What You Don’t Know Can Kill You
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Knowledge Is Power!
This is Dr. Simran Malhotra. She’s triple board-certified (in lifestyle medicine, internal medicine, and palliative care), and is also a health and wellness coach.
What does she want us to know?
Three things:
Wellness starts with your mindset
Dr. Malhotra shifted her priorities a lot during the initial and perhaps most chaotic phase of the COVID pandemic:
❝My husband, a critical care physician, was consumed in the trenches of caring for COVID patients in the ICU. I found myself knee-deep in virtual meetings with families whose loved ones were dying of severe COVID-related illnesses. Between the two of us, we saw more trauma, suffering, and death, than we could have imagined.
The COVID-19 pandemic opened my eyes to how quickly life can change our plans and reinforced the importance of being mindful of each day. Harnessing the power to make informed decisions is important, but perhaps even more important is focusing on what is in our control and taking action, even if it is the tiniest step in the direction we want to go!❞
~ Dr. Simran Malhotra
We can only make informed decisions if we have good information. That’s one of the reasons we try to share as much information as we can each day at 10almonds! But a lot will always depend on personalized information.
There are one-off (and sometimes potentially life-saving) things like health genomics:
The Real Benefit Of Genetic Testing
…but also smaller things that are informative on an ongoing basis, such as keeping track of your weight, your blood pressure, your hormones, and other metrics. You can even get fancy:
Track Your Blood Sugars For Better Personalized Health
Lifestyle is medicine
It’s often said that “food is medicine”. But also, movement is medicine. Sleep is medicine. In short, your lifestyle is the most powerful medicine that has ever existed.
Lifestyle encompasses very many things, but fortunately, there’s an “80:20 rule” in play that simplifies it a lot because if you take care of the top few things, the rest will tend to look after themselves:
These Top Few Things Make The Biggest Difference To Overall Health
Gratitude is better than fear
If we receive an unfavorable diagnosis (and let’s face it, most diagnoses are unfavorable), it might not seem like something to be grateful for.
But it is, insofar as it allows us to then take action! The information itself is what gives us our best chance of staying safe. And if that’s not possible e.g. in the worst case scenario, a terminal diagnosis, (bearing in mind that one of Dr. Malhotra’s three board certifications is in palliative care, so she sees this a lot), it at least gives us the information that allows us to make the best use of whatever remains to us.
See also: Managing Your Mortality
Which is very important!
…and/but possibly not the cheeriest note on which to end, so when you’ve read that, let’s finish today’s main feature on a happier kind of gratitude:
How To Get Your Brain On A More Positive Track (Without Toxic Positivity)
Want to hear more from Dr. Malhotra?
Showing how serious she is about how our genes do not determine our destiny and knowledge is power, here she talks about her “previvor’s journey”, as she puts it, with regard to why she decided to have preventative cancer surgery in light of discovering her BRCA1 genetic mutation:
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Take care!
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Total Fitness After 40 – by Nick Swettenham
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Time may march relentlessly on, but can we retain our youthful good health?
The answer is that we can… to a degree. And where we can’t, we can and should adapt what we do as we age.
The key, as Swettenham illustrates, is that there are lifestyle factors that will help us to age more slowly, thus retaining our youthful good health for longer. At the same time, there are factors of which we must simply be mindful, and take care of ourselves a little differently now than perhaps we did when we were younger. Here, Swettenham acts guide and instructor.
A limitation of the book is that it was written with the assumption that the reader is a man. This does mean that anything relating to hormones is assuming that we have less testosterone as we’re getting older and would like to have more, which is obviously not the case for everyone. However, happily, the actual advice remains applicable regardless.
Swettenham covers the full spread of what he believes everyone should take into account as we age:
- Mindset changes (accepting that physical changes are happening, without throwing our hands in the air and giving up)
- Focus on important aspects such as:
- strength
- flexibility
- mobility
- agility
- endurance
- Some attention is also given to diet—nothing you won’t have read elsewhere, but it’s a worthy mention.
All in all, this is a fine book if you’re thinking of taking up or maintaining an exercise routine that doesn’t stick its head in the sand about your aging body, but doesn’t just roll over and give up either. A worthy addition to anyone’s bookshelf!
Check Out Fitness After 40 On Amazon Today!
Looking for a more women-centric equivalent book? Vonda Wright M.D. has you covered (and her bio is very impressive)!
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Delicious Quinoa Avocado Bread
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They’re gluten-free, full of protein and healthy fats, generous with the fiber, easy to make, and tasty too! What’s not to love? Keep this recipe (and its ingredients) handy for next time you want healthy burger buns or similar:
You will need
- 2½ cups quinoa flour
- 2 cups almond flour (if allergic, just substitute more quinoa flour)
- 1 avocado, peeled, pitted, and mashed
- zest and juice of 1 lime
- 2 tbsp ground flaxseed
- 1 tsp baking powder
- ½ tsp MSG or 1 tsp low-sodium salt
- Optional: seeds, oats, or similar for topping the buns
Method
(we suggest you read everything at least once before doing anything)
1) Preheat the oven to 350℉/175℃.
2) Mix the flaxseed with ⅓ cup warm water and set aside.
3) Mix, in a large bowl, the quinoa flour and almond flour with the baking powder and the MSG or salt.
4) Mix, in a separate smaller bowl, the avocado and lime.
5) Add the wet ingredients to the dry, slowly, adding an extra ½ cup water as you do, and knead into a dough.
6) Divide the dough into 4 equal portions, each shaped into a ball and then slightly flattened, to create a burger bun shape. If you’re going to add any seeds or similar as a topping, add those now.
7) Bake them in the oven (on a baking sheet lined with baking paper) for 20–25 minutes. You can check whether they’re done the same way you would a cake, by piercing them to the center with a toothpick and seeing whether it comes out clean.
8) Serve when sufficiently cooled.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Gluten: What’s The Truth?
- Why You Should Diversify Your Nuts!
- Monosodium Glutamate: Sinless Flavor-Enhancer Or Terrible Health Risk?
Take care!
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Ear Candling: Is It Safe & Does It Work?
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Does This Practice Really Hold A Candle To Evidence-Based Medicine?
In Tuesday’s newsletter, we asked you your opinion of ear candling, and got the above-depicted, below-described set of responses:
- Exactly 50% said “Under no circumstances should you put things in your ear and set fire to them”
- About 38% said “It is a safe, drug-free way to keep the ears free from earwax and pathogens”
- About 13% said “Done correctly, thermal-auricular therapy is harmless and potentially beneficial”
This means that if we add the two positive-to-candling answers together, it’s a perfect 50:50 split between “do it” and “don’t do it”.
(Yes, 38%+13%=51%, but that’s because we round to the nearest integer in these reports, and more precisely it was 37.5% and 12.5%)
So, with the vote split, what does the science say?
First, a quick bit of background: nobody seems keen to admit to having invented this. One of the major manufacturers of ear candles refers to them as “Hopi” candles, which the actual Hopi tribe has spent a long time asking them not to do, as it is not and never has been used by the Hopi people. Other proposed origins offered by advocates of ear candling include Traditional Chinese Medicine (not used), Ancient Egypt (no evidence of such whatsoever), and Atlantis:
Quackwatch | Why Ear Candling Is Not A Good Idea
It is a safe, drug-free way to keep the ears free from earwax and pathogens: True or False?
False! In a lot of cases of alternative therapy claims, there’s an absence of evidence that doesn’t necessarily disprove the treatment. In this case, however, it’s not even an open matter; its claims have been actively disproven by experimentation:
- It doesn’t remove earwax; on the contrary, experimentation “showed no removal of cerumen from the external auditory canal. Candle wax was actually deposited in some“
- It doesn’t remove pathogens, and the proposed mechanism of action for removing pathogens, that of the “chimney effect”: the idea that the burning candle creates a vacuum that draws wax out of the ear along with debris and bacteria, simply does not work; on the contrary, “Tympanometric measurements in an ear canal model demonstrated that ear candles do not produce negative pressure”.
- It isn’t safe; on the contrary, “Ear candles have no benefit in the management of cerumen and may result in serious injury”
In a medium-sized survey (n=122), the following injuries were reported:
- 13 x burns
- 7 x occlusion of the ear canal
- 6 x temporary hearing loss
- 3 x otitis externa (this also called “swimmer’s ear”, and is an inflammation of the ear, accompanied by pain and swelling)
- 1 x tympanic membrane perforation
Indeed, authors of one paper concluded:
❝Ear candling appears to be popular and is heavily advertised with claims that could seem scientific to lay people. However, its claimed mechanism of action has not been verified, no positive clinical effect has been reliably recorded, and it is associated with considerable risk.
No evidence suggests that ear candling is an effective treatment for any condition. On this basis, we believe it can do more harm than good and we recommend that GPs discourage its use❞
Source: Canadian Family Physician | Ear Candling
Under no circumstances should you put things in your ear and set fire to them: True or False?
True! It’s generally considered good advice to not put objects in general in your ears.
Inserting flaming objects is a definite no-no. Please leave that for the Cirque du Soleil.
You may be thinking, “but I have done this and suffered no ill effects”, which seems reasonable, but is an example of survivorship bias in action—it doesn’t make the thing in question any safer, it just means you were one of the one of the ones who got away unscathed.
If you’re wondering what to do instead… Ear oils can help with the removal of earwax (if you don’t want to go get it sucked out at a clinic—the industry standard is to use a suction device, which actually does what ear candles claim to do). For information on safely getting rid of earwax, see our previous article:
Take care!
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When BMI Doesn’t Measure Up
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When BMI Doesn’t Quite Measure Up
Last month, we did a “Friday Mythbusters” edition of 10almonds, tackling many of the misconceptions surrounding obesity. Amongst them, we took a brief look at the usefulness (or lack thereof) of the Body Mass Index (BMI) scale of weight-related health for individuals. By popular subscriber request, we’re now going to dive a little deeper into that today!
The wrong tool for the job
BMI was developed as a tool to look at large-scale demographic trends, stemming from a population study of white European men, who were for the purpose of the study (the widescale health of the working class in that geographic area in that era), considered a reasonable default demographic.
In other words: as a system, it’s now being used in a way it was never made for, and the results of that misappropriation of an epidemiological tool for individual health are predictably unhelpful.
If you want to know yours…
Here’s the magic formula for calculating your BMI:
- Metric: divide your weight in kilograms by your height in square meters
- Imperial: divide your weight in pounds by your height in square inches and then multiply by 703
“What if my height doesn’t come in square meters or square inches, because it’s a height, not an area?”
We know. Take your height and square it anyway. If this seems convoluted and arbitrary, yes, it is.
But!
While on the one hand it’s convoluted and arbitrary… On the other hand, it’s also a gross oversimplification. So, yay for the worst of both worlds?
If you don’t want to grab a calculator, here’s a quick online tool to calculate it for you.
So, how did you score?
According to the CDC, a BMI score…
- Under 18.5 is underweight
- 18.5 to 24.9 is normal
- 25 to 29.9 is overweight
- 30 and over is obese
And, if we’re looking at a representative sample of the population, where the representation is average white European men of working age, that’s not a bad general rule of thumb.
For the rest of us, not so representative
BMI is a great and accurate tool as a rule of thumb, except for…
Women
An easily forgotten demographic, due to being a mere 51% of the world’s population, women generally have a higher percentage of body fat than men, and this throws out BMI’s usefulness.
If pregnant or nursing
A much higher body weight and body fat percentage—note that these are two things, not one. Some of the extra weight will be fat to nourish the baby; some will be water weight, and if pregnant, some will be the baby (or babies!). BMI neither knows nor cares about any of these things. And, this is a big deal, because BMI gets used by healthcare providers to judge health risks and guide medical advice.
People under the age of 16 or over the age of 65
Not only do people below and above those ages (respectively) tend to be shorter—which throws out the calculations and mean health risks may increase before the BMI qualifies as overweight—but also:
- BMI under 23 in people over the age of 65 is associated with a higher health risk
- A meta-analysis showed that a BMI of 27 was the best in terms of decreased mortality risk for the over-65 age group
This obviously flies in the face of conventional standards regards BMI—as you’ll recall from the BMI brackets we listed above.
Read the science: BMI and all-cause mortality in older adults: a meta-analysis
Athletic people
A demographic often described in scientific literature as “athletes”, but that can be misleading. When we say “athletes”, what comes to mind? Probably Olympians, or other professional sportspeople.
But also athletic, when it comes to body composition, are such people as fitness enthusiasts and manual laborers. Which makes for a lot more people affected by this!
Athletic people tend to have more lean muscle mass (muscle weighs more than fat), and heavier bones (can’t build strong muscles on weak bones, so the bones get stronger too, which means denser)… But that lean muscle mass can actually increase metabolism and help ward off many of the very same things that BMI is used as a risk indicator for (e.g. heart disease, and diabetes). So people in this category will actually be at lower risk, while (by BMI) getting told they are at higher risk.
If not white
Physical characteristics of race can vary by more than skin color, relevant considerations in this case include, for example:
- Black people, on average, not only have more lean muscle mass and less fat than white people, but also, have completely different risk factors for diseases such as diabetes.
- Asian people, on average, are shorter than white people, and as such may see increased health risks before BMI qualifies as overweight.
- Hispanic people, on average, again have different physical characteristics that throw out the results, in a manner that would need lower cutoffs to be even as “useful” as it is for white people.
Further reading on this: BMI and the BIPOC Community
In summary:
If you’re an average white European working-age man, BMI can sometimes be a useful general guide. If however you fall into one or more of the above categories, it is likely to be inaccurate at best, if not outright telling the opposite of the truth.
What’s more useful, then?
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 today’s newsletter!
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, sex, ethnicity, and lifestyle.
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Hummus vs Guacamole – Which is Healthier?
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Our Verdict
When comparing hummus to guacamole, we picked the guacamole.
Why?
First up, let’s assume that the standards are comparable, for example that both have been made with simple whole foods. The hummus is mostly chickpeas with tahini and a little olive oil and some seasoning; the guacamole is mostly avocado with a little lime juice and some seasoning.
In terms of macronutrients, hummus has slightly more protein and fiber, 2x the carbohydrates (but they are healthy carbs), and usually slightly less fat (but the fats are healthy in both cases).
In terms of micronutrients, the hummus is rich in iron and B vitamins, and the guacamole is rich in potassium, magnesium, vitamins C, E, and K.
So far, it’s pretty much tied. What else is there to consider?
We picked the guacamole because some of its nutrients (especially the potassium, magnesium, and vitamin K) are more common deficiencies in most people’s diets than iron and B vitamins. So, on average, it’s probably the one with the nutrients that you need more of at any given time.
So, it was very very close, and it came down to the above as the deciding factor.
However!
- If you like one and not the other? Eat that one; it’s good.
- If you like both but feel like eating one of them in particular? Eat that one; your body is probably needing those nutrients more right now.
- If you are catering for a group of people? Serve both!
- If you are catering for just yourself and would enjoy both? Serve both! There’s nobody to stop you!
Want to read more?
You might like: Avocado Oil vs Olive Oil – Which is Healthier?
Enjoy!
Don’t Forget…
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Should Men Over 50 Get PSA?
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
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
❝Loved the information on prostate cancer. Do recommend your readers get a PSA or equivalent test annually for over 50 yr old men.❞
(This is about: Prostate Health: What You Should Know)
Yep, or best yet, the much more accurate PSE test! But if PSA test is what’s available, it’s a lot better than nothing. And, much as it’s rarely the highlight of anyone’s day, a prostate exam by a suitably qualified professional is also a good idea.
Don’t Forget…
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