
The Menopause Manifesto – by Dr. Jen Gunter
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From the subtitle, you may wonder: with facts and feminism? Is this book about biology or sociology?
And the answer is: both. It’s about biology, principally, but without ignoring the context. We do indeed “live in a society”, and that affects everything from our healthcare options to what is expected of us as women.
So, as a warning: if you dislike science and/or feminism, you won’t like this book.
Dr. Jen Gunter, herself a gynaecologist, is here to arm us with science-based facts, to demystify an important part of life that is commonly glossed over.
She talks first about the what/why/when/how of menopause, and then delivers practical advice. She also talks about the many things we can (and can’t!) usefully do about symptoms we might not want, and how to look after our health overall in the context of menopause. We learn what natural remedies do or don’t work and/or can be actively harmful, and we learn the ins and outs of different hormone therapy options too.
Bottom line: no matter whether you are pre-, peri-, or post-menopausal, this is the no-BS guide you’ve been looking for. Same goes if you’re none of the above but spend any amount of time close to someone who is.
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Delay Ageing – by Dr. Colin Rose
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Note: the title is spelled that way because it is British English. We generally write in US English here at 10almonds, but we’ll first quote directly from Dr. Rose as written:
❝I have written Delay Ageing because there is some very important recent University research on ageing and age related illness that deserves to be made accessible to a general audience.❞
What is this research? Well, there’s quite a lot over its 300-odd pages (exact number depends on the edition and whether we count end matter), and most of it is tweaks and refinements on things with which you’ll probably be at least brushingly familiar if you’re a regular 10almonds reader.
Dr. Rose addresses the nine hallmarks of aging, of which there are ten, ranging from such things as “telomeres get shorter” and “DNA accumulates damage”, to “stem cells become exhausted” and “cells fail to communicate properly”, and asks the question “what if we were to target all these things simultaneously?”.
Rather than going for drugs on drugs on drugs (half of them to deal with undesired side effects of the previous ones), Dr. Cole leaves no stone unturned to find lifestyle interventions that will improve each of these, even if just a little. Because, all those “little” improvements add up and even compound, and on the flipside, mean that factors of aging aren’t adding up and compounding so much or so quickly anymore.
The rather broad umbrella of “lifestyle interventions” obviously includes food under its auspices, and with it, nutraceuticals. So to give one example, if you’re taking a fisetin supplement (a natural senolytic agent), you’ll find science vindicating that here. And much more.
The style is… Less pop-science and more “textbook written for laypersons”, and you may be thinking “isn’t that the same?” and the difference is that the textbook has a lot less polish and finesse, but often more precise information.
Bottom line: if you’d like to combat aging on 10 different fronts with easily implementable lifestyle interventions, and know exactly what is doing what and how, then this is the book for you.
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We looked at 700 plant-based foods to see how healthy they really are. Here’s what we found
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If you’re thinking about buying plant-based foods, a trip to the supermarket can leave you bewildered.
There are plant-based burgers, sausages and mince. The fridges are loaded with non-dairy milk, cheese and yoghurt. Then there are the tins of beans and packets of tofu.
But how much is actually healthy?
Our nutritional audit of more than 700 plant-based foods for sale in Australian supermarkets has just been published. We found some products are so high in salt or saturated fat, we’d struggle to call them “healthy”.
We took (several) trips to the supermarket
In 2022, we visited two of each of four major supermarket retailers across Melbourne to collect information on the available range of plant-based alternatives to meat and dairy products.
We took pictures of the products and their nutrition labels.
We then analysed the nutrition information on the packaging of more than 700 of these products. This included 236 meat substitutes, 169 legumes and pulses, 50 baked beans, 157 dairy milk substitutes, 52 cheese substitutes and 40 non-dairy yoghurts.
Plant-based meats were surprisingly salty
We found a wide range of plant-based meats for sale. So, it’s not surprising we found large variations in their nutrition content.
Sodium, found in added salt and which contributes to high blood pressure, was our greatest concern.
The sodium content varied from 1 milligram per 100 grams in products such as tofu, to 2,000mg per 100g in items such as plant-based mince products.
This means we could eat our entire daily recommended sodium intake in just one bowl of plant-based mince.
An audit of 66 plant-based meat products in Australian supermarkets conducted in 2014 found sodium ranged from 316mg in legume-based products to 640mg in tofu products, per 100g. In a 2019 audit of 137 products, the range was up to 1,200mg per 100g.
In other words, the results of our audit seems to show a consistent trend of plant-based meats getting saltier.
Looking for plant-based meat? Check the label for the sodium content.
Michael Vi/Shutterstock
What about plant-based milks?
