World Menopause Day Health News Round-Up
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In order to provide variety in this week’s round-up, not all of this is menopause-related, but it is all important:
Menopause & CVD
Untreated menopause is associated with higher incidence of heart disease, and higher mortality. People often forget about how much estrogen does for us (well, for those of us with a physiology running on estrogen, anyway; gentlemen, your testosterone is fine for you), and think it is “just” a sex hormone, but it’s a lot more.
Read in full: Menopause transition linked to increased heart disease risk
Related: What Menopause Does To The Heart
Extraterrestrial medical technology
The much lower gravity in Earth orbit has allowed for tissue engineering techniques that Earth’s normal gravity imposes limitations on. This is big news, because it means that rather than replacing a whole liver, tissue implants could be grafted, allowing the extant liver to repair itself (something livers are famously good at, but they need enough undamaged base material to work with).
Read in full: How liver tissue from the International Space Station may transform tissue engineering
Related: How To Unfatty A Fatty Liver
One thing and then another
As if endometriosis weren’t unpleasant enough in and of itself, the endothelial dysfunction inherent to it also raises cardiovascular disease risk. This is important, because while endometriosis has (like many maladies predominantly affecting women) generally been shrugged off by the medical world as an unhappy inconvenience but not life-threatening, now we know it comes with extra existential risks too:
Read in full: Understanding cardiovascular risks in endometriosis patients
Related: What You Need To Know About Endometriosis
Push-button meditation
Unlike mindfulness meditation, listening to music is a very passive experience, and thus requires less effort from the user. And yet, it has been associated with lower perceived pain levels, lower self-reported anxiety levels, less opioid use, and measurably lower heart-rate.
Read in full: Listening to music may speed up recovery from surgery, research suggests
Related: Nobody Likes Surgery, But Here’s How To Make It Much Less Bad
Cholesterol in menopause: quality over quantity
Much like previous research has shown that the quantity of LDL is not nearly so predictive of health outcomes in women as it is in men, this study into HDL and menopausal women shows that quantity of HDL does not matter nearly so much as the quality of it.
Read in full: HDL quality, not quantity, contribute to the first sign of Alzheimer’s disease in women
Related: Statins: His & Hers? ← consistent with the above, statins (to lower LDL cholesterol) generally help more for men and produce more adverse side effects for women. So again, a case of “the actual amount of cholesterol isn’t so important for women as for men”.
Take care!
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When BMI Doesn’t Measure Up
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When BMI Doesn’t Quite Measure Up
Last month, we did a “Friday Mythbusters” edition of 10almonds, tackling many of the misconceptions surrounding obesity. Amongst them, we took a brief look at the usefulness (or lack thereof) of the Body Mass Index (BMI) scale of weight-related health for individuals. By popular subscriber request, we’re now going to dive a little deeper into that today!
The wrong tool for the job
BMI was developed as a tool to look at large-scale demographic trends, stemming from a population study of white European men, who were for the purpose of the study (the widescale health of the working class in that geographic area in that era), considered a reasonable default demographic.
In other words: as a system, it’s now being used in a way it was never made for, and the results of that misappropriation of an epidemiological tool for individual health are predictably unhelpful.
If you want to know yours…
Here’s the magic formula for calculating your BMI:
- Metric: divide your weight in kilograms by your height in square meters
- Imperial: divide your weight in pounds by your height in square inches and then multiply by 703
“What if my height doesn’t come in square meters or square inches, because it’s a height, not an area?”
We know. Take your height and square it anyway. If this seems convoluted and arbitrary, yes, it is.
But!
While on the one hand it’s convoluted and arbitrary… On the other hand, it’s also a gross oversimplification. So, yay for the worst of both worlds?
If you don’t want to grab a calculator, here’s a quick online tool to calculate it for you.
So, how did you score?
According to the CDC, a BMI score…
- Under 18.5 is underweight
- 18.5 to 24.9 is normal
- 25 to 29.9 is overweight
- 30 and over is obese
And, if we’re looking at a representative sample of the population, where the representation is average white European men of working age, that’s not a bad general rule of thumb.
For the rest of us, not so representative
BMI is a great and accurate tool as a rule of thumb, except for…
Women
An easily forgotten demographic, due to being a mere 51% of the world’s population, women generally have a higher percentage of body fat than men, and this throws out BMI’s usefulness.
If pregnant or nursing
A much higher body weight and body fat percentage—note that these are two things, not one. Some of the extra weight will be fat to nourish the baby; some will be water weight, and if pregnant, some will be the baby (or babies!). BMI neither knows nor cares about any of these things. And, this is a big deal, because BMI gets used by healthcare providers to judge health risks and guide medical advice.
People under the age of 16 or over the age of 65
Not only do people below and above those ages (respectively) tend to be shorter—which throws out the calculations and mean health risks may increase before the BMI qualifies as overweight—but also:
- BMI under 23 in people over the age of 65 is associated with a higher health risk
- A meta-analysis showed that a BMI of 27 was the best in terms of decreased mortality risk for the over-65 age group
This obviously flies in the face of conventional standards regards BMI—as you’ll recall from the BMI brackets we listed above.
Read the science: BMI and all-cause mortality in older adults: a meta-analysis
Athletic people
A demographic often described in scientific literature as “athletes”, but that can be misleading. When we say “athletes”, what comes to mind? Probably Olympians, or other professional sportspeople.
But also athletic, when it comes to body composition, are such people as fitness enthusiasts and manual laborers. Which makes for a lot more people affected by this!
Athletic people tend to have more lean muscle mass (muscle weighs more than fat), and heavier bones (can’t build strong muscles on weak bones, so the bones get stronger too, which means denser)… But that lean muscle mass can actually increase metabolism and help ward off many of the very same things that BMI is used as a risk indicator for (e.g. heart disease, and diabetes). So people in this category will actually be at lower risk, while (by BMI) getting told they are at higher risk.
If not white
Physical characteristics of race can vary by more than skin color, relevant considerations in this case include, for example:
- Black people, on average, not only have more lean muscle mass and less fat than white people, but also, have completely different risk factors for diseases such as diabetes.
- Asian people, on average, are shorter than white people, and as such may see increased health risks before BMI qualifies as overweight.
- Hispanic people, on average, again have different physical characteristics that throw out the results, in a manner that would need lower cutoffs to be even as “useful” as it is for white people.
Further reading on this: BMI and the BIPOC Community
In summary:
If you’re an average white European working-age man, BMI can sometimes be a useful general guide. If however you fall into one or more of the above categories, it is likely to be inaccurate at best, if not outright telling the opposite of the truth.
What’s more useful, then?
For heart disease risk and diabetes risk both, waist circumference is a much more universally reliable indicator. And since those two things tend to affect a lot of other health risks, it becomes an excellent starting point for being aware of many aspects of health.
Pregnancy will still throw off waist circumference a little (measure below the bump, not around it!), but it will nevertheless be more helpful than BMI even then, as it becomes necessary to just increase the numbers a little, according to gestational month and any confounding factors e.g. twins, triplets, etc. Ask your obstetrician about this, as it’s beyond the scope of today’s newsletter!
As to what’s considered a risk:
- Waist circumference of more than 35 inches for women
- Waist circumference of more than 40 inches for men
These numbers are considered applicable across demographics of age, sex, ethnicity, and lifestyle.
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When supplies resume, should governments subsidise drugs like Ozempic for weight loss? We asked 5 experts
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Hundreds of thousands of people worldwide are taking drugs like Ozempic to lose weight. But what do we actually know about them? This month, The Conversation’s experts explore their rise, impact and potential consequences.
You’ve no doubt heard of Ozempic but have you heard of Wegovy? They’re both brand names of the drug semaglutide, which is currently in short supply worldwide.
Ozempic is a lower dose of semaglutide, and is approved and used to treat diabetes in Australia. Wegovovy is approved to treat obesity but is not yet available in Australia. Shortages of both drugs are expected to last throughout 2024.
Both drugs are expensive. But Ozempic is listed on Australia’s Pharmaceutical Benefits Schedule (PBS), so people with diabetes can get a three-week supply for A$31.60 ($7.70 for concession card holders) rather than the full price ($133.80).
Wegovy isn’t listed on the PBS to treat obesity, meaning when it becomes available, users will need to pay the full price. But should the government subsidise it?
