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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I’m feeling run down. Why am I more likely to get sick? And how can I boost my immune system?
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It has been a long winter, filled with many viruses and cost-of-living pressures, on top of the usual mix of work, study, life admin and caring responsibilities.
Stress is an inevitable part of life. In short bursts, our stress response has evolved as a survival mechanism to help us be more alert in fight or flight situations.
But when stress is chronic, it weakens the immune system and makes us more vulnerable to illnesses such as the common cold, flu and COVID.
Pexels/Ketut Subiyanto Stress makes it harder to fight off viruses
When the immune system starts to break down, a virus that would normally have been under control starts to flourish.
Once you begin to feel sick, the stress response rises, making it harder for the immune system to fight off the disease. You may be sick more often and for longer periods of time, without enough immune cells primed and ready to fight.
In the 1990s, American psychology professor Sheldon Cohen and his colleagues conducted a number of studies where healthy people were exposed to an upper respiratory infection, through drops of virus placed directly into their nose.
These participants were then quarantined in a hotel and monitored closely to determine who became ill.
One of the most important factors predicting who got sick was prolonged psychological stress.
Cortisol suppresses immunity
“Short-term stress” is stress that lasts for a period of minutes to hours, while “chronic stress” persists for several hours per day for weeks or months.
When faced with a perceived threat, psychological or physical, the hypothalamus region of the brain sets off an alarm system. This signals the release of a surge of hormones, including adrenaline and cortisol.
The hypothalamus sets off an alarm system in response to a real or perceived threat. stefan3andrei/Shutterstock In a typical stress response, cortisol levels quickly increase when stress occurs, and then rapidly drop back to normal once the stress has subsided. In the short term, cortisol suppresses inflammation, to ensure the body has enough energy available to respond to an immediate threat.
But in the longer term, chronic stress can be harmful. A Harvard University study from 2022 showed that people suffering from psychological distress in the lead up to their COVID infection had a greater chance of experiencing long COVID. They classified this distress as depression, probable anxiety, perceived stress, worry about COVID and loneliness.
Those suffering distress had close to a 50% greater risk of long COVID compared to other participants. Cortisol has been shown to be high in the most severe cases of COVID.
Stress causes inflammation
Inflammation is a short-term reaction to an injury or infection. It is responsible for trafficking immune cells in your body so the right cells are present in the right locations at the right times and at the right levels.
The immune cells also store a memory of that threat to respond faster and more effectively the next time.
Initially, circulating immune cells detect and flock to the site of infection. Messenger proteins, known as pro-inflammatory cytokines, are released by immune cells, to signal the danger and recruit help, and our immune system responds to neutralise the threat.
During this response to the infection, if the immune system produces too much of these inflammatory chemicals, it can trigger symptoms such as nasal congestion and runny nose.
Our immune response can trigger symptoms such as a runny nose. Alyona Mandrik/Shutterstock What about chronic stress?
Chronic stress causes persistently high cortisol secretion, which remains high even in the absence of an immediate stressor.
The immune system becomes desensitised and unresponsive to this cortisol suppression, increasing low-grade “silent” inflammation and the production of pro-inflammatory cytokines (the messenger proteins).
Immune cells become exhausted and start to malfunction. The body loses the ability to turn down the inflammatory response.
Over time, the immune system changes the way it responds by reprogramming to a “low surveillance mode”. The immune system misses early opportunities to destroy threats, and the process of recovery can take longer.
So how can you manage your stress?
We can actively strengthen our immunity and natural defences by managing our stress levels. Rather than letting stress build up, try to address it early and frequently by:
1) Getting enough sleep
Getting enough sleep reduces cortisol levels and inflammation. During sleep, the immune system releases cytokines, which help fight infections and inflammation.
2) Taking regular exercise
Exercising helps the lymphatic system (which balances bodily fluids as part of the immune system) circulate and allows immune cells to monitor for threats, while sweating flushes toxins. Physical activity also lowers stress hormone levels through the release of positive brain signals.
3) Eating a healthy diet
Ensuring your diet contains enough nutrients – such as the B vitamins, and the full breadth of minerals like magnesium, iron and zinc – during times of stress has a positive impact on overall stress levels. Staying hydrated helps the body to flush out toxins.
4) Socialising and practising meditation or mindfulness
These activities increase endorphins and serotonin, which improve mood and have anti-inflammatory effects. Breathing exercises and meditation stimulate the parasympathetic nervous system, which calms down our stress responses so we can “reset” and reduce cortisol levels.
Sathana Dushyanthen, Academic Specialist & Lecturer in Cancer Sciences & Digital Health| Superstar of STEM| Science Communicator, The University of Melbourne
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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The Best Form Of Sugar During Exercise
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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 is the best form of sugar for an energy kick during exercise? Both type of sugar eg glicoae fructose dextrose etc and medium, ie drink, gel, solids etc❞
Great question! Let’s be clear first that we’re going to answer this specifically for the context of during exercise.
Because, if you’re not actively exercising strenuously right at the time when you’re taking the various things we’re going to be talking about, the results will not be the same.
For scenarios that are anything less than “I am exercising right now and my muscles (not joints, or anything else) are feeling the burn”, then instead please see this:
Snacks & Hacks: Eating For Energy (In Ways That Actually Work)
Because, to answer your question, we’re going to be going 100% against the first piece of advice in that article, which was “Skip the quasi-injectables”, i.e., anything marketed as very quick release. Those things are useful for diabetics to have handy just in case of needing to urgently correct a hypo, but for most people most of the time, they’re not. See also:
Which Sugars Are Healthier, And Which Are Just The Same?
However…
When strenuously exercising in a way that is taxing our muscles, we do not have to worry about the usual problem of messing up our glucose metabolism by overloading our body with sugars faster than it can use it (thus: it has to hurriedly convert glucose and shove it anywhere it’ll fit to put it away, which is very bad for us), because right now, in the exercise scenario we’re describing, the body is already running its fastest metabolism and is grabbing glucose anywhere it can find it.
Which brings us to our first key: the best type of sugar for this purpose is glucose. Because:
- glucose: the body can use immediately and easily convert whatever’s spare to glycogen (a polysaccharide of glucose) for storage
- fructose: the body cannot use immediately and any conversion of fructose to glycogen has to happen in the liver, so if you take too much fructose (without anything to slow it down, such as the fiber in whole fruit), you’re not only not going to get usable energy (the sugar is just going to be there in your bloodstream, circulating, not getting used, because it doesn’t trigger insulin release and insulin is the gatekeeper that allows sugar to be used), but also, it’s going to tax the liver, which if done to excess, is how we get non-alcoholic fatty liver disease.
- sucrose: is just a disaccharide of glucose and fructose, so it first gets broken down into those, and then its constituent parts get processed as above. Other disaccharides you’ll see mentioned sometimes are maltose and lactose, but again, they’re just an extra step removed from useful metabolism, so to save space, we’ll leave it at that for those today.
- dextrose: is just glucose, but when the labeller is feeling fancy. It’s technically informational because it specifies what isomer of glucose it is, but basically all glucose found in food is d-glucose, i.e. dextrose. Other isomers of glucose can be synthesized (very expensively) in laboratories or potentially found in obscure places (the universe is vast and weird), but in short: unless someone’s going to extreme lengths to get something else, all glucose we encounter is dextrose, and all (absolutely all) dextrose is glucose.
We’d like to show scientific papers contesting these head-to-head for empirical proof, but since the above is basic chemistry and physiology, all we could find is papers taking this for granted and stating in their initial premise that sports drinks, gels, bars usually contain glucose as their main sugar, potentially with some fructose and sucrose. Like this one:
A Comprehensive Study on Sports and Energy Drinks
As for how to take it, again this is the complete opposite of our usual health advice of “don’t drink your calories”, because in this case, for once…
(and again, we must emphasize: only while actively doing strenuous exercise that is making specifically your muscles burn, not your joints or anything else; if your joints are burning you need to rest and definitely don’t spike your blood sugars because that will worsen inflammation)
…just this once, we do want those sugars to be zipping straight into the blood. Which means: liquid is best for this purpose.
And when we say liquid: gel is the same as a drink, so far as the body is concerned, provided the body in question is adequately hydrated (i.e., you are also drinking water).
Here are a pair of studies (by the same team, with the same general methodology), testing things head-to-head, with endurance cyclists on 6-hour stationary cycle rides:
CHO Oxidation from a CHO Gel Compared with a Drink during Exercise
Meanwhile, liquid beat solid, but only significantly so from the 90-minute mark onwards, and even that significant difference was modest (i.e. it’s clinically significant, it’s a statistically reliable result and improbable as random happenstance, but the actual size of the difference was not huge):
Oxidation of Solid versus Liquid CHO Sources during Exercise
We would hypothesize that the reason that liquids only barely outperformed solids for this task is precisely because the solids in question were also designed for the task. When a company makes a fast-release energy bar, they don’t load it with fiber to slow it down. Which differentiates this greatly from, say, getting one’s sugars from whole fruit.
If the study had compared apples to apple juice, we hypothesize the results would have been very different. But alas, if that study has been done, we couldn’t find it.
Today has been all about what’s best during exercise, so let’s quickly finish with a note on what’s best before and after:
Before: What To Eat, Take, And Do Before A Workout
After: Overdone It? How To Speed Up Recovery After Exercise
Take care!
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The How Not to Die Cookbook – by Dr. Michael Greger
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We’ve previously reviewed Dr. Greger’s “How Not To Die”, which is excellent and/but very science-dense.
This book is different, in that the science is referenced and explained throughout, but the focus is the recipes, and how to prepare delicious healthy food in accordance with the principles laid out in How Not To Die.
It also follows “Dr Greger’s Daily Dozen“, that is to say, the 12 specific things he advises we make sure to have every day, and thus helps us to include them in an easy, no-fuss fashion.
The recipes themselves are by Robin Robertson, and/but with plenty of notes by Dr Greger; they clearly collaborated closely in creating them.
The ingredients are all things one can find in any well-stocked supermarket, so unless you live in a food desert, you can make these things easily.
And yes, the foods are delicious too.
Bottom line: if you’re interested in cooking according to perhaps the most science-based dietary system out there, then this book is a top-tier choice.
Click here to check out The How Not To Die Cookbook, and live well!
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How an Idaho vaccine advocacy org plans its annual goals
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The start of a new year means many nonprofits and community health workers are busy setting goals and reflecting on what’s worked and what hasn’t. For those engaged in vaccine outreach, it also means reflecting on the tools and tactics that help them communicate better with their communities about why vaccines matter.
Across the country, childhood vaccination rates have declined since the COVID-19 pandemic, resulting in a resurgence of preventable diseases like pertussis.
Also known as whooping cough, pertussis has surged in states like Idaho, said Karen Jachimowski Sharpnack, executive director of the Idaho Immunization Coalition, in a conversation with PGN about the organization’s 2025 priorities.
Sharpnack shared how spikes in infectious respiratory illnesses can create opportunities to listen better and understand the nuances of the communities they serve.
Here’s more of what Sharpnack said.
[Editor’s note: The contents of this interview have been edited for length and clarity.]
PGN: Whooping cough cases are up in your state. Can you share an example of how your organization is responding?
Karen Jachimowski Sharpnack: If you look at Treasure Valley and Northern Idaho, the majority of those cases have been reported, and it’s like five times as much as we had the previous year.
So, two things that the Coalition is doing in response: First, we put out radio public service announcements throughout those particular areas about what whooping cough is, how contagious it is, and what you should do if you think your child or anyone you know has it.
Second, we are contacting every school superintendent, principal, school nurse, with a letter from us at the Coalition [to warn about] the whooping cough outbreaks in schools right now. Here’s what the symptoms are, here’s what you can do, and then here’s how you can protect yourself and your families.
It doesn’t mean the health district wouldn’t do it, or the Department of Health and Welfare can’t do it. But from our standpoint, at least we are bringing an awareness to the schools that this is happening.
PGN: How does your organization decide when outreach is needed? How do you take a pulse of your communities’ vaccine attitudes?
K.J.S.: We consistently hold listening sessions. We do them in English and Spanish if we need to, and we go around—and I’m talking about the southern part of the state—and bring people together.
We’ve done adults, we’ve done teenagers, we’ve done college students, we’ve done seniors, we’ve done all age groups.
So, we’ll bring eight or 10 people together, and we’ll spend a couple of hours with them. We feed them and we also pay them to be there. We say, ‘We want to hear from you about what you’re hearing about vaccines, what your views are if you’re vaccinated.’ Anytime, by the way, they can get up and leave and still get paid.
We want to hear what they’re hearing on the ground. And these sessions are extremely informational. For one, we learn about the misinformation that goes out there, like immediately. And two, we’re able to then focus [on how to respond]. If we’re hearing this, what kind of media campaign do we need to get together?
PGN: How do these listening sessions inform your work?
K.J.S.: So, a couple times a year we also pay a professional poller to do a poll. And when we get those results we check them against our listening sessions. We want to see: Are we on target? Are we ahead?
We just finished putting a one-pager together for legislators, so we’re ready to go with the new [legislative] session. We do this poll every year in August-September to know how Idahoans are feeling about vaccines. We get the results in October, because we’re getting ready for the next year.
We actually poll 19-to-64-year-olds, really honing in on questions like, ‘Do you believe vaccines are safe and effective?’ ‘Do you believe that school vaccination rules should still be in place?’
And what’s pretty cool is that two-thirds of Idahoans still believe vaccines are safe and effective, want to keep school rules in place, and believe that the infrastructure systems that we have in place for our vaccine registry should remain the same. Those are important to hear, so this is really good information that we can pull out and do something with.
PGN: Like what?
K.J.S.: Here’s the bottom line. It takes money to do this work, so you have to be able to say what you are going to do with the results.
Doing a poll costs anywhere from $15,000 to $35,000. This is an expensive investment, but we know that the polling is so important to us, along with the time that I have my staff go out and do the listening sessions and get feedback.
We take those results to educate, to talk to our legislators, and advocate for vaccines. We actually do these high-level media campaigns around the state. So, we are actually doing something with the polling. We’re not just sharing the results out.
And then we actually ask, what can we do to make a change? What are we hearing that we need to focus on?
That’s why it’s really important, because we are actually pushing this out for 2025. We know where we’re going in 2025 programmatically with marketing, and we know where we’re going with advocacy work.
We’re not guessing. We’re actually listening to people. And then we’re making really concrete decisions on how we’re going to move the organization forward to be able to help our communities.
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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Grapefruit vs Lemon – Which is Healthier?
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Our Verdict
When comparing grapefruit to lemon, we picked the lemon.
Why?
Grapefruit has its merits, but in the battle of the citrus fruits, lemons come out on top nutritionally:
In terms of macros, grapefruit has more carbs while lemons have more fiber. So, while both have a low glycemic index, lemon is still the winner by the numbers.
Looking at the vitamins, here we say grapefruit’s strengths: grapefruit has more of vitamins A, B2, B3, and choline, while lemon has more of vitamins B6 and C. So, a 4:2 win for grapefruit here.
In the category of minerals, lemons retake the lead: grapefruit has more zinc, while lemon has more calcium, copper, iron, manganese, and selenium.
One final consideration that’s not shown in the nutritional values, is that grapefruit contains high levels of furanocoumarin, which can inhibit cytochrome P-450 3A4 isoenzyme and P-glycoptrotein transporters in the intestine and liver—slowing down their drug metabolism capabilities, thus effectively increasing the bioavailability of many drugs manifold.
This may sound superficially like a good thing (improving bioavailability of things we want), but in practice it means that in the case of many drugs, if you take them with (or near in time to) grapefruit or grapefruit juice, then congratulations, you just took an overdose. This happens with a lot of meds for blood pressure, cholesterol (including statins), calcium channel-blockers, anti-depressants, benzo-family drugs, beta-blockers, and more. Oh, and Viagra, too. Which latter might sound funny, but remember, Viagra’s mechanism of action is blood pressure modulation, and that is not something you want to mess around with unduly. So, do check with your pharmacist to know if you’re on any meds that would be affected by grapefruit or grapefruit juice!
PS: the same substance is quite available in pummelos and sour oranges (but not meaningfully in sweet oranges); you can see a chart here showing the relative furanocoumarin contents of many citrus fruits, or lack thereof as the case may be, as it is for lemons and most limes)
Adding up the sections gives us a clear win for lemons, but by all means enjoy either or both; just watch out for that furanocoumarin content of grapefruit if you’re on any meds affected by such (again, do check with your pharmacist, as our list was far from exhaustive—and yes, this question is one that a pharmacist will answer more easily and accurately than a doctor will).
Want to learn more?
You might like to read:
Top 8 Fruits That Prevent & Kill Cancer ← citrus fruits in general make the list; they inhibit tumor growth and kill cancer cells; regular consumption is also associated with a lower cancer risk 🙂
Enjoy!
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Gut-Healthy Labneh Orecchiette
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Labneh (a sort of yogurt-cheese made from strained yogurt) is a great probiotic, and there’s plenty of resistant starch in this dish too, from how we cook, cool, and reheat the pasta. Add to this the lycopene from the tomatoes, the ergothioneine from the mushrooms, and the healthful properties of the garlic, black pepper, and red chili, and we have a very healthy dish!
You will need
- 10 oz labneh (if you can’t buy it locally, you can make your own by straining Greek yogurt through a muslin cloth, suspended over a bowl to catch the water that drips out, overnight—and yes, plant-based is also fine if you are vegan, and the gut benefits are similar because unlike vegan cheese, vegan yogurt is still fermented)
- 6 oz wholegrain orecchiette (or other pasta, but this shape works well for this sauce)
- ¼ bulb garlic, grated
- Juice of ½ lemon
- Large handful chopped parsley
- Large handful chopped dill
- 9 oz cherry tomatoes, halved
- 9 oz mushrooms (your choice what kind), sliced (unless you went for shiitake or similar, which don’t need it due to already being very thin)
- 2 tsp black pepper, coarse ground
- 1 tsp red chili flakes
- ¼ tsp MSG or ½ tsp low-sodium salt
- Extra virgin olive oil
Method
(we suggest you read everything at least once before doing anything)
1) Cook the pasta as you normally would. Drain, and rinse with cold water. Set aside.
2) Combine the labneh with the garlic, black pepper, dill, parsley, and lemon juice, in a large bowl. Set aside.
3) Heat a little olive oil in a skillet; add the chili flakes, followed by the mushrooms. Cook until soft and browned, then add the tomatoes and fry for a further 1 minute—we want the tomatoes to be blistered, but not broken down. Stir in the MSG/salt, and take off the heat.
4) Refresh the pasta by passing a kettle of boiling water through it in a colander, then add the hot pasta to the bowl of labneh sauce, stirring to coat thoroughly.
5) Serve, spooning the mushrooms and tomatoes over the labneh pasta.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Making Friends With Your Gut (You Can Thank Us Later)
- Lycopene’s Benefits For The Gut, Heart, Brain, & More
- “The Longevity Vitamin” (That’s Not A Vitamin)
Take care!
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