Being Mortal – by Dr. Atul Gawande
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Maybe you want to “live forever or die trying”, and that’s an understandable goal… But are you prepared for “or die trying” being the outcome?
This is not a cheerful book, if you’re anything like this reviewer, you will need a little towel or something to mop up the tears while you read. But it’s worth it.
Dying is one thing; fighting for life is even generally considered a noble endeavor. Suffering alone isn’t fun, losing independence can feel humiliating, and seeing someone who was always a tower of strength, now a frail shadow of their former self, reduced to begging for something that they’re “not allowed”, can be worse.
Do we want that for ourselves? For our loved ones? Can there be a happy medium between that, and the alternative to indeed “go gentle into that good night”?
Dr. Gawande, a surgeon well-acquainted with death and dying, thinks so. But it involves work on our part, and being prepared for hard decisions.
- What is most important to us, and what tradeoffs are we willing to make for it?
- What, even, is actually an option to us with the resources available?
- Can we make peace with a potentially bad lot? And… Should we?
- When is fighting important, and when is it self-destructive?
These (and others) are all difficult questions posed by Dr. Gawande, but critical ones.
We don’t usually quote other people’s reviews when reviewing books here, but let’s consider the following words from the end of a long review on Amazon:
❝If “dying as we lived” is some kind of standard for how we should go, then maybe alone and medicalized makes some sense right now after all.❞
Bottom line: we all deserve better than that. And if we don’t take the time to think about what’s most important, then time will take it from us. This very insightful book may not have all the answers, but it has the questions, and it can help a lot in exploring them and deciding what matters most to us in the end, really.
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Running or yoga can help beat depression, research shows – even if exercise is the last thing you feel like
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At least one in ten people have depression at some point in their lives, with some estimates closer to one in four. It’s one of the worst things for someone’s wellbeing – worse than debt, divorce or diabetes.
One in seven Australians take antidepressants. Psychologists are in high demand. Still, only half of people with depression in high-income countries get treatment.
Our new research shows that exercise should be considered alongside therapy and antidepressants. It can be just as impactful in treating depression as therapy, but it matters what type of exercise you do and how you do it.
Walk, run, lift, or dance away depression
We found 218 randomised trials on exercise for depression, with 14,170 participants. We analysed them using a method called a network meta-analysis. This allowed us to see how different types of exercise compared, instead of lumping all types together.
We found walking, running, strength training, yoga and mixed aerobic exercise were about as effective as cognitive behaviour therapy – one of the gold-standard treatments for depression. The effects of dancing were also powerful. However, this came from analysing just five studies, mostly involving young women. Other exercise types had more evidence to back them.
Walking, running, strength training, yoga and mixed aerobic exercise seemed more effective than antidepressant medication alone, and were about as effective as exercise alongside antidepressants.
But of these exercises, people were most likely to stick with strength training and yoga.
Antidepressants certainly help some people. And of course, anyone getting treatment for depression should talk to their doctor before changing what they are doing.
Still, our evidence shows that if you have depression, you should get a psychologist and an exercise plan, whether or not you’re taking antidepressants.
Join a program and go hard (with support)
Before we analysed the data, we thought people with depression might need to “ease into it” with generic advice, such as “some physical activity is better than doing none.”
But we found it was far better to have a clear program that aimed to push you, at least a little. Programs with clear structure worked better, compared with those that gave people lots of freedom. Exercising by yourself might also make it hard to set the bar at the right level, given low self-esteem is a symptom of depression.
We also found it didn’t matter how much people exercised, in terms of sessions or minutes a week. It also didn’t really matter how long the exercise program lasted. What mattered was the intensity of the exercise: the higher the intensity, the better the results.
Yes, it’s hard to keep motivated
We should exercise caution in interpreting the findings. Unlike drug trials, participants in exercise trials know which “treatment” they’ve been randomised to receive, so this may skew the results.
Many people with depression have physical, psychological or social barriers to participating in formal exercise programs. And getting support to exercise isn’t free.
We also still don’t know the best way to stay motivated to exercise, which can be even harder if you have depression.
Our study tried to find out whether things like setting exercise goals helped, but we couldn’t get a clear result.
Other reviews found it’s important to have a clear action plan (for example, putting exercise in your calendar) and to track your progress (for example, using an app or smartwatch). But predicting which of these interventions work is notoriously difficult.
A 2021 mega-study of more than 60,000 gym-goers found experts struggled to predict which strategies might get people into the gym more often. Even making workouts fun didn’t seem to motivate people. However, listening to audiobooks while exercising helped a lot, which no experts predicted.
Still, we can be confident that people benefit from personalised support and accountability. The support helps overcome the hurdles they’re sure to hit. The accountability keeps people going even when their brains are telling them to avoid it.
So, when starting out, it seems wise to avoid going it alone. Instead:
- join a fitness group or yoga studio
get a trainer or an exercise physiologist
- ask a friend or family member to go for a walk with you.
Taking a few steps towards getting that support makes it more likely you’ll keep exercising.
Let’s make this official
Some countries see exercise as a backup plan for treating depression. For example, the American Psychological Association only conditionally recommends exercise as a “complementary and alternative treatment” when “psychotherapy or pharmacotherapy is either ineffective or unacceptable”.
Based on our research, this recommendation is withholding a potent treatment from many people who need it.
In contrast, The Royal Australian and New Zealand College of Psychiatrists recommends vigorous aerobic activity at least two to three times a week for all people with depression.
Given how common depression is, and the number failing to receive care, other countries should follow suit and recommend exercise alongside front-line treatments for depression.
I would like to acknowledge my colleagues Taren Sanders, Chris Lonsdale and the rest of the coauthors of the paper on which this article is based.
If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.
Michael Noetel, Senior Lecturer in Psychology, The University of Queensland
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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The Surprising Link Between Type 2 Diabetes & Alzheimer’s
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The Surprising Link Between Type 2 Diabetes & Alzheimer’s
This is Dr. Rhonda Patrick. She’s a biomedical scientist with expertise in the areas of aging, cancer, and nutrition. In the past five years she has expanded her research of aging to focus more on Alzheimer’s and Parkinson’s, as she has a genetic predisposition to both.
What does that genetic predisposition look like? People who (like her) have the APOE-ε4 allele have a twofold increased risk of Alzheimer’s disease—and if you have two copies (i.e., one from each of two parents), the risk can be up to tenfold. Globally, 13.7% of people have at least one copy of this allele.
So while getting Alzheimer’s or not is not, per se, hereditary… The predisposition to it can be passed on.
What’s on her mind?
Dr. Patrick has noted that, while we don’t know for sure the causes of Alzheimer’s disease, and can make educated guesses only from correlations, the majority of current science seems to be focusing on just one: amyloid plaques in the brain.
This is a worthy area of research, but ignores the fact that there are many potential Alzheimer’s disease mechanisms to explore, including (to count only mainstream scientific ideas):
- The amyloid hypothesis
- The tau hypothesis
- The inflammatory hypothesis
- The cholinergic hypothesis
- The cholesterol hypothesis
- The Reelin hypothesis
- The large gene instability hypothesis
…as well as other strongly correlated factors such as glucose hypometabolism, insulin signalling, and oxidative stress.
If you lost your keys and were looking for them, and knew at least half a dozen places they might be, how often would you check the same place without paying any attention to the others?
To this end, she notes about those latter-mentioned correlated factors:
❝50–80% of people with Alzheimer’s disease have type 2 diabetes; there is definitely something going on❞
There’s another “smoking gun” for this too, because dysfunction in the blood vessels and capillaries that line the blood-brain barrier seem to be a very early event that is common between all types of dementia (including Alzheimer’s) and between type 2 diabetes and APOE-ε4.
Research is ongoing, and Dr. Patrick is at the forefront of that. However, there’s a practical take-away here meanwhile…
What can we do about it?
Dr. Patrick hypothesizes that if we can reduce the risk of type 2 diabetes, we may reduce the risk of Alzheimer’s with it.
Obviously, avoiding diabetes if possible is a good thing to do anyway, but if we’re aware of an added risk factor for Alzheimer’s, it becomes yet more important.
Of course, all the usual advices apply here, including a Mediterranean diet and regular moderate exercise.
