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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Big Think’s #1 Antidote To Aging
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Why This Video Is Important
A lot of what we talk about here at 10almonds is focused on healthy aging. We want you – our lovely readers – to not only live for a long time, but also be healthy enough to enjoy that “long time”.
We’ve talked about anything from Dr. Greger’s eight anti-aging interventions, to the specific benefits of resveratrol or metformin in combatting aging, to even reducing stress-induced aging.
So, why is this video important? It goes beyond just talking about what we know about living longer, but also focuses on how we should live longer; there’s a big difference between living a long life but never leaving your house vs. living a long life beyond your front door.
The Takeaways
The core message that Big Think wants to convey is that our lifestyle is our best bet in slowing the aging process. Our bodies are adaptive systems, responding positively to healthy lifestyle choices. They focus on exercise: regular physical activity increases healthspan, consequently extending lifespan.
A key takeaway is the difference between physical activity and exercise. While any movement counts as physical activity, exercise is a deliberate, health-focused activity. It benefits the brain by releasing growth factors that strengthen critical areas like the hippocampus and prefrontal cortex.
The video encourages embracing physical activity in any form available to you, from gardening to walking. The goal isn’t to hit a specific number of steps but to stay active in a way that suits your lifestyle.
Science may not solve death. Yet. But focusing on maintaining a healthy, functioning state for as long as possible is the real victory in the battle against aging. And, at the moment, exercise seems to be our best bet:
How did you find that video? If you’ve discovered any great videos yourself that you’d like to share with fellow 10almonds readers, then please do email them to us!
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Rebuilding Milo – by Dr. Aaron Horschig
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The author, a doctor of physical therapy, also wrote another book that we reviewed a while ago, “The Squat Bible” (which is also excellent, by the way). This time, it’s all about resistance training in the context of fixing a damaged body.
Resistance training is, of course, very important for general health, especially as we get older. However, it’s easy to do it wrongly and injure oneself, and indeed, if one is carrying some injury and/or chronic pain, it becomes necessary to know how to fix that before continuing—without just giving up on training, because that would be a road to ruin in terms of muscle and bone maintenance.
The book explains all the necessary anatomy, with clear illustrations too. He talks equipment, keeping things simple and practical, letting the reader know which things actually matter in terms of quality, and what things are just unnecessary fanciness and/or counterproductive.
Most of the book is divided into chapters per body part, e.g. back pain, shoulder pain, ankle pain, hip pain, knee pain, etc; what’s going on, and how to fix it to rebuild it stronger.
The style is straightforward and simple, neither overly clinical nor embellished with overly casual fluff. Just, clear simple explanations and instructions.
Bottom line: if you’d like to get stronger and/or level up your resistance training, but are worried about an injury or chronic condition, this book can set you in good order.
Click here to check out Rebuilding Milo, and rebuild yourself!
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What To Leave Off Your Table (To Stay Off This Surgeon’s)
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Why we eat too much (and how we can fix that)
This is Dr. Andrew Jenkinson. He’s a Consultant Surgeon specializing in the treatment of obesity, gallstones, hernias, heartburn and abdominal pain. He runs regular clinics in both London and Dubai. What he has to offer us today, though, is insight as to what’s on our table that puts us on his table, and how we can quite easily change that up.
So, why do we eat too much?
First things first: some metabolic calculations. No, we’re not going to require you to grab a calculator here… Your body does it for you!
Our body’s amazing homeostatic system (the system that does its best to keep us in the “Goldilocks Zone” of all our bodily systems; not too hot or too cold, not dehydrated or overhydrated, not hyperglycemic or hypoglycemic, blood pressure not too high or too low, etc, etc) keeps track of our metabolic input and output.
What this means: if we increase or decrease our caloric consumption, our body will do its best to increase or decrease our metabolism accordingly:
- If we don’t give it enough energy, it will try to conserve energy (first by slowing our activities; eventually by shutting down organs in a last-ditch attempt to save the rest of us)
- If we give it too much energy, it will try to burn it off, and what it can’t burn, it will store
In short: if we eat 10% or 20% more or less than usual, our body will try to use 10% to 20% more or less than usual, accordingly.
So… How does this get out of balance?
The problem is in how our system does that, and how we inadvertently trick it, to our detriment.
For a system to function, it needs at its most base level two things—a sensor and a switch:
- A sensor: to know what’s going on
- A switch: to change what it’s doing accordingly
Now, if we eat the way we’re evolved to—as hunter-gatherers, eating mostly fruit and vegetables, supplemented by animal products when we can get them—then our body knows exactly what it’s eating, and how to respond accordingly.
Furthermore, that kind of food takes some eating! Most fruit these days is mostly water and fiber; in those days it often had denser fiber (before agricultural science made things easier to eat), but either way, our body knows when we are eating fruit and how to handle that. Vegetables, similarly. Unprocessed animal products, again, the gut goes “we know what this is” and responds accordingly.
But modern ultra-processed foods with trans-fatty acids, processed sugar and flour?
These foods zip calories straight into our bloodstream like greased lightning. We get them so quickly so easily and in such great caloric density, that our body doesn’t have the chance to count them on the way in!
What this means is: the body has no idea what it’s just consumed or how much or what to do with it, and doesn’t adjust our metabolism accordingly.
Bottom line:
Evolutionarily speaking, your body has no idea what ultra-processed food is. If you skip it and go for whole foods, you can, within the bounds of reason, eat what you like and your body will handle it by adjusting your metabolism accordingly.
Now, advising you “avoid ultra-processed foods and eat whole foods” was probably not a revelation in and of itself.
But: sometimes knowing a little more about the “why” makes the difference when it comes to motivation.
Want to know more about Dr. Jenkinson’s expert insights on this topic?
If you like, you can check out his website here—he has a book too
Why We Eat (Too Much) – Dr. Andrew Jenkinson on the Science of Appetite
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Superfood Soba Noodle Salad
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This Japanese dish is packed with nutrients and takes very little preparation time, involving only one cooked ingredient, and a healthy one at that!
You will need
- 8 oz dried soba noodles
- ½ bulb garlic, finely chopped
- 2 tbsp avocado oil
- 2 tsp soy sauce
- ¼ cucumber, cut into thin batons (don’t peel it first)
- ½ carrot, grated (don’t peel it first)
- 6 cherry tomatoes, halved (you wouldn’t peel these, right? Please don’t)
- ½ red onion, finely sliced (ok, this one you can peel first! Please do)
- 1 tbsp chia seeds
- 1 tsp crushed red chili flakes
- Garnish: fresh parsley, chopped
Method
(we suggest you read everything at least once before doing anything)
1) Cook the soba noodles (boil in water for 10 mins or until soft). Rinse with cold water (which lowers the glycemic index further, and also we want them cold anyway) and set aside.
2) Make the dressing by blending the garlic, avocado oil, and soy cauce. Set it aside.
3) Assemble the salad by thoroughly but gently mixing the noodles with the cucumber, carrot, tomatoes, and onion. Add the dressing, the chia seeds, and the chili flakes, and toss gently to combine.
4) Serve, adding the parsley garnish.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Rice vs Buckwheat – Which is Healthier? ← soba noodles are made from buckwheat, which by the way is also a good source of rutin, which can strengthen blood vessel walls against damage, reducing the risk of atheroma
- Cucumber Extract Beats Glucosamine & Chondroitin… At 1/135th Of The Dose?!
- Our Top 5 Spices: How Much Is Enough For Benefits?
- Chia: The Tiniest Seeds With The Most Value
Take care!
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Sometimes, Perfect Isn’t Practical!
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝10 AM breakfast is not realistic for most. What’s wrong with 8 AM and Evening me at 6. Don’t quite understand the differentiation.❞
(for reference, this is about our “Breakfasting For Health?” main feature)
It’s not terrible to do it the way you suggest It’s just not optimal, either, that’s all!
Breakfasting at 08:00 and then dining at 18:00 is ten hours apart, so no fasting benefits between those. Let’s say you take half an hour to eat dinner, then eat nothing again until breakfast, that’s 18:30 to 08:00, so that’s 13½ hours fasting. You’ll recall that fasting benefits start at 12 hours into the fast, so that means you’d only get 1½ hours of fasting benefits.
As for breakfasting at 08:00 regardless of intermittent fasting considerations, the reason for the conclusion of around 10:00 being optimal, is based on when our body is geared up to eat breakfast and get the most out of that, which the body can’t do immediately upon waking. So if you wake and get sunlight at 08:30, get a little moderate exercise, then by 10:00 your digestive system will be perfectly primed to get the most out of breakfast.
However! This is entirely based on you waking and getting sunlight at 08:30.
So, iff you wake and get sunlight at 06:30, then in that case, breakfasting at 08:00 would give the same benefits as described above. What’s important is the 1½ hour priming-time.
Writer’s note: our hope here is always to be informational, not prescriptive. Take what works for you; ignore what doesn’t fit your lifestyle.
I personally practice intermittent fasting for about 21hrs/day. I breakfast (often on nuts and perhaps a little salad) around 16:00, and dine at around 18:00ish, giving myself a little wiggleroom. I’m not religious about it and will slide it if necessary.
As you can see: that makes what is nominally my breakfast practically a pre-dinner snack, and I clearly ignore the “best to eat in the morning” rule because that’s not consistent with my desire to have a family dinner together in the evening while still practicing the level of fasting that I prefer.
Science is science, and that’s what we report here. How we apply it, however, is up to us all as individuals!
Enjoy!
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The Blue Zones, Second Edition – by Dan Buettner
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Eat beans & greens, take walks, have a purpose; you can probably list off the top of your head some of the “advices from Blue Zones”, so what makes this book stand out?
This is perhaps one of the most thoughtful investigations; the author (a National Geographic researcher) toured and researched all the Blue Zones, took many many notes (we get details), and asked a lot of questions that others skipped.
For example, a lot of books about the Blue Zones mention the importance of community—but they don’t go into much detail of what that looks like… And they certainly don’t tend to explain what we should do about it.
And that’s because community is often viewed as environmental in a way that we can’t control. If we want to take supplements, eat a certain way, exercise, etc, we can do all those things alone if we want. But if we want community? We’re reliant on other people—and that’s a taboo in the US, and US-influenced places.
So, one way this book excels is in describing how exactly people foster community in the Blue Zones (hint: the big picture—the form of the community—is different in each place, but the individual actions taken are similar), with particular attention to the roles actively taken on by the community elders.
In a similar vein, “reduce stress” is good, but what mindsets and mechanisms do they use that are still reproducible if we are not, for example, Okinawan farmers? Again, Buettner delivers in spades.
Bottom line: this is the Blue Zones book that digs deeper than others, and makes the advices much more applicable no matter where we live.
Click here to check out The Blue Zones, and build these 9 things into your life!
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