The Keys to Good Mental Wellbeing

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The 10almonds Team

The Nine Keys To Good Mental Wellbeing

Today’s main feature is a bit “pop psychology”, but it has its underpinnings in actual psychology, and is especially useful if approached from that angle.

What it’s most popularly enjoyed as:

  • A personality-typing system.
  • People love little quizzes and identifiers and such.

What it’s actually really useful as:

  • A tool for understanding why people (including ourselves) are the way we are
  • A foundational knowledge for living better ourselves, and helping others too

This stems from the fairly simple principle, uncontroversial in psychology:

  • We have needs, desires, and aversions
  • We act in a way that tries to get our needs met and avoid suffering
  • Thus: Need/Fear → Motivation → Action

The Enneagram

The Enneagram (ἐννέα = “nine” in Ancient Greek) system posits that we each have one fundamental need/fear (from a list of nine) that’s strongest for us. A deep-seated insecurity/longing, that we’ll go to almost any lengths to try to meet. Sometimes, in good ways, sometimes, bad.

The Nine Basic Fears/Insecurities, And Their Corresponding Needs/Desires:

  1. Fear of being a fundamentally bad, wrong person / Need to be good and correct
  2. Fear of being fundamentally unloveable / Need to be loved
  3. Fear of being fundamentally worthless / Need to be valued
  4. Fear of being like everyone else / Need to be different
  5. Fear of being useless / Need to be useful
  6. Fear of being outcast / Need to have a set place in the group
  7. Fear of missing out / Need to experience things
  8. Fear of being hurt or controlled / Need to be in control
  9. Fear of conflict / Need to be at peace

Of course, most of us have most of these fears/needs to some extent, though usually one will stand out—especially if we aren’t managing it well. The less healthy our coping mechanisms, the more obvious it is how we’re trying to overcompensate in some fashion. For example:

  1. A person who fears being wrong and so becomes a perfectionist rules-abider to a fault
  2. A person who fears being unloveable, and so exaggerates problems to get pity, as the next best thing
  3. A person who fears being worthless, and so exaggerates their accomplishments in order to be admired and valued
  4. A person who fears being like everyone else, and so descends into a “nobody could ever possibly understand me” black hole of pathos.
  5. A person who fears being useless, so burns themself out trying to be an omnicompetent Leonardo da Vinci without ever actually taking the time to stop and smell the flowers as Leonardo did.
  6. A person who fears being outcast, so becomes clingy, passive-aggressive, and suspicious
  7. A person who fears missing out, so tries to experience all the things all the time, ruining their health with dizzying highs and crushing lows.
  8. A person who fears being hurt or controlled, so becomes aggressive and domineering
  9. A person who fears conflict, so shuts down at the slightest hint of it

If we have healthier coping mechanisms, these same nine people can look a lot different, but in much more subtle ways because we’re not trying to overcompensate so badly:

  1. A person who lives their life rationally by principles that can be adapted as they learn
  2. A person who loves and is loved, as perhaps the most notable part of their character
  3. A person who sets reasonable goals and accomplishes them, and seeks to uplift others
  4. A person who creates and innovates, enriching their own life and the lives of others
  5. A person who is simply very competent and knowledgeable, without overstretching
  6. A person who is dependable and loyal, and a reliable part of something bigger than themself
  7. A person who is fun to be around and loves trying new things, while also knowing how to relax
  8. A person who develops their leadership skills and is a tower of strength for others
  9. A person who knows how to make peace and does so—by themself, and with others

By being aware of our own fears/insecurities that may drive our motivations and thus underpin our behaviors, we can usually manage them in a much more mindful fashion. Same goes when it comes to managing interactions with other people, too:

  • Letting the Type 3 know you value them, not their accomplishments or what they can do for you.
  • Appreciating the Type 5’s (varied or specialist) skills and knowledge.
  • Giving love to a Type 2 unprompted, but on your own terms, with your own boundaries.
  • And so on for other types

Or for yourself…

  • As a Type 8, remembering that you can let go sometimes and let someone else be in charge.
  • As a Type 1, catching yourself holding yourself (or others) to impossible standards, and then easing up on that a little.
  • As a Type 9, remembering to stand up for yourself and others, however gently, but firmly.
  • And so on for other types

If you’re unsure what to focus on, ask yourself: what’s your worst nightmare or greatest daydream? Then work out what it is about that, that makes it feel so bad or good.

Then, approach things mindfully. Catch yourself in your unhealthy coping mechanisms, and find healthy ones instead.

What if I get my type wrong? Or I get someone else’s type wrong?

Obviously it’s better to get them right for maximum effect, but you can never go too far wrong anyway… because we all have all nine of those qualities in us, it’s just a matter of how strong a factor each is for us. So in the worst case scenario, you’ll make someone feel more secure about something that was only a very minor insecurity for them, for example.

Or in the case of your own type, you may mistakenly think you’re acing being the world’s healthiest Type 5, until you realize you’re actually a Type 3 who thought learning all those things would make you more worthy (spoiler: those things are great, but you’re worthy already). Again, not the end of the world! No matter what, you’re learning and growing, and that’s good.

Want to delve further?

Read: The Nine Enneagram Type Descriptions (Basic, but more detailed descriptions than the above)

Read: How The Enneagram System Works (More complex. Now we’re getting into the more arcane stuff we didn’t have time for today—wings and lines, triads, health levels, directions of integration and disintegration, and more)

Like learning from books? Here are our top two picks, depending on your learning style:

We’d love to offer a quick free test here, but all the tests we could find either require paid registration or are wildly inaccurate, so we’ll not waste your time.

However, we do also think that working it out for yourself is better, as it means you have a handle on what those ideas, fears, insecurities, desires, needs, really mean to you—that way you can actually use the information!

We’ll close by repeating our previous advice: If you’re unsure what to focus on, ask yourself: what’s your worst nightmare or greatest daydream? Then work out what it is about those scenarios that make them so bad or good. That’ll help you find your real fears/needs, such that you can work on them.

Good luck!

Don’t Forget…

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  • An apple cider vinegar drink a day? New study shows it might help weight loss

    Evangeline Mantzioris – University of South Australia

    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.

    Made from fermented apples and naturally high in acetic acid, apple cider vinegar has been popular in recent years for its purported health benefits – from antibacterial properties to antioxidant effects and potential for helping manage blood sugars.

    Its origins as a health tonic stretch much further back. Hippocrates used it to treat wounds, fever and skin sores.

    An experimental study, released today, looks into whether apple cider vinegar could be effective for weight loss, reduce blood glucose levels and reduce blood lipids (cholesterol and triglycerides).

    The results suggest it could reduce all three – but it might not be as simple as downing an apple cider vinegar drink a day.

    What did they do?

    A group of scientists in Lebanon did a double-blinded, randomised, clinical trial in a group of overweight and obese young people aged from 12–25 years.

    Researchers randomly placed 30 participants in one of four groups. The participants were instructed to consume either 5, 10 or 15ml of apple cider vinegar diluted into 250ml of water each morning before they ate anything for 12 weeks. A control group consumed an inactive drink (a placebo) made (from lactic acid added to water) to look and taste the same.

    Typically this sort of study provides high quality evidence as it can show cause and effect – that is the intervention (apple cider vinegar in this case) leads to a certain outcome. The study was also double-blinded, which means neither the participants or the scientists involved with collecting the data knew who was in which group.

    So, what did they find?

    After a period of three months apple cider vinegar consumption was linked with significant falls in body weight and body mass index (BMI). On average, those who drank apple cider vinegar during that period lost 6–8kg in weight and reduced their BMI by 2.7–3 points, depending on the dose. They also showed significant decreases in the waist and hip circumference.

    The authors also report significant decreases in levels of blood glucose, triglycerides, and cholesterol in the apple cider groups. This finding echoes previous studies. The placebo group, who were given water with lactic acid, had much smaller decreases in weight and BMI. There were also no significant decreases in blood glucose and blood lipids.

    From animal studies, it is thought the acetic acid in apple cider vinegar may affect the expression of genes involved in burning fats for energy. The new study did not explore whether this mechanism was involved in any weight loss.

    Is this good news?

    While the study appears promising, there are also reasons for caution.

    Firstly, study participants were aged from 12 to 25, so we can’t say whether the results could apply to everyone.

    The statistical methods used in the study don’t allow us to confidently say the same amount of weight loss would occur again if the study was done again.

    And while the researchers kept records of the participants’ diet and exercise during the study, these were not published in the paper. This makes it difficult to determine if diet or exercise may have had an impact. We don’t know whether participants changed the amount they ate or the types of food they ate, or whether they changed their exercise levels.

    The study used a placebo which they tried to make identical in appearance and taste to the active treatment. But people may still be able to determine differences. Researchers may ask participants at the end of a study to guess which group they were in to test the integrity of the placebo. Unfortunately this was not done in this study, so we can’t be certain if the participants knew or not.

    Finally, the authors do not report whether anyone dropped out of the study. This could be important and influence results if people who did not lose weight quit due to lack of motivation.

    open glass of liquid with cloudy substance at bottom, surrounded by apples
    Is that you mother? The enzymes in apple cider vinegar might be health-giving.
    Shutterstock

    Any other concerns?

    Apple cider vinegar is acidic and there are concerns it may erode tooth enamel. This can be a problem with any acidic beverages, including fizzy drinks, lemon water and orange juice.

    To minimise the risk of acid erosion some dentists recommend the following after drinking acidic drinks:

    • rinsing out your mouth with tap water afterwards
    • chewing sugar-free gum afterwards to stimulate saliva production
    • avoiding brushing your teeth immediately after drinking because it might damage the teeth’s softened top layer
    • drink with a straw to minimise contact with the teeth.
    woman holds glass of water and has full cheeks
    Rinsing with water could prevent acid damaging your teeth.
    Shutterstock

    Down the hatch?

    This study provides us with some evidence of a link between apple cider vinegar and weight loss. But before health professionals can recommend this as a weight loss strategy we need bigger and better conducted studies across a wider age range.

    Such research would need to be done alongside a controlled background diet and exercise across all the participants. This would provide more robust evidence that apple cider vinegar could be a useful aid for weight loss.

    Still, if you don’t mind the taste of apple cider vinegar then you could try drinking some for weight loss, alongside a healthy balanced and varied dietary intake. This study does not suggest people can eat whatever they like and drink apple cider vinegar as a way to control weight. The Conversation

    Evangeline Mantzioris, Program Director of Nutrition and Food Sciences, Accredited Practising Dietitian, University of South Australia

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

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  • Mythbusting Moldy Food

    The 10almonds Team

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Most Food Should Not Be Fuzzy

    In yesterday’s newsletter, we asked you for your policy when it comes to mold on food (aside from intentional mold, e.g. blue cheese etc), and the responses were interesting:

    • About 49% said “throw the whole thing away no matter what it is; it is dangerous”
    • About 24% said “cut the mold off and eat the rest of whatever it is”
    • The remainder were divided equally between “eat it all; keep the immune system on its toes” and “cut the mold off bread, but moldy animal products are dangerous”

    So what does the science say?

    Some molds are safe to eat: True or False?

