From Painkillers To Hunger-Killers
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Here’s this week’s selection of health news discoveries, the science behind them, what they mean for you, and where you can go from there:
Killing more than pain
It’s well-known that overuse of opioids can lead to many problems, and here’s another one: messing with the endocrine system. This time, mostly well-evidenced in men—however, the researchers are keen to point out that absence of evidence is very much not evidence of absence, hence “the hidden effects” in the headline below. It’s not that the effects are hard to see—it’s that a lot of the research has yet to be done. For now, though, we know at the very least that there’s an association between opioid use and hyperprolactinemia in men. The same research also begins to shine a light on the effects of opioid use on the hypothalamic-pituitary system and bone health, too:
Read in full: The hidden effects of opioid use on the endocrine system
Related: The 7 Approaches To Pain Management
Gut microbiome dysbiosis may lead to slipping disks
These things sound quite unconnected, but the association is strong. The likely mechanism of action is that the gut dysbiosis influences systemic inflammation, and thus spinal health—because the gut-spine axis cannot really be disconnected (while you’re alive, at least). It’s especially likely if you’re over 50 and female:
Read in full: Are back problems influenced by your gut?
Related: Is Your Gut Leading You Into Osteoporosis?
The Internet is really really great (for brains)
It’s common to see many articles on the Internet telling us, paradoxically, that we should spend less time on the Internet. However… Remember when in the 90s, it was all about “the information superhighway”? It turns out, the fact that it’s more like “the information spaghetti junction” these days doesn’t change the fact that stimulation is good for our brains, and daily Internet use improves memory, because of the different way that we index and store information that came from a virtual source. While there are parts of your brain for “things at home” and “things at the local supermarket”, there are also parts for “things at 10almonds” and “things at Facebook” and so forth. You are, in effect, building a vast mental library as you surf:
Read in full: Daily internet use supercharges your memory!
Related: Make Social Media Work For Your Mental Health
Fall back
Around this time of year in many places in the Northern Hemisphere, the clocks go back an hour (it’s next weekend in the US and Canada, by the way, and this weekend in most of Europe). Many enjoy this as the potential for an extra hour’s sleep, but for night owls, it can be more of a nuisance than a benefit—throwing out what’s often an already difficult relationship with the clock, and presenting challenges both practical and physiological (different processing of melatonin, for instance). Here be science:
Read in full: Why night owls struggle more when the clocks go back
Related: Early Bird Or Night Owl? Genes vs Environment
Can you outrun your hunger?
It seems so, though benefits are strongest in women. We say “outrun”, though this study did use stationary cycling. To put it in few words, intense exercise (but not moderate exercise) significantly reduced acylated ghrelin (hunger hormone) levels, and subjective reports of hunger, especially in women:
Read in full: Study finds intense exercise may suppress appetite in healthy humans
Related: 3 Appetite Suppressants Better Than Ozempic
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Behind Book Recommendations
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It’s Q&A Day!
Each Thursday, we respond to subscriber questions and requests! If it’s something small, we’ll answer it directly; if it’s something bigger, we’ll do a main feature in a follow-up day instead!
So, no question/request to big or small; they’ll just get sorted accordingly
Remember, you can always hit reply to any of our emails, or use the handy feedback widget at the bottom. We always look forward to hearing from you!
Q: What’s the process behind the books you recommend? You seem to have a limitless stream of recommendations
We do our best!
The books we recommend are books that…
- are on Amazon—it makes things tidy, consistent, and accessible. And if you end up buying one of the books, we get a small affiliate commission*.
- we have read—we would say “obviously”, but you might be surprised how many people write about books without having read them.
- pertain in at least large part to health and/or productivity.
- are written by humans—bookish people (and especially Kindle Unlimited users) may have noticed lately that there are a lot of low quality AI-written books flooding the market, sometimes with paid 5-star reviews to bolster them. It’s frustrating, but we can tell the difference and screen those out.
- are of a certain level of quality. They don’t have to be “top 5 desert-island books”, because well, there’s one every day and the days keep coming. But they do have to genuinely deliver the value that we describe, and merit a sincere recommendation.
- are varied—we try to not give a run of “samey” books one after another. We will sometimes review a book that covers a topic another previously-reviewed book did, but it must have something about it that makes it different. It may be a different angle or a different writing style, but it needs something to set it apart.
*this is from Amazon and isn’t product-specific, so this is not affecting our choice of what books to review at all—just that they will be books that are available on Amazon.
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The Oh She Glows Cookbook – by Angela Liddon
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Let’s get the criticism out of the way first: notwithstanding the subtitle promising over 100 recipes, there are about 80-odd here, if we discount recipes that are no-brainer things like smoothies, sides such as for example “roasted garlic”, or meta-ingredients such as oat flour (instructions: blend the oats and you get oat flour).
The other criticism is more subjective: if you are like this reviewer, you will want to add more seasonings than recommended to most of the recipes. But that’s easy enough to do.
As for the rest: this is a very healthy cookbook, and quite wide-ranging and versatile, with recipes that are homely, with a lot of emphasis on comfort foods (but still, healthy), though certainly some are perfectly worthy of entertaining too.
A nice bonus of this book is that it offers a lot of available substitutions (much like we do at 10almonds), and also ways of turning the recipe into something else entirely with just a small change. This trait more than makes up for the slight swindle in terms of number of recipes, since some of the recipes have bonus recipes snuck in.
Bottom line: if you’d like to broaden your plant-based cooking range, this book is a fine option for expanding your repertoire.
Click here to check out The Oh She Glows Cookbook, and indeed glow!
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What Flexible Dieting Really Means
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When Flexibility Is The Dish Of The Day
This is Alan Aragon. Notwithstanding not being a “Dr. Alan Aragon”, he’s a research scientist with dozens of peer-reviewed nutrition science papers to his name, as well as being a personal trainer and fitness educator. Most importantly, he’s an ardent champion of making people’s pursuit of health and fitness more evidence-based.
We’ll be sharing some insights from a book of his that we haven’t reviewed yet, but we will link it at the bottom of today’s article in any case.
What does he want us to know?
First, get out of the 80s and into the 90s
In the world of popular dieting, the 80s were all about calorie-counting and low-fat diets. They did not particularly help.
In the 90s, it was discovered that not only was low-fat not the way to go, but also, regardless of the diet in question, rigid dieting leads to “disinhibition”, that is to say, there comes a point (usually not far into a diet) whereby one breaks the diet, at which point, the floodgates open and the dieter binges unhealthily.
Aragon would like to bring our attention to a number of studies that found this in various ways over the course of the 90s measuring various different metrics including rigid vs flexible dieting’s impacts on BMI, weight gain, weight loss, lean muscle mass changes, binge-eating, anxiety, depression, and so forth), but we only have so much room here, so here’s a 1999 study that’s pretty much the culmination of those:
Flexible vs. Rigid Dieting Strategies: Relationship with Adverse Behavioral Outcomes
So in short: trying to be very puritan about any aspect of dieting will not only not work, it will backfire.
Next, get out of the 90s into the 00s
…which is not only fun if you read “00s” out loud as “naughties”, but also actually appropriate in this case, because it is indeed important to be comfortable being a little bit naughty:
In 2000, Dr. Marika Tiggemann found that dichotomous perceptions of food (e.g. good/bad, clean/dirty, etc) were implicated as a dysfunctional cognitive style, and predicted not only eating disorders and mood disorders, but also adverse physical health outcomes:
Dieting and Cognitive Style: The Role of Current and Past Dieting Behaviour and Cognitions
This was rendered clearer, in terms of physical health outcomes, by Dr. Susan Byrne & Dr. Emma Dove, in 2009:
❝Weight loss was negatively associated with pre-treatment depression and frequency of treatment attendance, but not with dichotomous thinking. Females who regard their weight as unacceptably high and who think dichotomously may experience high levels of depression irrespective of their actual weight, while depression may be proportionate to the degree of obesity among those who do not think dichotomously❞
Aragon’s advice based on all this: while yes, some foods are better than others, it’s more useful to see foods as being part of a spectrum, rather than being absolutist or “black and white” about it.
Next: hit those perfect 10s… Imperfectly
The next decade expanded on this research, as science is wont to do, and for this one, Aragon shines a spotlight on Dr. Alice Berg’s 2018 study with obese women averaging 69 years of age, in which…
In other words (and in fact, to borrow Dr. Berg’s words from that paper),
❝encouraging a flexible approach to eating behavior and discouraging rigid adherence to a diet may lead to better intentional weight loss for overweight and obese older women❞
You may be wondering: what did this add to the studies from the 90s?
And the key here is: rather than being observational, this was interventional. In other words, rather than simply observing what happened to people who thought one way or another, this study took people who had a rigid, dichotomous approach to food, and gave them a 6-month behavioral intervention (in other words, support encouraging them to be more flexible and open in their approach to food), and found that this indeed improved matters for them.
Which means, it’s not a matter of fate or predisposition, as it could have been back in the 90s, per “some people are just like that; who’s to say which factor causes which”. Instead, now we know that this is an approach that can be adopted, and it can be expected to work.
Beyond weight loss
Now, so far we’ve talked mostly about weight loss, and only touched on other health outcomes. This is because:
- weight loss a very common goal for many
- it’s easy to measure so there’s a lot of science for it
Incidentally, if it’s a goal of yours, here’s what 10almonds had to say about that, along with two follow-up articles for other related goals:
Spoiler: we agree with Aragon, and recommend a relaxed and flexible approach to all three of these things
Aragon’s evidence-based approach to nutrition has found that this holds true for other aspects of healthy eating, too. For example…
To count or not to count?
It’s hard to do evidence-based anything without counting, and so Aragon talks a lot about this. Indeed, he does a lot of counting in scientific papers of his own, such as:
and
The effect of protein timing on muscle strength and hypertrophy: a meta-analysis
…as well as non-protein-related but diet-related topics such as:
But! For the at-home health enthusiast, Aragon recommends that the answer to the question “to count or not to count?” is “both”:
- Start off by indeed counting and tracking everything that is important to you (per whatever your current personal health intervention is, so it might be about calories, or grams of protein, or grams of carbs, or a certain fat balance, or something else entirely)
- Switch to a more relaxed counting approach once you get used to the above. By now you probably know the macros for a lot of your common meals, snacks, etc, and can tally them in your head without worrying about weighing portions and knowing the exact figures.
- Alternatively, count moderately standardized portions of relevant foods, such as “three servings of beans or legumes per day” or “no more than one portion of refined carbohydrates per day”
- Eventually, let habit take the wheel. Assuming you have established good dietary habits, this will now do you just fine.
This latter is the point whereby the advice (that Aragon also champions) of “allow yourself an unhealthy indulgence of 10–20% of your daily food”, as a budget of “discretionary calories”, eventually becomes redundant—because chances are, you’re no longer craving that donut, and at a certain point, eating foods far outside the range of healthiness you usually eat is not even something that you would feel inclined to do if offered.
But until that kicks in, allow yourself that budget of whatever unhealthy thing you enjoy, and (this next part is important…) do enjoy it.
Because it is no good whatsoever eating that cream-filled chocolate croissant and then feeling guilty about it; that’s the dichotomous thinking we had back in the 80s. Decide in advance you’re going to eat and enjoy it, then eat and enjoy it, then look back on it with a sense of “that was enjoyable” and move on.
The flipside of this is that the importance of allowing oneself a “little treat” is that doing so actively helps ensure that the “little treat” remains “little”. Without giving oneself permission, then suddenly, “well, since I broke my diet, I might as well throw the whole thing out the window and try again on Monday”.
On enjoying food fully, by the way:
Mindful Eating: How To Get More Nutrition Out Of The Same Food
Want to know more from Alan Aragon?
Today we’ve been working heavily from this book of his; we haven’t reviewed it yet, but we do recommend checking it out:
Enjoy!
