Cheeky diet soft drink getting you through the work day? Here’s what that may mean for your health
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Many people are drinking less sugary soft drink than in the past. This is a great win for public health, given the recognised risks of diets high in sugar-sweetened drinks.
But over time, intake of diet soft drinks has grown. In fact, it’s so high that these products are now regularly detected in wastewater.
So what does the research say about how your health is affected in the long term if you drink them often?
What makes diet soft drinks sweet?
The World Health Organization (WHO) advises people “reduce their daily intake of free sugars to less than 10% of their total energy intake. A further reduction to below 5% or roughly 25 grams (six teaspoons) per day would provide additional health benefits.”
But most regular soft drinks contain a lot of sugar. A regular 335 millilitre can of original Coca-Cola contains at least seven teaspoons of added sugar.
Diet soft drinks are designed to taste similar to regular soft drinks but without the sugar. Instead of sugar, diet soft drinks contain artificial or natural sweeteners. The artificial sweeteners include aspartame, saccharin and sucralose. The natural sweeteners include stevia and monk fruit extract, which come from plant sources.
Many artificial sweeteners are much sweeter than sugar so less is needed to provide the same burst of sweetness.
Diet soft drinks are marketed as healthier alternatives to regular soft drinks, particularly for people who want to reduce their sugar intake or manage their weight.
But while surveys of Australian adults and adolescents show most people understand the benefits of reducing their sugar intake, they often aren’t as aware about how diet drinks may affect health more broadly.
What does the research say about aspartame?
The artificial sweeteners in soft drinks are considered safe for consumption by food authorities, including in the US and Australia. However, some researchers have raised concern about the long-term risks of consumption.
People who drink diet soft drinks regularly and often are more likely to develop certain metabolic conditions (such as diabetes and heart disease) than those who don’t drink diet soft drinks.
The link was found even after accounting for other dietary and lifestyle factors (such as physical activity).
In 2023, the WHO announced reports had found aspartame – the main sweetener used in diet soft drinks – was “possibly carcinogenic to humans” (carcinogenic means cancer-causing).
Importantly though, the report noted there is not enough current scientific evidence to be truly confident aspartame may increase the risk of cancer and emphasised it’s safe to consume occasionally.
Will diet soft drinks help manage weight?
Despite the word “diet” in the name, diet soft drinks are not strongly linked with weight management.
In 2022, the WHO conducted a systematic review (where researchers look at all available evidence on a topic) on whether the use of artificial sweeteners is beneficial for weight management.
Overall, the randomised controlled trials they looked at suggested slightly more weight loss in people who used artificial sweeteners.
But the observational studies (where no intervention occurs and participants are monitored over time) found people who consume high amounts of artificial sweeteners tended to have an increased risk of higher body mass index and a 76% increased likelihood of having obesity.
In other words, artificial sweeteners may not directly help manage weight over the long term. This resulted in the WHO advising artificial sweeteners should not be used to manage weight.
Studies in animals have suggested consuming high levels of artificial sweeteners can signal to the brain it is being starved of fuel, which can lead to more eating. However, the evidence for this happening in humans is still unproven.
What about inflammation and dental issues?
There is some early evidence artificial sweeteners may irritate the lining of the digestive system, causing inflammation and increasing the likelihood of diarrhoea, constipation, bloating and other symptoms often associated with irritable bowel syndrome. However, this study noted more research is needed.
High amounts of diet soft drinks have also been linked with liver disease, which is based on inflammation.
The consumption of diet soft drinks is also associated with dental erosion.
Many soft drinks contain phosphoric and citric acid, which can damage your tooth enamel and contribute to dental erosion.
Moderation is key
As with many aspects of nutrition, moderation is key with diet soft drinks.
Drinking diet soft drinks occasionally is unlikely to harm your health, but frequent or excessive intake may increase health risks in the longer term.
Plain water, infused water, sparkling water, herbal teas or milks remain the best options for hydration.
Lauren Ball, Professor of Community Health and Wellbeing, The University of Queensland and Emily Burch, Accredited Practising Dietitian and Lecturer, Southern Cross University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Doctors Are as Vulnerable to Addiction as Anyone. California Grapples With a Response
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BEVERLY HILLS, Calif. — Ariella Morrow, an internal medicine doctor, gradually slid from healthy self-esteem and professional success into the depths of depression.
Beginning in 2015, she suffered a string of personal troubles, including a shattering family trauma, marital strife, and a major professional setback. At first, sheer grit and determination kept her going, but eventually she was unable to keep her troubles at bay and took refuge in heavy drinking. By late 2020, Morrow could barely get out of bed and didn’t shower or brush her teeth for weeks on end. She was up to two bottles of wine a day, alternating it with Scotch whisky.
Sitting in her well-appointed home on a recent autumn afternoon, adorned in a bright lavender dress, matching lipstick, and a large pearl necklace, Morrow traced the arc of her surrender to alcohol: “I’m not going to drink before 5 p.m. I’m not going to drink before 2. I’m not going to drink while the kids are home. And then, it was 10 o’clock, 9 o’clock, wake up and drink.”
As addiction and overdose deaths command headlines across the nation, the Medical Board of California, which licenses MDs, is developing a new program to treat and monitor doctors with alcohol and drug problems. But a fault line has appeared over whether those who join the new program without being ordered to by the board should be subject to public disclosure.
Patient advocates note that the medical board’s primary mission is “to protect healthcare consumers and prevent harm,” which they say trumps physician privacy.
The names of those required by the board to undergo treatment and monitoring under a disciplinary order are already made public. But addiction medicine professionals say that if the state wants troubled doctors to come forward without a board order, confidentiality is crucial.
Public disclosure would be “a powerful disincentive for anybody to get help” and would impede early intervention, which is key to avoiding impairment on the job that could harm patients, said Scott Hambleton, president of the Federation of State Physician Health Programs, whose core members help arrange care and monitoring of doctors for substance use disorders and mental health conditions as an alternative to discipline.
But consumer advocates argue that patients have a right to know if their doctor has an addiction. “Doctors are supposed to talk to their patients about all the risks and benefits of any treatment or procedure, yet the risk of an addicted doctor is expected to remain a secret?” Marian Hollingsworth, a volunteer advocate with the Patient Safety Action Network, told the medical board at a Nov. 14 hearing on the new program.
Doctors are as vulnerable to addiction as anyone else. People who work to help rehabilitate physicians say the rate of substance use disorders among them is at least as high as the rate for the general public, which the federal Substance Abuse and Mental Health Services Administration put at 17.3% in a Nov. 13 report.
Alcohol is a very common drug of choice among doctors, but their ready access to pain meds is also a particular risk.
“If you have an opioid use disorder and are working in an operating room with medications like fentanyl staring you down, it’s a challenge and can be a trigger,” said Chwen-Yuen Angie Chen, an addiction medicine doctor who chairs the Well-Being of Physicians and Physicians-in-Training Committee at Stanford Health Care. “It’s like someone with an alcohol use disorder working at a bar.”
From Pioneer to Lagger
California was once at the forefront of physician treatment and monitoring. In 1981, the medical board launched a program for the evaluation, treatment, and monitoring of physicians with mental illness or substance use problems. Participants were often required to take random drug tests, attend multiple group meetings a week, submit to work-site surveillance by colleagues, and stay in the program for at least five years. Doctors who voluntarily entered the program generally enjoyed confidentiality, but those ordered into it by the board as part of a disciplinary action were on the public record.
The program was terminated in 2008 after several audits found serious flaws. One such audit, conducted by Julianne D’Angelo Fellmeth, a consumer interest lawyer who was chosen as an outside monitor for the board, found that doctors in the program were often able to evade the random drug tests, attendance at mandatory group therapy sessions was not accurately tracked, and participants were not properly monitored at work sites.
Today, MDs who want help with addiction can seek private treatment on their own or in many cases are referred by hospitals and other health care employers to third parties that organize treatment and surveillance. The medical board can order a doctor on probation to get treatment.
In contrast, the California licensing boards of eight other health-related professions, including osteopathic physicians, registered nurses, dentists, and pharmacists, have treatment and monitoring programs administered under one master contract by a publicly traded company called Maximus Inc. California paid Maximus about $1.6 million last fiscal year to administer those programs.
When and if the final medical board regulations are adopted, the next step would be for the board to open bidding to find a program administrator.
Fall From Grace
Morrow’s troubles started long after the original California program had been shut down.
The daughter of a prominent cosmetic surgeon, Morrow grew up in Palm Springs in circumstances she describes as “beyond privileged.” Her father, David Morrow, later became her most trusted mentor.
But her charmed life began to fall apart in 2015, when her father and mother, Linda Morrow, were indicted on federal insurance fraud charges in a well-publicized case. In 2017, the couple fled to Israel in an attempt to escape criminal prosecution, but later they were both arrested and returned to the United States to face prison sentences.
The legal woes of Morrow’s parents, later compounded by marital problems related to the failure of her husband’s business, took a heavy toll on Morrow. She was in her early 30s when the trouble with her parents started, and she was working 16-hour days to build a private medical practice, with two small children at home. By the end of 2019, she was severely depressed and turning increasingly to alcohol. Then, the loss of her admitting privileges at a large Los Angeles hospital due to inadequate medical record-keeping shattered what remained of her self-confidence.
Morrow, reflecting on her experience, said the very strengths that propel doctors through medical school and keep them going in their careers can foster a sense of denial. “We are so strong that our strength is our greatest threat. Our power is our powerlessness,” she said. Morrow ignored all the flashing yellow lights and even the red light beyond which serious trouble lay: “I blew through all of it, and I fell off the cliff.”
By late 2020, no longer working, bedridden by depression, and drinking to excess, she realized she could no longer will her way through: “I finally said to my husband, ‘I need help.’ He said, ‘I know you do.’”
Ultimately, she packed herself off to a private residential treatment center in Texas. Now sober for 21 months, Morrow said the privacy of the addiction treatment she chose was invaluable because it shielded her from professional scrutiny.
“I didn’t have to feel naked and judged,” she said.
Morrow said her privacy concerns would make her reluctant to join a state program like the one being considered by the medical board.
Physician Privacy vs. Patient Protection
The proposed regulations would spare doctors in the program who were not under board discipline from public disclosure as long as they stayed sober and complied with all the requirements, generally including random drug tests, attendance at group sessions, and work-site monitoring. If the program put a restriction on a doctor’s medical license, it would be posted on the medical board’s website, but without mentioning the doctor’s participation in the program.
Yet even that might compromise a doctor’s career since “having a restricted license for unspecified reasons could have many enduring personal and professional implications, none positive,” said Tracy Zemansky, a clinical psychologist and president of the Southern California division of Pacific Assistance Group, which provides support and monitoring for physicians.
Zemansky and others say doctors, just like anyone else, are entitled to medical privacy under federal law, as long as they haven’t caused harm.
Many who work in addiction medicine also criticized the proposed new program for not including mental health problems, which often go hand in hand with addiction and are covered by physician health programs in other states.
“To forgo mental health treatment, I think, is a grave mistake,” Morrow said. For her, depression and alcoholism were inseparable, and the residential program she attended treated her for both.
Another point of contention is money. Under the current proposal, doctors would bear all the costs of the program.
The initial clinical evaluation, plus the regular random drug tests, group sessions, and monitoring at their work sites could cost participants over $27,000 a year on average, according to estimates posted by the medical board. And if they were required to go for 30-day inpatient treatment, that would add an additional $40,000 — plus nearly $36,000 in lost wages.
People who work in the field of addiction medicine believe that is an unfair burden. They note that most programs for physicians in other states have outside funding to reduce the cost to participants.
“The cost should not be fully borne by the doctors, because there are many other people that are benefiting from this, including the board, malpractice insurers, hospitals, the medical association,” said Greg Skipper, a semi-retired addiction medicine doctor who ran Alabama’s state physician health program for 12 years. In Alabama, he said, those institutions contribute to the program, significantly cutting the amount doctors have to pay.
The treatment program that Morrow attended in spring of 2021, at The Menninger Clinic in Houston, cost $80,000 for a six-week stay, which was covered by a concerned family member. “It saved my life,” she said.
Though Morrow had difficulty maintaining her sobriety in the first year after treatment, she has now been sober since April 2, 2022. These days, Morrow regularly attends therapy and Alcoholics Anonymous and has pivoted to become an addiction medicine doctor.
“I am a better doctor today because of my experience — no question,” Morrow said. “I am proud to be a doctor who’s an alcoholic in recovery.”
This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
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Sleeping on Your Back after 50; Yay or Nay?
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Sleeping Differently After 50
Sleeping is one of those things that, at any age, can be hard to master. Some of our most popular articles have been on getting better sleep, and effective sleep aids, and we’ve had a range of specific sleep-related questions, like whether air purifiers actually improve your sleep.
But perhaps there’s an underlying truth hidden in our opening sentence…is sleeping consistently difficult because the way we sleep should change according to our age?
Inspired by Brad and Mike’s video below (which was published to their 5 million+ subscribers!), there are 4 main elements to consider when sleeping on your back after you’ve hit the 50-year mark:
- Degenerative Disk Disease: As you age, your spine may start to show signs of wear and tear, which directly affects comfort while lying on your back.
- Sleep Apnea and Snoring: Sleep Apnea and snoring become more of an issue with age, and sleeping on your back can exacerbate these problems; when you sleep on your back, the soft tissues in your throat, as well as your tongue, “fall back” and partly obstruct your the airway.
- Spinal Stenosis: Spinal Stenosis–the often-age-related narrowing of your spinal canal–can put pressure on the nerves that travel through the spine, which equally makes back-sleeping harder.
- GERD: The all-too-familiar gastroesophageal reflux disease can be more problematic when lying flat on your back, as doing so can allow easy access for stomach acid to move upwards.
Alternatives to Back Sleeping
Referencing the Mayo Clinic’s Sleep Facility’s director, Dr. Virend Somers, today’s video suggests a simple solution: sleeping on your side. The video goes into a bit more detail but, as you know, here at 10almonds we like to cut to the chase.
Modifications for Back Sleeping
If you’re a lifelong back-sleeping and cannot bear the idea of changing to your side, or your stomach, then there are a few modifications that you can make to ease any pain and discomfort.
Most solutions revolve around either leg wedges or pillow adjustments. For instance, if you’re suffering from back pain, try propping your knees up. Or if GERD is your worst enemy, a wedge pillow could help keep that acid down.
As can be expected, the video dives into more detail:
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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Banana vs Goji Berries – Which is Healthier?
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Our Verdict
When comparing banana to goji berries, we picked the goji berries.
Why?
Both are great! But…
In terms of macros, goji berries have much more fiber, carbs, and protein, thus making it the most nutrient-dense option, as we might expect from a dried fruit being compared to a non-dried fruit—since the non-dried fruit has water weight that the dried fruit doesn’t, its percentages of other things will be proportionally lower, because the percentages must still add up to 100%, and if 75% is water (as is the case for bananas, compared to goji berries’ 7.5% water), then that only leaves 25% to work with, while goji berries have 92.5% to work with. In short, an easy and expected win for goji berries.
In the category of vitamins, bananas have more of vitamin B6, while goji berries have more of vitamins A, B1, B3, B5, B9, C, E, and K. A clear win for goji berries.
When it comes to minerals, bananas are not higher in any minerals, while goji berries have more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc. Another easy win for goji berries.
As for polyphenols, you may well imagine that the brightly-colored bitter-tasting berries have more, and you’d be right; you can read more about the exciting phytochemical properties of goji berries in the links below.
Meanwhile, adding up the sections show a clear overall win for goji berries, but by all means enjoy either or both; diversity is good!
Want to learn more?
You might like:
- The Top Micronutrient Deficiency In High Blood Pressure ← it’s potassium, and because of some popular mentions in TV shows, people get hung up on bananas being a good source of potassium. Which they are, but they’re not even in the top 10 of fruits for potassium. Here’s a non-exhaustive list of fruits that have more potassium than bananas, portion for portion
- Goji Berries: Which Benefits Do They Really Have? ← many!
- The Sugary Food That Lowers Blood Sugars ← it’s goji berries!
Enjoy!
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No-Exercise Exercise!
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Do you love to go to the gym?
If so, today’s article might not be for you so much. Or maybe it will, because let’s face it, exercise is fun!
At least… It can be, and should be 😎
So without further ado, here’s a slew of no-exercise exercise ideas; we’re willing to bet that somewhere in the list there’s at least some you haven’t tried before, and probably some you haven’t done in a while but might enjoy making a reprise!
Walking
No surprises here: walking is great. Hopefully you have some green spaces near you, but if you don’t, [almost] any walking is better than no walking. So unless there’s some sort of environmental disaster going on outside, lace up and get stepping.
If you struggle to “walk for walking’s sake” give yourself a little mission. Walk to the shop to buy one item. Walk to the park and find a flower to photograph. Walk to the library and take out a book. Whatever works for you!
See also: The Doctor Who Wants Us To Exercise Less, And Move More
Take the stairs
This one doesn’t need many words, just: make it a habit.
Treat the elevators as though they aren’t there!
See also: How To Really Pick Up (And Keep!) Those Habits
Dance
Dance is amazing! Any kind of dance, whatever suits your tastes. This writer loves salsa and tango, but no matter whether for you it’s zouk or zumba, breakdancing or line dancing, whatever gets you moving is going to be great for you.
If you don’t know how, online tutorials abound, and best of all is to attend local classes if you can, because they’re always a fun social experience too.
Make music
Not something often thought of as an exercise, but it is! Most instruments require that we be standing or siting with good posture, focusing intently on our movements, and often as not, breathing very mindfully too. And yes, it’s great for the brain as well!
Check out: This Is Your Brain on Music: The Science of a Human Obsession – by Dr. Daniel Levitin
Take a stand
If you spend a lot of time at a desk, please consider investing in a standing desk; they can be truly life-changing. Not only is it so much better for your back, hips, neck, and internal organs, but also it burns hundreds more calories than sitting, due to the no-exercise exercise that is keeping your body constantly stabilized while on your feet.
(or, if you’re like this writer: on your foot. I do have two feet, I just spend an inordinate amount of time at my desk standing on one leg at a time; I’m a bit of a flamingo like that)
See also: Deskbound: Standing Up to a Sitting World – by Kelly Starrett and Glen Cordoza
Sit, but…
Sit in a sitting squat! Sometimes called a Slav squat, or an Asian squat, or a resting squat, or various other names:
Click Here If The Embedded Video Doesn’t Load Automatically!
Alternatively, sitting in seiza (the traditional Japanese sitting position) is also excellent, but watch out! While it’s great once your body is accustomed to it, if you haven’t previously sat this way much, you may cut off your own circulation, hurt your knees, and (temporarily) lose feeling in your feet. So if you don’t already sit in seiza often, gradually work up the time period you spend sitting in seiza, so that your vasculature can adapt and improve, which honestly, is a very good thing for your legs and feet to have.
Breathe
Perhaps the absolute most “no-exercise exercise” there is. And yes, of course you are (hopefully) breathing all the time, but how you are breathing matters a lot:
The Inside Job Of Fixing Our Breathing: Exercises That Can Fix Sinus Problems (And More)
Clean
This doesn’t have to mean scrubbing floors like a sailor—even merely giving your house the Marie Kondo treatment counts, because while you’re distracted with all the objects, you’re going to be going back and forth, getting up and down, etc, clocking up lots of exercise that you barely even notice!
PS, check out: The Life-Changing Manga Of Tidying Up – by Marie Kondo
Garden
As with the above, it’s lots of activity that doesn’t necessarily feel like it (assuming you’re doing more pruning and weeding etc, and less digging ditches etc), and as a bonus, there are a stack of mental health benefits to being in a green natural environment and interacting with soil:
Read more: The Antidepressant In Your Garden
Climb
Depending on where you live, this might mean an indoor climbing wall, but give it a go! They have color-coded climbs from beginner to advanced, so don’t worry about being out of your depth.
And the best thing is, the beginner climbs will be as much a workout to a beginner as the advanced climbs will be to an advanced climber, because at the end of the day, you’re still clinging on for dear life, no matter whether it’s a sizeable handhold not far from the ground, or the impression of a fingernail crack in an overhang 100ft in the air.
Video games (but…)
Less in the category of Stardew Valley, and more in the category of Wii Fit.
So, dust off that old controller (or treat yourself to one if you didn’t have one already), and get doing a hundred sports and other physical activities in the comfort of your living room, with a surprisingly addictive gaming system!
Sex!
You probably don’t need instructions here, and if you do, well honestly, we’re running out of space today. But the answer to “does xyz count?” is “did it get your heart racing?” because if so, it counts
Take care!
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Seriously Useful Communication Skills!
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What Are Communication Skills, Really?
Superficially, communication is “conveying an idea to someone else”. But then again…
Superficially, painting is “covering some kind of surface in paint”, and yet, for some reason, the ceiling you painted at home is not regarded as equally “good painting skills” as Michaelangelo’s, with regard to the ceiling of the Sistine Chapel.
All kinds of “Dark Psychology” enthusiasts on YouTube, authors of “Office Machiavelli” handbooks, etc, tell us that good communication skills are really a matter of persuasive speaking (or writing). And let’s not even get started on “pick-up artist” guides. Bleugh.
Not to get too philosophical, but here at 10almonds, we think that having good communication skills means being able to communicate ideas simply and clearly, and in a way that will benefit as many people as possible.
The implications of this for education are obvious, but what of other situations?
Conflict Resolution
Whether at work or at home or amongst friends or out in public, conflict will happen at some point. Even the most well-intentioned and conscientious partners, family, friends, colleagues, will eventually tread on our toes—or we, on theirs. Often because of misunderstandings, so much precious time will be lost needlessly. It’s good for neither schedule nor soul.
So, how to fix those situations?
I’m OK; You’re OK
In the category of “bestselling books that should have been an article at most”, a top-tier candidate is Thomas Harris’s “I’m OK; You’re OK”.
The (very good) premise of this (rather padded) book is that when seeking to resolve a conflict or potential conflict, we should look for a win-win:
- I’m not OK; you’re not OK ❌
- For example: “Yes, I screwed up and did this bad thing, but you too do bad things all the time”
- I’m OK; you’re not OK ❌
- For example: “It is not I who screwed up; this is actually all your fault”
- I’m not OK; you’re OK ❌
- For example: “I screwed up and am utterly beyond redemption; you should immediately divorce/disown/dismiss/defenestrate me”
- I’m OK; you’re OK ✅
- For example: “I did do this thing which turned out to be incorrect; in my defence it was because you said xyz, but I can understand why you said that, because…” and generally finding a win-win outcome.
So far, so simple.
“I”-Messages
In a conflict, it’s easy to get caught up in “you did this, you did that”, often rushing to assumptions about intent or meaning. And, the closer we are to the person in question, the more emotionally charged, and the more likely we are to do this as a knee-jerk response.
“How could you treat me this way?!” if we are talking to our spouse in a heated moment, perhaps, or “How can you treat a customer this way?!” if it’s a worker at Home Depot.
But the reality is that almost certainly neither our spouse nor the worker wanted to upset us.
Going on the attack will merely put them on the defensive, and they may even launch their own counterattack. It’s not good for anyone.
Instead, what really happened? Express it starting with the word “I”, rather than immediately putting it on the other person. Often our emotions require a little interrogation before they’ll tell us the truth, but it may be something like:
“I expected x, so when you did/said y instead, I was confused and hurt/frustrated/angry/etc”
Bonus: if your partner also understands this kind of communication situation, so much the better! Dark psychology be damned, everything is best when everyone knows the playbook and everyone is seeking the best outcome for all sides.
The Most Powerful “I”-Message Of All
Statements that start with “I” will, unless you are rules-lawyering in bad faith, tend to be less aggressive and thus prompt less defensiveness. An important tool for the toolbox, is:
“I need…”
Softly spoken, firmly if necessary, but gentle. If you do not express your needs, how can you expect anyone to fulfil them? Be that person a partner or a retail worker or anyone else. Probably they want to end the conflict too, so throw them a life-ring and they will (if they can, and are at least halfway sensible) grab it.
- “I need an apology”
- “I need a moment to cool down”
- “I need a refund”
- “I need some reassurance about…” (and detail)
Help the other person to help you!
Everything’s best when it’s you (plural) vs the problem, rather than you (plural) vs each other.
Apology Checklist
Does anyone else remember being forced to write an insincere letter of apology as a child, and the literary disaster that probably followed? As adults, we (hopefully) apologize when and if we mean it, and we want our apology to convey that.
What follows will seem very formal, but honestly, we recommend it in personal life as much as professional. It’s a ten-step apology, and you will forget these steps, so we recommend to copy and paste them into a Notes app or something, because this is of immeasurable value.
It’s good not just for when you want to apologize, but also, for when it’s you who needs an apology and needs to feel it’s sincere. Give your partner (if applicable) a copy of the checklist too!
- Statement of apology—say “I’m sorry”
- Name the offense—say what you did wrong
- Take responsibility for the offense—understand your part in the problem
- Attempt to explain the offense (not to excuse it)—how did it happen and why
- Convey emotions; show remorse
- Address the emotions/damage to the other person—show that you understand or even ask them how it affected them
- Admit fault—understand that you got it wrong and like other human beings you make mistakes
- Promise to be better—let them realize you’re trying to change
- Tell them how you will try to do it different next time and finally
- Request acceptance of the apology
Note: just because you request acceptance of the apology doesn’t mean they must give it. Maybe they won’t, or maybe they need time first. If they’re playing from this same playbook, they might say “I need some time to process this first” or such.
Want to really superpower your relationship? Read this together with your partner:
Hold Me Tight: Seven Conversations for a Lifetime of Love, and, as a bonus:
The Hold Me Tight Workbook: A Couple’s Guide for a Lifetime of Love
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Learn to Age Gracefully
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- I’m not OK; you’re not OK ❌
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Long-Covid Patients Are Frustrated That Federal Research Hasn’t Found New Treatments
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Erica Hayes, 40, has not felt healthy since November 2020 when she first fell ill with covid.
Hayes is too sick to work, so she has spent much of the last four years sitting on her beige couch, often curled up under an electric blanket.
“My blood flow now sucks, so my hands and my feet are freezing. Even if I’m sweating, my toes are cold,” said Hayes, who lives in Western Pennsylvania. She misses feeling well enough to play with her 9-year-old son or attend her 17-year-old son’s baseball games.
Along with claiming the lives of 1.2 million Americans, the covid-19 pandemic has been described as a mass disabling event. Hayes is one of millions of Americans who suffer from long covid. Depending on the patient, the condition can rob someone of energy, scramble the autonomic nervous system, or fog their memory, among many other http://symptoms.in/ addition to the brain fog and chronic fatigue, Hayes’ constellation of symptoms includes frequent hives and migraines. Also, her tongue is constantly swollen and dry.
“I’ve had multiple doctors look at it and tell me they don’t know what’s going on,” Hayes said about her tongue.
Estimates of prevalence range considerably, depending on how researchers define long covid in a given study, but the Centers for Disease Control and Prevention puts it at 17 million adults.
Despite long covid’s vast reach, the federal government’s investment in researching the disease — to the tune of $1.15 billion as of December — has so far failed to bring any new treatments to market.
This disappoints and angers the patient community, who say the National Institutes of Health should focus on ways to stop their suffering instead of simply trying to understand why they’re suffering.
“It’s unconscionable that more than four years since this began, we still don’t have one FDA-approved drug,” said Meighan Stone, executive director of the Long COVID Campaign, a patient-led advocacy organization. Stone was among several people with long covid who spoke at a workshop hosted by the NIH in September where patients, clinicians, and researchers discussed their priorities and frustrations around the agency’s approach to long-covid research.
Some doctors and researchers are also critical of the agency’s research initiative, called RECOVER, or Researching COVID to Enhance Recovery. Without clinical trials, physicians specializing in treating long covid must rely on hunches to guide their clinical decisions, said Ziyad Al-Aly, chief of research and development with the VA St Louis Healthcare System.
“What [RECOVER] lacks, really, is clarity of vision and clarity of purpose,” said Al-Aly, saying he agrees that the NIH has had enough time and money to produce more meaningful progress.
Now the NIH is starting to determine how to allocate an additional $662 million of funding for long-covid research, $300 million of which is earmarked for clinical trials. These funds will be allocated over the next four http://years.at/ the end of October, RECOVER issued a request for clinical trial ideas that look at potential therapies, including medications, saying its goal is “to work rapidly, collaboratively, and transparently to advance treatments for Long COVID.”
This turn suggests the NIH has begun to respond to patients. This has stirred cautious optimism among those who say that the agency’s approach to long covid has lacked urgency in the search for effective treatments.Stone calls this $300 million a down payment. She warns it’s going to take a lot more money to help people like Hayes regain some degree of health.“There really is a burden to make up this lost time now,” Stone said.
The NIH told KFF Health News and NPR via email that it recognizes the urgency in finding treatments. But to do that, there needs to be an understanding of the biological mechanisms that are making people sick, which is difficult to do with post-infectious conditions.
That’s why it has funded research into how long covid affects lung function, or trying to understand why only some people are afflicted with the condition.
Good Science Takes Time
In December 2020, Congress appropriated $1.15 billion for the NIH to launch RECOVER, raising hopes in the long-covid patient community.
Then-NIH Director Francis Collins explained that RECOVER’s goal was to better understand long covid as a disease and that clinical trials of potential treatments would come later.
According to RECOVER’s website, it has funded eight clinical trials to test the safety and effectiveness of an experimental treatment or intervention. Just one of those trials has published results.
On the other hand, RECOVER has supported more than 200 observational studies, such as research on how long covid affects pulmonary function and on which symptoms are most common. And the initiative has funded more than 40 pathobiology studies, which focus on the basic cellular and molecular mechanisms of long covid.
RECOVER’s website says this research has led to crucial insights on the risk factors for developing long covid and on understanding how the disease interacts with preexisting conditions.
It notes that observational studies are important in helping scientists to design and launch evidence-based clinical trials.
Good science takes time, said Leora Horwitz, the co-principal investigator for the RECOVER-Adult Observational Cohort at New York University. And long covid is an “exceedingly complicated” illness that appears to affect nearly every organ system, she said.
This makes it more difficult to study than many other diseases. Because long covid harms the body in so many ways, with widely variable symptoms, it’s harder to identify precise targets for treatment.
“I also will remind you that we’re only three, four years into this pandemic for most people,” Horwitz said. “We’ve been spending much more money than this, yearly, for 30, 40 years on other conditions.”
NYU received nearly $470 million of RECOVER funds in 2021, which the institution is using to spearhead the collection of data and biospecimens from up to 40,000 patients. Horwitz said nearly 30,000 are enrolled so far.
This vast repository, Horwitz said, supports ongoing observational research, allowing scientists to understand what is happening biologically to people who don’t recover after an initial infection — and that will help determine which clinical trials for treatments are worth undertaking.
“Simply trying treatments because they are available without any evidence about whether or why they may be effective reduces the likelihood of successful trials and may put patients at risk of harm,” she said.
Delayed Hopes or Incremental Progress?
The NIH told KFF Health News and NPR that patients and caregivers have been central to RECOVER from the beginning, “playing critical roles in designing studies and clinical trials, responding to surveys, serving on governance and publication groups, and guiding the initiative.”But the consensus from patient advocacy groups is that RECOVER should have done more to prioritize clinical trials from the outset. Patients also say RECOVER leadership ignored their priorities and experiences when determining which studies to fund.
RECOVER has scored some gains, said JD Davids, co-director of Long COVID Justice. This includes findings on differences in long covid between adults and kids.But Davids said the NIH shouldn’t have named the initiative “RECOVER,” since it wasn’t designed as a streamlined effort to develop treatments.
“The name’s a little cruel and misleading,” he said.
RECOVER’s initial allocation of $1.15 billion probably wasn’t enough to develop a new medication to treat long covid, said Ezekiel J. Emanuel, co-director of the University of Pennsylvania’s Healthcare Transformation Institute.
But, he said, the results of preliminary clinical trials could have spurred pharmaceutical companies to fund more studies on drug development and test how existing drugs influence a patient’s immune response.
Emanuel is one of the authors of a March 2022 covid roadmap report. He notes that RECOVER’s lack of focus on new treatments was a problem. “Only 15% of the budget is for clinical studies. That is a failure in itself — a failure of having the right priorities,” he told KFF Health News and NPR via email.
And though the NYU biobank has been impactful, Emanuel said there needs to be more focus on how existing drugs influence immune response.
He said some clinical trials that RECOVER has funded are “ridiculous,” because they’ve focused on symptom amelioration, for example to study the benefits of over-the-counter medication to improve sleep. Other studies looked at non-pharmacological interventions, such as exercise and “brain training” to help with cognitive fog.
People with long covid say this type of clinical research contributes to what many describe as the “gaslighting” they experience from doctors, who sometimes blame a patient’s symptoms on anxiety or depression, rather than acknowledging long covid as a real illness with a physiological basis.
“I’m just disgusted,” said long-covid patient Hayes. “You wouldn’t tell somebody with diabetes to breathe through it.”
Chimére L. Sweeney, director and founder of the Black Long Covid Experience, said she’s even taken breaks from seeking treatment after getting fed up with being told that her symptoms were due to her diet or mental health.
“You’re at the whim of somebody who may not even understand the spectrum of long covid,” Sweeney said.
Insurance Battles Over Experimental Treatments
Since there are still no long-covid treatments approved by the Food and Drug Administration, anything a physician prescribes is classified as either experimental — for unproven treatments — or an off-label use of a drug approved for other conditions. This means patients can struggle to get insurance to cover prescriptions.
Michael Brode, medical director for UT Health Austin’s Post-COVID-19 Program — said he writes many appeal letters. And some people pay for their own treatment.
For example, intravenous immunoglobulin therapy, low-dose naltrexone, and hyperbaric oxygen therapy are all promising treatments, he said.
For hyperbaric oxygen, two small, randomized controlled studies show improvements for the chronic fatigue and brain fog that often plague long-covid patients. The theory is that higher oxygen concentration and increased air pressure can help heal tissues that were damaged during a covid infection.
However, the out-of-pocket cost for a series of sessions in a hyperbaric chamber can run as much as $8,000, Brode said.
“Am I going to look a patient in the eye and say, ‘You need to spend that money for an unproven treatment’?” he said. “I don’t want to hype up a treatment that is still experimental. But I also don’t want to hide it.”
There’s a host of pharmaceuticals that have promising off-label uses for long covid, said microbiologist Amy Proal, president and chief scientific officer at the Massachusetts-based PolyBio Research Foundation. For instance, she’s collaborating on a clinical study that repurposes two HIV drugs to treat long covid.
Proal said research on treatments can move forward based on what’s already understood about the disease. For instance, she said that scientists have evidence — partly due to RECOVER research — that some patients continue to harbor small amounts of viral material after a covid infection. She has not received RECOVER funds but is researching antivirals.
But to vet a range of possible treatments for the millions suffering now — and to develop new drugs specifically targeting long covid — clinical trials are needed. And that requires money.
Hayes said she would definitely volunteer for an experimental drug trial. For now, though, “in order to not be absolutely miserable,” she said she focuses on what she can do, like having dinner with her http://family.at/ the same time, Hayes doesn’t want to spend the rest of her life on a beige couch.
RECOVER’s deadline to submit research proposals for potential long-covid treatments is Feb. 1.
This article is from a partnership that includes NPR and KFF Health News.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
This article first appeared on KFF Health News and is republished here under a Creative Commons license.
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