Feeling more happy after a run? Or feeling a bit blue during the dark winter days? Regular exercising and regular daylight exposure can influence your mood, behaviour and sleep-wake cycle 1,2,3. But can this also be used in a therapeutical setting, for instance in addition to or instead of the usual treatment with medication?

The PROUD trial aims to investigate the potential of bright light therapy and physical exercise to improve and prevent depression and obesity in adolescents and young adults with ADHD. This clinical trial is part of the CoCA research project, in which comorbid conditions of ADHD are investigated [insert hyperlink: https://coca-project.eu/coca-phase-iia-trial/study/]. In addition, we collect the stool samples of all participants in order to investigate the effects of physical exercise on the gut microbiome and how this is linked to behaviour. That part of the study is part of the Eat2beNICE research project.

Most people with Attention Deficit Hyperactivity Disorder (ADHD) receive medication to reduce their symptoms4. While this medication works well for many people, there is a lot of interest in other types of treatment. One reason for this is that people with ADHD suffer from additional conditions, such as depression5 and obesity6. The risk for developing these comorbid conditions is especially high during adolescence and young adulthood4.

Adolescents and young adults (age 14-45) with ADHD that want to participate are randomly assigned to one of three groups: 10-weeks of daily light therapy (30 minutes), 10-weeks of daily physical exercise (3x per day) or 10-week care as usual (for instance, the normal medication). The random assignment is very important here in order to compare the different interventions. We don’t want to have all people that like sports in the physical exercise group, because then we don’t know if the effects of the physical exercise are due to the intervention, or due to the fact that these people just like sports better.

Another nice feature of the study is that it uses a phone app (called m-Health). This app is used to remind the participants to do their exercise or light therapy, but it also gives feedback and summaries of how the participant is doing. The app is linked to a wrist sensor that measures activity and light.

The clinical trial is currently ongoing in London (England), Nijmegen (Netherlands), Frankfurt (Germany) and Barcelona (Spain). We can’t look at the results until the end of the trial, so for those we will need to wait until 2021. But in the mean time the PROUD-researchers have interviewed four participants. You can read these interviews here:

This blog is based on the blog “10 weeks of physical exercise or light therapy: what’s it like to participate in our clinical trial?” by Jutta Mayer and Adam Pawley, 9 Oct. 2018 on MiND the Gap – https://mind-the-gap.live/2018/10/09/10-weeks-of-physical-exercise-or-light-therapy/

REFERENCES

  1. Terman, M. Evolving applications of light therapy. Sleep Medicine Reviews. 2007; 11(6): 497-507.
  2. Stanton, R. & Reaburn, P. Exercise and the treatment of depression: A review of the exercise program variables. Journal of Science and Medicine in Sport. 2014; 17(2):177-182
  3. Youngstedt, S.D. Effects of exercise on sleep. Clinical Sports Medicine. 2005; 24(2):355-365.
  4. Cortese S, Adamo N, Del Giovane C, Mohr-Jensen C, Hayes AJ, Carucci S, et al. Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis. Lancet Psychiatry. 2018;5(9):727-738.
  5. Jacob CP, Romanos J, Dempfle A, Heine M, Windemuth-Kieselbach C, Kruse A, et al. Co-morbidity of adult attention-deficit/hyperactivity disorder with focus on personality traits and related disorders in a tertiary referral center. Eur Arch Psychiatry Clin Neurosci. 2007;257:309–17.
  6. Cortese S, Moreira-Maia CR, St Fleur D, Morcillo-Penalver C, Rohde LA, Faraone SV. Association between ADHD and obesity: a systematic review and meta-analysis. Am J Psychiatry. 2016;173:34–43.
  7. Meinzer MC, Lewinsohn PM, Pettit JW, Seeley JR, Gau JM, Chronis-Tuscano A, et al. Attention-deficit/hyperactivity disorder in adolescence predicts onset of major depressive disorder through early adulthood. Depress Anxiety. 2013;30:546–53
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Yoga practice has become very popular in the last two centuries. In most western countries, yoga studios are booming. For example, Dutch practitioners are said to spent 325 million euros per year on yoga classes, clothes and events.

