Is ADHD Being Over-Diagnosed For Cash?

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Is ADHD Being Systematically Overdiagnosed?

The BBC’s investigative “Panorama” program all so recently did a documentary in which one of their journalists—who does not have ADHD—went to three private clinics and got an ADHD diagnosis from each of them:

So… Is it really a case of show up, pay up, and get a shiny new diagnosis?

The BBC Panorama producers cherry-picked 3 private providers, and during those clinical assessments, their journalist provided answers that would certainly lead to a diagnosis.

This was contrasted against a three-hour assessment with an NHS psychiatrist—something that rarely happens in the NHS. Which prompts the question…

How did he walk into a 3-hour psychiatrist assessment, when most people have to wait in long waiting lists for a much more cursory appointment first with assorted gatekeepers, before going on another long waiting list, for an also-much-shorter appointment with a psychiatrist?

That would be because the NHS psychiatrist was given advance notification that this was part of an investigation and would be filmed (the private clinics were not gifted the same transparency)

So, maybe just a tad unequal treatment!

In case you’re wondering, here’s what that very NHS psychiatrist had to say on the topic:

Is it really too easy to be diagnosed with ADHD?

(we’ll give you a hint—remember Betteridge’s Law!)

❝Since the documentary aired, I have heard from people concerned that GPs could now be more likely to question legitimate diagnoses.

But as an NHS psychiatrist it is clear to me that the root of this issue is not overdiagnosis.

Instead, we are facing the combined challenges of remedying decades of underdiagnosis and NHS services that were set up when there was little awareness of ADHD.❞

~ Dr. Mike Smith, Psychiatrist

The ADHD foundation, meanwhile, has issued its own response, saying:

❝We are disappointed that BBC Panorama has opted to broadcast a poorly researched, sensationalist piece of television journalism.❞

Click here to read their full statement!

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  • Antihistamines’ Generation Gap

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    Are You Ready For Allergy Season?

    For those of us in the Northern Hemisphere, fall will be upon us soon, and we have a few weeks to be ready for it. A common seasonal ailment is of course seasonal allergies—it’s not serious for most of us, but it can be very annoying, and can disrupt a lot of our normal activities.

    Suddenly, a thing that notionally does us no real harm, is making driving dangerous, cooking take three times as long, sex laughable if not off-the-table (so to speak), and the lightest tasks exhausting.

    So, what to do about it?

    Antihistamines: first generation

    Ye olde antihistamines such as diphenhydramine and chlorpheniramine are probably not what to do about it.

    They are small molecules that cross the blood-brain barrier and affect histamine receptors in the central nervous system. This will generally get the job done, but there’s a fair bit of neurological friendly-fire going on, and while they will produce drowsiness, the sleep will usually be of poor quality. They also tax the liver rather.

    If you are using them and not experiencing unwanted side effects, then don’t let us stop you, but do be aware of the risks.

    See also: Long-term use of diphenhydramine ← this is the active ingredient in Benadryl in the US and Canada, but safety regulations in many other countries mean that Benadryl has different, safer active ingredients elsewhere.

    Antihistamines: later generations

    We’re going to aggregate 2nd gen, 3rd gen, and 4th gen antihistamines here, because otherwise we’ll be writing a history article and we don’t have room for that. But suffice it to say, later generations of antihistamines do not come with the same problems.

    Instead of going in all-guns-blazing to the CNS like first-gens, they are more specific in their receptor-targetting, resulting in negligible collateral damage:

    CSACI position statement: Newer generation H1-antihistamines are safer than first-generation H1-antihistamines and should be the first-line antihistamines for the treatment of allergic rhinitis and urticaria

    Special shout-out to cetirizine and loratadine, which are the drugs behind half the brand names you’ll see on pharmacy shelves around most of the world these days (including many in the US and Canada).

    Note that these two are very often discussed in the same sentence, sit next to each other on the shelf, and often have identical price and near-identical packaging. Their effectiveness (usually: moderate) and side effects (usually: low) are similar and comparable, but they are genuinely different drugs that just happen to do more or less the same thing.

    This is relevant because if one of them isn’t working for you (and/or is creating an unwanted side effect), you might want to try the other one.

    Another honorable mention goes to fexofenadine, for which pretty much all the same as the above goes, though it gets talked about less (and when it does get mentioned, it’s usually by its most popular brand name, Allegra).

    Finally, one that’s a little different and also deserving of a special mention is azelastine. It was recently (ish, 2021) moved from being prescription-only to being non-prescription (OTC), and it’s a nasal spray.

