Authors: Dr Paul Offit
To lessen the risk of bone thinning, postmenopausal women are advised to eat diets rich in calcium. Because most women get enough calcium in their diet, and because supplementary calcium has not been shown to reduce fractures in otherwise healthy postmenopausal women, the United States Preventive Services Task Force does not recommend supplemental calcium.
V
itamin D and calcium are linked. People who take in adequate amounts of calcium might still have a problem with bone strength if they do not also get sufficient amounts of vitamin D. That is because vitamin D helps the body absorb calcium from the gut. The good news is that vitamin D is readily made in the skin when exposed to sunlight. To get an adequate amount of vitamin D, people need only expose their face, arms, hands, or back to sunlight (without sunblock) for ten to fifteen minutes a day at least twice a week. This will provide the 600 IU of vitamin D recommended by the Institute of Medicine.
Some people, however, either don't get out into the sun much or live in climates where there isn't much sunlight. For this reason, many foods are supplemented with vitamin D, such as milk, bread, pastries, oil spreads, breakfast cereals, and some brands of orange juice, yogurt, margarine, and soy beverages. Because most people get enough vitamin D in their foods or from exposure to sunlight, the United States Preventive Services Task Force does not recommend supplemental vitamin D. There are, however, two exceptions: babies who are exclusively breast-fed should receive 400 IU a day of supplemental vitamin D, because it isn't contained in human
milk and because they don't get out into the sun much; and elderly adults over sixty-five years old should receive 800 IU daily because it's been shown to reduce the high risk of bone fractures.
F
inally, folic acid is a B-complex vitamin necessary for the production of red blood cells. Without folic acid, people develop anemia. But that's not the biggest problem. Researchers have shown that folic acid deficiency can cause something far worse: severe birth defects. Pregnant women deficient in folic acid have delivered babies with malformations of the spine, skull, and brain. To avoid folic acid deficiency, people need about 400 micrograms a day.
Foods rich in folic acid include vegetables such as spinach, broccoli, lettuce, turnip greens, okra, and asparagus; fruits such as bananas, melons, and lemons; and beans, yeast, mushrooms, beef liver and kidney, orange juice, and tomato juice. Although there are plenty of sources of this nutrient, many pregnant women weren't getting enough folic acid in their diets. So on January 1, 1998, the FDA required manufacturers to add folic acid to breads, breakfast cereals, flours, cornmeals, pastas, white rice, bakery items, cookies, crackers, and some grains. Now it's almost impossible to become folicacid deficient. Nonetheless, women are advised to take 400 micrograms of folic acid every day, obtained either from foods or supplements or both. Because about half of pregnancies are unplanned and because birth defects occur very early in pregnancy, all women of childbearing age should make sure they're getting enough folic acid.
I
n the end, if a medicine works (like folic acid to prevent birth defects), it's valuable, and if it doesn't work (like saw palmetto to shrink prostates), it's not. “There's a name for alternative medicines that work,” says Joe Schwarcz, professor of chemistry and the director of the Office for Science and Society at McGill University. “It's called medicine.”
Do not go gentle into that good night.
Rage, rage against the dying of the light.
âDylan Thomas
C
elebrities sell products. Queen Latifah sells CoverGirl makeup. Snoop Dogg sells Pepsi Max. Shaquille O'Neal sells Comcast cable. And Snooki sells Wonderful Pistachios. Andâbecause we trust celebritiesâwe buy what they're selling. Expertise has nothing to do with it. We don't buy products because we think Queen Latifah is a beauty expert, or Snoop Dogg a beverage expert, or Shaq a media expert, or Snooki a nutrition expert. We buy because we enjoy their acting, singing, dunking, and whatever it is that Snooki does.
Celebrities also offer medical advice. Larry King tells us that ginkgo improves memory; Tom Cruise that psychiatry is
a pseudoscience; Roger Moore that duck liver may cause Alzheimer's disease; and British model Heather Mills that meat stays in our colon for forty years. Indeed, celebrities as diverse as Pamela Anderson, Cindy Crawford, Jude Law, David Beckham, Paul McCartney, Prince Charles, and Cher have trumpeted the benefits of homeopathic remedies for decades.
B
ut when it comes to selling alternative medical products, perhaps no celebrity has been more financially successful than Suzanne Somers.
Somers first appeared as the blonde in the Thunderbird in
American Graffiti
and as a pool girl in Clint Eastwood's
Magnum Force
. In 1978, she got her first big break, landing the role of Chrissy Snow on ABC's
Three's Company
, co-starring Joyce DeWitt and John Ritter. At the beginning of the fifth season, Somers alienated her co-stars. Incensed that male actors like Alan Alda and Carroll O'Connor were making more money, she demanded a pay raise from $30,000 to $150,000 per episode. When the producers refused, Somers boycotted, claiming a broken rib. At the end of the season, she was fired and replaced by Jenilee Harrison. Somers sued ABC for $2 million, unsuccessfully, but she quickly found other work. From the mid-1980s into the 1990s, she starred in the sit-coms
She's the Sheriff
and
Step by Step
. She also performed in Las Vegas. But her most recognized role was as the spokesperson for Thigh-Master, “the best way to tone, shape, and firm your inner thighs with just a few squeezes a day.”
In 2001, after undergoing conventional treatment for breast cancer (lumpectomy and radiation therapy), Somers chose an
alternative medicine for her post-cancer care. “I chose a nonconventional way to treat my cancer,” she told Larry King. “At the time they said, âOkay, here's what we're going to do ⦠Tamoxifen, which is the after-care drug, which, oh, by the way, is going to make you gain weight. And oh, by the way, you'll probably get a little depressed for five years.' And I thought,
It just doesn't sound like a great option.
And then I found a medicine that builds up your immune system. And I thought,
Build up or poison?
So, I decided to go this other way.” Instead of Tamoxifen Somers chose Iscador, an alternative remedy made from mistletoe.
Breast cancer had brought Suzanne Somers into the world of alternative medicine. But it was menopause that made her a crusader.
W
hen it hit me, it was like a Mack truck,” Somers told Oprah eight years after her battle with breast cancer. “It was on my fiftieth birthday. And that began a three-year odyssey of not sleeping, of moodiness, of weight gain, of changes in my hair, changes in my skin.” On the same show, Oprah asked Christiane Northrup, a gynecologist, to explain what had happened. “When someone refers to hot flashes, mood swings, irritability, irregular periods, they're really referring to the perimenopausal transition. It is usually a five-to-eight-year process, and it begins with the start of irregular periods, usually by age forty-five.” In simple terms, the ovaries stop producing two hormones: estrogen and progesterone. Somers's description was more entertaining: “Suddenly the Seven Dwarfs of Menopause arrived at my door without warning: Itchy, Bitchy, Sweaty, Sleepy, Bloated, Forgetful, and All-Dried-Up.”
Somers was frustrated by the medical establishment's inability to provide relief. “As I went from doctor to doctor,” she wrote, “I realized I was on my own. No doctor seemed to understand this passage [into menopause]. ⦠I wanted a natural, effective way to deal with this. ⦠[T]hen I found the solutionâa cutting-edge endocrinologist/anti-aging doctor who prescribed a treatment.” The effect was immediate. “Wow!” wrote Somers. “What a difference in my life. I was sleeping again. I was happy again. I stopped itching, and bitching, and crying, and, best of all, getting fat.” Somers was a convert. She wanted “to scream it from the rooftop.” She wrote books about it. She told Larry King about it on CNN. She told Rosie O'Donnell, who later talked about it on
The Joy Behar Show
.
B
EHAR
: Are you still in menopause? You used to have hot flashes every day when we were on
The View
.
O'D
ONNELL
: Done. Started at 41, ended at 44. After I was off
The View
Suzanne Somers called me up and said, “You know, I have a feeling that some of your rage [can be cured].”
B
EHAR
: Really.
O'D
ONNELL
: I'm like, “Are you kidding me?” She's like, “No, really, why don't you try this.” And I went to one of her doctors, and I have been putting that cream on me for the last four years and I feel a thousand percent better.
B
EHAR
: And the rage is gone?
O'D
ONNELL
: Kind of.
Then Somers told Oprah about it. “After one day ⦠I felt the veil lift,” Oprah wrote in her magazine. “After three days,
the sky was bluer, my brain was no longer fuzzy; my memory was sharper. I was literally singing and had a skip in my step.” For Suzanne Somers, Rosie O'Donnell, and Oprah Winfrey, the symptoms of menopause had been cured. What was this wondrous medicine?
T
reatment of menopause has undergone several shifts. Initially, the approach seemed obvious: replace estrogen and progesterone. “In the 1960s, a book by Robert Wilson called
Feminine Forever
became very popular,” Christiane Northrup told Oprah. “It touted the benefits of estrogens as the panacea. Estrogens became the magic bullet that everyone should go on.”
As it turns out, it wasn't that easy. Although replacement hormones worked, they came with a price. In 2002, investigators from the Women's Health Initiativeâpart of the National Institutes of Healthâstudied the effects of estrogen and progesterone in 17,000 women. Researchers had initially planned to follow women for eight years, but the study was cut short when they noticed a dramatic increase in breast cancer. And it wasn't only breast cancer; replacement hormones also increased the risk of heart disease, strokes, and blood clots. As a consequence, hormone replacement therapy became something doctors began to fear, not embrace.
Women were at a loss. But Suzanne Somers had an answerâan answer that gave birth to a billion-dollar industry. “What was it that sent those wretched dwarfs packing?” wrote Somers. “Natural bioidentical hormones.” Somers
believed that replacement hormones caused heart disease, blood clots, and cancer because they were made by big pharmaceutical companiesâthey weren't natural. If women used hormones found in plantsâand made by little compounding pharmaciesâthey could rid themselves of the Seven Dwarfs of Menopause without risk.
S
upported by Oprah Winfrey, promoted by Suzanne Somers, and backed by gynecologists like Christiane Northrup, bioidentical hormones have become a national phenomenon. There are, however, a few flaws in the logic.
First, estrogen is estrogen. Whether it's isolated from soy-beans, wild yams, or horse's urine, it's the same molecule; the source is irrelevant. The only thing that matters is the molecular structure of the final product. “The implication is that [bioidentical hormones are] something better and something different,” said Lauren Streicher, an assistant professor of obstetrics and gynecology at Northwestern University's Feinberg School of Medicine, in Chicago. “Chemically, the structure is exactly the same [as] the FDA products.” “Now, repeat after me,” wrote McGill's Joe Schwarcz. “âThe properties of a substance depend on molecular structure, not ancestry. When it comes to assessing effectiveness and safety, whether the substance is synthetic or natural is totally irrelevant.'”
Second, the distinction between Big Pharma and small compounding pharmacies, while appealing to the public, is misleading. “They [bioidentical and conventional hormones] are primarily all made at the same factory in Germany,” says Streicher. “There's a couple [of large factories] in the United
States. They're the ones that synthesize it from plants and then send it to [small] compounding pharmacies
and
to the major pharmaceutical companies.”
If bioidentical and conventional hormones are the same products made in the same place, then they probably carry the same risks. “The big marketing approach of the bioidentical industry is that you can have your cake and eat it,” says Wulf Utian, a professor of obstetrics and gynecology at Case Western University. “That these products are not like those made by pharmaceutical companies. They have all the benefits, but they carry none of the risks. And if you believe in that, you believe in the Tooth Fairy.”
The difference between bioidentical and conventional hormones isn't that one is natural and the other isn't. Or that one is safe and the other isn't. It's that one is the product of an unsupervised industry and the other isn't. “There's this sense that they're not dangerous,” says Streicher, “that people don't have to be monitored. I think they should be regulated so we know the quality that you're getting.” Streicher has reason for concern. In 2001, the FDA analyzed twenty-nine products from twelve compounding pharmacies and found that 34 percent failed standard quality or potency tests. For these reasons, agencies responsible for the public's health haven't embraced the bioidentical hormone revolution. The American College of Obstetricians and Gynecologists, the American Association of Clinical Endocrinologists, the American Medical Association, the American Cancer Society, the Mayo Clinic, and the FDA have all issued statements asserting that bioidentical hormones are probably as risky as their conventional counterparts.