Chili Chestnut, Sweet Apricot, & Whipped Feta Toasts
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This is a delightful breakfast or light lunch option, full of gut-healthy ingredients and a fair list of healthy polyphenols too.
You will need
- ½ baguette, sliced into ½” slices; if making your own, feel free to use our Delicious Quinoa Avocado Bread recipe. If buying shop-bought, a sourdough baguette will likely be the healthiest option, and tasty too.
- 4 oz feta cheese; if you are vegan, a plant-based version will work in culinary terms, but will have a different (less gut-healthy) nutritional profile, as plant-based cheeses generally use a lot of coconut oil and potato starch, and are not actually fermented.
- 1 tbsp yogurt; your preference what kind; live-cultured with minimal additives is of course best—and this time, plant-based is also just as good, healthwise, since they are fermented and contain more or less the same beneficial bacteria, and have a good macro profile too.
- 4 oz precooked chestnuts, finely chopped
- 6 dried apricots, finely chopped
- ¼ bulb garlic, grated
- 2 tsp harissa paste
- 1 tsp black pepper, coarse ground
- ¼ tsp MSG or ½ tsp low-sodium salt
- Extra virgin olive oil, for frying
- Optional garnish: finely chopped chives
Method
(we suggest you read everything at least once before doing anything)
1) Combine the feta and yogurt in a small, high-speed blender and process into a smooth purée. If it isn’t working, add 1 tbsp kettle-hot water and try again.
2) Heat the oil in a skillet over a medium heat; add the garlic and when it starts to turn golden, add the chestnuts and harissa, as well as the black pepper and MSG/salt. Stir for about 2 minutes, and then stir in the apricots and take it off the heat.
3) Toast the baguette slices under the grill. If you’re feeling bold about the multitasking, you can start this while still doing the previous step, for optimal timing. If not, simply doing it in the order presented is fine.
4) Assemble: spread the whipped feta over the toast; add the apricot-chestnut mixture, followed by the finely chopped chives if using, and serve immediately:
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)
- Apricots vs Peaches – Which is Healthier?
- Why You Should Diversify Your Nuts!
- Capsaicin For Weight Loss And Against Inflammation
- The Many Health Benefits Of Garlic
- Black Pepper’s Impressive Anti-Cancer Arsenal (And More)
- Sea Salt vs MSG – Which is Healthier?
Take care!
Don’t Forget…
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The Seven Circles – by Chelsey Luger & Thosh Collins
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At first glance, this can seem like an unscientific book—you won’t find links to studies in this one, for sure! However, if we take a look at the seven circles in question, they are:
- Food
- Movement
- Sleep
- Ceremony
- Sacred Space
- Land
- Community
Regular 10almonds readers may notice that these seven items contain five of the things strongly associated with the “supercentenarian Blue Zones”. (If you are wondering why Native American reservations are not Blue Zones, the answer there lies less in health science and more in history and sociology, and what things have been done to a given people).
The authors—who are Native American, yes—present in one place a wealth of knowledge and know-how. Not even just from their own knowledge and their own respective tribes, but gathered from other tribes too.
Perhaps the strongest value of this book to the reader is in the explanation of noting the size of each of those circles, how they connect with each other, and providing a whole well-explained system for how we can grow each of them in harmony with each other.
Or to say the same thing in sciencey terms: how to mindfully improve integrated lifestyle factors synergistically for greater efficacy and improved health-adjusted quality-of-life years.
Bottom line: if you’re not averse to something that mostly doesn’t use sciencey terms of have citations to peer-reviewed studies peppered through the text, then this book has wisdom that’s a) older than the pyramids of Giza, yet also b) highly consistent with our current best science of Blue Zone healthy longevity.
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Ouch. That ‘Free’ Annual Checkup Might Cost You. Here’s Why.
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When Kristy Uddin, 49, went in for her annual mammogram in Washington state last year, she assumed she would not incur a bill because the test is one of the many preventive measures guaranteed to be free to patients under the 2010 Affordable Care Act. The ACA’s provision made medical and economic sense, encouraging Americans to use screening tools that could nip medical problems in the bud and keep patients healthy.
So when a bill for $236 arrived, Uddin — an occupational therapist familiar with the health care industry’s workings — complained to her insurer and the hospital. She even requested an independent review.
“I’m like, ‘Tell me why am I getting this bill?’” Uddin recalled in an interview. The unsatisfying explanation: The mammogram itself was covered, per the ACA’s rules, but the fee for the equipment and the facility was not.
That answer was particularly galling, she said, because, a year earlier, her “free” mammogram at the same health system had generated a bill of about $1,000 for the radiologist’s reading. Though she fought that charge (and won), this time she threw in the towel and wrote the $236 check. But then she dashed off a submission to the KFF Health News-NPR “Bill of the Month” project:
“I was really mad — it’s ridiculous,” she later recalled. “This is not how the law is supposed to work.”
The ACA’s designers might have assumed that they had spelled out with sufficient clarity that millions of Americans would no longer have to pay for certain types of preventive care, including mammograms, colonoscopies, and recommended vaccines, in addition to doctor visits to screen for disease. But the law’s authors didn’t reckon with America’s ever-creative medical billing juggernaut.
Over the past several years, the medical industry has eroded the ACA’s guarantees, finding ways to bill patients in gray zones of the law. Patients going in for preventive care, expecting that it will be fully covered by insurance, are being blindsided by bills, big and small.
The problem comes down to deciding exactly what components of a medical encounter are covered by the ACA guarantee. For example, when do conversations between doctor and patient during an annual visit for preventive services veer into the treatment sphere? What screenings are needed for a patient’s annual visit?
A healthy 30-year-old visiting a primary care provider might get a few basic blood tests, while a 50-year-old who is overweight would merit additional screening for Type 2 diabetes.
Making matters more confusing, the annual checkup itself is guaranteed to be “no cost” for women and people age 65 and older, but the guarantee doesn’t apply for men in the 18-64 age range — though many preventive services that require a medical visit (such as checks of blood pressure or cholesterol and screens for substance abuse) are covered.
No wonder what’s covered under the umbrella of prevention can look very different to medical providers (trying to be thorough) and billers (intent on squeezing more dollars out of every medical encounter) than it does to insurers (who profit from narrower definitions).
For patients, the gray zone has become a billing minefield. Here are a few more examples, gleaned from the Bill of the Month project in just the past six months:
Peter Opaskar, 46, of Texas, went to his primary care doctor last year for his preventive care visit — as he’d done before, at no cost. This time, his insurer paid $130.81 for the visit, but he also received a perplexing bill for $111.81. Opaskar learned that he had incurred the additional charge because when his doctor asked if he had any health concerns, he mentioned that he was having digestive problems but had already made an appointment with his gastroenterologist. So, the office explained, his visit was billed as both a preventive physical and a consultation. “Next year,” Opasker said in an interview, if he’s asked about health concerns, “I’ll say ‘no,’ even if I have a gunshot wound.”
Kevin Lin, a technology specialist in Virginia in his 30s, went to a new primary care provider to take advantage of the preventive care benefit when he got insurance; he had no physical complaints. He said he was assured at check-in that he wouldn’t be charged. His insurer paid $174 for the checkup, but he was billed an additional $132.29 for a “new patient visit.” He said he has made many calls to fight the bill, so far with no luck.
Finally, there’s Yoori Lee, 46, of Minnesota, herself a colorectal surgeon, who was shocked when her first screening colonoscopy yielded a bill for $450 for a biopsy of a polyp — a bill she knew was illegal. Federal regulations issued in 2022 to clarify the matter are very clear that biopsies during screening colonoscopies are included in the no-cost promise. “I mean, the whole point of screening is to find things,” she said, stating, perhaps, the obvious.
Though these patient bills defy common sense, room for creative exploitation has been provided by the complex regulatory language surrounding the ACA. Consider this from Ellen Montz, deputy administrator and director of the Center for Consumer Information and Insurance Oversight at the Centers for Medicare & Medicaid Services, in an emailed response to queries and an interview request on this subject: “If a preventive service is not billed separately or is not tracked as individual encounter data separately from an office visit and the primary purpose of the office visit is not the delivery of the preventive item or service, then the plan issuer may impose cost sharing for the office visit.”
So, if the doctor decides that a patient’s mention of stomach pain does not fall under the umbrella of preventive care, then that aspect of the visit can be billed separately, and the patient must pay?
And then there’s this, also from Montz: “Whether a facility fee is permitted to be charged to a consumer would depend on whether the facility usage is an integral part of performing the mammogram or an integral part of any other preventive service that is required to be covered without cost sharing under federal law.”
But wait, how can you do a mammogram or colonoscopy without a facility?
Unfortunately, there is no federal enforcement mechanism to catch individual billing abuses. And agencies’ remedies are weak — simply directing insurers to reprocess claims or notifying patients they can resubmit them.
In the absence of stronger enforcement or remedies, CMS could likely curtail these practices and give patients the tools to fight back by offering the sort of clarity the agency provided a few years ago regarding polyp biopsies — spelling out more clearly what comes under the rubric of preventive care, what can be billed, and what cannot.
The stories KFF Health News and NPR receive are likely just the tip of an iceberg. And while each bill might be relatively small compared with the stunning $10,000 hospital bills that have become all too familiar in the United States, the sorry consequences are manifold. Patients pay bills they do not owe, depriving them of cash they could use elsewhere. If they can’t pay, those bills might end up with debt-collection agencies and, ultimately, harm their credit score.
Perhaps most disturbing: These unexpected bills might discourage people from seeking preventive screenings that could be lifesaving, which is why the ACA deemed them “essential health benefits” that should be free.
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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“Why Does It Hurt When I Have Sex?” (And What To Do About It)
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This is one that affects mostly women, with 43% of American women reporting such issues at some point. There’s a distribution curve to this, with higher incidence in younger and older women; younger while first figuring things out, and older with menopause-related body changes. But, it can happen at any time (and often not for obvious reasons!), so here’s what OB/GYN Dr. Jennifer Lincoln advises:
Many possibilities, but easily narrowed down
Common causes include:
- vaginal dryness, which itself can have many causes (half of which are “low estrogen levels” for various different reasons)
- muscular issues, which can be in response to anxiety, pain, and occur as a result of pelvic floor muscle tightening
- vulvar issues, ranging from skin disorders (e.g. lichen sclerosis or lichen planus) to nerve disorders (e.g. vestibulitis or vestibulodynia)
- uterine issues, including endometriosis, fibroids, or scar tissue if you had a surgery
- infections, of the STI variety, but bear in mind that some STIs such as herpes do not necessarily require direct sexual contact per se, and yeast infections definitely don’t. Some STIs are more serious than others, so getting things checked out is a good idea (don’t worry, clinics are discreet about this sort of thing)
- bowel issues, notwithstanding that we have been talking about vaginal sex here, it can’t be happy if its anatomical neighbors aren’t happy—so things like IBS, Crohn’s, or even just constipation, aren’t irrelevant
- trauma, of various kinds, affecting sexual experiences
That’s a lot of possibilities, so if there’s not something standing out as “yes, now that you mention it, it’s obviously that”, Dr. Lincoln recommends a full health evaluation and examination of medical history, as well as a targeted physical exam. That may not be fun, but at least, once it’s done, it’s done.
Treatments vary depending on the cause, of course, and there are many kinds of physical and psychological therapies, as well as surgeries for the uterine issues we mentioned.
Happily, many of the above things can be addressed with simpler and less invasive methods, including learning more about the relevant anatomy and physiology and how to use it (be not ashamed; most people never got meaningful education about this!)*, vulvar skin care (“gentle” is the watchword here), the difference a good lube can make, and estrogen supplementation—which if you’re not up for general HRT, can be a topical estrogen cream that alleviates sexual function issues without raising blood serum estradiol levels.
*10almonds tip: check out the recommended book “Come As You Are” in our links below; it has 400 pages of stuff most people never knew about anatomy and physiology down there; you can thank us later!
Meanwhile, for more on each of these, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
- Water-based Lubricant vs Silicon-based Lubricant – Which is Healthier? (counterintuitively, it’s the silicon! But do give it a quick read, because here be science)
- How To Avoid Urinary Tract Infections (may be relevant; always good to know)
- Come As You Are – by Dr. Emily Nagoski (book; if we could only recommend one book on responsible vagina ownership, this would be the one)
Take care!
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Bread & Weight Gain/Loss: What’s The Truth?
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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!
No question/request too big or small 😎
❝Every now and again I try quitting bread to lose some weight and it works, but it always seems to come back and then I eat bread again anyway. Is there a way to break out of this cycle?❞
Yes! You can break out of that cycle by simply enjoying bread in moderation without quitting (and then you will certainly not be in the cycle of quitting it and restarting it).
However, to give an answer that’s probably more in the spirit of your question:
Firstly, know that a lot of the short-term benefits of quitting bread are unrelated to fat loss. We’ve covered this part before, and in few words:
Cutting bread for 30 days can lead to weight loss for some people, but the initial change is often more a matter of reduced water retention and bloating rather than immediate fat loss. In particular, it’s common for people feel lighter within the first week or so because reducing fermentable carbohydrates can decrease gas production and resultant digestive discomfort, especially in those with sensitive guts.
You can read more about this, here: Does Quitting Bread For 30 Days Trigger Weight Loss?
Next, understand that oftentimes the issue is not the bread, so much as the glycemic index thereof, and this can vary wildly from one bread to another.
We wrote about this, here: Is Flour As Bad As Sugar?
And more broadly, here: Grains: Bread Of Life, Or Cereal Killer?
Lastly (for today), there’s some recent science that indicates the issue with bread is actually in your non-bread dietary components.
Researchers (Dr. Miona Marutani et al.) found that mice given access to carbohydrate-heavy foods like bread, rice, and wheat strongly preferred them over standard mouse food and gained body fat despite eating roughly the same number of calories.
In other words, the body fat gain wasn’t about eating more bread; it was about eating less of the other food!
You can read the paper itself, here: Wheat Flour Intake Promotes Weight Gain and Metabolic Changes in Mice
Now, this was a mouse study and may or may not be replicated in humans, but it at the very least presents us with an important reminder of the value of positive dieting, that is to say, worrying less about what to exclude from our diets, and more about what to include, to ensure we get good, diverse, nutrient coverage.
Yes, even if your goal is fat loss, making conscious choices about what to include, rather than what to exclude, can help a lot.
For more on that, enjoy: Intuitive Eating Might Not Be What You Think
Want to enjoy bread, healthily?
As we’ve said, moderation is key, as we as a focus on making sure to include plenty of good nutrients.
There are several ways to do this, including:
- A healthy sandwich with lots of nutritious things inside!
- Healthy things on toast (avocado toast is a great example)
- Soup with bread (just make sure there’s plenty of healthy stuff in the soup!)
Another approach (which can be done in tandem with the above) is to make healthier, non-wheat bread, for example:
- “4-Ingredient 10-Minute Bread” That’s High-Protein, High-Fiber, Gluten-Free
- Healthy Homemade Flatbreads ← a different healthy bread recipe of ours
- Delicious Quinoa Avocado Bread ← another one, also in text
Enjoy!
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Marathons in Mid- and Later-Life
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.
It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
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
We had several requests pertaining to veganism, meatless mondays, and substitutions in recipes—so we’re going to cover those on a different day!
As for questions we’re answering today…
Q: Is there any data on immediate and long term effects of running marathons in one’s forties?
An interesting and very specific question! We didn’t find an overabundance of studies specifically for the short- and long-term effects of marathon-running in one’s 40s, but we did find a couple of relevant ones:
The first looked at marathon-runners of various ages, and found that…
- there are virtually no relevant running time differences (p<0.01) per age in marathon finishers from 20 to 55 years
- the majority of middle-aged and elderly athletes have training histories of less than seven years of running
From which they concluded:
❝The present findings strengthen the concept that considers aging as a biological process that can be considerably speeded up or slowed down by multiple lifestyle related factors.❞
See the study: Performance, training and lifestyle parameters of marathon runners aged 20–80 years: results of the PACE-study
The other looked specifically at the impact of running on cartilage, controlled for age (45 and under vs 46 and older) and activity level (marathon-runners vs sedentary people).
The study had the people, of various ages and habitual activity levels, run for 30 minutes, and measured their knee cartilage thickness (using MRI) before and after running.
They found that regardless of age or habitual activity level, running compressed the cartilage tissue to a similar extent. From this, it can be concluded that neither age nor marathon-running result in long-term changes to cartilage response to running.
Or in lay terms: there’s no reason that marathon-running at 40 should ruin your knees (unless you are doing something wrong).
That may or may not have been a concern you have, but it’s what the study looked at, so hey, it’s information.
Here’s the study: Functional cartilage MRI T2 mapping: evaluating the effect of age and training on knee cartilage response to running
Q: Information on [e-word] dysfunction for those who have negative reactions to [the most common medications]?
When it comes to that particular issue, one or more of these three factors are often involved:
- Hormones
- Circulation
- Psychology
The most common drugs (that we can’t name here) work on the circulation side of things—specifically, by increasing the localized blood pressure. The exact mechanism of this drug action is interesting, albeit beyond the scope of a quick answer here today. On the other hand, the way that they work can cause adverse blood-pressure-related side effects for some people; perhaps you’re one of them.
To take matters into your own hands, so to speak, you can address each of those three things we just mentioned:
Hormones
Ask your doctor (or a reputable phlebotomy service) for a hormone test. If your free/serum testosterone levels are low (which becomes increasingly common in men over the age of 45), they may prescribe something—such as testosterone shots—specifically for that.
This way, it treats the underlying cause, rather than offering a workaround like those common pills whose names we can’t mention here.
Circulation
Look after your heart health; eat for your heart health, and exercise regularly!
Cold showers/baths also work wonders for vascular tone—which is precisely what you need in this matter. By rapidly changing temperatures (such as by turning off the hot water for the last couple of minutes of your shower, or by plunging into a cold bath), your blood vessels will get practice at constricting and maintaining that constriction as necessary.
Psychology
[E-word] dysfunction can also have a psychological basis. Unfortunately, this can also then be self-reinforcing, if recalling previous difficulties causes you to get distracted/insecure and lose the moment. One of the best things you can do to get out of this catch-22 situation is to not worry about it in the moment. Depending on what you and your partner(s) like to do in bed, there are plenty of other equally respectable options, so just switch track!
Having a conversation about this in advance will probably be helpful, so that everyone’s on the same page of the script in that eventuality, and it becomes “no big deal”. Without that conversation, misunderstandings and insecurities could arise for your partner(s) as well as yourself (“aren’t I desirable enough?” etc).
So, to recap, we recommend:
- Have your hormones checked
- Look after your circulation
- Make the decision to have fun!
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Is Chiropractic All It’s Cracked Up To Be?
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Is Chiropractic All It’s Cracked Up To Be?
Yesterday, we asked you for your opinions on chiropractic medicine, and got the above-depicted, below-described set of results:
- 38% of respondents said it keeps us healthy, and everyone should do it as maintenance
- 33% of respondents said it can correct some short-term skeletal issues, but that’s all
- 16% of respondents said that it’s a dangerous pseudoscience and can cause serious harm
- 13% of respondents said that it’s mostly just a combination of placebo and endorphins
Respondents also shared personal horror stories of harm done, personal success stories of things cured, and personal “it didn’t seem to do anything for me” stories.
What does the science say?
It’s a dangerous pseudoscience and can cause harm: True or False?
Mixed and True, respectively.
That is to say, chiropractic in its simplest form that makes the fewest claims, is not a pseudoscience. If somebody physically moves your bones around, your bones will be physically moved. If your bones were indeed misaligned, and the chiropractor is knowledgeable and competent, this will be for the better.
However, like any form of medicine, it can also cause harm; in chiropractic’s case, because it more often than not involves manipulation of the spine, this can be very serious:
❝Twenty six fatalities were published in the medical literature and many more might have remained unpublished.
The reported pathology was usually vascular accidents involving the dissection of a vertebral artery.
Conclusion: Numerous deaths have occurred after chiropractic manipulations. The risks of this treatment by far outweigh its benefit.❞
Source: Deaths after chiropractic: a review of published cases
From this, we might note two things:
- The abstract doesn’t note the initial sample size; we would rather have seen this information expressed as a percentage. Unfortunately, the full paper is not accessible, and nor are many of the papers it cites.
- Having a vertebral artery fatally dissected is nevertheless not an inviting prospect, and is certainly a very reasonable cause for concern.
It’s mostly just a combination of placebo and endorphins: True or False?
True or False, depending on what you went in for:
- If you went in for a regular maintenance clunk-and-click, then yes, you will get your clunk-and-click and feel better for it because you had a ritualized* experience and endorphins were released.
- If you went in for something that was actually wrong with your skeletal alignment, to get it corrected, and this correction was within your chiropractor’s competence, then yes, you will feel better because a genuine fault was corrected.
*this is not implying any mysticism, necessarily, though that can certainly also be a component for many, and indeed, chiropractic was originally founded as a new religious movement. Outside of the context of spirituality, however, it means simply that placebo effect is strongest when there is a ritual associated with it. In this case it means going to the place, sitting in a pleasant waiting room, being called in, removing your shoes and perhaps some other clothes, getting the full attention of a confident and assured person for a while, this sort of thing.
With regard to its use to combat specifically spinal pain (i.e., perhaps the most obvious thing to treat by chiropractic spinal manipulation), evidence is slightly in favor, but remains unclear:
❝Due to the low quality of evidence, the efficacy of chiropractic spinal manipulation compared with a placebo or no treatment remains uncertain. ❞
Source: Clinical Effectiveness and Efficacy of Chiropractic Spinal Manipulation for Spine Pain
It can correct some short-term skeletal issues, but that’s all: True or False?
Probably True.
Why “probably”? The effectiveness of chiropractic treatment for things other than short-term skeletal issues has barely been studied. From this, we may wish to keep an open mind, while also noting that it can hardly claim to be evidence-based—and it’s had hundreds of years to accumulate evidence. In all likelihood, publication bias has meant that studies that were conducted and found inconclusive or negative results were simply not published—but that’s just a hypothesis on our part.
In the case of using chiropractic to treat migraines, a very-related-but-not-skeletal issue, researchers found:
❝Pre-specified feasibility criteria were not met, but deficits were remediable. Preliminary data support a definitive trial of MCC+ for migraine.❞
Translating this: “it didn’t score as well as we hoped, but we can do better. We got some positive results, and would like to do another, bigger, better trial; please fund it”
Source: Multimodal chiropractic care for migraine: A pilot randomized controlled trial
Meanwhile, chiropractors’ claims for very unrelated things have been harshly criticized by the scientific community, for example:
Misinformation, chiropractic, and the COVID-19 pandemic
About that “short-term” aspect, one of our subscribers put it quite succinctly:
❝Often a skeletal correction is required for initial alignment but the surrounding fascia and muscles also need to be treated to mobilize the joint and release deep tissue damage surrounding the area. In combination with other therapies chiropractic support is beneficial.❞
This is, by the way, very consistent with what was said in the very clinically-dense book we reviewed yesterday, which has a chapter on the short-term benefits and limitations of chiropractic.
A truism that holds for many musculoskeletal healthcare matters, holds true here too:
❝In a battle between muscle and bone, muscle will always win❞
In other words…
Chiropractic can definitely help put misaligned bones back where they should be. However, once they’re there, if the cause of their misalignment is not treated, they will just re-misalign themselves shortly after you walking out of your session.
This is great for chiropractors, if it keeps you coming back for endless appointments, but it does little for your body beyond give you a brief respite.
So, by all means go to a chiropractor if you feel so inclined (and you do not fear accidental arterial dissection etc), but please also consider going to a physiotherapist, and potentially other medical professions depending on what seems to be wrong, to see about addressing the underlying cause.
Take care!
Don’t Forget…
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