Typically, doctors advise people with type 2 diabetes to eat about six times a day. But this approach can lead to a vicious cycle in which individuals require more intensive treatments. Could a different approach to diet be more suitable?

Type 2 diabetes is one of the most common metabolic conditions. Across the globe, over 400 million people live with it.

Usually, doctors prescribe drugs that will help individuals with diabetes keep their blood sugar levels under control, as well as advise them on how to change their dietary habits to aid treatment.

Many healthcare providers believe that the best approach for people with type 2 diabetes is to eat more, smaller meals at regular intervals throughout the day. Typically experts recommend eating six times a day.

However, this approach can lead to problems. Some people who follow this type of diet plan require more intensive treatments. This is particularly true of those with severe forms of diabetes who need to inject themselves with high doses of insulin to counterbalance insulin resistance.

However, high-dosage insulin injections can introduce glucose (blood sugar) level imbalances. They can also cause weight gain and lead to a higher risk of cardiovascular problems.

Recently, a team of researchers from Tel Aviv University in Israel has hypothesized that eating according to a person’s natural “body clock” — which typically calls for three larger meals a day — might help physiological processes to synchronize better and reduce the amount of insulin a person requires.

Weight loss and improved blood sugar

“The traditional [diet for people with diabetes] specifies six small meals spread throughout the day,” says Prof. Daniela Jakubowicz. “But [this diet],” she adds, “has not been effective for sugar control, so [people with diabetes] require additional medication and insulin. And insulin injections lead to weight gain, which further increases blood sugar levels.”

Prof. Jakubowicz and team have now conducted a study confirming that the three meals a day approach could be more helpful for those with type 2 diabetes.

Our research proposes shifting the starch-rich calories to the early hours of the day. This produces a glucose balance and improved glycemic control among [people with type 2 diabetes],” the specialist explains.

“We believe that through this regimen, it will be possible for [people with diabetes] to significantly reduce or even stop the injections of insulin, and most antidiabetic medications, to achieve excellent control of glucose levels.”

Prof. Daniela Jakubowicz

In their study paper — which features in the journal Diabetes Care — the investigators note that they based their findings on a trial involving 28 participants with type 2 diabetes.

The researchers split the participants into two groups and randomly assigned them to follow either the typical six meals a day diet or the newly devised three meals a day diet.

In the three meals a day approach, participants had to follow a diet plan that is supposedly more in line with humans’ natural inclination to eat more in the morning, and fast in the evening and during the night.

This diet requires eating a breakfast of bread, fruit, and sweets early in the morning, having a sizeable lunch, and a small meal at dinnertime, which must not feature any starchy foods, sweets or fruit.

The team assessed the participants’ body weight, blood sugar control, appetite, and circadian clock (body clock) gene expression both at baseline, and then again at 2 weeks after the start of the trial, and at 12 weeks after.

Prof. Jakubowicz and team observed that the participants with diabetes who followed the typical six meal diet did not lose any weight and did not see better blood sugar control. However, those who ate three meals a day saw the opposite effect: they lost weight and had much improved blood sugar levels.

“Their need for diabetic medication, especially for insulin doses, dipped substantially. Some were even able to stop using insulin altogether,” notes Prof. Jakubowicz.

“In addition, the [three meal diet] improved the expression of biological clock genes. This suggests that the diet is not only more effective in controlling diabetes. It may also prevent many other complications, such as cardiovascular disease, aging, and cancer, which are all regulated by the biological clock genes,” Prof. Jakubowicz hypothesizes.

Vaginal pain can be a temporary symptom of infection or injury. Or, it can be a chronic symptom with no known cause.

Persistent vaginal pain with no clear cause is called vulvodynia. It is a common gynecological condition, affecting up to 16% of women in the United States.

Fear or embarrassment may keep a person from seeking professional treatment for vaginal pain. Some who have sought treatment report that the doctors were quick to dismiss their symptoms.

However, the right healthcare provider will work diligently to diagnose and treat the problem.

Causes of vaginal pain

A wide range of conditions can cause vaginal pain, but the following are the most common:

Infection

Yeast infections are among the most common causes of vaginal pain. About 75% of women develop a vaginal yeast infection at some point.

A yeast infection can cause itching, burning, and sometimes cottage cheese-like discharge from the vagina.

These infections do not usually spread through sexual intercourse, and most experts do not recommend treating sexual partners.

Bacterial vaginosis (BV) is also common, particularly among people who are sexually active.

While BV may cause no symptoms, it can cause the following symptoms in the vagina:

• pain
• itching
• burning
• a fishy odor
• uncomfortable sex

Many people mistake the symptoms of BV for those of a yeast infection. However, the two have different causes and require different treatments.

Some other infections, especially the sexually transmitted infections (STIs) chlamydia and gonorrhea, can also cause pain and unusual discharge.

Physical trauma

Physical injury to the vagina or vulva can cause vaginal pain. Injuries such as cuts from shaving may be responsible, but one of the most common causes of injury and pain is childbirth.

Giving birth causes vaginal tearing in most women the first time that they go into labor. The tear usually extends into the perineum, which is the area between the vagina and anus. Doctors refer to this as a perineal tear. It is also possible for the clitoris or labia to tear during childbirth.

A doctor or midwife may need to stitch up serious tears. The stitches dissolve over time and do not require removal.

Pelvic floor dysfunction or injury

Damage to the muscles of the pelvic floor can cause pain in the vagina, stomach, back, and muscles in other areas.

Some factors that can increase the risk of pelvic floor problems include:

• age
• pregnancy
• injury from childbirth
• episiotomy, which is a surgical incision to enlarge the vaginal opening into the perineum during labor

Some people with pelvic floor dysfunction also experience incontinence, especially when sneezing or jumping. A person may also experience fecal incontinence, pain when passing stool, or both.

Vulvodynia

Vulvodynia is a type of chronic pain in the vulva, vagina, or both. The pain varies from person to person, but many report a burning pain that is fairly continuous, though it can be triggered or worsened by intercourse.

Doctors do not fully understand vulvodynia and why it occurs. The diagnostic process can be lengthy because it involves excluding other causes of vaginal pain.

Anyone who suspects that they have vulvodynia should see a doctor — various treatments are available.

Bartholin’s cyst

The Bartholin’s glands sit on either side of the entrance to the vagina and help lubricate it.

A blockage in one of these glands can give rise to a cyst, which may feel like a hard lump or look like a pimple. The cyst can cause pain, usually on one side of the vagina.

Bartholin’s cysts may get larger over several days, then disappear or rupture. Sometimes they become infected, causing intense pain.

Symptoms

Vaginal pain can have many different characteristics. Describing the pain in detail can help a healthcare provider correctly diagnose the problem.

Below are the most common types of vaginal pain.

Burning

Vaginal yeast infections, BV, and other types of infection often cause a burning sensation, especially during or after intercourse.

Also, vulvodynia often causes burning pain and typically other symptoms, as well.

Itching

Itchiness is a classic sign of an infection, such as a yeast infection, BV, or an STI.

Less frequently, a pelvic floor injury causes nerve dysfunction that feels like itchiness or another unusual sensation.

Some people experience vaginal itchiness specifically during intercourse. Some possible causes of this include:

• vulvodynia
• the rupture of a Bartholin’s cyst
• healing following a physical injury

Tension or muscle spasms

Tightness, soreness, and muscle spasms in the vagina may indicate pelvic floor dysfunction. Some people also experience pain with different characteristics or in other areas, such as lower back pain or hip discomfort.

Vulvodynia can cause the vaginal muscles to tense before or during intercourse. Some people report that their muscles tense so forcefully that they are unable to have intercourse.

Tenderness or sensitivity

If the skin around the vagina and vulva feels painful, tender, or sensitive, this may be a symptom of a Bartholin’s cyst.

The area may also be red, and there may be a hard lump or visible swelling. If an infection develops, the pain may become intense.

Trauma to the vagina or vulva can also cause tenderness and sensitivity. Many women report soreness after giving birth, especially following a perineal tear.

Pain during intercourse

Intercourse can make any type of vaginal pain worse because friction causes irritation.

However, if a person only experiences vaginal pain during intercourse, vulvodynia may be the cause.

If a fishy odor follows painful intercourse, this could indicate BV.

Diagnosis

A doctor can usually diagnose a vaginal yeast infection based on a person’s symptoms alone, though they may need to test a sample of discharge. This will help the doctor rule out bacterial infections and STIs, such as gonorrhea and chlamydia.

The doctor may also:

• perform a physical examination of the area to check for recent injuries
• perform an internal vaginal exam to check for muscle abnormalities, swelling, and irritation
• take a comprehensive medical history, including questions about risk factors for specific vaginal health issues

People with vulvodynia do not typically have detectable symptoms of a physical disorder. For this reason, the doctor will need to rule out other causes of vaginal pain before arriving at the diagnosis.

Treatments

The right treatment depends on the cause of the pain.

Antibiotics can treat gonorrhea, BV, chlamydia, and some other bacterial infections. Physical injuries, such as deep or infected wounds, may also require antibiotics.

Because yeast is a fungus — not a bacteria — antibiotics will not treat a yeast infection, and they may make it worse. Instead, the doctor may recommend an over-the-counter treatment or prescribe oral antifungal medication.

Bartholin’s cysts typically go away on their own, and warm compresses can speed this process. If a cyst grows very large, a doctor may surgically drain it. If a cyst becomes infected, it may require antibiotics.

Physical therapy may help with pelvic floor injuries, and the therapist can work with the person to develop a plan for strengthening the pelvic floor at home. Physical therapy may also help with vulvodynia.

Vulvodynia is notoriously difficult to treat. The right treatment varies from person to person, but it often includes a combination of:

• oral and topical pain medications
• nerve stimulation
• drugs called nerve blocks
• pelvic floor exercises
• sex therapy
• lifestyle adjustments, such as avoiding triggers

Home remedies

Home remedies cannot treat bacterial vaginal infections, and trying these methods may give an infection time to get worse.

Anyone who suspects that they have a bacterial infection should see a doctor for a diagnosis and treatment.

The following home remedies may help with symptoms of other conditions:

• applying warm compresses to a Bartholin’s cyst several times a day
• using a sitz bath, ice packs, numbing sprays, or a combination to ease the pain of a vaginal tear

Prevention

Some strategies for preventing some forms of vaginal pain include:

• wearing a condom during sex
• undergoing regular STI testing and asking all partners about their STI status
• not wearing wet clothes, which can provide an ideal environment for yeast
• asking a doctor or midwife about methods of preventing tears during childbirth

Summary

Vaginal pain may be temporary or chronic, and it can range from mild irritation to severe, debilitating pain. The feeling may result from infection, injury, or no identifiable reason.

Anyone with vaginal pain should see a doctor or another healthcare provider for a diagnosis. Most often, vaginal pain goes away once a person finds the right treatment.

The cause of chronic vaginal pain can be difficult to diagnose. Typically, a healthcare provider will only diagnose vulvodynia after ruling out other possible causes of the pain. Although experts know little about the causes of vulvodynia, there are many treatments available.

Some people report that healthcare providers are unsympathetic or unhelpful about vaginal pain. If this is the case, ask for a second opinion from someone who specializes in this type of pain.

A new study looks for the neural links between a range of mental disorders.

In the largest study of its kind, researchers identify similarities in the brain activity of people with major depressive disorder, post-traumatic stress disorder, bipolar disorder, and anxiety disorders.

Mental health disorders, although incredibly prevalent, remain poorly understood.

According to the National Institute of Mental Health, almost 1 in 5 adults in the United States live with a mental illness.

About half

of the U.S. population will experience a mental health condition at some point in their life.

Medication and talking therapies are useful for many people, but understanding the neurological roots of these conditions is proving challenging.

Overlap and comorbidity

Post-traumatic stress disorder (PTSD), anxiety disorders, and mood disorders — such as major depressive disorder and bipolar disorder — have distinct symptoms, but they overlap significantly.

For instance, someone with generalized anxiety disorder might experience depressive symptoms, and someone with major depressive disorder might experience heightened anxiety.

Also, scientists have noted that these conditions often appear together, which they refer to as comorbidity. As the authors of the recent study write:

“Up to 90% of patients with an anxiety disorder meet criteria for a concurrent mood disorder, and as many as 70% of individuals with mood disorders meet criteria for an anxiety disorder during their lifetime.”

9,000 brain scans

This comorbidity and overlap of symptoms infer that there might be neurological similarities between the conditions. A recent study, featuring in JAMA Psychiatry

The authors, from various institutions in the U.S., Italy, and Germany, decided to collate and analyze brain scans from previous studies. They hoped to build a clearer picture of what is happening in the brains of people with these disorders.

To investigate, they looked at functional MRI (fMRI) scans from 367 experiments, which included data from 4,507 people with a mental health disorder and 4,755 healthy control participants. In total, they analyzed more than 9,000 brain scans.

These studies all investigated changes in brain activity while participants carried out cognitive tasks.

As far as the authors can identify, this is the largest analysis of its kind to date.

Joint features of multiple conditions

The scientists searched for brain regions that were either more active (hyperactive) or less active (hypoactive) in the participants with mental health conditions than among the control group. As expected, the researchers found that certain features of brain activity were consistent across mood disorders, PTSD, and anxiety disorders.

Perhaps surprisingly, they found the most significant differences between the two groups of participants when they searched for hypoactive regions. The authors outline their primary findings:

“We detected statistically robust transdiagnostic clusters of hypoactivation in the inferior prefrontal cortex/insula, the inferior parietal lobule, and the putamen.”

These regions are significant because they are all involved in emotional and cognitive control. Specifically, they play an important role in stopping cognitive and behavioral processes and switching to new ones.

Senior author Dr. Sophia Frangou explains: “These brain imaging findings provide a science-based explanation as to why patients with mood and anxiety disorders seem to be ‘locked in’ to negative mood states. They also corroborate the patients’ experience of being unable to stop and switch away from negative thoughts and feelings.”

The authors also outline how these findings lend support to earlier studies in people with these disorders, which found “deficits of large effect size in stopping and shifting responses in a range of tasks.”

In other words, individuals with these mental health disorders found switching between tasks as difficult as they found switching away from negative thoughts.

The hypoactivity in these regions might explain why the “locked in” states occur in both thoughts and behaviors.

Less hyperactivity

The scientists also identified hyperactivity in some regions of the brain. However, the differences were less pronounced than those that they found in the hypoactive regions.

In particular, the anterior cingulate cortex, left amygdala, and thalamus were more active in people with mood disorders, PTSD, and anxiety disorders. These regions are important in processing emotional thoughts and feelings.

For instance, the cingulate cortex helps regulate emotional experience and appraisal, while the amygdala, among other roles, helps people form and retrieve emotional memories.

Although this study is the largest of its type, there are certain limitations. For instance, as the authors explain, they focused only on adults. The differences in brain activity might not hold true in children or older adults.

The authors hope that, in the future, these brain regions might function as “targets for interventions aiming to improve clinical outcomes and reduce or prevent affective morbidity in the general population.”

Blood pressure should be basically stable. If it regularly changes from very high to very low, a range of complications can result.

It is normal for blood pressure to vary slightly throughout the day, but blood pressure that fluctuates from one extreme to the other should be monitored and managed.

Home remedies, lifestyle changes, and some medications can help to regulate blood pressure.

It is important to get it checked regularly because blood pressure can reveal a lot about a person’s health.

Below are five factors that can cause dangerous fluctuations in blood pressure.

Causes of fluctuating blood pressure:

1. White coat hypertension

This term describes blood pressure that is higher at the doctor’s office, often because the person is anxious about the appointment.

A study published in 2013 concluded that people with white coat hypertension should be monitored for heart disease risk factors, especially abnormal blood sugar levels.

White coat hypertension is not necessarily as concerning as blood pressure that is consistently high.

A 2016 meta-analysis published in the Journal of Hypertension found that people with white coat hypertension had a lower risk of heart disease and a better outlook than people with lasting hypertension.

2. Medications

Certain medications can temporarily reduce blood pressure. They include:

• diuretics
• beta-blockers and other heart medications
• tricyclic antidepressants
• medications for high blood pressure, especially if the dose is too high
• medications for Parkinson’s disease
• medications for erectile dysfunction, especially if taken with nitroglycerine

3. Emotional upset, anxiety, and stress

Strong emotions, particularly stress and anxiety, can cause blood pressure to spike. This is the body’s natural response to a stressful event, and the pressure will eventually return to normal as the person calms down.

However, long-term stress and untreated anxiety can have lasting, harmful effects on blood pressure and overall health.

4. Temperature

Being in a warm room or taking a hot bath can temporarily lower blood pressure. This is usually not a cause for concern, as long as blood pressure does not dip too low.

Symptoms of dangerously low blood pressure include dizziness, nausea, and fainting.

5. Street drugs

Cocaine and methamphetamine can cause extreme spikes in blood pressure.

Risk factors

The factors below may increase the risk of dangerous swings in blood pressure:

• an irregular work schedule, especially one involving night shifts
• smoking and tobacco use
• high levels of stress
• anxiety
• incorrect use of blood pressure medication
• incorrect prescription or dosage of blood pressure medication
• obstructive sleep apnea and other sleep disorders
• kidney disease
• diabetes and blood sugar problems
• thyroid problems
• heart disease
• conditions affecting the nervous system

How is fluctuating blood pressure treated?

First, a doctor will determine the underlying cause. They will ask about a person’s history and discuss their lifestyle and current medications. The doctor may also order or conduct tests.

Medications can lower blood pressure and prevent dangerous fluctuations. A person may also be able to achieve this by making changes to their lifestyle.

By attending follow-up visits, a person can ensure that their blood pressure remains within normal limits and that medications are not causing unpleasant side effects.

Home remedies and lifestyle changes

The following actions can help to normalize blood pressure:

• Stop smoking: Smoking harms the arteries and causes high blood pressure.
• Eat more fruits, vegetables, whole grains, and lean protein: Reduce or eliminate added sugars and processed foods.
• Get regular exercise: Moderate-intensity exertion, such as walking at a quick pace, is recommended by the American Heart Association. A person should do this for 30 minutes per day, at least 5 days a week.
• Limit alcohol consumption: Women should drink no more than one drink per day and men no more than two drinks per day. Drinking more than this can raise blood pressure.
• Find healthy ways to lower stress: Meditation, deep breathing exercises, guided imagery, and other techniques to manage stress can help to avoid spikes in blood pressure.
• Consume less sodium: Excessively salty foods can cause sharp increases in blood pressure.
• Reduce the intake of caffeine: Caffeinated drinks can cause temporary spikes in blood pressure, and they may make anxiety worse.

Consult a doctor for personalized guidance.

Complications

Regular fluctuations in blood pressure can increase the risk of:

• a heart attack
• a stroke
• heart failure
• kidney disease or failure
• vision loss
• sexual dysfunction
• peripheral artery disease

A study

Trusted Source

from 2015 suggested that people with blood pressure that varied significantly between medical appointments were more likely to have a heart attack, a stroke, or heart failure.

Research published in The BMJ

Trusted Source

indicated that high variability in blood pressure put a person at the same risk for cardiac problems as high cholesterol.

A study from 2017 concluded that older adults with daily fluctuations in blood pressure were more likely to develop dementia. This supports the findings of a study from 2016, which suggested a link between high variability in blood pressure and declines in cognitive ability and memory.

Prevention

Healthy lifestyle choices, and in some cases medication, can resolve fluctuations in blood pressure.

Have blood pressure checked regularly, and seek treatment for any conditions that may affect it.

Takeaway

While fluctuations in blood pressure can be dangerous, medications and lifestyle changes can manage the situation.

After a doctor determines the cause of changing blood pressure, they will help to develop a treatment plan. A person should have their blood pressure checked regularly.

Follow the advice of doctors and take medicines as prescribed.

New research finds that the placebo effect may be socially contagious. In other words, a doctor’s beliefs about whether or not a pain treatment will work can exert a subtle influence on how much pain the patient will actually experience. 

A doctor’s display of confidence in a treatment may make it more effective.

The power of placebo may extend beyond what researchers previously believed.

At first, they only used placebos as controls in drug experiments.

With time, however, placebos proved to have value as potential treatments in their own right.

Pain, depression, anxiety, irritable bowel syndrome, Parkinson’s disease, and epilepsy are only some of the conditions that placebos have shown promise in treating.

A new study has looked into another fascinating aspect of the placebo: Does it transmit socially, from one person to another? If so, how? More specifically, how does a doctor’s belief about the effects of a medication affect their patient’s experience of pain?

Laboratory at Dartmouth College in Hanover, NH — is the corresponding author of the new study.

Chang and colleagues have published their findings in the journal Nature Human Behaviour

Testing placebo power in 3 experiments

To study the phenomenon of socially transmitted placebo, the researchers devised three experiments. All three involved two different creams that were meant to relieve heat-induced pain by targeting pain receptors on the participants’ skin.

One of the creams was called thermedol, and the other was a control cream. Although different in appearance, both creams were actually placebos — namely, petroleum jelly with no pain relieving properties at all.

The researchers asked undergraduate students to play the roles of “doctors” and “patients.” They informed the “doctors” of the creams’ benefits and conditioned them to believe that thermedol was better at relieving pain than the control cream.

The first experiment consisted of 24 “doctor-patient” pairs. In each pair, the “patient” did not know which cream was thermedol and which was the control. Only the “doctor” knew which was the “effective” cream.

The researchers then applied the creams to the participants’ arms, followed by pain-inducing heat, in order to evaluate the effects of the cream. All participants received the same amount of heat.

During the experiment, all participants wore cameras that recorded their facial expressions in the doctor-patient interactions.

Using a machine-learning algorithm trained on facial signals of pain, the researchers were able to examine the effect of cues such as raised eyebrows, raised upper lips, or nose wrinkling on the perceived effectiveness of the treatments.

In this experiment, the participants reported experiencing less pain with thermedol, and skin conductance tests suggested that they actually did experience less discomfort. Their facial expressions also reflected less pain with thermedol.

In the other two experiments, the researchers applied the creams in different orders, and they led the doctors to believe that they were using thermedol when they were using the control creams, and vice versa.

The experimenters themselves were also blind to the study, not knowing which cream was which. In these experiments, the results were the same.

How doctors’ beliefs affect clinical results

Overall, across all three experiments, the results revealed that when the “doctors” believed that a treatment was effective, the “patients” reported feeling less pain. Their facial expressions and skin conductance tests also revealed fewer signs of pain.

The reasons for this remain unclear. However, the researchers believe that social contagion via facial cues is the most likely explanation.

“When the doctor thought that the treatment was going to work, the patient reported feeling that the doctor was more empathetic,” says Chang.

“The doctor may have come across as warmer or more attentive. Yet, we don’t know exactly what the doctor was doing differently to convey these beliefs that a treatment works. That’s the next thing that we’re going to explore,” he adds.

“What we do know though is that these expectations are not being conveyed verbally but through subtle social cues,” explains Chang.

“These findings demonstrate how subtle social interactions can impact clinical outcomes. You can imagine that in a real clinical context, if the healthcare providers seemed competent, empathetic, and confident that a treatment may work, the impact on patient outcomes could be even stronger.”