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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Cashew Nuts vs Macadamia Nuts – Which is Healthier?
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Our Verdict
When comparing cashews to macadamias, we picked the cashews.
Why?
In terms of macros, cashews have more than 2x the protein, while macadamias have nearly 2x the fat. The fats are mostly monounsaturated, so it’s still healthy in moderation, but still, we’re going to prize the protein over it and call this category a nominal win for cashews.
When it comes to vitamins, things are fairly even; cashews have more of vitamins B5, B6, B9, and E, while macadamias have more of vitamins B1, B2, B3, and C.
In the category of minerals, cashews take the clear lead; cashews have more copper, iron, magnesium, phosphorus, potassium, selenium, and zinc, while macadamias have more calcium and manganese.
In short, enjoy both (as macadamias have their benefits too), but cashews win in total nutrient density.
Want to learn more?
You might like to read:
Why You Should Diversify Your Nuts
Take care!
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Mung Beans vs Black Gram – Which is Healthier?
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Our Verdict
When comparing mung beans to black gram, we picked the black gram.
Why?
Both are great, and it was close!
In terms of macros, the main difference is that mung beans have slightly more fiber, while black gram has slightly more protein. So, it comes down to which we prioritize out of those two, and we’re going to call it fiber and thus hand the win in this category to mung beans—but it’s very close in either case.
In the category of vitamins, mung beans have more of vitamins B1, B6, and B9, while black gram has more of vitamins A, B2, B3, and B5. They’re equal on vitamins C, E, K, and choline. So, a marginal victory by the numbers for black gram here.
When it comes to minerals, mung beans have more copper and potassium, while black gram has more calcium, iron, magnesium, manganese, and phosphorus. They’re equal on selenium and zinc. Another win for black gram.
Adding up the sections makes for an overall win for black gram, but by all means enjoy either or both; diversity is good!
Want to learn more?
You might like to read:
What’s Your Plant Diversity Score?
Enjoy!
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Tribulus Terrestris For Testosterone?
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(Clinical) Trials and Tribul-ations
In the category of supplements that have enjoyed use as aphrodisiacs, Tribulus terrestris (also called caltrop, goat’s head, gokshura, or puncture vine) has a long history, having seen wide use in both Traditional Chinese Medicine and in Ayurveda.
It’s been used for other purposes too, and has been considered a “general wellness” plant.
So, what does the science say?
Good news: very conclusive evidence!
Bad news: the conclusion is not favorable…
Scientists are known for their careful use of clinical language, and it’s very rare for a study/review to claim something as proven (scientists leave journalists to do that part), and in this case, when it comes to Tribulus’s usefulness as a testosterone-enhancing libido-boosting supplement…
❝analysis of empirical evidence from a comprehensive review of available literature proved this hypothesis wrong❞
Strong words! You can read it in full here; they do make some concessions along the way (e.g. mentioning unclear or contradictory findings, suggesting that it may have some effect, but by an as-yet unknown mechanism if it does—although some potential effect on nitric oxide levels has been hypothesized, which is reasonable if so, as NO does feature in arousal-signalling), but the general conclusion is “no, this doesn’t have androgen-enhancing properties”:
Pro-sexual and androgen enhancing effects of Tribulus terrestris L.: Fact or Fiction
That’s a review though, what about taking a look at a representative RCT? Here we go:
❝Tribulus terrestris was not more effective than placebo on improving symptoms of erectile dysfunction or serum total testosterone❞
As a performance-enhancer in sport
We’ll be brief here: it doesn’t seem to work and it may not be safe:
Insights into Supplements with Tribulus Terrestris used by Athletes
From sport, into general wellness?
Finally, a study that finds it may be useful for something!
❝Overall, participants supplemented with TT displayed significant improvements in lipid profile. Inflammatory and hematological biomarkers showed moderate beneficial effects with no significant changes on renal biomarkers. No positive effects were observed on the immune system response. Additionally, no TT-induced toxicity was reported.
In conclusion, there was no clear evidence of the beneficial effects of TT supplementation on muscle damage markers and hormonal behavior.❞
About those lipids…
Animal studies have shown that it may not only improve lipid profiles, but also may partially repair the endothelial dysfunction resulting from hyperlipidemia:
Want to try some?
In the unlikely event that today’s research review has inspired you with an urge to try Tribulus terrestris, here’s an example product on Amazon
If on the other hand you’d like to actually increase testosterone levels, then we suggest:
Topping Up Testosterone? ← a previous main feature did earlier this year
Take care!
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Brazil Nuts vs Cashews – Which is Healthier?
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.
Our Verdict
When comparing Brazil nuts to cashews, we picked the cashews.
Why?
Looking at the macros first, Brazil nuts have more fat and fiber, while cashews have more carbs and protein. So, it really comes down to what you want to prioritize. We’d generally consider fiber the tie-breaker, making this category a subjective marginal win for Brazil nuts—and especially marginal since they are both low glycemic index foods in any case.
When it comes to vitamins, Brazil nuts have more of vitamins C, E, and choline, while cashews have more of vitamins B2, B3, B5, B6, B7, B9, and K, so while both are great, this category is a clear by-the-numbers win for cashews.
The category of minerals is an interesting one. Brazil nuts have more calcium, magnesium, phosphorus, and selenium, while cashews have more copper, iron, manganese, and zinc. That would be a 4:4 tie, but let’s take a closer look at those selenium levels:
- A cup of cashews contains 109% of the RDA of selenium. Your hair will be luscious and shiny.
- A cup of Brazil nuts contains 10,456% of the RDA of selenium. This is way past the point of selenium toxicity, and your (luscious, shiny) hair will fall out.
For this reason, it’s recommended to eat no more than 3–4 Brazil nuts per day.
We consider that a point against Brazil nuts.
Adding up the section makes for a win for cashews. Of course, enjoy Brazil nuts too if you will, but in careful moderation please!
Want to learn more?
You might like to read:
Why You Should Diversify Your Nuts
Take care!
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We’re only using a fraction of health workers’ skills. This needs to change
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Roles of health professionals are still unfortunately often stuck in the past. That is, before the shift of education of nurses and other health professionals into universities in the 1980s. So many are still not working to their full scope of practice.
There has been some expansion of roles in recent years – including pharmacists prescribing (under limited circumstances) and administering a wider range of vaccinations.
But the recently released paper from an independent Commonwealth review on health workers’ “scope of practice” identifies the myriad of barriers preventing Australians from fully benefiting from health professionals’ skills.
These include workforce design (who does what, where and how roles interact), legislation and regulation (which often differs according to jurisdiction), and how health workers are funded and paid.
There is no simple quick fix for this type of reform. But we now have a sensible pathway to improve access to care, using all health professionals appropriately.
A new vision for general practice
I recently had a COVID booster. To do this, I logged onto my general practice’s website, answered the question about what I wanted, booked an appointment with the practice nurse that afternoon, got jabbed, was bulk-billed, sat down for a while, and then went home. Nothing remarkable at all about that.
But that interaction required a host of facilitating factors. The Victorian government regulates whether nurses can provide vaccinations, and what additional training the nurse requires. The Commonwealth government has allowed the practice to be paid by Medicare for the nurse’s work. The venture capitalist practice owner has done the sums and decided allocating a room to a practice nurse is economically rational.
The future of primary care is one involving more use of the range of health professionals, in addition to GPs.
It would be good if my general practice also had a physiotherapist, who I could see if I had back pain without seeing the GP, but there is no Medicare rebate for this. This arrangement would need both health professionals to have access to my health record. There also needs to be trust and good communication between the two when the physio might think the GP needs to be alerted to any issues.
This vision is one of integrated primary care, with health professionals working in a team. The nurse should be able to do more than vaccination and checking vital signs. Do I really need to see the GP every time I need a prescription renewed for my regular medication? This is the nub of the “scope of practice” issue.
How about pharmacists?
An integrated future is not the only future on the table. Pharmacy owners especially have argued that pharmacists should be able to practise independently of GPs, prescribing a limited range of medications and dispensing them.
This will inevitably reduce continuity of care and potentially create risks if the GP is not aware of what other medications a patient is using.
But a greater role for pharmacists has benefits for patients. It is often easier and cheaper for the patient to see a pharmacist, especially as bulk billing rates fall, and this is one of the reasons why independent pharmacist prescribing is gaining traction.
It’s often easier for a patient to see a pharmacist than a GP. PeopleImages.com – Yuri A/Shutterstock Every five years or so the government negotiates an agreement with the Pharmacy Guild, the organisation of pharmacy owners, about how much pharmacies will be paid for dispensing medications and other services. These agreements are called “Community Pharmacy Agreements”. Paying pharmacists independent prescribing may be part of the next agreement, the details of which are currently being negotiated.
GPs don’t like competition from this new source, even though there will be plenty of work around for GPs into the foreseeable future. So their organisations highlight the risks of these changes, reopening centuries old turf wars dressed up as concerns about safety and risk.
Who pays for all this?
Funding is at the heart of disputes about scope of practice. As with many policy debates, there is merit on both sides.
Clearly the government must increase its support for comprehensive general practice. Existing funding of fee-for-service medical benefits payments must be redesigned and supplemented by payments that allow practices to engage a range of other health professionals to create health-care teams.
This should be the principal direction of primary care reform, and the final report of the scope of practice review should make that clear. It must focus on the overall goal of better primary care, rather than simply the aspirations of individual health professionals, and working to a professional’s full scope of practice in a team, not a professional silo.
In parallel, governments – state and federal – must ensure all health professionals are used to their best of their abilities. It is a waste to have highly educated professionals not using their skills fully. New funding arrangements should facilitate better access to care from all appropriately qualified health professionals.
In the case of prescribing, it is possible to reconcile the aspirations of pharmacists and the concerns of GPs. New arrangements could be that pharmacists can only renew medications if they have agreements with the GP and there is good communication between them. This may be easier in rural and suburban areas, where the pharmacists are better known to the GPs.
The second issues paper points to the complexity of achieving scope of practice reforms. However, it also sets out a sensible path to improve access to care using all health professionals appropriately.
Stephen Duckett, Honorary Enterprise Professor, School of Population and Global Health, and Department of General Practice and Primary Care, The University of Melbourne
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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How Likely Are You To Live To 100?
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How much hope can we reasonably have of reaching 100?
Yesterday, we asked you: assuming a good Health-Related Quality of Life (HRQoL), how much longer do you hope to live?
We got the above-depicted, below-described, set of responses:
- A little over 38% of respondents hope to live another 11–20 years
- A little over 31% hope to live another 31–40 years
- A little over 7% will be content to make it to the next decade
- One (1) respondent hopes to live longer than an additional 100 years
This is interesting when we put it against our graph of how old our subscribers are:
…because it corresponds inversely, right down to the gap/dent in the 40s. And—we may hypothesize—that one person under 18 who hopes to live to 120, perhaps.
This suggests that optimism remains more or less constant, with just a few wobbles that would probably be un-wobbled with a larger sample size.
In other words: most of our education-minded, health-conscious subscriber-base hope to make it to the age of 90-something, while for the most part feeling that 100+ is overly optimistic.
Writer’s anecdote: once upon a time, I was at a longevity conference in Brussels, and a speaker did a similar survey, but by show of hands. He started low by asking “put your hands up if you want to live at least a few more minutes”. I did so, with an urgency that made him laugh, and say “Don’t worry; I don’t have a gun hidden up here!”
Conjecture aside… What does the science say about our optimism?
First of all, a quick recap…
To not give you the same information twice, let’s note we did an “aging mythbusting” piece already covering:
- Aging is inevitable: True or False?
- Aging is, and always will be, unstoppable: True or False?
- We can slow aging: True or False?
- It’s too early to worry about… / It’s too late to do anything about… True or False?
- We can halt aging: True or False?
- We can reverse aging: True or False?
- But those aren’t really being younger, we’ll still die when our time is up: True or False?
You can read the answers to all of those here:
Age & Aging: What Can (And Can’t) We Do About It?
Now, onwards…
It is unreasonable to expect to live past 100: True or False?
True or False, depending on your own circumstances.
First, external circumstances: the modal average person in Hong Kong is currently in their 50s and can expect to live into their late 80s, while the modal average person in Gaza is 14 and may not expect to make it to 15 right now.
To avoid extremes, let’s look at the US, where the modal average person is currently in their 30s and can expect to live into their 70s:
United States Mortality Database
Now, before that unduly worries our many readers already in their 70s…
Next, personal circumstances: not just your health, but your socioeconomic standing. And in the US, one of the biggest factors is the kind of health insurance one has:
SOA Research Institute | Life Expectancy Calculator 2021
You may note that the above source puts all groups into a life expectancy in the 80s—whereas the previous source gave 70s.
Why is this? It’s because the SOA, whose primary job is calculating life insurance risks, is working from a sample of people who have, or are applying for, life insurance. So it misses out many people who die younger without such.
New advances in medical technology are helping people to live longer: True or False?
True, assuming access to those. Our subscribers are mostly in North America, and have an economic position that affords good access to healthcare. But beware…
On the one hand:
The number of people who live past the age of 100 has been on the rise for decades
On the other hand:
The average life expectancy in the U.S. has been on the decline for three consecutive years
COVID is, of course, largely to blame for that, though:
❝The decline of 1.8 years in life expectancy was primarily due to increases in mortality from COVID-19 (61.2% of the negative contribution).
The decline in life expectancy would have been even greater if not for the offsetting effects of decreases in mortality due to cancer (43.1%)❞
Source: National Vital Statistics Reports
The US stats are applicable to Canada, the UK, and Australia: True or False?
False: it’s not quite so universal. Differences in healthcare systems will account for a lot, but there are other factors too:
- Life expectancy in Canada fell for the 3rd year in a row. What’s happening?
- UK life expectancy lagging behind rest of G7 except the US
- Australians are living longer but what does it take to reach 100 years old?
Here’s an interesting (UK-based) tool that calculates not just your life expectancy, but also gives the odds of living to various ages (e.g. this writer was given odds of living to 87, 96, 100).
Check yours here:
Office of National Statistics | Life Expectancy Calculator
To finish on a cheery note…
Data from Italian centenarians suggests a “mortality plateau”:
❝The risk of dying leveled off in people 105 and older, the team reports online today in Science.
That means a 106-year-old has the same probability of living to 107 as a 111-year-old does of living to 112.
Furthermore, when the researchers broke down the data by the subjects’ year of birth, they noticed that over time, more people appear to be reaching age 105.❞
Pop-sci source: Once you hit this age, aging appears to stop
Actual paper: The plateau of human mortality: demography of longevity pioneers
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