
Hormones & Health, Beyond The Obvious
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Wholesome Health

This is Dr. Sara Gottfried, who some decades ago got her MD from Harvard and specialized as an OB/GYN at MIT. She’s since then spent the more recent part of her career educating people (mostly: women) about hormonal health, precision, functional, & integrative medicine, and the importance of lifestyle medicine in general.
What does she want us to know?
Beyond “bikini zone health”
Dr. Gottfried urges us to pay attention to our whole health, in context.
“Women’s health” is often thought of as what lies beneath a bikini, and if it’s not in those places, then we can basically treat a woman like a man.
And that’s often not actually true—because hormones affect every living cell in our body, and as a result, while prepubescent girls and postmenopausal women (specifically, those who are not on HRT) may share a few more similarities with boys and men of similar respective ages, for most people at most ages, men and women are by default quite different metabolically—which is what counts for a lot of diseases! And note, that difference is not just “faster” or “slower””, but is often very different in manner also.
That’s why, even in cases where incidence of disease is approximately similar in men and women when other factors are controlled for (age, lifestyle, medical history, etc), the disease course and response to treatment may vary considerable. For a strong example of this, see for example:
- The well-known: Heart Attack: His & Hers ← most people know these differences exist, but it’s always good to brush up on what they actually are
- The less-known: Statins: His & Hers ← most people don’t know these differences exist, and it pays to know, especially if you are a woman or care about one
Nor are brains exempt from his…
The female brain (kinda)
While the notion of an anatomically different brain for men and women has long since been thrown out as unscientific phrenology, and the idea of a genetically different brain is… Well, it’s an unreliable indicator, because technically the cells will have DNA and that DNA will usually (but not always; there are other options) have XX or XY chromosomes, which will usually (but again, not always) match apparent sex (in about 1/2000 cases there’s a mismatch, which is more common than, say, red hair; sometimes people find out about a chromosomal mismatch only later in life when getting a DNA test for some unrelated reason), and in any case, even for most of us, the chromosomal differences don’t count for much outside of antenatal development (telling the default genital materials which genitals to develop into, though this too can get diverted, per many intersex possibilities, which is also a lot more common than people think) or chromosome-specific conditions like colorblindness…
The notion of a hormonally different brain is, in contrast to all of the above, a reliable and easily verifiable thing.
See for example:
Alzheimer’s Sex Differences May Not Be What They Appear
Dr. Gottfried urges us to take the above seriously!
Because, if women get Alzheimer’s much more commonly than men, and the disease progresses much more quickly in women than men, but that’s based on postmenopausal women not on HRT, then that’s saying “Women, without women’s usual hormones, don’t do so well as men with men’s usual hormones”.
She does, by the way, advocate for bioidentical HRT for menopausal women, unless contraindicated for some important reason that your doctor/endocrinologist knows about. See also:
Menopausal HRT: A Tale Of Two Approaches (Bioidentical vs Animal)
The other very relevant hormone
…that Dr. Gottfried wants us to pay attention to is insulin.
Or rather, its scrubbing enzyme, the prosaically-named “insulin-degrading enzyme”, but it doesn’t only scrub insulin. It also scrubs amyloid beta—yes, the same that produces the amyloid beta plaques in the brain associated with Alzheimer’s. And, there’s only so much insulin-degrading enzyme to go around, and if it’s all busy breaking down excess insulin, there’s not enough left to do the other job too, and thus can’t break down amyloid beta.
In other words: to fight neurodegeneration, keep your blood sugars healthy.
This may actually work by multiple mechanisms besides the amyloid hypothesis, by the way:
The Surprising Link Between Type 2 Diabetes & Alzheimer’s
Want more from Dr. Gottfried?
You might like this interview with Dr. Gottfried by Dr. Benson at the IMCJ:
Integrative Medicine: A Clinician’s Journal | Conversations with Sara Gottfried, MD
…in which she discusses some of the things we talked about today, and also about her shift from a pharmaceutical-heavy approach to a predominantly lifestyle medicine approach.
Enjoy!
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Water’s Counterintuitive Properties
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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
❝Why are we told to drink more water for everything, even if sometimes it seems like the last thing we need? Bloated? Drink water. Diarrhea? Drink water. Nose running like a tap? Drink water❞
While water will not fix every ill, it can fix a lot, or at least stop it from being worse!
Our bodies are famously over 60% water (exact figure will depend on how well-hydrated you are, obviously, as well as your body composition in terms of muscle and fat). Our cells (which are mostly full of mostly water) need replacing all the time, and almost everything that needs transporting almost anywhere is taken there by blood (which is also mostly water). And if we need something moving out of the body? Water is usually going to be a large part of how it gets ejected.
