10% Human

I just can't stop talking about the importance of healthy gut bacteria.  I borrowed the title for this article from a book I have been reading by Alanna Collen.  In it she discusses the importance of gut bacteria, also known as your microbiome.  The title refers to the percentage of our bodies that are actually human cells.  Of all the cells we walk around with each day, only 10% by number are actually our skin, blood, organs, tissues, etc.  The rest are mostly bacteria with some fungi and viruses. Slowly science is realizing just how important all these bugs in our body really are.  In order for us to evolve, we have had to hire out some of our essential functions.  These bacteria help break down plant fibers, fight off bad bacteria, create vitamin B12 and shape the intestinal wall just to name a few.  And in return we give them a nice place to live with lots of food.  But what happens when this symbiotic relationship gets disrupted?

Most people think their gut is only for digesting food, but in fact the digestive tract is the central area for the nervous, hormonal and immune systems.   This means that an imbalance in this area can have far reaching, and seemingly unrelated, effects throughout the body.

Improper or lacking gut bacteria (dysbiosis) are associated with digestive disorders such as irritable bowel syndrome, irritable bowel disease, Crohn’s disease, celiac disease and food intolerances.  Any of these problems can cause debilitating symptoms.  Several autoimmune diseases are also associated with dysbiosis.  These include rheumatoid arthritis, MS, Type I diabetes and lupus. 

Our digestive tract and our little bacterial friends play a role in regulating our mood.  One of the functions of gut bacteria is to make neurotransmitters such as GABA.  GABA is the calming chemical in the brain that decreases anxiety and helps relieve anxious depression.  Therefore a lack of gut bacteria can lead to anxiety and depression.  Gut bacteria are also involved in other mental health disorders.  A recent study found that supplementing a baby with probiotics (supplement form of good gut bacteria) decreased the incidence of ADHD when these children became teenagers.

Dysbiosis is also associated with autism, allergies, eczema, asthma, some cancers and obesity.  And these are just the health problems we know of so far.  Research is only just beginning to understand the importance of the bugs that live in our digestive tract.  Scientists keep looking for a genetic cause for diseases because we have the technology to change some genes, at least for the coming generation.  But most of these disorders didn’t exist 100 years ago.  Human genetics have not changed that fast.  So that means something must have changed in our environment and lifestyles.

Next article I will talk about what you might be doing to upset your precious bacterial friends in your gut and how you can keep them happy and working hard for you.

In the meantime be nice to your microbiome!

Carrot Ginger Soup with Coconut Poached Chicken

I'm not usually one to share recipes but this one worked out so well I needed to share it.  Delicious on a cold rainy day (like it is here today!).  It will warm you up and even my kids ate it!

Ingredients:

1 onion

3 cloves garlic

2 – 1 inch pieces of fresh ginger

3 large carrots (I also added a small sweet potato)

3 cups stock (I used A.Vogel Herbamare Bouillon Plantaforce)

2 Tbsp butter or coconut oil

1 can coconut milk

500g chicken breast – cut up into slices to decrease cooking time

Cut up onion, garlic, ginger, carrot and sweet potato.  Carrot and sweet potato can be in large pieces as they are going to be blended later.  Put in a pot with the butter and cook until onion is translucent.  Add 2 cups of stock and cook until tender.  Once cooked, blend until smooth.  I put it through my Vitamix but a stick blender is also useful.

While that is cooking put coconut milk and remaining 1 cup of stock in another pot and heat up.  Add the chicken.  Cook until chicken is cooked through.  Don’t let the coconut milk boil or it will separate. 

Once the chicken is cooked, fish it out with a slotted spoon.  Poor the remaining coconut milk/stock mixture into the carrot mixture until the desired consistency is reached. 

Take two forks and shred the chicken to bite sized pieces.  Add the chicken back into the soup and you’re done!  Add a sprig of cilantro to serve if desired.  I served it with homemade garlic bread. Mmmmmmm

Water, Water Everywhere

Our bodies are made up of over two-thirds water.  We need water for the proper functioning of all systems of the body including creating saliva, perspiration and joint fluids, moistening mucous membranes, dissolving and carrying minerals and nutrients throughout the body and flushing out waste products.   Our bodies are unable to store water so we can only last for a few days without consuming it.

Some symptoms of dehydration include headaches, fatigue, poor sleep quality, dark coloured urine, constipation, dry mouth, dizziness, muscle cramps and dry skin.  With chronic dehydration the body learns to adapt and changes the point at which it asks for water.  The less water you drink on a regular basis, the less water your body will ask for.

