The Obesity Code – by Dr. Jason Fung
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Firstly, if you have already read Dr. Fung’s other book, The Diabetes Code, which we reviewed a little while ago, you can probably skip this one. It has mostly the same information, presented with a different focus.
While The Diabetes Code assumes you are diabetic, or prediabetic, or concerned about avoiding/reversing those conditions, The Obesity Code assumes you are obese, or heading in that direction, or otherwise are concerned about avoiding/reversing obesity.
What it’s not, though, is a weight loss book. Will it help if you want to lose weight? Yes, absolutely. But there is no talk here of weight loss goals, nor any motivational coaching, nor week-by-week plans, etc.
Instead, it’s more an informative textbook. With exactly the sort of philosophy we like here at 10almonds: putting information into people’s hands, so everyone can make the best decisions for themselves, rather than blindly following someone else’s program.
Dr. Fung explains why various dieting approaches don’t work, and how we can work around such things as our genetics, as well as most external factors except for poverty. He also talks us through how to change our body’s insulin response, and get our body working more like a lean machine and less like a larder for hard times.
Bottom line: this is a no-frills explanation of why your body does what it does when it comes to fat storage, and how to make it behave differently about that.
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In Plain English…
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It’s Q&A Time!
This is the bit whereby each week, we respond to subscriber questions/requests/etc
Have something you’d like to ask us, or ask us to look into? Hit reply to any of our emails, or use the feedback widget at the bottom, and a Real Human™ will be glad to read it!
Q: Love to have someone research all the additives in our medicines, (risk of birth control and breast cancer) and what goes in all of our food and beverages. So much info out there, but there are so many variations, you never know who to believe.
That’s a great idea! There are a lot of medicines and food and beverages out there, so that’s quite a broad brief, but! We could well do a breakdown of very common additives, and demystify them, sorting them into good/bad/neutral, e.g:
- Ascorbic acid—Good! This is Vitamin C
- Acetic acid—Neutral! This is vinegar
- Acetylsalicylic acid—Good or Bad! This is aspirin (a painkiller and blood-thinning agent, can be good for you or can cause more problems than it solves, depending on your personal medical situation. If in doubt, check with your doctor)
- Acesulfame K—Generally Neutral! This is a sweetener that the body can’t metabolize, so it’s also not a source of potassium (despite containing potassium) and will generally do nothing. Unless you have an allergy to it, which is rare but is a thing.
- Sucralose—Neutral! This is technically a sugar (as is anything ending in -ose), but the body can’t metabolize it and processes it as a dietary fiber instead. We’d list it as good for that reason, but honestly, we doubt you’re eating enough sucralose to make a noticeable difference to your daily fiber intake.
- Sucrose—Bad! This is just plain sugar
Sometimes words that sound the same can ring alarm bells when they need not, for example there’s a big difference between:
- Potassium iodide (a good source of potassium and iodine)
- Potassium cyanide (the famous poison; 300mg will kill you; half that dose will probably kill you)
- Cyanocobalamine (Vitamin B12)
Let us know if there are particular additives (or particular medications) you’d like us to look at!
While for legal reasons we cannot give medical advice, talking about common contraindications (e.g., it’s generally advised to not take this with that, as one will stop the other from working, etc) is definitely something we could do.
For example! St. John’s Wort, very popular as a herbal mood-brightener, is on the list of contraindications for so many medications, including:
- Antidepressants
- Birth control pills
- Cyclosporine, which prevents the body from rejecting transplanted organs
- Some heart medications, including digoxin and ivabradine
- Some HIV drugs, including indinavir and nevirapine
- Some cancer medications, including irinotecan and imatinib
- Warfarin, an anticoagulant (blood thinner)
- Certain statins, including simvastatin
Q: As I am a retired nurse, I am always interested in new medical technology and new ways of diagnosing. I have recently heard of using the eyes to diagnose Alzheimer’s. When I did some research I didn’t find too much. I am thinking the information may be too new or I wasn’t on the right sites.
(this is in response to last week’s piece on lutein, eyes, and brain health)
We’d readily bet that the diagnostic criteria has to do with recording low levels of lutein in the eye (discernible by a visual examination of macular pigment optical density), and relying on the correlation between this and incidence of Alzheimer’s, but we’ve not seen it as a hard diagnostic tool as yet either—we’ll do some digging and let you know what we find! In the meantime, we note that the Journal of Alzheimer’s Disease (which may be of interest to you, if you’re not already subscribed) is onto this:
See also:
- Journal of Alzheimer’s Disease (mixture of free and paid content)
- Journal of Alzheimer’s Disease Reports (open access—all content is free)
Q: As to specific health topics, I would love to see someone address all these Instagram ads targeted to women that claim “You only need to ‘balance your hormones’ to lose weight, get ripped, etc.” What does this mean? Which hormones are they all talking about? They all seem to be selling a workout program and/or supplements or something similar, as they are ads, after all. Is there any science behind this stuff or is it mostly hot air, as I suspect?
Thank you for asking this, as your question prompted yesterday’s main feature, What Does “Balancing Your Hormones” Even Mean?
That’s a great suggestion also about addressing ads (and goes for health-related things in general, not just hormonal stuff) and examining their claims, what they mean, how they work (if they work!), and what’s “technically true but may
be misleading* cause confusion”*We don’t want companies to sue us, of course.
Only, we’re going to need your help for this one, subscribers!
See, here at 10almonds we practice what we preach. We limit screen time, we focus on our work when working, and simply put, we don’t see as many ads as our thousands of subscribers do. Also, ads tend to be targeted to the individual, and often vary from country to country, so chances are good that we’re not seeing the same ads that you’re seeing.
So, how about we pull together as a bit of a 10almonds community project?
- Step 1: add our email address to your contacts list, if you haven’t already
- Step 2: When you see an ad you’re curious about, select “share” (there is usually an option to share ads, but if not, feel free to screenshot or such)
- Step 3: Send the ad to us by email
We’ll do the rest! Whenever we have enough ads to review, we’ll do a special on the topic.
We will categorically not be able to do this without you, so please do join in—Many thanks in advance!
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The 6 Dimensions Of Sleep (And Why They Matter)
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How Good Is Your Sleep, Really?
This is Dr. Marie-Pierre St-Onge, Director of Columbia University’s Center of Excellence for Sleep and Circadian Research.
The focus of Dr. St-Onge’s research is the study of the impact of lifestyle, especially sleep and diet, on cardio-metabolic risk factors.
She conducts clinical research combining her expertise on sleep, nutrition, and energy regulation.
What kind of things do her studies look at?
Her work focuses on questions about…
- The role of circadian rhythms (including sleep duration and timing)
- Meal timing and eating patterns
…and their impact on cardio-metabolic risk.
What does she want us to know?
First things first, when not to worry:
❝Getting a bad night’s sleep once in a while isn’t anything to worry about. That’s what we would describe as transient insomnia. Chronic insomnia occurs when you spend three months or more without regular sleep, and that is when I would start to be concerned.❞
But… as prevention is (as ever) better than cure, she also advises that we do pay attention to our sleep! And, as for how to do that…
The Six Dimensions of Sleep
One useful definition of overall sleep health is the RU-Sated framework, which assesses six key dimensions of sleep that have been consistently associated with better health outcomes. These are:
- regularity
- satisfaction with sleep
- alertness during waking hours
- timing of sleep
- efficiency of sleep
- duration of sleep
You’ll notice that some of these things you can only really know if you use a sleep-monitoring app. She does recommend the use of those, and so do we!
We reviewed and compared some of the most popular sleep-monitoring apps! You can check them out here: Time For Some Pillow Talk
You also might like…
We’re not all the same with regard to when is the best time for us to sleep, so:
Use This Sleep Cycle Calculator To Figure Out the Optimal Time for You To Go to Bed and Wake Up
AROUND THE WEB
What’s happening in the health world…
- Aspirin may make your breathing worse
- Taking naps for more than 30 minutes may raise your metabolic disease risk
- How to ease back into exercise after surgery
- Study provides evidence that breathing exercises may reduce your Alzheimer’s risk
- No one in movies knows how to swallow a pill
More to come tomorrow!
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Can a child legally take puberty blockers? What if their parents disagree?
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Young people’s access to gender-affirming medical care has been making headlines this week.
Today, federal Health Minister Mark Butler announced a review into health care for trans and gender-diverse children and adolescents. The National Health and Medical Research Council will conduct the review.
Yesterday, The Australian published an open letter to Prime Minister Anthony Albanese calling for a federal inquiry, and a nationwide pause on puberty blockers and hormone therapy for minors.
This followed Queensland Health Minister Tim Nicholls earlier this week announcing an immediate pause on access to puberty blockers and hormone therapies for new patients under 18 in the state’s public health system, pending a review.
In the United States, President Donald Trump signed an executive order this week directing federal agencies to restrict access to gender-affirming care for anyone under 19.
This recent wave of political attention might imply gender-affirming care for young people is risky, controversial, perhaps even new.
But Australian courts have already extensively tested questions about its legitimacy, the conditions under which it can be provided, and the scope and limits of parental powers to authorise it.
MirasWonderland/Shutterstock What are puberty blockers?
Puberty blockers suppress the release of oestrogen and testosterone, which are primarily responsible for the physical changes associated with puberty. They are generally safe and used in paediatric medicine for various conditions, including precocious (early) puberty, hormone disorders and some hormone-sensitive cancers.
International and domestic standards of care state that puberty blockers are reversible, non-harmful, and can prevent young people from experiencing the distress of undergoing a puberty that does not align with their gender identity. They also give young people time to develop the maturity needed to make informed decisions about more permanent medical interventions further down the line.
Puberty blockers are one type of gender-affirming care. This care includes medical, psychological and social interventions to support transgender, gender-diverse and, in some cases, intersex people.
Young people in Australia need a medical diagnosis of gender dysphoria to receive this care. Gender dysphoria is defined as the psychological distress that can arise when a person’s gender identity does not align with their sex assigned at birth. This diagnosis is only granted after an exhaustive and often onerous medical assessment.
After a diagnosis, treatment may involve hormones such as oestrogen or testosterone and/or puberty-blocking medications.
Hormone therapies involving oestrogen and testosterone are only prescribed in Australia once a young person has been deemed capable of giving informed consent, usually around the age of 16. For puberty blockers, parents can consent at a younger age.
Gender dysphoria comes with considerable psychological distress. slexp880/Shutterstock Can a child legally access puberty blockers?
Gender-affirming care has been the subject of extensive debate in the Family Court of Australia (now the Federal Circuit and Family Court).
Between 2004 and 2017, every minor who wanted to access gender-affirming care had to apply for a judge to approve it. However, medical professionals, human rights organisations and some judges condemned this process.
In research for my forthcoming book, I found the Family Court has heard at least 99 cases about a young person’s gender-affirming care since 2004. Across these cases, the court examined the potential risks of gender-affirming treatment and considered whether parents should have the authority to consent on their child’s behalf.
When determining whether parents can consent to a particular medical procedure for their child, the court must consider whether the treatment is “therapeutic” and whether there is a significant risk of a wrong decision being made.
However, in a landmark 2017 case, the court ruled that judicial oversight was not required because gender-affirming treatments meet the standards of normal medical care.
It reasoned that because these therapies address an internationally recognised medical condition, are supported by leading professional medical organisations, and are backed by robust clinical research, there is no justification for treating them differently from any other standard medical intervention. These principles still stand today.
What if parents disagree?
Sometimes parents disagree with decisions about gender-affirming care made by their child, or each other.
As with all forms of health care, under Australian law, parents and legal guardians are responsible for making medical decisions on behalf of their children. That responsibility usually shifts once those children reach a sufficient age and level of maturity to make their own decisions.
However, in another landmark case in 2020, the court ruled gender-affirming treatments cannot be given to minors without consent from both parents, even if the child is capable of providing their own consent. This means that if there is any disagreement among parents and the young person about either their capacity to consent or the legitimacy of the treatment, only a judge can authorise it.
In such instances, the court must assess whether the proposed treatment is in the child’s best interests and make a determination accordingly. Again, these principals apply today.
If a parent disagrees with their child, the matter can go to court. PeopleImages.com – Yuri A/Shutterstock Have the courts ever denied care?
Across the at least 99 cases the court has heard about gender-affirming care since 2004, 17 have involved a parent opposing the treatment and one has involved neither parent supporting it.
Regardless of parental support, in every case, the court has been responsible for determining whether gender-affirming treatment was in the child’s best interests. These decisions were based on medical evidence, expert testimony, and the specific circumstances of the young person involved.
In all cases bar one, the court has found overwhelming evidence to support gender-affirming care, and approved it.
Supporting transgender young people
The history of Australia’s legal debates about gender-affirming care shows it has already been the subject of intense legal and medical scrutiny.
Gender-affirming care is already difficult for young people to access, with many lacking the parental support required or facing other barriers to care.
Gender-affirming care is potentially life-saving, or at the very least life-affirming. It almost invariably leads to better social and emotional outcomes. Further restricting access is not the “protection” its opponents claim.
If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14. For LGBTQIA+ peer support and resources, you can also contact Switchboard, QLife (call 1800 184 527), Queerspace, Transcend Australia (support for trans, gender-diverse, and non-binary young people and their families) or Minus18 (resources and community support for LGBTQIA+ young people).
Matthew Mitchell, Lecturer in Criminology, Deakin University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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The Fast-Mimicking Diet
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Live, Fast, Live Long
This is Dr. Valter Longo. He’s a biogerontologist and cell biologist, whose work has focused on fasting and nutrient response genes, and how we can leverage them against diseases and aging in general.
We reviewed his book recently:
What does he want us to know?
What to eat
Dr. Longo recommends a mostly plant-based diet (especially vegetables, whole grains, and legumes), but also having some fish. The bulk of our dietary fats, however, he says are best coming from olive oil and nuts.
He also advises aiming for nutritional density of vitamins and minerals in our diet, and/but supplementing with a multivitamin once every few days to cover any gaps.
If in doubt choosing between plant-based whole foods, he recommends that we choose those our ancestors will have eaten.
Read more: Longevity Diet For Adults
When to eat
Dr. Longo recommends time-restricted eating within a 12-hour window per day.
See also: Intermittent Fasting: We Sort The Science From The Hype
However, he also recommends (additionally or separately; it’s up to us; additionally is better but the point is it still has excellent benefits separately too) his “fast-mimicking diet” (FMD), which involves eating according to what we said in “What to eat”, but restricting it to 750 kcal per day, 5 days in a row, but not necessarily 5 days per week.
For example, the following was a 3-month study that involved doing this for only one 5-day cycle per month:
❝Three FMD cycles reduced body weight, trunk, and total body fat; lowered blood pressure; and decreased insulin-like growth factor 1 (IGF-1). No serious adverse effects were reported.
A post hoc analysis of subjects from both FMD arms showed that body mass index, blood pressure, fasting glucose, IGF-1, triglycerides, total and low-density lipoprotein cholesterol, and C-reactive protein were more beneficially affected in participants at risk for disease than in subjects who were not at risk.
Thus, cycles of a 5-day FMD are safe, feasible, and effective in reducing markers/risk factors for aging and age-related diseases.❞
~ Dr. Min Wei et al. ← Dr. Longo was
Note: the introduction mentions FMD in mice, but this is just referencing previous studies. This study is about FMD in humans!
Read in full: Fasting-mimicking diet and markers/risk factors for aging, diabetes, cancer, and cardiovascular disease
Want to know more?
You might like this (text-based) interview with Dr. Longo, with the Health Sciences Academy:
Eat, fast and live longer? Interview with Professor Valter Longo
Take care!
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Elon Musk says ‘disc replacement’ worked for him. But evidence this surgery helps chronic pain is lacking
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Last week in a post on X, owner of the platform Elon Musk recommended people look into disc replacement if they’re experiencing severe neck or back pain.
According to a biography of the billionaire, he’s had chronic back and neck pain since he tried to “judo throw” a 350-pound sumo wrestler in 2013 at a Japanese-themed party for his 42nd birthday, and blew out a disc at the base of his neck.
In comments following the post, Musk said the surgery was a “gamechanger” and reduced his pain significantly.
Musk’s original post has so far had more than 50 million views and generated controversy. So what is disc replacement surgery and what does the evidence tells us about its benefits and harms?
What’s involved in a disc replacement?
Disc replacement is a type of surgery in which one or more spinal discs (a cushion between the spine bones, also known as vertebrae) are removed and replaced with an artificial disc to retain movement between the vertebrae. Artificial discs are made of metal or a combination of metal and plastic.
Disc replacement may be performed for a number of reasons, including slipped discs in the neck, as appears to be the case for Musk.
Disc replacement is major surgery. It requires general anaesthesia and the operation usually takes 2–4 hours. Most people stay in hospital for 2–7 days. After surgery patients can walk but need to avoid things like strenuous exercise and driving for 3–6 weeks. People may be required to wear a neck collar (following neck surgery) or a back brace (following back surgery) for about 6 weeks.
Costs vary depending on whether you have surgery in the public or private health system, if you have private health insurance, and your level of coverage if you do. In Australia, even if you have health insurance, a disc replacement surgery may leave you more than A$12,000 out of pocket.
Disc replacement surgery is not performed as much as other spinal surgeries (for example, spinal fusion) but its use is increasing.
In New South Wales for example, rates of privately-funded disc replacement increased six-fold from 6.2 per million people in 2010–11 to 38.4 per million in 2019–20.
What are the benefits and harms?
People considering surgery will typically weigh that option against not having surgery. But there has been very little research comparing disc replacement surgery with non-surgical treatments.
Clinical trials are the best way to determine if a treatment is effective. You first want to show that a new treatment is better than doing nothing before you start comparisons with other treatments. For surgical procedures, the next step might be to compare the procedure to non-surgical alternatives.
Unfortunately, these crucial first research steps have largely been skipped for disc replacement surgery for both neck and back pain. As a result, there’s a great deal of uncertainty about the treatment.
There are no clinical trials we know of investigating whether disc replacement is effective for neck pain compared to nothing or compared to non-surgical treatments.
For low back pain, the only clinical trial that has been conducted to our knowledge comparing disc replacement to a non-surgical alternative found disc replacement surgery was slightly more effective than an intensive rehabilitation program after two years and eight years.
Many people experience chronic pain. Yan Krukau/Pexels Complications are not uncommon, and can include disclocation of the artificial disc, fracture (break) of the artificial disc, and infection.
In the clinical trial mentioned above, 26 of the 77 surgical patients had a complication within two years of follow up, including one person who underwent revision surgery that damaged an artery leading to a leg needing to be amputated. Revision surgery means a re-do to the primary surgery if something needs fixing.
Are there effective alternatives?
The first thing to consider is whether you need surgery. Seeking a second opinion may help you feel more informed about your options.
Many surgeons see disc replacement as an alternative to spinal fusion, and this choice is often presented to patients. Indeed, the research evidence used to support disc replacement mainly comes from studies that compare disc replacement to spinal fusion. These studies show people with neck pain may recover and return to work faster after disc replacement compared to spinal fusion and that people with back pain may get slightly better pain relief with disc replacement than with spinal fusion.
However, spinal fusion is similarly not well supported by evidence comparing it to non-surgical alternatives and, like disc replacement, it’s also expensive and associated with considerable risks of harm.
Fortunately for patients, there are new, non-surgical treatments for neck and back pain that evidence is showing are effective – and are far cheaper than surgery. These include treatments that address both physical and psychological factors that contribute to a person’s pain, such as cognitive functional therapy.
While Musk reported a good immediate outcome with disc replacement surgery, given the evidence – or lack thereof – we advise caution when considering this surgery. And if you’re presented with the choice between disc replacement and spinal fusion, you might want to consider a third alternative: not having surgery at all.
Giovanni E Ferreira, NHMRC Emerging Leader Research Fellow, Institute of Musculoskeletal Health, University of Sydney; Christine Lin, Professor, Institute for Musculoskeletal Health, University of Sydney; Christopher Maher, Professor, Sydney School of Public Health, University of Sydney; Ian Harris, Professor of Orthopaedic Surgery, UNSW Sydney, and Joshua Zadro, NHMRC Emerging Leader Research Fellow, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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The Spectrum of Hope – by Dr. Gayatri Devi
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We’ve written before about Dr. Devi’s work (See: “Alzheimer’s: The Bad News And The Good“) but she has plenty more to say than we could fit in an article.
The book is written for patients, family/carers, and clinicians—without getting deep into the science, which it is assumed clinicians will know. the general style of the book is pop-science, and it’s more about addressing the misconceptions around Alzheimer’s, rather than focusing on neurological features such as beta amyloid plaques and tau proteins and the like.
Dr. Devi explains a lot about the experience of Alzheimer’s—what to expect, or rather, what to know about in advance. Because, as she explains, there are a lot of different manifestations of Alzheimer’s that are all lumped under the same umbrella.
This means that a person could have negligible memory but perfect language and reasoning skills, or the other way around, or some other combination of symptoms showing up or not.
Which means that any plan for managing one’s Alzheimer’s needs to be adaptable and personalized, which is something Dr. Devi talks us through, too.
Bottom line: if you are a loved one has Alzheimer’s, or you just like to be prepared, this is a great book to prepare anybody for just that.
Click here to check out The Spectrum of Hope, and hold onto that hope!
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Learn to Age Gracefully
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