Debate over tongue tie procedures in babies continues. Here’s why it can be beneficial for some infants
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There is increasing media interest about surgical procedures on new babies for tongue tie. Some hail it as a miracle cure, others view it as barbaric treatment, though adverse outcomes are rare.
Tongue tie occurs when the tissue under the tongue is attached to the lower gum or floor of the mouth in a way that can restrict the movement or range of the tongue. This can impact early breastfeeding in babies. It affects an estimated 8% of children under one year of age.
While there has been an increase in tongue tie releases (also called division or frenotomy), it’s important to keep this in perspective relative to the increase in breastfeeding rates.
The World Health Organization recommends exclusive breastfeeding for the first six months of life, with breastfeeding recommended into the second year of life and beyond for the health of mother and baby as well as optimal growth. Global rates of breastfeeding infants for the first six months have increased from 38% to 48% over the past decade. So, it is not surprising there is also an increase in the number of babies being referred globally with breastfeeding challenges and potential tongue tie.
An Australian study published in 2023 showed that despite a 25% increase in referrals for tongue tie division between 2014 and 2018, there was no increase in the number of tongue tie divisions performed. Tongue tie surgery rates increased in Australia in the decade from 2006 to 2016 (from 1.22 per 1,000 population to 6.35) for 0 to 4 year olds. There is no data on surgery rates in Australia over the last eight years.
Tongue tie division isn’t always appropriate but it can make a big difference to the babies who need it. More referrals doesn’t necessarily mean more procedures are performed.
How tongue tie can affect babies
When tongue tie (ankyloglossia) restricts the movement of the tongue, it can make it more difficult for a baby to latch onto the mother’s breast and painlessly breastfeed.
Earlier this month, the International Consortium of oral Ankylofrenula Professionals released a tongue tie position statement and practice guideline. Written by a range of health professionals, the guidelines define tongue tie as a functional diagnosis that can impact breastfeeding, eating, drinking and speech. The guidelines provide health professionals and families with information on the assessment and management of tongue tie.
Tongue tie release has been shown to improve latch during breastfeeding, reduce nipple pain and improve breast and bottle feeding. Early assessment and treatment are important to help mothers breastfeed for longer and address any potential functional problems.
Where to get advice
If feeding isn’t going well, it may cause pain for the mother or there may be signs the baby isn’t attaching properly to the breast or not getting enough milk. Parents can seek skilled help and assessment from a certified lactation consultant or International Board-Certified Lactation Consultant who can be found via online registry.
Alternatively, a health professional with training and skills in tongue tie assessment and division can assist families. This may include a doctor, midwife, speech pathologist or dentist with extended skills, training and experience in treating babies with tongue tie.
When access to advice or treatment is delayed, it can lead to unnecessary supplementation with bottle feeds, early weaning from breastfeeding and increased parental anxiety.
Getting a tongue tie assessment
During assessment, a qualified health professional will collect a thorough case history, including pregnancy and birth details, do a structural and functional assessment, and conduct a comprehensive breastfeeding or feeding assessment.
They will view and thoroughly examine the mouth, including the tongue’s movement and lift. The appearance of where the tissue attaches to the underside of the tongue, the ability of the tongue to move and how the baby can suck also needs to be properly assessed.
Treatment decisions should focus on the concerns of the mother and baby and the impact of current feeding issues. Tongue tie division as a baby is not recommended for the sole purpose of avoiding speech problems in later life if there are no feeding concerns for the baby.
Treatment options
The Australian Dental Association’s 2020 guidelines provide a management pathway for babies diagnosed with tongue tie.
Once feeding issues are identified and if a tongue tie is diagnosed, non-surgical management to optimise positioning, latch and education for parents should be the first-line approach.
If feeding issues persist during follow-up assessment after non-surgical management, a tongue tie division may be considered. Tongue tie release may be one option to address functional challenges associated with breastfeeding problems in babies.
There are risks associated with any procedure, including tongue tie release, such as bleeding. These risks should be discussed with the treating practitioner before conducting any laser, scissor or scalpel tongue tie procedure.
Post-release support by a certified lactation consultant or feeding specialist is necessary after a tongue tie division. A post-release treatment plan should be developed by a team of health professionals including advice and support for breastfeeding to address both the mother and baby’s individual needs.
We would like to acknowledge the contribution of Raymond J. Tseng, DDS, PhD, (Paediatric Dentist) to the writing of this article.
Sharon Smart, Lecturer and Researcher (Speech Pathology) – School of Allied Health, Curtin University; David Todd, Associate Professor, Neonatology, ANU Medical School, Australian National University, and Monica J. Hogan, PhD student, ANU School of Medicine and Psychology, Australian National University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Can kimchi really help you lose weight? Hold your pickle. The evidence isn’t looking great
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Fermented foods have become popular in recent years, partly due to their perceived health benefits.
For instance, there is some evidence eating or drinking fermented foods can improve blood glucose control in people with diabetes. They can lower blood lipid (fats) levels and blood pressure in people with diabetes or obesity. Fermented foods can also improve diarrhoea symptoms.
But can they help you lose weight, as a recent study suggests? Let’s look at the evidence.
Remind me, what are fermented foods?
Fermented foods are ones prepared when microbes (bacteria and/or yeast) ferment (or digest) food components to form new foods. Examples include yoghurt, cheese, kefir, kombucha, wine, beer, sauerkraut and kimchi.
As a result of fermentation, the food becomes acidic, extending its shelf life (food-spoilage microbes are less likely to grow under these conditions). This makes fermentation one of the earliest forms of food processing.
Fermentation also leads to new nutrients being made. Beneficial microbes (probiotics) digest nutrients and components in the food to produce new bioactive components (postbiotics). These postbiotics are thought to contribute to the health benefits of the fermented foods, alongside the health benefits of the bacteria themselves.
What does the evidence say?
A study published last week has provided some preliminary evidence eating kimchi – the popular Korean fermented food – is associated with a lower risk of obesity in some instances. But there were mixed results.
The South Korean study involved 115,726 men and women aged 40-69 who reported how much kimchi they’d eaten over the previous year. The study was funded by the World Institute of Kimchi, which specialises in researching the country’s national dish.
Eating one to three servings of any type of kimchi a day was associated with a lower risk of obesity in men.
Men who ate more than three serves a day of cabbage kimchi (baechu) were less likely to have obesity and abdominal obesity (excess fat deposits around their middle). And women who ate two to three serves a day of baechu were less likely to have obesity and abdominal obesity.
Eating more radish kimchi (kkakdugi) was associated with less abdominal obesity in both men and women.
However, people who ate five or more serves of any type of kimchi weighed more, had a larger waist sizes and were more likely to be obese.
The study had limitations. The authors acknowledged the questionnaire they used may make it difficult to say exactly how much kimchi people actually ate.
The study also relied on people to report past eating habits. This may make it hard for them to accurately recall what they ate.
This study design can also only tell us if something is linked (kimchi and obesity), not if one thing causes another (if kimchi causes weight loss). So it is important to look at experimental studies where researchers make changes to people’s diets then look at the results.
How about evidence from experimental trials?
There have been several experimental studies looking at how much weight people lose after eating various types of fermented foods. Other studies looked at markers or measures of appetite, but not weight loss.
One study showed the stomach of men who drank 1.4 litres of fermented milk during a meal took longer to empty (compared to those who drank the same quantity of whole milk). This is related to feeling fuller for longer, potentially having less appetite for more food.
Another study showed drinking 200 millilitres of kefir (a small glass) reduced participants’ appetite after the meal, but only when the meal contained quickly-digested foods likely to make blood glucose levels rise rapidly. This study did not measure changes in weight.
Kefir, a fermented milk drink, reduced people’s appetite.
Ildi Papp/ShutterstockAnother study looked at Indonesian young women with obesity. Eating tempeh (a fermented soybean product) led to changes in an appetite hormone. But this did not impact their appetite or whether they felt full. Weight was not measured in this study.
A study in South Korea asked people to eat about 70g a day of chungkookjang (fermented soybean). There were improvements in some measures of obesity, including percentage body fat, lean body mass, waist-to-hip ratio and waist circumference in women. However there were no changes in weight for men or women.
A systematic review of all studies that looked at the impact of fermented foods on satiety (feeling full) showed no effect.
What should I do?
The evidence so far is very weak to support or recommend fermented foods for weight loss. These experimental studies have been short in length, and many did not report weight changes.
To date, most of the studies have used different fermented foods, so it is difficult to generalise across them all.
Nevertheless, fermented foods are still useful as part of a healthy, varied and balanced diet, particularly if you enjoy them. They are rich in healthy bacteria, and nutrients.
Are there downsides?
Some fermented foods, such as kimchi and sauerkraut, have added salt. The latest kimchi study said the average amount of kimchi South Koreans eat provides about 490mg of salt a day. For an Australian, this would represent about 50% of the suggested dietary target for optimal health.
Eating too much salt increases your risk of high blood pressure, heart disease and stroke.
Evangeline Mantzioris, Program Director of Nutrition and Food Sciences, Accredited Practising Dietitian, University of South Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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The Inflammation Spectrum – by Dr. Will Cole
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We’ve previously reviewed Dr. Cole’s other book “Gut Feelings”, and now he’s back, this time to tackle inflammation.
The focus here is on understanding what things trigger inflammation in your body—personally yours, not someone else’s—by something close to the usual elimination process yes, but he offers a way of sliding into it gently instead of simply quitting all the things and gradually adding everything back in.
The next step he takes the reader through is eating not just to avoid triggering inflammation, but to actively combat it. From there, it should be possible for the reader to build an anti-inflammatory cookbook, that’s not only one’s own personal repertoire of cooking, but also specifically tailored to one’s own personal responses to different ingredients.
The style of this book is very pop-science, helpful, walking-the-reader-by-the-hand through the processes involved. Dr. Cole wants to make everything as easy as possible.
Bottom line: if your diet could use an anti-inflammatory revamp, this is a top-tier guidebook for doing just that.
Click here to check out The Inflammation Spectrum, find your food triggers and reset your system!
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What’s Your Ikigai?
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Ikigai: A Closer Look
We’ve mentioned ikigai from time to time, usually when discussing the characteristics associated with Blue Zone centenarians, for example as number 5 of…
It’s about finding one’s “purpose”. Not merely a function, but what actually drives you in life. And, if Japanese studies can be extrapolated to the rest of the world, it has a significant and large impact on mortality (other factors being controlled for); not having a sense of ikigai is associated with an approximately 47%* increase in 7-year mortality risk in the categories of cardiovascular disease and external cause mortality:
Sense of life worth living (ikigai) and mortality in Japan: Ohsaki Study
*we did a lot of averaging and fuzzy math to get this figure; the link will show you the full stats though!
In case that huge (n=43,391) study didn’t convince you, here’s another comparably-sized (n=43,117) one that found similarly, albeit framing the numbers the other way around, i.e. a comparable decrease in mortality risk for having a sense of ikigai:
This study was even longer (12 years rather than 7), so the fact that it found pretty much the same results the 7-year study we cited just before is quite compelling evidence. Again, multivariate hazard ratios were adjusted for age, BMI, drinking and smoking status, physical activity, sleep duration, education, occupation, marital status, perceived mental stress, and medical history—so all these things were effectively controlled for statistically.
Three kinds of ikigai
There are three principal kinds of ikigai:
- Social ikigai: for example, a caring role in the family or community, volunteer work, teaching
- Asocial ikigai: for example, a solitary practice of self-discipline, spirituality, or study without any particular intent to teach others
- Antisocial ikigai: for example, a strong desire to outlive an enemy, or to harm a person or group that one hates
You may be thinking: wait, aren’t those last things bad?
And… Maybe! But ikigai is not a matter of morality or even about “warm fuzzy feelings”. The fact is, having a sense of purpose increases longevity regardless of moral implications or niceness.
Nevertheless, for obvious reasons there is a lot more focus on the first two categories (social and asocial), and of those, especially the first category (social), because on a social level, “we all do well when we all do well”.
We exemplified them above, but they can be defined:
- Social: working for the betterment of society
- Asocial: working for the betterment of oneself
Of course, for many people, the same ikigai may cover both of those—often somebody who excels at something for its own sake and/but shares it with others to enrich their lives also, for example a teacher, an artist, a scientist, etc.
For it to cover both, however, requires that both parts of it are genuinely part of their feeling of ikigai, and not merely unintended consequences.
For example, a piano teacher who loves music in general and the piano in particular, and would gladly spend every waking moment studying/practising/performing, but hates having to teach it, but needs to pay the bills so teaches it anyway, cannot be said to be living any kind of social ikigai there, just asocial. And in fact, if teaching the piano is causing them to not have the time or energy to pursue it for its own sake, they might not even be living any ikigai at all.
One other thing to watch out for
There is one last stumbling block, which is that while we can find ikigai, we can also lose it! Examples of this may include:
- A professional whose job is their ikigai, until they face mandatory retirement or are otherwise unable to continue their work (perhaps due to disability, for example)
- A parent whose full-time-parent role is their ikigai, until their children leave for school, university, life in general
- A married person whose “devoted spouse” role is their ikigai, until their partner dies
For this reason, people of any age can have a “crisis of identity” that’s actually more of a “crisis of purpose”.
There are two ways of handling this:
- Have a back-up ikigai ready! For example, if your profession is your ikigai, maybe you have a hobby waiting in the wings, that you can smoothly jump ship to upon retirement.
- Embrace the fluidity of life! Sometimes, things don’t happen the way we expect. Sometimes life’s surprises can trip us up; sometimes they can leave us a sobbing wreck. But so long as life continues, there is an opportunity to pick ourselves up and decide where to go from that point. Note that this is not fatalism, by the way, it doesn’t have to be “this bad thing happened so that we could find this good thing, so really it was a good thing all along”. Rather, it can equally readily be “well, we absolutely did not want that bad thing to happen, but since it did, now we shall take it this way from here”.
For more on developing/maintaining psychological resilience in the face of life’s less welcome adversities, see:
Psychological Resilience Training
…and:
Putting The Abs Into Absurdity ← do not underestimate the power of this one
Take care!
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No-Frills, Evidence-Based Mindfulness
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What’s on your mind, really?
We hear a lot about “the evidence-based benefits of mindfulness”, but what actually are they? And what is the evidence? And, perhaps most importantly: how do we do it?
What are the benefits?
The benefits of mindfulness are many, and include:
- reducing stress
- reducing pain
- improving quality of life
- reducing fatigue
- providing relief from digestive disorders
- reducing symptoms of sleep disorders
- improving immune response
- providing support for caregivers
The evidence is also abundant, and includes:
- Effects of mindfulness exercises as stand-alone intervention on symptoms of anxiety and depression: Systematic review and meta-analysis
- Fusing character strengths and mindfulness interventions: Benefits for satisfaction and performance
- Evidence for the Role of Mindfulness in Cancer: Benefits and Techniques
- Effects of mindfulness-based stress reduction on anxiety symptoms: A systematic review and meta-analysis
- The benefits of meditation and mindfulness practices during times of crisis such as COVID-19
Sounds great… What actually is it, though?
Mindfulness is the state of being attentive to one’s mind. This is at its heart a meditative practice, but that doesn’t necessarily mean you have to be sitting in the lotus position with candles—mindfulness can be built into any daily activity, or even no activity at all.
An exercise you can try right now:
Take a moment to notice everything you can hear. For this writer, that includes:
- The noise of my keystrokes as I type
- The ticking of the clock on the wall
- The gentle humming of my computer’s processor
- The higher-pitched noise of my computer’s monitor
- Birdsong outside
- Traffic further away
- My own breathing
- The sound of my eyelids as I blink
Whatever it is for you, notice how much you can notice that you had previously taken for granted.
You can repeat this exercise with other senses, by the way! For example:
- Notice five things you can see in your immediate environment that you’ve never noticed before. If you’re at home reading this, you probably think you’re very familiar with everything around you, but now see that mark on the wall you’d never noticed before, or a quirk of some electrical wiring, or the stitching on some furnishing, for example.
- Notice the textures of your clothes, or your face, or perhaps an object you’ve never paid attention to touching before. Your fingertips, unless you have some special reason this doesn’t apply to you, are far more sensitive than you probably give them credit for, and can notice the tiniest differentiation in textures, so take a moment to do that now.
- Mindful eating can be an especially healthful practice because it requires that we pay every attention to what we’re putting in our mouth, tasting, chewing, swallowing. No more thoughtlessly downing a box of cookies; every bite is now an experience. On the one hand, you’ll probably eat less at a sitting. On the other hand, what a sensory experience! It really reminds one that life is for living, not just for zipping through at a speed-run pace!
What about mindfulness as a meditative practice?
Well, those are meditative practices! But yes, mindfulness goes for more formal meditation too. For example:
Sit comfortably, with good posture, whatever that means to you. No need to get too caught up in the physical mechanics here—it’d take a whole article. For now, if you’re sitting and comfortable, that’s enough.
Notice your breathing. No need to try to control it—that’s not what this is about today. Just notice it. The in, the out, whether you breathe to your chest or abdomen, through your nose or mouth, don’t worry about doing it “right”, just notice what you are doing. Observe without judgement.
Notice your thoughts—no need to try to stop them. Notice noticing your thoughts, and again, observe without judgement. Notice your feelings; are you angry, hopeful, stressed, serene? There are no wrong answers here, and there’s nothing you should try to “correct”. Just observe. No judgement, only observe. Watch your thoughts, and watch your thoughts go.
Did you forget about your breathing while watching your thoughts? Don’t worry about that either if so, just notice that it happened. If you have any feelings about that, notice them too, and carry on observing.
We go through so much of our lives in “autopilot”, that it can be an amazing experience to sometimes just “be”—and be aware of being.
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Feel Better In 5 – by Dr. Rangan Chatterjee
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We’ve featured Dr. Rangan Chatterjee before, and here’s a great book of his.
The premise is a realistic twist on a classic, the classic being “such-and-such, in just 5 minutes per day!”
In this case, Dr. Chatterjee offers many lifestyle interventions that each take just 5 minutes, with the idea that you implement 3 of them per day (your choice which and when), and thus gradually build up healthy habits. Of course, once things take as habits, you’ll start adding in more, and before you know it, half your lifestyle has changed for the better.
Which, you may be thinking “my lifestyle’s not that bad”, but if you improve the health outcomes of, say, 20 areas of your life by just a few percent each, you know much better health that adds up to? We’ll give you a clue: it doesn’t add up, it compounds, because each improves the other too, for no part of the body works entirely in isolation.
And Dr. Chatterjee does tackle the body systematically, by the way; interventions for the gut, heart, brain, and so on.
As for what these interventions look like; it is very varied. One might be a physical exercise; another, a mental exercise; another, a “make this health 5-minute thing in the kitchen”, etc, etc.
Bottom line: this is the most supremely easy of easy-ins to healthier living, whatever your starting point—because even if you’re doing half of these interventions, chances are you aren’t doing the other half, and the idea is to pick and choose how and when you adopt them in any case, just picking three 5-minute interventions each day with no restrictions. In short, a lot of value to had here when it comes to real changes to one’s serious measurable health.
Click here to check out Feel Better In 5, and indeed feel better in 5!
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Bromelain vs Inflammation & Much More
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Let’s Get Fruity
Bromelain is an enzyme* found in pineapple (and only in pineapple), that has many very healthful properties, some of them unique to bromelain.
*actually a combination of enzymes, but most often referred to collectively in the singular. But when you do see it referred to as “they”, that’s what that means.
What does it do?
It does a lot of things, for starters:
❝Various in vivo and in vitro studies have shown that they are anti-edematous, anti-inflammatory, anti-cancerous, anti-thrombotic, fibrinolytic, and facilitate the death of apoptotic cells. The pharmacological properties of bromelain are, in part, related to its arachidonate cascade modulation, inhibition of platelet aggregation, such as interference with malignant cell growth; anti-inflammatory action; fibrinolytic activity; skin debridement properties, and reduction of the severe effects of SARS-Cov-2❞
Some quick notes:
- “facilitate the death of apoptotic cells” may sound alarming, but it’s actually good; those cells need to be killed quickly; see for example: Fisetin: The Anti-Aging Assassin
- If you’re wondering what arachidonate cascade modulation means, that’s the modulation of the cascade reaction of arachidonic acid, which plays a part in providing energy for body functions, and has a role in cell structure formation, and is the precursor of assorted inflammatory mediators and cell-signalling chemicals.
- Its skin debridement properties (getting rid of dead skin) are most clearly seen when using bromelain topically (one can literally just make a pineapple poultice), but do occur from ingestion also (because of what it can do from the inside).
- As for being anti-thrombotic and fibrinolytic, let’s touch on that before we get to the main item, its anti-inflammatory properties.
If you want to read more of the above before moving on, though, here’s the full text:
Anti-thrombotic and fibrinolytic
While it does have anti-thrombotic effects, largely by its fibrinolytic action (i.e., it dissolves the fibrin mesh holding clots together), it can have a paradoxically beneficial effect on wound healing, too:
For more specifically on its wound-healing benefits:
In Vitro Effect of Bromelain on the Regenerative Properties of Mesenchymal Stem Cells
Anti-inflammatory
Bromelain is perhaps most well-known for its anti-inflammatory powers, which are so diverse that it can be a challenge to pin them all down, as it has many mechanisms of action, and there’s a large heterogeneity of studies because it’s often studied in the context of specific diseases. But, for example:
❝Bromelain reduced IL-1β, IL-6 and TNF-α secretion when immune cells were already stimulated in an overproduction condition by proinflammatory cytokines, generating a modulation in the inflammatory response through prostaglandins reduction and activation of cascade reactions that trigger neutrophils and macrophages, in addition to accelerating the healing process❞
~ Dr. Taline Alves Nobre et al.
Read in full:
Bromelain as a natural anti-inflammatory drug: a systematic review
Or if you want a more specific example, here’s how it stacks up against arthritis:
❝The results demonstrated the chondroprotective effects of bromelain on cartilage degradation and the downregulation of inflammatory cytokine (tumor necrosis factor (TNF)-α, IL-1β, IL-6, IL-8) expression in TNF-α–induced synovial fibroblasts by suppressing NF-κB and MAPK signaling❞
~ Dr. Perephan Pothacharoen et al.
Read in full:
More?
Yes more! You’ll remember from the first paper we quoted today, that it has a long laundry list of benefits. However, there’s only so much we can cover in one edition, so that’s it for today
Is it safe?
It is generally recognized as safe. However, its blood-thinning effect means it should be avoided if you’re already on blood-thinners, have some sort of bleeding disorder, or are about to have a surgery.
Additionally, if you have an allergy, this one may not be for you.
Aside from that, anything can have drug interactions, so do check with your doctor/pharmacist to be sure.
Want to try some?
You can just eat pineapples, but if you don’t enjoy that and/or wouldn’t want it every day, bromelain is available in supplement form too.
We don’t sell it, but here for your convenience is an example product on Amazon
Enjoy!
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