Are You Taking PIMs?
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Getting Off The Overmedication Train
The older we get, the more likely we are to be on more medications. It’s easy to assume that this is because, much like the ailments they treat, we accumulate them over time. And superficially at least, that’s what happens.
And yet, almost half of people over 65 in Canada are taking “potentially inappropriate medications”, or PIMs—in other words, medications that are not needed and perhaps harmful. This categorization includes medications where the iatrogenic harms (side effects, risks) outweigh the benefits, and/or there’s a safer more effective medication available to do the job.
You may be wondering: what does this mean for the US?
Well, we don’t have the figures for the US because we’re working from Canadian research today, but given the differences between the two country’s healthcare systems (mostly socialized in Canada and mostly private in the US), it seems a fair hypothesis that if it’s almost half in Canada, it’s probably more than half in the US. Socialized healthcare systems are generally quite thrifty and seek to spend less on healthcare, while private healthcare systems are generally keen to upsell to new products/services.
The three top categories of PIMs according to the above study:
- Gabapentinoids (anticonvulsants also used to treat neuropathic pain)
- Proton pump inhibitors (PPIs)
- Antipsychotics (especially, to people without psychosis)
…but those are just the top of the list; there are many many more.
The list continues: opioids, anticholinergics, sulfonlyurea, NSAIDs, benzodiazepines and related rugs, and cholinesterase inhibitors. That’s where the Canadian study cuts off (although it also includes “others” just before NSAIDs), but still, you guessed it, there are more (we’re willing to bet statins weigh heavily in the “others” section, for a start).
There are two likely main causes of overmedication:
The side effect train
This is where a patient has a condition and is prescribed drug A, which has some undesired side effects, so the patient is prescribed drug B to treat those. However, that drug also has some unwanted side effects of its own, so the patient is prescribed drug C to treat those. And so on.
For a real-life rundown of how this can play out, check out the case study in:
The Hidden Complexities of Statins and Cardiovascular Disease (CVD)
The convenience factor
No, not convenient for you. Convenient for others. Convenient for the doctor if it gets you out of their office (socialized healthcare) or because it was easy to sell (private healthcare). Convenient for the staff in a hospital or other care facility.
This latter is what happens when, for example, a patient is being too much trouble, so the staff give them promazine “to help them settle down”, notwithstanding that promazine is, besides being a sedative, also an antipsychotic whose common side effects include amenorrhea, arrhythmias, constipation, drowsiness and dizziness, dry mouth, impotence, tiredness, galactorrhoea, gynecomastia, hyperglycemia, insomnia, hypotension, seizures, tremor, vomiting and weight gain.
This kind of thing (and worse) happens more often towards the end of a patient’s life; indeed, sometimes precipitating that end, whether you want it or not:
Mortality, Palliative Care, & Euthanasia
How to avoid it
Good practice is to be “open-mindedly skeptical” about any medication. By this we mean, don’t reject it out of hand, but do ask questions about it.
Ask your prescriber not only what it’s for and what it’ll do, but also what the side effects and risks are, and an important question that many people don’t think to ask, and for which doctors thus don’t often have a well-prepared smooth-selling reply, “what will happen if I don’t take this?”
And look up unbiased neutral information about it, from reliable sources (Drugs.com and The BNF are good reference guides for this—and if it’s important to you, check both, in case of any disagreement, as they function under completely different regulatory bodies, the former being American and the latter being British. So if they both agree, it’s surely accurate, according to best current science).
Also: when you are on a medication, keep a journal of your symptoms, as well as a log of your vitals (heart rate, blood pressure, weight, sleep etc) so you know what the medication seems to be helping or harming, and be sure to have a regular meds review with your doctor to check everything’s still right for you. And don’t be afraid to seek a second opinion if you still have doubts.
Want to know more?
For a more in-depth exploration than we have room for here, check out this book that we reviewed not long back:
To Medicate or Not? That is the Question! – by Dr. Asha Bohannon
Take care!
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Celery vs Carrot – Which is Healthier?
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Our Verdict
When comparing celery to carrot, we picked the carrot.
Why?
