Women want to see the same health provider during pregnancy, birth and beyond

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Hazel Keedle, Western Sydney University and Hannah Dahlen, Western Sydney University

In theory, pregnant women in Australia can choose the type of health provider they see during pregnancy, labour and after they give birth. But this is often dependent on where you live and how much you can afford in out-of-pocket costs.

While standard public hospital care is the most common in Australia, accounting for 40.9% of births, the other main options are:

  • GP shared care, where the woman sees her GP for some appointments (15% of births)
  • midwifery continuity of care in the public system, often called midwifery group practice or caseload care, where the woman sees the same midwife of team of midwives (14%)
  • private obstetrician care (10.6%)
  • private midwifery care (1.9%).

Given the choice, which model would women prefer?

Our new research, published BMC Pregnancy and Childbirth, found women favoured seeing the same health provider throughout pregnancy, in labour and after they have their baby – whether that’s via midwifery group practice, a private midwife or a private obstetrician.

Assessing strengths and limitations

We surveyed 8,804 Australian women for the Birth Experience Study (BESt) and 2,909 provided additional comments about their model of maternity care. The respondents were representative of state and territory population breakdowns, however fewer respondents were First Nations or from culturally or linguistically diverse backgrounds.

We analysed these comments in six categories – standard maternity care, high-risk maternity care, GP shared care, midwifery group practice, private obstetric care and private midwifery care – based on the perceived strengths and limitations for each model of care.

Overall, we found models of care that were fragmented and didn’t provide continuity through the pregnancy, birth and postnatal period (standard care, high risk care and GP shared care) were more likely to be described negatively, with more comments about limitations than strengths.

What women thought of standard maternity care in hospitals

Women who experienced standard maternity care, where they saw many different health care providers, were disappointed about having to retell their story at every appointment and said they would have preferred continuity of midwifery care.

Positive comments about this model of care were often about a midwife or doctor who went above and beyond and gave extra care within the constraints of a fragmented system.

The model of care with the highest number of comments about limitations was high-risk maternity care. For women with pregnancy complications who have their baby in the public system, this means seeing different doctors on different days.

Some respondents received conflicting advice from different doctors, and said the focus was on their complications instead of their pregnancy journey. One woman in high-risk care noted:

The experience was very impersonal, their focus was my cervix, not preparing me for birth.

Why women favoured continuity of care

Overall, there were more positive comments about models of care that provided continuity of care: private midwifery care, private obstetric care and midwifery group practice in public hospitals.

Women recognised the benefits of continuity and how this included informed decision-making and supported their choices.

The model of care with the highest number of positive comments was care from a privately practising midwife. Women felt they received the “gold standard of maternity care” when they had this model. One woman described her care as:

Extremely personable! Home visits were like having tea with a friend but very professional. Her knowledge and empathy made me feel safe and protected. She respected all of my decisions. She reminded me often that I didn’t need her help when it came to birthing my child, but she was there if I wanted it (or did need it).

However, this is a private model of care and women need to pay for it. So there are barriers in accessing this model of care due to the cost and the small numbers working in Australia, particularly in regional, rural and remote areas, among other barriers.

Women who had private obstetricians were also positive about their care, especially among women with medical or pregnancy complications – this type of care had the second-highest number of positive comments.

This was followed by women who had continuity of care from midwives in the public system, which was described as respectful and supportive.

However, one of the limitations about continuity models of care is when the woman doesn’t feel connected to her midwife or doctor. Some women who experienced this wished they had the opportunity to choose a different midwife or doctor.

What about shared care with a GP?

While shared care between the GP and hospital model of care is widely promoted in the public maternity care system as providing continuity, it had a similar number of negative comments to those who had fragmented standard hospital care.

Considering there is strong evidence about the benefits of midwifery continuity of care, and this model of care appears to be most acceptable to women, it’s time to expand access so all Australian women can access continuity of care, regardless of their location or ability to pay.

Hazel Keedle, Senior Lecturer of Midwifery, Western Sydney University and Hannah Dahlen, Professor of Midwifery, Associate Dean Research and HDR, Midwifery Discipline Leader, Western Sydney University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Why do I poo in the morning? A gut expert explains

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    No, you’re not imagining it. People really are more likely to poo in the morning, shortly after breakfast. Researchers have actually studied this.

