
Flossing Without Flossing?
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Flossing Without Flossing?
You almost certainly brush your teeth. You might use mouthwash. A lot of people floss for three weeks at a time, often in January.
There are a lot of options for oral hygiene; variations of the above, and many alternatives too. This is a big topic, so rather than try to squeeze it all in one, this will be a several-part series.
The first part was: Toothpastes & Mouthwashes: Which Help And Which Harm?
How important is flossing?
Interdental cleaning is indeed pretty important, even though it may not have the heart health benefits that have been widely advertised:
However! The health of our gums is very important in and of itself, especially as we get older:
Flossing Is Associated with Improved Oral Health in Older Adults
But! It helps to avoid periodontal (e.g. gum) disease, not dental caries:
Flossing for the management of periodontal diseases and dental caries in adults
And! Most certainly it can help avoid a stack of other diseases:
Interdental Cleaning Is Associated with Decreased Oral Disease Prevalence
…so in short, if you’d like to have happy healthy teeth and gums, flossing is an important adjunct, and/but not a one-stop panacea.
Is it better to floss before or after brushing?
As you prefer. A team of scientists led by Dr. Claudia Silva studied this, and found that there was “no statistical difference between brush-floss and floss-brush”:
Flossing is tedious. How do we floss without flossing?
This is (mostly) about water-flossing! Which does for old-style floss what sonic toothbrushes to for old-style manual toothbrushes.
If you’re unfamiliar, it means using a device that basically power-washes your teeth, but with a very narrow high-pressure jet of water.
Do they work? Yes:
As for how it stacks up against traditional flossing, Liang et al. found:
❝In our previous single-outcome analysis, we concluded that interdental brushes and water jet devices rank highest for reducing gingival inflammation while toothpick and flossing rank last.
In this multioutcome Bayesian network meta-analysis with equal weight on gingival inflammation and bleeding-on-probing, the surface under the cumulative ranking curve was 0.87 for water jet devices and 0.85 for interdental brushes.
Water jet devices and interdental brushes remained the two best devices across different sets of weightings for the gingival inflammation and bleeding-on-probing. ❞
~ Journal of Evidence-Based Dental Practice
You may be wondering how safe it is if you have had dental work done, and, it appears to be quite safe, for example:
BDJ | Water-jet flossing: effect on composites
Want to try water-flossing?
Here are some examples on Amazon:
- Waterpik Complete Care 9.0 ← example of a top-end water-flossing device
- Philips Sonicare Power Flosser 3000 ← top-tier not-Waterpik-brand device
- INSMART Cordless Water Dental Flosser ← very low price and still average 4.5 star reviews, so in our opinion, a fine first choice
Bonus: if you haven’t tried interdental brushes, here’s an example for that
Enjoy!
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A Guide to the Good Life – by Dr. William Irvine
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“Living well” is a surprisingly underrated part of wellness. We spend much of our lives in turmoil. Some of us, windswept and battered by the storms of life; others, up in quietly crumbling towers, seemingly “great” but definitely not feeling it. Diet and exercise etc will only get us so far. What else, then, can we do?
For Dr. Irvine, the key lies in two main things:
- Deciding how we intend to live our life (and doing so)
- Remaining tranquil in the face of external stressors
In Japanese terms, these things can be seen in ikigai and zen, respectively. This book puts them in Western terms, specifically, that of Stoic philosophy. But the goals and methods are very similar.
Far from being an abstract tome of wishy-washy philosophy, this book offers down-to-earth practical exercises and easily applicable advice. There was even an exercise that was new to this reviewer who has been reading such things for decades.
The writing style is also, true to Stoic principles, unpretentious and simple. This is an easy book to read, while being nonethless very engaging from start to finish—and thereafter!
Bottom line: so far as we know, we only get one shot at life, so we might as well make it a good one. Applying the ideas found in this book can help any reader to live better, and take more joy in it along the way.
Click here to check out a Guide to the Good Life, and live your best!
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6 Worst Foods That Cause Dementia
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How many do you consume?
The hit list
Dr. Li bids us avoid:
High carb, low fiber foods: consuming a diet high in carbohydrates, particularly refined carbs like cakes, white bread, pizza, and sugary syrups, can significantly harm brain health. Over time, imbalanced (i.e. not balanced with fiber) carbohydrate consumption leads to the growth of visceral fat (not the same as subcutaneous fat, which is the squishy bits just under your skin; visceral fat is further underneath, around your viscera), , which triggers systemic inflammation and oxidative stress. These processes disrupt communication between brain cells, impair memory, and increase the risk of diseases like Alzheimer’s and Parkinson’s. High carb diets can also contribute to metabolic syndrome—a cluster of conditions, including diabetes, obesity and high blood pressure—that damage blood vessels, leading to strokes and vascular dementia.
Trans fats: these are region-bound, as they’re banned in some places and not others—check your local regulations. Found in processed foods such as fried items, baked goods, packaged snacks, and margarine, trans fats are created through hydrogenation, which makes fats more stable at room temperature. These artificial fats raise bad cholesterol, lower good cholesterol, and promote atherosclerosis. This damages the brain by reducing oxygen supply, triggering chronic inflammation, and increasing the risk of Alzheimer’s and dementia.
Sodas: regular consumption of sodas, whether sugary or artificially sweetened, is harmful to brain health. A single can of soda contains around 9 teaspoons of sugar, which overwhelms metabolism, contributes to insulin resistance, and leads to inflammation. These effects damage blood vessels and brain tissue, disrupt neuron function, and increase the risk of type 2 diabetes and dementia. Furthermore, insulin resistance caused by excessive sugar intake can impair neuronal survival, activate immune responses, and exacerbate cognitive decline. As for the artificial sweeteners, the mechanism of harm depends on the sweetener (and some can also mess up insulin response, for reasons that are not entirely clear yet, but they measurably do), but even picking the healthiest artificial sweetener, training your palate to enjoy hyper-sweetened things will tend to lead to more sugar-laden food choices in other parts of one’s diet.
Processed foods: arguably a broad category that encompasses some of the above, but it’s important to consider it separately for catch-all purposes: these convenience foods, laden with artificial preservatives, colors, and sweeteners, harm brain health through chronic inflammation and usually a lack of essential nutrients. Processed foods are also a significant source of microplastics, which have been found to accumulate in the arteries, contributing to plaque build-up, atherosclerosis, and reduced blood flow to the brain. This combination of inflammation and oxidative stress from microplastics damages brain cells, paving the way for cognitive decline and dementia.
Seafood with high mercury levels: large fish such as tuna, swordfish, sharks, and tilefish accumulate high amounts of mercury, a potent neurotoxin. Fish that are larger, older, and/or higher up the food chain will have the most mercury (and other cumulative contaminants, for that matter, but we’re considering mercury here). Mercury disrupts essential brain chemicals like dopamine and serotonin, triggering oxidative stress and damaging brain cells. Chronic exposure to mercury leads to inflammation and neuroinflammation, both of which increase the risk of Alzheimer’s and dementia.
Alcohol: contrary to popular belief, any amount of alcohol is detrimental to brain health. While red wine is often promoted for its health benefits, the purported positive effects come from polyphenols, not the alcohol itself, and (for example) resveratrol from red wine cannot be delivered in meaningful doses without drinking an impossibly large quantity. Alcohol is a neurotoxin that can damage or kill brain cells, impair neuronal communication, and lead to cognitive decline. Excessive drinking results in hangover symptoms like headaches and brain fog, which are indicators of its harmful impact on the brain. Chronic alcohol consumption exacerbates neuron death, increases inflammation, and raises the risk of dementia.
As for what to eat instead?
Dr. Li recommends including foods such as:
- foods rich in omega-3s that aren’t mercury-laden fish, e.g. flaxseeds, chia seeds, walnuts, and hemp seeds, as they reduce inflammation, protect blood vessel linings, and prevent vascular dementia.
