Health & Fitness

Currently, the only FDA approved biomarker for ICI melanoma treatment is the tumor mutation burden assay, but the mechanisms linking it to ICI remain unclear. However, new research now provides evidence of novel, reliable biomarkers that predict therapy response using advanced computer technology.

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Am I over the hill? This question comes up regularly among workers over 50. A common prejudice is that older people's efficiency and stress-tolerance are continuously decreasing. But mental performance, self-confidence, psychological resilience and well-being can be improved in the 50-plus generation.

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Honey has been valued for its antimicrobial properties for thousands of years. Made from flower nectar, honey contains sugars, amino acids, phenolics and other compounds that combine to exert a wealth of medicinal properties. When it comes to broad-spectrum antimicrobial activity, however, manuka honey deserves top billing.

Produced from certain manuka plants — also known as tea trees — of the Leptospermum species native to New Zealand and Australia,¹ manuka is used for a variety of medical-grade applications, including honey gel, honey for wound dressings and nebulized honey used to treat asthma.²

The nectar from manuka flowers contains dihydroxyacetone, a precursor to methylglyoxal (MGO), an antimicrobial compound not found in most other honey. The presence of MGO is credited for much of manuka honey’s medicinal prowess, which includes the ability to combat complex antibiotic-resistant respiratory infections.³

Manuka Honey Treats Aggressive Lung Infection

Mycobacterium abscessus is a type of mycobacteria that often cause aggressive lung infections in people with cystic fibrosis, bronchiectasis and other preexisting lung conditions. Conventional treatment often involves more than 12 months of antimicrobial chemotherapy, which still doesn’t get rid of the infection in many cases.⁴

According to researchers with the U.K.’s Aston University, patients often stop taking the drugs due to severe side effects, including nausea, vomiting, liver damage, low platelet levels and low white blood cell count. Even among those who do stick with the intensive drug treatment, it’s only successful 30% to 50% of the time.⁵

“New and novel strategies are urgently required to combat these infections,” the researchers wrote. “One such strategy thus far overlooked for mycobacteria is manuka honey.”⁶

The Aston University team conducted a study using samples of Mycobacterium abscessus from 16 infected patients with cystic fibrosis to determine the effectiveness of manuka honey against it.⁷ All four varieties of manuka honey tested showed antimicrobial activity against the bacteria, including 16 drug-resistant clinical isolates.⁸

The researchers used a nebulizer and lung model to test the results of manuka honey with the drug amikacin, which is used to treat bacterial infections. A typical dosage of amikacin used in the treatment of Mycobacterium abscessus is 16 micrograms per milliliter.

When combined with manuka honey, however, not only was the duo effective but far less amikacin — just 2 micrograms per milliliter — was needed.⁹ According to study author Jonathan Cox, a senior lecturer in microbiology at Aston University:¹⁰

"By combining a totally natural ingredient such as manuka honey with amikacin, one of the most important yet toxic drugs used for treating Mycobacterium abscessus, we have found a way to potentially kill off these bacteria with eight times less drug than before. This has the potential to significantly reduce amikacin-associated hearing loss and greatly improve the quality of life of so many patients — particularly those with cystic fibrosis.

I am delighted with the outcome of this research because it paves the way for future experiments and we hope that with funding we can move towards clinical trials that could result in a change in strategy for the treatment of this debilitating infection."

Honey Works for Upper Respiratory Tract Infections

Upper respiratory tract infections (URTIs), otherwise known as the common cold, are a common reason why people are prescribed antibiotics unnecessarily, exacerbating antimicrobial resistance.¹¹ Honey makes a suitable option for symptom relief, working better than usual care, according to a systematic review and meta-analysis published in BMJ Evidence-Based Medicine.¹²

After reviewing 1,345 records from 14 studies, the researchers found that, compared with usual care, honey improved cough frequency and cough severity, as well as the combined symptom score. They noted:

“Honey was superior to usual care for the improvement of symptoms of upper respiratory tract infections. It provides a widely available and cheap alternative to antibiotics. Honey could help efforts to slow the spread of antimicrobial resistance, but further high quality, placebo controlled trials are needed.”

The results support previous studies with similar results. In one Italian study involving 134 children with a nonspecific cough, researchers compared the use of multiple doses of honey to the use of dextromethorphan and levodropropizine, two commonly prescribed over-the-counter cough medications in Italy.¹³

The children were given either a mixture of milk and wildflower honey or a dose of one of the medications, based on the group they were assigned to. The researchers found that the milk and honey mixture was at least as effective as the medications. Similar results were found by a study published in the Cochrane Database of Systematic Reviews that looked into honey for the treatment of acute cough in children. It concluded:¹⁴

“Honey probably relieves cough symptoms to a greater extent than no treatment, diphenhydramine, and placebo, but may make little or no difference compared to dextromethorphan. Honey probably reduces cough duration better than placebo and salbutamol.”

How Do Manuka Honey’s Antibacterial Properties Work?

Different types of manuka honey have varying levels of antibacterial potency, which is related to its Unique Manuka Factor (UMF) rating. UMF is correlated to a particular honey’s content of MGO and total phenols. While some types of manuka honey may be more potent than others, no bacterial resistance to honey has been identified to date, possibly because it’s made up of such a complex mixture of MGO and other substances.¹⁵

Honey may also affect bacterial cell morphology and growth by altering its shape and size, according to an overview published in AIMS Microbiology.¹⁶ It also noted that manuka honey can stimulate macrophages to release mediators such as interleukin 6 and tumor necrosis factor α, which are necessary for reducing microbial infections and promoting tissue healing.¹⁷ Other active compounds in honey that may affect its antibacterial activity include:¹⁸

• Hydrogen peroxide (especially in non-manuka honey)
• Acidic pH level
• Hyper-osmolality effect
• Bee defensin-1, an antimicrobial bee-derived peptide¹⁹

“Manuka honey can be safely used as an alternative natural antibiotic,” the researchers noted, adding, “Finally, the conclusion is that honey is a natural and safe antibiotic, since no literature published has reported bacterial resistance for honey, which is attributed to the complexity of honey components working solely or in a synergistic manner with other components.”²⁰

