Young Forever – by Dr. Mark Hyman
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A lot of work on the topic of aging looks at dealing with symptoms of aging, rather than the causes. And, that’s worthy too! Those symptoms often do need addressing. But this book is about treating the causes.
Dr. Hyman outlines:
- How and why we age
- The root causes of aging
- The ten hallmarks of aging
From there, we go on to learn about the foundations of longevity, and balancing our seven core biological systems:
- Nutrition, digestion, and the microbiome
- Immune and inflammatory system
- Cellular energy
- Biotransformation and elimination/detoxification*
- Hormones, neurotransmitters, and other signalling molecules
- Circulation and lymphatic flow
- Structural health, from muscle and bones to cells and tissues
*This isn’t about celery juice fasts and the like; this talking about the work your kidneys, liver, and other organs do
The book goes on to detail how, precisely, with practical actionable advices, to optimize and take care of each of those systems.
All in all: if you want a great foundational understanding of aging and how to slow it to increase your healthy lifespan, this is a very respectable option.
Click here to get your copy of “Young Forever” from Amazon today!
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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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Things Many People Forget When It Comes To Hydration
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Good hydration is about more than just “drink lots of water”, and in fact it’s quite possible for a person to drink too much water, and at the same time, be dehydrated. Here’s how and why and what to do about it:
Water, water, everywhere
Factors that people forget:
- Electrolyte balance: without it, we can technically have lots of water while either retaining it (in the case of too high salt levels) or peeing it out (in the case of too low salt levels), neither of which are as helpful as getting it right and actually being able to use the water.
- Gastrointestinal health: conditions like IBS, Crohn’s, or celiac disease can impair water and nutrient absorption, affecting hydration
- Genetic factors: some people simply have a predisposition to need more or less water for proper hydration
- Dietary factors: high salt, caffeine, and alcohol intake (amongst other diuretics) can increase water loss, while water-rich foods (assuming they aren’t also diuretics) increase hydration.
Strategies to do better:
- Drink small amounts of water consistently throughout the day rather than large quantities at once—healthy kidneys can process about 1 liter (about 1 quart) of water per hour, so drinking more than that will not help, no matter how dehydrated you are when you start. If your kidneys aren’t in peak health, the amount processable per hour will be lower for you.
- Increase fiber intake (e.g., fruit and vegetables) to retain water in the intestines and improve hydration
- Consume water-rich foods (e.g., watermelon, cucumbers, grapes) to enhance overall hydration and support cellular function (the body can use this a lot more efficiently than if you just drink water).
- Counteract the diuretic effects of caffeine and alcohol by drinking an additional 12 oz of water for every 8 oz of these beverages. Best yet, don’t drink alcohol and keep caffeine to a low level (or quit entirely, if you prefer, but for most people that’s not necessary).
- If you are sweating (be it because of weather, exercise, or any other reasons), include electrolyte fluids to improve cellular hydration, as they contain essential minerals like magnesium, potassium, and in moderation yes even sodium which you will have lost in your sweat too, supporting fluid regulation.
For more details on all of these, enjoy:
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Want to learn more?
You might also like to read:
- Water’s Counterintuitive Properties
- Hydration Mythbusting
- When To Take Electrolytes (And When We Shouldn’t!)
- Keeping Your Kidneys Healthy (Especially After 60)
Take care!
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Seven and a Half Lessons About the Brain – by Dr. Lisa Feldman Barrett
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We’ve reviewed books about neurology before, and we always try to review books that bring something new/different. So, what makes this one stand out?
Dr. Lisa Feldman Barrett, one of the world’s foremost neuroscientists, starts with an overview of how our unusual brain (definitely our species’ defining characteristic) came to be, and then devotes the rest of the book to mostly practical information.
She explains, in clear terms and without undue jargon, how the brain goes about such things as making constant predictions and useful assumptions about our environment, and reports these things to us as facts—which process is usually useful, and sometimes counterproductive.
We learn about how the apparently mystical trait of empathy works, in real flesh-and-blood terms, and why some kinds of empathy are more metabolically costly than others, and what that means for us all.
Unlike many such books, this one also looks at what is going on in the case of “different minds” that operate very dissimilarly to our own, and how this neurodiversity is important for our species.
Critically, she also looks at what else makes our brains stand out, the symphony of “5 Cs” that aren’t often found to the same extent all in the same species: creativity, communication, copying, cooperation, and compression. This latter being less obvious, but perhaps the most important; Dr. Feldman Barrett explains how we use this ability to layer summaries of our memories, perceptions, and assumptions, to allow us to think in abstractions—something that powers much of what we do that separates us from other animals.
Bottom line: if you’d like to learn more about that big wet organ between your ears, what it does for you, and how it goes about doing it, then this book gives a very practical foundation from which to build.
Click here to check out Seven and a Half Lessons about the Brain, and learn more about yours!
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Aging Is Inevitable… Or is it?
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Aging is inevitable… Or is it?
We’ve talked before about how and why aging happens. We’ve also talked about the work to tackle aging as basically an engineering problem, with the premise that our bodies are biological machines, and machines can be repaired. We also recommended a great book about this, by the way. But that’s about interfering with the biological process of aging. What about if the damage is already done?
“When the damage is done, it’s done”
We can do a lot to try to protect ourselves from aging, and we might be able to slow down the clock, but we can’t stop it, and we certainly can’t reverse it… right?
Wrong! Or at least, so we currently understand, in some respects. Supplementation with phosphatidylserine, for example, has shown promise for not just preventing, but treating, neurodegeneration (such as that caused by Alzheimer’s disease). It’s not a magic bullet and so far the science is at “probably” and “this shows great promise for…” and “this appears to…”
Phosphatidylserene does help slow neurodegeneration
…because of its role in allowing your cells to know whether they have permission to die.
This may seem a flippant way of putting it, but it’s basically how cell death works. Cells do need to die (if they don’t, that’s called cancer) and be replaced with new copies, and those copies need to be made before too much damage is accumulated (otherwise the damage is compounded with each new iteration). So an early cell death-and-replacement is generally better for your overall health than a later one.
However, neurons are tricky to replace, so phosphatidylserine effectively says “not you, hold on” to keep the rate of neuronal cell death nearer to the (slow) rate at which they can be replaced.
One more myth to bust…
For the longest time we thought that adults, especially older adults, couldn’t make new brain cells at all, that we grew a certain number, then had to hang onto them until we died… suffering diminished cognitive ability with age, on account of losing brain cells along the way.
It’s partly true: it’s definitely easier to kill brain cells than to grow them… Mind you, that’s technically true of people, too, yet the population continues to boom!
Anyway, new research showing that adults do, in fact, grow new braincells was briefly challenged by a 2018 study that declared: Human hippocampal neurogenesis drops sharply in children to undetectable levels in adults after all, never mind, go back to your business.
So was adult neurogenesis just a myth to be busted after all? Nope.
It turned out, the 2018 study had a methodological flaw!
To put it in lay terms: they had accidentally melted the evidence.
A 2019 study overcame this flaw by using a shorter fixation time for the cell samples they wanted to look at, and found that there were tens of thousands of “baby neurons” (again with the lay terms), newly-made brain cells, in samples from adults ranging from 43 to 87.
Now, there was still a difference: the samples from the youngest adult had 30% more newly-made braincells than the 87-year-old, but given that previous science thought brain cell generation stopped in childhood, the fact that an 87-year-old was generating new brain cells 30% less quickly than a 43-year-old is hardly much of a criticism!
As an aside: samples from patients with Alzheimer’s also had a 30% reduction in new braincell generation, compared to samples from patients of the same age without Alzheimer’s. But again… Even patients with Alzheimer’s were still growing some new brain cells.
Read it for yourself: Adult hippocampal neurogenesis is abundant in neurologically healthy subjects and drops sharply in patients with Alzheimer’s disease
In a nutshell…
- We can’t fully hit pause on aging just yet, but we can definitely genuinely slow it
- We can also, in some very specific ways, reverse it
- We can slow the loss of brain cells
- We can grow new brain cells
- We can reduce our risk of Alzheimer’s, and at least somewhat mitigate it if it appears
- We know that phosphatidylserine supplementation may help with most (if not all) of the above
- We don’t sell that (or anything else) but for your convenience, here it is on Amazon if you’re interested
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The 6 Pillars Of Nutritional Psychiatry
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Dr. Naidoo’s To-Dos
This is Dr. Uma Naidoo. She’s a Harvard-trained psychiatrist, professional chef graduating with her culinary school’s most coveted award, and a trained nutritionist. Between those three qualifications, she knows her stuff when it comes to the niche that is nutritional psychiatry.
She’s also the Director of Nutritional and Lifestyle Psychiatry at Massachusetts General Hospital (MGH) & Director of Nutritional Psychiatry at MGH Academy while serving on the faculty at Harvard Medical School.
What is nutritional psychiatry?
Nutritional psychiatry is the study of how food influences our mood (in the short term) and our more generalized mental health (in the longer term).
We recently reviewed a book of hers on this topic:
This Is Your Brain On Food – by Dr. Uma Naidoo
The “Six Pillars” of nutritional psychiatry
Per Dr. Naidoo, these are…
Be Whole; Eat Whole
Here Dr. Naidoo recommends an “80/20 rule”, and a focus on fiber, to keep the gut (“the second brain”) healthy.
See also: The Brain-Gut Highway: A Two-Way Street
Eat The Rainbow
This one’s simple enough and speaks for itself. Very many brain-nutrients happen to be pigments, and “eating the rainbow” (plants, not Skittles!) is a way to ensure getting a lot of different kinds of brain-healthy flavonoids and other phytonutrients.
The Greener, The Better
As Dr. Naidoo writes:
❝Greens contain folate, an important vitamin that maintains the function of our neurotransmitters. Its consumption has been associated with a decrease in depressive symptoms and improved cognition.❞
Tap into Your Body Intelligence
This is about mindful eating, interoception, and keeping track of how we feel 30–60 minutes after eating different foods.
Basically, the same advice here as from: The Kitchen Doctor
(do check that out, as there’s more there than we have room to repeat here today!)
Consistency & Balance Are Key
Honestly, this one’s less a separate item and is more a reiteration of the 80/20 rule discussed in the first pillar, and an emphasis on creating sustainable change rather than loading up on brain-healthy superfoods for half a weekend and then going back to one’s previous dietary habits.
Avoid Anxiety-Triggering Foods
This is about avoiding sugar/HFCS, ultra-processed foods, and industrial seed oils such as canola and similar.
As for what to go for instead, she has a broad-palette menu of ingredients she recommends using as a base for one’s meals (remember she’s a celebrated chef as well as a psychiatrist and nutritionist), which you can check out here:
Dr. Naidoo’s “Food for Mood” project
Enjoy!
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Why is pain so exhausting?
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One of the most common feelings associated with persisting pain is fatigue and this fatigue can become overwhelming. People with chronic pain can report being drained of energy and motivation to engage with others or the world around them.
In fact, a study from the United Kingdom on people with long-term health conditions found pain and fatigue are the two biggest barriers to an active and meaningful life.
But why is long-term pain so exhausting? One clue is the nature of pain and its powerful effect on our thoughts and behaviours.
Short-term pain can protect you
Modern ways of thinking about pain emphasise its protective effect – the way it grabs your attention and compels you to change your behaviour to keep a body part safe.
Try this. Slowly pinch your skin. As you increase the pressure, you’ll notice the feeling changes until, at some point, it becomes painful. It is the pain that stops you squeezing harder, right? In this way, pain protects us.
When we are injured, tissue damage or inflammation makes our pain system become more sensitive. This pain stops us from mechanically loading the damaged tissue while it heals. For instance, the pain of a broken leg or a cut under our foot means we avoid walking on it.
The concept that “pain protects us and promotes healing” is one of the most important things people who were in chronic pain tell us they learned that helped them recover.
But long-term pain can overprotect you
In the short term, pain does a terrific job of protecting us and the longer our pain system is active, the more protective it becomes.
But persistent pain can overprotect us and prevent recovery. People in pain have called this “pain system hypersensitivity”. Think of this as your pain system being on red alert. And this is where exhaustion comes in.
When pain becomes a daily experience, triggered or amplified by a widening range of activities, contexts and cues, it becomes a constant drain on one’s resources. Going about life with pain requires substantial and constant effort, and this makes us fatigued.
About 80% of us are lucky enough to not know what it is like to have pain, day in day out, for months or years. But take a moment to imagine what it would be like.
Imagine having to concentrate hard, to muster energy and use distraction techniques, just to go about your everyday tasks, let alone to complete work, caring or other duties.
Whenever you are in pain, you are faced with a choice of whether, and how, to act on it. Constantly making this choice requires thought, effort and strategy.
Mentioning your pain, or explaining its impact on each moment, task or activity, is also tiring and difficult to get across when no-one else can see or feel your pain. For those who do listen, it can become tedious, draining or worrying.
No wonder pain is exhausting
In chronic pain, it’s not just the pain system on red alert. Increased inflammation throughout the body (the immune system on red alert), disrupted output of the hormone cortisol (the endocrine system on red alert), and stiff and guarded movements (the motor system on red alert) also go hand in hand with chronic pain.
Each of these adds to fatigue and exhaustion. So learning how to manage and resolve chronic pain often includes learning how to best manage the over-activation of these systems.
Loss of sleep is also a factor in both fatigue and pain. Pain causes disruptions to sleep, and loss of sleep contributes to pain.
In other words, chronic pain is seldom “just” pain. No wonder being in long-term pain can become all-consuming and exhausting.
What actually works?
People with chronic pain are stigmatised, dismissed and misunderstood, which can lead to them not getting the care they need. Ongoing pain may prevent people working, limit their socialising and impact their relationships. This can lead to a descending spiral of social, personal and economic disadvantage.
So we need better access to evidence-based care, with high-quality education for people with chronic pain.
There is good news here though. Modern care for chronic pain, which is grounded in first gaining a modern understanding of the underlying biology of chronic pain, helps.
The key seems to be recognising, and accepting, that a hypersensitive pain system is a key player in chronic pain. This makes a quick fix highly unlikely but a program of gradual change – perhaps over months or even years – promising.
Understanding how pain works, how persisting pain becomes overprotective, how our brains and bodies adapt to training, and then learning new skills and strategies to gradually retrain both brain and body, offers scientifically based hope; there’s strong supportive evidence from clinical trials.
Every bit of support helps
The best treatments we have for chronic pain take effort, patience, persistence, courage and often a good coach. All that is a pretty overwhelming proposition for someone already exhausted.
So, if you are in the 80% of the population without chronic pain, spare a thought for what’s required and support your colleague, friend, partner, child or parent as they take on the journey.
More information about chronic pain is available from Pain Revolution.
Michael Henry, Physiotherapist and PhD candidate, Body in Mind Research Group, University of South Australia and Lorimer Moseley, Professor of Clinical Neurosciences and Foundation Chair in Physiotherapy, University of South Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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