5 Ways To Beat Afternoon Energy Slumps
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This is Nisha Vora, of Rainbow Plant Life fame. After graduating from Harvard Law School, she realized she hated being a lawyer, and pivoted completely to become what she now is 12 years later, a chef and health coach.
Here are her tips for boosting energy through the day:
Caffeine timing
If you don’t do caffeine at all, no need to change that, but if you do, Vora advises that midday is the best time for it, with a very good rationale:
- of course it should not be too late in the day, because the elimination half-life of caffeine (4–8 hours to eliminate just half of the caffeine, depending on genes, call it 6 hours as an average though honestly for most people it will either be 4 or 8, not 6) is such that it can easily interfere with sleep for most people
- because caffeine is an adenosine blocker, not an adenosine inhibitor, taking caffeine in the morning means either there’s no adenosine to block, or it’ll just “save” that adenosine for later, i.e. when the caffeine is eliminated, then the adenosine will kick in, meaning that your morning sleepiness has now been deferred to the afternoon, rather than eliminated.
Another reminder that caffeine is the “payday loan” of energy. So, midday it is. No morning sleepiness to defer, and yet also not so late as to interfere with sleep.
See also: Calculate (And Enjoy) The Perfect Night’s Sleep
Simplify what can be simplified
This one’s not from a physiological basis, but rather, that a lot of the time most of us have much of our energy being taken by constant task-switching (what gets called multitasking, but as our brain is a single processor, it really means switching rapidly between different kinds of cognition, which is not efficient). In order to avoid that energy drain, try to streamline things and make a particular effort to not only single-task, but to do so without distractions.
Counterpoint: if you have unmedicated ADHD, then chances are you’ll do better with a single small distraction chosen by you, than trying to go without distractions, because your brain will find distractions anyway, so you might as well choose one (for many people it is background music, or a podcast or TV show that one doesn’t may attention to but it’s there) as a matter of harm reduction, and that way you’ll do better at focusing on your primary task than if your brain were reaching out for every and any possible distraction.
Manage your blood sugars
In particular, she advocates for avoiding sugary breakfasts, opting instead for protein, fat, and fiber-rich options. For more in this regard, see:
10 Ways To Balance Your Blood Sugars
Walk after meals
You don’t have to don hiking boots and “I am just going outside and may be some time“; rather, even a 2–5 minute walk after a meal helps regulate digestion and glucose levels, avoiding postprandial energy slumps.
So,
- if you have a treadmill, after eating is a great time to use it for a few minutes
- if you have stairs, now’s a great time to go up and down them a few times
One last technique for when everything else fails
We’ll quote her directly on this one:
❝Despite my best efforts, soemtimes I just have one of those days. Maybe I didn’t sleep well or I’m distracted by my never ending thoughts. If I need to be productive or energized on those days, I will do something that I absolutely hate:
I will take a cold shower.
And I hate it because I’m already always cold all the time, so why would I want to get a cold shower?
Well, it’s because cold water immersion has been shown to dramatically boost your dopamine levels, which gives you more energy and motivation.
In the moment though, it’s mostly painful and I hate everything and everyone around me.
But I know that if I can suffer through two minutes of a cold shower, I will feel so refreshed.❞
There are more benefits than just that, though, see:
A Cold Shower A Day Keeps The Doctor Away?
Want more from Nisha Vora?
We reviewed one of her books a while back:
The Vegan Instant Pot Cookbook – by Nisha Vora
Enjoy!
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Better Than BMI
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BMI is a very flawed system, and there are several more useful ways of measuring our bodies. Let’s take a look at them!
What’s wrong with BMI?
Oof, what isn’t wrong with BMI?
In short, it was developed as a demographic-based tool to specifically chart the weight-related health of working-age European white men a little under 200 years ago.
This means that if you are, perchance, not a working-age European white man in 1830 or so, then it’s not so useful. It’d be like first establishing height norms based on NBA basketball players, and then applying it to the general population, and thus coming to the conclusion that someone who is 6’2″ is very short.
In long, we did a deep-dive into it here, and in particular what things go dangerously wrong when it’s applied to women, non-white people, athletic people, pregnant people, people under 16 or over 65 and more:
When BMI Doesn’t Quite Measure Up
What we usually recommend instead
For heart disease risk and diabetes risk both, waist circumference is a much more universally reliable indicator. And since those two things tend to affect a lot of other health risks, it becomes an excellent starting point for being aware of many aspects of health.
Pregnancy will still throw off waist circumference a little (measure below the bump, not around it!), but it will nevertheless be more helpful than BMI even then, as it becomes necessary to just increase the numbers a little, according to gestational month and any confounding factors e.g. twins, triplets, etc. Ask your obstetrician about this, as it’s beyond the scope of our article today!
As to what’s considered a risk:
- Waist circumference of more than 35 inches for women
- Waist circumference of more than 40 inches for men
These numbers are considered applicable across demographics of age, ethnicity, and lifestyle.
Bonus extra measurement based on the above
Important also is waist to hip ratio.
How to calculate it:
- measure your waist circumference
- measure your hip circumference
- divide the first measurement by the second one
Because it’s a ratio, it doesn’t matter what units you use (e.g. inches, cm, etc) so long as you use the same units for both measurements.
The World Health Organization offers the following chart:
Health risk Women Men Low 0.80 or lower 0.95 or lower Moderate 0.81–0.85 0.96–1.0 High 0.86 or higher 1.1 or higher Source: Waist Circumference and Waist-Hip Ratio: Report of a WHO Expert Consultation
This is especially relevant for cardiovascular disease risk:
…and also holds true for all-cause mortality:
Waist-Hip-Ratio as a Predictor of All-Cause Mortality in High-Functioning Older Adults
An ancient contender that’s still more useful than BMI
Remember Archimedes? The (perhaps apocryphal) story of his “Eureka” moment in the bathtub when he realized that water displacement could be used to measure the volume of an irregular shape?
Just like Archimedes (who, the story goes, had been hired to determine the composition of a crown that might or might not have been pure gold), we can use this method to determine body composition, because we have references for how much a given volume of a given substance will weigh, so combing what we know about a body’s weight and volume will tell us about its composition in ways that neither metric could give us alone.
Indeed, it’s one of the commonly-mentioned flaws of BMI that muscle weighs more than fat, and Archimedes’ method not only avoids that problem, but also, actually turns that knowledge (muscle weighs more than fat) to our advantage.
It’s called “hydrostatic weighing” now:
You may be wondering: what about bones? Or internal organs?
The fact is that those are slightly confounding factors that do get in the way of a truly accurate analysis, but the variation in how much one person’s skeleton weighs vs another’s, or one person’s set of organs weigh than another’s, is too small to make an important difference to the health implications.
Lastly…
Hydrostatic weighing isn’t the only way to work out how much of our body is made of fat; if you have for example a smart scale at home (like this one) that tells you your body fat percentage, that is an estimate based on bioelectrical impedance analysis.
It’s less accurate than the hydrostatic method, but easier to do at home!
As to what percentages are “best”, healthy body fat percentages are (assuming normal hormones) generally considered to be in the range of 20–25% for women and 15–20% for men.
You can read more about this here:
Is A Visible Six-Pack Obtainable Regardless Of Genetic Predisposition?
Take care!
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From Dr. Oz to Heart Valves: A Tiny Device Charted a Contentious Path Through the FDA
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In 2013, the FDA approved an implantable device to treat leaky heart valves. Among its inventors was Mehmet Oz, the former television personality and former U.S. Senate candidate widely known as “Dr. Oz.”
In online videos, Oz has called the process that brought the MitraClip device to market an example of American medicine firing “on all cylinders,” and he has compared it to “landing a man on the moon.”
MitraClip was designed to spare patients from open-heart surgery by snaking hardware into the heart through a major vein. Its manufacturer, Abbott, said it offered new hope for people severely ill with a condition called mitral regurgitation and too frail to undergo surgery.
“It changed the face of cardiac medicine,” Oz said in a video.
But since MitraClip won FDA approval, versions of the device have been the subject of thousands of reports to the agency about malfunctions or patient injuries, as well as more than 1,100 reports of patient deaths, FDA records show. Products in the MitraClip line have been the subject of three recalls. A former employee has alleged in a federal lawsuit that Abbott promoted the device through illegal inducements to doctors and hospitals. The case is pending, and Abbott has denied illegally marketing the device.
The MitraClip story is, in many ways, a cautionary tale about the science, business, and regulation of medical devices.
Manufacturer-sponsored research on the device has long been questioned. In 2013, an outside adviser to the FDA compared some of the data marshaled in support of its approval to “poop.”
The FDA expanded its approval of MitraClip to a wider set of patients in 2019, based on a clinical trial in which Abbott was deeply involved and despite conflicting findings from another study.
In the three recalls, the first of which warned of potentially deadly consequences, neither the manufacturer nor the FDA withdrew inventory from the market. The company told doctors it was OK for them to continue using the recalled products.
In response to questions for this article, both Abbott and the FDA described MitraClip as safe and effective.
“With MitraClip, we’re addressing the needs of people with MR who often have no other options,” Abbott spokesperson Brent Tippen said. “Patients suffering from mitral regurgitation have severely limited quality of life. MitraClip can significantly improve survival, freedom for hospitalization and quality of life via a minimally invasive, now common procedure.”
An FDA spokesperson, Audra Harrison, said patient safety “is the FDA’s highest priority and at the forefront of our work in medical device regulation.”
She said reports to the FDA about malfunctions, injuries, and deaths that the device may have caused or contributed to are “consistent” with study results the FDA reviewed for its 2013 and 2019 approvals.
In other words: They were expected.
Inspiration in Italy
When a person has mitral regurgitation, blood flows backward through the mitral valve. Severe cases can lead to heart failure.
With MitraClip, flaps of the valve — known as “leaflets” — are clipped together at one or more points to achieve a tighter seal when they close. The clips are deployed via a catheter threaded through a major vein, typically from an incision in the groin. The procedure offers an alternative to connecting the patient to a heart-lung machine and repairing or replacing the mitral valve in open-heart surgery.
Oz has said in online videos that he got the idea after hearing a doctor describe a surgical technique for the mitral valve at a conference in Italy. “And on the way home that night, on a plane heading back to Columbia University, where I was on the faculty, I wrote the patent,” he told KFF Health News.
A patent obtained by Columbia in 2001, one of several associated with MitraClip, lists Oz first among the inventors.
But a Silicon Valley-based startup, Evalve, would develop the device. Evalve was later acquired by Abbott for about $400 million.
“I think the engineers and people at Evalve always cringe a little bit when they see Mehmet taking a lot of, you know, basically claiming responsibility for what was a really extraordinary team effort, and he was a small to almost no player in that team,” one of the company’s founders, cardiologist Fred St. Goar, told KFF Health News.
Oz did not respond to a request for comment on that statement.
As of 2019, the MitraClip device cost $30,000 per procedure, according to an article in a medical journal. According to the Abbott website, more than 200,000 people around the world have been treated with MitraClip.
Oz filed a financial disclosure during his unsuccessful run for the U.S. Senate in 2022 that showed him receiving hundreds of thousands of dollars in annual MitraClip royalties.
Abbott recently received FDA approval for TriClip, a variation of the MitraClip system for the heart’s tricuspid valve.
Endorsed ‘With Trepidation’
Before the FDA said yes to MitraClip in 2013, agency staffers pushed back.
Abbott had originally wanted the device approved for “patients with significant mitral regurgitation,” a relatively broad term. After the FDA objected, the company narrowed its proposal to patients at too-high risk for open-heart surgery.
Even then, in an analysis, the FDA identified “fundamental” flaws in Abbott’s data.
One example: The data compared MitraClip patients with patients who underwent open-heart surgery for valve repair — but the comparison might have been biased by differences in the expertise of doctors treating the two groups, the FDA analysis said. While MitraClip was implanted by a highly select, experienced group of interventional cardiologists, many of the doctors doing the open-heart surgeries had performed only a “very low volume” of such operations.
FDA “approval is not appropriate at this time as major questions of safety and effectiveness, as well as the overall benefit-risk profile for this device, remain unanswered,” the FDA said in a review prepared for a March 2013 meeting of a committee of outside advisers to the agency.
Some committee members expressed misgivings. “If your right shoe goes into horse poop and your left shoe goes into dog poop, it’s still poop,” cardiothoracic surgeon Craig Selzman said, according to a transcript.
The committee voted 5-4 against MitraClip on the question of whether it proved effective. But members voted 8-0 that they considered the device safe and 5-3 that the benefits of the device outweighed its risks.
Selzman voted yes on the last question “with trepidation,” he said at the time.
In October 2013, the FDA approved the MitraClip Clip Delivery System for a narrower group of patients: those with a particular type of mitral regurgitation who were considered a surgery risk.
“The reality is, there is no perfect procedure,” said Jason Rogers, an interventional cardiologist and University of California-Davis professor who is an Abbott consultant. The company referred KFF Health News to Rogers as an authority on MitraClip. He called MitraClip “extremely safe” and said some patients treated with it are “on death’s door to begin with.”
“At least you’re trying to do something for them,” he said.
Conflicting Studies
In 2019, the FDA expanded its approval of MitraClip to a wider set of patients.
The agency based that decision on a clinical trial in the United States and Canada that Abbott not only sponsored but also helped design and manage. It participated in site selection and data analysis, according to a September 2018 New England Journal of Medicine paper reporting the trial results. Some of the authors received consulting fees from Abbott, the paper disclosed.
A separate study in France reached a different conclusion. It found that, for some patients who fit the expanded profile, the device did not significantly reduce deaths or hospitalizations for heart failure over a year.
The French study, which appeared in the New England Journal of Medicine in August 2018, was funded by the government of France and Abbott. As with the North American study, some of the researchers disclosed they had received money from Abbott. However, the write-up in the journal said Abbott played no role in the design of the French trial, the selection of sites, or in data analysis.
Gregg Stone, one of the leaders of the North American study, said there were differences between patients enrolled in the two studies and how they were medicated. In addition, outcomes were better in the North American study in part because doctors in the U.S. and Canada had more MitraClip experience than their counterparts in France, Stone said.
Stone, a clinical trial specialist with a background in interventional cardiology, acknowledged skepticism toward studies sponsored by manufacturers.
“There are some people who say, ‘Oh, well, you know, these results may have been manipulated,’” he said. “But I can guarantee you that’s not the truth.”
‘Nationwide Scheme’
A former Abbott employee alleges in a lawsuit that after MitraClip won approval, the company promoted the device to doctors and hospitals using inducements such as free marketing support, the chance to participate in Abbott clinical trials, and payments for participating in “sham speaker programs.”
The former employee alleges that she was instructed to tell referring physicians that if they observed mitral regurgitation in their patients to “just send it” for a MitraClip procedure because “everything can be clipped.” She also alleges that, using a script, she was told to promote the device to hospital administrators based on financial advantages such as “growth opportunities through profitable procedures, ancillary tests, and referral streams.”
The inducements were part of a “nationwide scheme” of illegal kickbacks that defrauded government health insurance programs including Medicare and Medicaid, the lawsuit claims.
The company denied doing anything illegal and said in a court filing that “to help its groundbreaking therapy reach patients, Abbott needed to educate cardiologists and other healthcare providers.”
Those efforts are “not only routine, they are laudable — as physicians cannot use, or refer a patient to another doctor who can use, a device that they do not understand or in some cases even know about,” the company said in the filing.
Under federal law, the person who filed the suit can receive a share of any money the government recoups from Abbott. The suit was filed by a company associated with a former employee in Abbott’s Structural Heart Division, Lisa Knott. An attorney for the company declined to comment and said Knott had no comment.
Reports to the FDA
As doctors started using MitraClip, the FDA began receiving reports about malfunctions and cases in which the product might have caused or contributed to a death or an injury.
According to some reports, clips detached from valve flaps. Flaps became damaged. Procedures were aborted. Mitral leakage worsened. Doctors struggled to control the device. Clips became “entangled in chordae” — cord-like structures also known as heartstrings that connect the valve flaps to the heart muscle. Patients treated with MitraClip underwent corrective operations.
As of March 2024, the FDA had received more than 17,000 reports documenting more than 22,000 “events” involving mitral valve repair devices, FDA data shows. All but about 200 of those reports mention one iteration of MitraClip or another, a KFF Health News review of FDA data found.
Almost all the reports came from Abbott. The FDA requires manufacturers to submit reports when they learn of mishaps potentially related to their devices.
The reports are not proof that devices caused problems, and the same event might be reported multiple times. Other events may go unreported.
Despite the reports’ limitations, the FDA provides an analysis of them for the public on its website.
MitraClip’s risks weren’t a surprise.
Like the rapid-fire fine print in television ads for prescription drugs, the original product label for the device listed more than 60 types of potential complications.
Indeed, during clinical research on the device, about 6% of patients implanted with MitraClip died within 30 days, according to the label. Almost 1 in 4 — 23.6% – were dead within a year.
The FDA spokesperson, Harrison, pointed to a study originally published in 2021 in The Annals of Thoracic Surgery, based on a central registry of mitral valve procedures, that found lower rates of death after MitraClip went on the market.
“These data confirmed that the MitraClip device remains safe and effective in the real-world setting,” Harrison said.
But the study’s authors, several of whom disclosed financial or other connections to Abbott, said data was missing for more than a quarter of patients one year after the procedure.
A major measure of success would be the proportion of MitraClip patients who are alive “with an acceptable quality of life” a year after undergoing the procedure, the study said. Because such information was available for fewer than half of the living patients, “we have omitted those outcomes from this report,” the authors wrote.
If you’ve had an experience with MitraClip or another medical device and would like to tell KFF Health News about it, click here to share your story with us.
KFF Health News audience engagement producer Tarena Lofton contributed to this report.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
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Forever Strong – by Dr. Gabrielle Lyon
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Obesity kills a lot of people (as does medical neglect and malpractice when it comes to obese patients, but that is another matter), but often the biggest problem is not “too much fat” but rather “too little muscle”. This gets disguised a bit, because these factors often appear in the same people, but it’s a distinction that’s worthy of note.
Dr. Lyon lays out a lot of good hard science in this work, generally in the field of protein metabolism, but also with a keen eye on all manner of blood metrics (triglycerides, LDL/HDL, fasting blood sugars, assorted other biomarkers of metabolic health).
The style of this book is two books in one. It’s a very accessible pop-science book in its primary tone, with an extra layer of precise science and lots of references, for those who wish to dive into that.
In the category of criticism, the diet plan section of the book is rather meat-centric, but the goal of this is protein content, not meat per se, so substitutions can easily be made. That’s just one small section of the book, though, and it’s little enough a downside that even Dr. Mark Hyman (a popular proponent of plant-based nutrition) highly recommends the book.
Bottom line: if you’d like to be less merely fighting decline and more actually becoming healthier as you age, then this book will help you do just that.
Click here to check out Forever Strong, and level up your wellness as you age!
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Foods for Stronger Bones
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It’s Q&A Day!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
This newsletter has been growing a lot lately, and so have the questions/requests, and we love that! In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
Q: Foods that help build stronger bones and cut inflammation? Thank you!
We’ve got you…
For stronger bones / To cut inflammation
That “stronger bones” article is about the benefits of collagen supplementation for bones, but there’s definitely more to say on the topic of stronger bones, so we’ll do a main feature on it sometime soon!
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Is It Dementia?
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Spot The Signs (Because None Of Us Are Immune)
Dementia affects increasingly many people, and unlike a lot of diseases, it disproportionately affects people in wealthy industrialized nations.
There are two main reasons for this:
- Longevity (in poorer countries, more people die of other things sooner; can’t get age-related cognitive decline if you don’t age)
- Lifestyle (in the age of convenience, it has never been easier to live an unhealthy lifestyle)
The former is obviously no bad thing for those of us lucky enough to be in wealthier countries (though even in such places, good healthcare access is of course sadly not a given for all).
The latter, however, is less systemic and more epidemic. But it does cut both ways:
- An unhealthy lifestyle is much easier here, yes
- A healthier lifestyle is much easier here, too!
This then comes down to two factors in turn:
- Information: knowing about dementia, what things lead to it, what to look out for, what to do
- Motivation: priorities, and how much attention we choose to give this matter
So, let’s get some information, and then give it our attention!
More than just memory
It’s easy to focus on memory loss, but the four key disabilities directly caused by dementia (each person may not get all four), can be remembered by the mnemonic: “AAAA!”
No, somebody didn’t just murder your writer. It’s:
- Amnesia: memory loss, in one or more of its many forms
- e.g. short term memory loss, and/or inability to make new memories
- Aphasia: loss of ability to express oneself, and/or understand what is expressed
- e.g. “More people have been to Berlin than I have”
- Or even less communication-friendly, Broca’s (Expressive) Aphasia and Wernicke’s (Receptive) Aphasia
- Apraxia: loss of ability to do things, through no obvious physical disability
- e.g. staring at the bathroom mirror wondering how to brush one’s teeth
- Agnosia: loss of ability to recognize things
- e.g. prosopagnosia, also called face-blindness.
If any of those seem worryingly familiar, be aware that while yes, it could be a red flag, what’s most important is patterns of these things.
Another difference between having a momentary brainlapse and having dementia might be, for example, the difference between forgetting your keys, and forgetting what keys do or how to use one.
That said, some are neurological deficits that may show up quite unrelated to dementia, including most of those given as examples above. So if you have just one, then that’s probably worthy of note, but probably not dementia.
Writer’s anecdote: I have had prosopagnosia all my life. To give an example of what that is like and how it’s rather more than just “bad with faces”…
Recently I saw my neighbor, and I could tell something was wrong with her face, but I couldn’t put my finger on what it was. Then some moments later, I realized I had mistaken her hat for her face. It was a large beanie with a panda design on it, and that was facelike enough for me to find myself looking at the wrong face.
Subjective memory matters as much as objective
Objective memory tests are great indicators of potential cognitive decline (or improvement!), but even a subjective idea of having memory problems, that one’s memory is “not as good as it used to be”, can be an important indicator too:
Subjective memory may be marker for cognitive decline
And more recently:
If your memory feels like it’s not what it once was, it could point to a future dementia risk
If you’d like an objective test of memory and other cognitive impairments, here’s the industry’s gold standard test (it’s free):
SAGE: A Test to Detect Signs of Alzheimer’s and Dementia
(The Self-Administered Gerocognitive Exam (SAGE) is designed to detect early signs of cognitive, memory or thinking impairments)
There are things that can look like dementia that aren’t
A person with dementia may be unable to recognize their partner, but hey, this writer knows that feeling very well too. So what sets things apart?
More than we have room for today, but here’s a good overview:
What are the early signs of dementia, and how does it differ from normal aging?
Want to read more?
You might like our previous article more specifically about reducing Alzheimer’s risk:
Reducing Alzheimer’s Risk Early!
Take care!
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Progesterone Menopausal HRT: When, Why, And How To Benefit
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Progesterone doesn’t get talked about as much as other sex hormones, so what’s its deal? Dr. Heather Hirsch explains:
Menopausal progesterone
Dr. Hirsch considers progesterone essential for menopausal women who are taking estrogen and have an intact uterus, to keep conditions at bay such as endometriosis or even uterine cancer.
However, she advises it is not critical in those without a uterus, unless there was a previous case of one of the above conditions.
10almonds addition: on the other hand, progesterone can still be beneficial from a metabolic and body composition standpoint, so do speak with your endocrinologist about it.
As an extra bonus: while not soporific (it won’t make you sleepy), taking progesterone at night will improve the quality of your sleep once you do sleep, so that’s a worthwhile thing for many!
Dr. Hirsch also discusses the merits of continuous vs cyclic use; continuous maintains the above sleep benefits, for example, while cyclic use can help stabilize menstrual patterns in late perimenopause and early menopause.
For more on these things, plus discussion of different types of progesterone, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
- What Does “Balance Your Hormones” Even Mean?
- What You Should Have Been Told About The Menopause Beforehand
- HRT: Bioidentical vs Animal – A Tale Of Two Approaches
Take care!
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails: