Do You Believe In Magic? – by Dr. Paul Offit
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Here at 10almonds, we like to examine and present the science wherever it leads, so this book was an interesting read.
Dr. Offit, himself a much-decorated vaccine research scientist, and longtime enemy of the anti-vax crowd, takes aim at alternative therapies in general, looking at what does work (and how), and what doesn’t (and what harm it can cause).
The style of the book is largely polemic in tone, but there’s lots of well-qualified information and stats in here too. And certainly, if there are alternative therapies you’ve left unquestioned, this book will probably prompt questions, at the very least.
And science, of course, is about asking questions, and shouldn’t be afraid of such! Open-minded skepticism is a key starting point, while being unafraid to actually reach a conclusion of “this is probably [not] so”, when and if that’s where the evidence brings us. Then, question again when and if new evidence comes along.
To that end, Dr. Offit does an enthusiastic job of looking for answers, and presenting what he finds.
If the book has downsides, they are primarily twofold:
- He is a little quick to dismiss the benefits of a good healthy diet, supplemented or otherwise.
- His keenness here seems to step from a desire to ensure people don’t skip life-saving medical treatments in the hope that their diet will cure their cancer (or liver disease, or be it what it may), but in doing so, he throws out a lot of actually good science.
- He—strangely—lumps menopausal HRT in with alternative therapies, and does the exact same kind of anti-science scaremongering that he rails against in the rest of the book.
- In his defence, this book was published ten years ago, and he may have been influenced by a stack of headlines at the time, and a popular celebrity endorsement of HRT, which likely put him off it.
Bottom line: there’s something here to annoy everyone—which makes for stimulating reading.
Click here to check out Do You Believe In Magic, and expand your knowledge!
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What Does “Balance Your Hormones” Even Mean?
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Hormonal Health: Is It Really A Balancing Act?
Have you ever wondered what “balancing your hormones” actually means?
The popular view is that men’s hormones look like this:
Testosterone (less) ⟷ Testosterone (more)
…And that women’s hormones look more like this:
♀︎ Estrogen ↭ Progesterone ⤵︎
⇣⤷ FSH ⤦ ↴ ☾ ⤹⤷ Luteinizing Hormone ⤦
DHEA ↪︎ Gonadotrophin ⤾
↪︎ Testosterone? ⥅⛢
Clear as mud, right?
But, don’t worry, Supplements McHerbal Inc will sell you something guaranteed to balance your hormones!
How can a supplement (or dietary adjustment) “balance” all that hotly dynamic chaos, and make everything “balanced”?
The truth is, “balanced” in such a nebulous term, and this is why you will not hear endocrinologists using it. It’s used in advertising to mean “in good order”, and “not causing problems”, and “healthy”.
In reality, our hormone levels depend on everything from our diet to our age to our anatomy to our mood to the time of the day to the phase of the moon.
Not that the moon has an influence on our physiology at all—that’s a myth—but you know, 28 day cycle and all. And, yes, half the hormones affect the levels of the others, either directly or indirectly.
Trying to “balance” them would be quite a game of whack-a-mole, and not something that a “cure-all” single “hormone-balancing” supplement could do.
So why aren’t we running this piece on Friday, for our “mythbusting” section? Well, we could have, but the more useful information is yet to come and will take up more of today’s newsletter than the myth-busting!
What, then, can we do to untangle the confusion of these hormones?
Well first, let’s understand what they do, in the most simple terms possible:
- Estrogen—the most general feminizing hormone from puberty onwards, busiest in the beginning of the menstrual cycle, and starts getting things ready for ovulation.
- Progesterone—secondary feminizing hormone, fluffs the pillows for the oncoming fertilized egg to be implanted, increases sex drive, and adjusts metabolism accordingly. Busiest in the second half of the menstrual cycle.
- Testosterone—is also present, contributes to sex drive, is often higher in individuals with PCOS. If menopause is untreated, testosterone will also rise, because there will be less estrogen
- (testosterone and estrogen “antagonize” each other, which is the colorfully scientific way of saying they work against each other)
- DHEA—Dehydroepiandrosterone, supports production of testosterone (and estrogen!). Sounds self-balancing, but in practice, too much DHEA can thus cause elevated testosterone levels, and thus hirsutism.
