Effect of Peanut Butter Intake on Sleep Health in Firefighters: A Randomized Controlled Trial.

Sleep is often impaired in firefighters due to the psychologically and physiologically intense nature of their work and working shift schedules. Peanut butter is affordable and a substantial source of monounsaturated fatty acids, which may aid sleep health. Thus, this study sought to determine if a daily serving of peanut butter consumed before bedtime for seven weeks altered sleep quality and quantity among full-time firefighters. Forty firefighters (peanut butter group = 20; control group = 20) participated in this eight-week randomized controlled trial. All participants completed a subjective questionnaire on mood, focus, and alertness twice daily and wore an Actigraph wristwatch to measure sleep variables, including latency, efficiency, time in bed, time asleep, wake after sleep onset, number of awakenings, and time spent awake. After a baseline week, the peanut butter group consumed two tablespoons of peanut butter two hours prior to bedtime for seven weeks. Compared to the control group, the peanut butter group did not demonstrate significant changes (p > 0.05) in sleep measures or subjective feelings of mood, focus, or alertness after consuming peanut butter for seven weeks. Therefore, peanut butter as a source of peanuts did not alter sleep quality or quantity in this group of firefighters.

Enjoyment and Affective Responses to Moderate and High-Intensity Exercise: A Randomized Controlled Trial in Individuals with Subsyndromal PTSD.

This crossover randomized controlled trial examined the acute psychological effects of a bout of moderate-intensity continuous aerobic exercise (MICE) and a bout of high-intensity functional exercise (HIFE), relative to a no-exercise sedentary control (SED), in participants (N = 21; 15 f; 24.7 ± 9.3 years) with subsyndromal post-traumatic stress disorder (PTSD). Affective state (Energy, Tiredness, Tension, Calmness) was assessed before (Pre), immediately after (Post 0), 20-min after (Post 20), and 40-min after (Post 40) each condition. Affective valence was assessed during each condition, and exercise enjoyment was assessed at Post 0. Enjoyment was significantly greater following HIFE and MICE relative to SED. Energy was significantly increased Post 0 HIFE and MICE but decreased Post 0 SED. Tension was reduced following all conditions and was significantly lower at Post 40 relative to Pre for HIFE, MICE, and SED. Tiredness was significantly reduced at Post 40 relative to Pre following MICE only, while Calmness was significantly lower at Post 40 relative to Pre following MICE and SED. Overall, both exercise conditions were enjoyed to a greater extent than the control, but MICE may provide greater psychological benefits with respect to Calmness and Tiredness. This study is among the first to assess acute changes in affective states relative to various exercise modes in individuals living with subsyndromal PTSD.

The Cyclical Battle of Insomnia and Mental Health Impairment in Firefighters: A Narrative Review.

The occupational requirements of full-time non-administrative firefighters include shift-work schedules and chronic exposure to alerting emergency alarms, hazardous working conditions, and psychologically traumatic events that they must attend and respond to. These compiling and enduring aspects of the career increase the firefighter's risk for insomnia and mental health conditions compared to the general population. Poor sleep quality and mental health impairments are known to coincide with and contribute to the symptom severity of one another. Thus, it is important to determine approaches that may improve sleep and/or mental health specifically for firefighters, as their occupation varies in many aspects from any other occupation. This review will discuss symptoms of insomnia and mental health conditions such as PTSD, anxiety, depression, substance abuse, and suicide in firefighters. The influencing factors of sleep and mental health will be examined including anxiety sensitivity, emotional regulation, and distress tolerance. Current sleep and mental health interventions specific to full-time firefighters are limited in number; however, the existing experimental studies will be outlined. Lastly, this review will provide support for exploring exercise as a possible intervention that may benefit the sleep and mental health of this population.

A randomized, double-blind, clinical pilot trial of adjunct ketone supplement compared to placebo for treating posttraumatic stress disorder.

