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 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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Ending Aging – by Dr. Aubrey de Grey
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We know about how to slow aging. We know about diet, exercise, sleep, intermittent fasting, and other lifestyle tweaks to make. But how much can we turn back the clock, according to science?
Dr. Aubrey de Grey’s foundational principle is simple: the body is a biological machine, and aging is fundamentally an engineering problem.
He then outlines the key parts to that problem: the princple ways in which cells (and DNA) get damaged, and what we need to do about that in each case. Car tires get damaged over time; our approach is to replace them within a certain period of time so that they don’t blow out. In the body, it’s a bit similar with cells so that we don’t get cancer, for example.
The book goes into detail regards each of the seven main ways we accumulate this damage, and highlights avenues of research looking to prevent it, and in at least some cases, the measures already available to so.
Bottom line: if you want a hard science overview of actual rejuvenation research in biogerontology, this is a book that presents that comprehensively, without assuming prior knowledge.
Click here to check out Ending Aging and never stop learning!
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Alpha, beta, theta: what are brain states and brain waves? And can we control them?
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There’s no shortage of apps and technology that claim to shift the brain into a “theta” state – said to help with relaxation, inward focus and sleep.
But what exactly does it mean to change one’s “mental state”? And is that even possible? For now, the evidence remains murky. But our understanding of the brain is growing exponentially as our methods of investigation improve.
Brain-measuring tech is evolving
Currently, no single approach to imaging or measuring brain activity gives us the whole picture. What we “see” in the brain depends on which tool we use to “look”. There are myriad ways to do this, but each one comes with trade-offs.
We learnt a lot about brain activity in the 1980s thanks to the advent of magnetic resonance imaging (MRI).
Eventually we invented “functional MRI”, which allows us to link brain activity with certain functions or behaviours in real time by measuring the brain’s use of oxygenated blood during a task.
We can also measure electrical activity using EEG (electroencephalography). This can accurately measure the timing of brain waves as they occur, but isn’t very accurate at identifying which specific areas of the brain they occur in.
Alternatively, we can measure the brain’s response to magnetic stimulation. This is very accurate in terms of area and timing, but only as long as it’s close to the surface.
What are brain states?
All of our simple and complex behaviours, as well as our cognition (thoughts) have a foundation in brain activity, or “neural activity”. Neurons – the brain’s nerve cells – communicate by a sequence of electrical impulses and chemical signals called “neurotransmitters”.
Neurons are very greedy for fuel from the blood and require a lot of support from companion cells. Hence, a lot of measurement of the site, amount and timing of brain activity is done via measuring electrical activity, neurotransmitter levels or blood flow.
We can consider this activity at three levels. The first is a single-cell level, wherein individual neurons communicate. But measurement at this level is difficult (laboratory-based) and provides a limited picture.
As such, we rely more on measurements done on a network level, where a series of neurons or networks are activated. Or, we measure whole-of-brain activity patterns which can incorporate one or more so-called “brain states”.
According to a recent definition, brain states are “recurring activity patterns distributed across the brain that emerge from physiological or cognitive processes”. These states are functionally relevant, which means they are related to behaviour.
Brain states involve the synchronisation of different brain regions, something that’s been most readily observed in animal models, usually rodents. Only now are we starting to see some evidence in human studies.
Various kinds of states
The most commonly-studied brain states in both rodents and humans are states of “arousal” and “resting”. You can picture these as various levels of alertness.
Studies show environmental factors and activity influence our brain states. Activities or environments with high cognitive demands drive “attentional” brain states (so-called task-induced brain states) with increased connectivity. Examples of task-induced brain states include complex behaviours such as reward anticipation, mood, hunger and so on.
In contrast, a brain state such as “mind-wandering” seems to be divorced from one’s environment and tasks. Dropping into daydreaming is, by definition, without connection to the real world.
We can’t currently disentangle multiple “states” that exist in the brain at any given time and place. As mentioned earlier, this is because of the trade-offs that come with recording spatial (brain region) versus temporal (timing) brain activity.
Brain states vs brain waves
Brain state work can be couched in terms such as alpha, delta and so forth. However, this is actually referring to brain waves which specifically come from measuring brain activity using EEG.
EEG picks up on changing electrical activity in the brain, which can be sorted into different frequencies (based on wavelength). Classically, these frequencies have had specific associations:
- gamma is linked with states or tasks that require more focused concentration
- beta is linked with higher anxiety and more active states, with attention often directed externally
- alpha is linked with being very relaxed, and passive attention (such as listening quietly but not engaging)
- theta is linked with deep relaxation and inward focus
- and delta is linked with deep sleep.
Brain wave patterns are used a lot to monitor sleep stages. When we fall asleep we go from drowsy, light attention that’s easily roused (alpha), to being relaxed and no longer alert (theta), to being deeply asleep (delta).
Can we control our brain states?
The question on many people’s minds is: can we judiciously and intentionally influence our brain states?
For now, it’s likely too simplistic to suggest we can do this, as the actual mechanisms that influence brain states remain hard to detangle. Nonetheless, researchers are investigating everything from the use of drugs, to environmental cues, to practising mindfulness, meditation and sensory manipulation.
Controversially, brain wave patterns are used in something called “neurofeedback” therapy. In these treatments, people are given feedback (such as visual or auditory) based on their brain wave activity and are then tasked with trying to maintain or change it. To stay in a required state they may be encouraged to control their thoughts, relax, or breathe in certain ways.
The applications of this work are predominantly around mental health, including for individuals who have experienced trauma, or who have difficulty self-regulating – which may manifest as poor attention or emotional turbulence.
However, although these techniques have intuitive appeal, they don’t account for the issue of multiple brain states being present at any given time. Overall, clinical studies have been largely inconclusive, and proponents of neurofeedback therapy remain frustrated by a lack of orthodox support.
Other forms of neurofeedback are delivered by MRI-generated data. Participants engaging in mental tasks are given signals based on their neural activity, which they use to try and “up-regulate” (activate) regions of the brain involved in positive emotions. This could, for instance, be useful for helping people with depression.
Another potential method claimed to purportedly change brain states involves different sensory inputs. Binaural beats are perhaps the most popular example, wherein two different wavelengths of sound are played in each ear. But the evidence for such techniques is similarly mixed.
Treatments such as neurofeedback therapy are often very costly, and their success likely relies as much on the therapeutic relationship than the actual therapy.
On the bright side, there’s no evidence these treatment do any harm – other than potentially delaying treatments which have been proven to be beneficial.
Susan Hillier, Professor: Neuroscience and Rehabilitation, University of South Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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The Dental Diet – by Dr. Steven Lin
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As it turns out, there’s a lot more to healthy teeth than skipping the sugar and getting some calcium.
The author’s journey started with the realization that most of his work as a dentist should be unnecessary, and not just in the “you should have been flossing” sense. Rather, he came to the same conclusions as his fellow dentist Weston Price before him, and this time (unlike Price) he stuck to his own field, dentistry—meaning that the conclusions he kept were the more valid ones.
Another thing he does better than Price is that he contextualizes the information—we don’t need, for example, to be eating seal fat as a main component of our diet, but we do need to be getting sufficient amounts of certain fat-soluble vitamins. And most people aren’t. Same with what’s good or bad for our oral microbiome, and by extension, our saliva, and by extension, our teeth and gums.
There’s a lot of nutritional information in here; macros and micronutrients alike, but the book goes further than that, to also recommend minimally-processed food that requires more chewing, for example. Not just for its nutritional content, but because that helps our teeth move to (and then stay) where they are ideally supposed to be. No amount of perfectly-blended nutritional supplement drink will align your maxilla for you, say. But chomping on raw carrots? Different story.
Dr. Lin offers a 40-day meal plan, but aware that if you’re vegetarian or vegan you’re probably going to have to rethink it yourself using the information he gives, because his meal plan includes animal products.
Bottom line: if you’d like to eat for better oral health (nutritionally, physically, and for your oral microbiome), this book has all the information you’ll need.
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Tasty Tabbouleh with Tahini
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Tabbouleh is a salad, but it’s not “just a salad”. It’s a special kind of salad that’s as exciting for the tastebuds as it is healthy for the body and brain. Its core ingredients have been traditional for about a dozen generations, and seasonings are always a personal matter (not to mention that Lebanese tabbouleh-makers centuries ago might not have used miso and nooch, as we will today), but the overall feel of the Gestalt of tabbouleh seasonings remains the same, and this recipe is true to that.
You will need
For the tabbouleh:
- 1 cup bulgur wheat
- 1 cup plum tomatoes, chopped
- 1 cucumber, peeled and chopped (add the peel to a jug of water and put it in the fridge; this will be refreshing cucumber water later!)
- 1 cup chickpeas, cooked without salt
- 1/2 cup parsley, chopped
- 1/2 cup mint, chopped
- 2 spring onions, finely chopped
- 2oz fresh lemon juice
- 1 tsp white miso paste
- 1 tsp garlic powder
- 1 tsp ground cumin
- 1 tsp ground celery seeds
- 1 tsp ground nigella seeds
- 1 tsp ground black pepper
- 1 tsp MSG, or 1/2 tsp low sodium salt (you can find it in supermarkets, the sodium chloride is cut with potassium chloride to make it have less sodium and more potassium)
- 1 tbsp nutritional yeast (nooch), ground (it comes in flakes; you will have to grind it in a spice grinder or with a pestle and mortar)
For the tahini sauce:
- 3 garlic cloves, crushed
- 3 tbsp tahini
- 1 tbsp fresh lemon juice
- 1 tbsp white miso paste
- 1 tsp ground cumin
To serve:
- A generous helping of leafy greens; we recommend collard greens, but whatever works for you is good; just remember that dark green is best. Consider cavolo nero, or even kale if that’s your thing, but to be honest this writer doesn’t love kale
- 1 tsp coarsely ground nigella seeds
- Balsamic vinegar, ideally aged balsamic vinegar (this is thicker and sweeter, but unlike most balsamic vinegar reductions, doesn’t have added sugar).
Method
(we suggest you read everything at least once before doing anything)
1) Rinse the bulgur wheat and then soak it in warm water. There is no need to boil it; the warm water is enough to soften it and you don’t need to cook it (bulgur wheat has already been parboiled before it got to you).
2) While you wait, take a small bowl and mix the rest of the ingredients from the tabbouleh section (so, the lemon juice, miso paste, and all those ground spices and MSG/salt and ground nutritional yeast); you’re making a dressing out of all the ingredients here.
3) When the bulgur wheat is soft (expect it to take under 15 minutes), drain it and put it in a big bowl. Add the tomatoes, cucumber, chickpeas, parsley, mint, and spring onions. This now technically qualifies as tabbouleh already, but we’re not done.
4) Add the dressing to the tabbouleh and mix thoroughly but gently (you don’t want to squash the tomatoes, cucumber, etc). Leave it be for at least 15 minutes while the flavors blend.
5) Take the “For the tahini sauce” ingredients (all of them) and blend them with 4 oz water, until smooth. You’re going to want to drizzle this sauce, so if the consistency is too thick for drizzling, add a little more water and/or lemon juice (per your preference), 1 tbsp at a time.
6) Roughly chop the leafy greens and put them in a bowl big enough for the tabbouleh to join them there. The greens will serve as a bed for the tabbouleh itself.
7) Drizzle the tahini over the tabbouleh, and drizzle a little of the aged balsamic vinegar too.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
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Nicotine Benefits (That We Don’t Recommend)!
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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
❝Does nicotine have any benefits at all? I know it’s incredibly addictive but if you exclude the addiction, does it do anything?❞
Good news: yes, nicotine is a stimulant and can be considered a performance enhancer, for example:
❝Compared with the placebo group, the nicotine group exhibited enhanced motor reaction times, grooved pegboard test (GPT) results on cognitive function, and baseball-hitting performance, and small effect sizes were noted (d = 0.47, 0.46 and 0.41, respectively).❞
Read in full: Acute Effects of Nicotine on Physiological Responses and Sport Performance in Healthy Baseball Players
However, another study found that its use as a cognitive enhancer was only of benefit when there was already a cognitive impairment:
❝Studies of the effects of nicotinic systems and/or nicotinic receptor stimulation in pathological disease states such as Alzheimer’s disease, Parkinson’s disease, attention deficit/hyperactivity disorder and schizophrenia show the potential for therapeutic utility of nicotinic drugs.
In contrast to studies in pathological states, studies of nicotine in normal-non-smokers tend to show deleterious effects.
This contradiction can be resolved by consideration of cognitive and biological baseline dependency differences between study populations in terms of the relationship of optimal cognitive performance to nicotinic receptor activity.
Although normal individuals are unlikely to show cognitive benefits after nicotinic stimulation except under extreme task conditions, individuals with a variety of disease states can benefit from nicotinic drugs❞
Read in full: Effects of nicotinic stimulation on cognitive performance
Bad news: its addictive qualities wipe out those benefits due to tolerance and thus normalization in short order. So you may get those benefits briefly, but then you’re addicted and also lose the benefits, as well as also ruining your health—making it a lose/lose/lose situation quite quickly.
As an aside, while nicotine is poisonous per se, in the quantities taken by most users, the nicotine itself is not usually what kills. It’s mostly the other stuff that comes with it (smoking is by far and away the worst of all; vaping is relatively less bad, but that’s not a strong statement in this case) that causes problems.
See also: Vaping: A Lot Of Hot Air?
However, this is still not an argument for, say, getting nicotine gum and thinking “no harmful effects” because then you’ll be get a brief performance boost yes before it runs out and being addicted to it and now being in a position whereby if you stop, your performance will be lower than before you started (since you now got used to it, and it became your new normal), before eventually recovering:
In summary
We recommend against using nicotine in the first place, and for those who are addicted, we recommend quitting immediately if not contraindicated (check with your doctor if unsure; there are some situations where it is inadvisable to take away something your body is dependent on, until you correct some other thing first).
For more on quitting in general, see:
Addiction Myths That Are Hard To Quit
Take care!
Don’t Forget…
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Pulse – by Jenny Chandler
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Beans, chickpeas, and lentils are well-established super-healthy foods, but they’re often not a lot of people’s favorite. And why? Usually because of unhappy associations with boring dishes that can barely be called dishes.
This book raises the bar for pulses of various kinds, and not only provides recipes (180 of them) but also guidelines on principles, tips and tricks, what works and what doesn’t, what makes things better or worse, perfect partners, sprouting, and more.
The recipes themselves are not all vegan, nor even all vegetarian, but the beans are the star throughout. For those who are vegan or vegetarian, it’s easy to make substitutions, not least of all because the author is generous with “try this instead of that” and “consider also” suggestions, to help us tailor each dish to our personal preferences, and even the desired vibe of a given meal.
The dishes are neither overly simplistic (it’s not a student survival cookbook, by any means) nor overly complicated; rather, enough is done to make each dish invitingly tasty, and nothing extraneous or pretentious is added for the sake of being fancy. This is about delicious home cooking, nothing more nor less.
If the book has a weakness, it’s that visual learners will feel the absence of pictures for many recipes. But, the text is clear, the instructions are easy to follow, and a photo for each dish would probably have doubled the cost of the book, at least, while halving the number of recipes.
Bottom line: if you’d like to get more beans and other pulses in your diet, but are unsure how to make it exciting, this is an excellent option.
Click here to check out Pulse, and expand your kitchen repertoire!
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