Whether you are here because you read Part I of TDEE and are in dire curiosity to know the answers to my teaser questions in Part I, or you landed here via a random Google search, you are still going to get an easy recap of Part I, Netflix style. 

In Part I we learned about the fundamentals of TDEE – the what, why, and how, the various components of TDEE namely BMR/REE, EAT, NEAT, and TEF, calorie calculators and methods to calculate your TDEE using the Harris-Benedict equation, and the relevance of TDEE in a CICO diet – how you can use TDEE as a starting point to understand your daily caloric needs but not as a sole tool for overall health management inclusive of weight management.

In this article, let us dive a little deeper into the nuances of TDEE with respect to changes in the seasons. 

A Little Magic Called Thermogenesis

Like any other biological parameter, TDEE is influenced by a vast number of factors. The human body, as a whole and in parts, is a dynamic, complex intertwined web of processes that influence each other and the overall existence of the being, which will always continue to fascinate mankind. Without a doubt, an individual’s metabolic rate is also influenced by a variety of factors ranging from what you eat, to the intensity of UV radiation from the sun. A key physiological process that is tied to the metabolic rate is thermogenesis. In literal terms, thermogenesis is ‘heat production’. Physiologically, thermogenesis translates to ‘the heat produced in direct response to a meal, which is then utilized in the digestion, absorption, assimilation of nutrients and disposal of waste’. This utilization of heat is termed the ‘Thermic Effect of Food (TEF)’. [1], [2] If that was a little too over your head, just remember the layman’s version – when you eat, your body generates heat as it breaks down what you eat. 

TDEE x Heat Waves

Now, let us look at what happens to your appetite when the temperature soars outside. Our bodies are not exposed to high temperatures on an everyday basis, which means we are not attuned to thrive in hot weather without significant changes happening to some physiological and biological processes to help our body get acclimatized. Once the body’s natural adaptive mechanisms kick in, it gets acclimatized to the heat. The first thing your body does is prioritize cooling the body in whatever way it can. This is why  you get thirsty a lot more often in summer than in winter; which is also why you experience reduced appetite because less appetite = reduced consumption of food = reduced thermic effect of food.  Your body needs less energy to maintain homeostasis in summer and so your TDEE is lowered by way of a natural caloric deficit. [3]

In addition, your hormones also experience a natural shift due to the shift in seasons, thus impacting physiological processes. Specifically, it has been noted that Ghrelin – the hunger hormone – and Leptin, the hormone that triggers satiety,fluctuate with the seasons. [4] While a lot of research is still emerging in this area, there are enough studies that indicate warmer seasons cause an increase in leptin in combination with a decrease in ghrelin leading to a reduced appetite. [5], [6]

TDEE x Sweater Weather

On the contrary, during colder seasons, the lower temperatures in the external environment mean your body needs to expend more energy to try and keep you warm and stay in homeostasis. In other words, your body wants to increase the level of thermogenesis, and in order to do that, your appetite is stimulated to increase the consumption of food, leading to an increased thermic effect of food. Naturally, this translates to an increase in TDEE. Ghrelin and Leptin also shift with the drop in temperature. Colder seasons lead to an increase in ghrelin and a drop in leptin leading to an increased appetite. [7]

In summary, TDEE is never constant and keeps fluctuating with the change in seasons. 

So what?

With all these science-y pieces of information, two questions loom over our heads: If TDEE is going to stay inconsistent through the year, what is the point of even taking it into account? Also, if I were to use TDEE as a measure of calorie intake, how do I leverage that against the fluctuations in TDEE that arise from seasonal shifts?

As mentioned in Part 1, TDEE is not all that useless. TDEE is a great starting point to understand your metabolic requirements, as long as you have factored in your activity levels as accurately as possible. Yes, it is not a super accurate measure, but hey – we’re not all Sheldon, so we can do with what the Harris-Benedict equation outputs. Or the Katch-McArdle if you get your TDEE worked out by a professional. One can also be wise and use the TDEE to plan your meals in such a way that you get a variety of nutrients from whole foods across the day, as well as get enough calories in a meal. As seasons shift, shift your eating patterns accordingly so you meet your natural TDEE. Eat to satiety, and eat in such a way that works in tandem with the body’s need to stay in homeostasis. For example, in summer, spruce up your plate with foods that can cool down your body – think cucumbers, melons, avocados, fish, lean cuts of chicken, coconut water, etc. This helps your body to balance into homeostasis a little easier without having to experience a massive drop in appetite. Similarly, during colder seasons, add warming spices like cinnamon, ginger, nutmeg, and cumin to your dishes so your body grows warm to combat the external cold. Add a few extra reps to your workout to increase blood circulation, which will allow your body to stay warm as well. 

As Thomas Huxley would say, “Science is simply common sense at its best, that is, rigidly accurate in observation, and merciless to fallacy in logic.” So, use your TDEE measures wisely, with an extra ounce of common sense, for a healthy you.

References

1. https://www.ncbi.nlm.nih.gov/books/NBK236229/
2. https://www.researchgate.net/publication/260397860_Metabolic_adaptation_to_weight_loss_Implications_for_the_athlete
3. https://nap.nationalacademies.org/read/2094/chapter/13#192
4. https://www.pnas.org/doi/10.1073/pnas.2003926118
5. https://nutritionandmetabolism.biomedcentral.com/articles/10.1186/s12986-019-0348-5
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3735984/
7. https://www.nature.com/articles/s41430-019-0408-y

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Water has been used for ages for many different purposes like drinking, cooking or washing but it has also been a vital element in therapies. There are two types of water therapies, Hot and Cold. While we all have heard a lot about saunas and hot water baths, let us today understand the benefits of cold water therapies.

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Water is used in therapies and is commonly practised in the form of ice baths AKA cold water immersion¹. Ice bath therapy is a method that involves immersing the body in a tub filled with ice and water for a short time. The duration of the therapy can vary, but it typically lasts between 5 to 15 minutes.

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The cold temperature of the water helps to reduce inflammation, swelling, and pain in the muscles. This is achieved by constricting the blood vessels and reducing blood flow to the affected area, which in turn reduces the amount of inflammation and swelling. The reduced inflammation and swelling can help to speed up the recovery process and alleviate muscle soreness. Ice baths are commonly used for recovery by athletes and people who engage in intense workouts. Some people also use ice baths as a way to boost their immune system and improve circulation. Cold water immersion is one of the classic examples of hormesis.

What is Hormesis?

Chronic stress resulting from factors such as an endless workload, bad relationships, disturbed circadian rhythm, or financial hardships can severely impact one's health. This is known as harmful stress².  

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On the other hand, Hormesis, or hormetic stressors, are regulated, short-period stressors that activate beneficial adaptive responses in the body. Hormesis is based on the dose-response relationship in the body, i.e., short-term doses of stress activate powerful cellular pathways that benefit overall health. Hormesis is associated with intermittent fasting, heat exposure, high-intensity interval training and even with phytonutrients present in cruciferous vegetables. Long periods of cold exposure can also lead to hypothermia. Hence, regulated cold water immersions are best when taken for a shorter time. Some of the benefits of cold water immersion include the shifting of fluid inside the cells and vessels, reduction of muscle swelling, increased cardiac output, and help with enhanced blood flow, nutrient distribution, and waste transportation. Some of these may be beneficial in recovery from exercise. There may also be an added psychological benefit whereby immersion reduces fatigue ¹.

How does this work?

A variety of things come under the umbrella of hormetic stressors and activate similar pathways. To one’s surprise, oxidative stress is one of the underlying pathways.

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Methods to achieve hormesis naturally induce a few reactive oxygen species, aka “free radicals”, in the body. The powerhouse of every cell, known as ‘mitochondria’, is responsible for producing the energy for the cells to function optimally. In the presence of a few radicals, it also makes copies of itself. And for a fact, you tend to feel tired more often because you lose mitochondria as you age. By regenerating mitochondria, you can improve your health².

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Hormesis causes short spurts of oxidative stress which impacts several cellular signalling systems. One of them includes the transcription factor Nrf-2. Transcription factors are a type of protein that activate genes by binding to the DNA. Nrf-2 protein breakdown slows down in the presence of free radicals, which leads to more Nrf-2 in the nucleus of cells. It further binds to the DNA present in the nucleus and activates the production of the most powerful antioxidant – glutathione – and enzymes that are involved in phase two detoxification. Phase two detoxification and these detoxifying enzymes help the body neutralize harmful toxins and oxidative stress.

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To summarize, activating low levels of oxidative stress now which are neutralized by hormetic stress later is oddly helpful².

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Ice bath therapy for Fitness enthusiasts:

Ice baths are commonly used by athletes and fitness enthusiasts as a post-workout recovery method. After engaging in intense exercise, muscles can become sore and inflamed due to micro-tears in muscle fibres. Ice baths are believed to help reduce inflammation, swelling, and pain in the muscles. This can lead to a faster recovery time and improved performance in subsequent workouts.

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However, it should be noted that ice baths are not a substitute for proper rest, nutrition, and hydration, which are also crucial for muscle recovery. Let us understand a few benefits of ice bath therapies in post-exercise.

Possible mechanisms of ice bath therapy post-exercise include:

• Intense exercises cause microtrauma and tears in the muscle fibres. Immersing oneself in ice water constricts the blood vessels, which has been proven to help with post-muscle soreness and pain³.
• The mechanism of blood vessel constriction is also advised as a mechanism that helps flush waste products, such as lactic acid, out of the affected tissue ^1,4.
• The cold temperature can cause a slowing down of the physiological processes & will reduce swelling and tissue breakdown.

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If this method is performed with proper guidance and training, it will benefit those actively participating in physical activities. 

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5 benefits of ice baths to keep in mind:

1. Aids Muscle Recovery & Cellular Energy: Professional athletes who jump into ice baths post-workout are onto something. As shown in a 2022 meta-analysis published in the journal Sports Medicine, cold water exposure is beneficial for muscle recovery⁵.

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2. Reduces Fatigue: It was observed that immersing oneself in an ice bath after an intense workout improved the quality of sleep². This improved sleep can benefit the Central Nervous System and, thus, makes you feel better, leading to less fatigue. It can help improve reaction time and performance in coming workouts, too.

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3. Reduces Inflammation: Taking an ice bath caps the inflammatory response as the cold temperature narrows your blood vessels. This leads to decreased blood flow to your muscles and may help in reducing inflammation and swelling.

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4. Enhances Performance: An ice bath in hot or humid temperatures before a long race can lower the core body temperature by a few degrees, leading to better performance.

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5. Improves Stress Management: Lastly, ice baths train your vagus nerve, which is linked with the parasympathetic nervous system. Training the vagus nerve can help you face stressful situations better. 

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Despite these benefits, there are some things to consider before indulging in ice baths, especially if an individual has cardiovascular conditions, hypertension, or low blood flow. It could lead to hypothermia if not done with proper guidance⁶. 

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4 tips to harness health benefits:

1. Encourage yourself to do challenging workouts: High-intensity interval training (HIIT), intense swimming sessions, a boxing routine, or any such workout routine that challenges your body. Also, keep in mind to do slow workouts like walking or yoga. Just like a balanced meal, a balanced workout is also necessary. 

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2. Practise Pranayama daily: While more research needs to be conducted on breathwork and hormesis, it can help increase your lung capacity and better cognition.

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3. Put your body out of your comfort zone: Just like ice bath immersions have a lot of benefits, there are benefits to heat as well. Saunas, hot baths, and working out in a hot environment can help in improving the immune system and reduce mortality risk as well.

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4. Add colourful foods to your plate: Plant foods can help activate a hormetic stress response in the body, via a process called ‘xenohormesis’. A few xenohormetic nutrients are curcumin from turmeric, resveratrol from berries, and allicin from garlic.

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It might feel like you are ready to harness the power of hormesis but it is easily possible to overdo these stressors. While eating a lot of colourful foods or doing HIIT is beneficial, it is always important to examine one’s stress levels and make sure you do not overdo hormesis. Make sure you are relaxed and your cup is not overflowing as hormesis is done to defend against future stressors, and not when you are susceptible to more stress. 

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Hormesis exists in multiple ways and can be beneficial to us when done in the right situation. Take proper guidance and understand the ice bath technique for beneficial results.

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References:

1. Lateef F. Post-exercise ice water immersion: Is it a form of active recovery? J Emerg Trauma Shock. 2010;3(3):302. doi:10.4103/0974-2700.66570

2. 6 Ways To Strategically Stress Your Body Out For Longevity & Immunity. mindbodygreen. Published February 28, 2021. Accessed February 8, 2023. https://www.mindbodygreen.com/articles/hormesis

3. Effect of hydrotherapy on recovery from fatigue - PubMed. Accessed March 21, 2023. https://pubmed.ncbi.nlm.nih.gov/18058595/

4. Ice-water immersion and delayed-onset muscle soreness: a randomised controlled trial - PubMed. Accessed March 21, 2023. https://pubmed.ncbi.nlm.nih.gov/17261562/

5. Are Ice Baths Worth It? What Experts Say About Their Benefits. mindbodygreen. Published December 16, 2022. Accessed February 8, 2023. https://www.mindbodygreen.com/articles/ice-bath-benefits

6. Ice Bath Benefits: Research, Tips, and More. Healthline. Published April 9, 2019. Accessed March 22, 2023. https://www.healthline.com/health/exercise-fitness/ice-bath-benefits

Math is undeniably no fun, at least for me it is not. But nutrition is no fun without its math. In this article, let us talk about numbers and metrics in nutrition. Before I even delve any further, here is a list of key metrics that will be used in their abbreviated form across the article and what they stand for. 

TDEE – Total Daily Energy Expenditure

BMR – Basal Metabolic Rate

NEAT – Non-Exercise Activity Thermogenesis

REE – Resting Energy Expenditure

TEF – Thermic Effect of Feeding

EAT – Exercise Activity Thermogenesis

NREE - Non-Resting Energy Expenditure

Now that we have got that out of the way, let us dive deeper into the most talked about, most famous metric – the TDEE. 

What is TDEE?

If you have been looking into what you eat, specifically on the lines of weight loss, and/or weight gain, TDEE is something you must have come across a million times now. TDEE, as the name stands for, is simply the total number of calories that your body needs, based on your energy expenditure. In layman’s terms, energy expenditure translates to - a) your activity levels – both exercise and non-exercise activity, and b) the number of calories your body burns at rest. Knowing your TDEE helps you in many ways – a) helps you determine how many calories you need to consume daily with relative accuracy b) helps you plan your meals better to ensure you get a whole host of nutrients in, and c) helps you plan your exercise levels in tandem with your calorie intake to achieve your fitness goals.

Components of TDEE:

TDEE is made up of 4 components – BMR (which is also your REE) being the largest – 70% of your TDEE, followed by 3 NREE components – NEAT – 25% of your TDEE, TEF – 10% of your TDEE, and EAT – just about 5% of your TDEE.[1] The fact that exercise makes up just about 5% of your TDEE can always be surprising, no matter how many times you read it. 

• Basal metabolic rate (BMR) refers to the number of calories you burn to perform essential biological functions like sleeping, breathing, digestion, etc. It makes up the largest portion of your TDEE - 70 percent.
• Non-exercise activity thermogenesis (NEAT) refers to calories burnt from any activity that is not exercise based, such as moving around the house, climbing that one flight of stairs to your terrace, that crazy set of moves you dance to a funky tune from the 90s, that meeting you take standing, etc. This makes up 25 percent of your TDEE.
• The thermic effect of food (TEF) is the amount of calories your body burns to digest, absorb, metabolize, and assimilate the food you consume, accounting for 10 percent of your TDEE
• Exercise activity thermogenesis (EAT) is the amount of calories burnt during exercise – i.e., when you are trying to break a sweat on purpose, accounting for only 5 percent of your TDEE.
• Non-resting Energy Expenditure (NREE) is the total amount of calories burnt through physical activity and thermogenesis.

Keep in mind that these numbers are average figures, as they do tend to vary based on your constitution, lifestyle, food consumption, and activity levels.

How to calculate TDEE?

The easiest way to calculate TDEE is to use one of the online TDEE calculators popularly known as calorie calculators. These calculators use age, gender, height, weight, and activity level as input to calculate your TDEE. While this is an easy and quick way to determine your TDEE, most online calculators are deficient in that they tend to have the user make assumptions about body composition, not factor in muscle mass, etc. thus leading to an incorrect estimate of your TDEE. Typically, these calculators are one-step calculators and do not take BMR into account. A more accurate way of determining your TDEE is to use a TDEE formula that takes BMR into account. Again, there are several formulae that one can use to determine, but by far the most popular and accurate formulae are the Katch-McArdle equation and the Harris-Benedict equation.

Katch-McArdle Equation for BMR

The Katch-McArdle equation factors in lean body mass percentage, which is a great parameter to make your TDEE figures more accurate. However, calculating Lean Body Mass (LBM) needs an accurate measure of your body fat %, which can be acquired only with the help of a professional. Once you have your body fat %, you can plug it into the following equation to arrive at your LBM:[2] 

Lean Body Mass = (1 - (body fat/100)) x weight in kg

We then use the LBM figure in the Katch-Mcardle equation to arrive at the BMR as follows:

BMR = 370 + (9.82 x lean body mass)

Harris-Benedict Equation for BMR

On the other hand, the Harris-Benedict equation uses weight, height, and age and multiplies them by pre-determined constants to determine BMR: [3]

• BMR for men = 88.362 + (13.397 x weight in kg) + (4.799 x height in cm) - (5.677 x age in years)
• BMR for women = 447.593 + (9.247 x weight in kg) + (3.098 x height in cm) - (4.330 x age in years)

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Calculating TDEE

After you get your BMR, you can then multiply it by the respective physical activity factor from the table below to get your TDEE:

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TDEE and The Calories-In-Calories-Out(CICO) Diet:

More often than not, those who have their TDEE calculated, venture into the popular Calories-In-Calories-Out (CICO) diet. The CICO diet is simply a dictation of how many calories you eat to lose weight. You calculate your TDEE and deduct a few calories (typically 10-15% of your TDEE) in order to introduce a calorie deficit in order to eat fewer calories than you burn. For example, if your TDEE is 2000 kcals, you eat 1800 kcals worth of food every day which will then allow your body to burn stored body fat to meet energy requirements. Sounds easy, and it definitely is a great first step to moving your body toward optimal body weight. However, eating fewer calories than needed in the long run is a no-no. 

Why CICO Doesn’t Work: 100g of Ice Cream Vs 100g of Chicken

Eating fewer calories than needed for a continued period of time slows down your metabolism.[4] Additionally, if you have been experiencing poor appetite, staying on a calorie deficit is only going to make it worse. On a CICO diet plan, one can eat 100g of vanilla ice cream worth 207 calories or 100g of chicken worth 220 calories every single day and still stay in a calorie deficit. In fact, the ice cream does seem more lucrative simply because it is slightly fewer calories than the chicken. However, when we start breaking down the nutrients in the ice cream vs that in chicken, the chicken is a clear winner because of the plethora of nutrients in it, in comparison with the ice cream. Deprivation of nutrients for sustained periods of time can also be a leading factor in poor mental health as nutrition is heavily intertwined with human cognition, behavior, and emotions.[5] 

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Conclusion

Thus, it is safe to conclude that, while TDEE is a great tool to understand one’s daily caloric needs and use it as a guide to planning your meals more effectively, it is definitely not the sole tool that one should rely on to manage your overall health, inclusive of weight management. 

But hey, I have a question, you ask. How can my TDEE be constant? Is it not going to change as I lose or gain weight., as I age, and modify my physical lifestyle? Of course, it does. As you age, or as you lose weight and your body composition changes, your body’s basal metabolic rate changes, in addition to the thermic effect of food which is unique to one’s constitution. But my dear reader, will you please let me pique your curiosity as I tell you TDEE can also change with the change in seasons, as well as geographic regions? More on that in part 2- coming soon.

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References

1. https://www.researchgate.net/publication/260397860_Metabolic_adaptation_to_weight_loss_Implications_for_the_athlete
2. https://books.google.co.in/books?id=XOyjZX0Wxw4C&lpg=PA859 
3. https://globalrph.com/medcalcs/harris-benedict-equation-updated-basal-metabolic-rate/
4. https://www.health.harvard.edu/diet-and-weight-loss/does-metabolism-matter-in-weight-loss
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2738337/ 

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Season. A period of the year based on defined characteristics such as the intensity of sunlight, humidity, rain, and other changes in ecology, and weather of the environment. The modern Gregorian calendar that we use today divides the year into 4 broad seasons – spring, summer, autumn, and winter. The number of seasons you may witness varies from four to six depending on where you live on Earth.  In addition to the four seasons of the Gregorian calendar, there is also the monsoon season and the dry season. Different cultures have very interesting ways of dividing the year into seasons – the Indian calendar divides a year into 6 seasons, the Chinese calendar has 24 seasonal points, and the Japanese calendar has 72 micro seasons. Regardless of how many seasons a year was divided into, our ancestors used this division of seasons to eat better and eat in response to the change in climatic conditions. In this article, let us delve deeper into why we need to eat seasonally, and how we can do that today.

Seasons and Gut Microbiome

As they say, change is the only constant. The world around us changes every day, and more specifically with every season. We see various ecological changes around us with every shift in seasons including but not limited to – the flowering and fruiting of flora, falling of leaves, hibernation of animals, etc. Human beings as part of this changing ecosystem, also experience changes in the body as the external environment around them changes. 

Our bodies appear to have evolved to naturally adapt to seasonal changes. Research has shown that people who live in regions with colder climatic conditions have different gut microbiome compositions than those who live in warmer climatic conditions. Other studies show that exposure to cold on a seasonal basis changes the makeup of your gut microbiome in replicable, specific ways. While there is more research to be done in this space, it looks like our bodies are meant to slow down and focus on fattening up in response to cold so that we can survive the winter. Exposure to cold can lead to shifts in your metabolism, your body tends to absorb calories faster, and your gut composition trends towards microbes that digest heavier, starchier foods better. [1], [2]

Seasons and Circadian Rhythm

The biological processes in our body relate to one another, and they have a phase relationship with one another. Changes in the external environment also aggravate specific stressors in the body. If this stress is not dealt with by adapting to the external environment, via food and lifestyle changes specific to that season, then homeostasis is disrupted and this makes way for lifestyle diseases. 

Similarly, the natural circadian rhythm also changes with the seasons. Several studies on sleep and circadian rhythms have indicated significant effects of ecological factors on the overall circadian rhythm. To explain it simply, the shift in the intensity of sunlight, and the earth’s axial rotation affecting the length of the day causes shifts in the timing of sleep, the mean body temperature, the phases of circadian temperature and melatonin rhythms, and the phase relation between sleep and the rectal temperature rhythm. [3],[4],[5]

Thus, in order to remain one with nature, and move in the same direction as nature, it is important to look into eating seasonally. In addition to optimizing the health of your body, eating seasonally also has some macro effects on the environment in itself – promoting sustainability, impacting the environment, health, society, and economy, but that’s for another day. 

Seasonal Eating & Nutrition

Eating seasonally, literally means that you eat produce specific to that season – those that are harvested and ripe for consumption in that season. You also eat foods that are easier to digest in that season, as your body’s ability to digest different foods vary across seasons. The health benefits apart, eating seasonally also means eating foods that taste better. Produce grown and consumed in their appropriate seasons taste a whole lot better, and they are also nutrient dense. Produce that is grown out of their appropriate seasons cannot follow their natural growing and ripening rhythms. They also have higher levels of harmful substances like lectin, which damages the walls of your intestines and makes it easier for your gut microbiome to become unbalanced. For certain fruits and vegetables to be available throughout the year, ripening agents and post-harvest treatments are used. These processes enable the production of vegetables and fruits in larger quantities by means of slowing down the maturation and ripening process. While this process ensures year-round availability, it also gives way to produce of poor nutrition. Many fruits and vegetables lose phenolics, vitamin C, and anthocyanins — which are antioxidants that fight free radical damage and oxidative stress in the body — after 15 days of cold storage. [6]

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Eating Seasonally Helps The Environment

Eating seasonally is also a great way to lower the carbon footprint. Sourcing seasonal food means produce spending less time on the truck and the lack of need to hold them in cold storage, leading to lower Green House Gas (GHG) emissions. 

How to eat seasonally?

Shop at the local farmers’ market

A very good way to start eating seasonally is to go to your local farmers’ market and start observing the different produce that is being sold. Go as often as you can. Talk to the farmers and produce sellers about what is in season. You will notice that local, seasonal produce is usually available in large volumes in season, and cheaper as well. Other places that you can check are the local co-op society gardens and local farms. 

Growing your own food

Another great way to incorporate seasonal eating is to grow your own seasonal produce as much as possible. This is also a great way to understand the cycles and patterns of the microcosm around you and adapt yourself better to the very microenvironment you live in. As you grow your own food, you also develop a closer relationship with your food, as your produce becomes the labour of your love.

Listening to your body

The third, and my personal favorite way of eating seasonally is by listening to your body. In addition to eating what is in season, eating what your body needs the most will work wonders. Look at parameters such as – hunger patterns – are you feeling intense hunger or mild hunger, how often are you feeling hungry, sleep quality, energy levels, bowel movements, and digestion patterns, and then opt for the right foods. For example, if it is a warmer season, and your hunger is mild, you feel less hungry for the most part of the day, and your sleep quality and bowel movements are fine, you can opt for nourishing and warming soups or light to digest meals with plenty of herbs like ginger, oregano, etc. with a good portion of lean protein. This enables you to have more holistic control over your body as the seasons shift. 

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References

1. https://pubmed.ncbi.nlm.nih.gov/24522631/
2. https://pubmed.ncbi.nlm.nih.gov/26638070/
3. https://pubmed.ncbi.nlm.nih.gov/1590482/
4. https://www.sciencedirect.com/science/article/pii/S0960982216315226
5. https://www.nature.com/articles/s41746-021-00435-2 
6. https://pubmed.ncbi.nlm.nih.gov/17852499/

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Under the surface of our daily lives, a secret world exists that is dominated not by bacteria or viruses but rather by cunning and adaptable fungi. These mysterious organisms, with their alluring capacity for transformation and adaptation, hold the key to an exclusive domain of infections unmatched by anything else. They can live happily in their native environments, but once they get inside the human body, they turn into ruthless devils.

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Imagine a group of fungi having a wild party in your toenails or creating a complex web of pain in the small crevices of your epidermis (the outer layer of your skin). These alluring invaders have the ability to go deep inside your lungs, where they can establish a camp and create havoc. Please don't worry, dear reader! Our exploration of fungal diseases will arm you with the knowledge and tactics necessary to outwit these crafty enemies. 

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When a microorganism enters a person's body and causes distress, this is referred to as an infection. The microbe survives, reproduces, and colonizes that person's body. However, not all microbes are harmful. A microbe becomes a pathogen when it comes with drastic consequences. Pathogens are infectious microscopic organisms that multiply quickly and harm an individual's body. Diseases can be passed from person to person by direct touch, airborne droplets, contaminated food or drink, or insect or animal bites⁽¹⁾. There are several forms of infections, and their severity varies based on the type of microbe, the afflicted location of the body, and the individual's general health. Some infections are minor and self-limiting, while others are serious and potentially fatal.

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Fungal infections

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Fungi are a broad collection of organisms that may thrive in various conditions, such as soil, air, water, and plants, causing fungal illnesses. While most fungi are safe for humans, some can cause illnesses. Fungal infections, sometimes known as mycosis, are caused by various fungi that can infect many regions of the body, including the skin, nails, respiratory system, and internal organs. Fungi are abundant in the environment and are normally harmless, although select species can cause illnesses in humans and animals⁽²⁾.

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Factors influencing fungal infections

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1. Environmental exposure - Fungi in the environment, such as those found in soil or on plants, might increase the likelihood of acquiring fungal infections. This is especially true for people who work in specific vocations, such as farmers or construction workers.
2. Weakened immune system - Fungal infections can be exacerbated by a compromised immune system caused by illnesses such as HIV/AIDS, cancer, diabetes, or long-term use of immunosuppressive medicines.
3. Poor hygiene - Poor hygiene can raise the risk of fungal infections, especially in difficult-to-clean body parts like the feet and groin.
4. Age - Because of changes in the skin and immune system that occur with age, older persons are more susceptible to fungal infections^(3,4). 

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Symptoms of Fungal infections

The intensity of the symptoms is determined by the type of illness and the individual's general health, and can include: ^(4,5)

• Fever
• Weariness
• Body pains
• Coughing
• Sneezing
• Diarrhoea . 

While keeping an eye out for the symptoms is useful, it is even more handy to understand potential causes for fungal diseases and what you can do to treat them if you have been afflicted.

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Common fungal Diseases

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We have delved into the nuances of signs and symptoms and the underlying causes of fungi infections, better preparing ourselves to face these mysterious foes. Now, it's time to bravely go into the infections themselves, which are the true source of the problem.

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1. Athlete’s foot (Tinea Pedis): 

It is caused by a dermatophyte fungus that often grows between the toes. Damp surfaces in locker rooms, showers, and swimming pools are frequently to blame⁽⁶⁾.

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Treatment:

• Apply anti-fungal ointments
• Change your socks frequently
• Avoid walking barefoot
• Apply tea tree oil
• Maintain hygiene^(7,4).

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2. Cryptococcosis:

Two species of Cryptococcus viz., neoformans and gattii, infect humans mainly by inhalation of the fungus. This causes a lung infection, which can travel to the brain and cause a disease called meningoencephalitis^(8,9).

‍

Treatment:

• Depending on the patient’s condition, surgery may be required for removing the fungal mass
• Avoid going to places where there is excessive fungi growth⁽⁸⁾. 

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3. Vaginal yeast infection:

The fungus Candida albicans is responsible for most vaginal yeast infections. Inflammation, discharge, and extreme itching of the vagina and vulva — the tissues at the vaginal opening — caused by a fungal infection⁽¹⁰⁾.

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Treatment:

• Avoid scented feminine products
• Avoid unnecessary use of antibiotics which might kill your good bacteria
• Maintain proper sanitation
• Avoid hot tub baths
• Change your undergarments frequently⁽¹⁰⁾.

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4. Dandruff: 

Malassezia fungus forms on oily scalps due to excessive sebum production. This fungus feeds on the natural oils in the hair and only leaves the oleic acid left. The body responds to this shift by rapidly multiplying cells, resulting in degeneration of the skin on your scalp and white flaky particles that appear as dandruff in your hair⁽¹¹⁾.

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Treatment:

• Use natural masks made of ginger, hibiscus, onion, and fenugreek
• Wash your hair often, with a mild shampoo
• Manage your stress levels⁽¹²⁾.

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5. Ringworm (Tinea corporis): 

Trichophyton, Microsporum, and Epidermophytonis cause ringworm. It is characterized by a red, round, flat sore that may be accompanied by scaly skin. The skin outside the sore may be elevated, while the skin in the centre  seems normal. Red rings or patches may overlap⁽¹³⁾.

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Treatment:

• Apply anti-fungal ointments
• Avoid putting on bandages
• Maintain proper sanitation⁽¹⁴⁾.

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As we conclude our exhilarating exploration of fungal infections, we stand in awe of the complex tapestry that they weave within our lives. We have started on a journey of information and understanding, exploring the causes, signs, and stories of various illnesses. But keep in mind that our comprehension is merely the tip of the iceberg. The field of fungi infections is large, constantly changing, and full of unsolved puzzles. Let's embrace the joy that research offers as it points the way to better prevention and treatment and promises future breakthroughs. Keep your curiosity stoked because the fascinating world of fungal illnesses is still developing and enticing us towards a time when health will prevail over adversity.

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References

(1) Healy, B.; Freedman, A. Infections. BMJ 2006, 332 (7545), 838–841. https://doi.org/10.1136/bmj.332.7545.838.

(2) Spallone, A.; Schwartz, I. S. Emerging Fungal Infections. Infect. Dis. Clin. North Am. 2021, 35 (2), 261–277. https://doi.org/10.1016/j.idc.2021.03.014.

(3) Maertens, J.; Vrebos, M.; Boogaerts, M. Assessing Risk Factors for Systemic Fungal Infections. Eur. J. Cancer Care (Engl.) 2001, 10 (1), 56–62. https://doi.org/10.1046/j.1365-2354.2001.00241.x.

(4) Fungal Infections: Types, Symptoms, Diagnosis, Treatments. Verywell Health. https://www.verywellhealth.com/fungal-infections-5323789 (accessed 2023-03-29).

(5) Sanghvi, A. S. Fungal Infections: Symptoms, Risk Factors, & Treatment. eMediHealth. https://www.emedihealth.com/skin-beauty/fungal-infections/fungal-infections (accessed 2023-03-29).

(6) Leyden, J. J. Interdigital Athlete’s Foot: The Interaction of Dermatophytes and Resident Bacteria. Arch. Dermatol. 1978, 114 (10), 1466. https://doi.org/10.1001/archderm.1978.01640220015004.

(7) Common Vitamins and Supplements to Treat tinea-pedis. https://www.webmd.com/vitamins/condition-1685/tinea-pedis (accessed 2023-03-29).

(8) Cryptococcosis: Symptoms, Treatment, Diagnosis, Prevention & Causes. eMedicineHealth. https://www.emedicinehealth.com/cryptococcosis/article_em.htm (accessed 2023-03-29).

(9) van Rhijn, N.; Bromley, M. The Consequences of Our Changing Environment on Life Threatening and Debilitating Fungal Diseases in Humans. J. Fungi 2021, 7 (5), 367. https://doi.org/10.3390/jof7050367.

(10) Yeast infection (vaginal) - Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/yeast-infection/symptoms-causes/syc-20378999 (accessed 2023-03-29).

(11) Is There A Connection Between Dandruff And Fungus?. MyCocoSoul. https://mycocosoul.com/blogs/hair-problem-benefits/is-dandruff-a-fungus (accessed 2023-03-29).

(12) [No Title Found]. Int. J. Pharm. Sci. Res. 9 (2).

(13) Contributors, W. E. Fungal Infections of the Skin. WebMD. https://www.webmd.com/skin-problems-and-treatments/guide/fungal-infections-skin (accessed 2023-03-29).

(14) How to Get Rid of Ringworm: 7 Treatments. Healthline. https://www.healthline.com/health/how-to-get-rid-of-ringworm (accessed 2023-03-29).

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Whether you have a keen interest in nutrition or if you are just another digital user sucking in the plethora of information that is being thrown at you, I am sure you have seen a surge in references to the D word and the P word. Don’t roll your eyes, you dirty mind. I am talking about Diabetes and Probiotics. The onset of industrialization also marks the silent beginning of not one, but many chronic metabolic diseases, for industrialization, simply did not just change the way things were produced, but the absolute lifestyle of a human. Of the many changes that industrialization - specifically food industrialization, brought to the human body, perhaps the most crucial and disastrous change is the changes in our gut microbiome - particularly the depletion of healthy colonies in our gut. As humankind struggles to thrive at the apogee of chronic diseases, it becomes crucial for us to bring back ancestral practices and norms that can help reverse chronic diseases and live in our best health. In this article, we will dive deeper into probiotics, a class of live microorganisms that are essential and have a strong impact on the overall health of a person. 

Diabetes – Factors

Diabetes, being clinically defined as a chronic disease that sets in as a result of the pancreas’ inability to produce enough insulin or when the body is unable to effectively use the insulin it produces, is often linked to genetics, epigenetics, obesity, hormonal imbalances, poor physical activity, and diet. 

Another key factor that has been gaining traction recently is the gut microbiota and its role in regulating metabolism and immune functions. The gut microbiome which is defined by a person’s food habits and lifestyle has a significant impact on patients with diabetes, not only in terms of the criticality of just diabetes, but also in terms of co-morbidity determining the impact on other organs as well. 

The Gut-Diabetes connection

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a) Gut Inflammation

Scientific investigations [1] have concluded that there are specific classes of microbes such as Bifidobacterium, Bacteroides, Faecalibacterium, Akkermansia, and Roseburia that help combat diabetes. However, people with diabetes commonly have a gut microbiota depleted of the classes as mentioned above and systemic inflammation. In addition, butyrate-producing bacteria are also present in low numbers in people diagnosed with diabetes, specifically T2DM, thus affecting homeostasis. On the contrary, it has also been concluded that certain classes such as Ruminococcus, Fusobacterium, and Blautia contribute to furthering diabetes, and are thus usually present in large numbers in diabetics. With such stark evidence of the impact of the gut microbiome in diabetics, it does become imperative to pay attention to gut health as part of a holistic approach to diabetes. 

b) Homeostasis of Glucose Metabolism

One of the key functions of the gut microbiota as part of maintaining overall homeostasis is homeostasis of glucose metabolism [2]. While there is a deficit in knowledge regarding which compositional and/or functional characteristics of the gut microbiota are relevant for metabolic health, and through which mechanisms they affect host glucose homeostasis, plenty of studies indicate the dysbiosis of gut microbiome does impact the metabolism of glucose, through mechanisms such as a) increased systemic lipopolysaccharide (LPS), b) changes in bile acid metabolism, c) alterations in short chain fatty acid (SCFA) production, d) alterations in gut hormone secretion, and d) changes in circulating branched-chain amino acids which are made possible through the intestinal permeability and metabolic outputs produced by the gut microbiota. 

c) Change in microbiome composition

Another key evidence of the role of the gut microbiome in chronic metabolic diseases is the change in the microbiome composition along the digestive tract [3]. It is a common misconception that the gut microbiome primarily resides in the intestines and the mouth. While the largest colonies are indeed present in the intestines, the microbiome is present across the human body and more specifically along the entire length of the digestive tract. Small intestinal bacterial overgrowth popularly known as SIBO is commonly witnessed in diabetic, and to a certain degree pre-diabetic individuals as well and is known to act as a causative factor for diabetes and other metabolic diseases. SIBO results in the breaking down of complex carbohydrates and bile acid in the upper gastrointestinal (GI) tract as opposed to the lower GI tract, which leads to the deprivation of the colon bacteria as well. 

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‍

Balancing the gut

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With enough given scientific evidence that the gut microbiome does impact diabetes, here are a few ways to ensure a healthy gut microbiome, particularly in the realm of diabetes. 
‍

1. Fermented foods: Every culture has its own kind of unique fermented food that enables the production of short-chain fatty acids that feed the good bacteria in the gut. Some classic examples are coconut curd, sauerkraut, apple cider vinegar (with the "mother"), dietary supplements kimchi, etc. Adding a locally fermented food of your choice does great good to your gut and overall health. However, if you have an ongoing incident of SIBO, stay away from fermented foods of any kind as it can aggravate SIBO further.

2. Bone broth: A healthy home makes way for happy bacteria. Bone broth is a functional food that is rich in a plethora of minerals like calcium, manganese, potassium, zinc, iron, boron, etc., and amino acids like glycine and arginine that can help protect and heal the mucosal lining of the digestive tract, heal inflammation, and keeps intestinal permeability in check.[4]

3. Probiotic supplements: A good store-bought probiotic supplement that is high on the count in Bifidobacterium, Bacteroides, and Akkermansia can help restore your gut microbiome. Studies have shown that probiotics have a positive effect in lowering fasting blood glucose in Type 2 Diabetes Mellitus patients, specifically on those with poorly controlled diabetes and not on any insulin therapy. The effect of probiotics on glucose homeostasis likely stems from changing the composition of the host gut microbiota. Altering the gut microbiota can improve intestinal barrier integrity to reduce circulating bacterial endotoxin, and ultimately, reduce systemic inflammation.[5],[6] Ensure you speak to a practitioner to get access to a good probiotic. 

4. Digestive bitters and herbs: These are specifically for when your gut is out of balance and you have a case of dysbiosis. The incorporation of bitters in a cyclic fashion will help in the reduction of bad microbes. Some classic digestive bitters and herbs that specifically work on the gut microbiome are licorice, dandelion roots, neem, oregano, ginger, garlic, and grapeseed. Start with a small quantity of a single herb, stay put for a couple of weeks, and then cycle it with a different herb. The kind of herb that will work best for you, depends on what type of SIBO you are experiencing - methane dominant vs hydrogen dominant. Work with a functional health practitioner to determine what single herbs/herbs in combination work best for your case. [7]

5. Sugar:  This is something to avoid, for sugar is a favorite food of non-beneficial bacteria in the microbiome. Recent research has concluded consumption of dietary sugar leads to gut inflammation and the growth of non-beneficial bacteria [8]. Lower your dietary sugar and hidden sugar intake to as low as possible, enabling a good microbiome balance. 

‍

References

1. https://www.thelancet.com/journals/ebiom/article/PIIS235239641930800-X/fulltext
2. https://gutpathogens.biomedcentral.com/articles/10.1186/s13099-021-00446-0
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4880177/
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3358810/
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8166562/
6. https://www.nature.com/articles/s41598-020-68440-1
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4030608/
8. https://www.cell.com/cell/fulltext/S0092-8674(22)00992-8‍

Other references

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7915949/

https://pubmed.ncbi.nlm.nih.gov/23969321/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8909623/

https://www.sciencedirect.com/science/article/abs/pii/S1744388121001420

Nothing beats a cold beverage on a hot day. An ice-cold soft drink sounds just right to quench your thirst, and the bubbly sensation gives a pleasant change from regular water. Drinks infused with soda instantly boost spirits and provide the jolt of refreshment needed in oppressively hot weather.

Soft drinks are manufactured and widely distributed throughout the world. Various brews can be made using soda water and syrups to create a delicious bubbly beverage. These drinks get their enjoyable sparkling sensation and fizzy taste thanks to the dissolved carbon dioxide (CO₂) that’s added to the drinks. But is fizzy enjoyment all there is to sodas? What impact does it have on our bodies?

But before we get into that, we should consider what makes sodas such desirable beverages.

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What Makes Soda Appealing?

The main components of carbonated drinks include water, carbon dioxide, sweeteners, colours, acids, and added flavours. Sometimes, drinks can also contain caffeine. These components transform the plain carbonated soda into a sugary sweet, flavorful beverage. These flavours could come from fruit juice, natural extracts, or artificial sources.
The chilled temperature at which these beverages are served and the sugar factor make them highly desirable, especially during hot days. Sometimes, people want a combination of thirst-quenching and flavour. The added sugars might be the primary reason people prefer these over natural fruit juices and plain water. Sugar triggers dopamine release in the brain, making people crave these drinks more and more when the good feelings of a dopamine rush wear off. But sugar is not solely responsible for the addictive nature of these drinks, because people often crave the “diet” or “zero sugar” versions of carbonated beverages too. The addictive nature also comes from the other components. Caffeine, for example, is another addictive substance found in some carbonated drinks. And the carbonation itself is said to be a contributor to the reason why people crave aerated beverages.^(1,2)

Health Consequences of Drinking Sugary Soda (soft drinks)

These drinks are often consumed in high amounts, offer no nutritional value to any individual and are associated with a wide range of health effects. 

Most of these carbonated drinks have a harmful effect on the dental and general health of people, including children and adolescents. The high sugar content in these beverages has a high cariogenic (ability to cause tooth decay) and acidogenic (ability to produce acid or cause acidity) potential.⁽³⁾

Both, regular and diet sodas have been connected to obesity, kidney damage, and several malignancies, like:

‍

1. Blood Pressure: Regularly drinking soft drinks has been linked to the development of blood pressure issues⁽⁴⁾. The possible involvement of high-fructose corn syrup in soft drinks has been linked to oxidative stress, adipogenesis, and increased blood pressure. Moreover, fructose promotes fat storage and causes vascular damage. The little to no caloric compensation, lack of satiety, and high added sugar content are other mechanisms contributing to why the rise in blood pressure can be caused by soft drinks⁽⁵⁾.
   ‍
2. Chronic Diseases⁽⁶⁾: Soda sweetened with sugars can lead to chronic disorders like:

• Type-2 diabetes
• Heart disease
• Kidney disease
• Non-alcoholic liver disease

3. Weight Gain: Prolonged consumption of carbonated soft drinks is a major risk factor for weight gain and obesity because consuming the same number of calories in soda as in solid food does not result in the same feeling of fullness. Some people could keep eating after having a calorie-dense beverage. Additionally, calorie-dense foods may tempt you more when you consume sweet-tasting drinks⁽⁷⁾.

