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Yoga for anxiety: A systematic review and meta-analysis of randomized controlled trials.
Cramer, H, Lauche, R, Anheyer, D, Pilkington, K, de Manincor, M, Dobos, G, Ward, L
Depression and anxiety. 2018;35(9):830-843
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While temporary anxiety is a natural response, excessive and prolonged anxiety can lead to a wide range of physical symptoms and behavior changes. Current treatment options include psychological approaches and medication, however many individuals experiencing anxiety choose to self-manage their condition. Yoga has become a popular approach to improve emotional well-being, and based on a recent study, yoga practitioners have reported managing stress and anxiety as one of the main reasons for practicing. The aim of this meta-analysis was to review the effectiveness and safety of yoga for anxiety. Eight studies with 319 participants were included in this systematic review. Among these studies, no effects were found for patients with anxiety disorders diagnosed by the Diagnostic and Statistical Manual (DSM) criteria, only for patients without a formal diagnosis. Based on these results, the authors conclude yoga may be beneficial in the short-term for individuals with elevated levels of anxiety, however there was no conclusive evidence for individuals when only DSM-diagnosed anxiety disorders were considered. These findings warrant further studies to better understand the connection between mindfulness practices and anxiety.
Abstract
Yoga has become a popular approach to improve emotional health. The aim of this review was to systematically assess and meta-analyze the effectiveness and safety of yoga for anxiety. Medline/PubMed, Scopus, the Cochrane Library, PsycINFO, and IndMED were searched through October 2016 for randomized controlled trials (RCTs) of yoga for individuals with anxiety disorders or elevated levels of anxiety. The primary outcomes were anxiety and remission rates, and secondary outcomes were depression, quality of life, and safety. Risk of bias was assessed using the Cochrane tool. Eight RCTs with 319 participants (mean age: 30.0-38.5 years) were included. Risk of selection bias was unclear for most RCTs. Meta-analyses revealed evidence for small short-term effects of yoga on anxiety compared to no treatment (standardized mean difference [SMD] = -0.43; 95% confidence interval [CI] = -0.74, -0.11; P = .008), and large effects compared to active comparators (SMD = -0.86; 95% CI = -1.56, -0.15; P = .02). Small effects on depression were found compared to no treatment (SMD = -0.35; 95% CI = -0.66, -0.04; P = .03). Effects were robust against potential methodological bias. No effects were found for patients with anxiety disorders diagnosed by Diagnostic and Statistical Manual criteria, only for patients diagnosed by other methods, and for individuals with elevated levels of anxiety without a formal diagnosis. Only three RCTs reported safety-related data but these indicated that yoga was not associated with increased injuries. In conclusion, yoga might be an effective and safe intervention for individuals with elevated levels of anxiety. There was inconclusive evidence for effects of yoga in anxiety disorders. More high-quality studies are needed and are warranted given these preliminary findings and plausible mechanisms of action.
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The association of diabetes-related self-care activities with perceived stress, anxiety, and fatigue: a cross-sectional study.
Zhao, FF, Suhonen, R, Katajisto, J, Leino-Kilpi, H
Patient preference and adherence. 2018;12:1677-1686
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Diabetes treatments rely on the individual’s ability to perform diabetes-related self-care activities (DRSCA), which involves tasks such as medication adherence, regulating diet, physical activity, blood glucose monitoring and foot care, however it appears that many individuals do not perform one or all of these tasks. Reasons why have been investigated, but remain insufficient. In this cross-sectional study of 248 individuals with type 2 diabetes (T2D) DRSCA was investigated in relation to stress, anxiety, and fatigue. The results showed that there was evidence of mid-level performance of DRSCA activities and performing DRSCA activities was likely to reduce stress levels but was not related to anxiety or fatigue. Individuals who had T2D for more than 5 years and women were more likely to have anxiety. Interestingly in contradiction to previous studies, support from outside sources did not affect levels of stress, anxiety and fatigue. It was concluded that improving the level of DRSCA may reduce stress. The fact that the performance of DRSCA was not related to anxiety may be because these activities impose restrictions on patients’ lives. This study could be used by healthcare professionals to understand that the performance of DRSCA may reduce stress levels, however as this study was an observational study, direct causal relationships are hard to determine.
Abstract
PURPOSE Many people with type 2 diabetes (T2DM) do not sustain sufficient diabetes-related self-care activities (DRSCA) in their daily lives. To provide additional information about the positive influence of DRSCA, this study was conducted to examine whether DRSCA were associated with reduced perceived stress, anxiety, and fatigue among people with T2DM and to explore the level of DRSCA, perceived stress, anxiety, and fatigue and their association with background information. PATIENTS AND METHODS This study was a cross-sectional survey including 251 participants aged 18 years and older recruited from two hospitals in the eastern part of China. The study utilized self-report questionnaires that consisted of background information, DRSCA, perceived stress, anxiety, and fatigue. Hierarchical multiple regression analysis was conducted to explore the association of DRSCA with perceived stress, anxiety, and fatigue while adjusting for background information. RESULTS The results indicated that the level of self-care activities, stress, and fatigue was around middle level. The prevalence of anxiety was 19%. A high level of DRSCA was likely to reduce perceived stress but was not linked to anxiety and fatigue. Women were more susceptible to stress and anxiety, and people who had diabetes for >5 years were more likely to have anxiety. The background information included diabetes duration, standardized diabetes education, and high social support, all of which are factors that may influence DRSCA. CONCLUSION The findings suggest that improving the level of DRSCA might effectively reduce perceived stress. The potential benefits of DRSCA can provide both motivational and evaluative data for self-care programs. In addition, the findings show that DRSCA were not linked to anxiety and fatigue, which implies that their positive influence on anxiety and fatigue may be offset by the load of frequent DRSCA. It is suggested that helping patients to make tailored plans to integrate DRSCA into their daily lives is needed. Meanwhile, in the background information, it is suggested that standardized diabetes education and high social support can benefit DRSCA; in improving psychological health, more attention should be paid to women and patients with diabetes duration <5 years.
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Effectiveness of plant-based diets in promoting well-being in the management of type 2 diabetes: a systematic review.
Toumpanakis, A, Turnbull, T, Alba-Barba, I
BMJ open diabetes research & care. 2018;6(1):e000534
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Diabetes can cause a number of health complications if not well managed and treated and has the potential to have a huge impact on people’s physical and psychological wellbeing. The aims of this review are to systematically analyse the available literature on plant-based diet interventions targeting and/or including adults with diabetes and to clearly define the benefits on well-being of such interventions. This study is a systemic review of 11 controlled trials, of which 7 were randomised. Results demonstrate that a plant-based diet can significantly improve psychological well-being, quality of life, control of type 2 diabetes measured by glycated haemoglobin [is a form of haemoglobin that is measured primarily to know the average plasma glucose concentration over a three-month period] and a number of physical characteristics in people with type 2 diabetes. Authors conclude that future studies could explore ways of delivering proper nutritional education in order to support participants to follow healthier dietary patterns.
Abstract
Diet interventions have suggested an association between plant-based diets and improvements in psychological well-being, quality of life and glycated hemoglobin (HbA1c) control in populations with diabetes. The aims of this review are to systematically analyze the available literature on plant-based diet interventions targeting diabetes in adults and to clearly define the benefits on well-being of such interventions. This is a systematic review of controlled trials. A computerized systematic literature search was conducted in the following electronic databases: Allied and Complementary Medicine, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, E-Journals, Excerpta Medica Database, MEDLINE, Health Management Information Consortium, PsycARTICLES, PsycINFO, PubMed, SocINDEX and Web of Science. The search strategy retrieved 1240 articles, of which 11 met the inclusion criteria (n=433; mean sample age 54.8 years). Plant-based diets were associated with significant improvement in emotional well-being, physical well-being, depression, quality of life, general health, HbA1c levels, weight, total cholesterol and low-density lipoprotein cholesterol, compared with several diabetic associations' official guidelines and other comparator diets. Plant-based diets can significantly improve psychological health, quality of life, HbA1c levels and weight and therefore the management of diabetes.
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Anxiety, Depression, and the Microbiome: A Role for Gut Peptides.
Lach, G, Schellekens, H, Dinan, TG, Cryan, JF
Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics. 2018;15(1):36-59
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Hormones released in the gut can have an impact in the brain through a bidirectional relationship, known as the gut-brain axis. The release of these hormones may be controlled by the gut microbiota, however exact mechanisms are not fully understood. Most hormones originating in the gut may have a role in obesity development, which is often associated with psychiatric disorders. Understanding the relationship between gut microbiota and depression through gut derived signalling molecules may be of benefit and was the focus of this review. Diversity and stability of the gut microbiota is important for health, which is disrupted during depression and anxiety. The gut microbiota serves to produce brain, hormone and immune signals that can travel to the brain, and can be affected by poor gut health. For those with depression, side effects of anti-depressants can be a disruption of the gut microbiota, however how this impacts symptoms is not fully understood. It was concluded that although there is strong research on the gut microbiota and depression it is still in its infancy. The role of gut microbiota on signalling with the brain and the rest of the body seems to be important for depression and anxiety. This study could be used by healthcare professionals to understand how the gut microbiota can play a role in depression.
Abstract
The complex bidirectional communication between the gut and the brain is finely orchestrated by different systems, including the endocrine, immune, autonomic, and enteric nervous systems. Moreover, increasing evidence supports the role of the microbiome and microbiota-derived molecules in regulating such interactions; however, the mechanisms underpinning such effects are only beginning to be resolved. Microbiota-gut peptide interactions are poised to be of great significance in the regulation of gut-brain signaling. Given the emerging role of the gut-brain axis in a variety of brain disorders, such as anxiety and depression, it is important to understand the contribution of bidirectional interactions between peptide hormones released from the gut and intestinal bacteria in the context of this axis. Indeed, the gastrointestinal tract is the largest endocrine organ in mammals, secreting dozens of different signaling molecules, including peptides. Gut peptides in the systemic circulation can bind cognate receptors on immune cells and vagus nerve terminals thereby enabling indirect gut-brain communication. Gut peptide concentrations are not only modulated by enteric microbiota signals, but also vary according to the composition of the intestinal microbiota. In this review, we will discuss the gut microbiota as a regulator of anxiety and depression, and explore the role of gut-derived peptides as signaling molecules in microbiome-gut-brain communication. Here, we summarize the potential interactions of the microbiota with gut hormones and endocrine peptides, including neuropeptide Y, peptide YY, pancreatic polypeptide, cholecystokinin, glucagon-like peptide, corticotropin-releasing factor, oxytocin, and ghrelin in microbiome-to-brain signaling. Together, gut peptides are important regulators of microbiota-gut-brain signaling in health and stress-related psychiatric illnesses.
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Recognizing Depression from the Microbiota⁻Gut⁻Brain Axis.
Liang, S, Wu, X, Hu, X, Wang, T, Jin, F
International journal of molecular sciences. 2018;19(6)
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Emerging research indicates that major depression is not just a mental disorder but also a systemic disease. In depression, the brain-gut axis, the bidirectional pathway that connects the brain and gut, is thought to be disturbed. This disruption is hypothesised to be a major pathological basis of depression. The aim of this paper is to explore this hypothesis by reviewing the current literature. According to the current literature, the authors found research stating the gut microbiota of depressed patients is significantly different from that of healthy controls. Additionally, disturbances or abnormalities in the gut can influence the susceptibility of onset of depression, while restoration of the gut will alleviate depression. Based on these findings, the authors conclude depression is closely related with the condition of the brain-gut axis, and that restoring the normal condition of gut microbiota may aid in the therapy of depression. The authors expect therapies that target gut microbiota will play an important role in the treatment and prevention of depression in the future.
Abstract
Major depression is one of the leading causes of disability, morbidity, and mortality worldwide. The brain⁻gut axis functions are disturbed, revealed by a dysfunction of the brain, immune system, endocrine system, and gut. Traditional depression treatments all target the brain, with different drugs and/or psychotherapy. Unfortunately, most of the patients have never received any treatment. Studies indicate that gut microbiota could be a direct cause for the disorder. Abnormal microbiota and the microbiota⁻gut⁻brain dysfunction may cause mental disorders, while correcting these disturbance could alleviate depression. Nowadays, the gut microbiota modulation has become a hot topic in treatment research of mental disorders. Depression is closely related with the health condition of the brain⁻gut axis, and maintaining/restoring the normal condition of gut microbiota helps in the prevention/therapy of mental disorders.
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Zinc, Magnesium, Selenium and Depression: A Review of the Evidence, Potential Mechanisms and Implications.
Wang, J, Um, P, Dickerman, BA, Liu, J
Nutrients. 2018;10(5)
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Adequate micronutrient consumption and mental health are of major public health importance. Recent findings suggest micronutrient deficiencies may play a role in the development and progression of depression, yet the findings remain unclear. The aim of this review is to present the recent evidence on the association between several micronutrients and depression and discuss the potential mechanisms and clinical implications. Based on the current literature, evidence shows an association between both zinc and magnesium deficiency and the risk of depression, with stronger evidence supporting zinc. Studies on selenium are limited or inconclusive. According to these findings, the authors support the importance of adequate micronutrient consumption for promoting mental health. They suggest future research should investigate the safety and efficacy of micronutrient supplementation as an adjunct treatment for depression to better inform current prevention and treatment strategies.
Abstract
Micronutrient deficiency and depression are major global health problems. Here, we first review recent empirical evidence of the association between several micronutrients—zinc, magnesium, selenium—and depression. We then present potential mechanisms of action and discuss the clinical implications for each micronutrient. Collectively, empirical evidence most strongly supports a positive association between zinc deficiency and the risk of depression and an inverse association between zinc supplementation and depressive symptoms. Less evidence is available regarding the relationship between magnesium and selenium deficiency and depression, and studies have been inconclusive. Potential mechanisms of action involve the HPA axis, glutamate homeostasis and inflammatory pathways. Findings support the importance of adequate consumption of micronutrients in the promotion of mental health, and the most common dietary sources for zinc and other micronutrients are provided. Future research is needed to prospectively investigate the association between micronutrient levels and depression as well as the safety and efficacy of micronutrient supplementation as an adjunct treatment for depression.
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Metabolic and Microbiota Measures as Peripheral Biomarkers in Major Depressive Disorder.
Horne, R, Foster, JA
Frontiers in psychiatry. 2018;9:513
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Though the connection between the gut microbiome, physical health and mental health is becoming more established, there remains a lack of understanding around the underlying cause of major depressive disorder (MDD). There is a need to identify biomarkers in MDD in order to help identify individual differences and improve treatment outcomes. The aim of this review is to investigate the link between metabolic biomarkers and the gut microbiota in individuals experiencing MDD. The current literature points to two potential biomarkers, leptin and ghrelin, which play a role in both metabolic disease and depression. Based on these findings, the authors conclude these biomarkers may help researchers and clinicians establish subgroups in depressed individuals in order to better predict treatment responses and develop more targeted therapies.
Abstract
Advances in understanding the role of the microbiome in physical and mental health are at the forefront of medical research and hold potential to have a direct impact on precision medicine approaches. In the past 7 years, we have studied the role of microbiota-brain communication on behavior in mouse models using germ-free mice, mice exposed to antibiotics, and healthy specific pathogen free mice. Through our work and that of others, we have seen an amazing increase in our knowledge of how bacteria signal to the brain and the implications this has for psychiatry. Gut microbiota composition and function are influenced both by genetics, age, sex, diet, life experiences, and many other factors of psychiatric and bodily disorders and thus may act as potential biomarkers of the gut-brain axis that could be used in psychiatry and co-morbid conditions. There is a particular need in major depressive disorder and other mental illness to identify biomarkers that can stratify patients into more homogeneous groups to provide better treatment and for development of new therapeutic approaches. Peripheral outcome measures of host-microbe bidirectional communication have significant translational value as biomarkers. Enabling stratification of clinical populations, based on individual biological differences, to predict treatment response to pharmacological and non-pharmacological interventions. Here we consider the links between co-morbid metabolic syndrome and depression, focusing on biomarkers including leptin and ghrelin in combination with assessing gut microbiota composition, as a potential tool to help identify individual differences in depressed population.
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Shared Concerns and Opportunity for Joint Action in Creating a Food Environment That Supports Health.
Sonneville, KR, Rodgers, RF
Nutrients. 2018;11(1)
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The food industry is a key player in the creation of a food environment, characterised by the over-abundance and aggressive marketing of engineered foods that may increase risk for eating disorders or negatively impact their remission. The aim of this study is to outline the rationale for leveraging food policy as an approach to eating disorders prevention. This study shows that a critical goal for universal prevention measures is to develop and implement effective policy approaches to limit the food industry’s capacity to continue shaping the food environment. However, discretion is important as an unintended consequence of this position may be the proliferation of food industry practices that might increase eating disorder risk. Authors note that eating disorders experts have a crucial part to play in informing policies targeting the food industry to ensure that such policies do no harm. Furthermore, policy efforts targeting the food industry should be considered as a means of improving universal prevention and decreasing an important environmental risk for eating disorders.
Abstract
The food industry is a for-profit industry with high relevance to universal eating disorders prevention. To date, policy which targets the food industry and food environment has been underutilized in efforts to decrease the incidence of eating disorders and associated risk factors. In contrast, food policy has been extensively leveraged with the aim of reducing the incidence of obesity. While philosophical misalignments with these later efforts may have constituted an obstacle to identifying the food environment as a key target for eating disorders prevention, food policy is an area where shared interests can be found. Specifically, a shared goal of obesity and eating disorders prevention efforts is creating a food environment that supports health, while minimizing the influence of the food industry that profits from the sale of highly palatable, processed foods and "diet" foods and from increasing portions of foods served and eaten.
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How and why weight stigma drives the obesity 'epidemic' and harms health.
Tomiyama, AJ, Carr, D, Granberg, EM, Major, B, Robinson, E, Sutin, AR, Brewis, A
BMC medicine. 2018;16(1):123
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Weight stigma is defined as the social rejection and devaluation that accrues to those who do not comply with prevailing social norms of adequate body weight and shape. In this opinion-based study, authors discuss that: • Latest literature indicates that weight stigma can trigger physiological and behavioural changes linked to poor metabolic health and increased weight gain. • Healthcare is a setting in which weight stigma is particularly pervasive, with significant consequences for the health of higher-weight patients. This stigma has direct and observable consequences for the quality and nature of services provided to those with obesity. • Stigma may be an unintended consequence of anti-obesity efforts, undermining their intended effect. Moreover, focusing solely on obesity treatment runs the risk of missing other diagnoses. • The science of weight stigma crystallizes a key point for future success – to tackle the obesity ‘epidemic’ we must tackle the parallel epidemic of weight stigma. • Public service messages are needed to educate people about the stigma, discrimination, and challenges facing higher-weight individuals. Authors conclude that to advance as an equal society, healthcare providers should lead the way for weight stigma eradication.
Abstract
BACKGROUND In an era when obesity prevalence is high throughout much of the world, there is a correspondingly pervasive and strong culture of weight stigma. For example, representative studies show that some forms of weight discrimination are more prevalent even than discrimination based on race or ethnicity. DISCUSSION In this Opinion article, we review compelling evidence that weight stigma is harmful to health, over and above objective body mass index. Weight stigma is prospectively related to heightened mortality and other chronic diseases and conditions. Most ironically, it actually begets heightened risk of obesity through multiple obesogenic pathways. Weight stigma is particularly prevalent and detrimental in healthcare settings, with documented high levels of 'anti-fat' bias in healthcare providers, patients with obesity receiving poorer care and having worse outcomes, and medical students with obesity reporting high levels of alcohol and substance use to cope with internalized weight stigma. In terms of solutions, the most effective and ethical approaches should be aimed at changing the behaviors and attitudes of those who stigmatize, rather than towards the targets of weight stigma. Medical training must address weight bias, training healthcare professionals about how it is perpetuated and on its potentially harmful effects on their patients. CONCLUSION Weight stigma is likely to drive weight gain and poor health and thus should be eradicated. This effort can begin by training compassionate and knowledgeable healthcare providers who will deliver better care and ultimately lessen the negative effects of weight stigma.
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Predictors of weight stigma experienced by middle-older aged, general-practice patients with obesity in disadvantaged areas of Australia: a cross-sectional study.
Spooner, C, Jayasinghe, UW, Faruqi, N, Stocks, N, Harris, MF
BMC public health. 2018;18(1):640
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People in higher categories of obesity are at substantially increased health risk because mortality increases sharply as body mass index rises above 30. In addition to physical health risks, people with obesity commonly experience weight-related stigma. The aim of this study was to identify predictors of perceived weight stigma among patients with obesity attending general practices in socioeconomically disadvantaged urban areas of Australia. This is a cross-sectional study for which data from telephone interviews with patients with obesity were used. Patients were recruited from 17 general practices in socioeconomically disadvantaged areas of Sydney and Adelaide. Results indicate that one-third of the sample had experienced direct forms of weight discrimination in the week before being interviewed. Furthermore, weight discrimination was more likely to be experienced by patients in higher obesity categories, who were not employed, who spoke a language other than English at home and who had lower scores on the Health Literacy Questionnaire domain (that measures the ability to actively engage with healthcare providers). Authors conclude that weight stigma may compound other forms of social disadvantage. Thus, strategies are needed to address weight stigma at the individual, system and population levels and to educate primary care providers to be more alert to the needs of their patients with obesity.
Abstract
BACKGROUND Rates of obesity have increased globally and weight stigma is commonly experienced by people with obesity. Feeling stigmatised because of one's weight can be a barrier to healthy eating, physical activity and to seeking help for weight management. The aim of this study was to identify predictors of perceived weight among middle-older aged patients with obesity attending general practices in socioeconomically disadvantaged urban areas of Australia. METHODS As part of a randomised clinical trial in Australia, telephone interviews were conducted with 120 patients from 17 general practices in socioeconomically disadvantaged of Sydney and Adelaide. Patients were aged 40-70 years with a BMI ≥ 30 kg/m2. The interviews included questions relating to socio-demographic variables (e.g. gender, language spoken at home), experiences of weight-related discrimination, and the Health Literacy Questionnaire (HLQ). Multi-level logistic regression data analysis was undertaken to examine predictors of recent experiences of weight-related discrimination ("weight stigma"). RESULTS The multi-level model showed that weight stigma was positively associated with obesity category 2 (BMI = 35 to < 40; OR 4.47 (95% CI 1.03 to 19.40)) and obesity category 3 (BMI = ≥ 40; OR 27.06 (95% CI 4.85 to 150.95)), not being employed (OR 7.70 (95% CI 2.17 to 27.25)), non-English speaking backgrounds (OR 5.74 (95% CI 1.35 to 24.45)) and negatively associated with the HLQ domain: ability to actively engage with healthcare providers (OR 0.12 (95% CI 0.05 to 0.28)). There was no association between weight stigma and gender, age, education or the other HLQ domains examined. CONCLUSIONS Weight stigma disproportionately affected the patients with obesity most in need of support to manage their weight: those with more severe obesity, from non-English speaking backgrounds and who were not in employment. Additionally, those who had experienced weight stigma were less able to actively engage with healthcare providers further compounding their disadvantage. This suggests the need for a more proactive approach to identify weight stigma by healthcare providers. Addressing weight stigma at the individual, system and population levels is recommended. TRIAL REGISTRATION The trial was registered with the Australian Clinical Trials Registry ACTRN126400102162 .