When Science Brings Hope
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There’s a lot of bad news out there at present, including in the field of healthcare. So as some measure of respite from that, here’s some good news from the world of health science, including some actionable things to do:
Run for your life! Or casually meander for your life; that’s fine too.
Those who enjoy the equivalent of an average of 160mins slow (3mph) walking per day also enjoy the greatest healthspan. Now, there may be an element of two-way causality here (moving more means we live longer, but also, sometimes people move less because of having crippling disabilities, which are themselves not great for healthspan, as well as having the knock-on effect of reducing movement, and so such conditions yield and anti-longevity double-whammy), but for any who are able to, increasing the amount of time per day spend moving, ultimately results (on average) in a lot of extra days in life that we’ll then get to spend moving.
Depending on how active or not you are already, every extra 1 hour walked could add two hours and 49 minutes to life expectancy:
Read in full: Americans over 40 could live extra 5 years if they were all as active as top 25% of population, modeling study suggests
Related: The Doctor Who Wants Us To Exercise Less & Move More
Re-teaching your brain to heal itself
Cancer is often difficult to treat, and brain tumors can be amongst the most difficult with which to contend. Not only is everything in there very delicate, but also it’s the hardest place in the body to get at—not just surgically, but even chemically, because of the blood-brain barrier. To make matters worse, brain tumors such as glioblastoma weaken the function of T-cells (whose job it is to eliminate the cancer) by prolonged exposure.
Research has found a way to restore the responsiveness of these T-cells to immune checkpoint inhibitors, allowing them to go about their cancer-killing activities unimpeded:
Read in full: New possibilities for treating intractable brain tumors unveiled
Related: 5 Ways To Beat Cancer (And Other Diseases)
Here’s to your good health!
GLP-1 receptor agonists, originally developed to fight diabetes and now enjoying popularity as weight loss adjuvants, work in large part by cutting down food cravings by interfering with the chemical messaging about such.
As a bonus, it seems that they also can reduce alcohol cravings, especially by targetting the brain’s reward center; this was based on a large review of studies looking at how GLP-1RA use affects alcohol use, alcohol-related health problems, hospital visits, and brain reactions to alcohol cues:
Read in full: Diabetes medication may be effective in helping people drink less alcohol, research finds
Related: How To Reduce Or Quit Alcohol
Take care!
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A person in Texas caught bird flu after mixing with dairy cattle. Should we be worried?
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The United States’ Centers for Disease Control and Prevention (CDC) has issued a health alert after the first case of H5N1 avian influenza, or bird flu, seemingly spread from a cow to a human.
A farm worker in Texas contracted the virus amid an outbreak in dairy cattle. This is the second human case in the US; a poultry worker tested positive in Colorado in 2022.
The virus strain identified in the Texan farm worker is not readily transmissible between humans and therefore not a pandemic threat. But it’s a significant development nonetheless.
Some background on bird flu
There are two types of avian influenza: highly pathogenic or low pathogenic, based on the level of disease the strain causes in birds. H5N1 is a highly pathogenic avian influenza.
H5N1 first emerged in 1997 in Hong Kong and then China in 2003, spreading through wild bird migration and poultry trading. It has caused periodic epidemics in poultry farms, with occasional human cases.
Influenza A viruses such as H5N1 are further divided into variants, called clades. The unique variant causing the current epidemic is H5N1 clade 2.3.4.4b, which emerged in late 2020 and is now widespread globally, especially in the Americas.
In the past, outbreaks could be controlled by culling of infected birds, and H5N1 would die down for a while. But this has become increasingly difficult due to escalating outbreaks since 2021.
Wild animals are now in the mix
Waterfowl (ducks, swans and geese) are the main global spreaders of avian flu, as they migrate across the world via specific routes that bypass Australia. The main hub for waterfowl to migrate around the world is Quinghai lake in China.
But there’s been an increasing number of infected non-waterfowl birds, such as true thrushes and raptors, which use different flyways. Worryingly, the infection has spread to Antarctica too, which means Australia is now at risk from different bird species which fly here.
H5N1 has escalated in an unprecedented fashion since 2021, and an increasing number of mammals including sea lions, goats, red foxes, coyotes, even domestic dogs and cats have become infected around the world.
Wild animals like red foxes which live in peri-urban areas are a possible new route of spread to farms, domestic pets and humans.
Dairy cows and goats have now become infected with H5N1 in at least 17 farms across seven US states.
What are the symptoms?
Globally, there have been 14 cases of H5N1 clade 2.3.4.4b virus in humans, and 889 H5N1 human cases overall since 2003.
Previous human cases have presented with a severe respiratory illness, but H5N1 2.3.4.4b is causing illness affecting other organs too, like the brain, eyes and liver.
For example, more recent cases have developed neurological complications including seizures, organ failure and stroke. It’s been estimated that around half of people infected with H5N1 will die.
The case in the Texan farm worker appears to be mild. This person presented with conjunctivitis, which is unusual.
Food safety
Contact with sick poultry is a key risk factor for human infection. Likewise, the farm worker in Texas was likely in close contact with the infected cattle.
The CDC advises pasteurised milk and well cooked eggs are safe. However, handling of infected meat or eggs in the process of cooking, or drinking unpasteurised milk, may pose a risk.
Although there’s no H5N1 in Australian poultry or cattle, hygienic food practices are always a good idea, as raw milk or poorly cooked meat, eggs or poultry can be contaminated with microbes such as salmonella and E Coli.
If it’s not a pandemic, why are we worried?
Scientists have feared avian influenza may cause a pandemic since about 2005. Avian flu viruses don’t easily spread in humans. But if an avian virus mutates to spread in humans, it can cause a pandemic.
One concern is if birds were to infect an animal like a pig, this acts as a genetic mixing vessel. In areas where humans and livestock exist in close proximity, for example farms, markets or even in homes with backyard poultry, the probability of bird and human flu strains mixing and mutating to cause a new pandemic strain is higher.
There are a number of potential pathways to a pandemic caused by influenza. Author provided The cows infected in Texas were tested because farmers noticed they were producing less milk. If beef cattle are similarly affected, it may not be as easily identified, and the economic loss to farmers may be a disincentive to test or report infections.
How can we prevent a pandemic?
For now there is no spread of H5N1 between humans, so there’s no immediate risk of a pandemic.
However, we now have unprecedented and persistent infection with H5N1 clade 2.3.4.4b in farms, wild animals and a wider range of wild birds than ever before, creating more chances for H5N1 to mutate and cause a pandemic.
Unlike the previous epidemiology of avian flu, where hot spots were in Asia, the new hot spots (and likely sites of emergence of a pandemic) are in the Americas, Europe or in Africa.
Pandemics grow exponentially, so early warnings for animal and human outbreaks are crucial. We can monitor infections using surveillance tools such as our EPIWATCH platform.
The earlier epidemics can be detected, the better the chance of stamping them out and rapidly developing vaccines.
Although there is a vaccine for birds, it has been largely avoided until recently because it’s only partially effective and can mask outbreaks. But it’s no longer feasible to control an outbreak by culling infected birds, so some countries like France began vaccinating poultry in 2023.
For humans, seasonal flu vaccines may provide a small amount of cross-protection, but for the best protection, vaccines need to be matched exactly to the pandemic strain, and this takes time. The 2009 flu pandemic started in May in Australia, but the vaccines were available in September, after the pandemic peak.
To reduce the risk of a pandemic, we must identify how H5N1 is spreading to so many mammalian species, what new wild bird pathways pose a risk, and monitor for early signs of outbreaks and illness in animals, birds and humans. Economic compensation for farmers is also crucial to ensure we detect all outbreaks and avoid compromising the food supply.
C Raina MacIntyre, Professor of Global Biosecurity, NHMRC L3 Research Fellow, Head, Biosecurity Program, Kirby Institute, UNSW Sydney; Ashley Quigley, Senior Research Associate, Global Biosecurity, UNSW Sydney; Haley Stone, PhD Candidate, Biosecurity Program, Kirby Institute, UNSW Sydney; Matthew Scotch, Associate Dean of Research and Professor of Biomedical Informatics, College of Health Solutions, Arizona State University, and Rebecca Dawson, Research Associate, The Kirby Institute, UNSW Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Gut Health for Women – by Aurora Bloom
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First things first: though the title says “For Women”, almost all of it applies to men too—and the things that don’t apply, don’t cause a problem. So if you’re cooking for your family that contains one or more men, this is still great.
Bloom gives us a good, simple, practical introduction to gut health. Her overview also covers gut-related ailments beyond the obvious “tummy hurts”. On which note:
A very valuable section of this book covers dealing with any stomach-upsets that do occur… without harming your trillions of tiny friends (friendly gut microbiota). This alone can make a big difference!
