Too Much Or Too Little Testosterone?
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One Man’s Saw Palmetto Is Another Woman’s Serenoa Repens…
Today we’re going to look at saw palmetto. So, first:
What is it?
Saw palmetto is a type of palm native to the southeastern United States. Its scientific name is “Serenoa repens”, so if that name appears in studies we cite, it’s the same thing. By whichever name, it’s widely enjoyed as a herbal supplement.
Why do people take it?
Here’s where it gets interesting, because people take it for some completely opposite reasons…
Indeed, searching for it on the Internet will cause Google to suggest “…for men” and “…for women” as the top suggestions.
That’s because it works on testosterone, and testosterone can be a bit of a double-edged sword, so some people want to increase or decrease certain testosterone-related effects on their body.
And it works for both! Here be science:
- Testosterone (henceforth, “T”) is produced in the human body.
- Yes, all human bodies, to some extent.
- An enzyme called 5-alpha-reductase converts T in to DHT (dihydrogen testosterone)
- DHT is a much more potent androgen (masculinizing agent) than T alone, such that its effects are often unwanted, including:
- Enlarged prostate (if you have one)
- Hair loss (especially in men)
- New facial hair growth (usually unwanted by women)
- Women are more likely to get this due to PCOS and/or the menopause
To avoid those effects, you really want less of your T to be converted into DHT.
Saw palmetto is a 5α-reductase inhibitor, so if you take it, you’ll have less DHT, and you’ll consequently lose less hair, have fewer prostate problems, etc.
^The above study showed that saw palmetto extract performed comparably to finasteride. Finasteride is the world’s main go-to prescription drug for treating enlarged prostate and/or hair loss.
See also: Natural Hair Supplement: Friend or Foe? Saw Palmetto, a Systematic Review in Alopecia
Hair today… Growing tomorrow!
So, what was that about increasing T levels?
Men usually suffer declining T levels as they get older, with a marked drop around the age of 45. With lower T comes lower energy, lower mood, lower libido, erectile dysfunction, etc.
Guess what… It’s T that’s needed for those things, not DHT. So if you block the conversion of T to DHT, you’ll have higher blood serum T levels, higher energy, higher mood, higher libido, and all that.
(the above assumes you have testicles, without which, your T levels will certainly not increase)
Saw Palmetto Against Enlarged Prostate?
With higher DHT levels in mid-late life, prostate enlargement (benign prostatic hyperlasia) can become a problem for many men. The size of that problem ranges from urinary inconvenience (common, when the prostate presses against the bladder) to prostate cancer (less common, much more serious). Saw palmetto, like other 5α-reductase inhibitors such as finasteride, may be used to prevent or treat this.
Wondering how safe/reliable it is? We found a very high-quality fifteen-year longitudinal observational study of the use of saw palmetto, and it found:
❝The 15 years’ study results suggest that taking S. repens plant extract continuously at a daily dose of 320 mg is an effective and safe way to prevent the progression of benign prostatic hyperplasia.❞
Want a second opinion? We also found a 10-year study (by different researchers with different people taking it), which reached the same conclusion:
❝The results of study showed the absence of progression, both on subjective criteria (IPSS, and QoL scores), and objective criteria (prostate volume, the rate of urination, residual urine volume). Furthermore, patients had no undesirable effects directly related to the use of this drug.❞
- IPSS = International Prostate Symptom Score
- QoL = Quality of Life
❝But wait a minute; I, a man over the age of 45 with potentially declining T levels but a fabulous beard, remember that you said just a minute ago that saw palmetto is used by women to avoid having facial hair; I don’t want to lose mine!❞
You won’t. Once your facial hair follicles were fully developed and activated during puberty, they’ll carry on doing what they do for life. That’s no longer regulated by hormones once they’re up and running.
The use of saw palmetto can only be used to limit facial hair if caught early—so it’s more useful at the onset of menopause, for those who have (or will have) such, or else upon the arrival of PCOS symptoms or hirsuitism from some other cause.
Take The Test!
Do you have a prostate, and would like to know your IPSS score, and what that means for your prostate health?
