Being Mortal – by Dr. Atul Gawande

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Maybe you want to “live forever or die trying”, and that’s an understandable goal… But are you prepared for “or die trying” being the outcome?

This is not a cheerful book, if you’re anything like this reviewer, you will need a little towel or something to mop up the tears while you read. But it’s worth it.

Dying is one thing; fighting for life is even generally considered a noble endeavor. Suffering alone isn’t fun, losing independence can feel humiliating, and seeing someone who was always a tower of strength, now a frail shadow of their former self, reduced to begging for something that they’re “not allowed”, can be worse.

Do we want that for ourselves? For our loved ones? Can there be a happy medium between that, and the alternative to indeed “go gentle into that good night”?

Dr. Gawande, a surgeon well-acquainted with death and dying, thinks so. But it involves work on our part, and being prepared for hard decisions.

  • What is most important to us, and what tradeoffs are we willing to make for it?
  • What, even, is actually an option to us with the resources available?
  • Can we make peace with a potentially bad lot? And… Should we?
  • When is fighting important, and when is it self-destructive?

These (and others) are all difficult questions posed by Dr. Gawande, but critical ones.

We don’t usually quote other people’s reviews when reviewing books here, but let’s consider the following words from the end of a long review on Amazon:

❝If “dying as we lived” is some kind of standard for how we should go, then maybe alone and medicalized makes some sense right now after all.❞

~ Pamela J. H.

Bottom line: we all deserve better than that. And if we don’t take the time to think about what’s most important, then time will take it from us. This very insightful book may not have all the answers, but it has the questions, and it can help a lot in exploring them and deciding what matters most to us in the end, really.

Click here to check out Being Mortal, and make every day count—because nothing matters more than that.

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  • How to Prepare for Your First Therapy Session

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    Everyone (who ever has therapy, anyway) has a first therapy session. So, how to make best use of that, and get things going most effectively? Dr. Tori Olds has advice:

    Things to prepare

    Questions that you should consider, and prepare answers to beforehand, include:

    • Why are you here? Not in any deep philosophical sense, but, what brought you to therapy?
    • What would you like to focus on? Chances are, you are paying a hefty hourly rate—so having considered this will allow you to get your money’s worth.
    • How will you know when you’ve met your goal? Note that this is really two questions in one, because first you need to identify your goal, and then you need to expand on it. If you woke up tomorrow and all your psychological problems were solved, how would you know? What would be different? What does it look like?

    If you have a little time between now and your first session, journaling can help a lot.

    Remember also that a first therapy session can also be like a mutual interview, to decide whether it’s a good match. Not every therapist is good at their job, and not every therapist will be good for you specifically. Sometimes, a therapist may be a mismatch through no fault of their own. Considering what those reasons might be can also be a good thing to think about in advance, to help find the best therapist for you in fewer tries!

    For most on these ideas, enjoy:

    Click Here If The Embedded Video Doesn’t Load Automatically!

    Want to learn more?

    You might also like to read:

    Take care!

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  • Does Your Butt…Wink?

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    What is a Butt Wink?

    A “butt wink” is a common issue that occurs during squatting exercises.

    Now, we’ve talked about the benefits of squatting countless times (see here or here for just a few examples). As with all exercises, using the correct technique is imperative, helping to both reduce injury and maximize gain.

    Given butt winks are a common issue when squatting, we thought it natural to devote an article to it.

    So, a butt wink happens when, at the bottom of your squat position, your pelvis tucks rotates backward (otherwise known as a “posterior pelvic tilt”) and the lower back rounds. This motion looks like a slight ‘wink’, hence the name.

    How to Avoid Butt Winking

    When the pelvis tucks under and the spine rounds, it can put undue pressure on the lumbar discs. This is especially risky when squatting with weights, as it can exacerbate the stress on the spine.

    To avoid a butt wink, it’s important to maintain a neutral spine throughout the squat and to work on flexibility and strength in the hips, glutes, and hamstrings. Adjusting the stance width or foot angle during squats can also help in maintaining proper form.

    A visual representation would likely work better than our attempt at describing what to do, so without further ado, here’s today’s video:

    How was the video? If you’ve discovered any great videos yourself that you’d like to share with fellow 10almonds readers, then please do email them to us!

