Heart Health vs Systemic Stress

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At The Heart Of Good Health

This is Dr. Michelle Albert. She’s a cardiologist with a decades-long impressive career, recently including a term as the president of the American Heart Association. She’s the current Admissions Dean at UCSF Medical School. She’s accumulated enough awards and honors that if we list them, this email will not fit in your inbox without getting clipped.

What does she want us to know?

First, lifestyle

Although Dr. Albert is also known for her work with statins (which found that pravastatin may have anti-inflammatory effects in addition to lipid-lowering effects, which is especially good news for women, for whom the lipid-lowering effects may be less useful than for men), she is keen to emphasize that they should not be anyone’s first port-of-call unless “first” here means “didn’t see the risk until it was too late and now LDL levels are already ≥190 mg/dL”.

Instead, she recommends taking seriously the guidelines on:

  • getting plenty of fruit, vegetables, whole grains, lean protein
  • avoiding red meat, processed meats, refined carbohydrates, and sweetened beverages
  • getting your 150 minutes per week of moderate exercise
  • avoiding alcohol, and definitely abstaining from smoking

See also: These Top Five Things Make The Biggest Difference To Health

Next, get your house in order

No, not your home gym—though sure, that too!

But rather: after the “Top Five Things” we linked just above, the sixth on the list would be “reduce stress”. Indeed, as Dr. Albert says:

❝Heart health is not just about the physical heart but also about emotional well-being. Stress management is crucial for a healthy heart❞

~ Dr. Michelle Albert

This is where a lot of people would advise mindfulness meditation, CBT, somatic therapies, and the like. And these things are useful! See for example:

No-Frills, Evidence-Based Mindfulness

…and:

How To Manage Chronic Stress

However, Dr. Albert also advocates for awareness of what some professionals have called “Shit Life Syndrome”.

This is more about socioeconomic factors. There are many of those that can’t be controlled by the individual, for example:

Adverse maternal experiences such as depression, economic issues and low social status can lead to poor cognitive outcomes as well as cardiovascular disease.

Many jarring statistics illuminate a marked wealth gap by race and ethnicity… You might be thinking education could help bridge that gap. But it is not that simple.

While education does increase wealth, the returns are not the same for everyone. Black persons need a post-graduate degree just to attain similar wealth as white individuals with a high school degree.

~ Dr. Michelle Albert

Read in full: AHA president: The connection between economic adversity and cardiovascular health

What this means in practical terms (besides advocating for structural change to tackle the things such as the racism that has been baked into a lot of systems for generations) is:

Be aware not just of your obvious health risk factors, but also your socioeconomic risk factors, if you want to have good general health outcomes.

So for example, let’s say that you, dear reader, are wealthy and white, in which case you have some very big things in your favor, but are you also a woman? Because if so…

Women and Minorities Bear the Brunt of Medical Misdiagnosis

See also, relevant for some: Obesity Discrimination In Healthcare Settings ← you’ll need to scroll to the penultimate section for this one.

In other words… If you are one of the majority of people who is a woman and/or some kind of minority, things are already stacked against you, and not only will this have its own direct harmful effect, but also, it’s going to make your life harder and that stress increases CVD risk more than salt.

In short…

This means: tackle not just your stress, but also the things that cause that. Look after your finances, gather social support, know your rights and be prepared to self-advocate / have someone advocate for you, and go into medical appointments with calm well-prepared confidence.

Take care!

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  • California Becomes Latest State To Try Capping Health Care Spending

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    California’s Office of Health Care Affordability faces a herculean task in its plan to slow runaway health care spending.

    The goal of the agency, established in 2022, is to make care more affordable and accessible while improving health outcomes, especially for the most disadvantaged state residents. That will require a sustained wrestling match with a sprawling, often dysfunctional health system and powerful industry players who have lots of experience fighting one another and the state.

    Can the new agency get insurers, hospitals, and medical groups to collaborate on containing costs even as they jockey for position in the state’s $405 billion health care economy? Can the system be transformed so that financial rewards are tied more to providing quality care than to charging, often exorbitantly, for a seemingly limitless number of services and procedures?

    The jury is out, and it could be for many years.

    California is the ninth state — after Connecticut, Delaware, Massachusetts, Nevada, New Jersey, Oregon, Rhode Island, and Washington — to set annual health spending targets.

    Massachusetts, which started annual spending targets in 2013, was the first state to do so. It’s the only one old enough to have a substantial pre-pandemic track record, and its results are mixed: The annual health spending increases were below the target in three of the first five years and dropped beneath the national average. But more recently, health spending has greatly increased.

    In 2022, growth in health care expenditures exceeded Massachusetts’ target by a wide margin. The Health Policy Commission, the state agency established to oversee the spending control efforts, warned that “there are many alarming trends which, if unaddressed, will result in a health care system that is unaffordable.”

    Neighboring Rhode Island, despite a preexisting policy of limiting hospital price increases, exceeded its overall health care spending growth target in 2019, the year it took effect. In 2020 and 2021, spending was largely skewed by the pandemic. In 2022, the spending increase came in at half the state’s target rate. Connecticut and Delaware, by contrast, both overshot their 2022 targets.

    It’s all a work in progress, and California’s agency will, to some extent, be playing it by ear in the face of state policies and demographic realities that require more spending on health care.

    And it will inevitably face pushback from the industry as it confronts unreasonably high prices, unnecessary medical treatments, overuse of high-cost care, administrative waste, and the inflationary concentration of a growing number of hospitals in a small number of hands.

    “If you’re telling an industry we need to slow down spending growth, you’re telling them we need to slow down your revenue growth,” says Michael Bailit, president of Bailit Health, a Massachusetts-based consulting group, who has consulted for various states, including California. “And maybe that’s going to be heard as ‘we have to restrain your margins.’ These are very difficult conversations.”

    Some of California’s most significant health care sectors have voiced disagreement with the fledgling affordability agency, even as they avoid overtly opposing its goals.

    In April, when the affordability office was considering an annual per capita spending growth target of 3%, the California Hospital Association sent it a letter saying hospitals “stand ready to work with” the agency. But the proposed number was far too low, the association argued, because it failed to account for California’s aging population, new investments in Medi-Cal, and other cost pressures.

    The hospital group suggested a spending increase target averaging 5.3% over five years, 2025-29. That’s slightly higher than the 5.2% average annual increase in per capita health spending over the five years from 2015 to 2020.

    Five days after the hospital association sent its letter, the affordability board approved a slightly less aggressive target that starts at 3.5% in 2025 and drops to 3% by 2029. Carmela Coyle, the association’s chief executive, said in a statement that the board’s decision still failed to account for an aging population, the growing need for mental health and addiction treatment, and a labor shortage.

    The California Medical Association, which represents the state’s doctors, expressed similar concerns. The new phased-in target, it said, was “less unreasonable” than the original plan, but the group would “continue to advocate against an artificially low spending target that will have real-life negative impacts on patient access and quality of care.”

    But let’s give the state some credit here. The mission on which it is embarking is very ambitious, and it’s hard to argue with the motivation behind it: to interject some financial reason and provide relief for millions of Californians who forgo needed medical care or nix other important household expenses to afford it.

    Sushmita Morris, a 38-year-old Pasadena resident, was shocked by a bill she received for an outpatient procedure last July at the University of Southern California’s Keck Hospital, following a miscarriage. The procedure lasted all of 30 minutes, Morris says, and when she received a bill from the doctor for slightly over $700, she paid it. But then a bill from the hospital arrived, totaling nearly $9,000, and her share was over $4,600.

    Morris called the Keck billing office multiple times asking for an itemization of the charges but got nowhere. “I got a robotic answer, ‘You have a high-deductible plan,’” she says. “But I should still receive a bill within reason for what was done.” She has refused to pay that bill and expects to hear soon from a collection agency.

    The road to more affordable health care will be long and chock-full of big challenges and unforeseen events that could alter the landscape and require considerable flexibility.

    Some flexibility is built in. For one thing, the state cap on spending increases may not apply to health care institutions, industry segments, or geographic regions that can show their circumstances justify higher spending — for example, older, sicker patients or sharp increases in the cost of labor.

    For those that exceed the limit without such justification, the first step will be a performance improvement plan. If that doesn’t work, at some point — yet to be determined — the affordability office can levy financial penalties up to the full amount by which an organization exceeds the target. But that is unlikely to happen until at least 2030, given the time lag of data collection, followed by conversations with those who exceed the target, and potential improvement plans.

    In California, officials, consumer advocates, and health care experts say engagement among all the players, informed by robust and institution-specific data on cost trends, will yield greater transparency and, ultimately, accountability.

    Richard Kronick, a public health professor at the University of California-San Diego and a member of the affordability board, notes there is scant public data about cost trends at specific health care institutions. However, “we will know that in the future,” he says, “and I think that knowing it and having that information in the public will put some pressure on those organizations.”

    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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  • Smart Hearing – by Katherine Bouton

    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 author’s hearing loss began in her 30s, and now she’s in her 70s with even less hearing, and/but much more experience. Having worked at the Hearing Loss Association of America for much of that time, she has a lot to share.

    This book is a practical guide to adult-onset hearing loss, and aims to help the reader navigate not just the difficulties inherent to the condition, but also the complexities around it that are largely societal, administrative, financial, and so forth.

    She advocates for early intervention where possible, and that most people in the early stages of hearing loss don’t realize what’s happening. They will tend to just blame the noisy environment, or the speaker, for example. And beyond just hearing tests, she recommends specifics that you might not have heard of, such as the speech-in-noise test.

    With regard to technology, she covers the various options,and also ways to pay for them (because Medicare won’t)—which latter is specific to the US, so if you’re from somewhere else, then probably a) this advice won’t help, but b) you probably won’t need it, as most places have more comprehensive healthcare coverage.

    The style is quite personal while remaining professional; she often uses her own story as an illustration, but covers experiences other than hers just as thoroughly, so that no major variant of hearing loss gets overlooked.

    Bottom line: if you and/or a loved one aren’t hearing/understanding auditory things so well as you used to, this book can help guide you into a position of more practical empowerment, without the need for quite so much trial and error as you might otherwise find alone.

    Click here to check out Smart Hearing, and live better with hearing loss!

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  • Paving The Way To Good Health

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    This is Dr. Michelle Tollefson. She’s a gynecologist, and a menopause and lifestyle medicine expert. She’s also a breast cancer survivor, and, indeed, thriver.

    So, what does she want us to know?

    A Multivector Approach To Health

    There’s a joke that goes: a man is trapped in a flooding area, and as the floodwaters rise, he gets worried and begins to pray, but he is interrupted when some people come by on a raft and offer him to go with them. He looks at the rickety raft and says “No, you go on, God will spare me”. He returns to his prayer, and is further interrupted by a boat and finally a helicopter, and each time he gives the same response. He drowns, and in the afterlife he asks God “why didn’t you spare me from the flood?”, and God replies “I sent a raft, a boat, and a helicopter; what more did you want?!”

    People can be a bit the same when it comes to different approaches to cancer and other serious illness. They are offered chemotherapy and say “No, thank you, eating fruit will spare me”.

    Now, this is not to trivialize those who decline aggressive cancer treatments for other reasons such as “I am old and would rather not go through that; I’d rather have a shorter life without chemo than a longer life with it”—for many people that’s a valid choice.

    But it is to say: lifestyle medicine is, mostly, complementary medicine.

    It can be very powerful! It can make the difference between life and death! Especially when it comes to things like cancer, diabetes, heart disease, etc.

    But it’s not a reason to decline powerful medical treatments if/when those are appropriate. For example, in Dr. Tollefson’s case…

    Synergistic health

    Dr. Tollefson, herself a lifestyle medicine practitioner and gynecologist (and having thus done thousands of clinical breast exams for other people, screening for breast cancer), says she owes her breast cancer survival to two things, or rather two categories of things:

    1. a whole-food, plant predominant diet, daily physical activity, prioritizing sleep, minimizing stress, and a strong social network
    2. a bilateral mastectomy, 16 rounds of chemotherapy, removal of her ovaries, and several reconstructive surgeries

    Now, one may wonder: if the first thing is so good, why need the second?

    Or on the flipside: if the second thing was necessary, what was the point of the first?

    And the answer she gives is: the first thing was the reason she was able to make it through the second thing.

    And on the next level: the second thing was the reason she’s still around to talk about the first thing.

    In other words: she couldn’t have done it with just one or the other.

    A lot of medicine in general, and lifestyle medicine in particular, is like this. If we note that such-and-such a thing decreases our risk of cancer mortality by 4%, that’s a small decrease, but it can add up (and compound!) if it’s surrounded by other things that also each decrease the risk by 12%, 8%, 15%, and so on.

    Nor is this only confined to cancer, nor only to the positives.

    Let’s take cardiovascular disease: if a person smokes, drinks, eats red meat, stresses, and has a wild sleep schedule, you can imagine those risk factors add up and compound.

