Pain Doesn’t Belong on a Scale of Zero to 10

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Over the past two years, a simple but baffling request has preceded most of my encounters with medical professionals: “Rate your pain on a scale of zero to 10.”

I trained as a physician and have asked patients the very same question thousands of times, so I think hard about how to quantify the sum of the sore hips, the prickly thighs, and the numbing, itchy pain near my left shoulder blade. I pause and then, mostly arbitrarily, choose a number. “Three or four?” I venture, knowing the real answer is long, complicated, and not measurable in this one-dimensional way.

Pain is a squirrely thing. It’s sometimes burning, sometimes drilling, sometimes a deep-in-the-muscles clenching ache. Mine can depend on my mood or how much attention I afford it and can recede nearly entirely if I’m engrossed in a film or a task. Pain can also be disabling enough to cancel vacations, or so overwhelming that it leads people to opioid addiction. Even 10+ pain can be bearable when it’s endured for good reason, like giving birth to a child. But what’s the purpose of the pains I have now, the lingering effects of a head injury?

The concept of reducing these shades of pain to a single number dates to the 1970s. But the zero-to-10 scale is ubiquitous today because of what was called a “pain revolution” in the ’90s, when intense new attention to addressing pain — primarily with opioids — was framed as progress. Doctors today have a fuller understanding of treating pain, as well as the terrible consequences of prescribing opioids so readily. What they are learning only now is how to better measure pain and treat its many forms.

About 30 years ago, physicians who championed the use of opioids gave robust new life to what had been a niche specialty: pain management. They started pushing the idea that pain should be measured at every appointment as a “fifth vital sign.” The American Pain Society went as far as copyrighting the phrase. But unlike the other vital signs — blood pressure, temperature, heart rate, and breathing rate — pain had no objective scale. How to measure the unmeasurable? The society encouraged doctors and nurses to use the zero-to-10 rating system. Around that time, the FDA approved OxyContin, a slow-release opioid painkiller made by Purdue Pharma. The drugmaker itself encouraged doctors to routinely record and treat pain, and aggressively marketed opioids as an obvious solution.

To be fair, in an era when pain was too often ignored or undertreated, the zero-to-10 rating system could be regarded as an advance. Morphine pumps were not available for those cancer patients I saw in the ’80s, even those in agonizing pain from cancer in their bones; doctors regarded pain as an inevitable part of disease. In the emergency room where I practiced in the early ’90s, prescribing even a few opioid pills was a hassle: It required asking the head nurse to unlock a special prescription pad and making a copy for the state agency that tracked prescribing patterns. Regulators (rightly) worried that handing out narcotics would lead to addiction. As a result, some patients in need of relief likely went without.

After pain doctors and opioid manufacturers campaigned for broader use of opioids — claiming that newer forms were not addictive, or much less so than previous incarnations — prescribing the drugs became far easier and were promoted for all kinds of pain, whether from knee arthritis or back problems. As a young doctor joining the “pain revolution,” I probably asked patients thousands of times to rate their pain on a scale of zero to 10 and wrote many scripts each week for pain medication, as monitoring “the fifth vital sign” quickly became routine in the medical system. In time, a zero-to-10 pain measurement became a necessary box to fill in electronic medical records. The Joint Commission on the Accreditation of Healthcare Organizations made regularly assessing pain a prerequisite for medical centers receiving federal health care dollars. Medical groups added treatment of pain to their list of patient rights, and satisfaction with pain treatment became a component of post-visit patient surveys. (A poor showing could mean lower reimbursement from some insurers.)

But this approach to pain management had clear drawbacks. Studies accumulated showing that measuring patients’ pain didn’t result in better pain control. Doctors showed little interest in or didn’t know how to respond to the recorded answer. And patients’ satisfaction with their doctors’ discussion of pain didn’t necessarily mean they got adequate treatment. At the same time, the drugs were fueling the growing opioid epidemic. Research showed that an estimated 3% to 19% of people who received a prescription for pain medication from a doctor developed an addiction.

Doctors who wanted to treat pain had few other options, though. “We had a good sense that these drugs weren’t the only way to manage pain,” Linda Porter, director of the National Institutes of Health’s Office of Pain Policy and Planning, told me. “But we didn’t have a good understanding of the complexity or alternatives.” The enthusiasm for narcotics left many varietals of pain underexplored and undertreated for years. Only in 2018, a year when nearly 50,000 Americans died of an overdose, did Congress start funding a program — the Early Phase Pain Investigation Clinical Network, or EPPIC-Net — designed to explore types of pain and find better solutions. The network connects specialists at 12 academic specialized clinical centers and is meant to jump-start new research in the field and find bespoke solutions for different kinds of pain.

A zero-to-10 scale may make sense in certain situations, such as when a nurse uses it to adjust a medication dose for a patient hospitalized after surgery or an accident. And researchers and pain specialists have tried to create better rating tools — dozens, in fact, none of which was adequate to capture pain’s complexity, a European panel of experts concluded. The Veterans Health Administration, for instance, created one that had supplemental questions and visual prompts: A rating of 5 correlated with a frown and a pain level that “interrupts some activities.” The survey took much longer to administer and produced results that were no better than the zero-to-10 system. By the 2010s, many medical organizations, including the American Medical Association and the American Academy of Family Physicians, were rejecting not just the zero-to-10 scale but the entire notion that pain could be meaningfully self-reported numerically by a patient.

In the years that opioids had dominated pain remedies, a few drugs — such as gabapentin and pregabalin for neuropathy, and lidocaine patches and creams for musculoskeletal aches — had become available. “There was a growing awareness of the incredible complexity of pain — that you would have to find the right drugs for the right patients,” Rebecca Hommer, EPPIC-Net’s interim director, told me. Researchers are now looking for biomarkers associated with different kinds of pain so that drug studies can use more objective measures to assess the medications’ effect. A better understanding of the neural pathways and neurotransmitters that create different types of pain could also help researchers design drugs to interrupt and tame them.

Any treatments that come out of this research are unlikely to be blockbusters like opioids; by design, they will be useful to fewer people. That also makes them less appealing prospects to drug companies. So EPPIC-Net is helping small drug companies, academics, and even individual doctors design and conduct early-stage trials to test the safety and efficacy of promising pain-taming molecules. That information will be handed over to drug manufacturers for late-stage trials, all with the aim of getting new drugs approved by the FDA more quickly.

The first EPPIC-Net trials are just getting underway. Finding better treatments will be no easy task, because the nervous system is a largely unexplored universe of molecules, cells, and electronic connections that interact in countless ways. The 2021 Nobel Prize in Physiology or Medicine went to scientists who discovered the mechanisms that allow us to feel the most basic sensations: cold and hot. In comparison, pain is a hydra. A simple number might feel definitive. But it’s not helping anyone make the pain go away.

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.

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  • Red Lentils vs Green Lentils – Which is Healthier?

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    Our Verdict

    When comparing red lentils to green lentils, we picked the green.

    Why?

    Yes, they’re both great. But there are some clear distinctions!

    First, know: red lentils are, secretly, hulled brown lentils. Brown lentils are similar to green lentils, just a little less popular and with (very) slightly lower nutritional values, as a rule.

    By hulling the lentils, the first thing that needs mentioning is that they lose some of their fiber, since this is what was removed. While we’re talking macros, this does mean that red lentils have proportionally more protein, because of the fiber weight lost. However, because green lentils are still a good source of protein, we think the fat that green lentils have much more fiber is a point in their favor.

    In terms of micronutrients, they’re quite similar in vitamins (mostly B-vitamins, of which, mostly folate / vitamin B9), and when it comes to minerals, they’re similarly good sources of iron, but green lentils contain more magnesium and potassium.

    Green lentils also contain more antixoidants.

    All in all, they both continue to be very respectable parts of anyone’s diet—but in a head-to-head, green lentils do come out on top (unless you want to prioritize slightly higher protein above everything else, in which case, red).

    Want to get some in? Here are the specific products we featured today:

    Red Lentils | Green Lentils

    Enjoy!

    Want to learn more?

    You might like to read:

    Take care!

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  • You can now order all kinds of medical tests online. Our research shows this is (mostly) a bad idea

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Elena.Katkova/Shutterstock

    Many of us have done countless rapid antigen tests (RATs) over the course of the pandemic. Testing ourselves at home has become second nature.

    But there’s also a growing worldwide market in medical tests sold online directly to the public. These are “direct-to-consumer” tests, and you can access them without seeing a doctor.

    While this might sound convenient, the benefits to most consumers are questionable, as we discovered in a recent study.

    What are direct-to-consumer tests?

    Let’s start with what they’re not. We’re not talking about patients who are diagnosed with a condition, and use tests to monitor themselves (for example, finger-prick testing to monitor blood sugar levels for people with diabetes).

    We’re also not talking about home testing kits used for population screening, such as RATs for COVID, or the “poo tests” sent to people aged 50 and over for bowel cancer screening.

    Direct-to-consumer tests are products marketed to anyone who is willing to pay, without going through their GP. They can include hormone profiling tests, tests for thyroid disease and food sensitivity tests, among many others.

    Some direct-to-consumer tests allow you to complete the test at home, while self-collected lab tests give you the equipment to collect a sample, which you then send to a lab. You can now also buy pathology requests for a lab directly from a company without seeing a doctor.

    Hands preparing a RAT.
    We’ve all become accustomed to RATs during the pandemic.
    Ground Picture/Shutterstock

    What we did in our study

    We searched (via Google) for direct-to-consumer products advertised for sale online in Australia between June and December 2021. We then assessed whether each test was likely to provide benefits to those who use them based on scientific literature published about the tests, and any recommendations either for or against their use from professional medical organisations.

    We identified 103 types of tests and 484 individual products ranging in price from A$12.99 to A$1,947.

    We concluded only 11% of these tests were likely to benefit most consumers. These included tests for STIs, where social stigma can sometimes discourage people from testing at a clinic.

    A further 31% could possibly benefit a person, if they were at higher risk. For example, if a person had symptoms of thyroid disease, a test may benefit them. But the Royal Australian College of General Practitioners does not recommend testing for thyroid disease in people without symptoms because evidence showing benefits of identifying and treating people with early thyroid disease is lacking.

    Some 42% were commercial “health checks” such as hormone and nutritional status tests. Although these are legitimate tests – they may be ordered by a doctor in certain circumstances, or be used in research – they have limited usefulness for consumers.

    A test of your hormone or vitamin levels at a particular time can’t do much to help you improve your health, especially because test results change depending on the time of day, month or season you test.

    Most worryingly, 17% of the tests were outright “quackery” that wouldn’t be recommended by any mainstream health practitioner. For example, hair analysis for assessing food allergies is unproven and can lead to misdiagnosis and ineffective treatments.

    More than half of the tests we looked at didn’t state they offered a pre- or post-test consultation.

    A woman opening a box, which sits on her lap.
    Ordering medical tests online probably isn’t a good idea.
    fizkes/Shutterstock

    Products available may change outside the time frame of our study, and direct-to-consumer tests not promoted or directly purchasable online, such as those offered in pharmacies or by commercial health clinics, were not included.

    But in Australia, ours is the first and only study we know of mapping the scale and variety of direct-to-consumer tests sold online.

    Research from other countries has similarly found a lack of evidence to support the majority of direct-to-consumer tests.

    4 questions to ask before you buy a test online

    Many direct-to-consumer tests offer limited benefits, and could even lead to harms. Here are four questions you should ask yourself if you’re considering buying a medical test online.

    1. If I do this test, could I end up with extra medical appointments or treatments I don’t need?

    Doing a test yourself might seem harmless (it’s just information, after all), but unnecessary tests often find issues that would never have caused you problems.

    For example, someone taking a diabetes test may find moderately high blood sugar levels see them labelled as “pre-diabetic”. However, this diagnosis has been controversial, regarded by many as making patients out of healthy people, a large number of whom won’t go on to develop diabetes.

    2. Would my GP recommend this test?

    If you have worrying symptoms or risk factors, your GP can recommend the best tests for you. Tests your GP orders are more likely to be covered by Medicare, so will cost you a lot less than a direct-to-consumer test.

    3. Is this a good quality test?

    A good quality home self-testing kit should indicate high sensitivity (the proportion of true cases that will be accurately detected) and high specificity (the proportion of people who don’t have the disease who will be accurately ruled out). These figures should ideally be in the high 90s, and clearly printed on the product packaging.

    For tests analysed in a lab, check if the lab is accredited by the National Association of Testing Authorities. Avoid tests sent to overseas labs, where Australian regulators can’t control the quality, or the protection of your sample or personal health information.

    4. Do I really need this test?

    There are lots of reasons to want information from a test, like peace of mind, or just curiosity. But unless you have clear symptoms and risk factors, you’re probably testing yourself unnecessarily and wasting your money.

    Direct-to-consumer tests might seem like a good idea, but in most cases, you’d be better off letting sleeping dogs lie if you feel well, or going to your GP if you have concerns.The Conversation

    Patti Shih, Senior Lecturer, Australian Centre for Health Engagement, Evidence and Values, University of Wollongong; Fiona Stanaway, Associate Professor in Clinical Epidemiology, University of Sydney; Katy Bell, Associate Professor in Clinical Epidemiology, Sydney School of Public Health, University of Sydney, and Stacy Carter, Professor and Director, Australian Centre for Health Engagement, Evidence and Values, University of Wollongong

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Does intermittent fasting increase or decrease our risk of cancer?

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    Research over the years has suggested intermittent fasting has the potential to improve our health and reduce the likelihood of developing cancer.

    So what should we make of a new study in mice suggesting fasting increases the risk of cancer?

    Stock-Asso/Shutterstock

    What is intermittent fasting?

    Intermittent fasting means switching between times of eating and not eating. Unlike traditional diets that focus on what to eat, this approach focuses on when to eat.

    There are lots of commonly used intermittent fasting schedules. The 16/8 plan means you only eat within an eight-hour window, then fast for the remaining 16 hours. Another popular option is the 5:2 diet, where you eat normally for five days then restrict calories for two days.

    In Australia, poor diet contributes to 7% of all cases of disease, including coronary heart disease, stroke, type 2 diabetes, and cancers of the bowel and lung. Globally, poor diet is linked to 22% of deaths in adults over the age of 25.

    Intermittent fasting has gained a lot of attention in recent years for its potential health benefits. Fasting influences metabolism, which is how your body processes food and energy. It can affect how the body absorbs nutrients from food and burns energy from sugar and fat.

    What did the new study find?

    The new study, published in Nature, found when mice ate again after fasting, their gut stem cells, which help repair the intestine, became more active. The stem cells were better at regenerating compared with those of mice who were either totally fasting or eating normally.

    This suggests the body might be better at healing itself when eating after fasting.

    However, this could also have a downside. If there are genetic mutations present, the burst of stem cell-driven regeneration after eating again might make it easier for cancer to develop.

    Polyamines – small molecules important for cell growth – drive this regeneration after refeeding. These polyamines can be produced by the body, influenced by diet, or come from gut bacteria.

    The findings suggest that while fasting and refeeding can improve stem cell function and regeneration, there might be a tradeoff with an increased risk of cancer, especially if fasting and refeeding cycles are repeated over time.

    While this has been shown in mice, the link between intermittent fasting and cancer risk in humans is more complicated and not yet fully understood.

    What has other research found?

    Studies in animals have found intermittent fasting can help with weight loss, improve blood pressure and blood sugar levels, and subsequently reduce the risks of diabetes and heart disease.

    Research in humans suggests intermittent fasting can reduce body weight, improve metabolic health, reduce inflammation, and enhance cellular repair processes, which remove damaged cells that could potentially turn cancerous.

    However, other studies warn that the benefits of intermittent fasting are the same as what can be achieved through calorie restriction, and that there isn’t enough evidence to confirm it reduces cancer risk in humans.

    What about in people with cancer?

    In studies of people who have cancer, fasting has been reported to protect against the side effects of chemotherapy and improve the effectiveness of cancer treatments, while decreasing damage to healthy cells.

    Prolonged fasting in some patients who have cancer has been shown to be safe and may potentially be able to decrease tumour growth.

    On the other hand, some experts advise caution. Studies in mice show intermittent fasting could weaken the immune system and make the body less able to fight infection, potentially leading to worse health outcomes in people who are unwell. However, there is currently no evidence that fasting increases the risk of bacterial infections in humans.

    So is it OK to try intermittent fasting?

    The current view on intermittent fasting is that it can be beneficial, but experts agree more research is needed. Short-term benefits such as weight loss and better overall health are well supported. But we don’t fully understand the long-term effects, especially when it comes to cancer risk and other immune-related issues.

    Since there are many different methods of intermittent fasting and people react to them differently, it’s hard to give advice that works for everyone. And because most people who participated in the studies were overweight, or had diabetes or other health problems, we don’t know how the results apply to the broader population.

    For healthy people, intermittent fasting is generally considered safe. But it’s not suitable for everyone, particularly those with certain medical conditions, pregnant or breastfeeding women, and people with a history of eating disorders. So consult your health-care provider before starting any fasting program.

    Amali Cooray, PhD Candidate in Genetic Engineering and Cancer, WEHI (Walter and Eliza Hall Institute of Medical Research)

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • What Are The “Bright Lines” Of Bright Line Eating?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    This is Dr. Susan Thompson. She’s a cognitive neuroscientist who has turned her hand to helping people to lose weight and maintain it at a lower level, using psychology to combat overeating. She is the founder of “Bright Line Eating”.

    We’ll say up front: it’s not without some controversy, and we’ll address that as we go, but we do believe the ideas are worth examining, and then we can apply them or not as befits our personal lives.

    What does she want us to know?

    Bright Line Eating’s general goal

    Dr. Thompson’s mission statement is to help people be “happy, thin, and free”.

    You will note that this presupposes thinness as desirable, and presumes it to be healthy, which frankly, it’s not for everyone. Indeed, for people over a certain age, having a BMI that’s slightly into the “overweight” category is a protective factor against mortality (which is partly a flaw of the BMI system, but is an interesting observation nonetheless):

    When BMI Doesn’t Quite Measure Up

    Nevertheless, Dr. Thompson makes the case for the three items (happy, thin, free) coming together, which means that any miserable or unhealthy thinness is not what the approach is valuing, since it is important for “thin” to be bookended by “happy” and “free”.

    What are these “bright lines”?

    Bright Line Eating comes with 4 rules:

    1. No flour (no, not even wholegrain flour; enjoy whole grains themselves yes, but flour, no)
    2. No sugar (and as a tag-along to this, no alcohol) (sugars naturally found in whole foods, e.g. the sugar in an apple if eating an apple, is ok, but other kinds are not, e.g. foods with apple juice concentrate as a sweetener; no “natural raw cane sugar” etc is not allowed either; despite the name, it certainly doesn’t grow on the plant like that)
    3. No snacking, just three meals per day(not even eating the ingredients while cooking—which also means no taste-testing while cooking)
    4. Weigh all your food (have fun in restaurants—but more seriously, the idea here is to plan each day’s 3 meals to deliver a healthy macronutrient balance and a capped calorie total).

    You may be thinking: “that sounds dismal, and not at all bright and cheerful, and certainly not happy and free”

    The name comes from the idea that these rules are lines that one does not cross. They are “bright” lines because they should be observed with a bright and cheery demeanour, for they are the rules that, Dr. Thompson says, will make you “happy, thin, and free”.

    You will note that this is completely in opposition to the expert opinion we hosted last week:

    What Flexible Dieting Really Means

    Dr. Thompson’s position on “freedom” is that Bright Line Eating is “very structured and takes a liberating stand against moderation”

    Which may sound a bit of an oxymoron—is she really saying that we are going to be made free from freedom?

    But there is some logic to it, and it’s about the freedom from having to make many food-related decisions at times when we’re likely to make bad ones:

    Where does the psychology come in?

    Dr. Thompson’s position is that willpower is a finite, expendable resource, and therefore we should use it judiciously.

    So, much like Steve Jobs famously wore the same clothes every day because he had enough decisions to make later in the day that he didn’t want unnecessary extra decisions to make… Bright Line Eating proposes that we make certain clear decisions up front about our eating, so then we don’t have to make so many decisions (and potentially the wrong decisions) later when hungry.

    You may be wondering: ”doesn’t sticking to what we decided still require willpower?”

    And… Potentially. But the key here is shutting down self-negotiation.

    Without clear lines drawn in advance, one must decide, “shall I have this cake or not?”, perhaps reflecting on the pros and cons, the context of the situation, the kind of day we’re having, how hungry we are, what else there is available to eat, what else we have eaten already, etc etc.

    In short, there are lots of opportunities to rationalize the decision to eat the cake.

    With clear lines drawn in advance, one must decide, “shall I have this cake or not?” and the answer is “no”.

    So while sticking to that pre-decided “no” still may require some willpower, it no longer comes with a slew of tempting opportunities to rationalize a “yes”.

    Which means a much greater success rate, both in adherence and outcomes. Here’s an 8-week interventional study and 2-year follow-up:

    Bright Line Eating | Research Publications

    Counterpoint: pick your own “bright lines”

    Dr. Thompson is very keen on her 4 rules that have worked for her and many people, but she recognizes that they may not be a perfect fit for everyone.

    So, it is possible to pick and choose our own “bright lines”; it is after all a dietary approach, not a religion. Here’s her response to someone who adopted the first 3 rules, but not the 4th:

    Bright Lines as Guidelines for Weight Loss

    The most important thing for Bright Line Eating, therefore, is perhaps the action of making clear decisions in advance and sticking to them, rather than seat-of-the-pantsing our diet, and with it, our health.

    Want to know more from Dr. Thompson?

    You might like her book, which we reviewed a while ago:

    Bright Line Eating – by Dr. Susan Peirce Thompson

    Enjoy!

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  • To Err Is Human; To Forgive, Healthy

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    How To Forgive (And Why)

    There’s an old saying that holding onto a grudge is like drinking poison and expecting the other person to die. If only it were so simple and easy as just choosing to let go!

    But it’s not, is it?

    When people have wronged us and/or wronged our loved ones, it’s hard to forgive, especially if they have not changed. For that matter, it can be hard to forgive ourselves for mistakes that we made, too.

    Either way, “drinking that poison” can be close to literal, in terms of what harboring such anger and resentment can do for our cortisol levels.

    So, what to do about it?

    If you have a dialogue with the person, our previous article on communication may help a lot.

    If you don’t, there are various other angles that can be taken:

    The Unsent Letter

    You can even send it, if you like, but it’s not the point here. The idea is to write to the person, expressing your grievances. But, (as per the above-linked article on communication) try to focus at least as much on your feelings as their actions. “When you did/said x, I felt y”, etc.

    This is important for helping you process your feelings. If you send the letter, it’s also important for the other person to be able to understand your feelings.

    Sometimes, we feel the things we do so strongly because we don’t have an outlet for them. Pouring out our emotions in such a fashion, on the other hand, means (to labor the metaphor) they’re no longer bottled up. Even just in and of itself, that can provide us a lot of relief.

    And when we the negative emotions are no longer such high pressure, it can be easier to let go of them.

    Mindfulness

    Following on from the above idea, a good strategy can be simply sitting and feeling everything you need to feel, noticing it without judgement, like a curious observer.

    Sometimes what we need is just to be heard, and that starts with hearing ourselves.

    Compassion

    There’s a Buddhist exercise that involves actively feeling compassion for three people: a loved one, a stranger, and an enemy. Many people report that it’s actually harder to feel compassion for a random stranger, than an enemy. Why? Because we don’t know them; we don’t know what’s good and bad about them in our estimation.

    If you’re reading this because you want to be able to gain the peace of being able to forgive someone (even if that someone is yourself), then in at least some respect right now, that person is in the “enemy” category. So how do we unpack that?

    To err is human. Everybody screws up sometimes. And also, everyone has a reason (or a complex of reasons) for acting the way they do. This does not mean that those reasons excuse the behavior, but it can explain it.

    You don’t get angry at a storm for soaking you through. Even if you might not understand the physics of it in the way a meteorologist might, you understand that there were things that led to that, and you were just in the wrong place at the wrong time.

    So why do we get angry at someone else for wronging us? Even if we might not understand the personal background of it in the way their psychologist or therapist might, we (hopefully) understand that there were things that caused them to be the way they were, and we were just in the wrong place at the wrong time.

    And ourselves? We probably know, when we made a mistake, why we made it. Maybe we were afraid, insecure, reactive, forgetful, or too focused on some other thing. Whatever it was, we did our best at the time and, apparently, our best wasn’t as good as we’d like.

    If we didn’t deserve forgiveness, we wouldn’t be critical of our past selves in the first place.

    And, the science is very clear that it’s important for our health for other reasons besides cortisol management, too.

    And as for others? They did the best they knew how. Maybe they were afraid, insecure, reactive, forgetful, or too focused on some other thing. Same story, different character.

    Remembering that can be key to “accepting the apology we never received”.

    Forgiving without forgetting

    Developing the ability to forgive is a useful tool for our own mental health. It doesn’t mean we must or even should make ourselves a doormat.

    “I forgive you” does not have to mean a clean slate; it means remembering that the thing happened, and just not holding on to the anger/resentment associated with it.

    It may be water under the bridge now, but it might have been a devastatingly destructive wave at the time, and continuing to acknowledge truth that is sensible. Just, from a position of peace now, hopefully.

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  • Food for Life – by Dr. Tim Spector

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    This book is, as the author puts it, “an eater’s guide to food and nutrition”. Rather than telling us what to eat or not eat, he provides an overview of what the latest science has to say about various foods, and leaves us to make our own informed decisions.

    He also stands firmly by the “personalized nutrition” idea that he introduced in his previous book which we reviewed the other day, and gives advice on what tests we might like to perform.

    The writing style is accessible, without shying away from reference to hard science. Dr. Spector provides lots of information about key chemicals, genes, gut bacteria, and more—as well as simply providing a very enjoyable read along the way.

    Bottom line: if you’d like a much better idea of what food is (and isn’t) doing what, this book is an invaluable resource.

    Click here to check out Food for Life, and make the best decisions for you!

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