- Gonadotrophin—or more specifically human chorionic gonadotrophin, HcG, is “the pregnancy hormone“, present only during pregnancy, and has specific duties relating to such. This is what’s detected in (most) pregnancy test kits.
- FSH—follicle stimulating hormone, is critical to ovulation, and is thus essential to female fertility. On the other hand, when the ovaries stop working, FSH levels will rise in a vain attempt to encourage the ovulation that isn’t going to happen anymore.
- Luteinizing hormone—says “go” to the new egg and sends it on its merry way to go get fertilized. This is what’s detected by ovulation prediction kits.
Sooooooo…
What, for most women, most often is meant by a “hormonal imbalance” is:
- Low levels of E and/or P
- High levels of DHEA and/or T
- Low or High levels of FSH
In the case of low levels of E and/or P, the most reliable way to increase these is, drumroll please… To take E and/or P. That’s it, that’s the magic bullet.
Bonus Tip: take your E in the morning (this is when your body will normally make more and use more) take your P in the evening (it won’t make you sleepy, but it will improve your sleep quality when you do sleep)
In the case of high levels of DHEA and/or T, then that’s a bit more complex:
- Taking E will antagonize (counteract) the unwanted T.
- Taking T-blockers (such as spironolactone or bicalutamide) will do what it says on the tin, and block T from doing the jobs it’s trying to do, but the side-effects are considered sufficient to not prescribe them to most people.
- Taking spearmint or saw palmetto will lower testosterone’s effects
- Scientists aren’t sure how or why spearmint works for this
- Saw palmetto blocks testosterone’s conversion into a more potent form, DHT, and so “detoothes” it a bit. It works similarly to drugs such as finasteride, often prescribed for androgenic alopecia, called “male pattern baldness”, but it affects plenty of women too.
In the case of low levels of FSH, eating leafy greens will help.
In the case of high levels of FSH, see a doctor. HRT (Hormone Replacement Therapy) may help. If you’re not of menopausal age, it could be a sign something else is amiss, so it could be worth getting that checked out too.
What can I eat to boost my estrogen levels naturally?
A common question. The simple answer is:
- Flaxseeds and soy contain plant estrogens that the body can’t actually use as such (too incompatible). They’ve lots of high-quality nutrients though, and the polyphenols and isoflavones can help with some of the same jobs when it comes to sexual health.
- Fruit, especially peaches, apricots, blueberries, and strawberries, contain a lot of lignans and also won’t increase your E levels as such, but will support the same functions and reduce your breast cancer risk.
- Nuts, especially almonds (yay!), cashews, and pistachios, contain plant estrogens that again can’t be used as bioidentical estrogen (like you’d get from your ovaries or the pharmacy) but do support heart health.
- Leafy greens and cruciferous vegetables support a lot of bodily functions including good hormonal health generally, in ways that are beyond the scope of this article, but in short: do eat your greens!
Note: because none of these plant-estrogens or otherwise estrogenic nutrients can actually do the job of estradiol (the main form of estrogen in your body), this is why they’re still perfectly healthy for men to eat too, and—contrary to popular “soy boy” social myths—won’t have any feminizing effects whatsoever.
On the contrary, most of the same foods support good testosterone-related health in men.
The bottom line:
- Our hormones are very special, and cannot be replaced with any amount of herbs or foods.
- We can support our body’s natural hormonal functions with good diet, though.
- Our hormones naturally fluctuate, and are broadly self-correcting.
- If something gets seriously out of whack, you need an endocrinologist, not a homeopath or even a dietician.
In case you missed it…
We gave a more general overview of supporting hormonal health (including some hormones that aren’t sex hormones but are really important too), back in February.
Check it out here: Healthy Hormones And How To Hack Them
Want to read more?
Anthea Levi, RD, takes much the same view:
❝For some ‘hormone-balancing’ products, the greatest risk might simply be lost dollars. Others could come at a higher cost.❞
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Sugar Blues – by William Dufty
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This is a “read it cover to cover” book. It charts the rise of sugar’s place in world diets in general and the American diet in particular, and draws many conclusions about the effect this has had on us.
This book will challenge you. Sometimes, it will change your mind. Sometimes, you’ll go “no, I’m sure that’s not right”, and you’ll go Googling. Either way, you’ll learn something.
And that, for us, is the most important measure of any informational book: did we gain something from it? In Sugar Blues, perhaps the single biggest “gain” for the reader is that it’s an eye-opener and a call-to-arms—the extent to which you heed that is up to you, but it sure is good to at least be familiar with the battlefield.
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Antibiotics? Think Thrice
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Antibiotics: Useful Even Less Often Than Previously Believed (And Still Just As Dangerous)
You probably already know that antibiotics shouldn’t be taken unless absolutely necessary. Not only does taking antibiotics frivolously increase antibiotic resistance (which is bad, and kills people), but also…
It’s entirely possible for the antibiotics to not only not help, but instead wipe out your gut’s “good bacteria” that were keeping other things in check.
Those “other things” can include fungi like Candida albicans.
Candida, which we all have in us to some degree, feeds on sugar (including the sugar formed from breaking down alcohol, by the way) and refined carbs. Then it grows, and puts its roots through your intestinal walls, linking with your neural system. Then it makes you crave the very things that will feed it and allow it to put bigger holes in your intestinal walls.
Don’t believe us? Read: Candida albicans-Induced Epithelial Damage Mediates Translocation through Intestinal Barriers
(That’s scientist-speak for “Candida puts holes in your intestines, and stuff can then go through those holes”)
And as for how that comes about, it’s like we said:
See also: Candida albicans as a commensal and opportunistic pathogen in the intestine
That’s not all…
And that’s just C. albicans, never mind things like C. diff. that can just outright kill you easily.
We don’t have room to go into everything here, but you might like to check out:
Four Ways Antibiotics Can Kill You
It gets worse (now comes the new news)
So, what are antibiotics good for? Surely, for clearing up chesty coughs, lower respiratory tract infections, right? It’s certainly one of the two things that antibiotics are most well-known for being good at and often necessary for (the other being preventing/treating sepsis, for example in serious and messy wounds).
But wait…
A large, nationwide (US) observational study of people who sought treatment in primary or urgent care settings for lower respiratory tract infections found…
(drumroll please)
…the use of antibiotics provided no measurable impact on the severity or duration of coughs even if a bacterial infection was present.
Read for yourself:
And in the words of the lead author of that study,
❝Lower respiratory tract infections tend to have the potential to be more dangerous, since about 3% to 5% of these patients have pneumonia. But not everyone has easy access at an initial visit to an X-ray, which may be the reason clinicians still give antibiotics without any other evidence of a bacterial infection.❞
So, what’s to be done about this? On a large scale, Dr. Merenstein recommends:
❝Serious cough symptoms and how to treat them properly needs to be studied more, perhaps in a randomized clinical trial as this study was observational and there haven’t been any randomized trials looking at this issue since about 2012.❞
This does remind us that, while not a RCT, there is a good ongoing observational study that everyone with a smartphone can participate in:
Dr. Peter Small’s medical AI: “The Cough Doctor”
In the meantime, he advises that when COVID and SARS have been ruled out, then “basic symptom-relieving medications plus time brings a resolution to most people’s infections”.
You can read a lot more detail here:
Antibiotics aren’t effective for most lower tract respiratory infections
In summary…
Sometimes, antibiotics really are a necessary and life-saving medication. But most of the time they’re not, and given their great potential for harm, they may be best simultaneously viewed as the very dangerous threat they also are, and used only when those “heavy guns” are truly what’s required.
Take care!
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The Real Reason Your Metabolism Slows After 50 (And How To Fix It)
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It’s not just about menopause:
The other factors
Researchers (cited in the video) found that menopause itself didn’t significantly reduce metabolic rate in the women studied; instead, differences in metabolism are mainly explained by differences in fat-free mass, which is largely muscle mass.
Note: the basal metabolic rate (BMR) is the energy your body uses at rest for essential functions like breathing, circulation, and organ function; if BMR falls while calorie intake stays the same, excess energy is more likely to be stored as fat.
The study, at a glance:
- Design: the researchers compared 21 premenopausal, 21 perimenopausal, and 21 postmenopausal women with stable body weight, low exercise levels, no medications including HRT, and BMIs between 18.5 and 35.
- Metrics: the study assessed body composition with DEXA scans, activity levels with wearable tracking devices, and metabolism through respiratory quotient measurements taken at rest and after a standardized 500-calorie meal.
- Results: there were no significant differences between the groups in calories burned at rest, calories burned after eating, or whether the body preferentially burned carbohydrates or fat.
However! Those women with more fat-free mass burned more calories both at rest and after meals, suggesting muscle mass was far more important than menopausal status in determining metabolic rate.
Aside from the obvious “exercise for muscle mass”, two important things that often get missed are:
- getting the right amount of protein spread over the course of the day (don’t cram it all into one meal; your body can’t use more than 20–30g at a time anyway)
- getting good sleep; in particular, deep sleep was highlighted as important for muscle repair and growth, making menopause-related sleep disruption another indirect factor affecting body composition
For more on all of this, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like:
The Diet That Reduces Postmenopausal Weight Gain, Hot Flashes, & More
Take care!
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Can Medical Schools Funnel More Doctors Into the Primary Care Pipeline?
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Throughout her childhood, Julia Lo Cascio dreamed of becoming a pediatrician. So, when applying to medical school, she was thrilled to discover a new, small school founded specifically to train primary care doctors: NYU Grossman Long Island School of Medicine.
Now in her final year at the Mineola, New York, school, Lo Cascio remains committed to primary care pediatrics. But many young doctors choose otherwise as they leave medical school for their residencies. In 2024, 252 of the nation’s 3,139 pediatric residency slots went unfilled and family medicine programs faced 636 vacant residencies out of 5,231 as students chased higher-paying specialties.
Lo Cascio, 24, said her three-year accelerated program nurtured her goal of becoming a pediatrician. Could other medical schools do more to promote primary care? The question could not be more urgent. The Association of American Medical Colleges projects a shortage of 20,200 to 40,400 primary care doctors by 2036. This means many Americans will lose out on the benefits of primary care, which research shows improves health, leading to fewer hospital visits and less chronic illness.
Many medical students start out expressing interest in primary care. Then they end up at schools based in academic medical centers, where students become enthralled by complex cases in hospitals, while witnessing little primary care.
The driving force is often money, said Andrew Bazemore, a physician and a senior vice president at the American Board of Family Medicine. “Subspecialties tend to generate a lot of wealth, not only for the individual specialists, but for the whole system in the hospital,” he said.
A department’s cache of federal and pharmaceutical-company grants often determines its size and prestige, he said. And at least 12 medical schools, including Harvard, Yale, and Johns Hopkins, don’t even have full-fledged family medicine departments. Students at these schools can study internal medicine, but many of those graduates end up choosing subspecialties like gastroenterology or cardiology.
One potential solution: eliminate tuition, in the hope that debt-free students will base their career choice on passion rather than paycheck. In 2024, two elite medical schools — the Albert Einstein College of Medicine and the Johns Hopkins University School of Medicine — announced that charitable donations are enabling them to waive tuition, joining a handful of other tuition-free schools.
But the contrast between the school Lo Cascio attends and the institution that founded it starkly illustrates the limitations of this approach. Neither charges tuition.
In 2024, two-thirds of students graduating from her Long Island school chose residencies in primary care. Lo Cascio said the tuition waiver wasn’t a deciding factor in choosing pediatrics, among the lowest-paid specialties, with an average annual income of $260,000, according to Medscape.
At the sister school, the Manhattan-based NYU Grossman School of Medicine, the majority of its 2024 graduates chose specialties like orthopedics (averaging $558,000 a year) or dermatology ($479,000).
Primary care typically gets little respect. Professors and peers alike admonish students: If you’re so smart, why would you choose primary care? Anand Chukka, 27, said he has heard that refrain regularly throughout his years as a student at Harvard Medical School. Even his parents, both PhD scientists, wondered if he was wasting his education by pursuing primary care.
Seemingly minor issues can influence students’ decisions, Chukka said. He recalls envying the students on hospital rotations who routinely were served lunch, while those in primary care settings had to fetch their own.
Despite such headwinds, Chukka, now in his final year, remains enthusiastic about primary care. He has long wanted to care for poor and other underserved people, and a one-year clerkship at a community practice serving low-income patients reinforced that plan.
When students look to the future, especially if they haven’t had such exposure, primary care can seem grim, burdened with time-consuming administrative tasks, such as seeking prior authorizations from insurers and grappling with electronic medical records.
While specialists may also face bureaucracy, primary care practices have it much worse: They have more patients and less money to hire help amid burgeoning paperwork requirements, said Caroline Richardson, chair of family medicine at Brown University’s Warren Alpert Medical School.
“It’s not the medical schools that are the problem; it’s the job,” Richardson said. “The job is too toxic.”
Kevin Grumbach, a professor of family and community medicine at the University of California-San Francisco, spent decades trying to boost the share of students choosing primary care, only to conclude: “There’s really very little that we can do in medical school to change people’s career trajectories.”
Instead, he said, the U.S. health care system must address the low pay and lack of support.
And yet, some schools find a way to produce significant proportions of primary care doctors — through recruitment and programs that provide positive experiences and mentors.
U.S. News & World Report recently ranked 168 medical schools by the percentage of graduates who were practicing primary care six to eight years after graduation.
The top 10 schools are all osteopathic medical schools, with 41% to 47% of their students still practicing primary care. Unlike allopathic medical schools, which award MD degrees, osteopathic schools, which award DO degrees, have a history of focusing on primary care and are graduating a growing share of the nation’s primary care physicians.
At the bottom of the U.S. News list is Yale, with 10.7% of its graduates finding lasting careers in primary care. Other elite schools have similar rates: Johns Hopkins, 13.1%; Harvard, 13.7%.
In contrast, public universities that have made it a mission to promote primary care have much higher numbers.
The University of Washington — No. 18 in the ranking, with 36.9% of graduates working in primary care — has a decades-old program placing students in remote parts of Washington, Wyoming, Alaska, Montana, and Idaho. UW recruits students from those areas, and many go back to practice there, with more than 20% of graduates settling in rural communities, according to Joshua Jauregui, assistant dean for clinical curriculum.
Likewise, the University of California-Davis (No. 22, with 36.3% of graduates in primary care) increased the percentage of students choosing family medicine from 12% in 2009 to 18% in 2023, even as it ranks high in specialty training. Programs such as an accelerated three-year primary care “pathway,” which enrolls primarily first-generation college students, help sustain interest in non-specialty medical fields.
The effort starts with recruitment, looking beyond test scores to the life experiences that forge the compassionate, humanistic doctors most needed in primary care, said Mark Henderson, associate dean for admissions and outreach. Most of the students have families who struggle to get primary care, he said. “So they care a lot about it, and it’s not just an intellectual, abstract sense.”
Establishing schools dedicated to primary care, like the one on Long Island, is not a solution in the eyes of some advocates, who consider primary care the backbone of medicine and not a separate discipline. Toyese Oyeyemi Jr., executive director of the Social Mission Alliance at the Fitzhugh Mullan Institute of Health Workforce Equity, worries that establishing such schools might let others “off the hook.”
Still, attending a medical school created to produce primary care doctors worked out well for Lo Cascio. Although she underwent the usual specialty rotations, her passion for pediatrics never flagged — owing to her 23 classmates, two mentors, and her first-year clerkship shadowing a community pediatrician. Now, she’s applying for pediatric residencies.
Lo Cascio also has deep personal reasons: Throughout her experience with a congenital heart condition, her pediatrician was a “guiding light.”
“No matter what else has happened in school, in life, in the world, and medically, your pediatrician is the person that you can come back to,” she said. “What a beautiful opportunity it would be to be that for someone else.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
This article first appeared on KFF Health News and is republished here under a Creative Commons license.
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Semaglutide for Weight Loss?
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Semaglutide for weight loss?
Semaglutide is the new kid on the weight-loss block, but it’s looking promising (with some caveats!).
Most popularly by brand names Ozempic and Wegovy, it was first trialled to help diabetics*, and is now sought-after by the rest of the population too. So far, only Wegovy is FDA-approved for weight loss. It contains more semaglutide than Ozempic, and was developed specifically for weight loss, rather than for diabetes.
*Specifically: diabetics with type 2 diabetes. Because it works by helping the pancreas to make insulin, it’s of no help whatsoever to T1D folks, sadly. If you’re T1D and reading this though, today’s book of the day is for you!
First things first: does it work as marketed for diabetes?
It does! At a cost: a very common side effect is gastrointestinal problems—same as for tirzepatide, which (like semaglutide) is a GLP-1 agonist, meaning it works the same way. Here’s how they measure up:
- Head-to-head study: Effects of subcutaneous tirzepatide versus placebo or semaglutide on pancreatic islet function and insulin sensitivity in adults with type 2 diabetes
- Head-to-head systematic review: Semaglutide for the treatment of type 2 Diabetes Mellitus: A systematic review and network meta-analysis of safety and efficacy outcomes
As you can see, both of them work wonders for pancreatic function and insulin sensitivity!
And, both of them were quite unpleasant for around 20% of participants:
❝Tirzepatide, oral and SC semaglutide has a favourable efficacy in treating T2DM. Gastrointestinal adverse events were highly recorded in tirzepatide, oral and SC semaglutide groups.❞
What about for weight loss, if not diabetic?
It works just the same! With just the same likelihood of gastro-intestinal unpleasantries, though. There’s a very good study that was done with 1,961 overweight adults; here it is:
Once-Weekly Semaglutide in Adults with Overweight or Obesity
The most interesting things here are the positive results and the side effects:
❝The mean change in body weight from baseline to week 68 was −14.9% in the semaglutide group as compared with −2.4% with placebo, for an estimated treatment difference of −12.4 percentage points (95% confidence interval [CI], −13.4 to −11.5; P<0.001).❞
In other words: if you take this, you’re almost certainly going to get something like 6x better weight loss results than doing the same thing without it.
❝Nausea and diarrhea were the most common adverse events with semaglutide; they were typically transient and mild-to-moderate in severity and subsided with time. More participants in the semaglutide group than in the placebo group discontinued treatment owing to gastrointestinal events (59 [4.5%] vs. 5 [0.8%])❞
~ ibid.
In other words: you have about a 3% chance of having unpleasant enough side effects that you don’t want to continue treatment (contrast this with the 20%ish chance of unpleasant side effects of any extent)!
Any other downsides we should know about?
If you stop taking it, weight regain is likely. For example, a participant in one of the above-mentioned studies who lost 22% of her body weight with the drug’s help, says:
❝Now that I am no longer taking the drug, unfortunately, my weight is returning to what it used to be. It felt effortless losing weight while on the trial, but now it has gone back to feeling like a constant battle with food. I hope that, if the drug can be approved for people like me, my [doctor] will be able to prescribe the drug for me in the future.❞
~ Jan, a trial participant at UCLH
Is it injection-only, or is there an oral option?
An oral option exists, but (so far) is on the market only in the form of Rybelsus, another (slightly older) drug containing semaglutide, and it’s (so far) only FDA-approved for diabetes, not for weight loss. See:
A new era for oral peptides: SNAC and the development of oral semaglutide for the treatment of type 2 diabetes ← for the science
FDA approves first oral GLP-1 treatment for type 2 diabetes ← For the FDA statement
Where can I get these?
Availability and prescribing regulations vary by country (because the FDA’s authority stops at the US borders), but here is the website for each of them if you’d like to learn more / consider if they might help you:
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