- berries, and in particular he recommends organic strawberries, which are rich in ellagic acid and anthocyanins, which improve memory, reduce depressive symptoms, and enhance cognitive function.
For more on all of these, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
Take care!
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Knit for Health & Wellness – by Betsan Corkhill
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Betsan Corkhill, a physiotherapist, has more than just physiotherapy in mind when it comes to the therapeutic potential of knitting (although yes, also physiotherapy!), and much of this book is about the more psychological benefits that go way beyond “it’s a relaxing pastime”.
She makes the case for how knitting (much like good mental health) requires planning, action, organization, persistence, focus, problem-solving, and flexibility—and thus the hobby develops and maintains all the appropriate faculties for those things, which will then be things you get to keep in the rest of your life, too.
Fun fact: knitting, along with other similar needlecrafts, was the forerunner technology for modern computer programming! And indeed, early computers, the kind with hole-punch data streams, used very similar pattern-storing methods to knitting patterns.
So, for something often thought of as a fairly mindless activity for those not in the know, knitting has a lot to offer for what’s between your ears, as well as potentially something for keeping your ears warm later.
One thing this book’s not, by the way: a “how to” guide for learning to knit. It assumes you either have that knowledge already, or will gain it elsewhere (there are many tutorials online).
Bottom line: if you’re in the market for a new hobby that’s good for your brain, this book will give you great motivation to give knitting a go!
Click here to check out Knit For Health & Wellness, and get knitting!
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Kale vs Watercress – Which is Healthier?
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Our Verdict
When comparing kale to watercress, we picked the kale.
Why?
It was very close! If ever we’ve been tempted to call something a tie, this has been the closest so far.
Their macros are close; watercress has a tiny amount more protein and slightly lower carbs, but these numbers are tiny, so it’s not really a factor. Nevertheless, on macros alone we’d call this a slight nominal win for watercress.
In terms of vitamins, they’re even. Watercress has higher vitamin E and choline (sometimes considered a vitamin), as well as being higher in some B vitamins. Kale has higher vitamins A and K, as well as being higher in some other B vitamins.
In the category of minerals, watercress has higher calcium, magnesium, phosphorus, and potassium, while kale has higher copper, iron, manganese, and zinc. The margins are slightly wider for kale’s more plentiful minerals though, so we’ll call this section a marginal win for kale.
When it comes to polyphenols, kale takes and maintains the lead here, with around 2x the quercetin and 27x the kaempferol. Watercress does have some lignans that kale doesn’t, but ultimately, kale’s strong flavonoid content keeps it in the lead.
So of course: enjoy both if both are available! But if we must pick one, it’s kale.
Want to learn more?
You might like to read:
- Fight Inflammation & Protect Your Brain, With Quercetin
- Spinach vs Kale – Which is Healthier?
- Thai-Style Kale Chips (recipe)
Take care!
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Two Things You Can Do To Improve Stroke Survival Chances
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Dr. Andrew’s Stroke Survival Guide
This is Dr. Nadine Andrew. She’s a Senior Research Fellow in the Department of Medicine at Monash University. She’s the Research Data Lead for the National Center of Healthy Aging. She is lead investigator on the NHMRC-funded PRECISE project… The most comprehensive stroke data linkage study to date! In short, she knows her stuff.
We’ve talked before about how sample size is important when it comes to scientific studies. It’s frustrating; sometimes we see what looks like a great study until we notice it has a sample size of 17 or something.
Dr. Andrew didn’t mess around in this regard, and the 12,386 participants in her Australian study of stroke patients provided a huge amount of data!
With a 95% confidence interval because of the huge dataset, she found that there was one factor that reduced mortality by 26%.
And the difference was…
Whether or not patients had a chronic disease management plan set up with their GP (General Practitioner, or “family doctor”, in US terms), after their initial stroke treatment.
45% of patients had this; the other 55% did not, so again the sample size was big for both groups.
Why this is important:
After a stroke, often a patient is discharged as early as it seems safe to do so, and there’s a common view that “it just takes time” and “now we wait”. After all, no medical technology we currently have can outright repair that damage—the body must repair itself! Medications—while critical*—can only support that and help avoid recurrence.