(takes 1 minute, no need to pee or go probing for anything)
Bottom Line on Saw Palmetto
- It blocks the conversion of T into DHT
- It will increase blood serum T levels, thus boosting mood, energy, libido, etc in men (who typically have more T, but whose T levels decline with age)
- It will decrease DHT levels, thus limiting hair loss (especially in men) and later-life new facial hair growth (especially in women).
- It can be used to prevent or treat prostate enlargement
- Bonus: it’s a potent antioxidant and thus reduces general inflammation (in everyone)
Want To Try Saw Palmetto?
We don’t sell it (or anything else), but for your convenience…
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The Yoga of Breath – by Richard Rosen
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You probably know to breathe through your nose, and to breathe with your diaphragm. But did you know you’re usually only breathing through one nostril at a time, and alternate between nostrils every few hours? And did you know how to breathe through both nostrils equally instead, and the benefits that can bring?
The above is one example of many, of things that make this book stand out from the crowd when it comes to breathing exercises. Author Richard Rosen has a deep expertise in this topic, and explains everything clearly and comprehensively, without leaving room for ambiguity.
While most of the book focuses on the mechanics and physical techniques of breathing, he does also cover some more mindstate-related things too—without which, it wouldn’t be yoga.
If the book has a downside, it’s that its comprehensive nature could be off-putting to readers new to breathing work in general. However, since he does explain everything from the ground up, that’s no reason to be put off this book, iff you’re serious about learning.
Bottom line: if you’d like a deeper understanding of breathwork than “breathe slowly through your nose, using your diaphragm”, this book will teach you depths of breathing you probably didn’t know were possible.
Click here to check out The Yoga of Breath, and catch yours!
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Lucid Dreaming – by Stephen LaBerge Ph.D.
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For any unfamiliar: lucid dreaming means being aware that one is dreaming, while dreaming, and exercising a degree of control over the dream. Superficially, this is fun. But if one really wants to go deeper into it, it can be a lot more:
Dr. Stephen LaBerge takes a science-based approach to lucid dreaming, and in this work provides not only step-by-step instructions of several ways of inducing lucid dreaming, but also, opens the reader’s mind to things that can be done there beyond the merely recreational:
In lucid dreams, he argues and illustrates, it’s possible to talk to parts of one’s own subconscious (Inception, anyone? Yes, this book came first) and get quite an amount of self-therapy done. And that hobby you wish you had more time to practice? The possibilities just became limitless. And who wouldn’t want that?
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HRT: Bioidentical vs Animal
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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
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:
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!
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Grains: Bread Of Life, Or Cereal Killer?
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Going Against The Grain?
In Wednesday’s newsletter, we asked you for your health-related opinion of grains (aside from any gluten-specific concerns), and got the above-depicted, below-described, set of responses:
- About 69% said “They are an important cornerstone of a healthy balanced diet”
- About 22% said “They can be enjoyed in moderation, but watch out”
- About 8% said “They are terrible health-drainers that will kill us”
So, what does the science say?
They are terrible health-drainers that will kill us: True or False?
True or False depending on the manner of their consumption!
There is a big difference between the average pizza base and a bowl of oats, for instance. Or rather, there are a lot of differences, but what’s most critical here?
The key is: refined and ultraprocessed grains are so inferior to whole grains as to be actively negative for health in most cases for most people most of the time.
But! It’s not because processing is ontologically evil (in reality: some processed foods are healthy, and some unprocessed foods are poisonous). although it is a very good general rule of thumb.
So, we need to understand the “why” behind the “key” that we just gave above, and that’s mostly about the resultant glycemic index and associated metrics (glycemic load, insulin index, etc).
In the case of refined and ultraprocessed grains, our body gains sugar faster than it can process it, and stores it wherever and however it can, like someone who has just realised that they will be entertaining a houseguest in 10 minutes and must tidy up super-rapidly by hiding things wherever they’ll fit.
And when the body tries to do this with sugar from refined grains, the result is very bad for multiple organs (most notably the liver, but the pancreas takes quite a hit too) which in turn causes damage elsewhere in the body, not to mention that we now have urgently-produced fat stored in unfortunate places like our liver and abdominal cavity when it should have gone to subcutaneous fat stores instead.
