Overdone It? How To Speed Up Recovery After Exercise

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How To Speed Up Recovery After A Workout (According To Actual Science)

Has your enthusiasm ever been greater than your ability, when it comes to exercise?

Perhaps you leapt excitedly into a new kind of exercise, or maybe you made a reprise of something you used to do, and found out the hard way you’re not in the same condition you used to be?

If you’ve ever done an exercise session and then spent the next three days recovering, this one’s for you. And if you’ve never done that? Well, prevention is better than cure!

Post-exercise stretching probably won’t do much to help

If you like to stretch after a workout, great, don’t let us stop you. Stretching is, generally speaking, good.

But: don’t rely on it to hasten recovery. Here’s what scientists Afonso et al. had to say recently, after doing a big review of a lot of available data:

❝There wasn’t sufficient statistical evidence to reject the null hypothesis that stretching and passive recovery have equivalent influence on recovery.

Data is scarce, heterogeneous, and confidence in cumulative evidence is very low. Future research should address the limitations highlighted in our review, to allow for more informed recommendations.

For now, evidence-based recommendations on whether post-exercise stretching should be applied for the purposes of recovery should be avoided, as the (insufficient) data that is available does not support related claims.❞

Source: The Effectiveness of Post-exercise Stretching in Short-Term and Delayed Recovery of Strength, Range of Motion and Delayed Onset Muscle Soreness: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

…and breath! What a title.

Hot and Cold

Contrast bath therapy (alternating hot and cold, which notwithstanding the name, can also be done in a shower) can help reduce muscle soreness after workout, because of how the change in temperature stimulates vasodilation and vasoconstriction, reducing inflammation while speeding up healing:

Contrast Water Therapy and Exercise Induced Muscle Damage: A Systematic Review and Meta-Analysis

If doing this in the shower isn’t practical for you, and you (like most people) have only one bathtub, then cold is the way to go for the most evidence-based benefits:

Whole-Body Cryotherapy in Athletes: From Therapy to Stimulation. An Updated Review of the Literature

Eat protein whenever, carbs after

Eating protein before a workout can boost muscle protein synthesis. Be aware that even if you’re not bodybuilding, your body will still need to do cell replacement and repair, including in any muscle tissue that got damaged* during the workout

If you don’t like eating before a workout, eating protein after is fine too:

Pre- versus post-exercise protein intake has similar effects on muscular adaptations

*Note: muscle tissue is supposed to get damaged (slightly!) during many kinds of workout.

From lactic acid (that “burn” you feel when exercising) to microtears, the body’s post-workout job is to make the muscle stronger than before, and to do that, it needs you to have found the weak spots for it.

That’s what exercise-to-exhaustion does.

Eating carbs after a workout helps replace lost muscle glycogen.

For a lot more details on optimal nutrition timing in the context of exercise (carbs, proteins, micronutrients, different kinds of exercise, etc), check out this very clear guide:

International society of sports nutrition position stand: nutrient timing

Alcohol is not the post-workout carb you want

Shocking, right? But of course, it’s very common for casual sportspeople to hit the bar for a social drink after their activity of choice.

However, consuming alcohol after exercise doesn’t merely fail to help, it actively inhibits glycogen replacement and protein synthesis:

Alcohol Ingestion Impairs Maximal Post-Exercise Rates of Myofibrillar Protein Synthesis following a Single Bout of Concurrent Training

Also, if you’re tempted to take alcohol “to relax”, please be aware that alcohol only feels relaxing because of what it does to the brain; to the rest of the body, it is anything but, and also raises blood pressure and cortisol levels.

As to what to drink instead…

Hydrate, and consider creatine and tart cherry supplementation

Hydration is a no-brainer, but when you’re dehydrated, it’s easy to forget!

Creatine is a very well-studied supplement, that helps recovery from intense exercise:

International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine

Tart cherry juice has been found to reduce muscle damage, soreness, and inflammation after exercise:

Powdered tart cherry supplementation demonstrates benefit on markers of catabolism and muscle soreness following an acute bout of intense lower body resistance exercise

Wondering where you can get tart cherry powder? We don’t sell it (or anything else), but here’s an example product on Amazon.

And of course, actually rest

That includes good sleep, please. Otherwise…

Effects of Sleep Deprivation on Acute Skeletal Muscle Recovery after Exercise

Rest well!

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  • Gluten: What’s The Truth?

    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.

    Gluten: What’s The Truth?

    We asked you for your health-related view of gluten, and got the above spread of results. To put it simply:

    Around 60% of voters voted for “Gluten is bad if you have an allergy/sensitivity; otherwise fine

    The rest of the votes were split fairly evenly between the other three options:

    • Gluten is bad for everyone and we should avoid it
    • Gluten is bad if (and only if) you have Celiac disease
    • Gluten is fine for all, and going gluten-free is a modern fad

    First, let’s define some terms so that we’re all on the same page:

    What is gluten?

    Gluten is a category of protein found in wheat, barley, rye, and triticale. As such, it’s not one single compound, but a little umbrella of similar compounds. However, for the sake of not making this article many times longer, we’re going to refer to “gluten” without further specification.

    What is Celiac disease?

    Celiac disease is an autoimmune disease. Like many autoimmune diseases, we don’t know for sure how/why it occurs, but a combination of genetic and environmental factors have been strongly implicated, with the latter putatively including overexposure to gluten.

    It affects about 1% of the world’s population, and people with Celiac disease will tend to respond adversely to gluten, notably by inflammation of the small intestine and destruction of enterocytes (the cells that line the wall of the small intestine). This in turn causes all sorts of other problems, beyond the scope of today’s main feature, but suffice it to say, it’s not pleasant.

    What is an allergy/intolerance/sensitivity?

    This may seem basic, but a lot of people conflate allergy/intolerance/sensitivity, so:

    • An allergy is when the body mistakes a harmless substance for something harmful, and responds inappropriately. This can be mild (e.g. allergic rhinitis, hayfever) or severe (e.g. peanut allergy), and as such, responses can vary from “sniffly nose” to “anaphylactic shock and death”.
      • In the case of a wheat allergy (for example), this is usually somewhere between the two, and can for example cause breathing problems after ingesting wheat or inhaling wheat flour.
    • An intolerance is when the body fails to correctly process something it should be able to process, and just ejects it half-processed instead.
      • A common and easily demonstrable example is lactose intolerance. There isn’t a well-defined analog for gluten, but gluten intolerance is nonetheless a well-reported thing.
    • A sensitivity is when none of the above apply, but the body nevertheless experiences unpleasant symptoms after exposure to a substance that should normally be safe.
      • In the case of gluten, this is referred to as non-Celiac gluten sensitivity

    A word on scientific objectivity: at 10almonds we try to report science as objectively as possible. Sometimes people have strong feelings on a topic, especially if it is polarizing.

    Sometimes people with a certain condition feel constantly disbelieved and mocked; sometimes people without a certain condition think others are imagining problems for themselves where there are none.

    We can’t diagnose anyone or validate either side of that, but what we can do is report the facts as objectively as science can lay them out.

    Gluten is fine for all, and going gluten-free is a modern fad: True or False?

    Definitely False, Celiac disease is a real autoimmune disease that cannot be faked, and allergies are also a real thing that people can have, and again can be validated in studies. Even intolerances have scientifically measurable symptoms and can be tested against nocebo.

    See for example:

    However! It may not be a modern fad, so much as a modern genuine increase in incidence.

    Widespread varieties of wheat today contain a lot more gluten than wheat of ages past, and many other molecular changes mean there are other compounds in modern grains that never even existed before.

    However, the health-related impact of these (novel proteins and carbohydrates) is currently still speculative, and we are not in the business of speculating, so we’ll leave that as a “this hasn’t been studied enough to comment yet but we recognize it could potentially be a thing” factor.

    Gluten is bad if (and only if) you have Celiac disease: True or False?

    Definitely False; allergies for example are well-evidenced as real; same facts as we discussed/linked just above.

    Gluten is bad for everyone and we should avoid it: True or False?

    False, tentatively and contingently.

    First, as established, there are people with clinically-evidenced Celiac disease, wheat allergy, or similar. Obviously, they should avoid triggering those diseases.

    What about the rest of us, and what about those who have non-Celiac gluten sensitivity?

    Clinical testing has found that of those reporting non-Celiac gluten sensitivity, nocebo-controlled studies validate that diagnosis in only a minority of cases.

