In This Oklahoma Town, Most Everyone Knows Someone Who’s Been Sued by the Hospital

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McALESTER, Okla. — It took little more than an hour for Deborah Hackler to dispense with the tall stack of debt collection lawsuits that McAlester Regional Medical Center recently brought to small-claims court in this Oklahoma farm community.

Hackler, a lawyer who sues patients on behalf of the hospital, buzzed through 51 cases, all but a handful uncontested, as is often the case. She bantered with the judge as she secured nearly $40,000 in judgments, plus 10% in fees for herself, according to court records.

It’s a payday the hospital and Hackler have shared frequently over the past three decades, records show. The records indicate McAlester Regional Medical Center and an affiliated clinic have filed close to 5,000 debt collection cases since the early 1990s, most often represented by the father-daughter law firm of Hackler & Hackler.

Some of McAlester’s 18,000 residents have been taken to court multiple times. A deputy at the county jail and her adult son were each sued recently, court records show. New mothers said they compare stories of their legal run-ins with the medical center.

“There’s a lot that’s not right,” Sherry McKee, a dorm monitor at a tribal boarding school outside McAlester, said on the courthouse steps after the hearing. The hospital has sued her three times, most recently over a $3,375 bill for what she said turned out to be vertigo.

In recent years, major health systems in Virginia, North Carolina, and elsewhere have stopped suing patients following news reports about lawsuits. And several states, such as Maryland and New York, have restricted the legal actions hospitals can take against patients.

But with some 100 million people in the U.S. burdened by health care debt, medical collection cases still clog courtrooms across the country, researchers have found. In places like McAlester, a hospital’s debt collection machine can hum away quietly for years, helped along by powerful people in town. An effort to limit hospital lawsuits failed in the Oklahoma Legislature in 2021.

In McAlester, the lawsuits have provided business for some, such as the Adjustment Bureau, a local collection agency run out of a squat concrete building down the street from the courthouse, and for Hackler, a former president of the McAlester Area Chamber of Commerce. But for many patients and their families, the lawsuits can take a devastating toll, sapping wages, emptying retirement accounts, and upending lives.

McKee said she wasn’t sure how long it would take to pay off the recent judgment. Her $3,375 debt exceeds her monthly salary, she said.

“This affects a large number of people in a small community,” said Janet Roloff, an attorney who has spent years assisting low-income clients with legal issues such as evictions in and around McAlester. “The impact is great.”

Settled more than a century ago by fortune seekers who secured land from the Choctaw Nation to mine coal in the nearby hills, McAlester was once a boom town. Vestiges of that era remain, including a mammoth, 140-foot-tall Masonic temple that looms over the city.

Recent times have been tougher for McAlester, now home by one count to 12 marijuana dispensaries and the state’s death row. The downtown is pockmarked by empty storefronts, including the OKLA theater, which has been dark for decades. Nearly 1 in 5 residents in McAlester and the surrounding county live below the federal poverty line.

The hospital, operated by a public trust under the city’s authority, faces its own struggles. Paint is peeling off the front portico, and weeds poke up through the parking lots. The hospital has operated in the red for years, according to independent audit reports available on the state auditor’s website.

“I’m trying to find ways to get the entire community better care and more care,” said Shawn Howard, the hospital’s chief executive. Howard grew up in McAlester and proudly noted he started his career as a receptionist in the hospital’s physical therapy department. “This is my hometown,” he said. “I am not trying to keep people out of getting care.”

The hospital operates a clinic for low-income patients, whose webpage notes it has “limited appointments” at no cost for patients who are approved for aid. But data from the audits shows the hospital offers very little financial assistance, despite its purported mission to serve the community.

In the 2022 fiscal year, it provided just $114,000 in charity care, out of a total operating budget of more than $100 million, hospital records show. Charity care totaling $2 million or $3 million out of a $100 million budget would be more in line with other U.S. hospitals.

While audits show few McAlester patients get financial aid, many get taken to court.

Renee Montgomery, the city treasurer in an adjoining town and mother of a local police officer, said she dipped into savings she’d reserved for her children and grandchildren after the hospital sued her last year for more than $5,500. She’d gone to the emergency room for chest pain.

Dusty Powell, a truck driver, said he lost his pickup and motorcycle when his wages were garnished after the hospital sued him for almost $9,000. He’d gone to the emergency department for what turned out to be gastritis and didn’t have insurance, he said.