The book does of course also cover the things you’d most expect: things to eat or avoid. But it goes beyond that, looking at optimizing and maintaining your gut health. It’s not just dietary advice here, because the gut affects—and is affected by—other lifestyle factors too. Ranges from mindful eating, to a synchronous sleep schedule, to what kinds of exercise are best to keep your gut ticking over nicely.
There’s also a two-week meal plan, and an extensive appendix of resources, not to mention a lengthy bibliography for sourcing health claims (and suggesting further reading).
In short, a fine and well-written guide to optimizing your gut health and enjoying the benefits.
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Senior Meetup Groups Combating Loneliness
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
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
“I would like to read more on loneliness, meetup group’s for seniors. Thank you”
Well, 10almonds is an international newsletter, so it’s hard for us to advise about (necessarily: local) meetup groups!
But a very popular resource for connecting to your local community is Nextdoor, which operates throughout the US, Canada, Australia, and large parts of Europe including the UK.
In their own words:
Get the most out of your neighborhood with Nextdoor
It’s where communities come together to greet newcomers, exchange recommendations, and read the latest local news. Where neighbors support local businesses and get updates from public agencies. Where neighbors borrow tools and sell couches. It’s how to get the most out of everything nearby. Welcome, neighbor.
Curious? Click here to check it out and see if it’s of interest to you
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Hormones & Health, Beyond The Obvious
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Wholesome Health
This is Dr. Sara Gottfried, who some decades ago got her MD from Harvard and specialized as an OB/GYN at MIT. She’s since then spent the more recent part of her career educating people (mostly: women) about hormonal health, precision, functional, & integrative medicine, and the importance of lifestyle medicine in general.
What does she want us to know?
Beyond “bikini zone health”
Dr. Gottfried urges us to pay attention to our whole health, in context.
“Women’s health” is often thought of as what lies beneath a bikini, and if it’s not in those places, then we can basically treat a woman like a man.
And that’s often not actually true—because hormones affect every living cell in our body, and as a result, while prepubescent girls and postmenopausal women (specifically, those who are not on HRT) may share a few more similarities with boys and men of similar respective ages, for most people at most ages, men and women are by default quite different metabolically—which is what counts for a lot of diseases! And note, that difference is not just “faster” or “slower””, but is often very different in manner also.
That’s why, even in cases where incidence of disease is approximately similar in men and women when other factors are controlled for (age, lifestyle, medical history, etc), the disease course and response to treatment may vary considerable. For a strong example of this, see for example:
- The well-known: Heart Attack: His & Hers ← most people know these differences exist, but it’s always good to brush up on what they actually are
- The less-known: Statins: His & Hers ← most people don’t know these differences exist, and it pays to know, especially if you are a woman or care about one
Nor are brains exempt from his…
The female brain (kinda)
While the notion of an anatomically different brain for men and women has long since been thrown out as unscientific phrenology, and the idea of a genetically different brain is… Well, it’s an unreliable indicator, because technically the cells will have DNA and that DNA will usually (but not always; there are other options) have XX or XY chromosomes, which will usually (but again, not always) match apparent sex (in about 1/2000 cases there’s a mismatch, which is more common than, say, red hair; sometimes people find out about a chromosomal mismatch only later in life when getting a DNA test for some unrelated reason), and in any case, even for most of us, the chromosomal differences don’t count for much outside of antenatal development (telling the default genital materials which genitals to develop into, though this too can get diverted, per many intersex possibilities, which is also a lot more common than people think) or chromosome-specific conditions like colorblindness…
The notion of a hormonally different brain is, in contrast to all of the above, a reliable and easily verifiable thing.
See for example:
Alzheimer’s Sex Differences May Not Be What They Appear
Dr. Gottfried urges us to take the above seriously!
Because, if women get Alzheimer’s much more commonly than men, and the disease progresses much more quickly in women than men, but that’s based on postmenopausal women not on HRT, then that’s saying “Women, without women’s usual hormones, don’t do so well as men with men’s usual hormones”.
She does, by the way, advocate for bioidentical HRT for menopausal women, unless contraindicated for some important reason that your doctor/endocrinologist knows about. See also:
Menopausal HRT: A Tale Of Two Approaches (Bioidentical vs Animal)
The other very relevant hormone
…that Dr. Gottfried wants us to pay attention to is insulin.
Or rather, its scrubbing enzyme, the prosaically-named “insulin-degrading enzyme”, but it doesn’t only scrub insulin. It also scrubs amyloid beta—yes, the same that produces the amyloid beta plaques in the brain associated with Alzheimer’s. And, there’s only so much insulin-degrading enzyme to go around, and if it’s all busy breaking down excess insulin, there’s not enough left to do the other job too, and thus can’t break down amyloid beta.
In other words: to fight neurodegeneration, keep your blood sugars healthy.
This may actually work by multiple mechanisms besides the amyloid hypothesis, by the way:
The Surprising Link Between Type 2 Diabetes & Alzheimer’s
Want more from Dr. Gottfried?
You might like this interview with Dr. Gottfried by Dr. Benson at the IMCJ:
Integrative Medicine: A Clinician’s Journal | Conversations with Sara Gottfried, MD
…in which she discusses some of the things we talked about today, and also about her shift from a pharmaceutical-heavy approach to a predominantly lifestyle medicine approach.
Enjoy!
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Undoing The Damage Of Life’s Hard Knocks
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Sometimes, What Doesn’t Kill Us Makes Us Insecure
We’ve written before about Complex PTSD, which is much more common than the more popularly understood kind:
Given that C-PTSD affects so many people (around 1 in 5, but really, do read the article above! It explains it better than we have room to repeat today), it seems like a good idea to share tips for managing it.
(Last time, we took all the space for explaining it, so we just linked to some external resources at the end)
What happened to you?
PTSD has (as a necessity, as part of its diagnostic criteria) a clear event that caused it, which makes the above question easy to answer.
C-PTSD often takes more examination to figure out what tapestry of circumstances (and likely but not necessarily: treatment by other people) caused it.
Often it will feel like “but it can’t be that; that’s not that bad”, or “everyone has things like that” (in which case, you’re probably one of the one in five).
The deeper questions
Start by asking yourself: what are you most afraid of, and why? What are you most ashamed of? What do you fear that other people might say about you?
Often there is a core pattern of insecurity that can be summed up in a simple, harmful, I-message, e.g:
- I am a bad person
- I am unloveable
- I am a fake
- I am easy to hurt
- I cannot keep my loved ones safe
…and so forth.
For a bigger list of common insecurities to see what resonates, check out:
Basic Fears/Insecurities, And Their Corresponding Needs/Desires
Find where they came from
You probably learned bad beliefs, and consequently bad coping strategies, because of bad circumstances, and/or bad advice.
- When a parent exclaimed in anger about how stupid you are
- When a partner exclaimed in frustration that always mess everything up
- When an employer told you you weren’t good enough
…or maybe they told you one thing, and showed you the opposite. Or maybe it was entirely non-verbal circumstances:
- When you gambled on a good idea and lost everything
- When you tried so hard at some important endeavour and failed
- When you thought someone could be trusted, and learned the hard way that you were wrong
These are “life’s difficult bits”, but when we’ve lived through a whole stack of them, it’s less like a single shattering hammer-blow of PTSD, and more like the consistent non-stop tap tap tap that ends up doing just as much damage in the long run.
Resolve them
That may sound a bit like a “and quickly create world peace” level of task, but we have tools:
Ask yourself: what if…
…it had been different? Take some time and indulge in a full-blown fantasy of a life that was better. Explore it. How would those different life lessons, different messages, have impacted who you are, your personality, your behaviour?
This is useful, because the brain is famously bad at telling real memories from false ones. Consciously, you’ll know that one was an exploratory fantasy, but to your brain, it’s still doing the appropriate rewiring. So, little by little, neuroplasticity will do its thing.
Tell yourself a better lie
We borrowed this one from the title of a very good book which we’ve reviewed previously.
This idea is not about self-delusion, but rather that we already express our own experiences as a sort of narrative, and that narrative tends to contain value judgements that are often not useful, e.g. “I am stupid”, “I am useless”, and all the other insecurities we mentioned earlier. Some simple examples might be:
- “I had a terrible childhood” → “I have come so far”
- “I should have known better” → “I am wiser now”
- “I have lost so much” → “I have experienced so much”
So, replacing that self-talk can go a long way to re-writing how secure we feel, and therefore how much trauma-response (ideally: none!) we have to stimuli that are not really as threatening as we sometimes feel they are (a hallmark of PTSD in general).
Here’s a guide to more ways:
How To Get Your Brain On A More Positive Track (Without Toxic Positivity)
Take care!
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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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