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Daily Activity Levels & The Measurable Difference They Make To Brain Health
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Most studies into the difference that exercise makes to cognitive decline are retrospective, i.e. they look backwards in time, asking participants what their exercise habits were like in the past [so many] years, and tallying that against their cognitive health in the present.
Some studies are interventional, and those are most often 3, 6, or 12 months, depending on funding. In those cases, they make a hypothesis (e.g. this intervention will boost this measure of brain health) and then test it.
However, humans aren’t generally great at making short term decisions for long term gains. In other words: if it’s rainy out, or you’re a little pushed for time, you’re likely to take the car over walking regardless of what data point this adjusts in an overarching pattern that will affect your brain’s amyloid-β clean-up rates in 5–20 years time.
Nine days
The study we’re going to look at today was a 9-day observational study, using smartphone-based tracking with check-ins every 3½ hours, with participants reporting their physical activity as light, moderate, or intense (these terms were defined and exemplified, so that everyone involved was singing from the same songsheet in terms of what activities constitute what intensity).
The sample size was reasonable (n=204) and was generally heterogenous sample (i.e. varied in terms of sex, racial background, and fitness level) of New Yorkers aged 40–65.
So, the input variable was activity level, and the output variable was cognitive fitness.
As to how they measured the output, two brain games assessed:
- cognitive processing speed, and
- working memory (a proxy for executive function).
What they found:
- participants active within the last 3½ hours had faster processing speed, equivalent to being four years younger
- response times in the working memory (for: executive function) task reflected similar processing speed improvements, for participants active in the last 3½ hours
And, which is important to note,
❝This benefit was observed regardless of whether the activities they reported were higher intensity (e.g., running/jogging) or lower intensity (e.g., walking, chores).❞
Source: Cognitive Health Benefits of Everyday Physical Activity in a Diverse Sample of Middle-Aged Adults
Practical take-away:
Move more often! At least every couple of hours (when not sleeping)!
The benefits will benefit you in the now, as well as down the line.
See also:
The Doctor Who Wants Us To Exercise Less, & Move More
and, for that matter:
Do You Love To Go To The Gym? No? Enjoy These “No-Exercise Exercises”!
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Healthy Harissa Falafel Patties
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You can make these as regular falafel balls if you prefer, but patties are quicker and easier to cook, and are great for popping in a pitta.
You will need
For the falafels:
- 1 can chickpeas, drained, keep the chickpea water (aquafaba)
- 1 red onion, roughly chopped
- 2 tbsp chickpea flour (also called gram flour or garbanzo bean flour)
- 1 bunch parsley
- 1 tbsp harissa paste
- Extra virgin olive oil for frying
For the harissa sauce:
- ½ cup crème fraîche or plant-based equivalent (you can use our Plant-Based Healthy Cream Cheese recipe and add the juice of 1 lemon)*
- 1 tbsp harissa paste (or adjust this quantity per your heat preference)
*if doing this, rather than waste the zest of the lemon, you can add the zest to the falafels if you like, but it’s by no means necessary, just an option
For serving:
- Wholegrain pitta or other flatbread (you can use our Healthy Homemade Flatbreads recipe)
- Salad (your preference; we recommend some salad leaves, sliced tomato, sliced cucumber, maybe some sliced onion, that sort of thing)
Method
(we suggest you read everything at least once before doing anything)
1) Blend the chickpeas, 1 oz of the aquafaba, the onion, the parsley, and the harissa paste, until smooth. Then add in the chickpea flour until you get a thick batter. If you overdo it with the chickpea flour, add a little more of the aquafaba to equalize. Refrigerate the mixture for at least 30 minutes.
2) Heat some oil in a skillet, and spoon the falafel mixture into the pan to make the patties, cooking on both sides (you can use a spatula to gently turn them), and set them aside.
3) Mix the harissa sauce ingredients in a small bowl.
4) Assemble; best served warm, but enjoy it however you like!
Enjoy!
Want to learn more?
For those interested in more of what we have going on today:
- Why You’re Probably Not Getting Enough Fiber (And How To Fix It)
- Capsaicin For Weight Loss And Against Inflammation
- Hero Homemade Hummus ← another great option
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How long does back pain last? And how can learning about pain increase the chance of recovery?
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Back pain is common. One in thirteen people have it right now and worldwide a staggering 619 million people will have it this year.
Chronic pain, of which back pain is the most common, is the world’s most disabling health problem. Its economic impact dwarfs other health conditions.
If you get back pain, how long will it take to go away? We scoured the scientific literature to find out. We found data on almost 20,000 people, from 95 different studies and split them into three groups:
- acute – those with back pain that started less than six weeks ago
- subacute – where it started between six and 12 weeks ago
- chronic – where it started between three months and one year ago.
We found 70%–95% of people with acute back pain were likely to recover within six months. This dropped to 40%–70% for subacute back pain and to 12%–16% for chronic back pain.
Clinical guidelines point to graded return to activity and pain education under the guidance of a health professional as the best ways to promote recovery. Yet these effective interventions are underfunded and hard to access.
More pain doesn’t mean a more serious injury
Most acute back pain episodes are not caused by serious injury or disease.
There are rare exceptions, which is why it’s wise to see your doctor or physio, who can check for signs and symptoms that warrant further investigation. But unless you have been in a significant accident or sustained a large blow, you are unlikely to have caused much damage to your spine.
Your doctor or physio can rule out serious damage.
DG fotostock/ShutterstockEven very minor back injuries can be brutally painful. This is, in part, because of how we are made. If you think of your spinal cord as a very precious asset (which it is), worthy of great protection (which it is), a bit like the crown jewels, then what would be the best way to keep it safe? Lots of protection and a highly sensitive alarm system.
The spinal cord is protected by strong bones, thick ligaments, powerful muscles and a highly effective alarm system (your nervous system). This alarm system can trigger pain that is so unpleasant that you cannot possibly think of, let alone do, anything other than seek care or avoid movement.
The messy truth is that when pain persists, the pain system becomes more sensitive, so a widening array of things contribute to pain. This pain system hypersensitivity is a result of neuroplasticity – your nervous system is becoming better at making pain.
Reduce your chance of lasting pain
Whether or not your pain resolves is not determined by the extent of injury to your back. We don’t know all the factors involved, but we do know there are things that you can do to reduce chronic back pain:
- understand how pain really works. This will involve intentionally learning about modern pain science and care. It will be difficult but rewarding. It will help you work out what you can do to change your pain
- reduce your pain system sensitivity. With guidance, patience and persistence, you can learn how to gradually retrain your pain system back towards normal.
How to reduce your pain sensitivity and learn about pain
Learning about “how pain works” provides the most sustainable improvements in chronic back pain. Programs that combine pain education with graded brain and body exercises (gradual increases in movement) can reduce pain system sensitivity and help you return to the life you want.
Some programs combine education with gradual increases in movement.
Halfpoint/ShutterstockThese programs have been in development for years, but high-quality clinical trials are now emerging and it’s good news: they show most people with chronic back pain improve and many completely recover.
But most clinicians aren’t equipped to deliver these effective programs – good pain education is not taught in most medical and health training degrees. Many patients still receive ineffective and often risky and expensive treatments, or keep seeking temporary pain relief, hoping for a cure.
When health professionals don’t have adequate pain education training, they can deliver bad pain education, which leaves patients feeling like they’ve just been told it’s all in their head.
Community-driven not-for-profit organisations such as Pain Revolution are training health professionals to be good pain educators and raising awareness among the general public about the modern science of pain and the best treatments. Pain Revolution has partnered with dozens of health services and community agencies to train more than 80 local pain educators and supported them to bring greater understanding and improved care to their colleagues and community.
But a broader system-wide approach, with government, industry and philanthropic support, is needed to expand these programs and fund good pain education. To solve the massive problem of chronic back pain, effective interventions need to be part of standard care, not as a last resort after years of increasing pain, suffering and disability.
Sarah Wallwork, Post-doctoral Researcher, University of South Australia and Lorimer Moseley, Professor of Clinical Neurosciences and Foundation Chair in Physiotherapy, University of South Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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