
Progesterone Menopausal HRT: When, Why, And How To Benefit
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Progesterone doesn’t get talked about as much as other sex hormones, so what’s its deal? Dr. Heather Hirsch explains:
Menopausal progesterone
Dr. Hirsch considers progesterone essential for menopausal women who are taking estrogen and have an intact uterus, to keep conditions at bay such as endometriosis or even uterine cancer.
However, she advises it is not critical in those without a uterus, unless there was a previous case of one of the above conditions.
10almonds addition: on the other hand, progesterone can still be beneficial from a metabolic and body composition standpoint, so do speak with your endocrinologist about it.
As an extra bonus: while not soporific (it won’t make you sleepy), taking progesterone at night will improve the quality of your sleep once you do sleep, so that’s a worthwhile thing for many!
Dr. Hirsch also discusses the merits of continuous vs cyclic use; continuous maintains the above sleep benefits, for example, while cyclic use can help stabilize menstrual patterns in late perimenopause and early menopause.
For more on these things, plus discussion of different types of progesterone, enjoy:
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Want to learn more?
You might also like to read:
- What Does “Balance Your Hormones” Even Mean?
- What You Should Have Been Told About The Menopause Beforehand
- HRT: Bioidentical vs Animal – A Tale Of Two Approaches
Take care!
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Cooking for Longevity – by Nisha Melvani
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Before it gets to the recipes, this book kicks off with a lot of science (much more than is usual for even healthy-eating recipe books), demystifying more nutrients than most people think of on a daily basis, what they do and where to get them, and even how to enhance nutrient absorption.
As well as an up-front ingredients list, we additionally get not just meal planning advice in the usual sense of the word, but also advice on timing various aspects of nutrition in order to enjoy the best metabolic benefits.
The recipes themselves are varied and good. It’s rare to find a recipe book that doesn’t include some redundant recipes, and this one’s no exception, but it’s better to have too much information than too little, so it’s perhaps no bad thing that all potentially necessary bases are covered.
In terms of how well it delivers on the title’s promised “cooking for longevity” and the subtitle’s promised “boosting healthspan”, the science is good; very consistent with what we write here at 10almonds, and well-referenced too.
Bottom line: if you’d like recipes to help you live longer and more healthily, then this book has exactly that.
Click here to check out Cooking For Longevity, and cook for longevity!
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Calm Your Mind with Food – by Dr. Uma Naidoo
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From the author of This Is Your Brain On Food, the psychiatrist-chef (literally, she is a Harvard-trained psychiatrist and an award-winning chef) is back with a more specific work, this time aimed squarely at what it says in the title; how to calm your mind with food.
You may be wondering: does this mean comfort-eating? And, well, not in the sense that term’s usually used. There will be eating and comfort will occur, but the process involves an abundance of nutrients, a minimization of health-deleterious ingredients, and a “for every chemical its task” approach. In other words, very much “nutraceuticals”, as our diet.
On which note: as we’ve come to expect from Dr. Naidoo, we see a lot of hard science presented simply and clearly, with neither undue sensationalization nor unnecessary jargon. We learn about the brain, the gut, relevant biology and chemistry, and build up from understanding ingredients to dietary patterns to having a whole meal plan, complete with recipes.
You may further be wondering: how much does it add that we couldn’t get from the previous book? And the answer is, not necessarily a huge amount, especially if you’re fairly comfortable taking ideas and creating your own path forwards using them. If, on the other hand, you’re a little anxious about doing that (as someone perusing this book may well be), then Dr. Naidoo will cheerfully lead you by the hand through what you need to know and do.
Bottom line: if not being compared to her previous book, this is a great standalone book with a lot of very valuable content. However, the previous book is a tough act to follow! So… All in all we’d recommend this more to people who want to indeed “calm your mind with food”, who haven’t read the other book, as this one will be more specialized for you.
Click here to check out Calm Your Mind With Food, and do just that!
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How To *Really* Pick Up (And Keep!) Those Habits
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The Healthiest Habit-Building
Why was that book “Atomic Habits” called that? It wasn’t just because it’s a catchy title…
Habits are—much like atoms—things that are almost imperceptibly small, yet when stacked, they make up the substance of many much larger and more obvious things, and also contain an immense amount of potential power.
About that power…
Habits are the “compound interest” of natural human life. Every action we take, every decision we make, makes our life (often imperceptibly) better or worse. But getting even just 1% better or 1% worse at something every day? That’s going to not just add up over time… It’ll actively compound over time.
Habits will snowball one way or the other, good or bad. So, we want to control that snowball so that it works for us rather than against us.
Thus, we need to choose habits that are helpful to us, rather than those that are harmful to us. Top examples include:
- Making healthy food choices rather than unhealthy ones
- Moving our body regularly rather than being sedentary
- Having a good bedtime/morning routine rather than a daily chaotic blur
- Learning constantly rather than digging into old beliefs out of habit
- Forging healthy relationships rather than isolating ourselves
We all know that to make a habit stick, we need to practice it regularly, with opinions varying on how long it takes for something to become habit. Some say 21 days; some say 66. The number isn’t the important part!
What is important
You will never get to day 66, much less will you get to day 366, if you don’t first get to day 6 (New Year’s Resolutions, anyone?).
So in the early days especially, when the habit is most likely to get dropped, it’s critical to make the habit as easy as possible to form.
That means:
- The habit should be made as pleasant as possible
- (e.g. by making modifications to it if it’s not already intrinsically pleasant)
- The habit should take under 2 minutes to do at first
- (no matter if it takes longer than 2 minutes to be useful; it’ll never be useful if you don’t first get it to stick, so make your initial commitment only 2 minutes, just to get in the habit)
- The habit should have cues to remind you
- (as it’s not habit yet, you will need to either set a reminder on your phone, or leave a visual reminder, such as your workout clothes laid out ready for you in the morning, or a bowl of fruit in plain view where you spend a lot of time)
What gets measured, gets done
Streaks are a great way to do this. Habit-tracking apps help. Marks on a calendar or in a journal are also totally fine.
What can help especially, and that a lot of people don’t do, is to have a system of regular personal reviews—like a work “performance review”, but for oneself and one’s own life.
Set a reminder or write on the calendar / in your diary, to review monthly, or weekly if you prefer, such things as:
- How am I doing in the areas of life that are important to me?
- Have a list of the areas of life that are important to you, by the way, and genuinely reflect on each of them, e.g:
- Health
- Finances
- Relationships
- Learning
- Sleep
- Etc
- Have a list of the areas of life that are important to you, by the way, and genuinely reflect on each of them, e.g:
- What is working for me, and what isn’t working for me?
- What will I do better in this next month/week?
…and then do it!
Good luck, and may it all stack up in your favor!
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What Happens Every Day When You Quit Sugar For 30 Days
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We all know that sugar isn’t exactly a health food, but it can be hard to quit. How long can cravings be expected to last, and when can we expect to see benefits? Today’s video covers the timeline in a realistic yet inspiring fashion:
What to expect on…
Day 1: expect cravings and withdrawal symptoms including headaches, fatigue, mood swings, and irritability—as well as tiredness, without the crutch of sugar.
Days 2 & 3: more of the same, plus likely objections from the gut, since your Candida albicans content will not be enjoying being starved of its main food source.
Days 4–7: reduction of the above symptoms, better energy levels, improved sleep, and likely the gut will be adapting or have adapted.
Days 8–14: beginning of weight loss, clearer skin, improved complexion; taste buds adapt too, making foods taste sweeter. Continued improvement in energy and focus, as well.
Days 15–21: more of the same improvements, plus the immune system will start getting stronger around now. But watch out, because there may still be some cravings from time to time.
Days 22–30: all of the above positive things, few or no cravings now, and enhanced metabolic health as a whole.
For more specificity on each of these stages, enjoy:
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Want to learn more?
You might also like to read:
The Not-So-Sweet Science Of Sugar Addiction
Take care!
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The Fiber Fueled Cookbook – by Dr. Will Bulsiewicz
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We’ve previously reviewed Dr. Bulsiewicz’s book “Fiber Fuelled” (which is great), but this one is more than just a cookbook with the previous book in mind. Indeed, this is even a great stand-alone book by itself, since it explains the core principles well enough already, and then adds to it.
It’s also about a lot more than just “please eat more fiber”, though. It looks at FODMAPs, purine, histamine intolerance, celiac disease, altered gallbladder function, acid reflux, and more.
He offers a five-part strategy:
Genesis (what is the etiology of your problem)
- Restrict (cut things out to address that first)
- Observe (keep a food/symptom diary)
- Work things back in (re-add potential triggers one by one, see how it goes)
- Train your gut (your microbiome does not exist in a vacuum, and communication is two-way)
- Holistic healing (beyond the gut itself, looking at other relevant factors and aiming for synergistic support)
As for the recipes themselves, there are more than a hundred of them and they are good, so no more “how can I possibly cook [favorite dish] without [removed ingredient]?”
Bottom line: if you’d like better gut health, this book is a top-tier option for fixing existing complaints, and enjoying plain-sailing henceforth.
Click here to check out The Fiber Fueled Cookbook; your gut will thank you later!
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A New $16,000 Postpartum Depression Drug Is Here. How Will Insurers Handle It?
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A much-awaited treatment for postpartum depression, zuranolone, hit the market in December, promising an accessible and fast-acting medication for a debilitating illness. But most private health insurers have yet to publish criteria for when they will cover it, according to a new analysis of insurance policies.
The lack of guidance could limit use of the drug, which is both novel — it targets hormone function to relieve symptoms instead of the brain’s serotonin system, as typical antidepressants do — and expensive, at $15,900 for the 14-day pill regimen.
Lawyers, advocates, and regulators are watching closely to see how insurance companies will shape policies for zuranolone because of how some handled its predecessor, an intravenous form of the same drug called brexanolone, which came on the market in 2019. Many insurers required patients to try other, cheaper medications first — known as the fail-first approach — before they could be approved for brexanolone, which was shown in early trials reviewed by the FDA to provide relief within days. Typical antidepressants take four to six weeks to take effect.
“We’ll have to see if insurers cover this drug and what fail-first requirements they put in” for zuranolone, said Meiram Bendat, a licensed psychotherapist and an attorney who represents patients.
Most health plans have yet to issue any guidelines for zuranolone, and maternal health advocates worry that the few that have are taking a restrictive approach. Some policies require that patients first try and fail a standard antidepressant before the insurer will pay for zuranolone.
In other cases, guidelines require psychiatrists to prescribe it, rather than obstetricians, potentially delaying treatment since OB-GYN practitioners are usually the first medical providers to see signs of postpartum depression.
Advocates are most worried about the lack of coverage guidance.
“If you don’t have a published policy, there is going to be more variation in decision-making that isn’t fair and is less efficient. Transparency is really important,” said Joy Burkhard, executive director of the nonprofit Policy Center for Maternal Mental Health, which commissioned the study.
With brexanolone, which was priced at $34,000 for the three-day infusion, California’s largest insurer, Kaiser Permanente, had such rigorous criteria for prescribing it that experts said the policy amounted to a blanket denial for all patients, according to an NPR investigation in 2021.
KP’s written guidelines required patients to try and fail four medications and electroconvulsive therapy before they would be eligible for brexanolone. Because the drug was approved only for up to six months postpartum, and trials of typical antidepressants take four to six weeks each, the clock would run out before a patient had time to try brexanolone.
An analysis by NPR of a dozen other health plans at the time showed Kaiser Permanente’s policy on brexanolone to be an outlier. Some did require that patients fail one or two other drugs first, but KP was the only one that recommended four.
Miriam McDonald, who developed severe postpartum depression and suicidal ideation after giving birth in late 2019, battled Kaiser Permanente for more than a year to find effective treatment. Her doctors put her on a merry-go-round of medications that didn’t work and often carried unbearable side effects, she said. Her doctors refused to prescribe brexanolone, the only FDA-approved medication specifically for postpartum depression at the time.
“No woman should suffer like I did after having a child,” McDonald said. “The policy was completely unfair. I was in purgatory.”
One month after NPR published its investigation, KP overhauled its criteria to recommend that women try just one medication before becoming eligible for brexanolone.
Then, in March 2023, after the federal Department of Labor launched an investigation into the insurer — citing NPR’s reporting — the insurer revised its brexanolone guidelines again, removing all fail-first recommendations, according to internal documents recently obtained by NPR. Patients need only decline a trial of another medication.
“Since brexanolone was first approved for use, more experience and research have added to information about its efficacy and safety,” the insurer said in a statement. “Kaiser Permanente is committed to ensuring brexanolone is available when physicians and patients determine it is an appropriate treatment.”
“Kaiser basically went from having the most restrictive policy to the most robust,” said Burkhard of the Policy Center for Maternal Mental Health. “It’s now a gold standard for the rest of the industry.”
McDonald is hopeful that her willingness to speak out and the subsequent regulatory actions and policy changes for brexanolone will lead Kaiser Permanente and other health plans to set patient-friendly policies for zuranolone.
“This will prevent other women from having to go through a year of depression to find something that works,” she said.
Clinicians were excited when the FDA approved zuranolone last August, believing the pill form, taken once a day at home over two weeks, will be more accessible to women compared with the three-day hospital stay for the IV infusion. Many perinatal psychiatrists told NPR it is imperative to treat postpartum depression as quickly as possible to avoid negative effects, including cognitive and social problems in the baby, anxiety or depression in the father or partner, or the death of the mother to suicide, which accounts for up to 20% of maternal deaths.
So far, only one of the country’s six largest private insurers, Centene, has set a policy for zuranolone. It is unclear what criteria KP will set for the new pill. California’s Medicaid program, known as Medi-Cal, has not yet established coverage criteria.
Insurers’ policies for zuranolone will be written at a time when the regulatory environment around mental health treatment is shifting. The U.S. Department of Labor is cracking down on violations of the Mental Health Parity and Addiction Equity Act of 2008, which requires insurers to cover psychiatric treatments the same as physical treatments.
Insurers must now comply with stricter reporting and auditing requirements intended to increase patient access to mental health care, which advocates hope will compel health plans to be more careful about the policies they write in the first place.
In California, insurers must also comply with an even broader state mental health parity law from 2021, which requires them to use clinically based, expert-recognized criteria and guidelines in making medical decisions. The law was designed to limit arbitrary or cost-driven denials for mental health treatments and has been hailed as a model for the rest of the country. Much-anticipated regulations for the law are expected to be released this spring and could offer further guidance for insurers in California setting policies for zuranolone.
In the meantime, Burkhard said, patients suffering from postpartum depression should not hold back from asking their doctors about zuranolone. Insurers can still grant access to the drug on a case-by-case basis before they formalize their coverage criteria.
“Providers shouldn’t be deterred from prescribing zuranolone,” Burkhard said.
This article is from a partnership that includes KQED, NPR and KFF Health News.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
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