The Five Invitations – by Frank Ostaseski
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This book covers exactly what its subtitle promises, and encourages the reader to truly live life fully, something that Ostaseski believes cannot be done in ignorance of death.
Instead, he argues from his experience of decades working at a hospice, we must be mindful of death not only to appreciate life, but also to make the right decisions in life—which means responding well to what he calls, as per the title of this book, “the five invitations”.
We will not keep them a mystery; they are:
- Don’t wait; do the important things now
- Welcome everything; push away nothing
- Bring your whole self to the experience
- Find a place in the middle of things
- Cultivate a “don’t know” mind
Note, for example, that “do the important things now” requires knowing what is important. For example, ensuring a loved one knows how you feel about them, might be more important than scratching some item off a bucket list. And “push away nothing” does mean bad things too; rather, of course try to make life better rather than worse, but accept the lessons and learnings of the bad too, and see the beauty that can be found in contrast to it. Enjoying the fullness of life without getting lost in it; carrying consciousness through the highs and lows. And yes, approaching the unknown (which means not only death, but also the large majority of life) with open-minded curiosity and wonder.
The style of the book is narrative and personal, without feeling like a collection of anecdotes, but rather, taking the reader on a journey, prompting reflection and introspection along the way.
Bottom line: if you’d like to minimize the regrets you have in life, this book is a fine choice.
Click here to check out The Five Invitations, and answer with a “yes” to the call of life!
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Dietary Changes for Artery Health
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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
❝How does your diet change clean out your arteries of the bad cholesterol?❞
There’s good news and bad news here, and they can both be delivered with a one-word reply:
Slowly.
Or rather: what’s being cleaned out is mostly not the LDL (bad) cholesterol, but rather, the result of that.
When our diet is bad for cardiovascular health, our arteries get fatty deposits on their walls. Cholesterol gets stuck here too, but that’s not the main physical problem.
Our body’s natural defenses come into action and try to clean it up, but they (for example macrophages, a kind of white blood cell that consumes invaders and then dies, before being recycled by the next part of the system) often get stuck and become part of the buildup (called atheroma), which can lead to atherosclerosis and (if calcium levels are high) hardening of the arteries, which is the worst end of this.
This can then require medical attention, precisely because the body can’t remove it very well—especially if you are still maintaining a heart-unhealthy diet, thus continuing to add to the mess.
However, if it is not too bad yet, yes, a dietary change alone will reverse this process. Without new material being added to the arterial walls, the body’s continual process of rejuvenation will eventually fix it, given time (free from things making it worse) and resources.
In fact, your arteries can be one of the quickest places for your body to make something better or worse, because the blood is the means by which the body moves most things (good or bad) around the body.
All the more reason to take extra care of it, since everything else depends on it!
You might also like our previous main feature:
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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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Blue Light At Night? Save More Than Just Your Sleep!
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Beating The Insomnia Blues
You previously asked us about recipes for insomnia (or rather, recipes/foods to help with easing insomnia). We delivered!
But we also semi-promised we’d cover a bit more of the general management of insomnia, because while diet’s important, it’s not everything.
Sleep Hygiene
Alright, you probably know this first bit, but we’d be remiss if we didn’t cover it before moving on:
- No caffeine or alcohol before bed
- Ideally: none earlier either, but if you enjoy one or the other or both, we realize an article about sleep hygiene isn’t going to be what changes your mind
- Fresh bedding
- At the very least, fresh pillowcase(s). While washing and drying an entire bedding set constantly may be arduous and wasteful of resources, it never hurts to throw your latest pillowcase(s) in with each load of laundry you happen to do.
- Warm bed, cool room = maximum coziness
- Dark room. Speaking of which…
About That Darkness…
When we say the room should be dark, we really mean it:
- Not dark like “evening mood lighting”, but actually dark.
- Not dark like “in the pale moonlight”, but actually dark.
- Not dark like “apart from the light peeking under the doorway”, but actually dark.
- Not dark like “apart from a few LEDs on electronic devices that are on standby or are charging”, but actually dark.
There are many studies about the impact of blue light on sleep, but here’s one as an example.
If blue light with wavelength between 415 nm and 455 nm (in the visible spectrum) hits the retina, melatonin (the sleep hormone) will be suppressed.
The extent of the suppression is proportional to the amount of blue light. This means that there is a difference between starting at an “artificial daylight” lamp, and having the blue LED of your phone charger showing… but the effect is cumulative.
And it gets worse:
❝This high energy blue light passes through the cornea and lens to the retina causing diseases such as dry eye, cataract, age-related macular degeneration, even stimulating the brain, inhibiting melatonin secretion, and enhancing adrenocortical hormone production, which will destroy the hormonal balance and directly affect sleep quality.❞
Read it in full: Research progress about the effect and prevention of blue light on eyes
See also: Age-related maculopathy and the impact of blue light hazard
So, what this means, if we value our health, is:
- Switch off, or if that’s impractical, cover the lights of electronic devices. This might be as simple as placing your phone face-down rather than face-up, for instance.
