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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How To *Really* Pick Up (And Keep!) Those Habits
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The Healthiest Habit-Building
Why was that book “Atomic Habits” called that? It wasn’t just because it’s a catchy title…
Habits are—much like atoms—things that are almost imperceptibly small, yet when stacked, they make up the substance of many much larger and more obvious things, and also contain an immense amount of potential power.
About that power…
Habits are the “compound interest” of natural human life. Every action we take, every decision we make, makes our life (often imperceptibly) better or worse. But getting even just 1% better or 1% worse at something every day? That’s going to not just add up over time… It’ll actively compound over time.
Habits will snowball one way or the other, good or bad. So, we want to control that snowball so that it works for us rather than against us.
Thus, we need to choose habits that are helpful to us, rather than those that are harmful to us. Top examples include:
- Making healthy food choices rather than unhealthy ones
- Moving our body regularly rather than being sedentary
- Having a good bedtime/morning routine rather than a daily chaotic blur
- Learning constantly rather than digging into old beliefs out of habit
- Forging healthy relationships rather than isolating ourselves
We all know that to make a habit stick, we need to practice it regularly, with opinions varying on how long it takes for something to become habit. Some say 21 days; some say 66. The number isn’t the important part!
What is important
You will never get to day 66, much less will you get to day 366, if you don’t first get to day 6 (New Year’s Resolutions, anyone?).
So in the early days especially, when the habit is most likely to get dropped, it’s critical to make the habit as easy as possible to form.
That means:
- The habit should be made as pleasant as possible
- (e.g. by making modifications to it if it’s not already intrinsically pleasant)
- The habit should take under 2 minutes to do at first
- (no matter if it takes longer than 2 minutes to be useful; it’ll never be useful if you don’t first get it to stick, so make your initial commitment only 2 minutes, just to get in the habit)
- The habit should have cues to remind you
- (as it’s not habit yet, you will need to either set a reminder on your phone, or leave a visual reminder, such as your workout clothes laid out ready for you in the morning, or a bowl of fruit in plain view where you spend a lot of time)
What gets measured, gets done
Streaks are a great way to do this. Habit-tracking apps help. Marks on a calendar or in a journal are also totally fine.
What can help especially, and that a lot of people don’t do, is to have a system of regular personal reviews—like a work “performance review”, but for oneself and one’s own life.
Set a reminder or write on the calendar / in your diary, to review monthly, or weekly if you prefer, such things as:
- How am I doing in the areas of life that are important to me?
- Have a list of the areas of life that are important to you, by the way, and genuinely reflect on each of them, e.g:
- Health
- Finances
- Relationships
- Learning
- Sleep
- Etc
- Have a list of the areas of life that are important to you, by the way, and genuinely reflect on each of them, e.g:
- What is working for me, and what isn’t working for me?
- What will I do better in this next month/week?
…and then do it!
Good luck, and may it all stack up in your favor!
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Eat to Your Heart’s Content – by Dr. Sat Bains
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Making food heart-healthy and tasty is a challenge that vexes many, but it doesn’t have to be so difficult.
Dr. Sat Bains, a professional chef with multiple Michelin stars to his name, is an expert on “tasty”, and after surviving a heart attack himself, he’s become an expert on “heart-healthy” since then.
The book contains not only the recipes (of which there are 68, by the way), but also large sections of explanation of what makes various ingredients or methods heart-healthy or heart-unhealthy.
There’s science in there too, and these sections were written under the guidance of Dr. Neil Williams, a lecturer in physiology and nutrition.
You may be wondering as to why the author himself has a doctorate too; in fact he has three, none of which are relevant:
- Doctor of Arts
- Doctor of Laws
- Doctor of Hospitality (Honorary)
…but we prefix “Dr.” when people are that and he is that. The expertise we’re getting here though is really his culinary skill and extracurricular heart-healthy learning, plus Dr. Williams’ actual professional health guidance.
Bottom line: if you’d like heart-healthy recipes with restaurant-level glamour, this book is a fine choice.
Click here to check out Eat To Your Heart’s Content, and look after yours!
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From Strength to Strength – by Dr. Arthur Brooks
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For most professions, there are ways in which performance can be measured, and the average professional peak varies by profession, but averages are usually somewhere in the 30–45 range, with a pressure to peak between 25–35.
With a peak by age 45 or perhaps 50 at the latest (aside from some statistical outliers, of course), what then to expect at age 50+? Not long after that, there’s a reason for mandatory retirement ages in some professions.
Dr. Brooks examines the case for accepting that rather than fighting it, and/but making our weaknesses into our strengths as we go. If our fluid intelligence slows, our accumulated crystal intelligence (some might call it “wisdom“) can make up for it, for example.
But he also champions the idea of looking outside of ourselves; of the importance of growing and fostering connections; giving to those around us and receiving support in turn; not transactionally, but just as a matter of mutualism of the kind found in many other species besides our own. Indeed, Dr. Brooks gives the example of a grove of aspen trees (hence the cover art of this book) that do exactly that.
The style is very accessible in terms of language but with frequent scientific references, so very much a “best of both worlds” in terms of readability and information-density.
Bottom line: if ever you’ve wondered at what age you might outlive your usefulness, this book will do as the subtitle suggests, and help you carve out your new place.
Click here to check out From Strength To Strength, and find yours!
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Wasting Your Vitamins?
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Are you flushing away your vitamins?
Most likely…but you don’t have to.
We all know what a wasteful expense supplements can sometimes be, but you can optimise your intake to get more bang for your buck!
Top Tips for Getting Your Money’s Worth:
- Liquids are better than tablets—the body can’t absorb nutrients from tablets anywhere as easily as it can from liquids, with some saying as low as a 50% absorption rate for tablets, so if your supplement can come in drinkable form, take it that way!
- Capsules are better than tablets—capsules, depending on the kind, contain either a powder (true capsules) or a liquid (softgels). Once the capsule/softgel is broken down in the stomach, it releases its contents, which will now be absorbed as though you took it as a drink.
- Stay hydrated—on that note, your body can only make use of nutrients that it can easily transport, and if you’re dehydrated, the process is sluggish! Having a big glass of water with your supplements will go a long way to helping your body get them where they’re needed.
- Take with black pepper—studies disagree on exactly how much black pepper improves absorption of nutrients. Some say it improves it by 50%, others say as much as 7x better. The truth is probably that it varies from one nutrient to the next, but what is (almost) universally accepted is that black pepper helps you absorb many nutrients you take orally.
- Take with a meal—bonus if you seasoned it with black pepper! But also: many nutrients are best absorbed alongside food, and many are specifically fat-soluble (so you want to take a little fat around the same time for maximum absorption)
- Consider split doses—a lot of nutrients are best absorbed when spread out a bit. Why? Your body can often only absorb so much at once, and what it couldn’t absorb can, depending on the nutrient, pass right through you. So better to space out the doses—breakfast and dinner make for great times to take them.
- Consider cycling—no, not the two-wheeled kind, though feel free to do that too! What cycling means when it comes to supplements is to understand that your body can build a tolerance to some supplements, so you’ll get gradually less effect for the same dose. Combat this by scheduling a break—five days on, two days off is a common schedule—allowing your body to optimise itself in the process!
- Check Medications—and, as is always safe, make sure you check whether any medications you take can interrupt your supplement absorption!
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What Too Much Exercise Does To Your Body And Brain
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“Get more exercise” is a common rallying-cry for good health, but it is possible to overdo it. And, this is not just a matter of extreme cases of “exercise addiction”, but even going much above certain limits can already result in sabotaging one’s healthy gains. But how, and where does the line get drawn?
Too Much Of A Good Thing
The famous 150 minutes per week of moderate exercise (or 75 minutes of intense exercise) is an oft-touted figure. This video, on the other hand, springs for 5 hours of moderate exercise or 2.5 hours intense exercise as a good guideline.
We’re advised that going over those guidelines doesn’t necessarily increase health benefits, and on the contrary, may reduce or even reverse them. For example, we are told…
- Light to moderate running reduces the risk of death, but running intensely more than 3 times a week can negate these benefits.
- Extreme endurance exercises, like ultra-marathons, may cause heart damage, heart rhythm disorders, and artery enlargement.
- Women who exercise strenuously every day have a higher risk of heart attacks and strokes compared to those who exercise moderately.
- Excessive exercise in women can lead to the “female athlete triad” (loss of menstruation, osteoporosis, and eating disorders).
- In men, intense exercise can lower libido due to fatigue and reduced testosterone levels.
- Both men and women are at increased risk of overuse injuries (e.g., tendinitis, stress fractures) and impaired immunity from excessive exercise.
- There is a 72-hour window of impaired immunity after intense exercise, increasing the risk of infections.
Exercise addiction is rare, though, with this video citing “around 1 million people in the US suffer from exercise addiction”.
For more on finding the right balance, enjoy:
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Want to learn more?
You might also like to read:
Take care!
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Vision for Life, Revised Edition – by Dr. Meir Schneider
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The “ten steps” would be better called “ten exercises”, as they’re ten things that one can (and should) continue to do on an ongoing basis, rather than steps to progress through and then forget about.
We can’t claim to have tested the ten exercises for improvement (this reviewer has excellent eyesight and merely hopes to maintain such as she gets older) but the rationale is compelling, and the public testimonials abundant.
Dr. Schneider also talks about improving and correcting errors of refraction—in other words, doing the job of any corrective lenses you may currently be using. While he doesn’t claim miracles, it turns out there is a lot that can be done for common issues such as near-sightedness and far-sightedness, amongst others.
There’s a large section on managing more chronic pathological eye conditions than this reviewer previously knew existed; in some cases it’s a matter of making sure things don’t get worse, but in many others, there’s a recurring of theme of “and here’s an exercise for correcting that”.
The writing style is a little more “narrative prose” than we’d have liked, but the quality of the content more than makes up for any style preference issues.
Bottom line: the human body is a highly adaptive organism, and sometimes it just needs a little help to correct itself. This book can help with that.
Click here to check out Vision for Life, and take good care of yours!
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