The Hormone Therapy That Reduces Breast Cancer Risk & More
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The Hormone Balancing Act
We’ve written before about menopausal HRT:
What You Should Have Been Told About Menopause Beforehand
…and even specifically about the considerations when it comes to breast cancer risk:
Menopausal Hormone Replacement Therapy
this really does bear reading, by the way—scroll down to the bit about breast cancer risk, because it’s not a simple increased/decreased risk; it can go either way, and which way it goes will depend on various factors including your medical history and what HRT, if any, you are taking.
Hormone Modulating Therapy
Hormone modulating therapy, henceforth HMT, is something a little different.
Instead of replacing hormones, as hormone replacement therapy does, guess what hormone modulating therapy does instead? That’s right…
MHT can modulate hormones by various means, but the one we’re going to talk about today does it by blocking estrogen receptors,
Isn’t that the opposite of what we want?
You would think so, but since for many people with an increased breast cancer risk, the presence of estrogen increases that risk, which leaves menopausal (peri- or post) people in an unfortunate situation, having to choose between increased breast cancer risk (with estrogen), or osteoporosis and increased dementia risk, amongst other problems (without).
However, the key here (in fact, that’s a very good analogy) is in how the blocker works. Hormones and their receptors are like keys and locks, meaning that the wrong-shaped hormone won’t accidentally trigger it. And when the right-shaped hormone comes along, it gets activated and the message (in this case, “do estrogenic stuff here!” gets conveyed). A blocker is sufficiently similar to fit into the receptor, without being so similar as to otherwise act as the hormone.
In this case, it has been found that HMT blocking estrogen receptors was sufficient to alleviate the breast cancer risk, while also being associated with a 7% lower risk of developing Alzheimer’s disease or related dementias, with that risk reduction being even greater for some demographics depending on race and age. Black women in the 65–74 age bracket enjoyed a 24% relative risk reduction, with white women of the same age getting an 11% relative risk reduction. Black women enjoyed the same benefits after that age, whereas white women starting it at that age did not get the same benefits. The conclusion drawn from this is that it’s good to start this at 65 if relevant and practicable, especially if white, because the protective effect is strongest when gained aged 65–69.
Here’s a pop-science article that goes into the details more deeply than we have room for here:
Hormone therapy for breast cancer linked with lower dementia risk
And here’s the paper itself; we highly recommend reading at least the abstract, because it goes into the numbers in much more detail than we reasonably can here. It’s a huge cohort study of 18,808 women aged 65 years or older, so this is highly relevant data:
Want to learn more?
If you’d like a much deeper understanding of breast cancer risk management, including in the context of hormone therapy, you might like this excellent book that we reviewed recently:
The Smart Woman’s Guide to Breast Cancer – by Dr. Jenn Simmons
Take care!
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The Not-So-Sweet Science Of Sugar Addiction
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One
LumpMechanism Of Addiction Or Two?
In Tuesday’s newsletter, we asked you to what extent, if any, you believe sugar is addictive; we got the above-depicted, below-described, set of responses:
- About 47% said “Sugar is chemically addictive, comparable to alcohol”
- About 34% said “Sugar is chemically addictive, comparable to cocaine”
- About 11% said “Sugar is not addictive; that’s just excuse-finding hyperbole”
- About 9% said “Sugar is a behavioral addiction, comparable to video gaming”
So what does the science say?
Sugar is not addictive; that’s just excuse-finding hyperbole: True or False?
False, by broad scientific consensus. As ever, the devil’s in the
detailsdefinitions, but while there is still discussion about how best to categorize the addiction, the scientific consensus as a whole is generally: sugar is addictive.That doesn’t mean scientists* are a hive mind, and so there will be some who disagree, but most papers these days are looking into the “hows” and “whys” and “whats” of sugar addiction, not the “whether”.
*who are also, let us remember, a diverse group including chemists, neurobiologists, psychologists, social psychologists, and others, often collaborating in multidisciplinary teams, each with their own focus of research.
Here’s what the Center of Alcohol and Substance Use Studies has to say, for example:
Sugar Addiction: More Serious Than You Think
Sugar is a chemical addiction, comparable to alcohol: True or False?
True, broadly, with caveats—for this one, the crux lies in “comparable to”, because the neurology of the addiction is similar, even if many aspects of it chemically are not.
In both cases, sugar triggers the release of dopamine while also (albeit for different chemical reasons) having a “downer” effect (sugar triggers the release of opioids as well as dopamine).
Notably, the sociology and psychology of alcohol and sugar addictions are also similar (both addictions are common throughout different socioeconomic strata as a coping mechanism seeking an escape from emotional pain).
See for example in the Journal of Psychoactive Drugs:
On the other hand, withdrawal symptoms from heavy long-term alcohol abuse can kill, while withdrawal symptoms from sugar are very much milder. So there’s also room to argue that they’re not comparable on those grounds.
Sugar is a chemical addiction, comparable to cocaine: True or False?
False, broadly. There are overlaps! For example, sugar drives impulsivity to seek more of the substance, and leads to changes in neurobiological brain function which alter emotional states and subsequent behaviours:
The impact of sugar consumption on stress driven, emotional and addictive behaviors
However!
Cocaine triggers a release of dopamine (as does sugar), but cocaine also acts directly on our brain’s ability to remove dopamine, serotonin, and norepinephrine:
The Neurobiology of Cocaine Addiction
…meaning that in terms of comparability, they (to use a metaphor now, not meaning this literally) both give you a warm feeling, but sugar does it by turning up the heating a bit whereas cocaine does it by locking the doors and burning down the house. That’s quite a difference!
Sugar is a behavioral addiction, comparable to video gaming: True or False?
True, with the caveat that this a “yes and” situation.
There are behavioral aspects of sugar addiction that can reasonably be compared to those of video gaming, e.g. compulsion loops, always the promise of more (without limiting factors such as overdosing), anxiety when the addictive element is not accessible for some reason, reduction of dopaminergic sensitivity leading to a craving for more, etc. Note that the last is mentioning a chemical but the mechanism itself is still behavioral, not chemical per se.
So, yes, it’s a behavioral addiction [and also arguably chemical in the manners we’ve described earlier in this article].
For science for this, we refer you back to:
The impact of sugar consumption on stress driven, emotional and addictive behaviors
Want more?
You might want to check out:
Beating Food Addictions: When It’s More Than “Just” Cravings
Take care!
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Why Do We Have Pores, And Could We Not?
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
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
❝Do we really need pores, and why are they bigger on the face?❞
Pores secrete sweat or sebum (there are different kinds of pores for each).
If we didn’t have sweat pores, we’d be unable to sweat, which superficially may seem like a bonus, but it’d make us prone to overheating (like dogs, pigs, and other mammals that cannot sweat).
If we didn’t have sebum pores (usually called hair follicles, which are supplied by a sebaceous gland), we’d be completely hairless, and also unable to supply our skin with natural oils that keep it healthy. So we’d have no hair and very unhappy skin.
Which is ironic, because to believe beauty magazines, we must at all costs minimize our pores (and indeed, interventions like botox* can kill them).
*Let’s give that its full name though:
Suffice it to say, we do not recommend getting injected with neurotoxins unless it is truly necessary to ward off a greater harm.
As for being bigger on the face, they need not be, but sebaceous glands are more active and numerous there, being most active and numerous in the face/forehead—which is why oily skin is more likely to appear there than other parts of the body.
If your facial sebaceous glands are too active for your liking…
…there are ways to reduce that, a simple and relatively gentle way (relative, for example, botox) is with retinoids, including retinols or retinoic acids. Here’s some of the science of that; the paper is about treating acne, but the mechanism of action is the same (down-regulating the sebaceous glands’ action):
The potential side-effects, however were noted as:
- Cheilitis
- Desquamation of the skin
- Pruritus
Which, in translation from sciencese, means:
- Chapped lips
- Flaky skin
- Itchiness
Which aren’t necessarily fun, which is why with retinoids are best taken in very small doses at first to see how your skin reacts.
Remember when we said what your skin would be like without pores? This is what would happen, only much worse.
Take care!
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Do you have knee pain from osteoarthritis? You might not need surgery. Here’s what to try instead
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Most people with knee osteoarthritis can control their pain and improve their mobility without surgery, according to updated treatment guidelines from the Australian Commission on Safety and Quality in Health Care.
So what is knee osteoarthritis and what are the best ways to manage it?
Pexels/Kindelmedia More than 2 million Australians have osteoarthritis
Osteoarthritis is the most common joint disease, affecting 2.1 million Australians. It costs the economy A$4.3 billion each year.
Osteoarthritis commonly affects the knees, but can also affect the hips, spine, hands and feet. It impacts the whole joint including bone, cartilage, ligaments and muscles.
Most people with osteoarthritis have persistent pain and find it difficult to perform simple daily tasks, such as walking and climbing stairs.
Is it caused by ‘wear and tear’?
Knee osteoarthritis is most likely to affect older people, those who are overweight or obese, and those with previous knee injuries. But contrary to popular belief, knee osteoarthritis is not caused by “wear and tear”.
Research shows the degree of structural wear and tear visible in the knee joint on an X-ray does not correlate with the level of pain or disability a person experiences. Some people have a low degree of structural wear and tear and very bad symptoms, while others have a high degree of structural wear and tear and minimal symptoms. So X-rays are not required to diagnose knee osteoarthritis or guide treatment decisions.
Telling people they have wear and tear can make them worried about their condition and afraid of damaging their joint. It can also encourage them to try invasive and potentially unnecessary treatments such as surgery. We have shown this in people with osteoarthritis, and other common pain conditions such as back and shoulder pain.
This has led to a global call for a change in the way we think and communicate about osteoarthritis.
What’s the best way to manage osteoarthritis?
Non-surgical treatments work well for most people with osteoarthritis, regardless of their age or the severity of their symptoms. These include education and self-management, exercise and physical activity, weight management and nutrition, and certain pain medicines.
Education is important to dispel misconceptions about knee osteoarthritis. This includes information about what osteoarthritis is, how it is diagnosed, its prognosis, and the most effective ways to self-manage symptoms.
Health professionals who use positive and reassuring language can improve people’s knowledge and beliefs about osteoarthritis and its management.
Many people believe that exercise and physical activity will cause further damage to their joint. But it’s safe and can reduce pain and disability. Exercise has fewer side effects than commonly used pain medicines such as paracetamol and anti-inflammatories and can prevent or delay the need for joint replacement surgery in the future.
Many types of exercise are effective for knee osteoarthritis, such as strength training, aerobic exercises like walking or cycling, Yoga and Tai chi. So you can do whatever type of exercise best suits you.
Increasing general physical activity is also important, such as taking more steps throughout the day and reducing sedentary time.
Weight management is important for those who are overweight or obese. Weight loss can reduce knee pain and disability, particularly when combined with exercise. Losing as little as 5–10% of your body weight can be beneficial.
Pain medicines should not replace treatments such as exercise and weight management but can be used alongside these treatments to help manage pain. Recommended medicines include paracetamol and non-steroidal anti-inflammatory drugs.
Opioids are not recommended. The risk of harm outweighs any potential benefits.
What about surgery?
People with knee osteoarthritis commonly undergo two types of surgery: knee arthroscopy and knee replacement.
Knee arthroscopy is a type of keyhole surgery used to remove or repair damaged pieces of bone or cartilage that are thought to cause pain.
However, high-quality research has shown arthroscopy is not effective. Arthroscopy should therefore not be used in the management of knee osteoarthritis.
Joint replacement involves replacing the joint surfaces with artificial parts. In 2021–22, 53,500 Australians had a knee replacement for their osteoarthritis.
Joint replacement is often seen as being inevitable and “necessary”. But most people can effectively manage their symptoms through exercise, physical activity and weight management.
The new guidelines (known as “care standard”) recommend joint replacement surgery only be considered for those with severe symptoms who have already tried non-surgical treatments.
I have knee osteoarthritis. What should I do?
The care standard links to free evidence-based resources to support people with osteoarthritis. These include:
- education, such as a decision aid and four-week online course
- self-directed online exercise and yoga programs
- weight management support
- pain management strategies, such as MyJointPain and painTRAINER.
If you have osteoarthritis, you can use the care standard to inform discussions with your health-care provider, and to make informed decisions about your care.
Belinda Lawford, Postdoctoral research fellow in physiotherapy, The University of Melbourne; Giovanni E. Ferreira, NHMRC Emerging Leader Research Fellow, Institute of Musculoskeletal Health, University of Sydney; Joshua Zadro, NHMRC Emerging Leader Research Fellow, Sydney Musculoskeletal Health, University of Sydney, and Rana Hinman, Professor in Physiotherapy, The University of Melbourne
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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The Cluttered Mind – by Deborah McKenna
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Coming from an eclectic psychotherapy background, Deborah McKenna outlines a wide array of techniques to “do what it says on the tin”, that is:
Organizing the junk drawer of your mind.
McKenna argues that it’s natural for something so gargantuan as our mind to get cluttered… but that it’s perfectly possible, with a good system, to tidy up considerably.
The benefit of this is much like the benefit of tidying a room:
Imagine a kitchen in which half the things have not been put away; there are dishes in the sink, something is growing behind the trash can… and you have a vague suspicion that if you open a certain cupboard, its contents are going to come falling out on your head. How are you going to cook a meal here?
Imagine a mind when many thoughts have been left untended; there are things you needed to process, and there’s a steady resentment of something growing in some dark part of your mind… and there’s some part of your memory that you’re afraid to even look at it, because of all it’ll cause to come surging back at you. How are you going to strategize your life here?
Fortunately, McKenna is here to guide you through doing for your mind what Marie Kondo would do for your home. And, even better, McKenna does it with a simple and clear writing style, assorted diagrams, and a step-by-step approach to getting everything in order.
Give Your Mind A Spring-Cleaning With This Book From Amazon Today
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Learning to Love Midlife – by Chip Conley
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While the book is titled about midlife, it could have said: midlife and beyond.
Some of the benefits discussed in this book really only kick in during one’s 50s, 60s, or 70s, usually. Which, for all but the most optimistic, is generally considered to be stretching beyond what is usually called “midlife”.
However! Chip Conley makes the argument for midlife being anywhere from one’s early 30s to mid-70s, depending on what (and how) we’re doing in life.
He talks about (as the subtitle promises) 12 reasons life gets better with age, and those reasons are grouped into 5 categories, thus:
- Physical life
- Emotional life
- Mental life
- Vocational life
- Spiritual life
It may surprise some readers that there are physical benefits that come with aging, but we do get two chapters in that category.
The writing style is very casual, yet with references to science throughout, and a bibliography for such.
Bottom line: if you’d like to make sure you’re making the most of your midlife and beyond, this a book that offers a lot of guidance on doing so!
Click here to check out Learning to Love Midlife, and age in style!
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Breast Milk’s Benefits That Are (So Far) Not Replicable
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Simply The Breast 🎶
In Wednesday’s newsletter, we asked you for your opinion on breast vs formula milk (for babies!), and got the above-depicted, below-described, set of responses:
- 80% said “Breast is best, as the slogan goes, and should be first choice”
- 20% said “They both have their strengths and weaknesses; use whatever”
- 0% said “Formula is formulated to be best, and should be first choice”
That’s the first time we’ve ever had a possible poll option come back with zero votes whatsoever! It seems this topic is relatively uncontentious amongst our readership, so we’ll keep things brief today, but there is still a little mythbusting to be done.
So, what does the science say?
[Breast milk should be the first choice] at least for the few few weeks and months for the benefit of baby’s health as breast milk has protective factors formula does not: True or False?
True! The wording here was taken from one of our readers’ responses, by the way (thank you, Robin). There are a good number of those protective factors, the most well-known of which is passing on immune cells and cell-like things; in other words, immune-related information being passed from parent* to child.
*usually the mother, though in principle it could be someone else and in practice sometimes it is; the only real requirements are that the other person be healthy, lactating, and willing.
As for immune benefits, see for example:
Perspectives on Immunoglobulins in Colostrum and Milk
And for that matter, also:
(Colostrum is simply the milk that is produced for a short period after giving birth; the composition of milk will tend to change later)
In any case, immunoglobulin A is a very important component in breast milk (colostrum and later), as well as lactoferrin (has an important antimicrobial effect and is good for the newborn’s gut), and a plethora of cytokines:
As for that about the gut, lactoferrin isn’t the only breast milk component that benefits this, by far, and there’s a lot that can’t be replicated yet:
Human Breast Milk and the Gastrointestinal Innate Immune System
As long as your infant/child is nutritiously fed, it shouldn’t matter if it comes from breast or formula: True or False?
False! Formula milk will not convey those immune benefits.
This doesn’t mean that formula-feeding is neglectful; as several people who commented mentioned*, there are many reasons a person may not be able to breastfeed, and they certainly should not be shamed for that.
*(including the reader whose words we borrowed for this True/False item; the words we quoted above were prefaced with: “Not everyone is able to breastfeed for many different reasons”)
But, while formula milk is a very good second choice, and absolutely a respectable choice if breast milk isn’t an option (or an acceptable option) for whatever reason, it still does not convey all the health benefits of breast milk—yet! The day may come when they’ll find a way to replicate the immune benefits, but today is not that day.
They both have their strengths and weaknesses: True or False?
True! But formula’s strengths are only in the category of convenience and sometimes necessity—formula conveys no health benefits that breast milk could not do better, if available.
For many babies, formula means they get to eat, when without it they would starve due to non-availability of breast milk. That’s a pretty important role!
Note also: this is a health science publication, not a philosophical publication, but we’d be remiss not to mention one thing; let’s bring it in under the umbrella of sociology:
The right to bodily autonomy continues to be the right to bodily autonomy even if somebody else wants/needs something from your body.
Therefore, while there are indeed many good reasons for not being able to breastfeed, or even just not being safely* able to breastfeed, it is at the very least this writer’s opinion that nobody should be pressed to give their reason for not breastfeeding; “no” is already a sufficient answer.
*Writer’s example re safety: when I was born, my mother was on such drugs that it would have been a very bad idea for her to breastfeed me. There are plenty of other possible reasons why it might be unsafe for someone one way or another, but “on drugs that have a clear ‘do not take while pregnant or nursing’ warning” is a relatively common one.
All that said, for those who are willing and safely able, the science is clear: breast is best.
Want to read more?
The World Health Organization has a wealth of information (including explanations of its recommendations of, where possible, exclusive breastfeeding for the first 6 months, ideally continuing some breastfeeding for the first 2 years), here:
World Health Organization | Breastfeeding
Take care!
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