An Apple (Cider Vinegar) A Day…

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An Apple (Cider Vinegar) A Day…

You’ve probably heard of people drinking apple cider vinegar for its health benefits. It’s not very intuitive, so today we’re going to see what the science has to say…

Apple cider vinegar for managing blood sugars

Whether diabetic, prediabetic, or not at all, blood sugar spikes aren’t good for us, so anything that evens that out is worth checking out. As for apple cider vinegar…

Diabetes Control: Is Vinegar a Promising Candidate to Help Achieve Targets?

…the answer found by this study was “yes”, but their study was small, and they concluded that more research would be worthwhile. So…

The role of acetic acid on glucose uptake and blood flow rates in the skeletal muscle in humans with impaired glucose tolerance

…was also a small study, with the same (positive) results.

But! We then found a much larger systematic review was conducted, examining 744 previously-published papers, adding in another 14 they found via those. After removing 47 duplicates, and removing another 15 for not having a clinical trial or not having an adequate control, they concluded:

❝In this systematic review and meta-analyses, the effect of vinegar consumption on postprandial glucose and insulin responses were evaluated through pooled analysis of glucose and insulin AUC in clinical trials. Vinegar consumption was associated with a statistically significant reduction in postprandial glucose and insulin responses in both healthy participants and participants with glucose disorder.❞

~ Sishehbor, Mansoori, & Shirani

Check it out:

Vinegar consumption can attenuate postprandial glucose and insulin responses; a systematic review and meta-analysis of clinical trials

Apple cider vinegar for weight loss?

Yep! It appears to be an appetite suppressant, probably moderating ghrelin and leptin levels.

See: The Effects of Vinegar Intake on Appetite Measures and Energy Consumption: A Systematic Literature Review

But…

As a bonus, it also lowers triglycerides and total cholesterol, while raising HDL (good cholesterol), and that’s in addition to doubling the weight loss compared to control:

See for yourself: Beneficial effects of Apple Cider Vinegar on weight management, Visceral Adiposity Index and lipid profile in overweight or obese subjects receiving restricted calorie diet: A randomized clinical trial

How much to take?

Most of these studies were done with 1–2 tbsp of apple cider vinegar in a glass of water, at mealtime.

Obviously, if you want to enjoy the appetite-suppressant effects, take it before the meal! If you forget and/or choose to take it after though, it’ll still help keep your blood sugars even and still give you the cholesterol-moderating benefits.

Where to get it?

Your local supermarket will surely have it. Or if you buy it online, you can even get it in capsule form!

Don’t Forget…

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  • Antioxidant Matcha Snack Bars

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    The antioxidants in this come not just from the matcha, but also the cacao nibs and chocolate, as well as lots of nutrients from the hazelnuts and cashews. If you’re allergic to nuts, we’ll give you substitutions that will change the nutritional profile (and flavor), but still work perfectly well and be healthy too.

    You will need

    For the base:

    • ⅔ cup roasted hazelnuts (if allergic, substitute dessicated coconut)
    • ⅔ cup chopped dates

    For the main part:

    • 1 cup raw cashews (if allergic, substitute raw coconut, chopped)
    • ½ cup almond milk (or your preferred milk of any kind)
    • ½ cup cacao nibs
    • 2 tbsp lime juice
    • 1 tbsp matcha powder
    • 1 tbsp maple syrup (omit if you don’t care for sweetness)

    For the topping (optional):

    • 2oz dark chocolate, melted (and if you like, tempered—but this isn’t necessary; it’ll just make it glossier if you do)
    • Spare cacao nibs, chopped nuts, or anything else you might want on there

    Method

    (we suggest you read everything at least once before doing anything)

    1) Blend the base ingredients in a food processor until it has a coarse sticky texture, but isn’t yet a paste or dough.

    2) Line a cake pan with baking paper and spread the base mix on the base; press it down to compact it a little and ensure it is flat. If there’s room, put this in the freezer while you do the next bit. If not, the fridge will suffice.

    3) Blend the main part ingredients apart from the cacao nibs, until smooth. Stir in the cacao nibs with a spoon.

    4) Spread the main part evenly over the base, and allow everything you’ve built (in this recipe, not in life in general) to chill in the fridge for at least 4 hours.

    5) Cut it into blocks of the size and shape you want to eat them, and (if adding the optional topping) separate the blocks slightly from each other, before drizzling with the chocolate topping. Put it back in the fridge to cool this too; an hour should be sufficient.

    6) Serve!

    Enjoy!

    Want to learn more?

    For those interested in some of the science of what we have going on today:

    Take care!

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  • Passion Fruit vs Persimmon – 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 passion fruit to persimmon, we picked the passion fruit.

    Why?

    You may be wondering: “what is this fruit passionate about?” and the answer is: delivering nutrients of many kinds!

    Looking at the macros first, passion fruit has a little more protein and a lot more fiber, while persimmon has more carbs. This means that while persimmon’s glycemic index isn’t bad, passion fruit’s glycemic index is a lot lower.

    In terms of vitamins, passion fruit has a lot more of vitamins A, B2, B3, B6, B9, E, K, and choline, while persimmon has more vitamin C. For the record passion fruit is also a good source of vitamin C, with a cup of passion fruit already giving a day’s daily dose of vitamin C, but persimmon gives twice that. Still, that’s a 8:1 win for passion fruit.

    When it comes to minerals, passion fruit has more copper, magnesium, phosphorus, potassium, selenium, and zinc, while persimmon has more calcium and iron, meaning a 6:2 win for passion fruit.

    Adding up the three convincing individual victories shows a clear overall win for passion fruit.

    Enjoy (passionately, even)!

    Want to learn more?

    You might like to read:

    Take care!

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  • How weight bias in health care can harm patients with obesity: Research

    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.

    Patients who weigh more than what medical authorities generally consider healthy often avoid seeing doctors for fear of being judged, insulted or misdiagnosed, decades of research find. Meanwhile, academic studies consistently show many health care professionals discriminate against heavier patients and that weight bias can drive people with obesity to gain weight.

    Weight bias refers to negative attitudes, stereotypes and discrimination aimed at individuals with excess body fat. When scholars reviewed 41 studies about weight bias in health care, published from 1989 to 2021, they found it comes in many forms: contemptuous language, inappropriate gestures, expressing a preference for thinner patients, avoiding physical touch and eye contact, and attributing all of a person’s health issues to their weight.

    “Weight bias has been reported in physicians, nurses, dietitians, physiotherapists, and psychologists, as well as nutritionists and exercise professionals, and it is as pervasive among medical professionals as it is within the general population,” write the authors of the research review, published in 2021 in the journal Obesity.

    That’s a problem considering an estimated 4 out of 10 U.S. adults aged 20 years and older have obesity, a complex and often misunderstood illness that the American Medical Association voted in 2013 to recognize as a disease. By 2030, half of U.S. adults will have obesity, researchers project in a 2020 paper in the International Journal of Epidemiology.

    Worldwide, the obesity rate among adults aged 18 and older was 13% in 2016, according to the World Health Organization. If current trends continue, the World Obesity Federation projects that, by 2035, 51% of the global population will be living with overweight or obesity.

    The harms of weight bias

    Weight stigma — the societal devaluation of people perceived to be carrying excess weight — drives weight bias. It’s so physically and emotionally damaging that a panel of 36 international experts issued a consensus statement in 2020 to raise awareness about and condemn it. Dozens of medical and academic organizations, including 15 scholarly journals, endorsed the document, published in Nature Medicine.

    The release of a consensus statement is a significant event in research, considering it represents the collective position that experts in a particular field have taken on an issue, based on an analysis of all the available evidence.

    Research to date indicates heavier individuals who experience weight bias and stigma often:

    • Avoid doctors and other health care professionals, skipping routine screenings as well as needed treatments.
    • Change doctors frequently.
    • Are at a higher risk for depression, anxiety, mood disorders and other mental health problems.
    • Avoid or put off exercise.
    • Consume more food and calories.
    • Gain weight.
    • Have disrupted sleep.

    The consensus statement notes that educating health care providers, journalists, policymakers and others about obesity is key to changing the narrative around the disease.

    “Weight stigma is reinforced by misconceived ideas about body-weight regulation and lack of awareness of current scientific evidence,” write the experts, led by Francesco Rubino, the chair of metabolic and bariatric surgery at Kings College London.

    “Despite scientific evidence to the contrary, the prevailing view in society is that obesity is a choice that can be reversed by voluntary decisions to eat less and exercise more. These assumptions mislead public health policies, confuse messages in popular media, undermine access to evidence-based treatments, and compromise advances in research.”

    Weight bias and stigma appear to stimulate the secretion of the stress hormone cortisol and promote weight gain, researchers write in a 2016 paper published in Obesity.

    A. Janet Tomiyama, a psychology professor at UCLA who directs the university’s Dieting, Stress, and Health research lab, describes weight stigma as “a ‘vicious cycle’ — a positive feedback loop wherein weight stigma begets weight gain.”

    “This happens through increased eating behavior and increased cortisol secretion governed by behavioral, emotional, and physiological mechanisms, which are theorized to ultimately result in weight gain and difficulty of weight loss,” Tomiyama writes in her 2014 paper, “Weight Stigma is Stressful. A Review of Evidence for the Cyclic Obesity/Weight-Based Stigma Model.”

    The consensus statement spotlights 13 recommendations for eliminating weight bias and stigma, some of which are specifically aimed at health care providers, the media, researchers or policymakers. One of the recommendations for the health care community: “[Health care providers] specialized in treating obesity should provide evidence of stigma-free practice skills. Professional bodies should encourage, facilitate, and develop methods to certify knowledge of stigma and its effects, along with stigma-free skills and practices.”

    The one recommendation for the media: “We call on the media to produce fair, accurate, and non-stigmatizing portrayals of obesity. A commitment from the media is needed to shift the narrative around obesity.”

    Why obesity is a complicated disease

    It’s important to point out that having excess body fat does not, by itself, mean an individual is unhealthy, researchers explain in a 2017 article in The Conversation, which publishes research-based news articles and essays. But it is a major risk factor for cardiovascular disease, including stroke, as well as diabetes, some types of cancer, and musculoskeletal disorders such as osteoarthritis.

    Doctors often look at patients’ body mass index — a number that represents their weight in relation to their height — to gauge the amount of fat on their bodies. A BMI of 18.5 to 24.9 is ideal, according to the U.S. Centers for Disease Control and Prevention. A BMI of 25.0 to 29.9, indicates excess body fat, or “overweight,” while a BMI of 30 and above indicates obesity.

    In June, the American Medical Association announced a new policy clarifying how BMI can be used to diagnose obesity. Because it’s an imperfect measure for body fat, the organization suggests BMI be used in conjunction with other measures such as a patient’s waist circumference and skin fold thickness.

    Two specialists who have been working for years to dispel myths and misconceptions about obesity are Fatima Cody Stanford, an obesity physician and associate professor at Harvard Medical School, and Rebecca Puhl, the deputy director of the Rudd Center for Food Policy and Obesity at the University of Connecticut.

    Cody Stanford has called obesity “a brain disease” because the brain tells the body how much to eat and what to do with the food consumed. One pathway in the brain directs the body to eat less and store less fat, she explains in a February 2023 podcast produced by the American Medical Association.

    “For people that signal really great down this pathway, they tend to be very lean, not struggle with their weight in the same way that people that have excess weight do,” she says during the podcast, adding that people with obesity receive signals from an alternate pathway that “tells us to eat more and store more.”

    Academic studies demonstrate that a wide variety of factors can affect weight regulation, including sleep quality and duration, gut health, genetics, medication, access to healthy foods and even early life experiences.

    For example, a 2020 paper in the journal JAMA Network Open suggests female infants born by cesarean delivery have a higher risk of obesity during adulthood than female infants born by vaginal delivery. The study of 33,226 U.S. women born between 1946 and 1964 found that a cesarean delivery is associated with an 11% higher risk of developing obesity and a 46% higher risk of developing type 2 diabetes.

    Scholars have also found that traumatic childhood experiences such as abuse and neglect are linked to adult obesity, according to a research review published in 2020.

    Income inequality seems to play a role as well. When researchers from the Johns Hopkins Bloomberg School of Public Health studied the link between income inequality and obesity for a sample of 36,665 U.S. adults, they discovered women with lower incomes are more likely to have obesity than women with higher incomes.

    Their analysis indicates the opposite is true for men, whose odds of obesity rise with their income, the researchers write in a 2021 paper in the International Journal of Environmental Research and Public Health.

    Weight bias among doctor trainees

    While scholars have learned a lot about obesity and weight bias in recent decades, the information might not be reaching people training to become doctors. A study published in October finds that some resident physicians believe obesity to be the result of poor choices and weak willpower.

    Researchers asked 3,267 resident physicians who graduated from a total of 49 U.S. medical schools a series of questions to gauge their knowledge of obesity and attitudes toward heavier patients. What they learned: Nearly 40% of resident physicians agreed with the statement, “Fat people tend to be fat pretty much through their own fault.” Almost half agreed with the statement, “Some people are fat because they have no willpower.”

    The study also reveals that about one-third of participants said they “feel more irritated when treating an obese patient than a non-obese patient.”

    “Notably, more than a quarter of residents expressed slight-to-strong agreement with the item ‘I dislike treating obese patients,’” the researchers write.

    Another takeaway from the paper: Resident physicians specializing in orthopedic surgery, anesthesiology and urology expressed the highest levels of dislike of heavier patients. Of the 16 medical specialties represented, residents in family medicine, psychiatry and pediatrics reported the lowest levels of dislike.

    Kimberly Gudzune, medical director of the American Board of Obesity Medicine, asserts that doctors and medical students need to be educated about obesity. The topic “is grossly neglected” in medical schools and medical training programs worldwide, research has found.

    Many physicians don’t understand obesity, Gudzune explains in a July 2023 interview on the internal medicine podcast “The Curbsiders.”

    “I think back to when I was a medical student, when I was a resident, I really didn’t learn much about obesity and how to treat it, yet it’s a problem that affects the majority of our patients,” she tells podcast listeners. “I think there’s a lot of evidence out there showing that primary care physicians don’t really know where to start.”

    In 2011, the American Board of Obesity Medicine established a program through which doctors could become certified in obesity medicine. Since then, a total of 6,729 U.S. doctors have earned certification, the vast majority of whom specialize in family and internal medicine.

    What health care providers think

    The experts who created the consensus statement on weight bias and stigma noted health care providers’ shortcomings in the document. They write that the common themes they discovered in the research include “contemptuous, patronizing, and disrespectful treatment” of patients, a lack of training, poor communication and assumptions about weight gain.

    Puhl, the deputy director of the Rudd Center at the University of Connecticut, is a pioneer in weight bias research and one of the experts who wrote the consensus statement. During an episode of “The Leading Voices in Food,” a podcast created by Duke University’s World Food Policy Center, she shares details about what she has learned over the years.

    “[Health care providers’] views that patients with obesity are lazy or lacking control, are to blame for their weight or noncompliant with treatment,” she says during the interview. “We know, for example, that some physicians spend less time in their appointments with patients [who] have a larger body size. They give them less education about health. They’re more reluctant to perform certain screenings. They talk about treating patients with obesity as being a greater waste of their time than providing care to thinner patients. And we know that patients seem to be aware of these biases from providers and that can really contribute to patients avoiding health care because they just don’t want to repeat those negative experiences of bias.”

    To set the record straight, the experts who wrote the the consensus statement listed the following five common assumptions as being “at odds with a definitive body of biological and clinical evidence.”

    1. Body weight = calories in – calories out.

    This equation oversimplifies the relationship between body weight and energy consumed and used, the experts write. “Both variables of the equation depend on factors additional to just eating and exercising. For instance, energy intake depends on the amount of food consumed, but also on the amount of food-derived energy absorbed through the gastrointestinal tract, which in turn is influenced by multiple factors, such as digestive enzymes, bile acids, microbiota, gut hormones, and neural signals, none of which are under voluntary control.”

    2. Obesity is primarily caused by voluntary overeating and a sedentary lifestyle.

    According to the experts, overeating and forgoing exercise might be symptoms of obesity rather than the root causes. There are many possible causes and contributors “including geneticand epigenetic factors, foodborne factors, sleep deprivation and circadian dysrhythmia, psychological stress, endocrine disruptors, medications, and intrauterine and intergenerational effects. These factors do not require overeating or physical inactivity to explain excess weight.” they write.

    3. Obesity is a lifestyle choice.

    “People with obesity typically recognize obesity as a serious health problem, rather than a conscious choice,” the experts write. “Given the negative effects of obesity on quality of life, the well-known risks of serious complications and reduced life expectancy associated with it, it is a misconception to define obesity as a choice.”

    4. Obesity is a condition, not a disease.

    The criteria generally used to determine disease status “are clearly fulfilled in many individuals with obesity as commonly defined, albeit not all,” the experts explain. “These criteria include specific signs or symptoms (such as increased adiposity), reduced quality of life, and/or increased risk of further illness, complications, and deviation from normal physiology — or well-characterized pathophysiology (for example, inflammation, insulin resistance, and alterations of hormonal signals regulating satiety and appetite).”

    5. Severe obesity is usually reversible by voluntarily eating less and exercising more.

    “A large body of clinical evidence has shown that voluntary attempts to eat less and exercise more render only modest effects on body weight in most individuals with severe obesity,” the experts write. “When fat mass decreases, the body responds with reduced resting energy expenditure and changes in signals that increase hunger and reduce satiety (for example, leptin, ghrelin). These compensatory metabolic and biologic adaptations promote weight regain and persist for as long as persons are in the reduced-energy state, even if they gain some weight back.”

    Health care facility improvements

    The expert panel also determined that many health care facilities aren’t equipped to treat people with obesity. Examination gowns, blood pressure cuffs, chairs and examination tables often are too small, patients have reported.

    When researchers from the University of Minnesota, Minneapolis Veterans Affairs Medical Center and Mayo Clinic studied the quality of care that patients with obesity receive, they learned that a clinic’s physical environment can have a big effect on a patient’s experience.

    They write in a 2015 study published in Obesity Reviews: “Waiting room chairs with armrests can be uncomfortable or too small. Equipment such as scales, blood pressure cuffs, examination gowns and pelvic examination instruments are often designed for use with smaller patients. When larger alternatives are not available, or are stored in a place that suggests infrequent use, it can signal to patients that their size is unusual and that they do not belong. These experiences, which are not delivered with malicious intent, can be humiliating.”

    When medical equipment is the wrong size, it may not work correctly. For instance, chances are high that a blood pressure reading will be inaccurate if a health care professional uses a blood pressure cuff that’s too small on a patient with obesity, a 2022 paper finds.

    To create a comfortable environment for patients with high body weights, the Rudd Center for Food Policy and Obesity recommends that health care facilities provide, among other things, extra-large exam gowns, chairs that can support more than 300 pounds and do not have arms, and wide exam tables that are bolted to the floor so they don’t move.

    The consensus statement also recommends improvements to health care facilities.

    “Given the prevalence of obesity and obesity-related diseases,” the 36 international experts write, “appropriate infrastructure for the care and management of people with obesity, including severe obesity, must be standard requirement for accreditation of medical facilities and hospitals.”

    Source list:

    Weight Bias Among Health Care Professionals: A Systematic Review and Meta-Analysis
    Blake J. Lawrence; et al. Obesity, November 2021.

    Joint International Consensus Statement for Ending Stigma of Obesity
    Francesco Rubino, et al. Nature Medicine, March 2020.

    Perceived Weight Discrimination and Chronic Biochemical Stress: A Population-Based Study Using Cortisol in Scalp Hair
    Sarah E. Jackson, Clemens Kirschbaum and Andrew Steptoe. Obesity, December 2016.

    Weight Stigma is Stressful. A Review of Evidence for the Cyclic Obesity/Weight-Based Stigma Model
    A. Janet Tomiyama. Appetite, November 2014.

    Association of Birth by Cesarean Delivery with Obesity and Type 2 Diabetes Among Adult Women
    Jorge E. Chavarro. JAMA Network Open, April 2020.

    Adverse Childhood Experiences and Adult Obesity: A Systematic Review of Plausible Mechanisms and Meta-Analysis of Cross-Sectional Studies
    David A. Wiss and Timothy D. Brewerton. Physiology & Behavior, September 2020.

    Income Inequality and Obesity among U.S. Adults 1999–2016: Does Sex Matter?
    Hossein Zare, Danielle D. Gaskin and Roland J. Thorpe Jr. International Journal of Environmental Research and Public Health, July 2021.

    Comparisons of Explicit Weight Bias Across Common Clinical Specialties of U.S. Resident Physicians
    Samantha R. Philip, Sherecce A. Fields, Michelle Van Ryn and Sean M. Phelan. Journal of General Internal Medicine, October 2023.

    Impact of Weight Bias and Stigma on Quality of Care and Outcomes for Patients with Obesity
    S.M. Phelan; et al. Obesity Reviews, April 2015.

    One Size Does Not Fit All: Impact of Using A Regular Cuff For All Blood Pressure Measurements
    Tammy. M. Brady; et al. Circulation, April 2022.

    This article first appeared on The Journalist’s Resource and is republished here under a Creative Commons license.

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Related Posts

  • Creatine: Very Different For Young & Old People
  • Never Too Old?

    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.

    Age Limits On Exercise?

    In Tuesday’s newsletter, we asked you your opinion on whether we should exercise less as we get older, and got the above-depicted, below-described, set of responses:

    • About 42% said “No, we must keep pushing ourselves, to keep our youth“
    • About 29% said “Only to the extent necessary due to chronic conditions etc”
    • About 29% said “Yes, we should keep gently moving but otherwise take it easier”

    One subscriber who voted for “No, we must keep pushing ourselves, to keep our youth“ wrote to add:

    ❝I’m 71 and I push myself. I’m not as fast or strong as I used to be but, I feel great when I push myself instead of going through the motions. I listen to my body!❞

    ~ 10almonds subscriber

    One subscriber who voted for “Only to the extent necessary due to chronic conditions etc” wrote to add:

    ❝It’s never too late to get stronger. Important to keep your strength and balance. I am a Silver Sneakers instructor and I see first hand how helpful regular exercise is for seniors.❞

    ~ 10almonds subscriber

    One subscriber who voted to say “Yes, we should keep gently moving but otherwise take it easier” wrote to add:

    ❝Keep moving but be considerate and respectful of your aging body. It’s a time to find balance in life and not put yourself into a positon to damage youself by competing with decades younger folks (unless you want to) – it will take much longer to bounce back.❞

    ~ 10almonds subscriber

    These will be important, because we’ll come back to them at the end.

    So what does the science say?

    Endurance exercise is for young people only: True or False?

    False! With proper training, age is no barrier to serious endurance exercise.

    Here’s a study that looked at marathon-runners of various ages, and found that…

    • the majority of middle-aged and elderly athletes have training histories of less than seven years of running
    • there are virtually no relevant running time differences (p<0.01) per age in marathon finishers from 20 to 55 years
    • after 55 years, running times did increase on average, but not consistently (i.e. there were still older runners with comparable times to the younger age bracket)

    See: Performance, training and lifestyle parameters of marathon runners aged 20–80 years: results of the PACE-study

    The researchers took this as evidence of aging being indeed a biological process that can be sped up or slowed down by various lifestyle factors.

    See also:

    Age & Aging: What Can (And Can’t) We Do About It?

    this covers the many aspects of biological aging (it’s not one number, but many!) and how our various different biological ages are often not in sync with each other, and how we can optimize each of them that can be optimized

    Resistance training is for young people only: True or False?

    False! In fact, it’s not only possible for older people, but is also associated with a reduction in all-cause mortality.

    Specifically, those who reported strength-training at least once per week enjoyed longer lives than those who did not.

    You may be thinking “is this just the horse-riding thing again, where correlation is not causation and it’s just that healthier people (for other reasons) were able to do strength-training more, rather than the other way around?“

    …which is a good think to think of, so well-spotted if you were thinking that!

    But in this case no; the benefits remained when other things were controlled for:

    ❝Adjusted for demographic variables, health behaviors and health conditions, a statistically significant effect on mortality remained.

    Although the effects on cardiac and cancer mortality were no longer statistically significant, the data still pointed to a benefit.

    Importantly, after the physical activity level was controlled for, people who reported strength exercises appeared to see a greater mortality benefit than those who reported physical activity alone.❞

    ~ Dr. Jennifer Kraschnewski

    See the study: Is strength training associated with mortality benefits? A 15 year cohort study of US older adults

    And a pop-sci article about it: Strength training helps older adults live longer

    Closing thoughts

    As it happens… All three of the subscribers we quoted all had excellent points!

    Because in this case it’s less a matter of “should”, and more a selection of options:

    • We (most of us, at least) can gain/regain/maintain the kind of strength and fitness associated with much younger people, and we need not be afraid of exercising accordingly (assuming having worked up to such, not just going straight from couch to marathon, say).
    • We must nevertheless be mindful of chronic conditions or even passing illnesses/injuries, but that goes for people of any age
    • We also can’t argue against a “safety first” cautious approach to exercise. After all, sure, maybe we can run marathons at any age, but that doesn’t mean we have to. And sure, maybe we can train to lift heavy weights, but if we’re content to be able to carry the groceries or perhaps take our partner’s weight in the dance hall (or the bedroom!), then (if we’re also at least maintaining our bones and muscles at a healthy level) that’s good enough already.

    Which prompts the question, what do you want to be able to do, now and years from now? What’s important to you?

    For inspiration, check out: Train For The Event Of Your Life!

    Take care!

    Don’t Forget…

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

    Learn to Age Gracefully

    Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:

  • Brown Rice Protein: Strengths & Weaknesses

    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

    ❝I had a friend mention that recent research showed Brown Rice Protein Powder can be bad for you, possibly impacting your nutrient absorption. Is this true? I’ve been using it given it’s one of the few plant-based proteins with a full essential amino acid profile!❞

    Firstly: we couldn’t find anything to corroborate the “brown rice protein powder [adversely] impacts nutrient absorption” idea, but we suspect that the reason for this belief is: brown rice (not brown rice protein powder) contains phytic acid, which is something of an antinutrient, in that it indeed reduces absorption of various other nutrients.

    However, two things are important to note here:

    1. the phytic acid is found in whole grains, not in protein isolates as found in brown rice protein powder. The protein isolates contain protein… Isolated. No phytates!
    2. even in the case of eating whole grain rice, the phytic acid content is greatly reduced by two things: soaking and heating (especially if those two things are combined) ← doing this the way described results in bioavailability of nutrients that’s even better than if there were just no phytic acid, albeit it requires you having the time to soak, and do so at temperature.

    tl;dr = no, it’s not true, unless there truly is some groundbreaking new research we couldn’t find—it was almost certainly a case of an understandable confusion about phytic acid.

    Your question does give us one other thing to mention though:

    Brown rice indeed technically contains all 9 essential amino acids, but it’s very low in several of them, most notably lysine.

    However, if you use our Tasty Versatile Rice Recipe, the chia seeds we added to the rice have 100x the lysine that brown rice does, and the black pepper also boosts nutrient absorption.

    Because your brown rice protein powder is a rice protein powder and not simply rice, it’s possible that they’ve tweaked it to overcome rice’s amino acid deficiencies. But, if you’re looking for a plant-based protein powder that is definitely a complete protein, soy is a very good option assuming you’re not allergic to that:

    Amino Acid Compositions Of Soy Protein Isolate

    If you’re wondering where to get it, you can see examples of them next to each other on Amazon here:

    Brown Rice Protein Powder | Soy Protein Isolate Powder

    Enjoy!

    Don’t Forget…

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    Learn to Age Gracefully

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  • The Burden of Getting Medical Care Can Exhaust Older Patients

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    Susanne Gilliam, 67, was walking down her driveway to get the mail in January when she slipped and fell on a patch of black ice.

    Pain shot through her left knee and ankle. After summoning her husband on her phone, with difficulty she made it back to the house.

    And then began the run-around that so many people face when they interact with America’s uncoordinated health care system.

    Gilliam’s orthopedic surgeon, who managed previous difficulties with her left knee, saw her that afternoon but told her “I don’t do ankles.”

    He referred her to an ankle specialist who ordered a new set of X-rays and an MRI. For convenience’s sake, Gilliam asked to get the scans at a hospital near her home in Sudbury, Massachusetts. But the hospital didn’t have the doctor’s order when she called for an appointment. It came through only after several more calls.

    Coordinating the care she needs to recover, including physical therapy, became a part-time job for Gilliam. (Therapists work on only one body part per session, so she has needed separate visits for her knee and for her ankle several times a week.)

    “The burden of arranging everything I need — it’s huge,” Gilliam told me. “It leaves you with such a sense of mental and physical exhaustion.”

    The toll the American health care system extracts is, in some respects, the price of extraordinary progress in medicine. But it’s also evidence of the poor fit between older adults’ capacities and the health care system’s demands.

    “The good news is we know so much more and can do so much more for people with various conditions,” said Thomas H. Lee, chief medical officer at Press Ganey, a consulting firm that tracks patients’ experiences with health care. “The bad news is the system has gotten overwhelmingly complex.”

    That complexity is compounded by the proliferation of guidelines for separate medical conditions, financial incentives that reward more medical care, and specialization among clinicians, said Ishani Ganguli, an associate professor of medicine at Harvard Medical School.

    “It’s not uncommon for older patients to have three or more heart specialists who schedule regular appointments and tests,” she said. If someone has multiple medical problems — say, heart disease, diabetes, and glaucoma — interactions with the health care system multiply.

    Ganguli is the author of a new study showing that Medicare patients spend about three weeks a year having medical tests, visiting doctors, undergoing treatments or medical procedures, seeking care in emergency rooms, or spending time in the hospital or rehabilitation facilities. (The data is from 2019, before the covid pandemic disrupted care patterns. If any services were received, that counted as a day of health care contact.)

    That study found that slightly more than 1 in 10 seniors, including those recovering from or managing serious illnesses, spent a much larger portion of their lives getting care — at least 50 days a year.

    “Some of this may be very beneficial and valuable for people, and some of it may be less essential,” Ganguli said. “We don’t talk enough about what we’re asking older adults to do and whether that’s realistic.”

    Victor Montori, a professor of medicine at the Mayo Clinic in Rochester, Minnesota, has for many years raised an alarm about the “treatment burden” that patients experience. In addition to time spent receiving health care, this burden includes arranging appointments, finding transportation to medical visits, getting and taking medications, communicating with insurance companies, paying medical bills, monitoring health at home, and following recommendations such as dietary changes.

    Four years ago — in a paper titled “Is My Patient Overwhelmed?” — Montori and several colleagues found that 40% of patients with chronic conditions such as asthma, diabetes, and neurological disorders “considered their treatment burden unsustainable.”

    When this happens, people stop following medical advice and report having a poorer quality of life, the researchers found. Especially vulnerable are older adults with multiple medical conditions and low levels of education who are economically insecure and socially isolated.

    Older patients’ difficulties are compounded by medical practices’ increased use of digital phone systems and electronic patient portals — both frustrating for many seniors to navigate — and the time pressures afflicting physicians. “It’s harder and harder for patients to gain access to clinicians who can problem-solve with them and answer questions,” Montori said.

    Meanwhile, clinicians rarely ask patients about their capacity to perform the work they’re being asked to do. “We often have little sense of the complexity of our patients’ lives and even less insight into how the treatments we provide (to reach goal-directed guidelines) fit within the web of our patients’ daily experiences,” several physicians wrote in a 2022 paper on reducing treatment burden.

    Consider what Jean Hartnett, 53, of Omaha, Nebraska, and her eight siblings went through after their 88-year-old mother had a stroke in February 2021 while shopping at Walmart.

    At the time, the older woman was looking after Hartnett’s father, who had kidney disease and needed help with daily activities such as showering and going to the bathroom.

    During the year after the stroke, both of Hartnett’s parents — fiercely independent farmers who lived in Hubbard, Nebraska — suffered setbacks, and medical crises became common. When a physician changed her mom’s or dad’s plan of care, new medications, supplies, and medical equipment had to be procured, and new rounds of occupational, physical, and speech therapy arranged.

    Neither parent could be left alone if the other needed medical attention.

    “It wasn’t unusual for me to be bringing one parent home from the hospital or doctor’s visit and passing the ambulance or a family member on the highway taking the other one in,” Hartnett explained. “An incredible amount of coordination needed to happen.”

    Hartnett moved in with her parents during the last six weeks of her father’s life, after doctors decided he was too weak to undertake dialysis. He passed away in March 2022. Her mother died months later in July.

    So, what can older adults and family caregivers do to ease the burdens of health care?

    To start, be candid with your doctor if you think a treatment plan isn’t feasible and explain why you feel that way, said Elizabeth Rogers, an assistant professor of internal medicine at the University of Minnesota Medical School. 

    “Be sure to discuss your health priorities and trade-offs: what you might gain and what you might lose by forgoing certain tests or treatments,” she said. Ask which interventions are most important in terms of keeping you healthy, and which might be expendable.

    Doctors can adjust your treatment plan, discontinue medications that aren’t yielding significant benefits, and arrange virtual visits if you can manage the technological requirements. (Many older adults can’t.)

    Ask if a social worker or a patient navigator can help you arrange multiple appointments and tests on the same day to minimize the burden of going to and from medical centers. These professionals can also help you connect with community resources, such as transportation services, that might be of help. (Most medical centers have staff of this kind, but physician practices do not.)

    If you don’t understand how to do what your doctor wants you to do, ask questions: What will this involve on my part? How much time will this take? What kind of resources will I need to do this? And ask for written materials, such as self-management plans for asthma or diabetes, that can help you understand what’s expected.

    “I would ask a clinician, ‘If I chose this treatment option, what does that mean not only for my cancer or heart disease, but also for the time I’ll spend getting care?’” said Ganguli of Harvard. “If they don’t have an answer, ask if they can come up with an estimate.”

    We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care, and advice you need in dealing with the health care system. Visit http://kffhealthnews.org/columnists to submit your requests or tips.

    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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