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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Cognitive Enhancement Without Drugs
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Cognitive Enhancement Without Drugs
This is Elizabeth Ricker. She’s a Harvard-and-MIT-trained neuroscientist and researcher, who now runs the “Citizen Science” DIY-neurohacking organization, NeuroEducate.
Sounds fun! What’s it about?
The philosophy that spurs on her research and practice can be summed up as follows:
❝I’m not going to leave my brain up to my doctor or [anyone else]… My brain is my own responsibility, and I’m going to do the best that I can to optimize it❞
Her goal is not just to optimize her own brain though; she wants to make the science accessible to everyone.
What’s this about Citizen Science?
“Citizen Science” is the idea that while there’s definitely an important role in society for career academics, science itself should be accessible to all. And, not just the conclusions, but the process too.
This can take the form of huge experiments, often facilitated these days by apps where we opt-in to allow our health metrics (for example) to be collated with many thousands of others, for science. It can also involve such things as we talked about recently, getting our own raw genetic data and “running the numbers” at home to get far more comprehensive and direct information than the genetic testing company would ever provide us.
For Ricker, her focus is on the neuroscience side of biohacking, thus, neurohacking.
I’m ready to hack my brain! Do I need a drill?
Happily not! Although… Bone drills for the skull are very convenient instruments that make it quite hard to go wrong even with minimal training. The drill bit has a little step/ledge partway down, which means you can only drill through the thickness of the skull itself, before the bone meeting the wider part of the bit stops you from accidentally drilling into the brain. Still, please don’t do this at home.
What you can do at home is a different kind of self-experimentation…
If you want to consider which things are genuinely resulting in cognitive enhancement and which things are not, you need to approach the matter like a scientist. That means going about it in an organized fashion, and recording results.
There are several ways cognitive enhancement can be measured, including:
- Learning and memory
- Executive function
- Emotional regulation
- Creative intelligence
Let’s look at each of them, and what can be done. We don’t have a lot of room here; we’re a newsletter not a book, but we’ll cover one of Ricker’s approaches for each:
Learning and memory
This one’s easy. We’re going to leverage neuroplasticity (neurons that fire together, wire together!) by simple practice, and introduce an extra element to go alongside your recall. Perhaps a scent, or a certain item of clothing. Tell yourself that clinical studies have shown that this will boost your recall. It’s true, but that’s not what’s important; what’s important is that you believe it, and bring the placebo effect to bear on your endeavors.
You can test your memory with word lists, generated randomly by AI, such as this one:
You’ll soon find your memory improving—but don’t take our word for it!
Executive function
Executive function is the aspect of your brain that tells the other parts how to work, when to work, and when to stop working. If you’ve ever spent 30 minutes thinking “I need to get up” but you were stuck in scrolling social media, that was executive dysfunction.
This can be trained using the Stroop Color and Word Test, which shows you words, specifically the names of colors, which will themselves be colored, but not necessarily in the color the word pertains to. So for example, you might be shown the word “red”, colored green. Your task is to declare either the color of the word only, ignoring the word itself, or the meaning of the word only, ignoring its appearance. It can be quite challenging, but you’ll get better quite quickly:
The Stroop Test: Online Version
Emotional Regulation
This is the ability to not blow up angrily at the person with whom you need to be diplomatic, or to refrain from laughing when you thought of something funny in a sombre situation.
It’s an important part of cognitive function, and success or failure can have quite far-reaching consequences in life. And, it can be trained too.
There’s no online widget for this one, but: when and if you’re in a position to safely* do so, think about something that normally triggers a strong unwanted emotional reaction. It doesn’t have to be something life-shattering, but just something that you feel in some way bad about. Hold this in your mind, sit with it, and practice mindfulness. The idea is to be able to hold the unpleasant idea in your mind, without becoming reactive to it, or escaping to more pleasant distractions. Build this up.
*if you perchance have PTSD, C-PTSD, or an emotional regulation disorder, you might want to talk this one through with a qualified professional first.
Creative Intelligence
Another important cognitive skill, and again, one that can be cultivated and grown.
The trick here is volume. A good, repeatable test is to think of a common object (e.g. a rock, a towel, a banana) and, within a time constraint (such as 15 minutes) list how many uses you can think of for that item.
Writer’s storytime: once upon a time, I was sorting through an inventory of medical equipment with a colleague, and suggested throwing out our old arterial clamps, as we had newer, better ones—in abundance. My colleague didn’t want to part with them, so I challenged him “Give me one use for these, something we could in some possible world use them for that the new clamps don’t do better, and we’ll keep them”. He said “Thumbscrews”, and I threw my hands up in defeat, saying “Fine!”, as he had technically fulfilled my condition.
What’s the hack to improve this one? Just more volume. Creativity, as it turns out, isn’t something we can expend—like a muscle, it grows the more we use it. And because the above test is repeatable (with different objects), you can track your progress.
And if you feel like using your grown creative muscle to write/paint/compose/etc your magnum opus, great! Or if you just want to apply it to the problem-solving of everyday life, also great!
In summary…
Our brain is a wonderful organ with many functions. Society expects us to lose these as we get older, but the simple, scientific truth is that we can not only maintain our cognitive function, but also enhance and grow it as we go.
Want to know more from today’s featured expert?
You might enjoy her book, “Smarter Tomorrow”, which we reviewed back in March
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Metformin For Weight-Loss & More
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Metformin Without Diabetes?
Metformin is a diabetes drug; it works by:
- decreasing glucose absorption from the gut
- decreasing glucose production in the liver
- increasing glucose sensitivity
It doesn’t change how much insulin is secreted, and is unlikely to cause hypoglycemia, making it relatively safe as diabetes drugs go.
It’s a biguanide drug, and/but so far as science knows (so far), its mechanism of action is unique (i.e. no other drug works the same way that metformin does).
Today we’ll examine its off-label uses and see what the science says!
A note on terms: “off-label” = when a drug is prescribed to treat something other than the main purpose(s) for which the drug was approved.
Other examples include modafinil against depression, and beta-blockers against anxiety.
Why take it if not diabetic?
There are many reasons people take it, including just general health and life extension:
However, its use was originally expanded (still “off-label”, but widely prescribed) past “just for diabetes” when it showed efficacy in treating pre-diabetes. Here for example is a longitudinal study that found metformin use performed similarly to lifestyle interventions (e.g. diet, exercise, etc). In their words:
❝ Lifestyle intervention or metformin significantly reduced diabetes development over 15 years. There were no overall differences in the aggregate microvascular outcome between treatment groups❞
But, it seems it does more, as this more recent review found:
❝Long-term weight loss was also seen in both [metformin and intensive lifestyle intervention] groups, with better maintenance under metformin.
Subgroup analyses from the DPP/DPPOS have shed important light on the actions of metformin, including a greater effect in women with prior gestational diabetes, and a reduction in coronary artery calcium in men that might suggest a cardioprotective effect.
Long-term diabetes prevention with metformin is feasible and is supported in influential guidelines for selected groups of subjects.❞
Source: Metformin for diabetes prevention: update of the evidence base
We were wondering about that cardioprotective effect, so…
Cardioprotective effect
In short, another review (published a few months after the above one) confirmed the previous findings, and also added:
❝Patients with BMI > 35 showed an association between metformin use and lower incidence of CVD, including African Americans older than age 65. The data suggest that morbidly obese patients with prediabetes may benefit from the use of metformin as recommended by the ADA.❞
We wondered about the weight loss implications of this, and…
For weight loss
The short version is, it works:
- Effectiveness of metformin on weight loss in non-diabetic individuals with obesity
- Metformin for weight reduction in non-diabetic patients: a systematic review and meta-analysis
- Metformin induces weight loss associated with gut microbiota alteration in non-diabetic obese women
…and many many more where those came from. As a point of interest, it has also been compared and contrasted to GLP-1 agonists.
Compared/contrasted with GLP-1 agonists
It’s not quite as effective for weight loss, and/but it’s a lot cheaper, is tablets rather than injections, has fewer side effects (for most people), and doesn’t result in dramatic yoyo-ing if there’s an interruption to taking it:
Or if you prefer a reader-friendly pop-science version:
Ozempic vs Metformin: Comparing The Two Diabetes Medications
Is it safe?
For most people yes, but there are a stack of contraindications, so it’s best to speak with your doctor. However, particular things to be aware of include:
- Usually contraindicated if you have kidney problems of any kind
- Usually contraindicated if you have liver problems of any kind
- May be contraindicated if you have issues with B12 levels
See also: Metformin: Is it a drug for all reasons and diseases?
Where can I get it?
As it’s a prescription-controlled drug, we can’t give you a handy Amazon link for this one.
However, many physicians are willing to prescribe it for off-label use (i.e., for reasons other than diabetes), so speak with yours (telehealth options may also be available).
If you do plan to speak with your doctor and you’re not sure they’ll be agreeable, you might want to get this paper and print it to take it with you:
Off-label indications of Metformin – Review of Literature
Take care!
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Radical Remission – by Dr. Kelly Turner
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First, what this is not:an autobiographical account of the “I beat cancer and you can too” pep-talk style.
What it is: a very readable pop-science book based on the author’s own PhD research into radical remission.
She knew that a very small percentage of people experience spontaneous radical remission (or quasi-spontaneous, if the remission is attributed to lifestyle changes, and/or some alternative therapy), but a small percentage of people means a large number worldwide, so she travelled the world studying over 1,000 cases of people with late-stage cancer who had either not gone for conventional anticancer drugs, or had and then stopped, and lived to tell the tale.
While she doesn’t advocate for any particular alternative therapy, she does report on what things came to her attention. She does advocate for some lifestyle changes.
Perhaps the biggest value this book offers is in its promised “9 key factors that can make a real difference”, which are essentially her conclusions from her PhD dissertation.
There isn’t room to talk about them here in a way that wouldn’t be misleading/unhelpful for a paucity of space, so perhaps we’ll do a main feature one of these days.
Bottom line: if you have (or a loved one has) cancer, this is an incredibly sensible book to read. If you don’t, then it’s an interesting and thought-provoking book to read.
Click here to check out Radical Remission, and learn about the factors at hand!
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Anti-Inflammatory Khichri & Tadka
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This is halfway between a daal and a risotto; it’s delicious and it’s full of protein, fiber, heathy fats, and flavors. And those flavors? Mostly from health-giving phytochemicals of one kind of another.
You will need
For the khichri:
- 1 oz chana dal
- 1 oz red lentils
- 1 oz brown lentils
- 1 oz quinoa
- 4 oz wholegrain basmati rice
- 1 tbsp chia seeds
- 1 tsp ground turmeric
- ½ tsp MSG or 1 tsp low-sodium salt
For the tadka:
- 2 tbsp avocado oil (or other oil suitable for high temperatures—so, not olive oil on this occasion!)
- ¼ bulb garlic, thinly sliced
- 1 fresh red chili (adjust per heat preferences)
- 1 fresh green chili (adjust per heat preferences)
- 1 tsp cumin seeds
- 6 curry leaves
- 12 twists of freshly ground black pepper
To serve:
- Optional: flatbreads or poppadoms
- Optional: lemon wedges or lime wedges
- Optional: chopped cilantro or parsley
Method
(we suggest you read everything at least once before doing anything)
1) Simmer the khichri ingredients in 5 cups of water, stirring occasionally if necessary, until it has a risotto-like consistency; this will probably take about 30–40 minutes. This time can be greatly reduced by using a pressure cooker, but obviously you won’t be able to check or stir, so do that only if you know what you’re doing cooking those grains and pseudograins in there, and what settings/timings to use for your specific device.
2) Make the tadka when the khichri is nearly ready, by heating the 2 tbsp of avocado oil in a skillet until very hot but not smoking, Add the rest of the ingredients from the tadka section, and cook until the garlic is nice and golden.
3) Pour the tadka over the khichri to serve, with any of the optional accompaniments we mentioned.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Capsaicin For Weight Loss And Against Inflammation
- The Many Health Benefits Of Garlic
- Black Pepper’s Impressive Anti-Cancer Arsenal (And More)
- Why Curcumin (Turmeric) Is Worth Its Weight In Gold
- If You’re Not Taking Chia, You’re Missing Out
Take care!
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Mental illness, psychiatric disorder or psychological problem. What should we call mental distress?
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We talk about mental health more than ever, but the language we should use remains a vexed issue.
Should we call people who seek help patients, clients or consumers? Should we use “person-first” expressions such as person with autism or “identity-first” expressions like autistic person? Should we apply or avoid diagnostic labels?
These questions often stir up strong feelings. Some people feel that patient implies being passive and subordinate. Others think consumer is too transactional, as if seeking help is like buying a new refrigerator.
Advocates of person-first language argue people shouldn’t be defined by their conditions. Proponents of identity-first language counter that these conditions can be sources of meaning and belonging.
Avid users of diagnostic terms see them as useful descriptors. Critics worry that diagnostic labels can box people in and misrepresent their problems as pathologies.
Underlying many of these disagreements are concerns about stigma and the medicalisation of suffering. Ideally the language we use should not cast people who experience distress as defective or shameful, or frame everyday problems of living in psychiatric terms.
Our new research, published in the journal PLOS Mental Health, examines how the language of distress has evolved over nearly 80 years. Here’s what we found.
Generic terms for the class of conditions
Generic terms – such as mental illness, psychiatric disorder or psychological problem – have largely escaped attention in debates about the language of mental ill health. These terms refer to mental health conditions as a class.
Many terms are currently in circulation, each an adjective followed by a noun. Popular adjectives include mental, mental health, psychiatric and psychological, and common nouns include condition, disease, disorder, disturbance, illness, and problem. Readers can encounter every combination.
These terms and their components differ in their connotations. Disease and illness sound the most medical, whereas condition, disturbance and problem need not relate to health. Mental implies a direct contrast with physical, whereas psychiatric implicates a medical specialty.
Mental health problem, a recently emerging term, is arguably the least pathologising. It implies that something is to be solved rather than treated, makes no direct reference to medicine, and carries the positive connotations of health rather than the negative connotation of illness or disease.
Arguably, this development points to what cognitive scientist Steven Pinker calls the “euphemism treadmill”, the tendency for language to evolve new terms to escape (at least temporarily) the offensive connotations of those they replace.
English linguist Hazel Price argues that mental health has increasingly come to replace mental illness to avoid the stigma associated with that term.
How has usage changed over time?
In the PLOS Mental Health paper, we examine historical changes in the popularity of 24 generic terms: every combination of the nouns and adjectives listed above.
We explore the frequency with which each term appears from 1940 to 2019 in two massive text data sets representing books in English and diverse American English sources, respectively. The findings are very similar in both data sets.
The figure presents the relative popularity of the top ten terms in the larger data set (Google Books). The 14 least popular terms are combined into the remainder.
Several trends appear. Mental has consistently been the most popular adjective component of the generic terms. Mental health has become more popular in recent years but is still rarely used.
Among nouns, disease has become less widely used while illness has become dominant. Although disorder is the official term in psychiatric classifications, it has not been broadly adopted in public discourse.
Since 1940, mental illness has clearly become the preferred generic term. Although an assortment of alternatives have emerged, it has steadily risen in popularity.
Does it matter?
Our study documents striking shifts in the popularity of generic terms, but do these changes matter? The answer may be: not much.
One study found people think mental disorder, mental illness and mental health problem refer to essentially identical phenomena.
Other studies indicate that labelling a person as having a mental disease, mental disorder, mental health problem, mental illness or psychological disorder makes no difference to people’s attitudes toward them.
We don’t yet know if there are other implications of using different generic terms, but the evidence to date suggests they are minimal.
Is ‘distress’ any better?
Recently, some writers have promoted distress as an alternative to traditional generic terms. It lacks medical connotations and emphasises the person’s subjective experience rather than whether they fit an official diagnosis.
Distress appears 65 times in the 2022 Victorian Mental Health and Wellbeing Act, usually in the expression “mental illness or psychological distress”. By implication, distress is a broad concept akin to but not synonymous with mental ill health.
But is distress destigmatising, as it was intended to be? Apparently not. According to one study, it was more stigmatising than its alternatives. The term may turn us away from other people’s suffering by amplifying it.
So what should we call it?
Mental illness is easily the most popular generic term and its popularity has been rising. Research indicates different terms have little or no effect on stigma and some terms intended to destigmatise may backfire.
We suggest that mental illness should be embraced and the proliferation of alternative terms such as mental health problem, which breed confusion, should end.
Critics might argue mental illness imposes a medical frame. Philosopher Zsuzsanna Chappell disagrees. Illness, she argues, refers to subjective first-person experience, not to an objective, third-person pathology, like disease.
Properly understood, the concept of illness centres the individual and their connections. “When I identify my suffering as illness-like,” Chappell writes, “I wish to lay claim to a caring interpersonal relationship.”
As generic terms go, mental illness is a healthy option.
Nick Haslam, Professor of Psychology, The University of Melbourne and Naomi Baes, Researcher – Social Psychology/ Natural Language Processing, The University of Melbourne
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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The Squat Bible – by Dr. Aaron Horschig
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You probably know the following three things about squats:
- Squatting is great for the health in many ways
- There are many different ways to squat
- Not all of them are correct, and some may even do harm
Dr. Aaron Horschig makes the case for squats being a movement first, and an exercise second. To this end, he takes us on a joint-by-joint tour of the anatomy of squatting, so that we get it right from top to toe.
Or rather: from toe to top, since he starts with the best foundation.
What this means is that if you’ve struggled to squat because you find some discomfort in your ankles, or a weakness in the knees, or you can’t get your back quite right, Dr. Horschig will have a fix for you. He also takes a realistic look about how people’s anatomy varies from person to person, and what differences this makes to how we each should best squat.
The explanations are clear and so are the pictures—we recommend getting the color print edition (linked), as the image quality is better than the black and white and/or Kindle edition.
Bottom-line: squats are one of the single best exercises we can do for our health—but we can miss out on benefits (or even do ourselves harm) if we don’t do them well. This book is a comprehensive reference resource for making sure we get the most out of our squatting ability.
Click here to check out The Squat Bible, and master this all-important movement!
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