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 insulin 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:

One of the cheapest diabetes drugs on the market can also slow aging and extend your life span. Here’s how

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❞

Source: Long-term effects of lifestyle intervention or metformin on diabetes development and microvascular complications over 15-year follow-up

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.❞

Real World Data: Off-Label Metformin in Patients with Prediabetes is Associated with Improved Cardiovascular Outcomes

We wondered about the weight loss implications of this, and…

For weight loss

The short version is, it works:

…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:

Comparison of Beinaglutide Versus Metformin for Weight Loss in Overweight and Obese Non-diabetic Patients

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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  • Small Changes For A Healthier Life
    Have you ever thought about skipping the ham and adding flavor with salt, yeast extract, and smoked paprika? Or, did you know that MSG could be a good alternative to salt? Find out more in this article.

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  • How Many Steps Per Day To Beat Alzheimer’s? (A Lot Fewer Than You Might Think)

    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.

    “Walking is good for the health” is not, of course, breaking news.

    “Exercise helps keep Alzheimer’s at bay”, meanwhile, is something that probably most people don’t know, but regular 10almonds readers certainly will.

    There are numerous reasons, and the first and foremost is that “what’s good for your heart is good for your brain” (because the heart feeds the brain, and also ultimately clears away detritus, including the amyloid-β famously associated with Alzheimer’s).

    For more on how this works, see: What’s Your Vascular Dementia Risk? ← includes actual numbers and a risk calculator tool and things like that

    How many steps?

    We previously wrote about merely moving one’s body enough to not be considered to have a “sedentary lifestyle” is already hugely beneficial.

    How To Walk Away From Alzheimer’s ← this is less about how much you exercise or how intensely, and more about how much time you spend simply “not sitting”. So, for example, walking.

    Most recently, researchers (Dr. Wendy Yau et al.) found that regular walking, even in modest amounts, help build cognitive resilience and delay symptom onset in preclinical Alzheimer’s disease.

    How modest? To put it in numbers,

    • walking under 3,000 steps/day meant faster buildup of amyloid-β and tau proteins, and quicker cognitive and functional decline.
    • walking 3,000–5,000 steps/day delayed cognitive decline by about 3 years.
    • walking 5,000–7,500 steps/day delayed decline by about 7 years.

    In other words, even a day in which you just amble around the house, perhaps doing some housework, can probably clock up 3,000 steps per day, and is already beneficial.

    Of course, more is better; as you can clearly see, there’s a dose-dependent response, at least up as far as 7,500 steps/day.

    To quote Dr. Yau herself,

    ❝Every step counts—and even small increases in daily activities can build over time to create sustained changes in habit and health.❞

    Read the paper in full: Physical activity as a modifiable risk factor in preclinical Alzheimer’s disease

    As for that “build over time” part, this is very important too. For example another study recently found that being physically active over long periods (not just sporadically) was mostly strongly linked to maintaining better cognitive health. and that the more often and longer people stayed active, the stronger the protective effect became—which means that yes, those benefits grew over time.

    You can read that paper in full too, here: Long-term cumulative physical activity associated with less cognitive decline: Evidence from a 16-year cohort study

    So with that in mind, you might want to check out: No-Exercise Exercise! ← for ways to get that regular physical activity in, without it feeling like you are doing so

    There are more things you can do too, of course; exercise is not the only tool available (albeit it is a critical one).

    For a more comprehensive overview of anti-Alzheimer’s tools, enjoy: How To Reduce Your Alzheimer’s Risk

    Want to learn more?

    You might like this book that we reviewed a little while back:

    Brain Health Action Plan: Simple, Science-Backed Lifestyle Changes that Optimize Cognitive Fitness and Reduce Alzheimer’s Risk – by Dr. Teryn Clarke

    Take care!

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  • What is silicosis and what does research say about it?

    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.

    Silicosis is a progressive, debilitating and sometimes fatal lung disease caused by breathing silica dust from cutting, drilling, chipping or grinding materials such as granite, sandstone, slate or artificial stone. The dust gets trapped in the lung tissue, causing inflammation, scarring and permanent damage.

    Silicosis is a job-related lung disease and has no cure. The disease mostly affects workers in construction, stone countertop fabrication, mining, and even those who sandblast and stonewash denim jeans to create a ‘worn out’ look.

    Silica is one of the most common minerals in nature. About 59% of the Earth’s crust is made of silica, found in quartz, granite, sandstone, slate and sand. Historically, people at the highest risk for the disease have worked in natural environments — mining, digging tunnels or doing quarry work. The disease was first documented by the Greek physician Hippocrates, who in 430 B.C. described breathing disorders in metal diggers.

    But in recent decades there’s been renewed attention to the disease due to its more rapid progression and severity among younger workers. Research has shown that the culprit is artificial stone mostly used for countertops for kitchens and bathrooms, which has a very high silica content.

    The new generation of coal miners is also at an increased risk of silicosis, in addition to black lung, because layers of coal have become thinner, forcing them to dig deeper into rock, as explained in a joint investigation by the Pittsburgh Post-Gazette and the Medill Investigative Lab at Northwestern University published on Dec. 4. CBS Sunday Morning also had a report on the same issue among West Virginia coal miners, aired as part of its Dec. 10 episode.

    Silicosis in modern industries

    Artificial, or engineered, stone used for countertops, also known as “quartz,” is formed from finely crushed rocks mixed with resin. Quartz is a natural mineral, but man-made products like many quartz countertops consist of not just quartz, but also resin, colors and other materials that are used to style and strengthen them.

    The silica content of artificial stone is about 90%, compared with the 3% silica content of natural marble and 30% silica content in granite stones, according to the authors of a 2019 systematic review published in the International Journal of Environmental Research and Public Health.

    The first reported case of silicosis associated with working with artificial stone was from Italy in 2010, according to a 2020 study published in Allergy. Since then, more studies have documented the growing number of cases among artificial stone workers, many of whom are from marginalized populations, such as immigrants.

    A July 2023 study published in JAMA Internal Medicine found that in California, the disease mainly occurred among young Latino immigrant men. The disease was severe in most men by the time they sought care.

    An August 2022 study, published in Occupational & Environmental Medicine, analyzing the Global Silicosis Registry, with workers in Israel, Spain, Australia and the U.S., found “a substantial emerging population of workers worldwide with severe and irreversible silica-associated diseases,” due to exposure from silica dust from engineered stone.

    Other modern occupations such as denim sandblasting, work on dental prostheses, manufacturing of electrical cables and working on jewelry and semi-precious stones also put workers at risk of silicosis.

    In the wake of modern-day silicosis cases, researchers have called for larger studies to better understand the disease and the discovery of effective treatments.

    In the U.S. about 2.3 million workers are exposed to silica dust on the job, according to the American Lung Association. Other estimates show approximately 10 million workers in India, 3.2 million in the European Union and 2 million in Brazil work with material containing silica.

    However, “the reporting system for occupational injuries and illnesses in the United States fails to capture many cases, leading to a poor understanding of silicosis incidence and prevalence,” writes Ryan F. Hoy, who has published extensively on the topic, in a June 2022 article in Respirology.

    A 2015 study in the Morbidity & Mortality Weekly Report found the annual number of silicosis deaths declined from 185 people in 1999 to 111 in 2013, but the decline appeared to have leveled off between 2010 and 2013, the authors write. Another 2015 study in MMWR, examining silicosis deaths between 2001 and 2010, found the death rate from silicosis was significantly higher among Black people compared with whites and other races. Men also have a significantly higher death rate from silicosis than women.

    The 2019 Global Burden of Disease Study estimates that more than 12,900 people worldwide die from silicosis each year.

    Silicosis has no cure, but it’s preventable when workers have access to proper respiratory protection and are educated on safe practices set by regulatory bodies such as the U.S. National Institute for Occupational Safety and Health. The European Network on Silica also has guidelines on handling and using materials containing silica. A March 2023 study published in Environmental Science and Pollution Research International finds that “education, training, and marketing strategies improve respirator use, while training and education motivate workers to use dust control measures.”

    Silicosis symptoms and treatment

    Symptoms of silicosis include cough, fatigue, shortness of breath and chest pain. There’s no specific test for silicosis. The first signs may show in an abnormal chest X-ray and a slowly developing cough, according to the American Lung Association.

    Silicosis symptoms don’t appear right away in most cases, usually taking several years to develop working with silica dust. However, studies indicate that symptoms of silicosis due to exposure to artificial stone appear quicker than exposure to natural silica sources, potentially due to the higher concentration of silica in artificial stone.

    There are three types of silicosis: acute (most commonly caused by working with artificial stone), accelerated and chronic, depending on the level of exposure to silica dust, according to the Centers for Disease Control and Prevention, which explains the severity of each type on its website.

    Complications from silicosis can include tuberculosis, lung cancer, chronic bronchitis, kidney disease and autoimmune disorders. In some cases, silicosis can cause severe scarring of the lung tissue, leading to a condition called progressive massive fibrosis, or PMF. Some patients may require a lung transplant.

    Lung damage from silicosis is irreversible, so treatment of silicosis is aimed at slowing down the disease and relieving its symptoms.

    In 1995, the World Health Organization called for the elimination of silicosis by 2030, but research studies and news stories show it remains a threat to many workers.

    Below, we have gathered several studies on the topic to help journalists bolster their reporting with academic research.

    Research roundup

    Artificial Stone Associated Silicosis: A Systematic Review
    Veruscka Leso, et al. International Journal of Environmental Research and Public Health, February 2019.

    This systematic review aims to verify the association between exposure to silica dust in artificial stone and the development of silicosis.

    Researchers narrowed down their selection from 75 papers to seven studies that met their inclusion criteria. The seven studies were from Australia, Israel and Spain. Most of the studies are observational and impede a definite association between exposure to silica while working with artificial stone and developing silicosis, the authors note.

    However, “the unusually high incidence of the disease that was reported over short periods of investigations, and the comparable occupational histories of affected workers, all being involved in the manufacture and manipulation of engineered stones, may indicate a cause-effect relationship of this type.”

    The review of studies reveals a lack of basic preventive measures such as lack of access to disposable masks; lack of information and training on the dangers of silica dust; and lack of periodic medical examinations, including a chest X-ray, among workers. There was limited environmental monitoring of dust levels at the workplace. Also, there was no dust suppression system, such as the use of water when polishing the stones, or effective ventilation. Machinery and tools weren’t properly set up and didn’t undergo routine checks, the authors write.

    The authors recommend environmental monitoring for assessing silica levels in the workplace and verifying the effectiveness of personal protections. They also recommend the health surveillance of workers exposed to silica dust.

    “Stakeholders, manufacturers, occupational risk prevention services, insurance companies for occupational accidents and diseases, business owners, occupational health physicians, general practitioners, and also employees should be engaged, not only in designing/planning processes and operational working environments, but also in assessing the global applicability of proactive preventive and protective measures to identify and control crystalline silica exposure, especially in new and unexpected exposure scenarios, the full extent of which cannot yet be accurately predicted,” they write.

    Silica-Related Diseases in the Modern World
    Ryan F. Hoy and Daniel C. Chambers. Allergy, November 2020.

    The study is a review of the mineralogy of silica, epidemiology, clinical and radiological features of the various forms of silicosis and other diseases associated with exposure to silica.

    The primary factor associated with the development of silicosis is the intensity and duration of cumulative exposure to silica dust. Most countries regulate silica dust occupational exposure limits, generally in the range of 0.05 mg/m3 to 0.1 mg/m3, although the risk of dust exposure to workers still remains high at those levels.

    The study provides a list of activities that could expose workers to silica dust. They include abrasive blasting of sand and sandstone; cement and brick manufacturing; mixing, glazing or sculpting of china, ceramic and pottery; construction involving bricklaying, concrete cutting, paving and demolition; sandblasting denim jeans; working with and polishing dental materials; mining and related milling; handling raw material during paint manufacturing; road and highway construction and repair; soap and cosmetic production; blasting and drilling tunnels; and waste incineration.

    “Despite the large number of workers in the construction sector, there have been few studies of [silica dust] exposure in this industry,” the authors note.

    Other than silicosis, conditions associated with silica exposure include sarcoidosis, an inflammatory disease that commonly affects the lungs and lymph nodes, autoimmune disease, lung cancer and pulmonary infections.

    “Recent outbreaks of silica-associated disease highlight the need for constant vigilance to identify and control new and well-established sources of silica exposure. While there are currently no effective treatments for silicosis, it is a completely preventable lung disease,” the authors write.

    A Systematic Review of the Effectiveness of Dust Control Measures Adopted to Reduce Workplace Exposure
    Frederick Anlimah, Vinod Gopaldasani, Catherine MacPhail and Brian Davies. Environmental Science and Pollution Research International, March 2023.

    This study provides an overview of various interventions and their effectiveness in preventing exposure to silica dust based on a review of 133 studies from 16 countries, including the U.S., Canada, China, India, Taiwan and Australia, and published between 2010 and 2020.

    These dust control measures range from simple work practices such as the use of respirators to more sophisticated technologies, such as water and air curtains and foam technology, the authors note.

    The review finds increasing research interest in dust reduction, mainly in China. But overall, regulatory influence remains inadequate in preventing miners’ exposure to silica dust.

    “Results from the review suggest that adopted interventions increase knowledge, awareness, and attitudes about respirator usage and generate positive perceptions about respirator usage while reducing misconceptions,” the authors write. “Interventions can increase the use, proper use, and frequency of use of respirators and the adoption readiness for dust controls but may not provide sustained motivation in workers for the continual use of dust controls or [personal protective equipment.]”

    Notes from the Field: Surveillance of Silicosis Using Electronic Case Reporting — California, December 2022–July 2023
    Jennifer Flattery, et al. Morbidity and Mortality Weekly Report, November 2023.

    This study examines the use of electronic case reporting to identify silicosis cases in California. Electronic case reporting, or eCR, is the automated, real-time exchange of case report information between electronic health records at health facilities at state and local public health agencies in the U.S. It is a joint effort between the Association of Public Health Laboratories, the Council of State and Territorial Epidemiologists, and the CDC. Currently, 208 health conditions can be reported using eCR. All 50 states and other U.S.-affiliated jurisdictions are connected to eCR. Once a public health agency receives a case report, it reaches out to the patient for contact tracing or other actions.

    From October 2022 to July 2023, the California Department of Public Health received initial silicosis case reports for 41 individuals. A review of medical records confirmed 19 cases and 16 probable cases. Six of the 41 cases were considered unlikely to be silicosis after a review of medical records.

    Notably, engineered stone countertop fabrication was a significant source of exposure, especially among Hispanic and Latino workers.

    At least seven of the 19 confirmed cases were associated with the fabrication of engineered stone — quartz — countertops. The 19 patients’ ages ranged from 33 to 51 and all were Hispanic or Latino. One patient died and two had both lungs replaced. One was evaluated for a lung transplant.

    The median age of the 35 patients with probable or confirmed silicosis was 65, ranging from 33 to 89 years, and 91% were men.

    “It is important that health care providers routinely ask patients about their work as an important determinant of health,” the authors write. “Being aware of the risks associated with work exposures, as well as the regulations, medical monitoring, and prevention strategies that address those risks can help guide patient care.”

    Additional research

    Understanding the Pathogenesis of Engineered Stone-Associated Silicosis: The Effect of Particle Chemistry on the Lung Cell Response
    Chandnee Ramkissoon, et al. Respirology, December 2023.

    Silicosis, Tuberculosis and Silica Exposure Among Artisanal and Small-Scale Miners: A Systematic Review and Modelling Paper
    Patrick Howlett, et al. PLOS Global Public Health, September 2023.

    Silicosis Among Immigrant Engineered Stone (Quartz) Countertop Fabrication Workers in California
    Jane C. Fazio, et al. JAMA Internal Medicine, July 2023.

    Silicosis and Tuberculosis: A Systematic Review and Meta-Analysis
    P. Jamshidi, et al. Pulmonology, June 2023.

    From Basic Research to Clinical Practice: Considerations for Treatment Drugs for Silicosis
    Rou Li, Huimin Kang and Shi Chen. International Journal of Molecular Science, May 2023.

    Silicosis After Short-Term Exposure
    J. Nowak-Pasternak, A. Lipińska-Ojrzanowska and B. Świątkowska. Occupational Medicine, January 2023.

    Occupational Silica Exposure and Dose-Response for Related Disorders—Silicosis, Pulmonary TB, AIDs and Renal Diseases: Results of a 15-Year Israeli Surveillance
    Rachel Raanan, et al. International Journal of Environmental Research and Public Health, November 2022.

    Demographic, Exposure and Clinical Characteristics in a Multinational Registry of Engineered Stone Workers with Silicosis
    Jeremy Tang Hua, et al. Occupational & Environmental Medicine, August 2022.

    Current Global Perspectives on Silicosis — Convergence of Old and Newly Emergent Hazards
    Ryan F. Hoy, et al. Respirology, March 2022.

    The Association Between Silica Exposure, Silicosis and Tuberculosis: A systematic Review and Metal-Analysis
    Rodney Ehrlich, Paula Akugizibwe, Nandi Siegfried and David Rees. BMC Public Health, May 2021.

    Silicosis, Progressive Massive Fibrosis and Silico-Tuberculosis Among Workers with Occupational Exposure to Silica Dusts in Sandstone Mines of Rajasthan State
    Subroto Nandi, Sarang Dhatrak, Kamalesh Sarkar. Journal of Family Medicine and Primary Care, February 2021.

    Artificial Stone Silicosis: Rapid Progression Following Exposure Cessation
    Antonio León-Jiménez, et al. Chest, September 2020.

    Silica-Associated Lung Disease: An Old-World Exposure in Modern Industries
    Hayley Barnes, Nicole S.L. Goh, Tracy L. Leong and Ryan Hoy. Respirology, September 2019.

    Australia Reports on Audit of Silicosis for Stonecutters
    Tony Kirby. The Lancet, March 2019.

    Artificial Stone-Associated Silicosis: A Rapidly Emerging Occupational Lung Disease
    Ryan F. Hoy, et al. Occupational & Environmental Medicine, December 2017.

    This article first appeared on The Journalist’s Resource and is republished here under a Creative Commons license.

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  • Hormones & Health, Beyond The Obvious

    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.

    Wholesome Health

    This is Dr. Sara Gottfried, who some decades ago got her MD from Harvard and specialized as an OB/GYN at MIT. She’s since then spent the more recent part of her career educating people (mostly: women) about hormonal health, precision, functional, & integrative medicine, and the importance of lifestyle medicine in general.

    What does she want us to know?

    Beyond “bikini zone health”

    Dr. Gottfried urges us to pay attention to our whole health, in context.

    “Women’s health” is often thought of as what lies beneath a bikini, and if it’s not in those places, then we can basically treat a woman like a man.

    And that’s often not actually true—because hormones affect every living cell in our body, and as a result, while prepubescent girls and postmenopausal women (specifically, those who are not on HRT) may share a few more similarities with boys and men of similar respective ages, for most people at most ages, men and women are by default quite different metabolically—which is what counts for a lot of diseases! And note, that difference is not just “faster” or “slower””, but is often very different in manner also.

    That’s why, even in cases where incidence of disease is approximately similar in men and women when other factors are controlled for (age, lifestyle, medical history, etc), the disease course and response to treatment may vary considerable. For a strong example of this, see for example:

    • The well-known: Heart Attack: His & Hers ← most people know these differences exist, but it’s always good to brush up on what they actually are
    • The less-known: Statins: His & Hers ← most people don’t know these differences exist, and it pays to know, especially if you are a woman or care about one

    Nor are brains exempt from his…

    The female brain (kinda)

    While the notion of an anatomically different brain for men and women has long since been thrown out as unscientific phrenology, and the idea of a genetically different brain is… Well, it’s an unreliable indicator, because technically the cells will have DNA and that DNA will usually (but not always; there are other options) have XX or XY chromosomes, which will usually (but again, not always) match apparent sex (in about 1/2000 cases there’s a mismatch, which is more common than, say, red hair; sometimes people find out about a chromosomal mismatch only later in life when getting a DNA test for some unrelated reason), and in any case, even for most of us, the chromosomal differences don’t count for much outside of antenatal development (telling the default genital materials which genitals to develop into, though this too can get diverted, per many intersex possibilities, which is also a lot more common than people think) or chromosome-specific conditions like colorblindness…

    The notion of a hormonally different brain is, in contrast to all of the above, a reliable and easily verifiable thing.

    See for example:

    Alzheimer’s Sex Differences May Not Be What They Appear

    Dr. Gottfried urges us to take the above seriously!

    Because, if women get Alzheimer’s much more commonly than men, and the disease progresses much more quickly in women than men, but that’s based on postmenopausal women not on HRT, then that’s saying “Women, without women’s usual hormones, don’t do so well as men with men’s usual hormones”.

    She does, by the way, advocate for bioidentical HRT for menopausal women, unless contraindicated for some important reason that your doctor/endocrinologist knows about. See also:

    Menopausal HRT: A Tale Of Two Approaches (Bioidentical vs Animal)

    The other very relevant hormone

    …that Dr. Gottfried wants us to pay attention to is insulin.

    Or rather, its scrubbing enzyme, the prosaically-named “insulin-degrading enzyme”, but it doesn’t only scrub insulin. It also scrubs amyloid beta—yes, the same that produces the amyloid beta plaques in the brain associated with Alzheimer’s. And, there’s only so much insulin-degrading enzyme to go around, and if it’s all busy breaking down excess insulin, there’s not enough left to do the other job too, and thus can’t break down amyloid beta.

    In other words: to fight neurodegeneration, keep your blood sugars healthy.

    This may actually work by multiple mechanisms besides the amyloid hypothesis, by the way:

    The Surprising Link Between Type 2 Diabetes & Alzheimer’s

    Want more from Dr. Gottfried?

    You might like this interview with Dr. Gottfried by Dr. Benson at the IMCJ:

    Integrative Medicine: A Clinician’s Journal | Conversations with Sara Gottfried, MD

    …in which she discusses some of the things we talked about today, and also about her shift from a pharmaceutical-heavy approach to a predominantly lifestyle medicine approach.

    Enjoy!

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  • Astaxanthin: Super-Antioxidant & Neuroprotectant

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    Think Pink For Brain Health!

    Astaxanthin is a carotenoid that’s found in:

    • certain marine microalgae
    • tiny crustaceans that eat the algae
    • fish (and flamingos!) that eat the crustaceans

    Yes, it’s the one that makes things pink.

    But it does a lot more than that…

    Super-antioxidant

    Move over, green tea! Astaxanthin has higher antioxidant activity than most carotenoids. For example, it is 2–5 times more effective than alpha-carotene, lutein, beta-carotene, and lycopene:

    Antioxidant activities of astaxanthin and related carotenoids

    We can’t claim credit for naming it a super-antioxidant though, because:

    Astaxanthin: A super antioxidant from microalgae and its therapeutic potential

    Grow new brain cells

    Axtaxanthin is a neuroprotectant, but that’s to be expected from something with such a powerful antioxidant ability.

    What’s more special to astaxanthin is that it assists continued adult neurogenesis (creation of new brain cells):

    ❝The unique chemical structure of astaxanthin enables it to cross the blood-brain barrier and easily reach the brain, where it may positively influence adult neurogenesis.

    Furthermore, astaxanthin appears to modulate neuroinflammation by suppressing the NF-κB pathway, reducing the production of pro-inflammatory cytokines, and limiting neuroinflammation associated with aging and chronic microglial activation.

    By modulating these pathways, along with its potent antioxidant properties, astaxanthin may contribute to the restoration of a healthy neurogenic microenvironment, thereby preserving the activity of neurogenic niches during both normal and pathological aging. ❞

    Source: Dietary Astaxanthin: A Promising Antioxidant and Anti-Inflammatory Agent for Brain Aging and Adult Neurogenesis

    That first part is very important, by the way! There are so many things that our brain needs, and we can eat, but the molecules are unable to pass the blood-brain barrier, meaning they either get wasted, or used elsewhere, or dismantled for their constituent parts. In this case, it zips straight into the brain instead.

    See also:

    How To Grow New Brain Cells (At Any Age)

    (Probably) good for the joints, too

    First, astaxanthin got a glowing report in a study we knew not to trust blindly:

    A Multicenter, Randomized, Double-Blinded, Placebo-Controlled Clinical Trial to Evaluate the Efficacy and Safety of a Krill Oil, Astaxanthin, and Oral Hyaluronic Acid Complex on Joint Health in People with Mild Osteoarthritis

    …and breathe. What a title that was! But, did you catch why it’s not to be trusted blindly? It was down at the bottom…

    ❝Conflict of interest statement

    NOVAREX Co., Ltd. funded the study. Valensa International provided the FlexPro MD® ingredients, and NOVAREX Co., Ltd. encapsulated the test products (e.g., both FlexPro MD® and placebo)❞

    Studies where a supplement company funded the study are not necessarily corrupt, but they can certainly sway publication bias, i.e. the company funds a bunch of studies and then pulls funding from the ones that aren’t going the way it wants.

    So instead let’s look at:

    Astaxanthin attenuates joint inflammation induced by monosodium urate crystals

    and

    Astaxanthin ameliorates cartilage damage in experimental osteoarthritis

    …which had no such conflicts of interest.

    They agree that astaxanthin indeed does the things (attenuates joint inflammation & ameliorates cartilage damage).

    However, they are animal studies (rats), so we’d like to see studies with humans to be able to say for sure how much it helps these things.

    Summary of benefits

    Based on the available research, astaxanthin…

    • is indeed a super-antioxidant
    • is a neuroprotective agent
    • also assists adult neurogenesis
    • is probablygood for joints too

    How much do I take, and is it safe?

    A 2019 safety review concluded:

    ❝Recommended or approved doses varied in different countries and ranged between 2 and 24 mg.

    We reviewed 87 human studies, none of which found safety concerns with natural astaxanthin supplementation, 35 with doses ≥12 mg/day.❞

    Source: Astaxanthin: How much is too much? A safety review

    In short: for most people, it’s very safe and well-tolerated. If you consume it to an extreme, you will likely turn pink, much as you would turn orange if you did the same thing with carrots. But aside from that, the risks appear to be minimal.

    However! If you have a seafood allergy, please take care to get a supplement that’s made from microalgae, not one that’s made from krill or other crustaceans, or from other creatures that eat those.

    Where can I get it?

    We don’t sell it, but here’s an example product on Amazon, for your convenience

    Enjoy!

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  • Metabolism Made Simple – by Sam Miller

    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.

    The author, a nutritionist, sets out to present exactly what the title promises: metabolism made simple.

    On this, he delivers. Explaining things from the most basic elements upwards, he gives a well-rounded introduction to the science of metabolism and what it means for us when it comes to our dietary habits.

    The book is in large part a how-to, but with a lot of flexibility left to the reader. He doesn’t advocate for any particular dietary plan, but he does give the reader the tools necessary to make an informed choice and go from there—including the pros and cons of some popular dietary approaches.

    He talks a lot about getting the most out of whatever we do choose to—managing appetite, mitigating adaptation, maximizing adherence, optimizing absorption of nutrients, and so forth.

    The book does also touch on things like exercise and stress management, but diet is always center-stage and is the main topic of the book.

    The style is—as promised by the title—simple. However, this simply means that he avoids unnecessary jargon and explains any necessary terms along the way. As for backing up claims with science, there are 22 pages of references, which is always a good sign.

    Bottom line: if you’d like a simple, practical guide to eating for metabolic health, this book will start you off on a good footing.

    Click here to check out Metabolism Made Simple, and give your metabolic health a boost!

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  • Relaxation Revolution – by Dr. Herbert Benson & Dr. William Proctor

    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.

    Stress management makes a huge difference to a lot of aspects of physical health, yet it’s a very commonly overlooked area for improvement. Everyone’s all “I must eat better and exercise more”, but the truth is that being able to relax is just as important.

    The premise of this book is to first do something that we should find not at all arduous or unpleasant to do (that is: relax) and then weaponize that against all manner of ailments.

    Of course, it’s not a panacea, but stress makes almost every bodily process worse (aside from some of those actually needed in an acute crisis, e.g. to fight a tiger), which means that relaxation makes almost every bodily process better.

    The style of the book is a mix of old-school pop-science, anecdotes, and direct, practical “do this, do that” advice, often in the form of meditative exercises to perform, as well as what doesn’t get called CBT in the book, but it is.

    We’ll also mention that there are 22 pages of bibliography at the back, which is sufficiently respectable for a book of this size (good rule of thumb = if the bibliography is at least 10% of the size of the main content section of the book, it’s probably decent).

    Bottom line: if you’d like to be walked through the process of leveraging relaxation to improve your body’s ability to look after (and restore and repair) itself, then this book can help with that.

    Click here to check out Relaxation Revolution, and indeed relax!

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