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
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:
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!
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Eggs: Nutritional Powerhouse or Heart-Health Timebomb?
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Eggs: All Things In Moderation?
We asked you for your (health-related) opinion on eggs. We specified that, for the sake of simplicity, let’s say that they are from happy healthy backyard hens who enjoy a good diet.
Apparently this one wasn’t as controversial as it might have been! We (for myth-busting purposes) try to pick something polarizing and sometimes even contentious for our Friday editions, and pick apart what science lies underneath public perceptions.
However, more than half (in fact, 60%) of the subscribers who voted in the poll voted for “Eggs are nutritionally beneficial as part of a balanced diet”, which very moderate statement is indeed pretty much the global scientific consensus.
Still, we’ve a main feature to write, so let’s look at the science, and what the other 40% had in mind:
Eggs are ruinous to health, especially cardiometabolic health: True or False?
False, per best current science, anyway!
Scientific consensus has changed over the years. We learned about cholesterol, then we learned about different types of cholesterol, and now we’ve even learned about in some instances even elevated levels of “bad” cholesterol aren’t necessarily a cause of cardiometabolic disorders so much as a symptom—especially in women.
Not to derail this main feature about eggs (rather than just cholesterol), but for those who missed it, this is actually really interesting: basically, research (pertaining to the use of statins) has found that in women, higher LDL levels aren’t anywhere near the same kind of risk factor as they are for men, and thus may mean that statins (whose main job is reducing LDL) may be much less helpful for women than for men, and more likely to cause unwanted serious side effects in women.
Check out our previous main feature about this: Statins: His & Hers?
But, for back on topic, several large studies (totalling 177,000 people in long-term studies in 50 countries) found:
❝Results from the three cohorts and from the updated meta-analysis show that moderate egg consumption (up to one egg per day) is not associated with cardiovascular disease risk overall, and is associated with potentially lower cardiovascular disease risk in Asian populations.❞
Egg whites are healthy (protein); egg yolks are not (cholesterol): True or False?
True and False, respectively. That is to say, egg whites are healthy (protein), and egg yolks are also healthy (many nutrients).
We talked a bit already about cholesterol, so we’ll not rehash that here. As to the rest:
Eggs are one of the most nutritionally dense foods around. After all, they have everything required to allow a cluster of cells to become a whole baby chick. That’s a lot of body-building!
They’re even more nutritionally heavy-hitters if you get omega-3 enriched eggs, which means the hens were fed extra omega-3, usually in the form of flax seeds.
Also, free-range is better healthwise than others. Do bear in mind that unless they really are from your backyard, or a neighbor’s, chances are that the reality is not what the advertising depicts, though. There are industry minimum standards to be able to advertise as “free-range”, and those standards are a) quite low b) often ignored, because an occasional fine is cheaper than maintaining good conditions.
So if you can look after your own hens, or get them from somewhere that you can see for yourself how they are looked after, so much the better!
Check out the differences side-by-side, though:
Pastured vs Omega-3 vs “Conventional” Eggs: What’s the Difference?
Stallone-style 12-egg smoothies are healthy: True or False?
False, at least if taken with any regularity. One can indeed have too much of a good thing.
So, what’s the “right amount” to eat?
It may vary depending on individual factors (including age and ethnicity), but a good average, according to science, is to keep it to 3 eggs or fewer per day. There are a lot of studies, but we only have so much room here, so we’ll pick one. Its findings are representative of (and in keeping with) the many other studies we looked at, so this seems uncontroversial scientifically:
❝Intake of 1 egg/d was sufficient to increase HDL function and large-LDL particle concentration; however, intake of 2-3 eggs/d supported greater improvements in HDL function as well as increased plasma carotenoids. Overall, intake of ≤3 eggs/d favored a less atherogenic LDL particle profile, improved HDL function, and increased plasma antioxidants in young, healthy adults.❞
Enjoy!
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Ayurveda’s Contributions To Science
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Ayurveda’s Contributions To Science (Without Being Itself Rooted in Scientific Method)
Yesterday, we asked you for your opinions on ayurveda, and got the above-depicted, below-described, set of responses. Of those who responded…
- A little over 41% said “I don’t know what ayurveda is without looking it up”
- A little over 37% said “It is a fine branch of health science with millennia of evidence”
- A little over 16% said “It gets some things right, but not by actual science”
- A little over 4% said “It is a potentially dangerous pseudoscience”
So, what does the science say?
Ayurveda is scientific: True or False?
False, simply. Let’s just rip the band-aid off in this case. That doesn’t mean it’s necessarily without merit, though!
Let’s put it this way:
- If you drink coffee to feel more awake because scientific method has discerned that caffeine has vasoconstrictive and adenosine-blocking effects while also promoting dopaminergic activity, then your consumption of coffee is evidence-based and scientific. Great!
- If you drink coffee to feel more awake because somebody told you that that somebody told them that it energizes you by balancing the elements fire (the heat of the coffee), air (the little bubbles on top), earth (the coffee grinds), water (the water), and ether (steam), then that isneither evidence-based nor scientific, but it will still work exactly the same.
Ayurveda is a little like that. It’s an ancient traditional Indian medicine, based on a combination of anecdotal evidence and supposition.
- The anecdotal evidence from ayurveda has often resulted in herbal remedies that, in modern scientific trials, have been found to have merit.
- Ayurvedic meditative practices also have a large overlap with modern mindfulness practices, and have also been found to have merit
- Ayurveda also promotes the practice of yoga, which is indeed a very healthful activity
- The supposition from ayurveda is based largely in those five elements we mentioned above, as well as a “balancing of humors” comparable to medieval European medicine, and from a scientific perspective, is simply a hypothesis with no evidence to support it.
Note: while ayurveda is commonly described as a science by its practitioners in the modern age, it did not originally claim to be scientific, but rather, wisdom handed down directly by the god Dhanvantari.
Ayurveda gets some things right: True or False?
True! Indeed, we covered some before in 10almonds; you may remember:
Bacopa Monnieri: A Well-Evidenced Cognitive Enhancer
(Bacopa monnieri is also known by its name in ayurveda, brahmi)
There are many other herbs that have made their way from ayurveda into modern science, but the above is a stand-out example. Others include:
- Ashwagandha: The Root of All Even-Mindedness?
- Boswellia serrata (Frankincense) Against Pain and Depression/Anxiety
Yoga and meditation are also great, and not only that, but great by science, for example:
- NCCIH | Yoga for Health: Clinical Guidelines, Scientific Literature, Info for Patients
- The Neuroscience of Mindfulness: How Mindfulness Alters the Brain and Facilitates Emotion Regulation
Ayurveda is a potentially dangerous pseudoscience: True or False?
Also True! We covered why it’s a pseudoscience above, but that doesn’t make it potentially dangerous, per se (you’ll remember our coffee example).
What does, however, make it potentially dangerous (dose-dependent) is its use of heavy metals such as lead, mercury, and arsenic:
Heavy Metal Content of Ayurvedic Herbal Medicine Products
Some final thoughts…
Want to learn more about the sometimes beneficial, sometimes uneasy relationship between ayurveda and modern science?
A lot of scholarly articles trying to bridge (or further separate) the two were very biased one way or the other.
Instead, here’s one that’s reasonably optimistic with regard to ayurveda’s potential for good, while being realistic about how it currently stands:
Development of Ayurveda—Tradition to trend
Take care!
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Can a drug like Ozempic help treat addictions to alcohol, opioids or other substances?
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Semaglutide (sold as Ozempic, Wegovy and Rybelsus) was initially developed to treat diabetes. It works by stimulating the production of insulin to keep blood sugar levels in check.
This type of drug is increasingly being prescribed for weight loss, despite the fact it was initially approved for another purpose. Recently, there has been growing interest in another possible use: to treat addiction.
Anecdotal reports from patients taking semaglutide for weight loss suggest it reduces their appetite and craving for food, but surprisingly, it also may reduce their desire to drink alcohol, smoke cigarettes or take other drugs.
But does the research evidence back this up?
Animal studies show positive results
Semaglutide works on glucagon-like peptide-1 receptors and is known as a “GLP-1 agonist”.
Animal studies in rodents and monkeys have been overwhelmingly positive. Studies suggest GLP-1 agonists can reduce drug consumption and the rewarding value of drugs, including alcohol, nicotine, cocaine and opioids.
Out team has reviewed the evidence and found more than 30 different pre-clinical studies have been conducted. The majority show positive results in reducing drug and alcohol consumption or cravings. More than half of these studies focus specifically on alcohol use.
However, translating research evidence from animal models to people living with addiction is challenging. Although these results are promising, it’s still too early to tell if it will be safe and effective in humans with alcohol use disorder, nicotine addiction or another drug dependence.