In the cases of the examples you gave…
- Bloating: bloating is often a matter of water retention, which often happens as a result of having too much salt, and/or sometimes too much fat. So the body’s homeostatic system (the system that tries to maintain all kinds of equilibrium, keeping salt balance, temperature, pH, and many other things in their respective “Goldilocks zones”) tries to add more water to where it’s needed to balance out the salt etc.
- Consequently, drinking more water means the body will note “ok, balance restored, no need to keep retaining water there, excess salts being safely removed using all this lovely water”.
- Diarrhea: this is usually a case of a bacterial infection, though there can be other causes. Whether for that reason or another, the body has decided that it needs to give your gut an absolute wash-out, and it can only do that from the inside—so it uses as much of the body’s water as it needs to do that.
- Consequently, drinking more water means that you are replenishing the water that the body has already 100% committed to using. If you don’t drink water, you’ll still have diarrhea, you’ll just start to get dangerously dehydrated.
- Runny nose: this is usually a case of either fighting a genuine infection, or else fighting something mistaken for a pathogen (e.g. pollen, or some other allergen). The mucus is an important part of the body’s defense: it traps the microbes (be they bacteria, virus, whatever) and water-slides them out of the body.
- Consequently, drinking more water means the body can keep the water-slide going. Otherwise, you’ll just get gradually more dehydrated (because as with diarrhea, your body will prioritize this function over maintaining water reserves—water reserves are there to be used if necessary, is the body’s philosophy) and if the well runs dry, you’ll just be dehydrated and have a higher pathogen-count still in your body.
Some previous 10almonds articles that might interest you:
- Hydration Mythbusting
- When To Take Electrolytes (And When We Shouldn’t!)
- Keeping Your Kidneys Healthy (Especially After 60)
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- Bloating: bloating is often a matter of water retention, which often happens as a result of having too much salt, and/or sometimes too much fat. So the body’s homeostatic system (the system that tries to maintain all kinds of equilibrium, keeping salt balance, temperature, pH, and many other things in their respective “Goldilocks zones”) tries to add more water to where it’s needed to balance out the salt etc.
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Sunflower Seeds vs Sesame Seeds – Which is Healthier?
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Our Verdict
When comparing sunflower seeds to sesame seeds, we picked the sunflower.
Why?
In moderation, both are very healthy. We say “in moderation” because they’re both about 50% fat and such fats, while vital for life, are generally best enjoyed in small portions. Of that fat, sunflower has the slightly better fat profile; they’re both mostly poly- and monounsaturated fats, but sunflower has 10% saturated fat while sesame has 15%. Aside from fats, sunflower has slightly more protein and sesame has slightly more carbs. While sesame has slightly more fiber, because of the carb profile sunflower still has the lower glycemic index. All in all, a moderate win for sunflower in the macros category.
You may be wondering, with all that discussion of fats, what they’re like for omega-3, and sesame seeds have more omega-3, though sunflower seeds contain it too. Still, a point in sesame’s favor here.
When it comes to vitamins, sunflower has more of vitamins A, B1, B2, B3, B5, B6, B9, C, E, and choline, while sesame is not higher in any vitamins.
In the category of minerals, sunflower has more phosphorus, potassium, and selenium, while sesame has more calcium, copper, iron, and zinc. This is nominally a marginal win for sesame, but it should be noted that sunflower is still very rich in copper, iron, and zinc too (but not calcium).
Adding up the categories makes for a moderate win for sunflower seeds, but as ever, enjoy both; diversity is best!
Want to learn more?
You might like to read:
Sunflower Seeds vs Pumpkin Seeds – Which is Healthier?
Take care!
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The Most Annoying Nutrition Tips (7 Things That Actually Work)
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You can’t out-exercise a bad diet, and getting a good diet can be a challenge depending on your starting point. Here’s Cori Lefkowith’s unglamorous seven-point plan:
Step by step
Seven things to do:
- Start tracking first: track your food intake (as it is, without changing anything) without judgment to identify realistic areas for improvement.
- Add protein: add 10g of protein to three meals daily to improve satiety, aid fat loss, and retain muscle.
- Fiber swaps: swap foods for higher-fiber options where possible to improve gut health, improve heart health, support fat loss, and promote satiety.
- Hydration: take your body weight in kilograms (or half your body weight in pounds), then get that many ounces of water daily to support metabolism and reduce cravings.
- Calorie swaps: replace or reduce calorie-dense foods to create a small, modestly sustainable calorie deficit. Your body will still adjust to this after a while; that’s fine; it’s about a gradual reduction.
- Tweak and adjust: regularly reassess and adjust your diet and habits to fit your lifestyle and progress.
