State of Slim – by Dr. James Hill & Dr. Holly Wyatt
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The premise of this book is “people in Colorado are on average the slimmest in the US”, and sets about establishing why, and then doing what Coloradans are doing. As per the subtitle (drop 20 pounds in 8 weeks), this is a weight loss book and does assume that you want to lose weight—specifically, to lose fat. So if that’s not your goal, you can skip this one already.
The authors explain, as many diet and not-diet-but-diet-adjacent book authors do, that this is not a diet—and then do refer to it as the Colorado Diet throughout. So… Is it a diet?
The answer is a clear “yes, but”—and the caveat is “yes, but also some associated lifestyle practices”.
The diet component is basically a very low-carb diet to start with (with the day’s ration of carbs being a small amount of oats and whatever you can get from some non-starchy vegetables such as greens, tomatoes, etc), and then reintroducing more carbohydrate centric foods one by one, stopping after whole grains. If you are vegan or vegetarian, you can also skip this one already, because this advises eating six animal protein centric meals per day.
The non-diet components are very general healthy-living advices mixed in with popular “diet culture” advices, such as practice mindful eating, don’t eat after 8pm, exercise more, use small plates, enjoy yourself, pre-portion your snacks, don’t drink your calories, get 8 hours sleep, weigh all your food, etc.
Bottom line: this is a very mixed bag, even to the point of being a little chaotic. It gives sometimes contradictory advice, and/but this results in a very “something for everyone” cafeteria approach to dieting. The best recommendation we can give for this book is “it has very many ideas for you to try and see if they work for you”.
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People with dementia aren’t currently eligible for voluntary assisted dying. Should they be?
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Dementia is the second leading cause of death for Australians aged over 65. More than 421,000 Australians currently live with dementia and this figure is expected to almost double in the next 30 years.
There is ongoing public discussion about whether dementia should be a qualifying illness under Australian voluntary assisted dying laws. Voluntary assisted dying is now lawful in all six states, but is not available for a person living with dementia.
The Australian Capital Territory has begun debating its voluntary assisted dying bill in parliament but the government has ruled out access for dementia. Its view is that a person should retain decision-making capacity throughout the process. But the bill includes a requirement to revisit the issue in three years.
The Northern Territory is also considering reform and has invited views on access to voluntary assisted dying for dementia.
Several public figures have also entered the debate. Most recently, former Australian Chief Scientist, Ian Chubb, called for the law to be widened to allow access.
Others argue permitting voluntary assisted dying for dementia would present unacceptable risks to this vulnerable group.
Inside Creative House/Shutterstock Australian laws exclude access for dementia
Current Australian voluntary assisted dying laws exclude access for people who seek to qualify because they have dementia.
In New South Wales, the law specifically states this.
In the other states, this occurs through a combination of the eligibility criteria: a person whose dementia is so advanced that they are likely to die within the 12 month timeframe would be highly unlikely to retain the necessary decision-making capacity to request voluntary assisted dying.
This does not mean people who have dementia cannot access voluntary assisted dying if they also have a terminal illness. For example, a person who retains decision-making capacity in the early stages of Alzheimer’s disease with terminal cancer may access voluntary assisted dying.
What happens internationally?
Voluntary assisted dying laws in some other countries allow access for people living with dementia.
One mechanism, used in the Netherlands, is through advance directives or advance requests. This means a person can specify in advance the conditions under which they would want to have voluntary assisted dying when they no longer have decision-making capacity. This approach depends on the person’s family identifying when those conditions have been satisfied, generally in consultation with the person’s doctor.
Another approach to accessing voluntary assisted dying is to allow a person with dementia to choose to access it while they still have capacity. This involves regularly assessing capacity so that just before the person is predicted to lose the ability to make a decision about voluntary assisted dying, they can seek assistance to die. In Canada, this has been referred to as the “ten minutes to midnight” approach.
But these approaches have challenges
International experience reveals these approaches have limitations. For advance directives, it can be difficult to specify the conditions for activating the advance directive accurately. It also requires a family member to initiate this with the doctor. Evidence also shows doctors are reluctant to act on advance directives.
Particularly challenging are scenarios where a person with dementia who requested voluntary assisted dying in an advance directive later appears happy and content, or no longer expresses a desire to access voluntary assisted dying.
What if the person changes their mind? Jokiewalker/Shutterstock Allowing access for people with dementia who retain decision-making capacity also has practical problems. Despite regular assessments, a person may lose capacity in between them, meaning they miss the window before midnight to choose voluntary assisted dying. These capacity assessments can also be very complex.
Also, under this approach, a person is required to make such a decision at an early stage in their illness and may lose years of otherwise enjoyable life.
Some also argue that regardless of the approach taken, allowing access to voluntary assisted dying would involve unacceptable risks to a vulnerable group.
More thought is needed before changing our laws
There is public demand to allow access to voluntary assisted dying for dementia in Australia. The mandatory reviews of voluntary assisted dying legislation present an opportunity to consider such reform. These reviews generally happen after three to five years, and in some states they will occur regularly.
The scope of these reviews can vary and sometimes governments may not wish to consider changes to the legislation. But the Queensland review “must include a review of the eligibility criteria”. And the ACT bill requires the review to consider “advanced care planning”.
Both reviews would require consideration of who is able to access voluntary assisted dying, which opens the door for people living with dementia. This is particularly so for the ACT review, as advance care planning means allowing people to request voluntary assisted dying in the future when they have lost capacity.
The legislation undergoes a mandatory review. Jenny Sturm/Shutterstock This is a complex issue, and more thinking is needed about whether this public desire for voluntary assisted dying for dementia should be implemented. And, if so, how the practice could occur safely, and in a way that is acceptable to the health professionals who will be asked to provide it.
This will require a careful review of existing international models and their practical implementation as well as what would be feasible and appropriate in Australia.
Any future law reform should be evidence-based and draw on the views of people living with dementia, their family caregivers, and the health professionals who would be relied on to support these decisions.
Ben White, Professor of End-of-Life Law and Regulation, Australian Centre for Health Law Research, Queensland University of Technology; Casey Haining, Research Fellow, Australian Centre for Health Law Research, Queensland University of Technology; Lindy Willmott, Professor of Law, Australian Centre for Health Law Research, Queensland University of Technology, Queensland University of Technology, and Rachel Feeney, Postdoctoral research fellow, Queensland University of Technology
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Calm Your Mind with Food – by Dr. Uma Naidoo
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From the author of This Is Your Brain On Food, the psychiatrist-chef (literally, she is a Harvard-trained psychiatrist and an award-winning chef) is back with a more specific work, this time aimed squarely at what it says in the title; how to calm your mind with food.
You may be wondering: does this mean comfort-eating? And, well, not in the sense that term’s usually used. There will be eating and comfort will occur, but the process involves an abundance of nutrients, a minimization of health-deleterious ingredients, and a “for every chemical its task” approach. In other words, very much “nutraceuticals”, as our diet.
On which note: as we’ve come to expect from Dr. Naidoo, we see a lot of hard science presented simply and clearly, with neither undue sensationalization nor unnecessary jargon. We learn about the brain, the gut, relevant biology and chemistry, and build up from understanding ingredients to dietary patterns to having a whole meal plan, complete with recipes.
You may further be wondering: how much does it add that we couldn’t get from the previous book? And the answer is, not necessarily a huge amount, especially if you’re fairly comfortable taking ideas and creating your own path forwards using them. If, on the other hand, you’re a little anxious about doing that (as someone perusing this book may well be), then Dr. Naidoo will cheerfully lead you by the hand through what you need to know and do.
Bottom line: if not being compared to her previous book, this is a great standalone book with a lot of very valuable content. However, the previous book is a tough act to follow! So… All in all we’d recommend this more to people who want to indeed “calm your mind with food”, who haven’t read the other book, as this one will be more specialized for you.
Click here to check out Calm Your Mind With Food, and do just that!
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Loss, Trauma, and Resilience – by Dr. Pauline Boss
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Most books about bereavement are focused on grieving healthily and then moving on healthily. And, while it may be said “everyone’s grief is on their own timescale”… society’s expectation is often quite fixed:
“Time will heal”, they say.
But what if it doesn’t? What happens when that’s not possible?
Ambiguous loss occurs when someone is on the one hand “gone”, but on the other hand, not necessarily.
This can be:
- Someone was lost in a way that didn’t leave a body to 100% confirm it
- (e.g. disaster, terrorism, war, murder, missing persons)
- Someone remains physically present but in some ways already “gone”
- (e.g. Alzheimer’s disease or other dementia, brain injury, coma)
These things stop us continuing as normal, and/but also stop us from moving on as normal.
When either kind of moving forward is made impossible, everything gets frozen in place. How does one deal with that?
Dr. Boss wrote this book for therapists, but its content is equally useful for anyone struggling with ambiguous loss—or who has a loved one who is, in turn, struggling with that.
The book looks at the impact of ambiguous loss on continuing life, and how to navigate that:
- How to be resilient, in the sense of when life tries to break you, to have ways to bend instead.
- How to live with the cognitive dissonance of a loved one who is a sort of “Schrödinger’s person”.
- How, and this is sometimes the biggest one, to manage ambiguous loss in a society that often pushes toward: “it’s been x period of time, come on, get over it now, back to normal”
Will this book heal your heart and resolve your grief? No, it won’t. But what it can do is give a roadmap for nonetheless thriving in life, while gently holding onto whatever we need to along the way.
Click here to check out “Ambiguous loss, Trauma, and Resilience” on Amazon—it can really help
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- Someone was lost in a way that didn’t leave a body to 100% confirm it
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Fat’s Real Barriers To Health
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Fat Justice In Healthcare
This is Aubrey Gordon, an author, podcaster, and fat justice activist. What does that mean?
When it comes to healthcare, we previously covered some ideas very similar to her work, such as how…
There’s a lot of discrimination in healthcare settings
In this case, it often happens that a thin person goes in with a medical problem and gets treated for that, while a fat person can go in with the same medical problem and be told “you should try losing some weight”.
Top tip if this happens to you… Ask: “what would you advise/prescribe to a thin person with my same symptoms?”
Other things may be more systemic, for example:
When a thin person goes to get their blood pressure taken, and that goes smoothly, while a fat person goes to get their blood pressure taken, and there’s not a blood pressure cuff to fit them, is the problem the size of the person or the size of the cuff? It all depends on perspective, in a world built around thin people.
That’s a trivial-seeming example, but the same principle has far-reaching (and harmful) implications in healthcare in general, e.g:
- Surgeons being untrained (and/or unwilling) to operate on fat people
- Getting a one-size-fits-all dose that was calculated using average weight, and now doesn’t work
- MRI machines are famously claustrophobia-inducing for thin people; now try not fitting in it in the first place
…and so forth. So oftentimes, obesity will be correlated with a poor healthcare outcome, where the problem is not actually the obesity itself, but rather the system having been set up with thin people in mind.
It would be like saying “Having O- blood type results in higher risks when receiving blood transfusions”, while omitting to add “…because we didn’t stock O- blood”.
Read more on this topic: Shedding Some Obesity Myths
Does she have practical advice about this?
If she could have you understand one thing, it would be:
You deserve better.
Or if you are not fat: your fat friends deserve better.
How this becomes useful is: do not accept being treated as the problem!
Demand better!
If you meekly accept that you “just need to lose weight” and that thus you are the problem, you take away any responsibility from your healthcare provider(s) to actually do their jobs and provide healthcare.
See also Gordon’s book, which we’ve not reviewed yet but probably will one of these days:
“You Just Need to Lose Weight”: And 19 Other Myths About Fat People – by Aubrey Gordon
Are you saying fat people don’t need to lose weight?
That’s a little like asking “would you say office workers don’t need to exercise more?”; there are implicit assumptions built into the question that are going unaddressed.
Rather: some people might benefit healthwise from losing weight, some might not.
In fact, over the age of 65, being what is nominally considered “overweight” reduces all-cause mortality risk.
For details of that and more, see: When BMI Doesn’t Measure Up
But what if I do want/need to lose weight?
Gordon’s not interested in helping with that, but we at 10almonds are, so…
Check out: Lose Weight, But Healthily
Where can I find more from Aubrey Gordon?
You might enjoy her blog:
Aubrey Gordon | Your Fat Friend
Or her other book, which we reviewed previously:
What We Don’t Talk About When We Talk About Fat – by Aubrey Gordon
Enjoy!
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Heart Healthy Diet Plan – by Stephen William
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We’ve covered heart-healthy cooking books before, but variety is good, and boredom is an enemy of health, so let’s shake it up with a fresh stack of recipes!
After a brief overview of the relevant science (which if you’re a regular 10almonds reader, probably won’t be new to you), the author takes the reader on a 28-day journey. Yes, we know the subtitle says 30 days, but unless they carefully hid the other two days somewhere we didn’t find, there are “only” 28 inside. Perhaps the publisher heard it was a month and took creative license. Or maybe there’s a different edition. Either way…
Rather than merely giving a diet plan (though yes, he also does that), he gives a wide range of “spotlight ingredients”, such that many of the recipes, while great in and of themselves, can also be jumping-off points for those of us who like to take recipes and immediately do our own things to them.
Each day gets a breakfast, lunch, dinner, and he also covers drinks, desserts, and such like.
Notwithstanding the cover art being a lot of plants, the recipes are not entirely plant-based; there are a selection of fish dishes (and other seafood, e.g. shrimp) and also some dairy products (e.g. Greek yoghurt). The recipes are certainly very “plant-forward” though and many are just plants. If you’re a strict vegan though, this probably isn’t the book for you.
Bottom line: if you’d like to cook heart-healthy but are often stuck wondering “aaah, what to cook again today?”, then this is the book to get you out of any culinary creative block!
Click here to check out the Heart Healthy Diet Plan, and widen your heart-healthy repertoire!
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No, you don’t need the ‘Barbie drug’ to tan, whatever TikTok says. Here’s why melanotan-II is so risky
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TikTok and Instagram influencers have been peddling the “Barbie drug” to help you tan.
But melanotan-II, as it’s called officially, is a solution that’s too good to be true. Just like tanning, this unapproved drug has a dark side.
Doctors, researchers and Australia’s drug regulator have been warning about its side effects – from nausea and vomiting to brain swelling and erection problems.
There are also safer ways of getting the tanned look, if that’s what you’re after.
AtlasStudio/Shutterstock What is melanotan-II?
No, it’s not a typo. Melanotan-II is very different from melatonin, which is a hormonal supplement used for insomnia and jet lag.
Melanotan-II is a synthetic version of the naturally ocurring hormone α-melanocyte stimulating hormone. This means the drug mimics the body’s hormone that stimulates production of the pigment melanin. This is what promotes skin darkening or tanning, even in people with little melanin.
Although the drug is promoted as a way of getting a “sunless tan”, it is usually promoted for use with UV exposure, to enhance the effect of UV and kickstart the tanning process.
Melanotan-II is related to, but different from, melanotan-I (afamelanotide), an approved drug used to treat the skin condition erythropoietic protoporphyria.
Melanotan-II is not registered for use with Australia’s Therapeutic Goods Administration (TGA). It is illegal to advertise it to the public or to provide it without a prescription.
However, social media has been driving unlicensed melanotan-II sales, a study published last year confirms.
There are many black market suppliers of melanotan-II injections, tablets and creams. More recently, nasal sprays have become more popular.
What are the risks?
Just like any drug, melanotan-II comes with the risk of side effects, many of which we’ve known about for more than a decade. These include changes in the size and pigmentation of moles, rapid appearance of new moles, flushing to the face, abdominal cramps, nausea, vomiting, chest pain and brain swelling.
It can also cause rhabdomyolysis, a dangerous syndrome where muscle breaks down and releases proteins into the bloodstream that damage the kidneys.
For men, the drug can cause priapism – a painful erection that does not go away and can damage the penis, requiring emergency treatment.
Its use has been linked with melanoma developing from existing moles either during or shortly after using the drug. This is thought to be due to stimulating pigment cells and causing the proliferation of abnormal cells.
Despite reports of melanoma, according to a study of social media posts the drug is often marketed as protecting against skin cancer. In fact, there’s no evidence to show it does this.
Social media posts about melanotan-II rarely mention health risks.
There are no studies on long-term safety of melanotan-II use.
Then there’s the issue of the drug not held to the high safety standards as TGA-approved products. This could result in variability in dose, undeclared ingredients and potential microbial contamination.
Thinking about melanotan-II? The drug can cause a long-lasting painful erection needing urgent medical care. Eugenio Marongiu/Shutterstock The TGA has previously warned consumers to steer clear of the drug due to its “serious side effects that can be very damaging to your health”.
According to an ABC article published earlier this week, the TGA is cracking down on the illegal promotion of the drug on various websites. However, we know banned sellers can pop back up under a different name.
TikTok has banned the hashtags #tanningnasalspray, #melanotan and #melanotan2, but these products continue to be promoted with more generic hashtags, such as #tanning.
Part of a wider trend
Australia has some of the highest rates of skin cancer in the world. The “slip, slop, slap” campaign is a public health success story, with increased awareness of sun safety, a cultural shift and a decline in melanoma in young people.
However, the image of a bronzed beach body remains a beauty standard, especially among some young people.
Disturbingly, tan lines are trending on TikTok as a sought after summer accessory and the hashtag #sunburnttanlines has millions of views. We’ve also seen a backlash against sunscreen among some young people, again promoted on TikTok.
The Cancer Council is so concerned about the trend towards normalising tanning it has launched the campaign End the Trend.
You have other options
There are options beyond spraying an illegal, unregulated product up your nose, or risking unprotected sun exposure: fake tan.
Fake tan tends to be much safer than melanotan-II and there’s more long-term safety data. It also comes with potential side effects, albeit rare ones, including breathing issues (with spray products) and skin inflammation in some people.
Better still, you can embrace your natural skin tone.
Rose Cairns, Senior Lecturer in Pharmacy, NHMRC Emerging Leadership Fellow, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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