“Everyone in this town probably has a story about McAlester Regional,” said another former patient who spoke on the condition she not be named, fearful to publicly criticize the hospital in such a small city. “It’s not even a secret.”

The woman, who works at an Army munitions plant outside town, was sued twice over bills she incurred giving birth. Her sister-in-law has been sued as well.

“It’s a good-old-boy system,” said the woman, who lowered her voice when the mayor walked into the coffee shop where she was meeting with KFF Health News. Now, she said, she avoids the hospital if her children need care.

Nationwide, most people sued in debt collection cases never challenge them, a response experts say reflects widespread misunderstanding of the legal process and anxiety about coming to court.

At the center of the McAlester hospital’s collection efforts for decades has been Hackler & Hackler.

Donald Hackler was city attorney in McAlester for 13 years in the ’70s and ’80s and a longtime member of the local Lions Club and the Scottish Rite Freemasons.

Daughter Deborah Hackler, who joined the family firm 30 years ago, has been a deacon at the First Presbyterian Church of McAlester and served on the board of the local Girl Scouts chapter, according to the McAlester News-Capital newspaper, which named her “Woman of the Year” in 2007. Since 2001, she also has been a municipal judge in McAlester, hearing traffic cases, including some involving people she has sued on behalf of the hospital, municipal and county court records show.

For years, the Hacklers’ debt collection cases were often heard by Judge James Bland, who has retired from the bench and now sits on the hospital board. Bland didn’t respond to an inquiry for interview.

Hackler declined to speak with KFF Health News after her recent court appearance. “I’m not going to visit with you about a current client,” she said before leaving the courthouse.

Howard, the hospital CEO, said he couldn’t discuss the lawsuits either. He said he didn’t know the hospital took its patients to court. “I had to call and ask if we sue people,” he said.

Howard also said he didn’t know Deborah Hackler. “I never heard her name before,” he said.

Despite repeated public records requests from KFF Health News since September, the hospital did not provide detailed information about its financial arrangement with Hackler.

McAlester Mayor John Browne, who appoints the hospital’s board of trustees, said he, too, didn’t know about the lawsuits. “I hadn’t heard anything about them suing,” he said.

At the century-old courthouse in downtown McAlester, it’s not hard to find the lawsuits, though. Every month or two, another batch fills the docket in the small-claims court, now presided over by Judge Brian McLaughlin.

After court recently, McLaughlin, who is not from McAlester, shook his head at the stream of cases and patients who almost never show up to defend themselves, leaving him to issue judgment after judgment in the hospital’s favor.

“All I can do is follow the law,” said McLaughlin. “It doesn’t mean I like it.”

About This Project

“Diagnosis: Debt” is a reporting partnership between KFF Health News and NPR exploring the scale, impact, and causes of medical debt in America.

The series draws on original polling by KFF, court records, federal data on hospital finances, contracts obtained through public records requests, data on international health systems, and a yearlong investigation into the financial assistance and collection policies of more than 500 hospitals across the country. 

Additional research was conducted by the Urban Institute, which analyzed credit bureau and other demographic data on poverty, race, and health status for KFF Health News to explore where medical debt is concentrated in the U.S. and what factors are associated with high debt levels.

The JPMorgan Chase Institute analyzed records from a sampling of Chase credit card holders to look at how customers’ balances may be affected by major medical expenses. And the CED Project, a Denver nonprofit, worked with KFF Health News on a survey of its clients to explore links between medical debt and housing instability. 

KFF Health News journalists worked with KFF public opinion researchers to design and analyze the “KFF Health Care Debt Survey.” The survey was conducted Feb. 25 through March 20, 2022, online and via telephone, in English and Spanish, among a nationally representative sample of 2,375 U.S. adults, including 1,292 adults with current health care debt and 382 adults who had health care debt in the past five years. The margin of sampling error is plus or minus 3 percentage points for the full sample and 3 percentage points for those with current debt. For results based on subgroups, the margin of sampling error may be higher.

Reporters from KFF Health News and NPR also conducted hundreds of interviews with patients across the country; spoke with physicians, health industry leaders, consumer advocates, debt lawyers, and researchers; and reviewed scores of studies and surveys about medical debt.

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.

Subscribe to KFF Health News’ free Morning Briefing.

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  • Take This Two-Minute Executive Dysfunction Test

    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.

    Roll For Initiative

    Some of us struggle with executive dysfunction a lot; others, a little.

    What Is Executive Dysfunction?

    Executive function is a broad group of mental skills that enable people to complete tasks and interact with others.

    • Executive dysfunction can impair a person’s ability to organize and manage behavior

    • Executive dysfunction is not a specific stand-alone diagnosis or condition.

    • Instead, conditions such as depression and ADHD (amongst others) can affect a person’s executive function.

    Medical News Today

    Take This Two-Minute Executive Dysfunction Test

    How did you score? (8/16 here!)

    Did you do it? (it honestly is really two minutes and is quite informative)

    If not, here’s your cue to go back up and do it

    For almost all of us, we sometimes find ourselves torn between several competing tasks, and end up doing… none of them.

    For such times, compile yourself a “productivity buffet”, print it, and pin it above your desk or similar space.

    What’s a productivity buffet?

    It’s a numbered list of 6, 8, 10, 12 or 20 common tasks that pretty much always need doing (to at least some extent!). Doesn’t matter how important they are, just that they are frequently recurring tasks. For example:

    1. Tidy desk (including that drawer!)
    2. Reply to emails/messages
    3. Drink water
    4. Collect stray one-off to-dos into a list
    5. Stretch (or at least correct your posture!)
    6. Extend that Duolingo streak
    7. Read one chapter of a book
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    Why 6, 8, 10, 12, or 20?

    Because those are common denominations of polyhedral dice that are very cheap to buy!

    Keep the relevant die to hand (perhaps in your pocket or on your desk), and when you know you should be doing something but can’t decide what exactly, roll the die and do the item corresponding to the number you roll.

    And if you find yourself thinking “damn, I got 12, I wanted 7!” then go ahead and do item 7—the dice aren’t the boss of you, they’re just there to break the ice between you and your to-do list!

    The Housekeeper In Your Pocket?

    If you found the tidying tips (up top) helpful, but don’t like cleaning schedules because you just can’t stick to them, this one’s for you.

    It’s easy to slip into just doing the same few easy tasks while neglecting others for far too long.

    The answer? Outsource!

    Not “get a cleaner” (though if you want to and can, great, go for it, this one won’t be for you after all), but rather, try this nifty little app that helps you keep on top of daily cleaning—which we all know is better than binge-cleaning every few months.

    Sweepy keeps track of:

    • What jobs there are that might need doing in each room (or type of room) in the house
    • How often those jobs generally need doing
    • How much of your energy (a finite resource, which it also takes into account!) those jobs will take
    • How much energy you are prepared to spend per day (you can “lighter/heavier” days, or even “off-days”, too)

    …and then it populates a small daily task list according to what needs cleaning and how much energy it’ll take.

    For example, today Sweepy gives me (your trusty writer, hi! ) the tasks:

    • Bathroom: clean sink (every 3 days, 1pt of energy)
    • Dining room: clean and tidy table (every day, 1pt of energy)
    • Bedroom: vacuum floor (every 7 days, 2pts of energy)
    • Kitchen: clean coffee machine (every 30 days, 2pts of energy)

    And that’s my 6pts of energy I’ve told Sweepy I’m happy to spend per day cleaning. There are “3 pts” tasks too—cleaning the oven, for example—but none came up today.

    Importantly: it does not bother me about any other tasks today (even if something’s overdue), and I don’t have to worry my pretty head about it.

    I don’t have to feel guilty for not doing other cleaning tasks; if they need doing, Sweepy will tell me tomorrow, and it will make sure I don’t get behind or leave anything neglected for too long.

    Check it out (available for both iOS and Android)

    PS: to premium or not to premium? We think the premium is worth it (unlocks some extra customization features) but the free version is sufficient to get your house in order, so don’t be afraid to give it a try first.

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  • I’m iron deficient. Which supplements will work best for me and how should I take them?

    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.

    Iron deficiency is common and can be debilitating. It mainly affects women. One in three premenopausal women are low in iron compared to just 5% of Australian men. Iron deficiency particularly affects teenage girls, women who do a lot of exercise and those who are pregnant.

    The body needs iron to make new red blood cells, and to support energy production, the immune system and cognitive function. If you’re low, you may experience a range of symptoms including fatigue, weakness, shortness of breath, headache, irregular heartbeat and reduced concentration.

    If a blood test shows you’re iron deficient, your doctor may recommend you start taking an oral iron supplement. But should you take a tablet or a liquid? With food or not? And when is the best time of day?

    Here are some tips to help you work out how, when and what iron supplement to take.

    LittlePigPower/Shutterstock

    How do I pick the right iron supplement?

    The iron in your body is called “elemental iron”. Choosing the right oral supplement and dose will depend on how much elemental iron it has – your doctor will advise exactly how much you need.

    The sweet spot is between 60-120 mg of elemental iron. Any less and the supplement won’t be effective in topping up your iron levels. Any higher and you risk gastrointestinal symptoms such as diarrhoea, cramping and stomach pain.

    Three pregnant bellies during a stretching class.
    Low iron can especially affect people during pregnancy and women who do a lot of sport. Kamil Macniak/Shutterstock

    In Australia, iron salts are the most common oral supplements because they are cheap, effective and come in different delivery methods (tablets, capsules, liquid formulas). The iron salts you are most likely to find in your local chemist are ferrous sulfate (~20% elemental iron), ferrous gluconate (~12%) and ferrous fumarate (~33%).

    These formulations all work similarly, so your choice should come down to dose and cost.

    Many multivitamins may look like an iron supplement, but it’s important to note they usually have too little iron – usually less than 20 mg – to correct an iron deficiency.

    Should I take tablets or liquid formulas?

    Iron contained within a tablet is just as well absorbed as iron found in a liquid supplement. Choosing the right one usually comes down to personal preference.

    The main difference is that liquid formulas tend to contain less iron than tablets. That means you might need to take more of the product to get the right dose, so using a liquid supplement could work out to be more expensive in the long term.

    What should I eat with my iron supplement?

    Research has shown you will absorb more of the iron in your supplement if you take it on an empty stomach. But this can cause more gastrointestinal issues, so might not be practical for everyone.

    If you do take your supplement with meals, it’s important to think about what types of food will boost – rather than limit – iron absorption. For example, taking the supplement alongside vitamin C improves your body’s ability to absorb it.

    Some supplements already contain vitamin C. Otherwise you could take the supplement along with a glass of orange juice, or other vitamin C-rich foods.

    A woman pours orange juice into a glass next to a bowl of strawberries and kiwifruit.
    Taking your supplement alongside foods rich in vitamin C, like orange juice or kiwifruit, can help your body absorb the iron. Anete Lusina/Pexels

    On the other hand, tea, coffee and calcium all decrease the body’s ability to absorb iron. So you should try to limit these close to the time you take your supplement.

    Should I take my supplement in the morning or evening?

    The best time of day to take your supplement is in the morning. The body can absorb significantly more iron earlier in the day, when concentrations of hepcidin (the main hormone that regulates iron) are at their lowest.

    Exercise also affects the hormone that regulates iron. That means taking your iron supplement after exercising can limit your ability to absorb it. Taking your supplement in the hours following exercise will mean significantly poorer absorption, especially if you take it between two and five hours after you stop.

    Our research has shown if you exercise every day, the best time to take your supplement is in the morning before training, or immediately after (within 30 minutes).

    My supplements are upsetting my stomach. What should I do?

    If you experience gastrointestinal side effects such as diarrhoea or cramps when you take iron supplements, you may want to consider taking your supplement every second day, rather than daily.

    Taking a supplement every day is still the fastest way to restore your iron levels. But a recent study has shown taking the same total dose can be just as effective when it’s taken on alternate days. For example, taking a supplement every day for three months works as well as every second day for six months. This results in fewer side effects.

    Oral iron supplements can be a cheap and easy way to correct an iron deficiency. But ensuring you are taking the right product, under the right conditions, is crucial for their success.

    It’s also important to check your iron levels prior to commencing iron supplementation and do so only under medical advice. In large amounts, iron can be toxic, so you don’t want to be consuming additional iron if your body doesn’t need it.

    If you think you may be low on iron, talk to your GP to find out your best options.

    Alannah McKay, Postdoctoral Research Fellow, Sports Nutrition, Australian Catholic University

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

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  • Cordyceps: Friend Or Foe?

    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.

    Cordyceps: friend or foe?

    Cordyceps is a famously frightening fungus. It’s the one responsible for “zombie ants” and other zombie creatures, and it’s the basis for the existential threat to humanity in the TV show The Last of Us.

    It’s a parasitic fungus that controls the central and peripheral nervous systems of its host, slowly replacing the host’s body, as well as growing distinctive spines that erupt out of the host’s body. Taking over motor functions, it compels the host to do two main things, which are to eat more food, and climb to a position that will be good to release spores from.

    Fortunately, none of that matters to humans. Cordyceps does not (unlike in the TV show) affect humans that way.

    What does Cordyceps do in humans?

    Cordyceps (in various strains) is enjoyed as a health supplement, based on a long history of use in Traditional Chinese Medicine, and nowadays it’s coming under a scientific spotlight too.

    The main health claims for it are:

    • Against inflammation
    • Against aging
    • Against cancer
    • For blood sugar management
    • For heart health
    • For exercise performance

    Sounds great! What does the science say?

    There’s a lot more science for the first three (which are all closely related to each other, and often overlapping in mechanism and effect).

    So let’s take a look:

    Against inflammation

    The science looks promising for this, but studies so far have either been in vitro (cell cultures in petri dishes), or else murine in vivo (mouse studies), for example:

    In summary: we can see that it has anti-inflammatory properties for mice and in the lab; we’d love to see the results of studies done on humans, though. Also, while it has anti-inflammatory properties, it performed less well than commonly-prescribed anti-inflammatory drugs, for example:

    ❝C. militaris can modulate airway inflammation in asthma, but it is less effective than prednisolone or montelukast.❞

    Source: Effects of the immunomodulatory agent Cordyceps militaris on airway inflammation in a mouse asthma model

    Against aging

    Because examining the anti-aging effects of a substance requires measuring lifespans and repeating the experiment, anti-aging studies do not tend to be done on humans, because they would take lifetimes to perform. To this end, it’s inconvenient, but not a criticism of Cordyceps, that studies have been either mouse studies (short lifespan, mammals like us) or fruit fly studies (very short lifespan, genetically surprisingly similar to us).

    The studies have had positive results, with typical lifespan extensions of 15–20%:

    Against cancer

    Once again, the studies here have been in vitro, or murine in vivo. They do look good though:

    In vitro (human cell cultures in a lab):

    In vivo (mouse studies):

    Summary of these is: Cordyceps quite reliably inhibits tumor growth in vitro (human cell cultures) and in vivo (mouse studies). However, trials in human cancer patients are so far conspicuous by their absence.

    For blood sugar management

    Cordyceps appears to mimic the action of insulin, without triggering insulin sensitivity. For example:

    The anti-hyperglycemic activity of the fruiting body of Cordyceps in diabetic rats

    There were some other rat/mouse studies with similar results. No studies in humans yet.

    For heart health

    Cordyceps contains adenosine. You may remember that caffeine owes part of its stimulant effect to blocking adenosine, the hormone that makes us feel sleepy. So in this way, Cordyceps partially does the opposite of what caffeine does, and may be useful against arrhythmia:

    Cardiovascular protection of Cordyceps sinensis act partially via adenosine receptors

    For exercise performance

    A small (30 elderly participants) study found that Cordyceps supplementation improved VO2 max by 7% over the course of six weeks:

    Randomized double-blind placebo-controlled clinical trial and assessment of fermentation product of Cordyceps sinensis in enhancing aerobic capacity and respiratory function of the healthy elderly volunteers

    However, another small study (22 young athletes) failed to reproduce those results:

    Cordyceps Sinensis supplementation does not improve endurance exercise performance

    In summary…

    Cordyceps almost certainly has anti-inflammation, anti-aging, and anti-cancer benefits.

    Cordyceps may have other benefits too, but the evidence is thinner on the ground for those, so far.

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Related Posts

  • Paris in spring, Bali in winter. How ‘bucket lists’ help cancer patients handle life and death
  • Tourette’s Syndrome Treatment Options

    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.

    It’s Q&A Day at 10almonds!

    Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!

    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

    ❝Is there anything special that might help someone with Tourette’s syndrome?❞

    There are of course a lot of different manifestations of Tourette’s syndrome, and some people’s tics may be far more problematic to themselves and/or others, while some may be quite mild and just something to work around.

    It’s an interesting topic for sure, so we’ll perhaps do a main feature (probably also covering the related-and-sometimes-overlapping OCD umbrella rather than making it hyperspecific to Tourette’s), but meanwhile, you might consider some of these options:

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  • How To Out-Cheat “Cheat Days”

    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.

    Out-Cheating “Cheat Days” (Or Even Just “Cheat Meals”)

    If you are in the habit of eating healthily, the idea of a “cheat day” probably isn’t appealing—because you simply don’t crave junk food; it’s not what your gut is used to.

    Nevertheless, sometimes cheat days, or at least cheat meals, choose us rather than the other way around. If your social group is having a pizza night or meeting up at the burger bar, probably you’re going to be having a meal that’s not ideal.

    So, what to do about it?

    Well, first of all, relax. If it really is an exception and not a regular occurrence, it’s not going to have a big health impact. Assuming that your basic dietary requirements are taken care of (e.g. free from allergens as necessary, vegan/vegetarian if that’s appropriate for you, adhering to any religious restrictions that are important to you, etc), then you’re going to have a good time, which is what scientists call a “pro-social activity” and is not a terrible thing.

    See also: Is Fast Food Really All That Bad? ← answer: yes it is, but the harm is cumulative and won’t all happen the instant you take a bite of a chicken nugget

    Think positive

    No, not in the “think positive thoughts” sense (though feel free, if that’s your thing), but rather: focus on adding things rather than subtracting things.

    It’s said:

    It’s not the calories in your food that make the biggest impact on your health; it’s the food in your calories❞e

    …and that’s generally true. The same goes for “bad things” in the food, e.g. added sugar, salt, seed oils, etc. They really are bad! But, in this case you’re going to be eating them and they’re going to be nearly impossible to avoid in the social scenarios we described. So, forget that sunk treasure, and instead, add nutrients.

    10almonds tip: added nutrients remain added nutrients, even if the sources were not glowing with health-appeal and/or you ate them alongside something unhealthy:

    • Those breaded garlic mushrooms are still full of magnesium and fiber and ergothioneine.
    • The chili-and-mint peas that came as an overpriced optional side-dish with your burger are still full of protein, fiber, and a stack of polyphenols.

    …and so on. And, the more time you spend eating those things, the less time you spend eating the real empty-calorie foods.

    Fix the flaw

    We set out to offer this guide without arguing for abstemiousness or making healthy substitutions, because we assume you knew already that you can not eat things, and as for substitutions, often they are not practical, especially if dining out or ordering in.

    Also, sometimes even when home-cooking something unhealthy, taking the bad ingredient out takes some of the joy out with it.

    Writers example: I once incorrectly tried to solve the fat conundrum of my favorite shchi (recipe here) by trying purely steaming the vegetables instead of my usual frying/sautéing them, and let’s just say, that errant-and-swiftly-abandoned version got recorded in my nutrition-tracker app as “sad shchi”.

    So instead, fix the flaw by countering it if possible:

    • The meal is devoid of fiber? Preload with some dried figs (you can never have too many dried figs in your pantry)
    • The meal is high in saturated fat? Enjoy fiber before/during/after, per what’s convenient for you. Fiber helps clear out excess cholesterol, which is usually the main issue with saturated fat.
    • The meal is salty? Double down on your hydration before, during, and after. If that sounds like a chore, then remember, it’s more fun than getting bloated (which results, counterintuitively, from dehydration—because your body detects the salt, and panics and tries to retain as much water as possible to restore homeostasis, resulting in bloating) and hypertensive (which results from the combination of the blood having too much salt and too little water, and cells retaining too much water and pressing inwards because it is the cells themselves that are bloated). So, tending to your hydration can help mitigate all of the above.
    • The meal is full of high-GI carbs? Preload with fiber, enjoy the carbs together with fats, and have something acidic (e.g. some kind of vinegar, or citrus fruit) with it if that’s a reasonable option. Yes, this does mean that a Whiskey Sour is better for your blood sugars than an Old Fashioned, by the way, and/but no, it doesn’t make either of them healthy.
    • The meal is inflammatory? Doing all of the above things will help, as will eating it slowly/mindfully, which latter makes it less of a shock to your system.

    See also: How To Get More Nutrition From The Same Food

    Enjoy!

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  • Carbonated Water: For Weight Loss, Satiety, Or Just Gas?

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    There are two main mechanisms of action by which sparkling water is considered to help satiety and/or weight loss; they are:

    1. It “fills us up” such that we feel fuller sooner, and thus eat less, and thus (all other things being equal) perhaps lose weight
    2. The carbon dioxide is absorbed into the bloodstream, where (as a matter of chemistry) it improves glucose metabolism, thus lowering blood sugars and indirectly leading (potentially) to weight loss, but even if not, lowered blood sugars are good for most people most of the time, right?

    However, there are just a few problems:

    Full of gas?

    Many people self-report enjoying sparkling water as a way to feel fuller while fasting (or even while eating). However, the plural of “anecdote” is not “data”, so, here be data… Ish:

    ❝In order to determine whether such satiating effects occur through oral carbonic stimulation alone, we conducted modified sham-feeding (SF) tests (carbonated water ingestion (CW), water ingestion (W), carbonated water sham-feeding (CW-SF), and water sham-feeding (W-SF)), employing an equivalent volume and standardized temperature of carbonated and plain water, in a randomized crossover design.

    Thirteen young women began fasting at 10 p.m. on the previous night and were loaded with each sample (15ºC, 250 mL) at 9 a.m. on separate days. Electrogastrography (EGG) recordings were obtained from 20 min before to 45 min after the loading to determine the power and frequency of the gastric myoelectrical activity. Appetite was assessed using visual analog scales. After ingestion, significantly increased fullness and decreased hunger ratings were observed in the CW group. After the load, transiently but significantly increased fullness as well as decreased hunger ratings were observed in the CW-SF group. The powers of normogastria (2-4 cpm) and tachygastria (4-9 cpm) showed significant increases in the CW and W groups, but not in the CW-SF and W-SF groups. The peak frequency of normogastria tended to shift toward a higher band in the CW group, whereas it shifted toward a lower band in the CW-SF group, indicating a different EGG rhythm.

    Our results suggest that CO2-induced oral stimulation is solely responsible for the feeling of satiety.❞

    ~ Dr. Maki Suzuki et al.

    Now, that’s self-reported, and a sample size of 13, so it’s not the most airtight science ever, but it is at least science. Here’s the paper, by the way:

    Oral Carbonation Attenuates Feeling of Hunger and Gastric Myoelectrical Activity in Young Women

    Here’s another small study with 8 people, which found that still and sparkling water had the exact same effect:

    Effect of carbonated water on gastric emptying and intragastric meal distribution

    However, drinking water (still or sparkling) with a meal will not have anywhere near the same effect for satiety as consuming food that has a high water-content.

    See also: Some Surprising Truths About Hunger And Satiety ← our main feature in which we examine the science of volumetrics, including a study that shows how water incorporated into a food (but not served with a food) decreases caloric intake.

    As an aside, one difference that carbonation can make is to increase ghrelin levels—that’s the hunger hormone (the satiety hormone is leptin, by the way). This one’s a rat study, but it seems reasonable that the same will be true of humans:

    Carbon dioxide in carbonated beverages induces ghrelin release and increased food consumption in male rats: implications on the onset of obesity

    …which is worth bearing in mind even if you yourself are not, in fact, a male rat.

    The glucose guzzler?

    This one has simply been the case of a study being misrepresented, for example here:

    Fizzy water might aid weight loss by providing a small boost to glucose uptake and metabolism

    The idea is that higher levels of carbon dioxide in the blood mean faster glucose metabolism, which is technically true. Now, often “technically true” is the best kind of true, but not here, because it’s simply not useful.

    In short, we produce so much carbon dioxide as part of our normal respiratory processes, that any carbon dioxide we might consume in a carbonated water is barely a blip in the graph.

    Oh, and that article we just linked? Even within the article, despite running with that headline, the actual scientists quoted are saying such things as:

    ❝While there is a hypothetical link between carbonated water and glucose metabolism, this has yet to be tested in well-designed human intervention studies❞

    ~ Professor Sumantra Ray

    Note: the word “hypothetical” means “one level lower than theoretical”. This is very far from being a conclusion.

    And the study itself? Wasn’t even about carbonated water, it was about kidney dialysis and how the carbon dioxide content can result in hypoglycemia:

    The mechanism of hypoglycemia caused by hemodialysis

    …which got referenced in this paper (not a study):

    Can carbonated water support weight loss?

    …and even that concluded:

    ❝CO2 in carbonated water may promote weight loss by enhancing glucose uptake and metabolism in red blood cells.

    However, the amount is so small that it is difficult to expect weight loss effects solely from the CO2 in carbonated water.

    Drinking carbonated water may also affect blood glucose measurements.❞

    Note: the word “may”, when used by a scientist and in the absence of any stronger claims, means “we haven’t ruled out the possibility”.

    What breaking news that is.

    Stop the press! No, really, stop it!

    So… What does work?

    There are various ways of going about actually hacking hunger (and they stack; i.e. you can use multiple methods and get cumulative results), and we wrote about them here:

    Hack Your Hunger

    Enjoy!

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