The Diabetes Code – by Dr. Jason Fung

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The 10almonds Team

Cure this serious disease with diet!” is often a bold-claim that overreaches scientific rigor, but in this case, it’s well-established as scientifically valid.

Caveat up-front: the only known circumstance in which this won’t work is if you have comorbidities that prevent you from following the advice.

You may be wondering: is this just the Mediterranean diet again? The answer is that the Mediterreanean diet (or similar) is part of it. But there’s a lot more to this book than that.

Dr. Fung explains to us a lot of the physiology of type 2 diabetes; how insulin resistance occurs, how it becomes a vicious cycle that we get locked into, and how to escape it.

  • We learn about the role of fructose, and why fruit is very healthful whereas high-fructose corn syrup and similars are very much not.
  • We learn about the role of the liver in glycogen metabolism, and how to un-fatty a fatty liver. Good news: the liver has famously strong self-regenerative abilities, if we give it a break to allow it to do so!
  • We learn why portion control doesn’t work, and why intermittent fasting does (here be science).

Dr. Fung’s very readable explanations are free from needless jargon while not dumbing down. The writing style is clear and direct: “this happens this way”, “do this, not that”, etc.

Bottom line: if you have type 2 diabetes and would like to not have that (or if you are pre-diabetic and would like to avoid diabetes) this is a book for you. If you are in great metabolic health and would like to stay that way as you get older, then this is a book for you too.

Click here to check out The Diabetes Code, and get/keep your metabolic health in order!

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  • This salt alternative could help reduce blood pressure. So why are so few people using it?

    Xiaoyue Xu (Luna) and Alta Schutte – UNSW Sydney, Bruce Neal – George Institute for Global Health

    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.

    One in three Australian adults has high blood pressure (hypertension). Excess salt (sodium) increases the risk of high blood pressure so everyone with hypertension is advised to reduce salt in their diet.

    But despite decades of strong recommendations we have failed to get Australians to cut their intake. It’s hard for people to change the way they cook, season their food differently, pick low-salt foods off the supermarket shelves and accept a less salty taste.

    Now there is a simple and effective solution: potassium-enriched salt. It can be used just like regular salt and most people don’t notice any important difference in taste.

    Switching to potassium-enriched salt is feasible in a way that cutting salt intake is not. Our new research concludes clinical guidelines for hypertension should give patients clear recommendations to switch.

    What is potassium-enriched salt?

    Potassium-enriched salts replace some of the sodium chloride that makes up regular salt with potassium chloride. They’re also called low-sodium salt, potassium salt, heart salt, mineral salt, or sodium-reduced salt.

    Potassium chloride looks the same as sodium chloride and tastes very similar.

    Potassium-enriched salt works to lower blood pressure not only because it reduces sodium intake but also because it increases potassium intake. Insufficient potassium, which mostly comes from fruit and vegetables, is another big cause of high blood pressure.

    What is the evidence?

    We have strong evidence from a randomised trial of 20,995 people that switching to potassium-enriched salt lowers blood pressure and reduces the risks of stroke, heart attacks and early death. The participants had a history of stroke or were 60 years of age or older and had high blood pressure.

    An overview of 21 other studies suggests much of the world’s population could benefit from potassium-enriched salt.

    The World Health Organisation’s 2023 global report on hypertension highlighted potassium-enriched salt as an “affordable strategy” to reduce blood pressure and prevent cardiovascular events such as strokes.

    What should clinical guidelines say?

    We teamed up with researchers from the United States, Australia, Japan, South Africa and India to review 32 clinical guidelines for managing high blood pressure across the world. Our findings are published today in the American Heart Association’s journal, Hypertension.

    We found current guidelines don’t give clear and consistent advice on using potassium-enriched salt.

    While many guidelines recommend increasing dietary potassium intake, and all refer to reducing sodium intake, only two guidelines – the Chinese and European – recommend using potassium-enriched salt.

    To help guidelines reflect the latest evidence, we suggested specific wording which could be adopted in Australia and around the world:

    Recommended wording for guidance about the use of potassium-enriched salt in clinical management guidelines.

    Why do so few people use it?

    Most people are unaware of how much salt they eat or the health issues it can cause. Few people know a simple switch to potassium-enriched salt can help lower blood pressure and reduce the risk of a stroke and heart disease.

    Limited availability is another challenge. Several Australian retailers stock potassium-enriched salt but there is usually only one brand available, and it is often on the bottom shelf or in a special food aisle.

    Potassium-enriched salts also cost more than regular salt, though it’s still low cost compared to most other foods, and not as expensive as many fancy salts now available.

    Woman gets man to try her cooking
    It looks and tastes like normal salt.
    Jimmy Dean/Unsplash

    A 2021 review found potassium-enriched salts were marketed in only 47 countries and those were mostly high-income countries. Prices ranged from the same as regular salt to almost 15 times greater.

    Even though generally more expensive, potassium-enriched salt has the potential to be highly cost effective for disease prevention.

    Preventing harm

    A frequently raised concern about using potassium-enriched salt is the risk of high blood potassium levels (hyperkalemia) in the approximately 2% of the population with serious kidney disease.

    People with serious kidney disease are already advised to avoid regular salt and to avoid foods high in potassium.

    No harm from potassium-enriched salt has been recorded in any trial done to date, but all studies were done in a clinical setting with specific guidance for people with kidney disease.

    Our current priority is to get people being managed for hypertension to use potassium-enriched salt because health-care providers can advise against its use in people at risk of hyperkalemia.

    In some countries, potassium-enriched salt is recommended to the entire community because the potential benefits are so large. A modelling study showed almost half a million strokes and heart attacks would be averted every year in China if the population switched to potassium-enriched salt.

    What will happen next?

    In 2022, the health minister launched the National Hypertension Taskforce, which aims to improve blood pressure control rates from 32% to 70% by 2030 in Australia.

    Potassium-enriched salt can play a key role in achieving this. We are working with the taskforce to update Australian hypertension management guidelines, and to promote the new guidelines to health professionals.

    In parallel, we need potassium-enriched salt to be more accessible. We are engaging stakeholders to increase the availability of these products nationwide.

    The world has already changed its salt supply once: from regular salt to iodised salt. Iodisation efforts began in the 1920s and took the best part of 100 years to achieve traction. Salt iodisation is a key public health achievement of the last century preventing goitre (a condition where your thyroid gland grows larger) and enhancing educational outcomes for millions of the poorest children in the world, as iodine is essential for normal growth and brain development.

    The next switch to iodised and potassium-enriched salt offers at least the same potential for global health gains. But we need to make it happen in a fraction of the time.The Conversation

    Xiaoyue Xu (Luna), Scientia Lecturer, UNSW Sydney; Alta Schutte, SHARP Professor of Cardiovascular Medicine, UNSW Sydney, and Bruce Neal, Executive Director, George Institute Australia, George Institute for Global Health

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

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  • Age & Aging: What Can (And Can’t) We Do About It?

    The 10almonds Team

    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 old do you want to be?

    We asked you how old you are, and got an interesting spread of answers. This wasn’t too surprising; of course we have a general idea of who our readership is and we write accordingly.

    What’s interesting is the gap for “40s”.

    And, this wasn’t the case of a broken poll button, it’s something that crops up a lot in health-related sociological research. People who are most interested in taking extra care of their body are often:

    • Younger people full of optimism about maintaining this perfectly healthy body forever
    • Older people realizing “if I don’t want to suffer avoidable parts of age-related decline, now is the time to address these things”

    In between, we often have a gap whereby people no longer have the optimism of youth, but do not yet feel the pressure of older age.

    Which is not to say there aren’t 40-somethings who do care! Indeed, we know for a fact we have some subscribers in their 40s (and some in their 90s, too), just, they evidently didn’t vote in this poll.

    Anyway, let’s bust some myths…

    Aging is inevitable: True or False?

    False, probably. That seems like a bold (and fortune-telling) claim, so let’s flip it to deconstruct it more logically:

    Aging is, and always will be, unstoppable: True or False?

    That has to be “False, probably”. To say “true” now sounds like an even bolder claim. Just like “the moon will always be out of reach”.

    • When CPR was first developed, first-aiders were arrested for “interfering with a corpse”.
    • Many diseases used to be death sentences that are now “take one of these in the morning”
      • If you think this is an appeal to distant history, HIV+ status was a death sentence in the 90s. Now it’s “take one of these in the morning”.

    But, this is an appeal to the past, and that’s not always a guarantee of the future. Where does the science stand currently? How is the research and development doing on slowing, halting, reversing aging?

    We can slow aging: True or False?

    True! There’s a difference between chronological age (i.e., how much time has passed while we’ve been alive) and biological age (i.e., what our diverse markers of aging look like).

    Biological age often gets talked about as a simplified number, but it’s more complex than that, as we can age in different ways at different rates, for example:

    • Visual markers of aging (e.g. wrinkles, graying hair)
    • Performative markers of aging (e.g. mobility tests)
    • Internal functional markers of aging (e.g. tests for cognitive decline, eyesight, hearing, etc)
    • Cellular markers or aging (e.g. telomere length)
    • …and more, but we only have so much room here

    There are things we can do to slow most of those, including:

    In the case of cognitive decline particularly, check out our previous article:

    How To Reduce Your Alzheimer’s Risk

    It’s too early to worry about… / It’s too late to do anything about… True or False?

    False and False!

    Many things that affect our health later in life are based on early-life choices and events. So it’s important for young people to take advantage of that. The earlier one adopts a healthy lifestyle, the better, because, and hold onto your hats for the shocker here: aging is cumulative.

    However, that doesn’t mean that taking up healthy practices (or dropping unhealthy ones) is pointless later in life, even in one’s 70s and beyond!

    Read about this and more from the National Institute of Aging:

    What Do We Know About Healthy Aging?

    We can halt aging: True or False?

    False, for now at least. Our bodies are not statues; they are living organisms, constantly rebuilding themselves, constantly changing, every second of every day, for better or for worse. Every healthy or unhealthy choice you make, every beneficial or adverse experience you encounter, affects your body on a cellular level.

    Your body never, ever, stops changing for as long as you live.

    But…

    We can reverse aging: True or False?

    True! Contingently and with limitations, for now at least.

    Remember what we said about your body constantly rebuilding itself? That goes for making itself better as well as making itself worse.

    But those aren’t really being younger, we’ll still die when our time is up: True or False?

    False and True, respectively.

    Those kinds of things are really being younger, biologically. What else do you think being biologically younger is?

    We may indeed die when our time is up, but (unless we suffer fatal accident or incident first) “when our time is up” is something that is decided mostly by the above factors.

    Genetics—the closest thing we have to biological “fate”—accounts for only about 25% of our longevity-related health*.

    Genes predispose, but they don’t predetermine.

    *Read more: Human longevity: Genetics or Lifestyle? It takes two to tango

    (from the Journal of Immunity and Ageing)

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  • Should We Skip Shampoo?

    The 10almonds Team

    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.

    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 😎

    ❝What’s the science on “no poo”? Is it really better for hair? There are so many mixed reports out there.❞

    First, for any unfamiliar: this is not about constipation; rather, it is about skipping shampoo, and either:

    • Using an alternative cleaning agent, such as vinegar and/or sodium bicarbonate
    • Using nothing at all, just conditioner when wet and brushing when dry

    Let’s examine why the trend became a thing: the thinking went “shampoo does not exist in nature, and most of our body is more or less self-cleaning; shampoos remove oils from hair, and the body has to produce more sebum to compensate, resulting in a rapid cycle of dry and greasy hair”.

    Now let’s fact-check each of those:

    • shampoo does not exist in nature: true (except in the sense that everything that exists can be argued to exist in nature, since nature encompasses everything—but the point is that shampoo is a purely artificial human invention)
    • most of our body is more or less self-cleaning: true, but our hair is not, for the same reason our nails are not: they’re not really a living part of the overall organism that is our body, so much as a keratinous protrusion of neatly stacked and hardened dead cells from our body. Dead things are not self-cleaning.
    • shampoos remove oils from hair: true; that is what they were invented for and they do it well
    • the body has to produce more sebum to compensate, resulting in a rapid cycle of dry and greasy hair: false; or at least, there is no evidence for this.

    Our hair’s natural oils are great at protecting it, and also great at getting dirt stuck in it. For the former reason we want the oil there; for the latter reason, we don’t.

    So the trick becomes: how to remove the oil (and thus the dirt stuck in it) and then put clean oil back (but not too much, because we don’t want it greasy, just, shiny and not dry)?

    The popular answer is: shampoo to clean the hair, conditioner to put an appropriate amount of oil* back.

    *these days, mostly not actually oil, but rather silicon-based substitutes, that do the same job of protecting hair and keeping it shiny and not brittle, without attracting so much dirt. Remember also that silicon is inert and very body safe; its molecules are simply too large to be absorbed, which is why it gets used in hair products, some skin products, and lube.

    See also: Water-based Lubricant vs Silicon-based Lubricant – Which is Healthier?

    If you go “no poo”, then what will happen is either you dry your hair out much worse by using vinegar or (even worse) bicarbonate of soda, or you just have oil (and any dirt stuck in it) in your hair for the life of the hair. As in, each individual strand of hair has a lifespan, and when it falls out, the dirt will go with it. But until that day, it’s staying with you, oil and dirt and all.

    If you use a conditioner after using those “more natural” harsh cleaners* that aren’t shampoo, then you’ll undo a lot of the damage done, and you’ll probably be fine.

    *in fact, if you’re going to skip shampoo, then instead of vinegar or bicarbonate of soda, dish soap from your kitchen may actually do less damage, because at least it’s pH-balanced. However, please don’t use that either.

    If you’re going to err one way or the other with regard to pH though, erring on the side of slightly acidic is much better than slightly alkaline.

    More on pH: Journal of Trichology | The Shampoo pH can Affect the Hair: Myth or Reality?

    If you use nothing, then brushing a lot will mitigate some of the accumulation of dirt, but honestly, it’s never going to be clean until you clean it.

    Our recommendation

    When your hair seems dirty, and not before, wash it with a simple shampoo (most have far too many unnecessary ingredients; it just needs a simple detergent, and the rest is basically for marketing; to make it foam completely unnecessarily but people like foam, to make it thicker so it feels more substantial, to make it smell nice, to make it a color that gives us confidence it has ingredients in it, etc).

    Then, after rinsing, enjoy a nice conditioner. Again there are usually a lot of unnecessary ingredients, but an argument can be made this time for some being more relevant as unlike with the shampoo, many ingredients are going to remain on your hair after rinsing.

    Between washes, if you have long hair, consider putting some hair-friendly oil (such as argan oil or coconut oil) on the tips daily, to avoid split ends.

    And if you have tight curly hair, then this advice goes double for you, because it takes a lot longer for natural oils to get from your scalp to the ends of your hair. For those of us with straight hair, it pretty much zips straight on down there within a day or two; not so if you have beautiful 4C curls to take care of!

    For more on taking care of hair gently, check out:

    Gentler Hair Care Options, According To Science

    Take care!

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  • I’ve been given opioids after surgery to take at home. What do I need to know?

    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.

    The 10almonds Team

    Opioids are commonly prescribed when you’re discharged from hospital after surgery to help manage pain at home.

    These strong painkillers may have unwanted side effects or harms, such as constipation, drowsiness or the risk of dependence.

