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…

Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!

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  • Women spend more of their money on health care than men. And no, it’s not just about ‘women’s issues’

    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.

    Medicare, Australia’s universal health insurance scheme, guarantees all Australians access to a wide range of health and hospital services at low or no cost.

    Although access to the scheme is universal across Australia (regardless of geographic location or socioeconomic status), one analysis suggests women often spend more out-of-pocket on health services than men.

    Other research has found men and women spend similar amounts on health care overall, or even that men spend a little more. However, it’s clear women spend a greater proportion of their overall expenditure on health care than men. They’re also more likely to skip or delay medical care due to the cost.

    So why do women often spend more of their money on health care, and how can we address this gap?

    Elizaveta Galitckaia/Shutterstock

    Women have more chronic diseases, and access more services

    Women are more likely to have a chronic health condition compared to men. They’re also more likely to report having multiple chronic conditions.

    While men generally die earlier, women are more likely to spend more of their life living with disease. There are also some conditions which affect women more than men, such as autoimmune conditions (for example, multiple sclerosis and rheumatoid arthritis).

    Further, medical treatments can sometimes be less effective for women due to a focus on men in medical research.

    These disparities are likely significant in understanding why women access health services more than men.

    For example, 88% of women saw a GP in 2021–22 compared to 79% of men.

    As the number of GPs offering bulk billing continues to decline, women are likely to need to pay more out-of-pocket, because they see a GP more often.

    In 2020–21, 4.3% of women said they had delayed seeing a GP due to cost at least once in the previous 12 months, compared to 2.7% of men.

    Data from the Australian Bureau of Statistics has also shown women are more likely to delay or avoid seeing a mental health professional due to cost.

    A senior woman in a medical waiting room looking at a clipboard.
    Women are more likely to live with chronic medical conditions than men. Drazen Zigic/Shutterstock

    Women are also more likely to need prescription medications, owing at least partly to their increased rates of chronic conditions. This adds further out-of-pocket costs. In 2020–21, 62% of women received a prescription, compared to 37% of men.

    In the same period, 6.1% of women delayed getting, or did not get prescribed medication because of the cost, compared to 4.9% of men.

    Reproductive health conditions

    While women are disproportionately affected by chronic health conditions throughout their lifespan, much of the disparity in health-care needs is concentrated between the first period and menopause.

    Almost half of women aged over 18 report having experienced chronic pelvic pain in the previous five years. This can be caused by conditions such as endometriosis, dysmenorrhoea (period pain), vulvodynia (vulva pain), and bladder pain.

    One in seven women will have a diagnosis of endometriosis by age 49.

    Meanwhile, a quarter of all women aged 45–64 report symptoms related to menopause that are significant enough to disrupt their daily life.

    All of these conditions can significantly reduce quality of life and increase the need to seek health care, sometimes including surgical treatment.

    Of course, conditions like endometriosis don’t just affect women. They also impact trans men, intersex people, and those who are gender diverse.

    Diagnosis can be costly

    Women often have to wait longer to get a diagnosis for chronic conditions. One preprint study found women wait an average of 134 days (around 4.5 months) longer than men for a diagnosis of a long-term chronic disease.

    Delays in diagnosis often result in needing to see more doctors, again increasing the costs.

    Despite affecting about as many people as diabetes, it takes an average of between six-and-a-half to eight years to diagnose endometriosis in Australia. This can be attributed to a number of factors including society’s normalisation of women’s pain, poor knowledge about endometriosis among some health professionals, and the lack of affordable, non-invasive methods to accurately diagnose the condition.

    There have been recent improvements, with the introduction of Medicare rebates for longer GP consultations of up to 60 minutes. While this is not only for women, this extra time will be valuable in diagnosing and managing complex conditions.

    But gender inequality issues still exist in the Medicare Benefits Schedule. For example, both pelvic and breast ultrasound rebates are less than a scan for the scrotum, and no rebate exists for the MRI investigation of a woman’s pelvic pain.

    Management can be expensive too

    Many chronic conditions, such as endometriosis, which has a wide range of symptoms but no cure, can be very hard to manage. People with endometriosis often use allied health and complementary medicine to help with symptoms.

    On average, women are more likely than men to use both complementary therapies and allied health.

    While women with chronic conditions can access a chronic disease management plan, which provides Medicare-subsidised visits to a range of allied health services (for example, physiotherapist, psychologist, dietitian), this plan only subsidises five sessions per calendar year. And the reimbursement is usually around 50% or less, so there are still significant out-of-pocket costs.

    In the case of chronic pelvic pain, the cost of accessing allied or complementary health services has been found to average A$480.32 across a two-month period (across both those who have a chronic disease management plan and those who don’t).

    More spending, less saving

    Womens’ health-care needs can also perpetuate financial strain beyond direct health-care costs. For example, women with endometriosis and chronic pelvic pain are often caught in a cycle of needing time off from work to attend medical appointments.

    Our preliminary research has shown these repeated requests, combined with the common dismissal of symptoms associated with pelvic pain, means women sometimes face discrimination at work. This can lead to lack of career progression, underemployment, and premature retirement.

    A woman speaks over the counter to a male pharmacist.
    More women are prescribed medication than men. PeopleImages.com – Yuri A/Shutterstock

    Similarly, with 160,000 women entering menopause each year in Australia (and this number expected to increase with population growth), the financial impacts are substantial.

    As many as one in four women may either shift to part-time work, take time out of the workforce, or retire early due to menopause, therefore earning less and paying less into their super.

    How can we close this gap?

    Even though women are more prone to chronic conditions, until relatively recently, much of medical research has been done on men. We’re only now beginning to realise important differences in how men and women experience certain conditions (such as chronic pain).

    Investing in women’s health research will be important to improve treatments so women are less burdened by chronic conditions.

    In the 2024–25 federal budget, the government committed $160 million towards a women’s health package to tackle gender bias in the health system (including cost disparities), upskill medical professionals, and improve sexual and reproductive care.

    While this reform is welcome, continued, long-term investment into women’s health is crucial.

    Mike Armour, Associate Professor at NICM Health Research Institute, Western Sydney University; Amelia Mardon, Postdoctoral Research Fellow in Reproductive Health, Western Sydney University; Danielle Howe, PhD Candidate, NICM Health Research Institute, Western Sydney University; Hannah Adler, PhD Candidate, Health Communication and Health Sociology, Griffith University, and Michelle O’Shea, Senior Lecturer, School of Business, Western Sydney University

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

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  • 3 Things Everyone Over 50 Must Do Daily for Healthy Feet

    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.

    Will Harlow, the over-50s specialist physio, wants you to be on a good footing:

    Daily steps in the right direction

    The three daily exercises recommended in the video are:

    Exercise 1: Towel Scrunch

    The towel scrunch exercise strengthens the flexor muscles in the feet, improving balance and improving contact with the ground. To do this exercise, sit on a chair with a towel placed on the floor beneath your toes while keeping your heels on the ground. Use only your toes to pull the towel toward your heel, scrunching it up as much as possible. This movement strengthens the arch of the foot and can help alleviate symptoms of flat feet. For best results, practice this exercise for 2–3 minutes once or twice daily. Once you’ve got the hand of doing it sitting, do it while standing.

    Exercise 2: Big Toe Extension

    Big toe extension is an essential exercise for maintaining foot mobility and improving walking kinesthetics by preventing stiffness in the big toe. To do this exercise, keep your foot flat on the floor and try to lift only your big toe while keeping the four other toes firmly pressed down. To be clear, we mean under its own power; not using your hands to help. Many people find this difficult initially, but it’s due to a loss of neural connection rather than muscle strength, so with practice, the ability to isolate the movement improves quite quickly. Perform 10 repetitions in a row, three times per day, for optimal benefits. Once you’ve got the hand of doing it sitting, do it while standing.

    Exercise 3: Calf Stretch

    The calf stretch is an important exercise for maintaining foot health by preventing tight calves, which can contribute to issues like plantar fasciitis and Morton’s neuroma. To do this stretch, place your hands against a wall for support and extend one leg straight behind you while keeping your other heel firmly on the floor. The front knee should be bent while the back leg remains straight, creating a stretch in the calf. Hold this position for 30 seconds (building up to that, if necessary). Since the effectiveness of stretching comes from frequency rather than duration, this stretch should be performed three to four times per day for the best results.

    For more on each of these, plus visual demonstrations, enjoy:

    Click Here If The Embedded Video Doesn’t Load Automatically!

    Want to learn more?

    You might also like to read:

    Steps For Keeping Your Feet A Healthy Foundation ← this one’s about general habits, not exercises

    Take care!

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  • What’s the difference between shyness and social anxiety?

    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.

    What’s the difference? is a new editorial product that explains the similarities and differences between commonly confused health and medical terms, and why they matter.

    The terms “shyness” and “social anxiety” are often used interchangeably because they both involve feeling uncomfortable in social situations.

    However, feeling shy, or having a shy personality, is not the same as experiencing social anxiety (short for “social anxiety disorder”).

    Here are some of the similarities and differences, and what the distinction means.

    pathdoc/Shutterstock

    How are they similar?

    It can be normal to feel nervous or even stressed in new social situations or when interacting with new people. And everyone differs in how comfortable they feel when interacting with others.

    For people who are shy or socially anxious, social situations can be very uncomfortable, stressful or even threatening. There can be a strong desire to avoid these situations.

    People who are shy or socially anxious may respond with “flight” (by withdrawing from the situation or avoiding it entirely), “freeze” (by detaching themselves or feeling disconnected from their body), or “fawn” (by trying to appease or placate others).

    A complex interaction of biological and environmental factors is also thought to influence the development of shyness and social anxiety.

    For example, both shy children and adults with social anxiety have neural circuits that respond strongly to stressful social situations, such as being excluded or left out.

    People who are shy or socially anxious commonly report physical symptoms of stress in certain situations, or even when anticipating them. These include sweating, blushing, trembling, an increased heart rate or hyperventilation.

    How are they different?

    Social anxiety is a diagnosable mental health condition and is an example of an anxiety disorder.

    For people who struggle with social anxiety, social situations – including social interactions, being observed and performing in front of others – trigger intense fear or anxiety about being judged, criticised or rejected.

    To be diagnosed with social anxiety disorder, social anxiety needs to be persistent (lasting more than six months) and have a significant negative impact on important areas of life such as work, school, relationships, and identity or sense of self.

    Many adults with social anxiety report feeling shy, timid and lacking in confidence when they were a child. However, not all shy children go on to develop social anxiety. Also, feeling shy does not necessarily mean a person meets the criteria for social anxiety disorder.

    People vary in how shy or outgoing they are, depending on where they are, who they are with and how comfortable they feel in the situation. This is particularly true for children, who sometimes appear reserved and shy with strangers and peers, and outgoing with known and trusted adults.

    Individual differences in temperament, personality traits, early childhood experiences, family upbringing and environment, and parenting style, can also influence the extent to which people feel shy across social situations.

    Shy child hiding behind tree
    Not all shy children go on to develop social anxiety. 249 Anurak/Shutterstock

    However, people with social anxiety have overwhelming fears about embarrassing themselves or being negatively judged by others; they experience these fears consistently and across multiple social situations.

    The intensity of this fear or anxiety often leads people to avoid situations. If avoiding a situation is not possible, they may engage in safety behaviours, such as looking at their phone, wearing sunglasses or rehearsing conversation topics.

    The effect social anxiety can have on a person’s life can be far-reaching. It may include low self-esteem, breakdown of friendships or romantic relationships, difficulties pursuing and progressing in a career, and dropping out of study.

    The impact this has on a person’s ability to lead a meaningful and fulfilling life, and the distress this causes, differentiates social anxiety from shyness.

    Children can show similar signs or symptoms of social anxiety to adults. But they may also feel upset and teary, irritable, have temper tantrums, cling to their parents, or refuse to speak in certain situations.

    If left untreated, social anxiety can set children and young people up for a future of missed opportunities, so early intervention is key. With professional and parental support, patience and guidance, children can be taught strategies to overcome social anxiety.

    Why does the distinction matter?

    Social anxiety disorder is a mental health condition that persists for people who do not receive adequate support or treatment.

    Without treatment, it can lead to difficulties in education and at work, and in developing meaningful relationships.

    Receiving a diagnosis of social anxiety disorder can be validating for some people as it recognises the level of distress and that its impact is more intense than shyness.

    A diagnosis can also be an important first step in accessing appropriate, evidence-based treatment.

    Different people have different support needs. However, clinical practice guidelines recommend cognitive-behavioural therapy (a kind of psychological therapy that teaches people practical coping skills). This is often used with exposure therapy (a kind of psychological therapy that helps people face their fears by breaking them down into a series of step-by-step activities). This combination is effective in-person, online and in brief treatments.

    Man working at home with laptop open on lap
    Treatment is available online as well as in-person. ImYanis/Shutterstock

    For more support or further reading

    Online resources about social anxiety include:

    We thank the Black Dog Institute Lived Experience Advisory Network members for providing feedback and input for this article and our research.

    Kayla Steele, Postdoctoral research fellow and clinical psychologist, UNSW Sydney and Jill Newby, Professor, NHMRC Emerging Leader & Clinical Psychologist, UNSW Sydney

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

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  • Fennel vs Onion – 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 fennel to onion, we picked the fennel.

    Why?

    First note, in case you didn’t see the picture: we are talking about white onions here (also called brown onions, by virtue of their attire).

    Looking at the macros, fennel has nearly 2x the fiber and a little more protein, while onion has more carbs. An easy win in this category for the fennel.

    In the category of vitamins, fennel has more of vitamins A, B2, B3, B5, B9, C, E, K, and choline (most of them by generous margins and some by especially large margins, we are talking, for example, 480x the vitamin A, 29x the vitamin E, and 157x the vitamin K), while onions have more of vitmains B1 and B6. Another clear win for fennel.

    When it comes to minerals, fennel has more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc, while onion is not higher in any minerals. No prizes for guessing: fennel wins this category too.

    You may be curious as to how they add up on the polyphenol front, and the answer is, they don’t, much. Wonderful as these two vegetables are, an abundance of polyphenols is not amongst their strengths; fennel has some lignans and onion has some flavonols, but we’re talking tiny numbers here (in contrast, red onion would have aced it with 120mg/100g quercetin, amongst others, but red onion wasn’t on trial today).

    Adding up the sections makes a clear win for fennel today.

    Want to learn more?

    You might like to read:

    What’s Your Plant Diversity Score?

    Take care!

    Don’t Forget…

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  • Eggcellent News Against Dementia?

    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 that time of the week again… We hope all our readers have had a great and healthy week! Here are some selections from health news from around the world:

    Moderation remains key

    Eggs have come under the spotlight for their protective potential against dementia, largely due to their content of omega-3 fatty acids, choline, and other nutrients.

    Nevertheless, the study had some limitations (including not measuring the quantity of eggs consumed, just the frequency), and while eating eggs daily showed the lowest rates of dementia, not eating them at all did not significantly alter the risk.

    Eating more than 2 eggs per day is still not recommended, however, for reasons of increasing the risk of other health issues, such as heart disease.

    Read in full: Could eating eggs prevent dementia?

    Related: Eggs: Nutritional Powerhouse or Heart-Health Timebomb?

    More than suitable

    It’s common for a lot of things to come with the warning “not suitable for those who are pregnant or nursing”, with such frequency that it can be hard to know what one can safely do/take while pregnant or nursing.

    In the case of COVID vaccines, though, nearly 90% of babies who had to be hospitalized with COVID-19 had mothers who didn’t get the vaccine while they were pregnant.

    And as for how common that is: babies too young to be vaccinated (so, under 6 months) had the highest covid hospitalization rate of any age group except people over 75.

    Read in full: Here’s why getting a covid shot during pregnancy is important

    Related: The Truth About Vaccines

    Positive dieting

    Adding things into one’s diet is a lot more fun than taking things out, is generally easier to sustain, and (as a general rule of thumb; there are exceptions of course) give the greatest differences in health outcomes.

    This is perhaps most true of beans and pulses, which add many valuable vitamins, minerals, protein, and perhaps most importantly of all (single biggest factor in reducing heart disease risk), fiber.

    Read in full: Adding beans and pulses can lead to improved shortfall nutrient intakes and a higher diet quality in American adults

    Related: Intuitive Eating Might Not Be What You Think

    Clearing out disordered thinking

    Hoarding is largely driven by fear of loss, and this radical therapy tackles that at the root, by such means as rehearsing alternative outcomes of discarding through imagery rescripting, and examining the barriers to throwing things away—to break down those barriers one at a time.

    Read in full: Hoarding disorder: sensory CBT treatment strategy shows promise

    Related: When You Know What You “Should” Do (But Knowing Isn’t The Problem)

    Superfluous

    Fluoridated water may not be as helpful for the teeth as it used to be prior to about 1975. Not because it became any less effective per se, but because of the modern prevalence of fluoride-containing toothpastes, mouthwashes, etc rendering it redundant in more recent decades.

    Read in full: Dental health benefits of fluoride in water may have declined, study finds

    Related: Water Fluoridation, Atheroma, & More

    Off-label?

    With rising costs of living including rising healthcare costs, and increasing barriers to accessing in-person healthcare, it’s little wonder that many are turning to the gray market online to get their medications.

    These websites typically use legal loopholes to sell prescription drugs to the public, by employing morally flexible doctors who are content to expediently rubber-stamp prescriptions upon request, on the basis of the patient having filled out a web form and checked boxes for their symptoms (and of course also having waived all rights of complaint or legal recourse).

    However, some less scrupulous sorts are exploiting this market, to sell outright fake medications, using a setup that looks like a “legitimate” gray market website. Caveat emptor indeed.

    Read in full: CDC warns of fake drug dangers from online pharmacies

    Related: Are You Taking PIMs? Getting Off The Overmedication Train

    A rising threat

    In 2021 (we promise the paper was published only a few days ago!), the leading causes of death were:

    1. COVID-19
    2. Heart disease
    3. Stroke

    …which latter represented a rising threat, likely in part due to the increase in the aging population.

    Read in full: Stroke remains a leading cause of death globally, with increased risk linked to lifestyle factors

    Related: 6 Signs Of Stroke (One Month In Advance)

    Take care!

    Don’t Forget…

    Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!

    Learn to Age Gracefully

    Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:

  • The Alzheimer’s Gene That Varies By Race & Sex

    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.

    The Alzheimer’s Gene That Varies By Race & Sex

    You probably know that there are important genetic factors that increase or decrease Alzheimer’s Risk. If you’d like a quick refresher before we carry on, here are two previous articles on this topic:

    A Tale of Two Alleles

    It has generally been understood that APOE-ε2 lowers Alzheimer’s disease risk, and APOE-ε4 increases it.

    However, for reasons beyond the scope of this article, research populations for genetic testing are overwhelmingly white. If you, dear reader, are white, you may be thinking “well, I’m white, so this isn’t a problem for me”, you might still want to read on…

    An extensive new study, published days ago, by Dr. Belloy et al., looked at how these correlations held out per race and sex. They found:

    • The “APOE-ε2 lowers; APOE-ε4 increases” dictum held out strongest for white people.
    • In the case of Hispanic people, there was only a small correlation on the APOE-ε4 side of things, and none on the APOE-ε2 side of things per se.
    • East Asians also saw no correlation with regard to APOE-ε2 per se.
    • But! Hispanic and East Asian people had a reduced risk of Alzheimer’s if and only if they had both APOE-ε2 and APOE-ε4.
    • Black people, meanwhile, saw a slight correlation with regard to the protective effect of APOE-ε2, and as for APOE-ε4, if they had any European ancestry, increased European ancestry meant a higher increased risk factor if they had APOE-ε4. African ancestry, on the other hand, had a protective effect, proportional to the overall amount of that ancestry.

    And as for sex…

    • Specifically for white people with the APOE-ε3/ε4 genotype, especially in the age range of 60–70, the genetic risk for Alzheimer’s was highest in women.

    If you’d like to read more and examine the data for yourself:

    APOE Genotype and Alzheimer Disease Risk Across Age, Sex, and Population Ancestry

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