- Guard against complacency: track consistently, and stay on course.
For more on all of these, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like:
The Smartest Way To Get To 20% Body Fat (Or 10% For Men)
Take care!
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Blackberries vs Grapes – Which is Healthier?
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Our Verdict
When comparing blackberries to grapes, we picked the blackberries.
Why?
It’s not even close:
In terms of macros, blackberries have more than 5x the fiber, for about half the carbs, resulting in a notably lower glycemic index. They also have more than 2x the protein, but unlike the fiber, it’s not much in either fruit, so we might disregard it. Still, an easy win for blackberries either way.
In the category of vitamins, blackberries have more of vitamins A, B3, B5, B9, C, E, K, and choline, while grapes have more of vitamins B1, B2, and B6. Another clear win for blackberries.
When it comes to minerals, blackberries have a lot more calcium, copper, iron, magnesium, phosphorus, selenium, and zinc, while grapes have slightly more manganese and potassium. Once again, blackberries emerge victorious.
Looking at polyphenols, both have an abundance of many polyphenols, but blackberries have more, both in types and in total mass (mg/100g).
Thus, blackberries overwhelmingly win the day, but by all means enjoy either or both; diversity is good!
Want to learn more?
You might like:
Can We Drink To Good Health? ← while there are polyphenols such as resveratrol in red wine that per se would boost heart health, there’s so little per glass that you may need 100–1000 glasses per day to get the dosage that provides benefits in mouse studies.
If you’re not a mouse, you might even need more than that!
To this end, many people prefer resveratrol supplementation ← link is to an example product on Amazon, but there are plenty more so feel free to shop around 😎
Enjoy!
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Syringe Exchange Fears Hobble Fight Against West Virginia HIV Outbreak
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CHARLESTON, http://w.va/. — More than three years have passed since federal health officials arrived in central Appalachia to assess an alarming outbreak of HIV spread mostly between people who inject opioids or methamphetamine.
Infectious disease experts from the Centers for Disease Control and Prevention made a list of recommendations following their visit, including one to launch syringe service programs to stop the spread at its source. But those who’ve spent years striving to protect people who use drugs from overdose and illness say the situation likely hasn’t improved, in part because of politicians who contend that such programs encourage illegal drug use.
Joe Solomon is a Charleston City Council member and co-director of SOAR WV, a group that works to address the health needs of people who use drugs. He’s proud of how his close-knit community has risen to this challenge but frustrated with the restraints on its efforts.
“You see a city and a county willing to get to work at a scale that’s bigger than ever before,” Solomon said, “but we still have one hand tied behind our back.”
The hand he references is easier access to clean syringes.
In April 2021, the CDC came to Charleston — the seat of Kanawha County and the state capital, tucked into the confluence of the Kanawha and Elk rivers — to investigate dozens of newly detected HIV infections. The CDC’s HIV intervention chief called it “the most concerning HIV outbreak in the United States” and warned that the number of reported diagnoses could be just “the tip of the iceberg.”
Now, despite attention and resources directed toward the outbreak, researchers and health workers say HIV continues to spread. In large part, they say, the outbreak lingers because of restrictions state and local policymakers have placed on syringe exchange efforts.
Research indicates that syringe service programs are associated with an estimated 50% reduction in HIV and hepatitis C, and the CDC issued recommendations to steer a response to the outbreak that emphasized the need for improved access to those services.
That advice has thus far gone unheeded by local officials.
In late 2015, the Kanawha-Charleston Health Department launched a syringe service program but shuttered it in 2018 under pressure, with then-Mayor Danny Jones calling it a “mini-mall for junkies and drug dealers.”
SOAR stepped in, hosting health fairs at which it distributed naloxone, an opioid overdose reversal drug; offered treatment and referrals; provided HIV testing; and exchanged clean syringes for used ones.
But in April 2021, the state legislature passed a bill limiting the number of syringes people could exchange and made it mandatory to present a West Virginia ID. The Charleston City Council subsequently added guidelines of its own, including requiring individual labeling of syringes.
As a result of these restrictions, SOAR ceased exchanging syringes. West Virginia Health Right now operates an exchange program in the city under the restrictions.
Robin Pollini is a West Virginia University epidemiologist who conducts community-based research on injection drug use. “Anyone I’ve talked to who’s used that program only used it once,” she said. “And the numbers they report to the state bear that out.”
A syringe exchange run by the health department in nearby Cabell County — home to Huntington, the state’s largest city after Charleston — isn’t so constrained. As Solomon notes, that program exchanges more than 200 syringes for every one exchanged in Kanawha.
A common complaint about syringe programs is that they result in discarded syringes in public spaces. Jan Rader, director of Huntington’s Mayor’s Office of Public Health and Drug Control Policy, is regularly out on the streets and said she seldom encounters discarded syringes, pointing out that it’s necessary to exchange a used syringe for a new one.
In August 2023, the Charleston City Council voted down a proposal from the Women’s Health Center of West Virginia to operate a syringe exchange in the city’s West Side community, with opponents expressing fears of an increase in drug use and crime.
Pollini said it’s difficult to estimate the number of people in West Virginia with HIV because there’s no coordinated strategy for testing; all efforts are localized.
“You would think that in a state that had the worst HIV outbreak in the country,” she said, “by this time we would have a statewide testing strategy.”
In addition to the testing SOAR conducted in 2021 at its health fairs, there was extensive testing during the CDC’s investigation. Since then, the reported number of HIV cases in Kanawha County has dropped, Pollini said, but it’s difficult to know if that’s the result of getting the problem under control or the result of limited testing in high-risk groups.
“My inclination is the latter,” she said, “because never in history has there been an outbreak of injection-related HIV among people who use drugs that was solved without expanding syringe services programs.”
“If you go out and look for infections,” Pollini said, “you will find them.”
Solomon and Pollini praised the ongoing outreach efforts — through riverside encampments, in abandoned houses, down county roads — of the Ryan White HIV/AIDS Program to test those at highest risk: people known to be injecting drugs.
“It’s miracle-level work,” Solomon said.
But Christine Teague, Ryan White Program director at the Charleston Area Medical Center, acknowledged it hasn’t been enough. In addition to HIV, her concerns include the high incidence of hepatitis C and endocarditis, a life-threatening inflammation of the lining of the heart’s chambers and valves, and the cost of hospital resources needed to address them.
“We’ve presented that data to the legislature,” she said, “that it’s not just HIV, it’s all these other lengthy hospital admissions that, essentially, Medicaid is paying for. And nothing seems to penetrate.”
Frank Annie is a researcher at CAMC specializing in cardiovascular diseases, a member of the Charleston City Council, and a proponent of syringe service programs. Research he co-authored found 462 cases of endocarditis in southern West Virginia associated with injection drug use, at a cost to federal, state, and private insurers of more than $17 million, of which less than $4 million was recovered.
Teague is further concerned for West Virginia’s rural counties, most of which don’t have a syringe service program.
Tasha Withrow, a harm reduction advocate in bordering rural Putnam County, said her sense is that HIV numbers aren’t alarmingly high there but said that, with little testing and heightened stigma in a rural community, it’s difficult to know.
In a January 2022 follow-up report, the CDC recommended increasing access to harm reduction services such as syringe service programs through expansion of mobile services, street outreach, and telehealth, using “patient-trusted” individuals, to improve the delivery of essential services to people who use drugs.
Teague would like every rural county to have a mobile unit, like the one operated by her organization, offering harm reduction supplies, medication, behavioral health care, counseling, referrals, and more. That’s an expensive undertaking. She suggested opioid settlement money through the West Virginia First Foundation could pay for it.
Pollini said she hopes state and local officials allow the experts to do their jobs.
“I would like to see them allow us to follow the science and operate these programs the way they’re supposed to be run, and in a broader geography,” she said. “Which means that it shouldn’t be a political decision; it should be a public health decision.”
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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Smart Sex – by Dr. Emily Morse
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First, what this isn’t: this isn’t a mere book of sex positions and party tricks, nor is it a book of Cosmo-style “drive your man wild by using hot sauce as lube” advice.
What it offers instead, is a refreshingly mature take on sex, free from the “teehee” titillations and blushes that many books of the genre go for.
Dr. Emily Morse outlines five pillars of sex:
- Embodiment
- Health
- Collaboration
- Self-knowledge
- Self-acceptance
…and talks about each of them in detail, and how we can bring them together. And, of course, how we or our partner(s) could accidentally sabotage ourselves or each other, and the conversations we can (and should!) have, to work past that.
She also, critically, and this is a big source of value in the book, looks at “pleasure thieves”: stress, trauma, and shame. The advice for overcoming these is not “don’t worry; be happy” but rather is actual practical steps one can take.
The style throughout is direct and unpatronizing. Since the advice within pertains to everyone who has and/or wants an active sex life, very little is divided by gender etc.
There is some attention given to anatomy and physiology, complete with clear diagrams. Honestly, most people could benefit from these, because most people’s knowledge of the relevant anatomy stopped with a very basic high school text book diagram that missed a lot out.
Bottom line: this book spends more time on what’s between your ears than what’s between your legs, and yet is very comprehensive in all areas. Everyone has something to gain from this one.
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