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

First: a correction and expansion!

After yesterday’s issue of 10almonds covering breast cancer risks and checks, a subscriber wrote to say, with regard to our opening statement, which was:

“Anyone (who has not had a double mastectomy, anyway) can get breast cancer”

❝I have been enjoying your newsletter. This statement is misleading and should have a disclaimer that says even someone who has had a double mastectomy can get breast cancer, again. It is true and nothing…nothing is 100% including a mastectomy. I am a 12 year “thriver” (I don’t like to use the term survivor) who has had a double mastectomy. I work with a local hospital to help newly diagnosed patients deal with their cancer diagnosis and the many decisions that follow. A double mastectomy can help keep recurrence from happening but there are no guarantees. I tried to just delete this and let it go but it doesn’t feel right. Thank you!❞

Thank you for writing in about this! We wouldn’t want to mislead, and we’re always glad to hear from people who have been living with conditions for a long time, as (assuming they are a person inclined to learning) they will generally know topics far more deeply than someone who has researched it for a short period of time.

Regards a double mastectomy (we’re sure you know this already, but noting here for greater awareness, prompted by your message), a lot of circumstances can vary. For example, how far did a given cancer spread, and especially, did it spread to the lymph nodes at the armpits? And what tissue was (and wasn’t) removed?

Sometimes a bilateral prophylactic mastectomy will leave the lymph nodes partially or entirely intact, and a cancer could indeed come back, if not every last cancerous cell was removed.

A total double mastectomy, by definition, should have removed all tissue that could qualify as breast tissue for a breast cancer, including those lymph nodes. However, if the cancer spread unnoticed somewhere else in the body, then again, you’re quite correct, it could come back.

Some people have a double mastectomy without having got cancer first. Either because of a fear of cancer due to a genetic risk (like Angelina Jolie), or for other reasons (like Elliot Page).

This makes a difference, because doing it for reasons of cancer risk may mean surgeons remove the lymph nodes too, while if that wasn’t a factor, surgeons will tend to leave them in place.

In principle, if there is no breast tissue, including lymph nodes, and there was no cancer to spread, then it can be argued that the risk of breast cancer should now be the same “zero” as the risk of getting prostate cancer when one does not have a prostate.

But… Surgeries are not perfect, and everyone’s anatomy and physiology can differ enough from “textbook standard” that surprises can happen, and there’s almost always a non-zero chance of certain health outcomes.

For any unfamiliar, here’s a good starting point for learning about the many types of mastectomy, that we didn’t go into in yesterday’s edition. It’s from the UK’s National Health Service:

NHS: Mastectomy | Types of Mastectomy

And for the more sciency-inclined, here’s a paper about the recurrence rate of cancer after a prophylactic double mastectomy, after a young cancer was found in one breast.

The short version is that the measured incidence rate of breast cancer after prophylactic bilateral mastectomy was zero, but the discussion (including notes about the limitations of the study) is well worth reading:

Breast Cancer after Prophylactic Bilateral Mastectomy in Women with a BRCA1 or BRCA2 Mutation

❝[Can you write about] the availability of geriatric doctors Sometimes I feel my primary isn’t really up on my 70 year old health issues. I would love to find a doctor that understands my issues and is able to explain them to me. Ie; my worsening arthritis in regards to food I eat; in regards to meds vs homeopathic solutions.! Thanks!❞

That’s a great topic, worthy of a main feature! Because in many cases, it’s not just about specialization of skills, but also about empathy, and the gap between studying a condition and living with a condition.

About arthritis, we’re going to do a main feature specifically on that quite soon, but meanwhile, you might like our previous article:

Keep Inflammation At Bay (arthritis being an inflammatory condition)

As for homeopathy, your question prompts our poll today!

(and then we’ll write about that tomorrow)

It’s Q&A Day at 10almonds!

Have a question or a request? We love to hear from you!

In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!

As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!

So, no question/request too big or small 😎

❝What is the best form of sugar for an energy kick during exercise? Both type of sugar eg glicoae fructose dextrose etc and medium, ie drink, gel, solids etc❞

Great question! Let’s be clear first that we’re going to answer this specifically for the context of during exercise.

Because, if you’re not actively exercising strenuously right at the time when you’re taking the various things we’re going to be talking about, the results will not be the same.