    True! We don’t think this is contentious so we’ll not spend much time on it, but just for the sake of being methodical: foods that are supposed to have mold on, including many kinds of cheese and even some kinds of cured meat (salami is an example; that powdery coating is mold).

    We could give a big list of safe and unsafe molds, but that would be a list of names and let’s face it, they don’t introduce themselves by name.

    However! The litmus test of “is it safe to eat” is:

    Did you acquire it with this mold already in place and exactly as expected and advertised?

    • If so, it is safe to eat (unless you have an allergy or such)
    • If not, it is almost certainly not safe to eat

    (more on why, later)

    The “sniff test” is a good way to tell if moldy food is bad: True or False?

    False. Very false. Because of how the sense of smell works.

    You may feel like smell is a way of knowing about something at a distance, but the only way you can smell something is if particles of it are physically connecting with your olfactory receptors inside you. Yes, that has unfortunate implications about bathroom smells, but for now, let’s keep our attention in the kitchen.

    If you sniff a moldy item of food, you will now have its mold spores inside your respiratory system. You absolutely do not want them there.

    If we cut off the mold, the rest is safe to eat: True or False?

    True or False, depending on what it is:

    • Hard vegetables (e.g carrots, cabbage), and hard cheeses (e.g. Gruyère, Gouda) – cut off with an inch margin, and it should be safe
    • Soft vegetables (e.g. tomatoes, and any vegetables that were hard but are now soft after cooking) – discard entirely; it is unsafe
    • Anything else – discard entirely; it is unsafe

    The reason for this is because in the case of the hard products mentioned, the mycelium roots of the mold cannot penetrate far.

    In the case of the soft products mentioned, the surface mold is “the tip of the iceberg”, and the mycelium roots, which you will not usually be able to see, will penetrate the rest of it.

    “Anything else” seems like quite a sweeping statement, but fruits, soft cheeses, yogurt, liquids, jams and jellies, cooked grains and pasta, meats, and yes, bread, are all things where the roots can penetrate deeply and easily. Regardless of you only being able to see a small amount, the whole thing is probably moldy.

    The USDA has a handy downloadable factsheet:

    Molds On Food: Are They Dangerous?

    Eating a little mold is good for the immune system: True or False?

    False, generally. There are of course countless types of mold, but not only are many of them pathogenic (mycotoxins), but also, a food that has mold will usually also have pathogenic bacteria along with the mold.

    See for example: Occurrence, Toxicity, and Analysis of Major Mycotoxins in Food

    Food poisoning will never make you healthier.

    But penicillin is safe to eat: True or False?

    False, and also penicillin is not the mold on your bread (or other foods).

    Penicillin, an antibiotic* molecule, is produced by some species of Penicillium sp., a mold. There are hundreds of known species of Penicillium sp., and most of them are toxic, usually in multiple ways. Take for example:

    Penicillium roqueforti PR toxin gene cluster characterization

    *it is also not healthy to consume antibiotics unless it is seriously necessary. Antibiotics will wipe out most of your gut’s “good bacteria”, leaving you vulnerable. People have died from C. diff infections for this reason. So obviously, if you really need to take antibiotics, take them as directed, but if not, don’t.

    See also: Four Ways Antibiotics Can Kill You

    One last thing…

    It may be that someone reading this is thinking “I’ve eaten plenty of mold, and I’m fine”. Or perhaps someone you tell about this will say that.

    But there are two reasons this logic is flawed:

    • Survivorship bias (like people who smoke and live to 102; we just didn’t hear from the 99.9% of people who smoke and die early)
    • Being unaware of illness is not being absent of illness. Anyone who’s had an alarming diagnosis of something that started a while ago will know this, of course. It’s also possible to be “low-level ill” often and get used to it as a baseline for health. It doesn’t mean it’s not harmful for you.

    Stay safe!

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  • Chickpeas vs Peas – Which is Healthier?

    The 10almonds Team

    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.

    Our Verdict

    When comparing chickpeas to peas, we picked the chickpeas.

    Why?

    Both are great! But…

    In terms of macros, chickpeas have more protein, fiber, and carbs, the ratio of which latter two also gives them the lower glycemic index. It’s worth noting that peas are not far behind chickpeas here, but by the numbers, it’s a win for chickpeas in this category.

    In the category of vitamins, chickpeas have more of vitamins B9, E, and choline, while peas have more of vitamins A, B1, B2, B3, B5, B6, C, and K. So, a win for peas this time!

    When it comes to minerals, however, chickpeas have more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc, while peas are not higher in any minerals.

    Adding up the sections gives a 2:1 victory for chickpeas, but by all means enjoy either or both; diversity is good!

    Want to learn more?

    You might like:

    Plant vs Animal Protein: Head to Head

    Enjoy!

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  • What is silicosis and what does research say about it?

    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.

    Naseem S. Miller – The Journalist's Resource

    Silicosis is a progressive, debilitating and sometimes fatal lung disease caused by breathing silica dust from cutting, drilling, chipping or grinding materials such as granite, sandstone, slate or artificial stone. The dust gets trapped in the lung tissue, causing inflammation, scarring and permanent damage.

    Silicosis is a job-related lung disease and has no cure. The disease mostly affects workers in construction, stone countertop fabrication, mining, and even those who sandblast and stonewash denim jeans to create a ‘worn out’ look.

    Silica is one of the most common minerals in nature. About 59% of the Earth’s crust is made of silica, found in quartz, granite, sandstone, slate and sand. Historically, people at the highest risk for the disease have worked in natural environments — mining, digging tunnels or doing quarry work. The disease was first documented by the Greek physician Hippocrates, who in 430 B.C. described breathing disorders in metal diggers.

    But in recent decades there’s been renewed attention to the disease due to its more rapid progression and severity among younger workers. Research has shown that the culprit is artificial stone mostly used for countertops for kitchens and bathrooms, which has a very high silica content.

    The new generation of coal miners is also at an increased risk of silicosis, in addition to black lung, because layers of coal have become thinner, forcing them to dig deeper into rock, as explained in a joint investigation by the Pittsburgh Post-Gazette and the Medill Investigative Lab at Northwestern University published on Dec. 4. CBS Sunday Morning also had a report on the same issue among West Virginia coal miners, aired as part of its Dec. 10 episode.

    Silicosis in modern industries

    Artificial, or engineered, stone used for countertops, also known as “quartz,” is formed from finely crushed rocks mixed with resin. Quartz is a natural mineral, but man-made products like many quartz countertops consist of not just quartz, but also resin, colors and other materials that are used to style and strengthen them.

    The silica content of artificial stone is about 90%, compared with the 3% silica content of natural marble and 30% silica content in granite stones, according to the authors of a 2019 systematic review published in the International Journal of Environmental Research and Public Health.

    The first reported case of silicosis associated with working with artificial stone was from Italy in 2010, according to a 2020 study published in Allergy. Since then, more studies have documented the growing number of cases among artificial stone workers, many of whom are from marginalized populations, such as immigrants.

    A July 2023 study published in JAMA Internal Medicine found that in California, the disease mainly occurred among young Latino immigrant men. The disease was severe in most men by the time they sought care.

    An August 2022 study, published in Occupational & Environmental Medicine, analyzing the Global Silicosis Registry, with workers in Israel, Spain, Australia and the U.S., found “a substantial emerging population of workers worldwide with severe and irreversible silica-associated diseases,” due to exposure from silica dust from engineered stone.

    Other modern occupations such as denim sandblasting, work on dental prostheses, manufacturing of electrical cables and working on jewelry and semi-precious stones also put workers at risk of silicosis.

    In the wake of modern-day silicosis cases, researchers have called for larger studies to better understand the disease and the discovery of effective treatments.

    In the U.S. about 2.3 million workers are exposed to silica dust on the job, according to the American Lung Association. Other estimates show approximately 10 million workers in India, 3.2 million in the European Union and 2 million in Brazil work with material containing silica.

    However, “the reporting system for occupational injuries and illnesses in the United States fails to capture many cases, leading to a poor understanding of silicosis incidence and prevalence,” writes Ryan F. Hoy, who has published extensively on the topic, in a June 2022 article in Respirology.

    A 2015 study in the Morbidity & Mortality Weekly Report found the annual number of silicosis deaths declined from 185 people in 1999 to 111 in 2013, but the decline appeared to have leveled off between 2010 and 2013, the authors write. Another 2015 study in MMWR, examining silicosis deaths between 2001 and 2010, found the death rate from silicosis was significantly higher among Black people compared with whites and other races. Men also have a significantly higher death rate from silicosis than women.

    The 2019 Global Burden of Disease Study estimates that more than 12,900 people worldwide die from silicosis each year.

    Silicosis has no cure, but it’s preventable when workers have access to proper respiratory protection and are educated on safe practices set by regulatory bodies such as the U.S. National Institute for Occupational Safety and Health. The European Network on Silica also has guidelines on handling and using materials containing silica. A March 2023 study published in Environmental Science and Pollution Research International finds that “education, training, and marketing strategies improve respirator use, while training and education motivate workers to use dust control measures.”

    Silicosis symptoms and treatment

    Symptoms of silicosis include cough, fatigue, shortness of breath and chest pain. There’s no specific test for silicosis. The first signs may show in an abnormal chest X-ray and a slowly developing cough, according to the American Lung Association.

    Silicosis symptoms don’t appear right away in most cases, usually taking several years to develop working with silica dust. However, studies indicate that symptoms of silicosis due to exposure to artificial stone appear quicker than exposure to natural silica sources, potentially due to the higher concentration of silica in artificial stone.

    There are three types of silicosis: acute (most commonly caused by working with artificial stone), accelerated and chronic, depending on the level of exposure to silica dust, according to the Centers for Disease Control and Prevention, which explains the severity of each type on its website.

    Complications from silicosis can include tuberculosis, lung cancer, chronic bronchitis, kidney disease and autoimmune disorders. In some cases, silicosis can cause severe scarring of the lung tissue, leading to a condition called progressive massive fibrosis, or PMF. Some patients may require a lung transplant.

    Lung damage from silicosis is irreversible, so treatment of silicosis is aimed at slowing down the disease and relieving its symptoms.

    In 1995, the World Health Organization called for the elimination of silicosis by 2030, but research studies and news stories show it remains a threat to many workers.

    Below, we have gathered several studies on the topic to help journalists bolster their reporting with academic research.

    Research roundup

    Artificial Stone Associated Silicosis: A Systematic Review
    Veruscka Leso, et al. International Journal of Environmental Research and Public Health, February 2019.

    This systematic review aims to verify the association between exposure to silica dust in artificial stone and the development of silicosis.

    Researchers narrowed down their selection from 75 papers to seven studies that met their inclusion criteria. The seven studies were from Australia, Israel and Spain. Most of the studies are observational and impede a definite association between exposure to silica while working with artificial stone and developing silicosis, the authors note.

    However, “the unusually high incidence of the disease that was reported over short periods of investigations, and the comparable occupational histories of affected workers, all being involved in the manufacture and manipulation of engineered stones, may indicate a cause-effect relationship of this type.”

    The review of studies reveals a lack of basic preventive measures such as lack of access to disposable masks; lack of information and training on the dangers of silica dust; and lack of periodic medical examinations, including a chest X-ray, among workers. There was limited environmental monitoring of dust levels at the workplace. Also, there was no dust suppression system, such as the use of water when polishing the stones, or effective ventilation. Machinery and tools weren’t properly set up and didn’t undergo routine checks, the authors write.

    The authors recommend environmental monitoring for assessing silica levels in the workplace and verifying the effectiveness of personal protections. They also recommend the health surveillance of workers exposed to silica dust.

    “Stakeholders, manufacturers, occupational risk prevention services, insurance companies for occupational accidents and diseases, business owners, occupational health physicians, general practitioners, and also employees should be engaged, not only in designing/planning processes and operational working environments, but also in assessing the global applicability of proactive preventive and protective measures to identify and control crystalline silica exposure, especially in new and unexpected exposure scenarios, the full extent of which cannot yet be accurately predicted,” they write.

    Silica-Related Diseases in the Modern World
    Ryan F. Hoy and Daniel C. Chambers. Allergy, November 2020.

    The study is a review of the mineralogy of silica, epidemiology, clinical and radiological features of the various forms of silicosis and other diseases associated with exposure to silica.

    The primary factor associated with the development of silicosis is the intensity and duration of cumulative exposure to silica dust. Most countries regulate silica dust occupational exposure limits, generally in the range of 0.05 mg/m3 to 0.1 mg/m3, although the risk of dust exposure to workers still remains high at those levels.

    The study provides a list of activities that could expose workers to silica dust. They include abrasive blasting of sand and sandstone; cement and brick manufacturing; mixing, glazing or sculpting of china, ceramic and pottery; construction involving bricklaying, concrete cutting, paving and demolition; sandblasting denim jeans; working with and polishing dental materials; mining and related milling; handling raw material during paint manufacturing; road and highway construction and repair; soap and cosmetic production; blasting and drilling tunnels; and waste incineration.

    “Despite the large number of workers in the construction sector, there have been few studies of [silica dust] exposure in this industry,” the authors note.

    Other than silicosis, conditions associated with silica exposure include sarcoidosis, an inflammatory disease that commonly affects the lungs and lymph nodes, autoimmune disease, lung cancer and pulmonary infections.

    “Recent outbreaks of silica-associated disease highlight the need for constant vigilance to identify and control new and well-established sources of silica exposure. While there are currently no effective treatments for silicosis, it is a completely preventable lung disease,” the authors write.

    A Systematic Review of the Effectiveness of Dust Control Measures Adopted to Reduce Workplace Exposure
    Frederick Anlimah, Vinod Gopaldasani, Catherine MacPhail and Brian Davies. Environmental Science and Pollution Research International, March 2023.

    This study provides an overview of various interventions and their effectiveness in preventing exposure to silica dust based on a review of 133 studies from 16 countries, including the U.S., Canada, China, India, Taiwan and Australia, and published between 2010 and 2020.

    These dust control measures range from simple work practices such as the use of respirators to more sophisticated technologies, such as water and air curtains and foam technology, the authors note.

    The review finds increasing research interest in dust reduction, mainly in China. But overall, regulatory influence remains inadequate in preventing miners’ exposure to silica dust.

    “Results from the review suggest that adopted interventions increase knowledge, awareness, and attitudes about respirator usage and generate positive perceptions about respirator usage while reducing misconceptions,” the authors write. “Interventions can increase the use, proper use, and frequency of use of respirators and the adoption readiness for dust controls but may not provide sustained motivation in workers for the continual use of dust controls or [personal protective equipment.]”

    Notes from the Field: Surveillance of Silicosis Using Electronic Case Reporting — California, December 2022–July 2023
    Jennifer Flattery, et al. Morbidity and Mortality Weekly Report, November 2023.

    This study examines the use of electronic case reporting to identify silicosis cases in California. Electronic case reporting, or eCR, is the automated, real-time exchange of case report information between electronic health records at health facilities at state and local public health agencies in the U.S. It is a joint effort between the Association of Public Health Laboratories, the Council of State and Territorial Epidemiologists, and the CDC. Currently, 208 health conditions can be reported using eCR. All 50 states and other U.S.-affiliated jurisdictions are connected to eCR. Once a public health agency receives a case report, it reaches out to the patient for contact tracing or other actions.

    From October 2022 to July 2023, the California Department of Public Health received initial silicosis case reports for 41 individuals. A review of medical records confirmed 19 cases and 16 probable cases. Six of the 41 cases were considered unlikely to be silicosis after a review of medical records.

    Notably, engineered stone countertop fabrication was a significant source of exposure, especially among Hispanic and Latino workers.

    At least seven of the 19 confirmed cases were associated with the fabrication of engineered stone — quartz — countertops. The 19 patients’ ages ranged from 33 to 51 and all were Hispanic or Latino. One patient died and two had both lungs replaced. One was evaluated for a lung transplant.

    The median age of the 35 patients with probable or confirmed silicosis was 65, ranging from 33 to 89 years, and 91% were men.

    “It is important that health care providers routinely ask patients about their work as an important determinant of health,” the authors write. “Being aware of the risks associated with work exposures, as well as the regulations, medical monitoring, and prevention strategies that address those risks can help guide patient care.”

    Additional research

    Understanding the Pathogenesis of Engineered Stone-Associated Silicosis: The Effect of Particle Chemistry on the Lung Cell Response
    Chandnee Ramkissoon, et al. Respirology, December 2023.

    Silicosis, Tuberculosis and Silica Exposure Among Artisanal and Small-Scale Miners: A Systematic Review and Modelling Paper
    Patrick Howlett, et al. PLOS Global Public Health, September 2023.

    Silicosis Among Immigrant Engineered Stone (Quartz) Countertop Fabrication Workers in California
    Jane C. Fazio, et al. JAMA Internal Medicine, July 2023.

    Silicosis and Tuberculosis: A Systematic Review and Meta-Analysis
    P. Jamshidi, et al. Pulmonology, June 2023.

    From Basic Research to Clinical Practice: Considerations for Treatment Drugs for Silicosis
    Rou Li, Huimin Kang and Shi Chen. International Journal of Molecular Science, May 2023.

    Silicosis After Short-Term Exposure
    J. Nowak-Pasternak, A. Lipińska-Ojrzanowska and B. Świątkowska. Occupational Medicine, January 2023.

    Occupational Silica Exposure and Dose-Response for Related Disorders—Silicosis, Pulmonary TB, AIDs and Renal Diseases: Results of a 15-Year Israeli Surveillance
    Rachel Raanan, et al. International Journal of Environmental Research and Public Health, November 2022.

    Demographic, Exposure and Clinical Characteristics in a Multinational Registry of Engineered Stone Workers with Silicosis
    Jeremy Tang Hua, et al. Occupational & Environmental Medicine, August 2022.

    Current Global Perspectives on Silicosis — Convergence of Old and Newly Emergent Hazards
    Ryan F. Hoy, et al. Respirology, March 2022.

    The Association Between Silica Exposure, Silicosis and Tuberculosis: A systematic Review and Metal-Analysis
    Rodney Ehrlich, Paula Akugizibwe, Nandi Siegfried and David Rees. BMC Public Health, May 2021.

    Silicosis, Progressive Massive Fibrosis and Silico-Tuberculosis Among Workers with Occupational Exposure to Silica Dusts in Sandstone Mines of Rajasthan State
    Subroto Nandi, Sarang Dhatrak, Kamalesh Sarkar. Journal of Family Medicine and Primary Care, February 2021.

    Artificial Stone Silicosis: Rapid Progression Following Exposure Cessation
    Antonio León-Jiménez, et al. Chest, September 2020.

    Silica-Associated Lung Disease: An Old-World Exposure in Modern Industries
    Hayley Barnes, Nicole S.L. Goh, Tracy L. Leong and Ryan Hoy. Respirology, September 2019.

    Australia Reports on Audit of Silicosis for Stonecutters
    Tony Kirby. The Lancet, March 2019.

    Artificial Stone-Associated Silicosis: A Rapidly Emerging Occupational Lung Disease
    Ryan F. Hoy, et al. Occupational & Environmental Medicine, December 2017.

    This article first appeared on The Journalist’s Resource and is republished here under a Creative Commons license.

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  • Led by RFK Jr., Conservatives Embrace Raw Milk. Regulators Say It’s Dangerous.

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    Stephanie Armour

    In summertime, cows wait under a canopy to be milked at Mark McAfee’s farm in Fresno, California. From his Cessna 210 Centurion propeller plane, the 63-year-old can view grazing lands of the dairy company he runs that produces products such as unpasteurized milk and cheese for almost 2,000 stores.

    Federal regulators say it’s risky business. Samples of raw milk can contain bird flu virus and other pathogens linked to kidney disease, miscarriages, and death.

    McAfee, founder and CEO of the Raw Farm, who also leads the Raw Milk Institute, says he plans to soon be in a position to change that message.

    Robert F. Kennedy Jr., the anti-vaccine activist President Donald Trump has tapped to run the Department of Health and Human Services, recruited McAfee to apply for a job as the FDA’s raw milk standards and policy adviser, McAfee said. McAfee has already written draft proposals for possible federal certification of raw dairy farms, he said.

    Virologists are alarmed. The Centers for Disease Control and Prevention recommends against unpasteurized dairy that hasn’t been heated to kill pathogens such as bird flu. Interstate raw milk sales for human consumption are banned by the FDA. A Trump administration that weakens the ban or extols raw milk, the scientists say, could lead to more foodborne illness. It could also, they say, raise the risk of the highly pathogenic H5N1 bird flu virus evolving to spread more efficiently, including between people, possibly fueling a pandemic.

    “If the FDA says raw milk is now legal and the CDC comes through and says it advises drinking raw milk, that’s a recipe for mass infection,” said Angela Rasmussen, a virologist and co-editor-in-chief of the medical journal Vaccine and an adjunct professor at Stony Brook University in New York.

    The raw milk controversy reflects the broader tensions President Donald Trump will confront when pursuing his second-administration agenda of rolling back regulations and injecting more consumer choice into health care.

    Many policies Kennedy has said he wants to revisit — from the fluoridation of tap water to nutrition guidance to childhood vaccine requirements — are backed by scientific research and were established to protect public health. Some physician groups and Democrats are gearing up to fight initiatives they say would put people at risk.

    Raw milk has gained a following among anti-regulatory conservatives who are part of a burgeoning health freedom movement.

    “The health freedom movement was adopted by the tea party, and conspiracy websites gave it momentum,” said Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, who has studied the history of the anti-vaccine movement.

    Once-fringe ideas are edging into the mainstream. Vaccine hesitancy is growing.

    Arkansas, Utah, and Kentucky are weighing legislation that would relax or end requirements for fluoride in public water. And 30 states now allow for the sale of raw milk in some form within their borders.

    While only an estimated 3% of the U.S. population consumes raw milk or cheese, efforts to try to restrict its sales have riled Republicans and provided grist for conservative podcasts.

    Many conservatives denounced last year’s execution of a search warrant when Pennsylvania agriculture officials and state troopers arrived at an organic farm tucked off a two-lane road on Jan. 4, 2024. State inspectors were investigating cases of two children sickened by E. coli bacteria and sales of raw dairy from the operation owned by Amish farmer Amos Miller, according to a complaint filed by the state’s agricultural department.

    Bundled in flannel shirts and winter jackets, the inspectors put orange stickers on products detaining them from sale, and they left toting product samples in large blue-and-white coolers, online videos show. The 2024 complaint against Miller alleged that he and his wife sold dairy products in violation of state law.

    The farm was well known to regulators. They say in the complaint that a Florida consumer died after being sickened in 2014 with listeria bacteria found in raw dairy from Miller’s farm. The FDA said a raw milk sample from the farm indicates it was the “likely source” of the infection, based on the complaint.

    Neither Miller’s farm nor his lawyer returned calls seeking comment.

    The Millers’ attorney filed a preliminary objection that said “shutting down Defendants would cause inequitable harm, exceed the authority of the agency, constitute an excessive fine as well as disparate, discriminatory punishment, and contravene every essential Constitutional protection and powers reserved to the people of Pennsylvania.”

    Regulators in Pennsylvania said in a press release they must protect the public, and especially children, from harm. “We cannot ignore the illnesses and further potential harm posed by distribution of these unregulated products,” the Pennsylvania agricultural department and attorney general said in a joint statement.

    Unpasteurized dairy products are responsible for almost all the estimated 761 illnesses and 22 hospitalizations in the U.S. that occur annually because of dairy-related illness, according to a study published in the June 2017 issue of Emerging Infectious Diseases.

    But conservatives say raiding an Amish farm is government overreach. They’re “harassing him and trying to make an example of him. Our government is really out of control,” Pennsylvania Republican Sen. Doug Mastriano said in a video he posted to Facebook.

    Videos show protesters at a February 2024 hearing on Miller’s case included Amish men dressed in black with straw hats and locals waving homemade signs with slogans such as “FDA Go Away.” A court in March issued a preliminary injunction that barred Miller from marketing and selling raw dairy products within the commonwealth pending appeal, but the order did not preclude sales of raw milk to customers out of state. The case is ongoing.

    With Kennedy, the raw milk debate is poised to go national. Kennedy wrote on X in October that the “FDA’s war on public health is about to end.” In the post, he pointed to the agency’s “aggressive suppression” of raw milk, as one example.

    McAfee is ready. He wants to see a national raw milk ordinance, similar to one that exists for pasteurized milk, that would set minimal national standards. Farmers could attain certification through training, continuing education, and on-site pathogen testing, with one standard for farms that sell to consumers and another for retail sales.

    The Trump administration didn’t return emails seeking comment.

    McAfee has detailed the system he developed to ensure his raw dairy products are safe. He confirmed the process for KFF Health News: cows with yellow-tagged ears graze on grass pastures and are cleansed in washing pens before milking. The raw dairy is held back from consumer sale until it’s been tested and found clear of pathogens.

    His raw dairy products, such as cheese and milk, are sold by a variety of stores, including health, organic, and natural grocery chains, according to the company website, as well as raw dairy pet products, which are not for human consumption.

    He said he doesn’t believe the raw milk he sells could contain or transmit viable bird flu virus. He also said he doesn’t believe regulators’ warnings about raw milk and the virus.

    “The pharmaceutical industry is trying to create a new pandemic from bird flu to get their stock back up,” said McAfee, who says he counts Kennedy as a customer. His view is not shared by leading virologists.

    In December, the state of California secured a voluntary recall of all his company’s raw milk and cream products due to possible bird flu contamination.

    Five indoor cats in the same household died or were euthanized in December after drinking raw milk from McAfee’s farm, and tests on four of the animals found they were infected with bird flu, according to the Los Angeles County Department of Health.

    In an unrelated case, Joseph Journell, 56, said three of his four indoor cats drank McAfee’s raw milk. Two fell sick and died, he said. His third cat, a large tabby rescue named Big Boy, temporarily lost the use of his hind legs and had to use a specialized wheelchair device, he said. Urine samples from Big Boy were positive for bird flu, according to a copy of the results from Cornell University and the U.S. Department of Agriculture.

    McAfee dismissed connections between the cats’ illnesses and his products, saying any potential bird flu virus would no longer be viable by the time his raw milk gets to stores. He also said he believes that any sick cats got bird flu from recalled pet food.

    Journell said he has hired a lawyer to try to recover his veterinary costs but remains a staunch proponent of raw milk.

    “Raw milk is good for you, just not if it has bird flu in it,” he said. “I do believe in its healing powers.”

    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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  • Statins: His & Hers?

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    The 10almonds Team

    The Hidden Complexities of Statins and Cardiovascular Disease (CVD)

    This is Dr. Barbara Roberts. She’s a cardiologist and the Director of the Women’s Cardiac Center at one of the Brown University Medical School teaching hospitals. She’s an Associate Clinical Professor of Medicine and takes care of patients, teaches medical students, and does clinical research. She specializes in gender-specific aspects of heart disease, and in heart disease prevention.

    We previously reviewed Dr. Barbara Roberts’ excellent book “The Truth About Statins: Risks and Alternatives to Cholesterol-Lowering Drugs”. It prompted some requests to do a main feature about Statins, so we’re doing it today. It’s under the auspices of “Expert Insights” as we’ll be drawing almost entirely from Dr. Roberts’ work.

    So, what are the risks of statins?

    According to Dr. Roberts, one of the biggest risks is not just drug side-effects or anything like that, but rather, what they simply won’t treat. This is because statins will lower LDL (bad) cholesterol levels, without necessarily treating the underlying cause.

    Imagine you got Covid, and it’s one of the earlier strains that’s more likely deadly than “merely” debilitating.

    You’re coughing and your throat feels like you gargled glass.

