Ultra-Processed People – by Dr. Chris van Tulleken
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It probably won’t come as a great surprise to any of our readers that ultra-processed food is—to make a sweeping generalization—not fabulous for the health. So, what does this book offer beyond that?
Perhaps this book’s greatest strength is in showing not just what ultra-processed foods are, but why they are. In principle, food being highly processed should be neither good nor bad by default. Much like GMOs, if a food is modified to be more nutritious, that should be good, right?
Only, that’s mostly not what happens. What happens instead is that food is modified (be it genetically or by ultra-processing) to be cheaper to produce, and thus maximise the profit margin.
The addition of a compound that increases shelf-life but harms the health, increases sales and is a net positive for the manufacturer, for instance. Dr. van Tulleken offers us many, many, examples and explanations of such cost-cutting strategies at our expense.
In terms of qualifications, the author has an MD from Oxford, and also a PhD, but the latter is in molecular virology; not so relevant here. Yet, we are not expected to take an “argument from authority”, and instead, Dr. van Tulleken takes great pains to go through a lot of studies with us—the good, the bad, and the misleading.
If the book has a downside, then this reviewer would say it’s in the format; it’s less a reference book, and more a 384-page polemic. But, that’s a subjective criticism, and for those who like that sort of thing, that is the sort of thing that they like.
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The Lupus Encyclopedia – by Dr. Donald Thomas
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First, a note on the authorship: while this is broadly by Donald E. Thomas Jr. MD FACP FACR, there were more contributors, namely:
Jemima Albayda, MD; Divya Angra, MD; Alan N. Baer, MD; Sasha Bernatsky, MD, PhD; George Bertsias, MD, PhD; Ashira D. Blazer, MD; Ian Bruce, MD; Jill Buyon, MD; Yashaar Chaichian, MD; Maria Chou, MD; Sharon Christie, Esq; Angelique N. Collamer, MD; Ashté Collins, MD; Caitlin O. Cruz, MD; Mark M. Cruz, MD; Dana DiRenzo, MD; Jess D. Edison, MD; Titilola Falasinnu, PhD; Andrea Fava, MD; Cheri Frey, MD; Neda F. Gould, PhD; Nishant Gupta, MD; Sarthak Gupta, MD; Sarfaraz Hasni, MD; David Hunt, MD; Mariana J. Kaplan, MD; Alfred Kim, MD; Deborah Lyu Kim, DO; Rukmini Konatalapalli, MD; Fotios Koumpouras, MD; Vasileios C. Kyttaris, MD; Jerik Leung, MPH; Hector A. Medina, MD; Timothy Niewold, MD; Julie Nusbaum, MD; Ginette Okoye, MD; Sarah L. Patterson, MD; Ziv Paz, MD; Darryn Potosky, MD; Rachel C. Robbins, MD; Neha S. Shah, MD; Matthew A. Sherman, MD; Yevgeniy Sheyn, MD; Julia F. Simard, ScD; Jonathan Solomon, MD; Rodger Stitt, MD; George Stojan, MD; Sangeeta Sule, MD; Barbara Taylor, CPPM, CRHC; George Tsokos, MD; Ian Ward, MD; Emma Weeding, MD; Arthur Weinstein, MD; Sean A. Whelton, MD
The reason we mention this is to render it clear that this isn’t one man’s opinions (as happens with many books about certain topics), but rather, a panel of that many doctors all agreeing that this is correct and good, evidence-based, up-to-date (as of the publication of this latest revised edition last year) information.
And if you have lupus, you’ll be aware there are a lot of doctors who don’t know a tremendous amount about it, hence the value of this “…for patients and healthcare providers” tome.
It is what it claims to be: a very comprehensive guide. It’s not light reading, and it is 848 pages of information-dense text and diagrams. If you want to know something, anything, about lupus, then if science knows it, then chances are it is in this book, or this book will at least point you directly to a paper you can read about your specific query.
The style is, nevertheless, about as readable for the layperson as possible, which is quite an achievement for a book with this amount of dense scientific information. For that, the author thanks his husband, for being the non-doctor beta-reader to screen it for readability—quite a service, with all those doctors writing!
Bottom line: if you or someone you love has lupus, this book should absolutely be in your collection.
Click here to check out The Lupus Encyclopedia, and have everything at your fingertips!
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Head Over Hips
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We’ve written before about managing osteoarthritis (or ideally: avoiding it, but that’s not always an option on the table, of course), so here’s a primer/refresher before we get into the meat of today’s article:
Avoiding/Managing Osteoarthritis
When the head gets in the way
Research shows that the problem with recovery in cases of osteoarthritis of the hip is in fact often not the hip itself, but rather, the head:
❝In fact, the stronger your muscles are, the more protected your joint is, and the less pain you will experience.
Our research has shown that people with hip osteoarthritis were unable to activate their muscles as efficiently, irrespective of strength.
Basically, people with hip arthritis are unable to activate their muscles properly because the brain is actively putting on the brake to stop them from using the muscle.❞
This is a case of a short-term protective response being unhelpful in the long-term. If you injure yourself, your brain will try to inhibit you from exacerbating that injury, such as by (for example) disobliging you from putting weight on an injured joint.
This is great if you merely twisted an ankle and just need to sit back and relax while your body works its healing magic, but it’s counterproductive if it’s a chronic issue like osteoarthritis. In such (i.e. chronic) cases, avoidance of use of the joint will simply cause atrophy of the surrounding muscle and other tissues, leading to more of the very wear-and-tear that led to the osteoarthritis in the first place.
So… How to deal with that?
You probably can exercise
It’s easy to get caught between the dichotomy of “exercise and inflame your joints” vs “rest and your joints seize up”, which is not pleasant.
However, the trick lies in how you exercise, per joint type:
When Bad Joints Stop You From Exercising (5 Things To Change)
…which to be clear, isn’t a case of “avoid using the joint that’s bad”, but is rather “use it in this specific way, so that it gets stronger without doing it more damage in the process”.
Which is exactly what is needed!
Further resources
For those who like learning from short videos, here’s a trio of helpers (along with our own text-based overview for each):
- The Most Underrated Hip Mobility Exercise (Not Stretching)
- Overcome Front-Of-Hip Pain
- 10 Tips To Reduce Morning Pain & Stiffness With Arthritis
And for those who prefer just reading, here’s a book we reviewed on the topic:
11 Minutes to Pain-Free Hips – by Melinda Wright
Take care!
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Fennel vs Onion – Which is Healthier?
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Our Verdict
When comparing fennel to onion, we picked the fennel.
Why?
First note, in case you didn’t see the picture: we are talking about white onions here (also called brown onions, by virtue of their attire).
Looking at the macros, fennel has nearly 2x the fiber and a little more protein, while onion has more carbs. An easy win in this category for the fennel.
In the category of vitamins, fennel has more of vitamins A, B2, B3, B5, B9, C, E, K, and choline (most of them by generous margins and some by especially large margins, we are talking, for example, 480x the vitamin A, 29x the vitamin E, and 157x the vitamin K), while onions have more of vitmains B1 and B6. Another clear win for fennel.
When it comes to minerals, fennel has more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc, while onion is not higher in any minerals. No prizes for guessing: fennel wins this category too.
You may be curious as to how they add up on the polyphenol front, and the answer is, they don’t, much. Wonderful as these two vegetables are, an abundance of polyphenols is not amongst their strengths; fennel has some lignans and onion has some flavonols, but we’re talking tiny numbers here (in contrast, red onion would have aced it with 120mg/100g quercetin, amongst others, but red onion wasn’t on trial today).
Adding up the sections makes a clear win for fennel today.
Want to learn more?
You might like to read:
What’s Your Plant Diversity Score?
Take care!
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Steps For Keeping Your Feet A Healthy Foundation
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Important Steps For Good Health
This is Dr. Kelly Starrett. He’s a physiotherapist, author, speaker, trainer. He has been described as a “celebrity” and “founding father” of CrossFit. He mostly speaks and writes about mobility in general; today we’re going to be looking at what he has to say specifically about our feet.
A strong foundation
“An army marches on its stomach”, Napoleon famously wrote.
More prosaically: an army marches on its feet, and good foot-care is a top priority for soldiers—indeed, in some militaries, even so much as negligently getting blisters is a military offense.
Most of us are not soldiers, but there’s a lesson to be learned here:
Your feet are the foundation for much of the rest of your health and effectiveness.
KISS for feet
No, not like that.
Rather: “Keep It Simple, Stupid”
Dr. Starrett is not only a big fan of not overcomplicating things, but also, he tells us how overcomplicating things can actively cause problems. When it comes to footwear, for example, he advises:
❝When you wear shoes, wear the flat kind. If you’re walking the red carpet on Oscar night, fine, go ahead and wear a shoe with a heel. Once in a while is okay.
But most of the time, you should wear shoes that are flat and won’t throw your biological movement hardware into disarray.
When you have to wear shoes, whether it’s running shoes, work shoes, or combat boots, buy the flat kind, also known as “zero drop”—meaning that the heel is not raised above the forefoot (at all).
What you want to avoid, or wean yourself away from, are shoes with the heels raised higher off the ground than the forefeet.❞
Of course, going barefoot is great for this, but may not be an option for all of us when out and about. And in the home, going barefoot (or shod in just socks) will only confer health benefits if we’re actually on our feet! So… How much time do you spend on your feet at home?
Allow your feet to move like feet
By evolution, the human body is built for movement—especially walking and running. That came with moving away from hanging around in trees for fruit, to hunting and gathering between different areas of the savannah. Today, our hunting and gathering may be done at the local grocery store, but we still need to keep our mobility, especially when it comes to our feet.
Now comes the flat footwear you don’t want: flip-flops and similar
If we wear flip-flops, or other slippers or shoes that hold onto our feet only at the front, we’re no longer walking like we’re supposed to. Instead of being the elegant product of so much evolution, we’re now walking like those AT-AT walkers in Star Wars, you know, the ones that fell over so easily?
Our feet need to be able to tilt naturally while walking/running, without our footwear coming off.
Golden rule for this: if you can’t run in them, you shouldn’t be walking in them
Exception: if for example you need something on your feet for a minute or two in the shower at the gym/pool, flip-flops are fine. But anything more than that, and you want something better.
Watch your step
There’s a lot here that’s beyond the scope of what we can include in this short newsletter, but:
If we stand or walk or run incorrectly, we’re doing gradual continual damage to our feet and ankles (potentially also our knees and hips, which problems in turn have a knock-on effect for our spine, and you get the idea—this is Bad™)
Some general pointers for keeping things in good order include:
- Your weight should be mostly on the balls of your feet, not your heels
- Your feet should be pretty much parallel, not turned out or in
- When standing, your center of gravity should be balanced between heel and forefoot
Quick tip for accomplishing this last one: Stand comfortably, your feet parallel, shoulder-width apart. Now, go up on your tip-toes. When you’ve done so, note where your spine is, and keep it there (apart from in its up-down axis) when you slowly go back to having your feet flat on the ground, so it’s as though your spine is sliding down a pole that’s fixed in place.
If you do this right, your center of gravity will now be perfectly aligned with where it’s supposed to be. It might feel a bit weird at first, but you’ll get used to it, and can always reset it whenever you want/need, by repeating the exercise.
If you’d like to know more from Dr. Starrett, you can check out his website here 🙂
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Which Gadgets Help, & Which Are A Waste Of Time?
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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 😎
❝I’m a 67- year old yoga teacher and runner. A lifelong runner, I started long distance running when I was 58. One of my friends loves rucking? I recently bought a rucking vest. Your thoughts? Any risks?
As a perk of my yoga instructor job I get cryotherapy, red light therapy, infrared sauna, and Normatec boots for a nominal fee. Even though they are almost free, I don’t take advantage of them as I can’t find evidence of their value and don’t want to waste my time. Do you recommend any of them?❞On rucking and rucking vests
First, for any unfamiliar, this is about walking/running/exercising in general, with a weighted backpack or weight vest.
As for whether this is beneficial, it depends on your goals. Once upon a very long time ago when this writer was a soldier, it was vitally important to for me be able to [fall from the sky and then] run about 2km carrying a certain (hefty) amount of weight and still be able to fight at the other end of it, or else I would die. Thus, between deployments, I’d often carry a sturdy rucksack with concrete slabs in it, to keep myself accustomed to that burden (funny story: someone once tried to steal that when I had put it down while doing something—the would-be thief fell over instantly and then ran away empty-handed). And, here’s the thing: this kind of training did for me what I needed it to do for me. As a 67-year-old yoga teacher, your needs are probably very different.
A common reason to use weight vests is in an effort against osteoporosis, but the evidence is lacking (or very weak, at best), as we wrote about a while back:
Weight Vests Against Osteoporosis: Do They Really Build Bone?
With regard to risks… Let’s put it this way: my old regiment, in addition to the usual soldierly problems like hearing damage and PTSD, has quite a reputation for producing veterans with spinal compression injuries. And that’s entirely because of the whole “running with a large amount of weight strapped to us” thing. So, you probably don’t want that.
If you are going to do that though, then:
- a weight best is a lot better than a backpack (better distribution of weight)
- start with low weight and work up, and don’t push your limits
We’re not the boss of you, so by all means do as you see fit, but unless there’s a special reason why being able to run with a heavy weight is important to you, then running with a light weight is already more than good enough.
About those job perks
Again, of course, it depends on what you hope to get out of them, but in some cases there is a lot of evidence for benefit.
On cryotherapy: Ice Baths: To Dip Or Not To Dip? ← there are definite benefits for most people!
On red light therapy: Red Light, Go! Casting Yourself In A Healthier Light ← there are some caveats re people who should not do this or at least should be very wary, but for most people, this does a lot of good, and is very well-evidenced to be beneficial
On infrared saunas: we’re unaware of any special evidence in favor of these. However, traditional saunas have plenty of well-evidenced benefits: Saunas: Health Benefits (& Caveats)
On Normatec boots: for the unfamiliar, this is a brand name for compression technology. Again, it depends on what you want to get out of it, though. If you are in good health, then what it’s generally being advertised for is to prevent/reduce exercise-induced muscle damage caused by the stress that endurance training can place on skeletal muscle. Just one problem—it doesn’t seem to work:
❝Athletes attempt to aid their recovery in various ways, one of which is through compression. Dynamic compression consists of intermittent pneumatic compression (IPC) devices, such as the NormaTec Recovery System and Recovery Pump
Clinical Question: What are the effects of IPC on the reduction of Exercise-Induced Muscle Damage (EIMD) in endurance athletes following prolonged exercise? Summary of Key Findings: The current literature was searched to identify the effects of IPC, and 3 studies were selected: 2 randomized controlled trials and 1 randomized cross-over study. Two studies investigated the effect of IPC on delayed onset muscle soreness and plasma creatine kinase in ultramarathoners. The other looked at the impact of IPC on delayed onset muscle soreness in marathoners, ultramarathoners, triathletes, and cyclists.
All studies concluded IPC was not an effective means of improving the reduction of EIMD in endurance-trained athletes.❞
However! If you have lipedema and/or lymphedema and want to manage that, then compression gear may help:
Take care!
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Which Sugars Are Healthier, And Which Are Just The Same?
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From Apples to Bees, and High-Fructose Cs
We asked you for your (health-related) policy on sugar. The trends were as follows:
- About half of all respondents voted for “I try to limit sugar intake, but struggle because it’s in everything”
- About a quarter of all respondents voted for “Refined sugar is terrible; natural sugars (e.g. honey, agave) are fine”
- About a quarter of all respondents voted for “Sugar is sugar and sugar is bad; I avoid it entirely”
- One (1) respondent voted for “Sugar is an important source of energy, so I consume plenty”
Writer’s note: I always forget to vote in these, but I’d have voted for “I try to limit sugar intake, but struggle because it’s in everything”.
Sometimes I would like to make my own [whatever] to not have the sugar, but it takes so much more time, and often money too.
So while I make most things from scratch (and typically spend about an hour cooking each day), sometimes store-bought is the regretfully practical timesaver/moneysaver (especially when it comes to condiments).
So, where does the science stand?
There has, of course, been a lot of research into the health impact of sugar.
Unfortunately, a lot of it has been funded by sugar companies, which has not helped. Conversely, there are also studies funded by other institutions with other agendas to push, and some of them will seek to make sugar out to be worse than it is.
So for today’s mythbusting overview, we’ve done our best to quality-control studies for not having financial conflicts of interest. And of course, the usual considerations of favoring high quality studies where possible Large sample sizes, good method, human subjects, that sort of thing.
Sugar is sugar and sugar is bad: True or False?
False and True, respectively.
- Sucrose is sucrose, and is generally bad.
- Fructose is fructose, and is worse.
Both ultimately get converted into glycogen (if not used immediately for energy), but for fructose, this happens mostly* in the liver, which a) taxes it b) goes very unregulated by the pancreas, causing potentially dangerous blood sugar spikes.
This has several interesting effects:
- Because fructose doesn’t directly affect insulin levels, it doesn’t cause insulin insensitivity (yay)
- Because fructose doesn’t directly affect insulin levels, this leaves hyperglycemia untreated (oh dear)
- Because fructose is metabolized by the liver and converted to glycogen which is stored there, it’s one of the main contributors to non-alcoholic fatty liver disease (at this point, we’re retracting our “yay”)
Read more: Fructose and sugar: a major mediator of non-alcoholic fatty liver disease
*”Mostly” in the liver being about 80% in the liver. The remaining 20%ish is processed by the kidneys, where it contributes to kidney stones instead. So, still not fabulous.
Fructose is very bad, so we shouldn’t eat too much fruit: True or False?
False! Fruit is really not the bad guy here. Fruit is good for you!
Fruit does contain fructose yes, but not actually that much in the grand scheme of things, and moreover, fruit contains (unless you have done something unnatural to it) plenty of fiber, which mitigates the impact of the fructose.
- A medium-sized apple (one of the most sugary fruits there is) might contain around 11g of fructose
- A tablespoon of high-fructose corn syrup can have about 27g of fructose (plus about 3g glucose)
Read more about it: Effects of high-fructose (90%) corn syrup on plasma glucose, insulin, and C-peptide in non-insulin-dependent diabetes mellitus and normal subjects
However! The fiber content (in fruit) mitigates the impact of the fructose almost entirely anyway.
And if you take fruits that are high in sugar and/but high in polyphenols, like berries, they now have a considerable net positive impact on glycemic health:
- Polyphenols and Glycemic Control
- Polyphenols and their effects on diabetes management: A review
- Dietary polyphenols as antidiabetic agents: Advances and opportunities
You may be wondering: what was that about “unless you have done something unnatural to it”?
That’s mostly about juicing. Juicing removes much (or all) of the fiber, and if you do that, you’re basically back to shooting fructose into your veins:
- Effect of Fruit Juice on Glucose Control and Insulin Sensitivity in Adults: A Meta-Analysis of 12 Randomized Controlled Trials
- Intake of Fruit, Vegetables, and Fruit Juices and Risk of Diabetes in Women
Natural sugars like honey, agave, and maple syrup, are healthier than refined sugars: True or False?
True… Sometimes, and sometimes marginally.
This is partly because of the glycemic index and glycemic load. The glycemic index scores tail off thus:
- table sugar = 65
- maple syrup = 54
- honey = 46
- agave syrup = 15
So, that’s a big difference there between agave syrup and maple syrup, for example… But it might not matter if you’re using a very small amount, which means it may have a high glycemic index but a low glycemic load.
Note, incidentally, that table sugar, sucrose, is a disaccharide, and is 50% glucose and 50% fructose.
The other more marginal health benefits come from that fact that natural sugars are usually found in foods high in other nutrients. Maple syrup is very high in manganese, for example, and also a fair source of other minerals.
But… Because of its GI, you really don’t want to be relying on it for your nutrients.
Wait, why is sugar bad again?
We’ve been covering mostly the more “mythbusting” aspects of different forms of sugar, rather than the less controversial harms it does, but let’s give at least a cursory nod to the health risks of sugar overall:
- Obesity and associated metabolic risk
- Main contributor to non-alcoholic fatty liver disease
- Increased risk of heart disease
- Insulin resistance and diabetes risk
- Cellular aging (shortened telomeres)
- 95% increased cancer risk
That last one, by the way, was a huge systematic review of 37 large longitudinal cohort studies. Results varied depending on what, specifically, was being examined (e.g. total sugar, fructose content, sugary beverages, etc), and gave up to 200% increased cancer risk in some studies on sugary beverages, but 95% increased risk is a respectable example figure to cite here, pertaining to added sugars in foods.
And finally…
The 56 Most Common Names for Sugar (Some Are Tricky)
How many did you know?
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