How Does Someone Die From Dementia?
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Dementia is most often thought of in terms of the loss of certain cognitive faculties during the disease’s progress. So how does death occur?
A quiet departure
Notwithstanding it being a widely-feared disease (or set of diseases, since we’re using the umbrella term of dementia, and not the most well-known and common kind, Alzheimer’s), death from dementia is usually a peaceful one; any distressing confusions are usually in the past by this point.
Sometimes, it is not the dementia itself that directly causes death; rather, it leaves someone much more vulnerable to infections, with pneumonia being top of the list, and UTIs also ranking highly. And while a younger healthier person might drink some cranberry juice and shrug it off, for an older person with dementia, even a UTI can be much more serious. Pneumonia, of course, is well-known for often being the final straw.
Sometimes, it is the dementia that directly causes death; the disease causes a slow decline until the person stops eating and drinking. At this time, they will also tend to sleep more, and as mentioned, experience much less agitation and confusion than previously.
In terms of caregiving at this late stage, the hospice worker in the video recommends to do one’s best to keep the person clean and safe from falls or infections, check common pressure sore sites for redness, changing their position if necessary and using pillows to relieve any undue pressure.
For more on all of this, see:
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Want to learn more?
You might also like to read:
When Planning Is A Matter of Life & Death: Managing Your Mortality
Take care!
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Random Acts of Medicine – by Dr. Anupam Jena & Dr. Christopher Worsham
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We talked recently of small things that can change how productive your doctor’s appointment is, and this book is a more scientific version of that, and on a grander scale.
The author use what they call “natural experiments”, essentially observational studies, to determine what factors beyond the obvious affect health outcomes. With this approach, they address such questions as why kids with summer birthdays are more likely to get the flu, and why heart attack outcomes improve when there’s a cardiologists’ convention elsewhere. And many more such things that can seem like non-causal correlation, until one examines the causative factors, and controls (in the statistical analysis; remember this is still entirely observational, so no interventions are made) for other potential confounding factors.
They also look at what factors influence doctors’ decisions in ways they certainly shouldn’t, but they do, because doctors are as prone to biases as everyone else. And, for that matter, what factors influence patients’ decisions in ways they certainly shouldn’t—for the same reason. The authors acknowledge that they themselves are not immune, and you, dear reader, are not immune either.
Nevertheless, the practical value in this book comes from trying to at least be more aware of such things, the better to either leverage them, or at least ensure you don’t fall foul of them.
The style is conversational pop-science, making for quite light reading, albeit with many footnotes and a respectable bibliography.
Bottom line: if you’d like to understand more about the machinations that decide who lives and who dies (especially when sometimes it will be you or a loved one who lives or dies), then this is a fascinating book that that delves deeply into that.
Click here to check out Random Acts Of Medicine, and be aware!
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How To *Really* Pick Up (And Keep!) Those Habits
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The Healthiest Habit-Building
Why was that book “Atomic Habits” called that? It wasn’t just because it’s a catchy title…
Habits are—much like atoms—things that are almost imperceptibly small, yet when stacked, they make up the substance of many much larger and more obvious things, and also contain an immense amount of potential power.
About that power…
Habits are the “compound interest” of natural human life. Every action we take, every decision we make, makes our life (often imperceptibly) better or worse. But getting even just 1% better or 1% worse at something every day? That’s going to not just add up over time… It’ll actively compound over time.
Habits will snowball one way or the other, good or bad. So, we want to control that snowball so that it works for us rather than against us.
Thus, we need to choose habits that are helpful to us, rather than those that are harmful to us. Top examples include:
- Making healthy food choices rather than unhealthy ones
- Moving our body regularly rather than being sedentary
- Having a good bedtime/morning routine rather than a daily chaotic blur
- Learning constantly rather than digging into old beliefs out of habit
- Forging healthy relationships rather than isolating ourselves
We all know that to make a habit stick, we need to practice it regularly, with opinions varying on how long it takes for something to become habit. Some say 21 days; some say 66. The number isn’t the important part!
What is important
You will never get to day 66, much less will you get to day 366, if you don’t first get to day 6 (New Year’s Resolutions, anyone?).
So in the early days especially, when the habit is most likely to get dropped, it’s critical to make the habit as easy as possible to form.
That means:
- The habit should be made as pleasant as possible
- (e.g. by making modifications to it if it’s not already intrinsically pleasant)
- The habit should take under 2 minutes to do at first
- (no matter if it takes longer than 2 minutes to be useful; it’ll never be useful if you don’t first get it to stick, so make your initial commitment only 2 minutes, just to get in the habit)
- The habit should have cues to remind you
- (as it’s not habit yet, you will need to either set a reminder on your phone, or leave a visual reminder, such as your workout clothes laid out ready for you in the morning, or a bowl of fruit in plain view where you spend a lot of time)
What gets measured, gets done
Streaks are a great way to do this. Habit-tracking apps help. Marks on a calendar or in a journal are also totally fine.
What can help especially, and that a lot of people don’t do, is to have a system of regular personal reviews—like a work “performance review”, but for oneself and one’s own life.
Set a reminder or write on the calendar / in your diary, to review monthly, or weekly if you prefer, such things as:
- How am I doing in the areas of life that are important to me?
- Have a list of the areas of life that are important to you, by the way, and genuinely reflect on each of them, e.g:
- Health
- Finances
- Relationships
- Learning
- Sleep
- Etc
- Have a list of the areas of life that are important to you, by the way, and genuinely reflect on each of them, e.g:
- What is working for me, and what isn’t working for me?
- What will I do better in this next month/week?
…and then do it!
Good luck, and may it all stack up in your favor!
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Reishi Mushrooms: Which Benefits Do They Really Have?
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Reishi Mushrooms
Another Monday Research Review, another mushroom! If we keep this up, we’ll have to rename it “Mushroom Monday”.
But, there’s so much room for things to say, and these are fun guys to write about, as we check the science for any spore’ious claims…
Why do people take reishi?
Popular health claims for the reishi mushroom include:
- Immune health
- Cardiovascular health
- Protection against cancer
- Antioxidant qualities
- Reduced fatigue and anxiety
And does the science agree?
Let’s take a look, claim by claim:
Immune health
A lot of research for this has been in vitro (ie, with cell cultures in labs), but promising, for example:
Immunomodulating Effect of Ganoderma lucidum (Lingzhi) and Possible Mechanism
(that is the botanical name for reishi, and the Chinese name for it, by the way)
That’s not to say there are no human studies though; here it was found to boost T-cell production in stressed athletes:
Cardiovascular health
Here we found a stack of evidence for statistically insignificant improvements in assorted measures of cardiovascular health, and some studies where reishi did not outperform placebo.
Because the studies were really not that compelling, instead of taking up room (and your time) with them, we’re going to move onto more compelling, exciting science, such as…
Protection against cancer
There’s a lot of high quality research for this, and a lot of good results. The body of evidence here is so large that even back as far as 2005, the question was no longer “does it work” or even “how does it work”, but rather “we need more clinical studies to find the best doses”. Researchers even added:
❝At present, lingzhi is a health food supplement to support cancer patients, yet the evidence supporting the potential of direct in vivo anticancer effects should not be underestimated.❞
Check it out:
Anticancer effects of Ganoderma lucidum: a review of scientific evidence
Just so you know we’re not kidding about the weight of evidence, let’s drop a few extra sources:
- Ganoderma lucidum: a rational pharmacological approach to surmount cancer
- Ganoderma lucidum as an anti-cancer agent
- Extract from Ganoderma lucidum suppresses cervical cancer cell malignancy
- Ganoderma lucidum spore oil induces apoptosis of breast cancer cells
- Ganoderma lucidum enhances carboplatin chemotherapy effect
- Ganoderma lucidum inhibits prostate cancer cell migration
- Ganoderma lucidum fruiting body extracts inhibit colorectal cancer
- Inhibitory activity of medicinal mushroom Ganoderma lucidum on colorectal cancer
- Ganoderma lucidum (reishi mushroom) for cancer treatment
By the way, we shortened most of those titles for brevity, but almost all of the continued with “by” followed by a one-liner of how it does it.
So it’s not a “mysterious action” thing, it’s a “this is a very potent medicine and we know how it works” thing.
Antioxidant qualities
Here we literally only found studies to say no change was found, one that found a slight increase of antioxidant levels in urine. It’s worth noting that levels of a given thing (or its metabolites, in the case of some things) in urine are often quite unhelpful regards knowing what’s going on in the body, because we get to measure only what the body lost, not what it gained/kept.
So again, let’s press on:
Reduced fatigue and anxiety
Most of the studies for this that we could find pertained to health-related quality of life for cancer patients specifically, so (while they universally give glowing reports of reishi’s benefits to health and happiness of cancer patients), that’s a confounding factor when it comes to isolating its effects on reduction of fatigue and anxiety in people without cancer.
Here’s one that looked at it in the case of reduction of fatigue, anxiety, and other factors, in patients without cancer (but with neurathenia), in which they found it was “significantly superior to placebo with respect to the clinical improvement of symptoms”.
Summary:
- Reishi mushroom’s anti-cancer properties are very, very clear
- There is also good science to back immune health claims
- It also has been found to significantly reduce fatigue and anxiety in unwell patients (we’d love to see more studies on its benefits in otherwise healthy people, though)
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Forever Strong – by Dr. Gabrielle Lyon
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Obesity kills a lot of people (as does medical neglect and malpractice when it comes to obese patients, but that is another matter), but often the biggest problem is not “too much fat” but rather “too little muscle”. This gets disguised a bit, because these factors often appear in the same people, but it’s a distinction that’s worthy of note.
Dr. Lyon lays out a lot of good hard science in this work, generally in the field of protein metabolism, but also with a keen eye on all manner of blood metrics (triglycerides, LDL/HDL, fasting blood sugars, assorted other biomarkers of metabolic health).
The style of this book is two books in one. It’s a very accessible pop-science book in its primary tone, with an extra layer of precise science and lots of references, for those who wish to dive into that.
In the category of criticism, the diet plan section of the book is rather meat-centric, but the goal of this is protein content, not meat per se, so substitutions can easily be made. That’s just one small section of the book, though, and it’s little enough a downside that even Dr. Mark Hyman (a popular proponent of plant-based nutrition) highly recommends the book.
Bottom line: if you’d like to be less merely fighting decline and more actually becoming healthier as you age, then this book will help you do just that.
Click here to check out Forever Strong, and level up your wellness as you age!
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Level-Up Your Fiber Intake! (Without Difficulty Or Discomfort)
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Why You’re Probably Not Getting Enough Fiber (And How To Fix It)
First things first… How much fiber should we be eating?
- The World Health Organization recommends we each get at least 25g of fiber per day:
- A more recent meta-review of studies, involving thousands of people and decades of time, suggests 25–29g is ideal:
- The British Nutritional Foundation gives 30g as the figure:
- The US National Academy of Sciences’ Institute of Medicine recommends 21g–38g per day, depending on age and sex:
- A large study last year gave 30–40g as the figure:
*This one is also a great read to understand more about the “why” of fiber
Meanwhile, the average American gets 16g of fiber per day.
So, how to get more fiber, without piling on too many carbs?
Foods that contain fiber generally contain carbs (there’s a limit to how much celery most people want to eat), so there are two key ideas here:
- Getting a good carb:fiber ratio
- Making substitutions that boost fiber without overdoing (or in some case, even changing) carbs
Meat → Lentils
Well-seasoned lentils can be used to replaced ground beef or similar. A cup of boiled lentils contains 18g of fiber, so you’re already outdoing the average American’s daily total.
Meat → Beans
Black beans are a top-tier option here (15g per cup, cooked weight), but many kinds of beans are great.
Chicken/Fish → Chickpeas
Yes, chicken/fish is already meat, but we’re making a case for chickpeas here. Cooked and seasoned appropriately, they do the job, and pack in 12g of fiber per cup. Also… Hummus!
Bonus: Hummus, eaten with celery sticks.
White pasta/bread → Wholewheat pasta/bread
This is one where “moderation is key”, but if you’re going to eat pasta/bread, then wholewheat is the way to go. Fiber amounts vary, so read labels, but it will always have far more than white.
Processed salty snacks → Almonds and other nuts
Nuts in general are great, but almonds are top-tier for fiber, amongst other things. A 40g handful of almonds contains about 10g of fiber.
Starchy vegetables → Non-starchy vegetables
Potatoes, parsnips, and their friends have their place. But they cannot compete with broccoli, peas, cabbage, and other non-starchy vegetables for fiber content.
Bonus: if you’re going to have starchy vegetables though, leave the skins on!
Fruit juice → Fruit
Fruit juice has had most, if not all, of its fiber removed. Eat an actual juicy fruit, instead. Apples and bananas are great options; berries such as blackberries and raspberries are even better (at around 8g per cup, compared to the 5g or so depending on the size of an apple/banana)
Processed cereals → Oats
5g fiber per cup. Enough said.
Summary
Far from being a Herculean task, getting >30g of fiber per day can be easily accomplished by a lentil ragù with wholewheat pasta.
If your breakfast is overnight oats with fruit and some chopped almonds, you can make it to >20g already by the time you’ve finished your first meal of the day.
Enjoy!
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Self-Compassion – by Dr. Kristin Neff
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A lot of people struggle with self-esteem, and depending on one’s surrounding culture, it can even seem socially obligatory to be constantly valuing oneself highly (or else, who else will if we do not?). But, as Dr. Neff points out, there’s an inherent problem with reinforcing for oneself even a positive message like “I am smart, strong, and capable!” because sometimes all of us have moments of being stupid, weak, and incapable (occasionally all three at once!), which places us in a position of having to choose between self-deceit and self-deprecation, neither of which are good.
Instead, Dr. Neff advocates for self-compassion, for treating oneself as one (hopefully) would a loved one—seeing their/our mistakes, weaknesses, failures, and loving them/ourself anyway.
She does not, however, argue that we should accept just anything from ourselves uncritically, but rather, we identify our mistakes, learn, grow, and progress. So not “I should have known better!”, nor even “How was I supposed to know?!”, but rather, “Now I have learned a thing”.
The style of the book is quite personal, as though having a heart-to-heart over a hot drink perhaps, but the format is organized and progresses naturally from one idea to the next, taking the reader to where we need to be.
Bottom line: if you have trouble with self-esteem (as most people do), then that’s a trap that there is a way out of, and it doesn’t require being perfect or lowering one’s standards, just being kinder to oneself along the way—and this book can help inculcate that.
Click here to check out Self-Compassion, and indeed be kind to yourself!
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