    Your doctor gives you a miracle cough medicine that stops your coughing and makes your throat feel much better.

    (Then a few weeks later, you die, because this did absolutely nothing for the underlying problem)

    You see the problem?

    Are there problematic side-effects too, though?

    There can be. But of course, all drugs can have side effects! So that’s not necessarily news, but what’s relevant here is the kind of track these side-effects can lead one down.

    For example, Dr. Roberts cites a case in which a woman’s LDL levels were high and she was prescribed simvastatin (Zocor), 20mg/day. Here’s what happened, in sequence:

    1. She started getting panic attacks. So, her doctor prescribed her sertraline (Zoloft) (a very common SSRI antidepressant) and when that didn’t fix it, paroxetine (Paxil). This didn’t work either… because the problem was not actually her mental health. The panic attacks got worse…
    2. Then, while exercising, she started noticing progressive arm and leg weakness. Her doctor finally took her off the simvastatin, and temporarily switched to ezetimibe (Zetia), a less powerful nonstatin drug that blocks cholesterol absorption, which change eased her arm and leg problem.
    3. As the Zetia was a stopgap measure, the doctor put her on atorvastatin (Lipitor). Now she got episodes of severe chest pressure, and a skyrocketing heart rate. She also got tremors and lost her body temperature regulation.
    4. So the doctor stopped the atorvastatin and tried rosovastatin (Crestor), on which she now suffered exhaustion (we’re not surprised, by this point) and muscle pains in her arms and chest.
    5. So the doctor stopped the rosovastatin and tried lovastatin (Mevacor), and now she had the same symptoms as before, plus light-headedness.
    6. So the doctor stopped the lovastatin and tried fluvastatin (Lescol). Same thing happened.
    7. So he stopped the fluvastatin and tried pravastatin (Pravachol), without improvement.
    8. So finally he took her off all these statins because the high LDL was less deleterious to her life than all these things.
    9. She did her own research, and went back to the doctor to ask for cholestyramine (Questran), which is a bile acid sequestrent and nothing to do with statins. She also asked for a long-acting niacin. In high doses, niacin (one of the B-vitamins) raises HDL (good) cholesterol, lowers LDL, and lowers tryglycerides.
    10. Her own non-statin self-prescription (with her doctor’s signature) worked, and she went back to her life, her work, and took up running.

    Quite a treatment journey! Want to know more about the option that actually worked?

    Read: Bile Acid Resins or Sequestrants

    What are the gender differences you/she mentioned?

    Actually mostly sex differences, since this appears to be hormonal (which means that if your hormones change, so will your risk). A lot of this is still pending more research—basically it’s a similar problem in heart disease to one we’ve previously talked about with regard to diabetes. Diabetes disproportionately affects black people, while diabetes research disproportionately focuses on white people.

    In this case, most heart disease research has focused on men, with women often not merely going unresearched, but also often undiagnosed and untreated until it’s too late. And the treatments, if prescribed? Assumed to be the same as for men.

    Dr. Roberts tells of how medicine is taught:

    ❝When I was in medical school, my professors took the “bikini approach” to women’s health: women’s health meant breasts and reproductive organs. Otherwise the prototypical patient was presented as a man.❞

    There has been some research done with statins and women, though! Just, still not a lot. But we do know for example that some statins can be especially useful for treating women’s atherosclerosis—with a 50% success rate, rather than 31% for men.

    For lowering LDL itself, however, it can work but is generally not so hot in women.

    Fun fact:

    In men:

    • High total cholesterol
    • High non-HDL cholesterol
    • High LDL cholesterol
    • Low HDL cholesterol

    …are all significantly associated with an increased risk of death from CVD.

    In women:

    …levels of LDL cholesterol even more than 190 were associated with only a small, statistically insignificant increased risk of dying from CVD.

    So…

    The fact that women derive less benefit from a medicine that mainly lowers LDL cholesterol, may be because elevated LDL cholesterol is less harmful to women than it is to men.

    And also: Treatment and Response to Statins: Gender-related Differences

    And for that matter: Women Versus Men: Is There Equal Benefit and Safety from Statins?*

    Definitely a case where Betteridge’s Law of Headlines applies!

    What should women do to avoid dying of CVD, then?

    First, quick reminder of our general disclaimer: we can’t give medical advice and nothing here comprises such. However… One particularly relevant thing we found illuminating in Dr. Roberts’ work was this observation:

    The metabolic syndrome is diagnosed if you have three (or more) out of five of the following:

    1. Abdominal obesity (waist >35″ if a woman or >40″ if a man)
    2. Fasting blood sugars of 100mg/dl or more
    3. Fasting triglycerides of 150mg/dl or more
    4. Blood pressure of 130/85 or higher
    5. HDL <50 if a woman or <40 if a man

    And yet… because these things can be addressed with exercise and a healthy diet, which neither pharmaceutical companies nor insurance companies have a particular stake in, there’s a lot of focus instead on LDL levels (since there are a flock of statins that can be sold be lower them)… Which, Dr. Roberts says, is not nearly as critical for women.

    So women end up getting prescribed statins that cause panic attacks and all those things we mentioned earlier… To lower our LDL, which isn’t nearly as big a factor as the other things.

    In summary:

    Statins do have their place, especially for men. They can, however, mask underlying problems that need treatment—which becomes counterproductive.

    When it comes to women, statins are—in broad terms—statistically not as good. They are a little more likely to be helpful specifically in cases of atherosclerosis, whereby they have a 50/50 chance of helping.

    For women in particular, it may be worthwhile looking into alternative non-statin drugs, and, for everyone: diet and exercise.

    Further reading: How Can I Safely Come Off Statins?

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