Occasional Drinking? 3x Risk Of Liver Scarring
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Fun thought for the day in 3 parts:
- “Occasional drinking” is often seen as healthy
- Binge-drinking often comes in the form of “occasional drinking”
- The Threshold For Binge-Drinking Is Lower Than Most Think
…and as we wrote in the above-linked article:
The term “binge-drinking” typically conjures images of people in the 18–22 age range (general figure; if we get geographic about it, then perhaps 21–25 in the US, or 15–21 in Europe) swinging around lampposts while very drunk, very loud, minimally-clothed, and liable to waking up somewhere new and exciting that they’ve never seen before.
But in fact, while definitions do vary a bit, a prevailing and representative scientific definition is:
❝consuming four or more standard drinks on one occasion for women and five or more standard drinks on one occasion for men❞
Learn more: Heterogeneity of definitions and measurements of binge drinking in research on adolescents and young adults
Now, that paper’s looking at research on adolescents and younger adults because that’s where most of the research is, but it doesn’t mean older adults are magically immune—quite the opposite!
One other quick thing…
Note that that “four standard drinks” is often only two drinks where each drink is a “double measure”, such as a double-shot of spirits or a large glass of wine.
This gets particularly relevant for those who “only drink on special occasions”, but then have several drinks.
Here’s a good example of that: You’d Better Watch Out: Why More Cardiac Deaths Happen On Dec 25 Than Any Other Day
So what’s this about liver scarring?
“Alcohol is bad for your liver” is something most people know, but often the actual mechanism at hand can remain a mystery. So, let’s demystify it a bit:
The liver is a remarkably self-regenerating organ; we wrote about it here: How To Unfatty A Fatty Liver
…but there’s more to it than that. Liver tissue is remarkably regenerative (cut away 49% of an otherwise healthy liver, and it’ll just regrow itself), but large alcohol doses (again, by the above definitions, not just by what most people think are large doses) at once can overwhelm your liver, increasing inflammation and accelerating fibrosis (scarring), particularly in already metabolically stressed livers.
Scar tissue is different from regular tissue in its structure and composition, and the same is true for scarred liver tissue, and that makes a difference, greatly reducing, if not outright halting, its regenerative ability.
Recent research (linked below) has found that even once-a-month binge-drinking (≥4 drinks for women or ≥5 for men in one day) was linked to a 3× higher risk of advanced liver fibrosis in people with metabolic dysfunction–associated steatotic liver disease (MASLD)*
*Formerly known as Non-Alcoholic Fatty Liver Disease (NAFLD), now it’s MASLD instead. Attentive readers may have noticed that there appears to be a D missing from the new acronym. We noticed that too, and were not able to find any explanation of why it’s not MDASLD However, you can read about why the change was made, and how the decision was agreed upon, here: A multisociety Delphi consensus statement on new fatty liver disease nomenclature
In any case, about 1 in 3 adults have MASLD, and over half of adults reported episodic heavy drinking.
This is a problem, because many guidelines focus on total weekly alcohol, but this study shows how you drink matters as much as how much you drink, with large single-session intake posing greater risk than spreading drinks out; indeed, in this case, people consuming the same total alcohol per week had worse liver outcomes when intake was concentrated into sessions of 4+ drinks.
You can find the paper itself, here: Episodic Heavy Drinking and Implications for Steatotic Liver Disease Nomenclature: A National Cross-Sectional Study
What to do about it?
First of all, know that it’s not too late:
What Happens To Your Body When You Stop Drinking Alcohol ← a realistic timeline of recovery
If you’d like to give your liver a helping hand, consider:
N-Acetyl Cysteine For The Liver & More
Take care!
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Do Try This At Home: The 12-Week Brain Fitness Program
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12 Weeks To Measurably Boost Your Brain
This is Dr. Majid Fotuhi. From humble beginnings (being smuggled out of Iran in 1980 to avoid death in the war), he went on (after teaching himself English, French, and German, hedging his bets as he didn’t know for sure where life would lead him) to get his MD from Harvard Medical School and his PhD in neuroscience from Johns Hopkins University. Since then, he’s had a decades-long illustrious career in neurology and neurophysiology.
What does he want us to know?
The Brain Fitness Program
This is not, by the way, something he’s selling. Rather, it was a landmark 12-week study in which 127 people aged 60–80, of which 63% female, all with a diagnosis of mild cognitive impairment, underwent an interventional trial—in other words, a 12-week brain fitness course.
After it, 84% of the participants showed statistically significant improvements in cognitive function.
Not only that, but of those who underwent MRI testing before and after (not possible for everyone due to practical limitations), 71% showed either no further deterioration of the hippocampus, or actual growth above the baseline volume of the hippocampus (that’s good, and it means functionally the memory center of the brain has been rejuvenated).
You can read a little more about the study here:
As for what the program consisted of, and what Dr. Fotuhi thus recommends for everyone…
Cognitive stimulation
This is critical, so we’re going to spend most time on this one—the others we can give just a quick note and a pointer.
In the study this came in several forms and had the benefit of neurofeedback technology, but he says we can replicate most of the effects by simply doing something cognitively stimulating. Whatever challenges your brain is good, but for maximum effect, it should involve the language faculties of the brain, since these are what tend to get hit most by age-related cognitive decline, and are also what tends to have the biggest impact on life when lost.
If you lose your keys, that’s an inconvenience, but if you can’t communicate what is distressing you, or understand what someone is explaining to you, that’s many times worse—and that kind of thing is a common reality for many people with dementia.
To keep the lights brightly lit in that part of the brain: language-learning is good, at whatever level suits you personally. In other words: there’s a difference between entry-level Duolingo Spanish, and critically analysing Rumi’s poetry in the original Persian, so go with whatever is challenging and/but accessible for you—just like you wouldn’t go to the gym for the first time and try to deadlift 500lbs, but you also probably wouldn’t do curls with the same 1lb weights every day for 10 years.
In other words: progressive overloading is key, for the brain as well as for muscles. Start easy, but if you’re breezing through everything, it’s time to step it up.
If for some reason you’re really set against the idea of learning another language, though, check out:
Reading As A Cognitive Exercise ← there are specific tips here for ensuring your reading is (and remains) cognitively beneficial
Mediterranean diet
Shocking nobody, this is once again recommended. You might like to check out the brain-healthy “MIND” tweak to it, here:
Four Ways To Upgrade The Mediterranean Diet ← it’s the fourth one
Omega-3 supplementation
Nothing complicated here. The brain needs a healthy balance of these fatty acids to function properly, and most people have an incorrect balance (too little omega-3 for the omega-6 present):
What Omega-3 Fatty Acids Really Do For Us ← scroll to “against cognitive decline”
Increasing fitness
There’s a good rule of thumb: what’s healthy for your heart, is healthy for your brain. This is because, like every other organ in your body, the brain does not function well without good circulation bringing plenty of oxygen and nutrients, which means good cardiovascular health is necessary. The brain is extra sensitive to this because it’s a demanding organ in terms of how much stuff it needs delivering via blood, and also because of the (necessary; we’d die quickly and horribly without it) impediment of the blood-brain barrier, and the possibility of beta-amyloid plaques and similar woes (they will build up if circulation isn’t good).
How To Reduce Your Alzheimer’s Risk ← number two on the list here
Practising mindfulness medication
This is also straightforward, but not to be underestimated or skipped over:
No-Frills, Evidence-Based Mindfulness
Want to step it up? Check out:
Meditation Games That You’ll Actually Enjoy
Lastly…
Dr. Fotuhi wants us to consider looking after our brain the same way we look after our teeth. No, he doesn’t want us to brush our brain, but he does want us to take small measurable actions multiple times per day, every day.
You can’t just spend the day doing nothing but brushing your teeth for the entirety of January the 1st and then expect them to be healthy for the rest of the year; it doesn’t work like that—and it doesn’t work like that for the brain, either.
So, make the habits, and keep them going
Take care!
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Living a Healthy Life with Chronic Conditions – by Dr. Kate Lorig et al.
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The “et al.” here is a collection of other medical professionals, and indeed the first edition of this book was based on a 5-year study they did. Since then, it’s grown as a collaborative endeavour between the listed authors and colleagues in their field who didn’t make the author list on the front cover, but did contribute research, feedback, additions, etc. This has been so comprehensive that one could argue that in essence, this whole book itself has been as-though peer-reviewed by the extent of the professional collaboration.
The authors make the case that while a lot of people are in the happy position of considering “chronic conditions” to be something suffered by other people, most of us—even most of the healthiest of us—will acquire at least one in our lifetime.
You may be wondering how the book addresses the incredible heterogeneity of chronic conditions; surely there is no one-size-fits-all advice for sufferers of things as diverse as diabetes and lupus and long COVID and osteoporosis and depression.
And the answer is that while there are sections for condition-specific advice, a lot of the book takes a “different conditions, similar symptoms” approach that notes that, in fact, self-managing these symptoms typically is an endeavor in which we find more commonalities than differences.
Nor is it your average industry professional book of “get some exercise, eat more plants, do some meditation”. Because yes, those things are good (and the book does cover them too), but that’s a little basic and is more a fair topic for a leaflet than a 418*-page tome. Instead, this book goes far beyond that, covering everything from self-advocacy in healthcare settings, to sex positions (in fact there is a whole chapter about sex and intimacy, including dealing with symptoms that occur during sex, and other ways that chronic conditions can change sex, and what can be done about that in practical terms).
*The Amazon listing currently says 344 pages, but this reviewer is distinctly looking at page 418 here, so perhaps the 344-page count got copied and pasted from a listing of an older edition.
There are also whole chapters about managing medications actively (i.e. not just doing whatever you are told without question, but actually being able to understand and make more decisions for yourself), pain management of course, the broad topic of safety and freedom (reducing the limits placed on one’s life and what one can do, where one can go, etc, and doing so safely) and so much more.
The style is highly-polished high-quality science education. It’s neither dumbed-down pop-science nor inaccessible academia. It’s clear and easy to read, and incredibly informative.
Bottom line: if you or a loved one has a chronic health condition, we recommend getting a copy of this.
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Dial Down Your Pain
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This is Dr. Christiane Wolf. Is than an MD or a PhD, you ask? The answer is: yes (it is both; the latter being in psychosomatic medicine).
She also teaches Mindfulness-Based Stress Reduction, which as you may recall is pretty much the most well-evidenced* form of meditation there is, in terms of benefits:
No-Frills, Evidence-Based Mindfulness
*which is not to claim it is necessarily the best (although it also could be); rather, this means that it is the form of meditation that’s accumulated the most scientific backing in total. If another equal or better form of meditation enjoyed less scientific scrutiny, then there could an alternative out there languishing with only two and a half scientific papers to its name. However, we at 10almonds are not research scientists, and thus can only comment on the body of evidence that has been published.
In any case, today is going to be about pain.
What does she want us to know?
Your mind does matter
It’s easy to think that anything you can do with your mind is going to be quite small comfort when your nerves feel like they’re on fire.
However, Dr. Wolf makes the case for pain consisting of three components:
- the physical sensation(s)
- the emotions we have about those
- the meaning we give to such (or “the story” that we use to describe it)
To clarify, let’s give an example:
- the physical sensations of burning, searing, and occasionally stabbing pains in the lower back
- the emotions of anguish, anger, despair, self-pity
- the story of “this pain has ruined my life, is making it unbearable, will almost certainly continue, and may get worse”
We are not going to tell you to throw any of those out of the window for now (and, would that you could throw the first line out, of course).
The first thing Dr. Wolf wants us to do to make this more manageable is to break it down.
Because presently, all three of those things are lumped together in a single box labelled “pain”.
If each of those items is at a “10” on the scale of pain, then this is 10×10×10=1000.
If our pain is at 1000/10, that’s a lot. We want to leave the pain in the box, not look at it, and try to distract ourselves. That is one possible strategy, by the way, and it’s not always bad when it comes to giving oneself a short-term reprieve. We balanced it against meditation, here:
Managing Chronic Pain (Realistically)
However, back to the box analogy, if we open that box and take out each of those items to examine them, then even without changing anything, even with them all still at 10, they can each be managed for what they are individually, so it’s now 10+10+10=30.
If our pain is at 30/10, that’s still a lot, but it’s a lot more manageable than 1000/10.
On rating pain, by the way, see:
Get The Right Help For Your Pain
Dealing with the separate parts
It would be nice, of course, for each of those separate parts to not be at 10.
With regard to the physical side of pain, this is not Dr. Wolf’s specialty, but we have some good resources here at 10almonds:
- The 7 Approaches To Pain Management
- 10 Tips To Reduce Morning Pain & Stiffness With Arthritis
- Science-Based Alternative Pain Relief: When Painkillers Aren’t Helping, These Things Might
When it comes to emotions associated with pain, Dr. Wolf (who incidentally is a Buddhist and also a teacher of same, and runs meditation retreats for such), recommends (of course) mindfulness, and what in Dialectical Behavior Therapy (DBT) is called “radical acceptance” (in Buddhism, it may be referred to as being at one with things). We’ve written about this here:
“Hello, Emotions”: Radical Acceptance In CBT & DBT
Once again, the aim here is still not to throw the (often perfectly valid) emotions out of the window (unless you want to), but rather, to neutrally note and acknowledge the emotions as they arrive, á la “Hello, despair. Depression, my old foe, we meet again. Hello again, resentment.” …and so on.
The reason this helps is because emotions, much like the physical sensations of pain, are first and foremost messengers, and sometimes (as in the case of chronic pain) they get broken and keep delivering the message beyond necessity. Acknowledging the message helps your brain (and all that is attached to it) realize “ok, this message has been delivered now; we can chill about it a little”.
Having done that, if you can reasonably tweak any of the emotions (for example, perhaps that self-pity we mentioned could be turned into self-compassion, which is more useful), that’s great. If not, at least you know what’s on the battlefield now.
When we examine the story of our pain, lastly, Dr. Wolf invites us to look at how one of the biggest drivers of distress under pain is the uncertainty of how long the pain will last, whether it will get worse, whether what we are doing will make it worse, and so forth. See for example:
How long does back pain last? And how can learning about pain increase the chance of recovery?
And of course, many things we do specifically in response to pain can indeed make our pain worse, and spread:
Dr. Wolf’s perspective says:
- Life involves pain
- Pain invariably has a cause
- What has a cause, can have an end
- We just need to go through that process
This may seem like small comfort when we are in the middle of the pain, but if we’ve broken it down into parts with Dr. Wolf’s “box method”, and dealt with the first two parts (the sensations and the emotions) as well as reasonably possible, then we can tackle the third one (the story) a little more easily than we could if we were trying to come at it with no preparation.
What used to be:
“This pain has ruined my life, is making it unbearable, will almost certainly continue, and may get worse”
…can now become:
“This pain is a big challenge, but since I’m here for it whether I want to be or not, I will suffer as I must, while calmly looking for ways to reduce that suffering as I go.”
In short: you cannot “think healing thoughts” and expect your pain to go away. But you can do a lot more than you might (if you left it unexamined) expect.
Want to know more from Dr. Wolf?
We reviewed a book of hers recently, which you might enjoy:
Outsmart Your Pain – by Dr. Christiane Wolf
Take care!
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Is there a right way to talk to your baby? A baby brain expert explains ‘parentese’
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You might have seen those heartwarming and often funny viral videos where parents or carers engage in long “talks” with young babies about this and that – usually just fun chit chat of no great consequence.
They’re often very sweet, and it’s lovely to see the babies’ faces lighting up at the sound of their mother or carer’s voice, or seeming to talk back. In one, the baby appears to reply in an accent strikingly similar to their carer’s:
So, what’s going on when we chat like this to babies? And is it better to chat to them in the tone and pace we’d use when talking to other adults, or is it OK to talk in a slower, higher pitched, sing-song voice?
Here’s what the research shows so far.
2p2play/Shutterstock Talking to your baby matters
When you speak with your baby, they are exposed to a rich tapestry of sounds and movements. Can babies make sense of all this input?
Well, by the time they’re born babies are already highly experienced with their mother’s voice as well as other language sounds they’ve heard while in utero.
In fact, research shows newborns prefer listening to the language they heard in utero rather than an unfamiliar language.
They also prefer to hear the story their mother read aloud regularly in the final weeks of pregnancy, compared to a different story – regardless of who is reading it.
So, although newborns are yet to understand the meaning of these words, they are already tuned in to the importance of language.
Given the vast exposure that most young babies have with their parent’s voice, passively listening to mum or dad talking is likely to be comforting.
Time spent together in close physical contact with a highly familiar person producing familiar sounds creates a safe, secure space rich in learning opportunities.
Babies can learn a lot about conversational style from just listening to and watching the way their parent communicates.
In fact, babies mimic their parents’ gestures, which can help build their vocabulary over time. The social context influences language skills.
Time spent in close physical contact with a familiar person producing familiar sounds creates a safe learning space for baby. Photo by Josh Willink/Pexels What if I run out of things to say?
If you’re not a fan of monologuing to your baby, don’t worry. They’re not missing out.
In fact, constant exposure to long monologues by a parent is unlikely to provide the baby with a particularly supportive language environment for developing their understanding or production of words.
Adult language is extremely complex. It takes a lot of experience with language before a string of sounds like “Yourdadlikeschocolatemoltenlavacake” can be interpreted as individual words linked to people, objects, or concepts.
One of the most effective ways to support early word recognition and promote attention to the structure of language is for the adult to use a simplified way of speaking to the baby.
“Parentese” is characterised by the use of higher pitch sounds, elongated vowels, and a slower pace of speaking. Real words are presented in a sing-song, happy voice.
Parentese draws the baby’s attention to words, and highlights how information in speech chunks together. Babies have been found to prefer to listen to this style of speaking compared to standard speech.
Time spent talking together in face-to-face interactions best supports language development. Tomsickova Tatyana/Shutterstock Speaking ‘parentese’
Parentese is not the same thing as “baby talk”. Baby talk involves the use of nonsense words, and the modelling of incorrect speech sounds and grammar. A baby is not being supported to learn the word “water” if they are repeatedly presented with a nonsense label like “waa waa” for their drink.
One US study found that when parents were trained to use parentese with their infants at six and ten months, the infants showed an increase in babbling and said more words at 14 months, compared to infants of parents who did not receive this training.
Other research has shown consistent use of parentese in the early years can help build the complexity of children’s language skills at five years of age.
Learning to talk is not simply the product of hearing lots of words. In the first weeks of life, infants are already beginning to produce coos and murmurs that both parents and outside observers judge to be intentional vocalisations.
Try responding to these sounds by imitating them and then interpreting what your baby might be trying to say. This enables them to take a turn as a social partner in the conservation.
When even very young babies take turns in conversations with an adult, the quality of their vocalisations increases.
At the youngest ages, time spent talking together in face-to-face interactions best supports language development.
With age, babies become increasingly interested in the objects in their environment.
Try responding to your baby’s sounds by imitating them and interpreting what they might be trying to say. Halfpoint/Shutterstock So, what should I do?
An effective way to boost language learning from about nine months of age is to notice what’s captured your baby’s attention and talk about that.
Try labelling and describing what your baby is looking at, playing with, pointing at, or babbling towards.
Research by colleagues and I found encouraging parents to engage in 15 minutes of this kind of talk a day with their 11-month-olds for a month was effective in promoting vocabulary growth at 15 and 18 months.
Overall, a rich language environment is created by engaging with your baby in a wide range of activities – via games, songs, and reading aloud – not just having focused conversations.
Jane Herbert, Associate Professor in Developmental Psychology, University of Wollongong
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Edam vs Gouda – Which is Healthier?
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Our Verdict
When comparing edam to gouda, we picked the edam.
Why?
There’s not a lot between them, but there are some differences:
In terms of macros, their numbers are all close enough that one may beat the other by decimal place rounding, so we’ll call this a tie. Same goes for their fat type breakdowns; per 100g they both have 18g saturated, 8g monounsaturated, and 1g polyunsaturated.
In the category of vitamins, edam has slightly more of vitamins A, B1, B2, and B3, while gouda has slightly more of vitamins B5 and B9. A modest 4:2 win for edam.
When it comes to minerals, edam has more calcium, iron, and potassium, while gouda is not higher in any minerals. A more convincing win for edam.
In short, enjoy either or both in moderation, but if you’re going to choose one over the other, edam is the way to go.
Want to learn more?
You might like to read:
Can Saturated Fats Be Healthy?
Take care!
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Demystifying C-Reactive Protein (CRP)!
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Most people over a certain age who are at least somewhat invested in their health know that c-reactive protein (CRP) is a blood biomarker that’s considered an indicator of cardiovascular health (or: illness, as the case may be), but often know little more than that.
So, what is it and what does it mean?
Oh, CRP
CRP is produced by the liver in response to immune activation from infections, tissue damage, autoimmune disease, obesity, and diabetes.
As for what its actual job is (because the body does produce it for reasons other than for its usefulness as a biomarker in blood tests),
❝Similar to immunoglobulin (Ig)G, it activates complement, binds to Fc receptors and acts as an opsonin for various pathogens. Interaction of CRP with Fc receptors leads to the generation of proinflammatory cytokines that enhance the inflammatory response. Unlike IgG, which specifically recognizes distinct antigenic epitopes, CRP recognizes altered self and foreign molecules based on pattern recognition. Thus, CRP is though to act as a surveillance molecule for altered self and certain pathogens. This recognition provides early defense and leads to a proinflammatory signal and activation of the humoural, adaptive immune system.❞
Source: Function of C-reactive protein
Translating that from sciencese: CRP acts like a first-responder version of an antibody. Like IgG antibodies, it can activate the complement* system, latch onto immune cell receptors, and tag microbes so they are easier for immune cells to destroy. When CRP binds to these receptors, it also triggers the release of inflammatory signals that dial up the immune response.
The key difference is how it recognizes threats: antibodies such as IgG are very specific—they are custom-made to recognize one precise target and nothing else. CRP, in contrast, looks for broad patterns that signal damage or danger, whether from invading microbes or the body’s own altered cells. Thus, CRP acts as an immune surveillance sensor, providing early warning and kick-starting inflammation and the wider adaptive immune response. Which, in the case of an actual infection or similar, is a good thing.
*You may be wondering what, in turn, the complement system is and what activating it means. In simple terms, it starts off as a bunch of proteins circulating in your blood in an inactive form. When CRP (or an antibody) binds to a microbe or a damaged cell, it can activate this cascade, which then joints the fight and also does the latching on and tagging that we mentioned, by:
- directly damaging microbes: in some cases, complement proteins punch holes in bacterial membranes, leading to their death.
- tagging the target for destruction: complement proteins typically coat the surface of the microbe or damaged cell, making it easier for immune cells to recognize and engulf it.
- dialling up inflammation: small complement fragments act like chemical alarms, attracting immune cells and increasing local inflammation.
Again, if there’s actually a genuine threat to respond to, these are all good things for it to be doing.
CRP as a biomarker
CRP is a very useful biomarker of low-grade inflammation, and evidence from decades of research shows it predicts heart attacks and strokes better than LDL cholesterol and lipoprotein(a), and at least as well as blood pressure: Inflammation, Cholesterol, Lipoprotein(a), and 30-Year Cardiovascular Outcomes in Women
Same goes for when we look at mortality: C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality: an individual participant meta-analysis
For this reason, the American College of Cardiology recommended universal CRP screening alongside cholesterol testing to improve cardiovascular risk assessment. You can read that in full, here:
You may be wondering about numbers: CRP under 1 mg/dL indicates low inflammation and lower risk, while CRP above 3 mg/dL signals higher inflammation and higher risk.
How likely is it that you are at risk? Well, about 52% of Americans have elevated CRP, so that’s not a promising figure to start with. Now, 10almonds readers are doubtlessly healthier than the average American as a general demographic, but still, it’s worth bearing in mind and not assuming that it could only apply to other people.
And as for how to improve your numbers? Same deal as most heart health advice that we give here: enjoy a plants-forward (if not entirely plant-based) diet, especially making sure to get a lot of fiber and as many different sources of polyphenols as is reasonable. Get good sleep, do exercise often, and don’t smoke or drink.
About the dietary aspects specifically, see:
- What Matters Most For Your Heart?
- What Do The Different Kinds Of Fiber Do? 30 Foods That Rank Highest
- 21 Most Beneficial Polyphenols & What Foods Have Them
Want to learn more?
If you’d like a comprehensive guide to reducing your heart disease risk, no matter your starting point, then you might like to consider:
Dr. Dean Ornish’s Program For Reversing Heart Disease – by Dr. Dean Ornish
Take care!
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