 

The only possible way to accurately conclude that these findings are the sole contributor of pain and dysfunction is to perform an MRI immediately before the onset of pain and then again immediately after the onset of pain and compare the difference. Though, this is obviously not feasible. Even still, there could be minor changes that are not detected on the image that explain the onset of pain. 

But imaging doesn’t lie, does it?

It does, sometimes. In another study by Herzog et al. In 2017, they asked a 63-year-old female to receive an MRI at ten different MRI centers over a 3 week span. This lady did have a history of low back pain and shooting pains down the leg. Across the 49 distinct findings amongst all 10 of the MRI’s, there were NO findings that were reported in all ten reports! One finding was reported in 9/10 MRI’s and 32.7% of the findings were only reported once. Let that sink in… 

How can an image lie? 

Because images are interpreted by a radiologist to produce a summary of what they see and don’t see. Some radiologists consider certain findings ‘normal’ and some don’t, some may miss something others see, and sometimes the image is blurry and difficult to accurately assess. While this process is meant to be as objective as possible, there is still room for interpreter bias. 

However, imaging is absolutely necessary sometimes and I do not mean to take away from it’s importance in diagnosis and treatment. It certainly helps us paint a complete picture, especially when there is such intense pain that a full functional exam is not appropriate. 

This edition simply aims to help educate the general population about the use of imaging and to always take the findings of an image with a grain of salt, or two, and using the results of an image combined with a functional exam can help you decide the best course of treatment. 

If you have any questions, don’t hesitate to ask! Grant@advancedmanualtherapies.com

Thanks for reading!

-Dr. Grant

Heat vs Ice

The mnemonic RICE was created in 1978 by Gabe Mirkin, a Sports Medicine Physician, that describes the use of Rest, Ice, Compression, and Elevation to treat sport-specific injuries. Today, this mnemonic has become standard practice immediately following any injury. However, after many years of experience and practice, Dr. Mirkin began to notice that the site of injury reaches a point where it no longer requires the anti-inflammatory effects of ice. In fact, if used past the acute stage of injury, it can impede and interfere with the body’s natural healing response. Because of this, Dr. Mirkin recanted his mnemonic in 2014. 

Before we talk about heat or ice, let’s discuss the stages of healing. 

First, we have the Acute stage, a.k.a. the Inflammatory phase. This stage most commonly lasts between 24-72 hours following the injury. During this stage, the body is focusing white blood cells and inflammatory markers to the site of injury in order to protect it from further injury/infection and begin the healing process. This is what causes swelling. 

Next, we have the Sub-Acute stage, a.k.a. the Proliferative phase. This stage can occur anywhere from 2 days to 6 weeks where the body transitions from the Acute to Chronic Stages. We typically see a reduction in swelling, though pain and loss of function persist. The body has sent the proper chemicals to the area signaling a need for repair and the healing process has begun by lying down new tissue. However, this new tissue is not mature enough to replace the original, damaged tissue.

Finally, the Chronic stage, a.k.a. the Remodeling phase. During this stage, the new tissue is being remodeled and strengthened in order to perform the function of the original, damaged tissue. This stage can last from weeks to months, even years, depending on the severity of the injury. Typically we see scar tissue first. But over time, can be replaced with viable, functioning tissue more similar to that of the original, damaged tissue.

What are the effects of Heat and Ice?

Ice reduces blood flow via vasoconstriction, or narrowing of the blood vessels. Ice also increases fluid viscosity (makes it thicker), makes the area numb to pain, and reduces the flexibility/mobility of the underlying tissue by reducing it’s elasticity. 

On the other hand, Heat increases blood flow, decreases fluid viscosity (makes it thinner), and increases the flexibility/mobility of underlying tissue by increasing it’s elasticity. 

So how does this relate to tissue injury?

Injuries with a specific Mechanism Of Injury (MOI), such as a traumatic event, sets off the 3 stages of healing. Ice can be useful during the acute stage in order to prevent excessive inflammation and swelling. Inflammation is necessary and helpful during this stage, but too much can be harmful. This is where the ice is important during the first 24-72 hours. 

If ice is used after this stage of healing, it can inhibit the body’s natural healing response by reducing blood flow, reducing mobility/flexibility, and increasing the viscosity of the interstitial fluid or remaining swelling. These effects make it more difficult for the body to remove and flush the area of the swelling and slow down the laying of new, healthy tissue. 

During the sub-acute and chronic stages, heat is more appropriate in order to continue bringing healthy blood, oxygen, and nutrients to the area and remove swelling and metabolic byproducts. Continued use of heat can facilitate this process. In addition, the heat will further improve the tissue’s flexibility and mobility as it matures and strengthens as to avoid a loss in any range of motion or elasticity during this time. 

I see many people that come in and are still using ice weeks and months following the onset of injury or pain. At this point, the ice is simply slowing down the body’s natural healing response and likely contributing to a bigger problem! 

What about Chronic pain without a specific MOI? 

In this scenario, we need to conceptualize a different model of healing. Chronic pain can be due to many factors, from neurological, centrally-mediated pain sensitivity, muscle guarding/spasms, etc. Because of this, heat or ice recommendations should be on a case-by-case basis. However, what’s most important is achieving some form of relief. For this reason, I usually ask my patients to try both and go with whichever one feels better! 

While this is a very generalized explanation of tissue healing and the effects of heat or ice, I hope this edition provides some clarity to the Heat vs Ice debate and helps you make a decision as to which is most appropriate for you. 

Thanks for reading! 

-Dr. Grant