Cupping: How It Works (And How It Doesn’t)
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Good Health By The Cup?
In Tuesday’s newsletter, we asked you for your opinion of cupping (the medical practice), and got the above-depicted, below-described, set of responses:
- About 40% said “It may help by improving circulation and stimulating the immune system”
- About 26% said “I have never heard of the medical practice of cupping before this”
- About 19% said “It is pseudoscience and/or placebo at best, but probably not harmful
- About 9% said “It is a good, evidence-based practice that removes toxins and stimulates health”
- About 6% said “It is a dangerous practice that often causes harm to people who need medical help”
So what does the science say?
First, a quick note for those unfamiliar with cupping: it is the practice of placing a warmed cup on the skin (open side of the cup against the skin). As the warm air inside cools, it reduces the interior air pressure, which means the cup is now (quite literally) a suction cup. This pulls the skin up into the cup a little. The end result is visually, and physiologically, the same process as what happens if someone places the nozzle of a vacuum cleaner against their skin. For that matter, there are alternative versions that simply use a pump-based suction system, instead of heated cups—but the heated cups are most traditional and seem to be most popular. See also:
National Center for Complementary and Integrative Health | Cupping
It is a dangerous practice that often causes harm to people who need medical help: True or False?
False, for any practical purposes.
- Directly, it can (and usually does) cause minor superficial harm, much like many medical treatments, wherein the benefits are considered to outweigh the harm, justifying the treatment. In the case of cupping, the minor harm is usually a little bruising, but there are other risks; see the link we gave just above.
- Indirectly, it could cause harm by emboldening a person to neglect a more impactful treatment for their ailment.
But, there’s nothing for cupping akin to the “the most common cause of death is when someone gets a vertebral artery fatally severed” of chiropractic, for example.
It is a good, evidence-based practice that removes toxins and stimulates health: True or False?
True and False in different parts. This one’s on us; we included four claims in one short line. But let’s look at them individually:
- Is it good? Well, those who like it, like it. It legitimately has some mild health benefits, and its potential for harm is quite small. We’d call this a modest good, but good nonetheless.
- Is it evidence-based? Somewhat, albeit weakly; there are some papers supporting its modest health claims, although the research is mostly only published in journals of alternative medicine, and any we found were in journals that have been described by scientists as pseudoscientific.
- Does it remove toxins? Not directly, at least. There is also a version that involves making a small hole in the skin before applying the cup, the better to draw out the toxins (called “wet cupping”). This might seem a little medieval, but this is because it is from early medieval times (wet cupping’s first recorded use being in the early 7th century). However, the body’s response to being poked, pierced, sucked, etc is to produce antibodies, and they will do their best to remove toxins. So, indirectly, there’s an argument.
- Does it stimulate health? Yes! We’ll come to that shortly. But first…
It is pseudoscience and/or placebo at best, but probably not harmful: True or False?
True in that its traditionally-proposed mechanism of action is a pseudoscience and placebo almost certainly plays a strong part, and also in that it’s generally not harmful.
On it being a pseudoscience: we’ve talked about this before, but it bears repeating; just because something’s proposed mechanism of action is pseudoscience, doesn’t necessarily mean it doesn’t work by some other mechanism of action. If you tell a small child that “eating the rainbow” will improve their health, and they believe this is some sort of magical rainbow power imbuing them with health, then the mechanism of action that they believe in is a pseudoscience, but eating a variety of colorful fruit and vegetables will still be healthy.
In the case of cupping, its proposed mechanism of action has to do withbalancing qi, yin and yang, etc (for which scientific evidence does not exist), in combination with acupuncture lore (for which some limited weak scientific evidence exists). On balancing qi, yin and yang etc, this is a lot like Europe’s historically popular humorism, which was based on the idea of balancing the four humors (blood, yellow bile, black bile, phlegm). Needless to say, humorism was not only a pseudoscience, but also eventually actively disproved with the advent of germ theory and modern medicine. Cupping therapy is not more scientifically based than humorism.
On the placebo side of things, there probably is a little more to it than that; much like with acupuncture, a lot of it may be a combination of placebo and using counter-irritation, a nerve-tricking method to use pain to reduce pain (much like pressing with one’s nail next to an insect bite).
Here’s one of the few studies we found that’s in what looks, at a glance, to be a reputable journal:
Cupping therapy and chronic back pain: systematic review and meta-analysis
It may help by improving circulation and stimulating the immune system: True or False?
True! It will improve local circulation by forcing blood into the area, and stimulate the immune system by giving it a perceived threat to fight.
Again, this can be achieved by many other means; acupuncture (or just “dry needling”, which is similar but without the traditional lore), a cold shower, and/or exercise (and for that matter, sex—which combines exercise, physiological arousal, and usually also foreign bodies to respond to) are all options that can improve circulation and stimulate the immune system.
You can read more about using some of these sorts of tricks for improving health in very well-evidenced, robustly scientific ways here:
The Stress Prescription (Against Aging!)
Take care!
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The Lupus Encyclopedia – by Dr. Donald Thomas
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First, a note on the authorship: while this is broadly by Donald E. Thomas Jr. MD FACP FACR, there were more contributors, namely:
Jemima Albayda, MD; Divya Angra, MD; Alan N. Baer, MD; Sasha Bernatsky, MD, PhD; George Bertsias, MD, PhD; Ashira D. Blazer, MD; Ian Bruce, MD; Jill Buyon, MD; Yashaar Chaichian, MD; Maria Chou, MD; Sharon Christie, Esq; Angelique N. Collamer, MD; Ashté Collins, MD; Caitlin O. Cruz, MD; Mark M. Cruz, MD; Dana DiRenzo, MD; Jess D. Edison, MD; Titilola Falasinnu, PhD; Andrea Fava, MD; Cheri Frey, MD; Neda F. Gould, PhD; Nishant Gupta, MD; Sarthak Gupta, MD; Sarfaraz Hasni, MD; David Hunt, MD; Mariana J. Kaplan, MD; Alfred Kim, MD; Deborah Lyu Kim, DO; Rukmini Konatalapalli, MD; Fotios Koumpouras, MD; Vasileios C. Kyttaris, MD; Jerik Leung, MPH; Hector A. Medina, MD; Timothy Niewold, MD; Julie Nusbaum, MD; Ginette Okoye, MD; Sarah L. Patterson, MD; Ziv Paz, MD; Darryn Potosky, MD; Rachel C. Robbins, MD; Neha S. Shah, MD; Matthew A. Sherman, MD; Yevgeniy Sheyn, MD; Julia F. Simard, ScD; Jonathan Solomon, MD; Rodger Stitt, MD; George Stojan, MD; Sangeeta Sule, MD; Barbara Taylor, CPPM, CRHC; George Tsokos, MD; Ian Ward, MD; Emma Weeding, MD; Arthur Weinstein, MD; Sean A. Whelton, MD
The reason we mention this is to render it clear that this isn’t one man’s opinions (as happens with many books about certain topics), but rather, a panel of that many doctors all agreeing that this is correct and good, evidence-based, up-to-date (as of the publication of this latest revised edition last year) information.
And if you have lupus, you’ll be aware there are a lot of doctors who don’t know a tremendous amount about it, hence the value of this “…for patients and healthcare providers” tome.
It is what it claims to be: a very comprehensive guide. It’s not light reading, and it is 848 pages of information-dense text and diagrams. If you want to know something, anything, about lupus, then if science knows it, then chances are it is in this book, or this book will at least point you directly to a paper you can read about your specific query.
The style is, nevertheless, about as readable for the layperson as possible, which is quite an achievement for a book with this amount of dense scientific information. For that, the author thanks his husband, for being the non-doctor beta-reader to screen it for readability—quite a service, with all those doctors writing!
Bottom line: if you or someone you love has lupus, this book should absolutely be in your collection.
Click here to check out The Lupus Encyclopedia, and have everything at your fingertips!
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The Conquest of Happiness – by Bertrand Russell
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When we have all our physical needs taken care of, why are we often still not happy, and what can we do about that?
Mathematician, philosopher, and Nobel prizewinner Bertrand Russell has answers. And, unlike many of “the great philosophers”, his writing style is very clear and accessible.
His ideas are simple and practical, yet practised by few. Rather than taking a “be happy with whatever you have” approach, he does argue that we should strive to find more happiness in some areas and ways—and lays out guidelines for doing so.
Areas to expand, areas to pull back on, areas to walk a “virtuous mean”. Things to be optimistic about; things to not get our hopes up about.
Applying Russell’s model, there’s no more “should I…?” moments of wondering which way to jump.
Bottom line: if you’ve heard enough about “how to be happy” from wishy-washier sources, you might find the work of this famous logician refreshing.
Click here to check out The Conquest of Happiness, and see how much happier you might become!
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Uric Acid’s Extensive Health Impact (And How To Lower It)
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Uric Acid’s Extensive Health Impact (And How To Lower It)
This is Dr. David Perlmutter. He’s a medical doctor, and a Fellow of the American College of Nutrition. He’s a member of the Editorial Board for the Journal of Alzheimer’s Disease, and has been widely published in many other peer-reviewed journals.
What does he want us to know?
He wants us to know about the health risks of uric acid (not something popularly talked about so much!), and how to reduce it.
First: what is it? Uric acid is a substance we make in our own body. However, unlike most substances we make in our body, we have negligible use for it—it’s largely a waste product, usually excreted in urine.
However, if we get too much, it can build up (and crystallize), becoming such things as kidney stones, or causing painful inflammation if it shows up in the joints, as in gout.
More seriously (unpleasant as kidney stones and gout may be), this inflammation can have a knock-on effect triggering (or worsening) other inflammatory conditions, ranging from non-alcoholic fatty liver disease, to arthritis, to dementia, and even heart problems. See for example:
- David Perlmutter | Uric Acid and Cognitive Decline
- American Heart Association | Uric acid linked to later risk for irregular heart rhythm
- World Journal of Gastroenterology | The role of uric acid in non-alcoholic steatohepatitis development
How can we reduce our uric acid levels?
Uric acid is produced when we metabolize purine nucleotides, which are found in many kinds of food. We can therefore reduce our uric acid levels by reducing our purine intake, as well as things that mess up our liver’s ability to detoxify things. Offsetting the values for confounding variables (such as fiber content, or phytochemicals that mitigate the harm), the worst offenders include…
Liver-debilitating things:
- Alcohol (especially beer)
- High-fructose corn syrup (and other fructose-containing things that aren’t actual fruit)
- Other refined sugars
- Wheat / white flour products (this is why beer is worse than wine, for example; it’s a double-vector hit)
Purine-rich things:
- Red meats and game
- Organ meats
- Oily fish, and seafood (great for some things; not great for this)
Some beans and legumes are also high in purines, but much like real fruit has a neutral or positive effect on blood sugar health despite its fructose content, the beans and legumes that are high in purines, also contain phytochemicals that help lower uric acid levels, so have a beneficial effect.
Eggs (consumed in moderation) and tart cherries have a uric-acid lowering effect.
Water is important for all aspects of health, and doubly important for this.
Hydrate well!
Lifestyle matters beyond diet
The main key here is metabolic health, so Dr. Perlmutter advises the uncontroversial lifestyle choices of moderate exercise and good sleep, as well as (more critically) intermittent fasting. We wrote previously on other things that can benefit liver health:
…in this case, that means the liver gets a break to recuperate (something it’s very good at, but does need to get a chance to do), which means that while you’re not giving it something new to do, it can quickly catch up on any backlog, and then tackle any new things fresh, next time you start eating.
Want to know more about this from Dr. Perlmutter?
You might like his article:
An Integrated Plan for Lowering Uric Acid ← more than we had room for here; he also talks about extra things to include in your diet/supplementation regime for beneficial effects!
And/or his book:
…on which much of today’s main feature was based.
Take care!
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The Squat Bible – by Dr. Aaron Horschig
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You probably know the following three things about squats:
- Squatting is great for the health in many ways
- There are many different ways to squat
- Not all of them are correct, and some may even do harm
Dr. Aaron Horschig makes the case for squats being a movement first, and an exercise second. To this end, he takes us on a joint-by-joint tour of the anatomy of squatting, so that we get it right from top to toe.
Or rather: from toe to top, since he starts with the best foundation.
What this means is that if you’ve struggled to squat because you find some discomfort in your ankles, or a weakness in the knees, or you can’t get your back quite right, Dr. Horschig will have a fix for you. He also takes a realistic look about how people’s anatomy varies from person to person, and what differences this makes to how we each should best squat.
The explanations are clear and so are the pictures—we recommend getting the color print edition (linked), as the image quality is better than the black and white and/or Kindle edition.
Bottom-line: squats are one of the single best exercises we can do for our health—but we can miss out on benefits (or even do ourselves harm) if we don’t do them well. This book is a comprehensive reference resource for making sure we get the most out of our squatting ability.
Click here to check out The Squat Bible, and master this all-important movement!
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No Equipment Muscle Gain Routine for Ages 50+
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Sarcopenia, the loss of muscle mass commonly associated with aging, can be a big problem as it leaves us vulnerable to injury (and also isn’t great for the metabolism—keeping adequate muscle mass ensures keeping the metabolism ticking over nicely). Will Harlow, over-50s specialist physiotherapist, is here to share a routine that works without weights:
Where it counts
There’s a fair amount of emphasis here on the lower body and core. That’s because in practical terms, this is what matters more for our health than having bulging biceps:
- First exercise: donkey calf raises to build strength in the calves using a chair.
- Second exercise: single-leg elevated lunge to work the quads and glutes, using a step or books for elevation.
- Third exercise: slow sit-to-stand for quads, glutes, and core strength, focusing on a slow descent.
- Fourth exercise: wall press-up to strengthen the chest, shoulders, and arms, with a variation using towels for increased resistance.
- Final exercise: shoulder raises using bottles or similar weights to target the shoulders and rotator cuffs.
Ok, so that last one was a slight cheat on his part as it does require grabbing a weight, but it’s not specialist equipment at least, and can just be something you grabbed at home. It’s also the least important of the five exercises, and can be skipped if necessary.
For more on all of these plus visual demonstrations, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
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Ginger Does A Lot More Than You Think
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Ginger’s benefits go deep!
You are doubtlessly already familiar with what ginger is, so let’s skip right into the science.
The most relevant active compound in the ginger root is called gingerol, and people enjoy it not just for its taste, but also a stack of health reasons, such as:
- For weight loss
- Against nausea
- Against inflammation
- For cardiovascular health
- Against neurodegeneration
Quite a collection! So, what does the science say?
For weight loss
This one’s quite straightforward. It not only helps overall weight loss, but also specifically improves waist-hip ratio, which is a much more important indicator of health than BMI.
Against nausea & pain
Ginger has proven its effectiveness in many high quality clinical trials, against general nausea, post-surgery nausea, chemotherapy-induced nausea, and pregnancy-related nausea.
Source: Ginger on Human Health: A Comprehensive Systematic Review of 109 Randomized Controlled Trials
However! While it very clearly has been shown to be beneficial in the majority of cases, there are some small studies that suggest it may not be safe to take close to the time of giving birth, or in people with a history of pregnancy loss, or unusual vaginal bleeding, or clotting disorders.
See specifically: Ginger for nausea and vomiting of pregnancy
As a side note on the topic of “trouble down there”, ginger has also been found to be as effective as Novafen (a combination drug of acetaminophen (Tylenol), caffeine, and ibuprofen), in the task of relieving menstrual pain:
See: Effect of Ginger and Novafen on menstrual pain: A cross-over trial
Against inflammation & pain
Ginger has well-established anti-inflammatory (and, incidentally, which affects many of the same systems, antioxidant) effects. Let’s take a look at that first:
Read: Effect of Ginger on Inflammatory Diseases
Attentive readers will note that this means that ginger is not merely some nebulous anti-inflammatory agent. Rather, it also specifically helps alleviate delineable inflammatory diseases, ranging from colitis to Crohn’s, arthritis to lupus.
We’ll be honest (we always are!), the benefits in this case are not necessarily life-changing, but they are a statistically significant improvement, and if you are living with one of those conditions, chances are you’ll be glad of even things described in scientific literature as “modestly efficacious”.
What does “modestly efficacious” look like? Here are the numbers from a review of 593 patients’ results in clinical trials (against placebo):
❝Following ginger intake, a statistically significant pain reduction SMD = −0.30 ([95% CI: [(−0.50, −0.09)], P = 0.005]) with a low degree of inconsistency among trials (I2 = 27%), and a statistically significant reduction in disability SMD = −0.22 ([95% CI: ([−0.39, −0.04)]; P = 0.01; I2 = 0%]) were seen, both in favor of ginger.❞
To de-mathify that:
- Ginger reduced pain by 30%
- Ginger reduced disability by 22%
Read the source: Efficacy and safety of ginger in osteoarthritis patients: a meta-analysis of randomized placebo-controlled trials
Because (in part) of the same signalling pathways, it also has benefits against cancer (and you’ll remember, it also reduces the symptoms of chemotherapy).
See for example: Ginger’s Role in Prevention and Treatment of Gastrointestinal Cancer
For cardiovascular health
In this case, its benefits are mostly twofold:
- It significantly reduces triglycerides and LDL cholesterol, while increasing HDL cholesterol
- It significantly reduces fasting blood sugar levels and HbA1c levels (both risk factors for CVD)
Against neurodegeneration
This is in large part because it reduces inflammation, which we discussed earlier.
But, not everything passes the blood-brain barrier, so it’s worth noting when something (like gingerol) does also have an effect on brain health as well as the rest of the body.
You do not want inflammation in your brain; that is Bad™ and strongly associated with Alzheimer’s and Parkinson’s.
As well as reducing neuroinflammation, ginger has other relevant mechanisms too:
❝Its bioactive compounds may improve neurological symptoms and pathological conditions by modulating cell death or cell survival signaling molecules.
The cognitive enhancing effects of ginger might be partly explained via alteration of both the monoamine and the cholinergic systems in various brain areas.
Moreover, ginger decreases the production of inflammatory related factors❞
Check it out in full, as this is quite interesting:
Role of Ginger in the Prevention of Neurodegenerative Diseases
How much to take?
In most studies, doses of 1–3 grams/day were used.
Where to get it?
Your local supermarket, as a first port-of-call. Especially given the dose you want, it may be nicer for you to have a touch of sliced ginger root in your cooking, rather than taking 2–6 capsules per day to get the same dose.
Obviously, this depends on your culinary preferences, and ginger certainly doesn’t go with everything!
If you do want it as a supplement, here is an example product on Amazon, for your convenience.
Enjoy!
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