Treat Your Own Knee – by Robin McKenzie
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First, a note about the author: he’s a physiotherapist and not a doctor, but with 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.
The book covers recognizing the difference between arthritis, degeneration, or normal wear and tear, before narrowing down what your actual problem is and what can be done about it.
While there are many possible causes of knee pain (and by causes, we mean the first-level cause, such as “bad posture” or “old sports injury” or “inflammatory diet” or “repetitive strain” etc, not second-level causes that are also symptoms, like inflammation), McKenzie’s approach involves customizing his system to your body’s specific problems and needs. That’s what most of the book is about.
The style is direct and to-the-point; there’s no sensationalization here nor a feel of being sold anything. There’s lots of science scattered throughout, but all with the intent of enabling the reader to understand what’s going on with the problems, processes, and solutions, and why/how the things that work, work. Where there are exercises offered they are clearly-described and well-illustrated.
Bottom line: this is not a fancy book but it is an effective one. If you have knee pain, this is a very worthwhile one to read.
Click here to check out Treat Your Own Knee, and treat your own knee!
PS: if you have musculoskeletal problems elsewhere in your body, you might want to check out the rest of his body parts series (back, hip, neck, wrist, ankle, etc) for the one that’s tailored to your specific problem.
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“You Just Need to Lose Weight” And 19 Other Myths About Fat People – by Aubrey Gordon
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We’ve previously reviewed another book by this author, “What We Don’t Talk About When We Talk About Fat”, and this time, she’s doing some important mythbusting.
The titular “you just need to lose weight” is a commonly-taken easy-out for many doctors, to avoid having to dispense actual treatment for an actual condition. Whether or not weight loss would help in a given situation is often immaterial; “kicking the can down the road” is the goal.
Most of the book is divided into 20 chapters, each of them devoted to debunking one myth. Think of it like 10almonds’ “Mythbusting Friday” edition (indeed, we did one about obesity), but with an entire book, and as much room as she needs to provide much more detail than we can ever get into in a single article.
And far from being a mere polemic, she does indeed provide that detail—this is clearly a very well-researched book, above and beyond the author’s own personal experience. Further, all the key points are illustrated and articulated clearly, making the book’s ideas very comprehensible.
The style is pop-science, but with frequent bibliographical references for relevant sources.
Bottom line: for some readers, this book will come as a great validation; for others, it may be eye-opening. Either way, it’s a very worthwhile read.
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Menopause, & When Not To Let Your Guard Down
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This is Dr. Jessica Shepherd, a physician Fellow of the American College of Obstetricians & Gynecologists, CEO at Sanctum Medical & Wellness, and CMO at Hers.
She’s most well-known for her expertise in the field of the menopause. So, what does she want us to know?
Untreated menopause is more serious than most people think
Beyond the famous hot flashes, there’s also the increased osteoporosis risk, which is more well-known at least amongst the health-conscious, but oft-neglected is the increased cardiovascular disease risk:
What Menopause Does To The Heart
…and, which a lot of Dr. Shepherd’s work focuses on, it also increases dementia risk; she cites that 60–80% of dementia cases are women, and it’s also established that it progresses more quickly in women than men too, and this is associated with lower estrogen levels (not a problem for men, because testosterone does it for them) which had previously been a protective factor, but in untreated menopause, was no longer there to help:
Alzheimer’s Sex Differences May Not Be What They Appear
Treated menopause is safer than many people think
The Women’s Health Initiative (WHI) study, conducted in the 90s and published in 2002, linked HRT to breast cancer, causing fear, but it turned out that this was quite bad science in several ways and the reporting was even worse (even the flawed data did not really support the conclusion, much less the headlines); it was since broadly refuted (and in fact, it can be a protective factor, depending on the HRT regimen), but fearmongering headlines made it to mainstream news, whereas “oopsies, never mind, we take that back” didn’t.
The short version of the current state of the science is: breast cancer risk varies depending on age, HRT type, and dosage; some kinds of HRT can increase the risk marginally in those older than 60, but absolute risk is low compared to placebo, and taking estrogen alone can reduce risk at any age in the event of not having a uterus (almost always because of having had a hysterectomy; as a quirk, it is possible to be born without, though).
It’s worth noting that even in the cases where HRT marginally increased the risk of breast cancer, it significantly decreased the risk of cancers in total, as well fractures and all-cause-mortality compared to the placebo group.
In other words, it might be worth having a 0.12% risk of breast cancer, to avoid the >30% risk of osteoporosis, which can ultimately be just as fatal (without even looking at the other things the HRT is protective against).
However! In the case of those who already have (or have had) breast cancer, increasing estrogen levels can indeed make that worse/return, and it becomes more complicated in cases where you haven’t had it, but there is a family history of it, or you otherwise know you have the gene for it.
You can read more about HRT and breast cancer risk (increases and decreases) here:
…and about the same with regard to HMT, here:
The Hormone Therapy That Reduces Breast Cancer Risk & More
Lifestyle matters, and continues to matter
Menopause often receives the following attention from people:
- Perimenopause: “Is this menopause?”
- Menopause: “Ok, choices to make about HRT or not, plus I should watch out for osteoporosis”
- Postmenopause: “Yay, that’s behind me now, back to the new normal”
The reality, Dr. Shepherd advises, is that “postmenopause” is a misnomer because if it’s not being treated, then the changes are continuing to occur in your body.
This is a simple factor of physiology; your body is always rebuilding itself, will never stop until you die, and in untreated menopause+postmenopause, it’s now doing it without much estrogen.
So, you can’t let your guard down!
Thus, she recommends: focus on maintaining muscle mass, bone health, and cardiovascular health. If you focus on those things, the rest (including your brain, which is highly dependent on cardiovascular health) will mostly take care of itself.
Because falls and fractures, particularly hip fractures, drastically reduce quality and length of life in older adults, it is vital to avoid those, and try to be sufficiently robust so that if you do go A over T, you won’t injure yourself too badly, because your bones are strong. As a bonus, the same things (especially that muscle mass we talked about) will help you avoid falling in the first place, by improving stability.
See also: Resistance Is Useful! (Especially As We Get Older)
And about falls specifically: Fall Special: Be Robust, Mobile, & Balanced!
Want to know more from Dr. Shepherd?
You might like this book of hers that we reviewed not long back:
Generation M – by Dr. Jessica Shepherd
Take care!
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Flexible Dieting – by Alan Aragon
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This is the book from which we were working, for the most part, in our recent Expert Insights feature with Alan Aragon. We’ll re-iterate here: despite not being a Dr. Aragon, he’s a well-published research scientist with decades in the field of nutritional science, as well as being a personal trainer and fitness educator.
As you may gather from our other article, there’s a lot more to this book than “eat what you like”. Specifically, as the title suggests, there’s a lot of science—decades of it, and while we had room to cite a few studies in our article, he cites many many more; several citations per page of a 288-page book.
So, that sets the book apart from a lot of its genre; instead of just “here’s what some gym-bro thinks”, it’s “here’s what decades of data says”.
Another strength of this book is how clearly he explains such a lot of science—he explains terms as they come up, as well as having a generous glossary. He also explains things clearly and simply without undue dumbing down—just clarity of communication.
The style is to-the-point and instructional; it’s neither full of fitness-enthusiast hype nor dry academia, and keeps a light and friendly conversational tone throughout.
Bottom line: if you’d like to get your diet in order and you want to do it right while also knowing which things still need attention (and why) and which you can relax about (and why), then this book will get you there.
Click here to check out Flexible Dieting, and take an easy, relaxed control of yours!
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The Non-Alcoholic Drinker – by James Ellison
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A mere few decades ago, it was often considered antisocial not to smoke. These days, it’s antisocial if you do. The same social change is starting to happen now with alcohol—Millennials are drinking much less than they did in decades past, and Gen Z are hardly drinking at all.
The author, himself a Baby Boomer, champions the cause of mindful, and/but joyful, abstemiousness. Which latter two words don’t often go together, but in this case, he really has put in a lot of work to make non-alcoholic drinking as exciting, fun, and sophisticated as alcoholic drinking always marketed itself to be.
The mocktail recipes in this book are an order of magnitude better than any others this reviewer has encountered before, and did you know they have non-alcoholic bitters now? As in, the cocktail ingredient. Nor is it the only non-alcoholic botanical used, and the ingredients in general are as varied and flavorful, if not sometimes more so, than many that get used in alcoholic mixes.
This book is a very far cry from “rum and coke without the rum”, and instead will have you excited to go ingredient-shopping, and even more excited when you find out how great non-alcoholic things can taste if given the right attention.
As a convenient extra touch, all the ingredients he mentions are available from Amazon, which takes away the fear of “ok, but where do I get…” when it comes to getting things in.
The book does cover things besides just the recipes themselves though, and also talks the reader through navigating non-alcoholism when friends of your own age (unless you’re one of our younger readers) are probably mostly still partying with alcohol.
Really, the biggest value of this book is the recipes, though.
Bottom line: if you’d like to entertain with sophistication and grace and/but not with alcohol, or even just take up a fun new healthy hobby, this book is by far the best book on non-alcoholic mixology that this reviewer has seen to date.
Click here to check out The Non-Alcoholic Drinker, and get mixing non-alcoholically!
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Dial Down Your Pain
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This is Dr. Christiane Wolf. Is than an MD or a PhD, you ask? The answer is: yes (it is both; the latter being in psychosomatic medicine).
She also teaches Mindfulness-Based Stress Reduction, which as you may recall is pretty much the most well-evidenced* form of meditation there is, in terms of benefits:
No-Frills, Evidence-Based Mindfulness
*which is not to claim it is necessarily the best (although it also could be); rather, this means that it is the form of meditation that’s accumulated the most scientific backing in total. If another equal or better form of meditation enjoyed less scientific scrutiny, then there could an alternative out there languishing with only two and a half scientific papers to its name. However, we at 10almonds are not research scientists, and thus can only comment on the body of evidence that has been published.
In any case, today is going to be about pain.
What does she want us to know?
Your mind does matter
It’s easy to think that anything you can do with your mind is going to be quite small comfort when your nerves feel like they’re on fire.
However, Dr. Wolf makes the case for pain consisting of three components:
- the physical sensation(s)
- the emotions we have about those
- the meaning we give to such (or “the story” that we use to describe it)
To clarify, let’s give an example:
- the physical sensations of burning, searing, and occasionally stabbing pains in the lower back
- the emotions of anguish, anger, despair, self-pity
- the story of “this pain has ruined my life, is making it unbearable, will almost certainly continue, and may get worse”
We are not going to tell you to throw any of those out of the window for now (and, would that you could throw the first line out, of course).
The first thing Dr. Wolf wants us to do to make this more manageable is to break it down.
Because presently, all three of those things are lumped together in a single box labelled “pain”.
If each of those items is at a “10” on the scale of pain, then this is 10×10×10=1000.
If our pain is at 1000/10, that’s a lot. We want to leave the pain in the box, not look at it, and try to distract ourselves. That is one possible strategy, by the way, and it’s not always bad when it comes to giving oneself a short-term reprieve. We balanced it against meditation, here:
Managing Chronic Pain (Realistically)
However, back to the box analogy, if we open that box and take out each of those items to examine them, then even without changing anything, even with them all still at 10, they can each be managed for what they are individually, so it’s now 10+10+10=30.
If our pain is at 30/10, that’s still a lot, but it’s a lot more manageable than 1000/10.
On rating pain, by the way, see:
Get The Right Help For Your Pain
Dealing with the separate parts
It would be nice, of course, for each of those separate parts to not be at 10.
With regard to the physical side of pain, this is not Dr. Wolf’s specialty, but we have some good resources here at 10almonds:
- The 7 Approaches To Pain Management
- 10 Tips To Reduce Morning Pain & Stiffness With Arthritis
- Science-Based Alternative Pain Relief: When Painkillers Aren’t Helping, These Things Might
When it comes to emotions associated with pain, Dr. Wolf (who incidentally is a Buddhist and also a teacher of same, and runs meditation retreats for such), recommends (of course) mindfulness, and what in Dialectical Behavior Therapy (DBT) is called “radical acceptance” (in Buddhism, it may be referred to as being at one with things). We’ve written about this here:
“Hello, Emotions”: Radical Acceptance In CBT & DBT
Once again, the aim here is still not to throw the (often perfectly valid) emotions out of the window (unless you want to), but rather, to neutrally note and acknowledge the emotions as they arrive, á la “Hello, despair. Depression, my old foe, we meet again. Hello again, resentment.” …and so on.
The reason this helps is because emotions, much like the physical sensations of pain, are first and foremost messengers, and sometimes (as in the case of chronic pain) they get broken and keep delivering the message beyond necessity. Acknowledging the message helps your brain (and all that is attached to it) realize “ok, this message has been delivered now; we can chill about it a little”.
Having done that, if you can reasonably tweak any of the emotions (for example, perhaps that self-pity we mentioned could be turned into self-compassion, which is more useful), that’s great. If not, at least you know what’s on the battlefield now.
When we examine the story of our pain, lastly, Dr. Wolf invites us to look at how one of the biggest drivers of distress under pain is the uncertainty of how long the pain will last, whether it will get worse, whether what we are doing will make it worse, and so forth. See for example:
How long does back pain last? And how can learning about pain increase the chance of recovery?
And of course, many things we do specifically in response to pain can indeed make our pain worse, and spread:
Dr. Wolf’s perspective says:
- Life involves pain
- Pain invariably has a cause
- What has a cause, can have an end
- We just need to go through that process
This may seem like small comfort when we are in the middle of the pain, but if we’ve broken it down into parts with Dr. Wolf’s “box method”, and dealt with the first two parts (the sensations and the emotions) as well as reasonably possible, then we can tackle the third one (the story) a little more easily than we could if we were trying to come at it with no preparation.
What used to be:
“This pain has ruined my life, is making it unbearable, will almost certainly continue, and may get worse”
…can now become:
“This pain is a big challenge, but since I’m here for it whether I want to be or not, I will suffer as I must, while calmly looking for ways to reduce that suffering as I go.”
In short: you cannot “think healing thoughts” and expect your pain to go away. But you can do a lot more than you might (if you left it unexamined) expect.
Want to know more from Dr. Wolf?
We reviewed a book of hers recently, which you might enjoy:
Outsmart Your Pain – by Dr. Christiane Wolf
Take care!
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How To Keep On Keeping On?
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How To Keep On Keeping On… Long Term!
For many when it comes to health-related goals and practices, it’s easy to find ourselves in a bit of a motivational dip around this time of year. The enthusiasm of new year’s resolutions has been and gone, and there’s not yet much of a drive to “get a beach body” or “be summer-ready”.
A word to the wise on those before moving on, though:
- How to get a beach body: take your body to a beach. Voilà. Beach body.
- Remember: the beach is there for your pleasure and entertainment, not the other way around!
- How to be summer-ready: the real question is, will summer be ready for you?
But what is this, demotivational rhetoric to discourage you from getting fit and healthy?
Not at all, but rather, to be sure that you’re pursuing your own goals and not just what you feel might be expected of you.
All that in mind, let’s get to the tips…
Focus on adding health
It can be tempting (and even, good) to cut down on unhealthy things. But when it comes to motivation, it’s harder to stay motivated for deprivation, than it is for some healthy addition to life.
So for example, this philosophy would advocate for:
- Instead of counting calories, count steps! Or even…
- Instead of counting calories, count colors! Eat the rainbow and all that. No, skittles do not count, but eating a variety of naturally different-colored foods will tend to result in adding different nutrients to your diet.