Wegovy’s manufacturer will need to make the case for it to be added to the PBS to an independent advisory committee. The company will need to show Wegovy is a safe, clinically effective and cost-effective treatment for obesity compared to existing alternatives.
In the meantime, we asked five experts: when supplies resume, should governments subsidise drugs like Ozempic for weight loss?
Four out of five said yes
This is the last article in The Conversation’s Ozempic series. Read the other articles here.
Disclosure statements: Clare Collins is a National Health and Medical Research Council (NHMRC) Leadership Fellow and has received research grants from the National Health and Medical Research Council (NHMRC), the Australian Research Council (ARC), the Medical Research Future Fund (MRFF), the Hunter Medical Research Institute, Diabetes Australia, Heart Foundation, Bill and Melinda Gates Foundation, nib foundation, Rijk Zwaan Australia, the Western Australian Department of Health, Meat and Livestock Australia, and Greater Charitable Foundation. She has consulted to SHINE Australia, Novo Nordisk (for weight management resources and an obesity advisory group), Quality Bakers, the Sax Institute, Dietitians Australia and the ABC. She was a team member conducting systematic reviews to inform the 2013 Australian Dietary Guidelines update, the Heart Foundation evidence reviews on meat and dietary patterns and current co-chair of the Guidelines Development Advisory Committee for Clinical Practice Guidelines for Treatment of Obesity; Emma Beckett has received funding for research or consulting from Mars Foods, Nutrition Research Australia, NHMRC, ARC, AMP Foundation, Kellogg and the University of Newcastle. She works for FOODiQ Global and is a fat woman. She is/has been a member of committees/working groups related to nutrition or food, including for the Australian Academy of Science, the NHMRC and the Nutrition Society of Australia; Jonathan Karnon does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment; Nial Wheate in the past has received funding from the ACT Cancer Council, Tenovus Scotland, Medical Research Scotland, Scottish Crucible, and the Scottish Universities Life Sciences Alliance. He is a fellow of the Royal Australian Chemical Institute, a member of the Australasian Pharmaceutical Science Association and a member of the Australian Institute of Company Directors. Nial is the chief scientific officer of Vaihea Skincare LLC, a director of SetDose Pty Ltd (a medical device company) and a Standards Australia panel member for sunscreen agents. Nial regularly consults to industry on issues to do with medicine risk assessments, manufacturing, design and testing; Priya Sumithran has received grant funding from external organisations, including the NHMRC and MRFF. She is in the leadership group of the Obesity Collective and co-authored manuscripts with a medical writer provided by Novo Nordisk and Eli Lilly.
Fron Jackson-Webb, Deputy Editor and Senior Health Editor, The Conversation
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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CBD Against Diabetes!
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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
❝CBD for diabetes! I’ve taken CBD for body pain. Did no good. Didn’t pay attention as to diabetes. I’m type 1 for 62 years. Any ideas?❞
Thanks for asking! First up, for reference, here’s our previous main feature on the topic of CBD:
CBD Oil: What Does The Science Say?
There, we touched on CBD’s effects re diabetes:
in mice / in vitro / in humans
In summary, according to the above studies, it…
- lowered incidence of diabetes in non-obese diabetic mice. By this they mean that pancreatic function improved (reduced insulitis and reduced inflammatory Th1-associated cytokine production). Obviously this has strong implications for Type 1 Diabetes in humans—but so far, just that, implications (because you are not a mouse).
- attenuated high glucose-induced endothelial cell inflammatory response and barrier disruption. Again, this is promising, but it was an in vitro study in very controlled lab conditions, and sometimes “what happens in the Petri dish, stays in the Petri dish”—in order words, these results may or may not translate to actual living humans.
- Improved insulin response ← is the main take-away that we got from reading through their numerical results, since there was no convenient conclusion given. Superficially, this may be of more interest to those with type 2 diabetes, but then again, if you have T1D and then acquire insulin resistance on top of that, you stand a good chance of dying on account of your exogenous insulin no longer working. In the case of T2D, “the pancreas will provide” (more or less), T1D, not so much.
So, what else is there out there?
The American Diabetes Association does not give a glowing review:
❝There’s a lot of hype surrounding CBD oil and diabetes. There is no noticeable effect on blood glucose (blood sugar) or insulin levels in people with type 2 diabetes. Researchers continue to study the effects of CBD on diabetes in animal studies. ❞
~ American Diabetes Association
Source: ADA | CBD & Diabetes
Of course, that’s type 2, but most research out there is for type 2, or else have been in vitro or rodent studies (and not many of those, at that).
Here’s a relatively more recent study that echoes the results of the previous mouse study we mentioned; it found:
❝CBD-treated non-obese diabetic mice developed T1D later and showed significantly reduced leukocyte activation and increased FCD in the pancreatic microcirculation.
Conclusions: Experimental CBD treatment reduced markers of inflammation in the microcirculation of the pancreas studied by intravital microscopy. ❞
~ Dr. Christian Lehmann et al.
Read more: Experimental cannabidiol treatment reduces early pancreatic inflammation in type 1 diabetes
…and here’s a 2020 study (so, more recent again) that was this time rats, and/but still more promising, insofar as it was with rats that had full-blown T1D already:
Read in full: Two-weeks treatment with cannabidiol improves biophysical and behavioral deficits associated with experimental type-1 diabetes
Finally, a paper in July 2023 (so, since our previous article about CBD), looked at the benefits of CBD against diabetes-related complications (so, applicable to most people with any kind of diabetes), and concluded:
❝CBDis of great value in the treatment of diabetes and its complications. CBD can improve pancreatic islet function, reduce pancreatic inflammation and improve insulin resistance. For diabetic complications, CBD not only has a preventive effect but also has a therapeutic value for existing diabetic complications and improves the function of target organs❞
…before continuing:
❝However, the safety and effectiveness of CBD are still needed to prove. It should be acknowledged that the clinical application of CBD in the treatment of diabetes and its complications has a long way to go.
The dissecting of the pharmacology and therapeutic role of CBD in diabetes would guide the future development of CBD-based therapeutics for treating diabetes and diabetic complications❞
~ Ibid.
Now, the first part of that is standard ass-covering, and the second part of that is standard “please fund more studies please”. Nevertheless, we must also not fail to take heed—little is guaranteed, especially when it comes to an area of research where the science is still very young.
In summary…
It seems well worth a try, and with ostensibly nothing to lose except the financial cost of the CBD.
If you do, you might want to keep careful track of a) your usual diabetes metrics (blood sugar levels before and after meals, insulin taken), and b) when you took CBD, what dose, etc, so you can do some citizen science here.
Lastly: please remember our standard disclaimer; we are not doctors, let alone your doctors, so please do check with your endocrinologist before undertaking any such changes!
Want to read more?
You might like our previous main feature:
How To Prevent And Reverse Type 2 Diabetes ← obviously this will not prevent or reverse Type 1 Diabetes, but avoiding insulin resistance is good in any case!
If you’re not diabetic and you’ve perhaps been confused throughout this article, then firstly thank you for your patience, and secondly you might like this quick primer:
The Sweet Truth About Diabetes: Debunking Diabetes Myths! ← this gives a simplified but fair overview of types 1 & 2
(for space, we didn’t cover the much less common types 3 & 4; perhaps another time we will)
Meanwhile, take care!
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What’s Your Ikigai?
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Ikigai: A Closer Look
We’ve mentioned ikigai from time to time, usually when discussing the characteristics associated with Blue Zone centenarians, for example as number 5 of…
It’s about finding one’s “purpose”. Not merely a function, but what actually drives you in life. And, if Japanese studies can be extrapolated to the rest of the world, it has a significant and large impact on mortality (other factors being controlled for); not having a sense of ikigai is associated with an approximately 47%* increase in 7-year mortality risk in the categories of cardiovascular disease and external cause mortality:
Sense of life worth living (ikigai) and mortality in Japan: Ohsaki Study
*we did a lot of averaging and fuzzy math to get this figure; the link will show you the full stats though!
In case that huge (n=43,391) study didn’t convince you, here’s another comparably-sized (n=43,117) one that found similarly, albeit framing the numbers the other way around, i.e. a comparable decrease in mortality risk for having a sense of ikigai:
This study was even longer (12 years rather than 7), so the fact that it found pretty much the same results the 7-year study we cited just before is quite compelling evidence. Again, multivariate hazard ratios were adjusted for age, BMI, drinking and smoking status, physical activity, sleep duration, education, occupation, marital status, perceived mental stress, and medical history—so all these things were effectively controlled for statistically.
Three kinds of ikigai
There are three principal kinds of ikigai:
- Social ikigai: for example, a caring role in the family or community, volunteer work, teaching
- Asocial ikigai: for example, a solitary practice of self-discipline, spirituality, or study without any particular intent to teach others
- Antisocial ikigai: for example, a strong desire to outlive an enemy, or to harm a person or group that one hates
You may be thinking: wait, aren’t those last things bad?
And… Maybe! But ikigai is not a matter of morality or even about “warm fuzzy feelings”. The fact is, having a sense of purpose increases longevity regardless of moral implications or niceness.
Nevertheless, for obvious reasons there is a lot more focus on the first two categories (social and asocial), and of those, especially the first category (social), because on a social level, “we all do well when we all do well”.
We exemplified them above, but they can be defined:
- Social: working for the betterment of society
- Asocial: working for the betterment of oneself
Of course, for many people, the same ikigai may cover both of those—often somebody who excels at something for its own sake and/but shares it with others to enrich their lives also, for example a teacher, an artist, a scientist, etc.
For it to cover both, however, requires that both parts of it are genuinely part of their feeling of ikigai, and not merely unintended consequences.
For example, a piano teacher who loves music in general and the piano in particular, and would gladly spend every waking moment studying/practising/performing, but hates having to teach it, but needs to pay the bills so teaches it anyway, cannot be said to be living any kind of social ikigai there, just asocial. And in fact, if teaching the piano is causing them to not have the time or energy to pursue it for its own sake, they might not even be living any ikigai at all.
One other thing to watch out for
There is one last stumbling block, which is that while we can find ikigai, we can also lose it! Examples of this may include:
- A professional whose job is their ikigai, until they face mandatory retirement or are otherwise unable to continue their work (perhaps due to disability, for example)
- A parent whose full-time-parent role is their ikigai, until their children leave for school, university, life in general
- A married person whose “devoted spouse” role is their ikigai, until their partner dies
For this reason, people of any age can have a “crisis of identity” that’s actually more of a “crisis of purpose”.
There are two ways of handling this:
- Have a back-up ikigai ready! For example, if your profession is your ikigai, maybe you have a hobby waiting in the wings, that you can smoothly jump ship to upon retirement.
- Embrace the fluidity of life! Sometimes, things don’t happen the way we expect. Sometimes life’s surprises can trip us up; sometimes they can leave us a sobbing wreck. But so long as life continues, there is an opportunity to pick ourselves up and decide where to go from that point. Note that this is not fatalism, by the way, it doesn’t have to be “this bad thing happened so that we could find this good thing, so really it was a good thing all along”. Rather, it can equally readily be “well, we absolutely did not want that bad thing to happen, but since it did, now we shall take it this way from here”.
For more on developing/maintaining psychological resilience in the face of life’s less welcome adversities, see:
Psychological Resilience Training
…and:
Putting The Abs Into Absurdity ← do not underestimate the power of this one
Take care!
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Ice Baths: To Dip Or Not To Dip?
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We asked you for your (health-related) view of ice baths, and got the above-depicted, below-described, set of responses:
- About 31% said “ice baths are great for the health; we should take them”
- About 29% said “ice baths’ risks outweigh their few benefits”
- About 26% said “ice baths’ benefits outweigh their few risks”
- About 14% said “ice baths are dangerous and can kill you; best avoided”
So what does the science say?
Freezing water is very dangerous: True or False?
True! Water close to freezing point is indeed very dangerous, and can most certainly kill you.
Fun fact, though: many such people are still saveable with timely medical intervention, in part because the same hypothermia that is killing them also slows down the process* of death
Source (and science) for both parts of that:
Cold water immersion: sudden death and prolonged survival
*and biologically speaking, death is a process, not an event, by the way. But we don’t have room for that today!
(unless you die in some sudden violent way, such as a powerful explosion that destroys your brain instantly; then it’s an event)
Ice baths are thus also very dangerous: True or False?
False! Assuming that they are undertaken responsibly and you have no chronic diseases that make it more dangerous for you.
What does “undertaken responsibly” mean?
Firstly, the temperature should not be near freezing. It should be 10–15℃, which for Americans is 50–59℉.
You can get a bath thermometer to check this, by the way. Here’s an example product on Amazon.
Secondly, your ice bath should last no more than 10–15 minutes. This is not a place to go to sleep.
What chronic diseases would make it dangerous?
Do check with your doctor if you have any doubts, as no list we make can be exhaustive and we don’t know your personal medical history, but the main culprits are:
- Cardiovascular disease
- Hypertension
- Diabetes (any type)
The first two are for heart attack risk; the latter is because diabetes can affect core temperature regulation.
Ice baths are good for the heart: True or False?
True or False depending on how they’re done, and your health before starting.
For most people, undertaking ice baths responsibly, repeated ice bath use causes the cardiovascular system to adapt to better maintain homeostasis when subjected to thermal shock (i.e. sudden rapid changes in temperature).
For example: Respiratory and cardiovascular responses to cold stress following repeated cold water immersion
And because that was a small study, here’s a big research review with a lot of data; just scroll to where it has the heading“Specific thermoregulative adaptations to regular exposure to cold air and/or cold water exposure“ for many examples and much discussion:
Health effects of voluntary exposure to cold water: a continuing subject of debate
Ice baths are good against inflammation: True or False?
True! Here’s one example:
Uric acid and glutathione levels (important markers of chronic inflammation) are also significantly affected:
Uric acid and glutathione levels during short-term whole body cold exposure
Want to know more?
That’s all we have room for today, but check out our previous “Expert Insights” main feature looking at Wim Hof’s work in cryotherapy:
A Cold Shower A Day Keeps The Doctor Away?
Enjoy!
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The Galveston Diet – by Dr. Mary Claire Haver
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We’ve previously reviewed “It’s Not You, It’s Your Hormones” by nutritionist Nikki Williams, and noted at the time that it was very similar to the bestselling “The Galveston Diet”, not just in its content but all the way down its formatting. Some Amazon reviewers have even gone so far as to suggest that “It’s Not You, It’s Your Hormones” (2017) brazenly plagiarized “The Galveston Diet” (2023). However, after carefully examining the publication dates, we feel quite confident that the the earlier book did not plagiarize the later one.
Of course, we would not go so far as to make a counter-accusation of plagiarism the other way around; it was surely just a case of Dr. Haver having the same good ideas 6 years later.
Still, while the original book by Nikki Williams did not get too much international acclaim, the later one by Dr. Mary Claire Haver has had very good marketing and thus received a lot more attention, so let’s review it:
Dr. Haver’s basic principle is (again) that we can manage our hormonal fluctuations, by managing our diet. Specifically, in the same three main ways:
- Intermittent fasting
- Anti-inflammatory diet
- Eating more protein and healthy fats
Why should these things matter to our hormones? The answer is to remember that our hormones aren’t just the sex hormones. We have hormones for hunger and satedness, hormones for stress and relaxation, hormones for blood sugar regulation, hormones for sleep and wakefulness, and more. These many hormones make up our endocrine system, and affecting one part of it will affect the others.
Will these things magically undo the effects of the menopause? Well, some things yes, other things no. No diet can do the job of HRT. But by tweaking endocrine system inputs, we can tweak endocrine system outputs, and that’s what this book is for.
The style is once again very accessible and just as clear, and Dr. Haver also walks us just as skilfully through the changes we may want to make, to avoid the changes we don’t want. The recipes are also very similar, so if you loved the recipes in the other book, you certainly won’t dislike this book’s menu.
In the category of criticism, there is (as with the other book by the other author) some extra support that’s paywalled, in the sense that she wants the reader to buy her personally-branded online plan, and it can feel a bit like she’s holding back in order to upsell to that.
Bottom line: this book is (again) aimed at peri-menopausal and post-menopausal women. It could also (again) definitely help a lot of people with PCOS too, and, when it comes down to it, pretty much anyone with an endocrine system. It’s (still) a well-evidenced, well-established, healthy way of eating regardless of age, sex, or (most) physical conditions.
Click here to check out The Galveston Diet, and enjoy its well-told, well-formatted advice!
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