Drug Metabolism (When You’re Not Average!)
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When Your Medications Run Out… Of You
Everybody knows that alcohol can affect medications’ effects, but what of smoking, and what of obesity? And how does the alcohol thing work anyway?
It’s all about the enzymes
Medicines that are processed by the liver (which is: most medicines) are metabolized there by specialist enzymes, and the things we do can increase or decrease the quantity of those enzymes—and/or how active they are.
Dr. Kata Wolff Pederson and her team of researchers at Aarhus University in Denmark examined the livers of recently deceased donors in ways that can’t (ethically) be done with live patients, and were able to find the associations between various lifestyle factors and different levels of enzymes responsible for drug metabolism.
And it’s not always how you might think!
Some key things they found:
- Smokers have twice as high levels of enzyme CYP1A2 than non-smokers, which results in the faster metabolism of a lot of drugs.
- Drinkers have 30% higher levels of enzyme CYP2E1, which also results in a faster metabolism of a lot of drugs.
- Patients with obesity have 50% lower levels of enzyme CYP3A4, resulting in slower metabolism of many drugs
This gets particularly relevant when we take into account the next fact:
- Of the individuals in the study, 40% died from poisoning from a mixture of drugs (usually: prescription and otherwise)
Read in full: Sex- and Lifestyle-Related Factors are Associated with Altered Hepatic CYP Protein Levels
Read a pop-sci article about it: Your lifestyle can determine how well your medicine will work
How much does the metabolism speed matter?
It can matter a lot! If you’re taking drugs and carefully abiding by the dosage instructions, those instructions were assuming they know your speed of metabolism, and this is based on an average.
- If your metabolism is faster, you can get too much of a drug too quickly, and it can harm you
- If your metabolism is faster, it also means that while yes it’ll start working sooner, it’ll also stop working sooner
- If it’s a painkiller, that’s inconvenient. If it’s a drug that keeps you alive, then well, that’s especially unfortunate.
- If your metabolism is slower, it can mean your body is still processing the previous dose(s) when you take the next one, and you can overdose (and potentially die)
We touched on this previously when we talked about obesity in health care settings, and how people can end up getting worse care:
As for alcohol and drugs? Obviously we do not recommend, but here’s some of the science of it with many examples:
Why it’s a bad idea to mix alcohol with some medications
Take care!
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Chestnuts vs Hazelnuts – Which is Healthier?
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Our Verdict
When comparing chestnuts to hazelnuts, we picked the hazelnuts.
Why?
This one’s not close.
In terms of macros, we have some big difference to start with, since chestnuts contain a lot more water and carbs whereas hazelnuts contain a lot more protein, fats, and fiber. The fats, as with most nuts, are healthy; in this case mostly being monounsaturated fat.
Because of the carbs and fiber being so polarized (i.e., chestnuts have most of the carbs and hazelnuts have most of the fiber), there’s a big difference in glycemic index; chestnuts have a GI of 52 while hazelnuts have a GI of 15.
In the category of vitamins, chestnuts contain more vitamin C, while hazelnuts contain more of vitamins A, B1, B2, B3, B5, B6, and B9.
When it comes to minerals, the story is similar: chestnuts contain a tiny bit more potassium, while hazelnuts contain a lot more calcium, copper, iron, magnesium, manganese, phosphorus, and zinc.
All in all, chestnuts aren’t bad for the health, but hazelnuts are a lot better in almost every way.
Want to learn more?
You might like to read:
Why You Should Diversify Your Nuts
Take care!
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Aging Is Inevitable… Or is it?
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Aging is inevitable… Or is it?
We’ve talked before about how and why aging happens. We’ve also talked about the work to tackle aging as basically an engineering problem, with the premise that our bodies are biological machines, and machines can be repaired. We also recommended a great book about this, by the way. But that’s about interfering with the biological process of aging. What about if the damage is already done?
“When the damage is done, it’s done”
We can do a lot to try to protect ourselves from aging, and we might be able to slow down the clock, but we can’t stop it, and we certainly can’t reverse it… right?
Wrong! Or at least, so we currently understand, in some respects. Supplementation with phosphatidylserine, for example, has shown promise for not just preventing, but treating, neurodegeneration (such as that caused by Alzheimer’s disease). It’s not a magic bullet and so far the science is at “probably” and “this shows great promise for…” and “this appears to…”
Phosphatidylserene does help slow neurodegeneration
…because of its role in allowing your cells to know whether they have permission to die.
This may seem a flippant way of putting it, but it’s basically how cell death works. Cells do need to die (if they don’t, that’s called cancer) and be replaced with new copies, and those copies need to be made before too much damage is accumulated (otherwise the damage is compounded with each new iteration). So an early cell death-and-replacement is generally better for your overall health than a later one.
However, neurons are tricky to replace, so phosphatidylserine effectively says “not you, hold on” to keep the rate of neuronal cell death nearer to the (slow) rate at which they can be replaced.
One more myth to bust…
For the longest time we thought that adults, especially older adults, couldn’t make new brain cells at all, that we grew a certain number, then had to hang onto them until we died… suffering diminished cognitive ability with age, on account of losing brain cells along the way.
It’s partly true: it’s definitely easier to kill brain cells than to grow them… Mind you, that’s technically true of people, too, yet the population continues to boom!
Anyway, new research showing that adults do, in fact, grow new braincells was briefly challenged by a 2018 study that declared: Human hippocampal neurogenesis drops sharply in children to undetectable levels in adults after all, never mind, go back to your business.
So was adult neurogenesis just a myth to be busted after all? Nope.
It turned out, the 2018 study had a methodological flaw!
To put it in lay terms: they had accidentally melted the evidence.
A 2019 study overcame this flaw by using a shorter fixation time for the cell samples they wanted to look at, and found that there were tens of thousands of “baby neurons” (again with the lay terms), newly-made brain cells, in samples from adults ranging from 43 to 87.
Now, there was still a difference: the samples from the youngest adult had 30% more newly-made braincells than the 87-year-old, but given that previous science thought brain cell generation stopped in childhood, the fact that an 87-year-old was generating new brain cells 30% less quickly than a 43-year-old is hardly much of a criticism!
As an aside: samples from patients with Alzheimer’s also had a 30% reduction in new braincell generation, compared to samples from patients of the same age without Alzheimer’s. But again… Even patients with Alzheimer’s were still growing some new brain cells.
Read it for yourself: Adult hippocampal neurogenesis is abundant in neurologically healthy subjects and drops sharply in patients with Alzheimer’s disease
In a nutshell…
- We can’t fully hit pause on aging just yet, but we can definitely genuinely slow it
- We can also, in some very specific ways, reverse it
- We can slow the loss of brain cells
- We can grow new brain cells
- We can reduce our risk of Alzheimer’s, and at least somewhat mitigate it if it appears
- We know that phosphatidylserine supplementation may help with most (if not all) of the above
- We don’t sell that (or anything else) but for your convenience, here it is on Amazon if you’re interested
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Fasting Without Crashing?
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Intermittent Fasting: What’s the truth?
Before we get to facts and fictions, let’s quickly cover:
What is Intermittent Fasting?
Intermittent Fasting (IF) is an umbrella term for various kinds of time-restricted fasting, based on a schedule. Types include:
Time-restricted IF, for example:
- 16:8—Fast for 16 hours, eat during an 8-hour window
- 18:6–Fast for 18 hours, eat during a 6-hour window
- 20:4—Fast for 20 hours, eat during a 4-hour window
24hr fasting, including:
- Eat Stop Eat—basically, take a day off from eating once a week
- Alternate Day Fasting—a more extreme version of the above; it is what it sounds like; eat one day, fast the next, repeat
Non-fast fasting, e.g:
- 5:2—Eat normally for 5 days, have a very reduced calorie intake (⅓ of normal intake) for the other 2 days
- Fruit Fasting—have a small amount of fruit on “fast” days, but no other food
- The Warrior Diet—as above, but include a small amount of non-starchy vegetables
Why IF?