    It can cause drowsiness, but it’s considered safe and effective for most people. Its main benefit is not really the difference in drug, so much as the difference in the route of administration (nasal rather than oral). Because the drug is in liquid spray form, it can be absorbed through the mucus lining of the nose and get straight to work on blocking the symptoms—in contrast, oral antihistamines usually have to go into your stomach and take their chances there (we say “usually”, because there are some sublingual antihistamines that dissolve under the tongue, but they are less common.)

    Better than antihistamines?

    Writer’s note: at this point, I was given to wonder: “wait, what was I squirting up my nose last time anyway?”—because, dear readers, at the time I got it I just bought one of every different drug on the shelf, desperate to find something that worked. What worked for me, like magic, when nothing else had, was beclometasone dipropionate, which a) smelled delightfully of flowers, which might just be the brand I got, b) needs replacing now because I got it in March 2023 and it expired July 2024, and c) is not an antihistamine at all.

    But, that brings us to the final chapter for today: systemic corticosteroids

    They’re not ok for everyone (check with your doctor if unsure), and definitely should not be taken if immunocompromised and/or currently suffering from an infection (including colds, flu, COVID, etc) unless your doctor tells you otherwise (and even then, honestly, double-check).

    But! They can work like magic when other things don’t. Unlike antihistamines, which only block the symptoms, systemic corticosteroids tackle the underlying inflammation, which can stop the whole thing in its tracks.

    Here’s how they measure up against antihistamines:

    ❝The results of this systematic review, together with data on safety and cost effectiveness, support the use of intranasal corticosteroids over oral antihistamines as first line treatment for allergic rhinitis.❞

    ~ Dr. Robert Puy et al.

    Read in full: Intranasal corticosteroids versus oral H1 receptor antagonists in allergic rhinitis: systematic review of randomised controlled trials

    Take care!

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  • Unprocessed – by Kimberly Wilson

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    First, what this is not: hundreds of pages to say “eat less processed food”. That is, of course, also advisable (and indeed, is advised in the book too), but there’s a lot more going on here too.

    Though not a doctor, the author is a psychologist who brings a lot of data to the table, especially when it comes to the neurophysiology at hand, what forgotten micronutrients many people are lacking, and what trends in society worsen these deficiencies in the population at large.

    If you only care about the broadest of take-away advice, it is: eat a diet that’s mostly minimally processed plants and some oily fish, watch out for certain deficiencies in particular, and increase dietary intake of them where necessary (with taking supplements as a respectable next-best remedy).

    On which note, a point of criticism is that there’s some incorrect information about veganism and brain health; she mentions that DHA is only found in fish (in fact, fish get it from algae, which has it, and is the basis of many vegan omega-3 supplements), and the B12 is found only in animals (also found in yeast, which is not an animal, as well as various bacteria in soil, and farm animals get their B12 from supplements these days anyway, so it is arguable that we could keep things simpler by just cutting out the middlecow).

    However, the strength of this book really is in the delivery of understanding about why certain things matter. If you’re told “such-and-such is good for the brain”, you’ll up your intake for 1–60 days, depending on whether you bought a supermarket item or ordered a batch of supplements. And then you’ll forget, until 6–12 months later, and you’ll do it again. On the other hand, if you understand how something is good or bad for the brain, what it does (for good or ill) on a cellular level, the chemistry and neurophysiology at hand, you’ll make new habits for life.

    The style is middle-range pop-science; by this we mean there are tables of data and some long words that are difficult to pronounce, but also it’s not just hard science throughout—there’s (as one might expect from an author who is a psychologist) a lot about the psychology and sociology of why many people make poor dietary decisions, and the things governments often do (or omit doing) that affect this adversely—and how we can avoid those traps as individuals (unless we be incarcerated or such).

    As an aside, the author is British, so governmental examples are mostly UK-based, but it doesn’t take a lot to mentally measure that against what the governments of, for example, the US or Canada do the same or differently.

    Bottom line: there’s a lot of great information about brain health here; the strongest parts are whether the author stays within her field (psychology encompasses such diverse topics as neurophysiology and aspects of sociology, but not microbiology, for example). If you want to learn about the physiology of brain health and enjoy quite a sociopolitical ride along the way, this one’s a good one for that.

    Click here to check out Unprocessed, and make the best choices for you!

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  • New News From The Centenarian Blue Zones

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    From Blue To Green…

    We sometimes write about supercentenarians, which word is usually used in academia to refer to people who are not merely over 100 years of age, but over 110 years. These people can be found in many countries, but places where they have been found to be most populous (as a percentage of the local population) have earned the moniker “Blue Zones”—of which Okinawa and Sardinia are probably the most famous, but there are others too.

    This is in contrast to, for example “Red Zones”, a term often used for areas where a particular disease is endemic, or areas where a disease is “merely” epidemic, but particularly rife at present.

