Savor: Mindful Eating, Mindful Life – by Thich Nhat Hanh and Dr. Lilian Cheung
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.
We’ve talked about mindful eating before at 10almonds, so here’s a book about it. You may wonder how much there is to say!
As it happens, there’s quite a bit. The authors, a Buddhist monk (Hanh) and a Harvard nutritionist (Dr. Cheung) explore the role of mindful eating in our life.
There is an expectation that we the reader want to lose weight. If we don’t, those parts of the book will be a “miss” for us, but still contain plenty of other value.
Most of the same advices can be applied equally to other aspects of health, in any case. A lot of that comes from the book’s Buddhist principles, including the notion that:
- We are experiencing suffering
- Suffering has a cause
- What has a cause can have an end
- The way to this end is mindfulness
As such, the process itself is also mindfulness all the way through:
- To be mindful of our suffering (and not let it become background noise to be ignored)
- To be mindful of the cause of our suffering (rather than dismissing it as just how things are)
- To be mindful of how to address that, and thus end the suffering (rather than despairing in inaction)
- To engage mindfully in the process of doing so (and thus not fall into the trap of thinking “job done”)
And, as for Dr. Cheung? She also has input throughout, with practical advice about the more scientific side of rethinking one’s diet.
Bottom line: this is an atypical book, and/but perhaps an important one. Certainly, at the very least it may be one to try if more conventional approaches have failed!
Click here to check out “Savor” on Amazon today, and get mindful!
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Recommended
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:
-
Pain Doesn’t Belong on a Scale of Zero to 10
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.
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.
Subscribe to KFF Health News’ free Morning Briefing.
Share This Post
-
Hazelnuts vs Chestnuts – Which is Healthier?
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.
Our Verdict
When comparing hazelnuts to chestnuts, we picked the hazelnuts.
Why?
This one’s not close.
In terms of macros, we have some big difference to start with, since chestnuts contain a lot more water and carbs whereas hazelnuts contain a lot more protein, fats, and fiber. The fats, as with most nuts, are healthy; in this case mostly being monounsaturated fat.
Because of the carbs and fiber being so polarized (i.e., chestnuts have most of the carbs and hazelnuts have most of the fiber), there’s a big difference in glycemic index; hazelnuts have a GI of 15 while chestnuts have a GI of 52.
In the category of vitamins, hazelnuts contain more of vitamins A, B1, B2, B3, B5, B6, and B9, while chestnuts contain more vitamin C.
When it comes to minerals, the story is similar: hazelnuts contain a lot more calcium, copper, iron, magnesium, manganese, phosphorus, and zinc, while chestnuts contain a tiny bit more potassium.
All in all, enjoy either or both, but nutritionally speaking, hazelnuts are a lot better in almost every way.
Want to learn more?
You might like to read:
Why You Should Diversify Your Nuts
Take care!
Share This Post
-
How To Rebuild Your Cartilage
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.
We’ve covered before the topic of wear-and-tear on joints such as:
Avoiding/Managing Osteoarthritis
But what of cartilage, in particular? A common belief is “once it’s gone, it’s gone”, but that’s not quite right.
Cartilage is living tissue (metabolically active, with living cells). Within this tissue, specialist cells called chondrocytes produce extracellular cartilage matrix and collagen fibers, which provide smooth joint gliding as well as shock absorption.
Is exercise good or bad for cartilage?
Yes, yes it is. Exercise is good or bad for cartilage depending on the details:
- High-impact exercise e.g. running, jumping) places stress on cartilage, which is broadly bad
- However, impact loading strengthens the subchondral bone plate (layer under cartilage)
Strengthening this bone layer can help in long-term adaptation for high-impact sports.
See also: Resistance Is Useful! (Especially As We Get Older)
So, how to do that without wiping out your cartilage first?
Building up
A gradual process is what’s called-for here:
- Start with cyclic, non-impact moderate resistance exercises (e.g. cycling, rowing, swimming).
- Gradually add soft-impact loading (e.g. fast walking, soft jogging).
- Incorporate strength training to improve overall joint stability (e.g. leg press, for lower body joints)
- Slowly transition to running and jumping over a long period to allow tissues to adapt.
