Not All Maca Is Created Equal: A Review of Colors, Nutrition, Phytochemicals, and Clinical Uses.

Maca (Lepidium meyenii, Lepidium peruvianum) is part of the Brassicaceae family and grows at high altitudes in the Peruvian Andes mountain range (3500-5000 m). Historically, it has been used as a nutrient-dense food and for its medicinal properties, primarily in enhancing energy and fertility. Scientific research has validated these traditional uses and other clinical applications by elucidating maca's mechanisms of action, nutrition, and phytochemical content. However, research over the last twenty years has identified up to seventeen different colors (phenotypes) of maca. The color, hypocotyl size, growing location, cultivation, and post-harvest processing methods can have a significant effect on the nutrition content, phytochemical profile, and clinical application. Yet, research differentiating the colors of maca and clinical applications remains limited. In this review, research on the nutrition, phytochemicals, and various colors of maca, including black, red, yellow (predominant colors), purple, gray (lesser-known colors), and any combination of colors, including proprietary formulations, will be discussed based on available preclinical and clinical trials. The gaps, deficiencies, and conflicts in the studies will be detailed, along with quality, safety, and efficacy criteria, highlighting the need for future research to specify all these factors of the maca used in publications.

Psychobiotics: Are they the future intervention for managing depression and anxiety? A literature review.

Mental health is a public health concern among professional organizations, clinicians, and consumers alike, especially in light of the COVID-19 pandemic. Indeed, the World Health Organization has identified mental health as an epidemic of the 21st century contributing to the global health burden, which highlights the urgency to develop economical, accessible, minimally invasive interventions to effectively manage depression, anxiety, and stress. Nutritional approaches, including the use of probiotics and psychobiotics to manage depression and anxiety, have elicited interest in recent years. This review aimed to summarize evidence from studies including animal models, cell cultures, and human subjects. Overall, the current evidence suggests that 1) Specific strains of probiotics can reduce depressive symptoms and anxiety; 2) Symptoms may be reduced through one or more possible mechanisms of action, including impact on the synthesis of neurotransmitters such as serotonin and GABA, modulation of inflammatory cytokines, or enhancing stress responses through effects on stress hormones and the HPA axis; and 3) While psychobiotics may offer therapeutic benefits to manage depression and anxiety, further research, particularly human studies, is needed to better characterize their mode of action and understand optimal dosing in the context of nutritional interventions.

The Effects of Cadence Manipulation on Joint Kinetic Patterns and Stride-to-Stride Kinetic Variability in Female Runners.

Altering running cadence is commonly done to reduce the risk of running-related injury/reinjury. This study examined how altering running cadence affects joint kinetic patterns and stride-to-stride kinetic variability in uninjured female runners. Twenty-four uninjured female recreational runners ran on an instrumented treadmill with their typical running cadence and with a running cadence that was 7.5% higher and 7.5% lower than typical. Ground reaction force and kinematic data were recorded during each condition, and principal component analysis was used to capture the primary sources of variability from the sagittal plane hip, knee, and ankle moment time series. Runners exhibited a reduction in the magnitude of their knee extension moments when they increased their cadence and an increase in their knee extension moments when they lowered their cadence compared with when they ran with their typical cadence. They also exhibited greater stride-to-stride variability in the magnitude of their hip flexion moments and knee extension moments when they deviated from their typical running cadence (ie, running with either a higher or lower cadence). These differences suggest that runners could alter their cadence throughout a run in an attempt to limit overly repetitive localized tissue stresses.

Managing mood-related symptoms utilizing diet, targeted nutrient supplementation, and lifestyle changes: A case series.

BACKGROUND: The Office of Disease Prevention and Health Promotion reports that mental health disorders are one of the most "common causes of disability," affecting 18.1% of adults in the United States. This case series examines the use of diet, targeted nutrient supplementation with a focus on amino acids, and lifestyle interventions for the management of mood-related symptoms as a treatment option. CASE PRESENTATIONS: The three cases included a personalized amino acid therapy protocol, nutrient cofactor supplementation, and diet and lifestyle recommendations. Clinical assessment questionnaires completed by the clients at intervals during care were used to determine proper amino acid dosing. The first client is a 65-year-old Caucasian male presenting with increased stress, anxiety, depression, and sleep disturbances. A marked decrease in symptoms was experienced three months. The second client is a 24-year-old Caucasian male presenting with concentration and memory impairment, anxiety and depression, food cravings leading to binge eating of carbohydrates, low sleep quality, and unsustainable energy. A substantial decrease in symptoms was achieved in under four months. The third client is a 23-year-old Caucasian male presenting with depression, easy agitation while ruminating on negative thoughts, difficulty focusing and making decisions, poor memory, concentration, and sleep quality, gaming addiction, and low energy and motivation. The client experienced considerable relief from all symptoms in under six months. CONCLUSION: The case series demonstrated marked improvement in mood-related symptoms in as little as 3-6 months for three individuals utilizing amino acid therapy along with dietary, targeted nutrient supplementation, and lifestyle choices.

Nutritional management of surgically induced menopause: A case report.

Hot flashes are a primary reason for medical visits during menopause. They can interfere with sleep, cause mood disturbances, decrease the overall quality of life, and are associated with significant health care and societal costs. This case report examines the safety and effectiveness of Lepidium peruvianum (maca) for the management of menopausal-related symptoms. A 32-year-old White female presented with hot flashes, night sweats, anxiety, and mood changes following a hysterectomy and oophorectomy. She was provided with a personalized nutrition plan, Lepidium peruvianum (maca), targeted nutrient supplementation, and lifestyle recommendations. These interventions resulted in the safe and effective resolution of hot flashes and anxiety in 2 months and significantly improved her moods and sleep. This case report demonstrated that the use of Lepidium peruvianum, in conjunction with dietary and targeted supplement modifications, appeared to be safe and resulted in the rapid improvements and resolution of symptoms associated with menopause.

Innovative therapies for mood disorders: A case report.

BACKGROUND: Mood disorders, including depression and anxiety, are complex and multifactorial, impacting the quality of life for those suffering and making them difficult to manage for their providing health care providers. Diet, stress, medication, genetics, and the microbiome have been attributed to playing a role. Currently, prescription drugs are the first course of treatment despite the World Health Organization calling for a need to develop lifestyle interventions to manage these disorders. The use of single amino acids to impact selected neurotransmitters has demonstrated positive outcomes in the literature, however, the use of multiple amino acids, alongside personalized nutritional therapies is not well documented for mood disorders. This case report demonstrates the effective use of amino acids as an innovative therapy for the management of mood disorders. CASE DESCRIPTION: A 26-year-old Caucasian female presented with anxiety, depression, sleep disturbances, carbohydrate cravings, and low energy. She had been diagnosed with Post Traumatic Stress Disorder (PTSD), bipolar depression II and generalized anxiety. The patient was under the care of a counselor and physician and was prescribed Lamictal (200 mg/day). With only moderate success with other therapies, the patient sought nutritional counseling. A personalized nutrition intervention was created to include targeted amino acid therapy (tryptophan, glycine, L-glutamine, D-phenylalanine, L-theanine, and L-tyrosine), select nutrients (multi vitamin/mineral, zinc, vitamin C, GLA and magnesium) and a low-glycemic diet to be followed for 12 weeks. CONCLUSION: This case report demonstrated the use of targeted micronutrient and amino acid therapy, along with a low glycemic diet, resulted in marked improvement in all mood disorder symptoms this patient experienced. It also highlights that a comprehensive integrative approach may be a beneficial option for individuals with mood disorders.

Lower-Limb Factors Associated with Balance and Falls in Older Adults: A Systematic Review and Clinical Synthesis.

BACKGROUND: Despite sufficient evidence to suggest that lower-limb-related factors may contribute to fall risk in older adults, lower-limb and footwear influences on fall risk have not been systematically summarized for readers and clinicians. The purpose of this study was to systematically review and synethesize the literature related to lower-limb, foot, and footwear factors that may increase the risk of falling among community-dwelling older adults. METHODS: We searched PubMed, Embase, PsycINFO, CINAHL, Web of Science, Cochrane Library, and AgeLine. To describe the trajectory toward increasing risk of falls, we examined those articles that linked age-related changes in the lower limb or footwear to prospective falls or linked them to evidenced-based fall risk factors, such as gait and balance impairment. RESULTS: This systematic review consisted of 81 articles that met the review criteria, and the results reflect a narrative review of the appraised literature for eight pathways of lower-limb-related influences on fall risk in older adults. Six of the eight pathways support a direct link to fall risk. Two other pathways link to the intermediate factors but lack studies that provide evidence of a direct link. CONCLUSIONS: This review provides strong guidance to advance understanding and assist with managing the link between lower-limb factors and falls in older adults. Due to the lack of literature in specific areas, some recommendations were based on observational studies and should be applied with caution until further research can be completed.

A Feasibility Study to Assess Vibration and Sound From Zygapophyseal Joints During Motion Before and After Spinal Manipulation.

OBJECTIVE: This feasibility study used novel accelerometry (vibration) and microphone (sound) methods to assess crepitus originating from the lumbar spine before and after side-posture spinal manipulative therapy (SMT). METHODS: This study included 5 healthy and 5 low back pain (LBP) participants. Nine accelerometers and 1 specialized directional microphone were applied to the lumbar region, allowing assessment of crepitus. Each participant underwent full lumbar ranges of motion (ROM), bilateral lumbar SMT, and repeated full ROM. After full ROMs the participants received side-posture lumbar SMT on both sides by a licensed doctor of chiropractic. Accelerometer and microphone recordings were made during all pre- and post-SMT ROMs. Primary outcome was a descriptive report of crepitus prevalence (average number of crepitus events/participant). Participants were also divided into 3 age groups for comparisons (18-25, 26-45, and 46-65 years). RESULTS: Overall, crepitus prevalence decreased pre-post SMT (average pre = 1.4 crepitus/participant vs post = 0.9). Prevalence progressively increased from the youngest to oldest age groups (pre-SMT = 0.0, 1.67, and 2.0, respectively; and post-SMT = 0.5, 0.83, and 1.5). Prevalence was higher in LBP participants compared with healthy (pre-SMT-LBP = 2.0, vs pre-SMT-healthy = 0.8; post-SMT-LBP = 1.0 vs post-SMT-healthy = 0.8), even though healthy participants were older than LBP participants (40.8 years vs 27.8 years); accounting for age: pre-SMT-LBP = 2.0 vs pre-SMT-healthy = 0.0; post-SMT-LBP = 1.0 vs post-SMT-healthy = 0.3. CONCLUSIONS: Our findings indicated that a larger study is feasible. Other findings included that crepitus prevalence increased with age, was higher in participants with LBP than in healthy participants, and overall decreased after SMT. This study indicated that crepitus assessment using accelerometers has the potential of being an outcome measure or biomarker for assessing spinal joint (facet/zygapophyseal joint) function during movement and the effects of LBP treatments (eg, SMT) on zygapophyseal joint function.

Retention of blinding at follow-up in a randomized clinical study using a sham-control cervical manipulation procedure for neck pain: secondary analyses from a randomized clinical study.

OBJECTIVE: Participants in clinical trials of spinal manipulation have not been rigorously blinded to group assignment. This study reports on secondary analyses of the retention of participant blinding beyond the immediate posttreatment time frame following a single-session, randomized clinical study. A novel control cervical manipulation procedure that has previously been shown to be therapeutically inert was contrasted with a typical manipulation procedure. METHODS: A randomized clinical study of a single session of typical vs sham-control manipulation in patients with chronic neck pain was conducted. Findings of self-reported group registration at 24 to 48 hours posttreatment were computed. The Blinding Index (BI) of Bang et al was then applied to both the immediate and post-24- to 48-hour results. RESULTS: Twenty-four to 48 hours after treatment, 94% and 22% of participants in the typical and control groups, respectively, correctly identified their group assignment. When analyzed with the BI of Bang et al, the immediate posttreatment BI for the group receiving a typical manipulation was 0.22 (95% confidence interval [CI], -0.03 to 0.47); for the group receiving a control manipulation, it was 0.19 (95% CI, -0.06 to 0.43). The BI at post-24 hours was as follows: typical = 0.75 (95% CI, 0.59-0.91) and control = -0.34 (95% CI, -0.58 to -0.11). CONCLUSIONS: This study found that the novel sham-control cervical manipulation procedure may be effective in blinding sham group allocation up to 48 hours posttreatment. It appears that, at 48 hours posttreatment, the modified form of the typical cervical manipulation was not. The sham-control procedure appears to be a promising procedure for future clinical trials.

Quantification of cavitation and gapping of lumbar zygapophyseal joints during spinal manipulative therapy.

OBJECTIVES: The purpose of this study was to use previously validated methods to quantify and relate 2 phenomena associated with chiropractic spinal manipulative therapy (SMT): (1) cavitation and (2) the simultaneous gapping (separation) of the lumbar zygapophyseal (Z) joint spaces. METHODS: This was a randomized, controlled, mechanistic clinical trial with blinding. Forty healthy participants (18-30 years old) without a history of low-back pain participated. Seven accelerometers were affixed to the skin overlying the spinous processes of L1 to L5 and the S1 and S2 sacral tubercles. Two additional accelerometers were positioned 3 cm left and right lateral to the L4/L5 interspinous space. Participants were randomized into group 1, side-posture SMT (n = 30), or group 2, side-posture positioning (SPP, n = 10). Cavitations were determined by accelerometer recordings during SMT and SPP (left side = upside for both groups); gapping (gapping difference) was determined by the difference between pre- and postintervention magnetic resonance imaging scan joint space measurements. Results of mean gapping differences were compared. RESULTS: Upside SMT and SPP joints gapped more than downside joints (0.69 vs -0.17 mm, P < .0001). Spinal manipulative therapy upside joints gapped more than SPP upside joints (0.75 vs 0.52 mm, P = .03). Spinal manipulative therapy upside joints gapped more in men than in women (1.01 vs 0.49 mm, P < .002). Overall, joints that cavitated gapped more than those that did not (0.56 vs 0.22 mm, P = .01). No relationship was found between the occurrence of cavitation and gapping with upside joints alone (P = .43). CONCLUSIONS: Zygapophyseal joints receiving chiropractic SMT gapped more than those receiving SPP alone; Z joints of men gapped more than those of women, and cavitation indicated that a joint had gapped but not how much a joint had gapped.

Evaluating the relationship among cavitation, zygapophyseal joint gapping, and spinal manipulation: an exploratory case series.

OBJECTIVE: This project determined the feasibility of conducting larger studies assessing the relationship between cavitation and zygapophyseal (Z) joint gapping following spinal manipulative therapy (SMT). METHODS: Five healthy volunteers (average age, 25.4 years) were screened and examined against inclusion and exclusion criteria. High-signal magnetic resonance imaging (MRI) markers were fixed to T12, L3, and S1 spinous processes. Scout images were taken to verify the location of the markers. Axial images of the L4/L5 and L5/S1 levels were obtained in the neutral supine position. Following the first MRI, accelerometers were placed over the same spinous processes; and recordings were made from them during side-posture positioning and SMT. The accelerometers were removed, and each subject was scanned in side-posture. The greatest central anterior to posterior Z joint spaces (gap) were measured from the first and second MRI scans. Values obtained from the first scan were subtracted from those of the second, with a positive result indicating an increase in gapping following SMT (positive gapping difference). Gapping difference was compared between the up-side (SMT) joints vs the down-side (non-SMT) joints and between up-side cavitation vs up-side noncavitation joints. RESULTS: Greater gapping was found in Z joints that received SMT (0.5 ± 0.6 mm) vs non-SMT joints (-0.2 ± 0.6 mm), and vertebral segments that cavitated gapped more than those that did not cavitate (0.8 ± 0.7 vs 0.4 ± 0.5 mm). CONCLUSIONS: A future clinical study is quite feasible. Forty subjects (30 in an SMT group and 10 in a control group) would be needed for appropriate power (0.90).

Lumbar spine and pelvic posture between standing and sitting: a radiologic investigation including reliability and repeatability of the lumbar lordosis measure.

OBJECTIVE: Sitting has been identified as a cause of mechanical low back pain. The purpose of this study was to use plain film x-rays to measure lumbar spine and pelvic posture differences between standing and sitting. METHODS: Eight male subjects were radiographed standing and sitting in an automobile seat. Measures of lumbar lordosis, intervertebral disk angles, lumbosacral angle, lumbosacral lordosis, and sacral tilt were completed. One-way analysis of variance (alpha = .05) was conducted on the variables stated above. A Bland-Altman analysis was conducted to assess agreement and repeatability of the lumbar lordosis angle using 2 raters. RESULTS: Lumbar lordosis values in standing (average, 63 degrees +/- 15 degrees ) and sacral inclination (average, 43 degrees +/- 10 degrees ) decreased by 43 degrees and 44 degrees , respectively, in sitting. Intervertebral joint angles in sitting underwent substantial flexion (L1/L2-5 degrees [+/-3 degrees ], L2/L3-7 degrees [+/-3 degrees ], L3/L4-8 degrees [+/-3 degrees ], L4/L5-13 degrees [+/-3 degrees ], and L5/S1-4 degrees [+/-10 degrees ]). Measures of lumbar lordosis; intervertebral disk angles between L2/L3, L3/L4, and L4/L5; lumbosacral lordosis; lumbosacral angle; and sacral tilt were significantly decreased between standing and sitting (P < .001). Intervertebral disk angle between L5/S1 was not significantly different. Analysis using the Bland-Altman technique found good agreement and stable repeatability of measures with no statistical significant differences between or within raters (R1, P = .8474; R2, P = .4402; and R-R2, P = .8691). CONCLUSION: The significant differences in lumbar and pelvic measures from standing to sitting further emphasize the range of motion experienced at vertebral levels in sitting. Based on the results of this study, interventions to return motion segments to a less flexed posture should be investigated because they may play a role in preventing injury and low back pain.