More Salt, Not Less?
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
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
❝I’m curious about the salt part – learning about LMNT and what they say about us needing more salt than what’s recommended by the government, would you mind looking into that? From a personal experience, I definitely noticed a massive positive difference during my 3-5 day water fasts when I added salt to my water compared to when I just drank water. So I’m curious what the actual range for salt intake is that we should be aiming for.❞
That’s a fascinating question, and we’ll have to tackle it in several parts:
When fasting
3–5 days is a long time to take only water; we’re sure you know most people fast from food for much less time than that. Nevertheless, when fasting, the body needs more water than usual—because of the increase in metabolism due to freeing up bodily resources for cellular maintenance. Water is necessary when replacing cells (most of which are mostly water, by mass), and for ferrying nutrients around the body—as well as escorting unwanted substances out of the body.
Normally, the body’s natural osmoregulatory process handles this, balancing water with salts of various kinds, to maintain homeostasis.
However, it can only do that if it has the requisite parts (e.g. water and salts), and if you’re fasting from food, you’re not replenishing lost salts unless you supplement.
Normally, monitoring our salt intake can be a bit of a guessing game, but when fasting for an entire day, it’s clear how much salt we consumed in our food that day: zero
So, taking the recommended amount of sodium, which varies but is usually in the 1200–1500mg range (low end if over aged 70+; high end if aged under 50), becomes sensible.
More detail: How Much Sodium You Need Per Day
See also, on a related note:
When To Take Electrolytes (And When We Shouldn’t!)
When not fasting
Our readers here are probably not “the average person” (since we have a very health-conscious subscriber-base), but the average person in N. America consumes about 9g of salt per day, which is several multiples of the maximum recommended safe amount.
The WHO recommends no more than 5g per day, and the AHA recommends no more than 2.3g per day, and that we should aim for 1.5g per day (this is, you’ll note, consistent with the previous “1200–1500mg range”).
Read more: Massive efforts needed to reduce salt intake and protect lives
Questionable claims
We can’t speak for LMNT (and indeed, had to look them up to discover they are an electrolytes supplement brand), but we can say that sometimes there are articles about such things as “The doctor who says we should eat more salt, not less”, and that’s usually about Dr. James DiNicolantonio, a doctor of pharmacy, who wrote a book that, because of this question today, we’ve now also reviewed:
Spoiler, our review was not favorable.
The body knows
Our kidneys (unless they are diseased or missing) do a full-time job of getting rid of excess things from our blood, and dumping them into one’s urine.
That includes excess sugar (which is how diabetes was originally diagnosed) and excess salt. In both cases, they can only process so much, but they do their best.
Dr. DiNicolantino recognizes this in his book, but chalks it up to “if we do take too much salt, we’ll just pass it in urine, so no big deal”.
Unfortunately, this assumes that our kidneys have infinite operating capacity, and they’re good, but they’re not that good. They can only filter so much per hour (it’s about 1 liter of fluids). Remember we have about 5 liters of blood, consume 2–3 liters of water per day, and depending on our diet, several more liters of water in food (easy to consume several more liters of water in food if one eats fruit, let alone soups and stews etc), and when things arrive in our body, the body gets to work on them right away, because it doesn’t know how much time it’s going to have to get it done, before the next intake comes.
It is reasonable to believe that if we needed 8–10g of salt per day, as Dr. DiNicolantonio claims, our kidneys would not start dumping once we hit much, much lower levels in our blood (lower even than the daily recommended intake, because not all of the salt in our body is in our blood, obviously).
See also: How Too Much Salt Can Lead To Organ Failure
Lastly, a note about high blood pressure
This is one where the “salt’s not the bad guy” crowd have at least something close to a point, because while salt is indeed still a bad guy (if taken above the recommended amounts, without good medical reason), when it comes to high blood pressure specifically, it’s not the worst bad guy, nor is it even in the top 5:
Hypertension: Factors Far More Relevant Than Salt
Thanks for writing in with such an interesting question!
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Can We Do Fat Redistribution?
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The famous answer: no
The truthful answer: yes, and we are doing it all the time whether we want to or not, so we might as well know what things affect our fat distribution in various body parts.
There’s a kernel of truth in the “no”, though, and where that comes from is that we cannot exclusively put fat on in a certain area only, and nor can we do “spot reduction”, i.e., intentionally lose fat from only one place.
How, then, do we do fat redistribution?
Your body is a living organism, not a statue
It’s easy to think “I’ve been carrying this fat in this place for 20 years”, but during that time the fat has been replaced several times and moved often; in fact, the cells containing the fat have even been replaced. Because: fat can seem like a substance that’s alien to your body because it doesn’t respond like muscles, isn’t controllable like muscles, doesn’t have the same sensibility as muscles, etc. But, every bit of fat stored in your body is stored inside a fat cell; it’s not one big unit of fat; it’s lots of tiny ones.
In reality, any given bit of fat on your body has probably been there for 18–24 months at most:
Fat turnover in obese slower than average
…and there are assorted factors that can modify the rate at which our body deals with fat storage:
Human white adipose tissue: A highly dynamic metabolic organ
So, how do I get rid of this tummy?
There are plenty of stories of people who try to lose weight from one part of their body, and lose it from somewhere else instead. Say, a person wants to lose weight from her hips, and with careful diet and exercise, she loses weight—by dropping a couple of bra cup sizes while keeping the hips.
So, we must figure out: why is fat stored in certain places? And the main driving factors are:
- hormones
- metabolic health
- stress
Hormones affect fat distribution insofar as estrogen and progesterone will favor the hips, thighs, butt, breasts, and testosterone will favor a more central (but still subcutaneous, not visceral) distribution. Additionally, estrogen and progesterone will favor a higher body fat percentage, while testosterone will favor a lower one.
This is particularly relevant later in life, when suddenly the hormone(s) you’ve been relying on to keep your shape, are now declining, meaning your shape does too. This goes for everyone regardless of sex.
See:
- What You Should Have Been Told About The Menopause Beforehand
- The BAT-pause! ← this is about the conversion of white adipose tissue to brown adipose tissue, and how estrogen helps this happen
- Topping Up Testosterone?
Metabolic health affects fat distribution insofar as poor metabolic health will result in more fat being stored in the viscera, rather than in the usual subcutaneous places. This is a serious health risk.
See: Visceral Belly Fat & How To Lose It
Stress affects fat distribution insofar as chronically elevated cortisol levels see more fat sent to the stomach, face, and neck. This fat redistribution isn’t dangerous itself, but it can be indicative of the chronic stress, which does pose more of a general threat to health.
See: Lower Your Cortisol! (Here’s Why & How)
What this means in practical terms
Assuming that you would like the fat distribution that says “this is a healthy woman” or “this is a healthy man”, respectively, then you might want to:
- Check your sex hormone levels and get them adjusted if appropriate
- Improve your overall metabolic health—without necessarily trying to lose weight, just, take care of your blood sugars for example, and they will take care of you in terms of fat storage.
- Manage your stress (which includes any stress you are experiencing about your body not being how you’d like it to be).
If you are doing these things, and you don’t have any major untreated medical abnormalities that affect these things, then your fat will go to the places generally considered healthiest.
Can we speed it up?
Yes, we can! Firstly, we can speed up our overall metabolism:
Let’s Burn! Metabolic Tweaks And Hacks
Secondly, we can encourage our body to “move” fat by intentionally “yo-yoing”, something usually considered bad in dieting when people just want to lose weight and instead are going up and down, but: if you lose weight healthily, it comes off everywhere evenly, and if you gain weight healthily, it goes mostly to the places where it should be.
So, a sequence of lose-gain-lose-gain might look like “lose a bit from everywhere, put it back in the good place, lose a bit more from everywhere, put it back in the good place”, etc.
So, you might want to gently cycle these a few months apart, for example:
How To Lose Fat (Healthily!) | How To Gain Fat (Healthily!)
You can also cheat a little, if it suits your purpose! By this we mean: if you’d like a little extra where you already have a little fat, then you can put muscle on underneath it, it will pad it up, and (because of the layer of actual fat on top) nobody will know the difference unless you flex it with their hand on it.
Let’s put it this way: people doing squats for a bubble-butt aren’t doing it to put on fat; they’re putting muscle on under the fat they have.
So, check out: How To Gain Muscle (Healthily!)
And finally, for all your body-sculpting needs, we present these excellent books:
Women’s Strength Training Anatomy Workouts – by Frédéric Delavier
Strength Training Anatomy (For Men) – by Frédéric Delavier
Enjoy!
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Genius Foods – by Max Lugavere
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There is a lot of seemingly conflicting (or sometimes: actually conflicting!) information out there with regard to nutrition and various aspects of health. Why, for example, are we told:
- Be sure to get plenty of good healthy fats from nuts and seeds, for metabolic health and brain health too!
- But these terrible nut and seed oils lead to heart disease and dementia! Avoid them at all costs!
Max Lugavere demystifies this and more.
His science-led approach is primarily focused on avoiding dementia, and/but is at least not bad when it comes to other areas of health too.
He takes us on a tour of different parts of our nutrition, including:
- Perhaps the clearest explanation of “healthy” vs “unhealthy” fats this reviewer has read
- Managing carbs (simple and complex) for healthy glucose management—essential for good brain health
- What foods to improve or reduce—a lot you might guess, but this is a comprehensive guide to brain health so it’d be remiss to skip it
- The role that intermittent fasting can play as a bonus extra
While the main thrust of the book is about avoiding cognitive impairment in the long-term (including later-life dementia), he makes good, evidence-based arguments for how this same dietary plan improves cognitive function in the short-term, too.
Speaking of that dietary plan: he does give a step-by-step guide in a “make this change first, then this, then this” fashion, and offers some sample recipes too. This is by no means a recipe book though—most of the book is taking us through the science, not the kitchen.
Bottom line: this is the book for getting unconfused with regard to diet and brain health, making a lot of good science easy to understand. Which we love!
Click here to check out “Genius Foods” on Amazon today, give your brain a boost!
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The SharpBrains Guide to Brain Fitness – by Alvaro Fernandez et al.
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We say “et al.” in the by-line, because this one has a flock of authors, including Dr. Pascale Michelon, Dr. Sandra Bond Chapman, Dr. Elkehon Goldberg, and various others if we include the foreword, introduction, etc.
This is relevant, because those who contributed to the meat of the book (i.e., those listed above), it makes the work a lot more scientifically reliable; one skilled science writer might make a mistake; it’s much less likely to make it through to publication when there are a bevy of doctors in the mix, each staking their reputation on the book’s content, and thus having a vested interest in checking each other’s work as well as their own.
As for what this multidisciplinary team have to offer? The book covers such things as:
- how the brain works (especially the possibilities of neuroplasticity), and what that means for such things as memory and attention
- being “a coach not a patient”; i.e., being active rather than passive in one’s approach to brain health
- the relevance of physical exercise, how much, and what kind
- the relevance (and limitations) of diet choices for brain health
- the relevance of such things as learning new languages and musical training
- the relevance of social engagement, and how some (but not all) social engagement can boost cognition
- methods for managing stress and building resilience to same (critical for maintaining a healthy brain)
- “cross-fit for your brain”, that is to say, a multi-vector collection of tools to explore, ranging from meditation to CBT to biofeedback and more.
The style is pop-science without being sensationalist, just communicating ideas clearly, with enough padding to feel casual, and not like a dense read. Importantly, it’s also practical and applicable too, which is something we always look for here.
Bottom line: if you’d like to be given a good overview of what things work (and how much they can be expected to work), along with a good framework to put that knowledge into practice, then this is a great book for you.
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Apples vs Carrots – Which is Healthier?
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Our Verdict
When comparing apples to carrots, we picked the carrots.
Why?
Both are sweet crunchy snacks, both rightly considered very healthy options, but one comes out clearly on top…
Both contain lots of antioxidants, albeit mostly different ones. They’re both good for this.
Looking at their macros, however, apples have more carbs while carrots have more fiber. The carb:fiber ratio in apples is already sufficient to make them very healthy, but carrots do win.
In the category of vitamins, carrots have many times more of vitamins A, B1, B2, B3, B5, B6, B9, C, E, K, and choline. Apples are not higher in any vitamins.
In terms of minerals, carrots have a lot more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc. Apples are not higher in any minerals.
If “an apple a day keeps the doctor away”, what might a carrot a day do?
Want to learn more?
You might like to read:
Sugar: From Apples to Bees, and High-Fructose C’s
Take care!
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Do Breathe – by Michael Williams
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Have you ever felt you could get everything in your life in order, if you could just get a little breathing room first?
Notwithstanding the title, this is mostly not a book about breathing exercises. It does cover that too, but there’s a lot more.
The author’s advices draw from a variety of high quality sources. Well-read readers will certainly recognise sections that are straight from David Allen’s “Getting Things Done”, and Mihaly Czikszentmihalyi’s “Flow”, for example, as well as Francesco Cirillo’s “Pomodoro Technique”, and James Clear’s “Atomic Habits”.
We also learn about how even simple yoga can help us, and good sleep, and a healthy diet.
In short, if you’ve been reading 10almonds for a while, you might not actually learn much new! But it’s very nice to have all these things in one book, for sure, and it’s a pleasant, easy read too.
Bottom line: if you’d like to streamline your life and not have to buy a whole stack of different books to do it, this book is a great composite that will enable you to get the job done efficiently.
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In Crisis, She Went to an Illinois Facility. Two Years Later, She Still Isn’t Able to Leave.
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Series: Culture of Cruelty:Inside Illinois’ Mental Health System
State-run facilities in Illinois are supposed to care for people with mental and developmental disabilities. But patients have been subjected to abuse, neglect and staff misconduct for decades, despite calls for change.
Kaleigh Rogers was in crisis when she checked into a state-run institution on Illinois’ northern border two years ago. Rogers, who has cerebral palsy, had a mental health breakdown during the pandemic and was acting aggressively toward herself and others.
Before COVID-19, she had been living in a small group home; she had been taking college classes online and enjoyed going out with friends, volunteering and going to church. But when her aggression escalated, she needed more medical help than her community setting could provide.
With few viable options for intervention, she moved into Kiley Developmental Center in Waukegan, a much larger facility. There, she says she has fewer freedoms and almost nothing to do, and was placed in a unit with six other residents, all of whom are unable to speak. Although the stay was meant to be short term, she’s been there for two years.
The predicament facing Rogers and others like her is proof, advocates say, that the state is failing to live up to the promise it made in a 13-year-old federal consent decree to serve people in the community.
Rogers, 26, said she has lost so much at Kiley: her privacy, her autonomy and her purpose. During dark times, she cries on the phone to her mom, who has reduced the frequency of her visits because it is so upsetting for Rogers when her mom has to leave.
The 220-bed developmental center about an hour north of Chicago is one of seven in the state that have been plagued by allegations of abuse and other staff misconduct. The facilities have been the subject of a monthslong investigation by Capitol News Illinois and ProPublica about the state’s failures to correct poor conditions for people with intellectual and developmental disabilities. The news organizations uncovered instances of staff who had beaten, choked, thrown, dragged and humiliated residents inside the state-run facilities.
Advocates hoped the state would become less reliant on large institutions like these when they filed a lawsuit in 2005, alleging that Illinois’ failure to adequately fund community living options ended up segregating people with intellectual and developmental disabilities from society by forcing them to live in institutions. The suit claimed Illinois was in direct violation of a 1999 U.S. Supreme Court decision in another case, which found that states had to serve people in the most integrated setting of their choosing.
Negotiations resulted in a consent decree, a court-supervised improvement plan. The state agreed to find and fund community placements and services for individuals covered by the consent decree, thousands of adults with intellectual and developmental disabilities across Illinois who have put their names on waiting lists to receive them.
Now, the state has asked a judge to consider ending the consent decree, citing significant increases in the number of people receiving community-based services. In a court filing in December, Illinois argued that while its system is “not and never will be perfect,” it is “much more than legally adequate.”
But advocates say the consent decree should not be considered fulfilled as long as people with disabilities continue to live without the services and choices that the state promised.
Across the country, states have significantly downsized or closed their large-scale institutions for people with developmental and intellectual disabilities in favor of smaller, more integrated and more homelike settings.
But in Illinois, a national outlier, such efforts have foundered. Efforts to close state-operated developmental centers have been met with strong opposition from labor unions, the communities where the centers are located, local politicians and some parents.
U.S. District Judge Sharon Johnson Coleman in Chicago is scheduled in late summer to decide whether the state has made enough progress in building up community supports to end the court’s oversight.
For some individuals like Rogers, who are in crisis or have higher medical or behavioral challenges, the state itself acknowledges that it has struggled to serve them in community settings. Rogers said she’d like to send this message on behalf of those in state-operated developmental centers: “Please, please get us out once and for all.”
“Living Inside a Box”
Without a robust system of community-based resources and living arrangements to intervene during a crisis, state-operated developmental centers become a last resort for people with disabilities. But under the consent decree agreement, the state, Equip for Equality argues, is expected to offer sufficient alternative crisis supports to keep people who want them out of these institutions.
In a written response to questions, Rachel Otwell, a spokesperson for the Illinois Department of Human Services, said the state has sought to expand the menu of services it offers people experiencing a crisis, in an effort to keep them from going into institutions. But Andrea Rizor, a lawyer with Equip for Equality, said, “They just don’t have enough to meet the demand.”
For example, the state offers stabilization homes where people can live for 90 days while they receive more intensive support from staff serving the homes, including medication reviews and behavioral interventions. But there are only 32 placements available — only four of them for women — and the beds are always full, Rizor said.
Too many people, she said, enter a state-run institution for short-term treatment and end up stuck there for years for various reasons, including shortcomings with the state’s discharge planning and concerns from providers who may assume those residents to be disruptive or difficult to serve without adequate resources.
That’s what happened to Rogers. Interruptions to her routine and isolation during the pandemic sent her anxiety and aggressive behaviors into overdrive. The staff at her community group home in Machesney Park, unsure of what to do when she acted out, had called the police on several occasions.
Doctors also tried to intervene, but the cocktail of medications she was prescribed turned her into a “zombie,” Rogers said. Stacey Rogers, her mom and legal guardian, said she didn’t know where else to turn for help. Kiley, she said, “was pretty much the last resort for us,” but she never intended for her daughter to be there for this long. She’s helped her daughter apply to dozens of group homes over the past year. A few put her on waitlists; most have turned her down.
“Right now, all she’s doing is living inside a box,” Stacey Rogers said.
Although Rogers gave the news organizations permission to ask about her situation, IDHS declined to comment, citing privacy restrictions. In general, the IDHS spokesperson said that timelines for leaving institutions are “specific to each individual” and their unique preferences, such as where they want to live and speciality services they may require in a group home.
Equip for Equality points to people like Rogers to argue that the consent decree has not been sufficiently fulfilled. She’s one of several hundred in that predicament, the organization said.
“If the state doesn’t have capacity to serve folks in the community, then the time is not right to terminate this consent decree, which requires community capacity,” Rizor said.
Equip for Equality has said that ongoing safety issues in these facilities make it even more important that people covered by the consent decree not be placed in state-run institutions. In an October court brief, citing the news organizations’ reporting, Equip for Equality said that individuals with disabilities who were transferred from community to institutional care in crisis have “died, been raped, and been physically and mentally abused.”
Over the summer, an independent court monitor assigned to provide expert opinions in the consent decree, in a memo to the court, asked a judge to bar the state from admitting those individuals into its institutions.
In its December court filing, the state acknowledged that there are some safety concerns inside its state-run centers, “which the state is diligently working on,” as well as conditions inside privately operated facilities and group homes “that need to be addressed.” But it also argued that conditions inside its facilities are outside the scope of the consent decree. The lawsuit and consent decree specifically aimed to help people who wanted to move out of large private institutions, but plaintiffs’ attorneys argue that the consent decree prohibits the state from using state-run institutions as backup crisis centers.
In arguing to end the consent decree, the state pointed to significant increases in the number of people served since it went into effect. There were about 13,500 people receiving home- and community-based services in 2011 compared with more than 23,000 in 2023, it told the court.
The state also said it has significantly increased funding that is earmarked to pay front-line direct support professionals who assist individuals with daily living needs in the community, such as eating and grooming.
In a statement to reporters, the human services department called these and other improvements to the system “extraordinary.”
Lawyers for the state argued that those improvements are enough to end court oversight.
“The systemic barriers that were in place in 2011 no longer exist,” the state’s court filing said.
Among those who were able to find homes in the community is Stanley Ligas, the lead plaintiff in the lawsuit that led to the consent decree. When it was filed in 2005, he was living in a roughly 100-bed private facility but wanted to move into a community home closer to his sister. The state refused to fund his move.
Today, the 56-year-old lives in Oswego with three roommates in a house they rent. All of them receive services to help their daily living needs through a nonprofit, and Ligas has held jobs in the community: He previously worked in a bowling alley and is now paid to make public appearances to advocate for others with disabilities. He lives near his sister, says he goes on family beach vacations and enjoys watching professional wrestling with friends. During an interview with reporters, Ligas hugged his caregiver and said he’s “very happy” and hopes others can receive the same opportunities he’s been given.
While much of that progress has come only in recent years, under Gov. JB Pritzker’s administration, it has proven to be vulnerable to political and economic changes. After a prolonged budget stalemate, the court in 2017 found Illinois out of compliance with the Ligas consent decree.
At the time, late and insufficient payments from the state had resulted in a staffing crisis inside community group homes, leading to escalating claims of abuse and neglect and failures to provide routine services that residents relied on, such as help getting to work, social engagements and medical appointments in the community. Advocates worry about what could happen under a different administration, or this one, if Illinois’ finances continue to decline as projected.
“I acknowledge the commitments that this administration has made. However, because we had so far to come, we still have far to go,” said Kathy Carmody, chief executive of The Institute on Public Policy for People with Disabilities, which represents providers.
While the wait for services is significantly shorter than it was when the consent decree went into effect in 2011, there are still more than 5,000 adults who have told the state they want community services but have yet to receive them, most of them in a family home. Most people spend about five years waiting to get the services they request. And Illinois continues to rank near the bottom in terms of the investment it makes in community-based services, according to a University of Kansas analysis of states’ spending on services for people with intellectual and developmental disabilities.
Advocates who believe the consent decree has not been fulfilled contend that Illinois’ continued reliance on congregate settings has tied up funds that could go into building up more community living options. Each year, Illinois spends about $347,000 per person to care for those in state-run institutions compared with roughly $91,000 per person spent to support those living in the community.
For Rogers, the days inside Kiley are long, tedious and sometimes chaotic. It can be stressful, but Rogers told reporters that she uses soothing self-talk to calm herself when she feels sad or anxious.
“I tell myself: ‘You are doing good. You are doing great. You have people outside of here that care about you and cherish you.’”
This article is republished from ProPublica under a Creative Commons license. Read the original article.
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