ADHD For Smart Ass Women – by Tracy Otsuka

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We’ve reviewed books about ADHD in adults before, what makes this one different? It’s the wholly female focus. Which is not to say some things won’t apply to men too, they will.

But while most books assume a male default unless it’s “bikini zone” health issues, this one is written by a woman for women focusing on the (biological and social) differences in ADHD for us.

A strength of the book is that it neither seeks to:

  • over-medicalize things in a way that any deviation from the norm is inherently bad and must be fixed, nor
  • pretend that everything’s a bonus, that we are superpowered and beautiful and perfect and capable and have no faults that might ever need addressing actually

…instead, it gives a good explanation of the ins and outs of ADHD in women, the strengths and weaknesses that this brings, and good solid advice on how to play to the strengths and reduce (or at least work around) the weaknesses.

Bottom line: this book has been described as “ADHD 2.0 (a very popular book that we’ve reviewed previously), but for women”, and it deserves that.

Click here to check out ADHD for Smart Ass Women, and fall in love with your neurodivergent brain!

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Recommended

  • Chew On This… But Don’t Swallow − by Dr. Blanche Grube & Anita Vasquez-Tibau
  • Rethinking Exercise: The Workout Paradox
    Running a caloric deficit? Think again! Our bodies are savvy accountants, especially with exercise, and fat loss isn’t as simple as numbers on a treadmill.

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  • Increase in online ADHD diagnoses for kids poses ethical questions

    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.

    In 2020, in the midst of a pandemic, clinical protocols were altered for Ontario health clinics, allowing them to perform more types of care virtually. This included ADHD assessments and ADHD prescriptions for children – services that previously had been restricted to in-person appointments. But while other restrictions on virtual care are back, clinics are still allowed to virtually assess children for ADHD.

    This shift has allowed for more and quicker diagnoses – though not covered by provincial insurance (OHIP) – via a host of newly emerging private, for-profit clinics. However, it also has raised significant ethical questions.

    It solves an equity issue in terms of rural access to timely assessments, but does it also create new equity issues as a privatized service?

    Is it even feasible to diagnose a child for a condition like ADHD without meeting that child in person?

    And as rates of ADHD diagnosis continue to rise, should health regulators re-examine the virtual care approach?

    Ontario: More prescriptions, less regulation

    There are numerous for-profit clinics offering virtual diagnoses and prescriptions for childhood ADHD in Ontario. These include KixCare, which does not offer the option of an in-person assessment. Another clinic, Springboard, makes virtual appointments available within days, charging around $2,600 for assessments, which take three to four hours. The clinic offers coaching and therapy at an additional cost, also not covered by OHIP. Families can choose to continue to visit the clinic virtually during a trial stage with medications, prescribed by a doctor in the clinic who then sends prescribing information back to the child’s primary care provider.

    For-profit clinics like these are departing from Canada’s traditional single-payer health care model. By charging patients out-of-pocket fees for services, the clinics are able to generate more revenue because they are working outside of the billing standards for OHIP, standards that set limits on the maximum amount doctors can earn for providing specific services. Instead many services are provided by non-physician providers, who are not limited by OHIP in the same way.

    Need for safeguards

    ADHD prescriptions rose during the pandemic in Ontario, with women, people of higher income and those aged 20 to 24 receiving the most new diagnoses, according to research published in January 2024 by a team including researchers from the Centre for Addictions and Mental Health and Holland Bloorview Children’s Hospital. There may be numerous reasons for this increase but could the move to virtual care have been a factor?

    Ontario psychiatrist Javeed Sukhera, who treats both children and adults in Canada and the U.S., says virtual assessments can work for youth with ADHD, who may receive treatment quicker if they live in remote areas. However, he is concerned that as health care becomes more privatized, it will lead to exploitation and over-diagnosis of certain conditions.

    “There have been a lot of profiteers who have tried to capitalize on people’s needs and I think this is very dangerous,” he said. “In some settings, profiteering companies have set up systems to offer ADHD assessments that are almost always substandard. This is different from not-for-profit setups that adhere to quality standards and regulatory mechanisms.”

