When You Know What You “Should” Do (But Knowing Isn’t The Problem)
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When knowing what to do isn’t the problem
Often, we know what we need to do. Sometimes, knowing isn’t the problem!
The topic today is going to be a technique used by therapeutic service providers to help people to enact positive changes in their lives.
While this is a necessarily dialectic practice (i.e., it involves a back-and-forth dialogue), it’s still perfectly possible to do it alone, and that’s what we’ll be focussing on in this main feature.
What is Motivational Interviewing?
❝Motivational interviewing (MI) is a technique that has been specifically developed to help motivate ambivalent patients to change their behavior.❞
Read in full: Motivational Interviewing: An Evidence-Based Approach for Use in Medical Practice
It’s mostly used for such things as helping people reduce or eliminate substance abuse, or manage their weight, or exercise more, things like that.
However, it can be employed for any endeavour that requires motivation and sustained willpower to carry it through.
Three Phases
Motivational Interviewing traditionally has three phases:
- Exploring and understanding the issue at hand
- Guiding and deciding importance and goals
- Choosing and setting an action plan
In self-practice, maybe you can already know and understand what it is that you want/need to change.
If not, consider asking yourself such questions as:
- What does a good day look like? What does a bad day look like?
- If things are not good now, when were they good? What changed?
- If everything were perfect now, what would that look like? How would you know?
Once you have a clear idea of where you want to be, the next thing to know is: how much do you want it? And how confident are you in attaining it?
This is a critical process:
- Give your answers numerically on a scale from 0 to 10
- Whatever your score, ask yourself why it’s not lower. For example, if you scored your motivation 4 and your confidence 2, what factors made your motivation not a lower number? What factors made your confidence not a lower number?
- In the unlikely event that you gave yourself a 0, ask whether you can really afford to scrap the goal. If you can’t, find something, anything, to bring it to at least a 1.
- After you’ve done that, then you can ask yourself the more obvious question of why your numbers aren’t higher. This will help you identify barriers to overcome.
Now you’re ready to choose what to focus on and how to do it. Don’t bite off more than you can chew; it’s fine to start low and work up. You should revisit this regularly, just like you would if you had a counsellor helping you.
Some things to ask yourself at this stage of the motivational self-interviewing:
- What’s a good SMART goal to get you started?
- What could stop you from achieving your goal?
- How could you overcome that challenge?
- What is your backup plan, if you have to scale back your goal for some reason?
A conceptual example: if your goal is to stick to a whole foods Mediterranean diet, but you are attending a wedding next week, then now is the time to decide in advance 1) what personal lines-in-the-sand you will or will not draw 2) what secondary, backup plan you will make to not go too far off track.
The same example in practice: wedding menus often offer meat/fish/vegetarian options, so you might choose the fish or vegetarian, and as for sugar and alcohol, you might limit yourself to “a small slice of wedding cake only; coffee/cheese option instead of dessert”, and “alcohol only for toasts”.
Giving yourself the permission well in advance for small (clearly defined and boundaried!) diversions from the plan, will stop you from falling into the trap of “well, since today’s a cheat-day now…”
Secret fourth stage
The secret here is to keep going back and reassessing at regular intervals. Set your own calendar; you might want to start out weekly and then move to monthly when you’re more strongly on-track.
For this reason, it’s good to keep a journal with your notes from your self-interview sessions, the scores you gave yourself, the goals and plans you set, etc.
When conducting your regular review, be sure to examine what worked for you, and what didn’t (and why). That way, you can practice trial-and-improvement as you go.
Want to learn more?
We only have so much room here, but there are lots of resources out there.
Here’s a high-quality page that:
- explains motivational interviewing in more depth than we have room for here
- offers a lot of free downloadable resource packs and the like
Check it out: Motivational Interviewing Theory & Resources
Enjoy!
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Keep Cellulite At Bay
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? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small 😎
❝Does anything actually get rid of cellulite? Nothing seems to❞
Let’s get the bad news over with in one go:
Nothing (that the scientific world currently knows of) can get rid of cellulite permanently, nor completely guard against it proactively. Which, given that it affects up to 98% of women to some degree, and often shows up not long after puberty (though it can appear at any time and often increases later in life), any pre-emptive health regime would need to be started as a child in any case.
As with many things that predominantly affect women, the world of medicine isn’t entirely sure what causes it, let alone how to effectively treat it.
Obviously hormones are implicated, namely estrogen.
Obviously adiposity is implicated, because one can’t have dimples in one’s fat if one doesn’t have enough fat to dimple.
Other hypothesized contributory factors include genetics, poor diet, inactivity, unhealthy lifestyle (in ways not previously mentioned, e.g. use of alcohol, tobacco, etc), accumulated toxins, and pregnancy.
Here’s an old paper (from 2004); today’s reviews say pretty much the same thing, but we love how succinctly (albeit, somewhat depressingly) this abstract states how little we know and how little we can do:
Cellulite: a review of its physiology and treatment
However, all is not lost!
There are some things that can affect how much cellulite we get, and there are some things that can reduce it, and even some things that can get rid of it completely—albeit temporarily.
First, a quick refresher on what it actually is, physiologically speaking: cellulite occurs when connective tissue bands pull the skin down in places, where fat tissue has been able to squeeze through. One of the reasons it is hypothesized women get this more than men is because our fat is not merely different in distribution and overall percentage, but also in how the fat cells stack up; we generally have have of a vertical stacking structure going on, while men generally have a more horizontal structure. This means that it can be easier for ours to get moved about differently, causing the connective tissue to pull on the skin unevenly in places.
With that in mind…
Prevention is, as we say, probably impossible if your body is running on estrogen. However, those contributory factors we mentioned above? Most of those are modifiable, including these things that it is hypothesized can reduce it:
Diet: as it seems to be worsened by inflammation (what isn’t?), an anti-inflammatory diet is recommended.
Exercise: there are three things here: 1) exercises to improve circulation and thus the body’s ability to sort things out by itself 2) HIIT exercise to reduce body fat percentage, if one has a high enough starting body fat percentage for that to be a healthy goal 3) mobility exercises, to ensure our connective tissues are the right amount of mobile.
Creams and lotions
These reduce the superficial appearance of cellulite, without actually treating the thing itself. Mostly they are caffeine-based, which when used topically increases blood flow and works as a local diuretic, reducing the water content of the fat cells, diminishing the appearance of the cellulite by making each fat cell physically smaller (while still containing the same amount of fat, and it’ll bounce back in size as soon as the body can restore osmotic balance).
Medical procedures
There are too many of these to discuss them all separately, but they all work on the principle of breaking up the tough bands of connective tissue to eliminate the dimpling of cellulite.
The methods they use vary from ultrasound to cryolipolysis to lasers to “vacuum-assisted precise tissue release”, which involves a suction pump and a multipronged robotic assembly with needles to administer anaesthetic as it goes and small blades to cut the connective tissues under the skin:
Tissue Stabilized–Guided Subcision for the Treatment of Cellulite
That last one definitely sounds like the least fun, but it’s also the only one that doesn’t take months to maybe see results.
Cellulite can and almost certainly will come back after all of these.
Home remedies
Aside from at-home versions of the above (not the robots with vacuum pumps and needles and microblades, hopefully, but for example homemade caffeine creams), and of course diet and exercise which can be considered “home remedies”, there are two more things worth mentioning:
Dry brushing: using a body brush to, as the name suggests, simply brush one’s skin. The “dry” aspect here is simply that it’s not done in the bath or shower; it’s done while dry. It can improve local circulation of blood and lymph, allowing for better detoxification and redistribution of needed bodily resources.
Here’s an example dry brushing body brush on Amazon; this writer has one and hates it, but I’ve also tried with other kinds of brush and hate them too, so it seems to be a me thing rather than a brush thing, and I have desisted in trying, now. Maybe you will like it better; many people do.
Self-massage: or massage by someone else, if that’s an option for you and you prefer. In this case, it works by a different mechanism than dry brushing; this time it’s working by the same principle as the medical techniques described in the previous section; it’s physically breaking down the toughened bits of connective tissue.
Here’s an example wooden massage roller on Amazon; this writer has one and loves it; it’s sooooooo good. I got it as a matter of general maintenance for my fascia, but it’s also very good if I get a muscular pain now and again. As for cellulite, I personally get just a little cellulite sometimes (in the backs of my thighs), and whenever I use this regularly, it goes away for at least a while.
A quick note in closing
Cellulite is normal for women and is not unhealthy. Much like gray hair for example, it’s something that can be increased by poor health, but the thing itself isn’t intrinsically unhealthy, and most of us get it to some degree at some point.
Nevertheless, aesthetic factors can also have a role to play in mental health, and we tend to feel best when we like the way our body looks. If for you that means wanting less/no cellulite, then the above are some ways towards that.
As a bonus, most of the nonmedical options are directly good for the physical health anyway, so doing them is of course good.
In particular that last one (the wooden massage roller), because that connective tissue we talked about? It matters for a lot more than just cellulite, and is heavily implicated in a lot of kinds of chronic pain, so it pays to keep it in good health:
Fascia: Why (And How) You Should Take Care Of Yours
(that article, also written by this same writer by the way, suggests a vibrating foam roller—those are very popular; I just really love my wooden one, and find it more effective)
Take care!
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Can You Gain Muscle & Lose Fat At The Same Time?
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small 😎
❝Is it possible to lose fat and gain muscle at the same time, or do we need to focus on one and then the other, and if so, which order is best?❞
Contrary to popular belief, you can do both simultaneously! However, it’s not as easy as doing just one or the other, which is why most bodybuilders, for example, have a “building phase” and a “cutting phase”.
The reason it’s difficult is because of the diet. Growing muscle doesn’t just take protein and micronutrients; it takes energy as well, which must come from carbohydrates and/or fats. Therefore, it is tricky to eat enough to build muscle and to fuel the workouts that are required to build the muscle (you can’t hit the gym in a state of rabbit starvation* and expect to perform well at your workout), while at the same time not eating enough carbs/fats to have any excess to store as fat.
*So-called because rabbit-meat is very lean, such that when during times of famine, European peasants tried to subsist off mostly rabbits, their health quickly plummeted for lack of energy. It’s also been called “salmon starvation”, apparently, for the same reason:
In French it’s called “Mal de caribou” (caribou sickness), by the way. But you get the idea: eat too much lean protein without enough carbs/fats, and woe shall befall.
So, if you want to do both at once, you need to be incredibly on top of your macros, and the bad news is, only you (or a coach working directly with you) can work out what precise macros requirements your body has, because it depends on your body and your activities.
The easier “half-way house”
We will get to the “building phase” and “cutting phase” of bodybuilders, but first, here’s an option that’s very worthy of consideration, and it is: forget about your weight and just focus on health while incidentally doing regular resistance exercises and HIIT.
What will happen if you do this (assuming a healthy balanced diet, nothing special and without counting anything, but we’re talking at least mostly whole-foods, and at least mostly plants; the Mediterranean diet is great for this, as it is for most things) is:
- The dietary approach described will gradually improve your metabolic health if it wasn’t already good. If it was already good, it’ll likely just maintain it, rather than improve it.
- The resistance exercises will, if engaged with seriously (it has to be difficult to do, or your muscles won’t have any reason to grow), gradually build muscle. This will be very gradual, because you’re not eating for bodybuilding, nor optimizing your general lifestyle for same. Historically many women have feared lifting weights because they don’t want to “look like a weightlifter”, but the kinds of bodies that word brings to mind are not the kind that happen by accident (especially for women, with our different hormones guiding our bodies to a different composition); it takes a lot of single-minded dedication to specifically optimize size gains, for a long time.
- The high-intensity interval training (HIIT) will more rapidly improve your metabolic health, and unlike most forms of exercise, it will actually result in a gradual reduction of fat, if you have superfluous fat to lose. This is because whereas most forms of cardio exercise increase the heartrate for a while but then have a corresponding metabolic slump afterwards to make up for it, HIIT confuses the heart (in a good way) which results in it having to grow stronger, and not doing any compensatory metabolic slump:
How To Do HIIT (Without Wrecking Your Body) ← as well as the “how to”, this also gives some of the science behind it, too
This will, thus, result in gradual gain of muscle and loss of fat—or if you take it easier with the exercise, then you can easily settle into just maintaining your body composition as it is, but that wasn’t the question today.
So, there you have it, that’s how to do both at once! Now, if you want more dramatic results, then more dramatic methods are called for:
What bodybuilders (mostly) do
Matters of genetic predisposition and commonplace use of steroids aside, here’s how bodybuilders get that “lots of muscle, no fat” figure:
- First, get into “moderate” shape if not already there.
- Bulk up: eat amounts of food that will seem unreasonable to a non-bodybuilder; eating 2x or even 3x the “recommended” daily calorie amount is common; focus is typically on getting adequate (for bodybuilding purposes) protein while also carb-loading for workouts and getting at least enough fats for fat-soluble vitamins to work. In the gym, focus on doing sets of very few reps with the heaviest weights one can safely lift, while doing minimal cardio, and also sleeping a lot (9–12hrs per day), which is essential because this is putting a huge strain on the body and it needs a chance to recover and rebuild.
- Cut down: maintain protein intake (to at least mostly maintain muscles) while keeping carbs and fats low, doing cardio work (HIIT is still ideal) and running a calorie deficit for a short while (there is no use in trying to maintain a long-term calorie deficit; your body will try to save you from starvation by storing any fat it can and slowing your metabolism).
Phases 2 and 3 are then cycled, alternating every month, or every 6 weeks, or every 2 months or so, depending on personal preferences and scheduling considerations (bodybuilders will often have competitions they are working towards, so they need to time things to be at the end of a cutting phase to look their “best” by bodybuilder standards).
Disclaimer: bodybuilding is complex, and can be ruinous to the health if practised inexpertly, because of its extreme nature. We don’t recommend serious bodybuilding per se in general, but if you are going to do it, please consult with a professional bodybuilding coach, and do not rely on a few paragraphs from us that are intended only to give the most basic overview of how bodybuilders can approach the “gain muscle, lose fat” problem.
Want to know more?
We’ve written on some related topics previously; here’s a three-part series:
- How To Lose Weight (Healthily!)
- How To Build Muscle (Healthily!)
- How To Gain Weight (Healthily!) ← this one’s specifically about gaining healthy levels of fat, for any who want/need that
And also:
Can We Do Fat Redistribution? ← yes we can, but there are caveats
Take care!
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The Kitchen Prescription – by Saliha Mahmood Ahmed
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One of the biggest challenges facing anyone learning to cook more healthily, is keeping it tasty. What to cook when your biggest comfort foods all contain things you “should” avoid?
Happily for us, Dr. Ahmed is here with a focus on comfort food that’s good for your gut health. It’s incidentally equally good for the heart and good against diabetes… but Dr. Ahmed is a gastroenterologist, so that’s where she’s coming from with these.
There’s a wide range of 101 recipes here, including many tagged vegetarian, vegan, and/or gluten-free, as appropriate.
While this is not a vegetarian cookbook, Dr. Ahmed does consider the key components of a good diet to be, in order of quantity that should be consumed:
- Fruits and vegetables
- Whole grains
- Legumes
- Pulses
- Nuts and seeds
…and as such, the recipes are mostly plant-based.
The recipes are from all around the world, and/but the ingredients are mostly things that are almost universal. In the event that something might be hard-to-get, she suggests an appropriate substitution.
The recipes are straightforward and clear, as well as being beautifully illustrated.
All in all, a fine addition to anyone’s kitchen!
Get your copy of The Kitchen Prescription from Amazon today!
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The Five Invitations – by Frank Ostaseski
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This book covers exactly what its subtitle promises, and encourages the reader to truly live life fully, something that Ostaseski believes cannot be done in ignorance of death.
Instead, he argues from his experience of decades working at a hospice, we must be mindful of death not only to appreciate life, but also to make the right decisions in life—which means responding well to what he calls, as per the title of this book, “the five invitations”.
We will not keep them a mystery; they are:
- Don’t wait; do the important things now
- Welcome everything; push away nothing
- Bring your whole self to the experience
- Find a place in the middle of things
- Cultivate a “don’t know” mind
Note, for example, that “do the important things now” requires knowing what is important. For example, ensuring a loved one knows how you feel about them, might be more important than scratching some item off a bucket list. And “push away nothing” does mean bad things too; rather, of course try to make life better rather than worse, but accept the lessons and learnings of the bad too, and see the beauty that can be found in contrast to it. Enjoying the fullness of life without getting lost in it; carrying consciousness through the highs and lows. And yes, approaching the unknown (which means not only death, but also the large majority of life) with open-minded curiosity and wonder.
The style of the book is narrative and personal, without feeling like a collection of anecdotes, but rather, taking the reader on a journey, prompting reflection and introspection along the way.
Bottom line: if you’d like to minimize the regrets you have in life, this book is a fine choice.
Click here to check out The Five Invitations, and answer with a “yes” to the call of life!
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Most People Who Start GLP-1 RAs Quit Them Within A Year (Here’s Why)
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Specifically, 54% quit within one year, with that number rising to 72% within two years.
We first wrote about GLP-1 receptor agonists (i.e. semaglutide drugs like Ozempic and Wegovy) a couple of years ago when popularity was just beginning to take off:
However, as we had room only to touch briefly on the side effects and what happens when you stop taking it, you might also want to check out:
What happens when I stop taking a drug like Ozempic or Mounjaro?
…and:
Notwithstanding all this information, there’s a lot of science that has still yet to be done. If you’re a regular 10almonds reader, you’ll be familiar with our research review articles—this one was more of a non-research review, i.e. looking at the great absence of evidence in certain areas, and the many cases of research simply not asking the right questions, for example:
❝Of the four studies that actually looked at the macros (unlike most studies), they found that on average, protein intake decreased by 17.1%. Which is a big deal!
It’s an especially big deal, because while protein’s obviously important for everyone, it’s especially important for anyone trying to lose weight, because muscle mass is a major factor in metabolic base rate—which in turn is much important for fat loss/maintenance than exercise, when it comes to how many calories we burn by simply existing.
A reasonable hypothesis, therefore, is that one of the numerous reasons people who quit GLP-1 agonists immediately put fat back on, is because they probably lost muscle mass in amongst their weight loss, meaning that their metabolic base rate will have decreased, meaning that they end up more disposed to put on fat than before.❞
Read in full: Semaglutide’s Surprisingly Unexamined Effects ← there are a lot more (equally concerning) items discussed in this article
Why people quit GLP-1 RAs
There was a large (n=125,474) study of US adults. The average age was about 54 years, and about 65% were female.
From the total data pool (i.e. not narrowing it down by demographic), 54% stopped within a year, and 72% within two years.
The factors most associated with discontinuation were:
- age above 65 years
- not having type 2 diabetes
The main reasons given for discontinuation were:
- High costs: self-explanatory, but it’s worth noting that people who stopped for this reason were more likely to restart later.
- Adverse side effects: the most common ones were nausea, vomiting, diarrhea, constipation, stomach pain, and loss of appetite. Rarer, but more seriously, side effects included: pancreatitis (severe abdominal pain, nausea, vomiting), gallbladder issues (gallstones, cholecystitis), kidney problems, severe allergic reactions (rash, swelling, difficulty breathing), hypoglycemia, especially if taken with insulin or other diabetes medications, changes in vision (worsening diabetic retinopathy), and an increased heart rate.
- Disappointingly little weight loss: the researchers noted that GLP-1 RA results are “heterogenous”, meaning, they differ a lot. For those for whom it didn’t work, quitting was more likely, for obvious reasons. See also: 10 Mistakes To Sabotage Your Ozempic Progress
- Successful weight loss: while it is widely known that if one stops taking GLP-1 RAs, weight regain is the usual next thing to happen, there are a lot of people who go onto GLP-1 RAs with the rationale “I’ll just use this to lose the weight, and then I’ll keep the weight off with my diet and lifestyle”. Which sounds reasonable, but because of the specific mechanisms of actions of GLP-1 RAs, it simply doesn’t work that way (and, as we mentioned above, there are reasons that you may, after stopping taking GLP-1 RAs, be more disposed to put weight on than you were before you started). So, by the best of current science (which admittedly is not amazing when it comes to this topic), it does seem that taking GLP-1 RAs is a lifetime commitment.
You can read the study itself here:
Want to get similar results, without GLP-1 RAs?
Then check out:
5 Ways To Naturally Boost The “Ozempic Effect” ← this is about natural ways of doing similar hormone-hacking to what GLP-1 RAs do
and
Ozempic vs Five Natural Supplements ← this is about metabolism-tweaking supplements
and
Hack Your Hunger ← this is about appetite management
Take care!
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Guava vs Passion Fruit – Which is Healthier?
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Our Verdict
When comparing guava to passion fruit, we picked the guava.
Why?
There aren’t many fruits that can beat passion fruit for nutritional density! And even in this case, it wasn’t completely so in every category:
In terms of macros, passion fruit has more carbs and fiber, the ratio of which give it the slightly lower glycemic index. Thus, a modest win for passion fruit in this category.
In the category of vitamins, guava has more of vitamins B1, B5, B6, B9, C, E, and K, while passion fruit has more of vitamins A, B2, and B3. A clear win for guava this time.
When it comes to minerals, it’s a little closer, but: guava has more calcium, copper, manganese, potassium, and zinc, while passion fruit has more iron, magnesium, and phosphorus. So, another win for guava.
Adding up the sections makes for guava winning the day, but by all means enjoy either or both; diversity is good!
Want to learn more?
You might like to read:
Fruit Is Healthy; Juice Isn’t (Here’s Why)
Enjoy!
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Learn to Age Gracefully
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