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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What Matters Most For Your Heart?
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Eat More (Of This) For Lower Blood Pressure
Heart disease remains the world’s #1 killer. We’d say “and in the US, it’s no different”, but in fact, the US is #1 country for heart disease. So, it’s worse and perhaps some extra care is in order.
But how?
What matters the most
Is it salt? Salt plays a part, but it’s not even close to the top problem:
Hypertension: Factors Far More Relevant Than Salt
Is it saturated fat? Saturated fat from certain sources plays more of a role than salt, but other sources may not be so much of an issue:
Can Saturated Fats Be Heart-Healthy?
Is it red meat? Red meat is not great for the heart (or for almost anything else, except perhaps anemia):
The Whys and Hows of Cutting Meats Out Of Your Diet
…but it’s still not the top dietary factor.
The thing many don’t eat
All the above are foodstuffs that a person wanting a healthier heart and cardiovascular system in general might (reasonably and usually correctly) want to cut down, but there’s one thing that most people need more of:
Why You’re Probably Not Getting Enough Fiber (And How To Fix It)
And this is especially true for heart health:
❝Dietary fiber has emerged as a crucial yet underappreciated part of hypertension management.
Our comprehensive analysis emphasizes the evidence supporting the effectiveness of dietary fiber in lowering blood pressure and reducing the risk of cardiovascular events.❞
Specifically, she and her team found:
- Each additional 5g of fiber per day reduces blood pressure by 2.8/2.1 (systolic/diastolic, in mmHG)
- Dietary fiber works in several ways to improve cardiovascular health, including via gut bacteria, improved lipids profiles, and anti-inflammatory effects
- Most people are still only getting a small fraction (¼ to ⅓) of the recommended daily amount of fiber. To realize how bad that is, imagine if you consumed only ¼ of the recommended daily amount of calories every day!
You can read more about it here:
Dietary fiber critical in managing hypertension, international study finds
That’s a pop-science article, but it’s still very informative. If you prefer to read the scientific paper itself (or perhaps as well), you can find it below
Recommendations for the Use of Dietary Fiber to Improve Blood Pressure Control
Want more from your fiber?
Here’s yet another way fiber improves cardiometabolic health, hot off the academic press (the study was published just a couple of weeks ago):
How might fiber lower diabetes risk? Your gut could hold the clues
this pop-science article was based on this scientific paper
Gut Microbiota and Blood Metabolites Related to Fiber Intake and Type 2 Diabetes
Take care!
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The Lymphatic System Against Cancer & More
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Ask Not What Your Lymphatic System Can Do For You…
Just kidding; we’ll cover that first, as it’s definitely not talked about enough.
The lymphatic system is the system in the body that moves lymph around. It’s made of glands, nodes, and vessels:
- The glands (such as the tonsils and the adenoids) and nodes filter out bacteria and produce white blood cells. Specific functions may be, well, specialized—beyond the scope of today’s article—but that’s the broad function.
- The vessels are the tubes that allow those things to be moved around, suspended in lymph.
What’s lymph? It’s a colorless water-like liquid that transports immune cells, nutrients (and waste) around the body (through the lymphatic system).
Yes, it works alongside your vasculature; when white blood cells aren’t being deployed en masse into your bloodstream to deal with some threat, they’re waiting in the wings in the lymphatic system.
While your blood is pumped around by your heart, lymph moves based on a variety of factors, including contractions of small specialized lymphatic muscles, the pressure gradient created by the combination of those and gravity, and the movements of your body itself.
Here’s a larger article than we have room for, with diagrams we also don’t have room for:
Modelling the lymphatic system
To oversimplify it in few words for the sake of moving on: you can most of the time: think of it as an ancillary network supporting your circulatory system that unlike blood, doesn’t deal with oxygen or sugars, but does deal with a lot of other things, including:
- water and salt balance
- immune cells and other aspects of immune function
- transports fats (and any fat-soluble vitamins in them) into circulation
- cleans up stuff that gets stuck between cells
- general detoxification
There’s a lot that can go wrong if lymph isn’t flowing as it should
Too much to list here, but to give an idea:
- Arthritis and many autoimmune diseases
- Cardiovascular disease and metabolic syndrome
- Obesity, diabetes, and organ failure
- Alzheimer’s and other dementias
- Lymphadenitis, lymphangitis, and lymphedenopathy
- Lymphomas and Hodgkin’s disease (both are types of lymphatic cancer)
- Cancers of other kinds, because of things not being cleaned up where and when they should be
Yikes! That’s a lot of important things for a mostly-forgotten system to be taking care of protecting us from!
