Better Than BMI

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BMI is a very flawed system, and there are several more useful ways of measuring our bodies. Let’s take a look at them!

What’s wrong with BMI?

Oof, what isn’t wrong with BMI?

In short, it was developed as a demographic-based tool to specifically chart the weight-related health of working-age European white men a little under 200 years ago.

This means that if you are, perchance, not a working-age European white man in 1830 or so, then it’s not so useful. It’d be like first establishing height norms based on NBA basketball players, and then applying it to the general population, and thus coming to the conclusion that someone who is 6’2″ is very short.

In long, we did a deep-dive into it here, and in particular what things go dangerously wrong when it’s applied to women, non-white people, athletic people, pregnant people, people under 16 or over 65 and more:

When BMI Doesn’t Quite Measure Up

What we usually recommend instead

For heart disease risk and diabetes risk both, waist circumference is a much more universally reliable indicator. And since those two things tend to affect a lot of other health risks, it becomes an excellent starting point for being aware of many aspects of health.

Pregnancy will still throw off waist circumference a little (measure below the bump, not around it!), but it will nevertheless be more helpful than BMI even then, as it becomes necessary to just increase the numbers a little, according to gestational month and any confounding factors e.g. twins, triplets, etc. Ask your obstetrician about this, as it’s beyond the scope of our article today!

As to what’s considered a risk:
  • Waist circumference of more than 35 inches for women
  • Waist circumference of more than 40 inches for men

These numbers are considered applicable across demographics of age, ethnicity, and lifestyle.

Source: Waist circumference as a vital sign in clinical practice: a Consensus Statement from the IAS and ICCR Working Group on Visceral Obesity

Bonus extra measurement based on the above

Important also is waist to hip ratio.

How to calculate it:

  1. measure your waist circumference
  2. measure your hip circumference
  3. divide the first measurement by the second one

Because it’s a ratio, it doesn’t matter what units you use (e.g. inches, cm, etc) so long as you use the same units for both measurements.

The World Health Organization offers the following chart:

Health riskWomenMen
Low0.80 or lower0.95 or lower
Moderate0.81–0.850.96–1.0
High0.86 or higher1.1 or higher

Source: Waist Circumference and Waist-Hip Ratio: Report of a WHO Expert Consultation

This is especially relevant for cardiovascular disease risk:

Waist circumference and waist-to-hip ratio as predictors of cardiovascular events: meta-regression analysis of prospective studies

…and also holds true for all-cause mortality:

Waist-Hip-Ratio as a Predictor of All-Cause Mortality in High-Functioning Older Adults

An ancient contender that’s still more useful than BMI

Remember Archimedes? The (perhaps apocryphal) story of his “Eureka” moment in the bathtub when he realized that water displacement could be used to measure the volume of an irregular shape?

Just like Archimedes (who, the story goes, had been hired to determine the composition of a crown that might or might not have been pure gold), we can use this method to determine body composition, because we have references for how much a given volume of a given substance will weigh, so combing what we know about a body’s weight and volume will tell us about its composition in ways that neither metric could give us alone.

Indeed, it’s one of the commonly-mentioned flaws of BMI that muscle weighs more than fat, and Archimedes’ method not only avoids that problem, but also, actually turns that knowledge (muscle weighs more than fat) to our advantage.

It’s called “hydrostatic weighing” now:

Hydrostatic Weighing: Evaluation of body composition parameters using various diagnostic methods: A meta analysis study

You may be wondering: what about bones? Or internal organs?

The fact is that those are slightly confounding factors that do get in the way of a truly accurate analysis, but the variation in how much one person’s skeleton weighs vs another’s, or one person’s set of organs weigh than another’s, is too small to make an important difference to the health implications.

Lastly…

Hydrostatic weighing isn’t the only way to work out how much of our body is made of fat; if you have for example a smart scale at home (like this one) that tells you your body fat percentage, that is an estimate based on bioelectrical impedance analysis.

It’s less accurate than the hydrostatic method, but easier to do at home!

