Menopause, & When Not To Let Your Guard Down
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This is Dr. Jessica Shepherd, a physician Fellow of the American College of Obstetricians & Gynecologists, CEO at Sanctum Medical & Wellness, and CMO at Hers.
She’s most well-known for her expertise in the field of the menopause. So, what does she want us to know?
Untreated menopause is more serious than most people think
Beyond the famous hot flashes, there’s also the increased osteoporosis risk, which is more well-known at least amongst the health-conscious, but oft-neglected is the increased cardiovascular disease risk:
What Menopause Does To The Heart
…and, which a lot of Dr. Shepherd’s work focuses on, it also increases dementia risk; she cites that 60–80% of dementia cases are women, and it’s also established that it progresses more quickly in women than men too, and this is associated with lower estrogen levels (not a problem for men, because testosterone does it for them) which had previously been a protective factor, but in untreated menopause, was no longer there to help:
Alzheimer’s Sex Differences May Not Be What They Appear
Treated menopause is safer than many people think
The Women’s Health Initiative (WHI) study, conducted in the 90s and published in 2002, linked HRT to breast cancer, causing fear, but it turned out that this was quite bad science in several ways and the reporting was even worse (even the flawed data did not really support the conclusion, much less the headlines); it was since broadly refuted (and in fact, it can be a protective factor, depending on the HRT regimen), but fearmongering headlines made it to mainstream news, whereas “oopsies, never mind, we take that back” didn’t.
The short version of the current state of the science is: breast cancer risk varies depending on age, HRT type, and dosage; some kinds of HRT can increase the risk marginally in those older than 60, but absolute risk is low compared to placebo, and taking estrogen alone can reduce risk at any age in the event of not having a uterus (almost always because of having had a hysterectomy; as a quirk, it is possible to be born without, though).
It’s worth noting that even in the cases where HRT marginally increased the risk of breast cancer, it significantly decreased the risk of cancers in total, as well fractures and all-cause-mortality compared to the placebo group.
In other words, it might be worth having a 0.12% risk of breast cancer, to avoid the >30% risk of osteoporosis, which can ultimately be just as fatal (without even looking at the other things the HRT is protective against).
However! In the case of those who already have (or have had) breast cancer, increasing estrogen levels can indeed make that worse/return, and it becomes more complicated in cases where you haven’t had it, but there is a family history of it, or you otherwise know you have the gene for it.
You can read more about HRT and breast cancer risk (increases and decreases) here:
…and about the same with regard to HMT, here:
The Hormone Therapy That Reduces Breast Cancer Risk & More
Lifestyle matters, and continues to matter
Menopause often receives the following attention from people:
- Perimenopause: “Is this menopause?”
- Menopause: “Ok, choices to make about HRT or not, plus I should watch out for osteoporosis”
- Postmenopause: “Yay, that’s behind me now, back to the new normal”
The reality, Dr. Shepherd advises, is that “postmenopause” is a misnomer because if it’s not being treated, then the changes are continuing to occur in your body.
This is a simple factor of physiology; your body is always rebuilding itself, will never stop until you die, and in untreated menopause+postmenopause, it’s now doing it without much estrogen.
So, you can’t let your guard down!
Thus, she recommends: focus on maintaining muscle mass, bone health, and cardiovascular health. If you focus on those things, the rest (including your brain, which is highly dependent on cardiovascular health) will mostly take care of itself.
Because falls and fractures, particularly hip fractures, drastically reduce quality and length of life in older adults, it is vital to avoid those, and try to be sufficiently robust so that if you do go A over T, you won’t injure yourself too badly, because your bones are strong. As a bonus, the same things (especially that muscle mass we talked about) will help you avoid falling in the first place, by improving stability.
See also: Resistance Is Useful! (Especially As We Get Older)
And about falls specifically: Fall Special: Be Robust, Mobile, & Balanced!
Want to know more from Dr. Shepherd?
You might like this book of hers that we reviewed not long back:
Generation M – by Dr. Jessica Shepherd
Take care!
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Dentists Debunk 15 Teeth Myths
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Dentists Dr. John Yoo and Dr. Jason Lin leave no gaps in the truth:
The tooth, the whole tooth, and nothing but the tooth
Not only is there no tooth fairy (we are shocked), but also…
- “Baby teeth aren’t important.”
False! Baby teeth act as space holders for permanent teeth, affect speech development, and influence a child’s psychological well-being. - “Acidic fruits will whiten your smile.”
False! In any practical sense, anyway: acidic fruits may temporarily make teeth appear whiter by dispersing stains but cause enamel erosion and weaken teeth over time. - “Fillings last forever.”
False! Fillings can wear down, fail, or develop cavities underneath if oral hygiene isn’t maintained, requiring replacement over time. - “Cavities are irreversible.”
False! Cavities in the enamel can be reversed with fluoride and good oral hygiene, but cavities that reach the dentin are typically irreversible. - “Braces are just for crooked teeth.”
False! Braces also correct functional issues like overbites, underbites, crossbites, and prevent future complications like tooth impaction. - “A knocked-out tooth is gone for good.”
False! A knocked-out tooth can be reimplanted if done quickly (ideally within an hour); storing it in whole milk or saliva helps preserve it. - “Diet sodas won’t give you cavities.”
False! Diet sodas can still cause cavities due to their acidic pH, which erodes enamel, even without sugar. - “Dental cleanings aren’t necessary.”
False! Dental cleanings help remove plaque and tartar that regular brushing can’t, and allow for regular oral health checkups. - “Retainers aren’t for life.”
False! To maintain teeth alignment after braces, retainers should be worn long-term as teeth can shift even years later. - “You should floss before brushing.”
False! The order doesn’t matter, but do floss regularly. - “Everyone has wisdom teeth.”
False! Not everyone is born with wisdom teeth; they are the most commonly missing teeth, and not everyone needs them removed. - “Hydrogen peroxide and baking soda are good toothpaste replacements.”
False! While they are common components in toothpaste, they lack fluoride, which is essential for remineralizing and protecting enamel. - “You’re too old to get braces.”
False! There’s no age limit for braces or aligners; adults often seek them for both aesthetic and functional reasons. - “Teeth that have had root canals can’t feel.”
False! Teeth with root canals can’t feel pain from nerves, but you can still sense pressure due to surrounding ligaments. - “You’ll inevitably lose all your teeth when you’re old.”
False! Good oral hygiene and regular dental care can preserve natural teeth into old age, though genetics also play a role.
For more on each of these, enjoy:
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Want to learn more?
You might also like to read:
Take care!
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- “Baby teeth aren’t important.”
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The Food For Life Cookbook – by Dr. Tim Spector
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We’ve previously reviewed Dr. Spector’s “Food For Life”, and while that was more of an “explanatory science” book, this one takes that science (reiterating it more briefly this time, by way of introduction) and makes a cookbook of it.
The nutritional emphasis in these recipes is on two things: maximizing fiber, and maximizing plant diversity. The recipes are not all vegan or even vegetarian, but they are plant-centric, and if the reader is vegetarian/vegan, then substitutions are easy to make.
The recipes themselves are simple without being boring, and are easy to follow, with full-page photos to accompany them. The science parts are very clear, accessible, and pop-science in style.
Bottom line: if you’d like to incorporate more fiber and more plants into your diet without it being a burden, this book is great for that.
Click here to check out the Food For Life Cookbook, and get cooking for life!
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Ozempic Helps People Walk Further
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There’s often a catch-22 when it comes to exercise: it’s important for good health, and/but people with ill health usually cannot exercise much.
A recent (published today, at time of writing, the 29th of March 2025, never let it be said we don’t bring you the very most up-to-date health science!) study by Dr. Neda Rasouli et al. has shown there is a possible way through that catch-22, depending on the nature of the illness.
This study followed 792 people across 112 outpatient clinical trial sites in 20 countries in North America, Asia, and Europe, with type 2 diabetes and peripheral artery disease.
What they found
Patients taking semaglutide (specifically, 1mg Ozempic) enjoyed a 21% median increase in walking distance, as well as some bonus benefits, namely:
- Weight reduction: the semaglutide group saw a greater reduction in body weight (–4.1 kg; P < 0 .0001)
- HbA1c levels: semaglutide lowered HbA1c by 1 percentage point (P < 0.0001)
- Blood pressure: systolic blood pressure decreased by 3.2 mmHg (P = 0.0042)
You may be wondering what that “P =” means: it’s the probability of this occurring by random chance, on a scale from zero (impossible outcome) to 1 (unavoidable outcome).
For example:
“We hypothesized that singing the happy birthday song before tossing a coin would result in it landing on heads. We sang the happy birthday song and tossed the coin; it landed on heads (P = 0.5)”
In science, generally speaking anything with a probability of under 0.05 (expressed as: “P < 0.05”) is considered a statistically significant result.
All this to say, the cited figures of, for example, P < 0.0001, are very significant indeed.
On which note, that 21% median increase in walking distance? P < 0.0004.
As for side effects? Serious adverse events related to the drug occurred in 1% of the semaglutide group vs 2% in the placebo group. So, that seems quite safe indeed.
You can find the paper itself here:
Want to learn more?
Check out:
- The Doctor Who Wants Us To Exercise Less, & Move More
- Walking… Better.
- 5 Ways To Naturally Boost The “Ozempic Effect”
Take care!
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16 Overlooked Autistic Traits In Women
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We hear a lot about “autism moms”, but Taylor Heaton is an autistic mom, diagnosed as an adult, and she has insights to share about overlooked autistic traits in women.
The Traits
- Difficulty navigating romantic relationships: often due to misreading signs
- Difficulty understanding things: including the above, but mostly: difficulty understanding subtext, when people leave things as “surely obvious”. Autistic women are likely to be aware of the possible meanings, but unsure which it might be, and may well guess wrongly.
- Masking: one of the reasons for the gender disparity in diagnosis is that autistic women are often better at “masking”, that is to say, making a conscious effort to blend in to allistic society—often as a result of being more societally pressured to do so.
- Honesty: often to a fault
- Copy and paste: related to masking, this is about consciously mirroring others in an effort to put them at ease and be accepted
- Being labelled sensitive and/or gifted: usually this comes at a young age, but the resultant different treatment can have a lifetime effect
- Secret stims: again related to masking, and again for the same reasons that displaying autistic symptoms is often treated worse in women, autistic women’s stims tend to be more subtle.
- Written communication: autistic women are often more comfortable with the written word than the spoken
- Leadership: autistic women will often gravitate to leadership roles, partly as a survival mechanism
- Gaslighting: oneself, e.g. “If this person did this without that, then I can to” (without taking into account that maybe the circumstances are different, or maybe they actually did lean on crutches that you didn’t know were there, etc).
- Inner dialogue: rich inner dialogue, but unable to express it outwardly—often because of the sheer volume of thoughts per second.
- Fewer female friends: often few friends overall, for that matter, but there’s often a gender imbalance towards male friends, or where there isn’t, towards more masculine friends at least.
- Feeling different: often a matter of feeling one does not meet standard expectations in some fashion
- School: autistic women are often academically successful
- Special interests: often more “socially accepted” interests than autistic men’s.
- Flirting: autistic women are often unsure how to flirt or what to do about it, which can result in simple directness instead
For more details on all of these, enjoy:
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Related reading:
You might like a main feature of ours from not long back:
Miss Diagnosis: Anxiety, ADHD, & Women
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Triple Life Threat – by Donald R. Lyman
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This book takes a similar approach to “How Not To Die” (which we featured previously), but focussed specifically on three things, per the title: chronic pulmonary obstructive disease (CPOD), diabetes (type 2), and Alzheimer’s disease.
Lyman strikes a great balance of being both information-dense and accessible; there’s a lot of reference material in here, and the reader is not assumed to have a lot of medical knowledge—but we’re not patronized either, and this is an informative manual, not a sensationalized scaremongering piece.
All in all… if you have known risk factors for one or more of three diseases this book covers, the information within could well be a lifesaver.
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Turmeric (Curcumin) Dos and Don’ts With Dr. Kim
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Turmeric is a fabulous spice, most well-known for its anti-inflammatory powers; its antioxidant effects benefit all of the body, including the brain. While it fights seemingly everything from arthritis to atherosclerosis to Alzheimer’s and more, it also boosts brain-derived neurotrophic factor, looks after your cardiovascular health, holds back diabetes, reduces the risk of cancer, fights depression, slows aging, and basically does everything short of making you sing well too.
Dr. Leonid Kim goes over the scientific evidence for these, and also talks about some of the practicalities of taking turmeric, and safety considerations.
For the most part, turmeric is very safe even at high doses (up to 8g at least); indeed, at smaller doses (e.g. 500mg) it largely does the same job as non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, with fewer problems.
It also does the job of several antidiabetic medications, by increasing uptake of glucose (thus reducing blood sugar levels) while simultaneously decreasing the glucose secretion from the liver. It does this by regulating the AMPK signalling pathway, just like metformin—while again, being safer.
Dr. Kim also looks at the (good!) evidence for turmeric in managing PCOS and undoing NAFLD; so far, so good.
Dosage: he bids us pay attention whether we’re taking it as turmeric itself or as curcumin standardized extract. The latter is the active compound, and in principle more powerful, but in practice it can get metabolized too quickly and easily—before it can have its desired effect. So, turmeric itself is a very good choice.
Absorption: since we do want it to be absorbed well, though, he does recommend taking it with piperine (as in black pepper).
You may be thinking: isn’t this going to cause the same problem you were just talking about, and cause it to be metabolized too quickly? And the answer is: no! How piperine works is almost the opposite; it protects the curcumin in the turmeric from our digestive enzymes, and thus allows them to get absorbed without being broken down too quickly—thus increasing the bioavailability by slowing the process down.
Lipophilia: no, that’s not a disease (or a fetish), rather it means that curcumin is soluble in fats, so we should take it near in time to a meal that contains at least a tablespoon of oil in total (so if you’re cooking a curry with your turmeric, this need is covered already, for example).
Supplement provenance: he recommends picking a supplement that’s been tested by a reputable 3rd party, as otherwise turmeric can be quite prone to impurities (which can include lead and arsenic, so, not great).
Contraindications: for some people, curcumin can cause gastrointestinal issues (less likely if taking with meals), and also, it can interact with blood-thinners. While taking aspirin or curcumin alone might help avoid circulatory problems, taking both could increase the bleeding risk for some people, for example. Similarly, if taking curcumin and metformin while diabetic, one must watch out for the combination being too effective at lowering blood sugar levels, and thus causing hypoglycemia instead. Similar deal with blood pressure medications.
There’s more in the video though (yes really; we know we wrote a lot but it’s information-dense), so do check it out:
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Want to know more?
You can also check out our related articles:
Why Curcumin (Turmeric) Is Worth Its Weight In Gold
Black Pepper’s Impressive Anti-Cancer Arsenal (And More)Don’t Forget…
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