What are heart rate zones, and how can you incorporate them into your exercise routine?
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If you spend a lot of time exploring fitness content online, you might have come across the concept of heart rate zones. Heart rate zone training has become more popular in recent years partly because of the boom in wearable technology which, among other functions, allows people to easily track their heart rates.
Heart rate zones reflect different levels of intensity during aerobic exercise. They’re most often based on a percentage of your maximum heart rate, which is the highest number of beats your heart can achieve per minute.
But what are the different heart rate zones, and how can you use these zones to optimise your workout?
The three-zone model
While there are several models used to describe heart rate zones, the most common model in the scientific literature is the three-zone model, where the zones may be categorised as follows:
- zone 1: 55%–82% of maximum heart rate
- zone 2: 82%–87% of maximum heart rate
- zone 3: 87%–97% of maximum heart rate.
If you’re not sure what your maximum heart rate is, it can be calculated using this equation: 208 – (0.7 × age in years). For example, I’m 32 years old. 208 – (0.7 x 32) = 185.6, so my predicted maximum heart rate is around 186 beats per minute.
There are also other models used to describe heart rate zones, such as the five-zone model (as its name implies, this one has five distinct zones). These models largely describe the same thing and can mostly be used interchangeably.
What do the different zones involve?
The three zones are based around a person’s lactate threshold, which describes the point at which exercise intensity moves from being predominantly aerobic, to predominantly anaerobic.
Aerobic exercise uses oxygen to help our muscles keep going, ensuring we can continue for a long time without fatiguing. Anaerobic exercise, however, uses stored energy to fuel exercise. Anaerobic exercise also accrues metabolic byproducts (such as lactate) that increase fatigue, meaning we can only produce energy anaerobically for a short time.
On average your lactate threshold tends to sit around 85% of your maximum heart rate, although this varies from person to person, and can be higher in athletes.
In the three-zone model, each zone loosely describes one of three types of training.
Zone 1 represents high-volume, low-intensity exercise, usually performed for long periods and at an easy pace, well below lactate threshold. Examples include jogging or cycling at a gentle pace.
Zone 2 is threshold training, also known as tempo training, a moderate intensity training method performed for moderate durations, at (or around) lactate threshold. This could be running, rowing or cycling at a speed where it’s difficult to speak full sentences.
Zone 3 mostly describes methods of high-intensity interval training, which are performed for shorter durations and at intensities above lactate threshold. For example, any circuit style workout that has you exercising hard for 30 seconds then resting for 30 seconds would be zone 3.
Striking a balance
To maximise endurance performance, you need to strike a balance between doing enough training to elicit positive changes, while avoiding over-training, injury and burnout.
While zone 3 is thought to produce the largest improvements in maximal oxygen uptake – one of the best predictors of endurance performance and overall health – it’s also the most tiring. This means you can only perform so much of it before it becomes too much.
Training in different heart rate zones improves slightly different physiological qualities, and so by spending time in each zone, you ensure a variety of benefits for performance and health.
So how much time should you spend in each zone?
Most elite endurance athletes, including runners, rowers, and even cross-country skiers, tend to spend most of their training (around 80%) in zone 1, with the rest split between zones 2 and 3.
Because elite endurance athletes train a lot, most of it needs to be in zone 1, otherwise they risk injury and burnout. For example, some runners accumulate more than 250 kilometres per week, which would be impossible to recover from if it was all performed in zone 2 or 3.
Of course, most people are not professional athletes. The World Health Organization recommends adults aim for 150–300 minutes of moderate intensity exercise per week, or 75–150 minutes of vigorous exercise per week.
If you look at this in the context of heart rate zones, you could consider zone 1 training as moderate intensity, and zones 2 and 3 as vigorous. Then, you can use heart rate zones to make sure you’re exercising to meet these guidelines.
What if I don’t have a heart rate monitor?
If you don’t have access to a heart rate tracker, that doesn’t mean you can’t use heart rate zones to guide your training.
The three heart rate zones discussed in this article can also be prescribed based on feel using a simple 10-point scale, where 0 indicates no effort, and 10 indicates the maximum amount of effort you can produce.
With this system, zone 1 aligns with a 4 or less out of 10, zone 2 with 4.5 to 6.5 out of 10, and zone 3 as a 7 or higher out of 10.
Heart rate zones are not a perfect measure of exercise intensity, but can be a useful tool. And if you don’t want to worry about heart rate zones at all, that’s also fine. The most important thing is to simply get moving.
Hunter Bennett, Lecturer in Exercise Science, University of South Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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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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Coconut vs Avocado – Which is Healthier?
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Our Verdict
When comparing coconut to avocado, we picked the avocado.
Why?
In terms of macros, avocado is lower in carbs and also in net carbs—coconut’s a little higher in fiber, but not enough to make up for the difference in carbs nor, when it comes to glycemic index and insulin index, the impact of coconut’s much higher fat content on insulin responses too. On which note, while coconut’s fats are broadly considered healthy (its impressive saturated fat content is formed of medium-chain triglycerides which, in moderation, are heart-healthy), avocado’s fats are even healthier, being mostly monounsaturated fat with some polyunsaturated (and about 15x less saturated fat). All in all, a fair win for avocado on the macros front, but coconut isn’t bad in moderation.
When it comes to vitamins, avocados are higher in vitamins A, B1, B2, B3, B5, B6, B9, C, E, K, and choline. Most of those differences are by very large margins. Coconuts are not higher in any vitamins. A huge, easy, “perfect score” win for avocados.
In the category of minerals, however, it’s coconut’s turn to sweep with more calcium, copper, iron, magnesium, manganese, phosphorus, zinc, and selenium—though the margins are mostly not nearly as impressive as avocado’s vitamin margins. Speaking of avocados, they do have more potassium than coconuts do, but the margin isn’t very large. A compelling win for coconut’s mineral content.
Adding up the sections, we get to a very credible win for avocados, but coconuts are also very respectable. So, as ever, enjoy both (although we do recommend exercising moderation in the case of coconuts, mainly because of the saturated fat content), and if you’re choosing between them for some purpose, then avocado will generally be the best option.
Want to learn more?
You might like to read:
- Can Saturated Fats Be Healthy? ← defying Betteridge’s Law here!
- Avocado, Coconut & Lime Crumble Pots ← if you do want to enjoy both, here’s a fabulous way to do so in style
Take care!
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Take Care Of Your Lymphatic System To Beat Cognitive Decline
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
First of all, for any unfamiliar with the lymphatic system, it’s mostly the body’s clean-up system (as well as a big part of the body’s anticancer system).
See: The Lymphatic System Against Cancer & More
It may not be the most glamorous job, but it’s certainly an essential one.
There’s no lymph in the brain, but…
Because of the blood-brain barrier (BBB) that keeps the astonishingly sensitive brain as safe as it can from unwanted things, there are many aspects of our physiology that only happen inside the brain, or only happen outside of it, as the compounds in question may be too large to get through the BBB.
The lymphatic system is, in and of itself, an entirely outside-of-the-brain affair. So, how does stuff get cleaned out from the brain (such as beta-amyloid and alpha-synuclein clearance, to avoid Alzheimer’s and Parkinson’s, respectively)?
The glymphatic system (a portmanteau of glial cells doing the job of the lymphatic system) is the brain’s own cleanup crew, and we wrote about it here:
How To Clean Your Brain (Glymphatic Health Primer)
Why lymph still matters for the brain
Although the glymphatic system is doing a (hopefully) fine job of scrubbing up the brain, if the lymphatic system isn’t working at least as well, then this becomes the equivalent of what would happen if you at home were very attentive to taking the trash out, but the garbage disposal crews stopped doing their job, or did it much less well than they need to. Soon, you’d end up with a mountain of trash at home, even though you were doing your part correctly.
In short: the glymphatic system needs to pass the waste on somewhere, and the lymphatic system is its go-to.
You may be wondering about the role of blood in all of this, and the answer is that no part of any of the above systems can do its job without adequate oxygenation, and our blood also assists in the transport of things removed—which is one of the reasons why there are blood-based Alzheimer’s tests that can be done; they measure certain markers of neurodegeneration that become present in the blood having left the brain:
Early Dementia Screening From Your Blood & More ← the “and more” is actually quite interesting, but it’s the blood we’re interested in for this section
What can be done about it
Our first two links up above, about the lymphatic and glymphatic systems, respectively, also tell how to look after each of them, but we’ll mention a few salient pointers here.
For the lymphatic system:
- do lymphatic massage
- exercise, with a focus on maximizing movement
- eat an anti-inflammatory diet
For the glymphatic system:
- do vagal massage (Vagal! Not vaginal, which will not help! Or rather: it won’t help the glymphatic system, anyway)
- exercise, and/but also rest well (good quality sleep)
- eat omega-3 fatty acids
For more details and suggestions on each though, do check out:
Lymphatic health primer | Glymphatic health primer
How this was discovered
Until as recently as 2014, it was not known that there was any part of the lymphatic system around the brain, waiting to take things from the glymphatic system. Since then, research has slowly been done about the relationship between the two, how things work, and what affects what and how.
Most recently (the study was published two days ago, at time of writing this) it was discovered that, in mice at least, improving lymphatic function just outside of the brain (the meningeal lymphatic vessels, responsible for draining waste from the brain) improves memory.
Aged mice who underwent a process that rejuvenated the meningeal lymphatic vessels, performed better in memory tests afterwards.
How this worked, step-by-step:
- The mice were given a special protein that rejuvenated the meningeal lymphatic vessels¹
- The lymphatic vessels were then able to do their job better
- This meant that the glial cells of the glymphatic system were no longer drowning in excess stuff
- This reduced levels of a protein that says “help, too much stuff!” and starts inhibiting everything it can to try to cope²
- This meant that neural activity was no longer being suppressed, and memory improved
Technical bits for those who want it:
¹ We’re not being secretive about what this special protein was; it’s just that the special protein is called adeno-associated virus 1 cytomegalovirus murine vascular endothelial growth factor C, or “AAV1-CMV-mVEGF-C” for short, so for readability, “a special protein” does the job. Suffice it to say, a) you can’t exactly buy AAV1-CMV-mVEGF-C on Amazon, and b) you wouldn’t want it anyway, you’d want its close cousin AAV1-CMV-hVEGF-C (“m” for murine, i.e. mousey, vs “h” for human)
² This one’s just called interleukin-6 (IL-6); perhaps you’ve heard of interleukin; we’ve mentioned it sometimes before.
You can read the paper in its entirety here; if you don’t mind reading very technical stuff, it is very interesting:
Meningeal lymphatics-microglia axis regulates synaptic physiology
Enjoy!
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From immunotherapy to mRNA vaccines – the latest science on melanoma treatment explained
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More than 16,000 Australians will be diagnosed with melanoma each year. Most of these will be caught early, and can be cured by surgery.
However, for patients with advanced or metastatic melanoma, which has spread from the skin to other organs, the outlook was bleak until the advent of targeted therapies (that attack specific cancer traits) and immune therapies (that leverage the immune system). Over the past decade, these treatments have seen a significant climb in the number of advanced melanoma patients surviving for at least five years after diagnosis, from less than 10% in 2011 to around 50% in 2021.
While this is great news, there are still many melanoma patients who cannot be treated effectively with current therapies. Researchers have developed two exciting new therapies that are being evaluated in clinical trials for advanced melanoma patients. Both involve the use of immunotherapy at different times and in different ways.
The first results from these trials are now being shared publicly, offering insight into the future of melanoma treatment.
Svitlana Hulko/Shutterstock Immunotherapy before surgery
Immunotherapy works by boosting the power of a patient’s immune system to help kill cancer cells. One type of immunotherapy uses something called “immune checkpoint inhibitors”.
Immune cells carry “immune checkpoint” proteins, which control their activity. Cancer cells can interact with these checkpoints to turn off immune cells and hide from the immune system. Immune checkpoint inhibitors block this interaction and help keep the immune system activated to fight the cancer.
Results from an ongoing phase 3 trial using immune checkpoint inhibitors were recently published in the New England Journal of Medicine.
This trial used two types of immune checkpoint inhibitors: nivolumab, which blocks an immune checkpoint called PD-1, and ipilimumab, which blocks CTLA-4.
More than 16,000 Australians are diagnosed with melanoma each year. Delovely Pics/Shutterstock Some 423 patients (including many from Australia) were enrolled in the trial, and participants were randomly assigned to one of two groups.
The first group had surgery to remove their melanoma, and were then given immunotherapy (nivolumab) to help kill any remaining cancer cells. Giving a systemic (whole body) therapy such as immunotherapy after surgery is a standard way of treating melanoma. The second group received immunotherapy first (nivolumab plus ipilimumab) and then underwent surgery. This is a new approach to treating these cancers.
Based on previous observations, the researchers had predicted that giving patients immunotherapy while the whole tumour was still present would activate the tumour-fighting abilities of the patient’s immune system much better than giving it once the tumour had been removed.
Sure enough, 12 months after starting therapy, 83.7% of patients who received immunotherapy before surgery remained cancer-free, compared to 57.2% in the control group who received immunotherapy after surgery.
Based on these results, Australian of the year Georgina Long – who co-led the trial with Christian Blank from The Netherlands Cancer Institute – has suggested this method of immunotherapy before surgery should be considered a new standard of treatment for higher risk stage 3 melanoma. She also said a similar strategy should be evaluated for other cancers.
The promising results of this phase 3 trial suggest we might see this combination treatment being used in Australian hospitals within the next few years.
mRNA vaccines
Another emerging form of melanoma therapy is the post-surgery combination of a different checkpoint inhibitor (pembrolizumab, which blocks PD-1), with a messenger RNA vaccine (mRNA-4157).
While checkpoint inhibitors like pembrolizumab have been around for more than a decade, mRNA vaccines like mRNA-4157 are a newer phenomenon. You might be familiar with mRNA vaccines though, as the biotechnology companies Pfizer-BioNTech and Moderna released COVID vaccines based on mRNA technology.
mRNA-4157 works basically the same way – the mRNA is injected into the patient and produces antigens, which are small proteins that train the body’s immune system to attack a disease (in this case, cancer, and for COVID, the virus).
However, mRNA-4157 is unique – literally. It’s a type of personalised medicine, where the mRNA is created specifically to match a patient’s cancer. First, the patient’s tumour is genetically sequenced to figure out what antigens will best help the immune system to recognise their cancer. Then a patient-specific version of mRNA-4157 is created that produces those antigens.
The latest results of a three-year, phase 2 clinical trial which combined pembrolizumab and mRNA-4157 were announced this past week. Overall, 2.5 years after starting the trial, 74.8% of patients treated with immunotherapy combined with mRNA-4157 post-surgery remained cancer-free, compared to 55.6% of those treated with immunotherapy alone. These were patients who were suffering from high-risk, late-stage forms of melanoma, who generally have poor outcomes.
It’s worth noting these results have not yet been published in peer-reviewed journals. They’re available as company announcements, and were also presented at some cancer conferences in the United States.
Based on the results of this trial, the combination of pembrolizumab and the vaccine progressed to a phase 3 trial in 2023, with the first patients being enrolled in Australia. But the final results of this trial are not expected until 2029.
It is hoped this mRNA-based anti-cancer vaccine will blaze a trail for vaccines targeting other types of cancer, not just melanoma, particularly in combination with checkpoint inhibitors to help stimulate the immune system.
Despite these ongoing advances in melanoma treatment, the best way to fight cancer is still prevention which, in the case of melanoma, means protecting yourself from UV exposure wherever possible.
Sarah Diepstraten, Senior Research Officer, Blood Cells and Blood Cancer Division, WEHI (Walter and Eliza Hall Institute of Medical Research) and John (Eddie) La Marca, Senior Research Officer, Blood Cells and Blood Cancer, WEHI (Walter and Eliza Hall Institute of Medical Research)
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Mango vs Guava – Which is Healthier?
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Our Verdict
When comparing mango to guava, we picked the guava.
Why?
Looking at macros first, these two fruits are about equal on carbs (nominally mango has more, but it’s by a truly tiny margin), while guava has more than 3x the protein and more than 3x the fiber. A clear win for guava.
In terms of vitamins, mango has more of vitamins A, E, and K, while guava has more of vitamins B1, B2, B3, B5, B7, B9, and C. Another win for guava.
In the category of minerals, mango is not higher in any minerals, while guava is higher in calcium, copper, iron, magnesium, manganese, phosphorus, potassium, and zinc.
In short, enjoy both; both are healthy. But if you’re choosing one, there’s a clear winner here, and it’s guava.
Want to learn more?
You might like to read:
What’s Your Plant Diversity Score?
Take care!
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Lower Your Cortisol! (Here’s Why & How)
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Cortisol, or “the stress hormone” to its friends, is produced by your adrenal glands, and is generally considered “not fun”.
It does serve a purpose, of course, just like almost everything else our body does. It serves as part of the “fight or flight” response, for example, and helps you to wake up in the morning.
While you do need some cortisol (and a small percentage of people have too little), most of us have too much.
Why? Simply put, modern life is not what 200,000* years of human evolution prepared us for:
- Agriculture (which allowed us to settle down and cease being nomadic) happened during the last 6% of those 200,000 years.
- The Industrial Revolution and the onset of modern capitalism happened during only during the last 0.1% of those 200,000 years.
*the 200,000 years figure is conservative and doesn’t take into account the 200,000,000 years of pre-hominid mammalian evolution. Doing so, on the basis of the mammalian brain & physiology being what’s important here, means our modern stressors have been around for <0.0001% of the time we have.
So guess what, our bodies haven’t caught up. As far as our bodies are concerned, we are supposed to be enjoying the sunshine of grassy plains and the shade of woodland while eating fruit.
- When the alarm clock goes off, our body panics and prepares us to either flee or help fight the predator, because why else would we have been woken so?
- When we have a pressing deadline for work, our brain processes this as “if we don’t do this, we will literally starve and die”.
- When people are upset or angry with us, there’s a part of our brain that fears exile from the tribe and resultant death.
…and so on.
Health Risks of High Cortisol
The long-term stressors are the biggest issue for health. Unless you have a heart condition or other relevant health problem, almost anyone can weather a brief unpleasant surprise. But if something persists? That prompts the body to try to protect you, bless it. The body’s attempts backfire, because…
- One way it does this by making sure to save as much food as possible in the form of body fat
- It’ll also increase your appetite, to make sure you eat anything you can while you still can
- It additionally tries to protect you by keeping you on the brink of fight-or-flight readiness, e.g:
- High blood pressure
- High blood sugar levels
- Rapid mood changes—gotta be able to do those heel-turns as necessary and react quickly to any possible threat!
Suffice it to say, these things are not good for your long-term health.
That’s the “Why”—now here’s the “How”:
Lowering your cortisol levels mostly means lowering your stress and/or lowering your stress response. We previously gave some powerful tools for lowering anxiety, which for these purposes amounts to the same thing.
However, we can also make nutritional and lifestyle changes that will reduce our cortisol levels, for example:
- Reduce (ideally: eliminate from your lifestyle) caffeine
- Reduce (ideally: eliminate from your lifestyle) alcohol
- Yes, really. While many understandably turn to alcohol specifically to help manage stress, it only makes it worse long-term.
- Additionally, alcohol directly stimulates cortisol production, counterintuitive as that may be.
Read: Alcohol, Aging, and the Stress Response ← full article (with 37 sources of its own) from the NYMC covering how alcohol stimulates cortisol production and what that means for us
As well as reductions/eliminations, are some things you can add into your lifestyle that will help!
We’ve written previously about some:
Read: Ashwagandha / Read: L-Theanine / Read: CBD Oil
Other things include, no surprises here:
- The Mediterranean diet (nutritious and delicious): https://10almonds.com/mediterranean-diet
- Get 7–9 hours (good quality!) sleep per night: https://10almonds.com/time-pillow-talk
- Get regular exercise (the regularity matters most!): https://10almonds.com/keep-on-keeping-on
Progressive Relaxation
We’ll give this one its own section because we’ve not talked about it before. Maybe you’re familiar. If not, then in a nutshell: progressive relaxation means progressively tensing and then relaxing each part of your body in turn.
Why does this work? Part of it is just a physical trick involving biofeedback and the natural function of muscles to contract and relax in turn, but the other part is even cleverer:
It basically tricks the most primitive part of your brain, the limbic system, into thinking you had a fight and won, telling it “thank you very much for the cortisol but we don’t need it anymore”.
Take a Hike! Or a Stroll… You Do You!
Last but not least: go connect with your roots. Spend time in the park, or at least the garden. Have a picnic, if the weather suits. Go somewhere you can spend time around leafy green things under a blue sky (we realize the blue sky may be subject to availability in some locations, but do what you can!).
Remember also: just as your body’s responses will be tricked by the alarm clock or the housework, they will also be easily tricked by blue and green stuff around you. If a sunny garden isn’t available in your location, a picture of one as your desktop background is the next best thing.
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