Three other things Dr. Patrick specifically recommends (to reduce both type 2 diabetes risk and to reduce Alzheimer’s risk) include:
(links are to her blog, with lots of relevant science for each)
You can also hear more from Dr. Patrick personally, as a guest on Dr. Peter Attia’s podcast recently. She discusses these topics in much greater detail than we have room for in our newsletter:
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Instant Quiz Results, No Email Needed
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❓ Q&A With 10almonds Subscribers!
Q: I like that the quizzes (I’ve done two so far) give immediate results , with no “give us your email to get your results”. Thanks!
A: You’re welcome! That’s one of the factors that influences what things we include here! Our mission statement is “to make health and productivity crazy simple”, and the unwritten part of that is making sure to save your time and energy wherever we reasonably can!
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Astaxanthin: Super-Antioxidant & Neuroprotectant
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Think Pink For Brain Health!
Astaxanthin is a carotenoid that’s found in:
- certain marine microalgae
- tiny crustaceans that eat the algae
- fish (and flamingos!) that eat the crustaceans
Yes, it’s the one that makes things pink.
But it does a lot more than that…
Super-antioxidant
Move over, green tea! Astaxanthin has higher antioxidant activity than most carotenoids. For example, it is 2–5 times more effective than alpha-carotene, lutein, beta-carotene, and lycopene:
Antioxidant activities of astaxanthin and related carotenoids
We can’t claim credit for naming it a super-antioxidant though, because:
Astaxanthin: A super antioxidant from microalgae and its therapeutic potential
Grow new brain cells
Axtaxanthin is a neuroprotectant, but that’s to be expected from something with such a powerful antioxidant ability.
What’s more special to astaxanthin is that it assists continued adult neurogenesis (creation of new brain cells):
❝The unique chemical structure of astaxanthin enables it to cross the blood-brain barrier and easily reach the brain, where it may positively influence adult neurogenesis.
Furthermore, astaxanthin appears to modulate neuroinflammation by suppressing the NF-κB pathway, reducing the production of pro-inflammatory cytokines, and limiting neuroinflammation associated with aging and chronic microglial activation.
By modulating these pathways, along with its potent antioxidant properties, astaxanthin may contribute to the restoration of a healthy neurogenic microenvironment, thereby preserving the activity of neurogenic niches during both normal and pathological aging. ❞
That first part is very important, by the way! There are so many things that our brain needs, and we can eat, but the molecules are unable to pass the blood-brain barrier, meaning they either get wasted, or used elsewhere, or dismantled for their constituent parts. In this case, it zips straight into the brain instead.
See also:
How To Grow New Brain Cells (At Any Age)
(Probably) good for the joints, too
First, astaxanthin got a glowing report in a study we knew not to trust blindly:
…and breathe. What a title that was! But, did you catch why it’s not to be trusted blindly? It was down at the bottom…
❝Conflict of interest statement
NOVAREX Co., Ltd. funded the study. Valensa International provided the FlexPro MD® ingredients, and NOVAREX Co., Ltd. encapsulated the test products (e.g., both FlexPro MD® and placebo)❞
Studies where a supplement company funded the study are not necessarily corrupt, but they can certainly sway publication bias, i.e. the company funds a bunch of studies and then pulls funding from the ones that aren’t going the way it wants.
So instead let’s look at:
Astaxanthin attenuates joint inflammation induced by monosodium urate crystals
and
Astaxanthin ameliorates cartilage damage in experimental osteoarthritis
…which had no such conflicts of interest.
They agree that astaxanthin indeed does the things (attenuates joint inflammation & ameliorates cartilage damage).
However, they are animal studies (rats), so we’d like to see studies with humans to be able to say for sure how much it helps these things.
Summary of benefits
Based on the available research, astaxanthin…
- is indeed a super-antioxidant
- is a neuroprotective agent
- also assists adult neurogenesis
- is probablygood for joints too
How much do I take, and is it safe?
A 2019 safety review concluded:
❝Recommended or approved doses varied in different countries and ranged between 2 and 24 mg.
We reviewed 87 human studies, none of which found safety concerns with natural astaxanthin supplementation, 35 with doses ≥12 mg/day.❞
Source: Astaxanthin: How much is too much? A safety review
In short: for most people, it’s very safe and well-tolerated. If you consume it to an extreme, you will likely turn pink, much as you would turn orange if you did the same thing with carrots. But aside from that, the risks appear to be minimal.
However! If you have a seafood allergy, please take care to get a supplement that’s made from microalgae, not one that’s made from krill or other crustaceans, or from other creatures that eat those.
Where can I get it?
We don’t sell it, but here’s an example product on Amazon, for your convenience
Enjoy!
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The Magic of L-theanine
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All The Benefits Of Caffeine And More, Without The Drawbacks? What’s The Catch?
It just takes one extra supplement.
For many of us, our morning brew is practically a ritual, but caffeine can also cause all kinds of problems ranging from caffeine jitters to caffeine crashes to caffeine addiction and withdrawal. Surely, something could be better?
Well, yes it could! You doubtlessly know about green tea’s antioxidant properties, but its amino acid, l-theanine (which can be taken as a supplement with coffee, if you don’t enjoy green tea) has so much more to offer:
- L-theanine has been found to reduce stress responses—and let’s face it, when we most want/need a coffee is often when facing stress
- It also reduces anxiety, making it a very safe “downer” without the problems of, for example, alcohol—or other potentially addictive substances
- It’s far more than just that, though! Paradoxically, l-theanine also improves alertness (what other calming things promote alertness? Not so many)
- Part of its trick is that it also improves accuracy—whereas stimulants like caffeine may produce a twitchy, jumpy, responsiveness, l-theanine’s signature effect is a calm state of sharp readiness. Caffeine works by stimulating the adrenal gland and increasing blood pressure, while simultaneously blocking adenosine receptors so that your body doesn’t notice its own tiredness—which is why you’re likely to crash later, when the tiredness that had been masked, all hits at once. Instead, l-theanine taken with caffeine acts as a moderator of that, making for a longer, gentler curve. In terms of subjective experience, what this can mean for many people is: no more caffeine jitters!
- All this means that while l-theanine can boost all kinds of cognitive function, including alertness and accuracy, many like to take in the evening as it can also promote a good night’s sleep, ready to be at your best the next day.
- How much to take? 200mg is a commonly used dosage, which in supplement terms is usually a single capsule. A lot easier to take than the 40 cups of green tea that this dosage would otherwise be!
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Genetic Risk Factors For Long COVID
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Some people, after getting COVID, go on to have Long COVID. There are various contributing factors to this, including:
- Lifestyle factors that impact general disease-proneness
- Immune-specific factors such as being immunocompromised already
- Genetic factors
We looked at some modifiable factors to improve one’s disease-resistance, yesterday:
And we’ve taken a more big-picture look previously:
Beyond Supplements: The Real Immune-Boosters!
Along with some more systemic issues:
Why Some People Get Sick More (And How To Not Be One Of Them)
But, for when the “don’t get COVID” ship has sailed, one of the big remaining deciding factors with regard to whether one gets Long COVID or not, is genetic
The Long COVID Genes
For those with their 23andMe genetic data to hand…
❝Study findings revealed that three specific genetic loci, HLA-DQA1–HLA-DQB1, ABO, and BPTF–KPAN2–C17orf58, and three phenotypes were at significantly heightened risk, highlighting high-priority populations for interventions against this poorly understood disease.❞
For those who don’t, then first: you might consider getting that! Here’s why:
Genetic Testing: Health Benefits & Methods
But also, all is not lost meanwhile:
The same study also found that individuals with genetic predispositions to chronic fatigue, depression, and fibromyalgia, as well as other phenotypes such as autoimmune conditions and cardiometabolic conditions, are at significantly higher risk of long-COVID than individuals without these conditions.
Good news, bad news
Another finding was that women and non-smokers were more likely to get Long COVID, than men and smokers, respectively.
Does that mean that those things are protective against Long COVID, which would be very counterintuitive in the case of smoking?
Well, yes and no; it depends on whether you count “less likely to get Long COVID because of being more likely to just die” as protective against Long COVID.
(Incidentally, estrogen is moderately immune-enhancing, while testosterone is moderately immune-suppressing, so the sex thing was not too surprising. It’s also at least contributory to why women get more autoimmune disorders, while men get more respiratory infections such as colds and the like)
Want to know more?
You can read the paper itself, here:
*GWAS = Genome-Wide Association Study
Take care!
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