Reflexology: What The Science Says

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How Does Reflexology Work, Really?

In Wednesday’s newsletter, we asked you for your opinion of reflexology, and got the above-depicted, below-described set of responses:

  • About 63% said “It works by specific nerves connecting the feet and hands to various specific organs, triggering healing remotely”
  • About 26% said “It works by realigning the body’s energies (e.g. qi, ki, prana, etc), removing blockages and improving health“
  • About 11% said “It works by placebo, at best, and has no evidence for any efficacy beyond that”

So, what does the science say?

It works by realigning the body’s energies (e.g. qi, ki, prana, etc), removing blockages and improving health: True or False?

False, or since we can’t prove a negative: there is no reliable scientific evidence for this.

Further, there is no reliable scientific evidence for the existence of qi, ki, prana, soma, mana, or whatever we want to call it.

To save doubling up, we did discuss this in some more detail, exploring the notion of qi as bioelectrical energy, including a look at some unreliable clinical evidence for it (a study that used shoddy methodology, but it’s important to understand what they did wrong, to watch out for such), when we looked at [the legitimately very healthful practice of] qigong, a couple of weeks ago:

Qigong: A Breath Of Fresh Air?

As for reflexology specifically: in terms of blockages of qi causing disease (and thus being a putative therapeutic mechanism of action for attenuating disease), it’s an interesting hypothesis but in terms of scientific merit, it was pre-emptively supplanted by germ theory and other similarly observable-and-measurable phenomena.

We say “pre-emptively”, because despite orientalist marketing, unless we want to count some ancient pictures of people getting a foot massage and say it is reflexology, there is no record of reflexology being a thing before 1913 (and that was in the US, by a laryngologist working with a spiritualist to produce a book that they published in 1917).

It works by specific nerves connecting the feet and hands to various specific organs, triggering healing remotely: True or False?

False, or since we can’t prove a negative: there is no reliable scientific evidence for this.

A very large independent review of available scientific literature found the current medical consensus on reflexology is that:

  • Reflexology is effective for: anxiety (but short lasting), edema, mild insomnia, quality of sleep, and relieving pain (short term: 2–3 hours)
  • Reflexology is not effective for: inflammatory bowel disease, fertility treatment, neuropathy and polyneuropathy, acute low back pain, sub acute low back pain, chronic low back pain, radicular pain syndromes (including sciatica), post-operative low back pain, spinal stenosis, spinal fractures, sacroiliitis, spondylolisthesis, complex regional pain syndrome, trigger points / myofascial pain, chronic persistent pain, chronic low back pain, depression, work related injuries of the hip and pelvis

Source: Reflexology – a scientific literary review compilation

(the above is a fascinating read, by the way, and its 50 pages go into a lot more detail than we have room to here)

Now, those items that they found it effective for, looks suspiciously like a short list of things that placebo is often good for, and/or any relaxing activity.

Another review was not so generous:

❝The best evidence available to date does not demonstrate convincingly that reflexology is an effective treatment for any medical condition❞

~ Dr. Edzard Ernst (MD, PhD, FMedSci)

Source: Is reflexology an effective intervention? A systematic review of randomised controlled trials

In short, from the available scientific literature, we can surmise:

  • Some researchers have found it to have some usefulness against chiefly psychosomatic conditions
  • Other researchers have found the evidence for even that much to be uncompelling

It works by placebo, at best, and has no evidence for any efficacy beyond that: True or False?

Mostly True; of course reflexology runs into similar problems as acupuncture when it comes to testing against placebo:

How Does One Test Acupuncture Against Placebo Anyway?

…but not quite as bad, since it is easier to give a random foot massage while pretending it is a clinical treatment, than to fake putting needles into key locations.

However, as the paper we cited just above (in answer to the previous True/False question) shows, reflexology does not appear to meaningfully outperform placebo—which points to the possibility that it does work by placebo, and is just a placebo treatment on the high end of placebo (because the placebo effect is real, does work, isn’t “nothing”, and some placebos work better than others).

For more on the fascinating science and useful (applicable in daily life!) practicalities of how placebo does work, check out:

How To Leverage Placebo Effect For Yourself

Take care!

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  • Nine Pints – by Rose George

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Rose George is not a scientist, but an investigative journalist. As such, she’s a leave-no-stone-unturned researcher, and that shows here.

    The style throughout is, as one might expect, journalistic. But, she’s unafraid of diving into the science of it, interviewing many medical professionals as part of her work. She also looks to people living with various blood-related conditions, ranging from hemophilia to HIV.

    Speakling of highly-stigmatized yet very manageable conditions, there’s also a fair section devoted to menstruation, menstrual blood, and societies’ responses to such, from shunning to active support.

    We also learn about the industrialization of blood—from blood banks to plasma labs to leech farms. You probably knew leeches are still used as a medical tool in even the most high-tech of hospitals, but you’ll doubtlessly learn a fascinating thing or two from the “insider views” along the way.

    Bottom line: if you’d like to know more about the red stuff in all its marvelous aspects, with neither sensationalization nor sanitization (the topic needs neither!), this is the book for you.

    Click here to check out Nine Pints, and learn more about yours!

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  • Pistachios vs Almonds – Which is Healthier?

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    Our Verdict

    When comparing pistachios to almonds, we picked the almonds.

    Why?

    It was very close! And those who’ve been following our “This or That” comparisons might be aware that pistachios and almonds have both been winning their respective comparisons with other nuts so far, so today we put them head-to-head.

    In terms of macros, almonds have a little more protein and a little more fiber—as well as slightly more fat, though the fats are healthy. Pistachios, meanwhile, are higher in carbs. A moderate win for almonds on the macro front.

    When it comes to vitamins, pistachios have more of vitamins A, B1, and B6, while almonds have more of vitamins B2, B3, and E. We could claim a slight victory for pistachios, based on the larger margins, or else a slight victory for almonds, based on vitamin E being a more common nutritional deficiency than vitamin A, and therefore the more useful vitamin to have more of. We’re going to call this category a tie.

    In the category of minerals, almonds lead with more calcium, magnesium, manganese, and zinc, while pistachios boast more copper, potassium, and selenium, though the margins are more modest for pistachios. A moderate win for almonds on minerals, therefore.

    Adding up the sections gives a win for almonds, but of course, do enjoy both, because both are excellent in their own right.

    Want to learn more?

    You might like to read:

    Take care!

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  • Tips for Avoiding PFAs

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    It’s Q&A Day at 10almonds!

    Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!

    In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!

    As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!

    So, no question/request too big or small

    ❝Hi, do you have anything helpful on avoiding PFAs?❞

    PFAS, or perfluoroalkyl and polyfluoroalkyl substances, are “forever chemicals” made specifically to avoid degradation of industrial and chemical products. Which is great for providing stain and water resistance, but not so great for our bodies or the environment.

    To go into all the harms they cause would take a main feature (maybe we will, one of these days), but suffice it to say, they’re not good, and range from cancer and insulin resistance to hypertension and reduced immune response.

    To answer your question in a nutshell, avoiding them completely would be almost impossible, but we can reduce our exposure a lot by avoiding single-use food/drink products that have been waterproofed, e.g. paper/bamboo straws, utensils, cups, dishes, take-out containers, etc.

    Also, anything advertised as “stain-resistant” that you suspect should be quite stainable by nature, is probably good to avoid too.

    For more detailed information than we have room for here today, here’s a helpful overview:

    Breaking down the Forever Chemicals: What are PFAS?

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    The Best Brains Bar Nun?

    This is Dr. David Snowdon. He’s an epidemiologist, and one of the world’s foremost experts on Alzheimer’s disease. He was also, most famously, the lead researcher of what has become known as “The Nun Study”.

    We recently reviewed his book about this study:

    Aging with Grace: What the Nun Study Teaches Us About Leading Longer, Healthier, and More Meaningful Lives – by Dr. David Snowdon

    …which we definitely encourage you to check out, but we’ll do our best to summarize its key points today!

    Reassurance up-front: no, you don’t have to become a nun

    The Nun Study

    In 1991, a large number (678) of nuns were recruited for what was to be (and until now, remains) the largest study of its kind into the impact of a wide variety of factors on aging, and in particular, Alzheimer’s disease.

    Why it was so important: because the nuns were all from the same Order, had the same occupation (it’s a teaching Order), with very similar lifestyles, schedules, socioeconomic status, general background, access to healthcare, similar diets, same relationship status (celibate), same sex (female), and many other factors also similar, this meant that most of the confounding variables that confound other studies were already controlled-for here.

    Enrollment in the study also required consenting to donating one’s brain for study post-mortem—and of those who have since died, indeed 98% of them have been donated (the other 2%, we presume, may have run into technical administrative issues with the donation process, due to the circumstances of death and/or delays in processing the donation).

    How the study was undertaken

    We don’t have enough space to describe the entire methodology here, but the gist of it is:

    • Genetic testing for relevant genetic factors
    • Data gathered about lives so far, including not just medical records but also autobiographies that the nuns wrote when they took their vows (at ages 19–21)
    • Extensive ongoing personal interviews about habits, life choices, and attitudes
    • Yearly evaluations including memory tests and physical function tests
    • Brain donation upon death

    What they found

    Technically, The Nun Study is still ongoing. Of the original 678 nuns (aged 75–106), three are still alive (based on the latest report, at least).

    However, lots of results have already been gained, including…

    Genes

    A year into the study, in 1992, the “apolipoprotein E” (APOE) gene was established as a likely causative factor in Alzheimer’s disease. This is probably not new to our readers in 2024, but there are interesting things being learned even now, for example:

    The Alzheimer’s Gene That Varies By Race & Sex

    …but watch out! Because also:

    Alzheimer’s Sex Differences May Not Be What They Appear

    Words

    Based on the autobiographies written by the nuns in their youth upon taking their vows, there were two factors that were later correlated with not getting dementia:

    • Longer sentences
    • Positive outlook
    • “Idea density”

    That latter item means the relative linguistic density of ideas and complexity thereof, and the fluency and vivacity with which they were expressed (this was not a wishy-washy assessment; there was a hard-science analysis to determine numbers).

    Want to spruce up yours? You might like to check out:

    Reading, Better: Reading As A Cognitive Exercise

    …for specific, evidence-based ways to tweak your reading to fight cognitive decline.

    Food

    While the dietary habits of the nuns were fairly homogenous, those who favored eating more and cooked greens, beans, and tomatoes, lived longer and with healthier brains.

    See also: Brain Food? The Eyes Have It!

    Other aspects of brain health & mental health

    The study also found that nuns who avoided stroke and depression, were also less likely to get dementia.

    For tending to these, check out:

    Community & Faith

    Obviously, in this matter the nuns were quite a homogenous group, scoring heavily in community and faith. What’s relevant here is the difference between the nuns, and other epidemiological studies in other groups (invariably not scoring so highly).

    Community & faith are considered, separately and together, to be protective factors against dementia.

    Faith may be something that “you have it or you don’t” (we’re a health science newsletter, not a theological publication, but for the interested, philosopher John Stuart Mill’s 1859 essay “On Liberty“ makes a good argument for it not being something one can choose, prompting him to argue for religious tolerance, on the grounds that religious coercion is a futile effort precisely because a person cannot choose to dis/believe something)

    …but community can definitely be chosen, nurtured, and grown. We’ve written about this a bit before:

    You might also like to check out this great book on the topic:

    Purpose: Design A Community And Change Your Life – by Gina Bianchini

    Want more?

    We gave a ground-up primer on avoiding Alzheimer’s and other dementias; check it out:

    How To Reduce Your Alzheimer’s Risk

    Take care!

    Don’t Forget…

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    Learn to Age Gracefully

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  • The Blue Zones, Second Edition – by Dan Buettner

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Eat beans & greens, take walks, have a purpose; you can probably list off the top of your head some of the “advices from Blue Zones”, so what makes this book stand out?

    This is perhaps one of the most thoughtful investigations; the author (a National Geographic researcher) toured and researched all the Blue Zones, took many many notes (we get details), and asked a lot of questions that others skipped.

    For example, a lot of books about the Blue Zones mention the importance of community—but they don’t go into much detail of what that looks like… And they certainly don’t tend to explain what we should do about it.

    And that’s because community is often viewed as environmental in a way that we can’t control. If we want to take supplements, eat a certain way, exercise, etc, we can do all those things alone if we want. But if we want community? We’re reliant on other people—and that’s a taboo in the US, and US-influenced places.

    So, one way this book excels is in describing how exactly people foster community in the Blue Zones (hint: the big picture—the form of the community—is different in each place, but the individual actions taken are similar), with particular attention to the roles actively taken on by the community elders.

    In a similar vein, “reduce stress” is good, but what mindsets and mechanisms do they use that are still reproducible if we are not, for example, Okinawan farmers? Again, Buettner delivers in spades.

    Bottom line: this is the Blue Zones book that digs deeper than others, and makes the advices much more applicable no matter where we live.

    Click here to check out The Blue Zones, and build these 9 things into your life!

    Don’t Forget…

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    Learn to Age Gracefully

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  • PS, We Love You

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    PS, we love you. With good reason!

    There are nearly 20,000 studies on PS listed on PubMed alone, and its established benefits include:

    We’ll explore some of these studies and give an overview of how PS does what it does. Just like the (otherwise unrelated) l-theanine we talked about a couple of weeks ago, it does do a lot of things.

    PS = Cow Brain?!

    Let’s first address a concern. You may have heard something along the lines of “hey, isn’t PS made from cow brain, and isn’t that Very Bad™ for humans, mad cow disease and all?”. The short answer is:

    Firstly: ingesting cow brain tissue is indeed generally considered Very Bad™ for humans, on account of the potential for transmission of Bovine Spongiform Encephalopathy (BSE) resulting in its human equivalent, Creutzfeldt–Jakob Disease (CJD), whose unpleasantries are beyond the scope of this newsletter.

    Secondly (and more pleasantly): whilst PS can be derived from bovine brain tissue, most PS supplements these days derive from soy—or sometimes sunflower lecithin. Check labels if unsure.

    Using PS to Improve Other Treatments

    In the human body, the question of tolerance brings us a paradox (not the tolerance paradox, important as that may also be): we must build and maintain a strong immune system capable of quickly adapting to new things, and then when we need medicines (or even supplements), we need our body to not build tolerance of them, for them to continue having an effect.

    So, we’re going to look at a very hot-off-the-press study (Feb 2023), that found PS to “mediate oral tolerance”, which means that it helps things (medications, supplements etc.) that we take orally and want to keep working, keep working.

    In the scientists’ own words (we love scientists’ own words because they haven’t been distorted by the popular press)…

    ❝This immunotherapy has been shown to prevent/reduce immune response against life-saving protein-based therapies, food allergens, autoantigens, and the antigenic viral capsid peptide commonly used in gene therapy, suggesting a broad spectrum of potential clinical applications. Given the good safety profile of PS together with the ease of administration, oral tolerance achieved with PS-based nanoparticles has a very promising therapeutic impact.❞

    Nguyen et al, Feb 2023

    In other words, to parse those two very long sentences into two shorter bullet points:

    • It allows a lot of important treatments to continue working—treatments that the body would otherwise counteract
    • It is very safe—and won’t harm the normal function of your immune system at large

    This is also very consistent with one of the benefits we mentioned up top—PS helps avoid rejection of implants, something that can be a huge difference to health-related quality of life (HRQoL), never mind sometimes life itself!

    What is PS Anyways, and How Does It Work?

    Phosphatidylserine is a phospholipid, a kind of lipid, found in cell membranes. More importantly:

    It’s a signalling agent, mainly for apoptosis, which in lay terms means: it tells cells when it’s time to die.

    Cellular death sounds like a bad thing, but prompt and efficient cellular apoptosis (death) and resultant prompt and efficient autophagy (recycling) reduce the risk of your body making mistakes when creating new cells from old cells.

    Think about photocopying:

    • Situation A: You have a document, and you want to copy it. If you copy it before it gets messed up, your copy will look almost, if not exactly, like the original. It’ll be super easy to read.
    • Situation B: You have a document, and you want to copy it, but you delay doing so for so long that the original is all scuffed and creased and has a coffee stain on it. These unwanted changes will get copied onto the new document, and any copy made of that copy will keep the problems too. It gets worse and worse each time.

    So, using this over-simplifier analogy, the speed of ‘copying’ is a major factor in cellular aging. The sooner cells are copied, before something gets damaged, the better the copy will be.

    So you really, really want to have enough PS (our bodies make it too, by the way) to signal promptly to a cell when its time is up.

    You do not want cells soldiering on until they’re the biological equivalent of that crumpled up, coffee-stained sheet of paper.

    Little wonder, then, that PS’ most commonly-sought benefit when it comes to supplementation is to help avoid age-related neurodegeneration (most notably, memory loss)!

    Keeping the cells young means keeping the brain young!

    PS’s role as a signalling agent doesn’t end there—it also has a lot to say to a wide variety of the body’s immunological cells, helping them know what needs to happen to what. Some things should be immediately eaten and recycled; other things need more extreme measures applied to them first, and yet other things need to be ignored, and so forth.

    You can read more about that in Elsevier’s publication if you’re curious 🙂

    Wow, what a ride today’s newsletter has been! We started at paracetamoxyfrusebendroneomycin, and got down to the nitty gritty with a bunch of hopefully digestible science!

    We love feedback, so please let us know if we’re striking the balance right, and/or if you’d like to see more or less of something—there’s a feedback widget at the bottom of this email!

    Don’t Forget…

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    Learn to Age Gracefully

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