As to what percentages are “best”, healthy body fat percentages are (assuming normal hormones) generally considered to be in the range of 20–25% for women and 15–20% for men.

You can read more about this here:

Is A Visible Six-Pack Obtainable Regardless Of Genetic Predisposition?

Take care!

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  • How To Keep On Keeping On?

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    How To Keep On Keeping On… Long Term!

    For many when it comes to health-related goals and practices, it’s easy to find ourselves in a bit of a motivational dip around this time of year. The enthusiasm of new year’s resolutions has been and gone, and there’s not yet much of a drive to “get a beach body” or “be summer-ready”.

    A word to the wise on those before moving on, though:

    • How to get a beach body: take your body to a beach. Voilà. Beach body.
      • Remember: the beach is there for your pleasure and entertainment, not the other way around!
    • How to be summer-ready: the real question is, will summer be ready for you?

    But what is this, demotivational rhetoric to discourage you from getting fit and healthy?

    Not at all, but rather, to be sure that you’re pursuing your own goals and not just what you feel might be expected of you.

    All that in mind, let’s get to the tips…

    Focus on adding health

    It can be tempting (and even, good) to cut down on unhealthy things. But when it comes to motivation, it’s harder to stay motivated for deprivation, than it is for some healthy addition to life.

    So for example, this philosophy would advocate for:

    • Instead of counting calories, count steps! Or even…
    • Instead of counting calories, count colors! Eat the rainbow and all that. No, skittles do not count, but eating a variety of naturally different-colored foods will tend to result in adding different nutrients to your diet.
    • Instead of cutting out sugar, add fruit! How many per day will you go for? If you don’t eat much fruit as it is, consider making it a goal to have even just one piece of fruit a day, then build up from there. Find fruit you like! If you pick the fruit you want instead of the fruit you think you “should” have, it’s basically a dessert snack.

    We’ve recommended it before, and we’ll recommend it again, but if you’re interested in “adding health”, you should definitely check out:

    Dr. Greger’s Daily Dozen (checklist, plus app if you want it)

    More details: it’s a checklist of 12 things you should try to include in your diet, with a free streak-tracking app, if you want it, all based on the same scientific research as the best-selling book “How Not To Die”.

    “Minimum effort!”

    Did you see the movie “Deadpool”? The protagonist has a catch-phrase as he goes into battle, saying to himself “Maximum effort!”.

    And, that’s all very well and good if your superpower is immediate recovery from pretty much anything, but for the rest of us, sometimes it’s good to hold ourselves to “minimum effort!”.

    Sometimes, something worth doing is worth doing just a little a bit. It’s always better than nothing! Even if feels like you gained nothing from it, it’s the foundation of a habit, and the habit will grow and add up. Sometimes it may even take you by surprise…

    Don’t feel like doing 20 bodyweight squats? Do literally just one. Make a deal with yourself: do just one, then you can stop if you like. Then after you’ve done one, you might think to yourself “huh, that wasn’t so bad”, and you try out a few more. Maybe after 5 you can feel your blood pumping a bit and you think “you know what, that’s enough for now”, and great, you did 5x as much exercise as you planned! Wonder what you’ll do tomorrow!

    (personal note from your writer here: I’ve managed to “just extend this exercise a little bit more than last time” my way into hour-long exercise sessions before now; I started with “just 10 squats” or “just one sun salutation” etc, to get myself out of a no-exercise period that I’d slipped into, and it’s amazing how quickly adding just a little bit to the previous day’s “minimum effort!” adds up to a very respectable daily exercise session)

    Wondering what a good, easy, respectable short term goal could be?

    Check Out, For Example: The Seven-Minute Workout

    (You might have heard of this one before; it’s an incredibly efficient well-optimized short complete workout that requires no special equipment, just a bit of floorspace and a wall—the above app allows for customizations of it per your preferences, but the basic routine is an excellent starting point for most people)

    Commit to yourself (and do any self-negotiation up-front)

    Really commit, though. No “or I will look silly because I told people I’d do it”, no “or I will donate x amount to charity” etc, just “I will do it and that’s that”. If you find yourself second-guessing yourself or renegotiating with yourself, just shut that down immediately and refuse to consider it.

    Note: you should have break-clauses in this contract with yourself, though. For example, “unless I am ill or injured” is a sensible rule to have in advance for most exercise regimes that weren’t undertaken with your illness or injury in mind.

    Make a “To-Don’t” list

    Much like how addicts are often advised to not try to quit more than one thing at once, we must also be mindful of not taking on too much at once. It can be very tempting to think:

    “I will turn my life around, now! I’ll quit alcohol and animal products and sugar and refined grains, and I’ll go for a run each morning, and I’ll do this and that and there, I’ve got it, here is the blueprint for my healthy perfect life from this day forth!”

    And, it’s great to have any and all of that as your end goal if you want, but please, pick one or two things at most to start with, focus on those, and when those have become second nature to you and just a normal part of your life, then choose the next thing to work on.

    (You can plan out the whole thing in advance if you want! i.e., I’ll do this, then this, then this, but just… make sure that you’ve really got each one down to a matter of comfort and ease before you take up the next one)

    In summary:

    • Focus on adding health, whatever that looks like to you
    • Figure out what “minimum effort!” is for you, and let that be your baseline
    • Commit to yourself (and do any self-negotiation up-front, not later)
    • Decide what you’re not going to do yet, and stick to that, too.

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  • Jasmine McDonald’s Ballet Stretching Routine

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    Why Jasmine’s Video is Useful

    Jasmine McDonald is not only a professional ballerina, but is also a certified personal trainer, so when it comes to keeping her body strong and flexible, she’s a wealth of knowledge. Her video (below) is a great example of this.

    In case you’re interested in learning more, she currently (privately) tutors over 30 people on a day-to-day basis. You can contact her here!

    Other Stretches?

    If you think that Jasmine’s stretches may be out of your league, we recommend checking out our other articles on stretching, including:

    Otherwise, let loose on these dancer stretches and exercises:

    How did you find that video? If you’ve discovered any great videos yourself that you’d like to share with fellow 10almonds readers, then please do email them to us!

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  • Why scrapping the term ‘long COVID’ would be harmful for people with the condition

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    The assertion from Queensland’s chief health officer John Gerrard that it’s time to stop using the term “long COVID” has made waves in Australian and international media over recent days.

    Gerrard’s comments were related to new research from his team finding long-term symptoms of COVID are similar to the ongoing symptoms following other viral infections.

    But there are limitations in this research, and problems with Gerrard’s argument we should drop the term “long COVID”. Here’s why.

    A bit about the research

    The study involved texting a survey to 5,112 Queensland adults who had experienced respiratory symptoms and had sought a PCR test in 2022. Respondents were contacted 12 months after the PCR test. Some had tested positive to COVID, while others had tested positive to influenza or had not tested positive to either disease.

    Survey respondents were asked if they had experienced ongoing symptoms or any functional impairment over the previous year.

    The study found people with respiratory symptoms can suffer long-term symptoms and impairment, regardless of whether they had COVID, influenza or another respiratory disease. These symptoms are often referred to as “post-viral”, as they linger after a viral infection.

    Gerrard’s research will be presented in April at the European Congress of Clinical Microbiology and Infectious Diseases. It hasn’t been published in a peer-reviewed journal.

    After the research was publicised last Friday, some experts highlighted flaws in the study design. For example, Steven Faux, a long COVID clinician interviewed on ABC’s television news, said the study excluded people who were hospitalised with COVID (therefore leaving out people who had the most severe symptoms). He also noted differing levels of vaccination against COVID and influenza may have influenced the findings.

    In addition, Faux pointed out the survey would have excluded many older people who may not use smartphones.

    The authors of the research have acknowledged some of these and other limitations in their study.

    Ditching the term ‘long COVID’

    Based on the research findings, Gerrard said in a press release:

    We believe it is time to stop using terms like ‘long COVID’. They wrongly imply there is something unique and exceptional about longer term symptoms associated with this virus. This terminology can cause unnecessary fear, and in some cases, hypervigilance to longer symptoms that can impede recovery.

    But Gerrard and his team’s findings cannot substantiate these assertions. Their survey only documented symptoms and impairment after respiratory infections. It didn’t ask people how fearful they were, or whether a term such as long COVID made them especially vigilant, for example.

    A man sits on a bed, appears exhausted.
    Tens of thousands of Australians, and millions of people worldwide, have long COVID.
    New Africa/Shutterstock

    In discussing Gerrard’s conclusions about the terminology, Faux noted that even if only 3% of people develop long COVID (the survey found 3% of people had functional limitations after a year), this would equate to some 150,000 Queenslanders with the condition. He said:

    To suggest that by not calling it long COVID you would be […] somehow helping those people not to focus on their symptoms is a curious conclusion from that study.

    Another clinician and researcher, Philip Britton, criticised Gerrard’s conclusion about the language as “overstated and potentially unhelpful”. He noted the term “long COVID” is recognised by the World Health Organization as a valid description of the condition.

    A cruel irony

    An ever-growing body of research continues to show how COVID can cause harm to the body across organ systems and cells.

    We know from the experiences shared by people with long COVID that the condition can be highly disabling, preventing them from engaging in study or paid work. It can also harm relationships with their friends, family members, and even their partners.

    Despite all this, people with long COVID have often felt gaslit and unheard. When seeking treatment from health-care professionals, many people with long COVID report they have been dismissed or turned away.

    Last Friday – the day Gerrard’s comments were made public – was actually International Long COVID Awareness Day, organised by activists to draw attention to the condition.

    The response from people with long COVID was immediate. They shared their anger on social media about Gerrard’s comments, especially their timing, on a day designed to generate greater recognition for their illness.

    Since the start of the COVID pandemic, patient communities have fought for recognition of the long-term symptoms many people faced.

    The term “long COVID” was in fact coined by people suffering persistent symptoms after a COVID infection, who were seeking words to describe what they were going through.

    The role people with long COVID have played in defining their condition and bringing medical and public attention to it demonstrates the possibilities of patient-led expertise. For decades, people with invisible or “silent” conditions such as ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome) have had to fight ignorance from health-care professionals and stigma from others in their lives. They have often been told their disabling symptoms are psychosomatic.

    Gerrard’s comments, and the media’s amplification of them, repudiates the term “long COVID” that community members have chosen to give their condition an identity and support each other. This is likely to cause distress and exacerbate feelings of abandonment.

    Terminology matters

    The words we use to describe illnesses and conditions are incredibly powerful. Naming a new condition is a step towards better recognition of people’s suffering, and hopefully, better diagnosis, health care, treatment and acceptance by others.

    The term “long COVID” provides an easily understandable label to convey patients’ experiences to others. It is well known to the public. It has been routinely used in news media reporting and and in many reputable medical journal articles.

    Most importantly, scrapping the label would further marginalise a large group of people with a chronic illness who have often been left to struggle behind closed doors.The Conversation

    Deborah Lupton, SHARP Professor, Vitalities Lab, Centre for Social Research in Health and Social Policy Centre, and the ARC Centre of Excellence for Automated Decision-Making and Society, UNSW Sydney

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Egg Noodles vs Soba Noodles – Which is Healthier?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Our Verdict

    When comparing egg noodles to soba noodles, we picked the soba.

    Why?

    First of all, for any unfamiliar, soba noodles are made with buckwheat. Buckwheat, for any unfamiliar, is not wheat and does not contain gluten; it’s just the name of a flowering plant that gets used as though a grain, even though it’s technically not.

    In terms of macros, egg noodles have slightly more protein 2x the fat (of which, some cholesterol) while soba noodles have very slightly more carbs and 3x the fiber (and, being plant-based, no cholesterol). Given that the carbs are almost equal, it’s a case of which do we care about more: slightly more protein, or 3x the fiber? We’re going with 3x the fiber, and so are calling this category a win for soba.

    In the category of vitamins, egg noodles have more of vitamins A, B12, C, D, E, K, and choline, while soba noodles have more of vitamins B1, B2, B3, B5, B6, and B9. That’s a 6:6 tie. One could argue that egg noodles’ vitamins are the ones more likely to be a deficiency in people, but on the other hand, soba noodles’ vitamins have the greater margins of difference. So, still a tie.

    When it comes to minerals, egg noodles have more calcium and selenium, while soba noodles have more copper, iron, magnesium, manganese, phosphorus, potassium, and zinc. So, this one’s not close; it’s an easy win for soba noodles.

    Adding up the sections makes for a clear win for soba noodles, but by all means, enjoy moderate portions of either or both (unless you are vegan or allergic to eggs, in which case, skip the egg noodles and just enjoy the soba!).

    Want to learn more?

    You might like to read:

    Egg Noodles vs Rice Noodles – Which is Healthier?

    Take care!

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  • What Size Breakfast Is Best, By Science?

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    “Breakfast is the most important meal of the day”, the popular wisdom goes. But, what should it consist of, and how much should we be eating for breakfast?

    It has been previously established that it is good if breakfast is the largest meal of the day:

    Mythbusting Breaktime

    …with meals getting progressively smaller thereafter.

    Of course, very many people do the inverse: small (or skipped) breakfast, moderate lunch, larger dinner. This, however, is probably more a result of when eating fits around the modern industrialized workday (and thus gets normalized), rather than actual health considerations.

    So, what’s the latest science?

    A plucky band of researchers led by Dr. Karla-Alejandra Pérez-Vega investigated the importance of breakfast in the context of heart health. This research was done as part of a larger study into the effects of the Mediterranean Diet on cardiovascular health, so if anyone wants a quick recap before we carry on, then:

    The Mediterranean Diet: What Is It Good For? ← the answer, by the way, is “pretty much everything”

    …and there are also different versions that each use the Mediterranean Diet as the core, while focussing extra on a different area of health, including one to make it extra heart-healthy:

    Four Ways To Upgrade The Mediterranean ← most anti-inflammatory / gut-healthiest / heart-healthiest / brain-healthiest

    What they found

    In their sample population (n=383) of Spanish adults aged 55–75 with pre-diagnosed metabolic syndrome who, as part of the intervention of this 36-month interventional study, had now for the past 36 months been on a Mediterranean diet but without specific guidance on portion sizes:

    • Participants with insufficient breakfast energy intake had the highest adiposity (which is a measure of body fat expressed as a percentage of total mass)
    • Participants with low or high (but not moderate) breakfast energy intake had the larger BMI and waist circumference over time
    • Participants with low or high (but not moderate) breakfast energy intake had higher triglyceride and lower HDL (good) cholesterol levels
    • Participants who consumed 20–30% of their daily calories at breakfast enjoyed the greatest improvements in lipid profiles, with lower triglycerides and higher HDL (good) cholesterol levels
    • Participants with lower breakfast quality (lower adherence to Mediterranean Diet) had higher blood pressure levels
    • Participants with lower breakfast quality (lower adherence to Mediterranean Diet) had higher blood sugar levels
    • Participants with lower breakfast quality (lower adherence to Mediterranean Diet) had lower estimated glomerular filtration rate (which is an indicator of kidney function)
    • Participants with higher breakfast quality (higher adherence to Mediterranean Diet) had lower waist circumference, higher HDL cholesterol, and better kidney function

    You can see the paper itself here in the Journal of Nutrition, Health, and Aging:

    Breakfast energy intake and dietary quality and trajectories of cardiometabolic risk factors in older adults

    What this means

    According to this research, the heart-healthiest breakfast is:

    • not skipped
    • Mediterranean Diet adherent
    • within the range of of 20–30% of the total calories for the day

    Want to make it even better?

    Consider:

    Before You Eat Breakfast: 3 Surprising Facts About Intermittent Fasting

    Enjoy!

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  • Toothpastes & Mouthwashes: Which Help And Which Harm?

