The Other Circadian Rhythms
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We’ve talked before about how circadian rhythm pertains not just to when it is ideal for us to sleep or be awake, but also at what times it is best to eat, exercise, and so forth:
The Circadian Rhythm: Far More Than Most People Know
Most people just know about the light consideration, per for example:
- How light can shift your mood and mental health, and
- How light tells you when to sleep, focus and poo
When your body parts clock on and off at the wrong time…
Now, new research has brought attention to how these things and more are governed by different physiological clocks within our bodies—and what this means for our health. In other words, if you are doing the various things at different times than you “should”, you will be training the different parts of your body (each with their independent clocks) to be on a different schedule, and so the different parts of your body will out of temporal sync with each other.
To put this in jet-lag terms: if your brain is in New York, while your heart is in Istanbul (not Constantinople) and your gut is in Tokyo, then this arrangement is not good for the health.
As for how it is not good for your health (i.e. the consequences) there’s still research to be done on some of the longer-term implications, but in the short term, one of the biggest effects is on our mood—most notably, increasing depression scores significantly.
And even more importantly, this is in the real world. That is to say, until quite recently, most data we had from studies on the circadian rhythm was from sleep clinic laboratories, which is great for RCTs but will always have as a limitation that someone sleeping in a lab is going to have some differences than someone sleeping in their own bed at home.
As the researchers said:
❝A critical step to addressing this is the noninvasive collection of physiological time-series data outside laboratory settings in large populations. Digital tools offer promise in this endeavor. Here, using wearable data, we first quantify the degrees of circadian disruption, both between different internal rhythms and between each internal rhythm and the sleep-wake cycle. Our analysis, based on over 50,000 days of data from over 800 first-year training physicians, reveals bidirectional links between digital markers of circadian disruption and mood both before and after they began shift work, while accounting for confounders such as demographic and geographic variables. We further validate this by finding clinically relevant changes in the 9-item Patient Health Questionnaire score.❞
Read in full: The real-world association between digital markers of circadian disruption and mental health risks
That questionnaire by the way sounds like an arbitrary thing they just made up, but the PHQ-9 (as it is known to its friends) is in fact the current intentional gold standard for measuring depression; we share it at the top of our article about depression, here:
The Mental Health First-Aid That You’ll Hopefully Never Need ← the test takes 2 minutes and you get immediate results
Want to know more?
For more about getting one’s entire self back into temporal sync (hey, wasn’t that the plot of a Star Trek episode?), sleep specialist Dr. Michael Breus wrote this excellent book that we reviewed a little while back:
Enjoy!
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Making Friends With Your Gut (You Can Thank Us Later)
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Gut Health 101
We have so many microorganisms inside us, that by cell count, their cells outnumber ours more than ten-to-one. By gene count, we have 23,000 and they have more than 3,000,000. In effect, we are more microbe than we are human. And, importantly: they form a critical part of what keeps our overall organism ticking on.
Read all about it: The role of the gut microbiota in nutrition and health
Our trillions of tiny friends keep us alive, so it really really pays to return the favor.
But how?
Probiotics and fermented foods
You probably guessed this one, but it’d be remiss not to mention it first. It’s no surprise that probiotics help; the clue is in the name. In short, they help add diversity to your microbiome (that’s a good thing).
Read from the NIH: Probiotics: What You Need To Know
As for fermented foods, not every fermented food will boost your microbiota, but great options include…
- Fermented vegetables (sauerkraut, pickles, etc)
- You’ll often hear kimchi mentioned; that is also pickled vegetables, usually mostly cabbage. It’s just the culinary experience that differs. Unlike sauerkraut, kimchi is usually spiced, for example.
- Kombucha (a fermented sweet tea)
- Miso & tempeh (different preparations of fermented soy)
The health benefits vary based on the individual strains of bacteria involved in the fermentation, so don’t get too caught up on which is best.
The best one is the one you enjoy, because then you’ll have it regularly!
Feed them plenty of prebiotic fibers
Those probiotics you took? The bacteria in them eat the fiber that you can’t digest without them. So, feed them those sorts of fibers.
Great options include:
- Bananas
- Garlic
- Onions
- Whole grains
Read more: Effects of Probiotics, Prebiotics, and Synbiotics on Human Health
Don’t feed them sugar and sweeteners
Sugar and (and, counterintuitively, aspartame) can cause unfortunate gut microbe imbalances. Put simply, they kill some of your friends and feed some of your enemies. For example…
Candida, which we all have in us to some degree, feeds on sugar (including the sugar formed from breaking down alcohol, by the way) and refined carbs. Then it grows, and puts its roots through your intestinal walls, linking with your neural system. Then it makes you crave the very things that will feed it and allow it to put bigger holes in your intestinal walls.
Do not feed the Candida.
Don’t believe us? Read: Candida albicans-Induced Epithelial Damage Mediates Translocation through Intestinal Barriers
(That’s scientist-speak for “Candida puts holes in your intestines, and stuff can then go through those holes”)
And as for how that comes about, it’s like we said:
❝Colonization of the intestine and translocation through the intestinal barrier are fundamental aspects of the processes preceding life-threatening systemic candidiasis. In this review, we discuss the commensal lifestyle of C. albicans in the intestine, the role of morphology for commensalism, the influence of diet, and the interactions with bacteria of the microbiota.❞
Source: Candida albicans as a commensal and opportunistic pathogen in the intestine
The usual five things
- Good diet (Mediterranean Diet is good; plant-based version of it is by far the best for this)
- Good exercise (yes, really)
- Good sleep (helps them, and they’ll help you get better sleep in return)
- Limit or eliminate alcohol consumption (what a shocker)
- Don’t smoke (it’s bad for everything, including gut health)
One last thing you should know:
If you’re used to having animal products in your diet, and make a sudden change to all plants, your gut will object very strongly. This is because your gut microbiome is used to animal products, and a plant-based diet will cause many helpful microbes to flourish in great abundance, and many less helpful microbes will starve and die. And they will make it officially Not Fun™ for you.
So, you have two options to consider:
- Do it anyway, and sit it out (and believe us, you’ll be sitting), get the change over with quickly, and enjoy the benefits and much happier gut that follows.
- Make the change gradual. Reduce portions of animal products slowly, have “Meatless Mondays” etc, and slowly make the change over. This—for most people—is pretty comfortable, easy, and effective.
And remember: the effects of these things we’ve talked about today compound when you do more than one of them, but if you don’t want to take probiotics or really hate kombucha or absolutely won’t consider a plant-based diet or struggle to give up sugar or alcohol, etc… Just do what you can do, and you’ll still have a net improvement!
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- Fermented vegetables (sauerkraut, pickles, etc)
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Kiwi vs Lemon – Which is Healthier?
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Our Verdict
When comparing kiwi to lemon, we picked the kiwi.
Why?
A fairly straightforward one today!
In terms of macros, kiwi has more protein, carbs, and fiber, the ratio of the latter two also giving it the lower glycemic index. An easy win for kiwi here.
In the category of vitamins, kiwi has more of vitamins A, B2, B3, B9, C, E, K, and choline, while lemon has more of vitamins B1 and B6. Yes, that’s right, lemon didn’t even win on the vitamin C that it’s famous for. In any case, a clear 8:2 win for kiwi.
Looking at minerals, kiwi has more calcium, copper, magnesium, manganese, phosphorus, potassium, and zinc, while lemon has more iron and selenium. So, looking at this 7:2 win for kiwi, you might want to reconsider that “glass of lemon water to replenish minerals” trend!
None of this is to knock lemons, by the way; lemons are still a very respectable fruit, nutritionally. Probably very few people are out there eating lemons the way one might eat kiwi…
(writer’s note: I say “very few”, as once upon a time when my son was small, I remember coming into the kitchen to find he had helped himself to lemon wedges and was just eating them, so it can happen. But I also one time when he was just as small, found him drinking hot sauce directly from the bottle, so hey, he clearly already enjoyed strong flavors. Lest I seem a very inattentive mother, I’ll say in my defense that our kitchen has no real toddler-height hazards when the oven is cold, and those items were from the bottom of the fridge, so easy to access if I leave the room for a moment to grab something)
…but what we do want to say here is: if you don’t care for lemons so much, you’re not missing out. If the lemon water isn’t calling to you, you can skip it guilt-free.
In any case, do enjoy either or both, but kiwi’s the clear winner here!
Want to learn more?
You might like to read:
Top 8 Fruits That Prevent & Kill Cancer ← kiwi is top of the list! It has some cool properties, as you’ll see, killing cancer cells while sparing healthy ones.
Take care!
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How To Make Your Doctor’s Appointment Do More For You
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Doctor: “So, how are you today?”
Patient: “Can’t complain; how about you?”Hopefully your medical appointments don’t start quite like that, but there can be an element of being “along for the ride” when it comes to consultations. They ask questions, we answer, they prescribe something, we thank them.
In principle, the doctor should be able to handle that; ask the right questions, determine the problem, and not need too much from you. After all, they have been trained to deal with an unconscious patient, so the fact you can communicate at all is a bonus.
However, leaving it all to them isn’t really playing the field.
Before the appointment
Research your issue, as best you understand it. Some doctors will be very averse to you telling them about having done this (taking it as an affront to their expertise), but here’s the thing:
You don’t have to tell them.
You just have to understand as much as possible, so that you will be as “up to speed” as possible in the conversation, and not be quickly out of your depth.
Have an agenda, based on the above. Literally, have a little set of bullet-points to remind you what you came in to discuss, so that nothing escapes you in the moment. This should also include:
- If you have additional reasons for a particular concern (e.g. family history of a certain problem), make them known
- If you plan to request any specific tests or treatments, be able to clearly state your reasons for the specific tests or treatments
- If you plan to write off any specific tests or treatments as something to which you will not consent, have your reasons ready—in a way that makes it clear it’s something more than “don’t want it”, for example, “I’ve already decided that this treatment would make a sufficient hit to my quality of life, as to make it not worthwhile for me personally” (or whatever the reason may be for you). It needs to be something they can write on their notes instead of simply “patient refused treatment”.
Compile a record of your symptoms (as appropriate), and any previous tests/treatments (as appropriate), in chronological order. If you take all this with you, perhaps in a nice folder, you will enjoy the following advantages:
- not forgetting anything
- ability to answer questions accurately
- give the (correct) impression you take your health seriously, which means they are more likely to do so also—especially because they will now know that if they fob you off and/or mess something up, you’ll be taking a record of that to your next appointment.
Plan your outfit. No, you don’t have to dress for the red carpet, but you want to satisfy two main conditions:
- Accessibility for examination (for example, if you are going in with a knee pain, maybe don’t wear the tight jeans today; if they’re going to take blood, be either sleeveless or have sleeves that are easily moved out of the way, etc)
- General presentability (it’s a sad fact that doctors are not immune to biases, and will treat people better if they respect them more)
During the appointment
Be friendly; doctors (like most people) will respond much better to that than to grumpiness—even if you have good reason for grumpiness and even if the doctor has been trained to help grumpy patients.
Be confident: when we say “be friendly”, that doesn’t mean to necessarily be so agreeable as to not advocate for yourself. In particular:
- If they explain something and it isn’t clear to you, ask them to clarify
- If you disagree with them about a value judgement, say so. By “a value judgement” here we mean things in the realm of subjectivity. If the doctor says you are prediabetic, then you won’t get much mileage out of arguing otherwise; the numbers have the final say on that one. But if the doctor says “the side effects of the treatment you’re requesting will make it not worthwhile for you” and you have understood the side effects and you still disagree, then your opinion counts for more than theirs—it is your decision to make.
- If they dismiss a concern, ask them to put in writing that they dismissed your concern of X, despite you providing evidence that Y, and it being well-known that Z. Often, rather than doing that, they’ll just fold and actually address your concern instead.
Writer’s example in that last category: I recently made a request for a bone density scan. I expect my bone density is great, because I do all the right things, however, as both of my parents suffered from osteoporosis and assorted resultant crushed bones and the terrible consequences thereof, I a) have reasonable grounds for extra concern, and b) I believe that even if my bone density is fine now, it’s good to establish a baseline so I can know, in 5, 10, 20 years etc, whether there has been any deterioration. Now, happily the doctor I saw agreed with my assessment at first presentation and so I got the referral, but had she not been, I would have said “Could you please put in writing that I asked for a bone density scan, and you refused, on the grounds that [details about what happened with my parents], and that osteoporosis is known to have a strong genetic component is not, in your opinion, any reason to worry?”
Be honest, and/but err on the side of overstating your symptoms rather than understating. For example, if it is about a chronic condition and the doctor asks “are you able to do xyz”, take the question as meaning “are you able to do xyz on your worst days?”. You can clarify that if you like in your answer, but you need to include the information that xyz is something that your condition can and sometimes does impede you from doing.
Leave your embarrassment at the door. To the doctor (unless they are a very unprofessional one), you really are just one more patient with symptoms they have (unless your condition is very rare) seen a thousand times before. If your symptom is embarrassing, it will not faze them and you definitely should not hold back from mentioning it, for example. This goes extra in the case of discussions around sexual health, by the way, in which field the details you’d perhaps rather not share with anybody, are the details they need to adequately treat you.
After the appointment
Follow up on anything that doesn’t happen as promised (e.g. referrals, things ordered, etc), to make sure nothing got lost in a bureacratic error.
Get a second opinion if you’re not satisfied with the first one. Doctors are fallible, and as a matter of professional pride, it’s likely the second doctor will be glad to find something the first doctor missed.
See also: Make Your Negativity Work For You
Take care!
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Healthy Living in a Contaminated World – by Dr. Donald Hoernschemeyer
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There’s a lot going on here, as this book tackles very many kinds of common contaminants, from waste products and industrial chemicals (such as from fracking), pesticides that are banned in most places but not the US, smog and soot from coal and oil power, mercury and other heavy metals, dioxins, Teflon and its close relatives, phthalates, BPA, and other things again regulated out of use in many countries but not entirely in the US (which bans them only in some things, like baby bottles), drinking water issues of various kinds, and much more.
Indeed, there’s a whole chapter on the US and international regulation of toxic substances; the problem is often that on a political level, the same people who are against nebulous “chemicals” are also against environmentalist regulations that would ban them. This is mostly not a political book though, and rather is chiefly a book of chemistry (the author’s field).
It does also cover the medical maladies associated with various contaminants, while the bulk of the data is on the chemistry side of such things as “elimination times for toxic chemicals”, “amounts of pesticides in fruit and vegetables”, “antibiotics and hormones used in animal agriculture”, and so forth.
The style is dense, and/but it is clear the author has made an effort to not be too dry. Still, this is not a fun read; it’s depressing in content and the style is more suited to academia. There are appendices containing glossaries and acronym tables, but reading front-to-back, there’s a lot that’s not explained so unless you also are a PhD chemist, chances are you’ll be needing to leaf forwards and backwards a lot.
Bottom line: this book is not thrilling, but what you don’t know, can kill you.
Click here to check out Healthy Living In A Contaminated World, and improve your odds!
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Health Care AI, Intended To Save Money, Turns Out To Require a Lot of Expensive Humans
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Preparing cancer patients for difficult decisions is an oncologist’s job. They don’t always remember to do it, however. At the University of Pennsylvania Health System, doctors are nudged to talk about a patient’s treatment and end-of-life preferences by an artificially intelligent algorithm that predicts the chances of death.
But it’s far from being a set-it-and-forget-it tool. A routine tech checkup revealed the algorithm decayed during the covid-19 pandemic, getting 7 percentage points worse at predicting who would die, according to a 2022 study.
There were likely real-life impacts. Ravi Parikh, an Emory University oncologist who was the study’s lead author, told KFF Health News the tool failed hundreds of times to prompt doctors to initiate that important discussion — possibly heading off unnecessary chemotherapy — with patients who needed it.
He believes several algorithms designed to enhance medical care weakened during the pandemic, not just the one at Penn Medicine. “Many institutions are not routinely monitoring the performance” of their products, Parikh said.
Algorithm glitches are one facet of a dilemma that computer scientists and doctors have long acknowledged but that is starting to puzzle hospital executives and researchers: Artificial intelligence systems require consistent monitoring and staffing to put in place and to keep them working well.
In essence: You need people, and more machines, to make sure the new tools don’t mess up.
“Everybody thinks that AI will help us with our access and capacity and improve care and so on,” said Nigam Shah, chief data scientist at Stanford Health Care. “All of that is nice and good, but if it increases the cost of care by 20%, is that viable?”
Government officials worry hospitals lack the resources to put these technologies through their paces. “I have looked far and wide,” FDA Commissioner Robert Califf said at a recent agency panel on AI. “I do not believe there’s a single health system, in the United States, that’s capable of validating an AI algorithm that’s put into place in a clinical care system.”
AI is already widespread in health care. Algorithms are used to predict patients’ risk of death or deterioration, to suggest diagnoses or triage patients, to record and summarize visits to save doctors work, and to approve insurance claims.
If tech evangelists are right, the technology will become ubiquitous — and profitable. The investment firm Bessemer Venture Partners has identified some 20 health-focused AI startups on track to make $10 million in revenue each in a year. The FDA has approved nearly a thousand artificially intelligent products.
Evaluating whether these products work is challenging. Evaluating whether they continue to work — or have developed the software equivalent of a blown gasket or leaky engine — is even trickier.
Take a recent study at Yale Medicine evaluating six “early warning systems,” which alert clinicians when patients are likely to deteriorate rapidly. A supercomputer ran the data for several days, said Dana Edelson, a doctor at the University of Chicago and co-founder of a company that provided one algorithm for the study. The process was fruitful, showing huge differences in performance among the six products.
It’s not easy for hospitals and providers to select the best algorithms for their needs. The average doctor doesn’t have a supercomputer sitting around, and there is no Consumer Reports for AI.
“We have no standards,” said Jesse Ehrenfeld, immediate past president of the American Medical Association. “There is nothing I can point you to today that is a standard around how you evaluate, monitor, look at the performance of a model of an algorithm, AI-enabled or not, when it’s deployed.”
Perhaps the most common AI product in doctors’ offices is called ambient documentation, a tech-enabled assistant that listens to and summarizes patient visits. Last year, investors at Rock Health tracked $353 million flowing into these documentation companies. But, Ehrenfeld said, “There is no standard right now for comparing the output of these tools.”
And that’s a problem, when even small errors can be devastating. A team at Stanford University tried using large language models — the technology underlying popular AI tools like ChatGPT — to summarize patients’ medical history. They compared the results with what a physician would write.
“Even in the best case, the models had a 35% error rate,” said Stanford’s Shah. In medicine, “when you’re writing a summary and you forget one word, like ‘fever’ — I mean, that’s a problem, right?”
Sometimes the reasons algorithms fail are fairly logical. For example, changes to underlying data can erode their effectiveness, like when hospitals switch lab providers.
Sometimes, however, the pitfalls yawn open for no apparent reason.
Sandy Aronson, a tech executive at Mass General Brigham’s personalized medicine program in Boston, said that when his team tested one application meant to help genetic counselors locate relevant literature about DNA variants, the product suffered “nondeterminism” — that is, when asked the same question multiple times in a short period, it gave different results.
Aronson is excited about the potential for large language models to summarize knowledge for overburdened genetic counselors, but “the technology needs to improve.”
If metrics and standards are sparse and errors can crop up for strange reasons, what are institutions to do? Invest lots of resources. At Stanford, Shah said, it took eight to 10 months and 115 man-hours just to audit two models for fairness and reliability.
Experts interviewed by KFF Health News floated the idea of artificial intelligence monitoring artificial intelligence, with some (human) data whiz monitoring both. All acknowledged that would require organizations to spend even more money — a tough ask given the realities of hospital budgets and the limited supply of AI tech specialists.
“It’s great to have a vision where we’re melting icebergs in order to have a model monitoring their model,” Shah said. “But is that really what I wanted? How many more people are we going to need?”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
This article first appeared on KFF Health News and is republished here under a Creative Commons license.
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Paulina Porizkova (Former Supermodel) Talks Menopause, Aging, & Appearances
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Are supermodels destined to all eventually become “Grizabella the Glamor Cat”, a washed-up shell of their former glory? Is it true that “men grow cold as girls grow old, and we all lose our charms in the end”? And what—if anything—can we do about it?
Insights from a retired professional
Paulina Porizkova is 56, and she looks like she’s… 56, maybe? Perhaps a little younger or a bit older depending on the camera and lighting and such.
It’s usually the case, on glossy magazine covers and YouTube thumbnails, that there’s a 20-year difference between appearance and reality, but not here. Why’s that?
Porizkova noted that many celebrities of a similar age look younger, and felt bad. But then she noted that they’d all had various cosmetic work done, and looked for images of “real” women in their mid-50s, and didn’t find them.
Note: we at 10almonds do disagree with one thing here: we say that someone who has had cosmetic work done is no less real for it; it’s a simple matter of personal choice and bodily autonomy. She is, in our opinion, making the same mistake as people make when they say such things as “real people, rather than models”, as though models are not also real people.
Porizkova found modelling highly lucrative but dehumanizing, and did not enjoy the objectification involved—and she enjoyed even less, when she reached a certain age, negative comments about aging, and people being visibly wrong-footed when meeting her, as they had misconceptions based on past images.
As a child and younger adult through her modelling career, she felt very much “seen and not heard”, and these days, she realizes she’s more interesting now but feels less seen. Menopause coincided with her marriage ending, and she felt unattractive and ignored by her husband; she questioned her self-worth, and felt very bad about it. Then her husband (they had separated, but had not divorced) died, and she felt even more isolated—but it heightened her sensitivity to life.
In her pain and longing for recognition, she reached out through her Instagram, crying, and received positive feedback—but still she struggles with expressing needs and feeling worthy.
And yet, when it comes to looks, she embraces her wrinkles as a form of expression, and values her natural appearance over cosmetic alterations.
She describes herself as a work in progress—still broken, still needing cleansing and healing, but proud of how far she’s come so far, and optimistic with regard to the future.
For all this and more in her own words, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
The Many Faces Of Cosmetic Surgery
Take care!
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