Avoiding/Managing Osteoarthritis
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Avoiding/Managing Osteoarthritis
Arthritis is the umbrella term for a cluster of joint diseases involving inflammation of the joints, hence “arthr-” (joint) “-itis” (suffix used to denote inflammation).
Inflammatory vs Non-Inflammatory Arthritis
Arthritis is broadly divided into inflammatory arthritis and non-inflammatory arthritis.
Some forms, such as rheumatoid arthritis, are of the inflammatory kind. We wrote about that previously:
See: Avoiding/Managing Rheumatoid Arthritis
You may be wondering: how does one get non-inflammatory inflammation of the joints?
The answer is, in “non-inflammatory” arthritis, such as osteoarthritis, the damage comes first (by general wear-and-tear) and inflammation generally follows as part of the symptoms, rather than the cause.
So the name can be a little confusing. In the case of osteo- and other “non-inflammatory” forms of arthritis, you definitely still want to keep your inflammation at bay as best you can; it’s just not the prime focus.
So, what should we focus on?
First and foremost: avoiding wear-and-tear if possible. Naturally, we all must live our lives, and sometimes that means taking a few knocks, and definitely it means using our joints. An unused joint would suffer just as much as an abused one. But, we can take care of our joints!
We wrote on that previously, too:
See: How To Really Look After Your Joints
New osteoarthritis medication (hot off the press!)
At 10almonds, we try to keep on top of new developments, and here’s a shiny new one from this month:
- Methotrexate to treat hand osteoarthritis with synovitis (12th Oct, clinical trial)
- New research has found an existing drug could help many people with painful hand osteoarthritis (24th Oct, pop-science article about the above, but still written by one of the study authors!)
Note also that Dr. Flavia Cicuttini there talks about what we talked about above—that calling it non-inflammatory arthritis is a little misleading, as the inflammation still occurs.
And finally…
You might consider other lifestyle adjustments to manage your symptoms. These include:
- Exercise—gently, though!
- Rest—while keeping mobility going.
- Mobility aids—if it helps, it helps.
- Go easy on the use of braces, splints, etc—these can offer short-term relief, but at a long term cost of loss of mobility.
- Only you can decide where to draw the line when it comes to that trade-off.
You can also check out our previous article:
See: Managing Chronic Pain (Realistically!)
Take good care of yourself!
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How long does back pain last? And how can learning about pain increase the chance of recovery?
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Back pain is common. One in thirteen people have it right now and worldwide a staggering 619 million people will have it this year.
Chronic pain, of which back pain is the most common, is the world’s most disabling health problem. Its economic impact dwarfs other health conditions.
If you get back pain, how long will it take to go away? We scoured the scientific literature to find out. We found data on almost 20,000 people, from 95 different studies and split them into three groups:
- acute – those with back pain that started less than six weeks ago
- subacute – where it started between six and 12 weeks ago
- chronic – where it started between three months and one year ago.
We found 70%–95% of people with acute back pain were likely to recover within six months. This dropped to 40%–70% for subacute back pain and to 12%–16% for chronic back pain.
Clinical guidelines point to graded return to activity and pain education under the guidance of a health professional as the best ways to promote recovery. Yet these effective interventions are underfunded and hard to access.
More pain doesn’t mean a more serious injury
Most acute back pain episodes are not caused by serious injury or disease.
There are rare exceptions, which is why it’s wise to see your doctor or physio, who can check for signs and symptoms that warrant further investigation. But unless you have been in a significant accident or sustained a large blow, you are unlikely to have caused much damage to your spine.
Your doctor or physio can rule out serious damage.
DG fotostock/ShutterstockEven very minor back injuries can be brutally painful. This is, in part, because of how we are made. If you think of your spinal cord as a very precious asset (which it is), worthy of great protection (which it is), a bit like the crown jewels, then what would be the best way to keep it safe? Lots of protection and a highly sensitive alarm system.
The spinal cord is protected by strong bones, thick ligaments, powerful muscles and a highly effective alarm system (your nervous system). This alarm system can trigger pain that is so unpleasant that you cannot possibly think of, let alone do, anything other than seek care or avoid movement.
The messy truth is that when pain persists, the pain system becomes more sensitive, so a widening array of things contribute to pain. This pain system hypersensitivity is a result of neuroplasticity – your nervous system is becoming better at making pain.
Reduce your chance of lasting pain
Whether or not your pain resolves is not determined by the extent of injury to your back. We don’t know all the factors involved, but we do know there are things that you can do to reduce chronic back pain:
- understand how pain really works. This will involve intentionally learning about modern pain science and care. It will be difficult but rewarding. It will help you work out what you can do to change your pain
- reduce your pain system sensitivity. With guidance, patience and persistence, you can learn how to gradually retrain your pain system back towards normal.
How to reduce your pain sensitivity and learn about pain
Learning about “how pain works” provides the most sustainable improvements in chronic back pain. Programs that combine pain education with graded brain and body exercises (gradual increases in movement) can reduce pain system sensitivity and help you return to the life you want.
Some programs combine education with gradual increases in movement.
Halfpoint/ShutterstockThese programs have been in development for years, but high-quality clinical trials are now emerging and it’s good news: they show most people with chronic back pain improve and many completely recover.
But most clinicians aren’t equipped to deliver these effective programs – good pain education is not taught in most medical and health training degrees. Many patients still receive ineffective and often risky and expensive treatments, or keep seeking temporary pain relief, hoping for a cure.
When health professionals don’t have adequate pain education training, they can deliver bad pain education, which leaves patients feeling like they’ve just been told it’s all in their head.
Community-driven not-for-profit organisations such as Pain Revolution are training health professionals to be good pain educators and raising awareness among the general public about the modern science of pain and the best treatments. Pain Revolution has partnered with dozens of health services and community agencies to train more than 80 local pain educators and supported them to bring greater understanding and improved care to their colleagues and community.
But a broader system-wide approach, with government, industry and philanthropic support, is needed to expand these programs and fund good pain education. To solve the massive problem of chronic back pain, effective interventions need to be part of standard care, not as a last resort after years of increasing pain, suffering and disability.
Sarah Wallwork, Post-doctoral Researcher, University of South Australia and Lorimer Moseley, Professor of Clinical Neurosciences and Foundation Chair in Physiotherapy, University of South Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Does intermittent fasting have benefits for our brain?
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Intermittent fasting has become a popular dietary approach to help people lose or manage their weight. It has also been promoted as a way to reset metabolism, control chronic disease, slow ageing and improve overall health.
Meanwhile, some research suggests intermittent fasting may offer a different way for the brain to access energy and provide protection against neurodegenerative diseases like Alzheimer’s disease.
This is not a new idea – the ancient Greeks believed fasting enhanced thinking. But what does the modern-day evidence say?
First, what is intermittent fasting?
Our diets – including calories consumed, macronutrient composition (the ratios of fats, protein and carbohydrates we eat) and when meals are consumed – are factors in our lifestyle we can change. People do this for cultural reasons, desired weight loss or potential health gains.
Intermittent fasting consists of short periods of calorie (energy) restriction where food intake is limited for 12 to 48 hours (usually 12 to 16 hours per day), followed by periods of normal food intake. The intermittent component means a re-occurrence of the pattern rather than a “one off” fast.
Food deprivation beyond 24 hours typically constitutes starvation. This is distinct from fasting due to its specific and potentially harmful biochemical alterations and nutrient deficiencies if continued for long periods.
4 ways fasting works and how it might affect the brain
The brain accounts for about 20% of the body’s energy consumption.
Here are four ways intermittent fasting can act on the body which could help explain its potential effects on the brain.
1. Ketosis
The goal of many intermittent fasting routines is to flip a “metabolic switch” to go from burning predominately carbohydrates to burning fat. This is called ketosis and typically occurs after 12–16 hours of fasting, when liver and glycogen stores are depleted. Ketones – chemicals produced by this metabolic process – become the preferred energy source for the brain.
Due to this being a slower metabolic process to produce energy and potential for lowering blood sugar levels, ketosis can cause symptoms of hunger, fatigue, nausea, low mood, irritability, constipation, headaches, and brain “fog”.
