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 Gain Weight (Healthily!)
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What Do You Have To Gain?
We have previously promised a three-part series about changing one’s weight:
- Losing weight (specifically, losing fat)
- Gaining weight (specifically, gaining muscle)
- Gaining weight (specifically, gaining fat)
There will be, however, no need for a “losing muscle” article, because (even though sometimes a person might have some reason to want to do this), it’s really just a case of “those things we said for gaining muscle? Don’t do those and the muscle will atrophy naturally”.
Here’s our first article: How To Lose Weight (Healthily!)
While some people will want to lose fat, please do be aware that the association between weight loss and good health is not nearly so strong as the weight loss industry would have you believe:
And, while BMI is not a useful measure of health in general, it’s worth noting that over the age of 65, a BMI of 27 (which is in the high end of “overweight”, without being obese) is associated with the lowest all-cause mortality:
BMI and all-cause mortality in older adults: a meta-analysis
Here was our second article: How To Build Muscle (Healthily!)
And now, it’s time for the last part, which yes, is also something that some people want/need to do (healthily!), and want/need help with that.
How to gain fat, healthily
Fat gets a bad press, but when it comes to health, we would die without it.
Even in the case of having excess fat, the fat itself is not generally the problem, so much as comorbid metabolic issues that are often caused by the same things as the excess fat.
So, how to gain fat healthily?
- Obvious but potentially dangerously misleading answer: “in moderation”
- More useful answer: “carefully”
Because, you can “in moderation” put on less than one pound per week for a few years and be in very bad health by the end of it. So how does this “carefully” work any differently to “in moderation”?
The key is in how we store the fat
Not merely where we store it (though that’ll follow from the “how”), but specifically: how we store it.
- When we consume energy from food in excess of our immediate survival needs, our body stores what it can. This is good!
- When our body is receiving energy from food faster than it can physically process it to store it healthily, it will start shoving it wherever it can instead. This is bad!
This is the physiological equivalent of the difference between tidying a room carefully, and cramming everything into one cupboard in 30 seconds just to get it out of sight.
So, you do need to consume calories yes, but you need to consume them in a way your body can take its time about storing them.
We’ve written before about the science of this, so we’ll share some links to that in a moment, but first, here are the practical tips:
- Do not drink your calories. Drinking calories tends to be the equivalent of injecting sugars directly into your veins, in terms of how quickly it gets received.
- See also: How To Unfatty A Fatty Liver ← this is highly relevant, because the same process that results in unhealthy weight gain, results in liver disease, by the same mechanism (the liver gets overwhelmed).
- Eat your greens. No, they won’t provide many calories, but they are critical to your body not being overwhelmed by the arrival of sugars.
- See also: 10 Ways To Balance Blood Sugars ← the other 9 things are also helpful for not putting on fat unhealthily, so using these alongside a calorie-dense diet can result in healthy fat gain as needed
- Get more of your calories from fats than carbs. Fats will not overwhelm your body’s glycemic response in the same way that carbs will.
- Again this is about getting calories while not getting metabolic disease. See also: How To Prevent And Reverse Type Two Diabetes as the advice is the same for that, for the same reason!
- Consider going low-carb, but even if you choose not to, go for carbs with a low glycemic index instead of a high glycemic index.
- For reference, see: Glycemic Index Chart: Glycemic index and glycemic load ratings for 500+ foods
- Need healthy fats in a snack? Enjoy nuts (unless you have an allergy); they will be your best friend in this regard. As an example, a mere 1oz portion of cashew nuts has 157 calories.
- See also: Why You Should Diversify Your Nuts
- Need health fats for cooking? Enjoy olive oil, as it has one of the healthiest lipids profiles available, and is a great way to increase the calorific content of many meals.
Lastly…
Be patient, enjoy your food, and stick as best you can to the above considerations. All strength to you.
Take care!
