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Feb 16

There are treatments for overactive bladder – Hays Daily News

Dr. Keith Roach M.D.| Hays Daily News

DEAR DR. ROACH: Is there a cure for overactive bladder? -- R.H.

ANSWER: The underlying reason for overactive bladder is not well understood, and although there are medications to treat symptoms, there is not a cure for the condition.

The main symptoms of overactive bladder are urinary symptoms, especially urgency (the need to go RIGHT AWAY), increased urinary frequency (this may include symptoms at night), and incontinence. Before considering medication, there are other treatments to try. These include weight loss if appropriate, pelvic floor exercises, bladder training and, in women, evaluation for vaginal atrophy. In men, it can sometimes be difficult to separate prostate symptoms from overactive bladder.

It may be treated with anticholinergic drugs such as oxybutynin. These are modestly effective, but can have side effects such as dry mouth. Recent studies have also implicated anticholinergic drugs as a possible factor in dementia. For these reasons, anticholinergic drugs are used only when necessary and at the lowest effective dose.

Another medicine option in the beta-3 drug mirabegron (Myrbetriq). It can increase blood pressure and should not be used in a person with uncontrolled high blood pressure. Otherwise it is safe and about as effective as the anticholinergic drugs.

Botulinum toxin and nerve stimulators are sometimes used in people can't take or tolerate the medication. Surgery is considered as a last resort.

DEAR DR. ROACH: I'm a 74-year-old man. A year ago, my triglyceride reading was 197. Two weeks ago, it was 301. After being pretty sedentary, I started walking 2 miles at least five days a week about eight months ago. I would think this would have caused my triglycerides to go down. A week before the blood test, my doctor had me taking prednisone for a chest infection. I read that prednisone may make triglycerides go up. Do you think this may have caused the big increase? -- G.C.

ANSWER: Prednisone, a glucocorticoid related to cortisone, has many effects on different tissues and metabolic processes. Some of the most important ones include increases in blood pressure and blood sugar, but when taken long term, it makes people susceptible to weight gain and adverse effects on the skin, and increases infection risk by suppressing inflammation.

It also may cause changes to the cholesterol and triglyceride levels. Fortunately, short-term use should not increase your risk of heart disease. Keep up your daily walking. A follow-up check of your cholesterol and triglycerides after finishing the prednisone is probably a good idea.

Reducing simple sugars and starches are the most important dietary changes to keep triglycerides down.

DEAR DR. ROACH: Is it advisable or inadvisable to take naproxen sodium at the time of COVID-19 vaccination to alleviate potential side effects of the vaccine? -- B.S.

ANSWER: Although some studies have shown that people who get a fever reducer such as acetaminophen (Tylenol) at the time of a vaccine have lower antibody titers, not all studies have shown this, and those that have still showed an adequate antibody level. Booster vaccines showed a "robust" response.

Having had the Pfizer COVID-19 vaccine myself and in observing many of my colleagues, I would say very few have had systemic side effects, such as fever, bad enough to be concerning. A sore arm has generally been the worst. Anecdotally, however, the second vaccine does seem to cause more side effects, perhaps a bit more than a typical flu vaccine but less than the new shingles vaccine.

If you have had side effects of this or other vaccines, taking acetaminophen, ibuprofen or naproxen beforehand is reasonable; otherwise, I would wait a few hours to see if you need one.

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There are treatments for overactive bladder - Hays Daily News


Feb 16

Powerlifting vs. Bodybuilding: Differences, Pros, and Cons – Healthline

Powerlifting and bodybuilding are sports that revolve around resistance training using weights.

If youre new to weight training in general, powerlifting and bodybuilding may seem remarkably similar.

While both sports rely on lifting weights, the goals within each sport are quite different.

This article compares powerlifting and bodybuilding, discusses their benefits and downsides, and provides tips on incorporating either into your fitness routine even if you dont plan to compete.

Powerlifting is a competitive sport that assesses your ability to lift the maximum weight possible for one repetition, commonly referred to as one rep max (1RM), using a barbell in the following three lifts:

From an exercise science standpoint, the goal of powerlifting is to generate the maximum amount of muscular force for the given movements.

In powerlifting competitions, three judges assign a pass-fail score to the technique for each lift. A passing score from at least two judges is needed for the lift to count.

Presuming you execute the lift according to proper technique standards, the sole measure of performance is your 1RM on each lift (1).

Your score is then calculated in terms of the absolute weight lifted and the weight lifted relative to your weight.

Powerlifting competition rules are usually broken down into raw and equipped, with equipped allowing special suits and knee wraps, while raw generally allows only a lifting belt and knee sleeves (1).

Since powerlifting focuses on 1RM performance in the squat, bench press, and deadlift, the training revolves around increasing strength in these movements.

Given that the goal is lifting the most amount of weight, powerlifters generally opt for the low-bar back squat variation, a medium-to-wide grip bench press, and either a standard or sumo-style deadlift (2).

When practiced over time, these lifting techniques allow you to lift the most amount of weight due to optimal leverage and recruitment of the largest muscles.

With the massive amount of weight your body must support to be effective at powerlifting, you need to train additional exercises in conjunction with your squat, bench, and deadlift.

These additional exercises are typically known as assistance exercises and primarily used to strengthen the muscles that assist in stabilizing during the main lifts, thereby helping avoid muscular imbalances and reducing the risk of injury.

For example, on a squat- or deadlift-focused day, an intermediate or advanced powerlifter might add the following exercises for additional glute and hamstring strengthening:

In general, powerlifters focus most of their efforts on lower repetition ranges of 15 reps with heavy weights and long rest periods to improve maximal strength.

In the long run, you may also have periods of training at higher rep ranges to maintain and increase muscle size. However, this is always in support of maximal strength performance in the three lifts and will not be present in every training cycle.

Powerlifting is a sport that revolves around lifting the most weight for a 1RM on the squat, deadlift, and bench press. Powerlifting training primarily focuses on lifting heavy weights for 15 repetitions.

Bodybuilding is a sport that judges competitors based on their overall physical appearance on competition day.

Bodybuilders pose onstage in speedos, bikinis, or other revealing outfits and receive a score based on muscle size, symmetry, and definition.

While posing for bodybuilding requires you to practice and perfect your routine, youre judged based on the aesthetic of your appearance, not on any measure of physical performance.

As a competitive bodybuilder, your goals are the following:

The overall purpose is to reveal the definition of your hard-earned muscle mass.

The judges will score you based on the criteria of the competition, as well as your appearance relative to the other competitors.

Certain bodybuilding competitions have different clothing requirements and may favor different overall looks from the competitors physiques.

Nevertheless, the primary drivers of victory in bodybuilding are size and muscle definition displayed through posing routines onstage.

Bodybuilding primarily relies on resistance training with barbells, dumbbells, and machine-based weights to maximize your muscle growth.

Since bodybuilding requires symmetrical growth in most of your major muscles, youll spend more time lifting weights in slightly higher repetition ranges, such as 815 reps, which stimulates more muscle growth than lower repetition sets.

While you still lift reasonably heavy weights, you lift slightly less weight than a powerlifting workout but do more overall repetitions.

The rest periods for these workouts tend to be somewhat shorter as well, roughly 12 minutes between sets.

Bodybuilding also requires more time spent on isolating muscle groups. For example, these exercises are frequently found in bodybuilding routines and less common in powerlifting:

While powerlifters may perform a few of these exercises in certain programs, bodybuilding almost always involves several isolation exercises per workout, in addition to higher repetitions of compound movements like squats and presses.

For long-term bodybuilding, youll eventually incorporate heavier training using lower repetitions and near-maximum weights. The purpose of heavier training in bodybuilding is to improve strength that eventually allows more high repetition training using heavier weights.

Ultimately, if you can lift a heavier weight for more repetitions, it will increase the overall muscle-building stimulus of your workout.

However, bodybuilding ultimately aims at increasing muscle growth itself via high repetition training.

Bodybuilding is a sport that focuses on maximizing muscle size and growth while minimizing body fat on competition day. Training for bodybuilding involves higher repetitions using medium-to-heavy weights and isolation movements.

Bodybuilding and powerlifting share some similarities and differences.

Both sports rely on weight training to succeed in competition.

However, the purpose of the weight training for each sport is different, which ultimately results in substantially differing workout programs over time, despite some overlapping methods.

For general fitness, both sports offer the benefits associated with resistance training.

Powerlifting training using heavy weights and lower repetitions is incredibly beneficial even for non-competitive lifters.

A few of the potential benefits of powerlifting training are meeting performance-based goals and increased functional strength and bone density.

Using heavy weights for low reps is effective for improving maximal strength, including increasing bone and connective-tissue density.

Studies have shown that lifting close to your 1RM during training provides the greatest stimulus to bone and tissue growth, compared with training at a lower intensity (3).

Given that the movements used in powerlifting develop maximal strength across the biggest muscles in your body, powerlifting can improve your overall functional strength for performing day-to-day activities.

In particular, heavy squats and deadlifts build the strength and core stability required to avoid throwing out your back while bending over or standing up, especially as you get older.

While improving your health or appearance may be your primary motivator for training, having performance-based fitness goals is a good way to stay motivated while striving to meet your long-term goals, such as improving your health.

Powerlifting focuses on measurable performance improvements regarding how much weight youre lifting.

The positive feeling of getting measurably stronger week-to-week or even month-to-month is incredibly rewarding and helps break up the monotony of simply going to the gym.

Not everyone is motivated by numerical improvements in the weight they lift. However, if youre someone who enjoys the feeling of measurably improving at an activity, powerlifting is a great training option.

You dont need to be an aspiring bodybuilding champion to take advantage of the benefits of bodybuilding. Its an excellent way to build muscle and improve your fitness, even as a non-competitive individual.

While bodybuilding and powerlifting training techniques overlap at times, the main benefits of bodybuilding include building muscle, focusing on nutrition, and incorporating more aerobic exercise.

Bodybuilding training using medium-to-heavy weights for 812 repetitions and multiple sets per muscle group is the best method to build muscle mass (4).

Even if youre not interested in a more athletic physique, increasing your muscle mass offers many health benefits.

It has been linked to improved insulin sensitivity, reductions in blood fat and body fat levels, and a higher resting metabolic rate (5).

Resistance training may delay, offset, or even reverse age-related muscle loss, all of which are important for older adults who want to maintain their health, strength, and quality of life well into their golden years (6).

Given that the sport of bodybuilding requires competitors to reach exceptionally low body fat percentages, nutrition is a key aspect of all bodybuilding training.