BACKGROUND: Despite some evidence of the helpful role of ketones in some neuropsychiatric disorders, there are no clinical trials that examine these agents for posttraumatic stress disorder (PTSD). Our aim was to investigate whether ketone salt supplementation can improve PTSD symptoms in a randomized, placebo-controlled trial. METHODS: A total of 21 participants were recruited and randomized to placebo or ketone supplement. Each dose of ketone supplement included 7 g of ketones in the form of beta-hydroxybutyrate for a total of 14 g/d. Data were collected through questionnaires to assess PTSD symptoms. We used Fisher's exact tests for categorical variables and 2-sample t tests for continuous variables to examine differences in baseline values between treatment groups. Mixed models were employed to examine changes over time between groups on the PTSD Checklist for DSM-5 (PCL-5). RESULTS: There were no statistically significant differences in PCL-5 medians between the ketone and control groups at pretest (P = 1.0000) or post-test (P = .6020). The ketone group had a statistically significant decrease in median PCL-5 scores from 58.5 (pretest) to 54.0 (posttest; P = .0003) but the control group did not change (34 at pretest and at posttest; P = .4418). CONCLUSIONS: The ketone group showed a significant decrease in PCL-5 score at posttest compared with pretest that was not seen in the control group, although these changes were not statistically significant between groups. The small sample size limited the study and likely contributed to the lack of significance. Larger trials are needed to more definitively examine these findings.

Reliability and diagnostic performance of a new blood ketone and glucose meter in humans.

BACKGROUND: Accurate and reliable monitoring of blood ketone and glucose levels is useful for athletes adhering to a ketogenic diet who want to verify that they are in a state of ketosis and, therefore, accruing performance adaptations. However, the cost of devices and testing materials may prohibit their use. More affordable field testing systems are available, but their accuracy and reliability remain in question. The objectives of this study were to evaluate the agreement between a previously validated ketone and glucose meter (Meter 1 - Precision Xtra) and a more affordable meter that has not been validated (Meter 2 - Keto-Mojo), and also to assess the diagnostic performance of Meter 2 for identifying nutritional ketosis. METHODS: Thirteen participants (7 females and 6 males; 21.6 ± 3.0 years old) visited the laboratory three times in this randomized, double-blind cross-over design study. Ketone and glucose levels were measured with Meter 1 and Meter 2 twice before and twice after ingestion of a racemic ketone, natural ketone, or maltodextrin supplement. Intraclass correlation coefficient (ICC) estimates and their 95% confidence intervals were calculated to evaluate interrater reliability for Meter 1 and Meter 2. Bland-Altman plots were constructed to visually assess the agreement between devices. Area under the ROC curve analysis was performed to evaluate the diagnostic ability of Meter 2 to detect nutritional ketosis at a threshold ketone level of 0.5 mM as identified by Meter 1. RESULTS: Reliability between the meters was excellent for measuring ketones (ICC = .968; .942-.981) and good for measuring glucose (ICC = .809; .642-.893), though the Bland-Altman plot revealed substantial differences in agreement for measuring glucose. Area under the ROC curve (Area = 0.913; 0.828-0.998) was excellent for diagnosing nutritional ketosis. CONCLUSIONS: Both Meter 1 and Meter 2 displayed excellent agreement between each other for ketone measurement. Meter 2 also displayed an excellent level of accuracy for diagnosing nutritional ketosis at a threshold value of 0.5 mM, making it an effective and affordable alternative to more expensive testing devices.

Examining the characteristics of patients who continue participation in vs those who drop out of a PTSD clinical trial

BACKGROUND: Patients who drop out of clinical trials examining posttraumatic stress disorder (PTSD) may have different characteristics than patients who continue. These characteristics have never been examined in prior PTSD and attrition trials. Our goal was to examine how demographic and clinical characteristics of patients with PTSD impact attrition in a randomized controlled trial. METHODS: A total of 18 participants were recruited. Data were collected through questionnaires to assess PTSD, depression, and mood disorders. Fisher's exact test was used to examine the association of various categorical demographic and clinical variables with dropout. A Wilcoxon rank sum test was used to examine differences in medians. RESULTS: The median total PTSD Checklist for DSM-5 score was 38 for patients who dropped out and 53 for those who did not. The depression scale total was also lower for the dropout group (7 vs 15). The insomnia index was lower for those who did not remain in the study (15 vs 21). CONCLUSIONS: Posttraumatic stress disorder symptoms, depression, and insomnia were less severe in patients who dropped out compared with those who did not. Larger studies are needed to further examine these findings. This study could help guide future recruitment efforts for clinical trials examining PTSD.