How to fall asleep within minutes

If you have trouble sleeping, you should read this exceedingly short article about how to fall asleep in two minutes. It’s used by soldiers in non-ideal sleep conditions. Here’s my summary:

  1. Relax your facial muscles. (There’s a lot. Pay particular attention to the occipitofrontalis.)
  2. Relax your shoulders. (This means that they won’t be anywhere near your ears.)
  3. Relax your arms, one side at a time.
  4. Exhale.
  5. Relax your legs, one side at a time.
  6. Spend 10 seconds thinking about lying on something that rocks back and forth. The rhythmic motion is key. The article proposes a canoe or a hammock.
  7. Alternatively, you can spend 10 seconds thinking “don’t think” repetitively. This is effective because you can process only one thought at a time. (Multitasking is a myth. Some people are able to switch mental tasks more quickly than others, but thinking different thoughts simultaneously does not occur.)

As with anything, this takes practice. Keep at it, and let me know about your experience in the comments below or at your next appointment. What type of imagery do you use to fall asleep? What thoughts do you think?

About metabolism

You guys, this is an excellent read (long, but well worth it). Not only is this woman’s journey into metabolic chamber illuminating, the links to other concepts that research has revealed about metabolism were very educational. (Does anyone else click through some all the links in an article to learn more out of fear of missing out?)

Also, I definitely just signed up to be a research participant. If anyone at the NIH is reading, please choose me.

Penny for your thoughts in the comments below or at your next appointment.

ACP’s new guidelines for the treatment of low back pain

This Harvard article directed me to the American College of Physicians (ACP) article elucidating new guidelines for the treatment of low back pain. Indeed, the Harvard article is a summary of it, and I’d like to provide my own summary for you.

 

Before I continue, I’d like to comment that I share actual research articles here because journalism is a different form of literature than scientific writing. Thus, it takes a different method of reading to process a research article than a news article. It’s a cognitive exercise to switch between different methods of reading, and you get the added benefit of knowing exactly what the scientists say about their research versus what the journalists say that the scientists say. I think anyone, despite what you studied in school, can learn to read and understand scientific research. It just takes practice.

 

The ACP provides three recommendations. They even grade their own recommendations, e.g. strong or weak, in addition to evaluating the quality of evidence that resulted in the recommendation.

 

The first recommendation is for treatment of patients with acute or subacute low back pain. This means that the patient has been experiencing low back pain for less than twelve weeks. The ACP strongly recommends the following treatment:

 

  • superficial heat
  • massage
  • acupuncture
  • spinal manipulation (That’s chiropractic, folks.)

 

I will comment that you can seek out of a combination of these forms of care, depending on the time available to you.

 

The second recommendation pertains to patients who have chronic low back pain. This means the low back pain has been ongoing for twelve or more weeks. The ACP strongly recommends the following:

 

  • exercise
  • multidisciplinary rehabilitation
  • acupuncture
  • mindfulness-based stress reduction (I wrote a series on this.)
  • tai chi
  • yoga
  • motor control exercise
  • progressive relaxation
  • electromyography biofeedback
  • low-level laser therapy
  • operant therapy
  • cognitive behavioral therapy
  • spinal manipulation (chiropractic, again)

 

I will not summarize ACP’s third recommendation because it is pharmacological in nature. As a chiropractor, I do not comment on the materia medica. I will, however, note that the ACP only weakly recommends this third, pharmacological recommendation. I think this gives quite a bit of credence to their first two, non-pharmacological recommendations. In particular, I’m honored that the organization doubly recommended chiropractic for treatment of low back pain.

 

I’d love to hear your thoughts. How would you have summarized ACP’s recommendations? Let me know in the comments, or at your next appointment.

Blue light

Folks, I have a confession.

 

I’ve come to the realization that I spend more time behind a computer (typing up notes, blogging, reading up on the latest chiropractic literature, etc.) than I do delivering chiropractic adjustments. Of course, the chiropractic adjustment is quite time-efficient (in fact, its mechanism requires speed). In addition, behind-the-scenes work in front of a computer screen is necessary for operating a business in this age. So, how do we mitigate screen time’s negative effects on our health?

 

First of all, why is staring at a screen for long periods a big deal? It’s because of blue light, which is elucidated in this Harvard Health article. Blue light has the following actions:

 

  • Increase attention
  • Increase reaction time
  • Improve mood

 

These seem quite beneficial, during waking hours, that is. Imagine that it’s time to wind down for sleep. These benefits may become counterproductive, or even detrimental, when the goal is rest. Light, especially blue light, suppresses melatonin secretion, the hormone responsible to sleep-wake cycles. Without it, our ability to regulate these cycles is impaired. While there’s research that suggests that blue light may have more ominous effects on long-term health, I choose to focus on its known effects on our activities of daily living.

 

I will summarize Harvard’s suggestions for combatting negative effects of blue light.

 

  • If you must use night lights, use ones that emit red light.
  • Avoid screen time two to three hours before sleep. (My commentary: I use Night Shift on my Apple devices, if I have to continue using my electronics.)
  • Shift workers can use blue light-blocking glasses. (My commentary: Energy-efficient lighting has more blue light than the fluorescent bulbs of old. Ask your employer if more energy-efficient lights can be installed to aid alertness while you’re on shift, and wear blue light-blocking glasses after shift.)
  • Seek out light when appropriate, i.e. when you’re awake, whenever that may be.

 

Do you think you’ll be able to implement any of these suggestions? Why or why not? Do you have any insights of your own? Let me know in the comments or at your next appointment.

 

P.S. Curious for more information about blue light or sleep in general? Head over to Tuck Sleep, for more insights on sleep health.

On alcohol

I wrote in the margin of my clinical pathology notes, next to discussion on fat metabolism disorders: resveratrol, 1 glass of red wine per day for women, 2 glasses per day for men. I remember it clearly, my professor remarking that it’s a shame the concentration of resveratrol is not as high in her preferred form of alcohol (tequila) and that it’s patently unfair that men are allowed more glasses of wine per day. There was a healthy dose of laughter in the auditorium after her comments, as she shifted the discussion to further dietary recommendations and lifestyle modifications for high cholesterol and high triglycerides.

 

So, when my father, an immunologist, told me about new research that alcohol confers no benefit to health, I was very surprised. (This article is published by The Lancet, that also published the studies recommending spinal manipulative therapy as a viable and preferred treatment option for low back pain.) Time published an article summarizing the study’s findings, and other experts’ commentary on those results. TL;DR? Worry not, because I will break this debate down for you.

 

Pro-moderate drinking

  1. Moderate drinking offers some cardiovascular benefit, especially for women.
  2. Copious data still exist that concludes that moderate drinking correlates with decreased total mortality and decreased risk of cardiovascular disease.
  3. While tuberculosis may be the leading alcohol-related disease worldwide, it is very rare in the United States. Because The Lancet article researched worldwide morbidity and mortality resulting from alcohol consumption, its results may not be completely applicable to the United States.

 

Anti-moderate drinking

  1. While a drink a day decreases risk for cardiovascular disease, it increases a women’s risk for breast cancer.
  2. Consumption of one alcoholic drink per day afforded a 0.5% increase in risk of developing one of twenty-three alcohol-related health conditions in a year (not a huge increase).
  3. Consumption of two alcoholic drinks per day afforded a 7% increase in risk of developing one of twenty-three alcohol-related health conditions in a year (uh oh).
  4. Consumption of three alcoholic drinks per day afforded a 37% increase in risk of developing one of twenty-three alcohol-related health conditions in a year. (Note the exponential increase in risk, from adding just one drink.)
  5. Alcohol was the seventh leading risk factor for premature death in 2016.

 

I have never recommended to a patient to start drinking in interest of cardiovascular health, and I never will. Indeed, as many experts quoted in the Time article state, the positive research on moderate drinking merely suggest that people who drink moderately may not incur adverse health effects. However, this last statement is called into question by The Lancet article. Is moderate drinking truly harmless? Or, should we steer the conversation towards other dietary recommendations and lifestyle modifications, as my professor did in clinical pathology class?

 

I’d love to hear your thoughts on this topic. Comment below, or we can discuss at your next appointment.

More definitions of subluxation

In 2013, the Council on Chiropractic Practice published the fourth edition of Clinical Practice Guidelines. (Fun fact: This was the year of my matriculation to chiropractic school.) I may be five years behind schedule, but I finally gave it a read, and I must say that I find their definition of subluxation particularly thought-provoking.

 

“Subluxation is a neurological imbalance or distortion in the body associated with adverse and/or structural changes, which may become persistent and progressive. The most frequent site for the chiropractic correction of the subluxation is via the vertebral column.”

 

Note that this definition does not make any reference to joints, but rather to “distortion in the body.” Also notice that structural changes may or may not be observed, and therefore are not required to diagnose subluxation. Contrast this definition with the World Health Organization and Medicare definition. The CCP definition is undoubtedly the broadest.

 

I’ve added the CCP definition to the What is subluxation? page on this website because I find it quite monumental and because the diversity of definitions reminds me of a brief remark by our business and professional foundations professor: that there is no one, agreed-upon definition of subluxation. Indeed, even though there is an original philosophy of chiropractic, there is a multitude of sub-philosophies and interpretations thereof. The diversity also reminds me of a public speaking project assigned by the same business professor, wherein we could either talk about why we are interested in chiropractic or what is our chiropractic philosophy. Though almost all of my classmates chose to talk about their journey to chiropractic school, I spoke about my chiropractic philosophy. I remember the beaming smile on my professor’s face after I finished my speech, even though I know he disagreed on at least some of my points.

 

Thus, to promote diversity of thought, I’d like to invite you to contribute your definition of subluxation and/or chiropractic, which, with your permission, I’d like to showcase on a separate page on this website. Don’t feel as if you have to be a health professional in order to formulate a definition. As you know, I’m curious about innate intelligence, and I think that streams of thought reflect the innate. If you’re brave, do share your thoughts in the comments, or let me know at your next appointment.

Matrix Repatterning

As you know, I was out of the office on Wednesday, meeting with a colleague. I accompanied a patient to visit Dr. Chasse, a physical therapist who performs Matrix Repatterning. We have been doing this for a few months now, as this patient has told me that while chiropractic is beneficial, her experience with this particular form of manual therapy was especially life-changing. Because I had never heard of this therapy, and because I have a propensity to be a lifelong learner, we set up appointments with Dr. Chasse in which I would observe and study, while the patient receives the treatment. It’s a wonderful arrangement, and I look forward to the (more or less) monthly trip to Orange. I’m happy to report that on Wednesday, Dr. Chasse allowed me to participate in delivering portions of the treatment.

 

Matrix Repatterning is very subtle, and therefore challenging to explain in words. Chiropractic is performed through the alignment of bones by the manipulation of joints, in order to positively alter function by achieving optimal structure. Matrix Repatterning is also concerned with alignment, but accomplishes this through moving the fascia. It proposes that the fascia, because its function is the separation of muscle and organ, has therapeutic effects on both. While both the patient and Dr. Chasse hope that I attend the seminar to become certified in this technique, I may not be able to make it this year. It is a future goal, however.

 

Have you ever heard of or experienced Matrix Repatterning? How would you describe it and how was your experience? Let me know in the comments or at your next appointment.

Good Morning America speaks on low back pain

In March, a series of articles published by The Lancet made even more news when Good Morning America featured their findings in a TV segment. GMA summarized the recommendations as follows:

 

  1. Stay active.
  2. Educate yourself about low back pain and pain management. (To help you with this, check out my series on mind-body methods for managing pain.)
  3. Try superficial heat, spinal manipulation therapy (SMT), massage, and acupuncture. FYI, SMT = chiropractic.
  4. If #3 fails, try NSAIDs.

 

The Lancet articles posit that low back pain is the number one cause of disability in the world, but most cases are “nonspecific.” In other words, a specific cause (fracture, inflammatory processes, etc.) cannot be pinpointed. Their detailed recommendations for treatment of nonspecific low back pain are as follows:

 

  1. Avoid opioids.
  2. Decrease use of imaging, medication, and surgery. If all options (see #3) fail, the lowest effective dose of NSAIDs can be used for the shortest possible amount of time.
  3. Manage with self-care, physical and psychological therapies, SMT, and other complementary and alternative medicine.
  4. Because the brain starts to draw a connection between the presence of pain and disability, treatment should focus on reframing beliefs about pain and cultivating new behaviors in response to pain.

 

This is quite a glowing review of chiropractic and its powerful role in treating low back pain. It’s inspiring to see this system of health care make its rounds in the media, with increasing frequency, even though it comes across my desk a few months late (oops!).

 

Questions about low back pain or the article? Ask me in the comments, or at your next appointment.

Attention, and the lack thereof

A few days ago, a classmate from chiropractic school contacted me via Facebook.

 

“Hi Wei Wei, I hope you are doing wonderful! I’ve recently opened my own practice in Algoma, WI. A couple years ago you told me about some natural ADD supplements. I was wondering if you would tell me your recommendations for natural supplements. Thank you!”

 

I remember having this conversation with her when we were students. I shared that I had attention deficit hyperactivity disorder (ADHD) and that as a child and much of early adulthood, I had managed it with medication. A few years prior to our conversation, I was speaking to another friend, who also had this condition and who told me that she had started using caffeine, in the form of coffee, to manage. I tried it, and it worked for me. I was thrilled. I started drinking coffee on the days I didn’t take medication, such as on weekends or on vacation. (To qualify this statement, in adulthood, my psychiatrist had told me that I didn’t need to take the medication every day, but only when I needed it. If you have prescribed medication(s), you’ll have to take it/them as instructed, which may not mirror the instructions I was given.) A few years later, another friend with ADHD (we have quite a community) revealed that she used rhodiola. I gave this a try, and was again elated when it worked for me.

 

And thus, I answered my colleague, “coffee and rhodiola,” but I made a mental note to look into this further. I have, and I would like to share with you what I’ve found. Natural Medicines is a database that “grades” complementary and alternative therapies on their efficacy. In other words, it summarizes the evidence and lets you know what chemicals and what methods have significant, limited, or no clinical research support to treat this, that, or the other condition. I did a search for ADHD and the following compounds and therapy are “possibly effective,” according to the current research evidence:

 

  • Fish oil: may improve attention, cognitive function, and behavior in children with ADHD
  • Massage (!): given for 2-4 weeks, can improve mood and behavior in children with ADHD
  • Zinc: can improve symptoms of hyperactivity, impulsivity, and impaired socialization in some children with ADHD; may NOT improve attention deficit

 

What’s missing? My recommendations, caffeine and rhodiola! In fact, Natural Medicines ranks caffeine as “possibly ineffective” in treatment of ADHD and its sequelae. The database has no commentary on rhodiola (!), in regards to the condition, implying that the research is sparse in this area, if not nonexistent.

 

What does this mean? I think this is a very poignant lesson in how powerful the placebo effect is. No matter our education level, there is so much more to learn. Prior knowledge can and should be modified with modern evidence. And in time, everything can gradually be illuminated.

 

Have you ever experienced a placebo effect? Let me know in the comments, or at your next appointment.