Water Fluoridation, Atheroma, & More
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small 😎
❝I watched a documentary recently on Fluoride in our drinking water & the dangers of it. Why are we poisoning our water?❞
This is a great question, and it certainly is controversial. It sounds like the documentary you watched was predominantly or entirely negative, but there’s a lot of science to back both sides of this, and it’s not even that the science is contradictory (it’s not). It’s that what differs is people’s opinions about whether benefiting one thing is worth creating a risk to another, and that means looking at:
- What is the risk associated with taking no action (error of omission)?
- What is the risk associated with taking an action (error of commission)?
The whole topic is worth a main feature, but to summarize a few key points:
- Water fluoridation is considered good for the prevention of dental cavities
- Water fluoridation aims to deliver fluoride and doses far below dangerous levels
- This requires working on consumer averages, though
- ”Where do we put the safety margins?” is to some extent a subjective question, in terms of trading off one aspect of health for another
- Too much fluoride can also be bad for the teeth (at least cosmetically, creating little white* spots)
- Detractors of fluoride tend to mostly be worried about neurological harm
- However, the doses in public water supplies are almost certainly far below the levels required to cause this harm.
- That said, again this is working on consumer averages, though.
- However, the doses in public water supplies are almost certainly far below the levels required to cause this harm.
- A good guide is: watch your teeth! Those white* spots will be “the canary in the coal mine” of more serious harm that could potentially come from higher levels due to overconsumption of fluorine.
*Teeth are not supposed to be pure white. The “Hollywood smile” is a lie. Teeth are supposed to be a slightly off-white, ivory color. Anything whiter than that is adding something else that shouldn’t be there, or stripping something off that should be there.
❝How does your diet change clean out your arteries of the bad cholesterol?❞
There’s good news and bad news here, and they can both be delivered with a one-word reply:
Slowly.
Or rather: what’s being cleaned out is mostly not the LDL (bad) cholesterol, but rather, the result of that.
When our diet is bad for cardiovascular health, our arteries get fatty deposits on their walls. Cholesterol gets stuck here too, but that’s not the main physical problem.
Our body’s natural defenses come into action and try to clean it up, but they (for example macrophages, a kind of white blood cell that consumes invaders and then dies, before being recycled by the next part of the system) often get stuck and become part of the buildup (called atheroma), which can lead to atherosclerosis and (if calcium levels are high) hardening of the arteries, which is the worst end of this.
This can then require medical attention, precisely because the body can’t remove it very well—especially if you are still maintaining a heart-unhealthy diet, thus continuing to add to the mess.
However, if it is not too bad yet, yes, a dietary change alone will reverse this process. Without new material being added to the arterial walls, the body’s continual process of rejuvenation will eventually fix it, given time (free from things making it worse) and resources.
In fact, your arteries can be one of the quickest places for your body to make something better or worse, because the blood is the means by which the body moves most things (good or bad) around the body.
All the more reason to take extra care of it, since everything else depends on it!
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Fast Exercise – by Dr. Michael Mosley & Peta Bee
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We’ve written before about the benefits of High-Intensity Interval Training (HIIT), but there’s more to say than we can fit in a short article!
Dr. Michael Mosley, who hates exercise but knows his stuff when it comes to the benefits, teamed up with Peta Bee, who loves exercise and is a science journalist with degrees in sports science and nutrition, to bring us this book.
In it, we learn a lot about:
- the science of HIIT
- what makes it so different from most kinds of exercise
- exactly what benefits one can expect
…in a very detailed clinical fashion (while still remaining very readable).
By “very detailed clinical fashion”, here we mean “one minute of this kind of exercise this many times per week over this period of time will give this many extra healthy life-years”, for example, along with lots of research to back numbers, and explanations of the mechanisms of action (e.g. reducing inflammatory biomarkers of aging, increasing cellular apoptosis, improving cardiometabolic stats for reduced CVD risk, and many things)
There’s also time/space given over to exactly what to do and how to do it, giving enough options to suit personal tastes/circumstances.
Bottom line: if you’d like to make your exercise work a lot harder for you while you spend a lot less time working out, then this book will help you do just that!