    But why mornings? What if you tend to poo later in the day? And is it worth training yourself to be a morning pooper?

    To understand what makes us poo when we do, we need to consider a range of factors including our body clock, gut muscles and what we have for breakfast.

    Here’s what the science says.

    H_Ko/Shutterstock

    So morning poos are real?

    In a UK study from the early 1990s, researchers asked nearly 2,000 men and women in Bristol about their bowel habits.

    The most common time to poo was in the early morning. The peak time was 7-8am for men and about an hour later for women. The researchers speculated that the earlier time for men was because they woke up earlier for work.

    About a decade later, a Chinese study found a similar pattern. Some 77% of the almost 2,500 participants said they did a poo in the morning.

    But why the morning?

    There are a few reasons. The first involves our circadian rhythm – our 24-hour internal clock that helps regulate bodily processes, such as digestion.

    For healthy people, our internal clock means the muscular contractions in our colon follow a distinct rhythm.

    There’s minimal activity in the night. The deeper and more restful our sleep, the fewer of these muscle contractions we have. It’s one reason why we don’t tend to poo in our sleep.

    Diagram of digestive system including colon and rectum
    Your lower gut is a muscular tube that contracts more strongly at certain times of day. Vectomart/Shutterstock

    But there’s increasing activity during the day. Contractions in our colon are most active in the morning after waking up and after any meal.

    One particular type of colon contraction partly controlled by our internal clock are known as “mass movements”. These are powerful contractions that push poo down to the rectum to prepare for the poo to be expelled from the body, but don’t always result in a bowel movement. In healthy people, these contractions occur a few times a day. They are more frequent in the morning than in the evening, and after meals.

    Breakfast is also a trigger for us to poo. When we eat and drink our stomach stretches, which triggers the “gastrocolic reflex”. This reflex stimulates the colon to forcefully contract and can lead you to push existing poo in the colon out of the body. We know the gastrocolic reflex is strongest in the morning. So that explains why breakfast can be such a powerful trigger for a bowel motion.

    Then there’s our morning coffee. This is a very powerful stimulant of contractions in the sigmoid colon (the last part of the colon before the rectum) and of the rectum itself. This leads to a bowel motion.

    How important are morning poos?

    Large international surveys show the vast majority of people will poo between three times a day and three times a week.

    This still leaves a lot of people who don’t have regular bowel habits, are regular but poo at different frequencies, or who don’t always poo in the morning.

    So if you’re healthy, it’s much more important that your bowel habits are comfortable and regular for you. Bowel motions do not have to occur once a day in the morning.

    Morning poos are also not a good thing for everyone. Some people with irritable bowel syndrome feel the urgent need to poo in the morning – often several times after getting up, during and after breakfast. This can be quite distressing. It appears this early-morning rush to poo is due to overstimulation of colon contractions in the morning.

    Can you train yourself to be regular?

    Yes, for example, to help treat constipation using the gastrocolic reflex. Children and elderly people with constipation can use the toilet immediately after eating breakfast to relieve symptoms. And for adults with constipation, drinking coffee regularly can help stimulate the gut, particularly in the morning.

    A disturbed circadian rhythm can also lead to irregular bowel motions and people more likely to poo in the evenings. So better sleep habits can not only help people get a better night’s sleep, it can help them get into a more regular bowel routine.

    Man preparing Italian style coffee at home, adding coffee to pot
    A regular morning coffee can help relieve constipation. Caterina Trimarchi/Shutterstock

    Regular physical activity and avoiding sitting down a lot are also important in stimulating bowel movements, particularly in people with constipation.

    We know stress can contribute to irregular bowel habits. So minimising stress and focusing on relaxation can help bowel habits become more regular.

    Fibre from fruits and vegetables also helps make bowel motions more regular.

    Finally, ensuring adequate hydration helps minimise the chance of developing constipation, and helps make bowel motions more regular.

    Monitoring your bowel habits

    Most of us consider pooing in the morning to be regular. But there’s a wide variation in normal so don’t be concerned if your poos don’t follow this pattern. It’s more important your poos are comfortable and regular for you.

    If there’s a major change in the regularity of your bowel habits that’s concerning you, see your GP. The reason might be as simple as a change in diet or starting a new medication.

    But sometimes this can signify an important change in the health of your gut. So your GP may need to arrange further investigations, which could include blood tests or imaging.

    Vincent Ho, Associate Professor and clinical academic gastroenterologist, Western Sydney University

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Support For Long COVID & Chronic Fatigue

    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.

    Long COVID and Chronic Fatigue

    Getting COVID-19 can be very physically draining, so it’s no surprise that getting Long COVID can (and usually does) result in chronic fatigue.

    But, what does this mean and what can we do about it?

    What makes Long COVID “long”

    Long COVID is generally defined as COVID-19 whose symptoms last longer than 28 days, but in reality the symptoms not only tend to last for much longer than that, but also, they can be quite distinct.

    Here’s a large (3,762 participants) study of Long COVID, which looked at 203 symptoms:

    Characterizing long COVID in an international cohort: 7 months of symptoms and their impact

    Three symptoms stood at out as most prevalent:

    1. Chronic fatigue (CFS)
    2. Cognitive dysfunction
    3. Post-exertional malaise (PEM)

    The latter means “the symptoms get worse following physical or mental exertion”.

    CFS, Chronic Fatigue Syndrome, is also called Myalgic Encephalomyelitis (ME).

    What can be done about it?

    The main “thing that people do about it” is to reduce their workload to what they can do, but this is not viable for everyone. Note that work doesn’t just mean “one’s profession”, but anything that requires physical or mental energy, including:

    • Childcare
    • Housework
    • Errand-running
    • Personal hygiene/maintenance

    For many, this means having to get someone else to do the things—either with support of family and friends, or by hiring help. For many who don’t have those safety nets available, this means things simply not getting done.

    That seems bleak; isn’t there anything more we can do?

    Doctors’ recommendations are chiefly “wait it out and hope for the best”, which is not encouraging. Some people do recover from Long COVID; for others, it so far appears it might be lifelong. We just don’t know yet.

    Doctors also recommend to journal, not for the usual mental health benefits, but because that is data collection. Patients who journal about their symptoms and then discuss those symptoms with their doctors, are contributing to the “big picture” of what Long COVID and its associated ME/CFS look like.

    You may notice that that’s not so much saying what doctors can do for you, so much as what you can do for doctors (and in the big picture, eventually help them help people, which might include you).

    So, is there any support for individuals with Long COVID ME/CFS?

    Medically, no. Not that we could find.

    However! Socially, there are grassroots support networks, that may be able to offer direct assistance, or at least point individuals to useful local resources.

    Grassroots initiatives include Long COVID SOS and the Patient-Led Research Collaborative.

    The patient-led organization Body Politic also used to have such a group, until it shut down due to lack of funding, but they do still have a good resource list:

    Click here to check out the Body Politic resource list (it has eight more specific resources)

    Stay strong!

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  • From straight to curly, thick to thin: here’s how hormones and chemotherapy can change your hair

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    Head hair comes in many colours, shapes and sizes, and hairstyles are often an expression of personal style or cultural identity.

    Many different genes determine our hair texture, thickness and colour. But some people’s hair changes around the time of puberty, pregnancy or after chemotherapy.

    So, what can cause hair to become curlier, thicker, thinner or grey?

    Curly or straight? How hair follicle shape plays a role

    Hair is made of keratin, a strong and insoluble protein. Each hair strand grows from its own hair follicle that extends deep into the skin.

    Curly hair forms due to asymmetry of both the hair follicle and the keratin in the hair.

    Follicles that produce curly hair are asymmetrical and curved and lie at an angle to the surface of the skin. This kinks the hair as it first grows.

    The asymmetry of the hair follicle also causes the keratin to bunch up on one side of the hair strand. This pulls parts of the hair strand closer together into a curl, which maintains the curl as the hair continues to grow.

    Follicles that are symmetrical, round and perpendicular to the skin surface produce straight hair.

    A diagram shows the hair follicle shape of straight, curly and coiled hair.
    Each hair strand grows from its own hair follicle.
    Mosterpiece/Shutterstock

    Life changes, hair changes

    Our hair undergoes repeated cycles throughout life, with different stages of growth and loss.

    Each hair follicle contains stem cells, which multiply and grow into a hair strand.

    Head hairs spend most of their time in the growth phase, which can last for several years. This is why head hair can grow so long.

    Let’s look at the life of a single hair strand. After the growth phase is a transitional phase of about two weeks, where the hair strand stops growing. This is followed by a resting phase where the hair remains in the follicle for a few months before it naturally falls out.

    The hair follicle remains in the skin and the stems cells grow a new hair to repeat the cycle.

    Each hair on the scalp is replaced every three to five years.

    A woman with curly hair works on her computer.
    Each hair on the scalp is replaced every three to five years.
    Just Life/Shutterstock

    Hormone changes during and after pregnancy alter the usual hair cycle

    Many women notice their hair is thicker during pregnancy.

    During pregnancy, high levels of oestrogen, progesterone and prolactin prolong the resting phase of the hair cycle. This means the hair stays in the hair follicle for longer, with less hair loss.

    A drop in hormones a few months after delivery causes increased hair loss. This is due to all the hairs that remained in the resting phase during pregnancy falling out in a fairly synchronised way.

    Hair can change around puberty, pregnancy or after chemotherapy

    This is related to the genetics of hair shape, which is an example of incomplete dominance.

    Incomplete dominance is when there is a middle version of a trait. For hair, we have curly hair and straight hair genes. But when someone has one curly hair gene and one straight hair gene, they can have wavy hair.

    Hormonal changes that occur around puberty and pregnancy can affect the function of genes. This can cause the curly hair gene of someone with wavy hair to become more active. This can change their hair from wavy to curly.

    Researchers have identified that activating specific genes can change hair in pigs from straight to curly.

    Chemotherapy has very visible effects on hair. Chemotherapy kills rapidly dividing cells, including hair follicles, which causes hair loss. Chemotherapy can also have genetic effects that influence hair follicle shape. This can cause hair to regrow with a different shape for the first few cycles of hair regrowth.

    A woman with wavy hair looks in a mirror
    Your hair can change at different stages of your life.
    Igor Ivakhno/Shutterstock

    Hormonal changes as we age also affect our hair

    Throughout life, thyroid hormones are essential for production of keratin. Low levels of thyroid hormones can cause dry and brittle hair.

    Oestrogen and androgens also regulate hair growth and loss, particularly as we age.

    Balding in males is due to higher levels of androgens. In particular, high dihydrotestosterone (sometimes shortened to DHT), which is produced in the body from testosterone, has a role in male pattern baldness.

    Some women experience female pattern hair loss. This is caused by a combination of genetic factors plus lower levels of oestrogen and higher androgens after menopause. The hair follicles become smaller and smaller until they no longer produce hairs.

    Reduced function of the cells that produce melanin (the pigment that gives our hair colour) is what causes greying.The Conversation

    Theresa Larkin, Associate professor of Medical Sciences, University of Wollongong

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • What’s the difference between ADD and ADHD?
  • Ovarian cancer is hard to detect. Focusing on these 4 symptoms can help with diagnosis

    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.

    Ovarian cancers are often found when they are already advanced and hard to treat.

    Researchers have long believed this was because women first experienced symptoms when ovarian cancer was already well-established. Symptoms can also be hard to identify as they’re vague and similar to other conditions.

    But a new study shows promising signs ovarian cancer can be detected in its early stages. The study targeted women with four specific symptoms – bloating, abdominal pain, needing to pee frequently, and feeling full quickly – and put them on a fast track to see a specialist.

    As a result, even the most aggressive forms of ovarian cancer could be detected in their early stages.

    So what did the study find? And what could it mean for detecting – and treating – ovarian cancer more quickly?

    Ground Picture/Shutterstock

    Why is ovarian cancer hard to detect early?

    Ovarian cancer cannot be detected via cervical cancer screening (which used to be called a pap smear) and pelvic exams aren’t useful as a screening test.

    Current Australian guidelines recommend women get tested for ovarian cancer if they have symptoms for more than a month. But many of the symptoms – such as tiredness, constipation and changes in menstruation – are vague and overlap with other common illnesses.

    This makes early detection a challenge. But it is crucial – a woman’s chances of surviving ovarian cancer are associated with how advanced the cancer is when she is diagnosed.

    If the cancer is still confined to the original site with no spread, the five-year survival rate is 92%. But over half of women diagnosed with ovarian cancer first present when the cancer has already metastatised, meaning it has spread to other parts of the body.

    If the cancer has spread to nearby lymph nodes, the survival rate is reduced to 72%. If the cancer has already metastasised and spread to distant sites at the time of diagnosis, the rate is only 31%.

    There are mixed findings on whether detecting ovarian cancer earlier leads to better survival rates. For example, a trial in the UK that screened more than 200,000 women failed to reduce deaths.

    That study screened the general public, rather than relying on self-reported symptoms. The new study suggests asking women to look for specific symptoms can lead to earlier diagnosis, meaning treatment can start more quickly.

    What did the new study look at?

    Between June 2015 and July 2022, the researchers recruited 2,596 women aged between 16 and 90 from 24 hospitals across the UK.

    They were asked to monitor for these four symptoms:

    • persistent abdominal distension (women often refer to this as bloating)
    • feeling full shortly after starting to eat and/or loss of appetite
    • pelvic or abdominal pain (which can feel like indigestion)
    • needing to urinate urgently or more often.

    Women who reported at least one of four symptoms persistently or frequently were put on a fast-track pathway. That means they were sent to see a gynaecologist within two weeks. The fast track pathway has been used in the UK since 2011, but is not specifically part of Australia’s guidelines.

    Some 1,741 participants were put on this fast track. First, they did a blood test that measured the cancer antigen 125 (CA125). If a woman’s CA125 level was abnormal, she was sent to do a internal vaginal ultrasound.

    What did they find?

    The study indicates this process is better at detecting ovarian cancer than general screening of people who don’t have symptoms. Some 12% of women on the fast-track pathway were diagnosed with some kind of ovarian cancer.

    A total of 6.8% of fast-tracked patients were diagnosed with high-grade serous ovarian cancer. It is the most aggressive form of cancer and responsible for 90% of ovarian cancer deaths.

    Out of those women with the most aggressive form, one in four were diagnosed when the cancer was still in its early stages. That is important because it allowed treatment of the most lethal cancer before it had spread significantly through the body.

    There were some promising signs in treating those with this aggressive form. The majority (95%) had surgery and three quarters (77%) had chemotherapy. Complete cytoreduction – meaning all of the cancer appears to have been removed – was achieved in six women out of ten (61%).

    It’s a promising sign that there may be ways to “catch” and target ovarian cancer before it is well-established in the body.

    What does this mean for detection?

    The study’s findings suggest this method of early testing and referral for the symptoms leads to earlier detection of ovarian cancer. This may also improve outcomes, although the study did not track survival rates.

    It also points to the importance of public awareness about symptoms.

    Clinicians should be able to recognise all of the ways ovarian cancer can present, including vague symptoms like general fatigue.

    But empowering members of the general public to recognise a narrower set of four symptoms can help trigger testing, detection and treatment of ovarian cancer earlier than we thought.

    This could also save GPs advising every woman who has general tiredness or constipation to undergo an ovarian cancer test, making testing and treatment more targeted and efficient.

    Many women remain unaware of the symptoms of ovarian cancer. This study shows recognising them may help early detection and treatment.

    Jenny Doust, Clinical Professorial Research Fellow, Australian Women and Girls’ Health Research Centre, The University of Queensland

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • How To Boost Your Memory Immediately (Without Supplements)

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    How To Boost Your Memory (Without Supplements)

    While we do recommend having a good diet and taking advantage of various supplements that have been found to help memory, that only gets so much mileage. With that in mind…

    First, how good is your memory? Take This 2-Minute Online Test

    Now, that was a test of short term memory, which tends to be the most impactful in our everyday life.

    It’s the difference between “I remember the address of the house where I grew up” (long-term memory) and “what did I come to this room to do?” (short-term memory / working memory)

    First tip:

    When you want to remember something, take a moment to notice the details. You can’t have a madeleine moment years later if you wolfed down the madeleines so urgently they barely touched the sides.

    This goes for more than just food, of course. And when facing the prospect of age-related memory loss in particular, people tend to be afraid not of forgetting their PIN code, but their cherished memories of loved ones. So… Cherish them, now! You’ll struggle to cherish them later if you don’t cherish them now. Notice the little details as though you were a painter looking at a scene for painting. Involve more senses than just sight, too!

    If it’s important, relive it. Relive it now, relive it tomorrow. Rehearsal is important to memory, and each time you relive a memory, the deeper it gets written into your long-term memory until it becomes indelible to all but literal brain damage.

    Second tip:

    Tell the story of it to someone else. Or imagine telling it to someone else! (You brain can’t tell the difference)

    And you know how it goes… Once you’ve told a story a few times, you’ll never forget it later. Isn’t your life a story worth telling?

    Many people approach memory like they’re studying for a test. Don’t. Approach it like you’re preparing to tell a story, or give a performance. We are storytelling creatures at heart, whether or not we realize it.

    What do you do when you find yourself in a room and wonder why you went there? (We’ve all been there!) You might look around for clues, but if that doesn’t immediately serve, your fallback will be retracing your steps. Literally, physically, if needs be, but at least mentally. The story of how you got there is easier to remember than the smallest bit of pure information.

    What about when there’s no real story to tell, but we still need to remember something?

    Make up a story. Did you ever play the game “My granny went to market” as a child?

    If not, it’s a collaborative memory game in which players take turns adding items to a list, “My granny went to market and bought eggs”, My granny went to market and bought eggs and milk”, “my granny went to market and bought eggs and milk and flour” (is she making a cake?), “my granny went to market and bought eggs and milk and flour and shoe polish” (what image came to mind? Use that) “my granny went to market and bought eggs and milk and flour and shoe polish and tea” (continue building the story in your head), and so on.

    When we actually go shopping, if we don’t have a written list we may rely on the simple story of “what I’m going to cook for dinner” and walking ourselves through that story to ensure we get the things we need.

    This is because our memory thrives (and depends!) on connections. Literal synapse connections in the brain, and conceptual contextual connections in your mind. The more connections, the better the memory.

    Now imagine a story: “I went to Stonehenge, but in the background was a twin-peaked mountain blue. I packed a red suitcase, placing a conch shell inside it, when suddenly I heard a trombone, and…” Ring any bells? These are example items from the memory test earlier, though of course you may have seen different things in a different order.

    So next time you want to remember things, don’t study as though for a test. Prepare to tell a story!

    Try going through the test again, but this time, ignore their instructions because we’re going to use the test differently than intended (we’re rebels like that). Don’t rush, and don’t worry about the score this time (or even whether or not you saw a given image previously), but instead, build a story as you go. We’re willing to bet that after it, you can probably recite most of the images you saw in their correct order with fair confidence.

    Here’s the link again: Take The Same Test, But This Time Make It Story-Worthy!

    Again, ignore what it says about your score this time, because we weren’t doing that this time around. Instead, list the things you saw.

    What you were just able to list was the result of you doing story-telling with random zero-context images while under time pressure.

    Imagine what you can do with actual meaningful memories of your ongoing life, people you meet, conversations you have!

    Just… Take the time to smell the roses, then rehearse the story you’ll tell about them. That memory will swiftly become as strong as any memory can be, and quickly get worked into your long-term memory for the rest of your days.

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  • Peas vs Green Beans – Which is Healthier?

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    Our Verdict

    When comparing peas to green beans, we picked the peas.

    Why?

    Looking at macros first, peas have nearly 6x the protein, nearly 2x the fiber, and nearly 2x the carbs, making them the “more food per food” choice.

    In terms of vitamins, peas have more of vitamins A, B1, B2, B3, B5, B6, B7, B9, C, and choline, while green beans have more of vitamins E and K. An easy win for peas.

    In the category of minerals, peas have more copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc, while green beans have more calcium. Another overwhelming win for peas.

    In short, enjoy both (diversity is good), but there’s a clear winner here and it’s peas.

    Want to learn more?

    You might like to read:

    Peas vs Broad Beans – Which is Healthier?

    Take care!

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