Before You Reach For That Tylenol…
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First, on names: we’ve titled this with “Tylenol” because that’s a well-known brand name, but the drug name is paracetamol or acetaminophen:
- paracetamol is the drug name used by the World Health Organization, and thus also most countries.
- acetaminophen is the drug name used in Canada, Colombia, Iran, Japan, US, and Venezuela.
They are absolutely the same drug.
Firstly, obviously, do avoid overdose
The safe dosage described on the packet is generally accurate (usually around 4g/day, spaced out at 1g per 4 hours), and the dose required for toxicity is generally about 10g, or 200mg/kg body weight, whichever is lower. Since a single dose usually contains 2x 500mg = 1g, that makes overdose all too easy.
The amount required for toxicity can be misleading too, because that’s assuming…
- a healthy liver
- no other health problems
- no other medications that interact or add to the toxicity
- no medications that strain the liver (as with many pro-drugs, and drugs in general that are metabolized by the liver, which is lots).
Which is a lot of assumptions! Especially given that the liver can only process so much at once, meaning that if your liver has a lot of things to do, it can get a backlog, and you think “I’m not taking anything with this painkiller that I shouldn’t” but your liver is still metabolizing the last of last night’s glass of wine and one of your regular medications from this morning, because previously it was still metabolizing things from the day before yesterday, and so on.
See also: How To Regenerate Your Liver ← the liver is an incredible organ that does an amazing job, but it can’t do that if you don’t do this
Please don’t overdose deliberately either. Intentional overdoses make up a very large portion of acetaminophen overdoses (exact figures vary from year to year and place to place, but it’s always high), and what a lot of people doing that don’t realize is:
- it’s a very unpleasant way to die. You’ll take it, you might get some initial symptoms within the first hours or you might not, then you’ll probably feel better, and then the next day or so, you’ll enter the organs-shutting-down stage that usually will take most of a week to kill you slowly and painfully. Often your kidneys will go first but it’ll usually be liver necrosis that deals the final blow.
- it’s very difficult to treat. Stomach-pumping might work if you get it within 1 hour of overdose, and activated charcoal might help if you get it within 2 hours. Acetylcysteine may reduce the toxicity if you get it within the 8–48 hour window (depending on the speed of gastric emptying), but whether or not that will help depends on the severity of the overdose and other factors, so this is not something to bet on. After 48 hours, a liver transplant is the last resort, without which, mortality is around 95%.
Unfortunately, this means that a lot of people who do not fully intend to die horribly, and hoped to either die peacefully or else be saved, die horribly instead.
Ok, that was not a cheerful topic but it is important, before moving on, we’ll just put this here for anyone it may benefit:
How To Stay Alive (When You Really Don’t Want To) ← this is about suicidality, in yourself or others
Secondly, that dosage is for occasional use only
The problem often starts like this:
❝Due to its perceived safety, paracetamol has long been recommended as the first line drug treatment for osteoarthritis by many treatment guidelines, especially in older people who are at higher risk of drug-related complications❞
People with chronic pain, whether high or low on the pain level of that chronic pain, can very easily get into a habit of “I’ll just take this to take the edge off”, for example when getting up in the morning (often a trigger for pain starting) or going to bed at night (one needs to sleep and the pain is a barrier to that).
But… Those events, getting up and going to bed, it means that taking the drug also becomes part of one’s morning/evening routine—with many people even metering the doses out into pill organizers for the week, with this in mind.
A large (n=582,961) study looked at two groups of people, all aged 65+:
- 180,483 people who had been prescribed paracetamol repeatedly (≥2 prescriptions within six months)
- 402,478 people of the same age who had never been prescribed paracetamol repeatedly
The findings? Bearing in mind that “≥2 prescriptions within six months” is not something generally considered excessive…
❝Acetaminophen use was associated with an increased risk of peptic ulcer bleeding (aHR 1.24; 95% CI 1.16, 1.34), uncomplicated peptic-ulcers (aHR 1.20; 95% CI 1.10, 1.31), lower gastrointestinal-bleeding (aHR 1.36; 95% CI 1.29, 1.46), heart-failure (aHR 1.09; 95% CI 1.06, 1.13), hypertension (aHR 1.07; 95% CI 1.04, 1.11), and chronic kidney disease (aHR 1.19; 95% CI 1.13, 1.24).❞
The researchers concluded:
❝Despite its perceived safety, acetaminophen is associated with several serious complications. Given its minimal analgesic effectiveness, the use of acetaminophen as the first-line oral analgesic for long-term conditions in older people requires careful reconsideration.❞
You can see the study itself here: Incidence of side effects associated with acetaminophen in people aged 65 years or more: a prospective cohort study using data from the Clinical Practice Research Datalink
What to use instead?
It’s been established that taking aspirin regularly isn’t great either:
See: Low-Dose Aspirin & Anemia and Aspirin, CVD Risk, & Potential Counter-Risks
And as for ibuprofen, we don’t have an article about that yet, but it’s gut-unhealthy (harms your microbiome), and besides, anything it can do, ginger can do as well or better (in head-to-head trials; we’re not speaking hyperbolically here):
Ginger Does A Lot More Than You Think ← in fact, it was even found as effective as the combination of acetaminophen, ibuprofen, and caffeine
There are other options though, and as pain is complicated and there’s no one-size-fits-all solution, we’ve compiled the following:
- Dial Down Your Pain
- Stop Pain Spreading
- Managing Chronic Pain (Realistically!)
- The 7 Approaches To Pain Management
- Science-Based Alternative Pain Relief ← when painkillers aren’t helping, these things might
Take care!
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Soy Beans vs Kidney Beans – Which is Healthier?
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Our Verdict
When comparing soy beans to kidney beans, we picked the soy.
Why?
In terms of macros, soy has 2x the protein, while kidney beans have nearly 3x the carbs and very slightly more fiber. Ratio-wise, the “very slightly more fiber” does not offset the “nearly 3x the carbs” when it comes to glycemic index (though both are still good, really, but this is a head-to-head so the comparison is relevant), and 2x the protein is also quite a bonus, so this category’s an easy win for soy.
In the category of vitamins, soy beans have more of vitamins A, B2, B6, C, E, K, and choline, while kidney beans have more of vitamins B3, B5, and B9, thus making for a 7:3 win for soy.
When it comes to minerals, soy beans have more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc, while kidney beans are not higher in any mineral. Another clear win for soy.
Adding up the three strong wins for soy, makes for an overall easy win for soy. Still, enjoy either or both; diversity is good!
Want to learn more?
You might like to read:
Plant vs Animal Protein: Head to Head
Take care!
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Sunflower Seeds vs Sesame Seeds – Which is Healthier?
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Our Verdict
When comparing sunflower seeds to sesame seeds, we picked the sunflower.
Why?
In moderation, both are very healthy. We say “in moderation” because they’re both about 50% fat and such fats, while vital for life, are generally best enjoyed in small portions. Of that fat, sunflower has the slightly better fat profile; they’re both mostly poly- and monounsaturated fats, but sunflower has 10% saturated fat while sesame has 15%. Aside from fats, sunflower has slightly more protein and sesame has slightly more carbs. While sesame has slightly more fiber, because of the carb profile sunflower still has the lower glycemic index. All in all, a moderate win for sunflower in the macros category.
You may be wondering, with all that discussion of fats, what they’re like for omega-3, and sesame seeds have more omega-3, though sunflower seeds contain it too. Still, a point in sesame’s favor here.
When it comes to vitamins, sunflower has more of vitamins A, B1, B2, B3, B5, B6, B9, C, E, and choline, while sesame is not higher in any vitamins.
In the category of minerals, sunflower has more phosphorus, potassium, and selenium, while sesame has more calcium, copper, iron, and zinc. This is nominally a marginal win for sesame, but it should be noted that sunflower is still very rich in copper, iron, and zinc too (but not calcium).
Adding up the categories makes for a moderate win for sunflower seeds, but as ever, enjoy both; diversity is best!
Want to learn more?
You might like to read:
Sunflower Seeds vs Pumpkin Seeds – Which is Healthier?
Take care!
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Pistachios vs Almonds – Which is Healthier?
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Our Verdict
When comparing pistachios to almonds, we picked the almonds.
Why?
It was very close! And those who’ve been following our “This or That” comparisons might be aware that pistachios and almonds have both been winning their respective comparisons with other nuts so far, so today we put them head-to-head.
In terms of macros, almonds have a little more protein and a little more fiber—as well as slightly more fat, though the fats are healthy. Pistachios, meanwhile, are higher in carbs. A moderate win for almonds on the macro front.
When it comes to vitamins, pistachios have more of vitamins A, B1, and B6, while almonds have more of vitamins B2, B3, and E. We could claim a slight victory for pistachios, based on the larger margins, or else a slight victory for almonds, based on vitamin E being a more common nutritional deficiency than vitamin A, and therefore the more useful vitamin to have more of. We’re going to call this category a tie.
In the category of minerals, almonds lead with more calcium, magnesium, manganese, and zinc, while pistachios boast more copper, potassium, and selenium, though the margins are more modest for pistachios. A moderate win for almonds on minerals, therefore.
Adding up the sections gives a win for almonds, but of course, do enjoy both, because both are excellent in their own right.
Want to learn more?
You might like to read:
- Why You Should Diversify Your Nuts!
- Pistachios vs Walnuts – Which is Healthier?
- Almonds vs Cashews – Which is Healthier?
Take care!
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Black Beans vs Pinto Beans – Which is Healthier?
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Our Verdict
When comparing black beans to pinto beans, we picked the pinto beans.
Why?
Both of these beans have won all their previous comparisons, so it’s no surprise that this one was very close. Despite their different appearance, taste, and texture, their nutritional profiles are almost identical:
In terms of macros, pinto beans have a tiny bit more protein, carbs, and fiber. So, a nominal win for pinto beans, but again, the difference is very slight.
When it comes to vitamins, black beans have more of vitamins A, B1, B3, and B5, while pinto beans have more of vitamins B2, B6, B9, C, E, K and choline. Superficially, again this is nominally a win for pinto beans, but in most cases the differences are so slight as to be potentially the product of decimal place rounding.
In the category of minerals, black beans have more calcium, copper, iron, and phosphorus, while pinto beans have more magnesium, manganese, selenium, and zinc. That’s a 4:4 tie, but the only one with a meaningful margin of difference is selenium (of which pinto beans have 4x more), so we’re calling this one a very modest win for pinto beans.
All in all, adding these up makes for a “if we really are pressed to choose” win for pinto beans, but honestly, enjoy either in accordance with your preference (this writer prefers black beans!), or better yet, both.
Want to learn more?
You might like to read:
What’s Your Plant Diversity Score?
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Give Your Adrenal Glands A Chance
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The Hats Of Wrath
Your adrenal glands are two little hat-shaped glands that sit on top of your kidneys (like your kidneys are wearing them as hats, in fact).
They produce adrenaline, as you might have guessed, and also cortisol and aldosterone, which you might or might not have known, as well as some miscellaneous corticosteroids that are beyond the scope of today’s article.
Fun fact! For a long time, doctors thought adrenal glands were much larger than they usually are, because of learning anatomy from corpses that were dissected, but invariably the corpses were those of poor people, especially criminals, whose adrenal glands were almost always overworked and swollen.
You don’t want yours to be like that.
What goes wrong
Assuming you don’t have a rare disorder like Addison’s disease (in which the adrenal glands don’t produce enough of the hormones they’re supposed to), your adrenal glands will usually not have trouble producing enough adrenaline et al.
However, as we learned from the Victorian vagabonds, they can also have no problems producing too much—much like any organ that gets overworked, however, this has consequences.
Hopefully you’re not living a life of stressful crime on the streets, but maybe you have other reasons your adrenal glands are working overtime, such as any source of chronic stress, bad sleep (can’t recharge without this downtime), overuse of stimulants (including caffeine and/or nicotine), and, counterintuitively, alcohol. All these things can tax the adrenal glands considerably.
When this happens, in the extreme we can get Cushing’s syndrome, characterized by the symptoms: hypertension, cortisol-based fat distribution i.e. especially face and abdomen, weakness, fragile easily irritable skin, hair loss and/or hirsutism, paradoxically, and of course general fatigue.
In the non-extreme, we get all the same symptoms just to a lower level, and experience what the medical profession is begging us not to call “Adrenal Fatigue Syndrome” because that’s not an official diagnosis, whereas if it gets a name then they’ll be expected to treat it.
What keeps things going right
Obviously, the opposite of the above, for a start. Which means:
Manage chronic stress; see: How To Manage Chronic Stress
Get good sleep; see: Why You Probably Need More Sleep
Go easy on the caffeine; see: Caffeine Mythbusting
Skip the nicotine; see: Nicotine Benefits (That We Don’t Recommend)!
Avoid alcohol; see: How To Reduce Or Quit Alcohol
There are specific vitamins and minerals that support adrenal health too; they are: vitamins B5, B6, B12, C, & D, and also magnesium and zinc.
Good dietary sources of the above include green leafy things, cruciferous vegetables*, nuts and seeds, avocados, olive oil, and if you eat fish, then also fatty fish.
In contrast, it is good to cut down (or avoid entirely) red meat and unfermented dairy.
*Unsure how to get cruciferous vegetables in more often? Try today’s featured recipe, superfood broccoli pesto
Want to know more?
A large part of adrenal health is about keeping cortisol levels down generally (except: for most of us, we can have a little hormesis, as a treat), so for the rest of that you might like to read:
Lower Your Cortisol! (Here’s Why & How)
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‘It’s okay to poo at work’: new health campaign highlights a common source of anxiety
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For most people, the daily or near-daily ritual of having a bowel motion is not something we give a great deal of thought to. But for some people, the need to do a “number two” in a public toilet or at work can be beset with significant stress and anxiety.
In recognition of the discomfort people may feel around passing a bowel motion at work, the Queensland Department of Health recently launched a social media campaign with the message “It’s okay to poo at work”.
The campaign has gained significant traction on Instagram and Facebook. It has been praised by health and marketing experts for its humorous handling of a taboo topic.
A colourful Instagram post is accompanied by a caption warning of the health risks of “holding it in”, including haemorrhoids and other gastrointestinal problems. The caption also notes:
If you find it extremely difficult to poo around other people, you might have parcopresis.
Queensland Health/Instagram What is parcopresis?
Parcopresis, sometimes called “shy bowel”, occurs when people experience a difficulty or inability to poo in public toilets due to fear of perceived scrutiny by others.
People with parcopresis may find it difficult to go to the toilet in public places such as shopping centres, restaurants, at work or at school, or even at home when friends or family are around.
They may fear being judged by others about unpleasant smells or sounds when they have a bowel motion, or how long they take to go, for example.
Living with a gastrointestinal condition (at least four in ten Australians do) may contribute to parcopresis due to anxiety about the need to use a toilet frequently, and perceived judgment from others when doing so. Other factors, such as past negative experiences or accessibility challenges, may also play a role.
Some people may feel uncomfortable about using the toilet at work. Motortion Films/Shutterstock For sufferers, anxiety can present in the form of a faster heart rate, rapid breathing, sweating, muscle tension, blushing, nausea, trembling, or a combination of these symptoms. They may experience ongoing worry about situations where they may need to use a public toilet.
Living with parcopresis can affect multiple domains of life and quality of life overall. For example, sufferers may have difficulties relating to employment, relationships and social life. They might avoid travelling or attending certain events because of their symptoms.
How common is parcopresis?
We don’t really know how common parcopresis is, partly due to the difficulty of evaluating this behaviour. It’s not necessarily easy or appropriate to follow people around to track whether they use or avoid public toilets (and their reasons if they do). Also, observing individual bathroom activities may alter the person’s behaviour.
I conducted a study to try to better understand how common parcopresis is. The study involved 714 university students. I asked participants to respond to a series of vignettes, or scenarios.
In each vignette participants were advised they were at a local shopping centre and they needed to have a bowel motion. In the vignettes, the bathrooms (which had been recently cleaned) had configurations of either two or three toilet stalls. Each vignette differed by the configuration of stalls available.
The rate of avoidance was just over 14% overall. But participants were more likely to avoid using the toilet when the other stalls were occupied.
Around 10% avoided going when all toilets were available. This rose to around 25% when only the middle of three toilets was available. Men were significantly less likely to avoid going than women across all vignettes.
For those who avoided the toilet, many either said they would go home to poo, use an available disabled toilet, or come back when the bathroom was empty.
Parcopresis at work
In occupational settings, the rates of anxiety about using shared bathrooms may well be higher for a few reasons.
For example, people may feel more self-conscious about their bodily functions being heard or noticed by colleagues, compared to strangers in a public toilet.
People may also experience guilt, shame and fear about being judged by colleagues or supervisors if they need to make extended or frequent visits to the bathroom. This may particularly apply to people with a gastrointestinal condition.
Reducing restroom anxiety
Using a public toilet can understandably cause some anxiety or be unpleasant. But for a small minority of people it can be a real problem, causing severe distress and affecting their ability to engage in activities of daily living.
If doing a poo in a toilet at work or another public setting causes you anxiety, be kind to yourself. A number of strategies might help:
- identify and challenge negative thoughts about using public toilets and remind yourself that using the bathroom is normal, and that most people are not paying attention to others in the toilets
- try to manage stress through relaxation techniques such as deep breathing and progressive muscle relaxation, which involves tensing and relaxing different muscles around the body
- engaging in gradual exposure can be helpful, which means visiting public toilets at different times and locations, so you can develop greater confidence in using them
- use grounding or distraction techniques while going to the toilet. These might include listening to music, watching something on your phone, or focusing on your breathing.
If you feel parcopresis is having a significant impact on your life, talk to your GP or a psychologist who can help identify appropriate approaches to treatment. This might include cognitive behavioural therapy.
Simon Robert Knowles, Associate Professor and Clinical Psychologist, Swinburne University of Technology
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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