Is Estriol Better Than Estradiol for the Brain? Not So Fast…

Sketchy Data or Sketchy Understanding? A Response to Kim Einhorn MD

In this video I break down what the research actually shows on estradiol levels and bone protection, plus the cardiovascular evidence she dismissed as "sketchy". If you’ve been told we “don’t have enough data,” this one’s for you. We cover 1. What the cardiovascular and bone literature actually says about estradiol thresholds for protection 2. Why calling this “sketchy” ignores decades of published research 3. The cardiovascular evidence, including the timing hypothesis and what the major trials found 4. Why dismissing data isn’t the same as disproving it This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit hollywarnerhealth.substack.com/subscribe [https://hollywarnerhealth.substack.com/subscribe?utm_medium=podcast&utm_campaign=CTA_2]

Depression Isn’t a Fibre Deficiency

First off, I adore Dr haver, this is not an attack. This is me having a bit of an issue with how this “study” was framed and the bad taste it leaves when you look at the fact that she sells… fibre supplements. Not that there is anything wrong with selling supplements, even ones you’ve white labelled to for your own brand. I spent years in R&D, in fact I’ve helped develop some of the brands in Dr’s offices and on store shelves. I know how it works, white labelling and the push to have your own line. I opted out for a number of reasons, one is that you don’t need to reinvent the already perfect wheel in many cases. Another is that it can be seen as (especially in cases like this) a conflict of interest. I don’t have to push fibre, I don’t sell it as a supplement. You could be saying that I promote HRT and that’s the same thing, except I don’t make money off of how much or how little is prescribed. I’m paid for my service either way. Back to the main reason for this article, the video circulating about fibre and depression, based off of an association based “study”. This isn’t an interventional study. It’s observational, specifically a cross sectional analysis of NHANES data. That means it can show associations, not causation. These are the types of studies that we get slammed for when we try to use them to support a claim. These studies don’t hold weight, they’re a great eye opener to do a REAL trial/study, to look deeper and discover if there is something to it all. This study in particular took existing NHANES survey data, looked at self reported fibre intake from dietary recalls, and compared it to depression scores using the PHQ 9 at a single point in time. No intervention, no randomization, no temporality. Now for the flaws (and sadly there are several). First, reverse causation This is the biggest problem I see with this study. People with depression often eat differently. Lower appetite, less meal planning, more ultra processed food, less total intake. So is low fibre causing depression, or is depression causing low fibre intake? This study doesn’t answer that. The authors acknowledge it (which is great!), then they proceeded anyway (not so great). Second, dietary recall bias NHANES uses 24 hour dietary recalls, which are notoriously unreliable. People misreport, underreport, forget, or guess. Fibre intake is especially vulnerable to this since it depends on food type, preparation, and portion estimation (it’s usually guesswork not true calculations). One or two recalls don’t properly or accurately represent habitual intake. Third, fibre is a proxy, not a mechanism. What I mean is that high fibre intake correlates with a whole bunch of behaviours. Higher socioeconomic status, better access to food, more home cooking, higher protein quality, more micronutrients, more daylight exposure, more physical activity, less metabolic disease. Fibre isn’t acting alone ladies, but this analysis sure does treat it as if it is. Fourth, residual confounding They do adjust for some variables, but NHANES can’t fully control for things like trauma history, chronic illness burden, sleep quality, hormone status, perimenopause, antidepressant use duration, or inflammatory disease. These are all tightly linked to both mood and diet. Fifth, depression measurement limitations PHQ 9 is a screening tool, not a diagnostic tool. It captures symptoms over the previous two weeks. That’s a very small snapshot in time, not a clinical diagnosis, and it’s highly sensitive to acute stress, illness, and life events. You’re correlating a short term mood score with a presumed long term dietary pattern. That’s weak data at best. Sixth, no dose response clarity They show an association when intake is divided into four equal groups from lowest to highest, but this doesn’t establish a biologically meaningful threshold. There’s no evidence here that increasing fibre intake in someone with depression improves symptoms. That’s a leap that’s commonly made online and isn’t supported by this data. Seventh, sex and hormone blindness This is a big one for me, for obvious reasons (and because Dr Haver is in this space, it should have been for her as well). NHANES includes women across all ages, but the analysis doesn’t account for perimenopause or menopause status. Estradiol status is a massive contributing factor for mood, gut function, and dietary tolerance. Ignoring this makes the conclusions especially shaky for midlife women. I’m not saying this isn’t a real paper, it is. It’s published in a real journal, using real data. But it’s hypothesis generating only. It doesn’t prove that fibre reduces depression, treats depression, or should be prescribed as a mental health intervention. Observational nutrition data like this is cheap, it’s everywhere in abundance, and it’s ridiculously easy to mine. NHANES is a massive, and publicly available dataset. Anyone who has statistical software can slice it and dice it a hundred different ways until something lights up. Fibre is especially attractive since it correlates to so many as a marker of health. Plus association sounds just scientific enough for the public to eat it up (pun intended). The correct conclusion shouldn’t be that people with higher fibre intake report fewer depressive symptoms when we can’t determine direction, causality, or mechanism. I know plenty who have gone carnivore or animal based (cutting out all fibre) and completely reversed depression. But I wouldn’t go around stating carnivore is a cure for depression. Sadly most people don’t understand the difference between association and causation. We read “Associated with lower depression” and we hear “fibre improves mental health”. Saying something “may be an important modifiable factor” doesn’t mean the data proved it is one. These kinds of studies keep getting weaponized online to sell fibre supplements, and many other fancy things, despite (as my mentor used to always say) being grade D evidence at best. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit hollywarnerhealth.substack.com/subscribe [https://hollywarnerhealth.substack.com/subscribe?utm_medium=podcast&utm_campaign=CTA_2]

The Billion-Dollar Menopause Drug That Doesn’t Replace Estrogen

In this episode, we break down the billion-dollar hype behind Elinzanetant and Fezolinetant, the so-called non-hormonal menopause drugs. Learn how NK3 blockers reduce hot flashes without replacing estrogen, and why real HRT still wins for bone, brain, and heart protection. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit hollywarnerhealth.substack.com/subscribe [https://hollywarnerhealth.substack.com/subscribe?utm_medium=podcast&utm_campaign=CTA_2]

Stop the Panic: A Lump Isn’t a Diagnosis.

A breast lump is not cancer until it’s confirmed to be cancer. Yet some clinicians still advise women to stop ALL hormone therapy the moment a lump is found, before any imaging, biopsy, or investigative work is done. That’s not evidence-based medicine, it’s panic medicine. When used properly, estradiol is preventative medicine. It lowers risk factors for cardiovascular disease, dementia, bone loss, and even certain cancers. Automatically stopping estradiol without context is reckless. I understand the knee-jerk reaction from practitioners who lack hormone training, but saying “stop the estrogens” without nuance does more harm than good. And for clarity, estrogen and estradiol are not interchangeable terms. If caution feels warranted, fine…pause, assess, and refer back to the hormone specialist managing that patient’s care. That specialist knows the dosing, the receptor status, and the clinical context. They’re the ones who can determine whether something should be titrated, reduced, or continued. As for progesterone and testosterone, stopping those is flat-out wrong. Vaginal estradiol is also fine to continue, it’s NOT systemic folks. Many benign reasons exist for a breast lump, it could be cysts, fibrocystic changes, lipomas, and even if a biopsy confirms cancer, we must consider receptor type before making sweeping changes. Progesterone receptor–positive (PR+) and estrogen receptor–positive (ER+) cancers don’t automatically exclude bioidentical hormone therapy. In fact, studies show that natural progesterone (not progestins) induces apoptosis (programmed cell death) in abnormal breast cells and helps regulate estrogen’s proliferative effects. Real progesterone is protective. Progestins are not. Testosterone is also protective and, in many cases, therapeutic. Telling a woman to stop progesterone or testosterone “just in case” is outdated and dangerous. Properly used, these hormones improve outcomes, not worsen them. The responsible path isn’t to strip a woman of her protective hormones but to investigate properly, confirm pathology, and collaborate with the hormone specialist overseeing her therapy. A lump warrants investigation, not a hormone shutdown. Evidence-based care starts with facts, not fear. If you want to read more I have more articles specific to breast cancer that you might enjoy (or want to share with friends) This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit hollywarnerhealth.substack.com/subscribe [https://hollywarnerhealth.substack.com/subscribe?utm_medium=podcast&utm_campaign=CTA_2]

Why training, nuance and clinical expertise matter.

This episode takes on misinformation from a pharmacist giving advice on hormone therapy. While pharmacists know medications, that does not automatically mean they understand how those medications are applied in clinical practice. Hormone therapy is not simply about knowing what a drug is, it’s s about understanding dosing, timing, symptom tracking, lab interpretation, patient history, and how those factors interact in real life. Training matters. Credentials alone do not make someone qualified to advise on hormone therapy. Without advanced, hands-on training and clinical experience, it is easy to misinterpret research, oversimplify treatment, or make recommendations that do not work in practice. In this episode, I break down why the information in his video was incorrect and provide accurate, evidence-based corrections. If we want women to receive safe and effective care, the people speaking in this space must have both the knowledge and the clinical expertise to apply it. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit hollywarnerhealth.substack.com/subscribe [https://hollywarnerhealth.substack.com/subscribe?utm_medium=podcast&utm_campaign=CTA_2]