Blog – Dr. Clas Malmstrom

Blog / Newsletters

Welcome to my blog and website about HEALTH COMPETENCY, i.e. the knowledge and skills you need to attain good health. This means not only avoiding getting ill, but also obtaining wellness in the sense of high energy level, good tone both physically and mentally, high quality of life and stress-resistant performance. I will share valuable information and useful health advice based on scientific findings and news in health research and rehabilitation.
I promise to supply reliable advice and practical tips on health issues and psychosocial work environment.

Below in the blog, I publish newsletters and short articles commenting on new, interesting research results in wellness and preventive medicine. Above all, I want to highlight mental wellness and mental strength training, which are neglected areas of knowledge with lots of misconceptions and myths that need to be dispelled.
       I also work actively as an occupational physician and am particularly interested in how to develop the organisational and psychosocial work environment. I not only assist workplaces with problems, but also (and preferably!) work proactively on the basis of the question: -What happens in a really good workplace? Or maybe the question is better put like this: “What must happen to become and remain a good place to work?”
       Under the other tabs on this website you will find in-depth texts, articles and extracts from my books, as well as some video clips from my lectures. I hope you find something you can use! Feel free to contact me with any questions. I always try to answer them, although sometimes I get a lot of them and then it can take some time for me to get back to you.
     And, please, subscribe to the newsletters! It helps me to get sponsors and grants for my research and to do all the free work with this website.

Clas Malmstrom
MD, cert. physician and psychotherapist, occupational physician
specialist in psychophysiological behavioural medicine and rehabilitation

Recovery is not the same as resting

At least not if you use the common meaning of the term rest. Most people mean ‘getting out of work’ or ‘relief from effort’ when they say they need to rest. But if it’s real recovery you’re after, it’s not enough to ‘take time off’. Nor is it enough to lie down and close your eyes. If you cannot switch off your thoughts and put yourself in a peaceful state of mind, there will still be no quality in your recovery, even if it looks like you’re resting. This is because recovery is a complex process controlled by a psychophysiological system of nerves and hormones, which in turn are controlled by higher cognitive and emotional functions in the brain. This whole anabolical system is constructed in such a way that recovery processes cannot ‘kick in’ and become effective until you are in a calm state of mind. Mental relaxation, i.e. the ability to enter a calm mental state, is crucial for quality recovery.

Another common misconception about resting is that burnout/lasting fatigue is due to overwork and that it is relief that will solve the problem. But however relieved you are in an external sense, it is not certain that worried thoughts will cease. If your head is spinning with thoughts like: ‘I should…’, ‘I have to…’, ‘how long will I feel like this?’, ‘I’m afraid the tablets will cause side effects’, ‘what will my colleagues think of me for letting them down like this’, ‘I have to get a good night’s sleep tonight’… it is of course impossible to get some peace of mind and mental relaxation. And then there will be no good recovery, no matter how much time off or sick leave you take.

Qualitative recovery means replenishing several different energy systems. In addition to a good ability to relax, you need to top up with inspiration, enjoyable and meaningful activities, socialising with people who give you energy. Sleep is a separate chapter in this context. And more, and more. If you want to learn more about the components of recovery and get a more in-depth explanation of how to improve it, you can send an email to clas.m@clasmalmstrom.se and you will receive (for free!) a pdf describing a basic programme for enhanced recovery.

A glass per day is good for you, right…?

