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

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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!

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  • The Lifestyle Factors That Matter >8 Times More Than Genes
    Lifestyle trumps genes! A massive study reveals that environmental factors have an 8.5x greater impact on mortality than genetic predisposition. Time to prioritize healthy habits!

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  • Is alcohol good or bad for you? Yes.

    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 article originally appeared in Harvard Public Health magazine.

    It’s hard to escape the message these days that every sip of wine, every swig of beer is bad for your health. The truth, however, is far more nuanced.

    We have been researching the health effects of alcohol for a combined 60 years. Our work, and that of others, has shown that even modest alcohol consumption likely raises the risk for certain diseases, such as breast and esophageal cancer. And heavy drinking is unequivocally harmful to health. But after countless studies, the data do not justify sweeping statements about the effects of moderate alcohol consumption on human health.

    Yet we continue to see reductive narratives, in the media and even in science journals, that alcohol in any amount is dangerous. Earlier this month, for instance, the media reported on a new study that found even small amounts of alcohol might be harmful. But the stories failed to give enough context or probe deeply enough to understand the study’s limitations—including that it cherry-picked subgroups of a larger study previously used by researchers, including one of us, who concluded that limited drinking in a recommended pattern correlated with lower mortality risk.

    “We need more high-quality evidence to assess the health impacts of moderate alcohol consumption. And we need the media to treat the subject with the nuance it requires. Newer studies are not necessarily better than older research.”

    Those who try to correct this simplistic view are disparaged as pawns of the industry, even when no financial conflicts of interest exist. Meanwhile, some authors of studies suggesting alcohol is unhealthy have received money from anti-alcohol organizations.

    We believe it’s worth trying, again, to set the record straight. We need more high-quality evidence to assess the health impacts of moderate alcohol consumption. And we need the media to treat the subject with the nuance it requires. Newer studies are not necessarily better than older research.

    It’s important to keep in mind that alcohol affects many body systems—not just the liver and the brain, as many people imagine. That means how alcohol affects health is not a single question but the sum of many individual questions: How does it affect the heart? The immune system? The gut? The bones?

    As an example, a highly cited study of one million women in the United Kingdom found that moderate alcohol consumption—calculated as no more than one drink a day for a woman—increased overall cancer rates. That was an important finding. But the increase was driven nearly entirely by breast cancer. The same study showed that greater alcohol consumption was associated with lower rates of thyroid cancer, non-Hodgkin lymphoma, and renal cell carcinoma. That doesn’t mean drinking a lot of alcohol is good for you—but it does suggest that the science around alcohol and health is complex.

    One major challenge in this field is the lack of large, long-term, high-quality studies. Moderate alcohol consumption has been studied in dozens of randomized controlled trials, but those trials have never tracked more than about 200 people for more than two years. Longer and larger experimental trials have been used to test full diets, like the Mediterranean diet, and are routinely conducted to test new pharmaceuticals (or new uses for existing medications), but they’ve never been done to analyze alcohol consumption. 

    Instead, much alcohol research is observational, meaning it follows large groups of drinkers and abstainers over time. But observational studies cannot prove cause-and-effect because moderate drinkers differ in many ways from non-drinkers and heavy drinkers—in diet, exercise, and smoking habits, for instance. Observational studies can still yield useful information, but they also require researchers to gather data about when and how the alcohol is consumed, since alcohol’s effect on health depends heavily on drinking patterns.  

    For example, in an analysis of over 300,000 drinkers in the U.K., one of us found that the same total amount of alcohol appeared to increase the chances of dying prematurely if consumed on fewer occasions during the week and outside of meals, but to decrease mortality if spaced out across the week and consumed with meals. Such nuance is rarely captured in broader conversations about alcohol research—or even in observational studies, as researchers don’t always ask about drinking patterns, focusing instead on total consumption. To get a clearer picture of the health effects of alcohol, researchers and journalists must be far more attuned to the nuances of this highly complex issue. 

    One way to improve our collective understanding of the issue is to look at both observational and experimental data together whenever possible. When the data from both types of studies point in the same direction, we can have more confidence in the conclusion. For example, randomized controlled trials show that alcohol consumption raises levels of sex steroid hormones in the blood. Observational trials suggest that alcohol consumption also raises the risk of specific subtypes of breast cancer that respond to these hormones. Together, that evidence is highly persuasive that alcohol increases the chances of breast cancer.    

    Similarly, in randomized trials, alcohol consumption lowers average blood sugar levels. In observational trials, it also appears to lower the risk of diabetes. Again, that evidence is persuasive in combination. 

    As these examples illustrate, drinking alcohol may raise the risk of some conditions but not others. What does that mean for individuals? Patients should work with their clinicians to understand their personal risks and make informed decisions about drinking. 

    Medicine and public health would benefit greatly if better data were available to offer more conclusive guidance about alcohol. But that would require a major investment. Large, long-term, gold-standard studies are expensive. To date, federal agencies like the National Institutes of Health have shown no interest in exclusively funding these studies on alcohol.

    Alcohol manufacturers have previously expressed some willingness to finance the studies—similar to the way pharmaceutical companies finance most drug testing—but that has often led to criticism. This happened to us, even though external experts found our proposal scientifically sound. In 2018, the National Institutes of Health ended our trial to study the health effects of alcohol. The NIH found that officials at one of its institutes had solicited funding from alcohol manufacturers, violating federal policy.

    It’s tempting to assume that because heavy alcohol consumption is very bad, lesser amounts must be at least a little bad. But the science isn’t there, in part because critics of the alcohol industry have deliberately engineered a state of ignorance. They have preemptively discredited any research, even indirectly, by the alcohol industry—even though medicine relies on industry financing to support the large, gold-standard studies that provide conclusive data about drugs and devices that hundreds of millions of Americans take or use daily.

    Scientific evidence about drinking alcohol goes back nearly 100 years—and includes plenty of variability in alcohol’s health effects. In the 1980s and 1990s, for instance, alcohol in moderation, and especially red wine, was touted as healthful. Now the pendulum has swung so far in the opposite direction that contemporary narratives suggest every ounce of alcohol is dangerous. Until gold-standard experiments are performed, we won’t truly know. In the meantime, we must acknowledge the complexity of existing evidence—and take care not to reduce it to a single, misleading conclusion.

    This article first appeared on The Journalist’s Resource and is republished here under a Creative Commons license.

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  • Tourette’s Syndrome Treatment Options

    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

    ❝Is there anything special that might help someone with Tourette’s syndrome?❞

    There are of course a lot of different manifestations of Tourette’s syndrome, and some people’s tics may be far more problematic to themselves and/or others, while some may be quite mild and just something to work around.

    It’s an interesting topic for sure, so we’ll perhaps do a main feature (probably also covering the related-and-sometimes-overlapping OCD umbrella rather than making it hyperspecific to Tourette’s), but meanwhile, you might consider some of these options:

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  • Biohack Your Brain – by Dr. Kristen Willeumier

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    The title of this book is a little misleading, as it’s not really about biohacking; it’s more like a care and maintenance manual for the brain.

    This distinction is relevant, because to hack a thing is to use it in a way it’s not supposed to be used, and/or get it to do something it’s not supposed to do.

    Intead, what neurobiologist Dr. Kristen Willeumier offers us is much more important: how to keep our brain in good condition.

    She takes us through the various things that our brain needs, and what will happen if it doesn’t get them. Some are dietary, some are behavioral, some are even cognitive.

    A strength of this book is not just explaining what things are good for the brain, but also: why. Understanding the “why” can be the motivational factor that makes a difference between us doing the thing or not!

