Welcome to the June 2024 issue of Research Extracts. “The Extracts” is designed to keep busy practitioners and savvy consumers up to date on the latest research on diet, nutrients, botanicals, the microbiome, the environment, and lifestyle approaches to good health and wellness. Our medical team, including NDs, MDs, PhDs, RDs, an MS clinical nutrition, an MS biology, and an LAc, summarizes the essence of several interesting recent studies.

In this issue: (1) Mental Health Moment: Social isolation and mental health, (2) low vitamin D and metabolic syndrome risk, (3) caffeine and female athletic performance, and (4) mindfulness and cognitive therapy for chronic low back pain.

Mental Health Moment: Social Isolation, Eating Behaviors, and Mental Health

Socialization and personal connection to a community are key components of what it means to be human. These connections also impact overall health and wellbeing, as we saw during the COVID-19 pandemic. Perceived social isolation and loneliness have been shown in research to alter neural networks, contributing to psychological symptoms and negatively affecting lifestyle behaviors like physical activity and eating patterns. 

This study explains the connections between brain activity, loneliness, and eating behaviors of 93 healthy premenopausal women. Participant data included body measurements, including BMI and body composition scans, eating patterns, and mental health variables, such as anxiety or depression symptoms. The Perceived Isolation Scale measured social support and level of companionship. To assess visual food cue brain reactivity, fMRIs measured neural responses to sweet versus savory foods and food versus non-food cues. 

The results showed that participants with high perceived social isolation had significantly higher percent body fat, worse diet quality, more frequent maladaptive eating behaviors, such as uncontrolled eating or food addiction, and poorer mental health scores. The brain scans showed increased reactivity toward food cues, specifically the sweet food cues, because sweet foods are often associated with reward-based eating and food addiction. Food is often used as a coping strategy during emotionally difficult times, and the lack of social connectedness further exacerbates feelings of loneliness and negative mood symptoms.

Overall, the results indicate that physical health, lifestyle behaviors like food perception and consumption, and mental health are strongly adversely influenced by isolation and loneliness. 

Note: Read more about how your social network impacts your mental health here. 

Contributed by Carly Duffy, MPH, RD

Reference

Vitamin D Status is Associated with Metabolic Syndrome Risk

Approximately 25 percent of the world’s population has metabolic syndrome (MetS) and, in the United States, more than 34 percent have the condition. MetS is a collection of metabolic disorders with many contributing factors, including micronutrient deficiencies, dietary choices, sedentary lifestyle, age, and ethnicity. In previous studies, a low blood level of one micronutrient – vitamin D – was associated with increased risk of several metabolic disorders.

In a study of Chinese adults, more than 24,000 participants from 30 different cities completed annual health evaluations. Among those, 8,146 participants completed at least one follow-up evaluation. Each evaluation included lifestyle questionnaires (demographics, lifestyle factors, medical history), physical examinations (body weight, height, waist circumference, blood pressure), and fasting blood labs (vitamin D, insulin, glucose, triglycerides, total cholesterol, HDL cholesterol, and LDL cholesterol). Presence of metabolic syndrome was determined if at least two of the following factors were present:

  • Abdominal obesity – waist circumference ≥ 90 cm in men and ≥ 80 cm in women
  • Elevated triglycerides
  • Low HDL cholesterol
  • Hypertension – diastolic blood pressure ≥ 85 mmHG or systolic blood pressure ≥ 130 mmHg
  • Elevated blood glucose

Vitamin D deficiency occurred more often in women and in adults ages 18-44. Participants with the highest vitamin D levels were more likely to have lower diastolic blood pressure, smaller waist circumference, and lower levels of metabolic blood markers (fasting glucose, fasting insulin, and triglycerides, among others). Conversely, the presence of MetS occurred most frequently in individuals who had the lowest vitamin D levels.

The authors concluded that a low vitamin D level is associated with increased risk of MetS and might be a contributing factor to MetS development.

Note: Thorne’s Vitamin D Test is an at-home blood test that measures total vitamin D, which includes the two common forms of vitamin D – D2 (25OH-D2) and D3 (25OH-D3). Test results include detailed insights and a personalized health plan.

Contributed by Jennifer Greer, ND, MEd

Reference

Caffeine for Exercise Performance in Female Athletes

Although numerous studies tout the benefits of caffeine for sports performance, the majority of studies have been performed in male athletes.

This double-blind, placebo-controlled, crossover study examined the effect of different doses of caffeine on exercise performance in 16 young female team-sport athletes (average age 17). Participants took caffeine capsules (3 mg/kg, 6 mg/kg, 9 mg/kg body weight) or placebo one hour prior to engaging in various exercise challenges. Each study period was separated by at least 72 hours. Participants were asked to eat the same diet on the day prior to the experiment for each of the four sessions, to sleep at least seven hours the night before the experimental days, and to abstain from caffeine-containing beverages and foods for a full day prior to the experimental days.

Results of the performance tests include:

  • Countermovement jump test – improved with all caffeine doses but more so with 6- and 9-mg/kg doses (no difference between these latter two)
  • Modified agility t-test – significantly greater than placebo only with the 6- and 9-mg/kg doses
  • Repeated sprint ability (RSA) test – compared to placebo, both average RSA and best-performance RSA were significantly better with the 6- and 9-mg/kg doses, but not the 3-mg/kg dose 
  • Rating of perceived exertion – remained unchanged for all scenarios
  • Caffeine side-effect questionnaire – greatest number of side effects reported with the 9-mg/kg dose

The authors concluded that the ideal caffeine dose is 6 mg/kg body weight because it was equally effective as the 9-mg/kg dose, but with fewer side effects. For a 65-kg (140-pound) woman, that would be 390 mg of caffeine.

Note: If you’re looking for a workout supplement that won’t give you the jitters, then try Thorne’s Pre-Workout Elite. The ingredients in Pre-Workout Elite provide a boost to physical and mental energy production you can feel, without the unpleasant side effects often associated with other pre-workout supplements.* 

Guayusa in the supplement provides natural amounts of caffeine and a patented extraction process reduces the jitters and side effects common to other caffeine sources. This natural caffeine source supports physical and mental energy production, enhances blood flow, and improves reaction time and focus.*

Contributed by Kathi Head, ND

Reference

Mindfulness Meditation and Cognitive Therapy Improved Chronic Low Back Pain

Combinations of cognitive therapy (CT), behavioral activation (BA), and mindfulness meditation (MM), have shown benefit for chronic low back pain (CLBP).1

A three-arm, randomized clinical trial of 302 patients analyzed these three therapies individually for CLBP when delivered via group telehealth (Zoom).2 Participants were blinded to the specific outcomes being analyzed but were recruited based on CLBP reported in electronic health records that had lasted at least three months (average pain duration of 15 years), with pain occurring at least 50 percent of days during the prior six months. Levels of pain intensity and interference with daily activities were both ≥3 on an 11-point scale before treatment. Analgesic or other medication dosages must have been stable for at least four weeks prior to the study, and participants were excluded if they had had surgery or injury during the prior three months.

Participants were randomized to telehealth groups with an average of 7.7 people per group, receiving either CT (n=99; mean age 47) designed to restructure unhelpful thought patterns and foster adaptive beliefs, BA (n=101; mean age 51) to reduce unhelpful and sedentary behaviors and increase positive movement, or MM (n=102; mean age 49) to enhance present moment awareness and separate from automatic habits.

Therapies included two weekly 1.5-hour sessions for four weeks, and standardized protocols and manuals were used to ensure consistency and replicability. Information was shared during Zoom sessions, and additional readings and assignments were completed between sessions.

Subjective outcome measurements were assessed using standardized questions from the Patient Reported Outcomes Measurement Information Systems (PROMIS), and pain intensity was measured using a single-item, numerical rating scale. The study assessed the pre- and post-treatment effects of how much pain interfered with daily activities and quality of life in the prior week, as well as changes in pain intensity, physical function, mood, depressive symptoms, anxiety, sleep disturbance, pain medication use, and pain-related healthcare utilization.

All three types of telehealth therapies improved all outcome measures compared to pre-treatment scores, and the beneficial effects were maintained at both three- and six-month follow-up visits, long after treatment had concluded. Although the treatment effects did not significantly differ from each other in most cases, the behavioral activation treatment group had a 5.6-point decrease in pain interference scores compared to pre-treatment numbers and was found to have the greatest beneficial effect on sleep disturbances, followed by cognitive therapy. Interestingly, only minimal sleep benefits were seen with mindfulness meditation. 

Healthcare utilization for pain decreased in 35-50 percent of all participants after therapy. 

As one of the largest trials to date evaluating telehealth therapies in chronic low back pain, the beneficial effects reported here offer promise to those with limited access to in-person therapy and a viable alternative to traditional pain management.

Note: Thorne features several formulas that support joint mobility and a balanced inflammatory response, including Curcumin Phytosome, found to be 29-times better absorbed than ordinary curcumin, and Super EPA, a concentrated omega-3 formulation from sustainably-sourced, cold-water fish.*

Contributed by Carina Toledo, MS, MHI, CNS

References

  1. Qaseem A, Wilt TJ, Mclean RM, et al. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med 2017;166(7):514-530.
  2. Day MA, Ciol MA, Mendoza ME, et al. The effects of telehealth-delivered mindfulness meditation, cognitive therapy, and behavioral activation for chronic low back pain: a randomized clinical trial. BMC Med 2024;22(1):156. doi:10.1186/s12916-024-03383-2