The Polyvagal Theory – by Dr. Stephen Porges

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Do you ever find that your feelings (or occasionally: lack thereof) sometimes can seem mismatched with the observed facts of your situation? This book unravels that mystery—or rather, that stack of mysteries.

Dr. Porges’ work on this topic is, by the way, the culmination of 40 years of research. While he’s not exactly a household name to the layperson, he’s very respected in his field, and this book is his magnum opus.

Here he explains the disparate roles of the two branches of the vagus nerve (hence: polyvagal theory). At least, the two branches that we mammals have; non-mammalian vertebrates have only one. This makes a big difference, because of the cascade of inhibitions that this allows.

The answer to the very general question “What stops you from…?” is usually found somewhere down this line of cascade of inhibitions.

These range from “what stops you from quitting your job/relationship/etc” to “what stops you from freaking out” to “what stops you from relaxing” to “what stops you from reacting quickly” to “what stop you from giving up” to “what stops you from gnawing your arm off” and many many more.

And because sometimes we wish we could do something that we can’t, or wish we wouldn’t do something that we do, understanding this process can be something of a cheat code to life.

A quick note on style: the book is quite dense and can be quite technical, but should be comprehensible to any layperson who is content to take their time, because everything is explained as we go along.

Bottom line: if you’d like to better understand the mysteries of how you feel vs how you actually are, and what that means for what you can or cannot wilfully do, this is a top-tier book

Click here to check out Polyvagal Theory, and take control of your responses!

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  • Reduce Your Skin Tag Risk

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    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

    ❝As I get older, I seem to be increasingly prone to skin tags, which appear, seemingly out of nowhere, on my face, chest and back. My dermatologist happily burns them off – but is there anything I can do to prevent them?!❞

    Not a lot! But, potentially something.

    The main risk factor for skin tags is genetic, and you can’t change that in any easy way.

    The other main risk factors are connected to each other:

    Skin folds, and chafing

    Skin tags mostly appear where chafing happens. This can be, for example:

    • Inside joint articulations (especially groin and armpits)
    • Between fat rolls (if you have them)

    So, if you have fat rolls, then losing weight will also reduce the risk of skin tags.

    Additionally, obesity and some often-related problems such as diabetes, hypertension, and an atherogenic lipid profile also increase the risk of skin tags (amongst other more serious things):

    See: Association of Skin Tag with Metabolic Syndrome and its Components

    As for the chafing, this can be reduced in various ways, including:

    • losing weight if (and only if) you are carrying excess weight
    • dressing against chafing (consider your underwear choices, for example)
    • keeping hair in the armpits and groin (it’s part of what it’s there for)

    See also: Simply The Pits: These Underarm Myths!

    Take care!

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  • Rose Hips vs Blueberries – Which is Healthier?

    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.

    Our Verdict

    When comparing rose hips to blueberries, we picked the rose hips.

    Why?

    Both of these fruits are abundant sources of antioxidants and other polyphenols, but one of them stands out for overall nutritional density:

    In terms of macros, rose hips have about 2x the carbohydrates, and/but about 10x the fiber. That’s an easy calculation and a clear win for rose hips.

    When it comes to vitamins, rose hips have a lot more of vitamins A, B2, B3, B5, B6, C, E, K, and choline. On the other hand, blueberries boast more of vitamins B1 and B9. That’s a 9:2 lead for rose hips, even before we consider rose hips’ much greater margins of difference (kicking off with 80x the vitamin A, for instance, and many multiples of many of the others).

    In the category of minerals, rose hips have a lot more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, and zinc. Meanwhile, blueberries are not higher in any minerals.

    In short: as ever, enjoy both, but if you’re looking for nutritional density, there’s a clear winner here and it’s rose hips.

    Want to learn more?

    You might like to read:

    It’s In The Hips: Rosehip’s Benefits, Inside & Out

    Take care!

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  • Master Your Core – by Dr. Bohdanna Zazulak

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    In the category of “washboard abs”, this one isn’t particularly interested in how much or how little fat you have. What it’s more interested in is a strong, resilient, and stable core. Including your abs yes, but also glutes, hips, and back.

    Nor is the focus on superhuman feats of strength, though certainly one could use these exercises to work towards that. Rather, here we see importance placed on functional performance, mobility, and stability.

    Lest mobility and stability seem at odds with each other, understand:

    • By mobility we mean the range of movement we are able to accomplish.
    • By stability, we mean that any movement we make is intentional, and not because we lost our balance.

    Functional performance, meanwhile, is a function of those two things, plus strength.

    How does the book deliver on this?

    There are exercises to do. Exercises of the athletic kind you might expect, and also exercises including breathing exercises, which gets quite a bit of attention too. Not just “do abdominal breathing”, but quite an in-depth examination of such. There are also habits to form, and lifestyle tweaks to make.

    Of course, you don’t have to do all the things she suggests. The more you do, the better results you are likely to get, but if you adopt even some of the practices she recommends, you’re likely to see some benefits. And, perhaps most importantly, reduce age-related loss of mobility, stability, and strength.

    Bottom line: a great all-rounder book of core strength, mobility, and stability.

    Click here to check out Master Your Core and enjoy the more robust health that comes with it!

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  • How much time should you spend sitting versus standing? New research reveals the perfect mix for optimal 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.

    People have a pretty intuitive sense of what is healthy – standing is better than sitting, exercise is great for overall health and getting good sleep is imperative.

    However, if exercise in the evening may disrupt our sleep, or make us feel the need to be more sedentary to recover, a key question emerges – what is the best way to balance our 24 hours to optimise our health?

    Our research attempted to answer this for risk factors for heart disease, stroke and diabetes. We found the optimal amount of sleep was 8.3 hours, while for light activity and moderate to vigorous activity, it was best to get 2.2 hours each.

    Finding the right balance

    Current health guidelines recommend you stick to a sensible regime of moderate-to vigorous-intensity physical activity 2.5–5 hours per week.

    However mounting evidence now suggests how you spend your day can have meaningful ramifications for your health. In addition to moderate-to vigorous-intensity physical activity, this means the time you spend sitting, standing, doing light physical activity (such as walking around your house or office) and sleeping.

    Our research looked at more than 2,000 adults who wore body sensors that could interpret their physical behaviours, for seven days. This gave us a sense of how they spent their average 24 hours.

    At the start of the study participants had their waist circumference, blood sugar and insulin sensitivity measured. The body sensor and assessment data was matched and analysed then tested against health risk markers — such as a heart disease and stroke risk score — to create a model.

    Using this model, we fed through thousands of permutations of 24 hours and found the ones with the estimated lowest associations with heart disease risk and blood-glucose levels. This created many optimal mixes of sitting, standing, light and moderate intensity activity.

    When we looked at waist circumference, blood sugar, insulin sensitivity and a heart disease and stroke risk score, we noted differing optimal time zones. Where those zones mutually overlapped was ascribed the optimal zone for heart disease and diabetes risk.

    You’re doing more physical activity than you think

    We found light-intensity physical activity (defined as walking less than 100 steps per minute) – such as walking to the water cooler, the bathroom, or strolling casually with friends – had strong associations with glucose control, and especially in people with type 2 diabetes. This light-intensity physical activity is likely accumulated intermittently throughout the day rather than being a purposeful bout of light exercise.

    Our experimental evidence shows that interrupting our sitting regularly with light-physical activity (such as taking a 3–5 minute walk every hour) can improve our metabolism, especially so after lunch.

    While the moderate-to-vigorous physical activity time might seem a quite high, at more than 2 hours a day, we defined it as more than 100 steps per minute. This equates to a brisk walk.

    It should be noted that these findings are preliminary. This is the first study of heart disease and diabetes risk and the “optimal” 24 hours, and the results will need further confirmation with longer prospective studies.

    The data is also cross-sectional. This means that the estimates of time use are correlated with the disease risk factors, meaning it’s unclear whether how participants spent their time influences their risk factors or whether those risk factors influence how someone spends their time.

    Australia’s adult physical activity guidelines need updating

    Australia’s physical activity guidelines currently only recommend exercise intensity and time. A new set of guidelines are being developed to incorporate 24-hour movement. Soon Australians will be able to use these guidelines to examine their 24 hours and understand where they can make improvements.

    While our new research can inform the upcoming guidelines, we should keep in mind that the recommendations are like a north star: something to head towards to improve your health. In principle this means reducing sitting time where possible, increasing standing and light-intensity physical activity, increasing more vigorous intensity physical activity, and aiming for a healthy sleep of 7.5–9 hours per night.

    Beneficial changes could come in the form of reducing screen time in the evening or opting for an active commute over driving commute, or prioritising an earlier bed time over watching television in the evening.

    It’s also important to acknowledge these are recommendations for an able adult. We all have different considerations, and above all, movement should be fun.

    Christian Brakenridge, Postdoctoral research fellow at Swinburne University Centre for Urban Transitions, Swinburne University of Technology

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

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  • The Burden of Getting Medical Care Can Exhaust Older Patients

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    Susanne Gilliam, 67, was walking down her driveway to get the mail in January when she slipped and fell on a patch of black ice.

    Pain shot through her left knee and ankle. After summoning her husband on her phone, with difficulty she made it back to the house.

    And then began the run-around that so many people face when they interact with America’s uncoordinated health care system.

    Gilliam’s orthopedic surgeon, who managed previous difficulties with her left knee, saw her that afternoon but told her “I don’t do ankles.”

    He referred her to an ankle specialist who ordered a new set of X-rays and an MRI. For convenience’s sake, Gilliam asked to get the scans at a hospital near her home in Sudbury, Massachusetts. But the hospital didn’t have the doctor’s order when she called for an appointment. It came through only after several more calls.

    Coordinating the care she needs to recover, including physical therapy, became a part-time job for Gilliam. (Therapists work on only one body part per session, so she has needed separate visits for her knee and for her ankle several times a week.)

    “The burden of arranging everything I need — it’s huge,” Gilliam told me. “It leaves you with such a sense of mental and physical exhaustion.”

    The toll the American health care system extracts is, in some respects, the price of extraordinary progress in medicine. But it’s also evidence of the poor fit between older adults’ capacities and the health care system’s demands.

    “The good news is we know so much more and can do so much more for people with various conditions,” said Thomas H. Lee, chief medical officer at Press Ganey, a consulting firm that tracks patients’ experiences with health care. “The bad news is the system has gotten overwhelmingly complex.”

    That complexity is compounded by the proliferation of guidelines for separate medical conditions, financial incentives that reward more medical care, and specialization among clinicians, said Ishani Ganguli, an associate professor of medicine at Harvard Medical School.

    “It’s not uncommon for older patients to have three or more heart specialists who schedule regular appointments and tests,” she said. If someone has multiple medical problems — say, heart disease, diabetes, and glaucoma — interactions with the health care system multiply.

    Ganguli is the author of a new study showing that Medicare patients spend about three weeks a year having medical tests, visiting doctors, undergoing treatments or medical procedures, seeking care in emergency rooms, or spending time in the hospital or rehabilitation facilities. (The data is from 2019, before the covid pandemic disrupted care patterns. If any services were received, that counted as a day of health care contact.)

    That study found that slightly more than 1 in 10 seniors, including those recovering from or managing serious illnesses, spent a much larger portion of their lives getting care — at least 50 days a year.

    “Some of this may be very beneficial and valuable for people, and some of it may be less essential,” Ganguli said. “We don’t talk enough about what we’re asking older adults to do and whether that’s realistic.”

    Victor Montori, a professor of medicine at the Mayo Clinic in Rochester, Minnesota, has for many years raised an alarm about the “treatment burden” that patients experience. In addition to time spent receiving health care, this burden includes arranging appointments, finding transportation to medical visits, getting and taking medications, communicating with insurance companies, paying medical bills, monitoring health at home, and following recommendations such as dietary changes.

    Four years ago — in a paper titled “Is My Patient Overwhelmed?” — Montori and several colleagues found that 40% of patients with chronic conditions such as asthma, diabetes, and neurological disorders “considered their treatment burden unsustainable.”

    When this happens, people stop following medical advice and report having a poorer quality of life, the researchers found. Especially vulnerable are older adults with multiple medical conditions and low levels of education who are economically insecure and socially isolated.

    Older patients’ difficulties are compounded by medical practices’ increased use of digital phone systems and electronic patient portals — both frustrating for many seniors to navigate — and the time pressures afflicting physicians. “It’s harder and harder for patients to gain access to clinicians who can problem-solve with them and answer questions,” Montori said.

    Meanwhile, clinicians rarely ask patients about their capacity to perform the work they’re being asked to do. “We often have little sense of the complexity of our patients’ lives and even less insight into how the treatments we provide (to reach goal-directed guidelines) fit within the web of our patients’ daily experiences,” several physicians wrote in a 2022 paper on reducing treatment burden.

    Consider what Jean Hartnett, 53, of Omaha, Nebraska, and her eight siblings went through after their 88-year-old mother had a stroke in February 2021 while shopping at Walmart.

    At the time, the older woman was looking after Hartnett’s father, who had kidney disease and needed help with daily activities such as showering and going to the bathroom.

    During the year after the stroke, both of Hartnett’s parents — fiercely independent farmers who lived in Hubbard, Nebraska — suffered setbacks, and medical crises became common. When a physician changed her mom’s or dad’s plan of care, new medications, supplies, and medical equipment had to be procured, and new rounds of occupational, physical, and speech therapy arranged.

    Neither parent could be left alone if the other needed medical attention.

    “It wasn’t unusual for me to be bringing one parent home from the hospital or doctor’s visit and passing the ambulance or a family member on the highway taking the other one in,” Hartnett explained. “An incredible amount of coordination needed to happen.”

    Hartnett moved in with her parents during the last six weeks of her father’s life, after doctors decided he was too weak to undertake dialysis. He passed away in March 2022. Her mother died months later in July.

    So, what can older adults and family caregivers do to ease the burdens of health care?

    To start, be candid with your doctor if you think a treatment plan isn’t feasible and explain why you feel that way, said Elizabeth Rogers, an assistant professor of internal medicine at the University of Minnesota Medical School. 

    “Be sure to discuss your health priorities and trade-offs: what you might gain and what you might lose by forgoing certain tests or treatments,” she said. Ask which interventions are most important in terms of keeping you healthy, and which might be expendable.

    Doctors can adjust your treatment plan, discontinue medications that aren’t yielding significant benefits, and arrange virtual visits if you can manage the technological requirements. (Many older adults can’t.)

    Ask if a social worker or a patient navigator can help you arrange multiple appointments and tests on the same day to minimize the burden of going to and from medical centers. These professionals can also help you connect with community resources, such as transportation services, that might be of help. (Most medical centers have staff of this kind, but physician practices do not.)

    If you don’t understand how to do what your doctor wants you to do, ask questions: What will this involve on my part? How much time will this take? What kind of resources will I need to do this? And ask for written materials, such as self-management plans for asthma or diabetes, that can help you understand what’s expected.

    “I would ask a clinician, ‘If I chose this treatment option, what does that mean not only for my cancer or heart disease, but also for the time I’ll spend getting care?’” said Ganguli of Harvard. “If they don’t have an answer, ask if they can come up with an estimate.”

    We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care, and advice you need in dealing with the health care system. Visit http://kffhealthnews.org/columnists to submit your requests or tips.

    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.

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  • What are heart rate zones, and how can you incorporate them into your exercise routine?

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    If you spend a lot of time exploring fitness content online, you might have come across the concept of heart rate zones. Heart rate zone training has become more popular in recent years partly because of the boom in wearable technology which, among other functions, allows people to easily track their heart rates.

    Heart rate zones reflect different levels of intensity during aerobic exercise. They’re most often based on a percentage of your maximum heart rate, which is the highest number of beats your heart can achieve per minute.

    But what are the different heart rate zones, and how can you use these zones to optimise your workout?

    The three-zone model

    While there are several models used to describe heart rate zones, the most common model in the scientific literature is the three-zone model, where the zones may be categorised as follows:

    • zone 1: 55%–82% of maximum heart rate
    • zone 2: 82%–87% of maximum heart rate
    • zone 3: 87%–97% of maximum heart rate.

    If you’re not sure what your maximum heart rate is, it can be calculated using this equation: 208 – (0.7 × age in years). For example, I’m 32 years old. 208 – (0.7 x 32) = 185.6, so my predicted maximum heart rate is around 186 beats per minute.

    There are also other models used to describe heart rate zones, such as the five-zone model (as its name implies, this one has five distinct zones). These models largely describe the same thing and can mostly be used interchangeably.

    What do the different zones involve?

    The three zones are based around a person’s lactate threshold, which describes the point at which exercise intensity moves from being predominantly aerobic, to predominantly anaerobic.

    Aerobic exercise uses oxygen to help our muscles keep going, ensuring we can continue for a long time without fatiguing. Anaerobic exercise, however, uses stored energy to fuel exercise. Anaerobic exercise also accrues metabolic byproducts (such as lactate) that increase fatigue, meaning we can only produce energy anaerobically for a short time.

    On average your lactate threshold tends to sit around 85% of your maximum heart rate, although this varies from person to person, and can be higher in athletes.

    A woman with an activity tracker on her wrist looking at a smartphone.
    Wearable technology has taken off in recent years. Ketut Subiyanto/Pexels

    In the three-zone model, each zone loosely describes one of three types of training.

    Zone 1 represents high-volume, low-intensity exercise, usually performed for long periods and at an easy pace, well below lactate threshold. Examples include jogging or cycling at a gentle pace.

    Zone 2 is threshold training, also known as tempo training, a moderate intensity training method performed for moderate durations, at (or around) lactate threshold. This could be running, rowing or cycling at a speed where it’s difficult to speak full sentences.

    Zone 3 mostly describes methods of high-intensity interval training, which are performed for shorter durations and at intensities above lactate threshold. For example, any circuit style workout that has you exercising hard for 30 seconds then resting for 30 seconds would be zone 3.

    Striking a balance

    To maximise endurance performance, you need to strike a balance between doing enough training to elicit positive changes, while avoiding over-training, injury and burnout.

    While zone 3 is thought to produce the largest improvements in maximal oxygen uptake – one of the best predictors of endurance performance and overall health – it’s also the most tiring. This means you can only perform so much of it before it becomes too much.

    Training in different heart rate zones improves slightly different physiological qualities, and so by spending time in each zone, you ensure a variety of benefits for performance and health.

    So how much time should you spend in each zone?

    Most elite endurance athletes, including runners, rowers, and even cross-country skiers, tend to spend most of their training (around 80%) in zone 1, with the rest split between zones 2 and 3.

    Because elite endurance athletes train a lot, most of it needs to be in zone 1, otherwise they risk injury and burnout. For example, some runners accumulate more than 250 kilometres per week, which would be impossible to recover from if it was all performed in zone 2 or 3.

    Of course, most people are not professional athletes. The World Health Organization recommends adults aim for 150–300 minutes of moderate intensity exercise per week, or 75–150 minutes of vigorous exercise per week.

    If you look at this in the context of heart rate zones, you could consider zone 1 training as moderate intensity, and zones 2 and 3 as vigorous. Then, you can use heart rate zones to make sure you’re exercising to meet these guidelines.

    What if I don’t have a heart rate monitor?

    If you don’t have access to a heart rate tracker, that doesn’t mean you can’t use heart rate zones to guide your training.

    The three heart rate zones discussed in this article can also be prescribed based on feel using a simple 10-point scale, where 0 indicates no effort, and 10 indicates the maximum amount of effort you can produce.

    With this system, zone 1 aligns with a 4 or less out of 10, zone 2 with 4.5 to 6.5 out of 10, and zone 3 as a 7 or higher out of 10.

    Heart rate zones are not a perfect measure of exercise intensity, but can be a useful tool. And if you don’t want to worry about heart rate zones at all, that’s also fine. The most important thing is to simply get moving.

    Hunter Bennett, Lecturer in Exercise Science, University of South Australia

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

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