Irrespective of the type, duration and frequency of an activity performed any physical activity is sure to reap benefits for the person performing it. Each of us are struggling hard to squeeze in some time to fit in physical activity in our daily schedules somehow and the benefits incurred are regardless of whether it occurs as part of work, leisure, transport or housework. Walking was the only means of transport earlier and after the introduction of wheel, mankind progressed towards other means of transportation. Bicycle, an integral innovation has been also used as an excellent means of exercising since ages. But walking and cycling are activities that can be performed individually. Then how did the group fitness classes evolve?

The origin of group fitness can be traced back to 1968 when Kenneth H. Cooper introduced the concept of aerobic exercise. Immediately the following year dance-based fitness classes focusing on cardio, strength and stretch movements were introduced and it was not until early 1970s that Sorensen took a bit of aerobic programs, added some music and made the world become an ardent fan of aerobic dance that now prevails as the basis for group fitness programs these days. Group fitness classes are exercises performed by a group of people in the presence of an instructor attracting people with its different formats available-yoga, aquatic activity, core conditioning, resistance exercise, kickboxing, boot camps and more. There are a number of health centres and fitness clubs that bank on people’s interest to do different activities and their eagerness to have fun that they have reshuffled the entire concept of fitness. Group activities are encouraged these days as they motivate people to be regular for workouts, follow a consistent exercise schedule and reap the benefits of a fun environment. The question now is whether group fitness offers more benefits than individually performed exercises, especially for the elderly.
​
We are witnessing the fastest growth in the ageing population which brings with it a great burden on the society due to increased risk of mental and social health problems that grow alongside physical health problems as well. There is a dire need to promote physical activity among older people as its absence increases the risk of chronic degenerative diseases and disabilities. Ageing is by itself a risk factor for decline in daily functionality and mobility whose effect can be controlled with daily physical activity and exercise schedules. In such cases regular physical activity increases muscle strength, coordination and flexibility but to avail these benefits it must be performed regularly. But one requires knowledge, skills and perseverance for reaping the benefits of exercising. Don’t we see a group of elderly adults, men mostly, in parks going for a walk or a slow jog as well? These people enjoy each other’s company and have fun while exercising too. But the population of older adults is heterogenous as each of them have varying degrees of health, culture, attitudes and practices. Viewing them as one group might hamper us from providing the needed healthcare as it is essential to consider each of the elderly person’s individualized needs. How good can group exercising benefit older adults in such a scenario and what’s the impact of group exercising on the elderly population?

Japans prevails as the most rapidly aging country in the world where by 2035 one in every three adults will be aged 65 years and above. The study discussed here focuses on the experiences of older adults participating in regular group exercise and the effect of such activity on the person’s physical, mental and social changes. A community-wide intervention program named the ‘Fujisawa +10’ was created to spread the performance of physical activity among citizens based on the national physical activity recommendations made by the National Institute of Health and Nutrition of Japan. The Fujisawa+!0 exercise program was a community-wide intervention with exercise intensity at an extremely low level. Dynamic and static stretching exercises, knee-ups, squatting, knee exercises, arm circle exercises and body balance exercises done in standing or sitting positions are a regular part of the exercise routine programmed. These exercises were introduced to the elderly section of people who were voluntarily exercising together as a group at least once at the park (performed thrice a week) or community centre (performed once a week) in their community. All these adults were given a CD, DVD and manual instructions on how to exercise together as a group without an instructor.

Participants selected were older adults who were participating in the ‘regular group exercise’ in community A and B. Only those community-dwelling older adults who were above the age of 60 participating in regular exercise in community A or B and those living independently without any elderly care assistance were included in the study. The research team conducted four focus group interviews including 26 participants (11 males and 15 females) whose mean age was 74.69 years. Community A had 15 older adults (7 males and 8 females) grouped into two focus groups with 7 (3 men and 4 women) and 8 (4 men and 4 women) respectively. Community B had 11 older adults (4 male and 7 females) who were grouped into two focus groups with 5 (2 men and 3 women) and 6 (2 men and 4 women) participants respectively. Each of the interviews lasted for 60-80 min, none of the participants suffered from disabilities or were diagnosed with dementia, no participant received any formal care, five were living alone and one used a stick due to joint pain. Investigators who had expertise in conducting focus group interviews (HK and KY) served as facilitators while two investigators (YO and YS) and two graduate students attended the focus group meetings as observers.

Results

The researchers could clearly confirm that ‘regular group exercise contributes to balanced health in older adults’ which consisted of seven themes (regular group exercise, functional health, active mind, enjoyment, social connectedness, mutual support and expanding communities) under its umbrella. It was observed that group exercise contributed to physical, mental and social well-being helping them improve on their functional health, peer interaction and their degree of enjoyment. People working out in groups cared for each other, felt connected and had a sense of security in the community.

Older adults have aplenty free time after being done with their responsibilities towards their kids and hence, felt that regular exercise was critical in balancing overall health. Such regular exercises helped them lead an active life without succumbing to sedentary lifestyle habits that included getting up, sleeping or eating at haphazard timings. We also know that many elderly people live in isolation having lost their spouse or their kids stay away and they are forced to lead lives of their own. In such cases, gathering at one common place helped these people to interact with each other, prevent isolation and bring in a purpose to their living. When elderly individuals began their day with group exercises, they felt their body to be flexible, energized and fit while off days motivated them to exercise even stronger on other days. Exercises helped these participants to at least stay fit in their current level even if it did not help in improving their fitness quotient. Many participants felt that they were blessed to socialize and exercising individually at home could have never brought them this kind of an enjoyment. Group exercising also helped in expanding social connectedness and mutual support. The study clearly shows that group exercises benefit the overall development of the elderly individuals catering to their physical, social, emotional and mental needs.

Combined Intervention Program
While the advantages of group exercising seems to sound great there are also many downsides to it. It is not always possible for all the elderly individuals to commute as their health must permit and economic background should also support it; there is less attention paid to individual needs despite the fact that every ageing adults would be suffering from a different kind of body pain and finally, renting a place that’s close to many of the individuals participating and hiring an instructor for the same is not an easy job. Hence, merging a home-based intervention program with a group exercise program would be the best approach as it channelizes the individual’s exercising frequency, intensity and duration to the desired levels. A research team analysed the effects of a blended exercise program on adults in Europe.
Participants were selected from a community-based program known as More Exercise for Seniors in which more than 3,00,000 older adults above the age of 55 years participated in a weekly group-based exercise class under the supervision of a trained instructor. The elderly individuals were asked to sign up for the focus group and instructors were contacted revealing the study’s intention. A total of 15 instructors were contacted and 8 focus groups were held (including two pilots) with 48 older adults. The focus-groups happened at locations where the weekly MBvO-class were held with each consisting of an average of 6 participants. All the participants in the group were asked about their opinion on an additional home-based exercise program.

Results
The two pilot groups and one focus group where data was lost weren’t included in the study and hence, the data from the other 30 participants were included in the analysis. Average age of the participants were 74 years, the individuals had almost been participating for around 9 years in the community-based program and all of them were female.
Most participants took part in the weekly group exercise classes as they wanted to be physically fit and self-reliant without depending on others for their everyday chores and activities. Besides this, participants enjoyed being in the presence of others, felt motivated by each other, formed close friendship bonds and were delighted to have some quality fun. At the same time participants also revealed that home-based exercise programs brought about several benefits-it helped them fulfil their personal goals, could help them perform exercises that they were comfortable doing on that particular day owing to aggravated pain anywhere in the body and were also positive about the different levels of an exercise program that could be self-paced when performed individually. But many expressed motivation as a main concern while performing home-based exercises as group exercises are sure to be motivating and the presence of peers were a great support for regularity.
Yet another Japanese study that analysed the benefits of exercising alone versus exercising with others found that though both had its own health benefits increased frequency of exercising with others had tremendous health benefits irrespective of the total frequency of exercise.

References
Regular Group Exercise Contributes to Balanced Health in Older Adults in Japan: A Qualitative Study: https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-017-0584-3
​
Attitudes of Older Adults in a Group-based Exercise Program Toward a Blended Intervention: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5118593/
​
Exercising Alone Versus with Others & Associations with Subjective Health Status in Older Japanese: The JAGES Cohort Study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5156899/
​
The Evolution of Group Fitness: Shaping the History of Fitness: https://journals.lww.com/acsm-healthfitness/Fulltext/2014/11000/The_Evolution_of_Group_Fitness__Shaping_the.4.aspx?WT.mc_id=HPxADx20100319xMP
​

​If you are someone who loves to solve puzzles and can’t settle for anything lesser than solving it 100% good for you! But if you have taken up math or problem solving with the sole intention to escape from the clutches of dementia without a flair for it then you might struggle through the entire solving time trying to have fun but ending without any. Yes, puzzle solving is a tactic way to stay clear of dementia as your mind is being put into good use day in and day out. Dementia-what was considered a rare occurrence some decades back has now started showing its face in all corners of the Earth growing to be a public health concern increasing financial burden and affecting quality of life. Age is one important factor that can speed up the dementia process which is irreversible and so are the genetic causes behind it. So, apart from these the only way in which risk of dementia could be minimized is by figuring out the non-genetic factors that could be modified in order to prevent cognitive decline as there is no cure available for dementia until now.

Ageing has been associated with increased cognitive impairment that can be anything from mild cognitive impairment (MCI) to dementia with MCI having the ability to progress into dementia within 5 years of diagnosis. The world has more than 50 million people who are victims of dementia and the numbers are said to triple by 2050. Hence, it has become absolutely necessary to focus on those factors that can be modified to delay the onset of dementia as much as possible. We have numerous lifestyle and nutritional factors that exist as modifiable risk factors for cognitive decline and one such is the decreased levels of folate, vitamin B6 and vitamin B12 and increased homocysteine levels that contribute to cognitive dysfunction in ageing population. Homocysteine is the result of methylation cycle and cannot be produced from any dietary source. Folate and Vitamin B12 are essential in the methylation of homocysteine to methionine and in the re-methylation and synthesis of S-adenosylmethionine. Hyperhomocysteinemia due to disturbed monocarbon metabolism is a risk factor for cognitive impairment and Alzheimer’s disease. Increased plasma homocysteine (Hcy) levels indicate folate deficiency. Hence, increased plasma homocysteine levels in association with low levels of folate, vitamin B6 and B12 show decreased cognitive performance and supplementing the body with B vitamins helps in reversing or preventing cognitive decline.

We have numerous studies showing that increased Hcy levels is an independent risk factor for impaired cognitive function or Alzheimer’s disease (AD). We have several studies showing increased deficiency of folate, vitamin B6 and B12 in Western countries. Also, there are evidences of a relationship between levels of B vitamins in blood and cognitive function in these countries and South Korea also shows such relationships. We have an elderly Korean population study that shows that hyperhomocysteinemia might be a risk factor for mild cognitive impairment (MCI) and that plasma folate, vitamin B12 and Hcy are associated with cognitive function in cognitively impaired elderly population. Another study in Australia that looked into the relationship between serum B vitamin levels and cognitive function according to the degree of cognitive damage in AD, MCI and normal individuals did not possess any dietary information. We do know that B vitamin levels, especially folate levels, is affected by dietary intake and that low dietary intake of B vitamins is associated with cognitive decline or an increased risk of AD but there is little information on the relationship between B vitamins and cognitive function among elderly population in Korea-a country where folic acid fortification has not yet been made mandatory.
South Korea is one of the countries that has the highest growing ageing population in the world where almost 10% of the elderly above 65 years of age suffer from dementia and around 28% have MCI. This definitely calls for further research in understanding the relationship between B vitamins intake and cognitive function in normal, MCI and AD groups in Korean elderly over 60 years of age in South Korea.

South Korean Study
The study consisted of a total of 321 subjects of whom 121 were normal participants, 100 were MCI patients and 100 were AD patients. All the participants were given a Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD-K) that assessed for both neuropsychological and clinical symptoms. Information on age, gender, marital status, education, smoking, alcohol use; disease existence including diabetes mellitus, hypertension, stroke, dyslipidaemia, cardiovascular disease and thyroid disease and height, weight and BMI measurements were taken.

All the participants went through a 24-hour recall for information on dietary intake, their consumption of dietary supplements and nutrient content available in these supplements.

Results
The average age of the participants was 74.8 ± 7.2 years and patients with AD were older than those without AD, were less educated, less often lived with a spouse and comprised majorly of females. Energy intake of participants was 1490.4 ± 445.5 kcal and this was almost 75% lesser than the estimated energy requirement (EER) for KDRI. Energy, protein and folic acid intake was lower in both MCI and AD group compared to the normal group. Results showed that:

1. Folate intake was positively associated with total intake of protein, vitamin B2, vitamin B6 and folic acid and vitamin B12 intake was positively associated with total vitamin B2 intake.
2. Plasma Hcy was negatively correlated with total intake of vitamin B2, vitamin B6, B12 and folic acid
3. In those with AD, plasma folate was positively associated with total folic acid intake and Hcy was negatively associated with total vitamin B6 intake. No association was found between plasma vitamin B12 and intake of other B vitamins.
4. In those with MCI, plasma folate was positively associated with total intake of protein, vitamin B2, B6 and folic acid. Plasma vitamin B12 was positively correlated with total folic acid intake and Hcy was negatively corelated with total vitamin B2 intake.
5. In those individuals belonging to the normal group, plasma folate and vitamin B12 was positively associated with total protein intake, vitamin B2, B6 and folic acid but there was no association between plasma Hcy and B vitamins intake.
6. There was no association found between cognitive function scores and dietary parameters in AD subjects. In MCI subjects, dietary vitamin B2 intake was associated with World List Memory, World List Recognition and Constructional Recall Test scores. In normal individuals, vitamin B6 intake was positively associated with World List Memory Test scores.
7. Total vitamin B2 intake was positively linked with MMSE-KC and Boston Naming Test scores and total vitamin B6 intake was linked with Boston Naming Test scores. Folic acid consumption was linked to MMSE-KC, World List Memory Test and Constructional Recall Test scores. Vitamin B6 intake was linked to MMSE-KC, Boston Naming Test, World Fluency, World List Memory, World List Recognition Test, Constructional Recall Test and Constructional Praxis Test score.

The study showed that there was a strong association shown between B vitamins intake and those individuals with AD and MCI compared to normal individuals.

Northern Ireland Study
Another study focused on individuals aged >60 years not suffering from vitamin B12 deficiency. Each of their cognitive skills were assessed with a maximum score of 30 possible, a score <25 indicated possible cognitive impairment and <20 indicated dementia. All the participants reported of their dietary intake using a food frequency questionnaire. The study included a total of 155 participants with a mean age of 70 years, well-educated, most of whom were females with low rates of depression. Results showed that individuals with a lower vitamin B6 biomarker status or lower dietary B6 intake were at a 3.5-4-fold greater risk of cognitive decline. Lower dietary intake and vitamin B6 levels was linked to a greater rate of cognitive decline over a 4-year follow-up period. Participants with lower vitamin B6 status at baseline were at a 3.5 times greater rate of cognitive decline over a 4-year follow-up period and those with a lower dietary intake of vitamin B6 at baseline were 4 times likelier to experience greater cognitive decline over the 4-year period.

References
Association between Intake of B Vitamins and Cognitive Function in Elderly Koreans with Cognitive Impairment: https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-13-118
​
B-vitamin Intake & Biomarker Status in Relation to Cognitive Decline in Healthy Older Adults in a 4-Year Follow-up Study: https://www.mdpi.com/2072-6643/9/1/53/htm
​
Vitamin B12 Deficiency & Cognitive Impairment in Elderly Population: https://www.mdpi.com/2072-6643/9/1/53/htm

Grammatically, Translations in other languages are not 100% correct. We apologize. We are improving our translation.

Reference:  Wall Street Journal. 

Pls take this seriously. We Gain Nothing But Brain Drain By Taking Up the Junk Food Lane.

​Ref;  All video credits to DW Documentary https://www.youtube.com/watch?v=TLpbfOJ4bJU

Junk is thrown into the dustbin and cleared out of our homes every single day to keep our heavenly abodes neat and clean. Humanity lives by these principles taking extensive care to keep their homes (even if we don’t care much about our surroundings) clean but fails to keep their own body clean and healthy-our love for junk food shows a steady graphical increase with every passing day! Junk literally means garbage or trash but we shell out money or don’t mind putting on excess weight to indulge in junk foods. Eating yummy pizzas, burgers, crispy French fries, sweetened muffins or spicy hot dogs gratify our taste buds and invoke pleasure. Most humans feel content with such short-term happiness overlooking the long-term painful effects that could be caused due to our ignorance. Yes! High-calorie foods stacked with fats and sugars not only affect our physical health making us fat and prone to diseases but ruin our mental health too-they are hazardous enough to shrink our brain!
 
Shame on Us for Neglecting Our Brains
 
The human brain is an exciting organ that’s been an all-time favorite among researchers. It is full of surprises and information that help understand ourselves better. Even while sleeping our brain never relaxes but functions 24*7 to stay alive-not just to breathe but to lead a meaningful life! Humans need energy and fuel to function which is obtained from none other than the food that we eat. Anything that goes into the mouth does impact the brain in one way or the other-some foods in one way (promoting health)and some other foods in many ways (for instance, the junk or processed foods that ruin cognition, add body weight, etc.). While earlier research showed that certain foods have the ability to improve happiness also termed as mood-enhancing foods, we now have a greater number of research probing into the side effects of consuming junk food as individuals now are more inclined towards eating them.
 
Obesity is ruling the world due to which there are several health issues cropping up but we constantly keep forgetting the fact that health is a combination of both mental and physical health. While we were busy scrutinizing the impact of energy-dense foods on calorie gain the consequences of junk food on mental health remains unpopular among individuals though researchers have done their jobs well. Research and studies are shedding more and more light on this-increased violence, depression, anger, aggression, irritation, dissatisfaction among citizens could be due to increased intake of high-fat/high-sugar foods. Also, these foods act like slow poison subtly affecting our neurons, neurotransmitters, parts of the brain such as the hippocampus, memory capabilities and emotions. Are we inviting self-destruction here? How did it all begin?
 
Well-being & Health Starts from the Fetus
 
A mother is a child’s first relationship in this world through which the baby gets to know others. The relationship between a mom and a child starts right from fetal stage going strong until death. Women enjoy the best phase of life during pregnancy eating to their heart’s content and being pampered. Many go on an indefinite eating spree laying their hands on everything they could get. This puts the pregnant mother at risk for inappropriate weight gain which could lead to delivery-related problems. Besides, the developing fetus is at a very high risk of obesity and this is evidently clear with research results. But what we don’t know is that the nourishment of the expectant mothers affects the mental health of kids too. It’s only since the last decade that significant research and developments have been done in this field (maternal nutrition affects risk of mental illnesses, depression and anxiety in kids).
 
Food Intake of Expectant Mothers Affects Mental Health of Newborns
There are evidences showing that diet affects the development of neurotransmitter systems in the offspring and immune development too which in turn affects risk of mental health problems later in life. Rodent studies show that a diet rich in fats and sugars increases sympathetic nervous system activity and the creatures become hyperactive. We also know that lack of omega 3 fatty acids during fetal development reduces brain plasticity leading to anxiety-driven behavior in adult mice. A group of researchers studied the relationship between the mom’s nutritional intake during pregnancy and the child’s nutritional intake during the first five years of life and its effect on the child’s emotional health.
 
The study consisting of 23,020 children and women sent across self-reported questionnaires to pregnant women (17 weeks) and later after childbirth at regular intervals. The pregnant women were given a food frequency questionnaire (FFQ) which probed into their intake of more than 200 foods and beverages. The items were divided into two dietary patterns-health and unhealthy. The child’s diet was also analyzed from the baby’s 18th month using a 36 item FFQ which included foods such as cereal porridge, dairy-based products and fruit juices. The food range varied as the child grew old and during every stage the foods included were categorized as healthy (veggies, fruits, milk, etc.) or unhealthy (sweets, soda, chips, cookies, ice creams, etc.).
 
Results showed that kids whose moms ate a greater proportion of junk foods showed increased levels of externalizing behavior (antisocial behavior, hostility and aggression). It was also observed that kids who ate junk during the first five years of their development showed evident traits of aggression, anger and irritation. A study in Germany showed that increased intake of confectionery but not sugar-sweetened drinks/snacks led to increased risk of emotional problems and higher intake of healthy foods led to decreased risk of such problems. Human genome is extremely vulnerable to environmental factors during early developmental years of life and any disturbance to normal development affects the mental health of the developing offspring.
 
Processed Foods Silently Increase Violence Levels in Individuals
 
The more we stuff our brain with junk food the less space it has for chemicals needed for its proper functioning. Most are aware of the popular phrase ‘You are what you eat’-foods intake and dietary patterns shape our behavior and characteristics by affecting structural development of the brain, neurotransmitters and brain functioning. It is already well-established that malnourished kids show high risks of aggression, violence, antisocial behavior, declined cognition and externalizing problems. It is around 7, 12 and 15 years that a child’s brain functional development reaches its peak. Insufficient nutrition (especially proteins and energy insufficiency) affects the development of the brain’s grey matter in the prefrontal cortex that’s involved in judgement, attention, planning and self-control.
 
Omega 3 fatty acids leads to structural changes in the brain. This nutrient is vital for optimal grey matter volume in the brain in areas that are associated with mood and behaviors. The brain’s grey matter consists of 90% fats and sadly, our human body cannot produce it. The only means of obtaining this fat (omega 3’s) is via the diet that we eat. Dietary intake of polyunsaturated fatty acids has varied greatly over the years thereby reducing omega 3 intakes as well. That’s due to the over consumption of processed foods that lack any of the good fats or nutrients. Rather, one is expected to increase the intake of fatty fish such as salmon, tuna and sardines, nuts, flax seed and leafy vegetables.
 
A research study on juvenile jail inmates showed that most boys lacked all important nutrients needed for a healthy life. Once they were given nutrient-rich diets the percentage of violent incidents caused decreased by more than 50%. Though it’s only a hypothesis that nutritional food can decrease aggression and violence rates it is clearly evident from researches that violent prisoners (lacking in essential nutrients) who were supplemented with nutrient-enriched foods full of vitamins, minerals, proteins and fatty acids exhibited reduced levels of disciplinary offences and violence rates drops significantly.
 
Sugar: Most Potent Drug Used Universally
Increased sugar intake is a sure devil and a study shows that kids aged below 10 who ate sugar-rich foods such as cakes and chocolates regularly are at an increased risk of committing crime during their early adult years.  Food could be a medium for improving well-being and optimizing mental state of individuals.
 
The bite of a chocolate, just a drop of honey on the tongue or some sugar particles makes even babies experience ultimate pleasure and they long for more. Kids become used to regular intakes of sugar-laden foods such as cupcakes, caramel popcorn, cakes and sweets right from their younger age-in the form of reward foods that are regularly given by parents for completing homework, refraining from violent activities and so on. Eating such foods makes kids happy, at least for some time. They are full of joy and excitement until they eat it and even until the taste lingers in their tongue. But after a while, the same tantrums begin and surprisingly, the satisfaction comes only when the quantity given too increases. This is even proved by a research study.
 
Researchers at the University of Oregon probed into the influence of sweet foods on brain. They gave ice creams/milkshakes to two groups of people and recorded their brain activity using MRI. One group was given a daily supply of ice creams while the other group was given the same food only once a week. Results showed that the group that regularly consumed ice creams experienced reduced pleasure and increased dissatisfaction in comparison to the other group. The reward response of the brain decreases and the brain becomes hypersensitive to food images. For instance, the picture of an ice cream or juice activates brain regions and the individual immediately wishes to eat them for satisfying their taste buds and pleasure centers. By treating ourselves or feeding our kids with more and more junk foods that are sugar-dense we are inviting trouble to our lives.
 
Sugar could be considered a potent drug in the same lines of morphine, cocaine and alcohol. The more we consume, the greater we yearn for again and again. It could be called as an intoxicant too! Once we enjoy the taste of it our minds never stop craving for more. Research shows that increased glucose intake has the potential to alter areas of the brain that control emotions. Our satiety levels keep decreasing, pleasure-seeking traits keep increasing and our brain stoops to any low level to gratify our pleasure needs-in terms of any junk food that we could lay our hands on.
 
Invade Your Fading Memory Before You Lose It Altogether
 
Hippocampus, the brain’s CPU or memory center is frightfully affected by the junk that we eat. It is a part of the limbic system that helps in converting essential information from short-term memory to long-term memory and is also integral for spatial memory (help humans find directions or help rats find foods using particular routes). Our brain stores memories which are formed through connections that happen between neurons-this is called as neuroplasticity and it happens throughout our lives. Research shows that an individual whose diet comprises of junk foods mostly reduces the neuroplasticity capabilities of the brain-the process through which we cherish our happy memories forever in our life or learn new things. Its this ability that helps people excel in studies, remember multiple things or possess cognitive abilities.
 
A research team led by Prof. Margaret Morris at the University of Sydney showed how spatial memory damages are extensively observed in rats which were fed with junk foods such as pastries and doughnuts. Rats fed such foods doubled their food intake ratio and were never satisfied with the quantity of food fed to them. These creatures were also put to a test using two tea cups that were placed in two positions between which the rodents kept moving around. After sometime, one of the tea cups was removed but the rats, which are generally highly skilled in spatial memory skills (the ability with which they locate foods in a maze), failed to recognize the moved object. This shows the effect of junk food consumption on poor spatial memory skills in rodents. In humans too we have various studies reporting the effects of energy-dense food consumption on decreased hippocampus performance.
 
The same foods also prevent the formation of new neurons (neurogenesis) that are essential for forming new memories. They even lead to inflammation in the brain that damage these neurons in the process. Researchers in Australia have showed that a diet consisting of cakes, cookies or sugary drinks for 5 continuous days can increase inflammation levels in the hippocampus. Such people also  always feel hungry because its the hippocampus that receives fullness signs from the gut. And, when the hippocampus is damaged this cycle is broken causing people to desire for more and more food as they don’t receive satiety signs anymore.
 
Gut Microbiota & Food Choices
 
The human gut is indispensable for digesting food and expelling the unwanted ones. But recent research shows that the gut by itself could be a micro brain that rules our appetite and moods. Research even shows that our gut could be the culprit behind cravings for junk foods too. There is a two-way communication between the brain and the gut that happens via the brain-gut axis which is responsible for supervising our eating habits. This is evident from different research results-for instance, those who crave for more sweets have a different microbial breakdown composition in their urine that’s different from those who don’t crave.
 
The food we eat affects the bacterial composition of our gut. Its a conventional concept that our body desires for the nutrients it generally lacks. A study on flies that lacked proteins showed that surprisingly these specimens did not reach out for protein-rich foods placed in front of them even though they lacked this nutrient. The results showed that two specific microbes were responsible for suppressing the appetite for these proteins which made the researchers wonder whether the gut microbiota could affect food choices!
 
If that is true, then its better that we hold control over our gut composition before it starts affecting our food choices. This is possible by consuming enriching meals laden with ample nutrients. For instance, the best choice could be a Mediterranean diet that includes fruits, vegetables, nuts, seeds, legumes, olive oil, fish and whole grain, foods that are rich in all the essential nutrients needed for the healthy functioning of our body. Researches show that the degree of change in diet has a direct impact on the degree of change in emotions. In a study, a group of individuals who were habituated to regular consumption of junk foods switched over to a better diet-the healthy Mediterranean diet. Results showed that after a period of time, the degree of change in the diet had a direct impact on the degree of change in depression. As a welcome relief, the Mediterranean diet led to a decrease in depression levels proving that nutritious food choices go a long way towards better mental and physical health.
 
We have studies that have compared traditional diets such as the Mediterranean diets or the traditional Japanese diet to the Western diets whose results show that the risk of depression is 25-35% lower in those who eat these traditional diets. Such enormous difference is due to the nutritional composition of these diets which include fruits, vegetables, unprocessed grains and fish with optimal quantities of dairy and meat. Above all, these diets contain negligible amounts of sugar and refined foods that are the staple ingredients in junk foods and the Western diets. Unprocessed foods present in traditional diets are fermented and act as natural probiotics improving gut health.
 
Exploring the Flavors of Indian Spices
 
India is a country that’s proud of its cultural heritage, vibrant colors and above all, our healthy food habits and ingredients that promote good health, the most important of which are spices. Spices were an integral part of Indian medicines but now are being studied worldwide for their benefits in improving mental health. We love masala and spicy food. Spices such as turmeric, pepper, ginger and cumin seeds are a regular part of our daily cooking which shows that Indians have always been well-equipped for safeguarding their mental health. Spices have been shown to promote brain health, increase memory and cognition, enhance our focus and concentration and above all, protect brain cells health. Studies show that turmeric helps in repairing brain cells, cinnamon shows promising signs of improved cognition, the flavourful saffron is quoted to decrease depression and black pepper helps in increasing brain function and decreasing depression risks. But recent decades show a greater decline in the usage of such ingredients as many people have adopted the Western dietary routines and are fans of junk foods too. When our motherland is laden with all the wonderful spices and ingredients that promise wellness, health and fitness why are we craving for junk foods that take this all away and ruin our life? Include spices such as nutmeg, cloves, cinnamon, pepper, cumin, ginger and garlic in your daily cooking to reap potential health benefits.
 
It’s never feasible to make a radical change and stick to it. Try to cut down a couple of junk items from your food list every week. Experience the changes in physical and mental health that happen for the better as a result of this. Then, reintroduce the cut down foods once again and see how bad you feel in terms of overall health. First hand experience of both would definitely encourage every one of you to eradicate the presence of junk foods from your life forever. Once you feel the joy of better mental stability, happiness, better mood levels, decreased aggression and irritability why would you feel like going back to your unhealthy junk food life? Eat a variety of food with well-balanced nutrients, relish on your sweets or cookies rarely and exercise regularly for a healthy life. 

Ref :  https://www.dw.com/en/coronavirus-uk-human-vaccine-trials-to-begin/a-53206212

https://www.who.int/blueprint/priority-diseases/key-action/Novel_Coronavirus_Landscape_nCoV_11April2020.PDF?ua=1
​
​
A potential coronavirus vaccine being developed at the UK's University of Oxford is due to begin testing on human volunteers on Thursday.
Health Secretary Matt Hancock said the UK was at the "forefront of the global effort" to produce a vaccine, and was investing in manufacturing capacity to ensure any successful candidate could be made available to the public as soon as possible.
"Vaccine development is a process of trial and error, and trial again," he said, adding that the government was "throwing everything" at vaccine projects.
Read more: Coronavirus vaccine: 'Clinical tests' in Germany soon
The University of Oxford will receive 20 million pounds ($24.5 million; €22.5 million) from the government, Hancock said. Another project at the Imperial College London will receive 22.5 million pounds.
The World Health Organization has said developing a safe vaccine will take at least 12 to 18 months, but scientists at Oxford say they expect to produce a million doses of an experimental vaccine as early as September.

C-section delivery, a rarity in older days has become very common now. Call it a delivery of convenience to overpower nature by bringing in the newborn into this world at an auspicious time fixed by us or as a result of lifestyle changes that hamper the natural delivery mode that leads to failure in labour pain, correct positioning/fixation of the baby’s head and so on. Whatever it is, caesarean rates have spiked up from 6.7% in 1990 to 19.1% in 2014. Various reasons quoted for such increase in rates include advanced maternal age at childbirth, physician fear of litigation, decrease in vaginal births after C-section and access to private health insurance.
​
Gut microbiota shapes an individual’s health and babies born through C-section delivery are not exposed to the mom’s vagina as compared to babies born through natural delivery-initial microbiota of the fetus depends on the bacteria composition transferred from the mom to the child via her birth canal. Gut microbiome of c-section babies is not diverse and we have studies showing that their gut microbiome might harvest more dietary nutrients predisposing them to be obese/overweight. There have been numerous theories suggesting that kids born through C-section deliveries face higher risk of being obese/overweight compared to kids born through natural birth. Lets look at various studies that tried to find out the real link between mode of delivery and risk of overweight/obesity.

Evidence from Cohort Study
Detailed here is the growing up in Ireland (GUI) study that recruited 11,134 infants born in Ireland born between Dec 2007 and June 2008. When the infants were 9-months old all the families participated in a face-to-face questionnaire session conducted by trained interviewers. When the child was 3- and 5-years old all the mother-infant pairs followed up with home-based interview sessions. But after imposing various exclusion criteria the research team was left with 11,049 infant-mother pairs at baseline. Even those infants born through vaginal breech delivery were excluded from the study.

Delivery mode was split into four categories namely vaginal delivery (VD), assisted VD, elective/planned caesarean section (CS) and emergency/unplanned CS. Moms who opted for the last two options were either in pre-labour or in labour respectively. The time of labour contractions is important as the offspring’s microbial colonisation begins later. For instance, children born by pre-labour CS have no exposure to vaginal microflora whereas kids born through CS in labour comparatively have an advantageous edge as they are likelier to be exposed to the mom’s microbiome. Each of the child’s height, weight and BMI measurements were taken and they were all classified as thin, normal & overweight/obese depending on the values procured. Breastfeeding practice was also considered as mothers who opted for elective CS were unlikelier to breastfeed and its known that babies who don’t breastfeed are at a higher risk of obesity.

Results
8,175 of the 11,049 infants were delivered vaginally-almost 60% was by normal VD and the rest was by assisted VD. 26% of the deliveries were by CS-12.7% by elective CS and 13.3% by emergency CS. 51.1% of the participants were boys and almost 55% of deliveries were by assisted VD and emergency CS. Among women who opted for elective CS almost 50.4% of them 35 years and above. After birth it was observed that 13.9% kids were macrosomic (more than 4 kilograms), 10.9% were large for gestational age; at the age of 3, 1,767 (18.7%) of them were overweight and 506 (5.3%) were obese and at the age of five, 1389 (15.8%) of them were overweight and 437 (5%) were obese. While 5030 (57%) children were within normal BMI ranges between 3 and 5 years of age 175 (2%) were obese. Almost 3% kids who were obese at age 3 became non-obese at age five while 3% who were not obese at age 3 became obese at age 5. 13.2% mothers who delivered vaginally and 21.5% who delivered by CS were obese.

At 3 years: Results showed that a clear link between elective CS and obesity risk could be found at age 3 compared to those kids delivered vaginally (normal).  Overweight risk was linked to emergency CS and not elective CS. Elective CS was not linked to obesity risk at age 3 among appropriate for gestational age (AGA) infants. Small for gestational age (SGA) infants had a median birth weight of 3 kilogram and there was a link between emergency CS and obesity in AGA non-macrosomic kids.

At 5 years: There was a slight link between elective CS and obesity risk when the children were five years old and a similar link was seen between emergency CS and obesity risk as well.

Between age 3 and 5: Here, no association was found between elective CS and any BMI category transition. Kids born through emergency CS were at an increased risk of remaining obese between 3 and 5 years of age while those born through emergency CS were at an increased risk of making any other BMI transition.
This study doesn’t clearly prove that there is a causal relationship between elective CS and childhood obesity. An increased risk of obesity in kids born through emergency CS and not elective suggests that there is no causal effect due to vaginal microflora.

Obesity Risk in Preschool Kids in China
C-section delivery in some Chinese cities exceed 50% and generally too, rates of birth by CS has increased from 18% in 1992 to 40% in 2000. At the same time, overweight/obesity rates of kids also have increased from 12.6% in 1997 to 22.1% in 2009. A group of researchers set forth to analyse the effect of CS delivery and risk of childhood obesity in a large sample of preschool kids. 9103 kids aged 3-6 years from 35 different playschools in 5 different kids were included whose parents were given a questionnaire. It was observed that 8900 of 9103 were valid and hence, weight and height information of all these children were collected. WHO guidelines were taken for branding a kid to be overweight (BMI between 85th and 95th percentile) or obese (BMI ≥95th percentile). Delivery mode was also noted down classifying the child into one of the following categories-vaginal delivery and CS (elective/non-elective).

Information on the mother’s age, education, smoking and drinking status, pre-pregnancy weight, maternal weight, breastfeeding status and the child’s birthweight and sex were noted. Maternal pre-pregnancy BMI was calculated based on maternal height and pre-pregnancy weight and paternal BMI was also calculated based on weight and height values.

Results
67.3% kids were born via C-section delivery. It was moms who delivered after the age of 36, who were obese/overweight before pregnancy and with a higher education level (who gained more weight during pregnancy) who were at a higher risk of CS delivery. Of the total kids, 939 kids who were delivered through CS were obese and around 25% kids were not breastfed. Of the 5992 CS deliveries, 4016 (67%) were bon-elective and 1977 (33%) were elective. Of notable interest is the fact that paternal age, BMI and smoking status affected the delivery mode. CS delivery increased the risk of overweight/obesity in kids, both elective and non-elective types.

Longitudinal Cohort Study: Ireland
A longitudinal birth cohort with phenotyping of mom and infant was used to probe into the exact association between CS delivery, prelabour CS and childhood body composition and growth. Data for the study was fetched from the Screening for Pregnancy Endpoints (SCOPE) study and its follow-up prospective Irish birth cohort, the babies after SCOPE (BASELINE) study.

Participants from the BASELINE study were recruited around their 15th week of pregnancy in which 1774 gave their written informed consent and 1537 of them had infants recruited into the BASELINE study. The researchers segregated mode of delivery into four different categories namely unassisted vaginal delivery (VD), operative VD, prelabour lowest segment (LS) CS and LSCS in labour. Operative VD included the use of either forceps or vacuum for delivery. Whole body density, height and weight measurements for each infant were calculated and the kid was classified as either thin, normal, overweight or obese depending on BMI values.

Result
Of the 1305 infants 943 of them were delivered vaginally while the rest were delivered by CS: prelabour LSCS (12%) and LSCS in labour (15.8%). 13% of infants were macrosomic at birth and 11% were large for gestational age. At 2 years of age, 116 (10.9%) kids were overweight/obese and at the age of 5, the number increased to 118. Around 6 months the mean BMI of infants delivered vaginally and by CS was 17.3 and 17.6.
When infants were 2 months old there was no link between prelabour CS and body fat percentage (BF%) and LSCS in labour when compared to kids delivered through unassisted VD. Infants delivered through CS had higher BMI at six months of age compared to those born vaginally. But there was no link between prelabour CS or LSCS in labour and risk of being overweight/obese at age 2. When the kid was 5 years old, there was a nonsignificant link between prelabour CS and the risk of being overweight/obese. There is no clear evidence to support the link between prelabour CS and offspring being overweight/obese in early childhood.

No Link between Mode of Delivery & Overweight Risk
A research team was interested in the long-term effect of CS delivery on offspring health as CS delivery rates are presently higher than ever. They compared the BMI of almost 1,00,000 male individuals who were 18 years and divided them into three categories based on their mode of delivery-vaginally, elective C-section or non-elective C-section. Results showed that 5.5% and 5.6% of participants delivered through elective and non-elective C-section were obese compared to 4.9% of men delivered vaginally. The researchers commented that the mom’s weight before pregnancy had a greater impact on inheriting obesity or affecting foetal health in comparison to which mode of delivery played a negligible role in determining obesity/overweight risk. Researchers could observe that mode of delivery did not play a strong role in impacting obesity risk of offspring even after accounting for various factors such as BMI, maternal age, gestational age and presence of diabetes, BP and smoking in the mothers.
Mothers should be more concerned about their pre-pregnancy weight and health, take good care of themselves during the pregnancy tenure and focus on delivering a healthy baby rather than worrying about the mode of delivery.

References
The Impact of Caesarean Section on the Risk of Childhood Overweight & Obesity: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6181954/pdf/41598_2018_Article_33482.pdf

Caesarean Section May Increase the Risk of Both Overweight & Obesity in Preschool Children: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-016-1131-5

Association between Caeserean Section Delivery and Obesity in Childhood: https://bmjopen.bmj.com/content/9/3/e025051

Study Debunks Notion that C-section Would Increase Risk of Obesity in the Child: https://www.sciencedaily.com/releases/2019/12/191206152948.htm

Different diets have been implemented for the purpose of weight loss and most of them pass the test of time only as fad diets that don’t last long. But there are some others which have been strongly suggested even by physicians and health experts to resolve various health issues in individuals-such as the DASH or Ketogenic diet. The DASH diet has been approved for lowering hypertension and the Ketogenic diet exists as an effective treatment against epilepsy. Almost 70% of people with epilepsy could have their seizures controlled with anti-epileptic drugs (AEDs) and for those whose seizures are not arrested with AEDs, the Ketogenic diet proves to be an effective treatment plan. Following the diet helps in reducing the number of seizures, severity of each and also evoke other benefits.
​
The Ketogenic diet (KD) is a high fat, low carbohydrate, controlled protein diet used since the 1920s as an effective treatment for intractable epilepsy. Though its only a modified nutrient intake plan, physicians suggest taking up KD only after two suitable medications have been tried and have not provided any fruitful results. KD might be used for adults and children with maximum monitoring done on infants who have been suggested for the diet. It works on the principle that our body uses glucose from carbs as a source of energy. Chemicals called ketones are formed when our body uses fat as an energy source and a fatty acid called decanoic acid might be involved in the way the diet works. The KD mimics the body’s response to starvation by using fat as the primary energy source in the absence of sufficient carbohydrate source. Though the exact process by which ketosis control seizures is unknown researchers hypothesize that ketones have an anticonvulsant effect when crossing the blood brain barrier. It’s a known fact that the various options available for treating kids with pharmacoresistant epilepsy is limited and even surgery is not a viable option for most of them. Almost 30% kids with seizures remain unresponsive to pharmacologic treatment or suffer from extreme side effects of AEDs. It was then that the International Ketogenic Diet Study Group consisting of 26 paediatric epilepsy specialists and dietitians came to a conclusion that KD should be the suggested mode of treatment for those children who failed 2 or 3 anticonvulsant therapies, especially in those with symptomatic generalized epilepsies.

A meta-analysis of 19 observational studies in 2006 showed that six months after starting a ketogenic diet almost 60% kids were relieved from seizures by more than 50% and 30% kids had almost 90% reduction in seizures. It was kids aged 1-10 with generalized seizures who were maximum benefitted by the diet. Another study conducted sometime later on 145 kids aged 2-16 years suffering from daily seizures randomly divided into the diet or control group showed that seizure percentage was lower in the diet group compared to the control group; 28 kids in the diet group experienced 50% decrease in seizures compared to only 4 in the control group who benefited and 5 kids in diet group had 90% reduction in seizures while none in the control group benefited in such ways.

Single-Centre Retrospective Analysis
KD is a valuable option for those with drug-resistant epilepsy (DRE) which can be given for a minimum period of 3 months and continued for several years if it proves to be beneficial. But, constant monitoring of the child is required to keep it effective and prevent the onset of any adverse short-term or long-term effects which might include any effect on the child’s growth. There isn’t much data regarding the effects of KD on the affected kid’s growth-A study by Peterson et al. showed that participants with marked ketosis were characterized by decrease in height for age z-scores which was not evident in those with low or moderate ketosis. The same was also shown by Spulber et al. in a study of 22 kids showing negative link between child growth rate and blood beta-hydroxybutyrate (β-OHB) concentration. A retrospective study by Nation et al. showed that a caloric and protein intake <80% of the recommended values and protein/energy ratio ≤1.4g protein/100 kcal was linked to decreased growth percentile.

The study here probed into growth changes in 34 kids suffering from DRE (n=14) or glucose transporter type 1 deficiency syndrome (GLUT1-DS, n=20) all of whom were treated with KD for 12 months. Inclusion criteria was that kids should be 2-17 years of age, there should be a diagnosis for DRE or GLUT1-DS and treatment with KD done for at least 12 months. Kids with severe organ failure, thyroid disorders or needing enteral or parenteral nutrition were excluded from the study. Growth, clinical and body composition of the participants were calculated at baseline and 12 months after follow-up. Weekly food diaries were assessed to understand the weekly food caloric intake, food preferences and intolerances and total energy intake was formulated based on every patient’s need. Kids aged 3 months-10 years were assessed of their energy needs every quarter while adolescents were analysed every 6 months. The research group ensured that every participant was provided 0.8-1.0 gram of protein per kilogram of body weight from animal sources such as meat, fish, poultry, eggs and milk. All participants took multivitamin and mineral supplements as per their age and sex.

What started as a 1:1 ketogenic diet went to 2:1, 3:1 or 4:1 ratios and participants were assessed for fasting blood ketones, supplements use and for presence of any adverse effects. Each of the participant’s height, weight, BMI and other measurements were taken.

Results
Median age of study participants was 7.5 years, kids with GLUT1-DS were diagnosed at an older age than those with DRE and hence, started with dietary treatment immediately after diagnosis. All participants with GLUT1-DS were on ambulation and did not take AEDs and 10 patients with DRE were on multiple anti-epileptic drugs of which 5 were not able to ambulate. At baseline, there was no difference in height or other parameters between both set of patients. Even after 12 months of study the median height scores did not change significantly from baseline. The kids were put into three growth pattern groups after 12 months of KD-increased (Group-I), tracking (Group-T) and decreased (Group-D) linear growth. There were 6 kids in Group-I of whom 3 had GLUT1-DS; Group-T had 21 patients of whom 13 had GLUT1-DS and Group-D had 7 kids of whom 4 had GLUT1-DS. The three groups did not differ in characteristics at baseline. There was different in energy intake in Group-T compared to Group-I. 11 of 34 kids refused food intake or incomplete meal consumption at intervals. Not much difference in fasting β-OHB levels after 12 months were observed between the three groups. There was an inverse association between fasting β-OHB blood levels at 12 months and height.

While there was no significant difference in height, weight or BMI scores between the three groups at baseline after 12 months it was observed that height and growth velocity scores were lower in Group-D than in Group-I, weight scores were impaired in Group-D and T than in Group-I. There was no difference seen in fat mass percentage between the groups at baseline nor after 12 months.

A 10-Year, Single-Centre Study on Ketogenic Diet
The KD has been used at the Children’s Memorial Hospital, Chicago since the year 1963 and researchers focused on the effect of the diet in patients under the age of 3 in a span of ten year (April 2004 to June 2014). All the patients were grouped into two-early withdrawal or adherent group. The reason behind early withdrawal was questioned and this involved three clinical features-very short-term efficiency of KD, adverse events and implementation and practise of KD. Those kids who underwent 3 months of KD treatment were further classified into 4 groups based on percentage of seizure reduction 3 months-complete seizure control, >90% improvement, 50-90% improvement and <50% improvement. Anyone who experienced >50% seizure control was categorized as responders and others as non-responders. Patients were also classified based on their age into three groups-<1-year-old, 1-2-year olds and >2 years old. Each of the participants’ calorie and protein needs were calculated and vitamin and mineral supplementation was provided based on food intake and nutrient requirements.

Results
109 patients aged below 3 were given the Ketogenic diet and included in the analysis. The median age at which seizures started in them was around 4 months of age and each of them had used medications at least 4 times before starting the diet. More than 50% of them had West syndrome and all of the 109 participants’ EEG was abnormal at the start of the diet. The youngest patient was 3 weeks old. KD was initiated at a 1:1 ratio (fat grams: carbs + protein grams) increasing up to 3:1 on day 3. 20 patients were on a 3:1 ratio, 13 were on a 3.5:1 ratio and 59 were on 4:1 ration. 4.75:1 was the maximum observed ratio and every child reached a fat: no fat ratio of 3:1 or higher except one kid (2.75:1). Solids (33%), liquids (32%) and a combination of both (33%) were given to the kids. 8 of the kids fed on expressed breast milk, median duration of the diet was 1.1 years and one patient suffered from positive urine ketosis at some point of the diet. There was no response in seizures for 3 months of KD administration.
​
But after 3 months, 39% patients (n=42) experienced more than 50% reduction in seizures. Of the 42, 20 (18%) of them accomplished complete seizure control and another 3(3%) experienced >90% seizure reduction. Age was not a matter in enabling seizure reduction in kids following KD. But what surprised the researchers was the fact that a genetic mutation or a chromosomal abnormality in patients improved their response to seizures after starting on the KD diet. Though no adverse effects were seen but constipation was commonly reported in the adherent group who were on the diet for a longer period of time.

This shows that the KD is an effective and safe intervention for kids suffering from epilepsy. But given the advantages, the KD is not suitable for all kids and neither can be called ‘user friendly’ given the time and energy needed to maintain ketosis. Some kids refuse to follow the diet and even parents are stressed when diet-induced social modifications become essential. While many studies report the benefits of the diet the medical consequences of KD are not well documented. For instance, a study by Balaban-Gil et al. showed a 10% rate of serious complications in 52 kids with refractory epilepsy and we even have anecdotal reports of coma and death often blamed on metabolic diseases. Another study by Kang et al. showed that while kids following the diet reaped benefits in seizure control they also started experiencing dehydration and gastrointestinal complications within 4 weeks of diet onset. There were also cases of hypoglycaemia, aspiration pneumonia, serum lipid abnormalities, infectious diseases, electrolyte imbalance and acidosis, hepatitis and acute pancreatitis. Three patients died within 60 days of starting to follow the diet-all of them due to brain damage. But it was also observed that the dropout rate of study participants in the research conducted by Kang et al. was more than the dropout rate observed at other centres. But researchers feel that most complications of KD are temporary and could be managed with effective treatment. Ketogenic diet is complicated maybe even life threatening but with high levels of expertise, experience and monitoring it is possible to make the best of it as much as possible. The diet should be administered only by an expert dietitian who has potential knowledge and expertise in KD.

References
Impact of the Ketogenic Diet on Linear Growth in Children: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683244/pdf/nutrients-11-01442.pdf

The Ketogenic Diet in Children 3 Years of Age or Younger: https://www.nature.com/articles/s41598-019-45147-6

The Use of Ketogenic Diet in Paediatric Patients with Epilepsy : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3434405/pdf/ISRN.PEDIATRICS2012-263139.pdf
​
Food for Thought: The Ketogenic Diet & Adverse Effects in Children: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1198735/pdf/epc_00044.pdf

Exercise might be an integral part of daily routine, a sort of punishment as believed by kids, adolescents and few younger adults too and for few others exercise is their lifeline. While normally a person spends anywhere between 15 minutes and 75 minutes a day exercising there are some who invest 3,4 or 5 hours a day for exercising-it might be their profession, passion or a means to some other end. Too much of anything is not desirable and when individuals start performing too much exercise on any given day, they start feeling extremely tired and even fatigued. High intensity repetitive eccentric exercise causes muscle damage which decreases muscle strength and increases delayed onset muscle soreness (DOMS) and serum creatine kinase (CK) levels.
​
Starting a new exercise schedule is interesting and demanding as it involves planning, performing and balancing the newly formed routine. But beyond all these comes the muscle soreness that demands maximum attention-you might be finding it hard to even get out of bed or raise your hands to brush the teeth. Such soreness is something experienced by most individuals when they start working -called as DOMS. DOMS occurs when exercise causes stress to muscle tissue beyond what its accustomed to. Small microscopic tears occur in the muscle and there is damage to muscle fibre. There is damage to cell membrane and an inflammatory response often caused due to eccentric exercise performance such as running downhill, stepping, weight lift, etc. DOMS peaks 24-48 hours after activity and disappears without a trace 5-7 days after exercise. We know that DOMS is inevitable but there have been different research studies that have tried to control its impact with the help of warm-up exercises, stretches, ultrasound therapy, ice therapy, massage and supplementations but unfortunately, they have not been able to come to a definite conclusion regarding any of them. One must note that DOMS doesn’t spare anyone and even bodybuilders and athletes are bound to experience it.

Exercise needs energy to perform, a lot of energy! This leads to the production of free radicals, lipid hydroperoxides, oxidative stress and changes in blood antioxidant concentration. Such markers of oxidative stress lead to oxidative damage and inflammation paving way for the occurrence of metabolic diseases; they also bring about enhanced exhaustion as well as decreased efficiency. Researchers believe that oxidative stress might also be the reasons for DOMS. Hence, the fitness-conscious individuals have always been interested in minimizing oxidative stress via different methods-such as use of supplements rich in micronutrients such as vitamin A, E and minerals. There is the practise of taking these supplements by athletes and other individuals too but their actual effect on stress, insulin metabolism, lipid profiles, muscle recovery and performance remains unknown. Mankind is interested in trying out different ways and means to achieve a goal and that’s known already. We have different medicinal streams including Allopathy, Homeopathy, Ayurveda and so on-each of them are beneficial in their own way although we don’t have evident proofs supporting their effects on mankind. There has been an increased interest in using alternative medicine for treating diseases such as autism spectrum disorder and now, researchers have shown an inclination to use herbal medications such as grape seed extract (GSE) for decreasing oxidative stress in athletes.

Grape Seed Extract
GSE is one of the important supplements used as an anti-inflammatory agent in traditional medicine. Its also a vital source of oligomeric proanthocyanidine (OPC) that’s an excellent antioxidant compound that is touted to provide protection against free radicals. Its believed that GSE provides almost 50 times higher oxidant-lowering effect compared to vitamin C and E and is also a potent source of flavonoids, linoleic acid fatty acids and phenolic procyanidins. Its been already shown that OPC decreased oxidative and lipid damage to the brain, liver and gastrointestinal mucosa in diabetic animals. Another study by Shawo et al. showed that GSE reduced oxidative stress due to H2O2 while certain other studies have proved that GSE is rich in analgesic and anti-inflammatory properties that’s effective in reducing pain and inflammation due to DOMS.

GSE Effect on Preventing DOMS
A double-blind randomized study with 20 young healthy female students with no history of muscular bruising or regular activity for almost 6 months before the trial was conducted. Inclusion criteria included being in a specific period of menstruation, no steroid and non-steroid anti-inflammatory drugs and antioxidant supplements. All the participants were randomly assigned into one of the two groups-GSE (n=10) and control (n=10) group. Members of the GSE group received GSE as a capsule of 400 mg consuming 1200 mg/day, 7 days prior to exercise for 48 hours while members of the control group received lactose in the same fashion. All of them refrained from consuming any other supplements during this period and after the GSE/placebo supplement, an exercise protocol was followed by each participant-warm up for 15 minutes after which they sat in a chair for help with an assistant. CK and LDH (lactate dehydrogenase) levels were measured by taking their sample blood tests.
​
Results showed that there was no significant difference between the two groups at baseline in CK, LDH and VAS (visual analogue scale used to measure pain intensity). CK increased in both groups 24 and 48 hours after exercise with no significant difference between groups at any time. There was an increase in VAS scores in both groups after exercise compared to before exercise. VAS scores were significantly lower in the GSE group compared to the PLC group, 24h and 48h after exercise. It was observed that though GSE did not decrease CK and LDH enzyme activity its anti-inflammatory properties are helpful in reducing pain after DOMS.

GSE Effect on Muscle Damage After Eccentric Exercise
The study included 16 healthy male students who did not exercise for the past six months, had no musculoskeletal disease, did not smoke and did not take any supplements. Each of them was randomly assigned to either the GSE (n=8) or control (n=18) group. Each of them performed 2 sets of eccentric exercise consisting of 25 repetitions each with a rest time of 5 min between sets.

Participants in the intervention group consumed GSE extract in capsule form (300 mg) with water once per day in the evening up to 72 hours after eccentric exercise. The placebo consumed capsules containing starch in the same manner. Each of the participant’s maximum muscle strength was measured and the visual analogue scale (VAS) was used to measure muscle soreness. Blood samples were taken to measure CK levels. Results showed that there was no significant interaction between GSE supplementation and maximum muscle strength and muscle soreness. But CK levels showed a significant decrease between GSE and placebo groups, there was a significant decrease in CK levels 96h after exercise in the GSE group compared to the placebo group. This study showed that acute supplementation with GSE after exercise did not affect maximal muscle strength and muscle soreness in the present study.

GSE Supplementation & Effects on the Biomarkers of Oxidative Stress in Female Volleyball Players
This was a randomized, double-blind placebo-controlled trial which included 40 female volleyball players aged 14-42 years after imposing several exclusion and inclusion criteria. All of them were split into two groups-group 1 received 300 mg of GSE (n=20) and group 2 received placebo pearls (n=20) twice a day for eight weeks alongside lunch and dinner. Weight, height and BMI measurements of all participants was taken. Fasting blood samples were taken before and after the intervention-total antioxidant capacity (TAC) of the plasma was measured, total glutathione (GSH) and malondialdehyde (MDA) levels, nitrite/nitrate (NOx) and fasting plasma glucose (FPG) were measured using different methods. The homeostatic model of assessment for insulin resistance (HOMA-IR), the homeostatic model of assessment for beta cell function (HOMA-B), and the quantitative insulin sensitivity check index (QUICKI) were also measured.

Results showed that mean age, height, SBP (systolic blood pressure) and DBP (diastolic blood pressure) were not statistically different between the GSE and placebo groups nor were mean weight and BMI before and after the 8-week intervention period. There was no significant difference found in dietary micro- and macronutrient intake between GSE and placebo groups. There was a significant rise in plasma GSH and significant decrease in MDA and serum insulin concentration levels, HOMA-IR and HOMA-B. GSE had no effect on CPK, TAC, NO, FPG and lipid concentrations compared to placebo. Within-group differences showed a significant decrease in total-/HDL-C in the placebo group. The study showed that administration of GSE for eight weeks in female volleyball players showed beneficial effects on some biomarkers of oxidative stress and insulin metabolism parameters.

References
Delayed Onset Muscle Soreness (DOMS) in Young Healthy Female Students: http://www.sportscienceresearch.com/IJSEHR_201931_03.pdf

Effects of Acute Grape Seed Extract Supplementation on Muscle Damage After Eccentric Exercise: https://www.sciencedirect.com/science/article/pii/S1728869X18303344

Grape Seed Extract Supplementation & the Effects on the Biomarkers of Oxidative Stress & Metabolic Profiles in Female Volleyball Players: http://ircmj.com/en/articles/16766.html

Mankind is inching towards worsening quality of life with the proliferation of disruptive diseases and health problems. Diabetes and infertility are two of the common obstacles faced by many individuals in today’s life. Juvenile diabetes is extremely common these days and a greater number of middle-aged people are victims of type 2 diabetes mellitus (T2DM) owing to inappropriate lifestyle practises and social factors. Fertility rates don’t seem to be positive either-plenty of couples prefer ART methods for conception failing natural conception and there are others who don’t succeed in either. This again, is due to diminishing sperm quality, delayed pregnancies due to career/financial demands and likewise. Statistics show that almost 17% couples seek medical help for fertility treatment indicating deterioration in human reproductive health. This has elicited the attention of researchers and people worldwide on the reasons behind decreasing sperm quality and male fertility rates.

There has been ample discussion on obesity, sedentariness and lifestyle as the key reasons behind decreasing fertility rates in men but the impact of diabetes mellitus (DM) on male reproductive health remains arguable. Worldwide, there are more than 400 million people who suffer from diabetes, both type 1 and type 2. Each of the types has a different history behind its prevalence and brings about different effects on the human body. DM has the ability to garner long-term damage, dysfunction and failure of various organs including loss of vision, renal failure, foot amputation, foot ulcers, cardiovascular symptoms and sexual dysfunction. Diabetes causes substantial effect on the male reproductive system and glucose metabolism is an important event in spermatogenesis. There exists a number of studies, both in animals and humans, that confirm the deleterious effect of diabetes on sexual functions such as semen parameters, nuclear DNA fragments and chromatin quality. Animal models present us with better perspectives in this regard-all of them show decreased fecundity (potential to reproduce). We also have a study which shows that DM is linked to important changes in the metabolomic profile of the testis and a higher percentage of both sperm nuclear and mitochondrial DNA damage.

Diabetes Effect on Epigenetic Regulation of Spermatogenesis
Sperms primarily focus on transferring male haploid DNA to female DNA via a series of mechanisms. Sperm cells are used to trigger fertilization with the female egg and need energy to maintain motion competence after epididymal maturation as they are immobile in the testis. Much adenosine triphosphate (ATP) in sperms is consumed for maintaining this motility. They seek energy mainly in the form of sugar including glucose, fructose and mannose via two metabolic pathways namely anaerobic glycolysis and oxidative phosphorylation. Glucides are polar molecules rich I -OH groups capable of passing the lipidic bilayer in a very slow and inefficient way. An important role of supplying cells with energy is realized by different membrane proteins that can actively (sodium-dependent glucose transporters [SGLT]) or passively (glucose transporters [GLUT]) transport hexose through lipid bilayer. Proteins belonging to SGLT are primary transporters of sugars, especially glucose; proteins of GLUT too transport sugar besides other hexoses such as fructose and mannitol, vitamins and amino sugars. GLUTs mainly function to help the sperm adapt to changes in the environment, metabolic requirements etc but the presence of an abnormal environment such as diabetes can cause dysfunction in nutrient transport leading to decreased fertility rates and adverse foetal outcomes. A study examining GLUT expression of GLUT8 and GLUT9 in sperm and testes in 2 genetically modified diabetic rats showed that rats lacking GLUT9 protein had low sperm motility and decreased fertilization rates. Absence of insulin or hyperglycaemia was the reason behind impaired GLUT9 transcription which shows that insulin and glucose are important to sperm maturation. Treating these mice with insulin showed that sperm motility and concentration improved significantly proving that insulin played a dominant role in sperm quality. The study also showed that it was glucose and not fructose that was needed for fertilization-for sperm oocyte binding and embryo viability in the mouse.

Diabetes Impact on Male Fertility
Type 1 and type 2 diabetes, both affect testicular function and spermatogenesis. Type 1 diabetes brings about structural defects with nuclear and mitochondrial DNA fragmentation, reduced motility and decreased zona pellucida binding in sperm cells. Polyamines in sperms have antioxidant capability, are antiglycating agents and offer protection against structural/functional advanced glycation end products (AGE) modifications. Changes in antioxidant expression could be a triggering factor for oxidative stress (OS) and the number of sperms displaying the receptor for advanced glycation end product (RAGE). The protein content in sperms is normally higher than what is found in the sperm of type 1 diabetic men. Increase in AGE in seminal plasma of type 1 and type 2 diabetic subjects shows that glycation and increased OS play eminent roles in reproductive system dysfunction. Diabetic people suffer from increased levels of RAGE protein and DNA fragmentation in sperms which suggests clearly that RAGE plays a pivotal role in disturbing sexual functionality in diabetic men. Motility rates of these sperms too change owing to alterations in mitochondrial DNA in diabetes.

Researchers have proved that seminal plasma nitrate/nitrite levels and 8-hydroxydeoxyguanosine (8-OHdG) levels are observed to be drastically high in the diabetic group-such high nitrate/nitrite levels must be the work of ROS-induced DNA damage that’s related to 8-OHdG levels but not sperm parameters. But this does not affect sperm motility in any way. On the other hand, malondialdehyde, one of the final products of lipid peroxidation and well-known markers of OS is present in abundance in the semen of infertile men with T2DM and has also been negatively linked to sperm density, total sperm count, progressive motility and normal forms. Controlling glycemic levels in such patients helps in preventing sperm damage. A research by Paasch et al. showed that type 1 diabetes, type 2 diabetes and obesity are accompanied by multiple changes in the sperm proteome.

Absence of normal insulin levels decreases testosterone and Leydig cell function and also FSH, which in turn affects LH levels. Such FSH decrease affects sperm output and fertility. Streptozotocin (STZ) injected in mice for a month showed metabolic adaptations such as increase in efficiency of mitochondrial ATP production. Research shows that fertility rates in the STZ-injected mice were much below than that in the normal group. Even in the fertilized zygotes, embryo development rates to the blastocyst stage in two diabetic models were lower than that in controls. STZ-injected rats also displayed defective sperm maturation and insulin replacement prevented these changes partially or completely.  

Impact of Diabetes on Assisted Reproduction Treatment (ART)
A research set forth to analyse whether presence of diabetes in men affected ART outcomes. Men who reported as diabetic the first time they visited the centre for fertility treatment were considered for the study. Information fetched was split into three data stream which included male, female and assisted reproduction treatment. Information regarding date of birth, diabetes type and duration, smoking status and nature of the treatment was recorded for men. Sperm data regarding volume of ejaculate, sperm concentration and extent of liquefaction were also noted. In the case of female, information on number of cycles, number of eggs harvested, number fertilized, whether embryos were frozen and other clinical outcomes were measured. There were 80 couples among whom 18 diabetic men (aged 28-51 years) and their partner (aged 24-41 years) had undergone assisted reproductive treatment between 2004 and 2007.

Reasons for infertility was attributed to idiopathic male factor for 4 couples, polycystic ovary syndrome for 2 couples, unexplained causes for 10 couples, hyperprolactinaemia for one couple and endometriosis for one couple. While it was the first child for all female participants one subject had three previous miscarriages and another one had suffered from one miscarriage. On an average, men had suffered from diabetes for around 17 years. 38% reported that their levels were well-controlled, 27% told that it was poorly controlled and the other 35% reported that they were unaware of the status. Of the 18 diabetic males, 2 (11%) of them had retrograde ejaculation and two were azoospermic, none of them tested positive for antibody presence, liquification was normal for 13 subjects, reduced motility was present in 80% subjects and 60% showed decrease in percentage of normal forms.
Of the 18 couples who opted for ART 5 of them underwent 10 circles of IVF, 12 underwent 19 cycles of intracytoplasmic sperm injection (ICSI) and one couple underwent two cycles of IVF and one cycle of ICSI. 5 couples who started with ICSI opted for frozen embryo transfer (FET) (seven cycles). For IVF, a 68% fertilization rate was possible for 66 harvested eggs. In spite of 12 embryo transfers there was no signs of pregnancy. In the case of ICSI a fertilization rate of 62% was achieved for 198 harvested eggs. Here, despite 18 embryonic transfers there was only one clinical pregnancy represented and a combined IVF/ICSI clinical pregnancy rate per embryo transfer of 3.3% for fresh cycles occurred. FET showed better outcomes with 29% clinical pregnancy rate and no miscarriage or complications were present in any of the deliveries.

Type 1 & Type 2 Diabetes Effects on Sperm Quality
Here, study participants were divided into three groups-38 patients with DM1, 55 with DM2 and 100 healthy fertile subjects as controls. DM1 patients were further divided into three groups depending on the duration of the disease- <5 years, between 5 and 10 years and >10 years. All the participants underwent a sperm analysis, a flow cytometric sperm analysis, assessment of the presence of urogenital infection, oxidative stress evaluation and an andrological evaluation. Sperm parameters showed considerable difference between the three groups. Individuals with DM1 and DM2 showed decreased sperm concentration compared to controls while DM2 participants showed slightly lower sperm quality compared to DM1 individuals. Motility rates were lower in DM1 and DM2 individuals compared to controls, much lower in DM1 compared to DM2. Semen fluid volume was comparatively lower in patients with DM1 though not much significant in DM2 participants when compared to controls. Sperms having normal forms were in lower percentage compared to controls. Sperm vitality decreased in DM2 participants and one patient had higher degree of DNA fragmentation spermatozoa compared to DM1 patients and controls.

This study showed that type 1 diabetes patients have low ejaculate volume due to increased oxidative stress which can also alter other conventional sperm parameters. Type 2 diabetes patients suffer from increased concentration of seminal fluid leukocytes that raise OS levels damaging sperm parameters, sperm DNA and vitality.

All these show that glucose metabolism plays a pivotal role in sperm cells and any type of diabetes could have detrimental effects on male fertility, specifically sperm quality.

References
Diabetes Mellitus & Infertility: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5980990/pdf/fendo-09-00268.pdf

Male Diabetes Mellitus & Assisted Reproduction Treatment Outcome: https://www.rbmojournal.com/article/S1472-6483(10)00652-8/pdf

The Effects of Diabetes on Male Fertility & Epigenetic Regulation During Spermatogenesis: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4814953/pdf/AJA-17-948.pdf

Advertisements are shown with the only motive to lure consumers to buy products. Marketing people make the products as colorful, healthy and lovable as possible bringing in the right elements to connect with the viewers instantly. For instance, ads for toothpaste highlight the major medicinal ingredients such as spearmint and peppermint extracts used to make our teeth stronger and healthier. Mint is common but what is this spearmint? It’s a herb similar to mint that’s pleasant-smelling with a sweet taste and hence, often used in products such as mouthwashes, toothpaste and other health-food products too. Yes! The green leaf that you’ve assumed until now to be pudina (mint) is spearmint! Its often used as a therapeutic agent for its aplenty of health benefits (claimed) right from indigestion and gas to headache, toothache and cramps. There are some proposals for its use as an antioxidant and an agent to solve hirsutism in women. The latest of them is its benefits in improving memory and learning that could be helpful against age-related cognitive decline.
​
Ageing & Cognition
The cognitive process includes memory, attention, perception, problem-solving and decision-making skills and any disruptions in the neural physiology supporting cognition can lead to impairment and cognitive dysfunction. Memory capabilities differ individual to individual and there are some who are extremely forgetful even at a young age. Forgetfulness in school-going children can be extremely problematic for the kid as he/she often secures low marks at school. In my childhood days, I had a close friend who could not even remember three definitions precisely. His worried mother sought the help of friends and family among whom one of them suggested giving the boy a handful of the Indian pennywort (vallarai in Tamil, gotu kola in Hindi and mandukaparni in Sanskrit) extract which worked well for him. Nowadays, that’s what has been officially termed as supplements-we have got an entire range of them including multivitamins, minerals, folate, anti-ageing, weight-loss and the list goes on and on.

Not all supplements have government approval but still remain popular among people for its host of benefits. Supplements for improved brain structure and function contain different nutrients and there has been increased interest shown in using herbal preparations as cognitive-enhancing agents commonly called as nootropics. Nootropics might be used in everyday life for improved attention and focus while athletes and active individuals too use them for enhancing performance though we have negligible evidence showing increased cognitive skills to improve performance. While members of the mint family have been generally proposed for resolving nervous system disorders, respiratory and gastrointestinal issues recent research show that they also benefit memory due to their polyphenolic constituents. Spearmint is a member of this distinguished mint family that includes more than 900 species such as sage, rosemary and lemon balm.

Ageing is an inevitable process that’s commonly linked to cognitive decline including memory loss and decreased processing speed. Age-associated memory impairment (AAMI) is commonly linked to normal brain ageing and with the ageing adult population living through extended years we need to ensure their quality of life and preserve cognitive ability as much as possible. A variety of nutrients that have been studied for their neurocognitive benefits show different degrees of efficiency. There are studies that show improved cognitive skills after consuming plant extracts from the Lamiaceae family due to the polyphenols present in them. Free radicals and oxidation decrease cognitive function and as extracts from plants such as rosemary from the Lamiaceae family have increased antioxidant property they benefit in memory preservation. This is especially true in the case of rosmarinic acid (RA) that improves antioxidant status in neuronal cells and hippocampal tissue. A mouse model that used RA extract showed hopes for Alzheimer’s disease too. So, spearmint extract too might contain other phenolic compounds apart from RA that benefit cognition in humans. The first hint that dried aqueous extract from spearmint could support cognition was obtained from a mouse model of aging; the possibility of spearmint extract impacting working memory was deciphered from a study of older adults (who self-reported memory impairment) whose results showed that consuming the extract for 30 days improved cognitive performance.

Effect of Spearmint Extract on the Ageing Population
A randomized double-randomized placebo-controlled study was conducted on generally healthy men and women. The participants were included or excluded based on several criteria and their cognitive performance was measured using the Cognitive Drug Research (CDR) System and a word recall test was also conducted. The cognitive assessment was administered at -0.75, 0.5, 2, 4 and 6h during each visit at days 0, 45 and 90 respectively. There were 11 tasks including immediate word recall, simple reaction time, digit vigilance, choice reaction time, numeric working memory, word recognition and picture recognition that assessed attention and information processing, episodic and working memory, executive function and motor control.

Water-extracted dry spearmint extract that contained 14.5% RA and 24% total polyphenols including lithospermic, caftaric and salvianolic A and B acids and many others were made into study capsules that contained 300-450 mg of the spearmint extract. All the participants were instructed to consume two capsules with breakfast equivalent to 0, 600 or 900 mg/day of extract for 90 days. Mood of the participants were analyzed using the profile of mood states (POMS) questionnaire and were categorized as tension-anxiety, depression-dejection, anger-hostility, vigor-activity, fatigue-inertia, confusion-bewilderment and a total mood disturbance (TMD) score. Sleep was evaluated using the Leeds Sleep Evaluation Questionnaire (LSEQ) with four domains namely ease of getting to sleep, quality of sleep, awakening from sleep and behaviour following wakefulness. The 90 participants who were selected based on various eligibility criteria visited the research clinic in the morning for each test day (days 0, 45 and 90) after fasting for 10-14 h. All of them completed the POMS and LSEQ questionnaire and consumed a standard breakfast meal. All of them were requested to avoid any vigorous physical activity, alcoholic beverages, caffeine and tobacco use before and during all test visits.

Results
The 90 subjects were split into three groups-placebo, 600 mg spearmint extract or 900 mg spearmint extract. The cognitive drug research (CDR) battery identified a treatment effect in quality of working memory for all individuals who were supplemented with 90 days of spearmint extract. Results showed that:

1. Subjects who consumed 900mg/day of extract showed improved cognitive scores compared to those who consumed 600 mg/day or placebo. It improved by almost 22% for the 900 mg/day compared to 5% and 7% in the 600 mg/day and placebo group respectively.
2. There was significant improvement in spatial memory in comparison to baseline, almost 17% for those consuming 900 mg/day of extract compared to those consuming 600 mg/day (3%) or placebo (6%) group. There was no other differences in cognitive skills that were detected statistically.
3. There was a trend for improvement observed in those administered 900 mg/day of spearmint extract versus the other two groups
4. There was significant difference observed in ratings of sleep after the extract was given to participants. Those who consumed 900 mg/day of extract showed improved ability to get sleep versus subjects consuming placebo. They also displayed improved behaviour following wakefulness relative to those consuming 600 mg/day of spearmint extract. Quality of sleep or ease of awakening from sleep showed no differences.

The study proves that healthy older adults taking 900 mg/day of spearmint extract displayed improved working memory and self-reported ability to get to sleep.

Spearmint Extract Effects on Healthy Men & Women
To check whether the cognitive advantages of the extract also has a positive impact on the younger population a pilot study was conducted in young and healthy men and women who were supplemented with the same amount of extract as done in the above trial on ageing population.

A randomized, double-blind, placebo-controlled study including 1 screening visit at baseline (day 0) and 3 treatment visits at day 7, 30 and 90 was conducted on 142 participants who were placed in the 900 mg of proprietary spearmint extract (PSE) or placebo (PLA) group. The individuals were selected based on various criteria and stratified into 4 groups-young (18-35 years)/male, older (36-50 years)/male, young/female and older/female. Subjects were called as recreationally active when they completed ≥1 hour and ≤6 hours of moderate to vigorous physical activity every week. All the participants logged exercise, sleep and 3-day food logs and were read to refrain from consuming caffeine-containing products for 10 hours, alcohol consumption and any physical activity for 24 hours and any strenuous resistance exercise for 48 hours before and during all visits.
Cognitive skills were assessed using a computerized set of tests that included finger tapping, symbol digit coding, shifting attention, continuous performance, reasoning, 4-part continuous performance and digit span. The results from all the tests were combined for cognitive domain scores consisting. Here also, sleep was assessed using LSEQ administered at 7, 30 and 90 days respectively and mood through POMS. Three-day food logs were collected every time before the supplementation period to ensure that the diets remained the same throughout the study.

Results
69 participants were in the PLA group and 73 were in the PSE group but only 54 and 52 in the PLA and PSE group completed the study successfully. The treatment showed significant improvement for sustained attention at day 30 and 90. For complex attention, there was improvements seen in the PSE compared to the PLA at day 7. Good results were observed in PSE vs PLA in the shifting attention test for reduction of errors at day 7 and for reaction time of correct response at day 7 and at day 90. There was no commendable difference in any of the domain scores for LSEQ and mood scores too did not change much after extract administration. But there was improvement in quality of life in psychological and spiritual domain rating after administration of the extract.
Another study on recreationally active men and women who received 900 mg of PSE for testing reactive agility showed positive results.
 
References
Spearmint Extract Improves Working Memory in Men and Women with Age-associated Memory Impairment: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5779242/

The Attention-enhancing Effects of Spearmint Extract Supplementation in Healthy Men & Women: https://www.sciencedirect.com/science/article/pii/S0271531718308431

Efficacy of a Nootropic Spearmint Extract on Reactive Agility: A Randomized, Double-blind, Placebo-controlled, Parallel Trial: https://jissn.biomedcentral.com/articles/10.1186/s12970-018-0264-5

The shopping list is ready and you are at the supermarket to pick and choose the essentials for the month. Though you might be doing it on a weekend there isn’t much leisure time to shop at your desired pace. In such situations, it would be extremely helpful if the nutrition labels present in the pack is color-coded for quicker understanding, isn’t it? Nutrition labels on food products help us choose between various products and restrict our consumption of foods that’s high in fats, sugars and salt. The information provided is for 100 grams or per portion of the food and nowadays, due to increased interest in choosing healthier food options food manufacturers are highlighting fat, salt, sugar and energy content on the front of the packaging along with reference intake values. Some of these nutrition labels use colour codes such as red, amber and green and this helps us decode the fat, salt and sugar content of the food in a glance. 
​
This color-coded labelling is also called as ‘traffic light’ labelling that has been proposed as a public health intervention to minimize obesity risk by attending to the dietary intake of individuals. These occur as a part of the front-of-pack (FOP) nutrition rating systems that clearly detail the calories and nutrients present within the food pack. We already have studies that have given a green signal to traffic light food labelling as an excellent initiative to fight against obesity and a modelling study in Australia found it to be a cost-effective method for preventing obesity. Studies of summary indicator FOP systems show that this system is in fact efficient enough to promote healthier product reformulations by manufacturers-this was seen in Canadian manufacturers where they successfully reduced sodium in foods by 80-150 grams. There are different studies that show that sodium, fat and sugar consumption could be reduced if individuals replaced their regular foods with those that follow the FOP system criteria.

Canadian Study on Replacing ‘Red’ Label Foods with Healthier Options: A Nutrition Analysis
Fat, energy, sodium and sugar intake of Canadian adults were calculated using data from the Canadian Community Health Survey, Cycle 2.2 Nutrition (CCHS 2.2)- a national survey that’s aimed at providing authentic data regarding food and nutrients intake of Canadians. The CCHS 2.2 included a sample of 35,107 individuals aged 0 years and above whose food and nutrients intake was calculated through a 24-hour dietary recall. The present research primary included Canadian adults aged 19 years and above, excluded pregnant and breastfeeding women and also those whose food intake data was not available. The different foods consumed by individuals were color-coded in red, amber or green depending on the criteria for food and drinks described in the UK’s ‘Guide to Creating a Front of Pack (FoP) Nutrition Label for Pre-packaged Products Sold Through Retail Outlets’. This was used as the measure to compare against the fat, sodium and sugar intake of foods and drinks.

Those foods that had red color codes were replaced with similar foods that did not have the code for any of the nutrients. Whenever possible, the original food was replaced by the same food from a different brand that provided a healthier option and every effort was taken to ensure that the replaced food was as good as the original choice. For instance, lean ground beef was replaced with extra lean ground beef. There were also instances where some foods were replaced by the same foods but prepared in a much more nutritious manner. But when replacement was not possible the foods were not replaced.

Results
Totally, Canadian adults consumed 5655 unique foods and 495 unique beverages and it was found that 52% foods and 13% beverages contained at least one nutrient that qualified for a red traffic light. On analysis, it was seen that sodium was the nutrient associated with most (27%) red traffic lights while sugar was the nutrient that was least (14%) associated. For beverages, sugars was the nutrient that was mostly (10%) linked to red traffic lights while sodium and fats were least associated (2%). Though replacements for all foods were not possible, the percentage of foods and beverages that qualified for at least one red traffic light dropped to 40% and 2% respectively.

The traffic light food labelling helped Canadian adults reduce their overall intake of energy, total fat, saturated fat and sodium compared to baseline-calorie intake reduced by 5%, total fat by 13%, saturated fat by 14% and sodium by 6% among Canadians. Men reaped maximum benefits as they consumed 122 fewer calories, 12 g less total fat, 4 g less saturated fat and 199 mg less sodium under this food labelling model. The only nutrient that did not show considerable change was sugar. It was amazing to find that total intake of calories and fat were reduced to below recommended Daily Values and this included women’s total intake of saturated fats as well. This study shows that the traffic light labelling system has a positive impact on the individuals’ total nutrient and calorie intake decreasing the consumption of fats, sugars and sodium.

Sustenance of Dietary Changes Possible with Traffic Light Diet
The Massachusetts General Hospital (MGH) studied the nutrient intake of their employees implementing the traffic light diet in their hospital cafeteria with simple ‘traffic-light’ symbols-the program was devised such that green labels indicated healthiest foods, yellow labels indicated less healthy foods and red labels the least healthy ones based on positive and negative criteria. Details whether the main ingredient was fruit, vegetable, whole grain and likewise with the amount of saturated fat was also mentioned. The food habits of 5,695 employees were tracked via the purchases made once after the labels were added and once again after product-placement changes made healthier choices accessible. This analysis remained in place for 2 years.

Results showed that the purchases of red-labelled foods decreased while the proportion of green-labelled foods purchased increased. Such kind of labelling paved way for greater calorie reduction over the two-year period with the red-labelled foods contributing to major calorie reduction. On the whole, besides reducing total calorie intake the employees were also eating nutritious foods that contribute towards their total calorie intake. Some employees even lost up to 2 kg over time. This is not a weight loss program but one that aims at achieving a steady weight maintenance by individuals instead of allowing them to gain weight. This might be a good start for reversing the obesity epidemic. Organizations conduct wellness programs that help improve well-being of employees but such programs happen only for a short period. But this kind of an intervention is a continuing affair where people are exposed to it daily at work and in the long run it becomes a lifestyle practice. The traffic light labels could be implemented in all workplaces as employees love to eat well but don’t have enough time to read and decide. In such scenarios, the labelling helps them realize when they are about to make an unhealthy food choice and motivate them to choose a better option.

Green, Amber & Red: What Do Each of the Colours Stand For?
The colour codes depict whether a product is high (red), medium (amber) or low (green) in saturated fats, fat, salt and sugar and the total energy provided by it. Going by the color codes helps you choose the right food. For instance, if you would like to go for a veg roll read the color codes to decipher the nutrient content:

Green: If the label is mostly green this is a clear indication that the food is low in that nutrient (fat, sodium or sugar) and you are about to make a great choice.

Amber: This is an indication that the product is neither low nor high in that nutrient and it is always ok to eat foods that have amber on the labels any time.

Red: This is not a declaration to avoid such foods totally but a warning sign that they are high in fats, sugar and sodium. It is always recommended to decrease consumption of red-labelled foods and if you wish to have them, eat them as rarely as possible in minimal quantities.

References
Traffic-light Labels Could Reduce Population Intakes of Calories, Total Fats, Saturated Fats and Sodium: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5300258/pdf/pone.0171188.pdf

Traffic Light Food Labels Reduce Calories Purchased in Hospital Cafeteria: https://www.sciencedaily.com/releases/2019/07/190710134014.htm

Helping You Eat Well: https://www.nutrition.org.uk/healthyliving/helpingyoueatwell/324-labels.html?start=3

An unmarried man is an eligible bachelor even during his late 30s or 40s while women don’t find themselves a suitable groom as easy as men once they cross early 30s as the society fears that a woman’s reproduction capability and the strength to bear a child decreases as she grows old. We even fear that the child might be born with disorders and complications. The health of the lady remained the sole priority even before conception to ensure a healthy baby but as our knowledge base is expanding, we seem to accept the fact that men play a vital role too. Their health before conception has a greater say in the healthy outcome of the offspring.
​
The dad’s age too is being considered as a risk factor for the offspring’s health. Advanced paternal age (APA) at conception has been linked to numerous negative outcomes such as low academic achievement, hyperactivity and suicide. Maternal and paternal age is linked to neurodevelopmental disorders and more prominently enhancing the risk of autism spectrum disorder (ASD). Men who father a child at an older age increase the risk of congenital disorders such as Apert syndrome, craniosynostosis, situs inversus, syndactyly, cleft lip or cleft palate and hydrocephalus. The major reason quoted behind the occurrence of diseases such as ASD and schizophrenia is the prevalence of the increased risk of mutations that occur in the germline of the dads. Hence, getting to understand the relationship between paternal age and ASD can help in shedding light on the biological pathways resulting in ASD.

Advanced Paternal Age Increases ASD Risk in Offspring
Associating paternal age with ASD risk started as early as during the 1970s and the study elaborated here is a population-based cohort study to test this theory. It includes a total of 3,78,891 individuals born during 6 consecutive years of whom only 3,18,506 of them had data on paternal age at birth. Information on maternal age at birth was obtained for 1,32,271 people using paternal age data.

Paternal age was categorized into four groups: 15-29 years, 30-39 years, 40-49 years and above 50 years. Results for age was presented in terms of a 10-year increase in paternal age. Maternal age too was divided into 3 groups corresponding to paternal age categories: 15-29 years, 30-39 years and above 40 years. Results showed that the risk of ASD was around 8.4 cases per 10000 persons. It was observed that the risk of ASD increased with increase in paternal age. There were no signs of ASD risk in offspring of the youngest fathers as fathers younger than 20 years had no offspring with ASD. The risk of ASD almost doubled in men who were 10 years older.

Researchers propose that this increase in risk of ASD with increasing age could be due to mutagenesis which was initially called as the ‘copy error’ hypothesis by Penrose according to which new mutations could arise, propagate and accumulate in successive generations of sperm-producing cells. These might be chromosomal abnormalities that could possibly link paternal age with autism. Another reason could be imprinting-a form of gene regulation where the gene expression depends on whether the allele was inherited from the male or female parent in the previous generation. Imprinted genes that are paternally expressed silence maternal gene expression. Only one parental allele is expressed while the other remains silent due to DNA methylation. While the methylation pattern is maintained in somatic cells it is erased and re-established late in spermatogenesis for paternally imprinted genes, a process that could become impaired as age advances-this stands to be considered in the case of autism.

Effect of Paternal Age in Neurodevelopmental Disorders
We repeatedly research and talk about the link between APA and ASD as autism is more common these days that earlier but it was schizophrenia that was the first neuropsychiatric disorder that was linked to APA. Various studies showed that the risk of the disorder increased with paternal age increase though the risk degree differed between the studies. Risk for the disorder was already high for offspring of fathers in their mid-to-late 30s increasing as the paternal age increased. Those in their 40s during conception were at a 2-3 times increased risk of becoming a dad to a schizophrenic child compared to those in their 20s during conception. The link between APA and autism was reported first by Reichenberg et al. The risk with increase in age was on similar lines as for schizophrenia-greater risk in those aged mid-30s and above during conception.

Those studies focusing on the transgenerational persistence of APA-autism link showed conflicting results that the age of the maternal grandmother and maternal grandfather was linked to a higher risk of autism. Sullivan et al. reported that family history of schizophrenia and bipolar disorder was a risk factor for autism. Likewise, the presence of autism during early stages of life increases the risk of schizophrenia development during later stages. The reasons behind this link is usually attributed to genetic factors or genetic mutations in paternal gamates that arise as a consequence of ageing. The behaviour of men delaying fatherhood generally includes social withdrawal and social aloofness that’s greatly related to a higher genetic risk for autism or schizophrenia. Kids born to men with genetic variation are at an increased risk of such disorders irrespective of the father’s conception age. Though a study by Nilsen et al. showed that men who fathered their first child at an advanced age were surrounded by health problems and risky health behaviours other studies did not find any link between behavioural traits and paternal age.

We have numerous debates surrounding the inherited vs de novo effects of APA. Comparison effects of delayed fatherhood and advancing paternal age many studies support that it’s delayed fatherhood that’s increasingly linked to risk of schizophrenia. But a study by Hultman et al. showed that the child with the disorder is generally born later in the father’s life showing that age-dependent factors and not men’s stable traits affect its prevalence. All of the published animal studies show that advanced paternal age at conception is related to behavioural changes relevant to autism and schizophrenia.

Genetic Mutations
An infant is born unto this world with around 60-80 genetic mutations but these are enhanced to a greater degree in individuals with autism and schizophrenia. Genetic mutations that multiply as the paternal age increases affect the APA effect to a greater extent. Research shows that mutation rates double every 16.5 years expressing the risks associated with delayed fatherhood from the age of 25 to 40. Age-related increase in genetic mutations is larger in male than in female by almost 3-fold times and most of the genetic mutations in offspring are primarily from the father.

Selfish Spermatogonial Selection

According to this hypothesis, stem cells with mutations at certain loci gain selective advantage over non-mutated spermatogonial stem cells expanding clonally and becoming prominent in the germline. Activating mutations involved in receptor tyrosine kinase pathway enhance growth processes leading to abnormal proliferation of spermatogonial stem cells that carry these mutations via a process called oncogenesis. The disease phenotypes linked to the mutations make it unlikely for the mutations to be passed over multiple generations making it mostly unsuccessful for extrapolating the hypothesis for complex disorders like autism and schizophrenia. A study by Goriely et al. showed that the genes that were responsible for the selfish behaviour of spermatogonial stem cells belong to the RTK/RAS/MAPK pathway-one of the molecular modules that’s rich in deleterious variants in neurodevelopmental disorders. It is a common opinion among researchers that analysing the selfish selection hypothesis plays an integral role in triggering genetic mutation origins of APA effects.
​
APA and neuropsychiatric disorders also change based on epigenetic effects -the epigenetic markers regulate gene expression in offspring showing that paternally acquired factors affecting the offspring go beyond those proposed by the genome sequence alone.

DNA Methylation: This is the commonly studied epigenetic modification playing integral role in gene regulation. DNA methylation marks are stable, modification acquired are maintained in daughter cells accumulating over paternal lifespan in a similar fashion as de novo genetic mutation. It is to be noted that epigenetic programming occurs twice during fertilization-once before birth in embryonic primordial germ cells and then followed by establishment of new methylation patterns that’s different in male and female embryos. The programming once again occurs at fertilization. Ageing brings about changes in epigenetics and DNA methylation levels help in predicting chronological age of humans. It was Malaspina in 2001 who first proposed that age-related epigenetic modifications mediated APA effects. But, age-related disruption of normal DNA methylation in gametes cannot account for the father-to-offspring transmission of the APA effect. Even before the blastocyst stage paternal methylation marks are erased with only those in the imprinted regions remaining in the embryo’s somatic cells. So, the time frame within which paternally acquired non-imprinted DNA methylation marks could affect offspring development is scarce.

Genomic Imprinting: Imprinting is a complex phenomenon where differential DNA methylation in paternal gametes is linked to monoallelic gene expression in offspring. These imprints are seen in parental germline, inherited after fertilization, erased in fetal germline and later re-established in the offspring. The imprinting regions regulate gene expression which are found in both sexes and autosomal chromosomes characterized by age- and tissue-specific expression patterns. They also play a vital role in early development regulating placental formation and functioning and also early brain development.
​
The parental imprints in the germline could be present in the somatic offspring cells conveying the message that imprinted genes could be involved in mediating APA effects. Various studies have shown a number of neurodevelopmental disorders (such as Prader-Willi syndrome or Angelman syndrome) that have resulted as an outcome of errors in imprinting. But we have no research in humans that supports the theory that imprinting errors affect APA effect. It is hence seen that inherited and de novo factors contribute to epidemiological observations. But the evidence does not suggest that older men should refrain from having a child. There is a low occurrence rate of these disorders at baseline and a 5-fold increase in odds ratio even under a strong de novo effect gives us a low probability that the offspring will suffer from autism or schizophrenia due to a high paternal age.

Studying the Effects of Paternal Age on Twins
The present study uses a population-based sample of twins (Twins Early Development Study [TEDS]) to test the effect of paternal age on offspring behaviour. A study by Lundstrom et al. proved that the effects of APA was observed in the offspring only when he/she was around 9 years. Sample size from the TEDS study-of more than 15000 twin pairs-were collected. These individuals were assessed of their social functioning skills at age 4, 7, 9, 14 and 16 respectively.

Social development was measured using parent’s (mostly mothers) rating of the Strengths and Difficulties Questionnaire (SDQ) that helped in analysing both good and problematic aspects of childhood behaviour between 4 and 16 years. The questionnaire mainly focused on five subdomains including conduct problems, emotional symptoms, hyperactivity, peer problems and prosocial behaviour. The effect of paternal age on all five subdomains was checked through five questions scored from 0 to 2 such that the maximum score possible for the subdomain was 10. Contrary to other domains, high scores in the prosocial domain indicated less problematic behaviour.
Results showed that there was a significant link between paternal age and differences in social development in the general population with no effect on behaviour domains. Some kids born to older fathers find it difficult in social settings and the challenges they face increase as they get older. Genetic influence on social development is most pronounced on offspring of the oldest group of fathers.

References
Advancing Paternal Age and Autism: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/668208

Advanced Paternal Age Effects in Neurodevelopmental Disorders-Review of Potential Underlying Mechanisms: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5299396/pdf/tp2016294a.pdf

Paternal Age Alters Social Development in Offspring: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5409803/

Movies are not spicy without a villain and life too seems to be bland when it goes on and on without some challenges to dethrone. So is the connection between free radicals and antioxidants. Our body is our recluse from which we garner energy for day-to-day functioning of all activities. This energy is acquired from the food that we eat. Free radicals are produced as a consequence of metabolic steps when food is converted into energy, as a result of normal cellular function and also as part of natural physiological process of all living beings. They might also be derived from external sources such as exposure to X-rays, ozone, cigarette smoking and industrial chemicals. There is a continuous formation of free radicals happening in our body as a result of enzymatic and nonenzymatic reactions. Until their production is normal there is no harm caused from them but once overproduction happens, they can become dangerous to even basic processes needed to keep individuals alive. In order to avoid such damages, the cells also produce free radical scavengers known as antioxidants.

Free Radicals & Antioxidants
Free radicals are molecules that contain one or many unpaired electrons in their outer orbit which become highly unstable when they try to react with other molecules to attain molecular stability. In this outreach, the free radical robs other molecules of their electrons creating a chain reaction leading to the damage of DNA and protein breakdown. But it is essential to known that not all free radicals are harmful and there are some of them which help to wipe out invading pathogenic microbes to protect the body’s defense mechanism. In science, we use the terms reactive oxygen species (ROS) and reactive nitrogen species (RNS) to describe free radicals and other non-radical reactive derivatives.

The human body has its own tactical ways for self-defence. It has an excellent antioxidant network that plays the defense role helping to neutralize free radicals and maintain homeostasis. But the defense mechanism doesn’t work in favour of the individual all the time where an imbalance between free radical production and antioxidant defense is possible. Such imbalance leads to what we call ‘oxidative stress’. This oxidative stress is considered to be the starting point for the origin of numerous diseases, development of ageing and the onset of health problems such as arthritis, cardiovascular and neurodegenerative diseases, inflammation and cancer. Oxidative stress is also possible due to poor diet or disease. Nowadays, we read numerous articles that suggest the consumption of various foods for antioxidant benefits but there are also questions raised whether performance of exercise can alleviate the effects of free radicals.

Exercise & its Effect on Free Radicals
Physical activity has been proposed as a solution to remove the harmful effects caused by free radicals on the human body. Various studies these days show evidence that ROS are generated during exercise but physical activity helps in improving antioxidant defense. Physical activity is different from exercise. We define physical activity as some body movement produced by skeletal muscles resulting in energy consumption and examples include everyday life activities and exercises such as walking and cycling. Moderate exercise and an active lifestyle have been proposed as good ways to reduce oxidative stress. It finally depends on the exercise duration, intensity, fitness condition and nutritional status as to whether the reactive species are helpful or harmful. On the other hand, we also have research showing that exercise-induced free radical production promotes insulin sensitivity in humans thereby acting as a catalyst for type 2 diabetes prevention.

Regular practise of moderate-intensity exercise helps to stay away from oxidative stress while acute bodily exercises can cause oxidative stress and increase the production of free radicals. Overperformance of exercise increases the amount of reactive and nitrogen species which increase ROS production and RNS might cause imbalance among RONS and antioxidants. Hence, exercise-an activity that must benefit the body-becomes the cause for exhaustion and injury.

Effect of Low-intensity Exercise on Antioxidants & Oxidative Stress
The study included 2 groups: one group of low-intensity exercise performers (EXG) and another one performing no exercises called the control group (CG) with each group consisting of 20 participants. Low-intensity exercise is that which gets you to about 40-50% of your maximum heart rate (MHR) such as jogging and walking. Those individuals above the age of 30, suffering from chronic diseases or taking long-term medications were excluded from the study. Blood samples of all the participants were collected and antioxidant capacity of the samples was estimated using the Benzie and strain method.

A comparison between the two groups was made regarding body mass index (BMI), alanine transferase (ALT), alkaline phosphate (ALP), aspartate (AST) and FRAP. Significant difference in BMI values was found in both groups with BMI of CG less than the BMI of EXG. ALT of CG was less than that of EXG; ALP of CG was high than the ALP of EXG; AST of CG was less than the AST of EXG. The study concluded that low-intensity exercise had no effect on liver enzymes but improved blood life quality by reducing various health problems related to oxidative damage of cells and muscles fatigue.
​
Physical Activity Improves Antioxidant Capacity in Individuals with Type 2 Diabetes Mellitus
We have numerous evidences pointing to the fact that free radicals and oxidative stress contribute towards Type 2 diabetes mellitus (T2DM) and its related complications. Some of the causes of oxidative stress during diabetes include overproduction of ROS by mitochondria and nonenzymatic glycation. Physical activity or exercise helps to improve insulin resistance by improving insulin action and vascular function while decreasing ROS generation. Animal studies were conducted to bring about the effect of exercise on T2DM. Regular and moderate-intensity aerobic exercise that consisted of 12 weeks of swimming was conducted for both diabetic and lean rats which were between 8 and 20 weeks of age. The animals performed the exercise in a cylindrical tank that contained water in a controlled temperature. The animals were placed in the tank everyday at the same time. While the duration was for 15 min/d initially it was increased to 60 min/d by the end of the first week and the schedule was followed thrice every week. The sedentary rats were placed in similar containers where the swimming session was held for all the 60 min to ensure that rats in both groups underwent the same amount of stress. The research team observed an amelioration of insulin resistance and diabetic dysmetabolism. A decrease in systolic and mean blood pressure and heart rate, decrease in oxidative stress and increase in NO production was observed.
​
Antioxidants came to the defense of animals with T2DM in yet another study by Nishida et al. which reported increased Cu/Zn-SOD protein production as a result of low-intensity exercise in contrast with increased Mn-SOD after moderate-intensity exercise. Studies from other researchers on a six-month moderate-intensity aerobic exercise training showed decrease in lipid peroxidation, increase in GSH and catalase activity in T2DM and obese individuals. Oliveira et al. compared the effects of 12 weeks of training on 3 different exercises (aerobic, strength and combined training) on T2DM male and female human participants showing that aerobic training program provided important upregulation in antioxidant enzymes and increased NO bioavailability which helps to minimize oxidative stress and chronic complications of diabetes.

Hence, regular and moderate exercise can have antioxidant and anti-inflammatory effect in individuals with type 2 diabetes.

Both aerobic and anaerobic exercise can produce free radicals but oxidative stress always doesn’t occur because ROS production is dependent on the exercise intensity. While high ROS production due to acute exercise performance is harmful to the immune system chronic exercise produces physiological adaptations that can empower a person’s antioxidant system.

References
Regular Physical Exercise as a Strategy to Improve Antioxidant & Anti-inflammatory Status: Benefits in Type 2 Diabetes Mellitus: https://www.hindawi.com/journals/omcl/2012/741545/

Oxidants, Antioxidants & the Beneficial Roles of Exercise-induced Production o Reactive Species: https://www.hindawi.com/journals/omcl/2012/756132/
​
Is Exercise the Best Antioxidant Supplement? https://www.unm.edu/~lkravitz/Article%20folder/Antioxidants.pdf
Impact of Low-intensity Exercise on Liver Enzymes and Antioxidants Systems of the Body: https://www.unm.edu/~lkravitz/Article%20folder/Antioxidants.pdf

Obesity rates have become unjustifiable with more than 40% of adult population staying overweight and more than 14% of children existing in the obesity zone. Inappropriate environmental, biological and psychological factors have resulted in a situation where obesity rates have tripled since 1975. We have moved past the fact that adult obesity rates are inappropriately high and now researchers are mainly focusing on childhood obesity rates. 10% of the global population is obese and almost 15% of kids between 2 and 5 years old are obese. We have multiple research on the effect of early life factors and its effect on childhood obesity. Its also known that maternal and paternal obesity increase the risk of obesity in the offspring and most excess weight in childhood are gained during the preschool years. Some of the evident examples come from some of the most developed nations-U.S. has 69% adults and 32% kids either in the obese or overweight range; Western Europe exbibits some of the highest obesity/overweight rates and data from the ‘National Child Measurement programme’ (NCMP) shows that more than one in five kids in England are now obese/overweight by the time they are enrolled in primary school and the rates increase further to one in three by the age of 6. To make things worse, 8% of infants and toddlers display weight ranges above 95th percentile in the U.S.A. This is indeed a nightmare as obesity/overweight that’s prevalent in these tender years is sure to linger past adolescence and well into adulthood.
​
Childhood Obesity
Staying above recommended weight ranges since childhood puts the kid at a potential risk for comorbid conditions such as diabetes, cardiovascular problem and even cancer. We have a good number of research done on the risk factors of obesity during childhood years such as children’s eating habits, infant feeding practices and television viewing but what we need exactly is to understand the factors present in both parents and offspring that promote obesity across early life stages (right from preconception through prenatal period to infancy to the tender age of 2). Though researchers focus on risk of obesity through childhood and adolescent years we have evidence showing that the foundation for inappropriate weight gain is laid in early years of life by actions and interactions that can have biological and behavioural consequences. Such influences on obesity and risks for it are linked across generations-from parent to child. An understanding of various processes and sewing them together in the right order helps us focus on the generation link that’s evident.

The intrauterine environment shapes the trajectory of weight gain and after birth the teachings of parents and families combined with the socioeconomic environment has greater impact on the weight trajectories of infants and toddlers. Obesity rates of kids greatly vary depending on where they live.

Seeds of Obesity Sown Even Before Deciding to Plant
Preconception: The risk of obesity in the next generation starts even before conceiving. Until sometime back most studies focused on maternal influence of obesity on the offspring but recently even the paternal involvement in determining offspring’s health has now been taken into consideration.

The major factors affecting offspring include a mother’s birth weight, obesity and nutritional status throughout her life. Pre-pregnancy obesity rates have steadily increased since the last decade to the present one and statistics show that mothers who are overweight/obese before pregnancy are at an increased risk of having children who are large for gestational age at birth compared to their normal weight counterparts. A study by Whitaker et al. showed that maternal obesity during the first trimester of pregnancy doubled the risk of childhood obesity at 2 years of age. Fathers affect embryonic development through genetic and epigenetic mechanisms. Epigenetic changes affect the fetus’ metabolism which is primarily due to variations in the dad’s diet. This shows that paternal lifestyle behaviour definitely puts future kids at risk of obesity and obesity-related outcomes. These epigenetic changes could even be inherited by the developing sperm. All this clearly show one thing-the world that’s been monopolizing the attention to women who plan to conceive must also consider the health of men. A number of suggestions have been proposed for women in their reproductive years right from nutritional guidance to weight management. They are advised to take supplements that include multivitamins and folate to avoid deficiencies such as neural tube defects and likewise. A survey showed that 77% women opted for enrolling in a program that promoted effective lifestyle intervention before conceiving and this shows that women are on the right track. Men should also be encouraged to take care of their health. Actually, both men and women must be motivated to stay within normal weight ranges right from adolescence to help the future generation to stay at a minimal risk of obesity.

Prenatal influence: The environment affects us in many a way. Environmental exposure and timing of exposure to different factors within the environments produce interactions that are biologically seeded in the developing child. Epigenetic influence do exist and the gene sequence cannot be modified but we can indeed change the gene expression in response to environmental cues. For instance, changes to the placenta made as a result of maternal stressors or nutritional status prevails as the mediator between the developing child and the environment. This prevails as the trailer for the fetus before the main picture is shown (when the fetus then becomes a newborn). The fetus becomes adapted to epigenetic changes which then regulate behaviour, obesity and glucose tolerance. But when the fetus is small for gestational age during development or there was restricted intrauterine growth the growing newborn is at a greater risk of suffering during later stages in life.

When metabolic pathways, hormonal signalling and glucose metabolisms change by a greater margin during pregnancy it increases the risk of larger birth size and higher percentage of body fat at birth. The gut bacteria also play a critical role as researchers have come up with differences in the microbiome of overweight individuals compared to normal-weight people. The same is also seen in pregnant women and hence, might be transferred to the child too (as the child gets the microbiome composition from mother during birth through the birth canal and it’s also affected by the mode of delivery) thereby resulting in intergenerational transfer of obesity.

Maternal Lifestyle: Time and again gynaecologists insist on a healthy maternal weight gain and lifestyle behaviours to deliver a healthy offspring. Eating, physical activity and smoking levels during pregnancy have a strong impact on the risk of obesity for the fetus developing inside the mother’s womb. Besides preconception obesity gestational weight gain (GWG) changes the pregnant woman’s metabolism leading to higher risk for dyslipidaemia, glucose intolerance and insulin resistance. Such GWG leads to a greater percentage of offspring born with higher birth weight, increased body fat during the neonatal period and greater adiposity all though childhood and adulthood as well. All this is due to increased nutrition transfer from overnourished mothers to the developing fetus.

Moms pass on food likes and dislikes to the developing fetus. The food that she consumes, her tastes and smelling traits that are present during fetal development strongly influence a child’s preferences for food and flavour. Now we can understand why our little ones love sweets, hate certain vegetables and relish certain foods more than others. Performing physical activity regularly during pregnancy helps the woman deliver infants that are smaller than the ones born to women who don’t exercise. Different studies come up with different results and hence reviews are inconclusive. Another important factor affecting fetal weight is smoking status of the pregnant woman. Smoking, both maternal and paternal, during the prenatal period is strongly linked to obesity development in the offspring during childhood and adulthood.

Numerous systemic reviews and meta-analysis of data show that maternal pre-pregnancy weight gain is linked to an increased risk of overweight/obesity in the offspring, children born to moms after weight loss were only at a 35% risk of overweight/obesity compared to 60% risk in kids born to moms who remained obese, according to a study. A recent systemic review showed that 19 of 21 studies supported increased risk of childhood overweight in kids when moms experienced GWG. Kids of women who gained excessive weight during pregnancy were at a 4-times higher risk of being overweight at age 3 compared to kids whose mothers gained inadequate weight according to a study by Oken et al. A population-based cohort study proved that compared to infants of women who gained 8-10 kg of weight during pregnancy those of women who gained more than 23 kg were about 2.5 kg heavier at birth.

Factors Affecting Obesity Risk Up to 2 Years of Age: Infant birth weight is a strong determining factor of obesity/overweight risk in the child. Kids born either too small or big for gestational age are at an increased risk of overweight, obesity, metabolic disorders and cardiovascular diseases. The birth weight of the child is determined by the maternal weight at conception and GWG. As in adults, infants too should gain a definite weight in a definite period and accelerated weight gain occurring during the first 4 months of life are related to obesity at 7 years of age and a 60% increase in risk if weight gain happens within the first 2 years of life. but the reason behind rapid weight gain during this period is due to genetic factors, epigenetic processes, differences in placental leptin levels and the infant’s gut microbiome composition.

Infant-feeding habits: Kids depend on their parents for making the right decisions up to a certain age and food habits are one of those. What and how much food parents feed their infants directly affect the weight gain and obesity risks of child during later stages in life. There are not any recommended dietary guidelines for kids younger than 2 years of age to help parents and caregivers choose the right portions and foods to feed the kids. Infants are blessed with the knowledge to know how much to eat, when to eat and when they are full. They self-regulate their needs even while breastfeeding choosing how much to drink how often. That’s why infants fed on formula by parents gain more weight maybe due to the amount and pattern of feeding and so do infants who start weaning early in life. The child’s ability to self-regulate narrows down when it is dominated more and more by parental intervention.

Sometimes, parents feeding practices also depend on the child’s food choices which is affected greatly by its exposure to sweet and sour taste during prenatal exposure to the mother’s diet but they can be modified by repeated exposure to certain foods by the parents. Some parents also use feeding as a mechanism to soothe infants and such practices lead to unintentional weight gain in kids. Our lifestyle and sedentary behaviour also hold greater influence on obesity risks. The present world encourages the use of car seats and strollers that make the children idle, exposure to television starts right from their 3rd month sometimes and many suffer from lack of sleep due to increased screen time. A prospective cohort study on more than 900 infants showed that those who slept for less than 12 hours doubled their odds of becoming overweight by age 3 compared to others. An infant’s birth weight and rapid weight gain during the first months of life are clear cut indicators of future obesity risk. Hence, it does show that the way parents and caretakers feed infants and the steps that they take to engage children do affect the risk of long-term weight gain in these little ones.

In recent years, more attention has been focused on interventions targeting parents and modifiable risk factors that prevent obesity and promote healthy growth in the first 1000 days of life. Lifestyle and nutrition practices followed through life-before conception, time spent in utero and the following months after birth greatly affect the child’s weight at birth, during childhood and well into adulthood. Women who take care before conceiving, while pregnant and even after childbirth have greater chances of giving birth to and nurturing kids who are at a minimum risk of obesity in life. Nutritional interventions by parents, the steps they take to ensure kids’ exposure to healthy food and their participation in physical activity plans with the children do indeed help in making the kids as healthy as possible. It would be beneficial for both the kid and the mother when the woman strives for a healthy weight before pregnancy, abstains from smoking, strives for a normal weight gain during pregnancy, breastfeeds unless there is some health issue linked and takes care that infants get the desired sleep time during the first few years of life.

References
Preventing Obesity Across Generations: Evidence for Early Life Intervention: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5305001/

Prevention of Overweight & Obesity in Early Life: https://www.cambridge.org/core/journals/proceedings-of-the-nutrition-society/article/prevention-of-overweight-and-obesity-in-early-life/F9BB50517A0A0F9D4F542276A30926D5/core-reader

The Effect of Early Life Factors & Early Interventions on Childhood Overweight & Obesity: https://www.cambridge.org/core/journals/proceedings-of-the-nutrition-society/article/prevention-of-overweight-and-obesity-in-early-life/F9BB50517A0A0F9D4F542276A30926D5/core-reader

Preventing Childhood Obesity: Early Life Messages & Epidemiology: https://onlinelibrary.wiley.com/doi/full/10.1111/nbu.12277

Prenatal & Early Life Influences: https://www.hsph.harvard.edu/obesity-prevention-source/obesity-causes/prenatal-postnatal-obesity/

Despite our food being an enriching source of nutrients and full of goodness we don’t make utmost use of this naturally available health source but try to achieve the same through other means such as supplements and likewise. Fruits, vegetables and whole grains-authentic nutrient source-have been taken for granted and now, we are victims of serious nutrient deficiencies and health-related problems. Due to continuous breaching of these nutrient sources we have landed ourselves in a state where supplementation has become indispensable for a majority of individuals.
​
A majority of the population are regular consumers of multivitamin supplements on a daily basis. Vitamin D and vitamin B deficiencies are on a rise for which supplements have once again become mandatory otherwise this can result in serious health consequences. Another group of supplements that’s especially crucial for vegetarians and vegans are fish oil supplements that have been steadily used for lowering blood triglyceride levels in all individuals including athletes. So, what’s so special about these supplements that makes it a favourite of athletes too? The very fact that they contain omega-3 fatty acids which cannot be produced by our body but must be added via the food that we consume. Omega-3 fatty acids have been proposed for protecting the heart, improving mental life, easing inflammation and lengthening life and deficiencies have created innumerable problems right from arthritis and mood disorders to cancers, cardiovascular diseases and more. The most recent fascination on omega-3 supplementation is the fact that these have been proudly presented as an ergogenic aid for athletes for improved athletic performance.

Omega-3 Fatty Acids
Sharks, swordfish, tilefish and albacore tuna are rich sources of omega-3 fatty acids but they come with a statutory warning that these might be loaded with toxic substances. Hence, controlling the consumption of these fish is always recommended to avoid effects due to mercury overload and so. Fish oils are made from the tissues of oily fish and are overloaded with eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), both of which are forms of omega-3 fatty acids. Omega-3s are polyunsaturated fatty acids (PUFAs) which exert anti-inflammatory properties. Interestingly, though fish is the best source for omega-3 they too don’t produce it but acquire it by consuming microalgae or fish that’s enriched in omega-3 fatty acids. Sometimes called as vitamin F due to its presence in ‘fatty fish’ sea creatures such as krill, algae, microalgae and crustaceans are also excellent sources of n-3 PUFAs. Alpha-linolenic fatty acid (ALA) is also a form of omega-3 but primarily found in soybeans, pumpkin seeds, perilla seed oil, walnuts, flaxseed and canola. But sadly, ALA from food sources must be converted into DHA and EPA before reaping benefits. DHA and EPA have even been named as ‘brain food’ because of their prime participation in cognitive health.

So, fish oil supplements are indeed helpful in preventing illnesses and promoting health but they are not a one-stop solution for all the problems and illnesses as advertised by marketing individuals. With this in mind, let’s look at where we stand with respect to fish oil supplementation and athletic performance.

Fish Oil Supplements & Athletic Performance
Athletes need greater sustenance capacity and energy for maximized performance. Because of this, we have seen that most of them use dietary supplements to increase metabolic capability, delay fatigue, improve muscle hypertrophy and shorted recovery period. Any athletic performance requires a strict exercising routine that exerts physiological stress on the body. The body tries to counter this by going for a joint response by the cardiovascular, pulmonary and nervous system as this increases blood flow and oxygen supply to skeletal muscles. There is a tremendous change in blood flow during rest and exercise-while muscles receive 20% of total blood flow during rest, they receive more than 80% during exercise. In such scenarios ergogenic aids are of utmost use as they aid in improving exercise efficiency and also enhance recovery. Omega-3 are considered as an ergogenic aid here as they are helpful in restricting exercise-induced inflammation and enhancing health of muscle and energy availability.

Intense exercise can lead to oxidative stress and reactive oxygen species (ROS) production occurs due to muscle contraction. This is greater than antioxidant capacity of the muscles and might lead to fatigue development in athletes. There are various experimental studies showing that dietary intake of PUFAs could optimize immune and inflammatory response. The consumption of omega-3 decreases interleukin IL-1 and IL-6 prevents inflammation. Daily prescription of 4 g of n-3 PUFA on young and old subjects for 8 weeks showed significant increase in muscle protein synthesis; another study that administered the supplement for six months showed improved muscle mass and strength in elderly adults. Seven days of 3 g/day of PUFA supplementation decreased post-exercise muscle damage and soreness in individuals who performed eccentric biceps curls. Chronic supplementation of n-3 PUFAs improves neuromuscular activity in animal studies and they are indeed an excellent supplementation for athletes given the fact that they are helpful in recovery during training or competition. A study was conducted on 20 international rugby players for 5 weeks of pre-season training. These players were made to consume a protein-based supplement consisting of n-3 PUFA twice a day or a protein-based placebo to check on muscle soreness, countermovement jump performance and psychological well-being. All the players filled a questionnaire assessing their fatigue, sleep, stress and mood levels every day during the training period. Results showed that PUFA supplement improved better maintenance of explosive power in the rugby players during pre-season training.

Immune-related Effects
Exercise provides a platform for infectious agents to enter the body and cause diseases due to alterations in immune functions (this is the work of pro-inflammatory cytokine production, decreased neutrophil function and NK cell cytotoxicity). Studies show that n-3 PUFA supplementation decreased IL-6 production in athletes. A study focused on the immune functionality of fish oil supplementation on athletes who underwent endurance training-16 male subjects underwent a six-week double blind placebo supplementation trial involving two groups (fish oil or placebo oil). Each of them visited the research team twice-during the first visit they underwent a maximal exercise test and during the second they performed 1-h of endurance exercise on a cycle ergometer. Results showed that fish oil supplements reduce increase in peripheral blood mononuclear cell production. Immune levels are suppressed after performing high-intensity exercises and such decline in immunity levels increases the risk for upper respiratory tract infections. There are several studies that support the fact that n-3 PUFA supplementation can combat such infection risk.

Asthma-related Effects
A study defined asthma in elite athletes as ‘sport asthma’ that’s nothing but respiratory symptoms and bronchial hyperresponsiveness without allergic features. Some athletes, such as those involved in sports such as skiing and long-distance running/cycling that require intense breathing. Likewise, swimmers too face this issue due to inhalation of chlorine derivatives in the swimming pool. Eskimos exhibit low asthma rates as they consume more of omega-3 fatty fish. Studies show that n-3 PUFA intake reduces asthma rates because of its anti-inflammatory mechanism: Supplying asthmatic patients with 3.2 g of EPA and 2.0 g of DHA daily for 3 weeks reduces eicosanoids and pro-inflammatory cytokines concentration. Yet another study that supplied the same supplement combination and an anti-LT medication showed that both the supplement and the medication were independently effective in attenuating airway inflammation and bronchoconstriction. Exercise-induced bronchoconstriction improved when individuals were supplied with n-3 PUFAs.

Effects on Joint Pain
Joint pain is a common complaint for athletes especially those participating in sport with joint torsional movement such as football, volleyball and tennis or increased articular impact loading such as football, running and basketball. There is an increased chance of developing osteoarthritis in athletes when they are involved in playing a sport that has rapid acceleration/deceleration or causes high impact on joints continuously. Joint pain is the result of infiltration of inflammatory cells and n-3 PUFAs could help preserve joint health. A New Zealand study reported reduced inflammation in animal and human trials with 89% decrease in pain symptoms and 91% increase in quality of life.

Studies & their Supporting Evidences for Fish Oil Supplementation
Nieman et al. supplied 23 cyclists with 6 weeks of fish oil supplementation to check their effect on exercise performance, inflammation and immune measures. Results showed that the supplement increased blood levels of EPA and DHA but had no impact on exercise performance, inflammation and immune response. Poprzecki et al. showed that supplementing men with omega-3 for 6 weeks increased antioxidant activity. Omega-3 supplementation improves muscle flexibility in endurance athletes and in younger adult athletes it contributes to lower peak heart rate, reduces resting heart rate variability and oxygen consumption required while exercising. But there are several other studies showing not much improvements in markers of inflammation, performance and immunity. Another study on young men and women performing endurance exercise showed that supplementing with krill oil did not impact immune function nor affect markers of exercise performance.

Though fish oil supplements decrease triglyceride levels in athletes and nonathletes we need more concrete studies to show that they are an effective ergogenic aid for exercise performance. For those consuming fish, it is advantageous as it increases fish oil intake but too much of it is also hazardous to health. Get in touch with your physician for the recommended dosages of the supplements.

References
Omega-3 Polyunsaturated Fatty Acids: Benefits & Endpoints in Sport: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6357022/

Omega-3 Fatty Acid Supplementation: Helpful for Exercise? https://www.uws.edu/omega-3-fatty-acid-supplementation-helpful-for-exercise/

Fish Oil Supplementation & Athletic Performance: https://journals.lww.com/acsm-healthfitness/Fulltext/2012/09000/Fish_Oil_Supplementation_and_Athletic_Performance.9.aspx?WT.mc_id=HPxADx20100319xMP
​
Fish Oil: Friend or Foe? https://www.health.harvard.edu/blog/fish-oil-friend-or-foe-201307126467

Osteoporosis is a concern for each of us as there are millions of individuals around the world suffering from this debilitating condition. As the world’s ageing population seems to increase the prevalence of osteoporosis and osteopenia also increases characterized by decreased bone mass and increased fragility risk. According to the Osteoporosis Consensus Development osteoporosis is a metabolic bone disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. When the condition is not prevented it progresses until the bone is fractured (mostly includes regions of the hip, wrist and lumbar spine). Menopause brings about numerous hormonal changes in women and they can lose around 20% of bone mass in the initial 5-7 years which finally can result in osteoporosis. Its been shown that 50% of women and 25% of men over the age of 50 will suffer from fracture due to osteoporosis in their lifetime.

Bone is a living tissue that constantly breaks down and rebuilds but with the advent of diseases such as osteoporosis there is more breakdown than building up. But this is not irreversible and exercising helps in rebuilding bones and reducing the likelihood of fracture. Exercising has been recommended as an inexpensive and safe intervention technique for preserving musculoskeletal health but all types of exercises don’t have the same beneficial effect on bone mineral density (BMD). According to the World Health Organization (WHO) osteoporosis and osteopenia are defined as the lowest BMD T-score of ≤-2.5 and -2.5 to 1.0 measured at the lumbar hip or spine. Present guidelines include resistance training and weight-bearing exercises for preventing bone loss and preserving bone mass in patients with osteoporosis.

BEST Study
Strength training helps to maintain or rather improve BMD, promote increased levels of bone formation markers (such as type 1 collagen amino-terminal propeptide (P1NP)) and decrease levels of bone resorption markers (such as type 1 collagen C breakdown products (CTX)) in the blood. We have reports on a positive association between maximal muscle strength measured as 1-repetition maximum (1RM) and bone mass. We have strength training programs that focus on 1RM improvements to be helpful in improving BMD and bone mineral content (BMC), especially in postmenopausal women.

A study focused on 1-year and 4-year results from the Bone Estrogen Strength Training (BEST) Study was the most extensive study in United States that began in 1995 focusing mainly on how strength training combined with calcium intake impacts BMD in two groups of postmenopausal women. Anyone whether or not they were undergoing hormone replacement therapy (HRT) were allowed to participate in the study which meant a total of 266 women aged 45-65 years completed the first year of study. Sedentary (<120 minutes of exercise per week) postmenopausal women were selected and were randomly assigned to either control or exercise group and all participants took 800mg of calcium citrate supplements daily. Each of the participants’ dietary intake through the first year was assessed using 8 randomized days of dietary recall (DR) collected at baseline, 6 months and 12 months of study. While those in the control group continued with their sedentary lifestyle those in the exercise group performed weight bearing and resistance exercises 30 days per week on non-consecutive days. These exercise sessions lasted for 60-75 minutes and included weight-bearing activities for warm up, strength training and cardio weight bearing circuit of moderate impact activities at 70-80% of maximum heart rate such as stair climbing on step boxes wearing weight-bearing vests and small muscle exercises including stretching and balancing ones. All types of exercises and its duration was regularly monitored and the data entered by BEST trainers.

The participants performed strength training exercises using free weights and machines focusing on major muscle groups. 8 different exercises were performed that included seated leg press, weighted march, lat pull down, seated row, back extension, one-arm military press, squats and rotary torso machine. All the subjects completed two sets of 6-8 repetitions at 70% (twice a week) and 80% (once per week) of the one-repetition maximum.

1-Year Impact
Results were positive for those who exercised as exercise group participants witnessed improved BMD compared to the control group. In those who used HRT, the use of calcium, HRT supplements and exercising increased hip, neck and femoral BMD by 1-2% while the use of supplements with no exercise performance had a non-significant effect on BMD. In those participants who did not undergo HRT, the performance of regular exercise improved BMD by almost 1% whereas abstinence from exercising decreased their BMD to a great extent. The study clearly proves increased advantage for those women who use HRT.

Besides BMD, BEST intervention also had positive effects on soft tissue composition-inclusion of all body components except bone. DXA measurements showed that women who exercised regularly displayed whole body and regional (arms and legs) lean soft tissue (LST). Though there was no improvement in LST in those who used HRT the use of HRT did prevent loss of LST in those women who did not exercise. There was significant fat mass loss in those women who used HRT and also exercised. Nutrition intake also had a significant effect on BMD-a greater intake of calcium, iron, zinc, magnesium, phosphorus and vitamin D was significantly linked to better BMD at the end of the first year of study. At baseline, a subsample of 242 women who completed DRs having dietary iron intake levels greater than 20 mg/day was linked to greater BMD at several bone sites when the participant’s daily calcium intake was from 800-1200 mg/day only. At the end of the first year of study 228 women had complete DR data. Among the 228 women, those who took HRT and consumed lowest amount of calcium showed increase in BMD as iron intake levels increased from 7 mg/day to 32 mg/day. In those who did not take HRT there was BMD increase only in those who took highest calcium intake with no changes due to iron intake levels.
The study showed that when women lifted more weights, they experienced greatest improvements in BMD, more specifically at the hips. Bone loss is not a short-term effect but something that takes place for many years after menopause and performing exercise meanwhile can definitely curb this effect. There are many studies dealing with the effects of exercise only on short-term advantages-one that happens within 1-2 years of exercising. The BEST study focused on long-term results and found that two sets of exercise was sufficient to increase BMD and the initiate to lift weights was necessary to further improve BMD levels. To help participants continue with the BEST exercise program the duration of exercising was reduced to 45 minutes and 6 strength training exercises that excluded rotary torso machine and weighted march. Some of them were also involved in doing yoga, spinning and Pilates to break the monotony and bring in variety to their exercising schedule.

4-Year Impact
It was only 167 women who completed 4 years of participation in the BEST study. At the end of the first year all of them were encouraged to exercise on their own and also have yearly DXA assessments conducted by the study group. At the end of the second year, supervision was reduced in the facilities, in the other years trainers were there in the facility only once a month. After 4 years the participants’ exercise frequency varied from 0-94% of the various exercises mentioned above. those participants who were actively engaged in exercising maintained or improved BMD at the hip and lumbar spine (LS). Those who showed maximum exercising efficiency experienced greatest BMD improvements at all bone sites than those who exercised less often. But it was observed that greatest increase in LST and BMD occurred in the first year of the BEST study regardless of HRT use. While LST increased during first year the effect was lost for years 2-4 yet the overall gain remained well above normal ranges. It was the LS BMD that continued to improve consistently for 4 years of participation in the BEST study program.

Those women who completed 4 years of the study taking 800 mg/day of calcium supplements but who were not on HRT showed maximized improvements in BMD than those taking less calcium supplements. Those women not on HRT and following BEST exercise schedule need at least 1700mg/day (this is 500 mg more than recommended DRI values for women aged 50+) of calcium supplements to preserve BMD. This shows that calcium too apart from exercising plays a pivotal role in determining BMD in individuals.

At the end of the 4-year period it was noticed that women who attended maximum exercise sessions and lifted greatest amount of weights showed greatest gains in LS BMD compared to those women who attended minimum exercise sessions and lifted least amount of weights. At the end of 4 years training, there was a 2.5% difference in LS BMD between those women who lifted greatest amount of weight and those who lifted least. Those who lift the greatest weights reaped maximum BMD benefits. This study thus shows that physicians and health experts can use the BEST exercise program for improved bone density.

Strength Training Effect on Postmenopausal Women
We have one study reporting that power training focusing on high-speed contractions was more effective than conventional strength training for reducing bone loss while another study showed that neuromuscular performance (this makes rate of force development (RFD) capacity more important for skeletal adaptations) determined bone strength in postmenopausal women. Maximal strength training (MST) is characterized by high loads and fewer repetitions and till date there are no studies that have applied interventions combining heavy loads with high concentric acceleration as in MST promoting both 1RM and RFD improvements. The study below focused on the effect of squat exercise on MST on 1RM, RFD and bone-related parameters in patients with osteoporosis and osteopenia. 21 participants all of whom were at least 2 years postmenopausal, <75 years and having a BMD score between -1.5 and -4.0 at the lumbar spine, hip or neck were randomly assigned to either the training group (TG, n=10) or control group (CG, n=11). Participants in the training group followed a training program that comprised of MST for 12 weeks with 3 exercise sessions per week amounting to 36 sessions totally.  The training sessions consisted of one exercise which used the lower extremities in a squat exercise machine-it started with a warm up including 2 sets of 8-12 repetitions at approximately 50% of the participant’s training load followed by 4 sets of 3-5 repetitions at 85-90% of 1 RM. The training load was increased by 2.5 kg if the participants could perform >5 repetitions.

Each of the participant’s vitamin D levels were measured and treadmill tests were performed to define aerobic capacity among participants. The research team was left with 16 participants with 8 of them in each group completing the study. Results showed that:
​

1. At baseline, TG and CG differed in the half-squat 1RM and RFD
2. Individuals in TG completed 87% of training sessions and improved 1RM and dynamic RFD in the squat machine; peak force (PF) too improved within members of the TG group with no changes in endurance capacity parameters.
3. BMC at the lumbar spine increased from baseline in the TG group in comparison to the CG group
4. None of those participating in the study suffered from vitamin D deficiency but ratio of P1NP/CTX increased in the TG group but not quite significantly.
   
   

Resistance Training for Osteoporosis
We have studies showing that performing resistance exercises (REs) 2-3 times per week for a year maintained or increased BMD at the lumbar spine and hip in postmenopausal women. Combining RE and weight-bearing aerobic exercises improves musculoskeletal outcomes including BMD, muscle mass and strength in older men as well as women. Another study with an 18-month RE and weight-bearing impact activity showed significant increase in bone strength and BMD in middle-aged men and women. A systemic review and meta-analysis on the effects of exercising on postmenopausal women suggested that exercise decreased bone mass loss.

Performing exercises to build and maintain muscle mass and strength leads to stronger bones which in turn help in minimizing risk of fractures due to osteoporosis.

References
Preventing Osteoporosis the Bone Estrogen Strength Training Way: https://journals.lww.com/acsm-healthfitness/Fulltext/2007/01000/Preventing_Osteoporosis_the_Bone_Estrogen_Strength.8.aspx?WT.mc_id=HPxADx20100319xMP

Maximal Strength Training in Postmenopausal Women with Osteoporosis or Osteopenia: https://journals.lww.com/nsca-jscr/Fulltext/2013/10000/Maximal_Strength_Training_in_Postmenopausal_Women.32.aspx

Effects of Resistance Exercise on Bone Health: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6279907/pdf/enm-33-435.pdf

Nutrient insufficiency is omnipresent. There are not many who have a healthy stock of all the required nutrients in the body and those suffering from deficiencies mostly rely on supplements to fulfil their needs. Physicians generally recommend patients to eat a well-balanced diet that’s replete with nutrients and even suggest a list of fruits, vegetables and other foods that are enriched with the nutrients missing in their body. But mankind has always been lazy to incorporate ideological ways depending mostly on shortcuts to fulfil most of their requirements. Even supplements came into existence only due to our inadept handling of our food habits.
Fruits and vegetables have always been our holy grail to health. We also depend on other foods such as dairy, fats, whole grains, nuts, seeds and legumes to fulfil all our nutrient needs. The list seems to be in total contrast of the junk food list that makes our mouth water even when we are simply reading it. So, how do legumes and pulses fare in our list of daily food recommendations?

Make Some Room for Legumes in Your Diet
Legumes in general, especially soybeans, are extremely rich in iron and ferritin content. They constitute a major portion of the diet for a large section of the human population and germination enhances the iron bioavailability of soybean. Iron is available as heme and non-heme iron in animal- and plant-based products respectively. While heme iron is easier to absorb non-heme iron is less readily absorbed by the body. Soybeans are a potent non-heme iron source that’s been increasingly consumed these days for its potent iron composition.
​
Women in general suffer from anaemia problems and they mostly blame it on their menstruation cycle for this as they lose ample blood every month. Otherwise too the human population is not a big fan of iron adequacy as most people including infants, kids and the elderly suffer from iron deficiency. Suggesting such people to eat pomegranates, dates or beetroot is not something new but again have we ever followed any of the nutritional guidance given by others? Definitely not.

Meta-analysis on the Effect of Fortified Soybeans on Infants
Malnutrition and stunting are common problems in infants worldwide and China is no exception. Its been shown that infant malnutrition-related to stunting and anaemia are two of the commonest problems reported in infants and young children (IYC) in poor rural regions of China. Such unmatched nutrition levels elevate the risk of infectious diseases, cognitive disorder and chronic diseases as they grow. Statistics by the National Nutrition Survey show that anaemia rates in 0- to 6-, 6- to 12-, and 12- to 24-month-old IYC was 23.4%, 28.5% and 15.7% respectively with rates exceeding 40% in 6- to 24-month-old IYC in some regions of the country.

Its saddening to see that some newborn babies suffer from such complications soon after birth. At the same time, we need to come up with effective solutions to end this problem. Complementary food feeding is the best way to tackle stunting and anaemia in YIC. WHO reviewed the effects of micronutrient powder (MNP) on IYC revealing that MNP did improve haemoglobin concentration but did not do anything with regard to stunting.
Ying Yang Bao (YYB) is a soybean powder product enriched with vitamins and minerals often used as an MNP in China. It is commonly used as a complementary food containing protein and fat largely provided to infants in poor, rural regions of China. We have a number of studies probing into the effect of YYB on reducing infant malnutrition-related stunting and anaemia but results are contradictory. So, a group of researchers were determined to find the exact effect of the supplement on rural infants. They searched databases such as Central and Medline using several text terms such as Ying Yang Bao, anaemia, complementary food supplement, growth, development and so on to identify potential research materials.

Different eligibility criteria were imposed, randomized and quasi randomized trials were included and all the participants were healthy boy and girl IYC anywhere between 6 and 24 months without any health problem at the time of intervention. The researchers defined anaemia as haemoglobin values lower than 110g/L and stunting as having a z score <-2.0 for height for age. Underweight is defined as having a z score <-2.0 for weight for height.

Results
The database came up with 17340 publications from which only 22 articles were selected after imposing all the eligibility criteria. Again, 5 studies were excluded due to incomplete information available and the remaining 17 studies were included in the meta-analysis. All the studies included YYB durations between 3 and 18 months, sample size was between 76 and 2183, 8 of them were parallel control trials and 16 were before-after control trials.

Haemoglobin Concentration
YYB vs No-intervention Studies
There were 6 studies having 9 subgroups involved in this specific study containing a total of 4929 participants. YYB supplementation resulted in increased haemoglobin concentration when compared to the control group and the changes were significant across subgroups.

Before-after Studies
This included 10 studies with 15 subgroups with a total sample size of 15897 (8269 participants before and 7628 participants after study). Significant increase in haemoglobin concentration over baseline was visible in the studies after YYB supplementation. All the studies had a follow-up period either above or below 12 months and across these periods too the results remained significant.

Anaemia Rate
YYB vs No-intervention Studies
This included 7 studies with 12 subgroups with a total sample size of 11027 and YYB supplementation decreased anaemia rates across the intervention group in all the study participants in comparison to the control group.

Before-after Studies
13 studies with 20 subgroups were included here with a sample size of 26496.  Subgroup analysis showed that anaemia rate was lower after YYB intervention compared to baseline and the results remained the same even after excluding two studies after they displayed low quality.

Stunting
YYB vs No-intervention Studies
Four trials were included and they showed 47% reduction in stunting after the kids were fed with YYB.

Before-after Studies
12 subgroups were included here with 7536 participants before and 7895 participants after the study. While stunting effects were significantly decreased after providing YYB supplementation there was no effect of the supplement found in the subgroup under 12 months.

Underweight
YYB vs No-intervention Studies
Two trials with a sample size of 885 were included here where underweight prevalence decreased by as much as 46% compared to the no intervention group.

Before-after Studies
This analysis included 10 trials with a sample size of 7599 participants (3996 of them before study). Feeding the participants with YYB decreased underweight rates as much as by 51% and the results remained the same even after excluding 2 studies due to some reasons.

Wasting
YYB vs No-intervention Studies
Two trials with a sample size of 885 were included here but the supplement had no effect on wasting prevalence rates.

Before-after Studies
7 trials with a sample size of 5376 (2835 before and 2523 after) were included here and YYB supplementation showed significant decrease in wasting prevalence compared to baseline. Results showed no differences even after excluding a study.

YYB is an effective means to reduce anaemia, stunting and underweight in IYC. A study conducted in Guatemala in kids 2 years and above showed that consuming a supplement with high protein and energy content helped the kids score more in reading, math and other cognitive skills compared to those who did not consume such nutrients. Pollitt et al. conducted a follow-up study on kids aged under 18 months and found that after their 8th birthday these children showed better memory capability that those in the control group. This clearly shows that giving food supplements during appropriate periods of the kid’s growth and development has a long-term impact on their intelligence.

References
Supplementing Fortified Soybean Powder Reduced Anaemia in Infants & Young Children Aged 6-24 Months: https://www.sciencedirect.com/science/article/pii/S0271531718307553

Ageing is inevitable marked by deterioration in the functioning of cells and tissues. All of us age but how we age and the event as such is genetically-based and greatly affected by the surrounding environment too. The outline is clear but what causes these irreversible changes remains a mystery and understanding the ageing process might help to modify its effects. Immunosenescence is the gradual decline in immune function with ageing which is affected greatly by the composition of the gut microbiota; it can also be changes in the function or proportion of leucocytes that are potential sources of inbuilt immunity to the body. Ageing or rather aged people comprise of a majority of the world population who are sometimes overloaded with diseases and infections probably due to compromised immune systems.

The gastrointestinal tract (GT) is composed of bacteria that propagate immune cell maturation. The gut microbiota safeguards the intestine against colonization by pathogen by modulating host immune response. The functioning of the gut microbiota depends on the composition of the gut and any reduction in its diversity that happens as a result of ageing is seriously linked to frailty, infection susceptibility, inflammatory disease and increased morbidity. Each of our immune systems undergo definite changes with ageing specifically related to polymorphonuclear (PMN) cell phagocytic capacity and natural killer (NK) cell function. The PMN cells that initiate immune response to infection clearly display decreased functionality in older adults. Quantity doesn’t matter everywhere and this is once again proved by the NK cells which increase in numbers in the aged adults but their signalling efficiency and cytokine production decrease resulting in a net decrease in function. So, reinstating PMN and NK cell functionality is a sure-shot way to fight age-related immune function decline.
​
Probiotics: The Key to the Immunity ‘Cell’
We are all smart enough to understand that each of us grow old and die but what we strive to achieve is to make the ageing process as comfortable as possible optimizing quality of life. With ageing comes the risk of osteoarthritis, dementia, emphysema and heart problems; the gut too contributes to numerous problems many of which can increase morbidity rates. The ageing gut leads to overexpression of proinflammatory cytokine IL-6 that impacts performance of the immune system and intestinal barrier function also increasing the risk of cancer development and progression. Changes in intestinal permeability results in the progress of local (celiac disease, cancer and inflammatory bowel syndrome) and systemic diseases (obesity, diabetes, heart disease, etc.) which shows that protecting the intestine and preserving its health helps to improve quality of life in ageing adults.

One of the effective means to restore immune system functioning is through dietary intervention. Dietary restriction exists as one of the most researched and promoted nongenetic intervention in the ageing process, specifically its impact on the gut microbiota composition and inflammation. Taking up a healthy lifestyle with diets customized for the aging population that includes a good share of probiotics helps in decreasing inflammation and other age-related changes. Probiotics are live microorganisms which on administering in appropriate doses shower the host with benefits. If you notice, many of the probiotic bacteria are of the intestinal type introduced into the body through foods to improve gut health. Avoiding diarrheal diseases, increasing intestinal barrier function and improving inflammatory intestinal disorder and age-related immunological functions are some of the commonest advantages of consuming probiotics but we have not explored much about the effects of probiotics on intestinal barrier and immune function. Two of the commonest bacteria found in human gut as well as food supplements include lactic acid bacteria (LAB) and bifidobacterial whose immunomodulatory properties are fully utilized in severing age-related disorders. Various human studies showed the ability of participants to fight infections following probiotic consumption. Administration of certain strains of these bacteria increased cytotoxicity of NK cells in elderly women, reduced length of winter infections compared to control group and also nutritional and immunological status of subjects.

Isoflavones, ageing and probiotic bacteria: Isoflavones found in foods such as soy offer protection against certain diseases. LAB and bifidobacteria transform naturally occurring isoflavones to their bioactive form.
Lignans, ageing and probiotic bacteria: Though lignans are one of the major phytoestrogens occupying a major part of our diet plant lignans cannot be absorbed directly and must be metabolized to enterodiol and enterolactone before being absorbed. Deglycosylation of the secoisolariciresinol diglucoside (SDG) present in the lignan extracts into secoisolariciresinol (SECO) is the first step towards the formation of enterolignans. SDG hydrolysis that’s possible due to probiotic bacteria helps in the release of SECO.

Meta-analysis of Controlled Studies to Evaluate the Effect of Probiotics on Immune Activity
Databases such as Embase and Medline were checked using certain keywords for prospective studies on PMN cell phagocytic capacity or NK cell tumoricidal activity after consumption of probiotics in healthy older adults aged 60 and above. The team came up with 459 titles and abstracts but after imposing several other restriction criteria only 17 studies were included for analysis. There was a total of 733 subjects most of whom were healthy and predominantly females. There was a total of 13 different probiotic strains that was investigated in the studies. Of the 17 studies taken into account, 10 were randomized, 12 included patient blinding, phagocytic capacity was reported in 9 studies and NK cell activity was reported in 14 studies. Results showed that:

1. PMN cell capacity was definitely greater in those subjects taking probiotics versus the control group in 8 of 9 studies.
2. The standardized mean difference (SMD) for PMN phagocytic capacity was 1.37 showing that treating with probiotics did bring about advantageous effects
3. NK cell activity was higher in adults taking probiotic supplements versus controls in 7 of 15 studies
4. SMD for NK cell activity was 0.55 showing that there was only a moderate effect of the probiotic treatment experienced by the participants
5. There was a positive effect of probiotic administration seen on NK cell activity in all healthy elderly adults with respect to various study factors
   
   

Though evidence supporting advantages of probiotics on immune improvement is positive none of them were long-term studies as the duration of each was between 3 and 12 weeks only.

Effect of Bifidobacterium Lactis on Immune Functionality
A dietary trial invited elderly people in which 30 (12 men and 18 women) of them aged 63-84 years enrolled. After imposing inclusion criteria such as good health, mobility and a willingness to follow trial guidelines, and exclusion criteria such as recent history of acute or chronic debilitating illness and intolerance to milk products each of the participants were given low-fat milk (LFM) low in lactose in powdered form. B. lactis strain was obtained and Lyophilized bacteria was mixed with the powder to come up with two different doses-a typical dose and a low dose. Each of the participants was randomly assigned into one of the two groups (each group contained 15 participants). The diet was packed into sachets containing either the LFM powder or the B. lactis HN019-supplemented LFM powder. All the participants consumed the entire contents of the sachet by mixing it in 200 mL of cool drinking water.  

The trial was split into three stages with the first stage supplementing the subjects with unsupplemented milk twice a day, during the second stage they consumed milk supplemented with B. lactis HN019 (6 men and 9 women consumed a typical dose while 7 men and 8 women consumed a lower dose). During the third stage all of them consumed unsupplemented milk. Each of them was also enquired on their general health every time their immune measurement was taken. All of them were subjected to blood sampling four times during the trial- at week 0, at the end of week 3, at the end of week 6 and at the end of week 9.

Results
Of the 30 participants one participant withdrew quoting dislike of the milk’s taste and other digestion-related problems. Between-group analysis showed not much difference between the low-dose and typical-dose group but there were time-dependent treatment effects within both groups. While no difference was recorded between time points 1 and 2 there was significant change recorded for immune variable between time points 1 and 2 and time point 3.  While previous studies reported that dietary supplements were effective at increasing proportions of T lymphocyte subsets and enhancing NK cell functioning the present study clearly showed similar changes in cellular immunity after participants consumed the milk-based dietary supplement containing B. lactis HN019. Drinking B. lactis HN019 increased the presence of total, helper and activated T cells in the peripheral circulation and helped to significantly improve immune cells population that might facilitate health improvements in elderly. Maximum immune function due to B. lactis HN019 consumption occurred in those individuals who had poor pre-intervention immune responses revealing that B. lactis HN019 maximum benefited those with poorly functioning immune system even at a potentially low dose. B. lactis HN019 supplement is a good way to combat the effects of immunosenescence.

How Do Probiotics Stimulate the Immune System?
Probiotics deliver better health by inhibiting the growth of pathogenic bacteria. This is done by their active competition for nutrients (for growth and proliferation) which would otherwise be used by pathogens. Probiotics can withstand gastric juice and bile salt, multiply and function in the gut while some microbes that claim to be probiotics cannot withstand the acidity level of the gastric juice and bile salt. Another important trait for the probiotic to work properly is its ability to stick to epithelial cells. A study by Galdeano et al. showed that two microorganisms stick to intestinal epithelial cells (IECs) through toll-like receptors (TLRs) and mediate immune stimulation. Rather than the whole bacteria only fragments of the probiotic were internalized inside the IECs. The IECs in turn stimulate immune cells associated with the lamina propria, activate the innate response and cytokines released by T cells. There are several other studies that have shown positive effects of probiotics on reinstating intestinal barrier integrity through increased gene expression. Recently, there has been an increased interest shown over probiotic fermented milk (PFM). Fermentation helps in improving digestibility and nutritional quality of food. Probiotics also stimulate systemic immune response with an increase in specific antibiotic production.

Our eating habits and lifestyles change as we grow old and age-related changes in microbial diversity makes the elderly population at a risk of diseases and infections. Enhancing immune response by incorporating beneficial microorganisms in the gut helps these people avoid some of the age-related diseases.

References
Short-term Probiotic Supplementation Enhances Cellular Immune Function in Healthy Elderly: Systematic Review & Meta-analysis of Controlled Studies: https://www.sciencedirect.com/science/article/pii/S0271531718307978

Enhancement of Immunity in the Elderly by Dietary Supplementation with the Probiotic Bifidobacterium Lactis HN019: https://pdfs.semanticscholar.org/82dd/ed8dd509a95dc7a8f26ef242ec802d292156.pdf

Beneficial Effects of Probiotic Consumption on the Immune System: https://www.karger.com/Article/FullText/496426

Probiotic Bacteria for Healthier Ageing: Immunomodulation & Metabolism of Phytoestrogens: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5646295/

Old habits die hard, superstitions stay longer. Most individuals grow up having certain beliefs and sentiments that they strongly cling onto most times. Such sentiments are even stronger for sports personalities, celebrities and politicians who stick by certain principles believing it to bring about good luck. Common man too has a few ones on his own and the most common of them is to never allow a cat cross across your path! When it comes to health too, we have our own perceptions-some wear the same colour dress while going for a blood sugar test and some others believe that weather changes increase the degree of pain in individuals with osteoarthritis. They are even super confident about this, challenging physicians that they can predict the weather reports even better than the meteorological department but science has always doubted this belief and even research doesn’t support this.
​
Sophisticated medical equipment and latest technological skills equip physicians to save as much life as possible but the common man finds it assuring and satisfying to rely upon his/her proposed theories finding comfort in their own assessment. The anecdotal link between weather and pain remain unaffected by these sophistications in technology but researchers continue to figure out the weather sensitivity in people with arthritis-results are still inconclusive till date.

Weather & Knee Osteoarthritis
Pain due to osteoarthritis is episodic and patients often complain that weather changes in terms of chillness, air humidity and barometric pressure have the capacity to increase it. Patients with other chronic conditions have reported in similar lines and has been even more dominant in those residing in places where climate changes are frequently experienced. We do have studies supporting the link between arthritis and climate change but the magnitude of association was not clearly stated and pain levels were decided only depending on self-reports rather than scientific measurements.  A study by Timmermans et al. has shown a weak but significant link between humidity and joint pain but no positive relationship between temperature and pain in direct contrast to the study by McAlindon et al. who showed that changes in temperature and atmospheric pressure increases pain intensity in people with knee osteoarthritis.

A research team in Australia conducted a web-based case-crossover study to study the increase in osteoarthritic pain due to weather changes. Online ads for participation was posted and individuals were also invited using database of participants of previous studies on knee arthritis. A total of 345 of them were recruited using inclusion criteria such as minimum age limit of 40 years, suffering from knee pain at least 5 times/week with fluctuating intensity, must meet at least one of the American College of Rheumatology criteria for knee osteoarthritis, suffer from tibiofemoral or patellofemoral osteoarthritis and should be able to access the internet. All the participants were clarified on the goal of the study-to be able to find out the trigger factors, specific weather factors, that could aggravate pain. Each participant was asked to fill an online questionnaire on demographic and clinical data at baseline and every 10 days up to 90 days of study. They were asked to quote when the knee pain was minimal, when it was moderate and when it soared to maximum before start of study. During study, each of them were asked to enter details in the study website whenever they experienced debilitating knee pain that lasted for more than 8 hours. Increase in pain levels were measured via a Pain Numeric Rating Scale (NRS 0-10) defined as an increase of ≥2 on a 0-10 NRS in comparison to the mildest pain at baseline. ‘Pain at its mildest’ was used as the basic platform for comparison and participants were asked to provide zip codes of their location when they experienced knee pain exacerbation. The team defined hazard and control periods based on their previous research of gout risk that changed with weather and index data was calculated based on them for making assessments. Climate data was procured not only for the specific period but for 3 days preceding the index data as exacerbations don’t occur instantly after exposure to a specific weather.

Results
Of the 345 included 174 of them did not experience any pain exacerbation during the study period and hence were excluded from the analysis. The effect was finally studied on the remaining 171 participants (aged around 60 years with 64% belonging to the female gender) who contributed to a total of 404 counts of pain exacerbation (hazard periods) and 1021 control periods. Each of those participating suffered from knee osteoarthritis for 10.5 years with the mean age of diagnosis around 51 years. It was mostly the right knee that frequently remained as the commonly symptomatic knee.

At the start of study all the participants reported their pain intensity to be around 4.9 that increased to 8.3 when it was worse reducing to 2.9 when it was mildest. The average exacerbation intensity reported was 5.9 on the 10-point scale. Surprisingly, high temperatures 3 days before index date prompted increase in knee pain exacerbation. For instance, compared to 10-20-degree temperature measures the risk for increased knee pain increased, almost doubled, for temperature measures of 30 degree and above. But there was no link seen between other weather factors such as relative air humidity, precipitation and barometric pressure and knee pain increase risk. The study shows that despite repeated insistence by patients that weather changes affect pain intensity the results here show that weather factors don’t affect pain intensity in any way.

Pressure & Temperature Changes Influence Osteoarthritis Pain
A study on 205 participants with confirmed knee osteoarthritis focused on the relationship between arthritis pain and meteorological conditions. Each of them belonged to different parts of USA and also participated at different times of the year. The fact that weather influence was a part of the research was publicised to the participants only after the study to avoid any report bias. The studies focused on the relationship of pain with weather not only with ambient conditions but also with changes in conditions immediately before any pain report was delivered.

Pain assessment was made using questionnaires given every 2 weeks amounting to 7 assessments with scores between 0 and 20 reporting different pain levels experienced during different daily activities. Meteorological data was also collected. After imposing inclusion criteria 200 individuals were eligible for participation, their mean age was around 60 and more than 60% were females. Baseline pain score was around 9 and they provided a total of 935 pain reports. Results showed that both, barometric pressure and ambient temperature had insignificant effect on pain exacerbations. For instance, a temperature of 10 °F decrease increased knee pain score of 0.1. The study also noted that increasing barometric pressure was associated with increased pain. A study by Wilder et al. on 154 individuals with osteoarthritis showed positive associations with days of rising barometric pressure in the participants. But another study by Strusberg et al. found a positive link between pain and low ambient temperature but observed no impact of pressure. The researchers of the present study found their results to be similar to that of another researcher, Hollander who suggested that increase in humidity following a decrease in barometric pressure increased pain, swelling and stiffness in those suffering from arthritis.

Yet another study by Barrett et al. on participants aged 49 years and above also did not support the assumption that weather changes including barometric pressure, precipitation and temperature had any effect on pain intensity in patients with arthritis.

All these contradictory results against weather impact on pain levels make us wonder whether people have got it wrong or if they are the exceptions. But I have seen my own mother suffering from increased pain in her joints during winter! Its hard to let go of this theory when there are thousands of people reporting changes in pain intensities linked to weather changes. Could they all be an exception? Hardly! So, have researches always excluded these exceptions while conducting their studies? Science is showing us with hard-core facts that there is no link between weather changes and pain intensity changes in those suffering from osteoarthritis. On one hand we believe in our people and on the other hand we definitely believe in scientific evidence. While trust makes us support these people with arthritis who blame weather on increased pain levels we cannot come to definite conclusions unless we have more compelling evidence scientifically.
 
References
The Influence of Weather on the Risk of Pain Exacerbation in Patients with Knee Osteoarthritis: https://www.sciencedirect.com/science/article/pii/S1063458416302059
​
Changes in Barometric Pressure and Ambient Temperature Influence Osteoarthritis Pain: https://www.amjmed.com/article/S0002-9343%2806%2901026-6/pdf

Osteoarthritis Pain & Weather: https://academic.oup.com/rheumatology/article/42/8/955/1774101

For most, mornings are the busiest time of day and I feel today morning would have been no different. We are enveloped by stress and lack of time that’s become our daily routine almost every day. So, while all of us know about stress not many are aware of the science behind it. Our body releases cortisol, often known as the ‘stress hormone’ due to its connection to stress response, which helps in preparing the body for physical and mental stress by acting within the physiological processes. It also plays a critical role in the functioning of the body by affecting macronutrient metabolism, regulating water and electrolyte balance, blood pressure, body temperature and immune response. Your mood, behaviour, pain and appetite changes are the work of this hormone. All these functions make the cortisol hormone indispensable for good health and well-being. Maybe changes in the hormone levels can answer our lingering doubts why some people are always moody, anxious, stressed or even hungry!            

Cortisol is secreted in the body in the adrenal glands but is controlled/regulated by the hypothalamus, the pituitary gland and adrenal gland and their combination is often called the hypothalamus-pituitary-adrenal axis (HPA axis) which is involved in important functions such as regulating mood, sexuality, body temperature, digestion and energy use. The HPA axis is also one of the components of the fight-or-flight response.

Triggering Agents for Cortisol Production
Our food supplies us with the required nutrients and energy for proper functioning of the body but all this is possible only when we consume a well-balanced diet. Cholesterol helps in cortisol production through triple enzymatic hydroxylation. Liver is the primary source of cortisol metabolism and its secretion is affected by a variety of factors including circadian rhythm, negative external stimuli and feedback regulation.
​
In times of stress the hypothalamus releases corticotropin-releasing hormone (CRH) and vasopressin (ADH, antidiuretic hormone). This in turn triggers the pituitary gland to produce the adrenocorticotropic hormone (ACTH). ACTH impacts StAR protein which helps in transporting cholesterol thereby encouraging cortisol formation in the adrenal cortex. Once cortisol is released its impact on the body and our response entirely depend on the concentration of the hormone, timing of cell cycle and presence of endocrine disorders.

Important Functions
Besides performing the above-mentioned functions cortisol also influences insulin resistance, dyslipidaemia, hypertension and obesity. Above all, it has a strong impact on appetite. A study by De Sa et al. showed that administering cortisol orally influenced the participants to be highly responsive to those foods presented with high glycemic index but the same response was not given when they were shown a couple of other normal non-food images. Presence of ghrelin, the hunger hormone, increased cortisol levels greatly. Abnormally high or low cortisol concentrations have been commonly linked to upper body fat leading to what’s known as Cushing Syndrome. This syndrome is characterized by rapid weight gain in the face, abdomen and chest besides causing a flushed face, high blood pressure and changes in the skin.

Collagen synthesis stimulated by cortisol is inhibited when an individual is under too much stress or performs vigorous physical activity due to interruption of bone mineralization. Cortisol might enhance sensitivity of tissues of blood vessels and heart to noradrenaline, vasopressin and angiotensin II thereby leading to higher blood pressure levels. It also affects immune system in the form of hydrocortisone-it shows anti-inflammatory and immunosuppressive effects by disrupting the production of inflammatory cytokines, migration of WBCs to inflammatory sites and inducting cell apoptosis. By doing this, cortisol protects our body in times of injury being especially useful in the case of athletes involved in sports. Studies have shown that athletes who are highly motivated and successful show higher presence of the cortisol hormones in their body. Likewise, levels of cortisol hormone also influence the emotional feelings experienced during the start of a competition and also the degree of burden that they carry around before, during and after the competition. After completion of an athletic event or exercise, the cortisol levels vary depending on the fitness of the individual, his/her training duration and compliance to regular training.

Effects of Dietary Intake on Cortisol Levels
Our diet talks about our health. The food we eat, the nutrients we consume and the quantity of these influence the functioning of the body which includes the endocrine system as well. The type of carbohydrates we eat and how much of it we eat actively affect the endocrine system. Hence, before, during and after exercise or sports training it is imperative for individuals to replenish energy stores by taking appropriate carbohydrates.

Many individuals these days take dietary supplements alongside a well-balanced diet to maintain the nutritional requirements of the body. We can see an increasing number of elderly people, athletes and heavy workload people using nutritional supplements to improve their overall efficiency and functioning.  These are one of the groups of people who are highly susceptible to increased secretion and metabolism of hormones including cortisol. So, consuming dietary supplements helps them in stabilizing the effect of these hormones. For instance, cortisol levels might increase after exercising and supplementing the body with certain amino acids such as tryptophan decreases cortisol levels. One should carefully choose the supplements with the help of physician’s guidance-supplementing with amino acids such as glutamine and arginine have no impact on cortisol concentration.
​
Phospholipids too regulate cortisol levels and the best of them include phosphatidylserine and phosphatidic acid. But studies have shown that supplement dosage plays a great role in bringing about changes- a 400mg/day dose administered for 6 weeks reduced cortisol levels incremented due to exercising while consuming a 200mg/day dose had no significant effects. Protein-enriched products such as egg yolk are great sources of these phospholipids, yet another reason why we are always suggested to consume a protein-enriched diet. Fermented milk products, sprouts of brown rice, barley and beans can be consumed generously as these help in controlling cortisol release with the help of a chemical compound called GABA (gama aminobutyric acid) present in each of them. Besides foods, yoga has been proclaimed as one of the best ways to increase GABA concentration in brain.

Studies Supporting Supplement Intake
We have had numerous studies trying to understand the effect of ascorbic acid (vitamin C) intake on cortisol synthesis. A study by Brody et al. showed that consuming 3000 mg of vitamin C daily helps in cortisol recovery after psychological stress but does not contribute towards lowering cortisol levels. We have other studies showing that consuming high dosages of ascorbic acid (1000-1500 mg/day) before the start of an athletic session helps in restricting increasing cortisol levels, decreases muscle pain and facilitates efficient regenerative processes. Similar effects were observed for supplementing the body with vitamin B1, B2 and niacin. Vitamin D has always been mysteries and in the case of cortisol too the results have been controversial.

It has been well-known that exercise increases cortisol levels but a study by Golf et al. showed that supplementing our diet with magnesium inhibits exercise-induced increase in cortisol levels. But another study by Cinar et al. showed that magnesium supplements in combination with physical activity increased cortisol concentrations. Even vitamin E and omega-3 are proposed to be cortisol-lowering supplement aids but we don’t have authentic scientific evidence to support this. But a 3-week supplementation of fish oil helps in reducing cortisol and stress levels.

Coffee and tea have been always consumed in times of energy needs. A study by Arent et al. showed that consumption of black tea extract enriched with theaflavin helps reducing cortisol levels caused by stress and so does oolong tea. Contrarily, black coffee stimulates hydrocortisone secretion. The presence of caffeine in coffee prevents decrease in cortisol levels. Having caffeine before a workout leads to dose-dependent increase in cortisol and testosterone concentrations. Studies on individuals who consume drinks containing carbohydrates and caffeine during workout shows that maximum increase in cortisol levels was seen in the group supplemented with caffeine without carbohydrates. Study by Miyake et al. showed that supplementation with L-ornithine reduced serum cholesterol levels besides reducing anger and improving sleep quality. A 4-week supplementation of extracts found in the roots of Eurycoma longifolia (Malaysia ginseng) helped in reducing cortisol levels by 16% and increasing testosterone levels by 37%. Intake of enzyme-treated asparagus extract prevents cortisol increase and also raises sleep quality.

Vitamin D’s Impact on Cortisol Levels
Vitamin D deficiency is prevalent worldwide right from youngsters to elderly people. Chronic stress prevents the body from accepting stress challenges and this is termed as allostatic load which impairs normal levels of stress mediators such as cortisol (CORT). Changes in cortisol levels have been associated with a number of factors and the recent has been links between vitamin D deficiency (VDD) and lifestyle stressors. There has been an inverse association noticed between serum 25 (OH) D and postpartum allostatic stress and another similar one seen in preeclampsia patients too. Studies dealing with VDD’s link with stress has been inconsistent. Vitamin D3 supplements suppressed HPA-axis activity. While it was positively linked to coffee consumption in Koran participants another study in Saudi Arabia excluded coffee consumption as a contributing factor for VDD. Though we have a few studies linking VDD with obesity biomarkers such as hip, waist, weight and BMI we don’t have definite results relating VDD to lifestyle stressors. A study tried to analyse the relationship between VDD and lifestyle stressors in healthy Jordanians.

The study included male and female Jordanian Applied Science University students and their Anthropometric and lifestyle habits were noted with the help of a questionnaire. There were 371 participants who were eligible for analyses. Their serum 25(OH)D levels, serum CORT levels and serum PTH levels were measured using different techniques. All the participant were between 17 and 52 years of age and their mean serum 25(OH) levels was 12.2 ng/mL and this is classifiable under vitamin D deficiency. PTH, ionized calcium and phosphate besides serum morning cortisol were within physiological limits. 72% participants were females and some of the common positive traits observed among most of the participants in the study includes adequate sleeping hours during night, morning sun exposure, non-smokers and living with their family.

Anthropometric parameters showed very weak positive correlation with VDD, a poor correlation was seen between vitamin D levels and exposure to sunlight, larger number of family members implied severe VDD levels, LDL-C and TC showed a weak correlation with VDD severity.

Cortisol & Weight Changes
Stress rules the world, it rules our actions and even the choice of our foods. Effect of stress varies depending on the type and duration of stressors. Acute stress (developed as a result of exposure to some traumatic event) supresses appetite while chronic stress increases hunger and intake of high-fat and energy-dense foods. Chronic stress has been linked with obesity/overweight issues in a number of studies. Effects of chronic stress has been linked to disturbances in the HPA axis due to which cortisol hormones are secreted. This secretion triggers hunger hormones and increases intake of high-fat foods. The clear link between food cravings, stress, cortisol and appetite-inducing hormones are not understood until now.

A group of researchers tried to understand whether increased chronic stress, cortisol and appetite-related hormones triggered food cravings and weight gain. 339 participants aged between 18 and 50 years who were not pregnant, taking meds for any psychiatric disorders or suffering from chronic medical conditions were involved in the study. All of them underwent a biochemical evaluation after overnight fasting, psychological measures and a self-report questionnaire. Height and weight were measured at baseline.

Chronic stress was measured using a 62-item questionnaire in which items were rated as not true, some to very true. Questions included those on relationship with family, difficulties in work and home environment, etc. Food cravings were measured using a 28-item questionnaire rating each food on a scale of 1 (never) to 5 (always/almost every day). Items were split into four sub-categories-sweets, high fats, carbohydrates/starches and fast-food fats.

Results
Among the 339 participants almost 57% were females. Males had increased cravings for high fats and had high glucose levels. Females had higher ghrelin, leptin, cortisol and chronic stress besides cravings for sweets. Baseline BMI was positively associated with total and specific food cravings. Total food cravings were positively associated with leptin, insulin and glucose. Morning cortisol was inversely linked to chronic stress, cravings for high-fat foods, leptin and insulin. Leptin was positively associated with total food cravings. Cross-sectional model did not show any association between cortisol, chronic stress and weight. But cortisol, leptin, insulin and stress did not predict changes in food cravings over time.

Of the total participants almost 50% of them gained weight over the 3-month study period. Individuals with higher baseline cortisol gained an average of 1.12±0.33 kgs while those with a lower baseline cortisol gained 0.530.37 kgs. It was observed that higher baseline cortisol, insulin and chronic stress implied greater weight gain from baseline to 6 months.
​
Hence, it is imperative that each of take care and eat well to optimize cortisol levels in the body. It is an essential hormone which works wonders when the levels are balanced but which also has the ability to create tremors when the levels go too low or high.

References
The Effect of Diet Components on the Level of Cortisol: https://link.springer.com/article/10.1007/s00217-016-2772-3
​
Correlation of Selected Stress Associated Factors with Vitamin D Deficiency in Jordanian Men & Women: https://www.dovepress.com/correlation-of-selected-stress-associated-factors-with-vitamin-d-defic-peer-reviewed-fulltext-article-IJGM

Stress, Cortisol and Other Appetite-related Hormones: Prospective Prediction of 6-Month Changes in Food Cravings & Weight: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5373497/

What is Cortisol? https://www.hormone.org/your-health-and-hormones/glands-and-hormones-a-to-z/hormones/cortisol

Ageing is inevitable and remains the most familiar aspect of human biology. Almost 1/5th of the human population would be individuals aged above 60 by 2050 as the average life expectancy has drastically increased during the last couple of decades. How we age is a matter of concern here as ageing is often accompanied by metabolic disorders such as diabetes and health problems, atherosclerosis and neurodegenerations. Enormous research on ageing that has resulted in finding pharmacological agents that can extend lifespan and healthspan shows that ageing is malleable. The main issue that remains here is to live a longer life that’s devoid of age-related functional decline and fragility that includes diseases such as cancer. Cancer causes millions of deaths annually and in the future one in every eighth person would be a victim of this disease. Ageing can be delayed and so can cancer. Muscle atrophy is one definite side effect of cancer and cachexia (extreme weight loss and muscle wasting) is a positive sign of death in almost 22-40% cancer patients. Presently, cachexia is treated by improving the individual’s appetite with appetite stimulants and protein supplementation so as to supply the patient with nutrients. This, apart from improving chances of survival also improves the chances that the cancer patient withstands treatment procedures successfully. But these treatment procedures including physical rehabilitation and treatment for underlying diseases is not successful and what we need is an effective treatment protocol for correcting muscle wasting that helps in extending both, lifespan and healthspan.
​
We have always thought of procedures and treatments for inhibiting ageing in individuals which in turn helps to minimize the occurrence of diseases such as cancer. The invention patented here is of utmost use in each of our lives as it provides a method and system for extending healthspan and lifespan of humans as well as for preventing the onset of diseases such as cancer. Delaying ageing process delays/prevents the occurrence of debilitating illnesses such as cancer. The invention here looks at the large picture rather than its pieces in that rather than trying to deal with age-related pathologies one by one the invention tries to overcome age-related pathologies in general. By this, it focuses to bring an overall new approach to the current public health strategy which involves steps taken to prevent illnesses individually which can sometimes leave the patient susceptible to other illnesses in the treatment period.

Tomato fruit is mostly consumed by individuals in salads and curries and its consumption has greatly been associated with a reduced risk of inflammatory processes, cancer and non-communicable diseases that includes cardiovascular diseases (CVD such as heart disease, obesity and hypertension. One aspect of the invention uses a natural small molecule that’s been derived from tomato plants, tomatidine, that is associated with cell growth (majorly in skeletal muscle tissue). Basically, tomatidine is an inhibitor of muscle wasting and the invention here looks at providing cancer patients with bacteria that have been modified to produce tomatidine to address muscle atrophy linked to various cancers. Treatment for cancers are also linked to the production of p53, a tumor support factor. In one representation of the invention, cancer treatment was enabled by administering the microbiome of a subject with a bacterial combination that expresses p53 protein and tomatidine as in the case of breast, colorectal, kidney or bladder cancer. Particular agents and certain combinations are administered in various representation of the invention to lessen the occurrence of cancer which is due to the delay of ageing. One such agent is rapamycin (sirolimus), a bacteroid produced by the bacterium Streptomyces hygroscopicus.

Administering rapamycin via microbiome helps in fighting against age-related diseases. Rapamycin is an inhibitor of mTOR complex (mammalian target of rapamycin) which is a serine threonine kinase and a regulator of protein synthesis, cell growth and cell metabolism. Excessive mTORC1 activity has been noticed in various types of cancers, inflammatory skin diseases, bowel disease and neurodegenerative diseases. Rapamycin is used in the invention to treat/prevent medical conditions by inhibiting the mTORC1 pathway. Tomatidine and rapamycin both are used to sort out cancer, ageing and cachexia as the former has the ability to preserve muscle mass while the latter reduces growth of muscles (basically prevents the growth of cancer cells).
​
The modified bacteria used in the invention are administered directly though the mouth to deliver the therapeutic directly to the gastrointestinal tract. Shortening of telomers is associated with ageing but trying to rebuild shortened ends using telomerase often results in cancer. Ageing can cause telomer damage in the nucleus which in turn can trigger the activation of p53 that can have different effects on the individual. p53 is a gene that inhibits damaged cells to grow and this gene prevents cancer in younger people but at the same time, it can cause ageing by impairing the body’s ability to renew deteriorating tissues. Physical activity, diet modifications and addressing hormone signaling are all practical ways to extend human healthspan but the problem here is that most individuals don’t follow it. Shortening of telomers and using enzymes to rebuild telomers thereby lengthening the telomers at a risk of cancer is due to the effect of such enzymes on p53 mutation which deprives the individual of the cancer-inhibiting wild-type p53.

One representation of the invention looks at producing resveratrol by using an individual’s microbiome to delay ageing as well as treat cancer as it has been viewed to possess antioxidant, anti-inflammatory, anti-apoptotic and anti-cancerous effects. Hence, the basic principle of this invention is to achieve cellular rejuvenation by modifying microbes such that the individual’s own microbiome generates desired combinations of chemicals that extend life and health spans without altering the human genes. The patent was published on December 7th, 2017 and for more details on the patent please visit:

Untied States Patent & Trademark Office: http://patft.uspto.gov/netacgi/nph-Parser?Sect1=PTO2&Sect2=HITOFF&p=1&u=%2Fnetahtml%2FPTO%2Fsearch-adv.htm&r=32&f=G&l=50&d=PTXT&S1=(Kovarik+AND+cancer)&OS=Kovarik+AND+cancer&RS=(Kovarik+AND+cancer)

World Intellectual Property Organization: https://patentscope.wipo.int/search/en/detail.jsf?docId=US206640361&_cid=P20-JYIL0P-06069-1

Irrespective of the type, duration and frequency of an activity performed any physical activity is sure to reap benefits for the person performing it. Each of us are struggling hard to squeeze in some time to fit in physical activity in our daily schedules somehow and the benefits incurred are regardless of whether it occurs as part of work, leisure, transport or housework. Walking was the only means of transport earlier and after the introduction of wheel, mankind progressed towards other means of transportation. Bicycle, an integral innovation has been also used as an excellent means of exercising since ages. But walking and cycling are activities that can be performed individually. Then how did the group fitness classes evolve?  

The origin of group fitness can be traced back to 1968 when Kenneth H. Cooper introduced the concept of aerobic exercise. Immediately the following year dance-based fitness classes focusing on cardio, strength and stretch movements were introduced and it was not until early 1970s that Sorensen took a bit of aerobic programs, added some music and made the world become an ardent fan of aerobic dance that now prevails as the basis for group fitness programs these days. Group fitness classes are exercises performed by a group of people in the presence of an instructor attracting people with its different formats available-yoga, aquatic activity, core conditioning, resistance exercise, kickboxing, boot camps and more. There are a number of health centres and fitness clubs that bank on people’s interest to do different activities and their eagerness to have fun that they have reshuffled the entire concept of fitness. Group activities are encouraged these days as they motivate people to be regular for workouts, follow a consistent exercise schedule and reap the benefits of a fun environment. The question now is whether group fitness offers more benefits than individually performed exercises, especially for the elderly. 

We are witnessing the fastest growth in the ageing population which brings with it a great burden on the society due to increased risk of mental and social health problems that grow alongside physical health problems as well. There is a dire need to promote physical activity among older people as its absence increases the risk of chronic degenerative diseases and disabilities. Ageing is by itself a risk factor for decline in daily functionality and mobility whose effect can be controlled with daily physical activity and exercise schedules. In such cases regular physical activity increases muscle strength, coordination and flexibility but to avail these benefits it must be performed regularly. But one requires knowledge, skills and perseverance for reaping the benefits of exercising. Don’t we see a group of elderly adults, men mostly, in parks going for a walk or a slow jog as well? These people enjoy each other’s company and have fun while exercising too. But the population of older adults is heterogenous as each of them have varying degrees of health, culture, attitudes and practices. Viewing them as one group might hamper us from providing the needed healthcare as it is essential to consider each of the elderly person’s individualized needs. How good can group exercising benefit older adults in such a scenario and what’s the impact of group exercising on the elderly population? 

Advantages of Regular Group Exercising in Elderly in Japan 
Japans prevails as the most rapidly aging country in the world where by 2035 one in every three adults will be aged 65 years and above. The study discussed here focuses on the experiences of older adults participating in regular group exercise and the effect of such activity on the person’s physical, mental and social changes. A community-wide intervention program named the ‘Fujisawa +10’ was created to spread the performance of physical activity among citizens based on the national physical activity recommendations made by the National Institute of Health and Nutrition of Japan. The Fujisawa+!0 exercise program was a community-wide intervention with exercise intensity at an extremely low level. Dynamic and static stretching exercises, knee-ups, squatting, knee exercises, arm circle exercises and body balance exercises done in standing or sitting positions are a regular part of the exercise routine programmed. These exercises were introduced to the elderly section of people who were voluntarily exercising together as a group at least once at the park (performed thrice a week) or community centre (performed once a week) in their community. All these adults were given a CD, DVD and manual instructions on how to exercise together as a group without an instructor. 

Participants selected were older adults who were participating in the ‘regular group exercise’ in community A and B. Only those community-dwelling older adults who were above the age of 60 participating in regular exercise in community A or B and those living independently without any elderly care assistance were included in the study. The research team conducted four focus group interviews including 26 participants (11 males and 15 females) whose mean age was 74.69 years. Community A had 15 older adults (7 males and 8 females) grouped into two focus groups with 7 (3 men and 4 women) and 8 (4 men and 4 women) respectively. Community B had 11 older adults (4 male and 7 females) who were grouped into two focus groups with 5 (2 men and 3 women) and 6 (2 men and 4 women) participants respectively. Each of the interviews lasted for 60-80 min, none of the participants suffered from disabilities or were diagnosed with dementia, no participant received any formal care, five were living alone and one used a stick due to joint pain. Investigators who had expertise in conducting focus group interviews (HK and KY) served as facilitators while two investigators (YO and YS) and two graduate students attended the focus group meetings as observers.  

Results 
The researchers could clearly confirm that ‘regular group exercise contributes to balanced health in older adults’ which consisted of seven themes (regular group exercise, functional health, active mind, enjoyment, social connectedness, mutual support and expanding communities) under its umbrella. It was observed that group exercise contributed to physical, mental and social well-being helping them improve on their functional health, peer interaction and their degree of enjoyment. People working out in groups cared for each other, felt connected and had a sense of security in the community.  
​
Older adults have aplenty free time after being done with their responsibilities towards their kids and hence, felt that regular exercise was critical in balancing overall health. Such regular exercises helped them lead an active life without succumbing to sedentary lifestyle habits that included getting up, sleeping or eating at haphazard timings. We also know that many elderly people live in isolation having lost their spouse or their kids stay away and they are forced to lead lives of their own. In such cases, gathering at one common place helped these people to interact with each other, prevent isolation and bring in a purpose to their living. When elderly individuals began their day with group exercises, they felt their body to be flexible, energized and fit while off days motivated them to exercise even stronger on other days. Exercises helped these participants to at least stay fit in their current level even if it did not help in improving their fitness quotient. Many participants felt that they were blessed to socialize and exercising individually at home could have never brought them this kind of an enjoyment. Group exercising also helped in expanding social connectedness and mutual support. The study clearly shows that group exercises benefit the overall development of the elderly individuals catering to their physical, social, emotional and mental needs.  

Combined Intervention Program 
While the advantages of group exercising seems to sound great there are also many downsides to it. It is not always possible for all the elderly individuals to commute as their health must permit and economic background should also support it; there is less attention paid to individual needs despite the fact that every ageing adults would be suffering from a different kind of body pain and finally, renting a place that’s close to many of the individuals participating and hiring an instructor for the same is not an easy job. Hence, merging a home-based intervention program with a group exercise program would be the best approach as it channelizes the individual’s exercising frequency, intensity and duration to the desired levels. A research team analysed the effects of a blended exercise program on adults in Europe. 

Participants were selected from a community-based program known as More Exercise for Seniors in which more than 3,00,000 older adults above the age of 55 years participated in a weekly group-based exercise class under the supervision of a trained instructor. The elderly individuals were asked to sign up for the focus group and instructors were contacted revealing the study’s intention. A total of 15 instructors were contacted and 8 focus groups were held (including two pilots) with 48 older adults. The focus-groups happened at locations where the weekly MBvO-class were held with each consisting of an average of 6 participants. All the participants in the group were asked about their opinion on an additional home-based exercise program.  

Results 
The two pilot groups and one focus group where data was lost weren’t included in the study and hence, the data from the other 30 participants were included in the analysis. Average age of the participants were 74 years, the individuals had almost been participating for around 9 years in the community-based program and all of them were female.  

Most participants took part in the weekly group exercise classes as they wanted to be physically fit and self-reliant without depending on others for their everyday chores and activities. Besides this, participants enjoyed being in the presence of others, felt motivated by each other, formed close friendship bonds and were delighted to have some quality fun. At the same time participants also revealed that home-based exercise programs brought about several benefits-it helped them fulfil their personal goals, could help them perform exercises that they were comfortable doing on that particular day owing to aggravated pain anywhere in the body and were also positive about the different levels of an exercise program that could be self-paced when performed individually. But many expressed motivation as a main concern while performing home-based exercises as group exercises are sure to be motivating and the presence of peers were a great support for regularity.  

Yet another Japanese study that analysed the benefits of exercising alone versus exercising with others found that though both had its own health benefits increased frequency of exercising with others had tremendous health benefits irrespective of the total frequency of exercise.  

References 
Regular Group Exercise Contributes to Balanced Health in Older Adults in Japan: A Qualitative Study: https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-017-0584-3 

Attitudes of Older Adults in a Group-based Exercise Program Toward a Blended Intervention: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5118593/ 

Exercising Alone Versus with Others & Associations with Subjective Health Status in Older Japanese: The JAGES Cohort Study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5156899/ 
​
The Evolution of Group Fitness: Shaping the History of Fitness: https://journals.lww.com/acsm-healthfitness/Fulltext/2014/11000/The_Evolution_of_Group_Fitness__Shaping_the.4.aspx?WT.mc_id=HPxADx20100319xMP ​

These days we hear a number of young girls and women complaining of irregular periods or prolonged absence of menstruation for even 3 months or so. Polycystic ovary syndrome (PCOS) is a common disorder among females characterized by hyperandrogenism, menstrual and ovulatory alterations and polycystic ovarian morphology. This is a condition that affects the woman’s ability to produce eggs causing a profound number of cysts to appear on the surface of the ovaries. The cysts are nothing but follicles that contain underdeveloped eggs which are often released at irregular intervals. In some, PCOS totally stops the release of eggs. Such conditions lead to irregular/loss of periods, weight gain, acne, thinning of hair, excessive hair growth in other parts of the body and fertility problems. But the effects of PCOS go beyond the reproductive boundary extending to insulin resistance, type 2 diabetes mellitus (T2DM) and cardiovascular disease. Insulin resistance has been proposed as one of the key effects of PCOS resulting in reproductive as well as metabolic disturbances besides increasing the risk of cardiometabolic risk for women with PCOS. PCOS has been declared as a nonmodifiable risk factor for diabetes by the International Diabetes Federation & by the American Diabetes Association with evidence from observational, retrospective and short-term prospective studies. We don’t have much long-term studies identifying increased risk of T2DM in women with PCOS.
​
Long-Term Prospective Study on Diabetes Risk in Women with PCOS
PCOS is very common affecting 1 in every 5 women at some point of life. Though its cause remains unknown its believed that higher than normal androgen levels play an important part besides other risk factors such as excess weight and family history, both of which are also risk factors for insulin resistance.

A long-term observational study on Italian women with PCOS was conducted for at least 10 years to evaluate the incidence rate of type 2 diabetes during the period. During the first examination between 1978 and 1999 every woman was screened for PCOS and in 2009, all of those having PCOS were asked to come for a follow-up examination during which the same set of tests as done during the first examination was performed. Even before the start of study those women with Cushing’s syndrome, androgen-secreting neoplasm, hyperprolactinemia, congenital adrenal hyperplasia, thyroid disease, or other causes of amenorrhea, including premature ovarian failure were excluded. All the women were questioned on their smoking, drug therapy and any history of diseases, their height, weight, waist circumference and blood pressure measurements were taken. Fasting blood samples were taken to measure levels of different hormones such as luteinizing and follicle-stimulating hormone, 17β-estradiol, testosterone, and sex hormone-binding globulin (SHBG). Blood samples were taken during the first week after start of menstruation and after withdrawal of bleeding and glucose tolerance test was performed too.

Results
After implementing various exclusion criteria, a total of 277 women were involved in the study from 1978 to 1999. All of them were once again contacted in 2009 for follow-up but 22 women were unavailable for data due to various reasons (death, some did not want to pursue further or had given birth to a child). The remaining 255 women were re-evaluated in 2009 and the information collected was used to compare between the rates of type 2 diabetes of women with PCOS and the general female population. 226 women with PCOS were regularly followed-up by the research team checking on their performance every 1-2 years. During the follow-up period 163 participants were on oral contraceptive treatment for at least a year, 72 were on metformin, 29 were on flutamide, 22 were on antihypertensive drugs and 4 were on statins. At baseline, there was no difference observed in any of the parameters with the exception of luteinizing hormone blood levels which was higher than normal in the participants.

It was observed that 6 women were diabetic at baseline and 42 women developed type 2 diabetes during the follow-up. 39.3% of the population suffered from type 2 diabetes at the end of follow-up that’s higher than the general population. The follow-up period of diabetic women was much longer than that of nondiabetic women and, diabetic women were much older comparatively. They also had higher BMI and larger waist circumference, higher fasting glucose and insulin levels and higher glucose but lower sex hormone binding globulin (SHBG) levels. It was observed that a greater number of women with diabetes were under metformin treatment during follow-up compared to oral contraceptive treatment when compared to women free of disease. The incidence rate of type 2 diabetes increased with increasing BMI, fasting glucose and glucoseAUC rates at baseline. Whereas, a higher SHBG level at follow-up was linked to a lower risk of developing type 2 diabetes.

When comparing the risk of T2DM with BMI levels it was seen that risk of diabetes steadily increased with BMI and was especially high when BMI≥30. Obesity is a common risk factor for PCOS, BMI values increase with increasing obesity rates and such high BMI levels and glucose rates contributed to increase in type 2 diabetes rates in women with PCOS. The study shows that risk of type 2 diabetes increased in women with PCOS during middle-age and hence it is required that women with PCOS are regularly screened for diabetes risk.

Diabetes Risk for Women with PCOS based on CARDIA Study
The coronary artery risk development in young adults (CARDIA) study was used for procuring study sample for diabetes risk in PCOS-affected women. The sample included 1127 women who were present both at Year 2 and Year 16 examinations with Year 2 examination considered to be the baseline for the study. Androgen values were obtained from Year 2 and Year 16; at year 16 the participants were queried about symptoms at two time frames, past (ages 20-30) and current (ages 34-46). All the women were questioned on the length and regularity of menstrual cycles. PCOS was reported by self-reporting symptoms such as oligomenorrhea, hirsutism and serum androgen measures. Participants having oligomenorrhea between 20-32 years of age and hirsutism between 20 and 30 years of age were classified as having PCOS. Women with PCOS were classified during two time frames: Year 2 (ages 20-32) and Year 16 (ages 34-46). Weight, height, BMI and waist circumference was measured. Participants were classified as ‘never PCOS’ when they did not fulfil the criteria for PCOS during both time frames, ‘early PCOS’ when they fulfilled Year 2 criteria only and ‘persistent PCOS’ when they fulfilled PCOS criteria at both time frames. Participants were branded as diabetic when fasting plasma glucose ≥126 or when they were using diabetes measurements.

Of the 1127 women only 53 of them met PCOS criteria at ages 20-32. While PCOS-affected and normal participants did not differ in BMI, waist circumference, physical activity, alcohol use and tobacco use it was seen that women with PCOS had higher mean fasting insulin levels and had not given birth to babies. Both groups of women did not differ in terms of presence of hypertension and diabetes. Results showed that women with PCOS at ages 20-32 were likelier to develop diabetes by the time they reached 38-50 years of age and it doubled the risk of diabetes. PCOS increased the risk of diabetes by as much as 3-folds in normal weight women with PCOS compared to normal weight women without PCOS. Only 2% women met criteria for persistent PCOS while 3.5% were classified as having ‘early PCOS’. Those with persistent PCOS had a 7-fold risk of developing diabetes in the next 5 years compared to those without PCOS while those with early PCOS did not show such risks.

Risk of Gestational Diabetes Due to PCOS
Gestational diabetes mellitus (GDM) is a common concern in pregnant women whose rates can be anywhere from 9-25%. GDM and PCOS are one of the most common endocrine disorders in women of reproductive age both of which relate to overweight/obesity and insulin resistance and they are also clear indications of T2DM risk. A Finnish study tried to prove that PCOS is an independent risk factor for GDM.

The Finnish Gestational Diabetes Study (FinnGeDi study) recruited a group of 1115 women with GDM and a singleton pregnancy who were about to deliver. Another set of 1125 women with no GDM giving birth in the same hospital were recruited as controls. After imposing exclusion criteria the research team was left with 1146 in the GDM group and 1066 women in the non-diabetic control group. All the participants were asked to fill a questionnaire about their medical and family history also involving questions on oligomenorrhoea, the presence of hirsutism and prior diagnosis of PCOS. A total of 1030 candidates with GDM and 935 non-diabetic women returned the questionnaire. GDM was diagnosed by a 2-h 75 g oral glucose tolerance test (OGTT) after overnight fasting. OGTT is generally performed between the 24th and 28th weeks of pregnancy but also can be done between 12th and 16th week when the woman is at a high risk of GDM.

521 women had irregular menses (oligomenorrhoea), 207 had hirsutism while 87 suffered from both. 124 of them reported prior diagnosis of PCOS and 37 reported prior diagnosis and two symptoms. This led to a total of 174 women with both symptoms and prior diagnosis to suffer from PCOS. The total study population of 1941 women were divided into four groups: GDM+PCOS (n=105), GDM+non PCOS (n=909), non-GDM+PCOS (n=69) and controls (n=858).

Results

1. 10.4% women with GDM and 7.4% non-diabetic women reported symptoms and diagnosis of PCOS
2. Participants born with a low birth weight had a higher risk of GDM irrespective of the presence of PCOS probably due to slower foetal growth.
3. Participants born preterm were twice at a risk of GDM
4. Participants with GDM irrespective of PCOS state were less educated, had higher pre-preganncy BMI, were older, had 3 or more previous pregnancies and were short.
5. Participants in the PCOS+GDM group had higher pre-preganncy BMI and likelier to be obese than those in the other three groups.
6. The participant’s risk for GDM was doubled when her mother had a history of GDM or T2DM. When the participant’s father had a history of T2D the participant’s risk for GDM was 1.4-fold.

This study concluded that PCOS is not an independent risk factor for GDM and the increased risk of GDM in women with PCOS is mainly linked to adiposity. Obese women with PCOS who are at an increased risk for GDM need insulin treatment during pregnancy.

References
Polycystic Ovary Syndrome is a Risk Factor for Type 2 Diabetes: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3425413/

Polycystic Ovary Syndrome & Risk for Long-term Diabetes & Dyslipidaemia: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3060760/

Polycystic Ovary Syndrome & Risk Factors for Gestational Diabetes: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6026881/
​
The Link between Polycystic Ovary Syndrome & Type 2 Diabetes: What Do We Know Today? https://www.openaccessjournals.com/articles/the-link-between-polycystic-ovary-syndrome-and-type-2-diabetes-what-do-we-know-today.pdf

Crying is the only language known to newborn. They cry when they are hungry, when something is troubling them, if they are suffering from even mosquito bite or when their diaper is overfull. But it is the responsibility of the parents to find out the accurate source for the tears, correct it and help the infant resume sleep or movement of his/her hands and legs. While its often any of the above-quoted reasons sometimes when you notice keenly you can observe that the infant cries continuously during a particular period of the day some days of the week. If that’s the case your kid might be suffering from infantile colic.

Infantile colic is defined as episodes of inconsolable crying in an otherwise healthy infant younger than three months of age that lasts at least 3 hours a day and occurs at least 3 days a week over the course of at least three weeks in a month-this is a definition proposed first by Wessel. But a recent definition conveys that colicky infants cry constantly during the evening at the same time every day for at least a week but otherwise they are healthy. I guess many of you are interested to read further about this condition as most have faced or are facing this problem in bringing up our munchkins. Existing as a common condition around the world infantile colic affects one in five infants younger than three months affecting almost 28% infants in the first month of life. The symptoms worsen around 6 weeks after childbirth and improve gradually thereon. But we do have a Canadian study showing that 6.4% infants suffered from persistent colic symptoms at 3 months of age. Breastfeeding is advised until the infant’s sixth month and in such breastfed infants colic episodes are more common during late evening or early morning hours. Such disruptions during such odd hours ultimately results in maternal exhaustion and tiredness. Its been proposed that colic is not a sign of worry and there is nothing dangerous about it but it does indeed exist as a major burden to family members as it many-a-time leads to maternal depression (owing to unrealistic parental feeding expectations, irregular sleep patterns and constant worry over the baby) and might also cause shaken baby syndrome. There are even chances that the baby might stop breastfeeding earlier than expected and colicky behaviour that continues beyond the expected three months or so paves way for later sleep problems, allergic disorders, family dysfunction and behavioural problems.

At a Loss for the Cause behind Colic Problems
Almost every child faces this problem of infantile colic and the reasons remain elusive but we have various theories proposed.

Colic might simply be a part of the regular crying protocol followed by kids. There is even a hypothesis that it is due to the impact of abnormal gastrointestinal motility and pain signals from pathways in the gut. It has also been proposed that the absence of adequate lactobacilli in the gut and increased presence of coli in intestinal microbiota affect gut motor functions and gas production thereby leading to such a condition. Lactose intolerance, gut contractions, mistaken interpretation by parents when the child cries normally, lack of adequate parent-child interaction, family tension and parental anxiety are some of the assumed causes of infantile colic. Increased maternal age has also been proposed as a cause for colic action in infant.

On a Hunt Against Colic Brunt
If you notice, the very word ‘colic’ has an abdominal origin. But studies have failed to show a positive link between gastro-oesophageal reflux and crying in infants younger than three months old. A randomized control trial (RCT) in both breast-fed and formula-fed infants revealed that at two weeks of age the incidence of crying more than three hours a day was 43% in formula-fed infants and 16% in breast-fed infants. A recent trial proposed that one week of low allergen diet among exclusively breastfed infants (6 weeks old) with colic reduces the risk of colic symptoms by 37% and this brings upon hope that diet alterations in maternal women might bring about some positive changes.

A herbal drug containing chamomile, vervain, liquorice, fennel and balm-mint given to infants suffering from colic thrice a day showed marked improvement after seven days. But above all this a mother’s intervention might provide the best possible results against colicky infants. The study below is about one such intervention by moms.

Cross-sectional Study
The cross-sectional study involved infants younger than three months of age who had been diagnosed being colicky by their paediatrician. It included both breast-fed and formula-fed infants while those with diarrhoea, vomiting and abdominal distention were excluded. This left the study team with 400 infants of whom 181 were male and 173 were female. Moms were around 27 years of age and the infants birth weight were around 3100-3500 grams. 34% of the infant’s family had history of colic, 48.5% had normal vaginal delivery (NVD) and 92.5% mothers received breastfeeding training at the hospital. 196 infants (49%) were colicky and 204 infants (51%) were not. All the mothers imposed behavioural, nutritional or medical types of intervention to control infantile colic.

Behavioural approaches used included responding to the crying baby by feeding, hugging, carrying around, wrapping the child in clothes (swaddling), using a pacifier, giving him/her toys, playing music, putting the baby to sleep or giving the baby to someone else as the mother could not cope up with stress. Nutritional approaches followed by the moms included avoiding grains, cereals, dairy, vegetables and meat. Sometimes the mother consumed herbal tea, administered herbal tea to infants or both the mother and the baby consumed herbal tea. Chemical drugs were also consumed sometimes by the mother and some other times by the baby.

Behavioural intervention showed that the researchers could find significant difference between the two groups because of two main factors that included family income and mother’s education. In nutritional intervention, a significant difference was found between the two groups in their avoidance of a specific kind of food in accordance with the type of feeding. If the mother breastfed, she was actually pursuing more nutritional interventions. The herbal intervention group did not find any difference depending on family income, mom’s education level, family history of colic, infant sex, type of feeding, breastfeeding training and mother’s job.
​
Non-colic group showed that both moms and babies consumed more herbal tea than those in the colic group. Herbal tea consumption by mothers in the colic group was greater than those in the other group. When it came to comparing chemical drug intervention there was significant difference found between the two groups as a result of family income, mother’s education, infant’s birth order, mother’s age and previous breastfeeding training. Chemical intervention was mainly in the form of gripe water in these infants. Now, there would be a smile in many readers faces as this is one of the oldest solutions used to soothe a crying infant.

Effect of Maternal Diet Intervention on Colicky Infants
A randomized, control trial was performed by a study group to test whether elimination of allergic food proteins from the maternal diet helps to reduce crying and fussing in infants. The study included exclusively breastfed infants <6 weeks of age suffering from colic problem. The moms were informed that the study included two different diets that were proved to be beneficial in colic-affected infants which ultimately led to the elimination of strict vegan diets. One was a low-allergen diet that excluded major food allergens and the other was a control diet that included the excluded foods by the first diet group as well. None of the diets included those containing food preservatives, colours and additives. All the moms were randomly assigned to one of the two groups.

Low-allergen diet: Moms were asked to exclude all foods containing dairy products, soy, wheat, eggs, peanuts, tree nuts and fish from their diet. The diet primarily included meats, a rice milk drink, vegetables, fruits and cereals (corn and rice). Calcium supplements were prescribed and moms were also subscribed a plant-based drink in powder form alongside a daily consumption of fresh rice bread.

Control diet: This diet excluded all those foods excluded from the low-allergen diet. All moms were asked to eat 1 serving of peanuts, 1 serving of wheat and 1 chocolate muesli per day besides maintaining their intake of meats, rice, vegetables and cereals. All the mothers received soy and cow’s milk powder mixture to make 500mL of milk  which was consumed every day for 7 days.

Cry and fuss charts were recorded by the mothers on the study days.

Results
A total of 107 infants entered the study of which 90 (84%) completed the trial successfully. 47 of 53 from the low-allergen group and 43 of 54 from the control group completed the study successfully. Only those who experienced more than 25% reduction in crying/fussing rates were included in the results that showed that 35 of the 47 infants responded to the low-allergen diet program compared to 16 of the 43 infants on the control diet. Changing the cut-off to 20% did not show any changes in the results. When all non-completers were taken as non-responders, they witnessed a 36% risk reduction in the low-allergen diet group.

At the end of the study 61 of 90 infants still suffered from colic crying or fussing for a prolonged period of time. But, the cry/fuss duration per 48 hours was reduced by a greater proportion in the low-allergen group.
We also have studies showing that replacing cow’s milk with soy and other milk varieties helps in reducing occurrence of colic problems in infants. It is essential that the condition is treated and minimized in any authentic way to help families, reduce risk of depression in mother, ease the child out of the situation and also avoid early breastfeeding cessation.

References
Effective Interventions of Mothers in Colicky and Non-colicky Infants: https://www.omicsonline.org/open-access/effective-interventions-of-mothers-in-colicky-and-noncolicky-infants-2167-0846-1000305-96060.html

Effect of a Low-Allergen Maternal Diet on Colic Among Breastfed Infants: A Randomized, Controlled Trial: https://pediatrics.aappublications.org/content/pediatrics/116/5/e709.full.pdf?origin=publication_detail
​
Dietary Manipulations for Infantile Colic: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2791658/
Infantile Colic: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6091773/

Mankind is entitled to two official breaks during working hours at office- a snack/tea and a lunch break. All the other breaks that we take, even going to the cooler to fetch water, having a small chit-chat with a colleague, attending phones during working hours or surfing social media sites are all unofficial breaks that we take out of our own will during office hours. We have a new term for these kind of breaks – ‘microbreaks’.
​
Microbreaks are brief recovery periods taken between work-related activities. They are rest breaks taken to protect oneself against stress or accumulated trauma while working in a computer-related environment. In simple words, these are gaps taken between work schedules to enable the individual to replenish his/her lost energy stores occurred from prolonged work schedules. This gap might last anywhere from several seconds to minutes depending on the type of break availed. Two types of strategies are usually followed- one that focuses on recovery and another that focuses on maintaining work productivity. The former is productive than the latter as it replenishes resources while productivity-based strategies continue to deplete employee resources. There is no stipulated time duration and frequency but with only two rules that it should be short and voluntary. The concept of ‘microbreaks’ was invented in the late 1980s by researchers from the National Institute of Occupational Safety and Health in Ohio and Purdue University in Indiana. Each of the participants were allowed to take 27 seconds break every 40 minutes during which they remained seated at their workstations doing nothing. Though there was no significant difference seen in productivity people who had taken longer microbreaks reaped better benefits.

Advantage of Microbreaks for Surgeons
Microbreaks are used mainly to reduce the risk of developing injuries in the workplace. Surgeons are one of the main professionals who reap benefits of microbreaks as their job involves standing and focusing for long hours during surgeries which can cause fatigue, musculoskeletal disorders (MSDs) and work-related pain mainly in the neck, back and shoulders. Though ergonomic aids are suggested and have been used by surgeons but they don’t provide as much comfort and relaxation as expected. Also, we cannot expect surgeons to take breaks while doing a procedure as the patient’s safety becomes the first priority. Microbreaks were one remedy that promised to offer better results in minimizing ergonomic risk.

A focus group consisting of 10 users (6 males and 4 females) were considered to take up a study test on microbreaks with a series of stretch exercises that were to be performed in between surgeries. All the stretches were designed by a physical therapist in collaboration with an ergonomist to address major issues that include posture correction, normalization of tissue tension and soft tissue mobility/gliding and relaxation/stress reduction. All the participants performed the stretches giving feedbacks on the likes and dislikes about the stretches also mentioning the components that prevailed as a hindrance for their performance. Before doing any of the stretches they were all shown a pilot video for 90 seconds. With repeated discussions and demonstrations, the best combination of stretching exercises that could be used during surgery without any need to scrub out was identified.

The results were implemented into another video where two persons performed stretches with two views (side and frontal) for better visualization of the movement. They occupied the middle and left portion of the screen as these are the two places where we divert most of our attention. The video also had an audio that came up with step-by-step instruction for improved demonstration of the task, lower cognitive load and better accessibility in a sterile environment when the computer screen is not visible to the user sometimes. Keeping in view that surgeons become absorbed in the surgery a web app was developed in two stages which reminds them to take a break and talks them through the stretching procedure. The reminder included an alarm sound that did not startle the staff in the middle of a surgery, had a snooze option to delay the microbreak when the surgeon was in the middle of an important phase and was also made available to all the staff outside the operation room as well to help in snoozing or stopping the alarm. Once done, 7 surgeons (3 males, 4 females) consented to test the stretching app pilot in their ORs. Each of them performed at least 70% of the surgery and operative days were included if the procedure lasted for at least 2.5 hours with at least 4 hours of total surgical duration per day.

At the end of day, each of them filled a short online survey to give their feedback on the effectiveness of microbreaks. 4 metrics including ‘physical performance’, ‘mental focus’, ‘body pain/discomfort’ and ‘level of fatigue’ were measured using ratings including Better, No Change or Worse. Six other questions were rated on a scale of 0 (none) to 10 (maximum). Non-Routine Event (NRE) data was measured through observation for the participant’s operative procedure. NREs are events that are treated to be distracting, undesirable, unusual or atypical. Results showed that the participants found it difficult to understand and follow verbal instructions in the video due to vague descriptions, problems in viewing the stretches and coordination problems (syncing left and right hand/leg movements with that in the video). Keeping all this in mind the final video time was cut to 68 seconds. The 7 surgeons had 6 microbreaks and were observed for 12 surgical days. The four primary outcome questions that provided three options as answers showed that after surgical procedure better physical performance and lower fatigue was reported 91.67% surgical days. Better mental focus was reported on 83.33% of surgical days and less pain/discomfort was reported on 100% of surgical days. Frequency of NREs in procedures without microbreaks did not differ from those with microbreaks. The pilot study clearly shows that it is necessary to take microbreaks in between to prevent negative impact on patient care due to job demands. A study on call centre people (one of the most emotionally tiresome jobs) helping them with microbreak interventions showed excellent benefit-those who were not engaged with their jobs started benefitting from microbreaks with improved productivity and more positive feelings.

Another study conducted on 28 employees in a meatpacking plant over a 4-week period showed that active microbreaks reduced the discomfort faced by employees during the work day. Yet another study conducted on employees working on computer terminals focused on four main muscle areas and results showed that it reduced discomfort in all four areas during computer work especially when breaks were taken every 20 minutes.
So, don’t forget to take short breaks in between to stretch yourself, go to the washroom or get some fresh air. If you don’t have the habit of taking breaks or belong to the type of personality who would become immersed in the job at hand it is better to have a timer to remind you! Don’t feel guilty when you look at the phones often, engage in a funny video or call someone who would make you laugh. But also remember to engage in productive work without overdoing on the break timings. Else you cannot deliver what has been promised withing the stipulated time.

Providing Diverse Advantages
Hence microbreaks are proved to reduce stress, discomfort, keep workers engaged and make work more enjoyable.

References
Mini Breaks, Many Benefits: Development & Pilot Testing of An Intraoperative Microbreak Stretch Web-application for Surgeons: https://journals.sagepub.com/doi/pdf/10.1177/1541931218621240

Active Microbreak Effects on Musculoskeletal Comfort Ratings in Meatpacking Plants: https://www.tandfonline.com/doi/abs/10.1080/00140139508925107

Computer Terminal Work & the Benefit of Microbreaks: https://www.sciencedirect.com/science/article/abs/pii/S0003687000000715?via%3Dihub

A Series of Microbreaks Can Also Have a Powerful Effect on Your Body & Your Mind: https://www.bbc.com/worklife/article/20190312-the-tiny-breaks-that-ease-your-body-and-reboot-your-brain