    Sukhera’s concerns recall the case of Cerebral Inc., a New York state-based virtual care company founded in 2020 that marketed on social media platforms including Instagram and TikTok. Cerebral offered online prescriptions for ADHD drugs among other services and boasted more than 200,000 patients. But as Dani Blum reported in the New York Times, Cerebral was accused in 2023 of pressuring doctors on staff to prescribe stimulants and faced an investigation by state prosecutors into whether it violated the U.S. Controlled Substances Act.

    “At the start of the pandemic, regulators relaxed rules around medical prescription of controlled substances,” wrote Blum. “Those changes opened the door for companies to prescribe and market drugs without the protocols that can accompany an in-person visit.”

    Access increased – but is it equitable?

    Virtual care has been a necessity in rural areas in Ontario since well before the pandemic, although ADHD assessments for children were restricted to in-person appointments prior to 2020.

    But ADHD assessment clinics that charge families out-of-pocket for services are only accessible to people with higher incomes. Rural families, many of whom are low income, are unable to afford thousands for private assessments, let alone the other services upsold by providers. If the private clinic/virtual care trend continues to grow unchecked, it may also attract doctors away from the public model of care since they can bill more for services. This could further aggravate the gap in care that lower income people already experience.

    This could further aggravate the gap in care that lower income people already experience.

    Sukhera says some risks could be addressed by instituting OHIP coverage for services at private clinics (similar to private surgical facilities that offer mixed private/public coverage), but also with safeguards to ensure that profits are reinvested back into the health-care system.

    “This would be especially useful for folks who do not have the income, the means to pay out of pocket,” he said.

    Concerns of misdiagnosis and over-prescription

    Some for-profit companies also benefit financially from diagnosing and issuing prescriptions, as has been suggested in the Cerebral case. If it is cheaper for a clinic to do shorter, virtual appointments and they are also motivated to diagnose and prescribe more, then controls need to be put in place to prevent misdiagnosis.

    The problem of misdiagnosis may also be related to the nature of ADHD assessments themselves. University of Strathclyde professor Matthew Smith, author of Hyperactive: The Controversial History of ADHD, notes that since the publication of Diagnostic and Statistical Manual of Mental Disorders in 1980, assessment has typically involved a few hours of parents and patients providing their subjective perspectives on how they experience time, tasks and the world around them.

    “It’s often a box-ticking exercise, rather than really learning about the context in which these behaviours exist,” Smith said. “The tendency has been to use a list of yes/no questions which – if enough are answered in the affirmative – lead to a diagnosis. When this is done online or via Zoom, there is even less opportunity to understand the context surrounding behaviour.”

    Smith cited a 2023 BBC investigation in which reporter Rory Carson booked an in-person ADHD assessment at a clinic and was found not to have the condition, then had a private online assessment – from a provider on her couch in a tracksuit – and was diagnosed with ADHD after just 45 minutes, for a fee of £685.

    What do patients want?

    If Canadian regulators can effectively tackle the issue of privatization and the risk of misdiagnosis, there is still another hurdle: not every youth is willing to take part in virtual care.

    Jennifer Reesman, a therapist and Training Director for Neuropsychology at the Chesapeake Center for ADHD, Learning & Behavioural Health in Maryland, echoed Sukhera’s concerns about substandard care, cautioning that virtual care is not suitable for some of her young clients who had poor experiences with online education and resist online health care. It can be an emotional issue for pediatric patients who are managing their feelings about the pandemic experience.

    “We need to respect what their needs are, not just the needs of the provider,” says Reesman.

    In 2020, Ontario opted for virtual care based on the capacity of our health system in a pandemic. Today, with a shortage of doctors, we are still in a crisis of capacity. The success of virtual care may rest on how engaged regulators are with equity issues, such as waitlists and access to care for rural dwellers, and how they resolve ethical problems around standards of care.

    Children and youth are a distinct category, which is why we had restrictions on virtual ADHD diagnosis prior to the pandemic. A question remains, then: If we could snap our fingers and have the capacity to provide in-person ADHD care for all children, would we? If the answer to that question is yes, then how can we begin to build our capacity?

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

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  • If You’re Not Flexible, These Are The Only 3 Stretches You Need, To Fix That

    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.

    If you can’t put your leg behind your head while standing, try doing the splits against a wall first, and progress from there! ← text version of an item from a “if you can’t do this yet, try this first” picture set this writer saw on Instagram once upon a time

    So, what if you’re more at the point of not quite being able to touch your toes yet?

    From zero to…

    Liv, of LivInLeggings fame, has these three starter-stretches that are actually starter-stretches:

    Stretch 1: Reverse Tabletop with Foot Tuck Variation

    1. Sit on the floor, feet slightly wider than your hips, lean back onto your hands (fingertips pointing outward).
    2. Lift your hips towards a reverse tabletop, engage your glutes, and flatten the front of your hips.
    3. Add a foot tuck variation by stepping one foot back and pressing your weight forward.

    Benefits:

    • Stretches multiple muscles, including the soles of the feet.
    • Improves foot arches, balance, and stability.
    • Loosens fascia, enhancing flexibility in subsequent stretches.

    Stretch 2: Squat to Forward Fold

    1. Start in a low squat (feet wider than your hips, toes mostly forward).
    2. Alternate between a low squat and a forward fold, keeping your hands on the floor or your toes.

    Benefits:

    • Stretches hamstrings, glutes, and lower back.
    • Maintains good form and avoids overstraining.

    Stretch 3: Side Lunge with Side Body Reach

    1. Begin in a tall kneeling position, step one foot out to the side (toes pointing outward).
    2. Lunge your hips towards your front ankle, keeping your tailbone tucked.
    3. Add a side body reach by resting your forearm on your thigh and reaching the other arm overhead.
    4. For a deeper stretch, cradle the back of your head with your hand, pressing lightly for a tricep stretch.

    Benefits:

    • Stretches inner thighs, lats, and triceps.
    • Improves posture, shoulder mobility, and low squat ability.

    For more on each of these plus visual demonstrations, enjoy:

    Click Here If The Embedded Video Doesn’t Load Automatically!

    Want to learn more?

    You might also like to read:

    Test For Whether You Will Be Able To Achieve The Splits

    Take care!

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  • HRT Side Effects & Troubleshooting

    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.

    This is Dr. Heather Hirsch. She’s a board-certified internist, and her clinical expertise focuses on women’s health, particularly in midlife and menopause, and its intersection with chronic diseases (ranging from things associated with sexual health, to things like osteoporosis and heart disease).

    So, what does she want us to know?

    HRT can be life-changingly positive, but it can be a shaky start

    Hormone Replacement Therapy (HRT), and in this context she’s talking specifically about the most common kind, Menopausal Hormone Therapy (MHT), involves taking hormones that our body isn’t producing enough of.

    If these are “bioidentical hormones” as used in most of the industrialized world and increasingly also in N. America, then this is by definition a supplement rather than a drug, for what it’s worth, whereas some non-bioidentical hormones (or hormone analogs, which by definition function similarly to hormones but aren’t the same thing) can function more like drugs.

    We wrote a little about his previously:

    Hormone Replacement Therapy: A Tale Of Two Approaches

    For most people most of the time, bioidentical hormones are very much the best way to go, as they are not only more effective, but also have fewer side effects.

    That said, even bioidentical hormones can have some undesired effects, so, how to deal with those?

    Don’t worry; bleed happy

    A reprise of (usually quite light) menstrual bleeding is the most common side effect of menopausal HRT.

    This happens because estrogen affects* the uterus, leading to a build-up and shedding of the uterine lining.

    *if you do not have a uterus, estrogen can effect uterine tissue. That’s not a typo—here we mean the verb “effect”, as in “cause to be”. It will not grow a new uterus, but it can cause some clumps of uterine tissue to appear; this means that it becomes possible to get endometriosis without having a uterus. This information should not be too shocking, as endometriosis is a matter of uterine tissue growing inconveniently, often in places where it shouldn’t, and sometimes quite far from the uterus (if present, or its usual location, if absent). However, the risk of this happening is far lower than if you actually have a uterus:

    What you need to know about endometriosis

    Back to “you have a uterus and it’s making you wish you didn’t”:

    This bleeding should, however, be light. It’ll probably be oriented around a 28-day cycle even if you are taking your hormones at the same dose every day of the month, and the bleeding will probably taper off after about 6 months of this.

    If the bleeding is heavier, all the time, or persists longer than 6 months, then speak to your gynecologist about it. Any of those three; it doesn’t have to be all three!

    Bleeding outside of one’s normal cycle can be caused by anything from fibroids to cancer; statistically speaking it’s probably nothing too dire,but when your safety is in question, don’t bet on “probably”, and do get it checked out:

    When A Period Is Very Late (i.e., Post-Menopause)

    Dr. Hirsch recommends, as possible remedies to try (preferably under your gynecologist’s supervision):

    • lowering your estrogen dose
    • increasing your progesterone dose
    • taking progesterone continuously instead of cyclically

    And if you’re not taking progesterone, here’s why you might want to consider taking this important hormone that works with estrogen to do good things, and against estrogen to rein in some of estrogen’s less convenient things:

    Progesterone Menopausal HRT: When, Why, And How To Benefit

    (the above link contains, as well as textual information, an explanatory video from Dr. Hirsch herself)

    Get the best of the breast

    Calm your tits. Soothe your boobs. Destress your breasts. Hakuna your tatas. Undo the calamity beleaguering your mammaries.

    Ok, more seriously…

    Breast tenderness is another very common symptom when starting to take estrogen. It can worry a lot of people (à la “aagh, what is this and is it cancer!?”), but is usually nothing to worry about. But just to be sure, do also check out:

    Keeping Abreast Of Your Cancer Risk: How To Triple Your Breast Cancer Survival Chances

    Estrogen can cause feelings of breast fullness, soreness, nipple irritation, and sometimes lactation, but this later will be minimal—we’re talking a drop or two now and again, not anything that would feed a baby.

    Basically, it happens when your body hasn’t been so accustomed to normal estrogen levels in a while, and suddenly wakes up with a jolt, saying to itself “Wait what are we doing puberty again now? I thought we did menopause? Are we pregnant? What’s going on? Ok, checking all systems!” and then may calm down not too long afterwards when it notes that everything is more or less as it should be already.

    If this persists or is more than a minor inconvenience though, Dr. Hirsch recommends looking at the likely remedies of:

    • Adjust estrogen (usually the cause)
    • Adjust progesterone (less common)
    • If it’s progesterone, changing the route of administration can ameliorate things

    What if it’s not working? Is it just me?

    Dr. Hirsch advises the most common reasons are simply:

    • wrong formulation (e.g. animal-derived estrogen or hormone analog, instead of bioidentical)
    • wrong dose (e.g. too low)
    • wrong route of administration (e.g. oral vs transdermal; usually transdermal estradiol is most effective but many people do fine on oral; progesterone meanwhile is usually best as a pessary/suppository, but many people do fine on oral)

    Writer’s example: in 2022 there was an estrogen shortage in my country, and while I had been on transdermal estradiol hemihydrate gel, I had to go onto oral estradiol valerate tablets for a few months, because that’s what was available. And the tablets simply did not work for me at all. I felt terrible and I have a good enough intuitive sense of my hormones to know when “something wrong is not right”, and a good enough knowledge of the pharmacology & physiology to know what’s probably happening (or not happening). And sure enough, when I got my blood test results, it was as though I’d been taking nothing. It was such a relief to get back on the gel once it became available again!

    So, if something doesn’t seem to be working for you, speak up and get it fixed if at all possible.

    See also: What You Should Have Been Told About Menopause Beforehand

    Want to know more from Dr. Hirsch?

    You might like this book of hers, which we haven’t reviewed yet, but present here for your interest:

    Unlock Your Menopause Type: A Personalized Guide to Managing Your Menopausal Symptoms and Enhancing Your Health – by Dr. Heather Hirsch

    Enjoy!

