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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  • Hardcore Self Help: F**k Anxiety – by Dr. Robert Duff

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    We’ve reviewed other anxiety books before, so what makes this one different? Mostly, it’s the style.

    Aside from swearing approximately once every two lines (so you might want to skip this one if that would bother you), Dr. Duff’s writing is very down-to-earth in other ways too, making it unpretentiously comfortable and accessible without failing to draw upon the wealth of good-practice, evidence-based advice he has to offer.

    To that end, he talks about what anxiety is and isn’t, and goes over various approaches, explaining them in a “about” fashion, and also a “how to” fashion, covering areas such as CBT, somatic therapies, social support, when talk therapy is most likely to help.

    The book is a quick read (a modest 74 pages), and it’s refreshing that it hasn’t been padded unnecessarily, unlike a lot of books that could have been a fraction of the size without losing value.

    Bottom line: if you (or perhaps someone you care about) would benefit from a straight-to-the-point, no-BS approach to dealing with anxiety (that’s actually evidence-based, not just a “get over it” dismissal), then this is the book for you.

    Click here to check out Hardcore Self Help: F**k Anxiety, and indeed do just that!

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  • The Diet Compass – by Bas Kast

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    Facts about nutrition and health can be hard to memorize. There’s just so much! And often there are so many studies, and while the science is not usually contradictory, pop-science headlines sure can be. What to believe?

    Bas Kast brings us a very comprehensive and easily digestible solution.

    A science journalist himself, he has gone through the studies so that you don’t have to, and—citing them along the way—draws out the salient points and conclusions.

    But, he’s not just handing out directions (though he does that too); he’s arranged and formatted the information in a very readable and logical fashion. Chapter by chapter, we learn the foundations of important principles for “this is better than that” choices in diet.

    Most importantly, he lays out for us his “12 simple rules for healthy eating“, and they are indeed as simple as they are well-grounded in good science.

    Bottom line: if you want “one easy-reading book” to just tell you how to make decisions about your diet, simply follow those rules and enjoy the benefits… Then this book is exactly that.

    Click here to check out The Diet Compass and get your diet on the right track!

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  • Minimize Aging’s Metabolic Slump

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    It’s Q&A Day at 10almonds!

    Have a question or a request? We love to hear from you!

    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

    ❝I know that metabolism slows with age, are there any waypoints or things to look out for? I don’t know whether I should be eating less, or doing less, or taking some other approach entirely. What’s recommended?❞

    Age and sex count for a lot with this one! As metabolism is in large part directed by hormones:

    • For men, declining testosterone (often from around 45 onwards) can result in a metabolic slump
    • For women, declining estrogen with the menopause does have an effect, but progesterone is the bigger factor for metabolism in the sense you are talking about.

    In both cases, simply taking more of those hormones can often help, but please of course speak with an endocrinologist if that seems like a possible option for you, as your circumstances (and physiology) may vary.

    If you’d like to go to that conversation well-armed with information, here are some good starting points, by the way:

    And if you’re wondering about the natural vs pharmaceutical approaches…

    About your metabolic base rate

    We tend to think of “fast metabolism good, slow metabolism bad”, and that’s a reasonable general premise… but it’s not necessarily always so.

    After all, if you could double your metabolism and keep it there all the time, without changing anything else, well… You’ve heard the phrase “burning the candle at both ends”? So, having at least some downtime is important too.

    See for example: Sleep Deprivation & Diabetes Risk

    What’s critical, when it comes to base metabolic rate, is that your body must be capable of adequately processing what you are putting into it. Because if your body can’t keep up with the input, it’ll just start storing the excess chemical energy in the quickest and easiest way possible.

    …which is a fast track to metabolic disorder in general and type 2 diabetes in particular. For more on the science and mechanics of this, see:

    How To Prevent And Reverse Type 2 Diabetes

    As for portion sizes…

    Your body knows what you need, so listen to it. There is no external source of knowledge that can tell you how much food you need better than your own body itself can tell you.

    You may be wondering “how exactly do I listen to my body, though?”, in which case, check out:

    The Kitchen Doctor: Interoception & Mindful Eating

    As for exercise…

    When you exercise, your metabolic rate temporarily increases. After most kinds of exercise, your metabolism slumps again afterwards to compensate.

    There are two ways to avoid this:

    …which makes it pretty effective indeed

    Would you like this section to be bigger? If so, send us more questions!

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  • ‘Naked carbs’ and ‘net carbs’ – what are they and should you count them?

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    According to social media, carbs come in various guises: naked carbs, net carbs, complex carbs and more.

    You might be wondering what these terms mean or if all carbs are really the same. If you are into “carb counting” or “cutting carbs”, it’s important to make informed decisions about what you eat.

    What are carbs?

    Carbohydrates, or “carbs” for short, are one of the main sources of energy we need for brain function, muscle movement, digestion and pretty much everything our bodies do.

    There are two classifications of carbs, simple and complex. Simple carbs have one or two sugar molecules, while complex carbs are three or more sugar molecules joined together. For example, table sugar is a simple carb, but starch in potatoes is a complex carb.

    All carbs need to be broken down into individual molecules by our digestive enzymes to be absorbed. Digestion of complex carbs is a much slower process than simple carbs, leading to a more gradual blood sugar increase.

    Fibre is also considered a complex carb, but it has a structure our body is not capable of digesting. This means we don’t absorb it, but it helps with the movement of our stool and prevents constipation. Our good gut bacteria also love fibre as they can digest it and use it for energy – important for a healthy gut.

    What about ‘naked carbs’?

    “Naked carbs” is a popular term usually used to refer to foods that are mostly simple carbs, without fibre or accompanying protein or fat. White bread, sugary drinks, jams, sweets, white rice, white flour, crackers and fruit juice are examples of these foods. Ultra-processed foods, where the grains are stripped of their outer layers (including fibre and most nutrients) leaving “refined carbs”, also fall into this category.

    One of the problems with naked carbs or refined carbs is they digest and absorb quickly, causing an immediate rise in blood sugar. This is followed by a rapid spike in insulin (a hormone that signals cells to remove sugar from blood) and then a drop in blood sugar. This can lead to hunger and cravings – a vicious cycle that only gets worse with eating more of the same foods.

    donut with sprinkles in close up
    Naked carbs can make blood sugars spike then crash.
    Pexels/Alexander Grey

    What about ‘net carbs’?

    This is another popular term tossed around in dieting discussions. Net carbs refer to the part of the carb food that we actually absorb.

    Again, fibre is not easily digestible. And some carb-rich foods contain sugar alcohols, such as sweeteners (like xylitol and sorbitol) that have limited absorption and little to no effect on blood sugar. Deducting the value of fibre and sugar alcohols from the total carbohydrate content of a food gives what’s considered its net carb value.

    For example, canned pear in juice has around 12.3g of “total carbohydrates” per 100g, including 1.7g carb + 1.7g fibre + 1.9g sugar alcohol. So its net carb is 12.3g – 1.7g – 1.9g = 8.7g. This means 8.7g of the 12.3g total carbs impacts blood sugar.

    The nutrition labels on packaged foods in Australia and New Zealand usually list fibre separately to carbohydrates, so the net carbs have already been calculated. This is not the case in other countries, where “total carbohydrates” are listed.

    Does it matter though?

    Whether or not you should care about net or naked carbs depends on your dietary preferences, health goals, food accessibility and overall nutritional needs. Generally speaking, we should try to limit our consumption of simple and refined carbs.

    The latest World Health Organization guidelines recommend our carbohydrate intake should ideally come primarily from whole grains, vegetables, fruits and pulses, which are rich in complex carbs and fibre. This can have significant health benefits (to regulate hunger, improve cholesterol or help with weight management) and reduce the risk of conditions such as heart disease, obesity and colon cancer.

    In moderation, naked carbs aren’t necessarily bad. But pairing them with fats, protein or fibre can slow down the digestion and absorption of sugar. This can help to stabilise blood sugar levels, prevent spikes and crashes and support personal weight management goals. If you’re managing diabetes or insulin resistance, paying attention to the composition of your meals, and the quality of your carbohydrate sources is essential.

    A ketogenic (high fat, low carb) diet typically restricts carb intake to between 20 and 50g each day. But this carb amount refers to net carbs – so it is possible to eat more carbs from high-fibre sources.

    salad with quinoa and vegetables
    Choose complex carbohydrates with lots of fibre.
    Shutterstock

    Some tips to try

    Some simple strategies can help you get the most out of your carb intake:

    • reduce your intake of naked carbs and foods high in sugar and white flour, such as white bread, table sugar, honey, lollies, maple syrup, jam, and fruit juice

    • opt for protein- and fibre-rich carbs. These include oats, sweet potatoes, nuts, avocados, beans, whole grains and broccoli

    • if you are eating naked carbs, dress them up with some protein, fat and fibre. For example, top white bread with a nut butter rather than jam

    • if you are trying to reduce the carb content in your diet, be wary of any symptoms of low blood glucose, including headaches, nausea, and dizziness

    • working with a health-care professional such as an accredited practising dietitian or your GP can help develop an individualised diet plan that meets your specific needs and goals.

    Correction: this article has been updated to indicate how carbohydrates are listed on food nutrition labels in Australia and New Zealand.The Conversation

    Saman Khalesi, Senior Lecturer and Discipline Lead in Nutrition, School of Health, Medical and Applied Sciences, CQUniversity Australia; Anna Balzer, Lecturer, Medical Science School of Health, Medical and Applied Sciences, CQUniversity Australia; Charlotte Gupta, Postdoctoral research fellow, CQUniversity Australia; Chris Irwin, Senior Lecturer in Nutrition and Dietetics, School of Health Sciences & Social Work, Griffith University, and Grace Vincent, Senior Lecturer, Appleton Institute, CQUniversity Australia

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

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  • Gut Renovation – by Dr. Roshini Raj, with Sheila Buff

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    Unless we actually feel something going on down there, gut health is an oft-neglected part of overall health—which is unfortunate, because invisible as it may often be, it affects so much.

    Gastroenterologist Dr. Roshini Raj gives us all the need-to-know information, explanations of why things happen the way they do with regard to the gut, and tips, tricks, and hacks to improve matters.

    She also does some mythbusting along the way, and advises about what things don’t make a huge difference, including what medications don’t have a lot of evidence for their usefulness.

    The style is easy-reading pop-science, with plenty of high-quality medical content.

    Reading between the lines, a lot of the book as it stands was probably written by the co-author, Sheila Buff, who is a professional ghostwriter and specializes in working closely with doctors to produce works that are readable and informative to the layperson while still being full of the doctor’s knowledge and expertise. So a reasonable scenario is that Dr. Raj gave her extensive notes, she took it from there, passed it back to her for medical corrections, and they had a little back and forth until it was done. Whatever their setup, the end result was definitely good!

    Bottom line: if you’d like a guide to gut health that’s practical and easy to read, while being quite comprehensive and certainly a lot more than “eat probiotics and fiber”, then this book is a fine choice.

    Click here to check out Gut Renovation, and renovate yours!

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  • L-Theanine: What’s The Tea?

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    L-Theanine: What’s The Tea?

    We’ve touched previously on l-theanine, when this newsletter was new, and we had only a few hundred subscribers and the carefully organized format wasn’t yet what it is today.

    So now it’s time to give this potent dietary compound / nutritional supplement the “Monday Research Review” treatment…

    What is it?

    L-theanine is an amino acid found in tea. The human body can’t produce it, and/but it’s not essential for humans. It does have a lot of benefits, though. See for example:

    L-Theanine as a Functional Food Additive: Its Role in Disease Prevention and Health Promotion

    How does it work?

    L-theanine works by moderating and modulating the brain’s neurotransmitters.

    This sounds fancy, but basically it means: it doesn’t actually add anything in the manner of a drug, but it changes how we use what we have naturally.

    What does it do? Read on…

    It increases mental focus

    It has been believed that l-theanine requires the presence of caffeine to achieve this (i.e., it’s a combination-only effect). For example:

    The combination of L-theanine and caffeine improves cognitive performance and increases subjective alertness

    But as it turns out, when a group of researchers actually checked… This isn’t true, as Foxe et al. write:

    ❝We asked whether either compound alone, or both in combination, would affect performance of the task in terms of reduced error rates over time, and whether changes in alpha-band activity would show a relationship to such changes in performance. When treated with placebo, participants showed a rise in error rates, a pattern that is commonly observed with increasing time-on-task, whereas after caffeine and theanine ingestion, error rates were significantly reduced. The combined treatment did not confer any additional benefits over either compound alone, suggesting that the individual compounds may confer maximal benefits at the dosages employed❞

    See: Assessing the effects of caffeine and theanine on the maintenance of vigilance during a sustained attention task

    It promotes a calmly wakeful feeling of serenity

    Those are not words typically found in biopharmaceutical literature, but they’re useful here to convey:

    • L-theanine promotes relaxation without causing drowsiness
    • L-theanine promotes mental alertness without being a stimulant

    Here is where l-theanine really stands out from caffeine. If both substances promote mental focus, but one of them does it by making us “wired” and the other does it while simultaneously promoting calm, it makes the choice between them clearer!

    Read more: L-theanine, a natural constituent in tea, and its effect on mental state

    It relieves stress and anxiety

    Building on from the above, but there’s more: l-theanine relieves stress and anxiety in people experiencing stressful situations, without any known harmful side effects… This is something that sets it apart from a lot of anxiolytic (antianxiety) drugs!

    Here’s what a big systematic review of clinical trials had to say:

    Theanine consumption, stress and anxiety in human clinical trials: A systematic review

    L-theanine has other benefits too

    We’ve talked about some of the most popular benefits of l-theanine, and we can’t make this newsletter too long, but research also suggests that it…

    If you’re interested in this topic, we recommend also reading our previous article on l-theanine—pardon that we hadn’t really nailed down our style yet—but there’s a bunch of useful information about how l-theanine makes caffeine “better” in terms of benefits. We also talk dosage, and reference some other studies we didn’t have room to include today!

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