Understanding Cellulitis: Skin And Soft Tissue Infections
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What’s the difference between a minor passing skin complaint, and a skin condition that’s indicative of something more serious? Dr. Thomas Watchman explains:
More than skin-deep
Cellulitis sounds benign enough, like having a little cellulite perhaps, but in fact it means an infection of the skin and—critically—the underlying soft tissues.
Normally, the skin acts as a barrier against infections, but this barrier can be breached by physical trauma (i.e. an injury that broke the skin), eczema, fungal nail infections, skin ulcers, and other similar things that disrupt the skin’s ability to protect us.
Things to watch out for: Dr. Watchman advises we keep an eye out for warm, reddened skin, swelling, and blisters. Specifically, a golden-yellow crust to these likely indicates a Staphylococcus aureus infection (hence the name).
There’s a scale of degrees of severity:
- Class 1: No systemic toxicity or comorbidities
- Class 2: Systemic toxicity or comorbidities present
- Class 3: Significant systemic toxicity or comorbidities with risk of significant deterioration
- Class 4: Sepsis or life-threatening infection
…with antibiotics being recommended in the latter two cases there, or in other cases for frail, young, old, or immunocompromised patients. Given the rather “scorched earth” results of antibiotics (they cause a lot of collateral iatrogenic damage), this can be taken as a sign of how seriously such infections should be taken.
For more about all this, including visual guides, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
- Of Brains & Breakouts: The Brain-Skin Doctor
- Beyond Supplements: The Real Immune-Boosters!
- Antibiotics? You Might Want To Think Thrice
Take care!
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Lies I Taught in Medical School – by Dr. Robert Lufkin
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There seems to be a pattern of doctors who practice medicine one way, get a serious disease personally, and then completely change their practice of medicine afterwards. This is one of those cases.
Dr. Lufkin here presents, on a chapter-by-chapter basis, the titularly promised “lies” or, in more legally compliant speak (as he acknowledges in his preface), flawed hypotheses that are generally taught as truths. In many cases, the “lie” is some manner of “xyz is normal and nothing to worry about”, and/or “there is nothing to be done about xyz; suck it up”.
The end result of the information is not complicated—enjoy a plants-forward whole foods low-carb diet to avoid metabolic diseases and all the other things to branch off from same (Dr. Lufkin makes a fair case for metabolic disease leading to a lot of secondary diseases that aren’t considered metabolic diseases per se). But, the journey there is actually important, as it answers a lot of questions that are much less commonly understood, and often not even especially talked-about, despite their great import and how they may affect health decisions beyond the dietary. Things like understanding the downsides of statins, or the statistical models that can be used to skew studies, per relative risk reduction and so forth.
Bottom line: this book gives the ins and outs of what can go right or wrong with metabolic health and why, and how to make sure you don’t sabotage your health through missing information.
Click here to check out Lies I Taught In Medical School, and arm yourself with knowledge!
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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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Corn Chips vs Potato Chips: Which is Healthier?
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Our Verdict
When comparing corn chips to potato chips, we picked the corn chips.
Why?
First, let it be said, this was definitely a case of “lesser evil voting” as there was no healthy choice here. But as for which is relatively least unhealthy…
Most of the macronutrient and micronutrient profile is quite similar. Both foods are high carb, moderately high fat, negligible protein, and contain some trace minerals and even some tiny amounts of vitamins. Both are unhealthily salty.
Exact numbers will of course vary from one brand’s product to another, but you can see some indicative aggregate scores here in the USDA’s “FoodData Central” database:
The biggest health-related difference that doesn’t have something to balance it out is that the glycemic index of corn chips averages around 63, whereas the glycemic index of potato chips averages around 70 (that is worse).
That’s enough to just about tip the scales in favor of corn chips.
The decision thus having been made in favor of corn chips (and the next information not having been part of that decision), we’ll mention one circumstantial extra benefit to corn chips:
Corn chips are usually eaten with some kind of dip (e.g. guacamole, sour cream, tomato salsa, etc) which can thus deliver actual nutrients. Potato chips meanwhile are generally eaten with no additional nutrients. So while we can’t claim the dip as being part of the nutritional make-up of the corn chips, we can say:
If you’re going to have a habit of eating one or the other, then corn chips are probably the least unhealthy of the two.
And yes, getting vegetables (e.g. in the dips) in ways that are not typically associated with “healthy eating” is still better than not getting vegetables at all!
Check out: Level-Up Your Fiber Intake! (Without Difficulty Or Discomfort)
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When Bad Joints Stop You From Exercising (5 Things To Change)
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The first trick to exercising with bad joints is to have better joints.
Now, this doesn’t necessarily mean you can take a supplement and magically your joint problems will be cured, but there are adjustable lifestyle factors that can and will make things relatively better or worse.
We say “and will”, because you don’t get a choice in that part. Everything we do, every little choice in our day, makes our health a little better or a little worse in some aspect(s). But we do get a choice between “relatively better” and “relatively worse”.
With that in mind, do check out:
- Avoiding/Managing Osteoarthritis
- Avoiding/Managing Rheumatoid Arthritis
- How To Really Look After Your Joints
Ok, you have bad joints though; what next?
Let’s assume you’re doing your best with the above, and/or have simply decided not to, which is your call. You know your circumstances best. Either way, your joints are still not in sufficiently good condition to be able to exercise the way you’d like.
First, the obvious: enjoy low-impact exercises
For example:
- Swimming
- Yoga (much more appropriate here than the commonly-paired “and tai chi”)*
- Isometric exercises (i.e. exercise without movement, e.g. squeezing things, or stationary stability exercises)
*This is not to say that tai chi is bad. But if your problem is specifically your knees, there are many movements in most forms of tai chi that require putting the majority of one’s weight on one bent leg, which means the knee of that leg is going to suffer. If your knees are fine, then this won’t be an issue and it will simply continue strengthening your knees without discomfort. But they have to be fine first.
See also: Exercising With Osteoporosis
Second: support your joints through a full range of motion
If you have bad joints, you probably know that there’s an unfortunate paradox whereby you get to choose between:
- Exercise, and inflame your joints
- Rest, and your joints seize up
This is the way to get around that damaging dilemma.
Moving your joints through a full range of motion regularly is critical for their maintenance, so do that in a way that isn’t straining them:
If it’s your shoulders, for example, you can do (slow, gentle!) backstroke or front-crawl or butterfly motions while standing in the comfort of your living room.
If it’s your knees, then supported squats can do you a world of good. That means, squat in front of a table or other stable object, with your fingertips (or as much of your hands as you need) on it, to take a portion of your weight (it can be a large portion; that’s fine too!) while you go through the full range of motion of the squat. Repeat.
And so forth for other joints.
See also: The Most Underrated Hip Mobility Exercise (Not Stretching)
Third: work up slowly, and stop early
You can do exercises that involve impact, and if you live a fairly normal life, you’ll probably have to (walking is an impact exercise). You can also enjoy cycling (low-impact, but not so low-impact as we discussed in the last section) and work up to running if you want to.
However…
While building up your joints’ mobility and strength, it is generally a good idea to stop before you think you need to.
This means that it’s important to do those exercises in a way that you can stop early. For example, an exercise bike or a treadmill can be a lot of use here, so that you don’t find you need to stop for the day while miles from your house.
If you get such a device, it doesn’t even have to be fancy and/or expensive. This writer got herself an inexpensive exercise bike like this one, and it’s perfectly adequate.
Fourth: prioritize recovery, even if it doesn’t feel like you need it
Everyone should do this anyway, but if your joints are bad, it goes double:
Overdone It? How To Speed Up Recovery After Exercise (According To Actual Science)
Fifth: get professional help
Physiotherapists are great for this. Find one, and take their advice for your specific body and your specific circumstances and goals.
Take care!
Don’t Forget…
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How Nature Provides Us With A Surprisingly Powerful Painkiller
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It’s well-known (at least to regular 10almonds-readers) that seeing nature, ideally green leaves and blue sky, improves our mood by stimulating production of serotonin.
See also: Neurotransmitter Cheatsheet
But it does a lot more.
Reducing the actual signals of pain
Researchers at the University of Vienna have discovered that viewing nature scenes (even if just on video) alleviates physical pain—not just in self-reported subjective assessments, but also by a reduction of the neural activity that signals pain:
❝Pain is like a puzzle, made up of different pieces that are processed differently in the brain. Some pieces of the puzzle relate to our emotional response to pain, such as how unpleasant we find it. Other pieces correspond to the physical signals underlying the painful experience, such as its location in the body and its intensity.
Unlike placebos, which usually change our emotional response to pain, viewing nature changed how the brain processed early, raw sensory signals of pain.
Thus, the effect appears to be less influenced by participants’ expectations, and more by changes in the underlying pain signals❞
This was tested against, varyingly, viewing an urban environment or viewing an indoor environment, neither of which gave the same benefits.
The setup of the experiment is relevant, so…
Matching soundscape accompanied each visual stimulus. The three pain runs had a total duration of 9 min each, during which one environment was accompanied by 16 painful and 16 non-painful shocks. Neuroimaging was used for all parts, and participants were exposed to all environments:
- First, a cue indicating the intensity of the next shock (red = painful, yellow = not painful) was presented for 2000 milliseconds (ms).
- Second, a variable interval of 3500 ± 1500 ms was shown.
- Third, a cue indicating the intensity of the shock was presented for 1000 ms, accompanied by an electrical shock with a duration of 500 ms.
- Fourth, a variable interval of 3500 ± 1500 ms followed.
- Fifth, after each third trial, participants rated the shock’s intensity and unpleasantness at 6000 ms each.
- Sixth, each trial ended with an intertrial interval (ITI) presented for 2000 ms.
They found that as well as the self-assessment reports being as expected (nature scenes reduced subjective experience of pain),
❝In summary, the multivoxel and region of interest analyses converged in showing that pain responses when exposed to nature as compared to urban or indoor stimuli were associated with a decrease in neural processes related to lower-level nociception-related features (NPS, thalamus), as well as in regions of descending modulatory circuitry associated with attentional alterations of pain that also encode sensory-discriminative aspects (S2, pINS).❞
In other words—to the extent that pain can be quantified objectively by neural imaging—the pain was also objectively reduced, much like with a chemical painkiller.
You can read the paper in full, here:
Nature exposure induces analgesic effects by acting on nociception-related neural processing
How to benefit from this
Well, first there is the obvious, “view nature“.
However, note the timescales involved in the testing periods: 2000 milliseconds is two seconds, and that was the intertrial interval used—the equivalent of a washout phase in an interventional trial (but a drug/supplement/diet washout is usually a number of weeks).
The fact that the test periods were a matter of seconds, and the intertrial period was also literally two seconds, this means:
It works quickly, and the effect disappears quickly, too.
In other words: if you want pain relief from nature, the good news is you can get it immediately while viewing nature, and the bad news is that you have to keep viewing nature to continue enjoying the painkilling effect.
So that’s a limitation, but it’s still clearly a very worthy option for a little respite from chronic pain now and again, for example.
Want to learn more?
We’ve written quite a bit about pain management, including:
- Before You Reach For That Tylenol…
- How To Stop Pain Spreading
- How To Dial Down Your Pain
- Managing Chronic Pain (Realistically!)
- Get The Right Help For Your Pain
- The 7 Approaches To Pain Management
- Science-Based Alternative Pain Relief (When Painkillers Aren’t Helping, These Things Might)
Take care!
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The Many Faces Of Cosmetic Surgery
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Cosmetic Surgery: What’s The Truth?
In Tuesday’s newsletter, we asked you your opinion on elective cosmetic surgeries, and got the above-depicted, below-described, set of responses:
- About 48% said “Everyone should be able to get what they want, assuming informed consent”
- About 28% said “It can ease discomfort to bring features more in line with normalcy”
- 15% said “They should be available in the case of extreme disfigurement only”
- 10% said “No elective cosmetic surgery should ever be performed; needless danger”
Well, there was a clear gradient of responses there! Not so polarizing as we might have expected, but still enough dissent for discussion
So what does the science say?
The risks of cosmetic surgery outweigh the benefits: True or False?
False, subjectively (but this is important).
You may be wondering: how is science subjective?
And the answer is: the science is not subjective, but people’s cost:worth calculations are. What’s worth it to one person absolutely may not be worth it to another. Which means: for those for whom it wouldn’t be worth it, they are usually the people who will not choose the elective surgery.
Let’s look at some numbers (specifically, regret rates for various surgeries, elective/cosmetic or otherwise):
- Regret rate for elective cosmetic surgery in general: 20%
- Regret rate for knee replacement (i.e., not cosmetic): 17.1%
- Regret rate for hip replacement (i.e., not cosmetic): 4.8%
- Regret rate for gender-affirming surgeries (for transgender patients): 1%
So we can see, elective surgeries have an 80–99% satisfaction rate, depending on what they are. In comparison, the two joint replacements we mentioned have a 82.9–95.2% satisfaction rate. Not too dissimilar, taken in aggregate!
In other words: if a person has studied the risks and benefits of a surgery and decides to go ahead, they’re probably going to be happy with the results, and for them, the benefits will have outweighed the risks.
Sources for the above numbers, by the way:
- What is the regret rate for plastic surgery?
- Decision regret after primary hip and knee replacement surgery
- A systematic review of patient regret after surgery—a common phenomenon in many specialties but rare within gender-affirmation surgery
But it’s just a vanity; therapy is what’s needed instead: True or False?
False, generally. True, sometimes. Whatever the reasons for why someone feels the way they do about their appearance—whether their face got burned in a fire or they just have triple-J cups that they’d like reduced, it’s generally something they’ve already done a lot of thinking about. Nevertheless, it does also sometimes happen that it’s a case of someone hoping it’ll be the magical solution, when in reality something else is also needed.
How to know the difference? One factor is whether the surgery is “type change” or “restorative”, and both have their pros and cons.
- In “type change” (e.g. rhinoplasty), more psychological adjustment is needed, but when it’s all over, the person has a new nose and, statistically speaking, is usually happy with it.
- In “restorative” (e.g. facelift), less psychological adjustment is needed (as it’s just a return to a previous state), so a person will usually be happy quickly, but ultimately it is merely “kicking the can down the road” if the underlying problem is “fear of aging”, for example. In such a case, likely talking therapy would be beneficial—whether in place of, or alongside, cosmetic surgery.
Here’s an interesting paper on that; the sample sizes are small, but the discussion about the ideas at hand is a worthwhile read:
Does cosmetic surgery improve psychosocial wellbeing?
Some people will never be happy no matter how many surgeries they get: True or False?
True! We’re going to refer to the above paper again for this one. In particular, here’s what it said about one group for whom surgeries will not usually be helpful:
❝There is a particular subgroup of people who appear to respond poorly to cosmetic procedures. These are people with the psychiatric disorder known as “body dysmorphic disorder” (BDD). BDD is characterised by a preoccupation with an objectively absent or minimal deformity that causes clinically significant distress or impairment in social, occupational, or other areas of functioning.
For several reasons, it is important to recognise BDD in cosmetic surgery settings:
Firstly, it appears that cosmetic procedures are rarely beneficial for these people. Most patients with BDD who have had a cosmetic procedure report that it was unsatisfactory and did not diminish concerns about their appearance.
Secondly, BDD is a treatable disorder. Serotonin-reuptake inhibitors and cognitive behaviour therapy have been shown to be effective in about two-thirds of patients with BDD❞
~ Dr. David Castle et al. (lightly edited for brevity)
Which is a big difference compared to, for example, someone having triple-J breasts that need reducing, or the wrong genitals for their gender, or a face whose features are distinct outliers.
Whether that’s a reason people with BDD shouldn’t be able to get it is an ethical question rather than a scientific one, so we’ll not try to address that with science.
After all, many people (in general) will try to fix their woes with a haircut, a tattoo, or even a new sportscar, and those might sometimes be bad decisions, but they are still the person’s decision to make.
And even so, there can be protectionist laws/regulations that may provide a speed-bump, for example:
Take care!
Don’t Forget…
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