The Bare-Bones Truth About Osteoporosis
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In yesterday’s issue of 10almonds, we asked you “at what age do you think it’s important to start worrying about osteoporosis?”, and here’s the spread of answers you gave us:
The Bare-bones Truth About Osteoporosis
In yesterday’s issue of 10almonds, we asked you “at what age do you think it’s important to start worrying about osteoporosis?”, and here’s the spread of answers you gave us:
At first glance it may seem shocking that a majority of respondents to a poll in a health-focused newsletter think it’ll never be an issue worth worrying about, but in fact this is partly a statistical quirk, because the vote of the strongest “early prevention” crowd was divided between “as a child” and “as a young adult”.
This poll also gave you the option to add a comment with your vote. Many subscribers chose to do so, explaining your choices… But, interestingly, not one single person who voted for “never” had any additional thoughts to add.
We loved reading your replies, by the way, and wish we had room to include them here, because they were very interesting and thought-provoking.
Let’s get to the myths and facts:
Top myth: “you will never need to worry about it; drink a glass of milk and you’ll be fine!”
The body is constantly repairing itself. Its ability to do that declines with age. Until about 35 on average, we can replace bone mineral as quickly as it is lost. After that, we lose it by up to 1% per year, and that rate climbs after 50, and climbs even more steeply for those who go through (untreated) menopause.
Losing 1% per year might not seem like a lot, but if you want to live to 100, there are some unfortunate implications!
About that menopause, by the way… Because declining estrogen levels late in life contribute significantly to osteoporosis, hormone replacement therapy (HRT) may be of value to many for the sake of bone health, never mind the more obvious and commonly-sought benefits.
On the topic of that glass of milk…
- Milk is a great source of calcium, which is useless to the body if you don’t also have good levels of vitamin D and magnesium.
- People’s vitamin D levels tend to directly correlate to the level of sun where they live, if supplementation isn’t undertaken.
- Plant-based milks are usually fortified with vitamin D (and calcium), by the way.
- Most people are deficient in magnesium, because green leafy things don’t form as big a part of most people’s diets as they should.
See also: An update on magnesium and bone health
Next most common myth: “bone health is all about calcium”
We spoke a little above about the importance of vitamin D and magnesium for being able to properly use that. But potassium is also critical:
Read more: The effects of potassium on bone health
While we’re on the topic…
People think of collagen as being for skin health. And it is important for that, but collagen’s benefits (and the negative effects of its absence) go much deeper, to include bone health. We’ve written about this before, so rather than take more space today, we’ll just drop the link:
We Are Such Stuff As Fish Are Made Of
Want to really maximize your bone health?
You might want to check out this well-sourced LiveStrong article:
Bone Health: Best and Worst Foods
(Teaser: leafy greens are in 2nd place, topped by sardines at #1—where do you think milk ranks?)
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Yoga for Better Sleep – by Mark Stephens
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The book has, as you might expect:
- postural exercises
- breathing exercises
- meditation exercises
Instructions given in all of the above categories are clear and easy to follow, and there are photographic illustrations too where appropriate.
What sets it apart from many books of this kind is that it also has chapters dedicated to various specific circumstances; the many actual reasons people seriously struggle to sleep; not just “screentime too late”, but for example deprepression, sleep apnea, hyperarousal, or even just aging.
As well as the comprehensive exercises, there are also many tips, tricks, hacks, and workarounds—it’s a practical guidebook with practical advice.
While the book is about yogic practices, the author also does tackle this holistically, acknowledging that there are many factors going on, and that yogic practices should be one more string to our sleep-improving bow—as we continue with other general good advice for good sleep too, have medical tests if it seems appropriate, that kind of thing. Basically, to have one’s assorted approaches work together with synergistic effect.
Bottom line: this book will quite possibly put you to sleep! But only in the best possible way.
Click here to check out Yoga for Better Sleep, and get those valuable Zs in, healthily!
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The Cough Doctor
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The Cough Doctor
This is Dr. Peter Small, who worked in epidemiology since the beginning of HIV epidemic. He became a pioneer in the field of molecular epidemiology. As such, his work was a guiding beacon for the public health response to the resurgence of tuberculosis. He’s travelled the world spending years in various institutions studying all manner of respiratory illnesses…. These have ranged from tuberculosis to pneumonia to lung cancer and (back to epidemiology) Covid-19.
He’s now the Chief Medical Officer at…
Hyfe
Hyfe, a medical AI company, was founded in 2020. Its objective: to build acoustic tools for respiratory diagnostics and monitoring.
In other words: it records coughs and collects data about coughing.
❝It’s ironic how much people focus on counting steps while ignoring cough, which is far more consequential. Hyfe is a science-driven company with the technology to make cough count. Particularly now, with increased awareness of cough and the rapid growth of digital health driven by Covid-19, this technology can improve the lives of patients, the care provided by doctors, and the efficiency of health systems.❞
~ Dr. Peter Small, CMO, Hyfe
How does it do it?