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How To Leverage Attachment Theory In Your Relationship
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How To Leverage Attachment Theory In Your Relationship
Attachment theory has come to be seen in “kids nowadays”’ TikTok circles as almost a sort of astrology, but that’s not what it was intended for, and there’s really nothing esoteric about it.
What it can be, is a (fairly simple, but) powerful tool to understand about our relationships with each other.
To demystify it, let’s start with a little history…
Attachment theory was conceived by developmental psychologist Mary Ainsworth, and popularized as a theory bypsychiatrist John Bowlby. The two would later become research partners.
- Dr. Ainsworth’s initial work focused on children having different attachment styles when it came to their caregivers: secure, avoidant, or anxious.
- Later, she would add a fourth attachment style: disorganized, and then subdivisions, such as anxious-avoidant and dismissive-avoidant.
- Much later, the theory would be extended to attachments in (and between) adults.
What does it all mean?
To understand this, we must first talk about “The Strange Situation”.
“The Strange Situation” was an experiment conducted by Dr. Ainsworth, in which a child would be observed playing, while caregivers and strangers would periodically arrive and leave, recreating a natural environment of most children’s lives. Each child’s different reactions were recorded, especially noting:
- The child’s reaction (if any) to their caregiver’s departure
- The child’s reaction (if any) to the stranger’s presence
- The child’s reaction (if any) to their caregiver’s return
- The child’s behavior on play, specifically, how much or little the child explored and played with new toys
She observed different attachment styles, including:
- Secure: a securely attached child would play freely, using the caregiver as a secure base from which to explore. Will engage with the stranger when the caregiver is also present. May become upset when the caregiver leaves, and happy when they return.
- Avoidant: an avoidantly attached child will not explore much regardless of who is there; will not care much when the caregiver departs or returns.
- Anxious: an anxiously attached child may be clingy before separation, helplessly passive when the caregiver is absent, and difficult to comfort upon the caregiver’s return.
- Disorganized: a disorganizedly attached child may flit between the above types
These attachment styles were generally reflective of the parenting styles of the respective caregivers:
- If a caregiver was reliably present (physically and emotionally), the child would learn to expect that and feel secure about it.
- If a caregiver was absent a lot (physically and/or emotionally), the child would learn to give up on expecting a caregiver to give care.
- If a caregiver was unpredictable a lot in presence (physical and/or emotional), the child would become anxious and/or confused about whether the caregiver would give care.
What does this mean for us as adults?
As we learn when we are children, tends to go for us in life. We can change, but we usually don’t. And while we (usually) no longer rely on caregivers per se as adults, we do rely (or not!) on our partners, friends, and so forth. Let’s look at it in terms of partners:
- A securely attached adult will trust that their partner loves them and will be there for them if necessary. They may miss their partner when absent, but won’t be anxious about it and will look forward to their return.
- An avoidantly attached adult will not assume their partner’s love, and will feel their partner might let them down at any time. To protect themself, they may try to manage their own expectations, and strive always to keep their independence, to make sure that if the worst happens, they’ll still be ok by themself.
- An anxiously attached adult will tend towards clinginess, and try to keep their partner’s attention and commitment by any means necessary.
Which means…
- When both partners have secure attachment styles, most things go swimmingly, and indeed, securely attached partners most often end up with each other.
- A very common pairing, however, is one anxious partner dating one avoidant partner. This happens because the avoidant partner looks like a tower of strength, which the anxious partner needs. The anxious partner’s clinginess can also help the avoidant partner feel better about themself (bearing in mind, the avoidant partner almost certainly grew up feeling deeply unwanted).
- Anxious-anxious pairings happen less because anxiously attached people don’t tend to be attracted to people who are in the same boat.
- Avoidant-avoidant pairings happen least of all, because avoidantly attached people having nothing to bind them together. Iff they even get together in the first place, then later when trouble hits, one will propose breaking up, and the other will say “ok, bye”.
This is fascinating, but is there a practical use for this knowledge?
Yes! Understanding our own attachment styles, and those around us, helps us understand why we/they act a certain way, and realize what relational need is or isn’t being met, and react accordingly.
That sometimes, an anxiously attached person just needs some reassurance:
- “I love you”
- “I miss you”
- “I look forward to seeing you later”
That sometimes, an avoidantly attached person needs exactly the right amount of space:
- Give them too little space, and they will feel their independence slipping, and yearn to break free
- Give them too much space, and oops, they’re gone now
Maybe you’re reading that and thinking “won’t that make their anxious partner anxious?” and yes, yes it will. That’s why the avoidant partner needs to skip back up and remember to do the reassurance.
It helps also when either partner is going to be away (physically or emotionally! This counts the same for if a partner will just be preoccupied for a while), that they parameter that, for example:
- Not: “Don’t worry, I just need some space for now, that’s all” (à la “I am just going outside and may be some time“)
- But: “I need to be undisturbed for a bit, but let’s schedule some me-and-you-time for [specific scheduled time]”.
Want to learn more about addressing attachment issues?
Psychology Today: Ten Ways to Heal Your Attachment Issues
You also might enjoy such articles such as:
- Nurturing secure attachment: building healthy relationships
- Why anxious and avoidant often attracted each other
- How to help an insecurely attached partner feel loved
- How to cope with a dismissive-avoidant partner
Lastly, to end on a light note…
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Radical CBT
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Radical Acceptance!
A common criticism of Cognitive Behavioral Therapy (CBT) is that much of it hinges on the following process:
- You are having bad feelings
- Which were caused by negative automatic thoughts
- Which can be taken apart logically
- Thus diffusing the feelings
- And then feeling better
For example:
- I feel like I’m an unwanted burden to my friend
- Because he canceled on me today
- But a reasonable explanation is that he indeed accidentally double-booked himself and the other thing wasn’t re-arrangeable
- My friend is trusting me to be an understanding friend myself, and greatly values my friendship
- I feel better and look forward to our next time together
But what if the negative automatic thoughts are, upon examination, reasonable?
Does CBT argue that we should just “keep the faith” and go on looking at a cruel indifferent world through rose-tinted spectacles?
Nope, there’s a back-up tool.
This is more talked-about in Dialectic Behavior Therapy (DBT), and is called radical acceptance:
Radical acceptance here means accepting the root of things as true, and taking the next step from there. It follows a bad conclusion with “alright, and now what?”
“But all evidence points to the fact that my friend has been avoiding me for months; I really can’t ignore it or explain it away any longer”
“Alright. Now what?”- Maybe there’s something troubling your friend that you don’t know about (have you asked?)
- Maybe that something is nothing to do with you (or maybe it really is about you!)
- Maybe there’s a way you and he can address it together (how important is it to you?)
- Maybe it’s just time to draw a line under it and move on (with or without him)
Whatever the circumstances, there’s always a way to move forwards.
Feelings are messengers, and once you’ve received and processed the message, the only reason to keep feeling the same thing, is if you want to.
Note that this is true even when you know with 100% certainty that the Bad Thing™ is real and exactly as-imagined. It’s still possible for you to accept, for example:
“Alright, so this person really truly hates me. Damn, that sucks; I think I’ve been nothing but nice to them. Oh well. Shit happens.”
Feel all the feelings you need to about it, and then decide for yourself where you want to go from there.
Get: 25 CBT Worksheets To Help You Find Solutions To A Wide Variety of Problems
Recognizing Emotions
We talked in a previous edition of 10almonds’ Psychology Sunday about how an important part of dealing with difficult emotions is recognizing them as something that you experience, rather than something that’s intrinsically “you”.
But… How?
One trick is to just mentally (or out loud, if your current environment allows for such) greet them when you notice them:
- Hello again, Depression
- Oh, hi there Anxiety, it’s you
- Nice of you to join us, Anger
Not only does this help recognize and delineate the emotion, but also, it de-tooths it and recognizes it for what it is—something that doesn’t actually mean you any harm, but that does need handling.
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Related Posts
Hello Sleep – by Dr. Jade Wu
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We’ve reviewed other sleep books before, so what makes this one stand out?
Mostly, it’s because this one takes quite a different approach.
While still giving a nod to the sensible advice you’ve already read in many places (including here at 10almonds), Dr. Wu looks to help the reader avoid falling into the trap (or: help the reader get out of the trap, if already there) of focussing so much on getting better sleep that it becomes an all-consuming stressor that takes up much of the day thinking about it, and guess what, much of the night too, because you’re busy working out how sleep-deprived you’re going to be tomorrow.
Instead, Dr. Wu recommends to work with your body rather than against it, worry less, and ultimately sleep better. Of course, the “how” of this is what makes most of the book.
She does also give chapters on things that may be different for you, based on such things as hormones, age, or medical conditions.
The writing style is pop-science but with frequent references to scientific papers as appropriate, making good science very accessible.
Bottom line: if you’ve tried everything else and/but good sleep still eludes you, this book will help you to end the battle and make friends with your sleep (a metaphor the author uses throughout the book, by the way).
Click here to check out Hello Sleep, and indeed get better sleep!
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Mental illness, psychiatric disorder or psychological problem. What should we call mental distress?
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We talk about mental health more than ever, but the language we should use remains a vexed issue.
Should we call people who seek help patients, clients or consumers? Should we use “person-first” expressions such as person with autism or “identity-first” expressions like autistic person? Should we apply or avoid diagnostic labels?
These questions often stir up strong feelings. Some people feel that patient implies being passive and subordinate. Others think consumer is too transactional, as if seeking help is like buying a new refrigerator.
Advocates of person-first language argue people shouldn’t be defined by their conditions. Proponents of identity-first language counter that these conditions can be sources of meaning and belonging.
Avid users of diagnostic terms see them as useful descriptors. Critics worry that diagnostic labels can box people in and misrepresent their problems as pathologies.
Underlying many of these disagreements are concerns about stigma and the medicalisation of suffering. Ideally the language we use should not cast people who experience distress as defective or shameful, or frame everyday problems of living in psychiatric terms.
Our new research, published in the journal PLOS Mental Health, examines how the language of distress has evolved over nearly 80 years. Here’s what we found.
Engin Akyurt/Pexels Generic terms for the class of conditions
Generic terms – such as mental illness, psychiatric disorder or psychological problem – have largely escaped attention in debates about the language of mental ill health. These terms refer to mental health conditions as a class.
Many terms are currently in circulation, each an adjective followed by a noun. Popular adjectives include mental, mental health, psychiatric and psychological, and common nouns include condition, disease, disorder, disturbance, illness, and problem. Readers can encounter every combination.
These terms and their components differ in their connotations. Disease and illness sound the most medical, whereas condition, disturbance and problem need not relate to health. Mental implies a direct contrast with physical, whereas psychiatric implicates a medical specialty.
Mental health problem, a recently emerging term, is arguably the least pathologising. It implies that something is to be solved rather than treated, makes no direct reference to medicine, and carries the positive connotations of health rather than the negative connotation of illness or disease.
Is ‘mental health problem’ actually less pathologising? Monkey Business Images/Shutterstock Arguably, this development points to what cognitive scientist Steven Pinker calls the “euphemism treadmill”, the tendency for language to evolve new terms to escape (at least temporarily) the offensive connotations of those they replace.
English linguist Hazel Price argues that mental health has increasingly come to replace mental illness to avoid the stigma associated with that term.
How has usage changed over time?
In the PLOS Mental Health paper, we examine historical changes in the popularity of 24 generic terms: every combination of the nouns and adjectives listed above.
We explore the frequency with which each term appears from 1940 to 2019 in two massive text data sets representing books in English and diverse American English sources, respectively. The findings are very similar in both data sets.
The figure presents the relative popularity of the top ten terms in the larger data set (Google Books). The 14 least popular terms are combined into the remainder.
Relative popularity of alternative generic terms in the Google Books corpus. Haslam et al., 2024, PLOS Mental Health. Several trends appear. Mental has consistently been the most popular adjective component of the generic terms. Mental health has become more popular in recent years but is still rarely used.
Among nouns, disease has become less widely used while illness has become dominant. Although disorder is the official term in psychiatric classifications, it has not been broadly adopted in public discourse.
Since 1940, mental illness has clearly become the preferred generic term. Although an assortment of alternatives have emerged, it has steadily risen in popularity.
Does it matter?
Our study documents striking shifts in the popularity of generic terms, but do these changes matter? The answer may be: not much.
One study found people think mental disorder, mental illness and mental health problem refer to essentially identical phenomena.
Other studies indicate that labelling a person as having a mental disease, mental disorder, mental health problem, mental illness or psychological disorder makes no difference to people’s attitudes toward them.
We don’t yet know if there are other implications of using different generic terms, but the evidence to date suggests they are minimal.
The labels we use may not have a big impact on levels of stigma. Pixabay/Pexels Is ‘distress’ any better?
Recently, some writers have promoted distress as an alternative to traditional generic terms. It lacks medical connotations and emphasises the person’s subjective experience rather than whether they fit an official diagnosis.
Distress appears 65 times in the 2022 Victorian Mental Health and Wellbeing Act, usually in the expression “mental illness or psychological distress”. By implication, distress is a broad concept akin to but not synonymous with mental ill health.
But is distress destigmatising, as it was intended to be? Apparently not. According to one study, it was more stigmatising than its alternatives. The term may turn us away from other people’s suffering by amplifying it.
So what should we call it?
Mental illness is easily the most popular generic term and its popularity has been rising. Research indicates different terms have little or no effect on stigma and some terms intended to destigmatise may backfire.
We suggest that mental illness should be embraced and the proliferation of alternative terms such as mental health problem, which breed confusion, should end.
Critics might argue mental illness imposes a medical frame. Philosopher Zsuzsanna Chappell disagrees. Illness, she argues, refers to subjective first-person experience, not to an objective, third-person pathology, like disease.
Properly understood, the concept of illness centres the individual and their connections. “When I identify my suffering as illness-like,” Chappell writes, “I wish to lay claim to a caring interpersonal relationship.”
As generic terms go, mental illness is a healthy option.
Nick Haslam, Professor of Psychology, The University of Melbourne and Naomi Baes, Researcher – Social Psychology/ Natural Language Processing, The University of Melbourne
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Whole – by Dr. T. Colin Campbell
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Most of us have at least a broad idea of what we’re supposed to be eating, what nutrients we should be getting. Many of us look at labels, and try to get our daily dose of this and that and the other.
And what we don’t get from food? There are supplements.
Dr. Campbell thinks we can do better:
Perhaps most critical in this book, where it stands out from others (we may already know, for example, that we should try to eat diverse plants and whole foods) is its treatment of why many supplements aren’t helpful.
We tend to hear “supplements are a waste of money” and sometimes they are, sometimes they aren’t. How to know the difference?
Key: things directly made from whole food sources will tend to be better. Seems reasonable, but… why? The answer lies in what else those foods contain. An apple may contain a small amount of vitamin C, less than a vitamin C tablet, but also contains a whole host of other things—tiny phytonutrients, whose machinations are mostly still mysteries to us—that go with that vitamin C and help it work much better. Lab-made supplements won’t have those.
There’s a lot more to the book… A chunk of which is a damning critique of the US healthcare system (the author argues it would be better named a sicknesscare system). We also learn about getting a good balance of macro- and micronutrients from our diet rather than having to supplement so much.
The style is conversational, while not skimping on the science. The author has had more than 150 papers published in peer-reviewed journals, and is no stranger to the relevant academia. Here, however, he focuses on making things easily comprehensible to the lay reader.
In short: if you’ve ever wondered how you’re doing at getting a good nutritional profile, and how you could do better, this is definitely the book for you.
Click here to check out “Whole” on Amazon today, and level up your daily diet!
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