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  • How often should you really weigh yourself?

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    Few topics are more debated in health than the value of the humble bathroom scale. Some experts advocate daily self-weigh-ins to promote accountability for weight management, particularly when we’re following a diet and exercise program to lose weight.

    Others suggest ditching self-weigh-ins altogether, arguing they can trigger negative psychological responses and unhealthy behaviours when we don’t like, or understand, the number we see on the scale.

    Many, like me, recommend using scales to weigh yourself weekly, even when we’re not trying to lose weight. Here’s why.

    Diva Plavalaguna/Pexels

    1. Weighing weekly helps you manage your weight

    Research confirms regular self-weighing is an effective weight loss and management strategy, primarily because it helps increase awareness of our current weight and any changes.

    A systematic review of 12 studies found participants who weighed themselves weekly or daily over several months lost 1–3 BMI (body mass index) units more and regained less weight than participants who didn’t weight themselves frequently. The weight-loss benefit was evident with weekly weighing; there was no added benefit with daily weighing.

    Two people cross the road
    Weighing regularly means we know when our weight changes. Andres Ayrton/Pexels

    Self-weigh-ins are an essential tool for weight management as we age. Adults tend to gain weight progressively through middle age. While the average weight gain is typically between 0.5–1kg per year, this modest accumulation of weight can lead to obesity over time. Weekly weighing and keeping track of the results helps avoid unnecessary weight gain.

    Tracking our weight can also help identify medical issues early. Dramatic changes in weight can be an early sign of some conditions, including problems with our thyroid, digestion and diabetes.

    2. Weekly weighing accounts for normal fluctuations

    Our body weight can fluctuate within a single day and across the days of the week. Studies show body weight fluctuates by 0.35% within the week and it’s typically higher after the weekend.

    Daily and day-to-day body weight fluctuations have several causes, many linked to our body’s water content. The more common causes include:

    The type of food we’ve consumed

    When we’ve eaten a dinner higher in carbohydrates, we’ll weigh more the next day. This change is a result of our bodies temporarily carrying more water. We retain 3–4 grams of water per gram of carbohydrate consumed to store the energy we take from carbs.

    Our water content also increases when we consume foods higher in salt. Our bodies try to maintain a balance of sodium and water. When the concentration of salt in our bloodstream increases, a mechanism is triggered to restore balance by retaining water to dilute the excess salt.

    Bowl of pasta
    The morning after a big pasta dinner, we’ll carry more water weight. Dana Tentis/Pexels

    Our food intake

    Whether it’s 30 grams of nuts or 65 grams of lean meat, everything we eat and drink has weight, which increases our body weight temporarily while we digest and metabolise what we’ve consumed.

    Our weight also tends to be lower first thing in the morning after our food intake has been restricted overnight and higher in the evening after our daily intake of food and drinks.

    Exercise

    If we weigh ourselves at the gym after a workout, there’s a good chance we’ll weigh less due to sweat-induced fluid loss. The amount of water lost varies depending on things like our workout intensity and duration, the temperature and humidity, along with our sweat rate and hydration level. On average, we lose 1 litre of sweat during an hour of moderate-intensity exercise.

    Hormonal changes

    Fluctuations in hormones within your menstrual cycle can also affect fluid balance. Women may experience fluid retention and temporarily gain 0.5–2kg of weight at this time. Specifically, the luteal phase, which represents the second half of a woman’s cycle, results in a shift of fluid from your blood plasma to your cells, and bloating.

    Glass of water
    Most of our weight fluctuations are water-related. Engin Akyurt/Unsplash

    Bowel movements

    Going to the bathroom can lead to small but immediate weight loss as waste is eliminated from the body. While the amount lost will vary, we generally eliminate around 100 grams of weight through our daily bowel movements.

    All of these fluctuations are normal, and they’re not indicative of significant changes in our body fat or muscle mass. However, seeing these fluctuations can lead to unnecessary stress and a fixation with our weight.

    3. Weekly weighing avoids scale obsession and weight-loss sabotage

    Weighing too frequently can create an obsession with the number on the scales and do more harm than good.

    Often, our reaction when we see this number not moving in the direction we want or expect is to further restrict our food intake or embark on fad dieting. Along with not being enjoyable or sustainable, fad diets also ultimately increase our weight gain rather than reversing it.