While all sports at high performance levels involve nutritional considerations, diet and nutrition are integral components of bodybuilding training and culture.

The focus on healthy eating, macronutrient and micronutrient considerations, and monitoring calorie intake benefit anyone interested in improving their overall diet.

Aerobic exercise (cardio) is vital for any well-rounded fitness program. However, in the sport of powerlifting, cardio is often left out, as it may hinder improvements in maximal strength (7).

On the other hand, bodybuilders often incorporate cardio to increase calorie expenditure to help burn body fat, particularly during cutting periods.

Regardless of the motivation for doing cardio, a combination of aerobic and resistance training is the core of any good health-centered fitness program.

Powerlifting and bodybuilding training improve multiple health and lifestyle outcomes, even for non-competitive individuals.

While powerlifting and bodybuilding training can benefit nearly anyone looking to improve their health, there are a few potential shortcomings in both sports.

These issues primarily affect athletes pursuing the sports at the highest level, and theyre trade-offs that elite competitors must make. Still, its important to be aware of them.

The biggest downside to both sports is that they focus heavily on a singular aspect of fitness.

In the case of powerlifting, the goal is maximal strength in the three main lifts.

For bodybuilding, the goal is maximal muscle growth and minimimal body fat.

While most people are better off being stronger, more muscular, and leaner, these are far from the only considerations for overall health and well-being.

For powerlifting, the neglect of cardio exercise, and in certain cases, lack of overall balanced nutrition, may harm your health.

If you use powerlifting as your primary fitness activity and arent planning to compete, consider adding some cardio and ensuring you maintain a healthy diet.

Meanwhile, the focus on physical appearance in bodybuilding may lead to muscle dysmorphia, a psychological disorder characterized by being preoccupied with the idea that your body isnt lean and muscular enough (8).

This disorder causes emotional distress that may harm your overall quality of life. In some cases, it may lead to engaging in unhealthy behaviors, such as using anabolic steroids, leading to potentially serious health issues (9).

If youre interested in gaining muscle or burning fat for aesthetic purposes, be aware of your overall mental and physical health. No amount of muscle gain is worth jeapordizing your long-term health and well-being.

The best method for maintaining overall fitness is alternating between periods of resistance training and aerobic exercise, as well as maintaining a healthy diet.

Competitive bodybuilding and powerlifting focus on singular goals and may neglect other aspects of overall fitness. If youre simply looking to improve your fitness, be sure to alternate between training styles and incorporate some cardio exercise.

Powerlifting and bodybuilding are both sports that rely on resistance training using barbells, dumbbells, and other resistance equipment.

While the sports share many similarities, the competitive performance goals are quite different.

Powerlifting focuses on maximal strength in the three big barbell lifts, while bodybuilding is about maximizing muscle mass and reducing body fat to extreme levels.

Each sport may offer many health benefits, but there are also downsides to consider, mainly around the singular focus in each sport at the competitive level.

However, if you incorporate powerlifting or bodybuilding training into an overall balanced fitness routine, you can reap the benefits and significantly improve your strength and overall fitness.

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Powerlifting vs. Bodybuilding: Differences, Pros, and Cons - Healthline


Feb 10

How to Lose Weight and Still Eat What You Love By a Nutritionist – The Beet

When was the last time you tried a new diet and felt great, got to eat what you loved, and successfully lost weight? It may have never happened. Most diets leave you feeling hungry, deprived and then when you inevitably "cheat" and eat satisfying food, you end up defeated.

Yet it is possible to fill up on healthy, satisfying foods, have energy, and successfully lose weight, according to nutrition expert Nicole Osinga, a Registered Dietician who created The VegStart Diet as a way of helpingyou lose weight the healthy way, while still eating what you love, and filling up on plant-based meals and snacks that are so full of healthy ingredients, energizing antioxidants and filling fiber, that you never feel deprived, hungry or sluggish, and you lose weight in a sustainable way that makes it easy to keep it off.

Last week,we hosted Osinga on Facebook Live to discuss the health benefits of a plant-based diet, weight loss, and everything you need to know about our most popular meal plan,The VegStart Diet.

Osinga, a well-known nutritionist, created healthy, filling, low-calorie recipesfor the VegStartDiet, which are designed to help you lose weight while eating the foods you love, like pasta and bread, comfort food like soup, and even tasty sweet or crunchy snacks. The recipes are delicious, as confirmed by the 1.2million TikTok viewers who loved the Roasted Carrot and White Bean Soup. Osingadoesn't believe in extreme dieting andconsiders The VegStart a "sustainable weight loss program," so there's no worry of going hungry.

The program also includes a full meal plan with breakfast, lunch, and dinner, and snacks for Monday through Sunday,helpful shopping lists, and expert tips, plus a supportive community group, and live videos with Osinga so you can ask her one-on-one questions.

Aside from the diet questions, Osinga speaks the truth about the importance ofindulgences like wine, chocolate, and desserts. She shared her go-to cheat meals, how totreat yourself the healthy way, plus the tastiest plant-based proteins, and the most useful ingredients that everyone should have on hand. If this is your first approach to a plant-baseddiet or you started eating plant-based a while back, when meat alternatives weren't around, you probably have a lot of questions. Here are the top questions about weight loss and plant-based dieting,explained and answered by Nicole Osinga.

Nicole Osinga RD:I don't believe in extremes. I believe in sustainable changes. I have a lot of conversations with people today about this topic. If we're looking to lose weight, The VegStart diet program is designed for weight loss but certainly, everyone's individual needs are different. The diet focuses on sustainable weight loss that is still going to keep you feeling satisfied and meet your nutrition needs because we don't want to become nutrient deficient when we're sort of trying to follow something.There's definitely a lifestyle change aspect to the diet if you're not plant-based already.

Nicole Osinga RD:It's a great evidence-based way of eating that has been shown to reduce the risk of various conditions like cardiovascular diseases, and a number of cancers. I'm working part-time at the hospital in the cancer care clinics. So, I deal with people often who have various diagnoses and Irecommend those patients eatplant-based foods.

Nicole Osinga RD:It might be overwhelming to find different ways to cook those plant-based proteins and how to incorporate them into your family's meals, but find those proteins you like and focus on incorporating them into your diet.

Nicole Osinga RD: Probably my favorite is tempeh, followed by tofu which is a big one, and edamame...I love the ease of cooking it like typically I buy it frozen. I might just thaw it or put it in like a stir fry.

Nicole Osinga RD: I'd have to say basil and oregano. Those are definitely my go-to spices. I also love paprika, cumin, and cinnamon. I certainly have a sweet tooth so I like to add cinnamon into my overnight oats. I like the smoky flavors of cumin and paprika on my tempeh.

Nicole Osinga RD: I take a B12 supplement and an iron supplement. I mean, just because you follow a plant-based doesn't mean you're going to be low in iron, but I'm a runner as well. I'm a female of childbearing age. So, I'm sort of at a higher risk for iron deficiency. But you can also get the B12 from nutritional yeast and plant-based milk instead of taking a supplement.Sometimes I will takea plant-based omega-3 supplement, but again, you can get omega-3s in flaxseeds, chia seeds, and walnuts. The bottom line is, you certainly don't have to supplement, you can get enough nutrients through food but those are just ones I take for extra assurance.

Nicole Osinga RD: Whenever we're enjoying desserts, I call them fun meals. They sure don't have a ton of nutrients as our other meals do, but whenever we're enjoying them, eat them without guilt because if we have guilt we won't have acceptance then that's when it turns into you eating the whole bag of chips or chocolates. When we feel good about eating something we're likely to acknowledge it quicker. I normally say to aim for 90% regular meals and 10% fun meals. It's ok to have three fun meals per week, and the rest should be healthy meals. Definitely leave some room for un!

Nicole Osinga RD: The biggest thing you want to do is to feel sated. Of course, you want to meet those nutrient needs because we're not going to hit those long-term weight loss goals if we're feeling deprived. Whatever changes you're going to make, just make sure you can sustain them. I see so many people in my practice that are yo-yo dieters give up. That cycle is going to continue if we do things that are so, so restrictive. I saw someone yesterday in my practice who was eating one meal a day, just, that's it. That system worked for them, but, for most people, that's not going to besustainable.

Nicole Osinga RD: Not necessarily. If you're eating a whole food plant-based diet, you're eating beans and tofu for protein, and tofu costs $1 or $2 for a block, and you can get beans for less than a dollar. If you live in a warmer climate you obviously have better access to fresh produce all year round, but it's okay if to use frozen produce like I do because I live in Canada. I think it's cheaper to eat plant-based and it's a great way to save money.

Nicole Osinga RD: Just keep going. The best part is, you can keep mixing those recipes into your day-to-day routine anduse those lessons and tips you learned from TheVegStart diet. If you started meal prepping and planning, keep going with that. The calorie level of the diet is around 1,400 a day and if that works for you, continue doing that buy you can always make modifications to the recipes. I would recommend making more plant-based meals. The Beetposts new recipes every day so you know where you can get them. Try to make a plant-based diet part of your lifestyle.

Nicole Osinga RD:Personally, when I first went plant-based, about 10 years ago or so, I had a slow transition but it only took a month after eating this way to feel a noticeable difference.

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How to Lose Weight and Still Eat What You Love By a Nutritionist - The Beet


Feb 10

[Full text] A Bidirectional View of Migraine and Diet Relationship | NDT – Dove Medical Press

Introduction

Interest in headache1 is potentially as old as recorded human history. With all the advancements in understanding and management of headaches over the years, headache in general has remained a major complaint for which patients feel an urge for a medical consult. Costs related to headaches are high and are classified as direct (medical care) and indirect costs (loss of productivity). Therefore, if headaches can be diagnosed correctly and earlier, and if they can be managed properly, the burden to patients and societies will be dramatically reduced.

Based on the latest version of the headache classification, migraine is a form of primary headaches,2 ranked among the most disabling medical conditions.3 Number four of the Trndelag Health Survey (HUNT4 study) revealed that 18.1% of the studied population had active migraine.4 Migraine is characterized by headache attacks and associated symptoms presented in a multiphasic nature,5 where both peripheral nervous system and central nervous systems are considered involved.5,6 The recurrent nature of migraine and the fact that it can be triggered,7 have provided a key feature to explore internal and external triggers and through those, to study the mechanisms underlying the disorder. This phenomenon has also presented a unique opportunity to modify triggering factorsthose that can be modifiedto reduce intensity of migraine and how often it occurs. This concept is attractive, as it has been found that lifestyle factors,8 such as diet,9 can trigger migraine, and lifestyle modifications,10 for example diet modifications, and nutraceutical interventions11 have collectively shown beneficial effects in patients with migraine. Considering these options is important, because despite remarkable advancement in understanding of the pathogenesis of migraine and targeting migraine by the novel therapeutic options,6 challenges remain related to sufficient efficacy, and desirable safety, and the fact that nonresponders are present.12 In addition, a number of individuals with migraine are continuously searching for natural and device- or drug-free interventions outside of the typical therapeutic options. In this line, functional medicine approach to manage migraine has been proposed as a potential tool. This approach considers individual's genetic, biochemical, and lifestyle factors to construct plans for personalized treatment. Functional medicine consists of timeline, matrix, and the therapeutic lifestyle factors (for example, sleep, exercise, diet, and stress). Within this framework, functional food can also be defined for migraine. Generally, a food is defined functional if it is satisfactorily demonstrated to affect beneficially one or more target functions in the body, beyond adequate nutritional effects in a way that is relevant either to an improved state of health and well-being and/or reduction of risk of disease.13 Functional food has been tested to identify if it can exert beneficial effects for several diseases, for example for metabolic syndrome.14 This syndrome consists of several metabolic disorders (eg, high levels of fasting glucose and obesity) and enhances the risks of other diseases, for example stroke, diabetes, and cardiovascular diseases.14 Interestingly, migraine has also been recognized as a disorder related to metabolic imbalance, and that highlights a potential for functional food for migraine.15 William Amery in 1982, provided the first evidence that the metabolism is linked to the pathogenesis of migraine.16 Recent studies investigating metabolic alterations in migraine have proposed that a mismatch seems to exist between brain energy sources and the consumption of the sources,17 and have linked this energy deficit to mitochondrial dysfunction in migraine.18 It is hypothesized that energy-reserve deficit alone or combined with an overload of sensory input could activate the trigeminovascular system in the cascade of pathophysiological events in migraine.18 Based on this, a metabolic treatment of migraine has been proposed.17,19

While identification of dietary triggers and dietary interventions for migraine prevention are profound in the literature, the concept of dietary choices, and pattern of diet in migraine patients have been investigated less.20,21 The idea that mechanisms underlying migraine pathogenesis might influence dietary choices is valuable, but has sporadically been discussed.20,21 Epidemiological findings have demonstrated that choice of diet by individuals with migraine is different compared with individuals without migraine. Potential reasons for such difference have been explained by several factors, for example, contribution of neurotransmitters such as serotonin and orexin, hormones, and state of aura.21 A potential bidirectional relationship (Figure 1), where migraine influences food intake, and consumed food affects the manifestations of migraine, needs further investigation. Within this framework, investigation of the gutbrain axis contribution seems highly valuable.21

Figure 1 A potential bidirectional relationship between migraine and diet.

In the following sections, some examples from the current literature are presented to highlight what we already know about the effects of diet on migraine and the effects of migraine on dietary choices, and what remains unknown to stimulate further research. Therefore, the purpose of this targeted review is not to provide a comprehensive systematic review of the current literature on the role of diet in migraine; since several excellent reviews are already available (eg,9,2226). PubMed, Cochrane Library, EMBASE, and Web of Science databases were searched for studies using keywords of diet, migraine, food, and lifestyle with the aim of providing the current overview, and a viewpoint to the potential future directions. The ultimate goal is to form testable scientific hypotheses for future investigation of the bidirectional relationship of migraine and diet.

Studies that have investigated whether and how the consumption of dietary components can influence the manifestations of migraine are abundant. The potential role of dietary triggers, contribution of the immune system, metabolic systems, and the gutbrain axis contribution are among the examples focused on the effect of diet on migraine. The other direction, where migraine might also influence the food intake, has been less investigated. Presence of aura,2729 some neurotransmitters involved in pathogenesis of migraine (eg, serotonin,30,31 and orexin32), hormones (eg insulin33), and level of adiocytokines34 have been proposed to influence the choice of diet by affected individuals in terms of content, pattern, and amount of food intake.21 Several familiar and unknown factors can potentially influence this bidirectional relationship. These include, but are not limited to, gender, age, and geographical locations.9,24,3537

A large number and diverse range of factors (eg, dietary factors) with a high degree of heterogeneity have been reported capable of triggering migraine.38 For example, stress has been shown to exacerbate migraine, and having or expecting a migraine can negatively affect stress level of affected individuals. Menstrual migraine is a typical example of the link between hormones and migraine. Sleep and migraine have also been found interrelated where sleep disturbances aggravate migraine. Other environmental factors such as intense light, strong odors and high altitude have also been reported to influence migraine.39 Consequently, long lists of recommendations exist for avoiding potential triggers or coping strategies in order to prevent migraine or subsiding its frequency and severity; hence, enhancing the quality of life in affected patients.40

A meta-analysis of available studies for headache triggers has summarized data from 27,122 participants from 85 articles published between 1958 and 2015, and has provided 420 triggers.41 86% of the included participants in this meta-analysis had the minimum of one trigger for their headaches. Findings from this study highlighted that stress was the most prevalent trigger.41 Heterogeneity, however, was high and intra- and interindividual variations among trigger frequency and potency were also profound.41 Knowledge of migraine triggers can help in improving the management, coping, and care for migraine; but studying migraine triggers is not challenge-free. Using smartphone-based dairy studies that use ecological momentary assessment systems, has presented fatigue, sensory sensitivity, negative affect, specific foods, menstruation, and yawning as the most frequent triggers of migraine.4244 Correct understanding of trigger perception has been discussed by Turner et al45 to highlight how important are the behavioral changes in response to a headache trigger that is perceived by patients as a precipitating factor. An example is the avoidance of bright light if the individual with migraine perceives it as a migraine trigger. This controlling avoidance behavior may influence the scope of individual activities, and can negatively influence the quality of life.40,46,47 Perhaps that is why coping strategies are prioritized to avoidance strategies, in general.47

Collectively, the current ultimate recommendation for individuals with migraine has pointed to the value of maintaining an appropriate and healthy lifestyle.48 Lifestyle can be defined as the controlled behavior and activities of a person and many activities, habits, and practices involve risk factors. The contribution of dietary factors within the lifestyle modification has been recognized; however, proposed beneficial changes in lifestyle, consider a broader spectrum to not only include dietary aspects, but also monitoring of exercise, sleep, and stress.49

It has been proposed that modification of lifestyle might prevent migraine, which in turn would decrease the burden to individual patients, and health-related costs.50 However, due to the complexity of migraine, as a multidimensional disorder, and also the complexity of designing studies to test how dietary factors can influence migraine,49 inconsistency exists in the literature, ranging from a limited importance of dietary modification for migraine to some promising effects. Cross-sectional studies have been important in providing an overview of potential triggers;51 however, if the goal is to prove (or falsify) that a causal or a bidirectional relationship exists in the dietmigraine interaction, prospective studies with proper control groups must be designed that are also longitudinal in nature. For example, age of onset is extremely important.51 A migraine patient passes through different phases in an age span, from pediatric to geriatric migraines, for example. Puberty has been shown linked with migraine and migraine that occurs before puberty differs from post-puberty migraine. Several factors such as alteration in lifestyle, habits, and hormonal levels have been proposed to shape this evolution from pre- to post-puberty. A recent study52 has investigated this evolution in a selected pre-pubertal patients who were diagnosed with migraine. Researchers in this study collected medical records, migraine manifestations, and lifestyle-related factors, at baseline and at the two-year follow-up. Nineteen patients (migraine with aura: 27.5%) were recruited. The results of this study demonstrated that migraine accompanying symptoms changed with a significantly higher prevalence of dizziness, vertigo, mood changes, confusion, and allodynia.52 Prodromal symptoms became more prevalent, where sleep disturbances and schedule changes showed a significant increase as migraine triggers. Interestingly, at baseline, food was triggered at 11% of cases, but after two years, it went down to zero. Another study on the participants aged above 16, has also identified the appearance of new triggers over time. For example, new factors, including pain in neck, consumption of alcohol, hormonal changes, and smoking were notified.53 These studies provide valuable information that migraine triggers show changes during puberty, and new triggers can appear together with changes in habits along with physical and lifestyle changes, which collectively highlight attention to a potential dynamic pathological process that deserves further investigation. These studies also present a valuable point that besides studying dietary factors other daily lifestyle features, for example how a patient sleeps, makes a workrest balance, and deals with stressful situations are important to observe and note, because these factors are often interrelated and can influence each other directly or through indirect interactions. Comorbid conditions, such as other neurological, psychological, or cardiovascular disorders are also important and influential, because patients, influenced by those conditions, might follow a special lifestyle, including certain diets.1 For example, those who are diabetic or have a heart disease may follow a vegan diet for its beneficial effects,54,55 and some migraine patients might be on a vegan diet for comorbidy or other reasons.

A systematic review from 202022 has summarized the findings from 43 studies that have investigated and reported dietary patterns (11 studies), triggers (20 studies), and dietary interventions (12 studies) in patients with migraine.22 Level of evidence was determined as low level, because the authors identified that >50% of the studies were cross-sectional or patient surveys. Caffeine and alcohol were found as major triggers that could increase migraine frequency.22 Several dietary interventions were also reviewed, for example, elimination diets, low-fat diet, and ketogenic diet that presented promising results in managing migraine.22 However, this review did not present a choice or a favorable, so-called migraine diet, due to lack of qualified and sufficient information.

Elimination diets can be based on a diary for identification of triggers, or based on tests for the IgG-positive food, both strategies to limit those triggers. When participants were tested for antibodies against 266 foods and individually eliminated those foods that they had positive tests for, a reduction of 29% in migraine days was found.56 This study was, however, a small cross-sectional study, with some limitations. Another study, which was designed as a randomized controlled trial, eliminated those foods from diets of migraine patients who participated and were positive for certain food-related antibodies. When headache days were determined after four weeks on the elimination diet, a 19% reduction was found.57

Dietary interventions have mostly been investigated in a small population with no proper control group, hence results are heterogeneous and a sharp conclusion cannot be made. For example, a diet high in carbohydrate and low in tryptophan was tested in a group of seven patients and showed beneficial to subside headaches. The authors proposed that the positive effect has been apparently due to a mixture of lower intake of food that could trigger headache and also elevated levels of serotonin following the tested diet.58

Dietary lipids were investigated afterwards, because it was proposed that a diet high in lipids could cause headache following a potential lowering of serotonin levels in plasma that might be a result of higher platelet aggregation.59 A diet with a very low level of lipids (~20 g per day), therefore, was proposed to prevent headaches.60 A randomized, crossover trial reported in 201561 that low lipid compared with moderate lipid dietary intake could subside occurrence of migraine and headache intensity. It has also been reported that the dietary approaches to stop hypertension (DASH) diet could diminish the intensity of headache and duration in migraine.62 This particularly points to the importance of migraine comorbidities, and how dietary factors can influence an overall well-being of the affected patient.

Supplementation by a diverse range of vitamins and minerals has been reported beneficial for migraine. For example, based on a review from 2018, vitamin D, vitamin B2, vitamin B12, magnesium, carnitine, and niacin have reduced frequency of magnesium, carnitine, and niacin have reduced frequency of migraines.63

Even though beneficial effects of these dietary interventions have been reported in the literature,22 one must consider that individual patients may require special needs that importantly points towards the concept of precision medicine in migraine.64 Including larger cohorts of patients and considering follow-ups of longer duration could help in properly examining the effect of dietary interventions, a point to be considered in the future investigations. In this line, patient adherence and age influence on diet choices and dietary patterns emphasize the value of long-term assessments. However, plan, design, and conduct of long-term studies are difficult and several intractable factors need to be considered and integrated into the assessments. At present, comparisons between studies remain difficult because age, gender, cultural, and religious variations among different studied populations have largely been ignored. Gender of affected individuals is an important factor to consider,51 because changes in hormonal concentrations, for example plasma estrogen concentrations, have shown an association with migraine.65 Alternatively, dietary intakes that can alter estrogen activity to a lower level have been shown beneficial for premenstrual symptoms.66 Therefore, low fat, high fiber, or vegan diets, might help some patients, for example those who have menstrual migraines. In fact, a study67 has tested this hypothesis, by investigating the effects of a four-week low-fat vegan diet in migraine. Overall, headache severity, headache days and frequency subsided, but this study has some limitations in design preventing drawing a sharp conclusion.67 Besides linking beneficial effects of a vegan diet to a low fat content, and lowering estrogen activity, several other mechanisms have been proposed, for example antioxidant and anti-inflammatory properties of plant-based food. Since an involvement of neurogenic inflammation in migraine68 has been suggested, this might be an explanation. In addition, dairy products (eg, cheese) and meat49 are not present in a vegan diet and these components have often been reported as migraine triggers in the literature.69,70 Therefore, absence of these components in a vegan diet might exert an anti-inflammatory effect against migraine.

Weight loss has been reported beneficial in migraine,71,72 although open questions remain in the field due to design and studied populations in the current literate. A proof of concept study in 2015 presented that weight loss could result in symptom improvement.73 Based on a pilot study published in 2019,11 enhancing the quality of diet and maintaining a healthy weight, could improve some clinical features of migraine. In this open, and nonrandomized study, women with migraine received an individualized diet plan, which was based on a professional nutritional diagnosis. This study was first to provide evidence that diet quality and maintaining a healthy weight are important,11 not the weight loss per se. This means that for underweight patients a weight gain might be the successful strategy, while for overweight patients, a weight reduction strategy would provide beneficial effects on migraine.11

Bond et al74 designed a study to test if two different strategies for weight loss would be comparable or different. Migraine patients who were overweight or obese women (a population considered to be most affected by obesityrelated migraine risks)35,75,76 were included and divided into two groups. One group received a behavioral weight loss (BWL) that included both exercise and diet, and the other group received educational instructions on migraine. Findings from this study showed that both groups benefited from a reduction in headaches following the two strategies and there was no significant difference between the groups. This study presented that independent of the type of strategy; strategies for weight loss might be beneficial for this special population.

According to a systematic review and meta-analysis77 that has summarized and compared two strategies for weight loss, it was revealed that independent of technique, weight loss could reduce headache severity, frequency, duration, and associated disabilities. Therefore, weight loss was highlighted as the critical factor, not the amount of weight reduction, or the strategies that were used to achieve the loss.77 In fact, the obesity and migraine link has been a matter of investigation for a while. The fundamental questions are, do people with migraine gain weight because of migraine related disability? Or does obesity lead to greater migraine frequency? In other words, which comes first, obesity or migraine. Results are mixed in the literature. Winter et al in 201278 found that among 19,162 middle-aged women, those with migraine had a significantly higher risk to shift towards being overweight or obese. The risk was not different for women with or without aura.78 Age plays a role in obesitymigraine interactions,79 because age affects the body mass index (BMI), distribution of body fat, hormones, and prevalence of migraine. Reported in 2020, the HUNT3 (the third population-based Nord-Trndelag Health Study)80 showed that a greater association exists between migraine and obesity in younger adults, ie, those >50 years old, still within the reproductive age. Therefore, one must consider that in the study by Winter et al,78 where middle-aged women were included, other risk factors might have played a role.

A meta-analysis81 of 12 studies, including data from 288,981, demonstrated that body composition is a critical factor. When pooled data were adjusted for age and sex in this analysis, an increase risk of migraine (27%) was identified in obese vs normal weight and was not lost even after multivariate adjustments. The risk was shown slightly elevated (13%) in underweight vs normal weight and again it was not changed even after application of multiple adjustments. Therefore, it seems based on these results, that obesity and being underweight could enhance risk of migraine.81 An increased risk of migraines in underweight and obese women vs normal weight was presented in 2015 by Ornello et al.82 However, pre-obese subjects did not show any increasing risk.82

Multiple underlying mechanisms for the impact of obesity on migraine have been proposed, one of which is a neurometabolic impact.18 This has been based on reports in the literature that metabolic factors can trigger migraine, for example, fasting/hypoglycemia, dehydration, stress, alcohol, and lack of sleep. These factors have been found linked to reduced brain energy levels in migraine patients. It has been proposed that these triggers could reduce mitochondrial function, ATP generation, cellular glucose transport, and lipid oxidation, promote neuroinflammation (neuronal and glial signaling modulation), and astrocytic signaling.18,19 These mechanisms are also linked to increased cortical excitability that has been proposed in migraine pathophysiology.83 The review by Gross et al18 in 2019, summarized the available literature on the metabolic changes in migraine and how those changes can contribute in pathophysiology and being potential targets for treatments. One important feature in this context is that nutritional intervention to improve nutrient metabolism, neuroinflammation, and oxidative stress, can eventually improve migraine.18 This has shed light on the concept of obesity and migraine. Observations have provided evidence that the hypothalamus which is the first station for detecting of changes in peripheral energy status, is involved in migraine pathogenesis.84 Interestingly, it has been found that hypothalamic astrocytes have distinct responses to nutrients, ie fatty acid and glucose metabolism coupling.85 In addition, it has been found that different brain cells utilize, store, and modify their response to lipids. L-carnitine, which transports fatty acids into the mitochondria, where those are oxidized to produce ATP, has shown efficacy in blunting migraine.86 In contrast, saturated high-fat diets leading to obesity, promote metabolic dysfunction, depressive like behavior, and neuroinflammation.87 This has led to applying a strategy in which targeting obesity could suppress neuroinflammation and consequently block the depressive symptoms. Interestingly, increased mood disorders have been seen in migraine patients, so these basic research findings are clarifying some underlying mechanisms that might share commonalities in obesity, migraine, and mental health.88

The concept that migraine might be a response to low brain energy level or uncompensated oxidative stress,89 has brought the ketogenic diet back into attention.90 This diet acts in a similar way to fasting, where ketone bodies are elevated and can be used as an alternative source of energy to correct abnormalities in glucose metabolism reported in migraine. Some reports, including a proof of concept study,73 have demonstrated beneficial effects of a ketogenic diet to reduce migraine frequency. Recently, an alternative method has been considered to apply exogenous ketogenic substances.91 This means to provoke nutritional ketosis with ketogenic substances, for example, beta-hydroxybutyrate (HB) salts.91 A recent review90 summarized the potential mechanisms underlying the effect of ketone bodies and presented those as signaling molecules that can interfere with pathways involved in migraine pathophysiology.90 For example, ketogenic substances can reverse mitochondrial dysfunction, subside oxidative stress, reduce cerebral excitability, or lower the inflammation.90 Even though an extensive amount of work has been done in animals, clinical research is lacking to validate the findings as if these protective effects of ketone bodies (KBs) would also be present in patients with migraine. Supplementation with HB without a strict dietary change is under investigation91 and could help provide evidence and address those open questions.

Diet-induced obesity has been shown to reduce brain fatty acid uptake.92,93 This has opened up a concept that obesity could enhance deficits in brain energy reserves and metabolism that characterize migraine. Within this concept, omega-3 fatty acid supplementation has shown antidepressive action and reduced migraine frequency.94 Fish oil supplementation in obese mice95 has shown reduction in metabolic and anxiodepressive effects of diet-induced obesity and related alterations in the composition of brain lipid. Further investigation is required in humans, as mood, food, and obesity have been found interrelated in a complex interaction.96 In addition, it is still not known whether a migraineobesity association is different in females and males, in different ages, and in different subtypes of migraine, considering mood disorders and emotional behaviors in humans.

As the evidence continues to accumulate, it is suggested that physicians recommend weight loss to their patients who have comorbid obesity. This is because weight loss has proven to improve sleep, mood, and other factors that increase susceptibility for having more frequent or severe migraine attacks. Lifestyle changes overlap with migraine and can be beneficial in migraine management, in particular when migraine is comorbid with other conditions, such as depression. There are lifestyle modification approaches for obesity. For example, according to Wadden et al,97 diet, exercise, and behavioral therapy were major determinants of lifestyle modification, where a reduced-calorie diet and a high level physical activity could yield a long-term weight loss.97 Based on a recent review,26 diets that promote weight loss, such as the ketogenic diet, and low-calorie diets, could be considered beneficial for those headache patients who are obese. In addition, lowering intake of omega-6 and intake of higher amount of omega-3 in this group can be advantageous. However, another review9 has emphasized that the net outcome depends on several factors, for example, age, gender, genetic predisposition, and environmental factors. Therefore, in order to provide evidence-based dietary recommendations for migraine, we need to consider these influential factors in study designs. In addition, the more we know about the mechanisms leading to migraine, the better we can investigate different factors, including dietary factors, which can interfere with those mechanisms. Future research is needed to provide evidence of whether diet can be a disease-modifying agent for migraine, and how. Considering the big picture, this would also enable personalized recommendations that - are in line with biopsychosocial considerations in targeting migraine.

In addition, one must consider that if comorbidities exist with migraine, dietary modification might be beneficial in controlling the condition. For example, several studies have highlighted a solid link between migraine and gastrointestinal diseases, in particular, irritable bowel syndrome (IBS). For review see Camara-Lemarroy et al.98

The gutbrain axis is a term to describe a potential two-way relationship between the gut and the brain. The gutbrain axis might potentially explain the existing link between IBS and migraine.98 Evidence is accumulating on the role of gutbrain axis in several neurological disorders, and migraine is not an exemption, where this has been reviewed in a recent review.99 However, we still do not know how the gut and the brain may interact in migraine.99 Several mechanisms have been proposed,100 for example, composition of gut microbiota, proinflammatory substances such as interleukins, neuropeptides (eg, calcitonin gene-related peptide; CGRP), hormones, and dietary components.101

In a recent metagenome-wide association study (MWAS),102 fecal samples of elderly women with migraine have been compared with matched controls to determine if gut microbiota is associated with migraine. Results showed that patients and controls are different in terms of diversity of species in the gut. Clostridium species (an unhealthy composition) were significantly higher in the migraine group. However, a healthy composition (eg, Faecalibacterium prausnitzii, Bifidobacterium adolescentis, and Methanobrevibacter smithii) were profound in controls. Patients also presented a diminished metabolic function of the gut compared with the controls.102 These findings may pave the way toward diagnosis, prognosis, and response to treatment strategies, or point to a novel therapeutic target. Based on the results,102 and to maintain healthy composition of the gut microbiota, proper probiotics have been suggested to correct dysbiosis in migraine patients. The concept of using probiotics for maintaining well-being is not new,103 however, identification of the role of probiotics in minimizing neuroinflammation, a mechanism proposed for migraine,104 has attracted attention toward the use of probiotics for alleviating migraine attacks.105,106 In patients with episodic and chronic migraine, a multispecies probiotic supplement has been investigated to identify a potential beneficial effect and profile of inflammatory markers.106 Findings revealed that probiotic supplementation could reduce the frequency and severity of migraine attacks. In addition, patients had a lower number of migraine days in the month and consumed a lower number of drugs to stop migraine headaches.106 According to the findings by Sensenig et al, mineral and vitamins added into a probiotic regimen for 12 weeks could result in a remarkable improvement in headache in 60% of migraine patients. Improvement in quality of life was reported by 80% of patients.107

Probiotic interventions as a prophylactic way to treat migraine have been summarized in a recent systematic review.108 Out of 68 screened studies, only two studies were analyzed, one with negative 109 and one with positive outcome106 in diminishing migraine frequency and intensity. The authors of this review108 have recommended points for inclusion and exclusion for the enrolment of patients, considerations for study design that can recruit standard and comparable methods, and proper control groups, within sufficient time.108 Microbiome analysis, pre- and postintervention, has also been encouraged.108

Another potential explanation for the existing link between gastrointestinal disorders and migraine is the gut permeability,110 where the leaking of lipopolysaccharides from the lumen into the blood can trigger a proinflammatory response,111 which is known to play a role in migraine pathogenesis.112 In a group of migraine patients diagnosed with comorbid IBS, probiotics combined with an elimination diet were tested.113 Sixty patients were randomized into three groups to receive the elimination diet, probiotics, or diet plus probiotics.113 The study results demonstrated that the combination method was superior for improving migraine comorbid with IBS.113

In addition to gut composition, which was found different in migraine patients, collected samples from the oral cavity of patients with migraine have demonstrated different composition from controls.114,115 Significantly higher nitrate, nitrite, and nitric oxide reductase genes were found in oral cavity samples of migraine patients. Interestingly, nitrates and food additives are reported among headache triggers, and nitric oxide pathway has been linked to migraine.116,117 Therefore, bacterial composition can be investigated in oral cavity and fecal samples in migraine and composition might reveal differences from controls.114

Identification of the CGRP role in migraine, has led to the development of new targets118 such as monoclonal antibodies that target CGRP itself, or its receptor, and also new oral gepants, antagonists of CGRP receptor.119 Evidence is limited as if dietary components could interfere with CGRP in migraine. Cady and Durham treated rats with cocoa-enriched diets for 14 days and investigated the expression of CGRP in the trigeminal ganglion cells, where they reported a significant decrease in the expression.120 In cell models, CGRP secretion has also been diminished after treating cells with petasin, which is the active component of butterbur, grape seed, and ginger extract.121,122

In relation to CGRP, a new study123 has demonstrated that when migraine patients with episodic migraine were supplemented with vitamin D, they had lower headache days and disability assessed on the migraine-related disability score (MIDAS) showed a significant improvement after 12weeks.123 Researchers in this study analyzed the serum levels of CGRP and presented that in the group on vitamin D supplementation, CGRP level was significantly lower.123 Based on the findings and correlational analysis, the authors have proposed that vitamin D might exert some of its effect through lowering of the CGRP levels.123 A larger study with a longer duration together with supportive basic research studies to look into underlying mechanisms of vitamin D in lowering CGRP and exertion of antinociceptive effect through this path, have been suggested.123

Considering beneficial effects of targeting CGRP with recent compounds,118,119 this line of investigation remains open to identify how dietary components or patterns might interact with expression and function of CGRP to interact with migraine manifestations.

Neurologists often encourage their patients with migraine to follow a consistent lifestyle. This is based on the observation that sudden changes in any lifestyle component may provoke migraine attacks. This includes several components, such as exercise, sleep, workrest cycles, diet, etc. However, evidence is still limited. In addition, the pattern of diet or habits of dietary choices might be equally as important as content of the diets. A cross-sectional study in 2015124 that used logistic regression, found that migraine is associated with low intake of food, regardless of the type of food.

A review125 on dietary consistency has presented the topic from three different views to migraine. The authors have proposed migraine as an illness, a disease, and a state of inflammation.125 Within this proposed framework, the authors looked at the relationship between diet and migraine as a function of changes in these three.125 Other researchers have considered migraine a brain disorder of maladaptive response and have described a feedforward allostatic cascade model that can lead to migraine.126 In this model specific stressors such anxiety, noise, food, odors, and bright light can be tested. Each of these factors can contribute to the allostatic load with a different magnitude, and factors can be summed over time. Therefore, the authors have proposed that modification of these effectors or stressors can help to intervene with the skewed allostatic load in migraine.126 Independent of the viewpoint to migraine, maintaining consistency in daily living is not easy and most likely requires education, monitoring, and support, and scientifically driven patterns.125

Studies are vast in the literature to examine dietary triggers for migraine and to lesser to examine dietary intervention. However, the question remains open as to whether certain dietary intake patterns are specific to migraine and whether migraine pathogenesis would influence dietary choices and patterns. In this line, it is important to identify if the subtypes of migraine can have an influence on the choices. For example, if the state of aura would lead patients with migraine to select a specific dietary component or patterns, while those choices might be different from those patients who do not have aura, and in comparison with migraine-free individuals. To address this side of the diet-migraine relationship, studies with proper control groups, such as nonheadache and nonmigraine control groups, and including subtypes of migraine (episodic, chronic, with and without aura) would allow for a proper evaluation. However, the evidence is very limited. Pattern of food intake has been investigated in one study,124 where a large population of middle-aged women was included. This study124 was designed based on a hypothesis that migraine patients and healthy individuals are different when it comes to food intake and food avoidance behavior, and that subtypes of migraine (eg, with and without aura) may influence these behaviors even further. This study124 demonstrated that a migraine-specific pattern of food intake existed that was different from healthy individuals. The only exception was alcohol consumption. In addition, and based on the presence or absence of aura in migraine subtypes, the choice of certain food items was influenced. Those items were, for example, chocolate, processed meats, dairy products, and wine.124 Interestingly, lower intake of dietary compounds known as migraine triggers was not evident. This led to an assumption that those food items might have been avoided by patients within a particular subtype of migraine.124 Further studies, however, are required to investigate this arm of migrainediet relationship. Epidemiological findings have demonstrated that choice of diet by individuals with migraine is different from individuals without migraine and the difference reflects on several nutritional metrics,21 for instance, diet quality,127 diet composition,128 dietary schedule,50 and amount of consumption in a wide range of different foods.23,124,129 We still do not know if mechanisms underlying migraine pathogenesis might influence dietary intake.20,21 Future studies are warranted to identify the patterns and potential underlying mechanisms and to examine if migraine type, migraine frequency, and food intake are interrelated. Besides, longitudinal studies are preferred to cross-sectional studies.

Migraine pain and related disturbances may influence individuals with migraine to select a convenient, simple, or easy choice in diet, which might differ from those without migraine that have a tendency for a more complex dietary pattern. The choice can reflect on the amount, quality, timing, and patterns of dietary intake. This might be due to the fact that the hypothalamus has been found activated in the premonitory phase of migraine, the time that food cravings often occur.28,130 Food cravings, for instance for chocolate, have been reported to present and have accounted for triggering migraine attacks while this might be a part of the onset.1 Interestingly, chocolate has been a matter of investigation as one of the migraine triggers.131 A recent systematic review132 has looked into 25 studies that evaluated if chocolate acts as a trigger in migraine, where 23 studies reported that chocolate could trigger migraine. There were also three provocative studies133135 that tested the triggering effect of chocolate compared with placebo, and neither of those could identify a significant outcome. Therefore, based on these findings, the authors of the systematic review concluded that evidence is still lacking to draw any recommendation for migraine patients about eating or avoiding chocolate.132

Neurotransmitter, hormone, and adipocytokine levels in migraine patients are different compared with controls that might also influence the desire for food, or food intake or even the metabolic control of the hypothalamus18,136 in affected patients. For example, orexin A, was elevated in headache phase,32 while serotonin levels were lower during the interictal phase.30,31 Higher insulin resistance and elevated adipocytokines such as leptin are also reported in migraine patients compared with controls.33,34

The choice of mealtime by migraine patients might also affect the meal intake and its properties. There is a gap here for understanding how migraine history would influence a preferred mealtime in an attempt to manage migraines proactively. Mealtime can influence the content of meal depending on the time, and hence plays a role in the bidirectional loop of migraine-diet. In fact, a study from 2016137 has looked into the pattern of regular lifestyle behavior for three elements of sleep, mealtime, and daily exercise in patients with episodic and chronic migraine. This is the first study of the combined three variables compared with previous studies138140 that considered each domain separately. Findings from this study137 demonstrated that all three elements (ie, regular mealtime, regular sleep, and daily exercise) were lower in frequency among migraine patients with chronic migraine compared with episodic migraine. Interestingly, regular mealtime was found as the element that was adopted the best by both groups of migraine patients.137 The authors, therefore, proposed that self-regulated behaviors, such as regular mealtimes, would be beneficial for the affected patients to control their migraine.137 It is interesting to investigate whether genetic or epigenetic factors64 can influence the choice of mealtime by patients with migraine and if this differs between episodic and chronic migraine.

A small number of patients have been seen anecdotally to respond to the paleo diet or variations of this diet. The rationale follows a theory that modern era diseases, for example, diabetes, heart disease, and obesity were absent in the Paleolithic era. Therefore, a clear diet could also help prevent migraine. This diet is known for weight loss, and it is free from refined and processed food, additives and preservatives.

The gutbrain axis that is a bidirectional path, might also affect dietary choices here. Interestingly, the gutbrain axis has been discussed in terms of psychological aspects,141 named as gutbrain psychology, which brings mind to the equation of the brain and gut relationship. Based on this synchronism of gut, brain, and mind, it has been proposed that the gut microbiota could affect normal mental processes and under pathological mental and neurological disorders.141 Whether this can influence choice of diet in migraine, or when migraine is co-existent with other psychological conditions, eg, stress and anxiety, needs further investigation. This also remains to be tested as if other factors, eg, gender of migraine patients can affect this (by, eg, hormones or psychology-related factors). Figure 2 is an overview of the gutbrain axis and potential players in the bidirectional relationship of migraine and diet.

Figure 2 A bidirectional relationship of the gut and brain, and different factors that can potentially influence migrainediet bidirectional relationship within this system. Green arrows are toward improvement of migraine headache, while red arrows reflect on negative impact. For a comprehensive review on the gutbrain axis and migraine headache, please see Arzani et al.99

Taken together, a potential bidirectional relationship, where migraine influences food intake, and consumed food affects the manifestations of migraine, needs further investigation. The question, therefore, remains open as to whether migraine can affect dietary choices and to what extent, and how dietary choices can influence migraine. In a broader spectrum, the allostatic model in migraine126 could potentially help studying the influence of migraine on food intake and the influence of dietary intake on migraine. Table 1 provides an overview of the main points mentioned earlier for the dietmigraine relationship and considerations for future studies.

Table 1 A Summary of Main Elements in Bidirectional Aspects of DietMigraine and MigraineDiet Relationship

Diet as a potential trigger for migraine has been discussed for some time. Identification of potential dietary triggers for migraine125 has mainly emerged via keeping dairies, avoidance behavior, or elimination diets to help managing migraine.142,143 Some triggers appear common among the migraine population, while others appear to be unique to individuals. Therefore, identification of personal food triggers in each individual seems valuable to assist with a better way of coping with migraine. No particular migraine diet exists yet to lean on a strong evidence, and hence the investigation of dietary patterns is needed to confirm efficacy before recommending for migraine prevention. Types of evidence, including level of effect are, therefore, expected from these interventions. For each, one must consider the burden of various diets for patients and if any potential side effects or safety issues may occur.20

Comorbidities are also important to consider, such as IBS and in this regard, studying the role of the gutbrain axis is encouraged. Migraine has been also associated with cardiovascular and psychological disorders. Therefore, studying dietary interventions that can be beneficial for comorbid conditions are valuable. Dietary recommendations for migraine may aid in immediate control, slow progression, or prevention of diet-related comorbidities (eg, obesity, diabetes, and cardiovascular diseases). These recommendations are often included in a broader lifestyle modification, including sleep hygiene, stress management, regular exercise, or smoking cessation. A focus on maintenance of a consistent healthy lifestyle, in addition to nonpharmacological and pharmacological management of migraines seems to be the key for most of migraine patients.20 Implementation of any lifestyle changes, including dietary factors, needs a careful evaluation and a clear communication to help both clinicians and patients to achieve expected and reasonable goals. Education, monitoring, and support are essential elements in particular in long-term interventions and follow-ups.20 Effect of migraine or its evolution over age and among the genders for dietary choices, and dietary pattern is not known.51 Pattern, quality, and amount of food can also be influenced by geographical locations, cultural, and religious factors. These factors must be considered and reported in future studies of any potential bidirectional relationship between migraine and diet.

The author reports no conflicts of interest in this work.

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[Full text] A Bidirectional View of Migraine and Diet Relationship | NDT - Dove Medical Press


Feb 10

Kate Middleton diet: What is the Duchess routine to maintain her slim figure? – Express

Kate Middleton has looked more or less the same since she was first thrown into the limelight by marrying into the royal family in 2012. It was reported at the time that the Duchess followed the Dukan diet to lose weight before her wedding to Prince William, and then again in order to lose her baby weight after giving birth to her three children.

The Dukan diet was created in the 1970s by French general practitioner Pierre Dukan.

It involves removing carbohydrates from your diet and swapping them with proteins, vegetables, and healthy fats and oils.

The Dukan diet claims to produce rapid, permanent weight loss without hunger.

However, it is probably not a long-term solution for weight loss as carbohydrates are an essential part of anyones daily diet, according to Healthline.

READ MORE:Meghan Markle and Harry's body language 'unique' as Prince 'takes the lead'

The fourth phase of the diet is called the Stabilization Phase, according to Healthline, and it is the same as the third phase, but the rules can be loosened as the dieters weight starts to remain stable.

Oat bran is increased to three tablespoons every day.

The duration of each phase depends on how much weight the dieter wants to lose.

Dieters can eat plenty of meat as their protein intake during the diet, including chicken, turkey and pork.

Kate exercises regularly to maintain her goal weight, as well as her excellent figure.

The Duchess incorporates cardiovascular activity into her fitness regime, including running and cycling.

To develop upper body strength, she uses a Swiss gym ball.

Kate is also a fan of yoga, according to Marie Claire, which is beneficial in maintaining both a healthy body and mind.

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Kate Middleton diet: What is the Duchess routine to maintain her slim figure? - Express


Feb 10

Tummy Tucks and the Belly Button: What Happens to It? – Healthline

So, youve decided to get a tummy tuck.

But you still have some questions about the procedure including about what happens to your belly button after a tummy tuck.

Many people wonder this exact thing, as a botched belly button can make the tummy tuck not worth it at all. Rest assured that in most cases, the belly button wont be altered or moved, instead the skin and muscle around it will be tightened.

If you opt for a mini tummy tuck, the whole procedure will take place below the belly button, which is a good option for those who are just concerned about a small pooch in the lower belly.

During the tummy tuck procedure, an incision will be made in the low abdomen through which fat and stretched skin will be removed, and any loose muscles will be sewn together. Another incision will usually be made around the belly button.

The remaining upper skin is lifted up as high as the rib cage and pulled down like a window shade to the lower skin near the pubic bone. The skin is now stretched tight and the surgeon then chooses the new ideal position to place the stalk of the belly button.

Your belly button is actually attached to the muscles below. During the procedure, itll stay attached to its stalk. In most cases, the surgeon will create a new opening for the belly button, especially if its shape has become distorted after weight gain or pregnancy.

If this isnt done well, the belly button may end up looking distorted either too flat, too deep, or the wrong shape. So, its important to ask your surgeon to see their portfolio and ask about their ideas for your naval.

If youre healed from a tummy tuck and still dissatisfied with your belly button, you may consider an umbilicoplasty, which is a surgery to change the appearance of the belly button.

It can be helpful to see before and after photos of the belly button after a tummy tuck when deciding if the procedure is right for you. Check out the gallery of real patients below:

The recovery timeline after your tummy tuck will vary depending on several factors including your age, weight, and general health.

You may or may not have to spend the night in the hospital. Your drainage tubes, which pull fluid away from the abdomen, will likely remain in place for several days.

Youll also need to wear an abdominal binder for about 6 weeks. This is basically a very tight band around the belly that supports the tummy and helps to avoid fluid buildup.

Its especially important that you wear your binder and avoid strenuous activity so the belly button heals properly.

Your doctor should give instructions on how to care for your belly button after a tummy tuck. This may include cleaning the area with warm water or a saltwater solution.

Its normal for the area to look swollen and even a bit crusty after surgery, and it may take as long as 6 months for the belly button to heal.

Call your doctor right away if you notice signs of infection in the belly button after a tummy tuck. These signs include:

A tummy tuck can be a good way to flatten the stomach and tighten muscles in the abdomen that may have gotten loose from pregnancy, weight gain, or just general aging, but many people wonder whatll happen to the belly button as a result of the procedure.

Normally, an incision will be made around the naval and itll be lifted and put back in the appropriate place to fit the new shape of the stomach. Other times it may be necessary to make a new opening.

Its always a good idea to see before and after pictures from your surgeon and pay close attention to the belly button area when viewing them.

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Tummy Tucks and the Belly Button: What Happens to It? - Healthline


Feb 10

Marine mothers have year to return to fitness standards with new policy – Stars and Stripes

WASHINGTON The Marine Corps is giving women more time to get into physical shape after childbirth, according to a new policy change.

Once a pregnancy is confirmed, the woman is exempt from taking a fitness test or participating in the Body Composition Programor the Military Appearance Program. Those programs are aimed at Marines who are not meeting the services fitness and appearance standards.

After the birth of the child, the woman has at least 12 months to meet fitness and appearance standards, according to the new update posted Monday, which goes into effect immediately.

The extension was made in recognition of the individual circumstances of each Marines pregnancy and postpartum time and to alleviate the stress of returning to the services standards.

Affording a postpartum Marine more time before mandating fitness testing and body composition compliance will allow a fuller recovery, lower injury risk, prevent potential long-term persistent factors and eliminate potential impact to breast milk production due to rapid weight loss, Capt. Sam Stephenson, a spokesman for Marine Corps Training and Education Command, said in an email Tuesday.

The Marine Corps expects women to continue physical fitness routines during their pregnancies, citing new science that has shown it is good for their health and that of their children. The announcement also states that new mothers should start a gradual and appropriate exercise program as soon as their doctor approves.

The announcement cited the Pregnancy and Postpartum Physical Training Handbook as a resource that Marines can use to understand which fitness activities they can do during and after pregnancy.

With the update, Marines who have been placed in the Body Composition Programin the last three months after their postpartum period can be removed and reevaluated, according to the announcement. Also, Marines who completed their postpartum period within the last three months and received an adverse fitness report can now petition for relief with the Performance Evaluation Review Board.

Kenney.Caitlin@stripes.comTwitter: @caitlinmkenney

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Marine mothers have year to return to fitness standards with new policy - Stars and Stripes


Feb 10

The Effects of Artificial Sweeteners on the Body – LIVESTRONG.COM

There's budding research that artificial sweeteners can negatively affect gut health.

Image Credit: LIVESTRONG.com Creative

Equal, Splenda, Sweet'N Low artificial sweeteners have been household names for decades, but the debate surrounding their safety hasn't let up.

The ongoing controversy has a lot to do with the effects of artificial sweeteners on the body. Research suggests the faux sweet stuff may have complex effects on everything from the body's long term blood sugar control to the makeup of the gut microbiome and more.

First of All, What Are Artificial Sweeteners?

Before we dive into the effects of artificial sweeteners on our health, it's important to know what they are and how they're made. One note: The science community refers to these ingredients as "low-calorie sweeteners," or LCS, a term that encompasses both artificial sweeteners like Splenda as well as natural sweeteners like stevia.

Artificial sweeteners are lab-made additives that are either very low in calories (think: 4 calories per packet) or "non-nutritive," meaning free from calories altogether.

All LCS require some form of chemical manipulation and processing. For example, sucralose (aka Splenda) is a chlorinated derivative of real sugar that largely passes through the GI tract without getting absorbed, per a November 2016 review in Nutrition Reviews. The result is a calorie-free, ultra-sweet substance that can taste up to 600 times sweeter than regular sugar (sucrose), per the FDA.

Aspartame, the substance used in Equal and Nutrasweet, is a low-calorie sweetener made of amino acids it tastes about 200 times sweeter than sugar, per the FDA.

LCS are meant to satisfy a sweet tooth without spiking blood sugar or serving up many calories as our bodies don't fully absorb them. While that sounds straightforward enough, research suggests there may be more to the equation.

All high-intensity sweeteners currently approved for use in the U.S. have been deemed safe for consumption, per the FDA. However, third-party research sometimes suggests otherwise.

Effects of Artificial Sweeteners on the Body

Your Gut May Get Out of Whack

By now, we're aware our gut microbiome is very important: The trillions of bacteria that reside in our intestines affect everything from our immune function to our mood. But LCS may alter the makeup of our microbiome, potentially causing some of the bad gut bugs to proliferate.

Animal studies have linked sucralose to decreased diversity in the gut microbiomes of rats, with the sweetener lowering the amount of health-promoting bacteria (like bifidobacteria and lactobacilli) in the animals' intestines, per a January 2019 review in the journal Advances in Nutrition.

When it comes to humans, though, research on artificial sweeteners' effects on gut health is lacking. One October 2019 study in The British Journal of Nutrition reported that high doses of sucralose had no effects on the makeup in people's gut bacteria. Granted, the study only lasted a week. Adding a packet of Splenda to your morning coffee for 30 years may play out differently.

For now, evidence of the adverse effects of LCS on human gut health is "not strong," says Wendy Bazilian, DrPH, RDN, a California-based dietitian and author of Eat Clean, Stay Lean. Of course, a lack of data doesn't mean the additives are OK for the gut. "In classic scientist speak, more research is needed on this topic," Dr. Bazilian says.

It's Unclear if Your Risk of Getting Cancer Will Rise

The connection between artificial sweetener intake and cancer risk has been a concern since the 1970s when a major study published in the journal Environmental Health Perspectives reported that saccharin (aka Sweet'N Low) was associated with a greater incidence of bladder cancer in lab rats and mice.

Those findings led the government to slap warning labels on any product containing the sweetener in 1977. Since then, a number of studies have reported that the sweetener is not, in fact, cancer-causing in humans. As a result, the National Institutes of Health (NIH) said in 2000 that saccharin should no longer be considered a potential carcinogen, per the FDA.

Since the research has primarily been done in animal or in vitro studies, there's no clear link between artificial sweeteners and human cancer risk at this time, Dr. Bazilian says. "While it's been suggested that the plausible mechanisms are not the same for humans as in rats, that doesn't mean they don't exist with absolute certainty, either," she adds.

The bottom line: "Certainly, there is less risk from not consuming them than consuming them. They're not essential to the diet or human health," Dr. Bazilian says.

They Probably Won't Make You Gain Weight

In theory, LCS should promote weight loss when compared to the real deal. After all, table sugar serves up 4 calories per gram while alternatives like Sweet 'n Low deliver zero. But research suggests it may not be that simple.

One April 2015 study in the Journal of American Geriatrics Society found a dose-dependent relationship between diet soda intake and waist circumference in older adults meaning, the more artificially sweetened beverages they drank, the more abdominal weight they gained. Of note, excess belly fat, also called visceral adiposity, is known to raise the risk of heart disease and type 2 diabetes, per Harvard Health Publishing.

There are a number of possible mechanisms by which LCS may promote weight gain. For example, animal studies have shown the sweetener acesulfame potassium, or ace-K, may lower levels of the appetite-suppressing hormone leptin, per research conducted by the NIH.

"It could also be that there is compensatory eating happening along with the inclusion of LCS, meaning a false sense of freedom with other foods because you're saving in another," Dr. Bazilian says. "What's more, the foods LCS are added to, or the foods they're enjoyed with, could be sources of calories from fats, protein and carbs that may be in excess of daily needs." Think: sipping a diet soda along with a meatball sub and potato chips.

All that said, LCS probably don't cause weight gain on their own. And if they're included in a diet that's nutritious along with a consistent exercise regimen, they may be a helpful tool for weight loss, Dr. Bazilian says.

Just don't count on them regularly: "They could contribute to weight loss in small part by the few calories they may 'save,' but they are not something I recommend in my practice," Dr. Bazilian says.

Because LCS are significantly sweeter than natural sugars, they have the power to desensitize our tastebuds to sweet flavors over time. "As a result, many people who regularly consume artificial sweeteners may find naturally sweet foods like fruit and honey less appealing and may develop an increased desire for sweet-tasting foods, says Tamar Samuels, RD, a New Jersey-based dietitian and co-founder of Culina Health. Cue the cravings.

They Might Mess With Your Blood Sugar

LCS are often recommended for folks looking to control their blood sugar levels. Yet despite being sugar-free, some studies suggest that the additives can still negatively affect glycemic control.

Early research shows that artificial sweeteners like sucralose might activate sweet taste receptors, triggering the release of insulin, like regular sugar does, according to a September 2018 article in The American Journal of Clinical Nutrition.

Indeed, people with type 2 diabetes who ate artificial sweeteners were observed to have higher levels of insulin resistance compared to people who did not, per a January 2020 cross-sectional study in the Journal of Family Medicine and Primary Care.

Why does that matter? "Insulin resistance can lead to elevated blood sugar levels, which can contribute to a number of health problems including type 2 diabetes, increased risk for cardiovascular disease, kidney damage, eye damage and increased risk of infection," Samuels says.

"Elevated blood sugar can also make it difficult to lose weight, cause low energy and promote cravings for sweets and carbs."

Samuels typically recommends minimizing LCS, even for people with pre-diabetes or diabetes, due to their effects on cravings and insulin. If you have a sweet craving, you're better off choosing fresh fruit so you can get the additional water, fiber and antioxidants that are beneficial for people with diabetes, she says. If you want a sweetener, I recommend choosing one from natural sources like stevia or monk fruit and having them in limited amounts on occasion.

The jury is still out on what really happens when we regularly eat or drink LCS. Until we have more concrete evidence, Dr. Bazilian recommends avoiding them.

"I encourage enjoying sweet flavors and incorporating them in a balanced way," she says. "Removing LCS can help you taste the more subtle but also more complex flavor origins of naturally sweet foods like fruits."

For most people, a moderate amount of real sugar can safely fit into a healthy eating routine. If you find yourself hooked on the ultra-sweet additives, start by dialing back your intake slowly.

"I recommend gradually decreasing your portions of these sweeteners over time for an easier transition," Samuels says. "Start with having one less packet per week until you have eliminated them completely and replace them with one to two teaspoons of natural sugars like honey or pure maple syrup [as needed]."

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The Effects of Artificial Sweeteners on the Body - LIVESTRONG.COM


Feb 9

Egg diet for weight loss: Health benefits, side-effects, all you need to know about it – Times of India

There are countless things people do or eat in their pursuit to lose weight.Having eggs for weight loss is one that all weight watchers and fitness experts suggest.But, how about we tell you, there is a diet plan which just involves eating eggs and promises to make you drop the kilos faster?As baffling as it sounds, the egg diet plan is something which a lot of people try, and vouch for its promises to promote faster weight loss.

We explain to you how the diet works, its benefits and all you need to know about the same:

What does the egg diet plan involve?

Simply said, the egg diet plan is a novel weight loss strategy which requires dieters to consume at least one big meal of the day centring around eggs, traditionally considered to be a breakfast food.

The egg diet is also considered to be highly helpful for weight loss since it is ideally a low-calorie, protein-rich food which can help shed kilos faster and not make a person lose muscle mass.

Besides an obvious focus on eggs, the diet plan entails you to have three meals in a day, without snacking, have sufficient water intake ( and have other zero-calorie beverages).

The two most commonly followed variations of this dietplan are - an egg-only diet or a boiled egg diet.

What can you eat?

While the primary focus of the diet remains consuming eggs for weight loss, a lot of the other aspects depend on the foods you do eat.

There are variations of this diet plan which include foods like grilled chicken, seafood and steamed vegetables, but eliminate starchy, carbohydrate-rich foods.

In general, snacks and aerated drinks (which add calories) are forbidden. While one meal of the day needs to have an egg preparation, the other two meals can also have some form of lean protein.

A person can also add some form of low-carb vegetables, fruits. High-carb foods such as grains, some vegetables and fruits are not allowed. Processed foods are again a big no-no.

The diet is planned in such a way that you restrict certain foods for a few weeks time and then slowly ease back into a healthier eating pattern. There is also a variation of a diet which only allows a person to have just eggs and water.

Thre are also some interesting fad variations of this diet plan.

In an egg and grapefruit diet, a dieter is allowed to have a piece of grapefruit with eggs or some lean protein at every meal. No other fruit should be consumed.

It is usually practised for 14-21 days, no longer than that.

There is also an extreme version of the egg diet- one where a dieter survives on eggs (hard-boiled) and water for two weeks time. Since it comprises of a person solely relying on a single source of nutrition, it may not be so sustainable and can devoid you of other important vitamins and minerals.

Another form of the egg diet is the medical egg diet, wherein, a person consumes one egg with every meal, along with a piece of bread. Apart from eggs and bread, any number of low-calorie fruits and veggies can be included with this and beverages like water and black coffee can also be had.

There is also another version of the egg diet which pushes your body into ketosis to burn fat. As per this, a person is required to have eggs with fats like butter and cheese (the ratio is one egg to one tablespoon of fat), which makes the body produce ketones and lose weight. This is known as the Keto egg diet.

Having alcohol, sugary, processed foods, milk, juices, refined carbohydrate sources are also not allowed to be eaten with the diet.

Whats interesting to learn about the egg diet for weight loss is that unlike other diets, people arent encouraged to exercise during the dieting period, since a restricted diet plan could induce fatigue and may not help fuel the workout.

Are there any benefits?

A good benefit of the diet is that it restricts you from eating processed or unhealthy additives like sugar or too much caffeine, which are bad for you.

The diet has been designed to be continued for a maximum of some weeks time. Hence, the diet can be beneficial if short-term weight loss is on your mind.

The diet is also an inexpensive one since most of the ingredients in the diet are a staple, readily available foods. It also doesnt make you rely on other supplements or food brands for weight loss.

Are there any dietary shortcomings?

One of the biggest concerns with the diet is its restrictive nature. The diet solely focusses on the consumption of low-cal, low-carb foods and ditches other food groups from your meal plan. While the working of such a diet may speed up weight loss in the short run, restrictive diets aren't sustainable in the long run. Some even end up gaining weight after following restrictive diets.

Restrictions may also potentially increase your risk of nutritional deficiency and drain you of energy, which one needs to be careful about. After a while, the structure of the diet can also seem boring and prove difficult to follow so make you pick wisely.

One should also remember that eating eggs without moderation can induce digestive issues. Since the diet is devoid of fibre, having too many eggs can cause gastrointestinal problems. It can also raise cholesterol levels. The lack of carbohydrates in the diet can also leave you tired and fatigued more often since the body doesn't have good energy sources to rely on.

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Egg diet for weight loss: Health benefits, side-effects, all you need to know about it - Times of India


Feb 9

How Philly Is Learning to Ditch Dieting and Evolve Our Relationship With Food – Philadelphia magazine

Longform

With an overarching goal to have a healthier mindset around nutrition, we're working on eating and living guilt-free.

Veggie-forward dishes from fast-casual restaurant DIG in Rittenhouse. | Photograph by Jason Lecras

Its 2004, and Im celebrating my moms birthday in Northeast Philly with her six siblings and my 14 cousins. Our family is happily stuffing our faces with bubbling cheese pizza topped with sausage and mushrooms, lunch-meat-packed sandwiches from Marinuccis, and hearty slices of Stocks frosted pound cake. That is, everyone except the birthday girl. My mom is hunched over the kitchen counter, scribbling on what looks like a mini-golf scorecard. Next to her, a scant plate: a hoagie cut deliberately in half, and a few picked-off pizza mushrooms.

Though I didnt fully know it then, this kind of relationship with food isnt unique to my mom. Practices like counting calories and restricting portions pervaded the diet culture of the early 2000s. America was saturated with often-unsatisfactory weight-loss plans: Weight Watchers points were tallied religiously; devotees of the South Beach and Atkins diets requested bagels with the insides scooped out. Some people looking to lose weight may have seen success with these programs. But many didnt and, worse, many never learned the difference between nutrition and dieting. Despite some benefits, these plans never worked for everyone or made everyone feel good making the once-pervasive one-size-fits-all diet culture both frustrating and unrealistic.

Despite some benefits, these plans never worked for everyone or made everyone feel good making the once-pervasive one-size-fits-all diet culture both frustrating and unrealistic.

Diet programs have, thankfully, evolved since then, modifying their approaches to recognize that not all foods are created equal, nutritionally speaking. And of course, fad diets and calorie counting did (and continue to) work for some people my mom, for one, whos still tallying her numbers and eating half-sandwiches 20 years later. But over the decades, others became hungry for something new: an approach to nutrition that was not only less concerned with numbers and guilt, but more intuitive, personalized and practical.

In 2009, Whole30 emerged as an elimination diet: a method that involves removing certain food groups dairy, legumes, grains for a short period of time, then reintroducing them one by one in order to determine which might be causing GI distress, low energy or stress. It wasnt perfect, but this approach did shift American nutrition culture slightly. Diet was no longer strictly synonymous with weight loss, according to Theresa Shank, a licensed registered dietitian and owner of nutritional counseling service Philly Dietitian. Whole30 made people think about how food choices impact their nutrition, digestive health, mental health and overall wellness, says Shank. People went from being hyper-focused on calorie counts to taking a closer look at ingredients and quality.

It was around this time that many dietitians started changing their approaches, too, guiding clients to consume nutritionally dense food in order to boost health and reduce disease risk. Intuitive eating, or being mindful of and listening to your internal hunger cues, started to rise in popularity as well. Beth Auguste, a registered dietitian nutritionist and founder of BeWell with Beth, says that in the past decade, when clients started asking how to lose weight, she started asking why: It became important to find out what was really at stake for that desire, because it was usually rooted in another aspect of their general health, says Auguste.

It was becoming more widely known that everyones body responds differently to food, even if were all eating the same things. That means we cant all follow the same cookie-cutter nutrition plan and even if we did, we wouldnt all look or feel the same. Rather than logging each and every food item consumed throughout the day for the purpose of making the weekly weigh-in, folks were becoming more in tune with their bodies, figuring out which ingredients agreed with their own digestive systems, and embracing the notion that healthy can be defined in a multitude of ways not just by weight and size.

People were focused on coping with stress and how it can directly impact your consumption like emotional eating or food avoidance.

In 2010, Michelle Obama launched the Lets Move campaign, which encouraged families to make healthier food choices and keep kids active. The campaign successfully advocated for the passage of the Healthy, Hunger-Free Kids Act, which, according to public health writer Steven Ross Johnson, allowed the U.S. Agriculture Department to set new nutritional standards for all food sold in schools for the first time in more than 30 years. It called for, he continued, increased servings of fruits, vegetables and whole grains in meals. Encouraged to adopt an abundance mind-set over an avoidance outlook, Americans were slowly learning that adding more greens and nutrient-dense grains into our diets rather than totally forgoing foods typically villainized in diet culture, like white bread, rice and pasta would help us feel better, longer.

Philly embraced these trends, too. In 2010, the citys Department of Public Health, in conjunction with the Food Trust, debuted Get Healthy Philly and its sub-initiative, Philadelphia Campaign for Healthier Schools, thanks to more than $20 million in grants from the CDC as part of a program focused on community-based preventative health care. The two initiatives sought to help Philadelphians make more informed food choices and view wellness as a celebration of healthy living, says Jiana Murdic, the founder of wellness organization Get Fresh Daily, who worked on a campaign called HYPE for the program. (Read more about how she expanded health and nutrition education and founded Get Fresh Daily here.)

Now, in 2020, its apparent that the citys eating scene has capitalized on the plant-forward trend. Farmers markets and community gardens are booming; HipCityVeg slings plant-based burgers and sandwiches, and spots like Blackbird Pizzeria in NoLibs and West Phillys Veganish are making vegetarian and vegan lifestyles more mainstream. The impact of these evolving perspectives can also be seen in Phillys exercise scene. Its a slow road, but: In 2010, fitness and nutrition were very segmented, says Britney Kennedy, founder and CEO of OnPoint Nutrition. You went to the gym to work out, and instructors approached exercise as a way to burn calories. That has changed, especially in the past five years. Studios now seem more committed to clients overall health and happiness, promoting exercise as a means to feel good no matter what kind of body youre in.

Registered dietitian Dalina Soto encourages her clients to be flexible with their nutrition planning and grocery shopping. | Photograph by Heather McBride

In 2020, Auguste noticed many clients investing in their mental health alongside their nutritional plans. People were focused on coping with stress and how it can directly impact your consumption like emotional eating or food avoidance, she says. The pandemic also amplified the citys long-existing divide between those who can access a variety of foods and have the freedom to choose what theyre eating, and those who lack food access and nutritional autonomy, says registered dietitian and Nutritiously Yours founder Dalina Soto.

For years, Philadelphia, the poorest major city in the U.S., has struggled with with food security. From 2015 to 2017, according to data from the USDA, 302,685 city residents one in five were deemed food insecure. And data from the 2019 Neighborhood Food Retail in Philadelphia report revealed that lower-income neighborhoods suffer from an oversupply of food high in sugar, salt and unhealthy fats, making it more difficult for residents of these neighborhoods to obtain groceries that support long-term health. Organizations like the Food Trust and Philabundance are working to change this reality. They, along with groups like the Share Food Program and chef-led Everybody Eats, among many others, distributed boxes of healthy food to residents during the pandemic to mitigate this issue, but more significant long-term efforts need to come from policy changes at a government level.

Ask questions like, Can you cook? Where do you get your food? What factors impact your inability to access a grocery store? And then adapt nutritional plans.

Soto believes nutritionists can also help alleviate nutritional challenges by meeting clients where they are. In a city like Philly, she says, Ask questions like, Can you cook? Where do you get your food? What factors impact your inability to access a grocery store? And then adapt nutritional plans. Soto, who works with folks who live in low-income neighborhoods, reminds her clients that healthy food doesnt have to be expensive and that fresh isnt necessarily better than frozen or canned. The goal is consuming a variety of nutrient-dense foods in order to support long-term health, she says.

All in all, eating healthfully in 2020 has come to mean living healthfully pursuing a lifestyle that satisfies your mental, physical and emotional health. Our experts have seen more people intuitively eating and rejecting the diet mentality. Though intuitive eating doesnt account for underlying health or medical conditions that might impact a persons eating habits, it can help folks (especially those who dont see a nutritionist) avoid feeling guilty, pressured or restricted when it comes to food. (Here are some easy-to-implement at home nutrition tips from local pros.)

The goal is consuming a variety of nutrient-dense foods in order to support long-term health.

This anti-diet approach aligns with the newly popular framework Health At Every Size (HAES), which views health and wellness in inclusive, non-stigmatizing ways. Jenny Weinar, a licensed clinical social worker and therapist specializing in disordered eating and body image, says that HAES not only neutralizes weight in conversations about health; it also encourages health-promoting behaviors, like exercising and eating well, regardless of their outcome on weight.

So where is Phillys nutrition scene headed? Registered dietitian nutritionist Liz McMahon believes home cooking is here to stay, but healthy meal-delivery services will skyrocket we cant all be home chefs 24/7! Shank sees a deeper awareness of the connection between food and emotional health: Those modifying their diets these days might not be interested in losing weight, but instead determined to feel less sluggish and more alert during the workday. And with the overarching goal to have a healthier relationship with our eating habits, Soto hopes more people will stop banning certain foods (white rice! Pasta! Pecan freakin pie!) in order to eat and live guilt-free. See ya, celery juice.

This story was originally published in the Be Well Philly 2021 print issue as Our Plates, Evolved. To request a complimentary copy, follow this link.

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How Philly Is Learning to Ditch Dieting and Evolve Our Relationship With Food - Philadelphia magazine



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