Category: Health

If you spend a lot of time online, you may have noticed that parts of the internet have caught fasting fever. Online message boards are awash in posts touting the benefits of time-restricted eating and other intermittent-fasting approaches that involve going without caloric foods or drinks for an extended period of time—anywhere from 12 hours to several days. These online testimonials have helped popularize intermittent fasting, and they often feature two common-sense rationalizations: One, that human beings evolved in environments where food was scarce and meals occurred sporadically; and two, that the relatively recent shift to near round-the-clock eating has been disastrous for our intestinal and metabolic health.

Mining the internet for accurate information, especially when it comes to dieting, can feel like panning for gold. You’ve got to sift through a lot of junk to find anything valuable. But this is one case where nuggets may be easy to find. A lot of the published peer-reviewed research on intermittent fasting makes the same claims you’ll find on those Reddit message boards. “Until recently, food availability has been unpredictable for humans,” wrote the authors of a 2021 review paper in the American Journal of Physiology. “Knowledge of early human evolution and data from recent studies of hunter-gatherer societies suggest humans evolved in environments with intermittent periods of food scarcity.” They say that fasting regimens may provide a period of “gut rest” that could lead to several meaningful health benefits, including improved gut microbe diversity, gut barrier function, and immune function.

The past decade has witnessed an explosion in fasting-relatedid research. (According to Google Scholar, the last five years alone contain almost 150,000 articles that examine or mention fasting.) While that work has helped established links between intermittent fasting and weight loss, as well as other benefits, it’s not yet clear when (or if) fasting can help fix a sick gut. “I would still consider the evidence moderate,” says Dr. Emeran Mayer, a professor of medicine and founding director of the Goodman Luskin Microbiome Center at the University of California, Los Angeles. “[Fasting] looks like a prudent way to maintain metabolic health or reestablish metabolic health, but it’s not a miracle cure.”

When it comes to gut conditions such as inflammatory bowel disease (IBD), he says the research is either absent or inconclusive. To his point, researchers have found that Ramadan fasting—a month-long religious period when people don’t eat or drink between sunrise and sunset—can substantially “remodel” the gut’s bacteria communities in helpful and healthy ways. However, among people with IBD, studies on Ramadan fasting have also found that a person’s gut symptoms may grow worse.

While it’s too early to tout fasting plans as a panacea for gut-related disorders, experts say there’s still reason to hope these approaches may emerge as a form of treatment. It’s clear that some radical, and perhaps radically beneficial, things happen when you give your body breaks from food.

How fasting could repair the gut

For a series of recent studies, a team of researchers based in the Netherlands and China examined the effects of Ramadan-style intermittent fasting on the gut microbiome—the billions of bacteria that reside in the human gastrointestinal tract. (Ramadan comes up a lot in published research because it provides a real-world opportunity for experts to examine the effects of 12- or 16-hour fasts, which is what many popular intermittent fasting diets espouse.) “We really wanted to know what intermittent fasting does to the body,” says Dr. Maikel Peppelenbosch, a member of that research team and a professor of gastroenterology at Erasmus University Medical Center in the Netherlands. “Generally, we’ve seen that intermittent fasting changes the microbiome very clearly, and we view some of the changes as beneficial. If you look at fasting in general, not only Ramadan, you see certain types of bacteria increasing.”

For example, he says that intermittent fasting pumps up the gut’s population of a family of bacteria called Lachnospiraceae. “In the intestines, bacteria are constantly battling for ecological space,” he explains. Unlike some other gut microorganisms, Lachnospiraceae can survive happily in an empty GI tract. “They can live off the slime the gut makes itself, so they can outcompete other bacteria in a fasting state.” Lachnospiraceae produces a short-chain fatty acid called butyrate, which seems to be critically important for gut health. Butyrate sends anti-inflammatory signals to the immune system, which could help reduce pain and other symptoms of gut dysfunction. Butyrate also improves the barrier function of the intestines, Peppelenbosch says. This is, potentially, a very big deal. Poor barrier function (sometimes referred to as “leaky gut”) is a hallmark of common GI conditions, including inflammatory bowel disease. If intermittent fasting can turn down inflammation and also help normalize the walls of the GI tract, those changes may have major therapeutic implications.

Lachnospiraceae is only one of several types of helpful bacteria that research has linked to fasting plans. But at this point, there are still a lot of gaps in the science. Peppelenbosch says the guts of people with bowel disorders don’t seem to respond to fasting in exactly the same way as the guts of people without these health issues. “In ill people, we see the same changes to the microbiome, but it’s not as clear cut as in healthy volunteers,” he says. “So we are now actually trying to figure out what’s going on there.”

Healthy microbiome shifts aren’t the only possible benefits that researchers have linked to intermittent fasting. UCLA’s Mayer mentions a phenomenon called the migrating motor complex. “This is rarely mentioned in fasting articles today, but when I was a junior faculty it was one of the hottest discoveries in gastroenterology research,” he says. The migrating motor complex refers to recurrent cycles of powerful contractions that sweep the contents of the gut, including its bacteria, down into the colon. “It’s this 90-minute recurring contractile wave that swoops down the intestine, and its strength is comparable to a nutcracker,” he says. Essentially, this motor complex behaves like a street-cleaning crew tidying up after a parade. It ensures the gut is cleared out and cleaned up in between meals, via 90-minute repeating cycles that fasting allows to be become more frequent. It also helps rebalance the gut’s microbial populations so that more of them are residing in the colon and lower regions of the GI tract. “But it’s stopped the minute you take a bite—it turns off immediately,” he says.

Mayer says that modern eating habits—so-called “grazing,” or eating steadily throughout the day—leave little time for the migrating motor complex to do its thing. “This function has been relegated to the time when we sleep, but even this has been disrupted because a lot of people wake up in the middle of the night and snack on something,” he says. “So those longer periods of time when we re-cleanse and rebalance our gut so that we have normal distributions of bacteria and normal population densities—that has been severely disturbed by these lifestyle changes.”

Ideally, Mayer says people could (for the most part) adhere to the kind of time-restricted eating program that allows a full 12-to-14 hours each day for the motor complex to work. “If you don’t snack, this motor complex would happen between meals, and you’d also get this 12- to 14-hour window at night where the digestive system was empty,” he explains. In other words, sticking to three meals a day and avoiding between-meal bites (or nighttime snacks) could be sufficient. But again, it’s not clear whether this sort of eating schedule can undo gut damage or treat existing dysfunction.

Read More: The Truth About Fasting and Type 2 Diabetes

More potential benefits

Another possible perk of fasting involves a biological process called “autophagy.” During autophagy, old or damaged cells die and are cleared away by the body. Some researchers have called it a helpful housekeeping mechanism, and it occurs naturally when the body goes without energy (calories) for an extended period of time. There’s been some expert speculation, based mostly on evidence in lab and animal studies, that autophagy could help strengthen the gut or counteract the types of barrier problems seen in people with IBD. But these improvements have not yet been demonstrated in real-world clinical trials involving people.

Meanwhile, some experts have found that fasting may help recalibrate the gut’s metabolic rhythms in helpful ways. “By changing the timing of the diet, this will indeed change activity of the
microbiome, and that may have downstream impacts on health,” says Dr. Eran Elinav, principal investigator of the Host-Microbiome Interaction Research Group at the Weizmann Institute of Science in Israel.

Some of Elinav’s work, including an influential 2016 paper in the journal Cell, has shown that the gut microbiome undergoes day-night shifts that are influenced by a person’s eating schedule, and that lead to changing patterns of metabolite production, gene expression, and other significant elements of gut health. “If you change the timing of diet, you can flip the circadian activity of the microbiome,” he says. This is likely to have health implications, though what those are, precisely, remains murky.

Read More: What We Know About Leaky Gut Syndrome

Fasting isn’t going anywhere

It’s clear that when you eat, including how often you eat, matters to the health of your gut. But the devil’s in the details. At this point, it’s not clear how intermittent fasting can be used to help people with gut-related disorders or metabolic diseases.

“For a condition like IBD, it’s important to differentiate between what you do during a flare and what you do to prevent the next flare,” Mayer points out. The research on people observing Ramadan suggests that, at least during a flare, fasting may make a person’s IBD symptoms worse. Figuring out whether fasting could also lead to longer-term improvements is just one of many questions that needs to be answered.

While plenty of unknowns remain, experts say that common approaches to fasting appear to be safe for most people. Time-restricted eating, for example, involves cramming all your day’s calories into a single six-to-eight-hour eating window. Even among people with metabolic diseases such as Type 2 diabetes, research suggests that this form of fasting is safe, provided a person is not taking blood-glucose medications.

That said, there simply isn’t much work on intermittent fasting as a treatment for gut problems. Also, there is very little research on more extreme forms of fasting, such as plans that involve going without calories for several days at a stretch. These diets may turn out to be therapeutic, but they could also turn out to be dangerous. If you’re considering any of these approaches, talk with your health care provider first.

“We really need much better studies to compare all the different fasting protocols,” says Peppelenbosch. “But generally speaking, increasing the space between calorie consumption is a good thing for you. The body is not made to be eating all day.”

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9/23/2022|9:04

Wastewater surveillance uses local sewer systems to measure the health of the population and can be especially useful to detect infectious diseases that can be asymptomatic. The practice is currently being used to combat COVID-19 and could be a useful tool to fight Monkeypox and the resurgence of polio.

A recent study published in PLOS One and conducted by Beth Israel Deaconess Medical Center researchers in Boston reveals virtual reality use during hand surgery led to significant reductions in intraoperative anesthetic without negatively impacting patient-reported outcomes. 

In a small, eight-month randomized controlled trial, researchers evaluated 34 patients undergoing hand surgery and the amount of anesthesia administered intraoperatively in conjunction with or without VR use.

The VR group received significantly less propofol per hour than the control group. Notably, post-anesthesia care unit (PACU) length of stay was markedly decreased in the VR group, with patients discharged from the PACU 22 minutes earlier than control patients.

Patients were divided into a control group, provided anesthesia as recommended by an anesthesiologist during surgery, and a VR group, which viewed programming of their choice via a virtual reality headset and noise-canceling headphones.

The virtual programming, provided by telehealth VR clinic company XRHealth, was designed to promote relaxation and calmness, such as a peaceful meadow, forest or mountain top. Patients could also listen to a guided meditation in the immersive environments or select from a library of videos on a web-based user interface displayed as a theater screen surrounded by a “starry sky” background. 

WHY IT MATTERS

A common practice for anesthesia during hand surgery combines regional anesthesia administered before surgery and monitored anesthesia care during surgery. 

Although patients receive anesthesia preoperatively, they may need additional anesthesia intraoperatively, which can result in oversedation and potentially avoidable complications. 

Researchers in the above study noted, “VR could prove to be a valuable tool for patients and providers by distracting the mind from processing noxious stimuli resulting in minimized sedative use and reduced risk of oversedation without negatively impacting patient satisfaction.”

However, they did report limitations within the study, including participants being aware of the possibility of reduced sedative dosage. There could also be selection bias, as results from patients who agreed to minimal sedation may not be generalizable to the population as a whole.

Also, providers in the study were not blinded, which could have contributed to the dramatic differences in Propofol dosing between groups, researchers wrote. 

“Because of the potential for bias to influence both of these outcomes, our results should be interpreted as preliminary and needing validation in future trials. Further, given these major limitations, our results are therefore best suited to describe how the incorporation of VR immersion into current anesthesia practice for hand surgery can compare with the standard of care, not to serve as proof that VR is an effective pain control modality or is superior to other distraction techniques,” researchers noted. 

THE LARGER TREND

Extended reality (i.e., virtual, augmented and mixed reality) is currently used in various forms within the operating room and affects patients and surgeons.

Surgeons use augmented reality technology via Augmedics’ xvision system, for spine surgery. Augmedics’ technology allows a surgeon to see a 3D model of a patient’s spine during implant surgery and has demonstrated 99.1% percutaneous screw placement accuracy. 

Precision XR’s Surgical Theater enables surgeons to visualize a surgical experience by inputting 3D-imaging models into virtual reality. Providers perform a conventional scan of a patient’s body (MRI, CT scan, etc.). That scan is reconstructed into a 3D image in virtual reality for surgeons to analyze in-depth to prepare for an operation.  

Headspace Health has revealed two acquisitions this year, the latest coming earlier this month when the digital mental health company announced the purchase of mental wellness app Shine. 

In a crowded field of mental health startups, the company is using acquisitions to augment its product and add new capabilities. Leslie Witt, Headspace’s chief product and design officer, said the Shine deal is part of a larger effort to offer content that caters to the needs of more groups, including people of color, women and the LGBTQIA+ community. 

Headspace Health also scooped up Sayana, maker of AI-enabled mental health-tracking and sleep apps. And Headspace itself is the result of a merger between meditation app Headspace and virtual mental healthcare company Ginger, which closed nearly a year ago. 

Witt sat down with MobiHealthNews to discuss the company’s acquisition strategy, how its offering may change in the future and what’s next for the competitive digital mental health sector.

MobiHealthNews: So, this wasn’t Headspace’s first acquisition this year. How do you choose your acquisition targets? Do you think you’ll continue at a similar pace?

Leslie Witt: I think, as I’m sure you’re seeing, the long-rumored consolidation of mental health and behavioral health areas is starting to happen. In some ways, the biggest part of our story that merges with that is the merger of Ginger and Headspace proper. 

But we see a lot of opportunity across three lenses. Most of the acquisitions that we’ve made, both as a combined entity and some of the ones that we’ve made separately, fit the lens of either content that aligns with our core mission and helps to augment our reach from a self-serve mental health perspective, capabilities that bring new levels of tech — particularly around AI, conversation and community — and then talent.

All of these have been in the frame of small tuck-ins, where we’re not looking to sustain their offering as a stand-alone, but instead to incorporate the talent that they bring to the table into our core areas of prioritization, to accelerate our capability building and then to augment our content libraries.

MHN: You’ve been at Headspace for about two years, not too long before the merger with Ginger. How has the experience changed from the product point of view?

Witt: I’ll share with you a bit of why I joined Headspace, which was fundamentally to answer what we were hearing from our potential members — often members who came in and then didn’t find what they needed, which was higher-acuity mental health services and care. And from our enterprise buyers, they were seeing this well-loved brand, a well-known brand that was attracting 30%, 50% of their employee base to sign up and open a front door to care. 

But that front door only led so far. I fundamentally believe in the power of mindfulness and meditation tools, but they can’t serve all mental health needs. And particularly when someone’s in a state of acute anxiety, acute depression, they need access to professional, human services. 

For Headspace, it led to a direct realization that we had no viable and fast paths forward without merging, and Ginger was the perfect partner to pair with. We’ve been working across that landscape of services for the last year to ensure that we truly can open the front door to care for all. That we can learn who you are, what you need, assess your goals, triage you in a personalized capacity to the right kind of handoff of care, to the right beginning. And get you on a path where we’re really establishing the dimensions of a lifelong mental health journey, helping you build habits of practice that give you deeper self-care capability that then can scale up when the need occurs. 

MHN: What are some of your goals to change your offering in the future?

Witt: One is personalization – not just of services, but of measurement and outcome – so that we can continuously be in a learning and improvement loop where we understand what you need from the onset, serve up the right thing, evaluate whether or not that actually had efficacy for you, and do that both at the level of the individual and in aggregate.

We are building out what I often call the middle piece, the bridge that exists between the self-serve content in the Headspace app and the text-based coaching, teletherapy and telepsychiatry of the Ginger service. 

To really focus on more clinical content and programmatic content, we have launched a stress program. That’s a 30-day program that really takes you in a clinical and behavioral science-backed way from an introduction to stress reduction into a habit and practice of stress reduction. We’re doing the same across anxiety and sleep, and see a lot of potential to begin to hybridize the interplay between coaching and that human level of support into the core product itself. 

And then, last but not least, I think we have a lot of opportunity around community. We see folks almost engaging in kind of cohort-based ways around certain areas of content. [For example,] we see people coming to Headspace in moments of grappling with infertility and see a lot of potential and desire to begin to link community and peer-based support.

MHN: There are a lot of digital mental health companies right now, and you mentioned earlier we may be at the beginning of a combination wave. How do you think the space overall will change this year?

Witt: Some of the ways that I see the game changing is that we are going back to, in very good ways, some of our pre-COVID norms. And with that, I think there’s a lot of pressure on [figuring out] what is the persistence, the relevance of telehealth.

What we are generally finding is that, of all of the telehealth services, the ones that are the most sticky in a digitally delivered format are actually behavioral health.

We are beginning to lean into addressing some of that adolescent mental health crisis. I think that is under-tackled right now. And as a mom of 11-year-old twins who sees what is happening within that landscape, there needs to be more entrants in this space. And we need to celebrate those who’ve already been there and make sure that their ability and access is continued to be expanded for all. 

We also are seeing where enterprises played an outsized role in leaning into employee access to mental health services. More and more need and buy-in is coming through from the public sector. We have a relationship with L.A. County, and we see a lot of potential to partner with governments, with educational institutions, and more broadly with health systems in order to ensure that the goals of health parity and health equity are met.

JAMA Health Forum published a cross-sectional study suggesting reimplementing that licensure restrictions on out-of-state telemedicine, which were lifted due to the COVID-19 pandemic, would have the most significant effect on patients living near a state border, those in rural locations, and those receiving primary care or mental health treatment. 

“Relaxation of state restrictions would likely offer immediate convenience to patients who live near a state border and those receiving primary care and mental health treatment,” the study’s authors wrote. “These patients are subject to an accident of geography; two patients receiving the same care may have very different experiences. A patient with a primary care physician who lives in the middle of a state can access care via telemedicine. However, a similar patient living near a state border with a primary care physician in the neighboring state now will have to physically travel to that appointment.”

WHY IT MATTERS

When COVID-19 emerged, many states temporarily allowed physicians to provide care in states in which they did not hold a license, thus allowing for the increased availability of providers to those in areas with fewer medical facilities and resources. 

Researchers aimed to determine which patients and specialties were using out-of-state telemedicine visits among Medicare beneficiaries during COVID-19. They analyzed 100% Medicare fee-for-service (FFS) claims from January through June 2021.  

This period was chosen because it was after the impact of the early pandemic, when vaccines were available and the healthcare system stabilized but before temporary licensing regulations began to lapse. 

Researchers noted that in the first half of 2021, 8,392,092 patients had been seen by a provider via telemedicine, 5% of which had one or more telemedicine visits with an out-of-state provider.

Patients living in a county close to a state border accounted for 57.2% of all out-of-state telemedicine visits, and 64.3% of those out-of-state visits were with a primary care or mental health clinician. In 62.6% of all out-of-state visits, prior in-person visits occurred between the same patient and healthcare provider.

Compared with patients who only had in-state telehealth appointments, those accessing out-of-state care were more likely to be dual-eligible for Medicaid and live in rural areas. 

Researchers note there are limitations to their analysis, including its concentrated focus on the Medicare population, and its evaluation based on the patient’s home address and the clinician’s practice address, which could be inaccurate. They also focused on patients who had in-state and out-of-state telemedicine visits, not ones who had telemedicine visits in general.

The Jackson, Mississippi, water crisis this summer is a troubling reminder that some American communities are still failing to provide safe water to their residents. After Jackson’s primary water treatment plant failed, around 180,000 people were left with little or no sanitary water. It was reminiscent of the crisis in Flint, Michigan, which rose to broad public awareness in 2015, when residents learned that they’d been poisoned for months by drinking water containing bacteria, disinfectant byproducts, and lead.

The crisis is far from a distant memory in Flint. According to a new survey of nearly 2,000 adult community members published in JAMA Network Open on Sept. 20, residents were still struggling from the enduring mental health impact of the crisis, five years later. After conducting a survey from 2019 to 2020, the researchers estimated that in the year before the survey, about one in five Flint residents presumptively experienced major depression, while a quarter had PTSD, and one in 10 had both illnesses. Those who believed that they or their families were hurt by the contaminated water were significantly more likely to be affected. The authors note that lead itself can impact mental health, including mood.

Flint residents, who are largely low-income and people of color, were already vulnerable to mental-health issues, including because of systemic racism, a shortage of quality affordable housing, and widespread poverty. However, the researchers found evidence that the water crisis itself had a lasting mental health impact. For instance, 41% of respondents said they’d felt mental or emotional problems related to their concerns about water contamination. Flint residents were more than twice as likely to have had major depression compared to the general population rate in Michigan, U.S., or the world, and were twice as likely to have PTSD compared to veterans after deployment, according to the study.

The way the water crisis unfolded made Flint residents particularly vulnerable to long-term mental-health effects, the researchers say. One major problem is that public officials’ decisions caused the water crisis in 2014, when they switched the city to untreated water from the Flint River. Even after health care workers raised alarms about high levels of lead in children’s blood, officials misled the public by insisting that the water was safe. “Feelings that the community is not being looked after, or it’s in fact being abandoned, add an additional layer of stress,” says Aaron Reuben, a co-author of the new study and postdoctoral scholar at Duke University and the Medical University of South Carolina.

A lack of resources can also compound anxiety. Lottie Ferguson, the chief resilience officer for the City of Flint, noted that food insecurity made it harder for residents to eat a healthy diet rich with foods that mitigate the effects of lead toxicity. Ferguson, who worked in Flint during the crisis and whose children were exposed to lead, says that she felt for parents who didn’t have the same resources as her family. “I was more upset and more hurt for parents who didn’t have access to resources to ensure the futures of their children,” she says, adding that she understands why mistrust of officials is still common in Flint.

Also complicating the situation: the water crisis dragged on for a long period of time. Although the water supply was switched back to its original source in October 2015, lead levels didn’t drop below the federal limit until January 2017. That’s left Flint residents with a lasting sense of uncertainty about their health and safety. “It wasn’t like a hurricane that came and went, and then you rebuild,” says Lauren Tompkins, the former vice president of clinical operations at Genesee Health System, a nonprofit health care organization in Flint. She coordinated the emergency mental health resources available to residents in response to the crisis. “The pipes took quite some number of years to fix. So you’re just constantly in this state, for a long period of time, of worrying.”

In many ways, the water crisis has yet to end. For instance, researchers have described a rise in hyperactivity and learning delays among children. Residents still don’t know for sure how deeply they and their families were affected by the polluted water, and whether it triggered health problems they’re experiencing now. They also don’t know if new health issues will suddenly appear in the future.

That’s similar to what happened after the partial meltdown at Three Mile Island nuclear plant in Pennsylvania in 1979, says study co-author Dean G. Kilpatrick, a professor of psychiatry at the Medical University of South Carolina, who researches PTSD and traumatic events. Although locals weren’t exposed to dangerous levels of radiation, the fear that they would be led to lasting mental health harm. “If something’s invisible, tasteless, you can’t really tell if you’ve got it or not,” says Kilpatrick. “Even the perception that you might have been exposed to something, in and of itself, is sufficient to drive a lot of long-term mental-health effects.”

With the help of outside funding and assistance, Flint community members expanded mental-health offerings in Flint, both during the initial crisis and the years that followed. However, only 34.8% of respondents said they were offered mental-health services for symptoms related to the crisis, although 79.3% of those who were offered services took advantage of them. The study’s authors argue that their findings indicate Flint still needs a greater mental health response from the local, state, and federal government. There are also important lessons for other cities enduring water crises, including Jackson—such as how important it is to provide the public with clear, accurate information.

Overall, says Reuben, it’s essential to recognize that crises like what happened in Flint can have an enduring impact on mental health. In Jackson, “We want the community to know we’re thinking about them, and we’re going to think about their mental health,” he says. “Not just once the taps run clear, but potentially for years after.”

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