Fat’s Real Barriers To Health

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Fat Justice In Healthcare

This is Aubrey Gordon, an author, podcaster, and fat justice activist. What does that mean?

When it comes to healthcare, we previously covered some ideas very similar to her work, such as how…

There’s a lot of discrimination in healthcare settings

In this case, it often happens that a thin person goes in with a medical problem and gets treated for that, while a fat person can go in with the same medical problem and be told “you should try losing some weight”.

Top tip if this happens to you… Ask: “what would you advise/prescribe to a thin person with my same symptoms?”

Other things may be more systemic, for example:

When a thin person goes to get their blood pressure taken, and that goes smoothly, while a fat person goes to get their blood pressure taken, and there’s not a blood pressure cuff to fit them, is the problem the size of the person or the size of the cuff? It all depends on perspective, in a world built around thin people.

That’s a trivial-seeming example, but the same principle has far-reaching (and harmful) implications in healthcare in general, e.g:

  • Surgeons being untrained (and/or unwilling) to operate on fat people
  • Getting a one-size-fits-all dose that was calculated using average weight, and now doesn’t work
  • MRI machines are famously claustrophobia-inducing for thin people; now try not fitting in it in the first place

…and so forth. So oftentimes, obesity will be correlated with a poor healthcare outcome, where the problem is not actually the obesity itself, but rather the system having been set up with thin people in mind.

It would be like saying “Having O- blood type results in higher risks when receiving blood transfusions”, while omitting to add “…because we didn’t stock O- blood”.

Read more on this topic: Shedding Some Obesity Myths

Does she have practical advice about this?

If she could have you understand one thing, it would be:

You deserve better.

Or if you are not fat: your fat friends deserve better.

How this becomes useful is: do not accept being treated as the problem!

Demand better!

If you meekly accept that you “just need to lose weight” and that thus you are the problem, you take away any responsibility from your healthcare provider(s) to actually do their jobs and provide healthcare.

See also Gordon’s book, which we’ve not reviewed yet but probably will one of these days:

“You Just Need to Lose Weight”: And 19 Other Myths About Fat People – by Aubrey Gordon

Are you saying fat people don’t need to lose weight?

That’s a little like asking “would you say office workers don’t need to exercise more?”; there are implicit assumptions built into the question that are going unaddressed.

Rather: some people might benefit healthwise from losing weight, some might not.

In fact, over the age of 65, being what is nominally considered “overweight” reduces all-cause mortality risk.

For details of that and more, see: When BMI Doesn’t Measure Up

But what if I do want/need to lose weight?

Gordon’s not interested in helping with that, but we at 10almonds are, so…

Check out: Lose Weight, But Healthily

Where can I find more from Aubrey Gordon?

You might enjoy her blog:

Aubrey Gordon | Your Fat Friend

Or her other book, which we reviewed previously:

What We Don’t Talk About When We Talk About Fat – by Aubrey Gordon

Enjoy!

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  • The Sweet Truth About Diabetes

    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.

    There’s A Lot Of Confusion About Diabetes!

    For those readers who are not diabetic, nor have a loved one who is diabetic, nor any other pressing reason to know these things, first a quick 101 rundown of some things to understand the rest of today’s main feature:

    • Blood sugar levels: how much sugar is in the blood, measured in mg/dL or mmol/L
    • Hyperglycemia or “hyper” for short: too much sugar in the blood
    • Hypoglycemia or “hypo” for short: too little sugar in the blood
    • Insulin: a hormone that acts as a gatekeeper to allow sugar to pass, or not pass, into various parts of the body
    • Type 1 diabetes (sometimes capitalized, and/or abbreviated to “T1D”) is an autoimmune disorder that prevents the pancreas from being able to supply the body with insulin. This means that taking insulin consistently is necessary for life.
    • Type 2 diabetes is a matter of insulin resistance. The pancreas produces plenty of insulin, but the body has become desensitized to it, so it doesn’t work properly. Taking extra insulin may sometimes be necessary, but for many people, it can be controlled by means of a careful diet and other lifestyle factors.

    With that in mind, on to some very popular myths…

    Diabetes is caused by having too much sugar

    While sugar is not exactly a health food, it’s not the villain of this story either.

    • Type 1 diabetes has a genetic basis, triggered by epigenetic factors unrelated to sugar.
    • Type 2 diabetes comes from a cluster of risk factors which, together, can cause a person to go through pre-diabetes and acquire type 2 diabetes.
      • Those risk factors include:
        • A genetic predisposition
        • A large waist circumference
          • (this is more relevant than BMI or body fat percentage)
        • High blood pressure
        • A sedentary lifestyle
        • Age (the risk starts rising at 35, rises sharply at 45, and continues upwards with increasing age)

    Read more: Risk Factors for Type 2 Diabetes

    Diabetics can’t have sugar

    While it’s true that diabetics must be careful about sugar (and carbs in general), it’s not to say that they can’t have them… just: be mindful and intentional about it.

    • Type 1 diabetics will need to carb-count in order to take the appropriate insulin bolus. Otherwise, too little insulin will result in hyperglycemia, or too much insulin will result in hypoglycemia.
    • Type 2 diabetics will often be able to manage their blood sugar levels with diet alone, and slow-release carbs will make this easier.

    In either case, having quick release sugars will increase blood sugar levels (what a surprise), and sometimes (such as when experiencing a hypo), that’s what’s needed.

    Also, when it comes to sugar, a word on fruit:

    Not all fruits are equal, and some fruits can help maintain stable blood sugar levels! Read all about it:

    Fruit Intake to Prevent and Control Hypertension and Diabetes

    Artificial sweeteners are must-haves for diabetics

    Whereas sugar is a known quantity to the careful diabetic, some artificial sweeteners can impact insulin sensitivity, causing blood sugars to behave in unexpected ways. See for example:

    The Impact of Artificial Sweeteners on Body Weight Control and Glucose Homeostasis

    If a diabetic person is hyper, they should exercise to bring their blood sugar levels down

    Be careful with this!

    • In the case of type 2 diabetes, it may (or may not) help, as the extra sugar may be used up.
    • Type 1 diabetes, however, has a crucial difference. Because the pancreas isn’t making insulin, a hyper (above a certain level, anyway) means more insulin is needed. Exercising could do more harm than good, as unlike in type 2 diabetes, the body has no way to use that extra sugar, without the insulin to facilitate it. Exercising will just pump the syrupy hyperglycemic blood around the body, potentially causing damage as it goes (all without actually being able to use it).

    There are other ways this can be managed that are outside of the scope of this newsletter, but “be careful” is rarely a bad approach.

    Read more, from the American Diabetes Association:

    Exercise & Type 1 Diabetes

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  • 10 Simple Japanese Habits For Healthier & Longer 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.

    You don’t have to be Japanese or live in Okinawa to enjoy the benefits of healthy longevity. A lot of it comes down to simple habits:

    Easy to implement

    We’ll not keep the 10 habits a mystery; they are:

    1. Start the day with hot water: drinking hot water in the morning helps with hydration, warming the body, and aiding digestion.
    2. Enjoy a hearty breakfast: Japanese breakfasts are traditionally filling, nutritious, and help promote energy and longevity. Typical components include rice, miso soup, fish, and pickles.
    3. Take balanced meals: Japanese education emphasizes nutrition from a young age, promoting balanced meals with proteins, fiber, and vitamins & minerals.
    4. Enjoy fermented foods: fermented foods, such as nattō and soy-based condiments, support digestion, heart health, and the immune system.
    5. Drink green tea and matcha: both are rich in health benefits; preparing matcha mindfully adds a peaceful ritual to daily life too.
    6. Keep the “80% full” rule: “hara hachi bu” encourages eating until 80% full, which can improve longevity and, of course, prevent overeating.
    7. Use multiple small dishes: small servings and a variety of dishes help prevent overeating and ensure a diverse intake of nutrients.
    8. Gratitude before and after meals: saying “itadakimasu” and “gochisousama” promotes mindful eating, and afterwards, good digestion. Speaking Japanese is of course not the key factor here, but rather, do give yourself a moment of reflection before and after meals.
    9. Use vinegar in cooking: vinegar, often used in sushi rice and sauces like ponzu, adds flavor and offers health benefits, mostly pertaining to blood sugar balance.
    10. Eat slowly: Eating at a slower pace will improve digestion, and can enhance satiety and prevent accidentally overeating.

    For more on all of these, enjoy:

    Click Here If The Embedded Video Doesn’t Load Automatically!

    Want to learn more?

    You might also like to read:

    How To Get More Out Of What’s On Your Plate

    Take care!

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  • Having dense breasts is linked to cancer. But advice about breast density can depend on where you live

    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.

    Having dense breasts is a clear risk factor for breast cancer. It can also make cancers hard to spot on mammograms.

    Yet you might not be aware you have dense breasts, even after mammographic screening.

    In Australia, advice for women with dense breasts and their health-care professionals can be inconsistent and confusing.

    This is because there’s not currently consensus on whether women who have dense breasts, but no symptoms, benefit from further imaging such as ultrasounds. Concerns include potential cost of these tests and the risk they can produce false positives.

    Gorodenkoff/Shutterstock

    What is breast density?

    Breasts are made up of fatty tissue and fibroglandular tissue (including glands that make milk, held together by fibrous tissue).

    On a mammogram – an x-ray of the breast – fibroglandular tissue appears white and fatty tissue appears dark. The white areas are referred to as breast density.

    Hands in surgical gloves point a pen at a breast x-ray image.
    Fibroglandular tissue shows up white on a mammogram. Nata Sokhrannova/Shutterstock

    A higher proportion of fibroglandular tissue means your breasts are dense.

    There are four categories to classify breast density:

    • A: almost entirely fatty
    • B: scattered areas of fibroglandular density
    • C: heterogeneously or consistently dense
    • D: extremely dense.

    Breast density is very common. Around 40% of women aged 40–74 are estimated to have “dense breasts”, meaning they fall in category C or D.

    What’s the link to cancer?

    Breast density is associated with the risk of breast cancer in two ways.

    First, breast density usually decreases with age. But if a woman has high breast density for her age, it increases her likelihood of breast cancer.

    One study looked at the risk of breast cancer over the age of 50. It found there was a 6.2% risk for the one-third of women with the lowest density. For the 5% with the highest density, the risk was 14.7%.

    Second, breast density “masks” cancers if they develop. Both cancers and breast density appear white on a mammogram, making cancers very hard to see.

    Breast cancer screening saves lives through early detection and improved treatment options. But we don’t yet know if telling women about their breast density leads to earlier cancer detection, or lives saved.

    In Australia, screening mammography is free for all women* aged 40 and older. This is run through BreastScreen Australia, a joint national, state and territory initiative. Those aged 50-74 are invited to have a mammogram, but it’s available for free without a referral from age 40.

    However, the messages Australian women currently receive about breast density – and whether it’s recorded – depends on where they live.

    What does the advice say?

    In 2023, the Royal Australian and New Zealand College of Radiologists updated its position statement to recommend breast density is recorded during screening and diagnostic tests in Australia and New Zealand.

    Meanwhile BreastScreen Australia says it “should not routinely record breast density or provide supplemental testing for women with dense breasts”. However this position statement is from 2020 and is currently under review.

    Some state and territory BreastScreen programs, including in Western Australia, South Australia and soon Victoria, notify women if they have dense breasts. Victoria is currently at an early stage of its roll-out.

    While the messaging regarding breast density differs by state, none currently recommend further imaging for women with dense breasts without speaking to a doctor about individual risk.

    What are the issues?

    Providing recommendations for women with dense breasts is difficult.

    The European Society of Breast Imaging recommends women with extremely dense breasts aged 50–70 receive an MRI every two to four years, in addition to screening mammography. This is based on a large randomised controlled trial from the Netherlands.

    But the Royal Australian and New Zealand College of Radiologists describes this recommendation as “aspirational”, acknowledging cost, staffing and accessibility as challenges.

    That is, it is not feasible to provide a supplemental MRI for everyone in the screening population in category D with extremely dense breasts (around 10%).

    Further, there is no consensus on appropriate screening recommendations for women in the category C (heterogeneous density).

    We need a national approach to breast density reporting in Australia and to do better at identifying who is most likely to benefit from further testing.

    BreastScreen Australia is currently undergoing a review of its policy and funding.

    One of its goals is to enable a nationally consistent approach to breast screening practices. Hopefully breast density reporting, including funding to support national implementation, will be a priority.

    *This includes those recorded female at birth and who are gender diverse.

    Jennifer Stone, Principal Research Fellow, School of Population and Global Health, The University of Western Australia

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Can you die from long COVID? The answer is not so simple

    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.

    Nearly five years into the pandemic, COVID is feeling less central to our daily lives.

    But the virus, SARS-CoV-2, is still around, and for many people the effects of an infection can be long-lasting. When symptoms persist for more than three months after the initial COVID infection, this is generally referred to as long COVID.

    In September, Grammy-winning Brazilian musician Sérgio Mendes died aged 83 after reportedly having long COVID.

    Australian data show 196 deaths were due to the long-term effects of COVID from the beginning of the pandemic up to the end of July 2023.

    In the United States, the Centers for Disease Control and Prevention reported 3,544 long-COVID-related deaths from the start of the pandemic up to the end of June 2022.

    The symptoms of long COVID – such as fatigue, shortness of breath and “brain fog” – can be debilitating. But can you die from long COVID? The answer is not so simple.

    Jan Krava/Shutterstock

    How could long COVID lead to death?

    There’s still a lot we don’t understand about what causes long COVID. A popular theory is that “zombie” virus fragments may linger in the body and cause inflammation even after the virus has gone, resulting in long-term health problems. Recent research suggests a reservoir of SARS-CoV-2 proteins in the blood might explain why some people experience ongoing symptoms.

    We know a serious COVID infection can damage multiple organs. For example, severe COVID can lead to permanent lung dysfunction, persistent heart inflammation, neurological damage and long-term kidney disease.

    These issues can in some cases lead to death, either immediately or months or years down the track. But is death beyond the acute phase of infection from one of these causes the direct result of COVID, long COVID, or something else? Whether long COVID can directly cause death continues to be a topic of debate.

    Of the 3,544 deaths related to long COVID in the US up to June 2022, the most commonly recorded underlying cause was COVID itself (67.5%). This could mean they died as a result of one of the long-term effects of a COVID infection, such as those mentioned above.

    COVID infection was followed by heart disease (8.6%), cancer (2.9%), Alzheimer’s disease (2.7%), lung disease (2.5%), diabetes (2%) and stroke (1.8%). Adults aged 75–84 had the highest rate of death related to long COVID (28.8%).

    These findings suggest many of these people died “with” long COVID, rather than from the condition. In other words, long COVID may not be a direct driver of death, but rather a contributor, likely exacerbating existing conditions.

    A woman lying in bed in the dark.
    The symptoms of long COVID can be debilitating. Lysenko Andrii/Shutterstock

    ‘Cause of death’ is difficult to define

    Long COVID is a relatively recent phenomenon, so mortality data for people with this condition are limited.

    However, we can draw some insights from the experiences of people with post-viral conditions that have been studied for longer, such as myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS).

    Like long COVID, ME/CFS is a complex condition which can have significant and varied effects on a person’s physical fitness, nutritional status, social engagement, mental health and quality of life.

    Some research indicates people with ME/CFS are at increased risk of dying from causes including heart conditions, infections and suicide, that may be triggered or compounded by the debilitating nature of the syndrome.

    So what is the emerging data on long COVID telling us about the potential increased risk of death?

    Research from 2023 has suggested adults in the US with long COVID were at greater risk of developing heart disease, stroke, lung disease and asthma.

    Research has also found long COVID is associated with a higher risk of suicidal ideation (thinking about or planning suicide). This may reflect common symptoms and consequences of long COVID such as sleep problems, fatigue, chronic pain and emotional distress.

    But long COVID is more likely to occur in people who have existing health conditions. This makes it challenging to accurately determine how much long COVID contributes to a person’s death.

    Research has long revealed reliability issues in cause-of-death reporting, particularly for people with chronic illness.

    Flowers in a cemetery.
    Determining the exact cause of someone’s death is not always easy. Pixabay/Pexels

    So what can we conclude?

    Ultimately, long COVID is a chronic condition that can significantly affect quality of life, mental wellbeing and overall health.

    While long COVID is not usually immediately or directly life-threatening, it’s possible it could exacerbate existing conditions, and play a role in a person’s death in this way.

    Importantly, many people with long COVID around the world lack access to appropriate support. We need to develop models of care for the optimal management of people with long COVID with a focus on multidisciplinary care.

    Dr Natalie Jovanovski, Vice Chancellor’s Senior Research Fellow in the School of Health and Biomedical Sciences at RMIT University, contributed to this article.

    Rose (Shiqi) Luo, Postdoctoral Research Fellow, School of Health and Biomedical Sciences, RMIT University; Catherine Itsiopoulos, Professor and Dean, School of Health and Biomedical Sciences, RMIT University; Kate Anderson, Vice Chancellor’s Senior Research Fellow, RMIT University; Magdalena Plebanski, Professor of Immunology, RMIT University, and Zhen Zheng, Associate Professor, STEM | Health and Biomedical Sciences, RMIT University

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Cashew Nuts vs Coconut – Which is Healthier?

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    Our Verdict

    When comparing cashew nuts to coconut, we picked the cashews.

    Why?

    It can be argued this isn’t a fair comparison, as coconuts aren’t true nuts, but it’s at the very least a useful comparison, because they have very similar (often the same) culinary uses, so deciding between one or the other is something people will often do.

    In terms of macros, cashews have 6x the protein and more than 2x the fiber, as well as slightly more fat (but the fats are healthy, as are those of coconut, by the way) and 2x the carbs. Depending on what you’re looking for, this head-to-head could come out differently, but we say it’s a win for cashews.

    You may be wondering: if cashews have more of all those things, what are coconuts made of? And the answer is that coconuts have 8x the water (and yes, this is counting the coconut meat only, not including the milk inside). Of course, if you get dessicated coconut, then it won’t have that, but we’re comparing fresh to fresh.

    In the category of vitamins, cashews have a lot more of vitamins B1, B2, B3, B5, B6, E, and K. Meanwhile, coconut has more vitamin C, but it’s not a lot. An easy win for cashews here.

    When it comes to minerals, cashews have rather more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc. On the other hand, coconut has more sodium. Another easy win for cashews.

    Cashews also have the lower glycemic index.

    All in all, cashews win the day.

    Want to learn more?

    You might like to read:

    Take care!

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  • Men have a biological clock too. Here’s what’s more likely when dads are over 50

    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.

    We hear a lot about women’s biological clock and how age affects the chance of pregnancy.

    New research shows men’s fertility is also affected by age. When dads are over 50, the risk of pregnancy complications increases.

    Data from more than 46 million births in the United States between 2011 and 2022 compared fathers in their 30s with fathers in their 50s.

    While taking into account the age of the mother and other factors known to affect pregnancy outcomes, the researchers found every ten-year increase in paternal age was linked to more complications.

    The researchers found that compared to couples where the father was aged 30–39, for couples where the dad was in his 50s, there was a:

    • 16% increased risk of preterm birth
    • 14% increased risk of low birth weight
    • 13% increase in gestational diabetes.

    The older fathers were also twice as likely to have used assisted reproductive technology, including IVF, to conceive than their younger counterparts.

    Steven van Loy/Unsplash

    Dads are getting older

    In this US study, the mean age of all fathers increased from 30.8 years in 2011 to 32.1 years in 2022.

    In that same period, the proportion of men aged 50 years or older fathering a child increased from 1.1% to 1.3%.

    We don’t know the proportion of men over 50 years who father children in Australia, but data shows the average age of fathers has increased.

    In 1975 the median age of Australian dads was 28.6 years. This jumped to 33.7 years in 2022.

    How male age affects getting pregnant

    As we know from media reports of celebrity dads, men produce sperm from puberty throughout life and can father children well into old age.

    However, there is a noticeable decline in sperm quality from about age 40.

    Female partners of older men take longer to achieve pregnancy than those with younger partners.

    A study of the effect of male age on time to pregnancy showed women with male partners aged 45 or older were almost five times more likely to take more than a year to conceive compared to those with partners aged 25 or under. More than three quarters (76.8%) of men under the age of 25 years impregnated their female partners within six months, compared with just over half (52.9%) of men over the age of 45.

    Pooled data from ten studies showed that partners of older men are also more likely to experience miscarriage. Compared to couples where the male was aged 25 to 29 years, paternal age over 45 years increased the risk of miscarriage by 43%.

    Older men are more likely to need IVF

    Outcomes of assisted reproductive technology, such as IVF, are also influenced by the age of the male partner.

    A review of studies in couples using assisted reproductive technologies found paternal age under 40 years reduced the risk of miscarriage by about 25% compared to couples with men aged over 40.

    Having a male under 40 years also almost doubled the chance of a live birth per treatment cycle. With a man over 40, 17.6% of treatment rounds resulted in a live birth, compared to 28.4% when the male was under 40.

    How does male age affect the health outcomes of children?

    As a result of age-related changes in sperm DNA, the children of older fathers have increased risk of a number of conditions. Autism, schizophrenia, bipolar disorders and leukaemia have been linked to the father’s advanced years.

    A review of studies assessing the impact of advanced paternal age reported that children of older fathers have increased rates of psychiatric disease and behavioural impairments.

    But while the increased risk of adverse health outcomes linked to older paternal age is real, the magnitude of the effect is modest. It’s important to remember that an increase in a very small risk is still a small risk and most children of older fathers are born healthy and develop well.

    Improving your health can improve your fertility

    In addition to the effects of older age, some chronic conditions that affect fertility and reproductive outcomes become more common as men get older. They include obesity and diabetes which affect sperm quality by lowering testosterone levels.

    While we can’t change our age, some lifestyle factors that increase the risk of pregnancy complications and reduce fertility, can be tackled. They include:

    Get the facts about the male biological clock

    Research shows men want children as much as women do. And most men want at least two children.

    Yet most men lack knowledge about the limitations of female and male fertility and overestimate the chance of getting pregnant, with and without assisted reproductive technologies.

    We need better public education, starting at school, to improve awareness of the impact of male and female age on reproductive outcomes and help people have healthy babies.

    For men wanting to improve their chance of conceiving, the government-funded sites Healthy Male and Your Fertility are a good place to start. These offer evidence-based and accessible information about reproductive health, and tips to improve your reproductive health and give your children the best start in life.

    Karin Hammarberg, Senior Research Fellow, Global and Women’s Health, School of Public Health & Preventive Medicine, Monash University

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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