The generally accepted rule is to drink 8 glasses that are 8 oz each or almost 2L.  If you exercise during the day than this amount needs to increase depending on how much you sweat.  If you are exercising for longer than an hour, weigh yourself before and after exercise to see if you have lost weight due to dehydration.  If you weigh less after exercise, then you need to drink more water.  You may also need to add an electrolyte supplement if you are sweating a lot.

If you consume caffeine during the day than you also need to consume more water. Some people say you can count caffeinated beverages toward water intake.  I strongly disagree.  Caffeine is a diuretic. This means it increases the amount of water excreted in your urine.  My general rule for patients is if you drink a cup of a caffeinated beverage (coffee, tea, energy drink, soft drink) than you need to drink a cup of water to compensate.  This brings you back to zero and you have to drink your 2L on top of this.  Alcohol is an even stronger diuretic and requires even more compensation.  Some medications will also dehydrate you. 

As mentioned your body adapts to being dehydrated so you need to increase you intake slowly.  Increase your intake each week by 250ml per day.  Keep increasing until you get to 2L per day after compensating for your caffeine intake.  If you still have any of the above symptoms or your urine is still not clear or light coloured, talk to your naturopath before increasing more, as it is possible to drink too much water. 

Some of your water intake comes from fruits and vegetables especially high water content ones like watermelon or cucumber but unless you are consuming these in large quantities I don’t count them.  Juice is mostly water, but it also contains lots of sugar so should only be consumed in small quantities. If you don’t like the taste of water, add a squeeze of lemon, lime or orange.  Consult your naturopath if you are on any medications or have a kidney disease.  Start drinking water today and see the difference it makes!

Confused About Pregnancy Supplements?

It is generally accepted that prenatal vitamins are important during pregnancy; most people find out they are pregnant and rush to the chemist or drugstore.  But if you are planning on getting pregnant, you should start taking those vitamins right away!  Your baby starts growing from the moment of conception so it is important to start many supplements before becoming pregnant.  For personalised pregnancy advice, check out my website for locations and give me a call: www.natactive.com.au

Research has shown that women who did not take a prenatal vitamin for the 3 months prior to conception and the first month of pregnancy were twice as likely to have a child with an autism spectrum disorder.  The risk rose to seven times more likely when combined with genetic risk factors. It is unknown exactly why this is, however it may be due to folic acid and its effect on neurodevelopment.

Iodine is important for baby brain development so make sure the multivitamin you take contains iodine in the form of iodide.  A mother’s iodine deficiency in the first trimester can lead to a lower IQ and reading ability in the child at 9 years old.

Good gut bacteria has been shown to be important for all sorts of immune and digestive problems and it is also important for baby.  Taking a probiotic supplement during pregnancy lowers the risk of baby developing eczema after birth.  Make sure you take a good quality supplement with several different strains and billions of bacteria in each capsule.

Another important supplement to take during pregnancy is omega-3 fatty acids.  Supplementation of docosahexaenoic acid (DHA) during the third trimester may increase the length of gestation by up to 8 days. DHA is also required for proper brain development and supplementation during pregnancy may improve mental development in children. To increase your intake of omega-3 fatty acids eat more fatty coldwater fish such as salmon, herring, sardines, or trout or take a good quality fish oil supplement.  Avoid king mackerel, shark, swordfish and tuna due to their high mercury content.

When women become pregnant they are told there are many foods they should avoid but there are also certain foods women should make sure they eat. Consumption of wheat, dairy and peanuts during early pregnancy actually reduces the risk of children developing asthma, dermatitis and allergic rhinitis as they get older.

These are just a few supplements that are important for almost all pregnant women to take while pregnant. Everyone is different and you may require additional supplements before and after conception.  Talk to your local naturopath if you are thinking of getting pregnant so you can give your baby the best start possible!  Or check out my website and give me a call: www.natactive.com.au

Fertility. Not just for women!

When trying to conceive, most attention is on the health of the woman while the men’s health tends to be ignored until problems arise. Men contribute 50% of the DNA to create a baby, so it is important for men to contribute healthy sperm. It takes over 70 days for sperm to develop from immature to mature.  This is an important time for men to be taking charge of their health and lifestyle to give their baby the best start possible.

The place to start is to abstain from alcohol and quit smoking.  Male alcohol consumption, especially one month before conception, increases the risk miscarriage and not achieving a live birth.[i] Alcohol effects sperm quality possibly due to a lowering of testosterone.[ii] The effects of alcohol on sperm begin to reverse when intake is ceased which is why it is important to stop a few months before conceiving. It is also very important to quit smoking a few months before conception as smoking reduces sperm production and motility and increases DNA damage.[iii]

Being overweight can have a significant effect on fertility. Being overweight is associated with infertility, decreased sperm concentration, decreased sperm motility and increased DNA damage.  There is also a very strong relationship between obesity and erectile dysfunction. [iv]

Of course I can’t forget to mention exercise.  Moderate physical activity for one hour at least three times a week shows significant benefits on sperm morphology.[iv]

There are also several supplements that have been shown to improve male fertility.  A deficiency in omega-3 fatty acids is correlated with decreased sperm motility.[v] Sperm quantity can be increased with increased fish oil intake.[vi]  To ensure sufficient intake eat more fatty coldwater fish such as salmon, herring, sardines, or trout or take a good quality fish oil supplement.  Avoid king mackerel, shark, swordfish and tuna due to their high mercury content. High blood mercury levels are associated with abnormal semen.[vii]

Zinc is essential for male hormone metabolism, sperm formation and sperm motility.  Zinc deficiency can lead to decreased testosterone and low sperm count levels. Zinc supplementation has been found to improve these factors.[viii] Vitamin C also improves semen quality while vitamin E reduces oxidative damage and improves motility.[iv] Sperm motility and morphology are improved with coenzyme Q10 supplementation.[ix]

A diet high in fruits and vegetables is associated with improved semen quality.  This may be due to an increased antioxidant intake.[iv]  A pre-conception “Mediterranean” type diet by couples has been associated with increased conception success.[x]

There are many factors that effect male fertility.  If you are planning on conceiving, talk to your local naturopath to get personalized advice.  Start getting healthy at least three months before conceiving.  This will give you the highest chance of success and give your baby the best start.

References

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[i] Klonoff-Cohen H, Lam-Kruglick P, Gonzalez C. Effects of maternal and paternal alcohol consumption on the success rates of in vitro fertilization and gamete intrafallopian transfer. Fertility and Sterility. 2003 Feb; 79(2): 330-339.

[ii] La Vignera S, Condorelli RA, Balercia G, Vicari E, Calogero AE. Does alcohol have any effect on male reproductive function? A review of literature. Asian J. Androl. 2013 Mar; 15(2):221-5.

[iii] Mostafa T. Cigarette smoking and male infertility. Journal of Advanced Research. 2010 July; 1(3):179-186.

[iv] Sharma R, Biedenharn KR, Fedor JM, Agarwal A. Lifestyle factors and reproductive health: taking control of your fertility. Reprod Biol Endocrinol. 2013 July 16; 11: 66.

[v] Comhaire FH, Mahmoud A. The role of food supplements in the treatment of the infertile man. Reprod. Biomed. Online 2003 Oct-Nov; 7(4):385-91.

[vi] Safarinejad MR. Effect of omega-3 polyunsaturated fatty acid supplementation on semen profile and enzymatic anti-oxidant capacity of seminal plasma in infertile men with idiopathic oligoasthenoteratospermia: a double-blind, placebo-controlled, randomised study. Andrologia 2011 Feb; 43(1):38-47.

[vii] Choy CM, Lam CW, Cheung LT, Briton-Jones CM, Cheung LP, Haines CJ. Infertility, blood mercury concentrations and dietary seafood consumption: a case-control study. BJOG. 2002 Oct;109(10):1121-5.

[viii] Hunter P. Health Benefits of Zinc. Bioceuticals Advanced Clinical Insights, 2004; 5.

[ix] Safarinejad MR. Efficacy of Coenzyme Q10 on Semen Parameters, Sperm Function and Reproductive Hormones in Infertile Men. The Journal of Urology. 2009 July; 182(1):237-248.

[x] Vujkovic M, de Vries JH, Lindemans J, Macklon NS, van der Spek PJ, Steegers EA, Steegers-Theunissen RP. The preconception Mediterranean dietary pattern in couples undergoing in vitro fertilization/intracytoplasmic sperm injection treatment increases the chance of pregnancy. Fertil. Steril. 2010 Nov; 94(6):2096-101.

Stay Healthy this Winter (and all year long)!

While it is summer for all of you in the northern hemisphere, it is winter down under which means cold and flu season has come around again. Although for those of us with kids in daycare and school it seems that cold and flu season lasts all year-round! Here are some helpful hints for keeping the whole family healthy in winter and all year long.

Image from http://macomblearningcenter.com

Sleep is the most important activity your body needs. When sleeping, your body restores, heals, and creates important hormones. Get to bed early and stay there for at least 7-8 hours each night.  Avoid caffeine after noon to ensure you get a good quantity and quality of sleep.  Read my blog article “Having Trouble Sleeping?” for more advice.

Psychological stress is associated with a greater risk of depression, heart disease and infectious diseases.[i]  Take time out - exercise, garden, meditate, whatever it is that helps you to relax.

What would one of my articles be if I didn’t mention exercise?  Exercise is important for everyone. To keep your immune system at its best you want at least a brisk 30-minute walk each day.  If you are an avid athlete you also need to take care, as very high intensity exercise can put a strain on your immune system.[ii]

Always wash your hands before eating.  There was a 75% reduction in flu-like symptoms when a test group wore masks and washed their hands.[iii]  It can really be just that easy.

Our bodies are composed of 70% water. Proper hydration is important for the optimum functioning of all your body systems. Increase your water intake slowly getting up to 2L per day.

Hot-Cold showers are an excellent way of improving your immune system, increasing circula­tion and elevating energy levels. After finishing your regular shower routine, do 20 seconds of cold and 1 minute of hot. Alternate 2-3 times, ending with cold.  The increase in circulation will also help decrease sensitivity to the cold.

There are several supplements you can take to help boost your immune system. Daily zinc supplementation has been shown to shorten the duration and severity of the common cold, reduce the incidence of acute lower respiratory tract infections in preschool children by 45% and reduce the incidence of pneumonia by 41%.[iv]

Vitamin C is found in high concentrations in immune cells and is quickly consumed during an infection.  It is a natural antihistamine and has been found to reduce the severity and duration of the common cold and upper respiratory tract infections.

More than 80% of the body’s immune system is in the digestive tract.[v]  A lack of good bacteria in the digestive tract can cause a reduction in the immune system allowing increased infections.  Take a good quality probiotic to prevent bad bacteria from taking hold.

Vitamin D has a direct effect on the immune system. Vitamin D stimulates the production of natural antibiotic proteins thus killing more bacteria.  Insufficient levels are related to a deficiency in our immune system to protect us against infections. 

These are just a few suggestions.  For personalized advice, contact your local naturopath. Let's stay healthy this winter!

References

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[i] Cohen S, Janicki-Deverts D, Doyle WJ, Miller GE, Frank E, Rabin BS, Turner RB. Chronic stress, glucocorticoid receptor resistance, inflammation, and disease risk. PNAS, 2012 April 17; 109(16): 5995-5999.

[ii] Society for General Microbiology. Couch potato or elite athlete? A happy medium keeps colds at bay(Internet). ScienceDaily. 2012 January 5 (Retrieved 13 May 2012). Available from: www.sciencedaily.com/releases/2012/01/120105112158.htm

[iii] Aiello AE, Perez V, Coulborn RM, Davis BM, Uddin M, Monto AS. Facemasks, Hand Hygiene, and Influenza among Young Adults: A Randomized Intervention Trial. PLoS ONE, 2012; 7 (1): e29744.

[iv] Hunter P. Health Benefits of Zinc. Bioceuticals Advanced Clinical Insights, 2004; 5.

[v] Plummer N. Dysbiosis and Disease: Ground breaking new research into probiotics and their role in preventing treating disease (presentation notes). FIT-BioCeuticals, Ltd. Online. 2010.

We have good bacteria where?

What are good bacteria?

We have bacteria throughout our whole bodies including our mouths, respiratory tract, digestive tract, urinary tract and skin.   Good bacteria living in our bodies are often referred to as the microflora.  Babies gain their first exposure to good bacteria at birth when they pass through the vaginal tract and are also exposed through breast milk. Bacteria found in the digestive tract of babies are different to adults but by the age of two people have developed adult microflora through eating adult foods.[i]  The type and quantity of bacteria depend on the location in the body.  Most good bacteria are found in the large intestine.

What do good bacteria do?

The good bacteria in our bodies have many functions.  They help our intestines digest and absorb nutrients, synthesize vitamins and essential short chain fatty acids from soluble fibre, protect us from infection and stimulate and regulate the immune system.  If our body did not contain any good bacteria we would be very sick and die within a few years.[i] 

The digestive tract contains 80% of the body’s immune system.[i]  The good bacteria form a barrier in the mucosal lining against microbes.  Gaps can be created in this layer when a person has a poor diet, especially one low in fibre and high in processed foods and alcohol, antibiotics, stress (including from excessive exercise in elite athletes), lack of sleep or infections.  This leaves space for bad microbes to take hold and cause illness.

Signs of deficient good bacteria

The digestive system is the cornerstone to good health.  It is actually an external organ as it is exposed directly to elements from the outside world.  It is where nutrients are absorbed as well as many pathogens.  A poorly functioning digestive system can result in a wide range of symptoms.  These may include increased infections, bloating, IBS, diarrhea, eczema, allergies, food intolerances, and autoimmune diseases.

What are probiotics?

Probiotics are the supplement form of good bacteria.  Probiotics work by displacing the bad bacteria that try to adhere themselves to the digestive tract.[i]   There are many different strains of bacteria that may be in a supplement.  Different pathologies will respond better to different strains.  Taking probiotics can help to heal the above mentioned conditions as well as decrease the incidence of asthma and allergies in children when taken during pregnancy, improve breast pain in nursing mothers,[ii] and help treat pelvic inflammatory disease, thrush, and Gardnerella vaginalis, [iii] Supplementation has also been found to prevent and treat bad breath, periodontal disease and cavities.[iv]  Yogurt contains good bacteria but not enough to treat most disorders.  Most yogurts also contain large amounts of sugar that deplete your immune system.  Please read my blog article called “Healthy Eating?” for more information about hidden sugars.

If you think you may need probiotics talk to your local naturopath.  Although probiotics can treat some disorders, some symptoms may return once supplementation is stopped if you don’t find the cause of your problems.

References

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[i] Plummer N. Dysbiosis and Disease: Ground breaking new research into probiotics and their role in preventing treating disease (unpublished lecture notes). FIT-BioCeuticals, Ltd. Online. 2010

[ii] Koeman M. Conditions of the Breast (unpublished lecture notes). Health Masters Live, online; lecture given 2013 Nov 12.

[iii] O’Flynn K. Cervical and Vaginal Conditions (unpublished lecture notes). Health Masters Live, online; lecture given 2013 Nov 28.

[iv] Anilkumar K, Monisha AL. Role of friendly bacteria in oral health - a short review. Oral Health Prev Dent. 2012; 10(1):3-8.

Food Allergies vs Food Intolerances

There is often confusion between food allergies and food intolerances/sensitivities.  In this article I will explain what they each mean and help you decide if you should get tested for them.

Our bodies make several different immunoglobulins (Ig), also known as antibodies, which bind to microbes in order to neutralize them or tag them for other immune cells to deal with.

A food allergy is when the body has an immune response to a food protein.  This reaction is due to the immunoglobulin IgE. A food intolerance can be the immune response of the immunoglobulin IgG or sometimes a lack of certain enzymes needed to properly digest food.  An IgG reaction is also an immune response to a food protein, but the term ‘food allergy’ is reserved for IgE reactions.

Food Allergies

IgE attacks parasitic worms when they are present in our bodies and also binds to allergens to produce histamine.  IgE causes an immediate reaction in the body (usually in less than 2 hours) and can be in the form of asthma, hives, skin rash, headache or anaphylaxis.[i]  The most commonly talked about IgE reactions are those to peanuts and bees, but people can

have reactions to all sorts of substances including medications, dust mites, seafood, grass and pollen.  The most common test for this is a skin prick test where small scratches are made on the skin and small amounts of different allergens are applied.  This gives results in 10-20 minutes so they can be discussed immediately.  People are often able to self-diagnose food allergies due to the immediacy of the reaction.  One theory explaining the rise in food allergies is that we are not often exposed to worms leaving IgE with nothing to do.

Food Intolerance

IgG is the main immunoglobulin in the body and protects the body against viruses, bacteria and fungi.  IgG is the only immunoglobulin that passes the placental barrier providing protection to the fetus and also passes into breast milk along with IgA.  Measurement of IgG is used to check for immunity to some viruses such as measles, mumps and chicken pox. 

Unfortunately IgG can also react to foods if there is inflammation in the bowel allowing small particles of undigested food to pass through.  This can present as a variety of symptoms including headaches, fatigue, irritable bowel syndrome, depression, arthritis, chronic respiratory problems, weight problems, anxiety, insomnia and migraines.i [ii] IgG reactions are often delayed and can last for weeks or months after ingestion of the problem food. i Given this and the large variety of symptoms it can cause, it can be difficult to diagnose this reaction.  Common IgG reactions are to wheat, gluten, dairy and soy.  The common test for IgG reactions is an easy finger prick blood test.

If you think you may have food allergies or intolerances it is important to see your naturopath or other health care provider to ascertain the problem foods or substances so they can be avoided and you can begin the journey to better health.

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[i] Cooking for the low reactive (elimination) diet.  Vivienne Saville, ND. Aug 2006, Darwin.  Published by Recipe To Health

[ii] Food Detective (Internet). (cited 2014 Mar 3). Available from: www.food-detective.com.au/symptoms

Is Your Sleep Obstructed?

Sleep apnea is when there is a pause in breathing while asleep.  There are 3 different kinds of sleep anpea – obstructive, central and mixed.  Obstructive is when the airway has become narrow, blocked or floppy.  Central is when the brain temporarily stops sending signals to the muscles that are responsible for controlling breathing.  Mixed is a combination of the two.  This article will focus on obstructive sleep apnea (OSA), although many of the causes and treatments are similar for all kinds.

It is estimated that between 3% and 7% of the population have OSA but this number could be higher as many people do not seek treatment. Older men who are obese are more likely to have sleep apnea, but it can effect women and any age group including children.[i] Obesity is the biggest risk factor for OSA so it is projected that OSA will become more common as the population becomes bigger and bigger.

OSA can cause increased blood pressure and is associated with an increased risk of cardiovascular disease.[ii]  It is also associated with an increased risk of stroke, daytime drowsiness, motor vehicle accidents and lowered quality of life.[iii]  Rates of depression are also higher in people with OSA so it is very important to seek treatment.[iv]

Treatments

Starting to exercise is the first place to begin if you have OSA.  Studies have found that OSA improved even when participants didn’t lost weight.[v]  This can have a big effect on improving overall quality of life as decreased OSA will result in a better sleep leading to more energy during the day.  Then you will be able to exercise more!  You want to do at least 150 minutes of moderate intensity exercise a week.  See my blog article on exercise for weight loss for more details.

Studies have shown that acupuncture and herbal medicine are both safe and effective treatment options for OSA.[vi] [vii]

It is also important to avoid sleeping on your back.  Purchase a pillow that encourages you to sleep on your side or you can sew a tennis ball into the back of your pyjamas to keep yourself on your side.  Avoid alcohol.  Drinking alcohol within 6 hours of sleep will worsen sleep apnea. Quit smoking.  Easier said than done, but smoking is another major risk factor for OSA.

If you think you may have OSA it is important to see your healthcare provider as even mild cases are associated with increased morbidity.[viii]  For natural treatments, contact your local naturopath and start on your path to better sleep and better health.

References:

[i] Patil SP, Schneider H, Schwartz AR, Smith PL. Adult obstructive sleep apnea: pathophysiology and diagnosis. Chest. 2007 Jul;132(1):325-37.

[ii] Phillips CL, Cistulli PA. Obstructive sleep apnea and hypertension: epidemiology, mechanisms and treatment effects. Minerva Med. 2006 Aug;97(4):299-312.

[iii] Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002 May 1;165(9):1217-39.

[iv] Ejaz SM, Khawaja IS, Bhatia S, Hurwitz TD. Obstructive sleep apnea and depression: a review. Innov Clin Neurosci. 2011 Aug;8(8):17-25.

[v] Kline CE, Crowley EP, Ewing GB, Burch JB, Blair SN, Durstine JL, Davis JM, Youngstedt SD. The effect of exercise training on obstructive sleep apnea and sleep quality: a randomized controlled trial. Sleep. 2011 Dec 1;34(12):1631-40.

[vi] Freire AO, Sugai GC, Chrispin FS, Togeiro SM, Yamamura Y, Mello LE, Tufik S. Treatment of moderate obstructive sleep apnea syndrome with acupuncture: a randomised, placebo-controlled pilot trial. Sleep Med. 2007 Jan;8(1):43-50.

[vii] Wu YH, Wei YC, Tai YS, Chen KJ, Li HY. Clinical outcomes of traditional Chinese medicine compound formula in treating sleep-disordered breathing patients. Am J Chin Med. 2012;40(1):11-24.

[viii] Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002 May 1;165(9):1217-39.