Bone on Bone – by Dr. Meredith Warner
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What this is not: a book about one specific condition, injury, or surgery.
What this is: a guide to dealing with the common factors of many musculoskeletal conditions, inflammatory diseases, and their consequences.
Dr. Warner takes the opportunity to address the whole patient—presumably: the reader, though it could equally be a reader’s loved one, or even a reader’s patient, insofar as this book will probably be read by doctors also.
She takes an “inside-out and outside-in” approach; that is to say, addressing the problem from as many vectors as reasonably possible—including supplements, diet, dietary habits (things like intermittent fasting etc), exercise, and even sleep. And yes, she knows how difficult those latter items can be, and addresses them not merely with a “but it’s important” but also with practical advice.
As an orthopedic surgeon, she’s not a fan of surgery, and counsels the reader to avoid that if reasonably possible. She also talks about how many people in the US are encouraged to have MRI scans for financial reasons (as in, they can be profitable for the doctor/institution), and then any abnormality is used as justification for surgery, to backwards-justify the use of the MRI, even if the abnormality is not actually the cause of the pain.
Noteworthily, humans in general are a typically a pile of abnormalities in a trenchcoat. Our propensity to mutation has made us one of the most adaptable species on the planet, yet many would have us pretend that the insides of people look like they do in textbooks, or else are wrong. The reality is not so, and Dr. Warner rightly shows this for what it is.
Bottom line: if you or a loved one are suffering from, or at risk of, musculoskeletal and/or inflammatory conditions, this is a top-tier book for having a much easier time of it.
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The Cancer Journey – by Dr. Chadi Nabhan
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After a brief introduction of what cancer actually is and what causes it, the layout of the rest of the book is in chronological order of patient experience, that is to say, what to expect during the journey from screening and diagnosis, to one’s first oncology visit (the author being an oncologist himself), how cancer staging works, getting second opinions, and a chapter-by-chapter review of many different treatment options, ranging from surgery and chemotherapy, to radiation and hormonal therapies, and even more modern targeted therapies, immunotherapy, cellular therapies, and yes, complementary and alternative therapies, amongst others we haven’t listed for the sake of brevity.
He doesn’t leave it there though; he also talks managing side effects, monitoring for recurrence, and even caring for the caregiver(s), along with eventual survivorship and that emotional journey, or if it comes down to it, palliative and hospice care.
Finishing on a hopeful note, he also brings attention to novel approaches that are being trialled presently, and the prospects for the near future of cancer care.
The style is very human and readable, notwithstanding that the author has hundreds of peer-reviewed publications to his name, the content here is presented in a much more approachable, less clinical way, while still conveying all the information that needs to be conveyed.
Bottom line: if you or a loved one is facing cancer, this book will be an invaluable resource.
Click here to check out The Cancer Journey, and understand each part of it!
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Walnuts vs Cashews – Which is Healthier?
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Our Verdict
When comparing walnuts to cashews, we picked the walnuts.
Why?
It was close! In terms of macros, walnuts have about 2x the fiber, while cashews have slightly more protein. In the specific category of fats, walnuts have more fat. Looking further into it: walnuts’ fats are mostly polyunsaturated, while cashews’ fats are mostly monounsaturated, both of which are considered healthy.
Notwithstanding being both high in calories, neither nut is associated with weight gain—largely because of their low glycemic indices (of which, walnuts enjoy the slightly lower GI, but both are low-GI foods)
When it comes to vitamins, walnuts have more of vitamins A, B2, B3 B6, B9, and C, while cashews have more of vitamins B1, B5, E, and K. Because of the variation in their respective margins of difference, this is at best a moderate victory for walnuts, though.
In the category of minerals, cashews get their day, as walnuts have more calcium and manganese, while cashews have more copper, iron, magnesium, phosphorus, potassium, selenium, and zinc.
In short: unless you’re allergic, we recommend enjoying both of these nuts (and others) for a full range of benefits. However, if you’re going to pick one, walnuts win the day.
Want to learn more?
You might like to read:
Why You Should Diversify Your Nuts
Take care!
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Military Secrets (Ssh!)
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Can you keep a secret?
When actor Christopher Lee was asked about his time as a British special forces operative, he would look furtively around, and ask “can you keep a secret?” Upon getting a yes, he would reply:
“So can I”
We can’t, though! We just can’t help sharing cool, useful information that changes people’s lives. Never is that more critical than now, as the end of January has been called the most depressing time of year, according to Dr. Cliff Arnall at the University of Cardiff. It doesn’t have to be all doom and gloom, though:
Today we’re going to share a trick… It’s called the “secret of eternal happiness” (yes, we know… we didn’t come up with the name!) and is taught to soldiers to fend off the worst kinds of despair.
The soldiers would be ordered to take a moment to reflect on the sheer helplessness of their situation, the ridiculous impossibility of the odds against them, all and any physical pain they might suffer, the weakness of their faltering body… and just when everything feels as bad is it can possibly feel, they’re told to say out loud—as sadly as possible—this single word:
“Boop”
It all but guarantees to result in cracking a smile, no matter the situation.
Now this knowledge is yours too! Keep it secret! Or don’t. Sharing is caring.
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Beating Sleep Apnea
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Healthier, Natural Sleep Without Obstruction!
Obstructive Sleep Apnea, the sleep disorder in which one periodically stops breathing (and thus wakes up) repeatedly through the night, affects about 25% of men and 10% of women:
Prevalence of Obstructive Sleep Apnea Syndrome: A Single-Center Retrospective Study
Why the gender split?
There are clues that suggest it is at least partially hormonal: once women have passed menopause, the gender split becomes equal.
Are there other risk factors?
There are few risk other factors; some we can’t control, and some we can:
- Being older is riskier than being younger
- Being overweight is riskier than not being overweight
- Smoking is (what a shock) riskier than not smoking
- Chronic respiratory diseases increase risk, for example:
- Asthma
- COPD
- Long COVID*—probably. The science is young for this one so far, so we can’t say for sure until more research has been done.
- Some hormonal conditions increase risk, for example:
- Hypothyroidism
- PCOS
*However, patients already undergoing Continuous Positive Airway Pressure (CPAP) treatment for obstructive sleep apnea may have an advantage when fighting a COVID infection:
What can we do about it?
Avoiding the above risk factors, where possible, is great!
If you are already suffering from obstructive sleep apnea, then you probably already know about the possibility of a CPAP device; it’s a mask that one wears to sleep, and it does what its name says (i.e. it applies continuous positive airway pressure), which keeps the airway open.
We haven’t tested these, but other people have, so here are some that the Sleep Foundation found to be worthy of note:
Sleep Foundation | Best CPAP Machines of 2024
What can we do about it that’s not CPAP?
Wearing a mask to sleep is not everyone’s preferred way to do things. There are also a plethora of surgeries available, but we’ll not review those, as those are best discussed with your doctor if necessary.
However, some lifestyle changes can help, including:
- Lose weight, if overweight. In particular, having a collar size under 16” for women or under 17” for men, is sufficient to significantly reduce the risk of obstructive sleep apnea.
- Stop smoking, if you smoke. This one, we hope, is self-explanatory.
- Stop drinking alcohol, or at least reduce intake, if you drink. People who consume alcohol tend to have more frequent, and longer, incidents of obstructive sleep apnea. See also: How To Reduce Or Quit Drinking
- Avoid sedatives and muscle relaxants, if it is safe for you to do so. Obviously, if you need them to treat some other condition you have, talk this through with your doctor. But basically, they can contribute to the “airway collapses on itself” by reducing the muscular tension that keeps your airway the shape it’s supposed to be.
- Sleep on your side, not your back. This is just plain physics, and a matter of wear the obstruction falls.
- Breathe through your nose, not through your mouth. Initially tricky to do while sleeping, but the more you practice it while awake, the more it becomes possible while asleep.
- Consider a nasal decongestant before sleep, if congestion is a problem for you, as that can help too.
For more of the science of these, see:
Cultivating Lifestyle Transformations in Obstructive Sleep Apnea
There are more medical options available not discussed here, too:
American Sleep Apnea Association | Sleep Apnea Treatment Options
Take care!
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Are You Taking PIMs?
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Getting Off The Overmedication Train
The older we get, the more likely we are to be on more medications. It’s easy to assume that this is because, much like the ailments they treat, we accumulate them over time. And superficially at least, that’s what happens.
And yet, almost half of people over 65 in Canada are taking “potentially inappropriate medications”, or PIMs—in other words, medications that are not needed and perhaps harmful. This categorization includes medications where the iatrogenic harms (side effects, risks) outweigh the benefits, and/or there’s a safer more effective medication available to do the job.
You may be wondering: what does this mean for the US?
Well, we don’t have the figures for the US because we’re working from Canadian research today, but given the differences between the two country’s healthcare systems (mostly socialized in Canada and mostly private in the US), it seems a fair hypothesis that if it’s almost half in Canada, it’s probably more than half in the US. Socialized healthcare systems are generally quite thrifty and seek to spend less on healthcare, while private healthcare systems are generally keen to upsell to new products/services.
The three top categories of PIMs according to the above study:
- Gabapentinoids (anticonvulsants also used to treat neuropathic pain)
- Proton pump inhibitors (PPIs)
- Antipsychotics (especially, to people without psychosis)
…but those are just the top of the list; there are many many more.
The list continues: opioids, anticholinergics, sulfonlyurea, NSAIDs, benzodiazepines and related rugs, and cholinesterase inhibitors. That’s where the Canadian study cuts off (although it also includes “others” just before NSAIDs), but still, you guessed it, there are more (we’re willing to bet statins weigh heavily in the “others” section, for a start).
There are two likely main causes of overmedication:
The side effect train
This is where a patient has a condition and is prescribed drug A, which has some undesired side effects, so the patient is prescribed drug B to treat those. However, that drug also has some unwanted side effects of its own, so the patient is prescribed drug C to treat those. And so on.
For a real-life rundown of how this can play out, check out the case study in:
The Hidden Complexities of Statins and Cardiovascular Disease (CVD)
The convenience factor
No, not convenient for you. Convenient for others. Convenient for the doctor if it gets you out of their office (socialized healthcare) or because it was easy to sell (private healthcare). Convenient for the staff in a hospital or other care facility.
This latter is what happens when, for example, a patient is being too much trouble, so the staff give them promazine “to help them settle down”, notwithstanding that promazine is, besides being a sedative, also an antipsychotic whose common side effects include amenorrhea, arrhythmias, constipation, drowsiness and dizziness, dry mouth, impotence, tiredness, galactorrhoea, gynecomastia, hyperglycemia, insomnia, hypotension, seizures, tremor, vomiting and weight gain.
This kind of thing (and worse) happens more often towards the end of a patient’s life; indeed, sometimes precipitating that end, whether you want it or not:
Mortality, Palliative Care, & Euthanasia
How to avoid it
Good practice is to be “open-mindedly skeptical” about any medication. By this we mean, don’t reject it out of hand, but do ask questions about it.
Ask your prescriber not only what it’s for and what it’ll do, but also what the side effects and risks are, and an important question that many people don’t think to ask, and for which doctors thus don’t often have a well-prepared smooth-selling reply, “what will happen if I don’t take this?”
And look up unbiased neutral information about it, from reliable sources (Drugs.com and The BNF are good reference guides for this—and if it’s important to you, check both, in case of any disagreement, as they function under completely different regulatory bodies, the former being American and the latter being British. So if they both agree, it’s surely accurate, according to best current science).
Also: when you are on a medication, keep a journal of your symptoms, as well as a log of your vitals (heart rate, blood pressure, weight, sleep etc) so you know what the medication seems to be helping or harming, and be sure to have a regular meds review with your doctor to check everything’s still right for you. And don’t be afraid to seek a second opinion if you still have doubts.
Want to know more?
For a more in-depth exploration than we have room for here, check out this book that we reviewed not long back:
To Medicate or Not? That is the Question! – by Dr. Asha Bohannon
Take care!
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These Top Few Things Make The Biggest Difference To Health
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The Best Few Interventions For The Best Health
Writer’s note: I was going to do something completely different for today (so that can go out another week now), but when reflecting on my own “what should I focus on in the new year?” (in terms of my own personal health goals and such) it occured to me that I should look back on the year’s articles, to take our own advice myself, and see what most important things I should make sure to focus on.
In so doing for myself, it occured to me that you, our subscribers who like condensed information and simple interventions for big positive effects, might also find value in a similar once-over. And so, today’s main feature was born!
Sometimes at 10almonds we talk about “those five things that affect everything”. They are:
- Good diet
- Good exercise
- Good sleep
- Not drinking
- Not smoking
If we were to add a sixth in terms of things that make a huge difference, it would be “manage stress effectively” and a seventh, beyond the scope of our newsletter, would be “don’t be socioeconomically disadvantaged” (e.g. poor, and/or part of some disprivileged minority group).
But as for those five we listed, it still leaves the question: what are the few most effective things we can do to improve them? Where can we invest our time/energy/effort for greatest effect?
Good diet
Best current science consistently recommends the Mediterranean Diet:
The Mediterranean Diet: What Is It Good For?
But it can be tweaked for specific desired health considerations:
Four Ways To Upgrade The Mediterranean Diet
Other most-effective dietary tweaks that impact a lot of other areas of health include looking after your gut health and looking after your blood sugars:
Making Friends With Your Gut (You Can Thank Us Later)
and
“Let Them Eat Cake”, She Said (10 Ways To Balance Blood Sugars)
Good exercise
Most exercise is good, but two of the most beneficial things that are (for most people) easy to implement are walking, and High-Intensity Interval Training:
How To Do HIIT (Without Wrecking Your Body)
Good sleep
This means quality and quantity! We cannot skimp on either and expect good health:
Why You Probably Need More Sleep
and as for quality,
The Head-To-Head Of Google and Apple’s Top Apps For Getting Your Head Down
Not drinking
According to the World Health Organization, the only safe amount of alcohol is zero.
See also:
Can We Drink To Good Health? (e.g. Red Wine & Heart Health)
and
Not smoking
We haven’t done a main feature on this! It’s probably not really necessary, as it’s not very contentious to say “smoking is bad for everything”.
WHO | Tobacco kills up to half its users who don’t quit
However, as a side-note, while cannabis is generally recognised as not as harmful as tobacco-based products, it has some fairly major drawbacks too. For some people, the benefits (e.g. pain relief) may outweigh the risks, though:
Final thoughts
Not sure where to start? We suggest this order of priorities, unless you have a major health condition that makes something else a higher priority:
- If you smoke, stop
- If you drink, reduce, or ideally stop
- Improve your diet
About that diet…
- Worry less about what to exclude, and instead focus on adding more variety of fruit/veg
- See also: Level-Up Your Fiber Intake! (Without Difficulty Or Discomfort)
- That said, if you’re looking for things to cut, sugar is a top candidate (and red meat is in clear second place albeit some way below)
When it comes to exercise, get your 10,000 daily steps in (actually, science says 8,000 steps is fine), and consider adding HIIT per our above article, when you feel like adding that in. As for that about the steps:
When it comes to sleep, if you’re taking care of the above things then this will probably take care of itself, if you don’t have a sleep-inconvenient lifestyle (e.g. shift work, just had a baby, etc) or a sleep disorder.
Take care!
Don’t Forget…
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