Are Waist Trainers Just A Waste, And Are Posture Fixers A Quick Fix?

Yesterday, we asked you for your opinions on waist trainers and posture-fixing harnesses, and got the above-depicted, below-described set of results:

• The most popular response was “Waist trainers are purely cosmetic, so useless. Posture-fixers have merit”, with a little over a quarter of the votes.
• The least popular response was “Both are great tools to help us to optimal waist size and posture, respectively!”
• The other three answers each got a little under a quarter of the vote. In terms of discrete data, these were all 7±1, so basically, there was nothing in it.

The sample size was smaller than usual—perhaps the cluster of American holiday dates yesterday and today kept people busy! But, pressing on…

What does the science say?

Waist trainers are purely cosmetic, so, useless. True or False?

True, simply. Honestly, they’re not even that great for cosmetic purposes. They will indeed cinch in your middle, and this shape will be retained for a (very) short while after uncinching, because your organs have been squished inwards and may take a short while to get back to where they are supposed to be.

The American Board of Cosmetic Surgery may not be an unbiased source, but we’re struggling to find scientists who will even touch one of these, so, let’s see what these doctors have to say:

• Waist training can damage vital organs
• You will be slowly suffocating yourself
• Waist training simply doesn’t work
• You cannot drastically change your body shape with a piece of fabric*

Read: ABCS | 4 Reasons to Throw Your Waist Trainer in the Trash

*”But what about foot-binding?”—feet have many bones, whose growth can be physically restricted. Your waist has:

• organs: necessary! (long-term damage possible, but they’re not going away)
• muscles: slightly restrictable! (temporary restriction; no permanent change)
• fat: very squeezable! (temporary muffin; no permanent change)

Posture correctors have merit: True or False?

True—probably, and as a stepping-stone measure only.

The Ergonomics Health Association (a workplace health & safety organization) says:

❝Looking at the clinical evidence of posture correctors, we can say without a doubt that they do work, just not for everyone and not in the same way for all patients.❞

Source: Do Posture Correctors Work? Here’s What Our Experts Think

That’s not very compelling, so we looked for studies, and found… Not much, actually. However, what we did find supported the idea that “they probably do help, but we seriously need better studies with less bias”:

The use of posture-correcting shirts for managing musculoskeletal pain is not supported by current evidence

That is also not a compelling title, but here is where it pays to look at the studies and not just the titles. Basically, they found that the results were favorable to the posture-correctors—the science itself was just trash:

❝ The overall findings were that posture-correcting shirts change posture and subjectively have a positive effect on discomfort, energy levels and productivity.

The quality of the included literature was poor to fair with only one study being of good quality. The risk of bias was serious or critical for the included studies. Overall, this resulted in very low confidence in available evidence.❞

~ Palsson et al.

Since the benefit of posture correctors like this one is due to reminding the wearer to keep good posture, there is a lot more (good quality!) science for wearable biofeedback tech devices, such as this one:

Spine Cop: Posture Correction Monitor and Assistant

Take care!

HRT: A Tale Of Two Approaches

In yesterday’s newsletter, we asked you for your assessment of menopausal hormone replacement therapy (HRT).

• A little over a third said “It can be medically beneficial, but has some minor drawbacks”
• A little under a third said “It helps, but at the cost of increased cancer risk; not worth it”
• Almost as many said “It’s a wondrous cure-all that makes you happier, healthier, and smell nice too”
• Four said “It is a dangerous scam and a sham; “au naturel” is the way to go”

So what does the science say?

Which HRT?

One subscriber who voted for “It’s a wondrous cure-all that makes you healthier, happier, and smell nice too” wrote to add:

❝My answer is based on biodentical hormone replacement therapy. Your survey did not specify.❞

And that’s an important distinction! We did indeed mean bioidentical HRT, because, being completely honest here, this European writer had no idea that Premarin etc were still in such wide circulation in the US.

So to quickly clear up any confusion:

• Bioidentical hormones: these are (as the name suggests) identical on a molecular level to the kind produced by humans.
• Conjugated Equine Estrogens: such as Premarin, come from animals. Indeed, the name “Premarin” comes from “pregnant mare urine”, the substance used to make it.

There are also hormone analogs, such as medroxyprogesterone acetate, which is a progestin and not the same thing as progesterone. Hormone analogs such as the aforementioned MPA are again, a predominantly-American thing—though they did test it first in third-world countries, after testing it on animals and finding it gave them various kinds of cancer (breast, cervical, ovarian, uterine).

A quick jumping-off point if you’re interested in that:

Depot medroxyprogesterone acetate and the risk of breast and gynecologic cancer

this is about its use as a contraceptive (so, much lower doses needed), but it is the same thing sometimes given in the US as part of menopausal HRT. You will note that the date on that research is 1996; DMPA is not exactly cutting-edge and was first widely used in the 1950s.

Similarly, CEEs (like Premarin) have been used since the 1930s, while estradiol (bioidentical estrogen) has been in use since the 1970s.

In short: we recommend being wary of those older kinds and mostly won’t be talking about them here.

Bioidentical hormones are safer: True or False?

True! This is an open-and-shut case:

❝Physiological data and clinical outcomes demonstrate that bioidentical hormones are associated with lower risks, including the risk of breast cancer and cardiovascular disease, and are more efficacious than their synthetic and animal-derived counterparts.

Until evidence is found to the contrary, bioidentical hormones remain the preferred method of HRT. ❞

Further research since that review has further backed up its findings.

Source: Are Bioidentical Hormones Safer or More Efficacious than Other Commonly Used Versions in HRT?

So simply, if you’re going on HRT (estrogen and/or progesterone), you might want to check it’s the bioidentical kind.

HRT can increase the risk of breast cancer: True or False?

Contingently True, but for most people, there is no significant increase in risk.

First: again, we’re talking bioidentical hormones, and in this case, estradiol. Older animal-derived attempts had much higher risks with much lesser efficaciousness.

There have been so many studies on this (alas, none that have been publicised enough to undo the bad PR in the wake of old-fashioned HRT from before the 70s), but here’s a systematic review that highlights some very important things:

❝Estradiol-only therapy carries no risk for breast cancer, while the breast cancer risk varies according to the type of progestogen.

Estradiol therapy combined with medroxyprogesterone, norethisterone and levonorgestrel related to an increased risk of breast cancer, estradiol therapy combined with dydrogesterone and progesterone carries no risk❞

In fewer words:

• Estradiol by itself: no increased risk of breast cancer
• Estradiol with MDPA or other progestogens that aren’t really progesterone: increased risk of breast cancer
• Estradiol with actual progesterone: back to no increased risk of breast cancer

Source: Estradiol therapy and breast cancer risk in perimenopausal and postmenopausal women: a systematic review and meta-analysis

So again, you might want to make sure you are getting actual bioidentical hormones, and not something else!

However! If you are aware that you already have an increased risk of breast cancer (e.g. family history, you’ve had it before, you know you have certain genes for it, etc), then you should certainly discuss that with your doctor, because your personal circumstances may be different:

❝Tailored HRT may be used without strong evidence of a deleterious effect after ovarian cancer, endometrial cancer, most other gynecological cancers, bowel cancer, melanoma, a family history of breast cancer, benign breast disease, in carriers of BRACA mutations, after breast cancer if adjuvant therapy is not being used, past thromboembolism, varicose veins, fibroids and past endometriosis.

Relative contraindications are existing cardiovascular and cerebrovascular disease and breast cancer being treated with adjuvant therapies❞

Source: HRT in difficult circumstances: are there any absolute contraindications?

HRT makes you happier, healthier, and smell nice too: True or False?

Contingently True, assuming you do want its effects, which generally means the restoration of much of the youthful vitality you enjoyed pre-menopause.

The “and smell nice too” was partly rhetorical, but also partly literal: our scent is largely informed by our hormones, and higher estrogen results in a sweeter scent; lower estrogen results in a more bitter scent. Not generally considered an important health matter, but it’s a thing, so hey.

More often, people take menopausal HRT for more energy, stronger bones (reduced osteoporosis risk), healthier heart (reduced CVD risk), improved sexual health, better mood, healthier skin and hair, and general avoidance of menopause symptoms:

Read more: Skin, hair and beyond: the impact of menopause

We’d need another whole main feature to discuss all the benefits properly; today we’re just mythbusting.

HRT does have some drawbacks: True or False?

True, and/but how serious they are (beyond the aforementioned consideration in the case of an already-increased risk of breast cancer) is a matter of opinion.

For example, it is common to get a reprise of monthly cramps and/or mood swings, depending on how one is taking the HRT and other factors (e.g. your own personal physiology and genetic predispositions). For most people, these will even out over time.

It’s also even common to get a reprise of (much slighter than before) monthly bleeding, unless you have for example had a hysterectomy (no uterus = no bleeding). Again, this will usually settle down in a matter of months.

If you experience anything more alarming than that, then indeed check with your doctor.

HRT is a dangerous scam and sham: True or False?

False, simply. As described above, for most people they’re quite safe. Again, talking bioidentical hormones.

The other kind are in the most neutral sense a sham (i.e. they are literally sham hormones), though they’re not without their merits and for many people they may be better than nothing.

As for being a scam, biodentical hormones are widely prescribed in the many countries that have universal healthcare and/or a single-payer healthcare system, where there would be no profit motive (and considerable cost) in doing so.

They’re prescribed because they are effective and thus reduce healthcare spending in other areas (such as treating osteoporosis or CVD after the fact) and improve Health Related Quality of Life, and by extension, health-adjusted life-years, which is one of the top-used metrics for such systems.

See for example:

Menopausal Hormone Replacement Therapy and Reduction of All-Cause Mortality and Cardiovascular Disease

Our apologies, gentlemen

We wanted to also talk about testosterone therapy for the andropause, but we’ve run out of room today (because of covering the important distinction of bioidentical vs old-fashioned HRT)!

To make it up to you, we’ll do a full main feature on it (it’s an interesting topic) in the near future, so watch this space

Ladies, we’ll also at some point cover the pros and cons of different means of administration, e.g. pills, transdermal gel, injections, patches, pessaries, etc—which often have big differences.

That’ll be in a while though, because we try to vary our topics, so we can’t talk about menopausal HRT all the time, fascinating and important a topic it is.

Meanwhile… take care, all!