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

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

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

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

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

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

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

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

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

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

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

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

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

HRT does have some drawbacks: True or False?

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

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

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

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

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

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

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

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

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

See for example:

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

Our apologies, gentlemen

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

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

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

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

Meanwhile… take care, all!

Don’t Forget…

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  • Thinking of trying a new diet? 4 questions to ask yourself before you do

    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.

    We live in a society that glorifies dieting, with around 42% of adults globally having tried to lose weight. Messages about dieting and weight loss are amplified on social media, with a never-ending cycle of weight loss fads and diet trends.

    Amid often conflicting messages and misinformation, if you’re looking for diet advice online, it’s easy to become confused and overwhelmed.

    So before diving into the latest weight loss trend or extreme diet, consider these four questions to help you make a more informed decision.

    PeopleImages.com – Yuri A/Shutterstock

    1. Is the diet realistic?

    Have you considered the financial cost of maintaining the diet or lifestyle, and the time and resources that would be required? For example, do you need to purchase specific products, supplements, or follow a rigid meal plan?

    If the diet is coming from someone who is trying to sell you something – such as a particular weight-loss product you need in order to follow the diet – this could be a particular red flag.

    Many extreme diet recommendations come from a place of privilege and overlook food access, affordability, cooking skills, where you live, or even your culture and ethics.

    If the diet has these sorts of issues it can lead to frustration, stress, stigmatisation and feelings of failure for the person trying to adhere to the diet. But the problem may be with the diet itself – not with you.

    Man looks at flour at the supermarket
    Many diets promoted online will be expensive, or require a lot of time and resources. artem evdokimov/Shutterstock

    2. Is there evidence to support this diet?

    Self-proclaimed “experts” online will often make claims focused on specific groups, known as target populations. This might be 30- to 50-year-old men with diabetes, for example.

    In some cases, evidence for claims made may come from animal studies, which might not be applicable to humans at all.

    So be aware that if research findings are for a group that doesn’t match your profile, then the results might not be relevant to you.

    It takes time and a lot of high-quality studies to tell us a “diet” is safe and effective, not just one study. Ask yourself, is it supported by multiple studies in humans? Be critical and question the claims before you accept them.

    For accurate information look for government websites, or ask your GP or dietitian.

    3. How will this diet affect my life?

    Food is much more than calories and nutrients. It plays many roles in our lives, and likewise diets can influence our lives in ways we often overlook.

    Socially and culturally, food can be a point of connection and celebration. It can be a source of enjoyment, a source of comfort, or even a way to explore new parts of the world.

    So when you’re considering a new diet, think about how it might affect meaningful moments for you. For example, if you’re going travelling, will your diet influence the food choices you make? Will you feel that you can’t sample the local cuisine? Or would you be deterred from going out for dinner with friends because of their choice of restaurant?

    4. Will this diet make me feel guilty or affect my mental health?

    What is your favourite meal? Does this diet “allow” you to eat it? Imagine visiting your mum who has prepared your favourite childhood meal. How will the diet affect your feelings about these special foods? Will it cause you to feel stressed or guilty about enjoying a birthday cake or a meal cooked by a loved one?

    Studies have shown that dieting can negatively impact our mental health, and skipping meals can increase symptoms of depression and anxiety.

    Many diets fail to consider the psychological aspects of eating, even though our mental health is just as important as physical health. Eating should not make you feel stressed, anxious, or guilty.

    So before starting another diet, consider how it might affect your mental health.

    Moving away from a dieting mindset

    We’re frequently told that weight loss is the path to better health. Whereas, we can prioritise our health without focusing on our weight. Constant messages about the need to lose weight can also be harmful to mental health, and not necessarily helpful for physical health.

    Our research has found eating in a way that prioritises health over weight loss is linked to a range of positive outcomes for our health and wellbeing. These include a more positive relationship with food, and less guilt and stress.

    Our research also indicates mindful and intuitive eating practices – which focus on internal cues, body trust, and being present and mindful when eating – are related to lower levels of depression and stress, and greater body image and self-compassion.

    But like anything, it takes practice and time to build a positive relationship with food. Be kind to yourself, seek out weight-inclusive health-care professionals, and the changes will come. Finally, remember you’re allowed to find joy in food.

    Melissa Eaton, Accredited Practising Dietitian; PhD Candidate, University of Wollongong; Verena Vaiciurgis, Accredited Practising Dietitian; PhD Candidate, University of Wollongong, and Yasmine Probst, Associate Professor, School of Medical, Indigenous and Health Sciences, University of Wollongong

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • As The Summer Gets Hotter Still…

    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.

    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

    ❝I would love to see an article about heat dehydrated illness….so much of the US is under hot conditions. I had an fainting sweating episode and now trying to recoup from it. What should we do? Drink water,rest…???❞

    We have done some of this, but it’s always a good one to revisit! Last summer (N. Hemisphere summer), we wrote this:

    Stay Safe From Heat Exhaustion & Heatstroke!

    …and this year, it’s getting hotter still (and is already the hottest summer on record), with certainly much of the US seriously affected, as you say. Next year, it will probably be worse again; climate change is getting predictable like that, and likely will continue until fixed. We are but a health science publication, so we can’t fix the world’s climate, but we can reiterate the above advice, and urge everyone to take it seriously.

    Note: heat exhaustion and heatstroke kill. Yes, we’re including heat exhaustion in that, because by the time you get heat exhaustion, you’re often not in the best state of mind to take the correct steps to avoid the heatstroke that follows.

    To think otherwise would be akin to thinking “falling never killed anyone; it’s only when you stop falling that it’s dangerous”.

    This summer, we did also write this more niche article:

    Surviving Summer While Fat

    …whose advice won’t apply to everyone, but will be helpful to some, and honestly, some of that advice does go for everyone.

    One thing we didn’t write about in those articles that we’ll add here:

    Humidity is dangerous:

    • Dry heat: you sweat, the sweat evaporates, cooling you. As well as losing heat, you’ve also now lost water and salts, which you’ll need to replenish, but your body is operating correctly.
    • Humid heat: you sweat, and now you are just sweaty until further notice. It doesn’t evaporate because the surrounding humidity doesn’t provide the physics for that. Not only are you not losing heat through evaporating sweat, but also, if you’re wearing clothes, that’s now an insulating layer you’re wearing.

    …so that means, watch the humidity as carefully as you watch the temperature, and when it’s high, get extra serious about finding ways to keep yourself cool (e.g. shade, rest, cooling showers etc if you can, that kind of thing).

    Take care!

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  • Holding Back The Clock on Aging

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    Holding Back The Clock on Aging

    Dr. Eric Verdin specializes in Holding Back The Clock, with a focus on Aging.

    This is Dr. Eric Verdin, President and CEO of the Buck Institute of Research on Aging. He’s also held faculty positions at the University of Brussels, the NIH, and the Picower Institute for Medical Research. Dr. Verdin is also a professor of medicine at University of California, San Francisco.

    Dr. Verdin’s laboratory focuses on the role of epigenetic regulators (especially the behaviors of certain enzymes) in the aging process. He studies how metabolism, diet, and chemical factors regulate the aging process and its associated diseases, including Alzheimer’s.

    He has published more than 210 scientific papers and holds more than 15 patents. He is a highly cited scientist and has been recognized for his research with a Glenn Award for Research in Biological Mechanisms of Aging.

    And that’s just what we could fit here! Basically, he knows his stuff.

    What we can do

    Dr. Verdin’s position is bold, but rooted in evidence:

    ❝Lifestyle is responsible for about 93% of our longevity—only about 7% is genetics. Based on the data, if implementing health lifestyle choices, most people could live to 95 in good health. So there’s 15 to 17 extra years of healthy life that is up for grabs❞

    ~ Dr. Eric Verdin

    See for example:

    How we can do it

    Well, we all know “the big five”:

    • Good diet (Mediterranean Diet as usual is recommended)
    • Good exercise (more on this in a moment)
    • Good sleep (more on this in a moment)
    • Avoid alcohol (not controversial)
    • Don’t smoke (need we say more)

    When it comes to exercise, generally recognized as good is at least 150 minutes per week of moderate intensity exercise (for example, a brisk walk, or doing the gardening), and at least three small sessions a week of high intensity exercise, unless contraindicated by some medical condition.

    As for Dr. Verdin’s take on this…

    What Dr. Verdin recommends is:

    • make it personalized
    • make it pre-emptive
    • make it better

    The perfect exercise plan is only perfect if you actually do it. And if you actually can do it, for that matter.

    Prevention is so much better (and easier) than cure for a whole array of maladies. So while there may be merit in thinking “what needs fixing”, Dr. Verdin encourages us to take extra care to not neglect factors of our health that seem “good enough”. Because, give them time and neglect, and they won’t be!

    Wherever we’re at in life and health, there’s always at least some little way we could make it a bit better. Dr. Verdin advises us to seek out those little improvements, even if it’s just a nudge better here, a nudge better there, all those nudges add up!

    About sleep…

    It’s perhaps the easiest one to neglect (writer’s note: as a writer, I certainly feel that way!), but his biggest take-away tip for this is:

    Worry less about what time you set an alarm for in the morning. Instead, set an alarm for the evening—to remind you when to go to bed.

    Want to hear directly from the man himself?

    Here he is speaking on progress we can expect for the next decade in the field of aging research, as part of the 100 Minutes of Longevity session at The Longevity Forum, a few months ago:

    !

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  • Take Care Of Your “Unwanted” Parts Too!

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    Meet The Family…

    If you’ve heard talk of “healing your inner child” or similar ideas, then today’s featured type of therapy takes that to several extra levels, in a way that helps many people.

    It’s called Internal Family Systems therapy, often “IFS” for short.

    Here’s a quick overview:

    Psychology Today | Internal Family Systems Therapy

    Note: if you are delusional, paranoid, schizophrenic, or have some other related disorder*, then IFS would probably be a bad idea for you as it could worsen your symptoms, and/or play into them badly.

    *but bipolar disorder, in its various forms, is not usually a problem for IFS. Do check with your own relevant healthcare provider(s), of course, to be sure.

    What is IFS?

    The main premise of IFS is that your “self” can be modelled as a system, and its constituent parts can be examined, questioned, given what they need, and integrated into a healthy whole.

    For example…

    • Exile is the name given to parts that could be, for example, the “inner child” referenced in a lot of pop-psychology, but it could also be some other ignored and pushed-down part of oneself, often from some kind of trauma. The defining characteristic of an exile is that it’s a part of ourself that we don’t consciously allow ourselves to see as a current part of ourself.
    • Protector is the name given to a part of us that looks to keep us safe, and can do this in an adaptive (healthy) or maladaptive (unhealthy) way, for example:
      • Firefighter is the name given to a part of us that will do whatever is necessary in the moment to deal with an exile that is otherwise coming to the surface—sometimes with drastic actions/reactions that may not be great for us.
      • Manager is the name given to a part of us that has a more nurturing protective role, keeping us from harm in what’s often a more prophylactic manner.

    To give a simple illustration…

    A person was criticized a lot as a child, told she was useless, and treated as a disappointment. Consequently, as an adult she now has an exile “the useless child”, something she strives to leave well behind in her past, because it was a painful experience for her. However, sometimes when someone questions and/or advises her, she will get defensive as her firefighter “the hero” will vigorously speak up for her competence, like nobody did when she was a child. This vigor, however, manifests as rude abrasiveness and overcompensation. Finally, she has a manager, “the advocate”, who will do the same job, but in a more quietly confident fashion.

    This person’s therapy will look at transferring the protector job from the firefighter to the manager, which will involve examining, questioning, and addressing all three parts.

    The above example is fictional and created for simplicity and clarity; here’s a real-world case study if you’d like a more in-depth overview of how it can work:

    American Journal of Psychotherapy | The Teenager’s Confession: Regulating Shame in Internal Family Systems Therapy

    How it all fits together in practice

    IFS looks to make sure all the parts’ needs are met, even the “bad” ones, because they all have their functions.

    Good IFS therapy, however, can make sure a part is heard, and then reassure that part in a way that effectively allows that part to “retire”, safe and secure in the knowledge that it has done what it needed to, and/or the job is being done by another part now.

    That can involve, for example, thanking the firefighter for looking after our exile for all these years, but that our exile is safe and in good hands now, so it can put that fire-axe away.

    See also: On Being Reactive vs Being Responsive

    Questions you might ask yourself

    While IFS therapy is best given by a skilled practitioner, we can take some of the ideas of it for self-therapy too. For example…

    • What is a secret about yourself that you will take to the grave? And now, why did that part of you (now an exile) come to exist?
    • What does that exile need, that it didn’t get? What parts of us try to give it that nowadays?
    • What could we do, with all that information in mind, to assign the “protection” job to the part of us best-suited to healthy integration?

    Want to know more?

    We’ve only had the space of a small article to give a brief introduction to Family Systems therapy, so check out the “resources” tab at:

    IFS Institute | What Is Internal Family Systems Therapy?

    Take care!

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  • Do we really need to burp babies? Here’s what the research says

    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.

    Parents are often advised to burp their babies after feeding them. Some people think burping after feeding is important to reduce or prevent discomfort crying, or to reduce how much a baby regurgitates milk after a feed.

    It is true babies, like adults, swallow air when they eat. Burping releases this air from the top part of our digestive tracts. So when a baby cries after a feed, many assume it’s because the child needs to “be burped”. However, this is not necessarily true.

    Why do babies cry or ‘spit up’ after a feed?

    Babies cry for a whole host of reasons that have nothing to do with “trapped air”.

    They cry when they are hungry, cold, hot, scared, tired, lonely, overwhelmed, needing adult help to calm, in discomfort or pain, or for no identifiable reason. In fact, we have a name for crying with no known cause; it’s called “colic”.

    “Spitting up” – where a baby gently regurgitates a bit of milk after a feed – is common because the muscle at the top of a newborn baby’s stomach is not fully mature. This means what goes down can all too easily go back up.

    Spitting up frequently happens when a baby’s stomach is very full, there is pressure on their tummy or they are picked up after lying down.

    Spitting up after feeding decreases as babies get older. Three-quarters of babies one month old spit up after feeding at least once a day. Only half of babies still spit up at five months and almost all (96%) stop by their first birthdays.

    A woman pats her baby while she or she rests on on her shoulder
    There’s not much research out there on ‘burping’ babies. antoniodiaz/Shutterstock

    Does burping help reduce crying or spitting up?

    Despite parents being advised to burp their babies, there’s not much research evidence on the topic.

    One study conducted in India encouraged caregivers of 35 newborns to burp their babies, while caregivers of 36 newborns were not given any information about burping.

    For the next three months, mothers and caregivers recorded whether their baby would spit up after feeding and whether they showed signs of intense crying.

    This study found burping did not reduce crying and actually increased spitting up.

    When should I be concerned about spitting up or crying?

    Most crying and spitting up is normal. However, these behaviours are not:

    • refusing to feed
    • vomiting so much milk weight gain is slow
    • coughing or wheezing distress while feeding
    • bloody vomit.

    If your baby has any of these symptoms, see a doctor or child health nurse.

    If your baby seems unbothered by vomiting and does not have any other symptoms it is a laundry problem rather than something that needs medical attention.

    It is also normal for babies to cry and fuss quite a lot; two hours a day, for about the first six weeks is the average.

    This has usually reduced to about one hour a day by the time they are three months of age.

    Crying more than this doesn’t necessarily mean there is something wrong. The intense, inconsolable crying of colic is experienced by up to one-quarter of young babies but goes away with time on its own .

    If your baby is crying more than average or if you are worried there might be something wrong, you should see your doctor or child health nurse.

    A man gently pats his newborn baby on the back.
    If your baby likes being ‘burped’, then it’s OK to do it. But don’t stress if you skip it. Miljan Zivkovic/Shutterstock

    Not everyone burps their baby

    Burping babies seems to be traditional practice in some parts of the world and not in others.

    For example, research in Indonesia found most breastfeeding mothers rarely or never burped their babies after feeding.

    One factor that may influence whether a culture encourages burping babies may be related to another aspect of infant care: how much babies are carried.

    Carrying a baby in a sling or baby carrier can reduce the amount of time babies cry.

    Babies who are carried upright on their mother or another caregiver’s front undoubtedly find comfort in that closeness and movement.

    Babies in slings are also being held firmly and upright, which would help any swallowed air to rise up and escape via a burp if needed.

    Using slings can make caring for a baby easier. Studies (including randomised controlled trials) have also shown women have lower rates of post-natal depression and breastfeed for longer when they use a baby sling.

    It is important baby carriers and slings are used safely, so make sure you’re up to date on the latest advice on how to do it.

    So, should I burp my baby?

    The bottom line is: it’s up to you.

    Gently burping a baby is not harmful. If you feel burping is helpful to your baby, then keep doing what you’re doing.

    If trying to burp your baby after every feed is stressing you or your baby out, then you don’t have to keep doing it.

    Karleen Gribble, Adjunct Associate Professor, School of Nursing and Midwifery, Western Sydney University and Nina Jane Chad, Research Fellow, University of Sydney School of Public Health, University of Sydney

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • How To Avoid Self-Hatred & Learn To Love Oneself More

    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.

    Alain de Botton gives a compassionate, but realistic, explanation in this video:

    The enemy within

    Or rather, the collaborator within. Because there’s usually first an enemy without—those who are critical of us, who consider that we are bad people in some fashion, and may indeed get quite colorful in their expressions of this.

    Sometimes, their words will bounce straight off us; sometimes, their words will stick. So what’s the difference, and can we do anything about it?

    The difference is: when their words stick, it’s usually because on some level we believe their words may be true. That doesn’t mean they necessarily are true!

    They could be (and it would be a special kind of hubris to assume no detractor could ever find a valid criticism of us), but very often the reason we have that belief, or at least that fear/insecurity, is simply because it was taught to us at an early age, often by harsh words/actions of those around us; perhaps our parents, perhaps our schoolteachers, perhaps our classmates, and so forth.

    The problem—and solution—is that we learn emotions much the same way that we learn language; only in part by reasoned thought, and rather for the most part, by immersion and repetition.

    It can take a lot of conscious self-talk to undo the harm of decades of unconscious self-talk based on what was probably a few years of external criticisms when we were small and very impressionable… But, having missed the opportunity to start fixing this sooner, the next best time to do it is now.

    We cannot, of course, simply do what a kind friend might do and expect any better results; if a kind friend tells us something nice that we do not believe is true, then however much they mean it, we’re not going to internalize it. So instead, we must simply chip away at those unhelpful longstanding counterproductive beliefs, and simply build up the habit of viewing ourselves in a kinder light.

    For more on all this, enjoy:

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