Some 70% of the plant-based milks we audited were fortified with calcium, a nutrient important for bone health.
This is good news as a 2019-2020 audit of 115 plant-based milks from Melbourne and Sydney found only 43% of plant-based milks were fortified with calcium.
Of the fortified milks in our audit, almost three-quarters (73%) contained the recommended amount of calcium – at least 100mg per 100mL.
We also looked at the saturated fat content of plant-based milks.
Coconut-based milks had on average up to six times higher saturated fat content than almond, oat or soy milks.
Previous audits also found coconut-based milks were much higher in saturated fat than all other categories of milks.
Some plant-based milks were healthier than others.
TY Lim/Shutterstock
A first look at cheese and yoghurt alternatives
Our audit is the first study to identify the range of cheese and yoghurt alternatives available in Australian supermarkets.
Calcium was only labelled on a third of plant-based yoghurts, and only 20% of supermarket options met the recommended 100mg of calcium per 100g.
For plant-based cheeses, most (92%) were not fortified with calcium. Their sodium content varied from 390mg to 1,400mg per 100g, and saturated fat ranged from 0g to 28g per 100g.
So, what should we consider when shopping?
As a general principle, try to choose whole plant foods, such as unprocessed legumes, beans or tofu. These foods are packed with vitamins and minerals. They’re also high in dietary fibre, which is good for your gut health and keeps you fuller for longer.
If opting for a processed plant-based food, here are five tips for choosing a healthier option.
1. Watch the sodium
Plant-based meat alternatives can be high in sodium, so look for products that have around 150-250mg sodium per 100g.
2. Pick canned beans and legumes
Canned chickpeas, lentils and beans can be healthy and low-cost additions to many meals. Where you can, choose canned varieties with no added salt, especially when buying baked beans.
3. Add herbs and spices to your tofu
Tofu can be a great alternative to meat. Check the label and pick the option with the highest calcium content. We found flavoured tofu was higher in salt and sugar content than minimally processed tofu. So it’s best to pick an unflavoured option and add your own flavours with spices and herbs.
4. Check the calcium
When choosing a non-dairy alternative to milk, such as those made from soy, oat, or rice, check it is fortified with calcium. A good alternative to traditional dairy will have at least 100mg of calcium per 100g.
5. Watch for saturated fat
If looking for a lower saturated fat option, almond, soy, rice and oat varieties of milk and yoghurt alternatives have much lower saturated fat content than coconut options. Pick those with less than 3g per 100g.
Laura Marchese, PhD Student at the Institute for Physical Activity and Nutrition, Deakin University and Katherine Livingstone, NHMRC Emerging Leadership Fellow and Senior Research Fellow at the Institute for Physical Activity and Nutrition, Deakin University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Why Diets Make Us Fat – by Dr. Sandra Aamodt
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It’s well-known that crash-dieting doesn’t work. Restrictive diets will achieve short-term weight loss, but it’ll come back later. In the long term, weight creeps slowly upwards. Why?
Dr. Sandra Aamodt explores the science and sociology behind this phenomenon, and offers an evidence-based alternative.
A lot of the book is given over to explanations of what is typically going wrong—that is the title of the book, after all. From metabolic starvation responses to genetics to the negative feedback loop of poor body image, there’s a lot to address.
However, what alternative does she propose?
The book takes us on a shift away from focusing on the numbers on the scale, and more on building consistent healthy habits. It might not feel like it if you desperately want to lose weight, but it’s better to have healthy habits at any weight, than to have a wreck of physical and mental health for the sake of a lower body mass.
Dr. Aamodt lays out a plan for shifting perspectives, building health, and letting weight loss come by itself—as a side effect, not a goal.
In fact, as she argues (in agreement with the best current science, science that we’ve covered before at 10almonds, for that matter), that over a certain age, people in the “overweight” category of BMI have a reduced mortality risk compared to those in the “healthy weight” category. It really underlines how there’s no point in making oneself miserably unhealthy with the end goal of having a lighter coffin—and getting it sooner.
Bottom line: will this book make you hit those glossy-magazine weight goals by your next vacation? Quite possibly not, but it will set you up for actually healthier living, for life, at any weight.
Click here to check out Why Diets Make Us Fat, and live healthier and better!
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Do Try This At Home: The 12-Week Brain Fitness Program
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12 Weeks To Measurably Boost Your Brain
This is Dr. Majid Fotuhi. From humble beginnings (being smuggled out of Iran in 1980 to avoid death in the war), he went on (after teaching himself English, French, and German, hedging his bets as he didn’t know for sure where life would lead him) to get his MD from Harvard Medical School and his PhD in neuroscience from Johns Hopkins University. Since then, he’s had a decades-long illustrious career in neurology and neurophysiology.
What does he want us to know?
The Brain Fitness Program
This is not, by the way, something he’s selling. Rather, it was a landmark 12-week study in which 127 people aged 60–80, of which 63% female, all with a diagnosis of mild cognitive impairment, underwent an interventional trial—in other words, a 12-week brain fitness course.
After it, 84% of the participants showed statistically significant improvements in cognitive function.
Not only that, but of those who underwent MRI testing before and after (not possible for everyone due to practical limitations), 71% showed either no further deterioration of the hippocampus, or actual growth above the baseline volume of the hippocampus (that’s good, and it means functionally the memory center of the brain has been rejuvenated).
You can read a little more about the study here:
As for what the program consisted of, and what Dr. Fotuhi thus recommends for everyone…
Cognitive stimulation
This is critical, so we’re going to spend most time on this one—the others we can give just a quick note and a pointer.
In the study this came in several forms and had the benefit of neurofeedback technology, but he says we can replicate most of the effects by simply doing something cognitively stimulating. Whatever challenges your brain is good, but for maximum effect, it should involve the language faculties of the brain, since these are what tend to get hit most by age-related cognitive decline, and are also what tends to have the biggest impact on life when lost.
If you lose your keys, that’s an inconvenience, but if you can’t communicate what is distressing you, or understand what someone is explaining to you, that’s many times worse—and that kind of thing is a common reality for many people with dementia.
To keep the lights brightly lit in that part of the brain: language-learning is good, at whatever level suits you personally. In other words: there’s a difference between entry-level Duolingo Spanish, and critically analysing Rumi’s poetry in the original Persian, so go with whatever is challenging and/but accessible for you—just like you wouldn’t go to the gym for the first time and try to deadlift 500lbs, but you also probably wouldn’t do curls with the same 1lb weights every day for 10 years.
In other words: progressive overloading is key, for the brain as well as for muscles. Start easy, but if you’re breezing through everything, it’s time to step it up.
If for some reason you’re really set against the idea of learning another language, though, check out:
Reading As A Cognitive Exercise ← there are specific tips here for ensuring your reading is (and remains) cognitively beneficial
Mediterranean diet
Shocking nobody, this is once again recommended. You might like to check out the brain-healthy “MIND” tweak to it, here:
Four Ways To Upgrade The Mediterranean Diet ← it’s the fourth one
Omega-3 supplementation
Nothing complicated here. The brain needs a healthy balance of these fatty acids to function properly, and most people have an incorrect balance (too little omega-3 for the omega-6 present):
What Omega-3 Fatty Acids Really Do For Us ← scroll to “against cognitive decline”
Increasing fitness
There’s a good rule of thumb: what’s healthy for your heart, is healthy for your brain. This is because, like every other organ in your body, the brain does not function well without good circulation bringing plenty of oxygen and nutrients, which means good cardiovascular health is necessary. The brain is extra sensitive to this because it’s a demanding organ in terms of how much stuff it needs delivering via blood, and also because of the (necessary; we’d die quickly and horribly without it) impediment of the blood-brain barrier, and the possibility of beta-amyloid plaques and similar woes (they will build up if circulation isn’t good).
How To Reduce Your Alzheimer’s Risk ← number two on the list here
Practising mindfulness medication
This is also straightforward, but not to be underestimated or skipped over:
No-Frills, Evidence-Based Mindfulness
Want to step it up? Check out:
Meditation Games That You’ll Actually Enjoy
Lastly…
Dr. Fotuhi wants us to consider looking after our brain the same way we look after our teeth. No, he doesn’t want us to brush our brain, but he does want us to take small measurable actions multiple times per day, every day.
You can’t just spend the day doing nothing but brushing your teeth for the entirety of January the 1st and then expect them to be healthy for the rest of the year; it doesn’t work like that—and it doesn’t work like that for the brain, either.
So, make the habits, and keep them going
Take care!
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The Vegan Instant Pot Cookbook – by Nisha Vora
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We all know that we should “eat the rainbow” (and that no, Skittles do not count)… So why do we often find ourselves falling into the same familiar habits and well-worn comfort foods?
Nisha Vora, of “Rainbow Plant Life“, is here to make things a lot easier—brightening up our plates is her mission!
In this Instant Pot-authorized, beautifully illustrated cookbook, Vora offers us 90 recipes to do just that. And because it’s an Instant Pot cookbook, they’re all super easy.
What if you don’t have an Instant Pot? Well, don’t tell Instant Pot we said this, but another pressure cooker brand will work too. And if you don’t have any pressure cooker, the recipes are modifiable for regular pots and pans. The recipes also lend themselves well to slow-cooker cooking, for that matter!
Where Vora really excels though is in making mostly-one-pot dishes beautiful and tasty.
The recipes, by the way, are drawn from cuisines from all around the world, and cover:
- summer and winter dishes
- breakfasts, sides, mains, desserts
- the healthy and the decadent (and sometimes both!)
As for the presentation of each recipe, we get at least one full-page photo of the finished dish and sometimes extras of the steps. We get a little intro, the usual information about ingredients etc, and a no-fuss step-by-step method. It’s very easy to use.
If you have allergies or other dietary considerations, this book is pretty mindful of those, making substitutions minimal and easy.
Bottom line: this comprehensive book will seriously brighten up the colors of your cooking!
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How they did it: STAT reporters expose how ailing seniors suffer when Medicare Advantage plans use algorithms to deny care
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In a call with a long-time source, what stood out most to STAT reporters Bob Herman and Casey Ross was just how viscerally frustrated and angry the source was about an algorithm used by insurance companies to decide how long patients should stay in a nursing home or rehab facility before being sent home.
The STAT stories had a far-reaching impact:
- The U.S. Senate Committee on Homeland Security and Government Affairs took a rare step of launching a formal investigation into the use of algorithms by the country’s three largest Medicare Advantage insurers.
- Thirty-two House members urged the Centers for Medicare and Medicaid Services to increase the oversight of algorithms that health insurers use to make coverage decisions.
- In a rare step, CMS launched its own investigation into UnitedHealth. It also stiffened its regulations on the use of proprietary algorithms and introduced plans to audit denials across Medicare Advantage plans in 2024.
- Based on STAT’s reporting, Medicare Advantage beneficiaries filed two class-action lawsuits against UnitedHealth and its NaviHealth subsidiary, the maker of the algorithm, and against Humana, another major health insurance company that was also using the algorithm.
- Amid scrutiny, UnitedHealth renamed NaviHealth.
The companies never allowed an on-the-record interview with their executives, but they acknowledged that STAT’s reporting was true, according to the news organization.
Ross and Herman spoke with The Journalist’s Resource about their project and shared the following eight tips.
1. Search public comments on proposed federal rules to find sources.
Herman and Ross knew that the Centers for Medicare and Medicaid Services had put out a request for public comments, asking stakeholders within the Medicare Advantage industry how the system could improve.
There are two main ways to get Medicare coverage: original Medicare, which is a fee-for-service health plan, and Medicare Advantage, which is a type of Medicare health plan offered by private insurance companies that contract with Medicare. Medicare Advantage plans have increasingly become popular in recent years.
Under the Social Security Act, the public has the opportunity to submit comments on Medicare’s proposed national coverage determinations. CMS uses public comments to inform its proposed and final decisions. It responds in detail to all public comments when issuing a final decision.
The reporters began combing through hundreds of public comments attached to a proposed Medicare Advantage rule that was undergoing federal review. NaviHealth, the UnitedHealth subsidiary and the maker of the algorithm, came up in many of the comments, which include the submitters’ information.
“These are screaming all-caps comments to federal regulators about YOU NEED TO SOMETHING ABOUT THIS BECAUSE IT’S DISGUSTING,” Ross says.
“The federal government is proposing rules and regulations all the time,” adds Herman, STAT’s business of health care reporter. “If someone’s going to take the time and effort to comment on them, they must have at least some knowledge of what’s going on. It’s just a great tool for any journalist to use to figure out more and who to contact.”
The reporters also found several attorneys who had complained in the comments. They began reaching out to them, eventually gaining access to confidential documents and intermediaries who put them in touch with patients to show the human impact of the algorithm.
2. Harness the power of the reader submission box.
At the suggestion of an editor, the reporters added a reader submission box at the bottom of their first story, asking them to share their own experiences with Medicare Advantage denials.
The floodgates opened. Hundreds of submissions arrived.
By the end of their first story, Herman and Ross had confidential records and some patients, but they had no internal sources in the companies they were investigating, including Navihealth. The submission box led them to their first internal source.
(Screenshot of STAT’s submission box.) The journalists also combed through LinkedIn and reached out to former and current employees, but the response rate was much lower than what they received via the submission box.
The submission box “is just right there,” Herman says. “People who would want to reach out to us can do it right then and there after they read the story and it’s fresh in their minds.”
3. Mine podcasts relevant to your story.
The reporters weren’t sure if they could get interviews with some of the key figures in the story, including Tom Scully, the former head of the Centers for Medicare and Medicaid Services who drew up the initial plans for NaviHealth years before UnitedHealth acquired it.
But Herman and another colleague had written previously about Scully’s private equity firm and they had found a podcast where he talked about his work. So Herman went back to the podcast — where he discovered Scully had also discussed NaviHealth.
The reporters also used the podcast to get Scully on the phone for an interview.
“So we knew we had a good jumping off point there to be like, ‘OK, you’ve talked about NaviHealth on a podcast, let’s talk about this,’” Herman says. “I think that helped make him more willing to speak with us.”
4. When covering AI initiatives, proceed with caution.
“A source of mine once said to me, ‘AI is not magic,’” Ross says. “People need to just ask questions about it because AI has this aura about it that it’s objective, that it’s accurate, that it’s unquestionable, that it never fails. And that is not true.”
AI is not a neutral, objective machine, Ross says. “It’s based on data that’s fed into it and people need to ask questions about that data.”
He suggests several questions to ask about the data behind AI tools:
- Where does the data come from?
- Who does it represent?
- How is this tool being applied?
- Do the people to whom the tool is being applied match the data on which it was trained? “If racial groups or genders or age of economic situations are not adequately represented in the training set, then there can be an awful lot of bias in the output of the tool and how it’s applied,” Ross says.
- How is the tool applied within the institution? Are people being forced to forsake their judgment and their own ability to do their jobs to follow the algorithm?
5. Localize the story.
More than half of all Medicare beneficiaries have Medicare Advantage and there’s a high likelihood that there are multiple Medicare Advantage plans in every county across the nation.
“So it’s worth looking to see how Medicare Advantage plans are growing in your area,” Herman says.
Finding out about AI use will most likely rely on shoe-leather reporting of speaking with providers, nursing homes and rehab facilities, attorneys and patients in your community, he says. Another source is home health agencies, which may be caring for patients who were kicked out of nursing homes and rehab facilities too soon because of a decision by an algorithm.
The anecdote that opens their first story involves a small regional health insurer in Wisconsin, which was using NaviHealth and a contractor to manage post-acute care services, Ross says.
“It’s happening to people in small communities who have no idea that this insurer they’ve signed up with is using this tool made by this other company that operates nationally,” Ross says.
There are also plenty of other companies like NaviHealth that are being used by Medicare Advantage plans, Herman says. “So it’s understanding which Medicare Advantage plans are being sold in your area and then which post-acute management companies they’re using,” he adds.
Some regional insurers have online documents that show which contractors they use to evaluate post-acute care services.
6. Get familiar with Medicare’s appeals databases
Medicare beneficiaries can contest Medicare Advantage denials through a five-stage process, which can last months to years. The appeals can be filed via the Office of Medicare Hearings and Appeals.
“Between 2020 and 2022, the number of appeals filed to contest Medicare Advantage denials shot up 58%, with nearly 150,000 requests to review a denial filed in 2022, according to a federal database,” Ross and Herman write in their first story. “Federal records show most denials for skilled nursing care are eventually overturned, either by the plan itself or an independent body that adjudicates Medicare appeals.”
There are several sources to find appeals data. Be mindful that the cases themselves are not public to protect patient privacy, but you can find the number of appeals filed and the rationale for decisions.
CMS has two quality improvement organizations, or QIOs, Livanta and Kepro, which are required to file free, publicly-available annual reports, about the cases they handle, Ross says.
Another company, Maximus, a Quality Improvement Contractor, also files reports on prior authorization cases it adjudicates for Medicare. The free annual reports include data on raw numbers of cases and basic information about the percentage denials either overturned or upheld on appeal, Ross explains.
CMS also maintains its own database on appeals for Medicare Part C (Medicare Advantage plans) and Part D, which covers prescription drugs, although the data is not complete, Ross explains.
7. Give your editor regular updates.
“Sprinkle the breadcrumbs in front of your editors,” Ross says.
“If you wrap your editors in the process, you’re more likely to be able to get to the end of [the story] before they say, ‘That’s it! Give me your copy,’” Ross says.
8. Get that first story out.
“You don’t have to know everything before you write that first story,” Ross says. “Because with that first story, if it has credibility and it resonates with people, sources will come forward and sources will continue to come forward.”
Read the stories
Denied by AI: How Medicare Advantage plans use algorithms to cut off care for seniors in need
UnitedHealth pushed employees to follow an algorithm to cut off Medicare patients’ rehab care
UnitedHealth used secret rules to restrict rehab care for seriously ill Medicare Advantage patients
This article first appeared on The Journalist’s Resource and is republished here under a Creative Commons license.
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