In terms of macros, carrot has more protein, carbs, and fiber, and is thus the “most food per food” option. The carb:fiber ratio is such that they have about the same glycemic index (when raw, anyway).
In the category of vitamins, celery has more of vitamins B9 and K, while carrot has more of vitamins A, B1, B2, B3, B5, B6, C, E, and choline. An easy win for carrot here.
When it comes to minerals, celery has more calcium and selenium, while carrot has more copper, iron, magnesium, manganese, phosphorus, potassium, and zinc. Another clear win for carrot.
In short, both are very respectable foods, but carrot simply has more in it, and it’s all good.
Enjoy!
Want to learn more?
You might like to read:
Level-Up Your Fiber Intake! (Without Difficulty Or Discomfort)
Take care!
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Intermittent Fasting, Intermittently?
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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 😎
❝Have you come across any research on alternate-day intermittent fasting—specifically switching between one day of 16:8 fasting and the next day of regular eating patterns? I’m curious if there are any benefits or drawbacks to this alternating approach, or if the benefits mainly come from consistent intermittent fasting?❞
Short and unhelpful answer: no
Longer and hopefully more helpful answer:
As you probably know, usually people going for approaches based on the above terms either
- practise 16:8 fasting (fast for 16 hours each day, eat during an 8-hour window) or
- practise alternate-day fasting (fast for 24 hours, eat whenever for 24 hours, repeat)
…which latter scored the best results in this large meta-analysis of studies:
There is also the (popular) less extreme version of alternate-day fasting, sometimes called “eat stop eat”, which is not a very helpful description because that describes almost any kind of eating/fasting, but it usually refers to “once per week, take a day off from eating”.
You can read more about each of these (and some other variants), here:
Intermittent Fasting: What’s The Truth?
What you are describing (doing 16:8 fasting on alternate days, eating whenever on the other days) is essentially: intermittent fasting, just with one 16-hour fast per 48 hours instead of per the usual 24 hours.
See also: International consensus on fasting terminology ← the section on the terms “STF & PF” covers why this gets nudged back under the regular IF umbrella
Good news: this means there is a lot of literature into the acute (i.e., occurring the same day, not long-term)* benefits of 16:8 IF, and that means that you will be getting those benefits, every second day.
You remember that meta-analysis we posted above? While it isn’t mentioned in the conclusion (which only praised complete alternate-day fasting producing the best outcomes overall), sifting through the results data discovers that time-restricted eating (which is what you are doing, by these classifications) was the only fasting method to significantly reduce fasting blood glucose levels.
(However, no significant differences were observed between any IF form and the reference (continuous energy restriction, CER, i.e. calorie-controlled) diets in fasting insulin and HbA1c levels)
*This is still good news in the long-term though, because getting those benefits every second day is better than getting those benefits on no days, and this will have a long-term impact on your healthy longevity, just like how it is better to exercise every second day than it is to exercise no days, or better to abstain from alcohol every second day than it is to abstain on no days, etc.
In short, by doing IF every second day, you are still giving your organs a break sometimes, and that’s good.
All the same, if it would be convenient and practical for you, we would encourage you to consider either the complete alternate-day fasting (which, according to a lot of data, gives the best results overall),or time-restricted eating (TRE) every day (which, according to a lot of data, gives the best fasting blood sugar levels).
You could also improve the TRE days by shifting to 20:4 (i.e., 20 hours fasting and 4 hours eating), this giving your organs a longer break on those days.
Want to learn more?
For a much more comprehensive discussion of the strengths and weaknesses of different approaches to intermitted fasting, check out:
Enjoy!
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Just Be Well – by Dr. Thomas Sult
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Firstly, what this is not: a “think yourself well” book. It’s not about just deciding to be well.
Rather, it’s about ensuring the foundations of wellness, from which the rest of good health can spring, and notably, an absence of chronic illness. In essence: enjoying chronic good health.
The prescription here is functional medicine, which stands on the shoulders of lifestyle medicine. This latter is thus briefly covered and the basics presented, but most of the book is about identifying the root causes of disease and eliminating them one by one, by taking into account the functions of the body’s processes, both in terms of pathogenesis (and thus, seeking to undermine that) and in terms of correct functioning (i.e., good health).
While the main focus of the book is on health rather than disease, he does cover a number of very common chronic illnesses, and how even in those cases where they cannot yet be outright cured, there’s a lot more that can be done for them than “take two of these and call your insurance company in the morning”, when the goal is less about management of symptoms (though that is also covered) and more about undercutting causes, and ensuring that even if one thing goes wrong, it doesn’t bring the entire rest of the system down with it (something that often happens without functional medicine).
The style is clear, simple, and written for the layperson without unduly dumbing things down.
Bottom line: if you would like glowingly good health regardless of any potential setbacks, this book can help your body do what it needs to for you.
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Fatty Acids For The Eyes & Brain: The Good And The Bad
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Good For The Eyes; Good For The Brain
We’ve written before about omega-3 fatty acids, covering the basics and some lesser-known things:
What Omega-3 Fatty Acids Really Do For Us
…and while we discussed its well-established benefits against cognitive decline (which is to be expected, because omega-3 is good against inflammation, and a large part of age-related neurodegeneration is heavily related to neuroinflammation), there’s a part of the brain we didn’t talk about in that article: the eyes.
We did, however, talk in another article about supplements that benefit the eyes and [the rest of the] brain, and the important links between the two, to the point that an examination of the levels of lutein in the retina can inform clinicians about the levels of lutein in the brain as a whole, and strongly predict Alzheimer’s disease (because Alzheimer’s patients have significantly less lutein), here:
Now, let’s tie these two ideas together
In a recent (June 2024) meta-analysis of high-quality observational studies from the US and around the world, involving nearly a quarter of a million people over 40 (n=241,151), researchers found that a higher intake of omega-3 is significantly linked to a lower risk of macular degeneration.
To put it in numbers, the highest intake of omega-3s was associated with an 18% reduced risk of early stage macular degeneration.
They also looked at a breakdown of what kinds of omega-3, and found that taking a blend DHA and EPA worked best of all, although of people who only took one kind, DHA was the best “single type” option.
You can read the paper in full, here:
Association between fatty acid intake and age-related macular degeneration: a meta-analysis
A word about trans-fatty acids (TFAs)
It was another feature of the same study that, while looking at fatty acids in general, they also found that higher consumption of trans-fatty acids was associated with a higher risk of advanced age-related macular degeneration.
Specifically, the highest intake of TFAs was associated with a more than 2x increased risk.
There are two main dietary sources of trans-fatty acids:
- Processed foods that were made with TFAs; these have now been banned in a lot of places, but only quite recently, and the ban is on the processing, not the sale, so if you buy processed foods that contain ingredients that were processed before 2021 (not uncommon, given the long life of many processed foods), the chances of them having TFAs is higher.
- Most animal products. Most notably from mammals and their milk, so beef, pork, lamb, milk, cheese, and yes even yogurt. Poultry and fish technically do also contain TFAs in most cases, but the levels are much lower.
Back to the omega-3 fatty acids…
If you’re wondering where to get good quality omega-3, well, we listed some of the best dietary sources in our main omega-3 article (linked at the top of today’s).
However, if you want to supplement, here’s an example product on Amazon that’s high in DHA and EPA, following the science of what we shared today 😎
Take care!
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How Primary Care Is Being Disrupted: A Video Primer
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How patients are seeing their doctor is changing, and that could shape access to and quality of care for decades to come.
More than 100 million Americans don’t have regular access to primary care, a number that has nearly doubled since 2014. Yet demand for primary care is up, spurred partly by record enrollment in Affordable Care Act plans. Under pressure from increased demand, consolidation, and changing patient expectations, the model of care no longer means visiting the same doctor for decades.
KFF Health News senior correspondent Julie Appleby breaks down what is happening — and what it means for patients.
More From This Investigation
Primary Care Disrupted
Known as the “front door” to the health system, primary care is changing. Under pressure from increased demand, consolidation, and changing patient expectations, the model of care no longer means visiting the same doctor for decades. KFF Health News looks at what this means for patients.
Credits
Hannah Norman Video producer and animator Oona Tempest Illustrator and creative director KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
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Fixing Fascia
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Fascia: Why (And How) You Should Take Care Of Yours
Fascia is the web-like layer of connective tissue that divides your muscles and organs from each other. It simultaneously holds some stuff in place, and allows other parts to glide over each other with minimal friction.
At least, that’s what it’s supposed to do.
Like any body part, it can go wrong. More on this later. But first…
A quick note on terms
It may seem like sometimes people say “myofascial” because it sounds fancier, but it does actually have a specific meaning too:
- “Fascia” is what we just described above
- “Myofascial” means “of or relating to muscles and fascia”
For example, “myofascial release” means “stopping the fascia from sticking to the muscle where it shouldn’t” and “myofascial pain” means “pain that has to do with the muscles and fascia”. See also:
Myofascial vs Fascia: When To Use Each One? What To Consider
Why fascia is so ignored
For millennia, it was mostly disregarded as a “neither this nor that” tissue that just happens to be in the body. We didn’t pay attention to it, just like we mostly don’t pay attention to the air around us.
But, much like the air around us, we sure pay attention when something goes wrong with it!
However, even in more recent years, we’ve been held back until quite new developments like musculoskeletal ultrasound that could show us problems with the fascia.
What can go wrong
It’s supposed to be strong, thin, supple, and slippery. It holds on in the necessary places like a spiderweb, but for the most part, it is evolved for minimum friction.
Some things can cause it to thicken and become sticky in the wrong places. Things such as:
- Physical trauma, e.g. an injury or surgery—but we repeat ourselves, because a surgery is an injury! It’s a (usually) necessary injury, but an injury nonetheless.
- Compensation for pain. If a body part hurts for some reason, and your posture changes to accommodate that, doing so can mess up your fascia, and cause you different problems somewhere else entirely.
- This is not witchcraft; think of how, when using a corded vacuum cleaner, sometimes the cord can get snagged on something in the next room and we nearly break something because we expected it to just come with us and it didn’t? It’s like that.
- Repetitive movements (repetitive strain injury is partly a myofascial issue)
- Not enough movement: when it comes to range of motion, it’s “use it or lose it”.
- The human body tries its best to be as efficient as possible for us! So eventually it will go “Hey, I notice you never move more than 30º in this direction, so I’m going to stop making fascia that allows you to go past that point, and I’ll just dump the materials here instead”
“I’ll just dump the materials here instead” is also part of the problem—it creates what we colloquially call “knots”, which are not so much part of the muscle as the fascia that covers it. That’s an actual physical sticky lumpy bit.
What to do about it
Firstly, avoid the above things! But, if for whatever reason something has gone wrong and you now have sticky lumpy fascia that doesn’t let you move the way you’d like (if you have any mobility/flexibility issues that aren’t for another known reason, then this is usually it), there are things can be done:
- Heat—is definitely not a cure-all, but it’s a good first step before doing the other things. A heating pad or a warm bath are great.
- Here’s an example of a neck+back+shoulders heating pad; you can get them for different body parts, or just use an electric blanket!
- Massage—ideally, by someone else who knows what they are doing. Self-massage is possible, as is teaching oneself (there are plenty of video tutorials available), but skilled professional therapeutic myofascial release massage is the gold standard.
- Foam rollers are a great no-skill way to get going with self-massage, whether because that’s what’s available to you, or because you just want something you can do between sessions. Here’s an example of the kind we mean.
- Acupuncture—triggering localized muscular relaxation, an important part of myofascial release, is something acupuncture is good at.
- See also: Pinpointing The Usefulness Of Acupuncture ← noteworthily, the strongest criticism of acupuncture for pain relief is that it performs only slightly better than sham acupuncture, but taken in practical terms, all that really means is “sticking little needles in does work, even if not necessarily by the mechanism acupuncturists believe”
- Calisthenics—Pilates, yoga, and other forms of body movement training can help gradually get one’s fascia to where and how it’s supposed to be.
- This is that “use it or lose it” bodily efficiency we talked about!
Remember, the body is always rebuilding itself. It never stops, until you die. So on any given day, you get to choose whether it rebuilds itself a little bit worse or a little bit better.
Take care!
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