- Invest in blackout blinds/curtains (per your preference). Serious ones, like these ← see how they don’t have to be black to be blackout! You don’t have to sacrifice style for function
- If you can’t reasonably do the above, consider a sleep mask. Again, a good one. Not the kind you were given on a flight, or got free with some fluffy handcuffs. We mean a full-blackout sleep mask that’s designed to be comfortable enough to sleep in, like this one.
- If you need to get up to pee or whatever, do like a pirate and keep one eye covered/closed. That way, it’ll remain unaffected by the light. Pirates did it to retain their night vision when switching between being on-deck or below, but you can do it to halve the loss of melatonin.
Lights-Out For Your Brain Too
You can have all the darkness in the world and still not sleep if your mind is racing thinking about:
- your recent day
- your next day
- that conversation you wish had gone differently
- what you really should have done when you were 18
- how you would go about fixing your country’s socio-political and economic woes if you were in charge
- Etc.
We wrote about how to hit pause on all that, in a previous edition of 10almonds.
Check it out: The Off-Button For Your Brain—How to “just say no” to your racing mind (this trick really works)
Sweet dreams!
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- No caffeine or alcohol before bed
Surgery won’t fix my chronic back pain, so what will?
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This week’s ABC Four Corners episode Pain Factory highlighted that our health system is failing Australians with chronic pain. Patients are receiving costly, ineffective and risky care instead of effective, low-risk treatments for chronic pain.
The challenge is considering how we might reimagine health-care delivery so the effective and safe treatments for chronic pain are available to millions of Australians who suffer from chronic pain.
One in five Australians aged 45 and over have chronic pain (pain lasting three or more months). This costs an estimated A$139 billion a year, including $12 billion in direct health-care costs.
The most common complaint among people with chronic pain is low back pain. So what treatments do – and don’t – work?
Opioids and invasive procedures
Treatments offered to people with chronic pain include strong pain medicines such as opioids and invasive procedures such as spinal cord stimulators or spinal fusion surgery. Unfortunately, these treatments have little if any benefit and are associated with a risk of significant harm.
Spinal fusion surgery and spinal cord stimulators are also extremely costly procedures, costing tens of thousands of dollars each to the health system as well as incurring costs to the individual.
Addressing the contributors to pain
Recommendations from the latest Australian and World Health Organization clinical guidelines for low back pain focus on alternatives to drug and surgical treatments such as:
- education
- advice
- structured exercise programs
- physical, psychological or multidisciplinary interventions that address the physical or psychological contributors to ongoing pain.
Pain education is central. Monkey Business Images/Shutterstock Two recent Australian trials support these recommendations and have found that interventions that address each person’s physical and psychological contributors to pain produce large and sustained improvements in pain and function in people with chronic low back pain.
The interventions have minimal side effects and are cost-effective.
In the RESOLVE trial, the intervention consists of pain education and graded sensory and movement “retraining” aimed to help people understand that it’s safe to move.
In the RESTORE trial, the intervention (cognitive functional therapy) involves assisting the person to understand the range of physical and psychological contributing factors related to their condition. It guides patients to relearn how to move and to build confidence in their back, without over-protecting it.
Why isn’t everyone with chronic pain getting this care?
While these trials provide new hope for people with chronic low back pain, and effective alternatives to spinal surgery and opioids, a barrier for implementation is the out-of-pocket costs. The interventions take up to 12 sessions, lasting up to 26 weeks. One physiotherapy session can cost $90–$150.
In contrast, Medicare provides rebates for just five allied health visits (such as physiotherapists or exercise physiologists) for eligible patients per year, to be used for all chronic conditions.
Private health insurers also limit access to reimbursement for these services by typically only covering a proportion of the cost and providing a cap on annual benefits. So even those with private health insurance would usually have substantial out-of-pocket costs.
Access to trained clinicians is another barrier. This problem is particularly evident in regional and rural Australia, where access to allied health services, pain specialists and multidisciplinary pain clinics is limited.
Higher costs and lack of access are associated with the increased use of available and subsidised treatments, such as pain medicines, even if they are ineffective and harmful. The rate of opioid use, for example, is higher in regional Australia and in areas of socioeconomic disadvantage than metropolitan centres and affluent areas.
So what can we do about it?
We need to reform Australia’s health system, private and public, to improve access to effective treatments for chronic pain, while removing access to ineffective, costly and high-risk treatments.
Better training of the clinical workforce, and using technology such as telehealth and artificial intelligence to train clinicians or deliver treatment may also improve access to effective treatments. A recent Australian trial, for example, found telehealth delivered via video conferencing was as effective as in-person physiotherapy consultations for improving pain and function in people with chronic knee pain.
Advocacy and improving the public’s understanding of effective treatments for chronic pain may also be helpful. Our hope is that coordinated efforts will promote the uptake of effective treatments and improve the care of patients with chronic pain.
Christine Lin, Professor, University of Sydney; Christopher Maher, Professor, Sydney School of Public Health, University of Sydney; Fiona Blyth, Professor, University of Sydney; James Mcauley, Professor of Psychology, UNSW Sydney, and Mark Hancock, Professor of Physiotherapy, Macquarie University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Vit D + Calcium: Too Much Of A Good Thing?
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Vit D + Calcium: Too Much Of A Good Thing?
- Myth: you can’t get too much calcium!
- Myth: you must get as much vitamin D as possible!
Let’s tackle calcium first:
❝Calcium is good for you! You need more calcium for your bones! Be careful you don’t get calcium-deficient!❞
Contingently, those comments seem reasonable. Contingently on you not already having the right amount of calcium. Most people know what happens in the case of too little calcium: brittle bones, osteoporosis, and so forth.
But what about too much?
Hypercalcemia
Having too much calcium—or “hypercalcemia”— can lead to problems with…
- Groans: gastrointestinal pain, nausea, and vomiting. Peptic ulcer disease and pancreatitis.
- Bones: bone-related pains. Osteoporosis, osteomalacia, arthritis and pathological fractures.
- Stones: kidney stones causing pain.
- Moans: refers to fatigue and malaise.
- Thrones: polyuria, polydipsia, and constipation
- Psychic overtones: lethargy, confusion, depression, and memory loss.
(mnemonic courtesy of Sadiq et al, 2022)
What causes this, and how do we avoid it? Is it just dietary?
It’s mostly not dietary!
Overconsumption of calcium is certainly possible, but not common unless one has an extreme diet and/or over-supplementation. However…
Too much vitamin D
Again with “too much of a good thing”! While keeping good levels of vitamin D is, obviously, good, overdoing it (including commonly prescribed super-therapeutic doses of vitamin D) can lead to hypercalcemia.
This happens because vitamin D triggers calcium absorption into the gut, and acts as gatekeeper to the bloodstream.
Normally, the body only absorbs 10–20% of the calcium we consume, and that’s all well and good. But with overly high vitamin D levels, the other 80–90% can be waved on through, and that is very much Not Good™.
See for yourself:
- Hypercalcemia of Malignancy: An Update on Pathogenesis and Management
- Vitamin D-Mediated Hypercalcemia: Mechanisms, Diagnosis, and Treatment
How much is too much?
The United States’ Office of Dietary Supplements defines 4000 IU (100μg) as a high daily dose of vitamin D, and recommends 600 IU (15μg) as a daily dose, or 800 IU (20μg) if aged over 70.
See for yourself: Vitamin D Fact Sheet for Health Professionals ← there’s quite a bit of extra info there too
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Common Hospital Blood Pressure Mistake (Don’t Let This Happen To You Or A Loved One)
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There’s a major issue in healthcare, Dr. Suneel Dhand tells us, pertaining to the overtreatment of hypertension in hospitals. Here’s how to watch out for it and know when to question it:
Under pressure
When patients, particularly from older generations, are admitted to the hospital, their blood pressure often fluctuates due to illness, dehydration, and other factors. Despite this, they are often continued on their usual blood pressure medications, which can lead to dangerously low blood pressure.
Why does this happen? The problem arises from rigid protocols that dictate stopping blood pressure medication only if systolic pressure is below a certain threshold, often 100. However, Dr. Dhand argues that 100 is already low*, and administering medication when blood pressure is close to this can cause it to drop dangerously lower
*10almonds note: low for an adult, anyway, and especially for an older adult. To be clear: it’s not a bad thing! That is the average systolic blood pressure of a healthy teenager and it’s usually the opposite of a problem if we have that when older (indeed, this very healthy writer’s blood pressure averages 100/70, and suffice it to say, it’s been a long time since I was a teenager). But it does mean that we definitely don’t want to take medications to artificially lower it from there.
Low blood pressure from overtreatment can lead to severe consequences, requiring emergency interventions to stabilize the patient.
Dr. Dhand’s advice for patients and families is:
- Ensure medication accuracy: make sure the medical team knows the correct blood pressure medications and dosages for you or your loved one.
- Monitor vital signs: actively check blood pressure readings, especially if they are in the low 100s or even 110s, and discuss any medication concerns with the medical team.
- Watch for symptoms of low blood pressure: be alert for symptoms like dizziness or weakness, which could indicate dangerously low blood pressure.
For more on all of this, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
The Insider’s Guide To Making Hospital As Comfortable As Possible
Take care!
Don’t Forget…
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