What The New Cholesterol Guidelines Mean For You
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Sometimes, when new health guidelines come out, it’s just a case of a government saying “you should do more/less of these things you’re already doing/avoiding”.
This isn’t one of those occasions:
Knowledge is power health
New cholesterol management guidelines from the American College of Cardiology and American Heart Association have been released for the first time since 2018, and have been published in the Journal of the American College of Cardiology and Circulation.
The shortest version is: test everything, earlier and oftener
What’s mostly the same:
- Enjoying heart-healthy diet, regular physical activity, avoiding tobacco, getting good sleep, and maintaining a healthy weight remain the foundation, with 80%–90% of cardiovascular disease linked to modifiable risk factors.
- In particular, the guide still emphasizes lowering LDL cholesterol and other lipids like lipoprotein(a) to reduce risks of heart attack, stroke, heart failure, and cardiovascular disease in general.
What’s new:
- It recommends more individualized risk assessment using medical history, including conditions like rheumatoid arthritis, and life factors such as early menopause or pregnancy complications.
- It includes tailored advice for anyone who is pregnant or lactating, people over the age of 75, and people with conditions like diabetes, chronic kidney disease, HIV, or cancer.
- It recommends a one-time test for Lp(a), as elevated levels can raise heart disease risk by about 40% at 125 nmol/L and double it at 250 nmol/L.
- It also recommends monitoring C-reactive protein (CRP) levels in general, and high-sensitivity C-reactive protein (hsCRP) in particular.
- If you’re curious about this, we wrote about it here: Demystifying C-Reactive Protein (CRP)!
- It recommends more frequent coronary artery calcium scans to detect plaque and refine treatment decisions.
- It recommends earlier cholesterol screening, especially for people with a family history of cardiovascular disease or inherited condition.
- See also: Demystifying Cholesterol
- It also recommends that people with familial hypercholesterolemia should begin screening around age 9 or earlier.
- It has a new risk calculator; the PREVENT tool replaces older models, using much broader data (6.6 million people), and incorporating blood sugar and kidney health to estimate 10- and 30-year cardiovascular risk, starting from age 30.
On the topic of those cholesterol tests, you might be wondering about the targets, so…
LDL cholesterol goals are:
- <100 mg/dL for people in the “low risk” category based on other factors
- <70 mg/dL for people in the “intermediate risk” category based on other factors
- <55 mg/dL for people in the “high risk” category based on other factors
You can read the new guidelines for yourself, here: 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines
That sure is a lot of institutions that were involved in this and signed off on it, isn’t it?
If you’d like to get a head start on the tests, then check out: 6 Blood Markers That Predict Disease Years Before Symptoms Appear
And if you’d like to just directly get started on lowering your cholesterol levels, then we have you covered for that, too:
- Statins: His & Hers?
- Lower Cholesterol Naturally
- Take These To Lower Cholesterol! (Statin Alternatives)
- How To Lower Your Cholesterol By 50+ Points Without Drugs
- What Two Days Of Oats Will Do To Your Lipids
Want to learn more?
For a much deeper dive than we have room for here, you might want to consider this book we reviewed a while back:
Prevent & Reverse Heart Disease – by Dr. Caldwell Esselstyn
Take care!
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Citicoline: Better Than Dietary Choline?
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Citicoline: Better Than Dietary Choline?
Citicoline, also known as cytidine diphosphate-choline (or CDP-Choline, to its friends, or cytidine 5′-diphosphocholine if it wants to get fancy) is a dietary supplement that the stomach can metabolize easily for all the brain’s choline needs. What are those needs?
Choline is an essential nutrient. We technically can synthesize it, but only in minute amounts, far less than we need. Choline is a key part of the neurotransmitter acetylcholine, as well as having other functions in other parts of the body.
As for citicoline specifically… it appears to do the job better than dietary sources of choline:
❝Intriguing data, showing that on a molar mass basis citicoline is significantly less toxic than choline, are also analyzed.
It is hypothesized that, compared to choline moiety in other dietary sources such as phosphatidylcholine, choline in citicoline is less prone to conversion to trimethylamine (TMA) and its putative atherogenic N-oxide (TMAO).
Epidemiological studies have suggested that choline supplementation may improve cognitive performance, and for this application citicoline may be safer and more efficacious.❞
Source: Citicoline: A Superior Form of Choline?
Great! What does it do?
What doesn’t it do? When it comes to cognitive function, anyway, citicoline covers a lot of bases.
Short version: it improves just about every way a brain’s healthy functions can be clinically measured. From cognitive improvements in all manner of tests (far beyond just “improves memory” etc; also focus, alertness, verbal fluency, logic, computation, and more), to purely neurological things like curing tinnitus (!), alleviating mobility disorders, and undoing alcohol-related damage.
One of the reasons it’s so wide in its applications, is that it has a knock-on effect to other systems in the brain, including the dopaminergic system.
Long version: Citicoline: pharmacological and clinical review, 2022 update
(if you don’t want to sit down for a long read, we recommend skimming to the charts and figures, which are very elucidating even alone)
Spotlight study in memory
For a quick-reading example of how it helps memory specifically:
Keeping dementia at bay
For many older people looking to improve memory, it’s less a matter of wanting to perform impressive feats of memory, and more a matter of wanting to keep a sharp memory throughout our later years.
Dr. Maria Bonvicini et al. looked into this:
❝We selected seven studies including patients with mild cognitive impairment, Alzheimer’s disease or post-stroke dementia
All the studies showed a positive effect of citicoline on cognitive functions. Six studies could be included in the meta-analysis.
Overall, citicoline improved cognitive status, with pooled standardized mean differences ranging from 0.56 (95% CI: 0.37-0.75) to 1.57 (95% CI: 0.77-2.37) in different sensitivity analyses❞
The researchers concluded “yes”, and yet, called for more studies, and of higher quality. In many such studies, the heterogeneity of the subjects (often, residents of nursing homes) can be as much a problem (unclear whether the results will be applicable to other people in different situations) as it is a strength (fewer confounding variables).
Another team looked at 47 pre-existing reviews, and concluded:
❝The review found that citicoline has been proven to be a useful compound in preventing dementia progression.
Citicoline has a wide range of effects and could be an essential substance in the treatment of many neurological diseases.
Its positive impact on learning and cognitive functions among the healthy population is also worth noting.❞
Source: Application of Citicoline in Neurological Disorders: A Systematic Review
The dopamine bonus
Remember how we said that citicoline has a knock-on effect on other systems, including the dopaminergic system? This means that it’s been studied (and found meritorious) for alleviating symptoms of Parkinson’s disease:
❝Patients with Parkinson’s disease who were taking citicoline had significant improvement in rigidity, akinesia, tremor, handwriting, and speech.
Citicoline allowed effective reduction of levodopa by up to 50%.
Significant improvement in cognitive status evaluation was also noted with citicoline adjunctive therapy.❞
Source: Citicoline as Adjuvant Therapy in Parkinson’s Disease: A Systematic Review
Where to get it?
We don’t sell it, but here’s an example product on Amazon, for your convenience
Enjoy!
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How to Use Topical Estrogen Cream For Aging Skin
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Dr. Sam Ellis, dermatologist, explains:
Tackling the cause
Estrogen is important for very many aspects of health beyond the sexual aspects. When it comes to skin, a drop in estrogen (usually because of menopause) leads to changes like collagen loss, dryness, reduced elasticity, and slower wound healing. Applying estrogen creams to the skin can reverse these changes.
If your estrogen levels are already within normal pre-menopausal female ranges, by the way, there isn’t so much science to indicate its benefit when used topically. If you are already on systemic HRT (i.e., you take estrogen already to raise your blood estrogen levels and affect your body in its entirety), you may or may not gain extra benefits from the topical cream, depending on factors such as your estrogen dose, your route of administration, your cardiovascular health, and other factors.
For those with lower estrogen and not currently on HRT, you may be wondering: can topical estrogen cream affect systemic estrogen levels? And the answer is that it mostly depends on the dose. In other words: it’s definitely possible, but for most people it’s unlikely.
As ever, if thinking of taking up any hormonal treatment, do consult an endocrinologist and/or gynecologist, and if you have an increased breast cancer risk (for example genetically or prior history), then an oncologist too, just to be safe.
That sounds like a lot of scary things, but mostly it’s just to be on the safe side. The dose of estrogen is very low in topical creams, and even then, only a tiny amount is used per day.
For more on all of this, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
- “Why Does It Hurt When I Have Sex?” (And What To Do About It) ← because topical estrogen is not just for your face! Yes, you can use it down there too and it’s commonly prescribed for exactly this use.
- Hormones & Health, Beyond The Obvious
- The Hormone Therapy That Reduces Breast Cancer Risk & More
Take care!
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Can Reflexology Shoes Improve Your Focus?
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.
It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
No question/request too big or small 😎
❝What about shoes with insoles for reflexology, like the new ones with neuroscience claims. Are they legit?❞
First, a disclaimer-laden answer: probably by “legit” you mean “do they work to improve brain function?”, but it’s hard to uncouple “legit” from “legitimate” in the litigious sense. So, we will say, we are but a humble health science publication, and cannot comment on the legality of any company’s products or claims.
We can comment on more concrete scientific questions though, such as: does the evidence support claims that such shoes improve brain function?
In which case, the answer is: no
What you have to bear in mind is how a lot of companies will make claims that are technically true (for legal reasons) but functionally meaningless (in any practical sense that most readers would read it).
For example, let’s look at one such example that’s been making headlines lately, perhaps it’s even what you saw. It’s Nike’s new “neuroscience-based footwear”, which they describe with such statements as:
Nike is launching a new type of shoe designed to help athletes lock in their mindset pre- and post-competition.
The Mind 001 and Mind 002 are the first neuroscience-based footwear from Nike that tap into the mind-body connection by activating sensory receptors in the feet.
Nike is introducing its first neuroscience-based footwear: two mind-altering silhouettes designed to help athletes lock in their mindset before and after competition. Scientifically shown to activate key sensory areas of the brain via underfoot stimulation, the Nike Mind 001 mule and Mind 002 sneaker deepen an athlete’s awareness, helping ground them in their bodies and bring them back to the present moment.
Source: Nike Debuts its First Neuroscience-Based Footwear to Help Athletes Feel Calm, Focused and Present
These sound like strong claims, but let’s break it down a little:
designed to help athletes lock in their mindset pre- and post-competition
When this writer was small, she designed a pair of shoes to help her walk on water (there were shoe-sized pieces of wood attached under them, on the basis that wood floats).
Were they designed to help our intrepid writer to walk on water? Yes, they were. That was literally what they were designed to do.
Did they actually enable her to walk on water? No, they did not.
So, always watch out for such phrases as “designed to”, “intended to”, “aimed at helping”, and so forth.
Now, as for…
Scientifically shown to activate key sensory areas of the brain via underfoot stimulation
That’s a fair claim! But it’s also not what it might seem like. The reality is, anything that you can experience will activate key sensory areas in the brain. If it didn’t, then you wouldn’t experience it, because how could you, if it didn’t activate the relevant sensory areas in your brain?
And so on, with various other true claims.
Can they help anything?
Yes! Shoes are very relevant things for our health.
For example, shoes with “zero-drop”, i.e. with no incline/decline, and the inside sole of the foot is parallel to the floor (so, not like the featured image for this article, which are by no means high heels, but you can see the heel is raised more than the toes, and there’s a gradient between the two, as is common in most “flat” shoes that aren’t really flat), support good foot health for most people, and foot health is indeed the foundation of a lot of other good health, much like if your car tires are bad, the rest of your car won’t stay in good condition for long.
We wrote about the zero-drop issue here: Steps For Keeping Your Feet A Healthy Foundation
…which is consistent with such science as: Foot strike patterns and collision forces in habitually barefoot versus shod runners
However, some other things are less evidence-based, for example:
Are Grounding Mats Grounded In Good Science?
…and:
Reflexology: What The Science Says
Want to learn more?
You might also like:
The Foot Book – by Dr. Todd Brennan & Dr. Leslie Johnston
Take care!
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Vit D + Calcium: Too Much Of A Good Thing?
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Vit D + Calcium: Too Much Of A Good Thing?
- Myth: you can’t get too much calcium!
- Myth: you must get as much vitamin D as possible!
Let’s tackle calcium first:
❝Calcium is good for you! You need more calcium for your bones! Be careful you don’t get calcium-deficient!❞
Contingently, those comments seem reasonable. Contingently on you not already having the right amount of calcium. Most people know what happens in the case of too little calcium: brittle bones, osteoporosis, and so forth.
But what about too much?
Hypercalcemia
Having too much calcium—or “hypercalcemia”— can lead to problems with…
- Groans: gastrointestinal pain, nausea, and vomiting. Peptic ulcer disease and pancreatitis.
- Bones: bone-related pains. Osteoporosis, osteomalacia, arthritis and pathological fractures.
- Stones: kidney stones causing pain.
- Moans: refers to fatigue and malaise.
- Thrones: polyuria, polydipsia, and constipation
- Psychic overtones: lethargy, confusion, depression, and memory loss.
(mnemonic courtesy of Sadiq et al, 2022)
What causes this, and how do we avoid it? Is it just dietary?
It’s mostly not dietary!
Overconsumption of calcium is certainly possible, but not common unless one has an extreme diet and/or over-supplementation. However…
Too much vitamin D
Again with “too much of a good thing”! While keeping good levels of vitamin D is, obviously, good, overdoing it (including commonly prescribed super-therapeutic doses of vitamin D) can lead to hypercalcemia.
This happens because vitamin D triggers calcium absorption into the gut, and acts as gatekeeper to the bloodstream.
Normally, the body only absorbs 10–20% of the calcium we consume, and that’s all well and good. But with overly high vitamin D levels, the other 80–90% can be waved on through, and that is very much Not Good™.
See for yourself:
- Hypercalcemia of Malignancy: An Update on Pathogenesis and Management
- Vitamin D-Mediated Hypercalcemia: Mechanisms, Diagnosis, and Treatment
How much is too much?
The United States’ Office of Dietary Supplements defines 4000 IU (100μg) as a high daily dose of vitamin D, and recommends 600 IU (15μg) as a daily dose, or 800 IU (20μg) if aged over 70.
See for yourself: Vitamin D Fact Sheet for Health Professionals ← there’s quite a bit of extra info there too
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Long COVID is more than fatigue. Our new study suggests its impact is similar to a stroke or Parkinson’s
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When most people think of COVID now, they picture a short illness like a cold – a few days of fever, sore throat or cough before getting better.
But for many, the story doesn’t end there. Long COVID – defined by the World Health Organization (WHO) as symptoms lasting at least three months after infection – has become a lasting part of the pandemic.
Most research has focused on describing symptoms – such as fatigue, brain fog and breathlessness. But we know less about their effect on daily life, and this hasn’t been well studied in Australia. That’s where our new study, published today, comes in.
We show long COVID isn’t just uncomfortable or inconvenient. People with the condition told us it can profoundly limit their daily life and stop them from doing what they want to do, and need to do.
elenaleonova/Getty What is long COVID?
Long COVID affects about 6% of people with COVID, with more than 200 symptoms recorded. For some, it lasts a few months. For “long haulers” it stretches into years.
The size of the problem is hard to measure, because symptoms vary from person to person. This has led to debate about what long COVID really is, what causes it, and even whether it’s real.
But mounting evidence shows long COVID is very real and serious. Studies confirm it reduces quality of life to levels seen in illnesses such as chronic fatigue syndrome, stroke, rheumatoid arthritis and Parkinson’s disease.
Here’s what people with long COVID told us
We surveyed 121 adults across Australia living with long COVID. They had caught COVID between February 2020 and June 2022, with most aged 36–50. Most were never hospitalised, and managed their illness at home.
But months or years later, they were still struggling with daily activities they once took for granted.
To understand the impact, we asked them to complete two surveys widely used in health research to measure disability and quality of life – the WHO Disability Assessment Schedule (WHODAS 2.0) and the Short Form Health Survey (SF-36).
These surveys capture people’s own voices and lived experience. Unlike scans or blood tests, they show what symptoms mean for everyday life.
The results were striking.
People with long COVID reported worse disability than 98% of the general Australian population. A total of 86% of those with long COVID met the threshold for serious disability compared with 9% of Australians overall.
On average, people had trouble with daily activities on about 27 days a month and were unable to function on about 18 days.
Tasks such as eating or dressing were less affected, but more complex areas – housework and socialising – were badly impacted. People could often meet basic needs, but their ability to contribute to their homes, workplaces and communities was limited.
Quality of life was also badly affected. Energy levels and social life were the most impacted, reflecting how fatigue and brain fog affect activities, relationships and community connections. On average, overall quality of life scores were 23% lower than the general population.
What are the implications?
International research shows similar patterns. One study across 13 countries found similar levels of disability. It also found women had higher disability scores than men. As long COVID disability has many facets and can change a lot over time, it doesn’t fit into traditional ways of providing health care for chronic conditions.
Another key insight from our study is the importance of self-reported outcomes. Long COVID has no diagnostic test, and people often report health professionals are sceptical about their symptoms and their impact. Yet our study showed people’s own ratings of their recovery strongly predicted their disability and quality of life.
This shows self-reports are not just “stories”. They are valid and reliable indicators of health. They also capture what medical tests cannot.
For example, fatigue is not just being tired. It can mean losing concentration while driving, giving up hobbies, or pulling away from cherished friendships.
Our study shows long COVID disrupts futures, breaks connections, and creates daily struggles that ripple out to families, workplaces and communities.
What needs to happen next?
Evidence presented to the 2023 parliamentary long COVID inquiry estimates hundreds of thousands of Australians are living with long COVID.
We know disadvantaged communities are even more likely to be impacted by the cascading effects of long COVID. So ignoring the scale and severity of long COVID risks deepening inequality and worsening its impact even further.
By building services based on lived experience, we can move towards restoring not just health, but dignity and participation in daily life for people with long COVID.
We need rehabilitation and support services that go beyond basic medical care. People need support to manage fatigue, such as “pacing” and conserving energy by not overexerting themselves. Workplaces need to accommodate people with long COVID by reducing hours, redesigning job demands and offering flexible leave. People also need support to rebuild social connections.
All this requires people with long COVID to be thoughtfully assessed and treated. Listening to patients and valuing their experience is a crucial first step.
We’d like to acknowledge the following co-authors of the research mentioned in this article: Tanita Botha, Fisaha Tesfay, Sara Holton, Cathy Said, Martin Hensher, Mary Rose Angeles, Catherine Bennett, Bodil Rasmussen and Kelli Nicola-Richmond.
Danielle Hitch, Senior Lecturer in Occupational Therapy, Deakin University; Genevieve Pepin, Professor, School of Health and Social Development, Deakin University, and Kieva Richards, Lecturer in Occupational Therapy, La Trobe University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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The “Five Tibetan Rites” & Why To Do Them!
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Spinning Around
In Tuesday’s newsletter, we asked you for your opinion of the “Five Tibetan Rites”, and got the above-depicted, below-described, set of responses:
- About 41% said “I have never heard of these before”
- About 27% said “they restore youth by adjusting internal vortexes”
- About 22% said “they are basically yoga, by a different name”
- About 11% said “they are a pseudoscience popular in the US”
So what does the science say?
The Five Tibetan Rites are five Tibetan rites: True or False?
False, though this is more question of social science than of health science, so we’ll not count it against them for having a misleading name.
The first known mentioning of the “Five Tibetan Rites” is by an American named Peter Kelder, who in 1939 published, through a small LA occult-specialized publishing house, a booklet called “The Eye of Revelation”. This work was then varyingly republished, repackaged, and occasionally expanded upon by Kelder or other American authors, including Chris Kilham’s popular 1994 book “The Five Tibetans”.
The “Five Tibetan Rites” are unknown as such in Tibet, except for what awareness of them has been raised by people asking about them in the context of the American phenomenon.
Here’s a good history book, for those interested:
The author didn’t originally set out to “debunk” anything, and is himself a keen spiritualist (and practitioner of the five rites), but he was curious about the origins of the rites, and ultimately found them—as a collection of five rites, and the other assorted advices given by Kelder—to be an American synthesis in the whole, each part inspired by various different physical practices (some of them hatha yoga, some from the then-popular German gymnastics movement, some purely American spiritualism, all available in books that were popular in California in the early 1900s).
You may be wondering: why didn’t Kelder just say that, then, instead of telling stories of an ancient Tibetan tradition that empirically does not exist? The answer to this lies again in social science not health science, but it’s been argued that it’s common for Westerners to “pick ‘n’ mix” ideas from the East, champion them as inscrutably mystical, and (since they are inscrutable) then simply decide how to interpret and represent them. Here’s an excellent book on this, if you’re interested:
(in Kelder’s case, this meant that “there’s a Tibetan tradition, trust me” was thus more marketable in the West than “I read these books in LA”)
They are at least five rites: True or False?
True! If we use the broad definition of “rite” as “something done repeatedly in a solemn fashion”. And there are indeed five of them:
- Spinning around (good for balance)
- Leg raises (this one’s from German gymnastics)
- Kneeling back bend (various possible sources)
- Tabletop (hatha yoga, amongst others)
- Pendulum (hatha yoga, amongst others) ← you may recognize this one from the Sun Salutation
You can see them demonstrated here:
Click Here If The Embedded Video Doesn’t Load Automatically
Kelder also advocated for what was basically the Hay Diet (named not for the substance but for William Hay; it involved separating foods into acid and alkali, not necessarily according to the actual pH of the foods, and combining only “acid” foods or only “alkali” foods at a time), which was popular at the time, but has since been rejected as without scientific merit. Kelder referred to this as “the sixth rite”.
The Five Rites restore youth by adjusting internal vortexes: True or False?
False, in any scientific sense of that statement. Scientifically speaking, the body does not have vortexes to adjust, therefore that is not the mechanism of action.
Spiritually speaking, who knows? Not us, a humble health science publication.
The Five Rites are a pseudoscience popular in the US: True or False?
True, if 27% of those who responded of our mostly North American readership can be considered as representative of what is popular.
However…
“Pseudoscience” gets thrown around a lot as a bad word; it’s often used as a criticism, but it doesn’t have to be. Consider:
A small child who hears about “eating the rainbow” and mistakenly understands that we are all fuelled by internal rainbows that need powering-up by eating fruits and vegetables of different colors, and then does so…
…does not hold a remotely scientific view of how things are happening, but is nevertheless doing the correct thing as recommended by our best current science.
It’s thus a little similar with the five rites. Because…
The Five Rites are at least good for our health: True or False?
True! They are great for the health.
The first one (spinning around) is good for balance. Science would recommend doing it both ways rather than just one way, but one is not bad. It trains balance, trains our stabilizing muscles, and confuses our heart a bit (in a good way).
See also: Fall Special (How To Not Fall, And Not Get Injured If You Do)
The second one (leg raises) is excellent for core strength, which in turn helps keep our organs where they are supposed to be (this is a bigger health issue than most people realise, because “out of sight, out of mind”), which is beneficial for many aspects of our health!
See also: Visceral Belly Fat & How To Lose It ← visceral fat is the fat that surrounds your internal organs; too much there becomes a problem!
The third, fourth, and fifth ones stretch our spine (healthily), strengthen our back, and in the cases of the fourth and fifth ones, are good full-body exercises for building strength, and maintaining muscle mass and mobility.
See also: Building & Maintaining Mobility
So in short…
If you’ve been enjoying the Five Rites, by all means keep on doing them; they might not be Tibetan (or an ancient practice, as presented), and any mystical aspect is beyond the scope of our health science publication, but they are great for the health in science-based ways!
Take care!
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