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Circadian rhythm: why when matters (part 2)

4/10/2020

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We previously looked at how light affects our circadian clock and explored ways to support a healthy circadian rhythm using light and lighting (circadian-rhythm-why-when-matters.html). Food is the other main environmental cue that resets our rhythm through the peripheral clocks, for example in the liver, pancreas and gut.

Just like we have extended the day with artificial lighting, food is also now available around the clock. But our digestive and metabolic machinery was never designed to deal with a constant influx of nutrients or calories. Digestion is a complex, carefully orchestrated process. For example, secretion of saliva, gastric acid and digestive enzymes and intestinal motility have a clear circadian fluctuation. Our insulin secretion and insulin sensitivity are highest in the first half of the day, so eating the same amount of carbohydrates will have a different effect on blood sugar levels depending on what time of day it is consumed. The mucus layer protecting the gut lining replenishes overnight when we are fasting, and so does the damaged gut lining. Gut motility slows down in the evening and overnight so it takes a lot longer for the food to move down the tract. Even the gut microbiome has a circadian rhythm: in health, certain species peak at different times, creating the best conditions to digest what we eat when the body expects to receive food. With an eating pattern that is spread throughout a longer period of time leading to shorter periods of gut rest, both the diversity of the microbiome and the cycling of different species suffer.

Food presented at the wrong time can disrupt the circadian rhythm and it can also interfere with the restorative processes that need to happen in the digestive system overnight. The cumulative damage can lead to disease, quite possibly beyond the digestive tract as damaged gut barrier (“leaky gut”) increases systemic inflammation.


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When researchers looked at when people eat, it was astonishing that most of the studied individuals ate throughout almost their whole waking period. There was also a clear shift to later start and finish times during weekends compared to weekdays. For the digestive system this is like travelling to a different time zone and back.

From numerous animal studies we know that when there is unrestricted access to food, animals learn to eat for longer periods of time than what they normally would do, so they widen their eating window. Over time, they also become rather unhealthy – gain weight, develop diabetes and other metabolic abnormalities and even heartbeat irregularities, their endurance and physical performance suffers and sleep becomes disregulated. Interestingly enough, even when mice were fed their normal healthy diet but were given access to food around the clock, they became unhealthy, whereas mice eating an unhealthy diet but in a time-restricted fashion during their normal eating phase managed to stay healthy. Amazingly, obese mice showed marked improvements in their metabolic health parameters after only one intervention: narrowing their eating window.

Time-restricted eating is being increasingly studied in humans, and although so far the evidence has been mostly limited to either small numbers of participants or otherwise healthy individuals, the results are very encouraging. But researchers have also started looking at how time-restricted eating might affect people with diagnosed metabolic syndrome, or syndrome X, which is a constellation of conditions such as abdominal obesity, high blood pressure, high blood sugar and insulin resistance, abnormal cholesterol and triglyceride levels – all known to be risk factors for cardiovascular disease. It is estimated to affect as much as a third of the population, at least in the US.

A recent pilot study looked at 19 participants with a diagnosis of metabolic syndrome who were taking blood pressure or statin medications. They were instructed to eat within the same self-defined 10 hour interval for 12 weeks. At the end of that period they lost some weight (about 3 kg on average), their body fat dropped by 3% and the waist circumference by 4.4 cm. There was an improvement in their blood pressure, blood cholesterol and in markers of poor blood glucose control. As much as 70% reported either better sleep quality or the amount of sleep they were getting. Some patients were also able to lower or stop their medication after the study had finished. This is quite impressive considering the only intervention was restricting how long they were eating for. They didn't change what of how much they were eating. A great number of study participants were found to continue practicing TRE either full- or part-time for up to a year afterwards. A larger study with over 100 people is currently underway.

There is also evidence from over 2400 breast cancer survivors that those who fasted for less than 13 hours a day had a significantly higher rate (36% more) of cancer recurrence compared to those who fasted for over 13 hours. In this study longer nightly fasts (>13 hours) were also associated with longer sleep and better blood sugar control.
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Time-restricted eating (TRE)

Under TRE everything you eat in a day (including any snacks) should be confined to a specific, more or less consistent, interval followed by a period of fasting of at least 12 hours. Water is fine to drink at any time, however, beverages like black coffee or tea can reset our clocks so if used, should ideally be consumed within your chosen time window. The issue of caffeine is a complicated one with many factors to consider and researchers don't have all the answers. But for circadian eating it is recommended to consider caffeine consumption as breaking the fast. Being a stimulant that takes a long time to be cleared out of the system (it has a quarter life of 12 hours, meaning a quarter of the cup you drank in the morning is still in your system in 12 hours), it's also not going to help healthy sleep. As we get older, we also become more sensitive to caffeine and its sleep disrupting effects, as we take longer to process and clear it out of our system. It is worth noting that polyphenols even in decaffeinated coffee have been shown to enhance autophagy (the self-recycling process in our cells) so you should not necessarily give it up altogether. But the timing of intake is crucial so if used, caffeine is best reserved for the morning.

Allowing at least 12 hours of not eating seems to be the absolute minimum for the body to recover and repair. As mentioned above, people with metabolic syndrome can benefit from shrinking their eating window further to 10 hours a day. Dr Panda's data suggests that for weight loss, eating within 8-9 hours is beneficial, whereas eating within 11-12 hours is best for weight maintenance.

While a defined consistent eating window is clearly more beneficial than eating for over 12 hours a day, eating earlier in the day has even more health benefits. It is more in alignment with our circadian rhythm especially in some metabolic processes. Eating earlier in the day improves blood sugar control while eating late worsens glucose tolerance. It is recommended to leave at least 2-3 hours between the last bite and bedtime. One of the reasons for that is because the evening rise of melatonin (normally 2-4 hours before your habitual bedtime) reduces the pancreas secretion of insulin. So eating late in the day will produce a longer blood sugar spike and some might even be diagnosed as prediabetic if tested. Late eating and also eating most of the calories later in the day slows down weight loss efforts and leads to a more modest weight loss.

Eating late can contribute to acid reflux so if you suffer from this uncomfortable condition, shifting your last bite to an ealier time could have another positive consequence. A great number of people are taking medications to suppress acid production, often for years, as when they try to come off them, their symptoms return, sometimes with a vengeance. Long-term use of these medications is not without downsides. TRE on the other hand could offer a chemical-free solution.
​

Starting TRE can seem daunting and it's almost certain that making drastic changes in your eating window is not going to work, or be easy at the very least. Stopping evening snacks or starting with 12 hours to allow the necessary hormonal changes (for example, regulating hunger and satiety) to happen may be a better approach. Most people would do just fine on a 10-12 hour eating window without needing to narrow it down further but those needing to lose extra weight or who are prediabetic, may want to experiment with a shorter window e.g. 8 hrs. More research is needed for those taking medication (especially for diabetes). While it can be a useful adjunct to treatment, doing it under a doctor's supervision with regular bloodwork is needed to do it in a safe manner for these people.

Giving yourself the recommended minimum 8 hour sleep opportunity (i.e. time spent in bed) will hopefully allow you to get at least 7 hours of sleep that we need to function well. Getting enough sleep helps balance ghrelin and leptin, the hormones of hunger and satiety, making it easier to not need to eat all day. TRE itself has a positive effect on sleep so it works both ways.

TRE is a lifestyle, not a diet. Dr Panda compares it to brushing and flossing your teeth – a daily habit that keeps your teeth healthy, whereas longer fasts of e.g. 2 and more days are like a deeper clean by a dental hygienist. There are certainly those for whom these longer fasts are contraindicated but TRE can be practised indefinitely by most healthy people.


This post was inspired by the work of Dr Satchin Panda, one of the leading circadian biology researchers and the author of The Circadian Code, and Dr Matthew Walker, professor of neuroscience, the sleep diplomat and the author of Why We Sleep. I encourage everybody reading this to look into their work for more insights and inspiration to change your lifestyle and take your health into your own hands. Both have spoken extensively on their respective areas of research in various interviews and talks and their books are a wealth of eye-opening information and practical suggestions.

References:

Panda S. 2018 The Cricadian Code, Lose Weight, Supercharge Your Energy and Sleep Well Every Night, Ebury Publishing, London

Walker M. 2017 Why We Sleep: The New Science of Sleep and Dreams, Penguin Books, London

Wilkinson MJ, Manoogian ENC, Zadourian A, Navlakha S, Panda S, Taub PR. Ten-hour time-restricted eating reduces weight, blood pressure and atherogenic lipids in patients with metabolic syndrome. Cell Metabolism, 2020, 31(1): 92-104
https://www.ncbi.nlm.nih.gov/pubmed/31813824

Marinac CR, Nelson SH, Breen CI, et al. Prolonged Nightly Fasting and Breast Cancer Prognosis JAMA Oncol. 2016;2(8):1049–1055.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4982776/

Jamshed H, Beyl RA, Della Manna DL, Yang ES, Ravussin E, Peterson CM. Early Time-Restricted Feeding Improves 24-Hour Glucose Levels and Affects Markers of the Circadian Clock, Aging, and Autophagy in Humans. Nutrients. 2019;11(6):1234.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6627766/

Poggiogalle E, Jamshed H, Peterson CM. Circadian regulation of glucose, lipid, and energy metabolism in humans. Metabolism. 2018;84:11–27.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995632/

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Author

Aydan Hajiyeva
Hons Dip Gen Med, DO MOst
Registered Osteopath
​City Osteopaths

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Circadian rhythm: why when matters (part 1)

4/7/2020

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T​iming is everything. The vast majority of what is happening in living cells and organisms is not random or haphazard but undergoes specific fluctuations throughout the day or 24 hours. Genes switching on and off, hormone secretion, metabolism, cell and DNA repair, blood clotting, immune function, digestion, physical performance, mood and mental acuity etc. – everything is governed by the circadian rhythm. It is aligned with the light and dark cycle that our planet experiences every 24 hours or so. Having a strong, healthy circadian rhythm is undoubtedly associated with health and longevity, as we are beginning to realise. Unfortunately, industrialisation has led to a profound disruption of the normal circadian rhythm which has been linked to many chronic diseases including obesity, diabetes, heart disease, dementia and certain cancers. In fact, shift work is now recognised by the WHO as a probable carcinogen. Quite possibly, all this has to do with the effects of a disrupted circadian rhythm on sleep, the fundamental pillar of health on which the other two pillars (nutrition and exercise) rest. Circadian biology is asking more and more questions and future research will even explore ways to “drug the clock” which will be helpful for the sizable proportion of shift workers in the society. However, if you are not a shift worker, you are likely to sabotage your circadian rhythm every day, often without realising it. Nevertheless, for most people restoring balance may be easier than we think.
 
​But first it might help to understand how it all works. There are "clocks" in every cell and every organ. The master clock called the suprachiasmatic nucleus, or SCN, is located in the brain. This tiny structure sits in the hypothalamus which happens to be the link between the nervous and the endocrine system and oversees many physiological functions.
 
The clock is running all the time. Even in the absence of external cues from the environment every process in our body would continue to ebb and flow in a diurnal pattern with precision (and in fact, a 2017 Nobel prize in Physiology or Medicine was awarded to three scientists who figured out the molecular basis of that). But there are certain environmental signals that reset our circadian rhythm. The two main ones are light and food. Both used to be reliable indicators of whether it was day or night. Not anymore, which is probably why circadian rhythm disruption is so prevalent.
 
We will look at each of these signals in more detail, including how to use them to reset and sync up our clocks, focusing on light first. We will cover food in the next post. But before moving on, it is very important to realise that sticking to a routine, both daily and weekly, is key. Waking up and going to bed at the same time during the week and at the weekend, eating within a consistent time window are quite naturally fundamental to the success of addressing a circadian rhythm disruption. Sleeping in at the weekend can be tempting if you are chronically sleep-deprived but that just exacerbates instead of addressing the problem (which could be avoiding accumulating a sleep debt by getting enough sleep every day). It destabilises the circadian clock in the same way as jet lag and for every hour (or time zone) that our rhythm shifts we need a day to adjust. Now imagine doing it every week for months or years... Could it be that chronic disease and accelerated aging is just the accumulated damage of this constant tug of war?
 
Light and the master clock
 
The master clock receives information about light from a relatively small number of cells in our eyes and determines whether it's day or night. These cells are scattered among standard rods and cons in the retina, and what sets them apart is that they have a light-sensing protein, melanopsin, that is activated by blue light. Melanopsin was discovered about 20 years ago by a few labs around the same time, including the lab of Dr Satchin Panda, whose work on uncovering the significance of melanopsin in relation to our circadian clock has forever changed the way we look at how light (and lighting) affects us.
 
Melanopsin is quite peculiar in that it is not a very good light sensor - it takes a lot of bright light to activate it. But it can potentially integrate even dim light over time making it a bad idea to spend long periods of time after sunset even in a dimly lit environment or look at even dim light sources. It is also possible that light of other wavelengths can activate these melanopsin-containing cells normally tuned to blue light, as all retinal cells are interconnected. So while blue light is particularly detrimental to a healthy and timely melatonin release (and melatonin is necessary to make us sleepy), too much any light in the evening is going to suppress it, therefore prolonging wakefulness and depriving us of good quality sleep.​

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​Using light to restore a healthy circadian rhythm
 
Most of our day is usually spent indoors where it is not bright enough during the day. On the other hand, our evenings are brighter than they were even meant to be. This inversion of light exposure throughout the day is unnatural and is important to address to restore the normal circadian rhythm.
 
Bright natural light in the morning
 
Expose your eyes to bright daylight in the first half of the day, starting as early after waking as you can. This might be a short walk outside (with no sunglasses), sitting in the garden, on a porch or balcony or even just next to a large window with sunlight streaming in. Apparently even on a cloudy day there is enough blue light and brightness to stimulate our eyes and to reset our clock, although sunnier days do make it easier so it is a good idea to make the most of sunny mornings. If you are curious about actual brightness levels, you can turn your phone into a meter with a free app called MyLuxRecorder. The average person needs upwards of 1000 lux for at least 30 minutes a day to reduce sleepiness, increase alertness and boost mood (on a side note, to treat depression or seasonal affective disorder at least 10000 lux for 15-60 mins a day is necessary). But even a shorter exposure (10-15 mins) is still beneficial and doing it early in the morning is vital for a robust circadian rhythm. To be fully activated, melanopsin needs at least a few minutes of bright light. Dr Panda recommends having breakfast by a big window (although you have to be quite close to flood your eyes with enough light of sufficient brightness) and not wearing sunglasses on your morning commute, of course avoiding looking directly at the sun.
 
A note for older adults: our circadian rhythm changes throughout life and in our later years everything shifts to earlier in the day. So over time we tend to wake up earlier and feel sleepier earlier in the evening. To help mitigate this, Dr Matthew Walker, professor of neuroscience and a sleep researcher, suggests wearing sunglasses in the morning during any outdoor activity but then going back outside in the late afternoon, this time without sunglasses, and get plenty of sunlight exposure, thereby shifting the resetting of the clock to a later time. It may help counteract early evening sleepiness which often causes older people to nap in the evening and in turn makes it harder for them to fall asleep when they do eventually go to bed.
 
Less light in the evening
 
This applies to both digital screens and indoor lighting. Ideally you would want to avoid screens for 2-3 hours before bedtime. Most would agree that staring at a bright light source inches away from our eyes in the evening will never be natural. But it may be the hardest thing for a lot of people to give up initially, or some of us have to work late. The good news is that it may still be possible to make changes that will support rather than disrupt our circadian rhythm. However, it should be noted that all these workarounds should not be considered as full protection against harmful effects of evening light exposure on our circadian clock and sleep. In a study that looked at the effects of reading on an iPad during 4 hours before bedtime compared to reading a book, e-book readers were less sleepy at night and took longer to fall asleep but were sleepier in the morning and took longer to feel fully awake the next day. Their melatonin levels were found to be lower and peaked later. Their REM sleep amount was also significantly decreased. All this reinforces advice on reducing screen time in the evening as much as possible due to its devastating effects on sleep quality. Dr Walker recommends avoiding all screens at least in the last hour before bed.
 
So what can we do to mitigate some of the unhealthy aspects of light in the evening?
 
The night shift or mode on smartphones, tablets or computers is now a standard feature (in recognition of the importance of a normal circadian rhythm). You can take it a step further with software that desaturates the screen even more, such as f.lux or Iris.
 
Brightness is an important factor to consider. There is a way to reduce your screen brightness even below minimum, by either tweaking the Zoom feature in the Accessibility menu on iOS devices (YouTube has some good tutorials on that) or using third-party apps or software for Android or Windows.
 
A different way to approach the issue of digital screens we use in such proximity to our eyes (which is another cause for concern) is to use blue light blocking glasses. These have been shown to help avoid significant melatonin suppression by evening light exposure. There are models that block almost 100% blue light and would be ideal for any unavoidable screen time in the evening.
 
When it comes to ambient lighting in the evening, blue light blocking glasses can help too, but simply switching off half the lights and only using what is absolutely necessary to safely navigate around is a huge step towards reducing  mistimed light exposure. Using dim orange lights as opposed to bright white LED lights is a lot more conducive to a timely release of enough melatonin to support sleep. Dim lights can also help you wind down before bed and feel sleepy. Smart lighting systems that are programmed to change throughout the day to mimic sunlight in both wavelength composition and brightness is one way to go about this. Alternatively, there are special light bulbs that emit no blue light and give off yellow/orange light that are perfect for evening lighting and those that are devoid of both blue and green light (these are essentially red lights) and are great to use as night lights if you have to get up in the night. Just like with digital screens, brightness matters: while most indoor lighting is not bright enough to keep us alert and happy over the long term (we need at least 1000 lux for a minimum of 30 mins during the day), it is way too bright for the evening and affects melatonin release and peak levels, keeping us awake. For the best chance of a healthy sleep it is recommended to keep the brightness level to less than 20 lux for 2-3 hours before bed, the lower the better. Using MyLuxRecorder to check the brightness levels where you spend the last few hours of your day can be quite revealing. Dr Panda also recommends using task lighting e.g. with a table lamp instead of overhead lights as another way to reduce your evening light exposure. However, it's worth noting that a mere 8-10 lux has been shown to significantly delay melatonin release. It's about time we reclaim our “right to darkness” in the evening (and to natural daylight during the day).

Restoring a healthy circadian rhythm might take time. Some of the ideas presented here might be more difficult to implement than others but the effort will be worth it. Dr Satchin Panda has put forth the circadian theory of health placing circadian rhythm disruption at the heart of the current wide spread of chronic disease. Everyday habits we don’t think much about do affect our health and longevity. I hope you will be inspired to find out for yourself how little tweaks in the right places can lead to great changes.

References:
 
Panda S. 2018 The Cricadian Code, Lose Weight, Supercharge Your Energy and Sleep Well Every Night, Ebury Publishing, London
 
Walker M. 2017 Why We Sleep: The New Science of Sleep and Dreams, Penguin Books, London
 
Kwoon Y. Wong, Michael P. Flannery, Andrew M. Lynch, Bright H. Kim; Prolonged Light Stimulation of Intrinsically Photosensitive Retinal Ganglion Cells (ipRGCs) Reveals Novel Properties of Melanopsin Phototransduction. Invest. Ophthalmol. Vis. Sci. 2011; 52(14): 5286.  
https://iovs.arvojournals.org/article.aspx?articleid=2357898
 
Gooley JJ, Chamberlain K, Smith KA, Khalsa SB, Rajaratnam SM, Van Reen E, Zeitzer JM, Czeisler CA, Lockley SW. Exposure to room light before bedtime suppresses melatonin onset and shortens melatonin duration in humans. J Clin Endocrinol Metab. 2011; 96(3):E463–E472. 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3047226/

Chang AM, Aeschbach D, Duffy JF, Czeisler CA. Evening use of light-emitting eReaders negatively affects sleep, circadian timing, and next-morning alertness. Proc Natl Acad Sci U S A. 2015; 112(4):1232–1237.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4313820/
 
van der Lely S, Frey S,Garbazza C, Wirz-Justice A, Jenni OG, Steiner R, Wolf S, Cajochen C, Bromundt V, Schmidt C. Blue blocker glasses as a countermeasure for alerting effects of evening light-emitting diode screen exposure in male teenagers. J Adolesc Health 2015 Jan;56(1):113-9.
https://www.ncbi.nlm.nih.gov/pubmed/25287985


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Author

Aydan Hajiyeva
Hons Dip Gen Med, DO MOst
Registered Osteopath
​City Osteopaths

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Gentle Osteopathic Treatment of new born babies at City Osteopaths

9/24/2017

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Registered Osteopath Aydan Hajyeva treating a new born baby.
Over the past twenty five years in New Zealand, the awareness of osteopathic treatment for babies has increased, however we are still often asked when to seek treatment for a baby. We also often see older children who could have benefited from treatment as a baby. We are keen that all babies and children who need help, receive it in a timely fashion.

This article is to inform parents when to seek osteopathic treatment for their baby and what to look for in an osteopath.

​A baby will often communicate there is a problem by being unsettled, irritable or wakeful.
​Symptoms in a newborn baby to be aware of are:
  • colic
  • excessive wind
  • continuous crying
  • difficulty feeding or a preference to feed from one breast
  • sticky eyes
  • sleeping difficulties
  • stiffness of the neck muscles
  • favouring the head to one side 
  • a misshapen head
  • tongue tie or jaw restriction
PictureRegistered Osteopath Melanie Young treating a young baby
What education do Osteopaths have?

Osteopaths train for forty hours per week for five years full-time at university and are required to competently pass well over one hundred exams and undergo clinical competency training and exams.

Osteopaths are government regulated and registered with the Osteopathic Council of New Zealand and must partake in ongoing professional education each year. We are also ACC treatment providers.

Osteopaths who treat babies and young children ought to have done extra post graduate study in addition to their undergraduate paediatric study.
​

Why would a newborn baby have anything wrong with them that is needing help by an osteopath?
A baby's passage through the birth canal is usually a difficult process however nature ensures that the bones of the skull are pliable enough to overlap to enable this to happen. Sometimes the bones do not return to their normal positions after delivery. This can happen if the labour is unusually long or fast, if there is a large baby passing through a small pelvis, if a baby has a large head or if intervention is necessary for example a forceps delivery or ventouse extraction. A baby may suffer a cranial base, neck, shoulder or back strain during the birth process. Pre-term babies may have strain from being out of the uterus too early and there is also likely to be alterations in nervous system function.

A Caesarian birth may involve trauma to the baby who is stuck in the mother's pelvis. Alternatively, problems can occur in utero if there is insufficient amniotic fluid.

Very often your midwife or lead maternity carer will refer you and your baby to see an osteopath for assessment and treatment, particularly if the birth has been difficult. We also work with Lactation consultants to help with feeding issues. This can include jaw and cranial base problems that may be affecting the baby's ability to latch, or to treat the tongue and surrounding structures in cases where a posterior tongue tie is affecting baby's function.

How soon should my baby see an Osteopath?
If there is nothing particularly troublesome going on for your baby then we recommend two weeks after the birth is a good time to have made an appointment as that gives you time to feel settled at home and also figure out how to get out of the house and travel with a new baby.
If the birth has been difficult or your baby is very upset and won't settle, then we recommend bringing them in to see a cranial osteopath as soon as possible.
​
What does the assessment and treatment look like?
First a medical history of the mother and baby is taken relating to the pregnancy and birth and any concerns you may have. Then your baby is gently assessed from their feet up to their head. Findings and treatment process are explained and then treatment will take place with your consent.
The treatment looks calming and is very gentle for your baby. If necessary we can treat your baby while they are being breast fed or sucking on a finger to help soothe them. Osteopaths use their hands to gently help the baby undo strains in the fascia (the connective tissues of the body), to help restore better alignment and function. We are also able to assist the autonomic nervous system of the body, calming the sympathetic and boosting the parasympathetic nervous system. This is very relaxing and helps the digestion to settle and ideally the whole body to be in self healing mode. Please note cranial osteopathy is not just to do with the head, any tissue in the body can be  treated with this gentle approach. Our clients find it is surprisingly effective.

Afterwards your baby may be more hungry than usual and be a bit unsettled or sleep for longer periods as their body works with the treatment to undo strains and find better alignment and health. 
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Ideally all pregnant mums would be assessed and treated at around 35 weeks pregnant to help balance up the pelvis and ready the connective tissues of the body for birth.
Research shows 
http://jaoa.org/article.aspx?articleid=2092759) that this results in a better birth with fewer interventions. This also means post birth we can see you for a one hour 'Mother and baby' check up together.

Some research:
Meta-analysis of research shows Osteopathic treatment reduces length of stay and costs in preterm infants. March 2017 insights.ovid.com/crossref?an=00005792-201703240-00043
Osteopathic treatment of children with cerebral palsyjaoa.org/article.aspx?articleid=2093549#72971939

Research evidence for cranial bone mobility:

http://www.icnr.com/articles/radiographic-evidence-of-cranial-bone-mobility.html
​
Research on cranial rhythmic impulse and the Traube-Hering-Mayer oscillation:
http://jaoa.org/article.aspx?articleid=2092406 
Research on measuring intracranial wave form pulsatility:
http://www.ncbi.nlm.nih.gov/pubmed/9779147
Pre-term-infants(Research:http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0127370 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3648440/)
Research on treatment of colic http://​www.sciencedirect.com/science/article/pii/S1744388105001350
Research on plagiocephaly www.sciencedirect.com/science/article/pii/S174438811100020X
Research evidence on safety of Cranial Osteopathy: 
http://jaoa.org/article.aspx?articleid=2093194
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Thank you to the parents who have given us permission to use a photo of their baby.
For more information please see our website www.cityosteopaths.co.nz
For an appointment or if you have specific questions, one of our osteopaths can call you back on 04 4991439


Melanie Young 
B.A., B.App.Sc. (Clin.Sc.), B. Osteo.Sc. Reg. Osteopath, MONZ
Reg. Osteopath
Director City Osteopaths


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City Osteopaths article on osteopathic treatment before and during pregnancy - “supporting the change”

2/9/2017

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PictureOsteopaths love to help women through the process of fertility, pregnancy and birth
One of the most unique times in a woman’s life, pregnancy is quite a special state. Fortunately, many women have an easy, straightforward experience, but for those who don’t, osteopathic treatment can be very effective at easing discomfort and making this unique time enjoyable - the way it should be.

In an ideal world, every woman who is planning to become pregnant would have an osteopathic assessment and treatment in preparation for the journey ahead. This is particularly important if she has any musculoskeletal issues, be it lower back pain, neck and shoulders tension or pain, bad posture, or had a severe injury in the past (as for example, a past unresolved ankle sprain can alter walking patterns even slightly which may lead to tricky pelvic and spinal dysfunctions or restrictions that can interfere with the necessary postural adaptations in pregnancy and even labour). 
​​

PicturePain can crop up in pregnancy as your body is trying to adapt to major postural changes
​While particular attention should be directed towards the pelvis, osteopaths try to make sure the whole body is able to adapt efficiently to the incredible changes that happen on many levels during pregnancy. Some things we focus on pre-conception are improving blood flow and lymphatic circulation in the pelvis and abdomen. This is so important these days when most people spend hours sitting at their desks or in vehicles. Balancing the autonomic nervous system (which usually means reducing the effects of stress by calming the sympathetic nervous system) is another area that often needs help and can make for a very different experience once a woman becomes pregnant, for both herself and the baby.

While sorting out dysfunctions that can be dealt with pre-conception is ideal, treatment in pregnancy is very beneficial and often needed. Pregnancy is a very dynamic state where the body undergoes some profound changes in a relatively short space of time.



​​I will touch on a few of those below and mention briefly what osteopaths can do to help “support the change” or reduce discomfort if the changes are not happening as smoothly as they should:


1) Postural/mechanical changes: as the body’s centre of gravity shifts for obvious reasons, the posture changes dramatically. It is of vital importance to ensure that there are no major restrictions so the structure is able to adapt to new demands. One very important aspect is to ensure normal mobility of the sacrum so that it can move during labour thus making it easier for the baby to pass through the birth canal. But it’s not just about the pelvis. Chronic sitting in desk workers often leads to tension and sometimes constant pain in the shoulders/neck or between the shoulder blades. Not only is this uncomfortable and stressful, restrictions there would prevent a woman from achieving a deep squat with good form - which is one of the most useful exercises in pregnancy as well as a great position during labour that helps the baby descend. Having a mobile thoracic spine and ribcage also means you can breathe more efficiently getting more oxygen for yourself and the developing baby, have more energy and a clearer head! 


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Gentle Osteopathic treatment lying on the side to be most comfortable and safe.
With relaxin at play the ligaments soften and help the body adapt. Some osteopaths consider the increased secretion of relaxin a wonderful opportunity to work with old strain patterns as everything becomes so much more pliable, responsive and likely to change. However, sometimes this increased softening can contribute to strains and pains, especially in the pelvis, either at the back (sacroiliac joints) or in front (pubic symphysis). Having naturally looser joints (hypermobility) can make this more likely. In this situation gentle osteopathic techniques to balance the tension in the pelvic ligaments to allow the bones to find their natural position is very effective in most cases. Increased lower back curve (“swayback”) can lead to compression of the joints and soft tissues in the back and be quite uncomfortable but is also very amenable to osteopathic decompressive treatment.
It is important to realise that posture continues to change even after delivery - with new demands on the body such as feeding and carrying the baby, nappy changing etc. Gentle exercise such as yoga can help and osteopathic treatment (especially what we communicate to the joint position sensors) can be a useful adjunct, especially early on after giving birth when you should rest as much as possible (as a general rule, 6 weeks of no strenuous exercise after delivery).
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Feeding and carrying a baby for hours a day can be very tiring and hard work. We understand this and can help your body manage the stresses and strains.
2) In pregnancy there is a dramatic increase in the circulating blood volume. The expanding uterus may make venous drainage less efficient which can lead to congestive issues such as varicose veins in legs, vulval varicosities or haemorrhoids. Generalised fluid retention can also cause ankle swelling or carpal tunnel syndrome. Gentle rhythmic osteopathic techniques can assist drainage and reduce the discomfort of swelling.

​3) Changes in the digestive system: during pregnancy, constipation is a common issue and while the importance of a healthy diet (including adequate water intake) and regular movement such as walking, for example, cannot be underestimated, gentle manual treatment that helps balance the nerve supply to the gut can help too. With heartburn being another common problem, easing the pressure on the diaphragm and giving the internal organs more space by gently decompressing the spine, freeing up the lower ribcage and thoracic spine where the diaphragm attaches can make a significant difference.
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Osteopaths use their hands to diagnose and treat. Gently sorting out strains so your body can heal.
In summary, the aim of osteopathic treatment in pregnancy is to support and assist the expectant mother’s body in all the changes and adaptations it needs to go through to make the pregnancy and the delivery as easy as possible. It also creates the best conditions for the developing baby and the baby's passage through the birth canal - this is the ultimate preventative care!
​Our patients often describe a feeling of very deep relaxation during and after treatment, however there’s much more to it than just feeling nice. The more relaxed and well balanced you are, the more the powerful self healing “programme” inside your body is able to function optimally and that is very good for mums and their babies.
​
Some research on Osteopathic treatment in Pregnancy:
Osteopathic manipulative treatment for nonspecific low back pain: a systematic review and meta-analysis.
www.ncbi.nlm.nih.gov/pubmed/25175885 
Acute improvement in hemodynamic control after osteopathic manipulative treatment in the third trimester of pregnancy. https://www.ncbi.nlm.nih.gov/pubmed/24280470
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​Aydan Hajiyeva Honours Diploma in General Medicine, DO M.Ost. Reg. Osteopath MONZ
Aydan has an Integrated Master’s Degree course from the European School of Osteopathy (UK).
Having previously completed six years medical doctor training, she really appreciates the holistic nature of the osteopathic approach. She has been exposed to a variety of treatment approaches at university, including classical, cranial and visceral osteopathy and has undertaken post graduate education, including biodynamics of osteopathy, primitive reflexes and pregnancy care, which have helped her develop her vision of osteopathy. Aydan regards osteopathy as a philosophy allowing her to create a positive change in a patient, by facilitating the expression of the inherent wisdom of the body.
www.cityosteopaths.co.nz 
​Phone 04 4991439

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Osteopathic Testimonial Archive October 2016

10/9/2016

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Over the years we have been given wonderful testimonials by many of our patients. As of October 2016 the Osteopathic Council of New Zealand has stated that Registered Osteopaths should no longer display testimonials. In order to comply with this we have removed them from our osteopaths page. Our practice treats a wide range of unique conditions for patients which the testimonials reflect. We won't be adding any new ones but here they are for reference as they may be helpful to people in need.
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Registered Osteopaths Sebastian Tucker, Melanie Young, Chris Thompson, Aydan Hajyeva and Lara Sanders are in this photo, surrounded by our registered acupuncturists, naturopaths and massage therapists.
​All of these testimonials are from actual patients and are verifiable.
​

"I would highly recommend City Osteopaths, they are professional, efficient and yet still always make you feel like you are the most important person they are seeing that day.


I have Fibromyalgia which means there are regular issues I need to deal with on a day to day basis.  City Osteopaths have helped me combat everything from a painful jaw to a shortened hamstring to putting my upper back out – even headaches. 
I have been given the tools to be able to deal with a lot of the body issues I get myself now. I highly recommend City Osteopaths." - AW, Wellington



"My son had an accident which resulted in his front tooth being knocked forward and his top jawbone protruding through his gum. The dentist was going to cut the bone out. I went to City Osteopaths and after just one visit to Melanie, who is a cranial osteopath, the bone began to re-align into place. Within a week it was completely healed and the bone could not be seen at all. His behaviour, which had been affected badly due to headaches since the accident, also quickly came right after the treatment. I would highly recommend seeing an Osteopath to heal your ailments". - Mother of a ten year old boy, Wellington


"I have been treated by Melanie since April this year following an injury to my knee which was severely limiting what I could do. The injury also compounded problems with my back and neck. I had regular treatments with Melanie and several acupuncture sessions with Janine to add support to my healing process.This is one of the real benefits of coming to an integrated healthcare provider which practices an ethos of genuine care and support to people to do their healing. So I'm healing well and hugely grateful to be moving with increasing ease and confidence".  - Vicki


"I have had long term back and shoulder pain. This has been totally fixed by my osteopath Sebastian in the last three weeks. A great change to my life and lifestyle.  Recommend the practice (City Osteopaths) to anyone." T.Lynch


"Finally, thanks to my osteopath I am pain-free after 8 months of pain and various tests and a mis-diagnosis by my GP and specialists. I was getting desperate with not knowing what was causing my pain. The GP had pretty much given up on me as he had explored all the avenues he could think of. A friend recommended that I try her osteopath, who she described as "wonderful". I was a bit sceptical but thought I had nothing to lose and no-one else seemed to have any ideas about how I could investigate further. Within a couple of appointments I was feeling the benefit of the treatment - which was non-invasive and relaxing - and the improvement has continued with each appointment so that I am now pain-free. From talking to me the osteopath quickly identified the cause of the problem and was then able to treat it. 2010 is the year I will remember as "my year of pain" but that is now just a memory, thanks to the osteopath.
I would recommend an osteopath for any mysterious aches and pains you have which your GP cannot identify or treat successfully. It certainly worked for me".  - J McDougall

"Lara has a lovely, calm demeanour that allowed me to relax when she was working her magic on me. I had never been to an osteopath before but thought I'd give her a go after I found a GP's advice for my sore tailbone was not helpful. Lara's handy work and exercises she gave to do at home worked wonders and she has also been very effective with treating a sharp stabbing pain near my hip. Lara helped me to understand the reason for my pain, which really eased my mind". - N. Harris 


"I had constant sinus issues and headaches from the earlier stages in my pregnancy which I hadn't ever had before. I also had lower back pain. After visiting Melanie twice at five months pregnant, everything cleared up and my head, back and sinus have been fine during the pregnancy since. Would recommend this practice to anyone." - L.Snowdon


"Excellent work from City Osteopaths to resolve the ear pain and discomfort from a nasal fracture that was left to heal by itself after a visit to the doctor. I would recommend that everyone visits and osteopath for an annual checkup, these people can work wonders with things that you never knew needed healing." - A Google User


"Since being treated by Aydan for an ongoing compressed leg injury, my lifestyle has dramatically improved – subtle methods of therapy have helped me regain my ability to function at work, and even walk properly again. Whilst my treatment is still ongoing, I have regained my confidence and feel positive moving forward. I would happily recommend City Osteopaths to anyone experiencing physical difficulty, the staff give you 110% of their time and focus, dedicated to your eventual full recovery.”  - K.Wood


"I have been having seeing Sebastian for the last few months, after suffering from neck, shoulder pain and stiffness and lower back stiffness and discomfort. Most of the pain and stiffness I was experiencing has disappeared and my overall posture has improved significantly. Sebastian has also recommended targeted exercises and magnesium and vitamin B all to assist with my overall recovery".
M. Mallet


"For months I suffered lower back pain, specially when I played the piano - I couldn't work out what was wrong with my posture, but I began to think I'd have to stop playing.  When I went to Melanie with the problem,  I could hardly believe it when, with just gentle touching, she somehow magicked the pain away!  It wasn't even a question of it gradually getting better, it just went.  Extraordinary and wonderful".  - L. Cox 


As an athlete, my body needs to operate at 100%. The treatment I get from Sebastian at City Osteopaths is second to none. He gets me back into shape quicker so I perform at my best. I would highly recommend Sebastian to any prospective clients wanting to get back to their best"  April 2015 Feedback form


"I have been seeing Sebastian, and I was a little skeptical initially. However he has helped mobilise my back and pelvis to a point I have never had so much movement in my life. He has been so kind and supportive in every way possible and made me feel comfortable at all times. I have urged so many others to book in and see him". 
Sarah, Wellington



"I highly recommend City Osteopaths, I've suffered from migraines for the last 8 years and by chance was shown a video that Osteopath Chris posted about the connection between posture/neck/back tension and migraines. The knowledge and skill that Chris has is amazing and I haven't had a migraine since I've been working with City Osteopaths. Thank you!"
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