Aging with Grace – by Dr. David Snowdon

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First, what this book is not: a book about Christianity. Don’t worry, we didn’t suddenly change the theme of 10almonds.

Rather, what this book is: a book about a famous large (n=678) study into the biology of aging, that took a population sample of women who had many factors already controlled-for, e.g. they ate the same food, had the same schedule, did the same activities, etc—for many years on end. In other words, a convent of nuns.

This allowed for a lot more to be learned about other factors that influence aging, such as:

  • Heredity / genetics in general
  • Speaking more than one language
  • Supplementing with vitamins or not
  • Key adverse events (e.g. stroke)
  • Key chronic conditions (e.g. depression)

The book does also cover (as one might expect) the role that community and faith can play in healthy longevity, but since the subjects were 678 communally-dwelling people of faith (thus: no control group of faithless loners), this aspect is discussed only in anecdote, or in reference to other studies.

The author of this book, by the way, was the lead researcher of the study, and he is a well-recognised expert in the field of Alzheimer’s in particular (and Alzheimer’s does feature quite a bit throughout).

The writing style is largely narrative, and/but with a lot of clinical detail and specific data; this is by no means a wishy-washy book.

Bottom line: if you’d like to know what nuns were doing in the 1980s to disproportionally live into three-figure ages, then this book will answer those questions.

Click here to check out Aging with Grace, and indeed age with grace!

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    How To Stay Motivated for Long-Term Health Goals. Instead of depriving yourself, focus on adding healthy habits. Start small and build up. Commit to yourself and prioritize what you won’t do yet.

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  • Type 2 Diabetic Foot Problems

    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.

    It’s Q&A Day!

    Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!

    This newsletter has been growing a lot lately, and so have the questions/requests, and we love that! 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

    Q: I’d like to know more about type 2 diabetic foot problems

    You probably know that the “foot problems” thing has less to do with the feet and more to do with blood and nerves. So, why the feet?

    The reason feet often get something like the worst of it, is because they are extremities, and in the case of blood sugars being too high for too long too often, they’re getting more damage as blood has to fight its way back up your body. Diabetic neuropathy happens when nerves are malnourished because the blood that should be keeping them healthy, is instead syrupy and sluggish.

    We’ll definitely do a main feature sometime soon on keeping blood sugars healthy, for both types of diabetes plus pre-diabetes and just general advice for all.

    In the meantime, here’s some very good advice on keeping your feet healthy in the context of diabetes. This one’s focussed on Type 1 Diabetes, but the advice goes for both:

    !

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  • Pain Doesn’t Belong on a Scale of Zero to 10

    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.

    Over the past two years, a simple but baffling request has preceded most of my encounters with medical professionals: “Rate your pain on a scale of zero to 10.”

    I trained as a physician and have asked patients the very same question thousands of times, so I think hard about how to quantify the sum of the sore hips, the prickly thighs, and the numbing, itchy pain near my left shoulder blade. I pause and then, mostly arbitrarily, choose a number. “Three or four?” I venture, knowing the real answer is long, complicated, and not measurable in this one-dimensional way.

    Pain is a squirrely thing. It’s sometimes burning, sometimes drilling, sometimes a deep-in-the-muscles clenching ache. Mine can depend on my mood or how much attention I afford it and can recede nearly entirely if I’m engrossed in a film or a task. Pain can also be disabling enough to cancel vacations, or so overwhelming that it leads people to opioid addiction. Even 10+ pain can be bearable when it’s endured for good reason, like giving birth to a child. But what’s the purpose of the pains I have now, the lingering effects of a head injury?

    The concept of reducing these shades of pain to a single number dates to the 1970s. But the zero-to-10 scale is ubiquitous today because of what was called a “pain revolution” in the ’90s, when intense new attention to addressing pain — primarily with opioids — was framed as progress. Doctors today have a fuller understanding of treating pain, as well as the terrible consequences of prescribing opioids so readily. What they are learning only now is how to better measure pain and treat its many forms.

    About 30 years ago, physicians who championed the use of opioids gave robust new life to what had been a niche specialty: pain management. They started pushing the idea that pain should be measured at every appointment as a “fifth vital sign.” The American Pain Society went as far as copyrighting the phrase. But unlike the other vital signs — blood pressure, temperature, heart rate, and breathing rate — pain had no objective scale. How to measure the unmeasurable? The society encouraged doctors and nurses to use the zero-to-10 rating system. Around that time, the FDA approved OxyContin, a slow-release opioid painkiller made by Purdue Pharma. The drugmaker itself encouraged doctors to routinely record and treat pain, and aggressively marketed opioids as an obvious solution.

    To be fair, in an era when pain was too often ignored or undertreated, the zero-to-10 rating system could be regarded as an advance. Morphine pumps were not available for those cancer patients I saw in the ’80s, even those in agonizing pain from cancer in their bones; doctors regarded pain as an inevitable part of disease. In the emergency room where I practiced in the early ’90s, prescribing even a few opioid pills was a hassle: It required asking the head nurse to unlock a special prescription pad and making a copy for the state agency that tracked prescribing patterns. Regulators (rightly) worried that handing out narcotics would lead to addiction. As a result, some patients in need of relief likely went without.

    After pain doctors and opioid manufacturers campaigned for broader use of opioids — claiming that newer forms were not addictive, or much less so than previous incarnations — prescribing the drugs became far easier and were promoted for all kinds of pain, whether from knee arthritis or back problems. As a young doctor joining the “pain revolution,” I probably asked patients thousands of times to rate their pain on a scale of zero to 10 and wrote many scripts each week for pain medication, as monitoring “the fifth vital sign” quickly became routine in the medical system. In time, a zero-to-10 pain measurement became a necessary box to fill in electronic medical records. The Joint Commission on the Accreditation of Healthcare Organizations made regularly assessing pain a prerequisite for medical centers receiving federal health care dollars. Medical groups added treatment of pain to their list of patient rights, and satisfaction with pain treatment became a component of post-visit patient surveys. (A poor showing could mean lower reimbursement from some insurers.)

    But this approach to pain management had clear drawbacks. Studies accumulated showing that measuring patients’ pain didn’t result in better pain control. Doctors showed little interest in or didn’t know how to respond to the recorded answer. And patients’ satisfaction with their doctors’ discussion of pain didn’t necessarily mean they got adequate treatment. At the same time, the drugs were fueling the growing opioid epidemic. Research showed that an estimated 3% to 19% of people who received a prescription for pain medication from a doctor developed an addiction.

    Doctors who wanted to treat pain had few other options, though. “We had a good sense that these drugs weren’t the only way to manage pain,” Linda Porter, director of the National Institutes of Health’s Office of Pain Policy and Planning, told me. “But we didn’t have a good understanding of the complexity or alternatives.” The enthusiasm for narcotics left many varietals of pain underexplored and undertreated for years. Only in 2018, a year when nearly 50,000 Americans died of an overdose, did Congress start funding a program — the Early Phase Pain Investigation Clinical Network, or EPPIC-Net — designed to explore types of pain and find better solutions. The network connects specialists at 12 academic specialized clinical centers and is meant to jump-start new research in the field and find bespoke solutions for different kinds of pain.

    A zero-to-10 scale may make sense in certain situations, such as when a nurse uses it to adjust a medication dose for a patient hospitalized after surgery or an accident. And researchers and pain specialists have tried to create better rating tools — dozens, in fact, none of which was adequate to capture pain’s complexity, a European panel of experts concluded. The Veterans Health Administration, for instance, created one that had supplemental questions and visual prompts: A rating of 5 correlated with a frown and a pain level that “interrupts some activities.” The survey took much longer to administer and produced results that were no better than the zero-to-10 system. By the 2010s, many medical organizations, including the American Medical Association and the American Academy of Family Physicians, were rejecting not just the zero-to-10 scale but the entire notion that pain could be meaningfully self-reported numerically by a patient.

    In the years that opioids had dominated pain remedies, a few drugs — such as gabapentin and pregabalin for neuropathy, and lidocaine patches and creams for musculoskeletal aches — had become available. “There was a growing awareness of the incredible complexity of pain — that you would have to find the right drugs for the right patients,” Rebecca Hommer, EPPIC-Net’s interim director, told me. Researchers are now looking for biomarkers associated with different kinds of pain so that drug studies can use more objective measures to assess the medications’ effect. A better understanding of the neural pathways and neurotransmitters that create different types of pain could also help researchers design drugs to interrupt and tame them.

    Any treatments that come out of this research are unlikely to be blockbusters like opioids; by design, they will be useful to fewer people. That also makes them less appealing prospects to drug companies. So EPPIC-Net is helping small drug companies, academics, and even individual doctors design and conduct early-stage trials to test the safety and efficacy of promising pain-taming molecules. That information will be handed over to drug manufacturers for late-stage trials, all with the aim of getting new drugs approved by the FDA more quickly.

    The first EPPIC-Net trials are just getting underway. Finding better treatments will be no easy task, because the nervous system is a largely unexplored universe of molecules, cells, and electronic connections that interact in countless ways. The 2021 Nobel Prize in Physiology or Medicine went to scientists who discovered the mechanisms that allow us to feel the most basic sensations: cold and hot. In comparison, pain is a hydra. A simple number might feel definitive. But it’s not helping anyone make the pain go away.

    KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

    Subscribe to KFF Health News’ free Morning Briefing.

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  • Half Of Americans Over 50 Have Hemorrhoids, But They Can Be Prevented!

    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.

    It’s Q&A Day at 10almonds!

    Have a question or a request? We love to hear from you!

    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

    ❝Hello. I was hoping you could give some useful tips about how to avoid a painful ailment that has affected Ernest Hemingway, Karl Marx, David Livingstone, Napoleon, Marilyn Monroe, King Alfred, and Martin Luther, and, I confess, me from time to time … namely, hemorrhoids. Help!❞

    Firstly: that list could be a lot longer! We don’t have global stats, but in the US for example, half of adults over 50 have hemorrhoids.

    So, you’re certainly not alone. People just don’t talk about it.

    But, there are preventative things you can do:

    Fiber, fiber, fiber. See also:

    Level-Up Your Fiber Intake! (Without Difficulty Or Discomfort)

    Hydrate, hydrate, hydrate.

    This one’s simple enough. If you are dehydrated, constipation is more likely, and with it, hemorrhoids.

    Watch your meds…

    Some medications can cause constipation—painkillers containing codeine are a common culprit, for example.

    When you go, go!

    Not only can prolonged straining promote hemorrhoids, but also (if you’ll pardon the phrasing—there’s only so delicately we can say this) simply sitting with things partway “open” down there is not good for its health; things can quickly become irritated, and that can lead to hemorrhoids.

    So: when you go, go. Leave your phone in another room!

    Wash—but carefully.

    Beyond your normal showering/bathing routine, a bidet is a great option for keeping things happy down there, if you have that option available to you.

    However, if you have hemorrhoids, don’t use soap, as this can cause irritation and make it worse.

    Warm water is fine, as is a salt bath, and pat dry and/or use gentle wet-wipes rather than rougher paper.

    You can follow up with a hemorrhoid cream of your choice (or hydrocortisone, unless that’s contraindicated by another condition you have)

    Know when to seek help

    Hemorrhoids will usually go away by themselves if not exacerbated. But if it’s getting unduly difficult, and/or you’re bleeding down there, it’s time to see a doctor.

    Note on bleeding: even if you’re 100% sure you have hemorrhoids, there are still other reasons you could be bleeding, and so it needs checking out.

    Hemorrhoid treatment, if needed, will vary depending on severity. Beyond creams and lotions, there are other options that are less fun but sometimes necessary, including injections, electrotherapy, banding, or surgery.

    Take care!

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  • Unprocessed 10th Anniversary Edition – by Abbie Jay

    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.

    The main premise of this book is cooking…

    • With nutritious whole foods
    • Without salt, oil, sugar (“SOS”)

    It additionally does it without animal products and without gluten, and (per “nutritious whole foods”), and, as the title suggests, avoiding anything that’s more than very minimally processed. Remember, for example, that if something is fermented, then that fermentation is a process, so the food has been processed—just, minimally.

    This is a revised edition, and it’s been adjusted to, for example, strip some of the previous “no salt” low-sodium options (such as tamari with 233mg/tsp sodium, compared to salt’s 2,300mg/tsp sodium).

    You may be wondering: what’s left? Tasty, well-seasoned, plant-based food, that leans towards the “comfort food” culinary niche.

    Enough to sate the author, after her own battles with anorexia and obesity (in that order) and finally, after various hospital trips, getting her diet where it needed to be for the healthy lifestyle that she lives now, while still getting to eat such dishes as “Chef AJ’s Disappearing Lasagna” and peanut butter fudge truffles and 151 more.

    Bottom line: if you want whole-food plant-based comfort-food cooking that’s healthy in general and especially heart-healthy, this book has plenty of that.

    Click here to check out Unprocessed: 10th Anniversary Edition, and… Enjoy!

    Don’t Forget…

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  • Natural Alternatives for Depression Treatment

    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.

    Questions and Answers 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!

    This newsletter has been growing a lot lately, and so have the questions/requests, and we love that! 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

    Natural alternatives to medication for depression?

    Great question! We did a mean feature a while back, but we definitely have much more to say! We’ll do another main feature soon, but in the meantime, here’s what we previously wrote:

    See: The Mental Health First-Aid That You’ll Hopefully Never Need

    ^This covers not just the obvious, but also why the most common advice is not helpful, and practical tips to actually make manageable steps back to wellness, on days when “literally just survive the day” is one’s default goal.

    Don’t Forget…

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  • How To Out-Cheat “Cheat Days”

    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.

    Out-Cheating “Cheat Days” (Or Even Just “Cheat Meals”)

    If you are in the habit of eating healthily, the idea of a “cheat day” probably isn’t appealing—because you simply don’t crave junk food; it’s not what your gut is used to.

    Nevertheless, sometimes cheat days, or at least cheat meals, choose us rather than the other way around. If your social group is having a pizza night or meeting up at the burger bar, probably you’re going to be having a meal that’s not ideal.

    So, what to do about it?

    Well, first of all, relax. If it really is an exception and not a regular occurrence, it’s not going to have a big health impact. Assuming that your basic dietary requirements are taken care of (e.g. free from allergens as necessary, vegan/vegetarian if that’s appropriate for you, adhering to any religious restrictions that are important to you, etc), then you’re going to have a good time, which is what scientists call a “pro-social activity” and is not a terrible thing.

    See also: Is Fast Food Really All That Bad? ← answer: yes it is, but the harm is cumulative and won’t all happen the instant you take a bite of a chicken nugget

    Think positive

    No, not in the “think positive thoughts” sense (though feel free, if that’s your thing), but rather: focus on adding things rather than subtracting things.

    It’s said:

    It’s not the calories in your food that make the biggest impact on your health; it’s the food in your calories❞e

    …and that’s generally true. The same goes for “bad things” in the food, e.g. added sugar, salt, seed oils, etc. They really are bad! But, in this case you’re going to be eating them and they’re going to be nearly impossible to avoid in the social scenarios we described. So, forget that sunk treasure, and instead, add nutrients.

    10almonds tip: added nutrients remain added nutrients, even if the sources were not glowing with health-appeal and/or you ate them alongside something unhealthy:

    • Those breaded garlic mushrooms are still full of magnesium and fiber and ergothioneine.
    • The chili-and-mint peas that came as an overpriced optional side-dish with your burger are still full of protein, fiber, and a stack of polyphenols.

    …and so on. And, the more time you spend eating those things, the less time you spend eating the real empty-calorie foods.

    Fix the flaw

    We set out to offer this guide without arguing for abstemiousness or making healthy substitutions, because we assume you knew already that you can not eat things, and as for substitutions, often they are not practical, especially if dining out or ordering in.

    Also, sometimes even when home-cooking something unhealthy, taking the bad ingredient out takes some of the joy out with it.

    Writers example: I once incorrectly tried to solve the fat conundrum of my favorite shchi (recipe here) by trying purely steaming the vegetables instead of my usual frying/sautéing them, and let’s just say, that errant-and-swiftly-abandoned version got recorded in my nutrition-tracker app as “sad shchi”.

    So instead, fix the flaw by countering it if possible:

    • The meal is devoid of fiber? Preload with some dried figs (you can never have too many dried figs in your pantry)
    • The meal is high in saturated fat? Enjoy fiber before/during/after, per what’s convenient for you. Fiber helps clear out excess cholesterol, which is usually the main issue with saturated fat.
    • The meal is salty? Double down on your hydration before, during, and after. If that sounds like a chore, then remember, it’s more fun than getting bloated (which results, counterintuitively, from dehydration—because your body detects the salt, and panics and tries to retain as much water as possible to restore homeostasis, resulting in bloating) and hypertensive (which results from the combination of the blood having too much salt and too little water, and cells retaining too much water and pressing inwards because it is the cells themselves that are bloated). So, tending to your hydration can help mitigate all of the above.
    • The meal is full of high-GI carbs? Preload with fiber, enjoy the carbs together with fats, and have something acidic (e.g. some kind of vinegar, or citrus fruit) with it if that’s a reasonable option. Yes, this does mean that a Whiskey Sour is better for your blood sugars than an Old Fashioned, by the way, and/but no, it doesn’t make either of them healthy.
    • The meal is inflammatory? Doing all of the above things will help, as will eating it slowly/mindfully, which latter makes it less of a shock to your system.

    See also: How To Get More Nutrition From The Same Food

    Enjoy!

    Don’t Forget…

    Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!

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