Our Top Blog Posts From 2021

Our Top Blog Posts From 2021

By Dr. Sean M. Wells, DPT, PT, OCS, CNPT, ATC/L, CSCS, NSCA-CPT, Cert-DN

Our team has gathered copious research and written many blog posts in 2021. From gut biome studies to intermittent fasting, we have perused the literature to bring you the best in regards to nutrition specific for physical therapy practice. Much confusion and controversy still exists within nutrition science, but you, our fellow nutritional PT loyalist, have shown us the content you love the most. As such, we wanted to offer you a nice summary of what you liked the most from 2021.

Intermittent Fasting

Having such robust data on hoppers and mice is great, but what about human studies and the impact on physical therapy practice? A well-done systematic review outlines some of the following benefits for humans who undertake IM:

1. Improved stress response
2. Lowered cholesterol
3. Lowered blood pressure
4. Improved insulin response

Understanbly such benefits could help many patients in cardiac rehab, neuro physical therapy, and PTs working with diabetes. Some of this data focuses on time-restricted feeding, which many authors consider a form of intermittent fasting. Regardless, reducing food intake for a part or a whole day can confer substantial benefits to our patients.

What about musculoskeletal disorders and IM. Interestingly those who undertake IM during Ramadan, a Muslim fasting holiday, patients with rheumatoid arthritis (RA) and spondyloarthritis (SA) may see significant pain reduction and symptom improvement. The authors argue that IM may "may attenuate the inflammatory state by suppressing pro-inflammatory cytokine expression and reducing the body fat and the circulating levels of leukocytes." As such, PTs working with RA, SA, and other autoimmune patients may want to discuss IM with their patients and possibly seek a registered dietician (RD) referral for help. 

In the end, IMF shows promise and PTs need to keep their eyes open for future literature relating to neuromusculoskeletal health.

Dietary Supplement Guide: What PTs Need to Know

We started this post with a “dose” of discussing the lack of regulation for dietary supplementation. Moreover, we discussed the issues of legally prescribing supplements as well as the liability and risk associated with carrying supplements in your gym or clinic. It goes without saying that if you have an unregulated product with varying doses (or possibly no active ingredient at all) how do you get a desired response? Examining the literature from many systematic reviews, the data show that many dietary supplements have little to no impact on aging, cancer, heart health, pain, or performance. If there are small changes in some of these factors they are often of small magnitudes. For instance, several studies tout the benefits of green lipped mussels for joint arthritis. The reduction in knee pain scores is roughly 1 out of 10, which does not exceed MCIDs. Perhaps the patient should reduce their sugar or alcohol intake versus taking an expensive and strange substance. In the end, PTs need to 

BPPV and Vitamin D

Our final post that got much attention was a fun one! As PTs we all know the Epley and dix-hallpike to be standard practices in treating and evaluating BPPV – but what about nutrition? 

Several studies from the 1990s started to highlight a correlation of vitamin D and vertigo. Some of these studies highlighted how patients with recurrent BPPV had lower vitamin D status. Building on this data, researchers in the 2000s started analyzing cohort and cross-sectional studies and finding some robust connections with vitamin D status and BPPV. Basically, the lower the vitamin D status, the higher the rate of BPPV recurrence.

The pinnacle of the data came in 2020 with a high-impact systematic review and meta-analysis. Researchers found that patients with low vitamin D status were more than twice as likely to develop BPPV again (WMD 2.59, 95% CI 0.35–4.82, p = 0.023)! Take a look at this forrest plot from the 2020 Yang et al study:

The data also show that those currently with BPPV are also likely deficient in vitamin D status. This systematic review and meta-analysis is one of the most comprehensive assessments of BPPV and vitamin D status in the last decade. Another review study was published a few years back and found similar findings, but failed to include many of the observational studies the current 2020 Yang et al article did. Overall, an assessment of 18 studies found a clear correlation with vitamin D and BPPV -- so, the question remains, why?

Vitamin D helps the body absorb calcium. Most people understand that calcium is good for bone strength, but it is also crucial for anchoring the otoconia. When the free calcium concentration in internal lymphatic fluid is 20 μM, otoconia can dissolve completely; when the concentration is 500 μM, the crystals do not dissolve (Yang et al, 2020). Vitamin D can help maintain a sufficiently high free calcium concentration in the inner lymphatic fluid to prevent excessive dissolution of otoconia, likely thanks to its activation of transporter proteins that shuttle calcium from the utricle to the canals.

Many vestibular physical therapists know of the direct relationship between osteoporosis and BPPV. Deficiency in vitamin D can lead to calcium dissolution. This phenomenon not only happens in bone but may be occurring in or around the otoconia of the inner ear. In short, Vitamin D is essential for sustained inner ear functioning. So, other than self Epley's and X1 exercises, what should Doctors of Physical Therapy be recommending for their patients?

What’s New for 2022?

We hope you enjoyed our content. I am currently on my way to CSM 2022 in San Antonio and look forward to bringing back some awesome content for our blog in 2022. Keep your eyes open for more data on reducing inflammation, processed foods, and plant-based diets. Exciting times!

If you like what you see here then know there is more in our 3 board-approved continuing education courses on Nutrition specific for Physical Therapists. Enroll today in our new bundled course offering and save 20%, a value of $60!

Download Your Copy of the Free E-Book:

Learn about the Top 5 Functional Foods to Fight Inflammation and Pain in Physical Therapy. 

Keywords: nutrition, diet, continuing education, online, vitamin D, gut biome, PT, physical therapy, learning, BPPV, rehab, pediatrics, DPT, supplements

Disclaimer: The above article is written as an opinion piece and does not convey specific legal, medical, and/or practice act advice.