For scenarios that are anything less than “I am exercising right now and my muscles (not joints, or anything else) are feeling the burn”, then instead please see this:

Snacks & Hacks: Eating For Energy (In Ways That Actually Work)

Because, to answer your question, we’re going to be going 100% against the first piece of advice in that article, which was “Skip the quasi-injectables”, i.e., anything marketed as very quick release. Those things are useful for diabetics to have handy just in case of needing to urgently correct a hypo, but for most people most of the time, they’re not. See also:

Which Sugars Are Healthier, And Which Are Just The Same?

However…

When strenuously exercising in a way that is taxing our muscles, we do not have to worry about the usual problem of messing up our glucose metabolism by overloading our body with sugars faster than it can use it (thus: it has to hurriedly convert glucose and shove it anywhere it’ll fit to put it away, which is very bad for us), because right now, in the exercise scenario we’re describing, the body is already running its fastest metabolism and is grabbing glucose anywhere it can find it.

Which brings us to our first key: the best type of sugar for this purpose is glucose. Because:

• glucose: the body can use immediately and easily convert whatever’s spare to glycogen (a polysaccharide of glucose) for storage
• fructose: the body cannot use immediately and any conversion of fructose to glycogen has to happen in the liver, so if you take too much fructose (without anything to slow it down, such as the fiber in whole fruit), you’re not only not going to get usable energy (the sugar is just going to be there in your bloodstream, circulating, not getting used, because it doesn’t trigger insulin release and insulin is the gatekeeper that allows sugar to be used), but also, it’s going to tax the liver, which if done to excess, is how we get non-alcoholic fatty liver disease.
• sucrose: is just a disaccharide of glucose and fructose, so it first gets broken down into those, and then its constituent parts get processed as above. Other disaccharides you’ll see mentioned sometimes are maltose and lactose, but again, they’re just an extra step removed from useful metabolism, so to save space, we’ll leave it at that for those today.
• dextrose: is just glucose, but when the labeller is feeling fancy. It’s technically informational because it specifies what isomer of glucose it is, but basically all glucose found in food is d-glucose, i.e. dextrose. Other isomers of glucose can be synthesized (very expensively) in laboratories or potentially found in obscure places (the universe is vast and weird), but in short: unless someone’s going to extreme lengths to get something else, all glucose we encounter is dextrose, and all (absolutely all) dextrose is glucose.

We’d like to show scientific papers contesting these head-to-head for empirical proof, but since the above is basic chemistry and physiology, all we could find is papers taking this for granted and stating in their initial premise that sports drinks, gels, bars usually contain glucose as their main sugar, potentially with some fructose and sucrose. Like this one:

A Comprehensive Study on Sports and Energy Drinks

As for how to take it, again this is the complete opposite of our usual health advice of “don’t drink your calories”, because in this case, for once…

(and again, we must emphasize: only while actively doing strenuous exercise that is making specifically your muscles burn, not your joints or anything else; if your joints are burning you need to rest and definitely don’t spike your blood sugars because that will worsen inflammation)

…just this once, we do want those sugars to be zipping straight into the blood. Which means: liquid is best for this purpose.

And when we say liquid: gel is the same as a drink, so far as the body is concerned, provided the body in question is adequately hydrated (i.e., you are also drinking water).

Here are a pair of studies (by the same team, with the same general methodology), testing things head-to-head, with endurance cyclists on 6-hour stationary cycle rides:

CHO Oxidation from a CHO Gel Compared with a Drink during Exercise

Meanwhile, liquid beat solid, but only significantly so from the 90-minute mark onwards, and even that significant difference was modest (i.e. it’s clinically significant, it’s a statistically reliable result and improbable as random happenstance, but the actual size of the difference was not huge):

Oxidation of Solid versus Liquid CHO Sources during Exercise

We would hypothesize that the reason that liquids only barely outperformed solids for this task is precisely because the solids in question were also designed for the task. When a company makes a fast-release energy bar, they don’t load it with fiber to slow it down. Which differentiates this greatly from, say, getting one’s sugars from whole fruit.

If the study had compared apples to apple juice, we hypothesize the results would have been very different. But alas, if that study has been done, we couldn’t find it.

Today has been all about what’s best during exercise, so let’s quickly finish with a note on what’s best before and after:

Before: What To Eat, Take, And Do Before A Workout

After: Overdone It? How To Speed Up Recovery After Exercise

Take care!