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:

  1. 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.
  2. 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 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:

Take care!

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  • How to Eat (And Still Lose Weight) – by Dr. Andrew Jenkinson

    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.

    You may be wondering: what diet is he recommending?

    The answer is: some guiding principles aside…. He’s not recommending a diet, per se.

    What this book does instead is outline why we eat too muchlink is to where we previously had this author as a spotlight featured expert on this topic! Check it out!

    He goes into a lot more detail than we ever could have in our little article, though, and this book is one of those where the reader may feel as though we have had a few classes at medical school. The style, however, is very comprehensible and accessible; there’s no obfuscating jargon here.

    Once we understand the signalling that goes on in terms of hunger/satiety, and the signalling that goes on in terms of fat storage/metabolism, we can simply choose to not give our bodies the wrong signals. Yes, it’s really that simple. It feels quite like a cheat code!

    Bottom line: if you’d like a better understanding of what regulates our body’s “set point” in weight/adiposity, and what can change it (for better or for worse), then this is the book for you.

    Click here to check out How To Eat (And Still Lose Weight), and enjoy eating (while still losing weight)!

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  • The Galveston Diet – by Dr. Mary Claire Haver

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    We’ve previously reviewed “It’s Not You, It’s Your Hormones” by nutritionist Nikki Williams, and noted at the time that it was very similar to the bestselling “The Galveston Diet”, not just in its content but all the way down its formatting. Some Amazon reviewers have even gone so far as to suggest that “It’s Not You, It’s Your Hormones” (2017) brazenly plagiarized “The Galveston Diet” (2023). However, after carefully examining the publication dates, we feel quite confident that the the earlier book did not plagiarize the later one.

    Of course, we would not go so far as to make a counter-accusation of plagiarism the other way around; it was surely just a case of Dr. Haver having the same good ideas 6 years later.

    Still, while the original book by Nikki Williams did not get too much international acclaim, the later one by Dr. Mary Claire Haver has had very good marketing and thus received a lot more attention, so let’s review it:

    Dr. Haver’s basic principle is (again) that we can manage our hormonal fluctuations, by managing our diet. Specifically, in the same three main ways:

    • Intermittent fasting
    • Anti-inflammatory diet
    • Eating more protein and healthy fats

    Why should these things matter to our hormones? The answer is to remember that our hormones aren’t just the sex hormones. We have hormones for hunger and satedness, hormones for stress and relaxation, hormones for blood sugar regulation, hormones for sleep and wakefulness, and more. These many hormones make up our endocrine system, and affecting one part of it will affect the others.

    Will these things magically undo the effects of the menopause? Well, some things yes, other things no. No diet can do the job of HRT. But by tweaking endocrine system inputs, we can tweak endocrine system outputs, and that’s what this book is for.

    The style is once again very accessible and just as clear, and Dr. Haver also walks us just as skilfully through the changes we may want to make, to avoid the changes we don’t want. The recipes are also very similar, so if you loved the recipes in the other book, you certainly won’t dislike this book’s menu.

    In the category of criticism, there is (as with the other book by the other author) some extra support that’s paywalled, in the sense that she wants the reader to buy her personally-branded online plan, and it can feel a bit like she’s holding back in order to upsell to that.

    Bottom line: this book is (again) aimed at peri-menopausal and post-menopausal women. It could also (again) definitely help a lot of people with PCOS too, and, when it comes down to it, pretty much anyone with an endocrine system. It’s (still) a well-evidenced, well-established, healthy way of eating regardless of age, sex, or (most) physical conditions.

    Click here to check out The Galveston Diet, and enjoy its well-told, well-formatted advice!

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  • No Bad Parts – by Dr. Richard Schwartz

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    We’ve previously reviewed Dr. Schwartz’s “You Are The One You’ve Been Waiting For” and whereas that book doesn’t require having read this one, this one would be an excellent place to start, as it focuses on perhaps the most important core issues of IFS therapy.

    We all have different aspects that have developed within us for different reasons, and can generally “become as though a different person when…” and some condition that is met. Those are our “parts”, per IFS.

    This book makes the case that even the worst of our parts arose for reasons, that they often looked after us when no other part could or would, and at the very least, they tried. Rather than arguing for “so, everything’s just great”, though, Dr. Schwartz talks the reader through making peace with those parts, and then, where appropriate, giving them the retirement they deserve—of if that’s not entirely practical, arranging for them to at least take a seat and wait until called on, rather than causing problems in areas of life to which they are not well-suited.

    Throughout, there is a good balance of compassion and no-bullshit, both of which are really necessary in order to make this work.

    Bottom line: if there are parts of you you’re not necessarily proud of, this book can help you to put them peacefully to rest.

    Click here to check out No Bad Parts, and take care of yours!

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  • A drug that can extend your life by 25%? Don’t hold your breath

    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.