How exactly you go about that is a matter of personal taste, but here are some illustrative examples:
- Indoor* cycling
- Cross trainer
- Leg press machine
- Tennis
*Why indoor? It’s so that you can control the resistance level at the twist of a knob, and get on and off when you want.
See also: Treadmill vs Road ← for similar considerations when it comes to walking/running. Outdoor definitely has its advantages, but so does indoor!
And the very related: How To Do HIIT (Without Wrecking Your Body)
Note that HIIT is High Intensity Interval Training, not High Impact Interval Training!
Strength from the inside
One of the most important things for cartilage is collagen. You can supplement that, or if you’re vegetarian/vegan, you can take its constituent parts to improve your own synthesis of it.
See: Collagen For Your Skin, Joints, & Bones: We Are Such Stuff As Fish Are Made Of
Another supplement that can be helpful is glucosamine & chondroitin, which is best taken alongside a good omega-3 intake:
Want to know more?
This book is technically about (re)building strength and mobility in the case of arthritis specifically, but if your joints have more wear than you’d like, you may find this one an invaluable resource:
Take care!
Share This Post
Related Posts
-
Who you are and where you live shouldn’t determine your ability to survive cancer
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.
In Canada, nearly everyone has a cancer story to share. It affects one in every two people, and despite improvements in cancer survivorship, one out of every four people affected by cancer still will die from it.
As a scientist dedicated to cancer care, I work directly with patients to reimagine a system that was never designed for them in the first place – a system in which your quality of care depends on social drivers like your appearance, your bank statements and your postal code.
We know that poverty, poor nutrition, housing instability and limited access to education and employment can contribute to both the development and progression of cancer. Quality nutrition and regular exercise reduce cancer risk but are contingent on affordable food options and the ability to stay active in safe, walkable neighbourhoods. Environmental hazards like air pollution and toxic waste elevate the risk of specific cancers, but are contingent on the built environment, laws safeguarding workers and the availability of affordable housing.
On a health-system level, we face implicit biases among care providers, a lack of health workforce competence in addressing the social determinants of health, and services that do not cater to the needs of marginalized individuals.
Indigenous peoples, racialized communities, those with low income and gender diverse individuals face the most discrimination in health care, resulting in inadequate experiences, missed diagnosis and avoidance of care. One patient living in subsidized housing told me, “You get treated like a piece of garbage – you come out and feel twice as bad.”
As Canadians, we benefit from a taxpayer funded health-care system that encompasses cancer care services. The average Canadian enjoys a life expectancy of more than 80 years and Canada boasts high cancer survival rates. While we have made incredible strides in cancer care, we must work together to ensure these benefits are equally shared amongst all people in Canada. We need to redesign systems of care so that they are:
- Anti-oppressive. We must begin by understanding and responding to historical and systemic racism that shapes cancer risk, access to care and quality of life for individuals facing marginalizing conditions. Without tackling the root causes, we will never be able to fully close the cancer care gap. This commitment involves undoing intergenerational trauma and harm through public policies that elevate the living and working conditions of all people.
- Patient-centric. We need to prioritize patient needs, preferences and values in all aspects of their health-care experience. This means tailoring treatments and services to individual patient needs. In policymaking, it involves creating policies that are informed by and responsive to the real-life experiences of patients. In research, it involves engaging patients in the research process and ensuring studies are relevant to and respectful of their unique perspectives and needs. This holistic approach ensures that patients’ perspectives are central to all aspects of health care.
- Socially just. We must strive for a society in which everyone has equal access to resources, opportunities and rights, and systemic inequalities and injustices are actively challenged and addressed. When redesigning the cancer care system, this involves proactive practices that create opportunities for all people, particularly those experiencing the most marginalization, to become involved in systemic health-care decision-making. A system that is responsive to the needs of the most marginalized will ultimately work better for all people.
Who you are, how you look, where you live and how much money you make should never be the difference between life and death. Let us commit to a future in which all people have the resources and support to prevent and treat cancer so that no one is left behind.
This article is republished from HealthyDebate under a Creative Commons license. Read the original article.
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:
-
How old’s too old to be a doctor? Why GPs and surgeons over 70 may need a health check to practise
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.
A growing number of complaints against older doctors has prompted the Medical Board of Australia to announce today that it’s reviewing how doctors aged 70 or older are regulated. Two new options are on the table.
The first would require doctors over 70 to undergo a detailed health assessment to determine their current and future “fitness to practise” in their particular area of medicine.
The second would require only general health checks for doctors over 70.
A third option acknowledges existing rules requiring doctors to maintain their health and competence. As part of their professional code of conduct, doctors must seek independent medical and psychological care to prevent harming themselves and their patients. So, this third option would maintain the status quo.
PeopleImages.com – Yuri A/Shutterstock Haven’t we moved on from set retirement ages?
It might be surprising that stricter oversight of older doctors’ performance is proposed now. Critics of mandatory retirement ages in other fields – for judges, for instance – have long questioned whether these rules are “still valid in a modern society”.
However, unlike judges, doctors are already required to renew their registration annually to practise. This allows the Medical Board of Australia not only to access sound data about the prevalence and activity of older practitioners, but to assess their eligibility regularly and to conduct performance assessments if and when they are needed.
What has prompted these proposals?
This latest proposal identifies several emerging concerns about older doctors. These are grounded in external research about the effect of age on doctors’ competence as well as the regulator’s internal data showing surges of complaints about older doctors in recent years.
Studies of medical competence in ageing doctors show variable results. However, the Medical Board of Australia’s consultation document emphasises studies of neurocognitive loss. It explains how physical and cognitive impairment can lead to poor record-keeping, improper prescribing, as well as disruptive behaviour.
The other issue is the number of patient complaints against older doctors. These “notifications” have surged in recent years, as have the number of disciplinary actions against older doctors.
In 2022–2023, the Medical Board of Australia took disciplinary action against older doctors about 1.7 times more often than for doctors under 70.
In 2023, notifications against doctors over 70 were 81% higher than for the under 70s. In that year, patients sent 485 notifications to the Medical Board of Australia about older doctors – up from 189 in 2015.
While older doctors make up only about 5.3% of the doctor workforce in Australia (less than 1% over 80), this only makes the high numbers of complaints more starkly disproportionate.
It’s for these reasons that the Medical Board of Australia has determined it should take further regulatory action to safeguard the health of patients.
So what distinguishes the two new proposed options?
The “fitness to practise” assessment option would entail a rigorous assessment of doctors over 70 based on their specialisation. It would be required every three years after the age of 70 and every year after 80.
Surgeons, for example, would be assessed by an independent occupational physician for dexterity, sight and the ability to give clinical instructions.
Importantly, the results of these assessments would usually be confidential between the assessor and the doctor. Only doctors who were found to pose a substantial risk to the public, which was not being managed, would be obliged to report their health condition to the Medical Board of Australia.
The second option would be a more general health check not linked to the doctor’s specific role. It would occur at the same intervals as the “fitness to practise” assessment. However, its purpose would be merely to promote good health-care decision-making among health practitioners. There would be no general obligation on a doctor to report the results to the Medical Board of Australia.
In practice, both of these proposals appear to allow doctors to manage their own general health confidentially.
Older surgeons could be independently assessed for dexterity, sight and the ability to give clinical instructions. worradirek/Shutterstock The law tends to prioritise patient safety
All state versions of the legal regime regulating doctors, known as the National Accreditation and Registration Scheme, include a “paramountcy” provision. That provision basically says patient safety is paramount and trumps all other considerations.
As with legal regimes regulating childcare, health practitioner regulation prioritises the health and safety of the person receiving the care over the rights of the licensed professional.
Complicating this further, is the fact that a longstanding principle of health practitioner regulation has been that doctors should not be “punished” for errors in practice.
All of this means that reforms of this nature can be difficult to introduce and that the balance between patient safety and professional entitlements must be handled with care.
Could these proposals amount to age discrimination?
It is premature to analyse the legal implications of these proposals. So it’s difficult to say how these proposals interact with Commonwealth age- and other anti-discrimination laws.
For instance, one complication is that the federal age discrimination statute includes an exemption to allow “qualifying bodies” such as the Medical Board of Australia to discriminate against older professionals who are “unable to carry out the inherent requirements of the profession, trade or occupation because of his or her age”.
In broader terms, a licence to practise medicine is often compared to a licence to drive or pilot an aircraft. Despite claims of discrimination, New South Wales law requires older drivers to undergo a medical assessment every year; and similar requirements affect older pilots and air traffic controllers.
Where to from here?
When changes are proposed to health practitioner regulation, there is typically much media attention followed by a consultation and behind-the-scenes negotiation process. This issue is no different.
How will doctors respond to the proposed changes? It’s too soon to say. If the proposals are implemented, it’s possible some older doctors might retire rather than undergo these mandatory health assessments. Some may argue that encouraging more older doctors to retire is precisely the point of these proposals. However, others have suggested this would only exacerbate shortages in the health-care workforce.
The proposals are open for public comment until October 4.
Christopher Rudge, Law lecturer, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:
-
An Underrated Tool Against Alzheimer’s
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.
Dementia in general, and Alzheimer’s in particular, affects a lot of people, and probably even more than the stats show, because some (estimated to be: about half) will go undiagnosed and thus unreported:
Alzheimer’s: The Bad News And The Good
At 10almonds, we often talk about brain health, whether from a nutrition standpoint or other lifestyle factors. For nutrition, by the way, check out:
Today we’ll be looking at some new science for an underrated tool:
Bilingualism as protective factor
It’s well-known that bilingualism offers brain benefits, but most people would be hard-pressed to name what, specifically, those brain benefits are.
As doctors Kristina Coulter and Natalie Phillips found in a recent study, one of the measurable benefits may be a defense against generalized (i.e. not necessarily language-related) memory loss Alzheimer’s disease.
Specifically,
❝We used surface-based morphometry methods to measure cortical thickness and volume of language-related and AD-related brain regions. We did not observe evidence of brain reserve in language-related regions.
However, reduced hippocampal volume was observed for monolingual, but not bilingual, older adults with AD. Thus, bilingualism is hypothesized to contribute to reserve in the form of brain maintenance in the context of AD.❞
Read in full: Bilinguals show evidence of brain maintenance in Alzheimer’s disease
This is important, because while language is processed in various parts of the brain beyond the scope of this article, the hippocampi* are where memory is stored.
*usually mentioned in the singular as “hippocampus”, but you have one on each side, unless some terrible accident or incident befell you.
What this means in practical terms: these results suggest that being bilingual means we will retain more of our capacity for memory, even if we get Alzheimer’s disease, than people who are monolingual.
Furthermore, while we’re talking practicality:
❝…our subsample may be characterized as mostly late bilinguals (i.e., learning an L2 after age 5), having moderate self-reported L2 ability, and relatively few participants reporting daily L2 use (33 out of 119)❞
(L2 = second language)
This is important, because it means you don’t have to have grown up speaking multiple languages, you don’t even have to speak it well, and you don’t have to be using your second language(s) on a daily basis, to enjoy benefits. Merely having them in your head appears to be sufficient to trigger the brain to go “oh, we need to boost and maintain the hippocampal volume”.
We would hypothesize that using second language(s) regularly and/or speaking second language(s) well offers additional protection, and the data would support this if it weren’t for the fact that the sample sizes for daily and high-level speakers are a bit small to draw conclusions.
But the important part is: simply knowing another language, including if you literally just learned it later in life, is already protective of hippocampal volume in the context of Alzheimer’s disease.
Here’s a pop-science article about the study, that goes into it in more detail than we have room to here:
Bilingualism linked to greater brain resilience in older adults
Want to learn a new language?
Here are some options where you can get going right away:
If you are thinking “sounds good, but learning a language is too much work”, then that is why we included that third option there. It’s specifically for one language, and that language is Esperanto, arguably the world’s easiest language and specifically designed to be super quick and easy to get good at. Also, it’s free!
Do, kial ne lerni novan lingvon rapide kaj facile? 😉
Want to know more?
For ways to reduce your overall Alzheimer’s risk according to science, check out:
Take care!
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails: