12 Signs Of Liver Disease That You Can See
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“Liver spots” are not, in fact, a sign of liver disease. But here are 12 things that are:
Making sure your liver isn’t about to defy its name
Dr. Siobhan Deshauer explains:
- Muehrcke’s lines: horizontal white lines under the fingernail that don’t move as the nail grows; associated with low albumin levels due to liver disease.
- Terry’s nails: pale nails with a reduced or absent lunula (the half-moon shape at the base); also linked to low albumin from liver dysfunction.
- Clubbing: nails curve around enlarged fingertips and lose the diamond-shaped gap when nails are pressed together; associated with various chronic diseases including liver disease.
- Ascites: swelling of the abdomen due to fluid buildup caused by portal hypertension from liver scarring.
- Caput Medusae: enlarged, visible veins around the navel due to blood rerouting from high pressure in the portal vein.
- Varices: dilated veins in the esophagus or stomach that can rupture and bleed dangerously due to portal hypertension.
- Palmar erythema: redness on the palms, especially over the thenar and hypothenar areas, due to dangerously elevated estrogen levels being common in liver disease.
- Spider nevi: small, spider-like blood vessels on the skin that blanch when pressed; common in liver disease due to very high estrogen.
- Muscle wasting: loss of muscle mass, particularly noticeable in the hands and temples, as the body breaks down muscle for energy when the liver fails.
- Dupuytren’s contracture: thickening and tightening of the palm fascia leading to curled fingers, especially in the ring and pinky fingers.
- Hepatic encephalopathy: brain dysfunction from high ammonia levels due to the liver’s inability to get rid of toxins; includes symptoms like confusion and a flapping tremor (asterixis).
- Jaundice & easy bruising: yellowing of skin and eyes from bilirubin buildup, and frequent bruising or bleeding due to reduced clotting factors and platelets from liver dysfunction.
For more on each of these plus visual illustrations as applicable, enjoy:
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Seriously Useful Communication Skills!
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What Are Communication Skills, Really?
Superficially, communication is “conveying an idea to someone else”. But then again…
Superficially, painting is “covering some kind of surface in paint”, and yet, for some reason, the ceiling you painted at home is not regarded as equally “good painting skills” as Michaelangelo’s, with regard to the ceiling of the Sistine Chapel.
All kinds of “Dark Psychology” enthusiasts on YouTube, authors of “Office Machiavelli” handbooks, etc, tell us that good communication skills are really a matter of persuasive speaking (or writing). And let’s not even get started on “pick-up artist” guides. Bleugh.
Not to get too philosophical, but here at 10almonds, we think that having good communication skills means being able to communicate ideas simply and clearly, and in a way that will benefit as many people as possible.
The implications of this for education are obvious, but what of other situations?
Conflict Resolution
Whether at work or at home or amongst friends or out in public, conflict will happen at some point. Even the most well-intentioned and conscientious partners, family, friends, colleagues, will eventually tread on our toes—or we, on theirs. Often because of misunderstandings, so much precious time will be lost needlessly. It’s good for neither schedule nor soul.
So, how to fix those situations?
I’m OK; You’re OK
In the category of “bestselling books that should have been an article at most”, a top-tier candidate is Thomas Harris’s “I’m OK; You’re OK”.
The (very good) premise of this (rather padded) book is that when seeking to resolve a conflict or potential conflict, we should look for a win-win:
- I’m not OK; you’re not OK ❌
- For example: “Yes, I screwed up and did this bad thing, but you too do bad things all the time”
- I’m OK; you’re not OK ❌
- For example: “It is not I who screwed up; this is actually all your fault”
- I’m not OK; you’re OK ❌
- For example: “I screwed up and am utterly beyond redemption; you should immediately divorce/disown/dismiss/defenestrate me”
- I’m OK; you’re OK ✅
- For example: “I did do this thing which turned out to be incorrect; in my defence it was because you said xyz, but I can understand why you said that, because…” and generally finding a win-win outcome.
So far, so simple.
“I”-Messages
In a conflict, it’s easy to get caught up in “you did this, you did that”, often rushing to assumptions about intent or meaning. And, the closer we are to the person in question, the more emotionally charged, and the more likely we are to do this as a knee-jerk response.
“How could you treat me this way?!” if we are talking to our spouse in a heated moment, perhaps, or “How can you treat a customer this way?!” if it’s a worker at Home Depot.
But the reality is that almost certainly neither our spouse nor the worker wanted to upset us.
Going on the attack will merely put them on the defensive, and they may even launch their own counterattack. It’s not good for anyone.
Instead, what really happened? Express it starting with the word “I”, rather than immediately putting it on the other person. Often our emotions require a little interrogation before they’ll tell us the truth, but it may be something like:
“I expected x, so when you did/said y instead, I was confused and hurt/frustrated/angry/etc”
Bonus: if your partner also understands this kind of communication situation, so much the better! Dark psychology be damned, everything is best when everyone knows the playbook and everyone is seeking the best outcome for all sides.
The Most Powerful “I”-Message Of All
Statements that start with “I” will, unless you are rules-lawyering in bad faith, tend to be less aggressive and thus prompt less defensiveness. An important tool for the toolbox, is:
“I need…”
Softly spoken, firmly if necessary, but gentle. If you do not express your needs, how can you expect anyone to fulfil them? Be that person a partner or a retail worker or anyone else. Probably they want to end the conflict too, so throw them a life-ring and they will (if they can, and are at least halfway sensible) grab it.
- “I need an apology”
- “I need a moment to cool down”
- “I need a refund”
- “I need some reassurance about…” (and detail)
Help the other person to help you!
Everything’s best when it’s you (plural) vs the problem, rather than you (plural) vs each other.
Apology Checklist
Does anyone else remember being forced to write an insincere letter of apology as a child, and the literary disaster that probably followed? As adults, we (hopefully) apologize when and if we mean it, and we want our apology to convey that.
What follows will seem very formal, but honestly, we recommend it in personal life as much as professional. It’s a ten-step apology, and you will forget these steps, so we recommend to copy and paste them into a Notes app or something, because this is of immeasurable value.
It’s good not just for when you want to apologize, but also, for when it’s you who needs an apology and needs to feel it’s sincere. Give your partner (if applicable) a copy of the checklist too!
- Statement of apology—say “I’m sorry”
- Name the offense—say what you did wrong
- Take responsibility for the offense—understand your part in the problem
- Attempt to explain the offense (not to excuse it)—how did it happen and why
- Convey emotions; show remorse
- Address the emotions/damage to the other person—show that you understand or even ask them how it affected them
- Admit fault—understand that you got it wrong and like other human beings you make mistakes
- Promise to be better—let them realize you’re trying to change
- Tell them how you will try to do it different next time and finally
- Request acceptance of the apology
Note: just because you request acceptance of the apology doesn’t mean they must give it. Maybe they won’t, or maybe they need time first. If they’re playing from this same playbook, they might say “I need some time to process this first” or such.
Want to really superpower your relationship? Read this together with your partner:
Hold Me Tight: Seven Conversations for a Lifetime of Love, and, as a bonus:
The Hold Me Tight Workbook: A Couple’s Guide for a Lifetime of Love
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Broccoli vs Zucchini – Which is Healthier?
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Our Verdict
When comparing broccoli to zucchini, we picked the broccoli.
Why?
This one wasn’t close:
In terms of macros, broccoli has more than 2x the fiber, 2x the carbs, and 2x the protein, winning this first round easily.
In the category of vitamins, broccoli has more of vitamins A, B1, B2, B3, B5, B6, B7, B9, C, E, and K, while zucchini is not higher in any vitamins—another easy win for broccoli.
Looking at minerals, broccoli has more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc, sweeping yet another category as zucchini is not higher in any minerals.
In other consideration, broccoli has sulforaphane, which is another point in its favor.
Adding up the sections makes for a very clear overall win for broccoli, but still, do enjoy either or both, as diversity is best!
Want to learn more?
You might like:
Broccoli Sprouts & Sulforaphane
Enjoy!
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Ozempic’s cousin drug liraglutide is about to get cheaper. But how does it stack up?
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Fourteen years ago, the older drug cousin of semaglutide (Ozempic and Wegovy) came onto the market. The drug, liraglutide, is sold under the brand names Victoza and Saxenda.
Patents for Victoza and Saxenda have now expried. So other drug companies are working to develop “generic” versions. These are likely be a fraction of current cost, which is around A$400 a month.
So how does liraglutide compare with semaglutide?
Halfpoint/Shutterstock How do these drugs work?
Liraglutide was not originally developed as a weight-loss treatment. Like semaglutide (Ozempic), it originally treated type 2 diabetes.
The class of drugs liraglutide and semaglutide belong to are known as GLP-1 mimetics, meaning they mimic the natural hormone GLP-1. This hormone is released from your small intestines in response to food and acts in several ways to improve the way your body handles glucose (sugar).
How do they stop hunger?
Liraglutide acts in several regions of the unconscious part of your brain, specifically the hypothalamus, which controls metabolism, and parts of the brain stem responsible for communicating your body’s nutrient status to the hypothalamus.
Its actions here appear to reduce hunger in two different ways. First, it helps you to feel full earlier, making smaller meals more satisfying. Second, it alters your “motivational salience” towards food, meaning it reduces the amount of food you seek out.
Liraglutide’s original formulation, designed to treat type 2 diabetes, was marketed as Victoza. Its ability to cause weight loss was evident soon after it entered the market.
Shortly after, a stronger formulation, called Saxenda, was released, which was intended for weight loss in people with obesity.
How much weight can you lose with liraglutide?
People respond differently and will lose different amounts of weight. But here, we’ll note the average weight loss users can expect. Some will lose more (sometimes much more), others will lose less, and a small proportion won’t respond.
The first GLP-1 mimicking drug was exenatide (Bayetta). It’s still available for treating type 2 diabetes, but there are currently no generics. Exenatide does provide some weight loss, but this is quite modest, typically around 3-5% of body weight.
For liraglutide, those using the drug to treat obesity will use the stronger one (Saxenda), which typically gives about 10% weight loss.
Semaglutide, with the stronger formulation called Wegovy, typically results in 15% weight loss.
The newest GLP-1 mimicking drug on the market, tirzepatide (Mounjaro for type 2 diabetes and Zepbound for weight loss), results in weight loss of around 25% of body weight.
What happens when you stop taking them?
Despite the effectiveness of these medications in helping with weight loss, they do not appear to change people’s weight set-point.
So in many cases, when people stop taking them, they experience a rebound toward their original weight.
People often regain weight when when they stop taking the drug. Mohammed_Al_Ali/Shutterstock What is the dose and how often do you need to take it?
Liraglutide (Victoza) for type 2 diabetes is exactly the same drug as Saxenda for weight loss, but Saxenda is a higher dose.
Although the target for each formulation is the same (the GLP-1 receptor), for glucose control in type 2 diabetes, liraglutide has to (mainly) reach the pancreas.
But to achieve weight loss, it has to reach parts of the brain. This means crossing the blood-brain barrier – and not all of it makes it, meaning more has to be taken.
All the current formulations of GLP-1 mimicking drug are injectables. This won’t change when liraglutide generics hit the market.
However, they differ in how frequently they need to be injected. Liraglutide is a once-daily injection, whereas semaglutide and tirzepatide are once-weekly. (That makes semaglutide and tirzepatide much more attractive, but we won’t see semaglutide as a generic until 2033.)
What are the side effects?
Because all these medicines have the same target in the body, they mostly have the same side effects.
The most common are a range of gastrointestinal upsets including nausea, vomiting, bloating, constipation and diarrhoea. These occur, in part, because these medications slow the movement of food out of the stomach, but are generally managed by increasing the dose slowly.
Recent clinical data suggests the slowing in emptying of the stomach can be problematic for some people, and may increase the risk of of food entering the lungs during operations, so it is important to let your doctor know if you are taking any of these drugs.
Because these are injectables, they can also lead to injection-site reactions.
Gastrointestinal side effects are most common. Halfpoint/Shutterstock During clinical trials, there were some reports of thyroid disease and pancreatitis (inflammation of the pancreas). However, it is not clear that these can be attributed to GLP-1 mimicking drugs.
In animals, GLP-1 mimicking drugs drugs have been found to negatively alter the growth of the embryo. There is currently no controlled clinical trial data on their use during pregnancy, but based on animal data, these medicines should not be used during pregnancy.
Who can use them?
The GLP-1 mimicking drugs for weight loss (Wegovy, Saxenda, Zepbound/Mounjaro) are approved for use by people with obesity and are meant to only be used in conjunction with diet and exercise.
These drugs must be prescribed by a doctor and for obesity are not covered by the Pharmaceutical Benefits Scheme, which is one of the reasons why they are expensive. But in time, generic versions of liraglutide are likely to be more affordable.
Sebastian Furness, ARC Future Fellow, School of Biomedical Sciences, The University of Queensland
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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What Two Days Of Oats Will Do To Your Lipids
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Oats are great for the health, as a general rule of thumb. They have a great nutritional profile in general, for example:
- Brown Rice vs Oats – Which is Healthier?
- Oats vs Rye – Which is Healthier?
- Buckwheat vs Oats – Which is Healthier?
- Oats vs Pearl Barley – Which is Healthier?
- Red Lentils vs Oats – Which is Healthier?
…but its benefits go beyond mere nutrients:
More oats, less cholesterol
The fact that oats lower cholesterol is not new news. Simply, the fiber content of oats, most notably β-glucan, helps the body to remove LDL (“bad”) cholesterol (which binds to certain kinds of fibers, and that’s one of them, then it gets passed through with that fiber, instead of staying in the body).
You can read more about the other benefits of β-glucan, here: The Best Kind Of Fiber For Overall Health?
Researchers (Dr. Linda Klümpen et al.) found, in few words, that just 48 hours of a high-dose oat diet reduced LDL (“bad”) cholesterol by 10% in people with metabolic syndrome—and the effect was still measurable six weeks later.
What they did and how they did it:
- 32 adults with metabolic syndrome completed a two-day oat phase, during which…
- They ate 100 grams of oatmeal 3x per day (that’s equivalent to a medium-sized portion of oatmeal porridge)
- In fact, that is how they took it; as a porridge made with water
- Calories were controlled in an equal manner in both the intervention and control groups
What they found:
- LDL cholesterol dropped by 10% in the oat group.
- Those in the oat group lost an average of 2 kilograms (about 5 lbs) each
- Blood pressure also fell slightly in the oat group.
Why it worked, beyond just the already-known fiber effect: enjoying that quantity of oats per day increased the levels of certain beneficial bacteria, which produce phenolic compounds, including ferulic acid and dihydroferulic acid, which are linked to improved cholesterol metabolism. Other increased-by-oats bacteria also reduced histidine-related pathways connected to insulin resistance.
You may be thinking: shouldn’t I skip the oats and just take probiotics, then?
And the answer is: no, they will just die, they need the specific kinds of fiber from the oats in order to live
Learn more: Stop Sabotaging Your Gut
As for this study (and also to learn about the more modest benefits from less generous oat-substitution options, you can read the paper in full, here:
Don’t find oats exciting?
You might want to spice it up with:
Spiced Pear & Pecan Polyphenol Porridge
…or even try:
Anti-Cholesterol Cardamom & Pistachio Porridge
Enjoy!
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STI rates are increasing among midlife and older adults. We need to talk about it
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Globally, the rates of common sexually transmissible infections (STIs) are increasing among people aged over 50. In some cases, rates are rising faster than among younger people.
Recent data from the United States Centers for Disease Control and Prevention shows that, among people aged 55 and older, rates of gonorrhoea and chlamydia, two of the most common STIs, more than doubled between 2012 and 2022.
Australian STI surveillance data has reflected similar trends. Between 2013 and 2022, there was a steady increase in diagnoses of chlamydia, gonorrhoea and syphilis among people aged 40 and older. For example, there were 5,883 notifications of chlamydia in Australians 40 plus in 2013, compared with 10,263 in 2022.
A 2020 study of Australian women also showed that, between 2000 and 2018, there was a sharper increase in STI diagnoses among women aged 55–74 than among younger women.
While the overall rate of common STIs is highest among young adults, the significant increase in STI diagnoses among midlife and older adults suggests we need to pay more attention to sexual health across the life course.
Fit Ztudio/Shutterstock Why are STI rates rising among older adults?
STI rates are increasing globally for all age groups, and an increase among midlife and older people is in line with this trend.
However, increases of STIs among older people are likely due to a combination of changing sex and relationship practices and hidden sexual health needs among this group.
The “boomer” generation came of age in the 60s and 70s. They are the generation of free love and their attitude to sex, even as they age, is quite different to that of generations before them.
Given the median age of divorce in Australia is now over 43, and the internet has ushered in new opportunities for post-separation dating, it’s not surprising that midlife and older adults are exploring new sexual practices or finding multiple sexual partners.
People may start new relationships later in life. Tint Media/Shutterstock It’s also possible midlife and older people have not had exposure to sexual health education in school or do not relate to current safe sex messages, which tend to be directed toward young people. Condoms may therefore seem unnecessary for people who aren’t trying to avoid pregnancy. Older people may also lack confidence negotiating safe sex or accessing STI screening.
Hidden sexual health needs
In contemporary life, the sex lives of older adults are largely invisible. Ageing and older bodies are often associated with loss of power and desirability, reflected in the stereotype of older people as asexual and in derogatory jokes about older people having sex.
With some exceptions, we see few positive representations of older sexual bodies in film or television.
Older people’s sexuality is also largely invisible in public policy. In a review of Australian policy relating to sexual and reproductive health, researchers found midlife and older adults were rarely mentioned.
Sexual health policy generally targets groups with the highest STI rates, which excludes most older people. As midlife and older adults are beyond childbearing years, they also do not feature in reproductive health policy. This means there is a general absence of any policy related to sex or sexual health among midlife or older adults.
Added to this, sexual health policy tends to be focused on risk rather than sexual wellbeing. Sexual wellbeing, including freedom and capacity to pursue pleasurable sexual experiences, is strongly associated with overall health and quality of life for adults of all ages. Including sexual wellbeing as a policy priority would enable a focus on safe and respectful sex and relationships across the adult life course.
Without this priority, we have limited knowledge about what supports sexual wellbeing as people age and limited funding for initiatives to engage with midlife or older adults on these issues.
Midlife and older adults may have limited knowledge about STIs. Southworks/Shutterstock How can we support sexual health and wellbeing for older adults?
Most STIs are easily treatable. Serious complications can occur, however, when STIs are undiagnosed and untreated over a long period. Untreated STIs can also be passed on to others.
Late diagnosis is not uncommon as some STIs can have no symptoms and many people don’t routinely screen for STIs. Older, heterosexual adults are, in general, less likely than other groups to seek regular STI screening.
For midlife or older adults, STIs may also be diagnosed late because some doctors do not initiate testing due to concerns they will cause offence or because they assume STI risk among older people is negligible.
Many doctors are reluctant to discuss sexual health with their older patients unless the patient explicitly raises the topic. However, older people can be embarrassed or feel awkward raising matters of sex.
Resources for health-care providers and patients to facilitate conversations about sexual health and STI screening with older patients would be a good first step.
To address rising rates of STIs among midlife and older adults, we also need to ensure sexual health promotion is targeted toward these age groups and improve accessibility of clinical services.
More broadly, it’s important to consider ways to ensure sexual wellbeing is prioritised in policy and practice related to midlife and older adulthood.
A comprehensive approach to older people’s sexual health, that explicitly places value on the significance of sex and intimacy in people’s lives, will enhance our ability to more effectively respond to sexual health and STI prevention across the life course.
Jennifer Power, Associate Professor and Principal Research Fellow, Australian Research Centre in Sex, Health and Society, La Trobe University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Ice Baths: To Dip Or Not To Dip?
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We asked you for your (health-related) view of ice baths, and got the above-depicted, below-described, set of responses:
- About 31% said “ice baths are great for the health; we should take them”
- About 29% said “ice baths’ risks outweigh their few benefits”
- About 26% said “ice baths’ benefits outweigh their few risks”
- About 14% said “ice baths are dangerous and can kill you; best avoided”
So what does the science say?
Freezing water is very dangerous: True or False?
True! Water close to freezing point is indeed very dangerous, and can most certainly kill you.
Fun fact, though: many such people are still saveable with timely medical intervention, in part because the same hypothermia that is killing them also slows down the process* of death
Source (and science) for both parts of that:
Cold water immersion: sudden death and prolonged survival
*and biologically speaking, death is a process, not an event, by the way. But we don’t have room for that today!
(unless you die in some sudden violent way, such as a powerful explosion that destroys your brain instantly; then it’s an event)
Ice baths are thus also very dangerous: True or False?
False! Assuming that they are undertaken responsibly and you have no chronic diseases that make it more dangerous for you.
What does “undertaken responsibly” mean?
Firstly, the temperature should not be near freezing. It should be 10–15℃, which for Americans is 50–59℉.
You can get a bath thermometer to check this, by the way. Here’s an example product on Amazon.
Secondly, your ice bath should last no more than 10–15 minutes. This is not a place to go to sleep.
What chronic diseases would make it dangerous?
Do check with your doctor if you have any doubts, as no list we make can be exhaustive and we don’t know your personal medical history, but the main culprits are:
- Cardiovascular disease
- Hypertension
- Diabetes (any type)
The first two are for heart attack risk; the latter is because diabetes can affect core temperature regulation.
Ice baths are good for the heart: True or False?
True or False depending on how they’re done, and your health before starting.
For most people, undertaking ice baths responsibly, repeated ice bath use causes the cardiovascular system to adapt to better maintain homeostasis when subjected to thermal shock (i.e. sudden rapid changes in temperature).
For example: Respiratory and cardiovascular responses to cold stress following repeated cold water immersion
And because that was a small study, here’s a big research review with a lot of data; just scroll to where it has the heading“Specific thermoregulative adaptations to regular exposure to cold air and/or cold water exposure“ for many examples and much discussion:
Health effects of voluntary exposure to cold water: a continuing subject of debate
Ice baths are good against inflammation: True or False?
True! Here’s one example:
Uric acid and glutathione levels (important markers of chronic inflammation) are also significantly affected:
Uric acid and glutathione levels during short-term whole body cold exposure
Want to know more?
That’s all we have room for today, but check out our previous “Expert Insights” main feature looking at Wim Hof’s work in cryotherapy:
A Cold Shower A Day Keeps The Doctor Away?
Enjoy!
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