Three Critical Kitchen Prescriptions

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Three Critical Kitchen Prescriptions

This is Dr. Saliha Mahmood-Ahmed. She’s a medical doctor—specifically, a gastroenterologist. She’s also a chef, and winner of the BBC’s MasterChef competition. So, from her gastroenterology day-job and her culinary calling, she has some expert insights to share on eating well!

❝Food and medicine are inextricably linked to one another, and it is an honour to be a doctor who specialises in digestive health and can both cook, and teach others to cook❞

~ Dr. Saliha Mahmood-Ahmed, after winning MasterChef and being asked if she’d quit medicine to be a full-time chef

Dr. Mahmood-Ahmed’s 3 “Kitchen Prescriptions”

They are:

  1. Cook, cook, cook
  2. Feed your gut bugs
  3. Do not diet

Let’s take a look at each of those…

Cook, cook, cook

We’re the only species on Earth that cooks food. An easy knee-jerk response might be to think maybe we shouldn’t, then, but… We’ve been doing it for at least 30,000 years, which is about 1,500 generations, while a mere 100 generations is generally sufficient for small evolutionary changes. So, we’ve evolved this way now.

More importantly in this context: we, ourselves, should cook our own food, at least per household.

Not ready meals; we haven’t evolved for those (yet! Give it another few hundred generations maybe)

Feed your gut bugs

The friendly ones. Enjoy prebiotics, probiotics, and plenty of fiber—and then be mindful of what else you do or don’t eat. Feeding the friendly bacteria while starving the unfriendly ones may seem like a tricky task, but it actually can be quite easily understood and implemented. We did a main feature about this a few weeks ago:

Making Friends With Your Gut (You Can Thank Us Later)

Do not diet

Dr. Mahmood-Ahmed is a strong critic of calorie-counting as a weight-loss strategy:

Rather than focusing on the number of calories consumed, try focusing on introducing enough variety of food into your daily diet, and on fostering good microbial diversity within your gut.

It’s a conceptual shift from restrictive weight loss, to prescriptive adding of things to one’s diet, with fostering diversity of microbiota as a top priority.

This, too, she recommends be undertaken gently, though—making small, piecemeal, but sustainable improvements. Nobody can reasonably incorporate, say, 30 new fruits and vegetables into one’s diet in a week; it’s unrealistic, and more importantly, it’s unsustainable.

Instead, consider just adding one new fruit or vegetable per shopping trip!

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  • Metformin For Weight-Loss & More

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    Metformin Without Diabetes?

    Metformin is a diabetes drug; it works by:

    • decreasing glucose absorption from the gut
    • decreasing glucose production in the liver
    • increasing glucose sensitivity

    It doesn’t change how much insulin is secreted, and is unlikely to cause hypoglycemia, making it relatively safe as diabetes drugs go.

    It’s a biguanide drug, and/but so far as science knows (so far), its mechanism of action is unique (i.e. no other drug works the same way that metformin does).

    Today we’ll examine its off-label uses and see what the science says!

    A note on terms: “off-label” = when a drug is prescribed to treat something other than the main purpose(s) for which the drug was approved.

    Other examples include modafinil against depression, and beta-blockers against anxiety.

    Why take it if not diabetic?

    There are many reasons people take it, including just general health and life extension:

    One of the cheapest diabetes drugs on the market can also slow aging and extend your life span. Here’s how

    However, its use was originally expanded (still “off-label”, but widely prescribed) past “just for diabetes” when it showed efficacy in treating pre-diabetes. Here for example is a longitudinal study that found metformin use performed similarly to lifestyle interventions (e.g. diet, exercise, etc). In their words:

    ❝ Lifestyle intervention or metformin significantly reduced diabetes development over 15 years. There were no overall differences in the aggregate microvascular outcome between treatment groups❞

    Source: Long-term effects of lifestyle intervention or metformin on diabetes development and microvascular complications over 15-year follow-up

    But, it seems it does more, as this more recent review found:

    Long-term weight loss was also seen in both [metformin and intensive lifestyle intervention] groups, with better maintenance under metformin.

    Subgroup analyses from the DPP/DPPOS have shed important light on the actions of metformin, including a greater effect in women with prior gestational diabetes, and a reduction in coronary artery calcium in men that might suggest a cardioprotective effect.

    Long-term diabetes prevention with metformin is feasible and is supported in influential guidelines for selected groups of subjects.❞

    Source: Metformin for diabetes prevention: update of the evidence base

    We were wondering about that cardioprotective effect, so…

    Cardioprotective effect

    In short, another review (published a few months after the above one) confirmed the previous findings, and also added:

    ❝Patients with BMI > 35 showed an association between metformin use and lower incidence of CVD, including African Americans older than age 65. The data suggest that morbidly obese patients with prediabetes may benefit from the use of metformin as recommended by the ADA.❞

    Real World Data: Off-Label Metformin in Patients with Prediabetes is Associated with Improved Cardiovascular Outcomes

    We wondered about the weight loss implications of this, and…

    For weight loss

    The short version is, it works:

    …and many many more where those came from. As a point of interest, it has also been compared and contrasted to GLP-1 agonists.

    Compared/contrasted with GLP-1 agonists

    It’s not quite as effective for weight loss, and/but it’s a lot cheaper, is tablets rather than injections, has fewer side effects (for most people), and doesn’t result in dramatic yoyo-ing if there’s an interruption to taking it:

    Comparison of Beinaglutide Versus Metformin for Weight Loss in Overweight and Obese Non-diabetic Patients

    Or if you prefer a reader-friendly pop-science version:

    Ozempic vs Metformin: Comparing The Two Diabetes Medications

    Is it safe?

    For most people yes, but there are a stack of contraindications, so it’s best to speak with your doctor. However, particular things to be aware of include:

    • Usually contraindicated if you have kidney problems of any kind
    • Usually contraindicated if you have liver problems of any kind
    • May be contraindicated if you have issues with B12 levels

    See also: Metformin: Is it a drug for all reasons and diseases?

    Where can I get it?

    As it’s a prescription-controlled drug, we can’t give you a handy Amazon link for this one.

    However, many physicians are willing to prescribe it for off-label use (i.e., for reasons other than diabetes), so speak with yours (telehealth options may also be available).

    If you do plan to speak with your doctor and you’re not sure they’ll be agreeable, you might want to get this paper and print it to take it with you:

    Off-label indications of Metformin – Review of Literature

    Take care!

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  • Neuroaffirming care values the strengths and differences of autistic people, those with ADHD or other profiles. Here’s how

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    We’ve come a long way in terms of understanding that everyone thinks, interacts and experiences the world differently. In the past, autistic people, people with attention deficit hyperactive disorder (ADHD) and other profiles were categorised by what they struggled with or couldn’t do.

    The concept of neurodiversity, developed by autistic activists in the 1990s, is an emerging area. It promotes the idea that different brains (“neurotypes”) are part of the natural variation of being human – just like “biodiversity” – and they are vital for our survival.

    This idea is now being applied to research and to care. At the heart of the National Autism Strategy, currently in development, is neurodiversity-affirming (neuroaffirming) care and practice. But what does this look like?

    Unsplash

    Reframing differences

    Neurodiversity challenges the traditional medical model of disability, which views neurological differences solely through a lens of deficits and disorders to be treated or cured.

    Instead, it reframes it as a different, and equally valuable, way of experiencing and navigating the world. It emphasises the need for brains that are different from what society considers “neurotypical”, based on averages and expectations. The term “neurodivergent” is applied to Autistic people, those with ADHD, dyslexia and other profiles.

    Neuroaffirming care can take many forms depending on each person’s needs and context. It involves accepting and valuing different ways of thinking, learning and experiencing the world. Rather than trying to “fix” or change neurodivergent people to fit into a narrow idea of what’s considered “normal” or “better”, neuroaffirming care takes a person-centered, strengths-based approach. It aims to empower and support unique needs and strengths.

    girl sits on couch with colourful fidget toy
    Neuroaffirming care can look different in a school or clinical setting. Shutterstock/Inna Reznik

    Adaptation and strengths

    Drawing on the social model of disability, neuroaffirming care acknowledges there is often disability associated with being different, especially in a world not designed for neurodivergent people. This shift focuses away from the person having to adapt towards improving the person-environment fit.

    This can include providing accommodations and adapting environments to make them more accessible. More importantly, it promotes “thriving” through greater participation in society and meaningful activities.

    At school, at work, in clinic

    In educational settings, this might involve using universal design for learning that benefits all learners.

    For example, using systematic synthetic phonics to teach reading and spelling for students with dyslexia can benefit all students. It also could mean incorporating augmentative and alternative communication, such as speech-generating devices, into the classroom.

    Teachers might allow extra time for tasks, or allow stimming (repetitive movements or noises) for self-regulation and breaks when needed.

    In therapy settings, neuroaffirming care may mean a therapist grows their understanding of autistic culture and learns about how positive social identity can impact self-esteem and wellbeing.

    They may make efforts to bridge the gap in communication between different neurotypes, known as the double empathy problem. For example, the therapist may avoid relying on body language or facial expressions (often different in autistic people) to interpret how a client is feeling, instead of listening carefully to what the client says.

    Affirming therapy approaches with children involve “tuning into” their preferred way of communicating, playing and engaging. This can bring meaningful connection rather than compliance to “neurotypical” ways of playing and relating.

    In workplaces, it can involve flexible working arrangements (hours, patterns and locations), allowing different modes of communication (such as written rather than phone calls) and low-sensory workspaces (for example, low-lighting, low-noise office spaces).

    In public spaces, it can look like providing a “sensory space”, such as at large concerts, where neurodivergent people can take a break and self-regulate if needed. And staff can be trained to recognise, better understand and assist with hidden disabilities.

    Combining lived experience and good practice

    Care is neuroaffirmative when it centres “lived experience” in its design and delivery, and positions people with disability as experts.

    As a result of being “different”, people in the neurodivergent community experience high rates of bullying and abuse. So neuroaffirming care should be combined with a trauma-informed approach, which acknowledges the need to understand a person’s life experiences to provide effective care.

    Culturally responsive care acknowledges limited access to support for culturally and racially marginalised Autistic people and higher rates of LGBTQIA+ identification in the neurodivergent community.

    open meeting room with people putting ideas on colourful notes on wall
    In the workplace, we can acknowledge how difference can fuel ideas. Unsplash/Jason Goodman

    Authentic selves

    The draft National Autism Strategy promotes awareness that our population is neurodiverse. It hopes to foster a more inclusive and understanding society.

    It emphasises the societal and public health responsibilities for supporting neurodivergent people via public education, training, policy and legislation. By providing spaces and places where neurodivergent people can be their authentic, unmasked selves, we are laying the foundations for feeling seen, valued, safe and, ultimately, happy and thriving.

    The author would like to acknowledge the assistance of psychologist Victoria Gottliebsen in drafting this article. Victoria is a member of the Oversight Council for the National Autism Strategy.

    Josephine Barbaro, Associate Professor, Principal Research Fellow, Psychologist, La Trobe University

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

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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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    Questions and Answers at 10almonds

    Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!

    This newsletter has been growing a lot lately, and so have the questions/requests, and we love that! 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

    Side effects of statins, are they worth it? Depression, are antidepressants worth it?

    About statins, that depends a lot on you, your circumstances, and—as it happens—your gender. We covered this in a main feature recently, but a short answer is: for most people, they may not be the best first choice, and could even make things worse. For some people, however, they really are just what’s needed.

    • Factors that make them more likely better for you: being a man, or having atherosclerosis
    • Factors that make them more likely worse for you: being a woman in general

    Check out the main feature we did: Statins: His & Hers?

    As for antidepressants? That depends a lot on you, your physiology, your depression, your circumstances, and more. We’ll definitely do a main feature on that sometime soon, as there’s a lot that most people don’t know!

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  • Fermenting Everything – by Andy Hamilton

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    This is not justanother pickling book! This is, instead, what it says on the front cover, “fermenting everything”.

    Ok, maybe not literally everything, but every kind of thing that can reasonably be fermented, and it’s probably a lot more things than you might think.

    From habanero chutney to lacto-lemonade, aioli to kombucha, Ukrainian fermented tomatoes to kvass. We could go on, but we’d soon run out of space. You get the idea. If it’s a fermented product (food, drink, condiment) and you’ve heard of it, there’s probably a recipe in here.

    All in all, this is a great way to get in your gut-healthy daily dose of fermented products!

    He does also talk safety, and troubleshooting too. And so long as you have a collection of big jars and a fairly normally-furnished kitchen, you shouldn’t need any more special equipment than that, unless you decide to you your fermentation skills for making beer (which does need some extra equipment, and he offers advice on that—our advice as a health science publication is “don’t drink beer”, though).

    Bottom line: with this in hand, you can create a lot of amazing foods/drinks/condiments that are not only delicious, but also great for gut health.

    Click here to check out Fermenting Everything, and widen your culinary horizons!

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  • Meditation That You’ll Actually Enjoy

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    Meditation That You’ll Actually Enjoy

    We previously wrote about…

    No-Frills, Evidence-Based Mindfulness

    this is a great primer, by the way, for the science and simplicity of mindfulness, along with the simplest mindfulness meditation to get you going.

    Today, we’re going to have some fun with meditation.

    First: The Problem

    Once the usefulness and health benefits of meditation have been established, often people want to meditate, but complain they don’t have the time.

    But that’s not the real reason, though, is it?

    Let’s face it, a basic meditation can give benefits within two minutes. Or within two breaths, for that matter. So, it’s not really for a lack of time.

    The real reason is because it doesn’t feel productive, and it’s not fun. For us to feel motivated to do a thing, usually we need at least one or the other. And even if we know it really is productive, it not feeling that way will hobble us.

    So instead, let us make things a little more fun, with…

    Meditation games!

    As it turns out, there are good kinds of meditation with which one can have a little fun.

    Catch the next thought

    A common feature of many meditative practices is the experience of having fewer, or ideally no, thoughts.

    But it’s hard to enact a negative, and thoughts keep coming.

    So instead, make yourself comfortable, settle in, and lie in wait for thoughts. When one comes along, pounce on it in your mind. And then release it, and wait for the next.

    At first, your thoughts may be coming thick and fast, but soon, you’ll find the pauses between them lengthening, and you have moments of contented not-knowing of what the next thought will be before it comes along.

    This state of relaxed, ready alertness, calm and receptive, is exactly what we’re hoping to find here. But don’t worry about that while you’re busy lying in wait for the next wild thought to come along

    Counting breaths

    Many meditative practices involve focus on one’s breath. But it’s easy for attention to wander!

    This game is a simple one. Count your breaths, not trying to change your rate of breathing at all, just letting it be, and see how high you can get before you lose count.

    Breathing in and out, once, counts as one breath, by the way.

    You may find that your rate of breathing naturally slows while you’re doing this. That’s fine; let it. It’ll add to the challenge of the game, because before long there will be lengthy pauses between each number.

    If you lose count, just start again, and see if you can beat your high score.

    This meditation game is an excellent exercise to build for sustained focus, while also improving the quality of breathing (as a side-effect of merely paying attention to it).

    Hot spot, cold spot

    The above two meditation games were drawn from Japanese and Chinese meditative practices, zen and qigong respectively; this one’s from an Indian meditative practice, yoga nidra. But for now, just approach it with a sense of playful curiosity, for best results.

    Make yourself comfortable, lying on your back, arms by your sides.

    Take a moment first to pay attention to each part of your body from head to toe, and release any tension that you may be holding along the way.

    First part: mentally scan your body for where it feels warmest, or most active, or most wanting of attention (for example if there is pain, or an itch, or some other sensation); that’s your “hot spot” for the moment.

    Second part: mentally scan your body for where it feels coolest, or most inert, or almost like it’s not a part of your body at all; that’s your “cold spot” for the moment.

    Now, see if you can flip them. Whether you can or can’t, notice if your “hot spot” or “cold spot” moves, or if you can move them consciously.

    This meditation game is a great exercise to strengthen interoception and somatic awareness in general—essential for being able to “listen to your body”!

    Closing thoughts

    All three practices above have very serious reasons and great benefits, but make sure you don’t skip enjoyment of the fun aspects!

    Being “young at heart” is, in part, to do with the ability to enjoy—literally, to take joy in—the little things in life.

    With that in mind, all we have left to say here is…

    Enjoy!

    Don’t Forget…

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    Learn to Age Gracefully

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