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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  • Coenzyme Q10 From Foods & Supplements

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    Coenzyme Q10 and the difference it makes

    Coenzyme Q10, often abbreviated to CoQ10, is a popular supplement, and is often one of the more expensive supplements that’s commonly found on supermarket shelves as opposed to having to go to more specialist stores or looking online.

    What is it?

    It’s a compound naturally made in the human body and stored in mitochondria. Now, everyone remembers the main job of mitochondria (producing energy), but they also protect cells from oxidative stress, among other things. In other words, aging.

    Like many things, CoQ10 production slows as we age. So after a certain age, often around 45 but lifestyle factors can push it either way, it can start to make sense to supplement.

    Does it work?

    The short answer is “yes”, though we’ll do a quick breakdown of some main benefits, and studies for such, before moving on.

    First, do bear in mind that CoQ10 comes in two main forms, ubiquinol and ubiquinone.

    Ubiquinol is much more easily-used by the body, so that’s the one you want. Here be science:

    Comparison study of plasma coenzyme Q10 levels in healthy subjects supplemented with ubiquinol versus ubiquinone

    What is it good for?

    Benefits include:

    Can we get it from foods?

    Yes, and it’s equally well-absorbed through foods or supplementation, so feel free to go with whichever is more convenient for you.

    Read: Intestinal absorption of coenzyme Q10 administered in a meal or as capsules to healthy subjects

    If you do want to get it from food, you can get it from many places:

    • Organ meats: the top source, though many don’t want to eat them, either because they don’t like them or some of us just don’t eat meat. If you do, though, top choices include the heart, liver, and kidneys.
    • Fatty fish: sardines are up top, along with mackerel, herring, and trout
    • Vegetables: leafy greens, and cruciferous vegetables e.g. cauliflower, broccoli, sprouts
    • Legumes: for example soy, lentils, peanuts
    • Nuts and seeds: pistachios come up top; sesame seeds are great too
    • Fruit: strawberries come up top; oranges are great too

    If supplementing, how much is good?

    Most studies have used doses in the 100mg–200mg (per day) range.

    However, it’s also been found to be safe at 1200mg (per day), for example in this high-quality study that found that higher doses resulted in greater benefit, in patients with early Parkinson’s Disease:

    Effects of coenzyme Q10 in early Parkinson disease: evidence of slowing of the functional decline

    Wondering where you can get it?

    We don’t sell it (or anything else for that matter), and you can probably find it in your local supermarket or health food store. However, if you’d like to buy it online, here’s an example product on Amazon

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  • Laugh Often, To Laugh Longest!

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    Putting The Abs Into Absurdity

    We’ve talked before about the health benefits of a broadly positive outlook on life:

    Optimism Seriously Increases Longevity!

    …and we’re very serious about it, but that’s about optimistic life views in general, and today we’re about not just keeping good humor in questionable circumstances, but actively finding good humor in the those moments—even when the moments in question might not be generally described as good!

    After all, laughter really can be the best medicine, for example:

    The effect of laughter yoga exercises on anxiety and sleep quality in patients suffering from Parkinson’s disease

    From the roots

    First a quick recap on de-toothing the psychological aspect of threats, no matter how menacing they may be:

    Hello, Emotions: Time For Radical Acceptance!

    …which we can then take a step further:

    What’s The Worst That Could Happen?

    Choose your frame

    Do you remember when that hacker hacked and publicized the US Federal no-fly list, after already hacking a nationwide cloud-based security camera company, getting access to more than 150,000 companies’ and private individuals’ security cameras, amongst various other cyber crimes, mostly various kinds of fraud and data theft?

    Imagine how she (age 21) must have felt, when being indicted. What do you suppose this hacker had to say for itself under such circumstances?

    ❝congress is investigating now 🙂

    but i stay silly :3 ❞

    ~ maia arson crimew

    …the latter half of which, usually rendered “but I stay silly” or “but we stay silly” has since entered popular Gen-Z parlance, usually after expressing some negative thing, often in a state of powerlessness.

    Which is an important life skill if powerlessness is something that is often likely.

    It’s important for many Gen-Zs with negligible life prospects economically; it’s equally important for 60-somethings getting cancer diagnoses (statistically the most likely decade to find out one has cancer, by the way), and many other kinds of people younger, older, and in between.

    Because at the end of the day, we all start powerless and we all end powerless.

    Learned helplessness (two kinds)

    In psychology, “learned helplessness” occurs when a person or creature gives up after learning that all and any attempts to resist a Bad Thing™ fail, perhaps even badly. A lab rat may just shut down and sit there getting electroshocked, for example. A person subjected to abuse may stop trying to improve their situation, and just go with the path of least resistance.

    But, there’s another kind, wherein someone in a position of absolute powerlessness not only makes their peace with that, but also, decides that the one thing the outside world can’t control, is how they take it. Like the hacker we mentioned earlier.

    Sometimes the gallows humor is even more literal, laughing at one’s own impending death. Not as a matter of bravado, but genuinely seeing the funny side.

    But how?

    Unfortunately, fortunately

    The trick here is to “find a silver lining” that is nowhere near enough to compensate for the bad thing—and it may even be worse! But that’s fine:

    Unfortunately, I didn’t have time to do the dishes before leaving for my vacation. Fortunately, I also forgot to turn the oven off, so the house burning down covered up my messy kitchen”

    Writer’s personal less drastic example: today I set my espresso machine to press me an espresso; it doesn’t have an auto-off and I got distracted and it overflowed everywhere; my immediate reaction was “Oh! I have been blessed with an abundance of coffee!”

    This kind of silly little thing, on a daily basis, builds a very solid habit for life that allows one to see the funny side in even the most absurd situations, even matters of life and death (can confirm: been there enough times personally—so far so good, still alive to find the remembered absurdity silly).

    The point is not to genuinely value the “silver lining”, because half the time it isn’t even one, really, and it is useless to pretend, in seriousness.

    But to pretend in silliness? Now we’re onto something, and the real benefit is in the laughs we had along the way.

    Because those worst moments? Are probably when we need it the most, so it’s good to get some practice in!

    Want more ways to find the funny and make it a life habit?

    We reviewed a good book recently:

    The Humor Habit: Rewire Your Brain To Stress Less, Laugh More, And Achieve More’er – by Paul Osincup

    Stay silly!

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  • From banning junk food ads to a sugar tax: with diabetes on the rise, we can’t afford to ignore the evidence any longer

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    There are renewed calls this week for the Australian government to implement a range of measures aimed at improving our diets. These include restrictions on junk food advertising, improvements to food labelling, and a levy on sugary drinks.

    This time the recommendations come from a parliamentary inquiry into diabetes in Australia. Its final report, tabled in parliament on Wednesday, was prepared by a parliamentary committee comprising members from across the political spectrum.

    The release of this report could be an indication that Australia is finally going to implement the evidence-based healthy eating policies public health experts have been recommending for years.

    But we know Australian governments have historically been unwilling to introduce policies the powerful food industry opposes. The question is whether the current government will put the health of Australians above the profits of companies selling unhealthy food.

    benjamas11/Shutterstock

    Diabetes in Australia

    Diabetes is one of the fastest growing chronic health conditions in the nation, with more than 1.3 million people affected. Projections show the number of Australians diagnosed with the condition is set to rise rapidly in coming decades.

    Type 2 diabetes accounts for the vast majority of cases of diabetes. It’s largely preventable, with obesity among the strongest risk factors.

    This latest report makes it clear we need an urgent focus on obesity prevention to reduce the burden of diabetes. Type 2 diabetes and obesity cost the Australian economy billions of dollars each year and preventive solutions are highly cost-effective.

    This means the money spent on preventing obesity and diabetes would save the government huge amounts in health care costs. Prevention is also essential to avoid our health systems being overwhelmed in the future.

    What does the report recommend?

    The report puts forward 23 recommendations for addressing diabetes and obesity. These include:

    • restrictions on the marketing of unhealthy foods to children, including on TV and online
    • improvements to food labelling that would make it easier for people to understand products’ added sugar content
    • a levy on sugary drinks, where products with higher sugar content would be taxed at a higher rate (commonly called a sugar tax).

    These key recommendations echo those prioritised in a range of reports on obesity prevention over the past decade. There’s compelling evidence they’re likely to work.

    Restrictions on unhealthy food marketing

    There was universal support from the committee for the government to consider regulating marketing of unhealthy food to children.

    Public health groups have consistently called for comprehensive mandatory legislation to protect children from exposure to marketing of unhealthy foods and related brands.

    An increasing number of countries, including Chile and the United Kingdom, have legislated unhealthy food marketing restrictions across a range of settings including on TV, online and in supermarkets. There’s evidence comprehensive policies like these are having positive results.

    In Australia, the food industry has made voluntary commitments to reduce some unhealthy food ads directly targeting children. But these promises are widely viewed as ineffective.

    The government is currently conducting a feasibility study on additional options to limit unhealthy food marketing to children.

    But the effectiveness of any new policies will depend on how comprehensive they are. Food companies are likely to rapidly shift their marketing techniques to maximise their impact. If any new government restrictions do not include all marketing channels (such as TV, online and on packaging) and techniques (including both product and brand marketing), they’re likely to fail to adequately protect children.

    Food labelling

    Food regulatory authorities are currently considering a range of improvements to food labelling in Australia.

    For example, food ministers in Australia and New Zealand are soon set to consider mandating the health star rating front-of-pack labelling scheme.

    Public health groups have consistently recommended mandatory implementation of health star ratings as a priority for improving Australian diets. Such changes are likely to result in meaningful improvements to the healthiness of what we eat.

    Regulators are also reviewing potential changes to how added sugar is labelled on product packages. The recommendation from the committee to include added sugar labelling on the front of product packaging is likely to support this ongoing work.

    But changes to food labelling laws are notoriously slow in Australia. And food companies are known to oppose and delay any policy changes that might hurt their profits.

    A woman holding a young boy while looking at products on a supermarket shelf.
    Health star ratings are not compulsory in Australia. BLACKDAY/Shutterstock

    A sugary drinks tax

    Of the report’s 23 recommendations, the sugary drinks levy was the only one that wasn’t universally supported by the committee. The four Liberal and National party members of the committee opposed implementation of this policy.

    As part of their rationale, the dissenting members cited submissions from food industry groups that argued against the measure. This follows a long history of the Liberal party siding with the sugary drinks industry to oppose a levy on their products.

    The dissenting members didn’t acknowledge the strong evidence that a sugary drinks levy has worked as intended in a wide range of countries.

    In the UK, for example, a levy on sugary drinks implemented in 2018 has successfully lowered the sugar content in UK soft drinks and reduced sugar consumption.

    The dissenting committee members argued a sugary drinks levy would hurt families on lower incomes. But previous Australian modelling has shown the two most disadvantaged quintiles would reap the greatest health benefits from such a levy, and accrue the highest savings in health-care costs.

    What happens now?

    Improvements to population diets and prevention of obesity will require a comprehensive and coordinated package of policy reforms.

    Globally, a range of countries facing rising epidemics of obesity and diabetes are starting to take such strong preventive action.

    In Australia, after years of inaction, this week’s report is the latest sign that long-awaited policy change may be near.

    But meaningful and effective policy change will require politicians to listen to the public health evidence rather than the protestations of food companies concerned about their bottom line.

    Gary Sacks, Professor of Public Health Policy, Deakin University

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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Related Posts

  • Growing Young – by Marta Zaraska
  • Tips for Improving Memory

    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.

    Q&A with 10almonds Subscribers!

    Q: Any tips, other than supplements, for improving memory?

    A: So many tips! Certainly enough to do a main feature on, so again maybe we’ll do that in another issue soon. Meanwhile, here are the absolute most critical things for you to know, understand, and apply:

    • Memory is a muscle. Not literally, but in the sense that it will grow stronger if exercised and will atrophy if neglected.
    • Counterpart of the above: your memory is not a finite vessel. You can’t “fill it up with useless things”, so no need to fear doing so.
    • Your memory is the product of countless connections in your brain. The more connections lead to a given memory, the more memorable it will be. What use is this knowledge to you? It means that if you want to remember something, try to make as many connections to it as possible, so:
      • Involve as many senses as possible.
      • When you learn things, try to learn them in context. Then when your mind has reason to think about the context, it’ll be more likely to remember the thing itself too.
    • Rehearsal matters. A lot. This means repeatedly going over something in your head. This brings about the neural equivalent of “muscle memory”.
    • Enjoy yourself if you can. The more fun something is, the more you will mentally rehearse it, and the more mental connections you’ll make to it.

    Have a question you’d like to see answered here? Hit reply to this email, or use the feedback widget at the bottom! We always love to hear from you

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  • Why 7 Hours Sleep Is Not Enough

    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.

    How Sleep-Deprived Are You, Really?

    This is Dr. Matthew Walker. He’s a neuroscientist and sleep specialist, and is the Director of the Center for Human Sleep Science at UC Berkeley’s Department of Psychology. He’s also the author of the international bestseller “Why We Sleep”.

    What does he want us to know?

    Sleep deprivation is more serious than many people think it is. After about 16 hours without sleep, the brain begins to fail, and needs more than 7 hours of sleep to “reset” cognitive performance.

    Note: note “seven or more”, but “more than seven”.

    After ten days with only 7 hours sleep (per day), Dr. Walker points out, the brain is as dysfunctional as it would be after going without sleep for 24 hours.

    Here’s the study that sparked a lot of Dr. Walker’s work:

    The Cumulative Cost of Additional Wakefulness: Dose-Response Effects on Neurobehavioral Functions and Sleep Physiology From Chronic Sleep Restriction and Total Sleep Deprivation

    Importantly, in Dr. Walker’s own words:

    Three full nights of recovery sleep (i.e., more nights than a weekend) are insufficient to restore performance back to normal levels after a week of short sleeping❞

    ~ Dr. Matthew Walker

    See also: Why You Probably Need More Sleep

    Furthermore: the sleep-deprived mind is unaware of how sleep-deprived it is.

    You know how a drunk person thinks they can drive safely? It’s like that.

    You do not know how sleep-deprived you are, when you are sleep-deprived!

    For example:

    ❝(60.7%) did not signal sleepiness before a sleep fragment occurred in at least one of the four MWT trials❞

    Source: Sleepiness is not always perceived before falling asleep in healthy, sleep-deprived subjects

    Sleep efficiency matters

    With regard to the 7–9 hours band for optimal health, Dr. Walker points out that the sleep we’re getting is not always the sleep we think we’re getting:

    ❝Assuming you have a healthy sleep efficiency (85%), to sleep 9 hours in terms of duration (i.e. to be a long-sleeper), you would need to be consistently in bed for 10 hours and 36 minutes a night. ❞

    ~ Dr. Matthew Walker

    At the bottom end of that, by the way, doing the same math: to get only the insufficient 7 hours sleep discussed earlier, a with a healthy 85% sleep efficiency, you’d need to be in bed for 8 hours and 14 minutes per night.

    The unfortunate implication of this: if you are consistently in bed for 8 hours and 14 minutes (or under) per night, you are not getting enough sleep.

    “But what if my sleep efficiency is higher than 85%?”

    It shouldn’t be.If your sleep efficiency is higher than 85%, you are sleep-deprived and your body is having to enforce things.

    Want to know what your sleep efficiency is?

    We recommend knowing this, by the way, so you might want to check out:

    Head-To-Head Comparison of Google and Apple’s Top Sleep-Monitoring Apps

    (they will monitor your sleep and tell you your sleep efficiency, amongst other things)

    Want to know more?

    You might like his book:

    Why We Sleep: Unlocking the Power of Sleep and Dreams

    …and/or his podcast:

    The Matt Walker Podcast

    …and for those who like videos, here’s his (very informative) TED talk:

    !

    Prefer text? Click here to read the transcript

    Want to watch it, but not right now? Bookmark it for later

    Enjoy!

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  • How Are You, Really? And How Old Is Your Heart?

    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.

    How Are You, Really? The Free NHS Health Test

    We took this surprisingly incisive 10-minute test from the UK’s famous National Health Service—the test is part of the “Better Health” programme, a free-to-all (yes, even those from/in other countries) initiative aimed at keeping people healthy enough to have less need of medical attention.

    As one person who took the test wrote:

    ❝I didn’t expect that a government initiative would have me talking about how I need to keep myself going to be there for the people I love, let alone that a rapid-pace multiple-choice test would elicit these responses and give personalized replies in turn, but here we are❞

    It goes beyond covering the usual bases, in that it also looks at what’s most important to you, and why, and what might keep you from doing the things you want/need to do for your health, AND how those obstacles can be overcome.

    Pretty impressive for a 10-minute test!

    Is Your Health Above Average Already? Take the Free 10-minute NHS test now!

    How old are you, in your heart?

    Poetic answers notwithstanding (this writer sometimes feels so old, and yet also much younger than she is), there’s a biological answer here, too.

    Again free for the use of all*, here’s a heart age calculator.

    *It is suitable for you if you are aged 30–95, and do not have a known complicating cardiovascular disease.

    It will ask you your (UK) postcode; just leave that field blank if you’re not in the UK; it’ll be fine.

    How Old Are You, In Your Heart? Take the Free 10-minute NHS test now!

    (Neither test requires logging into anything, and they do not ask for your email address. The tests are right there on the page, and they give the answers right there on the page, immediately)

    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

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