Natto vs Tempeh – Which is Healthier?

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Our Verdict

When comparing nattō to tempeh, we picked the nattō.

Why?

Both are great, but in the battle of fermented soybeans vs fermented soybeans with extra steps, it turns out that the simplest option is the best, even if tempeh was a close runner-up:

In terms of macros, nattō has more carbs and fiber for the same protein and fat; we’ll call this category a tie or a marginal win for nattō.

In the category of vitamins, nattō has more of vitamins B1, C, E, K, and choline, while tempeh has more of vitamins B2, B3, B6, and B9. A clearer, yet still modest, win for nattō.

Minerals, however, are what really set them apart: nattō has more calcium, copper, iron, magnesium, manganese, potassium, selenium, and zinc, while tempeh has more phosphorus. An overwhelming win for nattō this time.

In short: enjoy either or both, but nattō is the more nutritionally dense option!

Want to learn more?

You might like:

21% Stronger Bones in a Year at 62? Yes, It’s Possible (No Calcium Supplements Needed!) ← nattō is featured as part of the diet 😎

Enjoy!

Don’t Forget…

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Recommended

  • Tuna vs Catfish – Which is Healthier?
  • Encyclopedia Of Herbal Medicine – by Andrew Chevallier
    This beautifully illustrated book bridges the gap between traditional use and scientific knowledge of herbal medicine. A must-have for anyone interested in natural remedies.

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  • The Truth About Vaccines

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    The Truth About Vaccines

    Yesterday we asked your views on vaccines, and we got an interesting spread of answers. Of those who responded to the poll, most were in favour of vaccines. We got quite a lot of comments this time too; we can’t feature them all, but we’ll include extracts from a few in our article today, as they raised interesting points!

    Vaccines contain dangerous ingredients that will harm us more than the disease would: True or False?

    False, contextually.

    Many people are very understandably wary of things they know full well to be toxic, being injected into them.

    One subscriber who voted for “Vaccines are poison, and/or are some manner of conspiracy ” wrote:

    ❝I think vaccines from 50–60 years ago are true vaccines and were safer than vaccines today. I have not had a vaccine for many, many years, and I never plan to have any kind of vaccine/shot again.❞

    They didn’t say why they personally felt this way, but the notion that “things were simpler back in the day” is a common (and often correct!) observation regards health, especially when it comes to unwanted additives and ultraprocessing of food.

    Things like aluminum or mercury in vaccines are much like sodium and chlorine in table salt. Sodium and chlorine are indeed both toxic to us. But in the form of sodium chloride, it’s a normal part of our diet, provided we don’t overdo it.

    Additionally, the amount of unwanted metals (e.g. aluminum, mercury) in vaccines is orders of magnitude smaller than the amount in dietary sources—even if you’re a baby and your “dietary sources” are breast milk and/or formula milk.

    In the case of formaldehyde (an inactivating agent), it’s also the dose that makes the poison (and the quantity in vaccines is truly miniscule).

    This academic paper alone cites more sources than we could here without making today’s newsletter longer than it already is:

    Vaccine Safety: Myths and Misinformation

    I have a perfectly good immune system, it can handle the disease: True or False?

    True! Contingently.

    In fact, our immune system is so good at defending against disease, that the best thing we can do to protect ourselves is show our immune system a dead or deactivated version of a pathogen, so that when the real pathogen comes along, our immune system knows exactly what it is and what to do about it.

    In other words, a vaccine.

    One subscriber who voted for “Vaccines are important but in some cases the side effects can be worse ” wrote:

    ❝In some ways I’m vacd out. I got COVid a few months ago and had no symptoms except a cough. I have asthma and it didn’t trigger a lot of congestion. No issues. I am fully vaccinated but not sure I’ll get one in fall.❞

    We’re glad this subscriber didn’t get too ill! A testimony to their robust immune system doing what it’s supposed to, after being shown a recent-ish edition of the pathogen, in deactivated form.

    It’s very reasonable to start wondering: “surely I’m vaccinated enough by now”

    And, hopefully, you are! But, as any given pathogen mutates over time, we eventually need to show our immune system what the new version looks like, or else it won’t recognize it.

    See also: Why Experts Think You’ll Need a COVID-19 Booster Shot in the Future

    So why don’t we need booster shots for everything? Often, it’s because a pathogen has stopped mutating at any meaningful rate. Polio is an example of this—no booster is needed for most people in most places.

    Others, like flu, require annual boosters to keep up with the pathogens.

    Herd immunity will keep us safe: True or False?

    True! Ish.

    But it doesn’t mean what a lot of people think it means. For example, in the UK, “herd immunity” was the strategy promoted by Prime Minister of the hour, Boris Johnson. But he misunderstood what it meant:

    • What he thought it meant: everyone gets the disease, then everyone who doesn’t die is now immune
    • What it actually means: if most people are immune to the disease (for example: due to having been vaccinated), it can’t easily get to the people who aren’t immune

    One subscriber who voted for “Vaccines are critical for our health; vax to the max! ” wrote:

    ❝I had a chiropractor a few years ago, who explained to me that if the general public took vaccines, then she would not have to vaccinate her children and take a risk of having side effects❞

    Obviously, we can’t speak for this subscriber’s chiropractor’s children, but this raises a good example: some people can’t safely have a given vaccine, due to underlying medical conditions—or perhaps it is not available to them, for example if they are under a certain age.

    In such cases, herd immunity—other people around having been vaccinated and thus not passing on the disease—is what will keep them safe.

    Here’s a useful guide from the US Dept of Health and Human Services:

    How does community immunity (a.k.a. herd immunity) work?

    And, for those who are more visually inclined, here’s a graphical representation of a mathematical model of how herd immunity works (you can run a simulation)!

    Stay safe!

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  • Ouch. That ‘Free’ Annual Checkup Might Cost You. Here’s Why.

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    When Kristy Uddin, 49, went in for her annual mammogram in Washington state last year, she assumed she would not incur a bill because the test is one of the many preventive measures guaranteed to be free to patients under the 2010 Affordable Care Act. The ACA’s provision made medical and economic sense, encouraging Americans to use screening tools that could nip medical problems in the bud and keep patients healthy.

    So when a bill for $236 arrived, Uddin — an occupational therapist familiar with the health care industry’s workings — complained to her insurer and the hospital. She even requested an independent review.

    “I’m like, ‘Tell me why am I getting this bill?’” Uddin recalled in an interview. The unsatisfying explanation: The mammogram itself was covered, per the ACA’s rules, but the fee for the equipment and the facility was not.

    That answer was particularly galling, she said, because, a year earlier, her “free” mammogram at the same health system had generated a bill of about $1,000 for the radiologist’s reading. Though she fought that charge (and won), this time she threw in the towel and wrote the $236 check. But then she dashed off a submission to the KFF Health News-NPR “Bill of the Month” project:

    “I was really mad — it’s ridiculous,” she later recalled. “This is not how the law is supposed to work.”

    The ACA’s designers might have assumed that they had spelled out with sufficient clarity that millions of Americans would no longer have to pay for certain types of preventive care, including mammograms, colonoscopies, and recommended vaccines, in addition to doctor visits to screen for disease. But the law’s authors didn’t reckon with America’s ever-creative medical billing juggernaut.

    Over the past several years, the medical industry has eroded the ACA’s guarantees, finding ways to bill patients in gray zones of the law. Patients going in for preventive care, expecting that it will be fully covered by insurance, are being blindsided by bills, big and small.

    The problem comes down to deciding exactly what components of a medical encounter are covered by the ACA guarantee. For example, when do conversations between doctor and patient during an annual visit for preventive services veer into the treatment sphere? What screenings are needed for a patient’s annual visit?

    A healthy 30-year-old visiting a primary care provider might get a few basic blood tests, while a 50-year-old who is overweight would merit additional screening for Type 2 diabetes.

    Making matters more confusing, the annual checkup itself is guaranteed to be “no cost” for women and people age 65 and older, but the guarantee doesn’t apply for men in the 18-64 age range — though many preventive services that require a medical visit (such as checks of blood pressure or cholesterol and screens for substance abuse) are covered.

    No wonder what’s covered under the umbrella of prevention can look very different to medical providers (trying to be thorough) and billers (intent on squeezing more dollars out of every medical encounter) than it does to insurers (who profit from narrower definitions).

    For patients, the gray zone has become a billing minefield. Here are a few more examples, gleaned from the Bill of the Month project in just the past six months:

    Peter Opaskar, 46, of Texas, went to his primary care doctor last year for his preventive care visit — as he’d done before, at no cost. This time, his insurer paid $130.81 for the visit, but he also received a perplexing bill for $111.81. Opaskar learned that he had incurred the additional charge because when his doctor asked if he had any health concerns, he mentioned that he was having digestive problems but had already made an appointment with his gastroenterologist. So, the office explained, his visit was billed as both a preventive physical and a consultation. “Next year,” Opasker said in an interview, if he’s asked about health concerns, “I’ll say ‘no,’ even if I have a gunshot wound.”

    Kevin Lin, a technology specialist in Virginia in his 30s, went to a new primary care provider to take advantage of the preventive care benefit when he got insurance; he had no physical complaints. He said he was assured at check-in that he wouldn’t be charged. His insurer paid $174 for the checkup, but he was billed an additional $132.29 for a “new patient visit.” He said he has made many calls to fight the bill, so far with no luck.

    Finally, there’s Yoori Lee, 46, of Minnesota, herself a colorectal surgeon, who was shocked when her first screening colonoscopy yielded a bill for $450 for a biopsy of a polyp — a bill she knew was illegal. Federal regulations issued in 2022 to clarify the matter are very clear that biopsies during screening colonoscopies are included in the no-cost promise. “I mean, the whole point of screening is to find things,” she said, stating, perhaps, the obvious.

    Though these patient bills defy common sense, room for creative exploitation has been provided by the complex regulatory language surrounding the ACA. Consider this from Ellen Montz, deputy administrator and director of the Center for Consumer Information and Insurance Oversight at the Centers for Medicare & Medicaid Services, in an emailed response to queries and an interview request on this subject: “If a preventive service is not billed separately or is not tracked as individual encounter data separately from an office visit and the primary purpose of the office visit is not the delivery of the preventive item or service, then the plan issuer may impose cost sharing for the office visit.”

    So, if the doctor decides that a patient’s mention of stomach pain does not fall under the umbrella of preventive care, then that aspect of the visit can be billed separately, and the patient must pay?

    And then there’s this, also from Montz: “Whether a facility fee is permitted to be charged to a consumer would depend on whether the facility usage is an integral part of performing the mammogram or an integral part of any other preventive service that is required to be covered without cost sharing under federal law.”

    But wait, how can you do a mammogram or colonoscopy without a facility?

    Unfortunately, there is no federal enforcement mechanism to catch individual billing abuses. And agencies’ remedies are weak — simply directing insurers to reprocess claims or notifying patients they can resubmit them.

    In the absence of stronger enforcement or remedies, CMS could likely curtail these practices and give patients the tools to fight back by offering the sort of clarity the agency provided a few years ago regarding polyp biopsies — spelling out more clearly what comes under the rubric of preventive care, what can be billed, and what cannot.

    The stories KFF Health News and NPR receive are likely just the tip of an iceberg. And while each bill might be relatively small compared with the stunning $10,000 hospital bills that have become all too familiar in the United States, the sorry consequences are manifold. Patients pay bills they do not owe, depriving them of cash they could use elsewhere. If they can’t pay, those bills might end up with debt-collection agencies and, ultimately, harm their credit score.

    Perhaps most disturbing: These unexpected bills might discourage people from seeking preventive screenings that could be lifesaving, which is why the ACA deemed them “essential health benefits” that should be free.

    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.

    Subscribe to KFF Health News’ free Morning Briefing.

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  • High Histamine Foods To Avoid (And Low Histamine Foods To Eat Instead)

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    Nour Zibdeh is an Integrative and Functional Dietician, and she helps people overcome food intolerances. Today, it’s about getting rid of the underdiagnosed condition that is histamine intolerance, by first eliminating the triggers, and then not getting stuck on the low-histamine diet

    The recommendations

    High histamine foods to avoid include:

    • Alcohol (all types)
    • Fermented foods—normally great for the gut, but bad in this case
    • That includes most cheeses and yogurts
    • Aged, cured, or otherwise preserved meat
    • Some plants, e.g. tomato, spinach, eggplant, banana, avocado. Again, normally all great, but not in this case.

    Low histamine foods to eat include:

    • Fruits and vegetables not mentioned above
    • Minimally processed meat and fish, either fresh from the butcher/fishmonger, or frozen (not from the chilled food section of the supermarket), and eaten the same day they were purchased or defrosted, because otherwise histamine builds up over time (and quite quickly)
    • Grains, but she recommends skipping gluten, given the high likelihood of a comorbid gluten intolerance. So instead she recommends for example quinoa, oats, rice, buckwheat, millet, etc.

    For more about these (and more examples), as well as how to then phase safely off the low histamine diet, enjoy:

    Click Here If The Embedded Video Doesn’t Load Automatically!

    Further reading

    Food intolerances often gang up on a person (i.e., comorbidity is high), so you might also like to read about:

    Take care!

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Related Posts

  • Tuna vs Catfish – Which is Healthier?
  • What you need to know about endometriosis

    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.

    Endometriosis affects one in 10 people with a uterus who are of reproductive age. This condition occurs when tissue similar to the endometrium—the inner lining of the uterus—grows on organs outside of the uterus, causing severe pain that impacts patients’ quality of life.

    Read on to learn more about endometriosis: What it is, how it’s diagnosed and treated, where patients can find support, and more.

    What is endometriosis, and what areas of the body can it affect?

    The endometrium is the tissue that lines the inside of the uterus and sheds during each menstrual cycle. Endometriosis occurs when endometrial-like tissue grows outside of the uterus.

    This tissue can typically grow in the pelvic region and may affect the outside of the uterus, fallopian tubes, ovaries, vagina, bladder, intestines, and rectum. It has also been observed outside of the pelvis on the lungs, spleen, liver, and brain.

    What are the symptoms?

    Symptoms may include pelvic pain and cramping before or during menstrual periods, heavy menstrual bleeding, bleeding or spotting between periods, pain with bowel movements or urination, pain during or after sex or orgasm, fatigue, nausea, bloating, and infertility.

    The pain associated with this condition has been linked to depression, anxiety, and eating disorders. A meta-analysis published in 2019 found that more than two-thirds of patients with endometriosis report psychological stress due to their symptoms.

    Who is at risk?

    Endometriosis most commonly occurs in people with a uterus between the ages of 25 and 40, but it can also affect pre-pubescent and post-menopausal people. In rare cases, it has been documented in cisgender men.

    Scientists still don’t know what causes the endometrial-like tissue to grow, but research shows that people with a family history of endometriosis are at a higher risk of developing the condition. Other risk factors include early menstruation, short menstrual cycles, high estrogen, low body mass, and starting menopause at an older age.

    There is no known way to prevent endometriosis.

    How does endometriosis affect fertility?

    Up to 50 percent of people with endometriosis may struggle to get pregnant. Adhesions and scarring on the fallopian tubes and ovaries as well as changes in hormones and egg quality can contribute to infertility.

    Additionally, when patients with this condition are able to conceive, they may face an increased risk of pregnancy complications and adverse pregnancy outcomes.

    Treating endometriosis, taking fertility medications, and using assistive reproductive technology like in vitro fertilization can improve fertility outcomes.

    How is endometriosis diagnosed, and what challenges do patients face when seeking a diagnosis?

    A doctor may perform a pelvic exam and request an ultrasound or MRI. These exams and tests help identify cysts or other unusual tissue that may indicate endometriosis.

    Endometriosis can only be confirmed through a surgical laparoscopy (although less-invasive diagnostic tests are currently in development). During the procedure, a surgeon makes a small cut in the patient’s abdomen and inserts a thin scope to check for endometrial-like tissue outside of the uterus. The surgeon may take a biopsy, or a small sample, and send it to a lab.

    It takes an average of 10 years for patients to be properly diagnosed with endometriosis. A 2023 U.K. study found that stigma around menstrual health, the normalization of menstrual pain, and a lack of medical training about the condition contribute to delayed diagnoses. Patients also report that health care providers dismiss their pain and attribute their symptoms to psychological factors.

    Additionally, endometriosis has typically been studied among white, cisgender populations. Data on the prevalence of endometriosis among people of color and transgender people is limited, so patients in those communities face additional barriers to care.

    What treatment options are available?

    Treatment for endometriosis depends on its severity. Management options include:

    • Over-the-counter pain medication to alleviate pelvic pain
    • Hormonal birth control to facilitate lighter, less painful periods
    • Hormonal medications such as gonadotropin-releasing hormone (GnRH) or danazol, which stop the production of hormones that cause menstruation
    • Progestin therapy, which may stop the growth of endometriosis tissue
    • Aromatase inhibitors, which reduce estrogen

    In some cases, a doctor may perform a laparoscopic surgery to remove endometrial-like tissue.

    Depending on the severity of the patient’s symptoms and scar tissue, some doctors may also recommend a hysterectomy, or the removal of the uterus, to alleviate symptoms. Doctors may also recommend removing the patient’s ovaries, inducing early menopause to potentially improve pain.

    Where can people living with endometriosis find support?

    Given the documented mental health impacts of endometriosis, patients with this condition may benefit from therapy, as well as support from others living with the same symptoms. Some peer support organizations include:

    For more information, talk to your health care provider.

    This article first appeared on Public Good News and is republished here under a Creative Commons license.

    Don’t Forget…

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  • Reporting on psychedelics research or legislation? Proceed with caution

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    More cities and states are introducing bills to decriminalize and regulate access to psychedelic drugs, which could potentially become another option to treat mental health conditions and substance use disorders. But the substances remain illegal under U.S. federal law and scientific evidence about their effectiveness is still far from conclusive.

    This month alone, California lawmakers introduced a bill to allow people 21 and older to consume psychedelic mushrooms under medical supervision. In Massachusetts, lawmakers are working on a bill that would legalize psilocybin, the active ingredient of psychedelic mushrooms. And Arizona legislators have also introduced a bill that would make psychedelic mushrooms available as a mental health treatment option.

    Last December, Congress passed legislation that included funding for psychedelic clinical trials for active-duty service members. And in January this year, the Department of Veterans Affairs announced that it will begin funding research on MDMA, also known as ecstasy, and psilocybin, to treat veterans with post-traumatic stress disorder and depression. This is the first time since the 1960s that the VA is funding research on such compounds, according to the department.

    The rise of proposed and passed legislation in recent years necessitates more journalistic coverage. But it’s important for journalists to go beyond what the bills and lawmakers say and include research studies about psychedelics and note the limitations of those studies.

    Major medical organizations, including the American Psychiatric Association, have not yet endorsed psychedelics to treat psychiatric disorders, except in clinical trials, due to inadequate scientific evidence.

    The authors of a 2023 study published in the journal Therapeutic Advances in Psychopharmacology, also advise “strong caution” regarding the hype around the potential medical use of psychedelics. “There is not enough robust evidence to draw any firm conclusions about the safety and efficacy of psychedelic therapy,” they write.

    Scientists are still trying to better understand how psychedelics work, what’s the best dose for treating different mental health conditions and how to reduce the risk of potential side effects such as intense emotional experiences or increased heart rate and blood pressure, the authors of a February 2024 study published in the journal Progress in Neuro-Psychopharmacology and Biological Psychiatry write.

    In a 2022 study published in JAMA Psychiatry, Dr. Joshua Siegel and his colleagues at Washington University in St. Louis write that while legislative reform for psychedelic drugs is moving forward rapidly, several issues have not been addressed, including:

    • A mechanism for verifying the chemical content of drugs that are obtained from outside the medical establishment.
    • Licensure and training criteria for practitioners who wish to provide psychedelic treatment.
    • Clinical and billing infrastructure.
    • Assessing potential interactions with other drugs.
    • How the drugs should be used in populations such as youths, older adults and pregnant people.

    “Despite the relative rapidity with which some have embraced psychedelics as legitimate medical treatments, critical questions about the mechanism of action, dose and dose frequency, durability of response to repeated treatments, drug-drug interactions, and the role that psychotherapy plays in therapeutic efficacy remain unanswered,” Siegel and colleagues write.

    What are psychedelics?

    Psychedelics are among the oldest class of mind-altering substances, used by humans for thousands of years in traditional or religious rituals.

    In 2021, 74 million people 12 years and older reported using hallucinogens, according to the National Survey on Drug Use and Health.

    The terms “psychedelics” and “hallucinogens” are used interchangeably in public discourse, but scientifically, hallucinogens fall into three groups based on chemical structure and mechanism of action, according to NIH’s National Institute on Drug Abuse:

    • Psychedelic drugs, also called “classic psychedelics” or simply “psychedelics,” mainly affect the way the brain processes serotonin, a chemical that carries messages between nerve cells in the brain and the body. These drugs can bring on vivid visions and affect a person’s sense of self, according to NIDA. Drugs in this category include:
      • Psilocybin is the active ingredient in psychedelic mushrooms, also known as “magic” mushrooms or shrooms. It’s a Schedule 1 drug in the U.S. under the Controlled Substances Act, which means it has a high potential for abuse and has no accepted medical use. However, some states have decriminalized it, according to NIDA. The drug has also been given the Breakthrough Therapy designation from the FDA, a process to speed up the development and review of drugs, for the treatment of major depressive disorder.
      • LSD, or lysergic acid diethylamide, is a synthetic chemical made from a fungus that infects rye. It’s a Schedule 1 drug.
      • DMT, or dimethyltryptamine, found in certain plants native to the Amazon rainforest, has been used in religious practices and rituals. The plants are sometimes used to make a tea called ayahuasca. DMT can also be made in the lab as a white powder. DMT is generally smoked or consumed in brews like ayahuasca. It’s a Schedule 1 drug.
      • Mescaline, a chemical compound found in a small cactus called peyote, has been used by Indigenous people in northern Mexico and the southwestern U.S. in religious rituals. Mescaline can also be produced in the lab. Mescaline and peyote are Schedule 1 drugs.
    • Dissociative drugs affect how the brain processes glutamate, an abundant chemical released by nerve cells in the brain that plays an important role in learning and memory. These drugs can make people feel disconnected from their bodies and surroundings. Drugs in this category include:
      • PCP, or phencyclidine, was developed in the 1950s as an injectable anesthetic but was discontinued because patients became agitated and delusional. Today it is an illegal street drug. It’s a Schedule 2 drug, which means it has a high potential for abuse, but lower compared to Schedule 1 drugs.
      • Ketamine, a drug developed in the 1960s and used as an anesthetic in the Vietnam War, is approved by the FDA as an anesthetic. It has been shown to play a role in pain management and treatment of depression. It is also illegally used for its hallucinogenic effects. It is a Schedule 3 drug, which means it has a moderate to low potential for physical and psychological dependence. A chemically-similar drug called esketamine is approved by the FDA for the treatment of depression that doesn’t respond to standard treatment.
    • Other hallucinogens, which affect different brain functions and can cause psychedelic and potentially dissociative effects, include:
      • MDMA, or ecstasy, is a synthetic drug that’s a stimulant and hallucinogen. It is a Schedule 1 drug. It has been given the Breakthrough Therapy designation from the FDA for the treatment of PTSD.
      • Salvia is an herb in the mint family that has hallucinogenic effects. It is not a federally controlled drug, but it is controlled in some states, according to the DEA.
      • Ibogaine is derived from the root bark of a West African shrub and is a stimulant and hallucinogen. It is a Schedule 1 drug.

    Research on psychedelics

    There was a wave of studies on psychedelics, particularly LSD, in the 1950s and 1960s, but they came to a halt when the U.S. declared a “War on Drugs” in 1971 and tightened pharmaceutical regulations. There was little research activity until the early 1990s when studies on drugs such as MDMA and DMT began to emerge.

    In 2006, researchers at Johns Hopkins University published a seminal double-blind study in which two-thirds of participants — who had never taken psychedelics previously — said their psychedelic sessions were among the most meaningful experiences of their lives.

    “These studies, among others, renewed scientific interest in psychedelics and, accordingly, research into their effects has continued to grow since,” Jacob S. Aday and colleagues write in a 2019 study published in Drug Science, Policy and Law.

    In their paper, Aday and colleagues argue that 2018 may be remembered as the true turning point in psychedelic research due to “advances within science, increased public interest, and regulatory changes,” such as psilocybin receiving the “breakthrough therapy” status from the FDA.

    Today, there are numerous ongoing clinical trials on the therapeutic potential of psychedelics for different conditions, including substance use disorders and mental health conditions such as depression, anxiety and post-traumatic stress disorder.

    Given the growing number of studies on psychedelics, the Food and Drug Administration issued a draft guidance in June 2023 for clinical trials with psychedelic drugs, aiming to help researchers design studies that will yield more reliable results for drug development.

    The systematic reviews highlighted below show that there’s a lack of robust study designs in many psychedelic clinical trials. Some have small sample sizes. Some include participants who have used psychedelics before, so when they participate in a randomized controlled clinical trial, they know whether they are receiving psychedelic treatment or a placebo. Or, some include participants who may have certain expectations due to positive coverage in the lay media, hence creating bias in the results.

    If you’re covering a study about psychedelics…

    It’s important for journalists to pay close attention to study design and speak with an expert who is not involved in the study.

    In a February 2024 blog post from Harvard Law School’s Petrie-Flom Center, Leiden University professors Eiko I. Fried and Michiel van Elk share several challenges in psychedelic research:

    • “Conclusions are dramatically overstated in many studies. This ranges from conclusions in the results sections, abstracts, and even titles of papers not consistent with the reported results.”
    • “There is emerging evidence that adverse events resulting from psychedelic substances are both common and underreported.”
    • Some studies don’t have control groups, which can create problems for interpreting results, “because treatments like psychedelics need to be compared against a placebo or other treatment to conclude that they work beyond the placebo effect or already existing, readily available treatments.”
    • “Participants in psychedelic studies usually know if they are in the treatment or control group, which artificially increases the apparent efficacies of psychedelics in clinical studies.”
    • Small sample sizes can affect the statistical power and generalizability of the findings. “Small samples also mean that results are not representative. For example, participants with severe or comorbid mental health problems are commonly excluded from psychedelic studies, and therefore results may look better in these studies than in real-world psychiatric settings.”
    • Many studies do not include long-term follow-ups of participants. “Studying how these people are feeling a few days or weeks after they receive treatment is not sufficient to establish that they are indeed cured from depression.”

    Fried and van Elk also have a useful checklist for assessing the quality and scientific rigor of psychedelic research in their 2023 study “History Repeating: Guidelines to Address Common Problems in Psychedelic Science,” published in the journal Therapeutic Advances in Psychopharmacology.

    Journalists should also remind their audiences that the drugs are still illegal under federal law and can pose a danger to health.

    In California, the number of emergency room visits involving the use of hallucinogens increased by 54% between 2016 and 2022, according to a January 2024 study published in Addiction. Meanwhile, the law enforcement seizure of psychedelic mushrooms has risen dramatically, increasing nearly four-fold between 2017 and 2022, according to a February 2024 study published in the journal Drug and Alcohol Dependence.

    Below, we have curated and summarized five recent studies, mostly systematic reviews and meta-analyses, which examine various aspects of psychedelic drugs, including legislative reform; long-term effects; efficacy and safety for the treatment of anxiety, depression and PTSD; and participation of older adults in clinical trials. The research summaries are followed by recommended reading.

    Research roundup

    Psychedelic Drug Legislative Reform and Legalization in the US
    Joshua S. Siegel, James E. Daily, Demetrius A. Perry and Ginger E. Nicol. JAMA Psychiatry, December 2022.

    The study: Most psychedelics are Schedule I drugs federally, but state legislative reforms are changing the prospects of the drugs’ availability for treatment and their illegal status. For a better understanding of the legislative reform landscape around Schedule I psychedelic drugs, researchers collected all bills and ballot initiatives related to psychedelic drugs that were introduced into state legislatures between 2019 and September 2022. They used publicly available sources, including BillTrack50, Ballotpedia and LexisNexis.

    The findings: In total, 25 states considered 74 bills, although the bills varied widely in their framework. A majority proposed decriminalization but only a few would require medical oversight and some would not even require training or licensure, the authors write. Ten of those bills became law in seven states — Colorado, Connecticut, Hawaii, New Jersey, Oregon, Texas and Washington. As of August 1, 2022, 32 bills were dead and 32 remained active.

    The majority of the bills — 67 of them — referred to psilocybin; 27 included both psilocybin and MDMA; 43 proposed decriminalization of psychedelic drugs.

    To predict the future legalization of psychedelics, the authors also created two models based on existing medical and recreational marijuana reform. Using 2020 as the year of the first psychedelic decriminalization in Oregon, their models predict that 26 states will legalize psychedelics between 2033 and 2037.

    In the authors’ words: “Despite the relative rapidity with which some have embraced psychedelics as legitimate medical treatments, critical questions about the mechanism of action, dosing and dose frequency, durability of response to repeated treatments, drug-drug interactions, and the role psychotherapy plays in therapeutic efficacy remain unanswered. This last point is critical, as a significant safety concern associated with drugs like psilocybin, MDMA, or LSD is the suggestibility and vulnerability of the patient while under the influence of the drug. Thus, training and clinical oversight is necessary to ensure safety and also therapeutic efficacy for this divergent class of treatments.”

    Who Are You After Psychedelics? A Systematic Review and a Meta-Analysis of the Magnitude of Long-Term Effects of Serotonergic Psychedelics on Cognition/Creativity, Emotional Processing and Personality
    Ivana Solaja, et al. Neuroscience & Behavioral Reviews, March 2024.

    The study: Many anecdotal reports and observational studies have reported that psychedelics, even at microdoses, which are roughly one-tenth of a typical recreational dose, may enhance certain aspects of cognition and/or creativity, including coming up with new, useful ideas. Cognition is a “range of intellectual functions and processes involved in our ability to perceive, process, comprehend, store and react to information,” the authors explain. There are established relationships between impaired cognitive functioning and mental health disorders.

    Due to limitations such as a lack of rigorous study designs, various populations in the studies and lack of documented dosage, it’s difficult to draw any conclusions about changes that last at least one week as a result of consuming psychedelics.

    The authors screened 821 studies and based on the criteria they had set, found 10 to be eligible for the review and meta-analysis. The drugs in the studies include psilocybin, ayahuasca and LSD.

    The findings: Overall, there was little evidence that these psychedelics have lasting effects on creativity. Also, there was not sufficient evidence to determine if this group of psychedelics enhances cognition and creativity in healthy populations or improves cognitive deficits in the study populations.

    Pooled data from three studies showed lasting improvement in emotional processing — perceiving, expressing and managing emotions.

    The studies offered little evidence suggesting lasting effects of psychedelics on personality traits.

    In the authors’ words: “Results from this study showed very limited evidence for any lasting beneficial effects across these three psychological constructs. However, preliminary meta-analytic evidence suggested that these drugs may have the potential to cause lasting improvement in emotional recognition time. Future studies investigating these constructs should employ larger sample sizes, better control conditions, standardized and validated measures and longer-term follow-ups.”

    The Impact of Psychedelics on Patients with Alcohol Use Disorder: A Systematic Review with Meta-Analysis
    Dakota Sicignano, et al. Current Medical Research and Opinion, December 2023.

    The study: Researchers are exploring the psychedelics’ potential for the treatment of alcohol use disorder, which affected nearly 30 million Americans in 2022. The authors of this study searched PubMed from 1960 to September 2023 for studies on the use of psychedelics to treat alcohol use disorder. Out of 174 English-language studies, they selected six studies that met the criteria for their analysis.

    The findings: LSD and psilocybin are promising therapies for alcohol use disorder, the authors report. However, five of the six trials were conducted in the 1960s and 1970s and may not reflect the current treatment views. Also, four of the six studies included patients who had used psychedelics before participating in the study, increasing the risk of bias.

    In the authors’ words: “Despite the existence of several clinical trials showing relatively consistent benefits of psychedelic therapy in treating alcohol use disorder, there are important limitations in the dataset that must be appreciated and that preclude a conclusive determination of its value for patient care at this time.”

    Older Adults in Psychedelic-Assisted Therapy Trials: A Systematic Review
    Lisa Bouchet, et al. Journal of Psychopharmacology, January 2024.

    The study: People 65 years and older have been underrepresented in clinical trials involving psychedelics, including the use of psilocybin for the treatment of depression and anxiety. About 15% of adults older than 60 suffer from mental health issues, the authors note. They wanted to quantify the prevalence of older adults enrolled in psychedelic clinical trials and explore safety data in this population. They searched for English-language studies in peer-reviewed journals from January 1950 to September 2023. Of 4,376 studies, the authors selected 36. The studies involved psilocybin, MDMA, LSD, ayahuasca, and DPT (dipropyltryptamine), which is a less-studied synthetic hallucinogen.

    The findings: Of the 1,400 patients participating in the selected studies, only 19 were 65 and older. Eighteen received psychedelics for distress related to cancer or other life-threatening illnesses. In a trial of MDMA-assisted therapy for PTSD, only one older adult was included. Adverse reactions to the drugs among older patients, including heart and gastrointestinal issues were resolved within two days and didn’t have a long-lasting impact.

    In the authors’ words: “Although existing data in older adults is limited, it does provide preliminary evidence for the safety and tolerability of [psychedelic-assisted therapy] in older patients, and as such, should be more rigorously studied in future clinical trials.”

    Efficacy and Safety of Four Psychedelic-Assisted Therapies for Adults with Symptoms of Depression, Anxiety, and Posttraumatic Stress Disorder: A Systematic Review and Meta-Analysis
    Anees Bahji, Isis Lunsky, Gilmar Gutierrez and Gustavo Vazquez. Journal of Psychoactive Drugs, November 2023.

    The study: LSD, psilocybin, ayahuasca and MDMA have been approved for clinical trials on psychedelic-assisted therapy of mental health conditions in Canada and the U.S. However, major medical associations, including the American Psychiatric Association, have argued that there is insufficient scientific evidence to endorse these drugs for treating mental health disorders. To better understand the current evidence, researchers reviewed 18 blinded, randomized controlled trials, spanning 2008 through 2023. Most studies were conducted in the U.S. or Switzerland.

    The findings: The studies overall suggest preliminary evidence that psychedelic drugs are mostly well-tolerated. Psilocybin and MDMA therapies may offer relief from depression and PTSD symptoms for at least a year. Most studies also used therapy and psychological support along with psychedelics.

    In the authors’ words: “Despite the promising evidence presented by our study and previous reviews in the field, the evidence base remains limited and underpowered. Long-term efficacy and safety data are lacking,” the authors write. “Future steps should encourage and highlight the need for more robust larger scale randomized controlled trials with longer follow-up periods, and efforts to address regulatory and legal barriers through the collaborations between researchers, healthcare professionals, regulatory bodies, and policymakers.”

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

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  • What Most People Don’t Know About HIV

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    What To Know About HIV This World AIDS Day

    Yesterday, we asked 10almonds readers to engage in a hypothetical thought experiment with us, and putting aside for a moment any reason you might feel the scenario wouldn’t apply for you, asked:

    ❝You have unprotected sex with someone who, afterwards, conversationally mentions their HIV+ status. Do you…❞

    …and got the above-depicted, below-described, set of responses. Of those who responded…

    • Just over 60% said “rush to hospital; maybe a treatment is available”
    • Just under 20% said “ask them what meds they’re taking (and perhaps whether they’d like a snack)”
    • Just over 10% said “despair; life is over”
    • Two people said “do the most rigorous washing down there you’ve ever done in your life”

    So, what does science say about it?

    First, a quick note on terms

    • HIV is the Human Immunodeficiency Virus. It does what it says on the tin; it gives humans immunodeficiency. Like many viruses that have become epidemic in humans, it started off in animals (called SIV, because there was no “H” involved yet), which were then eaten by humans, passing the virus to us when it one day mutated to allow that.
      • It’s technically two viruses, but that’s beyond the scope of today’s article; for our purposes they are the same. HIV-1 is more virulent and infectious than HIV-2, and is the kind more commonly found in most of the world.
    • AIDS is Acquired Immunodeficiency Syndrome, and again, is what it sounds like. When a person is infected with HIV, then without treatment, they will often develop AIDS.
      • Technically AIDS itself doesn’t kill people; it just renders people near-defenseless to opportunistic infections (and immune-related diseases such as cancer), since one no longer has a properly working immune system. Common causes of death in AIDS patients include cancer, influenza, pneumonia, and tuberculosis.

    People who contract HIV will usually develop AIDS if untreated. Untreated life expectancy is about 11 years.

    HIV/AIDS are only a problem for gay people: True or False?

    False, unequivocally. Anyone can get HIV and develop AIDS.

    The reason it’s more associated with gay men, aside from homophobia, is that since penetrative sex is more likely to pass it on, then if we go with the statistically most likely arrangements here:

    • If a man penetrates a woman and passes on HIV, that woman will probably not go on to penetrate someone else
    • If a man penetrates a man and passes on HIV, that man could go on to penetrate someone else—and so on
    • This means that without any difference in safety practices or promiscuity, it’s going to spread more between men on average, by simple mathematics.
    • This is why “men who have sex with men” is the generally-designated higher-risk category.

    There is medication to cure HIV/AIDS: True or False?

    False so far (though there have been individual case studies of gene treatments that may have cured people—time will tell).

    But! There are medications that can prevent HIV from being a life-threatening problem:

    • PrEP (Pre-Exposure Prophylaxis) is a medication that one can take in advance of potential exposure to HIV, to guard against it.
      • This is a common choice for people aren’t sure about their partners’ statuses, or people working in risky environments.
    • PEP (Post-Exposure Prophylaxis) is a medication that one can take after potential exposure to HIV, to “nip it in the bud”.
      • Those of you who were rushing to hospital in our poll, this is what you’re rushing there for.
    • ARVs (Anti-RetroVirals) are a class of medications (there are different options; we don’t have room to distinguish them) that reduce an HIV+ person’s viral load to undetectable levels.
      • Those of you who were asking what meds your partner was taking, these will be those meds. Also, most of them are to be taken in the morning with food, so that’s what the snack was for.

    If someone is HIV+, the risk of transmission in unprotected sex is high: True or False?

    True or False, with false being the far more likely. It depends on their medications, and this is why you were asking. If someone is on ARVs and their viral load is undetectable (as is usual once someone has been on ARVs for 6 months), they cannot transmit HIV to you.

    U=U is not a fancy new emoticon, it means “undetectable = untransmittable”, which is a mathematically true statement in the case of HIV viral loads.

    See: NIH | HIV Undetectable=Untransmittable (U=U)

    If you’re thinking “still sounds risky to me”, then consider this:

    You are safer having unprotected sex with someone who is HIV+ and on ARVs with an undetectable viral load, than you are with someone you are merely assuming is HIV- (perhaps you assume it because “surely this polite blushing young virgin of a straight man won’t give me cooties” etc)

    Note that even your monogamous partner of many decades could accidentally contract HIV due to blood contamination in a hospital or an accident at work etc, so it’s good practice to also get tested after things that involve getting stabbed with needles, cut in a risky environment, etc.

    If you’re concerned about potential stigma associated with HIV testing, you can get kits online:

    CDC | How do I find an HIV self-test?

    (these are usually fingerprick blood tests, and you can either see the results yourself at home immediately, or send it in for analysis, depending on the kit)

    If I get HIV, I will get AIDS and die: True or False?

    False, assuming you get treatment promptly and keep taking it. So those of you who were at “despair; life is over” can breathe a sigh of relief now.

    However, if you get HIV, it does currently mean you will have to take those meds every day for the rest of your (no reason it shouldn’t be long and happy) life.

    So, HIV is definitely still something to avoid, because it’s not great to have to take a life-saving medication every day. For a little insight as to what that might be like:

    HIV.gov | Taking HIV Medication Every Day: Tips & Challenges

    (as you’ll see there, there are also longer-lasting injections available instead of daily pulls, but those are much less widely available)

    Summary

    Some quick take-away notes-in-a-nutshell:

    • Getting HIV may have been a death sentence in the 1980s, but nowadays it’s been relegated to the level of “serious inconvenience”.
    • Happily, it is very preventable, with PrEP, PEP, and viral loads so low that they can’t transmit HIV, thanks to ARVs.
    • Washing will not help, by the way. Safe sex will, though!
      • As will celibacy and/or sexual exclusivity in seroconcordant relationships, e.g. you have the same (known! That means actually tested recently! Not just assumed!) HIV status as each other.
    • If you do get it, it is very manageable with ARVs, but prevention is better than treatment
    • There is no certain cure—yet. Some people (small number of case studies) may have been cured already with gene therapy, but we can’t know for sure yet.

    Want to know more? Check out:

    CDC | Let’s Stop HIV Together

    Take care!

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