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:

  1. Exploring and understanding the issue at hand
  2. Guiding and deciding importance and goals
  3. 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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  • As Nuns Disappear, Many Catholic Hospitals Look More Like Megacorporations

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    ST. LOUIS — Inside the more than 600 Catholic hospitals across the country, not a single nun can be found occupying a chief executive suite, according to the Catholic Health Association.

    Nuns founded and led those hospitals in a mission to treat sick and poor people, but some were also shrewd business leaders. Sister Irene Kraus, a former chief executive of Daughters of Charity National Health System, was famous for coining the phrase “no margin, no mission.” It means hospitals must succeed — generating enough revenue to exceed expenses — to fulfill their original mission.

    The Catholic Church still governs the care that can be delivered to millions in those hospitals each year, using religious directives to ban abortions and limit contraceptives, in vitro fertilization, and medical aid in dying.

    But over time, that focus on margins led the hospitals to transform into behemoths that operate for-profit subsidiaries and pay their executives millions, according to hospital tax filings. These institutions, some of which are for-profit companies, now look more like other megacorporations than like the charities for the destitute of yesteryear.

    The absence of nuns in the top roles raises the question, said M. Therese Lysaught, a Catholic moral theologist and professor at Loyola University Chicago: “What does it mean to be a Catholic hospital when the enterprise has been so deeply commodified?”

    The St. Louis area serves as the de facto capital of Catholic hospital systems. Three of the largest are headquartered here, along with the Catholic hospital lobbying arm. Catholicism is deeply rooted in the region’s culture. During Pope John Paul II’s only U.S. stop in 1999, he led Mass downtown in a packed stadium of more than 100,000 people.

    For a quarter century, Sister Mary Jean Ryan led SSM Health, one of those giant systems centered on St. Louis. Now retired, the 86-year-old said she was one of the last nuns in the nation to lead a Catholic hospital system.

    Ryan grew up Catholic in Wisconsin and joined a convent while in nursing school in the 1960s, surprising her family. She admired the nuns she worked alongside and felt they were living out a higher purpose.

    “They were very impressive,” she said. “Not that I necessarily liked all of them.”

    Indeed, the nuns running hospitals defied the simplistic image often ascribed to them, wrote John Fialka in his book “Sisters: Catholic Nuns and the Making of America.”

    “Their contributions to American culture are not small,” he wrote. “Ambitious women who had the skills and the stamina to build and run large institutions found the convent to be the first and, for a long time, the only outlet for their talents.”

    This was certainly true for Ryan, who climbed the ranks, working her way from nurse to chief executive of SSM Health, which today has hospitals in Illinois, Missouri, Oklahoma, and Wisconsin.

    The system was founded more than a century ago when five German nuns arrived in St. Louis with $5. Smallpox swept through the city and the Sisters of St. Mary walked the streets offering free care to the sick.

    Their early foray grew into one of the largest Catholic health systems in the country, with annual revenue exceeding $10 billion, according to its 2023 audited financial report. SSM Health treats patients in 23 hospitals and co-owns a for-profit pharmacy benefit manager, Navitus, that coordinates prescriptions for 14 million people.

    But Ryan, like many nuns in leadership roles in recent decades, found herself confronted with an existential crisis. As fewer women became nuns, she had to ensure the system’s future without them.

    When Ron Levy, who is Jewish, started at SSM as an administrator, he declined to lead a prayer in a meeting, Ryan recounted in her book, “On Becoming Exceptional.”

    “Ron, I’m not asking you to be Catholic,” she recalled telling him. “And I know you’ve only been here two weeks. So, if you’d like to make it three, I suggest you be prepared to pray the next time you’re asked.”

    Levy went on to serve SSM for more than 30 years — praying from then on, Ryan wrote.

    In Catholic hospitals, meetings are still likely to start with a prayer. Crucifixes often adorn buildings and patient rooms. Mission statements on the walls of SSM facilities remind patients: “We reveal the healing presence of God.”

    Above all else, the Catholic faith calls on its hospitals to treat everyone regardless of race, religion, or ability to pay, said Diarmuid Rooney, a vice president of the Catholic Health Association. No nuns run the trade group’s member hospitals, according to the lobbying group. But the mission that compelled the nuns is “what compels us now,” Rooney said. “It’s not just words on a wall.”

    The Catholic Health Association urges its hospitals to evaluate themselves every three years on whether they’re living up to Catholic teachings. It created a tool that weighs seven criteria, including how a hospital acts as an extension of the church and cares for poor and marginalized patients.

    “We’re not relying on hearsay that the Catholic identity is alive and well in our facilities and hospitals,” Rooney said. “We can actually see on a scale where they are at.”

    The association does not share the results with the public.

    At SSM Health, “our Catholic identity is deeply and structurally ingrained” even with no nun at the helm, spokesperson Patrick Kampert said. The system reports to two boards. One functions as a typical business board of directors while the other ensures the system abides by the rules of the Catholic Church. The church requires the majority of that nine-member board to be Catholic. Three nuns currently serve on it; one is the chair.

    Separately, SSM also is required to file an annual report with the Vatican detailing the ways, Kampert said, “we deepen our Catholic identity and further the healing ministry of Jesus.” SSM declined to provide copies of those reports.

    From a business perspective, though, it’s hard to distinguish a Catholic hospital system like SSM from a secular one, said Ruth Hollenbeck, a former Anthem insurance executive who retired in 2018 after negotiating Missouri hospital contracts. In the contracts, she said, the difference amounted to a single paragraph stating that Catholic hospitals wouldn’t do anything contrary to the church’s directives.

    To retain tax-exempt status under Internal Revenue Service rules, all nonprofit hospitals must provide a “benefit” to their communities such as free or reduced-price care for patients with low incomes. But the IRS provides a broad definition of what constitutes a community benefit, which gives hospitals wide latitude to justify not needing to pay taxes.

    On average, the nation’s nonprofit hospitals reported that 15.5% of their total annual expenses were for community benefits in 2020, the latest figure available from the American Hospital Association.

    SSM Health, including all of its subsidiaries, spent proportionately far less than the association’s average for individual hospitals, allocating roughly the same share of its annual expenses to community efforts over three years: 5.1% in 2020, 4.5% in 2021, and 4.9% in 2022, according to a KFF Health News analysis of its most recent publicly available IRS filings and audited financial statements.

    A separate analysis from the Lown Institute think tank placed five Catholic systems — including the St. Louis region’s Ascension — on its list of the 10 health systems with the largest “fair share” deficits, which means receiving more in tax breaks than what they spent on the community. And Lown said three St. Louis-area Catholic health systems — Ascension, SSM Health, and Mercy — had fair share deficits of $614 million, $235 million, and $92 million, respectively, in the 2021 fiscal year.

    Ascension, Mercy, and SSM disputed Lown’s methodology, arguing it doesn’t take into account the gap between the payments they receive for Medicaid patients and the cost of delivering their care. The IRS filings do.

    But, Kampert said, many of the benefits SSM provides aren’t reflected in its IRS filings either. The forms reflect “very simplistic calculations” and do not accurately represent the health system’s true impact on the community, he said.

    Today, SSM Health is led by longtime business executive Laura Kaiser. Her compensation in 2022 totaled $8.4 million, including deferred payments, according to its IRS filing. Kampert defended the amount as necessary “to retain and attract the most qualified” candidate.

    By contrast, SSM never paid Ryan a salary, giving instead an annual contribution to her convent of less than $2 million a year, according to some tax filings from her long tenure. “I didn’t join the convent to earn money,” Ryan said.

    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.

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

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  • Radishes vs Endives – Which is Healthier?

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    Our Verdict

    When comparing radishes to endives, we picked the endives.

    Why?

    These are both great, but there’s a clear winner here in every category!

    In terms of macros, radishes have more carbs while endives have more fiber and protein.

    In the category of vitamins, radishes have more of vitamins B6 and C, while endives have more of vitamins A, B1, B2, B4, B5, B7, B9, E, K, and choline.

    When it comes to minerals, things are not less one-sided: radishes have more selenium, while endives have more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, and zinc.

    You may be thinking: but what about radishes’ shiny red bit? Doesn’t that usually mean more of something important, like carotenoids or anthocyanins or something? And the answer is that the red pigment in radishes is so thinly-distributed on the exterior that it’s barely there and if we’re looking at values per 100g, it’s a tiny fraction of a tiny fraction.

    In both cases, their bitter taste comes mostly from flavonols, of which mostly kaempferol, of which endives have about 20x what radishes have, on average.

    All in all, an overwhelming win for endives.

    Want to learn more?

    You might like to read:

    Enjoy Bitter Foods For Your Heart & Brain

    Take care!

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  • The Emperor’s New Klotho, Or Something More?

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    Unzipping The Genes Of Aging?

    Klotho is an enzyme encoded in humans’ genes—specifically, in the KL gene.

    It’s found throughout all living parts of the human body (and can even circulate about in its hormonal form, or come to rest in its membranaceous form), and its subgroups are especially found:

    • α-klotho: in the brain
    • β-klotho: in the liver
    • γ-klotho: in the kidneys

    Great! Why do we care?

    Klotho, its varieties and variants, its presence or absence, are very important in aging.

    Almost every biological manifestation of aging in humans has some klotho-related indicator; usually the decrease or mutation of some kind of klotho.

    Which way around the cause and effect go has been the subject of much debate and research: do we get old because we don’t have enough klotho, or do we make less klotho because we’re getting old?

    Of course, everything has to be tested per variant and per system, so that can take a while (punctuated by research scientists begging for more grants to do the next one). Given that it’s about aging, testing in humans would take an incredibly long while, so most studies so far have been rodent studies.

    The general gist of the results of rodent studies is “reduced klotho hastens aging; increased klotho slows it”.

    (this can be known by artificially increasing or decreasing the level of klotho expression, again something easier in mice as it is harder to arrange transgenic humans for the studies)

    Here’s one example of many, of that vast set of rodent studies:

    Suppression of Aging in Mice by the Hormone Klotho

    Relevance for Alzheimer’s, and a science-based advice

    A few years ago (2020), an Alzheimer’s study was undertaken; they noted that the famous apolipoprotein E4 (apoE4) allele is the strongest genetic risk factor for Alzheimer’s, and that klotho may be another. FGF21 (secreted by the liver, mostly during fasting) binds to its own receptor (FGFR1) and its co-receptor β-klotho. Since this is a known neuroprotective factor, they wondered whether klotho itself may interact with β-amyloid (Aβ), and found:

    ❝Aβ can enhance the ability of klotho to draw FGF21 to regions of incipient neurodegeneration in AD❞

    ~ Dr. Lehrer & Dr. Rheinstein

    In other words: β-amyloid, the substance whose accumulation is associated with neurodegeneration in Alzheimer’s disease, is a mediator in klotho bringing a known neuroprotective factor, FGF21, to the areas of neurodegeneration

    In fewer words: klotho calls the firefighters to the scene of the fire

    Read more: Alignment of Alzheimer’s disease amyloid β-peptide and klotho

    The advice based on this? Consider practicing intermittent fasting, if that is viable for you, as it will give your liver more FGF21-secreting time, and the more FGF21, the more firefighters arrive when klotho sounds the alarm.

    See also: Intermittent Fasting: What’s the truth?

    …and while you’re at it:

    Does intermittent fasting have benefits for our brain?

    A more recent (2023) study with a slightly different (but connected) purpose, found results consistent with this:

    Longevity factor klotho enhances cognition in aged nonhuman primates

    …and, for that matter this (2023) study that found:

    Associations between klotho and telomere biology in high stress caregivers

    …which looks promising, but we’d like to see it repeated with a sounder method (they sorted caregiving into “high-stress” and “low-stress” depending on whether a child was diagnosed with ASD or not, which is by no means a reliable way of sorting this). They did ask for reported subjective stress levels, but to be more objective, we’d like to see clinical markers of stress (e.g. cortisol levels, blood pressure, heart rate changes, etc).

    A very recent (April 2024) study found that it has implications for more aspects of aging—and this time, in humans (but using a population-based cohort study, rather than lab conditions):

    The prognostic value of serum α-klotho in age-related diseases among the US population: A prospective population-based cohort study

    Can I get it as a supplement?

    Not with today’s technology and today’s paucity of clinical trials, you can’t. Maybe in the future!

    However… The presence of senescent (old, badly copied, stumbling and staggering onwards when they should have been killed and eaten and recycled already) cells actively reduces klotho levels, which means that taking supplements that are senolytic (i.e., that kill those senescent cells) can increase serum klotho levels:

    Orally-active, clinically-translatable senolytics restore α-Klotho in mice and humans

    Ok, what can I take for that?

    We wrote about a senolytic supplement that you might enjoy, recently:

    Fisetin: The Anti-Aging Assassin

    Want to know more?

    If you have the time, Dr. Peter Attia interviews Dr. Dena Dubal (researcher in several of the above studies) here:

    Click Here If The Embedded Video Doesn’t Load Automatically

    Enjoy!

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  • Bridging The Generation Gap Over The Holidays
  • CBD Oil’s Many Benefits

    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.

    CBD Oil: What Does The Science Say?

    CBD and THC are both derived from the hemp or cannabis plant, but only the latter has euphoriant psychoactive effects, i.e., will get you high. We’re writing here about CBD derived from hemp and not containing THC (thus, will not get you high).

    Laws and regulations differ far too much from place to place for us to try to advise here, so please check your own local laws and regulations. And also, while you’re at it, with your doctor and/or pharmacist.

    As ever, this newsletter is for purposes of education and enjoyment, and does not constitute any kind of legal (or medical) advice.

    With that in mind, onwards to today’s research review…

    CBD for Pain Relief

    CBD has been popularly touted as a pain relief panacea, and there are a lot of pop-science articles out there “debunking” this, but…

    The science seems to back it up. We couldn’t find studies refuting the claim (of CBD as a viable pain relief option). We did, however, find research showing it was good against:

    Note that that latter (itself a research review, not a single study, hence covering a lot of bases) describes it matter-of-factly, with no caveats or weasel-words, as:

    “CBD, a non-euphoriant, anti-inflammatory analgesic with CB1 receptor antagonist and endocannabinoid modulating effects”

    As a quick note: all of the above is about the topical use of CBD oil, not any kind of ingestion

    CBD for Anxiety/Depression

    There’s a well-cited study with what honestly we think was a bit of a small sample size, but compelling results within that:

    A study published in the Brazilian Journal of Psychiatry tested the anxiety levels of 57 men in a simulated public speaking test.

    Compared to placebo…

    • Those who received 300mg of CBD experienced significantly reduced anxiety during the test.
    • Those who received either 150mg or 600mg of CBD experienced more anxiety during the test than the 300mg group
    • This means there’s a sweet spot to the dosage

    There was also a clinical study that found CBD to have anti-depressant effects.

    The methodology was a lot more robust, but the subjects were mice. We can’t have everything in one study, apparently! There is probably a paucity of human volunteers to have their brain slices looked at after tests, though.

    Anyway, what makes this study interesting is that it measured quite an assortment of biological markers in the brain, and found that the CBD had a similar physiological effect to the antidepressant imipramine.

    CBD for Treating Opioid Addiction

    There are a lot of studies for this, both animal and human, but we’d like to put the spotlight on a human study (with the participation of heroin users) that found:

    ❝Within one week, CBD significantly reduced cravings, anxiety, resting heart rate, and salivary cortisol levels. No serious adverse effects were found.❞

    This is groundbreaking because the very thing about heroin is that it’s so addictive and the body rapidly needs more and more of it. You might think “duh”, but most people don’t realize this part:

    Heroin is attractive because it offers (and delivers) an immediate guaranteed “downer”, instant relaxation… with none of the bad side effects of, for example, alcohol. No nausea, no hangover, nothing.

    The problem is that the body gets tolerant to heroin very quickly, meaning your doses need to get bigger and more frequent to have the same effect.

    Before you know it, what seemed like an affordable “self-medication for a stressful life” is very much out of control! Many doctors have personally found this out the hard way.

    So, it’s ruinous:

    • first to your financial health, as the costs rapidly spiral
    • then to your physical health, as you either suffer from withdrawal or eventually overdose

    Consequently, heroin is an incredibly easy drug to get hooked onto, and incredibly difficult to get back off.

    So CBD offering relief is really a game-changer.

    Read it for yourself here!

    And more…

    CBD has been well-studied and found to be effective for a lot of things, more than we could hope to cover in a single edition here.

    Some further reading that may interest you includes:

    Let us know if there’s any of these (or other) conditions you’d like us to look more into the CBD-related research for, because there’s a lot! You can always hit reply to any of our emails, or use the feedback widget at the bottom

    Read (and shop, if you want and it’s permitted where you are):

    10 Best CBD Oils of 2023, According to the Forbes Health Advisory Board

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  • 5 Exercises That Fix 95% Of Your Problems

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    Well, your musculoskeletal problems, anyway! The exercises won’t, for example, do your taxes or deal with your loud neighbor for you. But, they will help your body be strong, supple, and pain-free:

    20 minutes total

    The exercises & what they do:

    • Dead hang: improves shoulder health, decompresses the spine, and strengthens grip. Hang from a bar for 20–30 seconds, progressing to 1–2 minutes.
    • Glute bridge: builds glute strength, improves core stability, and reduces lower back tension. Perform 2 sets of 10–15 reps, with variations like single-leg bridges or added weight.
    • Farmer’s walk: a full-body workout that strengthens the shoulders, core, and grip while improving posture. Walk with weights for 30–60 seconds, 3 rounds, increasing weight or duration over time.
    • Resting squat: enhances ankle, hip, and knee mobility, restoring natural functionality. Hold a deep squat for 20–30 seconds, progressing to 1–2 minutes. Use support for balance if necessary.
    • Thread the needle: improves flexibility, reduces tension, and enhances rotational mobility. Perform slow, controlled rotations from an all-fours position, 2 sets of 10 reps per side.

    Suggested 20-minute workout plan:

    1. Dead hang: 3 sets of 30 seconds
    2. Glute bridge: 2 sets of 10–15 reps
    3. Farmer’s walk: 30–60 seconds, 3 rounds
    4. Resting squat: hold for 20–30 seconds, 2–3 rounds
    5. Thread the needle: 2 sets of 10 reps per side

    It is recommended to perform this routine 3 times per week with 1-minute rests between sets.

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

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

    Want to learn more?

    You might also like:

    The Most Anti Aging Exercise

    Take care!

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  • Mediterranean Diet Book Suggestions

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    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

    ❝What is Mediterranean diet which book to read?❞

    We did a special edition about the Mediterranean Diet! So that’s a great starting point.

    As to books, there are so many, and we review books about it from time to time, so keep an eye out for our daily “One-Minute Book Review” section. We do highly recommend “How Not To Die”, which is a science-heavy approach to diet-based longevity, and essentially describes the Mediterranean Diet, with some tweaks.

    Don’t Forget…

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    Learn to Age Gracefully

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