4. Gout: Sweetened soda beverages are high in fructose, the one carbohydrate which is known to increase uric acid levels⁽⁸⁾. Such increased intake of fructose is associated with an increased risk of gout. It is observed that plasma uric acid concentrations increase soon after the infusion of fructose⁽⁹⁾. 

Health Risks for Children

Children who have a sweet tooth are highly likely to crave these unhealthy drinks because of the high sugar content. But how often a child is allowed to have soft drinks should be monitored as it can have critical health risks for the child.

• An excessive amount of added sugar, especially from sugar-sweetened beverages, can make kids more likely to develop obesity, tooth decay, and other health issues.
• It can also have an effect on bone health if children consume these beverages frequently, especially soda and energy drinks. During a child's critical growth and development, these drinks may impact bone density and the body's ability to absorb calcium⁽¹⁰⁾.

It would seem that soft drinks are indeed refreshing and delicious but for all the wrong reasons. The added sugars and flavourings make the beverage one of the worst things you could put in your body, as it has little to no benefits and can cause massive damage.

We recommend switching to healthier options to quench your thirst, especially in the summers, such as homemade iced tea with honey, coconut water, fruit and herb infusion water, cool watermelon juice, and other delicious and natural beverages. 

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By making small changes to our beverage choices, we can improve our overall health and still enjoy refreshing drinks during the hot summer months. So next time you reach for a soda, consider trying one of these healthier alternatives instead.

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Reference:

(1) Ranadheera, C. S.; Prasanna, P. H. P.; Pimentel, T. C.; Azeredo, D. R. P.; Rocha, R. S.; Cruz, A. G.; Vidanarachchi, J. K.; Naumovski, N.; McConchie, R.; Ajlouni, S. 6 - Microbial Safety of Nonalcoholic Beverages. In Safety Issues in Beverage Production; Grumezescu, A. M., Holban, A. M., Eds.; Academic Press, 2020; pp 187–221. https://doi.org/10.1016/B978-0-12-816679-6.00006-1.

(2) Carstens, E.; Iodi Carstens, M.; Dessirier, J.-M.; O’Mahony, M.; Simons, C. T.; Sudo, M.; Sudo, S. It Hurts so Good: Oral Irritation by Spices and Carbonated Drinks and the Underlying Neural Mechanisms. Food Qual. Prefer. 2002, 13 (7), 431–443. https://doi.org/10.1016/S0950-3293(01)00067-2.

(3) My library. https://books.google.co.in/books?uid=109365201605173880220&hl=en (accessed 2023-02-20).

(4) Saint-Eve, A.; Déléris, I.; Feron, G.; Ibarra, D.; Guichard, E.; Souchon, I. How Trigeminal, Taste and Aroma Perceptions Are Affected in Mint-Flavored Carbonated Beverages. Food Qual. Prefer. 2010, 21 (8), 1026–1033. https://doi.org/10.1016/j.foodqual.2010.05.021.

(5) Tahmassebi, J. F.; BaniHani, A. Impact of Soft Drinks to Health and Economy: A Critical Review. Eur. Arch. Paediatr. Dent. 2020, 21 (1), 109–117. https://doi.org/10.1007/s40368-019-00458-0.

(6) Boyles, S. Soda Health Facts: Are Soft Drinks Really Bad for You?. WebMD. https://www.webmd.com/diet/features/sodas-and-your-health-risks-debated (accessed 2023-02-20).

(7) Hernández-López, R.; Canto-Osorio, F.; Vidaña-Pérez, D.; Torres-Ibarra, L.; Rivera-Paredez, B.; Gallegos-Carrillo, K.; Velazquez, R.; Ramírez, P.; Barrientos-Gutiérrez, T.; Salmerón, J.; López-Olmedo, N. Soft Drink and Non-Caloric Soft Drink Intake and Their Association with Blood Pressure: The Health Workers Cohort Study. Nutr. J. 2022, 21 (1), 37. https://doi.org/10.1186/s12937-022-00792-y.

(8) CDC. Sugar Sweetened Beverage Intake. Centers for Disease Control and Prevention. https://www.cdc.gov/nutrition/data-statistics/sugar-sweetened-beverages-intake.html (accessed 2023-02-20).

(9) González-Morales, R.; Canto-Osorio, F.; Stern, D.; Sánchez-Romero, L. M.; Torres-Ibarra, L.; Hernández-López, R.; Rivera-Paredez, B.; Vidaña-Pérez, D.; Ramírez-Palacios, P.; Salmerón, J.; Popkin, B. M.; Barrientos-Gutiérrez, T. Soft Drink Intake Is Associated with Weight Gain, Regardless of Physical Activity Levels: The Health Workers Cohort Study. Int. J. Behav. Nutr. Phys. Act. 2020, 17 (1), 60. https://doi.org/10.1186/s12966-020-00963-2.

(10) Nakagawa, T.; Tuttle, K. R.; Short, R. A.; Johnson, R. J. Hypothesis: Fructose-Induced Hyperuricemia as a Causal Mechanism for the Epidemic of the Metabolic Syndrome. Nat. Clin. Pract. Nephrol. 2005, 1 (2), 80–86. https://doi.org/10.1038/ncpneph0019.

(11) Choi, H. K.; Curhan, G. Soft Drinks, Fructose Consumption, and the Risk of Gout in Men: Prospective Cohort Study. BMJ 2008, 336 (7639), 309–312. https://doi.org/10.1136/bmj.39449.819271.BE.

(12) How much soda should kids drink? | Children’s Mercy Kansas City. https://www.childrensmercy.org/parent-ish/2021/11/soda/ (accessed 2023-02-20).

(13) Graefer, D. Can I Drink Carbonated Water?. Gallbladder Attack. https://www.gallbladderattack.com/can-i-drink-carbonated-water/ (accessed 2023-05-11).

(14) https://wexnermedical.osu.edu/blog/addicted-to-soda#:~:text=In%20regular%20sodas%2C%20the%20sugar,at%20a%20fast%20food%20restaurant.

(15) https://edition.cnn.com/2019/10/28/health/soda-soft-drinks-addictive-drayer-food-wellness/index.html

Ever noticed these spotty skin areas that appear to come and go? They can be red, scaly, and downright annoying. You might have tried all kinds of lotions and potions to get rid of them, but nothing seems to work. My friend, it's possible that you have psoriasis.

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The annoying friend who constantly drops by uninvited and stays too long is psoriasis. It has an impact on millions of individuals throughout the world and can seriously lower your self-confidence and self-esteem. But fear not! It can make a huge difference to know what psoriasis is, what causes it, and how to treat and manage it the right way

‍

So let's start by diving in and learning more about this intriguing disease. We'll cover everything from the most recent studies to useful advice.

‍

WHAT IS PSORIASIS?

‍

Psoriasis is a chronic, autoimmune disease that affects the skin, nails, and joints. It is distinguished by red, scaly spots that are very unpleasant and uncomfortable. When healthy skin cells are erroneously attacked by the immune system, it can lead to psoriasis. This causes the healthy skin cells to expand and divide abnormally quickly. As a result, skin cells accumulate and create the scaly patches that are associated with the condition¹ . 

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Varying Incidence Rates Across the World

‍

The prevalence of Psoriasis varies widely worldwide ranging from 0.09% in Africa to 11.4% in Europe. The global prevalence of psoriasis was estimated to be 2.5%² . A meta-analysis of 52 studies on psoriasis in India estimated the overall prevalence of psoriasis in India to be 0.44% to 2,8 %. The study also reported a higher prevalence of psoriasis in the northern and western regions of India compared to the southern and eastern areas³ . 

‍

THE RED FLAGS 

‍

1. Skin lesions- The emergence of skin lesions is a defining characteristic of psoriasis. These lesions, which can occur anywhere on the body, are often red, scaly, and elevated. Lesions can be itchy or painful, or both.
2. Plaques- The most frequent form of skin lesion linked with psoriasis is plaque. These plaques are elevated, scaly skin areas that might be silver or red in hue.
3. Nail changes- Psoriasis can also cause changes in the nails, such as thickening, discolouration, and pitting.
4. Joint discomfort- Psoriasis can affect the joints in some cases, producing pain, stiffness, and edema. This is referred to as psoriatic arthritis.
5. Itching and burning- Psoriasis lesions can be itchy and painful, especially if they are in sensitive places such as the face, genitals, or skin folds.
6. Dry skin- Psoriasis can create dry, cracked skin that is prone to bleeding.
7. Scalp involvement- Psoriasis can cause red, scaly spots and peeling on the scalp⁴ .

‍

WHAT PUTS YOU AT RISK?

‍

Since the incidence of psoriasis varies significantly between different countries and can manifest at any age, it is likely that psoriasis is influenced by a person's ethnicity, genetic background, and environment. The development of psoriasis is significantly influenced by genetic factors^{5 6} . Here are some of the risk factors that play a role in the development of psoriasis.

‍

1. Genetics: One of the biggest risk factors for developing psoriasis is a family history of the condition. Genome-wide scans for psoriasis susceptibility have found strong evidence for a major locus on the short arm of chromosome 6 (PSORS1, Psoriasis Susceptibility 1) within the major histocompatibility complex⁷ .  The PSORS1 region contains several immune-related genes, including HLA-C, HCR (hematopoietic cell-specific transcript 1), CCHCR1 (coiled-coil alpha-helical rod protein 1), and several other unknown genes. Because certain HLA-C variants are strongly associated with psoriasis susceptibility, the HLA-C gene is especially important in the PSORS1 region⁸ . Up to 40% of those who have psoriasis are thought to have a familial history of the disorder ¹ .
2. Environmental triggers: Exposure to certain environmental variables can cause psoriasis in persons who are genetically prone to the condition. Air pollution has significantly impacted human skin throughout the years, and numerous air pollutants such as polycyclic aromatic hydrocarbons, volatile organic compounds, oxides, particulate matter, ozone, heavy metals, and UV harm the skin by producing oxidative stress⁹ . Smoking, illnesses, stress, and cold weather are all triggers. 
3. Obesity: Obesity is a significant risk factor for the development of psoriasis, especially in women. Body fat is inflammatory. Obese people have chronic low-grade inflammation in their adipose tissue(body fat), which can contribute to the development of psoriasis. Adipose tissue produces pro-inflammatory cytokines and chemokines that can promote immune cell migration and activation to the skin¹⁰ . Obese persons are at a higher risk of acquiring psoriasis, and losing weight can help alleviate symptoms in those who already have the illness^{11 12} . 
4. Medicines: Some medications, such as lithium, beta-blockers, and antimalarial treatments, like  (hydroxy)chloroquine, interferons, imiquimod, and terbinafine might cause psoriasis^{13 14} .
5. Vitamin D deficiency: Vitamin D is essential for the immune system and skin health. According to research, persons with psoriasis may have decreased vitamin D levels, and vitamin D treatment may assist some people to improve their symptoms¹⁵ .
6. Hypertension: Hypertension is associated with endothelial dysfunction, which can impair blood flow and oxygen delivery to the skin. This can contribute to the development and exacerbation of psoriasis by creating a pro-inflammatory environment.

It is also linked to low-grade chronic inflammation, which can aid in the development and exacerbation of psoriasis. Inflammatory cytokines and chemokines released by hypertensive individuals can activate immune cells and promote the migration of inflammatory cells to the skin. A meta-analysis found that people with psoriasis had a higher prevalence and incidence of hypertension. This meta-analysis also discovered that severe psoriasis was linked to an increased risk of hypertension. Psoriasis patients tend to have more severe hypertension¹⁶ .

7. Infections: The link between psoriasis and streptococcal infection is widely known. Psoriasis develops following streptococcal infection, with guttate psoriasis being the most prevalent kind. Although the symptoms are self-limiting, they might reoccur if the streptococcal infection is reactivated¹⁷ .

‍

CONVENTIONAL VS FUNCTIONAL MEDICINE: The differences in Treatment Approaches

‍

In conventional treatment, psoriasis is often treated with a combination of medication, lifestyle changes, and self-care techniques. For mild to moderate psoriasis, topical therapies such as corticosteroids, vitamin D analogues, and retinoids are frequently used as first-line therapy. These medications act by lowering inflammation and inhibiting skin cell proliferation¹⁸ . Under medical supervision, phototherapy, often known as light therapy, involves exposing the skin to UV radiation. This can assist to minimize inflammation and inhibit skin cell proliferation. Narrowband UVB and PUVA phototherapy are two forms of psoriasis phototherapy¹⁹ . 

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The functional approach is however different. To permanently reverse chronic illnesses instead of just managing symptoms, functional nutrition employs cutting-edge testing and root-cause analysis. It looks for the autoimmune trigger that sets off the attack on the skin cells.

In the majority of psoriasis instances, it was seen that the illness may be reversed by eliminating inflammatory items from the person's diet, improving their diet overall, treating any gut dysbiosis and healing their gut, and addressing any hormone imbalances and nutritional deficiencies best. Eliminating inflammatory foods and improving your diet can do wonders. Also get your micronutrient levels checked on a regular basis.

‍

Certain lifestyle changes can aid in the treatment of psoriasis. Maintaining a healthy weight, avoiding triggers that aggravate symptoms, controlling stress, and quitting smoking are all part of this²⁰ . Regular exercise can aid in the reduction of inflammation, the improvement of cardiovascular health, and the promotion of overall well-being. It can also help with stress management, which is a common cause of psoriasis flare-ups. Because stress can cause or worsen psoriasis flares, it is critical to find ways to manage stress. Deep breathing, meditation, or yoga are examples of relaxation techniques, as are hobbies or other activities that promote relaxation. Psoriasis flares can be triggered by skin trauma such as cuts, scrapes, or sunburn. It is critical to protect your skin by wearing protective clothing and preventing sunburn.

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Self-care techniques include regular bathing, the use of anti-bacterial moisturizers (or oregano oil), and the avoidance of harsh soaps and detergents²⁰ . One can also consume Krill oil supplements which play a vital role in the healing process. Wearing loose-fitting clothing and utilizing a humidifier in dry climates can also help decrease skin irritation.

It is necessary to consult with a healthcare specialist who can assist in developing a customized psoriasis treatment strategy. This can assist in ensuring that the therapy is successful and safe, as well as monitoring for any potential adverse effects.

All in, psoriasis care necessitates a multifaceted strategy that addresses both the physical and mental elements of the disease. Many patients with psoriasis can experience complete reversal or have the condition reduced to a relatively manageable state with the correct treatment and care.

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References:

(1) Kamiya, K.; Kishimoto, M.; Sugai, J.; Komine, M.; Ohtsuki, M. Risk Factors for the Development of Psoriasis. Int. J. Mol. Sci. 2019, 20 (18), 4347. https://doi.org/10.3390/ijms20184347.

(2) Parisi, R.; Iskandar, I. Y. K.; Kontopantelis, E.; Augustin, M.; Griffiths, C. E. M.; Ashcroft, D. M.; Global Psoriasis Atlas. National, Regional, and Worldwide Epidemiology of Psoriasis: Systematic Analysis and Modelling Study. BMJ 2020, 369, m1590. https://doi.org/10.1136/bmj.m1590.

(3) Dogra, S.; Yadav, S. Psoriasis in India: Prevalence and Pattern. Indian J. Dermatol. Venereol. Leprol. 2010, 76, 595. https://doi.org/10.4103/0378-6323.72443.

(4) Schleicher, S. M. Psoriasis: Pathogenesis, Assessment, and Therapeutic Update. Clin. Podiatr. Med. Surg. 2016, 33 (3), 355–366. https://doi.org/10.1016/j.cpm.2016.02.004.

(5) Parisi, R.; Symmons, D. P. M.; Griffiths, C. E. M.; Ashcroft, D. M.; Identification and Management of Psoriasis and Associated ComorbidiTy (IMPACT) project team. Global Epidemiology of Psoriasis: A Systematic Review of Incidence and Prevalence. J. Invest. Dermatol. 2013, 133 (2), 377–385. https://doi.org/10.1038/jid.2012.339.

(6) Michalek, I. M.; Loring, B.; John, S. M. A Systematic Review of Worldwide Epidemiology of Psoriasis. J. Eur. Acad. Dermatol. Venereol. JEADV 2017, 31 (2), 205–212. https://doi.org/10.1111/jdv.13854.

(7) Capon, F.; Munro, M.; Trembath, R.; Barker, J. Searching for the Major Histocompatibility Complex Psoriasis Susceptibility Gene. J. Invest. Dermatol. 2002, 118 (5), 745–751. https://doi.org/10.1046/j.1523-1747.2002.01749.x.

(8) Elder, J. T. PSORS1: Linking Genetics and Immunology. J. Invest. Dermatol. 2006, 126 (6), 1205–1206. https://doi.org/10.1038/sj.jid.5700357.

(9) Puri, P.; Nandar, S. K.; Kathuria, S.; Ramesh, V. Effects of Air Pollution on the Skin: A Review. Indian J. Dermatol. Venereol. Leprol. 2017, 83 (4), 415–423. https://doi.org/10.4103/0378-6323.199579.

(10) Kunz, M.; Simon, J. C.; Saalbach, A. Psoriasis: Obesity and Fatty Acids. Front. Immunol. 2019, 10.

(11) Barrea, L.; Nappi, F.; Di Somma, C.; Savanelli, M. C.; Falco, A.; Balato, A.; Balato, N.; Savastano, S. Environmental Risk Factors in Psoriasis: The Point of View of the Nutritionist. Int. J. Environ. Res. Public. Health 2016, 13 (5), 743. https://doi.org/10.3390/ijerph13070743.

(12) Jensen, P.; Zachariae, C.; Christensen, R.; Geiker, N. R. W.; Schaadt, B. K.; Stender, S.; Hansen, P. R.; Astrup, A.; Skov, L. Effect of Weight Loss on the Severity of Psoriasis: A Randomized Clinical Study. JAMA Dermatol. 2013, 149 (7), 795–801. https://doi.org/10.1001/jamadermatol.2013.722.

(13) Balak, D. M.; Hajdarbegovic, E. Drug-Induced Psoriasis: Clinical Perspectives. Psoriasis Auckl. NZ 2017, 7, 87–94. https://doi.org/10.2147/PTT.S126727.

(14) Kim, G. K.; Del Rosso, J. Q. Drug-Provoked Psoriasis: Is It Drug Induced or Drug Aggravated?: Understanding Pathophysiology and Clinical Relevance. J. Clin. Aesthetic Dermatol. 2010, 3 (1), 32–38.

(15) Murzaku, E. C.; Bronsnick, T.; Rao, B. K. Diet in Dermatology: Part II. Melanoma, Chronic Urticaria, and Psoriasis. J. Am. Acad. Dermatol. 2014, 71 (6), 1053.e1-1053.e16. https://doi.org/10.1016/j.jaad.2014.06.016.

(16) Armstrong, A. W.; Harskamp, C. T.; Armstrong, E. J. The Association between Psoriasis and Hypertension: A Systematic Review and Meta-Analysis of Observational Studies. J. Hypertens. 2013, 31 (3), 433–442; discussion 442-443. https://doi.org/10.1097/HJH.0b013e32835bcce1.

(17) Telfer, N. R.; Chalmers, R. J.; Whale, K.; Colman, G. The Role of Streptococcal Infection in the Initiation of Guttate Psoriasis. Arch. Dermatol. 1992, 128 (1), 39–42.

(18) Armstrong, A. W.; Read, C. Pathophysiology, Clinical Presentation, and Treatment of Psoriasis: A Review. JAMA 2020, 323 (19), 1945–1960. https://doi.org/10.1001/jama.2020.4006.

(19) Zhang, P.; Wu, M. X. A Clinical Review of Phototherapy for Psoriasis. Lasers Med. Sci. 2018, 33 (1), 173–180. https://doi.org/10.1007/s10103-017-2360-1.

(20) Kamiya, K.; Kishimoto, M.; Sugai, J.; Komine, M.; Ohtsuki, M. Risk Factors for the Development of Psoriasis. Int. J. Mol. Sci. 2019, 20 (18), 4347. https://doi.org/10.3390/ijms20184347.

Imagine this: You are relaxing in your home, perhaps it has been a long day. You would like to finally wind down, close your eyes and get some well-deserved sleep. You make the right atmosphere – the lights are low, the room is quiet, your bed is extremely comfortable, and just as your head hits the pillow – a loud, high-pitched ringing disturbs your rest.
You may get off the pillow and look around, but the room is silent. And as soon as you get back in bed, the ringing returns too. Soon enough, as the world outside also quietens down, you hear the sound no matter what you do or where you are. You realize the sound is not anywhere around you. It’s coming from inside your ears, and it’s here to stay.
This is the reality for an uncomfortably large number of people who suffer from Tinnitus: a high-pitched ringing or buzzing in one or both ears that may present suddenly and can be acute or chronic, depending on the person. Some others complain of a hissing, whooshing, or whistling noise, and it may also be accompanied by hearing loss, dizziness, and vertigo in some cases.

Besides senior citizens, multiple studies have shown that people in urban cities are more likely to develop tinnitus and/or hearing loss thanks to the unavoidable noise pollution they are immersed in^(1,2,3). Another study stated that tinnitus is so common, it affects nearly 7% of the Indian population. Additionally, innovations in the field of audio devices like earphones or loudspeakers enable us to listen to music at very high volumes – leading to rising rates of tinnitus cases. One study showed that earphones-users had a 1.27 times greater chance of tinnitus.

The story doesn’t end there. Not only is there a huge correlation between tinnitus and hearing loss – which is bad enough on its own – sufferers of tinnitus also present with anxiety and depression, lack of sleep, compromised social lives, difficulty in concentrating, increased irritability, and a generally reduced quality of life. It is therefore important to understand what places you at risk of developing tinnitus.

What Leads to Tinnitus?

The brain sometimes tries to fill in the gaps when it does not hear sounds of a certain frequency (within the audible range of humans), leading to subjective tinnitus. This sound is audible only to the person who has tinnitus. Objective tinnitus, on the other hand, is when the sound from the ear canal can be heard by another person if checked. This type is generally caused by some sort of physiological abnormalities, and it is rare.

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From a broad viewpoint, one can classify the causes of tinnitus as external or internal.
External causes for tinnitus include but aren’t limited to:

• One-time exposure to loud noises such as fireworks or gunshots.
• Repeated exposure to loud noise, such as listening to loud music for long durations, or being in loud environments like music concerts, construction sites, and traffic, without adequate ear protection.
• Traumatic brain injury.
• Injury to the eardrum or sensory hair cells of the inner ear.

While internal risk factors may be:

• Vitamin B12 and Vitamin D deficiency^{(4, 5)}
• Diets low in protein⁽⁶⁾ 
• Use of ototoxic medication like NSAIDS (Non-steroidal anti-inflammatory drugs), loop diuretics, etc.⁽⁷⁾
• High blood pressure.
• Chronic stress.
• Migraines.
• Hearing loss.
• Jaw problems.
• Fluid build-up.
• Congestion in the Eustachian Tube – a tube that connects the inner ear to the back of the throat.
• Ear infections and inflammation.

Certain diseases and conditions like Meniere’s Disease and Otosclerosis (when bones inside the middle ear fuse together), among others, can also cause tinnitus and hearing loss. Recent studies also suggest a genetic link for the condition, and would then place you at risk of inheriting it if your famiy has a history of tinnitus.
Some researchers are also looking for a link between covid vaccines and tinnitus when a large number of people complained of tinnitus after receiving the dose, however studies did not find a proven link between the jab and the condition, and more research is needed for conclusive evidence.

Now that we’ve understood some of the risk factors for Tinnitus, here are some ways to manage life with the condition.

Managing Tinnitus:
Try these methods to deal with your tinnitus for a calmer, quieter life:

1. Identify Root Cause: Functional medicine focuses on how to holistically heal your body and do away with health woes, and reverse chronic illnesses. To this effect, we recommend getting your blood tested to discover the Root Cause of your tinnitus, so that you can figure out exactly what treatment plan is best for you.
2. Get the Right Vitamins: Studies show that tinnitus can be linked to deficiencies of Vitamin B12 and D. If your blood biomarkers indicate that you are deficient, natural ways to up your vitamin intake are via sunlight, and through foods like eggs, fatty fish, and chicken.
3. Protein Rich Foods: Research has shown that diets high in protein are linked with reduced odds of tinnitus.⁽⁶⁾ Eggs, chicken, and organ meats like liver are a great way to get more protein in your diet.
4. Use Himalayan Salt: Excess table salt in the body can lead to fluid buildup, including in the middle ear which may lead to tinnitus. We recommend reducing your table salt intake and replacing it with Himalayan salt.
5. Herbal Supplementation: While natural is always best, sometimes using supplements can help to give bioavailable forms of vitamins and minerals to your body. It is believed that Ginkgo Biloba could have a role in helping to manage tinnitus as well, due to its anti-inflammatory properties.
6. Use Earphones Appropriately: The responsible use of audio devices at appropriate volumes and for healthy durations only, with breaks in between, can make a world of difference for people with tinnitus, especially if it is not yet severe and has not presented with hearing loss. For 1 hour of listening, consider taking a 30-minute break after the fact.
7. Use Protection: If you live in an environment that is at high risk for hearing loss and tinnitus, we recommend that you use ear protection such as earbuds or earplugs to protect your ears from damage. 

Take the appropriate measures to protect your ears and prevent the onset of tinnitus. If you already have tinnitus, know that you are not alone.

Tinnitus takes you by surprise, and it can get frustrating and overwhelming at times. Especially since the people around you may not relate to the disturbance caused by sounds that they cannot hear. It is also linked to anxiety, stress, worry, depression, and understandably so.

We recommend meditation and yoga to reduce stress and tension. Follow the tips in this article to manage your Tinnitus and walk towards a more peaceful, quiet life.

References:

1:
https://lacanadahearing.com/blog/how-to-protect-yourself-city-noise#:~:text=People%20who%20live%20in%20cities,10%20to%2015%20years%20older

2:
https://www.hindustantimes.com/lifestyle/health/link-between-traffic-noise-and-risk-of-tinnitus-research-101675576198134.html

3: https://www.noisyplanet.nidcd.nih.gov/have-you-heard/noisy-city-may-lead-to-hearing-loss

4 & 6: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7664714/#:~:text=Higher%20intakes%20of%20calcium%2C%20iron%20and%20fat%20were%20associated%20with,with%20reduced%20odds%20of%20tinnitus.

5: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8372974/#:~:text=Our%20findings%20suggest%20that%20a,assessment%20for%20all%20tinnitus%20patients.

7: https://www.asha.org/public/hearing/ototoxic-medications/#:~:text=Ototoxic%20medications%20cause%20damage%20to,cause%20hearing%20and%20balance%20problems.

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8: https://www.rupahealth.com/post/natural-approach-to-tinnitus
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