What you can do for your lymphatic system, to avoid those things!
Happily, there are easy things we can do to give our lymph some love, such as:
Massage therapy (and foam rolling)
This is the go-to that many people/publications recommend. It’s good! It’s certainly not the most important thing to do, but it’s good.
You can even use a simple gadget like this one to help move the lymph around, without needing to learn arcane massage techniques.
Exercise (move your body!)
This is a lot more important. The more we move our body, the more lymph moves around. The more lymph moves around today, the more easily it will move around tomorrow. A healthy constant movement of lymph throughout the lymphatic system is key to keeping everything running smoothly.
If you pick only one kind of exercise, make it High-Intensity Interval Training (HIIT):
How To Do HIIT (Without Wrecking Your Body)
If for some reason you really can’t do that, just spend as much of your waking time as reasonably possible, moving, per:
For ideas on how to do that, check out…
Get thee to a kitchen
This is about getting healthy food that gives your body’s clean-up crew (the lymphatic system) an easier time of it.
Rather than trying to “eat clean” which can be a very nebulous term and it’s often not at all clear (and/or hotly debated) what counts as “clean”, instead, stick to foods that constitute an anti-inflammatory diet:
Take care!
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Protein-Stuffed Bell Peppers
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Hot, tasty, meaty, and vegan! You can have it all. And with this recipe, you’ll want to err on the side of overcatering, because everyone will want some. As for healthiness, we’ve got lycopene, lutein and a stack of other carotenoids, a plethora of other polyphenols, and a veritable garden party of miscellaneous phytochemicals otherwise categorized. It’s full of protein, fiber, vitamins, and minerals, relatively low-fat but the fats present are healthy. It’s antidiabetic, anti-CVD, anticancer, antineurodegeneration, and basically does everything short of making you sing well too.
You will need
- 4 large bell peppers, tops sliced open and innards removed (keep the tops; we will put them back on later)
- 1 cup quinoa, rinsed
- 1 can black beans, drained and rinsed
- 1 small zucchini (diced)
- 1 small eggplant (diced)
- 1 small red onion (finely chopped)
- ½ bulb garlic, minced*
- 1 tbsp tomato paste
- 1 tbsp chia seeds
- 2 tbsp extra virgin olive oil
- 2 tsp dried basil
- 2 tsp dried thyme
- 2 tsp black pepper, coarse ground
- 2 tsp ground cumin
- 1 tsp smoked paprika
- ½ tsp MSG or 1 tsp low-sodium salt
*we always try to give general guidelines with regard to garlic, but the reality is it depends on the size and strength of your local garlic, which we cannot account for, as well as your personal taste. Same situation with hot peppers of various kinds. This writer (it’s me, hi) would generally use about 2x the garlic and pepper advised in our recipes. All we can say is: follow your heart!
Method
(we suggest you read everything at least once before doing anything)
1) Combine the quinoa with the chia seeds, and cook as per normal cooking of quinoa (i.e. bring to a boil and then simmer for about 15 minutes until cooked and fluffy). Drain and rinse (carefully, without losing the chia seeds; use a sieve).
2) Heat your grill to a high heat. Combine the zucchini, eggplant, onion, garlic, and olive oil in a big bowl and mix well, ensuring an even distribution of the oil. Now also add the herbs and spices (including the MSG or salt) and mix well again. Put them all to grill for about 5 minutes, turning as necessary.
3) Heat your oven to a high heat. Take the grilled vegetables and combine them in a bowl with the quinoa-and-chia, and the black beans, as well as the tomato paste. Mix everything well. Spoon the mixture generously into the bell peppers, replacing the tops (it can be loosely), and bake for about 5–10 minutes, keeping an eye on them; you want them to be lightly charred, but not a burnt offering.
4) Serve! This dish works well as a light lunch or as part of a larger spread.
(before going in the oven with lids replaced to keep moisture in)
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- A Spectrum Of Specialties: Which Color Bell Peppers To Pick?
- Why You’re Probably Not Getting Enough Fiber (And How To Fix It)
- The Tiniest Seeds With The Most Value: If You’re Not Taking Chia, You’re Missing Out
- Chickpeas vs Black Beans – Which is Healthier?
- The Many Health Benefits Of Garlic
- Black Pepper’s Impressive Anti-Cancer Arsenal (And More)
- Monosodium Glutamate: Sinless Flavor-Enhancer Or Terrible Health Risk?
Take care!
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Related Posts
16/8 Intermittent Fasting For Beginners
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Health Insider explains in super-simple fashion why and how to do Intermittent Fasting (IF), which is something that can sound complicated at first, but becomes very simple and easy once understood.
What do we need to know?
Intermittent fasting (IF) is a good, well-evidenced way to ease your body’s metabolic load, and
give your organs a chance to recover from the strain of digestion and its effects. That’s not just your gastrointestinal organs! It’s your pancreas and liver too, amongst others—this is about glucose metabolism as much as it is about digestion.This, in turn, allows your body some downtime to do its favorite thing, which is: maintenance!
This maintenance takes the form of enhanced cellular apoptosis and autophagy, helping to keep cells young and cancer-free.
In other words, with well-practised intermittent fasting, we can reduce our risk of metabolic disease (including heart disease and diabetes) as well as cancer and neurodegeneration.
You may be wondering: this sounds miraculous; what’s the catch? There are a couple:
- While fasting from food, the body’s enhanced metabolism requires more water, so you’ll need to take extra care keep on top of your hydration (this is one reason why Ramadan fasting, while healthy for most people, is not as healthy as IF—because Ramadan fasting means abstaining from water, too).
- If you are diabetic, and especially if you have Type 1 Diabetes, fasting may not be a safe option for you, since if you get a hypo in the middle of your fasting period, it’s obviously not a good idea to wait another many hours before fixing it.
Extra note on that last one: it’s easy to think “can’t I just lower my bolus insulin instead of eating?” and while superficially yes that will raise your blood sugar levels, it’s because the sugar will be sticking around in your blood, and not actually getting released into the organs that need it. So while your blood glucose monitor may say you’re fine, you will be starving your organs and if you keep it up they may suffer serious damage.
Disclaimer: our standard legal/medical disclaimer applies, and this is intended for educational purposes only; please do speak with your endocrinologist before changing anything you usually do with regard to your blood sugar maintenance.
Ok, back onto the cheerier topic at hand:
Aside from the above: for most people, IF is a remarkably healthful practice in very many ways.
For more on the science, practicalities, and things to do/avoid, enjoy this short (4:53) video:
Click Here If The Embedded Video Doesn’t Load Automatically
Want to know more?
Check out our previous main feature on this topic:
Intermittent Fasting: Mythbusting Edition
Enjoy!
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Ideal Blood Pressure Numbers Explained
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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
❝Maybe I missed it but the study on blood pressure did it say what the 2 numbers should read ideally?❞
We linked it at the top of the article rather than including it inline, as we were short on space (and there was a chart rather than a “these two numbers” quick answer), but we have a little more space today, so:
Category Systolic (mm Hg) Diastolic (mm Hg) Normal < 120 AND < 80 Elevated 120 – 129 AND < 80 Stage 1 – High Blood Pressure 130 – 139 OR 80 – 89 Stage 2 – High Blood Pressure 140 or higher OR 90 or higher Hypertensive Crisis Above 180 AND/OR Above 120 To oversimplify for a “these two numbers” answer, under 120/80 is generally considered good, unless it is under 90/60, in which case that becomes hypotension.
Hypotension, the blood pressure being too low, means your organs may not get enough oxygen and if they don’t, they will start shutting down.
To give you an idea how serious this, this is the closed-circuit equivalent of the hypovolemic shock that occurs when someone is bleeding out onto the floor. Technically, bleeding to death also results in low blood pressure, of course, hence the similarity.
So: just a little under 120/80 is great.
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When And Why Do We Pick Up Our Phones?
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The School of Life’s Alain de Botton makes the argument that—if we pay attention, if we keep track—there’s an understory to why we pick up our phones:
It’s not about information
Yes, our phones (or rather, the apps therein) are designed to addict us, to draw us back, to keep us scrolling and never let us go. We indeed seek out information like our ancestors once sought out berries; searching, encouraged by a small discovery, looking for more. The neurochemistry is similar.
But when we look at the “when” of picking up our phones, de Botton says, it tells a different story:
We pick them up not to find out what’s going on with the world, but rather specifically to not find out what’s going with ourselves. We pick them up to white out some anxiety we don’t want to examine, a line of thought we don’t want to go down, memories we don’t want to consider, futures we do not want to have to worry about.
And of course, phones do have a great educational potential, are an immensely powerful tool for accessing knowledge of many kinds—if only we can remain truly conscious while using them, and not take them as the new “opiate of the masses”.
De Botton bids us, when next we pick up our phone. ask a brave question:
“If I weren’t allowed to consult my phone right now, what might I need to think about?”
As for where from there? There’s more in the video:
Click Here If The Embedded Video Doesn’t Load Automatically!
Further reading
Making Social Media Work For Your Mental Health
Take care!
Don’t Forget…
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