Here’s Looking At Ya!

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This Main Feature Should Take You Two Minutes (and 18 Seconds) To Read*

*Or at least, that’s what we’re told by this software that checks things for readability!

There’s a problem nobody wants to talk about when it comes to speed-reading

If you’re not very conscientious in your method, information does get lost. Especially, anything over 500 words per minute is almost certainly skimming and not true speed-reading.

One of the reasons information gets lost is because of a weird and wonderful feature of our eyes and brain: saccades.

Basically, our eyes can either collect visual information or they can move; they can’t do both at once. And as you may know, our eyes are almost always moving. So why aren’t we blind most of the time?

We actually are.

Did you know: your eyes take two upside-down 2D images and your brain presents you one 3D image the right way around instead? You probably did know that. So: it’s a bit like that.

Your brain takes a series of snapshots from whenever your eyes weren’t moving, and mentally fills in the blanks for you, just like a studio animation. We have a “frame rate” of about 60 frames per second, by the way—that’s why many computer monitors use that frequency. Lower frequencies can result in a noticeable flicker, and higher frequencies are wasted on us mere mortals!

Our eyes do some super-speedy movements called saccades (up to 500º per second! Happily no, our eyes don’t rotate 500º, but that’s the “per second” rate) and our brain fills in the gaps with its best guesses. The more you push it, the more it’ll guess wrong.

We’re not making this up, by the way! See for yourself:

Eye Movements In Reading And Information Processing: 20 Years Of Research

Fortunately, it is possible to use your eyes in a way that reduces the brain’s need to guess. That also means it has more processing power left over to guess correctly when it does need to.

Yes, There’s An App For That

Actually there are a few! But we’re going to recommend Spreeder as a top-tier option, with very rapid improvement right from day one.

It works by presenting the text with a single unmoving focal point. This is the opposite of traditional speed-reading methods that involve a rapidly moving pacer (such as your finger on the page, or a dot on the screen).

This unmoving focal point (while the words move instead) greatly reduces the number of saccades needed, and so a lot less information is lost to optical illusions and guesswork.

Try Spreeder (any platform) Here Now!

If you find that easy to use and would like something with a few more features, you might like another app that works on the same principle: Spritz.

It can take a bit more getting-used-to, but allows for greater integrations with all your favourite content in the long-run:

Check Out Spritz: Android App / iOS App / Free Chrome Extension

Lastly, if you don’t want any of those fancy apps and would just like to read more quickly and easily with less eye-strain, Beeline has you covered.

For free, unless you want to unlock some premium features!

How Beeline works is by adding a color gradient to text on websites and in documents. This makes it a lot easier for the eye to track without going off-piste, skipping a line, or re-reading the same bit again, etc.

Try Out Beeline Reader (any platform) Here Now!

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  • Her Mental Health Treatment Was Helping. That’s Why Insurance Cut Off Her Coverage.

    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.

    Reporting Highlights

    • Progress Denials: Insurers use a patient’s improvement to justify denying mental health coverage.
    • Providers Disagree: Therapists argue with insurers and the doctors they employ to continue covering treatment for their patients.
    • Patient Harm: Some patients backslid when insurers cut off coverage for treatment at key moments.

    These highlights were written by the reporters and editors who worked on this story.

    Geneva Moore’s therapist pulled out her spiral notebook. At the top of the page, she jotted down the date, Jan. 30, 2024, Moore’s initials and the name of the doctor from the insurance company to whom she’d be making her case.

    She had only one chance to persuade him, and by extension Blue Cross and Blue Shield of Texas, to continue covering intensive outpatient care for Moore, a patient she had come to know well over the past few months.

    The therapist, who spoke on the condition of anonymity out of fear of retaliation from insurers, spent the next three hours cramming, as if she were studying for a big exam. She combed through Moore’s weekly suicide and depression assessments, group therapy notes and write-ups from their past few sessions together.

    She filled two pages with her notes: Moore had suicidal thoughts almost every day and a plan for how she would take her own life. Even though she expressed a desire to stop cutting her wrists, she still did as often as three times a week to feel the release of pain. She only had a small group of family and friends to offer support. And she was just beginning to deal with her grief and trauma over sexual and emotional abuse, but she had no healthy coping skills.

    Less than two weeks earlier, the therapist’s supervisor had struck out with another BCBS doctor. During that call, the insurance company psychiatrist concluded Moore had shown enough improvement that she no longer needed intensive treatment. “You have made progress,” the denial letter from BCBS Texas read.

    When the therapist finally got on the phone with a second insurance company doctor, she spoke as fast as she could to get across as many of her points as possible.

    “The biggest concern was the abnormal thoughts — the suicidal ideation, self-harm urges — and extensive trauma history,” the therapist recalled in an interview with ProPublica. “I was really trying to emphasize that those urges were present, and they were consistent.”

    She told the company doctor that if Moore could continue on her treatment plan, she would likely be able to leave the program in 10 weeks. If not, her recovery could be derailed.