What about research in humans?
Research findings are mixed in human studies.
Only one large randomised controlled trial has been conducted so far on alcohol. This study of 127 people found no difference between exenatide (a GLP-1 agonist) and placebo (a sham treatment) in reducing alcohol use or heavy drinking over 26 weeks.
In fact, everyone in the study reduced their drinking, both people on active medication and in the placebo group.
However, the authors conducted further analyses to examine changes in drinking in relation to weight. They found there was a reduction in drinking for people who had both alcohol use problems and obesity.
For people who started at a normal weight (BMI less than 30), despite initial reductions in drinking, they observed a rebound increase in levels of heavy drinking after four weeks of medication, with an overall increase in heavy drinking days relative to those who took the placebo.
There were no differences between groups for other measures of drinking, such as cravings.
Some studies show a rebound increase in levels of heavy drinking. Deman/Shutterstock In another 12-week trial, researchers found the GLP-1 agonist dulaglutide did not help to reduce smoking.
However, people receiving GLP-1 agonist dulaglutide drank 29% less alcohol than those on the placebo. Over 90% of people in this study also had obesity.
Smaller studies have looked at GLP-1 agonists short-term for cocaine and opioids, with mixed results.
There are currently many other clinical studies of GLP-1 agonists and alcohol and other addictive disorders underway.
While we await findings from bigger studies, it’s difficult to interpret the conflicting results. These differences in treatment response may come from individual differences that affect addiction, including physical and mental health problems.
Larger studies in broader populations of people will tell us more about whether GLP-1 agonists will work for addiction, and if so, for whom.
How might these drugs work for addiction?
The exact way GLP-1 agonists act are not yet well understood, however in addition to reducing consumption (of food or drugs), they also may reduce cravings.
Animal studies show GLP-1 agonists reduce craving for cocaine and opioids.
This may involve a key are of the brain reward circuit, the ventral striatum, with experimenters showing if they directly administer GLP-1 agonists into this region, rats show reduced “craving” for oxycodone or cocaine, possibly through reducing drug-induced dopamine release.
Using human brain imaging, experimenters can elicit craving by showing images (cues) associated with alcohol. The GLP-1 agonist exenatide reduced brain activity in response to an alcohol cue. Researchers saw reduced brain activity in the ventral striatum and septal areas of the brain, which connect to regions that regulate emotion, like the amygdala.
In studies in humans, it remains unclear whether GLP-1 agonists act directly to reduce cravings for alcohol or other drugs. This needs to be directly assessed in future research, alongside any reductions in use.
Are these drugs safe to use for addiction?
Overall, GLP-1 agonists have been shown to be relatively safe in healthy adults, and in people with diabetes or obesity. However side effects do include nausea, digestive troubles and headaches.
And while some people are OK with losing weight as a side effect, others aren’t. If someone is already underweight, for example, this drug might not be suitable for them.
In addition, very few studies have been conducted in people with addictive disorders. Yet some side effects may be more of an issue in people with addiction. Recent research, for instance, points to a rare risk of pancreatitis associated with GLP-1 agonists, and people with alcohol use problems already have a higher risk of this disorder.
Other drugs treatments are currently available
Although emerging research on GLP-1 agonists for addiction is an exciting development, much more research needs to be done to know the risks and benefits of these GLP-1 agonists for people living with addiction.
In the meantime, existing effective medications for addiction remain under-prescribed. Only about 3% of Australians with alcohol dependence, for example, are prescribed medication treatments such as like naltrexone, acamprosate or disulfiram. We need to ensure current medication treatments are accessible and health providers know how to prescribe them.
Continued innovation in addiction treatment is also essential. Our team is leading research towards other individualised and effective medications for alcohol dependence, while others are investigating treatments for nicotine addiction and other drug dependence.
Read the other articles in The Conversation’s Ozempic series here.
Shalini Arunogiri, Addiction Psychiatrist, Associate Professor, Monash University; Leigh Walker, , Florey Institute of Neuroscience and Mental Health, and Roberta Anversa, , The University of Melbourne
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Teriyaki Chickpea Burgers
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Burgers are often not considered the healthiest food, but they can be! Ok, so the teriyaki sauce component itself isn’t the healthiest, but the rest of this recipe is, and with all the fiber this contains, it’s a net positive healthwise, even before considering the protein, vitamins, minerals, and assorted phytonutrients.
You will need
- 2 cans chickpeas, drained and rinsed (or 2 cups of chickpeas, cooked drained and rinsed)
- ¼ cup chickpea flour (also called gram flour or garbanzo bean flour)
- ¼ cup teriyaki sauce
- 2 tbsp almond butter (if allergic, substitute with a seed butter if available, or else just omit; do not substitute with actual butter—it will not work)
- ½ bulb garlic, minced
- 1 large chili, minced (your choice what kind, color, or even whether or multiply it)
- 1 large shallot, minced
- 1″ piece of ginger, grated
- 2 tsp teriyaki sauce (we’re listing this separately from the ¼ cup above as that’ll be used differently)
- 1 tsp yeast extract (even if you don’t like it; trust us, it’ll work—this writer doesn’t like it either but uses it regularly in recipes like these)
- 1 tbsp black pepper
- 1 tsp fennel powder
- ½ tsp sweet cinnamon
- ½ tsp MSG or 1 tsp low-sodium salt
- Extra virgin olive oil for frying
For serving:
- Burger buns (you can use our Delicious Quinoa Avocado Bread recipe)
- Whatever else you want in there; we recommend mung bean sprouts, red onion, and a nice coleslaw
Method
(we suggest you read everything at least once before doing anything)
1) Preheat the oven to 400℉ / 200℃.
2) Roast the chickpeas spaced out on a baking tray (lined with baking paper) for about 15 minutes. Leave the oven on afterwards; we still need it.
3) While that’s happening, heat a little oil in a skillet to a medium heat and fry the shallot, chili, garlic, and ginger, for about 2–3 minutes. You want to release the flavors, but not destroy them.
4) Let them cool, and when the chickpeas are done, let them cool for a few minutes too, before putting them all into a food processor along with the rest of the ingredients from the main section, except the oil and the ¼ cup teriyaki sauce. Process them into a dough.
5) Form the dough into patties; you should have enough dough for 4–6 patties depending on how big you want them.
6) Brush them with the teriyaki sauce; turn them onto a baking tray (lined with baking paper) and brush the other side too. Be generous.
7) Bake them for about 15 minutes, turn them (taking the opportunity to add more teriyaki sauce if it seems to merit it) and bake for another 5–10 minutes.
8) Assemble; we recommend the order: bun, a little coleslaw, burger, red onion, more coleslaw, mung bean sprouts, bun, but follow your heart!
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Three Daily Servings of Beans/Legumes?
- Hoisin Sauce vs Teriyaki Sauce – Which is Healthier?
- Sprout Your Seeds, Grains, Beans, Etc
- Our Top 5 Spices: How Much Is Enough For Benefits? ← we scored 4/5 today!
- Monosodium Glutamate: Sinless Flavor-Enhancer Or Terrible Health Risk?
Take care!
Don’t Forget…
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How to Read a Book – by Mortimer J. Adler and Charles Van Doren
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Are you a cover-to-cover person, or a dip-in-and-out person?
Mortimer Adler and Charles van Doren have made a science out of getting the most from reading books.
They help you find what you’re looking for (Maybe you want to find a better understanding of PCOS… maybe you want to find the definition of “heuristics”… maybe you want to find a new business strategy… maybe you want to find a romantic escape… maybe you want to find a deeper appreciation of 19th century poetry, maybe you want to find… etc).
They then help you retain what you read, and make sure that you don’t miss a trick.
Whether you read books so often that optimizing this is of huge value for you, or so rarely that when you do, you want to make it count, this book could make a real difference to your reading experience forever after.
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The Diet Compass – by Bas Kast
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Facts about nutrition and health can be hard to memorize. There’s just so much! And often there are so many studies, and while the science is not usually contradictory, pop-science headlines sure can be. What to believe?
Bas Kast brings us a very comprehensive and easily digestible solution.
A science journalist himself, he has gone through the studies so that you don’t have to, and—citing them along the way—draws out the salient points and conclusions.
But, he’s not just handing out directions (though he does that too); he’s arranged and formatted the information in a very readable and logical fashion. Chapter by chapter, we learn the foundations of important principles for “this is better than that” choices in diet.
Most importantly, he lays out for us his “12 simple rules for healthy eating“, and they are indeed as simple as they are well-grounded in good science.
Bottom line: if you want “one easy-reading book” to just tell you how to make decisions about your diet, simply follow those rules and enjoy the benefits… Then this book is exactly that.
Click here to check out The Diet Compass and get your diet on the right track!
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