I’m Moving Forward and Facing the Uncertainty of Aging
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It takes a lot of courage to grow old.
I’ve come to appreciate this after conversations with hundreds of older adults over the past eight years for nearly 200 “Navigating Aging” columns.
Time and again, people have described what it’s like to let go of certainties they once lived with and adjust to new circumstances.
These older adults’ lives are filled with change. They don’t know what the future holds except that the end is nearer than it’s ever been.
And yet, they find ways to adapt. To move forward. To find meaning in their lives. And I find myself resolving to follow this path as I ready myself for retirement.
Patricia Estess, 85, of the Brooklyn borough of New York City spoke eloquently about the unpredictability of later life when I reached out to her as I reported a series of columns on older adults who live alone, sometimes known as “solo agers.”
Estess had taken a course on solo aging. “You realize that other people are in the same boat as you are,” she said when I asked what she had learned. “We’re all dealing with uncertainty.”
Consider the questions that older adults — whether living with others or by themselves — deal with year in and out: Will my bones break? Will my thinking skills and memory endure? Will I be able to make it up the stairs of my home, where I’m trying to age in place?
Will beloved friends and family members remain an ongoing source of support? If not, who will be around to provide help when it’s needed?
Will I have enough money to support a long and healthy life, if that’s in the cards? Will community and government resources be available, if needed?
It takes courage to face these uncertainties and advance into the unknown with a measure of equanimity.
“It’s a question of attitude,” Estess told me. “I have honed an attitude of: ‘I am getting older. Things will happen. I will do what I can to plan in advance. I will be more careful. But I will deal with things as they come up.’”
For many people, becoming old alters their sense of identity. They feel like strangers to themselves. Their bodies and minds aren’t working as they used to. They don’t feel the sense of control they once felt.
That requires a different type of courage — the courage to embrace and accept their older selves.
Marna Clarke, a photographer, spent more than a dozen years documenting her changing body and her life with her partner as they grew older. Along the way, she learned to view aging with new eyes.
“Now, I think there’s a beauty that comes out of people when they accept who they are,” she told me in 2022, when she was 70, just before her 93-year-old husband died.
Arthur Kleinman, a Harvard professor who’s now 83, gained a deeper sense of soulfulness after caring for his beloved wife, who had dementia and eventually died, leaving him grief-stricken.
“We endure, we learn how to endure, how to keep going. We’re marked, we’re injured, we’re wounded. We’re changed, in my case for the better,” he told me when I interviewed him in 2019. He was referring to a newfound sense of vulnerability and empathy he gained as a caregiver.
Herbert Brown, 68, who lives in one of Chicago’s poorest neighborhoods, was philosophical when I met him at his apartment building’s annual barbecue in June.
“I was a very wild person in my youth. I’m surprised I’ve lived this long,” he said. “I never planned on being a senior. I thought I’d die before that happened.”
Truthfully, no one is ever prepared to grow old, including me. (I’m turning 70 in February.)
Chalk it up to denial or the limits of imagination. As May Sarton, a writer who thought deeply about aging, put it so well: Old age is “a foreign country with an unknown language.” I, along with all my similarly aged friends, are surprised we’ve arrived at this destination.
For me, 2025 is a turning point. I’m retiring after four decades as a journalist. Most of that time, I’ve written about our nation’s enormously complex health care system. For the past eight years, I’ve focused on the unprecedented growth of the older population — the most significant demographic trend of our time — and its many implications.
In some ways, I’m ready for the challenges that lie ahead. In many ways, I’m not.
The biggest unknown is what will happen to my vision. I have moderate macular degeneration in both eyes. Last year, I lost central vision in my right eye. How long will my left eye pick up the slack? What will happen when that eye deteriorates?
Like many people, I’m hoping scientific advances outpace the progression of my condition. But I’m not counting on it. Realistically, I have to plan for a future in which I might become partially blind.
It’ll take courage to deal with that.
Then, there’s the matter of my four-story Denver house, where I’ve lived for 33 years. Climbing the stairs has helped keep me in shape. But that won’t be possible if my vision becomes worse.
So my husband and I are taking a leap into the unknown. We’re renovating the house, installing an elevator, and inviting our son, daughter-in-law, and grandson to move in with us. Going intergenerational. Giving up privacy. In exchange, we hope our home will be full of mutual assistance and love.
There are no guarantees this will work. But we’re giving it a shot.
Without all the conversations I’ve had over all these years, I might not have been up for it. But I’ve come to see that “no guarantees” isn’t a reason to dig in my heels and resist change.
Thank you to everyone who has taken time to share your experiences and insights about aging. Thank you for your openness, honesty, and courage. These conversations will become even more important in the years ahead, as baby boomers like me make their way through their 70s, 80s, and beyond. May the conversations continue.
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Avoiding Anemia (More Than Just “Get More Iron”)
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The Iron Dilemma: Factors To Consider
Anemia affects around 10% of American seniors, and that number jumps to 34–39% if there’s a comorbidity such as diabetes, hypertension, or hypercholesterolemia, which in turn climbs with increasing age or with other chronic conditions:
So, what can we do about it?
Get iron yes, but how?
We’d be remiss not to say: yes, do of course make sure you get plenty of iron.
Most people know that red meats, which are terrible for the heart and for cancer risk, are good sources of iron.
Well, good insofar as they provide plenty of it! They’re bad for other reasons.
❝Studies consistently show that consumption of red meat has been contributory to a multitude of chronic conditions such as diabetes, CVD, and malignancies.
There are various emerging reasons that strengthen this link-from the basic constituents of red meat like the heme iron component, the metabolic reactions that take place after consumption, and finally to the methods used to cook it.
The causative links show that even occasional use raises the risk of T2DM.❞
Source: Red Meat Consumption (Heme Iron Intake) and Risk for Diabetes and Comorbidities?
To heme or not to heme
Did you catch that in the middle there, about the heme iron component?
Dietary iron is broadly divided into two kinds: heme, and non-heme.
- Heme iron comes from animals
- Non-heme iron comes from plants
Bad news for vegans: non-heme iron is not so easily absorbed as heme iron.
This means that if you’re just eating plants, the RDA may be significantly lowballing the amount actually required. As a rule, about 1.8x more iron may be needed for vegans, to compensate for it being less easily absorbed.
Why this happens: it’s because of the phytic acid / phytate in the plants that contain the iron, blocking its absorption.
Good news for vegans: however, taking iron with vitamin C increases its absorption rate by about 5x better absorption, and several other side-along nutrients do similarly, including allium (from garlic), carotenoids (from many colorful plants), and fermented foods.
Why this happens: it’s because they bind with similar sites as phytic acid, without causing the same effect. To make a metaphor: these foods steal phytic acid’s parking space, so phytic acid can’t do its iron-blocking thing.
By happy coincidence, today’s featured recipe has all of these things in, by the way (vitamin C, allium, carotenoids, and fermented foods), and the star ingredient (fava beans) is a rich source of iron.
What are good sources of iron, then?
In the category of plants:
- Beans (pick your favorites / eat a variety)
- Lentils (pick your favorites / eat a variety)
- Greens (especially dark leafy greens)
- Apricots (you can get these dried, for convenience!)
- Dark chocolate (5mg per 1oz square!)*
*Ok, technically dark chocolate is not a plant; cacao is a plant; dark chocolate is usually plant-based, though, as there is no reason to add milk.
In the category of dairy products:
That’s not a publication error; dairy products are just not great for iron. Cheeses are more nutrient-dense than milk, and have less than 0.5mg per oz, in other words, the top dairy product has around 10x less iron than dark chocolate, which came in 5th place and let’s face it, we were doing broad categories there. If we listed all the beans, lentils, greens, etc it’d be a much longer list.
Eggs, which are sometimes considered under the category of dairy by virtue of not being an animal (yet!) but an animal product, have around 1mg per egg, by the way, so considering eggs are nearer 2oz, that’s not much better than the cheese.
“But what about if…”
The above is good science and general good advice for most people. That said, some people may have conditions that preclude the foods we recommended, or have other considerations, and so things may be different. Anemia can sometimes be caused by things that can’t be fixed by diet (beyond the scope of today’s article; another time, perhaps), but for example, if you have leukemia then definitely discuss things with your doctors first. Other illnesses, and some medications, can also have troublesome effects that can contribute to anemia. Again, we can offer very good general information here, but we don’t know your medical history, and our standard legal/medical disclaimer applies as always.
See also: Do We Need Animal Products To Be Healthy?
Take care!
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Gut Health for Women – by Aurora Bloom
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First things first: though the title says “For Women”, almost all of it applies to men too—and the things that don’t apply, don’t cause a problem. So if you’re cooking for your family that contains one or more men, this is still great.
Bloom gives us a good, simple, practical introduction to gut health. Her overview also covers gut-related ailments beyond the obvious “tummy hurts”. On which note:
A very valuable section of this book covers dealing with any stomach-upsets that do occur… without harming your trillions of tiny friends (friendly gut microbiota). This alone can make a big difference!
The book does of course also cover the things you’d most expect: things to eat or avoid. But it goes beyond that, looking at optimizing and maintaining your gut health. It’s not just dietary advice here, because the gut affects—and is affected by—other lifestyle factors too. Ranges from mindful eating, to a synchronous sleep schedule, to what kinds of exercise are best to keep your gut ticking over nicely.
There’s also a two-week meal plan, and an extensive appendix of resources, not to mention a lengthy bibliography for sourcing health claims (and suggesting further reading).
In short, a fine and well-written guide to optimizing your gut health and enjoying the benefits.
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How White Is Your Tongue?
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝So its normal to develop a white sort of coating on the tongue, right? It develops when I eat, and is able to (somewhat) easily be brushed off❞
If (and only if) there is no soreness and the coverage of the whiteness is not extreme, then, yes, that is normal and fine.
Your mouth has a microbiome, and it’s supposed to have one (helps keep the conditions in your mouth correct, so that food is broken down and/but your gums and teeth aren’t).
Read more: The oral microbiome: Role of key organisms and complex networks in oral health and disease
The whiteness you often see on a healthy tongue is, for the most part, bacteria and dead cells—harmless.
Cleaning the whiteness off with your brush is fine. You can also scrape off with floss is similar if you prefer. Or a tongue-scraper! Those can be especially good for people for whom brushing the tongue is an unpleasant sensation. Or you can just leave it, if it doesn’t bother you.
By the way, that microbiome is a reason it can be good to go easy on the mouthwash. Moderate use of mouthwash is usually fine, but you don’t want to wipe out your microbiome then have it taken over by unpleasantries that the mouthwash didn’t kill (unpleasantries like C. albicans).
There are other mouthwash-related considerations too:
Toothpastes and mouthwashes: which kinds help, and which kinds harm?
If you start to get soreness, that probably means the papillae (little villi-like things) are inflamed. If there is soreness, and/or the whiteness is extreme, then it could be a fungal infection (usually C. albicans, also called Thrush), in which case, antifungal medications will be needed, which you can probably get over the counter from your pharmacist.
Do not try to self-treat with antibiotics.
Antibiotics will make a fungal infection worse (indeed, antibiotic usage is often the reason for getting fungal growth in the first place) by wiping out the bacteria that normally keep it in check.
Other risk factors include a sugary diet, smoking, and medications that have “dry mouth” as a side effect.
Read more: Can oral thrush be prevented?
If you have any symptoms more exciting than the above, then definitely see a doctor.
Take care!
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Why Fibromyalgia Is Not An Acceptable Diagnosis
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Dr. Efrat Lamandre makes the case that fibromyalgia is less of a useful diagnosis and more of a rubber stamp, much like the role historically often fulfilled by “heart failure” as an official cause of death (because certainly, that heart sure did stop beating). It’s a way of answering the question without answering the question.
…and what to look for instead
Fibromyalgia is characterized by chronic pain, tenderness, sleep disturbances, fatigue, and other symptoms. It’s often considered an “invisible” illness, because it’s the kind that’s easy to dismiss if you’re not the one carrying it. A broken leg, one can point at and see it’s broken; a respiratory infection, one can see its effects and even test for presence of the pathogen and/or its antigens. But fibromyalgia? “It hurts and I’m tired” doesn’t quite cut it.
Much like “heart failure” as a cause of death when nothing else is implicated, fibromyalgia is a diagnosis that gets applied when known causes of chronic pain have been ruled out.
Dr. Lamandre advocates for functional medicine and seeking the underlying causes of the symptoms, rather than the industry standard approach, which is to just manage the symptoms themselves with medications (of course, managing the symptoms with medications has its place; there is no need to suffer needlessly if pain relief can be used; it’s just not a sufficient response).
She notes that potential triggers for fibromyalgia include microbiome imbalances, food sensitivities, thyroid issues, nutrient deficiencies, adrenal fatigue, mitochondrial dysfunction, mold toxicity, Lyme disease, and more. Is this really just one illness? Maybe, but quite possibly not.
In short… If you are given a diagnosis of fibromyalgia, she advises that you insist doctors keep on looking, because that’s not an answer.
For more on all of this, enjoy:
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Want to learn more?
You might also like to read:
- Managing Chronic Pain (Realistically!)
- How To Eat To Beat Chronic Fatigue ← yes, including how to do so when you are chronically fatigued. In other words, this isn’t just dietary advice, but rather practical advice too
- When Painkillers Aren’t Helping, These Things Might
Take care!
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The CBT Workbook for Mental Health – by Dr. Simon Rego & Sarah Fader
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We have often reviewed psychology books here with a note saying “and no, it’s not just a book of the standard CBT techniques that you probably already know”.
So today, this one’s for anyone who was ever thinking “but I don’t know the standard CBT techniques and I would like to know them!”.
The authors outline specific solutions to many common quantifiable problems, with simple exercises that are well-explained and easy to implement.
Cognitive Behavioral Therapy (CBT) is not a panacea, but for the things it can be used for, it’s very effective and is a very good “first thing to reach for” to see if it works, because its success rate for a lot of problems is very high.
What kinds of things is this book most likely to help with? A lot of common forms of stress, anxiety, self-esteem issues, cravings, shame, and relationship issues. Other things too, but we can’t list everything and that list already covers a lot of very high-incidence stuff.
Bottom line: if CBT isn’t something already in your toolbox, this book will help you add all its best tips and tricks.
Click here to check out The CBT Workbook for Mental Health, and get tooled up!
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Triple Life Threat – by Donald R. Lyman
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This book takes a similar approach to “How Not To Die” (which we featured previously), but focussed specifically on three things, per the title: chronic pulmonary obstructive disease (CPOD), diabetes (type 2), and Alzheimer’s disease.
Lyman strikes a great balance of being both information-dense and accessible; there’s a lot of reference material in here, and the reader is not assumed to have a lot of medical knowledge—but we’re not patronized either, and this is an informative manual, not a sensationalized scaremongering piece.
All in all… if you have known risk factors for one or more of three diseases this book covers, the information within could well be a lifesaver.
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