Chiropractors have been banned again from manipulating babies’ spines. Here’s what the evidence actually says
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Chiropractors in Australia will not be able to perform spinal manipulation on children under the age of two once more, following health concerns from doctors and politicians.
But what is the spinal treatment at the centre of the controversy? Does it work? Is there evidence of harm?
We’re a team of researchers who specialise in evidence-based musculoskeletal health. I (Matt) am a registered chiropractor, Joshua is a registered physiotherapist and Giovanni trained as a physiotherapist.
Here’s what the evidence says.
Remind me, how did this all come about?
A Melbourne-based chiropractor posted a video on social media in 2018 using a spring-loaded device (known as the Activator) to manipulate the spine of a two-week-old baby suspended upside down by the ankles.
The video sparked widespread concerns among the public, medical associations and politicians. It prompted a ban on the procedure in young children. The Victorian health minister commissioned Safer Care Victoria to conduct an independent review of spinal manipulation techniques on children.
Recently, the Chiropractic Board of Australia reinstated chiropractors’ authorisation to perform spinal manipulation on babies under two years old. But this week, it backflipped, following heavy criticism from medical associations and politicians.
What is spinal manipulation?
Spinal manipulation is a treatment used by chiropractors and other health professionals such as doctors, osteopaths and physiotherapists.
It is an umbrella term that includes popular “back cracking” techniques.
It also includes more gentle forms of treatment, such as massage or joint mobilisations. These involve applying pressure to joints without generating a “cracking” sound.
Does spinal manipulation in babies work?
Several international guidelines for health-care professionals recommend spinal manipulation to treat adults with conditions such as back pain and headache as there is an abundance of evidence on the topic. For example, spinal manipulation for back pain is supported by data from nearly 10,000 adults.
For children, it’s a different story. Safer Care Victoria’s 2019 review of spinal manipulation found very few studies testing whether this treatment was safe and effective in children.
Studies were generally small and were of poor quality. Some of those small, poor-quality studies, suggest spinal manipulation provides a very small benefit for back pain, colic and potentially bedwetting – some common reasons for parents to take their child to see a chiropractor. But overall, the review found the overall body of evidence was very poor.
However, for most other children’s conditions chiropractors treat – such as headache, asthma, otitis media (a type of ear infection), cerebral palsy, hyperactivity and torticollis (“twisted neck”) – there did not appear to be a benefit.
The number of studies investigating the effectiveness of spinal manipulation on babies under two years of age was even smaller.
There was one high-quality study and two small, poor quality studies. These did not show an appreciable benefit of spinal manipulation on colic, otitis media with effusion (known as glue ear) or twisted neck in babies.
Is spinal manipulation on babies safe?
In terms of safety, most studies in the review found serious complications were extremely rare. The review noted one baby or child dying (a report from Germany in 2001 after spinal manipulation by a physiotherapist). The most common complications were mild in nature such as increased crying and soreness.
However, because studies were very small, they cannot tell us anything about the safety of spinal manipulation in a reliable way. Studies that are designed to properly investigate if a treatment is safe typically include thousands of patients. And these studies have not yet been done.
Why do people see chiropractors?
Safer Care Victoria also conducted surveys with more than 20,000 people living in Australia who had taken their children under 12 years old to a chiropractor in the past ten years.
Nearly three-quarters said that was for treatment of a child aged two years or younger.
Nearly all people surveyed reported a positive experience when they took their child to a chiropractor and reported that their child’s condition improved with chiropractic care. Only a small number of people (0.3%) reported a negative experience, and this was mostly related to cost of treatment, lack of improvement in their child’s condition, excessive use of x-rays, and perceived pressure to avoid medications.
Many of the respondents had also consulted their GP or maternity/child health nurse.
What now for spinal manipulation in children?
At the request of state and federal ministers, the Chiropractic Board of Australia confirmed that spinal manipulation on babies under two years old will continue to be banned until it discusses the issue further with health ministers.
Many chiropractors believe this is unfair, especially considering the strong consumer support for chiropractic care outlined in the Safer Care Victoria report, and the rarity of serious reported harms in children.
Others believe that in the absence of evidence of benefit and uncertainty around whether spinal manipulation is safe in children and babies, the precautionary principle should apply and children and babies should not receive spinal manipulation.
Ultimately, high quality research is urgently needed to better understand whether spinal manipulation is beneficial for the range of conditions chiropractors provide it for, and whether the benefit outweighs the extremely small chance of a serious complication.
This will help parents make an informed choice about health care for their child.
Matt Fernandez, Senior lecturer and researcher in chiropractic, CQUniversity Australia; Giovanni E. Ferreira, NHMRC Emerging Leader Research Fellow, Institute of Musculoskeletal Health, University of Sydney, and Joshua Zadro, NHMRC Emerging Leader Research Fellow, Sydney Musculoskeletal Health, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Pistachios vs Cashews – Which is Healthier?
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Our Verdict
When comparing pistachios to cashews, we picked the pistachios.
Why?
In terms of macros, both are great sources of protein and healthy fats, and considered head-to-head:
- pistachios have slightly more protein, but it’s close
- pistachios have slightly more (health) fat, but it’s close
- cashews have slightly more carbs, but it’s close
- pistachios have a lot more fiber (more than 3x more!)
All in all, both have a good macro balance, but pistachios win easily on account of the fiber, as well as the slight edge for protein and fats.
When it comes to vitamins, pistachios have more of vitamins A, B1, B2, B3, B6, B9, C, & E.
Cashews do have more vitamin B5, also called pantothenic acid, pantothenic literally meaning “from everywhere”. Guess what’s not a common deficiency to have!
So pistachios win easily on vitamins, too.
In the category of minerals, things are more balanced, though cashews have a slight edge. Pistachios have more notably more calcium and potassium, while cashews have notably more selenium, zinc, and magnesium.
Both of these nuts have anti-inflammatory, anti-diabetic, and anti-cancer benefits, often from different phytochemicals, but with similar levels of usefulness.
Taking everything into account, however, one nut comes out in the clear lead, mostly due to its much higher fiber content and better vitamin profile, and that’s the pistachios.
Want to learn more?
Check out:
Why You Should Diversify Your Nuts
Enjoy!
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Undoing The Damage Of Life’s Hard Knocks
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Sometimes, What Doesn’t Kill Us Makes Us Insecure
We’ve written before about Complex PTSD, which is much more common than the more popularly understood kind:
Given that C-PTSD affects so many people (around 1 in 5, but really, do read the article above! It explains it better than we have room to repeat today), it seems like a good idea to share tips for managing it.
(Last time, we took all the space for explaining it, so we just linked to some external resources at the end)
What happened to you?
PTSD has (as a necessity, as part of its diagnostic criteria) a clear event that caused it, which makes the above question easy to answer.
C-PTSD often takes more examination to figure out what tapestry of circumstances (and likely but not necessarily: treatment by other people) caused it.
Often it will feel like “but it can’t be that; that’s not that bad”, or “everyone has things like that” (in which case, you’re probably one of the one in five).
The deeper questions
Start by asking yourself: what are you most afraid of, and why? What are you most ashamed of? What do you fear that other people might say about you?
Often there is a core pattern of insecurity that can be summed up in a simple, harmful, I-message, e.g:
- I am a bad person
- I am unloveable
- I am a fake
- I am easy to hurt
- I cannot keep my loved ones safe
…and so forth.
For a bigger list of common insecurities to see what resonates, check out:
Basic Fears/Insecurities, And Their Corresponding Needs/Desires
Find where they came from
You probably learned bad beliefs, and consequently bad coping strategies, because of bad circumstances, and/or bad advice.
- When a parent exclaimed in anger about how stupid you are
- When a partner exclaimed in frustration that always mess everything up
- When an employer told you you weren’t good enough
…or maybe they told you one thing, and showed you the opposite. Or maybe it was entirely non-verbal circumstances:
- When you gambled on a good idea and lost everything
- When you tried so hard at some important endeavour and failed
- When you thought someone could be trusted, and learned the hard way that you were wrong
These are “life’s difficult bits”, but when we’ve lived through a whole stack of them, it’s less like a single shattering hammer-blow of PTSD, and more like the consistent non-stop tap tap tap that ends up doing just as much damage in the long run.
Resolve them
That may sound a bit like a “and quickly create world peace” level of task, but we have tools:
Ask yourself: what if…
…it had been different? Take some time and indulge in a full-blown fantasy of a life that was better. Explore it. How would those different life lessons, different messages, have impacted who you are, your personality, your behaviour?
This is useful, because the brain is famously bad at telling real memories from false ones. Consciously, you’ll know that one was an exploratory fantasy, but to your brain, it’s still doing the appropriate rewiring. So, little by little, neuroplasticity will do its thing.
Tell yourself a better lie
We borrowed this one from the title of a very good book which we’ve reviewed previously.
This idea is not about self-delusion, but rather that we already express our own experiences as a sort of narrative, and that narrative tends to contain value judgements that are often not useful, e.g. “I am stupid”, “I am useless”, and all the other insecurities we mentioned earlier. Some simple examples might be:
- “I had a terrible childhood” → “I have come so far”
- “I should have known better” → “I am wiser now”
- “I have lost so much” → “I have experienced so much”
So, replacing that self-talk can go a long way to re-writing how secure we feel, and therefore how much trauma-response (ideally: none!) we have to stimuli that are not really as threatening as we sometimes feel they are (a hallmark of PTSD in general).
Here’s a guide to more ways:
How To Get Your Brain On A More Positive Track (Without Toxic Positivity)
Take care!
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The Other Significant Others – by Rhaina Cohen
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As we get older, it’s a function of statistics that increasingly many of us are divorced or widowed. While some will—after whatever time seems right to them—get back into dating, what about those of us who decide that we won’t?
Rhaina Cohen explores the importance of friendship, mutual support, and (Platonic!) closeness and yes, even kinds of intimacy (for that too can be Platonic!) as we go on.
Even from a purely evolutionary approach, we are fundamentally social creatures, and while as individuals we may exist on a spectrum from reclusive to extroverted, we all thrive better when we at least have access to community and friends.
The style of the book is easy-reading and exploratory, and is very compelling as a call-to-arms for those who may wish to give/receive support to/from those with whom we are not necessarily sleeping.
Because at the end of the day, why should sex and/or romance be a required feature for legal protections? Aren’t we adults who can make our own decisions about whom we trust to care for us?
Bottom line: if you’re happily partnered and expect to pre-decease your partner, this book might not be directly important for you (it might for your partner, though). Everyone else? This book may be important at some point. That point might even be now already; only you know.
Click here to check out The Other Significant Others, and make your own choices in life!
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Popcorn vs Peanuts – Which is Healthier
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Our Verdict
When comparing air-popped popcorn to peanuts (without an allergy), we picked the peanuts.
Why?
Peanuts, if we were to list popular nuts in order of healthfulness, would not be near the top of the list. Many other nuts have more nutrients and fewer/lesser drawbacks.
But the comparison to popcorn shines a different light on it:
Popcorn has very few nutrients. It’s mostly carbs and fiber; it’s just not a lot of carbs because the manner of its consumption makes it a very light snack (literally). You can eat a bowlful and it was perhaps 30g. It has some small amounts of some minerals, but nothing that you could rely on it for. It’s mostly fresh air wrapped in fiber.
Peanuts, in contrast, are a much denser snack. High in calories yes, but also high in protein, their fats are mostly healthy, and they have not only a fair stock of vitamins and minerals, but also a respectable complement of beneficial phytochemicals: mostly assorted antioxidant polyphenols, but also oleic acid (as in olives, good for healthy triglyceride levels).
Another thing worth a mention is their cholesterol-reducing phytosterols (these reduce the absorption of dietary cholesterol, “good” and “bad”, so this is good for most people, bad for some, depending on the state of your cholesterol and what you ate near in time to eating the nuts)
Peanuts do have their clear downsides too: its phytic acid content can reduce the bioavailability of iron and zinc taken at the same time.
In summary: while popcorn’s greatest claim to dietary beneficence is its fiber content and that it’s close to being a “zero snack”, peanuts (eaten in moderation, say, the same 30g as the popcorn) have a lot to contribute to our daily nutritional requirements.
We do suggest enjoying other nuts though!
Read more: Why You Should Diversify Your Nuts!
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No, taking drugs like Ozempic isn’t ‘cheating’ at weight loss or the ‘easy way out’
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Hundreds of thousands of people worldwide are taking drugs like Ozempic to lose weight. But what do we actually know about them? This month, The Conversation’s experts explore their rise, impact and potential consequences.
Obesity medication that is effective has been a long time coming. Enter semaglutide (sold as Ozempic and Wegovy), which is helping people improve weight-related health, including lowering the risk of a having a heart attack or stroke, while also silencing “food noise”.
As demand for semaglutide increases, so are claims that taking it is “cheating” at weight loss or the “easy way out”.
We don’t tell people who need statin medication to treat high cholesterol or drugs to manage high blood pressure they’re cheating or taking the easy way out.
Nor should we shame people taking semaglutide. It’s a drug used to treat diabetes and obesity which needs to be taken long term and comes with risks and side effects, as well as benefits. When prescribed for obesity, it’s given alongside advice about diet and exercise.
How does it work?
Semaglutide is a glucagon-like peptide-1 receptor agonist (GLP-1RA). This means it makes your body’s own glucagon-like peptide-1 hormone, called GLP-1 for short, work better.
GLP-1 gets secreted by cells in your gut when it detects increased nutrient levels after eating. This stimulates insulin production, which lowers blood sugars.
GLP-1 also slows gastric emptying, which makes you feel full, and reduces hunger and feelings of reward after eating.
GLP-1 receptor agonist (GLP-1RA) medications like Ozempic help the body’s own GLP-1 work better by mimicking and extending its action.
Some studies have found less GLP-1 gets released after meals in adults with obesity or type 2 diabetes mellitus compared to adults with normal glucose tolerance. So having less GLP-1 circulating in your blood means you don’t feel as full after eating and get hungry again sooner compared to people who produce more.
GLP-1 has a very short half-life of about two minutes. So GLP-1RA medications were designed to have a very long half-life of about seven days. That’s why semaglutide is given as a weekly injection.
What can users expect? What does the research say?
Higher doses of semaglutide are prescribed to treat obesity compared to type 2 diabetes management (up to 2.4mg versus 2.0mg weekly).
A large group of randomised controlled trials, called STEP trials, all tested weekly 2.4mg semaglutide injections versus different interventions or placebo drugs.
Trials lasting 1.3–2 years consistently found weekly 2.4 mg semaglutide injections led to 6–12% greater weight loss compared to placebo or alternative interventions. The average weight change depended on how long medication treatment lasted and length of follow-up.
Higher doses of semaglutide are prescribed for obesity than for type 2 diabetes. fcm82/Shutterstock Weight reduction due to semaglutide also leads to a reduction in systolic and diastolic blood pressure of about 4.8 mmHg and 2.5 mmHg respectively, a reduction in triglyceride levels (a type of blood fat) and improved physical function.
Another recent trial in adults with pre-existing heart disease and obesity, but without type 2 diabetes, found adults receiving weekly 2.4mg semaglutide injections had a 20% lower risk of specific cardiovascular events, including having a non-fatal heart attack, a stroke or dying from cardiovascular disease, after three years follow-up.
Who is eligible for semaglutide?
Australia’s regulator, the Therapeutic Goods Administration (TGA), has approved semaglutide, sold as Ozempic, for treating type 2 diabetes.
However, due to shortages, the TGA had advised doctors not to start new Ozempic prescriptions for “off-label use” such as obesity treatment and the Pharmaceutical Benefits Scheme doesn’t currently subsidise off-label use.
The TGA has approved Wegovy to treat obesity but it’s not currently available in Australia.
When it’s available, doctors will be able to prescribe semaglutide to treat obesity in conjunction with lifestyle interventions (including diet, physical activity and psychological support) in adults with obesity (a BMI of 30 or above) or those with a BMI of 27 or above who also have weight-related medical complications.
What else do you need to do during Ozempic treatment?
Checking details of the STEP trial intervention components, it’s clear participants invested a lot of time and effort. In addition to taking medication, people had brief lifestyle counselling sessions with dietitians or other health professionals every four weeks as a minimum in most trials.
Support sessions were designed to help people stick with consuming 2,000 kilojoules (500 calories) less daily compared to their energy needs, and performing 150 minutes of moderate-to-vigorous physical activity, like brisk walking, dancing and gardening each week.
STEP trials varied in other components, with follow-up time periods varying from 68 to 104 weeks. The aim of these trials was to show the effect of adding the medication on top of other lifestyle counselling.
Trial participants also exercised for 150 minutes a week. Elena Nichizhenova/Shutterstock A review of obesity medication trials found people reported they needed less cognitive behaviour training to help them stick with the reduced energy intake. This is one aspect where drug treatment may make adherence a little easier. Not feeling as hungry and having environmental food cues “switched off” may mean less support is required for goal-setting, self-monitoring food intake and avoiding things that trigger eating.
But what are the side effects?
Semaglutide’s side-effects include nausea, diarrhoea, vomiting, constipation, indigestion and abdominal pain.
In one study these led to discontinuation of medication in 6% of people, but interestingly also in 3% of people taking placebos.
More severe side-effects included gallbladder disease, acute pancreatitis, hypoglycaemia, acute kidney disease and injection site reactions.
To reduce risk or severity of side-effects, medication doses are increased very slowly over months. Once the full dose and response are achieved, research indicates you need to take it long term.
Given this long-term commitment, and associated high out-of-pocket cost of medication, when it comes to taking semaglutide to treat obesity, there is no way it can be considered “cheating”.
Read the other articles in The Conversation’s Ozempic series here.
Clare Collins, Laureate Professor in Nutrition and Dietetics, University of Newcastle
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Biohack Your Brain – by Dr. Kristen Willeumier
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The title of this book is a little misleading, as it’s not really about biohacking; it’s more like a care and maintenance manual for the brain.
This distinction is relevant, because to hack a thing is to use it in a way it’s not supposed to be used, and/or get it to do something it’s not supposed to do.
Intead, what neurobiologist Dr. Kristen Willeumier offers us is much more important: how to keep our brain in good condition.
She takes us through the various things that our brain needs, and what will happen if it doesn’t get them. Some are dietary, some are behavioral, some are even cognitive.
A strength of this book is not just explaining what things are good for the brain, but also: why. Understanding the “why” can be the motivational factor that makes a difference between us doing the thing or not!
For example, if we know that exercise is good for the brain, we think “sounds reasonable” and carry on with what we were doing. If, however, we also understand how increased bloodflow helps with the timely removal of beta-amyloids that are associated with Alzheimer’s, we’re more likely to make time for getting that movement going.
Bottom line: there are key things we can do to keep our brain healthy, and you probably wouldn’t want to miss any. This book is a great care manual for such!
Click here to check out Biohack Your Brain and keep your brain young and fit!
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