Treat Your Own Hip – by Robert McKenzie
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We previously reviewed another book by this author in this series, “Treat Your Own Knee”, and today it’s the same deal, but for the hip.
A quick note about the author first: a physiotherapist and not a doctor, but with over 40 years of practice to his name and 33 letters after his name (CNZM OBE FCSP (Hon) FNZSP (Hon) Dip MDT Dip MT), he seems to know his stuff.
He takes the reader through first diagnosing the nature of the pain (and how to rule out, for example, a back problem manifesting as hip pain, rather than a hip problem per se—and points to his own “Treat Your Own Back” manual if it turns out that that’s your problem instead), and then treating it. A bold claim, the kind that many people’s lawyers don’t let them make, but once again, this guy is pretty much the expert when it comes to this. Ask any other physiotherapist, and they probably have several of his books on their shelf.
The treatments recommend are tailored to the results of various diagnostic flowcharts; essentially troubleshooting your hip. However, they mainly consist of exercises (perhaps the greatest value of the book), and lifestyle adjustments (these ones, 10almonds readers probably know already, but a reminder never hurts).
The explanations are thorough while still being comprehensible, and there is zero sensationalization or fluff. It is straight to the point, and clearly illustrated too with diagrams and photographs.
Bottom line: if you’re looking for a “one-stop shop” for diagnosing and treating your bad hip, then this is it.
Click here to check out Treat Your Own Hip, and indeed Treat Your Own Hip!
PS: if you have musculoskeletal problems elsewhere in your body, you might want to check out the rest of his body parts series (neck, back, shoulder, wrist, knee, ankle) for the one that’s tailored to your specific problem.
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The Imperfect Nutritionist – by Jennifer Medhurst
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The idea of the “imperfect nutritionist” is to note that we’re all different with slightly different needs and sometimes very different preferences (or circumstances!) and having a truly perfect diet is probably a fool’s errand. Should we just give up, then? Not at all:
What we can do, Medhust argues, is find what’s best for us, realistically.
It’s better to have an 80% perfect diet 80% of the time, than to have a totally perfect diet for four and a half meals before running out of steam (and ingredients).
As for the “seven principles” mentioned in the title… we’re not going to keep those a mystery; they are:
- Focusing on wholefood
- Being diverse
- Knowing your fats
- Including fermented, prebiotic and probiotic foods
- Reducing refined carbohydrates
- Being aware of liquids
- Eating mindfully
The first part of the book is a treatise on how to implement those principles in your diet generally; the second part of the book is a recipe collection—70 recipes, with “these ingredients will almost certainly be available at your local supermarket” as a baseline. No instances of “the secret to being a good chef is knowing how to source fresh ingredients; ask your local greengrocer where to find spring-harvested perambulatory truffle-cones” here!
Basically, it focusses on adding healthy foods per your personal preferences and circumstances, and building these up into a repertoire of meals that will keep you and your family happy and healthy.
Pick Up Your Copy Of The Imperfect Nutritionist From Amazon Today!
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The Art and Science of Connection – by Kasley Killam, MPH
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We can eat well, exercise well, and even sleep well, and we’ll still have a +53% increased all-cause mortality if we lack social connection—even if we technically have support and access to social resources, just not the real human connection itself. And as we get older, it gets increasingly easy to find ourselves isolated.
The author is a social scientist by profession, and it shows. None of what she shares in the book is wishy-washy; it has abundant scientific references coming thick and fast, and a great deal of clarity with regard to terms, something often not found in books of this genre that lean more towards the art than the science.
On which note, for the reader who may be thinking “I am indeed quite alone”, she also offers proven techniques for remedying that; not in the way that many books use the word “proven” to mean “we got some testimonials”, but rather, proven in the sense of “we did science to it and based on these 17 large population-based retrospective cohort studies, we can say with 99% confidence that this is an effective tool to mediate improved social bonds and social health outcomes”.
To this end, it’s a very practical book also, and should bestow upon any isolated reader a sense of confidence that in fact, things can be better. A particular strength is that it also looks at many different scenarios, so for the “what if I…” people with clear reasons why social connection is not abundantly available, yes, she has such cases covered too.
Bottom line: if you’d like to live more healthily for longer, social health is an underrated and oft-forgotten way of greatly increasing those things, by science.
Click here to check out The Art And Science Of Social Connection, and get connected!
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Why Many Nonprofit (Wink, Wink) Hospitals Are Rolling in Money
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One owns a for-profit insurer, a venture capital company, and for-profit hospitals in Italy and Kazakhstan; it has just acquired its fourth for-profit hospital in Ireland. Another owns one of the largest for-profit hospitals in London, is partnering to build a massive training facility for a professional basketball team, and has launched and financed 80 for-profit start-ups. Another partners with a wellness spa where rooms cost $4,000 a night and co-invests with “leading private equity firms.”
Do these sound like charities?
These diversified businesses are, in fact, some of the country’s largest nonprofit hospital systems. And they have somehow managed to keep myriad for-profit enterprises under their nonprofit umbrella — a status that means they pay little or no taxes, float bonds at preferred rates, and gain numerous other financial advantages.
Through legal maneuvering, regulatory neglect, and a large dollop of lobbying, they have remained tax-exempt charities, classified as 501(c)(3)s.
“Hospitals are some of the biggest businesses in the U.S. — nonprofit in name only,” said Martin Gaynor, an economics and public policy professor at Carnegie Mellon University. “They realized they could own for-profit businesses and keep their not-for-profit status. So the parking lot is for-profit; the laundry service is for-profit; they open up for-profit entities in other countries that are expressly for making money. Great work if you can get it.”
Many universities’ most robust income streams come from their technically nonprofit hospitals. At Stanford University, 62% of operating revenue in fiscal 2023 was from health services; at the University of Chicago, patient services brought in 49% of operating revenue in fiscal 2022.
To be sure, many hospitals’ major source of income is still likely to be pricey patient care. Because they are nonprofit and therefore, by definition, can’t show that thing called “profit,” excess earnings are called “operating surpluses.” Meanwhile, some nonprofit hospitals, particularly in rural areas and inner cities, struggle to stay afloat because they depend heavily on lower payments from Medicaid and Medicare and have no alternative income streams.
But investments are making “a bigger and bigger difference” in the bottom line of many big systems, said Ge Bai, a professor of health care accounting at the Johns Hopkins University Bloomberg School of Public Health. Investment income helped Cleveland Clinic overcome the deficit incurred during the pandemic.
When many U.S. hospitals were founded over the past two centuries, mostly by religious groups, they were accorded nonprofit status for doling out free care during an era in which fewer people had insurance and bills were modest. The institutions operated on razor-thin margins. But as more Americans gained insurance and medical treatments became more effective — and more expensive — there was money to be made.
Not-for-profit hospitals merged with one another, pursuing economies of scale, like joint purchasing of linens and surgical supplies. Then, in this century, they also began acquiring parts of the health care systems that had long been for-profit, such as doctors’ groups, as well as imaging and surgery centers. That raised some legal eyebrows — how could a nonprofit simply acquire a for-profit? — but regulators and the IRS let it ride.
And in recent years, partnerships with, and ownership of, profit-making ventures have strayed further and further afield from the purported charitable health care mission in their community.
“When I first encountered it, I was dumbfounded — I said, ‘This not charitable,’” said Michael West, an attorney and senior vice president of the New York Council of Nonprofits. “I’ve long questioned why these institutions get away with it. I just don’t see how it’s compliant with the IRS tax code.” West also pointed out that they don’t act like charities: “I mean, everyone knows someone with an outstanding $15,000 bill they can’t pay.”
Hospitals get their tax breaks for providing “charity care and community benefit.” But how much charity care is enough and, more important, what sort of activities count as “community benefit” and how to value them? IRS guidance released this year remains fuzzy on the issue.
Academics who study the subject have consistently found the value of many hospitals’ good work pales in comparison with the value of their tax breaks. Studies have shown that generally nonprofit and for-profit hospitals spend about the same portion of their expenses on the charity care component.
Here are some things listed as “community benefit” on hospital systems’ 990 tax forms: creating jobs; building energy-efficient facilities; hiring minority- or women-owned contractors; upgrading parks with lighting and comfortable seating; creating healing gardens and spas for patients.
All good works, to be sure, but health care?
What’s more, to justify engaging in for-profit business while maintaining their not-for-profit status, hospitals must connect the business revenue to that mission. Otherwise, they pay an unrelated business income tax.
“Their CEOs — many from the corporate world — spout drivel and turn somersaults to make the case,” said Lawton Burns, a management professor at the University of Pennsylvania’s Wharton School. “They do a lot of profitable stuff — they’re very clever and entrepreneurial.”
The truth is that a number of not-for-profit hospitals have become wealthy diversified business organizations. The most visible manifestation of that is outsize executive compensation at many of the country’s big health systems. Seven of the 10 most highly paid nonprofit CEOs in the United States run hospitals and are paid millions, sometimes tens of millions, of dollars annually. The CEOs of the Gates and Ford foundations make far less, just a bit over $1 million.
When challenged about the generous pay packages — as they often are — hospitals respond that running a hospital is a complicated business, that pharmaceutical and insurance execs make much more. Also, board compensation committees determine the payout, considering salaries at comparable institutions as well as the hospital’s financial performance.
One obvious reason for the regulatory tolerance is that hospital systems are major employers — the largest in many states (including Massachusetts, Pennsylvania, Minnesota, Arizona, and Delaware). They are big-time lobbying forces and major donors in Washington and in state capitals.
But some patients have had enough: In a suit brought by a local school board, a judge last year declared that four Pennsylvania hospitals in the Tower Health system had to pay property taxes because its executive pay was “eye popping” and it demonstrated “profit motives through actions such as charging management fees from its hospitals.”
A 2020 Government Accountability Office report chided the IRS for its lack of vigilance in reviewing nonprofit hospitals’ community benefit and recommended ways to “improve IRS oversight.” A follow-up GAO report to Congress in 2023 said, “IRS officials told us that the agency had not revoked a hospital’s tax-exempt status for failing to provide sufficient community benefits in the previous 10 years” and recommended that Congress lay out more specific standards. The IRS declined to comment for this column.
Attorneys general, who regulate charity at the state level, could also get involved. But, in practice, “there is zero accountability,” West said. “Most nonprofits live in fear of the AG. Not hospitals.”
Today’s big hospital systems do miraculous, lifesaving stuff. But they are not channeling Mother Teresa. Maybe it’s time to end the community benefit charade for those that exploit it, and have these big businesses pay at least some tax. Communities could then use those dollars in ways that directly benefit residents’ health.
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.
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Keep Cellulite At Bay
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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 😎
❝Does anything actually get rid of cellulite? Nothing seems to❞
Let’s get the bad news over with in one go:
Nothing (that the scientific world currently knows of) can get rid of cellulite permanently, nor completely guard against it proactively. Which, given that it affects up to 98% of women to some degree, and often shows up not long after puberty (though it can appear at any time and often increases later in life), any pre-emptive health regime would need to be started as a child in any case.
As with many things that predominantly affect women, the world of medicine isn’t entirely sure what causes it, let alone how to effectively treat it.
Obviously hormones are implicated, namely estrogen.
Obviously adiposity is implicated, because one can’t have dimples in one’s fat if one doesn’t have enough fat to dimple.
Other hypothesized contributory factors include genetics, poor diet, inactivity, unhealthy lifestyle (in ways not previously mentioned, e.g. use of alcohol, tobacco, etc), accumulated toxins, and pregnancy.
Here’s an old paper (from 2004); today’s reviews say pretty much the same thing, but we love how succinctly (albeit, somewhat depressingly) this abstract states how little we know and how little we can do:
Cellulite: a review of its physiology and treatment
However, all is not lost!
There are some things that can affect how much cellulite we get, and there are some things that can reduce it, and even some things that can get rid of it completely—albeit temporarily.
First, a quick refresher on what it actually is, physiologically speaking: cellulite occurs when connective tissue bands pull the skin down in places, where fat tissue has been able to squeeze through. One of the reasons it is hypothesized women get this more than men is because our fat is not merely different in distribution and overall percentage, but also in how the fat cells stack up; we generally have have of a vertical stacking structure going on, while men generally have a more horizontal structure. This means that it can be easier for ours to get moved about differently, causing the connective tissue to pull on the skin unevenly in places.
With that in mind…
Prevention is, as we say, probably impossible if your body is running on estrogen. However, those contributory factors we mentioned above? Most of those are modifiable, including these things that it is hypothesized can reduce it:
Diet: as it seems to be worsened by inflammation (what isn’t?), an anti-inflammatory diet is recommended.
Exercise: there are three things here: 1) exercises to improve circulation and thus the body’s ability to sort things out by itself 2) HIIT exercise to reduce body fat percentage, if one has a high enough starting body fat percentage for that to be a healthy goal 3) mobility exercises, to ensure our connective tissues are the right amount of mobile.
Creams and lotions
These reduce the superficial appearance of cellulite, without actually treating the thing itself. Mostly they are caffeine-based, which when used topically increases blood flow and works as a local diuretic, reducing the water content of the fat cells, diminishing the appearance of the cellulite by making each fat cell physically smaller (while still containing the same amount of fat, and it’ll bounce back in size as soon as the body can restore osmotic balance).
Medical procedures
There are too many of these to discuss them all separately, but they all work on the principle of breaking up the tough bands of connective tissue to eliminate the dimpling of cellulite.
The methods they use vary from ultrasound to cryolipolysis to lasers to “vacuum-assisted precise tissue release”, which involves a suction pump and a multipronged robotic assembly with needles to administer anaesthetic as it goes and small blades to cut the connective tissues under the skin:
Tissue Stabilized–Guided Subcision for the Treatment of Cellulite
That last one definitely sounds like the least fun, but it’s also the only one that doesn’t take months to maybe see results.
Cellulite can and almost certainly will come back after all of these.
Home remedies
Aside from at-home versions of the above (not the robots with vacuum pumps and needles and microblades, hopefully, but for example homemade caffeine creams), and of course diet and exercise which can be considered “home remedies”, there are two more things worth mentioning:
Dry brushing: using a body brush to, as the name suggests, simply brush one’s skin. The “dry” aspect here is simply that it’s not done in the bath or shower; it’s done while dry. It can improve local circulation of blood and lymph, allowing for better detoxification and redistribution of needed bodily resources.
Here’s an example dry brushing body brush on Amazon; this writer has one and hates it, but I’ve also tried with other kinds of brush and hate them too, so it seems to be a me thing rather than a brush thing, and I have desisted in trying, now. Maybe you will like it better; many people do.
Self-massage: or massage by someone else, if that’s an option for you and you prefer. In this case, it works by a different mechanism than dry brushing; this time it’s working by the same principle as the medical techniques described in the previous section; it’s physically breaking down the toughened bits of connective tissue.
Here’s an example wooden massage roller on Amazon; this writer has one and loves it; it’s sooooooo good. I got it as a matter of general maintenance for my fascia, but it’s also very good if I get a muscular pain now and again. As for cellulite, I personally get just a little cellulite sometimes (in the backs of my thighs), and whenever I use this regularly, it goes away for at least a while.
A quick note in closing
Cellulite is normal for women and is not unhealthy. Much like gray hair for example, it’s something that can be increased by poor health, but the thing itself isn’t intrinsically unhealthy, and most of us get it to some degree at some point.
Nevertheless, aesthetic factors can also have a role to play in mental health, and we tend to feel best when we like the way our body looks. If for you that means wanting less/no cellulite, then the above are some ways towards that.
As a bonus, most of the nonmedical options are directly good for the physical health anyway, so doing them is of course good.
In particular that last one (the wooden massage roller), because that connective tissue we talked about? It matters for a lot more than just cellulite, and is heavily implicated in a lot of kinds of chronic pain, so it pays to keep it in good health:
Fascia: Why (And How) You Should Take Care Of Yours
(that article, also written by this same writer by the way, suggests a vibrating foam roller—those are very popular; I just really love my wooden one, and find it more effective)
Take care!
Don’t Forget…
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Chair Stretch Workout Guide
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It’s Q&A Day 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!
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
❝The 3 most important exercises don’t work if you can’t get on the floor. I’m 78, and have knee replacements. What about 3 best chair yoga stretches? Love your articles!❞
Here are six!
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What Matters Most For Your Heart?
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Eat More (Of This) For Lower Blood Pressure
Heart disease remains the world’s #1 killer. We’d say “and in the US, it’s no different”, but in fact, the US is #1 country for heart disease. So, it’s worse and perhaps some extra care is in order.
But how?
What matters the most
Is it salt? Salt plays a part, but it’s not even close to the top problem:
Hypertension: Factors Far More Relevant Than Salt
Is it saturated fat? Saturated fat from certain sources plays more of a role than salt, but other sources may not be so much of an issue:
Can Saturated Fats Be Heart-Healthy?
Is it red meat? Red meat is not great for the heart (or for almost anything else, except perhaps anemia):
The Whys and Hows of Cutting Meats Out Of Your Diet
…but it’s still not the top dietary factor.
The thing many don’t eat
All the above are foodstuffs that a person wanting a healthier heart and cardiovascular system in general might (reasonably and usually correctly) want to cut down, but there’s one thing that most people need more of:
Why You’re Probably Not Getting Enough Fiber (And How To Fix It)
And this is especially true for heart health:
❝Dietary fiber has emerged as a crucial yet underappreciated part of hypertension management.
Our comprehensive analysis emphasizes the evidence supporting the effectiveness of dietary fiber in lowering blood pressure and reducing the risk of cardiovascular events.❞
Specifically, she and her team found:
- Each additional 5g of fiber per day reduces blood pressure by 2.8/2.1 (systolic/diastolic, in mmHG)
- Dietary fiber works in several ways to improve cardiovascular health, including via gut bacteria, improved lipids profiles, and anti-inflammatory effects
- Most people are still only getting a small fraction (¼ to ⅓) of the recommended daily amount of fiber. To realize how bad that is, imagine if you consumed only ¼ of the recommended daily amount of calories every day!
You can read more about it here:
Dietary fiber critical in managing hypertension, international study finds
That’s a pop-science article, but it’s still very informative. If you prefer to read the scientific paper itself (or perhaps as well), you can find it below
Recommendations for the Use of Dietary Fiber to Improve Blood Pressure Control
Want more from your fiber?
Here’s yet another way fiber improves cardiometabolic health, hot off the academic press (the study was published just a couple of weeks ago):
How might fiber lower diabetes risk? Your gut could hold the clues
this pop-science article was based on this scientific paper
Gut Microbiota and Blood Metabolites Related to Fiber Intake and Type 2 Diabetes
Take care!
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