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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Peripheral Neuropathy: How To Avoid It, Manage It, Treat It
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Peripheral neuropathy (and what can be done about it)
Peripheral neuropathy is nerve damage, usually of the extremities. It can be caused by such things as:
- Diabetes
- Alcoholism
- Infection
- Injury
The manifestations can be different:
- In the case of diabetes, it’s also called diabetic neuropathy, and almost always affects the feet first.
- In the case of alcoholism, it is more generalized, but tends towards affecting the extremities first.
- In the case of infection, a lot depends on the nature of the infection and the body’s response.
- In the case of injury, it’ll naturally be the injured part, or a little “downstream” of the injured part.
- This could be the case of a single traumatic injury (e.g. hand got trapped in a slammed door)
This could be the case of a repetitive injury (carpal tunnel syndrome is a kind of peripheral neuropathy, and is usually caused by consistent misalignment of the carpal tunnel, the aperture through which a bundle of nerves make their way from the forearm to the hand)
Prevention is better than cure
If you already have peripheral neuropathy, don’t worry, we’ll get to that. But, if you can, prevention is better than cure. This means:
- Diabetes: if you can, avoid. This may seem like no-brainer advice, but it’s often something people don’t think about until hitting a pre-diabetic stage. Obviously, if you are Type 1 Diabetic, you don’t have this luxury. But in any case, whatever your current status, take care of your blood sugars as best you can, so that your blood can take care of you (and your nerves) in turn. You might want to check out our previous main feature about this:
- Alcoholism: obviously avoid, if you can. You might like this previous edition of 10almonds addressing this:
- Infection: this is so varied that one-liner advice is really just “try to look after your immune health”.
- We’ll do a main feature on this soon!
- Injury: obviously, try to be careful. But that goes for the more insidious version too! For example, if you spend a lot of time at your computer, consider an ergonomic mouse and keyboard.
- There are many kinds available, so read reviews, but here’s an example product on Amazon
Writer’s note: as you might guess, I spend a lot of time at my computer, and a lot of that time, writing. I additionally spend a lot of time reading. I also have assorted old injuries from my more exciting life long ago. Because of this, it’s been an investment in my health to have:
A standing desk
A vertical ergonomic mouse
An ergonomic split keyboard
A Kindle*
*Far lighter and more ergonomic than paper books. Don’t get me wrong, I’m writing to you from a room that also contains about a thousand paper books and I dearly love those too, but more often than not, I read on my e-reader for comfort and ease.
If you already have peripheral neuropathy
Most advice popular on the Internet is just about pain management, but what if we want to treat the cause rather than the symptom?
Let’s look at the things commonly suggested: try ice, try heat, try acupuncture, try spicy rubs (from brand names like Tiger Balm, to home-made chilli ointments), try meditation, try a warm bath, try massage.
And, all of these are good options; do you see what they have in common?
It’s about blood flow. And that’s why they can help even in the case of peripheral neuropathy that’s not painful (it can also manifest as numbness, and/or tingling sensations).
By getting the blood flowing nicely through the affected body part, the blood can nourish the nerves and help them function correctly. This is, in effect, the opposite of what the causes of peripheral neuropathy do.
But also don’t forget: rest
- Put your feet up (literally! But we’re talking horizontal here, not elevated past the height of your heart)
- Rest that weary wrist that has carpal tunnel syndrome (again, resting it flat, so your hand position is aligned with your forearm, so the nerves between are not kinked)
- Use a brace if necessary to help the affected part stay aligned correctly
- You can get made-for-purpose wrist and ankle braces—you can also get versions that are made for administering hot/cold therapy, too. That’s just an example product linked that we can recommend; by all means read reviews and choose for yourself, though. Try them and see what helps.
One more top tip
We did a feature not long back on lion’s mane mushroom, and it’s single most well-established, well-researched, well-evidenced, completely uncontested benefit is that it aids peripheral neurogenesis, that is to say, the regrowth and healing of the peripheral nervous system.
So you might want to check that out:
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Tribulus Terrestris For Testosterone?
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(Clinical) Trials and Tribul-ations
In the category of supplements that have enjoyed use as aphrodisiacs, Tribulus terrestris (also called caltrop, goat’s head, gokshura, or puncture vine) has a long history, having seen wide use in both Traditional Chinese Medicine and in Ayurveda.
It’s been used for other purposes too, and has been considered a “general wellness” plant.
So, what does the science say?
Good news: very conclusive evidence!
Bad news: the conclusion is not favorable…
Scientists are known for their careful use of clinical language, and it’s very rare for a study/review to claim something as proven (scientists leave journalists to do that part), and in this case, when it comes to Tribulus’s usefulness as a testosterone-enhancing libido-boosting supplement…
❝analysis of empirical evidence from a comprehensive review of available literature proved this hypothesis wrong❞
Strong words! You can read it in full here; they do make some concessions along the way (e.g. mentioning unclear or contradictory findings, suggesting that it may have some effect, but by an as-yet unknown mechanism if it does—although some potential effect on nitric oxide levels has been hypothesized, which is reasonable if so, as NO does feature in arousal-signalling), but the general conclusion is “no, this doesn’t have androgen-enhancing properties”:
Pro-sexual and androgen enhancing effects of Tribulus terrestris L.: Fact or Fiction
That’s a review though, what about taking a look at a representative RCT? Here we go:
❝Tribulus terrestris was not more effective than placebo on improving symptoms of erectile dysfunction or serum total testosterone❞
As a performance-enhancer in sport
We’ll be brief here: it doesn’t seem to work and it may not be safe:
Insights into Supplements with Tribulus Terrestris used by Athletes
From sport, into general wellness?
Finally, a study that finds it may be useful for something!
❝Overall, participants supplemented with TT displayed significant improvements in lipid profile. Inflammatory and hematological biomarkers showed moderate beneficial effects with no significant changes on renal biomarkers. No positive effects were observed on the immune system response. Additionally, no TT-induced toxicity was reported.
In conclusion, there was no clear evidence of the beneficial effects of TT supplementation on muscle damage markers and hormonal behavior.❞
About those lipids…
Animal studies have shown that it may not only improve lipid profiles, but also may partially repair the endothelial dysfunction resulting from hyperlipidemia:
Want to try some?
In the unlikely event that today’s research review has inspired you with an urge to try Tribulus terrestris, here’s an example product on Amazon
If on the other hand you’d like to actually increase testosterone levels, then we suggest:
Topping Up Testosterone? ← a previous main feature did earlier this year
Take care!
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5 dental TikTok trends you probably shouldn’t try at home
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TikTok is full of videos that demonstrate DIY hacks, from up-cycling tricks to cooking tips. Meanwhile, a growing number of TikTok videos offer tips to help you save money and time at the dentist. But do they deliver?
Here are five popular dental TikTok trends and why you might treat them with caution.
1. Home-made whitening solutions
Many TikTok videos provide tips to whiten teeth. These include tutorials on making your own whitening toothpaste using ingredients such as hydrogen peroxide, a common household bleaching agent, and baking soda (sodium bicarbonate).
In this video, the influencer says:
And then you’re going to pour in your hydrogen peroxide. There’s really no measurement to this.
But hydrogen peroxide in high doses is poisonous if swallowed, and can burn your gums, mouth and throat, and corrode your teeth.
High doses of hydrogen peroxide may infiltrate holes or microscopic cracks in your teeth to inflame or damage the nerves and blood vessels in the teeth, which can cause pain and even nerve death. This is why dental practitioners are bound by rules when we offer whitening treatments.
Sodium bicarbonate and hydrogen peroxide are among the components in commercially available whitening toothpastes. While these commercial products may be effective at removing surface stains, their compositions are carefully curated to keep your smile safe.
2. Oil pulling
Oil pulling involves swishing one tablespoon of sesame or coconut oil in your mouth for up to 20 minutes at a time. It has roots in Ayurvedic medicine, a traditional medicine practice that originates from the Indian subcontinent.
While oil pulling should be followed by brushing and flossing, I’ve had patients who believe oil pulling is a replacement for these practices.
There has been some research on the potential of oil pulling to treat gum disease or other diseases in the mouth. But overall, evidence that supports the effectiveness of oil pulling is of low certainty.
For example, studies that test the effectiveness of oil pulling have been conducted on school-aged children and people with no dental problems, and often measure dental plaque growth over a few days to a couple of weeks.
Chlorhexidine is an ingredient found in some commercially available mouthwashes.
In one study, people who rinsed with chlorhexidine mouthwash (30 seconds twice daily) developed less plaque on their teeth compared to those who undertook oil pulling for eight to 10 minutes.Ultimately, it’s unlikely you will experience measurable gain to your oral health by adding oil pulling to your daily routine. If you’re time-poor, you’re better off focusing on brushing your teeth and gums well alongside flossing.
3. Using rubber bands to fix gaps
This TikTok influencer shows his followers he closed the gaps between his front teeth in a week using cheap clear rubber bands.
But this person may be one of the lucky few to successfully use bands to close a gap in his teeth without any mishaps. Front teeth are slippery and taper near the gums into cone-shaped roots. This can cause bands to slide and disappear into the gums to surround the tooth roots, which can cause infections and pain.
If this happens, you may require surgery that involves cutting your gums to remove the bands. If the bands have caused an infection, you may lose the affected teeth. So it’s best to leave this sort of work to a dental professional trained in orthodontics.
4. Filing or cutting teeth to shape them
My teeth hurt just watching this video.
Cutting or filing teeth unnecessarily can expose the second, more sensitive tooth layer, called dentine, or potentially, the nerve and blood vessels inside the tooth. People undergoing this sort of procedure could experience anything from sensitive teeth through to a severe toothache that requires root canal treatment or tooth removal.
You may notice dentist drills spray water when cutting to protect your teeth from extreme heat damage. The drill in this video is dry with no water used to cool the heat produced during cutting.
It may also not be sterile. We like to have everything clean and sterile to prevent contaminated instruments used on one patient from potentially spreading an infection to another person.
Importantly, once you cut or file your teeth away, it’s gone forever. Unlike bone, hair or nails, our teeth don’t have the capacity to regrow.
5. DIY fillings
Many people on TikTok demonstrate filling cavities (holes) or replacing gaps between teeth with a material made from heated moulded plastic beads. DIY fillings can cause a lot of issues – I’ve seen this in my clinic first hand.
While we may make it look simple in dental surgeries, the science behind filling materials and how we make them stick to teeth to fill cavities is sophisticated.
Filling a cavity with the kind of material made from these beads will be as effective as using sticky tape on sand. Not to mention the cavity will continue to grow bigger underneath the untreated “filled” teeth.
I know it’s easy to say “see a dentist about that cavity” or “go to an orthodontist to fix that gap in your teeth you don’t like”, but it can be expensive to actually do these things. However if you end up requiring treatment to fix the issues caused at home, it may end up costing you much more.
So what’s the take-home message? Stick with the funny cat and dog videos on TikTok – they’re safer for your smile.
Arosha Weerakoon, Senior Lecturer and General Dentist, School of Dentistry, The University of Queensland
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Why Do We Have Pores, And Could We Not?
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
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
❝Do we really need pores, and why are they bigger on the face?❞
Pores secrete sweat or sebum (there are different kinds of pores for each).
If we didn’t have sweat pores, we’d be unable to sweat, which superficially may seem like a bonus, but it’d make us prone to overheating (like dogs, pigs, and other mammals that cannot sweat).
If we didn’t have sebum pores (usually called hair follicles, which are supplied by a sebaceous gland), we’d be completely hairless, and also unable to supply our skin with natural oils that keep it healthy. So we’d have no hair and very unhappy skin.
Which is ironic, because to believe beauty magazines, we must at all costs minimize our pores (and indeed, interventions like botox* can kill them).
*Let’s give that its full name though:
Suffice it to say, we do not recommend getting injected with neurotoxins unless it is truly necessary to ward off a greater harm.
As for being bigger on the face, they need not be, but sebaceous glands are more active and numerous there, being most active and numerous in the face/forehead—which is why oily skin is more likely to appear there than other parts of the body.
If your facial sebaceous glands are too active for your liking…
…there are ways to reduce that, a simple and relatively gentle way (relative, for example, botox) is with retinoids, including retinols or retinoic acids. Here’s some of the science of that; the paper is about treating acne, but the mechanism of action is the same (down-regulating the sebaceous glands’ action):
The potential side-effects, however were noted as:
- Cheilitis
- Desquamation of the skin
- Pruritus
Which, in translation from sciencese, means:
- Chapped lips
- Flaky skin
- Itchiness
Which aren’t necessarily fun, which is why with retinoids are best taken in very small doses at first to see how your skin reacts.
Remember when we said what your skin would be like without pores? This is what would happen, only much worse.
Take care!
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A new government inquiry will examine women’s pain and treatment. How and why is it different?
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The Victorian government has announced an inquiry into women’s pain. Given women are disproportionately affected by pain, such a thorough investigation is long overdue.
The inquiry, the first of its kind in Australia and the first we’re aware of internationally, is expected to take a year. It aims to improve care and services for Victorian girls and women experiencing pain in the future.
The gender pain gap
Globally, more women report chronic pain than men do. A survey of over 1,750 Victorian women found 40% are living with chronic pain.
Approximately half of chronic pain conditions have a higher prevalence in women compared to men, including low back pain and osteoarthritis. And female-specific pain conditions, such as endometriosis, are much more common than male-specific pain conditions such as chronic prostatitis/chronic pelvic pain syndrome.
These statistics are seen across the lifespan, with higher rates of chronic pain being reported in females as young as two years old. This discrepancy increases with age, with 28% of Australian women aged over 85 experiencing chronic pain compared to 18% of men.
It feels worse
Women also experience pain differently to men. There is some evidence to suggest that when diagnosed with the same condition, women are more likely to report higher pain scores than men.
Similarly, there is some evidence to suggest women are also more likely to report higher pain scores during experimental trials where the same painful pressure stimulus is applied to both women and men.
Pain is also more burdensome for women. Depression is twice as prevalent in women with chronic pain than men with chronic pain. Women are also more likely to report more health care use and be hospitalised due to their pain than men.
Women seem to feel pain more acutely and often feel ignored by doctors.
ShutterstockMedical misogyny
Women in pain are viewed and treated differently to men. Women are more likely to be told their pain is psychological and dismissed as not being real or “all in their head”.
Hollywood actor Selma Blair recently shared her experience of having her symptoms repeatedly dismissed by doctors and put down to “menstrual issues”, before being diagnosed with multiple sclerosis in 2018.
It’s an experience familiar to many women in Australia, where medical misogyny still runs deep. Our research has repeatedly shown Australian women with pelvic pain are similarly dismissed, leading to lengthy diagnostic delays and serious impacts on their quality of life.
Misogyny exists in research too
Historically, misogyny has also run deep in medical research, including pain research. Women have been viewed as smaller bodied men with different reproductive functions. As a result, most pre-clinical pain research has used male rodents as the default research subject. Some researchers say the menstrual cycle in female rodents adds additional variability and therefore uncertainty to experiments. And while variability due to the menstrual cycle may be true, it may be no greater than male-specific sources of variability (such as within-cage aggression and dominance) that can also influence research findings.
The exclusion of female subjects in pre-clinical studies has hindered our understanding of sex differences in pain and of response to treatment. Only recently have we begun to understand various genetic, neurochemical, and neuroimmune factors contribute to sex differences in pain prevalence and sensitivity. And sex differences exist in pain processing itself. For instance, in the spinal cord, male and female rodents process potentially painful stimuli through entirely different immune cells.
These differences have relevance for how pain should be treated in women, yet many of the existing pharmacological treatments for pain, including opioids, are largely or solely based upon research completed on male rodents.
When women seek care, their pain is also treated differently. Studies show women receive less pain medication after surgery compared to men. In fact, one study found while men were prescribed opioids after joint surgery, women were more likely to be prescribed antidepressants. In another study, women were more likely to receive sedatives for pain relief following surgery, while men were more likely to receive pain medication.
So, women are disproportionately affected by pain in terms of how common it is and sensitivity, but also in how their pain is viewed, treated, and even researched. Women continue to be excluded, dismissed, and receive sub-optimal care, and the recently announced inquiry aims to improve this.
What will the inquiry involve?
Consumers, health-care professionals and health-care organisations will be invited to share their experiences of treatment services for women’s pain in Victoria as part of the year-long inquiry. These experiences will be used to describe the current service delivery system available to Victorian women with pain, and to plan more appropriate services to be delivered in the future.
Inquiry submissions are now open until March 12 2024. If you are a Victorian woman living with pain, or provide care to Victorian women with pain, we encourage you to submit.
The state has an excellent track record of improving women’s health in many areas, including heart, sexual, and reproductive health, but clearly, we have a way to go with women’s pain. We wait with bated breath to see the results of this much-needed investigation, and encourage other states and territories to take note of the findings.
Jane Chalmers, Senior Lecturer in Pain Sciences, University of South Australia and Amelia Mardon, PhD Candidate, University of South Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Overcoming Tendonitis – by Dr. Steven Low & Dr. Frank Skretch
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If you assumed tendonitis to be an inflammatory condition, you’re not alone. However, it’s not; the “-itis” nomenclature is a misnomer, and while one can rarely go wrong with reducing chronic/systemic inflammation, it’s not the cure for tendonitis.
What, then, is tendonitis and what does cure it? It’s a non-inflammatory proliferation disorder, meaning, something is growing (or in this case, simply being replaced) in a way it shouldn’t. As to fixing it, that’s more complex.
This book does cover 20 interventions (sorted into “major” and “minor”), ranging from exercise therapies to surgery, with many things between. It also examines popular myths that do not help, such as rest, ice, heat, and analgesics.
The style of this book is hard science, but don’t worry, it explains everything along the way. It does however mean that if you’re not very accustomed to wading through scientific material, you can’t just dip into the middle of the book and be guaranteed to understand what’s going on. Indeed, before even getting to discussing tendonitis/tendinopathy, the first chapter is very reassuringly dedicated to “understanding the levels and classification of evidence in studies”, along with the assorted scales and guidelines of the Center for Evidence-Based Medicine.
The rest, however, is about the etiology, diagnosis, and treatment of tendonitis and tendinopathy more generally. One interesting thing is that, according to the abundant high-quality evidence presented in this book, what works for one body part’s tendonitis does not necessarily work for another body part, so we get quite a part-by-part rundown.
Bottom line: this book has a wealth of useful, applicable information about management of tendonitis, making it indispensable if you or a loved one suffer from such—but settle in, because it’s not a light read.
Click here to check out Overcoming Tendonitis, and overcome tendonitis!
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