Total Recovery – by Dr. Gary Kaplan
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First, know: Dr. Kaplan is an osteopath, and as such, will be mostly approaching things from that angle. That said, he is also board certified in other things too, including family medicine, so he’s by no means a “one-trick pony”, nor are there “when your only tool is a hammer, everything starts to look like a nail” problems to be found here. Instead, the scope of the book is quite broad.
Dr. Kaplan talks us through the diagnostic process that a doctor goes through when presented with a patient, what questions need to be asked and answered—and by this we mean the deeper technical questions, e.g. “what do these symptoms have in common”, and “what mechanism was at work when the pain become chronic”, not the very basic questions asked in the initial debriefing with the patient.
He also asks such questions (and questions like these get chapters devoted to them) as “what if physical traumas build up”, and “what if physical and emotional pain influence each other”, and then examines how to interrupt the vicious cycles that lead to deterioration of one’s condition.
The style of the book is very pop-science and often narrative in its presentation, giving lots of anecdotes to illustrate the principles. It’s a “sit down and read it cover-to-cover” book—or a chapter a day, whatever your preferred pace; the point is, it’s not a “dip directly to the part that answers your immediate question” book; it’s not a textbook or manual.
Bottom line: a lot of this work is about prompting the reader to ask the right questions to get to where we need to be, but there are many illustrative possible conclusions and practical advices to be found and given too, making this a useful read if you and/or a loved one suffers from chronic pain.
Click here to check out Total Recovery, and solve your own mysteries!
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Undo The Sun’s Damage To Your Skin
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It’s often said that our skin is our largest organ. Our brain or liver are the largest solid organs by mass (which one comes out on top will vary from person to person), our gut is the longest, and our lungs are the largest by surface area. But our skin is large, noticeable, and has a big impact on the rest of our health.
The sun is one of the main damaging factors for our skin; assorted toxins are also a major threat for many people, and once the skin barrier gets broken, it’s a field-day for bacteria.
So, what can we do about it?
Tretinoin: the skin’s rejuvenator
Tretinoin is also called retinoic acid, not to be mistaken for retinol, although they are both retinoids. Tretinoin is much stronger.
As for what it’s stronger at:
It’s usually prescribed for the treatment of sun-damage, acne, and wrinkles. Paradoxically, it works by inflaming the skin (and then making it better, and having done so, keeping it better).
In few words: it encourages your skin to speed up its life cycle, which means that cells die and are replaced sooner, which means the average age of skin cells will be considerably younger at any given time.
This is the same principle as we see at work when it comes to cellular apoptosis and autophagy in general, and specifically the same idea as we discussed when talking about senolytics, compounds that kill aging cells:
Fisetin: The Anti-Aging Assassin
About that paradoxical inflammation…
❝The topical use of tretinoin as an antiacne agent began almost a half century ago. Since that time it has been successfully used to treat comedonal and inflammatory acne.
Over the intervening years, the beneficial effects of tretinoin have grown from an understanding of its potent cornedolytie-related properties to an evolving appreciation of its antiinflammatory actions.
…
The topical use of clindamycin and tretinoin as a combination treatment modality that includes antibacterial, comedolytic, and antiinflammatoiy properties has proven to be a very effective therapy for treating the various stages of acne
…
It is now becoming increasingly clear that there may be good reasons for these observations.❞
~ Drs. Schmidt & Gans, lightly edited here for brevity
Read in full: Tretinoin: A Review of Its Anti-inflammatory Properties in the Treatment of Acne
Against damage by the sun
The older we get, the more likely sun damage is a problem than acne. And in the case of tretinoin,
❝In several well-controlled clinical trials, the proportion of patients showing improvement was significantly higher with 0.01 or 0.05% tretinoin cream than with placebo for criteria such as global assessment, fine and coarse wrinkling, pigmentation and roughness.
Improvements in the overall severity of photodamage were also significantly greater with tretinoin than with placebo.
…
Several placebo-controlled clinical studies have demonstrated that topical tretinoin has significant efficacy in the treatment of photodamaged skin. Improvements in subjective global assessment scores were recorded in:
49–100% of patients using once-daily 0.01% tretinoin,
68–100% of patients using 0.05% tretinoin, and
0–44% of patients using placebo.❞
~ Drs. Wagstaff & Noble
…which is quite compelling.
Read in full: Tretinoin: A Review of its Pharmacological Properties and Clinical Efficacy in the Topical Treatment of Photodamaged Skin
This is very well-established by now; here’s an old paper from when the mechanism of action was unknown (here in the current day, 17 mechanisms of action have been identified; beyond the scope of this article as we only have so much room, but it’s nice to see science building on science):
❝Tretinoin cream has been used extensively to reverse the changes of photoaging. It is the first topical therapy to undergo controlled clinical testing and proved to be efficacious. These results have been substantiated with photography, histopathologie examination, and skin surface replicas.
…
Tretinoin cream has an excellent safety record; a local cutaneous hypervitaminosis A reaction is the only common problem.❞
~ Dr. Goldfarb et al.
Read in full: Topical tretinoin therapy: Its use in photoaged skin
Is it safe?
For most people, when used as directed*, yes. However, it’s likely to irritate your skin at first, and that’s normal. If this persists more than a few weeks, or seems unduly severe, then you might want to stop and talk to your doctor again.
*See also: Scarring following inappropriate use of 0.05% tretinoin gel
(in the case of a young woman who used it 4x daily instead of 1x daily)
Want to try some?
Tretinoin is prescription-only, so speak with your doctor/pharmacist about that. Alternatively, retinol is the strongest natural alternative that works on the same principles; here’s an example product on Amazon 😎
Take care!
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The “Love Drug”
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Get PEA-Brained!
Today we’ll be looking at phenylethylamine, or PEA, to its friends.
Not to be mistaken for the related amino acid phenylalanine! Both ultimately have effects on the dopaminergic system, but the process and benefits are mostly quite different.
We thought we’d do this one in the week of Valentine’s Day, because of its popular association with love:
❝Phenylethylamine (PEA), an amphetamine-like substance that has been alluringly labeled the “chemical of love,” makes the best case for the love-chocolate connection since it has been shown that people in love may actually have higher levels of PEA in their brain, as surmised from the fact that their urine is richer in a metabolite of this compound. In other words, people thrashing around in the throes of love pee differently from others.❞
Source: Office for Science and Society | The Chemical of Love
What is it?
It’s an amino acid. Because we are mammals, we can synthesize it inside our bodies, so it’s not considered an “essential amino acid”, i.e. one that we need to get from our diet. It is found in some foods, though, including:
- Other animals, especially other mammals
- Various beans, legumes, nuts, seeds. In particular almonds, soybeans, lentils, and chickpeas score highly
- Fermented foods
- Chocolate (popular lore holds this to be a good source of PEA; science finds it to be a fair option, but not in the same ballpark as the other items)
Fun fact: the reason Marvel’s Venom has a penchant for eating humans and chocolate is (according to the comics) because phenylethylamine is an essential amino acid for it.
What does it do for us?
It’s a Central Nervous System (CNS) stimulant, and also helps us synthesize critical neurotransmitters such as dopamine, norepinephrine (adrenaline) and serotonin:
It works similarly, but not identically, to amphetamines:
Is it safe?
We normally do this after the benefits, but “it works similarly to amphetamines” may raise an eyebrow or two, so let’s do it here:
- It is recommended to take no more than 500mg/day, with 100mg–500mg being typical doses
- It is not recommended to take it at all if you have, or have a predisposition to, any kind of psychotic disorder (especially schizophrenia, or bipolar disorder wherein you sometimes experience mania)
- This isn’t a risk for most people, but if you fall into the above category, the elevated dopamine levels could nudge you into a psychotic/manic episode that you probably don’t want.
See for example: Does phenylethylamine cause schizophrenia?
There are other contraindications too, so speak with your doctor/pharmacist before trying it.
On the other hand, if you are considering ADHD medication, then phenylethylamine could be a safer thing to try first, to see if it helps, before going to the heavy guns of actual amphetamines (as are commonly prescribed for ADHD). Same goes for depression and antidepressants.
What can I expect from PEA?
More dopamine, norepinephrine, and serotonin. Mostly the former two. Which means, you can expect stimulation.
For focus and attention, it’s so effective that it has been suggested (as we mentioned above) as a safer alternative to ADHD meds:
β-phenylethylamine, a small molecule with a large impact
…and may give similar benefits to people without ADHD, namely improved focus, attention, and mental stamina:
It also improves mood:
❝Phenylethylamine (PEA), an endogenous neuroamine, increases attention and activity in animals and has been shown to relieve depression in 60% of depressed patients. It has been proposed that PEA deficit may be the cause of a common form of depressive illness.
Effective dosage did not change with time. There were no apparent side effects. PEA produces sustained relief of depression in a significant number of patients, including some unresponsive to the standard treatments. PEA improves mood as rapidly as amphetamine but does not produce tolerance.❞
Source: Sustained antidepressant effect of PEA replacement
Where can I get it?
We don’t sell it, but here is an example product on Amazon for your convenience
Enjoy!
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Thinking, Fast and Slow – by Dr. Daniel Kahneman
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We all try to make the best decisions we can with the information available… Don’t we?
Yet, somehow, a survival chance of 90% seems better than a mortality rate of 10%, and as it turns out, we as fallible humans are prey to all manner of dubious heuristics.
Nobel Prize winner Dr. Daniel Kahneman lays out for us two sytems of thought process:
- Fast, intuitive, emotional
- Slow, deliberate, logical
He makes the case for how and why we do need both, but often end up using the wrong one. He notes how the first is required for efficiency, or we would spend all day deciding what socks to wear… The second, meanwhile, is required for high-stakes decisions, but is lazy by nature, and often we don’t engage it when we ought to.
Over the course of many diverse examples, Dr. Kahneman shows how again and again, the second system is slowly cogitating at the back of the class, while the first system is bouncing up and down with its hand in the air saying “I know! I know!”, even when, in fact, it does not know.
For a book largely founded in economics (it’s a massive takedown of the notion of the rational consumer), it is not at all dry, and is very readable in style. It’s engaging throughout, and readers far removed from Wall Street will find plenty of ways it relates to our everyday lives.
Bottom line: if you’d like to avoid making many mistakes in what you’d assumed to be rational decisions, this book is critical reading.
Click here to check out “Thinking, Fast And Slow”, and enjoy the results of better decisions!
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An Unexpected Extra Threat Of Alcohol
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.
If You Could Use Some Exotic Booze…
…then for health reasons, we’re going to have to say “nay”.
We’ve written about alcohol before, and needless to say, it’s not good:
(the answer is “no, we cannot”)
In fact, the WHO (which unlike government regulatory bodies setting “safe” limits on drinking, makes no profit from taxes on alcohol sales) has declared that “the only safe amount of alcohol is zero”:
WHO: No level of alcohol consumption is safe for our health
Up there, where the air is rarefied…
If you’re flying somewhere this summer (Sinatra-style flying honeymoon or otherwise), you might want to skip the alcohol even if you normally do imbibe, because:
❝…even in young and healthy individuals, the combination of alcohol intake with sleeping under hypobaric conditions poses a considerable strain on the cardiac system and might lead to exacerbation of symptoms in patients with cardiac or pulmonary diseases.
These effects might be even greater in older people; cardiovascular symptoms have a prevalence of 7% of inflight medical emergencies, with cardiac arrest causing 58% of aircraft diversions.❞
Source: Alcohol plus cabin pressure at higher altitude may threaten sleeping plane passengers’ heart health
The experiment divided subjects into a control group and a study group; the study group were placed in simulated cabin pressure as though at altitude, which found, when giving some of them two small(we’re talking the kind given on flights) alcoholic drinks:
❝The combination of alcohol and simulated cabin pressure at cruising altitude prompted a fall in SpO2 to an average of just over 85% and a compensatory increase in heart rate to an average of nearly 88 beats/minute during sleep.❞
In contrast, that was 77 beats/minute for those who had alcohol but weren’t at altitude pressure, or 64 beats/minute for those who neither drank nor were at altitude pressure.
Lots more metrics were recorded and the study is interesting to read; if you’ve ever slept on a plane and thought “that sleep was not restful at all”, then know: it wasn’t just the seat’s fault, nor the engine, nor the recycled nature of the air—it was the reduced pressure causing hypoxia (defined as having oxygen levels lower than the healthy clinical norm of 90%) and almost halving your sleep’s effectiveness for a less than 10% drop in available oxygen in the blood (the sleepers not at altitude pressure averaged 96% SpO2, compared to the 85% at altitude).
We say “almost halving” because the deep sleep phase of sleep was reduced from 84 minutes (control) to 67.5 minutes at altitude without alcohol, or 46.5 minutes at altitude with alcohol.
Again, this was a pressure cabin in a lab—so this wasn’t about the other conditions of an airplane (seats, engine hundreds of other people, etc).
Which means: in an actual airplane it’s probably even worse.
Oh, and the study participants? All healthy individuals aged 18–40, so again probably worse for those older (or younger) than that range, or with existing health conditions!
Want to know more?
You can read the study in full here:
Want to drop the drink at any altitude? Check out:
Want to get that vacation feel without alcohol? You’re going to love:
Mocktails – by Moira Clark (book)
Enjoy!
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The Brain-Gut Highway: A Two-Way Street
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The Brain-Gut Two-Way Highway
This is Dr. Emeran Mayer. He has the rather niche dual specialty of being a gastroenterologist and a neurologist. He has published over 353 peer reviewed scientific articles, and he’s a professor in the Departments of Medicine, Physiology, and Psychiatry at UCLA. Much of his work has been pioneering medical research into gut-brain interactions.
We know the brain and gut are connected. What else does he want us to know?
First, that it is a two-way interaction. It’s about 90% “gut tells the brain things”, but it’s also 10% “brain tells the gut things”, and that 10% can make more like a 20% difference, if for example we look at the swing between “brain using that 10% communication to tell gut to do things worse” or “brain using that 10% communication to tell gut to do things better”, vs the midpoint null hypothesis of “what the gut would be doing with no direction from the brain”.
For example, if we are experiencing unmanaged chronic stress, that is going to tell our gut to do things that had an evolutionary advantage 20,000–200,000 years ago. Those things will not help us now. We do not need cortisol highs and adrenal dumping because we ate a piece of bread while stressed.
Read more (by Dr. Mayer): The Stress That Evolution Has Not Prepared Us For
With this in mind, if we want to look after our gut, then we can start before we even put anything in our mouths. Dr. Mayer recommends managing stress, anxiety, and depression from the head downwards as well as from the gut upwards.
Here’s what we at 10almonds have written previously on how to manage those things:
- No-Frills, Evidence-Based Mindfulness
- How To Set Anxiety Aside
- The Mental Health First-Aid You’ll Hopefully Never Need
Do eat for gut health! Yes, even if…
Unsurprisingly, Dr. Mayer advocates for a gut-friendly, anti-inflammatory diet. We’ve written about these things before:
…but there’s just one problem:
For some people, such as with IBS, Crohn’s, and colitis, the Mediterranean diet that we (10almonds and Dr. Mayer) generally advocate for, is inaccessible. If you (if you have those conditions) eat as we describe, a combination of the fiber in many vegetables and the FODMAPs* in many fruits, will give you a very bad time indeed.
*Fermentable Oligo-, Di-, Monosaccharides And Polyols
Dr. Mayer has the answer to this riddle, and he’s not just guessing; he and his team did science to it. In a study with hundreds of participants, he measured what happened with adherence (or not) to the Mediterranean diet (or modified Mediterranean diet) (or not), in participants with IBS (or not).
The results and conclusions from that study included:
❝Among IBS participants, a higher consumption of fruits, vegetables, sugar, and butter was associated with a greater severity of IBS symptoms. Multivariate analysis identified several Mediterranean Diet foods to be associated with increased IBS symptoms.
A higher adherence to symptom-modified Mediterranean Diet was associated with a lower abundance of potentially harmful Faecalitalea, Streptococcus, and Intestinibacter, and higher abundance of potentially beneficial Holdemanella from the Firmicutes phylum.
A standard Mediterranean Diet was not associated with IBS symptom severity, although certain Mediterranean Diet foods were associated with increased IBS symptoms. Our study suggests that standard Mediterranean Diet may not be suitable for all patients with IBS and likely needs to be personalized in those with increased symptoms.❞
In graphical form:
And if you’d like to read more about this (along with more details on which specific foods to include or exclude to get these results), you can do so…
- The study itself (full article): The Association Between a Mediterranean Diet and Symptoms of Irritable Bowel Syndrome
- Dr. Mayer’s blog (lay explanation): The Benefits of a Modified Mediterranean Diet for Irritable Bowel Syndrome
Want to know more?
Dr. Mayer offers many resources, including a blog, books, recipes, podcasts, and even a YouTube channel:
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Digital Minimalism – by Dr. Cal Newport
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There are a lot of books that advise “Unplug once in a while, and go outside”. But it doesn’t really take a book to convey that, does it? And it just leaves all the digital catching-up once we get back. Surely there must be a better way?
Rather than relying on a “digital detox”, Dr. Newport offers principles to apply to our digital lives, that allow us to reap the benefits of modern information technology without being obeisant to it.
The book’s greatest strength lies in that; having clear guidelines that can be applied to cut out the extra weight of digital media that has simply snuck in because of The Almighty Algorithm—and even tips on how to engage more mindfully with that if we still want to, for example using social media only in a web browser rather than on our phones, so that we can ringfence the time for it rather than having it spill into every spare moment.
In the category of criticism, the book sometimes lacks a little awareness when it comes to assumptions about the reader and the reader’s social circles; that (for example) nobody has any disabilities and everyone lives in the same town. But for most people most of the time, the advices will stand, and the exceptions can be managed by the reader neatly enough.
Stylistically, the book is not very minimalist, but this is not inconsistent with the advice of the book, if you’re curling up in the armchair with a physical copy, or a single-purpose ereader device.
Bottom line: if you’d like to streamline your use of digital media, but don’t want to lose out on the value it brings you, this book provides an excellent template
Click here to check out Digital Minimalism, and choose focused life in a noisy world!
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