The Lifestyle Factors That Matter >8 Times More Than Genes

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We’ve said before that “genes predispose; they don’t predetermine”. It can be good to know one’s genes, of course, and we’ve written about this here:

Genetic Testing: Health Benefits & Methods

…which can include some quite contemporary risks, such as:

Genetic Risk Factors For Long COVID

And yet…

Nurture Over Nature

A very large (n=492,567) study looked into the impact of 25 lifestyle/environmental factors, of which 23 are considered modifiable, and found that lifestyle/environmental factors accounted for 17% of the variation in mortality risk, while genetic predisposition accounted for less than 2%.

Which is good news, because it means we can improve our lot.

But how?

The strongest negative factors (that increased mortality the most) were:

  • Smoking
  • Not owning your home (interestingly, “live in accommodation rent-free vs own” performed just as badly as various kinds of “renting home vs own”, while “own house with mortgage, vs own outright” had only a marginal negative effect)
  • Sleeping more than 9 hours per day (performed even worse than sleeping under 7 hours per day, which also increased mortality risk, but not by as much as oversleeping)
  • Financial difficulties in the past two years
  • Homosexuality
  • Unemployment
  • Being an evening person
  • Lonely lifestyle
  • Frequent napping

We may hypothesize that homosexuality probably makes the list because of how it makes one more likely to have other items on the list, especially unemployment, and the various poverty-related indicators that come from unemployment.

Being an evening person, whatever its pathology, is a well-established risk factor that we’ve talked about before:

Early Bird Or Night Owl? Genes vs Environment ← this is also, by the way, an excellent example of how “genes predispose; they don’t predetermine”, because there is a genetic factor involved, and/but we absolutely can switch it up, if we go about it correctly, and become a morning person without trying to force it.

The strongest positive factors (that decreased mortality the most) were:

  • The inverse of all of the various above things, e.g. never having smoked, owning your own home, etc
  • Household income, specifically
  • Living with a partner
  • Having oil central heating
  • Gym use
  • Sun protection use
  • Physical activity, especially if in leisure time rather than as part of one’s work
  • Glucosamine supplements
  • Family visit frequency
  • Cereal fiber intake (i.e. whole grains)

We may hypothesize that having oil central heating is simply a more expensive option to install than many, and therefore likely one enjoyed by homeowners more often than renters.

We may hypothesize that glucosamine supplementation is an indication of the type of person who takes care of a specific condition (inflammation of the joints) without an existential threat; notably, multivitamin supplements don’t get the same benefit, probably because of their ubiquity.

We may hypothesize that “family visit frequency” is highly correlated to having a support network, being social (and thus not lonely), and likely is associated with household income too.

You can see the full list of factors and their impacts, here:

Environmental architecture of mortality in the UKB ← that’s the UK Biobank

You can read the paper in full, here:

Integrating the environmental and genetic architectures of aging and mortality

Practical takeaways

The priorities seem to be as follows:

Don’t smoke. Ideally you will never have smoked, but short of a time machine, you can’t change that now, so: what you can do is quit now if you haven’t already.

See also: Which Addiction-Quitting Methods Work Best?

Note that other factors often lumped in with such, for example daily alcohol consumption, red meat intake, processed meat intake, and salt intake, all significantly increased mortality risk, but none of them in the same league of badness as smoking.

See also: Is Sugar The New Smoking? ← simply put: no, it is not. Don’t get us wrong; added sugar is woeful for the health, but smoking is pretty much the worst thing you can do for your health, short of intentionally (and successfully) committing suicide.

Be financially secure, ideally owning your own home. For many (indeed, for most people in the world) this may be an “easier said than done” thing, but if you can make decisions that will improve your financial security, the mortality numbers are very clear on this matter.

Be social, as loneliness indeed kills, in numerous ways. Loneliness means a lack of a support network, and it means a lack of social contact (thus increased risk of cognitive decline), and likely decreased ikigai, unless your life’s purpose is something inherently linked to solitude (e.g. the “meditating on top of a mountain” archetype).

See also: What Loneliness Does To Your Brain And Body

And to fix it: How To Beat Loneliness & Isolation

Be active: especially in your leisure time; being active because you have to does convey benefits, but on the same level as physical activity because you want to.

See also: No-Exercise Exercises (That Won’t Feel Like “Having To Do” Exercise)

Use sunscreen: we’re surprised this one made the list; it’s important to avoid skin cancer of course, but we didn’t think it’d be quite such a driver of mortality risk mitigation as the numbers show it is, and we can’t think of a clear alternative explanation, as we could with some of the other “why did this make the list?” items. At worst, it could be a similar case to that of glucosamine use, and thus is a marker of a conscientious person making a regular sustained effort for their health. Either way, it seems like a good idea based on the numbers.

See also: Do We Need Sunscreen In Winter, Really?

Enjoy whole grains: fiber is super-important, and that mustn’t be underestimated!

See also: What Matters Most For Your Heart? ← hint: it isn’t about salt intake or fat

And, for that matter: The Best Kind Of Fiber For Overall Health?

Take care!

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  • Stop Sabotaging Your Gut

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    This is Dr. Robynne Chutkan. She’s an integrative gastroenterologist, and founder of the Digestive Center for Wellness, in Washington DC, which for the past 20 years has been dedicated to uncovering the root causes of gastrointestinal disorders, while the therapeutic side of things has been focused on microbial optimization, nutritional therapy, mind-body techniques, and lifestyle changes.

    In other words, maximal health for minimal medicalization.

    So… What does she want us to know?

    Live dirty

    While attentive handwashing is important to avoid the spread of communicable diseases*, excessive cleanliness in general can result in an immune system that has no idea how to deal with pathogens when exposure does finally occur.

    *See also: The Truth About Handwashing

    This goes doubly for babies: especially those who were born by c-section and thus missed out on getting colonized by vaginal bacteria, and especially those who are not breast-fed, and thus miss out on nutrients given in breast milk that are made solely for the benefit of certain symbiotic bacteria (humans can’t even digest those particular nutrients, we literally evolved to produce some nutrients solely for the bacteria).

    See also: Breast Milk’s Benefits That Are (So Far) Not Replicable

    However, it still goes for the rest of us who are not babies, too. We could, Dr. Chutkan tells us, stand to wash less in general, and definitely ease up on antibacterial soaps and so forth.

    See also: Should You Shower Daily?

    Take antibiotics only if absolutely necessary (and avoid taking them by proxy)

    Dr. Chutkan describes antibiotics as the single biggest threat to our microbiome, not just because of overprescription, but also the antibiotics that are used in animal agriculture and thus enter the food chain (and thus, enter us, if we eat animal products).

    Still, while the antibiotics meat/dairy-enjoyers will get from food are better avoided, antibiotics actually taken directly are even worse, and are absolutely a “scorched earth” tactic against whatever they’re being prescribed for.

    See also: Antibiotics? Think Thrice ← which also brings up “Four Ways Antibiotics Can Kill You”; seriously, the risks of antibiotics are not to be underestimated, including the risks associated only with them working exactly as intended—let alone if something goes wrong.

    Probiotics won’t save you

    While like any gastroenterologist (or really, almost any person in general), she notes that probiotics can give a boost to health. However, she wants us to know about two shortcomings that are little-discussed:

    1) Your body has a collection of microbiomes each with their own needs, and while it is possible to take “generally good” bacteria in probiotics and assume they’ll do good, taking Lactobacillus sp. will do nothing for a shortage of Bifidobacteria sp, and even taking the correct genus can have similar shortcomings if a different species of that genus is needed, e.g. taking L. acidophilus will do nothing for a shortage of L. reuteri.

    It’d be like a person with a vitamin D deficiency taking vitamin B12 supplements and wondering why they’re not getting better.

    2) Probiotics are often wasted if not taken mindfully of their recipient environment. For example, most gut bacteria only live for about 20 minutes in the gut. They’re usually inactive in the supplement form, they’re activated in the presence of heat and moisture and appropriate pH etc, and then the clock is ticking for them to thrive or die.

    This means that if you take a supplement offering two billion strains of good gut bacteria, and you take it on an empty stomach, then congratulations, 20 minutes later, they’re mostly dead, because they had nothing to eat. Or if you take it after drinking a soda, congratulations, they’re mostly dead because not only were they starved, but also their competing “bad” microbes weren’t starved and changed the environment to make it worse for the “good” ones.

    For this reason, taking probiotics with (or immediately after) plenty of fiber is best.

    This is all accentuated if you’re recovering from using antibiotics, by the way.

    Imagine: a nuclear war devastates the population of the Earth. Some astronauts manage to safely return, finding a mostly-dead world covered in nuclear winter. Is the addition of a few astronauts going to quickly repopulate the world? No, of course not. They are few, the death toll is many, and the environment is very hostile to life. A hundred years later, the population will be pretty much the same—a few straggling survivors.

    It’s the same after taking antibiotics, just, generations pass in minutes instead of decades. You can’t wipe out almost everything beneficial in the gut, create a hostile environment there, throw in a couple of probiotic gummies, and expect the population to bounce back.

    That said, although “probiotics will not save you”, they can help provided you give them a nice soft bed of fiber to land on, some is better than none, and guessing at what strains are needed is better than giving nothing.

    See also: How Much Difference Do Probiotic Supplements Make, Really?

    What she recommends

    So to recap, we’ve had:

    • Wash less, and/or with less harsh chemicals
    • Avoid antibiotics like the plague, unless you literally have The Plague, for which the treatment is indeed antibiotics
    • Avoid antibiotic-contaminated foods, which in the US is pretty much all animal products unless it’s, for example, your own back-yard hens whom you did not give antibiotics. Do not fall for greenwashing aesthetics in the packaging of “happy cows” and their beef, milk, etc, “happy hens” and their meat, eggs, etc… If it doesn’t explicitly claim to be free from the use of antibiotics, then antibiotics were almost certainly used.
      • Dr. Chutkan herself is not even vegan, by the way, but very much wants us to be able to make informed choices about this, and does recommend at least a “plants-forward” diet, for the avoiding-antibiotics reason and for the plenty-of-fiber reason, amongst others.
    • Consider probiotics, but don’t expect them to work miracles by themselves; you’ve got to help them to help you.
      • Dr. Chutkan also recommends getting microbiome tests done if you think something might be amiss, and then you can supplement with probiotics in a more targetted fashion instead of guessing at what species is needed where.

    She also recommends, of course, a good gut-healthy diet in general, especially “leafy green things that were recently alive; not powders”, beans, and nuts, while avoiding gut-unhealthy things such as sugars-without-fiber, alcohol, or some gut-harmful additives (such as most artificial sweeteners, although stevia is a gut-healthy exception, and sucralose is ok in moderation).

    For more on gut-healthy eating, check out:

    Make Friends With Your Gut (You Can Thank Us Later)

    Want to know more from Dr. Chutkan?

    We recently reviewed an excellent book of hers:

    The Anti-Viral Gut: Tackling Pathogens From The Inside Out – by Dr. Robynne Chutkan

    Enjoy!

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  • Elderberries vs Gooseberries – Which is Healthier?

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    Our Verdict

    When comparing elderberries to gooseberries, we picked the elderberries.

    Why?

    These are both berries more likely found in your garden or local wood than in the supermarket, but if you have convenient access to them, they’re great options for eating!

    In terms of macros, elderberry has nearly 2x the carbs and/but also nearly 2x the fiber, which in glycemic index terms, mostly cancels out (although: elderberry has the slightly lower glycemic index of the two)

    In the category of vitamins, both are great but elderberries are winning with more of vitamins A, B1, B2, B3, B6, and C, while gooseberries have more vitamin B5.

    When it comes to minerals, elderberries again lead with more calcium, iron, phosphorus, and potassium, while gooseberries have more magnesium.

    There is an extra category today, which is “extra medicinal properties”, and elderberries have extra immune-boosting qualities, whereas gooseberries—while being as polyphenol-laden as one usually expects berries to be—do not confer the same kind of benefit in this regard.

    You can check out the information about elderberry’s extra properties in the links section below; meanwhile, if you’re choosing between these berries, that’s the clear winner in every category today!

    Want to learn more?

    You might like to read:

    Take care!

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  • 5 Ways To Beat Afternoon Energy Slumps

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    This is Nisha Vora, of Rainbow Plant Life fame. After graduating from Harvard Law School, she realized she hated being a lawyer, and pivoted completely to become what she now is 12 years later, a chef and health coach.

    Here are her tips for boosting energy through the day:

    Caffeine timing

    If you don’t do caffeine at all, no need to change that, but if you do, Vora advises that midday is the best time for it, with a very good rationale:

    • of course it should not be too late in the day, because the elimination half-life of caffeine (4–8 hours to eliminate just half of the caffeine, depending on genes, call it 6 hours as an average though honestly for most people it will either be 4 or 8, not 6) is such that it can easily interfere with sleep for most people
    • because caffeine is an adenosine blocker, not an adenosine inhibitor, taking caffeine in the morning means either there’s no adenosine to block, or it’ll just “save” that adenosine for later, i.e. when the caffeine is eliminated, then the adenosine will kick in, meaning that your morning sleepiness has now been deferred to the afternoon, rather than eliminated.

    Another reminder that caffeine is the “payday loan” of energy. So, midday it is. No morning sleepiness to defer, and yet also not so late as to interfere with sleep.

    See also: Calculate (And Enjoy) The Perfect Night’s Sleep

    Simplify what can be simplified

    This one’s not from a physiological basis, but rather, that a lot of the time most of us have much of our energy being taken by constant task-switching (what gets called multitasking, but as our brain is a single processor, it really means switching rapidly between different kinds of cognition, which is not efficient). In order to avoid that energy drain, try to streamline things and make a particular effort to not only single-task, but to do so without distractions.

    Counterpoint: if you have unmedicated ADHD, then chances are you’ll do better with a single small distraction chosen by you, than trying to go without distractions, because your brain will find distractions anyway, so you might as well choose one (for many people it is background music, or a podcast or TV show that one doesn’t may attention to but it’s there) as a matter of harm reduction, and that way you’ll do better at focusing on your primary task than if your brain were reaching out for every and any possible distraction.

    Manage your blood sugars

    In particular, she advocates for avoiding sugary breakfasts, opting instead for protein, fat, and fiber-rich options. For more in this regard, see:

    10 Ways To Balance Your Blood Sugars

    Walk after meals

    You don’t have to don hiking boots and “I am just going outside and may be some time“; rather, even a 2–5 minute walk after a meal helps regulate digestion and glucose levels, avoiding postprandial energy slumps.

    So,

    • if you have a treadmill, after eating is a great time to use it for a few minutes
    • if you have stairs, now’s a great time to go up and down them a few times

    One last technique for when everything else fails

    We’ll quote her directly on this one:

    ❝Despite my best efforts, soemtimes I just have one of those days. Maybe I didn’t sleep well or I’m distracted by my never ending thoughts. If I need to be productive or energized on those days, I will do something that I absolutely hate:

    I will take a cold shower.

    And I hate it because I’m already always cold all the time, so why would I want to get a cold shower?

    Well, it’s because cold water immersion has been shown to dramatically boost your dopamine levels, which gives you more energy and motivation.

    In the moment though, it’s mostly painful and I hate everything and everyone around me.

    But I know that if I can suffer through two minutes of a cold shower, I will feel so refreshed.❞

    There are more benefits than just that, though, see:

    A Cold Shower A Day Keeps The Doctor Away?

    Want more from Nisha Vora?

    We reviewed one of her books a while back:

    The Vegan Instant Pot Cookbook – by Nisha Vora

    Enjoy!

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  • Sesame Oil vs Almond Oil – Which is Healthier?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Our Verdict

    When comparing sesame oil to almond oil, we picked the almond.

    Why?

    We were curious about this one! Were you, or were you confident? You see, almonds tend to blow away all the other nuts with their nutritional density, but they’re far from the oiliest of nuts, and their greatest strengths include their big dose of protein and fiber (which don’t make it into the oil), vitamins (most of which don’t make it into the oil) and minerals (which don’t make it into the oil). So, a lot will come down to the fat profile!

    On which note, looking at the macros first, it’s 100% fat in both cases, but sesame oil has more saturated fat and polyunsaturated fat, while almond oil has more monounsaturated fat. Since the mono- and poly-unsaturated fats are both healthy and each oil has more of one or the other, the deciding factor here is which has the least saturated fat—and that’s the almond oil, which has close to half the saturated fat of sesame oil. As an aside, neither of them are a source of omega-3 fatty acids.

    In terms of vitamins, there’s not a lot to say here, but “not a lot” is not nothing: sesame oil has nearly 2x the vitamin K, while almond oil has 28x the vitamin E*, and 2x the choline. So, another win for almond oil.

    *which is worth noting, not least of all because seeds are more widely associated with vitamin E in popular culture, but it’s the almond oil that provide much more here. Not to get too distracted into looking at the values of the actual seeds and nuts, almonds themselves do have over 102x the vitamin E compared to sesame seeds.

    Now, back to the oils:

    In the category of minerals, there actually is nothing to say here, except you can’t get more than the barest trace of any mineral from either of these two oils. So it’s a tie on this one.

    Adding up the categories makes for a clear win for almond oil!

    Want to learn more?

    You might like to read:

    Avocado Oil vs Olive Oil – Which is Healthier?

    Take care!

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  • The Disordered Mind – by Dr. Eric Kandel

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    We don’t generally include author bios in these reviews, but it’s worth mentioning that Dr. Kandel won the Nobel Prize in Physiology/Medicine, for studies related to the topics in this book.

    The premise in this book is as per the subtitle: what unusual brains tell us about ourselves. He assumes that the reader has a “usual” brain, but if you don’t, then all is not lost, and in fact he probably talks about your brain in the book too.

    Examining the brains of people with conditions ranging from autism to Alzheimer’s, schizophrenia to Parkinson’s, or even such common things as depression and anxiety and addiction, tells us a lot about what in our brain (anatomically and physiologically) is responsible for what, and how those things can be thrown out of balance.

    By inference, that also tells us how to keep things from being thrown out of balance. Even if the genetic deck is stacked against you, there are still things that can be done to avoid actual disease. After all, famously, “genes load the gun, but lifestyle pulls the trigger”.

    Dr. Kandel writes in a clear and lucid fashion, such that even the lay reader can quite comfortably learn about such things as prion-folding and inhibitory neurons and repressed transcription factors and more.

    Bottom line: if you’d like to understand more about what goes wrong and how and why and what it means for your so-far-so-good healthy brain, this is the book for that.

    Click here to check out The Disordered Mind, and understand more!

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  • LGBTQ+ People Relive Old Traumas as They Age on Their Own

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    Bill Hall, 71, has been fighting for his life for 38 years. These days, he’s feeling worn out.

    Hall contracted HIV, the virus that can cause AIDS, in 1986. Since then, he’s battled depression, heart disease, diabetes, non-Hodgkin lymphoma, kidney cancer, and prostate cancer. This past year, Hall has been hospitalized five times with dangerous infections and life-threatening internal bleeding.

    But that’s only part of what Hall, a gay man, has dealt with. Hall was born into the Tlingit tribe in a small fishing village in Alaska. He was separated from his family at age 9 and sent to a government boarding school. There, he told me, he endured years of bullying and sexual abuse that “killed my spirit.”

    Because of the trauma, Hall said, he’s never been able to form an intimate relationship. He contracted HIV from anonymous sex at bath houses he used to visit. He lives alone in Seattle and has been on his own throughout his adult life.

    “It’s really difficult to maintain a positive attitude when you’re going through so much,” said Hall, who works with Native American community organizations. “You become mentally exhausted.”

    It’s a sentiment shared by many older LGBTQ+ adults — most of whom, like Hall, are trying to manage on their own.

    Of the 3 million Americans over age 50 who identify as gay, bisexual, or transgender, about twice as many are single and living alone when compared with their heterosexual counterparts, according to the National Resource Center on LGBTQ+ Aging.

    This slice of the older population is expanding rapidly. By 2030, the number of LGBTQ+ seniors is expected to double. Many won’t have partners and most won’t have children or grandchildren to help care for them, AARP research indicates.

    They face a daunting array of problems, including higher-than-usual rates of anxiety and depression, chronic stress, disability, and chronic illnesses such as heart disease, according to numerous research studies. High rates of smoking, alcohol use, and drug use — all ways people try to cope with stress — contribute to poor health.

    Keep in mind, this generation grew up at a time when every state outlawed same-sex relations and when the American Psychiatric Association identified homosexuality as a psychiatric disorder. Many were rejected by their families and their churches when they came out. Then, they endured the horrifying impact of the AIDS crisis.

    “Dozens of people were dying every day,” Hall said. “Your life becomes going to support groups, going to visit friends in the hospital, going to funerals.”

    It’s no wonder that LGBTQ+ seniors often withdraw socially and experience isolation more commonly than other older adults. “There was too much grief, too much anger, too much trauma — too many people were dying,” said Vincent Crisostomo, director of aging services for the San Francisco AIDS Foundation. “It was just too much to bear.”

    In an AARP survey of 2,200 LGBTQ+ adults 45 or older this year, 48% said they felt isolated from others and 45% reported lacking companionship. Almost 80% reported being concerned about having adequate social support as they grow older.

    Embracing aging isn’t easy for anyone, but it can be especially difficult for LGBTQ+ seniors who are long-term HIV survivors like Hall.

    Related Links

    Of 1.2 million people living with HIV in the United States, about half are over age 50. By 2030, that’s estimated to rise to 70%.

    Christopher Christensen, 72, of Palm Springs, California, has been HIV-positive since May 1981 and is deeply involved with local organizations serving HIV survivors. “A lot of people living with HIV never thought they’d grow old — or planned for it — because they thought they would die quickly,” Christensen said.

    Jeff Berry is executive director of the Reunion Project, an alliance of long-term HIV survivors. “Here people are who survived the AIDS epidemic, and all these years later their health issues are getting worse and they’re losing their peers again,” Berry said. “And it’s triggering this post-traumatic stress that’s been underlying for many, many years. Yes, it’s part of getting older. But it’s very, very hard.”

    Being on their own, without people who understand how the past is informing current challenges, can magnify those difficulties.

    “Not having access to supports and services that are both LGBTQ-friendly and age-friendly is a real hardship for many,” said Christina DaCosta, chief experience officer at SAGE, the nation’s largest and oldest organization for older LGBTQ+ adults.

    Diedra Nottingham, a 74-year-old gay woman, lives alone in a one-bedroom apartment in Stonewall House, an LGBTQ+-friendly elder housing complex in New York City. “I just don’t trust people,“ she said. “And I don’t want to get hurt, either, by the way people attack gay people.”

    When I first spoke to Nottingham in 2022, she described a post-traumatic-stress-type reaction to so many people dying of covid-19 and the fear of becoming infected. This was a common reaction among older people who are gay, bisexual, or transgender and who bear psychological scars from the AIDS epidemic.

    Nottingham was kicked out of her house by her mother at age 14 and spent the next four years on the streets. The only sibling she talks with regularly lives across the country in Seattle. Four partners whom she’d remained close with died in short order in 1999 and 2000, and her last partner passed away in 2003.

    When I talked to her in September, Nottingham said she was benefiting from weekly therapy sessions and time spent with a volunteer “friendly visitor” arranged by SAGE. Yet she acknowledged: “I don’t like being by myself all the time the way I am. I’m lonely.”

    Donald Bell, a 74-year-old gay Black man who is co-chair of the Illinois Commission on LGBTQ Aging, lives alone in a studio apartment in subsidized LGBTQ+-friendly senior housing in Chicago. He spent 30 years caring for two elderly parents who had serious health issues, while he was also a single father, raising two sons he adopted from a niece.

    Bell has very little money, he said, because he left work as a higher-education administrator to care for his parents. “The cost of health care bankrupted us,” he said. (According to SAGE, one-third of older LGBTQ+ adults live at or below 200% of the federal poverty level.) He has hypertension, diabetes, heart disease, and nerve damage in his feet. These days, he walks with a cane.

    To his great regret, Bell told me, he’s never had a long-term relationship. But he has several good friends in his building and in the city.

    “Of course I experience loneliness,” Bell said when we spoke in June. “But the fact that I am a Black man who has lived to 74, that I have not been destroyed, that I have the sanctity of my own life and my own person is a victory and something for which I am grateful.”

    Now he wants to be a model to younger gay men and accept aging rather than feeling stuck in the past. “My past is over,” Bell said, “and I must move on.”

    KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

    Subscribe to KFF Health News’ free Morning Briefing.

    This article first appeared on KFF Health News and is republished here under a Creative Commons license.

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