Fat Injections For Plantar Fasciitis?

Beth Gusenoff et al. have just published the results of their study looking into the effects of fat cell injections for patients with plantar fasciitis. Plantar fasciitis is a common musculoskeletal condition that can lead to inflammation, degeneration and thickening of the plantar fascia. Patients usually present with heel pain during weight bearing activities. The symptoms are often worse in the morning and after periods of inactivity.

There are treatments such as arch-supporting insoles, night splints, soft tissue work, acupuncture, progressive stretching and strengthening, steroid injections, etc. But, the condition sometimes becomes chronic and lingers.

This was a very small study but it showed significant improvements in pain, function and structure of the plantar fascia after receiving perforating fat injections into the plantar fascia. It’s possible that the beneficial effects may be due to a healing response from the microtrauma caused by the needle. And/or the regenerative ability of stem cells and growth factors within fat.

The authors are planning large scale clinical trials to validate their results. It would be interesting for the authors to have a control group that is exposed to the needle microtrauma without the injection of fat cells. This would help determine whether it is the fat or the microtrauma that is responsible for the positive findings.

Covid-19 Research Update

Gu et al. (Nature) recently published a paper explaining the association between Covid-19 and inflammatory and blood coagulation disorders involving platelets and endothelial cells. This is probably why patients with cardiovascular risk factors such as diabetes, obesity and ageing have been particularly vulnerable to Covid-19.

Malas et al. have published a meta-analysis of 42 studies (8271 patients) looking into the association between thromboembolism (blood clots) and Covid-19. The overall venous thromboembolism rate was 21%, deep vein thrombosis (DVT) rate was 20% and pulmonary embolism rate was 13%. There was a positive correlation between disease severity and risk of blood clotting. The risk of thrombosis can affect any organ in the body. This has led to guidelines recommending the use of anticoagulants for Covid-19 patients, especially when hospitalised.

A Chinese cohort study published in The Lancet followed 1733 patients after they were discharged from hospital. They found that at 6 months after onset of Covid-19 symptoms most patients still had at least one symptom. The most common persisting problems were: fatigue or muscle weakness (63%), sleep difficulties (26%) and anxiety and/or depression (23%). Those that had been more severely ill had a high risk of pulmonary diffusion abnormalities and abnormal chest imaging. Persistent kidney dysfunction, diabetes and blood clotting disorders were also observed.

Vegans At Greater Risk of Fracture?

About a month ago a worrying study was published by researchers working on the EPIC-Oxford Study. They looked into the differences in fracture risk between meat eaters, vegetarians and vegans. It was done by following a group of around 55,000 men and women for an average of 17 years. It should be said that most fractures are generally due to poor bone health leading to decreased bone mineral density (BMD) and eventually osteoporosis.

The authors note that previous studies have shown that vegetarians (and vegans) have lower BMD than non-vegetarians but that the associated fracture risk is unclear. The combination of vitamin D and calcium has been found to be effective in decreasing fracture risk. Studies have also linked protein intake to bone health. High protein intake increases intestinal calcium absorption and stimulates the production of insulin-like growth factor (IGF-1) which is associated with better bone health. And finally, body mass index (BMI) could also play a part in fracture risk. The lower BMD found in US vegetarians may be explained by their lower BMI.

Tong et al. summarise their findings as follows:

 “The higher observed risks of fractures in non-meat eaters were usually stronger before BMI adjustment, which suggests that the risk differences were likely partially due to differences in BMI. Vegetarians and vegans generally have lower BMI than meat eaters, and previous studies have reported an inverse association between BMI and some fractures, particularly hip fractures, possibly due to reasons including the cushioning against impact force during a fall, enhanced oestrogen production with increased adiposity, or stronger bones from increased weight-bearing.”

“Although a statistically significant higher risk of total and hip fractures was only observed in vegans in the lower BMI category (<?22.5?kg/m²), our interpretation is limited by the small numbers of cases in each stratum in these analyses, especially because of the strong correlation between diet group and BMI, which results in very few vegans in the higher BMI category, and vice versa comparatively small numbers of meat eaters with a low BMI.”

“In this study and previous studies, vegans had substantially lower intakes of calcium than other diet groups since they do not consume dairy, a major source of dietary calcium, while both vegetarians and vegans had lower protein intakes on average. In the human body, 99% of calcium is present in bones and teeth in the form of hydroxyapatite, which in cases of calcium deficiency gets resorbed to maintain the metabolic calcium balance, and thus, osteoporosis could occur if the calcium was not restored.”

“Overall, vegans in this study had higher risks of total and some site-specific fractures (hip, leg, vertebra) than meat eaters. The strongest associations were observed for hip fractures, for which fish eaters, vegetarians, and vegans all had higher risks. These risk differences might be partially explained by the lower average BMI, and lower average intakes of calcium and protein in the non-meat eaters. However, because the differences remained, especially in vegans, after accounting for these factors, other unaccounted for factors may be important.”

We have known for some time that astronauts suffer from bone loss whilst in space. This is partly due to the effect of weightlessness and reduced physical activity leading to decreased bone compressive forces. Bone compressive forces help increase BMD and create stronger bones. As vegans usually have lower BMIs, their bones are subject to smaller compressive forces than meat-eaters. This can be overcome by resistance exercise and weight lifting. And of course, it is particularly important for those eating a plant-based diet to ensure they get an adequate intake of vitamin D, calcium and protein to maintain bone health.

Breathe Through Your Nose

This post is inspired by “Following Your Nose: Nasal Function and Energy” by Rudolph Ballentine (in Science of Breath, 1992).

The nose is the most restricted part of the respiratory tract and creates 150% more work than mouth breathing. So why should we breathe through our noses? Because the nose fulfils several crucial respiratory functions that our mouth is unable to fulfil. As air passes through the nose it’s filtered, humidified (98% humidity) and warmed (32-34 degrees C). This prepares it for passage to the lungs. When we breathe out through the nose, much of the moisture and heat is retained within the nose to be transferred to the next in-breath.

As we breathe deeply through our nose, mechanoreceptors on epithelial cells are activated and this results in the release of nitric oxide. Nitric oxide leads to bronchodilation and vasodilation which in turn increase circulation and the delivery of oxygen. Nitric oxide also has antimicrobial properties and promotes mucus production and ciliary movement which facilitate the evacuation of debris and microbes.

Apparently, the shape of our nose depends on the climate in which our ancestors evolved: a long big nose in cooler and dryer climates and a wide nose with open nostrils in warm, moist climates.

“Yesterday I was clever,

so I wanted to change the world.

Today I am wise,

so I am changing myself.”

Rumi

Nutrition, Immunity and COVID-19

Our immune system protects us from pathogens like viruses, bacteria, cancerous cells, etc. and it can be separated into 2 distinct branches: the innate immune system and the adaptive immune system. Our innate immune system uses cells such as macrophages, neutrophils and mast cells to mount a fast, generic response to pathogens. Inflammation is the hallmark of the innate immune system. On the other hand, the adaptive immune system uses T cells, B cells and natural killer cells to mount a slow, targeted response to pathogens. It’s the adaptive immune system that’s responsible for life-long immunity to certain diseases. In practice, the 2 branches interact to provide a comprehensive immune response.

In a recent article, Butler and Barrientos (2020) summarised the interactions between diet, immunity and COVID-19. They state that the typical western diet (high in saturated fats, refined carbohydrates and sugars, and low in fibre, unsaturated fats and antioxidants) “significantly impairs adaptive immunity while ramping up innate immunity, leading to chronic inflammation and severely impairing host defence against viral pathogens.”

The authors note that “T and B cell counts were also significantly lower in patients with severe COVID-19; thus, there could be a potential interaction between western diet consumption and COVID-19 on adaptive immunity impairment.” They suggest the higher rates of obesity and diabetes among ethnic minority populations may partly account for the health disparities seen in response to COVID-19.

Butler and Barrientos conclude “that individuals refrain from eating foods high in saturated fats and sugar and instead consume high amounts of fibre, whole grains, unsaturated fats, and antioxidants to boost immune function.”

Early Feeding Improves Pre-Diabetes and Blood Pressure

About a year ago Sutton et al. published a study that showed that intermittent fasting has benefits that are independent of food intake and weight loss. Their trial tested the effects of 5 weeks of “early time-restricted feeding” (eTRF) on 8 men with pre-diabetes. The subjects were asked to start breakfast between 6:30-8:30 and to eat their 3 meals in a 6-hour window with dinner before 15:00. They were fed enough food to maintain weight. The control group had similar meals but within a 12-hour feeding window. Five weeks of eTRF significantly improved insulin levels, insulin sensitivity, blood pressure and oxidative stress levels. The blood pressure improvements were particularly dramatic – morning levels of both systolic and diastolic blood pressure were reduced by about 10 mm Hg each.

Some of the benefits of eTRF are believed to originate from eating in alignment with our internal biological clocks which are primed for feeding early in the day. The authors state that “in humans, insulin sensitivity, beta cell responsiveness, and the thermic effect of food are all higher in the morning than in the afternoon or evening, suggesting that human metabolism is optimized for food intake in the morning”. Fortunately eTRF lowers the desire to eat in the evening!

Slow Breathing Regulates High Blood Pressure

Several years ago I wrote a few articles showing that exercise, yoga and other strategies were helpful at regulating high blood pressure (BP). Even small reductions in blood pressure can significantly reduce the risk of heart disease, stroke and kidney failure. The risks associated with hypertension are continuous – this means that with each 2mm Hg rise in systolic BP there is an associated 7% increase in mortality from heart disease and 10% increase in mortality from stroke.

I recently came across a few studies that have shown that paced, slow breathing can significantly decrease blood pressure in patients with hypertension. Joseph et al. (2005) demonstrated that paced breathing at 6 breaths/min for only a couple of minutes was able to decrease systolic BP by more than 8mm Hg and diastolic BP by about 5mm Hg. Similarly, Li et al. (2018) found that paced breathing at 8 breaths/min for 5min lowered systolic BP by about 4mm Hg and diastolic BP by over 8mm Hg. Because the slow breathing was only tested for a few minutes…the long-term effects of daily practice remain to be determined.

For those that are interested in giving it a go, I would recommend wearing loose-fitting clothing and either lying down or sitting back into a chair in a warm environment. Aim to progressively slow your breathing down to 5-7 breaths/min (there are several apps that can help pace your breathing). Breathe with an equal inhalation and exhalation. It may take several sessions to comfortably slow your breath to 5-7 breaths/min…take your time. Enjoy for 15-20min a day!

“Ever since happiness heard your name,

it has been running through the streets trying to find you...

…let it catch up.”

Hafez (modified by Joseph Goldstein)

Meal Times Crucial For Weight Loss

A few months ago Lopez-Minguez et al. reviewed studies looking at the effect of meal times on obesity and metabolic risk. Their findings are summed up in the following points:

• skipping breakfast is linked to obesity
• eating a large breakfast (within 2hrs of waking) decreases the probability of being obese by 50%
• a late lunch (after 3pm) hampers weight loss and has a negative effect on the diversity and composition of our microbiota
• a late dinner (less than 2hrs before bedtime) decreases glucose tolerance
• eating a large, late dinner (less than 2hrs before bedtime) leads to a 5-fold increase in the risk of becoming obese
• the timing of breakfast seems to be hereditary whereas the timing of dinner is mainly cultural

There may be some truth in the following quote by Adelle Davis.

“Eat breakfast like a king, lunch like a prince and dinner like a pauper”

As well as getting the timing right obviously!