    Every few weeks or months, the media reports on a new study that tantalisingly dangles the possibility of a new drug to give us longer, healthier lives.

    The latest study centres around a drug involved in targeting interleukin-11, a protein involved in inflammation. Blocking this protein appeared to help mice stave off disease and extend their life by more than 20%.

    If only defying the ravages of time could be achieved through such a simple and effort-free way – by taking a pill. But as is so often the case, the real-world significance of these findings falls a fair way short of the hype.

    Halfpoint/Shutterstock

    The role of inflammation in disease and ageing

    Chronic inflammation in the body plays a role in causing disease and accelerating ageing. In fact, a relatively new label has been coined to represent this: “inflammaging”.

    While acute inflammation is an important response to infection or injury, if inflammation persists in the body, it can be very damaging.

    A number of lifestyle, environmental and societal drivers contribute to chronic inflammation in the modern world. These are largely the factors we already know are associated with disease and ageing, including poor diet, lack of exercise, obesity, stress, lack of sleep, lack of social connection and pollution.

    While addressing these issues directly is one of the keys to addressing chronic inflammation, disease and ageing, there are a number of research groups also exploring how to treat chronic inflammation with pharmaceuticals. Their goal is to target and modify the molecular and chemical pathways involved in the inflammatory process itself.

    What the latest research shows

    This new interleukin-11 research was conducted in mice and involved a number of separate components.

    In one component of this research, interleukin-11 was genetically knocked out in mice. This means the gene for this chemical mediator was removed from these mice, resulting in the mice no longer being able to produce this mediator at all.

    In this part of the study, the mice’s lives were extended by over 20%, on average.

    Another component of this research involved treating older mice with a drug that blocks interleukin-11.

    Injecting this drug into 75-week old mice (equivalent to 55-year-old humans) was found to extend the life of mice by 22-25%.

    These treated mice were less likely to get cancer and had lower cholesterol levels, lower body weight and improved muscle strength and metabolism.

    From these combined results, the authors concluded, quite reasonably, that blocking interleukin-11 may potentially be a key to mitigating age-related health effects and improving lifespan in both mice and humans.

    Why you shouldn’t be getting excited just yet

    There are several reasons to be cautious of these findings.

    First and most importantly, this was a study in mice. It may be stating the obvious, but mice are very different to humans. As such, this finding in a mouse model is a long way down the evidence hierarchy in terms of its weight.

    Research shows only about 5% of promising findings in animals carry over to humans. Put another way, approximately 95% of promising findings in animals may not be translated to specific therapies for humans.

    Second, this is only one study. Ideally, we would be looking to have these findings confirmed by other researchers before even considering moving on to the next stage in the knowledge discovery process and examining whether these findings may be true for humans.

    We generally require a larger body of evidence before we get too excited about any new research findings and even consider the possibility of human trials.

    Third, even if everything remains positive and follow-up studies support the findings of this current study, it can take decades for a new finding like this to be translated to successful therapies in humans.

    Until then, we can focus on doing the things we already know make a huge difference to health and longevity: eating well, exercising, maintaining a healthy weight, reducing stress and nurturing social relationships.

    Hassan Vally, Associate Professor, Epidemiology, Deakin University

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

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  • I want to eat healthily. So why do I crave sugar, salt and carbs?

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    We all want to eat healthily, especially as we reset our health goals at the start of a new year. But sometimes these plans are sabotaged by powerful cravings for sweet, salty or carb-heavy foods.

    So why do you crave these foods when you’re trying to improve your diet or lose weight? And what can you do about it?

    There are many reasons for craving specific foods, but let’s focus on four common ones:

    1. Blood sugar crashes

    Sugar is a key energy source for all animals, and its taste is one of the most basic sensory experiences. Even without specific sweet taste receptors on the tongue, a strong preference for sugar can develop, indicating a mechanism beyond taste alone.

    Neurons responding to sugar are activated when sugar is delivered to the gut. This can increase appetite and make you want to consume more. Giving into cravings also drives an appetite for more sugar.

    In the long term, research suggests a high-sugar diet can affect mood, digestion and inflammation in the gut.

    While there’s a lot of variation between individuals, regularly eating sugary and high-carb foods can lead to rapid spikes and crashes in blood sugar levels. When your blood sugar drops, your body can respond by craving quick sources of energy, often in the form of sugar and carbs because these deliver the fastest, most easily accessible form of energy.

    2. Drops in dopamine and serotonin

    Certain neurotransmitters, such as dopamine, are involved in the reward and pleasure centres of the brain. Eating sugary and carb-rich foods can trigger the release of dopamine, creating a pleasurable experience and reinforcing the craving.

    Serotonin, the feel-good hormone, suppresses appetite. Natural changes in serotonin can influence daily fluctuations in mood, energy levels and attention. It’s also associated with eating more carb-rich snacks in the afternoon.

    Woman sits at her desk, tired
    Do you get 3pm sugar cravings? Serotonin could play a role.
    Marcus Aurelius/Pexels

    Low carb diets may reduce serotonin and lower mood. However, a recent systematic review suggests little association between these diets and risk for anxiety and depression.

    Compared to men, women tend to crave more carb rich foods. Feeling irritable, tired, depressed or experiencing carb cravings are part of premenstrual symptoms and could be linked to reduced serotonin levels.

    3. Loss of fluids and drops in blood sugar and salt

    Sometimes our bodies crave the things they’re missing, such as hydration or even salt. A low-carb diet, for example, depletes insulin levels, decreasing sodium and water retention.

    Very low-carb diets, like ketogenic diets, induce “ketosis”, a metabolic state where the body switches to using fat as its primary energy source, moving away from the usual dependence on carbohydrates.

    Ketosis is often associated with increased urine production, further contributing to potential fluid loss, electrolyte imbalances and salt cravings.

    4. High levels of stress or emotional turmoil

    Stress, boredom and emotional turmoil can lead to cravings for comfort foods. This is because stress-related hormones can impact our appetite, satiety (feeling full) and food preferences.

    The stress hormone cortisol, in particular, can drive cravings for sweet comfort foods.

    A 2001 study of 59 premenopausal women subjected to stress revealed that the stress led to higher calorie consumption.

    A more recent study found chronic stress, when paired with high-calorie diet, increases food intake and a preference for sweet foods. This shows the importance of a healthy diet during stress to prevent weight gain.

    What can you do about cravings?

    Here are four tips to curb cravings:

    1) don’t cut out whole food groups. Aim for a well-balanced diet and make sure you include:

    • sufficient protein in your meals to help you feel full and reduce the urge to snack on sugary and carb-rich foods. Older adults should aim for 20–40g protein per meal with a particular focus on breakfast and lunch and an overall daily protein intake of at least 0.8g per kg of body weight for muscle health
    • fibre-rich foods, such as vegetables and whole grains. These make you feel full and stabilise your blood sugar levels. Examples include broccoli, quinoa, brown rice, oats, beans, lentils and bran cereals. Substitute refined carbs high in sugar like processed snack bars, soft drink or baked goods for more complex ones like whole grain bread or wholewheat muffins, or nut and seed bars or energy bites made with chia seeds and oats

    2) manage your stress levels. Practise stress-reduction techniques like meditation, deep breathing, or yoga to manage emotional triggers for cravings. Practising mindful eating, by eating slowly and tuning into bodily sensations, can also reduce daily calorie intake and curb cravings and stress-driven eating

    3) get enough sleep. Aim for seven to eight hours of quality sleep per night, with a minimum of seven hours. Lack of sleep can disrupt hormones that regulate hunger and cravings

    4) control your portions. If you decide to indulge in a treat, control your portion size to avoid overindulging.

    Overcoming cravings for sugar, salt and carbs when trying to eat healthily or lose weight is undoubtedly a formidable challenge. Remember, it’s a journey, and setbacks may occur. Be patient with yourself – your success is not defined by occasional cravings but by your ability to manage and overcome them.The Conversation

    Hayley O’Neill, Assistant Professor, Faculty of Health Sciences and Medicine, Bond University

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

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  • Spinach vs Chard – Which is Healthier?

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    Our Verdict

    When comparing spinach to chard, we picked the spinach.

    Why?

    In terms of macros, spinach has slightly more fiber and protein, while chard has slightly more carbs. Now, those carbs are fine; nobody is getting metabolic disease from eating greens. But, by the numbers, this is a clear, albeit marginal, win for spinach.

    In the category of vitamins, spinach has more of vitamins A, B1, B2, B3, B5, B6, B9, E, and K, while chard has more of vitamins C and choline. An even clearer victory for spinach this time.

    When it comes to minerals, spinach has more calcium, copper, iron, magnesium, manganese, phosphorus, selenium, and zinc, while chard has more potassium. Once again, a clear win for spinach.

    You may be wondering about oxalates, in which spinach is famously high. However, chard is nearly 2x higher in oxalates. In practical terms, this doesn’t mean too much for most people. If you have kidney problems or a family history of such, it is recommended to avoid oxalates. For everyone else, the only downside is that oxalates diminish calcium bioavailability, which is a pity, as spinach is (by the numbers) a good source of calcium.

    However, oxalates are broken down by heat, so this means that cooked spinach (lightly steamed is fine; you don’t need to do anything drastic) will be much lower in oxalates (if you have kidney problems, do still check with your doctor/dietician, though).

    All in all, spinach beats chard by most metrics, and by a fair margin. Still, enjoy either or both, unless you have kidney problems, in which case maybe go for kale or collard greens instead!

    Want to learn more?

    You might like to read:

    Make Your Vegetables Work Better Nutritionally ← includes a note on breaking down oxalates, and lots of other information besides!

    Enjoy!

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