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 Smart Woman’s Guide to Breast Cancer – by Dr. Jenn Simmons
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There’s a lot more to breast cancer care than “check your breasts regularly”. Because… And then what? “Go see a doctor” obviously, but it’s a scary prospect with a lot of unknowns.
Dr. Simmons demystifies these unknowns, from both her position as an oncologist (and breast surgeon) and also her position as a breast cancer survivor herself.
What she found, upon getting to experience the patient side of things, was that the system is broken in ways she’d never considered before as a doctor.
This book is the product of the things she’s learned both within her field, and elsewhere because of realizing the former’s areas of shortcoming.
She gives a step-by-step guide, from diagnosis onwards, advising taking as much as possible into one’s own hands—especially in the categories of information and action. She also explains the things that make the biggest difference to cancer outcomes when it comes to eating, sleeping, and so forth, the best attitude to have to be neither despairing and giving up, nor overconfident and complacent.
She does also talk complementary therapies, be they supplements or more out-of-the-box approaches and the evidence for them where applicable, as well as doing some high-quality mythbusting about more prescription-based considerations such as HRT.
Bottom line: if you or a loved one have a breast cancer diagnosis, or you just prefer knowing this sort of thing than not, then this book is a top-tier “insider’s guide”.
Click here to check out the Smart Woman’s Guide To Breast Cancer, and take control!
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Aspirin, CVD Risk, & Potential Counter-Risks
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Aspirin Pros & Cons
In Tuesday’s newsletter, we asked your health-related opinion of aspirin, and got the above-depicted, below-described set of responses:
- About 42% said “Most people can benefit from low-dose daily use to lower CVD risk”
- About 31% said “It’s safe for occasional use as a mild analgesic, but that’s all”
- About 28% said “We should avoid aspirin; it can cause liver and/or kidney damage”
So, what does the science say?
Most people can benefit from low-dose daily aspirin use to lower the risk of cardiovascular disease: True or False?
True or False depending on what we mean by “benefit from”. You see, it works by inhibiting platelet function, which means it simultaneously:
- decreases the risk of atherothrombosis
- increases the risk of bleeding, especially in the gastrointestinal tract
When it comes to balancing these things and deciding whether the benefit merits the risk, you might be asking yourself: “which am I most likely to die from?” and the answer is: neither
While aspirin is associated with a significant improvement in cardiovascular disease outcomes in total, it is not significantly associated with reductions in cardiovascular disease mortality or all-cause mortality.
In other words: speaking in statistical generalizations of course, it may improve your recovery from minor cardiac events but is unlikely to help against fatal ones
The current prevailing professional (amongst cardiologists) consensus is that it may be recommended for secondary prevention of ASCVD (i.e. if you have a history of CVD), but not for primary prevention (i.e. if you have no history of CVD). Note: this means personal history, not family history.
In the words of the Journal of the American College of Cardiology:
❝Low-dose aspirin (75-100 mg orally daily) might be considered for the primary prevention of ASCVD among select adults 40 to 70 years of age who are at higher ASCVD risk but not at increased bleeding risk (S4.6-1–S4.6-8).
Low-dose aspirin (75-100 mg orally daily) should not be administered on a routine basis for the primary prevention of ASCVD among adults >70 years of age (S4.6-9).
Low-dose aspirin (75-100 mg orally daily) should not be administered for the primary prevention of ASCVD among adults of any age who are at increased risk of bleeding (S4.6-10).❞
~ Dr. Donna Arnett et al. (those section references are where you can find this information in the document)
Read in full: Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology
Or if you’d prefer a more pop-science presentation:
Many older adults still use aspirin for CVD prevention, contrary to clinical guidance
Aspirin can cause liver and/or kidney damage: True or False?
True, but that doesn’t mean we must necessarily abstain, so much as exercise caution.
Aspirin is (at recommended doses) not usually hepatotoxic (toxic to the liver), but there is a strong association between aspirin use in children and the development of Reye’s syndrome, a disease involving encephalopathy and a fatty liver. For this reason, most places have an official recommendation that aspirin not be used by children (cut-off age varies from place to place, for example 12 in the US and 16 in the UK, but the key idea is: it’s potentially dangerous for those who are not fully grown).
Aspirin is well-established as nephrotoxic (toxic to the kidneys), however, the toxicity is sufficiently low that this is not expected to be a problem to otherwise healthy adults taking it at no more than the recommended dose.
For numbers, symptoms, and treatment, see this very clear and helpful resource:
An evidence based flowchart to guide the management of acute salicylate (aspirin) overdose
Take care!
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The Galveston Diet – by Dr. Mary Claire Haver
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’ve previously reviewed “It’s Not You, It’s Your Hormones” by nutritionist Nikki Williams, and noted at the time that it was very similar to the bestselling “The Galveston Diet”, not just in its content but all the way down its formatting. Some Amazon reviewers have even gone so far as to suggest that “It’s Not You, It’s Your Hormones” (2017) brazenly plagiarized “The Galveston Diet” (2023). However, after carefully examining the publication dates, we feel quite confident that the the earlier book did not plagiarize the later one.
Of course, we would not go so far as to make a counter-accusation of plagiarism the other way around; it was surely just a case of Dr. Haver having the same good ideas 6 years later.
Still, while the original book by Nikki Williams did not get too much international acclaim, the later one by Dr. Mary Claire Haver has had very good marketing and thus received a lot more attention, so let’s review it:
Dr. Haver’s basic principle is (again) that we can manage our hormonal fluctuations, by managing our diet. Specifically, in the same three main ways:
- Intermittent fasting
- Anti-inflammatory diet
- Eating more protein and healthy fats
Why should these things matter to our hormones? The answer is to remember that our hormones aren’t just the sex hormones. We have hormones for hunger and satedness, hormones for stress and relaxation, hormones for blood sugar regulation, hormones for sleep and wakefulness, and more. These many hormones make up our endocrine system, and affecting one part of it will affect the others.
Will these things magically undo the effects of the menopause? Well, some things yes, other things no. No diet can do the job of HRT. But by tweaking endocrine system inputs, we can tweak endocrine system outputs, and that’s what this book is for.
The style is once again very accessible and just as clear, and Dr. Haver also walks us just as skilfully through the changes we may want to make, to avoid the changes we don’t want. The recipes are also very similar, so if you loved the recipes in the other book, you certainly won’t dislike this book’s menu.
In the category of criticism, there is (as with the other book by the other author) some extra support that’s paywalled, in the sense that she wants the reader to buy her personally-branded online plan, and it can feel a bit like she’s holding back in order to upsell to that.
Bottom line: this book is (again) aimed at peri-menopausal and post-menopausal women. It could also (again) definitely help a lot of people with PCOS too, and, when it comes down to it, pretty much anyone with an endocrine system. It’s (still) a well-evidenced, well-established, healthy way of eating regardless of age, sex, or (most) physical conditions.
Click here to check out The Galveston Diet, and enjoy its well-told, well-formatted advice!
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Laziness Does Not Exist – by Dr. Devon Price
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Some cultures prize productivity as an ideal above most other things, and it’s certainly so in the US. Not only is this not great for mental health in general, but also—as Dr. Price explains—it’s based on a lie.
Generally speaking, when a person appears lazy there is something stopping them/you from doing better, and it’s not some mystical unseen force of laziness, not a set character trait, not a moral failing. Rather, the root cause may be physical, psychological, socioeconomic, or something else entirely.
Those causes can in some cases be overcome (for example, a little CBT can often set aside perfectionist anxiety that results in procrastination), and in some cases they can’t, at least on an individual level (disabilities often stubbornly remain disabling, and societal problems require societal solutions).
This matters for our mental health in areas well beyond the labor marketplace, of course, and these ideas extend to personal projects and even personal relationships. Whatever it is, if it’s leaving you exhausted, then probably something needs to be changed (even if the something is just “expectations”).
The book does offer practical solutions to all manner of such situations, improving what can be improved, making easier what can be made easier, and accepting what just needs to be accepted.
The style of this book is casual yet insightful and deep, easy-reading yet with all the acumen of an accomplished social psychologist.
Bottom line: if life leaves you exhausted, this book can be the antidote and cure
Click here to check out Laziness Does Not Exist, and break free!
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The Medicinal Properties Of Bay Leaves
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The humble bay leaf has more uses than just culinary!
How about for hair growth?
Popularly recommended on social media with the promise of long and glowing hair… Guess how many scientific studies back up this claim!
If you guessed zero, you guessed correctly. At least, we were not able to find any. In fact, the only paper on the entirety of PubMed (a large online database of available scientific literature from most, if not all, reputable scientific journals) to return a hit for the search string “bay leaf hair growth” was this one:
You may notice that that has nothing to do with hair growth, and rather returned the hit because the acne bacteria are known to “proliferate within sebum-blocked skin hair follicles”.
So let’s talk about that instead:
Against acne & skin inflammation
Well, for that, it works! The research that we mentioned above concluded that:
❝LNE significantly suppressed the expression of P. acnes-mediated proinflammatory cytokines, such as IL-1β, IL-6, and NLRP3. We also found that LNE inhibited the inflammatory transcription factor NF-κB in response to P. acnes. In addition, eucalyptol, which is the main constituent of LNE, consistently inhibited P. acnes-induced inflammatory signaling pathways. Moreover, LNE significantly ameliorated P. acnes-induced inflammation in a mouse model of acne. We suggest for the first time that LNE hold therapeutic value for the improvement of P. acnes-induced skin inflammation.❞
LNE = Laurus nobilis extract, i.e. bay leaf extract
Now, that’s all about acne-induced skin inflammation, but what about other kinds?
Against inflammation in general
Bay leaves have an abundance of antioxidant polyphenols, and what’s good against oxidation is good against inflammation. For example:
Laurus nobilis leaf extract controls inflammation by suppressing NLRP3 inflammasome activation
That anti-inflammatory action is more than skin-deep though, because…
Against IBD / ulcerative colitis
It’s good for the gut, too, for example in this study (with mice, but the bacteria affected are the same as we have), which found:
❝…bay leaves showed the best treatment effects on gut microbiota compositions; promoting the growth of Bifidobacteria and Lactobacillus in addition to producing high butyric acid levels. Meanwhile, the number of Clostridium and sulfate-reducing bacteria was significantly reduced. Conclusively, consuming bay leaves brought significant colon health benefits other than stimulating appetite for a better taste.❞
Note that all of those gut-related changes are beneficial to us, increasing things that are best increased, and reducing things that are best reduced.
Against diabetes
It’s good for the blood—and for the heart, but more on that later. First, about diabetes:
❝All three levels of bay leaves reduced serum glucose with significant decreases ranging from 21 to 26% after 30 d.
Total cholesterol decreased, 20 to 24%, after 30 days with larger decreases in low density lipoprotein (LDL) cholesterol of 32 to 40%. High density lipoprotein (HDL) cholesterol increased 29 and 20% in the groups receiving 1 and 2 g of bay leaves, respectively. Triglycerides also decreased 34 and 25% in groups consuming 1 and 2 g of bay leaves, respectively, after 30 d. There were no significant changes in the placebo group.
In summary, this study demonstrates that consumption of bay leaves, 1 to 3 g/d for 30 days, decreases risk factors for diabetes and cardiovascular diseases and suggests that bay leaves may be beneficial for people with type 2 diabetes.❞
Again, all those changes are good:
Bay Leaves Improve Glucose and Lipid Profile of People with Type 2 Diabetes
Good for the heart
This one’s quite straight forward. Bay leaf tea is indeed good for the heart,
- Literally: Evaluation of Daily Laurus nobilis Tea Consumption on Lipid Profile Biomarkers in Healthy Volunteers
- Metaphorically: Evaluation of daily Laurus nobilis tea consumption on anxiety and stress biomarkers in healthy volunteers
Of course, even that latter is also good for the heart literally, just, indirectly, by reducing anxiety and stress, thus indirectly benefiting the heart itself.
But even before that, it’s already very directly beneficial to cardiovascular health, per its significant improvements to the lipid profile.
Anything else?
So much else, but there’s only so much we can feature in one day, so if you’d like to learn more, we recommend this very comprehensive paper:
…which discusses many benefits in considerable detail, including…
❝The LN leaves have various biological activities, such as antioxidant, wound healing, antibacterial, analgesic, and anti-inflammatory activities. However, oxidative stress, cancer, diabetes, microbial infections, and inflammatory diseases are closely linked. The objective of this research is to characterize Laurus nobilis (LN) aromatic oil (AO) and evaluate its antioxidant, antidiabetic, antiobesity, antimicrobial, and antimutagenic bioactivities.
The plant AO showed potent antioxidant activity (IC50 = 2.2 ± 1.38) and has moderate anti-amylase (IC50 = 60.25 ± 1.25), anti-glucosidase (IC50 = 131.82 ± 0.1), and antilipase (IC50 = 83.17 ± 0.06) activities.
Moreover, LNAO showed potent antimicrobial activity against Staphylococcus aureus, Escherichia coli, Klebsiella pneumonia, Proteus vulgaris (MICs = 1.56 µg/mL), methicillin-resistant Staphylococcus aureus (MRSA) (MIC = 3.125 µg/mL) and Candida albicans (MIC = 0.195 µg/mL). The cytotoxicity results demonstrated that at a concentration of 1 mg/mL, LNAO has potent breast cancer (MCF-7), and hepatocellular carcinoma (Hep 3B) cancer cells inhibitory activities of 98% and 95%, respectively.
Importantly, we are the first to show that LNAO significantly hinders hepatocellular carcinoma spheroids’ formation capacity in a 3D model.
These results show that LNAO is a promising natural source with powerful antioxidant, antidiabetic, anticancer, and antimicrobial activities that could be exploited in the future to treat a variety of diseases.❞
Want to try some?
We don’t sell it, but you can buy leaves from your local supermarket and make bay leaf tea, or alternatively, if you prefer essential oil form, here for your convenience is an example product on Amazon 😎
Enjoy!
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Mouthwatering Protein Falafel
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Baking falafel, rather than frying it, has a strength and a weakness. The strength: it is less effort and you can do more at once. The weakness: it can easily get dry. This recipe calls for baking them in a way that won’t get dry, and the secret is one of its protein ingredients: peas! Add to this the spices and a tahini sauce, and you’ve a mouthwatering feast that’s full of protein, fiber, polyphenols, and even healthy fats.
You will need
- 1 cup peas, cooked
- 1 can chickpeas, drained and rinsed (keep the chickpea water—also called aquafaba—aside, as we’ll be using some of it later)
- ½ small red onion, chopped
- 1 handful fresh mint, chopped
- 1 tbsp fresh parsley, chopped
- ½ bulb garlic, crushed
- 1 tbsp lemon juice
- 1 tbsp chickpea flour (also called gram flour, besan flour, or garbanzo bean flour) plus more for dusting
- 2 tsp red chili flakes (adjust per heat preferences)
- 2 tsp black pepper, coarse ground
- 1 tsp ground turmeric
- ½ tsp MSG or 1 tsp low-sodium salt
- Extra virgin olive oil
For the tahini sauce:
- 2 tbsp tahini
- 2 tbsp lemon juice
- ¼ bulb garlic, crushed
- 5 tbsp aquafaba (if for some reason you don’t have it, such as for example you substituted 1 cup chickpeas that you cooked yourself, substitute with water here)
To serve:
- Flatbreads (you can use our Healthy Homemade Flatbreads recipe if you like)
- Leafy salad
Method
(we suggest you read everything at least once before doing anything)
1) Preheat the oven to 350℉ / 180℃.
2) Blend the peas and chickpeas in a food processor for a few seconds. You want a coarse mixture, not a paste.
3) Add the rest of the main section ingredients except the olive oil, and blend again for a few more seconds. It should still have a chunky texture, or else you will have made hummus. If you accidentally make hummus, set your hummus aside and start again on the falafels.
4) Shape the mixture into balls; if it lacks structural integrity, fold in a little more chickpea flour until the balls stay in shape. Either way, once you have done that, dust the balls in chickpea flour.
5) Brush the balls in a little olive oil, as you put them on a baking tray lined with baking paper. Bake for 15–18 minutes until golden, turning partway through.
6) While you are waiting, making the tahini sauce by combining the tahini sauce ingredients in a high-speed blender and processing on high until smooth. If you do not have a small enough blender (a bullet-style blender should work for this), then do it manually, which means you’ll have to crush the garlic all the way into a smooth paste, such as with a pestle and mortar, or alternatively, use ready-made garlic paste—and then simply whisk the ingredients together until smooth.
7) Serve the falafels warm or cold, on flatbreads with leafy salad and the tahini sauce.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Tahini vs Hummus – Which is Healthier?
- Our Top 5 Spices: How Much Is Enough For Benefits? ← we scored 4/5 today!
Take care!
Don’t Forget…
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