By Michael Stanclift, ND

You’re feeling that rush as you catch your stride on your morning run. The air is perfect. Suddenly a cramp or muscle ache stops you dead in your tracks. You try to shake it off, but it just grabs more. Ah!
We still don’t completely understand why muscles tighten up involuntarily. Exercise, pregnancy, electrolyte imbalances, nerve compression, and diminished blood supply to the muscle all may contribute.1,2 So what can we do to combat these harmless but pesky discomforts? In this article we’ll look at what the research says. Surprisingly, some popular natural remedies don’t shine through in the current medical evidence. 

What might not help with cramping
​
Magnesium and Epsom salts:
A Cochrane Review found that oral magnesium wasn’t likely to help with muscle cramps in older people, and the findings were inconsistent in pregnant women.3 A recent randomized, placebo-controlled trial in pregnant women found no difference in leg cramps with magnesium compared to placebo.4
Epsom salt (magnesium sulfate) baths have long been a go-to for muscle relaxation, and “float” centers with sensory deprivation tanks full of the magnesium-rich water have popped up as an urban refuge from the constant stimulation of modern life. A study in nonathletic healthy men found a one-hour float (in magnesium sulfate) after exercise reduced pain perception compared to one hour of passive recovery.5 However, these findings are tough to attribute to magnesium, as the study’s control didn’t match other potentially therapeutic factors, such as body positioning and sensory deprivation.5 So a relaxing bath may help with cramping and muscles, but it’s unclear if adding Epsom salt makes a significant difference.

Active cool-down and static stretching:
Many believe after exercising intensely a period of low-to-moderate intensity will prevent muscle soreness and injuries, but this doesn’t appear to be true.6 A 2018 review found evidence on active cool-downs shows it doesn’t significantly reduce soreness, stiffness, or range of motion and may inhibit muscular glycogen resynthesis (energy storage).6 This same review found that static stretching before or after exercise didn’t reduce muscle soreness.6

What might help with muscle cramping:

​Foam rolling:
This surprisingly simple tool can be valuable if you suffer from muscle soreness and cramps. Using a foam roller after exercise can reduce muscle soreness and improve athletic performance the following day.6 Physical therapists from Harvard agree that 30-120 seconds per area can be helpful in relieving sore muscles and preventing cramps.7

Muscle soreness:

​Tart cherry or pomegranate juice:
A small randomized, double-blind, placebo-controlled trial found 355 ml (~12 oz.) of tart cherry juice drunk twice a day for a week before a 26 km (16-mile) run reduced the amount of pain reported from participants.8 A research review found similar effects from drinking tart cherry juice twice a day, and one study found pomegranate juice reduced soreness.9 But the research on these two drinks in relation to muscle soreness has shown mixed results.9 A recent study compared tart cherry, pomegranate, and placebo drinks to analyze the impact on muscle soreness in nonresistance trained men.10 In this study, the researchers were surprised to find that neither of the fruit drinks appeared to help with muscle soreness when compared to placebo.10

Ginger:
In a small double-blind, randomized, placebo-controlled trial in experienced runners, 5 days of powdered ginger supplementation (1.4 g/day) moderately reduced muscle soreness from a run (on day 3) during the supplement period.11 A review of randomized clinical trials found that consuming up to 4 g of ginger postintense exercise can reduce muscle soreness and improve muscle recovery.12 Lower single dosages of 2 g ginger did not help with muscle soreness when compared to placebo.12 This suggests it may take multiple days or higher doses to get the effect.

Curcumin:
It’s no surprise that curcumin, a bright orange compound from the spice turmeric is making news again. A research review found curcumin in a wide range of doses (150 mg-5,000 mg) can reduce muscle soreness after exercise.13 Curcumin can work when used on an “as needed” basis, with even a single dose (150-200 mg) showing effectiveness for muscle soreness following exercise.13 Interestingly, in this review they found small doses (90 mg twice a day) of curcumin taken for 7 days before exercise had no effect on postexercise soreness, while the same dosage taken after exercise for 4 days was effective.13 Other studies in the review at similar doses did not find curcumin improved muscle soreness compared to placebo, so differences in the trial participants and types of exercise may influence the effects.13

Conclusion:Cramping and muscle soreness can ruin a good exercise session, but they don’t have to. When it comes to combatting these annoying aches, you have numerous options—but beware that some popular natural treatments might be more hype than help.
​
​References:
1. Young G. Leg cramps. BMJ Clin Evid. 2015;2015:1113.
2. Mayo Clinic Staff. Muscle cramps. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/muscle-cramp/symptoms-causes/syc-20350820#:~:text=Overuse%20of%20a%20muscle%2C%20dehydration,Inadequate%20blood%20supply. Accessed February 11, 2021.
3. Garrison SR et al. Magnesium for skeletal muscle cramps. Cochrane Database Syst Rev. 2012;2012(9):CD009402.
4. Araújo CAL et al. Oral magnesium supplementation for leg cramps in pregnancy-An observational controlled trial. PLoS One. 2020;15(1):e0227497.
5. Morgan PM et al. The acute effects of flotation restricted environmental stimulation technique on recovery from maximal eccentric exercise. J Strength Cond Res. 2013;27(12):3467-3474.
6. Van Hooren B et al. Do we need a cool-down after exercise? A narrative review of the psychophysiological effects and the effects on performance, injuries and the long-term adaptive response. Sports Med. 2018;48(7):1575-1595.
7. Harvard Health Staff. Roll away muscle pain. Harvard Health Publishing. https://www.health.harvard.edu/staying-healthy/roll-away-muscle-pain#:~:text=Foam%20rollers%20are%20easy%2Dto,from%20exercise%2C%20and%20reduce%20injury.&text=As%20you%20age%2C%20occasional%20muscle,lightweight%20cylinder%20of%20compressed%20foam. Accessed February 11, 2021.
8. Kuehl KS et al. Efficacy of tart cherry juice in reducing muscle pain during running: a randomized controlled trial. J Int Soc Sports Nutr. 2010;7:17.
9. Bowtell J et al. Fruit-derived polyphenol supplementation for athlete recovery and performance. Sports Med. 2019;49(Suppl 1):3-23.
10. Lamb KL et al. No effect of tart cherry juice or pomegranate juice on recovery from exercise-induced muscle damage in non-resistance trained men. Nutrients. 2019;11(7):1593.
11. Wilson PB. A randomized double-blind trial of ginger root for reducing muscle soreness and improving physical performance recovery among experienced recreational distance runners. J Diet Suppl. 2020;17(2):121-132.
12. Rondanelli M et al. Clinical trials on pain lowering effect of ginger: A narrative review. Phytother Res. 2020;34(11):2843-2856.
13. Yoon WY et al. Curcumin supplementation and delayed onset muscle soreness (DOMS): effects, mechanisms, and practical considerations. Phys Act Nutr. 2020;24(3):39-43.

By Cassie Story, RDN

We are social creatures. Hardwired in our being is the desire to belong, fit in, and play with our fellow humans. In fact, survival depends on our ability to bond.

So what happens to your mental state when you remove yourself from others over the course of a year and a half? While long-term data on the mental health implications of isolation are currently being studied, we do have short-term studies emerging, which evaluated mental health concerns over the past year.

A new phenomenon has occurred for workers who have been utilizing online video platforms for a majority of their day-to-day work. “Zoom fatigue” may have inadvertently activated the fight or flight system within the brain.1 This is according to a recent report from Stanford that offers four potential aspects of Zoom fatigue and the unintended psychological consequences that follow.1

With this knowledge, it is important to recognize the spectrum of emotions that you might be feeling as you prepare to “get back” into the real world—to step out from behind the screen and live life again.

This article identifies common emotions that you may be experiencing, effective mantras for change, and supportive nutrients that can play a role in taking you from feeling blah to rah!

Emotional state: fear & anxietyIt is understandable to have some lingering fear and anxiety about social reentry. Due to our constant connection to news and information, many people have likely experienced some level of fear and anxiety that is atypical for themselves over the past year. It wouldn’t be realistic to expect yourself to go from living in that state of mind, to complete joy and jubilation.
Mantra: I am safe

Supportive nutrients: palmitoylethanolamide (PEA) and hemp

PEA is a bioactive lipid molecule that the body produces naturally and is found in the lipid extracts of foods.2 PEA has been researched for over 70 years and has a wide range of clinical applications from mild bodily discomfort and immune system support to mood and neurological health.2-6

Full-spectrum hemp is sourced from aerial plant parts including the stalk, stems, seed, and flower of the hemp plant and contains beneficial phytocannabinoids and terpenes.
They work together to produce a synergistic effect on the endocannabinoid system, which has been found to support a healthy stress response and has positive neurological benefits.7
Emotional state: stressLoneliness and isolation have been found to increase stress levels in the body.8 Couple that with uncertainty about the future and worry for your own health and wellbeing, as well as that of your friends and family, and this creates a perfect brew for stress to thrive. Are you ready to reclaim your balance?
Mantra: I am at peace

Supportive nutrient: phosphatidylserine

Phosphatidylserine is an important phospholipid in the brain and a key building block of nerve cell membranes.9 Research suggests that it may support mental focus and help support a healthy endocrine response to acute mental stress.10
Emotional state: low self-confidence or decline in body imageFor most people, due in part, to our society’s environmental factors of convenience foods and little built-in day-to-day movement, maintaining health and wellbeing requires routine and planning. Removing ourselves from typical day-to-day activities, and increasing a sedentary lifestyle, may lead to undesired weight gain.
If you have experienced an increase in body weight, first remind yourself, you are not alone. Second, find something about your body to be grateful for right now. Third, speak kindly to yourself.
If you have now found that a majority of your “real life” clothes no longer fit, maybe it is time to implement a supportive weight-loss routine.
Mantra: I am strong (or flexible, sexy, healthy)

Supportive nutrient: meal replacements

Meal replacements are reduced-calorie portion-controlled products often fortified with micronutrients. Studies show that replacing just one or two meals per day with a meal-replacement product produces greater total weight loss, and a greater proportion of participants meet their total weight-loss goals both in the short- and long-term, compared to a low-calorie diet without the use of meal replacements.11
Emotional state: lack of motivationSpending the majority of your time in a seated position, whether the couch or an office chair, can wreak havoc on motivation levels. Going from staring at one screen to the next, between your computer, TV, and phone, can cause a numbness of sorts and lead to lack of desire or motivation to try new things. We are hardwired to want to try new things. Being limited from participating in your favorite activities may have decreased your motivation without your realizing it.
Mantra: I enjoy new experiences

Supportive nutrients: holy basil, ashwagandha, amla fruit

These are a classic blend of Ayurvedic herbs. Holy basil (Ociumum sanctum) leaves and stems contain a variety of compounds including triterpenes (oleanolic and ursolic acid), saponins, flavonoids, and phenols.12 Roots of ashwagandha (Withania somniferum), an herb grown in India, contain withanolides.13 Amla fruit, or Indian gooseberry (Phyllanthus emblica), is rich in vitamin C, a potent antioxidant.14 
Research suggests these adaptogens may support the body in adjusting to various stressful environmental challenges.15 These herbs may help reduce some of the challenges associated with stress.16

Emotional state: excitementPerhaps you are experiencing a different type of emotion than those listed above. Maybe you are excited and “champing at the bit” to get back out into your typical social life. If you feel that you need some calming support because you just cannot wait to get back out there, here are some things to consider:
Mantra: I am calm

Supportive nutrients: folate, magnesium, vitamins B12 and B6

Folate & vitamin B12 are cofactors in the synthesis of neurotransmitters, including serotonin.17-18 Serotonin is associated with mood, sleep, and relaxation.19

Vitamin B6 is a factor in the body’s conversion of glutamate, which is a stimulatory neurotransmitter, into gamma-amino-butyric acid (GABA), which is associated with calming and relaxation.20

Magnesium is an essential mineral and acts as a cofactor in numerous metabolic processes. There is evidence that specific nutrients, such as magnesium, may help to promote muscle relaxation and restfulness—possibly playing a role in reducing daily stress levels.21

Conclusion
However you are feeling in any given moment is okay. As humans, we experience a multitude of emotions that change throughout the day. If you’ve noticed you haven’t felt yourself lately, remind yourself that every day is a new day—filled with opportunities for growth and change. Be kind to yourself, use the mantras within this article or create your own that speak to you and consider adding the supportive nutrients listed above to your routine if you are seeking nutritional support for your emotional state.

References:
1. Bailenson J. Technology, Mind, and Behavior. 2021;2:1.
2. Beggiato S et al. Front Pharmacol. 2019;10:821.
3. PubChem, U.S. National Library of Medicine, National Center for Biotechnology Information. https://pubchem.ncbi.nlm.nih.gov/compound/4671. Accessed September 20, 2019.
4. Passavanti MB et al. Syst Rev. 2019;8(9).
5. Hesselink JM et al. Int J Inflamm. 2019;2013(9).
6. Hesselink JMK. J Pain Res. 2013;6:625–634.
7. Tagne AM et al. Pharmacol Res. 2021:105545.
8. Hwang TJ et al. Int Psychogeriatr. 2020;32(10):1217-1220.
9. Kim H et al. Prog Lipid Res. 2014;56:1-18.
10.Benton D et al. Nutr Neurosci. 2001;4(3):169-178.
11. Heymsfield S et al. Int J Obes Relat Metab Disord. 2003;27(5):537-549.
12. Cohen MM. J Ayurveda Integr Med. 2014;5(4):251-259.
13. Mirjalili MH et al.  Molecules 2009;14:2373–2393.
14. Mindell E. New York, NY, Hachette Book Group, 2011.
15. Panossian AG et al. Med Res Rev. 2021;41(1):630-703.
16. Panossian A. Pharmaceuticals. 2010;3:188-224.
17. NIH Office of Dietary Supplements. Office of Dietary Supplements – Vitamin B12. https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/ . Accessed: August 5, 2021.
18. NIH Office of Dietary Supplements. Office of Dietary Supplements – Folate. https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/ . Accessed: August 5, 2021.
19. Young SN. J Psychiatry Neurosci. 2007;32:394-399.
20. Dakshinamurti K. Adv Nutr Res. 1982;4:143-179.
21. de Baaij JH, et al. Physiol Rev. 2015; 95:1-46.

By Michael Stanclift, ND

Since the 1950s we’ve associated HDL cholesterol with being a positive for our health, and to a large extent, that’s true.1-6 However, more recent studies show us that elevated HDL cholesterol can actually be cause for concern.7,8 So what do we think is going on here? Well, first we have to look at what we’re actually measuring when we look at HDL and why we have assumed that was protective for our cardiovascular systems.
​
For years I taught patients that they can remember the “H” in HDL means that’s the “healthy” cholesterol. While this is mostly a good rule of thumb, the HDL letters actually stand for high-density lipoproteins. High-density lipoproteins are like tiny little garbage trucks that take excess cholesterol out of our system so we can get rid of what we don’t need. And when we measure HDL cholesterol, we’re basically looking at how much “garbage” (cholesterol) is inside those little trucks.

It would make sense that the more garbage we find, the more we would assume the trucks are picking up. Unfortunately, this is making a lot of assumptions based on just one finding. We’re assuming that we have enough garbage trucks, that everything on them is working, and that they’ll be dumping that garbage as soon as they get to the landfill (our livers). As you might suspect, those aren’t always the case. Sometimes our HDL particles contain a lot of cholesterol because there are just not that many little garbage trucks to handle all the cholesterol that needs to be transferred.9 Our HDL garbage trucks may also be loaded with cholesterol because they just aren’t unloading it well, which is akin to them driving around full and not picking up more garbage—not useful.10

So what we really want to know when we look at HDL and use that to predict cardiovascular health, is how much healthy HDL function does the patient have? This has been a tricky measure to pin down, but researchers and laboratories are looking to create tests that will give us a clear indication of healthy HDL function and bring that to us as patients. There are a few advanced tests available that can help give indications of our HDL function, but they still need more refinement.9
You’re probably thinking, “Are there ideal HDL levels? When should I seek more investigation?” We do have some indications of ideal levels that suggest our HDL is likely functioning well.  

​One study found the following ideal HDL ranges:9

• Men: 54-77 mg/dL
• Women: 69-97 mg/dL

If your HDL levels fall within these ranges, it’s likely functioning as it should, protecting your cardiovascular system and cleaning up other various things your body no longer needs.9 These ranges show us that there is likely an upper limit to what is healthy and ideal and that we might need to rethink the “more is always better” axiom we’ve followed for decades.

References:
1. Barr DP et al. Am J Med. 1951;11(4):480-493.
2. Gordon T et al. Am J Med. 1977;62(5):707-714.
3. Castelli WP et al. JAMA. 1986;256(20):2835-2838.
4. Cullen P et al. Circulation. 1997;96(7):2128-2136.
5. Sharrett AR et al. Circulation. 2001;104(10):1108-1113.
6. Di Angelantonio E et al. JAMA. 2009;302(18):1993-2000
7. Madsen CM et al. Eur Heart J. 2017;38:2478-2486
8. Hamer M et al. Arterioscler Thromb Vasc Biol. 2018;38(3):669-672.
9. Khera AV et al. Circulation. 2017;135(25):2494-2504.
10. Hancock-Cerutti W et al. Molecules. 2021;26(22):6862.

Deanna Minich, PhD

Have you ever felt like reaching for the pint of strawberry ice cream after a long day at work?
Or eating potato chips after an argument with a loved one?
Or even craving chocolate when feeling bored or isolated?

If you answered “yes” to any of these questions, you might be “stress eating,” or what is commonly referred to as “emotional eating.” Stress eating is turning to food in times of psychological distress as a form of comfort rather than in response to hunger. Whether it’s stress or a specific emotion, like sadness, we may develop a coping response by eating, either overeating or under-eating. In general, emotional eating involves eating nutrient-poor foods, is often repetitive and automatic, and is not connected to body senses of physical hunger, but to an emotional stimulus.1 Some of us are more prone to being high reactors to stress and may be more vulnerable than others.2
Here’s a quick checklist to see whether you might be engaging in stress eating:

• Am I eating because I’m feeling emotional about something?
• Am I craving food as a reward?
• Am I bored or feeling isolated?
• Am I stressed without feeling in control of my life?
• Am I neglecting my body’s sense of hunger?
• Am I out of touch with my body?
• Am I eating in a way that is automatic and repetitive?

Of course, stress eating may occur periodically throughout your life. It is natural to feel the need to comfort yourself in response to something threatening. Where it becomes problematic is when it becomes cyclical and difficult to escape the eventual feeling of powerlessness, guilt, and shame that can settle in as a result.
Here are some things you can do to break the cycle of stress eating:

1. Be body aware: Practice checking in with your body on a regular basis. Most of us live “in our head” and not in our belly or even down to our toes. When you get the urge to eat, allow yourself to breathe, connect deeply to your body by getting in touch with your sensations through a simple act of focus or movement, like wiggling your toes. Once you are more present, ask yourself whether you need to eat in that moment or if you are responding to an emotion. If you are responding to an emotion, let that feeling fully express. Set an “emotional date” if you can’t express it right there and then, so you come back to it later. You might even find that when you feel an emotion, a specific part of your body responds to let you know, like flushing of your skin or a butterfly-like sensation of unsettledness in the gut. Honor that impulse from the body and either act in the moment or commit to it at a designated time.

1. Exercise your emotional muscle: Most people have lost the language of emotion. When people ask how we are doing, we may give an automatic answer of “fine.” We may even intellectualize or rationalize our emotions to the extent that we make ourselves feel like we should not be having the emotions. Some may believe emotional expression will be perceived as weakness. However, emotions are powerful forces in that they drive our behaviors. It’s been said that we move toward pleasure and away from pain. Therefore, it is best to get in touch with what we are feeling, identify the emotion, and let it flow in healthy ways.3 Emotions can become problematic when we vent them in a volatile way or we repress them inside. The more we can check in with how we are feeling, the better. Try using a log at bedtime to write down key words of how you felt that day. You can also do a quick emotional check-in on your smart phone by looking at the emojis and selecting ones that resemble your feelings. Engage a friend in the check-in process via text during days that are difficult.

1. Develop eating alternatives: Once you begin to get keyed in to how your body is responding and how your emotions are surfacing, you become more aware of your responses and can develop ways to navigate eating situations. If you have the urge to eat, and you know that you are not hungry and that you are feeling emotional, it might be worthwhile to have an alternative ready. Be prepared by making a specific list of at least five healthy things you can do instead of eating. For example, walking outside for 15 minutes in the fresh air, calling a friend and talking for 10 minutes, journaling in a notebook for a few minutes, or even taking a power nap. Removing yourself from the situation and resetting your neurochemistry is one way to rewire and refine your brain so that you can make other choices. Eventually, you’ll come to use different strategies when the need to unnecessarily eat arises.

1. Have healthy foods available: If you get a bout of uncontrollable munchies and can’t seem to replace it with an alternative on your list, aim for foods that you will feel good about eating so you don’t have the guilt that can result from emotional eating. Ideas for healthy foods include a banana with almond butter, a pitted date rolled in coconut, an avocado with sea salt, or vegetable (beet, carrot) chips. As research suggests, eating whole, plant-based foods, such as more fruits and vegetables, is associated with a greater sense of well being, creativity, curiosity, and even happiness.4 On the other hand, eating fast food and drinking sugar-sweetened beverages is associated with risk for depression.5,6 Help offset your roller coaster moods by selecting colorful foods!

1. Ensure your body has enough nutrients: Our brain chemistry can be affected by the nutrients in our diet. For example, the production of neurotransmitters like dopamine, serotonin, and GABA, which all play a role in stress response, are determined by nutrients available to the body, including certain amino acids, vitamins (e.g., vitamin C and B complex), and minerals (e.g., magnesium).7-13 Stress tends to drain our body of these precious reserves, and, as a result, we may end up with imbalanced neurochemistry.14 Therefore, it’s essential to look at what is essential for a healthy diet and incorporate foods and dietary supplements to meet daily nutrient requirements.

Stress eating can be a challenging cycle to break. There are several ways to address the cycle, whether through body awareness, emotional expression, alternative options, better choices, or simply, brain chemistry balance through nutrient sufficiency. Try out a variety of these approaches to see if you feel more empowered in your eating in times of distress.
​
References:

1. Nguyen-Michel ST et al. Dietary correlates of emotional eating in adolescence. Appetite. 2007;49(2):494-499.
2. Newman E et al. Daily hassles and eating behaviour: The role of cortisol reactivity status. Psychoneuroendocrinology. 2007;32(2):125-132.
3. Whiteside U et al. Difficulties regulating emotions: Do binge eaters have fewer strategies to modulate and tolerate negative affect? Eating Behaviors. 2007;8(2):162-169.
4. Mujcic R et al. Evolution of well-being and happiness after increases in consumption of fruit and vegetables. Am J Public Health. 2016;106(8):1504-1510.
5. Huang Q et al. Linking what we eat to our mood: A review of diet, dietary antioxidants, and depression. Antioxidants (Basel). 2019;8(9).
6. Sánchez-Villegas A et al. Fast-food and commercial baked goods consumption and the risk of depression. Public Health Nutr. 2012;15(3):424-432.
7. Fernstrom JD. Effects on the diet on brain neurotransmitters. Metabolism. 1977;26(2):207-223.
8. Wurtman RJ et al. Control of brain monoamine synthesis by diet and plasma amino acids. Am J Clin Nutr. 1975;28(6):638-647.
9. Meredith ME et al. Regulation of embryonic neurotransmitter and tyrosine hydroxylase protein levels by ascorbic acid. Brain Res. 2013;1539:7-14.
10. Linus Pauling Institute. Cognitive function in depth. https://lpi.oregonstate.edu/mic/health-disease/cognitive-function. Accessed March 26, 2020.
11. Harrison FE et al. Vitamin C function in the brain: Vital role of the ascorbate transporter (SVCT2). Free Radic Biol Med. 2009;46(6):719-730.
12. Mehrotra R et al. Nutrition and anemia in end-stage renal disease. 2013. https://www.sciencedirect.com/topics/neuroscience/pyridoxine. Accessed March 26, 2020.
13. Cuciureanu MD et al. Magnesium and stress.https://www.ncbi.nlm.nih.gov/books/NBK507250/. Accessed March 26, 2020.
14. Singh K. Nutrient and stress management. J Nutr Food Sci. 2016;6:528.