Alzheimer’s Causative Factors To Avoid
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The Best Brains Bar Nun?
This is Dr. David Snowdon. He’s an epidemiologist, and one of the world’s foremost experts on Alzheimer’s disease. He was also, most famously, the lead researcher of what has become known as “The Nun Study”.
We recently reviewed his book about this study:
…which we definitely encourage you to check out, but we’ll do our best to summarize its key points today!
Reassurance up-front: no, you don’t have to become a nun
The Nun Study
In 1991, a large number (678) of nuns were recruited for what was to be (and until now, remains) the largest study of its kind into the impact of a wide variety of factors on aging, and in particular, Alzheimer’s disease.
Why it was so important: because the nuns were all from the same Order, had the same occupation (it’s a teaching Order), with very similar lifestyles, schedules, socioeconomic status, general background, access to healthcare, similar diets, same relationship status (celibate), same sex (female), and many other factors also similar, this meant that most of the confounding variables that confound other studies were already controlled-for here.
Enrollment in the study also required consenting to donating one’s brain for study post-mortem—and of those who have since died, indeed 98% of them have been donated (the other 2%, we presume, may have run into technical administrative issues with the donation process, due to the circumstances of death and/or delays in processing the donation).
How the study was undertaken
We don’t have enough space to describe the entire methodology here, but the gist of it is:
- Genetic testing for relevant genetic factors
- Data gathered about lives so far, including not just medical records but also autobiographies that the nuns wrote when they took their vows (at ages 19–21)
- Extensive ongoing personal interviews about habits, life choices, and attitudes
- Yearly evaluations including memory tests and physical function tests
- Brain donation upon death
What they found
Technically, The Nun Study is still ongoing. Of the original 678 nuns (aged 75–106), three are still alive (based on the latest report, at least).
However, lots of results have already been gained, including…
Genes
A year into the study, in 1992, the “apolipoprotein E” (APOE) gene was established as a likely causative factor in Alzheimer’s disease. This is probably not new to our readers in 2024, but there are interesting things being learned even now, for example:
The Alzheimer’s Gene That Varies By Race & Sex
…but watch out! Because also:
Alzheimer’s Sex Differences May Not Be What They Appear
Words
Based on the autobiographies written by the nuns in their youth upon taking their vows, there were two factors that were later correlated with not getting dementia:
- Longer sentences
- Positive outlook
- “Idea density”
That latter item means the relative linguistic density of ideas and complexity thereof, and the fluency and vivacity with which they were expressed (this was not a wishy-washy assessment; there was a hard-science analysis to determine numbers).
Want to spruce up yours? You might like to check out:
Reading, Better: Reading As A Cognitive Exercise
…for specific, evidence-based ways to tweak your reading to fight cognitive decline.
Food
While the dietary habits of the nuns were fairly homogenous, those who favored eating more and cooked greens, beans, and tomatoes, lived longer and with healthier brains.
See also: Brain Food? The Eyes Have It!
Other aspects of brain health & mental health
The study also found that nuns who avoided stroke and depression, were also less likely to get dementia.
For tending to these, check out:
- Two Things You Can Do To Improve Stroke Survival Chances
- Depression, And The Mental Health First-Aid That You’ll Hopefully Never Need
- Behavioral Activation Against Depression & Anxiety
Community & Faith
Obviously, in this matter the nuns were quite a homogenous group, scoring heavily in community and faith. What’s relevant here is the difference between the nuns, and other epidemiological studies in other groups (invariably not scoring so highly).
Community & faith are considered, separately and together, to be protective factors against dementia.
Faith may be something that “you have it or you don’t” (we’re a health science newsletter, not a theological publication, but for the interested, philosopher John Stuart Mill’s 1859 essay “On Liberty“ makes a good argument for it not being something one can choose, prompting him to argue for religious tolerance, on the grounds that religious coercion is a futile effort precisely because a person cannot choose to dis/believe something)
…but community can definitely be chosen, nurtured, and grown. We’ve written about this a bit before:
You might also like to check out this great book on the topic:
Purpose: Design A Community And Change Your Life – by Gina Bianchini
Want more?
We gave a ground-up primer on avoiding Alzheimer’s and other dementias; check it out:
How To Reduce Your Alzheimer’s Risk
Take care!
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Dietary Changes for Artery Health
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝How does your diet change clean out your arteries of the bad cholesterol?❞
There’s good news and bad news here, and they can both be delivered with a one-word reply:
Slowly.
Or rather: what’s being cleaned out is mostly not the LDL (bad) cholesterol, but rather, the result of that.
When our diet is bad for cardiovascular health, our arteries get fatty deposits on their walls. Cholesterol gets stuck here too, but that’s not the main physical problem.
Our body’s natural defenses come into action and try to clean it up, but they (for example macrophages, a kind of white blood cell that consumes invaders and then dies, before being recycled by the next part of the system) often get stuck and become part of the buildup (called atheroma), which can lead to atherosclerosis and (if calcium levels are high) hardening of the arteries, which is the worst end of this.
This can then require medical attention, precisely because the body can’t remove it very well—especially if you are still maintaining a heart-unhealthy diet, thus continuing to add to the mess.
However, if it is not too bad yet, yes, a dietary change alone will reverse this process. Without new material being added to the arterial walls, the body’s continual process of rejuvenation will eventually fix it, given time (free from things making it worse) and resources.
In fact, your arteries can be one of the quickest places for your body to make something better or worse, because the blood is the means by which the body moves most things (good or bad) around the body.
All the more reason to take extra care of it, since everything else depends on it!
You might also like our previous main feature:
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Managing Sibling Relationships In Adult Life
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Managing Sibling Relationships In Adult Life
After our previous main feature on estrangement, a subscriber wrote to say:
❝Parent and adult child relationships are so important to maintain as you age, but what about sibling relationships? Adult choices to accept and move on with healthier boundaries is also key for maintaining familial ties.❞
And, this is indeed critical for many of us, if we have siblings!
Writer’s note: I don’t have siblings, but I do happen to have one of Canada’s top psychologists on speed-dial, and she has more knowledge about sibling relationships than I do, not to mention a lifetime of experience both personally and professionally. So, I sought her advice, and she gave me a lot to work with.
Today I bring her ideas, distilled into my writing, for 10almonds’ signature super-digestible bitesize style.
A foundation of support
Starting at the beginning of a sibling story… Sibling relationships are generally beneficial from the get-go.
This is for reasons of mutual support, and an “always there” social presence.
Of course, how positive this experience is may depend on there being a lack of parental favoritism. And certainly, sibling rivalries and conflict can occur at any age, but the stakes are usually lower, early in life.
Growing warmer or colder
Generally speaking, as people age, sibling relationships likely get warmer and less conflictual.
Why? Simply put, we mature and (hopefully!) get more emotionally stable as we go.
However, two things can throw a wrench into the works:
- Long-term rivalries or jealousies (e.g., “who has done better in life”)
- Perceptions of unequal contribution to the family
These can take various forms, but for example if one sibling earns (or otherwise has) much more or much less than another, that can cause resentment on either or both sides:
- Resentment from the side of the sibling with less money: “I’d look after them if our situations were reversed; they can solve my problems easily; why do they resent that and/or ignore my plight?”
- Resentment from the side of the sibling with more money: “I shouldn’t be having to look after my sibling at this age”
It’s ugly and unpleasant. Same goes if the general job of caring for an elderly parent (or parents) falls mostly or entirely on one sibling. This can happen because of being geographically closer or having more time (well… having had more time. Now they don’t, it’s being used for care!).
It can also happen because of being female—daughters are more commonly expected to provide familial support than sons.
And of course, that only gets exacerbated as end-of-life decisions become relevant with regard to parents, and tough decisions may need to be made. And, that’s before looking at conflicts around inheritance.
So, all that seems quite bleak, but it doesn’t have to be like that.
Practical advice
As siblings age, working on communication about feelings is key to keeping siblings close and not devolving into conflict.
Those problems we talked about are far from unique to any set of siblings—they’re just more visible when it’s our own family, that’s all.
So: nothing to be ashamed of, or feel bad about. Just, something to manage—together.
Figure out what everyone involved wants/needs, put them all on the table, and figure out how to:
- Make sure outright needs are met first
- Try to address wants next, where possible
Remember, that if you feel more is being asked of you than you can give (in terms of time, energy, money, whatever), then this discussion is a time to bring that up, and ask for support, e.g.:
“In order to be able to do that, I would need… [description of support]; can you help with that?”
(it might even sometimes be necessary to simply say “No, I can’t do that. Let’s look to see how else we can deal with this” and look for other solutions, brainstorming together)
Some back-and-forth open discussion and even negotiation might be necessary, but it’s so much better than seething quietly from a distance.
The goal here is an outcome where everyone’s needs are met—thus leveraging the biggest strength of having siblings in the first place:
Mutual support, while still being one’s own person. Or, as this writer’s psychology professor friend put it:
❝Circling back to your original intention, this whole discussion adds up to: siblings can be very good or very bad for your life, depending on tons of things that we talked about, especially communication skills, emotional wellness of each person, and the complexity of challenges they face interdependently.❞
Our previous main feature about good communication can help a lot:
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Antihistamines’ Generation Gap
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Are You Ready For Allergy Season?
For those of us in the Northern Hemisphere, fall will be upon us soon, and we have a few weeks to be ready for it. A common seasonal ailment is of course seasonal allergies—it’s not serious for most of us, but it can be very annoying, and can disrupt a lot of our normal activities.
Suddenly, a thing that notionally does us no real harm, is making driving dangerous, cooking take three times as long, sex laughable if not off-the-table (so to speak), and the lightest tasks exhausting.
So, what to do about it?
Antihistamines: first generation
Ye olde antihistamines such as diphenhydramine and chlorpheniramine are probably not what to do about it.
They are small molecules that cross the blood-brain barrier and affect histamine receptors in the central nervous system. This will generally get the job done, but there’s a fair bit of neurological friendly-fire going on, and while they will produce drowsiness, the sleep will usually be of poor quality. They also tax the liver rather.
If you are using them and not experiencing unwanted side effects, then don’t let us stop you, but do be aware of the risks.
See also: Long-term use of diphenhydramine ← this is the active ingredient in Benadryl in the US and Canada, but safety regulations in many other countries mean that Benadryl has different, safer active ingredients elsewhere.
Antihistamines: later generations
We’re going to aggregate 2nd gen, 3rd gen, and 4th gen antihistamines here, because otherwise we’ll be writing a history article and we don’t have room for that. But suffice it to say, later generations of antihistamines do not come with the same problems.
Instead of going in all-guns-blazing to the CNS like first-gens, they are more specific in their receptor-targetting, resulting in negligible collateral damage:
Special shout-out to cetirizine and loratadine, which are the drugs behind half the brand names you’ll see on pharmacy shelves around most of the world these days (including many in the US and Canada).
Note that these two are very often discussed in the same sentence, sit next to each other on the shelf, and often have identical price and near-identical packaging. Their effectiveness (usually: moderate) and side effects (usually: low) are similar and comparable, but they are genuinely different drugs that just happen to do more or less the same thing.
This is relevant because if one of them isn’t working for you (and/or is creating an unwanted side effect), you might want to try the other one.
Another honorable mention goes to fexofenadine, for which pretty much all the same as the above goes, though it gets talked about less (and when it does get mentioned, it’s usually by its most popular brand name, Allegra).
Finally, one that’s a little different and also deserving of a special mention is azelastine. It was recently (ish, 2021) moved from being prescription-only to being non-prescription (OTC), and it’s a nasal spray.
It can cause drowsiness, but it’s considered safe and effective for most people. Its main benefit is not really the difference in drug, so much as the difference in the route of administration (nasal rather than oral). Because the drug is in liquid spray form, it can be absorbed through the mucus lining of the nose and get straight to work on blocking the symptoms—in contrast, oral antihistamines usually have to go into your stomach and take their chances there (we say “usually”, because there are some sublingual antihistamines that dissolve under the tongue, but they are less common.)
Better than antihistamines?
Writer’s note: at this point, I was given to wonder: “wait, what was I squirting up my nose last time anyway?”—because, dear readers, at the time I got it I just bought one of every different drug on the shelf, desperate to find something that worked. What worked for me, like magic, when nothing else had, was beclometasone dipropionate, which a) smelled delightfully of flowers, which might just be the brand I got, b) needs replacing now because I got it in March 2023 and it expired July 2024, and c) is not an antihistamine at all.
But, that brings us to the final chapter for today: systemic corticosteroids
They’re not ok for everyone (check with your doctor if unsure), and definitely should not be taken if immunocompromised and/or currently suffering from an infection (including colds, flu, COVID, etc) unless your doctor tells you otherwise (and even then, honestly, double-check).
But! They can work like magic when other things don’t. Unlike antihistamines, which only block the symptoms, systemic corticosteroids tackle the underlying inflammation, which can stop the whole thing in its tracks.
Here’s how they measure up against antihistamines:
❝The results of this systematic review, together with data on safety and cost effectiveness, support the use of intranasal corticosteroids over oral antihistamines as first line treatment for allergic rhinitis.❞
~ Dr. Robert Puy et al.
Take care!
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What You Should Have Been Told About The Menopause Beforehand
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What You Should Have Been Told About Menopause Beforehand
This is Dr. Jen Gunter. She’s a gynecologist, specializing in chronic pain and vulvovaginal disorders. She’s also a woman on a mission to demystify things that popular culture, especially in the US, would rather not talk about.
When was the last time you remember the menopause being referenced in a movie or TV show? If you can think of one at all, was it just played for laughs?
And of course, the human body can be funny, so that’s not necessarily the problem, but it sure would be nice if that weren’t all that there is!
So, what does Dr. Gunter want us to know?
It’s a time of changes, not an end
The name “menopause” is misleading. It’s not a “pause”, and those menses aren’t coming back.
And yet, to call it a “menostop” would be differently misleading, because there’s a lot more going on than a simple cessation of menstruation.
Estrogen levels will drop a lot, testosterone levels may rise slightly, mood and sleep and appetite and sex drive will probably be affected (progesterone can improve all these things!) and
not to mention butwe’re going to mention: vaginal atrophy, which is very normal and very treatable with a topical estrogen cream. Untreated menopause can also bring a whole lot of increased health risks (for example, heart disease, osteoporosis, and, counterintuitively given the lower estrogen levels, breast cancer).However, with a little awareness and appropriate management, all these things can usually be navigated with minimal adverse health outcomes.
Dr Gunter, for this reason, refers to it interchangeably as “the menopausal transition”. She describes it as being less like a cliff edge we fall off, and more like a bridge we cross.
Bridges can be dangerous to cross! But they can also get us safely where we’re going.
Ok, so how do we manage those things?
Dr. Gunter is a big fan of evidence-based medicine, so we’ll not be seeing any yonic crystals or jade eggs. Or “goop”.
See also: Meet Goop’s Number One Enemy
For most people, she recommends Menopausal Hormone Therapy (MHT), which falls under the more general category of Hormone Replacement Therapy (HRT).
This is the most well-evidenced, science-based way to avoid most of the risks associated with menopause.
Nevertheless, there are scare-stories out there, ranging from painful recommencement of bleeding, to (once again) increased risk of breast cancer. However, most of these are either misunderstandings, or unrelated to menopause and MHT, and are rather signs of other problems that should not be ignored.
To get a good grounding in this, you might want to read her Hormone Therapy Guide, freely available as a standalone section on her website. This series of posts is dedicated to hormone therapy. It starts with some basics and builds on that knowledge with each post:
Dr. Gunter’s Guide To The Hormone Menoverse
What about natural therapies?
There are some non-hormonal things that work, but these are mostly things that:
- give a statistically significant reduction in symptoms
- give the same statistically significant reduction in symptoms as placebo
As Dr. Gunter puts it:
❝While most of the studies of prescription medications for hot flashes have an appropriate placebo arm, this is rarely the case with so-called alternative therapies.
In fact, the studies here are almost always low quality, so it’s often not possible to conclude much.
Many reviews that look at these studies often end with a line that goes something like, “Randomized trials with a placebo arm, a low risk of bias, and adequate sample sizes are urgently needed.”
You should interpret this kind of conclusion as the polite way of saying, “We need studies that aren’t BS to say something constructive.”❞
However, if it works, it works, whatever its mechanism. It’s just good, when making medical decisions, to do so with the full facts!
For that matter, even Dr. Gunter acknowledges that while MHT can be lifechanging (in a positive way) for many, it’s not for everyone:
Informed Decisions: When Menopause Hormone Therapy Isn’t Recommended
Want to know more?
Dr. Gunter also has an assortment of books available, including The Menopause Manifesto (which we’ve reviewed previously), and some others that we haven’t, such as “Blood” and “The Vagina Bible”.
Enjoy!
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Why Curcumin (Turmeric) Is Worth Its Weight In Gold
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Curcumin (Turmeric) is worth its weight in gold
Not financially! But, this inexpensive golden spice has an impressive list of well-studied health benefits, for something so freely available in any supermarket, and there’s a reason it gets a place in “Dr. Greger’s Daily Dozen”, right up there with things like “leafy greens” and “berries” when it comes to superfoods.
Let’s do a quick run-down:
- It fights inflammation, and thus helps fight many diseases where inflammation is a factor (ranging from atherosclerosis to arthritis to Alzheimer’s and more)
- It has powerful antioxidant effects too
- It boosts brain-derived neurotropic factor (BDNF) and thus improves memory and attention
- It helps protect against heart disease…
- …and can give a 65% decreased risk of experiencing a heart attack
- It can help prevent cancer, and reduce cancerous lesions by 40%
- It’s also good against depression
- It even slows aging
In short, it’s—like we said—worth its weight in gold.
Quick advice though before we move on…
If you take curcumin with black pepper, it allows your body to use the curcumin around 2,000% better. This goes whether you’re cooking with both, or take them as a supplement (they’re commonly sold as a combo-capsule for this reason).
Want to get some?
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Pumpkin Protein Crackers
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Ten of these (give or take what size you make them) will give you the 20g protein that most people’s body’s can use at a time. Five of these plus some of one of the dips we list at the bottom will also do it:
You will need
- 1 cup chickpea flour (also called gram flour or garbanzo bean flour)
- 2 tbsp pumpkin seeds
- 1 tbsp chia seeds
- 1 tsp baking powder
- ¼ tsp MSG or ½ tsp low-sodium salt
- 2 tbsp extra virgin olive oil
Method
(we suggest you read everything at least once before doing anything)
1) Preheat the oven to 350℉ / 180℃.
2) Combine the dry ingredients in a mixing bowl, and mix thoroughly.
3) Add the oil, and mix thoroughly.
4) Add water, 1 tbsp at a time, mixing thoroughly until the mixture comes together and you have a dough ball. You’ll probably need 3–4 tbsp in total, but do add them one at a time.
5) Roll out the dough as thinly and evenly as you can between two sheets of baking paper. Remove the top layer of the paper, and slice the dough into squares or triangles. You could use a cookie-cutter to make other shapes if you like, but then you’ll need to repeat the rolling to use up the offcuts. So we recommend squares or triangles at least for your first go.
6) Bake them in the oven for 12–15 minutes or until golden and crispy. Enjoy immediately or keep in an airtight container.
Enjoy!
Want to learn more?
For those interested in some things to go with what we have going on today:
- Muhammara ← this is a very nutritionally-dense dip (not to mention tasty; seriously, check out these flavors)
- Hero Homemade Hummus ← a classic
- Plant-Based Healthy Cream Cheese ← also a very respectable option
Take care!
Don’t Forget…
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Learn to Age Gracefully
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