Kava vs Anxiety
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Kava, sometimes also called “kava kava” but we’re just going to call it kava once for the sake of brevity, is a heart-shaped herb that bestows the powers of the Black Panther is popularly enjoyed for its anxiolytic (anxiety-reducing) effects. Despite the similarity of the name in many languages, it is unrelated to coffee (except insofar as they are both plants), and its botanical name is Piper methysticum.
Does it work?
Yes! At least in the short-term; more on that later.
Firstly, you may be wondering how it works; it works by its potentiation of GABA receptors in the brain. GABA (or gamma-aminobutyric acid, to give it its full name), as you may recall, is a neurotransmitter that is associated with feelings of calm; we wrote about it here:
So, what does “potentiation of GABA receptors” mean? It means… Scientists don’t for 100% sure know how it works yet, but it does make GABA receptors fire more. It’s possible that to some degree GABA fits the “molecular lock” of the receptors and causes them to say “GABA is here”; it’s also possible that they just make them more sensitive to the real GABA that is there, or there could be another explanation as yet undiscovered. Either way, it means that taking kava has a similar effect to having increased GABA levels in the brain:
As for how much to use, 20–300mg appears to be an effective dose, and most sources recommend 80–250mg:
Kava as a Clinical Nutrient: Promises and Challenges
This review of clinical trials found that it was more effective than placebo in only 3 of 7 trials; specifically, it was beneficial in the short-term and not in the long-term. For these reasons, the researchers concluded:
❝Kava Kava appears to be a short-term treatment for anxiety, but not a replacement for prolonged anti-anxiety use. Although not witnessed in this review, liver toxicity is especially possible if taken longer than 8 weeks.❞
Another review of clinical trials found better results over the course of 11 clinical trials, though again, short-term treatment only was considered to be where the “safe and effective” claim can be placed:
❝Compared with placebo, kava extract appears to be an effective symptomatic treatment option for anxiety. The data available from the reviewed studies suggest that kava is relatively safe for short-term treatment (1 to 24 weeks), although more information is required. Further rigorous investigations, particularly into the long-term safety profile of kava are warrant❞
Source: Kava extract for treating anxiety
Is it safe?
Nope! It has been associated with liver damage:
The likely main mechanism of toxicity is that it simply monopolizes the liver’s metabolic abilities, meaning that while it’s metabolizing the kava, it’s not metabolizing other things (such as alcohol or other medications), which will then build up, and potentially overwhelm the liver:
Constituents in kava extracts potentially involved in hepatotoxicity: a review
However, traditionally-prepared kava has not had the same effect as modern extracts; at first it seemed the difference was the traditional aqueous extracts vs modern acetonic/ethanolic extracts, but eventually that was found not to be the case, as toxicity occurred with industrial aqueous extracts too. The conclusion so far is that it is about the quality of the source ingredients, and the problems inherent to mass-production:
Meanwhile, short-term use doesn’t seem to have this problem, if you’re not drinking alcohol or taking medications that affect the liver:
Mechanisms/risk factors – kava-associated hepatotoxicity ← you’ll need to scroll down to 4.2.4 to read about this
Want to try it?
If the potential for hepatotoxicity doesn’t put you off, here’s an example product on Amazon ← we do not recommend it, but we are not the boss of you, and maybe you’re confident about your liver and want to use it only very short-term?
Take care!
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Anti-Inflammatory Cookbook for Beginners – by Melissa Jefferson
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For some of us, avoiding inflammatory food is a particularly important consideration. For all of us, it should be anyway.
Sometimes, we know what’s good against inflammation, and we know what’s bad for inflammation… but we might struggle to come up with full meals of just-the-good, especially if we want to not repeat meals every day!
The subtitle is slightly misleading! It says “Countless Easy and Delicious Recipes”, but this depends on your counting ability. Melissa Jefferson gives us 150 anti-inflammatory recipes, which can be combined for a 12-week meal plan. We think that’s enough to at least call it “many”, though.
First comes an introduction to inflammation, inflammatory diseases, and a general overview of what to eat / what to avoid. After that, the main part of the book is divided into sections:
- Breakfasts (20)
- Soups (15)
- Beans & Grains (20)
- Meat (20)
- Fish (20)
- Vegetables (20)
- Sides (15)
- Snacks (10)
- Desserts (10)
If you’ve a knowledge of anti-inflammation diet already, you may be wondering how “Meat” and “Desserts” works.
- The meat section is a matter of going light on the meat and generally favoring white meats, and certainly unprocessed.
- Of course, if you are vegetarian or vegan, substitutions may be in order anyway.
As for the dessert section? A key factor is that fruits and chocolate are anti-inflammatory foods! Just a matter of not having desserts full of sugar, flour, etc.
The recipes themselves are simple and to-the-point, with ingredients, method, and nutritional values. Just the way we like it.
All in all, a fine addition to absolutely anyone’s kitchen library… And doubly so if you have a particular reason to focus on avoiding/reducing inflammation!
Get your copy of “Anti-Inflammatory Cookbook for Beginners” from Amazon today!
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How light can shift your mood and mental health
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This is the next article in our ‘Light and health’ series, where we look at how light affects our physical and mental health in sometimes surprising ways. Read other articles in the series.
It’s spring and you’ve probably noticed a change in when the Sun rises and sets. But have you also noticed a change in your mood?
We’ve known for a while that light plays a role in our wellbeing. Many of us tend to feel more positive when spring returns.
But for others, big changes in light, such as at the start of spring, can be tough. And for many, bright light at night can be a problem. Here’s what’s going on.
An ancient rhythm of light and mood
In an earlier article in our series, we learned that light shining on the back of the eye sends “timing signals” to the brain and the master clock of the circadian system. This clock coordinates our daily (circadian) rhythms.
“Clock genes” also regulate circadian rhythms. These genes control the timing of when many other genes turn on and off during the 24-hour, light-dark cycle.
But how is this all linked with our mood and mental health?
Circadian rhythms can be disrupted. This can happen if there are problems with how the body clock develops or functions, or if someone is routinely exposed to bright light at night.
When circadian disruption happens, it increases the risk of certain mental disorders. These include bipolar disorder and atypical depression (a type of depression when someone is extra sleepy and has problems with their energy and metabolism).
Light on the brain
Light may also affect circuits in the brain that control mood, as animal studies show.
There’s evidence this happens in humans. A brain-imaging study showed exposure to bright light in the daytime while inside the scanner changed the activity of a brain region involved in mood and alertness.
Another brain-imaging study found a link between daily exposure to sunlight and how the neurotransmitter (or chemical messenger) serotonin binds to receptors in the brain. We see alterations in serotonin binding in several mental disorders, including depression.
What happens when the seasons change?
Light can also affect mood and mental health as the seasons change. During autumn and winter, symptoms such as low mood and fatigue can develop. But often, once spring and summer come round, these symptoms go away. This is called “seasonality” or, when severe, “seasonal affective disorder”.
What is less well known is that for other people, the change to spring and summer (when there is more light) can also come with a change in mood and mental health. Some people experience increases in energy and the drive to be active. This is positive for some but can be seriously destabilising for others. This too is an example of seasonality.
Most people aren’t very seasonal. But for those who are, seasonality has a genetic component. Relatives of people with seasonal affective disorder are more likely to also experience seasonality.
Seasonality is also more common in conditions such as bipolar disorder. For many people with such conditions, the shift into shorter day-lengths during winter can trigger a depressive episode.
Counterintuitively, the longer day-lengths in spring and summer can also destabilise people with bipolar disorder into an “activated” state where energy and activity are in overdrive, and symptoms are harder to manage. So, seasonality can be serious.
Alexis Hutcheon, who experiences seasonality and helped write this article, told us:
[…] the season change is like preparing for battle – I never know what’s coming, and I rarely come out unscathed. I’ve experienced both hypomanic and depressive episodes triggered by the season change, but regardless of whether I’m on the ‘up’ or the ‘down’, the one constant is that I can’t sleep. To manage, I try to stick to a strict routine, tweak medication, maximise my exposure to light, and always stay tuned in to those subtle shifts in mood. It’s a time of heightened awareness and trying to stay one step ahead.
So what’s going on in the brain?
One explanation for what’s going on in the brain when mental health fluctuates with the change in seasons relates to the neurotransmitters serotonin and dopamine.
Serotonin helps regulate mood and is the target of many antidepressants. There is some evidence of seasonal changes in serotonin levels, potentially being lower in winter.
Dopamine is a neurotransmitter involved in reward, motivation and movement, and is also a target of some antidepressants. Levels of dopamine may also change with the seasons.
But the neuroscience of seasonality is a developing area and more research is needed to know what’s going on in the brain.
How about bright light at night?
We know exposure to bright light at night (for instance, if someone is up all night) can disturb someone’s circadian rhythms.
This type of circadian rhythm disturbance is associated with higher rates of symptoms including self-harm, depressive and anxiety symptoms, and lower wellbeing. It is also associated with higher rates of mental disorders, such as major depression, bipolar disorder, psychotic disorders and post-traumatic stress disorder (or PTSD).
Why is this? Bright light at night confuses and destabilises the body clock. It disrupts the rhythmic regulation of mood, cognition, appetite, metabolism and many other mental processes.
But people differ hugely in their sensitivity to light. While still a hypothesis, people who are most sensitive to light may be the most vulnerable to body clock disturbances caused by bright light at night, which then leads to a higher risk of mental health problems.
Where to from here?
Learning about light will help people better manage their mental health conditions.
By encouraging people to better align their lives to the light-dark cycle (to stabilise their body clock) we may also help prevent conditions such as depression and bipolar disorder emerging in the first place.
Healthy light behaviours – avoiding light at night and seeking light during the day – are good for everyone. But they might be especially helpful for people at risk of mental health problems. These include people with a family history of mental health problems or people who are night owls (late sleepers and late risers), who are more at risk of body clock disturbances.
Alexis Hutcheon has lived experience of a mental health condition and helped write this article.
If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.
Jacob Crouse, Research Fellow in Youth Mental Health, Brain and Mind Centre, University of Sydney; Emiliana Tonini, Postdoctoral Research Fellow, Brain and Mind Centre, University of Sydney, and Ian Hickie, Co-Director, Health and Policy, Brain and Mind Centre, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Take Care Of Your “Unwanted” Parts Too!
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Meet The Family…
If you’ve heard talk of “healing your inner child” or similar ideas, then today’s featured type of therapy takes that to several extra levels, in a way that helps many people.
It’s called Internal Family Systems therapy, often “IFS” for short.
Here’s a quick overview:
Psychology Today | Internal Family Systems Therapy
Note: if you are delusional, paranoid, schizophrenic, or have some other related disorder*, then IFS would probably be a bad idea for you as it could worsen your symptoms, and/or play into them badly.
*but bipolar disorder, in its various forms, is not usually a problem for IFS. Do check with your own relevant healthcare provider(s), of course, to be sure.
What is IFS?
The main premise of IFS is that your “self” can be modelled as a system, and its constituent parts can be examined, questioned, given what they need, and integrated into a healthy whole.
For example…
- Exile is the name given to parts that could be, for example, the “inner child” referenced in a lot of pop-psychology, but it could also be some other ignored and pushed-down part of oneself, often from some kind of trauma. The defining characteristic of an exile is that it’s a part of ourself that we don’t consciously allow ourselves to see as a current part of ourself.
- Protector is the name given to a part of us that looks to keep us safe, and can do this in an adaptive (healthy) or maladaptive (unhealthy) way, for example:
- Firefighter is the name given to a part of us that will do whatever is necessary in the moment to deal with an exile that is otherwise coming to the surface—sometimes with drastic actions/reactions that may not be great for us.
- Manager is the name given to a part of us that has a more nurturing protective role, keeping us from harm in what’s often a more prophylactic manner.
To give a simple illustration…
A person was criticized a lot as a child, told she was useless, and treated as a disappointment. Consequently, as an adult she now has an exile “the useless child”, something she strives to leave well behind in her past, because it was a painful experience for her. However, sometimes when someone questions and/or advises her, she will get defensive as her firefighter “the hero” will vigorously speak up for her competence, like nobody did when she was a child. This vigor, however, manifests as rude abrasiveness and overcompensation. Finally, she has a manager, “the advocate”, who will do the same job, but in a more quietly confident fashion.
This person’s therapy will look at transferring the protector job from the firefighter to the manager, which will involve examining, questioning, and addressing all three parts.
The above example is fictional and created for simplicity and clarity; here’s a real-world case study if you’d like a more in-depth overview of how it can work:
How it all fits together in practice
IFS looks to make sure all the parts’ needs are met, even the “bad” ones, because they all have their functions.
Good IFS therapy, however, can make sure a part is heard, and then reassure that part in a way that effectively allows that part to “retire”, safe and secure in the knowledge that it has done what it needed to, and/or the job is being done by another part now.
That can involve, for example, thanking the firefighter for looking after our exile for all these years, but that our exile is safe and in good hands now, so it can put that fire-axe away.
See also: On Being Reactive vs Being Responsive
Questions you might ask yourself
While IFS therapy is best given by a skilled practitioner, we can take some of the ideas of it for self-therapy too. For example…
- What is a secret about yourself that you will take to the grave? And now, why did that part of you (now an exile) come to exist?
- What does that exile need, that it didn’t get? What parts of us try to give it that nowadays?
- What could we do, with all that information in mind, to assign the “protection” job to the part of us best-suited to healthy integration?
Want to know more?
We’ve only had the space of a small article to give a brief introduction to Family Systems therapy, so check out the “resources” tab at:
IFS Institute | What Is Internal Family Systems Therapy?
Take care!
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Why Diets Make Us Fat – by Dr. Sandra Aamodt
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It’s well-known that crash-dieting doesn’t work. Restrictive diets will achieve short-term weight loss, but it’ll come back later. In the long term, weight creeps slowly upwards. Why?
Dr. Sandra Aamodt explores the science and sociology behind this phenomenon, and offers an evidence-based alternative.
A lot of the book is given over to explanations of what is typically going wrong—that is the title of the book, after all. From metabolic starvation responses to genetics to the negative feedback loop of poor body image, there’s a lot to address.
However, what alternative does she propose?
The book takes us on a shift away from focusing on the numbers on the scale, and more on building consistent healthy habits. It might not feel like it if you desperately want to lose weight, but it’s better to have healthy habits at any weight, than to have a wreck of physical and mental health for the sake of a lower body mass.
Dr. Aamodt lays out a plan for shifting perspectives, building health, and letting weight loss come by itself—as a side effect, not a goal.
In fact, as she argues (in agreement with the best current science, science that we’ve covered before at 10almonds, for that matter), that over a certain age, people in the “overweight” category of BMI have a reduced mortality risk compared to those in the “healthy weight” category. It really underlines how there’s no point in making oneself miserably unhealthy with the end goal of having a lighter coffin—and getting it sooner.
Bottom line: will this book make you hit those glossy-magazine weight goals by your next vacation? Quite possibly not, but it will set you up for actually healthier living, for life, at any weight.
Click here to check out Why Diets Make Us Fat, and live healthier and better!
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How stigma perpetuates substance use
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In 2022, 54.6 million people 12 and older in the United States needed substance use disorder (SUD) treatment. Of those, only 24 percent received treatment, according to the most recent National Survey on Drug Use and Health.
SUD is a treatable, chronic medical condition that causes people to have difficulty controlling their use of legal or illegal substances, such as alcohol, tobacco, prescription opioids, heroin, methamphetamine, or cocaine. Using these substances may impact people’s health and ability to function in their daily life.
While help is available for people with SUD, the stigma they face—negative attitudes, stereotypes, and discrimination—often leads to shame, worsens their condition, and keeps them from seeking help.
Read on to find out more about how stigma perpetuates substance use.
Stigma can keep people from seeking treatment
Suzan M. Walters, assistant professor at New York University’s Grossman School of Medicine, has seen this firsthand in her research on stigma and health disparities.
She explains that people with SUD may be treated differently at a hospital or another health care setting because of their drug use, appearance (including track marks on their arms), or housing situation, which may discourage them from seeking care.
“And this is not just one case; this is a trend that I’m seeing with people who use drugs,” Walters tells PGN. “Someone said, ‘If I overdose, I’m not even going to the [emergency room] to get help because of this, because of the way I’m treated. Because I know I’m going to be treated differently.’”
People experience stigma not only because of their addiction, but also because of other aspects of their identities, Walters says, including “immigration or race and ethnicity. Hispanic folks, brown folks, Black folks [are] being treated differently and experiencing different outcomes.”
And despite the effective harm reduction tools and treatment options available for SUD, research has shown that stigma creates barriers to access.
Syringe services programs, for example, provide infectious disease testing, Narcan, and fentanyl test strips. These programs have been proven to save lives and reduce the spread of HIV and hepatitis C. SSPs don’t increase crime, but they’re often mistakenly “viewed by communities as potential settings of drug-related crime;” this myth persists despite decades of research proving that SSPs make communities safer.
To improve this bias, Walters says it’s helpful for people to take a step back and recognize how we use substances, like alcohol, in our own lives, while also humanizing those with addiction. She says, “There’s a lack of understanding that these are human beings and people … [who] are living lives, and many times very functional lives.”
Misconceptions lead to stigma
SUD results from changes in the brain that make it difficult for a person to stop using a substance. But research has shown that a big misconception that leads to stigma is that addiction is a choice and reflects a person’s willpower.
Michelle Maloney, executive clinical director of mental health and addiction recovery services for Rogers Behavioral Health, tells PGN that statements such as “you should be able to stop” can keep a patient from seeking treatment. This belief goes back to the 1980s and the War on Drugs, she adds.
“We think about public service announcements that occurred during that time: ‘Just say no to drugs,’” Maloney says. “People who have struggled, whether that be with nicotine, alcohol, or opioids, [know] it’s not as easy as just saying no.”
Stigma can worsen addiction
Stigma can also lead people with SUD to feel guilt and shame and blame themselves for their medical condition. These feelings, according to the National Institute on Drug Abuse, may “reinforce drug-seeking behavior.”
In a 2020 article, Dr. Nora D. Volkow, the director of NIDA, said that “when internalized, stigma and the painful isolation it produces encourage further drug taking, directly exacerbating the disease.”
Overall, research agrees that stigma harms people experiencing addiction and can make the condition worse. Experts also agree that debunking myths about the condition and using non-stigmatizing language (like saying someone is a person with a substance use disorder, not an addict) can go a long way toward reducing stigma.
Resources to mitigate stigma:
- CDC: Stigma Reduction
- National Harm Reduction Coalition: Respect To Connect: Undoing Stigma
- NIDA:
- Shatterproof: Addiction language guide (Disclosure: The Public Good Projects, PGN’s parent company, is a Shatterproof partner)
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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Ozempic’s cousin drug liraglutide is about to get cheaper. But how does it stack up?
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Fourteen years ago, the older drug cousin of semaglutide (Ozempic and Wegovy) came onto the market. The drug, liraglutide, is sold under the brand names Victoza and Saxenda.
Patents for Victoza and Saxenda have now expried. So other drug companies are working to develop “generic” versions. These are likely be a fraction of current cost, which is around A$400 a month.
So how does liraglutide compare with semaglutide?
How do these drugs work?
Liraglutide was not originally developed as a weight-loss treatment. Like semaglutide (Ozempic), it originally treated type 2 diabetes.
The class of drugs liraglutide and semaglutide belong to are known as GLP-1 mimetics, meaning they mimic the natural hormone GLP-1. This hormone is released from your small intestines in response to food and acts in several ways to improve the way your body handles glucose (sugar).
How do they stop hunger?
Liraglutide acts in several regions of the unconscious part of your brain, specifically the hypothalamus, which controls metabolism, and parts of the brain stem responsible for communicating your body’s nutrient status to the hypothalamus.
Its actions here appear to reduce hunger in two different ways. First, it helps you to feel full earlier, making smaller meals more satisfying. Second, it alters your “motivational salience” towards food, meaning it reduces the amount of food you seek out.
Liraglutide’s original formulation, designed to treat type 2 diabetes, was marketed as Victoza. Its ability to cause weight loss was evident soon after it entered the market.
Shortly after, a stronger formulation, called Saxenda, was released, which was intended for weight loss in people with obesity.
How much weight can you lose with liraglutide?
People respond differently and will lose different amounts of weight. But here, we’ll note the average weight loss users can expect. Some will lose more (sometimes much more), others will lose less, and a small proportion won’t respond.
The first GLP-1 mimicking drug was exenatide (Bayetta). It’s still available for treating type 2 diabetes, but there are currently no generics. Exenatide does provide some weight loss, but this is quite modest, typically around 3-5% of body weight.
For liraglutide, those using the drug to treat obesity will use the stronger one (Saxenda), which typically gives about 10% weight loss.
Semaglutide, with the stronger formulation called Wegovy, typically results in 15% weight loss.
The newest GLP-1 mimicking drug on the market, tirzepatide (Mounjaro for type 2 diabetes and Zepbound for weight loss), results in weight loss of around 25% of body weight.
What happens when you stop taking them?
Despite the effectiveness of these medications in helping with weight loss, they do not appear to change people’s weight set-point.
So in many cases, when people stop taking them, they experience a rebound toward their original weight.
What is the dose and how often do you need to take it?
Liraglutide (Victoza) for type 2 diabetes is exactly the same drug as Saxenda for weight loss, but Saxenda is a higher dose.
Although the target for each formulation is the same (the GLP-1 receptor), for glucose control in type 2 diabetes, liraglutide has to (mainly) reach the pancreas.
But to achieve weight loss, it has to reach parts of the brain. This means crossing the blood-brain barrier – and not all of it makes it, meaning more has to be taken.
All the current formulations of GLP-1 mimicking drug are injectables. This won’t change when liraglutide generics hit the market.
However, they differ in how frequently they need to be injected. Liraglutide is a once-daily injection, whereas semaglutide and tirzepatide are once-weekly. (That makes semaglutide and tirzepatide much more attractive, but we won’t see semaglutide as a generic until 2033.)
What are the side effects?
Because all these medicines have the same target in the body, they mostly have the same side effects.
The most common are a range of gastrointestinal upsets including nausea, vomiting, bloating, constipation and diarrhoea. These occur, in part, because these medications slow the movement of food out of the stomach, but are generally managed by increasing the dose slowly.
Recent clinical data suggests the slowing in emptying of the stomach can be problematic for some people, and may increase the risk of of food entering the lungs during operations, so it is important to let your doctor know if you are taking any of these drugs.
Because these are injectables, they can also lead to injection-site reactions.
During clinical trials, there were some reports of thyroid disease and pancreatitis (inflammation of the pancreas). However, it is not clear that these can be attributed to GLP-1 mimicking drugs.
In animals, GLP-1 mimicking drugs drugs have been found to negatively alter the growth of the embryo. There is currently no controlled clinical trial data on their use during pregnancy, but based on animal data, these medicines should not be used during pregnancy.
Who can use them?
The GLP-1 mimicking drugs for weight loss (Wegovy, Saxenda, Zepbound/Mounjaro) are approved for use by people with obesity and are meant to only be used in conjunction with diet and exercise.
These drugs must be prescribed by a doctor and for obesity are not covered by the Pharmaceutical Benefits Scheme, which is one of the reasons why they are expensive. But in time, generic versions of liraglutide are likely to be more affordable.
Sebastian Furness, ARC Future Fellow, School of Biomedical Sciences, The University of Queensland
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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