Click here to check out Fast Exercise, and enjoy the benefits!
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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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Doctors Are as Vulnerable to Addiction as Anyone. California Grapples With a Response
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BEVERLY HILLS, Calif. — Ariella Morrow, an internal medicine doctor, gradually slid from healthy self-esteem and professional success into the depths of depression.
Beginning in 2015, she suffered a string of personal troubles, including a shattering family trauma, marital strife, and a major professional setback. At first, sheer grit and determination kept her going, but eventually she was unable to keep her troubles at bay and took refuge in heavy drinking. By late 2020, Morrow could barely get out of bed and didn’t shower or brush her teeth for weeks on end. She was up to two bottles of wine a day, alternating it with Scotch whisky.
Sitting in her well-appointed home on a recent autumn afternoon, adorned in a bright lavender dress, matching lipstick, and a large pearl necklace, Morrow traced the arc of her surrender to alcohol: “I’m not going to drink before 5 p.m. I’m not going to drink before 2. I’m not going to drink while the kids are home. And then, it was 10 o’clock, 9 o’clock, wake up and drink.”
As addiction and overdose deaths command headlines across the nation, the Medical Board of California, which licenses MDs, is developing a new program to treat and monitor doctors with alcohol and drug problems. But a fault line has appeared over whether those who join the new program without being ordered to by the board should be subject to public disclosure.
Patient advocates note that the medical board’s primary mission is “to protect healthcare consumers and prevent harm,” which they say trumps physician privacy.
The names of those required by the board to undergo treatment and monitoring under a disciplinary order are already made public. But addiction medicine professionals say that if the state wants troubled doctors to come forward without a board order, confidentiality is crucial.
Public disclosure would be “a powerful disincentive for anybody to get help” and would impede early intervention, which is key to avoiding impairment on the job that could harm patients, said Scott Hambleton, president of the Federation of State Physician Health Programs, whose core members help arrange care and monitoring of doctors for substance use disorders and mental health conditions as an alternative to discipline.
But consumer advocates argue that patients have a right to know if their doctor has an addiction. “Doctors are supposed to talk to their patients about all the risks and benefits of any treatment or procedure, yet the risk of an addicted doctor is expected to remain a secret?” Marian Hollingsworth, a volunteer advocate with the Patient Safety Action Network, told the medical board at a Nov. 14 hearing on the new program.
Doctors are as vulnerable to addiction as anyone else. People who work to help rehabilitate physicians say the rate of substance use disorders among them is at least as high as the rate for the general public, which the federal Substance Abuse and Mental Health Services Administration put at 17.3% in a Nov. 13 report.
Alcohol is a very common drug of choice among doctors, but their ready access to pain meds is also a particular risk.
“If you have an opioid use disorder and are working in an operating room with medications like fentanyl staring you down, it’s a challenge and can be a trigger,” said Chwen-Yuen Angie Chen, an addiction medicine doctor who chairs the Well-Being of Physicians and Physicians-in-Training Committee at Stanford Health Care. “It’s like someone with an alcohol use disorder working at a bar.”
From Pioneer to Lagger
California was once at the forefront of physician treatment and monitoring. In 1981, the medical board launched a program for the evaluation, treatment, and monitoring of physicians with mental illness or substance use problems. Participants were often required to take random drug tests, attend multiple group meetings a week, submit to work-site surveillance by colleagues, and stay in the program for at least five years. Doctors who voluntarily entered the program generally enjoyed confidentiality, but those ordered into it by the board as part of a disciplinary action were on the public record.
The program was terminated in 2008 after several audits found serious flaws. One such audit, conducted by Julianne D’Angelo Fellmeth, a consumer interest lawyer who was chosen as an outside monitor for the board, found that doctors in the program were often able to evade the random drug tests, attendance at mandatory group therapy sessions was not accurately tracked, and participants were not properly monitored at work sites.
Today, MDs who want help with addiction can seek private treatment on their own or in many cases are referred by hospitals and other health care employers to third parties that organize treatment and surveillance. The medical board can order a doctor on probation to get treatment.
In contrast, the California licensing boards of eight other health-related professions, including osteopathic physicians, registered nurses, dentists, and pharmacists, have treatment and monitoring programs administered under one master contract by a publicly traded company called Maximus Inc. California paid Maximus about $1.6 million last fiscal year to administer those programs.
When and if the final medical board regulations are adopted, the next step would be for the board to open bidding to find a program administrator.
Fall From Grace
Morrow’s troubles started long after the original California program had been shut down.
The daughter of a prominent cosmetic surgeon, Morrow grew up in Palm Springs in circumstances she describes as “beyond privileged.” Her father, David Morrow, later became her most trusted mentor.
But her charmed life began to fall apart in 2015, when her father and mother, Linda Morrow, were indicted on federal insurance fraud charges in a well-publicized case. In 2017, the couple fled to Israel in an attempt to escape criminal prosecution, but later they were both arrested and returned to the United States to face prison sentences.
The legal woes of Morrow’s parents, later compounded by marital problems related to the failure of her husband’s business, took a heavy toll on Morrow. She was in her early 30s when the trouble with her parents started, and she was working 16-hour days to build a private medical practice, with two small children at home. By the end of 2019, she was severely depressed and turning increasingly to alcohol. Then, the loss of her admitting privileges at a large Los Angeles hospital due to inadequate medical record-keeping shattered what remained of her self-confidence.
Morrow, reflecting on her experience, said the very strengths that propel doctors through medical school and keep them going in their careers can foster a sense of denial. “We are so strong that our strength is our greatest threat. Our power is our powerlessness,” she said. Morrow ignored all the flashing yellow lights and even the red light beyond which serious trouble lay: “I blew through all of it, and I fell off the cliff.”
By late 2020, no longer working, bedridden by depression, and drinking to excess, she realized she could no longer will her way through: “I finally said to my husband, ‘I need help.’ He said, ‘I know you do.’”
Ultimately, she packed herself off to a private residential treatment center in Texas. Now sober for 21 months, Morrow said the privacy of the addiction treatment she chose was invaluable because it shielded her from professional scrutiny.
“I didn’t have to feel naked and judged,” she said.
Morrow said her privacy concerns would make her reluctant to join a state program like the one being considered by the medical board.
Physician Privacy vs. Patient Protection
The proposed regulations would spare doctors in the program who were not under board discipline from public disclosure as long as they stayed sober and complied with all the requirements, generally including random drug tests, attendance at group sessions, and work-site monitoring. If the program put a restriction on a doctor’s medical license, it would be posted on the medical board’s website, but without mentioning the doctor’s participation in the program.
Yet even that might compromise a doctor’s career since “having a restricted license for unspecified reasons could have many enduring personal and professional implications, none positive,” said Tracy Zemansky, a clinical psychologist and president of the Southern California division of Pacific Assistance Group, which provides support and monitoring for physicians.
Zemansky and others say doctors, just like anyone else, are entitled to medical privacy under federal law, as long as they haven’t caused harm.
Many who work in addiction medicine also criticized the proposed new program for not including mental health problems, which often go hand in hand with addiction and are covered by physician health programs in other states.
“To forgo mental health treatment, I think, is a grave mistake,” Morrow said. For her, depression and alcoholism were inseparable, and the residential program she attended treated her for both.
Another point of contention is money. Under the current proposal, doctors would bear all the costs of the program.
The initial clinical evaluation, plus the regular random drug tests, group sessions, and monitoring at their work sites could cost participants over $27,000 a year on average, according to estimates posted by the medical board. And if they were required to go for 30-day inpatient treatment, that would add an additional $40,000 — plus nearly $36,000 in lost wages.
People who work in the field of addiction medicine believe that is an unfair burden. They note that most programs for physicians in other states have outside funding to reduce the cost to participants.
“The cost should not be fully borne by the doctors, because there are many other people that are benefiting from this, including the board, malpractice insurers, hospitals, the medical association,” said Greg Skipper, a semi-retired addiction medicine doctor who ran Alabama’s state physician health program for 12 years. In Alabama, he said, those institutions contribute to the program, significantly cutting the amount doctors have to pay.
The treatment program that Morrow attended in spring of 2021, at The Menninger Clinic in Houston, cost $80,000 for a six-week stay, which was covered by a concerned family member. “It saved my life,” she said.
Though Morrow had difficulty maintaining her sobriety in the first year after treatment, she has now been sober since April 2, 2022. These days, Morrow regularly attends therapy and Alcoholics Anonymous and has pivoted to become an addiction medicine doctor.
“I am a better doctor today because of my experience — no question,” Morrow said. “I am proud to be a doctor who’s an alcoholic in recovery.”
This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
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The 7-Minute Morning Routine That Eliminates Stiffness
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The video title says “65+”, but honestly, if you are younger than that, and wait until you are 65 to attend to such things as mobility maintenance, then you’ll wish you’d started a long time previously!
So, today is always a good day to start, whatever your age.
A good way to start the day
The exercises do not, in fact, include the forwards bend depicted in the thumbnail. Rather, they are:
Exercise 1: toe wiggles (1 minute):
- while lying in bed, open and close your toes to improve foot mobility.
- this may seem silly and/or trivial, but it’s vital for overall mobility as foot health impacts daily movement, and your toes are responsible for a surprising amount when it comes to your posture, gait, etc.
Exercise 2: calf and hamstring stretch (1 minute):
- use a rolled-up towel (or similar non-stretchy long thing) to pull one foot towards you while straightening your leg.
- hold the stretch for 30 seconds per leg to relieve tightness in the calf or hamstring.
Exercise 3: knee flexion (1 minute):
- bend your knee as much as possible and pull your shin towards you.
- perform for 30 seconds per leg, gently easing into stiffness if necessary to improve knee mobility (i.e. if this is difficult at first).
Exercise 4: knee extension (1 minute):
- straighten one leg on the bed and press your knee down while pulling the toes up.
- hold for 5 seconds, repeat six times per leg, improving knee extension and strengthening the quads.
Exercise 5: hip flexion mobilization (1 minute):
- with your knees bent, pull one knee towards your chest and release in a rhythmic motion (see video for differences from #3)
- do 30 seconds per leg to improve hip mobility and loosen stiffness, especially beneficial for those with hip arthritis.
exercise 6: cat-cow stretch (1 minute):
- on all fours, alternate between arching your back (cat) and dipping it (cow).
- improves mobility in the neck, mid-back, and lower back.
exercise 7: shoulder and upper back stretch (1 minute):
- stand facing a wall, place your hands on the wall, and hinge at the hips to drop your torso between your arms.
- stretches lats, shoulders, and the upper back; do two 30-second holds..
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Want to learn more?
You might also like:
Over 50? Do These 3 Stretches Every Morning To Avoid Pain
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The Insider’s Guide To Making Hospital As Comfortable As Possible
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Nobody Likes Surgery, But Here’s How To Make It Much Less Bad
This is Dr. Chris Bonney. He’s an anesthesiologist. If you have a surgery, he wants you to go in feeling calm, and make a quick recovery afterwards, with minimal suffering in between.
Being a patient in a hospital is a bit like being a passenger in an airplane:
- Almost nobody enjoys the thing itself, but we very much want to get to the other side of the experience.
- We have limited freedoms and comforts, and small things can make a big difference between misery and tolerability.
- There are professionals present to look after us, but they are busy and have a lot of other people to tend to too.
So why is it that there are so many resources available full of “tips for travelers” and so few “tips for hospital patients”?
Especially given the relative risks of each, and likelihood, or even near-certainty of coming to at least some harm… One would think “tips for patients” would be more in demand!
Tips for surgery patients, from an insider expert
First, he advises us: empower yourself.
Empowering yourself in this context means:
- Relax—doctors really want you to feel better, quickly. They’re on your side.
- Research—knowledge is power, so research the procedure (and its risks!). Dr. Bonney, himself an anesthesiologist, particularly recommends you learn what specific anesthetic will be used (there are many, and they’re all a bit different!), and what effects (and/or after-effects) that may have.
- Reframe—you’re not just a patient; you’re a customer/client. Many people suffer from MDeity syndrome, and view doctors as authority figures, rather than what they are: service providers.
- Request—if something would make you feel better, ask for it. If it’s information, they will be not only obliged, but also enthusiastic, to give it. If it’s something else, they’ll oblige if they can, and the worst case scenario is something won’t be possible, but you won’t know if you don’t ask.
Next up, help them to help you
There are various ways you can be a useful member of your own care team:
- Go into surgery as healthy as you can. If there’s ever a time to get a little fitter, eat a little healthier, prioritize good quality sleep more, the time approaching your surgery is the time to do this.
- This will help to minimize complications and maximize recovery.
- Take with you any meds you’re taking, or at least have an up-to-date list of what you’re taking. Dr. Bonney has very many times had patients tell him such things as “Well, let me see. I have two little pink ones and a little white one…” and when asked what they’re for they tell him “I have no idea, you’d need to ask my doctor”.
- Help them to help you; have your meds with you, or at least a comprehensive list (including: medication name, dosage, frequency, any special instructions)
- Don’t stop taking your meds unless told to do so. Many people have heard that one should stop taking meds before a surgery, and sometimes that’s true, but often it isn’t. Keep taking them, unless told otherwise.
- If unsure, ask your surgical team in advance (not your own doctor, who will not be as familiar with what will or won’t interfere with a surgery).
Do any preparatory organization well in advance
Consider the following:
- What do you need to take with you? Medications, clothes, toiletries, phone charger, entertainment, headphones, paperwork, cash for the vending machine?
- Will the surgeons need to shave anywhere, and if so, might you prefer doing some other form of depilation (e.g. waxing etc) yourself in advance?
- Is your list of medications ready?
- Who will take you to the hospital and who will bring you back?
- Who will stay with you for the first 24 hours after you’re sent home?
- Is someone available to look after your kids/pets/plants etc?
Be aware of how you do (and don’t) need to fast before surgery
The American Society of Anesthesiologists gives the following fasting guidelines:
- Non-food liquids: fast for at least 2 hours before surgery
- Food liquids or light snacks: fast for at least 6 hours before surgery
- Fried foods, fatty foods, meat: fast for at least 8 hours before surgery
(see the above link for more details)
Dr. Bonney notes that many times he’s had patients who’ve had the worst thirst, or caffeine headache, because of abstaining unnecessarily for the day of the surgery.
Unless told otherwise by your surgical team, you can have black coffee/tea up until two hours before your surgery, and you can and should have water up until two hours before surgery.
Hydration is good for you and you will feel the difference!
Want to know more?
Dr. Bonney has his own website and blog, where he offers lots of advice, including for specific conditions and specific surgeries, with advice for before/during/after your hospital stay.
He also has a book with many more tips like those we shared today:
Calm For Surgery: Supertips For A Smooth Recovery
Take good care of yourself!
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The Other Significant Others – by Rhaina Cohen
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As we get older, it’s a function of statistics that increasingly many of us are divorced or widowed. While some will—after whatever time seems right to them—get back into dating, what about those of us who decide that we won’t?
Rhaina Cohen explores the importance of friendship, mutual support, and (Platonic!) closeness and yes, even kinds of intimacy (for that too can be Platonic!) as we go on.
Even from a purely evolutionary approach, we are fundamentally social creatures, and while as individuals we may exist on a spectrum from reclusive to extroverted, we all thrive better when we at least have access to community and friends.
The style of the book is easy-reading and exploratory, and is very compelling as a call-to-arms for those who may wish to give/receive support to/from those with whom we are not necessarily sleeping.
Because at the end of the day, why should sex and/or romance be a required feature for legal protections? Aren’t we adults who can make our own decisions about whom we trust to care for us?
Bottom line: if you’re happily partnered and expect to pre-decease your partner, this book might not be directly important for you (it might for your partner, though). Everyone else? This book may be important at some point. That point might even be now already; only you know.
Click here to check out The Other Significant Others, and make your own choices in life!
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