Health Library - UWS Connected Whole Health

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Health Library

Resources for patients and health care providers

This information is presented for educational purposes only and is not intended to diagnose or prescribe for any medical or psychological condition, nor to prevent, treat, mitigate or cure such conditions. The information contained herein is not intended to replace a one-on-one relationship with a doctor or qualified health care professional. Therefore, this information is not intended as medical or health care advice, but rather a sharing of knowledge and information based on research and experience. We encourage you to make your own health care decisions based on your judgment and research in partnership with a qualified health care professional. Please do not stop, adjust or modify your dose of any prescribed medications without the direct supervision of your health care practitioner.

For Patients

Can Magnesium Help You Sleep and Decrease Risk of Cardiovascular Events?

Author: Tandia Termuende, chiropractic intern

According to the American Sleep Association, as many as 50-70 million U.S. adults suffer sleep disorders, with insomnia being the most commonly reported. There are pharmaceutical interventions for insomnia but many individuals prefer to try naturopathic or supplemental alternatives. One such supplement that has shown to be beneficial for insomnia is magnesium.

Magnesium is a crucial essential element to many physiological processes in the body. A deficiency in magnesium can lead to negative health outcomes, including sleep disturbances. Unfortunately, the dietary intake of magnesium has shown to be insufficient in many populations. Magnesium is needed for proper muscle and nerve function, to monitor blood sugar levels and to support the immune system and the heart. Furthermore, magnesium is an agonist to GABA, which is the main inhibitory neurotransmitter in the central nervous system. Low GABA levels have also been linked to sleep disorders, as GABA helps to relax the nervous system and decrease the amount of time it takes to fall asleep. Studies have shown that magnesium can affect the pineal gland, which is responsible for sleep and circadian rhythm. The pineal gland secretes melatonin, and with increased activity due to magnesium, increased melatonin is secreted. Melatonin is secreted in response to darkness, and therefore is secreted at night to help you sleep. Studies have also shown that magnesium supplementation can result in decreased serum cortisol concentrations, which is the body’s stress hormone (Abbasi et al., 2012). Decreased cortisol means decreased stress levels and theoretically less difficulty sleeping.

A study by Takase and colleagues (2004) investigated the effects of chronic sleep deprivation on autonomic activity. The subjects were 30 healthy (without coronary risk factors) male college students between the ages of 20 to 24 years. Plasma levels of epinephrine, norepinephrine and erythrocyte-MG were measured four weeks prior to and immediately after college final exams. The results showed that chronic stress from exams caused an autonomic imbalance depicted by increased sympathetic activity and decreased parasympathetic activity. This was reflected with results showing low heart rate variability, high norepinephrine and low intracellular magnesium, all of which occur when an individual is at a higher risk for cardiovascular events.

Talk to your health care provider about magnesium supplementation and if it may be beneficial for you. They will be able to give you dosage recommendations and timing of consumption.

References:

Abbasi, B., Kimiagar, M., Sadeghniiat, K., Shirazi, M. M., Hedayati, M., & Rashidkhani, B. (2012). The effect of magnesium supplementation on primary insomnia in elderly: A double-blind placebo-controlled clinical trial. Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences17(12), 1161–1169.

Takase, B., Akima, T., Satomura, K., Mastui, T., Ishihara, M., & Kurita, A. (2004). Effects of chronic sleep deprivation on autonomic activity by examining heart rate variability, plasma catecholamine, and intracellular magnesium levels. Biomedicine & Pharmacotherapy58, S35-S39.

Chronic Pain: What is My Pain Experience?

Author: Emily Kahler, chiropractic intern

Am I going to hurt myself? Is my pain real? Why am I in pain? These questions are valid and normal for a patient who might be experiencing acute or chronic pain. It might be relieving to hear that all pain is real. Pain is complex and has many factors besides tissue damage or injury. The biopsychosocial model is a complex experience that explains how each person feels pain differently. Factors that may influence the pain experience are anxiety, depression, a history of injuries or disease, economic status, difficulty at home, difficulty with friends or family and job status. With persistent pain the brain adapts and forms more and more pathways that can create pain. We like to say nerves that fire together, wire together. The brain can change over time, and we can rewire these pathways to change our pain perception through fun activities, healthy food, positive thinking, restful sleep and knowledge about pain. Understanding that you are in charge of you pain experience opens up new ways to treat. At Connected Whole Health we want to help you with your pain journey!

References:

New to Exercise? Walk.

Author: Tyler Brookings, chiropractic intern

Motivation for change can be difficult to come by for many of us, especially when it comes to our overall health. It is all too easy to choose the comfortable couch over a crowded gym after a long day at work. Evidence has shown that walking is a highly-effective way to improve overall health, especially when it is done alongside our peers. While walking for 30 minutes per day is recommended to see peak benefits, any increased physical activity has been linked to improved health outcomes. A new exercise journey does not need to be done alone. Outdoor group walking has been linked to “statistically significant improvements” in a wide range of health measurements. These include but are not limited to reduction in overall blood pressure, improved resting heart rate, reduced body fat, reduced BMI, improvements in mental health and depression, and reported improvements in overall quality of life. At Connected Whole Health, we will happily work with you to provide an appropriate and personalized walking regimen and connect you with exercise and walking groups near you to kick start this new journey. Happy walking!

Reference:

Fundamentals of Sleep Hygiene

Author: Matt Graham, chiropractic intern

Sleep is essential for healthy human function and performance, though all too frequently it is overlooked and under prioritized. Inadequate sleep has been shown to have a significant negative impact on mortality, performance, memory and cognition. A recent study done by the CDC (2016) found that 35% of U.S. adults reported sleeping an average of less than the recommended minimum of at least seven hours per night.

In 2015, a joint consensus statement put forward by the Sleep Research Society and the American Academy of Sleep Medicine, recommended that adults aim to sleep seven or more hours per night in order to promote optimal health. Sleeping less than seven hours per night is associated with increased mortality rates and adverse health outcomes including impaired performance and immune function, increased risk of depression, hypertension, diabetes, weight gain and obesity, heart disease and stroke (Watson et al., 2015). Poor sleep quality and insufficient sleep have also been shown to be risk factors for chronic pain: short and disturbed sleep is associated with increased sensitivity to painful stimulation, known as hyperalgesia (Haack et al., 2020). Studies on athletes have associated sleep deprivation with negative impacts on reaction time, accuracy, submaximal strength, endurance and cognitive functions such as judgment and decision-making (Vitale et al,, 2019). Further, a 2017 meta-analysis found that drivers experiencing sleepiness at the wheel are at a greater risk of being in a motor vehicle accident (Bioulac et al., 2017).

Healthy sleep is dependent on good quality and quantity, adequate timing and regularity, and the absence of sleep disturbances. Sleep hygiene refers to the maintenance of high-quality sleeping environments and sleep-related habits which can be easily incorporated into day-to-day life. Practicing good sleep hygiene is an effective way to promote consistent, uninterrupted sleep.

Tips for improving sleep hygiene, according to the CDC (2016):

  • Keep a consistent sleep schedule. Wake up and go to bed at the same time every day, including on weekends and during vacations.
  • Avoid large meals, caffeine and alcohol before bedtime.
  • Limit exposure to screens at least 30 minutes before bedtime.
  • Exercise regularly and maintain a well-balanced diet.
  • Maintain a good sleeping environment. Keep bedrooms cool, dark, relaxing and free of electronic devices such as TVs, computers and smartphones.

Sleep disorders, such as insomnia and sleep apnea, are very common and often underdiagnosed. If you are having persistent sleep-related difficulties, reach out to your medical provider.

References:

Bioulac, S., Micoulaud-Franchi, J. A., Arnaud, M., Sagaspe, P., Moore, N., Salvo, F., & Philip, P. (2017). Risk of Motor Vehicle Accidents Related to Sleepiness at the Wheel: A Systematic Review and Meta-Analysis. Sleep, 40(10), 10.1093/sleep/zsx134. https://doi.org/10.1093/sleep/zsx134

Gardner, B., Lally, P., & Wardle, J. (2012). Making health habitual: the psychology of ‘habit-formation’ and general practice. The British journal of general practice : the journal of the Royal College of General Practitioners, 62(605), 664–666. https://doi.org/10.3399/bjgp12X659466

Haack, M., Simpson, N., Sethna, N., Kaur, S., & Mullington, J. (2020). Sleep deficiency and chronic pain: potential underlying mechanisms and clinical implications. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 45(1), 205–216. https://doi.org/10.1038/s41386-019-0439-z

National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. (2016, July 15). CDC – Sleep Hygiene Tips – Sleep and Sleep Disorders. Retrieved May 2, 2022, from https://www.cdc.gov/sleep/about_sleep/sleep_hygiene.html

US Department of Health and Human Services. Sleep Health Objectives. 2015. Mar 6, Available from: https://www.healthypeople.gov/2020/topics-objectives/topic/sleep-health/objectives.

Vitale, K. C., Owens, R., Hopkins, S. R., & Malhotra, A. (2019). Sleep Hygiene for Optimizing Recovery in Athletes: Review and Recommendations. International journal of sports medicine, 40(8), 535–543. https://doi.org/10.1055/a-0905-3103

Watson, N. F., Badr, M. S., Belenky, G., Bliwise, D. L., Buxton, O. M., Buysse, D., Dinges, D. F., Gangwisch, J., Grandner, M. A., Kushida, C., Malhotra, R. K., Martin, J. L., Patel, S. R., Quan, S. F., & Tasali, E. (2015). Recommended Amount of Sleep for a Healthy Adult: A Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society. Sleep, 38(6), 843–844. https://doi.org/10.5665/sleep.4716

Patient-Centered Care: For the Good of the Patient

Author: Bill Moreau, DC, DACBSP, FACSM

In a new blog series, Dr. Bill Moreau, UWS chief medical officer, will provide his thoughts from the field of integrated health care and his longstanding experience providing top-tier health care.

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Osteoarthritis (OA) and Exercise 

Author: Emma Scaro, DC

It is a common misbelief that exercise should be avoided with osteoarthritis (OA). In fact, one of the best conservative treatments to help with OA is exercise! There are many benefits to staying active with this degenerative process. The most recent studies indicate that light to moderate aerobic exercise is recommended for those with OA. Some activities include biking, swimming and walking. To Learn more about aerobic exercises and how to utilize them with OA. Talk to your health care provider about other forms of exercise, such as resistance training, that can help increase the stability in your affected joint.

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Some of the best ways to combat inflammation comes from the grocery store

Author: Emma Scaro, DC

While there is no specific “diet” for people with arthritis and other inflammatory concerns. Many of the anti-inflammatory foods include tomatoes, olive oil, green leafy vegetables, almonds, walnuts, fatty fish and fruits. What happens is your immune system becomes activated when your body recognizes anything that is foreign—such as an invading bacteria, pollen or chemicals. This in turn can trigger a process called inflammation which is how our body protects our health. Foods that cause inflammation can include refined carbohydrates (white bread and pastries), fried foods, sugar-sweetened beverages, red meat, processed meat, margarine and lard. Fruits and vegetables such as blueberries, apples and leafy greens that are high in natural antioxidants and polyphenols the protective compounds found in plants are especially useful.

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Should I Sit or Stand?

Author: Jesse Gordon, DC

Your muscles that keep your posture get tired after prolonged periods of sitting or standing. This contributes to the neck and back pain that is rampant in our society. Studies at Stanford university and Cornell university have found that taking a small microbreak every 30 minutes can help you be more productive, have better concentration, reduce incidence of back and neck pain and ultimately help keep you active and healthy. A typical microbreak should include some aspect of the following: standing up and reaching for the floor, rotating your torso back and forth, walking to get a drink of water and/or looking at an object 20 feet away for 20 seconds (the muscles in your eyes can get tired too).

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­­Got Headaches?

Author: Jasmine Piper, DC

Almost everyone will experience a headache at some point in their life, ranging from uncomfortable to unbearable. Fortunately, you do not have to live with this discomfort. Researchers have confirmed that there are over 150 different types of headaches with the most common causes being from stress, medications, diet, lack of sleep and posture. Connected Whole Health can help you. A few of the most effective and natural solutions for dealing with headaches include increasing chiropractic care, water intake, magnesium and B-vitamins. Chronic dehydration is the common cause for tension and migraine headaches. Drinking water has been shown to relieve headache symptoms in 30 minutes to three hours depending on the level of dehydration. Low levels of magnesium have been reported as a risk factor for migraine headaches. Eating plenty of magnesium rich foods like avocados, spinach and nuts can keep headaches under control. B- vitamins can help protect you from headaches by reducing stress and improving your overall mood. Eggs, lean meats and green vegetables are all high in B-vitamins and can be incorporated into your diet. Research shows that chiropractic care is an effective treatment for tension type headaches from the neck  by spinal adjustments, postural exercises and relaxation techniques. Now is time to take back control of your life and begin living headache-free!

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­­Heartburn Got You Up?

Author: Sarah Crockett, DC

“Heartburn” is a feeling of burning discomfort felt in the upper chest and sometimes throat most commonly present when you are lying down. Nighttime heartburn can adversely affect sleep and cause dysfunction in our day-to-day activities. Gastroesophageal reflux disease is when the stomach acid or food flows back up into your throat from your stomach, causing the pain known as “heartburn”. So why does it occur? Most commonly it is due to indigestion of certain foods. Common irritating foods include acidic foods, such as tomatoes or citrus fruits, dairy, fast food, caffeine and chocolate. It’s best to avoid these foods for your last meal, which should be consumed at least two hours before going to bed. Some additional risk factors include smoking, obesity, pregnancy and certain medications. While having heartburn once in a while is common, consistent symptoms could lead to more serious conditions.

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­If The Shoe Fits…Run In It

Author: Glenn Kasin, DC

One of the most overlooked and important decisions for new runner’s is using proper footwear to avoid injury and make your runs more enjoyable. There are so many brands on the market today and it can be quite overwhelming to pick a pair of running shoes. Everyone’s feet are shaped differently, so there is no one shoe that works well for everyone. Choosing the right shoe depends on many different factors; type of runner, running surface, foot shape, foot strike along with many others. To find a proper shoe go to your local specialty running store to have an experienced running footwear specialist help you. Proper sizing includes having roughly a thumbnails space in front of your toes with an upper that wraps around your foot and holds it firmly place.  Try around three different shoes on in the store because after three they all start to blend. Find something that feels good as soon as you slide it on and walk around the store for a few minutes. Look to see if you have any noticeable extra movement in the heel or are they feel too snug. You want a shoe that feels great the second you put it on, because if it does not feel great now, its’ probably not going to feel better after you been running in them!

How Long Does A Running Shoe Last?

Author: Glenn Kasin, DC

Running shoes are designed to last roughly 300-500 miles which equates to approximately four to six months for someone who runs 20 miles per week. To reduce the risk of injuries, make sure you replace your shoes once or twice per year. Your body will thank you for it in the long run. Signs your running shoes are worn out include new aches and pain after a run, the treads are worn out, the shoe feels stiffer or you are getting new blisters. For more information, go check out local experts like Portland running company. Talk to Dave or Paula! They have been in the running game forever and can point you in the right direction.

For Health Care Providers

Defining the Elite: Normative Values for Scat Major Components in Healthy Elite Athletes

Moreau W., Walden T. & Nabhan D. (2017, June). Br J Sports Med 2017, 51 (11) A74; DOI: 10.1136/bjsports-2016-097270.192.

Describe normative baseline SCAT 2 and 3 (SCAT) performance in elite athletes.

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Improved Reporting of Overuse Injuries and Health Problems in Sport: An Update of the Oslo Sport Trauma Research Center Questionnaires

Clarsen B, Bahr R, Myklebust G, Moreau, W. British Journal of Sports Medicine 2020; 54:390-396.

Article presents the updated versions of the questionnaires (OSTRC-O2 and OSTRC-H2), assesses the likely impact of the updates on future data collection and discusses practical issues related to application of the questionnaires.

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Survey of Income Comparison: General Practice and Sports Certified Doctors of Chiropractic

Moreau W., Holder T., & Nabhan D. (2019, May). Journal of Chiropractic Medicine. 18(1), 42–47.

The purpose of this study was to determine whether there are differences in reported gross billings and collections between doctors of chiropractic who have obtained a certificate of additional qualification (CAQ) in sports medicine compared with those without a CAQ in sports medicine.

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Sport Concussion Knowledge and Clinical Practices: A Survey of Doctors of Chiropractic With Sports Certification

Moreau WJ, Nabhan DC, Walden T. J Chiropr Med. 2015 Sep;14(3):169-75. doi: 10.1016/j.jcm.2015.08.003. Epub 2015 Nov 18.

The purpose of this study is to describe the knowledge base and clinical practices regarding concussion by sports-certified doctors of chiropractic.

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Detection of Persisting Concussion Effects on Neuromechanical Responsiveness

Wilkerson GB, Nabhan DC, Prusmack CJ, Moreau WJ. Med Sci Sports Exerc. 2018 Sep;50(9):1750-1756. doi: 10.1249/MSS.0000000000001647. PMID: 29683918.

Assessment of various indices of neuromechanical responsiveness for association with concussion history.

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Routine Screening for Iron Deficiency Is an Important Component of Athlete Care

Chapman R., Sinex J., Wilber R., Kendig A., Moreau W., Nabhan D., & Stray-Gundersen J. (2017, November). Med Sci Sports Exerc. 2017, 49 (11): 2364; DOI: 10.1249/MSS.0000000000001358.

We feel that the authors’ conclusion suggesting that “given the high costs of testing, screening practices at each institution should be thoughtfully selected and routinely reassessed” is not appropriate given the limitations inherent in their analysis, the existing literature supporting iron status monitoring, and the complete cost–benefit ratio for athletes and their universities.

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