Many people vaguely remember reading somewhere, or being told by someone who read somewhere or watched a TV documentary, that alcohol in small amounts can be good for the heart and blood vessels. Maybe even two glasses a day, especially if they are red wine…? Or maybe it wasn’t every day…?
– No, and not even once a week! A recent research report, from a study that followed a large group of people for many years, has cleared up all the questions and doubts. Many doctors and scientists have always questioned the interpretation of epidemiological statistics from studies that seem to show that small amounts of alcohol is better than none. The charts seem to show that those who regularly drink small amounts of alcohol do better than those who abstain completely.
Oops! We’ve lost our way here already, with the wording of the last sentence. Research has not investigated whether small amounts of alcohol ‘make you feel good’ at all. What some studies have found is a statistically significant association with a reduced risk of dying before retirement or shortly after.
However, many people intuitively feel that this misrepresentation is correct. ‘Sure, I feel good drinking a glass of wine in the evening. Or two, a glass before dinner also feels just right.’ BUT now, it’s not really that kind of misconception that is the reason I’m writing this article. The problem is bigger than that. A little is better than 0 is obviously right and proper in many contexts, but not when it comes to alcohol. A great many doctors and health researchers have always objected and put forward the alternative interpretation that the cause-effect relationship goes the other way round. That is, those who already have serious health problems drink less. Sick people often abstain completely from alcoholic drinks. Many oppose this claim on the grounds that they usually have a drink or two when they feel unwell and find that it alleviates the unpleasant symptoms. This is yet another example of how tricky it can be to trust your feelings/intuition. Sure, a glass of whisky can alleviate the symptoms of a cold, but it’s more of an anaesthetic than a cure. No matter what colours and flavours it is mixed with, alcohol cannot cure an infection. For frequent and heavy drinkers, we know for sure that the opposite is true. Alcohol impairs several functions of the immune system and infections become more prolonged. In addition, it increases the risk of complications (e.g. a simple viral infection turning into a serious pneumonia, a cystitis developing into a renal pelvic inflammation, etc.)

The new research projects I referred to in the introduction have been designed differently so that not only statistically significant correlations can be obtained, but causality can be more reliably assessed. When such methodology is used to investigate the long-term health effects of alcohol, the answer is clear: the less alcohol you drink, the better for your health.
Ethanol is a solvent that certainly occurs ‘naturally’ (e.g. in overripe fruit invaded by yeasts) but neither we nor any other animal has evolved a metabolic process that can eliminate alcohol from the blood without producing harmful breakdown products. In fact, ethyl alcohol is harmful in a number of ways and even in small amounts, frequent consumption increases the risk of infections, joint and back problems, cardiac arrhythmias, high blood pressure, cerebral haemorrhages, kidney disease and cancer (particularly of the stomach, intestines and liver), as well as various forms of mental illness (mood disorders and, for most people, even worse the next day when irritability, anxiety, sleep disturbances and abnormal mental fatigue become apparent). The parts of the brain that control deep REM sleep are very sensitive to alcohol. Even after two glasses of wine in the evening (or an equivalent amount of beer, cocktail or similar), the deep dream sleep is disturbed and the mental capacity the next day is markedly impaired. Yes, it’s true; cognitive and memory tests show that there are real differences! You might not notice it yourself, especially if you’ve become used to drinking a little every night. After a while, two glasses of wine won’t make you feel as drunk as you did at the beginning (it doesn’t take long to get used to it, only 4-5 days) and you won’t get as obviously drunk and ‘hungover’. However, both physical and cognitive tests reveal that there are significant effects that occur during the night and affect your brain the next day. Performance can be reduced by 30-40% without the habitually hungover person noticing (!) because it felt the same yesterday…

Now you might be thinking: ‘You sound like a sober preacher. Don’t you ever drink a drop?’ I apologise if a preachy tone has crept into what I have said above. I am not out to ban all forms of alcohol consumption, just the ‘unnecessary drinks’, those times when you could just as easily have had something as good without alcohol. A cold beer can be delicious, but beer is not a good thirst quencher, it is not the way to correct dehydration. Wine can be a fantastic flavour enhancer with some dishes, but half a glass can be enough with a steak and a cheese plate, you only need to take a tiny sip with every other bite. I can enjoy a good drink with alcohol in it, but I consciously try to keep my consumption down to a low level and not choose an alcoholic drink unnecessarily. My knowledge of the long-term health risks associated with heavy drinking certainly contributes to my motivation to maintain this awareness and to make active drink choices, but it is also the short-term effects of alcohol that motivate me. I’ve never appreciated a ‘proper drink’, it just makes me nauseous, not more fun. I also hate being ‘hungover’. As soon as I remind myself of how I will feel tomorrow if I drink ‘too much’ tonight, it becomes easy to choose other drinks. I know I’m not representative of everyone. Some have a harder time, perhaps especially those who experience a sense of liberation when intoxication sets in, a wonderful feeling of relief when the inner discomfort is released and you can relax.

Do you drink a little too much? Or too often? Do you find it hard to hold back once you’ve downed your first beer/drink/glass? Do you walk around with a slight, nagging worry inside you? Do you get a nice feeling of relief from the tension inside when you have some alcohol? Do you sometimes find yourself longing to get home and have a drink to yourself so you can relax? – If so, you are in trouble! Send me an email and we can agree on a personalised consultation where I will explain how you can overcome mild-moderate alcohol problems. – Note: This offer is not aimed at alcoholics with even worse problems. Their problems are of a different nature and require different measures initially. If you are one of them (i.e. drink a lot, often think about and long for the next drink, have started to feel the need for ‘restorers’ in the morning, are sometimes under the influence of alcohol during the day, etc.) then you should immediately contact the nearest addiction centre in your place of residence.

Psychological exhaustion (‘burnout’) is not due to overwork

Sorry, one should not express oneself so categorically about something so complicated, so let me immediately moderate the statement: Mental fatigue is not always due to overwork. Certainly, it can sometimes be the case that overexertion is behind a fatigue reaction, but 8-9 times out of 10 we find the cause at the other end of the scale in the form of under-recovery. Yes, I know, you can’t find the word under-recovery in the dictionary. But agree that it should exist, and should be used much more often than the word overexertion, because it gives a good clue to where to look for measures that can have an effect. For the person affected, as well as for friends and relatives, managers and colleagues, the concept of under-recovery is a useful guide and a reliable indicator of how best to help the exhausted person.
Indeed, this is also true for carers, doctors and psychotherapists, who too often focus on the exertion aspect and exaggerate the importance of relief from all kinds of effort. The problem with this is that it risks misleading the patient into missing the purpose of respite from work, which is to free up time, attention and energy to prioritise recovery. Getting rid of all responsibilities and getting rid of everything that consumes energy – i.e. the relief itself – does not solve the problem.

Stopping doing the wrong thing is not the same as doing the right thing!

Even though it is clearly wrong to perpetuate an incorrect prioritisation and continue to try to perform even when your energy is depleted, it is not enough to just stop trying. You need to switch to qualitative ‘battery recharging’. Recovery is a skill that many people need to train. Pseudo-rest is increasingly common nowadays. This is when tired people take a break and say they are going to rest, and perhaps do so physically, but are unable to bring their brain into rest mode. Resting with a screen is one common cause, but there are several others.

Want to learn more about this and get a more in-depth explanation of how to train mentally to improve the quality of your recovery? Send an email to clas.m@clasmalmstrom.se and you will receive (for free!) a pdf describing a basic programme for enhanced recovery.

Are you healthy? Or just not yet sick?

About the difference between preventing disease and promoting good health.

In the presentation of this website, I write that the key concept is HEALTH COMPETENCE, i.e. the ability to stay healthy not only in the sense of avoiding illness/injury but also to feel good and maintain good health and a high quality of life. Health literacy has two components. The first is what most people associate with health care, namely preventive competence, which is about understanding harmful influences and developing a skill in managing risk situations so that you do not unnecessarily expose yourself to things that make you ill. The second part is called promotive competence, which is about understanding one’s needs and developing the ability to expose oneself sufficiently to things that make body and mind function well. Unfortunately, the promotive component is unknown to most people, which is unfortunate because it is at least as important as taking preventive measures! But this is not really surprising, because if you look at the information on wellness that comes from health authorities and health counsellors on the web and in books, 99% of it is preventive advice, i.e. what to avoid to be spared from disease.
To try to offset this imbalance to some extent, I will focus more on promotive health literacy in this blog and throughout the website. Not because preventive competence is unimportant – as a doctor, I am extremely well versed in the importance of taking disease-preventing measures – but to increase awareness of how to take care of one’s health in the promotive, i.e. truly health-promoting way as well. In practice that means to expose oneself to such influencing factors that we need to be able to maintain healthy functions both physically and psychologically. This promotive competence is the practical application side of salutogenic research, which studies good health, as opposed to knowledge of preventive measures, which comes from pathogenic research, which studies how diseases occur.

If you want to read more about this, just send me an email and I will send you more detailed information (and for those who want/need to read original publications of research reports, I can also provide references to various sources).

That which feels best is not always the most effective way to do things

About emotional controle in learning and study skills

A good example of how Kahnemann’s theses work in practice (see previous post) is study technique, and learning in general. When you are sitting with a book, a lecture or web course or the like and really want to try to learn something (and remember it), it is easy to slip into the quick thinking track and do what feels best and at first glance seems easiest. But the easiest way is not the most effective!
       Research¹⁾ has clearly shown that people learn better and remember much more if they choose the slow train of thought instead, but in order to do so, they need to recognise and be prepared for the fact that it feels worse because it is more difficult and more work in the short term.
      The fast track could be, for example, reading the text several times and both underlining and using coloured highlighters. Or sitting in a lecture and taking notes so that the pen glows, writing down as much as possible. Sure, these methods can also be exhausting, but it still feels more comfortable and familiar to use them. They don’t challenge the brain as much as the slow track does. In which case you choose to read the text only twice, first to get an overall insight into the topic and then an intensive second read-through where you actively look for the important things while often stopping, summarising the paragraph you just read, retelling the content to yourself (without cheating = put the text away so you can’t look in it!). One important step is to write questions for yourself to answer a few hours later. That’s right, several hours later, not immediately. For this second reading to work, you have to tell yourself not to read the text again. One of the reasons why multiple read-throughs with underlining and highlighting do not work very well is that you trick yourself with the pleasant idea that “next time I read this, it will sink in…” I myself remember a course in study techniques I took at the beginning of medical school. We had to try to cross out the text with a black marker after the second reading! So that we could never read it again. It’s a bit nerve-wracking until you learn to trust your memory, but extremely effective. (That method is best suited to compendiums and cheap books, and is not suitable for expensive textbooks and reference books where you may need to look up facts for a long time.)
     Retrieving new knowledge from memory is an important step in activating learning and making it ‘stick’. Other types of active rehearsal can also be used. A powerful example is to sit for a while with a fellow student the next day and recount different passages to each other, ask each other about important points, etc.

A good summary can be found in the book “Outsmart your brain” by Daniel Willingham, professor at the University of Virginia. It also contains many good practical tips and descriptions of methods you can practice to become better at learning new skills.

An important aspect of mental strength

In memory of Daniel Kahneman — died on 27 March, 2025, aged 90.

Daniel Kahneman, economist and psychologist, was awarded the Nobel Prize in Economics in 2002 for his pioneering research on human judgement and decision-making.
In a popularised form, he explained his findings in the book “Thinking, Fast and slow” which I highly recommend (published in 2011 by Farrar, Straus & Giroux). In it, he provides new insights into how our lives can be very positively affected if we have a good balance between two types of thinking: 1. Fast, intuitive, emotional, impulsive, 2. Slow, reasoning, analysing, consequence calculating.
And vice versa: how the quality of life can be negatively affected for those who are too weak in either of them. We need to develop both of these cognitive functions to cope with our daily lives. And there are mental training methods to become more proficient in each of them, and to become better at recognising what kind of thinking you are currently doing, so that you can consciously switch when you have got it wrong.
For most of us, it is type 2 that fails. You can get a real boost in life by getting better at recognising in time when you have slipped into the fast, emotion-driven, impulsive train of thought in situations where you should stop for a few seconds, consider the options and think about the consequences. Our human brain has a built-in simulator that we can train and use more effectively so that we can visualise both what we can do, how we should do it and how the outcome occurs. In a grossly simplified form, this is sometimes referred to as goal image training in the mental training literature, but this concept is easily misunderstood and misused. If you think this sounds interesting and want to learn more, please send an email to clas.m@clasmalmstrom.se and I will send you in-depth information in the form of a compendium with practical tips on how to get started with this branch of mental strength training.