In contrast, whole grains come with fiber that slows down the absorption of the sugars, such that the body can deal with them in an ideal fashion, which usually means:
- using them immediately, or
- storing them as muscle glycogen, or
- storing them as subcutaneous fat
👆 that’s an oversimplification, but we only have so much room here.
For more on this, see:
Glycemic Index vs Glycemic Load vs Insulin Index
And for why this matters, see:
Which Sugars Are Healthier, And Which Are Just The Same?
And for fixing it, see:
They can be enjoyed in moderation, but watch out: True or False?
Technically True but functionally False:
- Technically true: “in moderation” is doing a lot of heavy lifting here. One person’s “moderation” may be another person’s “abstemiousness” or “gluttony”.
- Functionally false: while of course extreme consumption of pretty much anything is going to be bad, unless you are Cereals Georg eating 10,000 cereals each day and being a statistical outlier, the issue is not the quantity so much as the quality.
Quality, we discussed above—and that is, as we say, paramount. As for quantity however, you might want to know a baseline for “getting enough”, so…
They are an important cornerstone of a healthy balanced diet: True or False?
True! This one’s quite straightforward.
3 servings (each being 90g, or about ½ cup) of whole grains per day is associated with a 22% reduction in risk of heart disease, 5% reduction in all-cause mortality, and a lot of benefits across a lot of disease risks:
❝This meta-analysis provides further evidence that whole grain intake is associated with a reduced risk of coronary heart disease, cardiovascular disease, and total cancer, and mortality from all causes, respiratory diseases, infectious diseases, diabetes, and all non-cardiovascular, non-cancer causes.
These findings support dietary guidelines that recommend increased intake of whole grain to reduce the risk of chronic diseases and premature mortality.❞
~ Dr. Dagfinn Aune et al.
We’d like to give a lot more sources for the same findings, as well as papers for all the individual claims, but frankly, there are so many that there isn’t room. Suffice it to say, this is neither controversial nor uncertain; these benefits are well-established.
Here’s a very informative pop-science article, that also covers some of the things we discussed earlier (it shows what happens during refinement of grains) before getting on to recommendations and more citations for claims than we can fit here:
Harvard School Of Public Health | Whole Grains
“That’s all great, but what if I am concerned about gluten?”
There certainly are reasons you might be, be it because of a sensitivity, allergy, or just because perhaps you’d like to know more.
Let’s first mention: not all grains contain gluten, so it’s perfectly possible to enjoy naturally gluten-free grains (such as oats and rice) as well as gluten-free pseudocereals, which are not actually grains but do the same job in culinary and nutritional terms (such as quinoa and buckwheat, despite the latter’s name).
Finally, if you’d like to know more about gluten’s health considerations, then check out our previous mythbusting special:
Enjoy!
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What is a virtual emergency department? And when should you ‘visit’ one?
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For many Australians the emergency department (ED) is the physical and emblematic front door to accessing urgent health-care services.
But health-care services are evolving rapidly to meet the population’s changing needs. In recent years, we’ve seen growing use of telephone, video, and online health services, including the national healthdirect helpline, 13YARN (a crisis support service for First Nations people), state-funded lines like 13 HEALTH, and bulk-billed telehealth services, which have helped millions of Australians to access health care on demand and from home.
The ED is similarly expanding into new telehealth models to improve access to emergency medical care. Virtual EDs allow people to access the expertise of a hospital ED through their phone, computer or tablet.
All Australian states and the Northern Territory have some form of virtual ED at least in development, although not all of these services are available to the general public at this stage.
So what is a virtual ED, and when is it appropriate to consider using one?
Shutterstock/Nils Versemann How does a virtual ED work?
A virtual ED is set up to mirror the way you would enter the physical ED front door. First you provide some basic information to administration staff, then you are triaged by a nurse (this means they categorise the level of urgency of your case), then you see the ED doctor. Generally, this all takes place in a single video call.
In some instances, virtual ED clinicians may consult with other specialists such as neurologists, cardiologists or trauma experts to make clinical decisions.
A virtual ED is not suitable for managing medical emergencies which would require immediate resuscitation, or potentially serious chest pains, difficulty breathing or severe injuries.
A virtual ED is best suited to conditions that require immediate attention but are not life-threatening. These could include wounds, sprains, respiratory illnesses, allergic reactions, rashes, bites, pain, infections, minor burns, children with fevers, gastroenteritis, vertigo, high blood pressure, and many more.
People with these sorts of conditions and concerns may not be able to get in to see a GP straight away and may feel they need emergency advice, care or treatment.
When attending the ED, they can be subject to long wait times and delayed specialist attention because more serious cases are naturally prioritised. Attending a virtual ED may mean they’re seen by a doctor more quickly, and can begin any relevant treatment sooner.
From the perspective of the health-care system, virtual EDs are about redirecting unnecessary presentations away from physical EDs, helping them be ready to respond to emergencies. The virtual ED will not hesitate in directing callers to come into the physical ED if staff believe it is an emergency.
The doctor in the virtual ED may also direct the patient to a GP or other health professional, for example if their condition can’t be assessed visually, or if they need physical treatment.
The results so far
Virtual EDs have developed significantly over the past three years, predominantly driven by the COVID pandemic. We are now starting to slowly see assessments of these services.
A recent evaluation my colleagues and I did of Queensland’s Metro North Virtual ED found roughly 30% of calls were directed to the physical ED. This suggests 70% of the time, cases could be managed effectively by the virtual ED.
Preliminary data from a Victorian virtual ED indicates it curbed a similar rate of avoidable ED presentations – 72% of patients were successfully managed by the virtual ED alone. A study on the cost-effectiveness of another Victorian virtual ED suggested it has the potential to generate savings in health-care costs if it prevents physical ED visits.
Only 1.2% of people assessed in Queensland’s Metro North Virtual ED required unexpected hospital admission within 48 hours of being “discharged” from the virtual ED. None of these cases were life-threatening. This indicates the virtual ED is very safe.
The service experienced an average growth rate of 65% each month over a two-year evaluation period, highlighting increasing demand and confidence in the service. Surveys suggested clinicians also view the virtual ED positively.
The right advice could tell you whether you need to visit hospital in person or not. 1st footage/Shutterstock What now?
We need further research into patient outcomes and satisfaction, as well as the demographics of those using virtual EDs, and how these measures compare to the physical ED across different triage categories.
There are also challenges associated with virtual EDs, including around technology (connection and skills among patients and health professionals), training (for health professionals) and the importance of maintaining security and privacy.
Nonetheless, these services have the potential to reduce congestion in physical EDs, and offer greater convenience for patients.
Eligibility differs between different programs, so if you want to use a virtual ED, you may need to check you are eligible in your jurisdiction. Most virtual EDs can be accessed online, and some have direct phone numbers.
Jaimon Kelly, Senior Research Fellow in Telehealth delivered health services, The University of Queensland
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Potatoes & Anxiety
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝My other half considers potatoes a wonder food, except when fried. I don’t. I find, when I am eating potatoes I put on weight; and, when I’m not eating them, I lose it. Also, although I can’t swear to it, potatoes also make me feel a little anxious (someone once told me it could have something to do with where they are on the “glycemic index”). What does the science say?❞
The glycemic index of potatoes depends on the kind of potato (obviously) and also, less obviously, how it’s prepared. For a given white potato, boiling (which removes a lot of starch) might produce a GI of around 60, while instant mash (basically: potato starch) can be more like 80. For reference, pure glucose is 100. And you probably wouldn’t take that in the same quantity you’d take potato, and expect to feel good!
So: as for anxiety, it could be, since spiked blood sugars can cause mood swings, including anxiety.
Outside of the matter of blood sugars, the only reference we could find for potatoes causing anxiety was fried potatoes specifically:
❝frequent fried food consumption, especially fried potato consumption, is strongly associated with 12% and 7% higher risk of anxiety and depression, respectively❞
…which heavily puts the blame not on the potatoes themselves, but on acrylamide (the orange/brown stuff that is made by the Maillard reaction of cooking starches in the absence of water, e.g. by frying, roasting, etc).
Here’s a very good overview of that, by the way:
A Review on Acrylamide in Food: Occurrence, Toxicity, and Mitigation Strategies
Back on the core topic of potatoes and GI and blood sugar spikes and anxiety, you might benefit from a few tweaks that will allow you to enjoy potatoes without spiking blood sugars:
10 Ways To Balance Blood Sugars
Enjoy!
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