
I’m So Effing Tired – by Dr. Amy Shah
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It’s easy sometimes to feel like we know more or less what we should be doing… If only we had the energy to get going!
- We know we want a better diet… But we don’t have the time/energy to cook so will go for the quickest option even when it’s not the best?
- We know we should exercise… But feel we just need to crash out on the couch for a bit first?
- We would dearly love to get better sleep… But our responsibilities aren’t facilitating that?
…and so on. Happily, Dr. Amy Shah is here with ways to cut through the Gordian Knot that is this otherwise self-perpetuating cycle of exhaustion.
Most of the book is based around tackling what Dr. Shah calls “the energy trifecta“:
- Hormone levels
- Immune system
- Gut health
You’ll note (perhaps with relief) that none of these things require an initial investment of energy that you don’t have… She’s not asking you to hit the gym at 5am, or magically bludgeon your sleep schedule into its proper place, say.
Instead, what she gives is practical, actionable, easy changes that don’t require much effort, to gently slide us back into the fast lane of actually having energy to do stuff!
In short: if you’ve ever felt like you’d like to implement a lot of very common “best practice” lifestyle advice, but just haven’t had the energy to get going, there’s more value in this handbook than in a thousand motivational pep talks.
Click here to check out “I’m So Effing Tired” and get on a better track of life!
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Older Men’s Connections Often Wither When They’re on Their Own
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At age 66, South Carolina physician Paul Rousseau decided to retire after tending for decades to the suffering of people who were seriously ill or dying. It was a difficult and emotionally fraught transition.
“I didn’t know what I was going to do, where I was going to go,” he told me, describing a period of crisis that began in 2017.
Seeking a change of venue, Rousseau moved to the mountains of North Carolina, the start of an extended period of wandering. Soon, a sense of emptiness enveloped him. He had no friends or hobbies — his work as a doctor had been all-consuming. Former colleagues didn’t get in touch, nor did he reach out.
His wife had passed away after a painful illness a decade earlier. Rousseau was estranged from one adult daughter and in only occasional contact with another. His isolation mounted as his three dogs, his most reliable companions, died.
Rousseau was completely alone — without friends, family, or a professional identity — and overcome by a sense of loss.
“I was a somewhat distinguished physician with a 60-page resume,” Rousseau, now 73, wrote in the Journal of the American Geriatrics Society in May. “Now, I’m ‘no one,’ a retired, forgotten old man who dithers away the days.”
In some ways, older men living alone are disadvantaged compared with older women in similar circumstances. Research shows that men tend to have fewer friends than women and be less inclined to make new friends. Often, they’re reluctant to ask for help.
“Men have a harder time being connected and reaching out,” said Robert Waldinger, a psychiatrist who directs the Harvard Study of Adult Development, which has traced the arc of hundreds of men’s lives over a span of more than eight decades. The men in the study who fared the worst, Waldinger said, “didn’t have friendships and things they were interested in — and couldn’t find them.” He recommends that men invest in their “social fitness” in addition to their physical fitness to ensure they have satisfying social interactions.
Slightly more than 1 in every 5 men ages 65 to 74 live alone, according to 2022 Census Bureau data. That rises to nearly 1 in 4 for those 75 or older. Nearly 40% of these men are divorced, 31% are widowed, and 21% never married.
That’s a significant change from 2000, when only 1 in 6 older men lived by themselves. Longer life spans for men and rising divorce rates are contributing to the trend. It’s difficult to find information about this group — which is dwarfed by the number of women who live alone — because it hasn’t been studied in depth. But psychologists and psychiatrists say these older men can be quite vulnerable.
When men are widowed, their health and well-being tend to decline more than women’s.
“Older men have a tendency to ruminate, to get into our heads with worries and fears and to feel more lonely and isolated,” said Jed Diamond, 80, a therapist and the author of “Surviving Male Menopause” and “The Irritable Male Syndrome.”
Add in the decline of civic institutions where men used to congregate — think of the Elks or the Shriners — and older men’s reduced ability to participate in athletic activities, and the result is a lack of stimulation and the loss of a sense of belonging.
Depression can ensue, fueling excessive alcohol use, accidents, or, in the most extreme cases, suicide. Of all age groups in the United States, men over age 75 have the highest suicide rate, by far.
For this column, I spoke at length to several older men who live alone. All but two (who’d been divorced) were widowed. Their experiences don’t represent all men who live alone. But still, they’re revealing.
The first person I called was Art Koff, 88, of Chicago, a longtime marketing executive I’d known for several years. When I reached out in January, I learned that Koff’s wife, Norma, had died the year before, leaving him hobbled by grief. Uninterested in eating and beset by unremitting loneliness, Koff lost 45 pounds.
“I’ve had a long and wonderful life, and I have lots of family and lots of friends who are terrific,” Koff told me. But now, he said, “nothing is of interest to me any longer.”
“I’m not happy living this life,” he said.
Nine days later, I learned that Koff had died. His nephew, Alexander Koff, said he had passed out and was gone within a day. The death certificate cited “end stage protein calorie malnutrition” as the cause.
The transition from being coupled to being single can be profoundly disorienting for older men. Lodovico Balducci, 80, was married to his wife, Claudia, for 52 years before she died in October 2023. Balducci, a renowned physician known as the “patriarch of geriatric oncology,” wrote about his emotional reaction in the Journal of the American Geriatrics Society, likening Claudia’s death to an “amputation.”
“I find myself talking to her all the time, most of the time in my head,” Balducci told me in a phone conversation. When I asked him whom he confides in, he admitted, “Maybe I don’t have any close friends.”
Disoriented and disorganized since Claudia died, he said his “anxiety has exploded.”
We spoke in late February. Two weeks later, Balducci moved from Tampa to New Orleans, to be near his son and daughter-in-law and their two teenagers.
“I am planning to help as much as possible with my grandchildren,” he said. “Life has to go on.”
Verne Ostrander, a carpenter in the small town of Willits, California, about 140 miles north of San Francisco, was reflective when I spoke with him, also in late February. His second wife, Cindy Morninglight, died four years ago after a long battle with cancer.
“Here I am, almost 80 years old — alone,” Ostrander said. “Who would have guessed?”
When Ostrander isn’t painting watercolors, composing music, or playing guitar, “I fall into this lonely state, and I cry quite a bit,” he told me. “I don’t ignore those feelings. I let myself feel them. It’s like therapy.”
Ostrander has lived in Willits for nearly 50 years and belongs to a men’s group and a couples’ group that’s been meeting for 20 years. He’s in remarkably good health and in close touch with his three adult children, who live within easy driving distance.
“The hard part of living alone is missing Cindy,” he told me. “The good part is the freedom to do whatever I want. My goal is to live another 20 to 30 years and become a better artist and get to know my kids when they get older.”
The Rev. Johnny Walker, 76, lives in a low-income apartment building in a financially challenged neighborhood on Chicago’s West Side. Twice divorced, he’s been on his own for five years. He, too, has close family connections. At least one of his several children and grandchildren checks in on him every day.
Walker says he had a life-changing religious conversion in 1993. Since then, he has depended on his faith and his church for a sense of meaning and community.
“It’s not hard being alone,” Walker said when I asked whether he was lonely. “I accept Christ in my life, and he said that he would never leave us or forsake us. When I wake up in the morning, that’s a new blessing. I just thank God that he has brought me this far.”
Waldinger recommended that men “make an effort every day to be in touch with people. Find what you love — golf, gardening, birdwatching, pickleball, working on a political campaign — and pursue it,” he said. “Put yourself in a situation where you’re going to see the same people over and over again. Because that’s the most natural way conversations get struck up and friendships start to develop.”
Rousseau, the retired South Carolina doctor, said he doesn’t think about the future much. After feeling lost for several years, he moved across the country to Jackson, Wyoming, in the summer of 2023. He embraced solitude, choosing a remarkably isolated spot to live — a 150-square-foot cabin with no running water and no bathroom, surrounded by 25,000 undeveloped acres of public and privately owned land.
“Yes, I’m still lonely, but the nature and the beauty here totally changed me and focused me on what’s really important,” he told me, describing a feeling of redemption in his solitude.
Rousseau realizes that the death of his parents and a very close friend in his childhood left him with a sense of loss that he kept at bay for most of his life. Now, he said, rather than denying his vulnerability, he’s trying to live with it. “There’s only so long you can put off dealing with all the things you’re trying to escape from.”
It’s not the life he envisioned, but it’s one that fits him, Rousseau said. He stays busy with volunteer activities — cleaning tanks and running tours at Jackson’s fish hatchery, serving as a part-time park ranger, and maintaining trails in nearby national forests. Those activities put him in touch with other people, mostly strangers, only intermittently.
What will happen to him when this way of living is no longer possible?
“I wish I had an answer, but I don’t,” Rousseau said. “I don’t see my daughters taking care of me. As far as someone else, I don’t think there’s anyone else who’s going to help me.”
We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care, and advice you need in dealing with the health care system. Visit http://kffhealthnews.org/columnists to submit your requests or tips.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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How Not to Diet – by Dr. Michael Greger
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We’ve talked before about Dr. Greger’s famous “How Not To Die” book, and we love it and recommend it… But… It is, primarily, a large, dry textbook. Full of incredibly good science and information about what is statistically most likely to kill us and how to avoid that… but it’s not the most accessible.
“How Not To Diet“, on the other hand, is a diet book, is very readable, and assumes the reader would simply like to know how to healthily lose weight.
By focussing on this one problem, rather than the many (admittedly important) mortality risks, the reading is a lot easier and lighter. And, because it’s still Dr. Greger advocating for the same diet, you’ll still get to reduce all those all-cause mortality risks. You won’t be reading about them in this book; it will now just be a happy side effect.
While in “How Not To Die”, Dr. Greger looked at what was killing people and then tackled those problems, here he’s taken the same approach to just one problem… Obesity.
So, he looks at what is causing people to be overweight, and methodically tackles those problems.
We’ll not list them all here—there are many, and this is a book review, not a book summary. But suffice it to say, the work is comprehensive.
Bottom line: this book methodically and clinically (lots of science!) looks at what makes us overweight… And tackles those problems one by one, giving us a diet optimized for good health and weight loss. If you’d like to shed a few pounds in a healthy, sustainable way (that just happens to significantly reduce mortality risk from other causes too) then this is a great book for you!
Click here to check out “How Not To Diet” on Amazon and get healthy for life!
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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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The Herbal Supplement That Rivals Prozac
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Flower Power: St. John’s Wort’s Drug-Level Effectiveness
St. John’s wort is a small yellow flower, extract of which can be bought inexpensively off-the-shelf in pretty much any pharmacy in most places.
It’s sold and used as a herbal mood-brightener.
Does it work?
Yes! It’s actually very effective. This is really uncontroversial, so we’ll keep it brief.
The main findings of studies are that St. John’s wort not only gives significant benefits over placebo, but also works about as well as prescription anti-depressants:
A systematic review of St. John’s wort for major depressive disorder
They also found that fewer people stop taking it, compared to how many stop taking antidepressants. It’s not known how much of this is because of its inexpensive, freely-accessible nature, and how much might be because it gave them fewer adverse side effects:
Clinical use of Hypericum perforatum (St John’s wort) in depression: A meta-analysis
How does it work?
First and foremost, it’s an SSRI—a selective serotonin reuptake inhibitor. Basically, it doesn’t add serotonin, but it makes whatever serotonin you have, last longer. Same as most prescription antidepressants. It also affects adenosine and GABA pathways, which in lay terms, means it promotes feelings of relaxation, in a similar way to many prescription antianxiety medications.
Mechanism of action of St John’s wort in depression: what is known?
Any problems we should know about?
Yes, definitely. To quote directly from the National Center for Complementary and Integrative Health:
St. John’s wort can weaken the effects of many medicines, including crucially important medicines such as:
- Antidepressants
- Birth control pills
- Cyclosporine, which prevents the body from rejecting transplanted organs
- Some heart medications, including digoxin and ivabradine
- Some HIV drugs, including indinavir and nevirapine
- Some cancer medications, including irinotecan and imatinib
- Warfarin, an anticoagulant (blood thinner)
- Certain statins, including simvastatin
I’ve read all that, and want to try it!
As ever, we don’t sell it (or anything else), but here’s an example product on Amazon.
Please be safe and do check with your doctor and/or pharmacist, though!
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Lucid Dreaming – by Stephen LaBerge Ph.D.
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For any unfamiliar: lucid dreaming means being aware that one is dreaming, while dreaming, and exercising a degree of control over the dream. Superficially, this is fun. But if one really wants to go deeper into it, it can be a lot more:
Dr. Stephen LaBerge takes a science-based approach to lucid dreaming, and in this work provides not only step-by-step instructions of several ways of inducing lucid dreaming, but also, opens the reader’s mind to things that can be done there beyond the merely recreational:
In lucid dreams, he argues and illustrates, it’s possible to talk to parts of one’s own subconscious (Inception, anyone? Yes, this book came first) and get quite an amount of self-therapy done. And that hobby you wish you had more time to practice? The possibilities just became limitless. And who wouldn’t want that?
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Gut-Healthy Labneh Orecchiette
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Labneh (a sort of yogurt-cheese made from strained yogurt) is a great probiotic, and there’s plenty of resistant starch in this dish too, from how we cook, cool, and reheat the pasta. Add to this the lycopene from the tomatoes, the ergothioneine from the mushrooms, and the healthful properties of the garlic, black pepper, and red chili, and we have a very healthy dish!
You will need
- 10 oz labneh (if you can’t buy it locally, you can make your own by straining Greek yogurt through a muslin cloth, suspended over a bowl to catch the water that drips out, overnight—and yes, plant-based is also fine if you are vegan, and the gut benefits are similar because unlike vegan cheese, vegan yogurt is still fermented)
- 6 oz wholegrain orecchiette (or other pasta, but this shape works well for this sauce)
- ¼ bulb garlic, grated
- Juice of ½ lemon
- Large handful chopped parsley
- Large handful chopped dill
- 9 oz cherry tomatoes, halved
- 9 oz mushrooms (your choice what kind), sliced (unless you went for shiitake or similar, which don’t need it due to already being very thin)
- 2 tsp black pepper, coarse ground
- 1 tsp red chili flakes
- ¼ tsp MSG or ½ tsp low-sodium salt
- Extra virgin olive oil
Method
(we suggest you read everything at least once before doing anything)
1) Cook the pasta as you normally would. Drain, and rinse with cold water. Set aside.
2) Combine the labneh with the garlic, black pepper, dill, parsley, and lemon juice, in a large bowl. Set aside.
3) Heat a little olive oil in a skillet; add the chili flakes, followed by the mushrooms. Cook until soft and browned, then add the tomatoes and fry for a further 1 minute—we want the tomatoes to be blistered, but not broken down. Stir in the MSG/salt, and take off the heat.
4) Refresh the pasta by passing a kettle of boiling water through it in a colander, then add the hot pasta to the bowl of labneh sauce, stirring to coat thoroughly.
5) Serve, spooning the mushrooms and tomatoes over the labneh pasta.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Making Friends With Your Gut (You Can Thank Us Later)
- Lycopene’s Benefits For The Gut, Heart, Brain, & More
- “The Longevity Vitamin” (That’s Not A Vitamin)
Take care!
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