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In the Loop 
Issue 247 - June 3, 2020

Dupuytren's Disease

What is Dupuytren's disease?
Also called Viking’s disease, Dupuytren's disease is when the skin of the palm of your hand at the base of your fingers becomes abnormally thick and can develop into a thick band or hard lump (called the fascia). The fascia is a layer of tissue that helps to anchor and stabilize the skin on the palm side of the hand. Without the fascia, the skin on your palm would be as loose and movable as the skin on the back of your hand. Johns Hopkins Medicine explains that over time, Dupuytren's disease is can lead to one or more fingers to curl (contract) or pull sideways or in toward your palm, known as Dupuytren's contracture. Dr. Charles Eaton, executive director of the Dupuytren Research Group, states, “Dupuytren disease is the most common crippling hand condition that people have never heard of. It affects at least ten million Americans, making their fingers permanently bent, sometimes severely.”

Facts about Dupuytren's disease
  • The name Dupuytren comes from Guillaume Dupuytren (1777-1835) who was Napoleon’s surgeon, but Sir Astley Cooper of England had described the condition 10 years earlier.  
  • The little and ring fingers are the fingers most affected.
  • The disease may only involve the palm and never affect your fingers.
  • It affects both hands in many cases, although in rare cases the feet are affected. WebMD indicates that one hand is usually worse than the other. The Merck Manual reports that the disorder affects both hands in 50% of people. When only one hand is affected, the right hand is affected twice as often as the left.
  • People with Dupuytren disease have a greater risk for developing cardiovascular disease, several types of cancer, and early death. It is not known why this is the case.  
  • Famous people with this condition include former US president Ronald Reagan and UK Prime Minister Margaret Thatcher, entertainers Paul Newman and Frank Sinatra, and retired NFL football quarterback John Elway. It is estimated to affect 3 percent of Americans.
  • The severity of the condition varies from person to person. According to the American Society for Surgery of the Hand, it is difficult to predict how the disease will progress. In many cases, a Dupuytren's disease progresses very slowly over a period of years, and may remain mild enough such that no treatment is needed and it does not cause major problems. While some people only experience small lumps or cords, others will develop severely bent fingers. The disease tends to be more severe if it occurs at an earlier age and can start as early as age 20.
Causes
The exact cause is not known. Some factors that could play a role include:
  • Aging - the usual age of onset is in the middle ages (older than 50)
  • Being male - the disease is more common in men than women by a ratio of 4 to 1. According to the Dupuytren Research Group, one quarter of older adults males have some evidence of Dupuytren disease in their hands. Men have more severe contractures than women
  • Having a Northern European or Scandinavian background i.e., (English, Irish, Scottish, French, and Dutch, Swedish, Norwegian, and Finnish)
  • Having a family history - the strongest risk factor is having a parent or sibling with the condition, with one study finding that 68 percent of people diagnosed with Dupuytren’s contracture had a family member with the condition. Having a severe form of the disease is more likely if both parents have it. It is unclear whether Dupuytren’s disease is caused by one or multiple genes. The Michigan Medicine (University of Michigan) website adds that the condition can still develop in people without a family history
  • Other activities that increase the risk - smoking (perhaps because of microscopic changes within blood vessels caused by smoking), alcohol abuse, diabetes or taking anti-seizure medication for epilepsy
  • A handy injury or hand surgery - may trigger the condition in people who have a genetic predisposition for the condition
  • Cold temperature exposure - according to Carrie Swigart, MD, chief of Yale Medicine Hand & Upper Extremity Surgery Program, the risk is elevated with prolonged (over many, many years) exposure to cold temperatures, particularly in people whose hands are sensitive to cold
  • There is no evidence that it develops from doing a specific job or certain activity
 Symptoms
  • The three stages include: stage one (small nodules or lumps appear in the palm beneath the skin); stage two (condition progresses and involves the underlying tissue of the palm and fingers); and stage three (cord-like bands develop and result in the bending and curling of the fingers toward the palm, also known as contracture)
  • Unable to lay your hand flat palm down on a surface (called the table top test)
  • Nodules in the palm (one or more small and tender lumps with the tenderness usually going away over time). These nodules thicken and contract (tighten) and can cause thick bands of tissue under the skin in the palm of the hand. The lumps can be uncomfortable in some people, but Dupuytren’s disease is not typically painful
  • Pits or grooves in the skin result from the compression by the contracted finger which becomes an issue when they lead to soreness and skin loss if not able to heal properly
  • Hand function can be impaired
Diagnosis
An assessment involving the testing flexibility and feeling in the thumb and fingers, and sometimes an assessment of grip and pinch strength. The nodules and bands on the palm are measured. The degree of curling is measured, along with range of motion of the fingers. This provides a baseline so that the progression of the condition and treatment effectiveness can be measured.

Treatment
There is no cure for Dupuytren’s disease. The goal of treatment is to maintain hand function as well as possible. You don't need treatment unless your symptoms are bothersome. The particular treatment approach depends on your age, overall health, past health, severity, if the condition is expected to get worse, the appropriateness of medications, treatments or therapies and preferences of the person. The goal of treatment is to slow the progression and decrease symptoms. The condition is not dangerous but can affect a person’s quality of life. Hand function can be limited, preventing a person from grabbing large objects or straightening fingers.
  • Mild symptoms - for people experiencing mild symptoms, gentle stretching exercises and massage may be helpful, but HealthLink BC comments that little evidence supports the use of these strategies for reducing symptoms or slowing the progression of the condition. Stretching and massage may help with hand flexibility. Another tip is to avoid tightly curling the hand. Look for utensils and tools with larger handles or use plumbing insulation (Rubazote or foam tubing) around existing utensils and tools to build them up. The Mayo Clinic also suggests using gloves with heavy padding for grasping heavy objects.
  • Medical treatment - can include surgery to remove the thickened tissue. This is the most common intervention for advanced cases when hand function is limited. HealthLInk BC reports that even when surgery is successful, Dupuytren's disease comes back about half the time. Speak to a surgeon about the options, what the benefits and risks are, and what to expect afterwards. Surgery is reserved for those who are experiencing symptoms that interfere with hand function. The Merck Manual adds that surgery is usually needed when the hand cannot be placed flat on a table or when multiple fingers are involved.
  • Steroid shots - used for a painful lump and may stop the condition from worsening. Injections may need to be repeated.
  • Radiation therapy - not commonly used in the US, this involves low energy x-rays used on the nodules. Best results come from using this treatment early in the condition. By softening the nodules, it can help prevent contractions. 
  • Less invasive and newer procedures - these include an enzyme injection into the lump of tissue to break down and dissolve the bands, and needle aponeurotomy where a needle is used to divide the diseased tissue.
Resources
  • Mayo Clinic video (May 2014) 
  • Dupuytren Foundation website
Sources: HealthLink BC website, Johns Hopkins Medicine website, Mayo Clinic website, WebMD website, Living with Dupuytren's website, American Society for Surgery of the Hand website, The Playbook Blog - Hospital for Special Surgery website, Michigan Medicine - University of Michigan website, Yale Medicine website, Dupuytren Foundation website, Merck Manual website
 



How Often Should You Shower? 

The skin is the human body’s largest organ with its own ecosystem of microorganisms, also known collectively as the skin microbiome. It helps keep the skin healthy and in good condition. Conditions such as eczema and atopic dermatitis occur when there is an imbalance in the skin microbiome.
 
Showering/bathing removes dirt and dead skin cells and neutralizes odors, as well as providing an opportunity to relax, smell fresh or revitalize.
 
Frequency of showers
Dr. Robert Shmerling of Harvard Medical School reports that how often a person showers varies by country and is based on societal norms and habits. For example, two-thirds of Americans shower daily, 80 percent of Australians shower daily, while in China people bathe only two times a week.
 
How often should we be showering/bathing? According to Dr. Shmerling, an ideal frequency does not exist, but most experts suggest that several times a week is “plenty” for most people. Factors such as health conditions, where you live, temperature, lifestyle, skin type, and age can affect frequency. Dr. C. Brandon Mitchell, assistant professor in dermatology at George Washington University tells TIME that a daily shower is not necessary and once or twice a week will suffice. He feels that most people are overdoing it when it comes to bathing and showering. Dr. Mitchell states, “Your body is naturally a well-oiled machine. A daily shower isn’t necessary.” Professor Stephen Shumack, president of the Australian College of Dermatologists, agrees with Dr. Mitchell. He advocates that people should shower only when they need to, pointing out that it is only the last 50 or 60 years with the introduction of bathrooms and showers that showering daily was seen by some as a necessity. Saturday night baths were the norm for most of American history. Journalist Donnachadh McCarthy, in an article for the Guardian, believes we are over-bathing and showering because of marketing from shampoo and soap manufacturers. In the case of washing hair, while directions say to lather, rinse, and repeat, a second wash is not necessary. 
 
Factors that determine how often you should shower: 
  • Activity level - it is a good idea to have a shower following a workout to remove oil, skin cells, sweat, bacteria and dirt. If this accumulates, you can end up with acne, bacterial or fungal infections. If you are not able to shower afterwards, try to wipe down with water and a washcloth. If body odour is an issue, showering can help. 
  • Type of skin - people with oily skin - may want to keep to a daily shower, while those with sensitive or very dry skin can shower a couple of times a week. If you work out but you have dry skin, remember to use gentle soap, and moisturize.
  • Age - for older adults, the body makes less oil and too much bathing can result in skin problems, so this age group would want to shower a couple of times a week. Older adults who have drier skin do not need to frequently wash all body parts with soap. “Infants and elderly people have thinner, more sensitive skin, and baths should happen less frequently, with cooler water and they should use the most gentle cleansers made for sensitive skin,” advises dermatologist Jennifer Herrmann, MD. Children need exposure to dirt with its small doses of viruses and infections to build up their immune system. The immune system needs stimulation by normal microorganisms, dirt, and other environmental exposures to create protective antibodies and immune memory. Based on this, some pediatricians and dermatologists are not supportive of a daily bath for children because washing by showers or baths too often may reduce the ability of the immune system to function. The American Academy of Pediatrics recommends three times a week or less for bathing toddlers.  For children between the ages of 6 and 11, the American Academy of Dermatology suggests a bath once or twice a week. 
  • Environment - someone living in a hot humid environment would want a daily shower to remove the buildup of bacteria. During colder seasons, you can shower less because too much showering can result in dry skin. If the skin becomes very dried out, consider showing less and be gentle when cleansing i.e., limit scrubs or exfoliating cleansers, and just use a washcloth or your hand and body soap.
 Negatives of a daily shower
  • The body maintains a balance of good bacteria and other microorganisms as well as a layer of oil. Washing too much can change the nature of the skin microbiome, leading to dry, irritated, itchy, or cracked skin. This in turn increases the risk of bacteria breaching the skin barrier and causing infection. Older adults already have thinner and dryer skin. Showering too often will strip the skin of natural oils and protective organisms, leading to dryness and the potential to exacerbate skins conditions such as eczema, rosacea to psoriasis.  
  • Using antibacterial soaps also kills off normal bacteria. Plain soap is as effective as antibacterial soap for lowering the risk for infectious diseases.
  • More washing means more exposure to chemicals used in products to wash your skin and hair (additives, dyes, perfumes, and oils) and the potential for allergic reactions.
  • Frequent showers waste water and cost money According to an article in the Guardian, the average 10-minute shower uses 60 litres of water.
 Some tips on showering:
  • Use lukewarm (not hot) water
  • Do not shower for more than 10 minutes (ideally 3 to 4 minutes). The longer one stays in the shower, the more of the skin’s oils are removed.  The alliance’s water calculator can help you evaluate your water use
  • If you shower daily, Dr. Mitchell suggests just washing armpits, buttocks, and groin. It is not necessary to lather up the whole body. Soap should be used for armpits, groin, feet, hands and face and water for the rest of the body. Do not use soap on the vagina as this could irritate it and disrupt the balance of natural bacteria
  • Use the smallest amount of cleanser to clean your skin. Use mild soap, gentle cleansers, or shower gels with moisturizers. If you have sensitive skin, choose products that are fragrance free. Avoid harsh soaps that are drying
  • Do not use an exfoliant regularly unless advised by your dermatologist
  • For hair, Dr. Mitchell suggests those with dandruff or other scalp issues to wash a couple times a week
  • WebMD suggests trying to go longer between washes to see how it feels. Older adults don’t need to wash their hair as much because the scalp produces less oil. Most hair professionals agree that you should wash hair at most every two to three days since shampoo strips essential oils (called sebum) from the hair
  • Moisturize within a few minutes after drying off. Adding lotion while the skin is still damp can lock escaping moisture in the skin, according to David Leffell, author of Total Skin: The Definitive Guide to Whole Skin Care For Life and chief of dermatologic surgery at Yale School of Medicine.
  • Is there a best time of day to shower? Canadian microbiologist Jason Tetro tells Global News that the best time to bathe is in the morning but having a quick wash with water only at the end of the day can get rid of dirt. However, an evening shower can be helpful for people with insomnia. For individuals with insomnia, Dr. Janet Kennedy, a clinical psychologist, and sleep expert in New York suggests having a shower 90 minutes before bed. Dr. Gary Goldenberg, a dermatologist in New York and a professor at the Icahn School of Medicine at Mount Sinai, says that for most people, there is no ideal time to shower. While some people think having a shower before bed will keep the bed clean, you sweat during the night and the sweat and bacteria sit on your skin
Sources: Harvard Health Blog website, Health website, Nature Reviews Microbiology journal website, Dove website, Medical News Today website, Business Insider website, Global News website, Well and Good website, Independent website, BBC website, Science Alert website, The Guardian website, WebMD website, Columbia University Go Ask Alice website, TIME website
 

 



Pink Noise

Many people are familiar with using white noise machines to help fall asleep, but may not be as familiar with pink noise. Pink noise is defined as a mix of high and low frequencies that sounds more balanced and natural than white noise. White noise is described as a constant static or “shhhh” sound, whereas pink noise is pleasant, noticed by the brain but subtle enough not to disturb sleep, according to Dr. Phyllis Zee, a professor of neurology at Northwestern University School of Medicine. Examples of pink noise can be found in nature e.g., lapping waves, rustling leaves or a steady rainfall.

The Live Science website explains that pink noise, like white noise, contains all frequencies heard by humans (20 hertz to 20,000 hertz). White noise has equal power per hertz through all frequencies, while the power per hertz for pink noise decreases as the frequency increases. The Berkeley Wellness Letter gives the description that pink noise is “white noise with the bass turned up.” Other colours of noises include blue and brown noise. The different colours of noise refer to the differences in the distribution of frequencies audible by humans. The colours of noise are similar to light – white noise is a combination of all other sounds waves (violet, blue, white, pink and brown/red) just as white light is made up of all the colours of the rainbow.

Research on pink noise 
For people having difficulty falling asleep, white noise is often recommended and this approach is backed by “considerable evidence,” according to the Berkeley Wellness Letter, while much less research has focused on pink noise. Some studies have found that pink noise can improve sleep, deep sleep, and memory. Researchers are interested in the pink noise because the frequency of pink noise sound waves is similar to brain waves during stage 3 slow wave sleep, the sleep stage critical for memory consolidation. People with mild cognitive impairment can have sleep disturbances, the most significant one being less time in the deepest stage of sleep.

Pink noise research highlights:
  • A study from China in 2012 found that pink noise improved deep sleep at night and an even larger improvement for daytime napping, when compared to no noise exposure. Exposure to pink noise also resulted in a sleep that was reported as better than average. 
  • A 2013 study synced pink noise with participants’ brain waves during the deep sleep stage. The researchers found that people slept longer and had improved word pair recall when exposed to pink noise as compared with no noise.  
  • A 2017 Northwestern University study published in the journal Frontiers in Human Neuroscience involved older adults, as previous research had looked at younger adults. In the study, 13 participants 60 years of age and older had one night with sound stimulation (pink noise) and one night with a sham simulation (same protocol without the pink noise during sleep). The sound stimulation was delivered at the precise moment of deep sleep (brain wave or oscillation slows to about one per second). On both occasions, participants took a memory test before sleeping and the next morning. Memory improvement was three times greater after the pink-noise simulation versus the sham stimulation. The degree of slow wave sleep enhancement was related to the degree of memory improvement, suggesting slow wave sleep remains important for memory, even in old age. The authors concluded that pink noise was an innovative, simple and safe non-medication approach that may help improve brain health for older adult populations. Another study from the same group at Northwestern was done in 2019. Published in the Annals of Clinical and Translational Neurology, the study involved only 9 older adults (average age of 72) diagnosed with mild cognitive impairment. The same protocol was used. The researchers found a significant, but not statistically significant, positive relationship between the enhancements of deep sleep by sound and memory i.e., the greater the enhancement of deep sleep, the better the memory response, suggesting that a way to address dementia may be to improve sleep. Future studies require larger sample sizes tested over multiple nights and longer term study periods to determine how long effects may last. 
The future of research
More research is needed to confirm if these results can be replicated in “real world settings” and not only in sleep labs with controlled circumstances and sounds played to synchronize with the deep sleep stage. Future research can assess the comparative effectiveness of white and pink noise.

Using colour noises for sleep
Sleep medicine expert Dr. Michelle Drerup, PsyD, of the Cleveland Clinic suggests that if you struggle to get a restful sleep, “you can experiment with different types of sounds and volume.” Apps provide a variety of pink, white and brown noises, or you can stream noises from different websites. You can also purchase sound machines that play white, pink or other colours of noise. Dr. Drerup notes that both white and pink noise may help, but the exact technology used in research is not widely available and is not the same as found in an app, web or from a machine. She adds that pink noise is generally safe and a good idea for anyone of any age who wants to try. Individuals who may find pink noise frustrating include people with hearing loss or people with sensitivity to sounds, but they can still try and gauge their experience. Another important tip is that pink noise alone is not the answer to bad sleep hygiene - you still need to make sure you get an adequate number of hours of sleep, follow a regular sleep schedule, and watch your caffeine intake.

Sources: TIME website, LiveScience website, Berkeley Wellness Letter website, Marketwatch website, Cleveland Clinic Health Essentials website, Northwestern Medicine press release, Healthline website  
 



Sugary Drinks and Cardiovascular Disease Risk

Unfortunately, consumption of sugary drinks is on the rise. The Heart and Stroke organization points out that between 2004 and 2015, the sales of some sugary drinks increased significantly in Canada e.g., energy drinks by 638 percent, sweetened coffees by 579 percent, flavoured water by 579 percent, sweetened teas by 36 percent, flavoured milks by 21 percent and sports drinks by 4 percent. What impact does this increase in sugary drinks have on our health? A recent study published in the Journal of the American Heart Association used data from the California Teacher’s Study, a cohort (group of individuals who share a characteristic) of female teachers and administrators followed since 1995. Researchers looked at the relationship between the consumption of sugary drinks and cardiovascular disease. The Harvard TH Chan School of Public Health states that when it comes to ranking beverages best for our health, “sugary drinks fall at the bottom of the list because they provide so many calories and virtually no other nutrients.”  Previous studies of the link between sugary drinks and cardiovascular disease risk had found a positive relationship, but many of the studies had a short time frame. A strength of this study was that data was collected over a 20 year period.

The study included 106,000 women with an average age of 52. None of the women had heart disease, stroke or diabetes at the beginning of the study. The data was self-reported and included how much and what they drank. Sugary beverages included soft drinks, sweetened bottled waters or teas and sugar-added fruits drinks (not 100 percent fruit juice). Over the study period of 20 years, there were 8,946 cases of cardiovascular disease, most of which were strokes. Study highlights include:  
  • Women who drank the most sugary beverages were younger, more likely to be smoking, obese and less likely to eat healthy foods
  • Drinking one or more sugary beverages daily was associated with a 26 percent higher likelihood of needing a revascularization procedure (e.g., an angioplasty), and a 21 percent higher likelihood of having a stroke compared to women who rarely or did not drink sugary beverages
  • For sugar-added fruit drink consumption - drinking one or more daily was associated with a 42 percent higher likelihood of developing cardiovascular disease compared to those who rarely or never drank sugary beverages
  • For soft drink consumption - drinking soft drinks daily was associated with a 23 percent greater likelihood of cardiovascular disease overall, compared to those who rarely or never drank sugary beverages
The researchers concluded that if the findings are repeated in future studies, working to reduce sugary drink consumption may be a way to reduce the risk of cardiovascular disease in women.

It is important to note that the results show an association and not causation, i.e., drinking sugary beverages causes cardiovascular disease. The authors speculate, however, that the associations could come from increases in glucose levels and insulin concentrations in the blood which in turn increase appetite and obesity. Obesity is one of the main risk factors for cardiovascular disease. Also, having excess sugar in the blood is associated with a number of states that are linked to the narrowing of the arteries e.g., insulin resistance, oxidative stress and inflammation, unhealthy cholesterol levels and type 2 diabetes.

Sugar consumption
The American Heart Association comments that sugar should be limited to a maximum of 100 calories or 25 grams of sugar per day for most women. One can of soda has 34 grams of sugar, already exceeding the daily maximum while providing no vitamins or minerals. Many Canadians exceed their recommended daily intake of free sugars through sugar-sweetened beverage consumption alone. The Heart and Stroke Foundation of Canada reports that sugary drinks are the single largest contributor of sugar in the Canadian diet.
When choosing a beverage, read the nutrition label to see if it contains additives such as sucrose, maltose and syrups. Also, be aware that the amounts of these additives are for one serving size of the beverage, which may be much less than the entire bottle. The Unlockfood website advises people to limit or avoid juices, beverages like pop and energy drinks since they are high in sugar and can lead to weight gain.

While diet sodas may be seen as a sugar-free alternative, they contain artificial sweeteners. The Harvard TH Chan School of Public Health comments that the health effects of low-calorie sweeteners (LCS) are “inconclusive” because of mixed research findings, but LCS beverages can be used to transition from sugary drinks to water. The Canada Food Guide and the American Heart Association recommend water as the beverage of choice, as it contains no sugar, no artificial sweeteners, no calories and no cost to take from the tap.

Sugary drinks and children
The Canadian Paediatric Society, concerned about rising obesity rates in children, cites that excessive sugar-sweetened beverage consumption has been strongly associated with not only weight gain, but also chronic disease development and cavities. Currently one-third of Canadian children are overweight or obese, which is setting them up for chronic conditions later in life. The Society feels so strongly about this issue that on January 30, 2020 they published a position statement calling for increasing taxes on sugar-sweetened beverages i.e., an excise tax of at least 20 percent. Other Canadian organizations support this tax, including Dietitians of Canada, the Childhood Obesity Foundation, the Heart and Stroke Foundation of Canada, and Diabetes Canada.

Sources: Harvard TH Chan School of Public Health website, Heart and Stroke website, Canadian Paediatric Society website, CNN website, American Heart Association  Newsroom website, Science Daily website
 
 


Paleo Diet and Impact on Cardiovascular Disease Risk Factors 

Cardiovascular disease accounts for 30 percent of deaths worldwide. One area of research that is currently limited is the effect of diet on cardiovascular disease (CVD) risk factors. CVD can refer to several conditions including heart disease, heart attack, stroke, heart failure, arrhythmia, and heart valve problems. The Paleolithic or Paleo diet, also called the Caveman or Stone Age diet, is a popular high protein and low carbohydrate diet based on the eating patterns of hunter-gatherers. Proponents claim that this eating is healthier for our bodies by reducing the risk of heart disease, type 2 diabetes and chronic degenerative diseases. The diet focuses on nuts (not including peanuts), lean meat, fruits, fish and vegetables, while avoiding foods that come from agriculture, such as dairy, grains, and legumes (beans, peas and lentils), as well as added sugar and salt and processed foods. Because the evidence of Paleo diet’s impact on CVD risk factors is inconsistent, more research is needed.

A systematic review and meta-analysis of eight randomized controlled trials was done by researchers in Iran. Data was gathered from 266 participants with an average age of 53 years old. Participants had varying health status, ranging from healthy to having chronic condition or conditions. Outcome measures included weight changes, waist circumference, body mass index, body fat percentage, blood pressure, concentrations of fat in the blood, and a marker for inflammation (C-reactive protein or CRP). Comparisons were made between people following a Paleo diet and a control group who followed their regular diet or a specific diet. A control group is defined as a group of subjects closely resembling the group being studied who are acting as a comparison. Study highlights:
  • Paleo diet was effective at reducing weight, BMI, blood pressure (both systolic and diastolic), LDL “bad” cholesterol, total cholesterol, triglycerides and CRP, and increasing HDL “good” cholesterol. The researchers note, however, that when an analysis was done after removing certain studies, the effects of blood pressure, LDL cholesterol, HDL cholesterol, total cholesterol, triglycerides and CRP disappeared.  Results, therefore, need to be interpreted “with caution.”
  • More well-designed research is needed i.e., high-quality and longer-term studies.  
  • Limitations of this systematic review and meta-analysis included a small number of participants at 266, the varying levels of participants’ health, variation in how long participants had followed a Paleo diet, and the differences in the type of comparison diet.  
The Dietitians of Canada Unlockfood website acknowledges that the diet can help you lose weight in the short-term because foods are eliminated or restricted. They point out, however, that the diet is difficult to maintain in the long-term because you must avoid major food categories, and the diet may also increase the risk of deficiencies such as calcium, vitamin D, and B vitamins. Another negative noted by the UK Patient website is that the consumption of whole grains to reduce the risk of heart disease, stroke, type 2 diabetes and some cancers is supported by evidence, and the Paleo diet excludes whole grains. The organization agrees with other groups that there is not enough research yet to say if a Paleolithic diet is a healthy option. The Harvard TH Chan School of Public Health cites the issue that several studies have shown that a high intake of red meat is linked to a higher risk of death, cardiovascular disease, and diabetes. It also calls for more high-quality studies longer than one year in duration.

The bottom line: although the meta-analysis showed that a Paleo Diet has favourable effects on cardiovascular disease risk factors, the evidence is not conclusive and more research is needed.   

Sources: Unlockfood website, Patient website, Harvard TH Chan School of Public Health website, McMaster Optimal Aging Portal website, American Heart Association website  

 

 

 

Snacking During the Pandemic 

Food often becomes a comfort when we are feeling anxious, stressed or bored. Research has found that in crisis situations, eating behaviour is one of the first things to change. An article on the Bloomberg website is entitled “Americans Drop Kale and Quinoa to Lock Down with Chips and Oreos.” Snack food sales have increased in the US, and the same could be said in Canada. A Global News article reported that after the essentials of toilet paper, canned goods and flour, the next food items in high demand are snacks. In the US, popcorn sales increased by almost 48 percent, pretzel sales increased by 47 percent while potato chip sales increased by 30 percent compared to the same time last year. Other food items experiencing a surge in demand include cookies, crackers, soup, macaroni and cheese, breakfast food, potatoes and canned, dried and fresh meat.

You may have seen terms such as “COVID-20” meaning gaining 20 pounds during the pandemic, or the “quarantine 15” for 15 pounds of weight gain. Stress leads to an increase in cortisol levels which in turn increase our appetite. Less healthy foods activate the reward centres in the brain and make us feel good (high sugar foods generate dopamine, the neurotransmitter that plays a role in motivation and reward, and high calorie/high sugar foods boost our energy levels), thus explaining why we do not crave a salad in times of stress. For some, eating is the only coping mechanism. Chronic stress signals to the body that food may be scarce, so we tend to graze, snack and overeat. Stress and emotional eating are normal. We know that food choices are important. Processed foods high in carbohydrates can spike and crash our blood sugar levels, impacting our mood and increasing our anxiety. To make matters worse, we are staying at home where food is much more accessible. Snacking can become a problem if it is done too often and with the wrong food choices. Now, more than ever, it is important to keep up your immune system by eating a healthful diet. Stress suppresses the immune system. What we can control during the pandemic is our food choices. The following is a list of tips on how to stop stress eating/snacking during COVID-19
  • Stick to a normal eating schedule - have breakfast at the same time each day and plan a lunch and afternoon or morning snack. This trains your body to be hungry at regular times. Do not skip meals because you may binge later in the day.
  • Keep a food journal - if you are struggling, consider keeping a food journal with a schedule. Keeping track of what and when you eat helps you to avoid mindless snacking. As well, keeping track is an effective weight management strategy.
  • Plan your snacks ahead of time - Caroline Kamau, an organizational psychologist at the University of London emphasizes the importance of a schedule for well-being. Plan snacks the same way you plan meals. Make healthy snacks accessible by prepping them and having them in sight e.g., a bowl of fruit, cut up vegetables. If you prepared a snack for work, keep up this habit. Make the healthy choice the easy choice.
  • Portion control - instead of eating right out of the bag, take out your portion and put the bag away. Purchase lots of fruits and vegetables so they are readily available. UC Davis Health suggests choosing high protein snacks with healthy fats e.g., add a scoop of peanut butter to your fruit, serve crackers with cheese or meat, or dip veggies in hummus or Greek yogurt dip. Nuts and seeds are good examples of protein-dense snacks. Elizabeth Kitchin, PhD, an assistant professor with the University of Alabama at Birmingham’s Department of Nutrition Sciences, explains that adding the protein helps fill you up. For example, carrots on their own are not filling, but combining carrots with hummus is filling. If you have a craving for sweetness, choose healthier options such as dark chocolate, mini cookies, or go for fruit as your sweet dessert.   
  • Think about the environment - decrease the accessibility of less than healthy snacks by moving them to a place that requires a lot of effort to get to e.g., the garage. Another strategy is to avoid buying unhealthy snacks altogether. Some people fare better if they just do not have unhealthy snacks in the house, hence the saying, “Remember, if it’s in your house, it’s in your mouth.” Restriction, however, can be counterproductive. It will depend on what you find works best for you. If you are working from home, avoid eating in your office or in the bedroom for late night snacks. Reserve the kitchen for snacking.
  • Slow down and be mindful - the Canada Food Guide reminds us to eat mindfully i.e., take small portions, eat slowly, eat when you are hungry and not because your feel tired, bored or stressed, and eat without distraction. According to Amy Bondar, a nutritional therapist and certified eating psychology coach in Calgary, “see, taste, smell and hear each bit of food” or “experience the experience of eating.” If you check in with yourself and find you are snacking when you are not hungry, think about what else could be going on. Are you anxious, sad, mad, or just bored? Replace eating with another activity e.g., walking, reading a book, meditating, or call a friend. Exercise is a great alternative to snacking when you feel stress or anxiety. If you are bored, find a new hobby or activity. The internet has free online courses and workshops.  
  • Watch your alcohol consumption - recent data indicates that Canadians are purchasing more alcohol during the pandemic. A Nanos poll published its results on April 15 finding that 25 percent of Canadians (aged 35 to 54) and 21 percent of Canadians (aged 18 to 34) say they have increased the amount of alcohol they drink while spending more time at home during the COVID-19 pandemic. Only 10 percent of adults older than 54 say they have been drinking more alcohol since they began practicing social distancing and self-isolation. The main reasons for the increase among those who report drinking more are a lack of regular schedule (51 percent), boredom (49 percent) and stress (44 percent). Alcohol in excess has many negative health effects including excess calories. One way to counter this is to drink sparkling water or add seltzer to your alcohol. For guidance on drinking alcohol, you can download the brochure Canada’s Low-Risk Alcohol Drinking Guidelines.
  • Seek out social contact - one of the key actions to take to cope with stress is finding social connection.  Skype, Zoom, or FaceTime with family and friends. Share recipes or even cook virtually together.
  • Get adequate sleep (quality and quantity) - this can be challenging when you are feeling stressed. The connection to sleep and snacking is that poor sleep may contribute to increased cortisol levels, increased levels of the hormone that triggers hunger and decreased levels of the hormone that leads to feeling full, leading to over eating. 
  • Drink more water - this can decrease feelings of hunger
  • Practice self-compassion - it is okay to have a treat or a “party food” once and a while. It becomes an issue if you have excessive amounts. As Registered Dietitian Lalitha Taylor explains to Global News, “Feeling guilt, shame or anger towards yourself may perpetuate emotional eating. Instead, show yourself love and kindness.” Registered Dietitian, Rachel Iverson, in an interview with the KXNet website, believes that at times like this, people “don’t need to be one hundred percent healthy.” She suggests that we give ourselves permission to have some of the food we normally do not have.
  • Seek help - if you have disordered eating, this is an especially trying time. Seek professional help if you need it.  
Resources
  • Canada Food Guide website video on healthy snacks and tips
  • Unlockfood website video Quick and Easy Snack Ideas 
  • UC Davis Health website Simple and healthy snack ideas during COVID-19 quarantine 
  • HealthLink BC Dietitian Services website - phone 8-1-1 to speak with a registered dietitian
  • US Centers for Disease Control and Prevention food journal 
Sources: Canadian Centre on Substance Abuse and Addiction website, Livestrong website, UC Davis Health website, Harvard Health Blog website, Global News website, Global News website, BBC website, MSN website, University of Alabama at Birmingham News website, Everyday Health website, Today website, Canada Food Guide website, CTV News website, The Star website, Bloomberg website, KXNet website
 

 
 
BC's Restart Plan

When the COVID-19 pandemic hit BC, the provincial government asked British Columbians to do their part and stay home and help flatten the curve. With each day, the rate of growth in COVID-19 cases has steadily declined and more than 1,350 people have recovered. Did you know that BC has the lowest mortality of any jurisdiction in Canada, the United States and western Europe with more than 5 million people? 

BC’s Restart Plan lays out a series of steps that the provincial government will take together to protect people and ensure that our province can come back from COVID-19 stronger than before. BC's Restart Plan website provides information on what the "new normal" means for you along with information on available provincial supports. The website features a COVID-19 "digital assistant" who can help you find information. The BC Restart document can be downloaded.  

Dr. Bonnie Henry, Provincial Health Officer 

Please send your ideas and suggestions to theloop@uvic.ca.


Self-Management BC is supported and funded through a partnership with the Patients as Partners Initiative within the BC Ministry of Health.
 
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