    This was confirmed in a long-term study comparing intentional weight loss among more than 4,000 twins. The researchers found the likelihood of becoming overweight by the age of 25 was significantly greater for a twin who dieted to lose 5kg or more. This suggests frequent dieting makes us more susceptible to weight gain and prone to future weight gain.

    So what should you do?

    Weighing ourselves weekly gives a more accurate measure of our weight trends over time.

    Aim to weigh yourself on the same day, at the same time and in the same environment each week – for example, first thing every Friday morning when you’re getting ready to take a shower, after you’ve gone to the bathroom, but before you’ve drunk or eaten anything.

    Man weighs himself
    Weigh yourself at the same time on the same day of the week. Alexanderstock23/Shutterstock

    Use the best quality scales you can afford. Change the batteries regularly and check their accuracy by using a “known” weight – for example, a 10kg weight plate. Place the “known” weight on the scale and check the measurement aligns with the “known” weight.

    Remember, the number on the scale is just one part of health and weight management. Focusing solely on it can overshadow other indicators, such as how your clothes fit. It’s also essential to pay equal attention to how we’re feeling, physically and emotionally.

    Stop weighing yourself – at any time interval – if it’s triggering anxiety or stress, and get in touch with a health-care professional to discuss this.

    At the Boden Group, Charles Perkins Centre, we are studying the science of obesity and running clinical trials for weight loss. You can register here to express your interest.

    Nick Fuller, Charles Perkins Centre Research Program Leader, University of Sydney

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

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Related Posts

  • Do You Believe In Magic? – by Dr. Paul Offit
  • The CBT Workbook for Mental Health – by Dr. Simon Rego & Sarah Fader

    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 have often reviewed psychology books here with a note saying “and no, it’s not just a book of the standard CBT techniques that you probably already know”.

    So today, this one’s for anyone who was ever thinking “but I don’t know the standard CBT techniques and I would like to know them!”.

    The authors outline specific solutions to many common quantifiable problems, with simple exercises that are well-explained and easy to implement.

    Cognitive Behavioral Therapy (CBT) is not a panacea, but for the things it can be used for, it’s very effective and is a very good “first thing to reach for” to see if it works, because its success rate for a lot of problems is very high.

    What kinds of things is this book most likely to help with? A lot of common forms of stress, anxiety, self-esteem issues, cravings, shame, and relationship issues. Other things too, but we can’t list everything and that list already covers a lot of very high-incidence stuff.

    Bottom line: if CBT isn’t something already in your toolbox, this book will help you add all its best tips and tricks.

    Click here to check out The CBT Workbook for Mental Health, and get tooled up!

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  • Falling: Is It Due To Age Or Health Issues?

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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 😎

    ❝What are the signs that a senior is falling due to health issues rather than just aging?❞

    Superficial answer: having an ear infection can result in a loss of balance, and is not particularly tied to age as a risk factor

    More useful answer: first, let’s consider these two true statements:

    • The risks of falling (both the probability and the severity of consequences) increase with age
    • Health issues (in general) tend to increase with age

    With this in mind, it’s difficult to disconnect the two, as neither exist in a vacuum, and each is strongly associated with the other.

    So the question is easier to answer by first flipping it, to ask:

    ❝What are the health issues that typically increase with age, that increase the chances of falling?❞

    A non-exhaustive list includes:

    • Loss of strength due to sarcopenia (reduced muscle mass)
    • Loss of mobility due to increased stiffness (many causes, most of which worsen with age)
    • Loss of risk-awareness due to diminished senses (for example, not seeing an obstacle until too late)
    • Loss of risk-awareness due to reduced mental focus (cognitive decline producing absent-mindedness)

    Note that in the last example there, and to a lesser extent the third one, reminds us that falls also often do not happen in a vacuum. There is (despite how it may sometimes feel!) no actual change in our physical relationship with gravity as we get older; most falls are about falling over things, even if it’s just one’s own feet:

    The 4 Bad Habits That Cause The Most Falls While Walking

    Disclaimer: sometimes a person may just fall down for no external reason. An example of why this may happen is if a person’s joint (for example an ankle or a knee) has a particular weakness that means it’ll occasionally just buckle and collapse under one’s own weight. This doesn’t even have to be a lot of weight! The weakness could be due to an old injury, or Ehlers-Danlos Syndrome (with its characteristic joint hypermobility symptoms), or something else entirely.

    Now, notice how:

    • all of these things can happen at any age
    • all of these things are more likely to happen the older we get
    • none of these things have to happen at any age

    That last one’s important to remember! Aging is often viewed as an implacable Behemoth, but the truth is that it is many-faceted and every single one of those facets can be countered, to a greater or lesser degree.

    Think of a room full of 80-year-olds, and now imagine that…

    • One has the hearing of a 20-year-old
    • One has the eyesight of a 20-year-old
    • One has the sharp quick mind of a 20-year-old
    • One has the cardiovascular fitness of a 20-year-old

    …etc. Now, none of those things in isolation is unthinkable, so remember, there is no magic law of the universe saying we can’t have each of them:

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

    Which means: that goes for the things that increase the risk of falling, too. In other words, we can combat sarcopenia with protein and resistance training, maintain our mobility, look after our sensory organs as best we can, nourish our brain and keep it sharp, etc etc etc:

    Train For The Event Of Your Life! (Mobility As A Long-Term “Athletic” Goal For Personal Safety)

    Which doesn’t mean: that we will necessarily succeed in all areas. Your writer here, broadly in excellent health, and whose lower body is still a veritable powerhouse in athletic terms, has a right ankle and left knee that will sometimes just buckle (yay, the aforementioned hypermobility).

    So, it becomes a priority to pre-empt the consequences of that, for example:

    • being able to fall with minimal impact (this is a matter of knowing how, and can be learned from “soft” martial arts such as aikido), and
    • ensuring the skeleton can take a knock if necessary (keeping a good balance of vitamins, minerals, protein, etc; keeping an eye on bone density).

    See also:

    Fall Special ← appropriate for the coming season, but it’s about avoiding falling, and reducing the damage of falling if one does fall, including some exercises to try at home.

    Take care!

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  • Sea Salt vs MSG – Which is Healthier?

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    Our Verdict

    When comparing sea salt to MSG, we picked the MSG.

    Why?

    Surprise! Or maybe not? The results of the poll for this one should be interesting, and will help us know whether we need to keep mentioning in every second recipe that MSG is a healthier alternative to salt.

    First of all, two things:

    • Don’t be fooled by their respective names, and/or with such, an appeal to naturalism. For example, hydroxybenzoic acids are a major group of beneficial phenolic compounds, whereas hemlock is a wildflower that grows in this writer’s garden and will kill you if you eat it. Actually hydroxybenzoic acids also grow here (on the apple tree), but that’s not the point. The point is: worry less about names, and more about evidence!
    • Don’t be fooled by the packaging. A lot of products go for “greenwashing” of one kind or another. You’re not eating the packaging (hopefully), so don’t be swayed by a graphic designer’s implementation of a marketing team’s aesthetic choices.

    If naturalism is for some reason very important to you though, do bear in mind that glutamates occur generously in many common foodstuffs (tomatoes are a fine, healthy example) and eating tomato in the presence of salt will have the same biochemical effect as eating MSG, because it’s the same chemicals.

    Since there are bad rumors about MSG’s safety, especially in the US where there is often a strong distrust of anything associated with China (actually MSG was first isolated in Japan, more than 100 years ago, by Japanese biochemist Dr. Kikunae Ikeda, but that gets drowned out by the “Chinese Restaurant Syndrome” fear in the US), know that this has resulted in MSG being one of the most-studied food additives in the last 40 years or so, with many teams of scientists trying to determine its risks and not finding any (aside from the same that could be said of any substance; anything in sufficient excess will kill you, including water or oxygen).

    Well, that’s all been about safety, but what makes it healthier than sea salt?

    Simply, it has about ⅓ of the sodium content, that’s all. So, if you are laboring all day in a field under the hot summer sun, then probably the sea salt will be healthier, to replenish more of the sodium you lost through sweat. But for most people most of the time, having less sodium rather than more is the healthier option.

    Want to learn more?

    You might like to read:

    Take care!

    Don’t Forget…

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