*How critical? VERY critical. Critical critical. Dr. Andrew found, some years previously, that greater levels of medication adherence (ie, taking the correct dose on time and not missing any) significantly improved survival outcomes. No surprise, right? But what may surprise is that this held true even for patients with near-perfect adherence. In other words: miss a dose at your peril. It’s that important.
But, as Dr. Andrew’s critical research shows, that’s no reason to simply prescribe ongoing meds and otherwise cut a patient loose… or, if you or a loved one are the patient, to allow yourself/them to be left without a doctor’s ongoing active support in the form of a chronic disease management plan.
What does a chronic disease management plan look like?
First, what it’s not:
- “Yes yes, I’m here if you need me, just make an appointment if something changes”
- “Let’s pencil in a check-up in three months”
- Etc
What it actually looks like:
It looks like a plan. A personal care plan, built around that person’s individual needs, risks, liabilities… and potential complications.
Because who amongst us, especially at the age where strokes are more likely, has an uncomplicated medical record? There will always be comorbidities and confounding factors, so a one-size-fits-all plan will not do.
Dr. Andrew’s work took place in Australia, so she had the Australian healthcare system in mind… We know many of our subscribers are from North America and other places. But read this, and you’ll see how this could go just as much for the US or Canada:
❝The evidence shows the importance of Medicare financially supporting primary care physicians to provide structured chronic disease management after a stroke.
We also provide a strong case for the ongoing provision of these plans within a universal healthcare system. Strategies to improve uptake at the GP level could include greater financial incentives and mandates, education for patients and healthcare professionals.❞
See her groundbreaking study for yourself here!
The Bottom Line:
If you or a loved one has a stroke, be prepared to make sure you get a chronic health management plan in place. Note that if it’s you who has the stroke, you might forget this or be unable to advocate for yourself. So, we recommend to discuss this with a partner or close friend sooner rather than later!
“But I’m quite young and healthy and a stroke is very unlikely for me”
Good for you! And the median age of Dr. Andrew’s gargantuan study was 70 years. But:
- do you have older relatives? Be aware for them, too.
- strokes can happen earlier in life too! You don’t want to be an interesting statistic.
Some stroke-related quick facts:
Stroke is the No. 5 cause of death and a leading cause of disability in the U.S.
Stroke can happen to anyone—any age, any time—and everyone needs to know the warning signs.
On average, 1.9 million brain cells die every minute that a stroke goes untreated.
Stroke is an EMERGENCY. Call 911 immediately.
Early treatment leads to higher survival rates and lower disability rates. Calling 911 lets first responders start treatment on someone experiencing stroke symptoms before arriving at the hospital.
Source: https://www.stroke.org/en/about-stroke
What are the warning signs for stroke?
Use the letters F.A.S.T. to spot a stroke and act quickly:
- F = Face Drooping—does one side of the face droop or is it numb? Ask the person to smile. Is the person’s smile uneven?
- A = Arm Weakness—is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
- S = Speech Difficulty—is speech slurred?
- T = Time to call 911
Source: https://www.stroke.org/en/about-stroke/stroke-symptoms
Last but not least, while we’re sharing resources:
Download the PDF Checklist: 8 Ways To Help Prevent a Second Stroke
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How To Reduce Your Alzheimer’s Risk
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Reduce Your Alzheimer’s Risk
Alzheimer’s is just one cause of dementia, but it’s a very notable one, not least of all because it’s
- a) the most common cause of dementia, and
- b) a measurably terminal disease.
For that reason we’re focusing on Alzheimer’s today, although most of the advice will go for avoiding dementia in general.
First, some things not everyone knows about Alzheimer’s:
- Alzheimer’s is a terminal disease.
- People who get a diagnosis at age 60 are typically given 4–8 years to live.
- Some soldier on for as many as 20, but those are rare outliers.
- Alzheimer’s begins 20 years or more before other symptoms start to develop.
- This makes this information very relevant for younger people approaching 40, for example.
- Alzheimer’s accounts for 60–80% of dementia, and affects around 6% of people over 60.
- By the age of 65, that figure is 10%. By the age of 70, however, the percentage is still about the same—this is because of the mortality rate preventing the accumulation of Alzheimer’s patients over time.
Want to know more? Read: 2023 Alzheimer’s Disease Facts And Figures Special Report ← this is a very comprehensive downloadablereference, by the way, including a lot of information about diagnosis, treatmentpathways, and earlyinterventions.
Speaking of diagnosis…
Know what the symptoms are… and aren’t!
Forgetting your car keys can be frustrating. Forgetting them frequently can be worrying.
But: there’s a difference between forgetting your car keys, and forgetting what car keys are used for. The latter is the kind of memory loss that’s more of a red flag for Alzheimer’s.
Similarly: forgetting someone’s name can be embarrassing. Forgetting someone’s name, asking them, forgetting asking them, asking them again, forgetting again (lather rinse repeat) is more of a red flag for Alzheimer’s.
There are other symptoms too, some of them less commonly known:
❝Difficulty remembering recent conversations, names or events; apathy; and depression are often early symptoms. Communication problems, confusion, poor judgment and behavioral changes may occur next. Difficulty walking, speaking, and swallowing are common in the late stages of the disease❞
If you or a loved one are experiencing worrying symptoms: when it comes to diagnosis and intervention, sooner is a lot better than later, so do talk to your doctor.
As for reducing your risk? First, the obvious stuff:
The usual 5 things that go for almost everything:
- Have a good diet—the Mediterranean Diet is once again recommended (we expect this will not be a surprise to regular readers!)
- Get regular exercise—in the case of avoiding Alzheimer’s and other dementias, typically the most important thing here is heart health, so getting regular cardiovascular exercise, such walking, running, or dancing is great. Cycling too. Swimming, not so much. Not that swimming’s bad or anything, it’s just that when your body is horizontal, the heart has less work to do, especially in the upper part of the body, because it’s not defying gravity. Similarly, yoga is great for the health but won’t particularly help with this, nor will weight training.
- Get good sleep—as we get older, we tend to need less sleep, and tend more towards the lower end of the standard “7–9 hours” prescription, but getting at least those 7 hours makes a huge difference.
- Cut down (or eliminate) alcohol consumption—and especially avoid binge-drinking. While “binge-drinking” is typically associated with young people, that Christmas party where that one uncle gets very drunk is also binge-drinking, for example. Plus, heavy drinking in early life has also been correlated with higher risk of Alzheimer’s later.
- Don’t smoke. It’s bad for everything, and Alzheimer’s risk is no exception.
How much do lifestyle changes alone make a difference?
They make a big difference. This 2022 population-based cohort study (so: huge sample size) looked at people who had 4–5 of the healthy lifestyle factors being studied, vs people who had 0–1 of them. They found:
❝A healthy lifestyle was associated with a longer life expectancy among men and women, and they lived a larger proportion of their remaining years without Alzheimer’s dementia.❞
The numbers of years involved by the way ranged between 3 and 20 years, in terms of life expectancy and years without or with Alzheimer’s, with the average increase of healthy life years being approximately the same as the average increase in years. This is important, because:
A lot of people think “well if I’m going to go senile, I might as well [unhealthy choice that shortens lifespan]”, but they misunderstand a critical factor:
The unhealthy choices will reduce their healthy life years, and simply bring the unhealthy ones (and subsequent death) sooner. If you’re going to spend your last few years in ill-health, it’s better to do so at 90 than 50.
The other thing you may already know… And a thing about it that not everyone considers:
Keeping cognitively active is important. This much is broadly known by the general public, and to clinicians, this was the fourth “healthy factor” in the list of five (instead of the sleep that we put there, because we were listing the 5 things that go for most preventable health issues).
Everyone leaps to mention sudoku at this point, so if that’s your thing, great, enjoy it! (This writer personally enjoys chess, which isn’t everyone’s cup of tea; if it yours though, you can come join her on Chess.com and we’ll keep sharp together)
But the more parts of your mental faculties you keep active, the better. Remember, brainpower (as with many things in health and life) is a matter of “use it or lose it” and this is on a “per skill” basis!
What this means: doing sudoku (a number-based puzzle game) or chess (great as it may be) won’t help as much for keeping your language skills intact, for example. Given that language skills are one of the most impactful and key faculties to get lost to Alzheimer’s disease, neglecting such would be quite an oversight!
Some good ways to keep your language skills tip-top:
- Read—but read something challenging, if possible. It doesn’t have to be Thomas Scanlon’s What We Owe To Each Other, but it should be more challenging than a tabloid, for example. In fact, on the topic of examples:
- This newsletter is written to be easy to read, while not shying away from complex ideas or hard science. Our mission is literally to “make [well-sourced, science-based] health and productivity crazy simple”.
- But the academic papers that we link? Those aren’t written to be easy to read. Go read them, or at least the abstracts (in academia, an abstract is essentially an up-front summary, and is usually the first thing you’ll see when you click a link to a study or such). Challenge yourself!
- Write—compared to reading/listening, producing language is a (related, but) somewhat separate skill. Just ask any foreign language learner which is more challenging: reading or writing!
- Journaling is great, but writing for others is better (as then you’ll be forced to think more about it)
- Learn a foreign language—in this case, what matters it that you’re practicing and learning, so in the scale of easy to hard, or doesn’t matter if it’s Esperanto or Arabic. Duolingo is a great free resource that we recommend for this, and they have a wide range of extensive courses these days.
Now for the least obvious things…
Social contact is important.
Especially in older age, it’s easy to find oneself with fewer remaining friends and family, and getting out and about can be harder for everyone. Whatever our personal inclinations (some people being more introverted or less social than others), we are fundamentally a social species, and hundreds of thousands of years of evolution have built us around the idea that we will live our lives alongside others of our kind. And when we don’t, we don’t do as well.
See for example: Associations of Social Isolation and Loneliness With Later Dementia
If you can’t get out and about easily:
- Online socialising is still socializing.
- Online community is still community.
- Online conversations between friends are still conversations between friends.
If you don’t have much (or anyone) in the category of friends and family, join Facebook groups related to your interests, for example.
Berries are surprisingly good
^This may read like a headline from 200,000 BCE, but it’s relevant here!
Particularly recommended are:
- blueberries
- blackberries
- raspberries
- strawberries
- cranberries
We know that many of these berries seem to have a shelf-life of something like 30 minutes from time of purchase, but… Frozen and dried are perfectly good nutritionally, and in many cases, even better nutritionally than fresh.
Read: Effect of berry-based supplements and foods on cognitive function: a systematic review
Turmeric’s health benefits appear to include protecting against Alzheimer’s
Again, this is about risk reduction, and turmeric (also called curcumin, which is not the same as cumin) significantly reduces the build-up of amyloid plaques in the brain. Amyloid plaques are part of the progression of Alzheimer’s.
See for yourself: Protective Effects of Indian Spice Curcumin Against Amyloid Beta in Alzheimer’s Disease
If you don’t like it as a spice (and even if you do, you probably don’t want to put it in your food every day), you can easily get it as a supplement in capsule form.
Lower your homocysteine levels
Lower our what now? Homocysteine is an amino acid used for making certain proteins, and it’s a risk factor for Alzheimer’s.
Foods high in folate (and possible other B-vitamins) seem to lower homocysteine levels. Top choices include:
- Leafy greens
- Cruciferous vegetables
- Tomatoes
Get plenty of lutein
We did a main feature about specifically this a little while ago, so we’ll not repeat our work here, but lutein is found in, well, the same things we just listed above, and lower levels of lutein are associated with Alzheimer’s disease. It’s not a proven causative factor—we don’t know entirely what causes Alzheimer’s, just a lot of factors that have a high enough correlation that it’d be remiss to ignore them.
Catch up on our previous article: Brain Food? The Eyes Have It
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