Ketogenic Diet: Burning Fat Or Burning Out?
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In Wednesday’s newsletter, we asked you for your opinion of the keto diet, and got the above-depicted, below-described set of responses:
- About 45% said “It has its benefits, but they don’t outweigh the risks”
- About 31% said “It is a good, evidence-based way to lose weight, be energized, and live healthily”
- About 24% said “It is a woeful fad diet and a fast-track to ruining one’s overall health”
So what does the science say?
First, what is the ketogenic diet?
There are two different stories here:
- Per science, it’s a medical diet designed to help treat refractory epilepsy in children.
- Per popular lore, it’s an energizing weight loss diet for Instagrammers and YouTubers.
Can it be both? The answer is: yes, but with some serious caveats, which we’ll cover over the course of today’s feature.
The ketogenic diet works by forcing the body to burn fat for energy: True or False?
True! This is why it helps for children with refractory epilepsy. By starving the body (including the brain) of glucose, the liver must convert fat into fatty acids and ketones, which latter the brain (and indeed the rest of the body) can now use for energy instead of glucose, thus avoiding one of the the main triggers of refractory epilepsy in children.
See: The Ketogenic Diet: One Decade Later | Pediatrics
Even the pediatric epilepsy studies, however, conclude it does have unwanted side effects, such as kidney stones, constipation, high cholesterol, and acidosis:
Source: Dietary Therapies for Epilepsy
The ketogenic diet is good for weight loss: True or False?
True! Insofar as it does cause weight loss, often rapidly. Of course, so do diarrhea and vomiting, but these are not usually held to be healthy methods of weight loss. As for keto, a team of researchers recently concluded:
❝As obesity rates in the populace keep rising, dietary fads such as the ketogenic diet are gaining traction.
Although they could help with weight loss, this study had a notable observation of severe hypercholesterolemia and increased risk of atherosclerotic cardiovascular disease among the ketogenic diet participants.❞
~ Dr. Shadan Khdher et al.
On which note…
The ketogenic diet is bad for the heart: True or False?
True! As Dr. Joanna Popiolek-Kalisz concluded recently:
❝In terms of cardiovascular mortality, the low-carb pattern is more beneficial than very low-carbohydrate (including the ketogenic diet). There is still scarce evidence comparing ketogenic to the Mediterranean diet.
Other safety concerns in cardiovascular patients such as adverse events related to ketosis, fat-free mass loss, or potential pharmacological interactions should be also taken into consideration in future research.❞
~ Dr. Joanna Popiolek-Kalisz
Read in full: Ketogenic diet and cardiovascular risk: state of the art review
The ketogenic diet is good for short-term weight loss, but not long-term maintenance: True or False?
True! Again, insofar as it works in the short term. It’s not the healthiest way to lose weight and we don’t recommend it, but it did does indeed precipitate short-term weight loss. Those benefits are not typically observed for longer than a short time, though, as the above-linked paper mentions:
❝The ketogenic diet does not fulfill the criteria of a healthy diet. It presents the potential for rapid short-term reduction of body mass, triglycerides level, Hb1Ac, and blood pressure.
Its efficacy for weight loss and the above-mentioned metabolic changes is not significant in long-term observations.❞
~ Ibid.
The ketogenic diet is a good, evidence-based way to lose weight, be energized, and live healthily: True or False?
False, simply, as you may have gathered from the above, but we’ve barely scratched the surface in terms of the risks.
That said, as mentioned, it will induce short-term weight loss, and as for being energized, typically there is a slump-spike-slump in energy:
- At first, the body is running out of glucose, and so naturally feels weak and tired.
- Next, the body enters ketosis, and so feels energized and enlivened ← this is the part where the popular enthusiastic reviews come from
- Then, the body starts experiencing all the longer-term problems associated with lacking carbohydrates and having an overabundance of fat, so becomes gradually more sick and tired.
Because of this, the signs of symptoms of being in ketosis (aside from: measurably increased ketones in blood, breath, and urine) are listed as:
- Bad breath
- Weight loss
- Appetite loss
- Increased focus and energy
- Increased fatigue and irritability
- Digestive issues
- Insomnia
The slump-spike-slump we mentioned is the reason for the seemingly contradictory symptoms of increased energy and increased fatigue—you get one and then the other.
Here’s a small but illustrative study, made clearer by its participants being a demographic whose energy levels are most strongly affected by dietary factors:
The ketogenic diet is a woeful fad diet and a fast-track to ruining one’s overall health: True or False?
True, subjectively in the first part, as it’s a little harsher than we usually go for in tone, though it has been called a fad diet in scientific literature. The latter part (ruining one’s overall health) is observably true.
One major problem is incidental-but-serious, which is that a low-carb diet is typically a de facto low-fiber diet, which is naturally bad for the gut and heart.
