When Doctors Make House Calls, Modern-Style!
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In Tuesday’s newsletter, we asked you foryour opinion of telehealth for primary care consultations*, and got the above-depicted, below-described, set of responses:
- About 46% said “It is no substitute for an in-person meeting with a doctor; let’s keep the human touch”
- About 29% said “It means less waiting and more accessibility, while avoiding transmission of diseases”
- And 25 % said “I find that the pros and cons of telehealth vs in-person balance out, so: no preference”
*We specified that by “primary care” we mean the initial consultation with a non-specialist doctor, before receiving treatment or being referred to a specialist. By “telehealth” we mean by videocall or phonecall.
So, what does the science say?
A quick note first
Because telehealth was barely a thing (statistically speaking) before the first stages of the COVID pandemic, compared to how it is now, most of the science for this is young, and a lot of the science simply hasn’t been done yet, and/or has not been published yet, because the process can take years.
Because of this, some studies we do have aren’t specifically about primary care, and are sometimes about specialists. We think this should not affect the results much, but it bears highlighting.
Nevertheless, we’ll do what we can with the science we have!
Telehealth is more accessible than in-person consultations: True or False?
True, for most people. For example…
❝Data was found from a variety of emergency and non-emergency departments of primary, secondary, and specialised healthcare.
Satisfaction was high among recipients of healthcare, scoring 9-10 on a scale of 0-10 or ranging from 73.3% to 100%.
Convenience was rated high in every specialty examined. Satisfaction of clinicians was high throughout the specialities despite connection failure and concerns about confidentiality of information.❞
whereas…
❝Nonetheless, studies reported perception of increased barriers to accessing care and inequalities for vulnerable patients especially in older people❞
~ Ibid.
Source: Satisfaction with telemedicine use during COVID-19 pandemic in the UK: a systematic review
Now, perception of those things does necessarily equate to an actual increased barrier, but it is reasonable that someone who thinks something is inaccessible will be less inclined to try to access it.
The quality of care provided via telehealth is as good as in-person: True or False?
True, ostensibly, with caveats. The caveats are:
- We’re going offreported patient satisfaction, not objective patient health outcomes (we found little* science as yet for the relative incidence of misdiagnosis, for example—which kind of thing will take time to be revealed).
- We’re also therefore speaking (as statistics do) for the significant majority of people. However, if we happen to be (statistically speaking) an insignificant minority, well, that just sucks for us personally.
*we did find some, but it wasn’t very helpful yet. For example:
An electronic trigger to detect telemedicine-related diagnostic errors
this one does look at the incidence of diagnostic errors, but provides no control group (i.e. otherwise-comparable in-person consultations) for comparison.
While most oft-considered demographic groups reported comparable patient satisfaction (per race, gender, and socioeconomic status, for example), there was one outlier variable, which was age (as we quoted from that first study above).
However!
Looking under the hood of these stats, it seems that age is not the real culprit, so much as technological illiteracy, which is heavily correlated with age:
❝Lower eHealth literacy is associated with more negative attitudes towards I/C technology in healthcare. This trend is consistent across diverse demographics and regions. ❞
Source: Meta-analysis: eHealth literacy and attitudes towards internet/computer technology
There are things that can be done at an in-person consultation that can’t be done by telehealth: True or False?
True, of course. It is incredibly rare that we will cite “common sense”, (as sometimes “common sense” is actually “common mistakes” and is simply and verifiably wrong), but in this case, as one 10almonds subscriber put it:
❝The doctor uses his five senses to assess. This cannot be attained over the phone❞
~ 10almonds subscriber
A quick note first: if your doctor is using their sense of taste to diagnose you, please get a different doctor, because they should definitely not be doing that!
Not in this century, anyway… Once upon a time, diabetes was diagnosed by urine-tasting (and yes, that was a fairly reliable method).
However, nowadays indeed a doctor will use sight, sound, touch, and sometimes even smell.
In a videocall we’re down to two of those senses (sight and sound), and in a phonecall, down to one (sound) and even that is hampered. Your doctor cannot, for example, use a stethoscope over the phone.
With this in mind, it really comes down to what you need from your doctor in that consultation.
- If you’re 99% sure that what you need is to be prescribed an antidepressant, that probably doesn’t need a full physical.
- If you’re 99% sure that what you need is a referral, chances are that’ll be fine by telehealth too.
- If your doctor is 99% sure that what you need is a verbal check-up (e.g. “How’s it been going for you, with the medication that I prescribed for you a month ago?”, then again, a call is probably fine.
If you have a worrying lump, or an unhappy bodily discharge, or an unexplained mysterious pain? These things, more likely an in-person check-up is in order.
Take care!
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The Counterintuitive Dos and Don’ts of Nail Health
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
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
❝I take a vitamin supplement for strengthening my nails (particularly one of my big toes!) – but they are running out! What do you recommend for strengthening nails? What is/are the key ingredient(s)?❞
Vitamin-wise, biotin (vitamin B7) is an underrated and very important one. As a bonus, it’s really good for your hair too (hair and nails being made of fundamentally the same “stuff”. Because it has exceptionally low toxicity, it can be taken up to 10,000% of the NRV, so if shopping for supplements, a high biotin content is better than a low one.
A lot of products marketed as for “skin, hair, and nails” focus on vitamins A and E, which are good for the skin but aren’t so relevant for nails.
Nutritionally, getting plenty of protein (whatever form you normally take it is fine) is also important since keratin (as nails are made of) is a kind of protein.
Outside of nutritional factors, a few other considerations:
- Testosterone strengthens nails, and declining testosterone levels (as experienced by most men over the age of 45) can result in weaker nails. So for men over 45 especially, a diet that favors testosterone (think foods rich in magnesium and zinc) is good.
- Because estrogen doesn’t do for women’s nails what testosterone does for men’s nails, increasing our magnesium and zinc intake won’t help our nails (but it’s still good for other things, including energy levels in the day and good sleep at night, and most people are deficient in magnesium anyway)
- Those of us who enjoy painted nails would do well to let our nails go without polish sometimes, as it can dry them out. And, acrylic nails are truly ruinous to nail health, as are gel nails (the kind that use a UV lamp to harden them—which is also bad for the skin)
- When nails are brittle, it can be tempting to soak them to reduce their brittleness. However, this is actually counterproductive, as the water will leech nutrients from the nails, and by the time you’ve been out of the footbath (for example) for about an hour, your nails will bemore brittle than before you soaked them.
- Use a moisturizing lotion or nail-oil instead—bonus if it contains biotin, keratin, and/or other helpful nutrients.
- Keep yourself hydrated, too! Hydration that comes to your nails from the inside will deliver nutrients, rather than removing them.
About those supplements: we don’t sell them (or anything else) but for your convenience, here are some great ones (this writer takes pretty much the same, just a different brand because I’m in a different country):
Magnesium Gummies (600mg) & Biotin Gummies (10,000µg)
Enjoy!
❝I was wondering whether there were very simple, clear bullet points or instructions on things to be wary of in Yoga.❞
That’s quite a large topic, and not one that lends itself well to being conveyed in bullet points, but first we’ll share the article you sent us when sending this question:
Tips for Avoiding Yoga Injuries
…and next we’ll recommend the YouTube channel @livinleggings, whose videos we feature here from time to time. She (Liv) has a lot of good videos on problems/mistakes/injuries to avoid.
Here’s a great one to get you started:
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Stretching to Stay Young – by Jessica Matthews
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A lot of stretching gurus (especially the Instagrammable kind) offer advices like “if you can’t do the splits balanced between two chairs to start with, that’s fine… just practise by doing the splits against a wall first!”
Jessica Matthews, meanwhile, takes a more grounded approach. A lot of this is less like yoga and more like physiotherapy—it’s uncomplicated and functional. There’s nothing flashy here… just the promise of being able to thrive in your body; supple and comfortable, doing the activities that matter to you.
On which note: the book gives advices about stretches for before and after common activities, for example:
- a bedtime routine set
- a pre-gardening set
- a post-phonecall set
- a level-up-your golf set
- a get ready for dancing set
…and many more. Whether “your thing” is cross-country skiing or knitting, she’s got you covered.
The book covers the whole body from head to toe. Whether you want to be sure to stretch everything, or just work on a particular part of your body that needs special attention, it’s there… with beautifully clear illustrations (the front cover illustration is indicative of the style—note how the muscle being stretched is highlighted in orange, too) and simple, easy-to-understand instructions.
All in all, we’re none of us getting any younger, but we sure can take some of our youth into whatever years come next. This is the stuff that life is made of!
Get your copy of “Stretching To Stay Young” from Amazon today!
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Sunflower Seeds vs Sesame Seeds – Which is Healthier?
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Our Verdict
When comparing sunflower seeds to sesame seeds, we picked the sunflower.
Why?
In moderation, both are very healthy. We say “in moderation” because they’re both about 50% fat and such fats, while vital for life, are generally best enjoyed in small portions. Of that fat, sunflower has the slightly better fat profile; they’re both mostly poly- and monounsaturated fats, but sunflower has 10% saturated fat while sesame has 15%. Aside from fats, sunflower has slightly more protein and sesame has slightly more carbs. While sesame has slightly more fiber, because of the carb profile sunflower still has the lower glycemic index. All in all, a moderate win for sunflower in the macros category.
You may be wondering, with all that discussion of fats, what they’re like for omega-3, and sesame seeds have more omega-3, though sunflower seeds contain it too. Still, a point in sesame’s favor here.
When it comes to vitamins, sunflower has more of vitamins A, B1, B2, B3, B5, B6, B9, C, E, and choline, while sesame is not higher in any vitamins.
In the category of minerals, sunflower has more phosphorus, potassium, and selenium, while sesame has more calcium, copper, iron, and zinc. This is nominally a marginal win for sesame, but it should be noted that sunflower is still very rich in copper, iron, and zinc too (but not calcium).
Adding up the categories makes for a moderate win for sunflower seeds, but as ever, enjoy both; diversity is best!
Want to learn more?
You might like to read:
Sunflower Seeds vs Pumpkin Seeds – Which is Healthier?
Take care!
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Hungry? How To Beat Cravings
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The Science of Hunger, And How To Sate It
This is Dr. David Ludwig. That’s not a typo; he’s a doctor both ways—MD and PhD.
Henceforth we’ll just say “Dr. Ludwig”, though! He’s a professor in the Department of Nutrition at Harvard T.H. Chan School of Public Health, and director of the New Balance Foundation Obesity Prevention Center.
His research focuses on the effects of diet on hormones, metabolism, and body weight, and he’s one of the foremost experts when it comes to carbohydrates, glycemic load, and obesity.
Why are we putting on weight? What are we getting wrong?
Contrary to popular belief, Dr. Ludwig says, weight gain is not caused by a lack of exercise. In fact, people tend to overestimate how many calories are burned by exercise.
A spoonful of sugar may make the medicine go down, but it also contains 60 calories, and that’d take about 1,500 steps for the average person to burn off. Let’s put this another way:
If you walk 10,000 steps per day, that will burn off 400 calories. Still think you can exercise away that ice cream sundae or plate of fries?
Wait, this is interesting and all, but what does this have to do with hunger?
Why we get hungry
Two important things:
- All that exercise makes us hungry, because the more we exercise, the more the body speeds up our metabolism accordingly.
- Empty calories don’t just add weight themselves, they also make us hungrier
What are empty calories, and why do they make us hungrier?
Empty calories are calories that are relatively devoid of other nutrition. This especially means simple sugars (especially refined sugar), white flour and white flour products (quick-release starches), and processed seed oils (e.g. canola, sunflower, and friends).
They zip straight into our bloodstream, and our body sends out an army of insulin to deal with the blood sugar spike. And… that backfires.
Imagine a person whose house is a terrible mess, and they have a date coming over in half an hour.
They’re going to zoom around tidying, but they’re going to stuff things out of sight as quickly and easily as possible, rather than, say, sit down and Marie Kondo the place.
But superficially, they got the job done really quickly!
Insulin does similarly when overwhelmed by a blood sugar spike like that.
So, it stores everything as fat as quickly as possible, and whew, the pancreas needs a break now after all that exertion, and the blood is nice and free from blood sugars.
Wait, the blood is what now?
The body notices the low blood sugar levels, and it also knows you just stored fat so you must be preparing for starvation, and now the low blood sugar levels indicate starvation is upon us. Quick, we must find food if we want to survive! So it sends a hunger signal to make sure you don’t let the body starve.
You make a quick snack, and the cycle repeats.
Dr. Ludwig’s solution:
First, we need to break out of that cycle, and that includes calming down our insulin response (and thus rebuilding our insulin sensitivity, as our bodies will have become desensitized, after the equivalent of an air-raid siren every 40 minutes or so).
How to do that?
First, cut out the really bad things that we mentioned above.
Next: cut healthy carbs too—we’re talking unprocessed grains here, legumes as well, and also starchy vegetables (root vegetables etc). Don’t worry, this will be just for a short while.
The trick here is that we are resensitizing our bodies to insulin.
Keep this up for even just a week, and then gradually reintroduce the healthier carbs. Unprocessed grains are better than root vegetables, as are legumes.
You’re not going to reintroduce the sugars, white flour, canola oil, etc. You don’t have to be a puritan, and if you go to a restaurant you won’t undo all your work if you have a small portion of fries. But it’s not going to be a part of your general diet.
Other tips from Dr. Ludwig:
- Get plenty of high-quality protein—it’s good for you and suppresses your appetite
- Shop for success—make sure you keep your kitchen stocked with healthy easy snack food
- Nuts, cacao nibs, and healthy seeds will be your best friends and allies here
- Make things easy—buy pre-chopped vegetables, for example, so when you’re hungry, you don’t have to wait longer (and work more) to eat something healthy
- Do what you can to reduce stress, and also eat mindfully (that means paying attention to each mouthful, rather than wolfing something down while multitasking)
If you’d like to know more about Dr. Ludwig and his work, you can check out his website for coaching, recipes, meal plans, his blog, and other resources!
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Statins and Brain Fog?
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
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
❝I was wondering if you had done any info about statins. I’ve tried 3, and keep quitting them because they give me brain fog. Am I imagining this as the research suggests?❞
If you are female, the chances of adverse side-effects are a lot higher:
As an extra kicker, not only are the adverse side-effects more likely for women, but also, the benefits are often less beneficial, too (see the above main feature for some details).
That’s not to say that statins can’t have their place for women; sometimes it will still be the right choice. Just, not as readily so as for men.
Enjoy!
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Vision for Life, Revised Edition – by Dr. Meir Schneider
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The “ten steps” would be better called “ten exercises”, as they’re ten things that one can (and should) continue to do on an ongoing basis, rather than steps to progress through and then forget about.
We can’t claim to have tested the ten exercises for improvement (this reviewer has excellent eyesight and merely hopes to maintain such as she gets older) but the rationale is compelling, and the public testimonials abundant.
Dr. Schneider also talks about improving and correcting errors of refraction—in other words, doing the job of any corrective lenses you may currently be using. While he doesn’t claim miracles, it turns out there is a lot that can be done for common issues such as near-sightedness and far-sightedness, amongst others.
There’s a large section on managing more chronic pathological eye conditions than this reviewer previously knew existed; in some cases it’s a matter of making sure things don’t get worse, but in many others, there’s a recurring of theme of “and here’s an exercise for correcting that”.
The writing style is a little more “narrative prose” than we’d have liked, but the quality of the content more than makes up for any style preference issues.
Bottom line: the human body is a highly adaptive organism, and sometimes it just needs a little help to correct itself. This book can help with that.
Click here to check out Vision for Life, and take good care of yours!
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Learn to Age Gracefully
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