Two Things You Can Do To Improve Stroke Survival Chances
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Dr. Andrew’s Stroke Survival Guide
This is Dr. Nadine Andrew. She’s a Senior Research Fellow in the Department of Medicine at Monash University. She’s the Research Data Lead for the National Center of Healthy Aging. She is lead investigator on the NHMRC-funded PRECISE project… The most comprehensive stroke data linkage study to date! In short, she knows her stuff.
We’ve talked before about how sample size is important when it comes to scientific studies. It’s frustrating; sometimes we see what looks like a great study until we notice it has a sample size of 17 or something.
Dr. Andrew didn’t mess around in this regard, and the 12,386 participants in her Australian study of stroke patients provided a huge amount of data!
With a 95% confidence interval because of the huge dataset, she found that there was one factor that reduced mortality by 26%.
And the difference was…
Whether or not patients had a chronic disease management plan set up with their GP (General Practitioner, or “family doctor”, in US terms), after their initial stroke treatment.
45% of patients had this; the other 55% did not, so again the sample size was big for both groups.
Why this is important:
After a stroke, often a patient is discharged as early as it seems safe to do so, and there’s a common view that “it just takes time” and “now we wait”. After all, no medical technology we currently have can outright repair that damage—the body must repair itself! Medications—while critical*—can only support that and help avoid recurrence.
*How critical? VERY critical. Critical critical. Dr. Andrew found, some years previously, that greater levels of medication adherence (ie, taking the correct dose on time and not missing any) significantly improved survival outcomes. No surprise, right? But what may surprise is that this held true even for patients with near-perfect adherence. In other words: miss a dose at your peril. It’s that important.
But, as Dr. Andrew’s critical research shows, that’s no reason to simply prescribe ongoing meds and otherwise cut a patient loose… or, if you or a loved one are the patient, to allow yourself/them to be left without a doctor’s ongoing active support in the form of a chronic disease management plan.
What does a chronic disease management plan look like?
First, what it’s not:
- “Yes yes, I’m here if you need me, just make an appointment if something changes”
- “Let’s pencil in a check-up in three months”
- Etc
What it actually looks like:
It looks like a plan. A personal care plan, built around that person’s individual needs, risks, liabilities… and potential complications.
Because who amongst us, especially at the age where strokes are more likely, has an uncomplicated medical record? There will always be comorbidities and confounding factors, so a one-size-fits-all plan will not do.
Dr. Andrew’s work took place in Australia, so she had the Australian healthcare system in mind… We know many of our subscribers are from North America and other places. But read this, and you’ll see how this could go just as much for the US or Canada:
❝The evidence shows the importance of Medicare financially supporting primary care physicians to provide structured chronic disease management after a stroke.
We also provide a strong case for the ongoing provision of these plans within a universal healthcare system. Strategies to improve uptake at the GP level could include greater financial incentives and mandates, education for patients and healthcare professionals.❞
See her groundbreaking study for yourself here!
The Bottom Line:
If you or a loved one has a stroke, be prepared to make sure you get a chronic health management plan in place. Note that if it’s you who has the stroke, you might forget this or be unable to advocate for yourself. So, we recommend to discuss this with a partner or close friend sooner rather than later!
“But I’m quite young and healthy and a stroke is very unlikely for me”
Good for you! And the median age of Dr. Andrew’s gargantuan study was 70 years. But:
- do you have older relatives? Be aware for them, too.
- strokes can happen earlier in life too! You don’t want to be an interesting statistic.
Some stroke-related quick facts:
Stroke is the No. 5 cause of death and a leading cause of disability in the U.S.
Stroke can happen to anyone—any age, any time—and everyone needs to know the warning signs.
On average, 1.9 million brain cells die every minute that a stroke goes untreated.
Stroke is an EMERGENCY. Call 911 immediately.
Early treatment leads to higher survival rates and lower disability rates. Calling 911 lets first responders start treatment on someone experiencing stroke symptoms before arriving at the hospital.
Source: https://www.stroke.org/en/about-stroke
What are the warning signs for stroke?
Use the letters F.A.S.T. to spot a stroke and act quickly:
- F = Face Drooping—does one side of the face droop or is it numb? Ask the person to smile. Is the person’s smile uneven?
- A = Arm Weakness—is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
- S = Speech Difficulty—is speech slurred?
- T = Time to call 911
Source: https://www.stroke.org/en/about-stroke/stroke-symptoms
Last but not least, while we’re sharing resources:
Download the PDF Checklist: 8 Ways To Help Prevent a Second Stroke
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The Calorie Myth – by Jonathan Bailor
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First we’ll mention: the author is not a doctor, but the book is endorsed by assorted well-known doctors in the field, and the science described is consistent with current scientific consensus (and, for that matter, consistent with what we wrote in our mythbusting feature: Are You A Calorie-Burning Machine?).
It’s often (correctly) said that “not all calories are created equal”, but how should we quantify them? He proposes his “SANE solution”, which is based around the ideas of:
- Satiety: how quickly calories fill us up
- Aggression: how likely calories are to be stored as fat
- Nutrition: how many micronutrients calories bring with them, and how much
- Efficiency: how easily calories are converted
To this end, he recommends a diet high in foods that score well on his “SANE” factors, and provides such things as recipes, meal plans etc to help, as well principles for exercising more usefully in the context of metabolic base rate, and moving (rather than fighting) one’s “set point”, which is usually associated with one’s weight but it really has more to do with metabolic base rate. In fact, Bailor recommends throwing out the bathroom scale and focusing on pursuing good health itself, rather than obsessing over changing one’s relationship with the Earth’s gravitational field.
Yes, it says “lose weight” in the subtitle, but the idea is that this will be a by-product rather than the thing actively pursued. After all, we can control our actions, so that input variable is where we should put our focus, not the output variable of the numbers on the scale which can often be misleading (muscle weighing more than fat, tendency to water weight fluctuations, etc).
The style is a little flashy and salesy for this reviewer’s personal taste (a lot of references to his own businesses and neologisms associated with such), but it doesn’t take away from the quality of the content, and in terms of science, study references come at a rate of about one per page on average.
Bottom line: if you’d like to rethink your relationship with calories, then this book can help give you a much more practical angle.
Click here to check out The Calorie Myth, and take control of your metabolic base rate!
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Most adults will gain half a kilo this year – and every year. Here’s how to stop ‘weight creep’
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As we enter a new year armed with resolutions to improve our lives, there’s a good chance we’ll also be carrying something less helpful: extra kilos. At least half a kilogram, to be precise.
“Weight creep” doesn’t have to be inevitable. Here’s what’s behind this sneaky annual occurrence and some practical steps to prevent it.
Allgo/Unsplash Small gains add up
Adults tend to gain weight progressively as they age and typically gain an average of 0.5 to 1kg every year.
While this doesn’t seem like much each year, it amounts to 5kg over a decade. The slow-but-steady nature of weight creep is why many of us won’t notice the extra weight gained until we’re in our fifties.
Why do we gain weight?
Subtle, gradual lifestyle shifts as we progress through life and age-related biological changes cause us to gain weight. Our:
- activity levels decline. Longer work hours and family commitments can see us become more sedentary and have less time for exercise, which means we burn fewer calories
- diets worsen. With frenetic work and family schedules, we sometimes turn to pre-packaged and fast foods. These processed and discretionary foods are loaded with hidden sugars, salts and unhealthy fats. A better financial position later in life can also result in more dining out, which is associated with a higher total energy intake
- sleep decreases. Busy lives and screen use can mean we don’t get enough sleep. This disturbs our body’s energy balance, increasing our feelings of hunger, triggering cravings and decreasing our energy
Insufficient sleep can increase our appetite. Craig Adderley/Pexels - stress increases. Financial, relationship and work-related stress increases our body’s production of cortisol, triggering food cravings and promoting fat storage
- metabolism slows. Around the age of 40, our muscle mass naturally declines, and our body fat starts increasing. Muscle mass helps determine our metabolic rate, so when our muscle mass decreases, our bodies start to burn fewer calories at rest.
We also tend to gain a small amount of weight during festive periods – times filled with calorie-rich foods and drinks, when exercise and sleep are often overlooked. One study of Australian adults found participants gained 0.5 kilograms on average over the Christmas/New Year period and an average of 0.25 kilograms around Easter.
Why we need to prevent weight creep
It’s important to prevent weight creep for two key reasons:
1. Weight creep resets our body’s set point
Set-point theory suggests we each have a predetermined weight or set point. Our body works to keep our weight around this set point, adjusting our biological systems to regulate how much we eat, how we store fat and expend energy.
When we gain weight, our set point resets to the new, higher weight. Our body adapts to protect this new weight, making it challenging to lose the weight we’ve gained.
But it’s also possible to lower your set point if you lose weight gradually and with an interval weight loss approach. Specifically, losing weight in small manageable chunks you can sustain – periods of weight loss, followed by periods of weight maintenance, and so on, until you achieve your goal weight.
Holidays can also come with weight gain. Zan Lazarevic/Unsplash 2. Weight creep can lead to obesity and health issues
Undetected and unmanaged weight creep can result in obesity which can increase our risk of heart disease, strokes, type 2 diabetes, osteoporosis and several types of cancers (including breast, colorectal, oesophageal, kidney, gallbladder, uterine, pancreatic and liver).
A large study examined the link between weight gain from early to middle adulthood and health outcomes later in life, following people for around 15 years. It found those who gained 2.5 to 10kg over this period had an increased incidence of type 2 diabetes, heart disease, strokes, obesity-related cancer and death compared to participants who had maintained a stable weight.
Fortunately, there are steps we can take to build lasting habits that will make weight creep a thing of the past.
7 practical steps to prevent weight creep
1. Eat from big to small
Aim to consume most of your food earlier in the day and taper your meal sizes to ensure dinner is the smallest meal you eat.
A low-calorie or small breakfast leads to increased feelings of hunger, specifically appetite for sweets, across the course of the day.
We burn the calories from a meal 2.5 times more efficiently in the morning than in the evening. So emphasising breakfast over dinner is also good for weight management.
Aim to consume bigger breakfasts and smaller dinners. Michael Burrows/Pexels 2. Use chopsticks, a teaspoon or an oyster fork
Sit at the table for dinner and use different utensils to encourage eating more slowly.
This gives your brain time to recognise and adapt to signals from your stomach telling you you’re full.
3. Eat the full rainbow
Fill your plate with vegetables and fruits of different colours first to support eating a high-fibre, nutrient-dense diet that will keep you feeling full and satisfied.
Meals also need to be balanced and include a source of protein, wholegrain carbohydrates and healthy fat to meet our dietary needs – for example, eggs on wholegrain toast with avocado.
4. Reach for nature first
Retrain your brain to rely on nature’s treats – fresh vegetables, fruit, honey, nuts and seeds. In their natural state, these foods release the same pleasure response in the brain as ultra-processed and fast foods, helping you avoid unnecessary calories, sugar, salt and unhealthy fats.
5. Choose to move
Look for ways to incorporate incidental activity into your daily routine – such as taking the stairs instead of the lift – and boost your exercise by challenging yourself to try a new activity.
Just be sure to include variety, as doing the same activities every day often results in boredom and avoidance.
Try new activities or sports to keep your interest up. Cottonbro Studio/Pexels 6. Prioritise sleep
Set yourself a goal of getting a minimum of seven hours of uninterrupted sleep each night, and help yourself achieve it by avoiding screens for an hour or two before bed.
7. Weigh yourself regularly
Getting into the habit of weighing yourself weekly is a guaranteed way to help avoid the kilos creeping up on us. Aim to weigh yourself on the same day, at the same time and in the same environment each week and use the best quality scales you can afford.
At the Boden Group, Charles Perkins Centre, we are studying the science of obesity and running clinical trials for weight loss. You can register here to express your interest.
Nick Fuller, Clinical Trials Director, Department of Endocrinology, RPA Hospital, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Are Supplements Worth Taking?
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small 😎
❝There seems to be a lot of suggestions to take supplements for every thing, from your head to your toes. I know it’s up to the individual but what are the facts or stats to support taking them versus not?❞
Short answer:
- supplementary vitamins and minerals are probably neither needed nor beneficial for most (more on this later) people, with the exception of vitamin D which most people over a certain age need unless they are white and getting a lot of sun.
- other kinds of supplement can be very beneficial or useless, depending on what they are, of course, and also your own personal physiology.
With regard to vitamins and minerals, in most cases they should be covered by a healthy balanced diet, and the bioavailability is usually better from food anyway (bearing in mind, we say vitamin such-and-such, or name an elemental mineral, but there are usually multiple, often many, forms of each—and supplements will usually use whatever is cheapest to produce and most chemically stable).
However! It is also quite common for food to be grown in whatever way is cheapest and produces the greatest visible yield, rather than for micronutrient coverage.
This goes for most if not all plants, and it goes extra for animals (because of the greater costs and inefficiencies involved in rearing animals).
We wrote about this a while back in a mythbusting edition of 10almonds, covering:
- Food is less nutritious now than it used to be: True or False?
- Supplements aren’t absorbed properly and thus are a waste of money: True or False?
- We can get everything we need from our diet: True or False?
You can read the answers and explanations, and see the science that we presented, here:
Do We Need Supplements, And Do They Work?
You may be wondering: what was that about “most (more on this later) people”?
Sometimes someone will have a nutrient deficiency that can’t be easily remedied with diet. Often this occurs when their body:
- has trouble absorbing that nutrient, or
- does something inconvenient with it that makes a lot of it unusable when it gets it.
…which is why calcium, iron, vitamin B12, and vitamin D are quite common supplements to get prescribed by doctors after a certain age.
Still, it’s best to try getting things from one’s diet first all of all, of course.
Things we can’t (reasonably) get from food
This is another category entirely. There are many supplements that are convenient forms of things readily found in a lot of food, such as vitamins and minerals, or phytochemicals like quercetin, fisetin, and lycopene (to name just a few of very many).
Then there are things not readily found in food, or at least, not in food that’s readily available in supermarkets.
For example, if you go to your local supermarket and ask where the mimosa is, they’ll try to sell you a cocktail mix instead of the roots, bark, or leaves of a tropical tree. It is also unlikely they’ll stock lion’s mane mushroom, or reishi.
If perchance you do get the chance to acquire fresh lion’s mane mushroom, by the way, give it a try! It’s delicious shallow-fried in a little olive oil with black pepper and garlic.
In short, this last category, the things most of us can’t reasonably get from food without going far out of our way, are the kind of thing whereby supplements actually can be helpful.
And yet, still, not every supplement has evidence to support the claims made by its sellers, so it’s good to do your research beforehand. We do that on Mondays, with our “Research Review Monday” editions, of which you can find in our searchable research review archive ← we also review some drugs that can’t be classified as supplements, but mostly, it’s supplements.
Take care!
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Health & Happiness From Outside & In
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A friend in need…
In a recent large (n=3,486) poll across the US:
- 90% of people aged 50 and older say they have at least one close friend
- 75% say they have enough close friends
- 70% of those with a close friend say they can definitely count on them to provide health-related support
However, those numbers shrink by half when it comes to people whose physical and/or mental health is not so great, resulting in a negative feedback loop of fewer close friends whom one sees less often, and progressively worse physical and/or mental health. In other words, the healthier you are, the more likely you are to have a friend who’ll support you in your health:
Read in full: Friendships promote healthier living in older adults, says new survey
Related: How To Beat Loneliness & Isolation
Kindness makes a difference to healthcare outcomes
Defining kindness as action-oriented, positively focused, and purposeful in nature, this sets kindness apart from compassion and empathy, when it’s otherwise often been conflated with those, and thus overlooked. This also means that kindness can still be effected when clinicians are too burned-out to be compassionate, and/or when patients are not in a state of mind where empathy is useful.
Furthermore, unkindness (again, as defined by this review) was found in large studies to be the root cause of ¾ of patient harm events in hospital settings. This means that far from being a wishy-washy abstraction, kindness/unkindness can be a very serious factor when it comes to healthcare outcomes:
Read in full: Review suggests kindness could make for better health care
Related: The Human Touch vs AI, The Doctor That Never Tires
The gift of health?
🎵 Last Christmas, I gave you my heart
Which turned out to be a silly idea
This year, to save me from tears
I’ll just get you a Fitbit or something🎵Health & happiness go hand in hand, so does that make health stuff a good gift? It can do! But there are also plenty of opportunities for misfires.
For example, getting someone a gym membership when they don’t have time for that may not help them at all, and sports equipment that they’ll use once and then leave to gather dust might not be great either. In contrast, the American Heart Association recommends to first consider what they enjoy doing, and work with that, and ideally make it something versatile and/or portable. Wearable gadgets are a fine option for many, but a gift doesn’t have to be fancy to be good—with a blood pressure monitoring cuff being a suggestion from Dr. Sperling (a professor of preventative cardiology):
Read in full: Oh, there’s no gift like health for the holidays
Related: Here’s Where Activity Trackers Help (And Also Where They Don’t)
How you use social media matters more than how much
A study commissioned by the European Commission’s Joint Research Centre found that while the quantity of time one spends on social media is not associated (positively or negatively) with loneliness, they did find a correlation between passive (as opposed to engaged) use of social media, and loneliness. In other words, people who were chatting with friends less, were more lonely! Shocking news.
While the findings may seem obvious, it does present a call-to-action for anyone who is feeling lonely: to use social media not just to see what everyone else is up to, but also, to reach out to people.
Read in full: Unpacking the link between social media and loneliness
Related: Make Social Media Work For Your Mental Health Rather Than Against It
Gut-only antidepressants
Many antidepressants work by increasing serotonin levels in the brain; a new study suggests that targeting antidepressants to work only in the gut (which is where serotonin is made, not the brain) could not only be an effective treatment for mood disorders, but also cause fewer adverse side-effects:
Read in full: Antidepressants may act in gut to reduce depression and anxiety
Related: Antidepressants: Personalization Is Key!
Take care!
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Age Proof – by Dr. Rose Anne Kenny
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We don’t generally include an author bio, but in this case it’s worth noting that Dr. Kenny, the Chair of Medical Gerontology at Trinity College Dublin, with over 300 staff under her, has 704 peer-reviewed publications to her name, and enough awards and honors and achievements to more than fill a page on her university’s website.
In short, she knows her stuff.
A lot of the material in this book will not be completely new to regular 10almonds readers; there’s a lot about Blue Zones supercentenarians, the usual qualities associated with healthy longevity in those places (diet, lifestyle, etc), as well as genetic factors and epigenetic, and so forth.
Some items are… Not new, but not so commonly focused on in such works; for example, Dr. Kenny devotes a chapter to sleep, a chapter to laughter, a chapter to hormesis, and a chapter to sexual activity, amongst others.
Another thing she delivers that a lot of books of this kind don’t is that she has a collection of “Test Yourself” appendices, so that you can establish where you are relative to various benchmarks of aging.
Dr. Kenny also references her own work especially with TILDA (The Irish Longitudinal Study on Aging) that she has directed for many years, which has a vast amount of data and many important findings, which adds another extra strength to this book often not found in others.
The style is surprisingly personal, making it an enjoyable read as well as an educational one, and yet with a lot of hard science throughout—explained well for the layperson though, and thoroughly referenced with an extensive bibliography.
Bottom line: if you’d like to be (and continue to be!) “young for your years”, then this is an excellent book to get (and/or keep) you on the right track.
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Reading As A Cognitive Exercise
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Reading, Better
It is relatively uncontroversial to say that reading is good for cognitive health, but we don’t like to make claims without science if we can help it, so let’s get started:
There was a 2021 study, which found that even when controlling for many other factors, including highest level of education, socioeconomic status, and generalized pre-morbid intelligence:
❝high reading activity, as defined by almost daily reading, was associated with lower odds of cognitive decline, compared to low reading activity❞
Source: Can reading increase cognitive reserve?
However, not all reading is the same. And this isn’t just about complexity or size of vocabulary, either. It’s about engagement.
And that level of engagement remains the key factor, no matter how quickly or slowly someone reads, as the brain tends to automatically adjust reading speed per complexity, because the brain’s “processing speed” remains the same:
Read more: Cognitive coupling during reading
Everyone’s “processing speed” is different (and is associated with generalized intelligence and executive functions), though as a general rule of thumb, the more we practice it, the faster our processing speed gets. So if you balked at the notion of “generalized intelligence” being a factor, be reassured that this association goes both ways.
So is the key to just read more?
That’s a great first step! But…
The key factor still remains: engagement.
So what does that mean?
It is not just the text that engages you. You must also engage the text!
This is akin to the difference between learning to drive by watching someone else do it, and learning by getting behind the wheel and having a go.
When it comes to reading, it should not be a purely passive thing. Sure, if you are reading a fiction book at bedtime, get lost in it, by all means. But when it comes to non-fiction reading, engage with it actively!
For example, I (your writer here, hi), when reading non-fiction:
- Read at what is generally considered an unusually fast pace, but
- Write so many notes in the margins of physical books, and
- Write so many notes using the “Notes” function on my Kindle
And this isn’t just like a studious student taking notes. Half the time I am…
- objecting to content (disagreeing with the author), or
- at least questioning it, or which is especially important, or
- noting down questions that came to my mind as a result of what I am reading.
This latter is a bit like:
- when you are reading 10almonds, sometimes you will follow our links and go off down a research rabbit-hole of your own, and that’s great!
- sometimes you will disagree with something and write to tell us, and that’s great too (when this happens, one or the other or all of us will learn something, and yes, we have published corrections before now)!
- sometimes what you read here will prompt a further question, and you’ll send that to us, and guess what, also great! We love questions.
Now, if your enjoyment of 10almonds is entirely passive, don’t let us stop you (we know our readers like quick-and-easy knowledge, and that’s good too), it’s just, the more you actively engage with it, the more you’ll get out of it.
This, by the way, was also a lifelong habit of Leonardo da Vinci, which you can read about here:
How to Think Like Leonardo da Vinci: Seven Steps to Genius Every Day – by Michael J. Gelb
a very good book that we reviewed last year
How you read (i.e. what medium) matters too!
Are you reading this on a desktop/laptop, or a mobile device? That difference could matter more than the difference between paper and digital, according to this study from 2020 that found…
❝The cumulation of evidence from this and previous studies suggests that reading on a tablet affords different interactions between the reader and the text than reading on a computer screen.
Reading on a tablet might be more similar to reading on paper, and this may impact the attentional processes during reading❞
What if my mind wanders easily?
You can either go with it, or train to improve focus.
Going with it: just make sure you have more engaging reading to get distracted by. It’s all good.
Training focus: this is trickier, but worthwhile, as executive function (you will remember from earlier) was an important factor too, and training focus is training executive function.
As for one way to do that…
If you’d like a primer for getting going with that, then you may enjoy our previous main feature:
No-Frills, Evidence-Based Mindfulness
Enjoy!
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