    The doctor wasn’t convinced. He told the therapist that he would be upholding the initial denial. Internal notes from the BCBS Texas doctors say that Moore exhibited “an absence of suicidal thoughts,” her symptoms had “stabilized” and she could “participate in a lower level of care.”

    The call lasted just seven minutes.

    Moore was sitting in her car during her lunch break when her therapist called to give her the news. She was shocked and had to pull herself together to resume her shift as a technician at a veterinary clinic.

    “The fact that it was effective immediately,” Moore said later, “I think that was the hardest blow of it all.”

    Many Americans must rely on insurers when they or family members are in need of higher-touch mental health treatment, such as intensive outpatient programs or round-the-clock care in a residential facility. The costs are high, and the stakes for patients often are, too. In 2019 alone, the U.S. spent more than $106.5 billion treating adults with mental illness, of which private insurance paid about a third. One 2024 study found that the average quoted cost for a month at a residential addiction treatment facility for adolescents was more than $26,000.

    Health insurers frequently review patients’ progress to see if they can be moved down to a lower — and almost always cheaper — level of care. That can cut both ways. They sometimes cite a lack of progress as a reason to deny coverage, labeling patients’ conditions as chronic and asserting that they have reached their baseline level of functioning. And if they make progress, which would normally be celebrated, insurers have used that against patients to argue they no longer need the care being provided.

    Their doctors are left to walk a tightrope trying to convince insurers that patients are making enough progress to stay in treatment as long as they actually need it, but not so much that the companies prematurely cut them off from care. And when insurers demand that providers spend their time justifying care, it takes them away from their patients.

    “The issues that we grapple with are in the real world,” said Dr. Robert Trestman, the chair of psychiatry and behavioral medicine at the Virginia Tech Carilion School of Medicine and chair of the American Psychiatric Association’s Council on Healthcare Systems and Financing. “People are sicker with more complex conditions.”

    Mental health care can be particularly prone to these progress-based denials. While certain tests reveal when cancer cells are no longer present and X-rays show when bones have healed, psychiatrists say they have to determine whether someone has returned to a certain level of functioning before they can end or change their treatment. That can be particularly tricky when dealing with mental illness, which can be fluid, with a patient improving slightly one day only to worsen the next.

    Though there is no way to know how often coverage gets cut off mid-treatment, ProPublica has found scores of lawsuits over the past decade in which judges have sharply criticized insurance companies for citing a patient’s improvement to deny mental health coverage. In a number of those cases, federal courts ruled that the insurance companies had broken a federal law designed to provide protections for people who get health insurance through their jobs.

    Reporters reviewed thousands of pages of court documents and interviewed more than 50 insiders, lawyers, patients and providers. Over and over, people said these denials can lead to real — sometimes devastating — harm. An official at an Illinois facility with intensive mental health programs said that this past year, two patients who left before their clinicians felt they were ready due to insurance denials had attempted suicide.

    Dr. Eric Plakun, a Massachusetts psychiatrist with more than 40 years of experience in residential and intensive outpatient programs, and a former board member of the American Psychiatric Association, said the “proprietary standards” insurers use as a basis for denying coverage often simply stabilize patients in crisis and “shortcut real treatment.”

    Plakun offered an analogy: If someone’s house is on fire, he said, putting out the fire doesn’t restore the house. “I got a hole in the roof, and the windows have been smashed in, and all the furniture is charred, and nothing’s working electrically,” he said. “How do we achieve recovery? How do we get back to living in that home?”

    Unable to pay the $350-a-day out-of-pocket cost for additional intensive outpatient treatment, Moore left her program within a week of BCBS Texas’ denial. The insurer would only cover outpatient talk therapy.

    During her final day at the program, records show, Moore’s suicidal thoughts and intent to carry them out had escalated from a 7 to a 10 on a 1-to-10 scale. She was barely eating or sleeping.

    A few hours after the session, Moore drove herself to a hospital and was admitted to the emergency room, accelerating a downward spiral that would eventually cost the insurer tens of thousands of dollars, more than the cost of the treatment she initially requested.

    How Insurers Justify Denials

    Buried in the denial letters that insurance companies send patients are a variety of expressions that convey the same idea: Improvement is a reason to deny coverage.

    “You are better.” “Your child has made progress.” “You have improved.”

    In one instance, a doctor working for Regence Blue Cross and Blue Shield of Oregon wrote that a patient who had been diagnosed with major depression was “sufficiently stable,” even as her own doctors wrote that she “continued to display a pattern of severe impairment” and needed round-the-clock care. A judge ruled that “a preponderance of the evidence” demonstrated that the teen’s continued residential treatment was medically necessary. The insurer said it can’t comment on the case because it ended with a confidential settlement.

    In another, a doctor working for UnitedHealth Group wrote in 2019 that a teenage girl with a history of major depression who had been hospitalized after trying to take her own life by overdosing “was doing better.” The insurer denied ongoing coverage at a residential treatment facility. A judge ruled that the insurer’s determination “lacked any reasoning or citations” from the girl’s medical records and found that the insurer violated federal law. United did not comment on this case but previously argued that the girl no longer had “concerning medical issues” and didn’t need treatment in a 24-hour monitored setting.

