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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Longevity for the Lazy – by Dr. Richard Malish
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There are some people who devote all their resources to longevity, which can become a full-time occupation, not to mention a very expensive endeavor. This book’s for those who want to get the best possible “bang for buck” by doing the things that have the most favorable cost:worth ratio.
Dr. Malish covers what can be done easily for personal longevity, as well as what technological advances can be enjoyed that those before us didn’t have as options. He also discusses the diseases that are most likely to kill us, and how to avoid those.
He preaches a proactive approach, but one that is simple and consistent and based in good science, and good statistics. Indeed, while he’s served 20 years as an army doctor and a cardiologist, he now works as a healthcare policy consultant, so he is well-placed to advise.
The style of the book is halfway between regular pop-science and a textbook; you can either read it cover-to-cover, or skim first though the key points, highlight boxes, summaries, and the like. He also provides a time-phased task list, for those who like things to be laid out like that.
Bottom line: this is a very good, methodical guide to living longer without making it a full-time occupation.
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Next-Level Headache Hacks
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A Muscle With A Lot Of Therapeutic Value
First, a quick anatomy primer, so that the rest makes sense. We’re going to be talking about your sternocleidomastoid (SCM) muscle today.
To find it, there are two easy ways:
- look in a mirror, turn your head to one side and it’ll stick out on the opposite side of your neck
- look at this diagram
(we’re going to talk about it in the singular, but you have one on each side)
This muscle is interesting for very many reasons, but what we’re going to focus on today is that massaging/stretching it (correctly!) can benefit several things that are right next to it and/or behind it, namely:
- The tenth cranial nerve
- The eleventh cranial nerve
- The carotid artery
Why do we care about these?
Well, we would die quickly without the first and last of those. However, more practically, massaging each has benefits:
The tenth cranial nerve
This one is also known by its superhero alter-ego name:
The Vagus Nerve (And How You Can Make Use Of It)
The eleventh cranial nerve
This one’s not nearly so critical to life, but it does facilitate most of the motor functions in that general part of the body—including some mechanics of speech production, and maintaining posture of the shoulders/neck/head (which in turn strongly affects presence/absence of certain kinds of headaches).
The carotid artery
We suspect you know what this one does already; it supplies the brain (and the rest of your head, for that matter) with oxygenated blood.
What is useful to know today, is that it can be massaged, via the SCM, in a way that brings about a gentler version of this “one weird trick” to cure a lot of kinds of headaches:
Curing Headaches At Home With Actual Science
How (And Why) To Massage Your SCM
…to relieve many kinds of headache, migraine, eye-ache, and tension or pain the jaw. It’s not a magical cure all so this comes with no promises, but it can and will help with a lot of things.
In few words: turn your ahead away from the side where it hurts (if both, just pick one and then repeat for the other side), and slightly downwards. When your SCM sticks out a bit on the other side, gently pinch and rub it, working from the bottom to the top.
If you prefer videos, here is a demonstration:
How (And Why) To Stretch Your SCM
The above already includes a little stretch, but you can stretch it in a way that specifically stimulates your vagus nerve (this is good for many things).
In few words: stand (or sit) up straight, and interlace your fingers together. Put your hands on the back of your neck, thumbs-downwards, and (keeping your face forward) look to one side with your eyes only, and hold that until you feel the urge to yawn (it’ll probably take between about 3 seconds and 30 seconds). Then repeat on the other side.
If you prefer videos, this one is a very slight variation of what we just described but works the same way:
Take care!
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We looked at 700 plant-based foods to see how healthy they really are. Here’s what we found
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If you’re thinking about buying plant-based foods, a trip to the supermarket can leave you bewildered.
There are plant-based burgers, sausages and mince. The fridges are loaded with non-dairy milk, cheese and yoghurt. Then there are the tins of beans and packets of tofu.
But how much is actually healthy?
Our nutritional audit of more than 700 plant-based foods for sale in Australian supermarkets has just been published. We found some products are so high in salt or saturated fat, we’d struggle to call them “healthy”.
We took (several) trips to the supermarket
In 2022, we visited two of each of four major supermarket retailers across Melbourne to collect information on the available range of plant-based alternatives to meat and dairy products.
We took pictures of the products and their nutrition labels.
We then analysed the nutrition information on the packaging of more than 700 of these products. This included 236 meat substitutes, 169 legumes and pulses, 50 baked beans, 157 dairy milk substitutes, 52 cheese substitutes and 40 non-dairy yoghurts.
Plant-based meats were surprisingly salty
We found a wide range of plant-based meats for sale. So, it’s not surprising we found large variations in their nutrition content.
Sodium, found in added salt and which contributes to high blood pressure, was our greatest concern.
The sodium content varied from 1 milligram per 100 grams in products such as tofu, to 2,000mg per 100g in items such as plant-based mince products.
This means we could eat our entire daily recommended sodium intake in just one bowl of plant-based mince.
An audit of 66 plant-based meat products in Australian supermarkets conducted in 2014 found sodium ranged from 316mg in legume-based products to 640mg in tofu products, per 100g. In a 2019 audit of 137 products, the range was up to 1,200mg per 100g.
In other words, the results of our audit seems to show a consistent trend of plant-based meats getting saltier.
Looking for plant-based meat? Check the label for the sodium content.
Michael Vi/Shutterstock
What about plant-based milks?
Some 70% of the plant-based milks we audited were fortified with calcium, a nutrient important for bone health.
This is good news as a 2019-2020 audit of 115 plant-based milks from Melbourne and Sydney found only 43% of plant-based milks were fortified with calcium.
Of the fortified milks in our audit, almost three-quarters (73%) contained the recommended amount of calcium – at least 100mg per 100mL.
We also looked at the saturated fat content of plant-based milks.
Coconut-based milks had on average up to six times higher saturated fat content than almond, oat or soy milks.
Previous audits also found coconut-based milks were much higher in saturated fat than all other categories of milks.
Some plant-based milks were healthier than others.
TY Lim/Shutterstock
A first look at cheese and yoghurt alternatives
Our audit is the first study to identify the range of cheese and yoghurt alternatives available in Australian supermarkets.
Calcium was only labelled on a third of plant-based yoghurts, and only 20% of supermarket options met the recommended 100mg of calcium per 100g.
For plant-based cheeses, most (92%) were not fortified with calcium. Their sodium content varied from 390mg to 1,400mg per 100g, and saturated fat ranged from 0g to 28g per 100g.
So, what should we consider when shopping?
As a general principle, try to choose whole plant foods, such as unprocessed legumes, beans or tofu. These foods are packed with vitamins and minerals. They’re also high in dietary fibre, which is good for your gut health and keeps you fuller for longer.
If opting for a processed plant-based food, here are five tips for choosing a healthier option.
1. Watch the sodium
Plant-based meat alternatives can be high in sodium, so look for products that have around 150-250mg sodium per 100g.
2. Pick canned beans and legumes
Canned chickpeas, lentils and beans can be healthy and low-cost additions to many meals. Where you can, choose canned varieties with no added salt, especially when buying baked beans.
3. Add herbs and spices to your tofu
Tofu can be a great alternative to meat. Check the label and pick the option with the highest calcium content. We found flavoured tofu was higher in salt and sugar content than minimally processed tofu. So it’s best to pick an unflavoured option and add your own flavours with spices and herbs.
4. Check the calcium
When choosing a non-dairy alternative to milk, such as those made from soy, oat, or rice, check it is fortified with calcium. A good alternative to traditional dairy will have at least 100mg of calcium per 100g.
5. Watch for saturated fat
If looking for a lower saturated fat option, almond, soy, rice and oat varieties of milk and yoghurt alternatives have much lower saturated fat content than coconut options. Pick those with less than 3g per 100g.
Laura Marchese, PhD Student at the Institute for Physical Activity and Nutrition, Deakin University and Katherine Livingstone, NHMRC Emerging Leadership Fellow and Senior Research Fellow at the Institute for Physical Activity and Nutrition, Deakin University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Sweet Cinnamon vs Regular Cinnamon – Which is Healthier?
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Our Verdict
When comparing sweet cinnamon to regular cinnamon, we picked the sweet.
Why?
In this case, it’s not close. One of them is health-giving and the other is poisonous (but still widely sold in supermarkets, especially in the US and Canada, because it is cheaper).
It’s worth noting that “regular cinnamon” is a bit of a misnomer, since sweet cinnamon is also called “true cinnamon”. The other cinnamon’s name is formally “cassia cinnamon”, but marketers don’t tend to call it that, preferring to calling it simply “cinnamon” and hope consumers won’t ask questions about what kind, because it’s cheaper.
Note: this too is especially true in the US and Canada, where for whatever reason sweet cinnamon seems to be more difficult to obtain than in the rest of the world.
In short, both cinnamons contain cinnamaldehyde and coumarin, but:
- Sweet/True cinnamon contains only trace amounts of coumarin
- Regular/Cassia cinnamon contains about 250x more coumarin
Coumarin is heptatotoxic, meaning it poisons the liver, and the recommended safe amount is 0.1mg/kg, so it’s easy to go over that with just a couple of teaspoons of cassia cinnamon.
You might be wondering: how can they get away with selling something that poisons the liver? In which case, see also: the alcohol aisle. Selling toxic things is very common; it just gets normalized a lot.
Cinnamaldehyde is responsible for cinnamon’s healthier properties, and is found in reasonable amounts in both cinnamons. There is about 50% more of it in the regular/cassia than in the sweet/true, but that doesn’t come close to offsetting the potential harm of its higher coumarin content.
Want to learn more?
You may like to read:
- A Tale Of Two Cinnamons ← this one has more of the science of coumarin toxicity, as well as discussing (and evidencing) cinnamaldehyde’s many healthful properties against inflammation, cancer, heart disease, neurodegeneration, etc
Enjoy!
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Make Your Saliva Better For Your Teeth
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A new study has highlighted the importance of lifestyle factors in shaping the oral microbiome—that is to say, how the things we do affect the bacteria that live in our mouths:
Nepali oral microbiomes reflect a gradient of lifestyles from traditional to industrialized
Neither the study title nor the abstract elucidate how, exactly, one impacts the other, but the study itself does (of course) contain that information; we read it, and the short version is:
In terms of the extremes of “most traditional” to “most industrialized”, foragers have the most diverse oral microbiomes (that’s good), and people with an American industrialized lifestyle had the least diverse oral microbiomes (that’s bad). Between the two extremes, we see the gradient promised by the title.
If you do feel like checking it out, Figure 3 in the paper illustrates this nicely.
Also illustrated in the above-linked Figure 3 is oral microbiome composition. In other words (and to oversimplify it rather), how good or bad our mouth bacteria are for us, independent of diversity (so for example, are there more of this or that kind of bacteria).
Once again, there is a gradient, only this time, the ends of it are even more polarized: foragers have a diverse oral microbiome rich with healthy-for-humans bacteria, while people with an American industrialized lifestyle might not have the diversity, but do have a large number of bad-for-humans bacteria.
While many lifestyle factors are dietary or quasi-dietary, e.g. what kinds of foods people eat, whether they drink alcohol, whether they smoke or use gum, etc, many lifestyle factors were examined, including everything from medications and exercise, to things like kitchen location and what fuel is predominantly used, to education and sexual activity and many other things that we don’t have room for here.
You can see how each lifestyle factor stacked up, in Figure 5.
Why it matters
Our oral microbiome affects many aspects of health, including:
- Locally: caries, periodontal diseases, mucosal diseases, oral cancer, and more
- Systemically: gastrointestinal diseases in general, IBS in particular, nervous system diseases, Alzheimer’s disease, endocrine diseases, all manner of immune/autoimmune diseases, and more
Nor are the effects it has mild; oral microbiome health can be a huge factor, statistically, for many of the above. You can see information and data pertaining to all of the above and more, here:
Oral microbiomes: more and more importance in oral cavity and whole body
What to do about it
Take care of your oral microbiome, to help it to take care of you. As well as the above-mentioned lifestyle factors, it’s worth noting that when it comes to oral hygiene, not all oral hygiene products are created equal:
Toothpastes & Mouthwashes: Which Kinds Help, And Which Kinds Harm?
Additionally, you might want to consider gentler options, but if you do, take care to opt for things that science actually backs., rather than things that merely trended on social media.
This writer (hi, it’s me) is particularly excited about the science and use of the miswak stick, which comes from the Saladora persica tree, and has phytochemical properties that (amongst many other health-giving effects) improve the quality of saliva (i.e., improve its pH and microbiome composition). In essence, your own saliva gets biochemically nudged into being the safest, most effective mouthwash.
There’s a lot of science for the use of S. persica, and we’ve discussed it before in more detail than we have room to rehash today, here:
Less Common Oral Hygiene Options
If you’d like to enjoy these benefits (and also have the equivalent of a toothbrush that you can carry with you at all times and does not require water*), then here’s an example product on Amazon 😎
*don’t worry, it won’t feel like dry-brushing your teeth. Remember what we said about what it does to your saliva. Basically, you chomp it once, and your saliva a) increases and b) becomes biological tooth-cleaning fluid. The stick itself is fibrous, so the end of it frays in a way that makes a natural little brush. Each stick is about 5”×¼” and you can carry it in a little carrying case (you’ll get a couple with each pack of miswak sticks), so you can easily use it in, say, the restroom of a restaurant or before your appointment somewhere, just as easily as you could use a toothpick, but with much better results. You may be wondering how long a stick lasts; well, that depends on how much you use it, but in this writer’s experience, each stick lasts about a month maybe, using it at least 2–3 times per day, probably rather more since I use it after each meal/snack and upon awakening.
(the above may read like an ad, but we promise you it’s not sponsored and this writer’s just enthusiastic, and when you read the science, you will be too)
Enjoy!
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Meningitis Outbreak
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Don’t Let Your Guard Down
In the US, meningitis is currently enjoying a 10-year high, with its highest levels of infection since 2014.
This is a big deal, given the 10–15% fatality rate of meningitis, even with appropriate medical treatment.
But of course, not everyone gets appropriate medical treatment, especially because symptoms can become life-threatening in a matter of hours.
Most recent stats gave an 18% fatality rate for the cases with known outcomes in the last year:
CDC Emergency | Increase in Invasive Serogroup Y Meningococcal Disease in the United States
The quick facts:
❝Meningococcal disease most often presents as meningitis, with symptoms that may include fever, headache, stiff neck, nausea, vomiting, photophobia, or altered mental status.
[It can also present] as meningococcal bloodstream infection, with symptoms that may include fever and chills, fatigue, vomiting, cold hands and feet, severe aches and pains, rapid breathing, diarrhea, or, in later stages, a dark purple rash.
While initial symptoms of meningococcal disease can at first be non-specific, they worsen rapidly, and the disease can become life-threatening within hours. Immediate antibiotic treatment for meningococcal disease is critical.
Survivors may experience long-term effects such as deafness or amputations of the extremities.❞
~ Ibid.
The good news (but still don’t let your guard down)
Meningococcal bacteria are, happily, not spread as easily as cold and flu viruses.
The greatest risks come from:
- Close and enduring proximity (e.g. living together)
- Oral, or close-to-oral, contact (e.g. kissing, or coughing nearby)
Read more:
CDC | Meningococcal Disease: Causes & How It Spreads
Is there a vaccine?
There is, but it’s usually only offered to those most at risk, which is usually:
- Children
- Immunocompromised people, especially if HIV+
- People taking certain medications (e.g. Solaris or Ultomiris)
Read more:
CDC | Meningococcal Vaccine Recommendations
Will taking immune-boosting supplements help?
Honestly, probably not, but they won’t harm either. The most important thing is: don’t rely on them—too many people pop a vitamin C supplement and then assume they are immune to everything, and it doesn’t work like that.
On a tangential note, for more general immune health, you might also want to check out:
Beyond Supplements: The Real Immune-Boosters!
The short version:
If you or someone you know experiences the above-mentioned symptoms, even if it does not seem too bad, get thee/them to a doctor, and quickly, because the (very short) clock may be ticking already.
Better safe than sorry.
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