⋆ Second Gen Desi ⋆ – Page 10 – A Second Gen Desi documenting her experiences

Pree July 10, 2021 Milan, Italy

The Women’s Brain Book by Dr. Sarah McKay

Reading Time: 7 minutes

As a scientist with two years after her PhD training complete, I’ve realized time and time again the importance of effective scientific communication. I find value in reviewing the work of fellow colleagues and presenting it to an audience who has yet to be introduced to new findings.

I’ve mentioned before in previous “science-based” posts on this blog that science shouldn’t be intimidating, but oftentimes it comes across that way because many scientists are used to speaking with their peers. After years and years of school, training, and specialized research, technical terms become a part of one’s everyday jargon in the scientific research field.

So when I see scientific communicators like Bill Bryson—or in this post’s case, Dr. Sarah McKay—publish works meant for a general audience, I’m enthusiastic about reading them from a critical scientist’s point of view, and featuring them on this blog to pique your interest.

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The reason McKay’s book, The Women’s Brain Book, came across my (virtual) desk was because a fellow woman in STEM, Dr. Anjali Kasunich, and I connected on Instagram to form a “nerdy science girls” book club of sorts, because of our shared passion for disseminating topics in science for the general public. Anjali and I both thought TWBB would be a fascinating read for our inaugural IG Live book club series since it was expected to contain a hefty collection of peer-reviewed studies, simmered down to simplicity, in relation to a woman’s hormonal health and her brain.

TWBB has a chronological order to its chapters, with the book spanning over how a woman’s brain is formed, conditioned, influenced, and changed throughout all of life’s stages. Major external factors like the environment in which we grow up in, and the social connections we make, have a crucial impact on our general brain health as well.

Depending on your level of interest in a specific life stage and how it affects the woman’s brain, it’s easy to jump from one section to the other in the book without feeling incredibly lost. I decided to read the book in the “traditional” way, and while my background as a scientist made me familiar with some of the studies and concepts Dr. McKay mentions throughout the book, I found at least four key takeaways from the book that I thought were worth mentioning:

1. We are to be female, unless SRY has its way

My sub-heading title is not to be taken literally, but it refers to some interesting observations…

In the very first chapter of TWBB, McKay addresses an important detail – female brain development technically doesn’t take place right at conception, and its progression is based on whether or not the Y chromosome is present. If we define (in this context) a biological female as having two X chromosomes, and a biological male as having one X and Y chromosome, we can then understand why the presence of these chromosomes is life-changing.

McKay notes that when XY embryos are 6-8 weeks old, a gene known as the “sex-determining region of the Y chromosome” (SRY) is turned on. SRY allows for the development of the testes, as well as turns on several more genes that guide in other “male-associated” biological processes. Without the Y chromosome however, SRY and it’s associated genes remain off, and we become female!

I would have thought that if SRY has such a powerful role in male development, a similar gene would have a role in females, but that is not the case. I also found it interesting that while the presence of androgens (the family of male hormones that includes testosterone) turns on genes that involve the development of male organs and physical characteristics, the female hormone estrogen doesn’t have such a role in “feminization”. In fact, ovaries develop in the absence of testosterone.

We are conditioned to think that if A=Male, then B=Female, but perhaps we should think of it more like 0+A=Male and 0=Female. Nature prefers us to be female unless otherwise noted 😜.

2. Nature and nurture are equally important in brain development

Growing up in California, I remember seeing ads on TV—and later billboards, buses, and the metro when I moved to Los Angeles for grad school—for the First 5 California campaign, which emphasizes the importance of the first five years in a child’s life in regards to cognitive, physical, and emotional development.

In TWBB, McKay provides examples for which natural disasters could impact this development. One such example was an event that took place in Montreal in the late 90s. An ice storm left the city without power for 45 days, and researchers took it upon themselves to monitor women who were pregnant at that time to see how the development of their children was affected for years to come.

Understandably, the “Project Ice Storm” babies were born prematurely, and this also correlated to timing of a woman’s pregnancy (very early and very late stage pregnant women tended to have premature births). When the babies became toddlers, they not only had cognitive and language developmental delays, but attention deficits and behavioral problems as well. “Ice Storm Girls” had increased risk of puberty, obesity, and asthma, but interestingly, “Ice Storm Boys” tended to have more serious problems compared to the girls, and researchers hypothesize that this may be due to the fact that the female placenta is a more protective barrier against maternal stress hormones. While we can’t control the presence and timing of natural disasters, this study seems to demonstrate that external factors that impact a pregnant woman’s well-being can lead to striking outcomes in the development of her unborn children…

3. Hormone sensitivity and depression

I have struggled with depression as early as 18, but over the years, I have noticed that while it may be underlyingly chronic, there are certain periods in my life when the condition feels “stronger” than others. If I am to line up all the variables that could be involved, I automatically consider external factors contributing to stress, hormone fluctuations, and diet (quality and quantity of food, in addition to vitamin supplementation).

So I was certainly interested to see what sources McKay collected in regards to premenstural syndrome/ premenstrual dysphoric disorder, or PMS/PMDD. I am highly convinced that during a very stressful period of my life in late 2018 (the fourth year of my PhD, prior to the publication of my first paper…you can imagine), I was suffering from all symptoms associated with PMDD.

Some researchers have suggested that PMS is something that has developed out of social context, meant to “put down the woman” as a reason for her “inability” to perform activities. At first, I wasn’t sure how I felt about this because the way I see it, it is good to have a medical reason to explain why you feel certain symptoms at certain times of the month. Of course, each woman has a unique experience—unique symptoms, unique timings, you name it. I often found that in my situation, I had non-stop irritability, mood swings, intense bouts of crying, and physical issues like fatigue, sleepiness, and bloating that went on for half the month, only to quiet down around my period, but rise back up again within a few days after my period ended.

So, I did have these crazy symptoms, but sometimes it felt like I was under nature’s wrath for almost the entire month, or sometimes only in the two weeks before and after my period. Confusing in an understatement 🤷🏽‍♀️.

McKay’s note about a 2013 Canadian study titled “Mood in Daily Life (MiDL)” was able to find that in a cohort of women who were asked about their PMS-associated symptoms—without knowing they were being asked about PMS—there was no significant correlation that PMS phase influenced mood. The researchers suggested that the symptoms were more influenced by factors in a woman’s life that were external, like lack of social support, environmental stress, or poor health.

While this could be, I was relieved to see McKay included a note by Jayashri Kulkarni, a researcher who supports the study of endocrinology to understand what causes PMS. And when she said that “women may differ in their sensitivity to hormones, perhaps via genetic variations in receptor structure or number”, I wanted to stand up and scream RIGHT???? THANK YOU 😂! I’m sure some kind of specialized hormone profiling for women at different phases of their menstural cycle could bring SO much more insight into caring for unique sets of symptoms. And given that my family does have a (maternal) history of mental illness, I can’t help but hypothesize that my genetic make-up influences how reactive I am to the hormones in my body, and how that in turn can influence how I feel.

4. Estrogen’s importance in late life

Even though estrogen doesn’t seem to be “so important” in utero, we can see it has tremendous effects on our well-being as we get older. McKay noted several points about estrogen throughout the book, including the point that high levels of the hormone in young, fertile women are thought to lower schizophrenia risk (although, context is needed to clarify what is considered “high”), and that low levels of estrogen could exacerbate PMDD.

In the latter half of the book, McKay touches upon menopause, and how estrogen and glucose are essential players in menopausal outcomes. The brain’s main fuel source is glucose, and it is a greedy little organ consuming 20% of our resting metabolic rate (RMR). McKay mentions an interesting observation that women who’ve had their ovaries removed before menopause experience a critical drop in estrogen, and that this drop is associated with increased type 2 diabetes risk. This risk is similar in women after they experience menopause naturally, suggesting that estrogen may have an essential role in regulating glucose metabolism and lowering diabetes risk.

While we can’t fight nature on certain processes like menopause (although solutions like hormone replacement therapy are available, with McKay going into detail on that in the book as well), it’s eye-opening to see how such tiny molecules have an incredible impact on our metabolic processes and in turn, our physical outcomes and well-being. All the more reason to take care of ourselves as much as possible!

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McKay has done an incredible job compiling what is known about the field in regards to women’s health and the brain, but as she points out time and time again, there is still so much more that can be done to understand a woman’s biology and its impacts on her brain health.

Recently, the NIH and other research funding bodies have stressed the importance of including male and female subjects in future research projects—especially if you have any hope of wanting to have your research funded in the future. This is a great step in the right direction, but there is no doubt we have a lot of catching up to do, as well as needing to put in energy to shift the current social construct of how women’s health is perceived.

If you’ve ever been curious about what we know so far about women’s health and the brain, TWBB is certainly a resource for anyone in this regard, whether you have an extensive science background or not!

Pree June 15, 2021 Milan, Italy

Appreciating America

Reading Time: 8 minutes

It has been almost one year since I left for Italy—a year that oftentimes feels like ten.

In pre-pandemic times, my excitement for a new life experience in Italy was based on what I had read in travel memoirs, heard from Italian post-docs in my lab, and honestly, a number of baseless fantasies thought up by moi.

I had made trips to Europe before with family and by myself, and I was expecting Italy to match the classic, European allure of the other countries I had visited. Unfortunately, my expectations didn’t exactly match my imagination, and a lot of that was due to the pandemic. I’m still holding out on Rome though—I’m dying to know if the Eternal City matches up to all the pre-teen dreamy scenes of the Lizzie McGuire Movie…

When I see pastel-colored Vespas, I immediately think **Lizzie McGuire Movie**…

This, and many other observations and experiences over the past year have led me to actually feel something I never thought I would, to the extent that I feel it now.

I am very, very proud to be an American.

Part of being a good American is complaining about America. We are enlightened about our right to free speech from a very young age, and it’s something we shamelessly take for granted. And of course, I was one of those complaining folks. I would shake my head with embarrassment every time America ended up on the news for a radical remark a president had said, or for decisions the American government had made that other countries had the right to tease us about.

I once thought I was one of a country of uncultured swine, but that is too cruel of me to say. Especially since I now realize no country is perfect, including Italy. I’m not saying America is without its faults, in fact, incessant gun violence and a money-guzzling healthcare system are not things to brag about. But as an American citizen, I’ve come to realize that there are plenty of things I have taken for granted that living abroad has made me reflect on and “re-appreciate”.

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1) Financial security…

Before coming to Italy and taking on a post-doctoral scientist appointment, I was given an award letter for my fellowship. At first glance, I thought WOW, they are paying me double what I’m getting now as a first-year post-doc/recent PhD grad!

Haha, there was a catch.

The full amount of the fellowship covered my employer’s expenses for having me on as an employee, taxes, and then finally my actual salary—which ended up being equivalent to a little bit more than what I was getting as a PhD student 😶😶😶.

I definitely was in shock upon realizing this, and before confirming my decision to take on the role, there was at least two weeks of back-and-forth with HR trying to understand where my fellowship money going. I was told by some Italian acquaintances that my net earnings were very good for Italy, which horrified me.

Good for Italy? Like, people are OK with this? I can’t imagine what someone working a “minimum wage” job takes home…

And perhaps the general population is “vabbe” about this because of communal, multi-generational living arrangements (i.e. NO RENT) and paying things “on the down-low with ca$h money” (i.e. what taxes?), but even so, I can’t see how this can be good economically in the long run…

This is not to say America is handing fistfuls of dollar bills to every person aged 0-99 (although 3 COVID-19 stimulus packages argue against this…), but there is definitely room to negotiate luxurious salaries with the right degree and industry. For example, an entry level medical science liaison, a high-profile position in the pharmaceutical industry that is often sought after by terminal degree holders, can earn on average $80-100k a year. In Italy, it’s around €55,000 a year, on average. Approximately $67,000 a year.

Personally speaking, I would jump on this amount given that my current job pays less, but it surprises me that there is such a striking difference in the starting salary of a highly-qualified position between two countries…

This discrepancy is also quite confusing to my cute neighbor.

2) Fashion freedom

Before moving to Italy (specifically Milan), I did give a good thought to reshuffling my wardrobe so that I fit the “bella figura” stereotype that is often associated with the culture.

But, I am a girl who lived in pajamas and running clothes for 3 months during the pandemic—what can I say? I’m very low maintenance!

I didn’t think twice about walking into a Whole Foods or Trader Joe’s after a long run when I was in the US. I’d be a sweaty mess, but I didn’t let that stop me from getting an ice cold kombucha and a vegan treat to-go. I suppose I didn’t have to be self-conscious about walking around town in workout gear if every other person was doing it too.

But Italy doesn’t seem to offer that “chill” attitude, not even if I’m actually working out! During a particularly hot workout one Sunday afternoon, I remember an elderly couple giving me side-eye because of my short running shorts and tank top. It reminded me of the many judgmental desi aunties I’ve come across over the years, but I was honestly surprised to come across this in a “Western” country like Italy.

Judgy people exist everywhere, but I can’t exactly say I feel comfortable wearing sweaty running clothes to take care of errands in Milan’s city center vs. somewhere in SoCal. I suppose it serves as an excuse to freshen and dress up for an otherwise mundane occasion, but there is something about convenience and a relaxed attitude when it comes to “American fashion” that I do kinda miss…

Actually running 🏃🏾‍♀️ around the Duomo in workout clothes is one thing, but stares are guaranteed if you stay in said clothes after working out and continue on with errands 🤷🏽‍♀️

3) Vegan options and freedom to be a foodie!

Southern California spoiled me when it came to vegan food options—as long as I frequented Whole Foods and Sprouts, as well as bookmarked up-and-coming vegan cafes and restaurants spanning the Los Angeles and Orange County areas, I was all set. I have always been a vegetarian, but picking the vegan option whenever possible has always been my prerogative. And without a doubt, this was so much easier to do in the USA…even when I spent 3 months in Oklahoma!

Milan does have a few vegan outlets, but the quirky idea of “vegan-izing” everyday meals just hasn’t caught on in Italy as it has in the US. I will admit however that when it does come to proper labeling of supermarket items, Italy does a good job of saying “adatto ai vegetariani” or “vegano” on the label. As a strict vegetarian, it can be troublesome when simply “caglio” (rennet) is listed on an ingredient label, but I have found many brands that list “caglio microbio” which makes things less complicated.

And yes, I’m all for the nut-based crema spalmabile (especially pistacchio!!), rich scoops of neighborhood gelati, and Sicilian cannoli, but the incomprehensible food “rules” like “cappuccinos after noon are sin” or “pineapple on pizza deserves jail time” will never, ever make sense to me.

Even though I personally believe everyone has the right to have a cappuccino at any time of day, this is one “rule” I have ended up following due to daily routine. Sometimes the timing works out and a *pistacchio latte* is able to work it’s way into your day 😊

I just know that if a country is vehemently unaccepting of pineapple on pizza and BBQ sauce, I really do have to applaud America as being the land of the free (for foodies!). 😅

4) Feeling myself

I think the realization that I would always be innately me, wherever in the world I went, has hit me the hardest from all of these items listed.

In the US, I tended to lean towards the introverted side of the spectrum, but around friends and people I trusted, I was a chatty, witty, and incredibly fun person to be around. In professional settings, I felt absolutely comfortable speaking to colleagues, giving presentations, and mentoring my juniors.

And I believe part of this is because of my strong command of English. It is right now the only language I speak fluently, and it is the only way for me to express myself. My forays in writing have only enhanced my exposure to the language, and the fact that the US adamantly proclaims English as the one and only official language of the land makes things easier when it comes to communication and expression.

In Italy however, I feel like this identity is not quite the same. Opportunities to improve my Italian have been minimal, and the interactions I do have with people I come across on a daily basis have been restricted to English. Despite this, I oftentimes feel like I have to hold back when it comes to my true self. American slang and references can leave people lost, and so I’m not left with much to hold an “engaging” conversation. When I do attempt Italian, I am shut down when the person on the other end switches to English without giving me a chance. Just like in America, patience can be a hard thing to find in Italy.

I believe if I am given the opportunity to express myself in the truest sense, it will be possible to find and enjoy the person I am here, but it also depends on if I will ever find my people here. Friends who understand my humor, share similar interests, like the same TV shows (it doesn’t help that I like the American shows that have yet to cross the Atlantic on Netflix…). Social media and women’s’ networking circles can only do so much—at the end of the day, new, trusting relationships* require work which can be utterly exhausting.

*I should add that there is one relationship in my life that has blossomed since my stay in Italy, and it has allowed me to be myself to the fullest☺

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Maybe a lot of this reflection is fueled by homesickness, and the fact that I haven’t seen my family in almost a year. Even though I’ve lived on my own since 2014, this is the first time I’ve been oceans apart from the people I feel most comfortable around.

Maybe a visit home would help give me a much-needed reset to tackle Italy again under new and improved, recovery-from-COVID-19 circumstances. This past year has been a rough ride emotionally, and I’m sure this has also influenced a lot of the opinions detailed in this post.

Still, I won’t deny the fact that living abroad—living in Italy—has given me a new-found appreciation for the country of my birth: something I have struggled with for years, but now I find easy to accept, with open arms.

Pree May 28, 2021 Bellagio, Italy

Bellagio (Not the One in Vegas)

Reading Time: 6 minutes

Since my excursion to somewhere in Switzerland in late August of last year, no other opportunities made themselves available in regards to day trips in Italy or beyond.

Nope, the second wave of ‘rona got in the way of that.

I even went so far as to daydream about Christmas break trips to Venice or Rome, but after summer ended, the way reality was shaping up crushed those plans to smithereens.

That, plus work stress and life stress—it was all piling up, and putting in the time and energy to plan out trips “for the future” seemed like a lost cause.

