Osteoarthritis Of The Knee
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝Very informative thank you. And made me think. I am a 72 yr old whitewoman, have never used ( or even been offered) HRT since menopause ~15 yrs ago. Now I’m wondering if it would have delayed the onset of osteoarthritis ( knee) and give me more energy in general. And is it wise to start taking hrt after being without those hormones for so long?❞
(this was in response to our article about menopausal HRT)
Thanks for writing! To answer your first question, obviously we can never know for sure now, but it certainly is possible, per for example a large-ish (n=1003) study of women aged 45–64, in which:
- Those with HRT were significantly less likely to have knee arthritis than those without
- However, to enjoy this benefit depended on continued use (those who used it for a bit and then stopped did not enjoy the same results)
- While it made a big difference to knee arthritis, it made only a small (but still beneficial) difference to wrist/hand arthritis.
We could hypothesize that this is because the mechanism of action is more about strengthening the bones (proofing against osteoporosis is one of the main reasons many people take HRT) and cartilage than it is against inflammation directly.
Since the knee is load-bearing and the hand/wrist joints usually are not, this would mean the HRT strengthening the bones makes a big difference to the “wear and tear” aspect of potential osteoarthritis of the knee, but not the same level of benefit for the hand/wrist, which is less about wear and tear and more about inflammatory factors. But that latter, about it being load-bearing, is just this writer’s hypothesis as to why the big difference.
The researchers do mention:
❝In OA the mechanisms by which HRT might act are highly speculative, but could entail changes in cartilage repair or bone turnover, perhaps with cytokines such as interleukin 6, for example.❞
What is clear though, is that it does indeed appear to have a protective effect against osteoarthritis of the knee.
With regard to the timing, the researchers do note:
❝Why as little as three years of HRT should have a demonstrable effect is unclear. Given the difficulty in ascertaining when the disease starts, it is hard to be sure of the importance of the timing of HRT, and whether early or subclinical disease was present.
These results taken together suggest that HRT has a metabolic action that is only effective if given continuously, perhaps by preventing disease initiation; once HRT is stopped there might be a ‘rebound’ effect, explaining the rapid return to normal risk❞
~ Ibid.
You can read the study here:
On whether it is worth it now…
Again, do speak with an endocrinologist because your situation may vary, but:
- hormones are simply messengers, and your body categorically will respond to those messages regardless of age, or time elapsed without having received such a message. Whether it will repair all damage done is another matter entirely, but it would take a biological miracle for it to have no effect at all.
- anecdotally, many women do enjoy life-changing benefits upon starting HRT at your age and older!
(We don’t like to rely on “anecdotally”, but we couldn’t find studies isolating according to “length of time since menopause”—we’ll keep an eye out and if we find something in the future, we’ll mention it!)
Meanwhile, take care!
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Sunflower Corn Burger
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Burgers are rarely a health food, but in this case, everything in the patty is healthy, and it’s packed with protein, fiber, and healthy fats.
You will need
- 1 can chickpeas
- ¾ cup frozen corn
- ½ cup chopped fresh parsley
- ⅓ cup sunflower seeds
- ⅓ cup cornichon pickles
- ⅓ cup wholegrain bread crumbs (gluten-free, if desired/required)
- ¼ bulb garlic (or more if you want a stronger flavor)
- 1 tbsp extra virgin olive oil, plus more for frying
- 1 tbsp nutritional yeast (or 1 tsp yeast extract)
- 2 tsp ground cumin
- 2 tsp red pepper flakes
- 2 tsp black pepper, coarse ground
- 1 tsp Dijon mustard
- To serve: 4 burger buns; these are not usually healthy, so making your own is best, but if you don’t have the means/time, then getting similarly shaped wholegrain bread buns works just fine.
- Optional: your preferred burger toppings, e.g. greenery, red onion, tomato slices, avocado, jalapeños, whatever does it for you
Note: there is no need to add salt; there is enough already in the pickles.
Method
(we suggest you read everything at least once before doing anything)
1) Combine all the ingredients except the buns (and any optional toppings) in a food processor, pulsing a few times for a coarse texture (not a purée).
2) Shape the mixture into 4 burger patties, and let them chill in the fridge for at least 30 minutes.
3) Heat a skillet over a medium-high heat with some olive oil, and fry the burgers on both sides until they develop a nice golden crust; this will probably take about 4 minutes per side.
4) Assemble in the buns with any toppings you want, and serve:
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Sunflower Seeds vs Pumpkin Seeds – Which is Healthier? ← pumpkin seeds have more micronutrients; sunflower seeds have more healthy fats; feel free to use either or both in this recipe
- What Omega-3 Fatty Acids Really Do For Us
- Level-Up Your Fiber Intake! (Without Difficulty Or Discomfort)
- Making Friends With Your Gut (You Can Thank Us Later)
- Our Top 5 Spices: How Much Is Enough For Benefits?
Take care!
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Savory Protein Crêpe
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Pancakes have a bad reputation healthwise, but they don’t have to be so. Here’s a very healthy crêpe recipe, with around 20g of protein per serving (which is about how much protein most people’s body’s can use at one sitting) and a healthy dose of fiber too:
You will need
Per crêpe:
- ½ cup milk (your preference what kind; we recommend oat milk for this)
- 2 oz chickpea flour (also called garbanzo bean flour, or gram flour)
- 1 tsp nutritional yeast
- 1 tsp ras el-hanout (optional but tasty and contains an array of beneficial phytochemicals)
- 1 tsp dried mixed herbs
- ⅛ tsp MSG or ¼ tsp low-sodium salt
For the filling (also per crêpe):
- 6 cherry tomatoes, halved
- Small handful baby spinach
- Extra virgin olive oil
Method
(we suggest you read everything at least once before doing anything)
1) Mix the dry crêpe ingredients in a bowl, and then stir in the milk, whisking to mix thoroughly. Leave to stand for at least 5 minutes.
2) Meanwhile, heat a little olive oil in a skillet, add the tomatoes and fry for 1 minute, before adding the spinach, stirring, and turning off the heat. As soon as the spinach begins to wilt, set it aside.
3) Heat a little olive oil either in the same skillet (having been carefully wiped clean) or a crêpe pan if you have one, and pour in a little of the batter you made, tipping the pan so that it coats the pan evenly and thinly. Once the top is set, jiggle the pan to see that it’s not stuck, and then flip your crêpe to finish on the other side.
If you’re not confident of your pancake-tossing skills, or your pan isn’t good enough quality to permit this, you can slide it out onto a heatproof chopping board, and use that to carefully turn it back into the pan to finish the other side.
4) Add the filling to one half of the crêpe, and fold it over, pushing down at the edges with a spatula to make a seal, cooking for another 30 seconds or so. Alternatively, you can just serve a stack of crêpes and add the filling at the table, folding or rolling per personal preference:
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Level-Up Your Fiber Intake! (Without Difficulty Or Discomfort)
- Three Daily Servings of Beans?
- Lycopene’s Benefits For The Gut, Heart, Brain, & More
- Our Top 5 Spices: How Much Is Enough For Benefits?
- Sea Salt vs MSG – Which is Healthier?
Take care!
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The Immunostimulant Superfood –
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First, what this book is not: a “detox cleanse” book of the kind that claims you can flush out the autism if you just eat enough celery.
What it rather is: an overview brain chemistry, gut microbiota, and the very many other bodily systems that interact with these “two brains”.
She also does some mythbusting of popular misconceptions (for example with regard to tryptophan), and explains with good science just what exactly such substances as gluten and casein can and can’t do.
The format is less of a textbook and more a multipart (i.e., chapter-by-chapter) lecture, in pop-science style though, making it very readable. There are a lot of practical advices too, and options to look up foods by effect, and what to eat for/against assorted mental states.
Bottom line: anyone who eats food is, effectively, drugging themselves in one fashion or another—so you might as well make a conscious choice about how to do so.
Click here to check out This Is Your Brain On Food, and choose what kind of day you have!
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How Your Brain Chooses What To Remember
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During the day, your brain is simply too busy to encode memories without interfering with normal processing. At night, however…
The filing system
The brain decides which memories to keep based on significance, using sharp brain wave ripples as an internal bookmarking system. Everyday memories fade, while important events are tagged in this manner for consolidation during sleep.
How does it do this? It starts in the hippocampus, which records experiences during wakefulness and replays them repeatedly at high speed during sleep, preparing them for transfer to the neocortex.
How do we know? Uniform Manifold Approximation & Projection (UMAP) for dimension reduction is a tool that condenses 400-dimensional neural activity data into 3D for visualization. Mice navigating a maze showed hippocampal activity encoding location and learning progression; it also showed neural patterns reflecting maze layout and task mastery.
What this means in practical terms: you need to get good sleep if you don’t want to lose your memories!
For more on all of this, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
How To Boost Your Memory Immediately (Without Supplements)
Take care!
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Heart Health vs Systemic Stress
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At The Heart Of Good Health
This is Dr. Michelle Albert. She’s a cardiologist with a decades-long impressive career, recently including a term as the president of the American Heart Association. She’s the current Admissions Dean at UCSF Medical School. She’s accumulated enough awards and honors that if we list them, this email will not fit in your inbox without getting clipped.
What does she want us to know?
First, lifestyle
Although Dr. Albert is also known for her work with statins (which found that pravastatin may have anti-inflammatory effects in addition to lipid-lowering effects, which is especially good news for women, for whom the lipid-lowering effects may be less useful than for men), she is keen to emphasize that they should not be anyone’s first port-of-call unless “first” here means “didn’t see the risk until it was too late and now LDL levels are already ≥190 mg/dL”.
Instead, she recommends taking seriously the guidelines on:
- getting plenty of fruit, vegetables, whole grains, lean protein
- avoiding red meat, processed meats, refined carbohydrates, and sweetened beverages
- getting your 150 minutes per week of moderate exercise
- avoiding alcohol, and definitely abstaining from smoking
See also: These Top Five Things Make The Biggest Difference To Health
Next, get your house in order
No, not your home gym—though sure, that too!
But rather: after the “Top Five Things” we linked just above, the sixth on the list would be “reduce stress”. Indeed, as Dr. Albert says:
❝Heart health is not just about the physical heart but also about emotional well-being. Stress management is crucial for a healthy heart❞
~ Dr. Michelle Albert
This is where a lot of people would advise mindfulness meditation, CBT, somatic therapies, and the like. And these things are useful! See for example:
No-Frills, Evidence-Based Mindfulness
…and:
However, Dr. Albert also advocates for awareness of what some professionals have called “Shit Life Syndrome”.
This is more about socioeconomic factors. There are many of those that can’t be controlled by the individual, for example:
❝Adverse maternal experiences such as depression, economic issues and low social status can lead to poor cognitive outcomes as well as cardiovascular disease.
Many jarring statistics illuminate a marked wealth gap by race and ethnicity… You might be thinking education could help bridge that gap. But it is not that simple.
While education does increase wealth, the returns are not the same for everyone. Black persons need a post-graduate degree just to attain similar wealth as white individuals with a high school degree.❞
~ Dr. Michelle Albert
Read in full: AHA president: The connection between economic adversity and cardiovascular health
What this means in practical terms (besides advocating for structural change to tackle the things such as the racism that has been baked into a lot of systems for generations) is:
Be aware not just of your obvious health risk factors, but also your socioeconomic risk factors, if you want to have good general health outcomes.
So for example, let’s say that you, dear reader, are wealthy and white, in which case you have some very big things in your favor, but are you also a woman? Because if so…
Women and Minorities Bear the Brunt of Medical Misdiagnosis
See also, relevant for some: Obesity Discrimination In Healthcare Settings ← you’ll need to scroll to the penultimate section for this one.
In other words… If you are one of the majority of people who is a woman and/or some kind of minority, things are already stacked against you, and not only will this have its own direct harmful effect, but also, it’s going to make your life harder and that stress increases CVD risk more than salt.
In short…
This means: tackle not just your stress, but also the things that cause that. Look after your finances, gather social support, know your rights and be prepared to self-advocate / have someone advocate for you, and go into medical appointments with calm well-prepared confidence.
Take care!
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Unprocessed – by Kimberly Wilson
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First, what this is not: hundreds of pages to say “eat less processed food”. That is, of course, also advisable (and indeed, is advised in the book too), but there’s a lot more going on here too.
Though not a doctor, the author is a psychologist who brings a lot of data to the table, especially when it comes to the neurophysiology at hand, what forgotten micronutrients many people are lacking, and what trends in society worsen these deficiencies in the population at large.
If you only care about the broadest of take-away advice, it is: eat a diet that’s mostly minimally processed plants and some oily fish, watch out for certain deficiencies in particular, and increase dietary intake of them where necessary (with taking supplements as a respectable next-best remedy).
On which note, a point of criticism is that there’s some incorrect information about veganism and brain health; she mentions that DHA is only found in fish (in fact, fish get it from algae, which has it, and is the basis of many vegan omega-3 supplements), and the B12 is found only in animals (also found in yeast, which is not an animal, as well as various bacteria in soil, and farm animals get their B12 from supplements these days anyway, so it is arguable that we could keep things simpler by just cutting out the middlecow).
However, the strength of this book really is in the delivery of understanding about why certain things matter. If you’re told “such-and-such is good for the brain”, you’ll up your intake for 1–60 days, depending on whether you bought a supermarket item or ordered a batch of supplements. And then you’ll forget, until 6–12 months later, and you’ll do it again. On the other hand, if you understand how something is good or bad for the brain, what it does (for good or ill) on a cellular level, the chemistry and neurophysiology at hand, you’ll make new habits for life.
The style is middle-range pop-science; by this we mean there are tables of data and some long words that are difficult to pronounce, but also it’s not just hard science throughout—there’s (as one might expect from an author who is a psychologist) a lot about the psychology and sociology of why many people make poor dietary decisions, and the things governments often do (or omit doing) that affect this adversely—and how we can avoid those traps as individuals (unless we be incarcerated or such).
As an aside, the author is British, so governmental examples are mostly UK-based, but it doesn’t take a lot to mentally measure that against what the governments of, for example, the US or Canada do the same or differently.
Bottom line: there’s a lot of great information about brain health here; the strongest parts are whether the author stays within her field (psychology encompasses such diverse topics as neurophysiology and aspects of sociology, but not microbiology, for example). If you want to learn about the physiology of brain health and enjoy quite a sociopolitical ride along the way, this one’s a good one for that.
Click here to check out Unprocessed, and make the best choices for you!
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