When A Period Is Very Late (Post-Menopause)
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Knowledge Is Power Safety, Post-Menopause Too
Note: this article will be most relevant for a subset of our subscribership, but it’s a very large subset, so we’re going to go ahead and address the reader as “you”.
If, for example, you are a man and this doesn’t apply to you, we hope it will interest you anyway (we imagine there are women in your life).
PS: the appendicitis check near the end, works for anyone with an appendix
We’ve talked before about things that come with (and continue after) menopause:
- What You Should Have Been Told About The Menopause Beforehand
- What Menopause Does To The Heart
- Alzheimer’s Sex Differences May Not Be What They Appear
But what’s going on if certain menstrual symptoms reappear post-menopause (e.g. after more than a year with no menstruation)?
Bleeding
You should not, of course, be experiencing vaginal bleeding post-menopause. You may have seen “PSA” style posts floating around social media warning that this is a sign of cancer. And, it can be!
But it’s probably not.
Endometrial cancer (the kind that causes such bleeding) affects 2–3% of women, and of those reporting post-menopausal bleeding, the cause is endometrial cancer only 9% of those times.
So in other words, it’s not to be ignored, but for 9 people out of 10 it won’t be cancer:
Read more: Harvard Health | Postmenopausal bleeding: Don’t worry—but do call your doctor
Other more likely causes are uterine fibroids or polyps. These are unpleasant but benign, and can be corrected with surgery if necessary.
The most common cause, however is endometrial and/or vaginal atrophy resulting in tears and bleeding.
Tip: Menopausal HRT will often correct this.
Read more: The significance of “atrophic endometrium” in women with postmenopausal bleeding
(“atrophic endometrium” and “endometrial atrophy” are the same thing)
In summary: no need to panic, but do get it checked out at your earliest convenience. This is not one where we should go “oh that’s weird” and ignore.
Cramps
If you are on menopausal HRT, there is a good chance that these are just period cramps. They may feel different than they did before, because you didn’t ovulate and thus you’re not shedding a uterine lining now, but your body is going to do its best to follow the instructions given by the hormones anyway (hormones are just chemical messengers, after all).
If it is just this, then they will probably settle down to a monthly cycle and become quite predictable.
Tip: if it’s the above, then normal advice for period cramps will go here. We recommend ginger! It’s been found to be as effective as Novafen (a combination drug of acetaminophen (Tylenol), caffeine, and ibuprofen), in the task of relieving menstrual pain:
See: Effect of Ginger and Novafen on menstrual pain: A cross-over trial
It could also be endometriosis. Normally this affects those of childbearing age, but once again, exogenous hormones (as in menopausal HRT) can fool the body into doing it.
If you are not on menopausal HRT (or sometimes even if you are), uterine fibroids (as discussed previously) are once again a fair candidate, and endometriosis is also still possible, though less likely.
Special last note
Important self-check: if you are experiencing a sharp pain in that general area and are worrying if it is appendicitis (also a possibility), then pressing on the appropriately named McBurney’s point is a first-line test for appendicitis. If, after pressing, it hurts a lot more upon removal of pressure (rather than upon application of pressure), this is considered a likely sign of appendicitis. Get thee to a hospital, quickly.
And if it doesn’t? Still get it checked out at your earliest convenience, of course (better safe than sorry), but you might make an appointment instead of calling an ambulance.
Take care!
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How weight bias in health care can harm patients with obesity: Research
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Patients who weigh more than what medical authorities generally consider healthy often avoid seeing doctors for fear of being judged, insulted or misdiagnosed, decades of research find. Meanwhile, academic studies consistently show many health care professionals discriminate against heavier patients and that weight bias can drive people with obesity to gain weight.
Weight bias refers to negative attitudes, stereotypes and discrimination aimed at individuals with excess body fat. When scholars reviewed 41 studies about weight bias in health care, published from 1989 to 2021, they found it comes in many forms: contemptuous language, inappropriate gestures, expressing a preference for thinner patients, avoiding physical touch and eye contact, and attributing all of a person’s health issues to their weight.
“Weight bias has been reported in physicians, nurses, dietitians, physiotherapists, and psychologists, as well as nutritionists and exercise professionals, and it is as pervasive among medical professionals as it is within the general population,” write the authors of the research review, published in 2021 in the journal Obesity.
That’s a problem considering an estimated 4 out of 10 U.S. adults aged 20 years and older have obesity, a complex and often misunderstood illness that the American Medical Association voted in 2013 to recognize as a disease. By 2030, half of U.S. adults will have obesity, researchers project in a 2020 paper in the International Journal of Epidemiology.
Worldwide, the obesity rate among adults aged 18 and older was 13% in 2016, according to the World Health Organization. If current trends continue, the World Obesity Federation projects that, by 2035, 51% of the global population will be living with overweight or obesity.
The harms of weight bias
Weight stigma — the societal devaluation of people perceived to be carrying excess weight — drives weight bias. It’s so physically and emotionally damaging that a panel of 36 international experts issued a consensus statement in 2020 to raise awareness about and condemn it. Dozens of medical and academic organizations, including 15 scholarly journals, endorsed the document, published in Nature Medicine.
The release of a consensus statement is a significant event in research, considering it represents the collective position that experts in a particular field have taken on an issue, based on an analysis of all the available evidence.
Research to date indicates heavier individuals who experience weight bias and stigma often:
- Avoid doctors and other health care professionals, skipping routine screenings as well as needed treatments.
- Change doctors frequently.
- Are at a higher risk for depression, anxiety, mood disorders and other mental health problems.
- Avoid or put off exercise.
- Consume more food and calories.
- Gain weight.
- Have disrupted sleep.
The consensus statement notes that educating health care providers, journalists, policymakers and others about obesity is key to changing the narrative around the disease.
“Weight stigma is reinforced by misconceived ideas about body-weight regulation and lack of awareness of current scientific evidence,” write the experts, led by Francesco Rubino, the chair of metabolic and bariatric surgery at Kings College London.
“Despite scientific evidence to the contrary, the prevailing view in society is that obesity is a choice that can be reversed by voluntary decisions to eat less and exercise more. These assumptions mislead public health policies, confuse messages in popular media, undermine access to evidence-based treatments, and compromise advances in research.”
Weight bias and stigma appear to stimulate the secretion of the stress hormone cortisol and promote weight gain, researchers write in a 2016 paper published in Obesity.
A. Janet Tomiyama, a psychology professor at UCLA who directs the university’s Dieting, Stress, and Health research lab, describes weight stigma as “a ‘vicious cycle’ — a positive feedback loop wherein weight stigma begets weight gain.”
“This happens through increased eating behavior and increased cortisol secretion governed by behavioral, emotional, and physiological mechanisms, which are theorized to ultimately result in weight gain and difficulty of weight loss,” Tomiyama writes in her 2014 paper, “Weight Stigma is Stressful. A Review of Evidence for the Cyclic Obesity/Weight-Based Stigma Model.”
The consensus statement spotlights 13 recommendations for eliminating weight bias and stigma, some of which are specifically aimed at health care providers, the media, researchers or policymakers. One of the recommendations for the health care community: “[Health care providers] specialized in treating obesity should provide evidence of stigma-free practice skills. Professional bodies should encourage, facilitate, and develop methods to certify knowledge of stigma and its effects, along with stigma-free skills and practices.”
The one recommendation for the media: “We call on the media to produce fair, accurate, and non-stigmatizing portrayals of obesity. A commitment from the media is needed to shift the narrative around obesity.”
Why obesity is a complicated disease
It’s important to point out that having excess body fat does not, by itself, mean an individual is unhealthy, researchers explain in a 2017 article in The Conversation, which publishes research-based news articles and essays. But it is a major risk factor for cardiovascular disease, including stroke, as well as diabetes, some types of cancer, and musculoskeletal disorders such as osteoarthritis.
Doctors often look at patients’ body mass index — a number that represents their weight in relation to their height — to gauge the amount of fat on their bodies. A BMI of 18.5 to 24.9 is ideal, according to the U.S. Centers for Disease Control and Prevention. A BMI of 25.0 to 29.9, indicates excess body fat, or “overweight,” while a BMI of 30 and above indicates obesity.
In June, the American Medical Association announced a new policy clarifying how BMI can be used to diagnose obesity. Because it’s an imperfect measure for body fat, the organization suggests BMI be used in conjunction with other measures such as a patient’s waist circumference and skin fold thickness.
Two specialists who have been working for years to dispel myths and misconceptions about obesity are Fatima Cody Stanford, an obesity physician and associate professor at Harvard Medical School, and Rebecca Puhl, the deputy director of the Rudd Center for Food Policy and Obesity at the University of Connecticut.
Cody Stanford has called obesity “a brain disease” because the brain tells the body how much to eat and what to do with the food consumed. One pathway in the brain directs the body to eat less and store less fat, she explains in a February 2023 podcast produced by the American Medical Association.
“For people that signal really great down this pathway, they tend to be very lean, not struggle with their weight in the same way that people that have excess weight do,” she says during the podcast, adding that people with obesity receive signals from an alternate pathway that “tells us to eat more and store more.”
Academic studies demonstrate that a wide variety of factors can affect weight regulation, including sleep quality and duration, gut health, genetics, medication, access to healthy foods and even early life experiences.
For example, a 2020 paper in the journal JAMA Network Open suggests female infants born by cesarean delivery have a higher risk of obesity during adulthood than female infants born by vaginal delivery. The study of 33,226 U.S. women born between 1946 and 1964 found that a cesarean delivery is associated with an 11% higher risk of developing obesity and a 46% higher risk of developing type 2 diabetes.
Scholars have also found that traumatic childhood experiences such as abuse and neglect are linked to adult obesity, according to a research review published in 2020.
Income inequality seems to play a role as well. When researchers from the Johns Hopkins Bloomberg School of Public Health studied the link between income inequality and obesity for a sample of 36,665 U.S. adults, they discovered women with lower incomes are more likely to have obesity than women with higher incomes.
Their analysis indicates the opposite is true for men, whose odds of obesity rise with their income, the researchers write in a 2021 paper in the International Journal of Environmental Research and Public Health.
Weight bias among doctor trainees
While scholars have learned a lot about obesity and weight bias in recent decades, the information might not be reaching people training to become doctors. A study published in October finds that some resident physicians believe obesity to be the result of poor choices and weak willpower.
Researchers asked 3,267 resident physicians who graduated from a total of 49 U.S. medical schools a series of questions to gauge their knowledge of obesity and attitudes toward heavier patients. What they learned: Nearly 40% of resident physicians agreed with the statement, “Fat people tend to be fat pretty much through their own fault.” Almost half agreed with the statement, “Some people are fat because they have no willpower.”
The study also reveals that about one-third of participants said they “feel more irritated when treating an obese patient than a non-obese patient.”
“Notably, more than a quarter of residents expressed slight-to-strong agreement with the item ‘I dislike treating obese patients,’” the researchers write.
Another takeaway from the paper: Resident physicians specializing in orthopedic surgery, anesthesiology and urology expressed the highest levels of dislike of heavier patients. Of the 16 medical specialties represented, residents in family medicine, psychiatry and pediatrics reported the lowest levels of dislike.
Kimberly Gudzune, medical director of the American Board of Obesity Medicine, asserts that doctors and medical students need to be educated about obesity. The topic “is grossly neglected” in medical schools and medical training programs worldwide, research has found.
Many physicians don’t understand obesity, Gudzune explains in a July 2023 interview on the internal medicine podcast “The Curbsiders.”
“I think back to when I was a medical student, when I was a resident, I really didn’t learn much about obesity and how to treat it, yet it’s a problem that affects the majority of our patients,” she tells podcast listeners. “I think there’s a lot of evidence out there showing that primary care physicians don’t really know where to start.”
In 2011, the American Board of Obesity Medicine established a program through which doctors could become certified in obesity medicine. Since then, a total of 6,729 U.S. doctors have earned certification, the vast majority of whom specialize in family and internal medicine.
What health care providers think
The experts who created the consensus statement on weight bias and stigma noted health care providers’ shortcomings in the document. They write that the common themes they discovered in the research include “contemptuous, patronizing, and disrespectful treatment” of patients, a lack of training, poor communication and assumptions about weight gain.
Puhl, the deputy director of the Rudd Center at the University of Connecticut, is a pioneer in weight bias research and one of the experts who wrote the consensus statement. During an episode of “The Leading Voices in Food,” a podcast created by Duke University’s World Food Policy Center, she shares details about what she has learned over the years.
“[Health care providers’] views that patients with obesity are lazy or lacking control, are to blame for their weight or noncompliant with treatment,” she says during the interview. “We know, for example, that some physicians spend less time in their appointments with patients [who] have a larger body size. They give them less education about health. They’re more reluctant to perform certain screenings. They talk about treating patients with obesity as being a greater waste of their time than providing care to thinner patients. And we know that patients seem to be aware of these biases from providers and that can really contribute to patients avoiding health care because they just don’t want to repeat those negative experiences of bias.”
To set the record straight, the experts who wrote the the consensus statement listed the following five common assumptions as being “at odds with a definitive body of biological and clinical evidence.”
1. Body weight = calories in – calories out.
This equation oversimplifies the relationship between body weight and energy consumed and used, the experts write. “Both variables of the equation depend on factors additional to just eating and exercising. For instance, energy intake depends on the amount of food consumed, but also on the amount of food-derived energy absorbed through the gastrointestinal tract, which in turn is influenced by multiple factors, such as digestive enzymes, bile acids, microbiota, gut hormones, and neural signals, none of which are under voluntary control.”
2. Obesity is primarily caused by voluntary overeating and a sedentary lifestyle.
According to the experts, overeating and forgoing exercise might be symptoms of obesity rather than the root causes. There are many possible causes and contributors “including geneticand epigenetic factors, foodborne factors, sleep deprivation and circadian dysrhythmia, psychological stress, endocrine disruptors, medications, and intrauterine and intergenerational effects. These factors do not require overeating or physical inactivity to explain excess weight.” they write.
3. Obesity is a lifestyle choice.
“People with obesity typically recognize obesity as a serious health problem, rather than a conscious choice,” the experts write. “Given the negative effects of obesity on quality of life, the well-known risks of serious complications and reduced life expectancy associated with it, it is a misconception to define obesity as a choice.”
4. Obesity is a condition, not a disease.
The criteria generally used to determine disease status “are clearly fulfilled in many individuals with obesity as commonly defined, albeit not all,” the experts explain. “These criteria include specific signs or symptoms (such as increased adiposity), reduced quality of life, and/or increased risk of further illness, complications, and deviation from normal physiology — or well-characterized pathophysiology (for example, inflammation, insulin resistance, and alterations of hormonal signals regulating satiety and appetite).”
5. Severe obesity is usually reversible by voluntarily eating less and exercising more.
“A large body of clinical evidence has shown that voluntary attempts to eat less and exercise more render only modest effects on body weight in most individuals with severe obesity,” the experts write. “When fat mass decreases, the body responds with reduced resting energy expenditure and changes in signals that increase hunger and reduce satiety (for example, leptin, ghrelin). These compensatory metabolic and biologic adaptations promote weight regain and persist for as long as persons are in the reduced-energy state, even if they gain some weight back.”
Health care facility improvements
The expert panel also determined that many health care facilities aren’t equipped to treat people with obesity. Examination gowns, blood pressure cuffs, chairs and examination tables often are too small, patients have reported.
When researchers from the University of Minnesota, Minneapolis Veterans Affairs Medical Center and Mayo Clinic studied the quality of care that patients with obesity receive, they learned that a clinic’s physical environment can have a big effect on a patient’s experience.
They write in a 2015 study published in Obesity Reviews: “Waiting room chairs with armrests can be uncomfortable or too small. Equipment such as scales, blood pressure cuffs, examination gowns and pelvic examination instruments are often designed for use with smaller patients. When larger alternatives are not available, or are stored in a place that suggests infrequent use, it can signal to patients that their size is unusual and that they do not belong. These experiences, which are not delivered with malicious intent, can be humiliating.”
When medical equipment is the wrong size, it may not work correctly. For instance, chances are high that a blood pressure reading will be inaccurate if a health care professional uses a blood pressure cuff that’s too small on a patient with obesity, a 2022 paper finds.
To create a comfortable environment for patients with high body weights, the Rudd Center for Food Policy and Obesity recommends that health care facilities provide, among other things, extra-large exam gowns, chairs that can support more than 300 pounds and do not have arms, and wide exam tables that are bolted to the floor so they don’t move.
The consensus statement also recommends improvements to health care facilities.
“Given the prevalence of obesity and obesity-related diseases,” the 36 international experts write, “appropriate infrastructure for the care and management of people with obesity, including severe obesity, must be standard requirement for accreditation of medical facilities and hospitals.”
Source list:
Weight Bias Among Health Care Professionals: A Systematic Review and Meta-Analysis
Blake J. Lawrence; et al. Obesity, November 2021.Joint International Consensus Statement for Ending Stigma of Obesity
Francesco Rubino, et al. Nature Medicine, March 2020.Perceived Weight Discrimination and Chronic Biochemical Stress: A Population-Based Study Using Cortisol in Scalp Hair
Sarah E. Jackson, Clemens Kirschbaum and Andrew Steptoe. Obesity, December 2016.Weight Stigma is Stressful. A Review of Evidence for the Cyclic Obesity/Weight-Based Stigma Model
A. Janet Tomiyama. Appetite, November 2014.Association of Birth by Cesarean Delivery with Obesity and Type 2 Diabetes Among Adult Women
Jorge E. Chavarro. JAMA Network Open, April 2020.Adverse Childhood Experiences and Adult Obesity: A Systematic Review of Plausible Mechanisms and Meta-Analysis of Cross-Sectional Studies
David A. Wiss and Timothy D. Brewerton. Physiology & Behavior, September 2020.Income Inequality and Obesity among U.S. Adults 1999–2016: Does Sex Matter?
Hossein Zare, Danielle D. Gaskin and Roland J. Thorpe Jr. International Journal of Environmental Research and Public Health, July 2021.Comparisons of Explicit Weight Bias Across Common Clinical Specialties of U.S. Resident Physicians
Samantha R. Philip, Sherecce A. Fields, Michelle Van Ryn and Sean M. Phelan. Journal of General Internal Medicine, October 2023.Impact of Weight Bias and Stigma on Quality of Care and Outcomes for Patients with Obesity
S.M. Phelan; et al. Obesity Reviews, April 2015.One Size Does Not Fit All: Impact of Using A Regular Cuff For All Blood Pressure Measurements
Tammy. M. Brady; et al. Circulation, April 2022.This article first appeared on The Journalist’s Resource and is republished here under a Creative Commons license.
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Podiatrists Debunk 11 Feet Myths
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Podiatrists Dr. Sarah Haller and Dr. Brad Schaeffer put us on a better path:
Don’t get wrong-footed
We’ll not keep the 11 myths a mystery; they are…
- “You have warts because your feet are dirty.”
False! Warts are caused by a virus, not dirt. Viruses can be picked up from surfaces like yoga mats, pools, gyms, and showers. - “Bunions are caused by wearing heels.”
False! Bunions are genetic deformities where the bone behind the big toe shifts. Heels might worsen them but don’t cause them. - “Cutting the sides of my toenail will prevent an ingrown toenail.”
False! Toenails should be cut straight across. Cutting the sides can make ingrown toenails worse. - “Pedicures gave me toenail fungus.”
Partially true! You can get fungus from many places, but safe, sterile pedicures are generally fine. - “Only athletes get athlete’s foot.”
False! Athlete’s foot is a fungal infection caused by warm, moist environments. Anyone can get it, not just athletes. - “My feet are fine because I trained them to walk in stilettos.”
False! You can get used to stilettos, but they aren’t healthy long-term. They shorten the Achilles tendon and put pressure on the foot. - “You can’t do anything for a broken toe.”
False! Broken toes can be treated and should be checked by a doctor. They may need to be set for proper healing. - “It’s normal for your feet to hurt from standing all day.”
False! Foot pain isn’t normal and can be prevented with proper footwear, support, and compression socks. - “All inserts are the same.”
False! Everyone’s feet are different. Some may benefit from over-the-counter insoles, but others need custom orthotics. - “Sprained ankles are no big deal.”
False! Sprains can damage ligaments and lead to instability or arthritis if untreated. Proper stabilization is essential. - “If I can walk after an injury, I don’t need to see a doctor.”
False! You can still have serious injuries like fractures even if you can walk. Always get checked after an injury.
For more on each of these, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
Steps For Keeping Your Feet A Healthy Foundation
Take care!
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- “You have warts because your feet are dirty.”
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Broad Beans vs Sweetcorn – Which is Healthier?
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Our Verdict
When comparing broad beans to sweetcorn, we picked the broad beans.
Why?
Firstly, you may be wondering: “aren’t broad beans fava beans?”, and yes, yes they are, but by convention, broad beans are the young green beans, while fava beans are the mature beans of the plant. Similar situation to the relationship between edamame and soybeans. And, in both cases, you’re more likely to put the young green beans in a salad, thus making the broad beans the more reasonable vegetable to compare to the sweetcorn. On which note…
In terms of macros, the broad beans have more protein and fiber, while the sweetcorn has more carbs. We call that a win for the beans.
Looking at the vitamins, the broad beans have (barely) more vitamin B6, while the sweetcorn has more of vitamins A, B1, B2, B5, B9, E, and choline. An easy win for the corn this time.
In the category of minerals, the situation is reversed: broad beans have more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc, while sweetcorn is not higher in any minerals. So, a clear win for the beans.
Adding up the sections gives a 2:1 win for the beans over the corn, but by all means enjoy either or both—together is great, and diversity is good!
Want to learn more?
You might like to read:
What’s Your Plant Diversity Score?
Enjoy!
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The Food Additive You Do Want
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.
Q: When Is A Fiber Not A Fiber?
A: when it’s a resistant starch. What’s it resistant to? Digestion. So, it functions as though a fiber, and by some systems, may get classified as such.
It’s a little like how sucralose is technically a sugar, but the body processes it like a fiber (but beware, because the sweetness of this disaccharide alone can trigger an insulin response anyway—dose dependent)
There may be other problems too:
But today’s not about sucralose, it’s about…
Guar gum’s surprising dietary role
You may have noticed “guar gum” on the list of ingredients of all kinds of things from baked goods to dairy products to condiments to confectionary and more.
It’s also used in cosmetics and explosives, but let’s not focus on that.
It’s used in food products as…
- a bulking agent
- a thickener
- a stabilizer
Our attention was caught by a new study, that found:
Resistant starch intake facilitates weight loss in humans by reshaping the gut microbiota
Often people think of “fiber helps weight loss” as “well yes, if you are bulking out your food with sawdust, you will eat less”, but it’s not that.
There’s an actual physiological process going on here!
We can’t digest it, but our gut microbiota can and will ferment it. See also:
Fiber against pounds: Resistant starch found to support weight loss
Beyond weight loss
Not everyone wants to lose weight, and even where weight loss is a goal, it’s usually not the only goal. As it turns out, adding guar gum into our diet does more things too:
Resistant starch supplement found to reduce liver triglycerides in people with fatty liver disease
(specifically, this was about NAFLD, non-alcoholic fatty liver disease)
Digging a little, it seems the benefits don’t stop there either:
Diet high in guar gum fiber limits inflammation and delays multiple sclerosis symptoms
(this one was a rodent study, but still, it’s promising and it’s consistent with what one would expect based on what else we know about its function in diet)
Should we just eat foods with guar gum in as an additive?
That depends on what they are, but watch out for the other additives if you do!
You can just buy guar gum by itself, by the way (here’s an example product on Amazon).
It’s doubtlessly no fun to take as a supplement (we haven’t tried this one), but it can be baked into bread, if baking’s your thing, or just used as a thickener in recipes where ordinarily you might use cornstarch or something else.
Can I get similar benefits from other foods?
The relevant quality is also present in resistant starches in general, so you might want to check out these foods, for example:
9 Foods That Are High in Resistant Starch
You can also check out ways to increase your fiber intake in general:
Level-Up Your Fiber Intake! (Without Difficulty Or Discomfort)
Enjoy!
Don’t Forget…
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Radical Remission – by Dr. Kelly Turner
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First, what this is not:an autobiographical account of the “I beat cancer and you can too” pep-talk style.
What it is: a very readable pop-science book based on the author’s own PhD research into radical remission.
She knew that a very small percentage of people experience spontaneous radical remission (or quasi-spontaneous, if the remission is attributed to lifestyle changes, and/or some alternative therapy), but a small percentage of people means a large number worldwide, so she travelled the world studying over 1,000 cases of people with late-stage cancer who had either not gone for conventional anticancer drugs, or had and then stopped, and lived to tell the tale.
While she doesn’t advocate for any particular alternative therapy, she does report on what things came to her attention. She does advocate for some lifestyle changes.
Perhaps the biggest value this book offers is in its promised “9 key factors that can make a real difference”, which are essentially her conclusions from her PhD dissertation.
There isn’t room to talk about them here in a way that wouldn’t be misleading/unhelpful for a paucity of space, so perhaps we’ll do a main feature one of these days.
Bottom line: if you have (or a loved one has) cancer, this is an incredibly sensible book to read. If you don’t, then it’s an interesting and thought-provoking book to read.
Click here to check out Radical Remission, and learn about the factors at hand!
Don’t Forget…
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Which B Vitamins? It Makes A Difference
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Everyone knows “B vitamins are for energy!” and that is definitely a theme, but there’s a lot more to it than that, and in some cases, there are big mistakes that people make when it comes to supplementing their diet.
First, let’s do a quick overview of what each of the B vitamins do, by number, and putting names to them:
B1 (Thiamine)
- Function: helps convert carbohydrates into energy, supports nerve function
- Forms: thiamine hydrochloride, thiamine mononitrate, benfotiamine (fat-soluble form)
- Example foods: lentils, sunflower seeds
B2 (Riboflavin)
- Function: supports energy production, skin health, and eye function, turns your pee fluorescent yellow (the latter is really only if you consume exciting amounts of it; this will usually occur from supplementation, not from normal diet)
- Forms: riboflavin, riboflavin-5’-phosphate
- Example foods: almonds, mushrooms
B3 (Niacin)
- Function: aids metabolism, supports skin, nerves, and cholesterol levels
- Forms: niacin (nicotinic acid), niacinamide (nicotinamide), inositol hexanicotinate (flush-free niacin)
- Example foods: whole grains, peanuts (literally the best nut for this)
B5 (Pantothenic Acid)
- Function: essential for fatty acid metabolism and hormone production
- Forms: pantothenic acid, calcium pantothenate, panthenol (alcohol form!)
- Example foods: it’s in pretty much everything (hence the name); it’s almost impossible to be deficient in this vitamin unless you are literally starving
B6 (Pyridoxine)
- Function: needed for red blood cell production, supports brain function, as well as specifically being a part of neurotransmitter production (including dopamine and serotonin, despite them being made in different places—the brain and the gut, respectively),
- Forms: pyridoxine hydrochloride, pyridoxal-5’-phosphate (active form)
- Example foods: bananas, potatoes
B7 (Biotin)
- Function: helps with fatty acid synthesis, skin, hair, and nail health
- Forms: d-biotin, biotinylated compounds of various kinds
- Example foods: fava beans, walnuts
B9 (Folate/Folic Acid)
- Function: crucial for DNA synthesis, cell division, and fetal development
- Forms: folic acid, folinic acid, 5-methyltetrahydrofolate (5-MTHF, active form)
- Example foods: chickpeas, spinach ← we only mentioned one leafy green here for fairness, but leafy greens in general are great sources of vitamin B9, hence the name, from the Latin “folium”, meaning leaf.
B12 (Cobalamin)
- Function: supports red blood cell formation, nerve function, and DNA synthesis
- Forms: cyanocobalamin, methylcobalamin (active), hydroxocobalamin (active), adenosylcobalamin (active)
- Example foods: nutritional yeast, nori
You may be wondering: what about vitamins B4, B8, B10, and B11? Those are now vacant spots, that once contained things that are no longer considered vitamins.
Three Critical Vitamin B Mistakes That May Be Sabotaging Your Health
Some mistakes that people make include:
Not supplementing when necessary
This occurs most often after midlife, especially in women, and the most common deficiencies are B1, B9, and B12.
See also: These Signs Often Mean These Nutrient Deficiencies (Do You Have Any?)
While it’s tempting to think “if I have a good balanced diet, I won’t need…” but the fact is sometimes our diet isn’t as nutrient dense as we hope—often through no fault of our own! But many modern farming methods prioritize yield over nutritional value, and that can result in plants and animals that do not have the nutritional qualities they “should”.
We wrote about this a while back, weighing up the “supplementation vs diet alone” dilemma:
Does Our Diet Need A Little Help? ← this also has a very useful chart of which vitamins people usually get too little or too much of. Note however that the statement of marginally excessive folate is slightly misleading, as the data pool contains men and women aged 18–65, while B9 is mostly needed more by women, and especially around childbirth or menopause, so B9 is actually a very common deficiency, but here it’s being balanced out lots of men getting too much (because every multivitamin has it).
Supplementing to excess
Most B vitamins have a very high maximum tolerable dose, because (with the exception of where we marked otherwise) they are water-soluble, which means that if you take more than you need, you’ll just pee it out later. Hence the famous fluorescence, for example.
However, the fat soluble form of vitamin B1 is harder to get in and harder to get out.
As for the others, problems usually only occur if you take enough to cause toxicity, faster than you pee it out. In other words, go easy on those Berocca drinks!
Nevertheless, there are other problems that can arise:
Vitamin B6 is essential—but too much can be toxic. Here’s what to know to stay safe ← tl;dr: there are issues with it causing peripheral neuropathy at doses over 10mg (the safe dose is disputed, so we’re mentioning the lowest safe dose here, but you can read about the others in the article)
Getting forms that don’t work so well
Those different forms we listed? They are not all created equal! For example:
- Folic acid is cheap; unfortunately, it’s not absorbed or used well
- Cyanocobalamin is cheap; unfortunately, it’s not absorbed or used well
Let us quote a recent book review of ours:
❝Rather, the most common forms of vitamins B9 and B12 provided in supplements are folic acid and cyanocobalamin, respectively, which as he demonstrates with extensive research to back up his claims, cannot be easily absorbed or used especially well.
About those vitamers: a vitamer is simply a form of a vitamin—most vitamins we need can arrive in a variety of forms. In the case of vitamins B9 and B12, he advocates for ditching vitamers folic acid and cyanocobalamin, cheap as they are, and springing for bioactive vitamers L-methylfolate, methylcobalamin, and adenosylcobalamin.
He also discusses (again, just as well-evidenced as the above things) why we might struggle to get enough from our diet after a certain age. For example, if trying to get these vitamins from meat, 50% of people over 50 cannot manufacture enough stomach acid to break down that protein to release the vitamins.
And as for methyl-B12 vitamers, you might expect you can get those from meat, and technically you can, but they don’t occur in all animals, just in one kind of animal. Specifically, the kind that has the largest brain-to-body ratio. However, eating the meat of this animal can result in protein folding errors in general and Creutzfeldt–Jakob disease in particular, so the author does not recommend eating humans, however nutritionally convenient that would be.
All this means that supplementation after a certain age really can be a sensible way to do it—but do it wisely, and pick the right vitamers.❞
You can read that review in full here: Your Vitamins are Obsolete: The Vitamer Revolution – by Dr. Sheldon Zablow
Want to try those latter two?
We don’t sell them, but here for your convenience are example products on Amazon:
L-methylfolate (active form of vitamin B9)
Methylcobalamin, adenosylcobalamin, & hydroxocobalamin (active forms of vitamin B12)
Take care!
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