Other things are more specific to the keto diet, such as the problems with the kidneys:
However, kidney stones aren’t the worst of the problems:
Is Losing Weight Worth Losing Your Kidney: Keto Diet Resulting in Renal Failure
We’re running out of space and the risks associated with the keto diet are many, but for example even in the short term, it already increases osteoporosis risk:
❝Markers of bone modeling/remodeling were impaired after short-term low-carbohydrate high-fat diet, and only one marker of resorption recovered after acute carbohydrate restoration❞
~ Dr. Ida Heikura et al.
A Short-Term Ketogenic Diet Impairs Markers of Bone Health in Response to Exercise
Want a healthier diet?
We recommend the Mediterranean diet.
See also: Four Ways To Upgrade The Mediterranean
(the above is about keeping to the Mediterranean diet, while tweaking one’s choices within it for a specific extra health focus such as an anti-inflammatory upgrade, a heart-healthy upgrade, a gut-healthy upgrade, and a brain-healthy upgrade)
Enjoy!
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Driving under the influence of marijuana: An explainer and research roundup
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.
Update 1: On May 16, 2024, the U.S. Department of Justice sent a proposed rule to the Federal Register to downgrade marijuana from a Schedule I to a Schedule III drug. This is the first step in a lengthy approval process that starts with a 60-day comment period.
Update 2: Two recent research studies were added to the “Studies on marijuana and driving” section of this piece on July 18, 2024.
As marijuana use continues to rise and state-level marijuana legalization sweeps the U.S., researchers and policymakers are grappling with a growing public safety concern: marijuana-impaired driving.
As of April 2023, 38 U.S. states had legalized medical marijuana and 23 had legalized its recreational use, according to the National Conference of State Legislatures. Recreational or medical marijuana measures are on the ballot in seven states this year.
The issue of marijuana-impaired driving has not been an easy one to tackle because, unlike alcohol, which has well-established thresholds of impairment, the metrics for marijuana’s effects on driving remain rather elusive.
“We don’t have that kind of deep knowledge right now and it’s not because of lack of trying,” says Dr. Guohua Li, professor of epidemiology and the founding director of the Center for Injury Science and Prevention at Columbia University.
“Marijuana is very different from alcohol in important ways,” says Li, who has published several studies on marijuana and driving. “And one of them is that the effect of marijuana on cognitive functions and behaviors is much more unpredictable than alcohol. In general, alcohol is a depressant drug. But marijuana could act on the central nervous system as a depressant, a stimulant, and a hallucinogenic substance.”
Efforts to create a breathalyzer to measure the level of THC, the main psychoactive compound found in the marijuana plant, have largely failed, because “the THC molecule is much bigger than ethanol and its behavior after ingestion is very different from alcohol,” Li says.
Currently, the two most common methods used to measure THC concentration to identify impaired drivers are blood and saliva tests, although there’s ongoing debate about their reliability.
Marijuana, a term interchangeably used with cannabis, is the most commonly used federally illegal drug in the U.S.: 48.2 million people, or about 18% of Americans reported using it at least once in 2019, according to the latest available data from the Centers for Disease Control and Prevention. Worldwide, 2.5% of the population consumes marijuana, according to the World Health Organization.
Marijuana is legal in several countries, including Canada, where it was legalized in 2018. Despite state laws legalizing cannabis, it remains illegal at the federal level in the U.S.
As states grapple with the contentious issue of marijuana legalization, the debate is not just about public health, potential tax revenues and economic interests. At the heart of the discussion is also the U.S. criminal justice system.
Marijuana is shown to have medicinal qualities and, compared with substances like alcohol, tobacco, and opioids, it has relatively milder health risks. However, it’s not risk-free, a large body of research has shown.
Marijuana consumption can lead to immediate effects such as impaired muscle coordination and paranoia, as well as longer-term effects on mental health and cognitive functions — and addiction. As its use becomes more widespread, researchers are trying to better understand the potential hazards of marijuana, particularly for younger users whose brains are in critical stages of development.
Marijuana and driving
The use of marijuana among drivers, passengers and pedestrians has increased steadily over the past two decades, Li says.
Compared with the year 2000, the proportion of U.S. drivers on the road who are under the influence of marijuana has increased by several folds, between five to 10 times, based on toxicology testing of people who died in car crashes, Li says.
A 2022 report from the National Transportation Safety Board finds alcohol and cannabis are the two most commonly detected drugs among drivers arrested for impaired driving and fatally injured drivers. Most drivers who tested positive for cannabis also tested positive for another potentially impairing drug.
“Although cannabis and many other drugs have been shown to impair driving performance and are associated with increased crash risk, there is evidence that, relative to alcohol, awareness about the potential dangers of driving after using other drugs is lower,” according to the report.
Indeed, many U.S. adults perceive daily marijuana use or exposure to its smoke safer than tobacco, even though research finds otherwise.
Several studies have demonstrated marijuana’s impact on driving.
Marijuana use can reduce the drivers’ ability to pay attention, particularly when they are performing multiple tasks, research finds. It also slows reaction time and can impair coordination.
“The combination is that you potentially have people who are noticing hazards later, braking slower and potentially not even noticing hazards because of their inability to focus on competing things on the road,” says Dr. Daniel Myran, an assistant professor at the Department of Family Medicine and health services researcher at the University of Ottawa.
In a study published in September in JAMA Network Open, Myran and colleagues find that from 2010 to 2021 the rate of cannabis-involved traffic injuries that led to emergency department visits in Ontario, Canada, increased by 475%, from 0.18 per 1,000 traffic injury emergency department visits in 2010 to 1.01 visits in 2021.
To be sure, cannabis-involved traffic injuries made up a small fraction of all traffic injury-related visits to hospital emergency departments. Out of 947,604 traffic injury emergency department visits, 426 had documented cannabis involvement.
Myran cautions the increase shouldn’t be solely attributed to marijuana legalization. It captures changing societal attitudes toward marijuana and acceptance of cannabis use over time in the lead-up to legalization. In addition, it may reflect an increasing awareness among health care providers about cannabis-impaired driving, and they may be more likely to ask about cannabis use and document it in medical charts, he says.
“When you look at the 475% increase in cannabis involvement in traffic injuries, rather than saying legalizing cannabis has caused the roads to be unsafe and is a public health disaster, it’s that cannabis use appears to be growing as a risk for road traffic injuries and that there seem to be more cannabis impaired drivers on the road,” Myran says. “Legalization may have accelerated this trend. Faced with this increase, we need to think about what are public health measures and different policy interventions to reduce harms from cannabis-impaired driving.”
Setting a legal limit for marijuana-impaired driving
Setting a legal limit for marijuana-impaired driving has not been easy. Countries like Canada and some U.S. states have agreed upon a certain level of THC in blood, usually between 1 to 5 nanograms per milliliter. Still, some studies have found those limits to be weak indicators of cannabis-impaired driving.
When Canada legalized recreational marijuana in 2018, it also passed a law that made it illegal to drive with blood THC levels of more than 2 nanograms. The penalties are more severe for blood THC levels above 5 nanograms. The blood test is done at the police station for people who are pulled over and are deemed to be drug impaired.
In the U.S., five states — Ohio, Illinois, Montana, Washington and Nevada — have “per se laws,” which set a specific amount of THC in the driver’s blood as evidence of impaired driving, according to the National Conference of State Legislatures. That limit ranges between 2 and 5 nanograms of THC per milliliter of blood.
Colorado, meanwhile, has a “permissible inference law,” which states that it’s permissible to assume the driver was under the influence if their blood THC level is 5 nanograms per milliliter or higher, according to NCSL.
Twelve states, most which have legalized some form of marijuana of use, have zero tolerance laws for any amount of certain drugs, including THC, in the body.
The remaining states have “driving under the influence of drugs” laws. Among those states, Alabama and Michigan, have oral fluid roadside testing program to screen drivers for marijuana and other drugs, according to NCSL.
In May this year, the U.S. Department of Transportation published a final rule that allows employers to use saliva testing for commercially licensed drivers, including truck drivers. The rule, which went into effect in June, sets the THC limit in saliva at 4 nanograms.
Saliva tests can detect THC for 8 to 24 hours after use, but the tests are not perfect and can results in false positives, leading some scientists to argue against using them in randomly-selected drivers.
In a 2021 report, the U.S. National Institute of Justice, the research and development arm of the Department of Justice, concluded that THC levels in bodily fluids, including blood and saliva “were not reliable indicators of marijuana intoxication.”
Studies on marijuana and driving
Over the past two decades, many studies have shown marijuana use can impair driving. However, discussions about what’s the best way to measure the level of THC in blood or saliva are ongoing. Below, we highlight and summarize several recent studies that address the issue. The studies are listed in order of publication date. We also include a list of related studies and resources to inform your audiences.
State Driving Under the Influence of Drugs Laws
Alexandra N. Origenes, Sarah A. White, Emma E. McGinty and Jon S. Vernick. Journal of Law, Medicine & Ethics, July 2024.Summary: As of January 2023, 33 states and D.C. had a driving under the influence of drugs law for at least one drug other than cannabis. Of those, 29 states and D.C. had a law specifically for driving under the influence of cannabis, in addition to a law for driving under the influence of other drugs. Four states had a driving under the influence of drug laws, excluding cannabis. Meanwhile, 17 states had no law for driving under the influence of drugs, including cannabis. “The 17 states lacking a DUID law that names specific drugs should consider enacting such a law. These states already have expressed their concern — through legislation — with drug-impaired driving. However, failure to name specific drugs is likely to make the laws more difficult to enforce. These laws may force courts and/or law enforcement to rely on potentially subjective indicators of impairment,” the authors write.
Associations between Adolescent Marijuana Use, Driving After Marijuana Use and Recreational Retail Sale in Colorado, USA
Lucas M. Neuroth, et al. Substance Use & Misuse, October 2023.Summary: Researchers use data from four waves (2013, 2015, 2017 and 2019) of the Healthy Kids Colorado Survey, including 47,518 students 15 and older who indicated that they drove. They find 20.3% of students said that they had used marijuana in the past month and 10.5% said they had driven under the influence of marijuana. They find that the availability of recreational marijuana in stores was associated with an increased prevalence of using marijuana one to two times in the past month and driving under the influence of marijuana at least once. “Over the study period, one in ten high school age drivers engaged in [driving after marijuana use], which is concerning given the high risk of motor vehicle-related injury and death arising from impaired driving among adolescents,” the authors write.
Are Blood and Oral Fluid Δ9-tetrahydrocannabinol (THC) and Metabolite Concentrations Related to Impairment? A Meta-Regression Analysis
Danielle McCartney, et al. Neuroscience & Biobehavioral Reviews, March 2022.Summary: Commonly used THC measurements may not be strong indicators of driving impairment. While there is a relationship between certain biomarkers like blood THC concentrations and impaired driving, this correlation is often weak. The study underscores the need for more nuanced and comprehensive research on this topic, especially as cannabis usage becomes more widespread and legally accepted.
The Effects of Cannabis and Alcohol on Driving Performance and Driver Behaviour: A Systematic Review and Meta-Analysis
Sarah M. Simmons, Jeff K. Caird, Frances Sterzer and Mark Asbridge. Addiction, January 2022.Summary: This meta-analysis of experimental driving studies, including driving simulations, confirms that cannabis impairs driving performance, contrary to some beliefs that it might enhance driving abilities. Cannabis affects lateral control and speed — typically increasing lane excursions while reducing speed. The combination of alcohol and marijuana appears worse than either alone, challenging the idea that they cancel each other out.
Cannabis Legalization and Detection of Tetrahydrocannabinol in Injured Drivers
Jeffrey R. Brubacher, et al. The New England Journal of Medicine, January 2022.Summary: Following the legalization of recreational marijuana in Canada, there was a notable increase in injured drivers testing positive for THC, especially among those 50 years of age or older. This rise in cannabis-related driving incidents occurred even with new traffic laws aiming to deter cannabis-impaired driving. This uptick began before legalization became official, possibly due to perceptions that cannabis use was soon-to-be legal or illegal but not enforced. The data suggests that while legalization has broad societal impacts, more comprehensive strategies are needed to deter driving under the influence of cannabis and raise public awareness about its risks.
Cannabis and Driving
Godfrey D. Pearlson, Michael C. Stevens and Deepak Cyril D’Souza. Frontiers in Psychiatry, September 2021.Summary: Cannabis-impaired driving is a growing public health concern, and studies show that such drivers are more likely to be involved in car crashes, according to this review paper. Drivers are less affected by cannabis than they are by alcohol or cocaine, but the problem is expected to escalate with increasing cannabis legalization and use. Unlike alcohol, THC’s properties make it challenging to determine direct impairment levels from testing results. Current roadside tests lack precision in detecting genuine cannabis-impaired drivers, leading to potential wrongful convictions. Moreover, there is a pressing need for research on the combined effects of alcohol and cannabis on driving, as well as the impact of emerging popular forms of cannabis, like concentrates and edibles. The authors recommend public awareness campaigns about the dangers of driving under the influence of cannabis, similar to those against drunk driving, to address misconceptions. Policymakers should prioritize science-based decisions and encourage further research in this domain.
Demographic And Policy-Based Differences in Behaviors And Attitudes Towards Driving After Marijuana Use: An Analysis of the 2013–2017 Traffic Safety Culture Index
Marco H. Benedetti, et al. BMC Research Notes, June 2021.Summary: The study, based on a U.S. survey, finds younger, low-income, low-education and male participants were more tolerant of driving after marijuana consumption. Notably, those in states that legalized medical marijuana reported driving after use more frequently, aligning with studies indicating a higher prevalence of THC detection in drivers from these states. Overall, while the majority perceive driving after marijuana use as dangerous, not all research agrees on its impairment effects. Existing studies highlight that marijuana impacts motor skills and executive functions, yet its direct correlation with crash risk remains debated, given the variations in individual tolerance and how long THC remains in the system.
Driving Under the Influence of Cannabis: A Framework for Future Policy
Robert M. Chow, et al.Anesthesia & Analgesia, June 2019.Summary: The study presents a conceptual framework focusing on four main domains: legalization, driving under the influence of cannabis, driver impairment, and motor vehicle accidents. With the growing legalization of cannabis, there’s an anticipated rise in cannabis-impaired driving cases. The authors group marijuana users into infrequent users who show significant impairment with increased THC blood levels, chronic users with minimal impairment despite high THC levels, and those with consistent psychomotor deficits. Current challenges lie in the lack of standardized regulation for drivers influenced by cannabis, primarily because of state-to-state variability and the absence of a federal statutory limit for blood THC levels. European nations, however, have established thresholds for blood THC levels, ranging from 0.5 to 50.0 micrograms per liter depending on whether blood or blood serum are tested. The authors suggest the combined use of alcohol and THC blood tests with a psychomotor evaluation by a trained professional to determine impairment levels. The paper stresses the importance of creating a structured policy framework, given the rising acceptance and use of marijuana in society.
Additional research
Cannabis-Involved Traffic Injury Emergency Department Visits After Cannabis Legalization and Commercialization
Daniel T. Myran, et al. JAMA Network Open, September 2023.Driving Performance and Cannabis Users’ Perception of Safety: A Randomized Clinical Trial
Thomas D. Marcotte, et al. JAMA Psychiatry, January 2022.Medicinal Cannabis and Driving: The Intersection of Health and Road Safety Policy
Daniel Perkins, et al. International Journal of Drug Policy, November 2021.Prevalence of Marijuana Use Among Trauma Patients Before and After Legalization of Medical Marijuana: The Arizona Experience
Michael Levine, et al. Substance Abuse, July 2021.Self-Reported Driving After Marijuana Use in Association With Medical And Recreational Marijuana Policies
Marco H. Benedetti, et al. International Journal of Drug Policy, June 2021.Cannabis and Driving Ability
Eric L. Sevigny. Current Opinion in Psychology, April 2021.The Failings of per se Limits to Detect Cannabis-Induced Driving Impairment: Results from a Simulated Driving Study
Thomas R. Arkell, et al. Traffic Injury Prevention, February 2021.Risky Driving Behaviors of Drivers Who Use Alcohol and Cannabis
Tara Kelley-Baker, et al. Transportation Research Record, January 2021.Direct and Indirect Effects of Marijuana Use on the Risk of Fatal 2-Vehicle Crash Initiation
Stanford Chihuri and Guohua Li. Injury Epidemiology, September 2020Cannabis-Impaired Driving: Evidence and the Role of Toxicology Testing
Edward C. Wood and Robert L. Dupont. Cannabis in Medicine, July 2020.Association of Recreational Cannabis Laws in Colorado and Washington State With Changes in Traffic Fatalities, 2005-2017
Julian Santaella-Tenorio, et al. JAMA Internal Medicine, June 2020.Marijuana Decriminalization, Medical Marijuana Laws, and Fatal Traffic Crashes in US Cities, 2010–2017
Amanda Cook, Gregory Leung and Rhet A. Smith. American Journal of Public Health, February 2020.Cannabis Use in Older Drivers in Colorado: The LongROAD Study
Carolyn G. DiGuiseppi, et al. Accident Analysis & Prevention, November 2019.Crash Fatality Rates After Recreational Marijuana Legalization in Washington and Colorado
Jayson D. Aydelotte, et al. American Journal of Public Health, August 2017.Marijuana-Impaired Driving: A Report to Congress
National Highway Traffic Safety Administration, July 2017Interaction of Marijuana And Alcohol on Fatal Motor Vehicle Crash Risk: A Case–Control Study
Stanford Chihuri, Guohua Li and Qixuan Chen. Injury Epidemiology, March 2017.US Traffic Fatalities, 1985–2014, and Their Relationship to Medical Marijuana Laws
Julian Santaella-Tenorio, et al. American Journal of Public Health, February 2017.Delays in DUI Blood Testing: Impact on Cannabis DUI Assessments
Ed Wood, Ashley Brooks-Russell and Phillip Drum. Traffic Injury Prevention, June 2015.Establishing Legal Limits for Driving Under the Influence of Marijuana
Kristin Wong, Joanne E. Brady and Guohua Li. Injury Epidemiology, October 2014.Cannabis Effects on Driving Skills
Rebecca L. Hartman and Marilyn A. Huestis. Clinical Chemistry, March 2014.Acute Cannabis Consumption And Motor Vehicle Collision Risk: Systematic Review of Observational Studies and Meta-Analysis
Mark Asbridge, Jill A. Hayden and Jennifer L. Cartwright. The BMJ, February 2012.Resources for your audiences
The following resources include explainers from federal agencies and national organizations. You’re free to use images and graphics from federal agencies.
- CDC’s main marijuana page.
- CDC’s marijuana data and statistics.
- Marijuana Drug Facts from the National Institute on Drug Abuse.
- Health Effects of Marijuana from the CDC.
- Learn About Marijuana Risks from the Substance Abuse and Mental Health Services Administration.
- Marijuana and Lung Health from the American Lung Association.
- Substance Use Disorder 101 from the U.S. Department of Health & Human Services.
- What You Need To Know About Marijuana Use and Driving from the CDC.
- Does marijuana use affect driving? from the National Institute on Drug Abuse.
- Drug-Impaired Driving from the National Highway Traffic Safety Administration.
This article first appeared on The Journalist’s Resource and is republished here under a Creative Commons license.
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Blind Spots – by Dr. Marty Makary
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From the time the US recommended not giving peanuts to infants for the first three years of life “in order to avoid peanut allergies” (whereupon non-exposure to peanuts early in life led to, instead, an increase in peanut allergies and anaphylactic incidents), to the time the US recommended not taking HRT on the strength of the claim that “HRT causes breast cancer” (whereupon the reduced popularity of HRT led to, instead, an increase in breast cancer incidence and mortality), to many other such incidents of very bad public advice being given on the strength of a single badly-misrepresented study (for each respective thing), Dr. Makary puts the spotlight on what went wrong.
This is important, because this is not just a book of outrage, exclaiming “how could this happen?!”, but rather instead, is a book of inquisition, asking “how did this happen?”, in such a way that we the reader can spot similar patterns going forwards.
Oftentimes, this is a simple matter of having a basic understanding of statistics, and checking sources to see if the dataset really supports what the headlines are claiming—and indeed, whether sometimes it suggests rather the opposite.
The style is a little on the sensationalist side, but it’s well-supported with sound arguments, good science, and clear mathematics.
Bottom line: if you’d like to improve your scientific literacy, this book is an excellent illustrative guide.
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Make Your Vegetables Work Better Nutritionally
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.
Most people know that boiling vegetables to death is generally not best for them, but raw isn’t always best either, and if we want to not sabotage our food, then there’s more to bear in mind than “just steam them, then”.
So, what should we keep in mind?
Water solubility
Many nutrients are water-soluble, including vitamin C, vitamin B-complex (as in, the collection of B-vitamins), and flavonoids, as well as many other polyphenols.
This means that if you cook your vegetables (which includes beans, lentils, etc) in water, a lot of the nutrients will go into the water, and be lost if you then drain that.
There are, thus, options;
- Steaming, yes
- Use just enough water to slow-cook or pressure-cook things that are suitable for slow-cooking, or pressure-cooking such as those beans and lentils. That way, when it’s done, there’s no excess water to drain, and all the nutrients are still in situ.
- Use as much water as you like, but then keep the excess water to make a soup, sauce, or broth.
- Use a cooking method other than water, where appropriate. For example, roasting peppers is a much better idea than roasting dried pulses.
- Consume raw, where appropriate.
Fat solubility
Many nutrients are fat-soluble, including vitamins A, D, E, and K, as well as a lot of carotenoids (including heavy-hitters lycopene and β-carotene) and many other polyphenols.
We’re now going to offer almost the opposite advice to that we had about water solubility. This is because unless they are dried, vegetables already contain water, whereas many contain only trace amounts of fat. Consequently, the advice this time is to add fat.
There are options:
- Cook with a modest amount of your favorite healthy cooking oil (our general go-to is extra-virgin olive oil, but avocado oil is great especially for higher temperature cooking, and an argument can be made for coconut oil sometimes)
- Remember that this goes for roasting, too. Brush those vegetables with a touch of olive oil, and not only will they be delicious, they’ll be more nutritious, too.
- Drizzle some the the above, if you’re serving things raw and it’s appropriate. This goes also for things like salads, so dress them!
- Enjoy your vegetables alongside healthy fatty foods such as nuts and seeds (or fatty animal products, if you eat those; fatty fish is a fine option here, in moderation, as are eggs, or fermented dairy products).
For a deeper understanding: Can Saturated Fats Be Healthy?
Do not, however, deep-fry your foods unless it’s really necessary and then only for an occasional indulgence that you simply accept will be unhealthy. Not only is deep-frying terrible for the health in a host of ways (ranging from an excess of oil in the resultant food, to acrylamide, to creating Advanced Glycation End-products*), but also those fat-soluble nutrients? Guess where they’ll go. And unlike with the excess vegetable-cooking water that you can turn into soup or whatever, we obviously can’t recommend doing that with deep-fryer oil.
*see also: Are You Eating AGEs?