    In the following study, for example, only 16% of those reporting symptoms showed them in the trials, and 40% of those also showed a nocebo response (i.e., like placebo, but a bad rather than good effect):

    Suspected Nonceliac Gluten Sensitivity Confirmed in Few Patients After Gluten Challenge in Double-Blind, Placebo-Controlled Trials

    This one, on the other hand, found that positive validations of diagnoses were found to be between 7% and 77%, depending on the trial, with an average of 30%:

    Re-challenge Studies in Non-celiac Gluten Sensitivity: A Systematic Review and Meta-Analysis

    In other words: non-Celiac gluten sensitivity is a thing, and/but may be over-reported, and/but may be in some part exacerbated by psychosomatic effect.

    Note: psychosomatic effect does not mean “imagining it” or “all in your head”. Indeed, the “soma” part of the word “psychosomatic” has to do with its measurable effect on the rest of the body.

    For example, while pain can’t be easily objectively measured, other things, like inflammation, definitely can.

    As for everyone else? If you’re enjoying your wheat (or similar) products, it’s well-established that they should be wholegrain for the best health impact (fiber, a positive for your health, rather than white flour’s super-fast metabolites padding the liver and causing metabolic problems).

    Wheat itself may have other problems, for example FODMAPs, amylase trypsin inhibitors, and wheat germ agglutinins, but that’s “a wheat thing” rather than “a gluten thing”.

    That’s beyond the scope of today’s main feature, but you might want to check out today’s featured book!

    For a final scientific opinion on this last one, though, here’s what a respected academic journal of gastroenterology has to say:

    From coeliac disease to noncoeliac gluten sensitivity; should everyone be gluten-free?

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  • What Does “Balance Your Hormones” Even Mean?

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    Hormonal Health: Is It Really A Balancing Act?

    Have you ever wondered what “balancing your hormones” actually means?

    The popular view is that men’s hormones look like this:

    Testosterone (less) ⟷ Testosterone (more)

    …And that women’s hormones look more like this:

    ♀︎ Estrogen ↭ Progesterone ⤵︎

    ⇣⤷ FSH ⤦ ↴ ☾ ⤹⤷ Luteinizing Hormone ⤦

    DHEA ↪︎ Gonadotrophin ⤾

    ↪︎ Testosterone? ⥅⛢

    Clear as mud, right?

    But, don’t worry, Supplements McHerbal Inc will sell you something guaranteed to balance your hormones!

    How can a supplement (or dietary adjustment) “balance” all that hotly dynamic chaos, and make everything “balanced”?

    The truth is, “balanced” in such a nebulous term, and this is why you will not hear endocrinologists using it. It’s used in advertising to mean “in good order”, and “not causing problems”, and “healthy”.

    In reality, our hormone levels depend on everything from our diet to our age to our anatomy to our mood to the time of the day to the phase of the moon.

    Not that the moon has an influence on our physiology at all—that’s a myth—but you know, 28 day cycle and all. And, yes, half the hormones affect the levels of the others, either directly or indirectly.

    Trying to “balance” them would be quite a game of whack-a-mole, and not something that a “cure-all” single “hormone-balancing” supplement could do.

    So why aren’t we running this piece on Friday, for our “mythbusting” section? Well, we could have, but the more useful information is yet to come and will take up more of today’s newsletter than the myth-busting!

    What, then, can we do to untangle the confusion of these hormones?

    Well first, let’s understand what they do, in the most simple terms possible:

    • Estrogen—the most general feminizing hormone from puberty onwards, busiest in the beginning of the menstrual cycle, and starts getting things ready for ovulation.
    • Progesteronesecondary feminizing hormone, fluffs the pillows for the oncoming fertilized egg to be implanted, increases sex drive, and adjusts metabolism accordingly. Busiest in the second half of the menstrual cycle.
    • Testosterone—is also present, contributes to sex drive, is often higher in individuals with PCOS. If menopause is untreated, testosterone will also rise, because there will be less estrogen
      • (testosterone and estrogen “antagonize” each other, which is the colorfully scientific way of saying they work against each other)
      • DHEA—Dehydroepiandrosterone, supports production of testosterone (and estrogen!). Sounds self-balancing, but in practice, too much DHEA can thus cause elevated testosterone levels, and thus hirsutism.
    • Gonadotrophin—or more specifically human chorionic gonadotrophin, HcG, is “the pregnancy hormone“, present only during pregnancy, and has specific duties relating to such. This is what’s detected in (most) pregnancy test kits.
    • FSH—follicle stimulating hormone, is critical to ovulation, and is thus essential to female fertility. On the other hand, when the ovaries stop working, FSH levels will rise in a vain attempt to encourage the ovulation that isn’t going to happen anymore.
    • Luteinizing hormone—says “go” to the new egg and sends it on its merry way to go get fertilized. This is what’s detected by ovulation prediction kits.

    Sooooooo…

    What, for most women, most often is meant by a “hormonal imbalance” is:

    • Low levels of E and/or P
    • High levels of DHEA and/or T
    • Low or High levels of FSH

    In the case of low levels of E and/or P, the most reliable way to increase these is, drumroll please… To take E and/or P. That’s it, that’s the magic bullet.

    Bonus Tip: take your E in the morning (this is when your body will normally make more and use more) take your P in the evening (it won’t make you sleepy, but it will improve your sleep quality when you do sleep)

    In the case of high levels of DHEA and/or T, then that’s a bit more complex:

    • Taking E will antagonize (counteract) the unwanted T.
    • Taking T-blockers (such as spironolactone or bicalutamide) will do what it says on the tin, and block T from doing the jobs it’s trying to do, but the side-effects are considered sufficient to not prescribe them to most people.
    • Taking spearmint or saw palmetto will lower testosterone’s effects
      • Scientists aren’t sure how or why spearmint works for this
      • Saw palmetto blocks testosterone’s conversion into a more potent form, DHT, and so “detoothes” it a bit. It works similarly to drugs such as finasteride, often prescribed for androgenic alopecia, called “male pattern baldness”, but it affects plenty of women too.

    In the case of low levels of FSH, eating leafy greens will help.

    In the case of high levels of FSH, see a doctor. HRT (Hormone Replacement Therapy) may help. If you’re not of menopausal age, it could be a sign something else is amiss, so it could be worth getting that checked out too.

    What can I eat to boost my estrogen levels naturally?

    A common question. The simple answer is:

    • Flaxseeds and soy contain plant estrogens that the body can’t actually use as such (too incompatible). They’ve lots of high-quality nutrients though, and the polyphenols and isoflavones can help with some of the same jobs when it comes to sexual health.
    • Fruit, especially peaches, apricots, blueberries, and strawberries, contain a lot of lignans and also won’t increase your E levels as such, but will support the same functions and reduce your breast cancer risk.
    • Nuts, especially almonds (yay!), cashews, and pistachios, contain plant estrogens that again can’t be used as bioidentical estrogen (like you’d get from your ovaries or the pharmacy) but do support heart health.
    • Leafy greens and cruciferous vegetables support a lot of bodily functions including good hormonal health generally, in ways that are beyond the scope of this article, but in short: do eat your greens!

    Note: because none of these plant-estrogens or otherwise estrogenic nutrients can actually do the job of estradiol (the main form of estrogen in your body), this is why they’re still perfectly healthy for men to eat too, and—contrary to popular “soy boy” social myths—won’t have any feminizing effects whatsoever.

    On the contrary, most of the same foods support good testosterone-related health in men.

    The bottom line:

    • Our hormones are very special, and cannot be replaced with any amount of herbs or foods.
    • We can support our body’s natural hormonal functions with good diet, though.
    • Our hormones naturally fluctuate, and are broadly self-correcting.
    • If something gets seriously out of whack, you need an endocrinologist, not a homeopath or even a dietician.

    In case you missed it…

    We gave a more general overview of supporting hormonal health (including some hormones that aren’t sex hormones but are really important too), back in February.

    Check it out here: Healthy Hormones And How To Hack Them

    Want to read more?

    Anthea Levi, RD, takes much the same view:

    ❝For some ‘hormone-balancing’ products, the greatest risk might simply be lost dollars. Others could come at a higher cost.❞

    Read: Are Hormone-Balancing Products a Scam?

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  • Water Water Everywhere, But Which Is Best To Drink?

    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.

    Well Well Well…

    In Tuesday’s newsletter, we asked you for your (health-related) opinion on drinking water—with the understanding that this may vary from place to place. We got the above-depicted, below-described, set of responses:

    • About 65% said “Filtered is best”
    • About 20% said “From the mains is best”
    • About 8% said “Bottled is best”
    • About 3% said “Distilled is best”
    • About 3% said “Some other source is best”

    Of those who said “some other source is best”, one clarified that their preferred source was well water.

    So what does the science say?

    Fluoridated water is bad for you: True or False?

    False, assuming a normal level of consumption. Rather than take up more space today though, we’ll link to what we previously wrote on this topic:

    Q&A: Water Fluoridation

    You may be wondering: but what if my level of consumption is higher than normal?

    Let’s quickly look at some stats:

    • The maximum permitted safety level varies from place to place, but is (for example) 2mg/l in the US, 1.5mg/l in Canada & the UK.
    • The minimum recommended amount also varies from place to place, but is (for example) 0.7mg/l in Canada and the US, and 1mg/l in the UK.

    It doesn’t take grabbing a calculator to realize that if you drink twice as much water as someone else, then depending on where you are, water fluoridated to the minimum may give you more than the recommended maximum.

    However… Those safety margins are set so much lower than the actual toxicity levels of fluoride, that it doesn’t make a difference.

    For example: your writer here takes a medication that has the side effect of causing dryness of the mouth, and consequently she drinks at least 3l of water per day in a climate that could not be described as hot (except perhaps for about 2 weeks of the year). She weighs 72kg (that’s about 158 pounds), and the toxicity of fluoride (for ill symptoms, not death) is 0.2mg/kg. So, she’d need 14.4mg of fluoride, which even if the water fluoridation here were 2mg/l (it’s not; it’s lower here, but let’s go with the highest figure to make a point), would require drinking more than 7l of water faster than the body can process it.

    For more about the numbers, check out:

    Acute Fluoride Poisoning from a Public Water System

    Bottled water is the best: True or False?

    False, if we consider “best” to be “healthiest”, which in turn we consider to be “most nutrients, with highest safety”.

    Bottled water generally does have higher levels of minerals than most local mains supply water does. That’s good!

    But you know what else is generally has? Microplastics and nanoplastics. That’s bad!

    We don’t like to be alarmist in tone; it’s not what we’re about here, but the stats on bottled water are simply not good; see:

    We Are Such Stuff As Bottles Are Made Of

    You may be wondering: “but what about bottled water that comes in glass bottles?”

    Indeed, water that comes in glass bottles can be expected to have lower levels of plastic than water that comes in plastic bottles, for obvious reasons.

    However, we invite you to consider how likely you believe it to be that the water wasn’t stored in plastic while being processed, shipped and stored, before being portioned into its final store-ready glass bottles for end-consumer use.

    Distilled water is the best: True or False?

    False, generally, with caveats:

    Distilled water is surely the safest water anywhere, because you know that you’ve removed any nasties.

    However, it’s also devoid of nutrients, because you also removed any minerals it contained. Indeed, if you use a still, you’ll be accustomed to the build-up of these minerals (generally simplified and referenced as “limescale”, but it’s a whole collection of minerals).

    Furthermore, that loss of nutrients can be more than just a “something good is missing”, because having removed certain ions, that water could now potentially strip minerals from your teeth. In practice, however, you’d probably have to swill it excessively to cause this damage.

    Nevertheless, if you have the misfortune of living somewhere like Flint, Michigan, then a water still may be a fair necessity of life. In other places, it can simply be useful to have in case of emergency, of course.

    Here’s an example product on Amazon if you’d like to invest in a water still for such cases.

    PS: distilled water is also tasteless, and is generally considered bad, tastewise, for making tea and coffee. So we really don’t recommend distilling your water unless you have a good reason to do so.

    Filtered water is the best: True or False?

    True for most people in most places.

    Let’s put it this way: it can’t logically be worse than whatever source of water you put into it…

    Provided you change the filter regularly, of course.

    Otherwise, after overusing a filter, at best it won’t be working, and at worst it’ll be adding in bacteria that have multiplied in the filter over however long you left it there.

    You may be wondering: can water filters remove microplastics, and can they remove minerals?

    The answer in both cases is: sometimes.

    • For microplastics it depends on the filter size and the microplastic size (see our previous article for details on that).
    • For minerals, it depends on the filter type. Check out:

    The H2O Chronicles | 5 Water Filters That Remove Minerals

    One other thing to think about: while most water filtration jugs are made of PFAS-free BPA-free plastics for obvious reasons, for greater peace of mind, you might consider investing in a glass filtration jug, like this one ← this is just one example product on Amazon; by all means shop around and find one you like

    Take care!

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  • Ouch. That ‘Free’ Annual Checkup Might Cost You. Here’s Why.

    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.

    When Kristy Uddin, 49, went in for her annual mammogram in Washington state last year, she assumed she would not incur a bill because the test is one of the many preventive measures guaranteed to be free to patients under the 2010 Affordable Care Act. The ACA’s provision made medical and economic sense, encouraging Americans to use screening tools that could nip medical problems in the bud and keep patients healthy.

    So when a bill for $236 arrived, Uddin — an occupational therapist familiar with the health care industry’s workings — complained to her insurer and the hospital. She even requested an independent review.

    “I’m like, ‘Tell me why am I getting this bill?’” Uddin recalled in an interview. The unsatisfying explanation: The mammogram itself was covered, per the ACA’s rules, but the fee for the equipment and the facility was not.

    That answer was particularly galling, she said, because, a year earlier, her “free” mammogram at the same health system had generated a bill of about $1,000 for the radiologist’s reading. Though she fought that charge (and won), this time she threw in the towel and wrote the $236 check. But then she dashed off a submission to the KFF Health News-NPR “Bill of the Month” project:

    “I was really mad — it’s ridiculous,” she later recalled. “This is not how the law is supposed to work.”

    The ACA’s designers might have assumed that they had spelled out with sufficient clarity that millions of Americans would no longer have to pay for certain types of preventive care, including mammograms, colonoscopies, and recommended vaccines, in addition to doctor visits to screen for disease. But the law’s authors didn’t reckon with America’s ever-creative medical billing juggernaut.

    Over the past several years, the medical industry has eroded the ACA’s guarantees, finding ways to bill patients in gray zones of the law. Patients going in for preventive care, expecting that it will be fully covered by insurance, are being blindsided by bills, big and small.

    The problem comes down to deciding exactly what components of a medical encounter are covered by the ACA guarantee. For example, when do conversations between doctor and patient during an annual visit for preventive services veer into the treatment sphere? What screenings are needed for a patient’s annual visit?

    A healthy 30-year-old visiting a primary care provider might get a few basic blood tests, while a 50-year-old who is overweight would merit additional screening for Type 2 diabetes.

    Making matters more confusing, the annual checkup itself is guaranteed to be “no cost” for women and people age 65 and older, but the guarantee doesn’t apply for men in the 18-64 age range — though many preventive services that require a medical visit (such as checks of blood pressure or cholesterol and screens for substance abuse) are covered.

    No wonder what’s covered under the umbrella of prevention can look very different to medical providers (trying to be thorough) and billers (intent on squeezing more dollars out of every medical encounter) than it does to insurers (who profit from narrower definitions).

    For patients, the gray zone has become a billing minefield. Here are a few more examples, gleaned from the Bill of the Month project in just the past six months:

    Peter Opaskar, 46, of Texas, went to his primary care doctor last year for his preventive care visit — as he’d done before, at no cost. This time, his insurer paid $130.81 for the visit, but he also received a perplexing bill for $111.81. Opaskar learned that he had incurred the additional charge because when his doctor asked if he had any health concerns, he mentioned that he was having digestive problems but had already made an appointment with his gastroenterologist. So, the office explained, his visit was billed as both a preventive physical and a consultation. “Next year,” Opasker said in an interview, if he’s asked about health concerns, “I’ll say ‘no,’ even if I have a gunshot wound.”

    Kevin Lin, a technology specialist in Virginia in his 30s, went to a new primary care provider to take advantage of the preventive care benefit when he got insurance; he had no physical complaints. He said he was assured at check-in that he wouldn’t be charged. His insurer paid $174 for the checkup, but he was billed an additional $132.29 for a “new patient visit.” He said he has made many calls to fight the bill, so far with no luck.

    Finally, there’s Yoori Lee, 46, of Minnesota, herself a colorectal surgeon, who was shocked when her first screening colonoscopy yielded a bill for $450 for a biopsy of a polyp — a bill she knew was illegal. Federal regulations issued in 2022 to clarify the matter are very clear that biopsies during screening colonoscopies are included in the no-cost promise. “I mean, the whole point of screening is to find things,” she said, stating, perhaps, the obvious.

    Though these patient bills defy common sense, room for creative exploitation has been provided by the complex regulatory language surrounding the ACA. Consider this from Ellen Montz, deputy administrator and director of the Center for Consumer Information and Insurance Oversight at the Centers for Medicare & Medicaid Services, in an emailed response to queries and an interview request on this subject: “If a preventive service is not billed separately or is not tracked as individual encounter data separately from an office visit and the primary purpose of the office visit is not the delivery of the preventive item or service, then the plan issuer may impose cost sharing for the office visit.”

    So, if the doctor decides that a patient’s mention of stomach pain does not fall under the umbrella of preventive care, then that aspect of the visit can be billed separately, and the patient must pay?

    And then there’s this, also from Montz: “Whether a facility fee is permitted to be charged to a consumer would depend on whether the facility usage is an integral part of performing the mammogram or an integral part of any other preventive service that is required to be covered without cost sharing under federal law.”

    But wait, how can you do a mammogram or colonoscopy without a facility?

    Unfortunately, there is no federal enforcement mechanism to catch individual billing abuses. And agencies’ remedies are weak — simply directing insurers to reprocess claims or notifying patients they can resubmit them.

    In the absence of stronger enforcement or remedies, CMS could likely curtail these practices and give patients the tools to fight back by offering the sort of clarity the agency provided a few years ago regarding polyp biopsies — spelling out more clearly what comes under the rubric of preventive care, what can be billed, and what cannot.

    The stories KFF Health News and NPR receive are likely just the tip of an iceberg. And while each bill might be relatively small compared with the stunning $10,000 hospital bills that have become all too familiar in the United States, the sorry consequences are manifold. Patients pay bills they do not owe, depriving them of cash they could use elsewhere. If they can’t pay, those bills might end up with debt-collection agencies and, ultimately, harm their credit score.

    Perhaps most disturbing: These unexpected bills might discourage people from seeking preventive screenings that could be lifesaving, which is why the ACA deemed them “essential health benefits” that should be free.

    KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

    Subscribe to KFF Health News’ free Morning Briefing.

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  • Regular Nail Polish vs Gel Nail Polish – 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 regular nail polish to gel nail polish, we picked the regular.

    Why?

    This one’s less about what’s in the bottle, and more about what gets done to your hands:

    • Regular nail polish application involves carefully brushing it on.
    • Regular nail polish removal involves wiping with acetone.

    …whereas:

    • Gel nail polish application involves deliberately damaging (roughing up) the nail to allow the color coat to adhere, then when the top coat is applied, holding the nails (and thus, the attached fingers) under a UV light to set it. That UV lamp exposure is very bad for the skin.
    • Gel nail polish removal involves soaking in acetone, which is definitely worse than wiping with acetone. Failure to adequately soak it will result in further damage to the nail while trying to get the base coat off the nail that you already deliberately damaged when first applying it.

    All in all, regular nail polish isn’t amazing for nail health (healthiest is for nails to be free and naked), but for those of us who like a little bit of color there, regular is a lot better than gel.

    Gel nail polish damages the nail itself by necessity, and presents a cumulative skin cancer risk and accelerated aging of the skin, by way of the UV lamp use.

    For your interest, here are the specific products that we compared, but the above goes for any of this kind:

    Regular nail polish | Gel nail polish

    If you’d like to read more about nail health, you might enjoy reading:

    The Counterintuitive Dos and Don’ts of Nail Health

    Take care!

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  • Better Sex Through Mindfulness – by Dr. Lori Brotto

    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.

    Female sexuality is such a taboo topic that, if one searches for (ob/gyn professor, women’s health research director, and psychologist) Dr. Brotto’s book on Google or Amazon, it suggests only “lori brotto mindfulness book”. So, for those brave enough to read a book that would have shocked Victorians, what does this one contain?

    The focus is on, as the title suggests, better sex, by and for women. That said, it’s mostly because typically women are more likely to experience the problems described in the book; it’s nothing actually intrinsic to womanhood. A man with the same problems could read this book and benefit just the same.

    While the book covers many possible problems between the sheets, the overarching theme is problems of the mind, such as:

    • Not getting into the mood in the first place
    • Losing the mood quickly and easily, such as by becoming distracted
    • Difficulty achieving orgasm even when mechanically everything’s delightful
    • Physical discomfort creating a barrier to enjoyment

    …and yes, that last one is in part mind-stuff too! Though Dr. Brotto isn’t arguing that mindfulness is a panacea, just an incredibly useful tool. And, it’s one she not only explains very well, but also explains from the position of a wealth of scientific evidence… Enough so, that we see a one-star Amazon reviewer from Canada complained that it was too well-referenced! For us, though, it’s what we like to see.

    Good science, presented clearly and usefully, giving practical tips that improve people’s lives.

    Bottom line: if you’ve ever lost the mood because you got distracted into thinking about taxes or that meeting on Tuesday, this is the book for you.

    Click here to check out Better Sex Through Mindfulness—you can thank us later!

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