Steps For Keeping Your Feet A Healthy Foundation

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Important Steps For Good Health

This is Dr. Kelly Starrett. He’s a physiotherapist, author, speaker, trainer. He has been described as a “celebrity” and “founding father” of CrossFit. He mostly speaks and writes about mobility in general; today we’re going to be looking at what he has to say specifically about our feet.

A strong foundation

“An army marches on its stomach”, Napoleon famously wrote.

More prosaically: an army marches on its feet, and good foot-care is a top priority for soldiers—indeed, in some militaries, even so much as negligently getting blisters is a military offense.

Most of us are not soldiers, but there’s a lesson to be learned here:

Your feet are the foundation for much of the rest of your health and effectiveness.

KISS for feet

No, not like that.

Rather: “Keep It Simple, Stupid”

Dr. Starrett is not only a big fan of not overcomplicating things, but also, he tells us how overcomplicating things can actively cause problems. When it comes to footwear, for example, he advises:

❝When you wear shoes, wear the flat kind. If you’re walking the red carpet on Oscar night, fine, go ahead and wear a shoe with a heel. Once in a while is okay.

But most of the time, you should wear shoes that are flat and won’t throw your biological movement hardware into disarray.

When you have to wear shoes, whether it’s running shoes, work shoes, or combat boots, buy the flat kind, also known as “zero drop”—meaning that the heel is not raised above the forefoot (at all).

What you want to avoid, or wean yourself away from, are shoes with the heels raised higher off the ground than the forefeet.❞

Of course, going barefoot is great for this, but may not be an option for all of us when out and about. And in the home, going barefoot (or shod in just socks) will only confer health benefits if we’re actually on our feet! So… How much time do you spend on your feet at home?

Allow your feet to move like feet

By evolution, the human body is built for movement—especially walking and running. That came with moving away from hanging around in trees for fruit, to hunting and gathering between different areas of the savannah. Today, our hunting and gathering may be done at the local grocery store, but we still need to keep our mobility, especially when it comes to our feet.

Now comes the flat footwear you don’t want: flip-flops and similar

If we wear flip-flops, or other slippers or shoes that hold onto our feet only at the front, we’re no longer walking like we’re supposed to. Instead of being the elegant product of so much evolution, we’re now walking like those AT-AT walkers in Star Wars, you know, the ones that fell over so easily?

Our feet need to be able to tilt naturally while walking/running, without our footwear coming off.

Golden rule for this: if you can’t run in them, you shouldn’t be walking in them

Exception: if for example you need something on your feet for a minute or two in the shower at the gym/pool, flip-flops are fine. But anything more than that, and you want something better.

Watch your step

There’s a lot here that’s beyond the scope of what we can include in this short newsletter, but:

If we stand or walk or run incorrectly, we’re doing gradual continual damage to our feet and ankles (potentially also our knees and hips, which problems in turn have a knock-on effect for our spine, and you get the idea—this is Bad™)

Some general pointers for keeping things in good order include:

  • Your weight should be mostly on the balls of your feet, not your heels
  • Your feet should be pretty much parallel, not turned out or in
  • When standing, your center of gravity should be balanced between heel and forefoot

Quick tip for accomplishing this last one: Stand comfortably, your feet parallel, shoulder-width apart. Now, go up on your tip-toes. When you’ve done so, note where your spine is, and keep it there (apart from in its up-down axis) when you slowly go back to having your feet flat on the ground, so it’s as though your spine is sliding down a pole that’s fixed in place.

If you do this right, your center of gravity will now be perfectly aligned with where it’s supposed to be. It might feel a bit weird at first, but you’ll get used to it, and can always reset it whenever you want/need, by repeating the exercise.

If you’d like to know more from Dr. Starrett, you can check out his website here 🙂

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  • The Science of Nutrition – by Rhiannon Lambert
    Get a clear overview of the science of nutrition in this book by a nutritionist. The only downside is the section on Intermittent Fasting.

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  • 28-Day FAST Start Day-by-Day – by Gin Stephens

    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 have previously reviewed Gin Stephens’ other book, “Fast. Feast. Repeat.”, so what’s so special about this one that it deserves reviewing too?

    This one is all about troubleshooting the pitfalls that many people find when taking up intermittent fasting.

    To be clear: the goal here is not a “28 days and yay you did it, put that behind you now”, but rather “28 days and you are now intermittently fasting easily each day and can keep it up without difficulty”. As for the difficulties that may arise early in the 28 days…

    Not just issues of willpower, but also the accidental breaks. For example, some artificial sweeteners, while zero-calorie, trigger an insulin response, which breaks the fast on the metabolic level (avoiding that is the whole point of IF). Lots of little tips like that peppered through the book help the reader to stop accidentally self-sabotaging their progress.

    The author does talk about psychological issues too, and also how it will feel different at first while the liver is adapting, than later when it has already depleted its glycogen reserves and the body must burn body fat instead. Information like that makes it easier to understand that some initial problems (hunger, getting “hangry”, feeling twitchy, or feeling light-headed) will last only a few weeks and then disappear.

    So, understanding things like that makes a big difference too.

    The style of the book is simple and clear pop-science, with lots of charts and bullet points and callout-boxes and the like; it makes for very easy reading, and very quick learning of all the salient points, of which there are many.

    Bottom line: if you’ve tried intermittent fasting but struggled to make it stick, this book can help you get to where you want to be.

    Click here to check out 28-Day FAST Start, and start!

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  • The Brain-Gut Highway: A Two-Way Street

    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.

    The Brain-Gut Two-Way Highway

    This is Dr. Emeran Mayer. He has the rather niche dual specialty of being a gastroenterologist and a neurologist. He has published over 353 peer reviewed scientific articles, and he’s a professor in the Departments of Medicine, Physiology, and Psychiatry at UCLA. Much of his work has been pioneering medical research into gut-brain interactions.

    We know the brain and gut are connected. What else does he want us to know?

    First, that it is a two-way interaction. It’s about 90% “gut tells the brain things”, but it’s also 10% “brain tells the gut things”, and that 10% can make more like a 20% difference, if for example we look at the swing between “brain using that 10% communication to tell gut to do things worse” or “brain using that 10% communication to tell gut to do things better”, vs the midpoint null hypothesis of “what the gut would be doing with no direction from the brain”.

    For example, if we are experiencing unmanaged chronic stress, that is going to tell our gut to do things that had an evolutionary advantage 20,000–200,000 years ago. Those things will not help us now. We do not need cortisol highs and adrenal dumping because we ate a piece of bread while stressed.

    Read more (by Dr. Mayer): The Stress That Evolution Has Not Prepared Us For

    With this in mind, if we want to look after our gut, then we can start before we even put anything in our mouths. Dr. Mayer recommends managing stress, anxiety, and depression from the head downwards as well as from the gut upwards.

    Here’s what we at 10almonds have written previously on how to manage those things:

    Do eat for gut health! Yes, even if…

    Unsurprisingly, Dr. Mayer advocates for a gut-friendly, anti-inflammatory diet. We’ve written about these things before:

    …but there’s just one problem:

    For some people, such as with IBS, Crohn’s, and colitis, the Mediterranean diet that we (10almonds and Dr. Mayer) generally advocate for, is inaccessible. If you (if you have those conditions) eat as we describe, a combination of the fiber in many vegetables and the FODMAPs* in many fruits, will give you a very bad time indeed.

    *Fermentable Oligo-, Di-, Monosaccharides And Polyols

    Dr. Mayer has the answer to this riddle, and he’s not just guessing; he and his team did science to it. In a study with hundreds of participants, he measured what happened with adherence (or not) to the Mediterranean diet (or modified Mediterranean diet) (or not), in participants with IBS (or not).

    The results and conclusions from that study included:

    ❝Among IBS participants, a higher consumption of fruits, vegetables, sugar, and butter was associated with a greater severity of IBS symptoms. Multivariate analysis identified several Mediterranean Diet foods to be associated with increased IBS symptoms.

    A higher adherence to symptom-modified Mediterranean Diet was associated with a lower abundance of potentially harmful Faecalitalea, Streptococcus, and Intestinibacter, and higher abundance of potentially beneficial Holdemanella from the Firmicutes phylum.

    A standard Mediterranean Diet was not associated with IBS symptom severity, although certain Mediterranean Diet foods were associated with increased IBS symptoms. Our study suggests that standard Mediterranean Diet may not be suitable for all patients with IBS and likely needs to be personalized in those with increased symptoms.❞

    In graphical form:

    And if you’d like to read more about this (along with more details on which specific foods to include or exclude to get these results), you can do so…

    Want to know more?

    Dr. Mayer offers many resources, including a blog, books, recipes, podcasts, and even a YouTube channel:

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  • Hair-Loss Remedies, By Science

    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.

    10almonds Gets Hairy

    Hair loss is a thing that at some point affects most men and a large minority of women. It can be a source of considerable dysphoria for both, as it’s often seen as a loss of virility/femininity respectively, and is societally stigmatized in various ways.

    Today we’re going to focus on the most common kind: androgenic alopecia, which is called “male pattern baldness” in men and “female pattern baldness” in women, despite being the same thing.

    We won’t spend a lot of time on the science of why this happens (we’re going to focus on the remedies instead), but suffice it to say that genes and hormones both play a role, with dihydrogen testosterone (DHT) being the primary villain in this case.

    We’ve talked before about the science of 5α-reductase inhibitors to block the conversion of regular testosterone* to DHT, its more potent form:

    One Man’s Saw Palmetto Is Another Woman’s Serenoa Repens…

    *We all make this to a greater or lesser degree, unless we have had our ovaries/testes removed.

    Finasteride

    Finasteride is a 5α-reductase inhibitor that performs similarly to saw palmetto, but comes in tiny pills instead of needing to take a much higher dose of supplement (5mg of finasteride is comparable in efficacy to a little over 300mg of saw palmetto).

    Does it work? Yes!

    Any drawbacks? A few:

    • It’ll take 3–6 months to start seeing effects. This is because of the hormonal life-cycle of human hairs.
    • Common side-effects include ED.
    • It is popularly labelled/prescribed as “only for men

    On that latter point: the warnings about this are severe, detailing how women must not take it, must not even touch it if it has been cut up or crushed.

    However… That’s because it can carry a big risk to our unborn fetuses. So, if we are confident we definitely don’t have one of those, it’s not actually applicable to us.

    That said, finasteride’s results in women aren’t nearly so clear-cut as in men (though also, there has been less research, largely because of the above). Here’s an interesting breakdown in more words than we have room for here:

    Finasteride for Women: Everything You Need to Know

    Spironolactone

    This one’s generally prescribed to women, not men, largely because it’s the drug sometimes popularly known as a “chemical castration” drug, which isn’t typically great marketing for men (although it can be applied topically, which will have less of an effect on the rest of the body). For women, this risk is simply not an issue.

    We’ll be brief on this one, but we’ll just drop this, so that you know it’s an option that works:

    Spironolactone is an effective and safe treatment of androgenic alopecia which can enhance the efficacy when combined with other conventional treatments such as minoxidil.

    Topical spironolactone is safer than oral administration and is suitable for both male and female patients, and is expected to become a common drug for those who do not have a good response to minoxidil❞

    Read more: The Efficacy and Safety of Oral and Topical Spironolactone in Androgenetic Alopecia Treatment: A Systematic Review

    Minoxidil

    This one is available (to men and women) without prescription. It’s applied topically, and works by shortcutting the hair’s hormonal growth cycle, to reduce the resting phase and kick it into a growth phase.

    Does it work? Yes!

    Any drawbacks? A few:

    • Whereas you’ll remember finasteride takes 3–6 months to see any effect, this one will have an effect very quickly
      • Specifically, the immediate effect is: your rate of hair loss will appear to dramatically speed up
      • This happens because when hairs are kicked into their growth phase if they were in a resting phase, the first part of that growth phase is to shed each old hair to make room for the new one
    • You’ll then need the same 3–6 months as with finasteride, to see the regrowth effects
    • If you stop using it, you will immediately shed whatever hair you gained by this method

    Why do people choose this over finasteride? For one of three reasons, mainly:

    • They are women, and not offered finasteride
    • They are men, and do not want the side effects of finasteride
    • They just saw an ad and tried it

    As to how it works:

    Minoxidil upregulates the expression of vascular endothelial growth factor in human hair dermal papilla cells

    Some final notes:

    There are some other contraindications and warnings with each of these drugs by the way, so do speak with your doctor/pharmacist. For example:

    There are other hair loss remedies and practices, but the above three are the heavy-hitters, so that’s what we spent our time/space on today. We’ll perhaps cover the less powerful (but less risky) options one of these days.

    Meanwhile, take care!

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  • What You Should Have Been Told About The Menopause Beforehand
  • Algorithms to Live By – by Brian Christian and Tom Griffiths

    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.

    As humans, we subconsciously use heuristics a lot to make many complex decisions based on “fuzzy logic”. For example:

    Do we buy the cheap shoes that may last us a season, or the much more expensive ones that will last us for years? We’ll—without necessarily giving it much conscious thought—quickly weigh up:

    • How much do we like each prospective pair of shoes?
    • What else might we need to spend money on now/soon?
    • How much money do we have right now?
    • How much money do we expect to have in the future?
    • Considering our lifestyle, how important is it to have good quality shoes?

    How well we perform this rapid calculation may vary wildly, depending on many factors ranging from the quality of the advertising to how long ago we last ate.

    And if we make the wrong decision, later we may have buyer’s (or non-buyer’s!) remorse. So, how can we do better?

    Authors Brain Christian and Tom Griffiths have a manual for us!

    This book covers many “kinds” of decision we often have to make in life, and how to optimize those decisions with the power of mathematics and computer science.

    The problems (and solutions) run the gamut of…

    • Optimal stopping (when to say “alright, that’s good enough”)
    • Overcoming cognitive biases
    • Scheduling quandaries
    • Bayes’ Theorem
    • Game Theory
    • And when it’s more efficient to just leave things to chance!

    …and many more (12 main areas of decision-making are covered).

    For all it draws heavily from mathematics and computer science, the writing style is very easy-reading. It’s a “curl up in the armchair and read for pleasure” book, no matter how weighty and practical its content.

    Bottom line: if you improve your ability to make the right decisions even marginally, this book will have been worth your while in the long run!

    Order your copy of “Algorithms To Live By” from Amazon today!

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  • Early Detection May Help Kentucky Tamp Down Its Lung Cancer Crisis

    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.

    Anthony Stumbo’s heart sank after the doctor shared his mother’s chest X-ray.

    “I remember that drive home, bringing her back home, and we basically cried,” said the internal medicine physician, who had started practicing in eastern Kentucky near his childhood home shortly before his mother began feeling ill. “Nobody wants to get told they’ve got inoperable lung cancer. I cried because I knew what this meant for her.”

    Now Stumbo, whose mother died the following year, in 1997, is among a group of Kentucky clinicians and researchers determined to rewrite the script for other families by promoting training and boosting awareness about early detection in the state with the highest lung cancer death rate. For the past decade, Kentucky researchers have promoted lung cancer screening, first recommended by the U.S. Preventive Services Task Force in 2013. These days the Bluegrass State screens more residents who are at high risk of developing lung cancer than any state except Massachusetts — 10.6% of eligible residents in 2022, more than double the national rate of 4.5% — according to the most recent American Lung Association analysis.

    The effort has been driven by a research initiative called the Kentucky LEADS (Lung Cancer Education, Awareness, Detection, and Survivorship) Collaborative, which in 2014 launched to improve screening and prevention, to identify more tumors earlier, when survival odds are far better. The group has worked with clinicians and hospital administrators statewide to boost screening rates both in urban areas and regions far removed from academic medical centers, such as rural Appalachia. But, a decade into the program, the researchers face an ongoing challenge as they encourage more people to get tested, namely the fear and stigma that swirl around smoking and lung cancer.

    Lung cancer kills more Americans than any other malignancy, and the death rates are worst in a swath of states including Kentucky and its neighbors Tennessee and West Virginia, and stretching south to Mississippi and Louisiana, according to data from the Centers for Disease Control and Prevention.

    It’s a bit early to see the impact on lung cancer deaths because people may still live for years with a malignancy, LEADS researchers said. Plus, treatment improvements and other factors may also help reduce death rates along with increased screening. Still, data already shows that more cancers in Kentucky are being detected before they become advanced, and thus more difficult to treat, they said. Of total lung cancer cases statewide, the percentage of advanced cases — defined as cancers that had spread to the lymph nodes or beyond — hovered near 81% between 2000 and 2014, according to Kentucky Cancer Registry data. By 2020, that number had declined to 72%, according to the most recent data available.

    “We are changing the story of families. And there is hope where there has not been hope before,” said Jennifer Knight, a LEADS principal investigator.

    Older adults in their 60s and 70s can hold a particularly bleak view of their mortality odds, given what their loved ones experienced before screening became available, said Ashley Shemwell, a nurse navigator for the lung cancer screening program at Owensboro Health, a nonprofit health system that serves Kentucky and Indiana.

    “A lot of them will say, ‘It doesn’t matter if I get lung cancer or not because it’s going to kill me. So I don’t want to know,’” said Shemwell. “With that generation, they saw a lot of lung cancers and a lot of deaths. And it was terrible deaths because they were stage 4 lung cancers.” But she reminds them that lung cancer is much more treatable if caught before it spreads.

    The collaborative works with several partners, including the University of Kentucky, the University of Louisville, and GO2 for Lung Cancer, and has received grant funding from the Bristol Myers Squibb Foundation. Leaders have provided training and other support to 10 hospital-based screening programs, including a stipend to pay for resources such as educational materials or a nurse navigator, Knight said. In 2022, state lawmakers established a statewide lung cancer screening program based in part on the group’s work.

    Jacob Sands, a lung cancer physician at Boston’s Dana-Farber Cancer Institute, credits the LEADS collaborative with encouraging patients to return for annual screening and follow-up testing for any suspicious nodules. “What the Kentucky LEADS program is doing is fantastic, and that is how you really move the needle in implementing lung screening on a larger scale,” said Sands, who isn’t affiliated with the Kentucky program and serves as a volunteer spokesperson for the American Lung Association.

    In 2014, Kentucky expanded Medicaid, increasing the number of lower-income people who qualified for lung cancer screening and any related treatment. Adults 50 to 80 years old are advised to get a CT scan every year if they have accumulated at least 20 pack years and still smoke or have quit within the past 15 years, according to the latest task force recommendation, which widened the pool of eligible adults. (To calculate pack years, multiply the packs of cigarettes smoked daily by years of smoking.) The lung association offers an online quiz, called “Saved By The Scan,” to figure out likely eligibility for insurance coverage.

    Half of U.S. patients aren’t diagnosed until their cancer has spread beyond the lungs and lymph nodes to elsewhere in the body. By then, the five-year survival rate is 8.2%.

    But regular screening boosts those odds. When a CT scan detects lung cancer early, patients have an 81% chance of living at least 20 years, according to data published in November in the journal Radiology.

    Some adults, like Lisa Ayers, didn’t realize lung cancer screening was an option. Her family doctor recommended a CT scan last year after she reported breathing difficulties. Ayers, who lives in Ohio near the Kentucky border, got screened at UK King’s Daughters, a hospital in far eastern Kentucky. The scan didn’t take much time, and she didn’t have to undress, the 57-year-old said. “It took me longer to park,” she quipped.

    She was diagnosed with a lung carcinoid tumor, a type of neuroendocrine cancer that can grow in various parts of the body. Her cancer was considered too risky for surgery, Ayers said. A biopsy showed the cancer was slow-growing, and her doctors said they would monitor it closely.

    Ayers, a lifelong smoker, recalled her doctor said that her type of cancer isn’t typically linked to smoking. But she quit anyway, feeling like she’d been given a second chance to avoid developing a smoking-related cancer. “It was a big wake-up call for me.”

    Adults with a smoking history often report being treated poorly by medical professionals, said Jamie Studts, a health psychologist and a LEADS principal investigator, who has been involved with the research from the start. The goal is to avoid stigmatizing people and instead to build rapport, meeting them where they are that day, he said.

    “If someone tells us that they’re not ready to quit smoking but they want to have lung cancer screening, awesome; we’d love to help,” Studts said. “You know what? You actually develop a relationship with an individual by accepting, ‘No.’”

    Nationally, screening rates vary widely. Massachusetts reaches 11.9% of eligible residents, while California ranks last, screening just 0.7%, according to the lung association analysis.

    That data likely doesn’t capture all California screenings, as it may not include CT scans done through large managed care organizations, said Raquel Arias, a Los Angeles-based associate director of state partnerships at the American Cancer Society. She cited other 2022 data for California, looking at lung cancer screening for eligible Medicare fee-for-service patients, which found a screening rate of 1%-2% in that population.

    But, Arias said, the state’s effort is “nowhere near what it needs to be.”

    The low smoking rate in California, along with its image as a healthy state, “seems to have come with the unintended consequence of further stigmatizing people who smoke,” said Arias, citing one of the findings from a 2022 report looking at lung cancer screening barriers. For instance, eligible patients may be reluctant to share prior smoking habits with their health provider, she said.

    Meanwhile, Kentucky screening efforts progress, scan by scan.

    At Appalachian Regional Healthcare, 3,071 patients were screened in 2023, compared with 372 in 2017. “We’re just scratching the surface of the potential lives that we can have an effect on,” said Stumbo, a lung cancer screening champion at the health system, which includes 14 hospitals, most located in eastern Kentucky.

    The doctor hasn’t shed his own grief about what his family missed after his mother died at age 51, long before annual screening was recommended. “Knowing that my children were born, and never knowing their grandmother,” he said, “just how sad is that?”

    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.

    Subscribe to KFF Health News’ free Morning Briefing.

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  • The China Study – by Dr. T Colin Campbell and Dr. Thomas M. Campbell

    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.

    This is not the newest book we’ve reviewed (originally published 2005; this revised and expanded edition 2016), but it is a seminal one.

    You’ve probably heard it referenced, and maybe you’ve wondered what the fuss is about. Now you can know!

    The titular study itself was huge. We tend to think “oh there was one study” and look to discount it, but it literally looked at the population of China. That’s a large study.

    And because China is relatively ethnically homogenous, especially per region, it was easier to isolate what dietary factors made what differences to health. Of course, that did also create a limitation: follow-up studies would be needed to see if the results were the same for non-Chinese people. But even for the rest of us (this reviewer is not Chinese), it already pointed science in the right direction. And sure enough, smaller follow-up studies elsewhere found the same.

    But enough about the research; what about the book? This is a book review, not a research review, after all.

    The book itself is easy for a lay reader to understand. It explains how the study was conducted (no small feat), and how the data was examined. It also discusses the results, and the conclusions drawn from those results.

    In light of all this, it also offers simple actionable advices, on how to eat to avoid disease in general, and cancer in particular. In especially that latter case, one take-home conclusion was: get more of your protein from plants for a big reduction in cancer risk, for example.

    Bottom line: this book is an incredible blend of “comprehensive” and “readable” that we don’t often find in the same book! It contains not just a lot of science, but also an insight into how the science works, on a research level. And, of course, its results and conclusions have strong implications for all our lives.

    Click here to check out The China Study, to know more about it!

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