    In any case, back to the Blue Zones, where people live the longest and healthiest—because the latter part is important too! See also:

    • Lifespan: how long we live
    • Healthspan: how long we stay healthy (portmanteau of “healthy lifespan”)

    Most of our readers don’t live in a Blue Zone (in fact, many live in the US, which is a COVID Red Zone, a diabetes Red Zone, and a heart disease Red Zone), but that doesn’t mean we can’t all take tips from the Blue Zones and apply them, for example:

    You may be wondering… How much good will this do me? And, we do have an answer for that:

    When All’s Said And Done, How Likely Are You To Live To 100?

    Now that we’re all caught-up…

    The news from the Blues

    A team of researchers did a big review of observational studies of centenarians and near-centenarians (aged 95+). Why include the near-centenarians, you ask? Well, most of the studies are also longitudinal, and if we’re doing an observational study of the impact of lifestyle factors on a 100-year-old, it’s helpful to know what they’ve been doing recently. Hence nudging the younger-end cutoff a little lower, so as to not begin each study with fresh-faced 100-year-olds whom we know nothing about.

    Looking at thousands of centenarians (and near-centenarians, but also including some supercentenarians, up the age of 118), the researchers got a lot of very valuable data, far more than we have room to go into here (do check out the paper at the bottom of this article, if you have time; it’s a treasure trove of data), but one of the key summary findings was a short list of four factors they found contributed the most to extreme longevity:

    1. A diverse diet with low salt intake: in particular, a wide variety of plant diversity, including protein-rich legumes, though fish featured prominently also. On average they got 57% and 65% of their energy intake from carbohydrates, 12% to 32% from protein, and 27% to 31% from fat. As for salt, they averaged 1.6g of sodium per day, which is well within the WHO’s recommendation of averaging under 2g of sodium per day. As a matter of interest, centenarians in Okinawa itself averaged 1.1g of sodium per day.
    2. Low medication use: obviously there may be a degree of non-causal association here, i.e. the same people who just happened to be healthier and therefore lived longer, correspondingly took fewer medications—they took fewer medications because they were healthier; they weren’t necessarily healthier because they took fewer medications. That said, overmedication can be a big problem, especially in places with a profit motive like the US, and can increase the risk of harmful drug interactions, and side effects that then need more medications to treat the side effects, as well as direct iatrogenic damage (i.e. this drug treats your condition, but as the cost of harming you in some other way). Naturally, sometimes we really do need meds, but it’s a good reminder to do a meds review with one’s doctor once in a while, and see if everything’s still of benefit.
    3. Getting good sleep: not shocking, and this one’s not exactly news. But what may be shocking is that 68% of centenarians reported consistently getting enough good-quality sleep. To put that into perspective, only 35% of 10almonds readers reported regularly getting sleep in the 7–9 hours range.
    4. Rural living environment: more than 75% of the centenarians and near-centenarians lived in rural areas. This is not usually something touted as a Blue Zones thing on lists of Blue zones things, but this review strongly highlighted it as very relevant. In the category of things that are more obvious once it’s pointed out, though, this isn’t necessarily such a difference between “country folk” and “city folk”, so much as the ability to regularly be in green spaces has well-established health benefits physically, mentally, and both combined (such as: neurologically).

    See: The health benefits of the great outdoors: A systematic review and meta-analysis of greenspace exposure and health outcomes

    And showing that yes, even parks in cities make a significant difference:

    The association of green space, tree canopy and parks with life expectancy in neighborhoods of Los Angeles

    Want to know more?

    You can read the study in full here:

    A systematic review of diet and medication use among centenarians and near-centenarians worldwide

    Take care!

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  • Glutathione: More Than An Antioxidant

    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.

    Glutathione’s Benefits: The Usual And The Unique

    Glutathione is a powerful antioxidant that does all the things we might reasonably expect an antioxidant to do, plus some beneficial quirks of its own.

    We do make glutathione in our bodies, but we can also get it from our diet, and of course, we can also supplement it.

    What foods is it in?

    It’s in a lot of foods, but some top examples include:

    • turmeric
    • avocado
    • asparagus
    • almonds
    • cruciferous vegetables
    • watermelon
    • garlic

    For a fuller list and discussion, see:

    Glutathione for Food and Health Applications with Emphasis on Extraction, Identification, and Quantification Methods: A Review

    What does it do?

    Let’s start with the obvious; as with most things that are antioxidant, it is also anti-inflammatory. Increasing or decreasing glutathione levels is associated with decreased or increased inflammation, respectively. For example:

    Glutathione S-transferase theta 1 protects against colitis through goblet cell differentiation via interleukin-22

    It being anti-inflammatory also means it can be beneficial in calming autoimmune disorders:

    Glutathione: a key player in autoimmunity

    And to complete the triad of “those three things that generally go together”, yes, this means it also has anticancer potential, but watch out!

    ❝Although in healthy cells [glutathione] is crucial for the removal and detoxification of carcinogens, elevated [glutathione] levels in tumor cells are associated with tumor progression and increased resistance to chemotherapeutic drugs❞

    ~ Dr. Miroslava Cuperlovic-Culf et al.

    Read in full: Role of Glutathione in Cancer: From Mechanisms to Therapies

    So in other words, when it comes to cancer risk management, glutathione is a great preventative, but the opposite of a cure.

    What were those “beneficial quirks of its own”?

    They are mainly twofold, and the first is that it improves insulin sensitivity. There are many studies showing this, but here’s a recent one from earlier this year:

    The Role of Glutathione and Its Precursors in Type 2 Diabetes

    The other main “beneficial quirk of its own” is that it helps prevent and/or reverse non-alcoholic fatty liver disease, as in this study from last year:

    Glutathione: Pharmacological aspects and implications for clinical use in non-alcoholic fatty liver disease

    Because of glutathione’s presence in nuts, fruits, and vegetables, this makes it a great thing to work in tandem with a dietary approach to preventing/reversing NAFLD, by the way:

    How To Unfatty A Fatty Liver

    Anything else?

    It’s being investigated as a potential treatment for Parkinson’s disease symptoms, but the science is young for this one, so there is no definitive recommendation yet in this case. If you’re interested in that, though, do check out the current state of the science at:

    Potential use of glutathione as a treatment for Parkinson’s disease

    Is it safe?

    While there is no 100% blanket statement of safety that can ever be made about anything (even water can kill people, and oxygen ultimately kills everyone that something else doesn’t get first), glutathione has one of the safest general safety profiles possible, with the exception we noted earlier (if you have cancer, it is probably better to skip this one unless an oncologist or similar advises you otherwise).

    As ever, do speak with your doctor/pharmacist to be sure in any case, though!

    Want to try some?

    We don’t sell it, but here for your convenience is an example product on Amazon 😎

    Enjoy!

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  • Honeydew vs Cantaloupe – Which is Healthier?

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    Our Verdict

    When comparing honeydew to cantaloupe, we picked the cantaloupe.

    Why?

    In terms of macros, there’s not a lot between them—they’re both mostly water. Nominally, honeydew has more carbs while cantaloupe has more fiber and protein, but the differences are very small. So, a very slight win for cantaloupe.

    Looking at vitamins: honeydew has slightly more of vitamins B5 and B6 (so, the vitamins that are in pretty much everything), while cantaloupe has a more of vitamins A, B1, B2, B3, C, and E (especially notably 67x more vitamin A, whence its color). A more convincing win for cantaloupe.

    The minerals category is even more polarized: honeydew has more selenium (and for what it’s worth, more sodium too, though that’s not usually a plus for most of us in the industrialized world), while cantaloupe has more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, and zinc. An overwhelming win for cantaloupe.

    No surprises: adding up the slight win for cantaloupe, the convincing win for cantaloupe, and the overwhelming win for cantaloupe, makes cantaloupe the overall best pick here.

    Enjoy!

    Want to learn more?

    You might like to read:

    From Apples to Bees, and High-Fructose Cs: Which Sugars Are Healthier, And Which Are Just The Same?

    Take care!

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  • How To Reduce Knee Pain After Sitting

    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.

    Sitting is bad for the health, and doubly so if you have arthritis, as a lack of regular movement can cause joints to “seize up”. So, what to do about it if you have to sit for an extended time?

    Dr. Alyssa Kuhn, arthritis specialist, explains:

    Movement remains key

    The trick is to continue periodically moving, notwithstanding that you may need to remain seated. So…

    1. Heel slides
      • Straighten and bend your leg by sliding or lifting your heel.
      • Promotes blood flow and reduces fluid buildup in the knee.
      • Helps lubricate the joint, making standing up easier.
    2. Heel lifts
      • Lift your heels up and down while keeping feet on the ground.
      • This one’s ideal for tight spaces, such as when riding in a car or airplane.
      • Improves blood circulation and can reduce ankle swelling and leg heaviness.

    Do 20–30 repetitions every now and again, to keep your joints moving.

    Note: if you are a wheelchair user whose legs lack the strength and/or motor function to do this, in this case it’s the movement of the leg that counts, not where that movement originated from. So, if you use one hand to lift your leg slightly and the other to push it like a swing, that will also be sufficient to give the joint the periodic movement it needs.

    For more on all of this plus visual demonstrations, enjoy:

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

    Want to learn more?

    You might also like to read:

    Stand Up For Your Health (Or Don’t) ← our main feature on this also includes more things you can do if you must sit, to make sitting less bad!

    Take care!

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    Learn to Age Gracefully

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