The Whole-Body Approach to Osteoporosis – by Keith McCormick

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You probably already know to get enough calcium and vitamin D, and do some resistance training. What does this book offer beyond that advice?

It’s pretty comprehensive, as it turns out. It covers the above, plus the wide range of medications available, what supplements help or harm or just don’t have enough evidence either way yet, things like that.

Amongst the most important offerings are the signs and symptoms that can help monitor your bone health (things you can do at home! Like examinations of your fingernails, hair, skin, tongue, and so forth, that will reveal information about your internal biochemical make-up), as well as what lab tests to ask for. Which is important, as osteoporosis is one of those things whereby we often don’t learn something is wrong until it’s too late.

The author is a chiropractor, which doesn’t always have a reputation as the most robustly science-based of physical therapy options, but he…

  • doesn’t talk about chiropractic
  • did confer with a flock of experts (osteopaths, nutritionists, etc) to inform/check his work
  • does refer consistently to good science, and explains it well
  • includes 16 pages of academic references, and yes, they are very reputable publications

Bottom line: this one really does give what the subtitle promises: a whole body approach to avoiding (or reversing) osteoporosis.

Click here to check out The Whole Body Approach To Osteoporosis; sooner is better than later!

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    Transform your health with 15 simple habits that make fitness gains no sweat—no Rocky montage required!

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  • Heart Health vs Systemic Stress

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    At The Heart Of Good Health

    This is Dr. Michelle Albert. She’s a cardiologist with a decades-long impressive career, recently including a term as the president of the American Heart Association. She’s the current Admissions Dean at UCSF Medical School. She’s accumulated enough awards and honors that if we list them, this email will not fit in your inbox without getting clipped.

    What does she want us to know?

    First, lifestyle

    Although Dr. Albert is also known for her work with statins (which found that pravastatin may have anti-inflammatory effects in addition to lipid-lowering effects, which is especially good news for women, for whom the lipid-lowering effects may be less useful than for men), she is keen to emphasize that they should not be anyone’s first port-of-call unless “first” here means “didn’t see the risk until it was too late and now LDL levels are already ≥190 mg/dL”.

    Instead, she recommends taking seriously the guidelines on:

    • getting plenty of fruit, vegetables, whole grains, lean protein
    • avoiding red meat, processed meats, refined carbohydrates, and sweetened beverages
    • getting your 150 minutes per week of moderate exercise
    • avoiding alcohol, and definitely abstaining from smoking

    See also: These Top Five Things Make The Biggest Difference To Health

    Next, get your house in order

    No, not your home gym—though sure, that too!

    But rather: after the “Top Five Things” we linked just above, the sixth on the list would be “reduce stress”. Indeed, as Dr. Albert says:

    ❝Heart health is not just about the physical heart but also about emotional well-being. Stress management is crucial for a healthy heart❞

    ~ Dr. Michelle Albert

    This is where a lot of people would advise mindfulness meditation, CBT, somatic therapies, and the like. And these things are useful! See for example:

    No-Frills, Evidence-Based Mindfulness

    …and:

    How To Manage Chronic Stress

    However, Dr. Albert also advocates for awareness of what some professionals have called “Shit Life Syndrome”.

    This is more about socioeconomic factors. There are many of those that can’t be controlled by the individual, for example:

    Adverse maternal experiences such as depression, economic issues and low social status can lead to poor cognitive outcomes as well as cardiovascular disease.

    Many jarring statistics illuminate a marked wealth gap by race and ethnicity… You might be thinking education could help bridge that gap. But it is not that simple.

    While education does increase wealth, the returns are not the same for everyone. Black persons need a post-graduate degree just to attain similar wealth as white individuals with a high school degree.

    ~ Dr. Michelle Albert

    Read in full: AHA president: The connection between economic adversity and cardiovascular health

    What this means in practical terms (besides advocating for structural change to tackle the things such as the racism that has been baked into a lot of systems for generations) is:

    Be aware not just of your obvious health risk factors, but also your socioeconomic risk factors, if you want to have good general health outcomes.

    So for example, let’s say that you, dear reader, are wealthy and white, in which case you have some very big things in your favor, but are you also a woman? Because if so…

    Women and Minorities Bear the Brunt of Medical Misdiagnosis

    See also, relevant for some: Obesity Discrimination In Healthcare Settings ← you’ll need to scroll to the penultimate section for this one.

    In other words… If you are one of the majority of people who is a woman and/or some kind of minority, things are already stacked against you, and not only will this have its own direct harmful effect, but also, it’s going to make your life harder and that stress increases CVD risk more than salt.

    In short…

    This means: tackle not just your stress, but also the things that cause that. Look after your finances, gather social support, know your rights and be prepared to self-advocate / have someone advocate for you, and go into medical appointments with calm well-prepared confidence.

    Take care!

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  • Two Awesome Hours – by Dr. Josh Davis

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    The brain is an amazing and powerful organ, with theoretically unlimited potential in some respects. So why doesn’t it feel that way a lot of the time?

    The truth is that not only are we often tired, dehydrated, or facing other obvious physiological challenges to peak brain health, but also… We’re simply not making the best use of it!

    What Dr. Davis does is outline for us how we can create the conditions for “two awesome hours” of effective mental performance by:

    • Recognizing when to most effectively flip the switch on our automatic thinking
    • Scheduling tasks based on their “processing demand” and recovery time
    • Learning how to direct attention, rather than avoid distractions
    • Feeding and moving our bodies in ways that prep us for success
    • Identifying what matters in our environment to be at the top of our mental game

    Why only two hours? Why not four, or eight, or more?

    Well, our brains need recovery time too, so we can’t be “always on” and operating and peak efficiency. But, what we can do is optimize a couple of hours for absolute peak efficiency, and then enjoy the rest of time with lower cognitive-load activities.

    Bottom line: if the idea of what you could accomplish if you could just be guaranteed two schedulable hours (your preference when!) of peak cognitive performance per day, then this is a great book for you.

    Get your copy of “Two Awesome Hours” from Amazon today!

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  • Foam Rolling – by Karina Inkster

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    If you’ve ever bought a foam roller only to place it under your lower back once and then put it somewhere for safekeeping and never use it again, this book will help fix that.

    Karina Inkster (what a cool name) is a personal trainer, and the book also features tips and advice from physiotherapists and sports medicine specialist doctors too, so all bases are well and truly covered.

    This is not, in case you’re wondering, a book that could have been a pamphlet, with photos of the exercises and one-liner explanation and that’s it. Rather, Inkster takes us through the anatomy and physiology of what’s going on, so that we can actually use this thing correctly and get actual noticeable improvements to our health from it—as promised in the subtitle’s mention of “for massage, injury prevention, and core strength”. To be clear, a lot of it is also about soft tissue mobilization, and keeping our fascia healthy (an oft-underestimated aspect of general mobility).

    We would mention that since the photos are pleasantly colorful (like those on the cover) and this adds to the clarity, we’d recommend springing for the (quite inexpensive) physical copy, rather than a Kindle edition (if your e-reader is a monochrome e-ink device like this reviewer’s, anyway).

    Bottom line: this book will enable your foam roller to make a difference to your life.

    Click here to check out Foam Rolling, and get rolling (correctly)!

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  • I have a stuffy nose, how can I tell if it’s hay fever, COVID or something else?

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    Hay fever (also called allergic rhinitis) affects 24% of Australians. Symptoms include sneezing, a runny nose (which may feel blocked or stuffy) and itchy eyes. People can also experience an itchy nose, throat or ears.

    But COVID is still spreading, and other viruses can cause cold-like symptoms. So how do you know which one you’ve got?

    Lysenko Andrii/Shutterstock

    Remind me, how does hay fever cause symptoms?

    Hay fever happens when a person has become “sensitised” to an allergen trigger. This means a person’s body is always primed to react to this trigger.

    Triggers can include allergens in the air (such as pollen from trees, grasses and flowers), mould spores, animals or house dust mites which mostly live in people’s mattresses and bedding, and feed on shed skin.

    When the body is exposed to the trigger, it produces IgE (immunoglobulin E) antibodies. These cause the release of many of the body’s own chemicals, including histamine, which result in hay fever symptoms.

    People who have asthma may find their asthma symptoms (cough, wheeze, tight chest or trouble breathing) worsen when exposed to airborne allergens. Spring and sometimes into summer can be the worst time for people with grass, tree or flower allergies.

    However, animal and house dust mite symptoms usually happen year-round.

    Ryegrass
    Ryegrass pollen is a common culprit. bangku ceria/Shutterstock

    What else might be causing my symptoms?

    Hay fever does not cause a fever, sore throat, muscle aches and pains, weakness, loss of taste or smell, nor does it cause you to cough up mucus.

    These symptoms are likely to be caused by a virus, such as COVID, influenza, respiratory syncytial virus (RSV) or a “cold” (often caused by rhinoviruses). These conditions can occur all year round, with some overlap of symptoms:

    Natasha Yates/The Conversation

    COVID still surrounds us. RSV and influenza rates appear higher than before the COVID pandemic, but it may be due to more testing.

    So if you have a fever, sore throat, muscle aches/pains, weakness, fatigue, or are coughing up mucus, stay home and avoid mixing with others to limit transmission.

    People with COVID symptoms can take a rapid antigen test (RAT), ideally when symptoms start, then isolate until symptoms disappear. One negative RAT alone can’t rule out COVID if symptoms are still present, so test again 24–48 hours after your initial test if symptoms persist.

    You can now test yourself for COVID, RSV and influenza in a combined RAT. But again, a negative test doesn’t rule out the virus. If your symptoms continue, test again 24–48 hours after the previous test.

    If it’s hay fever, how do I treat it?

    Treatment involves blocking the body’s histamine release, by taking antihistamine medication which helps reduce the symptoms.

    Doctors, nurse practitioners and pharmacists can develop a hay fever care plan. This may include using a nasal spray containing a topical corticosteroid to help reduce the swelling inside the nose, which causes stuffiness or blockage.

    Nasal sprays need to delivered using correct technique and used over several weeks to work properly. Often these sprays can also help lessen the itchy eyes of hay fever.

    Drying bed linen and pyjamas inside during spring can lessen symptoms, as can putting a smear of Vaseline in the nostrils when going outside. Pollen sticks to the Vaseline, and gently blowing your nose later removes it.

    People with asthma should also have an asthma plan, created by their doctor or nurse practitioner, explaining how to adjust their asthma reliever and preventer medications in hay fever seasons or on allergen exposure.

    People with asthma also need to be alert for thunderstorms, where pollens can burst into tinier particles, be inhaled deeper in the lungs and cause a severe asthma attack, and even death.

    What if it’s COVID, RSV or the flu?

    Australians aged 70 and over and others with underlying health conditions who test positive for COVID are eligible for antivirals to reduce their chance of severe illness.

    Most other people with COVID, RSV and influenza will recover at home with rest, fluids and paracetamol to relieve symptoms. However some groups are at greater risk of serious illness and may require additional treatment or hospitalisation.

    For RSV, this includes premature infants, babies 12 months and younger, children under two who have other medical conditions, adults over 75, people with heart and lung conditions, or health conditions that lessens the immune system response.

    For influenza, people at higher risk of severe illness are pregnant women, Aboriginal people, people under five or over 65 years, or people with long-term medical conditions, such as kidney, heart, lung or liver disease, diabetes and decreased immunity.

    If you’re concerned about severe symptoms of COVID, RSV or influenza, consult your doctor or call 000 in an emergency.

    If your symptoms are mild but persist, and you’re not sure what’s causing them, book an appointment with your doctor or nurse practitioner. Although hay fever season is here, we need to avoid spreading other serious infectious.

    For more information, you can call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria); use the online Symptom Checker; or visit healthdirect.gov.au or the Australian Society of Clinical Immunology and Allergy.

    Deryn Thompson, Eczema and Allergy Nurse; Lecturer, University of South Australia

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

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  • Can Medical Schools Funnel More Doctors Into the Primary Care Pipeline?

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    Throughout her childhood, Julia Lo Cascio dreamed of becoming a pediatrician. So, when applying to medical school, she was thrilled to discover a new, small school founded specifically to train primary care doctors: NYU Grossman Long Island School of Medicine.

    Now in her final year at the Mineola, New York, school, Lo Cascio remains committed to primary care pediatrics. But many young doctors choose otherwise as they leave medical school for their residencies. In 2024, 252 of the nation’s 3,139 pediatric residency slots went unfilled and family medicine programs faced 636 vacant residencies out of 5,231 as students chased higher-paying specialties.

    Lo Cascio, 24, said her three-year accelerated program nurtured her goal of becoming a pediatrician. Could other medical schools do more to promote primary care? The question could not be more urgent. The Association of American Medical Colleges projects a shortage of 20,200 to 40,400 primary care doctors by 2036. This means many Americans will lose out on the benefits of primary care, which research shows improves health, leading to fewer hospital visits and less chronic illness.

    Many medical students start out expressing interest in primary care. Then they end up at schools based in academic medical centers, where students become enthralled by complex cases in hospitals, while witnessing little primary care.

    The driving force is often money, said Andrew Bazemore, a physician and a senior vice president at the American Board of Family Medicine. “Subspecialties tend to generate a lot of wealth, not only for the individual specialists, but for the whole system in the hospital,” he said.

    A department’s cache of federal and pharmaceutical-company grants often determines its size and prestige, he said. And at least 12 medical schools, including Harvard, Yale, and Johns Hopkins, don’t even have full-fledged family medicine departments. Students at these schools can study internal medicine, but many of those graduates end up choosing subspecialties like gastroenterology or cardiology.

    One potential solution: eliminate tuition, in the hope that debt-free students will base their career choice on passion rather than paycheck. In 2024, two elite medical schools — the Albert Einstein College of Medicine and the Johns Hopkins University School of Medicine — announced that charitable donations are enabling them to waive tuition, joining a handful of other tuition-free schools.

    But the contrast between the school Lo Cascio attends and the institution that founded it starkly illustrates the limitations of this approach. Neither charges tuition.

    In 2024, two-thirds of students graduating from her Long Island school chose residencies in primary care. Lo Cascio said the tuition waiver wasn’t a deciding factor in choosing pediatrics, among the lowest-paid specialties, with an average annual income of $260,000, according to Medscape.

    At the sister school, the Manhattan-based NYU Grossman School of Medicine, the majority of its 2024 graduates chose specialties like orthopedics (averaging $558,000 a year) or dermatology ($479,000).

    Primary care typically gets little respect. Professors and peers alike admonish students: If you’re so smart, why would you choose primary care? Anand Chukka, 27, said he has heard that refrain regularly throughout his years as a student at Harvard Medical School. Even his parents, both PhD scientists, wondered if he was wasting his education by pursuing primary care.

    Seemingly minor issues can influence students’ decisions, Chukka said. He recalls envying the students on hospital rotations who routinely were served lunch, while those in primary care settings had to fetch their own.

    Despite such headwinds, Chukka, now in his final year, remains enthusiastic about primary care. He has long wanted to care for poor and other underserved people, and a one-year clerkship at a community practice serving low-income patients reinforced that plan.

    When students look to the future, especially if they haven’t had such exposure, primary care can seem grim, burdened with time-consuming administrative tasks, such as seeking prior authorizations from insurers and grappling with electronic medical records.

    While specialists may also face bureaucracy, primary care practices have it much worse: They have more patients and less money to hire help amid burgeoning paperwork requirements, said Caroline Richardson, chair of family medicine at Brown University’s Warren Alpert Medical School.

    “It’s not the medical schools that are the problem; it’s the job,” Richardson said. “The job is too toxic.”

    Kevin Grumbach, a professor of family and community medicine at the University of California-San Francisco, spent decades trying to boost the share of students choosing primary care, only to conclude: “There’s really very little that we can do in medical school to change people’s career trajectories.”

    Instead, he said, the U.S. health care system must address the low pay and lack of support.

    And yet, some schools find a way to produce significant proportions of primary care doctors — through recruitment and programs that provide positive experiences and mentors.

    U.S. News & World Report recently ranked 168 medical schools by the percentage of graduates who were practicing primary care six to eight years after graduation.

    The top 10 schools are all osteopathic medical schools, with 41% to 47% of their students still practicing primary care. Unlike allopathic medical schools, which award MD degrees, osteopathic schools, which award DO degrees, have a history of focusing on primary care and are graduating a growing share of the nation’s primary care physicians.

    At the bottom of the U.S. News list is Yale, with 10.7% of its graduates finding lasting careers in primary care. Other elite schools have similar rates: Johns Hopkins, 13.1%; Harvard, 13.7%.

    In contrast, public universities that have made it a mission to promote primary care have much higher numbers.

    The University of Washington — No. 18 in the ranking, with 36.9% of graduates working in primary care — has a decades-old program placing students in remote parts of Washington, Wyoming, Alaska, Montana, and Idaho. UW recruits students from those areas, and many go back to practice there, with more than 20% of graduates settling in rural communities, according to Joshua Jauregui, assistant dean for clinical curriculum.

    Likewise, the University of California-Davis (No. 22, with 36.3% of graduates in primary care) increased the percentage of students choosing family medicine from 12% in 2009 to 18% in 2023, even as it ranks high in specialty training. Programs such as an accelerated three-year primary care “pathway,” which enrolls primarily first-generation college students, help sustain interest in non-specialty medical fields.

    The effort starts with recruitment, looking beyond test scores to the life experiences that forge the compassionate, humanistic doctors most needed in primary care, said Mark Henderson, associate dean for admissions and outreach. Most of the students have families who struggle to get primary care, he said. “So they care a lot about it, and it’s not just an intellectual, abstract sense.”

    Establishing schools dedicated to primary care, like the one on Long Island, is not a solution in the eyes of some advocates, who consider primary care the backbone of medicine and not a separate discipline. Toyese Oyeyemi Jr., executive director of the Social Mission Alliance at the Fitzhugh Mullan Institute of Health Workforce Equity, worries that establishing such schools might let others “off the hook.”

    Still, attending a medical school created to produce primary care doctors worked out well for Lo Cascio. Although she underwent the usual specialty rotations, her passion for pediatrics never flagged — owing to her 23 classmates, two mentors, and her first-year clerkship shadowing a community pediatrician. Now, she’s applying for pediatric residencies.

    Lo Cascio also has deep personal reasons: Throughout her experience with a congenital heart condition, her pediatrician was a “guiding light.”

    “No matter what else has happened in school, in life, in the world, and medically, your pediatrician is the person that you can come back to,” she said. “What a beautiful opportunity it would be to be that for someone else.”

    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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  • The Hormone Therapy That Reduces Breast Cancer Risk & More

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    The Hormone Balancing Act

    We’ve written before about menopausal HRT:

    What You Should Have Been Told About Menopause Beforehand

    …and even specifically about the considerations when it comes to breast cancer risk:

    Menopausal Hormone Replacement Therapy

    this really does bear reading, by the way—scroll down to the bit about breast cancer risk, because it’s not a simple increased/decreased risk; it can go either way, and which way it goes will depend on various factors including your medical history and what HRT, if any, you are taking.

    Hormone Modulating Therapy

    Hormone modulating therapy, henceforth HMT, is something a little different.

    Instead of replacing hormones, as hormone replacement therapy does, guess what hormone modulating therapy does instead? That’s right…

    MHT can modulate hormones by various means, but the one we’re going to talk about today does it by blocking estrogen receptors,

    Isn’t that the opposite of what we want?

    You would think so, but since for many people with an increased breast cancer risk, the presence of estrogen increases that risk, which leaves menopausal (peri- or post) people in an unfortunate situation, having to choose between increased breast cancer risk (with estrogen), or osteoporosis and increased dementia risk, amongst other problems (without).

    However, the key here (in fact, that’s a very good analogy) is in how the blocker works. Hormones and their receptors are like keys and locks, meaning that the wrong-shaped hormone won’t accidentally trigger it. And when the right-shaped hormone comes along, it gets activated and the message (in this case, “do estrogenic stuff here!” gets conveyed). A blocker is sufficiently similar to fit into the receptor, without being so similar as to otherwise act as the hormone.

    In this case, it has been found that HMT blocking estrogen receptors was sufficient to alleviate the breast cancer risk, while also being associated with a 7% lower risk of developing Alzheimer’s disease or related dementias, with that risk reduction being even greater for some demographics depending on race and age. Black women in the 65–74 age bracket enjoyed a 24% relative risk reduction, with white women of the same age getting an 11% relative risk reduction. Black women enjoyed the same benefits after that age, whereas white women starting it at that age did not get the same benefits. The conclusion drawn from this is that it’s good to start this at 65 if relevant and practicable, especially if white, because the protective effect is strongest when gained aged 65–69.

    Here’s a pop-science article that goes into the details more deeply than we have room for here:

    Hormone therapy for breast cancer linked with lower dementia risk

    And here’s the paper itself; we highly recommend reading at least the abstract, because it goes into the numbers in much more detail than we reasonably can here. It’s a huge cohort study of 18,808 women aged 65 years or older, so this is highly relevant data:

    Alzheimer Disease and Related Dementia Following Hormone-Modulating Therapy in Patients With Breast Cancer

    Want to learn more?

    If you’d like a much deeper understanding of breast cancer risk management, including in the context of hormone therapy, you might like this excellent book that we reviewed recently:

    The Smart Woman’s Guide to Breast Cancer – by Dr. Jenn Simmons

    Take care!

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