Medical Bulletin 07/August/2025

“Our findings suggest the massive burden of low back pain could be markedly reduced if health policies supported widespread implementation of high-value, low-risk and sustained interventions like CFT, instead of less effective, short-term and potentially harmful interventions like opioids or surgery,” says lead author Professor Mark Hancock, Professor of Physiotherapy at Macquarie University.

Unlike short-term solutions like medication or manual therapy, Cognitive Functional Therapy equips patients with lasting strategies.

Reference: Cognitive functional therapy with or without movement sensor biofeedback versus usual care for chronic, disabling low back pain (RESTORE): 3-year follow-up of a randomised, controlled trial, Hancock, Mark et al., The Lancet Rheumatology, Volume 0, Issue 0

Does Drinking Coffee at Night Make You More Impulsive?

Drinking coffee late at night could lead to more impulsive and potentially risky behaviour—especially in women—according to a new study conducted by researchers at The University of Texas at El Paso (UTEP). Published in the journal iScience, the research found that nighttime caffeine consumption disrupts inhibition and increases impulsivity, even when caffeine levels remain the same throughout the day.

To explore how caffeine affects behaviour during different times of the day, researchers used fruit flies (Drosophila melanogaster), a widely accepted model for studying complex behaviours due to their genetic and neurological similarities to humans. The research team introduced caffeine into the flies' diets under various controlled conditions, varying the dosage, time of consumption (day vs. night), and even pairing it with sleep deprivation.

They then evaluated the flies’ responses to strong airflow—a naturally aversive stimulus—to measure impulsivity. Normally, fruit flies reduce movement when exposed to strong gusts. However, this response changed when caffeine was introduced at night.

“Under normal circumstances, flies stop moving when exposed to strong airflow,” said Erick Saldes, a science research specialist at the University of Illinois College of Medicine Peoria. “We found that flies consuming caffeine at night were less able to suppress movement, displaying impulsive behaviours such as reckless flying despite these aversive conditions,” he added.

Interestingly, the same caffeine dose consumed during the day did not cause similar behavioural changes. Even more notable was the difference between male and female flies—females showed significantly higher impulsive responses to nighttime caffeine, despite having similar caffeine levels in their bodies.

“Flies don't have human hormones like oestrogen, suggesting that other genetic or physiological factors are driving the heightened sensitivity in females,” explained Professor Kyung-An Han of UTEP’s Department of Biological Sciences.

The findings may have real-world consequences for individuals who regularly consume caffeine at night, such as shift workers, healthcare professionals, and military personnel. The researchers hope that further exploration of these mechanisms will enhance understanding of how biological sex and circadian rhythms influence caffeine’s behavioural effects.

Reference: Nighttime caffeine intake increases motor impulsivity, Saldes, Erick Benjamin et al., iScience, Volume 28, Issue 8, 113197

One Diet, Dual Benefits: DASH4D Lowers Blood Sugar and Blood Pressure

A new study published in Nature Medicine reveals that a modified version of the DASH diet—known as DASH4D—can significantly improve blood glucose levels in individuals with type 2 diabetes. The clinical trial, led by researchers at the Johns Hopkins Bloomberg School of Public Health, shows that the tailored diet also helps participants spend more time within healthy blood sugar ranges, making it a promising dietary intervention for long-term diabetes management.

Originally developed in the 1990s to reduce high blood pressure, the DASH (Dietary Approaches to Stop Hypertension) diet is rich in fruits, vegetables, and low-fat dairy, and low in saturated fats and cholesterol. To adapt it for people with type 2 diabetes, researchers modified the diet by reducing carbohydrates, increasing unsaturated fats, and adjusting potassium levels to make it safer for those with kidney disease. This new version, called DASH4D, was tested in a 20-week controlled trial involving 89 participants.

During the study, participants ate only meals prepared at a clinical center—half the time following the DASH4D diet and half on a standard American-style diet. Each diet period lasted five weeks, and participants were randomly assigned to different sequences of diets with varying sodium levels. Blood glucose levels were continuously monitored using wearable CGM (continuous glucose monitoring) devices.

The results were notable. On the DASH4D diet, participants saw their average blood glucose levels drop by 11 mg/dL and spent 75 more minutes per day in the optimal glucose range. These changes are considered clinically meaningful and could help reduce risks of complications such as heart and kidney disease. The benefits were even more pronounced in individuals who had poorer glucose control at the start of the trial.

“The original DASH diet has long been recommended for people with diabetes and other health conditions due to its effectiveness in lowering blood pressure, but this is the first time a controlled study has shown a significant improvement in glucose control as well,” says study senior author Elizabeth Selvin, PhD, MPH, Director of the Welch Center for Prevention, Epidemiology and Clinical Research and professor in the Bloomberg School’s Department of Epidemiology.

Researchers believe these findings could influence future dietary guidelines and offer a sustainable way to help manage diabetes at the population level.

Reference: Fang, M., Wang, D., Rebholz, C.M. et al. DASH4D diet for glycemic control and glucose variability in type 2 diabetes: a randomized crossover trial. Nat Med (2025). https://doi.org/10.1038/s41591-025-03823-3