What Menopause Does To The Heart
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World Menopause Day: Menopause & Cardiovascular Disease Risk
Today, the 18th of October, is World Menopause Day.
The theme for this year is cardiovascular disease (CVD), and if your first reaction is to wonder what that has to do with the menopause, then this is the reason why it’s being featured. Much of the menopause and its effects are shrouded in mystery; not because of a lack of science (though sometimes a bit of that too), but rather, because it is popularly considered an unimportant, semi-taboo topic.
So, let’s be the change we want to see, and try to fix that!
What does CVD have to do with the menopause?
To quote Dr. Anjana Nair:
❝The metabolic and clinical factors secondary to menopause, such as dyslipidemia, insulin resistance, fat redistribution and systemic hypertension, contribute to the accelerated risk for cardiovascular aging and disease.
Atherosclerosis appears to be the end result of the interaction between cardiovascular risk factors and their accentuation during the perimenopausal period.
The increased cardiovascular risk in menopause stems from the exaggerated effects of changing physiology on the cardiovascular system.❞
Source: Cardiovascular Changes in Menopause
See also: Menopause-associated risk of cardiovascular disease
Can we do anything about it?
Yes, we can! Here be science:
- Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association
- Cardiovascular risk in menopausal women and our evolving understanding of menopausal hormone therapy: risks, benefits, and current guidelines for use
This (in few words: get your hormone levels checked, and consider HRT if appropriate) is consistent with the advice from gynecologist Dr. Jen Gunter, whom we featured back in August:
What You Should Have Been Told About The Menopause Beforehand
What about lifestyle changes?
We definitely can do some good things; here’s what the science has to say:
- Mediterranean diet: yes, evidence-based
- High soy consumption: mixed evidence, unclear. So, eat it if you want, don’t if you don’t.
- Supplements e.g. vitamins and minerals: yes, evidence-based.
- Supplements e.g. herbal preparations: many may help, but watch out for adverse interactions with meds. Check with your pharmacist or doctor.
- Supplements; specifically CBD: not enough evidence yet
- Exercise: yes, evidence-based—especially low-impact high-resistance training, for bone strength, as well as regular moderate-intensity exercise and/or High-Intensity Interval Training, to guard against CVD.
For a full low-down on all of these:
Revealing the evidence-based lifestyle solutions to managing your menopause symptoms
Want to know more?
You can get the International Menopause Society’s free downloadable booklet here:
Menopause & Cardiovascular Disease: What Women Need To Know
You may also like our previous main feature:
What Does “Balance Your Hormones” Even Mean?
Take care!
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Wise Old Fool
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How old is this dish? Well, let’s put it this way, it used to be called ” ” and remnants of it have been found at neolithic burial sites in Egypt. Nowadays it’s called “فول مدمس”, which gets rendered a lot of different ways in the Latin alphabet, but “fūl mudammas” is one option. For short, it’s just called “fūl”, which is pronounced like the English word “fool”, and it’s about the beans.
From chana masala with poori to frijoles refritos to beans on toast, lots of cultures have some version of this breakfast food, and all can be great (yes, even the beans on toast). But today we’re about this particular kind of morning protein, fiber, fats, and healthful spices.
You will need
- 2x 14 oz cans fava beans (other kinds of beans work as substitute; kidney beans are common substitution, but this writer prefers black beans personally if she doesn’t have fava in), drained
- 4 garlic cloves, crushed
- 1 tbsp extra virgin olive oil
- 1 teaspoon cinnamon (or ½ cinnamon stick)
- 1 tsp cumin seeds
- 1 tsp chili flakes
- 1 tsp paprika
- 1 tsp black pepper
- Juice of ½ lemon
- For the relish: 1 medium tomato, finely chopped; 1 tbsp extra virgin olive oil; 2 tbsp parsley, finely chopped
- To serve: 4 pitta breads, 2 eggs (omit if vegan), and a selection of pickled vegetables, drained
Method
(we suggest you read everything at least once before doing anything)
1) Add the olive oil to a saucepan over a medium heat; add the garlic, cumin seeds, and cinnamon. Keep these moving for a minute or two before moving to the next step.
2) Add the fava beans, as well as the other seasonings (chili flakes, paprika, black pepper), and mix thoroughly
3) Add 1 cup boiling water, and keep everything on a simmer for about 20 minutes, stirring often. Add the lemon juice while it’s simmering; when the beans start to break down and the mixture starts to thicken, it’s ready.
4) Mix the relish ingredients (finely chopped tomato, olive oil, parsley) thoroughly in a small bowl
5) Toast the pitta breads, and if using, soft-boil the eggs.
6) Serve! We suggest: fūl in a bowl, with one half of a soft-boiled egg per bowl, topped with the relish, and served with the pitta bread and pickled vegetables on the side.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Level-Up Your Fiber Intake! (Without Difficulty Or Discomfort)
- Making Friends With Your Gut (You Can Thank Us Later)
- Less Obvious Probiotic Benefits ← the pickled vegetables contain the probiotics here, while the beans are a great source of prebiotic fiber; this is why they work so well together
- Our Top 5 Spices: How Much Is Enough For Benefits?
- A Tale Of Two Cinnamons
- Eggs: All Things In Moderation?
Take care!
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Shrimp vs Caviar – Which is Healthier?
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Our Verdict
When comparing shrimp to caviar, we picked the caviar.
Why?
Both of these seafoods share a common history (also shared with lobster, by the way) of “nutrient-dense peasant-food that got gentrified and now it’s more expensive despite being easier to source”. But, cost and social quirks aside, what are their strengths and weaknesses?
In terms of macros, both are high in protein, but caviar is much higher in fat. You may be wondering: are the fats healthy? And the answer is that it’s a fairly even mix between monounsaturated (healthy), polyunsaturated (healthy), and saturated (unhealthy). The fact that caviar is generally enjoyed in very small portions is its saving grace here, but quantity for quantity, shrimp is the natural winner on macros.
…unless we take into account the omega-3 and omega-6 balance, in which case, it’s worthy of note that caviar has more omega-3 (which most people could do with consuming more of) while shrimp has more omega-6 (which most people could do with consuming less of).
When it comes to vitamins, caviar has more of vitamins A, B1, B2, B5, B6, B9, B12, D, K, and choline; nor are the margins small in most cases, being multiples (or sometimes, tens of multiples) higher. Shrimp, meanwhile, boasts only more vitamin B3.
In the category of minerals, caviar leads with more calcium, iron, magnesium, manganese, phosphorus, potassium, and selenium, while shrimp has more copper and zinc.
All in all, while shrimp has its benefits for being lower in fat (and thus also, for those whom that may interest, lower in calories), caviar wins the day by virtue of its overwhelming nutritional density.
Want to learn more?
You might like to read:
What Omega-3 Fatty Acids Really Do For Us
Take care!
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Increase in online ADHD diagnoses for kids poses ethical questions
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In 2020, in the midst of a pandemic, clinical protocols were altered for Ontario health clinics, allowing them to perform more types of care virtually. This included ADHD assessments and ADHD prescriptions for children – services that previously had been restricted to in-person appointments. But while other restrictions on virtual care are back, clinics are still allowed to virtually assess children for ADHD.
This shift has allowed for more and quicker diagnoses – though not covered by provincial insurance (OHIP) – via a host of newly emerging private, for-profit clinics. However, it also has raised significant ethical questions.
It solves an equity issue in terms of rural access to timely assessments, but does it also create new equity issues as a privatized service?
Is it even feasible to diagnose a child for a condition like ADHD without meeting that child in person?
And as rates of ADHD diagnosis continue to rise, should health regulators re-examine the virtual care approach?
Ontario: More prescriptions, less regulation
There are numerous for-profit clinics offering virtual diagnoses and prescriptions for childhood ADHD in Ontario. These include KixCare, which does not offer the option of an in-person assessment. Another clinic, Springboard, makes virtual appointments available within days, charging around $2,600 for assessments, which take three to four hours. The clinic offers coaching and therapy at an additional cost, also not covered by OHIP. Families can choose to continue to visit the clinic virtually during a trial stage with medications, prescribed by a doctor in the clinic who then sends prescribing information back to the child’s primary care provider.
For-profit clinics like these are departing from Canada’s traditional single-payer health care model. By charging patients out-of-pocket fees for services, the clinics are able to generate more revenue because they are working outside of the billing standards for OHIP, standards that set limits on the maximum amount doctors can earn for providing specific services. Instead many services are provided by non-physician providers, who are not limited by OHIP in the same way.
Need for safeguards
ADHD prescriptions rose during the pandemic in Ontario, with women, people of higher income and those aged 20 to 24 receiving the most new diagnoses, according to research published in January 2024 by a team including researchers from the Centre for Addictions and Mental Health and Holland Bloorview Children’s Hospital. There may be numerous reasons for this increase but could the move to virtual care have been a factor?
Ontario psychiatrist Javeed Sukhera, who treats both children and adults in Canada and the U.S., says virtual assessments can work for youth with ADHD, who may receive treatment quicker if they live in remote areas. However, he is concerned that as health care becomes more privatized, it will lead to exploitation and over-diagnosis of certain conditions.
“There have been a lot of profiteers who have tried to capitalize on people’s needs and I think this is very dangerous,” he said. “In some settings, profiteering companies have set up systems to offer ADHD assessments that are almost always substandard. This is different from not-for-profit setups that adhere to quality standards and regulatory mechanisms.”
Sukhera’s concerns recall the case of Cerebral Inc., a New York state-based virtual care company founded in 2020 that marketed on social media platforms including Instagram and TikTok. Cerebral offered online prescriptions for ADHD drugs among other services and boasted more than 200,000 patients. But as Dani Blum reported in the New York Times, Cerebral was accused in 2023 of pressuring doctors on staff to prescribe stimulants and faced an investigation by state prosecutors into whether it violated the U.S. Controlled Substances Act.
“At the start of the pandemic, regulators relaxed rules around medical prescription of controlled substances,” wrote Blum. “Those changes opened the door for companies to prescribe and market drugs without the protocols that can accompany an in-person visit.”
Access increased – but is it equitable?
Virtual care has been a necessity in rural areas in Ontario since well before the pandemic, although ADHD assessments for children were restricted to in-person appointments prior to 2020.
But ADHD assessment clinics that charge families out-of-pocket for services are only accessible to people with higher incomes. Rural families, many of whom are low income, are unable to afford thousands for private assessments, let alone the other services upsold by providers. If the private clinic/virtual care trend continues to grow unchecked, it may also attract doctors away from the public model of care since they can bill more for services. This could further aggravate the gap in care that lower income people already experience.
This could further aggravate the gap in care that lower income people already experience.
Sukhera says some risks could be addressed by instituting OHIP coverage for services at private clinics (similar to private surgical facilities that offer mixed private/public coverage), but also with safeguards to ensure that profits are reinvested back into the health-care system.
“This would be especially useful for folks who do not have the income, the means to pay out of pocket,” he said.
Concerns of misdiagnosis and over-prescription
Some for-profit companies also benefit financially from diagnosing and issuing prescriptions, as has been suggested in the Cerebral case. If it is cheaper for a clinic to do shorter, virtual appointments and they are also motivated to diagnose and prescribe more, then controls need to be put in place to prevent misdiagnosis.
The problem of misdiagnosis may also be related to the nature of ADHD assessments themselves. University of Strathclyde professor Matthew Smith, author of Hyperactive: The Controversial History of ADHD, notes that since the publication of Diagnostic and Statistical Manual of Mental Disorders in 1980, assessment has typically involved a few hours of parents and patients providing their subjective perspectives on how they experience time, tasks and the world around them.
“It’s often a box-ticking exercise, rather than really learning about the context in which these behaviours exist,” Smith said. “The tendency has been to use a list of yes/no questions which – if enough are answered in the affirmative – lead to a diagnosis. When this is done online or via Zoom, there is even less opportunity to understand the context surrounding behaviour.”
Smith cited a 2023 BBC investigation in which reporter Rory Carson booked an in-person ADHD assessment at a clinic and was found not to have the condition, then had a private online assessment – from a provider on her couch in a tracksuit – and was diagnosed with ADHD after just 45 minutes, for a fee of £685.
What do patients want?
If Canadian regulators can effectively tackle the issue of privatization and the risk of misdiagnosis, there is still another hurdle: not every youth is willing to take part in virtual care.
Jennifer Reesman, a therapist and Training Director for Neuropsychology at the Chesapeake Center for ADHD, Learning & Behavioural Health in Maryland, echoed Sukhera’s concerns about substandard care, cautioning that virtual care is not suitable for some of her young clients who had poor experiences with online education and resist online health care. It can be an emotional issue for pediatric patients who are managing their feelings about the pandemic experience.
“We need to respect what their needs are, not just the needs of the provider,” says Reesman.
In 2020, Ontario opted for virtual care based on the capacity of our health system in a pandemic. Today, with a shortage of doctors, we are still in a crisis of capacity. The success of virtual care may rest on how engaged regulators are with equity issues, such as waitlists and access to care for rural dwellers, and how they resolve ethical problems around standards of care.
Children and youth are a distinct category, which is why we had restrictions on virtual ADHD diagnosis prior to the pandemic. A question remains, then: If we could snap our fingers and have the capacity to provide in-person ADHD care for all children, would we? If the answer to that question is yes, then how can we begin to build our capacity?
This article is republished from healthydebate under a Creative Commons license. Read the original article.
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4 Critical Things Female Runners Should Know
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When it comes to keeping up performance in the face of menopause, Shona Hendricks has advice:
Don’t let menopause run you down
- Prioritize recovery! Overtraining without adequate recovery just leads to decreased performance in the long term, and remember, you may not recover as quickly as you used to. If you’re still achey from your previous run, give it another day, or at least make it a lighter run.
- Slow down in easy and long runs! This isn’t “taking the easy way out”; it will improve your overall performance, reducing muscle damage, allowing for quicker recovery and ultimately better fitness gains.
- Focus on nutrition! And that means carbs too. A lot of people fighting menopausal weight gain reduce their intake of food, but without sufficient energy availability, you will not be able to run well. In particular, carbohydrates are vital for energy. Consume them sensibly and with fiber and proteins and fats rather than alone, but do consume them.
- Incorporate strength training! Your run is not “leg day” by itself. Furthermore, do whole-body strength training, to prevent injuries and improve overall performance. A strong core is particularly important.
For more on each of these (and some bonus comments about mobility training for runners), enjoy:
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Want to learn more?
You might also like to read:
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Taurine: An Anti-Aging Powerhouse? Exploring Its Unexpected Benefits
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Dr. Mark Rosenberg explains:
Not a stimulant, but…
- Its presence in energy drinks often causes people to assume it’s a stimulant, but it’s not. In fact, it’s a GABA-agonist, thus having a calming effect.
- The real reason it’s in energy drinks is because it helps increase mitochondrial ATP production (ATP = adenosine triphosphate = how cells store energy that’s ready to use; mitochondria take glucose and make ATP)
- Taurine is also anti-inflammatory, antioxidant, and anticancer.
- In the category of aging, human studies are slow to give results for obvious reasons, but mouse studies show that supplementing taurine in middle-aged mice increased their lifespan by 10–12%, as well as improving various physiological markers of aging.
- Taking a closer look at aging—literally; looking at cellular aging—taurine reduces cellular senescence and protects telomeres, thus decreasing DNA mutations.
For more on the science of these, plus Dr. Rosenberg’s personal experience, enjoy:
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Want to learn more?
You might also like to read:
- Taurine’s Benefits For Heart Health And More
- Dr. Greger’s Anti-Aging Eight
- Age & Aging: What Can (And Can’t) We Do About It?
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The Doctor’s Kitchen – by Dr. Rupy Aujla
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We’ve featured Dr. Aujla before as an expert-of-the-week, and now it’s time to review a book by him. What’s his deal, and what should you expect?
Dr. Aujla first outlines the case for food as medicine. Not just “eat nutritionally balanced meals”, but literally, “here are the medicinal properties of these plants”. Think of some of the herbs and spices we’ve featured in our Monday Research Reviews, and add in medicinal properties of cancer-fighting cruciferous vegetables, bananas with dopamine and dopamine precursors, berries full of polyphenols, hemp seeds that fight cognitive decline, and so forth.
Most of the book is given over to recipes. They’re plant-centric, but mostly not vegan. They’re consistent with the Mediterranean diet, but mostly Indian. They’re economically mindful (favoring cheap ingredients where reasonable) while giving a nod to where an extra dollar will elevate the meal. They don’t give calorie values etc—this is a feature not a bug, as Dr. Aujla is of the “positive dieting” camp that advocates for us to “count colors, not calories”. Which, we have to admit, makes for very stress-free cooking, too.
Dr. Aujla is himself an Indian Brit, by the way, which gives him two intersecting factors for having a taste for spices. If you don’t share that taste, just go easier on the pepper etc.
As for the medicinal properties we mentioned up top? Four pages of references at the back, for any who are curious to look up the science of them. We at 10almonds do love references!
Bottom line: if you like tasty food and you’re looking for a one-stop, well-rounded, food-as-medicine cookbook, this one is a top-tier choice.
Don’t Forget…
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