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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Too Much Or Too Little Testosterone?
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One Man’s Saw Palmetto Is Another Woman’s Serenoa Repens…
Today we’re going to look at saw palmetto. So, first:
What is it?
Saw palmetto is a type of palm native to the southeastern United States. Its scientific name is “Serenoa repens”, so if that name appears in studies we cite, it’s the same thing. By whichever name, it’s widely enjoyed as a herbal supplement.
Why do people take it?
Here’s where it gets interesting, because people take it for some completely opposite reasons…
Indeed, searching for it on the Internet will cause Google to suggest “…for men” and “…for women” as the top suggestions.
That’s because it works on testosterone, and testosterone can be a bit of a double-edged sword, so some people want to increase or decrease certain testosterone-related effects on their body.
And it works for both! Here be science:
- Testosterone (henceforth, “T”) is produced in the human body.
- Yes, all human bodies, to some extent.
- An enzyme called 5-alpha-reductase converts T in to DHT (dihydrogen testosterone)
- DHT is a much more potent androgen (masculinizing agent) than T alone, such that its effects are often unwanted, including:
- Enlarged prostate (if you have one)
- Hair loss (especially in men)
- New facial hair growth (usually unwanted by women)
- Women are more likely to get this due to PCOS and/or the menopause
To avoid those effects, you really want less of your T to be converted into DHT.
Saw palmetto is a 5α-reductase inhibitor, so if you take it, you’ll have less DHT, and you’ll consequently lose less hair, have fewer prostate problems, etc.
^The above study showed that saw palmetto extract performed comparably to finasteride. Finasteride is the world’s main go-to prescription drug for treating enlarged prostate and/or hair loss.
See also: Natural Hair Supplement: Friend or Foe? Saw Palmetto, a Systematic Review in Alopecia
Hair today… Growing tomorrow!
So, what was that about increasing T levels?
Men usually suffer declining T levels as they get older, with a marked drop around the age of 45. With lower T comes lower energy, lower mood, lower libido, erectile dysfunction, etc.
Guess what… It’s T that’s needed for those things, not DHT. So if you block the conversion of T to DHT, you’ll have higher blood serum T levels, higher energy, higher mood, higher libido, and all that.
(the above assumes you have testicles, without which, your T levels will certainly not increase)
Saw Palmetto Against Enlarged Prostate?
With higher DHT levels in mid-late life, prostate enlargement (benign prostatic hyperlasia) can become a problem for many men. The size of that problem ranges from urinary inconvenience (common, when the prostate presses against the bladder) to prostate cancer (less common, much more serious). Saw palmetto, like other 5α-reductase inhibitors such as finasteride, may be used to prevent or treat this.
Wondering how safe/reliable it is? We found a very high-quality fifteen-year longitudinal observational study of the use of saw palmetto, and it found:
❝The 15 years’ study results suggest that taking S. repens plant extract continuously at a daily dose of 320 mg is an effective and safe way to prevent the progression of benign prostatic hyperplasia.❞
Want a second opinion? We also found a 10-year study (by different researchers with different people taking it), which reached the same conclusion:
❝The results of study showed the absence of progression, both on subjective criteria (IPSS, and QoL scores), and objective criteria (prostate volume, the rate of urination, residual urine volume). Furthermore, patients had no undesirable effects directly related to the use of this drug.❞
- IPSS = International Prostate Symptom Score
- QoL = Quality of Life
❝But wait a minute; I, a man over the age of 45 with potentially declining T levels but a fabulous beard, remember that you said just a minute ago that saw palmetto is used by women to avoid having facial hair; I don’t want to lose mine!❞
You won’t. Once your facial hair follicles were fully developed and activated during puberty, they’ll carry on doing what they do for life. That’s no longer regulated by hormones once they’re up and running.
The use of saw palmetto can only be used to limit facial hair if caught early—so it’s more useful at the onset of menopause, for those who have (or will have) such, or else upon the arrival of PCOS symptoms or hirsuitism from some other cause.
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Bottom Line on Saw Palmetto
- It blocks the conversion of T into DHT
- It will increase blood serum T levels, thus boosting mood, energy, libido, etc in men (who typically have more T, but whose T levels decline with age)
- It will decrease DHT levels, thus limiting hair loss (especially in men) and later-life new facial hair growth (especially in women).
- It can be used to prevent or treat prostate enlargement
- Bonus: it’s a potent antioxidant and thus reduces general inflammation (in everyone)
Want To Try Saw Palmetto?
We don’t sell it (or anything else), but for your convenience…
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- Testosterone (henceforth, “T”) is produced in the human body.
The Vitamin Solution – by Dr. Romy Block & Dr. Arielle Levitan
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A quick note: it would be remiss of us not to mention that the authors of this book are also the founders of a vitamin company, thus presenting a potential conflict of interest.
That said… In this reviewer’s opinion, the book does seem balanced and objective, regardless.
We talk a lot about supplements here at 10almonds, especially in our Monday Research Review editions. And yesterday, we featured a book by a doctor who hates supplements. Today, we feature a book by two doctors who have made them their business.
The authors cover all the most common vitamins and minerals popularly enjoyed as supplements, and examine:
- why people take them
- factors affecting whether they help
- problems that can arise
- complicating factors
The “complicating factors” include, for example, the way many vitamins and/or minerals interplay with each other, either by requiring the presence of another, or else competing for resources for absorption, or needing to be delicately balanced on pain of diverse woes.
This is the greatest value of the book, perhaps; it’s where most people go wrong with supplementation, if they go wrong.
While both authors are medical doctors, Dr. Romy Block is an endocrinologist specifically, and she clearly brought a lot of extra attention to relevant metabolic/thyroid issues, and how vitamins and minerals (such as thiamin and iron) can improve or sabotage such, depending on various factors that she explains. Informative, and so far as this reviewer could see, objective and well-balanced.
Bottom line: supplementation is a vast and complex topic, but this book does a fine job of demystifying and simplifying it in a clear and objective fashion, without resorting to either scaremongering or hype.
Click here to check out The Vitamin Solution, and upgrade your knowledge!
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The Plant Power Doctor
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A Prescription For GLOVES
This is Dr. Gemma Newman. She’s a GP (General Practitioner, British equivalent to what is called a family doctor in America), and she realized that she was treating a lot of patients while nobody was actually getting better.
So, she set out to help people actually get better… But how?
The biggest thing
The single biggest thing she recommends is a whole foods plant-based diet, as that’s a starting point for a lot of other things.
Click here for an assortment of short videos by her and other health professionals on this topic!
Specifically, she advocates to “love foods that love you back”, and make critical choices when deciding between ingredients.
Click here to see her recipes and tips (this writer is going to try out some of these!)
What’s this about GLOVES?
We recently reviewed her book “Get Well, Stay Well: The Six Healing Health Habits You Need To Know”, and now we’re going to talk about those six things in more words than we had room for previously.
They are six things that she says we should all try to get every day. It’s a lot simpler than a lot of checklists, and very worthwhile:
Gratitude
May seem like a wishy-washy one to start with, but there’s a lot of evidence for this making a big difference to health, largely on account of how it lowers stress and anxiety. See also:
How To Get Your Brain On A More Positive Track (Without Toxic Positivity)
Love
This is about social connections, mostly. We are evolved to be a social species, and while some of us want/need more or less social interaction than others, generally speaking we thrive best in a community, with all the social support that comes with that. See also:
How To Beat Loneliness & Isolation
Outside
This is about fresh air and it’s about moving and it’s about seeing some green plants (and if available, blue sky), marvelling at the wonder of nature and benefiting in many ways. See also:
Vegetables
We spoke earlier about the whole foods plant-based diet for which she advocates, so this is that. While reducing/skipping meat etc is absolutely a thing, the focus here is on diversity of vegetables; it is best to make a game of seeing how many different ones you can include in a week (not just the same three!). See also:
Three Critical Kitchen Prescriptions
Exercise
At least 150 minutes moderate exercise per week, and some kind of resistance work. It can be calisthenics or something; it doesn’t have to be lifting weights if that’s not your thing! See also:
Resistance Is Useful! (Especially As We Get Older)
Sleep
Quality and quantity. Yes, 7–9 hours, yes, regardless of age. Unless you’re a child or a bodybuilder, in which case make it nearer 12. But for most of us, 7–9. See also:
Why You Probably Need More Sleep
Want to know more?
As well as the book we mentioned earlier, you might also like:
The Plant Power Doctor – by Dr. Gemma Newman
While the other book we mentioned is available for pre-order for Americans (it’s already released for the rest of the world), this one is available to all right now, so that’s a bonus too.
If books aren’t your thing (or even if they are), you might like her award-winning podcast:
Take care!
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Fast Burn – by Dr. Ian K. Smith
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Intermittent fasting seems simple enough: how complicated can “stop eating for a bit” be? Well, there are nuances and tweaks and hacks and “if you do this bit wrong it will sabotage your benefits” things to know about, too.
Dr. Smith takes us through the basic essentials first, and covers each of the main kinds of intermittent fasting, for example:
- Time-restricted eating; 12:12, 16:8, etc, with those being hours fasting vs hours eating
- Caloric restriction models; for example 5:2, where one eats “normally” for 5 days a week, and on two non-consecutive days, eats only 500 calories
- Day off models and more; for example, “no eating on Sundays” that can, depending on your schedule, be anything from a 24-hour fast to 36 hours or more.
…and, most notably, what they each do metabolically.
Then, the real meat of the book is his program. Taking into account the benefits of each form of fasting, he weaves together a 9-week program to first ease us gently into intermittent fasting, and then enjoy the maximum benefits with minimum self-sabotage.
Which is the biggest stumbling-block for many trying intermittent fasting for the first time, so it’s a huge help that he takes care of this here.
He also includes meal plans and recipes; readers can use those or not; the fasting plan stands on its own two feet without them too.
Bottom line: if you’ve been thinking of trying intermittent fasting but have been put off by all the kinds or have had trouble sticking to it, this book may be just what you need.
Click here to check out Fast Burn on Amazon and see what you can achieve!
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Habits of a Happy Brain – by Dr. Loretta Graziano Breuning
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There are lots of books on “happy chemicals” and “how to retrain your brain”, so what makes this one different?
Firstly, it focuses on four “happy chemicals”, not just one:
- Serotonin
- Dopamine
- Oxytocin
- Endorphins
It also looks at the role of cortisol, and how it caps off each of those just a little bit, to keep us just a little malcontent.
Behavioral psychology tends to focus most on dopamine, while prescription pharmaceuticals for happiness (i.e., most antidepressants) tend to focus on serotonin. Here, Dr. Breuning helps us understand the complex interplay of all of the aforementioned chemicals.
She also clears up many misconceptions, since a lot of people misattribute the functions of each of these.
Common examples include “I’m doing this for the serotonin!” when the activity is dopaminergic not serotoninergic, or considering dopamine “the love molecule” when oxytocin, or even something else like phenylethylamine would be more appropriate.
The above may seem like academic quibbles and not something of practical use, but if we want to biohack our brains, we need to do better than the equivalent of a chef who doesn’t know the difference between salt and sugar.
Where things are of less practical use, she tends to skip over or at least streamline them. For example, she doesn’t really discuss the role of post-dopamine prolactin in men—but the discussion of post-happiness cortisol covers the same ground anyway, for practical purposes.
Dr. Breuning also looks at where our evolved neurochemical responses go wrong, and lays out guidelines for such challenges as overcoming addiction, or embracing delayed gratification.
Bottom line: this book is a great user-manual for the brain. If you’d like to be happier and more effective with fewer bad habits, this is the book for you.
Click here to check out Habits of a Happy Brain, and get biohacking yours!
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How much weight do you actually need to lose? It might be a lot less than you think
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If you’re one of the one in three Australians whose New Year’s resolution involved losing weight, it’s likely you’re now contemplating what weight-loss goal you should actually be working towards.
But type “setting a weight loss goal” into any online search engine and you’ll likely be left with more questions than answers.
Sure, the many weight-loss apps and calculators available will make setting this goal seem easy. They’ll typically use a body mass index (BMI) calculator to confirm a “healthy” weight and provide a goal weight based on this range.
Your screen will fill with trim-looking influencers touting diets that will help you drop ten kilos in a month, or ads for diets, pills and exercise regimens promising to help you effortlessly and rapidly lose weight.
Most sales pitches will suggest you need to lose substantial amounts of weight to be healthy – making weight loss seem an impossible task. But the research shows you don’t need to lose a lot of weight to achieve health benefits.
Using BMI to define our target weight is flawed
We’re a society fixated on numbers. So it’s no surprise we use measurements and equations to score our weight. The most popular is BMI, a measure of our body weight-to-height ratio.
BMI classifies bodies as underweight, normal (healthy) weight, overweight or obese and can be a useful tool for weight and health screening.
But it shouldn’t be used as the single measure of what it means to be a healthy weight when we set our weight-loss goals. This is because it:
- fails to consider two critical factors related to body weight and health – body fat percentage and distribution
- does not account for significant differences in body composition based on gender, ethnicity and age.
How does losing weight benefit our health?
Losing just 5–10% of our body weight – between 6 and 12kg for someone weighing 120kg – can significantly improve our health in four key ways.
1. Reducing cholesterol
Obesity increases the chances of having too much low-density lipoprotein (LDL) cholesterol – also known as bad cholesterol – because carrying excess weight changes how our bodies produce and manage lipoproteins and triglycerides, another fat molecule we use for energy.
Having too much bad cholesterol and high triglyceride levels is not good, narrowing our arteries and limiting blood flow, which increases the risk of heart disease, heart attack and stroke.
But research shows improvements in total cholesterol, LDL cholesterol and triglyceride levels are evident with just 5% weight loss.
2. Lowering blood pressure
Our blood pressure is considered high if it reads more than 140/90 on at least two occasions.
Excess weight is linked to high blood pressure in several ways, including changing how our sympathetic nervous system, blood vessels and hormones regulate our blood pressure.
Essentially, high blood pressure makes our heart and blood vessels work harder and less efficiently, damaging our arteries over time and increasing our risk of heart disease, heart attack and stroke.
Losing weight can lower your blood pressure.
Prostock-studio/ShutterstockLike the improvements in cholesterol, a 5% weight loss improves both systolic blood pressure (the first number in the reading) and diastolic blood pressure (the second number).
A meta-analysis of 25 trials on the influence of weight reduction on blood pressure also found every kilo of weight loss improved blood pressure by one point.
3. Reducing risk for type 2 diabetes
Excess body weight is the primary manageable risk factor for type 2 diabetes, particularly for people carrying a lot of visceral fat around the abdomen (belly fat).
Carrying this excess weight can cause fat cells to release pro-inflammatory chemicals that disrupt how our bodies regulate and use the insulin produced by our pancreas, leading to high blood sugar levels.
Type 2 diabetes can lead to serious medical conditions if it’s not carefully managed, including damaging our heart, blood vessels, major organs, eyes and nervous system.
Research shows just 7% weight loss reduces risk of developing type 2 diabetes by 58%.
4. Reducing joint pain and the risk of osteoarthritis
Carrying excess weight can cause our joints to become inflamed and damaged, making us more prone to osteoarthritis.
Observational studies show being overweight doubles a person’s risk of developing osteoarthritis, while obesity increases the risk fourfold.
Small amounts of weight loss alleviate this stress on our joints. In one study each kilogram of weight loss resulted in a fourfold decrease in the load exerted on the knee in each step taken during daily activities.
Losing weight eases stress on joints.
Shutterstock/Rostislav_SedlacekFocus on long-term habits
If you’ve ever tried to lose weight but found the kilos return almost as quickly as they left, you’re not alone.
An analysis of 29 long-term weight-loss studies found participants regained more than half of the weight lost within two years. Within five years, they regained more than 80%.
When we lose weight, we take our body out of its comfort zone and trigger its survival response. It then counteracts weight loss, triggering several physiological responses to defend our body weight and “survive” starvation.
Just as the problem is evolutionary, the solution is evolutionary too. Successfully losing weight long-term comes down to:
losing weight in small manageable chunks you can sustain, specifically periods of weight loss, followed by periods of weight maintenance, and so on, until you achieve your goal weight
making gradual changes to your lifestyle to ensure you form habits that last a lifetime.
Setting a goal to reach a healthy weight can feel daunting. But it doesn’t have to be a pre-defined weight according to a “healthy” BMI range. Losing 5–10% of our body weight will result in immediate health benefits.
At the Boden Group, Charles Perkins Centre, we are studying the science of obesity and running clinical trials for weight loss. You can register here to express your interest.
Nick Fuller, Charles Perkins Centre Research Program Leader, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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