Depending on where you live, you may have recently entered Daylight Savings Time, a time to “fall back” one hour. In the weeks leading up to this change, you might have noticed yourself staying up later or lingering in bed longer on dark mornings. Without conscious effort, your circadian rhythm gradually adjusted to the seasonal shift.

Recent research highlights that light profoundly influences human health, affecting metabolism, sleep, mood, and cellular function. Exposure to natural sunlight helps regulate circadian rhythms, initiates vitamin D synthesis, impacts mental health, enhances energy levels and cognitive performance, and influences appetite and metabolism.

Light and Circadian Rhythms
In 2017, the Nobel Prize was awarded to Jeffrey C. Hall, Michael Rosbash, and Michael W. Young for their discoveries of molecular mechanisms that control circadian rhythms. Circadian rhythms are driven by an internal biological clock that anticipates day/night cycles to optimize physiology and behavior (Nobelforsamlingen, 2017). Each mitochondrion, present in every cell, contains molecular timekeeping machinery that strongly influences body rhythms.

Research now shows that light stimulates these tiny clocks, programming circadian rhythm and activating mitochondria (Jiang et al., 2025; Trajano et al., 2025; Mezhnina et al., 2022). Because light directly nourishes mitochondria, the body’s powerhouses and timekeepers, it can be considered an essential nutrient.

By analogy, plants require light to thrive. While human physiology differs, light similarly drives cellular and molecular pathways. Insufficient natural light can impair mitochondrial function, affecting sleep, energy production, reproduction, and brain function (Trajano et al., 2025; Singh et al., 2025; Song et al., 2022).

Recent Research Linking Light to Health
Recent research highlights that light profoundly influences human health, affecting metabolism, sleep, mood, and cellular function. Exposure to natural sunlight initiates vitamin D synthesis, which is essential for bone health, immune regulation, and calcium absorption. Inadequate vitamin D production due to insufficient sunlight exposure can lead to conditions such as rickets and osteoporosis (Uçar & Holick, 2025).

In addition, light exposure has a significant impact on mental health. Sunlight increases serotonin levels, which improve mood and emotional well-being. A lack of light exposure, particularly in winter months, is associated with Seasonal Affective Disorder (SAD) and other depressive symptoms (Sanes et al, 2022).

Research also connects light to energy levels and cognitive performance. Exposure to bright, natural light during the morning and midday enhances concentration and productivity throughout the day (Islay et al., 2024).

Finally, studies show that light influences appetite regulation and metabolism. The timing and intensity of light exposure can affect glucose metabolism, insulin sensitivity, and energy expenditure, linking disrupted light patterns to obesity and metabolic disorders (Ishihara et al., 2024).

Taken together, these findings support the concept that light functions as a vital nutrient, nourishing both body and mind through its wide-ranging physiological effects.

Light exposure is as essential as nutrition – and perhaps looking at it from this perspective, we can learn ways to optimize our light diets.

Light in Modern Life
Our modern lifestyles can create imbalances in both nutrition and light exposure. While we carefully monitor food intake, we rarely consider how artificial lighting (LEDs, screens, and indoor lighting) affects our health. Excessive artificial blue light can disrupt circadian rhythms, mitochondrial function, and cellular health, in a manner comparable to processed foods that damage DNA (McNish et al., 2025; Trajano et al., 2025; Singh et al., 2025).

Morning sunlight acts as a “timestamp” for the circadian rhythm, regulating sleep and other physiological processes. Conversely, blue light exposure in the evening can suppress melatonin, affecting sleep quality (Ishizawa et al., 2021). Intentional daytime light exposure helps maintain natural rhythms, recharge mitochondria, and support overall health.

Practical Tips
Ask yourself: have you had your daily dose of natural light today? Morning exposure is ideal. Even a few minutes outside or near a bright window can help meet daily light requirements. If screen time is unavoidable in the evening, using blue-blocking glasses may reduce disruption to your sleep cycle (Ishizawa et al., 2021).

The Course
In Nutrition Perspectives in Pelvic Rehab, we go beyond nutrition basics. We delve into a systems approach to nourishment and introduce factors beyond foods that nourish our body, mind, and soul. We learn about our interconnected nature. And we are reminded that we are not nourished by food alone. Life requires light and is as essential as other nutrients for our health and well-being.

Please join us as we explore the many intriguing connections between nourishment, our cells, our systems, and our health and how we can better serve our pelvic health clients from this standpoint.

Nutrition Perspectives will be offered December 6-7, 2025, and quarterly in 2026.

References:

1. Cohen T, Medini H, Mordechai C, Eran A, Mishmar D. Human mitochondrial RNA modifications associate with tissue-specific changes in gene expression, and are affected by sunlight and UV exposure. Eur J Hum Genet. 2022 Dec;30(12):1363-1372. doi: 10.1038/s41431-022-01072-3. Epub 2022 Mar 4. PMID: 35246665; PMCID: PMC9712611.
2. Ishizawa M, Uchiumi T, Takahata M, Yamaki M, Sato T. Effects of pre-bedtime blue-light exposure on ratio of deep sleep in healthy young men. Sleep Med. 2021 Aug; 84:303-307. doi: 10.1016/j.sleep.2021.05.046. Epub 2021 Jun 8. PMID: 34217920.
3. Jiang Z, Wu S, Zhou S, Zheng H, Bai Y, Zhang Y, Yao M. Photobiomodulation mediates endoplasmic reticulum-mitochondria contact and ameliorates lipotoxicity in MASLD via Mfn2 upregulation. J Photochem Photobiol B. 2025 Sep; 270:113209. doi: 10.1016/j.jphotobiol.2025.113209. Epub 2025 Jul 2. PMID: 40633245.
4. McNish H, Mathapathi MS, Figlak K, Damodaran A, Birch-Machin MA. The Effect of Blue Light on Mitochondria in Human Dermal Fibroblasts and the Potential Aging Implications. FASEB J. 2025 Jun 15;39(11):e70675. doi: 10.1096/fj.202500746R. PMID: 40421626; PMCID: PMC12107506.
5. Mezhnina V, Ebeigbe OP, Poe A, Kondratov RV. Circadian Control of Mitochondria in Reactive Oxygen Species Homeostasis. Antioxid Redox Signal. 2022 Oct;37(10-12):647-663. doi: 10.1089/ars.2021.0274. Epub 2022 Feb 18. PMID: 35072523; PMCID: PMC9587791.
6. Nobelforsamlingen. Scientific Background Discoveries of Molecular Mechanisms Controlling the Circadian Rhythm. https://www.nobelprize.org/prizes/medicine/2017/advanced-information/  Accessed November 2, 2025.
7. Singh J, Kumar D, Kaur J, Singh A. The rhythm of decline: Circadian disruption in neurodegeneration. J Food Drug Anal. 2025 Sep 18;33(3):224-240. doi: 10.38212/2224-6614.3553. PMID: 41066745; PMCID: PMC12510711.
8. Song Y, Yang J, Law AD, Hendrix DA, Kretzschmar D, Robinson M, Giebultowicz JM. Age-dependent effects of blue light exposure on lifespan, neurodegeneration, and mitochondria physiology in Drosophila melanogaster. NPJ Aging. 2022 Jul 27;8(1):11. doi: 10.1038/s41514-022-00092-z. PMID: 35927421; PMCID: PMC9329351.
9. Trajano LADSN, Siqueira PB, Rodrigues MMS, Pires BRB, da Fonseca AS, Mencalha AL. Does photobiomodulation alter mitochondrial dynamics? Photochem Photobiol. 2025 Jan-Feb;101(1):21-37. doi: 10.1111/php.13963. Epub 2024 May 22. PMID: 38774941.
10. Uçar, N., & Holick, M. F. (2025). Illuminating the Connection: Cutaneous Vitamin D3 Synthesis and Its Role in Skin Cancer Prevention. Nutrients, 17(3). https://doi.org/10.3390/nu17030386
11. Sanes, J. R., et al. (2022). Researchers discover brain pathway that helps to explain light’s effect on mood. Proceedings of the National Academy of Sciences. (via Brown University). https://www.brown.edu/news/2022-07-06/light-mood
12. Campbell Islay, Sharifpour Roya, Aizpurua Jose Fermin Balda, Beckers Elise, Paparella Ilenia, Berger Alexandre, Koshmanova Ekaterina, Mortazavi Nasrin, Read John, Zubkov Mikhail, Talwar Puneet, Collette Fabienne, Sherif Siya, Phillips Christophe, Lamalle Laurent, Vandewalle Gilles (2024) Regional response to light illuminance across the human hypothalamus eLife 13:RP96576. https://doi.org/10.7554/eLife.96576.1
13. Ishihara, A., Courville, A. B., & Chen, K. Y. (2023). The Complex Effects of Light on Metabolism in Humans. Nutrients, 15(6), 1391. https://doi.org/10.3390/nu15061391

AUTHOR BIO
Megan Pribyl, PT, CMPT, CMPT/DN, PCES

Megan Pribyl (she/her) is a mastery-level physical therapist at the University of Kansas Health System in Olathe, KS, specializing in orthopedic care for a diverse outpatient population, including pelvic health, pregnancy, and postpartum rehabilitation. Her approach emphasizes the integration of health, wellness, and evidence-based practice.