While IF is perhaps most commonly undertaken as a means of fat loss or fat management (i.e., keeping fat down when it is already low), others cite different reasons, such as short term cognitive performance or long-term longevity.
But… Does it work?
Here we get into the myth-busting bit!
“IF promotes weight loss”
Mix of True and False. It can! But it also doesn’t have to. If you’re a bodybuilder who downs 4,000 calories in your 4hr eating window, you’re probably not going to lose weight! For such people, this is of course “a feature, not a bug” of IF—especially as it has been found that, in an acute study, IF did not adversely impact muscle protein synthesis.
“IF promotes fat loss, without eating less”
Broadly True. IF was found to be potentially equal to, but not necessarily better than, eating less.
“IF provides metabolic benefits for general health”
Broadly True. IF (perhaps counterintuitively) decreases the risk of insulin resistance, and also has anti-inflammatory effects, benefits a healthy gut microbiome, and promotes healthy autophagy (which as we noted in a previous edition of 10almonds, is important against both aging and cancer)
However, results vary according to which protocol you’re observing…
For what it’s worth, 16:8 is perhaps the most-studied protocol. Because such studies tend to have the eating window from midday to 8pm, this means that—going against popular wisdom—part of the advice here is basically “skip breakfast”.
“Unlike caloric restriction, IF is sustainable and healthy as a long-term protocol”
Broadly True. Of course, there’s a slight loophole here in that IF is loosely defined—technically everyone fasts while they’re sleeping, at the very least!
However, for the most commonly-studied IF method (16:8), this is generally very sustainable and healthy and for most people.
On the other hand, a more extreme method such as Alternate Day Fasting, may be trickier to sustain (even if it remains healthy to do so), because it’s been found that hunger does not decrease on fasting days—ie, the body does not “get used to it”.
The American Journal of Clinical Nutrition wrote:
❝Alternate-day fasting was feasible in nonobese subjects, and fat oxidation increased. However, hunger on fasting days did not decrease, perhaps indicating the unlikelihood of continuing this diet for extended periods of time. Adding one small meal on a fasting day may make this approach to dietary restriction more acceptable.❞
“IF improves mood and cognition”
Mix of True and False (plus an honest “We Don’t Know” from researchers).
Many studies have found benefits to both mood and cognition, but in the short-term, fasting can make people “hangry” (or: “experience irritability due to low blood sugar levels”, as the scientists put it), and in the long term, it can worsen symptoms of depression for those who already experience such—although some studies have found it can help alleviate depressive symptoms.
Basically this is one where researchers typically append the words “more research is needed” to their summaries.
“Anyone can do IF”
Definitely False, unless going by the absolute broadest possible interpretation of what constitutes “Intermittent Fasting” to the point of disingenuity.
For example, if you are Type 1 Diabetic, and your blood sugars are hypo, and you wait until tomorrow to correct that, you will stand a good chance of going into a coma instead. So please don’t.
(On the other hand, IF may help achieve remission of type 2 diabetes)
Lastly, IF is broadly not recommend to children and adolescents, anyone pregnant or breastfeeding, and certain underlying health conditions not mentioned above (we’re not going to try to give an exhaustive list here, but basically, if you have a chronic health condition, we recommend you check with your doctor first).
WHICH APP?
Choosing a fasting app
Thinking of giving IF a try and would like a little extra help? We’ve got you covered!
Check out: Livewire’s 7 Best Intermittent Fasting Apps of 2023
Prefer to just trust us with a recommendation?
We like BodyFast—it’s #2 on Lifewire’s list, but it has an array of pre-set plans to choose from (unlike Lifewire’s #1, Zero), and plenty of clear tracking, scheduling help, and motivational features.
Both are available on both iOS and Android:
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Heart Health vs Systemic Stress
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At The Heart Of Good Health
This is Dr. Michelle Albert. She’s a cardiologist with a decades-long impressive career, recently including a term as the president of the American Heart Association. She’s the current Admissions Dean at UCSF Medical School. She’s accumulated enough awards and honors that if we list them, this email will not fit in your inbox without getting clipped.
What does she want us to know?
First, lifestyle
Although Dr. Albert is also known for her work with statins (which found that pravastatin may have anti-inflammatory effects in addition to lipid-lowering effects, which is especially good news for women, for whom the lipid-lowering effects may be less useful than for men), she is keen to emphasize that they should not be anyone’s first port-of-call unless “first” here means “didn’t see the risk until it was too late and now LDL levels are already ≥190 mg/dL”.
Instead, she recommends taking seriously the guidelines on:
- getting plenty of fruit, vegetables, whole grains, lean protein
- avoiding red meat, processed meats, refined carbohydrates, and sweetened beverages
- getting your 150 minutes per week of moderate exercise
- avoiding alcohol, and definitely abstaining from smoking
See also: These Top Five Things Make The Biggest Difference To Health
Next, get your house in order
No, not your home gym—though sure, that too!
But rather: after the “Top Five Things” we linked just above, the sixth on the list would be “reduce stress”. Indeed, as Dr. Albert says:
❝Heart health is not just about the physical heart but also about emotional well-being. Stress management is crucial for a healthy heart❞
~ Dr. Michelle Albert
This is where a lot of people would advise mindfulness meditation, CBT, somatic therapies, and the like. And these things are useful! See for example:
No-Frills, Evidence-Based Mindfulness
…and:
However, Dr. Albert also advocates for awareness of what some professionals have called “Shit Life Syndrome”.
This is more about socioeconomic factors. There are many of those that can’t be controlled by the individual, for example:
❝Adverse maternal experiences such as depression, economic issues and low social status can lead to poor cognitive outcomes as well as cardiovascular disease.
Many jarring statistics illuminate a marked wealth gap by race and ethnicity… You might be thinking education could help bridge that gap. But it is not that simple.
While education does increase wealth, the returns are not the same for everyone. Black persons need a post-graduate degree just to attain similar wealth as white individuals with a high school degree.❞
~ Dr. Michelle Albert
Read in full: AHA president: The connection between economic adversity and cardiovascular health
What this means in practical terms (besides advocating for structural change to tackle the things such as the racism that has been baked into a lot of systems for generations) is:
Be aware not just of your obvious health risk factors, but also your socioeconomic risk factors, if you want to have good general health outcomes.
So for example, let’s say that you, dear reader, are wealthy and white, in which case you have some very big things in your favor, but are you also a woman? Because if so…
Women and Minorities Bear the Brunt of Medical Misdiagnosis
See also, relevant for some: Obesity Discrimination In Healthcare Settings ← you’ll need to scroll to the penultimate section for this one.
In other words… If you are one of the majority of people who is a woman and/or some kind of minority, things are already stacked against you, and not only will this have its own direct harmful effect, but also, it’s going to make your life harder and that stress increases CVD risk more than salt.
In short…
This means: tackle not just your stress, but also the things that cause that. Look after your finances, gather social support, know your rights and be prepared to self-advocate / have someone advocate for you, and go into medical appointments with calm well-prepared confidence.
Take care!
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Feeding You Lies – by Vani Hari
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When it comes to advertising, we know that companies will often be as misleading as they can get away with. But just how misleading is it?
Vani Hari, of “Food Babe” fame, is here to unravel it all.
The book covers many areas of food and drink advertising and marketing, and gives particular attention to:
- Sodas (with and without sugar), and how deleterious they are to the health—as well as not even helping people lose weight, but actively hindering
- Nutritionally fortified foods, and what we may or may not actually get from them by the time the processing is done
- Organic food, and what that may or may not mean
She also covers a lot of what happens outside of supermarkets, way back in universities and corporate boardrooms. In short, who is crossing whose palms with silver for a seal of approval… And what that means for us as consumers.
A strength of this book that sets it apart from many of its genre, by the way, is that while being deeply critical of certain institutions’ practices, it doesn‘t digress into tinfoil-hat pseudoscientific scaremongering, either. Here at 10almonds we love actual science, so that was good to see too.
Bottom line: is you’d like to know “can they say that and get away with it if it’s not true?” and make decisions based on the actual nutritional value of things, this is a great book for you.
Click here to check out “Feeding You Lies” on Amazon and make your shopping healthier!
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Jamaican Coconut Rice
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This is a great dish that can be enjoyed hot or cold, as a main or as a side. It has carbs, proteins, healthy fats, fiber, as well as an array of healthy phytochemicals. Not to mention, a great taste!
You will need
- 1 cup wholegrain basmati rice (it may also be called “brown basmati rice“; this is the same) (traditional recipe calls for pudding rice, but we’re going with the healthier option here)
- 2 cans (each 12 z / 400g) coconut milk
- 2 cups (or 2 cans, of which the drained weight is comparable to a cup each) cooked black beans. If you cook them yourself, this is better, as you will be able to cook them more al dente than you can get from a can, and this firmness is desirable. But canned is fine if that’s what’s available.
- 1 large red onion, finely chopped
- ½ cup low-sodium vegetable stock (ideally you made this yourself from vegetable offcuts you saved in the freezer for this purpose, but failing that, low-sodium stock cubes can be bought at any large supermarket)
- 2 serrano chilis, finely chopped
- 1 Scotch bonnet chili, without doing anything to it
- 1 tbsp black pepper, coarse ground
- 1 tbsp chia seeds
- 1 tbsp coconut oil
- Garnish: parsley, chopped
Note: we have erred on the side of low-heat when it comes to the chilis. If you know that you and (if applicable) everyone else eating would enjoy more heat, add more heat. If not, let extra heat be added at the table via your hot sauce of choice. Sounds heretical, but it ensures everyone gets the right amount! It’s easy to add heat than to take it out, after all.
However: if you do end up with too much heat in this or any other dish, adding acid will usually help to neutralize that. In the case of this dish, we’d recommend lime juice as a complementary flavor.
Method
(we suggest you read everything at least once before doing anything)
1) In a big sauté pan, add the coconut oil, melt it if not already melted, and add the chopped onion and the chopped chilis, at a temperature sufficient to sizzle. Keep them all moving. Once the coconut oil is absorbed into the onion (this will happen before the onion is fully cooked), add the vegetable stock, followed by the coconut milk; mix it all gently to create a smooth consistency.
2) Add the rice, chia seeds, and black pepper; mix it all gently but thoroughly; turn the temperature to a simmer, and add the Scotch bonnet chili, without cutting it at all.
3) Cover and keep on low for about 20–30 minutes until the rice is looking done. Check on it periodically to make sure it’s not running out of liquid, but resist the urge to stir it; it shouldn’t be burning but paradoxically, once you start stirring you can’t stop or it will definitely burn.
4) Take out the Scotch bonnet chili, and discard*. Add the black beans.
*its job was to add flavor without adding the high-level heat of that particular chili. If you’re a regular heat-fiend, feel free to experiment with using sliced Scotch bonnet chilis instead of serrano chilis; just be aware that there’s a big difference in heat. Only do this if you really like heat. Using it the way we described in the main recipe is what’s traditional in the Caribbean, by the way.
5) Now you can (and in fact must) stir, to mix in the black beans and bring them back to temperature within the dish. Be aware that once you start stirring, you need to keep stirring until you’re ready to take it off the heat.
6) Serve, adding the parsley garnish.
(this example went light on the beans; our recipe includes more for a heartier dish)
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Should You Go Light Or Heavy On Carbs?
- Our Top 5 Spices: How Much Is Enough For Benefits?
- Why You’re Probably Not Getting Enough Fiber (And How To Fix It)
- Burn! How To Boost Your Metabolism
- Capsaicin For Weight Loss And Against Inflammation
Take care!
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails: