
Dealing with Thirst!
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Busting The Myth of “Eight Glasses Of Water A Day”
Everyone knows we must drink 8 glasses of water a day, or else we’re going to get a failing grade at being a healthy human—like not flossing, or not using adequate sunscreen.
But… Do we? And does tea count? How about (we dare but whisper it) coffee? And soda drinks are mostly water, right? But aren’t some drinks dehydrating? Are special electrolyte drinks really better? There are so many things to consider, so many differing advices, and it’s easy to give up, or just choose what to believe in as a leap of faith.
A quick brain-teaser for you first, though:
If coffee and soda don’t count because they’re dehydrating, then what if you were to take:
– A concentrated tiny cup of espresso, and then a glass of water, would the glass of water count?
– Or (we don’t relish the thought) what if you took a spoonful of soda syrup, and then a glass of water, would the glass of water count?
If your answer was “yes, it’s a glass of water”, then why would it not count if it were taken all at once (e.g. as an Americano coffee, or a regular soda)?
If your answer was “yes, but that water might only offset the dehydration caused by the coffee/syrup, so I might only be breaking even”, then you were thinking about this the right way:
How much water you need depends on many factors that can be affected by what else you are consuming and what else you are doing. Science loves averages, so eight glasses a day may be great if you are of average health, and average body size, in a temperate climate, doing moderate exercise, and so on and so on.
If you’re not the most average person of all time? You may need to take into account a lot of factors, ranging from what you ate for dinner to how much you perspired during your morning exercises. As you (probably) don’t live in laboratory conditions, this can become an impossible task—and if you missed (or guessed incorrectly) even one factor, the whole calculation will be thrown off. But is there any other way to know?
What of the infamous pee test? Drink enough to make your urine as clear as possible, and if it’s dark, you’re dehydrated, common wisdom says.
In reality, however, that tells you not what’s in your body, but rather, what got ejected from your body. If your urine is dark, it might mean you had too little water, but it also could just mean you had the right amount of water but too much sodium, for instance. A study of this was done on athletes, and found no correlation between urine color and actual bodily hydration when measured directly via a blood test.
So, if we can’t just have an app tell us “drink this many glasses of water”, and we can’t trust urine color, what can we do?
What we can do is trust that our body comes with (for free!) a wonderful homeostatic system and it will try to correct any imbalances. If you are thirsty, you’re dehydrated. Drink something with plenty of water in, if not plain water.
But what about special electrolyte drinks? If you need salts, you will crave them. Craving a salty snack? Go for it! Or if you prefer not to snack, do a salt lick test (just put a little salt on your finger, and taste it; if it tastes good, wait a minute or two, and then have a little more, and repeat until it doesn’t).
Bonus Tip:
- Make sure you always have a source of hydration (that you enjoy!) to hand. Maybe it’s chilled water, maybe it’s a pot of tea, maybe it’s a sports drink, it doesn’t matter too much. Even coffee is actually fine, by the way (but don’t overdo it).
- Make a personal rule: “I will always make time for hydration”. That means, if you’re thirsty, have something with water in it now. Not when you’ve finished what you’re doing (unless you really can’t stop, because you are a racecar driver mid-race, or a surgeon mid-operation, or something), but now. Do not postpone it until after you’ve done some other thing first; you will forget and it will keep getting postponed. Always make time for water.
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Broccoli Sprouts & Sulforaphane
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small 😎
❝How much science is there behind sulforaphane / broccoli spirits and its health claims??❞
So, first of all, what it is: sulforaphane is a compound found in Brassica oleracea, of which species broccoli is a cultivar. It’s found in the other Brassica oleracea cultivars too (e.g. cauliflower, various cabbages, Brussels sprouts, kale, etc), but for whatever reason*, most research has been on broccoli and broccoli sprouts.
*Likely the reason is: research begets research—it’s easier to get funding to expand upon previous research, than it is to break ground on researching a different plant, where for the first third of your paper you have almost no existing scientific literature to cite. So once they got started on broccoli sprouts, everything else has been broccoli sprouts too.
And for clarity on what broccoli sprouts are: this means that when broccoli seeds have been germinated and just begun to sprout, they are harvested and eaten. That’s the one-line explanation, anyway; there’s a little more to it than that, so anyone interested should check out our previous main feature:
Good Things Come In Small Packages: Sprout Your Seeds, Grains, Beans, Etc
…and for more depth than we have room for in a one-page article, check out this book we reviewed:
The Sprout Book: Tap Into The Power Of The Planet’s Most Nutritious Food – by Doug Evans
One thing that the science is clear on: sprouts of a given plant indeed have much higher general nutritional density than their “adult” siblings. And in the case of sulforaphane specifically, it’s about 100x higher in broccoli sprouts than in adult broccoli:
Broccoli or Sulforaphane: Is It the Source or Dose That Matters? ← we suggest skipping down to the section “broccoli-based clinical trials”
So, that prompts the next question: do we care?
In other words: is sulforaphane really particularly important?
Sulforaphane vs cancer
The most well-evidenced health-giving property of sulforaphane is its anticancer activity:
Brassicaceae-Derived Anticancer Agents: Towards a Green Approach to Beat Cancer
A lot of the research there is epidemiological rather than RCTs, and where there are RCTs, they are mostly small ones, like this 10-person broccoli soup study about bioavailability (rather than the effects themselves):
Bioavailability of Glucoraphanin and Sulforaphane from High-Glucoraphanin Broccoli
To get into sulforaphane’s anticancer potential in seriousness, we have to look at a lot of in-vitro studies trialling it to limit carcinogenesis, or to shrink tumors with it, or specifically targetting cancer stem cells with it, which make for quite compelling reading:
A quick aside: if you’re reading that and thinking “Why is sonic the hedgehog in here?” it’s because after the observation of the influence of certain genes that influence cuticular denticles (the growth of spikes) on fruit fly larvae (bearing in mind the fruit fly Drosophila melanogaster is used for so much first- or second-line genetic research, being either the go-to or the go-to after the nematode C. elegans) caused the whole group of genes to get called “hedgehog genes” and then it became scientific convention to name each newly researched gene in that set after a different kind of hedgehog. One of them, instead of being named after a real-world hedgehog species like the others, got named after the videogame character.
Unfortunately, this now means that because the gene is associated with a certain congenital brain disorder, sometimes a doctor has to explain to a family that the reason their baby has a brain defect is because of a mutated sonic hedgehog.
Ok, back to talking about cancer. Let’s just quickly drop a few more papers so it’s clear that this is well-established:
- Multi-targeted prevention of cancer by sulforaphane ← this shows how it works on the cellular level
- Cruciferous vegetables: dietary phytochemicals for cancer prevention ← this shows how it works on the population level
However, that’s not the only established benefit:
❝SFN has other beneficial effects in addition to cancer protection. SFN exhibits neuroprotective effects and is implemented in treating conditions such as traumatic brain injury, Alzheimer’s disease and Parkinson’s disease.❞
Source: Sulforaphane in broccoli: The green chemoprevention!! Role in cancer prevention and therapy
Now, after the extract we quoted above, the rest of the section “other health benefits of sulforaphane” includes a lot of speculation, weak science, and/or things attributable to other phytochemicals in broccoli, including various polyphenols, vitamins, and minerals.
About those broccoli spirits
Ok, we know it was a typo, but… Actually, there is something worth mentioning here, and that’s that sulforaphane is only activated when glucoraphanin (its inactive form) comes into contact with myrosinase (an enzyme that’s only released when the plant is damaged).
In other words, it’s necessary to injure the broccoli before consuming it, in order to release the
spiritsmyrosinase. Now, while very few people are out there swallowing adult broccoli plants whole, it could well happen that people might wolf down uncut broccoli sprouts, since they are only small, after all.For this reason, it’s best that broccoli, even if it’s broccoli sprouts, be cut while raw before consumption.
In terms of cooking, heat in excess of 140℃ / 284℉ will destroy the glucoraphanin, and less/no glucoraphanin means less/no sulforaphane.
So, enjoying them raw or lightly steaming them seems to be best for this purpose:
Impact of thermal processing on sulforaphane yield from broccoli (Brassica oleracea L. ssp. italica)
Just want a supplement?
Many studies (including some cited by the research reviews we cited above) deal with sulforaphane in extract form, rather than whole plants, so there’s no shame in taking it that way if you’re not a fan of broccoli.
We don’t sell it, but here for your convenience is an example product on Amazon 😎
Enjoy!
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The Menopause Manifesto – by Dr. Jen Gunter
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From the subtitle, you may wonder: with facts and feminism? Is this book about biology or sociology?
And the answer is: both. It’s about biology, principally, but without ignoring the context. We do indeed “live in a society”, and that affects everything from our healthcare options to what is expected of us as women.
So, as a warning: if you dislike science and/or feminism, you won’t like this book.
Dr. Jen Gunter, herself a gynaecologist, is here to arm us with science-based facts, to demystify an important part of life that is commonly glossed over.
She talks first about the what/why/when/how of menopause, and then delivers practical advice. She also talks about the many things we can (and can’t!) usefully do about symptoms we might not want, and how to look after our health overall in the context of menopause. We learn what natural remedies do or don’t work and/or can be actively harmful, and we learn the ins and outs of different hormone therapy options too.
Bottom line: no matter whether you are pre-, peri-, or post-menopausal, this is the no-BS guide you’ve been looking for. Same goes if you’re none of the above but spend any amount of time close to someone who is.
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Elderhood – by Dr. Louise Aronson
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Where does “middle age” end, and “old age” begin? By the United States’ CDC’s categorization, human life involves:
- 17 stages of childhood, deemed 0–18
- 5 stages of adulthood, deemed 18–60
- 1 stage of elderhood, deemed 60+
Isn’t there something missing here? Do we just fall off some sort of conveyor belt on our sixtieth birthdays, into one big bucket marked “old”?
Yesterday you were 59 and enjoying your middle age; today you have, apparently, the same medical factors and care needs as a 114-year-old.
Dr. Louise Aronson, a geriatrician, notes however that medical science tends to underestimate the differences found in more advanced old age, and underresearch them. That elders consume half of a country’s medicines, but are not required to be included in clinical trials. That side effects not only are often different than for younger adults, but also can cause symptoms that are then dismissed as “Oh she’s just old”.
She explores, mostly through personal career anecdotes, the well-intentioned disregard that is frequently given by the medical profession, and—importantly—how we might overcome that, as individuals and as a society.
Bottom line: if you are over the age of 60, love someone over the age of 60, this is a book for you. Similarly if you and/or they plan to live past the age of 60, this is also a book for you.
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Is Vitamin C Worth The Hype? (Doctorly Investigates)
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Double Board-Certified Dermatologists Dr. Muneeb Shah & Dr. Luke Maxfield weigh in on vitamin C; is it worth the hype?
Yes it is, but…
There are some caveats, for example:
- It’s best to apply vitamin C on clean, dry skin and let it set before layering other products.
- Avoid mixing with oxidants like benzoyl peroxide (cancels out antioxidant effects).
- Avoid combining with copper (may negate brightening benefits).
- Do not use with hypochlorous acid (oxidative reactions cancel out benefits).
- Be cautious with retinol due to irritation risks.
However, used correctly, it does give very worthy benefits, and they recommend:
- Morning use: acts as an antioxidant, pairs well with sunscreen for better protection from sun and environmental damage.
- Night use: maximizes functions like improving tone, collagen production, texture, and reducing wrinkles.
That’s not to say that at night it stops being an antioxidant or during the day it isn’t critical for collagen synthesis, but it is to say: because of the different things our bodies typically encounter and/or do during the day or night, those are the best times to get the most out of those benefits.
They also review some popular products; here are some notes on their comments about them:
- Skinceuticals C E Ferulic: research-backed, $180, effective but potentially irritating.
- Skinceuticals Phloretin CF: includes 0.5% salicylic acid, good for acne-prone skin.
- Dermatology Vitamin C E Ferulic: relatively more affordable ($70), fragrance-free, includes peptides and ceramides.
- Drunk Elephant C-Firma: powder-to-serum formula, sued for patent infringement.
- Paula’s Choice C15 Booster: reformulated, fragrance-free, similar to Skinceuticals.
- Neutrogena Vitamin C Capsules: stabilized 20% ascorbic acid, single-use, travel-friendly.
- La Roche-Posay Vitamin C Serum: contains fragrance and alcohol, not ideal for sensitive skin.
- Matter of Fact Vitamin C Serum: includes ascorbic acid and ferulic acid, oily texture for dry skin.
- Medik8 Super C Ferulic: stable 30% ethyl ascorbic acid, lightweight texture.
- Naturium Vitamin C Complex: multi-form Vitamin C with niacinamide, alpha arbutin, and turmeric.
- Timeless Vitamin C Serum: affordable ($20), 20% ascorbic acid with E and ferulic acid.
For more on all of this, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like:
More Than Skin-Deep: Six Ways To Eat For Healthier Skin ← this one’s about a lot more than just vitamin C 😎
Take care!
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How Likely Are You To Live To 100?
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How much hope can we reasonably have of reaching 100?
Yesterday, we asked you: assuming a good Health-Related Quality of Life (HRQoL), how much longer do you hope to live?
We got the above-depicted, below-described, set of responses:
- A little over 38% of respondents hope to live another 11–20 years
- A little over 31% hope to live another 31–40 years
- A little over 7% will be content to make it to the next decade
- One (1) respondent hopes to live longer than an additional 100 years
This is interesting when we put it against our graph of how old our subscribers are:
…because it corresponds inversely, right down to the gap/dent in the 40s. And—we may hypothesize—that one person under 18 who hopes to live to 120, perhaps.
This suggests that optimism remains more or less constant, with just a few wobbles that would probably be un-wobbled with a larger sample size.
In other words: most of our education-minded, health-conscious subscriber-base hope to make it to the age of 90-something, while for the most part feeling that 100+ is overly optimistic.
Writer’s anecdote: once upon a time, I was at a longevity conference in Brussels, and a speaker did a similar survey, but by show of hands. He started low by asking “put your hands up if you want to live at least a few more minutes”. I did so, with an urgency that made him laugh, and say “Don’t worry; I don’t have a gun hidden up here!”
Conjecture aside… What does the science say about our optimism?
First of all, a quick recap…
To not give you the same information twice, let’s note we did an “aging mythbusting” piece already covering:
- Aging is inevitable: True or False?
- Aging is, and always will be, unstoppable: True or False?
- We can slow aging: True or False?
- It’s too early to worry about… / It’s too late to do anything about… True or False?
- We can halt aging: True or False?
- We can reverse aging: True or False?
- But those aren’t really being younger, we’ll still die when our time is up: True or False?
You can read the answers to all of those here:
Age & Aging: What Can (And Can’t) We Do About It?
Now, onwards…
It is unreasonable to expect to live past 100: True or False?
True or False, depending on your own circumstances.
First, external circumstances: the modal average person in Hong Kong is currently in their 50s and can expect to live into their late 80s, while the modal average person in Gaza is 14 and may not expect to make it to 15 right now.
To avoid extremes, let’s look at the US, where the modal average person is currently in their 30s and can expect to live into their 70s:
United States Mortality Database
Now, before that unduly worries our many readers already in their 70s…
Next, personal circumstances: not just your health, but your socioeconomic standing. And in the US, one of the biggest factors is the kind of health insurance one has:
SOA Research Institute | Life Expectancy Calculator 2021
You may note that the above source puts all groups into a life expectancy in the 80s—whereas the previous source gave 70s.
Why is this? It’s because the SOA, whose primary job is calculating life insurance risks, is working from a sample of people who have, or are applying for, life insurance. So it misses out many people who die younger without such.
New advances in medical technology are helping people to live longer: True or False?
True, assuming access to those. Our subscribers are mostly in North America, and have an economic position that affords good access to healthcare. But beware…
On the one hand:
The number of people who live past the age of 100 has been on the rise for decades
On the other hand:
The average life expectancy in the U.S. has been on the decline for three consecutive years
COVID is, of course, largely to blame for that, though:
❝The decline of 1.8 years in life expectancy was primarily due to increases in mortality from COVID-19 (61.2% of the negative contribution).
The decline in life expectancy would have been even greater if not for the offsetting effects of decreases in mortality due to cancer (43.1%)❞
Source: National Vital Statistics Reports
The US stats are applicable to Canada, the UK, and Australia: True or False?
False: it’s not quite so universal. Differences in healthcare systems will account for a lot, but there are other factors too:
- Life expectancy in Canada fell for the 3rd year in a row. What’s happening?
- UK life expectancy lagging behind rest of G7 except the US
- Australians are living longer but what does it take to reach 100 years old?
Here’s an interesting (UK-based) tool that calculates not just your life expectancy, but also gives the odds of living to various ages (e.g. this writer was given odds of living to 87, 96, 100).
Check yours here:
Office of National Statistics | Life Expectancy Calculator
To finish on a cheery note…
Data from Italian centenarians suggests a “mortality plateau”:
❝The risk of dying leveled off in people 105 and older, the team reports online today in Science.
That means a 106-year-old has the same probability of living to 107 as a 111-year-old does of living to 112.
Furthermore, when the researchers broke down the data by the subjects’ year of birth, they noticed that over time, more people appear to be reaching age 105.❞
Pop-sci source: Once you hit this age, aging appears to stop
Actual paper: The plateau of human mortality: demography of longevity pioneers
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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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