Temperature sensitivity
Many nutrients are sensitive to temperature, including vitamin C (breaks down when exposed to high temperatures) and carotenoids (are released when exposed to higher temperatures). Another special case is ergothioneine, “the longevity vitamin” that’s not a vitamin, found in mushrooms, which is also much more bioavailable when cooked.
So, if you’re eating something for vitamin C, then raw is best if that’s a reasonable option.
And if it’s not a reasonable option? Well, then you can either a) just cope with the fact it’s going to have less vitamin C in it, or b) cook it as gently and briefly as reasonably possible.
On the other hand, if you’re eating something for carotenoids (especially including lycopene and β-carotene), or ergothioneine, then cooked is best.
Additionally, if your food is high in oxalates (such as spinach), and you don’t want it to be (for example because you have kidney problems, which oxalates can exacerbate, or would like to get more calcium out of the spinach and into your body, which which oxalic acid would inhibit), then cooked is best, as it breaks down the oxalates.
Same goes for phytates, another “anti-nutrient” found in some whole grains (such as rice and wheat); cooking breaks it down, therefore cooked is best.
This latter is not, however, applicable in the case of brown rice protein powder, for those who enjoy that—because phytates aren’t found in the part of the rice that’s extracted to make that.
And as for brown rice itself? Does contain phytates… Which can be reduced by soaking and heating, preferably both, to the point that the nutritional value is better than it would have been had there not been phytic acid present in the first place; in other words: cooked is best.
You may be wondering: “who is eating rice raw?” and the answer is: people using rice flour.
See: Brown Rice Protein: Strengths & Weaknesses
Want to know more?
Here’s a great rundown from Dr. Rosalind Gibson, Dr. Leah Perlas, and Dr. Christine Hotz:
Improving the bioavailability of nutrients in plant foods at the household level
Enjoy!
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A Better Second Half – by Liz Earle
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Here we have a book that’s aimed at women from midlife onwards. The author is not a doctor or scientist, but has been in the wellness industry in one form or another for pretty much her entire career (and she’s now in her 60s), so you can imagine she’s accumulated a lot of knowledge and experience.
As a result, what she delivers is a guide to aging female health that is comprehensive in its recommendations, while being quite light on the underlying science (which she herself may or may not understand—she neither shows scientific expertise nor scientific ignorance; she simply doesn’t discuss the science beyond the level of mentioning that it is there).
To this end, we get practical advice on supplements, HRT, nutrition, exercise, brain health specifically, sleep, stress-management, social considerations, and even “beauty bio-hacks”.
The style is polished, including in her self-presentation when discussing her own practices and life history. The book is written in British English, by the way, which means not only spellings such as “oestrogen” but also things like her mentioning when she was at her heaviest, post-pregnancy, she weighed 12 stone. This European reviewer had to look up what that is (apparently it’s 76 kg, or 168 lbs, for Americans).
Bottom line: the advice here is good, albeit by no means groundbreaking or deep. If you’re a regular 10almonds reader, you’ll doubtlessly know the main content already, though you’ll probably also pick up at least some new information, since she peppers a great miscellany of facts throughout her work. Which, given the very minimal referencing, may then require fact-checking by the reader, but either way, learning occurs. Which is what we’re all about!
Click here to check out A Better Second Half, and enjoy a better second half!
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Recognize The Early Symptoms Of Parkinson’s Disease
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Parkinson’s disease is a degenerative condition with wide-reaching implications for health. While there is currently no known cure, there are treatments, so knowing about it sooner rather than later is important.
Spot The Signs
There are two main kinds of symptoms, motor and non-motor.
Motor symptoms include:
- trembling that occurs when muscles are relaxed; often especially visible in the fingers
- handwriting changes—not just because of the above, but also often getting smaller
- blank expression, on account of fewer instruction signals getting through to the face
- frozen gait—especially difficulty starting walking, and a reduced arm swing
Non-motor symptoms include:
- loss of sense of smell—complete, or a persistent reduction of
- sleepwalking, or sleep-talking, or generally acting out dreams while asleep
- constipation—on an ongoing basis
- depression/anxiety, especially if there was no prior history of these conditions
For more detail on each of these, as well as what steps you might want to take, check out what Dr. Luis Zayas has to say:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
Citicoline vs Parkinson’s (And More)
Take care!
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How Much Weight Gain Do Antidepressants Cause?
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There’s a lot of talk in the news lately about antidepressants and weight gain, so let’s look at some numbers.
Here’s a study from July 2024 that compared the weight gain of eight popular antidepressants, and pop-science outlets have reported it with such snippets as:
❝Bupropion users were approximately 15–20% less likely to gain a clinically significant amount of weight than those taking the most common medication, sertraline.
The researchers considered weight gain of 5% or more as clinically significant.❞
Read in full: Study compares weight gain across eight common antidepressants
At this point, you might (especially if you or a loved one is on sertraline) be grabbing a calculator and seeing what 5% of your weight is, and might be concerned at the implications.
However, this is a little like if, in our This or That section, we were to report that food A has 17x more potassium than food B, without mentioning that food A has 0.01mg/100g and food A has 0.17mg/100g, and thus that, while technically “17x more”, the difference is trivial.
As a quick aside: we do, by the way, try to note when things like that might skew the stats and either wipe them out by not mentioning that they contain potassium at all (as they barely do), or if it’s a bit more, describing them as being “approximately equal in potassium” or else draw attention to the “but the amounts are trivial in both cases”.
Back to the antidepressants: in fact, for those two antidepressants compared in that snippet, the truth is (when we go looking in the actual research paper and the data within):
- sertraline was associated with an average weight change of +1.5kg (just over 3lb) over the course of 24 months
- bupropion was associated with an average weight change of +0.5kg (just under 1lb) over the course of 24 months
Sertraline being the most weight-gain-inducing of the 8 drugs compared, and bupropion being the least, this means (with them both having fairly even curves):
- sertraline being associated with an average weight change of 0.06kg (about 2oz) per month
- bupropion being associated with an average weight change of 0.02kg (less than 1oz) per month
For all eight, see the chart here in the paper itself:
Medication-Induced Weight Change Across Common Antidepressant Treatments ← we’ve made the link go straight to the chart, for your convenience, but you can also read the whole paper there
While you’re there, you might also see that for some antidepressants, such as duloxetine, fluoxetine, and venlafaxine, there’s an initial weight gain, but then it clearly hits a plateau and weight ceases to change after a certain point, which is worth considering too, since “you’ll gain a little bit of weight and then stay at that weight” is a very different prognosis from “you’ll gain a bit of weight and keep gaining it forever until you die”.
But then again, consider this:
Most adults will gain half a kilo this year – and every year. Here’s how to stop “weight creep”
That’s more weight gain than one gets on sertraline, the most weight-gain-inducing antidepressant tested!
What about over longer-term use?
Here’s a more recent study (December 2024) that looked at antidepressant use over 6 years, and found an average 2% weight gain over those 6 years, but it didn’t break it down by antidepressant type, sadly:
…which seems like quite a wasted opportunity, since some of the medications considered are very different, working on completely different systems (for example, SSRIs vs NDRIs, working on serotonin or norepinephrine+dopamine, respectively—see our Neurotransmitter Cheatsheet for more about those) and having often quite different side effects. Nevertheless, the study (despite collecting this information) didn’t then tabulate the data, and instead considered them all to be the same factor, “antidepressants”.
What this study did do that was useful was included a control group not on antidepressants so we know that on average:
- never-users of antidepressants gained an average of 1% of their bodyweight over those 6 years
- users-and-desisters of antidepressants gained an average of 1.8% of their bodyweight over those 6 years*
- continuing users of antidepressants gained an average of 2% of their bodyweight over those 6 years
*for this group, weight gain was a commonly cited reason for stopping taking the antidepressants in question
Writer’s anecdote: I’ve been on mirtazapine (a presynaptic alpha2-adrenoreceptor antagonist which increases central noradrenergic and serotonergic neurotransmission) for some years and can only say that I wish I’d been on it decades previously. I requested mirtazapine specifically, because I’m me and I know my stuff and considered it would most likely be by far the best fit for me out of the options available. Starting at a low dose, the only meaningful side effect was mild sedation (expected, and associated only with low-dose use); increasing after a couple of weeks to a moderate dose, that side effect disappeared and now the only remaining side effect is a slight dryness of the mouth, which is fine, as it ensures I remember to stay hydrated 🙂 anyway, my weight hasn’t changed (beyond very small temporary fluctuations) in the time I’ve been on mirtazapine. Disclaimer: the plural of anecdote is not data, and I can only speak for my own experience, and am not making any particular recommendation here. Your personal physiology will be different from mine, and may respond well or badly to any given treatment according to your own physiology.
Further considerations
This is touched on in the “Discussion” section of the latter paper (so do check that out if you want all the details, more than we can reasonably put here), but there are other factors to consider, for example:
- whether people were underweight/healthy weight/overweight at baseline (sometimes, a weight gain can be a good thing, recovering from an illness, and in the case of the illness that is depression, weight can swing either way)
- antidepressants changing eating and exercise habits (generally speaking: more likely to eat more and exercise more)
- body composition! How did they not cover this (neither paper did)?! Muscle weighs more than fat, and improvements in exercise can result in an increase in muscle and thus an increase in overall weight.
As researchers like to say, “this highlights the need for more high-quality studies to look into…” (and then the various things that went unexamined).
Want to know more?
Check out our previous main feature:
Antidepressants: Personalization Is Key!
Take care!
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