    For example, if we know that exercise is good for the brain, we think “sounds reasonable” and carry on with what we were doing. If, however, we also understand how increased bloodflow helps with the timely removal of beta-amyloids that are associated with Alzheimer’s, we’re more likely to make time for getting that movement going.

    Bottom line: there are key things we can do to keep our brain healthy, and you probably wouldn’t want to miss any. This book is a great care manual for such!

    Click here to check out Biohack Your Brain and keep your brain young and fit!

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Related Posts

  • Why Adult ADHD Often Leads To Anxiety & Depression
  • Forget Ringing the Button for the Nurse. Patients Now Stay Connected by Wearing One.

    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.

    HOUSTON — Patients admitted to Houston Methodist Hospital get a monitoring device about the size of a half-dollar affixed to their chest — and an unwitting role in the expanding use of artificial intelligence in health care.

    The slender, battery-powered gadget, called a BioButton, records vital signs including heart and breathing rates, then wirelessly sends the readings to nurses sitting in a 24-hour control room elsewhere in the hospital or in their homes. The device’s software uses AI to analyze the voluminous data and detect signs a patient’s condition is deteriorating.

    Hospital officials say the BioButton has improved care and reduced the workload of bedside nurses since its rollout last year.

    “Because we catch things earlier, patients are doing better, as we don’t have to wait for the bedside team to notice if something is going wrong,” said Sarah Pletcher, system vice president at Houston Methodist.

    But some nurses fear the technology could wind up replacing them rather than supporting them — and harming patients. Houston Methodist, one of dozens of U.S. hospitals to employ the device, is the first to use the BioButton to monitor all patients except those in intensive care, Pletcher said.

    “The hype around a lot of these devices is they provide care at scale for less labor costs,” said Michelle Mahon, a registered nurse and an assistant director of National Nurses United, the profession’s largest U.S. union. “This is a trend that we find disturbing,” she said.

    The rollout of BioButton is among the latest examples of hospitals deploying technology to improve efficiency and address a decades-old nursing shortage. But that transition has raised its own concerns, including about the device’s use of AI; polls show the public is wary of health providers relying on it for patient care.

    In December 2022 the FDA cleared the BioButton for use in adult patients who are not in critical care. It is one of many AI tools now used by hospitals for tasks like reading diagnostic imaging results.

    In 2023, President Joe Biden directed the Department of Health and Human Services to develop a plan to regulate AI in hospitals, including by collecting reports of patients harmed by its use.

    The leader of BioIntelliSense, which developed the BioButton, said its device is a huge advance compared with nurses walking into a room every few hours to measure vital signs. “With AI, you now move from ‘I wonder why this patient crashed’ to ‘I can see this crash coming before it happens and intervene appropriately,’” said James Mault, CEO of the Golden, Colorado-based company.

    The BioButton stays on the skin with an adhesive, is waterproof, and has up to a 30-day battery life. The company says the device — which allows providers to quickly notice deteriorating health by recording more than 1,000 measurements a day per patient — has been used on more than 80,000 hospital patients nationwide in the past year.

    Hospitals pay BioIntelliSense an annual subscription fee for the devices and software.

    Houston Methodist officials would not reveal how much the hospital pays for the technology, though Pletcher said it equates to less than a cup of coffee a day per patient.

    For a hospital system that treats thousands of patients at a time — Houston Methodist has 2,653 non-ICU beds at its eight Houston-area hospitals — such an investment could still translate to millions of dollars a year.

    Hospital officials say they have not made any changes in nurse staffing and have no plans to because of implementing the BioButton.

    Inside the hospital’s control center for virtual monitoring on a recent morning, about 15 nurses and technicians dressed in scrubs sat in front of large monitors showing the health status of hundreds of patients they were assigned to monitor.

    A red checkmark next to a patient’s name signaled the AI software had found readings trending outside normal. Staff members could click into a patient’s medical record, showing patients’ vital signs over time and other medical history. These virtual nurses, if you will, could contact nurses on the floor by phone or email, or even dial directly into the patient’s room via video call.