In scientific research, yoga and its beneficial effects on physical and mental health, have also become a serious topic of interest. In a previous post, Hannah Kurts had already outlined the positive effects of yoga for several psychiatric disorders (https://newbrainnutrition.com/how-to-help-mental-health-with-yoga/)

Recently, the effects of yoga on cognitive performance and behavioral problems in 5-year old children have been examined. A group of Tunisian researchers offered 5-year old children in kindergarten a 12-week yoga program, regular physical education, or no kind of physical activities.

They found that this kind of kindergarten-based yoga practice, had significant positive effects on visual attention, visuo-motor precision and symptoms of hyperactivity and impulsivity, in comparison to regular physical activities or no physical activities [1].

One might wonder: Quiet and peaceful yoga exercises with a bunch of energetic 5-year olds? How would that even work?

The yoga they offered in this project was a 30-minute routine, instead of a more regular 90-min session: 5 minutes of warming up, doing jogging, jumping, stretching. Next, 15 minutes of the well-known yoga postures, standing, sitting, flexing. Next, 5 minutes of breathing techniques and lastly, 5 minutes of yogic games, to train memory, awareness and creativity. And they practiced only twice a week.

It seems very promising that such a curtailed version of yoga practice can have positive effects on attention, executive functions, and behavioral control, which are all skills that are vital to good academic performance [2][3].

In some European and North-American countries, the idea of school-based yoga practice isn’t so revolutionary anymore. France, Italy, Brazil, and Canada have recognized yoga practice in its school curriculum. Italy seems to be the school-yoga champion: Classroom-based yoga is performed in all Italian schools since 2000 [4].

REFERENCES
[1] Jarraya S, Wagner M, Jarraya M and Engel FA (2019) 12 Weeks of Kindergarten-Based Yoga Practice Increases Visual Attention, Visual-Motor Precision and Decreases Behavior of Inattention and Hyperactivity in 5-Year-Old Children. Front. Psychol. 10:796. doi: 10.3389/fpsyg.2019.00796

[2] Chaya, M. S., Nagendra, H., Selvam, S., Kurpad, A., and Srinivasan, K. (2012). Effect of yoga on cognitive abilities in schoolchildren from a socioeconomically disadvantaged background: a randomized controlled study. J. Altern. Complement. Med. 18, 1161–1167. doi: 10.1089/acm. 2011.0579

[3] Verma, A., Uddhav, S., Ghanshyam Thakur, S., Devarao, D., Ranjit, K., and Bhogal, S. (2014). The effect of yoga practices on cognitive development in rural residential school children in India. Natl. J. Lab. Med. 3, 15–19.

[4] Flak, M. (2003). Recherche Sur Le Yoga Dans L’éducation. 3ème Millénaire: Spiritualité – Connaissance De Soi – Non-Dualité – Méditation, 125. Available at: http://www.rye-yoga.fr/ (accessed July 15, 2018).

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The popularity of yoga practice has risen sharply in recent years. In 2006, already 2.6 million people in Germany practiced yoga regularly (1). The arguments for yoga are widely spread in the population, for example the energy and immune function are increased and back pain, arthritis and stress are relieved (2). For others, the practice of yoga is an important factor in doing something good for themselves, while for others the discipline and control of the body is more in focus.

But, where does yoga come from?
The yoga tradition originates from India, the religion of Buddhism, and has a philosophical background with original roots reaching back over 2000 to 5000 years. The term “yoga” comes from the word “yui”, which has its origin in Sanskrit, a very ancient Indian language, and means “unite”. Accordingly, yoga refers to the union of body, mind and soul (3).

What exactly does a yoga practice involve?
In western countries the focus is especially on the Asana practice, the postures. The postures can be lying, sitting or standing and should be performed as attentively as possible. All Asanas have associated Sanskrit names and also pictorial names such as the Cobra (Bhujangasana) or the down looking dog (Adho Mukha Svanasana). Further essential elements are the breathing techniques (Pranayama), where the breath is consciously directed (e.g. Kapalabathi, alternative breathing) and the meditation (Dhyana), where the mind is consciously directed, by calming down, insight can be attained and a state of deep relaxation can be achieved.

But, can yoga really have a positive effect on mental and physical health?
In view of the study and literature available, YES! A meta-analysis results that yoga is effective as a complementary treatment for psychiatric disorders such as schizophrenia, depression, anxiety, and posttraumatic stress disorder (4).

Yoga can have a positive influence on the reduction of depression symptoms, the reduction of stress and anxiety, and can lead to an increase in self-love, awareness and life satisfaction (5, 6). On the physiological level, the results can also be found in the reduction of the stress hormone cortisol (7).

In the case of anxiety disorders, relaxation is a central component of yoga practice. Clients lack confidence, courage and stability, so that autogenic training, progressive muscle relaxation and deep relaxation can be beneficial.

In the presence of eating disorders, yoga can make an important contribution to increasing body satisfaction, awareness and receptivity as well as reducing self-objectivity and psychological symptoms (8). Prevention programs with concentration on yoga appear promising, as body satisfaction and social self-concept have been increased and bulimic symptoms reduced.

Conclusion: The integration into the health system for prevention and complementary therapy seems to be reasonable and as Mind Body Therapy, integrated into the treatment concept, positive effects on mental health can be achieved. In addition to body awareness, yoga concentrates on personal awareness and self-love and has an effect on the emotional, mental, cognitive and physical body levels. The yoga classes can be specifically adapted to the needs of the participants and can be set up in a disorder-specific way.

Advantages of yoga as a complementary therapy:
– Lower costs
– At the same time positive effect on the body
– No side effects
– Preventive and therapeutic support
– Less time required
– New contacts

What do you need to consider?
1. Choice of Yoga-Studio (atmosphere, costs, course offers)
2. Yoga teacher (e.g. education of teacher, authentic)
3. Yoga style (discover your preference, adapt to your daily state, examples follow)

– Vinyasa = flowing asanas, activating, breath and asanas in harmony
– Hatha = origin, breathing exercises, meditation, gentle asanas
– Ashtanga = powerful, always constant flowing sequences, condition
– Yin = relaxing, longer lasting asanas, calm, passive
– Acro Yoga = combination of acrobatics and yoga
– Kundalini = spiritual, mantras singing, meditation, energies

REFERENCES

  1. Klatte, R., Pabst, S., Beelmann, A. & Rosendahl, J. S. (2016). The efficacy of body-oriented yoga in mental disorders. Deutsches Arzteblatt international, 113 (20), 359. https://doi.org/10.3238/arztebl.2016.0195.
  2. Cramer, H., Ward, L., Steel, A., Lauche, R., Dobos, G. & Zhang, Y. (2016). Prevalence, Patterns, and Predictors of Yoga Use: Results of a U.S. Nationally Representative Survey. American journal of preventive medicine, 50 (2), 230–235.
  3. Jaquemart, P. & Elkefi, S. (1995). Yoga als Therapie. Lehrbuch für die Arzt und Naturheilpraxis. Augsburg: Weltbild Verlag.
  4. Cabral P, Meyer HB, Ames D. (2011). Effectiveness of yoga therapy as a complementary treatment for major psychiatric disorders: A meta-analysis. Prim Care Companion CNS Disord. 2011;13:pii: PCC10r01068.
  5. Ponte, S. B., Lino, C., Tavares, B., Amaral, B., Bettencourt, A. L., Nunes, T. et al. (2019). Yoga in primary health care. A quasi-experimental study to access the effects on quality of life and psychological distress. Complementary therapies in clinical practice, 34, 1–7. https://doi.org/10.1016/j.ctcp.2018.10.012
  6. Snaith, N., Schultz, T., Proeve, M. & Rasmussen, P. (2018). Mindfulness, self-compassion, anxiety and depression measures in South Australian yoga participants: implications for designing a yoga intervention. Complementary therapies in clinical practice, 32, 92–99. https://doi.org/10.1016/j.ctcp.2018.05.009
  7. Bershadsky, S., Trumpfheller, L., Kimble, H. B., Pipaloff, D. & Yim, I. S. (2014). The effect of prenatal Hatha yoga on affect, cortisol and depressive symptoms. Complementary therapies in clinical practice, 20 (2), 106–113. https://doi.org/10.1016/j.ctcp.2014.01.002
  8. Neumark-Sztainer, D. (2014). Yoga and eating disorders: is there a place for yoga in the prevention and treatment of eating disorders and disordered eating behaviours? Advances in eating disorders (Abingdon, England ), 2 (2), 136 145. https://doi.org/10.1080/21662630.2013.862369

 

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Why do some people have a higher craving for carbohydrate-rich and junk-food than others? Why are weight-loss programs more effective in some individuals than others? And why are some people more physically active?

The dopamine system in the brain plays an important role in regulating how much you eat and whether or not you gain weight. When this system does not function optimally, people have a higher craving for junk-food, lower physical activity, and unsuccessful body weight control.

There are two mechanisms that determine food-related behaviour.

The more direct, homeostatic, mechanism constantly surveys the body’s energetic needs and holds them actively in balance. That is homeo-stasis.

The second non-homeostatic mechanism determines the way humans, and other animals, react to food: how willingly and often they will consume it again, and whether they feel anticipation or craving for it.

These behaviours are both largely regulated by the neurotransmitter dopamine, a chemical that conveys information in the brain. Once released by one nerve cell it binds to a receptor, a large molecule on the surface of the adjacent nerve cell, thus changing its functioning. A major component in eating-related behaviour is the dopaminergic D2 receptor (DRD2) that is most abundantly localized in striatum, a brain region activated by food anticipation and consumption1.

The function of the dopaminergic system affects eating and weight-related problems in four ways.

First, in some people, the dopamine system reacts more vigorously in response to food.

Second, this response leads to increased eating and possibly obesity.

Third, overeating and obesity lead to less efficient dopaminergic signaling.

Fourth, this lower dopaminergic signal needs to be compensated by more intense behaviour e.g., more eating2.

For example, in people with lower levels of dopamine D2 receptor, cravings for carbohydrate-rich food and junk-food are more prevalent3,4.

Besides eating-related behaviour, dopamine also affects health/obesity via voluntary physical activity, creating a vicious circle: obesity leads to weaker dopaminergic signal, especially lower levels of DRD2 receptor, and this, in turn, leads to decreased exercise and motivation for physical activity5–7.

Furthermore, individuals with lower levels of DRD2 receptors may benefit less from long-term weight loss programs and are less effective in weight maintenance8,9. Thus, dopamine affects body weight via choice of foods, physical activity, and body weight reduction efficacy. Despite the reasons for food-cravings, part of the solution is acknowledging and managing these impulses. Conscious action towards weight-reduction will lead to less pronounced food-cravings, which in turn leads to favourable solution of weight related problems10.

REFERENCES
1. Wise, R.A. Philos Trans R Soc Lond B Biol Sci 361, 1149–1158 (2006).
2. Alonso-Alonso, M. et al. Nutrition reviews 73, 296–307 (2015).
3. Lek, F.-Y., Ong, H.-H. & Say, Y.-H. Asia Pac J Clin Nutr 27, 707–717 (2018).
4. Yeh, J. et al. Asia Pac J Clin Nutr 25, 424–429 (2016).
5. Kravitz, A.V., O’Neal, T.J. & Friend, D.M. Front Hum Neurosci 10, 514–514 (2016).
6. Matikainen-Ankney, B.A. & Kravitz, A.V. Ann N Y Acad Sci 1428, 221–239 (2018).
7. Ruegsegger, G.N. & Booth, F.W. Front Endocrinol 8, 109–109 (2017).
8. Roth, C.L., Hinney, A., Schur, E.A., Elfers, C.T. & Reinehr, T. BMC Pediatr 13, 197–197 (2013).
9. Winkler, J.K. et al. Nutrition 28, 996–1001 (2012).
10. Smithson, E.F. & Hill, A.J. Eur J Clin Nutr 71, 625 (2016).

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Cigarette smoking may give immediate pleasure but is dangerous for your health. Smoking may be seen as a way to deal with feelings like anxiety and stress and may be viewed as a way of coping with everyday life. Smoking a cigarette may also be used as a reward, and as part of a celebration of big and small victories. But what happens to your mental well-being if you quit smoking?

Smoke cessation is one of the best things, if not the best, you can do for your health! Smoking is ranked as the second leading cause of death by a body called “the Global Burden of Disease 2017 Risk Factor Collaborators”.1 Quitting smoking lowers your risk of cardiovascular diseases and your risk of cancer. 2 But does this come at a price concerning your mental health – how is that impacted by quitting smoking?

A systematic review of 26 studies assessing mental health before and after smoking cessation found that quitting was associated with mental health benefits. 3 Assessment of mental health were made both in the general population and in clinical populations, including persons with physical or psychiatric conditions. In the included studies, the assessment of mental status at least 6 weeks after cessation was compared with the baseline assessment. Smoking cessation was associated with improvements in levels of anxiety, depression, stress and psychological quality of life. The authors point to clinicians to recommend smoking cessation interventions also among smokers with mental health problems.

There are several aides to be used by smoke quitters. These span from brief advice to nicotine replacement therapy. How do you get help for smoking cessation? Talk to your doctor about it! And don’t give up if you fail at a quit attempt! Each attempt will bring you closer to the status “former smoker”.

REFERENCES:

  1. Collaborators GBDRF. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018;392:1923-94.
  2. https://www.who.int/tobacco/quitting/benefits/en/
  3. Taylor G, McNeill A, Girling A, Farley A, Lindson-Hawley N, Aveyard P. Change in mental health after smoking cessation: systematic review and meta-analysis. BMJ 2014;348:g1151. https://www.bmj.com/content/348/bmj.g1151

 

 

 

 

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The food choices we make, how much we exercise and the amount of body fat we have affects our health already at a young age. Although seemingly healthy, our metabolism might tell a different story. This can already be seen at a young age.

The Estonian Children Personality Behaviour and Health Study (ECPBHS) started 20 years ago in 1998 and has since measured the participants’ body composition and assessed their metabolic abnormalities, such as insulin resistance and metabolic syndrome, at ages 15, 18, 25 and 33 years.

Insulin resistance is a state in which the body does not respond to normal levels of insulin efficiently, eventually causing a rise in blood sugar levels. It has been proposed that insulin resistance has a role in the development of several metabolic abnormalities what we know as metabolic syndrome1. These metabolic abnormalities include a large waistline (abdominal obesity), high levels of certain types of fat in the blood called triglycerides, a low level of HDL cholesterol, high blood pressure or usage of blood pressure medication and elevated fasting blood sugar levels or type 2 diabetes diagnosis2.

We have found that already at age 25, individuals who consumed more than 300 milligrams of cholesterol per day and had more than 4 hours of screen time were at higher risk of components of metabolic syndrome3. Insulin resistance was associated with male gender3,4, overweight and obesity, low physical activity levels and the consumption of lipids above the recommended daily energy intake*4. Individuals who consumed carbohydrates below the recommended daily energy intake*, were less likely to be insulin resistant. Already at age 25, insulin resistant individuals had higher serum cholesterol, lower HDL cholesterol, and higher triglyceride levels, fasting blood sugar and insulin levels. People who were overweight also had 4 times higher odds of insulin resistance and being obese increased the odds 12 times if compared to normal weight individuals4. From 15 to 25 years the occurrence of components of metabolic syndrome increased rapidly. At age 15 years 18% of participants had one or more metabolic abnormality and by age 25 years the number had doubled, whereas 5% already had metabolic syndrome.3 Individuals who were insulin resistant were more likely to have metabolic syndrome.4

Insulin resistance and the metabolic syndrome are risk factors for type 2 diabetes and cardiovascular disease later in life1. As we observed, one fifth of the adolescents already have at least one metabolic abnormality and the number of components of metabolic syndrome increases from adolescence to young adulthood. That is why it is important that healthy lifestyle habits should be introduced and encouraged already in early childhood. Although young people may seem to be healthy, the first signs of developing metabolic abnormalities may already be there.

*According to the Estonian nutrition and physical activity recommendations (2015), the recommended consumption of macronutrients from daily energy intake (E%) is as following: proteins 10–20%, lipids 25–35%, carbohydrates 50–60%5.

Written by:
Urmeli Joost, MSc is a PhD student at the Institute of Family Medicine and Public Health, University of Tartu, Estonia. Her main focus of research is the genetic, environmental and behavioural factors in obesity, dyslipidemia and glucose metabolism.

Inga Villa, MD, PhD is a Lecturer in Health Promotion at the Institute of Family Medicine and Public Health, University of Tartu, Estonia. Her main focus of research is nutrition, physical activity and sociocultural factors on health status and body composition.

REFERENCES
1. Xu, H., Li, X., Adams, H., Kubena, K. & Guo, S. Etiology of Metabolic Syndrome and Dietary Intervention. Int J Mol Sci 20, (2018).

2. Alberti, K. G. M. M. et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 120, 1640–1645 (2009).

3. Taimur, T. Metaboolse sündroomi komponentide levimus ja seosed toitumisega noorukieast täiskasvanueani. Tartu: Tartu Ülikooli peremeditsiini ja rahvatervishoiu instituut; 2018.

4. Joost U. Insuliinresistentsuse seosed elustiiliharjumustega noortel täiskasvanutel Eestis [masters thesis]. Tartu: Tartu Ülikooli tervishoiu instituut; 2015.

5. Pitsi, et al. Eesti toitumis- ja liikumissoovitused 2015. Tervise Arengu Instituut. Tallinn, 2017.

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Download your FREE REPORT

How do you eat in a healthy fashion?  Anne Siegl, PhD writes that a big part about eating healthy is nutritional diversity.  Not eating the same thing every day, but providing your body with a rich variety of all kinds of foods and nutrients.  Part of our objective is to keep our gut happy, because our gut drives so much of our health.  And we are discovering that the gut is in continual high-speed two-way communication with the brain.  If the bacteria (microbiota) in your gut are happy, you will lead a more healthy physical life, and we are learning, a more healthy mental life as well.  We are one organism, and it’s all connected.  Keep your gut microbiota healthy with a varied diet.

Download this important report today.

 

 

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Every child knows: sugar is bad for the teeth. Nutrition with a high amount of sugar does not only put you at a risk of dental cavities but also affects your physical and mental health, mood and memory.

Sick? Current researches associate sugar consumption with overweight and obesity, which increases the risk of various subsequent illnesses: diabetes type 2, cardiovascular diseases (risk for stroke and heart attack), dementia and cancer. (1)

Sad? In a study on patients with diabetes type 2 the level of blood sugar was manipulated. When the blood glucose was elevated (> 16,5 mmol/l) participants had a reduced energetic arousal and felt more sadness and anxiety (2).

Stupid? In a study on healthy adults memory skills and blood sugar levels were measured. Participants with higher blood sugar levels showed worse memory performance than adults with lower glucose levels. This difference was mediated by structural changes in the brain (3). Another study found that high blood sugar levels within the normal range (> 6.1 mmol) were associated with 6-10% loss in brain volume. The loss effected hippocampus and amygdala -areas that are important for learning, memory and cognitive skills (4).

The WHO recommends the intake of less than 10% or even better less than 5% free sugars of the daily total energy intake. For an adult that means less than 25 grams (6 teaspoons) per day (5). The problem is: there is a high amount of sugar in products where we don’t expect it.

So here are some tips to avoid sugar:
1. Pay attention to the ingredients list: There are many names to cover the total amount of contained sugar in products. Everything ending with “-ose” or “syrup” is sugar. The position on the list indicates the relative amount of a compound, so producers often mix different sugars in order to “hide” them at the end of the ingredients list. In “light” products the missing fat is often replaced by sugar. Better base your nutrition on staple foods like whole-grain food, fruits and vegetables to avoid hunger pangs as a response to changes in blood sugar level.
2. Avoid ready-made products such as pizza, sauces, soups or ketchup. You might be surprised how much sugar they contain! Also, many cereals and yoghurts contain high amounts of sugar. Prepare it yourself: Use unsweetened yoghurt and add your favourite fruits.
3. Step by step: Reduce your sugar intake slowly to be successful in the long term. For example, day by day put a bit less sugar into your coffee to get used to it.
4. Save on baking sugar: Just use less than stated in the recipe – it tastes just as good.
5. Replace sugary drinks with water or unsweetened teas. Add lemon, mint or pieces of fruit to your water.
6. Make it something special: If you don´t buy sweets you will be less tempted by them. It may be a good rule to eat cake and cookies only on special days or with friends.
7. Size does count: A small treat, when eaten attentive, will satisfy you better than the whole chocolate bar you consume while being absorbed by reading the newspaper, watching a movie, or driving your car.
8. Avoid sugar substitutes: Honey, agave syrup and fruit extract, etc have the same effects as refined sugars. It’s healthier to get used to less sweetness.
9. Experiment with spices: Instead of sugar, spices such as cinnamon, vanilla or cardamom can enhance flavor.
10. Eat fruits: Satisfy your sweet tooth with fruits instead of sugar.
Get to know the natural taste of your food 😊

Shortened version:
1. Pay attention to the ingredients list: Everything ending with “-ose” or “syrup” is sugar. In “light” products the missing fat is often replaced by sugar.
2. Avoid ready-made products such as pizza, sauces, soups or ketchup. Also, some cereals and yoghurts contain a relatively high amount of sugar.
3. Save on baking sugar: just use less than stated in the recipe – it tastes just as good.
4. Replace sugary drinks with water or unsweetened teas. Add lemon, mint or fruits to your water.
5. Avoid sugar substitutes: Honey, agave syrup and fruit extract, etc have the same effects as refined sugars. It’s healthier to get used to less sugar.
Get to know the natural taste of your food 😊

REFERENCES:
(1) Stanhope K. L. (2016). Sugar consumption, metabolic disease and obesity: The state of the controversy. Crit Rev Clin Lab Sci, 53(1): 52-67. doi: 10.3109/10408363.2015.1084990.

(2) Sommerfield, A. J., Deary I. J. & Frier, B. M. (2004). Acute Hyperglycemia Alters Mood State and Impairs Cognitive Performance in People With Type 2 Diabetes. Diabetes Care, 27: 2335–2340.
doi: 10.2337/diacare.27.10.2335.

(3) Kerti, L., Witte, A. V., Winkler, A., Grittner, U., Rujescu, D. & Flöel, A. (2013). Higher glucose levels associated with lower memory and reduced hippocampal microstructure. Neurology, 81 (20), 1746- 1752.
doi: 10.1212/01.wnl.0000435561.00234.ee.

(4) Cherbuin, N., Sachdev, P. &Anstey, K. J. (2912). Higher normal fasting plasma glucose is associated with hippocampal atrophy: The PATH Study. Neurology, 79 (10): 1019- 1026.
doi: 10.1212/WNL.0b013e31826846de.

(5) WHO Library Cataloguing-in-Publication Data (2015). Guideline: Sugar intake for adults and children. World Health Organization.
Retrieved from: http://apps.who.int/iris/bitstream/handle/10665/149782/9789241549028_eng.pdf;jsessionid=3F96BB43E2B34C12341B1EB60F035587?sequence=1.

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Dry January, a phenomenon that started in Scandinavia and has now gained more popularity in other parts of Europe. During “Dry January” people challenge themselves to temporary abstinence from alcohol for one month, in order to detox their bodies after the holiday season. The media states that one-month alcohol abstinence has a beneficial effect on your sleep pattern, alertness, mood, weight, skin, and your liver. Because I am currently participating in Dry January I was wondering if the results of alcohol abstinence for a short period of time are studied, and what these results might be.

Before we can understand what beneficial effects a month without alcohol can have, we need to know what alcohol does to our body. Alcohol has, amongst other things, an influence on our liver and on our mental health. When we consume alcohol, a part of the brain that is related to reward becomes active: the striatum. Also, dopamine is released which has an influence on feelings of reward and the control of impulsive behaviour. While the striatum is activated, the prefrontal cortex is inhibited which regulates impulses and emotion regulation.

When we consume an alcoholic beverage, the alcohol is absorbed in our blood which in turn is filtered by our liver. Alcohol damages the liver by stimulating the liver cells, which causes them to die. This leads to scarring of liver cells (fibrosis) and to shrinkage of the liver itself (cirrose). People with liver cirrose have a higher chance of developing liver cancer. The positive part of this story is the self-recovery function of our liver. Your liver can recover for up to 70% if you put aside alcohol for at least one month.

Researchers from the RadboudUMC1 in Nijmegen (2017) and the University of Sussex2 (2015) studied voluntarily temporary abstinence from alcohol to gain more insight in the effects of alcohol abstinence and alcohol use after Dry January and to gain more insight in the possibility of health-related benefits.

After going for a month without alcohol, 62% of the people reported better sleep and more energy2 and 57% had more concentration. Also, alertness was tested: participants who drank alcohol showed more impulsivity and were, therefore, quicker, but made more mistakes. After Dry January these participants reacted slightly slower but more accurate.

Also, various health-related benefits were reported: less liver cells were stimulated (2) or died (1), 54% had better skin and 70% had generally improved health (2). Also a reduction in belly fat was measured (1), this can be explained by the process in which the body breaks down fat cells, this process is slowed down by alcohol. Besides, the lowering of belly fat is also a result of a reduction of calorie intake (one glass of wine, for instance, has 82 kcal). Another quite important benefit: 88% of the participants saved money (2).

Before these studies, there was some negative criticism against Dry January. Professionals were scared that people would experience a rebound effect after the dry month, resulting in more alcohol consumption. However, the results reveal the opposite: one month of alcohol abstinence led to less alcohol consumption in the following six months (2). Saying “No” to alcohol for a month created an awareness about the effects of alcohol and the participants gained insight into their drinking behaviour (2).

Taken together it seems that quitting alcohol, even for a short period of time, has lots of beneficial effects. No reason to not try a dry month this year!

REFERENCES
1. Munsterman, I. Tjwa, E., Schellekens A. (2017). “Lever rust uit van een maand niet drinken”. https://dekennisvannu.nl/site/special/Een-maand-zonder-alcohol/82

2. De Visser, R.O., Robinson, E., Bond, R. (2016) Voluntary temporary abstinence from alcohol during “Dry January” and subsequent alcohol use. Health Psychology, Vol 35(3), 281-289

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Whenever I ask my patients, if they are eating their “5 a day”, the immediate answer is “Yes, sure”. However, sometimes I´m not sure if their “Yes, sure” belongs to their real eating behavior or if it is more like wishful thinking. This question applies for a broad range of behavior, like taking the stairs instead of the elevator, having enough sleep, walking the 10.000 steps a day etc.. But how can we be sure what people really do in their everyday life?

The answer is: Ambulatory Assessment

Ambulatory Assessment is the state of the art method for assessing current emotional states, feelings, and behavior in the natural environment of an individual’s everyday life. Equipped with smartphones and accelerometers, it is feasible to track how individuals feel at specific moments, what they are eating across a day and how they physically behave in real time and real life. Electronic e-diaries, provided by an App, prompt individuals whenever an event occur or randomly several times a day. Especially in patient groups with attention deficits, prompting short questionnaires several times a day show better recall than an extensive end-of-day questionnaire.

In the past, food-diaries were based on unhandy and retrospective paper-pencil-questionnaires or computer input. Nowadays, new technological opportunities pave the way to e-food-diaries on smartphones, enabling an immediate and flexible input capability. The design of e-food-diary-apps may be different, i.e., by photos, drop-down-menu, text, or voice records. Important is the documentation of what and how much the participants eat and drink and a database that can be connected to an international or national food code for data analysis.

In the Eat2beNICE research project, we assess food intake every time participants eat or drink by a drop-down-menu that leads from general to very detailed food-items and asks for general meal portions and amounts every time participants eat and drink across the day. If a participant cannot find a particular food-item, he or she has the opportunity to enter a free text message or to record a voice message. If participants forget to enter some foods and drinks across the day, they will receive a reminder in the evening to add forgotten items. This procedure enables very accurate tracking of participant’s food intake in our study.

To sum up, thanks to modern technology we can now accurately measure what a person feels, does and eats throughout the day. Of course, the design of an e-food-diary on the smartphone depends on the projects’- and samples’ requirements. Overall, it has to be easy to use, easy to implement in daily life and to be fun for the participants to obtain a high level of compliance and a high-quality database.

REFERENCES:
Ebner-Priemer, U. W., & Trull, T. J. (2009). Ambulatory Assessment: An Innovative and Promising Approach for Clinical Psychology. European Psychologist, 14, 109–119. https://doi.org/10.1027/1016-9040.14.2.109.

Engel, S. G., Crosby, Ross, Thomas, G., Bond, D., Lavender, J. M., Mason, T., . . . Wonderlich, Stephen. (2016). Ecological Momentary Assessment in Eating Disorder and Obesity Research: a Review of the Recent Literature. Current Psychiatry Reports, 18, 37. https://doi.org/10.1007/s11920-016-0672-7.

Fuller, N. R., Fong, M., Gerofi, J., Ferkh, F., Leung, C., Leung, L., . . . Caterson, I. D. (2017). Comparison of an electronic versus traditional food diary for assessing dietary intake-A validation study. Obesity Research & Clinical Practice, 11, 647–654. https://doi.org/10.1016/j.orcp.2017.04.001.

Smyth, J., Wonderlich, S., Crosby, R., Miltenberger, R., Mitchell, J., & Rorty, M. (2001). The use of ecological momentary assessment approaches in eating disorder research. The International Journal of Eating Disorders, 30, 83–95.

Stein, K. F., & Corte, C. M. (2003). Ecologic momentary assessment of eating-disordered behaviors. The International Journal of Eating Disorders, 34, 349–360. https://doi.org/10.1002/eat.10194.

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