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Related Posts

  • Chew On This… But Don’t Swallow − by Dr. Blanche Grube & Anita Vasquez-Tibau
  • What are compound exercises and why are they good for you?

    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.

    So you’ve got yourself a gym membership or bought a set of home weights. Now what? With the sheer amount of confusing exercise advice out there, it can be hard to decide what to include in a weights routine.

    It can help to know there are broadly two types of movements in resistance training (lifting weights): compound exercises and isolation exercises.

    So what’s the difference? And what’s all this got to do with strength, speed and healthy ageing?

    What’s the difference?

    Compound exercises involve multiple joints and muscle groups working together.

    In a push up, for example, your shoulder and elbow joints are moving together. This targets the muscles in the chest, shoulder and triceps.

    When you do a squat, you’re using your thigh and butt muscles, your back, and even the muscles in your core.

    It can help to think about compound movements by grouping them by primary movement patterns.

    For example, some lower body compound exercises follow a “squat pattern”. Examples include bodyweight squats, weighted squats, lunges and split squats.

    A woman does a Bulgarian split squat.
    A Bulgarian split squat is a type of compound movement exercise. Evelin Montero/Shutterstock

    We also have “hinge patterns”, where you hinge from a point on your body (such as the hips). Examples include deadlifts, hip thrusts and kettle bell swings.

    Upper body compounded exercises can be grouped into “push patterns” (such as vertical barbell lifts) or “pull patterns” (such as weighted rows, chin ups or lat pull downs, which is where you use a pulley system machine to lift weights by pulling a bar downwards).

    In contrast, isolation exercises are movements that occur at a single joint.

    For instance, bicep curls only require movement at the elbow joint and work your bicep muscles. Tricep extensions and lateral raises are other examples of isolation exercises.

    A woman sets up to lift a heavy weight while her trainer observes.
    Many compound exercises mimic movements we do every day. Photo by Ketut Subiyanto/Pexels

    Compound exercises can make daily life easier

    Many compound exercises mimic movements we do every day.

    Hinge patterns mimic picking something off the floor. A vertical press mimics putting a heavy box on a high shelf. A squat mimics standing up from the couch or getting on and off the toilet.

    That might sound ridiculous to a young, fit person (“why would I need to practise getting on and off a toilet?”).

    Unfortunately, we lose strength and muscle mass as we age. Men lose about 5% of their muscle mass per decade, while for women the figure is about 4% per decade.

    When this decline begins can vary widely. However, approximately 30% of an adult’s peak muscle mass is lost by the time they are 80.

    The good news is resistance training can counteract these age-related changes in muscle size and strength.

    So building strength through compound exercise movements may help make daily life feel a bit easier. In fact, our ability to perform compound movements are a good indicator how well we can function as we age.

    A woman gets a box down from a shelf.
    Want to be able to get stuff down from high shelves when you’re older? Practising compound exercises like a vertical press could help. Galina_Lya/Shutterstock

    What about strength and athletic ability?

    Compound exercises use multiple joints, so you can generally lift heavier weights than you could with isolation exercises. Lifting a heavier weight means you can build muscle strength more efficiently.

    One study divided a group of 36 people into two. Three times a week, one group performed isolation exercises, while the other group did compound exercises.

    After eight weeks, both groups had lost fat. But the compound exercises group saw much better results on measures of cardiovascular fitness, bench press strength, knee extension strength, and squat strength.

    If you play a sport, compound movements can also help boost athletic ability.

    Squat patterns require your hip, knee, and ankle to extend at the same time (also known as triple extension).

    Our bodies use this triple extension trick when we run, sprint, jump or change direction quickly. In fact, research has found squat strength is strongly linked to being able to sprint faster and jump higher.

    Isolation exercises are still good

    What if you’re unable to do compound movements, or you just don’t want to?

    Don’t worry, you’ll still build strength and muscle with isolation exercises.

    Isolation exercises are also typically easier to learn as there is no skill required. They are an easy and low risk way to add extra exercise at the end of the workout, where you might otherwise be too tired to do more compound exercises safely and with correct form.

    In fact, both isolation and compound exercises seem to be equally effective in helping us lose body fat and increase fat-free muscle mass when total intensity and volume of exercises are otherwise equal.

