A Statin-Free Life – by Dr. Aseem Malhotra

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.

Here at 10almonds, we’ve written before about the complexities of statins, and their different levels of risk/benefit for men and women, respectively. It’s a fascinating topic, and merits more than an article of the size we write here!

So, in the spirit of giving pointers of where to find a lot more information, this book is a fine choice.

Dr. Malhotra, a consultant cardiologist and professor of evidence-based medicine, talks genes and lifestyle, drugs and blood. He takes us on a tour of the very many risk factors for heart disease, and how cholesterol levels may be at best an indicator, but less likely a cause, of heart disease, especially for women. Further and even better, he discusses various more reliable indicators and potential causes, too.

Rather than be all doom and gloom, he does offer guidance on how to reduce each of one’s personal risk factors and—which is important—keep on top of the various relevant measures of heart health (including some less commonly tested ones, like the coronary calcium score).

The style is light reading andyet with a lot of reference to hard science, so it’s really the best of both worlds in that regard.

Bottom line: if you’re considering statins, or are on statins and are reconsidering that choice, then this book will (notwithstanding its own bias in its conclusion) help you make a more-informed decision.

Click here to check out A Statin-Free Life, and make the best choice for you!

Don’t Forget…

Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!

Recommended

  • Age Proof – by Dr. Rose Anne Kenny
  • Ageless Athletes – by Dr. Jim Madden
    Elevate your fitness after 50 with “Ageless Athlete,” a pragmatic guide to athletic strength without settling for mediocrity—featuring a tailored “Old Workhorse” protocol.

Learn to Age Gracefully

Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:

  • What happens in my brain when I get a migraine? And what medications can I use to treat it?

    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.

    Migraine is many things, but one thing it’s not is “just a headache”.

    “Migraine” comes from the Greek word “hemicrania”, referring to the common experience of migraine being predominantly one-sided.

    Some people experience an “aura” preceding the headache phase – usually a visual or sensory experience that evolves over five to 60 minutes. Auras can also involve other domains such as language, smell and limb function.

    Migraine is a disease with a huge personal and societal impact. Most people cannot function at their usual level during a migraine, and anticipation of the next attack can affect productivity, relationships and a person’s mental health.

    Francisco Gonzelez/Unsplash

    What’s happening in my brain?

    The biological basis of migraine is complex, and varies according to the phase of the migraine. Put simply:

    The earliest phase is called the prodrome. This is associated with activation of a part of the brain called the hypothalamus which is thought to contribute to many symptoms such as nausea, changes in appetite and blurred vision.

    The hypothalamus is shown here in red. Blamb/Shutterstock

    Next is the aura phase, when a wave of neurochemical changes occur across the surface of the brain (the cortex) at a rate of 3–4 millimetres per minute. This explains how usually a person’s aura progresses over time. People often experience sensory disturbances such as flashes of light or tingling in their face or hands.

    In the headache phase, the trigeminal nerve system is activated. This gives sensation to one side of the face, head and upper neck, leading to release of proteins such as CGRP (calcitonin gene-related peptide). This causes inflammation and dilation of blood vessels, which is the basis for the severe throbbing pain associated with the headache.

    Finally, the postdromal phase occurs after the headache resolves and commonly involves changes in mood and energy.

    What can you do about the acute attack?

    A useful way to conceive of migraine treatment is to compare putting out campfires with bushfires. Medications are much more successful when applied at the earliest opportunity (the campfire). When the attack is fully evolved (into a bushfire), medications have a much more modest effect.

    https://datawrapper.dwcdn.net/Pj1sC

    Aspirin

    For people with mild migraine, non-specific anti-inflammatory medications such as high-dose aspirin, or standard dose non-steroidal medications (NSAIDS) can be very helpful. Their effectiveness is often enhanced with the use of an anti-nausea medication.

    Triptans

    For moderate to severe attacks, the mainstay of treatment is a class of medications called “triptans”. These act by reducing blood vessel dilation and reducing the release of inflammatory chemicals.

    Triptans vary by their route of administration (tablets, wafers, injections, nasal sprays) and by their time to onset and duration of action.

    The choice of a triptan depends on many factors including whether nausea and vomiting is prominent (consider a dissolving wafer or an injection) or patient tolerability (consider choosing one with a slower onset and offset of action).

    As triptans constrict blood vessels, they should be used with caution (or not used) in patients with known heart disease or previous stroke.

    Nurse takes blood pressure
    Triptans should be used cautiously in patients with heart disease. CDC/Unsplash

    Gepants

    Some medications that block or modulate the release of CGRP, which are used for migraine prevention (which we’ll discuss in more detail below), also have evidence of benefit in treating the acute attack. This class of medication is known as the “gepants”.

    Gepants come in the form of injectable proteins (monoclonal antibodies, used for migraine prevention) or as oral medication (for example, rimegepant) for the acute attack when a person has not responded adequately to previous trials of several triptans or is intolerant of them.

    They do not cause blood vessel constriction and can be used in patients with heart disease or previous stroke.

    Ditans

    Another class of medication, the “ditans” (for example, lasmiditan) have been approved overseas for the acute treatment of migraine. Ditans work through changing a form of serotonin receptor involved in the brain chemical changes associated with the acute attack.

    However, neither the gepants nor the ditans are available through the Pharmaceutical Benefits Scheme (PBS) for the acute attack, so users must pay out-of-pocket, at a cost of approximately A$300 for eight wafers.

    What about preventing migraines?

    The first step is to see if lifestyle changes can reduce migraine frequency. This can include improving sleep habits, routine meal schedules, regular exercise, limiting caffeine intake and avoiding triggers such as stress or alcohol.

    Despite these efforts, many people continue to have frequent migraines that can’t be managed by acute therapies alone. The choice of when to start preventive treatment varies for each person and how inclined they are to taking regular medication. Those who suffer disabling symptoms or experience more than a few migraines a month benefit the most from starting preventives.

    Pharmacy assistant serves customer
    Some people will take medicines to prevent migraines. Tbel Abuseridze/Unsplash

    Almost all migraine preventives have existing roles in treating other medical conditions, and the physician would commonly recommend drugs that can also help manage any pre-existing conditions. First-line preventives include:

    • tablets that lower blood pressure (candesartan, metoprolol, propranolol)
    • antidepressants (amitriptyline, venlafaxine)
    • anticonvulsants (sodium valproate, topiramate).

    Some people have none of these other conditions and can safely start medications for migraine prophylaxis alone.

    For all migraine preventives, a key principle is starting at a low dose and increasing gradually. This approach makes them more tolerable and it’s often several weeks or months until an effective dose (usually 2- to 3-times the starting dose) is reached.

    It is rare for noticeable benefits to be seen immediately, but with time these drugs typically reduce migraine frequency by 50% or more.


    https://datawrapper.dwcdn.net/jxajY

    ‘Nothing works for me!’

    In people who didn’t see any effect of (or couldn’t tolerate) first-line preventives, new medications have been available on the PBS since 2020. These medications block the action of CGRP.

    The most common PBS-listed anti-CGRP medications are injectable proteins called monoclonal antibodies (for example, galcanezumab and fremanezumab), and are self-administered by monthly injections.

    These drugs have quickly become a game-changer for those with intractable migraines. The convenience of these injectables contrast with botulinum toxin injections (also effective and PBS-listed for chronic migraine) which must be administered by a trained specialist.

    Up to half of adolescents and one-third of young adults are needle-phobic. If this includes you, tablet-form CGRP antagonists for migraine prevention are hopefully not far away.

    Data over the past five years suggest anti-CGRP medications are safe, effective and at least as well tolerated as traditional preventives.

    Nonetheless, these are used only after a number of cheaper and more readily available first-line treatments (all which have decades of safety data) have failed, and this also a criterion for their use under the PBS.

    Mark Slee, Associate Professor, Clinical Academic Neurologist, Flinders University and Anthony Khoo, Lecturer, Flinders University

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

    Share This Post

  • The Healthiest Bread Recipe You’ll Probably Find

    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.

    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

    ❝[About accidental scalding with water] Is cold water actually the best immediate treatment for a burn? Maybe there is something better, or something I should apply after the cold water.❞

    If this is a case of spilled tea or similar—as in your story, which (apologies) we clipped for brevity—indeed, cold running water is best, and nothing else should be needed. It’s up to you whether you want to invest the time based on the extent of the scalding, but 10 minutes is recommended to minimize tissue damage.

    If it’s a more severe scalding or burning, seek medical attention immediately. If it’s a burn to anywhere other than the airway, cold running water is still best for 10 minutes, but if you have to choose between that and professional medical attention, don’t delay the help.

    If it’s a burn you’ve given 10 minutes of cold running water and it still hurts and/or has blistered, cover it in a sterile, non-adhesive dressing that extends well beyond the visible burn (because the actual damage probably extends further, and you don’t want to find this out the hard way later). If the burn is to the face, do still irrigate but not cover it; wait for help.

    Do not apply any kind of cream, lotion, oil, etc. No matter how tempting, no matter where the burn is.

    All of the above also goes for splashed oil, chemical burns, and electrical burns too (but obviously, make sure to get away from the electricity first).

    Source: this ex-military writer was trained for this sort of thing and, suffice it to say, has dealt with more serious things than spilled tea before now.

    Legal note: notwithstanding the above, we are a health science newsletter, not paramedics. Also, circumstances may differ, and best practices may change. In the case of serious injury, call emergency services first, and follow their instructions over ours.

    Take care!

    Share This Post

  • Strategic Wellness

    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.

    Strategic Wellness: planning ahead for a better life!

    This is Dr. Michael Roizen. With hundreds of peer-reviewed publications and 14 US patents, his work has been focused on the importance of lifestyle factors in healthy living. He’s the Chief Wellness Officer at the world-famous Cleveland Clinic, and is known for his “RealAge” test and related personalized healthcare services.

    If you’re curious about that, you can take the RealAge test here.

    (they will require you inputting your email address if you do, though)

    What’s his thing?

    Dr. Roizen is all about optimizing health through lifestyle factors—most notably, diet and exercise. Of those, he is particularly keen on optimizing nutritional habits.

    Is this just the Mediterranean Diet again?

    Nope! Although: he does also advocate for that. But there’s more, he makes the case for what he calls “circadian eating”, optimally timing what we eat and when.

    Is that just Intermittent Fasting again?

    Nope! Although: he does also advocate for that. But there’s more:

    Dr. Roizen takes a more scientific approach. Which isn’t to say that intermittent fasting is unscientific—on the contrary, there’s mountains of evidence for it being a healthful practice for most people. But while people tend to organize their intermittent fasting purely according to convenience, he notes some additional factors to take into account, including:

    • We are evolved to eat when the sun is up
    • We are evolved to be active before eating (think: hunting and gathering)
    • Our insulin resistance increases as the day goes on

    Now, if you’ve a quick mind about you, you’ll have noticed that this means:

    • We should keep our eating to a particular time window (classic intermittent fasting), and/but that time window should be while the sun is up
    • We should not roll out of bed and immediately breakfast; we need to be active for a bit first (moderate exercise is fine—this writer does her daily grocery-shopping trip on foot before breakfast, for instance… getting out there and hunting and gathering those groceries!)
    • We should not, however, eat too much later in the day (so, dinner should be the smallest meal of the day)

    The latter item is the one that’s perhaps biggest change for most people. His tips for making this as easy as possible include:

    • Over-cater for dinner, but eat only one portion of it, and save the rest for an early-afternoon lunch
    • First, however, enjoy a nutrient-dense protein-centric breakfast with at least some fibrous vegetation, for example:
      • Salmon and asparagus
      • Scrambled tofu and kale
      • Yogurt and blueberries

    Enjoy!

    Share This Post

Related Posts

  • Age Proof – by Dr. Rose Anne Kenny
  • Statins: Study Insights

    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.

    It’s Q&A Day at 10almonds!

    Q: Can you let us know about more studies that have been done on statins? Are they really worth taking?

    That is a great question! We imagine it might have been our recent book recommendation that prompted it? It’s quite a broad question though, so we’ll do that as a main feature in the near future!

    Don’t Forget…

    Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!

    Learn to Age Gracefully

    Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:

  • When Your Brain’s “Get-Up-And-Go” Has Got Up And Gone…

    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.

    Sometimes, there are days when the body feels heavy, the brain feels sluggish, and even the smallest tasks feel Herculean.

    When these days stack up, this is usually a sign of depression, and needs attention. Unfortunately, when one is in such a state, taking action about it is almost impossible.

    Almost, but not quite, as we wrote about previously:

    The Mental Health First-Aid You’ll Hopefully Never Need ← this is about as close to true mental health bootstrapping as actually works

    Today though, we’re going to assume it’s just an off-day or such. So, what to do about it?

    Try turning it off and on again

    Sometimes, a reboot is all that’s needed, and if napping is an option, it’s worth considering. However, if you don’t do it right, you can end up groggy and worse off than before, so do check out:

    How To Be An Expert Nap-Artist (No More “Sleep Hangovers”!)

    If your exhaustion is nevertheless accompanied by stresses that are keeping you from resting, then there’s another “turn it off and on again” process for that:

    The Off-Button For Your Brain

    Fuel in the tank

    Our brain is an energy-intensive organ, and cannot run on empty for long. Thus, lacking energy can sometimes simply be a matter of needing to supply some energy. Simple, no? Except, a lot of energy-giving foods can cause a paradoxical slump in energy, so here’s how to avoid that:

    Eating For Energy (In Ways That Actually Work)

    There are occasions when exhausted, when preparing food seems like too much work. If you’re not in a position to have someone else do it for you, how can you get “most for least” in terms of nutrition for effort?

    Many of the above-linked items can help (a bowl of nuts and/or dried fruit is probably not going to break the energy-bank, for instance), but beyond that, there are other considerations too:

    How To Eat To Beat Chronic Fatigue (While Chronically Fatigued) ← as the title tells, this is about chronic fatigue, but the advice therein definitely goes for acute fatigue also.

    The lights aren’t on

    Sometimes it may be that your body is actually fine, but your brain is working in a clunky fashion at best. Assuming there is no more drastic underlying cause for this, a lack of motivation is often as simple as a lack of appropriate dopamine response. When that’s the case…

    Lacking Motivation? Science Has The Answer

    If, instead, the issue is more serotonin-based than dopamine based, then green places with blue skies are ideal. Depending on geography and season, those things may be in short supply, but the brain is easily tricked with artificial plants and artificial sunlight. Is it as good as a walk in the park on a pleasant summer morning? Probably not, but it’s many times better than nothing, so get those juices flowing:

    Neurotransmitter Cheatsheet ← four for the price of one, here!

    Schedule time for rest, or your body/brain will schedule it for you

    There’s a saying in the field of engineering that “if you don’t schedule time for maintenance, your equipment will schedule it for you”, and the same is true of our body/brain. If you’re struggling to get good quantity, here’s how to at least get good quality:

    How To Rest More Efficiently (Yes, Really)

    And, importantly,

    7 Kinds Of Rest When Sleep Is Not Enough

    Take care!

    Don’t Forget…

    Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!

    Learn to Age Gracefully

    Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:

  • The Biological Mind – by Dr. Alan Jasanoff

    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.

    How special is our brain? According to Dr. Alan Jasanoff, it’s not nearly as special as we think it is.

    In this work, he outlines the case for how we have collectively overstated the brain’s importance. That it’s just another organ like a heart or a kidney, and that who we are is as much a matter of other factors, as what goes on in our brain.

    In this reviewer’s opinion, he overcorrects a bit. The heart and kidneys are very simple organs, as organs go. The brain is not. And while everything from our gut microbiota to our environment to our hormones may indeed contribute to what is us, our brain is one thing that can’t just be swapped out.

    Nevertheless, this very well-written book can teach us a lot about everything else that makes us us, including many biological factors that many people don’t know about or consider.

    Towards the end of the book, he switches into futurist speculation, and his speculation can be summed up as “we cannot achieve anything worthwhile in the future”.

    Bottom line: if you’ve an interest in such things as how transplanting glial cells can give a 30% cognitive enhancement, and how a brain transplant wouldn’t result in the same us in a different body, this is the book for you.

    Click here to check out The Biological Mind, and learn about yours!

    Don’t Forget…

    Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!

    Learn to Age Gracefully

    Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails: