The Knowledge That Harvard Medical School’s Clinical Instructor Dr. Monique Tello Thinks Everyone SHOULD Have About Heart Health
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Anyone (who has not had a double mastectomy, anyway) can get breast cancer.
Breast cancer, if diagnosed early (before it spreads), has a 98% survival rate.
That survival rate drops to 31% if diagnosed after it has spread through the body.
(The US CDC’s breast cancer “stat bite” page has more stats and interactive graphs, so click here to see those charts and get the more detailed low-down on mortality/survival rates with various different situations)
We think that the difference between 98% and 31% survival rates is more than enough reason to give ourselves a monthly self-check at the very least! You’ve probably seen how-to diagrams before, but here are instructions for your convenience:
This graphic created by the Jordan Breast Cancer Program (check them out, as they have lots of resources)
If you don’t have the opportunity to take matters into your own hands right now, rather than just promise yourself “I’ll do that later”, take this free 4-minute Breast Health Assessment from Aurora Healthcare. Again, we think the difference early diagnosis can make to your survival chances make these tests well worth it.
Lest we forget, men can also get breast cancer (the CDC has a page for men too), especially if over 50. But how do you check for breast cancer, when you don’t have breasts in the commonly-understood sense of the word?
So take a moment to do this (yes, really actually do it!), and set a reminder in your calendar to repeat it monthly—there really is no reason not to! Take care of yourself; you’re important.
Pssst! Did you scroll past the diagrams, looking for the online 4-minute test promised by the subtitle? If so, scroll back up; the link is in the middle!
Harvard Medical School’s Clinical Instructor’s Five-Point Plan for Heart Health
Dr. Monique Tello, M.D., M.P.H., is a practicing physician at Massachusetts General Hospital, director of research and academic affairs for the MGH DGM Healthy Lifestyle Program, clinical instructor at Harvard Medical School, and author of the evidence-based lifestyle change guide Healthy Habits for Your Heart.
Here are what she says are the five most important factors to help keep your ticker ticking:
5. Have (at most) a moderate alcohol intake! While there are polyphenols such as resveratrol in red wine that could boost heart health, there’s so little per glass that you may need 100–1000 glasses to get the dosage that provides benefits in mouse studies. If you’re not a mouse, it may not be as beneficial, and Dr. Tello recommends drinking no more than one glass per day of any alcohol. What constitutes a glass? It varies from one kind of drink to another, so here’s a handy guide.
4. Don’t smoke. Best of all to never start. But if you did, quit. Simple as that. There is no healthy amount of smoking. While paradoxically, quitting smoking may of course be stressful to you, the long term gains are considered more than worth it. As with all advice, do consult your own physician for guidance, as individual circumstances may vary, and that may change the best approach for you.
3. Maintain a healthy body weight. While BMI (Body Mass Index) is not a perfect system, it’s a system in popular use, and Dr. Tello recommends keeping a BMI between 18.5 and 24.9.
What’s your BMI? It takes into account your height and weight; here’s a Quick BMI Calculator for your convenience.
2. Keep a healthy level of physical activity—which ideally means at least 30 minutes per day vigorous activity, but obviously if you’re not used to this, take it slowly and build up over time. Even just small lifestyle changes (walking where possible, taking the stairs instead of the elevator where possible, etc) can add up to a big difference.
1. Enjoy a healthy diet. This is the single most important thing, and the best modern scientific consensus holds that the best diet contains plenty of vegetables, fruits and nuts, whole grains, and omega-3 fatty acids, while it avoids processed meats, sugar-sweetened beverages, trans fats (what are trans fats?), and too much sodium.
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Osteoarthritis Of The Knee
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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
❝Very informative thank you. And made me think. I am a 72 yr old whitewoman, have never used ( or even been offered) HRT since menopause ~15 yrs ago. Now I’m wondering if it would have delayed the onset of osteoarthritis ( knee) and give me more energy in general. And is it wise to start taking hrt after being without those hormones for so long?❞
(this was in response to our article about menopausal HRT)
Thanks for writing! To answer your first question, obviously we can never know for sure now, but it certainly is possible, per for example a large-ish (n=1003) study of women aged 45–64, in which:
- Those with HRT were significantly less likely to have knee arthritis than those without
- However, to enjoy this benefit depended on continued use (those who used it for a bit and then stopped did not enjoy the same results)
- While it made a big difference to knee arthritis, it made only a small (but still beneficial) difference to wrist/hand arthritis.
We could hypothesize that this is because the mechanism of action is more about strengthening the bones (proofing against osteoporosis is one of the main reasons many people take HRT) and cartilage than it is against inflammation directly.
Since the knee is load-bearing and the hand/wrist joints usually are not, this would mean the HRT strengthening the bones makes a big difference to the “wear and tear” aspect of potential osteoarthritis of the knee, but not the same level of benefit for the hand/wrist, which is less about wear and tear and more about inflammatory factors. But that latter, about it being load-bearing, is just this writer’s hypothesis as to why the big difference.
The researchers do mention:
❝In OA the mechanisms by which HRT might act are highly speculative, but could entail changes in cartilage repair or bone turnover, perhaps with cytokines such as interleukin 6, for example.❞
What is clear though, is that it does indeed appear to have a protective effect against osteoarthritis of the knee.
With regard to the timing, the researchers do note:
❝Why as little as three years of HRT should have a demonstrable effect is unclear. Given the difficulty in ascertaining when the disease starts, it is hard to be sure of the importance of the timing of HRT, and whether early or subclinical disease was present.
These results taken together suggest that HRT has a metabolic action that is only effective if given continuously, perhaps by preventing disease initiation; once HRT is stopped there might be a ‘rebound’ effect, explaining the rapid return to normal risk❞
~ Ibid.
You can read the study here:
On whether it is worth it now…
Again, do speak with an endocrinologist because your situation may vary, but:
- hormones are simply messengers, and your body categorically will respond to those messages regardless of age, or time elapsed without having received such a message. Whether it will repair all damage done is another matter entirely, but it would take a biological miracle for it to have no effect at all.
- anecdotally, many women do enjoy life-changing benefits upon starting HRT at your age and older!
(We don’t like to rely on “anecdotally”, but we couldn’t find studies isolating according to “length of time since menopause”—we’ll keep an eye out and if we find something in the future, we’ll mention it!)
Meanwhile, take care!
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What Omega-3 Fatty Acids Really Do For Us
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What Omega-3 Fatty Acids Really Do For Us
Shockingly, we’ve not previously covered this in a main feature here at 10almonds… Mostly we tend to focus on less well-known supplements. However, in this case, the supplement may be well known, while some of its benefits, we suspect, may come as a surprise.
So…
What is it?
In this case, it’s more of a “what are they?”, because omega-3 fatty acids come in multiple forms, most notably:
- Alpha-linoleic acid (ALA)
- Eicosapentaenoic acid (EPA)
- Docosahexanoic acid (DHA)
ALA is most readily found in certain seeds and nuts (chia seeds and walnuts are top contenders), while EPA and DHA are most readily found in certain fish (hence “cod liver oil” being a commonly available supplement, though actually cod aren’t even the best source—salmon and mackerel are better; cod is just cheaper to overfish, making it the cheaper supplement to manufacture).
Which of the three is best, or do we need them all?
There are two ways of looking at this:
- ALA is sufficient alone, because it is a precursor to EPA and DHA, meaning that the body will take ALA and convert it into EPA and DHA as required
- EPA and DHA are superior because they’re already in the forms the body will use, which makes them more efficient
As with most things in health, diversity is good, so you really can’t go wrong by getting some from each source.
Unless you have an allergy to fish or nuts, in which case, definitely avoid those!
What do omega-3 fatty acids do for us, according to actual research?
Against inflammation
Most people know it’s good for joints, as this is perhaps what it’s most marketed for. Indeed, it’s good against inflammation of the joints (and elsewhere), and autoimmune diseases in general. So this means it is indeed good against common forms of arthritis, amongst others:
Read: Omega-3 fatty acids in inflammation and autoimmune disease
Against menstrual pain
Linked to the above-referenced anti-inflammatory effects, omega-3s were also found to be better than ibuprofen for the treatment of severe menstrual pain:
Don’t take our word for it: Comparison of the effect of fish oil and ibuprofen on treatment of severe pain in primary dysmenorrhea
Against cognitive decline
This one’s a heavy-hitter. It’s perhaps to be expected of something so good against inflammation (bearing in mind that, for example, a large part of Alzheimer’s is effectively a form of inflammation of the brain); as this one’s so important and such a clear benefit, here are three particularly illustrative studies:
- Inadequate supply of vitamins and DHA in the elderly: implications for brain aging and Alzheimer-type dementia
- Fish consumption and cognitive decline with age in a large community study
- Fish consumption, long-chain omega-3 fatty acids and risk of cognitive decline or Alzheimer disease
Against heart disease
The title says it all in this one:
But what about in patients who do have heart disease?
Mozaffarian and Wu did a huge meta-review of available evidence, and found that in fact, of all the studied heart-related effects, reducing mortality rate in cases of cardiovascular disease was the single most well-evidenced benefit:
How much should we take?
There’s quite a bit of science on this, and—which is unusual for something so well-studied—not a lot of consensus.
However, to summarize the position of the academy of nutrition and dietetics on dietary fatty acids for healthy adults, they recommend a minimum of 250–500 mg combined EPA and DHA each day for healthy adults. This can be obtained from about 8 ounces (230g) of fatty fish per week, for example.
If going for ALA, on the other hand, the recommendation becomes 1.1g/day for women or 1.6g/day for men.
Want to know how to get more from your diet?
Here’s a well-sourced article about different high-density dietary sources:
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A Fresh Take On Hypothyroidism
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The Three Rs To Boost Thyroid-Related Energy Levels
This is Dr. Izabella Wentz. She’s a doctor of pharmacology, and after her own diagnosis with Hashimoto’s thyroiditis, she has taken it up as her personal goal to educate others on managing hypothyroidism.
Dr. Wentz is also trained in functional medicine through The Institute for Functional Medicine, Kalish Functional Medicine, and the American Academy of Anti-Aging Medicine. She is a Fellow of the American Society of Consultant Pharmacists, and holds certifications in Medication Therapy Management as well as Advanced Diabetes Care through the American Pharmacists Association. In 2013, she received the Excellence in Innovation Award from the Illinois Pharmacists Association.
Dr. Wentz’s mission
Dr. Wentz was disenchanted by the general medical response to hypothyroidism in three main ways. She tells us:
- Thyroid patients are not diagnosed appropriately.
- For this, she criticises over-reliance on TSH tests that aren’t a reliable marker of thyroid function, especially if you have Hashimoto’s.
- Patients should be better optimized on their medications.
- For this, she criticizes many prescribed drugs that are actually pro-drugs*, that don’t get converted adequately if you have an underactive thyroid.
- Lifestyle interventions are often ignored by mainstream medicine.
- Medicines are great; they truly are. But medicating without adjusting lifestyle can be like painting over the cracks in a crumbling building.
*a “pro-drug” is what it’s called when the drug we take is not the actual drug the body needs, but is a precursor that will get converted to that actual drug we need, inside our body—usually by the liver, but not always. An example in this case is T4, which by definition is a pro-drug and won’t always get correctly converted to the T3 that a thyroid patient needs.
Well that does indeed sound worthy of criticism. But what does she advise instead?
First, she recommends a different diagnostic tool
Instead of (or at least, in addition to) TSH tests, she advises to ask for TPO tests (thyroid peroxidase), and a test for Tg antibodies (thyroglobulin). She says these are elevated for many years before a change in TSH is seen.
Next, identify the root cause and triggers
These can differ from person to person, but in countries that add iodine to salt, that’s often a big factor. And while gluten may or may not be a factor, there’s a strong correlation between celiac disease and Hashimoto’s disease, so it is worth checking too. Same goes for lactose.
By “checking”, here we mean testing eliminating it and seeing whether it makes a difference to energy levels—this can be slow, though, so give it time! It is best to do this under the guidance of a specialist if you can, of course.
Next, get to work on repairing your insides.
Remember we said “this can be slow”? It’s because your insides won’t necessarily bounce back immediately from whatever they’ve been suffering from for what’s likely many years. But, better late than never, and the time will pass anyway, so might as well get going on it.
For this, she recommends a gut-healthy diet with specific dietary interventions for hypothyroidism. Rather than repeat ourselves unduly here, we’ll link to a couple of previous articles of ours, as her recommendations match these:
She also recommends regular blood testing to see if you need supplementary TSH, TPO antibodies, and T3 and T4 hormones—as well as vitamin B12.
Short version
After diagnosis, she recommends the three Rs:
- Remove the causes and triggers of your hypothyroidism, so far as possible
- Repair the damage caused to your body, especially your gut
- Replace the thyroid hormones and related things in which your body has become deficient
Learn more
If you’d like to learn more about this, she offers a resource page, with resources ranging from on-screen information, to books you can get, to links to hook you up with blood tests if you need them, as well as recommended supplements to consider.
She also has a blog, which has an interesting relevant article added weekly.
Enjoy, and take care of yourself!
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- Thyroid patients are not diagnosed appropriately.
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Gut Health and Anxiety
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝I’d like to read articles on gut health and anxiety❞
We hope you caught yesterday’s edition of 10almonds, which touched on both of those! Other past editions you might like include:
We’ll be sure to include more going forward, too!
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5 Surprising Benefits Of Exercise After 50 (More Than Just Fitness)
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It’s easy to want to do less as we get older, but the benefits of continuing to actively exercise, pushing oneself even just a little, can be far-reaching.
Direct and indirect benefits
As well as the obvious fitness benefits, keeping up good levels of exercise can also offer:
Healthy Skin
Exercise improves circulation, bringing growth factors (thus: regeneration, because it’s replacing cells), oxygen, and nutrients to the skin. Accordingly, it can lead to healthier, more youthful-looking skin as a low-cost alternative to a lot of skincare products. That said, it also encourages good skin habits, like daily sunscreen use.
Bone Health
Weight-bearing and resistance exercises (which between them, encompasses most forms of exercise) improve bone density. This is because physical stress signals bones to strengthen, reducing the risk of fractures. This includes activities like walking, hiking, and using resistance bands or weights. Note however that it is on a “per bone” basis. So for example, hiking will improve your lower body and spine, but do nothing for your arms. On the other hand, doing a daily groceries trip on foot, if local geography makes that practicable, can do the whole body, if one is then carrying groceries home (this writer lives about 2 miles from where she buys groceries, and does this pretty much daily).
Mental Health
Exercise, especially outdoors, has well-established positive effects on mental well-being, and can relieve stress and improve mood. As a bonus, community engagement and shared experiences can enhance mental health benefits for many people—but if you prefer it as peaceful time for yourself, that’s beneficial in its own way too!
Better Sleep
Physical activity helps promote better sleep quality, which is important for so many aspects of health—because fatiguing the body through exercise can lead to a more restful night, which is often harder to achieve with age.
Visibility and Confidence
Staying active and taking on challenges (e.g. training for some event) can boost visibility in social and family settings, countering “invisibility” often felt from midlife onwards. And even if one doesn’t do those things, exercise fosters confidence and helps people carry themselves with more self-assurance, which has a lot of knock-on benefits too.
For more on all of these things, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
Are There Any Sensible Age Limits To Exercise?
Take care!
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16/8 Intermittent Fasting For Beginners
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Health Insider explains in super-simple fashion why and how to do Intermittent Fasting (IF), which is something that can sound complicated at first, but becomes very simple and easy once understood.
What do we need to know?
Intermittent fasting (IF) is a good, well-evidenced way to ease your body’s metabolic load, and
give your organs a chance to recover from the strain of digestion and its effects. That’s not just your gastrointestinal organs! It’s your pancreas and liver too, amongst others—this is about glucose metabolism as much as it is about digestion.This, in turn, allows your body some downtime to do its favorite thing, which is: maintenance!
This maintenance takes the form of enhanced cellular apoptosis and autophagy, helping to keep cells young and cancer-free.
In other words, with well-practised intermittent fasting, we can reduce our risk of metabolic disease (including heart disease and diabetes) as well as cancer and neurodegeneration.
You may be wondering: this sounds miraculous; what’s the catch? There are a couple:
- While fasting from food, the body’s enhanced metabolism requires more water, so you’ll need to take extra care keep on top of your hydration (this is one reason why Ramadan fasting, while healthy for most people, is not as healthy as IF—because Ramadan fasting means abstaining from water, too).
- If you are diabetic, and especially if you have Type 1 Diabetes, fasting may not be a safe option for you, since if you get a hypo in the middle of your fasting period, it’s obviously not a good idea to wait another many hours before fixing it.
Extra note on that last one: it’s easy to think “can’t I just lower my bolus insulin instead of eating?” and while superficially yes that will raise your blood sugar levels, it’s because the sugar will be sticking around in your blood, and not actually getting released into the organs that need it. So while your blood glucose monitor may say you’re fine, you will be starving your organs and if you keep it up they may suffer serious damage.
Disclaimer: our standard legal/medical disclaimer applies, and this is intended for educational purposes only; please do speak with your endocrinologist before changing anything you usually do with regard to your blood sugar maintenance.
Ok, back onto the cheerier topic at hand:
Aside from the above: for most people, IF is a remarkably healthful practice in very many ways.
For more on the science, practicalities, and things to do/avoid, enjoy this short (4:53) video:
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Want to know more?
Check out our previous main feature on this topic:
Intermittent Fasting: Mythbusting Edition
Enjoy!
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