The FDA Wants to Remind You That It Has Not Approved Any Devices for ‘Vaginal Rejuvenation’

The term “vaginal rejuvenation” has been thrown around for years, but what, exactly, it’s supposed to be is a little murky given that this isn’t an actual medical procedure. At its core, vaginal rejuvenation seems to be a promise that by doing something, your vagina will be restored to its glory days…whatever that means.

Not only do procedures like that reinforce the misguided idea that there’s something wrong with your vagina that needs fixing, but they may also be marketed in sneaky ways, the Food and Drug Administration (FDA) said in a statement released Monday.

The FDA is warning patients that, despite marketing to the contrary, no medical procedures are FDA-approved for vaginal rejuvenation.

“We’ve recently become aware of a growing number of manufacturers marketing ‘vaginal rejuvenation’ devices to women and claiming these procedures will treat conditions and symptoms related to menopause, urinary incontinence, or sexual function,” FDA commissioner Scott Gottlieb, M.D., said in a statement. The FDA is specifically looking at procedures that use lasers, usually CO2 lasers, and “other energy-based devices” to “destroy or reshape vaginal tissue,” he continued. “These products have serious risks and don’t have adequate evidence to support their use for these purposes,” Gottlieb said. “We are deeply concerned women are being harmed.”

Mary Jane Minkin, M.D., a clinical professor of obstetrics and gynecology and reproductive sciences at Yale Medical School, tells SELF that she was “delighted” by the FDA’s statement. “Until we see prospective randomized trials, we really cannot say what any of these procedures are accomplishing,” she says.

“The idea that a laser is going to tighten your vagina and make you look more youthful is all nonsense and hasn’t been proven in scientific literature,” Lauren Streicher, M.D., an associate professor of clinical obstetrics and gynecology at Northwestern University Feinberg School of Medicine, tells SELF, adding that she’s “thrilled” with the statement. “You also have a lot of people like dermatologists and plastic surgeons offering ‘vaginal rejuvenation’ with these lasers who have no business doing that,” she says.

Jane G. Mazur, vice president of Global Divisional Communications at Hologic which is behind Cynosure (one of the companies called out by the FDA), tells SELF that her company is “aware” of the FDA’s statement. “As a leader in women’s health, Hologic has a strong track record of rooting our products in science and clinical evidence so we take the contents of this letter seriously,” she said. “We are evaluating the letter in full and will collaborate with the agency to ensure all product communications adhere to regulatory requirements.”

Technically, the devices themselves are FDA approved or cleared to treat certain conditions—but not for vaginal rejuvenation.

Those conditions include things like the destruction of abnormal or pre-cancerous cervical or vaginal tissue, as well as genital warts, Dr. Gottlieb pointed out. “But the safety and effectiveness of these devices hasn’t been evaluated or confirmed by the FDA for ‘vaginal rejuvenation,’” he wrote.

But that doesn’t mean providers can’t use the device in off-label ways.

There is some data that suggest that CO2 lasers are helpful for vaginal atrophy.

Vulvovaginal atrophy is a medical condition that causes vaginal dryness, irritation, soreness, and pain during sex, the Mayo Clinic explains. It usually occurs after a woman goes through menopause.

Although CO2 lasers aren’t FDA approved or cleared for treating vulvovaginal atrophy, Dr. Streicher points to the existing research as evidence that there may be some benefit for women who are struggling with the condition.

For instance, in a 12-week pilot study published in 2014, 50 postmenopausal women had their vulvovaginal atrophy symptoms measured before and after laser treatment, which consisted of three sessions. All of the women included had been dissatisfied with other treatment options, and 84 percent of them reported that they were satisfied with the laser treatment. However, this is a small study and did not include a control group.

Another study, also published in 2014 from the same group of researchers, looked specifically at sexual function following laser treatment in 77 postmenopausal women with vulvovaginal atrophy (the condition can cause painful sex). Using a similar 12-week treatment program, the researchers found that, of the 20 women in the study who initially reported avoiding sex due to the condition, 17 of them (85 percent) reported regaining a normal sex life after treatment. A 2016 study looking specifically at postmenopausal women who had also survived breast cancer found similar results.

Both a review of the safety of the procedure and the effectiveness of the procedure for this use conclude that there is promising evidence out there for it, but that evidence mainly comes from small prospective studies and needs to be reproduced on a larger scale.

“I applaud that the FDA talked about ‘vaginal rejuvenation’ and appropriate marketing, but I’m disappointed that they lumped that in the same category as experts who are treating vulvovaginal atrophy with the CO2 laser,” she says. “It has been a game-changer for many women.”

The American College of Obstetricians and Gynecologists (ACOG) does acknowledge the potential for using the devices in this way, but notes that the research supporting that use is “preliminary” and that “additional data clearly are needed to further assess the efficacy and safety of this procedure in treating vulvovaginal atrophy, particularly for long-term benefit.”

But Dr. Streicher likens using CO2 lasers for vulvovaginal atrophy to using hormonal birth control pills to try to help treat menstrual cramps. Technically it’s not FDA-approved for that use, but because there is some research, doctors may decide that this use is appropriate. She also offers information about this treatment on her website. Dr. Minkin agrees that there’s promise in using the devices in this way, but she adds that you need to do the treatments once a month for three months (as in the 12-week studies), which can be costly.

Even if there’s research to suggest that CO2 lasers can help with vulvovaginal atrophy, the FDA’s statement is aimed at all devices and procedures that promise “vaginal rejuvenation,” not just those treating menopause-related vulvovaginal changes.

And it’s important to keep in mind that procedures involving these devices may come with real health risks.

The FDA has received reports of some serious side effects associated with vaginal rejuvenating procedures, including “vaginal burns, scarring, pain during sexual intercourse, and recurring or chronic pain,” according to Dr. Gottlieb’s statement. But because the devices haven’t undergone a full review for this specific use, the FDA doesn’t have a complete understanding of the potential risks and can’t evaluate whether or not they outweigh the possible benefits. So, whether or not the procedure is worth the financial costs and potential health risks associated with it is currently up to you and your doctor.

If you feel like your vagina has changed and it bothers you, there are a few other options.

If tightness and incontinence is your concern, the first line of defense is typically Kegels, Dr. Minkin says. This is a non-invasive exercise you can do pretty much anywhere (though it’s best if you have a gynecologist or pelvic floor physical therapist explain how to do them properly) in which you tighten and release your pelvic floor muscles. Or, if you’re experiencing postmenopausal vaginal dryness, she recommends trying OTC vaginal moisturizers like Replens or Revaree. If that doesn’t do the trick, talk to your doctor about using a vaginal product with estrogen or prasterone, or an oral medication like ospemifene, which is designed to help treat pain during intercourse, she says.

Above all, talk to your doctor—and we mean your ob/gyn, not a plastic surgeon or dermatologist. This is what they do, and they should be able to help steer you toward a treatment that’s right for you.


The Weird Dream Symptom That Made Alan Alda Suspect He Had Parkinson’s Disease

Actor Alan Alda has revealed that he was diagnosed with Parkinson’s disease over three years ago. In an interview on CBS This Morning on Tuesday, Alda said he decided to speak publicly about his diagnosis because his thumb was twitching in recent TV interviews and he thought people would be curious.

But before his official diagnosis, it was a much weirder symptom that tipped him off.

Alda explained that he had been acting out his dreams during sleep.

“I was having a dream that someone was attacking me and I threw a sack of potatoes at him, but what I was really doing was throwing a pillow at my wife,” Alda, 82, said, noting that he didn’t have any other symptoms at the time. It wasn’t until months later that he noticed his thumb twitching.

So, Alda asked for a brain scan and was eventually diagnosed with the disease. Although there isn’t a specific test that can be used to definitively diagnose Parkinson’s, doctors may use brain scans, blood tests, and other exams to rule out other options.

Parkinson’s disease is a progressive disorder that affects the nerves and, consequently, movement, the Mayo Clinic explains. Although symptoms may start mildly, they become more severe over time and may include tremors as well as muscle stiffness, slowed movement, impaired balance, and changes in speech and/or writing. The exact cause of the disorder is unknown, but age, genes, and environmental factors may play a role.

Parkinson’s often comes with sleep disturbances, and acting out dreams can be an early warning sign.

Your sleep habits will change naturally as you age, but people with Parkinson’s tend to have more sleep issues than people without Parkinson’s of the same age, the UCSF Parkinson’s Disease Clinic and Research Center explains. Those disturbances may include insomnia, sleep apnea, and vivid dreams.

But if someone is acting out their dreams along with movements or vocalization during sleep, that’s a sign of an REM behavior disorder, a sleep disorder that occurs specifically during the dream-heavy REM stage. Those movements might include kicking, flailing your arms, or punching as if you’re defending yourself during a violet dream (as Alda described), and may be accompanied by laughing, talking, or shouting. These episodes may also gradually get worse.

People don’t normally move during REM-stage sleep thanks to the nervous system process that causes paralysis while you’re dreaming, according to the Mayo Clinic. So, if you are moving during that stage, that suggests there may be an issue affecting that process—possibly a neurological disorder like Parkinson’s.

If you’re experiencing any of these symptoms or symptoms of any other sleep disorder, it’s worth talking to your doctor.

But Alda, who shared that he takes boxing lessons three times a week, said that an early diagnosis of Parkinson’s doesn’t mean your life will immediately change monumentally. “In the beginning, to be immobilized by fear and think the worst thing has happened to you—it hasn’t happened to you,” he said. “You still have things you can do.”


Father’s genes can impact motherly love

A father’s genes are no longer thought to just provide a blueprint for the growth and development of their offspring. Research publishing 31 July in the open access journal PLOS Biology by scientists led by Professors Rosalind John and Anthony Isles from Cardiff University’s School of Biosciences finds that paternal genes can affect the type of care the offspring receives both before and after they are born.

The research team has been investigating the hormonal signals given off from the placenta during pregnancy. The placenta transports nutrients to the growing fetus during pregnancy and gives off hormonal signals in the mother’s bloodstream to establish and maintain a successful pregnancy. As well as being involved in nurturing the baby throughout the pregnancy, the placental signals are thought to be important for programming a mother’s behavior, preparing them for their new role as a parent.

These hormones are produced by placental cells called spongiotrophoblasts, whose proliferation (and therefore whose hormone output) is held in check by a gene called Phlda2. But here’s the twist; like most genes, the developing fetus has two copies of the Phlda2 gene, but unlike most genes, only one copy of Phlda2 is active. This is due to an evolutionarily intriguing phenomenon called genomic imprinting, whereby only the gene copy from one parent is switched on. In the case of Phlda2 it’s the father’s copy that’s silent.

Using genetically altered mice, the researchers asked what happened if both copies of the fetus’ Phlda2 gene were active (a “maternalized” condition) or if both were silent (a “paternalized” condition). They found that mothers exposed to pups with the highest Phlda2 activity (and therefore presumably reduced placental hormones) nursed and groomed their pups less and instead focused on nest building. Conversely, “paternalized” mothers, exposed to the lowest Phlda2 dose (and therefore higher hormone levels), spent more time nurturing their pups, and less on housekeeping tasks. The authors also showed corresponding changes in two regions of the mother’s brain — the hypothalamus and hippocampus.

Why is this important? Parenthood can be seen as a conflict between the interests of the two parents, with the father (and his genes) favoring maximum investment in the offspring, potentially at the expense of the mother’s best interests. The results of this study suggest that the father, by causing his Phlda2 gene to be silent in the fetus, can even affect the nurturing behavior of the mother after his offspring have been born.

The authors speculate that this may have relevance to humans, as levels of Phlda2 gene activity vary between human pregnancies and inversely correlate with placental hormones. Changes in the mother’s priorities during gestation and after birth are critically important for the wellbeing of the new baby and their lifelong mental health.

“Our previous work has reported that a similar placental gene is linked to prenatal depression, and we are currently asking whether similar gene changes are associated with poor quality maternal care in the Grown in Wales Study” said Professor John, lead author of the study. “More work must be done to further our understanding in how this works in humans.”

Adapted by PLOS Biology from release provided by Cardiff University.

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The tipping point: Service sector employees are more susceptible to mental health issues

Approximately 102 million Americans work in the service industry, according to the Pew Research Center, filling critical positions in restaurants, salons and transportation. In many cases, these jobs offer base pay at rates up to 71 percent lower than federal minimum wage, with the expectation that tips, which are highly unpredictable, will make up the difference.

However, service workers who rely on tips are at greater risk for depression, sleep problems and stress compared with employees who work in non-tipped positions, according to a study published today in the American Journal of Epidemiology. The analysis is based on data from a nationwide health study that followed thousands of participants from adolescence into adulthood.

“The higher prevalence of mental health problems may be linked to the precarious nature of service work, including lower and unpredictable wages, insufficient benefits, and a lack of control over work hours and assigned shifts,” said lead author Sarah Andrea, M.P.H., a Ph.D. candidate in epidemiology at the OHSU-PSU School of Public Health. “On average, tipped workers are nearly twice as likely to live in poverty relative to untipped workers.”

Both tipped and untipped workers in service occupations also are expected to control certain emotions, including anger or disagreement, as well as manage instances of sexualized or hostile behavior during interactions with customers. According to Andrea, these factors may further increase the risk of stress and mental health problems across the service industry, with the greatest impact to women, who comprise 56 percent of all service workers and 67 percent of all tipped workers.

“While the idea that ‘the customer is always right’ may be a valid business plan, our study results indicate that mentality may negatively impact employee health, especially in women,” said study co-author Janne Boone-Heinonen, Ph.D., M.P.H., an associate professor of epidemiology in the OHSU-PSU School of Public Health.

The research team suggests that additional research be conducted to better understand the factors that contributed to differences in mental health impact amongst this segment of workers.

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Wild Rice and Veggies With Parmesan

Wild Rice and Veggies With Parmesan

Andrew Purcell, Carrie Purcell

Makes 2 Servings

  • 1tablespoon olive oil, divided
  • 2 large eggs, beaten
  • 1 small bulb fennel, cored and chopped
  • 2cups baby spinach, packed
  • 3cups cooked wild rice
  • 1cup cherry tomatoes, halved
  • 2tablespoons fresh basil, chopped
  1. In a large skillet over medium heat, heat 1/2 tablespoon olive oil. When oil is hot, add eggs and cook, moving eggs around skillet constantly, until eggs are cooked and fluffy, about 30 seconds. Transfer eggs to a plate and set aside.

  2. Return skillet to medium heat and add remaining 1/2 tablespoon olive oil. Add fennel and cook until soft and starting to brown, about 3 minutes. Add spinach and stir to wilt. Add rice, tomato, and cooked egg. Cook, stirring, until rice is heated through and everything is thoroughly mixed. Remove from heat and stir in basil and Parmesan.

Nutrition Per Serving

425 calories
14 g fat (3 g saturated)
61 g carbs
11 g sugar
9 g fiber
20 g protein

Why You Should Do Butt Exercises Before Your Next Run

Before heading out on your next run, ask yourself one question: “How’s my butt?”

The answer matters. “The gluteal [butt] muscles are the strongest and most powerful muscles in the entire body,” Ashley Fluger, C.S.C.S., an exercise physiologist at the Hospital for Special Surgery in New York City, tells SELF. “The gluteal muscles include the gluteus maximus, gluteus medius, and gluteus minimus, and [they all work together to] help stabilize your pelvis and keep your hips and knees aligned.” Those jobs become even more important when you’re running.

“The gluteals are responsible for maintaining neutral pelvic alignment, especially during single-leg stance, and absorbing and transmitting forces from the impact of landing and pushing off with each stride,” David Reavy, P.T., a board-certified clinical specialist in orthopedic physical therapy and founder of React Physical Therapy in Chicago, tells SELF.

There are three main muscles in your butt, and all play a role in supporting your hips as you run.

The gluteus maximus is the largest of the three and primarily works to extend the hips. It’s that extension that drives the foot into the ground and powers your running strides, Reavy says. Meanwhile, the medius and minimus, which form the side butt, are tasked with stabilizing the hips as they extend, although they do play a small part in extension. The medius and minimus work together to perform hip abduction (moving the leg away from the center of the body) as well as external rotation (think: man-spreading), Fluger explains. Together, these two movements keep the femur, or thigh bone, situated in the pelvis at the right angle for the gluteus maximus to do its thing.

So, how’s your butt? Chances are, it’s too busy snoozing to answer.

If you spend the majority of your day sitting, your glutes are largely inactive, Kimbre V. Zahn, M.D., a sports medicine physician with Indiana University Health, tells SELF. Think about it: You have no need to contract them when you’re just sitting there not moving.

Sitting also puts your hip flexors in a shortened, tight position. This causes the glutes, an opposing muscle group (meaning they’re on the opposite side of the hip joint), to become lengthened. Over time, this lengthening (and lack of contraction) can mess with the way the muscles activate. Basically, the glutes become desensitized and ultimately unable to recruit as many muscle fibers and generate enough force when you do try to engage them.

It’s likely that when you lace up your sneakers and take off running, these crucial muscles won’t automatically switch back on, full speed ahead.

This is especially true for the gluteus mediuses and minimuses, which tend to be underdeveloped in most runners anyway. (It’s common for your big and powerful gluteus maximus to take over in traditional butt exercises, resulting in less training for the smaller muscles.) And, since your body relies on them the most during lateral, side-to-side movements, running straight forward won’t always be enough of a stimulus to rouse them from their slumber.

And this lack of activation can cause issues throughout your entire body. “When the glutes are not firing properly, your body does a good job of compensating, which translates to other muscle groups being forced to worker harder than intended,” Reavy says. “This can subsequently lead to poor alignment in the pelvis. Lack of gluteal activation causes muscle imbalances and can lead to excessive forces at the back, knee, foot, and ankle.” All of this can lead to a typical overuse injury like knee pain, achilles tendinitis, IT band syndrome, and more.

The best way to wake up your glutes is with what trainers call “activation” exercises.

Performed as part of a pre-run warm-up, activation exercises are low-intensity movements that accomplish a few things. First, they gently work a given muscle, in this case, the gluteus medius, increasing blood flow, temperature, and priming the neurological pathways by which motor neurons (muscles’ control centers) tell their attached muscle fibers to stop resting and start doing their job. (But they do it gently enough that they don’t actually fatigue the muscle.) They do all this while largely isolating the muscle, or at least greatly reducing how much other muscles are able to chip in, Fluger says.

In the end, the idea is that after performing glute activation exercises, you’re able to start your run with glutes that actually fire like they need to for optimal performance and injury prevention.

Try these four exercises before your next run to activate your glutes.

The below is a sampling of various glute activation exercises that you can incorporate into your pre-run routine, but the exact ones you use—as well as the number of reps and sets you perform—ultimately depends on what feels right for your body, Reavy says. The goal with these is to feel your glutes working (you can even poke them with your finger to tell!), but without exhausting them.

And while these exercises are a great way to wake up your backside before a run, “I’d emphasize that the runner should be performing these exercises consistently,” Zhan says. Work up to performing them daily, using them to break up long sitting stretches.

Tilapia Sandwich With Tomatoes and Basil-Parmesan Vinaigrette

Tilapia Sandwich With Tomatoes and Basil-Parmesan Vinaigrette

Andrew Purcell, Carrie Purcell

Makes 2 Servings

  • 1/4cup fresh basil, finely chopped
  • 1ounce Parmesan, finely chopped
  • Pinch of lemon zest
  • Juice of ½ lemon
  • 1 1/2tablespoons olive oil, divided
  • Salt
  • Pepper
  • 1 12-inch whole wheat baguette
  • 8ounces tilapia, skin removed, cut in rough 1-inch pieces
  • 1cup cherry tomatoes, chopped
  1. In a small bowl, stir together basil, Parmesan, lemon zest, lemon juice, and 1 tablespoon olive oil. Season with salt and pepper. Set aside. Mixture will be chunky and thick.

  2. Cut baguette into 2 6-inch pieces, then cut each piece in half lengthwise. Toast or broil baguettes to lightly crisp (optional).

  3. In a large skillet over medium-high heat, heat remaining ½ tablespoon olive oil. Season tilapia with salt and pepper on all sides. When oil is hot, carefully add pieces of fish to skillet and cook, without touching, until undersides are golden brown, about 2 minutes. Flip and cook 1 minute more, until fish is cooked through. Remove from skillet and set aside on a plate lined with paper towels.

  4. For each sandwich, lay cherry tomatoes over one piece of bread and smash slightly with a fork. Top with fish and spoon some of the basil-Parmesan pesto on top. Spread second piece of bread with more vinaigrette, then sandwich the two together.

Nutrition Per Serving

517 calories
23 g fat (6 g saturated)
56 g carbs
21 g sugar
4 g fiber
34 g protein

Our Idea of Healthy Eating Excludes Other Cultures, and That’s a Problem

Google the term “examples of healthy recipes” and you’ll notice there’s very little variety in what healthy eating looks like, and that the definition of “healthy” is pretty narrow. To be more specific, you’ll see recipes and meals that are considered mainstream for white, non-immigrant Americans. When healthy eating is presented through a Eurocentric lens the implication is that other cultures’ foods are not as healthy.

What you see online reflects popular attitudes about healthy eating—lots of kale, green smoothies, and quinoa. These popular ideas are often what dietitians are trained to see as healthy, too. When I was in college studying to become a registered dietitian I was taught that the MyPlate way of eating—filling half your plate with fruits and vegetables like broccoli and berries and the other half with an even split of protein like chicken and grains like rice or quinoa—was the gold standard of healthy eating. The extent of our education in cultural competency was extremely limited. If a patient was Mexican, we should teach them to sub out the potatoes on the MyPlate with a tortilla. If a patient was Asian, swap a serving of pasta for a serving of rice.

This way of nutrition counseling just didn’t feel right to me. My father is from Trinidad, and I grew up eating lots of Trinidadian food. I never saw any of the Trini foods my family ate in my textbooks.

And the way my family eats is plenty healthy even if our meals don’t look like what you see at We love to eat roti, which is a delicious, satisfying dish made with unleavened bread wrapped around a curry filling. And the way my family prepares it, it’s full of spices like turmeric, ginger and cumin, and filled with nutritious ingredients like potatoes, coconut milk, and, in some roti variations, chickpeas. I soon started to realize that our traditional dietetics education was not inclusive of other cultures. This also meant that we R.D.s were not being trained to use diverse examples of healthy eating when we counseled patients or wrote educational materials. We were often being taught to perpetuate idea that Eurocentric eating patterns were the only paths to healthy eating, that healthy eating means one thing and one thing only.

But teaching someone healthier eating isn’t about making swaps here and there to fit a patient’s culture into a Eurocentric diet. It should be about having a deep understanding of the way your patients eat, both on a daily basis and at special occasions, how they cook, their practices around preparing and serving food, and any other details about their diets, and counseling them to reach whatever their goals are with all those things in mind, and incorporated into the advice you give them.

Why? Because food is so much more than just energy for our bodies.

Food represents our heritage and our ancestry. It reminds us of our family and friends and our childhoods, weddings, or special events, like Carnival celebrations in Trinidad (and so many other countries). For so many people who move to a different country (or even to a different part of the same country), food is a part—and sometimes the only part—of home that they can still enjoy every day. Even though I didn’t immigrate to the U.S. from Trinidad, eating foods like roti make me feel just like I’m back in my childhood home, with my family.

When I counseled patients who had immigrated to the U.S., they would look at me, crestfallen, and say “I know I need to stop cooking and eating the way we do back home.” After a while, I realized because they never saw the foods that they were used to being represented as healthy eating, they took that to mean those foods weren’t healthy. It was like they had to choose between their heritage and their health. No person should ever have to make that decision. As dietitians we must make the effort to research the foods of our patient populations, and tailor our counseling and assessment methods to include those meals. It’s no different than working with a patient who has peanut allergies or is lactose intolerant. It’s simply part of our role as their healthcare provider.

Also, excluding other cultures when we talk about healthy eating perpetuates the idea of “good” and “bad” foods.

Besides the fact that placing foods on a good-bad binary is counterproductive and perpetuates toxic ways of thinking about food, this good/bad thinking also gives non-Eurocentric foods a bad rap. I’ve heard many American patients say they eat Mexican food when they are being “bad.” But what they really mean is that when they eat the Americanized version of Mexican food. Mexican food is not all tortilla chips, queso, and margaritas! There’s certainly nothing wrong with those chips and queso, it’s just that they don’t represent the variety in Mexican cuisine. In fact, I can’t think of a culture whose dietary customs don’t include all the things we think of as staples of a nutritious diet—fruit, vegetables, whole grains, and heart-healthy fats—along with other foods that might be less nutritious but are absolutely delicious. In other words, if our only exposure to the way another culture eats is American restaurants serving that cuisine, we’re judging the healthfulness of a culture’s food based on an Americanized interpretation, which is quite limited, and often excludes, at the very least, a culture’s plant-based eating pattern. Not only does this preserve the idea that Eurocentric culture is superior to others, but it’s yet another win for the good-versus-bad mindset that reinforces the worst parts of diet culture.

For us to truly help the communities we work with, health professionals need to embrace diversity, and expand the idea of what healthy eating looks like. We need to take the time to learn about other cultures’ foods. That goes beyond just visiting our local Korean barbecue joint in a gentrified neighborhood. If you live in an area with a large immigrant population, go visit the grocery stores and food markets in those neighborhoods. Learn what ingredients people cook with and talk to people who live in the area about how they prepare their meals. Eat at that little hole-in-the-wall place that is everyone’s neighborhood favorite. Or just start by making your next Netflix binge the late Anthony Bourdain’s series “Parts Unknown.” We R.D.s and other healthcare professionals need to be the leaders in challenging the status quo of what healthy eating looks like.

Tamara Melton is a registered dietitian and co-founder of Diversify Dietetics, a nonprofit organization dedicated to increasing racial and ethnic diversity in the nutrition and dietetics profession. You can follow her on Instagram here: @tamarameltonrdn.

Soccer heading may be riskier for female players

Researchers have found that women who play soccer may be more at risk than their male counterparts. According to a new study published in the journal Radiology, female soccer players exhibit more extensive changes to brain tissue after repetitive ‘heading’ of the soccer ball.

Soccer is the most popular competitive sport in the world, and female participation in the sport is on the rise. The Fédération Internationale de Football Association (FIFA) 2014 Women’s Football Survey reported more than 30 million female soccer players worldwide.

Heading, in which players field the soccer ball with their heads, is a key component of the game. Heading-related impacts have been associated with abnormalities in the brain’s white matter that are similar to those seen in patients with traumatic brain injury. Cumulative heading over a one-year period has been associated with cognitive dysfunction and microstructural changes to the brain’s white matter.

Long-term consequences of repeated exposure to heading is an area of concern because repetitive head injury in athletes has been associated with cognitive decline and behavioral changes.

“In general, men do a lot more heading than women, but we wanted to specifically examine if men and women fare similarly or differently with a similar amount of exposure to repeated impacts to the head,” said the study’s lead author, Michael L. Lipton, M.D., Ph.D., professor of radiology at the Gruss Magnetic Resonance Research Center at the Albert Einstein College of Medicine and medical director of MRI at Montefiore Medical Center in New York City.

Dr. Lipton and colleagues used diffusion tensor imaging (DTI), an advanced MRI technique, to assess microscopic changes in the brain’s white matter in 98 amateur soccer players — 49 men and 49 women — with an average age of 25.8 years. All participants had many years of soccer and heading exposure, including 12 months of frequent heading exposure leading up to the study (median headers: 487 per year for the men and 469 per year for the women). Participants had no significant differences in demographic factors.

DTI produces a measurement, called fractional anisotropy (FA), which characterizes the movement of water molecules in the brain. In healthy white matter, the direction of water movement is fairly uniform and measures high in FA. When water movement is more random, FA values decrease.

“A decline in FA is an indicator of changes in the white matter microstructure that may be indicative of inflammation or loss of neurons, for example,” Dr. Lipton said.

For the study, the researchers compared white matter FA values among the male and female soccer players. The analysis revealed that while both men and women experienced lower FA values related to more repetitive heading, women exhibited lower FA levels across a much larger volume of brain tissue.

“In both groups, this effect we see in the brain’s white matter increased with greater amounts of heading,” Dr. Lipton said. “But women exhibit about five times as much microstructural abnormality as men when they have similar amounts of heading exposure.”

Researchers were also able to identify specific regions of the brain where frequent heading was associated with lower FA: three brain regions in men and eight brain regions in women.

“The important message from these findings is that there are individuals who are going to be more sensitive to heading than others,” Dr. Lipton said. “Our study provides preliminary support that women are more sensitive to these types of head impacts at the level of brain tissue microstructure.”

Dr. Lipton cautions that more investigation is warranted to confirm and further characterize gender differences in vulnerability to brain injury due to heading.

“We don’t have enough information yet to establish guidelines to protect the players,” Dr. Lipton said. “But by understanding these relationships — how different people have different levels of sensitivity to heading — we can get to the point of determining the need for gender-specific recommendations for safer soccer play.”

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Past experiences shape what we see more than what we are looking at now

A rope coiled on dusty trail may trigger a frightened jump by hiker who recently stepped on a snake. Now a new study better explains how a one-time visual experience can shape perceptions afterward.

Led by neuroscientists from NYU School of Medicine and published online July 31 in eLife, the study argues that humans recognize what they are looking at by combining current sensory stimuli with comparisons to images stored in memory.

“Our findings provide important new details about how experience alters the content-specific activity in brain regions not previously linked to the representation of images by nerve cell networks,” says senior study author Biyu He, PhD, assistant professor in the departments of Neurology, Radiology, and Neuroscience and Physiology.

“The work also supports the theory that what we recognize is influenced more by past experiences than by newly arriving sensory input from the eyes,” says He, part of the Neuroscience Institute at NYU Langone Health.

She says this idea becomes more important as evidence mounts that hallucinations suffered by patients with post-traumatic stress disorder or schizophrenia occur when stored representations of past images overwhelm what they are looking at presently.

Glimpse of a Tiger

A key question in neurology is about how the brain perceives, for instance, that a tiger is nearby based on a glimpse of orange amid the jungle leaves. If the brains of our ancestors matched this incomplete picture with previous danger, they would be more likely to hide, survive and have descendants. Thus, the modern brain finishes perception puzzles without all the pieces.

Most past vision research, however, has been based on experiments wherein clear images were shown to subjects in perfect lighting, says He. The current study instead analyzed visual perception as subjects looked at black-and-white images degraded until they were difficult to recognize. Nineteen subjects were shown 33 such obscured “Mooney images” — 17 of animals and 16 humanmade objects — in a particular order. They viewed each obscured image six times, then a corresponding clear version once to achieve recognition, and then blurred images again six times after. Following the presentation of each blurred image, subjects were asked if they could name the object shown.

As the subjects sought to recognize images, the researchers “took pictures” of their brains every two seconds using functional magnetic resonance images (fMRI). The technology lights up with increased blood flow, which is known to happen as brain cells are turned on during a specific task. The team’s 7 Tesla scanner offered a more than three-fold improvement in resolution over past studies using standard 3 Tesla scanners, for extremely precise fMRI-based measurement of vision-related nerve circuit activity patterns.

After seeing the clear version of each image, the study subjects were more than twice as likely to recognize what they were looking at when again shown the obscured version as they were of recognizing it before seeing the clear version. They had been “forced” to use a stored representation of clear images, called priors, to better recognize related, blurred versions, says He.

The authors then used mathematical tricks to create a 2D map that measured, not nerve cell activity in each tiny section of the brain as it perceived images, but instead of how similar nerve network activity patterns were in different brain regions. Nerve cell networks in the brain that represented images more similarly landed closer to each other on the map.

This approach revealed the existence of a stable system of brain organization that processed each image in the same steps, and regardless of whether clear or blurry, the authors say. Early, simpler brain circuits in the visual cortex that determine edge, shape, and color clustered on one end of the map, and more complex, “higher-order” circuits known to mix past and present information to plan actions at the opposite end.

These higher-order circuits included two brain networks, the default-mode network (DMN) and frontoparietal network (FPN), both linked by past studies to executing complex tasks such as planning actions, but not to visual, perceptual processing. Rather than remaining stable in the face of all images, the similarity patterns in these two networks shifted as brains went from processing unrecognized blurry images to effortlessly recognizing the same images after seeing a clear version. After previously seeing a clear version (disambiguation), neural activity patterns corresponding to each blurred image in the two networks became more distinct from the others, and more like the clear version in each case.

Strikingly, the clear image-induced shift of neural representation towards perceptual prior was much more pronounced in brain regions with higher, more complex functions than in the early, simple visual processing networks. This further suggests that more of the information shaping current perceptions comes from what people have experienced before.