Thursday, August 9, 2018

The Sugar Rush: How to Balance Blood Sugar to Support Mental Wellbeing

Diets high in sugar (both refined and unrefined) have not only been linked to the western world’s biggest killers like type 2 diabetes, obesity, heart disease and now Alzheimer’s, but it is also linked to worsening symptoms of anxiety, depression, schizophrenia and bipolar disorder.  This is no surprise considering the evidence that shows how excessive sugar in diets can rapidly alter blood glucose and insulin levels, which leads to an increase of free radicals as well as pro-inflammatory cytokines. These inflammatory molecules can damage tissues and wreak havoc on the immune system, that consequently have a negative impact on the brain.
The human brain is the most energy-hungry organ in our body, stealing about 20% of the body’s energy requirements. It needs a constant, steady supply of fuel, which is mostly sourced from the food that we eat. The brain is therefore sensitive to drops in blood sugar levels and despite our body’s intelligent mechanisms to keep levels stable, when we eat foods that are high in sugar, these levels will fluctuate causing fatigue, poor concentration, and anxiety. If you are already suffering from a mental health disorder such as depression, bipolar disorder, chronic anxiety or schizophrenia, where symptoms caused by fluctuations in blood sugar may normally go unnoticed, already present symptoms related to these conditions can be magnified.
So what can we do to help keep our blood sugar levels even and promote mental wellbeing? Well, it’s easy to say avoid all refined sugar and added sugar in the most obvious foods such as biscuits, cakes, and chocolates. But what about the hidden sugars in savory foods or foods that are even labeled as healthier options? Sugar can be identified under a vast variety of different names, sometimes due to varying molecular structures or if the sugar comes from other sources like rice. This means that it is easy to consume food, which appears to be low in sugar or is outwardly a savory food, but has hidden sugar in it. This can be commonly found in food items such as bread, sauces, cereals, and dressings. Nutritional labels are by law required to list ingredients by order of content amount, starting with the ingredient with the most amount first. Manufacturers are therefore able to spread out the sugar by using a variety of different types of sugar and can as a consequence place the sweetening ingredients at the end of the list, making the product look like it is lower in sugar than it really is. You may be asking what are these hidden sugars called? Look out for names such as dextrose, dextrin, maltose, and galactose. These are just a few commonly found forms of sugar in food that often go unnoticed. If you’d like to have a comprehensive list please click here.

There are a few things you can start doing right now to help your blood sugar levels stabilize. One of the most crucial steps you can take is to switch from refined to complex carbohydrates. This means avoiding ‘white grains’ such as white bread (as well as pasta/spaghetti) and white rice. These foods have gone through a process where the grain’s outer husk has been removed, which is where all the fiber, nutrients and fatty acids are, leaving a refined version of the original grain that mainly contains sugar. Replace these foods with wholemeal/brown bread (wholemeal pasta/spaghetti or even with brown rice pasta or buckwheat pasta) and brown rice. You can also start including other grains such as quinoa, kamut, teff and buckwheat to introduce more variation.
Combining any form of carbohydrate with healthy fats and lean proteins can also really help in slowing the release of sugars in the bloodstream, so think about having a handful of seeds alongside your fruit and if you do eat a plate of pasta, make sure you are including vegetables and a source of protein such as salmon or pulses.
Another key step is to avoid drinking your fruits and eat them instead. Similarly to refined grains, in the juice-making process, the fruits have had their fiber taken away, leaving mainly the sugar component of the fruit. This means that by drinking a bottle of what may seem like a healthy drink option may contain up to 60g of sugar, which is an incredible amount to have in one sitting! Apart from the avoidance of obvious sweet foods such as confectionery, cakes, biscuits, pastries and fizzy drinks, another effective step to take is to increase your fiber by eating foods such as vegetables, pulses and nuts and seeds, as well as making sure you are eating protein with every meal. These steps are seemingly simple, but incredibly effective because the fiber content will prevent the food from being broken down too quickly, leading blood sugar levels to peak and crash, and instead maintain a steady stream of energy for the body and brain.
Taking these steps can encourage better sleep, improve concentration and memory as well as help stabilize mood. If you would like more support in your diet for specific mental health conditions, why not visit our ‘nutrition solutions’ page, which has comprehensive guidance on steps you can take to help support and manage symptoms related to conditions such as depression, anxiety, psychotic disorders and more. 

London, UK

Friday, August 3, 2018


How can soft tissue manual therapy techniques may help you?

According to Eric Kandel, our whole body carries memories, not only our minds

Our bodies store an extensive array of memories throughout our lives. Pleasant memories, heartfelt memories; however, some of them are not that great. And they could create trauma, scars in us.

With cumulative aggression, our bodies will carry SCARS and this will lead to dysfunctions. All bodies´ tissues carry memories of physical, psychological and toxicological traumas that may occur in any phase of life.

It is known that we can access the mind via body and access the body via the mind. It is a bidirectional process. It is said to be easier to stimulate the mind throughout the body because "touch" is extremely related to the emotional brain, much more, than the spoken word. 

Candice Perth, PhD. a prestigious neuroscientist and named the " Mother of Psychoneuroimmunology", in her book, Molecules of Emotion, writes that emotions are stored in the body, at some receptors, and that healthy communication via emotional expression was key to integrating the mind and the body. 
She called these biological mediators (“Informational Substances”) neuropeptides and immune system cytokines, as the agents that integrated communication between the brain and the body.

Bad, traumatic memories, chronic stress among others when not correctly interpreted and self-corrected by our bodies, may have numerous consequences and may lead up to illness and /or chronic pain, for instance.

Specific brain structures that are known to carry the memory of trauma, such as the Amygdala, are addressed, as is the release of cellular fear and tissue memory. Keratinocytes (cells in our skin), on the other hand, are responsible to gather information from the environment and inform the Central Nervous System. 

Recent research in neuroscience state that, the softest is the touch, the easier is to stimulate the Limbic System ( the part of the brain responsible for emotions).  We all know how good we can feel after a little caress, don´t we?

But let´s go back to science ...

Techniques in Physical Therapy that require soft touch (less than 5 gr) are able to establish this connection between body and mind and, therefore, help in some psychosomatic related diseases.

Thus, an Integrative Physical Therapy approach is a  program which utilizes body-mind techniques to release and resolve traumas by utilizing soft- touch manual therapy techniques to access the mind via body.

In your own timing, process-oriented bodywork, such as Heart Rate Variability (HRV), Somato-Emotional Release and Unwinding is used to gently encourage awareness and insight development.

Microkinesitherapie -  A French technique which optimizes the natural healing resources and mechanisms of our body, enhances health and wellness through manual technique. A primary aggression leaves traces (scars) which disturb the cells and tissues behavior, these traces remain stores in tissue/cell memory (loss of vitality) by a body and mind elimination deficiency regarded to the aggressor.
With cumulative aggression, our bodies will carry SCARS and this will lead to dysfunctions. All bodies´ tissues carry memories of physical, psychological and toxicological traumas that may occur in any phase of life.

Mindful movement and meditation techniques are taught for cultivating inner peace. 

Craniosacral therapy and Myofascial Release techniques facilitate core integration.

These treatments are for children, adults & families and they are provided with the sensitivity, insight, and gentle care that is needed to heal from a challenging experience.

Previous and ongoing consultation with a licensed mental health practitioner is recommended.

 Referrals can be provided.

Friday, July 27, 2018

 Why Physical Therapists Can use Heart Rate Variability (HRV) as a Measurement Tool

Have you ever wondered what the health impact of a stressful day was? Will you perform well during your long run tomorrow morning? Is there anything you can do today that would improve your ability to have a better day moving forward? HRV may be the piece of data that could help you answer these questions.

What is HRV?

HRV is simply a measure of the variation in time between each heartbeat. This variation is controlled by a primitive part of the nervous system called the autonomic nervous system (ANS). It works regardless of our desire and regulates, among other things, our heart rate, blood pressure, breathing, and digestion. The ANS is subdivided into two large components, the sympathetic and the parasympathetic nervous system, also known as the fight-or-flight mechanism and the relaxation response.
The brain is constantly processing information in a region called the hypothalamus. The hypothalamus, through the ANS, sends signals to the rest of the body either to stimulate or to relax different functions. It responds not only to a poor night of sleep, or that sour interaction with your boss, but also to the exciting news that you got engaged, or to that delicious healthy meal you had for lunch. Our body handles all kinds of stimuli and life goes on. However, if we have persistent instigators such as stress, poor sleep, unhealthy diet, dysfunctional relationships, isolation or solitude, and lack of exercise, this balance may be disrupted, and your fight-or-flight response can shift into overdrive.

Heart Rate Variability (HRV) – is recognized as a versatile, promising, non-invasive marker of modulations of the autonomous nervous system (ANS) and reflects the changes in the interval between heartbeats (R wave) over time.

B. Canon (Lang, 1994) observed that changes in the emotional state were followed by alterations in heart rate, blood pressure, breathing and digestion ( autonomic nervous system).

The autonomic nervous system regulates very important systems in our body, including heart and respiration rate and digestion. The autonomic nervous system has a parasympathetic (rest) and a sympathetic (activation) branch. Heart rate variability is an indicator that both branches are functioning – the parasympathetic in particular.

Intrinsic heart rate is measured in the condition in which neither parasympathetic nor sympathetic regulation is present. When completely blocked from autonomic regulation, a healthy heart contracts at a rate of about 100 beats per minute (the number is individual, though).

Parasympathetic regulation lowers your heart rate from the intrinsic level, giving more room for variability between successive heartbeats. Parasympathetic regulation causes almost immediate changes that affect only a few beats at a time, after which heart rate returns towards the intrinsic rate.

Sympathetic regulation elevates your heart rate from the intrinsic level, and there is less room for variability between successive heartbeats. Sympathetic regulation affects several consecutive heart beats.

The time between one R wave and the next, in milliseconds, is known as the R-R interval or the interval between beats.

This measurement is becoming more and more common in assessments of the presence of diseases the stratification of risk, autonomic dysfunction and intervention results.
HRV analysis provides a perspective of the function of the sympathetic and parasympathetic nervous systems as it is mainly controlled by the continuous interaction of the ANS.
Two components of frequency are usually distinguishable in the short-term HRV: high frequency (HF) and low frequency (LF). In normal resting conditions and healthy individuals, the parasympathetic route is dominant, resulting in a high HRV, whereas a lower HRV and health problems have been associated with an increase in sympathetic activity while at rest.
Put these together and we can formulate a rule that when the rest-related parasympathetic branch is active and the sympathetic branch is inactive, your heart rate is lower and HRV higher. Factors such as stress can lead to the withdrawal of parasympathetic activity, or activation of sympathetic branch even when you are resting, both leading to elevated heart rate and lowered HRV.

HRV and Aspects of Mental Health

There is interest in HRV in the field of psychophysiology. For example, HRV is related to emotional arousal. High-frequency (HF) activity has been found to decrease under conditions of acute time pressure and emotional strain and elevated state anxiety, presumably related to focused attention and motor inhibition.
HRV has been shown to be reduced in individuals reporting to worry more. In individuals with post-traumatic stress disorder (PTSD), HRV and its HF component (see below) are reduced whilst the low-frequency (LF) component is elevated. Furthermore, PTSD patients demonstrated no LF or HF reactivity to recalling a traumatic event.

The Polyvagal Theory

The Polyvagal Theory describes pathways in the autonomic nervous system that mediate HRV. This theory emphasizes the role of heart rate variability in understanding the magnitude and nature of vagal outflow to the heart. This theory decomposes heart rate variability based on frequency domain characteristics with an emphasis on respiratory sinus arrhythmia and its transmission by a neural pathway that is distinct from other components of HRV. There is anatomic and physiological evidence for a polyvagal control of the heart.

HRV and Cardiovascular Training.

When you start regular cardiovascular training, one of the fastest positive adaptations of your body is increased blood plasma volume, and subsequently increased stroke volume. As a result, your heart can keep the blood flowing and maintain adequate blood pressure at a lower heart rate. And as we remember, lower heart rate is regulated by the parasympathetic branch. Parasympathetic regulation causes longer interbeat intervals and elevated HRV. In the long term, regular exercise also strengthens the heart muscle, which once again means lower HR and higher HRV.
On the whole, high heart rate variability is an indication of especially cardiovascular, but also overall health as well as general fitness. Generally speaking, it tells us how recovered and ready we are for the day. Also, HRV can react to changes in our body even earlier than heart rate. This makes it a particularly sensitive tool that gives us insights into our wellbeing.
You might notice that a very intensive endurance exercise can acutely lower your HRV, but if you recover well, it will jump back up again soon. This is generally speaking a sign that your body handles the training load well. If your HRV doesn’t jump back up, you may have been training too hard or too often. Overall, it seems that regular endurance exercise does tend to increase HRV in the long run, and a high HRV value (compared to your baseline) means that your body should be ready for the next exercise.

 General Rules to Remember When Working with HRV

  • If you become stressed or don’t sleep well for a while, you could see your HRV values gradually dropping, indicating that your body might not be at its best, and you need to take some time for recovery.

  • One interesting finding is that your HRV can jump down if you’re about to get sick – even before you develop any symptoms. If this is the case, and you can take it easy for a day or two, your body might fight off the disease. If you get sick, your HRV can stay quite low even after the symptoms are gone. This indicates that your body is still recovering, and isn’t ready for maximal performances.

  • Smoking and alcohol consumption can reduce HRV. So, you will most probably notice that your HRV goes down momentarily after a night out in town.

  • If you’re an endurance athlete or otherwise exercise-oriented, these research findings* might interest you: among recreational endurance athletes, it seems that the level of HRV predicts training response for several weeks of training. If you have high HRV, your body can be expected to respond positively to high-intensity training. If you have low HRV, your body can be expected to respond positively to a high volume of low-intensity training.

  • Overall, HRV drops with dehydration but jumps back to its baseline level with good hydration. As discussed, both exercise and alcohol can cause dehydration – as can long bouts in the sauna.

The Bottom Line

Tracking HRV may be a great tool to motivate behavioral change for some. HRV measurements can help create more awareness of how you live and think, and how your behavior affects your nervous system and bodily functions. 
While it obviously can’t help you avoid stress, it could help you understand how to respond to stress in a healthier way. There are questions about measurement accuracy and reliability. 
However, I am hoping an independent agency eventually identifies which devices and software provide data we can trust. In the meantime, if you decide to use HRV as another piece of data, do not get too confident if you have a high HRV, or too scared if your HRV is low. Think of HRV as a preventive tool, a visual insight into the most primitive part of your brain.


  1. Pereira, A., Et al. Assessment of Heart Rate Variability in Fibromyalgia after Micro-physiotherapy. MTP&RehabJournal 2014, 12:730-743.
  2. Hautala AJ, Kiviniemi AM, Makikallio TH, Kinnunen H, Nissilä S, Huikuri HV, Tulppo MP. Individual differences in the responses to endurance and resistance training. _Eur J Appl Physiol_ 2006;96(5):535–42.
  3. Vesterinen V, Häkkinen K, Hynynen E, Mikkola J, Hokka L, Nummela A. Heart rate variability in prediction of individual adaptation to endurance training in recreational endurance runners. Scand J Med Sci Sports 2013;23(2):171–80.
  4. Vesterinen V, Häkkinen K, Laine T, Hynynen E, Mikkola J, Nummela A. Predictors of individual adaptation to high-volume or high-intensity endurance training in recreational endurance runners. Scand J Med Sci Sports 2016;26(8):885–93.

By Luciana Segantin Lopes.

What is Integrative Physical Therapy?

The Integrative Physical Therapy is an individual basis type of approach where the main focus goes to the patient and not to the disease.  

Muscular and joint pain, disturbances and imbalances, constant inflammation and postural alterations are among the symptoms of a majority search for intervention at the PT practices.

The Integrative approach of therapy assesses not only the musculoskeletal system but also the patient´s lifestyle, daily stressors, general nutrition, emotional health, exercise routine and many other factors that may be the cause or the aggravation of his or her pain.

During this thorough examination, we are more likely to understand what is the real cause of the patient´s complaints. 

The treatment is custom-based per individual´s needs and  is composed of  a variety of cutting-edge techniques which involves:

  • Manual therapy
  • Craniosacral therapy
  • Microkinesitherapie
  • Postural Analysis and Baropodometry
  • Biomechanical Running analysis
  • Pilates for Rehabilitation and Wellness
  • Core breathing techniques 
  • Heart rate variability assessment and treatment
  • Health coaching by Samadeva Libre University
  • Electrical neuromodulation of the Vagus Nerve and,

Education in some concepts of supplementation and nutrition that will address many areas of his/her life, elevating his sense of well-being and promoting a quality of life as best as possible.

It is well known, for instance, that chronic stress is related to a cascade of serious effects in our body. Higher levels of cortisol increase the activity of the adrenal gland and may cause an increase in body inflammation, muscular pain, and numerous other comorbidities. 
In time, I will be addressing the effects of cortisol in our body and how it relates to PT intervention.

An Integrative approach of therapy that associates mind-body techniques has the purpose to restore balance, promote healing and increase the ability to regain quality of life.

" The natural strength inside each of us is the best healer of  all"                                                                                                                                 Hippocrates

Thursday, July 26, 2018

My Path to Integrative Health - A New Outlook to Physical Therapy

Why I have migrated from mainstream Physical Therapy to a more Integrated Concept of Health.

by Luciana Segantin, MPT

I have been a PT for two decades now. Yes! Two decades!
It seemed yesterday when I graduated in Brazil. Life and options were endless and I decided that I was going to take my life by the horns...

As per my uncle invitation, he is a licensed  MD in the USA, I started as a volunteer PT in a hospital in North Carolina. A year later, while volunteering as a research assistant at NIH in Bethesda, MD  I  received my license as a PT and started practicing. Boy, I was excited!

However, little did I know that the PT practice was not as I had imagined nor as I had experienced in my early graduate years in Brazil. As much we have an immense array of equipment to help us here in the US and countless software to make "our lives easier" when it comes to access and bill patients, there was something missing. 

In order to fulfill insurance´s requirements and be able to handle caseloads, something and someone was always taking a tool. Usually,  therapists and patients were the ones to suffer. Especially the latter. 

Who hasn´t been to a gym where the PT is seeing many patients at the same time and patients are being overlooked? Yes, we try our best. We really do. Because we care.  However, it is almost humanly impossible to comply with all demands and still provide a good and sensible care. 

As a result, I was constantly in distress and in pain. Not to mention, I really didn´t have time to really listen (not hear) what actually consisted my patients complains. How they were really doing, how were their lives, their daily stressors, if they could cope or not with it and, especially, if all these factors could have caused or aggravated their pain.

We all know we are not only a compilation of bones, organs, skin, and muscles. We are more than that. We are what we eat, what we think, we are our relationships, what we see, what we hear.  All of these factors play a role in our health or lack thereof.

Thus, after doing some soul searching and a lot, but a lot of research, I decided to invest in myself and decided to pursue an education on Integrative Health techniques.

These techniques include manual therapy, soft touch techniques, concepts in psychoneuroimmunology, some concepts in nutrition, diet supplementation and spirituality. 

Since my background has always been evidence-based, I had to make sure those techniques had a scientific background to make me more comfortable to apply them. And they do! 

Neuroscience today is coming up with so many astounding discoveries... I will be gradually posting some of them, it is really amazing!

In sum,  I am still walking on this path and it has been more fulfilling each day for both myself and for my patients.  I can see them now with a different perspective, with a better, integrative set of tools that make me understand them in a deeper, full context.

There has been a beautiful path of self-knowledge and professional enhancement.

There is always more to learn and to share. But, from this point on, there is no turning back.

Just moving forward,