Exercise, The Miracle Drug By E. Dylan Mayer Levels of anxiety, stress and depression are at all-time highs during the COVID-19 pandemic, and there is little doubt that this compromised state of our mental wellness will continue into the next year. Many of us are in lockdowns, unable to gather with family & friends during the holidays and feeling claustrophobic from doing everything at home. While these negative emotional feelings are to be expected during a situation as unique as this one, my experience both as a neuroscience major and fitness enthusiast have taught me something about exercise and brain chemistry: physical exercise is not only good for your body, but it also has profound effects on your brain. The Centers for Disease Control and Prevention recommend that adults get at least 150 minutes of moderate-intensity aerobic activity per week.1 Even though we have always known that regular exercise is good for your metabolic and cardiovascular health, a large body of scientific evidence demonstrates that it is equally important for our brain, mental health and overall well-being. While it is known that physically active people have lower rates of anxiety and depression than sedentary people,2 do we know how regular running or walking or working out in the gym can affect the brain? There are at least 4 major mechanisms which have been implicated. Exercise helps stimulate parts of your brain that aren’t as responsive when you’re feeling depressed. More so, exercise promotes the release of endorphins - the “feel-good” neurotransmitter3 - which has a similar structure and acts on similar receptors as morphine does. Exercise-induced endorphin release is thought to be one of the mechanisms behind “runner’s high”, but unlike morphine, endorphin receptor activation does not lead to addiction or dependence.4 Exercise not only affects endorphin levels in the brain, but it also affects the release of other neurotransmitters such as dopamine, norepinephrine and serotonin, all of which are important chemicals involved in mood regulation.5 Similar to the effect of a certain class of antidepressants, like Prozac, exercise induced increases in brain levels of serotonin boosts your mood6 and overall sense of well-being. It can also help improve your appetite and sleep cycles, which are often negatively affected by depression.7 Several laboratory studies have demonstrated a beneficial effect of regular exercise on important brain chemicals. Researchers found that mice with free access to a running wheel versus those which…

The Remarkable Health Benefits of Abdominal Breathing By Suzanne Smith, RN, NP 2020 has been a challenging year to say the least. We have all been impacted significantly and many of the resources we rely on for our well-being are not available. Most gyms and studios are closed, it is not safe to gather in groups and most of us are working or studying from home making it difficult for work/life balance. It is especially important in these times to focus on healthy behaviors that promote a healthy immune and nervous system. Diaphragmatic breathing or abdominal breathing is a free, easily accessible and effective stress reduction tool that influences our physiological state and promotes a resilient nervous system. It creates a calm and vibrant energy and can be practiced sitting, standing or lying down by anyone at anytime. Breathing exercises for health benefits have been used for thousands of years in many cultures and mounting evidence is confirming these benefits. Breathing is regulated involuntarily by the autonomic nervous system according to a wide range of cues from the body and the environment. The autonomic nervous system consists of two main branches involved in breathing, the sympathetic branch which mediates “flight, flight, freeze” response, and the parasympathetic branch engaged during periods of “rest and digest”. When we experience a stressor, our body adjusts to the demands and adapts our breathing accordingly resulting in shallow breaths into our chest at an increased rate. We have all experienced the stress response and we usually recover within a short time. However, when stress is present for prolonged periods and sympathetic activity becomes dominant, a situation called in scientific terms Allostatic Load, our system moves out of balance which can lead to low-grade immune activation throughout the body and numerous health problems.1 The good news is that breathing is also a voluntary mechanism and by simply altering our breathing pattern, we can alter our physiology and bring it back into balance. Breathing is a great tool to regulate the stress response in the moment. For most adult people, even when we are not feeling stressed we automatically take shallow chest breaths and do not relax our abdomen. While deep chest breathing is optimal for the acute fight and flight response, it does not exercise our capacity for regular optimal breathing. When we consciously take slow deep breaths with movement from the diaphragm, our abdomen relaxes…

The Brain’s Powerful Role in Affecting Our Well-Being By Emeran A. Mayer, MD The close interactions between the mind, the gut and the microbiome have become an increasingly popular topic both in science and in the lay press. After decades of denying a role of the brain in such common disorders as irritable bowel syndrome (IBS) and “functional” dyspepsia, new medical guidelines1 are now referring to them as “disorders of altered brain gut interactions”, and treatments such as mindfulness-based stress reduction and cognitive behavioral therapies are increasingly accepted by both patients and physicians as treatments with equal or greater effectiveness, but without side effects (compared to expensive pharmaceutical treatments). At the same time, the possible role of alterations in the gut microbiome (“dysbiosis”) as a cause of symptoms in IBS, and as a possible target for microbiome targeted treatments (including probiotics, antibiotics) has received increasing attention. However, there is an equally important aspect of mind-gut and mind-body interactions that is often dismissed as a problem in clinical trials which aim to provide evidence-based proof for the superiority of a particular pharmaceutical intervention over a non-active treatment arm. I am obviously referring to the placebo effect, the objective treatment success associated with the intake of an inert sugar pill, indistinguishable from the active drug. As discussed in a recent review in the NEJM,2 in many well controlled clinical trials for pain, gastrointestinal or psychiatric disorders, responses to the inert sugar pill have been similar to the active drug. For example, there are almost no medications which have been shown to be more effective than 10% above active therapy in the treatment of IBS symptoms, and even this small advantage may be influenced by an underlying placebo response. Surprisingly, even when IBS patients were explicitly told that they are taking a placebo pill by their doctor, they showed greater symptom improvement than a control group without any intervention!3 Contrary to traditional explanations that the placebo response is a psychological phenomenon, science has revealed that these powerful effects are associated with the release of various neuro-active substances in the brain, including opioids, endocannabinoids, dopamine and oxytocin. What is even more intriguing is the fact that the brain’s influence on symptoms and their perception are not limited to positive, therapeutic effects, but can have a major negative influence on symptoms. Side effects thought to be due to the medications in the active treatment arm,…

Two Simple Changes for Better Metabolic Health By Jill Horn The body, and in particular the brain gut microbiome axis are complex systems with all parts being in constant bidirectional communication with each other through multiple feedback loops.1 The behavior of such complex systems is characterized by regular fluctuations or oscillations, which are a measure of the health of the system. On the other hand, a loss of oscillations is a sign of compromised resilience of the system and disease. One of the most important oscillation mechanisms for all life forms on earth is the circadian rhythm. The circadian rhythm is generated by a biological process which affects metabolism and behavior.1 A tiny region in the hypothalamus, the so-called suprachiasmatic nucleus or SCN is the “master clock” of the circadian rhythm and receives input from the retina about the concurrent light situation, through which it is synchronized with the “light-dark” cycle. The SCN then signals appropriate behavioral cues to the brain and peripheral organs via rhythmic humoral and neuronal signals. This means it synchronizes the “light-dark” and the “feeding-fasting” cycles and thus regulates circadian rhythm. In the brain and in the gut and its microbiome, oscillatory transcription and translation known as genetic feedback loops play a crucial role in the body’s metabolism.2 The feedback loop in the peripheral clocks, including the gut is mainly influenced by the time of food intake and thus sensitive to the feeding-fasting and the light dark cycle. In animal studies, dysfunction of the peripheral clock due to irregular feeding times or suppression of microbiome oscillations by broadspectrum antibiotic intake has been shown to disrupt lipid metabolism, glucose homeostasis, and inflammation,2 as well as causing weight gain and fatty liver disease.3 Time-restricted eating (TRE) (or time restricted feeding (TRF) in animals) is a dietary approach that limits food intake to about 8 hours per day and emphasizes the timing of food intake, rather than the total amount of food consumed. In contrast to intermittent fasting, which requires prolonged periods without any food intake and a reduction in caloric intake, TRE’s main focus is to ingest food at specific times of the day, while keeping the gut and its microbiome in a non-fed state for about 16 hours, with restricting caloric intake. This strategy has many different effects on the gut and its microbes, including the predominance of a unique pattern of gastrointestinal contractions (so called migrating…

Optimism and Cardiovascular Health By Jill Horn with Emeran A. Mayer, MD The concept of cardiovascular health (CVH) was developed by the American Heart Association, and is based on a shift of focus away from disease treatment and toward health prevention and promotion.1 CVH is a fundamental part of well-being even before the development of risk factors, and according to current research, less than 10% of middle-aged adults meet the criteria for favorable CVH.2 In fact, cardiovascular diseases make up the largest portion of the modern non-communicable chronic disease epidemic (which include metabolic syndrome, obesity, degenerative brain disorders, cancer and autoimmune diseases), and they are the leading cause of death on a global scale.3 Amongst other lifestyle factors, the Western diet has been identified as a major risk factor for all these diseases. There are several well-known factors that have been shown to positively affect CVH: a largely plant based diet (like the Mediterranean or Okinawan),4 low in saturated fat and in highly processed carbohydrates and high in fiber and polyphenols, regular physical exercise, the elimination of smoking, and a healthy body mass index.1 However, often neglected, research has also explored the role of the mind and mental states as an important determinant of CVH. According to a recent paper published by Julia Boehm and colleagues in the journal Psychosomatic Medicine, an optimistic view of life may have a small, but significantly favorable effect on CVH. The study, performed over a 10-year time period in 5,115 male and female participants from all socio demographic backgrounds found a small but statistically significant correlation between optimism and CVH, a correlation that was strongest in women.2 Even though the observed correlation was small, the authors emphasize the impact such a relatively small correlation can have on health outcomes across the life-span of a large population.2 In an earlier study, using a meta-analysis of 15 published studies, optimistic individuals were found to have a 35% decreased risk of suffering a cardiovascular event, when compared to individuals who were less optimistic.5 There are several reasons which could explain these findings: 1) Optimistic individuals often are more likely to pursue healthy lifestyles, including physical activity, healthy diets and social interactions, and are more likely to use effective coping strategies in the event of distress.6 More precisely, optimism was shown to reduce maladaptive coping mechanisms such as avoidance and withdrawal from stressful emotions. On the other hand,…