Rachele Pojednic

Introduction: Cannabidiol (CBD) use has increased substantially in the United States alongside expanding legalization of cannabis and hemp-derived products. CBD is widely marketed for recovery, sleep, stress reduction, and overall well-being, yet evidence supporting these claims in healthy, physically active populations remains limited and mixed. Most controlled trials have been conducted in predominantly male cohorts, and emerging data suggest potential sex differences in CBD pharmacokinetics, underscoring the need to characterize female users. Methods: This cross-sectional study examined behavioral and physiologic health correlates of real-world CBD use among recreationally active women aged 18–40 years. Participants completed validated assessments of physical activity (IPAQ), dietary patterns (PrimeScreen), sleep quality (PSQI), mental health (SFMHC), quality of life (QOL), and pain (VAP); a subset completed a 50-marker fasting blood panel. Current CBD users were compared to non-users (past and never users combined). Results: In the survey-only cohort ( n = 149; 78 current users), CBD users reported significantly lower total MET-minutes (6,627 ± 5,344 vs. 11,301 ± 9,805; p < 0.01), shorter sleep duration ( p < 0.001), and lower quality of life measures ( p < 0.01). Mental health scores were lower but not statistically significant. Dietary quality was slightly higher among users ( p < 0.01), though tobacco use was greater ( p = 0.04). Post-exercise pain did not differ. In the biomarker subcohort ( n = 20), non-users demonstrated higher basophils ( p = 0.02), sex hormone-binding globulin ( p = 0.04), and testosterone ( p < 0.01), and lower thyroid-stimulating hormone ( p = 0.05), with most values within reference ranges. Discussion: CBD use clustered with distinct behavioral and psychosocial characteristics, warranting longitudinal, sex-specific investigation.

Background: Nicotinamide adenine dinucleotide (NAD ⁺ ) is a cofactor for NAD ⁺ -dependent enzymes that regulate DNA repair, cellular metabolism, and immune function. Supplementation with NAD ⁺ and its precursors is commonly used to prevent age-related disease and extend healthspan. Commercial clinical and wellness settings increasingly provide intravenous (IV) NAD ⁺ and nicotinamide riboside (NR) despite limited evaluation of safety and effectiveness. These considerations are important, as NAD ⁺ and its precursors differ in reported side effects, cellular uptake, and metabolism. This study sought to compare commercially administered NAD ⁺ IV and NR IV in humans by evaluating infusion time, tolerability, safety markers, and metabolic outcomes. Methods: A retrospective review of electronic medical records was conducted in clients from a commercial setting. Participants received four consecutive days of 500 mg NAD ⁺ IV or NR IV, with 30 days follow-up. Primary outcomes included reported symptoms, total infusion time, blood pressure, resting heart rate, and biomarker assessments (ALT, AST, hsCRP, BUN/creatinine, and TSH). Exploratory analyses included metabolic biomarkers (HbA1c, fasting glucose, HDL-C, LDL-C, and triglycerides). Results: Tolerability differed between groups. Participants that received NAD ⁺ IV reported moderate to severe gastrointestinal symptoms, increased heart rate, and chest pressure during infusions. Participants receiving NR IV experienced minor tongue, jaw, and arm tingling and mild cramping during infusion. All symptoms resolved upon infusion completion. Moderate to severe symptoms with NAD ⁺ IV resulted in longer infusion times compared to NR IV, averaging 97 min versus 37 min, respectively. No significant changes were observed in ALT, AST, hsCRP, BUN/creatinine, or TSH. Alkaline phosphatase (ALP) decreased significantly in the NAD ⁺ IV group only, with values remaining within normal reference ranges. The NR IV group demonstrated a significant reduction in HbA1c, whereas the NAD ⁺ IV group showed a significant reduction in HDL-C. Neither group exhibited changes in fasting glucose or LDL-C over the 30-day period. Conclusion: This study directly compared commercially administered NAD ⁺ IV and NR IV, providing preliminary real-world evidence of infusion tolerability and short-term safety. Exploratory metabolic outcomes were variable and warrant further investigation. Additional studies are needed to evaluate dosage and effectiveness beyond 30 days.

Objective: Assess potential associations between the health behaviors, resilience, and body mass index (BMI) of first-year students and compare these metrics between students at a small military college and a representative national sample. Methods: Cross-sectional data were collected via an online survey administered by the American College Health Association (ACHA) during the fall of 2022 from first-year students at a senior military college (n = 77) and first-year college students who completed the NCHA-III (n = 7644). Results: Military college students had significantly higher levels of weekly vigorous physical activity and strength training than the national sample. Vigorous physical activity, strength training, and better sleep significantly predicted improved psychological resilience and BMI values in the national sample. No behaviors predicted psychological resilience or BMI in the military college sample. Conclusions: Health behaviors like physical activity and sleep may improve resilience and body weight in civilian college students. However, combining military training with college life appears to have less impact on the relationship between health behaviors and resilience.

Introduction: Clinical trials have shown efficacy of semaglutide for weight loss, but further study is needed in less controlled environments including impacts on body composition. Materials and Methods: This retrospective study included individuals who participated in a weight management programme at a commercial wellness studio receiving once‐weekly compounded semaglutide/cyanocobalamin injections from June 2023 to January 2024. Once‐weekly semaglutide/cyanocobalamin injected subcutaneously starting at 0.25 mg/0.125 mg and titrated to a maximum dose of 2.4 mg/0.24 mg. The primary endpoint was weight loss at 3 months, with secondary analyses including weight loss percentage, weight loss by body mass index (BMI) class and body composition changes including changes in total fat mass, lean body mass, skeletal muscle mass and trunk adiposity. Results: A total of 94 individuals were analysed (81F/13M), age in years mean (SD) = 46.57 (10.60). After 3 months, average weight loss was 4.11 (2.77) kg or 4.57% (2.96%). Individuals lost fat mass (2.67 (2.37) kg) and trunk fat mass (1.10 (1.36) kg), while also losing small amounts of lean mass (1.43 (1.41) kg) and skeletal muscle mass (0.88 (0.81) kg). As a proportion of total weight, fat mass decreased while lean muscle mass and skeletal muscle mass increased. Discussion: This study demonstrates that meaningful weight loss is achievable on semaglutide/cyanocobalamin outside of a closely controlled environment. In addition, body composition improved with losses in fat mass and gains in overall proportion of lean muscle and skeletal muscle.

Background and Objectives: In this study we analyzed the perceived effectiveness of cannabidiol (CBD) in adult women with inflammatory bowel disease (IBD). Materials and Methods: We conducted an online cross-sectional survey which assessed disease severity and quality of life (QOL) in women with IBD (Crohn’s disease and ulcerative colitis) who used CBD versus those who did not. The survey included: the Harvey–Bradshaw Index, Partial Mayo Score, Short Inflammatory Bowel Disease Questionnaire, Bristol Stool Scale, and the Prime Screen Short Food Frequency Questionnaire. CBD utilization practices were also examined. STROBE reporting outcomes were followed. Statistical methods included Pearson and Spearman’s correlations and chi-square analyses. Results: Seventy-one (n = 71) women were included. Twenty-five (n = 25) were CBD users and forty-six (n = 46) were past/never users. Most current users ingested CBD once per day (40%), acquired CBD from a dispensary (56%), and utilized an oral tincture (40%) at a dose of 25 mg or less (56%). There was no statistical association between CBD use and disease severity, quality of life (QOL), fecal consistency, or food intake. However, CBD users reported decreases in IBD-related pain and nausea (76% and 64%, respectively), and improvement in appetite (60%). Overall, disease severity and QOL were inversely correlated (past/never users: p = 0.000, r = −0.544; current users: p = 0.042, r = −0.427). Conclusions: Women with IBD who use CBD insignificantly trended toward improved disease-related symptoms, appetite, and QOL compared to non-users. Disease severity and QOL were inversely associated, regardless of CBD use. These preliminary outcomes indicate the need for further research on CBD use in women with IBD.

Background: Chronically elevated inflammation is implicated in many conditions, including obesity, metabolic syndrome, and cardiovascular disease, and has been associated with increased mortality risk. Whole-body cryotherapy (W-BC) is a promising modality to treat inflammation with demonstrated benefits for clinical subpopulations including those with arthritis, obesity, and type 2 diabetes. However, it is unclear whether the benefit from W-BC extends to healthy individuals prior to chronic disease–related inflammation. In addition, the long-term durability of W-BC effect is unknown. Objective: This study investigates the inflammatory response to W-BC in healthy adults with a biomarker of inflammation, high-sensitivity C-reactive protein (hsCRP), and clinical biomarkers of metabolism including fasting glucose, hemoglobin A1c (HbA1c), low-density lipoprotein (LDL) and high-density lipoprotein (HDL), and triglycerides. Methods: Fifteen individuals (n=9 female) participated in frequent recreational W-BC (3 minutes of cold exposure at –110 ℃) over approximately 9 months and had blood draws at baseline plus follow-up visits. Biomarkers were modeled as linear functions of W-BC sessions received in the month prior to blood draw. Results: The mean amount of W-BC received was 6.78 (SD 4.26) times per month with the cumulative total ranging from 13 to 157 W-BC sessions over the course of the study. On average, participants completed 1-2 sessions per week throughout the intervention. The number of W-BC sessions were associated with decreased hsCRP (–0.14 mg/L in hsCRP per W-BC session; P<.01) and with durability of up to 9 months. Increased W-BC was also associated with a downward trend in fasting glucose. This trend failed to reach significance at 1 month (–0.73 mg/dL in fasting glucose per W-BC session; P<.10) but was significant for 2- and 3-month windows (P<.05). HbA1c was increased significantly after 9 months (P<.01); however, the change occurred within normal ranges (difference=0.13% and .10), although LDL trended lower over the time period examined (P=.07). Conclusions: These results suggest that W-BC beneficially impacts systemic inflammation by lowering hsCRP levels in healthy individuals and may also have some modulating effect on fasting glucose.

Background: Poor physical fitness, stress, and fatigue are factors impacting military readiness, national security, and economic burden for the United States Department of Defense. Improved accuracy of wearable biosensors and remote field biologic sample collection strategies could make critical contributions to understanding how physical readiness and occupational stressors result in on-the-job and environment-related injury, sleep impairments, diagnosis of mental health disorders, and reductions in performance in war-fighters. Objective: This study aimed to evaluate the feasibility and acceptability of intensive biomarker and biometric data collection to understand physiological and psychological stress in Army Reserved Officer Training Corps cadets before, during, and after a 96-hour field training exercise (FTX). Methods: A prospective pilot study evaluated the feasibility and acceptability of multimodal field data collection using passive drool saliva sampling, sweat sensors, accelerometry, actigraphy, and photoplethysmography. In addition, physical fitness (Army Combat Fitness Test), self-reported injury, and psychological resilience (Brief Resilience Scale) were measured. Results: A total of 22 cadets were included. Two were lost to follow-up due to injury during FTX, for a retention rate of 91%. Assessments of performance and psychological resilience were completed for all remaining participants, resulting in 100% testing adherence. All participants provided saliva samples before the FTX, with 98% adherence at the second time point and 91% at the third. For sweat, data collection was not possible. Average daily wear time for photoplethysmography devices was good to excellent, meeting a 70% threshold with data collected for ≥80% of person-days at all time points. Of the participants who completed the FTX and 12 completed a post-FTX acceptability survey for a response rate of 60%. Overall, participant acceptance was high (≥80%) for all metrics and devices. Conclusions: This study demonstrates that wearable biosensors and remote field biologic sample collection strategies during a military FTX have the potential to be used in higher stakes tactical environments in the future for some, but not all, of the strategies. Overall, real-time biometric and biomarker sampling is feasible and acceptable during field-based training and provides insights and strategies for future interventions on military cadet and active-duty readiness, environmental stress, and recovery.

Background: Warfighters, often called tactical athletes, seek dietary supplementation to enhance training and recovery. Roughly 69% of active-duty US military personnel have reported consuming dietary supplements. The objective of this systematic review was to examine the impact of dietary supplements on muscle-related physical performance and recovery in active-duty military personnel. Methods: Randomized controlled trials and quasi-experimental controlled trials of oral dietary supplementation in active-duty military members were examined. A protocol was registered (PROSPERO CRD42023401472), and a systematic search of MEDLINE and CINAHL was undertaken. Inclusion criteria consisted of studies published between 1990–2023 with outcomes of muscle performance and recovery among active-duty military populations. The risk of bias was assessed with the McMaster University Guidelines and Critical Review Form for Quantitative Studies. Results: Sixteen studies were included. Four were conducted on protein or carbohydrate; four on beta-alanine alone, creatine alone, or in combination; two on mixed nutritional supplements; two on probiotics alone or in combination with beta hydroxy-beta methylbutyrate calcium; and four on phytonutrient extracts including oregano, beetroot juice, quercetin, and resveratrol. Ten examined outcomes related to physical performance, and six on outcomes of injury or recovery. Overall, protein, carbohydrate, beta-alanine, creatine, and beetroot juice modestly improved performance, while quercetin did not. Protein, carbohydrates, beta-alanine, probiotics, and oregano reduced markers of inflammation, while resveratrol did not. Conclusions: Nutrition supplementation may have small benefits on muscle performance and recovery in warfighters. However, there are significant limitations in interpretation due to the largely inconsistent evidence of ingredients and comparable outcomes. Thus, there is inadequate practical evidence to suggest how dietary supplementation may affect field performance.

BACKGROUND Chronically elevated inflammation is implicated in many conditions, including obesity, metabolic syndrome, and cardiovascular disease, and has been associated with increased mortality risk. Whole-body cryotherapy (W-BC) is a promising modality to treat inflammation with demonstrated benefits for clinical subpopulations including those with arthritis, obesity, and type 2 diabetes. However, it is unclear whether the benefit from W-BC extends to healthy individuals prior to chronic disease–related inflammation. In addition, the long-term durability of W-BC effect is unknown. OBJECTIVE This study investigates the inflammatory response to W-BC in healthy adults with a biomarker of inflammation, high-sensitivity C-reactive protein (hsCRP), and clinical biomarkers of metabolism including fasting glucose, hemoglobin A1c (HbA1c), low-density lipoprotein (LDL) and high-density lipoprotein (HDL), and triglycerides. METHODS Fifteen individuals (n=9 female) participated in frequent recreational W-BC (3 minutes of cold exposure at –110 ℃) over approximately 9 months and had blood draws at baseline plus follow-up visits. Biomarkers were modeled as linear functions of W-BC sessions received in the month prior to blood draw. RESULTS The mean amount of W-BC received was 6.78 (SD 4.26) times per month with the cumulative total ranging from 13 to 157 W-BC sessions over the course of the study. On average, participants completed 1-2 sessions per week throughout the intervention. The number of W-BC sessions were associated with decreased hsCRP (–0.14 mg/L in hsCRP per W-BC session; P<.01) and with durability of up to 9 months. Increased W-BC was also associated with a downward trend in fasting glucose. This trend failed to reach significance at 1 month (–0.73 mg/dL in fasting glucose per W-BC session; P<.10) but was significant for 2- and 3-month windows (P<.05). HbA1c was increased significantly after 9 months (P<.01); however, the change occurred within normal ranges (difference=0.13% and .10), although LDL trended lower over the time period examined (P=.07). CONCLUSIONS These results suggest that W-BC beneficially impacts systemic inflammation by lowering hsCRP levels in healthy individuals and may also have some modulating effect on fasting glucose.

BACKGROUND Poor physical fitness, stress, and fatigue are factors impacting military readiness, national security, and economic burden for the United States Department of Defense. Improved accuracy of wearable biosensors and remote field biologic sample collection strategies could make critical contributions to understanding how physical readiness and occupational stressors result in on-the-job and environment-related injury, sleep impairments, diagnosis of mental health disorders, and reductions in performance in war-fighters. OBJECTIVE This study aimed to evaluate the feasibility and acceptability of intensive biomarker and biometric data collection to understand physiological and psychological stress in Army Reserved Officer Training Corps cadets before, during, and after a 96-hour field training exercise (FTX). METHODS A prospective pilot study evaluated the feasibility and acceptability of multimodal field data collection using passive drool saliva sampling, sweat sensors, accelerometry, actigraphy, and photoplethysmography. In addition, physical fitness (Army Combat Fitness Test), self-reported injury, and psychological resilience (Brief Resilience Scale) were measured. RESULTS A total of 22 cadets were included. Two were lost to follow-up due to injury during FTX, for a retention rate of 91%. Assessments of performance and psychological resilience were completed for all remaining participants, resulting in 100% testing adherence. All participants provided saliva samples before the FTX, with 98% adherence at the second time point and 91% at the third. For sweat, data collection was not possible. Average daily wear time for photoplethysmography devices was good to excellent, meeting a 70% threshold with data collected for ≥80% of person-days at all time points. Of the participants who completed the FTX and 12 completed a post-FTX acceptability survey for a response rate of 60%. Overall, participant acceptance was high (≥80%) for all metrics and devices. CONCLUSIONS This study demonstrates that wearable biosensors and remote field biologic sample collection strategies during a military FTX have the potential to be used in higher stakes tactical environments in the future for some, but not all, of the strategies. Overall, real-time biometric and biomarker sampling is feasible and acceptable during field-based training and provides insights and strategies for future interventions on military cadet and active-duty readiness, environmental stress, and recovery. CLINICALTRIAL