- Instead of cutting out sugar, add fruit! How many per day will you go for? If you don’t eat much fruit as it is, consider making it a goal to have even just one piece of fruit a day, then build up from there. Find fruit you like! If you pick the fruit you want instead of the fruit you think you “should” have, it’s basically a dessert snack.
We’ve recommended it before, and we’ll recommend it again, but if you’re interested in “adding health”, you should definitely check out:
Dr. Greger’s Daily Dozen (checklist, plus app if you want it)
More details: it’s a checklist of 12 things you should try to include in your diet, with a free streak-tracking app, if you want it, all based on the same scientific research as the best-selling book “How Not To Die”.
“Minimum effort!”
Did you see the movie “Deadpool”? The protagonist has a catch-phrase as he goes into battle, saying to himself “Maximum effort!”.
And, that’s all very well and good if your superpower is immediate recovery from pretty much anything, but for the rest of us, sometimes it’s good to hold ourselves to “minimum effort!”.
Sometimes, something worth doing is worth doing just a little a bit. It’s always better than nothing! Even if feels like you gained nothing from it, it’s the foundation of a habit, and the habit will grow and add up. Sometimes it may even take you by surprise…
Don’t feel like doing 20 bodyweight squats? Do literally just one. Make a deal with yourself: do just one, then you can stop if you like. Then after you’ve done one, you might think to yourself “huh, that wasn’t so bad”, and you try out a few more. Maybe after 5 you can feel your blood pumping a bit and you think “you know what, that’s enough for now”, and great, you did 5x as much exercise as you planned! Wonder what you’ll do tomorrow!
(personal note from your writer here: I’ve managed to “just extend this exercise a little bit more than last time” my way into hour-long exercise sessions before now; I started with “just 10 squats” or “just one sun salutation” etc, to get myself out of a no-exercise period that I’d slipped into, and it’s amazing how quickly adding just a little bit to the previous day’s “minimum effort!” adds up to a very respectable daily exercise session)
Wondering what a good, easy, respectable short term goal could be?
Check Out, For Example: The Seven-Minute Workout
(You might have heard of this one before; it’s an incredibly efficient well-optimized short complete workout that requires no special equipment, just a bit of floorspace and a wall—the above app allows for customizations of it per your preferences, but the basic routine is an excellent starting point for most people)
Commit to yourself (and do any self-negotiation up-front)
Really commit, though. No “or I will look silly because I told people I’d do it”, no “or I will donate x amount to charity” etc, just “I will do it and that’s that”. If you find yourself second-guessing yourself or renegotiating with yourself, just shut that down immediately and refuse to consider it.
Note: you should have break-clauses in this contract with yourself, though. For example, “unless I am ill or injured” is a sensible rule to have in advance for most exercise regimes that weren’t undertaken with your illness or injury in mind.
Make a “To-Don’t” list
Much like how addicts are often advised to not try to quit more than one thing at once, we must also be mindful of not taking on too much at once. It can be very tempting to think:
“I will turn my life around, now! I’ll quit alcohol and animal products and sugar and refined grains, and I’ll go for a run each morning, and I’ll do this and that and there, I’ve got it, here is the blueprint for my healthy perfect life from this day forth!”
And, it’s great to have any and all of that as your end goal if you want, but please, pick one or two things at most to start with, focus on those, and when those have become second nature to you and just a normal part of your life, then choose the next thing to work on.
(You can plan out the whole thing in advance if you want! i.e., I’ll do this, then this, then this, but just… make sure that you’ve really got each one down to a matter of comfort and ease before you take up the next one)
In summary:
- Focus on adding health, whatever that looks like to you
- Figure out what “minimum effort!” is for you, and let that be your baseline
- Commit to yourself (and do any self-negotiation up-front, not later)
- Decide what you’re not going to do yet, and stick to that, too.
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- How to get a beach body: take your body to a beach. Voilà. Beach body.