    Nutanben Gandhi, a technician who was watching 446 patients on her monitor that morning, said that when she gets an alert, she looks at the patient’s health record to see if the anomaly can be easily explained by something in the patient’s condition or if she needs to contact nurses on the patient’s floor.

    Oftentimes an alert can be easily dismissed. But identifying signs of deteriorating health can be tough, said Steve Klahn, Houston Methodist’s clinical director of virtual medicine.

    “We are looking for a needle in a haystack,” he said.

    Donald Eustes, 65, was admitted to Houston Methodist in March for prostate cancer treatment and has since been treated for a stroke. He is happy to wear the BioButton.

    “You never know what can happen here, and having an extra set of eyes looking at you is a good thing,” he said from his hospital bed. After being told the device uses AI, the Montgomery, Texas, man said he has no problem with its helping his clinical team. “This sounds like a good use of artificial intelligence.”

    Patients and nurses alike benefit from remote monitoring like the BioButton, said Pletcher of Houston Methodist.

    The hospital has placed small cameras and microphones inside all patient rooms enabling nurses outside to communicate with patients and perform tasks such as helping with patient admissions and discharge instructions. Patients can include family members on the remote calls with nurses or a doctor, she said.

    Virtual technology frees up on-duty nurses to provide more hands-on help, such as starting an intravenous line, Pletcher said. With the BioButton, nurses can wait to take routine vital signs every eight hours instead of every four, she said.

    Pletcher said the device reduces nurses’ stress in monitoring patients and allows some to work more flexible hours because virtual care can be done from home rather than coming to the hospital. Ultimately it helps retain nurses, not drive them away, she said.

    Sheeba Roy, a nurse manager at Houston Methodist, said some members of the nursing staff were nervous about relying on the device and not checking patients’ vital signs as often themselves. But testing has shown the device provides accurate information.

    “After we implemented it, the staff loves it,” Roy said.

    Serena Bumpus, chief executive officer of the Texas Nurses Association, said her concern with any technology is that it can be more burdensome on nurses and take away time with patients.

    “We have to be hypervigilant in ensuring that we are not leaning on this to replace the ability of nurses to critically think and assess patients and validate what this device is telling us is true,” Bumpus said.

    Houston Methodist this year plans to send the BioButton home with patients so the hospital can better track their progress in the weeks after discharge, measuring the quality of their sleep and checking their gait.

    “We are not going to need less nurses in health care, but we have limited resources and we have to use those as thoughtfully as we can,” Pletcher said. “Looking at projected demand and seeing the supply we have coming, we will not have enough to meet demand, so anything we can do to give time back to nurses is a good thing.”

    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.

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  • The Secret To Better Squats: Foot, Knee, & Ankle Mobility

    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.

    We’ve talked before about how Slav squats, Asian squats, deep squats, sitting squats, or various other things they might by called (these are all different names for the same thing), are one of the most anti-aging exercises, if not outright the most anti-aging exercise. Yet, how to get good at them?

    “Just squat more” is fine advice and will get you there eventually, but there are ways to shorten the time it takes, by unlocking whatever part(s) might be holding you back:

    Piece by piece

    The key to improving the whole is to not neglect any of the parts—so here they are:

    1. Foot rolls: roll your foot onto its outer and inner edges to stretch; repeat for both legs.
    2. Toe lifts: lift your toes up and down while keeping your legs straight.
    3. Toe curls: curl your toes to engage foot muscles.
    4. Foot circles: rotate your feet in circles; repeat for both legs.
    5. Heel raises: stand tall, raise your heels off the ground, and engage your core.
    6. Tibialis anterior exercise: lean against a wall or similar, and lift your toes off ground to strengthen your tibialis anterior (important and oft-forgotten muscle, responsible for more than people think!)
    7. Heel drops: perform dynamic heel drops with your feet back, to stretch your ankles.
    8. Hamstring curls & leg extension: curl your leg back toward your glutes, and then extend it forwards; alternate legs.
    9. Dynamic calf stretch: bend and straighten your knees alternately in a forward lunge position.
    10. Squat to heel raise: perform squats with your heels lifting off the floor and your arms raised.
    11. Banded ankle dorsiflexion: use a yoga strap or towel to stretch your feet, calves, and hamstrings.
    12. Seated feet circles: extend your legs and rotate your feet in outward and inward circles.
    13. Dorsiflexion/plantar flexion: alternate one foot up and the other down dynamically.
    14. Seated knee flexion & extension: alternate lifting your knees and extending your legs, while seated.

    Note: “seated” in all cases means on the floor, not a chair!

    For more on all of these plus visual demonstrations, enjoy:

    Click Here If The Embedded Video Doesn’t Load Automatically!

    Want to learn more?

    You might also like to read:

    What Nobody Teaches You About Strengthening Your Knees ← about that tibialis anterior muscle and what it means for your knees

    Take care!

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  • Native Americans Have Shorter Life Spans. Better Health Care Isn’t the Only Answer.

    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.

    HISLE, S.D. — Katherine Goodlow is only 20, but she has experienced enough to know that people around her are dying too young.

    Goodlow, a member of the Lower Brule Sioux Tribe, said she’s lost six friends and acquaintances to suicide, two to car crashes, and one to appendicitis. Four of her relatives died in their 30s or 40s, from causes such as liver failure and covid-19, she said. And she recently lost a 1-year-old nephew.

    “Most Native American kids and young people lose their friends at a young age,” said Goodlow, who is considering becoming a mental health therapist to help her community. “So, I’d say we’re basically used to it, but it hurts worse every time we lose someone.”

    Native Americans tend to die much earlier than white Americans. Their median age at death was 14 years younger, according to an analysis of 2018-21 data from the Centers for Disease Control and Prevention

    The disparity is even greater in Goodlow’s home state. Indigenous South Dakotans who died between 2017 and 2021 had a median age of 58 — 22 years younger than white South Dakotans, according to state data.

    Donald Warne, a physician who is co-director of the Johns Hopkins Center for Indigenous Health and a member of the Oglala Sioux Tribe, can rattle off the most common medical conditions and accidents killing Native Americans.

    But what’s ultimately behind this low life expectancy, agree Warne and many other experts on Indigenous health, are social and economic forces. They argue that in addition to bolstering medical care and fully funding the Indian Health Service — which provides health care to Native Americans — there needs to be a greater investment in case management, parenting classes, and home visits.

    “It’s almost blasphemy for a physician to say,” but “the answer to addressing these things is not hiring more doctors and nurses,” Warne said. “The answer is having more community-based preventions.”

    The Indian Health Service funds several kinds of these programs, including community health worker initiatives, and efforts to increase access to fresh produce and traditional foods.

    Private insurers and state Medicaid programs, including South Dakota’s, are increasingly covering such services. But insurers don’t pay for all the services and aren’t reaching everyone who qualifies, according to Warne and the National Academy for State Health Policy.

    Warne pointed to Family Spirit, a program developed by the Johns Hopkins center to improve health outcomes for Indigenous mothers and children.

    Chelsea Randall, the director of maternal and child health at the Great Plains Tribal Leaders’ Health Board, said community health workers educate Native pregnant women and connect them with resources during home visits.

    “We can be with them throughout their pregnancy and be supportive and be the advocate for them,” said Randall, whose organization runs Family Spirit programs across seven reservations in the Dakotas, and in Rapid City, South Dakota.

    The community health workers help families until children turn 3, teaching parenting skills, family planning, drug abuse prevention, and stress management. They can also integrate the tribe’s culture by, for example, using their language or birthing traditions.

    The health board funds Family Spirit through a grant from the federal Health Resources and Services Administration, Randall said. Community health workers, she said, use some of that money to provide child car seats and to teach parents how to properly install them to counter high rates of fatal crashes.

    Other causes of early Native American deaths include homicide, drug overdoses, and chronic diseases, such as diabetes, Warne said. Native Americans also suffer a disproportionate number of infant and maternal deaths.

    The crisis is evident in the obituaries from the Sioux Funeral Home, which mostly serves Lakota people from the Pine Ridge Reservation and surrounding area. The funeral home’s Facebook page posts obituaries for older adults, but also for many infants, toddlers, teenagers, young adults, and middle-aged residents.

    Misty Merrival, who works at the funeral home, blames poor living conditions. Some community members struggle to find healthy food or afford heat in the winter, she said. They may live in homes with broken windows or that are crowded with extended family members. Some neighborhoods are strewn with trash, including intravenous needles and broken bottles.

    Seeing all these premature deaths has inspired Merrival to keep herself and her teenage daughter healthy by abstaining from drugs and driving safely. They also talk every day about how they’re feeling, as a suicide-prevention strategy.

    “We’ve made a promise to each other that we wouldn’t leave each other like that,” Merrival said.

    Many Native Americans live in small towns or on poor, rural reservations. But rurality alone doesn’t explain the gap in life expectancy. For example, white people in rural Montana live 17 years longer, on average, than Native Americans in the state, according to state data reported by Lee Enterprises newspapers.

    Many Indigenous people also face racism or personal trauma from child or sexual abuse and exposure to drugs or violence, Warne said. Some also deal with generational trauma from government programs and policies that broke up families and tried to suppress Native American culture.

    Even when programs are available, they’re not always accessible.

    Families without strong internet connections can’t easily make video appointments. Some lack cars or gas money to travel to clinics, and public transportation options are limited.

    Randall, the health board official, is pregnant and facing her own transportation struggles.

    It’s a three-hour round trip between her home in the town of Pine Ridge and her prenatal appointments in Rapid City. Randall has had to cancel several appointments when family members couldn’t lend their cars.

    Goodlow, the 20-year-old who has lost several loved ones, lives with seven other people in her mother’s two-bedroom house along a gravel road. Their tiny community on the Pine Ridge Reservation has homes and ranches but no stores.

    Goodlow attended several suicide-prevention presentations in high school. But the programs haven’t stopped the deaths. One friend recently killed herself after enduring the losses of her son, mother, best friend, and a niece and nephew.

    A month later, another friend died from a burst appendix at age 17, Goodlow said. The next day, Goodlow woke up to find one of her grandmother’s parakeets had died. That afternoon, she watched one of her dogs die after having seizures.

    “I thought it was like some sign,” Goodlow said. “I started crying and then I started thinking, ‘Why is this happening to me?’”

    Warne said the overall conditions on some reservations can create despair. But those same reservations, including Pine Ridge, also contain flourishing art scenes and language and cultural revitalization programs. And not all Native American communities are poor.

    Warne said federal, state, and tribal governments need to work together to improve life expectancy. He encourages tribes to negotiate contracts allowing them to manage their own health care facilities with federal dollars because that can open funding streams not available to the Indian Health Service.

    Katrina Fuller is the health director at Siċaŋġu Co, a nonprofit group on the Rosebud Reservation in South Dakota. Fuller, a member of the Rosebud Sioux Tribe, said the organization works toward “wicozani,” or the good way of life, which encompasses the physical, emotional, cultural, and financial health of the community.

    Siċaŋġu Co programs include bison restoration, youth development, a Lakota language immersion school, financial education, and food sovereignty initiatives.

    “Some people out here that are struggling, they have dreams, too. They just need the resources, the training, even the moral support,” Fuller said. “I had one person in our health coaching class tell me they just really needed someone to believe in them, that they could do it.”

    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.

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

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