Hyfe’s AI monitors the number of times a person coughs and the sound of the cough through any smartphone or other smart device.
This data collected over time provides increasingly more reliable information than a single visit to the doctor! By constantly listening and analyzing, it can detect patterns that might otherwise go unnoticed.
How big is this “big data” effort?
Hyfe maintains the largest cough dataset in the world. This means it can compare the sound of a patient’s cough with more than 400 million cough-like sounds from 83 countries across all continents.
The human brain doesn’t handle big numbers well. So, just to illustrate: if the average cough is 1 second long, that means it’d take more than 12 years to listen to them all.
Hyfe, meanwhile, can:
- listen to many things simultaneously
- index them all against user and location,
- use its ever-growing neural net to detect and illustrate patterns.
It’s so attentive, that it can learn to distinguish between different people’s coughs in the same household.
❝Companies like Google Health see even basic information such as getting an accurate count of the number of times a person coughs a day as a useful resource, and part of a larger need to collect and chronicle more health information to refine the way doctors diagnose disease and manage treatments in the future.❞
What are the public health implications?
The most obvious application is to note when there’s a spike in coughing, and see how such spikes grow and spread (if they do), to inform of contagion risks.
Another is to cross-reference it with data about local environmental allergens. Knowing how things like pollution and even pollen affect individuals differently could be helpful in identifying (and managing) chronic conditions like asthma.
What are the private health implications?
❝It’s going to transform the whole clinical approach for this common and chronic symptom. Patients will come in, have the data on how much they are coughing, and the physician can suggest a treatment based on that information to see if it makes the coughs better❞
~ Dr. Peter Small
Dr. Small’s colleague Dr. Cai, speaking for Google Health on this project, sees even more utility for diagnostics:
❝When I was in medical school, never ever did they teach us that we could listen to somebody cough and identify whether that person has TB (tuberculosis), COPD, or a tumor. But I keep seeing more and more studies of people coughing into a microphone, and an algorithm can detect whether somebody has TB with 95% specificity and sensitivity, or if someone has pneumonia or an exacerbation of COPD❞
~ Dr. Lawrence Cai
And the privacy implications?
Perhaps you don’t quite fancy the idea of not being able to cough without Google knowing about it. Hyfe’s software is currently opt-in, but…
If you cough near someone else’s Hyfe app, their app will recognize you’re not the app’s user, and start building a profile for you. Of course, that won’t be linked to your name, email address, or other IDs, as it would if you were the app’s user.
Hyfe will ask to connect to your social media, to collect more information about you and your friends.
Whether you’d like to try this or perhaps you’re just curious to learn more about this fascinating project, you can check out:
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Lobster vs Crab – Which is Healthier?
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Our Verdict
When comparing lobster to crab, we picked the crab.
Why?
Generally speaking, most seafood is healthy in moderation (assuming it’s well-prepared, not poisonous, and you don’t have an allergy), and for most people, these two sea creatures are indeed considered a reasonable part of a healthy balanced diet.
In terms of macros, they’re comparable in protein, and technically crab has about 2x the fat, but in both cases it’s next to nothing, so 2x almost nothing is still almost nothing. And, if we break down the lipids profiles, crab has a sufficiently smaller percentage of saturated fat (compared to monounsaturated and polyunsaturated), that crab actually has less saturated fat than lobster. In balance, the category of macros is either a tie or a slight win for crab, depending on your personal priorities.
When it comes to vitamins, crab wins easily with more of vitamins A, B1, B2, B6, B9, B12, and C, in most cases by considerable margins (we’re talking multiples of what lobster has). Lobster, meanwhile, has more of vitamin B3 (tiny margin) and vitamin B5 (pantothenic acid, as in, the vitamin that’s in basically everything edible, and thus almost impossible to be deficient in unless literally starving).
The minerals scene is more balanced; lobster has more calcium, copper, manganese, and selenium, while crab has more iron, magnesium, phosphorus, potassium, and zinc. The margins are comparable from one creature to another, so all in all the 4:5 score means a modest win for crab.
Both of these creatures are good sources of omega-3 fatty acids, but crab is better.
Lobster and crab are both somewhat high in cholesterol, but crab is the relatively lower of the two.
In short: for most people most of the time, both are fine to enjoy in moderation, but if picking one, crab is the healthier by most metrics.
Want to learn more?
You might like to read:
Shrimp vs Caviar – Which is Healthier?
Take care!
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Waist Size Worries: Age-Appropriate Solutions
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
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
❝My BMI is fine, but my waist is too big. What do I do about that? I am 5′ 5″ tall and 128 pounds and 72 years old.❞
It’s hard to say without knowing about your lifestyle (and hormones, for that matter)! But, extra weight around the middle in particular is often correlated with high levels of cortisol, so you might find this of benefit:
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When BMI Doesn’t Measure Up
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When BMI Doesn’t Quite Measure Up
Last month, we did a “Friday Mythbusters” edition of 10almonds, tackling many of the misconceptions surrounding obesity. Amongst them, we took a brief look at the usefulness (or lack thereof) of the Body Mass Index (BMI) scale of weight-related health for individuals. By popular subscriber request, we’re now going to dive a little deeper into that today!
The wrong tool for the job
BMI was developed as a tool to look at large-scale demographic trends, stemming from a population study of white European men, who were for the purpose of the study (the widescale health of the working class in that geographic area in that era), considered a reasonable default demographic.
In other words: as a system, it’s now being used in a way it was never made for, and the results of that misappropriation of an epidemiological tool for individual health are predictably unhelpful.
If you want to know yours…
Here’s the magic formula for calculating your BMI:
- Metric: divide your weight in kilograms by your height in square meters
- Imperial: divide your weight in pounds by your height in square inches and then multiply by 703
“What if my height doesn’t come in square meters or square inches, because it’s a height, not an area?”
We know. Take your height and square it anyway. If this seems convoluted and arbitrary, yes, it is.
But!
While on the one hand it’s convoluted and arbitrary… On the other hand, it’s also a gross oversimplification. So, yay for the worst of both worlds?
If you don’t want to grab a calculator, here’s a quick online tool to calculate it for you.
So, how did you score?
According to the CDC, a BMI score…
- Under 18.5 is underweight
- 18.5 to 24.9 is normal
- 25 to 29.9 is overweight
- 30 and over is obese
And, if we’re looking at a representative sample of the population, where the representation is average white European men of working age, that’s not a bad general rule of thumb.
For the rest of us, not so representative
BMI is a great and accurate tool as a rule of thumb, except for…
Women
An easily forgotten demographic, due to being a mere 51% of the world’s population, women generally have a higher percentage of body fat than men, and this throws out BMI’s usefulness.
If pregnant or nursing
A much higher body weight and body fat percentage—note that these are two things, not one. Some of the extra weight will be fat to nourish the baby; some will be water weight, and if pregnant, some will be the baby (or babies!). BMI neither knows nor cares about any of these things. And, this is a big deal, because BMI gets used by healthcare providers to judge health risks and guide medical advice.
People under the age of 16 or over the age of 65
Not only do people below and above those ages (respectively) tend to be shorter—which throws out the calculations and mean health risks may increase before the BMI qualifies as overweight—but also:
- BMI under 23 in people over the age of 65 is associated with a higher health risk
- A meta-analysis showed that a BMI of 27 was the best in terms of decreased mortality risk for the over-65 age group
This obviously flies in the face of conventional standards regards BMI—as you’ll recall from the BMI brackets we listed above.
Read the science: BMI and all-cause mortality in older adults: a meta-analysis
Athletic people
A demographic often described in scientific literature as “athletes”, but that can be misleading. When we say “athletes”, what comes to mind? Probably Olympians, or other professional sportspeople.
But also athletic, when it comes to body composition, are such people as fitness enthusiasts and manual laborers. Which makes for a lot more people affected by this!
Athletic people tend to have more lean muscle mass (muscle weighs more than fat), and heavier bones (can’t build strong muscles on weak bones, so the bones get stronger too, which means denser)… But that lean muscle mass can actually increase metabolism and help ward off many of the very same things that BMI is used as a risk indicator for (e.g. heart disease, and diabetes). So people in this category will actually be at lower risk, while (by BMI) getting told they are at higher risk.
If not white
Physical characteristics of race can vary by more than skin color, relevant considerations in this case include, for example:
- Black people, on average, not only have more lean muscle mass and less fat than white people, but also, have completely different risk factors for diseases such as diabetes.
- Asian people, on average, are shorter than white people, and as such may see increased health risks before BMI qualifies as overweight.
- Hispanic people, on average, again have different physical characteristics that throw out the results, in a manner that would need lower cutoffs to be even as “useful” as it is for white people.
Further reading on this: BMI and the BIPOC Community
In summary:
If you’re an average white European working-age man, BMI can sometimes be a useful general guide. If however you fall into one or more of the above categories, it is likely to be inaccurate at best, if not outright telling the opposite of the truth.
What’s more useful, then?
For heart disease risk and diabetes risk both, waist circumference is a much more universally reliable indicator. And since those two things tend to affect a lot of other health risks, it becomes an excellent starting point for being aware of many aspects of health.
Pregnancy will still throw off waist circumference a little (measure below the bump, not around it!), but it will nevertheless be more helpful than BMI even then, as it becomes necessary to just increase the numbers a little, according to gestational month and any confounding factors e.g. twins, triplets, etc. Ask your obstetrician about this, as it’s beyond the scope of today’s newsletter!
As to what’s considered a risk:
- Waist circumference of more than 35 inches for women
- Waist circumference of more than 40 inches for men
These numbers are considered applicable across demographics of age, sex, ethnicity, and lifestyle.
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Why You’re Tired & How To Fix It
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This is Sadia Badiei. A dietician by academic and professional background, she’s nowadays hung up her lab coat for a chef’s jacket, and is best known for her “Pick Up Limes” brand. Today, we’ll be taking her advice on managing energy levels with what’s on our plates!
Quick note: our usual medical/legal disclaimer applies, and this article cannot diagnose you from afar, and thus neither can it make any certain prescription; this is for educational purposes, and aimed at being applicable to most of our readers.
There are many possible things that can cause chronic fatigue, and not all of them can be fixed by diet. Your doctor will have access to tests and such that we, being a humble health science publication, do not.
You may recognize her; we’ve featured her videos occasionally, mostly recently:
Pick Up A Zest For Life: 10 Lessons For A Healthy Mind & Body
But, what does she want us to know about living life with more energy?
It starts with balance
Badiei makes the case that we should strive for a nutritionally-balanced diet; that may not come as much of a revelation, but what does that look like for a vegan (Badiei advocates for plant-based eating)?
She recommends that our diet consist of:
- About 50% fruits and vegetables
- About 25% grains and starches
- About 25% proteins
- Modest amounts of fats
- A little of well-chosen dairy substitutions
- Finally, a few judicious supplements to top it off
That does add up to more than 100%, but 1) we did say “About n%” and 2) this is not a bad thing to note, actually, since Badiei advocates (as we do) for focussing more on what we add into our diet, rather than what we take out.
Breaking it down a little further, she recommends making sure to get “the foundational seven”, which is a little like “Dr. Greger’s Daily Dozen”, but in this case it’s counted on a per-food-type basis.
Thus, she recommends:
- Dark green leafy vegetables
- Assorted other non-starchy vegetables (your choice what kind)
- Fruit, of any kinds (unlike Dr. Greger separating berries)
- Grains and starches (so for example, potatoes are lumped in with rice here, botanically very different, but often fulfil a similar culinary role)
- Nuts and seeds
- Legumes
- Fortified dairy alternatives
For full details including how much of each, and “what counts”, etc, see:
Pick Up Limes | The Nourish Method
Time your carbs
Slow-release carbohydrates, those with the most fiber, are best most of the time, giving us more sustained fuel, keeping us energized for longer after meals—even if we would rather sleep:
She cites: Fiber and Saturated Fat Are Associated with Sleep Arousals and Slow Wave Sleep
Quick-release carbohydrates, those with what’s generally considered a less favorable carb:fiber ratio, are best if we’re going to eat nearer to bedtime. We know, eating before bed is often considered a bit of a no-no, but Badiei bids us indulge if we so desire, as the quicker-absorbed carbohydrates support tryptophan reaching our brain more efficiently, and thus promote sleep onset.
See also: Should You Go Light Or Heavy On Carbs?
About that fat
We mentioned (or rather, Badiei’s citation mentioned) saturated fat. It is indeed linked with difficulty falling asleep, and/but omega-3 fatty acids, on the other hand, promote better sleep.
She cites: The relationship between sleep duration, sleep quality and dietary intake in adults
While you’re enjoying those nuts and seeds (for the omega-3 fatty acids), you might also note that several also star in Badiei’s list of plant-based foods that are rich in tryptophan, such as soy, cashews, pumpkin seeds, sunflower seeds, beans, green vegetables, and mushrooms.
Micronutrients
Badiei’s focus here is on B-vitamins, iron, magnesium, selenium, and zinc. We imagine most of our readers here are taking steps to ensure to get a full daily coverage of vitamins and minerals anyway, but you might want to read what she has to say about iron on a plant-based diet, because the numbers may be different than you think.
The reason for this is that while animal products contain mostly heme iron, which is easier to absorb but associated with a risk increase in some diseases, plant-based foods usually* contain only non-heme iron, which is healthier but not as bioavailable, so if eating only plants, we need more of it:
Pick Up Limes | Iron on a Plant-Based Diet
*If you eat a carnivorous plant, guess what, it’ll have heme iron in it, tangling that food web.
“What if I know I have chronic fatigue for non-dietary reasons?”
Well, that sucks, and we’re not going to pretend the above will magically fix it. However, there are still things that can at least relatively improve your experience:
Eat To Beat Chronic Fatigue! Yes, Even When Fatigued Chronically
(it’s a good guide to being able to consistently eat healthily when your energy levels are consistently at minimal, meaning that a lot of common advice becomes unusable)
Take care!
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