At the same time, as glucose metabolism in the brain declines with ageing, studies have shown ketones could provide an alternative energy source to preserve brain function and prevent age-related neurodegeneration disorders and cognitive decline.
Consistent with this, increasing ketones through supplementation or diet has been shown to improve cognition in adults with mild cognitive decline and those at risk of Alzheimer’s disease respectively.
2. Circadian syncing
Eating at times that don’t match our body’s natural daily rhythms can disrupt how our organs work. Studies in shift workers have suggested this might also make us more prone to chronic disease.
Time-restricted eating is when you eat your meals within a six to ten-hour window during the day when you’re most active. Time-restricted eating causes changes in expression of genes in tissue and helps the body during rest and activity.
A 2021 study of 883 adults in Italy indicated those who restricted their food intake to ten hours a day were less likely to have cognitive impairment compared to those eating without time restrictions.
Matching your eating to the active parts of your day may have brain benefits.
Shutterstock3. Mitochondria
Intermittent fasting may provide brain protection through improving mitochondrial function, metabolism and reducing oxidants.
Mitochondria’s main role is to produce energy and they are crucial to brain health. Many age-related diseases are closely related to an energy supply and demand imbalance, likely attributed to mitochondrial dysfunction during ageing.
Rodent studies suggest alternate day fasting or reducing calories by up to 40% might protect or improve brain mitochondrial function. But not all studies support this theory.
4. The gut-brain axis
The gut and the brain communicate with each other via the body’s nervous systems. The brain can influence how the gut feels (think about how you get “butterflies” in your tummy when nervous) and the gut can affect mood, cognition and mental health.
In mice, intermittent fasting has shown promise for improving brain health by increasing survival and formation of neurons (nerve cells) in the hippocampus brain region, which is involved in memory, learning and emotion.
What we eat can affect our brain, and vice versa.
ShutterstockThere’s no clear evidence on the effects of intermittent fasting on cognition in healthy adults. However one 2022 study interviewed 411 older adults and found lower meal frequency (less than three meals a day) was associated with reduced evidence of Alzheimer’s disease on brain imaging.
Some research has suggested calorie restriction may have a protective effect against Alzheimer’s disease by reducing oxidative stress and inflammation and promoting vascular health.
When we look at the effects of overall energy restriction (rather than intermittent fasting specifically) the evidence is mixed. Among people with mild cognitive impairment, one study showed cognitive improvement when participants followed a calorie restricted diet for 12 months.
Another study found a 25% calorie restriction was associated with slightly improved working memory in healthy adults. But a recent study, which looked at the impact of calorie restriction on spatial working memory, found no significant effect.
Bottom line
Studies in mice support a role for intermittent fasting in improving brain health and ageing, but few studies in humans exist, and the evidence we have is mixed.
Rapid weight loss associated with calorie restriction and intermittent fasting can lead to nutrient deficiencies, muscle loss, and decreased immune function, particularly in older adults whose nutritional needs may be higher.
Further, prolonged fasting or severe calorie restriction may pose risks such as fatigue, dizziness, and electrolyte imbalances, which could exacerbate existing health conditions.
If you’re considering intermittent fasting, it’s best to seek advice from a health professional such as a dietitian who can provide guidance on structuring fasting periods, meal timing, and nutrient intake. This ensures intermittent fasting is approached in a safe, sustainable way, tailored to individual needs and goals.
Hayley O’Neill, Assistant Professor, Faculty of Health Sciences and Medicine, Bond University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Healthiest-Three-Nut Butter
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We’re often telling you to “diversify your nuts”, so here’s a great way to get in three at once with no added sugar, palm oil, or preservatives, and only the salt you choose to put in. We’ve picked three of the healthiest nuts around, but if you happen to be allergic, don’t worry, we’ve got you covered too.
You will need
- 1 cup almonds (if allergic, substitute a seed, e.g. chia, and make it ½ cup)
- 1 cup walnuts (if allergic, substitute a seed, e.g. pumpkin, and make it ½ cup)
- 1 cup pistachios (if allergic, substitute a seed, e.g. poppy, and make it ½ cup)
- 1 tbsp almond oil (if allergic, substitute extra virgin olive oil) (if you prefer sweet nut butter, substitute 1 tbsp maple syrup; the role here is to emulsify the nuts, and this will do the same job)
- Optional: ¼ tsp MSG or ½ tsp low-sodium salt
Method
(we suggest you read everything at least once before doing anything)
1a) If using nuts, heat your oven to 350℉ / 180℃. Place the nuts on a baking tray lined with baking paper, and bake/roast for about 10 minutes, but keep an eye on it to ensure the nuts don’t burn, and jiggle them if necessary to ensure they toast evenly. Once done, allow to cool.
1b) If using seeds, you can either omit that step, or do the same for 5 minutes if you want to, but really it’s not necessary.
2) Blend all ingredients (nuts/seeds, oil, MSG/salt) in a high-speed blender. Note: this will take about 10 minutes in total, and we recommend you do it in 30-second bursts so as to not overheat the motor. You also may need to periodically scrape the mixture down the side of the blender, to ensure a smooth consistency.
3) Transfer to a clean jar, and enjoy at your leisure:
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Why You Should Diversify Your Nuts!
- Sesame Seeds vs Poppy Seeds – Which is Healthier?
- If You’re Not Taking Chia, You’re Missing Out
- Sea Salt vs MSG – Which is Healthier?
Take care!
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Optimism Seriously Increases Longevity!
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Always look on the bright side for life
❝I’m not a pessimist; I’m a realist!❞
~ every pessimist ever
To believe self-reports, the world is divided between optimists and realists. But how does your outlook measure up, really?
Below, we’ve included a link to a test, and like most free online tests, this is offered “as-is” with the usual caveats about not being a clinical diagnostic tool, this one actually has a fair amount of scientific weight behind it:
❝Empirical testing has indicated the validity of the Optimism Pessimism Instrument as published in the scientific journal Current Psychology: Research and Reviews.
The IDRlabs Optimism/Pessimism Test (IDR-OPT) was developed by IDRlabs. The IDR-OPT is based on the Optimism/Pessimism Instrument (OPI) developed by Dr. William Dember, Dr. Stephanie Martin, Dr. Mary Hummer, Dr. Steven Howe, and Dr. Richard Melton, at the University of Cincinnati.❞
Take This Short (1–2 mins) Test
How did you score? And what could you do to improve on that score?
We said before that we’d do a main feature on this sometime, and today’s the day! Fits with the theme of Easter too, as for those who observe, this is a time for a celebration of hope, new beginnings, and life stepping out of the shadows.
On which note, before we go any further, let’s look at a very big “why” of optimism…
There have been many studies done regards optimism and health, and they generally come to the same conclusion: optimism is simply good for the health.
Here’s an example. It’s a longitudinal study, and it followed 121,700 women (what a sample size!) for eight years. It controlled for all kinds of other lifestyle factors (especially smoking, drinking, diet, and exercise habits, as well as pre-existing medical conditions), so this wasn’t a case of “people who are healthy are more optimistic as a result. And, in the researchers’ own words…
❝We found strong and statistically significant associations of increasing levels of optimism with decreasing risks of mortality, including mortality due each major cause of death, such as cancer, heart disease, stroke, respiratory disease, and infection.
Importantly, findings were maintained after close control for potential confounding factors, including sociodemographic characteristics and depression❞
Read: Optimism and Cause-Specific Mortality: A Prospective Cohort Study
So that’s the why. Now for the how…
Positive thinking is not what you think it is
A lot of people think of “think positive thoughts” as a very wishy-washy platitude, but positive thinking isn’t about ignoring what’s wrong, or burying every negative emotion.
Rather, it is taking advantage of the basic CBT, DBT, and, for that matter, NLP principles:
- Our feelings are driven by our thoughts
- Our thoughts can be changed by how we frame things
This is a lot like the idea that “there’s not such thing as bad weather; only the wrong clothes”. Clearly written by someone who’s never been in a hurricane, but by and large, the principle stands true.
For example…
- Most problems can be reframed as opportunities
- Replace “I have to…” with “I get to…”
- Will the task be arduous? It’ll be all the better looking back on it.
- Did you fail abjectly? Be proud that you lived true to your values anyway.
A lot of this is about focusing on what you can control. If you live your life by your values (first figure out what they are, if you haven’t already), then that will become a reassuring thing that you can always count on, no matter what.
Practice positive self-talk (eliminate the negative)
We often learn, usually as children, to be self deprecatory so as to not appear immodest. While modesty certainly has its place, we don’t have to trash ourselves to do that!
There are various approaches to this, for example:
- Replacing a self-criticism (whether it was true or not) with a neutral or positive statement that you know is true. “I suck at xyz” is just putting yourself down, “Xyz is a challenge for me” asks the question, how will you rise to it?
- Replacing a self-criticism with irony. It doesn’t matter how dripping with sarcasm your inner voice is, the words will still be better. “Glamorous as ever!” after accidentally putting mascara in your eye. “So elegant and graceful!” after walking into furniture. And so on.
Practice radical acceptance
This evokes the “optimistic nihilism” approach to life. It’s perhaps not best in all scenarios, but if you’re consciously and rationally pretty sure something is going to be terrible (and/or know it’s completely outside of your control), acknowledging that possibility (or even, likelihood) cheerfully. Borrowing from the last tip, this can be done with as much irony as you find necessary. For example:
Facing a surgery the recovery from which you know categorically will be very painful: with a big smile “Yep, I am going to be in a lot of pain, so that’s going to be fun!” (fun fact: psychological misery will not make the physical pain any less painful, so you might as well see the funny side) ← see link for additional benefits laughter can add to health-related quality of life)
Plan for the future with love
You know the whole “planting trees in whose shade you’ll never sit”, thing, but: actually for yourself too. Plan (and act!) now, out of love and compassion for your future self.
Simple example: preparing (or semi-preparing, if appropriate) breakfast for yourself the night before, when you know in the morning you’ll be tired, hungry, and/or pressed for time. You’ll wake up, remember that you did that, and…
Tip: at moments like that, take a moment to think “Thanks, past me”. (Or call yourself by your name, whatever works for you. For example I, your writer here, might say to myself “Thanks, past Nastja!”)
This helps to build a habit of gratitude for your past self and love for your future self.
This goes for little things like the above, but it also goes for things whereby there’s much longer-term delayed gratification, such as:
- Healthy lifestyle changes (usually these see slow, cumulative progress)
- Good financial strategies (usually these see slow, cumulative progress)
- Long educational courses (usually these see slow, cumulative progress)
Basically: pay it forward to your future self, and thank yourself later!
Some quick ideas of systems and apps that go hard on the “long slow cumulative progress” approach that you can look back on with pride:
- Noom—nutritional program with a psychology-based approach to help you attain and maintain your goals, long term
- You Need A Budget—we’ve recommended it before and we’ll recommend it again. This is so good. If you click through, you can see a short explanation of what makes it so different to other budgeting apps.
- Duolingo—the famously persistence-motivational language learning app
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Body Image Dissatisfaction/Appreciation Across The Ages
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Every second news article about body image issues is talking about teens and social media use, but science tells a different story.
A large (n=1,327) study of people of mixed genders aged 16–88 examined matters relating to people’s body image, expecting…
❝We hypothesized that body dissatisfaction and importance of appearance would be higher in women than in men, that body dissatisfaction would remain stable across age in women, and that importance of appearance would be lower in older women compared to younger women. Body appreciation was predicted to be higher in men than in women.❞
As they discovered, only half of that turned out to be true:
❝In line with our hypotheses, body dissatisfaction was higher in women than in men and was unaffected by age in women, and importance of appearance was higher in women than in men.
However, only in men did age predict a lower level of the importance of appearance. Compared to men, women stated that they would invest more hours of their lives to achieve their ideal appearance.
Contrary to our assumption, body appreciation improved and was higher in women across all ages than in men.❞
You can read the study in full here:
That’s a lot of information, and we don’t have the space to go into all parts of it here, fascinating as that would be. So we’re going to put two pieces of information (from the above) next to each other:
- body dissatisfaction was higher in women than in men and was unaffected by age in women
- body appreciation improved and was higher in women across all ages than in men
…and resolve this apparent paradox.
Dissatisfied appreciation
How is it that women are both more dissatisfied with, and yet also more appreciative of, their bodies?
The answer is that we can have positive and negative feelings about the same thing, without them cancelling each other out. In short, simply, feeling more feelings about it.
Whether the gender-related disparity in this case comes more from hormones or society could be vigorously debated, but chances are, it’s both. And, for our gentleman-readers, note that the principle still applies to you, even if scaled down on average.
Call to action:
- be aware of the negative feelings of body dissatisfaction
- focus on the positive feelings of body appreciation
While in theory both could motivate us to action, in reality, the former will tend to inform us (about what we might wish to change), while the latter will actually motivate us in a useful way (to do something positive about it).
This is because the negative feelings about body image tend to be largely based in shame, and shame is a useless motivator (i.e., it simply doesn’t work) when it comes to taking positive actions:
Why Shame Only Works Negatively
You can’t hate yourself into a body you love
That may sound like a wishy-washy platitude, but given the evidence on how shame works (and doesn’t), it’s true.
Instead, once you’ve identified the things about your body with which you’re dissatisfied, you can then assess:
- what can reasonably be changed
- whether it is important enough to you to change it
- how to go about usefully changing it
While weight issues are perhaps the most commonly-discussed body image consideration, to the point that often all others get forgotten, let’s look at something that’s generally more specific to adults, and also a very common cause of distress for women and men alike: hair loss/thinning.
If your hair is just starting to thin and fall, then if this bothers you, there’s a lot that can be done about it quite easily, but (and this is important) you have to love yourself enough to actually do it. Merely feeling miserable about it, and perhaps like you don’t deserve better, or that it is somehow a personal failing on your part, will not help.
If your hair has been gone for years, then chances are you’ve made your peace with this by now, and might not even take it back if a fairy godmother came along and offered to restore it magically. On the other hand, let’s say that you’re just coming out the other end of a 10-year-long depression, and perhaps you let a lot of things go that you now wish you hadn’t, and maybe your hair is one of them. In this case, now you need to decide whether getting implants (likely the only solution at this late stage) is worth it.
Note that in both cases, whatever the starting point and whether the path ahead is easy or hard, the person who has dissatisfaction and/but still values themself and their body will get what they need.
In contrast, the person who has dissatisfaction and does not value themself and their body, will languish.
The person without dissatisfaction, of course, probably already has what they need.
In short: identification of dissatisfaction + love and appreciation of oneself and one’s body → motivation to usefully take action (out of love, not hate)
Now, dear reader, apply the same thinking to whatever body image issues you may have, and take it from there!
Embodiment
A quick note in closing: if you are a person with no body dissatisfactions, there are two main possible reasons:
- You are genuinely happy with your body in all respects. Congratulations!
- You have disassociated from your body to such an extent that it’s become a mere vehicle to you and you don’t care about it.
This latter may seem like a Zen-level win, but in fact it’s a warning sign for depression, so please do examine that even if you don’t “feel” depressed (depression is often characterized by a lack of feelings), perhaps by taking the (very quick) free PHQ9 Test ← under 2 minutes; immediate results; industry-standard diagnostic tool
Take care!
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Good Energy – by Dr. Casey Means
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For a book with a title like “Good Energy” and chapters such as “Bad Energy Is the Root of Disease”, this is actually a very science-based book (and there are a flock of well-known doctors saying so in the “praise for” section, too).
The premise is simple: most of our health is a matter of what our metabolism is (or isn’t) doing, and it’s not just a case of “doing more” or “doing less”. Indeed, a lot of “our” energy is expended doing bad things (such as chronic inflammation, to give an obvious example).
Dr. Means outlines about a dozen things many people do wrong, and about a dozen things we can do right, to get our body’s energy system working for us, rather than against us.
The style here is pop-science throughout, and in the category of criticism, the bibliography is offloaded to her website (we prefer to have things in our hands). However, the information here is good, clearly-presented, and usefully actionable.
Bottom line: if you ever find yourself feeling run-down and like your body is using your resources against you rather than for you, this is the book to get you out of that slump!
Click here to check out Good Energy, and get your metabolism working for you!
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