And it was, until April 26th, 2021 brought signs of hope. The following weekend—with the weather being a foreshadowing of a summer yet to come—was the first opportunity in months for lost souls to venture out once again.

I was itching to travel somewhere, anywhere, and I even thought about some “nearby” major cities I could try to visit from Milan.

Turin? Genova? Bergamo?

But, I ended up going somewhere not too far from my (weekend) homebase of Como—a special place at the center of Lago di Como, hand-in-hand with a special person—Bellagio.

Lago di Como is HUGE. From Como City, Bellagio is an HOUR away by car!!

Since moving to Italy, I have lost the urge to keep up with my early bird tendencies on weekends. With weekdays being harrowing at times, I decided that my time, on the weekend, should be spent in whichever way maximizes relaxation and recovery. And, whadya know, sleeping in till 11am or 12pm on Saturdays sometimes does the trick!

The good thing about Bellagio is that it’s small enough to explore within 2-3 hours. So even if you have errands to run on a Saturday morning but you’re somewhere in the Lago di Como region, it’s not too silly of an idea to drive up for a few hours of some nature eye-candy.

I. Mean. Eye. Candy.

At first, I wasn’t sure if I would end up going solo, but my companion offered to drive both of us in his car—on a winding, solitary road that overlooked the lake many times along the journey. It didn’t help that we were slowed down by a group of four girls who were also on their way to Bellagio, taking their share of pics for the ‘gram with their phones precariously held out the car windows.

When we did arrive close to 3pm, parking was a minor issue. We found a spot eventually, and shockingly had to pay by the hour. I guess it wasn’t too much of a surprise given that it’s a ploy to get every last bit of a tourist’s pocket change, but at least the rate wasn’t Los Angeles-crazy 😂.

City center is about a 15 min walk from the parking lot we used.

Since I’ve seen Lake Como from Como city many times, it seemed redundant to find a viewpoint to look out at the water in Bellagio, but that’s the main attraction 😂. Technically, there are some differences in the landscape…

It was interesting to see how the mountain “terrain” changed across a panoramic-like view.

Smoother textured mountains on the left, snow-capped mountains in the center…

But the best part of going out to see the water at this time and location, was the wildlife of course.

I had front-row seats for the Momma & Babes show 🥺!!!

We weren’t the only ones enamored by their cuteness. Other people surrounding the dock seemed to notice my excitement (I was literally pointing and waving my arms at the ducks!) and shifted the focus of their phone cameras from the landscape to a few baby birds.

After enough time was spent at the water, we decided to walk back towards the city center. My eyes fell upon the buildings that faced a central dining area of sorts, and I could not look away. The architecture was so fitting for Northern Italy.

A work colleague of my companion also happened to be in Bellagio at the same time and we ran into him. He was one of those guys who dresses up in a suit to eat pasta 😅.

South of the shops and eateries, there was a picturesque walking path with tall trees and perfectly-cut shrubbery all on the side.

Too pretty for a long run. Walking will have to suffice.

Once again, it was another ideal location to stop and look out at the water. And sneakily people watch.

Two hours had passed by this point, and so my companion and I decided to take “the long way” back to the car. We passed the I Giardini di Villa Melzi, but it was another tourist trap that we ran from. They couldn’t stop me from taking pictures through the gates!!

To be fair, there weren’t that many people walking around that day, but I secretly appreciated that we were walking away from the crowds.

I started to figure out why we weren’t seeing many people at the point…the roads were increasing in elevation and our casual stroll was becoming a stairclimber session.

The biggest perk of this surprise workout was “accidentally” falling upon the Church of Goats*.

When special guests donkey and black baby goat made their appearances, I literally died 😂. My name is Pree and I like animals.

Ducks, goats, donkeys, dogs, and cats. Bellagio has everything.

There was no issue with finding the parking lot since we pinned our location with Google Maps. We did however still have some more time left on the meter, so it was an excuse to walk through some alleyways for that authentic Italian “village” feel.

When we entered this path, I looked down at my sneakers and wished they had more padding at the bottom (can’t expect much from a cheap pair from Primark though…), but I was grateful that I wasn’t in a pair of high heels trying to navigate this pretty chaos!

As time started to inch closer to 6pm (or 18:00, military time for Europeans 😂), we called it a “day” and got back in the car. As I expected, I drifted in-and-out of sleep on the drive back: a genuine indication that I had a pleasantly exhausting time.

Wanna know one of the best things about travel, even if it’s just a short daytrip? Coming back home so exhausted and instantly falling into a deep sleep.

So, Bellagio. My few hours here were enjoyable and well-spent. And while the scenery was nice, the experience was much more memorable because I had someone special by my side. I could have gone on my own, but sometimes it’s nice to walk around with someone’s hand in yours.

And if they have a car, it saves you a bumpy bus ride 😂.

Pree May 6, 2021 Milan, Italy

International PB Craving

Reading Time: 6 minutes

Peanut butter was never a favorite of mine growing up, yet as I got older, it became an essential staple. But before that realization, I had a looooooong period of infatuation with other food spreads.

When I first tried Nutella as a kid, I was enamored. And when I learned that people on the other side of the globe—in fancy Europe—had Nutella on flaky croissants or on toasted bread for breakfast, I was convinced I was born on the wrong continent!

Peanut butter just seemed boring in comparison…it wasn’t even that sweet, so what was the point? I was the crazy child that would have rather had a jam-filled sandwich than the American PB&J classic. I know, crazy.

So when did things change?

When I got to college, and fell into the world of food blogging and food reviews, while also being restricted by an eating disorder. All of this led me to become obsessed with “protein-fortified” snacks that were marketed as healthy and for fitness enthusiasts—including peanut butter.

Nuts ‘N More was (and I believe still is) a popular brand specializing in “protein-packed” peanut butter, but stood out from the likes of Skippy and Jif with their collection of unique flavors—like Maple Pretzel, Birthday Cake, and Salted Caramel! Brands that struck gold in the protein bar and protein cookie industries weren’t the only ones dipping their toes into the pool of creativity—peanut butter was also becoming a canvas, and I was all for it!

After moving to Italy, I realized very quickly that Italians didn’t see peanut butter as a kitchen staple. When I paid my first visit to an Esselunga (the Italian equivalent of a Kroger I suppose), only two brands of peanut butter were on display.

One of two brands of peanut butter I’ve seen stocked on grocery shelves in Italy.

But there were tons of nocciole and pistacchi spreads—my dream was being overcompensated on one hand, while something too familiar to me was fading away in the aisles of an Italian supermarket.

If you ask Google about peanut butter in Italy, you get redirected to another blogger’s experience—and how you’re better off bringing it from outside the country!

It took me about six months of scooping through hazelnut spread jars for me to realize that my heart does have a soft spot for peanut butter, and that I missed the crazy flavors that I could find with ease back in the US.

And it’s as if Instagram read my mind, because the next thing I knew, I “found” Joey’s Spreads on my discover page, a small business churning out peanut butter from the UK. A single, top-view pic of their birthday cake flavor was enough for me to log onto their site and order myself a 4-pack of their offerings.

Ya know, treat yo’ self or something like that?

Yes, I paid almost 60 euros for peanut butter. But it was “fancy” peanut butter. And I saved 4.19…

Seeing as I used their “JAN” coupon, you can guess I made this order early this year. As with any company using shipping services in 2020 onwards, Joey’s gave me a heads up that delays due to COVID could impact the shipment and delivery of my order, but I didn’t think it would take almost two months.

I got in touch with them via email a month later, and then IG because I was impatient 😅. At least Joey’s was considerate about it, and replied straightaway. We kept in touch via Instagram DMs, and even though weeks were continuing to pass by, it seemed as though they were on top of checking in with the postal service they used.

Then, on fateful March 11th, my jars arrived.

(L to R -> Blueberry Muffin, Birthday Cake, Cookie Crumble & Carrot Cake)

Seeing their presence on my kitchen counter was a huge thrill after a particularly tiring and long day at work. I couldn’t hold back my excitement and had no issues deciding which flavor I’d try first.

I received the box in the morning, but didn’t have time to drop it off at home before leaving for work. So all four jars were taunting me for the entire work day until I could get home and consume them in peace 😆!

Of course, without a doubt, I decided that I would try Birthday Cake first.

I’m the kind of person who prefers a frosting-to-cake ratio of 75-to-25…if not more on the frosting side! And the more brightly-colored and sprinkled a frosting is, oh how better it is.

This jar had a generous layer of creamy pink frosting at the top with colorful bead-like sprinkles. If they want my opinion, I wouldn’t argue if they decided to change up the frosting-to-peanut butter ratio so that half the jar was frosting 😋. I think the point was to mix the frosting with the PB, but are you kidding? I think fellow frosting-lovers would agree—who in their right mind would do that?

The peanut butter itself had a nice crunch, but was still soft and chewy. So even though I inhaled all of the frosting, the PB itself was decent on its own.

Next was 🥕 Carrot Cake 🥕, because it had a frosting-like addition to it as well 😛.

Oh boy was the frosting delicious…it was actually so smooth and mixed with the PB almost to the bottom of the jar. To be honest, it was probably more like icing in consistency! The first flavor note I detected with my first spoonful (PB+icing together this time!) was that of orange. When I flipped the jar around, ‘orange’ was literally listed as one of the ingredients 😂. The next thing I knew, I struck an orange rind and a clump of raisins. Classic carrot cake things I guess?

With Blueberry Muffin, I was given a heads up:

And Joey’s was right, the jar had indeed “firmed up” thanks to a long trek across the pond and over to mainland Europe, but this did not impact the flavor.

I actually didn’t mind the crumbly texture, sharply-defined mini peanut chunks, and juicy blueberries (despite the fact they were dried, lol). The blue color reminded me of Sesame Street’s forever-hungry character Cookie Monster 😂.

And finally, there was Cookie Crumble:

This was a fun flavor to “go archaeologist” on. I was on a mission to dig up chunks of cookies, but I found mini chocolate pieces instead. Eventually I did find what I *thought* were cookie pieces—they at least had a crunch to them, so I assumed them to be so. Overall, the jar tasted and smelled like a giant, crushed chocolate chip cookie mixed with smooth peanut butter. Mission accomplished.

Overall, each jar of Joey’s Spread is a whopping 500g, so the amount you receive justifies the price. If I was living in the UK, I wouldn’t mind ordering from them more often. Their flavor offerings make up for what I’m missing out on back in the good ol’ US of A.

But realistically speaking, as much as I do miss peanut butter, I’ve gotten used to just seeing hazelnut and pistachio-based spreads in the grocery store, and being content with it. I mean, that’s what lil Pree used to dream of, so the least big Pree can do is buy a couple jars and indulge 😉.

Moral of the story is, Italy doesn’t offer anything spectacular in regards to peanut butter.

Shipping finely-ground peanuts from the US (yes, even with frosting mixed in) is not worth it, in my opinion.

So next best thing? Ordering from Joey’s Spread when that international PB craving hits.

Pree April 9, 2021

Digestible Science – CD8+ T Cells and COVID-19

Reading Time: 6 minutes

This is a blog post aimed to make technical scientific concepts more “digestible” for a lay audience. The work discussed is based on the research by Kusnadi et al., published in Science Immunology in January 2021. To read their work directly, please click here.

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It’s been over a year since the words lockdown, remote working, and stay-at-home became frequent in our conversations, and we have the global impact of the COVID-19 pandemic to thank for that.

Since then, we have applauded the efforts of fast-acting scientists and pharma in pumping out effective vaccines to help slow down transmission, but unfortunately, vaccine administration efforts have been inconsistent all over the world. Global herd immunity seems like a noble concept, but with conflicting policies and lack of organization among governments, it’s something that will be impossible to reach—at least in the short-term.

But those of us who have been vaccinated are incredibly lucky. Vaccines introduce biological material (based on an infectious agent) into the body to prompt a response from the immune system. If a vaccinated individual encounters the actual infectious agent in the future, their immune system should be able to recognize the foreign invader and prevent an infection from progressing. And of all the immune system’s key players, we have our lymphocytes—our T cells—to thank for this!

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In a previous blog post of mine, I described in general what CD8+ T cells are, but let’s recap:

T cells are born in the thymus (hence the “T” in their name) and primarily serve as “soldiers of the body”. If the body is under attack by foreign particles (often referred to as antigen), T cells are the main players in fighting off these particles to prevent damage in the body.

They are further categorized as “T helper” cells (CD4+) or “cytotoxic T” cells (CD8+). CD4 and CD8 are structures made out of carbohydrate and protein “blocks” and exist on the surface of T cells, giving off their identity. CD4+ and CD8+ T cells differ in how they interact with other cells in the immune system and foreign invaders.

So we know that vaccines can provide protection against viral infections like COVID-19 by introducing T cells to parts of a virus and priming them to recognize the virus in the future. But for those who were infected with COVID-19 directly, did the intensity of the symptoms they experienced alter their immune system at the cellular level?

A collaborative group of scientists out of San Diego, California and the United Kingdom believe this was something worth investigating, and went so far as to use advanced genetic sequencing techniques to conclude that when it comes to our immune system warriors—CD8+ T cells—the severity of COVID-19 symptoms could affect how these cells look and function. Their work was recently published in Science Immunology, a prestigious peer-reviewed journal in the immunology field.

Article by Kusnadi et al. recently published in *Science Immunology*

Since CD8+ T cells are critical when it comes to vaccine effectiveness and understanding immunity, it would make sense to characterize how CD8+ T cells are affected by COVID-19 infection. Obviously at the time this study began, not much was known regarding this, or much about COVID-19 in general.

The authors used blood samples from healthy donors, COVID-19 patients that were not hospitalized (characterized as ‘mild disease’ patients), and those that were hospitalized (‘severe’ patients) to isolate peripheral blood mononuclear cells (PBMCs).

PBMCs hold the key players of the immune system—T cells, B cells, natural killer (NK) cells, and monocytes—and are characterized by their round nuclei. Isolating this layer from the peripheral blood makes it easier to analyze CD8+ T cells in particular.

To isolate CD8+ T cells from the PBMC samples of COVID-19 virus-affected patients, the authors used a “cell sorter” to specifically collect CD8+ T cells expressing CD137 and CD69. Both of these markers indicate CD8+ memory T cells that are activated and are ready for battle. Going back to my earlier post, tacking the word ‘memory‘ next to CD8+ T cells indicates that these cells have the ability to recognize and act against a foreign invader.

Interestingly, the expression of CD137 and CD69 was increased in CD8+ memory T cells derived from “severe” COVID-19 patients compared to “mild” COVID-19 patients, perhaps indicating that severe patients could have an increased protective response to COVID-19 antigens in a future encounter.

A very basic and cartoonish depiction of activated CD8+ memory T cells in mild and severe COVID-19 patients.

Even though the analysis becomes more complex as the paper continues (given the nature of genetics-based techniques), there is no need to feel intimidated. There are still key take-aways from the paper that even someone with a non-scientific background would appreciate.

Depending on the viral infection, CD8+ memory T cells can respond by activating a number of different genes that can help with fighting back at the infection. For example, COVID-19-reactive CD8+ memory T cells were observed to express genes associated with exhaustion, the production of molecules (cytokines) that assist with fighting off infections, and activating T cells.

“T cell exhaustion” is exactly what it says—when T cells lose their ability to fight off infections due to non-stop stimulation by a foreign invader, they tire out and do not function optimally in their normal defensive roles. A common marker of “exhaustion” is programmed cell death protein (PD-1) which T cells can express on their surface. The issue is that PD-1 is also involved in the activation of T cells, so like most things in biology, it’s not black and white—there needs to be a balance.

The authors knowing this utilized single cell transcriptomics, a process that allows us to examine all sorts of genes expressed by an individual cell, to see if there was more to characterizing exhausted T cells beyond what is seen at the surface level.

Ultimately, they found that CD8+ memory T cells reactive to COVID-19 expressed a number of genes associated with exhaustion, because of their connection to type 1 interferon signaling. This cell signaling pathway is associated with immune system regulation and has been noted by earlier studies to be linked to the development of exhaustion in T cells.

A simplified version of a “cluster map” and a “heat map”. More advanced depictions of these plots can be used to assess how genes group together in a particular sample and if they share similar functions.

Although patients with mild disease had more exhausted CD8+ memory T cells compared to severe disease patients, the exhausted CD8+ memory T cells in severe patients showed an increase in the number of genes associated with toxicity and inflammation.

Even though we would see this as a “negative” attribute of severe infection, it was noted that those with severe disease had CD8+ memory T cells that could survive for a longer time, although whether this observation can provide long-term immunity still requires investigation.

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Given that this is a study involving live individuals, using PBMCs is the only way to go, even though the analysis can be limiting (we can’t exactly do lung biopsies willy-nilly!). Even with its limitations however, the overall study does bring valuable insight as to how CD8+ T cells are affected by mild vs. severe COVID-19 infection.

The authors were able to use techniques to isolate single CD8+ T cells reactive to COVID-19 and determine that although patients with mild disease have more CD8+ T cells that are exhausted, the exhausted CD8+ T cells that severe patients do have lean towards higher levels of toxicity and inflammation, despite these cells also exhibiting features of increased memory responses and survival…

Maybe in this case, quality does take precedence over quantity? It will be interesting to see if any follow-up studies are conducted based on the findings of this paper, as we still have so much to learn about COVID-19. Although I do think it’s safe to say the authors uncovered some interesting details on how COVID-19 infections impact our immune system’s essential soldiers.

This has certainly been a lot to digest, but it was a delicious meal of brain food to dive into!

Resources cited in this post: