The Sardinian Cholesterol Paradox

10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

The 10almonds Team

Broadly speaking, low-density lipoprotein (LDL), or “bad” cholesterol, is generally considered to be… Well… Bad. Specifically because of how it can functionally narrow arteries, causing bits of floating detritus to get stuck in it, narrow it further, and eventually harden into atherosclerotic plaque, at which point it becomes even harder for the body to clear out.

We wrote about the process here: Demystifying Cholesterol

When it comes to cholesterol, the most common lay understanding (especially under a certain age) is “it’s bad”.

A more informed view (and more common after a certain age) is “LDL cholesterol is bad; HDL cholesterol is good”.

A more nuanced view is “LDL cholesterol is established as significantly associated with (and almost certainly a causal factor of) atherosclerotic cardiovascular disease and related mortality in men; in women it is less strongly associated and may or may not be a causal factor”

We wrote more about that, here: Statins: His & Hers? ← despite most research being on men, statins have very different effects (and side effects) for women, often being relatively less useful, and more dangerous. There are exceptions (for some women’s specific profiles they can still be worthwhile), but the trend is certainly troubling.

What, then, of Sardinia?

Sardinia is well-known for being one of the “Supercentenarian Blue Zones”, a place whose inhabitants enjoy (on average, statistically) unusually healthy longevity. These places have been looked to for clues as to how to live the healthiest life.

For example: From Blue To Green: News From The Centenarian Blue Zones

However, researchers recently were investigating life in a region of Sardinia where a lot of people are aged 90+, and followed the health of 168 of them for up to 6 years (because in the case of those who died during that time, obviously the time was less than 6 years).

Note: because this was specifically a Blue Zones study, they only included participants of whom all four grandparents were born within the Blue Zone—so not, for example, looking at the health of someone who just moved there from New York, say.

They collected a lot of interesting data (of course), but what we’re talking about today is that they found that participants with LDL levels above 130 mg/dL had a significantly longer average survival than those with LDL levels below this threshold. Specifically, a 40% lower mortality risk.

This is interesting, because LDL levels ≥130 mg/dL are considered moderate hypercholesterolemia (i.e., the LDL levels are a bit too high).

However, if the same participants had total cholesterol levels over 250mg/dL, they got no extra survival benefits, and very high cholesterol was still linked with shorter survival.

You can read the paper here: The Cholesterol Paradox in Long-Livers from a Sardinia Longevity Hot Spot (Blue Zone)

But before you reach for the butter…

The researchers have several hypotheses about why these results could be so, including:

  • The longevity has less to do with LDL itself, and more to do with the diet, with the ratio of grain to olive oil.
  • Most of the participants with higher LDL cholesterol were on antihypertensive drugs, which a) will obviously have a cardioprotective effect, and b) means that their heart health is probably enjoying greater scrutiny, and medical scrutiny can also have a protective effect (indeed, that’s the point of it).
  • It was also speculated that the locals of that region may have a genetic defense against the harm of moderate hypercholesterolemia, due to historical exposure to malaria meaning that naturally slightly higher cholesterol levels without increased cardiovascular risk may have been naturally selected-for (i.e. those without it were more likely to die of malaria and not pass on their genes).

Thus, it may be that it’s not so applicable more generally. However, it is still reason to at least re-examine how bad LDL cholesterol actually is, and whether for some demographics it could have a protective factor (much like “overweight” BMI is a protective factor for people over 65).

Still, if you’d like to keep on top of your cholesterol levels, check out:

How To Lower Cholesterol Naturally, Without Statins

Enjoy!

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  • Why do I seem to get sick as soon as I take time off?

    Thea van de Mortel – Griffith University

    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.

    You’ve been hanging out for a break, getting through the busy last weeks of work or class. You’re finally ready to relax. And then tiredness descends, you feel the tickle in your throat, and you realise you’re getting sick.

    Why does this always seem to happen just in time for a holiday or the weekend?

    Some call this the let-down effect or leisure sickness.

    But is it real? While you may hear about leisure sickness online and anecdotally, studies on this phenomenon are very limited and often not well designed.

    So let’s take a look at the evidence – and what you can do to stay healthy.

    SolStock/Getty

    What the evidence shows

    Leisure sickness is a term coined by Dutch researchers in a 2002 study. It refers to people who are seldom ill during the working week but get sick relatively often on weekends or holidays.

    The researchers surveyed 1,893 people and found roughly 3% reported leisure sickness. Symptoms typically included headaches, tiredness, colds and flu, muscle pain and nausea. People were more likely to develop infections on vacation rather than weekends, and symptoms were most common during the first week of their holiday.

    However, this research relied on people’s recall, and memory can be unreliable. The definition of leisure sickness was also vague. For example, one person’s idea of “seldom” and “relatively often” may differ from another’s.

    Another 2014 study investigated “let-down headaches” by asking 22 participants who regularly experienced migraines to keep a diary of their stress levels and migraine onset.

    It might seem counter-intuitive, but reducing stress seemed to trigger the migraine. When they recorded a reduction in stress on one day, they typically developed a migraine within the next 24 hours. If work was the stressor, this could mean a pattern of migraines on their days off.

    Some evidence suggests strokes are also more common on weekends than weekdays in some groups. There is no clear cause, but the study authors suggested strokes could be triggered by lifestyle changes on weekends.

    So, what’s going on?

    The lack of quality research on leisure sickness means we don’t fully understand its potential causes. But there are some theories.

    People often travel during vacations, and sit in enclosed, crowded spaces such as planes, increasing their exposure to germs. Travel to distant locations can also expose us to strains of germs we’re not immune to.

    On holidays we may also drink more alcohol, which can reduce immune function. And we may be pushing our body to do things we don’t normally do, putting stress on it.

    Another theory is that being busy at work makes us distracted and less likely to pay attention to symptoms. On leave, symptoms such as muscle pain or a headache may become more obvious – and we can’t blame it on work. So we may notice sickness more.

    Tired man rubs his eyes.
    We may notice symptoms such as fatigue when we’re not distracted by work. Christopher Lemercier/Unsplash

    But isn’t relaxing good for your health?

    There is a complicated relationship between stress and the immune system.

    Stress activates the sympathetic nervous system and makes our bodies release hormones such as adrenaline and cortisol.

    Chronic stress can mean our cortisol levels are sustained at high levels. Over time, this reduces how well our immune cells respond to infection, so we are more likely to get sick if we come into contact with viruses or bacteria.

    But in the short term, both adrenaline and cortisol can actually enhance how well some parts of the immune system work. This means acute stress can temporarily improve our resistance to infection, which is why we may feel busy and stressed but not fall sick. Cortisol’s anti-inflammatory properties can also relieve pain.

    But when the acute stress stops – for example, when we finally get a chance to rest – there may be a sudden transition. We no longer benefit from the temporary immune boost or cortisol’s pain relief. So this is when we might fall sick, and feel symptoms such as headaches and muscle pain.

    How can I avoid getting sick?

    There’s still a lot we don’t understand about how or why leisure sickness might happen. But we know staying active, getting enough sleep and eating a healthy, balanced diet – even when you’re busy – can help boost your immune system.

    One Finnish study examined more than 4,000 public employees who were physically inactive. It found those who took up regular exercise, particularly vigorous exercise, were less likely to take sick leave than those who remained inactive.

    Given the link between chronic stress and multiple chronic diseases, it is also sensible to manage your workplace-related stress.

    There is good evidence that meditation, mindfulness and relaxation techniques can help reduce stress.

    There are also steps you can take to reduce the risk of respiratory infections on vacation, so you get to enjoy the whole holiday. Consider keeping up to date with flu and COVID boosters, and taking other precautions, such as wearing an N95 mask on planes and in airports.

    Thea van de Mortel, Professor Emerita, Nursing, School of Nursing and Midwifery, Griffith University

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • 6 Micro Habits That Reshape Your Body (No Gym Needed)

    The 10almonds Team

    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.

    It feels like almost nothing, but it makes all the difference:

    Do it the easy way

    First know this: your body shape is mainly driven by what you eat, how much you move, and how consistently you sustain both over time.

    1. Protein first: choose your protein source first at each meal to increase fullness during and after eating, reduce snacking, and slightly increase calorie burn through digestion.
    2. Add fruit & veg: include at least one additional fruit or vegetable with every meal to increase fiber, micronutrients, and meal volume while naturally improving portion balance.
    3. Tie water to meals: drink water with (and between) meals to support energy, reduce fatigue from dehydration, and help manage hunger without relying on willpower.
    4. Move for your phone: put your phone the other side of the room, so every check requires walking, sneakily increasing your daily step count while decreasing sedentary behavior.
    5. Take longer routes: deliberately choose longer routes (when walking, not when driving!) for everyday tasks, to accumulate extra steps and boost daily energy expenditure.
    6. Use waiting time: walk, otherwise exercise, or even just do a quick chore, while waiting for things like a kettle to boil to sneak in yet more extra movement.