Megan began her career in physical therapy in 2000 after earning her Master of Science in Physical Therapy from the University of Colorado Health Sciences Center. She also holds dual bachelor’s degrees in Nutrition and Exercise Sciences (B.S. Foods & Nutrition; B.S. Kinesiology) from Kansas State University. She later earned her Certified Manual Physical Therapist (CMPT) credential through the North American Institute of Orthopedic Manual Therapy and became certified in dry needling in 2019. Since 2015, Megan has served as a faculty member at the Herman & Wallace Pelvic Rehab Institute, where she enjoys both teaching and developing course content.

Her passion for nutrition and manual therapy inspired her to create Nutrition Perspectives for the Pelvic Rehab Therapist, a course designed to deepen understanding of human physiology as it relates to pelvic conditions, pain, healing, and therapeutic response. Megan combines traditional and contemporary approaches to provide clinicians with practical, immediately applicable tools to enhance patient care. Her teaching encourages a deeper appreciation for the complexity of clinical presentations in orthopedic manual therapy and pelvic rehabilitation.

As a new pelvic health physical therapist, you’re quickly discovering how interconnected the body’s systems truly are. Pain, bowel and bladder function, sexual health, and emotional well-being are all influenced by factors that extend beyond the musculoskeletal system. One emerging area that deserves attention is nutrition - a key player in inflammation, gut health, and even pelvic floor muscle function.

Integrating nutrition awareness into your practice doesn’t mean stepping outside your professional scope. It means understanding how diet affects the systems you already treat and collaborating effectively with nutrition professionals to optimize patient outcomes.

Why Nutrition Belongs in Pelvic Rehab
The gut and pelvic organs share complex neural and biochemical communication pathways. When the gut is inflamed or imbalanced, this “viscerosomatic crosstalk” can alter pelvic floor tone, coordination, and reflex activity, potentially amplifying pain via musculoskeletal pathways (1). Gut microbiota also influences the production of short-chain fatty acids and other byproducts that affect intestinal permeability, immune signaling, and systemic inflammation, which are key mechanisms in central sensitization and pelvic pain (2).

Certain foods may act as direct irritants to sensitive pelvic tissues, like the bladder or vulvar mucosa, triggering burning, urgency, or pain flares. In addition, food sensitivities or intolerances (especially non-IgE–mediated types) can increase inflammation or disrupt digestion in ways that influence pelvic symptoms (3). Understanding these connections helps you appreciate why some patients experience symptom changes after dietary shifts, even if formal nutrition counseling is provided by a functional nutrition provider or other nutrition professional.

While research is still developing, clinical studies are strengthening the nutrition–pelvic pain link. A 2023 study found that individuals with both IBS and endometriosis who followed a low-FODMAP diet experienced significant reductions in pain and improvements in quality of life (4). These results support what many clinicians observe in practice: thoughtful dietary modification can complement pelvic floor therapy and reduce symptom burden.

Practical Ways to Integrate Nutrition Awareness
As a new clinician, you don’t need to “prescribe” diets, but you can begin building awareness, gathering relevant information, and partnering with nutrition professionals.

1. Ask About Diet and GI Symptoms
   Include food-related questions in your intake:

• “Have you noticed any foods that make your symptoms better or worse?”
• “Do you experience bloating, urgency, or pain after meals?”
• “Have you ever tried dietary changes to help with your symptoms?”

Even these simple questions open the door for meaningful discussion and collaborative problem-solving.

2. Recognize Patterns and Refer Appropriately
   If a patient reports consistent food-related flares, unexplained weight loss, GI bleeding, or restrictive eating behaviors, refer to a physician or nutrition professional specializing in gastrointestinal or pelvic health. Working as a team ensures patients get safe, targeted guidance.

3. Use Low-Risk Dietary Experiments
   Under supervision or as part of a multidisciplinary plan, patients can trial small, low-risk adjustments such as reducing bladder irritants (caffeine, alcohol, acidic foods) or following a structured elimination/reintroduction process guided by a dietitian or functional nutritionist. The key is tracking outcomes systematically using food/symptom diaries.

4. Reinforce Foundational Nutrition Principles
   Encourage balanced, anti-inflammatory dietary patterns: vegetables, fruits, lean proteins, fiber (if tolerated), and healthy fats. These broad principles align with general wellness recommendations and support tissue healing, hormonal regulation, and immune balance.

Building Your Competence as a New PT
Early-career clinicians often feel pressure to “know everything.” When it comes to nutrition, your role is not to diagnose or prescribe, but to:

• Recognize when food may be contributing to symptoms.
• Collaborate with nutrition professionals and physicians to ensure comprehensive care.
• Educate patients on body awareness, symptom tracking, and realistic expectations.

Courses like Nutrition Perspectives for Pelvic Rehab, scheduled next on December 6-7, 2025, by Megan Pribyl, PT, CMPT, offer an excellent foundation. This course introduces the science of nutrition’s impact on pelvic health and provides practical frameworks for integrating it into clinical reasoning without overstepping scope of practice.

For new pelvic rehab therapists, integrating nutrition awareness offers a powerful way to enhance patient care. Understanding the links between diet, gut health, inflammation, and pelvic pain helps you view each patient through a truly whole-body lens.

By asking informed questions, observing patterns, and collaborating across disciplines, you can empower patients to take an active role in their healing. When nutrition meets pelvic rehab, we move closer to comprehensive, compassionate, and evidence-informed pelvic health care.

References:

1. Zhou Q, Verne GN. Molecular Mechanisms and Pathways in Visceral Pain. Cells. 2025 Jul 25;14(15):1146. doi: 10.3390/cells14151146. PMID: 40801578; PMCID: PMC12345894.
2. Palma, G. D., Reed, D. E., & Bercik, P. (2023). Diet–microbial cross–talk underlying increased visceral perception. Gut Microbes, 15(1), 2166780. https://doi.org/10.1080/19490976.2023.2166780
3. Ren, H., Cao, B., Xu, Q., Zhao, R., Li, H., & Wei, B. (2025). Role of microbiota in pain: From bench to bedside. IMetaOmics, 2(1), e58. https://doi.org/10.1002/imo2.58
4. Varney JE, So D, Gibson PR, Rhys-Jones D, Lee YSJ, Fisher J, Moore JS, Ratner R, Morrison M, Burgell RE, Muir JG. Clinical Trial: Effect of a 28-Day Low FODMAP Diet on Gastrointestinal Symptoms Associated With Endometriosis (EndoFOD)-A Randomised, Controlled Crossover Feeding Study. Aliment Pharmacol Ther. 2025 Jun;61(12):1889-1903. doi: 10.1111/apt.70161. Epub 2025 May 4. PMID: 40319391; PMCID: PMC12107219.

At Herman & Wallace, we know that pelvic rehabilitation is a dynamic and ever-evolving field. While foundational courses like Pelvic Function Level 1 and Dry Needling and Pelvic Health often get the spotlight, there are several highly valuable courses that tend to fly under the radar. These courses offer practitioners the opportunity to deepen their knowledge, broaden their skills, and better serve patients with complex needs.

Here are five underrated courses that can have a powerful impact on your practice:

1. Nutrition Perspectives for the Pelvic Rehab Therapist
Pelvic health doesn’t exist in isolation from the rest of the body, and nutrition plays a critical role in tissue healing, inflammation, digestion, and pelvic pain syndromes. This course introduces pelvic rehab practitioners to the fundamentals of nutrition as it relates to pelvic health.

Participants learn how to recognize when dietary factors may be contributing to issues such as constipation, bladder irritation, vulvar pain, or chronic inflammation. While not a course that trains clinicians to act as dietitians, it empowers them to screen for red flags, collaborate with nutrition professionals, and make basic, evidence-informed recommendations that can significantly impact patient outcomes.

2025 Course Date Options: October 11-12, December 6-7.

2. Oncology and the Pelvic Floor Series
(OPF1: Foundations, OPF2A: Male Pelvic & Colorectal Cancers, and OPF2B: Female Pelvic & Bladder Cancers)

Pelvic health isn’t just for perinatal or orthopedic populations. People undergoing treatment for pelvic and abdominal cancers face unique and complex challenges, including incontinence, pelvic pain, sexual dysfunction, and scar tissue restrictions.

The Oncology and the Pelvic Floor series offers a comprehensive framework for working with patients at every stage of the cancer journey, and provides the knowledge and sensitivity needed to support this underserved population, integrating trauma-informed care, manual therapy, exercise, and interdisciplinary collaboration.

2025 Course Date Options: Level 1 September 13-14, Level 2A December 6-7, Level 2B November 1-2.

3. Pharmacologic Considerations for the Pelvic Health Provider
Medications have a profound impact on the pelvic floor—often in ways that are overlooked. Whether it’s constipation from opioids, hormonal changes from contraceptives, or bladder irritation from certain antibiotics, understanding pharmacology is crucial.

This course demystifies medications commonly encountered in pelvic health practice. It helps clinicians understand how drugs can influence bowel, bladder, sexual function, pain processing, and healing. Armed with this knowledge, practitioners can engage in more informed discussions with patients and other members of the healthcare team, helping to troubleshoot barriers to progress.

2025 Course Date Option: September 13.

4. Yoga for Pelvic Pain
Yoga is more than stretching—it’s a mind-body practice with proven benefits for nervous system regulation, pain management, and muscular balance. Yoga for Pelvic Pain teaches practitioners how to integrate evidence-based yoga principles into rehabilitation for patients with chronic pelvic pain.

This course goes beyond asana (physical postures) to incorporate breathwork, mindfulness, and gentle movement tailored to the needs of people with complex pain syndromes. Participants leave with practical tools they can immediately incorporate into one-on-one sessions or group classes, supporting both physical function and emotional well-being.

2025 Course Date Option: September 13-14.

5. Rehabilitative Ultrasound Imaging: Pelvic Health & Orthopedic Topics
Rehabilitative Ultrasound Imaging (RUSI) provides real-time feedback for both clinicians and patients. It’s an invaluable tool for assessing muscle activation, motor control, and coordination - particularly for the deep core and pelvic floor muscles.

This course covers both pelvic health applications (like visualizing pelvic floor contractions) and broader orthopedic topics (like assessing the transverse abdominis or multifidus). Practitioners gain hands-on experience in using ultrasound to refine exercise prescription, improve patient engagement, and objectively document progress. Despite its transformative potential, RUSI remains underutilized in many pelvic rehab settings.

2025 Course Date Options for September 5-7: Self-hosted, Indianapolis IN, Seattle WA.

Don’t Overlook These Gems
Expanding your clinical toolbox with specialized knowledge can transform your patient care. Whether it’s understanding how nutrition, medications, cancer treatments, or mind-body practices influence the pelvic floor—or learning to harness the power of ultrasound imaging—these courses provide essential insights that go beyond the basics.

Ready to elevate your practice? Explore these courses and others at Herman & Wallace and continue your journey as a lifelong learner in pelvic rehabilitation.

In April, the U.S. Department of Health and Human Services and the U.S. Food and Drug Administration announced a series of new measures to phase out all petroleum-based synthetic dyes from the nation’s food supply. Studies in the 1950s were done because of concerns about petroleum-based food dyes and their potential toxicity (1). By the 1990s, it was well established that artificial colorants were harmful to humans (2). Yet here in 2025, their use remains prolific in many items, including obvious sources such as Skittles, Twizzlers, and Mountain Dew Code Red, and less obvious sources like pickles, yogurt, breakfast cereals, and processed meats.

This shocking situation is a microcosm of the chasm that often forms between scientific investigative findings and knowledge translation to practical applications. Scientists have long known these substances to be harmful, yet they have remained highly prevalent in our food supply all these years. Unfortunately, “for too long, some food producers have been feeding Americans petroleum-based chemicals without their knowledge or consent. These poisonous compounds offer no nutritional benefit and pose real, measurable dangers to our children’s health and development” (3). These artificial food dyes have been linked to cancer, inflammatory bowel diseases, neurodevelopmental disorders, and beyond (2, 4, 5).

Sometimes it’s difficult to wrap our minds around the fact that it has taken until this moment - 2025 - for the HHS and FDA to take action based on decades of research demonstrating the toxicity of these ubiquitous substances in our nation’s food supply – substances such as Red No. 40 – the most commonly used dye by the food industry that is present in over 40% of foods marketed to children (6). Many of us grew up surrounded by artificial food dyes. Today’s children are inundated with ultra-processed foods – many of them loaded with chemical ingredients, including these petroleum-based food dyes. Researchers have been looking at this issue for some time and have determined that for all populations and all exposure scenarios, the highest cumulative exposures are from FD&C Red No. 40, FD&C Yellow No. 5, and FD&C Yellow No. 6 (7). These, among others, are slated to be eliminated from our food supply by the end of next year.

A curious question might be: if so many of us have had long-term consistent exposure to such chemicals, might there be links between this and the rise in Early Onset Colorectal Cancer (EOCRC)? Attention deficit disorder? Other systemic inflammatory conditions? Current research stands firm: artificial food dyes cause DNA damage, colonic inflammation, and impact the microbiome negatively – all of which can contribute to colorectal cancer, whose incidence has been on the rise in those under 50 years of age over the last 40 years (8). Further, the underlying inflammation caused by such toxic exposure is a key mechanism triggering neurobehavioral dysregulation due to the impact on the gut-brain axis (4, 5). Correspondingly, it is well established that systemic inflammation underpins many non-communicable diseases such as Type 2 diabetes, autoimmune conditions, and even chronic pain. These dyes have been a contributor to this toxic load for years.

So, wouldn’t we want to do whatever is possible to minimize exposure to such substances - as soon as humanly possible? Even if it’s politically contentious?

It is necessary to approach such egregious missteps in the delay in safeguarding citizens’ health from an apolitical standpoint. The good news is that your cells and your microbiome, your colon, and your stomach, and even the structural part of your brain do not hold political affiliation. Whether our parts operate in health or dysfunction is a truly independent matter – from a political standpoint that is. But our health or dysfunction is highly dependent upon the foodstuffs we consume or nourishing foods we fail to consume. This phase-out of synthetic food dyes is a win for all US citizens of all ages.

The bottom line is that we as healthcare providers – now more than ever – need to have a foundational working knowledge of nutrition as it relates to overall health and a framework to take what we know from science and apply it to our patient care practices as soon as possible - vs. decades later! We must ask meaningful questions. We must share what we know to be important and relevant based on the literature. We must be curious investigators. Many of the answers we seek to the omnipresent health concerns of the 21st century await our discovery.

While we wait for the petroleum-based synthetic dyes to tiptoe quietly off of our grocery store shelves by the end of 2026, it would be wise to check food labels and leave those products with artificial food dyes at the grocers. It will be an adjustment for food producers and consumers, but the move away from highly processed ingredients such as these artificial food dyes is one critically important step toward improving the health and well-being of all.

To be ahead of the curve, please join me in my two-day remote course, Nutrition Perspectives in Pelvic Rehabilitation. The next class is scheduled for June 7-8, but you can also join me later in the year on October 11-12 or December 6-7. Remember, the food we eat impacts every system of the body, and our nourishment status directly relates to our overall health picture - affecting a multitude of conditions treated in pelvic rehabilitation. This course provides a unique opportunity to explore multi-dimensional connections between physical therapy, pelvic rehabilitation, and nutritional sciences. 

References:

1. Allmark, M. G., Grice, H. C., & Mannell, W. A. (1956). Chronic toxicity studies on food colours. II. Observations on the toxicity of FD&C green No. 2 (light green SF yellowish), FD&C orange No. 2 (orange SS) and FD&C red No. 32 (oil red XO) in rats. The Journal of pharmacy and pharmacology, 8(6), 417–424.
2. Hofseth LJ, Hebert JR, Murphy EA, Trauner E, Vikas A, Harris Q, Chumanevich AA. Allura Red AC is a xenobiotic. Is it also a carcinogen? Carcinogenesis. 2024 Oct 10;45(10):711-720. doi: 10.1093/carcin/bgae057. PMID: 39129647; PMCID: PMC11464682.
3. HHS, FDA to Phase Out Petroleum-Based Synthetic Dyes in Nation’s Food Supply. https://www.fda.gov/news-events/press-announcements/hhs-fda-phase-out-petroleum-based-synthetic-dyes-nations-food-supply  Accessed April 28, 2025.
4. He, Z., Chen, L., Catalan-Dibene, J., Bongers, G., Faith, J. J., Suebsuwong, C., DeVita, R. J., Shen, Z., Fox, J. G., Lafaille, J. J., Furtado, G. C., & Lira, S. A. (2021). Food colorants metabolized by commensal bacteria promote colitis in mice with dysregulated expression of interleukin-23. Cell metabolism, 33(7), 1358–1371.e5. https://doi.org/10.1016/j.cmet.2021.04.015
5. Sudhakaran G. (2023). Artificial food dyes are toxic: Neurobehavioral implications in children. Brain & spine, 4, 102869. https://doi.org/10.1016/j.bas.2024.102869
6. Batada, A., & Jacobson, M. F. (2016). Prevalence of Artificial Food Colors in Grocery Store Products Marketed to Children. Clinical pediatrics, 55(12), 1113–1119. https://doi.org/10.1177/0009922816651621
7. Doell, D. L., Folmer, D. E., Lee, H. S., Butts, K. M., & Carberry, S. E. (2016). Exposure estimate for FD&C colour additives for the US population. Food additives & contaminants. Part A, Chemistry, analysis, control, exposure & risk assessment, 33(5), 782–797. https://doi.org/10.1080/19440049.2016.1179536
8. Zhang, Q., Chumanevich, A. A., Nguyen, I., Chumanevich, A. A., Sartawi, N., Hogan, J., Khazan, M., Harris, Q., Massey, B., Chatzistamou, I., Buckhaults, P. J., Banister, C. E., Wirth, M., Hebert, J. R., Murphy, E. A., & Hofseth, L. J. (2023). The synthetic food dye, Red 40, causes DNA damage, causes colonic inflammation, and impacts the microbiome in mice. Toxicology reports, 11, 221–232. https://doi.org/10.1016/j.toxrep.2023.08.006
9. Potera C. (2010). The artificial food dye blues. Environmental health perspectives, 118(10), A428. https://doi.org/10.1289/ehp.118-a428

AUTHOR BIO
Megan Pribyl, PT, CMPT, CMTPT/DN, PCES

Megan Pribyl, PT, CMPT, CMTPT/DN, PCES (she/her) is a mastery-level physical therapist at the University of Kansas Health System in Olathe, KS treating a diverse outpatient population in orthopedics including pelvic health, pregnancy, and postpartum rehabilitation – all with integration of health and wellness. She began her PT career in 2000 after graduating from the University of Colorado Health Sciences Center with her Master of Science in Physical Therapy. Prior, she earned her dual degree in Nutrition and Exercise Sciences (B.S. Foods & Nutrition, B.S. Kinesiology) in 1998 from Kansas State University. Later, she obtained her CMPT from the North American Institute of Orthopedic Manual Therapy and became certified in dry needling in 2019. Since 2015, she has been a faculty member of Herman & Wallace Pelvic Rehab Institute and enjoys both teaching and developing content. She created and instructs Nutrition Perspectives for the Pelvic Rehab Therapist offered remotely through Herman & Wallace. She also teaches Pelvic Function – Level 1, Pregnancy Rehabilitation and Postpartum Rehabilitation. She brings many years of experience and insight to all courses. As a content developer, Megan has also contributed to the Herman & Wallace Oncology Series, Pelvic Function Level 2A, as well as the Pelvic Function Series Capstone Course.

Megan’s longstanding passion for both nutritional sciences and manual therapy culminated in her creating Nutrition Perspectives for the Pelvic Rehab Therapist designed to propel understanding of human physiology as it relates to pelvic conditions, pain, healing, and therapeutic response. She harnesses her passion to integrate ancient and traditional practices with cutting-edge discoveries creating a unique experience sure to elevate your level of appreciation for the complex and fascinating nature of clinical presentations in orthopedic manual therapy and pelvic rehabilitation. Clinicians will come away from this course with both simple and practical integrative tools that can be immediately utilized to help clients and providers alike - along their path of healing.

Megan enjoys her many fulfilling roles as an instructor, clinician, wife, and mom to two active teenagers and owner of two rambunctious golden retrievers. She loves to read, cook, be in the great outdoors, travel, and spend time with her family and friends. She has a passion for both the mountains and the beach, exploring scientific literature, and learning all she can about the power of using nature, nurture, and nutrition to heal and sustain health.

Chronic non-cancer pain (CNCP), defined as pain persisting for more than three months, affects approximately 20% of adults worldwide, with a higher prevalence among vulnerable populations such as the elderly and those from diverse cultural backgrounds. The economic burden of CNCP is substantial, exceeding that of heart disease, diabetes, and cancer in countries like the United States. Beyond the financial implications, CNCP significantly impacts individuals' quality of life, leading to absenteeism, loss of productivity, and increased healthcare utilization.

Traditionally, CNCP management has focused on pharmacological interventions and physical therapies. However, emerging evidence underscores the importance of a holistic, person-centered approach that addresses various lifestyle factors, including nutrition. Healthy eating patterns are associated with reduced systemic inflammation, as well as lower risk and severity of chronic non-cancer pain and associated comorbidities.

Persisting low-grade systemic inflammation is associated with CNCP and multiple comorbid chronic health conditions. Diet plays a complex role in modulating systemic inflammation. Knowledge is expanding rapidly in this area and multiple links between diet and inflammation have been identified. Metabolic mechanisms associated with postprandial hyperglycemia and frequent and prolonged rises in plasma insulin levels, influenced by dietary intake, can produce systemic inflammation.

Nutritional Strategies for Pain Management
Evidence from a number of recent systematic reviews shows that optimizing diet quality and incorporating foods containing anti-inflammatory nutrients such as fruits, vegetables, long-chain and monounsaturated fats, antioxidants, and fiber leads to a reduction in pain severity and interference.

Non-nutritive bioactive compounds such as polyphenols mitigate oxidative stress and inflammation, as well as modulate pain experiences. One such mechanism operates through the inhibition of COX-2 in neuromodulating pathways. Polyphenols are found in a range of foods such as fruits, vegetables, whole grains, cocoa, tea, coffee, and red wine.

Incorporating anti-inflammatory foods into one's diet can be a practical approach to managing CNCP. Emphasizing the consumption of fruits, vegetables, whole grains, and healthy fats, while reducing the intake of processed foods and sugars, can help modulate inflammation and alleviate pain. Additionally, maintaining a balanced diet supports overall health, which is crucial for individuals dealing with chronic pain.

Adopting a healthy, anti-inflammatory diet can reduce systemic inflammation and alleviate pain severity, contributing to improved quality of life for individuals with CNCP. As research in this field continues to evolve, healthcare providers should consider incorporating nutritional strategies into comprehensive, person-centered pain management plans.

To learn more about essential digestion concepts, nourishment strategies, and the interconnected nature of physical and emotional health across the lifespan join Megan Prybil in her upcoming course, Nutrition Perspectives for the Pelvic Rehab Therapist on February 23-24, 2025. Whether at the beginning of your journey or well on your way down the path of integrative care, this continually updated and relevant course is a unique, not-to-be-missed opportunity. 

Resources:

1. Brain K, Burrows TL, Bruggink L, Malfliet A, Hayes C, Hodson FJ, Collins CE. Diet and Chronic Non-Cancer Pain: The State of the Art and Future Directions. J Clin Med. 2021 Nov 8;10(21):5203. doi: 10.3390/jcm10215203. PMID: 34768723; PMCID: PMC8584994.
2. Nijs J, Malfliet A, Roose E, Lahousse A, Van Bogaert W, Johansson E, Runge N, Goossens Z, Labie C, Bilterys T, Van Campenhout J, Polli A, Wyns A, Hendrix J, Xiong HY, Ahmed I, De Baets L, Huysmans E. Personalized Multimodal Lifestyle Intervention as the Best-Evidenced Treatment for Chronic Pain: State-of-the-Art Clinical Perspective. J Clin Med. 2024 Jan 23;13(3):644. doi: 10.3390/jcm13030644. PMID: 38337338; PMCID: PMC10855981.
3. Elma Ö, Brain K, Dong HJ. The Importance of Nutrition as a Lifestyle Factor in Chronic Pain Management: A Narrative Review. J Clin Med. 2022 Oct 9;11(19):5950. doi: 10.3390/jcm11195950. PMID: 36233817; PMCID: PMC9571356.
4. Lahousse A, Roose E, Leysen L, Yilmaz ST, Mostaqim K, Reis F, Rheel E, Beckwée D, Nijs J. Lifestyle and Pain following Cancer: State-of-the-Art and Future Directions. J Clin Med. 2021 Dec 30;11(1):195. doi: 10.3390/jcm11010195. PMID: 35011937; PMCID: PMC8745758.
5. Nijs J, Reis F. The Key Role of Lifestyle Factors in Perpetuating Chronic Pain: Towards Precision Pain Medicine. J Clin Med. 2022 May 12;11(10):2732. doi: 10.3390/jcm11102732. PMID: 35628859; PMCID: PMC9145084.

The year was 1998 - my fellow classmates and I converged upon our journey in graduate school to become physical therapists. In our first semester, we shouldered a heavy load of coursework and were memorably immersed in a battle between courses taught by our anatomy and histology professors. Both professors claimed stake to the title of teaching the “most important course in the curriculum.” The connection between anatomy and physical therapy was clear and specific. But there were moments when the connection between histology and physical therapy seemed less relevant and the demands from our histology professor obtuse. The battle between courses played out in both the cadaver lab and the histology slide viewing rooms. My classmates and I found ourselves compelled to pour over both anatomy and histology with focused intensity; the figurative competition became a grind.

We shared in collective moans and groans surrounding the challenge of having a histology professor who thought so highly of cellular structure and function and insisted our appreciation of the topic should equal that of learning anatomy. This professor made exceedingly clear to each of us: “You MUST know what a normal cell looks like to understand basic anatomy and physiology. If you don’t know what normal looks like, then you’ll never know what abnormal looks like.”  We studied muscle slides, fibrocartilage slides, hyaline cartilage slides, endothelium slides, neuron slides, bone slides, tendon slides….and on and on and on. We counted mitochondria. We compared normal and abnormal. Over and over again.

Little did I know - our future understanding of health would literally hinge upon such things. Normal and abnormal cellular health. Intra- and Inter-cellular (mis)communication. Inter-cellular barrier integrity. Mitochondrial (dys)function.

In September 2024, Dr. Casey Means shined a spotlight on our country’s health crises by participating in a non-partisan roundtable discussion titled “American Health and Nutrition – a Second Opinion” – elucidating in a national forum the stark reality of the dismal nutrition situation that plagues our country resulting in equally dismal national health statistics. We are all witnesses to this health catastrophe. She also recently published “Good Energy,” a call-to-action she co-authored with her brother Cally Means. In the roundtable discussion and in the book, Dr. Means eloquently describes the driver of all health and disease states - the status of cellular function – and that this is foundationally driven by nutrition or lack thereof. Based on the overwhelming evidence in the literature I’ve read through the years, and compiled to create “Nutrition Perspectives in Pelvic Rehab,” I couldn’t agree with her more.

And I guess this is where I admit our histology professor was on to something.

As rehab professionals, we absolutely care about what cells look like, act like, move like, and feel like. We may not realize it, but cellular health or dysfunction can dictate if our patients have low energy, metabolic dysregulation (diabetes, obesity, fatty liver disease), neurodegenerative diseases like Parkinson’s, Alzheimer’s, dementia & peripheral neuropathy (Qiao et.al., 2024; Sabui et.al., 2022), neurocognitive changes, (Shatalina et.al., 2024) cancer, chronic pain, or even dysregulation of the gut-brain axis (found in conditions such as IBS). Cellular dysfunction is at the foundation of all of these conditions and their sequelae. We also may not realize it, but when we palpate tissue that is painful, inflamed, tense, tight, dyscoordinated, or find joints to be irritated (Seewald et.al. 2023) cellular dysfunction may be making itself manifest. Sarcopenia, muscle degeneration and weakness, also has underpinnings in metabolic and thus cellular dysregulation (Daily &Park, 2022;  Xie & Huang, 2024). Chronic systemic inflammation is by definition cellular dysregulation. (Kharrazian, 2022)

And finally, we also may not fully realize the decidedly negative impact our standard American diet has on each and every condition just listed, or more precisely, on our cellular health. Without normal cellular function our bodies will devolve into chaos - otherwise known as disease states.

As rehab professionals, we need to know all we can about anatomy, biomechanics, and therapeutic intervention. In my journey, it was the requisite histological training combined with my studies in nutritional sciences that allowed me to see how the “peripheral” topics of nutrition, health, and cellular function intersected in vivid clarity early in my career. This fueled my long-standing passion to share this information with other healthcare providers through the creation of “Nutrition Perspectives.”

This intersection should inform our intention as we steer towards solutions to the overarching American health crisis while helping our clients – one conversation at a time. “Nutrition Perspectives in Pelvic Rehab” (NPPR) provides practical steps to navigate a path forward to improve digestive health, gut health, and overall health. First, we must bravely confront the magnitude and complexity of the problem as we equip ourselves with working knowledge of functional nutrition as shared in NPPR.

Optimizing cellular health can positively influence everything we care about as rehab providers. I might argue in this context – that learning about functional nutrition may be equivalent in importance to anatomy and histology! More fairly – the intersection of anatomy, histology & nutrition will be the foundation upon which the future of health and wellness, and hopefully healthcare will eventually be built.

Nutrition Perspectives in Pelvic Rehab is nearing its 10th anniversary– 10 years of sharing profoundly important nutritional concepts that impact each one of us and the clients we serve. As the body of evidence explodes, the essence of the message within NPPR is unwavering and may just become your “most important course in the curriculum.” Nutrition matters deeply – all the way down to the cellular level.

Come learn the hows and whys in an upcoming offering of Nutrition Perspectives in Pelvic Rehab – available in remote format on the following dates:  Dec 7-8, 2024; Feb 22-23, 2025; June 7-8, 2025; Oct 11-12, 2025 & Dec 6-7, 2025.

Resources:

• American Health and Nutrition – A Second Opinion. https://rumble.com/v5fy7bv-american-health-and-nutrition-a-second-opinion.html
• Daily JW, Park S. Sarcopenia Is a Cause and Consequence of Metabolic Dysregulation in Aging Humans: Effects of Gut Dysbiosis, Glucose Dysregulation, Diet and Lifestyle. Cells. 2022 Jan 20;11(3):338. doi: 10.3390/cells11030338. PMID: 35159148; PMCID: PMC8834403.
• Kharrazian D. Functional Medicine Approaches to Neurodegeneration. Phys Med Rehabil Clin N Am. 2022 Aug;33(3):733-743. doi: 10.1016/j.pmr.2022.04.011. PMID: 35989061.
• Means, C;  Means, C. Good Energy – the Surprising Connection between Metabolism and Limitless Health. Avery. May 2024.
• Qiao L, Yang G, Wang P, Xu C. The Potential Role of Mitochondria in the Microbiota-Gut-Brain Axis: Implications for Brain Health. Pharmacol Res. 2024 Sep 25:107434. doi: 10.1016/j.phrs.2024.107434. Epub ahead of print. PMID: 39332752.
• Sabui A, Biswas M, Somvanshi PR, Kandagiri P, Gorla M, Mohammed F, Tammineni P. Decreased anterograde transport coupled with sustained retrograde transport contributes to reduced axonal mitochondrial density in tauopathy neurons. Front Mol Neurosci. 2022 Sep 30;15:927195. doi: 10.3389/fnmol.2022.927195. PMID: 36245925; PMCID: PMC9561864.
• Seewald LA, Sabino IG, Montney KL, Delco ML. Synovial fluid mitochondrial DNA concentration reflects the degree of cartilage damage after naturally occurring articular injury. Osteoarthritis Cartilage. 2023 Aug;31(8):1056-1065. doi: 10.1016/j.joca.2023.03.013. Epub 2023 Apr 6. PMID: 37028640; PMCID: PMC10524327.
• Shatalina E, Whitehurst TS, Onwordi EC, Gilbert BJ, Rizzo G, Whittington A, Mansur A, Tsukada H, Marques TR, Natesan S, Rabiner EA, Wall MB, Howes OD. Mitochondrial complex I density is associated with IQ and cognition in cognitively healthy adults: an in vivo [¹⁸F]BCPP-EF PET study. EJNMMI Res. 2024 Apr 17;14(1):41. doi: 10.1186/s13550-024-01099-1. PMID: 38632153; PMCID: PMC11024075.
• Xie X, Huang C. Role of the gut-muscle axis in mitochondrial function of aging muscle under different exercise modes. Ageing Res Rev. 2024 Jul;98:102316. doi: 10.1016/j.arr.2024.102316. Epub 2024 May 3. PMID: 38703951.

AUTHOR BIO
Megan Pribyl, PT, CMPT, CMTPT/DN, PCES

Megan Pribyl, PT, CMPT, CMTPT/DN, PCES (she/her) is a mastery-level physical therapist at the University of Kansas Health System in Olathe, KS treating a diverse outpatient population in orthopedics including pelvic health, pregnancy, and postpartum rehabilitation – all with integration of health and wellness. She began her PT career in 2000 after graduating from the University of Colorado Health Sciences Center with her Master of Science in Physical Therapy. Prior, she earned her dual degree in Nutrition and Exercise Sciences (B.S. Foods & Nutrition, B.S. Kinesiology) in 1998 from Kansas State University. Later, she obtained her CMPT from the North American Institute of Orthopedic Manual Therapy and became certified in dry needling in 2019. Since 2015, she has been a faculty member of Herman & Wallace Pelvic Rehab Institute and enjoys both teaching and developing content. She created and instructs Nutrition Perspectives for the Pelvic Rehab Therapist offered remotely through Herman & Wallace. She also teaches Pelvic Function – Level 1, Pregnancy Rehabilitation and Postpartum Rehabilitation. She brings many years of experience and insight to all courses. As a content developer, Megan has also contributed to the Herman & Wallace Oncology Series, Pelvic Function Level 2A, as well as the Pelvic Function Series Capstone Course.

Megan’s longstanding passion for both nutritional sciences and manual therapy culminated in her creating Nutrition Perspectives for the Pelvic Rehab Therapist designed to propel understanding of human physiology as it relates to pelvic conditions, pain, healing, and therapeutic response. She harnesses her passion to integrate ancient and traditional practices with cutting-edge discoveries creating a unique experience sure to elevate your level of appreciation for the complex and fascinating nature of clinical presentations in orthopedic manual therapy and pelvic rehabilitation. Clinicians will come away from this course with both simple and practical integrative tools that can be immediately utilized to help clients and providers alike - along their path of healing.

Megan enjoys her many fulfilling roles as an instructor, clinician, wife, and mom to two active teenagers and owner of two rambunctious golden retrievers. She loves to read, cook, be in the great outdoors, travel, and spend time with her family and friends. She has a passion for both the mountains and the beach, exploring scientific literature, and learning all she can about the power of using nature, nurture, and nutrition to heal and sustain health.

Megan Pribyl, PT, CMPT is a practicing physical therapist at the Olathe Medical Center in Olathe, KS treating a diverse outpatient population in orthopedics including pelvic rehabilitation. Megan’s longstanding passion for both nutritional sciences and manual therapy has culminated in the creation of her remote course, Nutrition Perspectives for the Pelvic Rehab Therapist, designed to propel understanding of human physiology as it relates to pelvic conditions, pain, healing, and therapeutic response.

She harnesses her passion to continually update this course with cutting-edge discoveries creating a unique experience sure to elevate your level of appreciation for the complex and fascinating nature of clinical presentations in orthopedic manual therapy and pelvic rehabilitation.

Indulgences over the holiday season lead many to experience symptoms of indigestion, part of the discomfort that fuels our renewed January focus on exercise and “eating right”.

With this in mind, let’s discuss how we as a nation handle GI distress or GERD (gastroesophageal reflux disease) symptoms. Typically here in the US, there are 2 methods we typically use:

1. The quick way - by popping a Tums or Rolaids or
2. The prolonged way - by taking PPI’s (proton pump inhibitors) or H-2 blockers on a regular basis (eg. Pepcid AC).

Both are reliable ways to efficiently feel a little less GI distress.

The quick relief strategy neutralizes the acid that is already in the stomach whereas the longer-acting PPI’s and H-2 blockers actually block or suppress acid production in the stomach. And even though these “longer term” drugs are designed for short-term use, the more I inquire about their use with my patients, the more a troublesome pattern emerges. Many of my patients struggling with complex symptom constellations (eg. a non-relaxing pelvic floor, constipation, perineal skin issues, gut issues, anxiety, depressive symptoms, etc.) describe that they have taken these “digestive aides” continually for years. YEARS.

So, this approach is fine, yes? We know acid reflux can lead to esophageal irritation, not to mention pain and nagging discomfort. It can lead to disordered sleep and its associated sequelae. In extreme cases, esophageal irritation could even progress to esophageal cancer. Therein lies the justification for using drugs that suppress or block acid production in the stomach over the long term. Even though long-term safe use of these drugs has never been established.

Hmmm. I hope this is cause for pause. It’s true we don’t want GERD or indigestion, yet it remains ubiquitous. The prevalence of at least weekly GERD symptoms in the US is approximately 20% (El-Serag et al., 2014) with an overall prevalence estimated up to 30% in the US (Eusebi et al., 2017). This prevalence of GERD is deemed “exceedingly common”, ranking as the most frequent gastrointestinal diagnosis associated with outpatient clinic visits in the US (Richter, 2018). For as frequently as I see these drugs listed on patient intake forms - or forgotten to be listed since it is such a part of one’s routine - I feel strongly that we are dealing with an epidemic I call “indigestion nation”.

Instead of blaming our stomach acid, it’s time for us to look at the other side of the issue and ask why. Why are so many struggling with digestion? And is there a better way to get a handle on this under-appreciated situation?

Next question: how often is nutrition or food digestibility considered in scenarios involving GERD symptoms, GI upset, or indigestion?

When I ask my patients about this, the standard answer prevails: they try their best to avoid known triggers including fried and spicy foods. Beyond that, there is little forward thinking in terms of where our collective indigestion originates.

Further, how many healthcare providers or patients contemplate what long-term acid suppression might look like?

• Isn’t our stomach SUPPOSED to be acidic? (Answer: it is)
• What happens if it isn’t? (Answer: lots of undesirable things)
• From there, we begin connecting the dots to find points of clarity.

In order to digest proteins, our stomach has to be acidic. The acid in the stomach also kills or deactivates harmful viruses and bacteria that could otherwise gain access to the rest of our system via the intestinal barrier. And our standard American diet does not include foods that contain important bioactive compounds and enzymes that take some of the burden of digestion off our plate – or rather our stomach, intestines, and accessory digestive organs. These are not frequently discussed principles of digestion.

We are conditioned to seek the quick fixes to our digestive woes. Woes that have increased in prevalence in North America by approximately 50%, relative to the baseline prevalence in the early to middle 1990s (Richter, 2018). Our go-to quick (Tums and Rolaids) and long-term strategies (Pepcid AC) are not without consequences. And I’m not even referring to the recently elucidated serious issue of the H-2 blocker ranitidine (generic Zantac) containing N-nitrosodimethylamine (NDMA)….a probable human carcinogen (Mahase, 2019).

Facts like these will sometimes get us to take notice. However, the more pervasive problem is this: components of our diets have become so difficult to digest, so physiologically incompatible with us, that we forget to examine this issue through such a simple lens. If our diet consists of foods that are difficult to break down or contain substances that can be disruptive to our digestive processes, it’s no surprise our body may reject them or be unable to digest them fully.

However, if our diet consists of foods that are designed for nourishment, naturally pre-digested and ready to assimilate or use by the body for building blocks and fuel, our body will know how to break them down and utilize them fully…..miraculously reducing the digestive burden and improving symptoms of GI distress including GERD and indigestion.

It sounds simple enough.

But in this day and age, the savvy healthcare provider will do well to learn and appreciate the breadth and depth of this concept and what it means to you as both a consumer of food and one who cares for others who consume food - all of us. This understanding - especially for a pelvic rehab provider- is critical to harness.

From simple but nuanced concepts, one can help prompt remarkable changes. I’ve seen it firsthand innumerable times.

I invite each of you to learn more about this fascinating topic and how it interrelates with so many facets of our health. Take advantage of the multiple remote-course offerings of Nutrition Perspectives for the Pelvic Rehab Therapist in 2024 - February 24-25, April 27-28, June 8-9, and December 7-8.

References:

• Richter, J. E., & Rubenstein, J. H. (2018). Presentation and Epidemiology of Gastroesophageal Reflux Disease. Gastroenterology, 154(2), 267-276. doi:10.1053/j.gastro.2017.07.045
• Eusebi LH, Ratnakumaran R, Yuan Y, et al. Global prevalence of, and risk factors for, gastro- oesophageal reflux symptoms: a meta-analysis. Gut. 2017
• El-Serag HB, Sweet S, Winchester CC, et al. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 2014; 63(6):871– [PubMed: 23853213]
• Mahase, E. (2019). FDA recalls ranitidine medicines over potential cancer causing impurity. BMJ, 367, l5832. doi:10.1136/bmj.l5832

Megan Pribyl, PT, CMPT is a practicing physical therapist at the Olathe Medical Center in Olathe, KS treating a diverse outpatient population in orthopedics including pelvic rehabilitation. Megan’s longstanding passion for both nutritional sciences and manual therapy has culminated in the creation of her remote course, Nutrition Perspectives for the Pelvic Rehab Therapist, designed to propel understanding of human physiology as it relates to pelvic conditions, pain, healing, and therapeutic response. She harnesses her passion to continually update this course with cutting-edge discoveries creating a unique experience sure to elevate your level of appreciation for the complex and fascinating nature of clinical presentations in orthopedic manual therapy and pelvic rehabilitation.

It has been nearly 8 years since I taught my first in-person rendition of “Nutrition Perspectives for the Pelvic Rehab Therapist” in Seattle, WA through Herman & Wallace – and over a decade since I began writing the course in earnest.  Creating and teaching this course has been an honor for me and truly a full-circle opportunity to share my passion for nutrition with other clinicians.  The mission of the course is to create a ripple effect from one person to the next. But if there’s anything the last couple of years has taught me, it’s that we still have a long way to travel to reach the destination of fully integrated care centered on the whole person.  As a guide, I tap the growing body of literature on nutrition and health to help show us the way.

I recall having taught this course on 11 occasions in-person between June 2015 and October 2019 at gracious site host clinics nationwide.  I enjoyed each and every one of these experiences.  Since the 2020 pivot to remote format, I have taught Nutrition Perspectives via Zoom 18 times - after we were faced with restrictions on traveling and gathering.

Having taught Nutrition Perspectives in both formats, I’d like to share with you first why I love teaching this course, and second why I love teaching it in its remote format.  It truly is a class perfectly suited to this mode of delivery.

First, why I love teaching this course:

It is my passion to share nutrition information with peers in pelvic rehab.  Before becoming a PT, I studied nutrition as an undergrad.  After becoming a PT, and more specifically a pelvic PT, it became crystal clear that we needed to incorporate the essence of nutritional sciences into pelvic rehab– and even into general clinical practice.  Nutrition Perspectives became my answer to the burning and urgent questions I had about how we could blend the worlds of rehabilitation and nutrition.  I scoured the literature to find answers – and what I found was astonishing.  Paradigm shifting.  Compelling.

Early in my career, I would only sporadically encounter patients who would experience what I would now describe as “functional gastro-intestinal disorders with extra-intestinal manifestations”.  Fast-forwarding to today, it is rare to see a patient who does not experience any conditions such as GERD, constipation, gas/abdominal pain/bloating/discomfort, anxiety, depression, and complex or chronic pain conditions.  Because of this reality, it has become essential for healthcare providers to have a basic working knowledge of functional nutrition.  Especially providers in pelvic rehabilitation.  Having a working knowledge of these conditions and potential nutritional underpinnings can help us better understand and serve our clients.

Not only does nutrition have significant relevance to our patients – it is relevant to each of us as human beings!   But be aware – the realm of nutrition appears chock-full of confusing contradictions.  And our patients are now – more than ever – asking us for our thoughts on nutrition-related topics.  They’re listening to podcasts.  They’re reading social media posts and blogs.  They’re watching short video clips to find quick answers to complex questions.  And they want to run some of their questions by you – their trusted health professional ally.   You want to feel confident and competent in what you’re sharing.  My mission is to make evidence-informed information accessible and relevant to you, the practicing clinician so then you can, in turn, share with confidence and competence.

Now, on to why I love teaching this course remotely:

Don’t get me wrong – I love to travel.  But imagine traveling alone to new cities -not as a free-spirited adventure solo traveler – but instead as an idealistic instructor who doesn’t want to be without any supplies needed for teaching a course far from home!  This translates to a very heavy suitcase filled with visual aids and lab supplies. This humongous check-in bag contains items necessary to conduct the course descriptively – books, empty product containers, glass jars (yes, GLASS), carefully packaged kefir grains, a SCOBY, bowls, spoons, kitchen towels, and those hard-to-find food items that one can’t be certain to find in an unfamiliar city.  And a tablecloth.  Because when we’re talking about food with guests, presentation is important!

Now imagine navigating travel challenges with said heavy, giant suitcase; chucking it on and off a rental car bus during a cold rainstorm for example..  Imagine pushing it down a carpeted hotel hallway that is so plush, it prohibits the wheels from functioning properly.  Imagine repacking in 15 minutes what took 3 hours to initially pack in order to catch a return flight home. 

This was the reality of logistics I eagerly and enthusiastically took on to be able to teach this class.  But that giant suitcase couldn’t hold even close to everything I wanted to share, and it actually was a bit cumbersome to manage.  Maybe a lot cumbersome.  Always plastered with the bright orange “HEAVY” sticker warning – there was a limit to what I could bring along to live course events.

When we first transitioned this course to remote format, it was a quick response to begin offering CEUs when lockdown mode began.  The silver lining, we discovered, was that the remote format for this course was in fact – much better than the live event format. 

Now, all the necessary supplies are right where I need them to best instruct.  Plus, predictable kitchen and lecture spaces create a seamless experience for the participants.  Teaching from home has been life-changing as an instructor.  I can practice what I preach about nourishing the nervous system and mitigating stress with lifestyle choices.  It is nourishing to be able to sleep well at home the nights before I teach.  Adequate rest is a superpower that allows me to give my best well-rested self to the participants.

The remote format is not just nourishing to me, but also to the participants who can attend from the comfort of home or familiarity of a clinic.  Wherever you are, you can take the course.  No airports, no suitcases, nor carpeted hotel hallways.  That’s accessibility.  That’s getting this information into the hands and minds of providers in locations all around this country and beyond.  We need this accessibility if we ever hope to reach our destination of fully integrative care of the whole person – for all.

For these reasons, Nutrition Perspectives for the Pelvic Rehab Therapist will remain in this remote format – even as our lives begin to involve travel and in-person events again.  All good things.  But I do hope you enjoy taking Nutrition Perspectives as much as I enjoy teaching it.  I invite you to join me on the journey toward implementing more integrative care as standard practice.  It’s not always an easy road, nor the popular road.   And sometimes it feels as hard as dragging a giant, heavy suitcase behind you.  But it’s a path worth taking – one that will be fruitful for both you and the clients you serve.  Let’s travel it together.

Nutrition Perspectives for the Pelvic Rehab Therapist will be offered quarterly in 2023:  January 21-22, June 10-11, September 16-17, and December 2-3. 

Nutrition Perspectives for the Pelvic Rehab Therapist

Course Dates:
January 21-22, June 10-11, September 16-17, and December 2-3

Price: $525
Experience Level: Beginner
Contact Hours: 17.75

Description: Participants will be introduced to the latest research in nutrition through immersive lectures and hands-on labs.  The course will cover essential digestion concepts, nourishment strategies, and the interconnected nature of physical and emotional health across the lifespan. Further, clinicians will delve into nutritional relevancies in bowel and bladder dysfunction, pelvic health, pain, and healing.  Labs throughout include insightful demonstrations and breakout sessions. The course participant will acquire new, readily applicable tools for patient empowerment, engagement, and self-management utilizing presented principles.

As 2022 has gotten underway, it has already brought many of us to a place where we simply need to hear something lighthearted. The start of a new year also gives us a chance to examine priorities and make room for what matters most. “What matters most” can look different for each of us; for me, it’s my family – including two dogs – Stella and Sadie. Of course, the dogs fall in line behind my human nuclear and extended families, however, they are such a part of my daily life and contribute to my quality of life, it seems only natural to share this story with a wider audience -especially because this story revolves around one of my favorite topics – intentional nourishment!

Let me begin by telling you about our 5-year-old Golden Retriever named Stella. She came to us as one of only three puppies in a litter; a pleasantly plump pup, she was well developed, well-fed, and well-loved. According to everyone who has had the opportunity to meet her, she is the happiest dog they’ve ever met. When we brought her home at eight weeks, she topped the scale at 21 lbs. 

Stella's fur was shiny, her disposition sunny; she emanated maturity and wisdom. She slept through the night with such efficiency, we hardly remember having to let her out at night as a puppy. She was content; the perfect combination of calm and energetic. She was a breeze to housetrain, has an impeccable record of only two accidents in the house, and nary an indoor fecal incontinence episode. Stella brought us so much joy that we decided on a whim to add a second puppy to the milieu.

The second puppy is our ~16-week-old Golden Retriever puppy named Sadie. This past October – by coincidence – my family learned about some surprise Goldens needing homes – 17 to be exact – and we wondered if we might be interested in one. Two weeks later, sweet Sadie came home with us. 

Weighing in at only 13 lbs 6 oz at eight weeks, she was miniature compared to Stella at the same age. It didn’t take us long to figure out that not only was she smaller, but her digestive tract and elimination systems were not like Stella’s either. Sadie pooped often - what seemed like every hour – including sometimes in the house. Her bottom was sore and irritated, and she seemed frustrated and uncomfortable. My husband and I looked at each other more than once thinking the same thought: WHAT did we get ourselves into?!?

Sadie tested negative for parasites, and the vet said she was just working on adjusting to her new home and to give it time. He also suggested we might be feeding her too much. So, we fed her less - but that didn’t help. We tried adding pumpkin, that didn’t help either. Then we upped her food amount again, tried timing her foods differently, tried feeding her more often, then less often. None of these approaches helped. The messes continued. 

We began to feel exasperated. I was reluctant to try adding new foods for fear of upsetting her GI tract further. 

This puppy was pooping nonstop – much of it type 6 & 7 applying the Bristol Scale to dogs (1). She barely came in at 16 lbs. week 10 and alarmingly, she still weighed 16 lbs. at week 12. The vet confirmed our concerns – she was too thin and needed to put on weight.  

Now I started to worry. With all the bowel troubles she had, how could she thrive? We weren’t getting any continuous hours of sleep at night which meant she wasn’t either. It was an exhausting few weeks. 

Given what we had tried – with no success – we had no choice but to begin what we called “Operation Nourishment” for this little puppy. We put worries aside about adding new foods and applied what we understand about functional nutrition to help our sweet Sadie.

“Operation Nourishment” consisted of following several basic digestive principles:

1. Make her food more digestible
2. Feed her nutrient-dense options (dog appropriate, of course)
3. Practice puppy-version mindfulness at mealtime
4. Help support her puppy microbiome

#1: Make her food more digestible: Without changing the kibble she was eating, we soaked it with a bit of water before ingestion to soften it. This helped make her food easier to break down in her digestive tract and also helped S L O W D O W N her tendency to inhale food. Prior, she was definitely not chewing her food thoroughly which can result in undigested food reaching the colon and causing irritation. The softened food facilitated just the slightest bit of chewing and tripled the time it took her to finish a meal, giving her GI tract less of a shock.

#2: Feed her nutrient-dense options: We began adding an organic egg (3,4) softly cooked in a tiny bit of coconut oil (2) to her breakfast. The egg adds a whole food-based protein-containing cholesterol, vitamins, and minerals -all important for building her gut lining and nervous system. Coming from such a large litter in a somewhat stressful/chaotic environment, her gut and nervous system may not have been at their healthiest and needed extra support (4).

#3: Practice mindfulness at mealtime: The egg at breakfast has quickly become the highlight of her day.

The anticipation while watching us cook it calms her. She intently follows as the pan comes out of the cupboard and onto the stove. She watches more intently as we slowly cook the egg. Then she must wait even longer while it sits in her bowl to cool up on the countertop. 

I presume this has taught her mindfulness and presence before eating – essential for thorough digestion!

#4: Help support her puppy microbiome: We gradually began to add a dollop of kefir (5) to her breakfast and dinner – knowing that even dogs have a microbiome and that cultured foods can help normalize gut flora which can help normalize stool consistency. A healthy gut helps us extract nutrients from the food we eat. It can also, fascinatingly, modulate our stress responses.

“Operation Nourishment” began to take effect almost immediately. She jumped from 16 to 24 lbs. in 3 weeks! We were so proud! She finally began to have a soft, healthy belly - and the vet was thrilled, “whatever you’re doing, keep it up!”. She began to sleep through the night – and WE were thrilled. She also began to sprout her golden retriever fur patterns and take on more shine. Brilliantly, her stools became formed – a perfect 4 on the Bristol Stool Scale (1) and had significantly less urgency which led to the elimination of accidents. We were shocked at how quickly her body adapted to a diet higher in nutrient density and digestibility– one that was safe and appropriate for puppies.

Upping her nutrient density and digestibility helped unlock her potential so she could become the best sweet version of herself. Once more deeply nourished, she happily settled into her calm, gentle nature. She and Stella have become quite the pair. And we – her humans - are finally, gratefully sleeping again (most nights), which makes us adore her even more.

How might A Tale of Two Goldens provide us with insight relevant to pelvic rehabilitation?

We acknowledge that no two people come into this world in exactly the same circumstance and that we each arrive with a certain level of built-in resiliency. Some of us come into this world with our tails wagging, ready to greet everything that comes our way. Many of us and those we serve– let’s face it –are figuratively more like Sadie. We have the potential waiting inside of us to become the best version of ourselves.  

Sometimes reaching that potential takes just a little tweaking, a little coaxing, a little know-how. Maybe that tweaking, coaxing, and know-how could include principles of “Operation Nourishment” for ourselves and those we serve in the form of nourishment-focused guidance. With a little patience, time, and intentional action, we may be surprised to see how a few small changes have an enormous impact on what matters most to each of us and those we serve. 

Nourishment knowledge – now more than ever – is vital. 

Join us in 2022 for Nutrition Perspectives for the Pelvic Rehab Therapist to learn more about these principles and beyond. Upcoming 2022 remote offerings include Feb 26-27, April 29-30, July 23-24, August 27-28, Sept 23-24, Oct 22-23, and Nov 11-12. We welcome you to join us.

References:

1. https://www.bladderandbowel.org/wp-content/uploads/2017/05/BBC002_Bristol-Stool-Chart-Jan-2016.pdf  Accessed January 11, 2022.

2. Alves DVS, Sousa MSB, Tavares MGB, Batista-de-Oliveira Hornsby M, Amancio-Dos-Santos A . Coconut oil supplementation during development reduces brain excitability in adult rats nourished and overnourished in lactation. Food Funct. 2021 Apr 7;12(7):3096-3103. doi: 10.1039/d1fo00086a. Epub 2021 Mar 15. PMID: 33720258.

3. Avirineni BS, Singh A, Zapata RC, Phillips CD, Chelikani PK. Dietary whey and egg proteins interact with inulin fiber to modulate energy balance and gut microbiota in obese rats. J Nutr Biochem. 2022 Jan;99:108860. doi: 10.1016/j.jnutbio.2021.108860. Epub 2021 Sep 11. PMID: 34520853.

4. Choi, M., Lee, J. H., Lee, Y. J., Paik, H. D., & Park, E. (2022). Egg Yolk Protein Water Extracts Modulate the Immune Response in BALB/c Mice with Immune Dysfunction Caused by Forced Swimming. Foods, 11(1). doi:10.3390/foods11010121

5. Vieira CP, Rosario AILS, Lelis CA, Rekowsky BSS, Carvalho APA, Rosário DKA, Elias TA, Costa MP, Foguel D, Conte-Junior CA. Bioactive Compounds from Kefir and Their Potential Benefits on Health: A Systematic Review and Meta-Analysis. Oxid Med Cell Longev. 2021 Oct 27;2021:9081738. doi: 10.1155/2021/9081738. PMID: 34745425; PMCID: PMC8566050.

Osteoporosis or low bone mass is much more common than most people realize. Approximately 1 in 2 women over the age of 50 will suffer a fragility fracture in their lifetime. A fragility fracture is identified as a fracture due to a fall from a standing height. According to the US Census Bureau there are 72 million baby boomers (age 51-72) in 2019. Currently over 10 million Americans have osteoporosis and 44 million have low bone mass.

Many myths abound regarding osteoporosis. Answer these 5 questions below to test your Osteoporosis IQ. ¹

1. “Men don’t get osteoporosis.”

Fact: In addition to the statistic above regarding the incidence of fractures in women, up to 1 in 4 men over the age of 50 will suffer a fragility fracture.

2. “Osteoporosis is a natural part of aging.”

Fact: Although we do lose bone density as we age, osteopenia or osteoporosis is a much more significant loss than seen in normal aging. DXA (dual energy x-ray absorptiometry) is the gold standard for measuring bone density and the test shows whether an individual’s numbers fall into the normal, osteopenia, or osteoporosis range based on his or her age.

3. “I don’t need to worry about osteoporosis until I’m older.”

Fact: Osteoporosis has been called a “pediatric condition which manifests itself in old age.” Up until the age of 30 we build bone faster than it breaks down. This includes the growth phase of infants and adolescents and is also the time to build as much bone density as possible. By the age of 30, called our Peak Bone Mass, we have accumulated as much bone density as we will ever have. Proper nutrition, osteoporosis specific exercises, and good body mechanics in our formative years can all play a role in reducing the effects of low bone mass later on.

4. “I exercise regularly (including sit ups and crunches for my core). I would know if I had a fracture.”

Fact: Two myths here. Flexion based exercises such as sit-ups, crunches, and toe touches are contraindicated for osteoporosis. A landmark study done by Dr. Sinaki from Mayo clinic showed women with osteoporosis had an 89% re-fracture rate after performing flexion based exercises. ²

Fact: Secondly, only 30% of vertebral compression fractures (VCF) are symptomatic meaning many individuals fracture without knowing it. This can lead to a fracture cascade as individuals continue performing movements and exercises that are contraindicated.

5. “Tests for osteoporosis are painful and expose you to a lot of radiation.”

Fact: The DXA is a simple and painless test which lasts 5-10 minutes. You lay on your back and the machine scans over you with an open arm- no enclosed spaces. There is very little radiation. Your exposure is 10-15 times more when flying from New York to San Francisco.

How did you do? Feel free to share these myths with your patients, many of whom may have osteoporosis in addition to the primary diagnosis for which they are being treated. To learn more about treating patients with low bone density/osteoporosis, consider attending a Meeks Method for Osteoporosis course!

1. www.nof.org
2. https://www.ncbi.nlm.nih.gov/pubmed/6487063
3. https://www.aafp.org/afp/2016/0701/p44.html