    To justify denials, the insurers cite guidelines that they use to determine how well a patient is doing and, ultimately, whether to continue paying for care. Companies, including United, have said these guidelines are independent, widely accepted and evidence-based.

    Insurers most often turn to two sets: MCG (formerly known as Milliman Care Guidelines), developed by a division of the multibillion-dollar media and information company Hearst, and InterQual, produced by a unit of UnitedHealth’s mental health division, Optum. Insurers have also used guidelines they have developed themselves.

    MCG Health did not respond to multiple requests for comment. A spokesperson for the Optum division that works on the InterQual guidelines said that the criteria “is a collection of established scientific evidence and medical practice intended for use as a first level screening tool” and “helps to move patients safely and efficiently through the continuum of care.”

    A separate spokesperson for Optum also said the company’s “priority is ensuring the people we serve receive safe and effective care for their individual needs.” A Regence spokesperson said that the company does “not make coverage decisions based on cost or length of stay,” and that its “number one priority is to ensure our members have access to the care they need when they need it.”

    In interviews, several current and former insurance employees from multiple companies said that they were required to prioritize the proprietary guidelines their company used, even if their own clinical judgment pointed in the opposite direction.

    “It’s very hard when you come up against all these rules that are kind of setting you up to fail the patient,” said Brittainy Lindsey, a licensed mental health counselor who worked at the Anthem subsidiary Beacon and at Humana for a total of six years before leaving the industry in 2022. In her role, Lindsey said, she would suggest approving or denying coverage, which — for the latter — required a staff doctor’s sign-off. She is now a mental health consultant for behavioral health businesses and clinicians.

    A spokesperson for Elevance Health, formerly known as Anthem, said Lindsey’s “recollection is inaccurate, both in terms of the processes that were in place when she was a Beacon employee, and how we operate today.” The spokesperson said “clinical judgment by a physician — which Ms. Lindsey was not — always takes precedence over guidelines.”

    In an emailed statement, a Humana spokesperson said the company’s clinician reviewers “are essential to evaluating the facts and circumstances of each case.” But, the spokesperson said, “having objective criteria is also important to provide checks and balances and consistently comply with” federal requirements.

    The guidelines are a pillar of the health insurance system known as utilization management, which paves the way for coverage denials. The process involves reviewing patients’ cases against relevant criteria every handful of days or so to assess if the company will continue paying for treatment, requiring providers and patients to repeatedly defend the need for ongoing care.

    Federal judges have criticized insurance company doctors for using such guidelines in cases where they were not actually relevant to the treatment being requested or for “solely” basing their decisions on them.

    Wit v. United Behavioral Health, a class-action lawsuit involving a subsidiary of UnitedHealth, has become one of the most consequential mental health cases of this century. In that case, a federal judge in California concluded that a number of United’s in-house guidelines did not adhere to generally accepted standards of care. The judge found that the guidelines allowed the company to wrongly deny coverage for certain mental health and substance use services the moment patients’ immediate problems improved. He ruled that the insurer would need to change its practices. United appealed the ruling on grounds other than the court’s findings about the defects in its guidelines, and a panel of judges partially upheld the decision. The case has been sent back to the district court for further proceedings.

    Largely in response to the Wit case, nine states have passed laws requiring health insurers to use guidelines that align with the leading standards of mental health care, like those developed by nonprofit professional organizations.

    Cigna has said that it “has chosen not to adopt private, proprietary medical necessity criteria” like MCG. But, according to a review of lawsuits, denial letters have continued to reference MCG. One federal judge in Utah called out the company, writing that Cigna doctors “reviewed the claims under medical necessity guidelines it had disavowed.” Cigna did not respond to specific questions about this.

    Timothy Stock, one of the BCBS doctors who denied Moore’s request to cover ongoing care, had cited MCG guidelines when determining she had improved enough — something judges noted he had done before. In 2016, Stock upheld a decision on appeal to deny continued coverage for a teenage girl who was in residential treatment for major depression, post-traumatic stress disorder and anxiety. Pointing to the guidelines, Stock concluded she had shown enough improvement.

    The patient’s family sued the insurer, alleging it had wrongly denied coverage. Blue Cross and Blue Shield of Illinois argued that there was evidence that showed the patient had been improving. But, a federal judge found the insurer misstated its significance. The judge partially ruled in the family’s favor, zeroing in on Stock and another BCBS doctor’s use of improvement to recommend denying additional care.

    “The mere incidence of some improvement does not mean treatment was no longer medically necessary,” the Illinois judge wrote.

    In another case, BCBS Illinois denied coverage for a girl with a long history of mental illness just a few weeks into her stay at a residential treatment facility, noting that she was “making progressive improvements.” Stock upheld the denial after an appeal.

    Less than two weeks after Stock’s decision, court records show, she cut herself on the arm and leg with a broken light bulb. The insurer defended the company’s reasoning by noting that the girl “consistently denied suicidal ideation,” but a judge wrote that medical records show the girl was “not forthcoming” with her doctors about her behaviors. The judge ruled against the insurer, writing that Stock and another BCBS doctor “unreasonably ignored the weight of the medical evidence” showing that the girl required residential treatment.

    Stock declined to comment. A spokesperson for BCBS said the company’s doctors who review requests for mental health coverage are board certified psychiatrists with multiple years of practice experience. The spokesperson added that the psychiatrists review all information received “from the provider, program and members to ensure members are receiving benefits for the right care, at the right place and at the right time.”

    The BCBS spokesperson did not address specific questions related to Moore or Stock. The spokesperson said that the examples ProPublica asked about “are not indicative of the experience of the vast majority of our members,” and that it is committed to providing “access to quality, cost-effective physical and behavioral health care.”

    A Lifelong Struggle

    A former contemporary dancer with a bright smile and infectious laugh, Moore’s love of animals is eclipsed only by her affinity for plants. She moved from Indiana to Austin, Texas, about six years ago and started as a receptionist at a clinic before working her way up to technician.

    Moore’s depression has been a constant in her life. It began as a child, when, she said, she was sexually and emotionally abused. She was able to manage as she grew up, getting through high school and attending Indiana University. But, she said, she fell back into a deep sadness after she learned in 2022 that the church she found comfort in as a college student turned out to be what she and others deemed a cult. In September of last year, she began an intensive outpatient program, which included multiple group and individual therapy sessions every week.

    Moore, 32, had spent much of the past eight months in treatment for severe depression, post-traumatic stress disorder and anxiety when BCBS said it would no longer pay for the program in January.

    The denial had come to her without warning.

    “I was starting to get to the point where I did have some hope, and I was like, maybe I can see an actual end to this,” Moore said. “And it was just cut off prematurely.”

    At the Austin emergency room where she drove herself after her treatment stopped, her heart raced. She was given medication as a sedative for her anxiety. According to hospital records she provided to ProPublica, Moore’s symptoms were brought on after “insurance said they would no longer pay.”

    A hospital social worker frantically tried to get her back into the intensive outpatient program.

    “That’s the sad thing,” said Kandyce Walker, the program’s director of nursing and chief operating officer, who initially argued Moore’s case with BCBS Texas. “To have her go from doing a little bit better to ‘I’m going to kill myself.’ It is so frustrating, and it’s heartbreaking.”

    After the denial and her brief admission to the hospital emergency department in January, Moore began slicing her wrists more frequently, sometimes twice a day. She began to down six to seven glasses of wine a night.

    “I really had thought and hoped that with the amount of work I’d put in, that I at least would have had some fumes to run on,” she said.

    She felt embarrassed when she realized she had nothing to show for months of treatment. The skills she’d just begun to practice seemed to disappear under the weight of her despair. She considered going into debt to cover the cost of ongoing treatment but began to think that she’d rather end her life.

    “In my mind,” she said, “that was the most practical thing to do.”

    Whenever the thought crossed her mind — and it usually did multiple times a day — she remembered that she had promised her therapist that she wouldn’t.

    Moore’s therapist encouraged her to continue calling BCBS Texas to try to restore coverage for more intensive treatment. In late February, about five weeks after Stock’s denial, records show that the company approved a request that sent her back to the same facility and at the same level of care as before.

    But by that time, her condition had deteriorated so severely that it wasn’t enough.

    Eight days later, Moore was admitted to a psychiatric hospital about half an hour from Austin. Medical records paint a harrowing picture of her condition. She had a plan to overdose and the medicine to do it. The doctor wrote that she required monitoring and had “substantial ongoing suicidality.” The denial continued to torment her. She told her doctor that her condition worsened after “insurance stopped covering” her treatment.

    Her few weeks stay at the psychiatric hospital cost $38,945.06. The remaining 10 weeks of treatment at the intensive outpatient program — the treatment BCBS denied — would have cost about $10,000.

    Moore was discharged from the hospital in March and went back into the program Stock had initially said she no longer needed.

    It marked the third time she was admitted to the intensive outpatient program.

    A few months later, as Moore picked at her lunch, her oversized glasses sliding down the bridge of her nose every so often, she wrestled with another painful realization. Had the BCBS doctors not issued the denial, she probably would have completed her treatment by now.

    “I was really looking forward to that,” Moore said softly. As she spoke, she played with the thick stack of bracelets hiding the scars on her wrists.

    A few weeks later, that small facility closed in part because of delays and denials from insurance companies, according to staff and billing records. Moore found herself calling around to treatment facilities to see which ones would accept her insurance. She finally found one, but in October, her depression had become so severe that she needed to be stepped up to a higher level of care.

    Moore was able to get a leave of absence from work to attend treatment, which she worried would affect the promotion she had been working toward. To tide her over until she could go back to work, she used up the money her mother sent for her 30th birthday.

    She smiles less than she did even a few months ago. When her roommates ask her to hang out downstairs, she usually declines. She has taken some steps forward, though. She stopped drinking and cutting her wrists, allowing scar tissue to cover her wounds.

    But she’s still grieving what the denial took from her.

    “I believed I could get better,” she said recently, her voice shaking. “With just a little more time, I could discharge, and I could live life finally.”

    Kirsten Berg contributed research.

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  • Fermenting Everything – by Andy Hamilton

    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 justanother pickling book! This is, instead, what it says on the front cover, “fermenting everything”.

    Ok, maybe not literally everything, but every kind of thing that can reasonably be fermented, and it’s probably a lot more things than you might think.

    From habanero chutney to lacto-lemonade, aioli to kombucha, Ukrainian fermented tomatoes to kvass. We could go on, but we’d soon run out of space. You get the idea. If it’s a fermented product (food, drink, condiment) and you’ve heard of it, there’s probably a recipe in here.

    All in all, this is a great way to get in your gut-healthy daily dose of fermented products!

    He does also talk safety, and troubleshooting too. And so long as you have a collection of big jars and a fairly normally-furnished kitchen, you shouldn’t need any more special equipment than that, unless you decide to you your fermentation skills for making beer (which does need some extra equipment, and he offers advice on that—our advice as a health science publication is “don’t drink beer”, though).

    Bottom line: with this in hand, you can create a lot of amazing foods/drinks/condiments that are not only delicious, but also great for gut health.

    Click here to check out Fermenting Everything, and widen your culinary horizons!

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  • Chromium Picolinate For Blood Sugar Control & Weight Loss

    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.

    First, a quick disambiguation:

    • chromium found in food, trivalent chromium of various kinds, is safe (in the quantities usually consumed) and is sometimes considered an essential mineral, sometimes considered unnecessary but beneficial. It’s hard to know for sure, since it’s in a lot of foods (naturally, like many trace elements)
    • chromium found in pollution, hexavalent chromium (so: twice as many cationic bonds, if this writer’s chemistry serves her correctly) is poisonous.

    We’re going to be writing about the food kind, which is also possible to take as a supplement.

    In this case, supplementing vs getting from food is quite a big difference, by the way, since (unlike for a lot of things, which are often the other way around) the bioavailability of chromium from food is very low (around 2.5%), whereas chromium picolinate, one of the most commonly-used supplement forms, boasts higher bioavailability.

    Does it work for blood sugars?

    Yes, it does! At least, it does in the case of people with type 2 diabetes. Rather than bombard you with many individual studies, here’s a systematic review and meta-analysis of 22 criteria-meeting randomized clinical trials that found:

    ❝The available evidence suggests favourable effects of chromium supplementation on glycaemic control in patients with diabetes.

    Chromium monosupplement may additionally improve triglycerides and HDL-C levels.❞

    Source: Systematic review and meta-analysis of the efficacy and safety of chromium supplementation in diabetes

    Type 1 diabetes does not have anything like the same weight of evidence, and indeed, we couldn’t find a single human study. It was beneficial for mice with artificially-induced T1D, though wait no, we have an update! We found literally a single human study:

    Chromium picolinate supplementation for diabetes mellitus

    Literally, as in: it’s a case study of one person, and the results were a modest reduction in Hb A1c levels after 3 months of 600μg daily; the researchers concluded that ❝chromium picolinate continues to fall squarely within the scope of “alternative medicine,” with both unproven benefits and unknown risks❞.

    As for people without diabetes, it may reduce the risk of diabetes:

    Risk of Type 2 Diabetes Is Lower in US Adults Taking Chromium-Containing Supplements

    However! This was an observational study, and correlation ≠ causation.

    Furthermore, they said:

    ❝Over one-half the adult US population consumes nutritional supplements, and over one-quarter consumes supplemental chromium. The odds of having T2D were lower in those who, in the previous 30 d, had consumed supplements containing chromium❞

    That “over one-quarter consumes supplemental chromium” brought our attention to the fact that this is not talking about specifically chromium “monosupplements” (definitely not quarter of the adult population take those), but rather, “multivitamin and mineral” supplements that also contain a tiny amount (often under 50μg) of chromium.

    In other words, this ruins the data and honestly the benefit could have been from anything in the “multivitamin and mineral” supplement, or indeed, could just be “the kind of person who takes supplements is the kind of person who lives a lifestyle that is less conducive to becoming diabetic”.

    Does it work for weight loss?

    We’re running out of space here, so we’ll be brief:

    No.

    There are many papers that have concluded this, but here are two:

    Chromium picolinate supplementation for overweight or obese adults

    and

    The potential value and toxicity of chromium picolinate as a nutritional supplement, weight loss agent and muscle development agent

    Is it safe?

    Science’s current best answer is “we don’t know; it hasn’t been tested enough; we haven’t even established the tolerable upper limit, which is usually step 1 of establishing safety”.

    Nor is there an estimated average requirement (if indeed there even is a requirement, which question is also not as yet answered conclusively by science), and science falls back to “here’s an average of what people consume in their diet, so that’s probably safe, we guess”.

    (that average was reckoned as 25μg/day for young women and 25μg/day for young men, by the way; older ages not as yet reckoned)

    You can read about this sorry state of affairs here.

    Want to try some?

    Notwithstanding the above lack of data for safety, it does have benefits for blood sugars, so if that’s a gamble you’re willing to make, then here’s an example product on Amazon.

    Note: the dosage per capsule there (800μg) is half of the low end of the dose that was implicated in the serious kidney condition caused in this case study (1200–2400μg), so if you are going to try it, we strongly recommend not taking more than one per day.

    Take care!

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  • Which Bell Peppers To Pick?
  • The Keys to Good Mental Wellbeing

    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 Nine Keys To Good Mental Wellbeing

    Today’s main feature is a bit “pop psychology”, but it has its underpinnings in actual psychology, and is especially useful if approached from that angle.

    What it’s most popularly enjoyed as:

    • A personality-typing system.
    • People love little quizzes and identifiers and such.

    What it’s actually really useful as:

    • A tool for understanding why people (including ourselves) are the way we are
    • A foundational knowledge for living better ourselves, and helping others too

    This stems from the fairly simple principle, uncontroversial in psychology:

    • We have needs, desires, and aversions
    • We act in a way that tries to get our needs met and avoid suffering
    • Thus: Need/Fear → Motivation → Action

    The Enneagram

    The Enneagram (ἐννέα = “nine” in Ancient Greek) system posits that we each have one fundamental need/fear (from a list of nine) that’s strongest for us. A deep-seated insecurity/longing, that we’ll go to almost any lengths to try to meet. Sometimes, in good ways, sometimes, bad.

    The Nine Basic Fears/Insecurities, And Their Corresponding Needs/Desires:

    1. Fear of being a fundamentally bad, wrong person / Need to be good and correct
    2. Fear of being fundamentally unloveable / Need to be loved
    3. Fear of being fundamentally worthless / Need to be valued
    4. Fear of being like everyone else / Need to be different
    5. Fear of being useless / Need to be useful
    6. Fear of being outcast / Need to have a set place in the group
    7. Fear of missing out / Need to experience things
    8. Fear of being hurt or controlled / Need to be in control
    9. Fear of conflict / Need to be at peace

    Of course, most of us have most of these fears/needs to some extent, though usually one will stand out—especially if we aren’t managing it well. The less healthy our coping mechanisms, the more obvious it is how we’re trying to overcompensate in some fashion. For example:

    1. A person who fears being wrong and so becomes a perfectionist rules-abider to a fault
    2. A person who fears being unloveable, and so exaggerates problems to get pity, as the next best thing
    3. A person who fears being worthless, and so exaggerates their accomplishments in order to be admired and valued
    4. A person who fears being like everyone else, and so descends into a “nobody could ever possibly understand me” black hole of pathos.
    5. A person who fears being useless, so burns themself out trying to be an omnicompetent Leonardo da Vinci without ever actually taking the time to stop and smell the flowers as Leonardo did.
    6. A person who fears being outcast, so becomes clingy, passive-aggressive, and suspicious
    7. A person who fears missing out, so tries to experience all the things all the time, ruining their health with dizzying highs and crushing lows.
    8. A person who fears being hurt or controlled, so becomes aggressive and domineering
    9. A person who fears conflict, so shuts down at the slightest hint of it

    If we have healthier coping mechanisms, these same nine people can look a lot different, but in much more subtle ways because we’re not trying to overcompensate so badly:

    1. A person who lives their life rationally by principles that can be adapted as they learn
    2. A person who loves and is loved, as perhaps the most notable part of their character
    3. A person who sets reasonable goals and accomplishes them, and seeks to uplift others
    4. A person who creates and innovates, enriching their own life and the lives of others
    5. A person who is simply very competent and knowledgeable, without overstretching
    6. A person who is dependable and loyal, and a reliable part of something bigger than themself
    7. A person who is fun to be around and loves trying new things, while also knowing how to relax
    8. A person who develops their leadership skills and is a tower of strength for others
    9. A person who knows how to make peace and does so—by themself, and with others

    By being aware of our own fears/insecurities that may drive our motivations and thus underpin our behaviors, we can usually manage them in a much more mindful fashion. Same goes when it comes to managing interactions with other people, too:

    • Letting the Type 3 know you value them, not their accomplishments or what they can do for you.
    • Appreciating the Type 5’s (varied or specialist) skills and knowledge.
    • Giving love to a Type 2 unprompted, but on your own terms, with your own boundaries.
    • And so on for other types

    Or for yourself…

    • As a Type 8, remembering that you can let go sometimes and let someone else be in charge.
    • As a Type 1, catching yourself holding yourself (or others) to impossible standards, and then easing up on that a little.
    • As a Type 9, remembering to stand up for yourself and others, however gently, but firmly.
    • And so on for other types

    If you’re unsure what to focus on, ask yourself: what’s your worst nightmare or greatest daydream? Then work out what it is about that, that makes it feel so bad or good.

    Then, approach things mindfully. Catch yourself in your unhealthy coping mechanisms, and find healthy ones instead.

    What if I get my type wrong? Or I get someone else’s type wrong?

    Obviously it’s better to get them right for maximum effect, but you can never go too far wrong anyway… because we all have all nine of those qualities in us, it’s just a matter of how strong a factor each is for us. So in the worst case scenario, you’ll make someone feel more secure about something that was only a very minor insecurity for them, for example.

    Or in the case of your own type, you may mistakenly think you’re acing being the world’s healthiest Type 5, until you realize you’re actually a Type 3 who thought learning all those things would make you more worthy (spoiler: those things are great, but you’re worthy already). Again, not the end of the world! No matter what, you’re learning and growing, and that’s good.

    Want to delve further?

    Read: The Nine Enneagram Type Descriptions (Basic, but more detailed descriptions than the above)

    Read: How The Enneagram System Works (More complex. Now we’re getting into the more arcane stuff we didn’t have time for today—wings and lines, triads, health levels, directions of integration and disintegration, and more)

    Like learning from books? Here are our top two picks, depending on your learning style:

    We’d love to offer a quick free test here, but all the tests we could find either require paid registration or are wildly inaccurate, so we’ll not waste your time.

    However, we do also think that working it out for yourself is better, as it means you have a handle on what those ideas, fears, insecurities, desires, needs, really mean to you—that way you can actually use the information!

    We’ll close by repeating our previous advice: If you’re unsure what to focus on, ask yourself: what’s your worst nightmare or greatest daydream? Then work out what it is about those scenarios that make them so bad or good. That’ll help you find your real fears/needs, such that you can work on them.

    Good luck!

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  • How To Make Your Doctor’s Appointment Do More For You

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    Doctor: “So, how are you today?”
    Patient: “Can’t complain; how about you?”

    Hopefully your medical appointments don’t start quite like that, but there can be an element of being “along for the ride” when it comes to consultations. They ask questions, we answer, they prescribe something, we thank them.

    In principle, the doctor should be able to handle that; ask the right questions, determine the problem, and not need too much from you. After all, they have been trained to deal with an unconscious patient, so the fact you can communicate at all is a bonus.

    However, leaving it all to them isn’t really playing the field.

    Before the appointment

    Research your issue, as best you understand it. Some doctors will be very averse to you telling them about having done this (taking it as an affront to their expertise), but here’s the thing:

    You don’t have to tell them.

    You just have to understand as much as possible, so that you will be as “up to speed” as possible in the conversation, and not be quickly out of your depth.

    Have an agenda, based on the above. Literally, have a little set of bullet-points to remind you what you came in to discuss, so that nothing escapes you in the moment. This should also include:

    • If you have additional reasons for a particular concern (e.g. family history of a certain problem), make them known
    • If you plan to request any specific tests or treatments, be able to clearly state your reasons for the specific tests or treatments
    • If you plan to write off any specific tests or treatments as something to which you will not consent, have your reasons ready—in a way that makes it clear it’s something more than “don’t want it”, for example, “I’ve already decided that this treatment would make a sufficient hit to my quality of life, as to make it not worthwhile for me personally” (or whatever the reason may be for you). It needs to be something they can write on their notes instead of simply “patient refused treatment”.

    Compile a record of your symptoms (as appropriate), and any previous tests/treatments (as appropriate), in chronological order. If you take all this with you, perhaps in a nice folder, you will enjoy the following advantages:

    • not forgetting anything
    • ability to answer questions accurately
    • give the (correct) impression you take your health seriously, which means they are more likely to do so also—especially because they will now know that if they fob you off and/or mess something up, you’ll be taking a record of that to your next appointment.

    Plan your outfit. No, you don’t have to dress for the red carpet, but you want to satisfy two main conditions:

    • Accessibility for examination (for example, if you are going in with a knee pain, maybe don’t wear the tight jeans today; if they’re going to take blood, be either sleeveless or have sleeves that are easily moved out of the way, etc)
    • General presentability (it’s a sad fact that doctors are not immune to biases, and will treat people better if they respect them more)

    During the appointment

    Be friendly; doctors (like most people) will respond much better to that than to grumpiness—even if you have good reason for grumpiness and even if the doctor has been trained to help grumpy patients.

    Be confident: when we say “be friendly”, that doesn’t mean to necessarily be so agreeable as to not advocate for yourself. In particular:

    • If they explain something and it isn’t clear to you, ask them to clarify
    • If you disagree with them about a value judgement, say so. By “a value judgement” here we mean things in the realm of subjectivity. If the doctor says you are prediabetic, then you won’t get much mileage out of arguing otherwise; the numbers have the final say on that one. But if the doctor says “the side effects of the treatment you’re requesting will make it not worthwhile for you” and you have understood the side effects and you still disagree, then your opinion counts for more than theirs—it is your decision to make.
    • If they dismiss a concern, ask them to put in writing that they dismissed your concern of X, despite you providing evidence that Y, and it being well-known that Z. Often, rather than doing that, they’ll just fold and actually address your concern instead.

    Writer’s example in that last category: I recently made a request for a bone density scan. I expect my bone density is great, because I do all the right things, however, as both of my parents suffered from osteoporosis and assorted resultant crushed bones and the terrible consequences thereof, I a) have reasonable grounds for extra concern, and b) I believe that even if my bone density is fine now, it’s good to establish a baseline so I can know, in 5, 10, 20 years etc, whether there has been any deterioration. Now, happily the doctor I saw agreed with my assessment at first presentation and so I got the referral, but had she not been, I would have said “Could you please put in writing that I asked for a bone density scan, and you refused, on the grounds that [details about what happened with my parents], and that osteoporosis is known to have a strong genetic component is not, in your opinion, any reason to worry?”

    Be honest, and/but err on the side of overstating your symptoms rather than understating. For example, if it is about a chronic condition and the doctor asks “are you able to do xyz”, take the question as meaning “are you able to do xyz on your worst days?”. You can clarify that if you like in your answer, but you need to include the information that xyz is something that your condition can and sometimes does impede you from doing.

    Leave your embarrassment at the door. To the doctor (unless they are a very unprofessional one), you really are just one more patient with symptoms they have (unless your condition is very rare) seen a thousand times before. If your symptom is embarrassing, it will not faze them and you definitely should not hold back from mentioning it, for example. This goes extra in the case of discussions around sexual health, by the way, in which field the details you’d perhaps rather not share with anybody, are the details they need to adequately treat you.

    After the appointment

    Follow up on anything that doesn’t happen as promised (e.g. referrals, things ordered, etc), to make sure nothing got lost in a bureacratic error.

    Get a second opinion if you’re not satisfied with the first one. Doctors are fallible, and as a matter of professional pride, it’s likely the second doctor will be glad to find something the first doctor missed.

    See also: Make Your Negativity Work For You

    Take care!

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  • How To Really Look After Your Joints

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    The Other Ways To Look After Your Joints

    When it comes to joint health, most people have two quick go-to items:

    • Stretching
    • Supplements like omega-3 and glucosamine sulfate

    Stretching, and specifically, mobility exercises, are important! We’ll have to do a main feature on these sometime soon. But for today, we’ll just say: yes, gentle daily stretches go a long way, as does just generally moving more.

    And, those supplements are not without their merits. For example:

    Of those, glucosamine sulfate may have an extra benefit in now just alleviating the symptoms, but also slowing the progression of degenerative joint conditions (like arthritis of various kinds). This is something it shares with chondroitin sulfate:

    Effect of glucosamine or chondroitin sulfate on the osteoarthritis progression: a meta-analysis

    An unlikely extra use for the humble cucumber…

    As it turns out, cucumber extract beats glucosamine and chondroitin by 200%, at 1/135th of the dose.

    You read that right, and it’s not a typo. See for yourself:

    Effectiveness of Cucumis sativus extract versus glucosamine-chondroitin in the management of moderate osteoarthritis: a randomized controlled trial

    Reduce inflammation, have happier joints

    Joint pain and joint degeneration in general is certainly not just about inflammation; there is physical wear-and-tear too. But combatting inflammation is important, and turmeric, which we’ve done a main feature on before, is a potent helper in this regard:

    Efficacy of Turmeric Extracts and Curcumin for Alleviating the Symptoms of Joint Arthritis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

    See also: Keep Inflammation At Bay

    (a whole list of tips for, well, keeping inflammation at bay)

    About that wear-and-tear…

    Your bones and joints are made of stuff, and that stuff needs to be replaced. As we get older, the body typically gets worse at replacing it in a timely and efficient fashion. We can help it do its job, by giving it more of the stuff it needs.

    And what stuff is that?

    Well, minerals like calcium and phosphorus are important, but a lot is also protein! Specifically, collagen. We did a main feature on this before, which is good, as it’d take us a lot of space to cover all the benefits here:

    We Are Such Stuff As Fish Are Made Of

    Short version? People take collagen for their skin, but really, its biggest benefit is for our bones and joints!

    Wrap up warmly and… No wait, skip that.

    If you have arthritis, you may indeed “feel it in your bones” when the weather changes. But the remedy for that is not to try to fight it, but rather, to strengthen your body’s ability to respond to it.

    The answer? Cryotherapy, with ice baths ranking top:

    Note that this can be just localized, so for example if the problem joints are your wrists, a washing-up bowl with water and ice will do just nicely.

    Note also that, per that last study, a single session will only alleviate the pain, not the disease itself. For that (per the other studies) more sessions are required.

    We did a main feature about cryotherapy a while back, and it explains how and why it works:

    A Cold Shower A Day Keeps The Doctor Away?

    Take care!

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