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    Toothpastes and mouthwashes: which kinds help, and which kinds harm?

    You almost certainly brush your teeth. You might use mouthwash. A lot of people floss for three weeks at a time, often in January.

    There are a lot of options for oral hygiene; variations of the above, and many alternatives too. This is a big topic, so rather than try to squeeze it all in one, this will be a several-part series.

    For today, let’s look at toothpastes and mouthwashes, to start!

    Toothpaste options

    Toothpastes may contain one, some, or all of the following, so here are some notes on those:

    Fluoride

    Most toothpastes contain fluoride; this is generally recognized as safe though is not without its controversies. The fluoride content is the reason it’s recommended not to swallow toothpaste, though.

    The fluoride in toothpaste can cause some small problems if overused; if you see unusually white patches on your teeth (your teeth are supposed to be ivory-colored, not truly white), that is probably a case of localized overcalcification because of the fluoride, and yes, you can have too much of a good thing.

    Overall, the benefits are considered to far outweigh the risks, though.

    Baking soda

    Whether by itself or as part of a toothpaste, baking soda is a safe and effective choice, not just for cosmetic purposes, but for boosting genuine oral hygiene too:

    Activated charcoal

    Activated charcoal is great at removing many chemicals from things it touches. That includes the kind you might see on your teeth in the form of stains.

    A topical aside on safety: activated charcoal is a common ingredient in a lot of black-colored Halloween-themed foods and drinks around this time of year. Beware, if you ingest these, there’s a good chance of it also cleaning out any meds you are taking. Ask your pharmacist about your own personal meds, but meds that (ingested) activated charcoal will usually remove include:

    • Oral HRT / contraceptives
    • Antidepressants (many kinds)
    • Heart medications (at least several major kinds)

    Toothpaste, assuming you are spitting-not-swallowing, won’t remove your medications though. Nor, in case you were worrying, will it strip tooth enamel, even if you have extant tooth enamel erosion:

    Source: Activated charcoal toothpastes do not increase erosive tooth wear

    However, it’s of no special extra help when it comes to oral hygiene itself, just removing stains.

    So, if you’d like to use it for cosmetic reasons, go right ahead. If not, no need.

    Hydrogen peroxide

    This is generally not a good idea, speaking for the health. For whitening, yes, it works. But for health, not so much:

    Hydrogen peroxide-based products alter inflammatory and tissue damage-related proteins in the gingival crevicular fluid of healthy volunteers: a randomized trial

    To be clear, when they say “alter”, they mean “in a bad way”. It increases inflammation and tissue damage.

    If buying commercially-available whitening toothpaste made with hydrogen peroxide, the academic answer is that it’s a lottery, because brands’ proprietorial compounding processes vary widely and constantly with little oversight and even less transparency:

    Is whitening toothpaste safe for dental health?: RDA-PE method

    Mouthwash options

    In the case of fluoride and hydrogen peroxide, the same advice (for and against) goes as per toothpaste.

    Alcohol

    There has been some concern about the potential carcinogenic effect of alcohol-based mouthwashes. According to the best current science, this one’s not an easy yes-or-no, but rather:

    • If there are no other cancer risk factors, it does not seem to increase cancer risk
    • If there are other cancer risk factors, it does make the risk worse

    Read more:

    Non-Alcohol

    Non-alcoholic mouthwashes are not without their concerns either. In this case, the potential problem is changing the oral microbiome (we are supposed to have one!), and specifically, that the spread of what it kills and what it doesn’t may result in an imbalance that causes a lowering of the pH of the mouth.

    Put differently: it makes your saliva more acidic.

    Needless to say, that can cause its own problems for teeth. The research on this is still emerging, with regard to whether the benefits outweigh the problems, but the fact that it has this effect seems to be a consensus. Here’s an example paper; there are others:

    Effects of Chlorhexidine mouthwash on the oral microbiome

    Flossing, scraping, and alternatives

    These are important (and varied, and interesting) enough to merit their own main feature, rather than squeezing them in at the end.

    So, watch this space for a main feature on these soon!

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