April 2nd, 2009

Osteoporosis (calcium loss from the bones, with fragility and increased liability to fracture) accounts for over 90,000 hip fractures in postmenopausal women every year. In addition to hip fracture, osteoporosis causes pain and disability from softening and collapse of vertebrae (spinal bones), with loss of height and rounding of the back. (See the section of this book that has been devoted to articles on this very serious disease.)

Osteoporosis, according to Geriatrics (37#3:18), is essentially preventable in women after the menopause if, in addition to taking calcium and vitamin D and regular exercise, they are given estrogens to replace the hormones that were produced by their ovaries before the menopause. While none of these measures must be overdone, all of them contribute to skeletal strength. Knowing this, the physician quoted by Geriatrics states that he finds it appalling that we are permitting this “preventable and treatable disease (osteoporosis) to blossom without doing anything about it.”

The reason, of course, is that estrogens have been linked to cancer of the uterus, thereby possibly doing more harm than good. About 10 years ago, when more cases of cancer of the endometrium (lining of the womb) were being detected in menopausal women, it was thought that estrogens might be the cause. Routine estrogen treatment of older women was therefore discontinued. The thought that estrogens might have been responsible was also strengthened when it was noticed that the number of cases of endometrial cancer being detected recently fell coincident in time with reduced estrogen usage.

Giving thought to this matter, Science points out that the apparent increase in endometrial cancer that accompanied the widespread use of estrogen could have been due simply to better cancer detection. Improved cancer-finding may well have temporarily increased the number of cases reported, but after those cases were found, the number reported would naturally decline to the previous level.

The point seems to be well taken. If estrogens were cancer-producing, one would expect endometrial cancer to be most common before the menopause, at a time of life when estrogen concentration in a woman’s body is at its highest. This is not the case. A Mayo Clinic specialist, writing in Geriatrics (37#3:79), notes that estrogen treatment does not increase the risk of heart attack or breast cancer in postmenopausal women. However, the author agrees that estrogen replacement therapy does slightly increase the risk of uterine cancer. Nevertheless, the article points out, if postmenopausal women being treated with estrogens are examined regularly and understand that they must report immediately if they develop vaginal bleeding, the relatively small risk from uterine cancer (which can be caught early and treated by surgery) will be well below that from osteoporotic fractures. It is important to remember that deaths from hip fracture and its complications are five times more common than cancer of the uterus.

One other caution for women taking estrogens: If you are taking estrogens with other ovarian-type hormones in mixtures such as Amen, Curretab, or Provera, you should stop the medication and contact your physician immediately if you develop any swelling or tenderness of the breasts.

With these safeguards, according to Geriatrics, it seems safer for women to take estrogens after the menopause to prevent osteoporosis than to try doing without them.

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As we age, our eyes change in several ways that make vision less clear. Many of the changes are unavoidable, but, since excessive light exposure is known to accelerate cataract formation and to damage the retina (both of which occur with aging), we should at least try to slow these effects of aging as much as possible by regularly wearing proper sunglasses whenever we are outdoors.

Another thing that we can do to help ourselves is to have eye tests regularly for glaucoma, a condition that becomes more likely if we take certain medicines, including antihistamines, cough medicine, some types of sleeping pills, antidepressants, and drugs for dizziness or Parkinson’s disease, Postgraduate Medicine (81#2:108) reports. These medications do not cause glaucoma but can aggravate it if it already exists. Furthermore, since these medicines are often essential, never discontinue them on this account without a doctor’s orders. If you are taking one of these medicines, regular glaucoma testing is especially important.

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The trouble with most cholesterol-lowering diets, comments Postgraduate Medicine (77#8:29) is that they involve far too many don’ts and only a few do’s.

Most of us find it difficult to reduce our intake of animal fats by significant amounts. Another problem we have is that, by increasing our intake of roughage (dietary fiber), we can only lower the blood cholesterol by about 10 percent. When the blood cholesterol level is dangerously high, of course, one has to take a cholesterol-lowering drug, and a few unlucky people need to do so all the time. But what should the average person wishing to lower the blood cholesterol do without resorting to medication?

The answer may well be that we should eat some whole oat bran regularly every day. According to the American Journal of Clinical Nutrition (40:1146), if we take about three and a half ounces of oat bran every day in the form of cereal and/or muffins (items sold in most supermarkets), most of us can easily bring the blood cholesterol level down by about 20 percent. This regimen should not be difficult to follow and is likely to be yet more effective if animal fats are also restricted, thereby in many cases making medicines for lowering cholesterol unnecessary. Cholesterol-lowering drugs, incidentally, tend to be expensive and to cause side effects.

Oat bran contains a vegetable fiber that is water soluble and brings down cholesterol blood levels in several ways. First, it stimulates the liver to include more acid (produced by tearing down cholesterol) in the bowel juice that it secretes into the intestines. Second, oat fiber is broken down in the i intestine into chemical fragments that, after being absorbed, inhibit cholesterol production by the tissues (cholesterol comes not only from our food but is also made by our own tissues).

According to Postgraduate Medicine (84#2:280), a carefully controlled study at the University of California compared the effects of oat bran with those of wheat bran, whole wheat flour, and a mixture of wheat and oat brans. Only oat bran brought about a significant drop in cholesterol and triglycerides. Interestingly, the amount of oat bran used in the study was only two rounded tablespoonfuls every day. No side effects were reported.

One wonders, though, whether some side effects would have been encountered if a larger amount of oat bran had been taken. Some people, as many as 15 percent in one survey, state that they are unable to take oat bran because it causes so much bloating and diarrhea. Possibly these people have been taking too much bran. They might well experience no bloating and diarrhea and derive just as much benefit, so far as cholesterol is concerned, if they were to take merely two rounded tablespoonfuls a day. Most good things are spoiled if taken in excess.

Oat bran reduces blood levels of cholesterol even in diabetics, who otherwise have trouble in keeping their cholesterol down at reasonable levels and are unusually prone to have cholesterol deposits in their arteries, with complications such as heart attack and stroke.

An oat bran hot cereal product is marketed by the Quaker Oats Company and is now available in many groceries and health food stores. With oat bran and salmon oil, we have two safe and very effective non-drug natural foodstuffs that can be used to control cholesterol.

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Before giving medications for essential hypertension (high blood pressure which is “spontaneous” rather than secondary to disease of the kidneys or some other organ), the doctor will usually try to help his patient by recommending lifestyle changes, such as weight loss and a restricted salt intake. Usually, only when such measures have been tried for some months and have failed will the doctor prescribe a medication.

Now,Drug Therapy (16#11:63) reports, many physicians are also recommending a calcium supplement as part of the lifestyle change. They are doing this because so many of us do not get sufficient calcium to maintain our tissues in good health, and, in some cases, this leads to hypertension. For example, studies at Oregon University revealed that 50 people with hypertension took 22 percent less calcium in their food than did people with normal blood pressure. Also, according to Medical World News, epidemiological data strongly suggest that salt causes less hypertension if taken with calcium, too. Since calcium is less expensive and much less likely to cause side effects than blood pressure medications, it is worth trying.

Furthermore, it has been found that by increasing the calcium intake of rats which spontaneously develop hypertension with age, the rise in their blood pressure can largely be prevented.

However, one must not overdo this calcium supplementation since, in excess, it will produce kidney stones, constipation, confusion, vomiting, etc. The safest sources of calcium are low-fat dairy products such as skim milk and cottage cheese, although some dairy products that are good sources of calcium also contain fat and cholesterol, which can lead to atherosclerosis. If you decide to take calcium in tablet form, calcium carbonate is the least expensive and safest product. In any event, never take more than is recommended, and take it in divided doses three times a day rather than all at one time.

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