Alzheimer’s Causative Factors To Avoid
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The Best Brains Bar Nun?
This is Dr. David Snowdon. He’s an epidemiologist, and one of the world’s foremost experts on Alzheimer’s disease. He was also, most famously, the lead researcher of what has become known as “The Nun Study”.
We recently reviewed his book about this study:
…which we definitely encourage you to check out, but we’ll do our best to summarize its key points today!
Reassurance up-front: no, you don’t have to become a nun
The Nun Study
In 1991, a large number (678) of nuns were recruited for what was to be (and until now, remains) the largest study of its kind into the impact of a wide variety of factors on aging, and in particular, Alzheimer’s disease.
Why it was so important: because the nuns were all from the same Order, had the same occupation (it’s a teaching Order), with very similar lifestyles, schedules, socioeconomic status, general background, access to healthcare, similar diets, same relationship status (celibate), same sex (female), and many other factors also similar, this meant that most of the confounding variables that confound other studies were already controlled-for here.
Enrollment in the study also required consenting to donating one’s brain for study post-mortem—and of those who have since died, indeed 98% of them have been donated (the other 2%, we presume, may have run into technical administrative issues with the donation process, due to the circumstances of death and/or delays in processing the donation).
How the study was undertaken
We don’t have enough space to describe the entire methodology here, but the gist of it is:
- Genetic testing for relevant genetic factors
- Data gathered about lives so far, including not just medical records but also autobiographies that the nuns wrote when they took their vows (at ages 19–21)
- Extensive ongoing personal interviews about habits, life choices, and attitudes
- Yearly evaluations including memory tests and physical function tests
- Brain donation upon death
What they found
Technically, The Nun Study is still ongoing. Of the original 678 nuns (aged 75–106), three are still alive (based on the latest report, at least).
However, lots of results have already been gained, including…
Genes
A year into the study, in 1992, the “apolipoprotein E” (APOE) gene was established as a likely causative factor in Alzheimer’s disease. This is probably not new to our readers in 2024, but there are interesting things being learned even now, for example:
The Alzheimer’s Gene That Varies By Race & Sex
…but watch out! Because also:
Alzheimer’s Sex Differences May Not Be What They Appear
Words
Based on the autobiographies written by the nuns in their youth upon taking their vows, there were two factors that were later correlated with not getting dementia:
- Longer sentences
- Positive outlook
- “Idea density”
That latter item means the relative linguistic density of ideas and complexity thereof, and the fluency and vivacity with which they were expressed (this was not a wishy-washy assessment; there was a hard-science analysis to determine numbers).
Want to spruce up yours? You might like to check out:
Reading, Better: Reading As A Cognitive Exercise
…for specific, evidence-based ways to tweak your reading to fight cognitive decline.
Food
While the dietary habits of the nuns were fairly homogenous, those who favored eating more and cooked greens, beans, and tomatoes, lived longer and with healthier brains.
See also: Brain Food? The Eyes Have It!
Other aspects of brain health & mental health
The study also found that nuns who avoided stroke and depression, were also less likely to get dementia.
For tending to these, check out:
- Two Things You Can Do To Improve Stroke Survival Chances
- Depression, And The Mental Health First-Aid That You’ll Hopefully Never Need
- Behavioral Activation Against Depression & Anxiety
Community & Faith
Obviously, in this matter the nuns were quite a homogenous group, scoring heavily in community and faith. What’s relevant here is the difference between the nuns, and other epidemiological studies in other groups (invariably not scoring so highly).
Community & faith are considered, separately and together, to be protective factors against dementia.
Faith may be something that “you have it or you don’t” (we’re a health science newsletter, not a theological publication, but for the interested, philosopher John Stuart Mill’s 1859 essay “On Liberty“ makes a good argument for it not being something one can choose, prompting him to argue for religious tolerance, on the grounds that religious coercion is a futile effort precisely because a person cannot choose to dis/believe something)
…but community can definitely be chosen, nurtured, and grown. We’ve written about this a bit before:
You might also like to check out this great book on the topic:
Purpose: Design A Community And Change Your Life – by Gina Bianchini
Want more?
We gave a ground-up primer on avoiding Alzheimer’s and other dementias; check it out:
How To Reduce Your Alzheimer’s Risk
Take care!
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Getting Flexible, Starting As An Adult: How Long Does It Really Take?
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Aleks Brzezinska didn’t start stretching until she was 21, and here’s what she found:
We’ll not stretch the truth
A lot of stretching programs will claim “do the splits in 30 days” or similar, and while this may occasionally be true, usually it’ll take longer.
Brzezinska started stretching seriously when she was 21, and made significant flexibility gains between the ages of 21 and 23 with consistent practice. Since then, she’s just maintained her flexibility.
There are facts that affect progress significantly, such as:
- Anatomy: body structure, age, and joint flexibility do influence flexibility; starting younger and/or having hypermobile joints does make it easier.
- Consistency: regular practice (2–3 times a week) is crucial, but avoid overdoing it, especially when sore.
- Lifestyle: weightlifting, running, and similar activities can tighten muscles, making flexibility harder to achieve.
- Hydration: staying hydrated is important for muscle flexibility.
She also recommends incorporating a variety of different stretching types, rather than just one method, for example passive stretching, active stretching, Proprioceptive Neuromuscular Facilitation (PNF) stretching, and mobility work.
For more on each of these, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like:
Jasmine McDonald’s Ballet Stretching Routine
Take care!
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The Truth About Statins – by Barbara H. Roberts, M.D.
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All too often, doctors looking to dispense a “quick fix” will prescribe from their playbook of a dozen or so “this will get you out of my office” drugs. Most commonly, things that treat symptoms rather than the cause. Sometimes, this can be fine! For example, in some cases, painkillers and antidepressants can make a big improvement to people’s lives. What about statins, though?
Prescribed to lower cholesterol, they broadly do exactly that. However…
Dr. Roberts wants us to know that we could be missing the big picture of heart health, and making a potentially fatal mistake.
This is not to say that the book argues that statins are necessarily terrible, or that they don’t have their place. Just, we need to understand what they will and won’t do, and make an informed choice.
To which end, she does advise regards when statins can help the most, and when they may not help at all. She also covers the questions to ask if your doctor wants to prescribe them. And—all so frequently overlooked—the important differences between men’s and women’s heart health, and the implications these have for the efficacy (or not) of statins.
With regard to the “alternatives to cholesterol-lowering drugs” promised in the subtitle… we won’t keep any secrets here:
Dr. Roberts (uncontroversially) recommends the Mediterranean diet. She also provides two weeks’ worth of recipes for such, in the final part of the book.
All in all, an important book to read if you or a loved one are taking, or thinking of taking, statins.
Pick up your copy of The Truth About Statins on Amazon today!
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One More Resource Against Osteoporosis!
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Your Bones Were Made For Moving Too!
We know that to look after bone health, resistance training is generally what’s indicated. Indeed, we mentioned it yesterday, and we’ve talked about it before:
Resistance Is Useful! (Especially As We Get Older)
We also know that if you have osteoporosis already, some exercises are a better or worse idea than others:
Osteoporosis & Exercises: Which To Do (And Which To Avoid)
However! New research suggests that also getting in your recommended 150 minutes per week of moderate exercise slows bone density loss.
The study by Dr. Tiina Savikangas et al. looked at 299 people in their 70s (just over half being women) and found that, over the course of a year, bone mineral density loss was inversely correlated with moderate exercise as recorded by an accelerometer (as found in most fitness-tracking wearables and smartphones).
In other words: those who got more minutes of exercise, kept more bone mineral density.
As well as monitoring bone mineral density, the study also looked at cross-sectional area, but that remained stable throughout.
As for how much is needed:
❝Even short bursts of activity can be significant for the skeleton, so we also looked at movement in terms of the number and intensity of individual impacts. For example, walking and running cause impacts of different intensities.
We found that impacts that were comparable to at least brisk walking were associated with better preservation of bone mineral density.❞
Read more: Impacts during everyday physical activity can slow bone loss ← pop-science source, interviewing the lead researcher
On which note, we’ve a small bone to pick…
As a small correction, the pop-science source says that the subjects’ ages ranged from 70 to 85 years; the paper, meanwhile, clearly shows that the age-range was 74.4±3.9 years (shown in the “Results” table), rounded to 74.4 ± 4 years, in the abstract. So, certainly no participant was older than 78 years and four months.
Why this matters: the age range itself may be critical or it might not, but what is important is that this highlights how we shouldn’t just believe figures cited in pop-science articles, and it’s always good to click through to the source!
This paper is a particularly fascinating read if you have time, because—unlike a lot of studies—they really took great care to note what exactly can and cannot be inferred from the data, and how and why.
Especially noteworthy was the diligence with which they either controlled for, or recognized that they could not control for, far more variables than most studies even bother to mention.
This kind of transparency is critical for good science, and we’d love to see more of it!
Want to apply this to your life?
Tracking minutes-of-movement is one of the things that fitness trackers are best at, so connect your favourite app (one of these days we’ll do a fitness tracker comparison article) and get moving!
And as for the other things that fitness trackers do? As it turns out, they do have their strengths and weaknesses, which are good to bear in mind:
Take care!
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Breakfasting For Health?
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Breakfast Time!
In yesterday’s newsletter, we asked you for your health-related opinions on the timings of meals.
But what does the science say?
Quick recap on intermittent fasting first:
Today’s article will rely somewhat on at least a basic knowledge of intermittent fasting, what it is, and how and why it works.
Armed with that knowledge, we can look at when it is good to break the fast (i.e. breakfast) and when it is good to begin the fast (i.e. eat the last meal of the day).
So, if you’d like a quick refresher on intermittent fasting, here it is:
Intermittent Fasting: We Sort The Science From The Hype
And now, onwards!
One should eat breakfast first thing: True or False?
True! Give or take one’s definition of “first thing”. We did a main feature about this previously, and you can read a lot about the science of it, and see links to studies:
The Circadian Rhythm: Far More Than Most People Know
In case you don’t have time to read that now, we’ll summarize the most relevant-to-today’s-article conclusion:
The optimal time to breakfast is around 10am (this is based on getting sunlight around 8:30am, so adjust if this is different for you)
It doesn’t matter when we eat; calories are calories & nutrients are nutrients: True or False?
Broadly False, for practical purposes. Because, indeed calories are calories and nutrients are nutrients at any hour, but the body will do different things with them depending on where we are in the circadian cycle.
For example, this study in the Journal of Nutrition found…
❝Our results suggest that in relatively healthy adults, eating less frequently, no snacking, consuming breakfast, and eating the largest meal in the morning may be effective methods for preventing long-term weight gain.
Eating breakfast and lunch 5-6 h apart and making the overnight fast last 18-19 h may be a useful practical strategy.❞
Read in full: Meal Frequency and Timing Are Associated with Changes in Body Mass Index
We should avoid eating too late at night: True or False?
False per se, True in the context of the above. Allow us to clarify:
There is nothing inherently bad about eating late at night; there is no “bonus calorie happy hour” before bed.
However…
If we are eating late at night, that makes it difficult to breakfast in the morning (as is ideal) and still maintain a >16hr fasting window as is optimal, per:
❝the effects of the main forms of fasting, activating the metabolic switch from glucose to fat and ketones (G-to-K), starting 12-16 h after cessation or strong reduction of food intake❞
~ Dr. Françoise Wilhelmi de Toledo et al.
So in other words: since the benefits of intermittent fasting start at 12 hours into the fast, you’re not going to get them if you’re breakfasting at 10am and also eating in the evening.
Summary:
- It is best to eat breakfast around 10am, generally (ideally after some sunlight and exercise)
- While there’s nothing wrong with eating in the evening per se, doing so means that a 10am breakfast will eliminate any fasting benefits you might otherwise get
- If a “one meal a day, and that meal is breakfast” lifestyle doesn’t suit you, then one possible good compromise is to have a large breakfast, and then a smaller meal in the late afternoon / early evening.
One last tip: the above is good, science-based information. Use it (or don’t), as you see fit. We’re not the boss of you:
- Maybe you care most about getting the best circadian rhythm benefits, in which case, prioritizing breakfast being a) in the morning and b) the largest meal of the day, is key
- Maybe you care most about getting the best intermittent fasting benefits, in which case, for many people’s lifestyle, a fine option is skipping eating in the morning, and having one meal in the late afternoon / early evening.
Take care!
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Why Lung Cancer Is On The Rise In Women Who’ve Never Smoked
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It’s easy to assume that if you’ve never smoked, lung cancer is just not a risk for you, unless you got very unlucky with an asbestos-laden environment or such.
And yes, smoking is indeed the most overwhelmingly strong risk factor:
❝It is estimated that cigarette smoking explains almost 90% of lung cancer risk in men and 70 to 80% in women❞
Which is a lot (and we’ll address that discrepancy by sex shortly), but meanwhile first let’s mention:
❝Compared with non-smokers, smokers have as much as a 30-fold increased risk of developing cancer.
31% and 26% of all cancer deaths in men and women, respectively, result from lung cancer in the United States.
Overall 5-year survival is only 15%, and 1-year survival is approximately 42%.
In total, lung cancer is responsible for more deaths than prostate, colon, pancreas, and breast cancers combined❞
Source: Smoking and Lung Cancer
Sobering statistics for any smoker, certainly.
But, “smoking is bad for the health” is not the breaking news of the century, so we’ll look now at the other risk factors.
Before we do though, let’s just drop this previous main feature of ours for anyone who does smoke or perhaps who has a loved one who smokes:
Which Addiction-Quitting Methods Work Best? ← it’s not specific just to smoking, but it does cover such also
So, Why the extra risk for women, even if we don’t smoke?
Let’s reframe that first statistic we gave, now presenting the same information differently:
Women who do not smoke are 2–3x more likely to get lung cancer than men who do not smoke.
So… why?
There are three main reasons:
Genetic risks
Cancer often arises from genetic mutations. In the case of lung cancer, genes such as ALK, ROS1, TP53, KRAS, and EGFR are implicated, and some of those are much more likely to mutate in women than in men.
In some cases, it’s because if you have XX chromosomes (as most women do), there are genes you have redundant copies of that people with XY chromosomes don’t. Other less common karyotypes, such as XXY, probably carry higher risks, but that’s just a hypothesis we’re making based on “more copies of a gene = more chances for it to mutate”.
See also: Frequency and Distinctive Spectrum of KRAS Mutations in Never Smokers with Lung Adenocarcinoma
In other cases, it’s because estrogen interacts with the gene mutations, making lung cancer more likely to develop in women over time:
Hormonal risks (but not what you might think)
When something affects women more, it’s easy to blame hormones, but, as researchers have concluded…
❝A reduced lung cancer risk was found for OC and HRT ever users. Both oestrogen only and oestrogen+progestin HRT were associated with decreased risk. No dose-response relationship was observed with years of OC/HRT use. The greatest risk reduction was seen for squamous cell carcinoma in OC users and in both adenocarcinoma and small cell carcinoma in HRT users.❞
OC = oral contraceptive
HRT = hormone replacement therapyNote: we snipped out the statistical calculations for readability and brevity, so if you are interested in those, check out the paper below:
Meanwhile, another research review of 22 studies with nearly a million participants found:
❝Current or ever HRT use is partly correlated with the decreased incidence of lung cancer in women.
Concerns about the incidence of lung cancer can be reduced when perimenopausal and postmenopausal women use current HRT to reduce menopausal symptoms.❞
So, the problem seems to at least a lot of the time be not estrogen (notwithstanding what we mentioned previously about mutations—sometimes a thing can have both pros and cons), but rather, untreated menopause being the higher risk factor.
This is very reminiscent of what we talked about in one of our main features about Alzheimer’s disease:
Alzheimer’s Sex Differences May Not Be What They Appear ← Women get Alzheimer’s at nearly 2x the rate than men do, and deteriorate more rapidly after onset, too.
Chronic inflammation
For reasons that have not been tied to genetics or hormones*, women suffer from autoimmune diseases at much higher rates than men.
*presumably it is at least one or the other, because there aren’t a lot of other options that seem plausible, but (as with many “this thing mainly affects women” maladies), science hasn’t yet determined the cause.
Because cancer is in part a disease of immune dysfunction (cells fail to kill cells they should be killing), having an autoimmune disease, or indeed chronic inflammation in general, will result in a higher risk of cancer.
For general theory, see: Cancer and Autoimmune Diseases: A Tale of Two Immunological Opposites?
For specifics, see: Non–Small Cell Lung Cancer: Role of the Immune System and Potential for Immunotherapy
And this one is the most likely explanation of why lung cancer in women who’ve never smoked is on the rise—it’s because chronic inflammation in women is on the rise. While people regardless of gender are getting chronic inflammation at increased rates nowadays (probably due in large part to the rise of ultra-processed food, as well as the higher stress of modern life, but again, we’re hypothesizing), if all other factors are equal, women will still get it more than men.
However!
Like the consideration of HRT’s protective effects (and unlike the genetic factors), this is one we can do something about.
For how, check out: How to Prevent (or Reduce) Inflammation
Want to know more?
For lung health in general, see:
Seven Things To Do For Good Lung Health!
Take care!
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What is type 1.5 diabetes? It’s a bit like type 1 and a bit like type 2 – but it’s often misdiagnosed
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While you’re likely familiar with type 1 and type 2 diabetes, you’ve probably heard less about type 1.5 diabetes.
Also known as latent autoimmune diabetes in adults (LADA), type 1.5 diabetes has features of both type 1 and type 2 diabetes.
More people became aware of this condition after Lance Bass, best known for his role in the iconic American pop band NSYNC, recently revealed he has it.
So, what is type 1.5 diabetes? And how is it diagnosed and treated?
Pixel-Shot/Shutterstock There are several types of diabetes
Diabetes mellitus is a group of conditions that arise when the levels of glucose (sugar) in our blood are higher than normal. There are actually more than ten types of diabetes, but the most common are type 1 and type 2.
Type 1 diabetes is an autoimmune condition where the body’s immune system attacks and destroys the cells in the pancreas that make the hormone insulin. This leads to very little or no insulin production.
Insulin is important for moving glucose from the blood into our cells to be used for energy, which is why people with type 1 diabetes need insulin medication daily. Type 1 diabetes usually appears in children or young adults.
Type 2 diabetes is not an autoimmune condition. Rather, it happens when the body’s cells become resistant to insulin over time, and the pancreas is no longer able to make enough insulin to overcome this resistance. Unlike type 1 diabetes, people with type 2 diabetes still produce some insulin.
Type 2 is more common in adults but is increasingly seen in children and young people. Management can include behavioural changes such as nutrition and physical activity, as well as oral medications and insulin therapy.
People with diabetes may need to regularly monitor their blood sugar levels. Dragana Gordic/Shutterstock How does type 1.5 diabetes differ from types 1 and 2?
Like type 1 diabetes, type 1.5 occurs when the immune system attacks the pancreas cells that make insulin. But people with type 1.5 often don’t need insulin immediately because their condition develops more slowly. Most people with type 1.5 diabetes will need to use insulin within five years of diagnosis, while those with type 1 typically require it from diagnosis.
Type 1.5 diabetes is usually diagnosed in people over 30, likely due to the slow progressing nature of the condition. This is older than the typical age for type 1 diabetes but younger than the usual diagnosis age for type 2.
Type 1.5 diabetes shares genetic and autoimmune risk factors with type 1 diabetes such as specific gene variants. However, evidence has also shown it may be influenced by lifestyle factors such as obesity and physical inactivity which are more commonly associated with type 2 diabetes.
What are the symptoms, and how is it treated?
The symptoms of type 1.5 diabetes are highly variable between people. Some have no symptoms at all. But generally, people may experience the following symptoms:
- increased thirst
- frequent urination
- fatigue
- blurred vision
- unintentional weight loss.
Typically, type 1.5 diabetes is initially treated with oral medications to keep blood glucose levels in normal range. Depending on their glucose control and the medication they are using, people with type 1.5 diabetes may need to monitor their blood glucose levels regularly throughout the day.
When average blood glucose levels increase beyond normal range even with oral medications, treatment may progress to insulin. However, there are no universally accepted management or treatment strategies for type 1.5 diabetes.
Type 1.5 diabetes might be managed with oral medications, at least initially. Dragana Gordic/Shutterstock Type 1.5 diabetes is often misdiagnosed
Lance Bass said he was initially diagnosed with type 2 diabetes, but later learned he actually has type 1.5 diabetes. This is not entirely uncommon. Estimates suggest type 1.5 diabetes is misdiagnosed as type 2 diabetes 5–10% of the time.
There are a few possible reasons for this.
First, accurately diagnosing type 1.5 diabetes, and distinguishing it from other types of diabetes, requires special antibody tests (a type of blood test) to detect autoimmune markers. Not all health-care professionals necessarily order these tests routinely, either due to cost concerns or because they may not consider them.
Second, type 1.5 diabetes is commonly found in adults, so doctors might wrongly assume a person has developed type 2 diabetes, which is more common in this age group (whereas type 1 diabetes usually affects children and young adults).
Third, people with type 1.5 diabetes often initially make enough insulin in the body to manage their blood glucose levels without needing to start insulin medication. This can make their condition appear like type 2 diabetes, where people also produce some insulin.
Finally, because type 1.5 diabetes has symptoms that are similar to type 2 diabetes, it may initially be treated as type 2.
We’re still learning about type 1.5
Compared with type 1 and type 2 diabetes, there has been much less research on how common type 1.5 diabetes is, especially in non-European populations. In 2023, it was estimated type 1.5 diabetes represented 8.9% of all diabetes cases, which is similar to type 1. However, we need more research to get accurate numbers.
Overall, there has been a limited awareness of type 1.5 diabetes and unclear diagnostic criteria which have slowed down our understanding of this condition.
A misdiagnosis can be stressful and confusing. For people with type 1.5 diabetes, being misdiagnosed with type 2 diabetes might mean they don’t get the insulin they need in a timely manner. This can lead to worsening health and a greater likelihood of complications down the road.
Getting the right diagnosis helps people receive the most appropriate treatment, save money, and reduce diabetes distress. If you’re experiencing symptoms you think may indicate diabetes, or feel unsure about a diagnosis you’ve already received, monitor your symptoms and chat with your doctor.
Emily Burch, Accredited Practising Dietitian and Lecturer, Southern Cross University and Lauren Ball, Professor of Community Health and Wellbeing, The University of Queensland
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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