    However, there are steps you can take to minimise those harms and use opioids more safely as you recover from surgery.

    Flystock/Shutterstock

    Which types of opioids are most common?

    The most commonly prescribed opioids after surgery in Australia are oxycodone (brand names include Endone, OxyNorm) and tapentadol (Palexia).

    In fact, about half of new oxycodone prescriptions in Australia occur after a recent hospital visit.

    Most commonly, people will be given immediate-release opioids for their pain. These are quick-acting and are used to manage short-term pain.

    Because they work quickly, their dose can be easily adjusted to manage current pain levels. Your doctor will provide instructions on how to adjust the dosage based on your pain levels.

    Then there are slow-release opioids, which are specially formulated to slowly release the dose over about half to a full day. These may have “sustained-release”, “controlled-release” or “extended-release” on the box.

    Slow-release formulations are primarily used for chronic or long-term pain. The slow-release form means the medicine does not have to be taken as often. However, it takes longer to have an effect compared with immediate-release, so it is not commonly used after surgery.

    Controlling your pain after surgery is important. This allows you get up and start moving sooner, and recover faster. Moving around sooner after surgery prevents muscle wasting and harms associated with immobility, such as bed sores and blood clots.

    Everyone’s pain levels and needs for pain medicines are different. Pain levels also decrease as your surgical wound heals, so you may need to take less of your medicine as you recover.

    But there are also risks

    As mentioned above, side effects of opioids include constipation and feeling drowsy or nauseous. The drowsiness can also make you more likely to fall over.

    Opioids prescribed to manage pain at home after surgery are usually prescribed for short-term use.

    But up to one in ten Australians still take them up to four months after surgery. One study found people didn’t know how to safely stop taking opioids.

    Such long-term opioid use may lead to dependence and overdose. It can also reduce the medicine’s effectiveness. That’s because your body becomes used to the opioid and needs more of it to have the same effect.

    Dependency and side effects are also more common with slow-release opioids than immediate-release opioids. This is because people are usually on slow-release opioids for longer.

    Then there are concerns about “leftover” opioids. One study found 40% of participants were prescribed more than twice the amount they needed.

    This results in unused opioids at home, which can be dangerous to the person and their family. Storing leftover opioids at home increases the risk of taking too much, sharing with others inappropriately, and using without doctor supervision.

    Kitchen cupboard full of stockpiled medicine
    Don’t stockpile your leftover opioids in your medicine cupboard. Take them to your pharmacy for safe disposal. Archer Photo/Shutterstock

    How to mimimise the risks

    Before using opioids, speak to your doctor or pharmacist about using over-the-counter pain medicines such as paracetamol or anti-inflammatories such as ibuprofen (for example, Nurofen, Brufen) or diclofenac (for example, Voltaren, Fenac).

    These can be quite effective at controlling pain and will lessen your need for opioids. They can often be used instead of opioids, but in some cases a combination of both is needed.

    Other techniques to manage pain include physiotherapy, exercise, heat packs or ice packs. Speak to your doctor or pharmacist to discuss which techniques would benefit you the most.

    However, if you do need opioids, there are some ways to make sure you use them safely and effectively:

    • ask for immediate-release rather than slow-release opioids to lower your risk of side effects
    • do not drink alcohol or take sleeping tablets while on opioids. This can increase any drowsiness, and lead to reduced alertness and slower breathing
    • as you may be at higher risk of falls, remove trip hazards from your home and make sure you can safely get up off the sofa or bed and to the bathroom or kitchen
    • before starting opioids, have a plan in place with your doctor or pharmacist about how and when to stop taking them. Opioids after surgery are ideally taken at the lowest possible dose for the shortest length of time.
    Woman holding hot water bottle (pink cover) on belly
    A heat pack may help with pain relief, so you end up using fewer painkillers. New Africa/Shutterstock

    If you’re concerned about side effects

    If you are concerned about side effects while taking opioids, speak to your pharmacist or doctor. Side effects include:

    • constipation – your pharmacist will be able to give you lifestyle advice and recommend laxatives
    • drowsiness – do not drive or operate heavy machinery. If you’re trying to stay awake during the day, but keep falling asleep, your dose may be too high and you should contact your doctor
    • weakness and slowed breathing – this may be a sign of a more serious side effect such as respiratory depression which requires medical attention. Contact your doctor immediately.

    If you’re having trouble stopping opioids

    Talk to your doctor or pharmacist if you’re having trouble stopping opioids. They can give you alternatives to manage the pain and provide advice on gradually lowering your dose.

    You may experience withdrawal effects, such as agitation, anxiety and insomnia, but your doctor and pharmacist can help you manage these.

    How about leftover opioids?

    After you have finished using opioids, take any leftovers to your local pharmacy to dispose of them safely, free of charge.

    Do not share opioids with others and keep them away from others in the house who do not need them, as opioids can cause unintended harms if not used under the supervision of a medical professional. This could include accidental ingestion by children.

    For more information, speak to your pharmacist or doctor. Choosing Wisely Australia also has free online information about managing pain and opioid medicines.

    Katelyn Jauregui, PhD Candidate and Clinical Pharmacist, School of Pharmacy, Faculty of Medicine and Health, University of Sydney; Asad Patanwala, Professor, Sydney School of Pharmacy, University of Sydney; Jonathan Penm, Senior lecturer, School of Pharmacy, University of Sydney, and Shania Liu, Postdoctoral Research Fellow, Faculty of Medicine and Dentistry, University of Alberta

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

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  • Can Home Tests Replace Check-Ups?

    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.

    The 10almonds Team

    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 recently hit 65 and try to get regular check-ups, but do you think home testing can be as reliable as a doctor visit? I try to keep as informed as I can and am a big believer in taking responsibility for my own health if I can, but I don’t want to miss something important either. Best as a supplemental thing, perhaps?❞

    Depends what’s being tested! And your level of technical knowledge, though there’s always something to be said for ongoing learning.

    • If you’re talking blood tests, urine tests, etc per at-home test kits that get sent off to a lab, then provided they’re well-sourced (and executed correctly by you), they should be as accurate as what a doctor will give, since they are basically doing the same thing (taking a sample and sending it off to a lab).
    • If you’re talking about checking for lumps etc, then a dual approach is best: check yourself at home as often as you feel is reasonable (with once per month being advised at a minimum, especially if you’re aware of an extra risk factor for you) and check-ups with the doctor per their recommendations.
    • If you’re talking about general vitals (blood pressure, heart rate, heart rate variability, VO₂ max, etc), then provided you have a reliable way of testing them, then doing them very frequently at home, to get the best “big picture” view. In contrast, getting them done once a year at your doctor’s could result in a misleading result, if you just ate something different that day or had a stressful morning, for example.

    Enjoy

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  • The Wandering Mind – by Dr. Michael Corballis

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    The 10almonds Team

    Our mind’s tendency to wander can be a disability, but could it also be a superpower? Dr. Corballis makes the case for such.

    While many authors focus on, well, how to focus, Dr. Corballis argues in this book that our wandering imagination can be more effective at problem-solving and creative tasks, than a focused, blinkered mind.

    The book’s a quick read (184 pages of quite light reading), and yet still quite dense with content. He takes us on a tour of the brain, theory of mind, the Default Mode Network (where a lot of the brain’s general ongoing organization occurs), learning, memory, forgetting, and creativity.

    Furthermore, he cites (and explains) studies showing what kinds of “breaks” from mental work allow the wandering mind to do its thing at peak efficiency, and what kinds of breaks are counterproductive. Certainly this has practical applications for all of us!

    Bottom line: if you’d like to be less frustrated by your mind’s tendency to wander, this is a fine book to show how to leverage that trait to your benefit.

    Click here to check out The Wandering Mind, and set yours onto more useful tracks!

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