Manuka Honey’s Wound-Healing Powers

Manuka honey has been widely explored for wound healing, in part due to its ability to wipe out bacteria living in biofilms, which often adhere to wound surfaces. Manuka honey is capable not only of disrupting existing biofilms, which can cause persistent infections, but also of preventing their formation.²¹

In addition to inhibiting the growth of all bacterial pathogens it’s been tested against, researchers noted, “Treatment with manuka honey results in a unique signature of differential gene expression with down-regulation of stress response and virulence-related genes.”²² When combined with antibiotics, it also works synergistically or enhances their effects, while preventing the development of resistance and even making resistant bacterial strains more susceptible to treatment.²³

In the case of wound healing, honey has been used for this purpose for thousands of years, and in the U.S. the use of medical grade honey for wound care is approved by the Food and Drug Administration.²⁴ Manuka honey has immunomodulatory properties that enhance wound healing and tissue regeneration.²⁵

Even in cases of chronic, nonhealing wounds, such as diabetic leg ulcers, manuka honey dressings have been found to mostly heal the sores within three months. “The antibacterial component of manuka honey is a small water-soluble molecule that diffuses easily, which explains why manuka honey has also exhibited efficacy against bacteria contained in biofilms,” according to a review published in Wounds.²⁶ The researchers explained:²⁷

“The manuka honey used in wound-care products can withstand dilution with substantial amounts of wound exudate and still maintain enough activity to inhibit the growth of bacteria. There is good evidence for honey also having bioactivities that stimulate the immune response (thus promoting the growth of tissues for wound repair), suppress inflammation, and bring about rapid autolytic debridement.”

Choosing High-Quality Honey

Medical grade honey is now widely available and used by some hospitals for wound healing and wound infection control. Medicinal honey products are also available over the counter for home use. However, keep in mind that the health benefits of honey do not extend to the processed honey you find on grocery store shelves, which is often little more than fructose syrup.

Contamination with chemicals, including glyphosate, most commonly known as the active ingredient in Roundup herbicide, is also a concern. In their National Chemical Residues Program Report released January 2020, it’s noted that 300 raw extracted archival and retail packed honey samples were tested for glyphosate residues during 2017/2018, while another 60 retail packed Manuka honey samples were tested for the herbicide during 2018/2019.²⁸

Out of the 300 samples, 22.3% contained glyphosate residues above the laboratory limit of reporting, with clover or pasture floral types testing positive more often than other varieties. About 1.7% of the unblended or unprocessed (raw extracted) honey samples contained glyphosate residues at levels above the regulatory limit.

Among the 2018/2019 retail samples tested, 18.3% contained glyphosate residues, though they were below the regulatory maximum. Beekeepers are, unfortunately, at the mercy of their neighbors’ glyphosate usage, as they can’t control which plants their bees choose to visit. Some beekeepers, however, are carefully managing where they put their hives to minimize pesticide exposure and keep track of when spraying occurs to help reduce exposures.²⁹

If you see the Detox Project’s glyphosate-residue-free certification on Manuka honey, it means the product has no glyphosate residues down to government-recognized limits of detection (usually 0.01 parts per million), and lower levels than the default government Maximum Residue Limits in the European Union and Japan.³⁰

For manuka honey, also keep an eye out on the UMF rating, which can range from UMF5+ to UMF30+. The higher the rating, the more MGO and other beneficial compounds it contains, so for medicinal purposes, generally the higher the UMF, the better.

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A few years ago, the term "gluten free" was mostly associated with wheat allergy and celiac disease. Those afflicted with either condition who adopted a gluten-free diet often reported a resurgence of health and well-being.

Today, gluten-free eating continues to attract attention, and there are likely more wheat-tolerant people eating gluten-free food than those who medically need it. Eating trends aside, here's what you need to know about gluten.

What Is Gluten?

Gluten is a protein found in wheat and cereal grains that is made up of glutenin and gliadin molecules. In the presence of water, these substances form an elastic bond that gives bread and other baked goods a springy, stretchy and spongy consistency. Because gluten gives dough elasticity, comparable gluten-free items are often dense and tend to crumble easily.

Gluten is found not only in wheat, but also other grains like barley, oats, rye and spelt. Beyond the whole grains known to be glutinous, gluten can hide in processed foods under a variety of names, including, but not limited to:¹

• Hydrolyzed vegetable protein (HVP)
• Malts
• Natural flavoring
• Starches
• Texturized vegetable protein (TVP)

While many foods such as whole fruits and vegetables are naturally gluten free, as are most dairy and meat products, grocery stores are full of gluten-containing products. Many of them fall into the category of ultraprocessed foods. Some of the most common gluten-laced foods include:

Beer	Cookies	Processed broth
Bouillon	Crackers and other snack foods	Sausages and hot dogs
Bread (white and wheat)	Lunch meat	Seasoning mixes
Cereal	Pasta	Soy sauce

Obviously, wheat-containing foods like wheat bran, wheat flour, wheat germ and wheat starch also contain gluten. Even though many think otherwise, white bread is also a source of wheat because it is made from wheat flour after the bran and germ are removed. Furthermore, because wheat is often used as a thickening agent, gluten is commonly found in canned soups and bottled sauces, as well as salad dressings.

How Gluten Can Negatively Impact Your Health

Gluten is known for its tendency to impede proper nutrient breakdown and absorption of foods, regardless of whether they do or do not contain gluten. Proper digestion can be impeded in the presence of gluten because in excess amounts it forms a glued-together constipating lump in your gut.

Some people react negatively to even small amounts of gluten because their body identifies it as a toxin, which causes their immune cells to overreact and attack it. In this scenario, the continued consumption of gluten will create inflammation and damage to the lining of the small intestine that may trigger more serious health issues over time, particularly if you have celiac disease.

Left unchecked, excessive gluten consumption and the inflammation that results may predispose you to malabsorption, nutrient deficiencies, osteoporosis and neurological and psychological conditions, as well as its potentially negative effects on your joints, liver, nervous system, skin and more.²

Beyond this, the Celiac Disease Foundation asserts undiagnosed celiac disease may contribute to the development of "autoimmune disorders like Type 1 diabetes and multiple sclerosis (MS), dermatitis herpetiformis (an itchy skin rash), anemia, osteoporosis, infertility and miscarriage … epilepsy and migraines, short stature and intestinal cancers."³

Signs of Gluten Intolerance

Signs of gluten intolerance include bloating, belly pain, diarrhea, fatigue and a general feeling of being unwell. Beyond this, other noticeable warning signs of your body's inability to handle gluten may include:

• Anxiety
• Confusion
• Headache
• Joint or muscle pain
• Nausea

While just 1 in 100 people worldwide have celiac disease, countless others may simply be undiagnosed, including an estimated 2.5 million Americans.⁴ Lack of a proper diagnosis may put you at risk of long-term health complications, some of which were mentioned above.

If you think you might have celiac disease or gluten sensitivity, it's best to talk to your health practitioner before you go gluten free. Once you have avoided gluten for a while, it becomes difficult to establish a conclusive relationship between gluten and your health problems.

You have a better chance for an accurate diagnosis of gluten-related illness if you are actively eating gluten at the time of the testing. Blood tests are usually the first step toward confirming celiac disease.⁵ If the blood tests and your symptoms indicate celiac, your doctor will likely suggest a biopsy of the lining of your small intestine to confirm the diagnosis.

If you suspect your body may not be able to tolerate gluten, pay attention to how you feel immediately after eating it. Feeling poorly after eating glutinous food may be a signal your body cannot handle gluten. For best results, you may want to keep a food diary, and you will definitely want to discuss your symptoms with your health practitioner.

Most Packaged Gluten-Free Food Is Glorified Junk Food

While the availability of gluten-free food options can be perceived as a help for those affected by a wheat allergy or celiac disease, I advise you approach a gluten-free diet and lifestyle cautiously. The reason: Most processed, packaged gluten-free food is glorified junk food.

I say that because packaged gluten-free foods are some of the most ultraprocessed foods on the planet. They lack fiber and are often loaded with toxic amounts of sugar, salt and unhealthy fats, which increase the number of empty calories derived from these foods. About this aspect of gluten-free foods, U.S. News and World Report states:⁶

"[G]luten-free packaged foods have one important thing in common with their glutinous counterparts: The majority of them are absolute junk.

These include empty-calorie chips, crackers and bars that are high in starchy carbs and sugar, while low in fiber; breads made from the least nutritious starches on the planet and held together by food gums; and high-glycemic cereals made from white rice flour or refined corn that's been sprinkled with vitamin dust."

You Might Gain Weight on a Conventional Gluten-Free Diet

Given the higher amounts of sugar in many packaged gluten-free foods, it's common for people to gain weight after going on a gluten-free diet. With respect to eating gluten-free and weight gain, nutrition communications expert Rachel Begun, a scientific/medical advisory council member for Beyond Celiac, said:⁷

"Now that we have an ample supply of gluten-free foods on the market, we're seeing extended weight gain. Many gluten-free products are high in … sugar, while also being low in nutrients. When people go gluten free and eat too much of these highly processed, low-nutrient foods they're likely to gain weight.

There's also a 'health halo' surrounding gluten-free right now. It's important that consumers understand that just because something is gluten free doesn't necessarily mean it's healthful or is a good option for weight loss."

Watch Out: Arsenic Often Found in Rice-Based Gluten-Free Food

If you decide to go gluten free, but are not doing so in response to a diagnosed medical condition such as a wheat allergy or celiac disease, proceed carefully to avoid unintentionally damaging your health.

Registered dietitian Laura Moore, who is on the nutrition faculty at the University of Texas School of Public Health in Houston, warns, "If you go completely gluten-free without the guidance of a nutritionist, you can develop deficiencies pretty quickly."⁸

Part of how that can happen, especially if you eat a mostly processed food diet, relates to the enrichment and fortification of foods, which is a common practice in the food industry. The simple fact is fewer gluten-free foods are enriched or fortified with nutrients like folic acid and iron, as compared to products containing wheat.^9,10

Rather than depend on processed foods for these and other vital nutrients, I recommend you eat a whole-food diet and take a high-quality supplement as needed. Beyond that, Consumer Reports says eating gluten free may increase your exposure to arsenic.

This is the case mainly due to the use of rice flour in many gluten-free foods and the uptake of arsenic in most of the world's rice crops.¹¹ As such, you may want to think twice before choosing rice-based gluten-free products and risking exposure to a known cancer-causer like arsenic.¹² About this, Consumer Reports stated:¹³

"About half of the gluten-free products Consumer Reports purchased contained rice flour or rice in another form. In 2012, we reported on our tests of more than 60 rices and packaged foods with rice (such as pasta, crackers and infant cereal).

We found measurable levels of arsenic in almost every product tested. Many of them contained worrisome levels of inorganic arsenic, a carcinogen."

In your attempts to avoid rice-containing gluten-free foods, you'll also want to steer clear of nonorganic products containing corn starch, corn flour, potato starch, potato flour and soy. That's because most conventional corn and soy crops are genetically engineered, while conventional potato crops are heavily sprayed with toxic herbicides and pesticides.

Not All Packaged Food Labeled Gluten-Free Is Free of Gluten

Another potential obstacle to gluten-free eating is the unfortunate reality that many packaged gluten-free foods have been found to be tainted with gluten.

"Cross-contamination can occur," Andrea Levario, senior public policy advocate for the Human Rights Campaign in Washington, D.C., explains. "Gluten-free products may be manufactured on the same equipment used for wheat or other gluten-containing products."¹⁴

The potential for cross-contamination is also of concern in instances where wheat is grown next to other grains, such as oats. Even though some suggest oats are a gluten-free food, you have to be careful to ensure the brand you purchase is certified gluten free.

Otherwise, it is very likely the oats were grown in or near wheat fields, in which case the product may be contaminated. A 2014 study published in the European Journal of Clinical Nutrition¹⁵ evaluated 158 food products labeled as gluten-free over a three-year time frame.

When testing for the presence of gluten, the researchers discovered 5% of the packaged items they tested — including some certified gluten-free — failed to meet the limit set by the U.S. Food and Drug Administration (FDA) for less than 20 parts per million of gluten. If you have questions about foods labeled as gluten-free, I encourage you to contact the manufacturer.

"They should be transparent about what tests they use to determine whether a product is gluten-free," said study author and registered dietitian Tricia Thompson, founder of Gluten Free Watchdog and creator of the Gluten-Free Dietitian website. "If they insist that it's proprietary information, that should set off an alarm."¹⁶

Finally, take care when purchasing food items labeled "wheat free," because being wheat-free doesn't automatically make a food gluten-free. That's because barley, rye and spelt-based ingredients, all of which contain gluten, may be used in products labeled wheat free.

Is a Gluten-Free Diet Right for You?

Whether or not you have a medical reason for choosing a gluten-free diet, nearly everyone can benefit from this style of eating. Grains, even whole sprouted varieties, tend to cause problems not only because of the presence of gluten, but also due to concerns around fructans, glyphosate contamination and wheat hybridization.

Furthermore, grains may damage your skin. Grains also have high net carbs and many people eat too many carbs. A healthier approach would be to reduce your consumption of grain-based carbs and increase your intake of healthy fats, thereby training your body to burn fat for fuel. (Be sure to moderate your protein intake, too.)

Becoming a fat burner will free you from the cycle of energy highs and lows that often result from overindulging in carbs.

While reducing your carb consumption may be a challenge, eating a gluten-free diet is relatively easy to do. You can accomplish this by focusing on whole, unprocessed foods that are naturally wheat- and gluten-free. As always, I recommend eating foods as close to their natural state as possible.

For that reason, I advise you forego the packaged gluten-free foods found online and in grocery stores. Below are a few of the foods you may enjoy on a naturally gluten-free diet:

Avocados	MCT oil	Organic fruits and vegetables
Coconut oil	Nuts (macadamias, pecans and walnuts)	Organic, grass fed meat
Fish (anchovies, herring, sardines and wild-caught Alaskan salmon)	Olives and olive oil	Organic, raw, grass fed dairy products (kefir and yogurt)
Grass-fed butter	Organic pastured eggs	Seeds (chia, pumpkin and sunflower)

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Back pain is one of the most common health complaints across the globe, with an estimated 80% of people experiencing back pain at some point in their life.¹ Not only is back pain the No. 1 cause of job disability,² it’s also one of the most common reasons for opioid dependence, the side effects of which can be lethal. In fact, opioids are now the leading cause of death among Americans under the age of 50.³

According to a 2018 study,^4,5 opioids — which modulate your brain’s reaction to pain — are the most commonly prescribed medications for people with chronic low back pain and, as you’d suspect, these drugs are typically used long-term in this population.

According to Pharmacy Times, about 20% of patients on long-term opioid therapy end up developing an opioid use disorder.⁶ Up to 25% of opioid users also end up with other substance-abuse disorders,⁷ which have additional risks.

The use of opioids for back pain flies in the face of guidelines⁸ from the American College of Physicians, which recommends heat wraps and exercise as a first line of treatment, stressing that prescription drugs should only be used as a last resort, as they completely fail to treat the underlying problem.

Research⁹ has also shown opioids (including morphine, Vicodin, oxycodone and fentanyl) fail to control moderate to severe pain any better than over-the-counter (OTC) drugs such as acetaminophen, ibuprofen and naproxen. In fact, those taking nonopioid pain relievers actually fared “significantly better” in terms of pain intensity.

Considering the immense risks associated with opioid use, you’d be wise to exhaust all other alternatives before jumping on that bandwagon to disaster. The good news is there are a wide variety of non-drug options available.

Unlearning Chronic Back Pain

Most recently, researchers have shown you can successfully reverse chronic back pain by retraining your brain with Pain Reprocessing Therapy (PRT).¹⁰ As reported by DW.com:¹¹

“PRT aims to rewire neural pathways in the brain to deactivate pain and train the brain to respond to signals from the body more appropriately, using what's called pain education. Ultimately, the goal is to reduce a patient's fear of certain movements, so that when they do move in those ways, they are confident that it won't cause them any pain.”

The article tells the story of one of the study participants, Daniel Waldrip, who had suffered chronic debilitating back pain for 18 years. One month after the conclusion of the study, Waldrip was 100% pain free, and he’s remained pain free in the four years since. “It completely changed my life,” he told DW.com.

Pain Processing Gone Haywire

If pain can be “unlearned,” what does that say about the nature of pain? Contrary to popular belief, chronic back pain is not always due to some structural or mechanical problem. More often than not, it’s actually caused by nerves sending incorrect or faulty signals to your brain. As explained by DW:¹²

“Pain is like an alarm system that alerts us when we may have hurt ourselves or become injured. But regardless of where a person hurts themselves physically, their sense of pain is formed in the brain.

Nerves send signals to the brain to let it know that something has happened in the body and the brain then decides whether to produce a pain sensation, and that depends on whether the brain thinks there is danger.

Pain draws a person's attention to potential harm and diminishes when that warning signal is no longer needed. This is called acute pain ... But pain that persists for more than three months despite treatment is considered chronic.

‘It's really important that people are able to experience pain. It's critical for survival, and yet some people [continue to have] pain even though their bodies have recovered,’ said James McAuley, a psychologist and professor at the University of New South Wales (UNSW).

While scientists have their theories, it is still unclear what causes chronic pain or how acute pain becomes chronic, said McAuley. But they do know that some changes occur in the brain when pain goes from acute to chronic.

‘The nerves are misfiring and advising the brain that the patient is having pain or is at a risk of damage,’ said Steven Faux, director of the Rehabilitation Unit at St Vincent's Public Hospital in Sydney, Australia.”

In all, two-thirds of the volunteers in the PRT group were either pain free or nearly pain free at the end of the treatment, compared to just one-fifth (20%) of those in the placebo group. Functional MRI scans performed at baseline and at the end of the trial also demonstrated that pain processing in the brain had been noticeably altered.

The Importance of Staying Active and Minimizing Sitting

Staying active and minimizing sitting are two strategies that can go a long way toward preventing — and treating — back pain. Both will improve muscle strength and coordination, reduce stiffness and improve blood flow, which may reduce back pain and lower your risk of developing back pain in the first place.

Oftentimes, back pain originates from tension and muscular imbalances. For example, sitting for long periods of time ends up shortening the iliacus, psoas and quadratus lumborum muscles that connect from your lumbar region to the top of your femur and pelvis.

When these muscles are chronically short, it can cause severe pain when you stand up as they will effectively pull your lower back (lumbar) forward. By bringing these muscles into better balance, you will remedy many of these common pains and discomforts.

This was certainly true for me when I had debilitating back pain about 10 years ago that failed to respond to all interventions. The only thing that worked was to stop sitting for over 12 hours a day. I shifted to a standing desk and the problem permanently resolved: Address the cause and you typically have a cure.

Overuse and misuse of the muscles supporting your spine, poor muscle strength and inappropriate posture while sitting, standing and walking are other common causes of low back pain. For instance, when walking with your toes pointed outward, the muscles in your hips and lower back tighten, increasing your risk for lower back pain.

Sitting with your shoulders hunched over a computer screen stretches muscles in your upper back and places added stress on your lower back, increasing your risk for both lower and upper back pain.

Walking with your head down is yet another posture-related problem that has repercussions on the rest of your back and hips,¹³ as your head is the single heaviest part of your body and will throw everything out of alignment. If poor posture is a culprit, consider doing some exercises to stretch out your shoulders, open up your hip flexors, and lift your chest.

Correct Improper Body Mechanics That Cause Pain

Techniques that can ease or erase back pain by teaching you proper body mechanics include:

Benefits of Chiropractic Care

Spinal adjustment by a chiropractor can also ease back pain in many cases. In one 2017 meta-analysis¹⁸ of 26 studies, spinal manipulation was associated with “statistically significant benefits in both pain and function, of on average modest magnitude, at up to six weeks.”

The average patient reported greater ease and comfort in their day-to-day activities, such as walking, sleeping or turning in bed. However, while these results appear to be modest in nature, it is important to recognize the results are an average, and that the participants only underwent manipulation. In other words, they were not given any additional rehabilitative exercises designed to maintain functional movement of the spine gained after manipulation, or to reduce inflammation.

A study^19,20 that did take physical therapy and/or anti-inflammatories into account, published in 2018, found this kind of multidisciplinary approach reduced discomfort and disability to a greater than standard medical care.

In all, 750 active duty military service members already being treated for lower back pain were evaluated. All were receiving physical therapy and/or drugs to ease pain and inflammation. The team added chiropractic treatment to half the participants, including spinal manipulation, rehabilitation exercises and treatment with cold or heat.

On average, the chiropractic treatment group received two to five treatments over a six-week period. After six weeks, patients who received chiropractic treatments experienced greater improvements in their lower back pain and less disability than those who did not receive the treatments. Lead study author and chiropractor Christine Goertz, Ph.D., commented on the results:²¹

“Spinal manipulation (often referred to as Hias chiropractic adjustment) may help heal tissues in your body that form as a result of injury, decreasing pain and improving your body's ability to move correctly.

It is also possible that manipulation impacts the way your body perceives pain through either the brain or spinal cord and or decreases pain from muscle strain, inflammation and or spasm in the muscles next to your spine.”

Aside from addressing any immediate spinal misalignment that might cause back pain, chiropractic care can also help address, prevent and treat deeper dysfunctions in your body. Chiropractic adjustments can actually affect the chemistry of biological processes on a cellular level, thereby reducing oxidative stress and improving immune function and DNA repair,²² for example.

Acupuncture and Massage

Acupuncture and massage also have their place, and often work well together. The WellBridge Clinic in Oregon is a proponent of acupuncture for back pain, stating on its website:²³

“There is extensive, conclusive research behind the use of acupuncture for pain resolution and management, especially for back pain. Modern science has found that targeting specific points in the body with acupuncture pins acts as a nociceptive stimulation that leads to the activation of the nerve-endocrine-immune systems.

This activation helps the body to begin to heal at the sites of injury and pain. Effectively, this means it increases blood flow and circulation to injured areas. It changes the electrical current that is the foundation of our biology. That’s how acupuncture releases endorphins to ease pain, release muscle tension, and change cellular processes so the body can heal.”

Back problems that may respond well to acupuncture include pinched nerves, sciatica, herniated discs and spinal stenosis. Massage therapy, meanwhile, releases endorphins that help induce relaxation, relieve pain and reduce levels of stress chemicals such as cortisol and noradrenaline. It also reverses the damaging effects of stress by slowing your heart rate, respiration and metabolism, and lowering high blood pressure.

Benefits of Compression Breathing

Certain breathing techniques can even be helpful. Compression breathing is actually an important aspect of Foundation Training. It helps re-educate the muscles surrounding the spine of your rib cage, teaching them to be in a state of expansion rather than contraction. This technique is demonstrated in the video above.

Done properly, it will help lengthen your hip flexors, stabilize your spine and support your core using transverse abdominal muscles. This strengthens your back and keeps your chest high and open — all of which can reduce pain. Here’s a quick summary of how to do structured decompression breathing:

1. Whether sitting down or standing, put your thumbs at the base of your rib cage, positioning your pinkies at the pointy bones at the front of your waist. Think of the space between your fingers as a measuring stick.
2. Pull your chin back so your chest is lifting upward. Take three slow deep breaths as instructed below.
3. The distance between your thumbs and pinkies should increase as you breathe in.
4. When you breathe out, tighten your abdominal muscles so your torso will not collapse back down. This is the most important step: Do not let your torso drop back down toward the pelvis as you exhale. It should be challenging, allowing you to feel your abdomen engage as you exhale.
5. With each breath, your aim is to increase the distance between your thumb and pinky fingers, as well as increase the width of your upper back. This occurs as you elongate the back of your rib cage. Each inhalation expands your rib cage, and each exhalation will keep the abdomen extended and tight. So, each in-breath fills up your rib cage, and each out-breath maintains the height and width of your rib cage.

Repeat five to 10 rounds with three to four breaths per round. Over time, your muscles will get stronger and your seated posture will gradually improve.

Simple Stretches to Help Relieve Lower Back Pain

Stretching is also important, as tight and stiff muscles and lack of flexibility will contribute to back pain. There are many options here. Below, I’ve highlighted six simple stretches commonly recommended for lower back pain.²⁴ The Yoga Journal²⁵ also has an online page demonstrating poses that can be helpful.

If these stretches are too painful to perform, stop doing them and consult your doctor, chiropractor or massage therapist before continuing. You may experience mild discomfort when you begin doing these stretches, especially if you are new to exercise or it has been a long time since you last exercised. My advice is to take it slowly and gradually increase your tolerance to these stretches over time.

Addressing the Emotional Root of Back Pain

Last but not least, there’s evidence that back pain may originate in, and is certainly exacerbated^26,27 by, psychological or emotional issues. The late Dr. John Sarno, a professor of rehabilitation medicine, gained notoriety using nothing but mind-body techniques to treat patients with severe low back pain.

His specialty was those who have already had surgery for low back pain and did not get any relief. This is a tough group of patients, yet he claimed to have a greater than 80% success rate using techniques like the Emotional Freedom Techniques (EFT).

As noted by Sarno in the documentary "All the Rage" — a four-minute trailer of which is included above — "I tell [my patient] what's going on, and lo and behold, it stops hurting." The "what" that is going on is not a physical problem at all — it's emotions: anger; fear; frustration; rage.

When these kinds of emotions are suppressed, your brain redirects the emotional impulses to restrict blood flow to certain parts of your body, such as your back, neck or shoulders, thereby triggering pain. This pain acts as a distraction from the anger, fear or rage you don't want to feel or think about.

The pain essentially acts as a lid, keeping unwanted emotions from erupting. You may feel anger at the pain, but you won't have to face the fact that you're actually angry at your spouse, your children or your best friend, or that you hate your job, or the fact that you feel taken advantage of.

As noted by Sarno, working hard and constantly trying to do everything perfectly to keep everybody around you happy, "is enraging to the unconscious mind." The term Sarno coined for this psychosomatic pain condition is "tension myoneural syndrome,"²⁸ and he firmly believed most people can overcome their pain by acknowledging its psychological roots.

While many of Sarno's patients got well without psychiatric help, he would often recommend seeking out a psychotherapist to explore repressed emotions, or to take up journaling to put your feelings on paper.

Another doctor who believes resolving suppressed emotions is key for those with chronic back pain is Dr. David Hanscom, an orthopedic surgeon. He prescribes expressive writing as a primary treatment tool for back pain. You can learn more about this on Hanscom’s website, backincontrol.com.²⁹

When to See a Doctor

While back pain is rarely indicative of something medically dangerous, if your pain is accompanied by one or more of the following symptoms, a thorough medical checkup would be in order to rule out a more serious problem.^30,31,32

Fever	Difficulty passing urine
Previous high risk of fracture	Loss of bladder or bowel control
Feeling like you need to pass urine but there is none	Loss of muscle strength or sensation in the legs
Night back pain not relieved by adjusting in bed or starting only at night	Impaired sexual function, such as loss of sensation, numbness or tingling in the genitals or buttocks
Pain in your upper or lower back not tied to a specific joint or muscle may signal a heart attack

Back Pain Is Common, yet Largely Avoidable

Once you understand that back pain is typically the result of poor posture, improper movement, faulty nerve signaling, emotional repression or a combination of these factors, it becomes clear why narcotics and surgery have such high failure rates. They simply don’t address any of the underlying causes.

So, if you’re among those seeking medical care for persistent back pain, I’d advise you to consider your options — several of which I’ve just reviewed — before filling that prescription or going under the knife.

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Mary Madigan couldn't help but be 'grumpy' when she read that the Pill can dent female ambition. Why? Because there's no better option for contraception for her body, and so, she must simply take this news on the chin and get on with it. She writes why 'good enough' should be seen as 'not good enough' when it comes to contraceptive options. 

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According to the Centers for Disease Control and Prevention (CDC), nearly one-half — 47% — of Americans have high blood pressure (hypertension).¹ Hypertension carries a high cost to your health. It is a major risk factor for cardiovascular disease and stroke,² which are in the first and fifth position for leading causes of death in the U.S.³

The financial burden is over $131 billion each year in direct medical costs and lost work days, but does not include a number of other health conditions worsened by hypertension, including kidney disease and cognitive decline.

Only 1 in 4 of those with hypertension have their blood pressure under control.⁴ Unfortunately, while blood pressure monitoring has become commonplace at dentists' and eye doctors' offices, the CDC estimates 1 in 3 people are not aware they have hypertension.⁵

There are several ways to reduce your blood pressure without drugs, which I discuss below. Among them is balancing your potassium level, as this electrolyte has a significant effect on muscle contraction and arterial wall relaxation, but most Americans barely get half of the recommended daily allowance.⁶

What Is High Blood Pressure?

When your physician takes your blood pressure, he uses a sphygmomanometer to measure the amount of pressure your heart exerts to push blood through your arterial system. The top number represents the highest pressure and the bottom number is the lowest pressure needed. These numbers are related to the elasticity and diameter of your arterial walls.

When the pressure required to circulate your blood is high, it places an abnormal amount of stress on your heart muscle and smaller arteries, and reduces the amount of oxygen delivered to the smallest blood vessels in your body. Both of these consequences account for many of the secondary effects of hypertension.

Your blood pressure reading can vary throughout the day, so one high reading is not a concern. It is only when your blood pressure is consistently or chronically higher than normal that significant health conditions may occur.

The validity of your blood pressure reading will be affected by the size of the blood pressure cuff, the position of the cuff on your arm and whether you're nervous. Measuring your blood pressure in both arms at the same office visit may also give your vital information about your circulatory health.

A number of studies have revealed that a significant difference between your right and left arm pressure may indicate circulatory problems that raise your risk for stroke, peripheral artery disease or other cardiovascular problems.

While small differences between your arms is normal, researchers found when there is a difference of 5 points in the systolic reading (top number) it doubled the risk of dying from heart disease in the following eight years.⁷ The difference suggests the presence of plaque in the artery supplying the arm with the higher pressure.⁸

In a meta-analysis evaluating mortality rates of over 17,000 participants with inter-arm systolic blood pressure differences, researchers found participants with less than 10 points difference compared to those with greater than 10 point difference between arms suffered a 58% increased risk of death from cardiovascular disease.⁹ However, when the difference increased to 15 points, the risk increased to 88%.

Potassium Level Impacts High Blood Pressure

Potassium is a naturally occurring mineral that your body uses as an electrolyte, or substance in solution that will conduct electricity, and is vital for normal functioning.

Diarrhea, vomiting, excessive sweating (such as when using a sauna) and some drugs may deplete or disrupt your potassium balance. But, the most common reason your potassium levels are not within normal limits is due to poor dietary choices.

The average reported intake of potassium from food is about half of the 4,700 milligrams (mg) recommended.¹⁰ Research demonstrates that these low levels of potassium may have a significant impact on blood pressure, especially as it relates to the amount of salt normally found in a Western diet.

Dr. Paul Whelton, professor of epidemiology at Tulane School of Public Health and Tropical Medicine, did an analysis in 1997 of over 29 trials that demonstrated low levels of potassium resulted in higher systolic blood pressure readings.¹¹ Studies performed since then have found similar results.^12,13 According to Whelton's research:¹⁴

"The results support the premise that low potassium intake may play an important part in the genesis of high BP. Increased potassium intake should be considered as a recommendation for prevention and treatment of hypertension, especially in those who are unable to reduce their intake of sodium."

Potassium works in your body to relax the walls of your arteries, keep your muscles from cramping, and lowers your blood pressure.¹⁵ The reduction in blood pressure with added potassium has also been associated in studies with a reduced risk of stroke.¹⁶

The Many Benefits of Potassium

Research has found that women without hypertension who consumed the most potassium (nearly 3,200 mg/day) had a 21% reduced risk of stroke. Further, women who consumed the most potassium were 12% less likely to die during the study period than those who consumed the least.¹⁷ According to the study's lead researcher:¹⁸

"Potassium may play a role in improving blood vessel function in our brains. This could allow better oxygenation of our brain tissue, and prevent tissue death that occurs from lack of oxygen to the brain …

The effect of potassium consumption on reduced stroke risk could also be due to a better diet overall, though we did not investigate this in our study."

Potassium should be the third most abundant mineral in the human body. Adequate amounts of potassium are also associated with quicker recovery from exercise and improved muscle strength.^19,20 As an electrolyte, potassium helps to regulate the fluid balance in your cells and throughout your body.²¹

Fluid balance is essential to maintaining life, preventing dehydration at the cellular level and maintaining brain function.²² Potassium is important in the transmission of nerve impulses in your brain, spinal cord and peripheral nervous system.²³

Nerve impulses transmitting information from one nerve to the next happens as the result of electrical activity. This activity is what an electrocardiogram measures as it tracks heart activity.

Low levels of potassium have been linked with high levels of insulin and glucose, associated with metabolic syndrome and Type 2 diabetes.²⁴ These results have been found in several studies,²⁵ leading researchers to recommend dietary choices that boost potassium levels and reduce the risk of type 2 diabetes.

Effects of High Blood Pressure on Your Body

Unfortunately, 20% of people who suffer with high blood pressure are unaware of the condition, significantly increasing their potential risk of health problems. With uncontrolled or poorly controlled hypertension, you increase the risk of significant health effects that reduce your quality of life and have a negative effect on the length of your life.

Hypertension increases your risk of stroke as it can cause blood vessels in your brain to rupture or clog more easily. In both instances, oxygen supply to a portion of the brain ceases and a stroke results.²⁶ The increased workload on the heart muscle may result in heart failure, and damage to the arteries supplying the heart muscle with oxygen may result in a heart attack.

Hypertension may damage the smaller arteries, reducing the amount of oxygen delivered and severely impacting the ability of organs to function, such as your kidneys and eyes. This may result in kidney failure and vision loss. The damage to smaller blood vessels is called microvascular disease and may lead to angina, or chest pain when the heart muscle doesn't get enough oxygen, and sexual dysfunction.

Atherosclerosis is another form of damage to the arterial system from hypertension that may result in peripheral vascular disease. The narrowing of the arteries may occur in the legs, arms, stomach and head, triggering pain and fatigue.

Sodium/Potassium Ratio Is Key

The key to relaxing your arterial walls and reducing your blood pressure is the sodium to potassium ratio. In the United States and many other developed countries, salt has been vilified as a primary cause of high blood pressure and heart disease. According to research presented at last year's American Heart Association meeting,²⁷ excessive salt consumption contributed to 2.3 million heart-related deaths worldwide in 2010.

However, it's important to realize that most Americans and other Westerners get the majority of their sodium from commercially available table salt and processed foods — not from natural unprocessed salt. So, not only is the ratio between potassium and sodium important, so is the type of sodium consumed.

If you eat a lot of processed foods and not many vegetables, there's a good chance your sodium-to-potassium ratio is unbalanced. If you're not sure, try using cronometer.com/mercola, which allows you to enter the foods you eat and then calculates the ratio automatically. It's generally recommended that you consume five times more potassium than sodium, but most Americans get the opposite ratio, eating two times more sodium than potassium.

This ratio is more important than your overall salt intake. A better strategy to promote public health would be to forgo the strict sodium reduction element and focus recommendations instead on a high-quality diet rich in potassium, as this nutrient helps offset the hypertensive effects of sodium. Imbalance in this ratio can not only lead to hypertension (high blood pressure) but also contribute to a number of other diseases, including:

Kidney stones	Memory decline	Cataracts
Osteoporosis	Erectile dysfunction	Stomach ulcers
Rheumatoid arthritis	Stomach cancer

Why a Balanced Diet Is Your Best Option

Getting nutrients from your food instead of supplements is preferable as your food contains more than a single nutrient and in different forms. For instance, potassium found in fruits and vegetables is potassium citrate or potassium malate, while supplements are often potassium chloride. The citrate and malate forms help produce alkali, which may promote bone health²⁸ and preserve lean muscle mass as you age.²⁹

Bone loss may lead to brittle bones or even osteoporosis. While potassium in fruits and vegetables may help build bone health, potassium chloride may not. As researcher Dr. Bess Dawson-Hughes from Tufts University explains:³⁰

"If you don't have adequate alkali to balance the acid load from the grains and protein in a typical American diet, you lose calcium in the urine and you have bone loss … When the body has more acid than it is easily able to excrete, bone cells get a signal that the body needs to neutralize the acid with alkali … And bone is a big alkali reservoir, so the body breaks down some bone to add alkali to the system."

Research by Dawson-Hughes found that people who were in the neutral range for net acid excretion, meaning they had a fairly healthy balance for bone and muscle health, were eating just over eight servings of fruits and vegetables a day along with 5.5 servings of grains.

When they rounded this out, it came to about half as many grains as fruits and vegetables. For many Americans a simple recommendation to increase your alkali (and potassium) while reducing acid is to eat more vegetables and fewer grains.³¹

Other Drug-Free Methods to Control Blood Pressure

Here are several suggestions to help keep your blood pressure under control and reduce your risk of organ damage.

Address insulin and leptin resistance to impact magnesium and nitric oxide — High blood pressure is associated with insulin resistance, which results from eating a diet too high in sugar. As your insulin level rises, so does your blood pressure. Insulin stores magnesium, but if your insulin receptors are blunted and your cells grow resistant to insulin, you can't store magnesium so it passes out of your body through urination. Magnesium stored in your cells relaxes muscles. If your magnesium level is too low, your blood vessels will constrict rather than relax, and this constriction raises your blood pressure. Fructose also elevates uric acid, which drives up your blood pressure by inhibiting the nitric oxide in your blood vessels. (Uric acid is a byproduct of fructose metabolism. In fact, fructose typically generates uric acid within minutes of ingestion.) Nitric oxide helps your vessels maintain their elasticity, so nitric oxide suppression leads to increases in blood pressure. If you're healthy, and want to stay that way, the general rule is to keep your total fructose intake to 25 grams per day or less. If you're insulin resistant and/or have high blood pressure, keep your total fructose to 15 grams or less per day until your condition has resolved.

Eat real food — A processed food diet, loaded with net carbohydrates (non-fiber carbs like sugar, fructose and grains) and trans fat (margarines and vegetable oils) is a recipe for hypertension. Instead, make whole, ideally organic foods the focus of your diet. Also remember to swap non-fiber carbs for healthy fats such as avocados, butter made from raw, grass-fed organic milk, organic pastured egg yolks, coconuts and coconut oil, raw nuts such as pecans and macadamia, grass-fed meats and pasture raised poultry. To learn more about healthy eating, please see my optimal nutrition plan.

Mind your sodium to potassium ratio — According to Lawrence Appel, lead researcher on the DASH diet and director of the Welch Center for Prevention, Epidemiology and Clinical Research at Johns Hopkins, your diet as a whole is the key to controlling hypertension — not salt reduction alone. He believes a major part of the equation is this balance of minerals, i.e., most people need less sodium and more potassium, calcium and magnesium. According to Appel,32 "Higher levels of potassium blunt the effects of sodium. If you can't reduce or won't reduce sodium, adding potassium may help. But doing both is better." Indeed, maintaining a proper potassium to sodium ratio in your diet is very important, and hypertension is but one of many side effects of an imbalance. A processed food diet virtually guarantees you'll have a lopsided ratio of too much sodium to potassium. Making the switch from processed foods to whole foods will automatically improve your ratios. Include foods high in potassium such as sweet potatoes, tomatoes, spinach, beets, black beans, wild caught salmon, edamame, butternut squash, Swiss chard, apricots, cantaloupe, mushrooms and tuna.33

Load up on veggies — Juicing is a simple way to increase the amount of vegetables in your diet, and many NO3-rich veggies (which raise your nitric oxide level) are suitable for juicing, such as beets, kale, celery, spinach, carrots and more. Allicin-rich garlic, leeks, shallots and chives also help improve your blood pressure, and are easy to add to salads and various dishes.

Optimize your vitamin D level

Boost your animal-based omega-3 intake — The best way to boost your omega-3 is to eat plenty of oily fish that are low in mercury and other pollutants. Good options include wild caught Alaskan salmon, sardines and anchovies. Alternatively, take a high-quality krill oil or fish oil supplement. Krill oil has advantages over fish oil, which is why I prefer it.

Consider intermittent fasting — Intermittent fasting is one of the most effective ways I've found to normalize your insulin/leptin sensitivity. It's not a diet in conventional terms, but rather a way of scheduling eating in such a way as to promote efficient energy use. Essentially, intermittent fasting means eating your calories during a specific window of the day, and choosing not to eat food during the rest. When you eat, your body reacts by elevating insulin and leptin.

Exercise regularly — A comprehensive fitness program can go a long way toward regaining your insulin sensitivity and normalizing your blood pressure. To reap the greatest rewards, I recommend including high intensity interval exercises in your routine. I also recommend training yourself to breathe through your nose when exercising, as mouth breathing during exercise can raise your heart rate and blood pressure, sometimes resulting in fatigue and dizziness.

Avoid smoking and other forms of pollution — Smoking is known to contribute to high blood pressure, as are other forms of air pollution, even noise pollution. To address these, avoid smoking, consider using ear plugs during sleep if you live in a noisy neighborhood (provided you cannot move), and take steps to improve your indoor air quality.

Walk barefoot — Going barefoot will help you ground to the earth. Experiments show that walking barefoot outside (also referred to as Earthing or grounding) improves blood viscosity and blood flow, which help regulate blood pressure. So, do yourself a favor and ditch your shoes now and then. Grounding also calms your sympathetic nervous system, which supports your heart rate variability. This in turn promotes homeostasis, or balance, in your autonomic nervous system. In essence, anytime you improve heart rate variability, you're improving your entire body and all of its functions.

Address your stress — The connection between stress and hypertension is well documented, yet still does not receive the emphasis it deserves. In fact, it has been shown that people with heart disease can lower their risk of subsequent cardiac events by over 70% simply by learning to manage their stress. Suppressed negative emotions such as fear, anger and sadness can severely limit your ability to cope with the unavoidable every day stresses of life. It's not the stressful events themselves that are harmful, but your lack of ability to cope. The good news is, strategies exist that quickly and effectively transform your suppressed, negative emotions, and relieve stress. My preferred method is the Emotional Freedom Techniques (EFT), an easy to learn, easy to use technique for releasing negative emotions. EFT combines visualization with calm, relaxed breathing, while employing gentle tapping to "reprogram" deeply seated emotional patterns.

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