TODAY'S AJENDA #79

Bread. 🍞 It’s beloved, buttery, blissful, and…optimized by sub-zero temperatures. While this sounds like half-baked nonsense, there is a real mechanism behind it. 

When bread is frozen, the starches inside undergo a chemical process called “retrogradation.” They reorganize into a form called resistant starch. 

The difference is significant: 

Regular starch is digested in the small intestine into glucose. This causes rapid blood sugar spikes followed by energy crashes. 

Resistant starch skips that step and arrives in the colon undigested, where it feeds good gut bacteria. It acts as a fiber, which may help stabilize your blood sugar (and energy) levels, improve digestion, and lower cholesterol. 

Has Science Tested Frozen Bread? 

Sure has. A 2007 study put this to the test by giving 10 volunteers the same white bread prepared four different ways:

1. Fresh 

2. Toasted 

3. Frozen and defrosted 

4. Frozen, defrosted, then toasted 

The verdict? All three modified preparation methods significantly lowered blood sugar compared to fresh bread. But the freeze-thaw-toast combo was the winner. 

• Doctor’s Note: This was a small study, so we can’t draw sweeping conclusions from it alone. Further research is needed. 

Which Bread is Best to Freeze? 

Before you toss any loaf in the freezer, let’s cover which bread is best. There’s a world between ultra-processed white bread and nutrient-dense options: 

1. Best: Sprouted Whole-Grain Breads: 

“Sprouted” means the grains were allowed to start germinating before being made into flour. This process lets your body better absorb minerals like iron, zinc, magnesium, and protein. 

Sprouted breads also tend to be higher in fiber, helping you reach that daily goal of 30-35 grams. 

2. Great: Whole-Grain Rye: 

Rye is rich in thick, gel-forming fibers called arabinoxylans, which can blunt post-meal insulin spikes and support heart health. Go for bread labeled “100% whole rye” instead of light rye that’s made mostly with wheat.

3. Good: Sourdough

Thanks to fermentation, sourdough tends to have a lower glycemic index than most breads. It also has lactic acid bacteria, which can slow starch digestion and improve mineral absorption (very important as we get older and have to prioritize bone health). Real sourdough bread has only three ingredients: salt, water and wheat. 

4. Last: Standard White Bread

No surprise here. Ultra-processed white bread is the lowest in fiber and most likely to spike glucose if eaten fresh. 

If white bread is what you have (or it’s the only bread your kids will touch), the freeze-thaw-toast method gives it a small upgrade. And it’s important to note: white bread is not the devil. It’s more important what you eat WITH the bread in many cases! 

A Mini Bread Freezing Guide 

If you’re in the bread aisle feeling like you need a nutrition degree to decode the labels, here’s your cheat sheet: 

• At least 3 grams of fiber per slice. 

• Less than 180 milligrams of sodium per slice. 

• Look for “100% whole grain,” “sprouted whole grain,” or “whole rye” as the first ingredient (and not buried somewhere after preservatives). 

• A carb-to-fiber ratio of 10:1 or better.  (10 grams of carbs to 1 gram of fiber). The holy grail is closer to 5:1, which is what you’ll find in truly whole-grain or sprouted breads. 

Last Few Things to Remember 

You don’t have to freeze your bread for months to get the full benefit. (Thank goodness.) Studies show resistant starch levels max out after about 7 days in the freezer. 

But nerding out over freeze-thaw-toast combos and optimal freezing windows isn’t the full picture. It should be a bonus on top of your fundamentals: exercise, sleep, and what you put on your bread. 

For example, protein and healthy fat. In The Wellness Experiment, we have tons of recipes to upgrade bread, from adding smoked salmon on rye to mashed avocado spread across sourdough. 

At the end of the day, this is bread, not broccoli. Pair your bread wisely, keep the portions reasonable, and choose whole grain or sprouted. The freezer trick is just the cherry on top. 

Most people dismiss the flu as “a bad cold.” That misconception can be deadly. I know, because I’ve seen the consequences firsthand. 

In all my years of practicing medicine, the only patient who died under my care was a pregnant teenager with influenza pneumonia. She was unvaccinated and became critically ill very quickly.  

(Both her parents were doctors, by the way, and her fetus died as well.)  

I’ve had influenza twice (and Covid twice). Both times in March, and I thought I was going to be hospitalized. I’d never been so sick in my life. I missed 10 days of work. While I’d been vaccinated, the illness would have been much more severe if I hadn’t been. And for me, my flu illnesses were much more severe than my Covid infections.

For these reasons, I take the flu very, very seriously.

What The Flu Does to Your Body

The flu doesn’t just give you a runny nose. It attacks the respiratory system, which can trigger secondary bacterial pneumonia (a lung infection that causes chest pain, chills, and shortness of breath). 

In addition, infection with influenza can stress the cardiovascular system. 

• Zoom In: If you’re 50 or older, even a mild case of flu can sharply increase the short-term risk of heart attack and ischemic stroke. That elevated risk can linger for weeks, even after you’ve “recovered.” 

Every season, there are thousands of hospitalizations and deaths from the flu. The flu vaccine is recommended for everyone 6 months of age and older. 

When Should I Get The Flu Shot? 

The sweet spot is usually October. This timing lets your immune system build antibodies before flu activity ramps up (December through March) and protects you during the winter stretch. 

“Can I just get it done early in the summer?”  

Not ideal, as vaccine effectiveness declines over time. Studies show it drops 6-11% per month after vaccination. The CDC advises against July or August shots for most people (especially those 65 and older) unless they can’t get vaccinated later. 

Side Note: This doesn’t mean that the vaccine “stops working.” Protection at any point is better than none (and flu viruses hang around into April and even May). Please still get vaccinated. 

Fine-Tuning Your Flu Shot Timing 

A few things to consider: 

• Travel or “high risk” events (e.g., wedding, family reunion, etc) coming up? Get your flu shot at least 2 weeks prior. 

• Live somewhere warm? If temps stay hotter into fall and people are still largely spending time outdoors, AND there are no rising flu cases, wait until November. 

I get my flu shot every November to coincide with weather changes, more indoor events, increasing local cases, and the timing of national flu increases.

Let’s Address Vaccine Objections, Shall We? 

“I heard you can get the flu from the flu shot.” Myth. It’s scientifically impossible since the vaccine doesn’t contain live influenza virus. If you get sick after your shot, you were exposed before or immediately after getting vaccinated. 

“Flu shots don’t work that well.” Myth (ish). Flu vaccines reduce your risk of getting sick enough to see a doctor by 40%-60% when the vaccine matches circulating strains well. 

• Zoom In: As vaccines go, this isn’t great, but it’s definitely better than nothing. In poorly matched years, protection dips lower; in good years, it climbs higher.

Even if you still catch the flu, vaccination makes it less dangerous. It reduces hospitalization, flu-related heart attacks or strokes, and death. 

Think of it like a seat belt. It doesn’t guarantee you won’t be killed in a motor vehicle accident, but it does increase your chances of survival. 

“I’ve never gotten a flu shot, and I’ve never had the flu.” I’ve heard this countless times, and my answer is always the same: it only takes once.  

Practical Flu Tips

• Aim for October or November. If you miss that window, get the shot the second you can, even if it’s in January or February. 

• If you’re 65 or older, ask for a high-dose or adjuvanted flu vaccine, which produces a stronger immune response. (Same timing advice applies.) 

• Allow two weeks for antibodies to build. Plan ahead for travel or gatherings. 

• It’s safe for most people to get a COVID-19 booster the same day. Ask your clinician if it’s right for you. 

• Remember that flu season tends to peak in January and February nationwide.  

This one simple step lowers your risk of severe illness, hospitalization, and cardiovascular complications. That is not fear. That is a scientific fact, and it is respect for a virus that deserves it.

I first discovered Pique’s Deep Hydration Protocol* a year ago when I started doing my own skincare experiment. Fast-forward to today, and my skin has become clearer and more deeply hydrated to the extent that people have been noticing and inquiring. 

As we head into fall (cue the drier air that leaves skin feeling parched and shorter days that deplete energy levels), I’m definitely planning to continue with this routine. 

Here’s how Pique’s Deep Hydration Protocol works: 

B•T Fountain in the AM: Electrolytes with clinically proven ceramides, hyaluronic acid, and bioavailable minerals can visibly hydrate, plump, and smooth skin while strengthening hair and nails. It also can support all-day energy as a result of good hydration. 

R•E Fountain in the PM: A calming electrolyte mix formulated with Triple Biomaxed Magnesium (glycinate, taurate, and L-threonate), which may promote deep calm, quality sleep, and cognitive recovery.

Bonus: It has zero artificial flavorings, sugar, or maltodextrin, and gets its beautiful blue color from organic spirulina. 

The Pique team was kind enough to offer a 20% off for life, plus a gift for Ajenda members when you subscribe. Get your discount right here. 

I get asked this question a lot (as in, all the time) because women aren’t sure how long they can “safely” stay on hormone replacement therapy (HRT). 

The honest answer? There’s no magic timer. The best path is a personalized, evolving conversation between you and your clinician, anchored in the current evidence and your risk factors. 

But let me walk you through what we know. 

First: The Debunked “Five-Year” Limit 

For 23 years, hormone therapy has been unfairly demonized. It all started when the Women’s Health Initiative released flawed data in 2002 that suggested scary long-term risks. Cue the “five-year” limit many doctors still follow today.  

(Those findings have been retracted conclusively, by the way.) 

Today, we know better. HRT isn’t a “five-year-only” drug. It’s a therapy that warrants ongoing reassessment, especially since menopause symptoms don’t magically cease at some arbitrary age or time span. 

The major menopause organizations now agree that: 

• There’s no fixed deadline. The North American Menopause Society (NAMS) says women can stay on HRT as long as they’re regularly monitored and good candidates. 

• Age isn’t a cutoff. Hormone therapy is acceptable in women over 65 with careful counseling and risk–benefit review (as it should be in every patient, frankly). 

• Symptoms trump timelines. If menopause symptoms persist and you're still a good candidate, the benefits of continuing hormone therapy tend to outweigh the risks (The British Menopause Society). 

What HRT Is Actually Approved For 

The FDA has approved HRT for four indications. Jot these down so you can guide the conversation with your clinician toward what matters most for you: 

1. Hot flashes. HT can help relieve vasomotor symptoms (VMS) like hot flashes, night sweats, mood swings, and sleep disruption. 

2. Bone protection. Research has found that HT may prevent bone loss in postmenopausal women and reduce fracture risk. 

3. Vulvovaginal symptoms. This includes vaginal dryness, painful intercourse, and urinary issues (known as genitourinary syndrome of menopause). 

4. Low estrogen. HT can also help treat hypoestrogenism caused by hypogonadism or premature ovarian failure. 

There’s also some evidence suggesting that HT may help with metabolism and glucose control. However, HT isn’t officially approved for diabetes prevention. 

The Risks of HRT 

Like any medical treatment, HT comes with risks: 

The first possible risk is cardiovascular. If you’re over 60 or started HT 15-20 years after menopause, the chance of heart disease or blood clots tends to be higher.  

• The Why: When you’re older, arteries are more likely to have stiffened or formed plaque. Adding estrogen may destabilize things and cause problems. 

On the other hand, the “timing hypothesis” suggests that beginning HT earlier (within 10 years of menopause) may come with lower cardiovascular risk. 

The next risk is venous thromboembolism. Oral estrogen increases the risk of clots in the legs or lungs, especially in the first 1-2 years and in women who are older, overweight, or smoke. This is a ‘class effect’ of any/all hormones, including birth control pills.

This is why many doctors may prefer transdermal estrogen (patches or gels) which carries a lower clot risk.

Lastly, we have to talk about breast cancer. The lay media and many physicians have wildly exaggerated this risk. The reality is that breast cancer risk naturally increases with age in all women, and hormone therapy’s contribution to that risk is minimal. Period. 

Let’s dig deeper. The North American Menopause Society admits we don’t have great long-term data on hormone therapy use over many (i.e., 20+) years. There are some studies that show an increased risk of breast cancer in women on HRT, but many don’t account for the fact that the incidence of breast cancer increases with age anyway. 

Also, we're talking about small increases that need to be weighed against significant quality-of-life benefits. And many negative effects diminish if you decide to stop hormone therapy. 

Okay, So How Long Should I Stay on HRT For? 

There’s no one formula. It could be two years, 10 years, or indefinite. It’s all reasonable as long as you still have menopausal symptoms and do regular check-ups. 

• Doctor’s Note: Every 6-12 months, revisit your risk profile. Check blood pressure, lipid profile, breast health, coagulation risk, family history, and any new conditions. If a change emerges, revisit whether to taper or discontinue.

Also, you’re never “too old” to start HT. Data shows women in their 70s and 80s are still getting symptom relief, especially via gels and patches at lower doses.

Bottom Line: Use HT as long as it’s improving your life with acceptable risk. Personally, I plan and hope to stay on HT for the rest of my life! It’s mind-boggling to me that only 5% of women use HT when it can be this transformative. We can’t let poorly interpreted studies rob women of decades of well-being. This stops here, with you and me. 

^{Thanks to one of my Instagram followers for this question! Submit your own question right here.} 

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ABOUT DR. JEN

In her former roles as chief medical correspondent for ABC News and on-air cohost of “GMA3: What You Need to Know,” Dr. Jennifer Ashton—”Dr. Jen”—has shared the latest health news and information with millions of viewers nationwide. As an OB-GYN, nutritionist, and board-certified obesity medicine specialist, she is passionate about promoting optimal health for “the whole woman.” She has authored several books, including the national best-seller, The Self-Care Solution: A Year of Becoming Happier, Healthier & Fitter—One Month at a Time. And she has gone through menopause…

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