The Checklist Manifesto – by Dr. Atul Gawande
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Dr. Gawande, himself a general surgeon, uses checklists a lot. He is, unequivocally, an expert in his field. He “shouldn’t” need a checklist to tell him to do such things as “Check you have the correct patient”. But checklists are there as a safety net. And, famously, “safety regulations are written in blood”, after all.
And, who amongst us has never made such a “silly” error? From forgetting to turn the oven on, to forgetting to take the handbrake off, it takes only a momentary distraction to think we’ve done something we haven’t.
You may be wondering: why a whole book on this? Is it just many examples of the usefulness of checklists? Because I’m already sold on that, so, what else am I going to get out of it?
Dr. Gawande also explains in clear terms:
- How to optimize “all necessary steps” with “as few steps as possible”
- The important difference between read-do checklists and do-confirm checklists
- To what extent we should try to account for the unexpected
- How to improve compliance (i.e., making sure you actually use it, no matter how tempting it will be to go “yeah this is automatic for me now” and gloss over it)
- The role of checklists in teams, and in passing on knowledge
…and more.
Bottom line: if you’ve ever tried to make tea without putting the tea-leaves in the pot, this is the book that will help you avoid making more costly mistakes—whatever your area of activity or interest.
Click here to check out the Checklist Manifesto, and make fewer mistakes!
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The Smart Woman’s Guide to Breast Cancer – by Dr. Jenn Simmons
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There’s a lot more to breast cancer care than “check your breasts regularly”. Because… And then what? “Go see a doctor” obviously, but it’s a scary prospect with a lot of unknowns.
Dr. Simmons demystifies these unknowns, from both her position as an oncologist (and breast surgeon) and also her position as a breast cancer survivor herself.
What she found, upon getting to experience the patient side of things, was that the system is broken in ways she’d never considered before as a doctor.
This book is the product of the things she’s learned both within her field, and elsewhere because of realizing the former’s areas of shortcoming.
She gives a step-by-step guide, from diagnosis onwards, advising taking as much as possible into one’s own hands—especially in the categories of information and action. She also explains the things that make the biggest difference to cancer outcomes when it comes to eating, sleeping, and so forth, the best attitude to have to be neither despairing and giving up, nor overconfident and complacent.
She does also talk complementary therapies, be they supplements or more out-of-the-box approaches and the evidence for them where applicable, as well as doing some high-quality mythbusting about more prescription-based considerations such as HRT.
Bottom line: if you or a loved one have a breast cancer diagnosis, or you just prefer knowing this sort of thing than not, then this book is a top-tier “insider’s guide”.
Click here to check out the Smart Woman’s Guide To Breast Cancer, and take control!
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Altered Traits – by Dr. Daniel Goleman & Dr. Richard Davidson
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We know that meditation helps people to relax, but what more than that?This book explores the available science.
We say “explore the available science”, but it’d be remiss of us not to note that the authors have also expanded the available science, conducting research in their own lab.
From stress tests and EEGs to attention tests and fMRIs, this book looks at the hard science of what different kinds of meditation do to the brain. Not just in terms of brain state, either, but gradual cumulative anatomical changes, too. Powerful stuff!
The style is very pop-science in presentation, easily comprehensible to all. Be aware though that this is an “if this, then that” book of science, not a how-to manual. If you want to learn to meditate, this isn’t the book for that.
Bottom line: if you’d like to understand more about how different kinds of meditation affect the brain differently, this is the book for you.
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Protein vs Sarcopenia
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Protein vs Sarcopenia
This is Dr. Gabrielle Lyon. A medical doctor, she’s board-certified in family medicine, and has also engaged in research and clinical practice in the fields of geriatrics and nutritional sciences.
A quick note…
We’re going to be talking a bit about protein metabolism today, and it’s worth noting that Dr. Lyon personally is vehemently against vegetarianism/veganism, and considers red meat to be healthy.
Scientific consensus on the other hand, holds that vegetarianism and veganism are fine for most people if pursued in an informed and mindful fashion, that white meat and fish are also fine for most people, and red meat is simply not.
If you’d like a recap on the science of any of that:
- Protein: How Much Do We Need, Really?
- Plant vs Animal Protein: Diversity is Key
- Do We Need Animal Products to be Healthy?
Nevertheless, if we look at the science that she provides, the advice is sound when applied to protein in general and without an undue focus on red meat.
How much protein is enough?
In our article linked above, we gave 1–2g/kg/day
Dr. Lyons gives the more specific 1.6g/kg/day for adults older than 40 (this is where sarcopenia often begins!) and laments that many sources offer 0.8g/kg.
To be clear, that “per kilogram” means per kilogram of your bodyweight. For Americans, this means dividing lbs by 2.2 to get the kg figure.
Why so much protein?
Protein is needed to rebuild not just our muscles, but also our bones, joint tissues, and various other parts of us:
We Are Such Stuff As Fish Are Made Of
Additionally, our muscles themselves are important for far more than just moving us (and other things) around.
As Dr. Lyon explains: sarcopenia, the (usually age-related) loss of muscle mass, does more than just make us frail; it also messes up our metabolism, which in turn messes up… Everything else, really. Because everything depends on that.
This is because our muscles themselves use a lot of our energy, and/but also store energy as glycogen, so having less of them means:
- getting a slower metabolism
- the energy that can’t be stored in muscle tissue gets stored somewhere else (like the liver, and/or visceral fat)
So, while for example the correlation between maintaining strong muscles and avoiding non-alcoholic fatty liver disease may not be immediately obvious, it is clear when one follows the metabolic trail to its inevitable conclusion.
Same goes for avoiding diabetes, heart disease, and suchlike, though those things are a little more intuitive.
How can we get so much protein?
It can seem daunting at first to get so much protein if you’re not used to it, especially as protein is an appetite suppressant, so you’ll feel full sooner.
It can especially seem daunting to get so much protein if you’re trying to avoid too many carbs, and here’s where Dr. Lyon’s anti-vegetarianism does have a point: it’s harder to get lean protein without meat/fish.
That said, “harder” does not mean “impossible” and even she acknowledges that lentils are great for this.
If you’re not vegetarian or vegan, collagen supplementation is a good way to make up any shortfall, by the way.
And for everyone, there are protein supplements available if we want them (usually based on whey protein or soy protein)
Anything else we need to do?
Yes! Eating protein means nothing if you don’t do any resistance work to build and maintain muscle. This can take various forms, and Dr. Lyon recommends lifting weights and/or doing bodyweight resistance training (calisthenics, Pilates, etc).
Here are some previous articles of ours, consistent with the above:
- Resistance Is Useful! (Especially As We Get Older)
- Overdone It? How To Speed Up Recovery After Exercise
- How To Do HIIT (Without Wrecking Your Body)
- Exercises To Do (And Ones To Avoid) If You Have Osteoporosis
Take care!
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Kiwi vs Grapefruit – Which is Healthier?
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Our Verdict
When comparing kiwi to grapefruit, we picked the kiwi.
Why?
In terms of macros, kiwi has nearly 2x the protein, slightly more carbs, and 2x the fiber; both fruits are low glycemic index foods, however.
When it comes to vitamins, kiwi has more of vitamins B3, B6, B7, B9, C, E, K, and choline, while grapefruit has more of vitamins A, B1, B2, and B5. An easy win for kiwi.
In the category of minerals, kiwi is higher in calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc, while grapefruit is not higher in any minerals. So, no surprises for guessing which wins this category.
One thing that grapefruit is a rich source of: furanocoumarin, which can inhibit cytochrome P-450 3A4 isoenzyme and P-glycoptrotein transporters in the intestine and liver—slowing down their drug metabolism capabilities, thus effectively increasing the bioavailability of many drugs manifold.
This may sound superficially like a good thing (improving bioavailability of things we want), but in practice it means that in the case of many drugs, if you take them with (or near in time to) grapefruit or grapefruit juice, then congratulations, you just took an overdose. This happens with a lot of meds for blood pressure, cholesterol (including statins), calcium channel-blockers, anti-depressants, benzo-family drugs, beta-blockers, and more. Oh, and Viagra, too. Which latter might sound funny, but remember, Viagra’s mechanism of action is blood pressure modulation, and that is not something you want to mess around with unduly. So, do check with your pharmacist to know if you’re on any meds that would be affected by grapefruit or grapefruit juice!
All in all, adding up the categories makes for an overwhelming total win for kiwis.
Want to learn more?
You might like to read:
Top 8 Fruits That Prevent & Kill Cancer ← kiwi is top of the list!
Take care!
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Fasting Without Crashing?
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Intermittent Fasting: What’s the truth?
Before we get to facts and fictions, let’s quickly cover:
What is Intermittent Fasting?
Intermittent Fasting (IF) is an umbrella term for various kinds of time-restricted fasting, based on a schedule. Types include:
Time-restricted IF, for example:
- 16:8—Fast for 16 hours, eat during an 8-hour window
- 18:6–Fast for 18 hours, eat during a 6-hour window
- 20:4—Fast for 20 hours, eat during a 4-hour window
24hr fasting, including:
- Eat Stop Eat—basically, take a day off from eating once a week
- Alternate Day Fasting—a more extreme version of the above; it is what it sounds like; eat one day, fast the next, repeat
Non-fast fasting, e.g:
- 5:2—Eat normally for 5 days, have a very reduced calorie intake (⅓ of normal intake) for the other 2 days
- Fruit Fasting—have a small amount of fruit on “fast” days, but no other food
- The Warrior Diet—as above, but include a small amount of non-starchy vegetables
Why IF?
While IF is perhaps most commonly undertaken as a means of fat loss or fat management (i.e., keeping fat down when it is already low), others cite different reasons, such as short term cognitive performance or long-term longevity.
But… Does it work?
Here we get into the myth-busting bit!
“IF promotes weight loss”
Mix of True and False. It can! But it also doesn’t have to. If you’re a bodybuilder who downs 4,000 calories in your 4hr eating window, you’re probably not going to lose weight! For such people, this is of course “a feature, not a bug” of IF—especially as it has been found that, in an acute study, IF did not adversely impact muscle protein synthesis.
“IF promotes fat loss, without eating less”
Broadly True. IF was found to be potentially equal to, but not necessarily better than, eating less.
“IF provides metabolic benefits for general health”
Broadly True. IF (perhaps counterintuitively) decreases the risk of insulin resistance, and also has anti-inflammatory effects, benefits a healthy gut microbiome, and promotes healthy autophagy (which as we noted in a previous edition of 10almonds, is important against both aging and cancer)
However, results vary according to which protocol you’re observing…
For what it’s worth, 16:8 is perhaps the most-studied protocol. Because such studies tend to have the eating window from midday to 8pm, this means that—going against popular wisdom—part of the advice here is basically “skip breakfast”.
“Unlike caloric restriction, IF is sustainable and healthy as a long-term protocol”
Broadly True. Of course, there’s a slight loophole here in that IF is loosely defined—technically everyone fasts while they’re sleeping, at the very least!
However, for the most commonly-studied IF method (16:8), this is generally very sustainable and healthy and for most people.
On the other hand, a more extreme method such as Alternate Day Fasting, may be trickier to sustain (even if it remains healthy to do so), because it’s been found that hunger does not decrease on fasting days—ie, the body does not “get used to it”.
The American Journal of Clinical Nutrition wrote:
❝Alternate-day fasting was feasible in nonobese subjects, and fat oxidation increased. However, hunger on fasting days did not decrease, perhaps indicating the unlikelihood of continuing this diet for extended periods of time. Adding one small meal on a fasting day may make this approach to dietary restriction more acceptable.❞
“IF improves mood and cognition”
Mix of True and False (plus an honest “We Don’t Know” from researchers).
Many studies have found benefits to both mood and cognition, but in the short-term, fasting can make people “hangry” (or: “experience irritability due to low blood sugar levels”, as the scientists put it), and in the long term, it can worsen symptoms of depression for those who already experience such—although some studies have found it can help alleviate depressive symptoms.
Basically this is one where researchers typically append the words “more research is needed” to their summaries.
“Anyone can do IF”
Definitely False, unless going by the absolute broadest possible interpretation of what constitutes “Intermittent Fasting” to the point of disingenuity.
For example, if you are Type 1 Diabetic, and your blood sugars are hypo, and you wait until tomorrow to correct that, you will stand a good chance of going into a coma instead. So please don’t.
(On the other hand, IF may help achieve remission of type 2 diabetes)
Lastly, IF is broadly not recommend to children and adolescents, anyone pregnant or breastfeeding, and certain underlying health conditions not mentioned above (we’re not going to try to give an exhaustive list here, but basically, if you have a chronic health condition, we recommend you check with your doctor first).
WHICH APP?
Choosing a fasting app
Thinking of giving IF a try and would like a little extra help? We’ve got you covered!
Check out: Livewire’s 7 Best Intermittent Fasting Apps of 2023
Prefer to just trust us with a recommendation?
We like BodyFast—it’s #2 on Lifewire’s list, but it has an array of pre-set plans to choose from (unlike Lifewire’s #1, Zero), and plenty of clear tracking, scheduling help, and motivational features.
Both are available on both iOS and Android:
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Are Brain Chips Safe?
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Ready For Cyborgization?
In yesterday’s newsletter, we asked you for your views on Brain-Computer Interfaces (BCIs), such as the Utah Array and Neuralink’s chips on/in brains that allow direct communication between brains and computers, so that (for example) a paralysed person can use a device to communicate, or manipulate a prosthetic limb or two.
We didn’t get as many votes as usual; it’s possible that yesterday’s newsletter ended up in a lot of spam filters due to repeated use of a word in “extra ______ olive oil” in its main feature!
However, of the answers we did get…
- About 54% said “It’s bad enough that our phones spy on us, without BCI monitoring our thoughts as well!”
- About 23% said “Sounds great in principle, but I don’t think we’re there yet safetywise”
- About 19% said “Sign me up for technological telepathy! I am ready for assimilation”
- One (1) person said “Electrode outside the skull are good; chips on the brain are bad”
But what does the science say?
We’re not there yet safetywise: True or False?
True, in our opinion, when it comes to the latest implants, anyway. While it’s very difficult to prove a negative (it could be that everything goes perfectly in human trials), “extraordinary claims require extraordinary evidence”, and so far this seems to be lacking.
The stage before human trials is usually animal trials, starting with small creatures and working up to non-human primates if appropriate, before finally humans.
- Good news: the latest hot-topic BCI device (Neuralink) was tested on animals!
- Bad news: to say it did not go well would be an understatement
The Gruesome Story of How Neuralink’s Monkeys Actually Died
The above is a Wired article, and we tend to go for more objective sources, however we chose this one because it links to very many objective sources, including an open letter from the Physicians’ Committee for Responsible Medicine, which basically confirms everything in the Wired article. There are lots of links to primary (medical and legal) sources, too.
Electrodes outside the skull are good; chips on/in the brain are bad: True or False?
True or False depending on how they’re done. The Utah Array (an older BCI implant, now 20 years old, though it’s been updated many times since) has had a good safety record, after being used by a few dozen people with paralysis to control devices:
How the Utah Array is advancing BCI science
The Utah Array works on the same general principle as Neuralink, but the mechanics of its implementation are very different:
- The Utah Array involves a tiny bundle of microelectrodes (held together by a rigid structure that looks a bit like a nanoscale hairbrush) put in place by a brain surgeon, and that’s that.
- The Neuralink has a dynamic web of electrodes, implanted by a little robot that acts like a tiny sewing machine to implant many polymer threads, each containing its own a bunch of electrodes.
In theory, the latter is much more advanced. In practice, so far, the former has a much better safety record.
I am right to be a little worried about giving companies access to my brain: True or False?
True or False, depending on the nature of your concern.
For privacy: current BCI devices have quite simple switches operated consciously by the user. So while technically any such device that then runs its data through Bluetooth or WiFi could be hacked, this risk is no greater than using a wireless mouse and/or keyboard, because it has access to about the same amount of information.
For safety: yes, probably there is cause to be worried. Likely the first waves of commercial users of any given BCI device will be severely disabled people who are more likely to waive their rights in the hope of a life-changing assistance device, and likely some of those will suffer if things go wrong.
Which on the one hand, is their gamble to make. And on the other hand, makes rushing to human trials, for companies that do that, a little more predatory.
Take care!
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