While people dealing with chronic back pain are often directed to physical therapy, research shows that psychological approaches that teach strategies to manage your experience of pain can help. So, would combining these approaches do more to ease the pain?

Worldwide, low back pain is a leading cause of disability. A recent systematic review of multiple studies suggests that it might.

Jone Mark

How big is this problem, and what did this study find?

Worldwide, low back pain is a leading cause of disability and affects more than 560 million people. In the US, four in 10 people surveyed in 2019 had experienced low back pain within the past three months, according to the Centers for Disease Control and Prevention.

• For improving physical function and fear-avoidance, pain education programs in conjunction with physical therapy offered the most sustained effects.
• For improving pain intensity, behavioral therapy combined with physical therapy offered the longest-lasting benefits.

Protect yourself from the damage of chronic inflammation.

Science has proven that chronic, low-grade inflammation can turn into a silent killer that contributes to cardiovas­cular disease, cancer, type 2 diabetes and other conditions. Get simple tips to fight inflammation and stay healthy — from Harvard Medical School experts.

The review revealed that physical therapy plus psychological approaches, such as pain education and cognitive behavioral therapy, more effectively improved chronic low back pain than physical therapy alone.

The study shows the advantages of an interdisciplinary approach to chronic low back pain. Integrating behavioral therapy and physical therapy helped people achieve better function, reduce the cycle of avoidant behavior, and reduce the intensity of their pain.

Like most the B vitamins, B₆ is essential, which means your body can’t synthesize it — you have to get this vital micronutrient from your diet. Are you getting all that your body needs? That’s worth asking, particularly if you’re eating less of certain foods for health or environmental reasons.

If you tasted a new wine variety each week, it would take you 40 years to try them all.

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What B₆ does in your body

Since 2014, the Mornington Peninsula Pinot Noir Rootstock Trial – involving growers from across Greater Victoria – has been comparing the performance of Pinot Noir scions grafted to14 different rootstocks on two commercial vineyards 15 kilometres apart and with more than 100 metres elevation difference. One vineyard is located in a warmer coastal area of the Mornington Peninsula, while the other sits in a cooler more elevated location.

A B₆ deficiency issue?

Vitamin B₆ plays a role in more than 100 enzyme reactions in the body. It helps your body break down protein, carbohydrates, and fats that build muscle, supply energy and fulfill a multitude of essential tasks. Vitamin B₆ also helps

• Keep your immune system working well
• Create important brain-signaling chemicals (neurotransmitters), including serotonin and dopamine
• Make hemoglobin, the protein responsible for carrying oxygen in red blood cells.

At both vineyards, Pinot Noir clone MV6 was grafted to 14 rootstocks with three replicates per treatment and one panel per replicate. Grapevines were also planted on their own roots as a control. 

Every day, about 11 people die from drowning in the United States. Swimming lessons can’t prevent all of those deaths, but they can prevent a lot of them. A child doesn’t need to be able to swim butterfly or do flip turns, but the ability to get back to the surface, float, tread water, and swim to where they can stand or grab onto something can save a life.

10 things parents should know about swimming lessons

That said, swim lessons between 1 and 4 years old can be useful. Not only are some kids simply ready earlier, but younger children can also learn some skills that can be useful if they fall into the water, like getting back to the side of a pool. The teachers should be trained. Again, this sounds obvious — but it’s not always the case.

Flotation devices should be used thoughtfully

Being scared of the water isn’t a reason not to take, or to quit, swimming lessons. It’s common and normal to be afraid of the water, and some children are more afraid than others. While you don’t want to force a child to do something they are terrified of doing, giving up isn’t a good idea either. Start more gradually, with lots of positive reinforcement. The swim teacher should be willing to help.

There is a lot of debate about the use of “bubbles” or other flotation devices to help children learn to swim. They can be very helpful with keeping children safe at the beginning and helping them learn proper positioning and stroke mechanics instead of swimming frantically to stay afloat, but if they are used, the lessons should be designed to gradually decrease any reliance on them.

However, there are no perfect tests for inflammation. And the best way to know if inflammation is present is to have routine medical care. Seeing a primary care physician, reviewing your medical history and any symptoms you have, having a physical examination, and having some basic medical tests are reasonable starting points. Such routine care does not typically include tests for inflammation.

By avoiding triggers of asthma, eczema, or allergic reactions you can reduce the burden of inflammation in your body.

Jone Mark

How is inflammation treated?

At first glance, treating unhealthy, chronic inflammation may seem simple: you take anti-inflammatory medications, right? Actually, there’s much more to it than that.

Anti-inflammatory medicines can be helpful to treat an inflammatory condition. And we have numerous FDA-approved options that are widely available — many in inexpensive generic versions. What’s more, these medicines have been around for decades.

The bottom line

• Jewish Fried Artichoke & Grechetto
• Carbonara & Lazio Bianco
• Garganelli alla Coda & Cesanese

Similarly, among people with rheumatoid arthritis, anti-inflammatory medicines such as ibuprofen or steroids may be a short-term approach that helps ease symptoms, yet joint damage may progress unabated. Controlling the underlying condition with medicines like methotrexate or etanercept can protect the joints and eliminate the need for other anti-inflammatory drugs.

Medicines to reduce inflammation do not solve the problem, aren’t particularly effective, and may cause intolerable side effects. However, treatments available now can cure most cases of chronic hepatitis C. Once completed, there is no need for anti-inflammatory treatment.

• A focus on gratitude for what is going well in my life and for those around me
• Mindfulness and presence at the moment
• Engaging in healthy habits: exercise, good nutrition, and, ideally, sleep (not my specialty!)
• Connection with others, open and honest communication, and empathy, including self-empathy.

The first is overcoming a vicious addiction to prescription painkillers, and the second is training to be a health and wellness coach.

Jone Mark

Unhelpful thinking and why we do it

Additionally, a critical component to attaining the serenity and focus one needs to be a wellness coach, and to move past an addiction, is learning how to recognize and defuse the cognitive distortions that we all employ. Cognitive distortions are internal mental filters or biases that increase our misery, fuel our anxiety, and make us feel bad about ourselves. 

What are unhelpful cognitive distortions?

Finally, many of us engage in emotional reasoning, a process in which our negative feelings about ourselves inform our thoughts, as if they were factually based, in the absence of any facts to support these unpleasant feelings. 

In other words, your emotions and feelings about a situation become your actual view of the situation, regardless of any information to the contrary. Emotional reasoning often employs many of the other cognitive filters to sustain it, such as catastrophizing and disqualifying the positive. Examples of this may be thinking:

• I’m a whale, even if you are losing weight
• I’m an awful student, even if you are getting some good grades
• My partner is cheating on me, even if there is no evidence for this (jealousy is defining your reality)
• Nobody likes me, even if you have friends (loneliness informs your thinking).

A big part of dismantling our cognitive distortions is simply being aware of them and paying attention to how we are framing things to ourselves. Good mental habits are as important as good physical habits. If we frame things in a healthy, positive way, we almost certainly will experience less anxiety and isolation. 

Veganism has become hip, in addition to having potential health benefits, like improved heart health and weight loss, from cutting out animal products and increasing vegetables. 

Understanding your why and motivations

It’s one thing to give up animal products, and that move can lead to health improvements.

Jone Mark

With any kind of change, the stronger and more personal your reason, the more likely you’ll stick with it. When deciding to be a vegan, there can be an ethical and even an emotional component of concern for animal welfare and the environment. Those things mean something to you, and you’re not going to eat, wear, or use any animal products because you consider that inhumane.

But what if better health is your primary reason for going vegan? The elimination of animal products and dairy means a reduction in saturated fats and sodium, which can help with losing weight and/or preventing weight gain, and can reduce the risks of cardiovascular disease, blood cholesterol, and diabetes, Stampfer says.

Planning for pitfalls

• How often do you eat out?
• Do you like to cook?
• Do you like to socialize?
• Do you know anyone else who’s vegan who can give you tips, recipes, vegan-friendly restaurants?

Preparation is key when trying a new way of eating. Find appealing vegan recipes in cookbooks or on websites, or set up a food subscription service, and at the beginning line up two weeks of meals so what you’re going to eat isn’t a constant scramble and daily stress, Rimm says.

None of the answers are disqualifying, but you can identify potential pitfalls and get a handle on how you approach food. And the last question is key, since having support when making a change can help smooth the transition and make you feel less alone in the attempt. “It prepares people for what they’re up against,” Rimm says.

Did you think of Alzheimer’s disease? Good! Alzheimer’s is the most common cause of dementia. Did you also think of vascular dementia or strokes? Excellent! Vascular dementia is the second most common cause. What about the third?

It turns out that about 40% of people with dementia have at least some LATE pathology in their brain. 

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What’s LATE?

In LATE, a protein called TDP-43 (which stands for transactive response DNA binding protein of 43 kDa) accumulates in brain cells. Once it accumulates, it injures and ultimately destroys the cells.

LATE generally damages many of the same areas affected by Alzheimer’s disease. These regions include

• the amygdala, involved in emotional regulation
• the hippocampus, involved in learning and memory
• the temporal lobe, involved in words and their meanings
• portions of the frontal lobes, involved with keeping the information in mind and manipulating it.

What are the symptoms of LATE?

Because LATE affects many of the same brain regions as Alzheimer’s disease, it often presents with similar symptoms, including

• memory loss (impairment in episodic memory)
• trouble finding and understanding words (impairment in semantic memory)
• trouble keeping information in mind (impairment in working memory)

LATE can only be diagnosed with certainty at autopsy. However, we can get a hint that LATE might be present when an older individual shows the memory loss and word-finding problems common in Alzheimer’s disease, but special tests used to confirm the diagnosis of Alzheimer’s come up negative.