    If this person and another with a heart-healthy lifestyle both have a stroke (it can happen to anyone, even if it’s less likely in this case), and both need treatment, then two things are true:

    • They are both still going to need treatment (medicines, and possibly a thrombectomy)
    • The second person is most likely to recover, and most likely to recover more quickly and easily

    The second person can be said to have paved the way to their recovery, with their lifestyle.

    Which is really important, because a lot of people think “what’s the point in living so healthily if [disease] strikes anyway?” and the answer is:

    A very large portion of your recovery is predicated on how you lived your life before The Bad Thing™ happened, and that can be the difference between bouncing back quickly and a long struggle back to health.

    Or the difference between a long struggle back to health, or a short struggle followed by rapid decline and death.

    In short:

    Play the odds, improve your chances with lifestyle medicine. Enjoy those cancer-fighting fruits:

    Top 8 Fruits That Prevent & Kill Cancer

    …but also, get your various bits checked when appropriate; we know, mammograms and prostate checks etc are not usually the highlight of most people’s days, but they save lives. And if it turns out you need serious medical interventions, consider them seriously.

    And, by all means, enjoy mood-boosting nutraceuticals such as:

    12 Foods That Fight Depression & Anxiety

    …but also recognize that sometimes, your brain might have an ongoing biochemical problem that a tablespoon of pumpkin seeds isn’t going to fix.

    And absolutely, you can make lifestyle adjustments to reduce the risks associated with menopause, for example:

    Menopause, & How Lifestyle Continues To Matter “Postmenopause”

    …but also be aware that if the problem is “not enough estrogen”, sometimes to solution is “take estrogen”.

    And so on.

    Want to know Dr. Tollefson’s lifestyle recommendations?

    Most of them will not be a surprise to you, and we mentioned some of them above (a whole-food, plant predominant diet, daily physical activity, prioritizing sleep, minimizing stress, and a strong social network), but for more specific recommendations, including numbers etc, enjoy:

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

    Take care!

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  • I’ve recovered from a cold but I still have a hoarse voice. What should I do?

    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.

    Cold, flu, COVID and RSV have been circulating across Australia this winter. Many of us have caught and recovered from one of these common upper respiratory tract infections.

    But for some people their impact is ongoing. Even if your throat isn’t sore anymore, your voice may still be hoarse or croaky.

    So what happens to the voice when we get a virus? And what happens after?

    Here’s what you should know if your voice is still hoarse for days – or even weeks – after your other symptoms have resolved.

    Why does my voice get croaky during a cold?

    A healthy voice is normally clear and strong. It’s powered by the lungs, which push air past the vocal cords to make them vibrate. These vibrations are amplified in the throat and mouth, creating the voice we hear.

    The vocal cords are two elastic muscles situated in your throat, around the level of your laryngeal prominence, or Adam’s apple. (Although everyone has one, it tends to be more pronounced in males.) The vocal cords are small and delicate – around the size of your fingernail. Any small change in their structure will affect how the voice sounds.

    When the vocal cords become inflamed – known as laryngitis – your voice will sound different. Laryngitis is a common part of upper respiratory tract infections, but can also be caused through misuse.

    Two drawn circles comparing normal vocal cords with inflamed, red vocal cords.
    Viruses such as the common cold can inflame the vocal cords. Pepermpron/Shutterstock

    Catching a virus triggers the body’s defence mechanisms. White blood cells are recruited to kill the virus and heal the tissues in the vocal cords. They become inflamed, but also stiffer. It’s harder for them to vibrate, so the voice comes out hoarse and croaky.

    In some instances, you may find it hard to speak in a loud voice or have a reduced pitch range, meaning you can’t go as high or loud as normal. You may even “lose” your voice altogether.

    Coughing can also make things worse. It is the body’s way of trying to clear the airways of irritation, including your own mucus dripping onto your throat (post-nasal drip). But coughing slams the vocal cords together with force.

    Chronic coughing can lead to persistent inflammation and even thicken the vocal cords. This thickening is the body trying to protect itself, similar to developing a callus when a pair of new shoes rubs.

    Thickening on your vocal cords can lead to physical changes in the vocal cords – such as developing a growth or “nodule” – and further deterioration of your voice quality.

    Diagram compares healthy vocal cords with cords that have nodules, two small bumps.
    Coughing and exertion can cause inflamed vocal cords to thicken and develop nodules. Pepermpron/Shutterstock

    How can you care for your voice during infection?

    People who use their voices a lot professionally – such as teachers, call centre workers and singers – are often desperate to resume their vocal activities. They are more at risk of forcing their voice before it’s ready.

    The good news is most viral infections resolve themselves. Your voice is usually restored within five to ten days of recovering from a cold.

    Occasionally, your pharmacist or doctor may prescribe cough suppressants to limit additional damage to the vocal cords (among other reasons) or mucolytics, which break down mucus. But the most effective treatments for viral upper respiratory tract infections are hydration and rest.

    Drink plenty of water, avoid alcohol and exposure to cigarette smoke. Inhaling steam by making yourself a cup of hot water will also help clear blocked noses and hydrate your vocal cords.

    Rest your voice by talking as little as possible. If you do need to talk, don’t whisper – this strains the muscles.

    Instead, consider using “confidential voice”. This is a soft voice – not a whisper – that gently vibrates your vocal cords but puts less strain on your voice than normal speech. Think of the voice you use when communicating with someone close by.

    During the first five to ten days of your infection, it is important not to push through. Exerting the voice by talking a lot or loudly will only exacerbate the situation. Once you’ve recovered from your cold, you can speak as you would normally.

    What should you do if your voice is still hoarse after recovery?

    If your voice hasn’t returned to normal after two to three weeks, you should seek medical attention from your doctor, who may refer you to an ear nose and throat specialist.

    If you’ve developed a nodule, the specialist would likely refer you to a speech pathologist who will show you how to take care of your voice. Many nodules can be treated with voice therapy and don’t require surgery.

    You may have also developed a habit of straining your vocal cords, if you forced yourself to speak or sing while they were inflamed. This can be a reason why some people continue to have a hoarse voice even when they’ve recovered from the cold.

    In those cases, a speech pathologist may play a valuable role. They may teach you to exercises that make voicing more efficient. For example, lip trills (blowing raspberries) are a fun and easy way you can learn to relax the voice. This can help break the habit of straining your voice you may have developed during infection.

    Yeptain Leung, Postdoctoral Research and Lecturer of Speech Pathology, School of Health Sciences, The University of Melbourne

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

    Don’t Forget…

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  • Tuna vs Catfish – Which is Healthier?

    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.

    Our Verdict

    When comparing tuna to catfish, we picked the tuna.

    Why?

    Today in “that which is more expensive and/or harder to get is not necessarily healthier”…

    Looking at their macros, tuna has more protein and less fat (and overall, less saturated fat, and also less cholesterol).

    In the category of vitamins, both are good but tuna distinguishes itself: tuna has more of vitamins A, B1, B2, B3, B6, and D, while catfish has more of vitamins B5, B9, B12, E, and K. They are both approximately equal in choline, and as an extra note in tuna’s favor (already winning 6:5), tuna is a very good source of vitamin D, while catfish barely contains any. All in all: a moderate, but convincing, win for tuna.

    When it comes to minerals, things are clearer still: tuna has more copper, iron, magnesium, phosphorus, potassium, and selenium, while catfish has more calcium, manganese, and zinc. Oh, and catfish is also higher in one other mineral: sodium, which most people in industrialized countries need less of, on average. So, a 6:3 win for tuna, before we even take into account the sodium content (which makes the win for tuna even stronger).

    In short: tuna wins the day in every category!

    Want to learn more?

    You might like to read:

    Farmed Fish vs Wild Caught (It Makes Quite A Difference)

    Take care!

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  • The Osteoporosis Breakthrough – by Dr. Doug Lucas

    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.

    “Osteoporosis” and “break” often don’t go well together, but here they do. So, what’s the breakthrough here?

    There isn’t one, honestly. But if we overlook the marketing choices and focus on the book itself, the content here is genuinely good:

    The book offers a comprehensive multivector approach to combatting osteoporosis, e.g:

    • Diet
    • Exercise
    • Other lifestyle considerations
    • Supplements
    • Hormones
    • Drugs

    The author considers drugs a good and important tool for some people with osteoporosis, but not most. The majority of people, he considers, will do better without drugs—by tackling things more holistically.

    The advice here is sound and covers all reasonable angles without getting hung up on the idea of there being a single magical solution for all.

    Bottom line: if you’re looking for a book that’s a one-stop-shop for strategies against osteoporosis, this is a good option.

    Click here to check out The Osteoporosis Breakthrough, and keep your bones strong!

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