Alzheimer’s risk 53 per cent higher for those with type 2 diabetes

 

A Curtin University-led review has revealed type 2 diabetes significantly raises risk of developing Alzheimer’s disease.

 

Researchers conducted a systematic review and meta-analysis of 40 studies and found if 1000 people living with type 2 diabetes were followed for a year, an estimated average of 4.7 would develop Alzheimer’s.

 

In a separate analysis, type 2 diabetes was associated with a 53 per cent higher adjusted relative risk of Alzheimer’s disease, compared with people living without type 2 diabetes.

 

Study author Dr Emmanuel Adewuyi, an NHMRC Investigator Fellow at the Curtin School of Population Health, said the review was important as it quantifies the relative risk and incidence if Alzheimer’s in people living with type 2 diabetes.

“While many earlier reviews combined different types of diabetes or dementia, this review focused specifically on type 2 diabetes and Alzheimer’s disease and estimated how often new cases occurred," Dr Adewuyi said.

"Relative risk tells us how two groups compare, while incidence tells us how often new cases occur: putting those numbers together gives us a clearer picture of the burden of Alzheimer’s disease among people living with type 2 diabetes.”

"Incidence and risk of Alzheimer’s disease in individuals with type 2 diabetes: a systematic review and meta-analysis," was published in Alzheimer's Research & Therapy.

---

Coffee appears to change how your gut functions

 

It may be a slightly awkward topic, but many of us know the feeling: that cup of coffee that gets things moving.

Research now suggests that regular coffee consumption affects how our digestive system functions.

A research team from the University of Copenhagen asked a group of Danish participants to swallow a small electronic capsule. As it travelled through the digestive tract, the capsule measured, among other things, transit time through the gastrointestinal system, temperature, pH levels and intestinal contractions.

The participants were categorised into frequent coffee drinkers, defined as consuming between one and five cups a day on more than three of the eight study days, and those who drank coffee less often.

The results first and foremost confirmed that coffee affects the composition of gut bacteria, as previous studies have suggested. Frequent coffee drinkers had a greater diversity of microorganisms in their gut than those who drank coffee less often.

"But perhaps more importantly, frequent coffee consumption appears to affect the physiology of the gut itself, in other words how the gut functions," says first author Francesca Bucci, a PhD student at the Department of Nutrition, Exercise and Sports at the University of Copenhagen.

It is already well established that moderate coffee consumption is associated with a reduced risk of cardiovascular disease, diabetes, depression and several types of cancer. However, much less is known about how habitual coffee consumption relates to physiological conditions within the gut.

Stimulates contractions in the gut

The researchers found that frequent coffee drinkers had a significantly lower pH in the small intestine than those who drank coffee less often. They also observed that higher coffee consumption was associated with more contractions in the colon.

So are these physiological differences beneficial or not?

"Contractions in the gut can support healthy digestion, help prevent constipation and keep the intestinal muscles in good condition," says Francesca Bucci.

The researchers cannot yet determine whether the lower pH is beneficial or harmful to health. However, the pH level in the small intestine plays an important role in the activity of digestive enzymes and in how food is broken down.

The researchers also stress that the study cannot establish whether the differences are caused solely by coffee consumption. Nevertheless, senior author Henrik Munch Roager believes there is good reason to think coffee plays a key role.

"For example, we already know from other studies that coffee can influence a range of processes in the digestive system, including acid secretion in the stomach. So there are good reasons to believe that what we are seeing is not merely coincidence. Anecdotally, many people also report that coffee affects their digestion," says Henrik Munch Roager, Associate Professor and Research Group Leader at the Department of Nutrition, Exercise and Sports.

Peanuts May Help Lower Type 2 Diabetes Risk

 

 A recent study from the University of Barcelona and the German Institute of Human Nutrition Potsdam-Rehbruecke has found that eating peanuts was associated with favorable changes in blood lipids linked to a lower risk of type 2 diabetes (T2D). The changes largely involved a class of lipids called sphingolipids, which contained very long-chain saturated fatty acids (VLCSFA). Unlike some other saturated fats, higher levels of VLCSFAs in the blood have been associated with lower T2D risk, better heart health and longevity in emerging research. The findings were recently published online in the international, peer-reviewed journal The American Journal of Clinical Nutrition.

Lexapro most effective anti-depressant

Antidepressants not only alleviate depression symptoms in the short term, but also help sustain these benefits over the longer term. A new, major comparative study has found that three medications are the most effective in this regard. 'This helps doctors choose a medication that not only helps patients to get well, but also keeps them well.'

Worldwide, nearly six percent of people experience depression. Many of them continue taking antidepressants after achieving symptomatic improvement, amongst others to prevent a relapse of depression. An international team of researchers investigated whether and which antidepressants in particular can not only get the patients well but also keep them well (sustained response). This is the first large-scale study to compare different antidepressants over both short- and long-term use. Results have now been published in The Lancet Psychiatry.

This study utilized evidence from 115 previously conducted randomized clinical trials, involving more than 30,000 participants in total. Researchers compared 20 antidepressants with one another and with the best-known antidepressant, fluoxetine. Results suggested that antidepressants can indeed keep people well also during long-term use. Moreover, the study found evidence of differences between the various medications. These findings should inform the initial choice of antidepressants in view of their potential long-term use.

Guidelines

Three antidepressants were found to be more effective in the long term: escitalopram, agomelatine, and duloxetine. These medications performed better than fluoxetine. 'Escitalopram is already widely used', says first author Paul van Haaren. 'Agomelatine works well, but one of its side effects is the risk of liver failure. Duloxetine is less well known and is prescribed less frequently as a first-line treatment.'

Many international guidelines advise SSRIs as primary choice antidepressants. 'Of these SSRIs, escitalopram  (commonly known by the brand name Lexapro) now appears to be the most effective, also for long-term use. This study may have implications for future treatment guidelines', says Eric Ruhé, Professor of Difficult to Treat Depression at Radboud university medical center.

Staying well

According to Ruhé, this does not mean that everyone with severe depression should now receive escitalopram. 'As a prescriber, you consider the balance between a medication’s benefits and side effects. That balance differs from person to person. Therefore, the choice of medication may vary for each individual patient. Nevertheless, our study can help inform the decisions that prescribers and patients make together: if you start an antidepressant, choose one that not only helps you to get well, but also keeps you well.' 

A longevity diet is not just about eating less—it is what, when, and for whom

 

A review of more than 30 large prospective cohorts proposes an age-stratified macronutrient framework and a longevity dietary pyramid for healthy aging

FacebookXLinkedInWeChatBlueskyMessageWhatsAppEmail

Caption

Diet shapes aging through both the amount of food eaten and the balance and quality of nutrients.

Evidence from animals and human populations shows that nutrition can influence lifespan and healthspan.

Younger adults need enough protein, while older adults may benefit from more plant foods and fiber.

Future diets may be personalized using genes, gut microbes, glucose patterns, and digital monitoring data.

Credit

Huang J., Huang D. and Wu Z. (2026). Beyond dietary restriction: Towards next-generation precision diets for healthy aging. The Innovation Nutrition 1:100034.

Eat less, live longer" has a firm footing in the laboratory: dietary restriction extends lifespan across species, from yeast to mammals. But a review published in The Innovation Nutrition argues that the slogan travels badly to the dinner table—and that what people eat may matter at least as much as how much. 

Drawing on more than thirty large prospective cohorts and meta-analyses, the authors—Jintao Huang, Dejian Huang, and corresponding author Ziyun Wu of Shanghai Jiao Tong University—assemble a case for "precision diets": optimizing macronutrient quality, sources, and proportions rather than cutting total energy. Severe restriction, they note, is hard to sustain and carries risks including reproductive impairment, menstrual irregularities, osteoporotic fractures, and cardiac arrhythmias. 

The evidence is organized around four nutrients. Carbohydrates follow a U-shaped curve: in several populations, moderate intake—about 50 to 55 percent of energy—is associated with lower all-cause mortality, with whole grains, legumes, vegetables, and whole fruits consistently outperforming refined grains and sugar-sweetened beverages. 

Protein shifts with age: in midlife, higher intake of animal protein correlates with higher mortality risk, whereas plant protein shows favorable associations; after 65, when sarcopenia and frailty take over, the recommendation flips toward moderately more high-quality protein from fish, legumes, and other sources.

 For fats, type beats quantity—unsaturated fats from nuts, olive oil, and fish are linked to better cardiovascular outcomes, while industrial trans fats should be limited. 

Dietary fiber, at roughly 25 to 29 grams per day, shows one of the most stable associations with lower mortality, likely mediated through short-chain fatty acids produced by gut microbes. 

The authors caution repeatedly against overreach. Cohort studies show associations, not causation. Clinical ketogenic diets are not ordinary low-carb diets and belong, they argue, in medically supervised, time-limited treatment rather than everyday longevity practice. The framework's age-stratified ratios—19 to 35, 36 to 64, and 65 onward—are research scaffolding, not validated prescriptions. The review's most forward-looking section is a feedback loop: because postprandial glucose, insulin, and triglyceride responses can differ up to tenfold between individuals eating identical meals, precision nutrition should mean continuous assessment—continuous glucose monitors, microbiome and multi-omics profiling, wearables, and artificial-intelligence-assisted diet design—rather than one personalized menu generated once. Time-restricted eating adds a temporal dimension. Early personalized-nutrition trials have improved short-term metabolic markers, but the authors stress that no tool has yet demonstrated longer healthspan; that will take multi-year randomized trials, enriched for adults over 75, non-European genetic backgrounds, and low- and middle-income regions. The public-health message that survives the caveats is deliberately unglamorous: choose high-quality carbohydrate sources, partially replace red and processed meat with plant proteins, favor unsaturated fats, eat enough fiber—and treat diet as one strand of a life woven together with sleep, circadian rhythm, exercise, and social connection. 

---

DOI

10.59717/j.xinn-nutri.2026.100034 

New Medicare policy could bring mental health care to millions more Americans

 Seven in 10 Americans want their primary care doctors to address both physical and mental health, yet nearly one-third say they have never been asked about their mental health during an office visit. Even more concerning, roughly one in three people who say they have anxiety, depression or substance use disorders, say they don’t know how to find a mental health provider, according to recent research from the West Health-Gallup Center on Healthcare in America.

That may soon change thanks to new payment policy announced today by the Centers for Medicare and Medicaid Services (CMS) that improves reimbursement for Collaborative Care, an evidence-based approach that integrates services into primary care.

Estimates suggest limited utilization of Collaborative Care despite decades of research demonstrating its effectiveness. Insufficient reimbursement, workforce shortages, and operational challenges have limited its reach, leaving millions of Americans without access to a proven approach to treating common mental health conditions.

“Americans want behavioral health to be part of their regular healthcare, and there is a proven way to deliver it. What has been missing is the support to make it widely available,” said Timothy A. Lash, President of West Health and Chair of the West Health Policy Center. “We applaud CMS for recognizing the value of Collaborative Care and taking an important step toward making this approach financially sustainable for primary care practices and available to millions more Americans.”

Collaborative Care brings together a primary care provider, behavioral health care manager, and a psychiatric consultant to coordinate treatment for patients with conditions such as depression and anxiety. Rather than requiring patients to figure out where and how they can get help, the model makes behavioral health treatment part of their regular medical care, which can lead to quicker diagnosis and treatment.

West Health has been working to accelerate the adoption of Collaborative Care through partnerships with leading health systems, Through the Northwestern Medicine West Health Accelerator, launched in 2024, the health system has expanded Collaborative Care to its entire primary care population (86 clinics), providing access to more than 500,000 patients.

“Improving access to behavioral health requires more than recognizing the problem. It requires changing how care is delivered, how providers are supported and how success is measured. We’re helping build those resources and capabilities today at Northwestern and leveraging that experience to help advance the model all over the country,” Lash said.

West Health is also partnering with the American Psychiatric Association on workforce training and the National Committee for Quality Assurance (NCQA) on establishing standard clinical and economic measures for the Collaborative Care Model.

In the CY 2027 Medicare Physician Fee Schedule final rule, released on Nov. 4, 2026, CMS finalized increases to the work RVUs for Collaborative Care services and updated the clinical labor rates for the Behavioral Health Care Manager. The change will increase payments as much as 73% from the previous Medicare rates and is a key step toward reducing the scale required to sustain a program and expanding access to the model.

Longer reproductive lifespan, hormone use associated with better brain health

 

Highlights: 

• A new study found that women with a longer reproductive lifespan had fewer signs of damage to the brain's small blood vessels and better brain health later in life.  

• Researchers looked at exposure to estrogen through reproductive lifespan, the time from first menstruation to menopause, birth control pill use and menopausal hormone therapy use.  

• Women with a longer reproductive span had 8% lower odds of having two or more signs of cerebral small vessel disease, which affects brain health. 

• Menopausal hormone therapy use was associated with fewer brain microbleeds and fewer enlarged spaces around blood vessels. 

• The most favorable vascular brain health was observed among women who had used oral contraceptives during their reproductive years and later received menopausal hormone therapy. 

• The study found associations and does not prove that reproductive lifespan or hormone use directly protect the brain. Further research, including clinical trials, is needed to establish causal links. 

A longer reproductive lifespan and a history of using birth control pills or menopausal hormone therapy were associated with certain signs of blood vessel health in the brain, according to a study published November 4, 2026, in Neurology®, the medical journal of the American Academy of Neurology.  

Cerebral small vessel disease affects tiny blood vessels within the brain and is associated with stroke, cognitive impairment and dementia.  

The study shows an association and does not prove that longer reproductive lifespan or hormone use directly leads to better brain health; this would require clinical trials.  

“Women are affected by Alzheimer’s disease more often than men. This may be related, in part, to fluctuations in estrogen levels throughout life,” said Anna Marseglia, PhD, of Karolinska Institutet in Stockholm, Sweden. “Estrogen is known to have protective effects on both neuronal cells and blood vessels in the brain. However, its potential role in women’s cerebrovascular health in later life has been largely understudied. Our study found that factors associated with longer estrogen exposure were associated with fewer signs of cerebral small vessel disease and better brain health in older age.” 

The study included 352 women who were 70 years old and without cognitive impairment at the start of the study. 

Researchers examined reproductive factors linked to lifetime estrogen exposure. They calculated each woman's reproductive lifespan, defined as the number of years between her first menstrual period and menopause or surgical removal of the ovaries. On average, women had a reproductive lifespan of 37 years. 

They also recorded if participants had ever used birth control pills or menopausal hormone therapy. Of participants, 73% had used birth control pills and 61% had used or were currently using menopausal hormone therapy.  

Participants had magnetic resonance imaging (MRI) brain scans at age 70 and 75. Researchers examined the scans for four signs of cerebral small vessel disease: areas of damaged tissue called white matter hyperintensities; microbleeds; small fluid-filled cavities called lacunes; and moderate to severe enlargement of spaces surrounding blood vessels. Each participant received a score from zero to four, with one point assigned for each sign present.  

After adjusting for factors like education, number of pregnancies and total months breastfeeding, researchers found that women with a longer reproductive lifespan had 8% lower odds of having two or more signs of cerebral small vessel disease. 

In a separate analysis that adjusted for factors like education, high blood pressure and heart disease, women who had or were still using menopausal hormone therapy were 59% less risk of having a greater small vessel disease burden, including fewer microbleeds and enlarged spaces around blood vessels. Birth control pills and menopausal hormone therapy use were associated with greater integrity of the brain’s white matter microstructure, an early marker of healthier brain tissue.  

Researchers also found that women who had used oral contraceptives and later received menopausal hormone therapy showed the most favorable vascular brain health. This group had lowest amount of cerebral small vessel disease and the healthiest white matter integrity compared with women who had never used hormonal therapies. 

“What was particularly striking was that the most favorable vascular brain health was observed among women who had used oral contraceptives during their reproductive years and later received menopausal hormone therapy” said Marseglia. “This suggests that hormonal factors acting across different stages of a woman's life may have cumulative associations with cerebrovascular health in older age. While these findings do not establish cause and effect, they underscore the importance of considering women's reproductive and hormonal history when studying brain aging and dementia risk not only in relation to Alzheimer’s disease but also to vascular disease.” 

Limitations of the study include that hormone exposure was reported by participants during the data collection interviews; they may not always have remembered accurately. Researchers could not track individual hormone levels over time, and there was a lack of detailed information on participants’ oral contraceptive and hormone therapy use. Because all participants were cisgender women and researchers had limited information on gender identity, the findings may not apply to all women. 

The study was supported by: the Swedish Research Council; the Swedish Research Council for Health, Working Life and Welfare; the Center for Innovative Medicine; the Swedish Dementia Foundation; the Swedish Alzheimer's Foundation; and the Gamla Tjännarinor Foundation. 

Discover more about brain health at BrainHealth.com, a free public resource from the American Academy of Neurology. It offers a website, podcast, and books, connecting you with trusted information from the world’s leading experts in brain health.