Adderall Misuse May Be Hidden Part of Teen Amphetamine Abuse

American teens underestimate their use of amphetamines, likely because many don’t know that the attention-deficit/hyperactivity disorder (ADHD) drug Adderall is an amphetamine, a new study suggests.

High school and college students sometimes use Adderall, a type of stimulant medication, without a doctor’s order because they believe it will boost their mental function and school performance.

Use of amphetamines without a doctor’s order, known as nonmedical use, carries a high risk of abuse and dependency, as well as potential harmful side effects such as heart problems and seizures. People who use prescription stimulants like amphetamines without a doctor’s order also are more likely to engage in other drug use and risky behaviors, the researchers said.

The researchers examined the responses of more than 24,000 high school seniors who took part in a national survey between 2010 and 2015. Though nearly 8 percent of the students reported nonmedical amphetamine use and about 7 percent reported nonmedical Adderall use in the past year, about 29 percent of nonmedical Adderall users reported no nonmedical amphetamine use.

Students aged 18 and older, black students, and students with parents with lower education levels were more likely than others to report no nonmedical amphetamine use, despite reporting nonmedical Adderall use, the study found. It was conducted by the Center for Drug Use and HIV/HCV Research at New York University’s Meyers College of Nursing in New York City.

“Over a quarter of teens who reported using Adderall without a doctor telling them to take it contradicted themselves by saying they do not use amphetamine,” senior author Joseph Palamar, an associate professor of population health, said in a university news release.

“As a result, the estimated prevalence of nonmedical amphetamine use of 7.9 percent may be an underestimate,” he said. “It may be as high as 9.8 percent, or one out of 10 high school seniors, when considering the discordant reporting we found.”

“Our findings suggest that many young people are unaware that Adderall is amphetamine,” Palamar said. “In addition, such conflicting reports mean that prescription stimulant misuse may be underestimated.”

The study was published Oct. 23 in the journal Drug and Alcohol Dependence.

“Alarmingly, we had similar findings regarding opioids in another study, with many teens appearing unaware that the Vicodin and OxyContin they took are opioids,” Palamar added. “Better drug education is needed to inform the public about common drugs like amphetamines and opioids.”

He and his colleagues also said their study shows the need to improve how drug use surveys are conducted. For example, surveys could provide images of specific substances to help respondents recognize specific pills.

SOURCE: New York University, news release, Oct. 23, 2017


A healthy heart may protect older adults from disability


A healthy heart is important to the well-being of older adults. The American Heart Association (AHA) defines “ideal cardiovascular health” based on four health behaviors (current smoking, body mass index, physical activity, and healthy diet and three health factors (total cholesterol, blood pressure), and fasting blood glucose level).

Recently, a team of researchers studied older Latin Americans to examine the relationship between the AHA guidelines and disability. Their study was published in the Journal of the American Geriatrics Association.

The relationship is an important one to consider, since heart disease (also known as “cardiovascular disease”) can lead to several disabling problems for older adults. In fact, heart attacks and strokes are the first and third most common causes of disability in the US. The effect of a stroke on the brain is a leading cause of disability. Cardiovascular disease is the second leading cause of dementia and, for older adults, the disease also can make it difficult to function in daily life.

In their study, the researchers used information from the Chilean National Health Survey conducted between 2009-2010. 460 Chilean adults all over age 65 participated in the study.

The researchers measured AHA-identified heart-healthy behaviors:

  • Maintain a Body Mass Index (BMI) of less than 25. (BMI is a ratio between your weight and height.)
  • Be physically active for at least 30 minutes a day, 5 or more days a week.
  • Don’t smoke tobacco.
  • Eat a healthy diet with plenty of fruits and vegetables and few to no processed or fast foods.

The researchers also measured these risk factor measurements of “ideal cardiovascular health”:

  • Blood pressure of 120/80
  • Total cholesterol under 200 mg/dL
  • Fasting blood sugar under 100 mg/dL

In their study, the researchers created three different levels of health based on the participants’ cardiovascular-healthy behaviors and heart health factors:

  • People in the healthiest level had 5 to 7 of the behaviors/measurements.
  • People in the middle level had 3 to 4 healthy behaviors/measurements.
  • People in the lowest (most unhealthy) level had 0 to 2 behaviors/measurements.

The researchers compared the behaviors/measurements with disability among the participants. They learned that having an ideal level of physical activity reduced the chances for being disabled for older adults, even for those who had a history of heart disease or arthritis.

The researchers also found that Chilean women tended to be less active and more disabled than Chilean men.

Compared to people with an unhealthy level of behaviors/measurements, people in the two healthier groups had a lower risk for disability.

Finally, people who had an ideal BMI had lower disability. The researchers noted that obesity may quicken age-related declines in functional ability, and poses a threat to independence as we age. The authors suggest that public policies might promote ideal health behaviors early in life, helping people maintain their health into older adulthood.


Does smell sensitivity change everyday?

It has always been apparent that some individuals have a better sense of smell than others, but a new study of 37 teens provides the first direct evidence that within each person, smell sensitivity varies over the course of each day. The pattern, according to the data, tracks with the body’s internal day-night cycle, or circadian rhythm.

“This finding is very important for olfactory perception science,” said Rachel Herz, lead author of the study in Chemical Senses and an adjunct assistant professor of psychiatry and human behavior at the Warren Alpert Medical School of Brown University. “This hadn’t been known before and this is the first clear, direct evidence.”

As one of the five senses, smell is an important ability, Herz noted, not only for experiencing and enjoying the world, but also for receiving information about danger, such as nearby fire or spoiled food, and for basic functions like eating. Changes in the sense during the day can affect all these capabilities.

Indeed Herz, an expert in the sense of smell, made the findings in collaboration with sleep expert Mary Carskadon, a Brown professor of psychiatry and human behavior. Carskadon is conducting a larger study with a hypothesis that circadian timing and sleep habits may affect the eating habits of teens, potentially contributing to obesity. Smell is associated with food consumption, notes Herz — who has authored the upcoming book “Why You Eat What You Eat” — so the researchers devised an experiment to determine whether smell varies with circadian rhythm.

28-hour ‘days’

To conduct the study, the researchers asked the 21 boys and 16 girls, all between ages 12 and 15, to sleep on a fixed schedule for two weeks before reporting to the Bradley Hospital sleep lab. After an adaptation night in the lab, the teens began a week of 28-hour days where their sleep was shifted four hours later each “night.”

All along, they lived indoors in dim light, socializing and participating in fun activities with each other and staff members. The goal was to separate them temporarily from typical sleep disruptions and from external cues of circadian timing. In this way, Carskadon said, their inherent, internal circadian rhythms could be measured, as could the sensitivity of their sense of smell at all times throughout their rhythms (in addition to other measures, such as food intake).

The team measured circadian rhythm by detecting levels of the sleep-cueing hormone melatonin in their saliva. Melatonin secretion begins about an hour before the urge to sleep hits. They assessed smell sensitivity using “Sniffin’ Sticks,” a common test for measuring odor detection thresholds. Each time they used the sticks, the researchers could determine the threshold concentration of the odor that the teens could detect. Smell was assessed every three hours while teens were awake.

The rhythm of smell

Individuals varied substantially in how much their smell sensitivity varied over a circadian cycle and in when it peaked. But there were clear patterns individually and overall. One was that the variance showed a circadian rhythm, and the other was that smell sensitivity was never strongest well into the “biological night,” or the period well after melatonin onset when people are most likely to be asleep and least likely to be eating. In clock terms, it’s from about 3 to 9 a.m.

“So we have 84 tests done on each child, and each one has a circadian phase associated with it,” Carskadon said. “There is a rhythm here, and it’s not flat or that you smell the same all the time. Your sense of smell changes in a predictable manner, though it’s not the same for every child.”

Carskadon said the findings should be of note to clinicians and researchers who seek to assess a patient’s sense of smell. The study suggests that sensitivity might be inherently higher at an afternoon appointment than in the early morning.

Herz noted that there could be implications for fire safety as well. A decade ago she and Carskadon had found that the sense of smell all but shuts down during sleep. Now there is evidence that the sense of smell is relatively weak during a quarter of the circadian cycle. This emphasizes, Herz said, the value of audible smoke alarms, since smell may be a poor indicator of that danger at least in the early morning hours.

On average, the peak of smell sensitivity was at the beginning of biological night, or about 9 p.m. for the teens.

Herz said she can only speculate about why smell sensitivity might peak, on average, in the late evening. From an evolutionary standpoint, it might be to ensure the greatest sense of satiety during the important end of day meal, it might be a way of increasing mating desire, or perhaps a way of scanning for nearby threats before bedding down for the evening.

For each individual, she said, knowing when during the day smell their sensitivity might peak could be a way of identifying the time when sensory experiences could be most pleasant.

For less ancient health concerns, however, Carskadon says more data from the experiments is coming to help the team determine whether the circadian fluctuations of smell sensitivity helps determine food choices and eating behaviors among teens.

“The sense of smell changes across the 24 hours of the day,” Carskadon said. “We don’t know if that difference will affect what or how people eat. There is more to come.”


Eating more fruits, vegetables boosts psychological well-being

Fruits and vegetables are a pivotal part of a healthful diet, but their benefits are not limited to physical health. New research finds that increasing fruit and vegetable consumption may improve psychological well-being in as little as 2 weeks.

Study leader Dr. Tamlin Conner, of the Department of Psychology at the University of Otago in New Zealand, and colleagues found that young adults who were given extra fruits and vegetables each day for 14 days ate more of the produce and experienced a boost in motivation and vitality.

The researchers recently reported their findings in the journal PLOS One.

According to the United States Department of Agriculture, adults should aim to consume around two cups of fruits and around two to three cups of vegetables daily.

One cup of fruits is the equivalent to half a grapefruit or a large orange, and one cup of vegetables is proportionate to one large red pepper or a large, baked sweet potato.

As part of a healthful diet, fruits and vegetables can help reduce the risk of obesity, type 2 diabetes, heart disease, stroke, and some types of cancer.

In recent years, studies have suggested that fruit and vegetable intake may also improve mental health. For their study, Dr. Conner and team set out to investigate this association further.

Increased motivation, vitality with higher intake of fruits and vegetables

The researchers enrolled 171 students aged between 18 and 25 to their study, and they were divided into three groups for 2 weeks.

One group continued with their normal eating pattern, one group was personally handed two additional servings of fresh fruits and vegetables (including carrots, kiwi fruit, apples, and oranges) each day, while the remaining group was given prepaid produce vouchers and received text reminders to consume more fruits and vegetables.

At the beginning and end of the study, participants were subjected to psychological assessments that evaluated mood, vitality, motivation, symptoms of depression and anxiety, and other determinants of mental health and well-being.

The researchers found that participants who personally received extra fruits and vegetables consumed the most of these products over the 2 weeks, at 3.7 servings daily, and it was this group that experienced improvements in psychological well-being. In particular, these participants demonstrated improvements in vitality, motivation, and flourishing.

The other two groups showed no improvements in psychological well-being over the 2-week period.

Furthermore, no improvements were seen in symptoms of depression and anxiety in any of the groups. “The majority of research linking depression to dietary patterns has been longitudinal, meaning that possible differences in ill-being may be established over a much longer period of time rather than our brief 2-week period,” note the authors.

Still, the researchers say that their findings indicate that increasing the intake of fruits and vegetables through personal delivery may lead to rapid benefits for psychological well-being.

The team concludes that:

“Providing young adults with high-quality FV [fruits and vegetables], not texting them reminders to eat more FV and giving them a voucher, resulted in improvements to their psychological well-being over a 2-week period.

This is the first study to show that providing high-quality FV to young adults can result in short-term improvements in vitality, flourishing, and motivation. Findings provide initial validation of a causal relationship between FV and well-being, suggesting that large-scale intervention studies are warranted.”


Insulin Use During, After Meals Raises Risk Of Non-Adherence

Individuals with type 2 diabetes who use bolus insulin during or after meals have a greater risk of non-adherence and poorer glycemic control than those who use insulin prior to meals, according to a recent analysis.

For their analysis, the researchers evaluated 1483 adult participants with type 2 diabetes from 12 countries in a web-based, self-reported, patient-preference survey. All patients included in the study had reported bolus insulin use.

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Post-Operative Cognitive Dysfunction Significantly More Likely With Diabetes

The Morisky Medication Adherence Scale questionnaire was used to measure adherence.

A total of 864 (58%) participants had reported dosing bolus insulin before meals (pre-meal group), 354 (24%) during or after meals (post-meal group), and 265 (18%) before, during, or after meals (mixed group). Only participants in the pre-meal and post-meal groups (n = 1218) were included in the present analysis.

Results indicated that hemoglobin A1c (HbA1c) levels varied significantly based on the timing of insulin doses. In the post-meal group, 40% of participants had an HbA1c of 9% of higher, compared with 29% of participants in the pre-meal group.

Ultimately, the researchers found that participants who used bolus insulin during or after meals were significantly more likely to report non-adherence vs those who used insulin before meals. Furthermore, participants who used insulin during or after meals more often reported participating in diabetes education programs.

The researchers also noted that 78% of all participants had reported preferring bolus insulin “administrable whenever convenient.”

“Approximately 24% of respondents never comply with guidelines for insulin dose timing, with higher risk of non-adherence and increased participation in diabetes care programs,” the researchers concluded.

“Respondents dosing insulin post-meal are more likely to have poor glycemic control (HbA1c [of 9% or more], 74.9 mmol/mol). Given that many respondents had high HbA1c and were non-adherent, a treatment [that] satisfies patient preference for bolus insulin with flexible dose timing could be considered.”

—Christina Vogt


Schaper NC, Nikolajsen A, Sandberg A, Buchs S, Bøgelund M. Timing of insulin injections, adherence, and glycemic control in a multinational sample of people with type 2 diabetes: a cross-sectional analysis [Published online October 23, 2017]. Diabetes Ther.


Cannabis can help children with epilepsy

Medical cannabinoids may benefit children undergoing chemotherapy and those who have epilepsy, according to a new study.

Authors emphasized the need to weigh the risks and benefits of the drug and called for more research on pediatric use.

“In this context, pediatricians, families, patients and policy makers continue to lack urgently needed information to make balanced decisions regarding the use of medical cannabinoids in children and adolescents,” authors wrote in the study “Medical Cannabinoids in Children and Adolescents: A Systematic Review” (Wong SS, Wilens TE. Pediatrics. Oct. 23, 2017,

Cannabinoids are the chemicals in marijuana that can have a medicinal effect. The Food and Drug Administration (FDA) has approved two synthesized cannabinoids for medical use. There also are two plant-derived cannabinoid medications undergoing FDA-regulated trials, according to the study. More than half of states have legalized plant-derived cannabinoid, known as medical marijuana, for medical use.

In a 2015 policy statement, the Academy said it “opposes ‘medical marijuana’ outside the regulatory process of the US Food and Drug Administration” but “recognizes that marijuana may currently be an option for cannabinoid administration for children with life-limiting or severely debilitating conditions and for whom current therapies are inadequate.”

To analyze the uses of cannabinoids to treat children, researchers performed a systematic review of literature that included 21 articles detailing 22 studies with 795 participants.

Four double-blind randomized controlled trials (RCTs) found cannabinoids helped reduce chemotherapy-induced nausea and vomiting (CINV). Studies also showed them to be more helpful than prochlorperazine, metoclopramide and domperidone.

One RCT also found a reduction in convulsive seizures. Additional studies on CINV, seizures, spasticity, tics, post-traumatic stress disorder and neuropathic pain “were not designed to evaluate the statistical significance of outcomes,” authors wrote.

“Beyond studies of CINV and epilepsy, the findings provided very limited evidence of variable quality supporting the use of cannabinoids for different clinical indications,” they said.

The authors suggested families and physicians consider possible side effects, including drowsiness, dizziness, somnolence, diarrhea and decreased appetite, and the potential for accidental overdose.

Research on long-term risks in children is limited, so the authors looked at risks of recreational cannabis use while noting there are differences in frequency, dosing and potency. Recreational use may impact the developing brain and has been linked to cognitive impairments. Studies also have found young users had increased risks of psychiatric harms and other substance use disorders.

“Additional larger, prospective, and controlled studies are required to better delineate the medical utility of cannabinoids in different pediatric disorders,” authors wrote. “This body of evidence has important implications in identifying the risks and benefits of medical cannabinoids in children and adolescents, especially in the context of psychiatric and neurocognitive adverse effects that have been identified from pediatric studies of recreational cannabis use.”


Teens don’t get enough sleep


If you’re a young person who can’t seem to get enough sleep, you’re not alone: A new study led by San Diego State University Professor of Psychology Jean Twenge finds that adolescents today are sleeping fewer hours per night than older generations. One possible reason? Young people are trading their sleep for smartphone time.

Most sleep experts agree that adolescents need 9 hours of sleep each night to be engaged and productive students; less than 7 hours is considered to be insufficient sleep. A peek into any bleary-eyed classroom in the country will tell you that many youths are sleep-deprived, but it’s unclear whether young people today are in fact sleeping less.

To find out, Twenge, along with psychologist Zlatan Krizan and graduate student Garrett Hisler — both at Iowa State University in Ames — examined data from two long-running, nationally representative, government-funded surveys of more than 360,000 teenagers. The Monitoring the Future survey asked U.S. students in the 8th, 10th and 12th grades how frequently they got at least 7 hours of sleep, while the Youth Risk Behavior Surveillance System survey asked 9th-12th-grade students how many hours of sleep they got on an average school night.

Combining and analyzing data from both surveys, the researchers found that about 40% of adolescents in 2015 slept less than 7 hours a night, which is 58% more than in 1991 and 17% more than in 2009.

Delving further into the data, the researchers learned that the more time young people reported spending online, the less sleep they got. Teens who spent 5 hours a day online were 50% more likely to not sleep enough than their peers who only spent an hour online each day.

Beginning around 2009, smartphone use skyrocketed, which Twenge believes might be responsible for the 17% bump between 2009 and 2015 in the number of students sleeping 7 hours or less. Not only might teens be using their phones when they would otherwise be sleeping, the authors note, but previous research suggests the light wavelengths emitted by smartphones and tablets can interfere with the body’s natural sleep-wake rhythm. The researchers reported their findings in the journal Sleep Medicine.

“Teens’ sleep began to shorten just as the majority started using smartphones,” said Twenge, author of iGen: Why Today’s Super-Connected Kids Are Growing Up Less Rebellious, More Tolerant, Less Happy — And Completely Unprepared for Adulthood. “It’s a very suspicious pattern.”

Students might compensate for that lack of sleep by dozing off during daytime hours, adds Krizan.

“Our body is going to try to meet its sleep needs, which means sleep is going to interfere or shove its nose in other spheres of our lives,” he said. “Teens may catch up with naps on the weekend or they may start falling asleep at school.”

For many, smartphones and tablets are an indispensable part of everyday life, so they key is moderation, Twenge stresses. Limiting usage to 2 hours a day should leave enough time for proper sleep, she says. And that’s valuable advice for young and old alike.

“Given the importance of sleep for both physical and mental health, both teens and adults should consider whether their smartphone use is interfering with their sleep,” she says. “It’s particularly important not to use screen devices right before bed, as they might interfere with falling asleep.”

Story Source:

Materials provided by San Diego State University. Note: Content may be edited for style and length.


Arsenic: A cause of cancer?

A new paper published in the Journal of the National Cancer Institute shows that arsenic in drinking water may have one of the longest dormancy periods of any carcinogen. By tracking the mortality rates of people exposed to arsenic-contaminated drinking water in a region in Chile, the researchers provide evidence of increases in lung, bladder, and kidney cancer even 40 years after high arsenic exposures ended.

Inorganic arsenic is naturally present at high levels in the groundwater of many countries, creating an important public health issue affecting millions of people. Severe health effects have been observed in populations drinking arsenic-contaminated water over long periods, and research has established that drinking water contaminated with arsenic causes skin cancer and several internal cancers such as lung, bladder, and kidney cancer, as well as cardiovascular disease and other adverse outcomes.

The water source in Antofagasta, a city in northern Chile, experienced a sudden major increase in arsenic water concentrations in 1958, followed by a major reduction in exposure when an arsenic removal plant was installed in 1970. As the driest inhabited place on earth, everyone living in Antofagasta within this time period had to drink from city water sources with known arsenic concentrations, thus exposing inhabitants to high concentrations of arsenic. Identifying a clear relationship between arsenic exposure and cancer mortality rates, the study found that lung, bladder, and kidney cancer mortality rates started to increase about 10 years after the high exposures commenced and did not peak until at least 20 years after exposer reduction began. For both men and women, mortality rates for these types of cancer remained high up to 40 years after the highest exposure stopped.

Although the researchers plan to continue studying this population, they can already conclude that the delay between exposure to arsenic and the development of related cancers could be one of the longest of any human carcinogen. These findings not only add important scientific information on latency patterns, they also may have direct public health implications.

The long latency after exposure reduction means the incidence of arsenic-related diseases is likely to remain very high for many years after arsenic exposures have stopped. Possible long-term interventions to reduce mortality and morbidity after high exposures end include disease screening, reducing important co-exposures, treatment and health services resource planning, and increasing public awareness of arsenic health effects.


Lucid dreaming could be real

In the 2010 film “Inception,” Cobb (Leonardo DiCaprio) describes his wife Mal’s trick for discerning reality from the fantastic dreamscape in which most of the film takes place: He uses what he calls a totem, a spinning top that will never fall over while he’s dreaming. But a totem, known to psychologists who study lucid dreams as a reality check, is actually one of the less-effective ways to tell whether you’re asleep, a new study from Australia finds.

If you’ve ever realized you were dreaming while you were still asleep, you’ve had what’s called a lucid dream. Though these dreams can happen by chance, there are communities of people who try different techniques to bring them about.

So, in the new study, researchers decided to take these techniques to task, testing out which methods worked best for inducing lucid dreams. If people know how to effectively induce a lucid dream, then researchers will be able to learn more about the dreams themselves down the road, the researchers said.

“Ultimately, I want to develop techniques that are effective enough to permit serious exploration of the many potential benefits and applications of lucid dreaming,” said lead study author Denholm Aspy, a visiting research fellow in psychology at the University of Adelaide in Australia.

In the study, which was published in the journal Dreaming in September, the researchers asked nearly 170 participants to try out three techniques that have been said to increase the likelihood of lucid dreaming.

One of the techniques tested in the study was the use of reality checks. These included closing one’s lips and trying to inhale; in a dream, you might get the sensation of breathing in because your body perceives the change in facial muscles. Another reality check was reading printed text, which, in dreams, often changes from one reading to another, the researchers said.

The two other techniques were called “wake back to bed” and “mnemonic induction of lucid dreams” (MILD). Both approaches involve waking up for a few minutes after 5 hours of sleep before going back to bed, but the MILD technique also involves repeating the phrase, “Next time I’m dreaming, I will remember that I’m dreaming,” before falling back to sleep.

At the beginning of the study, the participants recorded the number of lucid dreams they had over the course of a week. Then, for the second week, the participants were randomly assigned to one of the three groups: reality check, reality check plus wake back to bed, and reality check plus wake back to bed plus MILD. Again, the participants recorded the number of lucid dreams they had.

The researchers found that when all three techniques were used (the third group), people were able to recall more lucid dreams after two weeks than those who had done only one or two of the techniques. The group that tried all three techniques reported having a lucid dream 17 percent of the time. And falling asleep within 5 minutes of practicing the MILD approach bumped the success rate up to around 46 percent compared with those who tried this technique but took longer to fall asleep. Reality checks alone, however, were not linked with an increased rate of lucid dreams.

“Inception” fans shouldn’t necessarily throw out their collectible tops. Aspy told Live Science that other studies that ran as long as three weeks found more success with reality checks. Perhaps this technique wasn’t as effective in the new study because the participants didn’t have enough time to build up the habit to the point that they would think to try it while dreaming, Aspy said.

Dr. Rafael Pelayo, a sleep medicine specialist at Stanford University who was not involved in the research, said that “it’s nice that there’s actual research” lucid dreaming now. [Spooky! Top 10 Unexplained Phenomena]

Pelayo noted that lucid dreaming didn’t seem to be linked to a reduction in sleep quality, but that this might be an area for future research. Some brain-scan studies have suggested that when a person is experiencing a lucid dream, the brain is in a sort of hybrid sleep-awake state rather than fully asleep, he said.

In the future, the researchers hope to study practical uses for lucid dreaming, though these are still largely speculative, Aspy said. Some research, for example, suggests that lucid dreaming could be used to practice hobbies and crafts, and then see an improvement in waking life.

“We’re touching on some things that are hard to know,” Pelayo told Live Science. He thinks it’s unlikely, for example, that athletes could use lucid dreaming to effectively practice their sport, but he’s also interested in seeing what future research reveals down the road. It’s possible that one day, people with post-traumatic stress disorder could use lucid dreaming to help avoid nightmares, he said. But to study these applications, “the first step is teaching people to reliably do lucid dreaming, and that’s what this paper offered,” he added.

“Lucid dreaming has been around for a long time,” Pelayo said. “There are online communities around it, people buying supplements online, so adding some science can only be helpful. I think it’s long overdue.”

Originally published on Live Science.


Gastrointestinal Reflex Presentation

The digestive system functions via a system of long reflexes, short reflexes, and extrinsic reflexes from gastrointestinal (GI) peptides that work together.

Gastro Intestinal Reflexes Slide presentation text

1. Addis Ababa University College of Health Sciences Department of Medical Physiology Presentation on Gastro intestinal ReflexesBy Girmay fitiwi 10/30/2011 1

2. Presentation out Line1.Objectives2.Introduction3.Short reflexes4. Long reflexes 4.1. Defecation reflexes 4.2. Vomition (emesis ) reflexes5. References10/30/2011 gastro intestinal reflexes 2

3. 1. ObjectivesAt the end of this presentation students willable to :-• Mention the types of gastro intestinal reflexes• Clarify the roles of different GI reflexes• Explain the mechanisms of defecation reflexes• list the control mechanisms of defecation• Discuss the mechanism, merits and demerits of vomiting reflexes.10/30/2011 gastro intestinal reflexes 3

4. 2. introduction• The digestive system has a complex system of motility and secretion regulation which is vital for proper function.• Accomplished via a system of long reflexes from the CNS, short reflexes from ENS and reflexes from GI peptides working in harmony with each other.• Three types of gastrointestinal reflexes .10/30/2011 gastro intestinal reflexes 4

5. cont’d1. Local reflexes• Reflexes that are integrated entirely within the gut wall enteric nervous system.• These include reflexes that control much gastrointestinal secretion, peristalsis, mixing contractions, local inhibitory effects.10/30/2011 gastro intestinal reflexes 5

6. GI reflexes cont’d2. Short reflexes• Reflexes from the gut to the prevertebral sympathetic ganglia and then back to the gastrointestinal tract.• These reflexes transmit signals long distances to other areas of the gastrointestinal tract.• gastrocolic reflex• enterogastric reflex.• colonoileal reflex.• Ileogastric reflex10/30/2011 gastro intestinal reflexes

7. GI reflexes cont’d …………3.Long reflexes• Reflexes from the gut to the spinal cord or brain stem and then back to the gastrointestinal tract. Vago vagal reflexes Pain reflexes that cause general inhibition of the entire gastrointestinal tract. Defecation reflexes Vomition reflexes10/30/2011 gastro intestinal reflexes

8. Different nervous reflexes of the GIT10/30/2011 Fig.1 different gastro intestinal reflexes

9. GI reflex cont’d10/30/2011 Fig.2 reflex control of gut activity

10. Distension of stomach by food Mucous membrane of stomach is stimulated Afferents go to internal plexus Efferents from internal plexus G- cells in pyloric Gastric glands glands Release of gastric juice 10Fig .3 Short reflex

11. Presence of food in stomach Mucous membrane of stomach is stimulated Afferents go via the vagus Medullary centre Efferents come via vagus Synapse in the intrinsic plexuses G-cells in pyloric Gastric glands glandsFig.4 Long reflex 11 Release of gastric juice

12. 3.Short Reflexes1. Gastrocolic (Gastroileal) Reflex• Stomach activity leads to ileocecal relaxation and increased mass movements in the colon.• These reflexes are mediated through both long and short nervous pathways (extrinsic and intrinsic) and hormones (CCK, gastrin)  Most evident after first meal of the day.  Often followed by urge to defecate.  New born children routinely defecate after meal.10/30/2011 gastro intestinal reflexes

13. Short reflexes cont’d2.Enterogastric reflex When fat or protein chyme reaches the duodenum, receptors detect and send impulses to enteric nerves of the stomach that in turn cause the inhibition of stomacheal motility and secretion. Delays emptying.3. Intestino-intestinal Distention of one portion of the intestine leads to decreased contractions caudad of the bolus.  Depends on extrinsic neural connections.10/30/2011 gastro intestinal reflexes

14. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 4 Nerve impulses inhibit peristalsis in stomach wall From CNS Vagus nerve To CNS 1 Duodenum fills with chyme 3 Sensory nerve impulses travel to central 2 Sensory stretch nervous system receptors are10/30/2011 Fig.5 enterogastric reflexes 14 stimulated

15. Short reflexes cont’d4. Vago vagal reflexes• GI reflex circuits where afferent and efferent fibers of the vagus nerve coordinate responses to gut stimuli via the dorsal vagal complex in the brain.• Controls contraction of the GI muscle layers in response to distension of the tract by food.• Allows for the accommodation of large amounts of food in the GITs.10/30/2011 gastro intestinal reflexes 15

16. ……….cont’d• Carries signals from stretch receptors, osmoreceptors, and chemoreceptors to dorsal vagal complex where the signal may be further transmitted to autonomic centers in the medulla.• Efferent fibers of the vagus then carry signals to the gastrointestinal tract up to the splenic flexure.10/30/2011 gastro intestinal reflexes

17. ………….cont’dFunction• Active during the receptive relaxation of the stomach in response to swallowing of food .• When food enters the stomach a “vagovagal” reflex goes from the stomach to the brain, and then back again to the stomach causing a reduction in the muscular tone of the stomach wall.10/30/2011 gastro intestinal reflexes 17

18. …………..cont’dMechanism• when the corpus and fundus of the stomach are distended secondary to the entry of a food bolus.• stimulation of the mechanical receptors located in the gastric mucosa stimulates the vagus afferents.• The completion of the reflex circuit by vagus efferents leads to the stimulation of postganglionic muscarinic nerves.• These nerves release Ach to stimulate two end effects.10/30/2011 gastro intestinal reflexes

19. ……………..cont’d1.The parietal cells in the body of the stomach are stimulated to release H+.2. The ECL cells of the lamina propria of the body of the stomach are stimulated to release histamine.10/30/2011 gastro intestinal reflexes

20. 4. Long reflexes4.1 defecation reflexes• An Intrinsic reflex mediated by the local enteric nervous system in the rectal wall.• To be effective it usually must be fortified by parasympathetic defecation reflex• Distention of the rectum causes the internal anal sphincter to relax, which produces the urge to defecate.• The external anal sphincter is under voluntary control.• relaxation of this sphincter, coupled with contraction of the rectum and sigmoid colon, results in defecation.10/30/2011 gastro intestinal reflexes

21. Defecation reflexes cont’d10/30/2011 Fig 6. anatomical view of rectum and anal channel

22. …………..cont’d• Rectum usually (almost) empty (retrograde contractions return content to sigmoideum, until there is too much of it)• Just before defecation mass movement in sigmoideum fills rectum pressure reflex relaxation of inner sphincter (smooth muscle) & contraction of outer sph. (skeletal muscle controlled intentionally via pudendal nerves)• Stretch receptors in rectal wall can adapt – urge to defecate can temporarily subsided suppressed.10/30/2011 gastro intestinal reflexes

23. Defecation Reflexes cont’dA. Intrinsic reflex• Intrinsic reflex mediated entirely by ENS is initiated when feces enters rectum via mass movements and the rectal pressure increase to 55 mmHg. – Peristaltic waves in descending colon, sigmoid and rectum – Relaxation of internal anal sphincter (inhibitory action of the myenteric plexus) – Weak when functioning alone.10/30/2011 gastro intestinal reflexes

24. 10/30/2011 24 Fig7. defecation reflexes

25. …………cont’d B.Parasympathetic defecation reflex • Involves sacral segments of the spinal cord . • Greatly intensifies intrinsic reflex (but is not different qualitatively) • Afferent signals go to sacral cord and then back to descending and sigmoid colon, and rectum by way of parasympathetic fibers in pelvic nerves. • The lower neurons S2-S4 provide sensory and motor fibers for defecation reflex.10/30/2011 gastro intestinal reflexes 25
26. 10/30/2011 gastro intestinal reflexes

27. ………………….cont’d • Afferent signals entering spinal cord initiate other effects that require intact spinal cord.  Deep breath, closure of glottis, and increased abdominal pressure  Relaxation and movement of pelvis floor downward  All work to move fecal contents downward • Spinal transection or injury can make defecation a difficult process. • Cord defecation reflex can be excited (either digitally or with enema) ,Forcing fecal particles into the rectum to cause new reflexes, Not as effective as the natural reflexes.10/30/2011 gastro intestinal reflexes

28. Vomiting (emesis)• The ejection of stomach contents through the mouth.• preceded with nausea, sometimes anorexia, autonomic reactions (salivation, sweating, cold skin,…)• Vomiting center in medulla (next to cardiovascular & respiratory centers).• CTZ located in the root of 4 th ventricle.• Protective reflex against toxicity; however, longer vomiting can cause metabolic alkalosis & dehydration.10/30/2011 gastro intestinal reflexes

29. …………….cont’d  There is a neural connection between vomition center and CTZ.  CTZ causes central vomition and is stimulated by chemical substances (e.g., drugs like morphines , pregnancy, alcohol, movement etc.)10/30/2011 gastro intestinal reflexes

30. Vomiting cont’d• Reverse peristalsis from the middle of small intestine to larynx .• Strong contraction of abdominal muscles&diaphragm.• Relaxation, then closure of pylorus, relaxation of LES and finally UES (glottis closure, inhibition of breathing)• Forced inspiration against closed glottis – intrathoracic pressure, abdominal (diaphragm)10/30/2011 gastro intestinal reflexes

31. …………cont’d• Vomiting may be induced by:-1.Drugs like apomorphine stimulate CTZ.2.Afferent impulses from vestibular nuclei• They mediate vomiting of motion sickness3.Afferent impulses from viscera stimulate vomiting center via NTS.• Vomiting induced in visceral disease.10/30/2011 gastro intestinal reflexes

32. 10/30/2011 gastro intestinal reflexes

33. References• Berne and levy physiology, sixth edition Bruce M.Koeppen, Bruce A. Stanton• Guyton and Hall Textbook of Medical Physiology, 12th Edition.• Human physiology: The Basis of Medicine, 3rd Edition.• Lecture note• Institutional websites10/30/2011 gastro intestinal reflexes 33


U.S. and UAE face common healthcare challenges

The U.S. healthcare system and its hospitals are one of the most advanced in the world, despite the current tumultuous changes taking place in the sector. In 2014, 48 per cent of U.S. healthcare spending came from private funds, with 28 per cent coming from households and 20 per cent coming from private businesses, according to a finding by the
Department for Professional Employees (DPE).

It is a well-known fact that American university-affiliated hospitals are in the lead when it comes to research and development. From developing important medications to life-saving procedures, the whole world has benefitted from American innovations. The U.S. government is known to offer grants, patents, and exclusivity to companies who are willing to develop drugs for uncommon diseases.

But the system has certain issues to tackle and one of the common challenges that both the U.S. and the UAE face when it comes to healthcare is fighting obesity. It a growing problem across the world, and a recent study found that more than two billion adults and children across the globe are overweight or obese and suffer severe health problems, with the U.S. leading in such cases.

Reportedly, combining children and adults, the U.S. showed the largest obesity increase, from an obesity rate of 26.5 per cent in 2015. Some of the common risks associated with obesity include cardiovascular disease, diabetes, and cancer, among other life-threatening conditions.

Another study published in the journal Preventive Medicine, found that lack of exercise is contributing to the growing obesity epidemic, and the report found that activity levels of teenagers are shockingly comparable to that of 60-year-olds!

In the UAE too, over 36 per cent of children in the UAE are obese, according to World Health Organisation (WHO). Furthermore, according to a study by University of Washington’s Institute for Health Metrics and Evaluation, 66 per cent of men and 60 per cent of women in the UAE are obese, which clearly indicates that obesity is a advanced disease in the country and if not tackled early on, people are most likely to suffer debilitating health complications.

Dr. James Levine, M.D., Ph.D., Professor of Medicine at Mayo Clinic in Arizona, U.S., told Khaleej Times: “In the UAE, one in five people has type II diabetes. This is because obesity has swept through the adult population, and now children. The startling high rate of obesity-related type II diabetes has implications for the health of the nation, because it is associated with cardiovascular disease and cancer. Of even greater concern, however, is the fact that the rates of diabetes and high blood pressure are not levelling off in the UAE; the crisis is growing. The health consequences associated with diabetes, high blood pressure, cardiovascular disease and obesity are likely to continue to grow unless urgent action is taken. The UAE and the U.S. are on similar trajectories in this regard.”

Top tips to get fit

Dr. James Levine, Professor of Medicine at Mayo Clinic, highlights actions to prevent obesity:

– Be thoughtful about what you eat.

– Avoid second portions, decrease the amount of fat you eat, have scheduled meals and avoid snacks and sugary drinks.

– It is important to sit less and be more active. You don’t need to join a gym (unless you want to). Instead, make sure you walk every hour. Replace sitting times (such as watching TV) with walks and active socialising. Take a walk with a family member or friend, and ensure you take a 15-minute stroll after every meal.

Setting healthcare standards in the UAE

American Hospital Dubai: The hospital is a premium, multi-speciality healthcare facility offering the most advanced treatments for various types of cancers as well as other ailments. It has become the first accredited hospital of Mayo Clinic Care Network in the Middle East.

Cleveland Clinic Abu Dhabi: A branch of the U.S.-based healthcare institution, it offers a model of care, designed to address a range of complex and critical care requirements. It provides patients in the region direct access to some of the world’s best healthcare providers.


The Benefits Of Group Physiotherapy

When Linda Veres, Ross Winter and Robert Morassutti happened to sign up for the same physiotherapy class, little did they know the difference group therapy would make.

In fact, studies show that patients who participate in group-based physiotherapy after joint replacement surgery achieve statistically and clinically important improvements in mobility and function, and with similar satisfaction levels as patients who receive one-on-one therapy at home.

“In that group setting, they connected through their experiences of getting through surgery, and a common goal to get moving well again,” says Suzanne Denis, advanced practice physiotherapist, Holland Musculoskeletal Program who remembers Linda, Ross and Robert called themselves ‘the knee people’. They had knee replacement surgery at Sunnybrook’s Holland Centre then returned to join one of the group physiotherapy classes led by physiotherapist Mark Anunciacion.

Even though classes have ended, Linda, Ross and Robert continue to exercise together twice a week, motivating and supporting each other.

Beyond the clinical evidence, here are their reasons why getting together to exercise works:

Camaraderie – social + exercise: Ross says, “Doing physio alongside Linda and Robert who had a similar post-op (post-surgery) sensibility, allowed us to share with each other, experiences, knowledge, advice.”

Context – motivate yourself, but know your limits! “Doing therapy with others helps give you context. Everyone is different, even though we all had the same surgery,” says Robert. “And in some ways, it helped to ‘normalize’ things. We would ask each other: are you still using your cane? Being together gave you permission to either still be using the cane. Or not.”

Commitment: “Sometimes, I’d be thinking to myself: I’d rather not do this [the exercises],” says Robert, “but as a group, we had made a commitment. To be there for each other.” “And keep ourselves motivated,” adds Linda.

Commiserate, but with consideration: “Misery loves company and it’s better to share the pain than to suffer alone,” says Ross. “Group physio gave everyone the occasion to express frustration about their lack of progress, or the discomfort. But temper those occasional complaints, with humour,” says Linda. She recalls the generosity of the volunteers who would get ice for class participants. One particular day, she was feeling quite low and as the volunteer arrived with the ice, she joked, “Do you have gin with that?”

And because knee replacement is a ‘big deal’ even if some say it isn’t, Linda, Ross and Robert also offer words of encouragement:

Connect with friends and family: “As you prepare for surgery, think about what you will need, after surgery. It’s hard to ask for help, but do! And ask for specific help!” “Until you know the ‘new’ you, you need someone there, to help you.”
Careful: “Pace yourself, for yourself, and DO NOT fall!”
Consistency: “You have to keep at it [exercise]! Keep moving! Stretching and strengthening.”
Continuum: “Keep up the momentum even after ‘formal’ physio.”
Celebrate! “Everyone has their markers — milestones of progress, success, recovery.” “Celebrate being closer to what you used to do – getting on a streetcar, being able to put the rugs down again at home, driving a car, taking the bus to go to a movie with a friend…”


Physiotherapy and nutrition science courses offer a promising future

Considered one of the oldest ways to cure various physical ailments, the history of physiotherapy can be traced back to ancient Greece. Over the centuries, it has evolved from a simple massage-based treatment to a complex assortment of therapies with multiple and specialized applications.


Choosing a career in physiotherapy is a prudent decision in this day and age; it’s a stream that offers numerous job options, including some that are financially as rewarding as being doctors and engineers. Considered an allied health service, physiotherapy comes with a vast range of career alternatives both in India and abroad. At Manav Rachna Educational Institutions, the following courses in physiotherapy are on offer:

Bachelor of Physiotherapy (B.P.T) – A regular full-time course (41/2 years) divided into eight semesters and a six-month internship.

Master of Physiotherapy (M.P.T) – A 2-year course with specializations in musculoskeletal, sports, neurology, and cardiopulmonary physiotherapy

Nutrition and Dietetics

Nutritionists help us understand how diet affects one’s health and well-being. To be a nutritionist, it is necessary to gain a degree in nutrition science or dietetics, which incorporates human physiology and biochemistry. Based on their qualifications, people may find work as nutrition scientists, public health nutritionists, clinical nutritionists, or sports nutritionists. This field focuses on the scientific understanding of nutrition and its practical application in the field of healthcare and patient rehabilitation.

As health centres, fitness centres, and spas continue to flood the market, the career prospects in the field appear increasingly positive. At Manav Rachna, programmes offered under Nutrition & Dietetics include:

B.Sc. Nutrition & Dietetics(3-years) with two months of clinical/ industrial training

M.Sc. Nutrition & Dietetics (2-years) with specializations in Clinical Nutrition and Dietetics, Food Science and Technology, Sports Nutrition, and Public Health Nutrition

PhD in Health Sciences

Is it the right career for you?

As any career counsellor would suggest, it is important to pick a field that suits and matches one’s flair, and this holds true for physiotherapy as well as nutrition and dietetics. From a financial perspective, a career in these fields is definitely a good option, despite both physiotherapy and nutrition being fairly challenging positions. Professionals in these areas are qualified to perform physical examinations and conduct assessments during diagnosis. A successful physiotherapist uses various intervention techniques to treat a patient in the best possible manner.

Nutritionists have ample job prospects in hospitals, nursing homes, residential homes, and private practices. (Manav Rachna)
Job prospects

Due to our sedentary lifestyles, people face frequent musculoskeletal problems, which include issues such as backache, stiff shoulders and neck, osteoarthritis, obesity, etc. In curing such disorders, physiotherapists and nutritionists work wonderfully alongside mainstream doctors. Thus, physical therapists and dieticians/ nutritionists have ample job prospects in hospitals, nursing homes, residential homes, rehabilitation centres, and private practices or clinics. Additionally, qualified professionals can work at out-patient clinics, community healthcare centres, fitness centres or health clubs, occupational health centres, special schools and senior citizen centres.

Job prospects for such graduates are also bright in areas such as teaching and working in foreign countries with companies and NGOs, etc.

Why choose Manav Rachna?

Across a journey of 20 years, 45,000 + students, including an alumni base exceeding 17,000 students have been seen walking the MREI corridors of knowledge. The NAAC accredited ‘A’ Grade institute is committed towards providing quality education by motivating students through highly innovative and flexible horizons. The faculty in physiotherapy and nutrition offers state-of-the-art OPD and nutritional counselling facilities. It also keeps organizing regular workshops to update the knowledge of staffs and students. The centre focuses on evidence-based practice which is carried out in well-equipped labs designed for research purposes. Complete holistic development of students is offered through Personality Development Programs and interdisciplinary learning. International exposure is assured through various conferences and seminars, including international/ national CMEs, seminars, workshops and health camps.

In addition, the institution nurtures active tie-ups with renowned hospitals like VIMHANS, Batra Hospital and Medical Research Center, IBS hospital, ASIAN hospital, Sarvodaya Hospital, Metro Hospital, along with several old age homes and handicap schools.

Globalizing education with international collaborations

In its quest for excellence, MREI have academic tie-ups with 44 foreign universities, across USA, Canada, UK, South America, Far East, and other Asian countries. Partners include AIS St. Helens, Universiti Sains Malaysia, Lahti University, Missouri State University, Purdue University Northwest, and a host of others. The areas of collaborations cover exchange of undergraduate and graduate students, faculty and staff members, joint research and consultancy activities, participation in seminars and academic meetings, exchange of academic materials and other information, special short-term academic programmes and projects, cooperation in curriculum development, collaboration in international seminars and conferences, and cooperation in quality assurance which can transform graduates into quintessential global professionals.

Finally, besides quality education, Manav Rachna also provides 100% on-campus placement assistance to students. Alumni from these courses have been placed with renowned brands such as AIIMS, Batra Hospital, Bharti Enterprises, Apollo Hospital, Qi Spine, Religare, United Health Group, Kareer Gateway, Jindal Industries, Genpact, VLCC, Nutrilife and other leading government and private institutions.


Nitrate Rich Foods For Nitric Oxide Production

Nitric Oxide benefits are proven (check out our full spiel here). While you can get access to nitric oxide supplements, its a smart idea to incorporate foods into your regular diet routine that are high in nitrates and promote continuous nitric oxide production in the body. Start with these 18 nitrate rich foods:

18. Dark Cocoa

Several studies have documented that cocoa, especially the raw kind, increases nitric oxide production and lowers blood pressure. There is also evidence of cacao healing the endolethium (the thin layer of cells that lines the interior surface of blood vessels) by increasing the amount of cells that repair it. The crucial part in choosing right kind of cacao is the quality. If possible you should always buy raw unprocessed kind, because the ones they sell on markets are so over-processed that they shouldn’t be even called chocolate anymore.

17. Watermelon

Watermelon contains a lot of the amino acid L-Citrulline that is one of the best natural compounds to increase nitric oxide, proven by countless of studies. Read this post to learn more about L-Citrulline and how it converts into nitric oxide in the body.

16. Pomegranate

If I would have to choose the best food for nitric oxide production and testosterone levels, it would be pomegranate. Pomegranate has been performing perfectly in every single study that it has been researched for, producing effects such as reducing arterial plaque thickness by 30% and increasing testosterone levels by 22% in peer reviewed studies.

15. Walnuts

Walnuts are packed with vitamin E, which helps you arteries and testosterone levels. Also it has been recently studied and proved to increase nitric oxide production and also to lower blood pressure, significantly. This is probably due to the high amounts of L-Arginine found in walnuts, which has been linked to an increase in nitric oxide production, more about L-Arginine here.

14. Spinach

Spinach is known to have one of the highest nitrate contents of all plants, which means that it’s a pretty awesome food to eat if you are looking to increase nitric oxide production. Learn more about nitrates in foods and how those convert into nitric oxide, here.

13. Oranges

Oranges and orange juice contains high amounts of vitamin C, which has been shown to protect your precious nitric oxide molecules from free radicals. So ideally there would be no point in increasing your nitric oxide levels without consuming vitamin C and antioxidants at the same time, because without the vitamin C, your beloved nitric oxide would just oxidize away before really doing anything in your body.

12. Beets

Beetroot is one of those foods that contain nitrates as explained here. The thing that really makes beets so amazing is the fact that it is one of those foods that has highest nitrate count in all of plants, and at the same time beets are capable to lower your estrogen levels by acting as a methylate, as explained here.

11. Cranberries

There are countless of health benefits that link back to cranberries. Possibly one of the less known ones is the fact that cranberries increase nitric oxide production, while lowering blood pressure significantly at the same time. This was found out by a study conducted back in the year 2000.

10. Garlic

Researchers say that garlic is a potent activator of NOS (nitric oxide synthase), and produces same kind of effects as Cialis or Viagra. In one study it was noted that garlic decreased systolic and diastolic blood pressure by 8 points on subjects with high blood pressure. That’s a very impressive result from a food, as it shows to be working even better than most of the high blood pressure medications.

9. Black tea

contains caffeine, which acts as a vasoconstrictor, and that’s the main reason why black tea is not something you usually see on a list of foods that increase nitric oxide. But despite black teas caffeine content, it still has some major vasodilation effects. Many studies claim that black tea significantly increases nitric oxide production and lessens the arterial stiffness. On top of that there is this study done back in 2009 which claims that more black tea = more blood flow.

8. Cayenne pepper

contains high amount of capsaicin, the compound that makes all chili’s hot. One study noted that capsaicin has a dose dependent effect, meaning that more the subjects consumed capsaicin, the more their nitric oxide levels increased and arteries relaxed.

7. Honey

One animal study claims that honey significantly increases nitric oxide production. Either the high enzyme content probably causes this, or the high nitrate content that honey has.

6. Pistachios

Like almost all nuts, pistachios are also packed with L-Arginine, a precursor of nitric oxide that is known for its ability to increase nitric oxide production significantly.

5. Salmon

Wild salmon is a very good source of co-enzyme Q10, enzyme that can be spotted on moisturizer adds for women. Co-enzyme Q10 is not only great for soothing wrinkles; it’s also a very good nitric oxide booster as it has been shown in dozens of studies to increase nitric oxide production significantly.

4. Kale

Kale is also a very good source of co-enzyme Q10 that boosts nitric oxide. Kale also has very high nitrate content, which makes it very good nitric oxide booster. There are also many other health benefits linked to kale, such as increased testosterone levels and improved arterial health.

3. Animal Organs

One of the greatest foods that every man should be consuming are foods like animal liver. The organs contain high amounts of cholesterol and healthy fat-soluble vitamins that boost your testosterone levels. Those organs are also very good source for co-enzyme Q10 that increases nitric oxide levels, so it’s a win-win situation if you eat organs!

2. Onions

Onions are not only good for your testosterone levels, as they have been shown to increase nitric oxide production in 2 different studies. They are also a very good source of vitamin C, which as explained above protects your nitric oxide molecule from free radicals. Onions also contain a compound called Quercetin, explained briefly here. Quercetin is well known for its ability to boost nitric oxide levels.

1. Shrimp:

One of the best sources of dietary L-Arginine, as mentioned above L-Arginine is an amino acid and precursor of nitric oxide. By consuming shrimps you are essentially increasing the amount of L-Arginine in your body which then converts into nitric oxide.


Physiotherapy Equipment Market Is Expected To Grow At A Cagr Of 6.35% By 2020

Physiotherapy is a technique that uses various procedures and equipment to relieve physical ailments. It has evolved from a simple massage to a complex variety of treatments. It is an essential part of rehabilitation after surgeries, chemotherapy, and radiation procedures to promote mobility. Physiotherapy plays a significant role for physically challenged people and provides relief to the patients with injuries and chronic disorders such as stroke, arthritis, and cerebral palsy.

Browse the full report @:

How Big is the Global Physiotherapy Equipment Market?

The global physiotherapy equipment market to grow at a CAGR of 6.35% over the period 2014-2020.

The report covers the current scenario and the growth prospects of the global physiotherapy equipment market for the period of 2015-2020. To calculate the market size, the report considers revenue generated through sales of the following product categories:


Table of Contents

2 Research Methodology

3 Executive Summary

4 Premium Insights

5 Market Overview

6 Industry Insights

7 Physiotherapy Equipment Market,By Product

8 Physiotherapy Equipment Market, By Application

9 Physiotherapy Equipment Market, By End User

10 Geographic Analysis

11 Competitive Landscape

12 Company Profiles

12.1 Introduction

12.2 Djo Global/ Chattanooga

12.3 EMS Physio Ltd.

12.4 ENRAF-Nonius B.V.

12.5 BTL Industries Inc.

12.6 Isokinetics , Inc.

12.7 Patterson Companies Inc.

12.8 Morris Group Internationals

12.9 HMS Medical Systems

12.10 Dynatronics Corporation

12.11 Body Sport