    With that in mind and without further ado, here are the 6 habits:

    For more on each of these, enjoy:

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

    Want to learn more?

    You might also like:

    15 Easy Japanese Habits That Will Transform Your Health

    Take care!

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  • Managing Your Mortality

    The 10almonds Team

    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.

    When Planning Is a Matter of Life and Death

    Barring medical marvels as yet unrevealed, we are all going to die. We try to keep ourselves and our loved ones in good health, but it’s important to be prepared for the eventuality of death.

    While this is not a cheerful topic, considering these things in advance can help us manage a very difficult thing, when the time comes.

    We’ve put this under “Psychology Sunday” as it pertains to processing our own mortality, and managing our own experiences and the subsequent grief that our death may invoke in our loved ones.

    We’ll also be looking at some of the medical considerations around end-of-life care, though.

    Organizational considerations

    It’s generally considered good to make preparations in advance. Write (or update) a Will, tie up any loose ends, decide on funerary preferences, perhaps even make arrangements with pre-funding. Life insurance, something difficult to get at a good rate towards the likely end of one’s life, is better sorted out sooner rather than later, too.

    Beyond bureaucracy

    What’s important to you, to have done before you die? It could be a bucket list, or it could just be to finish writing that book. It could be to heal a family rift, or to tell someone how you feel.

    It could be more general, less concrete: perhaps to spend more time with your family, or to engage more with a spiritual practice that’s important to you.

    Perhaps you want to do what you can to offset the grief of those you’ll leave behind; to make sure there are happy memories, or to make any requests of how they might remember you.

    Lest this latter seem selfish: after a loved one dies, those who are left behind are often given to wonder: what would they have wanted? If you tell them now, they’ll know, and can be comforted and reassured by that.

    This could range from “bright colors at my funeral, please” to “you have my blessing to remarry if you want to” to “I will now tell you the secret recipe for my famous bouillabaisse, for you to pass down in turn”.

    End-of-life care

    Increasingly few people die at home.

    • Sometimes it will be a matter of fighting tooth-and-nail to beat a said-to-be-terminal illness, and thus expiring in hospital after a long battle.
    • Sometimes it will be a matter of gradually winding down in a nursing home, receiving medical support to the end.
    • Sometimes, on the other hand, people will prefer to return home, and do so.

    Whatever your preferences, planning for them in advance is sensible—especially as money may be a factor later.

    Not to go too much back to bureaucracy, but you might also want to consider a Living Will, to be enacted in the case that cognitive decline means you cannot advocate for yourself later.

    Laws vary from place to place, so you’ll want to discuss this with a lawyer, but to give an idea of the kinds of things to consider:

    National Institute on Aging: Preparing A Living Will

    Palliative care

    Palliative care is a subcategory of end-of-life care, and is what occurs when no further attempts are made to extend life, and instead, the only remaining goal is to reduce suffering.

    In the case of some diseases including cancer, this may mean coming off treatments that have unpleasant side-effects, and retaining—or commencing—pain-relief treatments that may, as a side-effect, shorten life.

    Euthanasia

    Legality of euthanasia varies from place to place, and in some times and places, palliative care itself has been considered a form of “passive euthanasia”, that is to say, not taking an active step to end life, but abstaining from a treatment that prolongs it.

    Clearer forms of passive euthanasia include stopping taking a medication without which one categorically will die, or turning off a life support machine.

    Active euthanasia, taking a positive action to end life, is legal in some places and the means varies, but an overdose of barbiturates is an example; one goes to sleep and does not wake up.

    It’s not the only method, though; options include benzodiazepines, and opioids, amongst others:

    Efficacy and safety of drugs used for assisted dying

    Unspoken euthanasia

    An important thing to be aware of (whatever your views on euthanasia) is the principle of double-effect… And how it comes to play in palliative care more often than most people think.

    Say a person is dying of cancer. They opt for palliative care; they desist in any further cancer treatments, and take medication for the pain. Morphine is common. Morphine also shortens life.

    It’s common for such a patient to have a degree of control over their own medication, however, after a certain point, they will no longer be in sufficient condition to do so.

    After this point, it is very common for caregivers (be they medical professionals or family members) to give more morphine—for the purpose of reducing suffering, of course, not to kill them.

    In practical terms, this often means that the patient will die quite promptly afterwards. This is one of the reasons why, after sometimes a long-drawn-out period of “this person is dying”, healthcare workers can be very accurate about “it’s going to be in the next couple of days”.

    The take-away from this section is: if you would like for this to not happen to you or your loved one, you need to be aware of this practice in advance, because while it’s not the kind of thing that tends to make its way into written hospital/hospice policies, it is very widespread and normalized in the industry on a human level.

    Further reading: Goods, causes and intentions: problems with applying the doctrine of double effect to palliative sedation

    One last thing…

    Planning around our own mortality is never a task that seems pressing, until it’s too late. We recommend doing it anyway, without putting it off, because we can never know what’s around the corner.

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  • Why You Don’t Need 8 Glasses Of Water Per Day

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    The 10almonds Team

    The idea that you need to drink eight glasses of water daily is a myth. For most people most of the time, this practice will not make your skin brighter, improve mental clarity, or boost energy levels. All that will happen as a result of drinking beyond your thirst, is that you’ll pee more.

    A self-regulating system

    Our kidneys regulate hydration by monitoring blood volume and salt levels. When blood becomes slightly saltier or its volume drops, such as through sweating, the kidneys absorb more water into the bloodstream. If needed, the body triggers thirst signals to encourage fluid intake.

    In most cases, you can rely on your body’s natural thirst cues to manage hydration. Thirst is a reliable indicator of when you need to drink water, making constant monitoring of water intake unnecessary for most people.

    There are some exceptions, though! Some people, such as those with kidney stones, especially older adults, or those with specific medical considerations and resultant advice from your doctor, may need to pay closer attention to their water intake.

    Nor does hydration have to be a matter of “drinking water”: many foods and drinks, such as fruit, coffee, soups, etc, contribute to your daily water intake and (because the body processes it more slowly) are often more hydrating than plain water (which can just pass straight through if you take more than a certain amount at once). If you listen to your body’s thirst signals, there’s no need to rigidly count eight glasses of water each day.

    For more on all of this, enjoy:

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

    Want to learn more?

    You might also like to read:

    Hydration Mythbusting ← this also covers why urine color is not as good a guide as your thirst

    Take care!

    Don’t Forget…

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  • Medications That Shouldn’t Be Taken Long-term (With Natural Alternatives)

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    The 10almonds Team

    Dr. Leonid Kim helps us avoid hurting our organs and more:

    Swaps to consider

    Body

    • PPIs (usually prescribed for heartburn): drugs like omeprazole and esomeprazole reduce stomach acid but long-term use is associated with kidney injury, magnesium deficiency (on which note, do be aware of: How’s Your Magnesium Depletion Score?), and a 65% increased odds of vitamin B12 deficiency after 2 or more years. If you are going to supplement B12, by the way, that’s a good idea for a lot of people, but do avoid making a common mistake that many make in this regard: Which B Vitamins? It Makes A Difference ← in short, the most common vitamer of B12, cyanocobalamin, isn’t that effective, and you might want to spring for methylcobalamin, hydroxycobalamin, and/or adenosylcobalamin, all three of which are active vitamers of B12 that the body can use much more efficiently. You may be wondering why, then, cyanocobalamin is the most common: simple, it’s cheaper to produce!
      • Heartburn alternatives: reduce visceral fat to lower stomach pressure, practice diaphragmatic breathing to strengthen the lower esophageal sphincter, and improve gastric emptying with walking after meals, and ginger tea. See also: Acid Reflux After Meals? Here’s How To Stop It Naturally
    • Z-drugs (sleep medications): drugs like zolpidem act on the GABA system to induce sleep but can lead to dependence within weeks, and are linked to complex sleep behaviors like sleepwalking, cooking, or driving while asleep. Needless to say, those things are not good for the health.
      • Sleep alternatives: maintain consistent sleep and wake times and get morning light exposure within 30 minutes of waking to regulate your circadian rhythm. If you do want something to take, though, swing by: Safe Effective Sleep Aids For Seniors
    • Anticholinergics: drugs like diphenhydramine, oxybutynin, and amitriptyline are used for allergies, bladder issues, sleep, and depression and are associated with a 46% increased risk of dementia after 3 or more months of use, with risk increasing alongside cumulative exposure.
    • Gabapentin: originally approved for seizures and postherpetic nerve pain but widely used for other conditions, with long-term use associated with cognitive slowing (we wrote about that here: The Painkiller That Increases Cognitive Impairment Risk By 85%), dizziness, impaired balance, and physical dependence.

    For less on all of this, enjoy:

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

    Want to learn more?

    You might also like:

    Are You Taking PIMs? Getting Off The Overmedication Train ← “PIMs” stands for “potentially inappropriate medications”, be they prescribed in error, or to treat a side effect of some other medication, or to treat something that has now long-since passed.

    Also, for that matter:

    Before You Reach For That Tylenol… ← Tylenol (paracetamol/acetaminophen) is intended for occasional use only, and can cause severe problems if used chronically (not to mention death, if overused)

    And while we’re doing painkillers, you might also want to check out:

    The Commonly-Prescribed Painkiller That Barely Works (And Is Dangerous)

    Take care!

    Don’t Forget…

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  • Type Of Olive Oil Does Matter, For Brain & Gut Health!

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    The 10almonds Team

    On the topic of olive oil and its virginity or lack thereof, we have previously written to answer the question: Is “Extra Virgin” Worth It?

    That article continues to be great and correct per the most up-to-date science of which we’re aware, and in fewest words, the overall conclusion was that the “extra” part doesn’t matter too much, but the “virgin” part definitely does. Indeed, we wrote:

    If you enjoy olive oil, then springing for extra virgin is worth it if that’s not financially onerous, both for health reasons and taste.

    However, if mere “virgin” is what’s available, it’s no big deal to have that instead; it still has a very similar nutritional profile, and most of the same benefits.

    Don’t settle for less than “virgin”, though.

    While some virgin olive oils aren’t marked as such, if it says “refined” or “blended”, then skip it. These will have been extracted by chemical means and/or blended with completely different oils (e.g. canola, which has a very different nutritional profile), and sometimes with a dash of virgin or extra virgin, for the taste and/or so that they can claim in big writing on the label something like:

    a blend of
    EXTRA VIRGIN OLIVE OIL
    and other oils

    …despite having only a tiny amount of extra virgin olive oil in it.

    (For more on this, do see our previous main feature about it, here)

    Meanwhile, we shall press on the topic of specific brain and gut benefits of virgin olive oil (extra or not):

    Pressed for the very first time 🎶

    It’s already known that olives themselves are good for brain health:

    How Olives Can Help Protect Your Brain ← they do it by means of hydroxytyrosol, which really is much healthier than it sounds!

    And, for that matter: Olive oil is healthy. Turns out olive leaf extract may be good for us too

    So, what’s the latest news?

    Researchers (Dr. Estefanía Toledo et al.) followed 656 adults with metabolic syndrome aged 55–75 years for 2 years to examine the effects of olive oil type on gut microbiota and cognitive change.

    And by “type”, here the distinction was “virgin olive oil” (VOO) vs “common olive oil” (COO).

    As for the effects each had:

    • Gut microbiota diversity: higher VOO intake was associated with greater alpha diversity (inverse Simpson and Chao1 indices) (that’s good), while higher COO intake was associated with lower alpha diversity, with no significant diversity differences across total olive oil tertiles.
      • In particular, 19 bacterial genera were associated with olive oil intake, and higher VOO and total olive oil intake were linked to reduced abundance of Adlercreutzia, which reduction was associated with improvements in cognitive function. On which note…
    • Cognitive outcomes: higher total and VOO intake were associated with modest but statistically significant improvements in general cognitive function, attention, executive function, and global cognition, while higher COO intake was associated with worse changes across several domains.
      • For this one, each 10 g/day increase in total or VOO intake was positively associated with beneficial cognitive changes, but each 10 g/day increase in COO intake was associated with accelerated cognitive decline.

    In case you’re wondering how the cognitive outcomes were tested,

    ❝Cognitive function was assessed using the clock drawing test, mini-mental state examination (MMSE), verbal fluency test, digit span test, and trail making test.

    A z-score was calculated for each cognitive test at baseline and follow-up. These scores were aggregated to generate composite scores for neurocognitive domains such as executive function and attention. Clock drawing test and MMSE scores were combined into a general cognitive function score. A global cognitive function score was computed by adding or subtracting individual z-scores based on whether higher scores indicated better or worse performance.

    The primary outcome was the change in composite cognitive scores from baseline to follow-up.❞

    You can read the paper in full, here: Total and different types of olive oil consumption, gut microbiota, and cognitive function changes in older adults

    Want to learn more?

    You might like:

    All About Olive Oil

    Enjoy!

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