How to Stay Sane – by Philippa Perry
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
First, what this book is not: a guide of “how to stay sane” in the popular use of the word “sane”, meaning free from serious mental illness of all and any kinds in general, and especially free from psychotic delusions. Alas, this book will not help with those.
What, then, is it? A guide of “how to stay sane” in the more casual sense of resiliently and adaptively managing stress, anxiety, and suchlike. The “light end” of mental health struggles, that nonetheless may not always feel light when dealing with them.
The author, a psychotherapist, draws from her professional experience and training to lay out psychological tools for our use, as well as giving the reader a broader understanding of the most common ills that may ail us.
The writing style is relaxed and personable; it’s not at all like reading a textbook.
The psychotherapeutic style is not tied to one model, and rather hops from one to another, per what is most likely to help for a given thing. This is, in this reviewer’s opinion at least, far better than the (all-too common) attempt made by a lot of writers to try to present their personal favorite model as the cure for all ills, instead of embracing the whole toolbox as this one does.
Bottom line: if your mental health is anywhere between “mostly good” and “a little frayed around the edges but hanging on by at least a few threads”, then this book likely can help you gain/maintain the surer foundation you’re surely seeking.
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Recommended
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:
Fully Present – by Dr. Susan Smalley and Diana Winston
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
“The Science and the Art of…” tends to be a bit of a fuzzy obfuscation, but in this case, it’s accurate, especially in this presentation. The authors are, indeed, a scientist and an artist—and both practitioners, meeting in the middle.
As such, we get the clinical insights of a researcher and professor of psychiatry, and the grounded-yet-spiritual insights of an erstwhile Buddhist nun.
While the book is pop psychology in essence, the format is much more that of a textbook than a self-help book. Will it be useful for helping yourself anyway, though? Yes, absolutely, if you apply the information contained within.
Don’t be fooled into thinking that a textbook format makes it dry, though—the writing is very compelling, and you’ll find yourself turning pages eagerly. There’s no time like the present, after all!
Bottom line: if you find the scientific evidence-base for the usefulness of mindfulness appealing, but find a lot of guides a little fluffy, this one is perfectly balanced—and very well written, too.
Click here to check out Fully Present, bring yourself into the moment, always!
Share This Post
Why do I keep getting urinary tract infections? And why are chronic UTIs so hard to treat?
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Dealing with chronic urinary tract infections (UTIs) means facing more than the occasional discomfort. It’s like being on a never ending battlefield against an unseen adversary, making simple daily activities a trial.
UTIs happen when bacteria sneak into the urinary system, causing pain and frequent trips to the bathroom.
Chronic UTIs take this to the next level, coming back repeatedly or never fully going away despite treatment. Chronic UTIs are typically diagnosed when a person experiences two or more infections within six months or three or more within a year.
They can happen to anyone, but some are more prone due to their body’s makeup or habits. Women are more likely to get UTIs than men, due to their shorter urethra and hormonal changes during menopause that can decrease the protective lining of the urinary tract. Sexually active people are also at greater risk, as bacteria can be transferred around the area.
Up to 60% of women will have at least one UTI in their lifetime. While effective treatments exist, about 25% of women face recurrent infections within six months. Around 20–30% of UTIs don’t respond to standard antibiotic. The challenge of chronic UTIs lies in bacteria’s ability to shield themselves against treatments.
Why are chronic UTIs so hard to treat?
Once thought of as straightforward infections cured by antibiotics, we now know chronic UTIs are complex. The cunning nature of the bacteria responsible for the condition allows them to hide in bladder walls, out of antibiotics’ reach.
The bacteria form biofilms, a kind of protective barrier that makes them nearly impervious to standard antibiotic treatments.
This ability to evade treatment has led to a troubling increase in antibiotic resistance, a global health concern that renders some of the conventional treatments ineffective.
Some antibiotics no longer work against UTIs.
Michael Ebardt/ShutterstockAntibiotics need to be advanced to keep up with evolving bacteria, in a similar way to the flu vaccine, which is updated annually to combat the latest strains of the flu virus. If we used the same flu vaccine year after year, its effectiveness would wane, just as overused antibiotics lose their power against bacteria that have adapted.
But fighting bacteria that resist antibiotics is much tougher than updating the flu vaccine. Bacteria change in ways that are harder to predict, making it more challenging to create new, effective antibiotics. It’s like a never-ending game where the bacteria are always one step ahead.
Treating chronic UTIs still relies heavily on antibiotics, but doctors are getting crafty, changing up medications or prescribing low doses over a longer time to outwit the bacteria.
Doctors are also placing a greater emphasis on thorough diagnostics to accurately identify chronic UTIs from the outset. By asking detailed questions about the duration and frequency of symptoms, health-care providers can better distinguish between isolated UTI episodes and chronic conditions.
The approach to initial treatment can significantly influence the likelihood of a UTI becoming chronic. Early, targeted therapy, based on the specific bacteria causing the infection and its antibiotic sensitivity, may reduce the risk of recurrence.
For post-menopausal women, estrogen therapy has shown promise in reducing the risk of recurrent UTIs. After menopause, the decrease in estrogen levels can lead to changes in the urinary tract that makes it more susceptible to infections. This treatment restores the balance of the vaginal and urinary tract environments, making it less likely for UTIs to occur.
Lifestyle changes, such as drinking more water and practising good hygiene like washing hands with soap after going to the toilet and the recommended front-to-back wiping for women, also play a big role.
Some swear by cranberry juice or supplements, though researchers are still figuring out how effective these remedies truly are.
What treatments might we see in the future?
Scientists are currently working on new treatments for chronic UTIs. One promising avenue is the development of vaccines aimed at preventing UTIs altogether, much like flu shots prepare our immune system to fend off the flu.
Emerging treatments could help clear chronic UTIs.
guys_who_shoot/ShutterstockAnother new method being looked at is called phage therapy. It uses special viruses called bacteriophages that go after and kill only the bad bacteria causing UTIs, while leaving the good bacteria in our body alone. This way, it doesn’t make the bacteria resistant to treatment, which is a big plus.
Researchers are also exploring the potential of probiotics. Probiotics introduce beneficial bacteria into the urinary tract to out-compete harmful pathogens. These good bacteria work by occupying space and resources in the urinary tract, making it harder for harmful pathogens to establish themselves.
Probiotics can also produce substances that inhibit the growth of harmful bacteria and enhance the body’s immune response.
Chronic UTIs represent a stubborn challenge, but with a mix of current treatments and promising research, we’re getting closer to a day when chronic UTIs are a thing of the past.
Iris Lim, Assistant Professor, Bond University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
Share This Post
When Doctors Make House Calls, Modern-Style!
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
In Tuesday’s newsletter, we asked you foryour opinion of telehealth for primary care consultations*, and got the above-depicted, below-described, set of responses:
- About 46% said “It is no substitute for an in-person meeting with a doctor; let’s keep the human touch”
- About 29% said “It means less waiting and more accessibility, while avoiding transmission of diseases”
- And 25 % said “I find that the pros and cons of telehealth vs in-person balance out, so: no preference”
*We specified that by “primary care” we mean the initial consultation with a non-specialist doctor, before receiving treatment or being referred to a specialist. By “telehealth” we mean by videocall or phonecall.
So, what does the science say?
A quick note first
Because telehealth was barely a thing (statistically speaking) before the first stages of the COVID pandemic, compared to how it is now, most of the science for this is young, and a lot of the science simply hasn’t been done yet, and/or has not been published yet, because the process can take years.
Because of this, some studies we do have aren’t specifically about primary care, and are sometimes about specialists. We think this should not affect the results much, but it bears highlighting.
Nevertheless, we’ll do what we can with the science we have!
Telehealth is more accessible than in-person consultations: True or False?
True, for most people. For example…
❝Data was found from a variety of emergency and non-emergency departments of primary, secondary, and specialised healthcare.
Satisfaction was high among recipients of healthcare, scoring 9-10 on a scale of 0-10 or ranging from 73.3% to 100%.
Convenience was rated high in every specialty examined. Satisfaction of clinicians was high throughout the specialities despite connection failure and concerns about confidentiality of information.❞
whereas…
❝Nonetheless, studies reported perception of increased barriers to accessing care and inequalities for vulnerable patients especially in older people❞
~ Ibid.
Source: Satisfaction with telemedicine use during COVID-19 pandemic in the UK: a systematic review
Now, perception of those things does necessarily equate to an actual increased barrier, but it is reasonable that someone who thinks something is inaccessible will be less inclined to try to access it.
The quality of care provided via telehealth is as good as in-person: True or False?
True, ostensibly, with caveats. The caveats are:
- We’re going offreported patient satisfaction, not objective patient health outcomes (we found little* science as yet for the relative incidence of misdiagnosis, for example—which kind of thing will take time to be revealed).
- We’re also therefore speaking (as statistics do) for the significant majority of people. However, if we happen to be (statistically speaking) an insignificant minority, well, that just sucks for us personally.
*we did find some, but it wasn’t very helpful yet. For example:
An electronic trigger to detect telemedicine-related diagnostic errors
this one does look at the incidence of diagnostic errors, but provides no control group (i.e. otherwise-comparable in-person consultations) for comparison.
While most oft-considered demographic groups reported comparable patient satisfaction (per race, gender, and socioeconomic status, for example), there was one outlier variable, which was age (as we quoted from that first study above).
However!
Looking under the hood of these stats, it seems that age is not the real culprit, so much as technological illiteracy, which is heavily correlated with age:
❝Lower eHealth literacy is associated with more negative attitudes towards I/C technology in healthcare. This trend is consistent across diverse demographics and regions. ❞
Source: Meta-analysis: eHealth literacy and attitudes towards internet/computer technology
There are things that can be done at an in-person consultation that can’t be done by telehealth: True or False?
True, of course. It is incredibly rare that we will cite “common sense”, (as sometimes “common sense” is actually “common mistakes” and is simply and verifiably wrong), but in this case, as one 10almonds subscriber put it:
❝The doctor uses his five senses to assess. This cannot be attained over the phone❞
~ 10almonds subscriber
A quick note first: if your doctor is using their sense of taste to diagnose you, please get a different doctor, because they should definitely not be doing that!
Not in this century, anyway… Once upon a time, diabetes was diagnosed by urine-tasting (and yes, that was a fairly reliable method).
However, nowadays indeed a doctor will use sight, sound, touch, and sometimes even smell.
In a videocall we’re down to two of those senses (sight and sound), and in a phonecall, down to one (sound) and even that is hampered. Your doctor cannot, for example, use a stethoscope over the phone.
With this in mind, it really comes down to what you need from your doctor in that consultation.
- If you’re 99% sure that what you need is to be prescribed an antidepressant, that probably doesn’t need a full physical.
- If you’re 99% sure that what you need is a referral, chances are that’ll be fine by telehealth too.
- If your doctor is 99% sure that what you need is a verbal check-up (e.g. “How’s it been going for you, with the medication that I prescribed for you a month ago?”, then again, a call is probably fine.
If you have a worrying lump, or an unhappy bodily discharge, or an unexplained mysterious pain? These things, more likely an in-person check-up is in order.
Take care!
Share This Post
Related Posts
HRT: Bioidentical vs Animal
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
HRT: A Tale Of Two Approaches
In yesterday’s newsletter, we asked you for your assessment of menopausal hormone replacement therapy (HRT).
- A little over a third said “It can be medically beneficial, but has some minor drawbacks”
- A little under a third said “It helps, but at the cost of increased cancer risk; not worth it”
- Almost as many said “It’s a wondrous cure-all that makes you happier, healthier, and smell nice too”
- Four said “It is a dangerous scam and a sham; “au naturel” is the way to go”
So what does the science say?
Which HRT?
One subscriber who voted for “It’s a wondrous cure-all that makes you healthier, happier, and smell nice too” wrote to add:
❝My answer is based on biodentical hormone replacement therapy. Your survey did not specify.❞
And that’s an important distinction! We did indeed mean bioidentical HRT, because, being completely honest here, this European writer had no idea that Premarin etc were still in such wide circulation in the US.
So to quickly clear up any confusion:
- Bioidentical hormones: these are (as the name suggests) identical on a molecular level to the kind produced by humans.
- Conjugated Equine Estrogens: such as Premarin, come from animals. Indeed, the name “Premarin” comes from “pregnant mare urine”, the substance used to make it.
There are also hormone analogs, such as medroxyprogesterone acetate, which is a progestin and not the same thing as progesterone. Hormone analogs such as the aforementioned MPA are again, a predominantly-American thing—though they did test it first in third-world countries, after testing it on animals and finding it gave them various kinds of cancer (breast, cervical, ovarian, uterine).
A quick jumping-off point if you’re interested in that:
Depot medroxyprogesterone acetate and the risk of breast and gynecologic cancer
this is about its use as a contraceptive (so, much lower doses needed), but it is the same thing sometimes given in the US as part of menopausal HRT. You will note that the date on that research is 1996; DMPA is not exactly cutting-edge and was first widely used in the 1950s.
Similarly, CEEs (like Premarin) have been used since the 1930s, while estradiol (bioidentical estrogen) has been in use since the 1970s.
In short: we recommend being wary of those older kinds and mostly won’t be talking about them here.
Bioidentical hormones are safer: True or False?
True! This is an open-and-shut case:
❝Physiological data and clinical outcomes demonstrate that bioidentical hormones are associated with lower risks, including the risk of breast cancer and cardiovascular disease, and are more efficacious than their synthetic and animal-derived counterparts.
Until evidence is found to the contrary, bioidentical hormones remain the preferred method of HRT. ❞
Further research since that review has further backed up its findings.
Source: Are Bioidentical Hormones Safer or More Efficacious than Other Commonly Used Versions in HRT?
So simply, if you’re going on HRT (estrogen and/or progesterone), you might want to check it’s the bioidentical kind.
HRT can increase the risk of breast cancer: True or False?
Contingently True, but for most people, there is no significant increase in risk.
First: again, we’re talking bioidentical hormones, and in this case, estradiol. Older animal-derived attempts had much higher risks with much lesser efficaciousness.
There have been so many studies on this (alas, none that have been publicised enough to undo the bad PR in the wake of old-fashioned HRT from before the 70s), but here’s a systematic review that highlights some very important things:
❝Estradiol-only therapy carries no risk for breast cancer, while the breast cancer risk varies according to the type of progestogen.
Estradiol therapy combined with medroxyprogesterone, norethisterone and levonorgestrel related to an increased risk of breast cancer, estradiol therapy combined with dydrogesterone and progesterone carries no risk❞
In fewer words:
- Estradiol by itself: no increased risk of breast cancer
- Estradiol with MDPA or other progestogens that aren’t really progesterone: increased risk of breast cancer
- Estradiol with actual progesterone: back to no increased risk of breast cancer
So again, you might want to make sure you are getting actual bioidentical hormones, and not something else!
However! If you are aware that you already have an increased risk of breast cancer (e.g. family history, you’ve had it before, you know you have certain genes for it, etc), then you should certainly discuss that with your doctor, because your personal circumstances may be different:
❝Tailored HRT may be used without strong evidence of a deleterious effect after ovarian cancer, endometrial cancer, most other gynecological cancers, bowel cancer, melanoma, a family history of breast cancer, benign breast disease, in carriers of BRACA mutations, after breast cancer if adjuvant therapy is not being used, past thromboembolism, varicose veins, fibroids and past endometriosis.
Relative contraindications are existing cardiovascular and cerebrovascular disease and breast cancer being treated with adjuvant therapies❞
Source: HRT in difficult circumstances: are there any absolute contraindications?
HRT makes you happier, healthier, and smell nice too: True or False?
Contingently True, assuming you do want its effects, which generally means the restoration of much of the youthful vitality you enjoyed pre-menopause.
The “and smell nice too” was partly rhetorical, but also partly literal: our scent is largely informed by our hormones, and higher estrogen results in a sweeter scent; lower estrogen results in a more bitter scent. Not generally considered an important health matter, but it’s a thing, so hey.
More often, people take menopausal HRT for more energy, stronger bones (reduced osteoporosis risk), healthier heart (reduced CVD risk), improved sexual health, better mood, healthier skin and hair, and general avoidance of menopause symptoms:
Read more: Skin, hair and beyond: the impact of menopause
We’d need another whole main feature to discuss all the benefits properly; today we’re just mythbusting.
HRT does have some drawbacks: True or False?
True, and/but how serious they are (beyond the aforementioned consideration in the case of an already-increased risk of breast cancer) is a matter of opinion.
For example, it is common to get a reprise of monthly cramps and/or mood swings, depending on how one is taking the HRT and other factors (e.g. your own personal physiology and genetic predispositions). For most people, these will even out over time.
It’s also even common to get a reprise of (much slighter than before) monthly bleeding, unless you have for example had a hysterectomy (no uterus = no bleeding). Again, this will usually settle down in a matter of months.
If you experience anything more alarming than that, then indeed check with your doctor.
HRT is a dangerous scam and sham: True or False?
False, simply. As described above, for most people they’re quite safe. Again, talking bioidentical hormones.
The other kind are in the most neutral sense a sham (i.e. they are literally sham hormones), though they’re not without their merits and for many people they may be better than nothing.
As for being a scam, biodentical hormones are widely prescribed in the many countries that have universal healthcare and/or a single-payer healthcare system, where there would be no profit motive (and considerable cost) in doing so.
They’re prescribed because they are effective and thus reduce healthcare spending in other areas (such as treating osteoporosis or CVD after the fact) and improve Health Related Quality of Life, and by extension, health-adjusted life-years, which is one of the top-used metrics for such systems.
See for example:
Our apologies, gentlemen
We wanted to also talk about testosterone therapy for the andropause, but we’ve run out of room today (because of covering the important distinction of bioidentical vs old-fashioned HRT)!
To make it up to you, we’ll do a full main feature on it (it’s an interesting topic) in the near future, so watch this space
Ladies, we’ll also at some point cover the pros and cons of different means of administration, e.g. pills, transdermal gel, injections, patches, pessaries, etc—which often have big differences.
That’ll be in a while though, because we try to vary our topics, so we can’t talk about menopausal HRT all the time, fascinating and important a topic it is.
Meanwhile… take care, all!
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:
Apple Cider Vinegar vs Balsamic Vinegar – Which is Healthier?
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Our Verdict
When comparing apple cider vinegar to balsamic vinegar, we picked the apple cider vinegar.
Why?
It’s close! And it’s a simple one today and they’re both great. Taking either for blood-sugar-balancing benefits is fine, as it’s the acidity that has this effect. But:
- Of the two, balsamic vinegar is the one more likely to contain more sugars, especially if it’s been treated in any fashion, and not by you, e.g. made into a glaze or even a reduction (the latter has no need to add sugar, but sometimes companies do because it is cheaper—so we recommend making your own balsamic vinegar reduction at home)
- Of the two, apple cider vinegar is the one more likely to contain “the mother”, that is to say, the part with extra probiotic benefits (but if the vinegar has been filtered, it won’t have this—it’s just more common to be able to find unfiltered apple cider vinegar, since it has more popular attention for its health benefits than balsamic vinegar does)
So, two wins for apple cider vinegar there.
Want to learn more?
You might like to read:
- 10 Ways To Balance Your Blood Sugars
- An Apple (Cider Vinegar) A Day…
- Apple Cider Vinegar vs Apple Cider Vinegar Gummies – Which is Healthier?
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:
Healthy Butternut Macaroni Cheese
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
A comfort food classic, healthy and plant-based, without skimping on the comfort.
You will need
- ½ butternut squash, peeled and cut into small pieces (if buying ready-chopped, this should be about 1 lb)
- 1 onion, chopped
- ¼ bulb garlic
- 2 tbsp extra virgin olive oil
- 12 oz (or thereabouts) wholegrain macaroni, or similar pasta shape (even penne works fine—which is good, as it’s often easier to buy wholegrain penne than wholegrain macaroni) (substitute with a gluten-free pasta such as buckwheat pasta, if avoiding gluten)
- 6 oz (or thereabouts) cashews, soaked in hot water for at least 15 minutes (but longer is better)
- ½ cup milk (your preference what kind; we recommend hazelnut for its mellow nutty flavor)
- 3 tbsp nutritional yeast
- Juice of ½ lemon
- 2 tsp black pepper, coarse ground
- ½ tsp MSG, or 1 tsp low-sodium salt
- Optional: smoked paprika, to serve
Note: if you are allergic to nuts, please accept our apologies that there’s no substitution available in this one. Simply put, removing the cashews would mean changing most of the rest of the recipe to compensate, so there’s no easy “or substitute with…” that we can mention. We’ll have to find/develop a good healthy plant-based no-nuts recipe for you at a later date.
Method
(we suggest you read everything at least once before doing anything)
1) Preheat the oven to 400℉ / 200℃.
2) Combine the butternut squash, onion, and garlic with the olive oil, in a large roasting tin, tossing thoroughly to ensure an even coat of oil. Roast them for about 25 minutes until soft.
3) Cook the macaroni while you wait (this should take about 10 minutes or so in salted water), drain, and rinse thoroughly in cold water, before setting aside. This cooling increases the pasta’s resistant starch content (that’s good, for your gut and for your blood sugars, and thus also for your heart and brain), and it will maintain this benefit even when we reheat it later.
4) Drain the cashews, and tip them into a high-speed blender with the milk, and process until smooth. Add the roasted vegetables and the remaining ingredients apart from the pasta, and continue to process until again smooth. You can add a little more milk if you need to, but go easy with it.
5) Heat the sauce (that you just made in the food processor) gently in a saucepan, and refresh the pasta by pouring a kettle of boiling water through it in a colander.
6) Optional: combine the pasta and sauce in an ovenproof dish or cast iron pan, and give it a few minutes under the hottest grill (or browning iron, if you have such) your oven can muster. Alternatively, use a culinary blowtorch, if you have one.
7) Serve; and if you didn’t do the optional step above, this means combining the pasta and sauce. You can also dust the top with some extra seasonings if you like. Smoked paprika works well for this.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Butternut Squash vs Pumpkin – Which is Healthier?
- Cashew Nuts vs Coconut – Which is Healthier?
- The Many Health Benefits Of Garlic
- Black Pepper’s Impressive Anti-Cancer Arsenal (And More)
- Sea Salt vs MSG – Which is Healthier?
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:
