Grain Brain – by Dr. David Perlmutter
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If you’re a regular 10almonds reader, you probably know that refined flour, and processed food in general, is not great for the health. So, what does this book offer more?
Dr. Perlmutter sets out the case against (as the subtitle suggests) wheat, carbs, and sugar. Yes, including wholegrain wheat, and including starchy vegetables such as potatoes and parsnips. Fruit does also come under scrutiny, a clear distinction is made between whole fruits and juices. In the latter case, the lack of fiber (along with the more readily absorbable liquid state) allows for those sugars to zip straight into our blood.
The book includes lots of stats and facts, and many study citations, along with infographics and clear explanations.
If the book has a weakness, it’s when it forgets to clarify something that was obvious to the author. For example, when he talks about our ancestors’ diets being 75% fat and 5% carbs, he neglects to mention that this is 75% by calorie count, not by mass or volume. This makes a huge difference! It’s the difference between a fat-guzzling engine, and someone who eats mostly fruit and oily nuts but also some very high-fat meat/organs.
The book’s strengths, on the other hand, are found in its explanation, backed by good science, of what wheat, along with excessive carbohydrates (especially sugar) can do to our body, including (and most focusedly, hence the title) our brain, leading the way to not just obvious metabolic disorders like diabetes, but also inflammatory diseases like Alzheimer’s.
Bottom line: you don’t have to completely revamp your diet if it’s working for you, but data is data, and this book has lots, making it well-worth a read.
Click here to check out Grain Brain, and learn about how to avoid inflaming yours!
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Constipation increases your risk of a heart attack, new study finds – and not just on the toilet
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If you Google the terms “constipation” and “heart attack” it’s not long before the name Elvis Presley crops up. Elvis had a longstanding history of chronic constipation and it’s believed he was straining very hard to poo, which then led to a fatal heart attack.
We don’t know what really happened to the so-called King of Rock “n” Roll back in 1977. There were likely several contributing factors to his death, and this theory is one of many.
But after this famous case researchers took a strong interest in the link between constipation and the risk of a heart attack.
This includes a recent study led by Australian researchers involving data from thousands of people.
Elvis Presley was said to have died of a heart attack while straining on the toilet. But is that true? Kraft74/Shutterstock Are constipation and heart attacks linked?
Large population studies show constipation is linked to an increased risk of heart attacks.
For example, an Australian study involved more than 540,000 people over 60 in hospital for a range of conditions. It found constipated patients had a higher risk of high blood pressure, heart attacks and strokes compared to non-constipated patients of the same age.
A Danish study of more than 900,000 people from hospitals and hospital outpatient clinics also found that people who were constipated had an increased risk of heart attacks and strokes.
It was unclear, however, if this relationship between constipation and an increased risk of heart attacks and strokes would hold true for healthy people outside hospital.
These Australian and Danish studies also did not factor in the effects of drugs used to treat high blood pressure (hypertension), which can make you constipated.
Researchers have studied thousands of people to see if there’s a link between constipation and heart attacks. fongbeerredhot/Shutterstock How about this new study?
The recent international study led by Monash University researchers found a connection between constipation and an increased risk of heart attacks, strokes and heart failure in a general population.
The researchers analysed data from the UK Biobank, a database of health-related information from about half a million people in the United Kingdom.
The researchers identified more than 23,000 cases of constipation and accounted for the effect of drugs to treat high blood pressure, which can lead to constipation.
People with constipation (identified through medical records or via a questionnaire) were twice as likely to have a heart attack, stroke or heart failure as those without constipation.
The researchers found a strong link between high blood pressure and constipation. Individuals with hypertension who were also constipated had a 34% increased risk of a major heart event compared to those with just hypertension.
The study only looked at the data from people of European ancestry. However, there is good reason to believe the link between constipation and heart attacks applies to other populations.
A Japanese study looked at more than 45,000 men and women in the general population. It found people passing a bowel motion once every two to three days had a higher risk of dying from heart disease compared with ones who passed at least one bowel motion a day.
How might constipation cause a heart attack?
Chronic constipation can lead to straining when passing a stool. This can result in laboured breathing and can lead to a rise in blood pressure.
In one Japanese study including ten elderly people, blood pressure was high just before passing a bowel motion and continued to rise during the bowel motion. This increase in blood pressure lasted for an hour afterwards, a pattern not seen in younger Japanese people.
One theory is that older people have stiffer blood vessels due to atherosclerosis (thickening or hardening of the arteries caused by a build-up of plaque) and other age-related changes. So their high blood pressure can persist for some time after straining. But the blood pressure of younger people returns quickly to normal as they have more elastic blood vessels.
As blood pressure rises, the risk of heart disease increases. The risk of developing heart disease doubles when systolic blood pressure (the top number in your blood pressure reading) rises permanently by 20 mmHg (millimetres of mercury, a standard measure of blood pressure).
The systolic blood pressure rise with straining in passing a stool has been reported to be as high as 70 mmHg. This rise is only temporary but with persistent straining in chronic constipation this could lead to an increased risk of heart attacks.
High blood pressure from straining on the toilet can last after pooing, especially in older people. Andrey_Popov/Shutterstock Some people with chronic constipation may have an impaired function of their vagus nerve, which controls various bodily functions, including digestion, heart rate and breathing.
This impaired function can result in abnormalities of heart rate and over-activation of the flight-fight response. This can, in turn, lead to elevated blood pressure.
Another intriguing avenue of research examines the imbalance in gut bacteria in people with constipation.
This imbalance, known as dysbiosis, can result in microbes and other substances leaking through the gut barrier into the bloodstream and triggering an immune response. This, in turn, can lead to low-grade inflammation in the blood circulation and arteries becoming stiffer, increasing the risk of a heart attack.
This latest study also explored genetic links between constipation and heart disease. The researchers found shared genetic factors that underlie both constipation and heart disease.
What can we do about this?
Constipation affects around 19% of the global population aged 60 and older. So there is a substantial portion of the population at an increased risk of heart disease due to their bowel health.
Managing chronic constipation through dietary changes (particularly increased dietary fibre), increased physical activity, ensuring adequate hydration and using medications, if necessary, are all important ways to help improve bowel function and reduce the risk of heart disease.
Vincent Ho, Associate Professor and clinical academic gastroenterologist, Western Sydney University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Stickers and wristbands aren’t a reliable way to prevent mosquito bites. Here’s why
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Protecting yourself and family from mosquito bites can be challenging, especially in this hot and humid weather. Protests from young children and fears about topical insect repellents drive some to try alternatives such as wristbands, patches and stickers.
These products are sold online as well as in supermarkets, pharmacies and camping stores. They’re often marketed as providing “natural” protection from mosquitoes.
But unfortunately, they aren’t a reliable way to prevent mosquito bites. Here’s why – and what you can try instead.
Why is preventing mosquito bites important?
Mosquitoes can spread pathogens that make us sick. Japanese encephalitis and Murray Valley encephalitis viruses can have potentially fatal outcomes. While Ross River virus won’t kill you, it can cause potentially debilitating illnesses.
Health authorities recommend preventing mosquito bites by: avoiding areas and times of the day when mosquitoes are most active; covering up with long sleeved shirts, long pants, and covered shoes; and applying a topical insect repellent (a cream, lotion, or spray).
I don’t want to put sticky and smelly repellents on my skin!
While for many people, the “sting” of a biting mosquitoes is enough to prompt a dose of repellent, others are reluctant. Some are deterred by the unpleasant feel or smell of insect repellents. Others believe topical repellents contain chemicals that are dangerous to our health.
However, many studies have shown that, when used as recommended, these products are safe to use. All products marketed as mosquito repellents in Australia must be registered by the Australian Pesticides and Veterinary Medicines Authority; a process that provides recommendations for safe use.
How do topical repellents work?
While there remains some uncertainty about how the chemicals in topical insect repellents actually work, they appear to either block the sensory organs of mosquitoes that drive them to bite, or overpower the smells of our skin that helps mosquitoes find us.
Diethytolumide (DEET) is a widely recommended ingredient in topical repellents. Picaridin and oil of lemon eucalyptus are also used and have been shown to be effective and safe.
How do other products work?
“Physical” insect-repelling products, such as wristbands, coils and candles, often contain a botanically derived chemical and are often marketed as being an alternative to DEET.
However, studies have shown that devices such as candles containing citronella oil provide lower mosquito-bite prevention than topical repellents.
A laboratory study in 2011 found wristbands infused with peppermint oil failed to provide full protection from mosquito bites.
Even as topical repellent formulations applied to the skin, these botanically derived products have lower mosquito bite protection than recommended products such as those containing DEET, picaridin and oil of lemon eucalyptus.
Wristbands infused with DEET have shown mixed results but may provide some bite protection or bite reduction. DEET-based wristbands or patches are not currently available in Australia.
There is also a range of mosquito repellent coils, sticks, and other devices that release insecticides (for example, pyrethroids). These chemicals are primarily designed to kill or “knock down” mosquitoes rather than to simply keep them from biting us.
What about stickers and patches?
Although insect repellent patches and stickers have been available for many years, there has been a sudden surge in their marketing through social media. But there are very few scientific studies testing their efficacy.
Our current understanding of the way insect repellents work would suggest these small stickers and patches offer little protection from mosquito bites.
At best, they may reduce some bites in the way mosquito coils containing botanical products work. However, the passive release of chemicals from the patches and stickers is likely to be substantially lower than those from mosquito coils and other devices actively releasing chemicals.
One study in 2013 found a sticker infused with oil of lemon eucalyptus “did not provide significant protection to volunteers”.
Clothing impregnated with insecticides, such as permethrin, will assist in reducing mosquito bites but topical insect repellents are still recommended for exposed areas of skin.
Take care when using these products
The idea you can apply a sticker or patch to your clothing to protect you from mosquito bites may sound appealing, but these devices provide a false sense of security. There is no evidence they are an equally effective alternative to the topical repellents recommended by health authorities around the world. It only takes one bite from a mosquito to transmit the pathogens that result in serious disease.
It is also worth noting that there are some health warnings and recommendations for their use required by Australian Pesticides and Veterinary Medicines Authority. Some of these products warn against application to the skin (recommending application to clothing only) and to keep products “out of reach of children”. This is a challenge if attached to young children’s clothing.
Similar warnings are associated with most other topical and non-topical mosquito repellents. Always check the labels of these products for safe use recommendations.
Are there any other practical alternatives?
Topical insect repellents are safe and effective. Most can be used on children from 12 months of age and pose no health risks. Make sure you apply the repellent as a thin even coat on all exposed areas of skin.
But you don’t need “tropical strength” repellents for short periods of time outdoors; a range of formulations with lower concentrations of repellent will work well for shorter trips outdoors. There are some repellents that don’t smell as strong (for example, children’s formulations, odourless formulations) or formulations that may be more pleasant to use (for example, pump pack sprays).
Finally, you can always cover up. Loose-fitting long-sleeved shirts, long pants, and covered shoes will provide a physical barrier between you and mosquitoes on the hunt for your or your family’s blood this summer.
Cameron Webb, Clinical Associate Professor and Principal Hospital Scientist, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Doctors Are as Vulnerable to Addiction as Anyone. California Grapples With a Response
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BEVERLY HILLS, Calif. — Ariella Morrow, an internal medicine doctor, gradually slid from healthy self-esteem and professional success into the depths of depression.
Beginning in 2015, she suffered a string of personal troubles, including a shattering family trauma, marital strife, and a major professional setback. At first, sheer grit and determination kept her going, but eventually she was unable to keep her troubles at bay and took refuge in heavy drinking. By late 2020, Morrow could barely get out of bed and didn’t shower or brush her teeth for weeks on end. She was up to two bottles of wine a day, alternating it with Scotch whisky.
Sitting in her well-appointed home on a recent autumn afternoon, adorned in a bright lavender dress, matching lipstick, and a large pearl necklace, Morrow traced the arc of her surrender to alcohol: “I’m not going to drink before 5 p.m. I’m not going to drink before 2. I’m not going to drink while the kids are home. And then, it was 10 o’clock, 9 o’clock, wake up and drink.”
As addiction and overdose deaths command headlines across the nation, the Medical Board of California, which licenses MDs, is developing a new program to treat and monitor doctors with alcohol and drug problems. But a fault line has appeared over whether those who join the new program without being ordered to by the board should be subject to public disclosure.
Patient advocates note that the medical board’s primary mission is “to protect healthcare consumers and prevent harm,” which they say trumps physician privacy.
The names of those required by the board to undergo treatment and monitoring under a disciplinary order are already made public. But addiction medicine professionals say that if the state wants troubled doctors to come forward without a board order, confidentiality is crucial.
Public disclosure would be “a powerful disincentive for anybody to get help” and would impede early intervention, which is key to avoiding impairment on the job that could harm patients, said Scott Hambleton, president of the Federation of State Physician Health Programs, whose core members help arrange care and monitoring of doctors for substance use disorders and mental health conditions as an alternative to discipline.
But consumer advocates argue that patients have a right to know if their doctor has an addiction. “Doctors are supposed to talk to their patients about all the risks and benefits of any treatment or procedure, yet the risk of an addicted doctor is expected to remain a secret?” Marian Hollingsworth, a volunteer advocate with the Patient Safety Action Network, told the medical board at a Nov. 14 hearing on the new program.
Doctors are as vulnerable to addiction as anyone else. People who work to help rehabilitate physicians say the rate of substance use disorders among them is at least as high as the rate for the general public, which the federal Substance Abuse and Mental Health Services Administration put at 17.3% in a Nov. 13 report.
Alcohol is a very common drug of choice among doctors, but their ready access to pain meds is also a particular risk.
“If you have an opioid use disorder and are working in an operating room with medications like fentanyl staring you down, it’s a challenge and can be a trigger,” said Chwen-Yuen Angie Chen, an addiction medicine doctor who chairs the Well-Being of Physicians and Physicians-in-Training Committee at Stanford Health Care. “It’s like someone with an alcohol use disorder working at a bar.”
From Pioneer to Lagger
California was once at the forefront of physician treatment and monitoring. In 1981, the medical board launched a program for the evaluation, treatment, and monitoring of physicians with mental illness or substance use problems. Participants were often required to take random drug tests, attend multiple group meetings a week, submit to work-site surveillance by colleagues, and stay in the program for at least five years. Doctors who voluntarily entered the program generally enjoyed confidentiality, but those ordered into it by the board as part of a disciplinary action were on the public record.
The program was terminated in 2008 after several audits found serious flaws. One such audit, conducted by Julianne D’Angelo Fellmeth, a consumer interest lawyer who was chosen as an outside monitor for the board, found that doctors in the program were often able to evade the random drug tests, attendance at mandatory group therapy sessions was not accurately tracked, and participants were not properly monitored at work sites.
Today, MDs who want help with addiction can seek private treatment on their own or in many cases are referred by hospitals and other health care employers to third parties that organize treatment and surveillance. The medical board can order a doctor on probation to get treatment.
In contrast, the California licensing boards of eight other health-related professions, including osteopathic physicians, registered nurses, dentists, and pharmacists, have treatment and monitoring programs administered under one master contract by a publicly traded company called Maximus Inc. California paid Maximus about $1.6 million last fiscal year to administer those programs.
When and if the final medical board regulations are adopted, the next step would be for the board to open bidding to find a program administrator.
Fall From Grace
Morrow’s troubles started long after the original California program had been shut down.
The daughter of a prominent cosmetic surgeon, Morrow grew up in Palm Springs in circumstances she describes as “beyond privileged.” Her father, David Morrow, later became her most trusted mentor.
But her charmed life began to fall apart in 2015, when her father and mother, Linda Morrow, were indicted on federal insurance fraud charges in a well-publicized case. In 2017, the couple fled to Israel in an attempt to escape criminal prosecution, but later they were both arrested and returned to the United States to face prison sentences.
The legal woes of Morrow’s parents, later compounded by marital problems related to the failure of her husband’s business, took a heavy toll on Morrow. She was in her early 30s when the trouble with her parents started, and she was working 16-hour days to build a private medical practice, with two small children at home. By the end of 2019, she was severely depressed and turning increasingly to alcohol. Then, the loss of her admitting privileges at a large Los Angeles hospital due to inadequate medical record-keeping shattered what remained of her self-confidence.
Morrow, reflecting on her experience, said the very strengths that propel doctors through medical school and keep them going in their careers can foster a sense of denial. “We are so strong that our strength is our greatest threat. Our power is our powerlessness,” she said. Morrow ignored all the flashing yellow lights and even the red light beyond which serious trouble lay: “I blew through all of it, and I fell off the cliff.”
By late 2020, no longer working, bedridden by depression, and drinking to excess, she realized she could no longer will her way through: “I finally said to my husband, ‘I need help.’ He said, ‘I know you do.’”
Ultimately, she packed herself off to a private residential treatment center in Texas. Now sober for 21 months, Morrow said the privacy of the addiction treatment she chose was invaluable because it shielded her from professional scrutiny.
“I didn’t have to feel naked and judged,” she said.
Morrow said her privacy concerns would make her reluctant to join a state program like the one being considered by the medical board.
Physician Privacy vs. Patient Protection
The proposed regulations would spare doctors in the program who were not under board discipline from public disclosure as long as they stayed sober and complied with all the requirements, generally including random drug tests, attendance at group sessions, and work-site monitoring. If the program put a restriction on a doctor’s medical license, it would be posted on the medical board’s website, but without mentioning the doctor’s participation in the program.
Yet even that might compromise a doctor’s career since “having a restricted license for unspecified reasons could have many enduring personal and professional implications, none positive,” said Tracy Zemansky, a clinical psychologist and president of the Southern California division of Pacific Assistance Group, which provides support and monitoring for physicians.
Zemansky and others say doctors, just like anyone else, are entitled to medical privacy under federal law, as long as they haven’t caused harm.
Many who work in addiction medicine also criticized the proposed new program for not including mental health problems, which often go hand in hand with addiction and are covered by physician health programs in other states.
“To forgo mental health treatment, I think, is a grave mistake,” Morrow said. For her, depression and alcoholism were inseparable, and the residential program she attended treated her for both.
Another point of contention is money. Under the current proposal, doctors would bear all the costs of the program.
The initial clinical evaluation, plus the regular random drug tests, group sessions, and monitoring at their work sites could cost participants over $27,000 a year on average, according to estimates posted by the medical board. And if they were required to go for 30-day inpatient treatment, that would add an additional $40,000 — plus nearly $36,000 in lost wages.
People who work in the field of addiction medicine believe that is an unfair burden. They note that most programs for physicians in other states have outside funding to reduce the cost to participants.
“The cost should not be fully borne by the doctors, because there are many other people that are benefiting from this, including the board, malpractice insurers, hospitals, the medical association,” said Greg Skipper, a semi-retired addiction medicine doctor who ran Alabama’s state physician health program for 12 years. In Alabama, he said, those institutions contribute to the program, significantly cutting the amount doctors have to pay.
The treatment program that Morrow attended in spring of 2021, at The Menninger Clinic in Houston, cost $80,000 for a six-week stay, which was covered by a concerned family member. “It saved my life,” she said.
Though Morrow had difficulty maintaining her sobriety in the first year after treatment, she has now been sober since April 2, 2022. These days, Morrow regularly attends therapy and Alcoholics Anonymous and has pivoted to become an addiction medicine doctor.
“I am a better doctor today because of my experience — no question,” Morrow said. “I am proud to be a doctor who’s an alcoholic in recovery.”
This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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Yoga Nidra Made Easy – by Dr. Uma Dinsmore-Tuli and Nirlipta Tuli
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We’ve reviewed books about yoga before, and about sleep. This one’s different.
It’s about a yogic practice that can be used to promote restful sleep—or just be a non-sleeping exercise that nonetheless promotes relaxation and recuperation.
While yoga nidra is as somatic as it is psychological, its corporeal aspects are all explored in a lying-down-on-one’s-back state. This isn’t a book of stretches and poses and such—those are great, but are simply not needed for this practice.
The authors explain, step-by-step, simply and clearly, how to practice yoga nidra, and get out of it what you want to (there are an assortment of possible outcomes, per your preference; there are options to choose along the way).
A lot of books about yoga, even when written in English, contain a lot of Sanskrit terms. This one doesn’t. And, that difference goes a long way to living up to the title of making this easy, for those of us who regrettably don’t read even transliterated Sanskrit.
Bottom line: if ever you struggle to relax, struggle to sleep, or struggle to find your get-up-and-go, this book provides all you need to engage in this very restorative practice!
Click here to check out Yoga Nidra Made Easy, and learn this restorative tool for yourself!
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Brain Food – by Dr. Lisa Mosconi
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We know that we should eat for brain health, but often that knowledge doesn’t go a lot further than “we should eat some nuts… but also not the wrong nuts, which would be bad”.
However, as Dr. Lisa Mosconi lays out for us, there’s a lot more than that!
This book is as much a treatise of brain health in the context of nutrition, as it is a “eat this and avoid that” guide.
Which is good, because our brains don’t exist in isolation, and nor do the nutrients that we consume. Put it this way:
We have a tendecy to think of our diets as a set of slider-bars, “ok, that’s 104% of my daily intake of fiber, I need another 10g protein and that’ll be at 100%, I’ve had 80% of the vitamin C that I need, and…”
Whereas in reality: much of what we eat interacts positively or negatively with other things, and thus needs to be kept in balance. And not only that, but other peri-nutritional factors play a big part too! From obvious things like hydration, to less obvious things like maintaining good gut microbiota, our brains rely on us to do a lot of things for them.
This book is very easy-reading, though a weakness is it doesn’t tend to summarise key ideas much, give cheat-sheets, that sort of thing. We recommend reading this book with a notebook to the side, to jot down things you want to attend to in your own dietary habits.
Bottom line: this is an excellent overview of brain health in the context of nutrition, and is more comprehensive than most “eat this for good brain health and avoid that” books.
Click here to check out “Brain Food” on Amazon and treat your brain like it deserves!
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Kiwi Fruit vs Pineapple – Which is Healthier?
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Our Verdict
When comparing kiwi fruit to pineapple, we picked the kiwi.
Why?
In terms of macros, they’re mostly quite comparable, being fruits made of mostly water, and a similar carb count (slightly different proportions of sugar types, but nothing that throws out the end result, and the GI is low for both). Technically kiwi has twice the protein, but they are fruits and “twice the protein” means “0.5g difference per 100g”. Aside from that, and more meaningfully, kiwi also has twice the fiber.
When it comes to vitamins, kiwi has more of vitamins A, B9, C, E, K, and choline, while pineapple has more of vitamins B1, B2, B3, B5, and B6. This would be a marginal (6:5) win for kiwi, but kiwi’s margins of difference are greater per vitamin, including 72x more vitamin E (with a cupful giving 29% of the RDA, vs a cupful of pineapple giving 0.4% of the RDA) and 57x more vitamin K (with a cupful giving a day’s RDA, vs a cupful of pineapple giving a little under 2% of the RDA). So, this is a fair win for kiwi.
In the category of minerals, things are clear: kiwi has more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc, while pineapple has more manganese. An overwhelming win for kiwi.
Looking at their respective anti-inflammatory powers, pineapple has its special bromelain enzymes, which is a point in its favour, but when it comes to actual polyphenols, the two fruits are quite balanced, with kiwi’s flavonoids vs pineapple’s lignans.
Adding up the sections, it’s a clear win for kiwi—but pineapple is a very respectable fruit too (especially because of its bromelain content), so do enjoy both!
Want to learn more?
You might like to read:
Bromelain vs Inflammation & Much More
Take care!
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