    Some people also do isolation exercises when they want to build up a particular muscle group for a certain sport or for a bodybuilding competition, for example.

    An older man does bicep curls in the gym
    Isolation exercises have their role to play. Photo by Kampus Production/Pexels

    I just want a time efficient workout

    Considering the above factors, you could consider prioritising compound exercises if you’re:

    • time poor
    • keen to lift heavier weights
    • looking for an efficient way to train many muscles in the one workout
    • interested in healthy ageing.

    That said, most well designed workout programs will include both compound and isolation movements.

    Correction: This article has been amended to reflect the fact a weighted row is a pull pattern, not a push pattern.

    Mandy Hagstrom, Senior Lecturer, Exercise Physiology. School of Health Sciences, UNSW Sydney and Anurag Pandit, PhD Candidate in Exercise Physiology, UNSW Sydney

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

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  • Is Ant Oil Just “Snake Oil”?

    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.

    We Tested Out “Ant Egg Oil”

    Did you know?! There’s a special protein found only in the eggs of a particular species of ant found in Turkey, that can painlessly and permanently stop (not just slow!) hair regrowth in places you’d rather not have hair.

    Neither did we, and when we heard about it, we did our usual research, and discovered a startling secret.

    …there probably isn’t.

    We decided to dig deeper, and the plot (unlike the hair in question) thickens:

    We could not find any science for or against (or even generally about) the use of ant egg oil to prevent hair regrowth. Not a peep. What we did find though was a cosmetic chemist who did an analysis of the oil as sold, and found its main ingredient appears to be furan-2-carbaldehyde, or Furfural, to its friends.

    Surprise! There’s also no science that we could find about the effect of Furfural (we love the name, though! Fur for all!) on hair, except that it’s bad for rodents (and their hair) if they eat a lot of it. So please don’t eat it. Especially if you’re a mouse.

    And yet, many ostensibly real reviews out in the wild claim it works wonders. So, we took the investigative reporting approach and tried it ourselves.

    That’s right, a plucky member of our team tried it, and she reports:

    ❝ At first glance, it seems like olive oil. There’s something else though, adding a darker colour and a slight bitterness to the smell.

    After waxing, I applied a little every few days. When the hair eventually regrew (and it did), it grew back thinner, and removing the new hairs was a strangely easy experience, like pulling hairs out of soft soap instead of out of skin. It didn’t hurt at all, either.

    I had more of the oil, so I kept going with the treatment, and twelve weeks later there are very few hairs regrowing at all; probably there will be none left soon. Whatever’s in this, be it from ant eggs or wheat bran or something else entirely, it worked for me!❞

    So in short: it remains a mystery for now! If you try it, let us know how it went for you.

    Here’s the “interesting” website that sells it, though you may find it for less on eBay or similar. (Note, we aren’t earning any commissions from these links. We just wanted to make it easier for you to dive deeper).

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    Learn to Age Gracefully

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  • 6-Minute Core Strength – by Dr. Jonathan Su

    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.

    We don’t normally do author biographies here, but in this case it’s worth noting that Dr. Su is a physiotherapist, military rehab expert, and an IAYT yoga therapist. So, these things together certainly do lend weight to his advice.

    About the “6-minute” thing: this is in the style of the famous “7-minute workout” and “5 Minutes’ Physical Fitness” etc, and refers to how long each exercise session should take. The baseline is one such session per day, though of course doing more than one set of 6 minutes each time is a bonus if you wish to do so.

    The exercises are focused on core strength, but they also include hip and shoulder exercises, since these are after all attached to the core, and hip and shoulder mobility counts for a lot.

    A particular strength of the book is in troubleshooting mistakes of the kind that aren’t necessarily visible from photos; in this case, Dr. Su explains what you need to go for in a certain exercise, and how to know if you are doing it correctly. This alone is worth the cost of the book, in this reviewer’s opinion.

    Bottom line: if you want core strength and want it simple yet comprehensive, this book can guide you.

    Click here to check out 6-Minute Core Strength, and strengthen yours!

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