The Checklist Manifesto – by Dr. Atul Gawande
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Dr. Gawande, himself a general surgeon, uses checklists a lot. He is, unequivocally, an expert in his field. He “shouldn’t” need a checklist to tell him to do such things as “Check you have the correct patient”. But checklists are there as a safety net. And, famously, “safety regulations are written in blood”, after all.
And, who amongst us has never made such a “silly” error? From forgetting to turn the oven on, to forgetting to take the handbrake off, it takes only a momentary distraction to think we’ve done something we haven’t.
You may be wondering: why a whole book on this? Is it just many examples of the usefulness of checklists? Because I’m already sold on that, so, what else am I going to get out of it?
Dr. Gawande also explains in clear terms:
- How to optimize “all necessary steps” with “as few steps as possible”
- The important difference between read-do checklists and do-confirm checklists
- To what extent we should try to account for the unexpected
- How to improve compliance (i.e., making sure you actually use it, no matter how tempting it will be to go “yeah this is automatic for me now” and gloss over it)
- The role of checklists in teams, and in passing on knowledge
…and more.
Bottom line: if you’ve ever tried to make tea without putting the tea-leaves in the pot, this is the book that will help you avoid making more costly mistakes—whatever your area of activity or interest.
Click here to check out the Checklist Manifesto, and make fewer mistakes!
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Avocado Oil vs Olive Oil – Which is Healthier?
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Our Verdict
When comparing avocado oil to olive oil, we picked the olive oil.
Why?
Avocados and olives are both very healthy foods. However, when they are made into oils, there’s an important distinguishing factor:
Olive oil usually retains a lot of the micronutrients from the olives (including vitamins E and K), whereas no measurable micronutrients usually remain in avocado oil.
So while both olive oil and avocado oil have a similar (excellent; very heart-healthy!) lipids profile, the olive oil has some bonuses that the avocado oil doesn’t.
We haven’t written about the nutritional profiles of either avocados or olives yet, but here’s what we had to say on the different kinds of olive oil available:
And here’s an example of a good one on Amazon, for your convenience 😎
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Tribulus Terrestris For Testosterone?
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(Clinical) Trials and Tribul-ations
In the category of supplements that have enjoyed use as aphrodisiacs, Tribulus terrestris (also called caltrop, goat’s head, gokshura, or puncture vine) has a long history, having seen wide use in both Traditional Chinese Medicine and in Ayurveda.
It’s been used for other purposes too, and has been considered a “general wellness” plant.
So, what does the science say?
Good news: very conclusive evidence!
Bad news: the conclusion is not favorable…
Scientists are known for their careful use of clinical language, and it’s very rare for a study/review to claim something as proven (scientists leave journalists to do that part), and in this case, when it comes to Tribulus’s usefulness as a testosterone-enhancing libido-boosting supplement…
❝analysis of empirical evidence from a comprehensive review of available literature proved this hypothesis wrong❞
Strong words! You can read it in full here; they do make some concessions along the way (e.g. mentioning unclear or contradictory findings, suggesting that it may have some effect, but by an as-yet unknown mechanism if it does—although some potential effect on nitric oxide levels has been hypothesized, which is reasonable if so, as NO does feature in arousal-signalling), but the general conclusion is “no, this doesn’t have androgen-enhancing properties”:
Pro-sexual and androgen enhancing effects of Tribulus terrestris L.: Fact or Fiction
That’s a review though, what about taking a look at a representative RCT? Here we go:
❝Tribulus terrestris was not more effective than placebo on improving symptoms of erectile dysfunction or serum total testosterone❞
As a performance-enhancer in sport
We’ll be brief here: it doesn’t seem to work and it may not be safe:
Insights into Supplements with Tribulus Terrestris used by Athletes
From sport, into general wellness?
Finally, a study that finds it may be useful for something!
❝Overall, participants supplemented with TT displayed significant improvements in lipid profile. Inflammatory and hematological biomarkers showed moderate beneficial effects with no significant changes on renal biomarkers. No positive effects were observed on the immune system response. Additionally, no TT-induced toxicity was reported.
In conclusion, there was no clear evidence of the beneficial effects of TT supplementation on muscle damage markers and hormonal behavior.❞
About those lipids…
Animal studies have shown that it may not only improve lipid profiles, but also may partially repair the endothelial dysfunction resulting from hyperlipidemia:
Want to try some?
In the unlikely event that today’s research review has inspired you with an urge to try Tribulus terrestris, here’s an example product on Amazon
If on the other hand you’d like to actually increase testosterone levels, then we suggest:
Topping Up Testosterone? ← a previous main feature did earlier this year
Take care!
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How To Recognize Perfectly Hidden Depression
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Dr. Margaret Rutherford shares her insights from 30 years of professional experience:
There’s only one way to know
In this video, Dr. Rutherford discusses several (presumably pseudonymized) cases of people who came to her therapy office seeming to have their lives very much together when they very much didn’t, including the woman who came in with symptoms of mild anxiety, and then tried to kill herself, and the man who was outwardly an overachiever while consumed with feelings of guilt and shame.
She discusses how even the most skilled mental health professionals will tend to miss hidden depression, as they focus on visible symptoms from the DSM criteria, which may not reflect the patient’s reality, especially for those hiding their struggles.
So, the crux becomes: why do people hide their struggles? One does not go to the emergency room with a broken limb and then say to the doctor “I’m fine thank you; how are you?” so why do people do that when it comes to mental health issues?
The reality is that the shame of revealing feelings like shame itself, fear, and self-loathing keeps people silent, and in particular, research (Schneiderman et al.) shows that emotional pain plays a central role in suicide, and (per Blatt et al.) perfectionism can drastically alter the presentation of depression, making it even harder to diagnose through standard criteria than it already was.
As for what can be done about it? Dr. Rutherford advocates for a cultural shift where talking about emotional pain, including suicidal thoughts, is seen as normal and not shameful. That people need to feel safe expressing these feelings, to prevent tragic outcomes. Instead of judging or dismissing someone with suicidal thoughts, she encourages a compassionate and accepting approach to open up dialogue and understanding.
In short, that everyone can contribute to a culture that views transparency and vulnerability as strengths, helping reduce the stigma around mental health struggles.
And that’s the only way we’ll ever be able to recognize perfectly hidden depression—if people no longer feel that they have to hide it.
For more on all of this, here’s Dr. Rutherford herself:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
- The Mental Health First Aid (That You’ll Hopefully Never Need) ← This is about managing depression, in yourself or others
- How To Stay Alive (When You Really Don’t Want To) ← This is about managing suicidality, in yourself or others
Take care!
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The “Five Tibetan Rites” & Why To Do Them!
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Spinning Around
In Tuesday’s newsletter, we asked you for your opinion of the “Five Tibetan Rites”, and got the above-depicted, below-described, set of responses:
- About 41% said “I have never heard of these before”
- About 27% said “they restore youth by adjusting internal vortexes”
- About 22% said “they are basically yoga, by a different name”
- About 11% said “they are a pseudoscience popular in the US”
So what does the science say?
The Five Tibetan Rites are five Tibetan rites: True or False?
False, though this is more question of social science than of health science, so we’ll not count it against them for having a misleading name.
The first known mentioning of the “Five Tibetan Rites” is by an American named Peter Kelder, who in 1939 published, through a small LA occult-specialized publishing house, a booklet called “The Eye of Revelation”. This work was then varyingly republished, repackaged, and occasionally expanded upon by Kelder or other American authors, including Chris Kilham’s popular 1994 book “The Five Tibetans”.
The “Five Tibetan Rites” are unknown as such in Tibet, except for what awareness of them has been raised by people asking about them in the context of the American phenomenon.
Here’s a good history book, for those interested:
The author didn’t originally set out to “debunk” anything, and is himself a keen spiritualist (and practitioner of the five rites), but he was curious about the origins of the rites, and ultimately found them—as a collection of five rites, and the other assorted advices given by Kelder—to be an American synthesis in the whole, each part inspired by various different physical practices (some of them hatha yoga, some from the then-popular German gymnastics movement, some purely American spiritualism, all available in books that were popular in California in the early 1900s).
You may be wondering: why didn’t Kelder just say that, then, instead of telling stories of an ancient Tibetan tradition that empirically does not exist? The answer to this lies again in social science not health science, but it’s been argued that it’s common for Westerners to “pick ‘n’ mix” ideas from the East, champion them as inscrutably mystical, and (since they are inscrutable) then simply decide how to interpret and represent them. Here’s an excellent book on this, if you’re interested:
(in Kelder’s case, this meant that “there’s a Tibetan tradition, trust me” was thus more marketable in the West than “I read these books in LA”)
They are at least five rites: True or False?
True! If we use the broad definition of “rite” as “something done repeatedly in a solemn fashion”. And there are indeed five of them:
- Spinning around (good for balance)
- Leg raises (this one’s from German gymnastics)
- Kneeling back bend (various possible sources)
- Tabletop (hatha yoga, amongst others)
- Pendulum (hatha yoga, amongst others) ← you may recognize this one from the Sun Salutation
You can see them demonstrated here:
Click Here If The Embedded Video Doesn’t Load Automatically
Kelder also advocated for what was basically the Hay Diet (named not for the substance but for William Hay; it involved separating foods into acid and alkali, not necessarily according to the actual pH of the foods, and combining only “acid” foods or only “alkali” foods at a time), which was popular at the time, but has since been rejected as without scientific merit. Kelder referred to this as “the sixth rite”.
The Five Rites restore youth by adjusting internal vortexes: True or False?
False, in any scientific sense of that statement. Scientifically speaking, the body does not have vortexes to adjust, therefore that is not the mechanism of action.
Spiritually speaking, who knows? Not us, a humble health science publication.
The Five Rites are a pseudoscience popular in the US: True or False?
True, if 27% of those who responded of our mostly North American readership can be considered as representative of what is popular.
However…
“Pseudoscience” gets thrown around a lot as a bad word; it’s often used as a criticism, but it doesn’t have to be. Consider:
A small child who hears about “eating the rainbow” and mistakenly understands that we are all fuelled by internal rainbows that need powering-up by eating fruits and vegetables of different colors, and then does so…
…does not hold a remotely scientific view of how things are happening, but is nevertheless doing the correct thing as recommended by our best current science.
It’s thus a little similar with the five rites. Because…
The Five Rites are at least good for our health: True or False?
True! They are great for the health.
The first one (spinning around) is good for balance. Science would recommend doing it both ways rather than just one way, but one is not bad. It trains balance, trains our stabilizing muscles, and confuses our heart a bit (in a good way).
See also: Fall Special (How To Not Fall, And Not Get Injured If You Do)
The second one (leg raises) is excellent for core strength, which in turn helps keep our organs where they are supposed to be (this is a bigger health issue than most people realise, because “out of sight, out of mind”), which is beneficial for many aspects of our health!
See also: Visceral Belly Fat & How To Lose It ← visceral fat is the fat that surrounds your internal organs; too much there becomes a problem!
The third, fourth, and fifth ones stretch our spine (healthily), strengthen our back, and in the cases of the fourth and fifth ones, are good full-body exercises for building strength, and maintaining muscle mass and mobility.
See also: Building & Maintaining Mobility
So in short…
If you’ve been enjoying the Five Rites, by all means keep on doing them; they might not be Tibetan (or an ancient practice, as presented), and any mystical aspect is beyond the scope of our health science publication, but they are great for the health in science-based ways!
Take care!
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Cavolo Nero & Sweet Potato Hash
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🎶 Sweet potato hash? It’s a seasonal smash… Catches on in a flash… Let’s do the hash 🎶
You will need
- 6 oz cavolo nero, tough stems removed, chopped
- 1 large sweet potato, diced
- 1 large red onion, finely chopped
- 1 parsnip, grated
- 1 small red pepper, chopped
- 4 oz baby portobello mushrooms, chopped
- ½ cup fresh or thawed peas
- ¼ bulb garlic, thinly sliced
- 1 tbsp nutritional yeast
- 2 tsp black pepper, coarse ground
- 1 tsp dried rosemary
- 1 tsp dried thyme (dried for convenience; fresh is also fine if you have it)
- 1 tsp red chili flakes (dried for convenience; fresh is also fine if you have it)
- 1 tsp ground turmeric
- ½ tsp MSG or 1 tsp low-sodium salt
- Extra virgin olive oil
Method
(we suggest you read everything at least once before doing anything)
1) Preheat the oven to 425℉ / 220℃.
2) Toss the diced sweet potato in 1 tbsp olive oil, as well as the nutritional yeast, ground turmeric, black pepper, and MSG/salt, ensuring an even distribution. Roast in the oven on a lined baking tray, for 30 minutes, turning at least once to get all sides of the potato. When it is done, remove from the oven and set aside.
3) Heat a little oil in a sauté pan or large skillet (either is fine; we’re not adding liquids today), and fry the onion, parsnip, and pepper until softened, which should take about 5 minutes (this is one reason why we grated the parsnip; the other is for the variation in texture).
4) Add the garlic, mushrooms, herbs, and chili flakes, and cook for a further 1 minute, while stirring.
5) Add the cavolo nero and peas, stir until the cavolo nero begins to wilt, and then…
6) Add the roasted sweet potato; cook for about 5 more minutes, pressing down with the spatula here and there to mash the ingredients together.
7) Turn the hash over when it begins to brown on the bottom, to lightly brown the other side too.
8) Serve hot.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Brain Food? The Eyes Have It!
- Which Bell Peppers To Pick?
- Ergothioneine: “The Longevity Vitamin” (That’s Not A Vitamin)
- Our Top 5 Spices: How Much Is Enough For Benefits?
- What’s Your Plant Diversity Score?
Take care!
Don’t Forget…
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Is Air-Fried Food Really 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.
Air-frying has a reputation for being healthy—and it generally is, provided it’s used carefully:
Just one thing to watch out for
An air-fryer is basically a small convection oven that uses circulating air rather than immersion in oil to cook food. The smallness of an air-fryer is a feature not a bug—if you get an air-fryer over a certain size, then congratulations, you just have a convection oven. The small size it what helps it to cook so efficiently. This is one reason that they’re not really used in industrial settings.
The documentary-makers from this video had their food (chicken, fish, and fries) lab-tested (for fat, cholesterol, and acrylamide), and found:
- Air-frying significantly reduced saturated fat (38–53%) and trans fats (up to 55%) in some foods.
- Cholesterol reduction varied depending on the food type.
- Acrylamide levels in air-fried potatoes were much higher due to cooking time and temperature.
About that acrylamide: acrylamide forms in starchy foods at high temperatures and may pose cancer risks (the research is as yet unclear, with conflicting evidence). Air-frying can cause higher acrylamide levels if cooking is prolonged or temperatures are too high.
Recommendations to reduce acrylamide:
- Soak potatoes before cooking.
- Use lower temperatures (e.g. 180℃/350℉) and shorter cooking times.
- Avoid over-browning food.
For more on all of this, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
Unlock Your Air-Fryer’s Potential!
Take care!
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails: