Vaping: A Lot Of Hot Air?
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Vaping: A Lot Of Hot Air?
Yesterday, we asked you for your (health-related) opinions on vaping, and got the above-depicted, below-described, set of responses:
- A little over a third of respondents said it’s actually more dangerous than smoking
- A little under a third of respondents said it’s no better nor worse, just different
- A little over 10% of respondents said it’s marginally less harmful, but still very bad
- A little over 10% of respondents said it’s a much healthier alternative to smoking
So what does the science say?
Vaping is basically just steam inhalation, plus the active ingredient of your choice (e.g. nicotine, CBD, THC, etc): True or False?
False! There really are a lot of other chemicals in there.
And “chemicals” per se does not necessarily mean evil green glowing substances that a comicbook villain would market, but there are some unpleasantries in there too:
- Potential harmful health effects of inhaling nicotine-free shisha-pen vapor: a chemical risk assessment of the main components propylene glycol and glycerol
- Inflammatory and Oxidative Responses Induced by Exposure to Commonly Used e-Cigarette Flavoring Chemicals and Flavored e-Liquids without Nicotine
So, the substrate itself can cause irritation, and flavorings (with cinnamaldehyde, the cinnamon flavoring, being one of the worst) can really mess with our body’s inflammatory and oxidative responses.
Vaping can cause “popcorn lung”: True or False?
True and False! Popcorn lung is so-called after it came to attention when workers at a popcorn factory came down with it, due to exposure to diacetyl, a chemical used there.
That chemical was at that time also found in most vapes, but has since been banned in many places, including the US, Canada, the EU and the UK.
Vaping is just as bad as smoking: True or False?
False, per se. In fact, it’s recommended as a means of quitting smoking, by the UK’s famously thrifty NHS, that absolutely does not want people to be sick because that costs money:
Of course, the active ingredients (e.g. nicotine, in the assumed case above) will still be the same, mg for mg, as they are for smoking.
Vaping is causing a health crisis amongst “kids nowadays”: True or False?
True—it just happens to be less serious on a case-by-case basis to the risks of smoking.
However, it is worth noting that the perceived harmlessness of vapes is surely a contributing factor in their widespread use amongst young people—decades after actual smoking (thankfully) went out of fashion.
On the other hand, there’s a flipside to this:
Flavored vape restrictions lead to higher cigarette sales
So, it may indeed be the case of “the lesser of two evils”.
Want to know more?
For a more in-depth science-ful exploration than we have room for here…
BMJ | Impact of vaping on respiratory health
Take care!
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Rethinking Exercise: The Workout Paradox
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The notion of running a caloric deficit (i.e., expending more calories than we consume) to reduce bodyfat is appealing in its simplicity, but… we’d say “it doesn’t actually work outside of a lab”, but honestly, it doesn’t actually work outside of a calculator.
Why?
For a start, exercise calorie costs are quite small numbers compared to metabolic base rate. Our brain alone uses a huge portion of our daily calories, and the rest of our body literally never stops doing stuff. Even if we’re lounging in bed and ostensibly not moving, on a cellular level we stay incredibly busy, and all that costs (and the currency is: calories).
Since that cost is reflected in the body’s budget per kg of bodyweight, a larger body (regardless of its composition) will require more calories than a smaller one. We say “regardless of its composition” because this is true regardless—but for what it’s worth, muscle is more “costly” to maintain than fat, which is one of several reasons why the average man requires more daily calories than the average woman, since on average men will tend to have more muscle.
And if you do exercise because you want to run out the budget so the body has to “spend” from fat stores?
Good luck, because while it may work in the very short term, the body will quickly adapt, like an accountant seeing your reckless spending and cutting back somewhere else. That’s why in all kinds of exercise except high-intensity interval training, a period of exercise will be followed by a metabolic slump, the body’s “austerity measures”, to balance the books.
You may be wondering: why is it different for HIIT? It’s because it changes things up frequently enough that the body doesn’t get a chance to adapt. To labor the financial metaphor, it involves lying to your accountant, so that the compensation is not made. Congratulations: you’re committing calorie fraud (but it’s good for the body, so hey).
That doesn’t mean other kinds of exercise are useless (or worse, necessarily counterproductive), though! Just, that we must acknowledge that other forms of exercise are great for various aspects of physical health (strengthening the body, mobilizing blood and lymph, preventing disease, enjoying mental health benefits, etc) that don’t really affect fat levels much (which are decided more in the kitchen than the gym—and even in the category of diet, it’s more about what and how and when you eat, rather than how much).
For more information on metabolic balance in the context of exercise, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
- Are You A Calorie-Burning Machine?
- Burn! How To Boost Your Metabolism
- How To Do HIIT (Without Wrecking Your Body)
- Lose Weight, But Healthily
- Build Muscle (Healthily!)
- How To Gain Weight (Healthily!)
Take care!
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Are Electrolyte Supplements Worth It?
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When To Take Electrolytes (And When We Shouldn’t!)
Any sports nutrition outlet will sell electrolyte supplements. Sometimes in the form of sports drinks that claim to be more hydrating than water, or tablets that can be dissolved in water to make the same. How do they work, and should we be drinking them?
What are electrolytes?
They’re called “electrolytes” because they are ionized particles (so, they have a positive or negative electrical charge, depending on which kind of ion they are) that are usually combined in the form of salts.
The “first halves” of the salts include:
- Sodium
- Potassium
- Calcium
- Magnesium
The “second halves” of the salts include:
- Chloride
- Phosphate
- Bicarbonate
- Nitrate
It doesn’t matter too much which way they’re combined, provided we get what we need. Specifically, the body needs them in a careful balance. Too much or too little, and bad things will start happening to us.
If we live in a temperate climate with a moderate lifestyle and a balanced diet, and have healthy working kidneys, usually our kidneys will keep them all in balance.
Why might we need to supplement?
Firstly, of course, you might have a dietary deficiency. Magnesium deficiency in particular is very common in North America, as people simply do not eat as much greenery as they ideally would.
But, also, you might sweat out your electrolytes, in which case, you will need to replace them.
In particular, endurance training and High Intensity Interval Training are likely to prompt this.
However… Are you in a rush? Because if not, you might just want to recover more slowly:
❝Vigorous exercise and warm/hot temperatures induce sweat production, which loses both water and electrolytes. Both water and sodium need to be replaced to re-establish “normal” total body water (euhydration).
This replacement can be by normal eating and drinking practices if there is no urgency for recovery.
But if rapid recovery (<24 h) is desired or severe hypohydration (>5% body mass) is encountered, aggressive drinking of fluids and consuming electrolytes should be encouraged to facilitate recovery❞
Source: Fluid and electrolyte needs for training, competition, and recovery
Should we just supplement anyway, as a “catch-all” to be sure?
Probably not. In particular, it is easy to get too much sodium in one’s diet, let alone by supplementation.And, oversupplementation of calcium is very common, and causes its own health problems. See:
To look directly to the science on this one, we see a general consensus amongst research reviews: “this is complicated and can go either way depending on what else people are doing”:
- Trace minerals intake: risks and benefits for cardiovascular health
- Electrolyte minerals intake and cardiovascular health
Well, that’s not helpful. Any clearer pointers?
Yes! Researchers Latzka and Mountain put together a very practical list of tips. Rather, they didn’t put it as a list, but the following bullet points are information extracted directly from their abstract, though we’ve also linked the full article below:
- It is recommended that individuals begin exercise when adequately hydrated.
- This can be facilitated by drinking 400 mL to 600 mL of fluid 2 hours before beginning exercise and drinking sufficient fluid during exercise to prevent dehydration from exceeding 2% body weight.
- A practical recommendation is to drink small amounts of fluid (150-300 mL) every 15 to 20 minutes of exercise, varying the volume depending on sweating rate.
- During exercise lasting less than 90 minutes, water alone is sufficient for fluid replacement
- During prolonged exercise lasting longer than 90 minutes, commercially available carbohydrate electrolyte beverages should be considered to provide an exogenous carbohydrate source to sustain carbohydrate oxidation and endurance performance.
- Electrolyte supplementation is generally not necessary because dietary intake is adequate to offset electrolytes lost in sweat and urine; however, during initial days of hot-weather training or when meals are not calorically adequate, supplemental salt intake may be indicated to sustain sodium balance.
Source: Water and electrolyte requirements for exercise
Bonus tip:
We’ve talked before about the specific age-related benefits of creatine supplementation, but if you’re doing endurance training or HIIT, you might also want to consider a creatine-electrolyte combination sports drink (even if you make it yourself):
Where can I get electrolyte supplements?
They’re easy to find in any sports nutrition store, or you can buy them online; here’s an example product on Amazon for your convenience
You can also opt for natural and/or homemade electrolyte drinks:
Healthline | 8 Healthy Drinks Rich in Electrolytes
Enjoy!
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How weight bias in health care can harm patients with obesity: Research
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Patients who weigh more than what medical authorities generally consider healthy often avoid seeing doctors for fear of being judged, insulted or misdiagnosed, decades of research find. Meanwhile, academic studies consistently show many health care professionals discriminate against heavier patients and that weight bias can drive people with obesity to gain weight.
Weight bias refers to negative attitudes, stereotypes and discrimination aimed at individuals with excess body fat. When scholars reviewed 41 studies about weight bias in health care, published from 1989 to 2021, they found it comes in many forms: contemptuous language, inappropriate gestures, expressing a preference for thinner patients, avoiding physical touch and eye contact, and attributing all of a person’s health issues to their weight.
“Weight bias has been reported in physicians, nurses, dietitians, physiotherapists, and psychologists, as well as nutritionists and exercise professionals, and it is as pervasive among medical professionals as it is within the general population,” write the authors of the research review, published in 2021 in the journal Obesity.
That’s a problem considering an estimated 4 out of 10 U.S. adults aged 20 years and older have obesity, a complex and often misunderstood illness that the American Medical Association voted in 2013 to recognize as a disease. By 2030, half of U.S. adults will have obesity, researchers project in a 2020 paper in the International Journal of Epidemiology.
Worldwide, the obesity rate among adults aged 18 and older was 13% in 2016, according to the World Health Organization. If current trends continue, the World Obesity Federation projects that, by 2035, 51% of the global population will be living with overweight or obesity.
The harms of weight bias
Weight stigma — the societal devaluation of people perceived to be carrying excess weight — drives weight bias. It’s so physically and emotionally damaging that a panel of 36 international experts issued a consensus statement in 2020 to raise awareness about and condemn it. Dozens of medical and academic organizations, including 15 scholarly journals, endorsed the document, published in Nature Medicine.
The release of a consensus statement is a significant event in research, considering it represents the collective position that experts in a particular field have taken on an issue, based on an analysis of all the available evidence.
Research to date indicates heavier individuals who experience weight bias and stigma often:
- Avoid doctors and other health care professionals, skipping routine screenings as well as needed treatments.
- Change doctors frequently.
- Are at a higher risk for depression, anxiety, mood disorders and other mental health problems.
- Avoid or put off exercise.
- Consume more food and calories.
- Gain weight.
- Have disrupted sleep.
The consensus statement notes that educating health care providers, journalists, policymakers and others about obesity is key to changing the narrative around the disease.
“Weight stigma is reinforced by misconceived ideas about body-weight regulation and lack of awareness of current scientific evidence,” write the experts, led by Francesco Rubino, the chair of metabolic and bariatric surgery at Kings College London.
“Despite scientific evidence to the contrary, the prevailing view in society is that obesity is a choice that can be reversed by voluntary decisions to eat less and exercise more. These assumptions mislead public health policies, confuse messages in popular media, undermine access to evidence-based treatments, and compromise advances in research.”
Weight bias and stigma appear to stimulate the secretion of the stress hormone cortisol and promote weight gain, researchers write in a 2016 paper published in Obesity.
A. Janet Tomiyama, a psychology professor at UCLA who directs the university’s Dieting, Stress, and Health research lab, describes weight stigma as “a ‘vicious cycle’ — a positive feedback loop wherein weight stigma begets weight gain.”
“This happens through increased eating behavior and increased cortisol secretion governed by behavioral, emotional, and physiological mechanisms, which are theorized to ultimately result in weight gain and difficulty of weight loss,” Tomiyama writes in her 2014 paper, “Weight Stigma is Stressful. A Review of Evidence for the Cyclic Obesity/Weight-Based Stigma Model.”
The consensus statement spotlights 13 recommendations for eliminating weight bias and stigma, some of which are specifically aimed at health care providers, the media, researchers or policymakers. One of the recommendations for the health care community: “[Health care providers] specialized in treating obesity should provide evidence of stigma-free practice skills. Professional bodies should encourage, facilitate, and develop methods to certify knowledge of stigma and its effects, along with stigma-free skills and practices.”
The one recommendation for the media: “We call on the media to produce fair, accurate, and non-stigmatizing portrayals of obesity. A commitment from the media is needed to shift the narrative around obesity.”
Why obesity is a complicated disease
It’s important to point out that having excess body fat does not, by itself, mean an individual is unhealthy, researchers explain in a 2017 article in The Conversation, which publishes research-based news articles and essays. But it is a major risk factor for cardiovascular disease, including stroke, as well as diabetes, some types of cancer, and musculoskeletal disorders such as osteoarthritis.
Doctors often look at patients’ body mass index — a number that represents their weight in relation to their height — to gauge the amount of fat on their bodies. A BMI of 18.5 to 24.9 is ideal, according to the U.S. Centers for Disease Control and Prevention. A BMI of 25.0 to 29.9, indicates excess body fat, or “overweight,” while a BMI of 30 and above indicates obesity.
In June, the American Medical Association announced a new policy clarifying how BMI can be used to diagnose obesity. Because it’s an imperfect measure for body fat, the organization suggests BMI be used in conjunction with other measures such as a patient’s waist circumference and skin fold thickness.
Two specialists who have been working for years to dispel myths and misconceptions about obesity are Fatima Cody Stanford, an obesity physician and associate professor at Harvard Medical School, and Rebecca Puhl, the deputy director of the Rudd Center for Food Policy and Obesity at the University of Connecticut.
Cody Stanford has called obesity “a brain disease” because the brain tells the body how much to eat and what to do with the food consumed. One pathway in the brain directs the body to eat less and store less fat, she explains in a February 2023 podcast produced by the American Medical Association.
“For people that signal really great down this pathway, they tend to be very lean, not struggle with their weight in the same way that people that have excess weight do,” she says during the podcast, adding that people with obesity receive signals from an alternate pathway that “tells us to eat more and store more.”
Academic studies demonstrate that a wide variety of factors can affect weight regulation, including sleep quality and duration, gut health, genetics, medication, access to healthy foods and even early life experiences.
For example, a 2020 paper in the journal JAMA Network Open suggests female infants born by cesarean delivery have a higher risk of obesity during adulthood than female infants born by vaginal delivery. The study of 33,226 U.S. women born between 1946 and 1964 found that a cesarean delivery is associated with an 11% higher risk of developing obesity and a 46% higher risk of developing type 2 diabetes.
Scholars have also found that traumatic childhood experiences such as abuse and neglect are linked to adult obesity, according to a research review published in 2020.
Income inequality seems to play a role as well. When researchers from the Johns Hopkins Bloomberg School of Public Health studied the link between income inequality and obesity for a sample of 36,665 U.S. adults, they discovered women with lower incomes are more likely to have obesity than women with higher incomes.
Their analysis indicates the opposite is true for men, whose odds of obesity rise with their income, the researchers write in a 2021 paper in the International Journal of Environmental Research and Public Health.
Weight bias among doctor trainees
While scholars have learned a lot about obesity and weight bias in recent decades, the information might not be reaching people training to become doctors. A study published in October finds that some resident physicians believe obesity to be the result of poor choices and weak willpower.
Researchers asked 3,267 resident physicians who graduated from a total of 49 U.S. medical schools a series of questions to gauge their knowledge of obesity and attitudes toward heavier patients. What they learned: Nearly 40% of resident physicians agreed with the statement, “Fat people tend to be fat pretty much through their own fault.” Almost half agreed with the statement, “Some people are fat because they have no willpower.”
The study also reveals that about one-third of participants said they “feel more irritated when treating an obese patient than a non-obese patient.”
“Notably, more than a quarter of residents expressed slight-to-strong agreement with the item ‘I dislike treating obese patients,’” the researchers write.
Another takeaway from the paper: Resident physicians specializing in orthopedic surgery, anesthesiology and urology expressed the highest levels of dislike of heavier patients. Of the 16 medical specialties represented, residents in family medicine, psychiatry and pediatrics reported the lowest levels of dislike.
Kimberly Gudzune, medical director of the American Board of Obesity Medicine, asserts that doctors and medical students need to be educated about obesity. The topic “is grossly neglected” in medical schools and medical training programs worldwide, research has found.
Many physicians don’t understand obesity, Gudzune explains in a July 2023 interview on the internal medicine podcast “The Curbsiders.”
“I think back to when I was a medical student, when I was a resident, I really didn’t learn much about obesity and how to treat it, yet it’s a problem that affects the majority of our patients,” she tells podcast listeners. “I think there’s a lot of evidence out there showing that primary care physicians don’t really know where to start.”
In 2011, the American Board of Obesity Medicine established a program through which doctors could become certified in obesity medicine. Since then, a total of 6,729 U.S. doctors have earned certification, the vast majority of whom specialize in family and internal medicine.
What health care providers think
The experts who created the consensus statement on weight bias and stigma noted health care providers’ shortcomings in the document. They write that the common themes they discovered in the research include “contemptuous, patronizing, and disrespectful treatment” of patients, a lack of training, poor communication and assumptions about weight gain.
Puhl, the deputy director of the Rudd Center at the University of Connecticut, is a pioneer in weight bias research and one of the experts who wrote the consensus statement. During an episode of “The Leading Voices in Food,” a podcast created by Duke University’s World Food Policy Center, she shares details about what she has learned over the years.
“[Health care providers’] views that patients with obesity are lazy or lacking control, are to blame for their weight or noncompliant with treatment,” she says during the interview. “We know, for example, that some physicians spend less time in their appointments with patients [who] have a larger body size. They give them less education about health. They’re more reluctant to perform certain screenings. They talk about treating patients with obesity as being a greater waste of their time than providing care to thinner patients. And we know that patients seem to be aware of these biases from providers and that can really contribute to patients avoiding health care because they just don’t want to repeat those negative experiences of bias.”
To set the record straight, the experts who wrote the the consensus statement listed the following five common assumptions as being “at odds with a definitive body of biological and clinical evidence.”
1. Body weight = calories in – calories out.
This equation oversimplifies the relationship between body weight and energy consumed and used, the experts write. “Both variables of the equation depend on factors additional to just eating and exercising. For instance, energy intake depends on the amount of food consumed, but also on the amount of food-derived energy absorbed through the gastrointestinal tract, which in turn is influenced by multiple factors, such as digestive enzymes, bile acids, microbiota, gut hormones, and neural signals, none of which are under voluntary control.”
2. Obesity is primarily caused by voluntary overeating and a sedentary lifestyle.
According to the experts, overeating and forgoing exercise might be symptoms of obesity rather than the root causes. There are many possible causes and contributors “including geneticand epigenetic factors, foodborne factors, sleep deprivation and circadian dysrhythmia, psychological stress, endocrine disruptors, medications, and intrauterine and intergenerational effects. These factors do not require overeating or physical inactivity to explain excess weight.” they write.
3. Obesity is a lifestyle choice.
“People with obesity typically recognize obesity as a serious health problem, rather than a conscious choice,” the experts write. “Given the negative effects of obesity on quality of life, the well-known risks of serious complications and reduced life expectancy associated with it, it is a misconception to define obesity as a choice.”
4. Obesity is a condition, not a disease.
The criteria generally used to determine disease status “are clearly fulfilled in many individuals with obesity as commonly defined, albeit not all,” the experts explain. “These criteria include specific signs or symptoms (such as increased adiposity), reduced quality of life, and/or increased risk of further illness, complications, and deviation from normal physiology — or well-characterized pathophysiology (for example, inflammation, insulin resistance, and alterations of hormonal signals regulating satiety and appetite).”
5. Severe obesity is usually reversible by voluntarily eating less and exercising more.
“A large body of clinical evidence has shown that voluntary attempts to eat less and exercise more render only modest effects on body weight in most individuals with severe obesity,” the experts write. “When fat mass decreases, the body responds with reduced resting energy expenditure and changes in signals that increase hunger and reduce satiety (for example, leptin, ghrelin). These compensatory metabolic and biologic adaptations promote weight regain and persist for as long as persons are in the reduced-energy state, even if they gain some weight back.”
Health care facility improvements
The expert panel also determined that many health care facilities aren’t equipped to treat people with obesity. Examination gowns, blood pressure cuffs, chairs and examination tables often are too small, patients have reported.
When researchers from the University of Minnesota, Minneapolis Veterans Affairs Medical Center and Mayo Clinic studied the quality of care that patients with obesity receive, they learned that a clinic’s physical environment can have a big effect on a patient’s experience.
They write in a 2015 study published in Obesity Reviews: “Waiting room chairs with armrests can be uncomfortable or too small. Equipment such as scales, blood pressure cuffs, examination gowns and pelvic examination instruments are often designed for use with smaller patients. When larger alternatives are not available, or are stored in a place that suggests infrequent use, it can signal to patients that their size is unusual and that they do not belong. These experiences, which are not delivered with malicious intent, can be humiliating.”
When medical equipment is the wrong size, it may not work correctly. For instance, chances are high that a blood pressure reading will be inaccurate if a health care professional uses a blood pressure cuff that’s too small on a patient with obesity, a 2022 paper finds.
To create a comfortable environment for patients with high body weights, the Rudd Center for Food Policy and Obesity recommends that health care facilities provide, among other things, extra-large exam gowns, chairs that can support more than 300 pounds and do not have arms, and wide exam tables that are bolted to the floor so they don’t move.
The consensus statement also recommends improvements to health care facilities.
“Given the prevalence of obesity and obesity-related diseases,” the 36 international experts write, “appropriate infrastructure for the care and management of people with obesity, including severe obesity, must be standard requirement for accreditation of medical facilities and hospitals.”
Source list:
Weight Bias Among Health Care Professionals: A Systematic Review and Meta-Analysis
Blake J. Lawrence; et al. Obesity, November 2021.Joint International Consensus Statement for Ending Stigma of Obesity
Francesco Rubino, et al. Nature Medicine, March 2020.Perceived Weight Discrimination and Chronic Biochemical Stress: A Population-Based Study Using Cortisol in Scalp Hair
Sarah E. Jackson, Clemens Kirschbaum and Andrew Steptoe. Obesity, December 2016.Weight Stigma is Stressful. A Review of Evidence for the Cyclic Obesity/Weight-Based Stigma Model
A. Janet Tomiyama. Appetite, November 2014.Association of Birth by Cesarean Delivery with Obesity and Type 2 Diabetes Among Adult Women
Jorge E. Chavarro. JAMA Network Open, April 2020.Adverse Childhood Experiences and Adult Obesity: A Systematic Review of Plausible Mechanisms and Meta-Analysis of Cross-Sectional Studies
David A. Wiss and Timothy D. Brewerton. Physiology & Behavior, September 2020.Income Inequality and Obesity among U.S. Adults 1999–2016: Does Sex Matter?
Hossein Zare, Danielle D. Gaskin and Roland J. Thorpe Jr. International Journal of Environmental Research and Public Health, July 2021.Comparisons of Explicit Weight Bias Across Common Clinical Specialties of U.S. Resident Physicians
Samantha R. Philip, Sherecce A. Fields, Michelle Van Ryn and Sean M. Phelan. Journal of General Internal Medicine, October 2023.Impact of Weight Bias and Stigma on Quality of Care and Outcomes for Patients with Obesity
S.M. Phelan; et al. Obesity Reviews, April 2015.One Size Does Not Fit All: Impact of Using A Regular Cuff For All Blood Pressure Measurements
Tammy. M. Brady; et al. Circulation, April 2022.This article first appeared on The Journalist’s Resource and is republished here under a Creative Commons license.
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52 Weeks to Better Mental Health – by Dr. Tina Tessina
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We’ve written before about the health benefits of journaling, but how to get started, and how to make it a habit, and what even to write about?
Dr. Tessina presents a year’s worth of journaling prompts with explanations and exercises, and no, they’re not your standard CBT flowchart things, either. Rather, they not only prompt genuine introspection, but also are crafted to be consistently uplifting—yes, even if you are usually the most disinclined to such positivity, and approach such exercises with cynicism.
There’s an element of guidance beyond that, too, and as such, this book is as much a therapist-in-a-book as you might find. Of course, no book can ever replace a competent and compatible therapist, but then, competent and compatible therapists are often harder to find and can’t usually be ordered for a few dollars with next-day shipping.
Bottom line: if undertaken with seriousness, this book will be an excellent investment in your mental health and general wellbeing.
Click here to check out 52 Weeks to Better Mental Health, and get on the best path for you!
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Paving The Way To Good Health
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This is Dr. Michelle Tollefson. She’s a gynecologist, and a menopause and lifestyle medicine expert. She’s also a breast cancer survivor, and, indeed, thriver.
So, what does she want us to know?
A Multivector Approach To Health
There’s a joke that goes: a man is trapped in a flooding area, and as the floodwaters rise, he gets worried and begins to pray, but he is interrupted when some people come by on a raft and offer him to go with them. He looks at the rickety raft and says “No, you go on, God will spare me”. He returns to his prayer, and is further interrupted by a boat and finally a helicopter, and each time he gives the same response. He drowns, and in the afterlife he asks God “why didn’t you spare me from the flood?”, and God replies “I sent a raft, a boat, and a helicopter; what more did you want?!”
People can be a bit the same when it comes to different approaches to cancer and other serious illness. They are offered chemotherapy and say “No, thank you, eating fruit will spare me”.
Now, this is not to trivialize those who decline aggressive cancer treatments for other reasons such as “I am old and would rather not go through that; I’d rather have a shorter life without chemo than a longer life with it”—for many people that’s a valid choice.
But it is to say: lifestyle medicine is, mostly, complementary medicine.
It can be very powerful! It can make the difference between life and death! Especially when it comes to things like cancer, diabetes, heart disease, etc.
But it’s not a reason to decline powerful medical treatments if/when those are appropriate. For example, in Dr. Tollefson’s case…
Synergistic health
Dr. Tollefson, herself a lifestyle medicine practitioner and gynecologist (and having thus done thousands of clinical breast exams for other people, screening for breast cancer), says she owes her breast cancer survival to two things, or rather two categories of things:
- a whole-food, plant predominant diet, daily physical activity, prioritizing sleep, minimizing stress, and a strong social network
- a bilateral mastectomy, 16 rounds of chemotherapy, removal of her ovaries, and several reconstructive surgeries
Now, one may wonder: if the first thing is so good, why need the second?
Or on the flipside: if the second thing was necessary, what was the point of the first?
And the answer she gives is: the first thing was the reason she was able to make it through the second thing.
And on the next level: the second thing was the reason she’s still around to talk about the first thing.
In other words: she couldn’t have done it with just one or the other.
A lot of medicine in general, and lifestyle medicine in particular, is like this. If we note that such-and-such a thing decreases our risk of cancer mortality by 4%, that’s a small decrease, but it can add up (and compound!) if it’s surrounded by other things that also each decrease the risk by 12%, 8%, 15%, and so on.
Nor is this only confined to cancer, nor only to the positives.
Let’s take cardiovascular disease: if a person smokes, drinks, eats red meat, stresses, and has a wild sleep schedule, you can imagine those risk factors add up and compound.
If this person and another with a heart-healthy lifestyle both have a stroke (it can happen to anyone, even if it’s less likely in this case), and both need treatment, then two things are true:
- They are both still going to need treatment (medicines, and possibly a thrombectomy)
- The second person is most likely to recover, and most likely to recover more quickly and easily
The second person can be said to have paved the way to their recovery, with their lifestyle.
Which is really important, because a lot of people think “what’s the point in living so healthily if [disease] strikes anyway?” and the answer is:
A very large portion of your recovery is predicated on how you lived your life before The Bad Thing™ happened, and that can be the difference between bouncing back quickly and a long struggle back to health.
Or the difference between a long struggle back to health, or a short struggle followed by rapid decline and death.
In short:
Play the odds, improve your chances with lifestyle medicine. Enjoy those cancer-fighting fruits:
Top 8 Fruits That Prevent & Kill Cancer
…but also, get your various bits checked when appropriate; we know, mammograms and prostate checks etc are not usually the highlight of most people’s days, but they save lives. And if it turns out you need serious medical interventions, consider them seriously.
And, by all means, enjoy mood-boosting nutraceuticals such as:
12 Foods That Fight Depression & Anxiety
…but also recognize that sometimes, your brain might have an ongoing biochemical problem that a tablespoon of pumpkin seeds isn’t going to fix.
And absolutely, you can make lifestyle adjustments to reduce the risks associated with menopause, for example:
Menopause, & How Lifestyle Continues To Matter “Postmenopause”
…but also be aware that if the problem is “not enough estrogen”, sometimes to solution is “take estrogen”.
And so on.
Want to know Dr. Tollefson’s lifestyle recommendations?
Most of them will not be a surprise to you, and we mentioned some of them above (a whole-food, plant predominant diet, daily physical activity, prioritizing sleep, minimizing stress, and a strong social network), but for more specific recommendations, including numbers etc, enjoy:
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Take care!
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Can We Side-Step Age-Related Alienation?
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When The World Moves Without Us…
We’ve written before about how reduced social engagement can strike people of all ages, and what can be done about it:
How To Beat Loneliness & Isolation
…but today we’re going to talk more about a specific aspect of it, namely, the alienation that can come with old age—and other life transitions too, but getting older is something that (unless accident or incident befall us first) all of us will definitely do.
What’s the difference?
Loneliness is a status, alienation is more of a process. It can be the alienation in the sense of an implicit “you don’t belong here” message from the world that’s geared around the average person and thus alienates those who are not that (a lack of accessibility to people with disabilities can be an important and very active example of this), and it can also be an alienation from what we’ve previously considered our “niche” in the world—the loss of purpose many people feel upon retirement fits this bill. It can even be a more generalized alienation from our younger selves; it’s easy to have a self-image that doesn’t match one’s current reality, for instance.
Read more: Estranged by Time: Alienation in the Aging Process
So, how to “un-alienate”?
To “un-alienate”, that is to say, to integrate/reintegrate, can be hard. Some things may even be outright impossible, but most will not be!
Consider how, for example, former athletes become coaches—or for that matter, how former party-goers might become party-hosts (even if the kind of “party” might change with time, give or take the pace at which we like to live our lives).
What’s important is that we take what matters the most to us, and examine how we can realistically still engage with that thing.
This is different from trying to hold on grimly to something that’s no longer our speed.
Letting go of the only thing we’ve known will always be scary; sometimes it’s for the best, and sometimes what we really need is just more of a pivot, like the examples above. The crux lies in knowing which:
- Is our relationship with the thing (whatever it may be) still working for us, or is it just bringing strife now?
- If it’s not working for us, is it because of a specific aspect that could be side-stepped while keeping the rest?
- If we’re going to drop that thing entirely (or be dropped by it, which, while cruel, also happens in life), then where are we going to land?
This latter is one where foresight is a gift, because if we bury our heads in the sand we’re going to land wherever we’re dropped, whereas if we acknowledge the process, we can make a strategic move and land on our feet.
Here’s a good pop-science article about this—it’s aimed at people around retirement age, but honestly the advice is relevant for people of all ages, and facing all manner of life transitions, e.g. career transitions (of which retirement is of course the career transition to end all career transitions), relationship transitions (including B/B/B/B: births, betrothals/break-ups, and bereavements) health transitions (usually: life-changing illnesses and/or disabilities—which again, happens to most of us if something doesn’t get us first), etc. So with all that in mind, this becomes more of a “how to reassess your life at those times when it needs reassessing”:
How to Reassess Your Life in Retirement
But that doesn’t mean that letting go is always necessary
Sometimes, the opposite! Sometimes, the age-old advice to “lean in” really is all the situation calls for, which means:
- Be ready to say “yes” to things, and if nobody’s asking, be ready to “hey, do you wanna…?” and take a “build it and they will come” approach. This includes with people of different ages, too! Intergenerational friendships can be very rewarding for all concerned, if done right. Communities that span age-ranges can be great for this—they might be about special interests (this writer has friends ranging through four generations from playing chess, for instance), they could be religious communities if we be religious, LGBT groups if that fits for us, even mutual support groups such as for specific disabilities or chronic illness if we have such—notice how the very things that might isolate us can also bring us together!
- Be open-minded to new experiences; it’s easy to get stuck in a rut of “I’ve never done that” and mistake that self-assessment for an uncritical assumption of “I’m not the kind of person who does that”. Sometimes, you really won’t be! But at least think about it and entertain the possibility, before dismissing it out of hand. And, here’s a life tip: it can be really good to (within the realms of safety, and one’s personal moral principles, of course) take an approach of “try anything once”. Even if we’re almost certain we won’t like it, and even if we then turn out to indeed not like it, it can be a refreshing experience—and now we can say “Yep, tried that, not doing that again” from a position of informed knowledge. That’s the only way we get to look back on a richly lived life of broad experiences, after all, and it is never too late for such.
- Be comfortable prioritizing quality over quantity. This goes for friends, it goes for activities, it goes for experiences. The topic of “what’s the best number of friends to have?” has been a matter of discussion since at least ancient Greek times (Plato and Aristotle examined this extensively), but whatever number we might arrive at, it’s clear that quality is the critical factor, and quantity after that is just a matter of optimizing.
In short: make sure you’re investing—in your relationships, in your areas of interest, in your community (whatever that may mean for you personally), and most of all, and never forget this: in yourself.
Take care!
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
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