Mocktails – by Moira Clark

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We’ve reviewed books about quitting alcohol before (such as this one), but today’s is not about quitting, so much as about enjoying non-alcoholic drinks; it’s simply a recipe book of zero-alcohol cocktails, or “mocktails”.

What sets this book apart from many of its kind is that every recipe uses only natural and fresh ingredients, rather than finding in the ingredients list some pre-made store-bought component. Instead, because of its “everything from scratch” approach, this means:

  • Everything is reliably as healthy as the ingredients you use
  • Every recipe’s ingredients can be found easily unless you live in a food desert

Each well-photographed and well-written recipe also comes with a QR code to see a step-by-step video tutorial (or if you get the ebook version, then a direct link as well).

Bottom line: this is the perfect mocktail book to have in (and practice with!) before the summer heat sets in.

Click here to check out Mocktails: A Delicious Collection of Non-Alcoholic Drinks, and get mixing!

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Recommended

  • A Guide to the Good Life – by Dr. William Irvine
  • Watermelon vs Grapes – Which is Healthier?
    Watermelon wins over grapes with higher Vitamin A and C and potent antioxidants like lycopene—your superior fruit choice!

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  • Why Many Nonprofit (Wink, Wink) Hospitals Are Rolling in Money

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    One owns a for-profit insurer, a venture capital company, and for-profit hospitals in Italy and Kazakhstan; it has just acquired its fourth for-profit hospital in Ireland. Another owns one of the largest for-profit hospitals in London, is partnering to build a massive training facility for a professional basketball team, and has launched and financed 80 for-profit start-ups. Another partners with a wellness spa where rooms cost $4,000 a night and co-invests with “leading private equity firms.”

    Do these sound like charities?

    These diversified businesses are, in fact, some of the country’s largest nonprofit hospital systems. And they have somehow managed to keep myriad for-profit enterprises under their nonprofit umbrella — a status that means they pay little or no taxes, float bonds at preferred rates, and gain numerous other financial advantages.

    Through legal maneuvering, regulatory neglect, and a large dollop of lobbying, they have remained tax-exempt charities, classified as 501(c)(3)s.

    “Hospitals are some of the biggest businesses in the U.S. — nonprofit in name only,” said Martin Gaynor, an economics and public policy professor at Carnegie Mellon University. “They realized they could own for-profit businesses and keep their not-for-profit status. So the parking lot is for-profit; the laundry service is for-profit; they open up for-profit entities in other countries that are expressly for making money. Great work if you can get it.”

    Many universities’ most robust income streams come from their technically nonprofit hospitals. At Stanford University, 62% of operating revenue in fiscal 2023 was from health services; at the University of Chicago, patient services brought in 49% of operating revenue in fiscal 2022.

    To be sure, many hospitals’ major source of income is still likely to be pricey patient care. Because they are nonprofit and therefore, by definition, can’t show that thing called “profit,” excess earnings are called “operating surpluses.” Meanwhile, some nonprofit hospitals, particularly in rural areas and inner cities, struggle to stay afloat because they depend heavily on lower payments from Medicaid and Medicare and have no alternative income streams.

    But investments are making “a bigger and bigger difference” in the bottom line of many big systems, said Ge Bai, a professor of health care accounting at the Johns Hopkins University Bloomberg School of Public Health. Investment income helped Cleveland Clinic overcome the deficit incurred during the pandemic.

    When many U.S. hospitals were founded over the past two centuries, mostly by religious groups, they were accorded nonprofit status for doling out free care during an era in which fewer people had insurance and bills were modest. The institutions operated on razor-thin margins. But as more Americans gained insurance and medical treatments became more effective — and more expensive — there was money to be made.

    Not-for-profit hospitals merged with one another, pursuing economies of scale, like joint purchasing of linens and surgical supplies. Then, in this century, they also began acquiring parts of the health care systems that had long been for-profit, such as doctors’ groups, as well as imaging and surgery centers. That raised some legal eyebrows — how could a nonprofit simply acquire a for-profit? — but regulators and the IRS let it ride.

    And in recent years, partnerships with, and ownership of, profit-making ventures have strayed further and further afield from the purported charitable health care mission in their community.

    “When I first encountered it, I was dumbfounded — I said, ‘This not charitable,’” said Michael West, an attorney and senior vice president of the New York Council of Nonprofits. “I’ve long questioned why these institutions get away with it. I just don’t see how it’s compliant with the IRS tax code.” West also pointed out that they don’t act like charities: “I mean, everyone knows someone with an outstanding $15,000 bill they can’t pay.”

    Hospitals get their tax breaks for providing “charity care and community benefit.” But how much charity care is enough and, more important, what sort of activities count as “community benefit” and how to value them? IRS guidance released this year remains fuzzy on the issue.

    Academics who study the subject have consistently found the value of many hospitals’ good work pales in comparison with the value of their tax breaks. Studies have shown that generally nonprofit and for-profit hospitals spend about the same portion of their expenses on the charity care component.

    Here are some things listed as “community benefit” on hospital systems’ 990 tax forms: creating jobs; building energy-efficient facilities; hiring minority- or women-owned contractors; upgrading parks with lighting and comfortable seating; creating healing gardens and spas for patients.

    All good works, to be sure, but health care?

    What’s more, to justify engaging in for-profit business while maintaining their not-for-profit status, hospitals must connect the business revenue to that mission. Otherwise, they pay an unrelated business income tax.

    “Their CEOs — many from the corporate world — spout drivel and turn somersaults to make the case,” said Lawton Burns, a management professor at the University of Pennsylvania’s Wharton School. “They do a lot of profitable stuff — they’re very clever and entrepreneurial.”

    The truth is that a number of not-for-profit hospitals have become wealthy diversified business organizations. The most visible manifestation of that is outsize executive compensation at many of the country’s big health systems. Seven of the 10 most highly paid nonprofit CEOs in the United States run hospitals and are paid millions, sometimes tens of millions, of dollars annually. The CEOs of the Gates and Ford foundations make far less, just a bit over $1 million.

    When challenged about the generous pay packages — as they often are — hospitals respond that running a hospital is a complicated business, that pharmaceutical and insurance execs make much more. Also, board compensation committees determine the payout, considering salaries at comparable institutions as well as the hospital’s financial performance.

    One obvious reason for the regulatory tolerance is that hospital systems are major employers — the largest in many states (including Massachusetts, Pennsylvania, Minnesota, Arizona, and Delaware). They are big-time lobbying forces and major donors in Washington and in state capitals.

    But some patients have had enough: In a suit brought by a local school board, a judge last year declared that four Pennsylvania hospitals in the Tower Health system had to pay property taxes because its executive pay was “eye popping” and it demonstrated “profit motives through actions such as charging management fees from its hospitals.”

    A 2020 Government Accountability Office report chided the IRS for its lack of vigilance in reviewing nonprofit hospitals’ community benefit and recommended ways to “improve IRS oversight.” A follow-up GAO report to Congress in 2023 said, “IRS officials told us that the agency had not revoked a hospital’s tax-exempt status for failing to provide sufficient community benefits in the previous 10 years” and recommended that Congress lay out more specific standards. The IRS declined to comment for this column.

    Attorneys general, who regulate charity at the state level, could also get involved. But, in practice, “there is zero accountability,” West said. “Most nonprofits live in fear of the AG. Not hospitals.”

    Today’s big hospital systems do miraculous, lifesaving stuff. But they are not channeling Mother Teresa. Maybe it’s time to end the community benefit charade for those that exploit it, and have these big businesses pay at least some tax. Communities could then use those dollars in ways that directly benefit residents’ health.

    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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  • Blood, urine and other bodily fluids: how your leftover pathology samples can be used for medical research

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    A doctor’s visit often ends with you leaving with a pathology request form in hand. The request form soon has you filling a sample pot, having blood drawn, or perhaps even a tissue biopsy taken.

    After that, your sample goes to a clinical pathology lab to be analysed, in whichever manner the doctor requested. All this is done with the goal of getting to the bottom of the health issue you’re experiencing.

    But after all the tests are done, what happens with the leftover sample? In most cases, leftover samples go in the waste bin, destined for incineration. Sometimes though, they may be used again for other purposes, including research.

    Kaboompics.com/Pexels

    Who can use my leftover samples?

    The samples we’re talking about here cover the range of samples clinical labs receive in the normal course of their testing work. These include blood and its various components (including plasma and serum), urine, faeces, joint and spinal fluids, swabs (such as from the nose or a wound), and tissue samples from biopsies, among others.

    Clinical pathology labs often use leftover samples to practise or check their testing methods and help ensure test accuracy. This type of use is a vital part of the quality assurance processes labs need to perform, and is not considered research.

    Leftover samples can also be used by researchers from a range of agencies such as universities, research institutes or private companies.

    They may use leftover samples for research activities such as trying out new ideas or conducting small-scale studies (more on this later). Companies that develop new or improved medical diagnostic tests can also use leftover samples to assess the efficacy of their test, generating data needed for regulatory approval.

    What about informed consent?

    If you’ve ever participated in a medical research project such as a clinical trial, you may be familiar with the concept of informed consent. In this process, you have the opportunity to learn about the study and what your participation involves, before you decide whether or not to participate.

    So you may be surprised to learn using leftover samples for research purposes without your consent is permitted in most parts of Australia, and elsewhere. However, it’s only allowed under certain conditions.

    In Australia, the National Health and Medical Research Council (NHMRC) offers guidance around the use of leftover pathology samples.

    One of the conditions for using leftover samples without consent for research is that they were received and retained by an accredited pathology service. This helps ensure the samples were collected safely and properly, for a legitimate clinical reason, and that no additional burdens or risk of harm to the person who provided the sample will be created with their further use.

    Another condition is anonymity: the leftover samples must be deidentified, and not easily able to be reidentified. This means they can only be used in research if the identity of the donor is not needed.

    Two women working in a lab.
    Leftover pathology samples are sometimes used in medical research. hedgehog94/Shutterstock

    The decision to allow a particular research project to use leftover pathology samples is made by an independent human research ethics committee which includes consumers and independent experts. The committee evaluates the project and weighs up the risks and potential benefits before permitting an exemption to the need for informed consent.

    Similar frameworks exist in the United States, the United Kingdom, India and elsewhere.

    What research might be done on my leftover samples?

    You might wonder how useful leftover samples are, particularly when they’re not linked to a person and their medical history. But these samples can still be a valuable resource, particularly for early-stage “discovery” research.

    Research using leftover samples has helped our understanding of antibiotic resistance in a bacterium that causes stomach ulcers, Helicobacter pylori. It has helped us understand how malaria parasites, Plasmodium falciparum, damage red blood cells.

    Leftover samples are also helping researchers identify better, less invasive ways to detect chronic diseases such as pulmonary fibrosis. And they’re allowing scientists to assess the prevalence of a variant in haemoglobin that can interfere with widely used diagnostic blood tests.

    All of this can be done without your permission. The kinds of tests researchers do on leftover samples will not harm the person they were taken from in any way. However, using what would otherwise be discarded allows researchers to test a new method or treatment and avoid burdening people with providing fresh samples specifically for the research.

    When considering questions of ethics, it could be argued not using these samples to derive maximum benefit is in fact unethical, because their potential is wasted. Using leftover samples also minimises the cost of preliminary studies, which are often funded by taxpayers.

    A man getting a blood test.
    The use of leftover pathology samples in research has been subject to some debate. Andrey_Popov/Shutterstock

    Inconsistencies in policy

    Despite NHMRC guidance, certain states and territories have their own legislation and guidelines which differ in important ways. For instance, in New South Wales, only pathology services may use leftover specimens for certain types of internal work. In all other cases consent must be obtained.

    Ethical standards and their application in research are not static, and they evolve over time. As medical research continues to advance, so too will the frameworks that govern the use of leftover samples. Nonetheless, developing a nationally consistent approach on this issue would be ideal.

    Striking a balance between ensuring ethical integrity and fostering scientific discovery is essential. With ongoing dialogue and oversight, leftover pathology samples will continue to play a crucial role in driving innovation and advances in health care, while respecting the privacy and rights of individuals.

    Christine Carson, Senior Research Fellow, School of Medicine, The University of Western Australia and Nikolajs Zeps, Professor, School of Public Health and Preventive Medicine, Monash University

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

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  • Brain Maker – by Dr. David Perlmutter

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    Regular 10almonds readers probably know about the gut-brain connection already, so what’s new here?

    Dr. David Perlmutter takes us on a tour of gut and brain health, specifically, the neuroprotective effect of healthy gut microbiota.

    This seems unlikely! After all, vagus nerve or no, the gut microbiota are confined to the gut, and the brain is kept behind the blood-brain barrier. So how does one thing protect the other?

    Dr. Perlmutter presents the relevant science, and the honest answer is, we’re not 100% sure how this happens! We do know part of it: that bad gut microbiota can result in a “leaky gut”, and that may in turn lead to such a thing as a “leaky brain”, where the blood-brain barrier has been compromised and some bad things can get in with the blood.

    When it comes to gut-brain health…

    Not only is the correlation very strong, but also, in tests where someone’s gut microbiota underwent a radical change, e.g. due to…

    • antibiotics (bad)
    • fasting (good)
    • or a change in diet (either way)

    …their brain health changed accordingly—something we can’t easily check outside of a lab, but was pretty clear in those tests.

    We’re also treated to an exposé on the links between gut health, brain health, inflammation, and dementia… Which links are extensive.

    In closing, we’ll mention that throughout this book we’re also given many tips and advices to improve our gut/brain health, reverse damage done already, and set ourselves up well for the future.

    Click here to check out “Brain Maker” on Amazon and take care of this important part of your health!

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Related Posts

  • A Guide to the Good Life – by Dr. William Irvine
  • Palliative care as a true art form

    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.

    How do you ease the pain from an ailment amidst lost words? How can you serve the afflicted when lines start to blur? When the foundation of communication begins to crumble, what will be the pillar health-care professionals can lean on to support patients afflicted with dementia during their final days?

    The practice of medicine is both highly analytical and evidence based in nature. However, it is considered a “practice” because at the highest level, it resembles a musician navigating an instrument. It resembles art. Between lab values, imaging techniques and treatment options, the nuances for individualized patient care so often become threatened.

    Dementia, a non-malignant terminal illness, involves the progressive cognitive and social decline in those afflicted. Though there is no cure, dementia is commonly met in the setting of end-of-life care. During this final stage of life, the importance of comfort via symptomatic management and communication usually is a priority in patient care. But what about the care of a patient suffering from dementia? While communication serves as the vehicle to deliver care at a high level, medical professionals are suddenly met with a roadblock. And there … behind the pieces of shattered communication and a dampened map of ethical guidelines, health-care providers are at a standstill.

    It’s 4:37 a.m. You receive a text message from the overnight nurse at a care facility regarding a current seizure. After lorazepam is ordered and administered, Mr. H, a quick-witted 76-year-old, stabilizes. Phenobarbital 15mg SC qhs was also added to prevent future similar events. You exhale a sigh of relief.

    Mr. H. has been admitted to the floor 36 hours earlier after having a seizure while playing poker with colleagues. Since he became your patient, he’s shared many stories from professional and family life with you, along with as many jokes as he could fit in between. However, over the course of the next seven days, Mr. H. would develop aspiration pneumonia, progressing to ventilator dependency and, ultimately, multi-organ failure with rapid cognitive decline.

    What strategies and tools would you use to maximize the well-being of your patient during his decline? How would you bridge the gap of understanding between the patient’s family and health-care team to provide the standard of care that all patients are owed?

    To give Mr. H. the type of care he would have wanted, upon his hospital admission, he should have been questioned about his understanding of illness along with the goals of care of the medical team. The patient should have been informed that it is imperative to adhere to the medical regimen implemented by his team along with the risks of not doing so. In the event disease-related complications arose, advanced directives should have been documented to avoid any unnecessary measures.

    It is important to note, that with each change in status of the patient’s health status, the goal of treatment must be reassessed. The patient or surrogate decision-maker’s understanding of these goals is paramount in maintaining the patient’s autonomy. It is often said that effective communication is the bedrock of a healthy relationship. This is true regardless of type of relationship.

    This is why I and Megan Vierhout wrote Integrated End of Life Care in Dementia: A Comprehensive Guide, a book targeted at providing a much-needed road map to navigate the many challenges involved in end-of-life care for individuals with dementia. Ultimately, our aim is to provide a compass for both health-care professionals and the families of those affected by the progressive effects of dementia. We provide practical advice on optimizing communication with individuals with dementia while taking their cognitive limitations, preferences and needs into account.

    I invite you to explore the unpredictable terrain of end-of-life care for patients with dementia. Together, we can pave a smoother, sturdier path toward the practice of medicine as a true art form.

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

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  • Built to Move – by Kelly starrett & Juliet Starrett

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    In our everyday lives, for most of us anyway, it’s not too important to be able to run a marathon or leg-press a car. Rather more important, however, are such things as:

    • being able to get up from the floor comfortably
    • reach something on a high shelf without twinging a shoulder
    • being able to put our socks on without making a whole plan around this task
    • get accidentally knocked by an energetic dog or child and not put our back out
    • etc

    Starrett and Starrett, of “becoming a supple leopard” fame, lay out for us how to make sure our mobility stays great. And, if it’s not already where it needs to be, how to get there.

    The “ten essential habits” mentioned in the subtitle “ten essential habits to help you move freely and live fully”, in fact also come with ten tests. No, not in the sense of arduous trials, but rather, mobility tests.

    For each test, it’s explained to us how to score it out of ten (this is an objective assessment, not subjective). It’s then explained how to “level up” whatever score we got, with different advices for different levels of mobility or immobility. And if we got a ten, then of course, we just build the appropriate recommended habit into our daily life, to keep it that way.

    The writing style is casual throughout, and a strong point of the book is its very clear illustrations, too.

    Bottom line: if you’d like to gain/maintain good mobility (at any age), this book gives a very reliable outline for doing so.

    Click here to check out Built to Move, and take care of your body!

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  • How gender-affirming care improves trans mental health

    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.

    In recent years, a growing number of states have passed laws restricting or banning gender-affirming care for transgender people, particularly minors. As conversations about gender-affirming care increase, so do false narratives about it, with some opponents falsely suggesting that it’s harmful to mental health.

    Despite widespread attacks against gender-affirming care, research clearly shows that it improves mental health outcomes for transgender people.

    Read on to learn more about what gender-affirming care is, how it benefits mental well-being, and how you can access it.

    What is gender-affirming care?

    Gender-affirming care describes a range of medical interventions that help align people’s bodies with their gender identities. While anyone can seek gender-affirming care in the form of laser hair removal, breast augmentation, erectile dysfunction medication, or hormone therapy, among other treatments, most conversations about gender-affirming care center around transgender people, whose gender identity or gender expression does not conform to their sex assigned at birth.

    Gender-affirming care for trans people varies based on age. For example, some trans adults seek hormone replacement therapy (HRT) or gender-affirming surgeries that help their bodies match their internal sense of gender.

    Trans kids entering adolescence might be prescribed puberty blockers, which temporarily delay the production of hormones that initiate puberty, to give them more time to figure out their gender identities before deciding on next steps. This is the same medication given to cisgender kids—whose gender identities match the sex they were assigned at birth—experiencing early puberty.

    What is gender dysphoria?

    Gender dysphoria describes a feeling of unease that some trans people experience when their perceived gender doesn’t match their gender identity. This can lead to a range of mental health conditions that affect their quality of life

    Some trans people may manage gender dysphoria by wearing gender-affirming clothing, opting for a gender-affirming hairstyle, or asking others to refer to them by a name and pronouns that authentically represent them. Others may need gender-affirming care to feel at home in their bodies.

    Trans people who desire gender-affirming care and have not been able to access it experience psychological distress, including depression, anxiety, self-harm, and suicidal ideation. The Trevor Project’s 2023 U.S. National Survey on the Mental Health of LGBTQ Young People found that roughly half of trans youth “seriously considered attempting suicide in the past year.”

    A grid shows 10 drawings of people in black and white. Seven of the people are highlighted in purple squares. Text on the image reads,

    How does gender-affirming care improve mental health?

    For trans adults, gender-affirming care can alleviate gender dysphoria, which has been shown to improve both short-term and long-term mental health. A 2018 study found that trans adults who do not undergo HRT are four times more likely to experience depression than those who do, although not all trans people desire HRT.

    Extensive research has shown that gender-affirming care also alleviates gender dysphoria and improves mental health outcomes in trans kids, teens, and young adults. A 2022 study found that access to HRT and puberty blockers lowered the odds of depression in trans people between the ages of 13 and 20 by 60 percent and reduced the risk of self-harm and suicidal thoughts by 73 percent.

    Both the Endocrine Society—which aims to advance hormone research—and the American Academy of Pediatrics recommend that trans kids and teens have access to developmentally appropriate gender-affirming care.

    How can I access gender-affirming care?

    If you’re a trans adult seeking gender-affirming care or a guardian of a trans kid or teen who’s seeking gender-affirming care, talk to your health care provider about your options. You can find a trans-affirming provider by searching the World Professional Association for Transgender Health directory or visiting your local LGBTQ+ health center or Planned Parenthood.

    Some gender-affirming care may not be covered by insurance. Learn how to make the most of your coverage from the National Center for Transgender Equality. Find insurance plans available through the Marketplace that cover gender-affirming care in some states through Out2Enroll.

    Some states restrict or ban gender-affirming care. Learn about the laws in your state by visiting the Trans Legislation Tracker.

    Where can trans people and their families find mental health support?

    In addition to working with a trans-affirming therapist, trans people and their families can find mental health support through these free services:

    • PFLAG offers resources for families and friends of LGBTQ+ people. Find a PFLAG chapter near you.
    • The Trevor Project’s hotline has trained counselors who help LGBTQ+ youth in crisis. Call the TrevorLifeline 1-866-488-7386 or text START to 678-678.
    • The Trans Lifeline was created by and for the trans community to support trans people in crisis. You can reach the Trans Lifeline hotline at 1-877-565-8860.

    For more information, talk to your health care provider.

    If you or anyone you know is considering suicide or self-harm or is anxious, depressed, upset, or needs to talk, call the Suicide & Crisis Lifeline at 988 or text the Crisis Text Line at 741-741. For international resources, here is a good place to begin.

    This article first appeared on Public Good News and is republished here under a Creative Commons license.

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