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A Comprehensive Guide to Almond Flour and Almond Meal

A Comprehensive Guide to Almond Flour and Almond Meal

For individuals practicing a low-carbohydrate eating style or want to try an alternative flour, can incorporating almond flour help in their wellness journey?

A Comprehensive Guide to Almond Flour and Almond Meal

Almond Flour

Almond flour and almond meal are gluten-free alternatives to wheat products in certain recipes. They are made by grinding almonds and can be bought prepared or made at home with a food processor or grinder. The flour is higher in protein and lower in starch than other gluten-free flour.

Almond Flour and Almond Meal

The flour is made with blanched almonds, meaning the skin has been removed. Almond meal is made with whole or blanched almonds. The consistency for both is more like corn meal than wheat flour. They can usually be used interchangeably, although using the blanched flour will produce a more refined, less grainy result. Superfine almond flour is great for baking cakes but is difficult to make at home. It can be found at grocery stores or ordered online.

Carbohydrates and Calories

A half cup of commercially prepared flour contains about:

  1. The glycemic index of almond flour is less than 1, which means it should have little effect on raising blood glucose levels.
  2. The high glycemic index of whole wheat flour is 71, and rice flour is 98.

Using Almond Flour

It is recommended for making gluten-free quick bread recipes, such as gluten-free:

  • Muffins
  • Pumpkin bread
  • Pancakes
  • Some cake recipes

Individuals are recommended to start with a recipe already adapted for almond flour and then make their own. A cup of wheat flour weighs around 3 ounces, while a cup of almond flour weighs almost 4 ounces. This will make a significant difference in baked goods. The flour is beneficial for adding nutrients to foods.

Almond Meal

  • Almond meal can be cooked as polenta or grits such as shrimp and grits.
  • Cookies can be made gluten-free with almond meal.
  • Almond meal biscuits can be made, but pay attention to the recipe.
  • Almond meal can be used to bread fish and other fried foods, but it must be taken care of so as not to burn.
  • Almond meal is not recommended for breads that require true dough with a developed gluten structure, like wheat flour.
  • More eggs are needed when baking with almond meal to provide the structure gluten in flour creates.

Adapting recipes to substitute almond meal for wheat flour can be a challenge that requires plenty of trial and error.

Sensitivities

Almonds are a tree nut, one of the eight most common food allergies. (Anaphylaxis UK. 2023) While peanuts are not tree nuts, many with peanut allergies can also have an almond allergy.

Making Your Own

It can be made in a blender or food processor.

  • Care must be taken not to grind it too long, or it will become almond butter, which can also be used.
  • Add a little at a time and pulse until it is ground into meal.
  • Store unused flour immediately in the refrigerator or freezer because it will go rancid quickly if left out.
  • Almonds are shelf-stable, and almond flour is not, so it is recommended that you grind only what is needed for the recipe.

Store Bought

Most health food stores sell almond flour, and more supermarkets are stocking it as it has become a popular gluten-free product. Packaged flour and meal will also go rancid after opening and should be kept in the refrigerator or freezer after opening.


Integrative Medicine


References

USDA FoodData Central. (2019). Almond Flour. Retrieved from https://fdc.nal.usda.gov/fdc-app.html#/food-details/603980/nutrients

Anaphylaxis UK. (2023). Allergy Factsheets (Anaphylaxis UK A brighter future for people with serious allergies, Issue. https://www.anaphylaxis.org.uk/factsheets/

Atkinson, F. S., Brand-Miller, J. C., Foster-Powell, K., Buyken, A. E., & Goletzke, J. (2021). International tables of glycemic index and glycemic load values 2021: a systematic review. The American journal of clinical nutrition, 114(5), 1625–1632. https://doi.org/10.1093/ajcn/nqab233

The Benefits of Sleeping with a Pillow Between the Legs

The Benefits of Sleeping with a Pillow Between the Legs

For individuals with back pain, can sleeping with a pillow between or under their knees help bring relief during sleep?

The Benefits of Sleeping with a Pillow Between the Legs

Sleep With A Pillow Between The Legs

Healthcare providers may recommend that individuals with back pain due to pregnancy or conditions like a herniated disc and sciatica sleep with a pillow between their legs. Sleeping with a pillow between the legs may help relieve back and hip pain, as the position helps maintain pelvis and spinal alignment. Proper spinal alignment can help relieve back stress and pain.

The Benefits

Some potential benefits of sleeping with a pillow between the knees.

Reduce Back and Hip Pain

When sleeping on the side, the spine, shoulders, and hips may twist to maintain the position because the center of gravity is elevated, causing instability. (Gustavo Desouzart et al., 2015) Placing a pillow between the knees may help maintain stability and reduce back and hip pain. (Gustavo Desouzart et al., 2015) The pillow neutralizes the position of the pelvis by slightly elevating the leg on top. This decreases the pressure on the lower back and hip joints, which may help reduce pain and allow for improved sleep.

Reduce Sciatica Symptoms

Sciatica nerve pain travels from the lower back down one leg due to a compressed spinal nerve root in the lower back. (American Academy of Orthopaedic Surgeons, 2021) Sleeping with a pillow between the knees may help reduce symptoms and sensations. A pillow between the legs can help prevent twisting the back, rotating the spine, or tilting the pelvis during sleep.

Reduce Herniated Disc Symptoms

A herniated disc can pressure the spinal nerves, leading to pain and numbness. (Penn Medicine. 2024) Sleeping on the side can worsen herniated disc pain; however, placing a pillow between the knees keeps the pelvis in neutral alignment and prevents spinal rotation. Sleeping on the back with a pillow under the knees can also help reduce pressure on the disc. (University of Central Florida. N.D.)

Improve Posture

Maintaining healthy posture while sitting or standing is important to neuromusculoskeletal health and injury prevention. Proper alignment during sleep can help improve posture (Doug Cary et al., 2021). According to one study, individuals spend more than half of their time sleeping in a side-lying posture. (Eivind Schjelderup Skarpsno et al., 2017) Sleeping on the side with the top leg frequently falls forward, bringing the pelvis into a forward tilt that places added pressure on the hips and spine connective tissues. This position disrupts the body’s natural alignment. (Doug Cary et al., 2021) Placing a pillow between the knees improves sleeping posture by lifting the top leg and prevents forward shifting. (University of Rochester Medical Center. 2024)

Pregnancy

Pregnancy pain in the back and pelvic girdle is due to: (Danielle Casagrande et al., 2015)

  • Increased weight leads to increased pressure on joints.
  • Significant change in the center of gravity.
  • Hormonal changes make connective tissues more lax.

Pregnant women with hip or back pain are often recommended to sleep with a pillow between their knees to relieve pain and discomfort. Doctors agree that lying on the left side is the best sleep position during the second and third trimesters. This position ensures optimal blood flow for the mother and baby and helps kidney function. (Standford Medicine, 2024) Placing a pillow between the knees can help reduce the pressure on the joints and also help maintain the left-side lying position. (O’Brien LM, Warland J. 2015) (Standford Medicine, 2024) Larger maternity pillows supporting the abdomen and lower back can provide more comfort.

Consult a healthcare provider about sleeping with a pillow between the knees to see if it is right for you.


What Causes Disc Herniation?


References

Desouzart, G., Matos, R., Melo, F., & Filgueiras, E. (2015). Effects of sleeping position on back pain in physically active seniors: A controlled pilot study. Work (Reading, Mass.), 53(2), 235–240. https://doi.org/10.3233/WOR-152243

American Academy of Orthopaedic Surgeons. (2021). Sciatica. OrthoInfo. https://orthoinfo.aaos.org/en/diseases–conditions/sciatica

Penn Medicine. (2024). Herniated disc disorders. Penn Medicine. https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/herniated-disc-disorders

University of Central Florida. (N.D.). The best sleeping position for lower back pain (and the worst). UFC Health Services. https://ucfhealth.com/our-services/lifestyle-medicine/best-sleeping-position-for-lower-back-pain/

Cary, D., Jacques, A., & Briffa, K. (2021). Examining relationships between sleep posture, waking spinal symptoms and quality of sleep: A cross sectional study. PloS one, 16(11), e0260582. https://doi.org/10.1371/journal.pone.0260582

Skarpsno, E. S., Mork, P. J., Nilsen, T. I. L., & Holtermann, A. (2017). Sleep positions and nocturnal body movements based on free-living accelerometer recordings: association with demographics, lifestyle, and insomnia symptoms. Nature and science of sleep, 9, 267–275. https://doi.org/10.2147/NSS.S145777

University of Rochester Medical Center. (2024). Good sleeping posture helps your back. Health Encyclopedia. https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=1&ContentID=4460

Casagrande, D., Gugala, Z., Clark, S. M., & Lindsey, R. W. (2015). Low Back Pain and Pelvic Girdle Pain in Pregnancy. The Journal of the American Academy of Orthopaedic Surgeons, 23(9), 539–549. https://doi.org/10.5435/JAAOS-D-14-00248

Standford Medicine. (2024). Sleeping positions during pregnancy. Standford Medicine Children’s Health. https://www.stanfordchildrens.org/en/topic/default?id=sleeping-positions-during-pregnancy-85-P01238

O’Brien, L.M., Warland, J. (2015). Maternal sleep position: what do we know where do we go? BMC Pregnancy Childbirth, 15, Article A4 (2015). https://doi.org/doi:10.1186/1471-2393-15-S1-A4

Peppermint: A Natural Remedy for Irritable Bowel Syndrome

Peppermint: A Natural Remedy for Irritable Bowel Syndrome

For individuals dealing with digestive issues or bowel disorders, can adding peppermint to a nutrition plan help manage symptoms and digestion?

Peppermint: A Natural Remedy for Irritable Bowel Syndrome

Peppermint

First grown in England, peppermint’s medicinal properties were soon recognized and are cultivated today in Europe and Northern Africa.

How It Is Used

  • Peppermint oil can be taken as a tea or in capsule form.
  • Consult a physician or licensed healthcare professional to determine the proper dosage for the capsule form.

For Irritable Bowel Syndrome

Peppermint is taken as a tea to treat general digestive problems. It is known to reduce the production of gas in the intestine. Today, researchers recognize peppermint as effective for irritable bowel syndrome when used in oil form. (N. Alammar et al., 2019) Peppermint oil has been approved for use by IBS patients in Germany. However, the FDA has not approved peppermint and oil to treat any condition, but it has listed peppermint and the oil as generally safe. (ScienceDirect, 2024)

Interactions With Other Medications

  • Individuals who take lansoprazole to reduce stomach acid may compromise the enteric coating of some commercial peppermint oil capsules. (Taofikat B. Agbabiaka et al., 2018)
  • This can happen using H2-receptor antagonists, proton pump inhibitors, and antacids.

Other potential interactions include: (Benjamin Kligler, Sapna Chaudhary 2007)

  • Amitriptyline
  • Cyclosporine
  • Haloperidol
  • Peppermint extract may increase serum levels of these medications.

It is recommended to discuss medication interactions with a healthcare provider before starting supplements if taking any of these medications.

Pregnancy

  • Peppermint is not recommended for use during pregnancy or by nursing individuals.
  • It is unknown if it could affect a developing fetus.
  • It is unknown if it can affect a nursing baby.

How To Use The Herb

It is not that common, but some individuals are allergic to peppermint. Peppermint oil should never be applied to the face or around mucous membranes (National Center for Complementary and Integrative Health. 2020). Using more than one form, such as tea and oil, is not recommended because it could lead to side effects.

  • Because the FDA does not regulate supplements like peppermint and others, their contents may be varied.
  • Supplements may contain harmful ingredients or not contain the active ingredient at all.
  • This is why seeking reputable brands and informing an individual’s healthcare team of what is being taken is highly recommended.

It has the potential to worsen certain conditions and should not be used by:

  • Individuals who have chronic heartburn. (National Center for Complementary and Integrative Health. 2020)
  • Individuals who have severe liver damage.
  • Individuals who have inflammation of the gallbladder.
  • Individuals who have obstruction of bile ducts.
  • Individuals who are pregnant.
  • Individuals with gallstones should consult their healthcare provider to see if it is safe.

Side Effects

  • The oil may cause an upset stomach or burning.
  • Enteric-coated capsules may cause a burning sensation in the rectum. (Brooks D. Cash et al., 2016)

Children and Infants

  • Peppermint was used to treat colic in infants but is not recommended today.
  • The menthol in the tea may cause infants and small children to choke.
  • Chamomile could be a possible alternative. Consult a healthcare provider to see if it is safe.

Beyond Adjustments: Chiropractic and Integrative Healthcare


References

Alammar, N., Wang, L., Saberi, B., Nanavati, J., Holtmann, G., Shinohara, R. T., & Mullin, G. E. (2019). The impact of peppermint oil on the irritable bowel syndrome: a meta-analysis of the pooled clinical data. BMC complementary and alternative medicine, 19(1), 21. https://doi.org/10.1186/s12906-018-2409-0

ScienceDirect. (2024). Peppermint Oil. https://www.sciencedirect.com/topics/nursing-and-health-professions/peppermint-oil#:~:text=As%20a%20calcium%20channel%20blocker,as%20safe%E2%80%9D%20%5B11%5D.

Agbabiaka, T. B., Spencer, N. H., Khanom, S., & Goodman, C. (2018). Prevalence of drug-herb and drug-supplement interactions in older adults: a cross-sectional survey. The British journal of general practice : the journal of the Royal College of General Practitioners, 68(675), e711–e717. https://doi.org/10.3399/bjgp18X699101

Kligler, B., & Chaudhary, S. (2007). Peppermint oil. American family physician, 75(7), 1027–1030.

National Center for Complementary and Integrative Health. (2020). Peppermint oil. Retrieved from https://www.nccih.nih.gov/health/peppermint-oil#safety

Cash, B. D., Epstein, M. S., & Shah, S. M. (2016). A Novel Delivery System of Peppermint Oil Is an Effective Therapy for Irritable Bowel Syndrome Symptoms. Digestive diseases and sciences, 61(2), 560–571. https://doi.org/10.1007/s10620-015-3858-7

Khanna, R., MacDonald, J. K., & Levesque, B. G. (2014). Peppermint oil for the treatment of irritable bowel syndrome: a systematic review and meta-analysis. Journal of clinical gastroenterology, 48(6), 505–512. https://doi.org/10.1097/MCG.0b013e3182a88357

Don’t Ignore Whiplash Signs and Symptoms: Seek Treatment

Don’t Ignore Whiplash Signs and Symptoms: Seek Treatment

Those experiencing neck pain, stiffness, headache, shoulder and back pain may suffer from a whiplash injury. Can knowing whiplash signs and symptoms help individuals recognize the injury and help healthcare providers develop an effective treatment plan?

Don't Ignore Whiplash Signs and Symptoms: Seek Treatment

Whiplash Signs and Symptoms

Whiplash is a neck injury that typically occurs after a motor vehicle collision or accident but can happen with any injury that rapidly whips the neck forward and backward. It is a mild to moderate injury of the neck muscles. Common whiplash signs and symptoms include:

  • Neck pain
  • Neck stiffness
  • Headache
  • Dizziness
  • Shoulder pain
  • Back pain
  • Tingling sensations in the neck or down the arms. (Johns Hopkins Medicine. 2024)
  • Some individuals can develop chronic pain and headaches.

The symptoms and treatment depend on the severity of the injury. Treatment can include over-the-counter pain medicines, ice and heat therapy, chiropractic, physical therapy, and stretching exercises.

Frequent Signs and Symptoms

The sudden whipping movement of the head can affect several structures within the neck. These structures include:

  • Muscles
  • Bones
  • Joints
  • Tendons
  • Ligaments
  • Intervertebral discs
  • Blood vessels
  • Nerves.
  • Any or all of these can be affected by a whiplash injury. (MedlinePlus, 2017)

Statistics

Whiplash is a neck sprain that occurs from a fast neck-jerking motion. Whiplash injuries account for more than half of vehicle traffic collision injuries. (Michele Sterling, 2014) Even with a minor injury, the most frequent symptoms include: (Nobuhiro Tanaka et al., 2018)

  • Neck pain
  • Next stiffness
  • Neck tenderness
  • Limited range of motion of the neck

Individuals can develop neck discomfort and pain shortly after an injury; however, the more intense pain and stiffness typically do not occur right after the injury. Symptoms tend to worsen the next day or 24 hours later. (Nobuhiro Tanaka et al., 2018)

Beginning Symptoms

Researchers have found that approximately more than half of individuals with whiplash develop symptoms within six hours of the injury. Around 90% develop symptoms within 24 hours, and 100% develop symptoms within 72 hours. (Nobuhiro Tanaka et al., 2018)

Whiplash vs. Traumatic Cervical Spine Injury

Whiplash describes a mild to moderate neck injury without significant skeletal or neurological symptoms. Significant neck injuries can lead to fractures and dislocations of the spine that can affect the nerves and spinal cord. Once an individual develops neurological problems associated with a neck injury, the diagnosis changes from whiplash to traumatic cervical spine injury. These differences can be confusing as they are on the same spectrum. To better understand the severity of a neck sprain, the Quebec classification system divides neck injury into the following grades (Nobuhiro Tanaka et al., 2018)

Grade 0

  • This means there are no neck symptoms or physical examination signs.

Grade 1

  • There is neck pain and stiffness.
  • Very few findings from the physical examination.

Grade 2

  • Indicates neck pain and stiffness
  • Neck tenderness
  • Decreased mobility or neck range of motion on physical examination.

Grade 3

  • Involves muscle pain and stiffness.
  • Neurologic symptoms include:
  • Numbness
  • Tingling
  • Weakness in the arms
  • Decreased reflexes

Grade 4

  • Involves a fracture or dislocation of the bones of the spinal column.

Other Symptoms

Other whiplash signs and symptoms that can be associated with the injury but are less common or only occur with a severe injury include (Nobuhiro Tanaka et al., 2018)

  • Tension headache
  • Jaw pain
  • Sleep problems
  • Migraine headache
  • Difficulty concentrating
  • Reading difficulties
  • Blurred vision
  • Dizziness
  • Driving difficulties

Rare Symptoms

Individuals with severe injuries can develop rare symptoms that often indicate traumatic cervical spine injury and include: (Nobuhiro Tanaka et al., 2018)

  • Amnesia
  • Tremor
  • Voice changes
  • Torticollis – painful muscle spasms that keep the head turned to one side.
  • Bleeding in the brain

Complications

Most individual generally recover from their symptoms within a few weeks to a few months. (Michele Sterling, 2014) However, whiplash complications can occur, especially with severe grade 3 or grade 4 injuries. The most common complications of a whiplash injury include chronic/long-term pain and headaches. (Michele Sterling, 2014) Traumatic cervical spine injury can affect the spinal cord and be associated with chronic neurological problems, including numbness, weakness, and difficulty walking. (Luc van Den Hauwe et al., 2020)

Treatment

The pain is typically more severe the next day than after the injury. Whiplash musculoskeletal injury treatment depends on whether it is an acute injury or the individual has developed chronic neck pain and stiffness.

  • Acute pain can be treated with over-the-counter medicines like Tylenol and Advil, which effectively treat the pain.
  • Advil is a nonsteroidal anti-inflammatory that can be taken with the pain reliever Tylenol, which works in different ways.
  • The mainstay of treatment is encouraging regular activity with stretching and exercise. (Michele Sterling, 2014)
  • Physical therapy uses various range of motion exercises to strengthen the neck muscles and relieve the pain.
  • Chiropractic adjustments and non-surgical decompression can help realign and nourish the spine.
  • Acupuncture can cause the body to release natural hormones that provide pain relief, help relax the soft tissues, increase circulation, and reduce inflammation. The cervical spine can return to alignment when the soft tissues are no longer inflamed and spasming. (Tae-Woong Moon et al., 2014)

Neck Injuries


References

Medicine, J. H. (2024). Whiplash Injury. https://www.hopkinsmedicine.org/health/conditions-and-diseases/whiplash-injury

MedlinePlus. (2017). Neck Injuries and Disorders. Retrieved from https://medlineplus.gov/neckinjuriesanddisorders.html#cat_95

Sterling M. (2014). Physiotherapy management of whiplash-associated disorders (WAD). Journal of physiotherapy, 60(1), 5–12. https://doi.org/10.1016/j.jphys.2013.12.004

Tanaka, N., Atesok, K., Nakanishi, K., Kamei, N., Nakamae, T., Kotaka, S., & Adachi, N. (2018). Pathology and Treatment of Traumatic Cervical Spine Syndrome: Whiplash Injury. Advances in orthopedics, 2018, 4765050. https://doi.org/10.1155/2018/4765050

van Den Hauwe L, Sundgren PC, Flanders AE. (2020). Spinal Trauma and Spinal Cord Injury (SCI). In: Hodler J, Kubik-Huch RA, von Schulthess GK, editors. Diseases of the Brain, Head and Neck, Spine 2020–2023: Diagnostic Imaging [Internet]. Cham (CH): Springer; 2020. Chapter 19. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554330/ doi: 10.1007/978-3-030-38490-6_19

Moon, T. W., Posadzki, P., Choi, T. Y., Park, T. Y., Kim, H. J., Lee, M. S., & Ernst, E. (2014). Acupuncture for treating whiplash associated disorder: a systematic review of randomised clinical trials. Evidence-based complementary and alternative medicine : eCAM, 2014, 870271. https://doi.org/10.1155/2014/870271

Enhance Your Breathing Technique for Optimal Fitness

Enhance Your Breathing Technique for Optimal Fitness

Can improving breathing patterns help further fitness and optimize overall health for individuals who walk for exercise?

Enhance Your Breathing Technique for Optimal Fitness

Improve Breathing and Walking

Exercising is a moment in which breathing can quicken and become labored if not done correctly. There is a proper way to breathe when exercising, especially when walking or speed walking. Breathing incorrectly causes rapid fatigue and exhaustion. Controlling the flow of one’s breath improves endurance and cardiovascular health, and it can also amplify metabolism, mood, and energy levels. (Hsiu-Chin Teng et al., 2018) Known as diaphragmatic breathing, it is used for those with reduced lung capacity, like individuals with chronic obstructive pulmonary disease/COPD. The practice improves lung capacity and is a recommended way to help relieve stress.

Physiology

  • During exercise, the oxygen inhaled converts the calories consumed into energy that fuels the body. This process is referred to as metabolism.
  • When the oxygen supply exceeds the body’s oxygen needs, the body is in an aerobic state. This means there is plenty of oxygen to fuel physical activity/exercise as there are calories to burn.
  • If the oxygen supply falls short of the body’s oxygen needs, the body falls into an anaerobic state.
  • Deprived of oxygen, the body turns to stored fuel in the muscles, known as glycogen.
  • This delivers a powerful burst of energy, but the fuel is quickly spent and fatigue and exhaustion soon follow.
  • Increasing airflow in and out of the lungs can prevent early exhaustion and help the body burn calories more effectively. (Your lungs and exercise. Breathe 2016)

Improved Breathing Benefits

Optimal breathing starts in infancy. When a baby breathes, their belly rises and falls. This facilitates respiration by pushing and pulling the diaphragm – the muscle that separates the lungs and abdominal cavity. When the baby inhales, the belly extends, pulling the diaphragm downward and allowing the lungs to fill with air. When the baby exhales, the belly draws in, pressing the diaphragm upward and forcing air out. As the body ages and the capacity of the lungs increases, individuals shift from belly-breathing to chest-breathing. Chest breathing involves the chest wall muscles with little use of the diaphragm. Chest breathing usually provides enough air for everyday activity but does not fill the lungs.

This is why individuals resort to mouth-breathing or gasping when the oxygen supply is limited. Even those in decent physical shape may be inadvertently undermining efforts by sucking in their stomach to look thinner, depriving themselves of complete inhalations and exhalations. To overcome this, individuals need to re-train their bodies to activate the abdominal muscles when walking. Belly or diaphragmatic breathing can extend the duration of exercise while strengthening the core muscles. (Nelson, Nicole 2012) By increasing core stability, individuals can better support the spine and maintain a healthy posture when walking. This stabilizes the hips, knees, upper back, and shoulders, making the body less prone to strain, instability, and fatigue from unhealthy posture. (Tomas K. Tong et al., 2014)

Breathing Correctly

The inhalation draws the belly out, pulls the diaphragm down, and inflates the lungs. Simultaneously, it extends the ribcage and lengthens the lower spine. This forces the shoulders and collarbone backward, further opening the chest. Exhaling does the reverse.

Walking

Start by inhaling and exhaling through the nose, ensuring that the inhalation duration matches the exhalation duration. When picking up the pace, individuals can resort to mouth-breathing, maintaining the same inhalation/exhalation rhythm. At no time should breathing be held in. Learning diaphragmatic breathing takes time, but the following steps can be a starting point:

  • Inhale by inflating the belly fully on a count of five.
  • Allow the lungs to fill, drawing the shoulders back as this happens.
  • Exhale by pulling the belly button toward the spine on a count of five.
  • Use the diaphragm to press the air out of the lungs, keeping the spine erect.
  • Repeat.

If unable to maintain a count of five, individuals can shorten the count or slow the pace of the walk. Individuals in good shape may be able to extend the count. Initially, diaphragmatic breathing may not come naturally, but it will become automatic with practice. Stop and place the hands over the head if short of breath when walking. Breathe in and out deeply and evenly until breathing returns to normal.


Unlocking Wellness


References

Teng, H. C., Yeh, M. L., & Wang, M. H. (2018). Walking with controlled breathing improves exercise tolerance, anxiety, and quality of life in heart failure patients: A randomized controlled trial. European journal of cardiovascular nursing, 17(8), 717–727. https://doi.org/10.1177/1474515118778453

Your lungs and exercise. (2016). Breathe (Sheffield, England), 12(1), 97–100. https://doi.org/10.1183/20734735.ELF121

Tong, T. K., Wu, S., Nie, J., Baker, J. S., & Lin, H. (2014). The occurrence of core muscle fatigue during high-intensity running exercise and its limitation to performance: the role of respiratory work. Journal of sports science & medicine, 13(2), 244–251.

Nelson, Nicole MS, LMT. (2012). Diaphragmatic Breathing: The Foundation of Core Stability. Strength and Conditioning Journal 34(5):p 34-40, October 2012. | DOI: 10.1519/SSC.0b013e31826ddc07

Comprehensive Support Therapies for Endometriosis Management

Comprehensive Support Therapies for Endometriosis Management

For individuals living with cyclical or chronic endometriosis symptoms, can incorporating support therapies help in disease management?

Comprehensive Support Therapies for Endometriosis Management

Support Therapies

Endometriosis is a disorder in which tissue similar to the uterine lining begins to grow outside the uterus where it does not belong. Endometriosis support therapies involve a comprehensive approach to treatment. It involves non-invasive treatments to help manage symptoms that can include:

  • Pelvic floor physical therapy
  • Massage
  • Medication
  • Transcutaneous Electrical Nerve Stimulation
  • Acupuncture
  • Chiropractic

Pelvic Floor Physical Therapy – PFPT

  • Endometriosis can cause or contribute to pelvic floor dysfunction, causing pain, urinary disorders, bowel problems, and painful sexual intercourse.
  • Pelvic floor physical therapy improves the strength and function of the pelvic floor muscles.
  • Example support therapies can include kegel exercises and biofeedback. (Christine Mansfield et al., 2022)

Therapeutic Massage

A physical therapist uses various pressures, stretching, and/or trigger point release. This helps: (Sylvia Mechsner, 2022)

  • Release muscle tension
  • Lower cortisol – stress hormone
  • Improve circulation
  • Release endorphins – the body’s natural painkillers

Medications

Nonsteroidal anti-inflammatory drugs or NSAIDs and hormonal contraceptives – birth control are the first line of treatment. Advil and Motrin are over-the-counter NSAIDs. If those don’t manage pain effectively, a healthcare provider may recommend prescription NSAIDs. (Sylvia Mechsner, 2022) Hormonal suppression agents or estrogen modulators are a second line of treatment for endometriosis and can include: (Christian M. Becker et al., 2022)

  • Gonadotropin-releasing hormone agonists (GnRH)
  • Antigonadotropic meds
  • Aromatase inhibitors
  • Selective estrogen receptor modulators (SERMs)

Other medications include:(Sylvia Mechsner, 2022)

  • Valium – diazepam suppositories – Muscle-relaxing medications.
  • Gabapentinoids – Medications that treat nerve pain.
  • Antidepressants – these can increase the pain-reducing effect of other medications.

An endometriosis specialist. (Endometriosis Foundation of America. 2015) may suggest seeing a pain management specialist who provides nerve blocks or Botox injections. (Augusto Pereira et al., 2022)

Birth Control

Hormonal contraceptives suppress or regulate periods. They are effective for management, but not everyone can take them because of medical history, side effects, or fertility disorders and conditions. (Mert Ilhan et al., 2019) A healthcare provider can recommend alternative support therapies.

Transcutaneous Electrical Nerve Stimulation

  • A transcutaneous electrical nerve stimulation utilizes a battery-operated device that delivers low-voltage electrical stimulation to nerve fibers through electrodes placed on the skin.
  • Sessions are usually 15 to 30 minutes and work by disrupting pain signals. (Sylvia Mechsner, 2022)

Acupuncture

  • Acupuncture is a therapy in which a practitioner inserts thin needles into specific acupoints on the body to promote the flow of energy and alleviate pain. (Nora Giese et al., 2023)

Chiropractic

  • Chiropractic care focuses on spinal adjustments and alignment to enhance nervous system function, help alleviate pelvic discomfort and nerve pain – sciatica – and improve overall well-being. (Robert J. Trager et al., 2021)
  • Non-surgical decompression could be recommended to gently stretch the spine, relieve pressure, and flood the spine with added nutrients.

Movement Medicine: Chiropractic Care


References

Mansfield, C., Lenobel, D., McCracken, K., Hewitt, G., & Appiah, L. C. (2022). Impact of Pelvic Floor Physical Therapy on Function in Adolescents and Young Adults with Biopsy-Confirmed Endometriosis at a Tertiary Children’s Hospital: A Case Series. Journal of pediatric and adolescent gynecology, 35(6), 722–727. https://doi.org/10.1016/j.jpag.2022.07.004

Mechsner S. (2022). Endometriosis, an Ongoing Pain-Step-by-Step Treatment. Journal of clinical medicine, 11(2), 467. https://doi.org/10.3390/jcm11020467

Ilhan, M., Gürağaç Dereli, F. T., & Akkol, E. K. (2019). Novel Drug Targets with Traditional Herbal Medicines for Overcoming Endometriosis. Current drug delivery, 16(5), 386–399. https://doi.org/10.2174/1567201816666181227112421

Becker, C. M., Bokor, A., Heikinheimo, O., Horne, A., Jansen, F., Kiesel, L., King, K., Kvaskoff, M., Nap, A., Petersen, K., Saridogan, E., Tomassetti, C., van Hanegem, N., Vulliemoz, N., Vermeulen, N., & ESHRE Endometriosis Guideline Group (2022). ESHRE guideline: endometriosis. Human reproduction open, 2022(2), hoac009. https://doi.org/10.1093/hropen/hoac009

Endometriosis Foundation of America. (2015). Seeking a doctor: finding the right endometriosis specialist. https://www.endofound.org/preparing-to-see-a-doctor

Pereira, A., Herrero-Trujillano, M., Vaquero, G., Fuentes, L., Gonzalez, S., Mendiola, A., & Perez-Medina, T. (2022). Clinical Management of Chronic Pelvic Pain in Endometriosis Unresponsive to Conventional Therapy. Journal of personalized medicine, 12(1), 101. https://doi.org/10.3390/jpm12010101

Giese, N., Kwon, K. K., & Armour, M. (2023). Acupuncture for endometriosis: A systematic review and meta-analysis. Integrative medicine research, 12(4), 101003. https://doi.org/10.1016/j.imr.2023.101003

Trager, R.J., Prosak, S.E., Leonard, K.A. et al. (2021). Diagnosis and management of sciatic endometriosis at the greater sciatic foramen: a case report. SN Comprehensive Clinical Medicine, 3. https://doi.org/doi:10.1007/s42399-021-00941-0

Understanding Egg Substitutes: What You Need to Know

Understanding Egg Substitutes: What You Need to Know

Can using egg substitutes or replacements be safe for individuals with an egg allergy?

Understanding Egg Substitutes: What You Need to Know

Substitutes and Replacements

Individuals should not assume either is safe unless they carefully read the label.

  • Egg substitutes may contain eggs.
  • Egg replacement products may be egg-free.
  • Look for alternatives labeled vegan or egg-free to ensure there are none.

Substitutes May Contain Eggs

Liquid egg substitutes in grocery store dairy aisles are made from eggs.  The following all contain eggs and are not safe for individuals with egg allergies:

  • Generic liquid egg substitutes in cartons
  • Egg Beaters
  • Powdered egg white products

Replacements Are Safe Alternatives

  • Special replacement products that do not contain eggs are available.
  • They are labeled vegan egg substitutes.
  • They are usually sold in powdered form.
  • They are useful for baking.
  • They cannot be used as a replacement for eggs in foods like a quiche.

Egg-Free Commercial Replacements

Always check the ingredients on the label before purchasing a product sold as a substitute or replacement to ensure it is completely free.

  • These products may also contain soy, dairy, or other food allergens.
  • Vegan – contains no animal products, which includes eggs and dairy.
  • Vegetarian – may contain eggs as they are not meat but an animal product.

Unaware of Foods With Eggs

Stay aware of eggs hidden in other food products, such as cakes, breads, pastries, noodles, crackers, and cereals.

  • The federal Food Allergen Labeling and Consumer Protection Act requires that all packaged food products that contain eggs as an ingredient must list the word egg on the label. (U.S. Food & Drug Administration. 2022)

Other ingredients that indicate eggs are in the product include:

  • Albumin
  • Globulin
  • Lysozyme
  • Lecithin
  • Livetin
  • Vitellin
  • Ingredients starting with – ova or ovo.

Allergy Symptoms

Symptoms may consist of: (John W. Tan, Preeti Joshi 2014)

  • Skin reactions – hives, rash, or eczema.
  • Allergic conjunctivitis  – itchy, red, watery eyes.
  • Angioedema – swelling of the lips, tongue, or face.
  • Airway symptoms – wheezing, coughing, or a runny nose.
  • Gastrointestinal symptoms – nausea, stomach pain, diarrhea or vomiting.
  • Severe reactions – such as anaphylaxis, can cause multiple organ system failure.
  • Anaphylaxis is an emergency and requires immediate medical treatment.

A Guide For Food Allergies, Hypersensitivity and Intolerances


References

U.S. Food & Drug Administration. (2022). Food Allergen Labeling and Consumer Protection Act (FALCPA). Retrieved from https://www.fda.gov/food/food-allergensgluten-free-guidance-documents-regulatory-information/food-allergen-labeling-and-consumer-protection-act-2004-falcpa

Tan, J. W., & Joshi, P. (2014). Egg allergy: an update. Journal of paediatrics and child health, 50(1), 11–15. https://doi.org/10.1111/jpc.12408

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